This interesting book examines the responsibilisation of citizens, defined as a process whereby the state encourages and compels ‘individuals to acknowledge and assume a degree of responsibility for managing their own risks’, involving a great degree of ‘self-management’ (p. 19). The book is strongly influenced by Foucault and spiced heavily with Foucauldian terminology. It identifies the unfolding of a new dispositif, i.e., a new rationality, in different arenas of life (e.g., healthcare, psychotherapy, social work) and at different societal levels.

At the individual level, new identities are emerging. Self-centered individualism and rational consumers are formed. This ties in with neo-liberalism, i.e., welfare state retrenchment and a shift taking place from public to private responsibility. Clients and patients become increasingly responsible for themselves. As such, citizenship (the state-citizen relationship) is changing, and new expectations towards citizens are developing. Citizens are expected to engage in the construction of their own health and as flexible recruits for the labour market. This includes not overeating or drinking excessively. Citizens are thus expected to follow the advice of (medical) experts and government agencies, i.e., citizens are expected to rely on expert guidance, backed up by new forms of steering such as ‘nudging’. But not all citizens are capable of self-monitoring (p. 175), i.e., can follow the advice and guidance of experts, and these individuals are not met by a caring, responsible and inclusive welfare state. Rather, they are met with medicalisation and criminal sanctions (incarceration), i.e., new forms of punitiveness, encouraging and enforcing responsibility.

This analytical framework is unfolded over nine chapters. The two first chapters introduce the general theoretical framework and central concepts are defined; Chapters 3 and 4 discuss responsibilisation in healthcare and healthcare services; Chapters 5 and 6 move on to mental healthcare and psychotherapy; and Chapter 7 discusses how criminal sanctions are introduced to enforce responsibility. The two final chapters discuss how responsibilisation impacts the conception of the self (Chapter 8) and citizenship (Chapter 9).

Brian. J. Brown and Sally Baker clearly emphasise that one should not ‘see an authoritarian conspiracy at work every time a doctor advises a patient to give up smoking’ (p. 6). The interpretation of Foucault used in this book, however, occasionally leaves the reader with the impression of a conspiracy in play. For instance, it is argued that screening programmes and advice against unhealthy diets, alcohol and salt intake are a symptom of a trend towards neo-liberal self-responsibility. It is an undisputed fact, however, that excessive salt intake contributes to high blood pressure. So what would a non-neo-liberal alternative to providing well-informed advice look like? Should knowledge about the unhealthiness of salt consumption not be disseminated to citizens? Should the responsible and caring state confiscate all readily available salt? The point is that information campaigns (about salt intake) may help citizens make informed choices. But such information campaigns are not necessarily or by definition embedded in a responsibilisation of citizens, i.e., that citizens become responsible for their own health and self-care, welfare state retrenchment and neo-liberalism. The book does not really demonstrate the hypothesised links between information campaigns and neo-liberalism. Prostate screening programmes and information campaigns are therefore fully compatible with a responsible welfare state.

This problematic is also associated with a displacement of central concepts throughout the book. Individualism becomes more or less synonymous with individualisation and individuality, just as neo-liberalism (as retrenchment) is linked with ‘late’ or ‘reflexive modernity’. It should be noted, however, that individuality – contrary to individualism – is preconditioned by a rather extensive welfare state providing citizens with opportunities and ‘second chances’ (Giddens, Reference Giddens1994). Thus, the theoretical link drawn by Brown and Baker between individualism, self-responsibility and neo-liberalism (as retrenchment) is clear-cut. The question becomes, however, whether concepts, such as individuality, actually fit into the Brown and Baker theoretical model.

Brown and Baker primarily see an increase in the so-called mental disorder as an outcome of the iron cage of responsibilisation of citizens. In some passages, however, the reader is led to think about the medicalisation of social problems as a form of ‘contre-pouvoir’; that is, if individuals are fortunate enough to receive a diagnosis, they are allowed to escape responsibilisation. It would have been more beneficial if such contradictions had been more explicitly discussed.

The book focusses on individualism, self-responsibility and neo-liberalism (as retrenchment). Still, it is a little strange that there is no mention of class or ethnicity in the book. It is argued, for instance, that the growth in prison population is associated with the dismantling of the welfare state. More specifically, it is said that the US prisoner population has increased more than six times since the early 1970s. Prisoners in the US (as elsewhere) are recruited from the lower classes and African-American communities. This calls for reflections about the extent to which the new dispositif is a new type of class war and represents new forms of racisms, but such reflections are unfortunately absent.

Brown and Baker tend to make extensive generalisations about the healthcare (and related) sector(s) from relatively few (primarily lifestyle) cases (e.g., eating, drinking). It is unclear, for instance, whether citizens also have become self-responsible in relation to a broken leg, appendicitis, etc. That said, however, it is an interesting book and certainly thought-provoking. The strength of the book is that it tries to reveal how a new and similar rationality is emerging in individuals and different spheres of society simultaneously.