In contrast to many institutional histories, this study of the Royal College of Psychiatrists (the professional body for psychiatrists in the UK) is commendably concise. Thomas Bewley, a former dean and president of the College, has placed the history of the College within the context of evolving ideas about the nature and treatment of mental illness. In addition, his research has included its predecessor bodies, notably the Royal Medico-Psychological Association (RMPA), which had been constituted in 1865 and granted a royal charter in 1926.

However, organizations composed of doctors are scarcely immune from internal politics as the machinations of Lords Horder and Moran at the Royal College of Physicians during the foundation of the National Health Service demonstrated. Evidence to identify political alliances and deals for the College's predecessor organizations appears to be lost, although Bewley presents revealing insights into the fierce debates that led up to its foundation in June 1971. When presented with a compelling case for reform, the council of the RMPA failed to agree on a strategy. Perhaps as a way of preserving its power, a majority of council members initially opposed the idea of a new institution and proposed that the Royal College of Physicians establish a Faculty of Psychiatrists. Junior doctors, in particular a vocal group in training at the Maudsley, lobbied for changes to the accreditation process. A wider ranging and more testing professional qualification was needed to take the place of the Diploma in Psychological Medicine (DPM) based not simply on an examination but also an approved programme of teaching and clinical training. This was sought, along with new structures and personnel, to ensure that the College was not simply the RMPA by another name.

In the post-1945 period, the opening of academic departments of psychological medicine in medical schools threatened the hegemony of the medical superintendents of the county asylums. The latter were often autocrats in charge of a hierarchy of assistant medical officers. Denied consultant status, asylum doctors were often cast as the poor relation of the medical profession. By contrast, psychiatrists in university departments sought to compete with other specialities in terms of research, publications and influence on public policy. Irreconcilable differences in aims and outlook between these two groups probably accounted for the inordinate delay in setting up a Royal College of Psychiatrists, an idea first proposed at a council meeting of the RMPA in July 1948 and an on-going agenda item from 1960.

Sources are not generally included in the text but can be found on the Royal College website where a composite list of obituaries is particularly helpful. However, fuller inclusion of published literature, particularly in historical journals, would have strengthened the study as a work of reference.

My one criticism of the study, revealed in the title Madness to Mental Illness, is that there is something of the ‘Whig interpretation of history’ in the text; that is a narrative which depicts events proceeding rationally and progressively from a period of ignorance and insensitivity towards insight and humanity in the present. To be fair, Dr Bewely discusses lasting innovations from the past and ill-advised innovations, such as insulin coma therapy, prefrontal leucotomy and in the post-1945 period the inhalation of carbon dioxide as treatment for psychoneurosis. Perhaps it should not be forgotten that the first two were widely practised and, when first introduced, hailed as significant breakthroughs in clinical practice. Nevertheless, this is a valuable contribution to the history of the psychiatric profession in the UK.