John Hunter 1728–1793

care, the panacea of the 1960s and '70s, have recently begun to attract scholarly attention. Levine documents many of the more egregious failures the revolving-door syndrome; the rise of a profit-making "trade in lunacy" centring around nursing homes, board and care facilities, and welfare hotels and analyses quite well the role of the state and federal bureaucracy in promoting and covering up the whole sorry mess. At the same time, he insists that the fault lay in the execution rather than the conception of community-based care, pointing to a handful of successful pilot programmes as evidence that the approach can work well. Two subsequent chapters examine the impact of the growing volume of mental health litigation on the delivery of care, and suggest that "while the results of litigation have often had important effects, too often the effects have been incomplete and fleeting" (p. 105). Generally, Levine is pessimistic about the chances for significant reforms flowing from this quarter, suggesting instead that "as the requirements for due process intensify, we will see more and more compliance on paper, for the record, with less attention to each individual" (p. 153). He concludes his book with a brief examination of the 1978 report of the President's Commission on Mental Health, pointing out the heavily political nature of its deliberations, the flawed character of the work done by its task forces, and the fact that the new mental health constituency is not the consumers of services, but "the set of providers of services and the research community that benefits economically from available funds" (p. 185). In brief, this flawed and uneven book contains little new information, but provides a useful overview of major recent developments in American mental health policy. Andrew Scull University of California at San Diego