Americans want to be humane toward the mentally ill, yet we have always been divided about what is best for them and for society. Now, the foremost historian of the care of the mentally ill compellingly recounts our various attempts to solve this ever-present dilemma. In the first comprehensive one-volume history of the treatment of the mentally ill, Gerald Grob begins with colonial America, when families and local communities accepted responsibility for their mentally ill members. Their solutions varied, from confinement under lock and key, to granting mentally ill persons a wide measure of autonomy. As American society grew larger and more complex, the first mental hospitals were created to deal with growing numbers of the severely and persistently mentally ill. Grob brings to life the charismatic and innovative individuals who administered these hospitals and shows how they were successful at first in providing humane care and treatment. But under the pressure of too many patients and too few resources, the hospitals subsequently deteriorated into custodial institutions, and Grob charts this transformation. He traces the growth of the psychiatric profession, the change of the mental health field during World War Il, and the use of controversial shock therapies, drugs, and lobotomies. Mounting criticism of some of these techniques and of mental institutions as inhumane places led to the emptying of the hospitals and a new emphasis on community care and treatment. Americans daily encounter the pitiful sight of homeless, mentally ill people in the streets of our cities, and wonder how it came to be this way. Grob shows that while many patients benefited from the new community policies, there arose a new group of mentally ill substance abusers who desperately need treatment but who resist it. He argues that these people, and not deinstitutionalized patients, make up most of the disturbed homeless who confront us today. Their presence demands new solutions, and Grob's definitive history points the way. It is at once an indispensable reference and a call for a humane and balanced policy in the future.