Unwin’s title promises something of beauty and something of a solution. Both are arguably much needed when considering learning disabilities. What the reader gets is something quite different, but I feel more valuable and engaging. This work is really a shortish history of nearly everything about learning disabilities.

The strengths of this book are the clarity of the writing and the ability of the author to relate to his individual experiences with his son. For the most part these experiences have led to a measured, pragmatic approach to challenging issues including definition and classification. He is in no particular camp and sees the issues, in part, through his life experience, and the book is better for it.

The ‘meat’ of the book focuses on a historical approach to society and learning disability. This is a detailed, reasoned and appalling story of inhumanity. The detail enables the reader to see how the horrors of the eugenic movement were not solely the domain of the right wing but were, in fact, supported in many cases by powerful individuals with a noticeably socialist and apparently otherwise enlightened worldview.

Reading these historical sections should be mandatory for any psychiatrist in learning disability and, in fact, any psychiatrist in training.

The review of scandals related to institutional and post-institutional care is no less powerful, with the author highlighting sufficient examples to show how institutions can bring out the worst in, and allow for the worst of, individuals’ behaviour when there is insufficient protection of the vulnerable.

As the author progresses further, commentaries on diverse, but important, topics such as normalisation, ordinary lives and advocacy are covered – supported by referenced evidence but with a view that comes from being a parent. Again, this is essential reading. I think it would be hard to find such a range of topics so easily accessible in other formats.

As we hear about labels and diagnosis we are told to look past the condition and see the individual. I felt that the value of modern genetic diagnosis is understated. No one can deny that we always see the individual first, but a trained professional can do both – that is, not to be so focused on the diagnosis as to miss the person. Healthcare is not a strength of the book, and certainly not at a level for a psychiatric trainee. However, the author recognises the challenges, such as resuscitation decisions and the risk of sudden unexpected death in epilepsy for those with epilepsy.

Psychiatrists do not come out of this well. It is at heart a personal view, and the author’s view is that sectioning in people is open to ‘grotesque abuse’, is not evidence-based and minimises the failures of community and societal support that so often lead to breakdowns in care. The importance of the existence of severe mental illness in people with an intellectual disability is insufficiently stressed.

The final chapters do not reach a specific resolution or solution in regard to how we could be better. They are, however, thoughtful and reasoned on the limitations of inclusion, especially in the arts and in regard to the role of families.

This is an informative book; it is challenging at times and may even annoy the occasional psychiatrist. It is an essential read which, after over 30 years in learning disability services, I found confirmed the simple fact that you should listen to the families as part of your balanced judgement.

I saw the beauty in the reflections of a father and how these inform broader issues. The powerful message was more about the way such beauty has been repressed historically. Sadly, it still will be to this day if the patient is without engaged, sensitive knowledgeable clinicians who listen to this point.