An Essay on the

Division of Expert Labor

Andrew Abbott
The University of Chicago Press
Chica@ and London
nte Universtty of Chi- Pres, Chica* a0637
The UniversiQ of C h k ~ o Press, Ltd., Lotidon
"i 1988 by T k University 4Chi-ago
al ri&ts reserved. Pub'shd 15388
Printed in &-a United States o l Am+
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.
I. Prafessions-United St.ates. S. Pmfessons-
Crwt BriLain. 3. Pmfessions-Eump. f . Title.
HD80".tiSAPjiB 1W 331.7'18'09 87-
ISBN S-0006Wf
Preface
1 Introduction
The Profes&ns Literature 3
The Concept
Cases of ProfesSu7d I e ue bmnt 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 117
lnternal Sbraefieation 118
C1'iC.n~ D$firent&tMn 122
Worklace, Work&ce St wur e , and I n t e d
Cart?ar Partem 129
Power 134
6The 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 Audi encesforJuTi sd~mI
Ck4m 157
Co-optabte Pmr 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 Tsk Area 226
Tke CombinedJunsdiclion 239
10 The Canshuction af the Personal ProbIems
Jursdiction M
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. Fknds had introdueed me to David Turner and
David Klass, consultant specialists at Mmteno, the great chronic hos-
pital that anchored the Illinois state mentaf health system. The plwx
overwhelnted me. Dozens of ward buildings covered a square mile of
praine. So repi ar 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 whe s the mncentnc outlines of equivatent
mhes 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 pa-
tients, Manteno employed only une hd-cert i fi ed psychiahist md
indeed only three or four Licensed physicians. Most medi d a r e was
perfornied by unleensed foreign dactors, who were at that very mo-
mn t dmadng the bmd-new Federal Liensing Emination. Turner
L U I ~ Kks, by eontrast, had both been chief residen& at the Universiv
of Chicago; in 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 P r d i
"fn an otfieial sense. . ." U"hat is it to p s e s s and control exper-
tnel" ARer Five years at Manteno, 1 hiid spent more time with wn 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 mt e . 1 h d helped
actminister several tons of thorazine, meIIaril, lutd their musins, and
the pouds of wgentin md .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 professional-
ism. 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, profes-
s~ofialjsm was either a phenomenon h-ppening to idividud profes-
sions or a ~yand sea change in the occupatianal system generally. There
was in this work t i de sense of thu squabbles between the Manteno psy-
chologis& and socd wr ke n over who cauld interpret di aes 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 exceptionofsome work by Everett HughesS students-par-
tieuhly Eiiot Freidsan, Rue Bucher, and Anselm Strauss-there was
no theory about them. Them was certainiy no attempt to see these
intefa>rufessiond battles as central aspects of pr&ssiondism, rather
than as isolated movements and pathologies.
In typieal Ghi-~ fsshion, then, this bouk grav out of my experi-
ences as a partieipmt observer. That the h k S evi dem is rnostly his-
should not obscum ib 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. Mat eno psychoko@sts agerly prutiei-
pated in their professiorls war with psychhm, aetively lobbfing for
t hUr i - w wpent. Yei tbeir everyday professiond world was so in-
scteure tbat t hq protested in vain whea administrators p k e d my un-
ceI.ti6ed self into the civil seMce "prrychologist" classifimtion.
P r e h Ki
'Yet these loml vicissituda reBect larger reality, and a sedous themy
of professiond developmnt must embi-ce and expbn thii b g e r re-
al i w as well, MantenoS pmfessionats strualed within a histofical envi-
mnment ofpeculiar intensiq. Deinstitutiondization of mental patients
was in fuU swuig, destfoying professionals' jobs as it hilfilled their ide-
ol^gies. Biol@d psyehiaq was rapidiy r aupi ng the doctors' psi -
tion a@nst the mumeiing pmfessions, dthough token mwmi e s
were m b g a subst an~d wuntemttack. Within the counseling are&
itseEf, psychmaiysis was at Iast losing its monopoiistk domi nm, and
the B d tide of nondi cal psychothempy begnning to fowr. It was a
time of great hope and change.
Yet the pr ~ai l i ng 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 past rank on rank
of empty wards, past swings and e mw 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 ai 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 Amer i as 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 in 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 va-
riety of professions in the Unitd States, E n h d , and, to some extent,
F m a and the other nations &continental Europe. 1 have been e a t h
lic in rny ttastes, Qi ng tu o&t the customar~ reliarice on Amedean
iaw and medicine. (1 have generally avoided writing &out aeademic
pdssi ons, hoping to escape eharges of navel gazing from nonaca- a
demic readers and the cense of we-knm-it-dl-already amang academ-
ia.) The brryadth of e mp 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 eni 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 wr k . Retlders can judge for themselves
whether that befief is mrrect.
Sinnr the rmt s of t he book lie in my persoml experiertces and ob-
servations, 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
Chi ago; to Jarf Dyrud and Dave Klass, who got me into Manteno; to
Uiss an8 Jon St ei nmt z, who managed to suppurt me there for five
years. Llke al1 &Id observers, 1 have great d e b s to my subjects. Un-
fike most obsemers, however, 1 have the pleasure, dor ded by ten
years' time d a book using Iittle of their rvidence directiy, of thank-
ittg t he most in~portant of them by name. Eberhad Uhlenhuth and his
clinic st& ~ i c u l a r l y Rose West, Mark Mouithrop, Dave Turner,
Poily Everett, Zanvel Klein, and Jeff Teich, helped me immensely. The
Chicago psych-tahic residents of the 1972-1934 cl ases 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 t he 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 can-
sultants. Finally, 1 must thank friends whose personal support got me
through Mantenok deadlier moments-Dave Kudoif, Margaret Kas-
per, Jon Steinmeh, and, dutcissim, Cindi Clyden.
C3ver the years, a n u mb 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 fa-
ther. 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 t he mi 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 t reat mnt are general
modes of knawl edg carne from D o d d bvi ne, and the vwancy meta-
phor 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 hough e ml 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 t he old Chi-o Schmi. Reading this work in
the early IrY?Os, 1 a m e to see social structures as fluctuating and gm-
grrtphic, cartceptions that strongly nnderiie this book. They underle as
well t he Chieago writers on ocxupations and professians, and t he b k
thus lies very much in the Everett Hughes tradition. The h k ' s com-
parative emphasis has diverse sources. Although 1 origndly designed
my dissertation study of American psychiatrists without much com-
parative knowledge, Joseph Ben-David shamed me into studying other
professions and other ~wuntries. The comparative emphasis was rein-
forced when 1 was abie to attend two years of sessions on the history
of professions at Princetonk Davis Center. Although the Princeton his-
t ori an~ 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 his-
roncal work. On the sociological side, Joseph Ben-David, Magali Lar-
son, EIiot Freidson, and Terence Johnson have been particularly im-
p 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 nur nhr of sociological calleagues have talked pmfessions
with me for years, and 1 must thank them, particularly Terence Halli-
day and Michael Powell, for their insights and criticism. To t he hista-
rians 1 owe a still greater debt, for theirs is the data that undergirds
the h k . Although suurces are of course i st ed where relevant, i must
thank here those historians who have personally shaped my ideas: Ger-
dd 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, Har-
rison White, and Susan Gd gave me very helphl, although often con-
tradictor~, 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 t he
mmuscnpt have appeared before, and 1 must thank the relevant jour-
xvi Preface
n its en-
w ~ o n s
Adg&. I must dso thank the Hat vad
oeioogy, whose invitation in 1982 pro-
v 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, James wd 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 md fazmer coileagries at Rutgers, Stan DeVney,
Andy Szasz, W y Smith, Rob Parker, and Judy Gerson have criti-
c i d , cheered, and supprted, as did that ant hr opol ~st who 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 of this
mmuxnpt as 1 do. She tlid not r ed 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 bt-
fow-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 ams 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 mal-
feasance, 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 wb 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 control-
ling 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 an-
swer 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 archi-
t d r e seemd 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~on was 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 w-
tivity occurs.
8 y fmusing on patallels in organizatond development, students of
the prafessions lost si&t o$' a h n d mn t a l fwt of professiond Iife-
interpmfessional cvmpetition. Contml of knowledge and its applica-
tion ma n s riuminating outsiden who anack that control. Control with-
out ~wmpt i t i on is trivial. Study of o r wi a t i o n d forms can i a d d
show h w ceftain wupat i ons control their knowiedge and its applica-
tion. But it cannot te11 why those forms emerge when they do or why
they sometimes sueceed md someti- fail. Only the s hdy of com-
*titiun can acwrnplish that.
The pmfessioi~s, that is, make up an intenlependent system. In this
systein, each pmfessian has its =tivities under various kinds of juris-
diction. 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 juris-
dictiorial di s ~ut es that is t he real, the determining historv of t he
professions. jurisdictiond claims furnish the impetus and t he pattern
. n i u s an effeetive historical sociology
uf pmfessions must b g i n with case studies of jurisdietions and juris-
dietian 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 ha p
ing systems of pmfessions. Only from such partraits can one derive an
effective m&( fnr understanding and predicting professional devel-
opment 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 ofpro-
fessiondi-ation and move an ta theorize the systematie relations of
professions. I then andym externa1 f o ms bearing on the system and
close by discussing three imporbnt evamples of contested jurisdie-
tioas. Thmuyhout, I addresss the familiar questions &ut professions.
How do pmfessions develop? How do they relate to one another?
tVhat determines t he kind of work they do?
But this summary slights a methodoloe;ical theme that accompanies
the s u b s ~ t i v e one as harmony does a melody. My substantive ques-
tions dl invoive generdizing about stories, such as stories of profes-
siondization. hly methsdoIogical mn mm is with how this generaliza-
tion takes place. Td 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 3
t h m t i d scheme, particularly in Chapter 4. illustrates a digerent
wsy of generaflzing about sequenws, one that makes them interde-
pendent. 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 de-
veiop 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 aito-
gether or Iost its firm grip on them. If an utready existing profession
t&es over a vacant jurisdietion, it may in t um vac.ate ~ o t h e r of its
junsdctions or retain mereiy superviso^ control of it. ni us events
p m m t e ba 6 kwd in sume sense, with jurisdictionat v mc 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, Suhstan-
tively, the bmk answers sume questions about the evoiution af profes-
sions. Methodologicallyy it considers the dimculties of generai i ng
a b u t sequenees of evvents ;md proposes a new way to address them. It
k h does historical sociology and asb how historieal smblo@ ought
to h done.
The Professioos Li t erat ure
Aithough t he professions derive from medieval or in some cases an-
eient 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 them-
selves, The nineteenth cnt ur y saw the Grst development of profes-
sions 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 ac-
countants signded t he change. In America the triumphs of regular
medicine over its various sects, t he growth of the univenity profes-
siona1 schools, and the host of would-be professions al1 testified to the
ntiw fonn of occupafion. "
The nineteenth een- professions were important but peculiar M-
ci d creatttres. With the exmption of a munt hg, they stood outside
the new commercial and industrial heart of society. They were orga-
ni& a collegial mmner that was distinctly anrrchntnistic. On t he
Continent, to be sure, the pmfessions were more hierab-chid. But this
h i e mh y carne not from the new captalist forms of orwi i l t t i on, but
rather fmm the Old Regimct, h m whieh it acquired a civil servant
quite pul i a r ia t he rnodern ~ n p a t t u n a l world. The profes-
sions, 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 i wored the Angla-America prohssioas altogether and iooked
to more f mi l i a Freneh occupations for his neacowratist future.$
It uras t he Endish themselves who perfora first andyzed these un-
usuaf occuei ons. Crr-Caunders and Wilsoni The Professutns, puh-
lished 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 profes-
sions that had by then come to dominate the writings both of the
pmfessions themseives and of the social xientists examining them.
Prufessions were orgmized Mi e s uf experts who applied esoteric
knowledge to partieuiar cases. They had elaborate systems of instrue-
tian 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 chs ~ct ens t i c of writing on pmfessions, combining naturalism and
~.poiogy. Eatly rticles on t he professions would summarize the life
history of their particular case, review the then-current essential traits
of 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 pmmst ean hed of es-
sentid traits. But that bed was so often refinished as it passed from
hand to hand that t he 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 pres-
ti@ous category of '"professions." He himself avoided this by identtfy-
ing only v e r - general tratts of professionalism (e.g., organizltion, edu-
cation, 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 mv n i o u s answer came from the t h ~ r i s t s of profession-
alization. The diversity of the would-be professions arose because pro-
fessional status wapr an end state that few had yet achieved. Diversity
~ u l d disappear wth time,, as mup pdua l l y q u i r e d al1 t he narks
of true professions. The mncept of professi ana1~i on thus mnsum-
mated the ~narriage of naiuralism and typoiogy. Prnfessodization
was a nabraf pmcess, as in the case study literature, but that process
e nt de 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 , t he
study of professions was suddenly reshaped by the new political cii-
mate of the 1960s. Early work on professionalization had rested on the
f unct i od assumptions cbaracteristic of postwar sociology. It attrib-
utml t he colle& o r wh t i o n of professions to their position as ex-
perts. The "asymmetry of expertise" reqnired the elient to tnist t he
profefsiond and the professiond to respect both clent and colleagues.
These reiations were gumnt eed by various institutional forms-
associations, licensure, ethics d e s . But theorists rejecting Eunct i od
assumptions disputed the whole picture. In a lucid analysis of profes-
siondism as a form of cuntrol, Johnson argued that the pmfessions did
not serve disembodied swial needs but rather irnposed both defini-
tions of needs and manner of service on a t o mi d consumers. Writing
on Americ;rui medicine, Elot Freidsan argued that dominante and au-
tonomy, not collegiality and trust, were the hallmarks of t ni e profes-
siondism. Another student of medicine, J eeey Be r h t , attributed t he
structures of professiondism directly to the goals of wn o mi c mo-
n d y . BerIantS work was the more stnking in that the feature ofpro-
fessionalism 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 relation-
ships, the new theorists moved the focus of debate from the fonns of
pmfessiondmtion to its functions. For t he new theorists, the regu-
Iarity of 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
of Prof.~sionBIism (l.%"?). Were professions were explicitiy market or-
6 fntraductian
~ i & i o n s attenpting 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~ati study 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 wss never formal-
ized independent of the state. Like her predt?cessars in the power
t rdi t on, she explicidy excluded thu orwizlttioa-brised professions-
rumtd md civil sefvice and clergt-that continne in the Ando-Ameri-
can world t he i.tistitutional forms of the Coixtinent. Through her focus
on dornsnance she ignured professiow like nursing that had aaept ed
subrdnaton. The exclusions shouId wme as no surprise. By aceept-
ing pmfessiondiwttion as the thing to be mplained, the new power
theuristi aecttpted the assumptions behind the eancept. These in-
cluded not only t he idea of a ixed sequen* of events or functions, but
dso wsumpt kns abaut the h s t examples of professionalism (American
medicine and Iaw), a h u t its essential qualities, and about t he c h mt e r
of the intefprofessiud world.
The split ht we e n t he Cnctiondists and the monopolists was thus
not totai. It was abo not one-dimnsional. First, the two groups em-
phasized dtferuat eonsequennces of professionalism, BerIant and Lar-
son were intemsted in t he eonsequems of me d i d professiondism
not for hedt h, but rather for the status and power of t he medical pro-
fession. '%ase were external, social consequences that derived h m
professional stahts or activity; siekness ww of littie interest. Other
wi t e n emphasized internal consequences of professiondism, ronse-
cluences affeding the afea uf professional wark itsetf-healing, audt-
ing, and so on. To k o n s , for example, the impact of professionalism
on sick individuals was af central i mp r t we . 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 di mnsi on of the split, which concems the locus of anaiysis; like
h a n but unlike hrsons, Freidson aimed his wdysi s at the social
level. He wked haw the overdl social handling of iliness was affected
by t he existen* and nature of professiond groups. SimiIar1y, h o n S
eunctsrn wirh t he 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 con-
cerned, like Freidson, with i nt enal mnseqnenms, saw them at the
individual level. Huw, they asked, does a social relaton be h~e e n client
and proessiori;xl have t o be stmtured for healng !$r some other id-
vidud professianal aet) to oceur?
Of murse, the cmssing of rhese km dichotomies implies a burth
appmh, oae exarnining externd fonseguences, as do aod
Brlant, but at the Ievel of individuals. This view has been argued at
kngb by Joseph Ben-David md Burton Bledstein, Both emphasize
the f uma n of prafessionatism in proteeting certain ndividuds-the
pmfessionds themmlves-from the struetured, rigid employment that
emerged with nineteerith century ccrpitalism. Beyond this independ-
en=, tbey both w e d , pmfessiondism alfa providd both an ideal
mr qhor 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. Probssisnafism 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 natu-
ralism to theory. It bgan with case studies and typoiopies. The inter-
nd mntradictions of these studies led ultimately to the idea of profes-
si odht i on, in wkch a dwelopmental typoloti;y generated the natural
histories, pduei ng 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 chan-
nek, while a fourth graup emphasized how it helped or hindered gen-
eral 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 charaeter-
istic of the perod of naturalistic studies. For many years the defini-
tional question was the f d issue of studies af pdssi ons, 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~neritan law and rnedi-
cine do nut in fact Iutk like onr images clf them. Only hatf of each is
c~ilirtnt;>loyed. TIre vzt tnajorie of wr k in b t h is utterly rootirre, A
s~iqrisirig rirrirri-wr itf prctfessionals, everi in these fields, will be in
nothrr <x:cripationai clssi[icatiun in twenty years." Securid, maity
I I ; ~ U I I ~ S tfiat ~bvi t t t i sl ~ ure prctfessions di1 tiot tcxtk like Ptrnerican medi-
cine and law at all. Eirglish barristers cio tlot neessarily traiii in urii-
vt'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~lesiatical structure. 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 t to cal1 atitontobile repair a profeasion hemuse they tforit
want tct accorcl it that cfignity. 'This itnwtlIir~gness pr<>hably tia less to
c o with the acttial char;*cteristics of autrtincrbile repair as arr iritellectiial
cliscipline-whieh are cu~r~ccptualiy quite cirtse to those of irtedicine-
than it does with the status of the w>rk aild of those who do ii. When
dtr&rrititjrks aint t c ~ distingiiish goups accwrding tu sxteh an externai
;ili;enfa. they are disltutct<f. When usrd to ariswer theoretieal ques-
ti<urs, thcy are rntt.
Ilefinitiuns, ihen, must I;>llow h m thmretical questions. The
theory 1 sketehed in the oi~eiting paragr~phs implies the very hose
c1efrrtitic)n that irr<tfcssons are exclusive t>cct~patinnal groups applying
s<>rnewhat abstract 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 ~~est i <~ri s conci<irn thc evolution and interrehtioris
of professioi~s, ancl, more geiierdly, the ways ctt'cupational gro~ips con-
trol krttlwledge aitd skil1. I have already argued that the evolution of
prtttessitrrts in fact results frorn their interrelatiorts. These interrela-
tions are in trirrt iieterminud by the way these grorips control their
kiio\vtedge and skill. There are h~.t) wther diEerent ways of accorn-
ptishitig this cuntrc>l. Oiie ernphasizes teclirtiqrte per se, aild ortcupa-
tions tisirrg it 1-e curnnionly called erafts. To control such an occupa-
tiori, a pclrlp directly cw~itrols its tech~tiiiie. The other forrn of control
irtvolves abitract knowledge. Here, praetical skill grows out of ata ab-
stratit system tif krto\vledge. and cu>titral of the tmupation lies in con-
trol of 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~~upat i rbns in generaf.
h a y wtclcuptiori can vbt a~n lieerisui- je.g., beautieiatzsi or develop an
rthics d e (e.g., real ectate). But ctilly a kn<xwIedge system gwerned
by abstriictitms can redetiae its ~sn>hleins arid tasks, defend thern from
interioper-ri, and seize new prcrhlcms-.S meticine ha'i re~ent l y seized
alcohoIisrn, mental illriess, hyperaetivity irt ehildreri, t>twsity, and nu-
rnemus other things. Abstraetun enal,les strrvival in the coonipetitive
systeirt t t l prttfessions. I f auto mechiir~ics had that kiiid of ahstrdction,
if they " ~ ~ n t a i n e d the relrvant sections ofvr;hat is prtasentfy the erigi-
neeriitg prufession, atld had ~u,~isi<lered taking ouer al! repair of inter-
rial cx>rnhustion ertgiiies oit abstrct grtltrr~ds, tttey wtriid, for my pur-
poses, krt a prufession.
My eentrai cluestions and nty fratnework tiros tletermine m); tlefini-
tlon of prof'ession. As wc have just seen, they determine first its ein-
phasis on the knowlrdge system md 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~i aI work and iiursing have Iretxinir wttefjate profes-
sions, ~nedicirle has 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 ut 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, md electrt>therapists. A definitioti ttw
speeific would exelude tiiem frorn view. Yet they too have r nde their
mark on t he systetn of professitns wr st-e tcttlay.i2
The Co~we pt of 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 profes-
siorts tend to develop i n a corninon patterri, cailed pn)fessiotialization.
Is there, in f xt , a i-ommori story of hotv professions develrjp? To an-
swer this cliiestion, we must first answer the prelitninary t l r~t : of what
w nien by "cc~mnion story." This (~uestion is tltrite eontplcx. There
"nve been matly theories of professionalization, arid they diEer along
hro distinetly diffi?rent di~nensions-the Formal ai d the sirbstaritive.
t e t us consider formal digerrrnces anrung theuries of professional-
iatiorr by stuciyirig some versirtns of the professioridiwtian story. In
t he 1% article r nen~oned esrlier, Nmld Wi t ensb discussed what
he called "the professionalizatton of eve-ne." Wi1ens.l looked at t he
dates of "first events" in varioos Ameriean pmkssions-first h-ining
schrwl, first uni vc r s i ~ sch-1, first I d association, first national as-
cocation, Erst state licensing law, and first d e of ethics. He found by
inspmtion that t he events tisud& fe11 in the order just listed. Reflect-
ing 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 kgi n when people "staft doitig full time the thing that needs do-
tng." But then the issue uf training arises, pushed by recntits or ciients.
SchmIs are created. T b new schwks, if not lteffun wikhn univenities, im-
nlediately seek &htion vrith them. Inevitably. there then develop higher
S, longer hsi ni n~~, earlier wmmi mnt ta the pmfession, ami a gruup
of fui1 time teaehers. %en the teaching prefessionds, aiong with their first
duat 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 wr 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 mnht at i ons with autsiders, This periad aiso contains
efforts to seeure state p-wtion, dthou& thif does not always accur arid is
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. He 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
w
rnodels underlying t he various tinks in this stary draw on different
general views of why things happen in social Iife. Schools arise fUnc-
tionally; they 611 a need. Del ept i on of tasks, by contrast, arises in a
histaricist rnanner (success confers the p we r to defegate, whieh fur-
ther snhmees s u e s s ) , while ethics c de s simp1y desee levitabfy.
Who is the subject of ths story? This, tm, is pmblematic. Ethics
d e s happen to t he profession as a whole. Yet at the beginning of
Wibuskyk story, the profession as a whole did not really exist. The
initial subjects me "those who do fiill time t he thing that needs doing."
Through t he stew t he proiession gatfudly emerges as the new central
subject. of the narative, dthough'often the getlts or
chmge :e= h m sab~oups. At one leve[ this seems obvioas enough.
One central p m s s of professionaization is cdexenee into a group.
But there is an essentid dfference between demonstmting emergente
as a procriss in the social world and pmsupposing it by
t ~ mt v e s t mdr 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 professiondiiza-
tion, he saw vdet y in the actual sequences aid advamd speeial ex-
gianations 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 Iilbel capabie of legishtive r eswun. Third,
they set up a mde ofettrics to assert their social utility, to further reguIate the
incompetent, and to reduce internai eompetiton. Fourth, they at at e polti-
ition, 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 ~uhi ders. )~~
Caplaw's story differs hom Wilensky's not only in chronology bnt in
narrative st rumre as weE. For one thing, it has a ungom central
subject. The profession appears at the be@nning of the stary and un-
derakes al1 the aetivity in it. For anather, ali links of the story are
functional, In f&, there is a seyuence of funetions. Exclusion is in-
cfuded in ail four links, a s a i o n of junsdiction in the lwt threcr-, inter-
nal 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 suassi on disappears in professionalimtion as dexribed
in Engtish muras. Ceoffrey MiliersonS explieit denial shows the very
daerent approaeh he takes to n m r a ~ g professional~tion.
ClearIy aII Quatifying
@sin professiad
a variety of mwns for establishutg an association; to co-ordinate the adivties
af workers within an oecu-o~; to a&r Wt 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:
t eehnol oM &vame d o r c o m m d advmment -demd Por person-
nej-wizatiun of personnel. More impurtiurt, such a notbn ignore the
variable ti=-lag beht:wn Rrst appe ar e of prsonnel 'and ultimale orgmi-
.mtion. %=timas Formation ant&p& an exwding d e m d in an occupa-
tianrd %ea, the establishment of spialists zind conpequeni n d for 'quaflfied
people'. hmiandiy Further development of assueiation justified the Found-
ers?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 person-
nel, 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 hi i eves that the
link ht we e n &ti-ti= work (.e., demand) and association may be em-
plotted in a vmiety of ways. In an eartier discussiun, after illustrating
the impossibility of a single plot, he lis& the passibkt models ( di func-
tiund) 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 re-
spand to utterly new orrcupational possibitities.
This diversity in part refleets the complexity of the Bn'tish profes-
sions. But it dso refltxts s e v e d decisions Millerson has m& about
how to te11 his story. First, he &S not accept t he implicit self-interest
mude1 that unifies t he professiodzation narratves of Wilensky and
Crrplow. Sdf-interest is but one mo a g a number of t heoret i dl y p-
sible motives for action. Second, he uses a different strategy to as-
sernble his data. Wilensky tmked at a set of fi nt faets across pmfessions
md 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. Mi krson, on the wntrary,
begins not with the bafe details of first facts, but 4 t h individud nar-
nitives, prdessian by pmfession, complete with s t a n M historial ac-
mun& of motivstion. He lmks at a11 hs 0rtl;anktiond histories and
sees tour or @ve remons why omizsations were set up. Si- he has
no f uadwncaI model of self-intere~t to tie aU these reasons together,
he leaves them as independent versions of the link from demand t a
o ~ l a ~ o n . f e emplOyS a similar sti"atem in studying the tink be-
meen s e h d s aod emrninations.
Miltersa& mLtiyss afso reminds us of the cornpl exi ~ involved in
ardered socid p r ws x s . Somet i ms 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 ned 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. Mi i l e~. ~n, on the other
hruid, generalb uses the iess-restddive idea of coritingent develop-
ment. Even though the p t shapt??i the fuhtre, khere are several out-
comes for any professional present. The next event after professional
rtssotiation may be licensiq, emminations, or an ethies d e . The irn-
portant 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 4ushnent to the social and e d u ~i o n a l climate of the time.'"1s For
som authors, this "individual uniqueness" is in fsk-t d i ~ l y attrbut-
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 dif-
ference les in her use of time. For Witensky, Capluw, and Millerson,
professions develop in abstract time. With the exettption of the "tern-
pering" 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 oth-
ers under corporate capitalism and hurea~~eracy. The murse of profm-
siimdization varies in each regime. The iarger story determines the
tme, the conditions, and the stntctures throngh which profssionaliza-
tion 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&u-
lar content to her genede st3ry of pmfessionalization. h y organiza-
tional pattern (association, lieensing, etc.) that furthers wp r a t e re-
ward 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 narra-
tive 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 situa-
tion. %se l i nk 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 mu 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 out ame,
sametirnes irreievant, sometirms in k h e e n . %ey also &e
a variety uf approaehes to issues of convergente and divergente-
some of them rewunting the emergente of a steacly state like "futl
professianalz~tiun," uthers the development of oscifiation or imbd-
ance. Teliers of social stories &o have met qhors for genedi zi ng
these stories. S o m employ the metaphor uf career or Iife course,
searchng for a single typicil sequence. Others employ more open-
ended 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 t he
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>ns of professiondiza-
tion, these substantive aspeets have sometintes been t he focus of atten-
tion. But other choices we set: as purely formal, Ike the choice of a
central suhject and a plot form, md it is i mprt ant 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" ar-
guments are cIassic examples. Their central subject is professionals as
an i nupat i onai 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 t he story are the externai rewads professionalization pro-
vides to individual professionals. Other versions, with different driving
forces, are wmpletely u ~ ~ &e c t e d . ~ ~
These formal differences in thmries of professiortalization exacer-
bate the enduring subsrantve differences, some of whieh 1 noted in
outlining the history of studies of professions. It is i~nportant to recall
t hme svbstantive digttrences here. I earlier distinguished studies of
professionr; in t er ~ns of their locus of at'talysis (individual or society) and
the consrquence-S of prafessionafism they studied {internd or exter-
nal.? 1 shdl classify substantive views of professionalzation sligfttiy &-
ferently, dthough a s i n in four basie categories. The b u r versians cm
be dl ed the hnctional, structurd, monopiist, and cukurai cnncepts
& p~fessionalimtion. The liinctional version was the first of these,
d o mi mt in t he wnl i ne 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 di sa~~peared *md the
stmcture alone remained. Profession was merely a form of occupa-
tionai control; the mntent f work and the expert-tjient relati- wem
les;$ i mprt ant . 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 devei opd the eql i ci t rnodels
d professionalization here analy2ed.m
The monopoly schoof saw the sane structural devetoprnents, but
ar i but ed them not to a "natural h," but tu a desire for domi-
nanee or a ut hi 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 aer i but d the
pattern of professionalmtion to Iarger, externa1 soeiaI processes-the
rise of bureaucracy in Larson, the shift fmm professiondism to meda-
tion 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
r e g u h i ~y that marked prior work on professiondization. Bfedstein,
Haskell, and others have emphasized the cultural authonty of profes-
sions, returning to the Parsonian fascinatien wirh expertise as a socid
rebi on. By making euiturai legitimation a central process in profes-
sionalization, these writers b v e set a n m enterion for the "profes-
siondity" of clccupations, replacing the oid one of organizatianal simi-
Iarity to iaw and medicine. As 1 nottd before, Bledstein has mnnected
this cultural authority diredty to i n&vi dd decisions for mobifity.a
Given such diversiSr, both fonnd and substantive, it m- seem hard
to consider t he v a I d i ~ of pmfessiondzatian argoments in generd.
WiIenskyS regular sequen= of organizations is a fw cry from Bled-
steins rise of a "metaphor and rneans" for vertical mobility. But it is
essentid that we do consider whether the general professiondization
argument can be sumsshl 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
t t i d 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 fom, the profcssiondization mmp t armes that these organi-
xations dwelop in a ceriain arder') CuIturaBy, professiois iegitin~ate their con-
trol by attwhing their expeftise to vatues with general culhiral le@timacy,
inmasindy the values of ratonality, eErlenq, and sciew*.
This synthetic professionaiirntioe eoncept has some pwerEul suc-
ettsses to its credit. As sociolo@c*\I concepts go, it is relatively coherent
md its tenns relativeiy well-deflned. in rhe stntng (stmctural) form
espi at t y, the orgitnizations and their sequence were prticularly easy
tu mwum and surprisindy c o m ~ a b l e &om case to case. The con-
eept's focus on expertise referred dirwtly to general theories of oecu-
palionnl eontml. Moreaver, not only was professiondization weli be-
haved thriuretiedly and oprationdly, it aiso had no smdl empineal
power. The major British and Amencan professiuns seemed to follow
it relatively wetl, al t houb owni zat i on- bad pmfessions Ike the
militar); and the ctergy createti some probiems. As 1 noted, Wilensky
tested t he strong f o m on a si abi e sarnpfe of Ameriean groups and
found great regularity in the sequence of orgmimtions.
At the s a m time, t he 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 Wi t ens w argtiment, 1 have studied the order of eight
events in 130 Amencan and British professions. My andysis spiits oe-
cupitions studied into three groups: recognized free professions (about
2G each in bath America and Bdtainr; subordinate professions (again
ahout 20 in each me ) , and an "other" gmup containing variotis pseudo
tuid wouid-be professio~is. The eventi ordered were:
l. First (national) professi od 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 universie- professiond eduat i on
6. First et h a cde
7. First natiod-fevel journa1
8. First accreditation of schools (U.S.) or eertification by asscxation
(Endmd)
The data were pt hered 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 met hds used.) The anaiysis praeeeded by
liinding mm "distances" between the events under a variety of metrics
(e.g., r ed 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 pus-
sibly a rewlar order among t he American free and subordinate profes-
sions, but none amung the Ameriean other ciategory or among any of
the three Bntish mtegories."
Perhaps more importantly, analysis of the assumptiuns of this for-
malization of WilenskyS approach shows that the results cmnot help
but be artlfactual. Sinee there is one rnajor, national professionai as-
socation hut, in many professions, dozens of schools, it is inevitable
by probability theory aione that tthe first schoot will precede the asso-
ciation. 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 t he fint univer-
sity 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 mi event. There is in faet no
real empiriml support for the strong form hypothesis that the organi-
zations seen in professionaiization arrive in a particular sequence.8*
The empirical pmblems of the strong form hypothesis of profession-
dization 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; profes-
sions evotve t mards 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 impor-
tant than the work professions do; the latter is unmentioned in rhm-
retical studies of professionalization, although it makes obligatory ap-
pearances in case studies. Fourth, pmfessions ase homogeneous units;
what intentat differentiation they possess refiects mntingencies of t he
"professionalization project." Fifth, pmfessionalization as a process
does not change with time; alrhough a description of history, it laeks a
hkt ov of its own. Of murse p&icular writers have avoided various of
18 lnhuhicilm
t k ~5sunipt1ms. NOT~~.lheks. thh sumnwy captures the nnwrpt
;rr i t IS genrrillv id.
?lw n?tsuiiiptkm of uriidtrecthmdity ha been utiorkcd by both m-
dologicril 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.reaW in pnift-ssrnnul Icpi ti mq mti ~l i t ormi y cin thaannr? hnt l and
ti, thc I eut ~i nq Iieiiefitr iif ~>nifesqiu~Iism fnr thc mcnihrrr of tlir
ptui.uions tm i he utlit-r. fhc hisioriaris Iiiivc otu<lid niinwnnis pnb
ft.rsioiiil ur psctdaprurclriori~~i p u i r p t h t hwe ~t;~lled or rvcn di 4
un tht. Iiigii niad d ~in~fturirin~lrrriit~ici-p'iychubl rnc<liumr. clcr-
tmtheriists ;in<l f i ~i l wy surgtwnri. cntnpotrr "mders." nikbivm.
Thev l ust . stutlied ui i al ~n~t i ut i . iunotig Rrilish iiiacteenth~~ntiirg
rkr*or~ tuid luiion# twenticth-c-entwy m-!el wlrkcn, end dsodi vui m
ainimy twrnticth mt r i r y Rntrtli Juctnr~ nnd iimoug ~ a i d 4 r eb
gtoiia wrkm in &nra. In short, tlterc are clrwlv a wukty ofdirec
ttorir for devclapmcnt. ;d dcvc!vpmeni tcmridu dnmg mt ml is hut
one E th*m."
Ti* ~aiinrptian thnt ame pmcmloni drwhpmcnt h indqmdm
rfianidher ir t h~wi crrc<l irnplicitly hatt no kw stnrngly. it is tnie thpt
m t wurk on prufc*iiunr cuiittnucir tu he done on a pmfrsson-by-
pmlerslon h t r . Birt m-idenre dl l i hl e in this very m r k qurstions
stich u pmmlurc ntmndy. Much w~rk cm subpmfiaiimis in the nwdi-
cid r ~mphssb~ t he inti.tcpcmlrncv ufpmfmonld dovelopmnt.
m <lo ~l i o rmcs of AiwM-aii pyrhiatry ttnd soc'ial wrk. of t ht W~ UUS
t y p s clf mrg~~mrs. of Iw mid imitinting. Bookr on individumi d e s -
sionu sl rd nitirh uf t k ~ t time oii intrrpmfmsiod mlutionr. but mma
dmur thu obvious mml that tntrrpmfbnional rnlatiotv are potenttaily
ihc ~ r n t d catiire uf pn~ft-ssiuniil dt-vek>pincnt.m
'thcl ammptictn that stmcturc is more imporbint thm smiP1 warlt
b, lih iindtmtioniility, m vjpcct of ?he wciologlcnl thcary chal-
lenged by histuric-l 4. S a w ~ l wiork on pmfesslnns, inclidtng
mirch of ihc puwcr literahare of thc last d e d e , littk attcntion I U
tlic ;triitnl wnrk i h t ir clane and thc errpcrtusc 4 to do it. FreldsmP
m>& is it striking mpt un. ! l t c i h l litdy, by cemtmt, har emphs-
zi zrd the actiial wvtk ~ri<mncd ln pmrcssfons ai divcm as 1ihru-i-
anahrp, ~ngwirning. pychmtry. nnd t hr 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 rmed h m thb thpt wwk
miut be thc hwtu of r txmmpt of proksslrmai Jmclgiment.*
Ipnoring i nt c ml dierentiution in pfersions hm helped the pro-
kiunilimtioti rn-t simplify h u t it h u to explain. But mrent
HV& i i npk that I ~ L ausumpthm, tw, is (hgemur. Sociolqists
themx'kes how mitilnitc<l unalyses uf diflmeiwifs in tnt-
si& pn'sti~p. in lo<.atir>rts nf w~rk. in JLCLYSS tu prafcrviond p r r .
\Vhilc saiulitgists Iwve ni ~t i t i neiirml r*>nnwtd t k r r intmiiil p t -
tr-rnc hi ptttrrtr cif l>tilftb~~itXK~l ti<8uclnpment. I i i smt i ast s hiive dt ~m w,
in stiidn- nf thc k-giil yn)L*aion. uf iwgiticr.riiiy. ul mduim. Ttic
d~r l ol ~nc nt IIC intcrtml ditfr.rtw'c1 is Imuntl dinvtlv tn thc dtwclnp-
tttcnt uC prufrssioniilism.)
Finilly, the asuinptinn thpt ~ ~ d f r a t i a n 1s a EP. I K. ~ p ~ m r
urithoirt uny history of its own tuu kw rhullcng+d fmrrliilly ty ihc
siciulo>nk-ai t k~r i st s themwlvm. priiculiirlv j~ihnwn riml liuawi.
&ah nutcd thrt the inmosfng invhlvcmcnt of the st-ate reshqwd p m
fcsrionuli7utiun. ;u ditl thr rciiwd dri f ttlwodr t>iiwilum~k pr;ictire.
%sr I csmn were npnled as 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 makl of pmfr~~ionuliirn
Icirig drimirnnt in Fronrc und ~ ~ y . ~
Onhal*ncc. thm.theevklenrcargtmfiwannr,yrpmchtopm-
f mbnd cbdqmwnt ta m p k tbe genmd pdewiundbtion con-
cq~t . Thrrr is. d mum. ~writ dlvmity n jwnfcsrkmdization t\ini-
r i a. Mudi o'it. as I hmc iugurd. i l Formal divenity. Them urc mmy
thmricr r hi mi n~ to I l c gmrrd thtvlnes rbout pmifnsiilid devchp
i m t thnt are in fact rpecial t hcwi ndt hi s~w thnt m u f i t , and
c ~ e n the gemrrJ tl>eories o k n puse their aalilyscs in furdnmrntdly
diHmnt riarrnttve ternis. And them are wirle di l n* mr in the suh-
s h r m u theJe p ; e n d tltpories-in Lhc drivin~ mmhinisms thpy
pmit. fn the pancm of di ~nt i on t h q dopt, in thc putkuiar rtmc-
tures tlwy crnphiisln' Yct inurt prurcJsint~niiitioa thrwirs falknv ui
commnn appru~ch to t!uir xub~ect, w b t 1 dkd the synthetic thrwy.
TMs synthrtic t1uxn-y. depite thc strung support thot m y case stud-
ier @ve it. lw profoiind shortmming. A rcriocio empirical test mjem
t. More impwtantly. its t>auc ousiirnptlons huve al1 I mn ovedmwn
by rcfcnt empi 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 popoi ~ m altmmth h m y tknt
merses thc pn>blcmatk assumptions 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 ~ e studics tcll ris is &angina It is control of wwir that brings
ttie professioas into mnUd with corh ather nnd rnnken t h r histories
intenkpcndent, Lt 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
mu p s with common work we repiwe seved of the problematic as-
sumptians at once.
"hrt central pheuontenon of professiond iife s thus the link be-
Meen a prdssion md its wrk, a link I shdl ai l jurisdiction, To ana-
lyu: pmfessianal development is to andym how this l hk is created in
work, h w it is anchored by fumal and idormal
how the inteqlay of jurisdictjod linlrs betweeu professians deter-
mines the histoq af the individual professions themselves.
Cases af Prdssiond Devefopment
To illustrate the cemptefuties that any theory of pmfessional develop-
meut nust handle, 1 shail give in the remainder of this chapter some
e m p b s af that p ms 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 mp b
vi gneRa e mMy a eompromise between severel ways of approaching
the data. A pi t i vi st would redme dl these histories to coded facts
and present them as d e p d e n t variables. A theorist wouid present an
exempl 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 con-
trating 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 pi ct ur e~. ~
Let us belgn with the familiar case of u r i c a n d i ~ i n e . ~ 1 Like
ntany Amen- pmfessions, e had two waves of professiond-
izing 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 Id 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 pwt i w, and the g d resnlts that attended it, made the h o m
paths mther h g e mu s &v e d e s to "regular d c i n e . " There en-
s u 4 an intense war over who hd the nght to cure people. Each side
c i a i d the leetirnacy of science, de&& the &&y of the puhlic, and
at hke d its oppanents in e-ditorieSs and speeches. Thr: regulars devised
exelusianary e t h b rules qui r i ng a dylng patient to dismiss an at-
tending irrtsgulm as a mdiGon of their own attention. In this, its
&h& hour, reph medicine at k t saw fit to found its nat i od as-
&y the late njnetwnth mntury, the regulars were fortifid
bythe a- wientifte &cine from Eurape. AIthou& wnafned with
&ngnosir, etiobgy, and pathology niore than with t ~ a t mn t , Euro-
a few spectibcular therapeutic successes that
pawer. Thus minforctrd, the n?gular?r started
their ethics, and be- tu refonn their
hgok.. Fmm the h o mp t h s they had learned to avod heroic treat-
d the twa graups united mound the turn of the eenhiry to
fbt off new oubide tbreats-the w t m ~ h s -od later the chiroprao
m* 1s a wh*l+nd of rehnn b m above, the nebuIous world of pri-
4 4 s b f s , pt ent d i c i n e , and uaregulatd practce
qmished under the clear omization radiating from a powerfuf, na-
u@& unted pmfession. le mmmunity general hospital, the &un-
w n orwiuttion of mctdeni medicine, devei od i-pidy. M&ough
f d I ofsbte intemention, A m m medielne pmfited irn-
f o r md o ~ 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 Amen- medicine shows h w eomplmted and inter-
wwen are the questions about what prufessions do and how they in-
temrke. 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 wms &e virtud dissolution of regu cine under th
nhn onslaubt. The "duing of hesling*' a free-foz--&.
tagonist itself i s not a mnthuous entity. Development, &vi% and
interprofessional reations are bound up together.
%e medid profcssh& absolute ainhul of bodty dis required de-
femive work on a nurnber of boders. Perhaps the most important of
thes borders was the hazy une between bodity and mental aifrnents.
Nere e mr 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 sec-
ond sketch, of bncan psyehiatfy, sshows again how complex and in-
is the web of pmfessiond developmnt. (1 will @ve a sus-
*& +sis of thif ose in chapter L0.P
Ps~hi at ry be* when a group of enterpdsing rnedicd reformers
medin tbe early nineteenth eentury that madmen ought to be re-
mmd &m &e jurisdidian of the legal authodws and plzlced under
t b t of the medical professian, Madmen are &k, they said; @ve them
to us and we wi U cure them. A new theory and therapy justified the
shifi, arid p~+vite Mies and state le@sttihrrcs were sooa dotting the
cauntryside with insane asyiums. Ps ychi m was the profession of
the superintendents of these instihtions. (Nonsuprintendents were
finaliy &mi@& to the or ga ni d prafession in the 1880s.) Like teach-
ing 2nd wid 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 pm-
fession, its memhrs exceeding most of their me di d bmthren in in-
comenie v e r , and prestige. But the latter hdf ef the cenhrry &so
brou& decline. The earIy hopes of cure proved illusory; the psychia-
trists p d u d l y k m ttdministrators of custodial warehouses.
Memwhile, the jundi&on that would ultimately become psychia-
tvSwas b i n g explord by other poneers, the neurolMsts. From
their b l d y bsptism in the field hoiipitaIs of the Civil Wa, 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 re-
lated to "nerves." Under this mnveniently vague heading, they rol-
i e + d the mi&& whase redcitrant iilnesses imouened the new e a -
. ..
corey of medicine. Heavily i nf i uend 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 &S-
m e s to general d i c a j ude t i on. The neuwiogists developed their
ascociation, journah, and univemity teaching positions during the sec-
ond wave of medi d professiorializrttion,
But they smn f owd themseives overvvhelmed by the ho& of "ner-
vous" 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 psychui-
trists hegan to handle this junsdiction together, the neurologists defin-
ing 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 ouwt i ent 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
m duwt r&ewaJ.s reflected the psychiatnsts' rapid, entreprenuer-
arrrras 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 ma mi wer juvenile delinquency, alcoholism, industra unrest,
stnk, and numerous other areas. This brought them into vio-
eng wmptition with the ciergy aml the 1aw among the otdtr pmfes-
-b@, d ~ c h o 1 ~ and mi al wr>lk among the newer ones, InteiIm-
&jyB rhe psychiatrists routed al4hut 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 so under-
s&d th.at pswhofw and mi& work pen*ated the third party pay-
mn 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 whe d &ron&
tfie formattitis of 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 cent d questions of h m pmfessiuns
dwehp are tied up with questions of inte~rofessionaf rehtiuns and
the mnteat of pmfessod HMQ. Pmfessionafization occurs, to be
sure, but in a context that helps determine its murse. A campmhen-
f pmfessional IIfe musc: deal with these compiex h of
wmpetition d nt eqmf wi od relations. Ths can be
re clearly in &e Britsh professiom.
Unlib Ameri w pmfessiuns of the b e eighteenth century, their
eont empdes in Engfand were not hmhat ed 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 befit-
ted ts semio@&d onlpns, bu
three Ieveis in each of a numbe
dst>eished by function, the
that of ord argument, the third that of mpmsenting or apvar~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 qui ~; 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
wer all fam& ma&ers otfer than propeftY.j
Tke carnmon kmand equity pfms onr of &e late ei&teenth cen-
tury were ia se- more 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. Di d p k e was exercised, very mb n d f g 5 by the
courts and the &i n&~@ve 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 e of the ms t e r s was upset by a mvolutiun fmm belm.
The aaomeys and fofititars built in the early nineteenthui centery a
national asmiiltion {really a metn>poliW one, far mast le& bus&=
), which undertmk what we would n m mi1 seriow
It mm&M a f m a l ~ ~ n t i c e s h p
r i d pmtitionem, i mp & professio
tions, and began a s&ous and careful pmfessiansJ
tiougtit far, ami won, a monopoly of &e newliy Iuerative business of
eonveyaneing ( p r o p r : ~ transferf. The brristers reswnded by consali-
cfating their own absolute mmpoly of verbal pleading, whleh had
been ganted several eent uds b&re over the intense objectiws of
the l wer b w h w , 2%- removed their fast wmpetitars, the mori-
ts, cansofidatmi the jdsdictions d their courts, and
the old rule tbat di judges be kristers. As for professiod-
ization in the nrodent sense, they did It?ss t hm nothing. By the mid-
~ e n t i e t h cenhrry there was sti f auhr i zed barnsten,
no nat i ad ascoeiation, no cen a y . The educationd
activities of the Inns continued hougb the English uni-
versities 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 expsi on. The e ws 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 expan-
m, In m-uenee, iis chief junsdktiond monoply, mnveymchg
b;rd by this century h n delegated to a subardinate profesdod
mups tIie ma @n g cleiks, who did the wark under the very Im
~pem&i on af cobtors. This i n t e d subdhat l on of routine work is
a cbet er i st i c sategy of professi g more jurisdction than
behg the best exanple.
Fmrn t h outside, however, compet i t b Gom a ne s
rs ta maneem how, why, md whether they were achiafly ni&-
me. In the area of advice and corporate r e s a d d n &
* w w a t s and colcitom remhed en uneasy truce. Each had its owa
me hirf; thk 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 ~ i c W ehrkship with a m m ~ r o
mIieitom, the chartered -untan& in fact had far more business than
their s f w growth could hande, and soon wem b md to tolerate at
le& one group of less educated and certified mmpetitors, the Incor-
m e d Awmtants, @he continued exclusvism of the Ckartered ami
f ~- pof a t e d A m t a n t s means that many other group of aaount-
atlB are o-& outside &ese Ieaden of the prdes9ion.) ln the pres-
at aabr y, the profession underwent a further change, in this case a
numkr of individuds and smdl erships doing a mmpletely dif-
ierent local busuiess.
case of Endish accaunting
a ~ d surgeons, md meatd al1 the pmmr annbutes of professionalsm
in s h r t o&. Wa t redly det emi nd the history af the professim
was the de-vebmnk and shift of its jundiction-frm bknrptcy to
audi*g, with &ud e ws i o n into cost munt i ng and n
'"managemnt semices," Here, too, we see a n u mk of other
teristic deveopments of profesGond life-the competition fmm be-
low, &e @ua malding of proftssion to clientete, the mainten- of
a stmte* h d m d mono~l y. Yet at the same time accounting showed
its wiilingness for h d - o n mmptit~n-with law over the degnition
of pro&, 4 t h Iaw aMf bl si ng over the juridietion of business advice,
over he pruvision of staF services. n e r e is much
more here than is told by the simple image of professiondtzation.
But even moro houbthg quest;ioas about the way pmfessans de-
velop and internefate &se when one leaves tha familisr Angfo-fheri-
t-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 over-
shadowed by the state. While indepndent competirion still takes
place, d i ndepdent professiond evolution OCCUIS, both aim im-
mdkteiy at the zhiwement of certain status wrh the stake. The
abdut e, cenhalized, and ratiodiztrf c-er of French govemment
I d it to take a ddsi ve 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 ig-
nored dtogether; things u iza3 by the shte e m u a b ~ r t mt .
Thus, the French legai , whiie in same ways reminiscent
of the Endish one, differs fmm it in esseatial ways.= iin the rst place,
it i s bmken up into a dserent set of jurisdictions, with diffemnt rela-
rions between thern. (J am here prmn&g t
197% fom. The fusion of that par meqed
meated a n- group of cotfs&)urid@ues ou
ea&, mi n g their I V O ~ woll baek into medieval times, are mughly
andogoift to bsrn~ters- They are into bars under ecich dif-
ferent caurt, aMf their W t monopoty of oral pledhg in many mur%
a
hrrnril in the Mapoleonic Code. But they are unlike the
gn&h m in mmy mys. T h q share their seUldisciplnary f unc~on
with rhc courts, as the B ~ &h have not sime the Middle Ages. Indeed,
t b ~renrh mortf have on oecasion r eor gani d their bars completely.
&rr aras ablished aftogether during the early years of the Reva-
R Yd was reinstated wth some reluctante by Napoleon, who de-
d m. The auoeats are also unlike the Ms t e r s in their
iremcnt of unversi* le& ednaiiom and br md at t endam at
t. requirernents for drnisfion to the bar dating frorn befm the
mth wabr 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 mag-
tx are a se-te group with separate educationd requimmnts.
is pemy tfte opposite of the British situation, where barriste=
~palize the bench in the higher couris.
yoad t k awat s , the French legal pmfession tooked in 1970 as
d no history. Its rnajor b-hes al1 had the same siructure and
d tfiat stmcture to the lucid cWt y of laws governing public o-
% various branches were separated by j hdi ct i on. The aeods
nred for their elents; they filed fonns and motions and shep-
ed the cases throu& the court. The notaires recorded formal
ma t s and eonducted the transactions so recordd. thus control-
narriage, property trander, probate, and other jurisdictions con-
d 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
w
re. So afsa was the profasiond stnicture. Each group (or ordre)
- orgsnized into local (%dementale), regional, arib natonal
&res. These Mi 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
th
LPtr
ir f
la-
n& afknshing aspect of the rwlations of these professional
ps, te t b AndeAmerican observer, is their formal pmvision for
9 p u r e k of ofliice. Eaeh mernber of these groups of oifciem min-
bought his position when he entered the pmfession and sold
or h u e a t h e d it) when he le& it. The pricct was normalfy from four
Peo tmes tbe annual imome. The state thus had indirect control
W@P tht? number of these officials, as well as over their be ha vio^.
6 ea5u& to emb- &e pkmmnaa of p m
f e s i d &be Wo aro S- h h M wth &e s m m af
d i - , n lar; tf-rt we k r ~ t the
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 pmt oprofmsi ons4i ~t chem, agenk, sur-
geons--art: one such example. Had they developed b ml d g e that
&& byond the wr l d of the rai-, they might have s uf i vd
jb Sut dispatching did what we now think of as opera-
ti- remmh, even thou& its central task was esst.niially under the
finsdictiun n w heId by that pmfesim. Because they !acked & s e -
tion, di s pt t hn && witb their tmhnolor2y. hot her 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 n of en-
rtainment t b u & thct media.
coum, 'trut only &ron& M m g a f oudt i on in the profession of
lblic &d t d i n g ' ) =
A & case of pdessiond death is that of the psychoI@cai 4-
m%. Mediums Bou&h& in the larter nineteenth eenhtry as t'tre pro-
f 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 ms , efFective eommuniation btween her audience and the
Wi-e of the s pwbd wrM. The first foI10wefs of the etJ1"mg be-
in io r6e I"iap, &&u& Mesmrism, Swt ?denbo~i s m, artd a va-
ety & &her predecessom had prepared the way. Tlie weekly journs)
ot' the mdums , Bamr 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 gmup such as th0 Natianal Organimtion of Spi f i ui st s
~ W h d brut.8~ amd discussed, in vain, the problem of regulating the
~whma An o~~ s c h l of d i u ms h i p was founded by Morris
at Whitemter, Wmnsi n.
It is i mp o b t to redize that di ums hi p fits the basie definition of
profeSSion vmy well. It appiied a set of esoteric skills to mpafticuh
mr. Cer t My it pos~ssed al1 the organizationaf parapheraalil af a
mksion-schwI, ~wi a t i o n , artempted rewkatian. It is imp-t,
trxl, r d that many we l E- b w Amentans ptmnized mediums
aPld thar spWUi sm was p e ~ e i v d as a kind of "scim- rehgion.
As R. L. Moore has pointed out, niediums enabled people to under-
take e e r d=i&am withuut impueing &&ng siates of social &m
w amming pemnd responsibility, It was a jurisdiction that psy-
.Ut fn&odu&on
ehiatv WM later to sturnble nto, ard indeed a number of psychiatryk
&y ht t t es wae fou&t with d u m s ami their descendcutts the
s wb d i s t bdem. =
f n reft.%et&g &ut the deveiopmnt of professions, &en, we musa
deveIop mwe 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 spi r i di sm was a ridculous waste of time
si- the d u m s simpty couldnt deliver results, Neither muld nine-
tmnth 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 and neumlogists, the iiea-
dernie psycftubmts wh5 took over psychic r es eah. 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 inter-
prafessional relations.
These brief e mp f e s show fome of the bwathtaking diversity of pro-
fessional 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 subordi-
nates, 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 df these are a paft of prrtfessiond life. Beyond this &ersity,
these e mp l e s show how the developnrent of the f a md atributes of
a pmfession s bound up with the pursuit of junsdjction and the best-
ig of rival professions. The o m Mo n a l farmdities 5f pmfessions
are meanin@esf unless we uudemtand hei r context. This eontext al-
ways relates bmk tu the power of the pmfessions' knnowbdge systerns,
their abstracting ability to define old probbms in new ways. Abstrae-
ton erisbles survivd. Lt is with abs-ion that law and mu 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
Amen- rriedieine claims al1 of deviance, the abstxaction of its 4-
Fhallp: 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 ~ludience that says
k m b s up or d m . It is important that the reader begin tu make their