This masterful book does a great service to promoting a better understanding of how racism worked during the colonial era and the slave trade, as well as how it works today in society and in psychiatric practice. Barham's initial thesis seems ambitious – to show how psychiatric practice, the institution of psychiatry as a state project rather than one organised by specific people, is stained with dark shadows of the past and expresses itself as racism in many spaces. The historical examples span the Americas and Europe, Africa and South Asia, but mostly Britain and its handling of racial injustice.

Barham promises a powerful read:

Quoting from Paul Gilroy's The Black Atlantic, he uncovers ‘a disturbing “complicity between rationality and the practice of racial terror,”’ and engages with the ‘historical positions of subjects who were never considered to be fully human and whose historical experiences have frequently been … expunged from the record'. (p. 3)

Barham's text patiently exposes detailed historical examples which support and gently strengthen the argument, leaving the reader in little doubt. The use of psychiatric diagnosis and legislation to entrap and coerce victims of slavery is interspersed with examples throughout history of people finding themselves incarcerated at the behest of the state and the profession, usually by application of a psychiatric diagnosis or admission to facilities for care of the mentally ill.

For example, Henrietta Dawson, a mixed-race woman admitted to the female lunatic asylum in Kingston, Jamaica between 1858 and 1960, gives testimony and exposes the practice of ‘tanking’: submerging patients, sometimes unclothed female patients by men, underwater in a tank to suffer injury as punishment; some died. The practice was hidden from the doctors and officials, until she gave testimony of cruelty, being beaten and having nowhere to wash in a court of law, despite potential reprisals (pp. 47–55).

Barham elegantly juxtaposes contemporary examples with those of the past, making the case more compelling throughout, given the persistence and timelessness of racism. He looks at the plight of African–Caribbean Black men and women in the psychiatric system in the UK in recent times, and the equally disquieting experiences of the white poor, also racialised as an underclass.

Rationality arguments of the Enlightenment are laid bare as fast-moving technical devices to propose that science and reason can save us, yet that very science and reason become the vehicle of tragedy and trepidation. Reason is revealed to compound multiple disadvantages at the intersections of race, gender, identity and place, in order to oppress and justify sustained and unopposed racism in new forms (p. 14).

Barham shows how celebrations of emancipation often camouflage less visible forms of ‘liberal incarceration’, replacing one form of slavery for another, one trade for another, one form of exploitation for another. Many well-informed psychiatrists and social scientists provide powerful evidence and narratives that Barham neatly sutures to form a startling fabric of personal stories and accounts, official reports and inquiries, histories and testimonials, all with a texture of racist intentions embroidered into our everyday lives.

Gender, race, place and poverty form the basis of removing privileges and inflicting harsh punishments and inducements to conform. I was struck by the centuries of ‘racial calculus’ and ‘political arithmetic’ celebrated as progressive societal reforms. Dehumanising care, stripping and coercive measures to force bathing and taking of medication happened in Britain in the 1980s, and might continue in some spaces today. I have resisted picking specific historical figures, as there are just too many. More recent fatalities (Winston Rose, Orville Blackwood, Stephen Lawrence) are explored to expose racist structures and ideologies which kill.

I have shared this book with my students and peers, and in presentations to provoke the dismantling of structures which can drive hermeneutic injustices. This is not an easy read, but an important one in which to ground any contemporary proposals to tackle racism. Barham persuaded me that we have much to do, and against his examples, we can test our own actions and agency towards racial justice in our organisations and practice – he does so through lived experience testimonies and history. What seemed like an ambitious manifesto that I hesitated to accept at face value, turned out – for me at least – to be convincing and proven. There are many more disturbing examples, so readers should be prepared to learn of our horrifying history and how we treat psychiatric patients and minorities, perhaps also today as well as in the past. I was left wondering about implications for contemporary policy and practice. Are we, today, conditioned to practices, policies and laws that are actually as cruel? Listening to people with mental illness and carers is important to unpack structural violence and expose historical traditions that need dismantling.