the public sat at the heart of many scandals, and the issue greatly concerned bodies claiming to speak for patient-consumers. The emergence of these organisations during the 1960s coincided with the broader professionalisation of collective consumer voices in post-war Britain and their institutionalisation within state bodies. 11 Moreover, groups like the Patients’ Association built upon contemporaneous public demands for autonomy and political accountability. Recent research on the 1970s and 1980s, for instance, has traced the migration of accountability practices
Individual professional autonomy certainly remains important to practitioners, and a significant proportion of newly qualified doctors are choosing occupations according to their control over working hours and conditions. 60 However, unaided clinical autonomy is no longer prized as it once was, and engaging with external input and critique has become essential to good practice. Undoubtedly, therefore, being a professional means something different at the beginning of the twenty-first century to what it did at the beginning of the twentieth, and the transformations in
curtail professional autonomy through private-sector accountability techniques. 25
Such broad-stroke accounts, however, have often downplayed the role of healthcare professionals in constructing the means for their own management, or have portrayed them as successfully restrained or co-opted by the state. To be sure, competing analyses have contradicted arguments of state success. Here, scholars have suggested that medical professionals responded effectively to political and administrative pressures, moving to maintain control over collective
the profession not less but more controversial – at least on the level of individual accountability.
In this sense, the doctor–state relationship proved ambivalent. While the medical profession relied on state protection to establish university-trained doctors as the dominant and indisputable authority in the health sector, its growing self-confidence based on more successful treatment led to a cry for institutional reform and professional autonomy.
Responsibility in transition: an
broader contemporary concerns about professional autonomy and masculine self-discipline, the Bowhill Working Party argued that pilots should not be divested of this responsibility by way of legislation.
This argument was predicated on a particular image of the post-war pilot. Pilots were, the Bowhill Working Party thought, trusted and skilled executives for whom professional autonomy was important. In this framework, pilots were envisioned as self-aware and self-sufficient, expected to be alert to mental and bodily
Balance, malleability and anthropology: historical contexts
, but here we are charting a particular instance of instability as a product of a particular resonance between history and anthropology at a certain time. In fact, in the early twentieth century, myriad stress researchers (the most famous of whom is Walter Cannon) were building a conception of human beings as balanced and stabilised through concepts of homeostasis and research into the autonomic nervous system.
At a particular point in time, stability and malleability circulate in different registers
ultimately hollow because of the concessions made to form the NHS. Already in the 1950s, central departments wanted to exercise some control over service expenditure, even if this infringed upon clinical decision-making. 49 Considerations of costs were shared by some elite GPs and emergent health service researchers, who progressively problematised variations in prescribing and speculated about accountability for resource use. 50 Nonetheless, the NHS had been founded on an informal agreement that doctors would have considerable autonomy of action within set budgets. 51
Measuring and displaying the functions of the autonomic nervous system was not new – for example, equipment had been developed in the nineteenth century to determine heart rate and skin resistance – but biofeedback devices helped demonstrate that these physiological functions could not only be measured and displayed but also voluntarily controlled. Jacobson himself had devised a neurovoltmeter in the 1920s, capable of detecting tiny changes in muscular electrical activity; indeed, making tension measurable was central to his formulation
stretched to non-human actants. Self-help books, audio equipment and exercise apparatus were just as important to projects of balanced selfhoods as life-writing and records were to the emergence of new forms of self-formation in medicine and the military.
Balancing the self in the twentieth century, therefore, did not mean exercising autonomy alone.
Structure and themes
Each chapter in this volume examines a novel instance of the ways in which selves became the objects of
Journal , 6:7 (1951), 89.
D. Armstrong, ‘Actors, patients and agency: a recent history’, Sociology of Health and Illness , 36:2 (2014), 163–74; Ian Hacking, ‘Making up people’, in H. C. Heller, M. Sosna and D. E. Wellbery (eds), Reconstructing Individualism: Autonomy, Individuality and the Self in Western Thought (Stanford: Stanford University Press, 1986), pp. 222