Antonia Hylton’s ‘Madness’ at last treats the Black patients of a notorious mental hospital with humanity

As a 19-year-old undergraduate, Antonia Hylton read an academic paper that mentioned Crownsville State Hospital, known at its founding as the Hospital for the Negro Insane. That reference triggered an obsession with the hospital’s bleak history that has carried her through the 10 years it took to produce Madness: Race and Insanity in a Jim Crow Asylum. Hylton brings both her journalistic talent and a deep, personal engagement to something she unabashedly describes as a “passion project.” In it, she recounts the 93-year life of Crownsville, tying that painful history to the story of the treatment of mental illness in the United States, especially in communities of color, and to her own family’s experiences with mental health.

Speaking via video from a conference room at NBC headquarters in New York City, Hylton brims with energy and enthusiasm. “If I could understand everything there was to know about Crownsville,” she says, “I would understand my family and my country better.” In her mind, “doing this would be cathartic; it would help me have conversations or fill in blanks that I was struggling to fill in otherwise.”

Hylton calls her book a “tribute to oral history,” and the more than 40 interviews she conducted with former staff and patients—some of them in their 80s or older—and her own family members deeply enrich the story. “This book came to life because of the stories people shared with me,” she says.

One of the greatest challenges in collecting those stories was gaining access to the patients, many of them deeply traumatized by their experiences at Crownsville. “To find patients who were ready to go on the record comfortably was an incredible challenge,” Hylton says, “and it took a lot of trust-building and community outreach. I really had to accept that it was going to be a one-person-at-a-time kind of thing.”

“In addition to putting years of reporting on the page, I put my heart out there.”

Thankfully, there are few people better prepared for this specific kind of work than Hylton. In less than a decade following her graduation from Harvard University, Hylton has already accumulated an impressive set of professional credentials and honors, including Emmy and Peabody awards. After several years as a correspondent and producer for VICE Media, she joined NBC News and MSNBC, where she works as a correspondent on stories at the intersection of politics, education and civil rights.

Book jacket image for Madness by Antonia HyltonBeginning in 2014, she spent long hours in the Maryland State Archives combing through Crownsville’s files, woefully incomplete thanks to shoddy record keeping and the destruction of decades of documents by the state. The paucity of documents would have been far worse had it not been for the efforts of Paul Lurz, a longtime Crownsville staff member who served as an unofficial preservationist. Hylton acknowledges feeling “really angry” that “no one had thought to dignify or track this information in the first place.”

Hylton follows the history of the hospital from its inception in 1911, when 12 Black men were transported to rural Maryland to begin constructing the facility that eventually would house them as its patients, to its closure in 2004. It’s a story of an institution where treatment was often crude and callous, though there were, at times, some who tried to treat their patients with humanity. Most notable among the latter was Jacob Morgenstern, a Holocaust survivor who became Crownsville’s superintendent in 1947, and who recruited a group of fellow survivors to serve as staff.

It’s hard not to read Madness without a mingled sense of anger and sadness, as Hylton patiently chronicles the decades when Black patients received substandard care in an overcrowded, understaffed hospital that deemed them less worthy of quality treatment than Maryland’s white mentally ill, even using some patients as subjects in scientific studies without their consent. The hospital was not desegregated until 1963, but in the ’60s and ’70s, as the approach to treating mental illness focused on shifting patients from large institutions like Crownsville to community mental health centers, its former patients were released into the population without access to the resources they needed to make that transition successfully.

Hylton says that what kept driving her to tell Crownsville’s anguished history was the door it opened into her own family’s painful past. She twines an institutional story with a deeply personal one, unearthing the stories of her cousin Maynard and great-grandfather Clarence, whose lives were tragically impacted by mental illness and then largely written out of her family’s history. “I’m going to resurrect Maynard and Clarence,” she says. “I’m going to give their lives some dignity. I’m going to give their struggles some context that wasn’t there decades ago.” Indeed, Hylton reveals, excavating these stories encouraged some family members to seek therapy to heal their own psychological wounds.

Read our starred review of Madness by Antonia Hylton.

The Maryland legislature has appropriated an initial $30 million for Anne Arundel County to turn the hospital grounds into a memorial, park and museum. Local historian and community organizer Janice Hayes-Williams has created an annual service she calls “Say My Name” at the site, to recall the some 1,700 patients buried there.

Hylton brings Madness to a moving climax with a scene she says “just poured out of me,” describing the 2022 commemoration at the onsite cemetery. On an April morning, she followed in the steps of community elders, clutching multicolored rose petals and a piece of paper bearing the name of Frances Clayton, a woman from Baltimore who died at Crownsville in 1924 at age 41. Kneeling down to place the petals on the ground, Hylton pressed her palm to the ground “to feel the pulse of the earth.” She writes that at that moment, she thought, “They’ve been waiting for us.”

“If I can inspire even just one family to have some of the conversations my family has been able to have as a result of this reporting, that’s what I want,” she says. The responses of some of her early readers “have already made me feel very whole, even with a story that is heartbreaking. In addition to putting years of reporting on the page, I put my heart out there.”

Photo of Antonia Hylton by Mark Clennon.

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