Race and Insanity in a Jim Crow Asylum


By Antonia Hylton

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New York Times Bestseller
Amazon Editor’s Pick for Best Books

In the tradition of The Immortal Life of Henrietta Lacks, a page-turning 93-year history of Crownsville Hospital, one of the nation’s last segregated asylums, that the New York Times described as “fascinating…meticulous research” and bestselling author Clint Smith endorsed it as “a book that left me breathless.”

On a cold day in March of 1911, officials marched twelve Black men into the heart of a forest in Maryland. Under the supervision of a doctor, the men were forced to clear the land, pour cement, lay bricks, and harvest tobacco. When construction finished, they became the first twelve patients of the state’s Hospital for the Negro Insane. For centuries, Black patients have been absent from our history books. Madness transports readers behind the brick walls of a Jim Crow asylum.
In Madness, Peabody and Emmy award-winning journalist Antonia Hylton tells the 93-year-old history of Crownsville Hospital, one of the last segregated asylums with surviving records and a campus that still stands to this day in Anne Arundel County, Maryland. She blends the intimate tales of patients and employees whose lives were shaped by Crownsville with a decade-worth of investigative research and archival documents. Madness chronicles the stories of Black families whose mental health suffered as they tried, and sometimes failed, to find safety and dignity. Hylton also grapples with her own family’s experiences with mental illness, and the secrecy and shame that it reproduced for generations.
As Crownsville Hospital grew from an antebellum-style work camp to a tiny city sitting on 1,500 acres, the institution became a microcosm of America’s evolving battles over slavery, racial integration, and civil rights. During its peak years, the hospital’s wards were overflowing with almost 2,700 patients. By the end of the 20th-century, the asylum faded from view as prisons and jails became America’s new focus.
In Madness, Hylton traces the legacy of slavery to the treatment of Black people’s bodies and minds in our current mental healthcare system. It is a captivating and heartbreaking meditation on how America decides who is sick or criminal, and who is worthy of our care or irredeemable.

  • USA Today Bestseller
  • National Indie Bestseller
  • ELLE Magazine's Best (and Most Anticipated) Nonfiction Books of 2024
  • Entertainment Weekly’s Best Books to Read 2024
  • An Amazon “Best Book of the Year”
  • “As masterfully recounted by journalist Antonia Hylton, from 1911 to 2004 the hospital exemplified and exploited society’s anxieties around Blackness and mental illness. In a time when medical racism and the prison industrial complex continue to tear apart families, this impeccably researched accounting is a must-read.” 
    Oprah Daily
  • “Fascinating…meticulous research.”
    The New York Times
  • “A thoroughgoing, often shocking exposé of segregation in the treatment (or nontreatment) of mental illness. [A] strong contribution to the literature of both mental health care and civil rights.”
    Kirkus (Starred Review)
  • “Hylton writes a scathing exposé on the bigotry that led to the mistreatment of hundreds of Black patients and the attempts to cover it up. Her book is also a call to action to reform the systems that treat people diagnosed with mental illnesses…This well-researched title is an important chronicle of the treatment of Black Americans and their mental health during the Jim Crow era. Beyond promoting systemic change, Hylton compels readers to look within to assess how they treat and view the people around them.”
    Library Journal
  • “A meticulous work of research and commitment . . . Madness is a radically complex work of historical study, etching the intersections of race, mental health, criminal justice, public health, memory, and the essential quest for human dignity.”
  • "Hylton spent a decade researching the history of Crownsville, a segregated mental hospital that operated in Maryland for 91 years. The result is not just a work of painstaking reporting, but a deeply human, often tragic story of an American failure to care for Black minds and bodies."
    The New York Times - Editors' Choice
  • “[An] impassioned, rigorous study.”
    The Guardian
  • “Madness, albeit harrowing, is a necessary book. It forces readers to reckon with the trauma that racism and exclusion have wrought on generations of black American families.”
    The Times
  • "Madness is an all-too-true story, tirelessly and comprehensively reported, of the reinstatement of antebellum conditions under the guise of mental-health treatment — an asylum for so-called “feeble-minded” Blacks that was, in fact, little more than slavery by another name. Antonia Hylton’s sensitive, searching account of the people forever changed by this place — and its very clear, dreadful connection to today’s carceral state — will leave you dumbfounded.”
    Robert Kolker, author of the #1 New York Times bestseller, Hidden Valley Road
  • "Antonia Hylton expertly weaves together a moving personal narrative, in-depth reporting, and illuminating archival research to produce a book that left me breathless. Madness is a haunting and revelatory examination of the way that America's history of racism is deeply entangled in our mental health system. A profoundly important book that helps us make sense of an underexamined aspect of our country’s history."
    Clint Smith, New York Times bestselling author of Above Ground and How the Word is Passed
  • Madness is a necessary and unforgettable book. It is a particular story of a Jim Crow institution that devastated the lives of many suffering Black Americans, but it is also a collective story about how mental health care is a social justice issue, and a personal story about love, loss, and holding onto loved ones through the ravages of living. With powerful and vulnerable writing, alongside diligent research, Hylton has delivered an important and timely work.”
    Imani Perry, National Book Award winner and New York Times bestselling author of South to America
  • Madness is a work of pure genius. Antonia Hylton breathtakingly joins archival persistence and keen insight to tell the story of lives lived and died at Crownsville, formerly Maryland’s Hospital for the Negro Insane. With courage and tenacity, she uncovers forgotten narratives and past crimes – and in so doing deepens our understanding of how ‘our traumas and illnesses are frequently intertwined with American history and the peculiar reality of being Black.’ This beautiful, brave, heartbreaking, and urgently important work will change the ways you think about race, sanity, and community.”
    Jonathan Metzl, author of Dying of Whiteness
  • "Madness is a remarkable feat of reporting, penetrating centuries-old brick walls to reveal in vivid detail long buried truths about the racism at the heart of our nation's ongoing mental health crisis. Many books are described as urgent. This one actually is."
    Wesley Lowery, Pulitzer Prize winning journalist and New York Times bestselling author of American Whitelash
  • “Madness is a haunting history of Crownsville Hospital, a segregated asylum in Anne Arundel County, Maryland.  Sweeping in its reach, the book—with its use of oral history and a rich archive—offers an astonishing account of the complex relation of race, racism, and mental healthcare in America.  But there is something more intimate in these pages: a story about families, about the failures of our country, and about the madness that touches us all.  A powerful read!”
    Eddie S. Glaude, Jr., Princeton University professor and New York Times bestselling author of Begin Again
  • “Hylton’s in-depth probing investigation of Crownsville’s history answers essential questions about what happened to the Black population of mentally ill decades after Emancipation.”
    King Davis, PhD, Research Professor at the University of Texas at Austin School of Information

On Sale
Jan 23, 2024
Page Count
368 pages
Legacy Lit

Antonia Hylton

About the Author

Antonia Hylton is a Peabody and Emmy-award winning journalist at NBC News reporting on politics and civil rights, and the co-host of the hit podcast Southlake and Grapevine. She graduated magna cum laude from Harvard University, where she received prizes for her investigative research on race, mass incarceration and the history of psychiatry. She lives in Brooklyn.

Learn more about this author