All posts by Andrea Gibbons

Gilding the Ghetto: Poverty and Poverty Programmes in the 60s and 70s

I’m not the only one who thinks this is extraordinary, but it is still something that maybe not everyone reads and it really is worth spending some time with Gilding the Ghetto, published in 1977. It’s a strange moment to be reading it really, after so many years of austerity, facing many of the same issues with the same roots, but in vastly different contexts. Still, both periods were framed in terms of crisis.

Towards the end of 1976 among the endless reminders of Britain’s economic predicament another theme was brought to public attention: the urban crisis.

This is how it opens – but they are quick to note that this urban crisis was not new — crisis was never new. Forty years later that shit is still not new.

Anyway, In the late 60s and early 70s a number of projects were started — and I found them fascinating so explore them in potentially boring detail here. For the most part they were attempted, they were awesome, but then they were finished and buried, and this cycle is so familiar.

Yet today there is an official silence about these programmes of the late 1960s and early seventies. A striking silence.

This report goes back to the early stage. Written by a group of workers from the National Community Development Project it tries to make sense of the spate of government ‘poverty initiatives’ beginning in 1968 of which CDP was a part. It is written from inside but, we hope, for an outside world. It comes from our own experience as some of the state’s ‘poverty’ workers, and from the doubts that experience raised in our minds about what our employers were really intending.

This sounds so familiar:

The Home Office, with James Callaghan as Home Secretary, embarked on CDP in 1969. The idea was to collaborate with local authorities in setting up local projects, each with a five- year lifespan as ‘a neighbourhood-based experiment aimed at finding new ways of meeting the needs of people living in areas of high social deprivation’. There were to be twelve projects … Their brief rested on three important assumptions. Firstly, that it was the ‘deprived’ themselves who were the cause of ‘urban deprivation’. Secondly, the problem could best be solved by overcoming these people’s apathy and promoting self-help. Thirdly, locally-based research into the problems would serve to bring about changes in local and central government policy.

Makes me really angry of course. Also unsurprising:

A few months’ field-work in areas suffering long-term economic decline and high unemployment was enough to provoke the first teams of CDP workers to question the Home Office’s original assumptions. There might certainly be in these areas a higher proportion of the sick and the elderly for whom a better co-ordination of services would undoubtedly be helpful, but the vast majority were ordinary working-class men and women who, through forces outside their control, happened to be living in areas where bad housing conditions, redundancies, lay-offs, and low wages were commonplace.

So they started organizing the people they were working with, using their research to pressure local authorities and councillors and investigating the structural issues at play – and that’s when they were shut down and buried really. In 1973 a central CDP Information and Intelligence Unit was set up and published a series of (probably embarrassing to the government) reports: The Poverty of the Improvement Programme, Whatever Happened to Council Housing? Profits against Houses and the Costs of Industrial Change. In 1974 central government asked for a review of the programme, with a goal of controlling, curtailing and closing down. (5)

Only six weeks after publishing the highly critical report on the government’s public spending cuts, Cutting the Welfare State (Who Profits), the Home Secretary ordered the closure of the unit.

This pamphlet was written in 1977, when a few projects were still running out their time, but finding it hard to coordinate work or collectively make sense of the findings.

This report is part of that attempt. Though it is not an account of our experience – that is to be found in the various local and inter-project reports — it tries to locate and explain that experience in the context of the series of government moves of which CDP was one….Still we hope that our analysis will help to clarify for others as it has for us, the role of government in relation to both the demands of the economy and pressures from the working class, and the part that such programmes we describe here as the ‘Poverty Programme’ play in maintaining the status quo. (6)

Part 1: The Poverty Programme

The men behind all of this top down malarky, well the men still look the same. Glasses are different of course.

A handful of home secretaries: top left, James Callaghan; right,
Robert Carr; bottom left, Roy Jenkins; right, Merlyn Rees. The
Home Office led the field in urban deprivation but it was a series
of official reports that triggered off the activity.

The Welfare state was under pressure, government unsure what to do, this all sounds familiar too. It was an experiment— the word comes up again and again — conducted with very limited resources in many separate laboratories. The central state drew in the local authorities, disregarding their traditional departmental boundaries. ‘Citizen involvement’ and ‘participation’ were recurring themes. Most important, all the schemes took as their testing grounds, small, working-class districts of Britain’s big cities and older industrial towns. These were the ‘areas of special need’ which had first come to the centre of official concern; soon they were being called ‘pockets of deprivation’. (9) In describing the programming that emerged in response, James Callaghan, Home Secretary said it was:

to provide for the care of our citizens who live in the poorest or most overcrowded parts of our cities and towns. It is intended to arrest, in so far as it is possible by financial means, and reverse the downward spiral which afflicts so many of these areas. There is a deadly quagmire of need and apathy. Hansard, 2.12.68 (10)

Quagmire. Right. Still, I’m only just beginning to realise what a big deal it has been, the centralisation of funds and control over programmes, so this is important

Responsibility for Urban Aid was located in the Community Relations Department of the Home Office, the department also responsible for the Community Relations Commission. The money made available for Urban Aid was not an extra government grant, but money already existing in the Rate Support Grant which was taken out of the general allocation and put into the Special Grant category. This allowed the government to have for the first time some direct control over what was going on ‘at the grass roots’. Local authorities could apply for grants from this Special Grant for specific projects which could be financed for up to five years on a 75/25% basis (10)

It still seems to have been quite decentralised, and going into quality programmes:

As the local authorities grasped the new idea and sent back descriptions of the areas they regarded as being ‘of special social need’ the kinds of projects supported through the Urban Aid Programme widened in scope. From the nursery schools, day nurseries and children’s homes, family advice centres and language classes for immigrants of the earlier phases, it had extended its embrace to many more informal kinds of organisation by the later phases. The Home Office actively encouraged local authorities to support autonomous forms of organisation that were already active in their areas. Women’s Aid centres, holiday play schemes, housing and neighbourhood advice centres, family planning projects were all included in later phases of the Urban Aid Programme. (11)

But of course there was never enough funding

there have been around five times more applications made than those granted. In 1971 for instance the London Borough of Lambeth submitted applications for projects to cost £103,500 – only £13,650 of this was approved (11)

In 1969 the Home Office set up its version of ‘action research’:  This included an array of programmes: Urban Aid (a neighbourhood-based experiment aimed at finding new ways of meeting the needs of people living in areas of high social deprivation; by bringing together the work of all the social services under the leadership of a special project team and also by tapping resources of self help and mutual help which may exist among the people in the neighbourhoods. Home Office Press Release 16.7.69 (12)); the Educational Priority Area (EPA) action-research project; Neighbourhood Schemes intensively targeting money into small deprived areas to complement the other programming; and the National Community Development Project. In the words of civil servant Derek Morell who pushed this through:

The whole project is aimed against fragmentation … The starting point of the project is that ours is a fragmented, disintegrating society. But the project aims at evolutionary changes, not revolution. Depersonalisation is another problem. The technical juggernaut is taking over and we are no longer the masters. The most difficult step will be how to discover how to perform the crucial task of raising the people of Hillfields from a fatalistic dependence on ‘the council’ to self-sufficiency and independence –Minutes, 14.7.69

That all sounds familiar too. And as if it were a race, the Department of the Environment announced in quick succession its own ‘total approach’ scheme: the Six Towns Studies.

In our approach to the environment, we have endeavoured in the first two years under the new DoE to make a switch of resources to bad areas .. . I believe that the next most important step for any department is to bring about a total approach to the urban problem. In the past the attitude has been a series of fragmented decisions not properly co-ordinated and not bringing about the improvement of urban areas which is necessary. –Peter Walker, then Secretary of State for the Environment, in the Budget Debate 1972, quoted in Community Action No.8. (13)

The Department of Health and Social Security (Sir Keith Joseph Minister), then set up a working party to explore ‘whether the cycle of transmitted deprivation would be a fruitful area of research’…investigating how ‘deprivation’ is passed on through the family. (13) Ah, how I love to hate that old chestnut. 1973 brought Quality of Life Studies, courtesy of the Department of the Environment, looking at improving access to leisure activities. They were a bit worried about how to coordinate it all by then, so created the Urban Deprivation Unit (UDU), and the Comprehensive Community Programmes. These were all partnerships between local and national government, but the European Economic Community (EEC) was also involved, and sponsored its own ‘Poverty Programme’ focused on the ‘chronically poor’. The research proliferated.

2. The (non) eradication of poverty

The aims of the EEC programme sound familiar: ‘to develop clearer perceptions of a complex problem and pioneer new techniques for tackling it‘.

The results? Mixed. The effort – beggars belief really.

The inner city areas of Liverpool are the delight of every deprivation theorist. They have been treated with each of the government’s urban deprivation programmes in turn, sometimes with several at a time. An EPA in 1969, a CDP in 1970, a Neighbourhood Scheme in 1971, an Inner Area Study in 1973 which then sponsored an Area Management experiment have all been tried there, and up to 1974 £1,707,213 had been spent on a stunning total of 146 different Urban Aid projects.

And yet:

In 1968 when the poverty initiatives came to town, 25,000 people were registered as out of work on Merseyside. Four years later their numbers had more than doubled with 52,000 people unemployed. Today, 85,600 men and women, 11.3% of Merseyside’s population, are out of work. Even these telling city-wide figures cover up the real story of the inner-city areas. There the predicament of would-be workers is even worse with up to 20% unemployed and up to 30% among younger people. (19)

It’s all structural, innit. No one wants to tackle that though.

Both the CDP and the Inner Area Study agreed that immediate action was needed to tackle inner-Liverpool’s housing crisis. But though the message of their reports became more insistent, the actual housing output declined. (20)

It all boils down to this, always and everywhere seems like:

The poverty initiatives then have clearly not made any great inroads on inner-Liverpool’s real material problems. All they have done is to restate, usually in academic terms, what the people who live there have known for a long time.

Let’s just repeat that, because we are still doing it.

All they have done is to restate, usually in academic terms, what the people who live there have known for a long time.

Right, to continue:

If you live on Merseyside you have a better than average chance of being made redundant, being on the dole for a long time, living in slum conditions, being evicted, and forced to wait over six months for hospital treatment. Your children are more likely to die in infancy, or when, after getting no nursery schooling, they finally get to school, of being in larger classes in worse buildings, only to emerge finally onto the dole. Over 10,000 people leave Liverpool each year as a way of avoiding these problems. Those who are left can debate them in the neighbourhood councils and area management experiments left behind by the ‘poverty projects’. But, as they well know, talk is not going to make any impact on the worsening situation that faces them. (20)

12.5%  households were still without hot water in 1966, though that had dropped to 6.5% by 1971 (21). Homelessness figures, though, were rising:

Homelessness has doubled since 1970. On an average day in that year there were 12,874 people applying for temporary accommodation throughout Britain: by 1975 this had increased to 25,120 people a day. Meanwhile there are one million households still on local authority housing waiting lists throughout England while in London alone the total number on the housing waiting list increased from 152,000 in 1965 to 233,000 in 1974. (21)

So what change was achieved?

The problems of ‘deprivation’ then would seem to be as acute as ever for those who live them, and the prospects are bleak. Neither the poverty initiatives, nor the government’s more general policies towards the poor could be said to have had much impact on the problems facing the people who live in the older urban areas. But the programmes have always been small compared to the size of these. Not so much geared to solving the problems, they set out to provide the basis on which policy at both central and local government levels could be improved. Did the EPAs, Inner Area Studies, CDPs and the rest at least succeed in this respect? When it came to it neither Tory nor Labour governments seem to have taken much notice of the major policy recommendations emerging from the programmes although several years have now passed since their first reports were available. (22)

For housing specifically:

In housing too the pattern is much the same. One of the major recommendations of all three Inner Area Studies was the need for more spending on house improvement, with changes in policy to allow poorer owner-occupiers to take up improvement grants and more powers to enable local authorities to ensure that rented property was improved. The local authorities got their greater powers in 1974, as part of the Housing Action Areas scheme, but powers alone are useless without money, and they have now been denied the resources to carry out these proposals at all as government spending on improvement grants has gradually been cut back from £195.2m in 19734 to £85.8m in 1975-6. (23)

1976 brought in a renewed period of cuts — more money going to the ‘urban problem’, but not as much as was being cut in other spending in face of national economic crisis.  So – it’s structural inequality. A great quote from the quote from the Liverpool Inner Area Study:

A number of issues emerge from this description of inner area characteristics and the work carried out by Inner Area Studies. The chief one is the poverty and neglect of the area and its people in every sense. To a great extent this poverty is a reflection of inequalities in society as a whole. Clearly the scale and character of the problem is too great for policies concerned solely and specifically with inner areas to be effective. Any fundamental change must come through policies concerned with the distribution of wealth and the allocation of resources. IAS/L1/6 Third Study Review, Nov. 1974. (24)

Next post — the larger political economy of the 1960s, and just why all this spending on certain kinds of solutions could never provide the right answers. I can’t believe we’re still having that conversation, but the CDP did it masterfully.

Young and Willmott on Leaving the Slums for the Estate

I know they are listed as Young and Willmott but that simply is impossible to roll off the tongue, I shall try and probably once again fail to write it this way in part two on Family and Kinship in East London (1957). From the densely woven networks of family described in part 1, held together in crowded rooms and turnings by living with parents or next door to them, by every day visits, shared meals, shared chores, shared lives, to spacious new council homes built on 44 acres near Epping Forest. This is how everything changed, and as Young and Willmott write, what better way to understand the importance of residence?

From Bethnal Green to Greenleigh (Debden)

Less than twenty miles away from Bethnal Green, the automatic doors of the tube train open on to the new land of Greenleigh. On one side of the railway are cows at pasture. On the other, the new housing estate. Instead of the shops of Bethnal Green there is the shopping centre at the Parade; instead of the street barrows piled high with fruit, fish, and dresses, instead of the cries of the costermongers from Spitalfields to Old Ford, there are orderly self-service stores in the marble halls of the great combines. In place of the gaunt buildings rising above narrow streets of narrow houses, there are up-to-date semi-detached residences. Bethnal Green encases the history of three hundred years. Cottages built for the descendants of Huguenot refugees, with their wide weavers’ windows and peeling plaster, stand next to Victorian red-brick on one side and massive blocks of Edwardian charity on the other. Greenleigh belongs firmly to the aesthetics of this mid-century. Built since the war to a single plan, it is all of one piece. Though the Council has mixed different types of houses, row upon row look practically identical, each beside a concrete road, each enclosed by a fence, each with its little patch of flower garden at front and larger patch of vegetable garden at back, each with expansive front windows covered over with net curtains; all built, owned, and guarded by a single responsible landlord.

Instead of the hundred fussy, fading little pubs of the borough, there are just the neon lights and armchairs of the Merchant Venturer and the Yeoman Arms. Instead of the barrel organ in Bethnal Green Road there is an electrically amplified musical box in a mechanical ice-cream van. In place of tiny workshops squeezed into a thousand back-yards rise the first few glass and concrete factories which will soon give work to Greenleigh’s children. Instead of the sociable squash of people and houses, workshops and lorries, there are the drawn-out roads and spacious open ground of the usual low-density estate. Instead of the flat land of East London, the gentle hills of Essex.

‘When I first came,’ said Mrs Sandeman, ‘I cried for weeks, it was so lonely. It was a shock to see such a deep hill going up to the shops.’ (121-122)

That gives such a beautiful sense of the differences, albeit a very particular view of them. But the scale is quite incredible.

Between 1931 and 1955 nearly 11,000 families containing over 40,000 people were rehoused from Bethnal Green on L.C.C. estates, many of them outside the county.’ (124)

People did, many of them, choose to come of course. Part of the study was to understand just why. The reasons were many, but not, for the most part, weaker attachments to their family.

lf the migrants did not have weaker kinship attachments than other people, why did they come? The main reason is {quite simple. The attraction is the house. Our couples left two or three damp rooms built in the last century for the ‘industrious classes ‘, and were suddenly transported to a spacious modern home. Instead of the tap in the backyard, there was a bathroom with hot and cold water. Instead of the gas stove on the landing, a real kitchen with a sink and a larder. Instead of the narrow living room with stained wallpaper and shaky floorboards, a newly painted lounge heated by a modern solid-fuel grate. And instead of the street for their children to play in, fields and trees and open country. The contrast is all the sharper because the new residents had, in the main, come from Bethnal Green’s worst houses. (126)

But the council in general had much more to do with it:

But, in general, the L.C.C.’s view of who needed it most decided who went. Our informants were mostly at the top of the L.C.C.’s housing list – they were living in the most overcrowded or the most unhealthy houses in the borough – and that is why they were selected. (127)

One of the tenants told them — ‘If we could take the house with us, we’d go back like a shot.’ (127)

For many, as with so many families, it was about the generations to come, not the generations they had left behind.

‘Everything seems quieter here, more calmer,’ said Mrs Vince. ‘The fresh air hits you when you come out of the station.’ Many people value the air and fields even more for their children than for themselves. Greenleigh is generally thought ‘better for the kiddies’.

So even where they left their kin with regret, the people were not deserting family so much as acting for it, on behalf of the younger rather than the older generation. (128)

But many did not stay.

Many migrants in fact decided that they had made the wrong decision, and left the estate, most of them to return to the East End. Altogether, from the opening of the Greenleigh estate until March, 1956, 26 percent of the tenants who had come there moved away again. (129)

The Family at Greenleigh

So what changed? Any friendly community feeling did not survive the scale of changing community. Everyone found the neighbors snobbish, stand-offish. Talked about the terrible loneliness. Some got part-time jobs just to survive it — one of those said ‘If I didn’t go to work I’d get melancholic.’ Her verdict on Greenleigh — ‘It’s like being in a box to die out here.’ (133)

The study found a great sense of loss, particularly women missing mothers. Most of the men continued to work in Bethnal Green as there were no jobs out near the estate, so suddenly they become the ones maintaining family ties. What made me most sad — it wasn’t distance or time that kept women from their wider families, but the cost of transport. In times of trouble they had no support, there was no one to lend money to tide people over, help when sick or pregnant, help with kids. Visiting was not a thing that was done.

Their study of Bethnal Green showed just how much happened in public spaces, not private ones, and these were precisely the spaces missing in the new estates.

One reason people have so little to do with neighbors is the absence of places to meet them. In Bethnal Green there is one pub for every 400 people, and one shop for every 44 (or one for every 14 households). At Greenleigh there is one pub for 5,000 people, and one shop for 300.

They had no cinemas, so could not congregate there either. This combination of distance and television changed things. Young & Willmott write:

The growth of television compensates for the absence of amenities outside the home, and serves to support the family in its isolation. (143)

Rents were also higher there on the council estate, often by 3 times. That in addition to fares meant people were trapped there.

Keeping Themselves to Themselves

Willmott and Young found people in Greenleigh eager to talk about their neighbours, how unfriendly they found them, and they always compared back to their community in Bethnal Green.

At Greenleigh they neither share long residence with their fellow tenants nor as a rule have kin to serve as bridges between the family and the wider community. These two vital interlocked conditions of friendship are missing, and their absence goes far to explain the attitude we have illustrated. (150)

They believed this to be partly due to the fact that everyone moving in at the same time, and there was no existing community for them to integrate into. While Willmott and Young describe their expectations that things would have improved over the few years between interviews, nothing really had changed. They blame a lack of density — a bit of catch phrase these days.

One reason it is taking so long is that the estate is so strung out — the number of people per acre at Greenleigh being only one-fifth what it is in Bethnal Green — and low density does not encourage sociability. (153)

The new big homes reinforced a feeling of what people lack, rather than all that they had. They were spending more on filling homes with objects, rather than entertainment and going out as they had before.

There is also a facsinating aside on time and space — in Bethnal Green people tended to be very informal, did ‘not need a highly-developed time sense…because it does not matter greatly whether her goes round to Mum’s at 10 o’clock or at 11. If Mum is not there someone will explain where she has gone‘ (157). This was not at all true of Greenleigh. Much of the difference lay in how close things were in Bethnal Green, with everything walking distance. In Greenleigh, life required a car and a telephone to ‘overcome geography and organize a more scattered life into a manageable whole (158)’.

The impact of this was quite profound, particularly on mental health, and particularly for women. This should not have been stuck in a footnote really:

Footnote 1, p 158: The chief psychiatrist at a local hospital told us that the loneliness of the women on this and other housing estates was the immediate, precipitating cause of so many of them coming to his department for treatment.

This lack of relationships, of knowing people, meant both a growing formality, as well as increased reliance on visual clues for judging strangers.

In a community of long-standing, status, in so far as it is determined by job and income and education, is more or less irrelevant to a person’s worth. He is judged instead, if he is judged at all, more in the round, as a person … How different is Greenleigh…Where nearly everyone is a stranger, there is no means of uncovering personality. (161-162)

They continue

Their relationships are window-to-window, not face-to-face. Their need for respect is just as strong as it ever was, but instead of  being able to find satisfaction in actual, living relationships, through the personal respect that accompanies almost any steady himan interaction, they have to turn to the other kind of respect which is awarded, by some strange sort of common understanding, for the quantity and quality of possessions which which the person surrounds himself (163-164)

They also note the lack of forward planning in the planning process for the estate itself…it has been developed as a community where people cannot age. When people’s children are grown where will they live? Nowhere for them to move close by, almost certain that enough existing units will not become vacant over the normal course of things, and it was council policy to prioritise outside people from the list rather than children. Willmott and Young note the protest that this raised among residents, a local association writing of the LCC in 1955 ‘We are in opposition to the view that people are simply units to be moved around the face of the earth in line with the impersonal schemes of some “Big Brother”...’

W&Y continue

The method by which the council has eased the housing shortage in the middle of the century is bound to create a further shortage in its last quarter. (168)

They weren’t wrong.

Movement between classes

They wanted to check and make sure that this growing sense of the importance of geography was not in fact more a function of social mobility, which leads to a rather interesting way to better understand class. Again, Willmott and Young trace sense of loss and disintegration of a sense of community it primarily back to the geography of the built environment — as people tend to seek out larger houses, they must look elsewhere. The authors write:

The East does not provide ‘middle-class’ people with ‘middle-class’ places to live, and such migration may therefore be more common than it would be in districts with more of a mixture of classes. (172)

In conclusion, though, of all of it.

…very few people wish to leave the East End. (186)

While the houses were better, Willmott and Young look at the networks of support, and find they are absent on the new estates. They have the best description of  the daughters’ new plight,  engaged in the ‘arduous…puzzling…monotonous‘ work of child rearing, while older people were cut off from remaining useful and part of the family. Willmott and Young are highly critical.

It seems that when the balance of a three-generation family is disturbed, the task of caring for dependents at both ends of life, always one of the great and indispensable functions of any society, becomes less manageable. (196)

So one key recommendation is to support these connections rather than tear them apart. Central to that there follows the need to maintain communities intact, and save as many of the existing houses as possible, updating the fabric, giving people new bathrooms, lavatories and kitchens.

I cannot help but agree with them, and wish this had been policy for the past few decades so as to build on the strengths of working class communities, rather than the opposite.

Young, Michael and Willmott, Peter ([1957] 1979) Family and Kinship in East London. Manchester: Penguin Books.

The Importance of Residence: Willmott and Young on Bethnal Green

Michael Young and Peter Willmott’s Family and Kinship in East London is an incredible book, and I am just sorry I didn’t get round to reading it while working in East London though it has been on my list to read for what feels like forever. There are a number of critiques of the book, based primarily on the ‘rosy’ views of working class life. Looking backwards it is hard to tell of course, but it seemed to me it captures much of what continues to be good about working class life…and there is enough here to show that such closeness of community is many-sided and not to everyone’s taste. I thought back to Morrison’s writings on East London, which accentuated the narrowness of life, the gossip in those Mean Streets. I don’t know that either is wrong or right, they can sit together in the richness of how people experience life. For myself, it is always the generousness of my class that has impressed me. Anyway.

This is quite a stupendous piece of research. Amazingly I found a pdf of some of the original survey instruments (original link here, another copy of the docs here)… very cool. But what I love most is they seemed to have actually listened to people, rather than categorising them, and in their work to have explored the intersections of family, home and neighbourhood in quite brilliant ways.

This book is about the effect of one of the newest upon one of the oldest of our social institutions. The new is the housing estate, hundreds of which have been built since the war. In the last century people moved into the cities; in this they have been moving steadily out again, towards the countryside from which their ancestors came. (11)

They write too, that ‘We were least prepared for what we found in the borough’. Because what did they expect? The familiar tale of the ‘good old days’ now gone.  They believed old patterns of wide extended families and support networks had disappeared over the course of industrialization and modernisation undergone in East London, but instead:

We were surprised to discover that the wider family, far from having disappeared, was still very much alive in the middle of London. This finding seemed to us of more interest than anything we had been led to expect, all the more so when it transpired that the absence of relatives seemed to be as significant on the estate as their presence in the borough.

and the last line, a rather fascinating methodological note

We decided, although we hit on it more or less accidentally, to make our main subject the wider family. (12)

This is perhaps why I didn’t prioritise this book, being less interested in constructions of family and more in community and home. But I was terribly wrong about that. In addition to tackling the myth f the destruction of familial networks, they take on others. Bethnal Green’ 54,000 residents in 1955 were almost all working class, but only 8% of population found to be Jewish, ‘contrary to popular opinion‘. So on to what they did find.

Kinship in Bethnal Green

The begin with a review of earlier studies — Charles Booth among others, who described barefoot children, undernourished babies, young moths sick and hungry. The majority of these blamed poverty, blamed the poor, and above all men for spending money on things they shouldn’t, particularly nights down the pub etc. This is the image of the brutal working class man, tales of drunkenness and forced sex, bruises, pregnancies.

Even though we may think the accounts overdrawn, and distrust the representativeness of the families they describe, we cannot ignore the historical evidence, all the more so since the notion still survives that the working-class man is a sort of absentee husband, sharing with his wife neither responsibility nor affection…(19)

But you look at the evidence drawn from their interviews, it is the falling death rate that seems the biggest factor in families remaining families — 29% of those born before 1890 came from homes broken up before they turned 15 by the death of a parent, as compared to 2% from divorce or separation. That is a crazy figure. It was still 19% for those born between 1921 and 1933, compared to 1% divorce and separation.

It had never occurred to me before to think seriously of how young people died, to understand what that meant for the living. To remember how soon this all began changing.

Still — things were improving — despite people living longer, more housing was being made available. In 1931 there were 3 households to every 2 dwellings. 1941, 4 households to every 5 dwellings. More space, less hard wear of space. More comfortable spaces you might want to spend time in as opposed to down the pub. It never occurred to me to think of that much either.

Nor labour patterns and rights, but of course those were also definitive.

The spread of the five-day week has created the ‘week-end’, a new term and a new experience for the working man. (24)

You can see, of course, why I should love this book, bringing all these structural factors together to understand just what life lived within their constraints might mean. It is also full of those details you only get with qualitative work. Like the descriptions of the rise of cinema and wireless — a lovely section on the impact it has had on naming children! No longer names that have always been in the family. Aspirations were changing in other ways — work for example. Primarily for sons, but I love the snark in this reply:

I’d like him to take up chemistry. It’s completely unproductive and therefore well paid. (29)

Young and Willmott continue:

A sizeable minority of men in Bethnal Green take a very different view from white-collar people about the status of manual work, placing jobs such as company director and chartered accountant towards the bottom of the scale and manual jobs, like agricultural laborer, coal miner, and bricklayer, towards the top. These men regard business managers with disfavour because ‘They’re not doing anything. They get their money for walking around’ … Agricultural laborers, on the other hand, they value highly because ‘you can’t do without grub’; coal-miners because ‘without coal, industry stops’; and bricklayers because ‘you’ve got to have houses’. But even some of the men that take this view are anxious that their children should get as good a technical education as possible. (29)

That is one of the best statements of how the world should work I have ever read.

Where People Live

Housing was always an issue given its scarcity, and there follows a long, and brilliantly detailed exploration of how and where people live. After marriage, if the new couple have no home of their own yet, they most often live with the wife’s parents — mother and daughter have a long term bond, can manage in the house together by custom. Willmott and Young write:

Their tenancy is the most valuable property-right many working-class people posses: where the property is privately owned, the rent is low and controlled by law. (33-34)

People inherited tenancies from their parents, sometime going back three generations. This was one of the positive aspects of remaining at home after marriage, but as Young and WiIlmott make clear, most people ‘don’t want to live with them, they want to live near them‘ (35). They include a brilliant quote from Sheldon’s, ‘The Medicine of Old Age’ about similar community in Wolverhampton:

The fact that no less than four per cent of the sample had children living actually next door is astonishing; and there is no doubt that this proportion would have been higher but for the general housing difficulties since 1939, for the opinion was frequently expressed by both generations that this is the best mode of life for the old people, since it enables them to preserve their independence and the married children to lead a separate life, while at the same time ensuring that help is at hand when needed. (36)

This study showed twice as many women as men living in same house with their parents, and twice as many in the same street or block. They talk about the matrilocality of the English working class, and spatially at least this is well born out. (37) They include brilliant little pieces of description of the neighbourhoods they are visiting, and the feel of life there, like their visit to:

a four-roomed house in Minton Street in the middle of the borough. The other houses (but not the two pubs, obviously newer) were all built in the 1870s, of brick which has become a uniform smoke-eaten grey. They are nearly all alike in plan; on the first floor two bedrooms, and on the ground floor a living room, a kitchen, and a small scullery opening on to a yard which has a lavatory at the end of it and patch of earth down one side. Many of the yards are packed with clothes hanging on the line, prams, sheds, boxes of geraniums and pansies, hutches for rabbits and guinea-pigs, lofts for pigeons, and pens for fowls. the only difference between the houses is the colour of the curtains and doorsteps which the wives redden or whiten when they wash down the pavement in front of their doors in the morning. Dilapidated but cosy, damp but friendly, in the eyes of most Bethnal Greeners these cottages are the place, much more so than the huge blocks of tenement buildings standing guard, like dark fortresses, over the little houses . On the warm summer evening of the interview, children were playing hop-scotch or ‘he’ in the roadway while their parents, when not watching the television, were at their open windows. Some of the older people were sitting in upright chairs on the pavement, just in front of the doors, or in the passages leading through to the sculleries, chatting with each other and watching the children at play. (38)

The mother is usually the one who helps get her daughter her own place after marriage — she is the one with connections through the rent collector and through friends. She knows who has died or who is moving out, if she is a good tenant the rent collector can assume her daughter will be too. This means empty apartments go to those from the local area due to this web of connections. Some charitable trusts who owned housing in the area had it as official policy that family gets first chance at flats opening up, in others while not official, that was generally the way things worked. Willmott & Young note too, some of the other arrangements that can be made to reduce animosity over flats where they are scarce, such as letting part to a family who also needs it etc.

This was very different from how the council operated, which is rather fascinating. Willmott &Young noted that at the time of writing the council owned a third of dwelling in the borough and that was increasing. The council worked off of lists not personal connection, and early version of today’s points and priority need. Preference was given to ‘slum’ dwellers and those with high need, and it is easy to see the argument for this, but also you can see what might be lost. In 1957, it was still true that

Bethnal Green suffers from a serious housing shortage. In time, we can hope, it will be much less acute… (42)

Mothers and Daughters

From the above, it is clear just important relationships are. Willmott and Young note the amount of time daughters spend with their mothers, and mothers with their daughters, how it makes no sense to talk about the household as such, particularly given how many meals people share. Again they quote Sheldon on Wolverhampton:

‘In at least 40 per cent of cases they must be regarded as part of a family group, the ramifications of which bear little or no relation to architectural limitations. (48)

I rather love how the family overflows and engulfs the limits of brick walls in that sentence.

There is a multitude of ways listed in which mothers and daughters help each other, but I found this sentence about work quite fascinating:

Part-time work is plentiful in Bethnal Green, both in the small local factories and in the tens of thousands of offices which have to be cleaned in the nearby City, and women are therefore less in need of help from relatives than they would be in many other places. (54)

This would change, I suppose, but it seems to me I have not read much at all that really looks at these employment patterns and the independence such work must have provided. While also being rather shit work.

Husbands and mothers

Another amazing description:

Once arrived in the Hanbury’s front room, most of the guests stood about rather stiffly, holding glasses of beer and sniffing the pickled onions. The Buxtons, that is the bridegroom’s family, were grouped by the window, looking disdainfully at the chipped china dogs on the mantelpiece, the worn linoleum on the floor and the pictures of country scenes which did not quite conceal the damp patches on the wall-paper. (62)

Things liven up though.

You’ll be happy to know that the study found sons to regularly check in on their mothers, it tended to be once a week, and it was often them dropping by on their own. Nice.

The Kinship Network

These are broad, reinforced by regular meetings, but often the mother/oldest sister at their centre, and they tend to dissipate after their death.

The Family in the Economy

More on the many jobs available — it is hard indeed not to think of them as better days:

You do not have to live in Bethnal Green, you only have to take a bus down the main street to notice that this is a place of many industries. You pass tailors’ workshops, furniture makers, Kearley & Tonge’s food warehouse, and near to Allen & Hanbury’s big factory. The borough has by itself a more diversified economy than some countries. But the borough has no frontiers: it belongs to the economy which stretches down both banks of the Thames. At its heart is the largest port in the world, which lines the rives for nearly twenty miles from London Bridge to Tilbury, and supports on every side a web of interconnected industries… (89)

More on immigration, some things don’t change.

Because the East End is a port, and near to the Continent, it is the place where for centuries foreigners have landed to escape from war and persecution in Europe. (89)

Immigration’s connection to employment, though becoming more tenuous

The Huguenots most famously, notes still hand-loom weavers in 1939 and the closure of the last Huguenot silk firm in 1955. Furniture, however, once a spin-off of this trade, still strong though showing signs of winding down…

Several chapters on they have another great story about the Huguenots, where a local resident showed them a document written about the time of the Revolution, some kind of petition to the Governors of the French hospital in Hackney (!) to employ, and treat, his granddaughter. Amazing. But I digress.

Despite this winding down of the furniture trade (though that was still existing in pieces when I worked there), they can still write:

East London is less vulnerable because it has many industries to lean on, and while it cannot avoid being harmed by a general contraction in trade. (91-92)

And they note that those in Bethnal Green able to take the job of their choice. It’s political leanings are no surprise:

Every constituency in East London returns a Labour member to Parliament and every council is controlled by the Labour Party, Bethnal Green regularly electing a complete slate of Labour Councillors almost as a matter of course, The people share their politics; they speak the same language with the same accents; they work with their hands; they have, in short, the same kind of life. These deep-lying bonds between members of a class are also bonds between members of the family. (94)

See? Good old days. Hard to imagine this as Labour now.

One change for the better? Things aren’t quite as openly racist as they used to be:

But for most people the Council is not the prize it was. Security does not now matter enough to offset the low pay. Mr Sanderson, a dustman, explained how far his job had sunk…

Things have got so bad that they recently started about a dozen black men. They’re got the rough and rebel from everywhere. One of the black men was sweeping roads with a cardboard box with eyeholes over his head. The foreman asked him what he was doing that for and he said “Well guv’nor, it’s cold.” If it’s a bad winter, they’ll pack up, go home, and make rum.” (96)

The docks a different story (though probably not in the matter of casual racism), ‘It is a matter of pride to belong to a docker’s family‘. (97) I love this story, though I can’t honestly tell if its racist or not:

There were many well-established families — in a nearby dock, one of these was…known as the ‘Flying Eighteen’, a group of brothers and uncles with legendary sensitivity to the ‘jungle drum beats which let them know a ship was coming up the Thames’. (98)

They always got there first. This closeness of community and family surely has its downside. The study looked at how unions and industries gave preference to members’ sons — Transport and General Workers’ Union, Billingsgate for fish, Covent Garden and Spitalfields for fruit and veg, and Smithfields for meat.  Printing, bookbinding and paper workers the same.

Kinship and Community

Willmott and Young meet some of these challenges head on, at least in terms of the wider white working class:

Since family life is so embracing in Bethnal Green, one might perhaps expect it would be all-embracing… Far from the family excluding ties to outsiders, it acts as an important means of promoting them… The kindred are, if we understand their functions aright, a bridge between the individual and the community… (104)

They give this amazing, cinematic description of Mrs ‘Landon’ doing her half-hour morning’s shopping and telling the name and background of everyone they pass. By her own record of who she saw in a week in the street that she considered herself to ‘know’, there were 63 in total, and 38 were the relatives of someone else she knew. It is in the street, the shop, the pub that people meet each other, NOT in the home, which remains private. But I think much more happened then in public that would now be considered things best kept private.

Again we have another  brilliant description of urban space:

The streets are known as ‘turnings’, and adjoining ones as ‘back-doubles’, Surrounded by their human associations, the words had a glow to them, ‘In our turning we‘, they would say, ‘do this, that, or the other.’ ‘I’ve lived in this turning for fifty years’, said one old man proudly, ‘and here I intend to stay’. The residents of the turning, who usually make up a sort of ‘village’ of 100 or 200 people, have their own places to meet, where few outsiders ever come — practically every turning has its one or two pubs, its two or three shops, and its ‘bookie’s runner’. They organize their own parties…some turnings have little war memorials… (109)

They mention a woman had lived in the same courtyard all of her 62 years, spoke of newcomers with only 18 years residence, shocked to hear the council thought of her court as a slum. Imagine.

Another quote from J.H. Robb Working Class Anti-Semite…I don’t quite know what that is about, will have to look it up, but the quote is a good one:

There is a further localism within the borough. People are apt to look for their friends and their club within a close range. The social settlements draw nearly all their members from within a third of  a mile, while tradition dictates which way borderline streets face for their social life. The main streets are very real social barriers… (110)

So in looking at what holds community together, they write:

The interaction between length of residence and kinship is therefore the crux of our interpretation. Neither is by itself a sufficient explanation. (115)

But above all it is place.

In ending this chapter…If we are to pick out one conclusion, it is the importance of residence.

Marriage, changes of life, all of it

A special cast is given to all these adjustments and readjustments by the fact that they are played out within a limited physical space.  (117)

What better way, they say, to study the importance of residence than to look at what happens to this thick web of connections when there is a change? So on to part two — the new council estate at ‘Greenleigh’, now the truth can come out of the name — the Debden Estate. Why did I think it was the Becontree Estate? Dear oh dear, but it matters not. That will be saved for part 2.

Young, Michael and Willmott, Peter ([1957] 1979) Family and Kinship in East London. Manchester: Penguin Books.

Antonovsky on Salutogenesis in Health, Stress, Coping

We’ve been doing so much work around social prescribing with Salford CVS, and salutogenesis is all over that literature. A concept developed by Aaron Antonovsky (1923-1994) for where the medical focus should lie: on how people become well, not on why they are sick. There’s some really good stuff in this sadly out-of-print book that I had to order on loan from the British Library.

It opens autobiographically — an intellectual history of Antonovsky’s work and the questions driving that work. I agree that this is the real question we need to be answering:

What are the stressors in the lives of poor people that underlie the brute fact that, with regard to everything related to health, illness, and patienthood, the poor are screwed? (3)

Given that, and all that follows, I can’t say it doesn’t trouble me greatly that Antonovsky moved from NY (and his work around studies of poverty and labour) to Israel, where it does not seem as though he undertook a study of mass Palestinian displacement into refugee camps or poverty or access to health care. Of course for him, understanding the echoes of the Holocaust in survivor’s health is clearly a driving question in his research, and this is where the example that he felt was foundational to his later theorising emerged from: In studying those camp survivors, he found that as a whole the group was unable to adapt as well as other groups to menopause. However, there were women within that group that adapted as well as anyone — so the question became to turn research around and ask why those women had adapted, and why they did so well despite their experiences? This led to what Antonovsky later came to call salutogenesis. Why people are ‘healthy’ not why they are sick. He makes the point that honestly, given how shit the world is, we should all be sick all of the time, so the real question becomes what is stopping that from happening?

It’s interesting, though, that the central concept of the book isn’t really this term salutogenesis, but what leads to it and ultimately what is at the foundation of health — what Antonovsky calls a ‘sense of coherence’:

a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected. (10)

This is what determines how well you deal with the daily bombardment of illness and disease. He also emphasizes that this is NOT the same as a feeling that ‘I am in control’. But more on that later.

I sit with this though. If this is true, then how thoroughly do we have to remake this world for health? Far beyond the policies I have seen Antonovsky quoted as a supporting reference for. For me, this becomes a new framework not only for the loss of my dad and many other people I have loved and lost to poverty and its many ills, but also for the millions of people now in hopelessness, precarity and movement across the planet.

Chapter One: Studying Health Instead of Disease

The problem of salutogenesis is one of the most mysterious, intriguing, and meaningful challenges for philosophy and the biological and social sciences… Pathogenesis–the origins of disease X, disease Y, disease Z–has preoccupied us … here, as in all of science, how one poses the question is crucial to the direction one takes in looking for the answers, (12)

We have looked for the origins of disease X, Y and Z and found them. He talks about the exogenous and endogenous bugs, the sets of agents that cause disease: ‘viruses, mutant cells, pollutants, or agents of physical trauma such as guns, knives, and motor vehicles, that pose a constant threat of damage…’ wait for it though, here it really comes:

And finally, there are those bugs variously called psychosocial stressors, presses, strains: alienation, rapid social change, identity crises, ends-means gaps, discrimination, anxiety, frustration. (14)

These are not, of course, considered working within a pathogenic model.

Our dominant ideological paradigm, which shapes our society’s clinical practice and scientific research, focuses on and responds to a particular disease or clinical entity. (15)

Near the end of the chapter, he gives three reasons why ‘the focus on pathogenesis is likely to handicap us in grappling with both the scientific problem of understanding why illness is far from deviant and the human problem of somewhat reducing pain… (my bullets, his words in what follows)

  1. the pathogenic approach pressures us to focus on the disease, on the illness, on the alteration of body fluids or structures, and to disregard the sickness… it blinds us to the subjective interpretation of the state of affairs of the person who is ill (36).
  2. thinking in pathogenic terms is most comfortable with the “magic-bullet” approach–one disease, one cure–which explains the resistance of many to the concept of multiple causation. … the assumption is that we are cleverer than the bugs and can eradicate them one by one (37)
  3. pathogenesis by definition is a model that postulates a state of disease that is qualitatively and dichotomously different from a state of nondisease…

And I’m going to separate this last bit of the paragraph out, because it better explains salutogenesis:

such dichotomization blinds us to a conceptualization made possible by a salutogenic model, namely, a multidimensional health-illness continuum between two poles that are useful only as heuristic devices and are never found in reality: absolute health and absolute illness. (38)

Chapter 2: Measuring Health on a Continuum

This returns to all the problems of thinking of health and illness as a dichotomy when the real question for Antanovsky is ‘Given the ubiquity of bugs, why does anyone ever stay alive and reasonably healthy?’ (39)

On epidemiology — I know it shouldn’t surprise me that the field of medicine is siloed within as much as without, and epidemiology is only one of those silos, and yet it does–he writes:

epidemiology is one of the major scientific disciplines that have developed in the service of the health care institution. There is no doubt in my mind that the epidemiological conceptualization of the health-illness phenomenon, the model or paradigm used by epidemiologists, is powerful and, for some purposes, far more powerful that the clinical model we have been discussing.

And continues, with bullets that are again my own

  1. epidemiologists are aware of the iceberg phenomenon. They assume, with adequate evidence, that for every case of a disease that has been brought to clinical attention…there are additional cases below the surface… (45)
  2. …they are kept in check by methodological sophistication and compulsiveness… [for clinicians] intuition, art and clinical skills are necessarily acceptable in arriving at a conclusion. The epidemiologist has the luxury of rejecting such subjectivism. (46)
  3. the sine qua non of the epidemiologist’s professional activity is to go beyond description and enter the field of analysis, to deal with causation. As such, it rounds out, complements, the field of laboratory and clinical research. But its core and strength are its understanding of causation as based on teh study of group rather than individual differences. (46)

Thus he gives the public health model higher marks than the clinical model (and I just read a splendid book about social epidemiology, but more on that later), yet it still suffers from this dichotomy of health and illness.

I was curious to find Antonovsky critiquing the WHO definition of health, not its utopian aspects but the way that it can’t be operationalized. He argues that this renders it harmless, and he might be right. He prefers Dubos’ definition of health (I am looking forward to reading Dubos) ‘a modus vivendi enabling imperfect men to achieve a rewarding and not too painful existence while they cope with an imperfect world (1968, p67).

Awesome definition, but I can see that not everyone would be inspired by that. Nor is this mapping of the continuum to inspirational either perhaps, but I found it useful:

As Antonovsky writes:

by defining health as coextensive with the many other dimensions of well-being, one makes the concept of health meaningless and impossible to study … Health wellbeing must be studied separately (68)

Chapter 3: Stressors, Tension, and Stress

Stressors are omnipresent in human existence … Poor tension management leads to the stress syndrome and movement toward dis-ease on the continuum. Good tension management pushes toward health ease. (71)

Everyone alive would agree with that statement. The list of stressors he gives:

accidents and the survivors; the untoward experiences of others in our social networks; the horrors of history in which we are involved; intrapsychic, unconscious conflicts and anxieties; the fear of aggression, mutilation, and destruction; the events of history brought into our living rooms; the changes of the narrower world in which we live; phase-specific psychosocial crises; other normative life-crises–role entries and exits, inadequate socialization, underload and overload; the inherent conflicts in all social relations; and the gap between culturally inculcated goals and socially structured means. (89-90)

Quite a list.

Chapter 4: Tension Management and Resources for Resistance

In moving towards an understanding of the foundations of salutogenesis, Antonovsky develops the concept of the Generalized Resistance Resource, or GRRs as those things that help keep us towards the healthy side of the continuum.

Antonovsky p 103

The principal individual characteristics include rationality, flexibility, farsightedness, but I’m most interested in what he calls Interpersonal-Relational GRRs, more generally known as social supports. These sit in opposition to social isolation — or what in those days seemed to have been termed ‘social isolates’ or ‘social destructs’. Goddamn, imagine being thought of as a social destruct. But we are finally working our way to understanding what Antonovsky means by coherence, ‘the GRR of deep, immediate, personal roots.’ (114) I haven’t read Malinowski since undergrad, but he’s cited here:

Malinowski says that culture gives each of us our place in the world…. In Chapter Three I defined a stressor as a demand made on one for which one does not have tan automatic and readily available response capacity. From this point of view, what culture does, in giving us our place in the world, is to give us an extraordinarily wide range of answers to demands. The demands and answers are routinized: from the psychological point of view, they are internalized; from the sociological point of view, they are institutionalized. (117)

A really fascinating way to think of culture in the abstract, but I can’t help but also think of the left’s too-often sneering attitudes to ‘identity politics’ and culture and struggle, and see how really this all ties in together. And just to repeat once again”

Ready answers provided by one’s culture and its social structure are probably the most powerful GRR of all. (119)

Chapter 5: Perceiving the World as Coherent

This is the central point of the book really, and the key idea for Antonovsky:

The sense of coherence is a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable, and that there is a high probability that things will work out as well as can reasonably be expected. (123)

He doesn’t once, that I remember, quote Voltaire. It’s extraordinary. He continues:

A sense of coherence, as I trust has become clear, does not at all imply that one is in control. It does involve one as a participant in the processes shaping one’s destiny as well as one’s daily experience.

The crucial issue is not whether power to determine such outcomes lies in our own hands or elsewhere. What is important is that the location of power where it is legitimately supposed to be. This may be within oneself; it may be in the hands of the head of the family, patriarchs, leaders, formal authorities, the party, history, or a deity. The element of legitimacy assures one that issues will, in the long run, be resolved by such authority in one’s own interests. Thus a strong sense of coherence is not at all endangered by not being in control oneself. (128)

It’s all about power over your fate — and in fact by this argument participation in struggle could be as powerful and positive a health determinant as being lucky enough to be born in the upper classes. Of course, Antonovsky also describes the way that certain kinds of faith stand in as much good stead. There is so much to think about here.

He gives case histories of Norman Cousins and Freud himself as examples — you have to like that. In thinking about the conditions under which a strong sense of coherence emerges, Antonovsky notes that one line of research might be investigating  how in the case studies given, the ‘one common substantive theme … is the continuous experience of participation in shaping one’s fate‘ (152).

Chapter 6: Relation of the Sense of Coherence to Health

A long chapter that states that as the sense of coherence has not been operationalized and therefore not tested, he is simply bringing together evidence for a ‘prima facie case for the plausibility of the hypothesis‘ (161). I think he manages.

Chapter 7: the Salutogenic Model of Health

And now back to salutogenesis, along with a helpful summary:

In Chapter One, I posed the problem of salutogenesis. Chapter Two proposed a solution to the problem of the measurement of health status consonant with the salutogenic orientation. At that point, the core of the question was put as the need to explain the location of a person near the ease end of the health ease/ dis-ease continuum. Chapter Three considered–and rejected–the hypothesis that the answer could be stressor avoidance. In Chapter Four, an initial alternative answer was presented: the availability of generalized resistance resources. The initial question was also broadened to consider maintenance or improvement of one’s position on the breakdown continuum, irrespective of location at any given time. Analysis of the nature of generalized resistance resources, of why they are hypothesized to facilitate tension management and avoid stress, led to the formulation of the central construct of the book, the sense of coherence, considered at length in Chapter Five. The final building block in which I call the salutogenic model appears in Chapter Six, which presents the evidence for linking the sense of coherence and health status. (182-183)

An amazing chart here to summarise the model. I give it to you:

Antonovsky -- The Salutogenic ModelAntonovsky -- The Salutogenic ModelAnd of course, as I’ve probably failed to make clear, salutogenesis really needs to be the focus of our current age, not instead of pathogenesis but after pathogenic success.

There is, indeed, good reason for the pathogenic model to have dominated thinking about disease for most of human history. The three-pronged power of stressors…which included perhaps above all nutritional deprivation and the most primitive level of sanitation, was sufficient to overcome even substantial resistance resources. When, however, the standard of living…reaches a rough level of adequacy, differences in health level no longer are overwhelmingly determined by biochemical and physical stressors (193).

Chapter 8: Implications for an Improved Health Care System

This isn’t easy, this is no ‘guide to the perplexed‘ — Antonovsky says that twice. But he has a few suggestions. One is to think of the doctor as a GRR — each encounter between doctor and patient a way to support a patient’s sense of coherence. This is particularly important as each encounter will generally involve ‘anxiety, uncertainty, unpredictability and dependence‘ for the patient. Above all this is key after a traumatic situation, when someone finds themselves, as Antonovsky writes, as generally ‘shattered‘. However routine encounters also important. For the most part, those encounters which allow the physician to see and to treat someone as a whole with a sense of their broader self and context are the best.

Near the end of the book, Antonovsky asks: ‘Can the medical profession and the individual physician engage in activities beyond the patient-doctor encounter that affect the sense of coherence?’ Yes of course, and there are four ways this might happen: ‘making health care available to all, promoting a preventive health orientation, buttressing faith in the physician, and reaching out to persons at high risk of damage to the sense of coherence‘. (217)

One of my favourite sentences:

A society, then, that has institutionalized a health care system that expresses consensus that health care is an inalienable right of all its citizens and is to be made available to all on the universalistic ground of being  a resident of that society is a society that has taken a step forward in strengthening the sense of coherence of its members. (217)

Those blocked from this due to poverty or race or rural living distant from health care necessarily lack this sense.

Penultimate paragraph from the epilogue:

If we wish to see the present and future soberly in our world, we must use words like capitalism and totalitarianism.  The social structures in which most of humanity lives and the daily experiences to which we are exposed in these structure are far from conducive to a strong sense of coherence…Societies with a marketing mentality and fetishism of commodities, with terror and arbitrary recasting of history, with grinding poverty and starvation cannot foster a view of the world as one that provides information and music except for the fortunate few.

It would take another book and an extensive research effort to subject to serious analysis the concrete social structures and social positions that in our world foster a strong sense of coherence. Improvement in health status is contingent on such analysis and on a program of social action that could follow. This analysis is one of the crucial tasks of social epidemiological research (227).

He hopes this book is one of the tools that makes this possible, and I believe it is.

[Antonovsky, Aaron (1985) Health, Stress, and Coping. San Francisco and London: Josey-Bass Publishers.]

Ibsen and Negotiating the Use of Candles

‘I should not like my dear sister to know, but I am reading the Plays of Ibsen, and I was finishing Hedda Gabler.’

Mrs Bradley nodded comprehendingly.

‘And of course, Ibsen being What he is, and the light in my room being Quite Invisible from my sister’s room, and our having agreed From the First to consider candles a Separate Item so that neither of us need make the burning of them an Affair of Conscience as, of course, we should be obliged to do if they came out of the housekeeping, I read on until past ten o’clock.’ (210)

An incredible passage about the ‘naughtiness’ of both reading late and Ibsen and the constraints on both that the economics of housekeeping can produce, if not carefully negotiated. Also, the wonderful use of capital letters.

Not until now do I realise how much luck it is to be born at a time when we do not have to negotiate the cost of a candle to read as late as we would like…

Mitchell, Gladys ([1935] 2014)The Devil At Saxon Well. London: Vintage Books.

Zaragoza Cityscapes

I liked Zaragoza, and for the first time in a long time felt properly hot. The old part of town with narrow streets kept cool and shaded by the unbroken rows of several-story buildings on either side. The ways that they suddenly opened up into small plazas, most of them filled with tables and chairs for food and drink, somewhere to sit for those who bought nothing. Wonderful public spaces, full of generations. The way that this old town centre was still so residential, full of life and children and a mingling of different kinds of people. We only found the wealthy area by accident on our last day, it relied more on trees for shade, and everyone wore the same well-groomed discontented faces. I didn’t like that part so much.

We were privileged to dine at Montal, delicious food and the best of brilliant post-viva company, and it gave a better sense of these old  residences with their open colonnaded centres stretching up two stories. They are so lovely. I explain them badly, so one individual picture.

Zaragoza

Too lovely for such a terrible hierarchy of aristocrats as once were found here. We were let down into the cellar to see the museum of the great leaning tower that once stood in this little plaza, there are hundreds of drawings of it, interspersed with gated doorways beyond which sit dusty bottles of wine.

The Museum of Goya is nearby, he lived here for a time and there is such a collection of his prints as will amaze you. They are wondrous, able to rip your heart out. We started in the print room as advised, and that was undoubtedly the very best way to experience the museum.

Roman ruins, the basilica, a river and ancient bridge, the mudéjar architectire and Aljafería, the graffiti…I did very much like this city.

 

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Zaragoza Graffiti: For the Women Who Gave Their Lives…

Penultimate post on this short holiday that already feels so so far away. I’ve finished a report, an executive summary for a second report, and edits on two short articles since then. So sad. Unlike the awesomeness of Zaragoza’s graffiti scene, which brought me immense happiness. This says:

En recuerdo de todas las mujeres que dieron su vida por la libertad y las ideas anarquistas | In memory of all the women who gave their lives for liberty and anarchist ideas

On this wall, with its many small fishes eating the large one, and long incredible figures almost disappearing into plaster:

There was so much that was brilliant, I miss this.

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Palacio de la Aljafería, and Zaragoza’s Mudéjar architecture

El Palacio de la Aljafería is an incredible building, containing within it the material remains of many periods of Spain’s troubled history as well as the ways that each of these histories has been reimagined and retold. It is built over an Islamic fortified enclosure, and the semi-circular turrets date and base of one of the towers date from the 9th Century. They are massive — and the contrast is wonderful with the delicate columns and arches of the inner courtyard, the carvings, the sound of running water, the oratory with its traceried windows. This dates from the period of the Taifas, or the independent kingdoms of Spain before the consolidation of the Almorávides. This period saw the building of the Alhambra as well, but this building predates it, and our guidebook describes it as a model for both that glorious place and the Reales Alcazares in Seville, which I have not seen.

This was the extent of the Taifa of Zaragoza as it was expanded under Abú Yaáfar Áhmad ibn Sulaymán al-Muqtádir, who had this exquisite courtyard built.

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

This also remains.

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

Other remnants sit engulfed in the architecture of Christian kings.

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

Zaragoza was conquered by Alfonso I (El Batallador) in 1118, and this was converted into the Palace of the Aragonese monarchs. This period remains visible through some of the interior rebuilding, above all these carved ceilings with their heraldic paintings.

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

In 1492, a new palace was plonked down on top of both the old by Ferdinand and Isabella — 1492 was such a terrible year. They did not have anyone as capable of the work as the Mudéjar architect, Faraig de Gali, and he blended the styles together as best he could. These, then, are on the top stories, with lovely tiles and interesting (if gaudy) carved and coffered ceilings.

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

Zaragoza: Palacio de la Aljafería

From here it enters its decline, Phillip the Second ordering it repurposed to become a fort in 1593. He built more defensive walls with pentagonal bastions at the corners and the moat and the drawbridges.

Zaragoza: Palacio de la Aljafería

You have to wonder why this fort was necessary in the middle of the Spain, the little pmaphlet states:

…the real reason for building this fort was none other than to show royal authority in teh face of teh Aragonese people’s demands for their rights as well as teh monarch’s wishing to curb possible revolts by the people of Zaragoza.

Nation building wasn’t entirely smooth it seems. The building later became a barracks. Many of the islamic carvings were removed and put into museums, and it was a very slow process (1931 declared historic, excavation and reconstruction began 1947) to convert this building into the palimpsest it represents today where original and reconstruction sit together, and they do it rather beautifully.

I remember reading of the Marranos y Moriscos, Jews and Arabs who to some extent or another or not really at all converted to Christianity and remained after Aragon and Castille conquered the Peninsula, who stayed through the Inquisition. But before this point in 1492 (and for how long after?) there were the Mudéjars. This is from the Encyclodpedia Britannica:

Mudejar, Spanish Mudéjar, (from Arabic mudajjan, “permitted to remain”), any of the Muslims who remained in Spain after the Reconquista, or Christian reconquest, of the Iberian Peninsula (11th–15th century). In return for the payment of a poll tax, the Mudejars—most of whom converted to Islam after the Arab invasion of Spain in the 8th century—were a protected minority, allowed to retain their own religion, language, and customs. With leaders assigned by the local Christian princes, they formed separate communities and quarters in larger towns, where they were subject to their own Muslim laws.

The Mudejars were highly skilled craftsmen who created an extremely successful mixture of Arabic and Spanish artistic elements. The Mudejar style is marked by the frequent use of the horseshoe arch and the vault, and it distinguishes the church and palace architecture of Toledo, Córdoba, Sevilla (Seville), and Valencia. The Mudejar hand is also evident in the ornamentation of wood and ivory, metalwork, ceramics, and textiles; and their lustre pottery is second only to that of the Chinese.

Such architecture is everywhere here in Aragon, what I think of as the heart of Spain. It is everywhere here, particularly churches, and very beautiful.

Zaragoza: Mudéjar style

Zaragoza: Mudéjar style

Zaragoza: Mudéjar style