This essay was written for a meeting held in Williamsburg, Virginia, in 1973 to commemorate the bicentennial of the British North American colonies' first public hospital for the mentally ill. The celebration was invested with a certain irony, an irony that needs little explanation. The reputation of inpatient psychiatry was at a particularly low level in the early 1970s. The movement to deinstitutionalize men and women diagnosed as “mentally ill” had already begun, crystallizing generations of criticism. Clinical optimism, psychopharmacology, and a new kind of assertive liberalism had made the state hospital's custodial back wards seem an indefensible relic of a more primitive social order, and the population of America''s state hospitals had already begun to decline. This was a period marked by a more general skepticism toward the medical enterprise, and in particular toward psychiatric diagnoses and the medical authority that legitimated and enforced them. To a generation wary of credentialed authority, the gap between the labeling of deviance and the diagnosis of illness had begun to narrow; the diagnosed had thus become more victim than patient, more stigmatized than understood. Social control rather than humane care was psychiatry's perceived purpose; women, the poor, and the deviant generally were seen as its chosen targets.