Polsky presents a thorough history of the creation and continuation of the "therapeutic" system of "treating" marginal citizens. While this history (and the critique that grows out of it) are in themselves fascinating, the most interesting theme of the book is its analysis of how policy, even unsuccessful policy, becomes institutional dogma. The problem that Polsky illuminates--the unwillingness of institutions to change course even when confronted with mounds of evidence that they should--has profound implications for politics.