An enduring if inconsistently vibrant subfield, the history of psychiatry in Latin America and the Caribbean has of late acquired renewed energy. A recent crop of books dedicated to Mexico's most important psychiatric institution, La Castañeda Asylum, probe issues of long-standing scholarly interest, such as the intersection between psychiatric and socio-political power, while also featuring new questions, including diagnosis (Ríos Molina 2017). In this respect, Cristina Rivera Garza's La Castañeda Insane Asylum: Narratives of Pain in Modern Mexico, ably translated from the Spanish by Laura Kanost, represents a unique contribution. For several decades now, Rivera Garza has been one of the pre-eminent interpreters of that history, with her published work reflecting a particular interest in gender, power and female subjectivity. Much of the writing in La Castañeda Insane Asylum first saw light in the form of a dissertation (1995) and was subsequently reinterpreted in fictional form (Nadie me verá llorar, 1999). The book thus bridges several analytical moments and modes to productive and occasionally disorienting effect, as Rivera Garza stages a reflexive dialogue with the asylum's history as well as her own efforts, past and present, to interpret it for a variety of audiences.Early chapters consider the cycles of rebuilding and disappointment common to all public psychiatric institutions, as well as the intersection between such efforts and the course of history outside the institution, especially the turbulence attending the Mexican Revolution. This territory necessarily leads Rivera Garza into discussions of how race, class, gender and sexuality shaped and differentiated the experiences of La Castañeda's inmates and employees alike. This context is largely familiar to readers of Rivera Garza's published work but is channelled productively here through the inner workings of the institution: its daily routines, the psychiatric interview and photography, to name a few points of entry. These chapters productively centre on patient life and subjectivity, though they perhaps occasionally overstate the 'agency' exercised by female patients in particular, as in the author's claim that the shift away from the diagnosis of moral insanity by 1930 reflected a 'clear victory for patients over Porfirian psychiatry' (p. 97).In general, however, the relationship between patients and psychiatrists is rendered with delicacy and circumspection. Rivera Garza ascribes particular importance to inmates' 'discursive strategies' in consequential but uneven dialogue with those of their physicians. In her words, patients' 'illness narratives did not arrive within a predetermined and apparently stable context, but rather, they helped to shape that context in fundamental and fraught ways. In other words, they did not resist a determined reality or social order, nor did they propose a counterhegemonic strategy; on the contrary, they were participating in its very creation' (p. 13). If this argument reflects a scholarly consensus at this point...