Yearly Archives: 2015

A Question of ‘Public Engagement’

Ayesha Nathoo

 

Over the last year, I have been involved in a number of public events related to my work on the history of therapeutic relaxation. These have included talks, displays and practical workshops at the “Being Human” festival of the humanities, the “Secret Garden Party” and the “Wilderness festival” (in collaboration with Guerilla Science and NOW live events), a “Friday Late Spectacular” and a discussion evening on “Rest and Relaxation in the Modern World” as part of Hubbub, at the Wellcome Collection, London.

 

 

The aims, scale, content and audiences varied for each of these events, but together they have left me reappraising my role as a historian, and reflecting on notions of expertise in such public forums. The central topics which comprise my research – ‘rest’, ‘balance’, ‘stress’ and ‘relaxation’ – affect us all, and many audience members were drawn to the events because of pre-existing interests in these matters. Others stumbled across the events by chance with little idea of what to expect or gain from them. In the music festivals, the historical material distinguished my workshops from the myriad other practice-based workshops on offer (such as yoga, mindfulness and massage); elsewhere the practical content differentiated my work from other more traditional academic contributions.

 

I am particularly interested in understanding relaxation as a taught practice, and the material, audio and visual culture that has furthered its development over the last hundred years in Western, secular, therapeutic contexts. Aural instruction given in classes or on cassettes were key methods for teaching and learning relaxation in the post-war decades and are central to understanding the growth of such practices in both clinical and domestic settings. As well as the instructions, the tone of voice, pace, pauses, and type of medium would have affected how relaxation was understood, distributed and practiced, so I have been keen to track down and share some of the original audio recordings to better understand these experiential and pedagogical aspects. If these have been unavailable I have instead endeavoured to recreate the ways in which different protagonists have taught relaxation, piecing together printed publications, archival material and oral historical resources to do so.

 

Many of those who participated in the workshops were curious to learn more about the techniques that I discussed – such as yoga, meditation or autogenic training – and their relationship to health and wellbeing. Yet as I was presenting the material primarily as a historian, rather than as a practitioner or advocate of any particular therapeutic practice, some unexpected tensions seemed to arise. Whilst the historical material inspired much interest, most centrally I found that people wanted to evaluate the specific techniques: What was going to work best for them for particular ailments or for general wellbeing? What is the best strategy for alleviating anxiety or chronic pain? Would I recommend relaxation for childbirth? Did I have copies of relaxation instructions that they could take away? Why was I talking about Progressive Muscle Relaxation, one lady asked, when the Alexander Technique (which she had taught for 20 years) was far superior? Was mindfulness meditation really a form of relaxation? Was it best to concentrate on relaxing the mind or the body? What is the evidence base for therapeutic relaxation? Why bother with daily relaxation training if there is a more accessible pharmaceutical option?

 

Although comparable questions have partly spurred my own interest in this research area, speaking as a historian I have felt uneasy about offering responses. The short, practical, personal questions are not compatible with in-depth answers that address broader medical, social and political contexts, such as the rise of individualism and the mass media, and changes in healthcare, lifestyle and biomedical models. Yet that is what has created and shaped successive demands for and critiques of therapeutic relaxation; contemporary concerns and understandings derive from these past contexts. This is the long and complex narrative that I am researching and whilst I certainly hope that it will have policy implications and be relevant to today’s medical landscape, I do not feel equipped to offer personal advice. Neither am I sure that I should be doing so.

 

I would speculate that this kind of professional reticence is a majority view amongst historians, and yet it is somewhat frustrating for interested lay audiences. If a professional researcher is investigating a particular subject, then why should they not state their opinions based on the knowledge gained from the research? I have come across this at various other points during past research, on topics ranging from the media coverage of the possible link between autism and the MMR vaccination to organ transplantation and donation. ‘Should I give my child the vaccination?’, mothers repeatedly asked me. ‘Were there any reasons not to sign the organ register?’ ‘Did I think there should be an opt-out clause to increase donation rates?’ It is not that I had not given enough thought to these matters – I had extensively mulled over them – yet I questioned my role as a historian to authoritatively influence other people’s present-day decisions, certainly without allowing the time and space to substantiate my points of view. The aim, however, would not be to give a ‘balanced’ view in the sense of ‘objectively’ presenting a full range of arguments for and against.

 

The personal is the historical: Knowledge and memories of the past shape views and actions for the future. And so a historian’s personal stance can generally be inferred from their authored work, amongst the layers of interpretations and the selection of sources. Perhaps then scholars should meet the challenge of more explicitly articulating their own views in public contexts, where audience members often lead conversations and set agendas and where the boundaries of expertise are fluid. As ‘public engagement’ becomes an increasingly significant part of academic life, it seems timely and important to open up these discussions.

‘On Balance: Lifestyle, Mental Health and Wellbeing’: Musings on Multidisciplinarity, from a Historian.

 

Ali Haggett

The first of three major conferences to be held in conjunction with the Lifestyle, Health and Disease project took place on the 25th and 26th of June at the University’s Streatham Campus. Focusing broadly on the strand of research that is concerned with mental health and wellbeing, the remit of the conference was to explore the ways in which changing notions of ‘balance’ have been used to understand the causes of mental illness; to rationalise new approaches to its treatment; and to validate advice relating to balance in work and family life. Drawing on a range of approaches and methodologies, the multidisciplinary conference attracted scholars from Britain and the United States, with diverse backgrounds, which included: history, anthropology, psychiatry, psychology and clinical medicine. On the evening of the 24th June, as a prelude to the event, we began by hosting a public panel debate, on the topic of ‘Defeating Depression: What Hope?’ at the Royal Albert Memorial Museum in Exeter. A photo gallery and a summary of the evening can be found on the Exeter Blog

 

Still at the formative stages of research, I hoped that the contributions from other scholars might provoke new lines of enquiry, or stimulate interesting alternative approaches to our work. One of the questions I am particularly interested in is: why does the concept of balance in mental health and wellbeing become influential at certain times through our recent history? As the conference progressed, and with the public panel event also in mind, I found myself wondering what a future historian might make of the contemporary themes and concerns that emerged from this conference. It struck me that many of the anxieties that were articulated by non-historians were not new, but that they had surfaced at regular junctures in modern history. At the heart of a number of papers, and evident from the contributions to the public debate, was a palpable dissatisfaction with the status quo – with ‘modern’ and perhaps ‘unbalanced’ ways of living and their effects on health. These concerns are reminiscent of those put forward much earlier, during the early and mid twentieth century, by proponents of the social medicine movement who were critical of rising consumerism, the breakdown of traditional values and kinship ties, and who were keen to reduce the burden of sickness by pressing for social improvements.[1] Misgivings about the current ‘neo-liberal’ political climate were evident, where, in some circles, the principles of free-market individualism are held to undermine collective action, community spirit and kinship, leading to disempowerment and ultimately to ill health. The prevailing interventionist, biomedical model of medicine practised in the West did not escape criticism. Some of the concerns raised resonated strongly with the ideas put forward by proponents of the ‘biopsychosocial’ model of medicine from the 1970s, which highlighted the importance of the social context of disease.[2] A number of papers raised important questions about the ways in which the current medical model appears to foreground the treatment of mental illness and underplay approaches to prevention. Speakers from the conference and contributions to the public debate noted, with some disquiet, that responsibility for protecting and maintaining mental health had increasingly shifted to the individual, instead of the ‘group’, the employer or the wider socio-economic environment.

 

Perhaps unsurprisingly, anxieties about mental illness and the field of psychiatry that first materialised during the 1960s and developed within the ‘anti-psychiatry’ movement were still conspicuous at the conference – anxieties about the classification, diagnosis and labelling of mental disorders; unease about the misapplication of ‘norms’, rating scales and the concept of ‘risk management’ in medicine. The disquiet that emerged during the 1960s was of course also intimately associated with the contemporary counter culture and broader concerns about the conformity and emptiness of the post-war world. Such ideas were evident in the literature of the period from authors such as George Orwell, William H. Whyte, David Riesman and Herbert Marcuse, who all variously disapproved of the social and cultural changes that took place in mid-century Britain and the United States.[3]

 

Defined by the Oxford Dictionary as ‘a situation in which different elements are in the correct proportions’, the concept of ‘balance’ remains at the core of all debates about mental health, whether we are talking about chemical imbalance, work-life balance or cognitive and mindful approaches to human behaviour. The papers delivered at the conference by my fellow historians neatly exposed the ways in which many of the themes discussed have emerged in the past and often reveal more about broader concerns, tensions and uncertainty about new ways of living and their effects on health than they do about epidemiological trends in mental illness. While historians are uniquely placed to add this important context, the joy of combining insights from several disciplines is that we are able to begin to redefine problems and reach solutions through new understandings. On a personal level, the contributions from other disciplines reminded me that perhaps, as an idealistic historian, I am sometimes distanced from the harsh realities of clinical practice. Collectively, the papers also prompted me to think about new ways of conceptualising and measuring what is ‘balanced’ in life and in health – and perhaps also to question the ways in which balance is somehow taken to be inherently desirable, or essential. There is no doubt that the global burden of mental ill health has become one of the most pressing social and medical problems of our time. Overcoming the challenges faced will require the knowledge of more than one discipline. As scholars engaged in research into mental health and wellbeing, we are all, in different ways, and with different approaches – and often with different opinions – ultimately seeking a shared goal of fostering ways to improve mental health and wellbeing in our society.

 

The conference organisers would like to thank the Wellcome Trust for supporting the conference and to the following speakers for their contributions:

Professor David Healy, Dr Matthew Smith, Professor Jonathan Metzl, Dr Nils Fietje, Professor Ed Watkins, Dr James Davies, Dr Ayesha Nathoo, Professor Michelle Ryan, Mr Frederick Cooper, Professor Femi Oyebode, Dr James Fallon and Dr Alex Joy.

[1] As examples: Stephen Taylor, ‘The suburban neurosis’, Lancet, 26 March 1938 and James L. Halliday, Psychosocial Medicine: A Study of the Sick Society (London, William Heinemann, 1948).

[2] See George L. Engel, ‘The need for a new medical model: a challenge for biomedicine’, Science (1977), 196, 129-36.

[3] An interesting discussion of the political and social context within which the antipsychiatry movement grew can be found in Nick Crossley, ‘R. D. Laing and the British anti-psychiatry movement: a socio-historical analysis’, Social Science and Medicine (1998), Vol. 47, No. 7, 877-89.

The Health of Pilots: Burnout, Fatigue, and Stress in Past and Present

Natasha Feiner

On 24 March 2015 a Germanwings Airbus crashed 100 kilometres northwest of Nice in the French Alps after a constant descent that began one minute after the last routine contact with air traffic control. All 144 passengers and six aircrew members were killed.

The crash, tragic as it was, attracted significant media attention and it was not long before attention turned to co-pilot Andreas Lubitz. German prosecutors said that they found indications that Lubitz had concealed an illness from his employer, hiding a sick note on the day of the crash. Whilst some media coverage looked to Lubitz’s history of depression, others investigated ‘burnout’. Der Spiegel reporter Matthias Gebauer tweeted in March that Lubitz was suffering with ‘burnout-syndrome’ when he took time out of pilot training in 2009.[1]

The term ‘burnout’ was coined by Herbert Freudenberger in 1974 and is still widely used in Germany (and to a lesser extent, the UK and America) today. Symptoms include long-term exhaustion and diminished interest in work, which is often assumed to be the result of chronic occupational stress.

The recent media discussion of burnout among pilots as a result of the Germanwings crash has brought the issue of pilot health into sharp relief. Several countries have implemented new cockpit regulations and there has been significant discussion of how pilots (and the airlines that employ them) should best deal with stress, personal problems, and exhaustion. These issues have their historical antecedent in late-twentieth century discussions of ‘pilot fatigue’.

It is widely acknowledged today that commercial airline pilots are employed in one of the most stressful occupations of the modern age. Before the Second World War this issue was rarely discussed outside academic circles. Traditionally conceived by the public as heroic and superhuman, early pilots were held up as paragons of masculine strength and vigour, able to manage great responsibilities with little (if any) impact on their physical or mental health.

Although fatigue was first recognised as a potential problem in the 1950s, it was not until the 1960s that the relationship between flying, fatigue, and the health of pilots was first discussed in the mainstream media. A number of newspaper articles highlighted the stressful nature of the pilot’s job and (from the early 1970s) a number of alarmist articles reported incidents of pilots falling asleep at their controls. In one report a pilot flying over Japan was said to have “nodded off” and then woken to find the rest of his flight crew asleep:

‘In the report… the BOAC captain said that when he felt himself dozing he shook himself, looked around the flight deck and found his two co-pilots and flight engineer asleep. “I immediately called for black coffee to bring everyone round” [he said]’.[2]

The increased media interest in ‘pilot fatigue’ coincided with a period of industrial strife amongst pilots who were experiencing radical changes not only in the type of aircraft they were asked to fly, but also in terms of management and working conditions. These issues came to the fore in 1961 when airline BEA released their summer flying schedules. The proposed schedules were intensive and many BEA pilots questioned the implications for safety. Long duty periods and inadequate rest breaks would, it was argued, cause dangerous fatigue that may increase the likelihood of accidents.

BEA relented and allowed an investigation of ‘pilot fatigue’. Carried out by physician of aeronautics H. P. Ruffell Smith, the investigation used a system of points for measuring flight time limitations, replacing the traditional hours system. The subsequent report suggested that BEA pilots should not fly more than 18 points per day, and extra points were awarded for especially stressful or fatiguing operations, such as take-off and landing. Ruffell-Smith’s report was never published and BEA did not enforce his recommendations. The problem of ‘pilot fatigue’ was not solved.

In the years that followed a number of high profile air disasters occurred, many of which were later attributed to ‘pilot fatigue’. In 1966 a Britannia plane crashed in Ljubljana, Yugoslavia, killing 98 people. One year later another plane crashed, this time in Stockport, killing 72 people. Then, in 1972 a BEA Trident plane crashed in Staines, killing 118 people. The Trident crash, in particular, caught media attention as the pilot in charge of the plane, Stanley Key, had made ‘numerous complaints’ about the length of the working day prior to his death.[3]

As a result of this, in 1972 pilots’ union BALPA revived its campaign to reduce working hours, shifting their focus to the dangers ‘pilot fatigue’ posed to passengers. By emphasising the potential dangers of fatigue, BALPA was able to convince airlines to carry out a further investigation into flight time limitations and pilot workload. Based on the results of the investigation, in 1975 the Civil Aviation Authority published strict regulations on flight times with the aim of avoiding ‘excessive fatigue’[4].

Whilst the problem of ‘pilot fatigue’ did not come to a neat conclusion in 1975 (BALPA continues to campaign on the issue to this day) the working conditions of pilots were drastically improved by the introduction of strict flight time limitations.[5] Such drastic changes would not, arguably, have taken place without the support of the British media. The alarmist nature of newspaper reports on the subject of ‘pilot fatigue’ forced airlines to take the health of pilots seriously, for fear of further frightening (and consequently losing) customers.

One would hope that the British media could play a similarly positive role today, following the Germanwings tragedy, by encouraging a re-evaluation of mental health policy by airlines (as well as by employers more generally). Although many initial newspaper reports about Lubitz were (sadly) insensitive and stigmatising, several recent articles have used a of discussion the Germanwings crash as a platform for encouraging greater awareness and understanding of mental health.[6] The tragedy may yet engender a re-evaluation of mental health and stress in the workplace, as the Trident crash did for ‘pilot fatigue’ in 1972.

 

[1] Gebauer is quoted in this news report: http://www.independent.co.uk/news/world/europe/germanwings-crash-copilot-andreas-lubitz-who-crashed-plane-suffered-burnout-says-friend-10137076.html [last accessed 23/06/15]

[2] The Times, Dec 13 1972, page 1.

[3] The Times, Nov 29 1972, page 4.

[4] The Avoidance of Excessive Fatigue in Aircrews: Requirements Document, (London, 1975), p. 1.

[5] For more information on BALPA’s current ‘Focus on Fatigue’ campaign see: http://www.balpa.org/Campaigns/Focus-on-Fatigue.aspx [last accessed 23/06/15].

[6] Alastair Campbell (‘Time to Change’ ambassador) on the stigma and taboo surrounding mental health: http://www.huffingtonpost.co.uk/alastair-campbell/andreas-lubitz-would-we-be-blaming-cancer_b_6961386.html [last accessed 23/06/15].

Coding Social Normality in Physiological Balance

Martin Moore

Every now and then, your research will turn up a source which so perfectly embodies your research interests that you can’t wait to share it with colleagues.

I had this experience recently when looking for material for my current work on the physiological balance strand of this project. Searching through the collections of the Wellcome Library, I came across this particularly fascinating video:

http://wellcomelibrary.org/player/b1665853x#?asi=0&ai=0

It was produced in 1959 in association with the Hammersmith and University College Hospitals of London, and aimed to walk a particularly thin and challenging clinical line: introducing newly diagnosed patients to the causes and dangers of diabetes, as well as covering its treatment and reassuring them of its manageability.

Of course, the video and its origins can be interpreted in any number of ways. Its hospital production could be seen as highlighting the prominent role of this institution in the care of patients. Its introduction of clinician and dietitian could be seen as evidence of expanding hospital care teams. Or its very existence could be read as testament to yet another way in which diabetes and its care has sat at the forefront of technological and clinical innovation in British medicine.[1]

Diabetes and the Culture of Capitalism

For me, however, it seemed to lay out perfectly how social and political norms have historically been embedded – or in the terms of theorists like Stuart Hall, been encoded – within instructions for ensuring physiological balance, as well as indicating how normality has provided a mechanism for encouraging patients to follow medical advice.[2] Examples can be found even within its first minute.

The video opens, for example, with images of passengers alighting a train, and pedestrians and shoppers passing down a high street. Over the top of these images we hear an RP-accented narrator inform viewers that diabetes is a condition that affects approximately 3 out of every 200 people in Britain, or 6 in every crowded train or street. However, the successfully “balanced diabetics”, we are informed, “go unnoticed in the crowd. They no longer suffer from diabetes, they have learned to manage the condition and they live usefully and normally with other people”. (00.00.43 – 00.01.09)

Ostensibly, the images of passengers, pedestrians and shoppers are included to ground potentially abstract figures of prevalence into familiar and concrete situations. A potentially “silent” disease with a prevalence rate of 1.5 per cent is thereby transformed into a condition that affects on average six people on a train – perhaps people viewers may know and with whom they regularly travel.

Along with the narration, though, these images also serve to represent and reinforce a particular view of normality. Pictures of well-heeled commuters, for instance, clearly link the notion of the “useful” individual to figures of the productive, though professional, worker, whilst footage of shoppers and high-street stores juxtaposes and implicitly connects normality to acts of consumption. The latter likely being a powerful image given post-war Britain’s recent boom in consumer goods, and recent relief of rationing.

Moving attention away from an undifferentiated, supposedly normal populous in this footage, and speaking to the newly diagnosed viewer, the video then promises that such lives and activities can (once again) be in reach of the diabetic if they are “well-balanced”, patently tying the importance of maintaining physiological balance with desired social normality. It is, moreover, a normality consistent with the values of professional work, consumption, and individual responsibility central to the political and economic logic of contemporary British capitalism, then characterised by a certain hybridity. That is, a liberalisation of production and consumption in some markets, but a cultural tendency towards professional economic management and planning more generally.[3] The culture of medicine, in other words, was clearly influenced by the political, social and economic context within which it took place, as well as to emergent themes of individualism in public health medicine more broadly.[4]

Normality, Balance and Patient Discipline

The link between physiological balance, normal social lives, and following medical advice is strengthened a few minutes later in the video, after the doctor has – with the help of some animated scales – described the cause of diabetes as resulting from an imbalance of insulin, dietary sugar and “our requirements”. (00.01.27-00.02.17).

In a subsequent exchange, a dietitian seeks to stress the importance of weight reduction to achieving balance in conversation with a stereotypical “fat” diabetic (to use the video’s terms. Interestingly, this type of patient is represented by a businessman from “the city”, Mr Anderson). Initially, upset by his new dietary prescription, our dietitian interrupts Mr Anderson’s efforts to relate his weight and diet to working conditions, and overcomes his resistance by suggesting that “this [diet] is going to alter your habits, but it won’t be the end of the world for you, and you must do it for your own sake”. (00.03.55-00.04.45). Initially, concerned by the extent to which his new diet might alter his activity at important business dinners, Mr Anderson is begrudgingly convinced by this argument and attention turns to “our thin friend”, Miss Smith (00.04.45-00.04.50). Accepting medical advice, therefore, Mr Anderson was now in a position to balance his physiology, and though this required some alteration to dietary practice, it would benefit himself and allow him to perform his broader role in society.

Future Research

In the future, I hope to be able to follow-up my interest in these representational devices with further research into their use and reception. Through oral history interviews with patients and practitioners, as well as other material, such as magazines and medical journals, I hope to trace how various actors decoded these messages.[5] To ask, in many respects, what the limits of medical intervention and regulation were.

I will also look to broaden thematically into questions of gender, class and ethnicity. This video, for instance, is very much focused on patients seen at the time to occupy the Registrar General’s classes I-III (then deemed the most liable to diabetes), and on white patients, despite the presence of black individuals in both British clinics and the video’s non-medical footage. I want to know when such material altered its boundaries in this respect, and to map this onto the changing demographics of treatment. Similarly, although it raises interesting questions about the power of gender ideals and assumptions in shaping practice, I hope to trace how such ideals affected patients, and how they changed over time.

[1] For a short and accessible overview: R.B. Tattersall, Diabetes: The Biography, (Oxford: Oxford University Press, 2009). For a more in-depth, but very engaging view of this history in the US: Chris Feudtner Bittersweet: Diabetes, Insulin and the Transformation of Illness, (Chapel Hill: University of Carolina Press, 2003).

[2] For an introduction see: Stuart Hall, ‘Encoding/Decoding’, in Meenaskshi Gigi Durham and Douglas M. Kellner, Media and Cultural Studies: Keyworks, 2nd Edition, (Oxford: Blackwell, 2006), 163-73.

[3] For an introduction to debates about post-war economic policy: Neil Rollings, ‘Poor Mr Butskell: A Short Life, Wrecked by Schizophrenia, Twentieth Century British History, Vol.5, (No.2, 1994), 183-205. And on planning and professionalism: Glen O’Hara, From Dreams to Disillusionment: Economic and Social Planning in 1960s, (Basingstoke: Palgrave Macmillan, 2007); Harold Perkin, The rise of professional society: England since 1880, (London: Routledge, 1989).

[4] On contemporary developments in public health, and regulated individualism: Virginia Berridge, ‘Medicine and the Public: The 1962 Report of the Royal College of Physicians and the New Public Health’, Bulletin of the History of Medicine, Vol.81, (No.1, 2007), 286-311; Dorothy Porter, Health Citizenship: Essays in Social Medicine and Biomedical Politics, Berkeley: University of California Press, 2011, 154-181.

Work-Life Balance: A Historical Perspective

Frederick Cooper

Over the last three decades, Work-Life Balance has entered comprehensively into the language that men and women in western societies use to frame their experiences of work, family and leisure. For a term with such widespread currency and no immediate medical connotations, it remains steeped in psychiatric anxieties. A clinical acceptance of lifestyle balance as a means of maintaining happiness – and imbalance as a route to illness – has placed serious psychological consequences just below the surface of one of the late twentieth and early twenty-first century’s more pervasive buzz-words.

This is an example of the power that mental health expertise has to shape the behaviour of individuals who might never come into contact with psychiatric services. Across the last century, groups such as overworked and unemployed men whose relationship with work has been interpreted as falling into one particular extreme have been increasingly described as putting themselves at risk of varying types of distress and disorder. As modern critics of work-life balance have argued, drawing on the initiatives of feminist scholars over the last seventy years, the picture for women has usually been far more complicated. In workplaces still dominated by sexist practices, women work harder and longer, returning home to perform unpaid and unrecognised labour which facilitates male leisure at the expense of personal wellbeing.

My research explores the emergence of balance between work and home as a blueprint for women’s psychological health. When British doctors and feminists began to advocate a dual role in the years following the Second World War, many of them envisioned a temporary period of social and psychological dislocation in which women would learn to reconcile their new responsibilities with traditional expectations. A meeting held in 1956 by the Medical Women’s International Association (MWIA) concluded the following:

“The problem [of women’s adaptation to new roles] was part of an evolutionary process which, like all others, was bound to claim its victims. It was the task of medicine to try to minimise any harmful effects of such developments.” – (British Medical Journal, Dec. 1st, 1956).

In 2015, medicine is still attempting to minimise their harmful effects. For the MWIA, the recognition that social change had its own casualties was by no means condemnatory. These debates took place in a context where sociologists and physicians were finding new ways of speaking about the adverse effects of domesticity upon the female psyche. As Jean Mingay put it in a lecture to the Old Girl’s Union of Bradford Grammar School in 1953, “the possible conflicts between philosophy and apron-strings are surely less deadly than the bondage of apron-strings alone.” Many women were rejecting the devil they knew, and they were framing their decisions and experiences in explicitly psychological terms.

The writers in the 1940s, 1950s and 1960s who were re-imagining women’s position in society represented their vision as ethical and natural, a common-sense solution requiring the dispelling of the conservative ideologies which had hitherto consigned women to domestic life. The ideas that they set out, however, were the product of a series of intellectual and practical collisions and compromises.

As a number of historians have observed, an intensification of psychological theories about maternal deprivation and child development during the same period leant scientific validity to full-time motherhood. Looking beyond the home for personal fulfilment, according to this framework, deprived the next generation of the attention they needed to form healthy personalities. Feminists such as Viola Klein, making extensive use of medical concerns about the frustration and loneliness of mothers, were able to subvert this narrative. Unhappy housewives, they argued, posed a far greater threat to child health than the women whose additional responsibilities took them away from the family but stabilised or improved their mood.

Similarly, ideas about the effect of working women on men’s mental health began to shift. An approach to marital relationships which located disharmony, neurosis and divorce in the deficit between adolescent expectations and the lived experience of marriage emphasised the potential for psychological emasculation in any challenge to male breadwinning. Pro-employment theorists set out to defuse this anxiety, telling husbands that women who worked made healthier wives with better-rounded personalities.

Although they were able to shift conceptions of ideal female lifestyle away from a sexual division of labour and towards a model which seemed to emulate the male experience, post-war writers were weaving gendered inequalities into the structure of the new orthodoxy. Contesting the association between work and disordered marriage and motherhood, they were unable to overturn the assumption that these were the criteria through which women’s health would be measured and valued. Parallel arguments, conversely, emphasised the benefits of family life for male productivity:

“The husbands who are most successful are those who achieve a personally satisfying balance between home and work. And in achieving this balance managers’ wives are of the very greatest importance.” – (Family Doctor, Housewife Special Issue, 1961).

Female imbalance – or, perhaps, overbalance – has been written directly into male success and fulfilment. This fundamental division has not been profoundly altered by women’s exodus into the workplace over the previous century. Although the current project is still taking shape, drawing focus towards the generative cultural, political and medical tensions which formed and shaped conceptions of balanced lifestyles may be able to aid an understanding of their enduring contradictions.