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Black Lives in Asylum Fiction

Understanding our sad legacy of white victimhood and Black caricature.

In the book One Flew Over the Cuckoo’s Nest, the evil Nurse Ratched lords over a prison-like asylum. Told from the perspective of a massive, mute patient called Chief Bromden, we learn about a plucky new inmate named Randle McMurphy. McMurphy is a tough Irish rebel who takes a stint at the mental hospital in order to get out of a prison gig, only to learn, to his horror, that Nurse Ratched does not intend to make things easy for him. In fact, she wants to break his will. She does not do the heavy lifting herself, though. For that, she has an army of African Americans.

Ken Kesey’s landmark novel made a huge impact when it hit the stands in 1962. College kids in particular loved its message of resisting the Establishment. In Kesey’s vision, the enemy is known as the Combine. As described by Chief Bromden, the Combine is “a huge organization that aims to adjust the Outside as well as [Nurse Ratched] has the Inside.” The asylum is a key base of operations for the Combine.

What is less-understood about the novel is the fact that Ratched relies on a crew of African American attendants. According to Kesey, Ratched chooses Black attendants because they are more “likely to devote” themselves “to cleaning and scrubbing and keeping the ward in order.” The terminology Kesey goes on to use to describe the attendants is incredibly racist. His language was so problematic that, when the film based on the novel came out in 1975, some critics breathed a sigh of relief that the attendants were portrayed as dignified and human.

Kesey’s decision to assign a crew of African American attendants to carry out the infernal wishes of a female martinet, in order to crush the spirit of beaten white men and their heroic white leader, taps longstanding American asylum themes. Dating from Edgar Allan Poe’s 1845 racialized asylum rebellion in “The System of Dr. Tarr and Prof. Fether,” carrying up through novels and films (see 1925’s The Monster) that use race to either suggest white degradation in asylums or to designate a category of mindless hirelings who serve brutal asylum masters, we encounter a troubling trend. Heroic white people in institutional settings are shown to be belittled by evil masterminds and their racialized, i.e. "Other," servants.

The historical reality of mental incarceration paints a far different picture. African Americans have been more likely than whites to be diagnosed schizophrenic and to be treated harshly by the institutional system. Segregated mental hospitals invariably were grossly underfunded, and segregated or overcrowded urban wards made a sad comparison to the relatively luxurious digs of places like McLean and Chestnut Lodge.

As a 1949 article in Ebony magazine noted, “if for white patients, the result [of historical treatment] has been institutions that are more jails than hospitals, then for Negroes the situation approaches Nazi concentration-camp standards—especially in the South, where three out of every five colored insane are confined.” At the State Hospital for the Colored Insane in Goldsboro, North Carolina, for instance, a Black man named Junius Wilson was castrated for behaviors that today would not even be diagnosed as serious mental illness (see the book Unspeakable: The Story of Junius Wilson).

So much of America’s asylum fiction focuses on the tribulations of white patients victimized by society and by medicine. The fact is, that while white folks suffering mental illness have often been wronged by stigma and institutional mistreatment, their story is only part of a larger story. Troublingly, their hardship is often creatively embroidered by writers who make problematic use of Black bodies.

Today we face a national crisis stemming from historical injustices and willfully false, racist narratives. It is time to reflect on the racial angle of our asylum plotlines. People of color have not only been treated disastrously by our society and its institutions, but their presence in asylum fiction has been deployed to buttress white victimhood, while eliding their own. Our task as academics (and any who want to investigate the past truthfully) is to shine a sharp light on the past and its stories. The misleading theme of “imperiled whiteness” carries a long pedigree. By reckoning honestly with the ways white people have defined their tribulations vis-à-vis crudely imagined African American foils, we might pave a path to a better future.


Burch and Joyner (2007). Unspeakable: The Story of Junius Wilson. Chapel Hill: The University of North Carolina Press.

Metzl (2009). The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press.

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