Acts of Conscience: World War II, Mental Institutions, and Religious Objectors.
Article Type: Book review
Subject: Books (Book reviews)
Author: Longmore, Paul K.
Pub Date: 06/22/2011
Publication: Name: Journal of Social History Publisher: Journal of Social History Audience: Academic Format: Magazine/Journal Subject: History; Sociology and social work Copyright: COPYRIGHT 2011 Journal of Social History ISSN: 0022-4529
Issue: Date: Summer, 2011 Source Volume: 44 Source Issue: 4
Topic: NamedWork: Acts of Conscience: World War II, Mental Institutions, and Religious Objectors (Nonfiction work)
Persons: Reviewee: Taylor, Steven J.
Accession Number: 260583119
Full Text: Acts of Conscience: World War II, Mental Institutions, and Religious Objectors. By Steven J. Taylor (Syracuse: Syracuse University Press, 2009. xv + 484 pp. $45.00).

Social justice efforts are often discontinuous. Campaigns arise and disappear without connection to preceding or succeeding activism. During and just after World War II, one such effort sought to reform institutions incarcerating "mentally ill" and "mentally defective" people. The federal Civilian Public Service (CPS) managed alternative service for 11,996 conscientious objectors. In response to wartime labor shortages and because these men requested to perform humanitarian public service, Selective Service eventually allowed some to work in "detached units." These included approximately 3,000 COs working as ward attendants or in other jobs at hospitals for the "mentally ill" and training schools for the "mentally defective." This group is the subject of Steven Taylor's exhaustively researched study.

Wartime labor and material shortages made institutional conditions even worse than before the war. To replace staffers who were drafted or went to work in higher-paying defense industries, institutions often hired untrained and irresponsible workers, and even alcoholic drifters, who managed institutional wards with violent, abusive methods, not only straitjackets and other harsh restraints, but fists, clubs, and hoses filled with buckshot. Material shortages also reduced already desperately inadequate supplies of clothing, cleaning materials, and other essentials.

Some COs filed complaints with hospital administrators, local and state government agencies, and community leaders. Sometimes local leaders, local and regional newspapers, and other individuals backed their calls for reform. But often officials and veterans groups denounced the pacifists as slackers and troublemakers. Four of the COs assigned to the Philadelphia State Hospital proposed a CPS Mental Hygiene Program. It published a newsletter and training materials outlining the proper care of patients. The leaders also solicited COs at other institutions to write accounts based on their observations. Drawing on more than 1,000 such reports, they compiled a comprehensive overview of institutional conditions. As the CPS came to a close in 1946, they secretly planned to publish that critical examination of public institutions throughout the U.S.

They also contacted journalists. Albert Deutsch of New York's P.M. newspaper and Albert Q. Maisel of Life magazine read the COs' reports. In April 1946, Deutsch wrote an expose of Philadelphia State Hospital and Cleveland State Hospital. In May, Life published Maisel's disturbing overview of mental hospitals across the country. In 1948, Deutsch gathered his investigations into a book, The Shame of the States. These and other media reports alerted the public to the shocking situations in hospitals and training centers.

Meanwhile, the discharged COs launched the National Mental Health Foundation which in 1947 published Out Of Sight, Out Of Mind, based on the COs' accounts. Reporting on conditions and treatment at forty-six unnamed mental hospitals, the book documented instances of medical neglect, indifference, cruelty, brutality, and death. News stories about the Foundation, its activities and report, appeared in Time, Newsweek, and newspapers around the country, describing understaffing and overcrowding, infectious diseases and infestations by vermin and parasites, and injuries and abuses by staff members. As Taylor explains, these facilities were what sociologist Erving Goffman called "total institutions." Completely self-sustaining and cut off from the larger society, they also stripped inmates of any markers of personal identity and produced the behaviors professionals identified as symptoms of mental disturbance and then presented as diagnoses to justify institutionalization and coercive treatment.

When CPS authorized the Mental Hygiene program it required oversight by medical experts. The CO leaders persuaded the National Committee for Mental Hygiene to sponsor it. NCMH's history highlighted the major obstacle to institutional reform. Its founder, Clifford Beers had written A Mind That Found Itself (1909), a shocking account of his own institutionalization in a mental hospital in the first decade of the century. He set up the Committee to campaign for the mental hospital reform. It later expanded its scope to include "mental defectives." But medical professionals who controlled the hospitals and training schools came to dominate NCMH's work. They resented and resisted public exposure of institutional conditions. When they began to acknowledge problems in the late 1940s, they attributed them to inadequate funding and public indifference.

In 1946, with discontinuance of the Mental Hygiene Program, the COs launched the NMHF to reform institutions. Suspicious of both the NCMH and the American Psychiatric Association, they nonetheless had to work with those organizations. NMHF struggled throughout its brief history with financial problems. The founding staff members also lost control to business and civic leaders who took over the Board of Directors. In 1950, NMHF was merged with NCMH and the Psychiatric Foundation to become the National Association for Mental Health. Dominated by medical professionals, it shifted priorities away from institutional reform. The COs' efforts were forgotten, but in the coming years some states did significantly boost funding for their mental hospitals.

But that, argues Taylor, was exactly the limitation of their agenda. They aimed to improve institutional care, not to propose alternatives to institutionalization. Many of their ideas reappeared in later reform efforts, though there was no connection to the COs' campaign. More important, reformers in the late 1960s and 1970s concluded that institutions were inevitably oppressive and should be abolished in favor of community-based alternatives. Later movements also involved former patients and their families, not just institutional workers. The psychiatric survivors movement and organizations such as the Association for Retarded Citizens and the self-advocacy group People First, reflected a much larger constituency with a personal stake that made their activism more effective politically. Allying with reform-minded professionals, they also had a greater impact on professional practices. For example, in the field of mental retardation new thinking rejected institutions as "retarding environments" and promoted "normalization." Meanwhile, the writings of radical psychiatrists R.D. Laing and Theodore Szasz, sociologist Erving Goffman, and labeling theorists bolstered the anti-institution movement.

By focusing on events of the 1940s and early 1950s, Taylor fills an important gap in the history of mental institutions. By examining the limitations of that era's reform effort, he helps us understand better the subsequent anti-institution movements.

Paul K. Longmore

San Francisco State University
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.