Book Review
Death of the Guilds: Professions, states, and the advance of capitalism, 1930 to the present
N Engl J Med 1997; 337:578August 21, 1997
- Article
Death of the Guilds: Professions, states, and the advance of capitalism, 1930 to the present
By Elliott A. Krause. 305 pp. New Haven, Conn., Yale University Press, 1996. $37.50. ISBN: 0-300-06758-5In this ambitious book, which crosses national boundaries and major time periods, Krause, a professor of sociology at Northeastern University, wants us to reconsider professionalization as a cross-cultural phenomenon. His thesis is that the organized power of traditional professions is slowly fading in the West. “Have capitalism and the state finally caught up with the last guilds?” he asks. The answer is explicit in the title of the book.
Krause examines the history of four professional groups in five countries — the United States, Britain, France, Italy, and Germany — from medieval times through the present. The professions are medicine, law, engineering, and the professoriate. This book thus has prima facie interest not only to students of the professions, but also to readers wanting to know about a specific profession in a given country. Those attempting to understand whether recent changes in the medical profession in the United States are commonplace, historically speaking, or internationally unique will also find this book engaging. Of the eight chapters, five are devoted to the history of the selected professions, one chapter for each country, with subsections for each profession. This method, with its rich historical detail, shows the extent to which professions are creatures of their wider social environments: in the United States they are unusually entwined with the market; Britain has its history of class consciousness; France is a strong state with what Krause calls clientele professions; Italy has politicized professions; and Germany is imbued with corporatism. The fact that there are substantial historical differences, expressed in part by varying roles for the state and the marketplace, adds force to Krause's overarching thesis that despite these differences the moral functions of modern professions have effectively disappeared across the board, and the professions no longer seem to exist as unified, self-regulating entities. From the material presented in these careful case studies, this is a reasonable, if discomfiting conclusion.
For students of the theory of professions, this book provides a valuable extension and clarification of what Krause calls “guild power.” He defines that power in terms of the right and monopoly of professional association (and monopoly over practitioner skills), control over the workplace and thus the terms of work, and control of the market for services. Alternatives to guild power, as depicted, are capitalist power and the state, with the three loci combining and conflicting with varying degrees of tension in different times and different places. Krause sees the 20th-century history of professions as one of conflict among these three powers as rivals, with the guild in decline as the others build. The story of American medicine is called “The Fall of a Giant.”
Whether one agrees with this delineation or not — and Krause is careful to say that he is talking about guild power, not the role or power of individuals working in a profession — this book makes a bold attempt to link the history and theory of professions with theories of capitalism and the state. It also makes clear the complexities and subtleties of cross-national investigation. The magnitude of the task often results in difficult reading, and perhaps experts in the primary source material of a specific profession in one country might cavil at some historical details, but the questions asked are important and provocative. I came away with a further question: Does it matter to a profession whether the state or private capital controls the market?
Rosemary A. Stevens, Ph.D.
University of Pennsylvania, Philadelphia, PA 19104- Citing Articles (2)
