Americans want to be humane toward the mentally ill, yet we have always been divided about what is best for them and for society. Now, the foremost historian of the care of the mentally ill compellingly recounts our various attempts to solve this ever-present dilemma. In the first comprehensive one-volume history of the treatment of the mentally ill, Gerald Grob begins with colonial America, when families and local communities accepted responsibility for their mentally ill members. Their solutions varied, from confinement under lock and key, to granting mentally ill persons a wide measure of autonomy. As American society grew larger and more complex, the first mental hospitals were created to deal with growing numbers of the severely and persistently mentally ill. Grob brings to life the charismatic and innovative individuals who administered these hospitals and shows how they were successful at first in providing humane care and treatment. But under the pressure of too many patients and too few resources, the hospitals subsequently deteriorated into custodial institutions, and Grob charts this transformation. He traces the growth of the psychiatric profession, the change of the mental health field during World War Il, and the use of controversial shock therapies, drugs, and lobotomies. Mounting criticism of some of these techniques and of mental institutions as inhumane places led to the emptying of the hospitals and a new emphasis on community care and treatment. Americans daily encounter the pitiful sight of homeless, mentally ill people in the streets of our cities, and wonder how it came to be this way. Grob shows that while many patients benefited from the new community policies, there arose a new group of mentally ill substance abusers who desperately need treatment but who resist it. He argues that these people, and not deinstitutionalized patients, make up most of the disturbed homeless who confront us today. Their presence demands new solutions, and Grob's definitive history points the way. It is at once an indispensable reference and a call for a humane and balanced policy in the future. Grob (history of medicine, Rutgers Univ.) chronicles the treatment of the mentally ill in America from the Colonial period to the present. This care has passed from the hands of families and local communities to asylums and finally to today's decentralized psychiatric system. Grob asserts that the emergence of a young adult chronic population has had an adverse effect on our current system of care, and he urges changes to meet the different disorders and needs of this group. Although his book is intended for a general audience, Grob's prose does not lend itself to this purpose. Still, since there are so few monographs on this subject, larger libraries may wish to purchase this work. - January Adams, ODSI Research Lib., Raritan, N.J. Copyright 1994 Reed Business Information, Inc. Besides covering the changes in attitude toward and the treatment of the mentally ill in the U.S., Grob shows how psychiatry has progressed from a close relationship with asylums to essentially a private-office practice. Moreover, he clearly sets forth the birth and development of the Association of Medical Superintendents of American Institutions for the Insane (parent of the American Psychiatric Association) and related organizations, as well as of such lay groups as the National Committee for Mental Hygiene and the Joint Commission on Mental Illness and Health. He limns the gradual change during the twentieth century from the mental hospitalization of the elderly to providing surrogate homes for them, and he places fads in psychiatry (dynamic, biological, etc.) in their historical contexts. Smoothly written and well documented, this is another example of Grob's gift for scholarly yet readable work in this important field. William Beatty An informative survey of America's evolving responses to the question of society's obligation to the mentally ill and how best to meet that obligation. Grob (History of medicine/Rutgers) has previously published scholarly works on the history of the care of the mentally ill. Here, he reaches out to a larger audience with a highly readable account that begins in the colonial days. Back then, ``lunaticks'' were primarily a family responsibility, and those without families to care for them were seen as a social and economic problem, not a medical one. Public almshouses took them in, along with widows, orphans, and others needing public assistance. By the middle of the 18th century, the Enlightenment, with its faith in reason and science, gave rise to the idea of treating and possibly curing the mad, and insane asylums began to appear in cities. Grob recounts the efforts of Dorothea Dix to persuade state legislatures to set up mental hospitals, and by the middle of the 19th century, most states had at least one. But the 20th century found these optimistically founded institutions overcrowded and largely