Asylums and After: A Revised History of the Mental Health Services, from the Early Eighteenth Century to the 1990s, and: The Mad among Us: A History of America's Care of the Mentally Ill (review)

Kathleen Jones and Gerald Grob have been contributing to the history of psychiatry since the mid-1950s and mid-1960s, respectively. Coincidentally, both have now chosen to synthesize much of their earlier work in order to provide unified interpretations of the history of the care of the mentally ill in England and the United States from the eighteenth century to the present. In doing so, both have also sought to take some account of other recent scholarship in the field—though their gestures in this direction usually prove somewhat half-hearted, perhaps because they are so profoundly out of sympathy with what others have had to say (or what they think others have been saying) about the history of Anglo-American responses to madness.

Jones’s Asylums and After is the more heavily rewritten of the two books. Events from the early eighteenth through the middle of the present century are covered in less than 150 pages, with the second half of the book being devoted to the half century since World War II. Jones has always been primarily an administrative historian, relying heavily on official inquiries and sources to construct her accounts, and dealing with only a very restricted range of issues. Her new book proves no exception to this generalization, many of its pages being devoted to detailed summaries of the reports of commissions and parliamentary committees, and endless recitations of the minutiae of the legislation that resulted. It scarcely constitutes a very appetizing mix, even when leavened by the occasional knockabout critique of figures like Goffman, Szasz, or Foucault.

On this occasion, Jones does recognize far more openly than before that the utopian hopes of the early-nineteenth-century reformers were scarcely borne out once their plans were implemented, noting that “asylums became huge, overcrowded monoliths” and the “Lunacy Commission became bureaucratic and remote” (p. 254). But we are left largely in the dark about why “such a wholesale defeat of good intentions” came to pass: “Somehow,” it would appear, “in the second half of the nineteenth century, the whole enterprise went badly wrong” (ibid). Indeed. But the historically interesting questions are in what ways the empire of asylumdom went wrong, and why—and here Jones has little to offer us, beyond a reiterated complaint about lawyers too concerned about civil liberties, whose interventions repeatedly served “to hamper the progress of the mental health movement” (p. 111).

The lawyers are among the main villains of the piece when Jones turns finally to a consideration of developments over the past half century, and more particularly to a consideration of “community care.” Chapters on “The Ideologies of Destruction,” “The Disappearing Services,” and “Distractions and Placebos” document how the old institutions—places she unblushingly claims had previously “set a standard for the rest of the world” (p. 253)—were deliberately allowed to deteriorate, without any sustained or systematic attempt to make any alternative provision for the gravely mentally ill. In Jones’s eyes, the results have been little short of disastrous, a situation she attributes in large measure to a mixture of the legal profession’s misplaced obsession with the civil rights of detained patients and the callousness and unconcern of a succession of right-wing monetarist governments, determined at all costs to trim public-sector expenditures. There is much to be said for such an interpretation, and, given the dearth of systematic discussions of the experience of community care (or neglect) in Britain, her modest survey of developments over the last four decades will doubtless prove moderately useful.

Gerald Grob is a far more serious and...