Jennifer L. Lambe's Madhouse : Psychiatry and Politics in Cuban History is about a space of seclusion, therapy and knowledge – the Mazorra. This is the setting for a book that brings together discussion of public health care and the institutionalisation of psychiatry, society and politics. The work is also closely linked to Cuban political history.

The trajectory that Madhouse covers, spanning almost a century, is tumultuous. In it, the reader follows the process of Cuba's independence from Spain (Chapter 1), the rapprochement with the United States, the coming and going of US military occupation forces (Chapters 2, 3, 4) and the Revolution, ending in the configuration of the Cuban post-revolutionary period (Chapter 5). Centre stage are public policies for the provision of care to the mentally ill and the consequent reforms these policies suffer in the name of science and citizens (Chapter 6); in the name of doing away with everything that the previous government represented (Chapter 7); and even in the name of overbilling and corruption (Chapter 4). Thus, giving due weight to ambivalence and complexity, the narrative shows how interventions, processes of revolution and independence impacted public healthcare conditions.

At a second level of analysis, Lambe scrutinises the first psychiatric hospital on the island, founded late in 1857 as the ‘Mazorra Hospital of the Demented’ (p. 5). This was the only hospital specialising in mental healthcare on the entire island prior to the year 1959. Founded as a public hospital, it was mainly poor coloured people who were cared for at the Mazorra. The reader can thus differentiate the care of this population from that of the privileged few, who received more specialised and comfortable care in private institutions (p. 5).

In presenting the asylum as central to public healthcare, the author also points to its role in the development of the Cuban medical–mental health profession, playing a key role in psychiatrists’ debates in the struggle for professional affirmation and for the rights of the ‘demented’. Lambe highlights the confrontations between the psychiatric and legal authorities in disputes over the monopoly on madness (Chapter 3) and the growing tension between the Church and science (Chapter 2). She also draws attention to the fact that modern practices were present in the Mazorra, but coexisted with overcrowding, overbilling and accusations of ill-treatment. We are informed that the mixture of treatment and abandonment was a constant in Mazorra throughout the period analysed.

We also learn that many Cubans attributed mental illnesses to spiritual evils, curable by rituals associated with former slaves and their descendants (Chapter 3). However, I would have welcomed elaboration on this issue, which came to be spurned by official medicine as charlatanism. I also felt the lack of a debate about the circulation of degenerationist, eugenic, racialist and constitutionalist theories, which were so prevalent in US and Latin American psychiatry for much of the period under investigation. Consequently, the book fails to embark on an in-depth discussion of mental health debates of the period about local primitivism and culture, which is undoubtedly a pity.

The political appears in the book in terms of state intervention in the asylum, as well as in different policies related to social welfare, when Lambe sets out to analyse the implications of different state government conflicts for the crises and changes that occurred in the Mazorra. However, the very interesting articulation between politics and madness, the struggles and clashes that took place around this theme, are not addressed. Certainly, the lack of the clinical records of the institution rendered some very interesting potential research unfeasible.

The lack of these sources may also explain Lambe's choice of turning the looking glass of the Mazorra towards Cuba proper, seeking to discuss the themes of the normal and the pathological from this broader angle. It is at this point in the book that the social issues of slavery and the sugar economy are related to the development of Cuban psychiatry. In the post-abolitionist era, the Mazorra was seen as a place of custody for many ex-slaves who, according to the physicians, could not adapt to the new, modern conditions of the island.

From Chapter 6 onwards, there are discussions about such social clinical practices. Between 1930 and 1940, psychiatry begins to infiltrate diverse debates about education and health and it played a part in the new constitution of 1940, with a marked emphasis on prophylaxis. Especially from the 1940s onwards, psychoanalysis came to the fore of psychiatric theories, often expressed in speeches on prophylaxis. Psychiatry and psychoanalysis had come to influence the general public, and with the ‘scientific’ lens provided by these disciplines, education and sexuality occupied a central place in the organisation of society.

But all this was about to change. Lambe leads us through the transformations in mental healthcare after the 1959 Revolution. Under new political-ideological direction, the Mazorra again redefined itself, this time to incorporate revolutionary rehabilitation. During the early years of the Revolution, hospital conditions improved significantly and the mortality rate of inmates declined dramatically. Therapeutic rehabilitation through work gained a new feature, namely collectivism. According to Lambe, in those years the hospital became a community of workers.

In the last chapters, the looking glass of the Mazorra is used to reflect Cuban psychiatry more broadly, exploring Cuba's attempt to export its mental health system model to the United States (Chapter 6). The theme unfolds in another chapter in which one can also observe the psychiatrisation of society and the incorporation of concepts from psychiatry in Cuban arts and culture (Chapter 7). Lastly, there is a brilliant discussion on the influence of Cuban psychiatry on the US health system.

In short, Madhouse is the upshot of a very ambitious project covering a great deal of ground. The effort made by the author is outstanding and the text is clearly expressed. It is to be expected that it will become a mandatory reference work not only for those interested in the history of psychiatry in Latin America, but also for a more general audience interested in the history of Cuba.