Book Review: History of Psychiatry: The Confinement of the Insane: International Perspectives, 1800–1965

History of Psychiatry The Confinement of Insane: International Perspectives, 1800-1965. Roy Porter, David Wright, editors. Cambridge (UK): Cambridge University Press; 2003. 371 p. US$70.00. Reviewer rating: Good This scholarly work exemplifies best traditions of history of medicine research. It gives reader a global perspective on asylum's evolution from 1800s to end of 20th century, incorporating 14 essays that cover its history in various locations throughout world. Included are essays from Europe, US, Canada, Argentina, Mexico, India, and Nigeria. This book analyzes in depth demographic, social, and political factors that shaped evolution of asylum in different societies; it is a data-rich formulation from a psychosocial and political perspective. What is missing for practising psychiatrists, however, is a review of changing psychopathology and diagnostic formulation. While there are numerous case studies, emphasis is on large psychosocial and political engines that shaped asylum's development. Only 1 of 17 contributors has formal psychiatric training: rest are social historians, some of whom (such as David Wright) have a special interest in historical epidemiology of mental illness. The opening chapter on history of South African asylum at Robin Island is illustrative of later chapters. In it, author emphasizes that initial function of this asylum was to house an overflow of black prison inmates. Over time, the proportion of white patients rose as asylum underwent reforms along moral management lines. By early 20th century, original forensic black population was restored as white middle-class inmates were channelled to new asylums. The remaining black inmates, who represented the most dangerous and threatening members of society, were both excluded from society and contained. The Canadian audience will be interested in chapter on Toronto, Hamilton, and London asylums. The inmate population reflects a more democratic selection of patients admitted across adult age spectrum and representing general population. The population also reflects wider sociopolitical issues of employment patterns, kinship networks, immigration, and socioeconomic growth in Victorian Ontario. This readable chapter, by David Wright and his colleagues, explodes myth that women were overrepresented within these institutions. The close proximity and reintegration of patients into their local family environment wherever possible portrays a kinder, more informed aspect of early Canadian asylum. Reference is made to book's on-going theme-the still-pressing need to place those who suffer from mental illness more appropriately in institutions other than jails. In Victorian Ontario, this issue was politicized, and development of asylums was fuelled in part by political orientation of local judiciary. As noted earlier, detailed analysis of psychiatric symptomotology has yet to be undertaken: for all work that has been conducted around world on socio-demographic characteristics of patients, there has been little attention paid to symptom profile of these patients (p 127) Later chapters on records from asylums in Berlin and South Carolina emphasize impact of war and local political climates on patient population and negative impact of a deteriorating socioeconomic climate on smooth running of institutions: deteriorating financial circumstances, overcrowding, and marginalization of basic custodial care. …

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