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.