Madness in Civilization

Madness in Civilization Plot Summary

Introduction

Throughout human history, the treatment of mental illness has reflected society's deepest fears, prejudices, and occasionally, its compassion. From the ancient world where madness was seen as divine punishment or demonic possession, to medieval monasteries that offered sanctuary to the "touched," to the sprawling Victorian asylums that warehoused thousands, the journey of mental health care tells us as much about our civilization as any political history. This evolution reveals three crucial tensions that have shaped our approach: between supernatural and scientific explanations, between punishment and treatment, and between institutional confinement and community integration. The struggle for dignity in mental health care has been marked by both remarkable breakthroughs and horrifying abuses. We'll explore how treatments evolved from exorcism and bloodletting to psychopharmacology and psychotherapy, and how societal attitudes shifted from fear and moral condemnation to medical understanding and rights advocacy. For anyone interested in medicine, social justice, or simply understanding the human condition, this historical journey illuminates not just how we've treated mental illness, but how we've defined what it means to be human, rational, and deserving of compassion in each era of our shared past.

Chapter 1: Divine Affliction: Ancient and Medieval Perceptions (Pre-1600)

In the ancient world, mental disturbances were primarily understood through supernatural frameworks. Across Mesopotamia, Egypt, Greece, and Biblical lands, unusual behaviors and thoughts were commonly attributed to divine punishment or demonic possession. The Biblical King Saul, whose episodes of rage and depression tormented him, was described as afflicted by "an evil spirit from the Lord." Similarly, in Greek mythology, Ajax's madness was portrayed as divine retribution from the goddess Athena. These explanations reflected societies where the boundaries between the natural and supernatural worlds remained fluid, and where moral transgression was thought to invite divine wrath. Yet even in this early period, more naturalistic explanations began to emerge. By the 5th century BCE, Greek physicians were developing alternative frameworks. Hippocrates famously challenged supernatural explanations in his treatise "On the Sacred Disease," arguing that epilepsy and certain mental conditions were disorders of the brain rather than divine afflictions. His humoral theory proposed that mental disturbances resulted from imbalances in the four bodily fluids: blood, phlegm, yellow bile, and black bile. Too much black bile, for instance, was thought to cause melancholia (depression). This theory, though incorrect by modern standards, represented a revolutionary step toward understanding mental illness as a natural phenomenon requiring medical intervention. Treatment approaches in the ancient world varied widely, reflecting these competing explanations. Religious treatments included exorcism, prayer, and pilgrimages to temples of healing gods like Asclepius. Medical treatments focused on restoring humoral balance through diet, exercise, bloodletting, and herbal remedies. The Romans, building on Greek foundations, developed more systematic approaches to care. While wealthy families typically cared for mentally ill members at home, some communities established rudimentary facilities for those without family support. In the Islamic world, the first dedicated mental hospitals (bimaristans) appeared in Baghdad and Cairo by the 8th century CE, offering remarkably humane care for their time. The medieval period in Europe saw the dominance of religious interpretations, though the picture was more complex than often portrayed. Monasteries frequently provided sanctuary for the mentally disturbed, offering basic care within religious frameworks. The Belgian town of Geel developed a unique community care system under the patronage of Saint Dymphna, where mentally ill pilgrims were placed with local families—a tradition that continues in modified form today. While demonic possession remained a common explanation, medieval theologians also recognized natural causes of mental illness, distinguishing between spiritual afflictions requiring exorcism and natural conditions requiring medical care. By the late medieval period, the first specialized institutions for the mentally ill began to appear in Europe. The Bethlem Royal Hospital (Bedlam) in London, founded in 1247, gradually specialized in mental cases. Similar institutions emerged in Spain, influenced by Islamic models. However, these early asylums were primarily custodial rather than therapeutic, often housing the mentally ill alongside other marginalized groups. Treatment remained rudimentary, combining physical remedies derived from humoral theory with religious interventions like prayer and confession. The pre-modern era thus established several patterns that would influence mental health care for centuries: the tension between supernatural and natural explanations; the dual impulses toward compassionate care and fearful containment; and the gradual development of specialized institutions. These early approaches reflected societies grappling with phenomena they could neither fully understand nor control—a struggle that would continue into the modern era with new scientific frameworks replacing, but not entirely displacing, earlier supernatural explanations.

Chapter 2: The Great Confinement: Birth of the Asylum System (1600-1800)

The period from 1600 to 1800 witnessed what historian Michel Foucault famously termed "the great confinement"—a systematic institutionalization of the mentally ill alongside other marginalized groups. This transformation began in 17th century France with the establishment of the Hôpital Général in Paris in 1656, an institution designed not as a medical facility but as a place of confinement for the poor, the idle, the criminal, and the insane. By royal decree, similar institutions were established throughout France, creating what amounted to a nationwide system of confinement. This movement reflected changing social attitudes toward poverty and deviance in an era of emerging capitalism and absolutist state power. In England, a different pattern emerged with the proliferation of private madhouses. Entrepreneurs established these facilities to house the mentally ill for profit, charging families fees for the confinement of troublesome relatives. The quality of these establishments varied enormously—some offering genuine attempts at care, others little more than prisons where patients were chained and neglected. The infamous Bethlem Hospital (Bedlam) continued to operate as London's primary public asylum, becoming a tourist attraction where visitors could pay a penny to view the inmates. This voyeuristic practice reflected the ambiguous status of the mad—simultaneously objects of fear, pity, and entertainment in the public imagination. The Enlightenment brought new approaches to understanding madness. Medical theories increasingly emphasized the role of the nervous system, with physicians like Thomas Willis and later George Cheyne proposing that mental disorders resulted from disturbances in the "animal spirits" or nerves. Cheyne's influential work "The English Malady" (1733) portrayed nervous disorders as diseases of civilization and refinement, particularly affecting the educated classes. This neurological framework provided a seemingly scientific explanation for mental phenomena without resorting to supernatural causes, though treatments remained largely ineffective, including bloodletting, purging, and various "nerve tonics." The late 18th century saw the beginnings of asylum reform with pioneers like Philippe Pinel in France and William Tuke in England advocating more humane approaches. Pinel, appointed to the Bicêtre asylum in Paris during the French Revolution, is famously credited with ordering the unchaining of the inmates—a symbolic act that, while likely exaggerated in historical accounts, represented a new therapeutic optimism. Tuke, a Quaker businessman, founded the York Retreat in 1796 as an alternative to the harsh conditions in public asylums. The Retreat pioneered what became known as "moral treatment"—an approach emphasizing kindness, minimal restraint, meaningful occupation, and attention to the physical environment. These reforms reflected broader Enlightenment values of reason and humanity, as well as changing conceptions of madness itself. Rather than seeing the mad as fundamentally different beings or as possessed by supernatural forces, reformers increasingly viewed them as fellow humans who had lost their reason but might regain it through proper treatment. This perspective was captured in Pinel's treatise "Traité médico-philosophique sur l'aliénation mentale" (1801), which portrayed mental illness as potentially curable through psychological understanding and moral guidance rather than physical coercion. By 1800, the foundations had been laid for the massive expansion of asylum care that would characterize the 19th century. The concept of specialized institutions for the mentally ill had been established, early models of humane treatment had been demonstrated, and a new medical specialty focused on mental disorders was emerging. However, these developments remained limited in scope—the vast majority of mentally ill people still lived with their families or wandered as vagrants. The tension between confinement and care, between social control and medical treatment, would continue to shape responses to mental illness in the coming century, as would the persistent gap between reformist ideals and institutional realities.

Chapter 3: Scientific Classification and Moral Treatment (1800-1900)

The 19th century marked the golden age of the asylum and the birth of psychiatry as a medical specialty. Inspired by the reforms of Pinel and Tuke, a wave of asylum construction swept across Europe and North America. In England, the 1808 County Asylums Act encouraged (though did not require) counties to build public asylums, while the 1845 Lunatics Act made such construction mandatory. In the United States, Dorothea Dix emerged as a tireless advocate for the mentally ill, campaigning state by state for the construction of public asylums. Her efforts led to the establishment of more than 30 state hospitals between 1840 and 1880. These institutions were initially built with high therapeutic hopes, designed according to principles that emphasized light, air, and access to nature. Moral treatment became the dominant therapeutic approach in these early asylums. This method emphasized psychological understanding, humane care, and the therapeutic potential of a well-ordered environment. Asylum superintendents, increasingly drawn from the medical profession, saw themselves as father figures presiding over therapeutic communities where patients would learn self-control through regular routines, productive work, religious instruction, and recreational activities. Early reports claimed impressive cure rates, particularly for recent cases, fueling optimism that insanity could be conquered through proper institutional care. The architecture of asylums reflected these therapeutic aspirations, with spacious grounds, well-ventilated wards, and facilities for work and recreation. Simultaneously, psychiatrists (then called alienists) worked to develop systematic classifications of mental disorders. Philippe Pinel distinguished four main types of mental alienation: mania, melancholia, dementia, and idiocy. His student Jean-Étienne Dominique Esquirol further refined this system, introducing the concept of monomania—a partial insanity where delusions were limited to specific topics. In Germany, Wilhelm Griesinger emphasized the brain as the seat of mental illness, declaring "mental diseases are brain diseases." By the late 19th century, Emil Kraepelin had developed a comprehensive classification system that distinguished between dementia praecox (later renamed schizophrenia) and manic-depressive illness based on their symptoms and course. These efforts to categorize mental disorders reflected the period's scientific aspirations and laid the groundwork for modern psychiatric diagnosis. However, the reality of asylum care soon diverged from these therapeutic ideals. As institutions grew larger—some housing thousands of patients—overcrowding, understaffing, and inadequate funding undermined treatment efforts. The patient population increasingly consisted of chronic cases deemed incurable, including many suffering from neurosyphilis, alcoholism, and what would later be recognized as schizophrenia. Mechanical restraints, initially abandoned under moral treatment, often returned as pragmatic responses to institutional pressures. By the late 19th century, therapeutic optimism had given way to therapeutic pessimism, with many psychiatrists viewing mental illness as largely incurable and hereditary. This pessimism was reinforced by the rise of degeneration theory, which portrayed mental illness as the result of inherited biological deterioration. Bénédict Augustin Morel proposed that certain families carried inheritable defects that worsened with each generation, eventually resulting in insanity, idiocy, and sterility. This theory provided a seemingly scientific explanation for the apparent increase in mental illness and linked it to other social problems like alcoholism, crime, and poverty. By the end of the century, these ideas were influencing social policy, providing justifications for increased surveillance and control of "dangerous" populations and laying intellectual groundwork for the eugenics movement that would gain momentum in the early 20th century. The 19th century thus witnessed contradictory developments in the approach to mental illness. The humanitarian impulse to provide specialized care led to the creation of an extensive asylum system, while scientific ambitions produced increasingly sophisticated classification systems. Yet these achievements were undermined by overcrowding, underfunding, and the growing influence of pessimistic biological theories. The asylum, initially envisioned as a place of healing, had become for many a place of permanent confinement—a transformation that would prompt new waves of reform in the coming century.

Chapter 4: Desperate Remedies: Shock Therapies and Surgical Interventions (1900-1950)

The first half of the 20th century witnessed a dramatic shift in psychiatric treatment, as asylum doctors sought more effective interventions for mental disorders that had previously seemed intractable. This period saw the development of a series of physical treatments that promised to cure or at least ameliorate serious mental illnesses. These interventions reflected both therapeutic desperation in the face of overcrowded asylums filled with chronic patients and the growing influence of biological approaches to psychiatry that sought to establish the field as a legitimate medical specialty. The first major breakthrough came with malaria therapy for general paresis (neurosyphilis), developed by Julius Wagner-Jauregg in 1917. By deliberately infecting patients with malaria to induce high fevers, Wagner-Jauregg found he could arrest the progression of this previously fatal condition. This success, which earned him the Nobel Prize in 1927, encouraged psychiatrists to explore other physical interventions. Soon came insulin coma therapy, developed by Manfred Sakel in 1933, which involved inducing hypoglycemic comas in patients with schizophrenia. Though dangerous and lacking clear scientific rationale, the treatment gained widespread adoption based on reports of improvement in some patients. The most influential of these somatic treatments was electroconvulsive therapy (ECT), developed by Ugo Cerletti and Lucio Bini in 1938. After observing that epileptic seizures sometimes alleviated psychotic symptoms, they developed a method to induce controlled seizures using electrical current. ECT proved particularly effective for severe depression, providing dramatic relief for some patients who had been unresponsive to other treatments. However, the procedure was initially performed without anesthesia or muscle relaxants, making it a frightening experience that could cause fractures and other injuries. These risks, combined with its sometimes coercive use, contributed to ECT's controversial reputation, though modified versions remain in use today for treatment-resistant depression. Perhaps the most dramatic and ultimately discredited intervention was prefrontal lobotomy, a form of psychosurgery developed by Portuguese neurologist Egas Moniz in 1935. The procedure involved severing connections in the brain's frontal lobes, which Moniz believed would disrupt pathological thought patterns. American neurologist Walter Freeman developed a simplified version called transorbital lobotomy, in which an ice-pick-like instrument was inserted through the eye socket and used to sever brain connections. Freeman traveled the country performing these operations, sometimes doing dozens in a single day. While lobotomy was promoted as a miracle cure that could empty asylums, its results were often devastating—leaving patients with profound personality changes, intellectual impairments, and emotional blunting. Nevertheless, tens of thousands of lobotomies were performed before the procedure fell into disrepute in the 1950s. World War I and II profoundly influenced psychiatric thinking during this period. The phenomenon of "shell shock" in WWI challenged prevailing notions about mental illness, demonstrating that psychological trauma could produce severe symptoms in previously healthy individuals. Military psychiatrists developed new approaches to treating acute stress reactions, emphasizing prompt intervention near the battlefield and expectation of recovery. These principles would later influence civilian psychiatric practice, though they were often forgotten between the wars only to be rediscovered. The massive psychiatric casualties of both world wars also highlighted the inadequacy of existing treatment approaches and created pressure for more effective interventions. By mid-century, psychiatry stood at a crossroads. The somatic treatments had demonstrated that biological interventions could affect mental states, yet their mechanisms remained poorly understood and their efficacy limited. The asylum system was increasingly recognized as inadequate, yet alternatives remained underdeveloped. This therapeutic and institutional crisis set the stage for two divergent responses that would transform mental health care in the coming decades: the psychopharmacological revolution, which would introduce effective medications for major mental disorders, and the deinstitutionalization movement, which would dramatically reduce the asylum population and shift care to community settings.

Chapter 5: Chemical Revolution: Psychopharmacology and Deinstitutionalization (1950-1980)

The discovery of chlorpromazine (marketed as Thorazine in the US and Largactil in Europe) in the early 1950s initiated a fundamental transformation in psychiatry. This first antipsychotic medication effectively reduced psychotic symptoms in many patients with schizophrenia, allowing them to function outside hospital settings. French psychiatrists Jean Delay and Pierre Deniker demonstrated chlorpromazine's effectiveness in 1952, and within a few years, the drug was being used worldwide. Unlike earlier sedatives, chlorpromazine specifically targeted psychotic symptoms like hallucinations and delusions without simply rendering patients unconscious. This specificity suggested that mental disorders might involve discrete neurochemical abnormalities that could be targeted with specific medications. The success of chlorpromazine prompted pharmaceutical companies to develop additional psychoactive compounds. The 1950s saw the introduction of the first antidepressant medications: monoamine oxidase inhibitors (MAOIs) like iproniazid and tricyclic antidepressants like imipramine. Lithium was recognized as an effective treatment for bipolar disorder, while benzodiazepines like chlordiazepoxide (Librium) and diazepam (Valium) provided safer alternatives to barbiturates for anxiety. By the 1960s, medication had become the primary treatment for serious mental illness, facilitating outpatient management of conditions previously requiring hospitalization. This pharmacological revolution reinforced biological understandings of mental disorders as primarily brain-based conditions, though the precise mechanisms of these medications remained poorly understood. Concurrent with this pharmacological revolution came the dramatic process of deinstitutionalization. Mental hospital populations, which had reached historic highs in the 1950s, began a steady decline that accelerated through the 1960s and 1970s. In the United States, the inpatient population fell from over 550,000 in 1955 to under 200,000 by 1980. Similar patterns occurred across Western nations. While often attributed to new medications, deinstitutionalization actually resulted from complex factors including fiscal pressures on states, changing social attitudes, legal reforms, and the creation of federal programs like Medicaid and Medicare that shifted costs away from state budgets. The Community Mental Health Centers Act of 1963, signed by President Kennedy, promised a network of local facilities to provide comprehensive services, though funding never matched the ambitious vision. The consequences of deinstitutionalization proved deeply contradictory. For many patients with less severe conditions, the opportunity to live in the community represented a genuine liberation from institutional confinement. New approaches like psychosocial rehabilitation, supported housing, and assertive community treatment demonstrated that many people with serious mental illnesses could thrive with appropriate support. However, deinstitutionalization also produced new forms of neglect and abandonment. Community mental health services were chronically underfunded and fragmented. Many former patients ended up homeless, imprisoned, or living in substandard board-and-care homes—a phenomenon critics called "transinstitutionalization." Families often shouldered caregiving responsibilities without adequate support. This period also saw significant legal reforms affecting mental health care. In the United States, cases like O'Connor v. Donaldson (1975) established that non-dangerous mentally ill individuals could not be confined against their will if they were capable of surviving safely in freedom. State legislatures enacted new commitment laws requiring proof of dangerousness rather than simply need for treatment. These reforms protected civil liberties but sometimes created barriers to treatment for severely ill individuals who lacked insight into their conditions. The patients' rights movement, inspired by broader civil rights activism, challenged psychiatric authority and coercive treatments, establishing important protections but sometimes idealizing autonomy at the expense of needed care. The pharmaceutical industry gained enormous influence over psychiatric practice and research during this period. Drug companies funded much of the research on mental disorders, shaped continuing medical education, and marketed aggressively to physicians. Critics argued that this commercial influence led to overdiagnosis, overtreatment, and a reductive biological model that neglected psychological and social factors in mental illness. These concerns would intensify in later decades with direct-to-consumer advertising and the development of newer, more expensive medications with questionable advantages over earlier drugs. By 1980, the landscape of mental health care had been transformed. The asylum era was ending, replaced by a fragmented system of community services, short-term hospital units, and various residential facilities. Medication had become the cornerstone of treatment, while psychosocial approaches struggled for recognition and funding. These changes represented both progress and new problems—expanded civil liberties and reduced institutional abuses, but also gaps in care and new forms of neglect for the most vulnerable. The challenge of creating truly humane and effective alternatives to institutional care would continue to define mental health services in the coming decades.

Chapter 6: From Stigma to Rights: The Patient Movement and Reform (1980-Present)

The last four decades have witnessed profound changes in how mental illness is understood, treated, and socially positioned. Perhaps the most significant development has been the emergence of a powerful consumer/survivor movement led by people with lived experience of mental illness and psychiatric treatment. Building on earlier patients' rights activism, this movement has challenged traditional power dynamics in mental health care, advocating for greater autonomy, dignity, and inclusion. Organizations like the National Alliance on Mental Illness (NAMI), founded in 1979, have brought together patients and families to advocate for improved services and reduced stigma. Meanwhile, more radical groups like MindFreedom International have questioned fundamental assumptions about psychiatric diagnosis and treatment, promoting alternatives to the medical model. The concept of recovery has transformed approaches to serious mental illness. Rather than focusing solely on symptom reduction or cure, recovery-oriented care emphasizes helping people live meaningful lives in their communities despite ongoing symptoms. This approach, which gained prominence in the 1990s, recognizes that clinical improvement is only one aspect of recovery—equally important are housing, employment, relationships, and a sense of purpose. Peer support specialists—individuals with lived experience of mental illness who provide services to others—have become integral to many mental health systems, offering hope and practical guidance based on personal experience rather than professional training. Biological psychiatry has continued to dominate research and treatment approaches, though with increasing recognition of its limitations. The 1990s, declared the "Decade of the Brain" by the U.S. Congress, saw massive investments in neuroscience research aimed at understanding the biological basis of mental disorders. New technologies like functional magnetic resonance imaging (fMRI) allowed researchers to observe brain activity in living subjects. Genetic studies sought to identify heritable risk factors for conditions like schizophrenia and bipolar disorder. While these approaches yielded important insights, they also revealed the extraordinary complexity of the brain and the multifactorial nature of mental disorders. Despite decades of intensive research, the biological basis of major psychiatric conditions remains incompletely understood. The pharmaceutical landscape has evolved significantly since 1980. The introduction of selective serotonin reuptake inhibitors (SSRIs) like Prozac in the late 1980s marked a turning point, as these medications were promoted not just as treatments for illness but as enhancers of normal functioning. Direct-to-consumer advertising, legalized in the United States in the 1990s, encouraged patients to request specific medications from their doctors. Meanwhile, second-generation antipsychotics promised fewer side effects than earlier drugs, though at much higher costs and with their own problematic effects like weight gain and metabolic syndrome. Critics have increasingly questioned whether newer psychiatric medications offer significant advantages over older ones, pointing to publication bias, selective reporting of clinical trials, and aggressive marketing as factors inflating perceptions of their efficacy. Global mental health has emerged as a significant field, bringing attention to the vast disparities in mental health care between high-income and low- and middle-income countries. The World Health Organization's Mental Health Gap Action Programme (mhGAP), launched in 2008, aims to scale up services for mental, neurological, and substance use disorders in resource-limited settings. However, critics have questioned whether Western psychiatric concepts and treatments can be appropriately applied across diverse cultural contexts. Indigenous communities and other cultural groups have reasserted traditional understandings of psychological experiences that Western psychiatry has pathologized, challenging the universality of psychiatric categories and treatments. The criminalization of mental illness has become increasingly recognized as a critical issue. In the United States, deinstitutionalization without adequate community services, combined with tough-on-crime policies, has resulted in jails and prisons becoming de facto mental health facilities. An estimated 20% of prison inmates have a serious mental illness, receiving inadequate treatment in environments that often exacerbate their conditions. Specialized mental health courts and crisis intervention teams for police have emerged as partial responses to this problem, though systemic change remains elusive. Similar patterns exist in other countries, reflecting the persistent challenge of creating appropriate community supports for vulnerable populations. As we move further into the 21st century, mental health care continues to evolve. Digital technologies offer new possibilities for monitoring symptoms, delivering interventions, and connecting individuals to support. The COVID-19 pandemic accelerated the adoption of telehealth services, potentially expanding access while raising questions about the quality of virtual care. Meanwhile, interest in psychedelic-assisted therapies has resurged, with substances like psilocybin and MDMA showing promise for conditions including depression and PTSD. These developments suggest that the field remains open to innovation, even as it continues to grapple with fundamental questions about the nature of mental illness and the most effective and humane approaches to alleviating psychological suffering.

Summary

The history of mental health care reveals a pendulum swinging between competing frameworks—supernatural versus natural, moral versus medical, psychological versus biological, institutional versus community-based. Each era has contributed valuable insights while also demonstrating the limitations of any single approach. From ancient supernatural explanations to medieval religious interpretations, from Enlightenment moral treatment to Victorian biological pessimism, from desperate experimental treatments to psychopharmacological interventions, our understanding has evolved not in a straight line of progress but through cycles of reform, reaction, and synthesis. Throughout this journey, the most enduring lesson may be the danger of reductionism—mental illness has repeatedly defied attempts to explain it through single-factor theories, whether demonic possession, humoral imbalances, psychodynamic conflicts, or neurotransmitter dysfunctions. As we look to the future, the challenge remains to develop approaches that integrate biological, psychological, and social dimensions while respecting the dignity and autonomy of those who suffer. This means creating mental health systems that provide effective treatments without coercion whenever possible, that recognize the expertise of lived experience alongside professional knowledge, and that address the social determinants of mental health including poverty, discrimination, and trauma. It also means acknowledging that our understanding remains incomplete and maintaining humility about our interventions. Perhaps most importantly, we must remember that behind every theory and treatment approach are real human beings whose experiences of distress demand our compassion and our continued efforts to understand and alleviate their suffering. The struggle for dignity in mental health care continues, informed by history but not bound by it, as we work toward more humane and effective responses to one of humanity's most persistent challenges.

About Author

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Andrew Scull

Andrew T. Scull (born 1947) is a British-born sociologist whose research is centered on the social history of medicine and particularly psychiatry. He is a Distinguished Professor of Sociology and Science Studies at University of California, San Diego and recipient of the Roy Porter Medal for lifetime contributions to the history of medicine. His books include Madhouse: A Tragic Tale of Megalomania and Modern Medicine and Madness in Civilization: A Cultural History of Insanity. Scull was born in Edinburgh, Scotland, the son of Allan Edward Scull, a civil engineer and Marjorie née Corrigan, a college teacher. He received his BA with first class honors from Balliol College, Oxford. He then studied at Princeton University, receiving his MA in Sociology in 1971 and his Ph.D. in 1974. He was a postdoc at University College London in 1976-77.Scull taught at the University of Pennsylvania from 1973 until 1978 when was appointed to the sociology faculty at University of California, San Diego as an Associate Professor. He was appointed a full professor in 1982, and Distinguished Professor in 1994.

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