During World War II, 3,000 conscientious objectors performed public service as attendants in mental hospitals and training schools. These idealistic young men were drawn primarily from peace-affiliated churches that opposed participation in war, including the Church of the Brethren, the Mennonites, and Society of Friends. They were dropped into institutions without either adequate training or warning of the brutal conditions they would encounter there. Steven J. Taylor's Acts of Conscience provides a comprehensive record of their turn to activism, nested within a larger narrative of attempts to reform mental hospitals in the 20th century.

Clifford Beers' 1908 autobiographical book, A Mind That Found Itself, drew attention to the wretched conditions in mental hospitals at the beginning of the 20th century and led to the creation of the National Committee for Mental Hygiene (NCMH). However, despite the attention Beers generated, his organization, which excluded laypersons (other than him) from participating, did not lead to significant improvements in institutions and was never patient-centered. In fact, the organization's appropriation by the medical establishment was so complete that, shortly after its founding, the NCMH went on record in support of eugenic sterilization of “defectives” housed in institutions. The assault on human dignity in mental hospitals continued unabated.

Several decades later, when conscientious objectors were introduced to hospitals and training schools, they were shocked by the conditions they encountered. The institutions were not only overcrowded and badly understaffed, but they lacked basic supplies for cleaning, medical treatment, and the clothing of patients. Some even lacked eating utensils. Naked residents, sometimes confined in cages or strapped to benches, cohabitated in filth with rats, roaches, and lice. They had to endure stopped-up and overflowing toilets, leaking roofs, and sadistic attendants who meted out vicious treatment with impunity. Many of these attendants, or “bughousers,” were troubled souls unable to find work anywhere else. Working under difficult conditions, they routinely resorted to violence—some carried clubs as tools of their trade—to ensure patient obedience. In some institutions, violent patients were permitted to roam freely and inflict injuries on patients in restraints, completely at their mercy.

With the nation united against a war initiated by German and Japanese aggression, the conscientious objectors were deeply unpopular. The American Legion and the Veterans of Foreign Wars were determined to make the objectors' lives difficult and were vigilant for signs that these “slackers,” “draft dodgers,” “cowards,” and “yellowbellies” might be coddled or granted unwarranted privileges. In this climate, the Selective Service imposed restrictions on conscientious objectors' activities and living conditions to ensure that they could not enjoy normal lives. Although Congress had approved payment of conscientious objectors as long as the amount did not exceed the pay of soldiers, the Selective Service never requested the allotment of these funds. Moreover, conscientious objectors were ineligible for workers compensation or funds for dependent care.

As the war neared its conclusion, Americans, with the rest of the world, were shocked to learn of the atrocities committed in Nazi concentration camps. Publicity about the camps, together with the widespread conviction that the war was one fought between the values of democracy and human rights versus totalitarianism and cruelty, led to a heightened interest in, and receptivity to, exposure of the terrible conditions in American mental institutions. Reports by conscientious objectors and crusading journalists about the mental hospitals invited comparisons with German concentration camps. Journalist Albert Deutsch wrote that “Byberry [the Philadelphia state hospital], along with too many of our state hospitals, can be compared only to Buchenwald and Belsen in its contempt for human dignity and human needs” (as cited in Taylor, 2009, p. 263). In addition, in a summary of observations by other conscientious objectors, which included the shocking finding that attendants were using wet towels to strangle patients into submission, Harold Barton wrote that “These and thousands of similar American atrocities are being committed every day in our public institutions” (as cited in Taylor, 2009, p. 285).

Barton, with three other conscientious objectors who had also worked at Byberry, succeeded in launching a new national organization, the National Mental Health Foundation (NMHF) that helped to galvanize public attention around the conditions in American institutions and temporarily awakened the Beers-founded National Committee for Mental Hygiene and American Psychiatric Association to acknowledge the problem. Working in concert with journalists and others, the NMHF helped focus so much attention on mental hospitals that, by 1947, it was noted that whenever the “man in the street… became bored with the newspapers for lack of titillating horror stories about concentration camps, he can turn to them for equally horrific stories about conditions in mental hospitals” (as cited in Taylor, 2009, p. 304). It was then seen as time for citizens to unite “to put an end to [American] concentration camps that masquerade as hospitals” (p. 291).

However, the effectiveness of the NMHF as a muckraking organization shortly faded along with the nation's outrage at the human rights abuses in its mental hospitals. Within a few years of its creation, the NMHF merged with older, more conservative organizations run by professionals rather than laypersons, who seemed more bent on protecting their privilege and interests than improving the lot of patients. Taylor concludes that the reform initiatives introduced by the NMHF were of only temporary benefit and that institutional life reassumed the same cast as before. The horrors of mental institutions were rediscovered in the 1960s with the release of Frederick Wiseman's documentary Titicut Follies, filmed in a Massachusetts mental hospital, and Ken Kesey's popular book (also made into an Oscar award–winning movie), One Flew Over the Cuckoo's Nest.

Acts of Conscience is a welcome and valuable addition to the fields of American and disability studies. Taylor describes in considerable detail the formation of the Civilian Public Service together with the political struggles that shaped its development and brought conscientious objectors to mental hospitals. He seems to have devoured every primary source available regarding his subject. Moreover, he is judicious in presenting the massive amount of evidence he collected, and readers will never doubt that he has told the story fairly. All in all, Acts of Conscience is a remarkable accomplishment.

Some may have difficulty with the amount of detail Taylor chose to include. Those who are fascinated by the topic may appreciate the inclusion of conscientious objector Clarence Kreider's listing of foods on the menu at the Western State Hospital in Virginia for 5 days in January, including the information that breakfast each day consisted of bread, oatmeal, and gravy” (as cited in Taylor, 2009, p. 194) [and that] “bread was included with each meal” (p. 195). However, I wished that more of this type of detail had been relegated to notes so that the essential story could emerge more clearly. This is a long book in which the first half is taken up with the story of the establishment of the Civilian Public Service. The reader must wait until page 202 before learning of the conscientious objectors' observations in the institutions and their reactions to what they saw.

One of the book's most powerful themes is its indictment of professional organizations for their deplorable failures of compassion and responsibility. The NCMH's journal, Mental Hygiene, rarely discussed the inadequate conditions in mental hospitals before the sensational revelations brought before the public in the late 1940s. The American Association on Mental Deficiency's American Journal of Mental Deficiency was worse. It failed to publish a single article about the abusive conditions in institutions during the period in which the conscientious objectors drew attention to the problem. Not to be outdone, the American Psychiatric Association assigned blame for the conditions in mental hospitals to an apathetic public and corrupt politicians. The psychiatrists who staffed the institutions were not to blame, they said.

Although some who ran institutions took the revelations seriously, more often complaints drew defensive responses and irresponsible countercharges. S. M. R. O'Hara, secretary of Pennsylvania's Department of Welfare, responded to conscientious objectors' revelations with the comment that “you fellows seem to have more time to write letters to the papers than you do to clean the floor” (as cited in Taylor, 2009, p. 262). O'Hara also falsely accused Albert Deutsch of advocating a centralized government takeover of all institutions, “a new variety of Fascism” (p. 264). The Ohio state welfare director, Herbert Mooney, dismissed revelations about conditions in the Cleveland state hospital as “gross exaggerations” put forward by “unreliable sources” (p. 245).

Near the end of Acts of Conscience Taylor turns his focus from mental hospitals to the history of training schools for persons with intellectual disabilities, particularly the normalization movement that transformed that field after the 1960s. The critiques offered at that time were informed by theoretical advances, such as labeling theory, and led to the conclusion that institutions, by their very nature, are abusive and immune to reform. It would have been helpful had Taylor also included a parallel discussion of the effects of the normalization movement on mental hospitals, which, far more than training schools, are the subject of this book.

Nevertheless, Acts of Conscience is an enormous achievement that will repay patient readers with a wealth of insight regarding the history of efforts to reform mental institutions and the politics and possibilities of organizational reform. Even more valuable, it invites deep reflection on the best and worst capacities of human beings and the role of organizations and institutions in drawing each forth.