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:

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.