Eric Engstrom is a bilingual historian who has already published scholarly works in both English and German, focusing on the 19th century. This time, he has examined the evolution of the psychiatric profession in Germany, from just before national unification to the outbreak of the First World War. In this story, he finds the outstanding process to be the rise of university psychiatric clinics, providing a contrast with the established culture of the asylum.

Engstrom describes the mental hospitals of the mid-century as ‘institutions of discipline and care, expressions of both bourgeois moralism and solicitude. Their directors were patriarchs... their exacting house rules effected a certain bedlamic order’ (‘bedlamic’ is a new adjective to me). In this they resembled institutions elsewhere in Europe and in the USA, but in Germany the system was more efficient and even more rigid. Nevertheless, by the end of the century ‘entirely different institutions had come to represent the epitome of professional power and knowledge’. These were the university psychiatric clinics, which were significantly smaller, centrally situated and headed by doctors who were not only clinicians and administrators but natural scientists. In Engstrom's view, they were nationally conceived to try to solve the troublesome ‘social problem’ of insanity. British readers will then wonder why nothing like this existed in the UK until the late 1930s – an enigma that awaits an historically satisfying answer.

One factor here may be the more intrusive power of the state in Wilhelmine Germany, which made professional practices inherently ‘political’. From the other direction, psychiatrists are said to have ‘mobilised much of the cultural machinery needed to expand the profession's influence across civil society’. Anticipating the 1960s, Engstrom identifies a movement of ‘antipsychiatry’ in this period, but regards fear of confinement in an asylum as indicating a ‘heightened sensitivity for liberal and democratic values’. There were even calls from some German psychiatrists for a move to community-based care, revealing an active response to the social questions of the day.

This is an exhaustively referenced work, and one that makes a significant contribution to the psychiatric history of the period. What would be fascinating would be an examination of how these trends influenced the German response to the mass psychiatric casualties of the First World War.