Wow I loved this book. Such an important topic deserves the utmost respect, research, and objectivity, and Lab Segrest has curated just that experience in this haunting recollection of systemic racism and its far-reaching implications. A must-read for anyone in the helping professions.

The book makes for some very grim reading, but that reading is important nonetheless. The author dives deep into the history of psychiatry. I would love to say I am shocked at the blatant racism of said origins of the field, but we all know that would be a big fat lie because racism is STILL everywhere. So many institutions that we know today were founded for the nefarious reasons of keeping Black and African-American people "in their place" and it will come as a surprise to literally no one who is a logical person that asylums operated for that purpose.

The author presents a slew of facts and anecdotes in such gripping detail that despite the horrible accounts, the book was hard to put down. The pain and trauma of so many years of abuses by those in power are hard to stomach, but Segrest's scholarship is top-notch.

The Milledgeville Asylum was founded in December of 1841, then called the Georgia State Lunatic, Idiot, and Epileptic Asylum. Within a century of its founding, Milledgeville housed 10,000 patients and held claim to the title of being the largest insane asylum in the world. Yet few people outside of the state seem to have heard of this place, and Segrest aims to change that.

I had no idea prior to reading this book of the originas of psychiatry - that psychiatry came from successful attempts to ensure that even though slavery was technically illegal, Black and African-American residents would still be held against their will. The author connects this terrible history to our modern world in a succinct and now-obvious way: the majority of psychiatry beds in the US are in prisons and jails. These same prisons and jails house a highly disproportionate amount of Blacks and African-Americans. The correlation is pretty hard to miss.

What's more, it was here at Milledgeville that the foundation would be laid on which the many eugenics theories would be built. Segrest discusses the basis of these policies and practices at length, and how the conversation by the 'experts' of the time gradually changed in order to accommodate the changing country. Slavery was good for the "Negro brain" because the constraints of slavery allowed for fewer cases of "insanity" among African-Americans. Basically, the psychiatrists believed that slaves were unbothered by stress due to their position as slaves. Sure, I am guessing that being a slave was not stressful at all. I would place my standard eye-roll here, but the subject is too horrific and infuriating.

Naturally these psychiatrists determined that emancipation would be terrible for all the "unstressed slaves" and wouldn't you know, in the eras following the Civil War - through Reconstruction, Jim Crow, and so on and so on, the conversation gradually became about mental illnesses then passing on to the next generation because it was hereditary and not the trauma after all.

Patient were subjected to all kinds of terrible procedures that had zero to do with healing. Forced sterilizations, lobotomies, the ice baths, it's all here and well-documented. Naturally these procedures were performed almost exclusively on women and African-Americans, because we all know that white dudes NEVER have mental health issues of any kind, and especially did not in the decades that Milledgeville was in operation.

Today roughly 200 buildings still stand on the 2,000 acres of land where Milledgeville was once a bustling and busy place. It is largely abandoned, but there are people working to preserve this history and I truly hope they are successful. These stories can never be forgotten, so that the thousands of nameless men, women, and children who died there are not forgotten either.

Administrations of Lunacy is an account of a single asylum in Milledgeville, GA from its founding on stolen indigenous lands to its eventual decline in the 20th century. Through it, Segrest is trying to tackle a lot of threads to ultimately make the case that early American psychiatry's racist past heavily informs our present:
"This is a history not only of the New Jim Crow, but also of the first Jim Crow, and before that of chattel slavery itself and the genocides of Indigenous people, and the still-fighting Confederacy, all of whose afterlives we have yet to vanquish."


As someone who wrote her thesis on 19th-century psychiatry and literature, I thought this book was for me, combining my interests and research passions. And to an extent, this book does that. Segrest often nicely contextualizes the specific historical records and lacunae in the broader context of American history--for instance, highlighting the notable lack of attention to very real traumas inflicted on Black Georgians by war, by lynch mobs, and by Jim Crow. (These do not show up as reasons for admission in the records.) She consistently calls attention to the injustices done by the asylum system to Black inpatients, and she vividly tells the stories of, I imagine, everyone that appears for more than a line or two in the historical record.

But my issue with the book is that the writing style is at once too dry and too speculative to really succeed as more than a historical narrative. There are a lot of statistics in this book, and so many patient stories are told that I began to wonder why the story was included at all. It seems like it'd be more impactful to include stories that were emblematic of an issue, but a lot of times it was like "here's another patient who was here in 1872."

As for the speculation, whenever Segrest describes a patient or a person who worked at the Milledgeville asylum, she over-relies on "perhaps" to try to appeal to pathos, but as a text dealing with historical archives, it comes across almost as fictionalizing their stories. For example, Segrest tells the story of Sue Pagan, a white woman who lived and worked as a laundress with a Black family after being separated from her baby and released for the first time from the Milledgeville asylum. She was taken back to the asylum despite presenting "no symptoms of insanity other than insomnia and talking at night." The facts alone are tragic, and Segrest deftly uses them to discuss the intersection of insanity, control, and white Reconstruction-era racial fears. But then she writes, "There is no record of what happened to Sue on the inside. Perhaps her work detail was the laundry, where she could remember the white sheets sailing on the clothes lines back in Shermantown and the two Black women who had treated her well." The perhapses, the fictionalization, galled me because they felt manipulative and detracted from the genre of the book as a historical monograph.

Originally published on my blog: Central State Hospital in Milledgeville GA, USA. Released 14th April by The New Press, it's 384 pages and available in hardcover, audio, and ebook formats.

This is an unflinching and unflattering deconstruction of the history of (at one time) the largest facility for treating and housing the mentally ill in the world. In continuous operation since December 1842 and now largely defunct, it's a huge sprawling (and mostly abandoned) complex of over 200 buildings on 2000 acres of land. Author Mab Segrest knits the facts and bald history of the place together with the systemic, wilful, historical administration and in-baked racist policies and treatment that people of color received throughout the institution's almost 180 year history.

Especially in the greater context of the continuing painful racist brutality that is rampant in the world today, this was a very difficult but important read. I found that I had to put the book down and walk away and think about and process the information at several points. The author is unsparing. There are frank discussions of (to modern people) barbaric, cruel, and senseless "treatments" and processes. The author's historical examination of eugenics as practiced by the non-consensual sterilization of inmates, torture, lobotomization, and other procedures is unstinting. The notes and references are academically rigorous, plentiful, and well organized.

General information and historical background are alternated throughout the book with personal stories of inmates (where known) or professionals employed in the care and operation of the facility. The author quotes a former staff member, Joe Ingram, when she devastatingly writes that there are "Rows upon rows of numbered, small, rusted markers as far as you can see... it must be the most gruesome sight in Georgia. Unknown humans, shunned when living, deprived of their very names in death... and literally known only to God".

Difficult reading. This would make a superlative adjunct text for related subjects, history of medicine, gender and race studies, psychiatry, mental health issues, public health, and so forth.

Four stars. Readers should certainly be prepared for triggering subject matter. It makes for grim reading.

Disclosure: I received an ARC at no cost from the author/publisher for review purposes.

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.

An in-depth look at not only a mental institution, but the people and the time and place that it existed. This mental institution was large and located in an interesting place especially at an interesting time in our nation's history - the south pre and post Civil War. With its location it had a trying relationship with race relations and how that fits into mental health. I have read other books, mostly historical fiction about mental institutions and the study of mental health and this was a different look at how it fits in the surrounding time.

I initially started reading this book via audiobook and had to stop and return it after three chapters as it wasn't keeping my attention and wasn't working for me, so I switched to ebook form and finished it reading that way.

The parts that I loved about this book were when it focused on a doctor or a patient inside the halls. The moments where the author took the reader outside of the asylum didn't interest me as much. I understand that she was trying to give context to what was going on at the same time, but for me those parts took up too much space and took away from the central reason for the book.

I didn't deduct any "points" from trying to read the audiobook and it not working out. I blame the narrator and I would never have that impact my review in the negative.

*Many thanks to Mab Segrest, The New Press and NetGalley for arc in exchaange for my honest review.*
My first read on racisim in the field of psychology. I found it difficult to follow at times due to the minute details, however, the theme of the book is both fascinating and upsetting at the same time. The book is brilliantly researched and gives the panorama of social problems and political background.

I would like to thank NetGalley, The New Press, and author Mab Segrest for providing me with a copy of this ARC.

Administrations of Lunacy is a heartbreaking, eye opening novel about the racism in psychiatry. I have always been interested in the field of Psych, especially this branch. When I saw this available for review on NetGalley, I couldn’t help but to put in for it. This book is something that should be included in history lessons, Psych classes, etc. You will learn so many things that were never mentioned in your classes. If you don’t know much about psych, don’t be put off by this book. It is reader friendly, no matter what kind of knowledge you have on the subject. This truly shows a piece of the dark side of psychiatry, and it needs to be brought to light.

You will learn so much while perusing the pages of this book. Thank you again to those listed above for the opportunity to read this ARC.

This book was intense and mind opening. I couldn't put it down. It was so interesting and heartbreaking.

Administrations of Lunacy is an eye-opening book on the racism in psychiatry. The author does the research to inform readers of an asylum in Georgia. She details reports and facts from her findings to show how racism shaped the world of psychiatry.

Mab begins the book and starts with details about the Milledgeville Asylum. There are many facts presented that show the conditions that patients, in particular, African Americans were put through. It is heartbreaking to know how poorly they were treated because of their race. She even shows how it impacted future theories like eugenics.

I learned a lot from this book. I really appreciated the detail and findings because the author was able to back up statements and opinions.

I give Administrations of Lunacy 4 stars. This book is a history lesson that needs to be talked about more. If you have ever wanted to know more about the world of psychiatry and the origin of some of its beliefs, then you will want to read this one.

An incredible well researched book, based un real information. As a history lover, being able to read such a book was amazing and I'm thankful for authors like her who really love to tell things with no hesitation. Mag Segrest, author, a long time scholar and social justice activist on issues of gender, race and class in the U.S. South 🌸 The story about 'Georgia State Lunatic, Idiot and Epileptic Asylum'. Milledgeville was the world's largest insane asylum. The stories surrounding this place are completely horrible, we all have heard about how people use to be treated in this places but to be able to read actual facts in this investigation was a total surprise for me. Since I requested this book I was completely convinced that I was going to enjoy it. I never read this stories in any other book before. It's completely heartbreaking how people used to live in this places, and the injustice that thousands had to deal with. 🌸 the only thing I didn't really like was that at some points it felt like I was doing a school assignment and can be boring but then you get along well with it. 🌸 if you like history you'll enjoy it!

Mab Segrest, a feminist and anti-racist author, painstakingly traces the racist origins of psychiatry in the United States through the lens of the patients and doctors who walked the corridors of Milledgeville Asylum in Georgia. These origins begin with the purchase of the land on which the Milledgeville asylum was built in 1841 -- lands that were stolen from native American. In subsequent years, those who practiced in the field of psychiatry would develop pseudo-medical theories that helped consolidate the racism that Georgia and other states in this country would use to justify segregation and white violence against African Americans. For example, lower rates of insanity among African Americans were attributed to the "healthy restraints" of slavery. Unlike white Americans, the "negro brain" was not bothered by the stresses of modern life. Thus "freedom" in the minds of Southern psychiatrists became a "disease factor." Such racist explanations of mental illness did not disappear with the onset of the twentieth century, rather they took new forms, as physicians became to place less emphasis on trauma and more emphasis on heredity as cause for mental disorders. These new theories would provide the justification for the sterilization of those with mental disorders -- a policy that disproportionately affected women and persons of color. For example in North Carolina of the 7797 sterilizations that took place between the 1930s and 1970s, 5000 of them were of African American women. Sadly, as the author shows racism and misogyny continue to inform policies of incarceration at both mental institutions and prisons. In short, the author has provided a thought-provoking history of the entangled relationship between psychiatry, racism, and misogyny. I only wish that in the early pages of this volume that the author had refrained from making quite so many speculative remarks about the feelings and thoughts of the asylum's early occupants. These speculations, at least for me, added little to what was otherwise a powerful and informative history of psychiatry's dark side.

Searing, emotional, and informative, Administrations of Lunacy focuses on one asylum in Georgia from pre-Civil War to the modern age. Confronting such topics as the abuse and neglect of the mentally ill, eugenics, racism, misogyny, and the modern prison industrial complex, this novel is a must read for an understanding of how the modern psychiatric community evolved and what the costs were throughout history,

Thank you to Netgalley for an ARC in exchange for an honest opinion.

As a psychology major this book held my interest. So much of what was discussed in this book had never made it to our classes, which is a good thing. I wanted to learn new things, and this book pretty much gives you really interesting facts and and little bits of knowledge. A must-read for psych and non-psych readers!