One has learned not to speculate about the shelf life of paradigms that shape historical studies of insanity. The current generation of historians, social scientists, and literary critics can easily recall the initial dominance of a medical triumphalism that celebrated the courageous efforts of early insanity reformers. These chest-thumping encomia were followed in due course by a no less triumphant demonization of medical authority, founded on the searing insight gained by exposing the nexus of (psychiatric) knowledge and power. In less than a generation, this enthusiasm for medical debunking was itself displaced by a sober reappraisal of the influence of the state and professional bodies in the confinement of the mad. In large part, current inquiry into the definition and labeling of madness has shifted so fundamentally due to the discovery of rich archival materials: court cases, patients’ narratives, asylum registers, and an array of legislative and administrative documents. Neither congratulating nor abominating medical influence, today's historian is likely to inquire into the nature of confinement itself. Do public mental institutions have an essential organizational history, one that follows its own bureaucratic trajectory regardless of the culture in which it is embedded, or are asylums the creation of a specific historical and national imagination, inextricably linked to temporal and culturally specific notions of dangerousness, care, and cure?

In The Confinement of the Insane David Wright and the late Roy Porter have assembled an estimable collection of essays that mine a remarkable range of hitherto untapped sources. No fewer than fourteen countries are surveyed, ranging from India to Argentina, Mexico to Nigeria, and Australia to South Africa. More familiar ground is also covered in studies from France, England, and America. This globalization of asylum studies affords a glimpse into a common effort to separate the mad from the population of the socially dangerous—the alcoholic and the criminal—and from medical patients as well: the epileptic, the leper, and the chronically ill. A depressingly similar story is told and retold. Regardless of the (often unbounded) therapeutic optimism that initiated the public asylum, the institution becomes a dumping ground for the chronic and the incurable, as well as the merely disruptive transferred from local jails and prisons. And the culprits for this policy of resignation were also lamentably similar: lack of funding, overcrowding, and physical plant deterioration, all of which produced the familiar snake pits of literary and cinematic lore.

The reader's attempt to draw out additional common themes is frustrated, however, by the incredibly expansive time period surveyed and the singular nature of various cataclysmic political events—the collapse of the Weimar Republic, the coming of Juan Peron, and the American Civil War and Reconstruction—that frame the cultural response to the insane. The irony here is that all too often the history of insanity has been examined in splendid isolation of particular historical events and nation-specific organizations—the “Society of Beneficence” in Argentina, for example—giving the misleading impression that provision for the mad was somehow insulated from cultural upheaval. The reader will find in this volume quite the reverse: essays that effectively situate the definition and treatment of the insane within the complex of specific colonial and historical settings, affording public asylums their distinctive mortar and mission.

Although the very breadth of the studies militates against inferring a common experience, important patterns do emerge that add immeasurably to an appreciation of the influential players in confinement. Lunacy commissioners and mad doctors—usually the focus of attempts to explain the direction of public policy—recede from the front to backstage, replaced by an array of social actors who constituted a “mixed economy” of confinement. Home custody, privately run “brain hospitals,” and privately licensed madhouses were among the preferred placements for the deranged and the distracted, even where public asylums existed. In yet further evidence that public policy affecting the insane was shaped “from below,” Akihito Suzuki persuasively demonstrates that legislation appearing to sanction extra-asylum placement in Japan was actually codifying long-standing cultural practice that parceled out the population of the mad into a variety of dispositions. Elaine Murphy's study of British social welfare provision further underscores the role of one of those cultural forces, the family, in a penetrating analysis of lunacy in East London. Medical personnel are clearly in evidence in decisions regarding the choice of placement, but she writes that the ultimate commitment was “the outcome of contractual and bargaining negotiations between family, poor-law officials and doctors, between the ‘community’ and ‘authority’ [rather] than an imposed medical solution” (336).

It is the family, in fact, that surfaces again and again. In Paris, placement volontaire permitted relatives to commit one of their own without police intervention. As Patricia Prestwick notes, however, psychiatrists could not invoke this practice as a vote of confidence in either their profession or the institution. Suspicious of medical supervision, family members might reclaim the patient without the doctor's consent, an action that underscored the symmetrical power relations between family and asylum. So far from sharing in the medical optimism of the asylum's capacity to effect a cure, official confinement was viewed as a last resort, chosen by families desperate to end what was referred to as a domestic “reign of terror” (91). Active involvement in sequestration did not end with formal confinement either. In India, families were encouraged to live with patients by erecting tents on the grounds of the Amritsar Mental Hospital

By the time of this contractual negotiation, however, another social actor has already played a pivotal role in the demographic makeup of the institution. Today's criminologist has grown increasingly aware of the police officer's reading of the suspect's behavioral cues and demeanor in the decision to arrest, an awareness that renders problematic the use of a captive prison or reformatory population for purposes of delineating the characteristics of criminal offenders. With the present collection of essays, historians and social scientists will be able to extend this insight to the shaping of the asylum population. Responsible for a great number of referrals to the asylum in a broad array of countries, the police were the actual “adjudicators of the boundary between sanity and insanity” (6). In time of political turmoil, the lunatic was often caught up in police sweeps in an effort to pacify urban unrest. In peacetime, “lunacy” could appear on a record as the recorded offense. The fact that gender, age, class, race, and occupation “mattered” in some countries but not in others suggests that the cultural definition of insane behavior was free to vary in time, place, and police practice. “Dangerousness,” a term that was often used to justify confinement, had remarkably protean characteristics: it could adhere to the violent offender in some countries, to women moving beyond traditional social roles in others, or to unmarried, unemployed men migrating from rural poverty to urban temptation. Each of these groups provoked fear on the part of the citizen, and action on the part of the police.

In the end, the asylum resembled its sister institutions—the penitentiary and the reformatory—in falling victim to an ambiguous mission and ambivalent attitudes regarding sufficient funding. To South Africans, the public asylum promised a cure for poverty and safety against violence. To the Swiss, it was a place for better management of services and a way to ensure public order. For Mexicans, the mental institution could serve as a locus of control and a place of refuge in early modern society. Although most public asylums descended into a custodial dumping ground, the individual histories differ appreciably, and it is a mark of the success of the editors of this fine volume to have illuminated the emergence and downward trajectory of the public asylum in response to extremely varied political and social forces. If the reader does not walk away from the volume with a new paradigm for unraveling the history of confinement, it is most likely because the place of the insane in the evolution—and in some cases, revolution—of individual societies was defined by a legal and administrative culture particular to that society and to that moment.

If there is a common lesson to grasp, it is cautionary one: whatever neglect the deranged had endured at the hands of their family and parish house, no improvement seems to have attended the state's intervening in their care. Indeed, it takes no shrill critic of medical authority to conclude, as Michael Ignatieff once pointed out in discussing the origins of the penitentiary, the grim consequences that can accrue when suffering caused by intent is substituted for that which is caused by neglect.