Summers on Segrest, 'Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum'

Mab Segrest
Martin Summers

Mab Segrest. Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum. New York: New Press, 2020. 384 pp. $28.99 (cloth), ISBN 978-1-62097-297-7

Reviewed by Martin Summers (Boston College) Published on H-Sci-Med-Tech (June, 2022) Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)

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In the epilogue of this powerfully argued and engagingly written book, Mab Segrest asks a question that will stop readers in their tracks: “How does a culture that justified slavery, and Jim Crow, and Muscogee and Cherokee removal decide who is and is not sane?” “It does so flagrantly,” she immediately answers, “mindless of its own contradictions” (p. 293). This is the kind of trenchant observation that fills Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum, a study that is unsparing in its critique of the psychiatric profession and its white supremacist past (and problematic present).

As the quotation provocatively reveals, Segrest is interested in examining the origins and evolution of American psychiatry within the larger historical context of anti-Black racism and Indigenous genocide. In doing so, she argues that we cannot understand the development of the mid-nineteenth-century asylum movement and the field of psychiatry more broadly outside of the history of settler colonialism, an argument similarly made by Susan Burch in her recently published Committed: Remembering Native Kinship in and beyond Institutions (2021). Drawing on Saidiya Hartman, and particularly her book Lose Your Mother: A Journey along the Atlantic Slave Route (2007), Segrest also encourages us to think about the racial logics that underpinned psychiatric institutionalization—in its various forms of the nineteenth-century asylum, the twentieth-century state mental hospital, and the twenty-first-century county jail—as manifestations of the “afterlives of slavery.”

Segrest’s focus is Georgia’s Milledgeville Asylum, which was founded in 1842 and operated as the state’s main public mental institution until it was forced to shut down in 2010 by a federal court order. From its very inception, Segrest persuasively demonstrates, the asylum was inextricably bound up in the marginalization of Black and Indigenous peoples. The institution itself was built on Muscogee land, and its construction was financed by the sale of confiscated Indigenous lands in other parts of the Southeast, linking the emergence of the asylum with the dispossession of Native peoples. Unlike most other southern states that constructed colored asylums only after the Civil War, Milledgeville admitted African American patients prior to the war and continued to do so after. However, as might be expected, racism shaped the staff’s thoughts about Black patients and the patients’ experiences of institutionalization.

African Americans who were deemed insane and admitted to the asylum were subjected to both discursive and material forms of racism. In terms of the former, for instance, psychiatrists at Milledgeville attributed the purported rise in rates of insanity among Blacks in the post-Reconstruction era to heredity or to their supposed deficient cognitive and moral capacity to adjust to life as free people. In doing so, psychiatrists not only accepted the erroneous assumption that insanity was actually increasing in the postemancipation period but also failed to consider how white southern violence during Reconstruction and the Jim Crow years was capable of producing severe psychological trauma in African Americans. Segrest beautifully makes this point in chapter 8 when she juxtaposes the traumatic lived experiences of Black patients during the white counterrevolution with the nonrecognition of those lived experiences by white psychiatrists—reflected in the all-too-common note “No history furnished” that accompanied African American patients’ entries in the asylum ledger.

Not surprisingly, these racist ideas about the Black psyche contributed to the racist treatment of Black patients within the asylum. Overcrowded wards and “semi-starvation” diets, characterized by Segrest as “epidemic violence,” increased patients’ exposure to such infectious diseases as tuberculosis and made them susceptible to pellagra, a disease caused by a niacin-deficient diet. As a result, Black patients had exceedingly high mortality rates. In terms of treatment, African Americans at Milledgeville tended to be funneled into forms of “occupational therapy” that resembled the limited economic opportunities that Blacks outside of the asylum had: agricultural laborers, laundresses, and cooks. The employment of Black male patients on the asylum’s “colony farm” paralleled the exploitation of Black men and women in the convict-lease system, and Segrest effectively draws these connections out to illustrate how the asylum functioned as one technology of control during the Jim Crow era. She further extends these connections into the twentieth-first century by making the compelling and devastating point that, in the age of mass incarceration, the largest providers of mental health care in the nation are county jails.

Another dimension of racism’s haunting of Milledgeville is the staff’s embrace of eugenics and the policy of forced sterilization. Here, Segrest does a good job of situating American psychiatric thought and practice within larger transatlantic conversations about what constituted deviance, pathology, normality, and health and examining how these definitions were fundamentally racialized. In this part of the study, however, white patients occupy the central part of the analysis and African Americans become fairly marginal subjects in the history. Of course, whiteness is a racialized identity and eugenics, alternatively referred to as “racial hygiene,” was a fundamentally racist project. But because discussion of Black patients recedes into the background in these chapters, one is left with a few questions: Were Blacks admitted to the Georgia School for Mental Defectives and, if so, were they forcefully sterilized? If they were not, what was the rationale? Segrest does go on to point out that forced sterilization disproportionately affected women of color across the nation throughout the twentieth century, but there is no concrete discussion of Black women at the Georgia school and whether or not they were victims of this practice.

A recent addition to the rapidly growing body of scholarship that uses race as an analytical category to examine the history of American psychiatry, Administrations of Lunacy is a bold and incisive study. Segrest has deepened our understanding of the racist past of psychiatry in the United States and the persistence of residual elements of this past—the “hauntings”—into our present. It is deserving of a wide readership.

Citation: Martin Summers. Review of Segrest, Mab, Administrations of Lunacy: Racism and the Haunting of American Psychiatry at the Milledgeville Asylum. H-Sci-Med-Tech, H-Net Reviews. June, 2022. URL:

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