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"Deaf and dumb, blind, insane, or idiotic" were designations used in the US Census to justify eugenics, medical experimentation, and continued enslavement post emancipation.
At the same time, medical racism frequently asserted that enslaved Africans and their descendants were deemed 3/5 of a human, ergo they could not experience mental health crisis or pain.
If you dig into the 1840 and 1850 census, it's a real nasty place. Even after so-called emancipation, a white person could come to your home, declare you an idiot, and have you enslaved in a work camp or jailed.
Why are these ableist terms important for people to keep?
I get it. Language can be hard to change. I can tell you exactly where I was and what I was doing the last time I used the R-slur unthinkingly. I changed because someone asked me to. Told me how it hurt them.
I changed because to stagnate is to die the worst kind of death. It's actually true that when you know better you can do better.
Let me give you a quick tour of both the pre and post emancipation intersection. All indented sections of text are direct quotes from the linked articles.
Post-emancipation, the sole care model for mentally ill Jamaicans was the Bellevue Lunatic Asylum, a vast Victorian institution built by the colonial government in 1862. Bellevue underlined and echoed the same principle of involuntary incarceration that had been a brutal hallmark of the slavery system. Among those incarcerated in desperate and deplorable conditions were political activists such as Rastafari and others displaying unusual or bizarre methods of expressing resistance to colonial apartheid.
What happens when you take a system built on the kidnapping, torture, and forced labor of Africans and their descendants and rebrand it? You get Bellevue. The Jamaican decolonization story matters because they did the work of dismantling it. They moved mental health care into communities and general hospitals instead of custodial asylums, reducing stigma and rejecting the asylum model entirely.
The decolonization project was about acknowledging that the asylum reproduced the violence of slavery: involuntary confinement, loss of personhood, forced labor. It recognized that political resistance was being pathologized. When your so-called mental illness is that you refuse to accept colonial apartheid, the diagnosis isn't about your brain. It's about control.
Frederick Hickling, who worked as a consultant psychiatrist at Bellevue in 1974 when it still housed 3,000 people, developed psychohistoriographic cultural therapy. The approach used historiography and oral tradition to help patients reconnect to a history of oppression. Not to wallow in it, but to understand the social forces at play. You can't heal what you won't name.
In 1848 John Galt, a physician and medical director of the Eastern Lunatic Asylum in Williamsburg, Virginia, offered that "blacks are immune to mental illness." Galt hypothesized that enslaved Africans could not develop mental illness because as enslaved people, they did not own property, engage in commerce, or participate in civic affairs such as voting or holding office. This immunity hypothesis assumed according to Galt and others at that time that the risk of "lunacy" would be highest in those populations who were emotionally exposed to the stress of profit making, principally wealthy white men.
The contradiction here is almost elegant in its perversity. You can't be mentally ill because you're not fully human. Your suffering doesn't count as suffering. But also, your natural state is one of servitude, so any deviation from docility is itself a mental illness requiring punishment.
Dr. Benjamin Rush, the so-called "father of American psychiatry," diagnosed Black people with "negritude," the supposed irrational desire to become white. His solution? Prevent interracial marriage to contain the disease. He never treated anyone for it. He theorized it into existence.
Other antebellum medical researchers promoted conditions such as Drapetomania, a disease that caused enslaved blacks to flee their plantations, or Dysaesthesia Aethiopia, a disease that purportedly caused a state of dullness and lethargy, which would now be considered depression. Dr. Samuel Cartwright, working in Louisiana, recommended severe whipping as treatment for both. Modern historians note that Drapetomania and Dysaesthesia Aethiopia were often accompanied by skin lesions, which historians now argue were most likely scars from the whippings. These physicians created the symptoms they claimed to treat.
And the children? Child-slaves being cared for in the yards of the asylums. These facilities ran without government oversight. The children, called "inmates," were regularly misdiagnosed and wrongly accused of crimes, extending their stay in these institutions. Forced to perform manual labor on asylum farms, directly foreshadowing the convict leasing systems that would devastate the post-Reconstruction South.
The Civil War didn't change much. In 1895, Dr. T.O. Powell, superintendent of the Georgia Lunatic Asylum, blamed freedom itself for rising rates of insanity among Black Georgians. Three decades of freedom, he argued, had left formerly enslaved people unable to control their "appetites and passions." He didn't consider poverty. Didn't consider racial violence (this was the peak of lynching in America). Didn't consider that the conditions of life under Jim Crow were themselves traumatizing.
By the early 20th century, the eugenics movement had arrived with a new solution: sterilization of the "unfit," which explicitly included people with mental illness, people living in poverty, and anyone deemed sexually deviant.
The proportionate number of slaves who become deranged is less than that of free coloured persons, and less than that of whites. From many of the causes affecting the other classes of our inhabitants, they are somewhat exempt: for example, they are removed from much of the mental excitement to which the free population of the Union is necessarily exposed in the daily routine of life.
—John Galt, Report of the Eastern Asylum (1848), Williamsburg, Va.
This article by King Davis traces how Virginia built the first segregated mental institution for Black people in America, and the theoretical gymnastics that justified it.
First came the immunity hypothesis: enslaved people can't get mentally ill because they don't own property or vote or experience the stresses of civic life. Then the 1840 census claimed free Black people in the North had higher rates of mental illness than enslaved people in the South. The data was garbage. Southern asylums were legally barred from admitting enslaved people, so of course their numbers were lower. But the conclusion stuck: freedom itself causes insanity.
Virginia passed legislation in 1848 allowing enslaved people "qualified admission" to Eastern Lunatic Asylum. The conditions: (1) the owner had to petition for admission, (2) the owner had to pay for care, and (3) admitting a Black person couldn't deny a spot to a white person. From 1765 to 1868, fewer than 100 free or enslaved Black people were legally admitted.
Then the theory flipped. Once emancipation became inevitable, the "immunity hypothesis" was replaced by the "exaggerated risk hypothesis": freed Black people would experience excess mental illness, dependency, and dangerousness. Hospitalization became about control.
The Freedmen's Bureau negotiated with Virginia to open the Central Lunatic Asylum for Colored Insane in 1868, the first mental asylum for Black people in America. Admissions increased sixfold by 1899. During the Depression, close to 10,000 people were admitted compared to 1,200 in the prior two decades. The hospital stayed segregated until 1968. It didn't hire its first Black director until 1985.
They didn't care about the science. They adjusted the theory to justify whatever policy they wanted at the time.
(Continued from article above)
Although sterilization lost some of its appeal when it was discovered Nazi Germany embraced the practice on a wide scale, by the 1970s some states in the South, including notably North Carolina and Alabama, still sterilized disproportionate numbers of black women who were declared by courts to be mentally deficient.
The eugenics movement didn't come from Nazi Germany. It went to Nazi Germany. American psychiatrists were instrumental in building the infrastructure that the Nazis would later adopt and accelerate.
Eugenics operated on twin principles: encourage reproduction among "good" genetic stock, and sterilize the "unfit." That second category included people with mental illness, people living in poverty, and anyone deemed sexually deviant or criminal. In practice, it was a targeting system for marginalized populations.
The numbers are stark. In California alone during the 1930s, Black people made up 1% of the population but 4% of forced sterilization victims. Eighteen states passed laws allowing widespread sterilization of institutionalized people, many of whom were Black, misdiagnosed, and falsely accused of crimes. The 1927 Supreme Court case Buck v. Bell ruled 8-1 that mandatory sterilization was constitutional. Justice Oliver Wendell Holmes wrote in the majority opinion that "society can prevent those who are manifestly unfit from continuing their kind."
The Nazis took notes. Literally. California's eugenics program was a direct model for Germany's forced sterilization laws. The Rockefeller Foundation funded the Kaiser Wilhelm Institute for Anthropology in Berlin. American eugenicists sent literature overseas to German scientists. When Hitler signed the order authorizing the killing of mental patients on September 1, 1939 (the same day Germany invaded Poland) he was building on foundations that American medicine had helped lay.
The through-line matters: census categories that designated people as "idiotic" or "insane" → medical diagnoses that pathologized Blackness → eugenics laws that authorized sterilization → Nazi genocide programs → continued forced sterilization in the American South for another three decades. Each step built on the one before. The language created the infrastructure. The infrastructure enabled the violence.
From our experience during the past two years… we are inclined to think that this manual labor is the chief, if not the only, means of cure we possess for this class of our insane, coming as they all do from the totally uneducated former slave class.
—Daniel Burr Conrad, first superintendent of Central State Hospital in Virginia
This 2024 article from the American Journal of Public Health opens with Jordan Neely, the 30-year-old Black man who was strangled to death on a New York City subway in May 2023. Neely was unhoused, mentally ill, and had been forcibly hospitalized multiple times. The authors use his killing to trace a direct line from antebellum racial science to now.
Asylums didn't replace slavery's violence. They reproduced it. They were designed to "restore docility in the Black population." From the late 19th century through the mid-20th century, Black patients were forced into physical labor dressed up as "occupational therapy." Theories about racial inferiority were being applied directly to Black bodies.
Follow the money. When Southern states debated funding institutions for Black citizens during Reconstruction, white legislators called it an unfair tax burden. Black legislators fought for public mental health services; white legislators defunded them. This is where the "undeserving poor" narrative comes from, the justification for withdrawing care from the people who need it most. When care was denied, Black Americans ended up in the criminal justice system instead. The authors describe it as moving from "the left hand to the right hand of the state," behavior criminalized rather than treated.
The politics are right there in the records. Cartwright's "drapetomania" diagnosis emerged in the immediate context of the Fugitive Slave Act of 1850. The condition was political before it was medical. After the Civil War, asylum physicians diagnosed Black patients with "political excitement" as a cause of insanity, blaming the Emancipation Proclamation for harming Black mental health. Confederate sympathizers using medical language to restore white supremacist order.
This isn't just history. Black Americans are still overdiagnosed with schizophrenia. Researchers still look for genetic explanations despite no evidence. White nationalists are actively trying to revive 19th-century racial science on fringe platforms, citing skull measurements and polygenesis. The old pseudoscience never died. It learned to code-switch.
The authors end with Mayor Eric Adams responding to Neely's killing by calling for more forced hospitalizations. The New York Civil Liberties Union called this a return to "the failed approaches of force and coercion." They're not wrong.
The through-line here is clear: ableist language was never just about language. It was infrastructure. Census categories became eugenics justifications. Medical diagnoses became enslavement mechanisms. And the carceral logic that started on plantations found new life in asylums, then prisons, then the subway cars where Black men are killed for existing while unhoused and unwell.
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