Summers shows that clinicians’ refusal to see African Americans as individuals led them to hold fast to the notion of a ‘distinctive black psyche’, even though ‘the empirical data failed to support their theoretical premises’ (p. 128). African-American patients were more than mere ‘objects of medical scrutiny’ (p. 155). Parsing annual reports and case records with exemplary sensitivity, Chapter 6 looks at the ways in which racialist assumptions and gender expectations shaped patients’ involvement with different therapies. For example, Summers observes that women were more likely than men to be treated with hydrotherapy, and that African-American men did not have access to therapeutic tubs at all. Laundry and kitchen labour, however, continued to be assigned exclusively to African Americans, although patients questioned labour’s therapeutic value and demanded compensation. Unfortunately, resistance sometimes provoked punitive responses, with black women disproportionately subjected to restraints and seclusion. Other challenges arose from the cultural incompetency of white clinicians who did not distinguish psychosis from the belief in conjure and ‘alternative medical epistemologies’ to which some black patients subscribed (p. 177). Chapters 7 and 8 consider reform at the hospital. The Progressive Era saw the broadening of community care programmes associated with the mental hygiene movement. There were limited collaborations with local partners such as Howard University, but the fortifying of segregation in the capital imposed boundaries. Several developments helped activists to overcome these boundaries and eventually end segregation. In 1946, the US Army and Navy began to send service members to Veterans Administration hospitals. Consequently, the admission of black civilians to Saint Elizabeths grew at the same moment that more white Washingtonians were moving to the suburbs. Civil rights and black professional organizations effectively drew attention to the hypocrisy of segregation and discriminatory hiring practices at a federal facility ‘in the capital of a nation that sought to project a self-image as a beacon of freedom and equality’ (p. 235), leading to the hospital’s gradual integration in the 1950s. The last two chapters deal with the aftermath of integration and de-institutionalization. While Chapter 9 shows that clinicians abandoned the ‘black psyche’ in favour of a universalist approach, the inaccessibility of patient records renders it impossible to know whether psychotropic drugs were disproportionately given to African Americans. What is certain is that ‘by 1955 the institution’s best days were behind it’ (p. 276). The final chapter delves into the vicissitudes of de-institutionalization, especially the loss of funding in the 1970s and 1980s that turned the hospital into an ‘emblem of federal neglect’ (p. 308). Madness in the City of Magnificent Intentions is a dense book that tells a complex story with acuity. Throughout, Summers toggles between the racialist theories that shaped the design and operation of Saint Elizabeths, and race as it was experienced by African Americans who lived in and near the institution. There are few asylum histories that grapple with race as thoroughly and thoughtfully as this one does, making it essential reading for historians of psychiatry. General readers who want to understand how and why disparities have undermined the treatment of the mentally ill in the USA will also be richly rewarded.

中文翻译：

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书评：黛博拉·布莱斯·多罗秀（Deborah Blythe Doroshow），《情绪失控：照顾美国陷入困境的儿童的历史》

萨默斯表明，临床医生拒绝将非裔美国人视为个体，导致他们坚持“独特的黑人心理”的概念，即使“经验数据未能支持他们的理论前提”（第 128 页）。非裔美国患者不仅仅是“医疗检查的对象”（第 155 页）。第 6 章以模范的敏感性分析年度报告和病例记录，着眼于种族主义假设和性别期望影响患者参与不同疗法的方式。例如，萨默斯观察到女性比男性更有可能接受水疗，而非洲裔美国男性根本无法使用治疗浴缸。然而，洗衣和厨房劳动力继续专门分配给非裔美国人，尽管患者质疑分娩的治疗价值并要求赔偿。不幸的是，抵抗有时会引发惩罚性反应，黑人女性不成比例地受到限制和隔离。其他挑战来自白人临床医生的文化上的无能，他们没有将精神病与一些黑人患者所认同的魔法和“替代医学认识论”的信念区分开来（第 177 页）。第 7 章和第 8 章考虑了医院的改革。进步时代见证了与心理卫生运动相关的社区护理计划的扩大。与当地合作伙伴（如霍华德大学）的合作有限，但首都强化种族隔离措施强加了界限。一些发展帮助活动家克服了这些界限并最终结束了种族隔离。1946 年，美国陆军和海军开始向退伍军人管理局医院派遣服役人员。因此，在更多白人华盛顿人搬到郊区的同时，黑人平民被接纳进入圣伊丽莎白。民权和黑人专业组织有效地提请注意“在一个试图将自我形象投射为自由和平等灯塔的国家首都”的联邦机构的隔离和歧视性招聘做法的虚伪性（第 235 页） ，导致医院在 1950 年代逐步整合。最后两章涉及整合和去机构化的后果。虽然第 9 章表明临床医生放弃了“黑人心理”，转而采用普遍主义的方法，但患者记录的不可访问性使得无法知道精神药物是否被不成比例地提供给非裔美国人。可以肯定的是，“到 1955 年，该机构最好的日子已经过去了”（第 276 页）。最后一章深入探讨了去机构化的变迁，尤其是 1970 年代和 1980 年代资金的流失，将医院变成了“联邦忽视的象征”（第 308 页）。《大意之城的疯狂》是一本厚重的书，敏锐地讲述了一个复杂的故事。在整个过程中，萨默斯在塑造圣伊丽莎白的设计和运营的种族主义理论和居住在该机构及其附近的非裔美国人所经历的种族之间切换。很少有庇护历史像这本书那样彻底和周到地处理种族问题，这使其成为精神病学历史学家的必读之物。想要了解差异如何以及为什么破坏美国精神病患者治疗的普通读者也将获得丰厚的回报。