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Medicine, politics and the regulation of health in the twentieth century

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.

Open Access (free)
Balance, malleability and anthropology: historical contexts
Chris Millard

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.

in Balancing the self
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Narratives of balance and moderation at the limits of human performance
Vanessa Heggie

This chapter investigates notions of balance in the ‘natural laboratories’ of extreme physiology – specifically the high Arctic, Antarctica and high altitude in South America and the Himalaya. Physiologists and other biomedical scientists celebrated these sites as spaces in which many varieties of imbalance could be studied. The chapter concentrates on three different kinds of balance: moderation, physiological homeostasis and psychological stress responses. Through these case studies extreme environments emerge as sites where, firstly, notions of balance could be debated and reconstituted, and secondly where the white adult male’s body became established as the norm for such research. This unquestioned centralisation of a very specific kind of body as a standard measure in balance research – particularly as it was a body not indigenous to extreme environments – had consequences for the practices of both science and exploration.

in Balancing the self
Alcohol health education campaigns in England
Alex Mold

This chapter explores the complex relationship between ‘the public’ and the ‘self’ in post-war British public health by tracing the development of alcohol health education during the 1970s and 1980s. Health education was put forward during these decades as a way to encourage individuals to moderate their alcohol consumption – to behave responsibly by becoming ‘sensible drinkers’. Yet, at the same time, considerable scepticism was expressed (even by those involved in the campaigns) about the ability of health education to change behaviour. Other approaches, such as increasing the price of alcohol, were suggested as ways of reducing alcohol consumption at the population level. At issue, however, was not simply the capacity for individuals to achieve healthy balance. Policy-makers weighed numerous social, economic and political concerns alongside health outcomes. A growing focus on moderation may have expanded public health’s target population, but a reliance on health education and nebulous concepts like the ‘sensible drinker’ also reflected the ways that disciplinary power could be counterbalanced by broader policy concerns.

in Balancing the self
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Balancing the self in the twentieth century
Mark Jackson and Martin D. Moore

This chapter introduces the volume’s major arguments and themes. It provides a critical account of prominent theorisations of balance and selfhood, and surveys and frames each contribution to the volume. In doing so, the chapter outlines what has been at stake in projects for achieving balanced selves in the twentieth century. It not only makes plain how historical investigations into balanced selfhood complicate assumptions about the links between individualised balance and forms of production or political regimes, but also highlights the malleability and multi-valence of balance as a concept. It argues, therefore, that the volume not only contributes to the cultural history of an everyday concept, but also generates insights into the history of health governance and subjectivity, and into the close connections between medicine, politics and the regulation of social life.

in Balancing the self
Visualising obesity as a public health concern in 1970s and 1980s Britain
Jane Hand

This chapter examines the use of visual images to promote healthy eating as a tool of disease prevention in British health education during the 1970s and 1980s. It analyses the activities of the HEC, and especially its poster output, in reorienting nutrition as a major part of its activities, and simultaneously highlights the role of public information films and commercial television in providing ancillary educative content through the documentary format. Though representing only a fraction of the filmic and poster material produced on nutrition and disease at this time, these examples reveal how scientific knowledge about dietetics and disease causation were entangled in a range of cultural and representational practices focused on tropes of gender, body image and the ‘cult’ of slimming. By coding disease risk in terms of particular visual attributes and specific practical preventive measures, these images functioned to express and articulate specific health ideologies. These ideologies promoted the idea that individualised health risks, often visualised through the obese body, could be overcome (at least in part) by complying with a myriad of health advice that together would construct individual balanced good health.

in Balancing the self
Natasha Feiner

This chapter outlines how and why civil aviation schedules were regulated in the post-war period, tracing the shifting regulatory relationships between the British state, business and individual workers during the four decades after 1954. It argues that programmes to manage imbalance did not neatly map onto broader changes in British politics. Throughout the second half of the twentieth century, British governments consistently refused to formally control airline schedules. Regulations limiting working hours and attempting to balance the duty cycle were introduced, but responsibility for fatigue management ultimately remained with individual pilots, and regulation and enforcement thus continued to be permissive and flexible. Despite supposed shifts from social democratic to neo-liberal governments in Britain, a liberal, gentlemanly professionalism remained a consistent frame for the regulation of work and fatigue. Through its examination of aviation scheduling, therefore, this chapter asks how and why new selves were constructed and regulated in the post-war period at the expense of structural adjustments to working environments; sets out a new timeline for twentieth-century subjectivity; and historicises present-day concerns with work-life balance and the costs of overwork.

in Balancing the self
Dietary advice and agency in North America and Britain
Nicos Kefalas

This chapter traces the history of healthy eating in the second half of the twentieth century in terms of the advice offered by the authors of self-help books in the USA and UK. It examines the transatlantic nature of programmes for balance, comparing advice about obesity and dieting, exploring the cultural authority of celebrity dietitians and assessing the degree of knowledge exchange between the two countries. In doing so, it investigates the ways in which readers learned about ‘healthy eating’ on a day-to-day level, generating a detailed historical analysis of the ‘healthy diet’ ideal and the ways in which the self-help genre contributed to the ‘health manufacturing’ process. Mobilising persuasive motivational language along with scientific jargon, self-help authors were able to simultaneously promote their own status and appeal to readers’ sense of agency. Analysis of self-help also reveals, however, the controversies associated with self-help and the promotion of healthy balanced diets.

in Balancing the self
Mark Jackson

This chapter investigates how the conjunction of socio-economic, cultural and political contexts made the midlife crisis – as both concept and experience – possible. By juxtaposing advice literature on healthy ageing in America, the work of marriage guidance counsellors in Britain, as well as cinematic and literary representations of the ‘emotional typhoon’ experienced during midlife transitions, it argues that the popularity of the term ‘midlife crisis’ lay in its resonance with growing concerns about the collapse of the American dream and post-Second World War anxieties about threats to the stability of the nuclear family. In both cases, notions of emotional balance were reconfigured by obsessions with the autonomous individual and the gospel of consumption. The belief that life could begin again at 40 was used to restabilise a seemingly unbalanced Western capitalist economy that could only be sustained by prolonging productivity and encouraging spending across the whole life course.

in Balancing the self
Open Access (free)
Teaching ‘relaxed living’ in post-war Britain
Ayesha Nathoo

Therapeutic relaxation techniques proliferated in the twentieth century, designed to counteract the myriad maladies popularly associated with the pace and pressures of modern Western living. Practitioners advocated forms of neuromuscular relaxation as safe, effective, drug-free therapies for conditions ranging from high blood pressure to migraine, labour pain and anxiety. However, the therapeutic efficacy of relaxation techniques relied on them being expertly taught, conscientiously learned and persistently practised. This chapter focuses on the pedagogy of twentieth-century therapeutic relaxation methods in Britain, paying particular attention to their material and audio-visual culture. Relaxation instruction and ideology were communicated through numerous channels including self-help books, group classes, correspondence courses, the mass media, teacher training forums, cassettes and biofeedback equipment. As the chapter makes clear, efforts to construct the self-balancing individual were deeply enmeshed with specific modes, processes and networks of communication. By considering the localised, socio-cultural specificities of relaxation therapies, it is possible to move beyond governmentality frameworks and develop more nuanced and culturally informed considerations of health education, health management and expertise of balance in the post-war period.

in Balancing the self