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

Categories: Philosophical, MentalHealth