Roy Porter and David Wright (eds), The confinement of the insane: international perspectives, 1800–1965 , Cambridge University Press, 2003, pp. xvii, 371, £50.00, US$70.00 (hardback 0-521-80206-7).

Roy Porter's untimely death seems as yet scarcely to have slowed the parade of volumes appearing with his name on them. Here is still another, co-edited with David Wright. Wright and Peter Bartlett's last edited collection, Outside the walls of the asylum (1999), argued (not entirely convincingly) that the asylum was not as central to the emergence of psychiatry as a previous historiography had maintained. Here, he and Porter have moved back to a consideration of the real psychiatric “Great Confinement”, this time in a broad international perspective. The book's title suggests that it might offer a comparative perspective on psychiatric institutionalization. By and large, however, this promise is not kept, at least in any direct and obvious sense. Most of the book's contributors stick closely to the particular national setting they purport to illuminate, and only a small handful of the essays try to draw contrasts or make comparisons with developments elsewhere. Catherine Colebourne's chapter on the treatment of the insane in Victoria is notable, among other things, for being one of the few that attempts to look at local developments in a larger context, drawing upon studies of Ireland, England, and South Africa as well as her Australian sources. And David Wright's own substantive chapter on Ontario asylums (written with James Moran and Sean Gouglas) develops instructive parallels with developments in England and in Europe. For the most part, however, it is left to the reader to disentangle the resemblances and differences, and to try to make sense of them. Porter contributed a characteristically facile and jaunty introduction to the collection, but neglected to use the opportunity to tackle these issues himself in any serious or sustained way. Geographically, the range of the contributions is quite wide, spanning Asia, Australia, Latin America, Canada and the United States, Europe and Africa. Some of the chapters summarize research reported at more length elsewhere. Jonathan Sadowsky reprises his work on psychiatry in colonial Nigeria, and Peter McCandless his discussion of developments at the South Carolina Lunatic Asylum. Others traverse fresher territory, but the variation in the intellectual sophistication and quality of these chapters is at least as great as their geographical heterogeneity. Akihito Suzuki contributes a characteristically superb exploration of Japanese materials, which draws substantially on his detailed knowledge of European developments and provides a compelling portrait of the relationships between state, family, and the insane in the period between 1900 and 1945. Jacques Gasser and Genevieve Heller provide a detailed comparative analysis of admissions to two Swiss asylums in a similar period, from 1900 to 1970, giving us a better sense of the types of patients committed to these places, and emphasizing that the Swiss asylums' primary role seems to have been to defuse short term public or familial crises, rather than to serve as instruments of long-term confinement. Other chapters, however, are far less successful. Andrea Dorries and Thomas Beddies' chapter on a Berlin asylum, though providing some insight into the impact of Weimar, Nazi, and post Second World War political regimes on hospital and patient, is marred throughout by a muddled and confused treatment of evidence (and includes the remarkable claim that electroconvulsive therapy was employed on the patients from the mid-1930s onwards, which could only be true if the hospital doctors invented the technique). Chapters on developments in Argentina and Mexico are insubstantial and poorly written, and Sanjeev Jain's chapter on India is a set of near random observations jumbled together in a barely coherent fashion. He does uncover, however, a “Mr. Porter, who has been suffering from a maniacal complaint” (p. 275)—perhaps we have at last discovered the secret of Roy's superhuman productivity! There is, then, some useful information in this volume. Overall, though, it lacks much sense of coherence, and the great variability in the quality of the contributions makes it difficult to recommend with any enthusiasm.