Stef Eastoe's Imbecility and Insanity in Victorian Society is the first history of the Caterham asylum from its origins in 1867 to the early twentieth century. It adds to a scholarship that is rich in case studies of individual asylums, but less so in institutions specifically devoted to “idiots” and “imbeciles.” Eastoe's text is a modern institutional history, clearly situating Caterham within the broader context of municipal politics and family life. Scholarship in this area really began in the 1990s, and specialists in the history of “idiocy,” “feeblemindedness,” and “imbecility” will find this a welcome addition. Even for nonspecialists, however, this case study would be a good introduction to recent scholarship on “idiocy,” or “lunacy” more generally, in both its approach and its general tone.

The first chapter serves as introduction to the historical context of the book and the relevant historiography. Without assuming too much knowledge on the part of the reader, Eastoe gives a clear and concise overview of the relevant historiography. The discussion of sources is thorough, though the methodology is somewhat vague. It is not clear exactly how many records were used, what is extant, and how detailed the case books proved to be. This is partly a problem of the text having no bibliography—one assumes a decision on the part of the press and not the author. However, a clearer outline of the specific methodology, in particular how cases were chosen to follow up in the subsequent record linkage chapter, would have been instructive.

The second chapter outlines the founding of Caterham and explores many of the institutional history features one might expect, including architectural design, daily routines, and sanitary practices. Eastoe is also careful to contextualize the creation of the asylum into its bureaucratic and medical contexts; opinions of the Metropolitan Asylum board, the Commissioners in Lunacy, and leading medical journals are all introduced to show the range of lay and medical opinions.

The next two chapters cover patient life at the asylum, from demographic details to patient work and leisure to the death and discharge rates. These chapters are the most traditional in the sense of representing the detailed reconstruction of life in a particular institution. In this monograph they represent thorough research but form the foundation of a work that attempts to use this core research as a foundation to place Caterham within broader conversations and to focus in on individual patients to give some sense of agency.

Following recent trends in historiography, Eastoe uses patient photographs in the chapter “Visualising Idiocy.” Instead of seeing these images as strictly medical sources to make mental disability visible to viewers, Eastoe attempts to use photographs to further unpack the asylum experience. Looking at clothing, hairstyles, backdrop and perhaps most challengingly, facial expression, Eastoe tries to convey sense of patient experience. The fact that these images rarely feature any accompanying texts makes them all the more elusive and intriguing. While acknowledging the challenges of using photographs as a source, Eastoe frames her study within recent scholarship that traces the potential of these photographs. Without drifting into speculation, Eastoe highlights details of asylum life and its residents that cannot be found in annual reports and casebooks.

The final chapter of the text uses record linkage to trace patients before and after their stay in the institution, exploring the broader geography of idiocy. Casebooks from Caterham along with census records and the Booth poverty maps help track lives before and after the asylum. Regrettably, Eastoe does not trace patients into workhouses, other asylums, or as boarders in private homes. This might have been beyond the scope of this project, but a study on the mixed economy of welfare would be welcome in future works. Eastoe also stresses that the desire to segregate idiot and imbecile patients from the surrounding population was only one factor motivating placement at an institution; Caterham was created as much to protect its residents from society as the other way around. Eastoe stresses that eugenic and degenerationalist ideology did not motivate the creation of Caterham nor was it a dominating factor in its management or daily practice. It is difficult to imagine, however, that the intense public debates and social panics about feeblemindedness failed to infiltrate the asylum at some level. However, the institutional sources could very well have been silent on these issues, and the particular management personnel not self-reflexive on the topic. This does not mean, however, that the cultural import might not have been there.

This work has shifted so far away from the Foucauldian model of the repressive, totalizing institution that one could almost imagine Caterham to be the idyllic site of rest and care its founders believed it to be. Idiocy, Imbecility and Insanity in Victorian Society starts with a stated goal to challenge works that emphasize narratives of repression and violence in the asylum. This is grounded in a both a desire to find the complexity of the patient experience and in the fact that the records do not record much explicit abuse at Caterham. While acknowledging unspoken abuses and neglect likely existed, Eastoe states that to focus only on those areas of history is to reinforce the stigma of the idiot in history and asylum care more generally. Readers will have to decide if this balance is fairly struck.