This work analyzes recent economic performance in the Commonwealth Caribbean by examining the IMF/World Bank Structural Adjustment Package and its relation to the deteriorating economic and social conditions in this part of the world. Ramesh F. Ramsaran not only takes a critical look at structural adjustment as it has been applied in the Caribbean but also examines recent structural adjustment theory in general and some of its contradictions in practice. Ramsaran argues that if structural adjustment programs are to be effective with minimum social cost, their design must take into account the specific conditions of individual countries. This argument against the general application of policies and principles remains firm, despite the fact that international aid agencies in the 1980s did find general guidelines useful in particular situations. His analysis will be of interest to scholars and policy-makers in international and development economics and international finance and trade.