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Related Topics
Conscience and ConvenienceReview - Conscience and Convenience
The Asylum and Its Alternatives in Progressive America
by David J. Rothman
Walter de Gruyter, 2002
Review by Colin A. Holmes, Ph.D.
Sep 30th 2003 (Volume 7, Issue 40)

This is a reprint, with one new chapter, of the 1971 classic by a highly respected historian, and the merits of the original material have been well-documented. It is a book about incarceration in America in the period 1900-1965, and thus primarily about society's response to offenders, rather than the mentally disordered, although it includes two chapters on 'mental health'. It is full of historical detail and finely crafted snapshots that will be fascinating for most readers, although Rothman's cynical tone may infuriate those who do not they share his critical assumptions. These assumptions revolve around the view that the response to crime ought to be exclusively therapeutic or rehabilitative, and that institutional care of any kind is inappropriate for people who are mentally disordered. As one who does not entirely share this perspective, I had the feeling that the steady stream of data had been painstakingly selected in order to depict the systems, policies, actions and values of the past as negatively as possible. Rothman's habit of generalizing from specific instances of abuse and mismanagement, albeit minutely described, to whole systems, is worrying in a professional historian, and reinforced my feeling that his 'position' had been established in advance and that his historical investigation was merely an exercise in self-justification rather than the creation of an account based on weighing all the evidence.

Certainly, Rothman's style gives me the impression of a 'mind set' out to prove a point, even if it means ignoring contrary evidence. It is a mind set which can see no good in the dedication and efforts of people who have worked with and for the incarcerated over the years, despite the fact that the constraints under which they worked are presented in detail. There are no kind words for the visionary, the self-sacrificing, or even the mass of simply well-intentioned people, involved in this history. The people who ran the mental hospitals were all uncaring and sought to promote only their own interests; prison staff were all paranoid, cruel and uncooperative; bureaucrats were all playing politics, deaf to the pleas of the managers of institutions, and blind to the evidence about the institutions' problems. Their practices and policies were uniformly inadequate, counterproductive or covertly self-serving, and in the final analysis can be dismissed as having "failed". The plethora of recent histories in this area provide ample evidence that this is an unfair assessment, and that there are many counter-examples.

It is difficult to be positive about the book, despite the high regard in which Professor Rothman is widely held. It demonstrates very clearly, for example, why it is unhelpful to mix accounts of the mental health system with those of the corrections system. To be sure, there are some interesting crossovers and parallels, but their histories are quite different. Even what we might count as 'failure' and 'success' differ; the 'external' factors impacting upon the two systems differ; and, despite Rothman's efforts to psychiatrize prisons and prisonize mental hospitals, their philosophies, objectives and methods are fundamentally different. Furthermore, in choosing to exploit their similarities and include both in his history, Rothman takes on a massive challenge which exposes serious limitations in the book. He inevitably overlooks important aspects of one or other system. He ignores the profound impact that psychotropic medication had when it was introduced in the 1950s, for example, and he ignores developments in sociological, criminological and penological thinking, and the rapidly expanding knowledge base and its impact on correctional and judicial practice during the 1950s and 60s. He ignores developments in law, which imposed increasing regulation and more ambitious standards upon prisons, hospitals and similar institutions, and which gradually laid a foundation for subsequent legislation recognizing the rights of the incarcerated individual. Rothman's depiction of 'progressive America' is ultimately parochial because he also fails to locate it within the wider picture. He fails to look beyond America's shoreline at what was happening elsewhere, and to interpret the American experience in terms of its intellectual contexts, despite the links implied in the 'conscience' and 'convenience' of his title.

As to the new edition, I wish I could be complimentary, but the additional 'Epilogue' is disappointingly brief and deals only with crime, in particular the reasons for the dramatic fall in the rates in New York City in the 1990s. It would have been interesting to read Rothman's take on the developments in mental health services -- the rise of forensic psychiatry, the development of community mental health centres, community treatment orders and early intervention programmes, for example, and on some of the other developments such as the sexual predator laws, sex offender treatment programmes, drug/mental health courts and 'therapeutic jurisprudence'. Maybe they would have been problematic for his committed 'position', maybe there simply wasn't room in what is already a long book. Whatever the reason, Rothman simply notes the continuing expansion of the US prison population and approvingly cites voices calling for alternatives, but -- as in the rest of the book -- he offers no suggestions as to what these alternatives should be, let alone on what grounds we should think they would be an improvement.

 

2003 Colin A. Holmes

 

Dr Colin A Holmes, School of Nursing Sciences, James Cook University, Townsville, Queensland, AUSTRALIA


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