Steven J. Taylor. Acts of Conscience: World War II, Mental Institutions, and Religious Objectors. Syracuse: Syracuse University Press, 2009. xv + 484 pp. $45.00 (cloth), ISBN 978-0-8156-0915-5.

Reviewed by Allison Carey (Shippensburg University)
Published on H-Disability (January, 2010)
Commissioned by Iain C. Hutchison (University of Glasgow)

War, Pacificism, and the Fight for Social Justice in America's Mental Institutions

What factors lead people to strive for social change? What factors enable such attempts to be effective and long lasting? In Acts of Conscience, Steve J. Taylor tackles these tough questions through a historical analysis of World War II conscientious objectors (COs) and their fight to improve conditions at America's mental institutions. Taylor creates a fascinating account of the processes by which internal motivations and external opportunities intersect to encourage or discourage large-scale social change.

According to Taylor, such reformers as Dorothea Dix advocated for the creation of mental institutions to ensure the provision of humane care and effective treatment to individuals with mental illness; however, institutions quickly devolved into overcrowded, understaffed warehouses with rampant abuse and neglect. In the 1940s, administrators, the broader mental health community, attendants, and even some families understood the severity of the problems facing America's mental institutions, but excused away such problems as isolated incidents or a temporary crisis due to the war. Content to assume that the mental health profession was offering the best care possible under the circumstances, Americans turned a blind eye to the human rights atrocities committed in their own country, even while defending democracy overseas.

World War II created the conditions through which an unlikely group of potential reformers, conscientious objectors, entered this situation. COs disagreed with the use of violence and asked to fulfill their national duty through placement in a variety of service positions, one of which became the mental institution. At least fifteen hundred COs worked in mental institutions by the end of 1945. Taylor documents the tension that emerged for these men: they tended to have strong religious convictions stressing peace and love, yet violence, force, and neglect were typical features of daily life in a mental institution. How could they justify using or even allowing violence to be committed against innocent humans when they had refused to use violence against a wartime enemy? COs felt a moral duty to restructure the institutional environment to decrease violence and encourage the provision of care to patients. Taylor argues that, in addition to a sense of moral imperative, the collective work of COs provided support for reform efforts. Whereas isolated individuals might have been overwhelmed by the complex institutional structure and intimidated by the credentials of mental health experts who defended institutional care, COs served within units of fellow COs and these units existed at multiple institutions, creating a network of men with similar Christian values facing similar dilemmas who could share information and develop common strategies of reform within and across institutions. Moreover, COs exercised some leverage within institutions as they tended to be diligent workers, and their labor was sorely needed due to wartime staff shortages. In their efforts to create change, COs utilized a variety of techniques including working with institutional administrators and, more famously, using the media to expose the horrific realities of institutional life to create pressure for change. Their goals typically centered on improving patient care through such initiatives as increasing funding for institutions, advocating for the training attendants, reducing the use of restraints and force, and advocating for individualized care. Taylor's detailed analysis takes the reader from institution to institution, recounting the ways in which COs challenged the system and built a repertoire of strategies to achieve reform. By the end of the war, it seemed COs had made a real difference.

This wave of reform was short-lived. Taylor argues, "Although many of the ideas of leaders of the national foundation emerged later in mental health and developmental disabilities, the new versions of these ideas cannot be traced to that organization. The ideas were rediscovered and not inherited or passed down over time to be refined by a new generation of reformers" (p. 393). As Taylor explains the failure of COs to create long-lasting reform, he shifts from what seems to be a historical account of a small set of men who took on a social system of oppression, to a complex analysis of the factors affecting the long-term success of a movement, and here Taylor develops the most compelling arguments of the book.

Taylor highlights the specific historical events, such as the conclusion of World War II and the dismantling of the CO program, that seriously weakened reform efforts. After the war, most COs went back to their normal lives, leaving the mental institutions behind them. Those who continued working in the field of mental health confronted harsh new realities, such as the need to pay salaries and build a new support base once former COs and churches shifted their focus. The National Mental Health Foundation (NMHF), a national organization created by COs dedicated to patient-centered institutional reform, faced financial crisis after the war ended and merged with two other national mental health organizations, the National Committee for Mental Hygiene and the American Psychiatric Foundation, to create the National Association for Mental Health (now the National Mental Health Association). Neither the passion for reform that had been the driving force of NMHF nor their key projects survived this merger. Thus the efforts of the COs, which had seemed so promising, did not withstand postwar conditions.

In the last two chapters of the book, Taylor further develops his argument concerning the failure to achieve long-term success by contrasting the reform efforts of COs to more effective reform movements that began in the 1970s. He points to at least two sociopolitical differences between the movements. First, COs sought to improve institutional conditions but offered no substantial alternative to the institution. According to Taylor, improvements in funding, attendant training and programming were necessarily insufficient because the nature of the institution itself dehumanizes through its focus on efficiency and mass service delivery. In contrast, reformers in the 1970s developed pathbreaking ways to think about disability and treatment, demanding that people with disabilities be guaranteed civil rights and be included in all facets of social life within their communities. Second, COs drew on a narrow activist base consisting largely of fellow COs and never systematically sought to include patients, former patients, their families, or attendants as key activists within their movement. In later reform efforts, these constituencies came to the political table and demonstrated a clear, zealous, and lasting interest in social reform.  

Taylor's comparison yields significant lessons regarding disability history and reform. In particular, history has proven that sustained vigilance is required to uphold the rights of people with disabilities, and therefore effective reform requires an unrelenting movement that diligently and continuously defends its past successes while pushing for future victories. Short-term zeal typically fails to achieve long-term goals. The contrast between the reform movements is quite insightful, but limited by the brief coverage of the later time period. Readers will come away with several astute comparisons, but not with a detailed understanding of the scope of later reform movements.

While Taylor does not delve deeply into later movements, his coverage of the CO movement is exceptional. He provides intricate historical detail, using an extensive range of sources including interviews, personal papers of former COs, and archival materials. The book opens with a history of the development of the CO program, the varied backgrounds of the men who entered it, the complex politics of the program, and the tensions within it. Of particular interest, Taylor documents the politics of the CO status. To reduce the risk of men using the CO program to evade their duties, the administration preferred men with long-term institutional affiliations with pacifist denominations rather than men whose individual conscience forbade their participation in this particular war effort. Thus, men from the historic peace churches including the Society of Friends (Quakers), Amish, and Mennonites had greater success obtaining CO status than individuals from denominations that lacked a clear pacifist stance, such as Catholics and Episcopalians and individuals without any religious affiliation, although men from these backgrounds did at times gain CO status. Taylor is to be particularly commended for his attention to both general trends in CO activity as well as to variations, such as differences across religious groups and at specific institutions. For example, Taylor points out that while those from the Society of Friends and Mennonites expressed deep concern over institutional conditions, the religious beliefs of Friends leaned more readily to political action and confrontation than the beliefs of Mennonites, leading to different strategies for dealing with and transforming the institutional environment. Furthermore, while this work is primarily a history of men, Taylor at least includes a discussion of the women who worked at these institutions and supported the CO movement.

I find my greatest disagreement with Taylor's final sentences, where he states that "acts of conscience in the name of benefiting humanity are always good and never bad or even neutral. Acts of conscience are inherently worthy and deserving of praise." Morality is a social construction, such that the values and beliefs guiding any given conscience vary dramatically across time, place, and group. Taylor recognizes this when he argues that moral beings do not always determine as immoral actions that later come to be defined this way; for example, COs who fought against systems of violence did not at first consider the use of restraints or unpaid patient labor to be immoral although they later came to this conclusion. Furthermore, Taylor mentions the idea that humanity is a social construction--"that the social meaning of a person is not inherent in the qualities or characteristics of that person but dependent upon how others 'construct' or define that person" (p. 234). Given that both morality and concepts of humanity vary culturally and temporally, actions taken in good conscience by some may seem shockingly immoral to others. Indeed, at various times and places people have denied individuals with disabilities the status of human beings, and segregated and disposed of them according to their conscience for the improvement of "humanity." Those who advocated for institutionalization, sterilization, and even euthanasia of people with disabilities were not simply or always people who acted without conscience. Indeed, the injustices committed against people with disabilities are all the more disturbing because they are so often legitimated by morality systems that discard the value of people with disabilities and are committed by parents, professionals, and others who act in "good conscience" according to the tenets of such morality systems. Hence, actions taken with a deep consideration of morality for the betterment of "humanity" do not necessarily make actions worthy of praise. While I too praise the COs for their reform efforts, my praise is linked to my own set of values, not a stance that supports the absolute worth of acts of conscience.

In conclusion, Acts of Conscience tells an important piece of the history of American social reform, particularly as related to mental institutions. The literature on disability studies is growing quickly, but there remains a paucity of social analysis regarding the histories of mental and developmental disabilities and institutionalization. In particular, histories of institutionalization tend to focus on the growth of institutions in the early part of the twentieth century and deinstitutionalization beginning in the 1970s, dismissing events in the mid-century as unimportant. Taylor's work helps to fill in these critical gaps in our knowledge. In doing so, he offers rich historical insight, contributes immensely to the study of disability, and informs the broader sociological and historical literatures regarding social change and reform.

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Citation: Allison Carey. Review of Taylor, Steven J., Acts of Conscience: World War II, Mental Institutions, and Religious Objectors. H-Disability, H-Net Reviews. January, 2010.
URL: http://www.h-net.org/reviews/showrev.php?id=29362

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