A reference companion to the history of abnormal psychology

substantiation. Finally, Hamowy asserts that licensing legislation "almost certainly raised the incomes of physicians" (p.167), but neither here nor elsewhere, are any data presented on changes in physicians' incomes as a consequence of legislative enactments. Though further examples of the casual use of evidence might be given, it appears fair to conclude that such methodology detracts substantially from the book's credibility. Hamowy's uninspired narrative seems in many respects indistinguishable from an older historiography which he, ironically, dismisses as "tedious, often banal", (p.6.). But the irony extends still further, for while he goes on to accuse physician-authored histories of suffering "from the worst form of special pleading" (p.6), his own volume is written to provide historical support for a very specific contemporary policy initiative. Medical licensing laws, according to the preface contributed by the Frazer Institute, should be repealed. Like airlines in Ronald Reagan's America, the deregulation of medicine would enhance competition and, therefore, efficiency and quality of service. Licensing legislation, far from restricting organized medicine, serves primarily to guarantee a lucrative but unjustifiable monopoly on medical practice. It is this point that provides the thesis underlying Hamowy's study. With a surprising naivet6 he announces that history reveals medicine's justification for its licensing privileges-the good of the public-as rhetoric designed to mask a second and more pressing motive: economic self-interest. This will hardly come as a surprise to anyone who has stopped to consider the tension between altruism and entrepreneurialism inherent in medical practice. It certainly should not provide the theme for a serious work of scholarship. But for Hamowy it becomes the key to explaining the appearance of licensing laws during the nineteenth century. Such enactments were cleverly imposed by organized medicine, using legislators easily duped by proclamations of public interest, on an unsympathetic but powerless public (pp.4,7,181). And, lest anyone discover the true origins of the medical monopoly, physicians have created historiography designed "intentionally [to] obscure the real motives behind much of the activity of organized medicine" (p.6). Hamowy, then, deploys a crude conspiracy thesis to explain the evolution of medical licensing. He fails to appreciate that medical professionalization, of which licensing legislation is one aspect, is a far more subtle historical phenomenon. No occupational group professionalizes by a unilateral seizure of privilege; it is the result of a negotiated interaction in which the group persuades society of its unique merit. For the discerning historian it is this interaction …