Illness puts money in the pockets of doctors and other health-care providers. Everyone understands this, and few object. After all, most physicians bring to their fight against disease an admirable professionalism that puts the health of their patients far ahead of their own desire for income. But only the naïve would suppose that financial incentives never cause medical professionals to commit medical fraud, to recommend unnecessary surgeries, or to return dubious diagnoses.

Indeed, a disturbing body of evidence implicates an enterprising but unethical minority of health professionals in the dubious practice of “disease mongering.” “Disease mongering,” as one investigator has explained, can take many forms — including unnecessary surgery and overly aggressive treatment — but it always amounts to “a strategy employed by the health care industry in exploiting patients to maximize profits.”1 For instance, pharmaceutical advertising often persuades those with minor or vague symptoms to purchase unnecessary medicines, so stretching “the boundaries of treatable illness ... to extend the markets for new medical products.” These disease-mongers work at “making healthy people feel sick” even as they promote costly new cures for their “sponsored” illness.2

For good reason, leading medical authorities have criticized colleagues for resorting to propagandists’ ruses in “selling sickness.” Some medical professionals, these critics allege, form “informal alliances” with others who share their economic interests and then “target the news media with stories designed to create fears about [some] condition or disease and draw attention to the latest treatment.” Media manipulation of this sort often involves the use of “disease prevalence estimates framed to maximize the size of a medical problem” and may include a “medical education plan” that amounts to no more than camouflaged “marketing strategy.”3

More alarming yet is the disease-mongering that takes place when health-care professionals take in huge sums by subjecting patients to invasive procedures not warranted by any real medical condition. One cardiac-surgery unit in California, for instance, was implicated in 2003 with having raked in over $90 million by performing hundreds of unnecessary open-heart surgeries.4 Similarly, in 2001 authorities in New York investigated doctors accused of performing “needless and inappropriate prostate surgery for mentally ill patients” subjected to “assembly line” procedures.5

Sensational circumstances made the California and New York cases headline news, but medical analysts suspect that physicians actually perform hundreds of thousands of unnecessary surgeries every year outside of media scrutiny. One study of myringotomies (insertions in the ear of tiny tubes to prevent infections) concluded that “well over half” of such operations were performed for “equivocal or inappropriate reasons” — including “desire for profits.”6 Even more disturbing was a 2003 study finding that in 75 percent of the 600,000 hysterectomies performed each year, this highly invasive procedure has been “inappropriately recommended.” Further analysis suggests that the physicians making such inappropriate recommendations are responding to a payment schedule that financially discourages “less invasive methods to treat female pain and bleeding” and “encourages jumping to hysterectomy because it will pay more.”7

Given that disease-mongers sometimes use the media to persuade the insecure and gullible to view “personal problems as medical,” it is hardly surprising that many patients actively seek out inappropriate medical procedures.8 However, while ethical health professionals help these misguided patients understand why they should not undergo the sought-for treatment, medical profiteers do not. Such profiteering may indeed be discerned behind the reports of thousands of cases of unnecessary and potentially dangerous plastic surgery, usually performed on affluent urban women suffering from “a body image disorder” not cured with a scalpel.9 Sufferers from the man-made disease of obesity likewise turn their personal problems into opportunities for medical profiteering when they resort to the surgeon: experts estimate that five million Americans are likely to have their stomach “surgically altered so as to keep food from being digested.” Surgeons who perform such operations report “long waiting lists.”10

Disease-mongering not only fills Americans with misguided hopes and shrouds them in ill-founded fears, but it also imposes tremendous financial costs. In the mid-Nineties, when the nation’s total annual health care bill was already approaching a trillion dollars ($400 million of it paid by the taxpayer), the RAND corporation concluded that fully “one-fourth to one-third of medical care is unwarranted or of debatable value.”11

The fraud and malpractice in the health-care industry should not blind Americans to the high quality of care that health-care professionals usually render. However, the documented and widely publicized abuses should remind Americans of the temptations likely to emerge in any situation in which one man’s illness swells another man’s income. And these temptations frequently show up far from the hospital and doctor’s office.

Does the profitability of pathology explain, for instance, why the United States now has the highest incarceration rate and the costliest prison system in the world? Many observers wonder.

Though much of the criticism of what has been dubbed the “Prison-Industrial Complex” has come from leftists, all Americans have good reason to ask why in 2000 the prison industry was the second-fastest growing industry in the country (trailing only the gambling industry in its growth rate). Why does a country inhabited by only five percent of the globe’s population account for fully 25 percent of the world’s prisoners?12

Something does indeed seem askew in a country that in the Nineties spent an average of $7 billion a year in building prisons and that by 2000 employed 523,000 of its citizens in building, guarding, or otherwise serving the prisons that have now become the compulsory home of more than two million inmates.13

To be sure, the nation’s leftist critics of the Prison-Industrial Complex too often ignore the real social perils let loose by the cultural firestorm of the Sixties. Still, just like the critics of medical disease-mongering, the critics of the Prison-Industrial Complex raise legitimate questions about the profits derived from social illness.

By characterizing the nation’s correctional system as “the Prison-Industrial Complex,” critics have identified a starting point for questions, for this characterization purposefully echoes President Dwight D. Eisenhower’s famous 1961 remarks about a “conjunction of an immense military establishment and a large arms industry” which was then “new in the American experience.” Because this conjunction posed the risk of a “disastrous rise of misplaced power,” Eisenhower urged Americans to “guard against the acquisition of unwarranted influence, whether sought or unsought by the military-industrial complex.”14 Eisenhower issued this warning at a time when defense contractors and their military, congressional, and media allies were fanning public fears of a “missile gap” supposedly giving the Soviet Union a perilous advantage over the Untied States. But Eisenhower knew from intelligence reports that no such gap existed and that those fostering groundless fears about it were simply trying to win profits or career advancement from an unnecessary enlargement of the military-industrial complex.15 In other words, Eisenhower saw professionals tied to the military engaging in the same kinds of dubious tactics deployed by disease-mongering professionals in the health-care industry : both groups seeking to justify costly (and profitable) responses to an exaggerated threat.

Critics of the nation’s Prison-Industrial Complex invoke Eisenhower’s cautionary analysis to buttress their own assertions that “the lure of big money is corrupting the nation’s criminal-justice system.”16 Like Eisenhower, such critics limn a problematic “conjunction” of political and economic interests and a real danger of “misplaced power.” These critics view with concern the way small-town mayors have “sought out prisons as economic saviors” and then have grown “anxious to fill the beds of their bars-and-concrete growth strategy.”17 These critics view with particular concern the establishment of 100 for-profit prisons in 27 states.18 Even defenders of the for-profit prisons acknowledge that many Americans wonder “whether it is seemly to make money from incarcerating fellow citizens.”19 But, of course, correctional system money flows to recipients other than the owners of for-profit prisons. As Atlantic Monthly writer Eric Schlosser remarks, “The prison-industrial complex includes some of the nation’s largest architecture and construction firms, Wall Street investment banks, and companies that sell everything from security cameras to padded cells available in a vast ‘color selection.’”20 The smell of leftist ideology hangs over the assertion that “money motivates the United States to keep millions behind bars, regardless of the crimes committed, regardless of the inhumanity, and regardless of the overall damage to entire communities.” 21 But the remarkable profitability of a Prison-Industrial Complex now incarcerating a record number of Americans should give pause even to those resistant to leftist doctrines. After all, if medical professionals — widely (and usually justly) regarded as models of integrity — sometimes allow financial incentives to lead them into inappropriate health-care decisions, how can Americans intelligently suppose that those associated with the nation’s correctional system are always immune to the influence of such incentives?

What is more, the Prison-Industrial Complex offers its supporters more than money; it also offers them many non-pecuniary but very real political and career rewards. Thus critics of the complex see politicians whose electoral success reflects their success in currying favor with constituents who profit from a growing Prison-Industrial Complex and in winning votes from constituents whose fears of crime make them supportive of “tough on crime” legislation. Critics also see many bureaucrats whose “fiefdoms have expanded along with the inmate population.”22 Thus while one of the more thoughtful critics acknowledges that “the prison-industrial complex is not a conspiracy, guiding criminal-justice policy behind closed doors,” he can still plausibly describe it as a troubling “confluence of special interests” sufficiently powerful to give “prison construction in the United Sates a seemingly unstoppable momentum.”23

Defenders of the Prison-Industrial Complex argue that it was precisely the expansion of this complex in the Nineties that pushed crime rates down during that decade. But after an exhaustive review of the data, two leading criminologists have concluded that although it appears to have succeeded in reducing property crime, America’s aggressive “incarceration explosion” of the Nineties merits no better than “a Gentleman’s C” in suppressing violent crime and that “even a D minus” would be “generous” in evaluating its effects on drug use and distribution.24 Critics of that complex also adduce evidence that its growth has been inordinate by pointing to Canada, which also saw its crime rates fall in the Nineties (down by 1998 to their lowest levels since 1969) with almost no expansion in its prison system.25 Indeed, since imprisonment is widely believed to harden young offenders, American citizens may have realized no more real benefit from an overly aggressive prison-building policy than American patients have realized from the overly aggressive medical practices that have accompanied disease-mongering.

More cynical defenders of the Prison-Industrial Complex might acknowledge that it has grown beyond any bounds defined by the public’s legitimate need to control crime, yet insist that such growth has still benefited the nation by stimulating the economy. Particularly in rural areas, some Americans do indeed now regard “a surfeit of prisons” as “integral to [the country’s] economy”26 This kind of thinking echoes in strange ways the 18th-century argument advanced by Bernard Mandeville in The Fable of the Bees: or Private Vices, Public Benefits (1714). Arguing that “it would be utterly impossible, either to raise any multitudes into a populous, rich and flourishing nature, or when so raised to keep and maintain them in that condition, without the assistance of what we call evil both natural and moral,” Mandeville viewed “vice ... [as] the very wheel that turned ... trade.”27 As a modern Enlightenment scholar has explained, Mandeville believed “it was greed, vanity and amour proper which actually kept the social merry-go-round turning — they provided work and created wealth.”28 “Bare virtue,” Mandeville asserted, “can’t make nations live in splendor,” since “few virtues employ any hands,” while “plagues and monsters” provide “livelihood to the vast multitudes.”29

Mandeville’s logic does indeed sound like a justification for the kind of profit-from-pathology social dynamics that have given America a burgeoning Prison-Industrial system. Mandeville truly sounds like an advisor to a small-town, 21st-century mayor lobbying for the construction of a prison in his community when he reasons that “private vices by the dextrous management of a skillful politician may be turned into public benefits.” Moreover, he sounds even more like an apologist for 21st-century disease-mongers when he rationalizes away the offenses of “physicians [who] valued fame and wealth above the drooping patient’s health” and who worried less about “their own skill” than about “the apothecary’s favour.”30 But as useful as they might prove to prison-builders or disease-mongers, Mandeville’s cynically opportunistic views on building a social economy out of vice provide an even better gloss on the morally dubious but financially and politically remunerative activities of the profiteers who have made the decay of the American family “the very wheel” that turns their diverse enterprises.

At one time, American family life offered almost no opening for Mandevillian enterprise. Living in nearly-complete economic autonomy, a 19th-century agrarian family satisfied most of its needs through the labors of family members, so staying clear of the money economy in which Mandeville saw vice serving as an indispensable stimulant.31 By the mid-20th century, though, the typical urban American family found itself fully enmeshed in the cash nexus so dear to Mandeville’s calculating heart. By that time, most American families relied heavily on factories for clothing, automobiles, and household goods; public schools for their children’s education; banks for financial services; and Hollywood and television for entertainment. Writing in the 1950’s, the Harvard sociologist Pitirim Sorokin expressed dismay that the American home had lost so many of its productive functions that it was fast becoming “a mere incidental parking place.”32 Somewhere the shade of Mandeville must have been smiling.

Nonetheless, the average American family of the Fifties or Sixties resisted the gravitational pull of a fully Mandevillian world by safeguarding certain family loyalties and honoring certain domestic obligations. Most mothers still cooked family meals rather than relying on restaurants or take-out; many still sewed some of their husbands’ and children’s clothing. Almost all mothers cared for their own young children rather than turning this task over to a paid surrogate. Fathers not only provided for their wives and children financially but also performed many home repair and maintenance tasks. Though it had surrendered much, the American family still retained a residual core of its traditional autonomy and self-reliance.

During the last three decades, however, the nation’s shrewdest Mandevillians have gone to work in turning family disintegration into a vast new opportunity to turn pathology into profit — with all the skill of the best disease-monger or prison-builder.

Long the heart of a healthy home, the homemaking mother came under strong attack in the Sixties and Seventies by Mandevillians who recognized how much ready cash they could pocket if they could only take over the tasks that the homemaker did without monetary compensation. Of course, to some degree advertisers had been busy for decades coaxing mothers out of “the handcraft age” in which they satisfied many of the household’s needs for food and clothing through their own productive labors and enticing them into a modern era in which they served chiefly as a household purchasing agent. The considerable success of this advertising threatened to make homemakers little more than the parking-lot attendant for the “mere incidental parking space” which the home was fast becoming. This cultural erosion of homemaking indeed helped create what one Seventies analyst called “the festering contradiction of modern womanhood.”33 Social physicians could have prescribed a curative restoration of productive activities to the home and so renewed a homemaker’s pride in her crafts. But where was the profit in that? No, the new Mandevillians recommended a radical but quite unnecessary kind of social surgery: It is time, they said, to cut the mother out of the home.

Like their distant cousins in disease-mongering medicine, these masters of social malpractice have understood very well the art of “making healthy people feel sick,” they have understood how to forge “informal alliances” with others who share their economic and political interests, and they have understood how to “target the news media with stories designed to create fears about [some] condition” that they can then promise to treat. By the early 1970’s, Americans were softened up to the idea of allowing their home to go under the scalpel for a mother-ectomy by a relentless bombardment from media commentators and feminist intellectuals. These well-placed disease-mongers explained to a bewildered public that instead of being the very center of a normal social life, the home was rather a “prison of domesticity,” “patriarchy’s chief institution,” and a horrible dead-end for enlightened women seeking “equality with men in the world of jobs and careers.”34

At first, the new Mandevillians in education and the media sought to persuade American families to submit to mother-ectomies voluntarily — like insecure women who seek out plastic surgeons or obese patients who ask doctors for a stomach stapling. But over time, the new Mandevillians won allies in government and adopted more coercive tactics: avoiding a mother-ectomy became more and more difficult as policymakers removed the tax protections previously afforded young families and utterly destroyed the traditional “family wage” regime which had given a married man enough income to support his homemaking wife and his children.35

And just as the new Mandevillians anticipated, as mothers surrendered the previously unremunerated task of caring for their children to paid surrogates, rivers of new money began to flow. By 1997, the nation’s nearly 44,000 child-care establishments were reporting total income of $8.4 billion with total annual payroll of just under $4 billion going to 389,000 employees.36 New money — public and private — has likewise flowed into after-school programs and summer camps serving families whose homemaking mother has been surgically excised in a social operation even more unnecessary than most hysterectomies and myringotomies. However, in the social merry-go-round the new Mandevillians have not set turning day-care providers, nor summer-camp operators, nor their political allies have been complaining: they have been too busy counting their profits. Also joy riding on the Mandevillian social merry-go-ride are the food-service providers, who saw their income rise to almost $90 billion in 2002 as they faced less and less competition from unpaid homemakers cooking meals at home.37And because the cash nexus is also the tax nexus, the Internal Revenue Service has especially enjoyed the increasingly frenetic whirling of the Mandevillian social merry-go-round: when money changes hands for childcare or meal preparation, the taxman collects revenues that were unavailable so long as homemaking mothers performed the tasks. The new tax money has helped to pay the army of new government workers licensing and supervising the new day-care centers and restaurants.

But as profitable as mother-ectomies have proven for them, the new Mandevillians see even bigger money in an even-more radical social surgery — the father-ectomy, more commonly called a divorce.

Naturally, just as they have done in promoting the mother-ectomy, the new Mandevillians have done some very successful disease-mongering in “making healthy people feel sick,” forging “informal alliances” with others who share their economic and political interests, and “target[ing] the news media with stories designed to create fears about [some] condition” that they could then promise to treat. In the late Sixties and Seventies, just as they filled the media with screeds about the awfulness of homemaking, progressive disease-mongers began to characterize wedlock as an outmoded institution, sexually repressive, professionally hobbling, and psychologically suffocating. “I wouldn’t say that marriage and self-actualization are necessarily mutually exclusive,” explained Laura Singer, president of the American Association for Marriage and Family Therapy during the Seventies, “But they are difficult to achieve together.”38 Some of the more aggressive disease-mongering advocates of father-ectomies began to warn of the dangers of domestic violence inherent in marital relationships, even describing the marriage license as “a hitting license.”39

Mandevillian legislators in every state soon enacted “no-fault” divorce statutes that made the state — as one legal analyst noted — an ally of “the spouse who wants to get divorced.”40 And by the early Eighties, a profitable new industry was in high gear, raking in professional fees with every turn of the disintegrative social merry-go-round. Profiteering attorneys found high salaries through employment in a Mandevillian system described by one observer as “‘a divorce industry’ ... of professional meddlers who make millions of dollars every year off marital turmoil, much of which they have a hand in creating themselves.”41 Indeed, although the sponsors of “no fault” divorce statutes promised that their passage would reduce adversarial litigation, legal analysts have seen an increase in property-division and child-custody litigation under “no fault,” an increase which caused one commentator to wonder “whether the legal profession has not been the major beneficiary of the no-fault divorce reforms.”42

But as any well-versed Mandevillian could explain, the divorce industry churns out economic benefits for many besides the courtroom lawyers. Therapists and psychologists have also turned divorce into an economically rewarding opportunity as they help “a dissolving couple system ... [to] achieve a constructive divorce.”43 Real-estate agents likewise punch their tickets on the divorce gravy train, since a divorcing family now needs two residences rather than just one. Even advertisers see new opportunities in making their consumer pitches to “a post marital society.”44

But in the true spirit of Bernard Mandeville, the divorce industry has created a particularly lucrative opportunity for those who perform a service that intact families simply do not need: collecting child-support from the non-custodial parent (almost always the father) and delivering it to the custodial parent (almost always the mother).45 In 2001, government agencies, divorce attorneys, and private collection agencies collected $19 billion in child support.46 Fathers, of course, would have earned that money for their families even if they had never been divorced. But only divorce creates a profit for those who collect and deliver that money. So profitable is this enterprise that, just as America’s incarceration boom has produced private for-profit prisons, even so, America’s divorce revolution has produced private for-profit child-support collection agencies. A single such company, Supportkids, has already claimed $40 million as its commission for collecting $120 million in child support. The size of such commissions has prompted a few journalists to ask, “Do [such] companies ... profit children or mainly themselves?” But defenders of such companies have responded by arguing that “the bounty-hunting industry might not exist if the government were more competent: the state is supposed to collect child support free of charge.”47

But then only the hopeless naïve supposes that the state has ever done anything “free of charge”: American taxpayers are now paying a great deal to fund the government sector of the Mandevillian child-support system. Government officials must spend approximately one tax dollar for every four child-support dollars collected, amounting to nearly $5 billion a year.48 Of course, neither the family-court judges, nor the collections officers and accountants, nor the child-support computer analysts, nor their vendors are complaining about this expenditure. Since the Federal government now offers incentive fees to states to collect child support, state officials are particularly unlikely to express dismay at how the child-support system is burdening the taxpayer.

It is not necessary to see anything conspiratorial in the child-support network to recognize that, just as in the Prison-Industrial Complex, this network has created a dubious “confluence of special interests.” Political scientist Stephen Baskerville has aptly pointed out, “fatherlessness and the judicial bureaucratic machinery connected with it have grown up together.” And within that Mandevillian machinery, “full-time lawyers, judges, child support enforcement agents, and representatives of other organizations ... have a vested interest in both removing children from their fathers and making the fathers’ support obligations as burdensome as possible.”49 Even a defender of that system acknowledges that “if all children lived with both of their biological parents in the same household, every civil servant who works in a child-support agency would be out of a job.”50 Since the government jobs of these civil servants usually pay well and offer good benefits — unlike the low-pay, no-benefit jobs multiplying in the service sector — it is hard not to wonder if such civil servants do not share with Bernard Mandeville a certain distaste for social virtue.

But the divorce industry generates profits from pathology for many besides its direct employees. Compared to children raised in intact families, children of divorced parents are much more likely to give work to pediatric and adolescent psychiatrists, juvenile detention and probation officers, social workers, and remedial teachers.51 Divorce even drives up the incidence of the domestic violence falsely associated with wedlock by the disease-mongering propagandists promoting the surgical dismembering of families.52

No one need suppose anything conspiratorial or even anything consciously Mandevillian in the growth of enterprises that profit from marital and family failure. But just as in the explosive growth of the Prison Industrial Complex and in the suspicious rise in doctors’ reliance on certain costly surgeries, Americans must wonder about a disturbingly Mandevillian confluence of special interests. Indeed, even if they trusted those employed in the divorce industry and its spin-offs as much as they trust physicians, Americans would still have reason to believe that this industry has performed unnecessary father-ectomies for profit at least as often as doctors have performed unnecessary hysterectomies and myringotomies for profit. And since many Americans actually regard the professionals at the very heart of the divorce industry — that is, lawyers and therapists — with considerable weariness,53 they might well wonder if the number of unnecessary father-ectomies performed for Mandevillian profits does not actually run far higher.

Even if those who profit from family failure do not deliberately subvert marriage and family life, only rare virtue could keep their behavior entirely unaffected by a vague awareness of how family disintegration enlarges their bank accounts and increases their political power. At a minimum, such an awareness fosters quiet acquiescence in policies that undermine wedlock and family life. Such awareness also weakens support for policies that reinforce marriage and family life.

But even evidence that many Americans now actively subvert wedlock for monetary and political profit would not horrify obdurate Mandevillians. Rehabilitating the arguments that Mandeville himself put forward almost three hundred years ago, these theorists would insist that, like other vices, family failure stimulates the economy. They could even plausibly assert that the success of all American marriages and families would mean unemployment for an army of convenience-goods makers and marketers, of day-care providers, of after-school program employees, of divorce court judges and attorneys, of child-support collection officers, and feminist-cause lobbyists. Similarly, they might warn that a strong resurgence in family life would throw tens of thousands of prison workers, detox specialists, pediatricians and abortion doctors, psychologists and therapists, juvenile court judges and officers out of work. These new Mandevillians might even characterize weak family life as an absolute necessity for sustaining the nation’s economy.

But Americans who look closely at the new economy of family failure will give little credence to Mandevillian justifications for its growth. In the first place, this dubious economy generates dollars only parasitically. When Americans spend their money on divorce proceedings, on collecting child support, or on giving therapy to children traumatized by family disintegration, they are producing nothing of positive value — not computers, not cars, not books, not steel or oil. They are instead consuming dollars produced in truly value-added enterprises. When a state legislator recently complained that money spent on building prisons was “just money down a rat hole” because it was money unavailable for genuinely productive pursuits,54 he might just as well be looking at the burgeoning family-failure industry. For building new divorce courts does no more to enrich society than does building more prisons. In fact the multiplication of divorce courts inevitably presages the multiplication of prisons.

Even the convenience foods, day care, and second homes that Americans buy when family life weakens or fails look like very poor purchases. How many fast-food meals compare to a lovingly prepared home-cooked meal? How many day-care-center workers will ever give the children in their care the kind of affection an at-home mother can? And how can a split family ever hope to maintain in two homes the same level of physical or emotional comfort that they could attain with comparable resources if living in just one home?

Nevertheless, of course, what is lost as the family-failure industry grows, cannot be measured monetarily because so much of it cannot be purchased at any price. Maternal love is not for sale in any day-care center. None of the collection agencies chasing down child-support dollars offers paternal devotion. And the carnal services sold as a pathetically incomplete substitute for spousal love bear the name of prostitution.

Also beyond price, civic health declines when family life disintegrates. The great 19th-century French economist Frederic Le Play understood the indispensability of strong family life to a harmonious society. As one of his disciples has explained, Le Play’s economics made “moral and social harmony ... of paramount importance; for without these wealth itself may be merely [an inducement] to feud, pride, bad blood, and envy, if not an instrument of positive oppression.” Rather than attending solely to the flow of money, Le Play made the family “the touchstone by which [he] test[ed] institutions” and economic arrangements. Wiser than Mandeville, Le Play viewed the strength of family life as a protection for ordinary citizens, who he felt needed to be “shielded ... from being blown about by every breath of economic influence.”55 The 21st-century Stanford economist Jennifer Roback Morse is thus updating Le Play’s style of economics when she asserts that “the loving family is surely the foundation of the moral and cultural [element] of a free society.” “A limited government and free market,” she explains, “cannot exist without a substantial component of self-restraint among the citizenry. This internalized ethic cannot come into existence in the absence of loving families taking personal care of their own children.”56

Hence, while family failure may generate huge political and monetary profits for shrewd Mandevillians, it eventually bankrupts society. For good reason, even among those most zealously involved in the family-failure industry, most keep Mandevillian justifications for their enterprises out of view, a dirty little secret confessed only under duress. Many even avoid any self-scrutiny that would entail sober reflection on what they are doing and why. But just as government investigators and media reporters have managed to expose the Mandevillian excesses of disease-mongering and prison-building, public-spirited government leaders and honest journalists need to start asking hard questions about America’s Mandevillian family-failure industry. Because those reaping some of the biggest profits from that industry now control many government offices and media forums, posing those questions will require persistence and resolution. But the reasons for asking those questions are no less urgent than those for inquiring into the Mandevillian dynamics behind disease-mongering and prison-building. Asked to comment on a coronary surgery which subsequent investigation revealed to have been performed for profit and not for legitimate medical reasons, one patient remarked only that such surgery “hurts like hell.”57 Millions of Americans who have seen their families dismembered by Mandevillian profiteers could speak with the same voice.

Endnotes

1 Lynn Payer, “How to protect yourself against disease-mongering,” Health Confidential July 1993: 7-8.

2 “Disease mongering is a marketing ploy,” Pharmaceutical Journal 20 April 2002.

3 Ray Moynihan, Iona Heath, and David Henry, “Selling sickness: the pharmaceutical industry and disease mongering,” BMJ: British Medical Journal 324 (2002): 886-890.

4 John Blackstone, “Unnecessary open-heart surgeries performed at Redding Medical Center in California on hundreds of people,” CBS Morning News, CBS News Transcripts, 7 May 2003.

5 Clifford J. Levy and Sarah Kershaw, “Inquiry Finds Mentally Ill Patients Endured ‘Assembly Line’ Surgery,” New York Times 18 March 2001: A1.

6 “Needless surgery, needless drugs,” Consumer Reports March 1998: 1-4.

7 Elizabeth Vargas, “Unnecessary Surgery Hysterectomies,” World News Tonight With Peter Jennings, ABC News Transcripts, 22 August 2003.

8 “Disease mongering,” op. cit.

9 J. Conant and J. Gordan, “Scalpel slaves just can’t quit,” Newsweek 11 January 1988: 58-59.

10 Anne Chisholm, “The land of the fat American is eating its way to an early grave,” Sunday Telegraph (London) 22 June 2003: 10.

11 Edmund Faltermayer and Rosalind Klein Berlin, “Why Health Costs Can Keep Slowing,” Fortune 24 January 1994: 76-81.

12 Andrew Hartman, “U.$. Prisons Mean Money,” Humanist November/December: 6-10.

13 “Prisons Fuel Profits,” New Internationalist May 2000: 8-15.

14Eisenhower quoted in Chalmers Johnson, The Sorrows of Empire: Militarism, Secrecy, and the End of the Republic (New York: Metropolitan Books, 2004), 39.

15 See Eric Schlosser, “The Prison-Industrial Complex,” Atlantic Monthly December 1998: 51-77.

16 Ibid.

17 Douglas Clement, “Big House on the Prairie,” Fedgazette (Minneapolis) January 2002: 2-7.

18 “Prisons Fuel Profits,” op. cit.

19 Cait Murphy, “Don’t Lock Out Private Prisons,” Fortune 11 June 2001: 54-58.

20 Op. cit.

21 Hartman, op. cit.

22 Schlosser, op cit.

23 Ibid.

24 Henry Ruth and Kevin R. Reitz, The Challenge of Crime: Rethinking Our Response (Cambridge: Harvard University Press, 2003), 102.

25 Schlosser, op. cit.

26 Jerome G. Miller, “The American Gulag,” Yes! A Journal of Positive Futures Fall 2000: 12-17.

27 Bernard Mandeville, The Fable of the Bees: or Private Vices, Public Benefits (1714), in Eighteenth-Century Poetry and Prose, ed. Louis I. Bredvold et al. (New York: Ronald, 1973), 324-356.

28 Roy Porter, Flesh in the Age of Reason (New York: W.W. Norton, 04), 143.

29 Mandeville, op. cit.

30 Ibid.

31 Allan Carlson, From Cottage to Work Station: The Family’s Search for Social Harmony in the Industrial Age (San Francisco: Ignatius, 1993).

32 Pitirim A. Sorokin, Social and Cultural Dynamics: A Study of Change in Major Systems of Art, Truth, Ethics, Law, and Social Relationships, rev. and abridged ed. (1957; rpt. New Brunswick: Transaction, 1985), 700.

33 Stuart Ewan, Captainsxa of Consciousness: Advertising and the Social Roots of the Consumer Culture (New York: McGraw-Hill, 1976), 164-166.

34 See Germaine Greer, The Female Eunuch (New York: McGraw-Hill, 1971), 216-220; Kate Millett, Sexual Politics (Garden City, Doubleday, 1970), 33, 126-127; and Christopher Lasch, Haven in a Heartless World (New York: Basic, 1977), xvi.

35 See Allan Carlson, Family Questions: Reflections on the American Social Crisis (New Brunswick: Transaction, 1988), 116-125.

36 U.S. Census Bureau, Statistical Abstract of the United States: 2002 (Washington: U.S. Government Printing Office, 2002), Table 546.

37 Ibid.

38 Singer quoted in Martha Weinman Lear, “Staying Together,” Ladies’ Home Journal September 1991: 60-64.

39 Jan E. Stets and Murray A. Straus, “The Marriage License as a Hitting License: A Comparison of Assaults in Dating, Cohabiting, and Married Couples,” paper presented at the annual meeting of the American Sociological Association, 8 July 1988.

40 Lenore Weitzman, The Divorce Revolution: The Unexpected Social and Economic Consequences for Women and Children in America (New York: The Free Press, 1985), ix.

41 Charles Edgley and Dennis Brissett, “A Nation of Meddlers,” Society May/June 1995:36.

42 See Lynn D. Wardle, “No-Fault Divorce and the Divorce Conundrum,” Brigham Young University Law Review 1 (1991): 79-142.

43 See Barbara F. Okun and Louis J. Rappaport, Working With Families: An Introduction to Family Therapy (North Scituate: Duxbury, 1980), 202.

44 See Martha Farnsworth Riche, “The Postmarital Society,” American Demographics November 1988: 23-26, 60.

45 Over 90% of those ordered to pay child support are fathers. See U.S. Bureau of the Census, op. cit., Table 539.

46 Ibid.

47 See Nadya Labi and Deirdre van Dyk, “Deadbeat Profiteers,” Time 2 September 2002: 43-44.

48 See Bryce Christensen, “The Strange Politics of Child Support,” Society November/December 2002: 69.

49 Stephen Baskerville, “The Politics of Fatherhood,” PS: Political Science and Politics 35 (2002): 695-697.

50 See Jo Michelle Beld, “Revisiting the ‘Politics of Fatherhood,’” PS: Political Science and Politics 36 (2003): 714.

51 See Bryce J. Christensen, ed., When Families Fail ... The Social Costs (Lanham: University Press of America, 1991).

52 See Christopher J. O’Donnell, Angie Smith, and Jeanne R. Madison, “Using Demographic Risk Factors to Explain Variations in the Incidence of Violence Against Women,” Journal of Interpersonal Violence 17 (2002): 1239-1262; see also Martin Daly and Margo Wilson, “Child Abuse and Other Risks of Not Living With Both Parents,” Ethology and Sociobiology 6 (1985): 197-209.

53 See Howard Troxler, “Lawyer jokes won’t vanish with a mere PR campaign,” St. Petersburg Times 8 July 2002: 1B; see also Philip Rieff, The Triumph of the Therapeutic (Chicago: University of Chicago Press, 1966), 243-261.

54 Quoted in Clement, op. cit.

55 See H. Higgs, “Frederic Le Play,” The Quarterly Journal of Economics 4 (1890): 412, 419, 422.

56 Jennifer Roback Morse, Love & Economics: Why the Laissez-Faire Family Doesn’t Work (Dallas: Spence, 2001), 229-231.

57 Quoted in Blackstone, op. cit.