It has been consistently observed that black Americans receive psychotic disorder diagnoses at higher rates than white Americans. While this finding has proven robust across time and setting, with other demographic variables accounted for, reasons for the disparity remain obscure. This paper aims to provide a psychoanalytic and historical framework for thinking about this correlation. Rather than categorizing black liberation as insane (a well-worn trend within American psychiatry) or dismissing the elevated rates of insanity as mere racist fabrication, here, I propose to listen to what speaks through insanity for what it may reveal about the historical and present realities of being black in America. To do so, I will first outline Francoise Davoine and Jean-Max Gaudilliere’s framework for thinking about psychosis alongside historical trauma and then turn to clinical experiences at a city hospital in the Bronx.