An open pamphlet titled Mental Health Briefs with a library stamp.

Jim Crow in the Asylum: Psychiatry and Civil Rights in the American South

Kylie M. Smith, PhD will give the 13th annual James H. Cassedy Memorial Lecture in the History of Medicine on Thursday, September 15, 2022 at 2:00 PM ET. This talk will be live-streamed globally, and archived, by NIH VideoCasting. Dr. Smith is Associate Professor, 2021-2022 President’s Humanities Fellow at the Fox Center for Humanistic Inquiry, and Andrew W. Mellon Faculty Fellow for Nursing & the Humanities at Emory University, and a 2019 NLM G13 grant recipient. Circulating Now interviewed her about her research and upcoming talk.

Circulating Now: Please tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Casual portrait of a white woman.Kylie Smith: Originally, I’m from Australia, I did a PhD in History at the University of Wollongong which is just an hour south of Sydney on the unceded lands of the Tharawal and Wadi Wadi people. I came to Emory 7 years ago as part of a Mellon Foundation program to bridge the humanities and the professions, so I became the sole historian in the Emory School of Nursing. I am now an associate professor there and affiliate faculty with the Emory Department of History. That means I get to work with a broad spectrum of students from History and African American Studies to Public Health and Nursing, and I teach a class on Race, Health, and US History that brings all those students into the same classroom, which makes for a really generative discussion. I also teach a class in our Nursing PhD program on the evolution of nursing science; and I do a lot of guest lectures about the history of psychiatry, psychiatric nursing, and racism across Emory. When I’m not doing that, I’m working on my new book, and also planning my next project which is a documentary film in collaboration with the Alabama Disability Advocacy Program. So my day depends on which of those projects I’m juggling! Outside of work I like to hang out with my dog Cookie, who is my inspiration. I like cooking and baking and I’m also a knitter, and for stress relief I’m in a choir and I swim laps.

CN: How did you originally become interested in the History of Medicine? What  inspires you in your work?

KS: My PhD was on the role of psychiatry in approaches to “juvenile delinquency” in Australia and I was working as a research assistant for the Dean of Nursing. Through him I met the Mental Health Nursing Team and I started to think about the role of nurses in the history of psychiatry, which led me to the work of Hildegard Peplau, an American psychiatric nurse. I was working on that book when I came to work at Emory in Atlanta, Georgia and I saw immediately the vast disparities in the provision of mental health care, and the way that people of color were frequently subject to violence and discrimination instead of mental health care. I’m inspired by the many people I know who work in that system, colleagues in psychiatry at Grady Hospital in particular trying to provide safe and inclusive care in an underfunded system, my psychiatric mental health nursing colleagues who are trying to change that system at the front lines, and the lawyers and activists I’ve talked to who sought to end discrimination in disability care. Mostly though I am inspired by the people I’ve met who’ve survived this system, patients and families who’ve shared their stories with me. Everything I do is for them.

CN: In your NLM History Talk, “Jim Crow in the Asylum: Psychiatry and Civil Rights in the American South” you discuss racial segregation policies in some southern states.  Can you describe what that looked like?

KS: It was both complicated and very simple, but different depending on which state. By complicated I mean it’s actually been difficult to uncover how segregation worked because hospital and state administrators sometimes pretended it wasn’t happening or just didn’t document it. But it’s also simple because it was treated like just a regular aspect of southern life and was unquestioned in that way. Black patients were admitted into all the state hospitals I’m studying in Alabama, Georgia and Mississippi, but they were kept strictly segregated, either in an entirely different facility hundreds of miles away like in Alabama, or on a different part of the campus. This segregation meant that equal services were not provided, and Black patients endured many forms of abuse, neglect, violence, and forced labor, as well as being diagnosed and treated differently.

A grou pf black men with agricultural tools stand in a field. Horse drawn plows are in the distance and a man on a horse in the adjacent road.
Jemison Center, Northport, Alabama in Report of the Board of Trustees of the Alabama State Hospitals, 1954.
Courtesy Reynolds Finley Historical Library, University of Alabama Birmingham

CN: You highlight the 1969 decision of Judge Frank M. Johnson of Alabama that ended segregation in the state’s psychiatric hospitals. Can you tell us a little about him?

KS: Judge Johnson was and is well known in Alabama as the upholder of all matters related to Civil Rights and because of his constant clashes with segregationist governors like George Wallace. The US District Courthouse Complex in Montgomery is now named for him, for example. But Johnson was only ever able to rule on the cases that appeared in his court, and so he relied on legal activists to bring those cases. Local civil rights lawyers like Orzelle Billingsley and Demetrious Newton, as well as John LeFlore in Mobile, worked closely with the NAACP Legal Defense Fund (LDF) to create court actions that would enforce the Civil Rights Act.

In my research, I’ve been able to talk to lawyers from the LDF about the cases they brought to end segregation in medical facilities in Alabama, and in relation to the psychiatric hospitals, I’ve spent some time with LDF lawyers Michael Meltzner and Conrad Harper, who argued a case in Judge Johnson’s court. Meltzner oversaw all the LDF’s medical segregation cases, and for the 1969 case in Alabama he sent Conrad Harper. Mr. Harper was 27 at the time, fresh out of Howard and Harvard Law School where he had been the only Black man in his class. He interned with the LDF and Jack Greenberg offered him a job when he graduated. I met Mr. Harper in New York City in January 2020, and he told me that being in Judge Johnson’s chambers was the experience of a life time—that he had never met a more articulate or committed judge, who brooked no nonsense. He told me that he will never forget looking at the Judge down the table and feeling that the times were with them then, in a way that they are not today. It still gives me goosebumps. Harper and the LDF won that case, and ended segregation in Alabama’s psychiatric hospitals.

CN: What kind of long-term consequences did these policies have for psychiatric care in the South?

KS: We are still seeing the consequences of segregation and other racist policies in psychiatry and mental health care today. There are two major consequences, one is structural and the other is ideological. The structural consequences are that governments didn’t automatically become anti-racist, they found ways to circumvent the mandate to integrate through a “freedom of choice” rhetoric or through geographical, or “de facto” segregation. When money became available for community health services, they didn’t always ensure that that money went equally across communities or counties either, and in those places where there were not hospitals or clinics, the police became, and still are, the first responders to mental health problems. This is a serious problem that we’re seeing right now that disproportionately effects people of color. These structural problems were, and are, underpinned by ideas within psychiatric practice itself that we can call racist—the idea that Black people feel or process emotion or stress differently simply because they are “Black.” In my research I’ve analyzed a lot of past diagnostic data that shows that Black men and women were much more likely to be erroneously diagnosed with schizophrenia for example, simply for being “angry” and we still see these kinds of diagnostic disparities today. All of these factors have combined to create a very well-founded mistrust of mental health systems.

CN: Your research draws on the archival collections at the National Library of Medicine, were there materials that were particularly useful to you or which stand out to you for some reason?

Books stacked on a table with a notebook and pencil.KS: The NLM has been a godsend for this project, and I spent many happy days early in my research at those scanners in Bethesda! It’s really the best collective source for any kind of government or medical association publication, because those haven’t necessarily been maintained or collected in one place in southern archives. Sometimes those things have been deliberately destroyed, but they live on at the NLM! Anything that was supported by NIH or NIMH money, which is a lot in mental health care, is documented and available at the NLM and that’s saved me time trying to track community mental health plans for example, which can be hard to find elsewhere. I’m also particularly grateful for the help in accessing state medical association publications which have been digitized. Big shout out to the NLM staff and to Jeff Reznick for his help always!

Kylie Smith’s presentation is part of our NLM History Talks, which promote awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All talks are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.

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