Medicine, the Penal System and Sexual Crimes in England, 1919–1960s: Diagnosing Deviance By Janet Weston. Bloomsbury. 2017. £85.00 (hb). 216 pp. ISBN 9781350021099

Back in the day psychiatrists seemed to have had more interest in sex offenders than they do now. Concerns about the ‘medical model’, the ascendance of cognitive–behavioural therapy in sex offender treatment, and a focus by psychiatrists on ‘serious mental illness’ have made the discipline reluctant to treat individuals who are often seen as law breakers rather than as patients with mental disorder, regardless of what the diagnostic manuals say about paraphilia. Janet Weston argues that after a steady increase in the involvement of doctors stretching from the First World War to the 1960s it has been downhill since.

Has she proved her point in this interesting canter through the way in which the British legal system dealt with sex offenders in the first part of the 20th century? Based on the material in her book, probably not. The story she tells suggests that medical input tread relatively flat ground with occasional inclines depending on the interests and enthusiasms of a small number of doctors, lawyers and judges who were never able to carry the mainstream with them. And although she mentions the 1959 Mental Health Act, she does not seem to appreciate its impact in enabling courts to send ‘psychopaths’ to what were then called the special hospitals rather than to prison – their ‘rehabilitation’ wards in the 1980s and 1990s were full of sex offender patients admitted years previously by enthusiastic doctors who moved on but left their patients nowhere to go.

This is an academic book (of its 216 pages 73 are notes, the bibliography and index), but in spite of that it is clearly written. It is a good reminder of the idiosyncratic and sometimes quaint nature of the origins of both prison medicine and forensic psychiatry, how they were shaped by cultural and what may now seem naive views of the causes of crime and sex offending, and how easy it is to confuse the needs of the patient with those of the state. If nothing else, the fact that the majority of sex crimes dealt with by doctors in the period covered by the book appear to have been homosexuality and indecent exposure tells you something.

Overall, the book would probably benefit from the perspective a doctor or lawyer might have added to the essentially social spotlight shined here. There is, however, much in it to think about, which is no bad thing.