Mental illness has existed since time immemorial. Author and curator Jay notes that mental illness labels have changed over the centuries, but the phenomena are persistent. What has changed, and what Jay portrays in a creative chronological depiction, is the continued dilemma of how to handle people who do not cognitively or behaviorally conform to those around them. The narrative, accompanied by over 600 interesting and telling photographs and drawings, revolves around the original Bethlem Royal Hospital (or "Bedlam") in 13th-century London and its various incarnations over time. Each version shows initial good intentions in treating mentally ill people, but the execution was invariably flawed due to insufficient knowledge about causes and cures, budgetary concerns, and inherent complexities of the issues. The book provides descriptions of treatments ranging from religion, medicine, and other societal models, highlighting varying successes and failures with each option. One of the author's messages about the treatment of mental illness today recalls physician Philippe Pinel's belief two centuries ago: those suffering from mental illness should be treated humanely. Jay points out that there is hope. Summing Up: Recommended. Lower-division undergraduates and above; general readers. --Bernard C. Beins, Ithaca College

MIKE JAY'S "This Way Madness Lies" accompanies an exhibition currently showing at Wellcome Collection in London called "Bedlam: The Asylum and Beyond." Both exhibition and book regard Bedlam, more properly known as the Bethlem Royal Hospital, as the asylum that came to define madness and its treatment. From its 15th-century home in Bishopsgate, East London, the institution moved to Moorfields and then, in 1815, to St. George's Fields in Southwark, to a building that now houses the Imperial War Museum. In 1930, the venerable asylum was removed to Monks Orchard, in a London suburb, where it continues to be "a safe place to go mad," at least in its ideal conception. Jay, a historian and a co-curator of the exhibition, provides a chronological account of a cyclical history. For centuries, the treatment of the mentally ill involved neglect and brutality. At times, these conditions stimulated efforts at reform, but energy tended to dissipate. Therapeutic pessimism and institutional decay ensued, new reforms were introduced, and the cycle began again. And today? "Troublesome cases," Jay reminds us, "are buried within the prison system from which the asylum was designed to rescue them." "This Way Madness Lies" tells a colorful history, one rich in incident. In 1800, James Hadfield attempted to shoot George III in his royal box at the theater. He missed and was tried for high treason, but was found to be acting under an insane delusion and acquitted. This sensational verdict created a new sort of madman, the "criminal lunatic," and significantly expanded the function of the asylum. In France at around the same time, Philippe Pinel was revolutionizing the understanding of insanity. He emphasized the importance of kindness and made the first serious attempts to diagnose the underlying causes of mental illness. Jay's book reproduces, in a fine two-page spread, Tony Robert-Fleury's 1876 masterpiece showing Pinel freeing a madwoman from her chains. Elsewhere, though, are truly horrifying pictures of instruments of restraint, including straitjackets, collars, manacles and harnesses of canvas, leather and iron. The early Victorians made serious progress in the reform of asylums, prisons and workhouses. After the Royal Bethlem moved to Southwark, there was great optimism, much zeal for change, but by the end of the century the cycle of reform had again reversed itself. Henry Maudsley, a giant of Victorian psychiatry in mid-century, gloomily concluded that insanity was hereditary in most cases; he provided scientific support to those who argued that the mad were "biologically unfit" and should be sterilized. The Nazis went further and systematically murdered 200,000 of those declared mentally ill. The book's wealth of artwork has been sumptuously reproduced. Here are Géricault's five lunatics of the Salpêtrière Hospital and the first eight plates of Hogarth's "A Rake's Progress." Among the works created by the mentally ill are two of Richard Dadd's extraordinary paintings from his years in Bedlam, where he was sent after murdering his father while believing himself controlled by the god Osiris. There is an oddly lovely painting of white wolves sitting in a tree by Sergei Pankejeff, Freud's celebrated "wolf man." But perhaps the most superbly morbid is William Kurelek's picture of the contents of his own head, including a sleeping rat, a man in a test tube and several crows about to devour a lizard. PATRICK MCGRATH'S "Writing Madness," a collection of his short fiction and nonfiction, will be published early next year.