Administrations of Lunacy

Racism and the Haunting of American Psychiatry at the Milledgeville Asylum

A scathing and original look at the racist origins of psychiatry, through the story of the largest mental institution in the world

“The situation approaches Nazi concentration camp standards . . . unbelievable this side of Dante’s Inferno.
—April 1949 issue of Ebony magazine, describing the situation for black patients at the Milledgeville asylum

Today, 90 percent of psychiatric beds are located in jails and prisons across the United States, institutions that confine disproportionate numbers of African Americans. After more than a decade of research, the celebrated scholar and activist Mab Segrest locates the deep historical roots of this startling fact, turning her sights on a long-forgotten cauldron of racial ideology: the state mental asylum system in which psychiatry was born and whose influences extend into our troubled present.

In December 1841, the Georgia State Lunatic, Idiot, and Epileptic Asylum was founded. A hundred years later, it had become the largest insane asylum in the world with over ten thousand patients. Administrations of Lunacy tells the story of this iconic and infamous southern institution, a history that was all but erased from popular memory and within the psychiatric profession.

Through riveting accounts of historical characters, Segrest reveals how modern psychiatric practice was forged in the traumas of slavery, the Civil War, Reconstruction, and Jim Crow. Deftly connecting this history to the modern era, Segrest then shows how a single asylum helped set the stage for the eugenics theories of the twentieth century and the persistent racial ideologies of our own times. She also traces the connections to today’s dissident psychiatric practices that offer sanity and create justice.

A landmark of scholarship, Administrations of Lunacy restores a vital thread between past and present, revealing the tangled racial roots of psychiatry in America.


“A valuable contribution to the history of mental health care and of the racist applications of medicine.”
Kirkus Reviews (starred review)
“From the author of the groundbreaking Memoir of a Race Traitor comes this compelling examination of racism in psychiatry through a case study of Milledgeville Asylum in Georgia.”
Ms. magazine
“After a decade of research, Mab Segrest, whose Memoir of a Race Traitor forever changed the way we think about race in America, turns sanity itself inside-out in a stunning book that will become an instant classic.”
365 Atlanta Traveler
“Based on a decade of research, this important history links the rise and fall of a major American insane asylum with the growth of the for-profit prison system.”
Shelf Awareness
“Incisive. . . . Impressive and meticulously documented.”
Public Books
“A thorough, revelatory history of Southern psychiatric racism.”
“Through engrossing tales of historical characters, Segrest reveals how modern psychiatric practice was forged in the traumas of slavery, the Civil War, Reconstruction, and Jim Crow.”
The Palm Beach Post
“This valuable book helps to show how white supremacy shaped the definition and care of people with mental illness from the start, and how psychiatry remains in its shadow.”
Administrations of Lunacy reaches across disciplines and sources making connections between people and institutions where records are often silent. . . . The book is at its best when Segrest stays grounded in the patient case files she is privy to, bringing to life some of Georgia’s most forgotten and marginalized people.”
Southern Spaces

News and Reviews


Read an op-ed by author Mab Segrest in Time about the history of bias in medicine and its risk to public health.

Atlanta Journal-Constitution

Read a feature piece about author Mab Segres, Administrations of Lunacy, and the Georgia Lunatic Asylum in the Atlanta Journal-Constitution.

Books by Mab Segrest

Memoir of a Race Traitor
Fighting Racism in the American South

Mab Segrest

Goodreads Reviews