Petteri Pietikainen, Madness: A History (Milton Park, Abingdon, UK, and New York: Routledge, 2015), pp. 346, £29.00, paperback, ISBN: 978-0-415-71318-4.Andrew Scull, Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine (Princeton, NJ and Oxford, UK: Princeton University Press, 2015), pp. 448, $24.95, paperback, ISBN: 978-0-691-16615-5, Colour plate illustrations.

epidemic self-harm in Britain by the mid-1960s, by focusing psychiatric attention upon the physically injured attempted-suicide patient at general hospitals. Chapters 4 shifts the focus back to the profession of psychiatric social work (the role of the psychiatric social worker features in Chapter 2) and describes how the profession is key to the conceptualisation of communicative self-harm. Set against the backdrop of de-institutionalisation in the 1960s, Millard reveals the development of self-poisoning and attempted suicide as part of ‘the broad turn to the social setting’ (121) and the consideration of its impact upon mental health and well-being. Patients presenting at hospitals after having harmed themselves were asked questions about their current social setting and relationships in an effort to understand the nature of their ‘distress’ and to make sense of the attempt (152). In Chapter 5, Millard investigates the rise in prominence, in the 1960s and 1970s, of a concept of self-cutting in British psychiatry, which marked ‘a significant shift away from the concern around self-poisoning’ (155). Specifically, Millard offers a critical assessment of the British literature on self-cutting, with the focus on how selfcutting comes under intensive psychiatric scrutiny in the ‘high-surveillance environment of a psychiatric inpatient ward’ (158) and is conceptualised as motivated by ‘internal emotional states, rather than communication’ (161). In his analysis of each clinical study of self-cutting, Millard details how cutting in psychiatric inpatient institutions emerged as an epidemic phenomenon and a management and behavioural problem. The move from socially embedded to internally self-regulating self-harm, Millard argues, was by no means inevitable. While the change in explanations was largely the outcome of practices of exclusion and emphasis, the corresponding ‘political fracturing of consensus around welfare and the ascendancy of a neo-liberal rhetoric of self-reliance’ (155) is also pointed to. With this study, Millard has managed to pack a wealth of detailed analysis and knowledge into a relatively short amount of space, but the book can sometimes seem overladen with a density of information, slowing the pace of the narrative. Nevertheless, the monograph’s focus on self-harm as a constructed part of broader changes in cultural, social and political spheres provides a welcome counterweight to other histories of selfharming behaviours that have predominantly focused on psychological and psychiatric theory and practice, and it makes a weighty contribution to our understanding of the shifting conceptual frameworks of self-harm in twentieth-century Britain.