The title of this book should not mislead the reader. It is not really a book about the history of psychiatry in the nineteenth century, and even less is it a history of the patients interned in asylums. Indeed, the author dismisses from the outset the idea of writing a history “from below” according to the program outlined by Roy Porter. The framework chosen by Jessie Hewitt – nineteenth-century French society, its conceptions of the family, and its treatment of the insane – is the point of departure from which she proposes to discuss the history of gender. The book is based on an assumption: the treatment of the insane reflects the masculine and bourgeois values of French elites during the nineteenth century. The reader will quickly be convinced: the new psychiatric ideology reifies the separation between men and women (as other ideological doctors did at the same time with regard to bodies and sexual representations), and bases the success of the so-called moral treatment therapy on the acceptance of gender norms. By contrast, divergences from social norms are pathologized. The chronological development of the book allows the author to affirm that this system, which interweaves the authority of the alienist and that of the bourgeoisie, declines at the end of the nineteenth century under the effect of political, social and psychiatric evolutions. This is why, if gender and class prejudices still remain in their minds, the alienists choose, according to the author, to abandon the moral treatment based on gender scenarios that had been the basis of their practice since the emergence of their profession.

The book does not propose an exhaustive history of the relationship between gender and psychiatry in the nineteenth century, but advances by successive scenes, some of which are well known to historians, and others less so. The first chapter, which evokes the beginnings of French psychiatry, before the passage of the Great Law of 1838 which legislated on the conditions for internment, is quite synthetic. It deals with the question of gender in the treatment of the insane over a period of forty years. If the evocation of the asylum as a large family and of the alienist as a father figure reminds us of some pages of Michel Foucault from the 1970s (Le pouvoir psychiatrique, for instance), the development on the gendered scenes of care (using the figures of soldiers and good mothers) is interesting and confirms what some historians have perceived through hospital archives: the conformity to one’s expected role as a woman or a man is worth treating and being removed from the asylum. Starting from a controversy about the cold shower, the second chapter evokes the specific history of the nursing homes that took care of wealthy patients at a time when the large public asylums took care of the indigent. Alienists like Blanche (on whom Laure Murat had worked in 2001) constructed their professional identity through a bourgeois representation of gender, the nursing home and paternalism being means of healing the sick through the family cocoon it represented (p. 66). This masculine modernity of Blanche was then opposed to the brutal masculinity of Leuret. Obviously, this interpretation should be qualified by reference to the sociology of the patients with whom the two doctors had to deal, but this is not the author’s intention. Chapter 3 evokes in an original way the history of a nursing home run by women, based on the house of Brierre de Boismont, an alienist who published a book in 1866 on the usefulness of family life in the treatment of patients. The pages on Boismont’s wife and her daughter, Mrs. Rivet, are a good example of an original treatment of the question raised in this chapter. It is interesting to see how family life, considered as curative in the middle of the nineteenth century in this institution, was later judged pathogenic in the twentieth century, as witnessed by Ken Loach’s beautiful film ‘Family Life’. It should not be forgotten that this family conception of the asylum continued into the twentieth century: a certain number of psychiatrists raised their children in the institutions of which they were in charge (sometimes being looked after by patients) and some of these children became psychiatrists themselves. Chapter 4 focuses on abusive confinements. The author uses this discussion to develop the link between the emergence of the psychiatric system and the evolution of patriarchal power. Did the Civil Code of 1804 temper the power of fathers as the author asserts (p. 95)? Nothing is less certain. It is obviously possible that the Insane Law of 1838 allowed young adults who did not conform to the expectations of their families to be put away, but it seems to us that this only confirms the legal orientation given by the Napoleonic Code. The last two chapters are devoted to the crises of the end of the nineteenth century and to the ways in which they affect the image of the alienists who, after having been supportive of the emperor, are shifting their allegiances to the republican power.

Several things are interesting in this book. Firstly, the approach that aims to use a recent notion to revisit the past: “it is possible for historians to productively make use of such theorizations to analyze gender’s operation in the past” (p. 3). This leads the author to privilege not, as is often the case, the history of female patients described as being under the yoke of male doctors, but to treat in an equivalent way the masculine and the feminine in their relationship to treatment, to the institution, and to the psychiatric profession. In doing so, we come across unusual female figures such as Jubline, Pussin’s wife, or Mrs. Rivet, the director of a nursing home. But, above all, we become aware in a different way of the professional history of psychiatry, based on questions that are distinct from those that were present, for example, when Jan Goldstein was working in the same period with a very similar chronology. One of the aims of the book is also to systematically cross the medical and legal fields to give a more complex history of madness. The book is thus a stimulating theoretical essay from a historical point of view, but one that lacks precision on certain points; it is centered on Paris, on very limited sources (it is based on a few treaties already well known to historians), and does not seem to mobilize the archives cited at the end of the book (notably those of the aphp). Reading this book, one thinks of the great Foucauldian narrative based on rather similar printed sources, all of which are derived from medical speech, or almost all of them (Esquirol, Blanche, Leuret, Brierre de Boismont …). Yet hospital archives are full of stories, practices, and institutional descriptions that would have provided a more solid foundation for this very theoretical approach. Underestimating certain major aspects of French social history, the author also fails to mention the way in which the asylums, and not only in the rare and elitist Parisian nursing homes, were run throughout the nineteenth century by women (“public asylums offered few opportunities for women to take on authoritative positions,” p. 68). Religious congregations owned dozens of asylums, each with hundreds of patients. At a time when the asylum was not very medicalized, they were masters of a large part of the French public asylums, running their internal services, pharmacies, and women’s services. When only one male physician was present, dozens of sisters had power in their institutions until late into the 1960s. A chapter on the Mother Superior and the Congregational Sisters would have been a welcome addition to this otherwise very stimulating picture of the history of gender in psychiatry in the nineteenth century.