This is an authorized facsimile and was produced by microfilm -x ero gr aph y in 1973 by Uni versity Microfilms, A Xerox Company, Ann Arbor, Michigan, U.S.A. University of Ghana http://ugspace.ug.edu.gh 70- 12,570 STINSON, Shirley Marie, 1929- DEPROFESSIONALIZATION IN NURSING? Columbia University, Ed.D., 1969 Health Sciences, nursing University Microfilms, Inc., Ann Arbor, Michigan g> Copyright 1970 by Shirley Marie Stinson University of Ghana http://ugspace.ug.edu.gh DEPROFESSIONALIZATION IN NURSING? by Shirley Marie Stinson Dissertation Committee: Professor Mildred L. Montag, Sponsor Professor Seymour Warkov Approved by the Committee on the Degree of Doctor of Education Date JUL 29 1969 Submitted in partial fulfillment of the requirements for the Degree of Doctor of Education in Teachers College, Columbia University 1969 ft). M. University of Ghana http://ugspace.ug.edu.gh <5 293023 I ^ D- * ««< (. v I ) c ; c .. i ) • University of Ghana http://ugspace.ug.edu.gh 1ABSTRACT DEPROFESSIONALIZATION IN NURSING? Shirley Marie Stinson The thesis of this study is that the occupation of nurs­ ing is undergoing a process of deprofessionalization, not a process of professionalization as most of the major works in the nursing literature would seem to assume. The central purposes underlying this study were to re­ examine and expand the concepts "profession" and "profes­ sionalization," develop the concept "deprofessionalization," and test the thesis in question. The approach used was that of a comparative social analysis, using current and historical data; the technique employed was that of a scholarly analysis of the literature. Because the concept "deprofessionalization" is a poorly developed one and because the thesis required that the con­ cepts "profession" and “professionalization" be -developed, including an assessment of the impact of bureaucratization upon professionalization, ..four ..chapters _w£tre devoted to these areas. Two major definitions of deprofessionalization were evolved: functional deprofessionalization was described as a process of "diseased professionalization," and dysfunc­ tional deprofessionalization as a process of moving from a state of excessive professionalization to a state of University of Ghana http://ugspace.ug.edu.gh 2functional professionalization. On the basis of the literature on professionalization, a documented case of deprofessionalization in law occurring in the nineteenth century, and upon examination of what would seem to constitute a case of deprofessionalization in diplomacy in the current century, a beginning typology was developed, the chief categories being: (1) direction (dysfunctional, functional), (2) duration (temporary, irreversible), (3! socio-political boundaries (international, continental, national, regional, state, local), (4) intra- occupational boundaries (intended to permit classification of deprofessionalization in "segments" of an occupation, e.g., criminal as opposed to corporate law, the bench as opposed to the bar), and (5) work-setting (under­ bureaucratized, bureaucratized, over-bureaucratized). Comparisons were made between professionalization in nursing c. 1920 and c. 1960, the former period being chosen because it both coincided with the heyday of solo practice in nursing, a characteristic frequently associated with the process of professionalization, and preceded the bulk of the immigration of nurses into bureaucratized work.-settings, a factor which the literature would suggest might con­ tribute toward deprofessionalization. It was concluded that within the social context of the times, the occupation of nursing c. 1920 exemplified to a greater degree the characteristics of professionalization University of Ghana http://ugspace.ug.edu.gh 3than is true of nursing today, some of the primary reasons being; (1) the relative integrity of the substantive knowledge-skill component, (2) the existence of a well- integrated professional culture, (3) the substantial articu­ lation of nursing roles with roles of related health per­ sonnel, (4) the relatively high degree of functional autonomy of the nursing practitioner, and (5) advancement in nursing was largely co-terminal with advanced technical expertise in nursing. Relevant categories of deprofessionalization were then applied to nursing c. 1960 and it was concluded that nursing is undergoing a process of dysfunctional deprofessionaliza­ tion of the national and over-bureaucratization types. Whether it is of a temporary or irreversible nature, only history will reveal. University of Ghana http://ugspace.ug.edu.gh 11 DEDICATION To my parents, whose encouragement for so many years has made the pursuit of my studies possible, and to . Dr. Herman Siemens (1904-1969), M.D., D.P.H., who has, through his pioneer work in public health, provided those in the health field a model of what it means to be "pro­ fessional." University of Ghana http://ugspace.ug.edu.gh ill ACKNOWLEDGMENTS Kind acknowledgment is made. to my sponsor and com­ mittee members, Professor Mildred L. Montag and Professor Seymour Warkov, without whose support and direction this study would not have been undertaken. Acknowledgment is also made to Professor Elizabeth C. Stobo for her interest and support from the very inception of the study and to both Professors Stobo and Maxine Greene for their critical appraisal of the final draft. Special thanks to my adviser, Professor Eleanor C. Lambertsen, for her willing­ ness to act as consultant and whose teaching over the past three years has had such a profound effect on my thinking, and to Professor Philip H. Phenix whose persuasive inter­ pretations of the many "Ways of Knowing" and whose assistance in. the formulative stages of the study were so very helpful. I am indebted, too, to Professor Helen M. Simon for her appraisal of Chapter V, to Mrs. Willetta Simonton who took time to give me very helpful advice about nursing statistical resource materials, and to Professor Bernard Phillips of Temple University for his consideration of my enquiry regarding the relationship between gendre and existential applications of knowledge. University of Ghana http://ugspace.ug.edu.gh iv Thanks, too, to the officers of the Canadian Red Cross, the Canadian Nurses' Foundation, the New York Trust Graduate Fellowship Awards Committee, the University of Alberta, Edmonton, and the Department of Public Health of the Govern­ ment of the Province of Alberta for the financial support which enabled me to undertake graduate study. Recognition is accorded the following publishers for permission to quote extensively from copyrighted materials: John Wiley and Sons, Harper and Row, Science Research Asso­ ciates, Incorporated, and the Russell Sage Foundation. tod to the many nurses of The hospital for Sick Children, Toronto, who through their exceptional skill in the nursiing of children convinced in that there is something unique about nursing knowledge and skills, my esteem and ny thanks. S. M. S. University of Ghana http://ugspace.ug.edu.gh VTABLE OF CONTENTS CHAPTER Page I. INTRODUCTION ................. . . . . . . . . 1 Deprofessionalization ...................... 5 Purposes of the S t u d y ...................... 7 The Approach...................... 8 Scholarly Analysis of the Literature . . . . 9 Temporal Comparisons .................... 10 Sequence of the Analysis................ 12 Limitations ...................... . . . . . 12 Suprapersonal and Superpersonal Elements in Research ...................... 14 II. THE CONCEPT "PROFESSION"..................... 16 The Concept "Profession": Definitions and Criteria .................. 18 Definitions.......................... . . 18 "Amateur" Versus "Professional" .......... 21 Criteria of a Profession.............. 22 The Concept of a Professional Continuum .................. . . . . . . 24 Variations Within Selected Criteria ........ 29 The Knowledge-Skill Component ............ 32 Autonomy .............................. 46 The Service Ideal , 57 Codes of E t h i c s .......................... 62 The Integral Nature of a Profession .................. . . . . . . . 73 University of Ghana http://ugspace.ug.edu.gh vl The Descriptive V ie w .......... 74 The Normative Vi e w........................ 74 III. THE PROCESS OF PROFESSIONALIZATION........... 80 Professionalization as a General Societal Phenomenon ...................... 80 Professionalization as a Movement from Unskilled Manual Occupations to White-Collar Occupations .............. 84 Professionalization as the Growth of Quinary Industries .................... 90 Education as an Index of Professionalization ...................... 92 Professionalization and the Assignment of Work........................ 101 Professionalization as an Occupa­ tional Group Phenomenon.................. 105 A Mini-Theory of Professionaliza­ tion Based on a Concept of Optimum Tension...................... 107 Steps in Professionalization.............. Ill Full-time Occupation . . . . ............ 115 Creating a New Occupational R o l e ........ 120 Establishing a Training School ............ 123 Establishment of a Local Pro­ fessional Association . ............ 125 Establishment of a University School.............................. 126 Establishing a National Pro­ fessional Association................ 129 The Enactment of Licensure L a w s .......... 135 Enactment of a Code of Ethics . . . . . . 139 CHAPTER Page University of Ghana http://ugspace.ug.edu.gh vi •<- Professionalization as Supplying Highly-Valued Services to Society . . . . 141 The Socialization of Practitioners . . . . 142 Identity and Commitment .............. 143 Professional Cultural Heroes, Values and Symbols............... 146 Occupational Choice .................. 149 Ongoing Socialization ................ 152 Leaders, Teachers, and Researchers . . . 153 Development of the Knowledge- Skill Component................ 156 Accumulating Knowledge and Skills . . . 157 Transmitting the Knowledge- Skill Component................. 161 Ongoing Development of the Knowledge-Skill Component .......... 164 Professionalization as Regulating Highly-Valued Services .................. 167 Standards . . . . .............. 168 Distributing and Articulating Professional Services ................ 171 Distribution .......................... 171 Articulation.............. 174 R e w a r d s ......... 178 Honorific Rewards .................... 178 Prestige............ 183 Monetary Rewards ...................... 189 Theoretical Limits to Pro­ fessionalization ........................ 192 CHAPTER Page University of Ghana http://ugspace.ug.edu.gh vii Measuring Professionalization: Some Guidelines .................... 198 Avoiding the "Sin of Monism" ............ 198 The Configuration of Variables ............ 199 Professionalization Criteria Must Be V a l i d .......................... 199 Avoiding a "The More The Better" Assumption.............................. 201 IV. BUREAUCRATIZATION AND PROFESSIONALIZATION . . . 204 The Traditional Ideal Type Bureaucracy . . . . 206 Effectiveness and Efficiency ; ............ 209 Rational Administration: Three Central Sub-types ........................ 211 Bureaucratication and Professionaliza­ tion: Compatibilities and Conflicts . . . . 213 Areas of Compatibility . ................ 213 Areas of Conflict................ 218 Autonomy........................,........ 220 Functional and Structural Contingencies ................. • 222 Changing Patterns of Organi­ zational Authority . . . . . . . . . . 224 Bureaucratization Threatens the Service I d e a l ............... 227 Integration....................... 229 Work Setting Orientations ............ 230 Differentiated Role Structures . . . . . 232 Differential Authority Structures . . . 235 Differential Reward Structures ........ 241 Bureaucratization, Professionaliza­ tion, and Deprofessionalization .......... 243 CHAPTER Page University of Ghana http://ugspace.ug.edu.gh viil V. DEPROFESSIONALIZATION ............. 246 The Use of the Term "Deprofessionali­ zation" in the Literature .......... 246 Deprofessionalization: A Conceptual Framework . .............. . . . . . . . 248 Kinds of Deprofessionalization: M Some Beginning Categories .............. 252 Categories Involving the Direc­ tion of Deprofessionalization ........ 252 Categories Involving Duration . . . . . . 253 Categories of Deprofessionaliza­ tion Involving Socio- Political Boundaries.................. 255 Types Involving Intra-Occupational "Boundaries"................ .......... 256 Categories of Deprofessionalization Involving the Organizational Structure of the Work-Setting . . . . . 256 Defining Deprofessionalization ............ 257 Dysfunctional Deprofessionalization . . . 257 Functional Deprofessionalization . . . . . 259 "Cases" in Deprofessionalization . . . . . . . 259 Law ........ 260 The Clergy................................ 262 Academia ........................ . . . . . 263 The Military.............................. 264 Diplomacy........... 266 The Impact on Diplomacy of Changes in Technology and Communications . . . . 268 Increased "Interference" from Public Opinion............ „ ......... 270 CHAPTER Page University of Ghana http://ugspace.ug.edu.gh Ideological Rifts ...................... 272 The Changing Status of the Highest Levels of Diplomats.................. 272 Applying Categorical Terms to the "Cases" of Law and Diplomacy . ........ 273 Applying Categorical Terms to the Case of L a w .................... 273 Applying Categorical Terms to the Case of Diplomacy........... . 274 "Steps," Sources, and Symptoms in Deprofessionalization .................... 276 "Steps" in Deprofessionalization .......... 276 Extra-occupational Sources and Symptoms of Deprofessionalization . . . . 278 Socio-political-cultural Sources and Symptoms.................. 278 Social Unrest ................. 280 Changing Ideologies and Shifts in P o w e r .................... 281 The Changing P u b l i c .................. 282 Structural Characteristics of Government .............. 284 Economic Factors ........ . . . . . . . . 285 Internal Sources and Symptoms ............ 287 The Knowledge-Skill Component . . . . . . 287 Deprofessionalization as Loss of Occupational Autonomy......... 289 Failures in Professional Socialization . . . . . . ............ 290 Deprofessionalization Related to the Quantity and Quality of Practitioners................... 292 CHAPTER Page University of Ghana http://ugspace.ug.edu.gh XMembership Versus Reference CHAPTER Page Groups 295 Rewards Are Not a Function of "Ideal Type" Professional Behaviors.......................... 297 The Character and Locus of the Work Situation.................. 299 Deprofessionalization and Technology . . 300 Deprofessionalization as Deficient Intra-, Inter-, and Extra- Occupational Articulation .......... 301 "Steps" in Deprofessionalization? ........ 302 Tentative Characteristics Associated with the Process of Dysfunctional Deprofessionalization ................ 304 VI. NURSING, C. 1920 AND C. 1960: AN OVERVIEW . . . 306 The Modal NUrse, c-. 1920 and c. 1960 ........ 309 The Modal Nurse: Circa 1920 .............. 309 The Modal Nurse: Circ,a 1960 . . . . . . . . . 314 Selected Characteristics of Profes­ sionalization in Nursing, Circa 1920 and Circa 1960 ...................... 320 The Knowledge-Skill Component in Nursing Circa 1920 and Circa 1960 . . . . 320 The Social Significance of Nursing . . . 320 Related Considerations ................ 329 Aura of Mystery......................... 331 Some Effects of Bureaucratization on Nursing ........................... 332 A utonomy.............................. 332 The Autonomy of the Individual Nursing Practitioner ............ 333 University of Ghana http://ugspace.ug.edu.gh The Nursing Department . . . . . . . . 336 Nursing Organization . . . .......... 338 Standards.............................. 339 Prestige and Bureaucratization . . . . . 341 The "Routinization" of Patients' Crises? .................... 341 Professional Versus Organiza­ tional Orientations .................. 344 Selected Aspects of the Professional Culture, Circa 1920 and Circa 1960 . . . 348 Cultural Heroes, Role Models, and Cultural Symbols in Nursing . . . . . . 348 Other Selected Aspects of the Socialization Process ................ 352 Codes...................... 356 Professional Culture and the Professional Association . . . . . . . 357 Professionalization in Nursing, C. 1920 and C. 1960: Supplying Valued Services to Society ................ 361 Quantity...................... 361 Quality........................ 363 Developing the Knowledge- Skill Component................. 365 Professionalization in Nursing, C. 1920 and C. 1960: Regulating Valued Services to Society............ 367 Articulation and Nursing, C. 1920 and C. 1960 .................. 367 Distribution .......................... 371 xi CHAPTER Page Rewards........................ 372 University of Ghana http://ugspace.ug.edu.gh Honorific Rewards ...................... 372 Differential Reward Structures ... . . . 376 Monetary Rewards ...................... 377 Conclusions................................ 377 VII. SUMMARY...................................... 381 BIBLIOGRAPHY ........................................... 385 APPENDIX Recommendations for Further Study .......... . . . . 414 Recommendations Pertaining to Policy at the National Organizational Level . . . . . . . . . 415 xii CHAPTER . Page University of Ghana http://ugspace.ug.edu.gh xiii LIST OF TABLES TABLE Page I. Gross Analysis of Elements in Selected Literature on the Criteria of a Profession.................................. 30 II. Distribution of Workers by Major Occu­ pation, Both Sexes, 1920 and 1960 ............ 85 III. Distribution of Workers by Major Occu­ pation and by Sex, 1920 and 1960 86 IV. Earned Degrees Compared to Total Population, 1920 and 1960 .................. 94 V. Earned Degrees, by Sex, Compared to Labor Force, by Sex, 1920 and 1960 95 VI. Earned Degrees, by Sex., Compared to the Professional and Technical Occupa­ tional Group, by Sex, 1920 and 1960 .......... 99 VII. Chronological Progression of Wilensky's Data on First State Licensure Laws Enacted in Selected Professions in the United States, 1732-1963 ............... 137 University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES FIGURE Page X. Discrete View of the Central Character­ istics of the Descriptive Ideal Type Profession............................... 75 2. Integral View of the Central Character­ istics of the Descriptive Ideal Type Profession........................ 75 3. Paradigm Showing the Mission-Tasks- Means Relationship of the Normative Ideal Type Profession......................... 78 4. Paradigm Reflecting the Theoretical Possibility That the Characteristics of Normative Professionalization May Be Identical for All Occupations Only in Some Respects.......................... 200 5. Paradigm Reflecting the Theoretical Possibility That the Characteristics of Normative Professionalization in One Occupation May Be Identical Only in Some Respects with Those of Another .................... 200 6. Paradigm Showing Types of Deprofes­ sionalization Occurring Where There Is Movement from One Area of Pro­ fessionalization to Another........... 250 7. Selected Factors Related to Variations in the Social Significance of Nursing 1900-1960, as Perceived by Patients, Doctors, and Nurses ........... » . . . 322 xiv University of Ghana http://ugspace.ug.edu.gh 1CHAPTER I INTRODUCTION Men's ideas of what is real, even if they do violence to the facts, even if they are unrealistic, are real in their consequences. . . .1 It would seem fair to state that most of the major works in the nursing literature appear to be predicated on the assumption that nursing is undergoing a process of pro­ fessionalization. The study presented here represents an attempt to challenge that assumption by testing the thesis that nursing is undergoing a process of deprofessionaliza­ tion. While at first glance this may seem to smack of heresy or idle rhetoric, and for those reasons be considered a somewhat destructive if not creative exercise, a second glance may indicate that it can also be interpreted as a concern for the fact that even our well-intentioned efforts, if based on erroneous assumptions, are likely to yield unpro­ ductive if not disastrous results. Blumer defines professionalization as representing "an indigenous effort to introduce order into areas of voca­ tional life which are prey to the free-playing and Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Founda­ tion, 1958) , p. 41. University of Ghana http://ugspace.ug.edu.gh 2disorganizing tendencies of a vast, mobile, and differen­ tiated society undergoing constant change." And by this definition the assumption that nursing is undergoing a process of professionalization might seem to be a fairly safe one in that much effort in this direction would seem to be evident. But while Blumer’s definition is helpful in conveying the dynamic nature of professionalization, it tends to minimize the concomitant point that unless this “indigenous effort" meets with some success, the kind and degree of professionalization which can be said to be 2 occurring is indeed limited. The genesis of this study is rooted in the questions, "To what extent are we confusing effort with success in re­ lation to the kind and degree of professionalization going on in nursing today? Is the very assumption that we are undergoing a process of professionalization a tenuous one?" In the same sense that the term "profession" must be thought of in relation to its social context, the question as to whether or not and to what degree professionalization Herbert Blumer, "Preface," in Howard M. Vollmer and Donald L. Mills, eds., Professionalization {Englewood Cliffs, N.J.: Prentice-Hall, 1966), p. xi. 2 William J. Goode, "The Librarian: From Occupation to Profession?" Library Quarterly, 31 ('October, 1961), 307. ^Joseph Ben-David, "The Growth of the Professions and the Class System," in Reinhard Bendix and Seymour M. Lipset, eds., Class, Status, and Power (New York: The Free Press, 1966),'p. 459. University of Ghana http://ugspace.ug.edu.gh 3is occurring must be gauged against the social backdrop of the times. While Wilensky categorizes nursing as an occu­ pational group "in the process" of becoming a profession,1 the earmarks by which he assigns this category, on six out 2 of seven counts, antedate 1910. His study confirms that by 1909 nursing was beginning to exhibit some of the charac­ teristics empirically associated with the process of profes­ sionalization; it tells us little or nothing as to the de­ gree to which these criteria are characteristic of nursing today, nor to what extent events in the intervening years may have affected the course of professionalization in nursing. This brings us to the second impetus for ques­ tioning the validity of the assumption that nursing is under­ going a process of professionalization. There was what could almost be termed a mass migration of nursing practitioners from relatively isolated work settings into bureaucratic structures within less than a Harold L. Wilensky, "The Professionalization of Everyone?" American Journal of Sociology, 70 (September, 1964), 141, 143. Wilensky also uses the designation "marginal professions" for this group. 2 Ibid., p. 143. The exception is a formal code of ethics (1950); the other six criteria are based on "first" dates as to (1) becoming a full-time occupation, (2) training school, (3) university school, (4) local pro­ fessional association, (5).national professional associa­ tion, and (6) state license law. University of Ghana http://ugspace.ug.edu.gh 4generation's time, beginning in the late 1930's. In view of the recent theory about the relationship between profes­ sionalization and bureaucratization one wonders what the impact of that migration might be. Hall concludes that "there is generally an inverse relationship between profes­ sionalization and bureaucratization, although there is con- 2 siderable variation within that relationship. . . . " The investigator wonders to what extent might current character­ istics of nursing as an occupation be embodiments of the residual of that migration, and what the ramifications were and are for the process of professionalization. 3 4While Mauksch and others have given attention to Gerald J. Griffin and H. Joanne King Griffin, Jensen's History and Trends of Professional Nursing (5th ed.; St. Louis: Mosby Company, 1965), p. 199, maintains that "private duty was at its height in the halcyon days of the twenties." See also Effie J. Taylor, "Present Trends in Nursing as Affecting Nursing Education and Nursing Service," in A. D. Bachmyer and G. Hartman, eds., The Hospital in Modern Society (New York: The Commonwealth Fund, 1943) , p. 171, where she states that "in 1927, seventy-three per cent of hospitals with schools did not employ a single graduate nurse for floor duty." Even by i'9 36, private duty nurse constituted the largest group of nurses, see Esther Lucile Brown, Nursing as a Profession (New York: Russell Sage Foundation, 1936), p. 76. 2 ■Richard H. Hall, "Professionalization and Bureaucrati­ zation," American Sociological Review, 33 (February, 1968), 92...................... ....... . Hans Mauksch, "The Organizational Context of Nursing Practice," in Fred Davis, ed., The Nursino Profession (New York: John Wiley and Sons, 1966), pp. 109-137. 4 E.g., Edith Aynes, "How Can Nursing Serve Two Masters?" Modern Hospital, 97 (October, 1961), 111-113; and Esther Lucile Brown, "Nursing and Patient Care," in Fred Davis, ed., The Nursing Profession (New York: John Wiley and Sons, 1966), University of Ghana http://ugspace.ug.edu.gh 5examining soma of the relationships between organizational setting and nursing functioning, the question of what impact such factors might have on the broader process of profes­ sionalization would seem to have had far less consideration.1 It is too simplistic to presume that bureaucratization is entirely antithetical to professionalization. Yet the strains inherent in the relationship would seem so funda- 2 mental as to make us wonder if possibly one of the extreme consequencss of the effects of bureaucratization might not only be a lessening of or an attenuation of professionaliza­ tion, but deprofessionalization. These, then, are the nascent beginnings of this study. Before proceeding with an explanation of the purposes, the investigator would interject two notes of caution regarding the term "deprofessionalization." Deprofessionalization As will be evident in the following chapter, there is a substantial amount of literature and sophistication of thought about the concept of professionalization; this is not the case with deprofessionalization. For example, the Mauksch underlines the need for study of this kind. See Hans Mauksch, "The Organizational Context of Nursing Practice," in Fred Davis, ed.. The Nursing Profession (New York: John Wiley and Sons, 1966), p. 110. 2 The nature of these strains will be discussed in Chapter IV. University of Ghana http://ugspace.ug.edu.gh 6word appears only once in Professionalization, one of the most recent and comprehensive resource books in this area.1 In examining the possible limits of and exceptions to the trend toward professionalization, Vollmer and Mills ask, “Can we find any situations in which 'deprofessionalization' 2 may be occurring today . . . ?" It is tempting to make "the assumption of symmetry"^ in regard to the terms "professionalization" and "deprofes­ sionalization, " conceiving of the latter as being the "opposite" of the former. Paraphrasing Willis, we would suggest that "if a certain set of conditions is known to lead to [professionalization], it does not follow that the absence of these conditions or the presence of logically opposite conditions will necessarily lead to . . . [depro- 4 fessionalization].“ The second point we would mention is that "deprofes­ sionalization" logically presupposes "professionalization," while the reverse would not necessarily hold true. This ^Howard M. Vollmer and Donald L. Mills, eds., Profes­ sionalization (Englewood Cliffs, N.J.: Prentice-Hall, 1966), p. 45. 2Ibid. ^Richard H. Willis, "Conformity, Independence, and .\nti- conformity," Human Relations18,(November, 1965), 373 4 Ibid. The title of the article conveys the nature of the author's argument, that there is some "middle state" which the opposites do not adequately describe. University of Ghana http://ugspace.ug.edu.gh 7has important methodological consequences for, in postulat­ ing that nursing is undergoing a process of deprofes­ sionalization, we are automatically committing ourselves to the task of demonstrating that within the social context of the times nursing at some previous period exemplified to a greater degree the characteristics of professionalization than is true of it today. Purposes of the Study Professionalization is one of the most fundamental processes affecting society today. Quite apart from its intrinsically interesting aspects, knowledge about this phenomenon-would seem a matter of great practical import, and current understanding of it is by no means comprehen- 2 sive. The purposes of this study lie in making a contribu­ tion to the literature on the subject, especially with re­ gard to the concept of deprofessionalization, and in con­ tributing insights which might serve to generate theory as to what is the essence of nursing in relation to society today. Howard M. Vollmer and Donald L. Mills, eds.. Profes­ sionalization (Englewood Cliffs, N.J.: Prentice-Hall, 1966), p. viii. 2Kenneth S. Lynn, "Introduction to the Issue, 'The Professions,'" Daedalus, 92 (Fall, 1963), 650. University of Ghana http://ugspace.ug.edu.gh 8The Approach Professionalization is a process involving complex interactions amongst social, political, cultural, and eco­ nomic factors.^ As such, the methods used to study it here must necessarily permit considerations as to relationships 2 amongst these variables. As was implied earlier, the thesis necessitates being able to make substantive and temporal comparisons about the kind and degree of professionalization in nursing as viewed against the broader social contexts of different times. The approach which would seem to be most appropriate for doing this would seem to be that of comparative social analysis, using current and historical data. In this sense, the investigator is assuming the role not of historian or sociologist, but that of an amateur behavioral scientist. Of the techniques which were considered, content analy­ sis of selected nursing literature was investigated as a possibility, but the problem of representativeness was such ^This statement is a composite based on readings in the field, e.g., Howard M. Vollmer and Donald L. Mills, eds., Professionalization (Englewood Cliffs, N.J.: Prentice-Hall, 1966). 2 See Ray Hyman, The Nature of Psychological Inquiry (Englewood Cliffs, N.J.: Prentice-Hall, 1964), p. 5, regard­ ing the logic for there being a "close relationship between subject matter and method." 3 Content analysis is becoming recognized as a valuable technique of research. See Bernard Berelson, Content Analysis in Communication Research (Glencoe, 111.: The Free Press, 1952), especially pp. 27-31. University of Ghana http://ugspace.ug.edu.gh 9that the range and depth of analysis entailed was beyond the limitations of time. The technique of structured per­ sonal interviews with subjects representing different in­ terest and generational groups was also considered, but this was rejected in view of the problems of establishing representativeness and reliability. A scholarly analysis of the literature appeared to be the technique best suited to the nature of the thesis, purposes of the study, and the intellectual skills and limitations of the investigator. Scholarly Analysis of the Literature The crucial difference between a broad acquaintance with the literature in a particular area and a scholarly analysis is that in the latter case the material is selected, analyzed, and evaluated on a systematic, purpose­ ful basis. In our case it seems, firstly, that the develop­ ment of the thesis requires looking into the literature from the two standpoints of: (1) what are the critical elements in and characteristics of professionalization, and (2) what is the evidence that these elements were and are character­ istic of nursing at different points in time? In that the impact of bureaucratization on professionalization is cen­ tral to the thesis, the relationship between these two processes would also be an inherent aspect of the analysis of the literature. University of Ghana http://ugspace.ug.edu.gh 10 An exhaustive review of the literature, then, is beyond the purposes and scope of this study. To paraphrase Glaser, "The principal criterion for the selection of [the literature in relation to the above two points] . . . is ideational. . . So that while the review may not be rep- 2 resentative in terms of "the range of data or of authors," it must reflect the central concepts. Secondly, the nature of the thesis requires that the concept of deprofessionalization be developed and at least tentatively defined. Temporal Comparisons Theoretically speaking, one could compare the charac­ teristics of an occupation from the standpoint of any two points in time. But the "is" in our thesis denotes the approximate present, a period we might refer to as "the 1960's." In that the stages and characteristics of profes­ sionalization evolve over fairly lengthy periods of time, barney G. Glaser, ed., Organizational Careers (Chicago: Aldine, 1968), p. 6. "Ideational" in italics in the original text. 2 Ibid. Original text written in italics. 3I.e., it is hard to estimate in what ways five or ten years might make a difference. E.g., in predominantly male occupations it would seem that occupational prestige has re­ mained relatively constant over a considerable period of time. See Robert W. Hodge, Paul M. Siegel, and Peter H. Rossi, "Occupational Prestige in the United States, 1925- 1963," American Journal of Sociology. 70 (November. 286-302 University of Ghana http://ugspace.ug.edu.gh 11 it would not seem too invalid to use as a basis for some of the statistical comparisons data from the last decennial census, nor would it seem highly inconsistent to use illus­ trations from statistical data on nurses and nursing which would range over the 1960-1968 period. The choice of the comparative period is somewhat more difficult. Although the 1930 census techniques for collect­ ing data on employment are much superior to those of preced­ ing years, the investigator's considered opinion is that it would be preferable to choose the 1920's as this period not only antedates the beginning of the migration of graduate nurses into bureaucratic settings, but it also represents the "halcyon days, not the waning period of private duty nursing, and, further, it precedes the period of the Great Depression, at which time hospital as opposed to hone care was becoming the norm for a wide variety of socioeconomic classes3 and a period in which a generalized economic depres­ sion might yield a distorted basis for making comparisons. For these reasons, the investigator chose to focus upon the 1920's as the period of time against which to contrast J. Jaffe and R. 0. Carlton, Occupational Mobility in the United States 19 30-60 (New York: Kinq's Crown Press, 1954), p. 6. 2 Gerald J. Griffin and H. Joanne King Griffin, Jensen's History and Trends of Professional Nursing (5th ed.; St. Louis: Jlosby Company, 1965), p. 199. 3Esther Lucile Brown, "Cursing and Patient Care,* in Fred Davis, ed., The Nursing Profession (New York: John Wiley and Sons, 1966), p. 178. University of Ghana http://ugspace.ug.edu.gh 12 Sequence of the Analysis The development of the thesis can be thought of as con­ stituting four major phases. Chapters IX and III represent evolvement of criteria which serve as bases for making later comparisons about professionalization in nursing. On the premise that understanding the nature of deprofessionaliza­ tion depends heavily upon understanding the concepts "pro­ fession" and "professionalization," considerable weight is given this first phase. Chapter IV is an assessment of the impact of bureaucratization on professionalization. In the third phase. Chapter V, the concept of deprofessionalization is developed. In the fourth major phase, Chapter VI, the idea that (1) within the social context of the times, nursing in the 1920's exemplified to a greater degree the character­ istics of professionalization than it now does, and (2) the thesis that nursing is now undergoing a process of deprofes­ sionalization are tested, and conclusions are drawn. The study is summarized in abstract style in Chapter VII. Limitations This study is confined to the Dnited States. Time is not the only factor in this decision. For one thing, while there are some studies which indicate considerable interna­ tional agreement in regard to some of the more discrete nursing in the 1960's. University of Ghana http://ugspace.ug.edu.gh 13 aspects of the phenomenon of professionalization, they tend to center on male occupations,1 so that generalizations as to whether this holds true for predominantly female occupa­ tions would be tenuous. Secondly, while there is historical and current evidence of similarities in nursing between even such closely related countries as Canada and the United 2 States, the kind and degree of differences would seem to be marked enough that they be considered as separate popula­ tions in the research sense of the word until more is under­ stood about the significance of these variations.^ The focus of the study will be on professionalization in the occupation of nursing in general. Although the study of differential professionalization in such special areas as the religious nursing orders, the military, public health, and psychiatric nursing would seem very worthwhile, they are E.g., Alex Inkeles and Peter H. Rossi, "National Com­ parisons of Occupational Prestige," American Journal of Sociology, 61 (January, 1956), 329-339. 2 Helen K. Mussallem, Nursing Education in Canada (Ottawa: The Queen's Printer, 1965), pp. 6-10, 74; Canadian Nurses' Association, The Leaf and the Lamp ;(0ttawa: The Association, 1968), pp. 32, 35. "*E.g., a cursory comparison of nursing statistics indicates that there are considerable degrees of difference in relation to such aspects as educational preparation, percentage of employed nurses married, ratio of registered nurses to qualified auxiliary nursing personnel, to name only a few. American Nurses' Association, Facts About Nursing: A Statistical Summary, 1966 Edition (New York: The Association, 1966); Canadian Nurses' Association, Countdown 1967 (Ottawa: The Association, 1968). University of Ghana http://ugspace.ug.edu.gh 14 not alluded to in this study except for purposes of develop­ ing the thesis in,general. Suprapersonal and Superpersonal Elements m Research An investigator's choice of topic is always in a sense "suprapersonal; for what particular . . . questions excite special interest at any given period is a sign of the general intellectual focus of that period. . . -”1 Yet sub­ jective involvement is also a vital factor in the choice and 2 direction of objective enquiry. Hearn says that the more value-laden the research topic is, the more important it is that the investigator "take full cognizance of his biases."3 This study is "suprapersonal" in that professionaliza­ tion is one of the most pervasive forces in modern day life. So far as subjective elements are concerned, it would seem important to keep in mind the danger that the thesis could become less an objective enquiry than an adaptive response to the somewhat overwhelming dissonance created by the great ^Agnes Arber, The Mind and the Eye (Cambridge: The University Press, 1964) , p. T. 2 In fact Kerlinger questions "that any significant work is ever done without great personal involvement." Fred N. Kerlinger, Foundations of Behavioral Research (New York: Holt, Rinehart, and Winston, 1966) , Preface, p. vii. ■ G^ordon Hearn, Theory Building in Social Work (Toronto: University of Toronto Press, 1958), p. 32. University of Ghana http://ugspace.ug.edu.gh 15 disparities between what could be done and what is being done in health care today; it could also be an adaptive response to the strains of marginality which are to a very large de­ gree inherent in the doctoral preparation of nurses today. But as Gouldner would remind us, we do not solve "the problem of objectivity by good-naturedly confessing . . . " subjective forces which may underlie our enquiries^ The watchword for the technique which underlies the approach to this study, that of a scholarly analysis of the literature, would seem to be soundly expressed in this quotation from Francis Bacon: Read not to contradict and confute, nor to believe and take for granted, nor to find talk and discourse, but to weigh and consider.* The ultimate criterion by which this study must be judged lies not in a categorical defense of the thesis per se, but in how objectively we have "weighed and considered" whether or not it is wise to base our actions upon the assumption that nursing is undergoing a process of profes­ sionalization. ^Alvin W. Gouldner, "The Sociologist as Partisan: Sociology and the Welfare State,'1 American Sociologist, 3 (May, 1968),- 112. 2 Excerpt from "Of Studies," in Essays; quoted by J. M. Cohen and M. J. Cohen, eds.. The Penguin Dictionary of Quotations (Hammondsworth, Middlesex: Penguin Books, i960), p. 19. University of Ghana http://ugspace.ug.edu.gh 16 CHAPTER II THE CONCEPT "PROFESSION” The concept "profession" explains the process of pro­ fessionalization no more than the concept "City" explains the process of urbanization. Yet each is a critical touch­ stone in understanding the phenomenon it exemplifies. For, as the concept "profession1’ is the model toward which the process of professionalization is directed,1 understanding the model is a prerequisite of understanding the dynamics of how and why occupational groups do or do not approximate the model. While the purpose of this chapter is to describe and examine the concept "profession" for the purpose of pro­ viding a frame of reference for later discussions of profes­ sionalization, bureaucratization, and deprofessionalization, the content here is less a summary of evidence as to the criteria of a profession per se than an examination of their sub-characteristics, relative significance, and their inter­ relatedness. For it is these latter dimensions, not the criteria themselves, which yield the major clues to the process of professionalization. As the term "ideal type" is of importance in the develop­ ment of our topic here, a preliminary note about it would 1Ever'ett C. Hughes, Men and Their Work (Glencoe, 111,; The Free Press, 1958)., pp. 44-45. University of Ghana http://ugspace.ug.edu.gh 17 seem in order. Ideal types, such as an ideal type bureauc­ racy or an ideal type profession,1 facilitate analyses and comparisons of phenomena by deliberately simplifying and exaggerating their characteristics. These characteristics may be chosen on a descriptive basis, that is, selected on the basis of the main traits of prototypes of the phenome­ non,^ or they may be normative in nature, selected on-the basis of the extremes of "what should be" rather than on 4 the extremes of "what is." No judgment is implied in the above statements, for ideal types based on either approach or, in all likelihood, ^follmer and Mills utilize the construct ideal type profession as a theoretical "model of the form of occupa­ tional organization that would result if any occupational group became completely professionalized." Howard M. Vollmer and Donald L. Mills, eds., Professionalization (Englewood Cliffs, N.J.! Prentice-Hall, 1966), p. vi. 2 Rexnhard Bendix, "Weber, Max," in David L. Sills, ed.. International Encyclopedia of the Social Sciences [here­ after designated as IESS], Vol. 16 (1968), 499. Bendix notes (p. 499) that Weber formulated this construct on the basis of Jacob Burckhardt’s writings. ^E.g., in describing an ideal type profession on this basis, the occupations of law and medicine might be used as prototypes. 4 Peter M. Blau, "Organizations: I. Theories of Organi­ zations," IESS, Vol. 11 (1968), 299; Blau maintains that it is not clear whether Weber's ideal type bureaucracy was normative or descriptive in its base.* It is, of course, fallacious to assume that the two bases are mutually exclu­ sive; yet Fromm warns that it is' dangerous to assume that we can and should infer the normative from the descriptive; see Erich Fromm, The Sane Society (New York: Rinehart and Company, 1955), especially pp. 191-196. University of Ghana http://ugspace.ug.edu.gh 18 upon a combination of the two, are potentially useful tools of analysis. The point we wish to make here is that it is sometimes far from clear what are the bases for the various descriptions of ideal type professions cited here. This poses certain problems. In the one sense, it can be argued that the principal criterion of an ideal type is how well it helps us to understand the essential nature of the phenomenon in question; yet if we intend to infer degrees of professionalization from how nearly an occupational group approximates the characteristics of a stated ideal type pro­ fession,1 we must keep in mind the ultimate question, "To the extent that descriptive and normative ideal types differ, which is the more valid index of the degree of professionali­ zation?" The Concept "Profession*: Definitions and Criteria Definitions Garceau, in examining variations in definitions of a profession, concludes that the only factor common to all is . 2their eulogistic flavor. While there would indeed seem to *A method of inference suggested by Harold L. Wilensky and Charles N. Lebeaux in Industrial Society and Social Welfare (New York: Russell Sage Foundation, 1958), pp. 284- 285 • 2 Oliver Garceau, The Political Life of the AMA (Cambridge, Mass.; Harvard University Press, 1941), p. 186. University of Ghana http://ugspace.ug.edu.gh 19 be considerable similarity in many definitions, there would also seem to be some subtle departures; and in our view understanding the concept involves paying attention to both. Drawing upon a comprehensive variety of sources , such as historical antecedents, legal decisions, socioeconomic categorizations, and philosophical and sociological explana­ tions, Cogan documents a wide range of meanings associated with the concept "profession." For example, there is dis­ agreement as to the historical antecedents of professions, the term "profession" does not always have a positive conno­ tation, licensure is not always a requirement of legal defini­ tions, and,even within the Federal government, definitions as to what constitutes a profession are not the same in the Departments of Labor and Commerce.1 An analysis of the definitions of Cogan, Glaser, and Millerson indicates that, directly or indirectly, they all touch on the process of professionalization in addition to enumerating structural and attitudinal characteristics. We draw attention to this detail to underline the larger point, that the concept “profession" cannot fully be apprehended apart from an understanding of the process of professionali­ zation. Cogan offers the following "tentative" definition: A profession is a vocation whose practice is founded upon an understanding of the theoreti­ cal structure of some department of learning - 1Morris L. Cogan, "Toward a Definition of Profession," Harvard Educational Review, 23 (January, 1953), 33-50. University of Ghana http://ugspace.ug.edu.gh 20 or science, and upon the abilities accompanying such understanding. This understanding and these abilities are applied to the vital practical affairs of man. The practices of the profession are modified by knowledge of a generalized nature and by the accumulated wisdom and experience of mankind, which serve to correct the errors of specialism. The profession, serving the vital needs of man, considers its first ethical impera­ tive to be altruistic service to the client.! Glaser offers a more concise definitions "A- profession is a cohesive and autonomous body of trained persons who perform work for the benefit of the public on the basis of 2applied scientific knowledge." Millerson's definition would seem a testimony to the difficulty of finding univer­ sally meaningful adjectives for describing the chief traits of a profession: [A profession] is a type of.higher-grade, non- manual occupation, with both subjectively and objectively recognized occupational status, possessing a well-defined area of study or con­ cern and providing a definite service, after advanced training and education.3 ^Morris L. Cogan, "Toward a Definition of Profession," Harvard Educational Review, 23 (January, 1953), 48-49. 2 ■William A. Glaser, "Nursing Leadership and Policy: Some Cross-National Comparisons,” in Fred Davis, ed., The Nursing Profession (New York: John Wiley and Sons, 1966), p. 7. ^Geoffrey Millerson, The Qualifying Associations (London: Routledge and Kegan Paul, 1964), p. 10. Miller­ son's definition is somewhat exceptional, for although it does not exclude the ideal of subordination of self- interest, it does not set it as a condition of the service which is provided. University of Ghana http://ugspace.ug.edu.gh 21 "Amateur" Versus "Professional” While in popular usage the terms "amateur" and "profes­ sional" are frequently used as opposites, the distinction between them is not clear cut. Dewey considers them as not being mutually exclusive, and Cogan points out, for example, that "claims for altruism and egoism are made for both."1 Increasingly, amateur activity in the intellectual disciplines is hampered by the need for systematic pre­ instruction. This was not the case even a century ago when amateur pursuits in such fields as botany, zoology, and 2 geology were fairly commonplace. Professional endeavor inheres the idea of "gainful work," both in the economic and social senses; further, it inheres a degree of obligation to serve society in some special way, a characteristic which is not inherent in the concept * amateur."^ Whereas "amateur" frequently connotes part-time endeavor, the word "professional" has come to mean full-time, if not lifetime, activity, both on the individual and collective \john Dewey, "Culture and Professionalism in Education," School and Society, IS (October 13, 1923), 423; Morris L. Cogan, "Toward a Definition of Profession," Harvard Educa­ tional Review, 23 (January, 1953), 39. 20eoffrey Millerson, The Qualifying Associations (London: Routledge and Kegan Paul, 1964), p. 22. ^Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), pp. 163-164. 4 Ibid. Phenix is emphatic that unless an occupation represents its members' lifetime work, it cannot be a true profession. University of Ghana http://ugspace.ug.edu.gh 22 levels. The point at which a set of activities becomes a full-time occupation is a primary step in the process of the professionalization of an occupational group.1 Ben-David and Collins state that one of the three factors upon which the emergence of the field of experimental psy­ chology hinged was the development of both philosophy and physiology into academic as opposed to amateur roles. This is one of the reasons that main thrusts in experimental psy­ chology occurred in Germany as opposed to Britain and France, where the parent disciplines were still based largely on the amateur pattern. In this sense, amateurism, rather than being a direct opposite of professionalism, could be thought of .as a precondition of, or even the first step in, professionalization. Criteria of a Profession Many scholars have sought to interpret "profession" not through definitions per se but through differentiating between the main characteristics of occupations generally thought of as "professions" as compared to characteristics of occupational groups in general. Two classical works on ^Harold L. Wilensky, "The Professionalization of Every­ one?" American Journal of Sociology, 70 (September, 1964), 143. ' 2 Joseph Ben-David and Randall Collins, "Social Factors in the Origins of a New Science: The Case of Psychology," American Sociological Review. 31 (August, 1966), 465. University of Ghana http://ugspace.ug.edu.gh 23 the criteria of a profession are those of Flexner and Carr- Saunders and Wilson. Flexner emphasizes six criteria: (1) the intellectual basis of professional techniques, (2) the learned nature of the sources and methods of profes­ sional knowledge, (3) the "practical" nature of professional endeavor, (4) the techniques must be "educationally com­ municable," (5) the characteristic of "self-organization," and (6) ’they are becoming increasingly altruistic in moti­ vation.’1 While refusing to attempt a definition of profession 2 per se, Carr-Saunders and Wilson maintain that "neverthe­ less, the term profession . . . clearly stands for something. That something is a complex of characteristics."3 Although they stress the cruciality of a "specialized intellectual technique," they underline that it "is the essence of pro­ fessionalism . . . because it gives rise to certain atti- 4tudes and activities." In addition to the intellectual 1Abraham Flexner, "Is Social Work a Profession?" School and Society, 1 (June 26, 1915), 903-904. His interpretation of the word "practical" is broad, and not limited to those objects "physical or tangible." 2 A. M. Carr-Saunders and P. Wilson, The Professions (London: Frank Cass and Company, 1933), pp. 4, 284. 3lbid., p. 284. ^Ibld., pp. 284-285, 289, 302-303, italics mine. The ’attitudes and activities" to which the authors refer in­ clude such characteristics as forming occupational associa­ tions, and being concerned with guaranteeing that members' conduct is competent and honorable. University of Ghana http://ugspace.ug.edu.gh 24 skill component, they cite four other earmarks of a profes­ sion, namely, the establishment of minimum fees or salary rates, and the existence of codes of ethics, professional associations, and minimum entry requirements.1 The Concept of a Professional Continuum Goode points out that many of the traits commonly asso­ ciated with the term "profession" are characteristic of any cohesive community, e.g., considerable agreement as to limits of behavior, development of roles, identification 2 with the group, and shared norms. This raises the very important question as to whether the essence of "profes­ sions" as distinct from other occupations lies primarily in matters of degree only, or whether there are also differences in the kinds of characteristics which set professions apart. In the article cited above, Goode asserts that professions differ from other communities in such aspects as methods of socialization and control and the choosing of clients;^ but it is unclear as to whether or not he considers these varia­ tions in form or in substance. M. Carr-Saunders and P. Wilson, The Professions (London: Frank Cass and Company, 1933) , pp. 284-287, 302. 2William J. Goode, "Community Within a Community: The Professions," American Sociological Review, 22 (Aoril. 1 cjS7^ . 194-200. ----------- 3Ibid.. p. 194. University of Ghana http://ugspace.ug.edu.gh 25 In a later article Goode subscribes to the idea of there being two "sociologically central" traits which characterize a profession: "(1) prolonged specialized training in a body of abstract knowledge, and (2) a collec­ tivity or service orientation."1 He sees these not as peculiar to professions but as "[each] forming a continuum along which a given occupation may move." In his view these primary characteristics are the determinants of other important traits such as autonomy, monopoly, prestige, and codes of ethics."* Where an occupation possesses a low degree of either of the central variables, it is not, in his opinion, a profession. In terms of the knowledge component Goode states that nursing is not and will not become a profession, and categorizes librarianship very 4 much in the same position. In sum, far from implying that the difference between professions and nonprofessions is "only" one of degree, it would seem that in Goode's view it is precisely the degrees of difference that matter. ^William J. Goode, "The Librarian: From Occupation to Profession?" Library Quarterly, 31 (October, 1961) , 307- 308. 2Ibld.; p. 307. 3Ibid.; pp. 307-308. 4Ibid., p. 307. University of Ghana http://ugspace.ug.edu.gh 26 Prior to Goode, Greenwood too subscribed to the idea of a continuum.1 Citing five criteria of a profession— " (1) systematic theory, (2) authority, (3) community sanc­ tion, (4) ethical codes, and (5) a culture"— Greenwood states that "strictly speaking, these attributes are not the exclusive monopoly of the professions; nonprofessional occupations also possess them, but to a lesser degree." In this perspective occupations are seen "as distributing them­ selves along a continuum" with professions such as law, medicine, and university teaching toward the one end and unskilled occupations, such as scrubwoman and manual 2 laborer, toward the other. At first glance the interpretations of these two authori­ ties would seem to be highly similar. Yet there are some subtle differences which would seem to be of theoretical import for the process if not the limits of professionaliza­ tion. While Greenwood's criteria are multidimensional, the continuum which h-e describes evokes the image of a single scale, ranging in values from zero to one; Goode's perspective As a matter of interest, we would suggest that the idea of a continuum applied to occupations with reference to certain characteristics is not new; although the above authors use a linear form, and A. M. Carr-Saunders and P. Wilson used a spherical one, the principle appears to b.e the same. See The Professions (London: Frank Cass and Company, 1933) pp. 284, 286. 2 Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 44-46. University of Ghana http://ugspace.ug.edu.gh 27 suggests a bi-dimensional continuum on two oontinua, uni­ directional in either case. Our first point is that in the latter instance, no matter how far an occupation advances on one criterion, it cannot be considered a "profession* if it does not possess a high degree of the other trait, whereas this does not seem to be so in the former instance. The sig­ nificance of this distinction may become more apparent when we discuss the integral nature of a profession. Secondly, both of the above authors treat the continua in a unidirectional fashion. We would question the validity and usefulness of conceiving the scales in these terms. Perhaps insight into the nature of professions might be ex­ panded by incorporating the principle of multiple, truly bi­ polar1 scales, ranging from -1 to +1 instead of restricting models to a lower bound of zero. To illustrate, we will use the example of professional theft. Using Carr-Saunder's and Wilson's criteria, Sutherland demonstrates that this occupational group displays to some degree all the characteristics associated with the concept "profession" except for ethics minimizing the pecuniary 2 motive. Do we, then, classify professional theft as a 1Although Greenwood talks in "polar" terms, his examples would seem to indicate a lower bound of zero; Richard H. Willis's classification of terms is helpful in this regard, see "Conformity, Independence, and Anti-conformity," Human Relations, 18 (November, 1965), 373. 2 Edwin H. Sutherland, The Professional Thief (Chicaao: The University of Chicago Press, 1937), p. 217. University of Ghana http://ugspace.ug.edu.gh 28 semiprofession except for this one aspect? Nonprofessional? Even the pecuniary motive aside, ^ is it meaningful to talk in terms of an anti-social profession? Clearly, our concern here is not with the particular dilemma of how to classify professional theft; it is with three conceptual traps into which the idea of a continuum may lead us. The first is related to the function of ideal types themselves. They are, as we have pointed out in the introduction to this chapter, deliberately exaggerated con­ structs; it is thus a fallacy to assume that the complete 2and utter attainment of such a criterion as autonomy is to reach an “ideal" state. Secondly, there is a tendency to in5>ly that, at worst, an occupational group is characterized by an absence of a particular characteristic rather than damned by possession of its opposite.3 And, thirdly, there is a tendency to treat variables as heing mutually exclusive rather than as forming an interdependent matrix. As Edwin H. Sutherland remarks (The Professional Thief [Chicago: The University of Chicago Press, 1937], p. 217), this distinction may not be peculiar to thieves; the succeed­ ing paragraphs will act to explain why we are not confining ourselves to Sutherland's exception. 2 Or, e.g., the extreme form of conformity of occupa­ tional members to existing practices could be interpreted as being antithetical to the stimulus and improvement which can come from departures from established modes. 3That constructing truly bipolar scales would present serious methodological problems is obvious; but it would seem contradictory to restrict the making of judgments about such a "value-laden" institution to lower limits of zero. University of Ghana http://ugspace.ug.edu.gh 29 The concept of a continuum raises the question of gradients within each of the contributing characteristics. It therefore seems important to examine variations within some of the more frequently cited criteria before attempting a summary of the main characteristics which typify a pro­ fession. / Variations Within Selected Criteria A gross comparison of several writings on the criteria of a profession (see Table I) indicates that, in one form or another, the traits knowledge and skill, autonomy, the "service ideal," and codes of ethics are repeatedly cited. Book-length treatment would be required to do full justice to the occupational significance of any one of these traits.1 Our objective for the moment is to highlight some of the dimensions of the above criteria for the purpose of pro­ viding a context for later use of these terms when the focus is on professionalization, bureaucratization, and deprofes­ sionalization. E.g., Corrine Lathrop Gilb has devoted an entire book to the subject of the government of professional associations: Hidden Hierarchies (New York: Harper and Row, 1966); Benson Y. Landis's Professional Codes: A Sociological Analysis to De­ termine Applications to the Educational Profession (New York: Bureau of Publications, Teachers College, Columbia Univer­ sity, 1927) is another such example; Geoffrey Millerson's focus is even more discrete as it deals primarily with the control of standards through professional association: The Qualifying Associations (London: Routledge and Keeqan PauTT 1964). University of Ghana http://ugspace.ug.edu.gh 30 TABLE I GROSS ANALYSIS OF ELEMENTS IN SELECTED LITERATURE ON THE CRITERIA OF A PROFESSION o O' ■O iia) H -H & (l)b to Se rv ic e w Id ea l e0c0 X) D < (3) ~ Co de of w Et hi cs 1*1t flj a 0•H ■P•H •tJ < (5) Flexner (1915) X X X 2° Carr-Saunders and 2d Wilson (19 33) Lieberman (1956) X X X X e Greenwood (1957) X X X if Phenix (1958) X X X 19 Wilensky and x h x iLebeaux (1958) Goode (1960) X X . . . 3 Barber (1963) X X X lk Parsons (1968) X 1 I 1 Abraham Flexner, "Is Social Work a Profession?" School and Society, 1 (June 26, 1915), 903-904; A. M. Carr-Saunders and P. Wilson, The Professions (London: Frank Cass Company, 1933), pp. 284-286, 302; Myron Lieberman, Education as a Profession (Englewood Cliffs, N.J.: Prentice-Hali, 1956), pp. 2-6; Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 44-45; Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958) , pp. 154-173; Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Foundation, 1958), pp. 284-285; William J. Goode, "Encroachment, Charlatanism, and the Emerging Profession: Psychology, Medi­ cine, and Sociology," American Sociological Review, 25 (December, 1960), 903; Bernard 3arber, "Some Problems in the Sociology of the Professions," Daedalus, 92 (Fall, 1963), 674; Talcott Parsons, "Professions," IESS, Vol. 12 (1968), 53,6. ^Column headings are broad in nature, thus Col. 1 does not differentiate as to what kinds of knowledge, theoretical University of Ghana http://ugspace.ug.edu.gh 31 TABLE I (continued) or otherwise; Col. 2 includes references to subordination of self-interest but does not necessarily connote altruism per se; professional associations and/or autonomy are in­ cluded under Col. 3; where additional criteria have not been subsumed under one of these four headings, special note of same is made in Col. 5. cFlexner, op. cit., emphasizes the "practical nature of the professions but extends this to teaching and research; he also stipulates that techniques must be "educationally communicable," dCarr-Saunders and Wilson, op. cit., cite the establish­ ment of minimum fees and entry requirements. eLieberman, op-, cit., cites four other criteria all of which-would seem to fit in under the headings indicated here, e.g., he separates the characteristics of individual and group autonomy. ^Greenwood, op. cit., adds the possession of a "culture." ^Phenix, op. cit. , emphasizes that a profession is an occupation which is one's "life work.” Niilensky and Lebeaux, op. cit., cite "adherence to pro­ fessional norms" as a general characteristic, the service ideal being one of them. ^Ibid. The authors specify that technical competence must be "exclusive." r ^Goode, o^ >. cit., maintains that all other character­ istics are derived from the two central criteria cited. v Barber, op. cit., stipulates that the system of rewards in professional occupations involves both honorary and mone­ tary symbols, and that these are "primarily. . . . symbols of work achievement . . . , not means to some end of indi­ vidual or self interest." ^Not only must professions possess a high degree of knowledge and skill but they must also have the institutional means for ensuring that these are put to socially responsible uses. Secondly, the knowledge and skill must be part of a "generalized cultural tradition," not simply complex, special competence. Parsons, op. cit. University of Ghana http://ugspace.ug.edu.gh 32 As an enumeration of variations in these four criteria, completely apart from reference to their significance in the process of professionalization, is likely to be shallow if not meaningless, some of the more dynamic aspects of these terms will be part of the discussion here. Merton and others have noted that the characteristics of a profession are in large part a complex of paradoxes.1 2 While this may be categorically inconvenient, it may well be a valuable clue to the possibility that the essence 'of the concept "profession" lies rooted in a complex set of ordinates and coordinates, not simply in unidirectional criteria. The Knowledge-Skill Component3 While there may be general agreement that this cri­ terion is an essential-* one, emphases on the nature of its See Everett C. Hughes, "Professions," Daedalus, 92 (Fall, 1963), 660; Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Foundation, 1958), pp. 298-308; and Robert K. Merton, "Some Preliminaries to a Sociology of Medicine," in Robert K. Merton et al., eds.. The Student Physician (Cambridge, Mass.: Harvard University Press, 1957), pp. 72-76. 2 I.e., it would be more difficult to construct ideal types where characteristics to be exaggerated are para­ doxical in nature. 3For purposes of brevity, we will hereafter refer to this as the "K-S" component. ^Geoffrey Millerson's analysis indicates that it is a characteristic not always cited. See The Qualifying Asso­ ciations (London: Routledge and Kegan Paul, 1964), Table I.I, p. 5. University of Ghana http://ugspace.ug.edu.gh 33 subcomponents vary, as do interpretations of its signifi­ cance in relation to the process of professionalization. The significance of the K-S component. A miniature symposium on the significance of this criterion might yield a variety of remarks such as these: Phenix: "A professional, first of all, is one who possesses some special competence. He knows things which most other people do not know, or he has skills which the average person does not have." And this gives him "a sense of superiority, of pos­ sessing insights reserved for the select few."* Marshall: Special competence is the legitimating basis for the professional's authority in society; it is the source of his freedom from ascriptive restraints.2 Carr Saunders and Wilson: The K-S factor is essen­ tial because it is the chief source of other attributes, such as self-organization and a deep sense of personal responsibility for contributing to the public good. Millerson: Were it not for the K-S component, any­ one could infiltrate the professions; it is the basis for the "exclusiveness" necessary to guarantee competence.4 Fichte: The distinction between the professional and the ordinary man is that through the K-S ^Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958) , p. 155. Italics mine. 2 T. H. Marshall, "Professionalism and Social Policy," in Sigmund Nosow and William H. Form, eds., Man, Work, and Society (New York: Basic Books, 1962), p. 228; see also Christopher Jencks and David Riesman, The Academic Revolution (Garden City, N.Y.: Doubleday and Company, 1968), p. 203. 3A. M. Carr-Saunders and P. Wilson, The Professions (London: Prank Cass and Company, 1933), pp. 286, 302-303. 4 Geoffrey Millerson, The Qualifying Associations (London: Routleage and Kegan Paul, 1964) , p. 11. University of Ghana http://ugspace.ug.edu.gh 34 component, the former is in a position to reinvest in society that which it has given to him; other­ wise there would be no accumulation of progress.1 Parsons: The character of the K-S component deter­ mines the limits of trust that clients will be will- ing to invest in the professional. It is nonsense to talk about professionals having different under­ lying motives than nonprofessionals— it's the K-S component that determines whether or not the so- called "service ideal" will be realized.^ Ben-David and Collins: The K-S component is nothing in itself if there is not a role developed on the basis of it. But we must admit there would be no professional role without itl3 Such are some of the psychological, socio-political, ethical, philosophical, structural, and functional reasons why the K-S component is considered so essential. Overly simplified? Yes. Comprehensive? No. But perhaps adequate to illustrate the wide range of contexts within which this criterion is considered central.^ And perhaps adequate to ^Johann G. Fichte, The Vocation of the Scholar, trans. William Smith (London: John Chapman, 1847), pp. 46-47, 54. 2Talcott Parsons, Essays in Sociological Theory (rev. ed.; Glencoe, 111 : The Free Press, 1954), pp. 34-49. 3 Joseph Ben-David and Randall Collins, "Social Factors in the Origins of a New Science: The Case of Psychology," American Sociological Review, 31 (August, 1966) , 451-465. 4 -William J. Goode has asserted that amongst criteria appearing in the several definitions of a profession there are "no contradictions, and the only differences are those of omission." While in one sense the terms appear high.ly similar, their contexts vary to the degree that we question the usefulness if not the validity of his observation. "Encroachment, Charlatanism, and the Emerging Profession: Psychology, Medicine, and Sociology," American Sociological Review, 25 (December, 1960), 903. University of Ghana http://ugspace.ug.edu.gh 35 suggest some underlying paradoxes, e.g., the source of pro­ fessional autonomy or freedom from societal control lies in the responsibility which occupations assume when they under­ take to offer unique kinds of services to society. Optimum K-S base. One of the central subcharacter- istics of the K-S component is its "specialism"; yet at the same time it must be knowledge-in-perspective.* Wilensky em­ phasizes that in order for an occupation to secure a reason­ able monopoly of skill, the knowledge component must neither 2be too narrow nor, on the other hand, too vague and general. "Functional specificity" is an important requisite of the development of client trust, emphasizes Parsons,3 yet the line is a fine one, e.g., today's heart-lung machine technicians seem hampered by too narrow a base of unique knowledge. On the other hand, Carr Saunders and Wilson say that the coming of business into professional status "is likely to be slow be- 4 cause the technique is generalized rather than specialized.” Morris L. Cogan, "Defining a Profession," Harvard Educa­ tional Review, 23 (January, 1953), 46; Robert K. Merton, "Some Preliminaries to a Sociology of Medical Education," in Robert K. Merton et al., eds., The Student Physician (Cambridge, Mass.: Harvard University Press, 1957), p. 73, says, e.g., "The physician must have the kind of detailed knowledge which often requires specialized education. But he should also be a well-rounded and broadly-educated man.” o Harold L. Wilensky, "The Professionalization of Every­ one?" American Journal of Sociology, 70 (September, 1964) , 149. 3Talcott Parsons, The Social System (New York: The Free Press, 1951), p. 456. 4A. M. Carr Saunders and P. Wilson, The Professions (London: Frank Cass and Company, 1933), p. 4 9 1. University of Ghana http://ugspace.ug.edu.gh 36 The question also arises as to how far Intraprofessional variation can safely depart from "the 'hard core' [of knowl­ edge and skills] which provides each profession with a dis­ tinctive focus."1 "Political science in its earliest form," says Boulding, "is the knowledge of how to take the food surplus away from the food producer without giving him very 2 much in return." Historically, the legal profession has focused on social order, medicine on illness, and engineer­ ing on physical processes,3 Rudolph says that such divisions 4 symbolize "the disunity of knowledge. . . . " The story of occupations which have maintained not necessarily the same focus but successful ones is the story of professionaliza­ tion, as distinct from that of deprofessionalization. "Pure" versus "applied" knowledge. Part of what separates the physicist from the mechanic, the electrical engineer from the television repairman, and the social psy­ chologist from the salesman is theoretical knowledge. Greenwood states that "systematic theory [is] a feature ^Harvey L. Smith, "Contingencies of Professional Differen­ tiation," in Sigmund Nosow and William H. Form, eds., Man, Work, and Society (New York: Basic Books, 1962), p. 224, points out that differentiation has occurred in medicine to the extent that there are "doctors' doctors," i.e., doctors without patients. 2 Kenneth E. Boulding, "Where Are We Going If Anywhere?" Human Organization, 21 (Summer, 1962), 162. 3Talcott Parsons, "Professions," IESS 196 8, Vol. 12. p. 537. 4 Frederick Rudolph, The American Colleqe and University (New York: Vintage Books, 1962), p. 399. His remarks are spe­ cifically aimed at departmentalization within universities. University of Ghana http://ugspace.ug.edu.gh 37 virtually absent in the training of the nonprofessional. Far from being an occupational device designed to create a mystique, it is a functionally-important cornerstone of rational practice.3 Theoretical insight permits "a rational understanding of the how and why of one's special ways of functioning."^ Without such a base, the choice of one’s actions is likely to be haphazard and their outcomes unpre­ dictable;^ further, lacking such a base, the search for additional knowledge or, indeed, the search for profes­ sional identity, is likely to be tangential, spasmodic, and unfruitful in the absence of theory.6 Ernest Greenwood, “Attributes of a Profession," Social Forces, 2 (July, 1957), 44-46. In fact he makes the generalization that "as an occupation moves toward profes­ sional status, apprenticeship training yields to formalized education because the function of theory as a groundwork for professional practice acquires increased importance.” 2 Although, granted, it does appear to serve a prestige function. See Geoffrey Millerson, The Qualifying Associa­ tions (London: Routledge and Kegan Paul, 1964), p. 11. ^Greenwood, op. cit., p. 11. 4 Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), p. 158. ^Morris L. Cogan, "Toward a Definition of Profession," Harvard Educational Review, 23 (January, 1953) , 47. ®This is the underlying point in Gordon Hearn's Theory Building in Social Work (Toronto: University of Toronto Press, 195 8) and Rose P. McKay's "The Process of Theory De­ velopment in Nursing" (unpublished doctoral dissertation; New York: Teachers College, Columbia University, 1965); see also Ray Hyman, The Nature of Psychological Inquiry (Engle­ wood Cliffs, N.J.: Prentice Hall, 19F4), p. 99, where he de­ velops B. F. Skinner's point that the value of theories' holding true for all time is less important than that they generate research which leads to new avenues of understanding. University of Ghana http://ugspace.ug.edu.gh 38 Neither only pure theoretical knowledge divorced from social applications nor only applied forms lacking theoreti­ cal underpinnings seems to fill the professional knowledge requirement. A century ago neither pure scientists nor applied engineers could be regarded as truly professional­ ized. Only when those occupations representing the pure sciences became aware of the "social component" of their work did they start to become "professionalized";* and only when their applications of knowledge became in large part intellectualized did engineers approach the professional 2model. Kornhauser interprets this as scientists becoming "professionalized 'from above’ and engineering 'from below.’"^ Perkins sums such dual convergence up in the say­ ing "'He who knows the theory but not the practice does not A know the whole theory.'" All professional knowledge is "applied," Parsons main­ tains. The application of pure knowledge in the areas, of teaching and research, i.e., "the profession of learning itself," is one mode; the application of knowledge to ^John J. Beer and W. David Lewis, "Aspects of the Pro­ fessionalization of Science," Daedalus, 92 (Fall, 1963), 764. 2 William Kornhauser with the assistance of Warren 0. Hagstrom, Scientists in Industry (Berkeley: University of California Press, 1963), p. 84. 3Ibid. . 4James A. Perkins, "The University and the Arts," T.C. Record, 66 (May, 1965), 676. University of Ghana http://ugspace.ug.edu.gh 39 so-called practical affairs is another. Parsons terms the former "cultural" and the latter "social."1 The essence of this distinction is reflected in Rodgers' clarification of academic versus clinical applications of knowledge in the discipline of psychology. The function of the former is, he says, "to ask prototypical questions and to seek general!zable answers the function of the latter is "to provide usable answers to important questions about par­ ticular rather than general events. The answers need not be prototypically correct if they are the most usable or satisfactory available, from a utilitarian point of view." To view the one as impractical and the other as "non- research-based" [or either, we might interject, as "nonpro­ fessional"] is to miss the point; the specific objectives of 2each are qualitatively, not quantitatively, different. ^Talcott Parsons, "Professions," IESS 1968, Vol. 12, p. 537. 2 David A. Rodgers, "In Favor of Separation of Academic and Professional Training," American Psychologist, 19 (August, 1964), 675. Italics the author's. As the title of his article indicates, Rodgers makes a semantic distinc­ tion between academics and applied professionals. As Parsons’ and, e.g., Jencks' and Riesman’s recent works sug­ gest, it is becoming commonplace to subsume both groups under the rubric "Professions." Christopher Jencks and David Riesman, The Academic Revolution (Garden City, N.Y.: Doubleday and Company, 1968), e.g., "lidademic professionals," p. 216; Robert K. Merton, "Some Preliminaries to a Sociology of Medi­ cine," in Robert K. Merton et al., eds.. The Student Physician (Cambridge, Mass.: Harvard University Press, 1957), p. 73! Kenneth Underwood, "On the Pinnacle of Power— The Business Executive," in Peter Berger, ed.. The Human Shape of Work (New York: The Macmillan Company, 1964), p, 180; and Lee Cronbach, "The Role of the University in Improving Education," Phi Delta Kappan, 42 (June, 1966), 540. University of Ghana http://ugspace.ug.edu.gh 40 "Technical" versus “professional" skills. While mental pictures of the dentist, surgeon, or concert pianist reflect high degrees of manual dexterity, many "professional" skills involve less physical dexterity than do nonprofessional ones. Lambertsen points out that it is not skill per se which dif­ ferentiates professional from technical tasks but the pur- 2poses of the skills which distinguish the two groups. Applying her criteria in the fields of, e.g., "pure" physics and legal practice, one can see that there are routine de­ finable tasks involved in both "cultural" and "social" pro­ fessions, e.g., in certain technical aspects of the prepara­ tion of a paper for publication and in the execution of cer­ tain documents of law.3 Professional knowledge: science, scientific effort, or scientism? The professional ideal type cannot be separated from the characteristic of skill in applying knowledge, whether the application is in the "cultural" or "social" spheres; in either case it is the centrality of "cognitive" skills which distinguishes professional from nonprofessional Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 45-46; those given are diamond-cutter and tool-and-die maker. 2 Eleanor C. Lambertsen, "The Emerging Health Occupa­ tions," Nursing Forum, 1 (Winter, 1968), 93; Shirley M. Stinson, "The Future Begins Now for Nursing in the Year 2000," Hospital Administration in Canada, 10 (September, 1968) . 93- 5TT 3"Call for Restructuring [Legal Education and Legal Tasks]," Time [Canada], March 29, 1968, pp. 40-41. University of Ghana http://ugspace.ug.edu.gh 41 occupations.1 Yet even in the traditional scientific fields, Whitehead questions how far cognition can progress apart from the use of bodily senses, maintaining that there is a "reciprocal influence" between what he terms •brain activity" and the use of the eyes, ears, voice, and 2 hands. Definitions of profession do not exclude occupations which are not based on the rational-empirical mode of thought;3 but there is a tendency to bestow prestige on those which are.^ McCully warns against "scientism," the view that "science yields a sure external guide to the reso­ lution of [all professional problems] ... . . "5 Goode points out that for an aspiring profession to succeed, it is necessary that its relevant publics value the kinds of knowledge it possesses.® And in that science is ^Talcott Parsons, "Professions," IESS 1968, Vol. 12, p. 536. ^Alfred North Whitehead, The Aims of Education (New York: The Macmillan Company, 1929), p. 58. 3E.g., Parsons, op. cit., pp. 537-538, discusses pro­ fessionalization in religion and the arts. 4C. Harold McCully, "Conceptions of Man and the Helping Professions," Personnel and Guidance Journal, 44 (May, 1966) , 912. 5Ibid. 6William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. University of Ghana http://ugspace.ug.edu.gh 42 "the chief distinguishing feature of modern civilization,"1 it may well be that "scientific" kinds of professional knowledge are the most highly valued, if not highly rewarded 2 of all. But, in sum, whether professional knowledge must meet the sub-criterion of being scientific would seem to depend partly on our use of the word. In Flexner's words, "If the term 'science' is to be strictly confined to knowl­ edge capable of quantitative expression and utilization, science would begin and end with mathematical physics— itself perhaps not the final character supposed in the days before Einstein. . . If, on the other hand, by science we mean "the severest effort capable of being made in the direction of purifying, extending, and organizing knowledge," then "the [professional] effort is scientific."4 This is far from saying that professions are by definition wedded to the use of one particular method of discovering and verifying ^Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), p. 324. 2 Thorstein Veblen maintains that "with the growth of industrial organization and efficiency there must, by selection and by adaptation, supervene a greater resort to the mechanical or dispassionate method of apprehending facts." As these modes and values become more and more part of the "scheme of life" of a society, objective knowl­ edge is more highly valued. See The Place of Science in Modern Civilization (New York: The Viking Press, 1919), p. 105. ^Abraham Flexner, Medical Education (New York: The Macmillan Company, 1925), p. 3. 4Ibld. University of Ghana http://ugspace.ug.edu.gh 43 knowledge.1 Yet the fact remains that the systematic exten­ sion of knowledge depends in large part on principles of scientific enquiry. Law, for example, is now directing more attention to the study of the effects and shortcomings of existing laws and legal procedures, not merely confining its 2 attention to precedent. The methods which underlie such an expanded focus necessarily involve principles akin to the so-called experimental method. Aura of mystery. A frequently-mentioned subcharacter­ istic of the K-S component is that it must inhere a mystique of some kind. The word mistery, Caplow explains, "originally referred to membership in a craft guild, and the secret understandings which such membership implied.1'3 Goode says that this control over occupational knowledge is a source of 4 mystery.to the ordinary man. See Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), pp. 323-330. The imposi­ tion of the methods of, e.g., physics into all facets of the social sciences may, indeed, be considered unscientific; see Karl Mannheim, Ideology and Utopia, trans. Louis Wirth and Edward Shils (New York: Harcourt, Brace, and World, n.d.), pp. 51-52; W. H. Walsh, for example, points out that the his­ torical method is distinctively suited to the disciplinary object, The Philosophy of History (New York:. Harper and Row, 1960), p. 10. 2 E.g., see Adam Podgorecki, "Law and Social Engineering," Human Organization, 31 (Fall, 1962), 181, and Martin P. Meyer's reference to the experiments of the Vera Institute of Justice, The Lawyers (New York: Dell Publishing Company, 1966), pp. 202-205. 3 Theodore Caplow, The Sociology of Work (Minneapolis: University of Minnesota Press, 1954), p. 23. 4William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. University of Ghana http://ugspace.ug.edu.gh 44 In part, the mystique is an outcome of the profes­ sional's need to obtain the layman's confidence and, thus, in medicine, for example, "(the doctor] surrounds himself with mystery and miracle."1 The rituals-of the nurse and pharmacist are part of this aura of mystery, and the pomp and circumstance of the court may be less procedural neces- 2 sity than a need to dazzle the client, says Hughes. But these explanations do not include another reason why an aura of mystery is such a pervasive subcharacteristic of profes­ sional knowledge; Wilensky adds that it is because profes­ sional knowledge is not communicable in the traditional sense, that it "is by its nature anti-traditional, never •established.'" Building on Polanyi's observation that "'there are things that we know but cannot tell,'" Wilensky maintains that to some extent professional knowl­ edge is "tacit" knowing.3 A. M. Carr-Saunders and P. Wilson, The Professions (London: Frank Cass Company, 1933), p. 104; James Howard Keans says the use of so many technological diagnostic devices has resulted in the doctor's losing "some of his apparent omniscience, prestige and mystique." See "Homo Medicus Americanus," Daedalus, 92 (Fall, 1963), 712. 2 Everett C. Hughes, "Mistakes at Work," Canadian Journal of Economics and Political Science, 17 (Auqust, 1951), 324-325. 3 • .Harold L. Wilensky, "The Professionalization of Everyone?" American Journal of Sociology, 70 -(September, 1964), 149. Wilensky cites "recognizing the mood of a face" as an example of this last point. University of Ghana http://ugspace.ug.edu.gh 45 Yet, again, while the characteristic of the mysterious is a positive, functional aspect of the knowledge criterion, an occupation with a totally mysterious body of knowledge is not consistent with the concept "profession." For one thing, the community is unlikely to sanction that which it cannot comprehend; secondly, such knowledge is too evasive from the standpoint of educating practitioners and thereby raises problems as to how to perpetuate that occupation. The professional group must develop the K-S component. It is not enough that an occupational group utilizes complex knowledge, "it must also help to create it.”1 Occupations which do not do so are unlikely to be regarded as being highly professional. Schaefer emphasizes that unless teach­ ing encompasses the production as well as the transmission ? of knowledge, it cannot truly be thought of as a profession. The above proviso inheres: (1) that there is a unique, codified body of knowledge which practitioners can develop, (2) that practitioners possess the skills necessary to such enquiry, and (3) that the structure of the work situation is conducive to enquiry.^ ^William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. 2 Robert J. Schaefer, The School as a Center of Inquiry (New York: Harper and Row, 1967)_, pp. 1, 43.' ^Ibid. This is the central theme of Schaefer's book. With regard to the first point, Marc Belth maintains that education is a discipline in its own right, see Education as a Discipline (Boston: Allyn and Bacon, 1965), especially pp. 6-8. University of Ghana http://ugspace.ug.edu.gh 46 Autonomy Although the terms used in reference to this character­ istic vary considerably (e.g., "autonomy,' "professional authority," "self-control”),1 they all seem to inhere not only kinds of occupational freedom from lay control but its attendant responsibilities. Professional authority is regarded both as a condition which permits the responsible 2 application of knowledge and skill and as a derivative of such competence.^ Frequently associated with the criterion Of autonomy are such factors as solo practice, monopolies, the "right" to decide on substantive matters, occupational associations, and control by colleagues. In that such factors are not always consistent with the essence of the concept "profes­ sion," it would seem worthwhile to examine how they are or are not functional to the descriptive and normative ideal Myron Lieberman, Education as a Profession (Englewood Cliffs, N.J.: Prentice-Hall, 1956), p. 3; Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 44-45; and Bernard Barber, "Some Problems in the Sociology of the Professions," Daedalus, 92 (Fall, 1963), 672. Lieberman, op. cit., p. 3. ^William J. Goode, "Encroachment, Charlatanism, and the Emerging Profession: Psychology, Medicine, and Sociology," Sociological Review, 25 (December, 1960), 903; Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Foundation, 1958), p. 285, consider monopolies of skill an outgrowth of tech­ nical competence, yet they seem also to consider it a con­ ditional criterion of the concept "profession" in that they use the term "exclusive technical competence1 as their first requisite of the characteristics of a profession. University of Ghana http://ugspace.ug.edu.gh 47 type professions. Solo practice. While the image of the professional may be that of a self-employed practitioner, the facts would seem otherwise. Even in 1870, half the professionals in the United States were employed on a salaried basis.1 Self-employment is more common among the "established" 2 professions; yet in that solo practice inheres some major threats to professionalization,3 as well as potential aids, Hfilllam Kornhauser, Scientists in Industry (Berkeley: University of California Press, 1963), p. 4. Going even further back, A. M. Carr-Saunders and P. Wilson point out that in previous centuries most professionals were not self- employed, but were members of orders of one type or another, The Professions (London: Frank Cass Company, 1933), pp. 289- 294. 2 Albert J. Reiss, Jr.’s study showed 43 per cent of established professionals as self-employed versus 29 per cent of the semiprofessionals, 22 per cent of the new pro­ fessions, 18 per cent of the would-be professions, and 17 per cent of marginal professions. "Occupational Mobility of Professional Workers," in Sigmund Nosqw and William H. Form, eds.y Man, Work, and Society (New York: Basic Books, 1962), p. 313. Martin P. Meyer, The Lawyers (New York: Dell Publishing Company, 1966), p. 28, says that by 1970 over one- half of United States lawyers will be in other than solo practice. In White Collar (New York: Oxford University Press, 1951), C. Wright Mills states that independent pro­ fessionals have continued to comprise about 1 per cent of the labor force over the last two generations, while salaried professionals have increased from 1 to 6 per cent in that same period (p. 113) . ^Joseph Ben-David, "The Professional Role of the Physi­ cian in Bureaucratized Medicine: A Study in Role Conflict," Human Relations, 11 (August, 1958), 256; Harold J. Laski, “The Decline of the Professions," Harper's Monthly Magazine, 171 (November, 1935), 679-680, maintains that the"self- employed practitioner is too vulnerable, that the solo prac­ titioner "lacks the one thing . . .which is fundamental to the preservation of the scientific temper— security." University of Ghana http://ugspace.ug.edu.gh 48 it would seem tenuous to regard solo practice as being entirely consistent with the concept "profession." For example, the salaried professional may be more likely to be free of substantively-unrelated constraints imposed by indi­ vidual clients or the local customs of the community; he may be more free to upgrade his experience by changing locale from time to time instead of being bound to an established community practice.1 The solo professional may end up being the "choreboy of his clients . . . [having] little or no 2 choice of what kinds of work he will do," and dependence upon expensive and complex technological resources sets con­ siderable limits to the range and level of functions pos­ sible in, if not limiting the prestige derived from, solo practice.^ In short, while the image of self-employed.practice may be part of the concept ’profession,” the realities would indicate that it is not in itself a reliable, valid index 4 of professional autonomy; on the other hand, if we Everett C. Hughes, "Professions," Daedalus, 92 (Fall, 1963), 665. 2Xbld., pp. 665-666. ^James Howard Means, "Homo Medicus Americanus," Daedalus, 92 (Fall, 1963), 712. 4 To paraphrase T. H. Marshall, "[solo practice in] the major professions was a product of circumstance. It was not the cornerstone of the building." "Professionalism and Social Policy," in Sigmund Nosow and William H. Form, eds., Man, Work, and Society (New York: Basic Books, 1962), p. 232. University of Ghana http://ugspace.ug.edu.gh 49 subscribe to the philosophy that, self-employed or salaried, "[the professional] can rely upon no one for unquestioned authority • . . the ideal type professional, whatever his work environment is, is a "solo" practitioner. Monopoly. Ideal type professional autonomy, both for the individual and the occupational group, is "functionally specific"; it permeates as far but no farther than the 2 parameters of technical and moral competence. To the extent that the technical competence of an occupational group is exclusive, it "represents a monopoly of skill, which is linked to standards of training and which justifies a monopoly of activity in an area."3 In this respect, Hughes distinguishes between "license," the legal right to perform certain tasks or functions, and "a legal, moral and intellectual mandate [through which professions], presume to tell society what is good and right for the individual and society at large in Donald P. Cottrell, "A Philosophy of Education," American Journal of Nursing, 40 (August, 1940), 915. Italics mine. 2 Talcott Parsons, Essays in Sociological Theory (rev. ed.; Glencoe, 111.: The Free Press, 1954), p. 38; Talcott Parsons, The Social System (New York: The Free Press, 1951), pp. 136, 456, 465; Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 44-48. 3Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Founda­ tion, 1958), p. 284. ~ University of Ghana http://ugspace.ug.edu.gh 50 some aspect of life."1 It is mandates, not licensure, which distinguish the true professions.2 But such extensive penetration of autonomy and influence would seem to be highly conditional, for community endorsement of monopolies of technical skill hinges in large part on a concomitant orientation of the occupational group to the ideal of com­ munity service. Any violation of this trust, be it tacit or formal violations, is likely to result in the community's withdrawing the sanctions which perpetuate it.^ Everett C. Hughes, Men and Their Work (Glencoe, 111.* The Free Press, 1958), p. 79, mandates being either "implicitly or explicitly granted [by society] as legiti­ mate." William Kornhauser with the assistance of Warren 0. Hagstrom, Scientists in Industry (Berkeley: University of California Press, 1963), p. 159, says, e.g., the physician’s authority over his clients "is implicitly recognized when we speak of 'doctor's orders..'" Gordon Hearn, Theory Building in Social Work (Toronto: University of Toronto Pr^ss, 1958), p. 1, goes so far as to say that "Practice is professional to the extent it is sanctioned by society." 2 Hughes, op. cit., p. 79; Corrine Lathrop Gilb dif­ ferentiates between various levels of professional organi­ zational autonomy, stating that the lowest level is that of occupational certification, the highest being complete, mandatory licensure (see Hidden Hierarchies [New York: Harper and Row, 1966] , p. 62); it is precarious to assume that licensure is an index of professional autonomy, e.g., barbers are licensed, teachers may be licensed, yet in most states they do not comprise the majority membership of the boards which issue teaching licenses while barbers do (see Myron Lieberman, Education as a Profession [Englewood Cliffs, N.J.; Prentice-Hall, 1956], p. 95). ^Samuel W. Bloom, The Doctor and His Patient (New York: Russell Sage Foundation, 1963), p. 92. University of Ghana http://ugspace.ug.edu.gh 51 Autonomy as the "right" to decide. Where an occupation has never had the prerogative of being "final arbiter" on questions involving substantive knowledge (or where this prerogative has been removed), Goode says that it is not a true profession.1 The extent to which the occupational group actually uses this prerogative is not the index of its autonomy, "it is the right to make the judgment . . which 2distinguishes the professions from the nonprofessions. Self-organization. Ianni points out that the formation of shared interest groups is a characteristic of all so­ cieties, civilized and primitive. Further, interest groups based on shared intellectual pursuits are not peculiar to the professions.3 Millerson argues that what ultimately distinguishes professional associations from other types of occupational organization is the scope and depth of authority 4they have over technical and ethical occupational standards. The shared knowledge base is the source of cohesion in ^William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961) , 308. 2 Everett C. Hughes, Men and Their Work (Glencoe, 111.: The Free Press, 1958), p. 94, italics his; see also Theodore Caplow, The Sociology of Work (Minneapolis: University of Minnesota Press, 1954), p. 103. ^Francis A. J. Ianni, Culture, Systems, and Behavior (Chicago: Science Research Associates, 1967), pp. 45, 73. 4This is the whole theme underlying Geoffrey Millerson's The Qualifying Associations (London: Routledge and Keegan Paul, 1964). University of Ghana http://ugspace.ug.edu.gh 52 professional occupational groups,1 and ultimately the . legitimating basis for control. As Gilb underlines, this is a two-way process: "Cohesion is necessary to attain 2 3control; control is necessary to attain cohesion." Roscoe Pound, an inveterate individualist himself, maintains that it is through collective, not individual, 4 action that high professional standards can be ensured. Describing four possible types of professional organizations, the Prestige Association, the Study Association, the Occu­ pational Association, and the Qualifying Association, Millerson says that it is the latter type which plays the key role in "convert[ing] occupations into professions."^ ^Bernard Barber, "Some Problems in the Sociology of the Professions," Daedalus, 92 (Fall, 1963), 672-673. 2 Corrine Lathrop Gilb, Hidden Hierarchies (New York: Harper and Row, 1966), p. '162, e.g., legislators are likely to be ill-disposed to give attention to the petitions of loosely-knit, segmented occupational groups. ^Ibid., p. 54. 4 Roscoe Pound, The Lawyer from Antiquity to Modern Times, with Particular Reference to the Development of Bar Associations in the United States (St. Paul, Minn.: West Publishing Company, 1953) , pp. Icf-11. ^Yet he also admits (p. 156) that it is effective only to the extent that members "rely on the association as a means of initial and continuing qualification." Geoffrey Millerson, The Qualifying Associations (London: Routledge and Keegan Paul, 1964), p. 25; see also pp. 33-41 to see that Millerson's use of the term "Qualifying Associations" is broad, covering control of, e'.g. , training standards, admission to practice, and standards of on-going profes­ sional conduct and development. The Prestige and*Study Asso­ ciations are self-explanatory; Occupational Associations' foci are limited to narrow coordinative functions and/or concerns with members’ remunerative or working conditions. University of Ghana http://ugspace.ug.edu.gh S3 The fundamental point which Millerson makes is that the qualifying association is the central formal means for ensuring that occupational standards are developed and main­ tained. It is too simplistic to interpret this to mean that professional organizations are "causal" criteria of a profession. Taylor and Hall, for example, underline the importance of informal, sometimes highly subtle mechanisms for shaping and controlling the behavior of occupational members, e.g., through tacit norms operating in physician referral systems.1 Yet it is equally simplistic to assume that professional organizations are no more than the sum of their members' values, so to speak. To think of profes­ sional associations in so limited a sense is to beg the question as to how homogeneous occupational norms would be and how long they would continue to be transmitted and/or developed in the absence of such organization, particularly in a rapidly-changing, highly mobile, geographically- dispersed society. Collegial authority and professional association structure. It is tempting to say that while the existence Oswald Hall, "The Stages of a Medical Career," American Journal of Sociology, 53 (March, 1948), 327-336; Lee Taylor, Occupational Sociology (New York: Oxford Uni­ versity PreSs, 1968), p. 131; see also.Robert K. Merton's "Priorities in Scientific Discovery: A Chapter in the Sociology of Science," American Sociological Review, 22 (December, 1957), 659, regarding the importance of honor­ ific mechanisms in perpetuating the norms in the scien­ tific community. University of Ghana http://ugspace.ug.edu.gh 54 of an occupational organization per se may not distinguish professions from nonprofessions, at least the structural characteristics of the former differ dramatically. Gilb’s brilliant analysis of professional organizations as quasi­ private governments would suggest that even this is a dubious point, for she ably shows that "the seeming para­ doxes of centralization and decentralization, bureaucratic oligarchy and democracy" are not traits, unique to profes­ sional associations, for they "also appear in American pub­ lic government and in other private organizations, [thus] it is reasonable to conclude that none of the traits is accidental [or unique], but rather that each is an integral part of the total development of the American socioeconomic- political system."1 Collegial authority is, in a phrase, the recognized 2 equality of equals, and it is on this principle that the structure of professional associations rests. Again, the legitimating basis for this collegial authority is the ^orrine Lathrop Gilb, Hidden Hierarchies (New York: Harper and Row, 1966) , p. 133. 2 An adaptation of Morris Janowitz's method of explain­ ing how fraternal authority differs from hierarchical, traditional superordinate-subordinate authority. He ex­ plains the former as being "the recognized equality of un­ equals" and maintains that it is this type of authority system which is becoming more typical of military struc­ ture, "Changing Patterns of Organizational Authority: The Military Establishment," Administrative Science Quarterly. 3 (March, 1959), 473-493, especially 488. University of Ghana http://ugspace.ug.edu.gh 55 knowledge base which occupational members share.1 But to what extent this is ideology as distinct from practice is a good question. For example, analyses of the occupational characteristics of professional association leaders would suggest that the power structure is somewhat unegalitarian in composition and oligarchic in function.2 Gilb points out that "the leaders are . . . people who occupy positions of relatively high prestige and authority within the profes­ sion (administrators and professors). . . They are likely to be men, from urban centers, in the middle of their career-lives, and have positions which permit flexibility for attending meetings and conventions.4 We raise these points here only to indicate that it may be categorically incorrect to put forth collegial egali­ tarianism as a sub-trait of professional versus nonprofes­ sional organizations, and that ideologically it would not ^Ernest Greenwood, "Attributes of a Profession," Social Forces, 2 (July, 1957), 45-48. .... 2 Corrine L. Glib, Hidden Hierarchies (New York: Harper and Row, 1966), pp. 128-133; see also Theodore Caplow, The Sociology of Work (Minneapolis: University of Minnesota Press, 1954), p. 126. 3Gilb, op. clt., p. 128. 4 ibid., pp. 128-129. We wonder if they are not also persons with private secretaries in their work-situations. See also William Kornhauser with the Assistance of Warren 0. Hagstrom, Scientists in Industry (Berkeley: Uni­ versity of California Press, 1963), pp. 92-93, for an examination of characteristics of professional leaders in science and engineering. University of Ghana http://ugspace.ug.edu.gh 56 seem a sub-trait unique to the former.1 If by "collegial" we mean an orientation to the opinions of one's peers as opposed to lay opinions and values, it may at first glance seem reasonable to agree with Jencks’ and Riesman's implied proposition that the more collegially- oriented an occupational group, the more "professional" it 2 is. But the extreme of this is that it is only with peer opinions and values that professionals concern themselves, a situation which is potentially dangerous to the public good,^ an outcome antithetical to the concept "profession." In sum, in the descriptive sense it can be argued that the more autonomous an occupational group, the more "profes­ sional" it is_; but in the normative sense it can be argued that the more autonomous an occupational group, the more "professional" it must be. For,.in the normative context, to the extent that professional autonomy is a direct func­ tion of the degree to which knowledge and skill are ^Indeed, it would be interesting to test the (descrip­ tive) proposition that the more unrepresentative the leadership, the more "professional" the occupation. 2 Christopher Jencks and David Riesman, The Academic Revolution (Garden City, N.Y.; Doubleday and Company, 1968), p. 201. ^This very situation would seem to have gone beyond the state of being a theoretical possibility. E.g., the Editors of The Yale Law Journal point to the peer-public conflicting loyalties of the A.M.A., see "The American Medical Association: Power, Purpose, and Politics in Organized Medicine," The Yale Law Journal, 63 (May, 1954), 938-947. University of Ghana http://ugspace.ug.edu.gh 57 developed and "put to socially responsible uses,"1 autonomy would seem to be a valid characteristic of the ideal type profession; to the extent that autonomy is dysfunctional to such a task, it would seem tenuous to consider it a valid trait of the concept "profession." The Service Ideal In the most rudimentary sense the service ideal "means that the professional decision is not properly to be based on the self-interest of the professional, but on the 2 need of the client.” Writ large, "A spirit of public service . . . " pervades the true profession.^ But is this altruism on the parts of occupational members— or is it 4 mainly “prudential” behavior? Altruism? Challenging the idea that one of the chief characteristics of professions, is altruism, as opposed to 1The phrase, not the argument in point, belongs to Talcott Parsons, "Professions," IESS 1968, Vol. 12, p. 536. William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. ^Roscoe Pound, The Lawyer'from Antiquity to Modern Times, with Particular Reference to the Development of Bar Associations in the United States (St. Paul, Minn.: West Publishing Company, 1953), p. 5. 4This term is employed in the sense that Phenix uses it in his discussion on foundations for codes of ethics, Fhilip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), pp. 168-169, and William K. Frankena's use of it in Ethics (Englewood Cliffs, N.J.; Prentice-Hall, 1963), pp. 96-98. University of Ghana http://ugspace.ug.edu.gh 58 the egoism of business, Parsons argues that the basic motives of each are the same. He maintains that the reason profes­ sions tend toward "disinterestedness," as opposed to "self- interest," is that the institutional values and norms of the former are, in the extreme, "rational," and "impersonal," whereas the norms of business are "acquisitive" in nature.1 Parsons states, "The essential goals in the two cases would appear to be substantially the same, objective achievement . . 2and recognition; the difference lies in the different paths to similar goals, which are in turn determined by the dif­ ference in the respective occupational situations."3 This viewpoint stands in sharp contrast to Ross's stance that certain occupations are professions because their member­ ship is restricted to men who come into them possessing a 4 high sense of honor. ^Talcott Parsons, Essays in Sociological Theory (rev. ed.; Glencoe, 111.: The Free Press, 1954), pp. 35-37. 2 Ibid., p. 44, e.g., in business, objective achievement could be increasing the size of one's department, in medi­ cine, effecting better cures of patients. Recognition for the former could be in the form of a promotion or an in­ crease in salary, for the latter, an honorary degree. 3Ibid. See also Robert K. Merton, "Priorities in Scien­ tific Discovery: A Chapter in the Sociology of Science," American Sociological Review, 22 (December, 1957), 640, in which he says that egotistical motives may operate at the psychological level, but at the institutional level, motiva­ tion steins from the need for "recognition" for the making of original discoveries in science. 4 Edward A. Ross, Principles of Sociology (1st rev.; New York: The Century Company, 1930), p. 437. University of Ghana http://ugspace.ug.edu.gh 59 Drawing upon Parsons' work, Wilensky and Lebeaux ex­ plain the functional necessity of the service ideal in occupational situations in which the client is vulnerable and in which the practitioner cannot "guarantee results, even though he must be paid."1 Phenix does not discount the idea that the motivations of the true professional are divorced from considerations of personal, social, and economic gain, nor from concern with the security and integrity of his profession, but he regards these considerations as being "largely prudential." The true professional, he maintains, "is also motivated by the pure ideal of rendering service. He finds intrinsic value and a sense of fulfillment in making available his 2 special ability for the welfare of others." To what extent the desire to help others might stem from a conscious commitment to the pure ideal of. service as opposed to an intuitive or even calculated conclusion Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Founda- tion, 1958), pp. 301-302; quotation taken from p. 302. ^Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958), p. 169. It might be added here that contesting the views of those who maintain that there is no such thing as professional altruism might be likened to arguing with a fatalist, for whatever in­ stances one might cite as altruistic behavior, it could be argued in turn that such conduct is essentially geared toward fulfilling egoistic needs. Yet, as William K. Frankena points out, "that we cannot prove judgments of intrinsic value does not mean that we cannot justify them or reasonably claim them to be justified." Ethics (Engle­ wood Cliffs, N.J.: Prentiee-Hall, 1963), p. 94. University of Ghana http://ugspace.ug.edu.gh 60 that man cannot survive without "helping" his fellow man is an unresolved question. A commitment to the "public good."1 Directly, as in the case of the pure ideal of service, or indirectly, in that community sanction of professional services hinges upon society's belief that the services are rendered in the public interest, the overriding standard to which both the normative and descriptive ideal type professions are committed is that of the public good. In this sense, we may conclude that the criterion of the "service ideal" is common to both. At the risk of oversimplification, we would suggest that the normative ideal type's commitment to the common good inheres two central components: (1) a "commitment to truth," and (2) a moral "commitment to right," the former being a commitment to the discovery of what i£ and what can be, and the latter a commitment to the discovery of what ought to be.^ The normative type commitment to the public ^Used here in the Rousseauian sense of the "general will," as distinct from the "will of all," see Robert Maclver, "The Social Significance of Professional Ethics," The Annals of the American Academy of Political and Social Science, 297 (January, 1955), 118-124; or, put another way, an "ideal" as opposed to an "actual" public consensus, see William K. Frankeha, Ethics (Englewood Cliffs, N.J.: Prentice-Hall, 1963), p. 96. 2 This model has been developed from Philip H. Phenix's “The Moral Imperative in Contemporary American Education," perspectives on Education, 2 (Winter, 1969), 6-13. University of Ghana http://ugspace.ug.edu.gh 61 good inheres a balance between these two components for, given an occupation concerned only with truth, we have Orwellian scientists; conversely, a concern for right sans a commitment to truth is likely to result, in Flexner's words, in only "vigor . . . without intelligence."1 In this view an organized scholarly discipline committed only to a search for truth is not a profession, for we cannot assume that such a commitment in and of itself is co­ terminal with the public good. (Merton says, "It required an atomic bomb to shake many scientists loose from this 2tenaciously held doctrine.") Neither is an occupation directed solely at the discovery of right a profession in the normative sense, for the discovery of truth can shed light on the discovery of what ought to be.^ There would seem to be two alternative ways to interpret the service ideal in relation to the descriptive ideal type. ^■Abraham Flexner, "Is Social Work a Profession?" School and Society, 1 (June 26, 1915), 910. 2 Robert K. Merton, "The Machine, the Worker, and the Engineer," in Sigmund Nosow and William H. Form, eds., Man, Work, and Society (New York: Basic Books, 1962), p. 86. ^Philip H. Phenix, "The Moral Imperative in Contempo­ rary American Education," Perspectives on Education, 2 (Winter, 1969), especially p. 13; Philip H. Phenix, Realms of Meaning (New York: McGraw-Hill Book Company, 1964) , especially pp. 97-137, 215-233; and Stephen Toulmin, The Philosophy of Science (New York: Harper and Row, lgeoTT"' pp. 54-55. University of Ghana http://ugspace.ug.edu.gh 62 Firstly, if we take the definist1 view of the Parsonian approach, "altruistic-type behavior" is a characteristic required of professions by society as a condition for obtaining community sanction. Or, secondly, we can take the view that this kind of behavior is adopted on a non- moral basis for reasons beyond those which are simply "prudential," a stance consistent with Frankena's line of reasoning that there can be "nonmoral reasons [for] adopt­ ing the moral way of thinking and living" and that "non- moral justification is not necessarily egoistic or pru­ dential."2 Codes of Ethics It is interesting to note that while Wilensky uses a "formal code of ethics" as a factor in professionalization, the occupations first to publish codes of ethics in the United States were: pharmacy (1850), dentistry (1866), and veterinary science (1866).3 Medicine and law did not ^I.e., where what one "ought" to do is grounded not in moral principles but in what "'we are required by society to do. . . .'" William K. Frankena, Ethics (Englewood Cliffs, N.J.: Prentice-Hall, 1963), p. 80. 2Ibid., pp. 97-98. 3Harold L. Wilensky, "The Professionalization of Every­ one?" American Journal of Sociology, 70 (September, 1964) , 143. We will later comment on the possible significance of the fact that the first three codes were from occupations "competitive" with that of medicine. University of Ghana http://ugspace.ug.edu.gh 63 publish codes until 1908 and 1912, respectively.1 Further, Millerson's extensive analysis of over 150 "Qualifying Asso­ ciations" in England indicated that less than 20 per* cent 2 have a formalized code. Yet when one turns from empirical analyses to verbal descriptions in the literature, a formal code of ethics is frequently mentioned as one of the essential character­ istics of the concept "profession."3 The investigator's frequency analysis of Millerson's descriptive table indicates that codes ranked 1.5 out of the seven most frequently mentioned items cited by the some twenty authors. However, making a further breakdown in terms of whether the sources of publication of these opinions are English or American in origin, codes are the Harold L. Wilensky, "The- Professionalization of Every­ one? American Journal of Sociology, 70 (September, 1964) , 143; Benson Y. Landis' more extensive documentation of medical codes indicates that "medical ethics were documented and adopted by the American Medical Association in 1848. The first formulation showed traces of English influences and followed historic statements of famous practitioners [e.g., Hippocrates'] as to the duties of a physician. A revision was made in 190 3. A new document was adopted in 1912 and revised in 1922." See Professional Codes: A Sociological Analysis to Determine Applications to the Edu­ cational Profession (New York: Bureau of Publications, Teachers College, Columbia University, 1927) , p. 41. It may be that Wilensky takes the 1912 date as the generic date so far as American medicine is concerned, but in that the values expressed in the new document would not seem to de­ part radically from those in the'earlier ones, this dis­ crepancy of dates would seem worth some consideration. 2 Geoffrey Millerson, The Qualifying Associations (London: Routledge and Keegan Paul, 1964) , p. 148. 3E.g., ibid. and our own analysis in Table I, p. 30, above. University of Ghana http://ugspace.ug.edu.gh 64 most frequently mentioned items cited in English sources, yet rank only 4.5 in frequency in American sources.1 The latter point substantiates Millerson’s verbal generalization that "written codes are a comparative rarity [in England], whereas in the United States they seem a commonplace neces- 2 sity.” The aforementioned inconsistencies aside, the general literature in this area would suggest that an ideal type profession must have codes of ethics consonant with the uses and abuses to which the knowledge component can be put, and inherent in this criterion is the principle that the occupational members "are more handsomely rewarded for con- 3 forming to its code of ethics than for failing to do so. Codes may be formal and/or informal, explicit and/or implicit, so long as they are effective. Millerson points out that in reality codes do not initiate standards so much a as they reflect what has become generally accepted practice. ^Geoffrey Millerson, The Qualifying Associations (London: Routledge and Keegan Paul, 1964), Table X.X, p. 5. In the American sources, "skill based on theoretical knowledge" ranked first in frequency, versus 4.5 in English sources. 2Ibid., p. 164. ^William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. 4 Millerson, op. cit., p. 160; see also "Mayor Asks Code for Teachers to Curb Slurs Causing Tension," New York Times, January 24, 1969, pp. 1, 20. To the extent Millerson's observation is true, it is meaningless for re­ lated administrative bodies to try to "impose" ethics. University of Ghana http://ugspace.ug.edu.gh 65 Codes are "particularistic" In nature. Professional codes.differ from general codes in that they are based on function rather than on authority or tradition.1 The func­ tion must be broad enough to be of significance, yet narrow enough to be distinctive. This principle applies not only between various occupational groups but within them.^ Normative codes are "designed to cover the distinctive powers which define . . . [aj particular vocational group and [take] cognizance of the distinctive moral obligations Robert Maclver, "The Social Significance of Profes­ sional Ethics," [The Annals of) American Academy of Political and Social Science, 297 (January, 1955), 53. One of Maclver’s central points is that as the latter two bases for ethics "weaken," ethics based on function act to strengthen community ethics. 2 C. Harold McCully says that where the function is too broad or too narrow, efforts at formulating codes of ethics are likely to amount to little more than "tactics," rather than being "developmental tasks" fundamental to the process of professionalization, "The School Counselor: Strategy for Professionalization," Personnel and Guidance Journal, 40 (April, 1962), 682. ......... . 3For example, while an Osier or a Nightingale may serve to symbolize the general character and function of a particular occupational group, more definitions are re­ quired "if professional norms and images are to be main­ tained." See Harvey L. Smith, "Contingencies of Profes­ sional Differentiation," in Sigmund Nosow and William H. Form, eds., Man, Work, and Society (New York: Basic Books, 1962), pp. 222-223. Returning to Rodgers' distinction between the functions of academic as opposed to clinical psychologists (page 39 above), ideally, there would be an over-all code for the profession of psychology but, in addition, there would be specific codes pertaining to the uses and abuses of the knowledge forms and work situations which distinguish the one area of specialty from the other. University of Ghana http://ugspace.ug.edu.gh 66 which accompany the exercise of those powers."1 The scien- 2 tist must declare truth even if it means losing his job; the clergyman must not divulge a troubled parishioner's confidences.3 Some of the main factors which may underlie inter- and intra-occupational differences in codes of ethics are: (1) the type of work situation of practitioners (e.g., solo or corporate), (2) the situation of the client (e.g., service to a single client or groups of clients), (3) the type of practice (e.g., that involving life as distinct from property), and (4) the degree to which the technique 4 is understood by the client. Some of the intra-occupational factors which are instrumental in determining the nature and limits of an ethical code are: (1) the extent, type, and diversity of training, (2) the extent and diversity of occupational ^Philip H. Phenix, Philosophy of Education (New York: Holt, Rinehart, and Winston, 1958) , p. 168. 2William J. Goode, "The Librarian: From Occupation to Profession?" The Library Quarterly, 31 (October, 1961), 308. ^Robert Maclver, "The Social Significance of Profes­ sional Ethics," The Annals of the American Academy of Political and Social Science, 297 (January, 1955) , 52. ^Geoffrey Millerson, The Qualifying Associations (London: Routledge and Keegan Paul, 1964), pp. 150-153. University of Ghana http://ugspace.ug.edu.gh 67 function, (3) whether or not there is a variety of em­ ployers,1 and (4) the degree to which occupational members rely on qualification by the occupational association for o the right to begin and to continue practice. To this list we would add a less obvious variable, the nature of the "service" component, for we would submit that if the Service ideal is based upon a definist ethic, codes are likely to be as specific or general, formal or informal, as the going mood of society requires.3 If, on the other 4 hand, codes are based on a "teleonomous" ethic, their scope, content, and form will reflect what "ought" to be, not merely those norms which society requires as a minimum. Codes must be "universalistic" in nature. "There is always a limit to the degree which the code and policy of an occupation can deviate from the general culture of the Geoffrey Millerson, The Qualifying Associations (London: Routledge and Keegan Paul, 1964), p. 156, main­ tains that "a single employer [such as the State's employ­ ment of teachers] reduces the need for an ethical code, though [sic] making it easier to introduce rules." Martin P. Meyer, The Schools (New York: Harper and Brothers, 1961), p. 20, decries the possibility of attaining value homogeneity amongst the huge number (1,400,000) of United States school teachers. 2 Millerson, op. cit., pp. 154-156. ^William K. Frankena, Ethics (Englewood Cliffs, N.J.: Prentice-Hall, 1963), p. 80. 4I.e., based on a "comprehensive purpose," reflecting not only the occupation's distinctive functions but its subsequent moral obligations, used here in the sense in which Philip H. Phenix employs it in "The Moral Imperative in Contemporary American Education," Perspectives in Educa­ tion, 2 (Winter, 1969), 10. ‘ " .... University of Ghana http://ugspace.ug.edu.gh 68 community."1 One might thus, for example, make the proposi­ tion that the degree to which a profession places Importance on the protection of individual rights is a function of the community norms surrounding this value. Ross maintains that "the older professions tended to put loyalty to the patron 2' above duty to society." Yet perhaps it was society itself which valued the rights of the individual beyond those of the collective good. It is interesting to contrast Ross's charge with the more recent principle cited in the ethical standards of the Section on Social Psychology of the American Sociological Association to the effect that standards "must be defined to give primacy to the needs and welfare of the client so long as they do not violate the rights and integrity of other individuals and organiza­ tions and are consistent with high ethical principles."^ It is a truism to say that, even in a democratic society, what constitutes individual rights is a complex question, ^Everett C. Hughes, Men and Their Work (Glencoe, 111.: The Free Press, 1958), p. 35; James Howard Means says, for example, that although birth control and Euthanasia are quite within the technical competency- of the medical profes­ sion, community norms preclude such policies' being a part of medical ethics, "Homo Medicus Americanus," Daedalus, 92 (Fall, 1963), 718. 2 Edward A. Ross, Principles of Sociology (1st rev.; New York: The Century Company, 1930), p. 440. 3Italics mine, Proceedings of the 55th Annual Meeting of the American Sociological Association, New York City, August 28, 29, 30, and 31, 1960, reported in The American Sociological Review, 25 (December, 1960) , 931. University of Ghana http://ugspace.ug.edu.gh 69 particularly when professional knowledge expands, for exam­ ple, to permit preventive as well as curative and pallia­ tive approaches in medicine.1 This fact that professional ethics cannot in them­ selves, then, be isolated from those of the whole community raises "the question of the limits of professional self- 2 government." Wilensky and Lebeaux maintain that there are "[four] moral norms that characterize the established professions."3 Building on Parsons' work, they state that a professional must be: (1) impersonal in his relations with clients The principle raised here is reflected in the writings of Gardner C. Quarton, "Deliberate Efforts to Control Human Behavior and Modify Personality," Daedalus, 96 (Summer, 1967), 837-853; Leonard Kraser and Leonard P. Ullmann, Research in Behavior Modification (New York: Holt, Rinehart, and Winston, 1965), p. 362; Adam Podgorecki, "Law and Social Engineering," Human Organization, 21 (Fall, 1962), 177-181; see also the special issue on "Ethical Aspects of Experimentation with Human Subjects," Daedalus, 98 (Spring, 1969), 219-594. 2 Robert Maclver, "The Social Significance of Profes­ sional Ethics," [The Annals of] American Academy of Politi­ cal and Social Science, 297 (January, 1955), 55. ^Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Founda­ tion, 1958), p. 285. We would draw attention to the point that although the authors refer to "moral" norms, they appear to defend their value on the basis of their functional worth. E.g., impersonalness aids the practitioner in restricting client demands to his area of competence and at the same time allows him to gain intimate types of information about the client, objectivity is necessary to the gathering of facts, and the need for client confidence means that condi­ tions for rendering services must be impartial (pp. 299-301). The functionality of the service norm has already been men­ tioned. University of Ghana http://ugspace.ug.edu.gh 70 (relations are "'functionally specific'"), (2) objective (he must have "emotional neutrality" toward the client), (3) impartial (he must not "give or withhold services, to serve poorly or well, on the basis of (the client's] per­ sonal characteristics . . and he must (4) "be moti­ vated by a service ideal (devotion to the client's interest more than profit should guide decisions when the two are in conflict)."1 But closer examination would suggest that even these norms have their coordinates. For example, Merton points out that while emotional neutrality is of importance, "excessive detachment" is to be avoided in the 2 physician-client relationship; "rapport" is a fundamental characteristic of the so-called helping professions.^ Hall's empirical data suggest that the higher the degree of the professionalization of an occupation, "the less imper­ sonality is stressed."4 Legal societies contribute services to clients because of the characteristics of their inability ^Harold L. Wilensky and Charles N. Lebeaux, Industrial Society and Social Welfare (New York: Russell Sage Founda­ tion, 1958), pp. 2S5, 299-301, italics the authors'; see also Talcott Parsons, The Social System (Ne,w York:' The Free Press, 1951), pp. 433-439, 455-463. 2Robert K. Merton, "Some Preliminaries to a Sociology of Medicine," in Robert K. Merton et al., eds., The Student Physician (Cambridge, Mass.: Ha-vard University Press, 1957), p. 74. ^Wilensky and Lebeaux, op. cit., p. 300. 4 Richard H. Hall, "Professionalization and Bureaucrati­ zation," American Sociological Revi-ew, 33 (February, 1968), University of Ghana http://ugspace.ug.edu.gh 71 to pay for services; and the scientist fnay withhold his services from corporations (i.e., his "clients") on the basis of their "personal" corporate characteristics. The principle which seems to operate throughout pro­ fessional codes is not so much that certain norms are in the extreme applicable to all professions but that the norms underlying the ideal type profession are consonant with the knowledge-ski11 component and are articulated with the basic norms of the wider community. The content of professional codes. Descriptively speaking, the content of professional codes varies so con­ siderably that generalizations are likely to be misleading. Content may center on specific rules and/or general prin­ ciples, professional-client, professional-professional, and professional-community relationships, emphasis on modes of remuneration, and/or technical interests.1 To cite "codes of ethics" as a criterion of the concept "profession" is relatively meaningless unless there are some sub-criteria by which to judge such codes. In Maclver's opinion it is in the area of "the relation of the profession as a whole ^E.g., see Geoffrey Millerson, The Qualifying Associa- tions (London: Routledge and Keegan Paul, 1964), p. 164; Benson 1'. Landis, Professional Codes; A Sociological Analy­ sis to Determine Applications to the Educational Profession (New York: Bureau of Publications, Teachers College, Columbia University, 1927), especially pp. 87-88; and Robert Maclver, "The Social. Significance of Professional Ethics," [The Annals of] American Academy of Political and Social Science, 29~7 (January, 19 55) , 53-54. ~ University of Ghana http://ugspace.ug.edu.gh 72 to the community that professional codes are still weakest and professional ethics least developed."1 He says: The service to the community they clearly envisage is the service rendered by individual members of the profession to members of the public. The pos­ sibility that there may still be an inclusive pro­ fessional interest— generally but not always an economic one— that at significant points is not always harmonized with the community interest is nowhere adequately recognized.2 Maintaining that, for the most part, existing profes­ sional codes have little of what can "be fairly called ethical significance,1’3 Cooke, in fact, suggests that the degree to which ethical codes provide for interpretation of the social obligation of the profession as a whole to society at large may well be a "dominant test” of an occu­ pation's professional status. He cites instances of the American Medical Association's blocking federal legislation for health insurance and lawyers' associations blocking •liberalizing measures" in legislation as examples "in which Robert Maclver, "The Social Significance of Profes­ sional Ethics," The Annals of the Anerican Academy of Political and Social Science, 297 (January, 1955), 53, italics his. 2Ibid. 3Morris L. Cooke, "Professional Ethics and Social Change." American Scholar, 15 (Autumn, 1946), 489, "The present-day status of professional codes is so tenuous that among the more influential (professions] it would be diffi­ cult to secure active interest either in revising an exist­ ing code or drafting a new one"; Martin Gross, The Doctors (New York: Random House, 1966), p. 544, maintains that "Medical ethics are actually (just]