The history of psychiatry in the United Kingdom and Ireland over the past two centuries is largely a history of institutions: why the mental hospitals emerged and grew so large; how they functioned; why they eventually declined, in the late 20th century; and what, if anything, has replaced them today. The story is a complicated one that mixes social history with medicine and psychiatry and mixes the history of institutions in general with the particular trajectory of the mentally ill and intellectually disabled in the hospitals, prisons and workhouses of the period.

The voices of individual patients are often difficult to trace within this history. There are remarkably few letters, personal stories or recorded testimonies, especially from Ireland’s asylums. There are also other forces at work that shape the historiography in specific and often regrettable ways. These include a tendency to focus on institutions in isolation from the communities that created and sustained them; a desire to diagnose patients from the past with the illnesses of today (an endeavour that can shed some light but requires great care) and a tendency to assume that thinking in the 19th century was somehow less sophisticated or enlightened than today (if anything, the opposite was true).

Against this background, there are still clearly many unresolved issues about the history of psychiatry and its institutions, so new work in this area is greatly to be encouraged. An Archaeology of Lunacy: Managing Madness in Early Nineteenth-Century Asylums by Katherine Fennelly is just such a work and it deserves close reading by anyone who is interested in this history.

An Archaeology of Lunacy is, essentially, an exploration of the first wave of public asylum building in Britain and Ireland, which occurred during the late-Georgian and early Victorian period. Katherine Fennelly, a lecturer in heritage at the University of Lincoln, examines both architecture and material culture in the asylums and proposes that the asylum archetype, usually associated with the Victorians, was in fact developed much earlier. She also explores the planning and construction of the early public asylums and assesses the extent to which popular ideas about reformed management practices for the insane were applied at ground level.

One of the key merits of the book is that Fennelly presents an especially broad cast of characters when telling her story, including keepers, clerks and patients, rather than just doctors and reformers. Inevitably, I would have liked to see more direct material from patients, but such material is very difficult to come by, and Fennelly does a good job exploring and presenting the material that she has.

Fennelly is especially engaging on the subjects of ‘reform, management and moral ideals’, drawing out nicely the precise extent to which apparently enlightened ideas about ‘moral management’ were actually implemented in practice, and noting (wisely) that the term ‘moral management’ is difficult to define. The links between treatment paradigms and building design are well demonstrated, as are the gaps between rhetoric and reality in the design and operation of the institutions. There is also an interesting graph showing expenditure on food in the Richmond and Maryborough asylums during the Famine: expenditure on food rose sharply in both institutions until around 1847 and declined thereafter, although not quite to pre-Famine levels.

Overall, An Archaeology of Lunacy is a useful addition to the historiography of psychiatry and, especially, the historiography of the early public asylums. Valuably, Fennelly concludes her account by pointing out that the asylums were not problematically peripheral or marginal to the very many people who interacted with them on a daily basis. She is correct on this issue and it is a point that needed to be made. There is a retrospective tendency to regard the asylums as having been entirely cut off from communities, as if they were somehow surgically separated from the societies that imagined, created and sustained them.

This is simply wrong. Patients were admitted to and discharged from the asylums continually, staff went to work there daily (and some stayed overnight) and visitors came and went constantly. It is too easy simply to say that all patients who were admitted were forgotten about. Virtually every patient in the asylums had a family who knew they were there, and every doctor who tried to discharge patients variously encountered cooperation from families, ambivalence and (all too commonly) obstruction from communities that were only too ready to label people as ‘other’, regardless of need.

If Fennelly’s lucid, humane book goes any distance towards dispelling some of these simplistic, self-serving fallacies in the troubled history of psychiatry, then it will prove very worthwhile indeed.