In London and its Asylums, 1888–1914: Politics and Madness, Robert Ellis provides a perceptive account of the history of the management and control of asylums and mental health care over a 26-year period. By closely scrutinizing London's local political issues and the financing of asylums, he gives a nuanced account of local government and welfare activism in the capital in the latter years of the nineteenth and early twentieth century. Ellis categorically states that his study of asylum history is not about the patients’ view or their political outlooks, but about the management of asylums. As he states, the patients’ views of the politics surrounding the treatment and administration of madness would be yet another way of approaching the topic. Ellis examines how local politics split on party political lines. On the London County Council the emergence of party political groupings was clearly defined into two factions, namely, the Progressives or Liberals and the Moderates and Municipal Reformers, or Conservatives. Ellis suggests that the splitting of local politics along party political lines, while not unique to London, could be said to be more defined in the capital than it was in other municipalities in England.

Ellis makes some very interesting observations about the role of women, their fields of influence, and their developing involvement in the political arena. For many women, local councils was a route into political life before general female suffrage. The London County Council was established at a time when women's suffrage and involvement in democratically elected bodies was a growing issue in all political movements. Although women had been able to serve on school boards since the Education Act in 1870, their path to becoming local councillors was blocked until 1907. When women were eventually able to take seats on the London County Council, they made an impression on the Asylum and Education committees in particular. Ellis notes that their influence on local government affairs tended to be limited to philanthropic activity. The London County Council was a male-dominated body, so despite the fact that there were 100,000 women out of a total of 600,000 voters in London, the focus on the male voter obscured the large number of enfranchised women in London County Council elections. Ellis suggests that it is challenging to tease out the “hidden histories of women in relation to the management of madness” (25), and he leaves clear signals to the potential for further study in this area.

Ellis clearly demonstrates that the local management of asylums by the London County Council was an issue that became something of a political football. The importance of patient opinion and experience of asylumdom was of less importance than personal party political affiliation. Ellis makes the important observation that both parties, the Progressives and the Moderates, made political capital out of the financial management of asylums. The wrangling about the economics of asylum management and its prioritization in London County Council budgets was indicative of the larger battles surrounding public spending. The provision of accommodation for the insane, the asylums’ overcrowding, and the desire that the system needed to be economically efficient had an impact on patient welfare. The actual needs of the asylums’ stakeholders from the patients and the staff, through the Poor Law Guardians to the Commissioners in Lunacy were, in effect, ignored.

Ellis chronicles the proposals for the management of madness away from large-scale institutions and bodies to more local smaller units. He highlights the impact of politics, from keeping the status quo to innovative change. When discussing the changes that were proposed for the London asylum provision, Ellis highlights and comments very knowledgeably on the various suggested innovations concerning redevelopment of the asylum accomodation and system. The London County Council, as a body, was building its reputation as a modern, forward-thinking institution, and Ellis comments on this in the light of international cooperation and reputation. In comparing London's system of asylum management with that of other cities internationally, Ellis notes, there was an element of self-aggrandisement. Ellis suggests that affirmation that the London County Council asylum management system was a model to be copied was an exercise in building civic reputation and pride. He notes that the London County Council was committed to working toward “a better and less expensive way of dealing with pauper lunatics” (203). In this respect, Ellis suggests that the kudos for setting an enviable economic standard of institution administration clouded decisions about the best system of care for the patients. Members of the medical profession suggested and proposed that a separate and modified system was better for the needs of acute cases, but the politicians were convinced that the existing mixed system was the more economical way forward. It would appear that patient care was secondary to economics.

The book's final chapter, “The Politics of Difference,” is very illuminating on the subject of Victorian and Edwardian views of “the Other.” The societal mindsets discussed in the chapter make uncomfortable reading for the modern-day reader. Anti-Semetic rhetoric and xenophobic attitudes affected the willingness—or not—to treat people in the asylum system who were deemed “foreigners” or “aliens.” Ellis conveys the human story behind the seemingly shameful repatriation and deportation of foreign “lunatics” in the case of Mario B., forcibly deported to a country he had left as a child. His discussion of the ignominy of such policies is presented in a thoughtful and empathetic manner.

Ellis's book highlights the internal political struggles that underpinned the complex functional discussions involved in constructing and managing the asylums. By assessing the impact of political wrangling and ambition, rather than medical developments, on the management and treatment of mental ill-health and madness in London, Ellis gives us an alternative approach to asylum history. The book is a valuable addition to the historiography of the English asylum system and management of mental illness. The different research approach of melding the evolution of asylumdom with development of local government in Victorian and Edwardian London, results in a thought-provoking work, one that should lead to other research on the topics raised.