In Out of His Mind: Masculinity and Mental Illness in Victorian Britain, Amy Milne-Smith recovers the figure of the madman within histories of nineteenth-century insanity. She argues that madness posed a challenge to dominant codes of masculinity well before World War I introduced the phenomenon of shellshock. Milne-Smith's study of male insanity in Victorian Britain highlights how a lunacy certification was felt as a powerfully emasculating experience, with both social and emotional consequences for men and their families.

Milne-Smith's book covers the period 1845–1914, a period bookended by the 1845 Lunacy Act and World War I. The 1845 Act established the Lunacy Commission, the reports of which, alongside asylum case notes, form the basis of the book's first chapter on care in the institution. By including male patients in criminal and military asylums, Milne-Smith corrects the notion that the asylum population was overwhelmingly women. She also emphasizes the diversity of treatment for mental illness in Victorian Britain, in line with recent historiography. Of particular interest is Milne-Smith's recovery of the practice of boarding pauper lunatics in the community, as a matter of course in Scotland and when asylum spaces were scarce in England and Wales.

Central to Out of His Mind is madness's incompatibility with dominant norms of Victorian masculinity. Certification and confinement in an asylum radically upset masculine privilege, stripping men of their autonomy and status as head of their household. Moreover, madness indicated a man's failure to live up the Victorian model of respectable masculinity. Insanity was marked by a loss of self-control, emasculating men as either weak-willed or violent beasts.

Male madness, Milne-Smith convincingly shows, was most often connected to violence. This association was particularly strong for working-class men, who were the subjects of frequent media panics around violent and criminal lunatics. In chapter five, Milne-Smith examines local and national newspaper reporting, showing that madmen were overwhelmingly depicted as violent beasts. Such stories were often presented in domestic settings, Milne-Smith argues, tapping into cultural anxieties about working-class masculinity's relationship to the domestic. Sensationalism was fueled by an increasingly competitive newspaper landscape, enlivening a discourse that stigmatized men's madness, creating fear and stoking debate over violent lunatics’ criminal responsibility. As Milne-Smith argues in chapter one, male asylum patients were at greater risk of violence and neglect from attendants who justified rough treatment through the belief that male lunatics were inherently violent.

A strength of Out of His Mind lies in Milne-Smith's empathetic reconstruction of the emotional consequences for men who received a lunacy certification. Madness, she argues in chapter three, was a shaming experience. Madness in men was often linked to intemperance or sexual excess, and the shame experienced by men who felt they could not control their impulses created additional emotional distress and psychic strain.

On the other hand, as Milne-Smith shows in chapter two, men's position of social superiority, particularly when supplemented with socio-economic status, enabled them to exert greater control over their treatment than women. Wealthy men in particular could deny the severity of their illness and escape certification through foreign travel, a practice which was believed to relieve nervous exhaustion. Even if men managed to convince their family to avoid the asylum, they could still face abuse and neglect at the hands of relatives. However, Milne-Smith argues from an assessment of sensational cases reported in newspapers, forced confinement at home was more likely to occur when there was another male relative to challenge the patients’ authority: wives found it almost impossible to defy their husband's will alone.

Out of His Mind is filled with diverse examples of men's experience of madness, drawn from the popular press, case notes, legal battles, lunacy commission reports, and fiction. One commonality is that madness pitted men against their extended families and communities. Men were “expected to demand their independence as a healthy expression of manliness, no matter their level of illness” (31). Men's failure to contest their diagnosis, whether privately or much more rarely, publicly through the courts, was seen as a symptom of mental disorder in itself.

Out of His Mind evidences a cultural fascination with madmen that tapped into anxieties about men who deviated from respectable models of Victorian masculinity. This book convincingly shows that madness operated as normative masculinity's foil. Milne-Smith goes beyond a purely cultural history, however, arguing that studying men's madness “allows for an exploration of the cultural expectations of male behaviour, and how men responded to those norms in their lived experience” (4). Yet asylum case notes, court reporting, and the popular press all heavily mediated the experience of mental distress. The patient's perspective was filtered through, and often obscured by, the medical, legal, and journalistic lens. Although it is unrealistic to expect completely unmediated access to experience, especially when writing histories of a marginalized population, more reflection on the difficulties these sources pose to histories of the experience of masculinity and madness would have been welcome.

A significant strength of the book is its retrieval of the diversity of mental health care even in the so-called age of the asylum, although this insight will not surprise readers of recent literature on nineteenth-century psychiatry. Moreover, consideration of the way that madness and masculinity interacted corrects an important oversight in older literature that has tended to see mental health diagnoses as a means of policing feminine gender norms exclusively. As Milne-Smith shows, madness interacted with masculinity in potentially just as devastating ways.