This chapter examines the psychological after effects of racialized sexual violence. Although few formal nineteenth-century records of mental illness, mental instability, or depression exist, written and oral slave narratives recount how “the entire life of the slave was hedged about with rules and regulations.” Samuel Cartwright, a well-known physician in the antebellum South, had a psychiatric explanation for runaway slaves, diagnosing them in 1851 as suffering from “drapetomania.” Classified as “a disease of the mind,” Cartwright defined drapetomania as a treatable and preventable condition that caused “negroes to run away.” Cartwright's published work established the foundation for “racism's historic impact” on black mental health. Indeed, Cartwright's pseudo-science, a potent mix of religion, pro-slavery politics, and medicine, forged a powerful connection between mental illness and race continued by subsequent generations of physicians and psychologists.