This book announces itself at the outset as an attempt to challenge Foucauldian interpretations of the history of British psychiatry. It moves beyond the confines of the asylum to consider the idea of mental hygiene: the prevention of psychopathology by intervening in the community rather than segregating the mentally ill in institutions. Although organizations explicitly dedicated to this goal only took shape in the aftermath of the First World War, Toms locates their origins much earlier, in the “moral treatment” famously pioneered by Samuel Tuke at the York Retreat in the late eighteenth century. Where Foucault saw Tuke as a symbol of the confrontation between abstract conceptions of Reason and Madness, Toms insists on the treatment's embodiment in relationships of personal authority. In particular, he argues, the dynamics of the bourgeois family that served as the model for Tuke did not merely internalize representations of rationality and irrationality; they also shaped a paternalistic ethos which held that individual self-mastery and collective self-government could only emerge through the benevolent tutelage of authority figures. Tracing this theme from late Victorian philanthropy through the interwar mental-hygiene movement and finally to the antipsychiatry activism of the late twentieth century, Toms outlines a narrative marked by contradictions and unintended consequences. While individuals deemed incapable of achieving psychological independence were labeled as “mentally deficient” or “subnormal” and isolated in grim institutions, the treatment of dysfunctional but salvageable cases aimed at cultivating emotional freedom in ways that gradually undermined rigid hierarchies. New therapeutic communities encouraged patients to question authority in their quest for autonomy; mental health experts increasingly blamed pathological cases on dysfunctional families and other social institutions rather than innate deficiency. In an ironic twist, Toms argues that the widespread rejection of long-term confinement by the 1970s emerged from a decades-long tradition of psychiatric social work, which developed ever more radical methods for nurturing patients' independence.

The time is undoubtedly ripe for a historiographical turn away from Foucault in scholarship on the human sciences. As Toms points out, the power/knowledge paradigm tends to obscure the study of power relations in a more conventional sense: how some individuals, social groups, and the state came to exercise control over others. One of the book's most original contributions is accordingly its reading of psychiatric practice in the context of political theory. Bernard and Helen Bosanquet—not only social workers but also early advocates for the segregation of the “feeble-minded”—figure here as formative influences on the late Victorian concept of mental hygiene, consigning to the asylum individuals who did not fit into their functionalist, organic vision of society. By contrast, Toms argues, the experimental therapies pioneered between the wars shared affinities with R. H. Tawney's vision of egalitarian fellowship. Like Mathew Thomson's Psychological Subjects: Identity, Culture, and Health in Modern Britain (2006) and Eli Zaretsky's Secrets of the Soul: A Social and Cultural History of Psychoanalysis (2005), Toms delivers a nuanced portrait of psychological expertise by stressing its liberatory as well as its authoritarian possibilities. Some interpretations are, of course, debatable; while Toms suggests that unease with psychiatric confinement began to surface in the interwar years, Deborah Cohen's superb recent Family Secrets: Shame and Privacy in Modern Britain (2013) identifies that period as a high point for putting “deficient” children out of sight. But this disagreement (perhaps merely a difference of emphasis) is in part a function of the new material Toms has uncovered in seldom-used archives. By focusing on the interstitial space between psychiatry and social work—largely neglected in the British case, though well studied by Hans Pols in the American context—Toms opens up a valuable perspective on the relationship between institutional care and expert action in the community.

Without lessening the force of his critique, the author might have acknowledged some of the ways in which his analysis remains indebted to Foucauldian theory. Interventions in the family, for instance, are described in biopolitical terms, “linking the domestic sphere with population and economy” (25). The book's style, moreover, may test the patience of some readers. Toms describes the idiosyncrasies of the text as a “challenge [to] the habitual disavowal, in contemporary Foucauldian academic work, of any tone that can be labeled sentimental or frivolous” (ix). Unfortunately, the results are often distracting. Biographical fragments about psychiatric social worker W. David Wills interrupt the flow of the argument, while some asides are simply bizarre: “Diabolic dialectic of reason, on it marches, like a demented Prussian general” (27). Worse, the most cogent summary of the book's argument is buried deep in a late chapter. But even these infelicities cannot overshadow the originality of the work as a whole. While skeptics might fault the Whiggishness of a narrative that ends by celebrating the civil rights approach of patient advocacy groups such as MIND, Toms persuasively counters that the tangible achievements of deinstitutionalization must be understood through a process of historical change rather than a timeless model of insidious control. The tradition of self-criticism that Toms locates at the heart of British psychiatry provides a useful counterpoint to conventional Foucauldian histories.