Addressing domestic abuse in general practice: The emotional labour of being a GP

Anna Dowrick is a doctoral researcher at Queen Mary University of London in the Centre for Primary Care and Public Health. Her research is interdisciplinary, using anthropology, sociology, science and technology studies, gender and feminist studies, and health services research to explore the work of improving the care of victims of abuse by health professionals. Before undertaking her PhD she developed UK health policy on a range of issues, including dementia and cancer.

We’re sitting in Joanne’s consulting room. A tall cheese plant (officially a ‘monstera deliciosa’ she informs me) sits on her desk next to a picture of two young children, taking attention away from the computer, papers, charts, and other medical paraphernalia that share the space.

Joanne is a GP in a north London practice, She’s been qualified for about 10 years. We’ve met to discuss her experiences of providing care to patients who have been victims of domestic abuse. This is part of a wider project exploring the implementation of a programme called IRIS, which aims to increase referrals between general practice and domestic violence support services.

Joanne was shocked to discover the prevalence of domestic abuse. 1 in 4 women in the UK are expected to experience a form of abuse across their lifetime. She’d learnt this during the training she’d received the previous year, offered as part of the  new IRIS domestic violence service. As part of this service, specialist domestic violence workers train primary care staff and offer them a referral pathway into support for their patients.

Before the training, she hadn’t realised what a big problem it was, or that the prevalence in general practice is even higher than the general population (1 in 3). Many people experience physical and mental health problems as a result of abuse which bring them to their GP. Depression, anxiety, chronic pain, IBS, headaches, tiredness. All things she saw regularly.

Health services, particularly general practitioners, have been positioned as important for improving the care of people affected by abuse by UK and international health organisations. The GP is considered a trusted figure and the practice a safe, accessible space to. A doctor’s visit can be the only opportunity someone has to be alone with a professional who could help.

My research explores the emotional labour that GPs do to as part of their job to present an appropriate emotional front to their patients.  While emotionally investing in patients is seen to be a core part of nursing and allied health professions, the historic Cartesian split between reason and emotion rests strongly on the side of reason for doctors. Good care is presented as a careful balance of empathy and objectivity.

Joanne doesn’t do this work because national guidance tells her to. She sees addressing domestic abuse as part and parcel of being a good GP. She differentiated herself from other GPs who were more ‘mechanistic’ and didn’t try and see patients as people.

Addressing domestic abuse didn’t feel different from the rest of her work. She sometimes worried about asking about abuse, appreciating that it was a stigmatised issue, but described feeling the same when discussing sexual health, drug and alcohol use, lifestyle choices. Being a GP was about creating a context to ask difficult questions.

In asking, she didn’t know what she might hear. Over her years as a practitioner she had become accustomed to her consulting room becoming a place of sanctuary, where tears could fall without judgement. Sometimes her patients’ stories affected her more than others, but she felt a professional responsibility to maintain emotional composure. It was after her surgery was finished that she might feel those emotions, often deciding to walk home rather than take the bus.

Though domestic violence was something that she felt a particular moral objection to, and would stir up feelings of sorrow, anger and frustration, knowing that she had a service she could offer to her patients made her feel better. Similarly to how her patients would describe disclosing abuse as taking a weight from their shoulders, she felt that having a referral pathway offered a way to share her own burden. She cautiously admitted that before the IRIS service she rarely asked about abuse because. She had been anxious about what she would be able to do about it.

She joked that her patients rarely did what she expected, and felt it was her responsibility to empower them to make their own choices. However, she saw a distinction between negotiating someone’s management of their diabetes, for example, and witnessing ongoing suffering resulting from domestic abuse. She felt domestic violence to be an injustice, an affront to her values. She had to draw a line between the things she could fix as a doctor and the things she couldn’t, and sometimes this recognition was painful. She felt fortunate to have a team that was supportive, with colleagues she could discuss complex cases with and acknowledged that not all doctors were so lucky.

Others of the 14 GPs I interviewed for this study offered a similar narrative. Caring for patients in abusive relationships fit neatly with what they understood about being a ‘good GP’.  The things that were difficult about it – asking personal questions, offering a empathetic but practical response, maintaining confidentiality, providing consistent ongoing care, bearing witness to their suffering – were also satisfying parts of medical professionalism. The challenge was having the emotional energy to invest in this work in the face of growing pressure on their time and a fragmented service environment.

In 1967, John Berger reflected on the work of his good friend and GP John Sassall:

What is the effect of facing, trying to understand, hoping to overcome the extreme anguish of other persons five or six times a week? I do not speak now of physical anguish, for that can usually be relieved in a matter of minutes. I speak of the anguish of dying, of loss, of fear, of loneliness, of being desperately beside oneself, of the sense of futility.

 John Berger (1967) A Fortunate Man: The Story of a Country Doctor

National and international policy-makers demand that GPs take a more central role in the response to domestic abuse. If we want them to face, understand and hope to overcome the extreme anguish of abuse, recognition of the emotional labour that this requires, and the support professionals themselves need, is vital. IRIS, as a service that shares the burden of care, is one step towards this but many more need to be taken.


Translating therapy

Depression is the leading cause of ill-health worldwide, but therapy is little known or practiced outside the West. If psychotherapy is going to become more popular in the non-western world, it needs to build bridges and find cultural parallels in local spiritual traditions. This is totally doable.

The UK has had a good last decade when it comes to mental health awareness. The Brits don’t talk about our emotions? We never shut up about them these days! Not a week goes by without some official or celebrity – Theresa May, Prince Harry, Rio Ferdinand – saying we need to talk more about mental health. That’s a good thing. It’s good to talk, though it’s even better when that talk is backed up by increases in government spending on mental health services.

The situation is a lot worse elsewhere. As the World Health Organization highlights today in its World Health Day campaign, depression is now the leading cause of ill health and disability worldwide, affecting more than 300 million people. While only around 50% of people with depression get therapy or medication in high income countries, in middle and low income countries, the percentage is closer to zero.

In half the countries in the world, there’s only one psychiatrist per 100,000 people. In India, where I spent the last three months, the country spends 1% of its GDP on health (the OECD average is 9%), and 0.1% of that on mental health services – one of the lowest figures in the world. There’s one psychiatrist for every 300,000 Indians, though in fact most psychiatrists are based in the big cities. In poorer rural regions, there might be one psychiatrist for every million people.

There’s a lot of stigma around mental illness around the world, and little awareness of psychotherapy. And there’s a cultural and language problem for both psychiatry and psychotherapy. Sadia Saeed Raval, who runs the Inner Space therapy centre in Mumbai, says: ‘Therapy in India is mainly Anglophone. The training is in English, the terminology is English, and the therapy techniques tend to be developed in the West.’

At a recent event I attended on mental health in India, the discussions were almost all in English, and even when a psychiatrist spoke in Hindi, he still used English words like ‘stigma’ and ‘depression’. The WHO’s own campaign posters, ‘Let’s Talk’, are also all in English. Imagine if we in the UK only had Indian words for depression, anxiety or other internal states.

This Anglicisation of therapy has limited its cultural dispersal in low and middle income countries to affluent, westernized elites. So how does everyone else cope with mental illness? In large part, by turning to religious or spiritual healing. This might sometimes work – it can help provide meaning, community support, meditation, and the powerful placebo of hope. But it doesn’t always work, and in some cases can be harmful.

What to do? Obviously, the best thing would be for countries to increase their spending on mental health services. I imagine the WHO is trying to get its member states to do that. But we shouldn’t assume that western psychiatry has all the answers to the meaning of life (look at suicide rates, where some Western countries do worse than many non-Western countries).

We can also try to help bridge the cultural gap between western psychiatry and psychotherapy, and non-western cultures. And here the medical humanities can help.

In the UK, the most popular and evidence-based therapy for depression and anxiety is Cognitive Behavioural Therapy (CBT). As I and others have researched, CBT has its roots in the ‘healing wisdom’ of Stoicism and, to a lesser extent, Buddhism.

That means that it is easily translatable into other cultural contexts, because the idea of ‘healing wisdom’ appears not just in Greek philosophy but also in Christianity, Islam, Judaism, Hinduism, Jainism and many other religious and spiritual traditions. Indeed, Stoicism was a big influence on therapeutic wisdom books in Christianity (Boethius’ Consolations of Philosophy, for example) and Islam (eg Al-Kindi’s On Dispelling Sadness).

There is also a great deal of similarity between Stoic-CBT therapeutic ideas and those found in the wisdom texts of Hinduism and Buddhism. For instance, Stoicism / CBT is based on Epictetus’ idea that ‘it’s not events, but our opinion about events, that cause us suffering’. Likewise, the Buddha taught: ‘We are what we think. All that we are arises with our thoughts. With our thoughts we make the world’.

Many different wisdom traditions recommend learning detachment, both from one’s own thoughts and desires, and from the ups and downs of fortune, and learning to accept the limit of one’s control over the world – both of which are central concepts in CBT and Positive Psychology. Many also recommend some form of mindfulness and techniques for improving it – Stoicism-CBT recommends keeping track of your thoughts and behaviour in a journal, Jesuits practice ‘recollection’ at the end of the day, Orthodox Christians practice ‘nepsis‘ or watchfulness, and so on.

Many different wisdom traditions emphasize that changing the self takes repetition and practice (askesis in ancient Greek), as CBT does. Proverbs, in the Bible, talks about seeking wisdom, and inscribing wisdom on the ‘tablet of your heart’ through memory and practice. The Bhagavad Gita says: ‘It is difficult to curb the restless mind, but it is possible by constant practice and by detachment’.

There is some evidence that CBT works better when its basic ideas and techniques are connected and translated into local language and local culture. Here, for example, is a paper on Islamically modified CBT. Others have developed Christian CBT, and of course mindfulness-CBT now has a strong evidence base, although ironically it is barely known or practiced in India, where Buddhism originated.

Medical humanities scholars can help explore the cultural connections between western psychotherapy and various wisdom traditions around the world, and help to discover the local vernacular for local emotional states.This will help people overcome their suspicion of therapy. Speaking personally, for example, I’ve done workshops on healing wisdom for evangelical Christians, where you can describe the basic ideas of CBT purely using quotes from the Bible and Christian wisdom literature. That is helpful for an audience which has traditionally been wary of psychiatry and psychology, partly because of psychiatry’s long history of hostility towards religion.

At the same time, we should remind ourselves that cultures aren’t static and monolithic. There is no such thing as ‘Indian culture’, for example, there are many Indian cultures, all in flux. A 2013 article in the Indian Journal of Psychiatry calls for the ‘Indianization of psychiatry’ to take account of cultural differences such as the greater emphasis on traditional family structures. Fine – but Indian therapists also tell me of the stress and suffering caused to some Indian women by the traditional understanding that their role is entirely to support their husband and his family. Therapy can help people not just adjust to traditional roles, but also help them evolve into new roles, new identities, a new place in society.

Working with local spiritual healers

A second way that medical humanities researchers can help to bridge the cultural gap between non-western cultures and western psychiatry / psychotherapy is by working with local religious and spiritual leaders, facilitating dialogues of mutual respect to work together.

Aaron Beck, one of the inventors of CBT, with the Dalai Lama, who has spoken about the close similarity between CBT and Buddhism’s theories of the emotions

At my university, Queen Mary University of London, a team of psychiatrists are working with local Muslim spiritual healers, to try and improve relationships with a community that has traditionally been very wary of psychiatry. The latest issue of the WHO’s Panorama magazine has an article on psychiatrists working with Kyrgyz spiritual healers. In India, I think it would help to work with local spiritual leaders like Sadhguru, the best-selling yogi who regularly speaks on yoga as a means to mental health. We already know how fruitful the dialogue has been between western psychiatrists and psychologists and the Dalai Lama – it has helped western psychotherapy advance.

Finally, I think technology has a role to play in improving global mental health. Governments are spending far too little on mental health services, and should be encouraged to spend more. But could the WHO or other organizations like the Wellcome Trust help to develop apps, websites and online courses, in local languages and local cultural terms, to disseminate basic therapeutic ideas and techniques? It would not be enough, but it would be something. And it would be cheap.

I’m working with the WHO on a project called the Cultural Contexts of Health. Find out more about it here.

Autism, Neurodiversity and the ‘Neurotypicals’

Bonnie Evans is a Postdoctoral Research Fellow at Queen Mary Centre for the History of the Emotions. Her book, The Metamorphosis of Autism: A History of Child Development in England, was recently published by Manchester University Press. This blog post is based on a talk she gave for ‘The Museum of the Normal’, which can be found online here.

Evans is organising a conference at QMUL on 20-21 April: The Globalisation of Autism: Historical, Sociological, and Anthropological Reflections. On the evening of 20 April, there will also be a free public lecture by Steve Silberman, bestselling author of Neurotribes.

Autism is now the most diagnosed psychological condition in childhood, with population studies putting the rate at 1 in every 64 children.  Adult diagnoses are also increasing apace, with women becoming the new ‘underdiagnosed’ group, often receiving later life diagnoses.  In 2009, the Autism Act was hailed as the first ever ‘disability-specific’ legislation to be passed in the UK, indicating the significance of autism to shaping individual rights to public services.  Yet, it was not always like this.  Just forty years ago, barely anyone had heard of autism.  It is only very recently that autism has become such a central concept for thinking about human difference.  Yet there is actually very little consensus amongst psychologists, geneticists, and autistic people themselves, over what, exactly, autism is.

In my recent book, The Metamorphosis of Autism, I consider the meaning of autism not from a psychological perspective, or a biomedical perspective, but rather from an historical perspective.  When considered in relation to the history of child development, it becomes clear that autism has always been a tricky concept to pin down. It has always been difficult to distinguish between ‘normal’ thinking, and ‘autistic’ thinking.  And autism has always been controversial.

The controversy started in the early twentieth century.  The word ‘autism’ was first coined in 1911 by Eugen Bleuler as a response to Sigmund Freud’s work on early ‘autoerotic’ thinking in infancy and childhood.  Freud had argued that infants were fascinated with their own bodies and thought of these as love objects in this early stage of thought.  Bleuler, however, argued that Freud was too obsessed with love and sex – a claim that many have since also leveled against him. Bleuler took the ‘erot’ part from the word ‘autoerotism’ and renamed this ‘autism’.

In the 1920s and 1930s, the famous child psychologist Jean Piaget, and many others understood autism as just an early stage of human thought that children ‘grew out’ of when they began to form relationships with other people.  However, there was still a huge degree of controversy over this early stage of thinking.  Freud’s daughter, Anna, and her followers, threw insults and vitriol at the followers of a prominent psychologist, Melanie Klein, in endless debates over what children were really thinking in the early stages of their life.  Klein said that children could conceptualise objects and parts of people from the day they left the womb, whereas Anna Freud said they were incapable of such a thing.  However, all psychologists in the early twentieth century argued that children spent a lot of time in dream-like fantasies imagining part objects and bodies around them, and that autism was just a feature of this ‘primitive’ thinking.

Anna Freud, c. 1970.

Anna Freud. Credit: Archiv für Kunst und Geschichte, Berlin

Leo Kanner is often hailed as the first person to properly describe ‘autism’ as a medical condition in 1943. However, this is a myth.  The moment that autism became fixed as medical diagnosis was not when a psychologist articulated children’s thought more successfully than anyone else had ever done before.  In fact, autism was only acknowledged as an exclusive diagnosis when it was used to grant particular children rights to education and access to social services.  The impetus for this was actually the closure in Britain and in many other parts of the Western world, from the late 1950s onwards, of institutions for children and adults with what was then called ‘mental deficiency’ or ‘mental retardation’. The closure of ‘mental deficiency’ institutions encouraged radical overhauls of the techniques for measuring and understanding child development. This encouraged psychologists, parents, and others, to create new diagnostic categories to advocate for the rights of children who had previously been ignored within established models of education and democracy as ‘ineducable’.  In particular, they wanted to turn autism into a category that could be defined, calculated and counted.

As an historian, I have trawled The National Autistic Society archives and the National Archives and found countless examples of parents and psychologists petitioning the Departments of Health and Education, arguing that autistic children required services that were specific to their needs.  When Edward Heath refused to provide such specific services in 1970, the National Autistic Society campaigned again and again, and counted more and more cases of autism, until the government had to respond.  When the pioneering parent and psychologist Lorna Wing argued that autism was a kind of ‘social impairment’ that could be quantified, and rectified via targeted policies, the government were finally listening.  Her proposals had a huge influence on Margaret Thatcher’s education reforms in the early 1980s, in which autistic children were granted unique rights to educational services, as well as unique protections from the expanding threat of neoliberal markets.  Wing’s work also influenced global definitions through the Diagnostic and Statistical Manual of Mental Disorders (DSM), also known as the ‘psychiatric bible’.  Autism then no longer referred to a stage of normal thinking but became a unique ‘impairment’.  Once this model of autism was established, as a means to carve out and protect a supposedly ‘impaired’ section of society, the numbers of reported cases began to increase.  By the 1990s, cases were sneaking up further, and by the 2000s, many began to talk of an ‘epidemic’.  Yet autism, this thing that was ‘epidemic’, was still not clearly defined.

National Autistic Society ‘Too Much Information’ campaign (2016)

In the 1990s, growing numbers of individuals with the autism diagnosis began to challenge the idea that people with autism were different, disadvantaged, disabled, or sick.  They argued that autism often represented merely a different way of thinking, which could in many cases be advantageous.  This was the birth of the ‘neurodiversity’ movement, in which autism is recognised as a variation within normal thinking rather than a categorical medical problem.  The neurodiversity movement then also created the category of ‘neurotypical’ to describe people who think typically, or normally, rather then those who have autistic traits or who represent a wider ‘diversity’ of thought.  Although at first the psychological establishment resisted this challenge, they eventually conceded that they couldn’t maintain the higher ground and researchers from Francesca Happé to Simon Baron Cohen now talk of the ‘neurodiverse’ and the ‘neurotypical’.

The neurodiversity movement never had a problem with the category of autism, per se, but merely the idea that autism was definable.  We have thus arrived back at some of the problems first laid out by psychologists in the early twentieth century when they debated our ability to define the early stages of children’s thought, and to understand the trajectories that that may take in later life.  Perhaps it is still the case that much of children’s early thought, together with the patterns and forms that it takes, is still indecipherable.

Emotional Experience as a Site of Agency

Jeremy C. Young is an assistant professor of history at Dixie State University (St. George, UT, USA) and the author of The Age of Charisma: Leaders, Followers, and Emotions in American Society, 1870-1940 (Cambridge University Press, 2017).  He earned his Ph.D. in United States history at Indiana University in 2013.  He is a historian of the 19th and 20th century United States, with particular interests in the history of emotions, social movements, and political communication.

In 1914, twenty-one-year-old Carl William Aschan watched evangelist Billy Sunday’s train depart from Des Moines, Iowa with a sense of spiritual emptiness – “as though the very soul of the city went away.”  Dejectedly, Aschan and his friend H. E. Benson wondered aloud, “What are we going to do now we can’t go to the meetings any more[?]”  “Let’s write to Mr. Sunday,” Benson suggested, “and perhaps he could give us some work to do, so we could be trying to do some good for humanity.”  Aschan put the question to Sunday in a letter.  “Mr Sunday if you have any thing for a couple of clean cut fellows to do would be more than glad to hear from you and do any thing for you we can.”[i]

Historians tend to think of emotions as an effect of cultural changes.  In many cases, we focus on the emotions that are considered acceptable or desirable within a culture, and we study how those emotional standards change over time.[ii]  It’s easy to view Aschan’s anguish over Sunday’s departure as conditioned by a largely Protestant society that privileged religious conversions, leading Aschan and Benson to lament the newfound lack of religious experience in their lives.  But what if we instead imagined emotions as a site of agency – as the cause of social and cultural shifts?  What if, simply by experiencing the influence of Billy Sunday, Carl William Aschan changed the course of history?

Converts such as Aschan generally expressed their desire to convert in personal terms, as a response to internal emotional crises.  Prior to his conversion, schoolteacher Edgar G. Gordon wrote, he had been consumed by self-loathing for his “pool-playing, card-playing, dancing, ‘suds’-sipping” ways.  “I had long had a vision of service and of my duty,” he wrote to Sunday in frustration in 1913, “but until you challenged, until you dared me to be a man, I had not the decision [to act upon it].”[iii]  Similarly, Charles H. Thurston detailed his struggles with alcoholism prior to his encounter with Sunday.  “In spite of all I could do the appetite [for alcohol] held me fast,” he lamented.  “This continued for seven or eight years” until a tabernacle conversion finally sobered him up.[iv]

Once they listened to Sunday’s emotional sermons and underwent powerful religious experiences, however, converts often found personal transformations to be inadequate expressions of their newfound selves.  Many were like Aschan and Benson, burning up for “any thing for a couple of clean cut fellows to do” – longing for a great collective work that would invest their conversions with an enduring sense of purpose.  Many found such a mission in Sunday’s exhortation to convert others.  William Ward Ayer, converted by Sunday at the age of nineteen, became a prominent New York minister and converted thousands or his parishioners.  “What happened to them,” he explained in 1960, “happened to them because of what happened to me through Billy Sunday.”[v]  Syracuse bank president Lucius A. Eddy, another Sunday follower, singlehandedly procured over four thousand converts over a twelve-year period.[vi]  Sunday followers who lacked the prominence of Ayer or the wealth of Eddy worked on a smaller scale, founding Billy Sunday Clubs designed to continue the work of conversion.  In a letter to Sunday, new convert Jamie Goldsmith confessed that he had not “done very much in trying to save souls” before he went to the revival meetings; now, however, Sunday had “shown me where I stand.”[vii]

When Sunday’s followers were not converting their neighbors, they were enthusiastically promoting the evangelist’s political platform – particularly his support for prohibition legislation.  Sunday revivals often doubled as political campaigns for local or state prohibition legislation, and converts’ sheer numbers and depth of commitment made their movement a force to be reckoned with.[viii]  Omaha mayor and prohibition opponent James C. Dahlman, responding to a report in the Omaha Bee that Sunday would like nothing better than to “inundate Jim and sweep him out of the city hall,” was so afraid of the Sunday revival in his city that he sang hymns in the front row of the tabernacle, praised Sunday in the press, and provided city facilities for the revivals free of charge.[ix]  Similarly, Sunday’s comment to a Columbus, Ohio reporter that mayor George Karb might have been “elected by the whiskey ring” was enough to send Karb skittering to address the tabernacle crowd in that city.[x]  Dahlman and Karb were right to fear the political power of Sunday’s movement.  In November 1916, Michigan voters passed a statewide ban on alcohol after Sunday preached in support of the bill in three of the state’s largest cities. Similarly, voters in Decatur, Illinois enacted prohibition just months after Sunday had conducted a revival there; journalist Bruce Barton noted that Sunday’s presence had galvanized local churches and converted the city’s most important newspaper to the dry cause.[xi]

Historians should fight the urge to dismiss these activities as conditioned solely by emotional and cultural standards.  It’s true that turn-of-the-century Americans, particularly those in the middle class, longed for intense emotional experiences that would ground them in a newly unfamiliar society, and that most converts wanted to find emotional fulfillment, not to drive national policy debates – at least at first.[xii]  Yet by attaching themselves to a leader and movement with a definite political platform, many Sunday followers decisively entered the public sphere.  Sunday’s movement was only as strong as the number of followers he could muster.  Simply by connecting emotionally with Sunday and converting in his tabernacle, converts swelled the ranks of his movement and made him and his causes politically powerful; their desire “to do some good for humanity” under his auspices only augmented their influence.  The emotional experiences of Sunday’s followers redirected their internal conflicts toward external political goals and helped them to shape historical trends.  By transforming themselves, converts such as Aschan transformed their society as well.


[i] Carl William Aschan to Billy Sunday, Dec. 22, 1914, folder 23, box 1 (reel 1), Papers of William and Helen Sunday, Grace College and Theological Seminary, Winona Lake, IN.

[ii] Peter N. Stearns and Carol Z. Stearns, “Emotionology: Clarifying the History of Emotions and Emotional Standards,” American Historical Review, Vol. 90, No. 4 (October 1985), 813, 816, 825.

[iii] Edgar G. Gordon to Billy Sunday, Nov. 16, 1913, folder 42, box 1 (reel 2), Papers of William and Helen Sunday.

[iv] Charles H. Thurston, “From One of the Converts,” in “Personal Gains from the Sunday Campaign: A Sheaf of Testimonies,” The Congregationalist, February 22, 1917, 257.

[v] Interview with William Ward Ayer in The Billy Sunday Story, dir. Irvin S. Yeaworth, Jr. (orig. pub. Chester Springs, Penn.: Sacred Cinema/Westchester Films, ca. 1960; Garland, Tex.: Beacon Video Ministries, 1989).

[vi] Homer Rodeheaver, Twenty Years with Billy Sunday (Winona Lake, IN.: Rodeheaver Hall-Mack, 1936), 125.

[vii] Jamie Biggerstaff Goldsmith to Billy Sunday, 1924, folder 33, box 1 (reel 2), Papers of William and Helen Sunday.

[viii] Rodeheaver, Twenty Years with Billy Sunday, 32.

[ix] Omaha Bee, Oct. 27, 1915, quoted in Leslie R. Valentine, “Evangelist Billy Sunday’s Clean-Up Campaign in Omaha: Local Reaction to His 50-Day Revival, 1915,” Nebraska History, 64 (1983), 222-23.

[x] “Sunday Comes Late Today,” Columbus Citizen, Dec. 28, 1912, 1, quoted in Donald Elden Pitzer, “The Ohio Campaigns of Billy Sunday with Special Emphasis upon the 1913 Columbus Revival” (M.A. thesis, Ohio State University, 1962), 95, 124.

[xi] Bruce Barton, “In the Wake of Billy Sunday,” Home Herald, Vol. 20, No. 22 (June 2, 1909), 4.

[xii] T. J. Jackson Lears, No Place of Grace: Antimodernism and the Transformation of American Culture, 1880-1920 (New York: Pantheon, 1981), 8-11.

Faces that matter: history, emotion, transplantation

Dr Fay Bound Alberti has published widely on the histories of medicine and science, gender, the body and emotions. Fay co-founded the Centre for the History of Emotions at Queen Mary University of London where she remains Honorary Senior Research Fellow. Other areas of interest include illness and disease, the history and ethics of cosmetic surgery and the relationship between mind and body and gender politics. Fay’s most recent book is This Mortal Coil: The Human Body in History and Culture (Oxford University Press, 2016). She is a regular blogger for The History Girls, a group of best-selling, award-winning writers of historical fiction and non-fiction. Fay’s forthcoming monograph is a cultural and emotional history of face transplants.

This post contains graphic descriptions of facial injury.

Faces matter. They signal our individuality, genetic inheritance, emotions and identity. Little wonder that a disrupted or disfigured appearance is a source of social stigma and distress.[1] Yet faces are also matter; reshaped by cosmetics, art and surgery. Today, faces are transplantable, able to be moved from one human being to another, from the dead to the living. This brings extensive ethical as well as medical considerations. As the medical anthropologist Linda Hogle put it, ‘you’re really transplanting more than the tissue itself [with face transplants]. You’re bringing someone’s identity and overlaying it on the recipient’s body’.[2] That challenge was realised in the person of Isabelle Dinoire, the world’s first partial face transplant recipient.

In 2005, the 38-year old French woman was savaged by her pet dog after she had taken an overdose of sleeping tablets. Whether the overdose was an accident or not has been a subject of debate. Dinoire described waking to find ‘a pool of blood next to me. And the dog was licking the blood. But I couldn’t imagine that it was my blood or my face. Or that he had chewed me.’[3] Still groggy and confused from her overdose, Dinoire sat up and tried to light a cigarette, an act she described as ‘an automatic gesture’. Confused that she could not keep the cigarette between her lips, Dinoire crawled to her bedroom to look in the mirror. That is when Dinoire discovered the full extent of her injuries. She had no lips, no chin and no nose. That was the moment she realised ‘it was not a dream, it was reality. I had no face.’[4]

Dinoire’s operation took place at a time of intense global competition to undertake the first successful face transplant; a development with echoes of the first heart transplant.[5] Images of Dinoire pre- and post-surgery and voyeuristic details of her rehabilitation were told by a mass media to a public repulsed and intrigued.[6]  When Dinoire died of cancer in 2016, her doctors denied it was in any way connected to the cocktail of immunosuppressant drugs she had been taking. Though those drugs are known to increase the risk of cancer.[7] I have written in detail about Dinoire elsewhere, for her case draws attention not only to complex, gendered assumptions about face transplant patients and the female body, but also to the political framework in which medical firsts take place.[8]

Since 2005 no more than forty face transplants have taken place around the world, in Spain, Turkey, China and Poland, with varying degrees of success.[9] Yet face transplants are a relatively neglected area of recent history, and discussion still revolves around medical and ethical rather than emotional and psychological concerns.[10] I am currently writing a monograph on the history and pre-history of face transplants that explores their affective and cultural context. For face transplants raise key questions about our identity as human beings, our relationships with others and the ways in which physical appearance is linked to experiences of anxiety, depression, fear and shame. Before her face transplant, Dinoire felt that her visage was ‘monstrous, traumatic, unshowable.’ After her transplant, she was still subject to the gaze of others, but now because she was a ‘circus animal.’ Her existence provoked mixed emotions in others: from her surgeons to her children, from the family of her donor to the unknown multitude who looked at her ‘before and after’ pictures and talked about medical miracles, the limits of science and whether she might ever ‘kiss again.’ This question does not seem to have been asked of male face transplant recipients.[11]

Dinoire’s experience is a reminder that facial disfigurement and reconstructive surgery does not take place in a vacuum. There are important historical accounts of facial disfigurement as a social and medical question, many of which show considerable nuance between medical and social models of disability. [12] Face transplants are both a continuation of the surgical reconstructive skills that developed after World War I and something else; the blending of two identities, old and new, and the creation of a ‘hybrid-being.’[13] While post-war reconstructive surgery primarily took place on soldiers returning from battle, informing a gendered narrative of disfigurement and heroism, today’s face transplants raise a different set of questions about gender, identity and emotion. Moreover, today the very act of getting older triggers fear and disgust, let alone a traumatic facial disfigurement or a surgical procedure as radical as a face transplant.[14] In writing the emotional and ethical history of face transplants, then, it may be society as much as surgery that needs to come under the spotlight.

[1] R. Lansdown et al (eds), Visibly Different: Coping with Disfigurement (Oxford; Boston: Butterworth-Heinemann, 1997); A. Clarke et al (eds), CBT for Appearance Anxiety: Psychosocial Interventions for Anxiety due to Visible Difference (Chichester: Wiley-Blackwell, 2013); N. Rumsey and D. Harcourt, The Psychology of Appearance (Milton Keynes: Open University Press, 2005).

[2] J. Bowen, ‘Gaining face,’ 19 May 1999: 1999/05/19/ face_transplants/ accessed 24 February 2016 and F. Baylis, ‘A Face is Not Just Like a Hand: Pace Barker,’ The American Journal of Bioethics, 4 (2004), 30-32.


[4] ‘La femme aux deux visages,’ [‘The Woman with Two Faces’] Le Monde, 7 July 2007:

[5] See Fay Bound Alberti, Matters of the Heart: History, Medicine, Emotion (Oxford; Oxford University Press, 2010). Introduction.



[8] ‘From Face/Off to the Face Race: The Case of Isabelle Dinoire and the Future of the Face Transplant, BMJ Medical Humanities, 9 December, 2016:

[9] S. Khalifian, P.S. Brazio and R. Mohan et al, ‘Facial Transplantation: The First 9 Years,’ The Lancet, 2014; 384: 2153-2163 and M. Sosin and E.D. Rodriguez, ‘The Face Transplantation Update: 2016,’ Plastic and Reconstructive Surgery, 2016, 137: 1841-1850

[10] A recent exception is Sharrona Pearl, Face/On: Face Transplants and the Ethics of the Other (forthcoming, University of Chicago, 2017).

[11] Bound Alberti, ‘From Face/Off to the Face Race.’

[12] M. Gehrhardt, ‘Gueules Cassées: The Men Behind the Masks,’ Journal of War and Culture Studies, 2013; 6: 267-281, S. Biernoff, ‘The Rhetoric of Disfigurement in First World War Britain,’ Social History of Medicine, 2007; 24: 666-685 and Portraits of Violence: War and the Aesthetics of Disfigurement, Ann Arbor: The University of Michigan Press, 2016

[13] This term is explored in Samuel Taylor-Alexander, On Face Transplantation: Life and Ethics in Experimental Biomedicine (Basingstoke: Palgrave Macmillan, 2014).  

[14] C. Saunders, J. Macnaughton and D. Fuller eds. The Recovery of Beauty: Arts, Culture, Medicine (Basingstoke: Palgrave Macmillan), 2015

The Museum of the Normal – What You Said





This is a post by Sarah Chaney and Helen Stark, both project managers in the Centre for the History of the Emotions.

‘I realised how normative, pseudo-scientific the idea of normal can be… Also that normal doesn’t necessarily equal healthier or better. There is a very subjective and biased sense of what normal is or should be.’

So commented one attendee at our drop-in late, the Museum of the Normal, a public event designed to address the history of being and defining normal. We wanted to measure whether there was a change in attitudes and the quotation above, taken from a follow-up survey, shows how this person’s perception of normality shifted – we might say, became more critical – as a result of the event.

We used 20 spot interviews on the night and a follow-up online survey, completed by 44 people, to assess responses to ‘The Museum of the Normal’. In the spot interviews, participants commented on activities they had enjoyed, but only a few looked at the wider concept of challenging what is normal and how this might change in different cultures and time periods. However, the follow-up survey showed much more reflective thinking. It might be that reflection was needed before changes in thinking could occur, or that those responding represented a different section of our audience or were reluctant to confess to a naivety about normativity in person.

I tell you what’s interesting about it, if you think about cultural norms and then like personal norms, and all the other, like, norms, then there must be some sort of like hierarchy, I don’t know, which overrides stuff. I don’t know, it’s just making me think about other stuff. So if you think it’s normal to go out on a Saturday night and have a few beers you know in some cultures they think that’s a bit weird, right, so that’s abnormal in that culture. But personally that’s ok. And culturally, like in Britain, that’s what we like to do, we like to go to the pub on Saturday, don’t we? So it, it’s quite interesting when you start to think about it in those terms. (transcribed from spot interview)

The results of our follow-up survey provide strong and cumulative evidence that participants experienced a change in attitude about ideas of the normal and healthy as a result of attending the event. One attendee commented ‘[The event] challenged my view immensely. Being normal is multi-faceted.’ Another wrote ‘It made me think about the historic concept of “being normal”, which I hadn’t really done before.’ In both the follow-up surveys and the audio interviews from the evening itself, participants reflected on the extent to which what is ‘normal’ is culturally constructed: ‘It highlighted how subjective normality is and how current trends are born out of cultural contexts rather than having any basis in hard fact. It was helpful to be reminded of this, making me feel more comfortable in being myself, whatever that is, rather than trying to conform to some constructed idea of how I should be.

Participants in the follow-up survey also indicated that the event had make them think more both about where our ideas of what is “normal” or “healthy” come from and the role of medicine and psychology in creating these norms. ‘It made me realise how difficult it is to define ‘normal’! While I had some understanding of it from a medical/mathematical perspective, it was really interesting to throw social, cultural, historical and linguistic ideals into the mix too – and realise that there really is no such thing as truly “normal”.’ ‘I realised how normative, pseudo-scientific the idea of normal can be… Also that normal doesn’t necessarily equal healthier or better. There is a very subjective and biased sense of what normal is or should be.’

Some audience feedback also supported the contention that challenging the emotional nature of normality is helpful – and can even be therapeutic. ‘It shed light on fresh dimensions of being, and not being, normal; how, in some ways, it is normal not to be normal. I feel it would have given reassurance to people who may often feel excluded from the mainstream.’ ‘It made me think that normality is a product of your surroundings – you gravitate towards situations or groups of people that are in some way similar to you, so you feel normal around them. A lot of problems have been caused by people being or feeling forced to conform to somebody else’s idea of normal.’

From audience feedback after the event, it was clear that a number of visitors had reflected on the themes of the event, considering where our ideas of what is normal and healthy come from, and how these change historically and across different cultures.

Wordcloud of responses to the Museum of the Normal follow-up survey

Want to know more? Read other posts about ‘The Museum of the Normal’ or listen to our Psychic Driving audio track.

How to Keep Calm in Kolkata

Life can be stressful in Kolkata – the crowds, the poverty, the heat, the constant cacophony of car-horns. And that’s just for me, a pampered western tourist. So how do the locals cope? More to the point, to what extent do locals seek therapy for mental health problems like depression, or for general life advice? To find out, I interviewed two Kolkata therapists, Mansi Poddar (left) and Charvi Jain (right), both of whom have successful local practices.

Why did you become a therapist?

Mansi Poddar: Since I was a kid, people have come to me to tell me their stories. When I was studying in Boston, I had a brilliant therapist, and she encouraged me to become one too. I did a masters at NYU, then came and started practicing here.

Charvi Jain: I come from a business family and was expected to go into business too. But I worked with a charity called Make a Difference, which works with underprivileged children, and that showed me I wanted to work around people, helping them. I did a masters at the Tata Institute of Social Sciences in Bombay. It was 95% women on the course, five men, and only one of them Indian! It’s still a woman’s job, because men feel more pressure to make money. After the masters I specialized in Cognitive Behavioural Therapy (CBT). It’s not a very well-known profession – I often have to explain what I do. It’s a bit easier after Dear Zindagi [a Bollywood film last year about a young woman who gets therapy]. But some of my relatives still don’t approve, they say it’s a waste of time. But I’m doing well – my appointments are fully booked for the next two weeks and I’m thinking of expanding.

How normal is it for people in Kolkata to go to a therapist?

Mansi: It’s not very normal. There’s a lot of stigma. People who do come feel a lot of shame about it, like it means they’re weak, so I have to work to remove that stigma for them.If you want to insult someone, you call them crazy or a psycho. Parents would say ‘if you don’t behave, we’ll send you to Ranchi [a famous psychiatric asylum]. People see beggars in the street with psychiatric problems and worry they’ll end up like that. There’s a fear of poverty, of family not accepting their problem. Families contribute a lot to the stigma by denying the reality of mental illness.

Charvi: People in their 20s or early 30s are more open to therapy, partly through exposure to American TV shows like Suits or How I Met Your Mother, which mention therapy. But people in their 30s or older tend not to come unless there’s a serious crisis. Often, people won’t tell their family or close friends they are getting therapy. Students may not tell their parents, and can’t pay for the sessions. Families can strengthen the stigma – you often hear ‘it’s all in your head’. I’m seeing a teenage girl with depression, and initially the family were supportive, but then when she didn’t get better they labelled her as lazy. People think they’re weak for not being able to cope without help. I tell them it’s the opposite – they’re strong for seeking help. Or they trivialize their problems – they say ‘do I really need therapy?’

And they still don’t know the distinction between a therapist and a psychiatrist. Many clinical psychologists here still have a very medical approach – their room is like a doctor’s chamber, with a table in between them and the client. That’s why I called my company Over A Cup of Tea. If people have been to counsellors before, often their experience wasn’t good – they get labelled, judged, with lots of morals enforced on them.

Mansi: Psychiatrists can also enforce their moral judgments. You still get psychiatrists recommending conversion therapy for homosexuality [which is illegal in India]. Or doctors saying ‘stop thinking about stuff so much, it’s not a big deal’.

Indian culture may not be very aware about therapy, but it does have a strong spiritual and religious culture – meditation, yoga and so on. Is that helpful? Do you draw on that in therapy?

Mansi: If people have a spirituality, it can be a great support system. Those who combine Cognitive Behavioural Therapy with their spirituality or faith tend to have a better outcome. On the other hand, spirituality can be too positive, it can encourage over-detachment. It can be like a drug – you keep needing to go to another workshop or retreat, and if you stop, things start falling apart.

Charvi: People sometimes bring in their religious or spiritual beliefs. If you can connect the therapy to that, it works better. For example, if someone is a Jain, like me, you can connect the therapy to the Jain idea of the ‘power within’. But usually people have already tried to get better through yoga or meditation. So if you mention it, it’s like a cliche.

How applicable have you found Cognitive Behavioural Therapy to Indian culture and Indian minds?

Mansi: It’s quite applicable and works quite well, partly because it fits with older Indian spiritual ideas [indeed, the inventor of CBT, Aaron Beck, was quite influenced by Buddhism and the Dalai Lama has said it’s very close to Buddhist theories of the emotions]. Mindfulness-CBT is obviously close to Indian spirituality, though it’s still very new here. I sometimes recommend clients use Headspace [a British meditation app].

Charvi: People find CBT very intriguing. Often they have Googled their problems, self-diagnosed, and found that CBT is effective for depression or anxiety.

Is therapy just for the well-off in India?

Mansi: I’m trying to create awareness among the less well-off but awareness is greater among the better-educated.

Charvi: Therapy is quite reasonably priced here, around INR500 a session [about $7]. I see people from lots of different classes.

India scored quite low in a UN global happiness survey last year – below Somalia in fact. And it has one of the higher suicide levels in the world, particularly for young people. Is it quite a stressed, unhappy culture? If so, why?

Mansi: I think a huge amount of depression goes unreported in India. I see a lot of depression among women, due to gender inequality in our culture. They are encouraged not to be individuals, to live purely for the happiness of their husband and his family. If they have a good husband and in-laws, it can be fine, but if not, it’s hellish. And if they have ‘home-maker depression’, there’s not much I can do for them, it’s a systemic problem. They can’t afford to divorce and be financially independent, and their families might not have them back. There are extreme cases of abuse, but in general it can be an insidious abuse where the mother-in-law makes their life hell. It comes from the man not supporting his wife, wanting to be a good son instead. Some women are standing up and breaking out of this. Maybe they demand more autonomy within the marriage, maybe they get divorced and start an independent life. It can be a huge struggle for them, but once they get there they enjoy better mental health. As for men, they often report problems at work, where office life can be very hierarchical and they feel bullied by their boss.

Charvi: There’s a lot of discontent – Indians tend to compare their life with others’ lives, with their friends or neighbours, and feel they’re not living well in comparison. There’s always someone doing better. Status anxiety is also very prevalent – people rely on external validation to feel they’re OK and doing well. I think a big problem is that, in the context of families and relationships, boundaries are very blurred. If you want to follow your passion, that comes with a lot of guilt – people feel obliged to be with their parents. But if they obey their parents, they feel they’re missing out and their lives lack meaning.

How about student mental health? Is there a lot of pressure to do well in your exams?

Mansi: A huge amount. There’s actually a campaign, Release the Pressure, about exam pressure and how harmful it can be. People think their exam results define their worth as a human being. I hear people say ‘she got 98% in her exams’ about a 36-year-old. Now there’s a slight change, parents are backing off a bit, or trying to expose their children more to things like the arts, outside of school.

What about sex therapy?

Mansi: I used to get a lot of work for sex therapy, and still get some. But I’ve had some bad experiences around it. A woman therapist working with me – I wouldn’t be able to handle that.

So how can public awareness around mental health be improved in India?

Charvi: There’s more talk about well-being in the media, in weekend supplements and things. But it tends to be more about physical health. I use articles and videos to try and increase awareness. [Mansi also often writes articles on mental health].

Here’s the video for the Release the Pressure campaign:

The ecstatic experience economy

There’s a new book out later this month on the psychology of ecstatic experiences, and why they’re good for us. It’s called Stealing Fire, by two performance coaches, Steven Kotler and Jamie Wheal. It might be disconcerting to have another book on ecstasy published two months before my own, but actually I’m glad others are walking the same path and coming to similar conclusions. I disagree on one or two points the authors make, however. The book isn’t out until later this month, but I heard them on The Psychology Podcast. Great podcast by the way.

So why did these two coaches, who specialize in teaching ‘flow’, start talking instead about ecstasy, or ‘ecstasis’ as they call it in the ancient Greek word. Kotler says that they started coming across similar experiences across a whole range of domains – meditation, psychedelics, the arts, sex, extreme sports. ‘It was a broader category of which flow is a subset.’ In fact, the Positive Psychologist Mihaly Czikszentmihayli developed his concept of flow (i.e moments where we’re blissfully absorbed into a challenging activity) out of the idea of ecstasy, as he told me in this interview.

Nomenclature is tricky for this domain of experience. William James and Alister Hardy wrote of ‘religious experiences’, defining them as ‘individuals standing alone in relation to the divine’ – but that ignored collective ecstatic experiences, and the fact atheists also have moments of self-transcendence. Durkheim spoke of ‘collective effervescence’ which sounds like a bubble bath. Abraham Maslow wrote of ‘peak experiences’, but that ignores the fact these experiences are often terrifying, and occur to people in life-crises. These days, the few psychologists who explore this terrain still haven’t agreed on nomenclature – some study ‘self-transcendence’, others ‘out-of-the-ordinary or anomalous experiences’, others ‘mystical experiences’, or ‘altered states of consciousness’. Not to mention the related research fields on hypnosis, trance and possession. The topic is so interdisciplinary – from aesthetics to sex to sports to politics – and the authors are to be applauded for recognizing that and not being deterred.

Personally, I’ve also gone for ‘ecstasy’ as my preferred term, because it’s got the longest history. But the risk of that is people think you mean either MDMA or ‘feeling very, very happy’. The authors make the mistake too of describing ecstasis as ‘north-of-happy states’. No! As Gordon Wasson, who reintroduced magic mushrooms into western culture, wrote: ‘In common parlance ecstasy is fun. But ecstasy is not fun. Your very soul is seized and shaken until it tingles. The vulgar abuse the word: we must recapture it in its full and terrifying sense.’ Another risk, which I may have fallen into, is that talking about ‘ecstatic experience’ makes it all about something happening within oneself, something one ‘has’, rather than something transpersonal happening beyond you, an encounter or realization rather than an experience (which sounds more like a thrill).

The altered states economy

The authors are coaches who make a lot of money giving talks and workshops to companies and CEOs on flow and peak performance, so they are quite focused on the practical business applications of ecstasy. They speak of the ‘altered states economy’, and suggest that today we spend around $4 trillion a year trying to get out of our heads and beyond our egos. ‘That’s insane, and no one’s talking about it’, says Wheal. To get to this figure, they added up all that we spend on, say, legal and illegal drugs, the alcohol industry, extreme sports, gaming, immersive arts like IMAX or festivals, gambling, self-help and psychology, and so on. It’s a bit rough-and-ready, but their basic point is right – the human desire for self-transcendence and ego-loss is fundamental, and late capitalism has found many ways to make money from it, including addictive behaviours like drugs and gambling. I’ve also written about what I call (in a nod to Joe Pine’s idea of the experience economy), the ‘ecstatic experience economy‘. There is also a political economy of ecstasy – states and empires use awe and wonder to increase their power, and now corporations like Disney, Cirque du Soleil and Magic Leap sell us enchantment and transcendence.

Tony Robbins and the human potential movement helped to instrumentalize ecstasy as a tool to capitalist success

The authors also want to convince us of how ecstasy leads to peak performance. This is very much in the tradition of human potential coaches like Anthony Robbins, who teaches how ecstatic or peak states can unlock our life-potential (hence his use of fire-walking, pumping techno, trampolines and so on). They’re particularly interested in how Silicon Valley entrepreneurs like Steve Jobs used meditation and psychedelics to unlock their creativity. They quote life-hacking guru Tim Ferriss: ‘The billionaires I know, almost without exception, use hallucinogens on a regular basis.’ Tune in, turn on, get rich!

This weird fusion of the ecstatic and the capitalist goes back to Stanford Uni in the 1970s, when pioneers of the digital economy like Jobs, Stewart Brand and Douglas Engelbart mixed coding with Bay Area spirituality. Engelbart introduced LSD boot-camps at his Stanford research unit (after one trip he invented a toilet that played music when you peed in it). This led to the idea that the main route to ecstatic experiences would be the start-up, the dot.commune, the guru-CEO creating a new utopia in cyberspace. A great introduction to this is Fred Turner’s history, From Counterculture to Cyberculture.

I guess my issue with the selling of ecstasy as a way to peak capitalist performance is that, historically, ecstatic experiences have involved a revolution in the self and a revolution in values. St Paul is utterly transformed after his Damascene moment, his values are utterly transformed – he has died, someone new has been born. The instrumental use of ecstasy for conventional goals of success and power seems to me closer to the magic of Simon Magus or Aleister Crowley. But it’s often there in religion too – what is the Prosperity Gospel if not the instrumentalization of ecstasy for worldly aims?

The risk of the psychology or neurobiology of ecstasy is it leaves out the ethics. Most spiritual traditions emphasize that ecstatic experiences are at best a distraction and at worst a serious risk if they’re not grounded in strong ethics. Later psychologists have come to this conclusion too – William James suggested we evaluate religious experiences based on the ‘fruits’. I think the authors understand this, they speak of the ‘dark side’ of ecstasy, and warn it often leads to unbridled hedonism. But that’s not the main risk, historically. The main risk is that ecstasy without humility leads to pride, the feeling that you’re special, chosen, elite, Crowleian supermen. Kotler and Wheal’s book, talking about the special ‘Prometheans’ or ‘supermen’ whose ecstatic experiences prove how wise and advanced they are (and rich! did we mention they’re rich?), could feed this tendency.

The four drivers of ecstasis

The authors argue we’re at a special moment in history, when suddenly we understand ecstatic experiences better than ever, and can get them ‘at a flick of a switch’. Why now? Because of four drivers. Firstly, psychology. Kotler says that, after William James’ Varieties of Religious Experience in 1902, psychology took a ‘hundred-year detour’ and focused on psychopathology. Altered states of consciousness were dismissed or pathologized, but in the last decade psychologists like Czikszentimihayli and David Yaden have realized they’re actually good for us. This is not quite right – as co-author Jamie Wheal notes, ecstatic experiences were hugely studied in the 1950s, 1960s and 1970s, particularly through the human potential movement and transpersonal psychology. What’s really happened in the last decade is that transpersonal psychology has gone mainstream, thanks to the rise of contemplative science and the return of psychedelic science.

Secondly, neurobiology. Brain-scanning techniques have enabled scientists to take ecstasy more seriously. Before, it seemed a very flakey topic for research, that led into career cul-de-sacs like parapsychology or after-death-investigations. But look, a brain-scan – something really is happening! This was reassuring for the Doubting Thomases in academia. Now, there is interesting neurobiology on ecstasy done by scientists like Andrew Newberg, Richard Davidson and Robin Carhart-Harris, showing the neural correlates of states of ego-loss and deep absorption.

There is a risk that these very early insights are then uncritically seized upon to argue that ‘the mystical is now neurobiological’, as Wheal puts it, or that the mystical has now been ‘decoded’ as Kotler says. In other words, because something happens in the brain, mystical experiences are nothing but brain events. This would be a big mistake by psychiatry – it has a 300-year bad record of pathologizing and ignoring these experiences, to the great harm of many people and of western culture in general, for which no one has ever apologized. Now, when it starts seeing the positive side of these experiences, it again rushes to a triumphalist scientistic interpretation.

As the podcast presenter, Scott Barry Kaufmann, who researches in this field, points out: ‘Everything is biologically mediated, so that statement is not as exciting as you think. There’s so much we don’t know – we’re at the start, not the end point.’ He’s quite right. Andrew Newberg, for example, has found that ecstatic experiences involve the emotional processing areas of the brain. Well, no shit! How is that useful, besides as a way of getting sceptical scientists to take ecstasy seriously?

The third driver the authors outline is pharmacological – particularly the ‘psychedelic renaissance’ today. No arguments there, though again it’s very very early days in the research. And the fourth driver is technological. New technology makes ecstasy more widely available than ever before, they argue. For example? New amplification technology makes music concerts better. In the old days it was just the Grateful Dead, now we have huge EDM festivals. Uh huh. And new skis make powder skiiing easier. Right….I’m not entirely convinced. Just because electric guitars are more advanced now than the 60s, doesn’t mean people play them better than Hendrix did, or that the experience of the audience is more intense than it was at Monterey or Woodstock (who really thinks that?) It’s partly the shock of the new that creates the ecstatic – the shock of, say, the first use of the Roland 303 in acid house. I’d say humans are constantly inventing new technologies and scripts for ecstasy, from cave paintings to virtual reality. Our age has developed some new scripts, but so did every age before us.

I also think that, like many secular psychologists and neuroscientists, the authors don’t entirely get the connection between ecstasy and ritual. Like Sam Harris, they’re impatient with ritual, which is all woo-woo. They want an entirely stripped-down, rationalist, flick-of-a-switch mechanistic ecstasy, one liberated from middle-men. Wheal says:

For folks who have mythological or mystical explanations and assumed [ecstasy] came from grace or adherence to religion, we can say, here are the mechanisms. It cuts out the middlemen, the priest class, those who presume to tell us how to get it. This is our human birthright. Mystical experiences can be demystified and we can create them a hell of a lot more often than when people are bowing and scraping to Mecca.

Kumbh Mela. Low-tech ecstasy

Never mind the casual insult to 1.6 billion Muslims, this fails to understand the power of rituals – including pilgrimages – to bring us to ecstasy. You think westerners now have more ecstasy than ever before? Compared to the Middle Ages? Compared to, say, Indian culture today? OK, Burning Man now attracts thousands and thousands of people…The Kumbh Mela in India attracted 120 million people in 2013, and they had no more technology than tents, chillums, bhang and a river. And what the Sixties showed us is you can do away with the ‘middlemen’ of Christianity, but often new middle-men rise up – gurus, artists, politicians, rockstars, dare I say it, even self-help coaches, who ‘presume’ to tell us how to find ecstasy and what it means.

I also think the authors miss out an important cultural driver for why we are talking about ecstatic / spiritual experiences today. The main reason, I think, is the decline of organized religion in the west. This has created a large group of ‘nones’ or ‘spiritual-but-not-religious’, who are just as hungry for spiritual experiences, perhaps even hungrier than before. Hence the fact that, while attendance at church is going down, the number of people who say they have had spiritual or mystical experience in the US and UK is going up.

But a spirituality based on ecstatic experiences and detached from moral dogma and community can make us overly attached to them, so that we fetishize them, we make them the goal of the journey, rather than something which may happen along the way. What then is the better goal? Love and awakening to our true selves, I would say. Transhumanists, life-hackers and human potential coaches always speak of ‘peak performance’, and rarely about love, vulnerability, openness. ‘Though I speak with the tongues of men and of angels, but do not have love, I have become a noisy gong or a clanging cymbal.’

Having said that, there’s much that I agree with in Kotler and Wheal’s analysis, particularly their insight that the internet has allowed an open-source big data approach to ecstasy, a ‘crowd-sourced Bible’ – the exact phrase I’ve used in my book! I didn’t copy you, guys, I swear. I’ll definitely give the full book a read when it’s out later this month.

Enjoyed this? Read more about Jules’ research trip to India on the blog.

Colonial Anxiety and Vulnerability in British India

This is a guest post by Mark Condos. Mark obtained both his BA and MA at Queen’s University in Canada. In 2013, he received his PhD from the University of Cambridge, where he worked under the supervision of the late Professor Sir Christopher Bayly. In 2014, Mark was awarded a Leverhulme Early Career Research Fellowship at Queen Mary, University of London. His current research examines how different forms of legal and extrajudicial violence were incorporated by the British and French empires in their attempts to police different frontier regions during the nineteenth and early twentieth centuries. He also written extensively on the history of ‘fanaticism’, colonial law, and violence.

In an essay written just a year after the suppression of the great Indian Rebellion of 1857, an officer within the Punjab administration named R.N. Cust bragged that, ‘It is the remarkable phenomenon of the English Rulers in India that they have no fear; either from ignorance, or the high spirit of youth, or the innate nobility of the conquering race, they go about alone among the people.’[1]

In many ways Cust’s statement was a typical example of what was known as the ‘Punjab School’ of colonial governance. This was a ‘rough and ready’ system of rule in which colonial officers were meant to live daily among their people, constantly touring their districts on horseback, while transacting their judicial and executive business with aplomb. These swaggering, swashbuckling figures projected an image of raw British power and invincibility that was meant to overawe their colonial subjects and cow them into submission.

Figure 1: Robert Needham Cust, c. 1840. From Robert Needham Cust, Memoirs of Past Years of a Septuagenarian (Hertford: Stephen Austin and Sons, 1899).

Cust was an archetypal Punjab School administrator, and his comments are a testament to this cult of the district officer: the mighty and courageous colonial administrator who shows no fear and never backs down. His statements also evoke a much wider culture of British sang froid where coolness, and stoic determination in the face of adversity and danger were prized above all else. Perhaps best epitomized by Kipling’s enduringly popular poem, ‘If—‘, the proverbial ‘stiff upper lip’ was one of the central conceits by which Britons imagined themselves from the mid-Victorian period onward.[2] In the imperial world, this British coolness became even more pronounced when contrasted against the supposedly ‘excitable,’ ‘hysterical,’ ‘childish,’ and excessively-effusive colonial subjects they encountered.

Yet for all of its bluster, this valorization of masculinity, self-control, and emotional restraint was ultimately an untenable imperial phantasmagoria. Kipling, for instance, was not always the unequivocal, jingoistic imperial cheerleader that his later incarnations seem to suggest he was, and many of his earlier stories actually evoke instances of colonial fallibility, frailty, and failure in India.[3] Even Cust himself raised some unsettling doubts about the supposed indomitability of British power. In the same essay cited above, Cust described how both his superior officer and assistant had been assassinated, and how he had been compelled to keep a loaded revolver in his desk by day, and under his pillow at night. Though he insisted he never had a ‘bad night from anxiety, or felt the necessity of beating a hasty retreat,’ he warned that if the British ever lost their prestige — their image of invincibility —— that colonial authority would collapse.[4]

Such an assertion was all the more poignant in the immediate aftermath of the 1857 Rebellion, which had shattered in spectacular fashion the notion of British invincibility. Far from being a simple expression of the bold self-confidence and swagger of the Punjab School and colonial rule more generally, then, Cust’s statements actually evoke a troubling and uncomfortable realization that British colonial power was fundamentally dependent on the illusion of its own strength.

Figure 2: ‘Unrest in Bengal’, from the cover of Black & White, 13 July 1907. This image poignantly conveys the British sense of being under ‘siege’ in India during a period of heightened anti-colonial resistance.

Imperial ideologies championing the strength and indomitability of the British conquering spirit, therefore, tended to obscure the fundamental doubts and uncertainties that were actually quite central to the colonial experience. This is the starting point for my most recent work, which explores the ‘dark underside’ of the ideologies that sustained British rule in India. The British, I argue, lived in a terrifying world, and were plagued by an unreasoning belief in their own vulnerability as rulers. Surrounded and outnumbered by strangers whom they did not fully understand, dependent on the loyalty of groups they were not always sure they could trust, and confronted with various forms of resistance on a regular basis, it is no surprise that the colonial regime spent so much time fretting about its own safety. These enduring anxieties, in turn, precipitated, and justified, an all too frequent recourse to violence, joined with an insistence on untrammelled power placed in the hands of executive (men like Cust).

While it would be a great overstatement to claim that the prevailing British experience in India was defined by a sense of weakness, or that the colonial state was somehow ‘powerless’, there was an abiding sense among Britons that India was an unfamiliar and potentially dangerous place. The British remained an exposed ruling minority and were very much alive to the danger that Indians might someday ‘call the bluff’ of their colonial overlords and rise up against them. In this anxious and fevered climate, dangers — both real and imagined — had a powerful impact in shaping the ways that colonial statecraft operated.


[1] Robert Needham Cust, ‘The Indian District’, Linguistic and Oriental Essays: Written from the Year 1840 to 1897, 2 vols. (London: Luzac & Co., 1898), vol. 1, p. 245.

[2] Thomas Dixon, Weeping Britannia: Portrait of a Nation in Tears (Oxford: OUP, 2015), chap. 14.

[3] See Rudyard Kipling, ‘Thrown Away’, Plain Tales from the Hills (1888; London: Macmillan and Co., 1920); and ibid., ‘On the City Wall’, In Black and White (New York: The Lovell Company 1899).

[4] Cust, ‘The Indian District’, p. 245.

No love lost: Antipathy, antagonism and anger in Singles magazine, 1977-1982

This is a guest post by Zoe Strimpel, a third-year doctoral student at the University of Sussex, where she holds the Asa Briggs PhD scholarship in Modern British History. Her thesis explores the relationship between the British matchmaking industry after 1970 and changing romantic norms and gender dynamics. She has written two non-academic trade books about dating and gender: What the Hell Is He Thinking: All The Questions You Ever Asked About Men Answered (Penguin: 2010) and The Man Diet: One Woman’s Quest to End Bad Romance (Harper Collins: 2012).

Change can be confusing and frightening, particularly when it feels like control – however tenuous – is slipping away. And when people are confused, scared, or feel they’re losing their grip, they get angry. And they write angry things. In my view, hot emotions such as anger not only provide a framework for considering the affective drivers of everyday experience but they act as a flare on the horizon, alerting us to areas of sensitivity we might otherwise miss. Sore spots nudge us to think about the usual historical narratives from a different point of view.

One plum opportunity I’ve had for doing this recently concerns the reactions of a group of largely conservative single people around 1980. Men and women countrywide of different incomes and ages, the diverse feelings of these lonely hearts are accessible through the numerous letters they penned to a national solos’ magazine called (shockingly) Singles. Many were divorced – swept up in the soaring divorce figures of the 1970s, when marriage terminations tripled, the women often struggling to raise children single-handedly. But many were also in their 20s and early 30s, people who found (or felt) themselves still standing when the music stopped. The never-marrieds were hardly alone either – the number of single person households (though this includes widows and widowers) was the fastest-growing type after the 70s.

Singles reader letters are curiously, depressingly addictive – the sheer intensity of sexually acrimonious feeling kept me reading and reading. They also made me think in new ways about the legacies of the 70s. Before, I’d tended to think about the decade’s sexual progress as inexorable, while also wondering how the explosion in feminist discourse fit within the larger moral and emotional landscape of a Britain whose adults had been born in the 20s, 30s, 40s and 50s.  These letters prompted me to reckon with all those who experienced feminism on a daily basis as a source of vexation, disagreement and confusion.

When Singles was launched in 1977, readers had been what they often called ‘subjected’ to nearly a decade of sexual liberation movements. Women’s liberation had introduced a whole new vocabulary, and whether or not its ideas and goals were agreed with, there was no getting away from the fact that ‘equality’ – in the bedroom, at work, at home, in childcare – was at the heart of a growing discourse that appeared everywhere from high politics to TV to Cosmopolitan magazine. The actions and calls of feminists were a media mainstay. Nor was it all talk – as Carol Dyhouse has chronicled, the expansion of higher education saw huge take-up of university places by women in the 70s, and more women were working in a (still limited) variety of jobs. By the time Margaret Thatcher became Prime Minister, it seemed like women had gained power across the board at a break-neck speed, their rights to succeed enshrined in the Equal Pay (1970) and Sex Discrimination Acts (1975). And having been in universal circulation for over a decade, the Pill had changed the entire relationship between sex, gender and family in ways not everybody was happy with. There were raw feelings about female sexuality and motherhood, which – in Singles letters – often took the form of accusations of women’s greed, selfishness and unreality.

But among Singles readers, feelings about women’s changing economic status prompted some of the most heated exchanges. Money was a cipher for power, and the easiest way into the question of how power was being reconfigured between the sexes was often through something as seemingly trivial as who paid for what on dates. But men’s feelings about women’s economic status were complicated, hedged on one hand by the sense that women had enough money of their own now to mean they (men) no longer had to pay for dinner, but also that women had actually become more money-grubbing at the same time. The idea that women had cried equality, got it and all its trappings (eg good jobs and good incomes) and still expected men to pay for them on dates was extremely galling to many. This was a moment in which the strength of the emotional response was the flare on the horizon rather than the perception contained within it. After all, the latter had little in common with reality as most women experienced it.

Here’s an example of anger about women and money. In the November 1978 issue, bachelor Noel Shaw wrote in the lonely hearts ads at the back of the magazine. ‘It will be found that roughly one in three women include in their requirements, one or more of the three words, “business”, “professional”, and “executive”. Using your red felt-tip, mark these “grabber”, “climber”, “leech”, 'When writing your ad' guidelineswhatever takes your fancy. Also, look for those including such phrases as “financially sound”, “wealthy”, “reasonably rich”, “successful”, “solvent”, “generous” and the like. Mark these “G/Digger” or with just a plain “£” or “$” sign. …. actually there may be some justification here, if there is any truth in the rumour that some women can only achieve orgasms in a bedroom with a £20 note pasted to the ceiling’

Weaving between the insulting and the sexually explicit, this kind of invective was fairly commonplace in the letters pages of the magazine, and underscores the kind of muddled feelings about women’s changing status – and the perceived attack on male resources – I’ve been talking about. Not all men were so crude, but letter after letter from men spurned in the lonely hearts pages essentially blamed the march of women’s rights for creating ‘a new breed of female predators’ that no man would ‘even want to marry, let alone live with’.

But what about the women? They in turn found their opposites unreliable, oafish, poor and shirking of their domestic and financial responsibilities.  A Ms M.P. of Surrey’s response to Noel Shaw’s letter was particularly passionate. Defending female terminology in the lonely hearts pages, she argued that it wasn’t women who were to blame, but the reality of experience with modern men that induced women to take semantic precautions.  Indeed, her profound dissatisfaction with contemporary gender relations pivoted on an idea of a better, vanished past. She fumed: ‘“Professional’ man is stipulated in order that unwashed unshaven and part dressed yobs don’t appear for meals and also to intimate that the advertiser would like to meet a male with a wider topic of conversation than football and bars.

As the testimony of the Singles readership suggests, the feelings that many daters brought to the courtship table ­– whether they were divorced or never married – were not those of love, affection, romantic sentiment and seductive ambition. Rather, faced with their opposite numbers at the end of a decade of unprecedented sexual change, singles vented anger, frustration, resentment, economic anxiety and sexual antipathy.  Being attentive to these feelings allows us to see a fuller picture of British emotional and relational life at this time, foregrounding the widespread backlash that would become so visible in the 1980s and unfortunately, in the age of Trump, so visible once again now.