In Black Religion in The Madhouse: Race and Psychiatry in Slavery’s Wake, Judith Weisenfeld provides a thorough examination of how Black religious life was interpreted, and often misinterpreted, by American psychiatric institutions in the years following slavery. Weisenfeld explores the ways that the spiritual expression of Black people was frequently pathologized and framed as evidence of mental illness, rather than understood within its cultural, theological, and historical context. She expertly guides the reader to learn of diagnoses that often say more about the assumptions of the medical system than about the mental health of the individual. Weisenfeld starts the book with a powerful description of a patient photograph, “I cannot forget that I have seen Judy B.’s photograph, her expression, the staff member’s hand on her head” (18), inviting the reader into her research experience, not just cognitively but emotionally. She provides the foundation for her compelling findings in the subsequent chapters. Then each chapter unfolds, starting with the origin story of “Black religious fanaticism” (19) and concluding with the integration of psychiatric services in the Black church.
Weisenfeld’s methodology is firmly grounded via in-depth review and citation of hospital and other medical records, state and legal documents, newspaper and other media, books, and articles. She lays the groundwork by providing historical context as groups of Black Americans began to gather after slavery ended, attracted to strong, and at times questionable, religious leaders who promised divine justice and emphasized the supernatural. Their message contrasted strongly with the beliefs promoted by the organized religion of the day, which used scriptures to support chattel slavery and saw Black Americans as engaged in activities that were intense and excessive. Using several case examples from medical records, Weisenfeld brings the reader into the psychiatric hospitals, where Black patients were admitted in increasingly high numbers with “religious excitement” as the official cause of their symptoms of mania and psychosis. She quotes physicians’ academic writings as they inform colleagues of their belief that an inability to handle freedom from slavery – a biological inability to self-govern, due to the assumption that Africans were inherently savages and not accustomed to civilization – was a primary cause of a marked increase in “insanity” (48, 56–66).
Weisenfeld uses legal records to show the intersection of criminality with psychiatric diagnosis and religion. She also introduces the prevalence of superstitious beliefs to explain how Black Americans sometimes understood the cause of their own mental health symptoms – most commonly a belief that they were “conjured” (78–79), as well as doctors’ beliefs that there was a connection between racially based “innate superstition” and a perceived increase in mental health diagnosis, including the new, though now archaic, diagnosis of dementia praecox. With this, Wiesenfeld highlights some of the earliest evidence that Black individuals were more likely to be diagnosed with psychosis.
After focusing on the concepts of Black fanaticism and Black supernaturalism, Weisenfeld looks at the concept of Black emotionalism, providing direct quotes from physicians claiming an inclination in Black individuals toward emotionalism due to a lack of a deeper philosophy to ground them (115) that predisposes them to mental illness. In this chapter, Weisenfeld makes the argument for the racialized pathologizing of religious passion and devotion while acknowledging the stance of the established AME church and Black public figures who expressed concern regarding certain Black religious groups’ level of emotionalism.
Weisenfeld uses text and visual illustrations to provide a window into the living conditions of Black hospital patients during segregation, and skillfully weaves in the perspective of Black psychiatrists, who are cited in statements offering a more comprehensive cultural and structural formulation of the mental health concerns that they assessed in Black patients and providing the known evidence-based treatments of the time. The rise of Black social scientists and psychiatrists led to the consideration of the broader context in which symptoms occur rather than through a racialized lens as being due to innate biological weaknesses.
Using media review and self-reports, Weisenfeld tells the inspiring story of the Lafargue clinic, the developing interest in the psychological effects of racism on Black Americans, and the more recent goal of providing expanded access to psychotherapy.
Black Religion in the Madhouse is a high-quality review not just of the overlap of religion and psychiatry, or of race and psychiatry, but of all three, using memorable case examples with historical fidelity. Weisenfeld seeks to show the reader a potentially overlooked aspect of the rise of psychiatry and its significance in the larger public discourse marked by shifting racial politics. Weisenfeld notably avoids injecting her own opinion or falling prey to conjecture, but instead presents a linear proposition based on historical sources. She is careful not to comment specifically on the accuracy of psychiatric diagnoses done by physicians and instead focuses the reader’s attention on the contextual factors that surround physicians’ use of a racial lens when assessing psychiatric symptoms. Black Religion in the Madhouse raises questions about whether our current psychiatric diagnostic system contains racial, cultural, or anti-religious biases, or attempts to avoid consideration of these issues by omission of their clinical relevance, except perhaps in the DSM Guide for Cultural Formulation.
This is a very readable book that will be appreciated by psychiatrists, psychologists, and other mental health providers. Many of its key findings should be incorporated into coursework for medical trainees of multiple disciplines. The history and implications of racializing medical assessment are worth further discussion in academic circles.
Weisenfeld could perhaps have included more content regarding the positive role of faith in sustaining resilience and hope for members of Black churches. It could also have been helpful to include a visual timeline – either at the beginning or end of the book – clearly marking key historical dates and events mentioned throughout the book. Such a visual could help to orient the reader and create a level playing field for readers who may differ in their foundational knowledge of American history.
Overall, Black Religion in the Madhouse is an important contribution to conversations about race, mental health, and religion in American history. It challenges readers to truly think about how authority, power, science, and bias have shaped diagnostic categories and how they continue to influence mental health care today.
