During the early decades of the twentieth century, William Alanson White and the medical staff at St Elizabeths Hospital in Washington, DC, developed an ambitious programme for US psychiatry wherein the profession would dedicate itself to the reconstitution of mentally-fit and socially-productive American citizens. The racist assumptions beneath this programme led most physicians at the institution to expect little more than deference, dependence and common labour from their black patients, preventing them from comprehending the impact of substandard and racially-segregated care. Black men and women were acutely aware of the injustices they faced. When they rejected elements of the hospital's medical regimen, these patients were also rejecting a social vision that consigned them to the margins of US civic life.
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