Non-fiction book about the history of an asylum in Georgia, USA
Content warning: racism, ableism, massacres, eugenics, neglect, abuse, slavery, forced sterlisation
I received a copy of this eBook courtesy of the publisher.
“Administrations of Lunacy: Racism and the haunting of American psychiatry at the Milledgeville Asylum” by Mab Segrest is a history of a mental health asylum from when it opened as the Georgia State Lunatic, Idiot, and Epileptic Asylum in 1842 and how it stood by, was influenced by, was complicit in and actively participated in features of American history such as the massacres of first nations people, slavery, the American Civil War, Jim Crow, forced labour, eugenics, forced sterilisation and the prison-industrial complex until its closure in 2010.
This is an exceptionally well-researched book. According to the acknowledgements, Segrest spent many years investigating the enormous institution that at one point was the largest mental health facility in the USA and the many threads that connected this facility to the American historical context. Under several iterations, and many more superintendents, the asylum is thoroughly deconstructed by Segrest who explores, through newspaper articles, annual reports, journals and clinical records, the impacts of racism, sexism, ableism and white supremacy on its administration and its patients. I felt like the case studies of individual patients who found themselves, one way or another, admitted to the asylum. Their stories were equal parts fascinating and heartbreaking, giving the reader a real appreciation of the impact of segregation, neglect, starvation, hard labour and forced sterilisation on the tens of thousands of individuals who lived and died there.
I thought that Segrest’s research clearly illustrated how dependent the conditions of the asylum were on personal views of those in charge – especially when it came to legislation and funding. As demonstrated by the way people with disability continue to fall through the cracks, better legislation and funding is critical to ensuring that they receive the support and dignity they deserve. It is clear that even in 2020, people with disability are still incredibly vulnerable to abuse. In just the past week here in Australia there have been three devastating stories of unfathomable abuse and neglect that demonstrate that on a systematic level as well as an individual level, people with disability are still being failed. The strongest parts of this book were the anecdotes about the day-to-day life of the patients who found themselves admitted to the asylum.
As is often the case with well-researched books, it can be difficult to decide what to include and what to leave out. There is no question about the breadth of Segrest’s research on this topic, and she follows up every single lead that might provide more understanding about the asylum and how it came to be. However, I think at times the breadth of this book was at the expense of the depth. While I appreciate how important political history is to the American psyche, and historical periods and events were to the nature of the asylum, I think a stronger focus on the asylum itself would have made the book a little easier to follow. Particularly in the earlier parts of the books, Segrest peppers the book so liberally with metaphors and historical and cultural references that it does at time result in quite dense reading.
Segrest approaches psychiatry with a level of skepticism informed by the circumstances through which the field has developed and evolved. She critically examines the social factors experienced by patients admitted to the asylum and offers alternative explanations for symptoms of mental illness including environmental factors such as poverty, physical illness, malnutrition, culture, abuse and prolonged exposure to trauma. I agree that these factors are important to consider, and I can understand Segrest’s reluctance to lean too far into genetic causes for mental illness and disability given the horrors of eugenics policies.
However, having worked in mental health, I feel that she did downplay the impact that untreated and unsupported mental illness can have on an individual’s life outside a clinical setting and that this too can leave them vulnerable to abuse, neglect and homelessness in the community, especially without families or friends equipped to care for them. Regardless of her views on the utility of diagnostic tools such as the DSM-5, I think that we must accept that sometimes people do have symptoms of a mental illness or disability that do not have an environmental cause. I think by accepting people for who they are without looking for an external explanation (and unintentionally apportioning blame), we can better design a system that works for the individuals affected.
An important and thoroughly-researched book whose proverbial forest was at times obscured by the (pecan) trees.