Manchester History of Medicine

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 balance.

in Balancing the self

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.

in Balancing the self
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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.

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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.

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

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

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

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

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

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

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