In Madness in Buenos Aires, Jonathan Ablard convincingly demonstrates that Argentine psychiatric institutions were not the agents of social control that Foucauldian scholars have maintained they were in Europe and the United States. While Argentina had the most developed system of mental hospitals in Latin America, according to Ablard a weak state limited these institutions' policing and coercive functions. Buenos Aires's two main hospitals, the Hospital Nacional de Alienadas (for women) and the Hospicio de las Mercedes (for men) attempted to replicate European psychiatric practice, including even having an equal percentage of the national population interned. Nonetheless, lack of funds, ineffective administration, chronic overcrowding, bureaucratic incompetence and the absence of proper legal controls made Buenos Aires's hospitals places where patients were more often neglected than captured by a 'clinical gaze'.

The book is based on meticulous use of primary and secondary sources and is divided into five chapters plus an introduction and conclusion. Chapters 2 to 5 cover the period between 1900 and 1946 and are a comprehensive history of the development and misfortunes of Buenos Aires's two hospitals. These chapters are made compelling by Ablard's skilful use of case histories to illustrate diagnosis, treatment and legal problems of the patients. The last chapter of the book deals with the changes in psychiatry from the time of Peron until the end of the military dictatorship in 1983. Argentina prided itself on its modernity and large European population, yet the conditions that existed in the two Buenos Aires hospitals were similar to those in other Latin American manicomios. In the first decades of the twentieth century, patients often lacked adequate food, clothing and even beds, to say nothing of medical attention. In the early 1930s, the women's hospital had over 3,000 patients in facilities designed for 1,900 and in 1935 the men's asylum had a population of 2,580, more than twice its capacity.

An overwhelmed legal system meant that, although there were laws to protect people from unjust incarceration, judicial review often came months after patients were committed. Because of court delays, and a law stipulating that only the authority that requested commitment could rescind it, people were often held in unhygienic and dangerous conditions for long periods after they had been medically cleared for release. Although patients were often trapped in the system it seems to have more often been due to bureaucratic incompetence than intention. Furthermore, although most patients had little recourse once committed, patient law suits and conflict among patients, doctors and administrators indicate that the control exercised by the institutions was often quite fragile.

Diagnoses of those admitted tended to correspond to international psychiatric and intellectual trends. In the early twentieth century, 'degeneration' (which was often judged by physical traits such as facial asymmetry) was often said to cause or confirm an inmate's insanity. Immigrants, especially political radicals, were considered particularly likely to be degenerate and at least part of the psychiatric profession believed it was their duty to incarcerate these dangerous insane for the good of society. As psychoanalytic theory gained authority, illness was more often attributed to psycho-sexual conflicts. In the case of women these often had to do with reproduction or menstruation or with deviating from acceptable feminine roles. Treatment in the hospital relied on cardiazol, insulin and electro-shock therapies, as well as medical cures for syphilis. Doctors also at least occasionally practised surgical interventions, including lobotomy. Albard indicates that, despite significant overcrowding, there may have been some use of psychoanalysis or psychotherapy in the hospitals.

The last chapter deals with the changing fortunes of the psychiatric profession under Peronism and succeeding (mostly military) regimes. Ablard contends that one reason that hospital administration and patient care did not improve during the period of Peronist populism was because Pero'n kept public institutions weak by making patronage and clientelism the means of remedying social and political problems. The chapter also examines new trends in treatment developed by progressive mental health professionals: small hospitals, more out-patient treatment, egalitarian therapeutic communities. Eventually the profession divided into two antagonistic camps: one that favoured social justice and political change and another that served as accomplices for the post-1976 military government in its interrogation and torture of prisoners. Many of the psychologists and psychiatrists who advocated more innovative and humane treatment for their patients eventually became targets of the military and at least 13 psychiatrists were disappeared. This is a very interesting but somewhat rushed chapter. It would benefit from more discussion of the importance of psychoanalysis in Argentinian life, the new types of therapy that developed from the 1950s onwards, and the roles of mental health professionals during and after the dictatorship.

Overall, this is a well written, carefully researched contribution to the history of medicine in Latin America and a refreshing revision to the now accepted wisdom that these institutions served as instruments of political policing and social control. It will be welcomed by those interested in the history of public health, state formation and Latin American history in general.

Ann Zulawski Smith College From: Social History of Medicine, March 2009