Roy Richard Grinker, a Georgetown University anthropologist whose family has included three generations of psychiatrists, traces how Western societies have understood and treated mental illness from ancient times to the present. Grinker argues that while stigma against mental illness remains powerful, the long arc of history reveals genuine progress toward acceptance and understanding. The book examines how different eras created categories of mental difference that reflected their economic and social needs, from the 'village idiot' tolerated in agricultural communities to the asylum patient confined during industrialization. Grinker draws on his family's clinical archives and his own research, including studies of autism in South Korea and South Africa, to show how cultural context shapes whether particular conditions are recognized, stigmatized, or accepted. The emergence of neurodiversity as a framework represents the latest chapter in this history, challenging the assumption that all mental differences require cure. Grinker neither romanticizes the past nor declares victory in the present, acknowledging that people with serious mental illness continue to face discrimination, inadequate treatment, and premature death. Yet by documenting the genuine changes that have occurred, he provides grounds for hope that continued advocacy can further reduce stigma. Essential reading for understanding how society's relationship with mental difference has evolved and might continue to change.