Chapter Ten
Progressive Dreams, Progressive Nightmares: Social Control in Twentieth-Century America

At the Rice University conference mentioned in the introduction to Chapter 2, David Rothman and I spent a good deal of time outside the formal conference session discussing his new book, Conscience and Convenience: The Asylum and Its Alternatives in Progressive America, which was then just a few weeks from publication. Not long after my return to southern California, the Stanford University Law Review invited me to write a review essay dealing with the issues raised in Rothman's book. Delighted to have an excuse to write something on developments in the early twentieth century, and eager to continue the debate Professor Rothman and I had begun in Houston, I agreed to do so. Coincidentally, when I had nearly completed work on the essay, David Brion Davis, who had spoken at the same conference, published his own assessment of the book in the New York Review of Books .^[1] Readers may care to compare our respective commentaries.

By the time Conscience and Convenience appeared, Rothman had almost completed his evolution from being simply a historian to being a historian and a public activist. His subsequent analysis of the horrors of institutional provision for the mentally retarded in contemporary New York, The Willowbrook Wars, was at once a piece of social reportage and a polemic against segregative and institutionally based responses to mental disorder and deficiency.^[2] As such, it provided further ammunition for

[1] David Brion Davis, "The Crime of Reform," New York Review of Books, 26 June 1980.

[2] David J. Rothman and Sheila M. Rothman, The Willowbrook Wars (New York: Harper and Row, 1984).

those critics who charged that Rothman's historical analysis had from the outset been dictated by a commitment to a particular political agenda. Rothman's own account of the intellectual origins of The Discovery of the Asylum casts considerable doubt on these claims, contending that his acquaintance with the advocates of deinstitutionalization, and adoption of their cause, came only after the writing of his book and its adoption by activists as an ideological weapon in their campaign against state hospitals.^[3] If true (and I suspect that it is), this version of events suggests that, ironically enough, some of his critics are guilty of the same sin they so vociferously accuse him of: deducing original intentions from subsequent events.

Gerald Grob has been perhaps the sternest of these critics. The first volume of Grob's examination of post-colonial American mental health policy appeared just two years after The Discovery of the Asylum and is discussed in Chapter 2. The second of a planned trilogy appeared in 1983.^[4]

Like its precursor, whose strengths and weaknesses it largely shares, Grob's Mental Illness and American Society is based on prodigious research into a wide variety of both printed and manuscript sources and provides a far more thorough and wide-ranging account of the period it covers than his rival's. The period surveyed was a bleak one for American psychiatry, and the thrust of Grob's narrative constitutes a damning critique of mental health policy and mental health professionals in the period. In his portrait, the behavior of the psychiatric profession is largely dictated by its desire to preserve its monopoly and autonomy. It offered no therapies that were demonstrably effective, and its concept of mental disease rested for the most part on little more than a vague faith in future progress. Moreover, seeking new, extra-institutional markets for its wares, the profession began an implicit abandonment of the chronically crazy, the bulk of those nominally in need of its services. Within state systems increasingly preoccupied with cost containment, the existing monasteries of the mad grew ever larger, a development that reflected the silting up of the "hospitals" with the senile and decrepit.

Grob successfully demonstrates that the profession's status concerns prompted a persistent attempt to rationalize caretaking behavior in medical terms; an ambivalent and eventually hostile relationship with potential competitors (social workers, psychologists); an insistence by many on the biological bases of mental disorder, coupled with a penchant to make use of ill-tested, often dangerous, and generally worthless somatic treatments; and a cavalier dismissal of all criticism by outsiders (in the words of one eminent psychiatrist, "'laymanization' was synon-

[3] See David Rothman, "An Interview with David Rothman," Canadian Criminology Forum 4 (1982): 152–62.

[4] Gerald Grob, Mental Illness and American Society, 1875–1940 (Princeton: Princeton University Press, 1983).

ymous with 'ignorization'"). The impact of his analysis is weakened, however, by its embedment in a mass of dreary administrative-cuminstitutional history and by Grob's wearisome insistence (familiar to readers of his earlier book) that those in charge always acted with the best of motives, making untoward consequences at worst the result of inadvertence. Such a Panglossian view of the world has, in my judgment, a profoundly distorting impact on his vision. Rather than lamenting the "agonizing dilemma" facing psychiatrists who claimed expertise but were unable to cure, one ought surely to sympathize with the patients, subjected to agonizing treatments by those concerned overwhelmingly with protecting their shaky scientific legitimacy and privileged social status.^[5] Still, for those interested in the twentieth-century history of American psychiatry, both Grob and Rothman are required, if not always very lively, reading.

Progressive Dreams, Progressive Nightmares: Social Control in Twentieth Century America

One of the most notable features of recent historical literature about society's responses to its misfits—the criminal, the delinquent, and the mentally disturbed—has been the emerging sign of its break with the biases and distortions of Whig historiography. A new generation of historians, abandoning the prejudice that crime and craziness are somehow unworthy of serious scholarly attention, has begun to cast a more critical and jaundiced gaze upon the traditional portrait of society's ever more rational and benevolent response to the mad and the bad. If one leaves aside the idiosyncratic intellectual pyrotechnics of Michel Foucault ^[1] —who attempts a peculiar marriage of history and French structuralism in a style evocative of James Joyce at his most obscure—the most widely

[5] Recently, a number of scholars have begun to look seriously, rather than sensationally, at this fascination with somatic treatments. Of particular importance in this regard are Elliot Valenstein, Great and Desperate Cures (New York: Basic Books, 1986); and Jack David Pressman, "Uncertain Promise: Psychosurgery and Development of Scientific Psychiatry in America, 1935–1955" (Ph.D. dissertation, University of Pennsylvania, 1986). I am presently at work on a more wide-ranging history of somatic therapies in psychiatry, which will appear as Desperate Remedies . See also Andrew Scull, "Desperate Remedies: A Gothic Tale of Madness and Modern Medicine," Psychological Medicine 17 (1987): 561 –77.

[1] Michel Foucault, Discipline and Punish: The Birth of the Prison (New York: Pantheon; London: Allen Lane, 1977); idem, Madness and Civilization (New York: Pantheon, 1965).

read and influential revisionist has certainly been Columbia historian David J. Rothman.

Rothman's controversial The Discovery of the Asylum^[2] pioneered the new approach nearly a decade ago. His bold and sweeping interpretation of the origins and achievements of America's first penitentiaries, juvenile reformatories, and mental hospitals during the Jacksonian era attracted widespread attention,^[3] sparking a fierce debate that prompted others to undertake research on the history of social control. Most of this work has shared with The Discovery of the Asylum a concern with the origins and impact of major transformations in social control structures rather than focusing on the more mundane aspects of institutionalized repression.^[4]

In reentering the fray, Rothman maintains this tradition. His new book, Conscience and Convenience: The Asylum and Its Alternatives in Progressive America,^[5] is a sequel to his earlier study that deliberately leaves unexamined the years from the Civil War to the end of the nineteenth century: For Rothman, the Progressive era—1900–1920—marks the second "major divide" in American society "in attitudes and practices toward the deviant, creating new ideas and procedures to combat crime, delinquency, and mental illness."^[6] The changes, in their way as revolutionary as those of the Jacksonian era, mark a distinct shift in approach that survived, largely intact, into the mid- 1960s, only then to falter in the face of the "post-Progressive—indeed, anti-Progressive"^[7] —upheaval. Later in this essay, I shall argue that Rothman's approach is in certain important respects mistaken and shall examine his cautious endorsement of the current anti-Progressive revolution. I shall begin, however, by discussing the value as well as the limitations of his more concrete analysis.

That analysis begins with a brief sketch of the parlous state to which prisons and asylums had degenerated by the last decades of the nineteenth century. Even within a small compass, the recital is vivid and convincing enough. Prisons were at once lax and brutal, relying heavily on intimidation and torture to secure a measure of order. Those who ran afoul of the authorities might find themselves suspended from a cord

[2] David Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic (Boston: Little, Brown, 1971).

[3] See Chapter 2.

[4] See, for example, Michael lgnatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution, 1750–1850 (New York: Pantheon, 1978); and Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (London: Allen Lane; New York: St. Martin's Press, 1979).

[5] David Rothman, Conscience and Convenience: The Asylum and Its Alternatives in Progressive America (Boston: Little, Brown, 1980).

[6] Ibid., 43.

[7] Ibid., 12.

bound round their thumbs, left to dangle till the blood ran from their mouths and the physician supervising the business ordered them cut down. Or they might be strapped into a coffinlike box with holes drilled in the lid, which, when slowly filled with water, produced the impression (and sometimes the reality) of slow drowning. Asylums were mere storage bins for human refuse, filled with chronic "patients" who seldom returned to the outside world. Here, the insane, if not the victims of violent assault by attendants or fellow inmates, passively rotted away, often spending their days restrained by camisoles and straitjackets and their nights locked into covered cribs.

During the last third of the nineteenth century, knowledge of such conditions produced a measure of criticism. The strongest complaints came from members of the newly emerging profession of neurology, who urged that the asylum's inherent deficiencies were so far-reaching as to require that it be used only as a last resort. But neither this nor any other proposal for fundamental change received serious consideration. Remarkably, society as a whole remained confident of the basic appropriateness of institutional control.^[8]

In some quarters, the modest cost of incarceration was sufficient motive for perpetuating places that conveniently got rid of the inconvenient. But even those of more tender conscience could rationalize continued support of the existing system out of fear that the alternative to institutions was a still worse catalogue of horrors, or, more positively, out of a desperate collective illusion that prisons and asylums might still somehow rehabilitate and cure, a willed suspension of disbelief when confronted with claims like those of the Elmira Reformatory to reform "more than 80 percent of those who are sent there."^[9]

All at once, however, such justifications lost their persuasiveness. With quite "incredible speed,"^[10] there developed a crisis of institutional legitimacy that the Progressives "solved" by an equally rapid spasm of reform. They introduced strikingly similar "open-ended, informal, and highly flexible policies" and programs based on a heightened ideological concern to break with the "rigid, inflexible, and machine-like" qualities of inherited approaches.^[11] Within Progressive social thought, a variety of explanations for what causes deviance competed for attention: environmental, psychological, and genetic. Yet underlying each is an almost uni-

[8] See Andrew Scull, Decarceration: Community Treatment and the Deviant—A Radical View 2d ed. (Oxford: Polity Press; New Brunswick, N.J.: Rutgers University Press, 1984), 95–133; Bonnie Blustein, "A Hollow Square of Psychological Science: American Neurologists and Psychiatrists in Conflict," in Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadelphia: University of Pennsylvania Press; London: Athlone Press, 198l), 241—70.

[9] Rothman, Conscience and Convenience, 35.

[10] Ibid., 44.

[11] Ibid., 43.

versal convergence on the need for a discretionary response to the individual case, coupled with blithe self-confidence in the Progressives' own capacity to design effective forms of treatment. Central, too, is a naive and dangerous faith in the benevolence of the state and its agents—a faith that prompted the new generation of reformers to promote program after program widening the scope of state action.

To individualize the response to the criminal, Progressives sought to widen the range of treatments while granting the authorities greater freedom to match diagnosis to therapy. (Use of the medical metaphor grew apace, for it legitimized official discretion and the emphasis on individual variability.) They started by making probation a more and more popular courtroom disposition.^[12] For more serious offenders came parole and the indeterminate sentence, innovations by means of which "the prisoner becomes the arbiter of his own fate. He carries the key to the prison in his own pocket."^[13] In addition, the prison's internal routines were adapted to permit a more flexible response to the individual offender. By the early 1920s, almost half the state prison population were serving indeterminate sentences, and more than half the prisoners released were on parole.^[14]

In the sphere of juvenile justice, change came with similar speed. The juvenile court emerged in Chicago at the turn of the century, quickly spread nationwide, and "revolutionized social policy toward the delinquent"^[15] by abandoning punishment for rehabilitation to help the individual child and thereby contribute to the welfare of society. Redirecting the wayward required not a response to a single delinquent act, but a global reformation of character, using techniques expertly tailored to the requirements of the individual case. And if this meant abandoning procedural safeguards and granting extraordinary latitude to intervene, Progressive reformers were willing, indeed eager, to do so.

They were likewise eager to break away from overreliance on a single solution to the problems posed by mental disorder. Instead of a monolithic asylum system, they proposed a network of psychopathic hospitals providing expert diagnosis and intensive treatment for recent curable cases; a massive effort to provide outpatient clinics and aftercare services for those discharged from the hospitals; financial aid, augmented by psychological support and counseling; and a new emphasis on preventing the outbreak of mental disorder through public education in mental hygiene. Central to most of these services was a new group of professionals, the social workers.

[12] In 1900, only six states provided for probation. In 1915 alone, thirty-three states created or extended the procedure, and by 1920 every state permitted juvenile probation and thirty-three states adult probation, lbid, 44.

[13] Ibid., 69.

[14] Ibid., 44.

[15] Ibid., 205.

By far the best and most convincing part of Rothman's book is his analysis of the unholy alliance between reformist conscience and administrative convenience that supported Progressive innovations. He argues that the symbiotic relationship of these two elements accounts for both the rapid shift in public policy and the persistence of the new programs even when, measured by the reformers' own criteria, they proved to be abject failures.

On one side stood a rather shadowy and ill-defined assortment of benevolent and philanthropic men and women, disinterested "moral entrepreneurs"^[16] whose impulse to do good was matched by an entirely misplaced confidence that they had discovered the "civic medicine"^[17] with which to cure crime, delinquency, and insanity. These altruistic crusaders "marched under a very appealing banner, asking citizens not to do less for fear of harm, but to do more, confident of favorable results."^[18] Theirs were the ideological formulations so essential to promoting change, along with the rhetoric that provided a veneer of legitimacy for the Progressive reforms. But their proselytizing succeeded only because some curious allies stood on the other side: The administrators of the very programs being attacked were eager for quite different reasons to embrace the reformers' proposals.

In welcoming this conversion of the heathen, the reformers "were never deeply disturbed by the fact that administrative convenience had become so well served in their programs."^[19] This passivity was, as Rothman sees it, an error with appalling consequences: The professionals who oversaw the implementation of the reforms proceeded to make sure that the new programs served primarily their bureaucratic self-interests. If the reformers were blind to the uses to which their stress on "discretionary responses to each case"^[20] were put, the administrators clearly were not. Thus, the introduction of probation and the indeterminate sentence multiplied the inducements to "cop a plea," and plea bargaining enabled judges and prosecutors to shorten trials, ease crowded court calendars, and raise the conviction rate, as well as insulate both their own and police conduct from further judicial scrutiny and review. Prison wardens welcomed the combination of parole and the indeterminate sentence with open arms, for with it the "reformers had delivered into their hands a disciplinary mechanism far more potent than the lash, and not insignificantly, far more legitimate."^[21] The reformers might be con-

[16] See Howard S. Becker, Outsiders: Studies in the Sociology of Deviance (Glencoe, Ill.: Free Press, 1963), 147–63.

[17] The term was first used by the leading early twentieth-century American psychiatrist, Adolf Meyer. See his "Case Work in Social Service and Medical and Social Cooperation in Nervous and Mental Diseases," in The Collected Papers of Adolf Meyer, ed. Eunice E. Winters (Baltimore: Johns Hopkins University Press, 1952), 4:225, 227.

[18] Rothman, Conscience and Convenience, 5.

[19] Ibid., l0.

[20] Ibid., 6 (emphasis omitted).

[21] Ibid., 74.

vinced that they had placed the inmate's "destiny . . . largely in his own hands,"^[22] but the wardens (and their prisoners) knew better. And although these changes apparently diminished judicial authority by transferring sentencing power to an executive and administrative body, judges gained, too. The indeterminate sentence gave them "added freedom to dispense justice as they saw fit."^[23] And with the parole board as a buffer and whipping boy, judges could escape political criticism for prisoner recidivism.

Elsewhere, whether one looks to programs for the delinquent or for the mentally ill, Progressive innovations fared no better. In every setting, the reveries of reformist conscience were transmuted under the pressures of administrative convenience into harsh caricatures of themselves. They served merely to advance the self-interest of the caretaker-professionals, or, as with social work, virtually to create the profession that perpetuated them.

Progressive reformers, though not unaware of the bastardization of their programs, resisted acknowledging how far the process had gone. Recognizing that their achievements were only partial and flawed, they sought consolation in the belief that they had prevented the perpetuation of barbarism—to them, the stark and singular alternative to a leap aboard their bandwagon. Their very commitment to the idea of progress and their own self-appointed role as its agents effectively blocked any alternative perception, and left them convinced that present horrors were at least less awful than those of the past. Finally, if all else failed, such horrors could always be attributed to improper implementation of Progressive programs, reflecting "not faulty conceptualization but inadequate funding."^[24]

But Rothman is determined to deny the progressives and their present-day apologists even this limited miserable measure of consolation. For him, their whole enterprise was unworkable from the outset, resting as it did on the fatally mistaken assumption that institutions "could coexist with, and even sponsor, non-institutional programs."^[25] This was a lesson the reformers simply would not learn, remaining heedless of their limitations and of the need to reconsider the premises of their programs in the wake of failure. "One searches in vain," as Rothman puts it, "for any thorough reappraisal of the Progressive ideology or any coherent effort to review reform postulates in the light of their marginal relationship to actual practices."^[26] In one of those cruel ironies with which the history of social control abounds, the consequence was that their ever-so-benevolently intended "reforms" only gave a further twist to the vicious logic of the existing system. Because they blithely substituted good inten-

[22] Ibid., 69.

[23] Ibid., 77.

[24] Ibid., 289.

[25] Ibid., 12.

[26] Ibid., 288.

tions for knowledge and continued to give a cloak of humanity and legitimacy to the Frankensteinian monster that emerged from their blueprints, the Progressives must bear a large measure of responsibility for the nightmares they created.

Historians of social reform have traditionally taken ideology very seriously. Indeed, they have been all too prone simply to reproduce it. Their work presents an elaborate morality play that, couched in the reformers' own rhetoric, attends earnestly to expressed intentions and scarcely at all to results. By forcing a sustained examination of the neglected gaps between rhetoric and reality, Rothman has done as much as anyone to debunk these pious myths and to invalidate the general approach on which they rest. Yet, despite the very different conclusions he reaches about the nature and outcome of reform, he ultimately shares earlier historians' convictions about the centrality of ideology in historical explanation.

The account he offers of the Jacksonian discovery of the asylum in his earlier book^[27] is an essentially intentionalist one, in which the new institutions emerge out of the reformers' fears for the stability of the social order and their sense that asylums to "control abnormal behavior promised to be the first step in establishing a new system for stabilizing the community, for binding citizens together."^[28] When he turns to examine the invention of probation, parole, outpatient care, and the juvenile court in the Progressive era, again his primary emphasis is on "the rhetoric of the reformers—for it is here that one will find the strongest clues to the origins of the changes and sources of their success, their legitimation if you will."^[29] Rothman is remarkably adept at capturing the hopes and fears of the reformers and at revealing nuances in their thought that have escaped earlier observers. At least in Conscience and Convenience, his examination of the fit between reformist conscience and administrative convenience moves beyond a fixation with ideas and goes some distance toward explaining why these ideas found a wider audience and were enacted so swiftly. To a significant extent, however, he remains trapped within the limitations of a fundamentally idealist worldview, and to that degree his explanations are necessarily flawed and incomplete.

The Discovery of the Asylum begins with the admonition that "institutions, whether social, political, or economic, cannot be understood apart from the society in which they flourished. The sturdy walls of the asylum were intended to isolate the inmates, not the historian."^[30] But both here and in Conscience and Convenience, Rothman's admirable methodological

[27] Rothman, Discovery of the Asylum .

[28] Ibid., 58–59.

[29] David Rothman, "Social Control: The Uses and Abuses of the Concept in the History of Incarceration," in Social Control and the State: Historical and Comparative Essays, ed. Stanley Cohen and Andrew Scull (Oxford: Basil Blackwell; New York: St. Martin's Press, 1981), 106–17.

[30] Rothman, Discovery of the Asylum, xx.

prescription has a scarcely discernible impact on his own analysis. In neither book does the larger social environment that both spawned and shaped reform receive the attention it warrants. Ideas remain free-floating, and change remains the product of "the power of the rhetoric"^[31] the reformers invent; both remain stubbornly unanchored in underlying transformations of social structures and practices. Beyond the occasional feeble gesture—a quasi-magical invocation of economic and demographic change or passing reference to immigration, the ghetto, and the settlement house (but scarcely a mention of class or race)—little dispels the illusion that the entire outcome rests on the rhetorical skills of a collection of moral entrepreneurs, allied with the bureaucratic self-interest of institutional administrators.

The crucial causal variable in The Discovery of the Asylum is allegedly a peculiarly American anxiety about the stability of the social order.^[32] In the book's sequel, the reform program centers on the virtues of flexibility, discretion, and the expertly tailored response to the individual case. In neither instance are matters pursued much further. It is as though such items as anxiety and optimism constituted primitive logical terms not susceptible of further examination or investigation; as though, in this instance at least, analysis must stop at the level of the reformers' presentation of self. But of course they are not and it cannot. One wants to know, for example, which segments of Jacksonian society felt anxious, about what, and why. One wonders to what extent all the talk of looming disorder and the promotion of the institutions' reformatory functions can be understood as the rhetoric of a particular social group, who employed it for particular polemical purposes: Similarly with the Progressives' positivism: their naive sense that the facts would speak for themselves; their belief that everything was adjustable, that there were no irreconcilable conflicts of interest; and their abandonment of laissez-faire for a new ideology of expertly guided state intervention to correct the imbalances and imperfections of the social system. These should mark the starting point of the search for understanding, not its culmination.

The two books share a further defect, an odd and perverse ethnocentrism. Rothman's insistence on viewing the invention of the penitentiary and the asylum as a uniquely American phenomenon was one of the bolder features of his earlier work. It is also an idea that has been subjected to withering criticism and must now be recognized as simply untenable.^[33] Yet, in David Brion Davis' words, the analysis in Conscience and

[31] Rothman, Conscience and Convenience, 215.

[32] See Rothman, Discovery of the Asylum , xviii–xx.

[33] See, for example, Richard Fox, "Beyond Social Control: Institutions and Disorder in Bourgeois Society," History of Education Quarterly 16 (1976): 203–7; Jacques Quen, "David Rothman's Discovery of the Asylum," Journal of Psychiatry and the Law 2 (1974): 105; Scull, Museums of Madness , passim; and Chapter 5 above.

Convenience continues to exhibit an "almost defiant indifference to European influences and parallels"^[34] and to proceed as though American developments can be examined in a vacuum. Other than the dearth of research on the European materials, it is difficult to understand why Rothman persists in this stance. But certainly the lapse is unfortunate, for a comparative perspective often points up the shallowness and inadequacy of solipsistic cultural "explanations" and may help uncover some of the underlying structural sources of social change.

By choosing to emphasize ideology so heavily, Rothman is led to misconstrue, and to overestimate, the significance of Progressive reforms. As we have seen,^[35] he presents the changes introduced in this period as if they were of revolutionary importance—a major shift that ranks, along with the discovery of the asylum and its contemporary demise, as one of the three major watersheds in the history of social control in America. At the level of rhetoric, such a judgment is perhaps defensible. Semantically, the transformations made in the Progressive era mark a sharp break with the past. Their emphasis on procedural informality and discretion and on a highly differentiated response to the individual case is combined with savage criticism of the very different practices inherited from the nineteenth century. But even at the outset, doubts arise. For although the distinctions between Progressive rhetoric and Jacksonian practice seem clear enough, the differences are not well marked when one's point of comparison is what the early-nineteenth-century reformers claimed to be doing. For example, their program for rescuing the mad from maltreatment leaned heavily upon a set of principles largely borrowed from abroad, known collectively as "moral treatment," that broke with a prior emphasis on indiscriminate mass medication and insisted on a flexible, noncoercive approach to curing the mad, carefully tailored to the individual case and dispensed by an asylum administrator armed with wide discretionary powers.^[36]

If the Progressives were not quite as distinctive ideologically as Rothman implies, their practice was even less so. Though he resolutely avoids confronting the implications of his findings, Rothman himself presents a remarkable array of evidence that demonstrates that most of the Progressive reformers' sound and fury in reality signified nothing: "therapeutic innovations had little effect on prison routines" and "change never moved beyond the superficial."^[37]

[34] David Brion Davis, "The Crime of Reform," New York Review of Books, 26 June 1980, 16.

[35] See p. 253.

[36] See, generally, Norman Dain, Concepts of Insanity in the United States, 1789–1865 (New Brunswick, N.J.: Rutgers University Press, 1964); Gerald Grob, Mental Institutions in America (New York: Free Press, 1973); and Chapter 5 above.

[37] Rothman, Conscience and Convenience, 133–34.

Reform on occasion did not even penetrate skin deep, as with the changeover from striped convict uniforms to more ordinary dress. Even when some new amenities were allowed—more exercise, more frequent visitors—the fundamental realities of prison life remained unaltered. The Progressive reformers' dream, "that they could transform a nightmarish prison, dedicated to punishment, into a community that would at once prepare the inmate for release and serve as a testing ground for society,"^[38] echoed the reveries of their Jacksonian counterparts. Reality once again proved brutally recalcitrant.

Nor did alternative, noninstitutional programs fare much better. Probation was scarcely more than a sham in all but densely populated areas.^[39] And even there, "the actual results were pitiful."^[40] Conditions in the system "not only made the fulfillment of case work principles well nigh impossible, [they] also prevented probation from carrying out a meaningful police function."^[41]

Examination of the juvenile justice system also reveals a litany of failure. Again and again, Rothman returns to the token quality of the Progressive emphasis on individualization, psychiatric guidance, and intervention, and to the persistence within institutions' walls of quasi-military routines not essentially different from those that characterized the Jacksonian asylum system. All of the reformers' brave words about breaking with the ugliness and failures of the past had little practical effect.^[42] At best, "the rhetoric of treatment provided only the external trappings. Inside, incapacitation and deterrence ruled, as befit a holding operation." ^[43]

Finally, the gap between the Progressives' ambitions and prosaic reality was nowhere greater than in the sphere of mental health.^[44] Only a handful of the network of psychopathic hospitals the reformers had envisaged were actually built. And, rather than serving as the core of intensive treatment and mental hygiene programs, they became little more than handmaidens to the traditional asylum system—"diagnostic centers" that were but "a first stop on the road to the state hospital,"^[45] for they made no sustained effort to treat or cure, but simply smoothed away

[38] Ibid., 127.

[39] "The translation bore very little resemblance to the original text. [It was] implemented in a most superficial, routine, and careless fashion [and] never did take root in rural areas or small towns. . . . In fact only densely populated areas established probation departments" (ibid., 83).

[40] Ibid., 84.

[41] Ibid., 91.

[42] "The ideals that justified incarceration had little relevance to actual circumstances. No matter how frequently juvenile court judges insisted that their sentences of confinement were for treatment and not punishment, no matter how vehemently superintendents declared that their institutions were rehabilitative and not correctional, conditions at training schools belied these claims" (ibid., 268).

[43] Ibid., 283.

[44] Ibid., 324.

[45] Ibid., 326.

obstacles to easy commitment. "The effort to extend the reach of treatment and the principles of prevention into the community"^[46] was likewise a dismal failure. Forced to compete for the same funds as the long-established state hospitals, while threatening to deprive them of the very patients whose labor contributed most to their low operating costs, such programs never had much chance of success. They were all but killed off by opposition from patients' families and from the community at large. Asylums endured, "and [their] needs shaped the outcome of all reform ventures."^[47]

From many perspectives, then, the transformations of the Progressive era were little more than another episode in the saga of reform by word magic. Houses of refuge now became training schools or industrial schools; prisons were renamed reformatories or correctional institutes; asylums turned into mental hospitals. Euphemisms abounded, papering over the degree to which "reform" left the underlying nineteenth-century structures largely untouched.

In developing his critique of the reformers' failures, Rothman unwittingly undermines his own claims for the revolutionary significance of Progressive reform. Not that the ideological changes he analyzes are without significance; the greater emphasis placed on medical and therapeutic rhetoric did indeed help legitimize a policy of ever greater intervention. And probation and parole were important innovations, however far they departed from the reformers' intentions, and however halfhearted their implementation. Probation in particular "expanded the scope of state action and state surveillance," and though its potential for coercion "was never realized" fully, probation "did have serious consequences for civil liberties."^[48] Such innovations widened the net and subjected new segments of the population to the risks of arbitrary state action; but they supplemented, rather than revolutionized, existing arrangements.

Rothman believes that one can learn from history; his work is self-consciously intended to speak to an audience far beyond those specializing in the social history of Jacksonian and Progressive America. It is "the enterprise of reform"^[49] as a whole that he seeks to illuminate, and his goal "is to inform both history and social policy, to analyze a revolution in practice that has an immediate relevance to present concerns."^[50] Judging by the extraordinary attention his work has attracted, he has certainly succeeded in reaching that wider audience. But what of the lessons he seeks to teach?

On one point Rothman is adamant: Notwithstanding the failures and disappointments of past attempts at reform, he will have no truck with pessimism, with those who argue that the whole enterprise is "at best

[46] Ibid., 360.

[47] Ibid., 395.

[48] Ibid., 112.

[49] Ibid., 5.

foolhardy, at worst deceptive."^[51] He is particularly eager to distinguish his position from that of Foucault, with whom he has often been lumped as a "revisionist" or "social control" historian. Unlike Foucault, he cannot accept the portrait of an inevitable and progressive intensification of discipline in an ever more rationalized capitalist society. On the contrary, to Rothman, the history of reform is of a process in which "choices were made, decisions reached; and to appreciate the dynamic is to be able to recognize the opportunity to affect it. . . . There is much more room for maneuver than a Foucault could ever imagine or allow."^[52]

The insistence that "men make their own history"^[53] is a welcome and necessary corrective to the narrow structural determinism now in vogue in certain historical circles,^[54] but only so long as one remembers the other half of Marx's famous aphorism: that "they do not make it just as they please; they do not make it under circumstances chosen by themselves" but as conditioned by and in the context of a particular historical inheritance and set of structural possibilities.^[55] As I have already suggested, Rothman is all too inclined to neglect structural factors. Precisely because he accords such a critical role to ideology, he readily assumes that had the reformers' zeal about eliminating the horrors of the Jacksonian asylum been more thoroughgoing, instead of falling into the egregious error of strengthening the segregative institutions he finds so loathsome, they would have destroyed them.

I think he is mistaken in this assumption. Institutional structures are far less malleable than the conceptual edifices constructed by intellectuals, even though the latter can prove resistant enough to modification and change. Notwithstanding Rothman's criticism of the Progressives for remaining wedded to the foolish notion that "the appropriate task was to reform incarceration, not to launch a fundamental attack upon it,"^[56] it is not at all clear how they could have done otherwise.^[57] And it is even less clear that, had they concluded that more radical change was essential, they could possibly have secured the enactment of their program. Rothman's reproaches here rest on arguments that are not properly spelled out, let alone explored through systematic empirical analysis.

[51] Ibid., 11.

[52] Ibid.

[53] Karl Marx, "The Eighteenth Brumaire of Louis Napoleon," reprinted in Karl Marx: Selected Writings, ed. David McLellan (London: Oxford University Press, 1977), 300.

[54] See, generally, E. P. Thompson, The Poverty of Theory and Other Essays (New York: Monthly Review Press, 1978).

[55] Marx, "Eighteenth Brumaire," 300. In his own words, "The tradition of all the dead generations weighs like a nightmare on the brains of the living."

[56] Rothman, Conscience and Convenience, 29.

[57] Certainly the claim that they should have taken "inspiration from the fact that incarceration was a relatively recent invention and therefore properly approached with skepticism" (ibid.) will not suffice to demonstrate the point.

Mutatis mutandis, the same can be said of his somewhat cautious endorsement of the anti-Progressive reforms advanced by contemporary men of conscience. Despite his insistence on learning from the past, Rothman is remarkably coy about suggesting a "platform for reform."^[58] Or perhaps it is rather that any program he could suggest would be a negative one, whose central theme would be the need to avoid the hubris that bedevils reformers. Like sociologists before him,^[59] Rothman has perceived that punishment and therapy are ultimately irreconcilable, and that in any attempt to combine them, the winner is predestined: "When treatment and coercion [meet], coercion [wins]."^[60] He has also grasped, though the point is not as novel as he implies, that institutional control systems necessarily rest on hierarchical levels of coercion.^[61] Still, he elegantly demonstrates that the problem is "not that we cannot here or there run one decent institution; [but] rather, that the decency of any one place rests ultimately . . . upon the presence of a still more coercive back-up."^[62]

What distinguishes us from the Progressives, apparently, is not our greater knowledge of how to do good. Rather, it is our recognition that we lack such knowledge, and our realization of the harm that can result should we attempt to substitute good intentions for it. Anti-Progressives have learned—partly from Rothman's prior work—the "limits of benevolence"^[63] and the dangers of expanding the boundaries of discretionary state action.

Thus, on Rothman's account, the current wave of reform—the attempt to decarcerate prisoners and patients^[64] —is again to be explained by changes at the level of ideas: our recognition that institutions for the deviant are irredeemably nasty, counterproductive places; our willingness to abandon the chimera of combining reformation and punishment; our sense of the need to restrict the scope of state power. Unlike the case of the Progressives, our quarrel with the principle of incarceration is a fundamental one, and our programs of community corrections and community-based treatment of the mentally ill are replacements for, not supplements of, old institutions.

[58] Ibid., 11.

[59] See, for example, American Friends Service Committee, Struggle for Justice (New York: Hill and Wang, 1971); Jessica Mitford, Kind and Usual Punishment: The Prison Business (New York: Knopf, 1973).

[60] Rothman, Conscience and Convenience, 10.

[61] See, for instance, Erring Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, N.Y.: Doubleday, 196l); S. Messinger, "Strategies of Control" (Ph.D. dissertation, University of California, Berkeley, 1968).

[62] Rothman, Conscience and Convenience, 420.

[63] W. Gaylin et al., Doing Good: The Limits of Benevolence (New York: Pantheon, 1978).

[64] David Rothman, "Decarcerating Prisoners and Patients," Civil Liberties Review 1 (1973): 8–30.

This is not the place to argue in detail that Rothman's explanation of the genesis of contemporary reforms is fundamentally mistaken.^[65] It is curious, however, that Rothman should be so willing to take contemporary reform movements at their own estimation and, like the Progressives before him, be so convinced of the horrors of past practices as to be certain beyond doubt that change must be for the better. Nor does he seriously appear to entertain the possibility that new forms of administrative convenience may play a crucial role in the success of contemporary men of conscience.

Yet, calls for retrenchment and cutbacks have an obvious attraction for state managers in periods of acute fiscal crisis, the more so if reductions in expenditures can simultaneously be portrayed as a splendid humanitarian gesture. Who can be surprised, therefore, that the new generation of reformers has met with such a friendly reception? For the mentally ill, at least, states have been only too willing to grant the negative right to be left alone, to be free from the obvious coercion that involuntary hospitalization represents. Neglect, after all, is cheaper than care, even at the minimal level traditionally provided by our state hospitals. Unfortunately, though, "there is no primal Arcady into which the mental patient can slip away from modern institutions of care and intervention. If he slips anywhere away from it at all, it will be into the gutter or the graveyard" or, perhaps worse, into the hands of the burgeoning class of entrepreneurs and professionals speculating in this form of human misery.^[66] Benevolence here is limited indeed!^[67]

[65] For a full discussion, see Scull, Decarceration .

[66] The quotation is from Peter Sedgwick's stimulating Psychopolitics (New York: Harper and Row; London: Pluto Press, 1982), 146. On the new use of the mad as a source of profit, see, for example, Senate Special Committee on Aging, Subcommittee on Long-Term Care, 94th Cong., 2d sess. 1976, Nursing Home Care in the United States: Failure in Public Policy, Support Paper no. 7, The Role of Nursing Homes' in Caring for Discharged Mental Patients, Committee Print; Comptroller General of the United States, Returning the Mentally Disabled to the Community: Government Needs to Do More (Washington, D.C.: Government Printing Office, 1977); A. Davis, S. Dinitz, and B. Pasamanick, Schizophrenia in the New Custodial Community (Columbus: Ohio State University Press, 1974); F. Arnhoff, "Social Consequences of Policy Toward Mental Illness," Science 188 (1975): 1277–81; E. Bassuk and S. Gerson, "Deinstitutionalization and Mental Health Services," Scientific American 238 (1978): 46–53; J. Chase, "Where Have All the Patients Gone?" Human Behavior (1973): 14–21; S. Kirk and M. Thierren, "Community Mental Health Myths and the Fate of Former Hospitalized Patients," Psychiatry 38 (1975): 209–17; H.R. Lamb and V. Goertzel, "Discharged Mental Patients—Are They Really in the Community?" Archives of General Psychiatry 24 (1971): 29–34; John Monahan, "Three Lingering Issues," in Patient Rights and Patient Advocacy: Issues and Evidence, ed. Bernard L. Bloom and Shirley J. Asher (New York: Plenum, 1981); Andrew Scull, "Deinstitutionalization and the Rights of the Deviant," Journal of Social Issues 37 (1981): 6–20; J. Wolpert and E. Wolpert, "The Relocation of Released Mental Patients into Residential Communities," Policy Sciences 7 (1976): 31–51.

[67] See generally Gaylin et al., Doing Good .

Since nonintervention in the penal context would clearly raise serious social and political problems,^[68] it is scarcely surprising that, for criminals and delinquents, community disapproval of alternatives to incarceration has proven as solid as it was in the Progressive era. In this setting, the reformers' conscience has once again been no match for the occupational interests of correctional and prison employees and administrators, or for public demands, partly instrumental and partly symbolic, for sterner measures to stop increasing crime. Despite rhetorical claims to the contrary, "the major results of the new movement towards 'community' and 'diversion' have been to increase the amount of intervention directed at many groups of deviants in the system and, probably, to increase rather than decrease the total number who get into the system in the first place. In other words: 'alternatives' become not alternatives at all, but new programs that supplement the existing system or else expand it by attracting new populations."^[69]

In the very first pages of Conscience and Convenience, Rothman confronts the question of whether Progressive innovations were better than the procedures that they replaced. To his credit, he provides a forthright answer: no, they were not. "Progressive innovations may well have done less to upgrade dismal conditions than they did to create nightmares of their own."^[70]

Plus ça change, plus c'est la même chose?

[68] Cf. Edwin Schur, Radical Non-intervention (Englewood Cliffs, NJ.: Prentice-Hall, 1975).

[69] Stanley Cohen, "The Punitive City: Notes on the Dispersal of Social Control," Contemporary Crises 3 (1979): 337, 347. See, generally, Paul Lerman, Community Treatment and Social Control (Chicago: University of Chicago Press, 1975); Norval Morris, The Future of Imprisonment (Chicago: University of Chicago Press, 1974); Thomas Blomberg, "Diversion and Accelerated Social Control," Journal of Criminal Law and Criminology 68 (1977): 274–82; Andrew Scull, "Community Corrections: Panacea, Progress, or Pretence?" in The Politics of Legal Informalism, ed. Richard Abel, vol. l (New York: Academic Press, 1981); 99–118; Sheldon Messinger, "Confinement in the Community," Journal of Research in Crime and Delinquency 13 (1976): 82–92.

[70] Rothman, Conscience and Convenience, 9.