How Doctors and Lawyers Got That Way

My route to work used to take me past a building that called itself “The Eutectic and Castolin Institute.” Those words refer to the science of sticking things together — welding to you, buddy. The Institute was a school for professional welders.

If one could fully understand the term “professional” the longings and pretensions imbedded therein—one might understand quite a bit about contemporary American life. We are aswarm with professionals, and with people who would be professional. Even in the literary trade, last refuge of bumblers, one hears more and more talk about “professional writers.”(That’s distinct from being “a pro,” roughshod usage which means, in Norman Mailers definition, “someone who can work on a bad day.”) A professional writer is a fellow with unambiguous standards, a well-educated and responsible type who knows right from wrong as surely as he knows how to avoid dangling modifiers. Writers are among the last people to pretend to professionalization. We already have professional insurance agents, car dealers, politicians.

Why anyone aspires to this rank is not immediately clear. Professionalism seems quite at odds with our national notions of glory — nothing romantic about being a dentist or a CPA. But professionalism offers something that outweighs romance: success. And more than that: sanctified success. Duty and disinterestedness, not greed and opportunism, are presumed to govern the professional’s life. His fruit ripens and falls at his deserving feet. He does well by doing good.

There is a further thing to be said about professionals: thev often make the rest of us feel like dirt. The relationship of the “lav person" to the professional is nicely symbolized by the naked patient waiting in the examining room for his whitecoated doctor to appear. To the professional. the lay person is defined by what he doesn’t know or can’t do — by his inadequacies. This does not make for warm fellow-feeling. Condescension comes easily to the professional. The license to practice sometimes seems to include a permit to be rude.

It is increasingly acceptable to raise one’s voice in public about professional arrogance. Everybody has a doctor story: even doctors have them. (It is not beyond the cardiologist to patronize the eye. ear. nose, and throat man.) A piece in Harper’s recently lamented the “plague of lawyers . . . that may be our terminal illness.”One can gel mad, but then again one can try to get even: hence the proliferation of places such as “The Eutectic and Castolin Institute" the desire among ordinary citizens pursuing ordinary jobs to confer upon themselves the dubious dignity of professionalism,

This sorry situation has a history, which is the subject of a dense but informative book by Burton Bledstein called Tut: CULTURE OF PROFESSIONALISM (Norton, $12.95). The history in question is surprisingly short. Although doctors, lawyers, and ministers have of course presided over civilized life since Colonial days, it was not until the mid-nineteenth century that something close to the contemporary concept of their roles emerged. Training, certification, adherence to objective standards, the notion of fraternity among experts — all these familiar traits of professionalism were invented by Americans of not much more than a century ago.

The institution that fostered this invention was the American university, and much of Bledstein’s book is given to an account of the radical changes that occurred in higher education within the space of a few decades. In the first third of the nineteenth century the American college was in a slate of disarray that makes the most chaotic moments on campuses in the 1960s seem models of decorum and purpose. Harvard and Yale were routinely the scenes of violent riots. The concept of an educator scarcely existed; teaching was done haphazardly by people on their way to or from other careers. The classical education such schools offered failed to connect with the ambitions of their students; the strict discipline the schools presumed to enforce was flouted. The United States was quickly on its way to becoming a restless, mobile, ambitious, middle-class society, and its institutions of higher learning were irrelevant to its wants.

But when the university caught up, it did so with a vengeance. By 1850, education had cornered the market on middleclass advancement. Universities not only increased spectacularly in size and number but they transformed themselves in style and function. They taught both skills and manners prerequisite to professional success. Science replaced classicism as the central value in the new university, and in every field there was an effort to create objective criteria for performance.

The rise of the professional class, and the concomitant growth of higher education. represented in some ways a major step forward. Obviously it was a benefit to mankind when the blood-pressure cuff replaced leeches on the biceps. And. scientific knowledge aside, the new class represented an advance in the democratization of the country. Bledstein remarks that the new culture “embodied a more radical idea of democracy than even the Jacksonian had dared to dream. . . . emancipated the active ego of a sovereign person ... a self-governing individual exercising his trained judgment in an open society.”

But there was another side to this progress, and it’s that side that chiefly interests Bledstein. Though the new culture provided unheard-of freedom for its beneficiaries, its effect on the larger society was essentially conservative. Each elevated figure, each person fortunate enough to be credentialed. took his place in a freshly minted elite. The new class, cut off from its origins, was all the more powerful because it was presumed to exist by virtue of individual merit rather than birth or circumstance.

One way of looking at professionalism. Bledstein argues, is as an ingenious native solution to a conflict (inherent in the American mind) between lust for power and obeisance to democratic ideals. The answer to this dilemma could not have been more sensible: invent an external sanctionfor success. “Far more than other societies, democratic ones required persuasive symbols of credible authority, symbols the majority of the people could reliably believe just and warranted. It became the function of the schools in America to legitimize the middle class by appealing to the universality and objectivity of science.” The new class had found a way to dodge the whole issue of class, by constructing the social form that we would later learn to call meritocracy. As Bledstein puts it. “The professional absolutely protected his precious autonomy against all assailants, not in the name of an irrational egotism, but in the name of a special grasp of the universe and a special place in it.”

For the excluded, the effects of the new professionalism were subtle and various. Social issues became redefined as technical ones. Often enough, of course, “scientific” explanations fit in cozily with the interests of those who did the explaining. Thus much medical evidence was advanced to prove the unfitness of women for public life; and physicians, demonstrating the coincidence of poverty and disease, found good reason to quarantine the ghettos while allowing freedom of movement to the middle class.

But the professional himself paid a price for his new status. The emergence of professionalism amounted to little less than a change in character for the middleclass American, particularly for the middle-class American male. The question of “career” became an all-consuming interest in a young man’s life; for the first time it became necessary to find out what one wanted “to do” in order to know what one was. The new character was selfabsorbed and upward-striving. The relationships that mattered to it radiated not outward into the community but upward toward higher rungs on the ladder of accomplishment. Emerson had a fine phrase for the change that was occurring (though his own celebration of selfdiscovery had helped inspire the phenomenon he lamented): “The young men.” he wrote, “were born with knives in their brain. ... It is the age of severance, of disassociation. of freedom, of analysis, of detachment.”

The new age is still with us. The hypocrisy and sanctimony and narrowness of personality that Bledstein finds in nineteenth-century America are all immediately recognizable to the reader today. The Culture of Professionalism does useful work in explaining the origins of a strain of character that pervades the contemporary middle class. The book suffers from the constrictions of its author’s own professional habitat (the University of Illinois history department): he musters a superabundance of data that doesn’t always serve the purposes of sequential thought. However, there is much here that is fascinating simply as lore. Bledstein is particularly good on the tenacious nature of early university presidents, and on the anguish of young men in crisis over their choice of careers.

In an epilogue addressed to the present moment, Bledstein asks, “How does society make professional behavior accountable to the public without curtailing the independence upon which creative skills and the imaginative use of knowledge depend?” A good question, but not the only question. Although our professionals are hardly free from out-and-out corruption, it is a lesser but more pervasive sin that distinguishes them: the inherited sense of their own worth, their emotional isolation from the rest of the populace. Our professionals not only need to be “accountable.” they also need somehow to understand that, like everyone else, they are amateurs at most things, such as ordinary decency.