This edited collection is the first volume to focus on patient work in psychiatric institutions. Given the central place of patient labour and occupation in the history of mental disorder, the absence of any sustained examination of the subject has been a significant omission, answered until now by only a handful of studies. This fine collection of essays is thus both welcome and significant. As its title suggests, the collection aims to broaden the context for the discussion of patient work beyond the narrow focus on ‘medical ideas and regimes’ (5) in which it has often been situated and to consider how its meanings and practices were influenced by broader social, political and economic contexts. Read in sequence, the chapters provide a history of patient work across more than two centuries, from its first inclusion ‘as an integral element of therapy’ in treatises on moral treatment (45) at the turn of the nineteenth century to present day ‘therapeutic work and rehabilitation’ (28).

Many of the chapters discuss the work of patients within institutions and the many rationales advanced for it. At different times and places, sometimes at the same time and in the same place, work was seen variously as curative, a distraction from morbid introspection, a way to reduce institutional costs, a means to induce order, an aid to social reintegration, a path to rehabilitation. The reader cannot help but be struck by the scale and ingenuity of some of these institutional work schemes. To take but a single example, in his chapter on patient work in British West Indian asylums, Leonard Smith notes that at its peak, the annual catch of the sea fishery established at the Jamaica Lunatic Asylum ‘exceeded 75 000 lb (33 750 kg)’, achieved using ‘a large net made in the asylum’ (147).

The ‘large-scale occupation of psychiatric patients’ at Zwiefalten Asylum in Württemberg in south-west Germany prompts Thomas Müller to ask ‘whether there was a conflict between the actual therapeutic benefits of work for the individual patient and the economic benefit reaped by the asylum through patient labour’ (222). The ‘tension between exploitation and therapy’ (99) is a theme in many of the chapters. Kathryn McKay, for example, analyses the narrative strategies that asylum superintendents in British Columbia deployed in their annual reports to counter potential accusations of exploitation. In his chapter on institutional work and occupational therapy in modern Japan, Akira Hashimoto recounts the development of a new form of occupational therapy, ‘life therapy’, in the 1950s and 1960s and the subsequent criticism of it as ‘exploitation of labour’ (172) in the 1970s.

Consistent with the recent interest in comparative and transnational approaches in the history of mental disorder, the collection is not confined by national borders and includes contributions on patient labour in North America, Britain, Europe, the West Indies, India and Japan, allowing the reader to make comparisons. Moreover, many of the chapters show how ideas about patient work moved across national boundaries. In her chapter on patient work in colonial hospitals in South Asia, Waltraud Ernst argues that in British India, ‘ideas and practices of patient work in therapeutic and institutional contexts were closely informed by varied European and North American psychiatric paradigms’ (117). However, here, and elsewhere, as other chapters also show, such ideas and practices were modified to better accord with local social, political and economic contexts. In contrast to Britain, where social class dictated expectations about which patients should work, in nineteenth-century British India, asylum superintendents considered labour inadvisable for all European patients, regardless of their class, an argument which reflected ideas about racial difference and reflected the assumptions of colonial rule.

The collection also ventures beyond institutional confines to good effect. James Moran, for example, explores how witnesses in nineteenth-century New Jersey lunacy trials understood ‘the relationship between work and madness’ (78). The ability to work effectively was understood as a sign of mental health; a converse inability to manage one’s labour productively might mark a loss or absence of reason. Osamu Nakamura examines patient work and family care at Iwakura, Japan, where patients lived in ‘home-style’ inns with families.

The voices of medical men dominate the discussion, as in much of the history of mental disorder. However, several chapters offer insights into the meaning of work for the patients who did, or sometimes refused to, work. Monika Ankele’s chapter, for example, examines the reaction of patients to the work therapy practiced in the Hamburg-Langenhorn Asylum in the Weimar period. She argues convincingly that their awareness of ‘wider social conditions’ shaped their perception of work inside the institution and their willingness to submit to work therapy (253). Some patients took advantage of work therapy to learn or maintain skills. Others refused to work, believing the activities offered would not assist them to find employment after discharge.

In her introduction to the collection, Ernst argues that ‘work, psychiatry and society are intrinsically bound up, and patients’ experiences of work and activity in mental institutions have consequently been varied over time’ (10). The essays in this collection affirm the complex intersections between patient work and the social, political and economic, as well as medical, contexts in which it occurred, demonstrating the many and diverse forms it has taken over the last two or more centuries. Work, Psychiatry and Society is thus essential reading for anyone interested in the subject of patient work both inside and outside the walls of psychiatric institutions.