Summers, Martin. Madness in the City of Magnificent Expectations: A History of Race and Mental Illness in the Nation’s Capital. New York: Oxford University Press, 2019.

Reviewed by Debra Kram-Fernandez

Madness in The City of Magnificent Expectations is concerned with the history of psychiatric care for Black, Brown, and White Americans suffering from serious and/or chronic mental illness. The study spans the period from the mid-nineteenth century to the 1970s, when deinstitutionalization resulted in the scaling back or closing of major mental hospitals. Author Martin Summers astutely focuses on the history of Saint Elizabeth’s Hospital in Southeast Washington, DC. 

Summers makes a convincing case for the importance of the hospital. Saint Elizabeth’s was the first psychiatric hospital to receive federal funding. A large part of its mission was to provide exceptional care to mentally disabled Civil War veterans. The hospital’s affiliation with teaching hospitals ensured up-to-date and progressive models for care and treatment. Federal support for the hospital contributed to its setting standards in the United States and abroad for quality and benevolent care. 

Originally the “Government Hospital for the Insane,” Saint Elizabeth’s was designed not only for whites requiring psychiatric services, but also for Black and Brown veterans, soldiers and naval officers, and civilian residents of Washington, DC. Inevitably a separate lodge for “colored people” was designed and built for what became the campus of Saint Elizabeth’s. Even so, Saint Elizabeth’s was perhaps the first hospital to take a proactive approach in handling the influx of Black and Brown patients suffering from serious mental illnesses.

Summers’s underlying concern is how at Saint Elizabeth’s the Black psyche was differentiated from the white, leading to racialized and often diminished treatment for Blacks. As there has been a dearth of studies concerning the history of treatment of mental illness among African Americans, this book goes a long way toward filling a gap in the literature.

His central argument is that Saint Elizabeth’s did more than reflect the racism of its time. As an influential institution it actively contributed to racism by privileging the white psyche as the norm while dismissing the Black psyche as aberrant and more resistant to treatment. Summers begins by showing the subpar living quarters at Saint Elizabeth’s for people of color, and that the conventional therapeutic activities for Blacks—active housekeeping and janitorial labor—often fell short of the meaningful and purposeful activities of whites. At Saint Elizabeth’s people of color might be perceived as dangerous, child-like and liable to breakdown under the stress of new-found freedom. Such prejudicial stereotyping significantly limited therapeutic expectations even during periods when, by modern standards, expectations for treatment were uncommonly optimistic.