In mid-nineteenth century America the asylum became the foundation of public policy. This ubiquitous institution was regarded as a symbol of an enlightened and progressive nation that no longer ignored or mistreated its severely and chronically mentally ill citizens. The faith in an institutional policy was embodied in a vast and costly system of state mental hospitals that by 1940 had an inpatient population of about 450,000. Despite the presence of serious problems, there was little disposition to call into doubt the wisdom of institutional care and treatment. Even though mental health policy was formulated within a decentralized and divided political system, there was no doubt that a holistic and clear consensus prevailed.

European socialists at the beginning of the twentieth century often expressed amazement at the fact that the United States, although one of the most advanced industrial nations in the world, also had one of the weakest socialist movements, as well as a trade union movement bent on avoiding any hard and fast political commitments. Yet, only a few short years before, it appeared as though the American working class had at last arrived at political maturity and was putting its potential voting strength to good advantage. In the elections of 1886, for example, labor tickets in the Northeast and Middle West polled substantial proportions of the vote and won some startling victories. In New York City, Henry George, running with labor and socialist backing, lost out in his race for mayor by only 22,000 votes, while in Chicago and Milwaukee a number of labor candidates swept to victory.

American psychiatry, perhaps more so than other medical specialties, has had a troubled and ambivalent past. For much of its history its members were employed in public mental hospitals and thus lacked the autonomy and independence of their colleagues in private practice. More significantly, psychiatry was indissolubly linked with the fate of public institutions, whose image and reputation often left much to be desired.

The ambivalent character of psychiatry has given rise to two distinct and polar interpretations of its past. On the one side is a Whiggish scholarship that indentifies the evolution of psychiatry with scientific progress. The barriers to the creation of a psychiatric utopia result from the actions of malevolent or narrow-minded individuals and groups unwilling to provide appropriate resources. Furthermore, there is a presumption that psychiatric scientific and objective knowledge provided the basis for policies capable of resolving many of the troublesome problems associated with mental illness. On the other side are those who maintain that psychiatrists were involved with the social control of deviant and troublesome individuals. Mental hospitals, therefore, were simply institutions that confined and brutalized individuals whose only crime was their inability to conform to traditional behavioral norms. Embedded in this approach is the assumption that mental disease is a social rather than a medical category.

The year 1886 was destined to be a crucial one in the history of the American labor movement. The eight-hour crusade, the numerous strikes, the Haymarket bomb, the entrance of workingmen into the political arena at the state and national levels, and the mushroom growth of labor organizations all contributed to the agitation and excitement of the year. Yet the importance of these events was overshadowed by a development that was to have such far-reaching implications that it would determine the future of the labor movement for the succeeding half century. That development was the declaration of war by the trade unions against the reform unionism of the Knights of Labour.

The National Labor Union represented the first attempt to organize a national federation of labor in the United States. The germ of the idea for such a national federation of labor had been planted at the beginning of the Civil War, but it was not until 1866 that plans were set in motion to organize such a body. In February of that year William Harding, the president of the Coachmakers' International Union, met with Willam H. Sylvis, president of the Iron Moulders' International Union. A preliminary meeting called by these two leaders led to the convening of a national labor convention in Baltimore on August 20, 1866. From this modest beginning the National Labor Union quickly rose to a prominent position. The Chicago Tribune in 1869 estimated its membership at 800,000, and Sylvis himself put the figure at 600,000. Both estimates are undoubtedly exaggerated, but it is quite apparent that the organization represented a large proportion of the nation's laboring force and perhaps at its peak strength numbered between 200,000 and 400,000. The decline of the union was almost as spectacular as its rise, and by 1872 it was totally defunct.