The attention Babcock and other white doctors, mostly from southern hospitals, gave to the increase in diagnoses of mental illness among African Americans in this period emerged within and contributed to the era’s hardening systems of segregation and racial containment that shaped Charles’s young adulthood. Potential for incarceration in a variety of institutions, including jails, penitentiaries, Magdalene houses, and poorhouses shadowed African Americans in the Jim Crow era, and commitment to mental institutions loomed as another possibility. Indeed, many Black people were sent to hospitals for the insane from county jails, prisons, and poorhouses (which was the case for Charles K.). In cases in which violence or crime occurred, the determination of criminal agency or mental illness took place through a combination of local legal, political, and social cultures along with medical standards of the day, including theories about religious causes. Thus, in the period in which African Americans were forging cultures and communities in slavery’s wake, they came under the scrutiny of white psychiatrists, police, and judges who applied racialized ideas about religion and mental normalcy, and they were sometimes consigned to the expanding system of state mental hospitals.

In accounting for and responding to what they saw as an emerging medical and social crisis, late-nineteenth- and early-twentieth-century white psychiatrists produced theories of religion that became constitutive elements of their racialized understandings of the normal and disordered mind. As a precipitating factor for mental illness, “excessive religious excitement,” as Georgia State Sanitarium clinical director E. M. Green, the son of a Presbyterian minister and grandson of an enslaver, characterized African Americans’ emotional propensities, was not a neutral notion.⁹ Like so much about valuations of religion in American culture, interpretations of religious expression—restrained and appropriate, or excited and excessive—were often racialized and gendered, as were assessments of theologies and forms of religious organization. White psychiatrists frequently invoked religious beliefs, sensibilities, and practices in their claims about the hereditary, historical, and social causes of mental instability among Black people, framed through the lens of white supremacy, American racial hierarchy, the doctors’ own family investments in the economic exploitation of Black people, and doctors’ religious commitments, most often to Protestant denominations.

What were the main elements of these racialized theories of religion and mental normalcy? It was routine for white psychiatric practitioners to frame their addresses and published studies about Black mental illness by constructing and rehearsing a trajectory from what they characterized as savagery (with its religious connotations), through enslavement, to recent emancipation. St. Elizabeths Hospital psychiatrist Mary O’Malley began her study of psychoses among Black patients with the assertion that, “only 300 years ago the Negro ancestors of this race were naked dwellers on the west coast of Africa . . . , found by the slave traders in the depths of savagery and suddenly transplanted to an environment of the highest civilization, and 250 years later had all the responsibilities of this higher race thrust upon them.”¹⁰

While the many similar accounts—like those historian Martin Summers describes as “rising to the level of genre”—marked change over time from Africa to the United States, white psychiatrists insisted on the lack of civilizational development or progress on the part of African Americans.¹¹ John E. Lind, O’Malley’s colleague at St. Elizabeths, asserted in one study, “Because [the Negro] wears a Palm Beach suit instead of a string of cowries, his psychology is no less that of the African” and “betray[s] the savage heart beneath the civilized exterior.”¹² These medical evaluations of African and African American culture claimed stunted growth because of cultural immaturity deriving from what these psychiatrists presented as essential race traits.

Another core component was the claim that slavery had been a benevolent institution for Black people’s moral, mental, and physical health. From his position as superintendent of Eastern Hospital in Goldsboro, North Carolina, that housed exclusively Black patients, active Southern Methodist layman J. F. Miller, whose family had enslaved dozens of Black people, summed up the opinion of many white psychiatrists of the beneficial environment of slavery for Black peoples’ mental and moral well-being: “It is an undisputed fact, known to our Southern people, that no race of men ever lived under better hygienic restraint or had governing their lives rules and regulations more conducive to physical health and mental repose. . . . Freedom came to [the Negro] and a change came over his entire life.”¹³

So, what did late-nineteenth-century psychiatrists mean when they diagnosed African American patients as suffering from mental illness—either mania or melancholia in this period—caused or precipitated by religious excitement? Religious excitement served as an umbrella term that white psychiatrists discussed in relation to what they imagined as two constituent components in the Black psyche: superstition and emotionalism.

White psychiatrists mobilized ideas about African religions as not real religion and evaluated their Black patients’ references to certain understandings of the supernatural as indications of the racial trait of “Negro superstition.” These understandings of the supernatural included the Africana spiritual practice of conjure that combined material and spiritual resources to heal or harm and mentions of spiritual beings like witches and their interactions with humans. St. Elizabeths Hospital’s William Bevis asserted in 1921 that, “nothing in the life of the Negro stands out more prominently than his superstition. It influences his thought and conduct more than anything else. In no other trait or peculiarity do we find more plainly the imprint of the primitive African life and customs.”¹⁴

Many white psychiatrists argued that what they viewed as African superstitions, as manifest in African American life, were all-consuming and tyrannical. E. M. Green, the clinical director of the Georgia State Sanitarium, argued in 1914 that, “from the cradle the negro lives in the fear of the supernatural. As an infant he is threatened with beasts, spooks, and witches. In childhood, the chief subjects of conversation which he overhears are witchcraft, spells, ghosts, and conjuring. Every sickness is attributed to the agency of poison; every misfortune to that of witchcraft.”¹⁵

It is not uncommon in the records of commitment hearings to find African Americans attributing mental disturbance to the effects of conjure. When 21-year-old Mary J. was brought from the Richmond County, Virginia, jail in 1885 to stand before justices of the peace for a determination on her sanity, the examining physicians reported that religious excitement was the supposed cause of her insanity and that she complained “of being tricked or conjured.”¹⁶ Mary had been arrested and charged with disorderly conduct once before but, in this case, it is likely that her assertion of belief in conjure—that is, her investment in this spiritual system of regulating interpersonal relations and health through appeal to natural and supernatural forces—was what led to the doctor’s characterization of her as suffering from religious excitement and her commitment to the Central State Asylum for the Colored Insane.¹⁷

In addition to the idea that African Americans experienced a kind of mental terror because of their presumed racial propensity for superstitious beliefs and failure to relegate religion to a limited arena of life, psychiatric assessment of the state of Black mental health generally presented emotional and spiritual excess, as opposed to moral or ethical concern, as the substance of Black religion. Georgia’s E. M. Green asserted that “[the Negro’s] religious convictions are most superficial, and while a great church goer, easily swayed by religious oratory and capable of excessive religious excitement, he has no realization of the basic principles of religion and gives way to all kinds of moral derelictions while professing deepest piety.”¹⁸ These ideas about Black religious emotional excess would frame interpretations of Black church worship, of Black participation in late-nineteenth-century revivals and early-twentieth-century Pentecostalism, and a host of individual visionary and ecstatic religious expressions.

Such assertions by white commentators of what they believed was the nature of African and African diaspora religion—primitive, superstitious, emotional, contagious, lacking in ethics and morals—can be found in literature before the era of the professionalization of psychiatry and in a range of contemporaneous social scientific and theological literature. Something else is at stake, however, when such racialized theories of religion become part of a medical specialty that has the capacity to link long-standing racialized constructions of deviant culture and religion to biological conceptions of the normal mind. Most white psychiatrists who published articles and delivered addresses about Black people and mental illness in this period were associated with one of the many state hospitals for the insane, primarily in the South in the late nineteenth century, but representing a broader geography into the twentieth. The frameworks they developed offering medical evidence for the purported connections between insanity and what they imagined as African savagery, Black people’s unfitness for civilization and freedom, propensity for superstitious belief, and overly emotional religious practice became authoritative and influential.

Judith Weisenfeld is Agate Brown and George L. Collord Professor of Religion at Princeton University. She is the author of New World A-Coming: Black Religion and Racial Identity during the Great Migration (New York University Press, 2016), and African American Women and Christian Activism: New York’s Black YWCA, 1905–1945 (Harvard University Press, 2007). Her forthcoming book, Black Religion in the Madhouse: Race and Psychiatry in Slavery’s Wake, will be published by New York University Press in 2025.