Little else is known about Stewart; the “remarks” section for his entry is blank. Nor do we know much about any of the tens of thousands of other Black patients who spent time at the hospital from its post-Civil War beginnings to the 1960s, when civil rights legislation forced state mental institutions to integrate. But researchers are beginning to uncover records like Stewart’s, long buried in the hospital’s storage rooms. Over the past decade, there has been an extraordinary effort to preserve and digitize these documents. While the records have thus far revealed little about individual patients, they have, in the aggregate, painted a disturbing picture of the facility’s past. And they say much about the history and oppression of institutionalized Black lives.
When the Civil War ended, Southern White health professionals believed they were facing a potential wave of Black patients. The contemporary racist thinking held that, without slavery, Black people would fall into illness and insanity. “Under the compulsive power of the white man,” influential physician Samuel A. Cartwright wrote in a 1851 article, “Report on the Diseases and Physical Peculiarities of the Negro Race,” “they are made to labor or exercise, which makes the lungs perform the duty of vitalizing the blood more perfectly than is done when they are left free to indulge in idleness.”
Virginia’s push to create an all-Black state asylum came out of this fear of Black madness, as well as the segregationist desire to house Black patients separately from White ones. Officially founded in 1869, the asylum at its inception committed 123 supposedly mentally ill patients and 100 who were poor or homeless and had nowhere else to go, many of them transferred from other state institutions.
There’s very little record of what it was truly like to be a patient at Central Lunatic Asylum. Many of the patients were illiterate — an outgrowth of the prohibition on reading among enslaved people — and the archives don’t include their writing anyway. And until recently, few of the records were available to researchers at all. The hospital — which exists today under the name Central State Hospital, in the town of Petersburg, about 25 miles south of Richmond — has been chronically underfunded and unable to protect its century-old files from deterioration. One historian who visited in 2003 describes watching in horror as a staff worker nearly tossed out a sheaf of papers in a cleanup effort.
In 2007, hospital administrators reached out to King Davis, a former mental health commissioner for Virginia and a professor of mental health policy at the University of Texas at Austin, with a plea to protect the archives. Davis quickly secured funding from the university and the National Association of State Mental Health Program Directors to begin what has become a more than decade-long project to preserve Central’s files. Since then, his team has digitized approximately 800,000 pages of documents, 10,000 photographs and hundreds of pages of negatives and slides about the hospital, among other records.
The documents and photos shed light on a painful history. Patients at Central in its first few decades lived in crowded and unsanitary conditions, subject to treatments that were anything but therapeutic, including experimental surgeries and forced sterilization. Because doctors believed that Black sanity depended on hard labor — and because that labor was free — patients were required to work at the hospital, tending its large farm or doing domestic chores such as laundry and cleaning. “Central really worked just to re-enslave the people who were there,” says Kirby Randolph, a professor of history and bioethics at the Kansas City University medical school who has studied the hospital’s early years.
Patients could be hospitalized for manias supposedly brought on by “religious excitement” or “freedom.” Women were committed because they were upset about their husband’s desertion, or because they had intense menstrual pain. People could be committed by a White employer or by others in the community, essentially on hearsay, with little chance to defend their sanity in court. Shelby Pumphrey, a Mellon Postdoctoral Fellow in African American history at Vassar College who has studied Central’s turn-of-the-century records closely, found only one reported instance of someone who avoided being committed once a process was initiated — and no one who committed themselves. Many patients attempted to escape, and many others, like Stewart, died of unrelated illnesses contracted in the hospital. Those who died were buried in unmarked graves, some of which may have been disturbed by grave robbers hunting for cadavers to be used at local medical colleges.
Some of these traumas were common among all patients in 19th-century mental institutions. But Davis has found that more Black patients than White ones were diagnosed at the time with some form of mania. “One of the reasons we got all these unusual diagnoses, particularly mania, had to do with perceptions of Black people, Black men, as being on the cusp always of violence and danger,” Davis told me. These misperceptions persist today. According to psychologist Arthur Whaley, who has studied race-based mental health inequities, Black people are more likely to be diagnosed with schizophrenia, to be hospitalized and to stay longer in hospitals than White people; once hospitalized, they’re more likely to be physically or chemically restrained. And when Black people resist arrest or hospitalization, their fear can be perceived as aggression, with sometimes devastating results.
“When African Americans respond or react to oppression, in an appropriate way, because those experiences are not shared by the mainstream, they’re seen as paranoid, and they’re misdiagnosed,” says Whaley, who does clinical work in Houston. The 19th century’s racist ideas around Black mental health — the notion that Black men are “on the cusp always of violence” — are still carried by some today, as evidenced by the disproportionate killings of Black men by law enforcement.
The papers at Central aren’t important just because of their relevance for today, of course — but that relevance certainly makes an urgent case for their preservation. “I don’t think we can fully appreciate where we are without understanding that past,” says Brandi Justice, Central’s acting director, who says she feels a strong responsibility toward the hospital’s former patients as well as its current ones.
And yet millions of pages, including treatment records that could offer vivid clarity on how patients were viewed and diagnosed, have yet to be digitized or preserved because of a lack of funding. In addition, the Library of Virginia has made a controversial decision to cut off researcher access to all state mental health records 125 years old or younger (previously, the number was 75), stymying crucial studies of Central’s history. In hopes of moving the project forward nonetheless, Davis is cheering on a bill recently introduced in the Virginia State Senate to allocate $150,000 to preservation efforts at Central. “You bring light to the system, to expose both its strengths as well as its weaknesses,” Davis says. “I think that’s how change starts to occur.”
Correction: An earlier version of this article incorrectly identified Kirby Randolph as a professor of history and bioethics at the University of Kansas. She is a professor at Kansas City University medical school.
Britt Peterson is a writer in Washington.