In this episode of Mental Health Pathfinders, Erin Connors speaks with Dr. King Davis about the historical significance of Central State Hospital, the first institution in the U.S. dedicated to the care of black patients. Dr. Davis discusses the challenges faced in preserving the hospital's history, the impact of racial segregation on mental health care, and the evolving understanding of race and mental illness. He emphasizes the need for continued research and preservation efforts to better understand the intersection of race and mental health care in America.

Transcript for Audio

[00:05.261] Erin Connors: Hello and welcome to Mental Health Pathfinders. I'm Erin Connors. Our guest today, Dr. King Davis, is a professor emeritus at the School of Information and Liberal Arts, UT Austin, and a former commissioner of behavioral health and developmental services in Virginia. He founded the Friends of Central State Hospital, a federally recognized nonprofit organization to further his work.

Among the crowning achievements of his career as a social worker, researcher, and educator is his preserving the records and history of Central State Hospital, a psychiatric hospital in Petersburg, Virginia, that was the first institution in the country dedicated solely to the care of black patients. Dr. Davis, I look so forward to this conversation today. Thanks for joining us.

[00:52.288] Dr. King Davis: Thank you. I appreciate the invitation, Aaron.

[00:56.833] Erin Connors: So let's get right to it. How did you become aware of Central State Hospital and its unique history?

[01:03.232] Dr. King Davis: Well, it'll seem a little strange perhaps to you, but I came to Virginia in 1972 as director of community mental health services. Central was not part of my package. I was only dealing with the services in the community, but I had an intern the first summer that I was at the department that was a student in the university that is in the same town as Central State and her summer project turned out to be Central State Hospital and its history.

And that's how I became aware of it many, many years ago. But that's continued over time because I've spent probably 20, 25 years in Virginia. And I've had the opportunity to visit Central at different time periods, different staff, different individuals. So it's worked out very well. I've just learned a lot about it since 1972.

[01:57.593] Erin Connors: It sounds like this is really important to preserve the history of Central State Hospital, you know, in the context of racial and mental health justice.

[02:05.778] Dr. King Davis: Absolutely. No question about it.

Central being the first institution of its kind in the United States. When you go back through the history, you really raise the question of why Virginia, why Central State, and what were the factors that combined to make this occur in the Commonwealth of Virginia? And I think in part, you have to put it in the context that Virginia was also the state that opened the first mental institution in the United States in Williamsburg at Eastern State.

They opened the second in Stanton, Virginia in 1827. They opened Central State Hospital then in 1868. So the first three very unique institutions from the mentally ill were established in the state of Virginia. And part of the history of looking at Central is to ask the question, why did Virginia do these things? And so that has moved my career along.

[03:07.637] Erin Connors: Yeah, that is fascinating. Did you run into any challenges during your during your work to research and raise awareness to the history of Central State Hospital?

[03:16.283] Dr. King Davis: Do you have three days for me to talk about that? I'm teasing, of course. Well, absolutely. No, absolutely. One of the most significant of all of these was that very few people, seemed, in positions of authority in government appreciated the history of central state. So that was the first barrier that we had. The governor that I worked for, individuals in the Department of Behavioral Health, mental health at the time.

[03:19.533] Erin Connors: please give us the highlights.

[03:45.466] Dr. King Davis: They saw no real value in the artifacts or in the memorabilia of any kind at Central that was worth pursuing. And when I first started raising questions about the archives, I was advised that the archives from Central had no historical value and should in fact be shredded. So yes, there are many, challenges, financial, programmatically, policy-wise.

the absence of interest in Central overall, there were numerous challenges. But probably the biggest challenge for us was trying to figure out where we got the dollars to do anything about preserving the records at Central. And that was the greatest challenge that we had.

[04:33.289] Erin Connors: Sure. And how did racial segregation impact the care and treatment of black patients at Central State?

[04:40.56] Dr. King Davis: You can almost reverse that there were no areas where it did not significantly influence central state and to probably put that in its broadest context, you really have to go to the 1840 census of population for the United States. That was the first census that identified as much as they could. Inaccurately, however, the extent of mental illness in various states and cities and by race.

Across the United States. And what it identified and proposed in the census material was that African Americans who were in northern states who had migrated from the south and from slavery to the north had mental illness rates that were going to be 10 times greater than the persons who were enslaved and remained in the south.

So that started a variety of questions and research hypotheses. In fact, trying to explain the condition or the value or the import of race in predicting or even in considering diagnosis of persons by race. And the notion was at least initially, as long as African-Americans stayed in the Southern States and enslaved, they were basically immune.

From the problems of mental illness. When they went further north, if they escaped slavery, if they became free, the notion was that a humongous amount, large numbers of African-Americans would in fact develop very severe mental illnesses. So yes, it's been a factor throughout our history, from 1840 at least, 1860, and with the end of the Civil War, the notion was

A separate institution for African Americans needed to be developed because of the prediction that of the 500,000 African Americans who were subsequently free, a significant number of those would develop serious problems of mental illness. That's how we got central. So yes, it's been a factor throughout our history.

[06:54.455] Erin Connors: So it sounds like, yeah, it sounds like the hospital played like a really big role in discussions about race, healthcare inequality and public policy along the way.

[07:04.285] Dr. King Davis: Absolutely. And you can probably think about, and I did for example, in raising the question of why was this done in Virginia? Why wasn't it done in Alabama or North Carolina or South Carolina? Why did the first mental institution in the U S get started here in Virginia? Was it related to the fact that Virginians opened the very first institution and the second mental hospital or asylum? Well, it really reflects

A dispute that was being held between the director of Eastern State, the first hospital, and the director of Western State Hospital, Francis, not Francis Jury, but another physician who believed and wanted to have his hospital at Stanton, Virginia be the hospital that basically only invited whites as staff or as patients. And because he felt

That if there were black patients or black staff that would influence the willingness of wealthier whites to come to his hospital, he petitioned state government to identify a separate place for black patients as opposed to utilizing the two state hospitals that actually existed. There were black patients at Eastern State Hospital almost from the beginning, but not at Western. And they didn't have black patients at Western until after

Teaching in 1970. So very significant in terms of history.

[08:38.347] Erin Connors: Absolutely. So in what ways can sharing the stories of black patients and staff at Central State Hospital contribute to a more complete understanding of the intersection of race and mental health care in America?

[08:52.709] Dr. King Davis: I think initially it did not. And the reason for that in part is that very little attention was paid to African Americans at that time period in part because of the presence of what I call the immunity hypothesis. The notion that as long as African Americans stayed somewhere in the South, hopefully in bondage, that they would be immune from problems of mental illness. After the end of slavery,

And after the end certainly of the Civil War, the hypothesis changed. And the new hypothesis was African Americans couldn't deal with freedom. So the possibility then existed that thousands and thousands and thousands would in fact flood cities with severe problems of mental illness. So services had to be provided. And that continued to be the case for almost 100 years.

1868, 1869 to 1964, when the Civil Rights Act of 1964 required a very different orientation about race and mental illness. What you probably recall as well is that it wasn't until 2002 was the Surgeon General's report written that raised these very significant questions about is there a relationship between race

And the risk or the probability of mental illness. So throughout the hundred years, we really didn't have a very good understanding or even a very good approach to looking at the relationship, if any, between race and mental illness.

Sounds difficult, it really is true that that's the way we approached it. Go ahead, I'm sorry.

[10:37.281] Erin Connors: This is video.

You know, no, that's okay. This has really been a great discussion and I'd love to know if there's anything else you'd like our listeners to know about the research you've conducted over the years.

[10:52.333] Dr. King Davis: Well, there has been a lot more research and there are a lot more questions being raised about the relationship between race and mental illness. I was in Austin just this past week. There are more States that are beginning to look at the historical records that they have. The hog foundation for mental health in Austin, Texas, for example, they've recently gotten a library grant to engage almost all of the Southern States.

And seeing whether or not there can be a united effort on the part of all of these states to take a look at their historical records and to preserve them. There's an archivist at the Hogg Foundation, Elizabeth Stauber. You might want to interview at some point because she's doing this new project that's taking an effort and making an effort to really integrate the information that we have about the relationship between race and mental illness. I think it would be great.

To look even more broadly at how the other states are dealing with the issue that Virginia has started to deal with now. Our next effort in Virginia is to take all of the records that we've accumulated, all 800,000 of them, and to provide a space where family members, researchers, scholars of various kinds, administrators from other states as well, can gain insight on

The probability of dealing with these issues that African-Americans have in a much more scientific way than what we've done. And by that part of what we've learned in our study of the Virginia examples, about 70 % of all the African-Americans that have been in the hospital, and that's close to 54,000 people, all had the exact same diagnosis. Well, that's almost impossible.

The work that we've done and the work that others have done, Lonnie Snowden, for example, in California, Bill Lawson in Washington, D.C., and many others should help to really change the approach that we've used, one, to diagnose, and secondly, to treat the persons of color.

[13:07.645] Dr. King Davis: Erin, any more questions or comments you want to raise?

[13:12.55] Erin Connors: No, doctor, doctor, thank you so much for joining us today. This has really been a fascinating discussion. really do appreciate you being here today.

[13:20.039] Dr. King Davis: My pleasure. Thank you very much for calling.

[13:24.459] Erin Connors: And to our listeners, you can join us for a new episode of Mental Health Pathfinders each month at psychiatry.org slash podcasts, or on your favorite podcasting platform.

[13:35.935] Dr. King Davis: Thanks, Erin.