Measuring difference, numbering normal provides a detailed study of the technological construction of disability by examining how the audiometer and spirometer were used to create numerical proxies for invisible and inarticulable experiences. Measurements, and their manipulation, have been underestimated as crucial historical forces motivating and guiding the way we think about disability. Using measurement technology as a lens, this book draws together several existing discussions on disability, healthcare, medical practice, embodiment and emerging medical and scientific technologies at the turn of the twentieth century. As such, this work connects several important and usually separate academic subject areas and historical specialisms. The standards embedded in instrumentation created strict but ultimately arbitrary thresholds of normalcy and abnormalcy. Considering these standards from a long historical perspective reveals how these dividing lines shifted when pushed. The central thesis of this book is that health measurements are given artificial authority if they are particularly amenable to calculability and easy measurement. These measurement processes were perpetuated and perfected in the interwar years in Britain as the previously invisible limits of the body were made visible and measurable. Determination to consider body processes as quantifiable was driven by the need to compensate for disability occasioned by warfare or industry. This focus thus draws attention to the biopower associated with systems, which has emerged as a central area of concern for modern healthcare in the second decade of the twenty-first century.
Chapter 2 first discusses the wider philosophical implications of the book’s historical research to argue that the naturalist position on disease and disability is undermined by consideration of how statistical normalcy is technologically constructed. Second, it argues that this presents a problem of ‘mechanical’ epistemic injustice and explores this concept in relation to the ways in which measurement tools have been prioritised as authoritative and trusted ahead of individual testimony about personal experiences of health. Sustained attention is given to the problem of using group averages and reference classes in relation to normalcy and the ways in which ‘correcting’ for attributes like sex, class and race (or not) impacts on the measurement of normalcy. Finally, research from disability studies and the field of hedonic psychology is explored to argue that the measurement of disability is far more complex than a medical model of disability suggests.
This chapter outlines the ways in which our understanding of normal health can shift according to measurement technologies and explains the historiographical and conceptual background to this research. Moving through an outline of each chapter of the book, this introduction argues that our desire for single numbers and quantifiable data has shaped our understanding of the normal as dichotomous to the abnormal. The idea of normalcy is historicised and explained in the context of an era that was overwhelmingly concerned with degeneration and disability and ways of quantifying these deviant attributes through either direct or indirect measurements. The idea that numerical measurable data has privileged (and powerful) epistemological significance is highlighted through explication of the comparison between hearing and breathing, which is characterised by extreme diversity in personal experience which eludes fixed representation. The impetus behind the reduction of these multidimensional sensorial qualities stemmed from powerful bureaucratic forces for whom numerical classification was especially important, namely, the British Post Office and the Medical Research Council, and this chapter details the importance of these two bodies to British society during the interwar years and explains the drive behind their standardisation of normalcy.
Moving on from Chapter 6’s analysis of the difficulties surrounding classification of individual respiratory disability, this chapter explores how those so classified lived with this disability in the interwar period. By discussing technologies designed to enable breathing, this chapter highlights user modification of respiratory technologies and particularly highlights the case of the Bragg–Paul pulsator. The pulsator was originally designed in collaboration between a user and an engineer. Yet the embodied knowledge that was used to create this mechanical respirator was not accepted by the medical establishment. Physiotherapists disputed its viability and questioned the health benefits of the principles by which the pulsator operated, and this dispute led to the MRC directing an intervention to decide on a ‘standard’ breathing machine. However, these inimitable breathing machines proved to be remarkably difficult to standardise.
This chapter explores how the drive to translate breathlessness into quantifiable, scalable measures was influenced by historical interactions between medical expertise, industrial interests and compensation schemes. Considering these interactions highlights the related processes by which we have variously decided which groups count as medically distinguishable populations. Tracking the changing normal values used in spirometry values through the prism of two groups considered to be significant categories at different points in the twentieth century – women and miners – highlights the interactions between race, class and gender in spirometry. Considering the first group, women, demonstrates how difference in lung function between men and women was established, and the varying extent to which such differences were attributed to biological or societal causes. Similarly, analysing the efforts to define normal lung function for miners highlights the way in which abnormal lung function was attributed to the essential nature of the miner’s body, and underlines the impact of politics on the classification of respiratory disability. In this way, Chapter 5 uses historical case studies to argue that the selection of healthy subjects to create a standard of normalcy worked as a powerful way to manipulate the categorisation of disability as well as to obscure its true causes.
This chapter explores the ways in which balance was configured in diabetes
care between the 1900s and 1960s. The balance of diet and insulin sat at the
heart of self-care programmes during this period. However, amid growing
political and popular interest in affective life, clinicians and a novel
patient organisation quickly connected bodily balance with psychological and
emotional stability in new ways. Depression, complacency, denial, fear and
optimism soon became subject to management in clinical spaces, mutual aid
publications and long-term professional–patient interactions, in response to
changing notions of health citizenship and self-discipline, and as certain
states came to be considered dangerous or beneficial to physiological and
political balance. The chapter begins to map out the extensive array of
tools and agencies involved in constructing selves oriented towards
This chapter investigates questions about balance in Parkinson’s Disease by
analysing historical shifts in debates about a predetermined behavioural
model of a Parkinson’s Disease personality, its relationship to artistic
creativity and implications for therapeutic equilibrium in clinical
management. The aim of the chapter is to demonstrate that focusing on
balance merely in terms of therapeutic dosage plans ignores broader
dimensions of balancing cultural conflict surrounding ontological and
emergent meanings of the disease and the transcendent metaphysics of
creativity. In this way it addresses the contingent scientific and clinical
normativities of physiological and psychological balance and their
relationship to models of the self. Drawing out the historical determinants
of contingently normative neo-humoralism threaded through the story of
Parkinson’s Disease, this chapter also explores an alternative, and equally
ancient, narrative of balance about the dualism of creative genius. Efforts
to balance drug reception in the brain, it argues, are bound to the legacy
of Enlightenment normative contingencies concerning madness and reason,
genius and lunacy, creativity and manic compulsion.
Concepts of ‘balance’ have been central to modern politics, medicine and society.
Yet, while many health, environmental and social challenges are discussed
globally in terms of imbalances in biological, social and ecological systems,
strategies for addressing modern excesses and deficiencies have focused almost
exclusively on the agency of the individual. Balancing the Self explores the
diverse ways in which balanced and unbalanced selfhoods have been subject to
construction, intervention and challenge across the long twentieth century.
Through original chapters on subjects as varied as obesity control, fatigue and
the regulation of work, and the physiology of exploration in extreme conditions,
the volume analyses how concepts of balance and rhetorics of empowerment and
responsibility have historically been used for a variety of purposes, by a
diversity of political and social agencies. Historicising present-day concerns,
as well as uncovering the previously hidden interests of the past, this volume’s
wide-ranging discussions of health governance, subjectivity and balance will be
of interest to historians of medicine, sociologists, social policy analysts, and
social and political historians alike.
Balance, malleability and anthropology: historical contexts
As the various contributions to this volume make clear, histories of notions
of ‘balanced selves’ are diverse. Ideas of balance differ across time and
cultural space, as do the ways in which balance might be regulated,
controlled and incentivised. Among all this variety, this chapter asks: How
is it possible to historicise balanced selfhood at all? What is the basis
for the assumption that human selves might be differently realised according
to the norms of different times and places? The chapter makes two arguments.
First, that a significant part of this notion of ‘malleable humanity’ comes
from early twentieth-century anthropology, especially from work in the
tradition of Franz Boas and Margaret Mead. Second, that the context for
these assumptions becoming visible is a resurgence of neurological,
neurochemical and genomic visions of humanity from the late 1990s onwards.
If the malleable selves that populate our histories of balance are
significantly anthropological, then their relationship with imperialism must
be clarified. In addition, as the visibility of malleable selves is related
to the resurgence of a new biological vision of humanity, the place of
historians in this contested terrain must also be clarified.