Following the classic work on asylums by Erving Goffman, this is a study of democratic tyranny, a tyranny of the therapeutic, in which naked power replaced the ideals of a therapeutic community designed to eliminate hierarchy and bureaucracy. It is a detailed study of a London day hospital, a model community for psychoanalytic treatment in a democratic setting which went badly wrong in its attempt to capture the momentum of de-institutionalization in mental health care. It is also a critique of power for our time, as it moves well beyond a case study to analyse shifts in social control.