An Essay on the Division of Expert Labor

Andrew Abbott

The University of Chicago Press

Chica@ and London

nte Universtty of ChiPres, Chica* a0637 The UniversiQ of C h k ~ Press, o Ltd., Lotidon
" i 1988 by T k University 4Chi-ago al ri&ts reserved. Pub'shd 15388 Printed in &-a United States o l A m +
W % % o t 9 ~ 1 ) 5 @ 1 9 0 8 9 8 8 W 1

I i b q nf Congres Gataoptng-in-Publicstion Data

BibIiwa&y: p. f ncludes index.

Crwt BriLain.

I. Prafessions-United St.ates. S. Pmfessons3. Pmfessions-Eump. f . Title. HD80".tiSAPjiB 1 W 331.7'18'09 8 7 ISBN S-0006Wf

Preface
1 Introduction The Profes&ns Literature 3 The Concept Cases of ProfesSu7d I e u e b m n t 20

2 Pmfessional Work

3 The Claim of Jurisdictian Audiences 59 S m k n t s 69 fntarnal Structure 79

4 The System of Professians The Insp~icatbns of Exclwion: A Systm of Professions 86 Sources of System Iisturbanees 91 The Machanisms oflunsdiction Shifi: Abstraetion 98 Conelusion 111

5 Internd Differen~aaon and the Pmblem sf Pwer lnternal Sbraefieation 118 C1'iC.n~ D$firent&tMn 122 Worklace, Work&ce S t w u r e , and I n t e d

117

Cart?ar Partem 129 Power 134

6 T h e Social Envimanent of Prtlfessional

Devebpment

143

Forces Opening and C&ng JunSdMions 144 Tke Z n t e d Organizntton ofProf@s&na Work 150 Changing AudiencesforJuTisd~mI C k 4 m 157 Co-optabte P m r s , Oiigarchy, ami the New C k 167

Changas in the Orgaanization ofIc'mb&e 177 New of legitima@ 184 The Rise of Unioer&ties 195

8 %e Information Professians

Thic Qualitaeue Task Area 21 7 Tht: Qwintitatiue T s k Area 226 Tke CombinedJunsdiclion 239

10 The Canshuction af the Personal ProbIems Jursdiction The Status of Personal P r o b b , f B50- 75 281

On a brave spring morning in 1973, 1 cat with two psychatrists in the oEce of John R. Collier, superintendent of Illinoisk Manteno State Hospital. After ayear observing rhe use of ps-hiatric knowledge in an ouwtient clinic, 1 was now ready to matyze the s-ger world of the mentaf hospital. F k n d s had introdueed me to David Turner and David Klass, consultant specialists at Mmteno, the great chronic hospital that anchored the Illinois state mentaf health system. The plwx overwhelnted me. Dozens of ward buildings covered a square mile of praine. So repiar wm their fannation that when we hid passed beside the oorthemmost ward on the way to the administration building, f had seen through its porch w h e s the mncentnc outlines of equivatent m h e s on ward after w d to the very end of the hospital. While Coller r e d my little letter dintent, 1 lmked out at the briskly snapping state Aag and thougbt of Foucault finding in those arches the tnumph of regufarity and onler. Turner and Klass joked quietly. Finaily, Collier gianced up. "1 don't ssee why you need to go on the wards to study psychiatric knuwledge," he grinned. "Al1 the psychiatric knowiedge in thts hospitaf? stting right here in this room." I wm later to see what Coltier had meant. To care for its 3,500 patients, Manteno employed only une hd-certified psychiahist m d indeed only three or four Licensed physicians. Most m e d i d a r e was perfornied by unleensed foreign dactors, who were at that very mom n t dmadng the bmd-new Federal Liensing Emination. Turner LUI~ K k s , by eontrast, had both been chief residen& at the Universiv of Chicago; i n an official se=, they and hne-Marie Rohan, the one boardertified s M memkr, did indeed possess al1 the psychat~c knodedge in the hospihl.

xii

Prdi

"fn an otfieial sense. . ." U"hat is it to p s e s s and control expertnel" ARer Five years at Manteno, 1 hiid spent more time with w n t d ptients, seen niore oftheir actrvities, and endured more of their jokes than most psychiatnsts do in a lgeiime. I had bst pool matches :so manic-depressives and poker garnes to schizophrenics. 1 had dodged clutching fingers that hrtd kiUed four less-agi1e people. 1 had conversed vvith an elderly rnan who lived what Wittgenstein m t e . 1 h d helped actminister several tons of thorazine, meIIaril, lutd their musins, and the p o u d s of wgentin m d .Mane to control their side effects. Yet, "in an oBckal sense,"' five yews at Manteno did not make me an expert on the insane. They did, huwever, make me wonder why 1 was not. 1 went on tu wrte a thesis on psychiatfy as n profmsion md then began to consider the general issue of how d e r n societies inszitutiondize exprtise. 1 knew that the common form ofthat institutionalization was professionalism. Many writers had studied professionalism, but few, 1 felt, studied the basic wnditions and contexts of the control of work. Most studied the organilalion and dliation d pfactitioners, and, for mast, profess~ofialjsm was either a phenomenon h-ppening to idividud professions o r a ~yand sea change in the occupatianal system generally. There was in this work t i d e sense of thu squabbles between the Manteno psychologis&and socd w r k e n over who cauld interpret d i a e s t i e tese, of the war between our attomeys and our were ineompetent ta stand triai, of the ner, and Rohm on the ane hand an 0 t h . Of murse, al1 of these prob1ems had been studied idvidualfy. But with tfie exceptionofsomework by Everett HughesS students-partieuhly Eiiot Freidsan, Rue Bucher, and Anselm Strauss-there was no theory about them. Them was certainiy no attempt to see these intefa>rufessiondbattles as central aspects of pr&ssiondism, rather than as isolated movements and pathologies. In typieal Ghi-~ fsshion, then, this bouk grav out of my experiences as a partieipmt observer. That the h k S evidem is rnostly hisshould not obscum i b fieldwork origns. My Manteno years, imd the clinic year befbre them, forced me tawanis a theory that could reconcile the hiftoricd continuity of professional apwaranees with the &y-to-day dixont.u>uities of professiond redity. I exwrienced this disjunction quite pemndIy. Mateno psychoko@sts agerly prutieipated in their professiorls war with psychhm, aetively lobbfing for t h U r i - w wpent. Yei tbeir everyday professiond world was so inscteure tbat t h q protested in vain whea administrators p k e d my unceI.ti6ed self into the civil seMce "prrychologist" classifimtion.

Preh

K i

'Yet these loml vicissituda reBect larger reality, and a sedous themy of professiond developmnt must embi-ce and expbn thii b g e r realiw as well, MantenoS pmfessionats strualed within a histofical envimnment ofpeculiar intensiq. Deinstitutiondization of mental patients was in fuU swuig, destfoying professionals'jobs as it hilfilled their ideol^gies. Biol@d psyehiaq was rapidiy r a u p i n g the doctors' p s i tion a@nst the mumeiing pmfessions, dthough token m w m i e s were m b g a substan~d wuntemttack. Within the counseling are& itseEf, psychmaiysis was at Iast losing its monopoiistk d o m i n m , and the B d tide of n o n d i c a l psychothempy begnning to fowr. It was a time of great hope and change. Yet the p r ~ a i l i n g feeling of the hospital wai of decline. Around us s t d mute witnesses to the death of the asylum. When 1 stayed at the hospital on summr eveningf I would walk at sunset p a s t rank on rank of empty wards, past swings and e m w s unused for thousand-me hospitid fafms had been nrnted to sod and wrn f m r s . The great southern lawn had become a public goif murse, The diese1 s+tching enEjne s t d idie by the pawer plant, behind the empty ktchens that had once fed ten thousand persons a &y. pwer phnt, the r a i l r d siding snaked hrio weedy mifes lllinois Central &acIca, passing an orchard where a few hardy trees sti'U produced wurm-eaten h i t . On sueh an evening, the whole histury of the asylum hospital glearned on the signs m i n g the wa&-the idedistk founders Pinel and Dix, the famous Europeans Kraepelin, Fmud, and Adler, the gceat A m e r i a s Rush, Meyer, and Mitchefl. There were huildtngs, tw, fOr other pmfessions important to the ay+lum hofpitaf--Barton and Nightingilie for the nurses, Addams and Wmes for the social workers, fames for the psychologists. ff 1 have eaptured i n this book a sense of professions' transiency, it mes much to this experienee of the dying hospitd. This b k , then, aims to show the professions &rwUWIng, spiitting, joining, adapting, dying. The objeets of its analysis inciude a wide variety of professions in the Unitd States, E n h d , and, to some extent, F m a and the other nations &continental Europe. 1have been e a t h lic in rny ttastes, Q i n g tu o&t the customar~ reliarice on Amedean iaw and medicine. (1 have generally avoided writing &out aeademic p d s s i o n s , hoping to escape eharges of navel gazing from nonacademic readers and the cense o f we-knm-it-dl-already amang academia.) The brryadth of e m p t e s requres the usual difctairner a synthetic miter makes to area specialists. Few of these analyses other than those in my own primary research areas wiU set?rn sophkticated to spcialists an individual professions. I have done rny best in unfamiliar t e n i t e

ries, but doubtfess many minor errors remain. On the other halid, that I wrte such a bsok testifies to my beiief t h symthesis will prove more worthwhile rhan further area w r k . Retlders can judge for themselves whether that befief is mrrect. Sinnr the rmts of the book lie in my persoml experiertces and observations, my fimt debts are to those who got me into the field; to Morfis Jmowitz, who pushed me into fietd study in my first year at Chiago; to Jarf Dyrud and Dave Klass, who got me into Manteno; to Uiss an8 Jon Steinmtz, who managed to suppurt me there for five years. Llke al1 &Id observers, 1 have great d e b s to my subjects. Unfike most obsemers, however, 1 have the pleasure, d o r d e d by ten years' time d a book using Iittle of their rvidence directiy, of thankittg the most in~portant of them by name. Eberhad Uhlenhuth and his Rose West, Mark Mouithrop, Dave Turner, clinic st& ~ i c u l a r l y Poily Everett, Zanvel Klein, and Jeff Teich, helped me immensely. The Chicago psych-tahic residents of the 1972-1934 clases put up with numemus bumbfings, for the most part with unfililing good humor. At Manteno rny debes are more extensive, because my stay was longer and my wrticipation more mrnpiete. For officiai authonzations md suppurt 1 must pafticularly thank Jack ColIier and his suceessor Ella Curry. For varying degrees of forbearance and helpiiilness 1 must thank the professiond staffs, particularly Solomon Noguera and Luis Wacios among the doctors, Henry Lin among psychoiogists, Nora Brashear and Bonnie Hellyer among social workers. h o n g ward p p i e I wje great debts especially tu Janet Tetrault, Penny Kneissler, Dorig Baldndge, Raymond Marshaif, Dennis Wopkins, Marge Curry, and I-iarold Spearin. Aniong the nonprofessional S@, Amada Rnder, Doris White, and Charlotte Margan were helpful and suppclrtive, as were John Cmyton and Mike Strizich among the Chicago-based cansultants. Finally, 1 must thank friends whose personal support got me through Mantenok deadlier moments-Dave Kudoif, Margaret Kasper, Jon Steinmeh, and, dutcissim, Cindi Clyden. C3ver the years, a n u m b r of frien& in diverse professions have &ked intimately about their work. For this 1 must thank in particular Scott Thatcher. RiehLud Kdb. and fames Gill. iawver. architect. and priest. I have learned much about engineering from talks with rny father. My mother taught ne about librananship by making me work in v d o u s Iibraries she ran, and 1 have induiged my endunng interest in librafies with indexing theorist Jim hnderson. My Grsthand knowiedge of the m i i i w 1 tlwe ta Richard Nixon. Beyond these general debts, 1 have some more specific debts for idea in tht?book. The notion that diagnosis and treatmnt are general

modes of knawledg carne from D o d d b v i n e , and the vwancy metaphor that underlies chilpter 4 from Narrison White. In most of the b k 1 have softened the vacancy metaphor into a more ecolo@& one so that the relative pos~tions of pmfessions might seem somwhat Iess exciusive, ~ l t h o u g h e m l o g is a fashionabte metitphor in foeiology ta&y, the b k J m?olo@cai flavor comes directly from Park, Burgess, p&rb.augh, and others of the old Chi-o Schmi. Reading this work in the early IrY?Os, 1 a m e to see social structures as fluctuating and gmgrrtphic, cartceptions that strongly nnderiie this book. They underle as well the Chieago writers on ocxupations and professians, and the b k thus lies very much in the Everett Hughes tradition. The h k ' s comparative emphasis has diverse sources. Although 1 origndly designed my dissertation study of American psychiatrists without much comparative knowledge, Joseph Ben-David shamed me into studying other professions and other ~wuntries.The comparative emphasis was reinforced when 1 was abie to attend two years of sessions on the history of professions at Princetonk Davis Center. Although the Princeton historian~ had little respect for suciologists, they did examine an immense amount of information about various professions, and 1 would not have dared so h r d a book without the exwsure 1 iicauired there. Like any synthetic scholar, 1 owe much to past sociotogiml and hisroncal work. On the sociological side, Joseph Ben-David, Magali Larson, EIiot Freidson, and Terence Johnson have been particularly imp u b t theoretical sources, as have the earlier synthetic b k s of Geoffrey Miibrson, W. J. Reader, and A. M. Carr-Saunders and P. A. Wiison. A n u r n h r of sociological calleagues have talked pmfessions with me for years, and 1 must thank them, particularly Terence Halliday and Michael Powell, for their insights and criticism. To the histarians 1 owe a still greater debt, for theirs is the data that undergirds the h k . Although suurces are of course isted where relevant, i must thank here those historians who have personally shaped my ideas: Gerdd Geison, Steve Botein, Nancy Tomes, Janet Tighe. C e r a Grob, Paul Miranti, and Robert Kohler. A number of people have read the book manuscrpt, or pieces of it. Terry Halliday, Mark Cranovetter, Doug Nelson, Eliot Freidson, Harrison White, and Susan Gd gave me very helphl, although often contradictor~, comments. Two research assistants, Bnice Cafnithers and Margaret Antinori, helped with material appearing in chapters 1 and 8. Ed L a u m n was helpful at publiation time. Financiai support cam ia s d l amoun& from faculty grants at Rutgers, and in large ones frorn rny d e ' s real world falary from Bell Laboralories. Portions of the mmuscnpt have appeared before, and 1 must thank the relevant jour-

xvi

Preface

n its enw~ons A d g & . I must dso thank the Hatvad oeioogy, whose invitation in 1982 prov o W rny first &m& dscussion of the centraf azgument of the b k . A fin;book is the pmper w i a n for wknwledgng he$ of years ig- th& led, I its &rcuitous way, to this present. I thank, then, my pments, Jamesw d Rita Abbott, for fostenng me in the tife of the mind iKKi some tetlchers wlxl hrthertrl that endmvor: Seaver Gilcreast, Sr,, Rabert Shiel-ds, George Best, S i m n Hyde, Dudley Fitts, R. H. C d y w , J. P ' Russo. 1 thank also t b s e who exempliled b r me what rhat Me wuid be: AIston Ghase, Roger Revefle, Moms Jmawitz. Lastly, 1 thank thuse who made Iife fun whife 1 wrote this book. hmung niy present m d fazmer coileagries at Rutgers, Stan DeVney, Andy Szasz, W y Smith, Rob Parker, and Judy Gerson have critic i d , cheered, and supprted, as did that a n t h r o p o l ~ s who t is still my cfosest friend thirty yeara af'ier we were thinf grade sweethearts. Finally, by her supprtft threat, cajolery, and exhortation, Sue Schktugh probabiy has as mueh to do with the appeamnee o f this mmuxnpt as 1do. She tlid not r e d it, or tM>e ft, or prepare the index. But she interrupted her plane tnps and expenmnts to do mueh more than her share of the dishwlishina. - and cleaninrr - .(1 think I've held UD rny end of the ironing and coakind. As any two-career eoupie knms, that's a big ded. We've had a q t time while this book was being minen, and that's an evee bigger deal. Thanks.
A.M.D.C.

Phillipsburg, New Jersey 14 July 1987

Note for the reader: This is a long book, with long and often involved arguments. To make the argument foltow&Ie, 1 have suppressed al1 eitation in text. This makes the schoiarly mrtchinery harder to btfow-something I resent when 1 read-but it makes the b k much more readable. 1 apologize to those who want tu check everything as they go dang, J a m s Anderson kindly assisted me with the index. Its unfo~unate brevity was dictated by considerations of space.

The pmfessions dominate our world. They heal our bodies, measure our profits, save our souls. Yet we are deeply ambivalent about them. For some, the rife of professions is a story of knawledge in tnumphant practice. It is the story d Pasteur and Osler and Sehweiker, a thread that ties the lawyer in a country village to the justicg on the Supreme Court bench. For others it is a sadder chroniele of monopoly and malfeasance, of unequaf justice administered hy sewants of p e r , of RockefeiIer medicine men."neath the impmsioned mntradictions af these interpretations lie some common ssumptions. Most authors study pmfessons one at a time. Most assume that professions grow through a series of stages called professionalimtion. Most talk hss about w b t professions do han about how they are organized to do it. These assumptions seem to emerge from our centfal questions about pmfessions. Why should there be occupational groups controlling the acquisition and application of various kinds of knrnvledge? Where and why did groups like medicine and iaw achieve their power? WilI pmfessionalism spread throughout the occupational world? To answer such puzding questions, it seemed neeessary to adopt simpl+ng assumptions. The complexities of the individual pmfessions forced case by case study. The faet that professions tike medicine and archit d r e s e e m d rnare similw in organivliional pattem than in actual work made organizatianal pattem the focus of analysis. The foeus on patkern implied in turn a search for its origins and fed to the idea of a common process of developmnt, the idea of professionalidon. But professlonaih~onwas at best a misleading concept, for it invoived more the forrns thasi the conten& of p&ss&naltlfe. It ignored who was dokg what to whom and how, comntrating instead on
1

ation, leensure, ethics code. In fact, not only did it miss the contents of pntfessional activity, but &so the larger situation in which that wtivity occurs. 8 y fmusing on patallels in organizatond development, students of the prafessions lost si&t o $ ' a h n d m n t a l fwt of professiond Iifeinterpmfessional cvmpetition. Contml of knowledge and its application m a n s riuminating outsiden who anack that control. Control without ~ w m p t i t i o nis trivial. Study of o r w i a t i o n d forms can i a d d show h w ceftain w u p a t i o n s control their knowiedge and its application. But it cannot t e 1 1 why those forms emerge when they do or why fail. Only the s h d y of comthey sometimes sueceed md someti*titiun c a n acwrnplish that. The pmfessioi~s,that is, make up an intenlependent system. In this systein, each pmfessian has its =tivities under various kinds of jurisdiction. Sometimes it has full control, sometimes control subordinate to ariother group. Junsdietionill boundaries are perptually in dispute, both in t d praetiee and in national claims. ft is the history of jurisdictiorial d i s ~ u t e sthat is the real, the determining historv of the professions. jurisdictiond claims furnish the impetus and the pattern . n i u s an effeetive historical sociology uf pmfessions must b g i n with case studies of jurisdietions and jurisdietian disputes. It must then pate these disputes in a larger context, mnsidering the system of professioas as a whole. It must study such evolving systems in several muntries to assess exogenous factors s h a p ing systems of pmfessions. Only from such partraits can one derive an effective m&( fnr understanding and predicting professional development in modern societies generaLiyYS The movernent from an individualistic to a systernatic view of pmfessions organiuls this b k . 1 begin by evdiiating the idea ofprofessiondi-ation and move an ta theorize the systematie relations of professions. I then andym externa1 f o m s bearing on the system and close by discussing three imporbnt evamples of contested jurisdietioas. Thmuyhout, I addresss the familiar questions &ut professions. How do pmfessions develop? How do they relate to one another? tVhat determines the kind of work they do? But this summary slights a methodoloe;ical theme that accompanies the s u b s ~ t i v one e as harmony does a melody. My substantive questions d l invoive generdizing about stories, such as stories of professiondization. hly methsdoIogical m n m m is with how this generalization takes place. T d i t i o n d theories of professiondization argue that proft3ssons MIw a e e W sequen= of devebprnent. This "careers" mde1 is une w q t.u generalhe about sequencTs of social events. My

fntraduction

t h m t i d scheme, particularly in Chapter 4. illustrates a digerent wsy of generaflzing about sequenws, one that makes them interdependent. Sime jurisdiction is the defining retation in professiond life, the s q e n c e s that 1 generdize are sequences of jurisdictiod control, describing who hod control of what, when, and how. Professions deveiop wben jurisdictions b m e vacant, whieh may happen because ehey s e newly created or because an earlier t e m t has left them aitogether or Iost its firm grip on them. If an utready existing profession t&es over a vacant jurisdietion, it may in tum vac.ate ~ o t h e of r its junsdctions or retain mereiy superviso^ control of it. n i u s events p m m t e b a 6 k w d in sume sense, with jurisdictionat v m c i e s , mther than the professions themselves, having much of the intiative. This simple system rnodel shows how a set of hstoncal stories rtan be andyzed without assuming a common c a e r pattern, as in the cancept of professiondimtion." Throughout the book, then, run two leveis of andysis, Suhstantively, the bmk answers sume questions about the evoiution af professions. Methodologicallyy it considers the dimculties of generaiing a b u t sequenees of evvents ;md proposes a new way to address them. It k h does historical sociology and a s b how historieal smblo@ ought to h done.

The Professioos Literature

Aithough the professions derive from medieval or in some cases aneient origins, the first systematic attempts to study them m e in this mntury. In part this refleeted the rise of the social scienees, but it refiected more importantly a great change in the professions themselves, The nineteenth c n t u r y saw the Grst development of professions as we know them today. fn Englmd the merging of apothetanes with surgeons and physicims, the rise of the lower hranch of the legal profession, and the appearmce of the surveyors, architects, and accountants signded the change. In America the triumphs of regular medicine over its various sects, the growth of the univenity professiona1 schools, and the host of would-be professions al1 testified to the ntiw fonn of occupafion. " The nineteenth eenprofessions were important but peculiar Mcid creatttres. With the exmption of a m u n t h g , they stood outside the new commercial and industrial heart of society. They were organi& a collegial mmner that was distinctly anrrchntnistic. On the Continent, to be sure, the pmfessions were more hierab-chid. But this h i e m h y carne not from the new captalist forms of orwiilttion, but

rather fmm the Old Regimct, h m whieh it acquired a civil servant quite p u l i a r ia the rnodern ~ n p a t t u n a world. l The professions, ami in partieulsr the Ando-American variety, were therefore a great p u d e for social theorists. Weber spent many embarwsed pages confmnting the wanton irrationaiity of the English Bar. DurMieim srmply iwored the Angla-America prohssioas altogether and iooked to more f m i l i a Freneh occupations for his neacowratist future.$ It uras the Endish themselves who perfora first andyzed these unusuaf o c c u e i o n s . Crr-Caunders and Wilsoni The Professutns, puhlished in 1934, w s the first sueh attempt.@ The hook gave historicat background on every group that coitld then be considered a profession in E n g l d . Its theoretical diseussion systematized a view of professions that had by then come to dominate the writings both of the pmfessions themseives and of the social xientists examining them. Prufessions were orgmized M i e s uf experts who applied esoteric knowledge to partieuiar cases. They had elaborate systems of instruetian and tmining, together with entry by examination and other formal prerequisites. They normdly possessed and e n f o d a d e of ethics ur behavior. This list ofproperties becarne the core of later definitions. The Carr-Saunders and Wilson volume epitomized two methodolo@es c h s ~ c t e n s t i c of writing on pmfessions, combining naturalism and ~.poiogy.Eatly rticles on the professions would summarize the life history of their particular case, review the then-current essential traits o f a b e profession, and decide whether socid work or nursing or whatever reaily was a profession. 'Nork in this genre mpidly built the stock of case studies, fitting each case into the pmmstean hed of essentid traits. But that bed was so often refinished as it passed from hand to hand that the case studies were never very comparable. By 1964, when Geoffrey Millerson attempted a new general analysis of professions, he had to treat earlier work as merely advisory and build on new data in a new framework.? Millerson recognized that trait-based definitions had often reflected political concerns. If one disiiked social work, one easily found some trait exeluding social wark &m the presti@ous category of '"professions." H e himself avoided this by identtfying only v e r - general tratts of professionalism (e.g., organizltion, education, ethics) and then permitting wide variation within them. Other authors c o n h n t d this empirical diversity more directiy. An early and p i m v n i o u s answer came from the t h ~ r i s t s of professionalization. The diversity of the would-be professions arose because professional status w a p r an end state that few had yet achieved. Diversity ~ u l disappear d wth time,, as mup p d u a l l y q u i r e d al1 the narks of true professions. The mncept of professiana1~ionthus mnsum-

mated the ~narriageof naiuralism and typoiogy. Prnfessodization was a nabraf pmcess, as in the c a s e study literature, but that process e n t d e d a series of types. In 1% Harold Witensky published an irticle that demonstrated such a regular sequence in the h r i c a n professions. Professiondistion seemed an eszablished fart. The newr mncepbdizLltion meant in turn a new thmretical question. Why did pmfesionalization follw the sequence it did? But just as professionafization beeame an established mwept, the study of professions was suddenly reshaped by the new political ciimate of the 1960s. Early work on professionalization had rested on the f u n c t i o d assumptions cbaracteristic of postwar sociology. It attributml the colle& o r w h t i o n of professions to their position as experts. The "asymmetry of expertise" reqnired the elient to tnist the profefsiond and the professiond to respect both clent and colleagues. These reiations were gumnteed by various institutional formsassociations, licensure, ethics d e s . But theorists rejecting Eunctiod assumptions disputed the whole picture. In a lucid analysis of professiondism as a form of cuntrol, Johnson argued that the pmfessions did not serve disembodied swial needs but rather irnposed both definitions of needs and manner of service on a t o m i d consumers. Writing on Americ;rui medicine, Elot Freidsan argued that dominante and autonomy, not collegiality and trust, were the hallmarks of tnie professiondism. Another student of medicine, J e e e y B e r h t , attributed the structures of professiondism directly to the goals of w n o m i c mon d y . BerIantS work was the more stnking in that the feature ofprofessionalism whose monopolistic funcion he most cxefully andyzed vas ethics d e s , whose dtruistic nature had been assumed by eariier workers.& By seeing monopoly rather than control of asymmetrie relationships, the new theorists moved the focus of debate from the fonns of pmfessiondmtion to its functions. For the new theorists, the reguIarity o f professionafization was not the visible reguiarity of schmt, then assmiation, then ethics d e , but rather the hidden one of s u c eessive functions for these professional forms. Ethics d e s came late in professionalization not because they were a culmination of natural w & h , but because they served the function of excluding outsiders, a function that important oniy after the professiond community had 'been generated and consolidated. Since ethics d e s did not serve these eartier functions, they m e late. The new v e r literature thus unmasked earlier work as ideolo@cal, This unmasking reached its final f a m in Magdi Larson? The Risa o f Prof.~sionBIism (l.%"?). Were professions were explicitiy market or-

fntraductian

~ i & i o n sattenpting the intellechal and organizationd dominatian of areas of soeial eancern. 't'et even while it reversed the traditional irnges of profession anct professiond, h o G s bovk d r w on themes ltnd msumptions s h d d thmughout the AngleArnen~atistudy of pmiessions. The old model wris aceepted for new rensons. Sinee she east professions as m&t dominating organizations, the prufessons of the Continent, where etxpertise w s s never formalized independent o f the state. Like her predt?cessars in the power trditon, she explicidy excluded thu orwizlttioa-brised professionsrumtd m d civil sefvice and clergt-that continne in the Ando-Americ a n world the i.tistitutional forms of the Coixtinent. Through her focus on dornsnance she ignured professiow like nursing that had a a e p t e d subrdnaton. The exclusions shouId w m e as no surprise. By aceepting pmfessiondiwttion as the thing to be mplained, the new power theuristi aecttpted the assumptions behind the eancept. These included not only the idea of a ixed sequen* of events or functions, but dso wsumptkns abaut the h s t examples of professionalism (American medicine and Iaw), a h u t its essential qualities, and about the c h m t e r of the intefprofessiud world. The split h t w e e n the Cnctiondists and the monopolists was thus not totai. It was a b o not one-dimnsional. First, the two groups emphasized dtferuat eonsequennces of professionalism, BerIant and Larson were intemsted in the eonsequems of m e d i d professiondism not for hedth, but rather for the status and power of the medical profession. '%ase were external, social consequences that derived h m professional stahts or activity; siekness ww of littie interest. Other w i t e n emphasized internal consequences of professiondism, ronsecluences affeding the afea uf professional wark itsetf-healing, audting, and so on. To k o n s , for example, the impact of professionalism on sick individuals was a f central i m p r t w e . Yet it was also central for Freidson, whose critica1 stance otherwise identifies him wth h o n and Berlant. This contrast between Parsons and Freidson indicates the other dimnsion of the split, which concems the locus of anaiysis; like h a n but unlike hrsons, Freidson aimed his wdysis at the social level. H e wked haw the overdl social handling of iliness was affected by the existen* and nature of professiond groups. SimiIar1y, h o n S eunctsrn wirh the external consequences of professiodism extended to the pmfession as a whole. She asked what professions got out of professionAsm and how. Parsons and other functionaiists, while concerned, like Freidson, with intenal mnseqnenms, saw them at the individual level. Huw, they asked, does a social relaton b e h ~ e e n client and proessiori;xl have to be stmtured for healng ! $ r some other i d vidud professianal aet) to oceur?

Of murse, the cmssing of rhese km dichotomies implies a burth a p p m h , oae exarnining externd fonseguences, as do aod Brlant, but at the Ievel of individuals. This view has been argued at k n g b by Joseph Ben-David md Burton Bledstein, Both emphasize the f u m a n of prafessionatism in proteeting certain ndividuds-the pmfessionds themmlves-from the struetured, rigid employment that emerged with nineteerith century ccrpitalism. Beyond this independen=, tbey both w e d , pmfessiondism alfa providd both an ideal m r q h o r for vertical mobiiity and the means with which to aMempt it. This arpment defines the chief impliations of professiondism as its externaf consequences (status, money, power), but at the individud fevel. P r o b s s i s n a f i s m was a matter of indvidud choiws and rowpate action &en to pmtect or extend them.s The librature on professions has thus grUdualfy moved from naturalism to theory. It bgan with case studies and typoiopies. The internd mntradictions of these studies led ultimately to the idea of profess i o d h t i o n , in wkch a dwelopmental typoloti;ygenerated the natural histories, p d u e i n g an apparent variety of professions. For the p w cess of professiondiz-ton there then emrged a variety of theoretieal interpretations. For some, pmfessiondkm was a means to tontrol a difficult social relation; fnr others, a species of corpomte extortion, For stiil others its impartance lay in building individuai whievement channek, while a fourth graup emphasized how it helped or hindered general social Eunctions like health and justice. Despite their substantive differences, authors of these thearies took a surpnsingly consistent view of what professions were and what about them must be expsined. Certainly all agreed that a profession was an ocvup&ional group with some speeid skill. Usually this was an abstraet skiil, one that required extensive training. It was not applied in a purely routine fashion, but required revised appliation case by case. In addition, pmfessions were more or less exclusive. This mnsensus seems surprising in light of the squabhles charaeteristic of the perod of naturalistic studies. For many years the definitional question was the f d issue of studies af pdssions, ohxung the substantive questions that made professions uiteresting in the first place.'0 But of murse the suwrising mnsensus of theoretical writers refleeted the pface of definition in theoretieal work, where it is a means to substantive en&. The mnfusion over definitions arose mainfy in witing that liicktxl heoretical ntent. There, definitions were judged by their ability to regenerate common opinions. Since those opinions were o - M around the fmiliar emp1es of Amencan law and niedicne, definitions excluded things that diddt look Iike law and ntedcine, sueh as automobile repair, and included thrngs that did, like

atxwutltirt:, aild perkops s<xt.ial work. There were arid are fuiidanrerital cfiCFicirlties witf-i this test-by-exanipfe. First, A~neritanlaw and rnedicine do nut in fact Iutk like onr images clf them. Only hatf of each is c~ilirtnt;>loyed. TIre vzt tnajorie of w r k in b t h is utterly rootirre, A s~iqrisirigrirrirri-wr itf prctfessionals, everi in these fields, will be in nothrr <x:cripationai clssi[icatiun in twenty years." Securid, maity II;~UII~ tfiat S ~bvitttisl ure ~ prctfessions di1 tiot tcxtk like Ptrnerican medicine and law at all. Eirglish barristers cio tlot neessarily traiii in uriivt'rsit? hilt rather By apprentic*ship and eatirig clinners "in hall." Atnericrarr clrrgy do not generally have ethics d e s nor, uiliif reeently, asstxiiitjctns indepeltdent of their ec~lesiaticalstructure. Yet k > t h KrOttpS are rrnn!istakal>ly prokssions. The urxcierlyiog proitiem is that for rrtany writers, taliing soritethirrg a profession nrakes t one. People cictn't w ~ i to t cal1 atitontobile repair a profeasion hemuse they tforit want tct accorcl it that cfignity. 'This itnwtlIir~gness pr<>hably t i a less to co with the acttial char;*cteristics of autrtincrbile repair as arr iritellectiial cliscipline-whieh are cu~r~ccptualiy quite cirtse to those of irtedicinethan it does with the status of the w>rk aild of those who do ii. When dtr&rrititjrks aint t c ~distingiiish g o u p s accwrding tu sxteh an externai ;ili;enfa. they are disltutct<f. When usrd to ariswer theoretieal questi<urs, thcy are rntt. Ilefinitiuns, ihen, must I;>llow h m thmretical questions. The theory 1 sketehed in the oi~eiting paragr~phsimplies the very h o s e c1efrrtitic)n that irr<tfcssonsare exclusive t>cct~patinnal groups applying s<>rnewhatabstract knowledge to particular cases. It is imptrriant to show why this clefinitictn is choseri Itere. 111 doiitg so, 1 can fiirther ctritlirte nty fundarnerttal thwtry. ?ity urlderfying <t~~esti<~ris conci<irn thc evolution and interrehtioris of professioi~s,ancl, more geiierdly, the ways ctt'cupational gro~ips control krttlwledge aitd skil1. I have already argued that the evolution of prtttessitrrts in fact results frorn their interrelatiorts. These interrelations are in trirrt iieterminud by the way these grorips control their kiio\vtedge and skill. There are h~.t) wther diEerent ways of accornptishitig this cuntrc>l. Oiie ernphasizes teclirtiqrte per se, aild ortcupations tisirrg it 1-e curnnionly called erafts. To control such an occupatiori, a pclrlp directly cw~itrols its tech~tiiiie.The other forrn of control irtvolves abitract knowledge. Here, praetical skill grows out of ata abstratit system tif krto\vledge. and cu>titral of the tmupation lies in control o f the bstractions thar gerrerate ihe practieat tcchniques. The techilirlues themsetves rnay in Fact be tlrlegated to other workers. For tne this chwxteristic ctf abstriiction is the une that best ideritifies the prukssiuns. For ai)~trcti~r~ is the quality that sets interprofessional

eompr?titiott apart frorn cunipetition amotkg c~~upatirbns in generaf. h a y wtclcuptiori can vbta~n lieerisui- je.g., beautieiatzsi or develop an rthics d e (e.g., real ectate). But ctilly a kn<xwIedgesystem gwerned by abstriictitms can redetiae its ~sn>hleins arid tasks, defend thern from interioper-ri,and seize new prcrhlcms-.S meticine ha'i r e ~ e n t l y seized alcohoIisrn, mental illriess, hyperaetivity irt ehildreri, t>twsity, and nurnemus other things. Abstraetun enal,les strrvival in the coonipetitive systeirt t t l prttfessions. I f auto mechiir~icshad that kiiid of ahstrdction, if they " ~ ~ n t a i n e d relrvant sections ofvr;hat is prtasentfy the erigithe neeriitg prufession, atld had ~u,~isi<lered taking ouer al! repair of interrial cx>rnhustionertgiiies oit abstrct grtltrr~ds,tttey wtriid, for my purposes, krt a prufession. My eentrai cluestions and nty fratnework tiros tletermine m); tlefinitlon of prof'ession. As wc have just seen, they determine first its einphasis on the knowlrdge system m d its degree f ahstraction, si~we these are the ultimate ciirreticy of eompetiti<>rt betweeri prtrfessions. But they also dt-termitie its relativity, siiice the degree ttf atlstractian rireessary tOr surviva! varies with tme and place in the system o f professioits. As sc~iaI work and iiursing have Iretxinir wttefjate professions, ~nedicirlehas ixu'rtme postgrduate. tlow aixstract is abstract cnough to be professiunal? The answer depends 01% time and placv. tVhat mUtters is abstraetioir effeetive enortgh to ctclnrpete in a particular hist<ori.il alid social mtntext, t i u t alstraction relative to mine supposed ahsoiute staitdarrl. 1 anl interested iiot mes-eiy in the Iving, doiriii~ant professions like medicine arid law, lrut ajso in the the morihund ppn13s like ntediuins, railway surgeoris, m d electrt>therapists. A definitioti ttw speeific would exelude tiiem frorn view. Yet they too have r n d e their mark on the systetn of professitns wr st-e tcttlay.i2

The C o ~ w e p of t Professionaiwtion
Having settled the defintianal isstre, t least tefl-tporarily, we may rnove on to examine past theuries of professional tlevelopment more closeky. Proi>ably the most rQmmon thenxe of past wurk is that professiorts tend to develop i n a corninon patterri, cailed pn)fessiotialization. Is there, in f x t , a i-ommori story of hotv professions develrjp? To answer this cliiestion, we must first answer the prelitninary t l r ~ t :of what w nien by "cc~mnionstory." This (~uestion is tltrite eontplcx. There "nve been matly theories of professionalization, arid they diEer along h r o distinetly diffi?rent di~nensions-the Formal a i d the sirbstaritive. t e t us consider formal digerrrnces anrung theuries of professionaliatiorr by stuciyirig some versirtns of the professioridiwtian story. In

the 1% article r n e n ~ o n e d esrlier, Nmld Witensb discussed what he called "the professionalizatton of eve-ne." Wi1ens.l looked at the dates of "first events" in varioos Ameriean pmkssions-first h-ining schrwl, first u n i v c r s i ~ sch-1, first I d association, first national ascocation, Erst state licensing law, and first d e of ethics. He found by inspmtion that the events tisud& fe11 in the order just listed. Reflecting on that arder, he then made up a story to w u n t For it. 1 shalf p q h m it as fotiuws: Pmfessions kgin when people "staft doitig full time the thing that needs dotng." But then the issue uf training arises, pushed by recntits or ciients. SchmIs are created. T b new schwks, if not lteffun wikhn univenities, imnlediately seek &htion vrith them. Inevitably. there then develop higher S, longer hsinin~~, earlier wmmimnt ta the pmfession, ami a gruup of fui1 time teaehers. %en the teaching prefessionds, aiong with their first d u a t e s , c-mbine to pmmote and create a professional association. The more

detve prufessional tife enabfed by this mxtciation leadil to wif-regection, to posiibb change of n w , and to an explicit attempt to separate eompetent from incumpetent. Re%e<:tion ahut central t%sks le& the pmfession to delewte rvutine w r k to p;uapn>fesuiod. At tbe same time the attempt to sep&te comptent fmin immpetent le& to interna mnffict between the u&iaIt.y trained younger generation and their on-tb-jobtrained elders, 8s weU as to incremingty vioient m n h t a t i o n s with autsiders, This periad aiso contains efforts to seeure state p-wtion, dthou& thif does not always accur arid i s no&peculiar to profesions in any ease. Finatly, the niles that these events &ve generated. mies eliminating interna1 comptition a& chariatanry and esbblishing client protmtion, d e s c e in a f o d ethics code.lS WilenskyS story etnsish of a series of narrative steps, each of which rnoves fmm sihtation tu event to situation. What propels these steps? Here Wilensky is less clear. H e tells who pushes for sehoois, but not why. Presumably he uses some eammonsense theory like "people who are dong something fui1 time want to do it well," or "see a need to do it well." or "beain to know what t is to do it well." Note that the c a u d rnodels underlying the various tinks in this stary draw on different general views of why things happen in social Iife. Schools arise fUnctionally; they 611 a need. Deleption of tasks, by contrast, arises in a histaricist rnanner (success confers the p w e r to defegate, whieh further snhmees s u e s s ) , while ethics c d e s simp1y d e s e e levitabfy. Who is the subject of ths story? This, tm, is pmblematic. Ethics d e s happen to the profession as a whole. Yet at the beginning of Wibuskyk story, the profession as a whole did not really exist. The initial subjects m e "thosewho do fiill time the thing that needs doing." Through the stew the proiession gatfudly emerges as the new central
w

subject. of the narative, dthough'often the getlts or chmge :e= h m s a b ~ o u p sAt . one leve[ this seems obvioas enough. One central p m s s of professionaization is c d e x e n e e into a group. But there is an essentid dfference between demonstmting emergente as a procriss in the social world and pmsupposing it by t~mtve s t m d r e . It is the latter that Wileush. has done; ttt least some of the "'fult-time doers" hrwe in Fact become degned ras charlatans by the iatter stages of the story. rtlthough Wiiensky theorized a generrrl process of professiondiization, he saw v d e t y in the actual sequences aid advamd speeial exgianations of deviations fiom his overalf story. Theadom Cq~low,in contrast, caw a more stricdy universd story. W ean p p h r a s e it as fitllows: Pmfessiotls begm with the establishment of pntfwsiowal awiations that have expkit membership rules to exciude the unqualified. Seeond, they c h g e their mmes, in order to ktse tbeir p t , to mert their munopoly, 4 , mast importantly, to @ve &emeIves a Iilbelcapabie of legishtive r e s w u n . Third, they set up a mde ofettrics to assert their social utility, to further reguIate the incompetent, and to reduce internai eompetiton. Fourth, they a t a t e poltiition, aning at itmt to lfrnit the mhsionai titie and later to crirninak unltcensed work in their jurisdietion. (The growth of whooling Capow sees as wncwmt with this poiiticai rictivity, as he does the establishment of n>nfi&ntiality rights and eEedve reiations with ~uhiders.)~~ Caplaw's story differs hom Wilensky's not only in chronology bnt in narrative strumre as weE. For one thing, it has a ungom central subject. The profession appears at the be@nningof the stary and underakes al1 the aetivity in it. For anather, ali links of the story are functional, In f&, there is a seyuence of funetions. Exclusion is incfuded in ail four links, a s a i o n of junsdiction in the lwt threcr-, internal control in the last two, md externa1 relations only in the last, This sequence of functions is tnggered by the need for professiomliation, which Caplow derives from Iarger social foms in a sepanate wgument. Yet despite these dBerences, Capiow's story shares with Wilensky's the assertion that there are clear sequenees of proftrssiondim~on, This clear suassion disappears in professionalimtion as dexribed in Engtish muras. Ceoffrey MiliersonS explieit denial shows the very daerent approaeh he takes to n m r a ~ professional~tion. g ClearIy aII Quatifying
@sin professiad

a variety of mwns for establishutgan association;to co-ordinate the adivties af workers within an oecu-o~; to a&r W t i e s not otherwise avaiiable; tu

pmvide f a nriw t'~:hnoI~@Jevelopmnt. Subsequently tbese associations inkduced emtinatiorts artd wught to i m p m rnembers' status. tons &en Med to follaw a simple chrn of events: teehnoloM &vame d o r c o m m d advmment-demd Por personnej-wizatiun of personnel. More impurtiurt, such a notbn ignore the variable ti=-lag beht:wn Rrst a p p e a r e of prsonnel 'and ultimale orgmi.mtion. %=timas Formation ant&p& an exwding d e m d in an occupatianrd %ea, the establishment of spialists zind conpequeni n d for 'quaflfied people'. hmiandiy Further development of assueiation justified the Founders?orresi&t. At times, s l w kvelnpnlent of the assoeiation suaestt-d the evident iflability of rhe assoeiatit~n to sahisfjr rwuirentents far qdified personnel, or a f& artridwtion of n d for orgsnimtian. Mrlfemn here insiss on a variety of possibilities. The orenization may ar~ticipate,it m- foiow a @ven demmd, t may be toa much t m w n , it may be too little too lote. That is, hnillerwn hiieves that the link h t w e e n &ti-ti= work (.e., demand) and association may be emplotted in a vmiety of ways. In an eartier discussiun, after illustrating the impossibility of a single plot, he lis& the passibkt models ( d i functiund) for the link leading to a successful qudrfying assoeiaton-to achieve or consalidate status or pm&ige, to break away or react to an existing assuchtian, to c ~ l d n a t e existing practitioners, and to respand to utterly new orrcupational possibitities. This diversity in part refleets the complexity of the Bn'tish profes& about sions. But it dso refltxts s e v e d decisions Millerson has m how to te11 his story. First, he &S not accept the implicit self-interest mude1 that unifies the professiodzation narratves of Wilensky and Crrplow. Sdf-interest is but one m o a g a number of theoretidly psible motives for action. Second, he uses a different strategy to assernble his data. Wilensky tmked a t a set of fint faets across pmfessions m d rnade up a story to fit them. Capiow's modei is ekearly based on much the san-ie pm-SS, using the stories of journalists, undertakers, junk deders, md labaratory technicims. Mikrson, on the wntrary, begins not with the bafe details of first facts, but 4 t h individud narnitives, prdessian by pmfession, complete with s t a n M historial acmun& of motivstion. He lmks at a11 hs 0rtl;anktiond histories and sees tour or @veremons why omizsations were set up. Sihe has U these reasons together, no f u a d w n c a I model of self-intere~t to tie a he leaves them as independent versions of the link from demand ta o ~ l a ~ o fn e .emplOyS a similar sti"atem in studying the tink bem e e n s e h d s aod emrninations. Miltersa& mLtiyss afso reminds us of the cornplexi~involved in ardered socid p r w s x s . Sometims we see the present as independ-

ent of the w t , a position Milierson fotfows wth regard to profesrriond ethics. Sonretims we see the present as uniquely detemined by the past; a pmfession has only one place to go n e d from where it is now, only one career to f o l h . This career model is the one chosen by Caplaw and to a lesser eitent by Wtensky. M i i l e ~ . ~ on n , the other hruid, generalb uses the iess-restddive idea of coritingent development. Even though the p t shapt??ithe fuhtre, khere are several outcomes for any professional present. The next event after professional rtssotiation may be licensiq, emminations, or an ethies d e . The irnportant questions are which one and why. klillerson despairs of finding a single story of professionajimtion. %e msounding impression is of individual uniqueness, tempered by an 4 u s h n e n t to the social and e d u ~ i o n aclimate l of the time.'"1s For s o m authors, this "individual uniqueness" is in fsk-t d i ~ l attrbuty able to "the social and educational climate of the time." Orie such is Ma& Larson. Larson tells the story of professionafizatian in a new way. The difference les in her use of time. For Witensky, Capluw, and Millerson, professions develop in abstract time. With the exettption of the "ternpering" just mentioned, this time has no properties of ts o - that cundition the developmnt af pmfessions. in cuntrast, for Larson such properties are central frces of prafessionalimtion Some pmfessions developed in aristocratc smieties, some in democratic ones, still others under corporate capitalism and hurea~~eracy. The murse of profmsiimdization varies in each regime. The iarger story determines the tme, the conditions, and the stntctures throngh which profssionalization takes place. l7 In general fom, h n k stories follow not the tonvergence piut, but rather a stqes-appmaching-a-stedy-state plot. The steady state is elite status. Larsonk central suhjects are elites of practitioners, which seek personal rewards through collective mobility. There is no p&ular content to her genede st3ry of pmfessionalization. h y organizational pattern (association, lieensing, etc.) that furthers w p r a t e reward is a logid next step, provid& that it is pssibie within the larger context of the xtciety. Thus the cansa1 links are Functiond, but their mntent is detemined by the societai context. Despite h s o n k unusual kndling of time, however, her story of professionalhtion stiI1 draws on the standard reprtory of techniques for tellng the story. t is useful to sumrnarize the dteniatives availabie in that repertory. First, stores may assume a centrd subject of narrative and fotlow it, or they may chronide the creation and discolution of such a snbject. Stones proceed by joning a series of specified sita-

ations with links ihat describe the snccessive resolution of each situation. %se l i n k are usually h w n Erom a timited set of basic models for why things occur in suciety-fvnctional, historicist, evolutionary, m d so t>n. Underlying these links is often a single simplifying assump tion abuut why events m u r , such as the self-nterest nivel. In putting these liriks together, social stories take a variety of appruaches to the o&r of events-making it sometimes essentjd to their o u t a m e , sametirnes irreievant, sometirms in k h e e n . %ey also &e a variety uf approaehes to issues of convergente and divergentesome of them rewunting the emergente of a steacly state like "futl professianalz~tiun,"uthers the development of oscifiation or imbdance. Teliers of social stories &o have metqhors for genedizing these stories. S o m employ the metaphor uf career or Iife course, searchng for a single typicil sequence. Others employ more openended link-by-link modeis, tisng m implicit metaphor of eclnversation or interaetion as their model for sequences. This somewhat literary malysis allows us to separate the formal from the substantive diversity of professionalization theories. Some of the choices made in analyzing patterns like professiondization we re& as si~bstantve-the choice of an underlying self-interest mvdel, or of functiond mUdels for links, or of p&icular stmctures (e.g., ethies codes) serving P #ven function. In past discussit>nsof professiondization, these substantive aspeets have sometintes been the focus of attention. But other choices we set: as purely formal, Ike the choice of a central suhject and a plot form, m d it is imprtant to r a g n i z e that many ineclmpatibilities among theories of professionalization arise out of these formal decisions. The "proletananization of professions" arguments are cIassic examples. Their central subject is professionals as an inupationai class, rather than professions qiia social groups. Yet they have been held to reject the concept af profesionalizatiun. What they have ia fact rejected, or rather qualified, is a certain version t>f the professionalization iigument, the version in which the motive forces of the story are the externai rewads professionalization provides to individual professionals. Other versions, with different driving forces, are wmpletely u ~ ~ & e c t e d . ~ ~ These formal differences in thmries of professiortalization exacerbate the enduring subsrantve differences, some of whieh 1 noted in outlining the history of studies of professions. It is i~nportant to recall thme svbstantive digttrences here. I earlier distinguished studies of professionr; in t e r ~ n of s their locus of at'talysis (individual or society) and the consrquence-S of prafessionafism they studied {internd or external.? 1shdl classify substantive views of professionalzation sligfttiy &-

ferently, dthough a s i n in four basie categories. The b u r versians cm

be dled the hnctional, structurd, monopiist, and cukurai cnncepts

& p~fessionalimtion. The liinctional version was the first of these, d o m i m t in the w n l i n e of Carr-Saunders and Wilso~l,Marshdl, and k s o n s . Profession was here a mems to ccintroi the wymmetric ex-irt-client relation. Professionaliraton wtls simply the evolution of stmcbral &uar.mtees for that mntro1. le 'fn the shucturaijst writers-three of whom 1 have just diseussed (MiBermn, %Yilensky, Caplawf-the funetons disa~~peared *md the stmcture alone remained. Profession was merely a form of occupationai control; the mntent f work and the expert-tjient relati- wem l e s ; $imprtant. Professionalization here became an explanation of why the professians display& such diverse propertes; the answer was that some had not finished professionalizing. The explicit focus on structure and its evolution Ied to theories a h u t the hstoricd forces driving the stmcture, and hence the stfuetnralists deveiopd the eqlicit rnodels d professionalization here analy2ed.m The monopoly schoof saw the sane structural devetoprnents, but a r i b u t e d them not to a "natural h," but tu a desire for dominanee or a u t h i t n ~ .Professions were corporate groups with "mobibty projects" airned at eantrol of work. For Larson and othen, as 1 have noted, this control was interesting for its inAuenee on the status and power of professions; Freidson was more interested in its effect on such soeai funetions aa: heating or justice. This sehoot a e r i b u t d the pattern of professionalmtion to Iarger, externa1 soeiaI processes-the rise of bureaucracy in Larson, the shift fmm professiondism to medation in Johnson. The actual sequence of struetures (associiltian, xhuol, ete.) became Iess impurtant than the sequence of functions they served jidentification, exciusion, ete. ).gi Some recent studies have moved away fmm the fmus on structural reguhi~y that marked prior work on professiondization. Bfedstein, Haskell, and others have emphasized the cultural authonty of professions, returning to the Parsonian fascinatien wirh expertise as a socid rebion. By making euiturai legitimation a central process in professionalization, these writers b v e set a n m enterion for the "professiondity" of clccupations, replacing the oid one of organizatianal simiIarity to iaw and medicine. As 1 nottd before, Bledstein has mnnected this cultural authority diredty to i n & v i d d decisions for mobifity.a Given such diversiSr, both fonnd and substantive, it m- seem hard to consider the v a I d i ~ of pmfessiondzatian argoments in generd. f organizations is a fw cry from BledWiIenskyS regular sequen= o steins rise of a "metaphor and rneans" for vertical mobility. But it is

essentid that we d o consider whether the general professiondization argument can be s u m s s h l t y defenrfed. The variuus vieurs can in f a c ~ be synthesized irtto a general concept of professionalization, as follows:
Expcrt, white-cal& orrupations evolve towards a particuI<u stmcturd and euC form of ofetrpatiunal control. The structuriil form is cdled profesiun and cnnsists o6 a seres o'oaaniitlions fw as.wiation, htr wntml, and for work. Iln its strong f o m , the profcssiondization m m p t armes that these organitheir conxations dwelop in a ceriain arder') CuIturaBy, professiois iegitin~ate trol by attwhing their expeftise to vatues with general culhiral le@timacy, inmasindy the values of ratonality, eErlenq, and sciew*.
ttid

This synthetic professionaiirntioe eoncept has some pwerEul sucettsses to its credit. As sociolo@c*\I concepts go, it is relatively coherent m d its tenns relativeiy well-deflned. in rhe stntng (stmctural) form e s p i a t t y , the orgitnizations and their sequence were prticularly easy tu m w u m and surprisindy c o m ~ a b l e &om case to case. The coneept's focus on expertise referred dirwtly to general theories of oecupalionnl eontml. Moreaver, not only was professiondization weli behaved thriuretiedly and oprationdly, it aiso had no smdl empineal power. The major British and Amencan professiuns seemed to follow it relatively wetl, a l t h o u b o w n i z a t i o n - b a d pmfessions Ike the militar); and the ctergy createti some probiems. As 1 noted, Wilensky tested the strong f o m on a siabie sarnpfe of Ameriean groups and found great regularity in the sequence of orgmimtions. At the s a m time, the professiondization coneept haf had some grave ditEiculties. First, it tums out that the results of WilenskyS strong furm test were largely attifwt~tai.Second, more than a d e d e of historicai case studies shows that most of its underlying assumptions are faice. To test W i t e n s w argtiment, 1 have studied the order of eight events in 130 Amencan and British professions. My andysis spiits oecupitions studied into three groups: recognized free professions (about 2G each in bath America and Bdtainr; subordinate professions (again ahout 20 in each m e ) , and an "other" gmup containing variotis pseudo tuid wouid-be professio~is.The eventi ordered were: l. First (national) professiod assaeiation 2. First guventmen&y spansored licensing le@sfaton 3. First arafessiond examinations 4. First pmfessional sehuol s e m e from some other profession 5. First universieprofessiond eduation 6. First e t h a c d e 7. First natiod-fevel journa1

8. First accreditation of schools (U.S.) or eertification by asscxation (Endmd) The data were pthered f r m a wide variety of soumrs and were, of murse, incomplete in mmy cases. (Missing data does not, however, bim the results, @ven the m e t h d s used.) The anaiysis praeeeded by liinding m m "distances" between the events under a variety of metrics (e.g., r e d time, iog time) and then using these distances to establish m "order of professonalzation." I applied a simple one-dimensional s=ling algorithm to find that order. The results were that there is pussibly a rewlar order among the American free and subordinate professions, but none amung the Ameriean other ciategory or among any of the three Bntish mtegories." Perhaps more importantly, analysis of the assumptiuns of this formalization of WilenskyS approach shows that the results cmnot help but b e artlfactual. Sinee there is one rnajor, national professionai assocation hut, in many professions, dozens of schools, it is inevitable by probability theory aione that tthe first schoot will precede the association. Similariy, Wilensky found universie education tu folkrx sepa-ate schmling not because it necessarily did, but hecause he included ~iniversity schmling as a subset of separate education generally. Thus, the date of the first %parate school was either that of the fint university school or that of the first nonuniversiq sehml, should one exist. It was therefore inevitable that the "separate schoui" event should a p p a r , generdiy, before the universiv x h m i event. There is in faet no real empiriml support for the strong form hypothesis that the organizations seen in professionaiization arrive in a particular sequence.8* The empirical pmblems of the strong form hypothesis of professiondization would not be so impartant were it nat for the evidence w u mulating against the underlying assumptions of the concept itself. There are five hasic assumptions hidden in my synthetic concept of pmfessiodization. The first is that ehange is unidirwtiond; professions evotve tmards a @ven brm, struchirally and culturally. Second, the evolution of individual professions does not explicitly depend on that of others; professionalization can he treated case by case. Third, the socid stnicture and cultural claims of professions are more important than the work professions do; the latter is unmentioned in rhmretical studies of professionalization, although it makes obligatory appearances in case studies. Fourth, pmfessions ase homogeneous units; what intentat differentiation they possess refiects mntingencies of the "professionalization project." Fifth, pmfessionalization as a process does not change with time; alrhough a description of history, it laeks a h k t o v of its own. Of murse p&icular writers have avoided various of

18

lnhuhicilm

k ~5sunipt1ms. NOT~~.lheks. thh sumnwy captures the nnwrpt genrrillv i d . ?lw n?tsuiiiptkmof uriidtrecthmdity h a been utiorkcd by both mdologicril ihtrsrirts aml liirtorram The theorfsts h ~ v c come iip w(ih <I<.l>rcilv~-iuiidli/~tnn, uini pmlrldnnimt~mi to rcfir tu tlic appucnt d<.t.reaWin pnift-ssrnnulIcpitimq mti ~ l i t o r m i cin y t h a a nnr?h n t l and ti, thc I e u t ~ i n q Iieiiefitr iif ~>nifesqiu~Iism fnr thc mcnihrrr of tlir ptui.uions tm ihe utlit-r. fhc hisioriaris Iiiivc otu<lidniinwnnis pnb ft.rsioiiil ur psctdaprurclriori~~i p u i r p t h t hwe ~t;~lled or rvcn d i 4 un tht. Iiigii niad d ~in~fturirin~lrrriit~ici-p'iychubl rnc<liumr. clcrtmtheriists ;in<l f i ~ i l w ysurgtwnri. cntnpotrr "mders." nikbivm. Thev l u s t . stutlied u i i a l ~ n ~ t i u t iunotig i. Rrilish iiiacteenth~~ntiirg t
;rr it IS

rkr*or~tuid luiion#twenticth-c-entwy m-!el wlrkcn, end d s o divuim ainimy twrnticth m t r i r y Rntrtli Juctnr~ nnd iimoug ~ a i d 4 reb gtoiia wrkm in &nra. In short, tlterc are clrwlv a wukty ofdirec
ttorir for devclapmcnt. ;d dcvc!vpmeni tcmridu dnmg m t m l is hut one E th*m." Ti* ~aiinrptian thnt ame pmcmloni drwhpmcnt h indqmdm rfianidher ir th~wicrrc<l irnplicitly hatt no kw stnrngly. it is tnie thpt m t wurk on prufc*iiunr cuiittnucir tu he done on a pmfrsson-bypmlerslon h t r . Birt m-idenre d l l i h l e in this very m r k qurstions stich u pmmlurc ntmndy. Much w~rk cm subpmfiaiimis in the nwdicid r~mphssb t he ~ inti.tcpcmlrncv ufpmfmonld dovelopmnt. m <lo ~ l i o rmcs of AiwM-aii pyrhiatry ttnd soc'ial wrk. o f tht W ~ U U S t y p s clf mrg~~mrs. of Iw mid imitinting. Bookr on individumi d e s sionu s l r d nitirh uf t k ~time t oii intrrpmfmsiod mlutionr. but mma dmur thu obvious m m l that tntrrpmfbnionalrnlatiotv are potenttaily ihc ~ r n t catiire d uf pn~ft-ssiuniil dt-vek>pincnt.m 'thcl ammptictn that stmcturc is more imporbint thm smiP1warlt b , l i h iindtmtioniility, m vjpcct of ?he wciologlcnl thcary challenged by histuric-l 4 . S a w ~wiork l on pmfesslnns, inclidtng mirch of ihc puwcr literahare of thc last d e d e , littk attcntion U I tlic ;triitnl wnrk i h t ir clane and thc errpcrtusc 4 to do it. FreldsmP m>& is it striking m p t u n . ! l t c i h l litdy, by cemtmt, har emphszizrd the actiial wvtk ~ri<mncd ln pmrcssfons ai divcm as 1ihru-ianahrp, ~ngwirning. pychmtry. nnd thr ckrgy, histwuins hivc shom the intlmte rcluikin tif prnfessiatd atntchire d eulture to wo* it*U. l i w nociologml thcorists lwvc n d I r m e d h m thb thpt wwk miut be thc hwtu of r txmmpt of proksslrmai Jmclgiment.* Ipnoring i n t c m l dierentiution in pfersions hm helped the prokiunilimtioti rn-t simplify h u t it h u to explain. But mrent HV& i i n p k that I ~ L ausumpthm, tw, is (hgemur. Sociolqists

themx'kes how mitilnitc<l unalyses uf diflmeiwifs in tntpn'sti~p.in lo<.atir>rts nf w~rk. in JLCLYSS tu prafcrviond p r r . \Vhilc saiulitgists Iwve n i ~itt i neiirml r*>nnwtd t k r r intmiiil p t ti<8uclnpment. Iiismtiasts hiive d t ~ m w, tr-rnc hi ptttrrtr cif l>tilftb~~itXK~l in stiidn- nf thc k-giil yn)L*aion. uf iwgiticr.riiiy. ul mduim. Ttic d~rlol~ncn IICt intcrtml ditfr.rtw'c1 is Imuntl dinvtlv tn thc dtwclnptttcnt uC prufrssioniilism.) a an E P . I K . ~p ~ m r Finilly, the asuinptinn thpt ~ ~ d f r a t i 1s urithoirt uny history of its own tuu kw rhullcng+dfmrrliilly ty ihc siciulo>nk-ai t k ~ r i s t s themwlvm. priiculiirlv j~ihnwnriml liuawi. &ah nutcd thrt the inmosfng invhlvcmcnt of the st-ate reshqwd p m fcsrionuli7utiun. ; u ditl thr rciiwd drif ttlwodr t>iiwilum~k pr;ictire. %sr I c s m n were npnled a s h g uvc.ttfuc I i y k>th the histnrnns md thr. ~uciolt>~isti irtiidving Gmtincntnl pn)imsiurw. for the clmgrs rl&bed ly Liuwm uncl Juhn~m I~mrpCht the itnusud profciric~ni d Englud 4 America mote in line with the m a k l of pmfr~~ionuliirn Icirig drimirnnt in Fronrc und ~ ~ y . ~

si&

Onhal*ncc. thm.theevklenrcargtmfiwannr,yrpmchtopmf m b n d c b d q m w n t ta m p k tbe genmd pdewiundbtion concq~t. Thrrr is. d mum. ~writ dlvmity n jwnfcsrkmdization t\inir i a . M u d i o'it. as I hmc iugurd. i l Formal divenity. Them urc mmy thmricr r h i m i n ~ t o I l c gmrrd thtvlnes rbout pmifnsiilid devchp i m t thnt are in fact rpecial t h c w i n d t h i s ~ w thnt m u f i t , and c~en the gemrrJ tl>eorieso k n puse their aalilyscs in furdnmrntdly diHmnt riarrnttve ternis. And them are wirle d i l n * m r in the suhs h r m u theJe p ; e n d tltpories-in Lhc drivin~ mmhinisms thpy pmit. fn the pancm o f d i ~ n t i o n t h q dopt, in thc putkuiar rtmctures tlwy crnphiisln' Yct inurt prurcJsint~niiitioathrwirs falknv ui commnn appru~ch t o t!uir xub~ect, w b t 1 dkd the synthetic thrwy. TMssynthrtic t1uxn-y. depite thc strung support thot m y case studier @ve it. lw profoiind shortmming. A rcriocio empirical test mjem t. More impwtantly. its t>auc ousiirnptlons huve al1 I m n ovedmwn by rcfcnt e m p i f i d m&.'Ihcw p m b h irnply thrt t k case study mppurt Ir more illuaory thon d. In thc rliaptm that Tnllow I tvill p o p o i ~ m altmmth h m y tknt m e r s e s thc pn>blcmatkassumptions of pmfemiunnliutimi theoriar. ThP alternative ;wiimpHons Iwgin witfi a &KIIS on wwk. The antral probkm with thc nirrent o-pt ofpmfmionai~caiim is its focur on srn~.him r u t k thin uark. I t i s the rwntcnl of the p ~ i o n s work ' t b t thc r a ~ studics e tcll ris is &angina It i s control of wwir that brings ttie professioas into m n U d with corh ather nnd rnnken t h r histories intenkpcndent, L t is ditlemtiation in typa ufwork thrt &m le&

to s-naus d&entiation within the professbns. By Mtching h m a fwus on the wwizationd sbc-res of prtsfessions to a focus on m u p s with common work we repiwe s e v e d of the problematic assumptians at once. "hrt central pheuontenon of professiond iife s thus the link beMeen a prdssion md its w r k , a link I s h d l a i l jurisdiction, To analyu: pmfessianal development is to andym how this l h k is created in work, h w it is anchored by fumal and idormal how the inteqlay of jurisdictjod linlrs betweeu professians determines the histoq af the individual professions themselves.

Cases af Prdssiond Devefopment

To illustrate the cemptefuties that any theory of pmfessional developmeut nust handle, 1 shail give i n the remainder of this chapter some

e m p b s af that p m s s . Them examples represent the much I q e r eolIectiun of case sh&es that I am trying to eqdain. Su& e x e m p b vigneRa e m M y a eompromise between severel ways of approaching the data. A p i t i v i s t would redme d l these histories to coded facts and present them as d e p d e n t variables. A theorist wouid present an e x e m p l q case at en& md delbeate the meehanisms ai play within it. r wish to &nce, these c a n t w imporatives. On the one h d , the divemity of the pt-fessions m w t s a narmtive presentation of contrating cases. On the other, we must ahstract from such cases and generate iestabke Ideas. My compromis is to illustrate the pmblems of expianation with these brief p i c t u r e ~ . ~ Let us belgn with the familiar case of u r i c a n d i ~ i n e . ~ Like 1 ntany Amenpmfessions, e had two waves of professiondizing activity. The first, which be* a Iittle before the Rewlution, saw the founding of a f i eady schools, the passage of some exclusive state licensing laws, and the creation and empowerment of some I d and state sdeties. The JackFonian era struck down this exclusivism and opened the gates ofcompetition. A variety of sectarian and fofk healers apperued. h o n g these were the hammpaths, who espoused, among other novel ideas, the practiee; nf not kiiling patients with treatment. This p w t i w , and the g d resnlts that attended it, made the h o m paths mther h g e m u s & v e d e s to "regular d c i n e . " There ens u 4 an intense war over who h d the nght to cure people. Each side c i a i d the leetirnacy of science, de&& the &&y of the puhlic, and a t h k e d its oppanents in e-ditorieSs and speeches. Thr: regulars devised exelusianary e t h b rules q u i r i n g a dylng patient to dismiss an attending irrtsgulm as a mdiGon of their own attention. In this, its

&h&

hour, r e p h medicine at k t saw fit to found its n a t i o d as&y the late njnetwnth mntury, the regulars were fortifid bythea- wientifte &cine from Eurape. AIthou& wnafned with &ngnosir, etiobgy, and pathology niore than with t ~ a t m n t ,Euroa few spectibcular therapeutic successes that pawer. Thus minforctrd, the n?gular?r started their ethics, and betu refonn their hgok.. Fmm the h o m p t h s they had learned t o avod heroic treatd the twa graups united mound the turn of the eenhiry to fbt off new oubide tbreats-the w t m ~ h -od s later the chiroprao m*1s a wh*l+nd of rehnn b m above, the nebuIous world of pri4 4 s b f s , ptent d i c i n e , and uaregulatd practce qmished under the clear omization radiating from a powerfuf, nau@& unted pmfession. le mmmunity general hospital, the &unw n orwiuttion of mctdeni medicine, d e v e i o d i-pidy. M&ough f d I ofsbte intemention, A m m medielne pmfited irnformdo~ of public arid private in cheme~, itg inam and prokssional h i n m i b tary it M = s u d a position of socid praminenct? and p e r euwied &mu&ut the occuptiond worId. Included in its vast organizationd empre wre a host of s u b d a t e pmfeaiond groups, %e case of Amenmedicine shows h w eomplmted and interwwen are the questions about what prufessions do and how they intemrke. If ane aims to "6d tfie orgins uf" Amdwn median#, then the h w o w t h are an outside follce tha enters the picture, fights with &e p q ~ n i s t and , then unites with it. But sueh aoi interpretation i w m s &e v i r t u d dissolution of regu cine under th nhn onslaubt. The "duing of hesling*' a free-foz--&. tagonist itself is not a mnthuous entity. Development, &vi% and interprofessional reations are bound up together. %e medid profcssh& absolute ainhul of bodty dis required defemive work on a nurnber of boders. Perhaps the most important of thes borders was the hazy une between bodity and mental aifrnents. Nere e m r g d a m n d pmfessiod group, o ~ i z a t i o n a y a pari of niedidne but hteUectually and practically separate from it. This second sketch, of b n c a n psyehiatfy, sshows again how complex and inis the web of pmfessiond developmnt. (1 will @ve a sus*& +sis of thif ose in chapter L 0 . P Ps~hiatry be* when a group of enterpdsing rnedicd reformers m e d in tbe early nineteenth eentury that madmen ought to be remmd &m &e jurisdidian of the legal authodws and plzlced under t b t of the medical professian, Madmen are &k, they said;@vethem

to us and we w i U cure them. A new theory and therapy justified the shifi, arid p~+vite M i e s and state le@sttihrrcswere sooa dotting the cauntryside with insane asyiums. P s y c h i m was the profession of the superintendents of these instihtions. (Nonsuprintendents were finaliy &mi@& to the o r g a n i d prafession in the 1880s.) Like teaching 2nd w i d work, and unlike its parent, medicine, psychiaw thus amse out of lui organizational &m-t-he hospieal fOr the insane. An iation, journd, and oAicid p ~ c i p t e s sprang sirnuItaneously into being in the mid-M&, about the same tme as the APIIA was faunded. Thruu&out the iatter half of the centuq, psychiatry was an elite pmfession, its memhrs exceeding most of their m e d i d bmthren in incomenie v e r , and prestige. But the latter hdf ef the cenhrry &so brou& decline. The earIy hopes of cure proved illusory; the psychiatrists p d u d l y k m ttdministrators of custodial warehouses. Memwhile, the jundi&on that would ultimately become psychiat v S was b i n g explord by other poneers, the neurolMsts. From their b l d y bsptism in the field hoiipitaIs of the Civil W a ,these men emerged to became general consulting speeialists, helping their m&cal colleagues with peqiexing cases. They took h m other physicians ny patient whose othenvis untreahble iltness couM somehw be related to "nerves." Under this mnveniently vague heading, they roli e + d the mi&& whase redcitrant iilnesses imouened . the new e a corey of medicine. Heavily i n f i u e n d by German medidne, they were ske~ticaf of treatment in ~ e n e d arid , whea cures were discovered. as fm ;he "nemus" enrfocrine diseases, they at onre retumed the &Sm e s to general d i c a j u d e t i o n . The neuwiogists developed their ascociation, journah, and univemity teaching positions during the second wave of m e d i d professiorializrttion, But they smn f o w d themseives overvvhelmed by the h o & of "nervous" patients ather physicians referred to them. These patients had few hut peqlexng organic symptoms; for the most part the problem seemed to be ''in their minds."'h a result, neumIogists and psychuitrists hegan to handle this junsdiction together, the neurologists defining the patients by their tack of response to standard treatment, the psycha*ts seeing them as irteipieatly insaile. For about twenty y e m after the tum of the century the iwo WUPS interpenetrated. Then in a suriden shifl, they divided. The tenn "neuroI@si' cante to refer to organic physkians generally wrkutg in ho~pitafs.Psych*sts took over the neudo@&' oId p i t o n as the ouwtient b d e r &u& of the medical pmfmsion, handling the symptoms and diseases that not quite red. At the samt. time, they began to accept direet refemfs R-m &e lay ciamrnunity.

InMuctMn

23

mduwt r&ewaJ.s reflected the psychiatnsts' rapid, entreprenuerarrrras of mi&control long domina& by otber he heip of a popular front orwization, the Nationd kwime on Mental Wygiene, psychhMsts in the twenties tried to eizft m a m i wer juvenile delinquency, alcoholism, industra unrest, stnk, and numerous other areas. This brought them into vioeng wmptition with the ciergy aml the 1aw among the otdtr pmfesb @ ,d~ c h o and 1m ~i a l wr>lk among the newer ones, InteiIm&jyB rhe psychiatrists routed a l 4 hut the law, dthough ther n u m b wem w srn& tu take more than a supervifory mle in the jufisdictions tt.lay Tfia pmfession continued u-ntmtled until the sudden egwsiom ofhrnanrrl for psyeh&hempy ia the 15470s found it s o unders&d th.at pswhofw and mi& work pen*ated the third party paym n t sehemes that had so long pmtected its munw+. %e sbry of psychiaby is thus a d&rent one frorn that of mdicine generdy. The professon began 6 t h an or@;anization.i t w h e d &ron& tfie formattitisof pmfesiondimtion-4ation, journd, d + i n a d d e . It c h g d jitrisdiction ahust wmpleteiy over rts IWyew hisbry. Ag& we see that the c e n t d questions of h m pmfessiuns d w e h p are tied up with questions of inte~rofessionafrehtiuns and the mnteat of pmfessod H M Q . Pmfessionafization occurs, to be sure, but in a context that helps determine its murse. A campmhenf pmfessional I I f e musc: deal with these compiex h of wmpetition d n t e q m f w i o d relations. Ths can be re clearly in &e Britsh professiom. Unlib Ameriw pmfessiuns of the b e eighteenth century, their e o n t e m p d e s in Engfand were not hmhated by a mehuplis distarit in spae, but by tfaditions distant in time. Law in particular eould trace its ofigins to the personal councih of the f h t Piantagene&." The sehmls and asmiatons of the Bar, the Inns of Court, had ktft their recurds so long before that no one knew how old they were. Even less was known about the Inns of Chanmry, in which were collected many mmbers of the lower b s of the pmfession, the ancestom of the present soIieitom. %e pmfession had an intrieate hierarchy, as befitted ts semio@&d onlpns, bu three Ieveis i neach of a numbe dst>eished by function, the that of ord argument, the third that of mpmsenting or a p v a r ~ l g for a lirigatnt. Eaeh court h;ud its own junsdt&ion and its own narnes , basristers, d wikitors in w m m kw; a(tomeys in e q u i ~judges, ; d d o s , and rts of Admaity and &hes. @he laft was

24

Intraduc*bn

the chisf ecctesasticat cuuit, whkh until the 1870s had juri&&on w e r all fam& ma&ers otfer than propeftY.j Tke carnmon k m and equity pfmsonr of &e late ei&teenth century were ia semore a p m m m than reality. %e Inns of Court, whicfr had at times been vibmt, active orgaabGons, were at rs and &rs leammi ther UIO& on the job. D i d p k e was exercised, very m b n d f g 5 by the courts and the & i n & ~ @ v e committees of the Inns, the knchers. Despite this e m m t iadolence, the wmmon hwyers of this penad h;pd jwt won a sigaal profedonal victory over the be~er-educated and more famally professianat dactors of civil faw. U & the leadmhip mon law judges, they hacl over he entire wmmedal j d i c t i a n it pa& of common h . %e ~ m u n of e the m s t e r s was upset by a mvolutiun fmm belm. The aaomeys and fofititars built i n the early nineteenthui centery a national asmiiltion {really a metn>poliW one, far mast le& bus&= ), which undertmk what we would n m mi1seriow It mm&M a f m a l ~ ~ n t i c e s h p r i d pmtitionem, i m p & professio tions, and began a s&ous and careful pmfessiansJ tiougtit far, a m i won, a monopoly of &e newliy Iuerative business of eonveyaneing ( p r o p r : transferf. ~ The brristers reswnded by consalicfating their own absolute mmpoly of verbal pleading, whleh had been ganted several eentuds b&re over the intense objectiws of the l w e r b w h w , 2 % removed their fast wmpetitars, the morits, cansofidatmi the jdsdictions d their courts, and the old rule tbat d i judges be kristers. As for professiodization in the nrodent sense, they did It?ssthm nothing. By the midf a u h r i z e d barnsten, ~entieth cenhrry there was sti no n a t i a d ascoeiation, no cen a y . The educationd activities of the Inns continued hougb the English universities naw gave &helor's h e e s in common law; passing the bar was stig a xnatter of sitting ternts at the ims and endufing a vague

vas a natural mne o e x p s i o n . The e w s i o n had a number of inter-

, & g effectii. First, the siow growth irnposed on the profession by its m S&& S m m t that it was ovemheImed by the welter of ~ m ~ e d estate work that was genemtd by business expanm,In m-uenee, iis chief junsdktiond monoply, mnveymchg b;rd by this century h n delegated to a subardinate profesdod m u p s tIie m a @ n g cleiks, who did the wark under the very I m ~pem&ion af cobtors. This i n t e d s u b d h a t l o n of routine work is a c b e t e r i s t i c sategy of professi g more jurisdction than behg the best exanple. Fmrn t h outside, however, competitb Gom a n e s

maneem how, why, m d whether they were achiafly ni&advice and corporate r e s a d d n & * w w a t sand colcitom remhed en uneasy truce. Each had its owa m e hirf; t h k area between was often one of eadict. 'Fb -untan& dmei& =tia& snd i d orgaoiz-aeons h u b w d y afuund 1880. %ir journai dates h m the wne period, as o. sbcr discipknq p d e s and the examinaaons for en. Amuntuy: edueation was supervi @d smiety, dthough t took plarx? in the ~ ~ o f ~ ehrkship i c W with a m m ~o r mIieitom, the chartered -untan& in fact had far more business than their s f w growth could hande, and soon wem b m d to tolerate at le& one group of less educated and certified mmpetitors, the Incorm e d Awmtants, @he continued exclusvism of the Ckartered ami f~-pofated A m t a n t s means that many other group of aaountatlBare o & outside &ese Ieaden of the prdes9ion.) ln the presa t a a b r y , the profession underwent a further change, in this case a
rs ta

me.In the area of

numkr of individuds and smdl ierent local busuiess. case of Endish accaunting

erships doing a mmpletely dif-

a ~ surgeons, d md meatd al1 the pmmr annbutes of professionalsm in s h r t o&. W a t redly d e t e m i n d the history af the professim was the de-vebmnk and shift of its jundiction-frm bknrptcy to audi*g, with &ud e w s i o n into cost m u n t i n g and n '"managemnt semices," Here, too, we see a n u m k of other teristic deveopments of profesGond life-the competition fmm below, &e @ua malding of proftssion to clientete, the maintenof a stmte* h d m d m o n o ~ l yYet . at the same time accountingshowed its wiilingness for h d - o n mmptit~n-with law over the degnition of pro&, 4 t h Iaw aMf b l s i n g over the juridietion of business advice, over he pruvision of staF services. n e r e i s much more here than is told by the simple image of professiondtzation. But even moro houbthg quest;ioas about the way pmfessans develop and internefate &se when one leaves tha familisr Angfo-fherit-an s u a s s stories and studies either the canttental professions wth their civil-servattt character or the failtd professions that litter our own history. In , the ncw effects arise because pdessional Iife is overshadowed by the state. While indepndent competirion still takes place, d i n d e p d e n t professiond evolution OCCUIS, both aim immdkteiy at the zhiwement of certain status wrh the stake. The abdute, cenhalized, and ratiodiztrf c e r of French govemment I d it to take a d d s i v e role in orgaiPng occupations both before and &er the Revolution. As a resuk, developed professons a@ tend to look alike in stmcture. At the me, pro~oprofessSons tend to be ignored dtogether; things u iza3 by the shte e m u a b ~ r t m t . , whiie in same ways reminiscent Thus, the French legai of the Endish one, differs fmm it in esseatial ways.= iin the rst place, it is bmken up into a dserent set of jurisdictions, with diffemnt relarions between thern. (J am here prmn&g t 197% fom. The fusion of that p a r meqed meated a n - group of cotfs&)urid@ues ou ea&, m i n g their I V O ~ woll baek into medieval times, are mughly andogoift to bsrn~tersThey are into bars under ecich different caurt, aMf their W t monopoty of oral pledhg in many mur%

hrrnril in the Mapoleonic Code. But they are unlike the gn&h in mmy mys. T h q share their seUldisciplnary f u n c ~ o n with rhc courts, as the B ~ & h have not sime the Middle Ages. Indeed, t b ~renrh mortf have on oecasion r e o r g a n i d their bars completely. &rr aras ablished aftogether during the early years of the RevaR Yd was reinstated wth some reluctante by Napoleon, who ded The auoeats are also unlike the M s t e r s in their iremcnt of unversi* le& ednaiiom and b r m d attendam at t. requirernents for drnisfion to the bar dating frorn befm the mth w a b r y . Under the Old Regime they s e l h if ever beame os in hi&r conrts, and in the madern French profession the magtx are a se-te group with separate educationd requimmnts. i s pemy tfte opposite of the British situation, where barriste= ~palize the bench in the higher couris. yoad t k a w a t s , the French legal pmfession tooked i n 1970 as d no history. Its rnajor b-hes al1 had the same siructure and d tfiat stmcture to the lucid c W t y of laws governing public o%various branches were separated by j h d i c t i o n . The aeods nred for their elents; they filed fonns and motions and sheped the cases throu& the court. The notaires recorded formal m a t s and eonducted the transactions so recordd. thus controlnarriage, property trander, probate, and other jurisdictions cond by attorneys in Engiand and hwyers in America. Huissiers d otfrcsi papers and levied executons, b t h for courts arrd for ita paraes, combining what in Arnerka would be the funetons of SS senrers, baiiigs, and collection agents. G r e w s kept court rls andr other ocial dwuments, pMcuIariy those pertaining tr, &esses. AIl of these iurisdctions were fomaiized in leeislaiion or re. So afsa was the profasiond stnicture. Each group (or ordre) - orgsnized into local (%dementale), regional, arib natonal &res. These M i e s were oicialiy charged by the state with keep;remrds and rolls, with originating disciphnary &ion and adminis%ng murt regulatons, wth running the we1fare systems far the % , arwlr with governing conditions for suix>rdinate workers. The S af-t set educationd reouiremnts far the various orden. Perhms n& afknshing aspect of the rwlations of these professional ps, te t b AndeAmerican observer, is their formal pmvision for t h9 p u r e k of ofliice. Eaeh mernber of these groups of oifciem minbought his position when he entered the pmfession and sold LPtr ir for h u e a t h e d it) when he le& it. The pricct was normalfy from four la- Peo tmes tbe annual imome. The state thus had indirect control W@Ptht? number of these officials, as well as over their be ha vio^.

m.

f e s i d &be di-, n

6ea5u& to emb- &e pkmmnaa of p m W o aro S-h h M wth &e s m m af lar; tf-rt we k r ~ the t

w p t i o n s thrir have & a p v d . Some have gone because the e h n t i o n or technalo~y thai crrratlwl them has disapwmd, "b && profwions and pmtoprofmsions4i~tchem,agenk, surgeons--art: one such example. Had they developed b m l d g e that && byond the w r l d of the rai-, they might have s u f i v d j b Sut dispatching did what we now think of as operatiremmh, even thou& its central task was esst.niially under the finsdictiun n w heId by that pmfesim. Because they !acked & s e tion, d i s p t t h n && witb their tmhnolor2y. h o t h e r such gmup are [he ithierant ente*em-musihs, dancing masters, snglg tea&S-whose ~ a m b m have been defimated by the ~ e n d b t i a of n enrtainment t b u & thct media. coum, 'trut only &ron& M m g a f o u d t i o n in the profession of lblic & d tding')= A &case of pdessiond death is that of the psychoI@cai 4m%. Mediums Bou&h& in the larter nineteenth eenhtry as t'tre prof e s b d e m w a n t of spinhalism. After the turn of the wntury, , hmfar as it s u r v l v d ak 41, an ormizedi chnrch uf the &erge, complete with eongre@ions and mnlsters. But for banner was carried by a group of mediums several hum-

The d i u m ' s skitl was her ability to encourage, through passiviiy d o p n m s , efFective eommuniation btween her audience and the Wi-e of the s p w b d wrM. The first foI10wefs of the etJ1"mgbeMesmrism, S w t ? d e n b o ~ i s m artd , a vaTlie weekly journs) ot' the m d u m s , B a m r uf i&&, appeared fmm 1857 to 1W. Tho Medims Mutual Aid Society, aimhg at inswctim and support of aii mhg mediamistic powers, was founded in 18e0. A variety of eBent turd mpwrt g m u p such as th0 Natianal Organimtion of S p i f i u i s t s ~ W h brut.8~ d a m d discussed, in vain, the problem of regulating the ~whma An o~~ s c h l of d i u m s h i p was founded by Morris at Whitemter, Wmnsin. It is i m p o b t to redize that d i u m s h i p fits the basie definition of profeSSion vmy well. It appiied a set of esoteric skills to m p a f t i c u h mr. C e r t M y it p o s ~ s s e d al1 the organizationaf parapheraalil af a mksion-schwI, ~ w i a t i o n artempted , rewkatian. It is imp-t, r d that many w e l E - b w Amentans ptmnized mediums trxl, aPld thar spWUism was p e ~ e i v d as a kind of "scimrehgion. As R. L . Moore has pointed out, niediums enabled people to undertake e e r d=i&am withuut impueing &&ng siates of social &m w amming pemnd responsibility, It was a jurisdiction that psyin

io r6e I"iap, &&u&

ety & &her predecessom had prepared the way.

.Ut

fn&odu&on

ehiatv WM later to sturnble nto, a r d indeed a number of psychiatryk &y htttes w a e fou&t with d u m s ami their descendcutts the s w b d i s t bdem.= f n reft.%et&g &ut the deveiopmnt of professions, &en, we musa deveIop m w e m that te11 us why inediumship grew the way it did and why it di& sa quickly. The mswers that spnng to mind are not very heJpful. It u3 useless faying s p i r i d i s m was a ridculous waste of time sithe d u m s simpty couldnt deliver results, Neither muld ninetmnth eentury n~edtcine. Nor is ii h e w I to identify '"external" faetors --th rise of s e i e e , the liloemk-ing of Protestantism, the r of the psyche. For these are di intimately tied to other ntmpeting professions-the clergy, the pfychiatrists a n d neumlogists, the iieadernie psycftubmts wh5 took over psychic r e s e a h . So that even while a d e l of pmfesstuual development must take aavtunt of such externd faetors, it must dso see their direct embsdiment in interprafessional relations. These brief e m p f e s show fome of the bwathtaking diversity of professional 1%. It has been easy to mistake Americao ntedicine for the paradigm. In reality the professions are a diverse Iot-winners and losers. puhlie otlicials and private individuals, aubcrats and subordinates, Many a profession has gone from mjp to riches, not a few the other way. Many clmants have never found a niche in the systern at all. Yet d f these are a paft of prrtfessiond life. Beyond this &ersity, these e m p l e s show how the developnrent of the f a m d atributes of a pmfession s bound up with the pursuit of junsdjction and the bestig of rival professions. The o m M o n a l farmdities 5f pmfessions are meanin@esf unless we uudemtand h e i r context. This eontext always relates bmk tu the power of the pmfessions' knnowbdge systerns, their abstracting ability to define old probbms in new ways. Abstraeton erisbles survivd. L t is with abs-ion that law and m u n t i n g hught Gontally over tax adviee, the one becanse it writes the laws, the other because it defines what the prescribed numbers meari. It is with abstmtions that psychiatry stob the neuroties from neurology, the Astlidetiow of its f w y new Freudianism. It is with abstraction that Amenrriedieine claims al1 of deviance, the abstxaction of its 4Fhallp: these vilqienes have inboduced some of my cast of c h m ters. Much of the book nvolves theorerieal statements that malre it easy to forget the h i s t o d events they abstraet. Tu me these events, case by cxrse, profession by profession, are t)le test of the enteqrise.

mnat build an argument that work in every case. 6ut one must

"jld arr. afgument that mrks for rnost. Case studies of professiom

fx>&

tbe raw material of the theary and the ~ludiencethat says

k m b s up or d m . It is important that the reader begin tu make their