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The Medical History of Speech Disorders

What did this piece of research entail?

Together with Dr Renata Whurr, I investigated the very first case of spasmodic dysphonia that is regularly cited in the current research literature. We found that the picture presented by this patient, translated from German in the 1870s, was not what it seemed. The clinical description was not consistent with our current view and it is likely that the patient didn’t actually have SD. Subsequently, we discovered that research by a British clinician, writing at the same time, contained observations very similar to our current characterization.

How did you get involved in historical research?

I was fortunate to have teachers throughout my training who stressed that the way to understand neurogenic disorders, observed clinically, was to go back and read earlier descriptions to understand how syndromes were characterized by the perspective of the observers which changed over time.

Can you explain how historical research impacts current and future research?

I believe that applied medical history can contribute important insights into current clinical issues. This method puts a spotlight on understanding the way assumptions, concerns and questions change over time and how that influences the types of answers that are pursued. This kind of approach may be particularly useful in making progress on points that have been debated over the years by analyzing the types of symptoms that have been considered central to different formulations in the past. For example, whether clinicians considered SD to be psychogenic or neurogenic has changed over time. To develop a more nuanced and detailed picture to drive forward future avenues of research, it is valuable to go back and review historical observations. It can be a source of inspiration to revisit previous hypotheses and characterizations. The benefit is that it may produce a reassessment of things that were held as unquestioned assumptions.

What drew you to spasmodic dysphonia research?

I began my involvement with spasmodic dysphonia research in the early 1990s through my work with Dr Renata Whurr who was head of Speech and Language Therapy at the National Hospital for Neurology and Neurosurgery at Queen Square London. Over the years we have collaborated on a variety of aspects regarding SD. Initially, this was focused on treatment. However, I later became interested in the linguistics aspects of the problem. We investigated how the vocal cord movement disorder interacted with the articulatory properties of different languages. One important finding drew attention to the fact that speakers with SD will have different vocal symptoms depending on what language they speak. For example, the diagnostic features of SD for English will not adequately describe the characteristics of French SD speakers. Put more simply, if you have SD, your symptoms will be slightly different depending on the language you speak.

What has surprised you the most about researching the history of spasmodic dysphonia?

When my colleague, Dr Whurr, and I went back to the original case of SD reported in the 1870s that is still cited today, we were amazed to find that the individual didn’t have a voice disorder that we would recognize as SD. This research revealed the common practice of perpetuating a reference to historical literature without necessarily going back to the source. The selection of emblematic cases is also influenced by the assumptions held by the researcher. Our work highlighted how a particular view of the past may be colored by present day biases. In this instance, a strong belief in Freudian psychology in the mid-20th century may have played a part in choosing a historical case that was formulated as “hysterical”. It also highlighted how more significant and worthwhile observations may not be promoted, because of social rather than scientific reasons. By reading the 19th century literature, we recovered important observations about SD that had been lost to posterity.

How do you think this research will help people with SD?

Our research has highlighted the contribution of the 19th-century clinician, Morell Mackenzie, who described the particular sound of a person’s voice, which will lead directly to the diagnosis of SD. This is of vital importance as there is often a long delay in diagnosing SD. It is important to recognize that changes in voice may be the only symptom of this neurogenic disorder.

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Assimilation and the immigration debate

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This article was written by Professor Eric Kaufmann of Birkbeck’s Department of Politics. It was originally published on the Fabian Society‘s blog.

Immigration has proven one of the hardest issues for Britain’s main parties to address, and UKIP has been the beneficiary. But, according to my YouGov/Birkbeck/Policy Exchange survey data, many UKIP voters will change their views on immigration if politicians can reassure them by highlighting the impressive rate of assimilation already taking place in British society. This doesn’t obviate the need to control immigration, but it offers a partial solution for what is a cultural problem, not an economic one.

In a hard-hitting piece in a recent Fabians’ report by senior Labour figures,Facing the Unknown, pollster James Morris writes that Labour must engage with the genuine concerns many ordinary Britons have about immigration. However, Labour’s leaders continue to deflect concerns onto the comfortable terrain of public spending and local planning. On Andrew Marr’s programme, when asked about his views on free movement, Jeremy Corbyn talked up the idea of an immigration impact fund. Sadiq Khan, in a recent article in the Chicago Tribune, spoke mainly about housing, planning and laws. Unfortunately, academic research suggests these policies will have little or no effect on the public’s view of immigration.

The consensus from scholarly research across the West is that cultural, not economic, motivations are central for those who want lower immigration. Immigration strips away the hazy illusion in the minds of many White Britons that their group is more or less the same thing as Britain. This ethnicises the majority, notably those who cherish their cultural traditions, myths and memories.

In response, politicians from Gordon Brown to David Cameron have articulated a centralised Britishness based on common values and institutions. But the question politicians need to be asking is not, ‘What does it mean to be British,’ but rather ‘What does it mean to be WhiteBritish’ in an age of migration. This is not racist, but reflects the fact that all ethnic groups – including the majority – want their community to have a future.

One liberal way groups perpetuate themselves is by assimilating others who wish to join. And the fact is that majority groups have an in-built advantage due to their influence on the mainstream national culture. In view of this, it is astounding how little we hear about the fact many members of ethnic minority groups – especially Europeans and those of mixed race – intermarry or identify with the White British majority.

Having written about this following UKIP’s ascent in 2014, I was curious whether knowing these facts might change the way White British people think about immigration. To find out, I conducted a survey, but split it into three random groups. All answered questions about immigration, but two of the groups were assigned to read a short passage about national identity.

Nations are like rivers: on the one hand, you can never put your foot in the same water twice, but if you look at it from a distance, it is unchanging. My first passage took the first path, offering the conventional storyline about a rapidly changing Britain:

‘Britain is changing, becoming increasingly diverse. The 2011 census shows that White British people are already a minority in four British cities, including London. Over a quarter of births in England and Wales are to foreign-born mothers. Young Britons are also much more diverse than older Britons. Just 4.5 per cent of those older than 65 are nonwhite but more than 20 per cent of those under 25 are. Minorities’ younger average age, somewhat higher birth rate and continued immigration mean that late this century, according to Professor David Coleman of Oxford University, White British people will be in the minority nationwide. We should embrace our diversity, which gives Britain an advantage in the global economy. Together, we can build a stronger, more inclusive Britain.’

The second changed the tune to one of timeless continuity through assimilation:

‘Immigration has risen and fallen over time, but, like the English language, Britain’s culture is only superficially affected by foreign influence. According to Professor Eric Kaufmann of the University of London, a large share of the children of European immigrants have become White British. Historians tell us that French, Irish, Jews and pre-war black immigrants largely melted into the white majority. Those of mixed race, who share common ancestors with White British people, are growing faster than all minority groups and 8 in 10 of them marry whites. In the long run, today’s minorities will be absorbed into the majority and foreign identities will fade, as they have for public figures with immigrant ancestors like Boris Johnson or Peter Mandelson. Britain shapes its migrants, migration doesn’t shape Britain.’

It’s rare for stories such as these to shift people’s attitudes on contentious issues like immigration, yet this is precisely what happened. When White British respondents read a story about change and diversity, this made them slightly more worried about immigration than when they read no passage. But when they read about how immigrants are assimilating into their ethnic group, they became noticeably more relaxed. This is especially true for working-class, tabloid-reading or UKIP-voting whites, many of whom simply haven’t heard this argument. In figure 1, for instance, 61 per cent of white working-class (C2, DE) respondents who read the diversity passage wanted immigration reduced a lot compared to 47 per cent of those who read the assimilation passage. Those who read no passage were in the middle, at 56 per cent.

Figure 1

Source: Yougov/Birkbeck/Policy Exchange survey, Aug. 20, 2016. Note: results significant at p<.05 level.

Respondents were also asked about the extent to which they were willing to pay for ‘hard Brexit’. In the event that Brexit causes financial hardship, this is a barometer of how much people would be willing to trade off access to the benefits of the single market in order to reduce European migration. Once again, what we see is that whites, especially working-class, tabloid-reading and UKIP voters, are reassured by the facts on assimilation. In Figure 2, for instance, the share of White British UKIP voters willing to pay 5 per cent of their income to cut European immigration to zero drops from 45 per cent after reading the diversity story to 16 per cent when reading the assimilation piece.

Figure 2

Source: Yougov/Birkbeck/Policy Exchange survey, Aug. 20, 2016. Note: results significant at p<.05 level.

If this is the case, why is it that politicians continue to hammer away at the diversity story? Probably because it’s the mainstream view and therefore all they know. In addition, they may be skittish about offending minorities who fear assimilation. But it’s not inconsistent to say, as Sadiq Khan did, that minorities can keep their culture, while pointing to evidence of voluntary assimilation. Dual identity is also common, with minorities pulled between their roots and the culture of the majority. For instance many British Jews identify with their ethnic group, yet most consider themselves – and are considered to be – White British.

It’s also the case that national identity is not monolithic but in the eye of the beholder: some members of minority groups may prefer to see Britain as ever-changing while conservative white Britons consider it a timeless river. It’s up to politicians to reach out to both with a different message, secure in the knowledge there is no single way of perceiving the nation.

Empire of Things

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The following are two excerpts from Prof Frank Trentmann‘s new book, Empire of Things How We Became a World of Consumers, from the Fifteenth Century to the Twenty-First (UK: Allen Lane, 2016; USA: HarperCollins, 2016).

In the book, which has been released today, Prof Trentmann unfolds the extraordinary history that has shaped our material world, from late Ming China, Renaissance Italy and the British empire to the present. Astonishingly wide-ranging and richly detailed, ‘Empire of Things’ explores how we have come to live with so much more, how this changed the course of history, and the global challenges we face as a result.

Introduction

We live surrounded by things. A typical German owns 10,000 objects. In Los Angeles, a middle-class garage often no longer houses a car but several hundred boxes of stuff. The United Kingdom in 2013 was home to 6 billion items of clothing, roughly a hundred per adult; a quarter of these never leave the wardrobe. Of course, people always had things, and used them not only to survive but for ritual, display and fun. But the possessions in a pre-modern village or an indigenous tribe pale when placed next to the growing mountain of things in advanced societies like ours.

This change in accumulation involved a historic shift in humans’ relations with things. In contrast to the pre-modern village, where most goods were passed on and arrived as gifts or with the wedding trousseau, things in modern societies are mainly bought in the marketplace. And they pass through our lives more quickly.

In the last few hundred years, the acquisition, flow and use of things – in short, consumption – has become a defining feature of our lives. It would be a mistake to think people at any time have had a single identity, but there have been periods when certain roles have been dominant, defining a society and its culture. In Europe, the High Middle Ages saw the rise of a ‘chivalrous society’ of knights and serfs.

The Reformation pitched one faith against another. In the nineteenth century, a commercial society gave way to an industrial class society of capitalists and wage workers. Work remains important today, but it defines us far less than in the heyday of the factory and the trade union. Instead of warriors or workers, we are more than ever before consumers.

In the rich world – and in the developing world increasingly, too – identities, politics, the economy and the environment are crucially shaped by what and how we consume. Taste, appearance and lifestyle define who we are (or want to be) and how others see us. Politicians treat public services like a supermarket of goods, hoping it will provide citizens with greater choice. Many citizens, in turn, seek to advance social and political causes by using the power of their purse in boycotts and buycotts. Advanced economies live or die by their ability to stimulate and maintain high levels of spending, with the help of advertising, branding and consumer credit. Perhaps the most existential impact is that of our materially intensive lifestyle on the planet. Our lifestyles are fired by fossil fuels. In the twentieth century, carbon emissions per person quadrupled. Today, transport and bigger, more comfortable homes, filled with more appliances, account for just under half of global CO2 emissions. Eating more meat has seriously disturbed the nitrogen cycle. Consumers are even more deeply implicated if the emissions released in the process of making and delivering their things are taken into account. And, at the end of their lives, many broken TVs and computers from Europe end up in countries like Ghana and Nigeria, causing illness and pollution as they are picked apart for precious materials.

How much and what to consume is one of the most urgent but also thorniest questions of our day. This book is a historical contribution to that debate. It tells the story of how we came to live with so much more, and how this has changed the course of history.

Age of Ideologies

She was just nineteen and lucky to be alive. Heidi Simon had been born the year Hitler came to power. Frankfurt am Main, her hometown, was among the cities worst hit by Allied bombing; the 1944 raids killed thousands and left half the population homeless. Now, in 1952, Heidi was one of the winners in an amateur photography competition to celebrate the American Marshall plan. Recovery had barely begun. The entries reflected the harsh realities of post-war Europe: ‘Bread for all’; ‘No more hunger’; ‘New homes’. She scooped one of the top prizes: a Vespa moped plus prize money. The officials at the Ministry for the
Marshall Plan may well have been surprised by her response. She was very happy about winning but, she wrote, to be honest and without trying to sound ‘impertinent’, she wondered whether she could not rather have a Lambretta than a Vespa. For the entire last year she had ‘passionately’ longed for a Lambretta. The Ministry refused and sent her the Vespa.

This snapshot of young Heidi Simon, tucked away in the German federal archives, is a reminder of how the large forces of history intersect with the material lives and dreams of ordinary people. The Marshall Plan was a critical moment in the reconstruction of Europe and the advancing Cold War divide between East and West, but its recipients were far from passive. Heidi’s outspoken desire for a particularly stylish consumer good in the midst of rubble also challenges the conventional idea that consumer society was the product of galloping growth in the age of affluence, the mid-1950s to 1973. It jars with the sometimes instinctive assumption that people turn to goods only for identity, communication or sheer fun after they have fulfilled their basic needs for food, shelter, security and health.

It is no coincidence that this psychological model of the ‘hierarchy of needs’, initially proposed by the American Abraham Maslow in 1943, gained in popularity just as affluence began to spread. According to this theory, Heidi Simon should have asked to trade in the Vespa for bricks and mortar and perhaps some savings bonds, rather than hoping for an upgrade to the 123cc Lambretta with its sleek single-piece tubular frame.

“Empire of Things How We Became a World of Consumers, from the Fifteenth Century to the Twenty-First” has been released today.
The book has been reviewed and cited in The Times, Independent, Financial Times, Daily Mail, Times Higher Education, The Guardian, Evening Standard,and The National.
Prof Trentmann also recently spoke about his work on BBC World Service radio’s The Forum. Listen to the interview here

Find out more

Gender and Class in English Asylums, 1890-1914

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This post was contributed by Dr Louise Hide, Honorary Research Fellow in Birkbeck’s Department of History, Classics and Archaeology.

In July 1905, a young draper’s assistant from south-east London was admitted to Bexley Asylum. Gertrude L. was 25 and this was her third admission into a lunatic asylum.

Initially, she was described as ‘strange and irrational in manner’. But by January 1906, she was corresponding with her friends on the outside. One letter that was copied and left in her case file provides an intriguing insight into asylum life from the patient’s point of view:

in this so called asylum … you are … treated like the worst form of cattle … We work all the hours God sends without proper nourishment or a proper bed … our hours of work are from 8 in the morn to 20 or 30 minutes past 7 in the evening … and you never see the colour of a copper coin.

From the 1960s to the late ‘80s, Marxist and feminist scholars set out to disabuse Whiggish historians of the notion that the understanding and treatment of mental illness had followed an uninterrupted upward trajectory called ‘progress’ from the late 18^th century. As a result of this work, we know a great deal about why and how people were admitted to asylums, but far less about what actually happened to them once the ward door had been shut and the key turned.

What was life like inside these vast ‘monster’ institutions? And how were relationships between doctors, nurses and attendants, and patients constructed by shifting ideas around masculinity and femininity?

My book, Gender and Class in English Asylums, 1890-1914, sets out to answer these questions through a detailed analysis primarily of asylum case notes, committee minutes and annual reports. I have focused on two institutions, Claybury and Bexley. Each was built for 2,000 patients by the newly formed London County Council and opened in 1893 and 1898 respectively.

The turn of the century was an important moment in asylum history. Late Victorian psychiatry was experiencing a ‘clinical turn’ away from the old prison-like asylums towards the new mental hospitals, from the ‘lunatic’ to the mental patient, the attendant to the nurse. That, at least, was the idea even though the reality took some time to catch up.

Location is important, too. London had far higher lunacy rates than any other part of the country. Why?

Migration into the city was one reason. Lack of space and desperate poverty was another; families were simply unable to look after members who could not contribute to the household budget. But there was another reason, too: the abhorrent notion of degeneracy, which claimed that physical, mental and moral ‘defects’ (criminality, prostitution etc.) were passed on from one generation to another, creating an increasingly ‘unfit’ population. And this hereditary ‘taint’ was believed to be particularly prevalent in large, overcrowded urban areas, such as London.

Indeed, degeneracy theory fed directly into eugenics, making the early 20^th century one of the darkest periods of psychiatric history.

My book looks at the impact of some of the overarching ideologies that were circulating at the time – degeneracy, feminism, socialism, science and the medicalisation of madness – on people in the asylum.

General hospitals had a powerful influence on the faltering discipline of psychiatry. Gradually, a new generation of well-qualified and scientifically-minded physicians, including a handful of women, started to take up asylum posts. Nurses began to receive formal training and gain recognised qualifications. And, perhaps most controversially, female nurses were moved into male wards shaking up these men-only bastions.

As a result, the highly gendered male doctor/female nurse binary was reinforced, marginalising many male attendants and reducing some to little more than nursing auxiliaries.

To return to Gertrude L., the patient experience is an important part of the book. During a period when virtually every aspect of asylum life was intended to act as ‘treatment’, I endeavour to reveal the effects on patients of the admission process, drugs, seclusion and restraint, the ward environment, work and amusements.

Why, for example, were the ‘rougher’ women put to work in the laundry? How were ward interiors designed in order to distract patients from their dark and troubling thoughts? In what way was food rationed according to a patient’s sex? And what were the consequences of forcing pauper patients to wear communal clothes?

There was, of course, no single patient experience. However, my book does, I hope, provide greater insights into how wider social and medical discourses influenced the lives of men and women living and working inside London’s late Victorian asylums at the most quotidian levels.

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