Month: November 2021

Review: The Sense of Movement

Roger Smith: The Sense of Movement. An Intellectual History (London: Process Press, 2019)

Sonsoles Hernández Barbosa, University of the Balearic Islands 

The Sense of Movement addresses bodily perceptions of movement over the last four centuries. The work begins by presenting philosophical debates about movement as a vital force which emerged in parallel with the birth of modern science in the seventeenth century, linking these with modern notions about the operation of the human brain. As the author points out, the study of movement and its conceptualisation involves setting up a dialogue between current and past understandings of the sense of movement.

Although The Sense of Movement begins with these reflections about the operation of the world of the senses connected with the scientific revolution in the seventeenth-century, some of its arguments reach back much further in time, specifically to the Aristotelian classification of the five senses. The very use of the expression ‘sense of movement’ implies a direct confrontation with the Aristotelian philosophical tenet, which held that movement could only be understood in relation to the sense of touch. Indeed, the extent to which we can refer to a sense of movement that is independent from touch is one of the main issues addressed by the book. Many of the historical difficulties raised by this issue are to do with the fact that the sense of movement and that of touch cannot be pinned down to a specific organ, insofar as the skin covers the whole body. Today, however, a conceptualisation of the senses that goes beyond the five traditional senses, including the perception of pain, temperature and even time, is widely accepted.[1]

Smith, whose areas of specialisation straddle the fields of philosophy and the history of science, argues that it was around 1800 that philosophy began to address the issue of human movement, when muscular motion was first recognised as a specific sense, distinct from touch. Charles Bell, who in an 1815 work referred to muscular sense as a sixth sense, played a pioneering role in this development. In another section of the book, however, Smith argues against the independent study of both senses – touch and movement – stating that the history of touch cannot neglect movement as a sense. In this, he follows the recent arguments of philosopher Matthew Ratcliffe, who considers movement part of the sense of touch. Thus, while in some parts of the book touch and movement are jointly considered, in others Smith makes a clear distinction between them.

In addition to the problematic distinction between the senses of touch and movement, the book deals with two additional thorny conceptual issues, ‘kinaesthesia’ and ‘proprioception’, which are not always used consistently even today. The former was introduced by the neurologist H. Charlton Bastian in the 1860s as a synonym for the ‘sense of movement’ but Smith prefers to use the term to refer to the ‘conscious awareness of one’s own movement’ (p. 193); ‘proprioception’, on the other hand, is used to allude to what the neurophysiologist Charles Scott Sherrington calls ‘the sensory nervous system, largely but not necessarily functioning without conscious awareness, central to the coordination of movement and posture’ (p. 10). Kinaesthesia, therefore, would imply conscious movement as opposed to proprioception, which involves a rearrangement of posture and movement that not always engages conciousness. As Smith points out, if we accept the existence of an embodied psyche this conceptualisation leads to an unsustainable dualism between body (unconscious) and mind (conscious) (p. 202). It is perhaps for this reason that other authors, in contrast with Smith, have preferred to understand proprioception as the perception of our muscles and internal organs.[2]

A final related aspect, which also hampers the imbrication of movement into traditional conceptualisations of the senses is the embodied conception of all sensorial impressions, which implies that all sensorial experiences mobilise more than one sense. In the same way that vision is embodied, the sense of movement does not depend solely on the muscles, but also on other mechanisms, such as retina images, the inner ear, tendons, joints, skin and other tissues, which means assuming the synesthetic character of all sensorial experiences.

Smith’s history of the sense of movement is a history of ideas. As such, the subject of study spans a number of fields, notably the history of science, the history of philosophy and the anthropology of the senses. The book is divided into fifteen independent chapters that could have been assembled into various sections in the table of contents, especially because some common threads readily come to mind, for instance that which links the postulates of natural science (Chapter 2) with thoughts on causality developed by natural philosophers in the eighteenth and nineteenth centuries (Chapter 5).

The mechanist consideration of the concept of force as movement – for instance through the principle of action-reaction – allows the author to situate this concept at the root of evolutionist ideas, thanks to the assumption among naturalists that living beings are subject to the same laws that rule over Nature . The application of this principle to the human body and the understanding of the process of evolution undergone by it emerged in the fields of naturalism and physiological studies (chapters 8 and 9). As a way of example, Herbert Spencer’s study of the phylogenetic evolution of the human body suggested the sense of touch, which includes muscular tension, as the most primitive of the senses, from which the rest of the body’s sensorial capacities derived.

Muscular effort, understood as an active force that poses resistance to events was a concept shared by scientists and idealist philosophers. The seminal nature assigned to the sense of movement in the development of the foundations of the self is a central aspect in philosophical thought that threads through the book, from Berkeley’s (Chapter 3) and Condillac’s (Chapter 4) empiricism to idealism (Chapter 7) and the phenomenology of perception (Chapter 14). Smith’s book shows that Enlightened philosophy introduced the will as a key element in the capacity for motion. Will is no longer considered dependent on the activity of the soul, but emerges from ‘la faculté de vouloir’ (p. 76), which idealism developed further as the idea of causal action (‘the Deed’) as a source of knowledge (Chapter 7). Chapter 10 specifically focuses on psychological reflections around movement.

Chapters that consider the cultural implications of movement are of special interest, for instance chapters 12 and 13, which link the perception of movement and mountaineering and contemporary dance, respectively, in connection with the idea of the individual as an active agent (Chapter 11). This amounts to a dialogue with the cultural history of the history of the senses, although Smith explicitly states that his intention is not to take a cultural history approach to the history of movement.

Overall, The Sense of Movement is a key contribution not only to understand the sense of movement but also as a general reflection on the senses more broadly. From the perspective of the history of ideas, it is a fundamental text to understand the epistemological potential of movement, which tracks a theoretical tradition that acted as a counterweight to ocularcentrism and the consideration of vision as the objective and epistemological sense par excellence.

[1] Phillip Vannini; Waskul, Dennis; Gottschalk, Simon: The Senses in Self, Society and Culture. A Sociology of the Senses [2012]. New York: Routledge, 2014, p. 6.

[2] Vannini; Waskul; Gottschalk, p. 6.

Review: Closing the Asylum

Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (London: Process Press, 2020)

Steffan Blayney, University of Sheffield

When the first edition of Peter Barham’s Closing the Asylum was published in 1992, it attempted to describe the historical underpinnings of a protracted upheaval in mental health provision which was still very much ongoing. While the dismantling of the Victorian asylum system had been the professed aim of successive British governments dating back at least to the 1959 Mental Health Act – and while the overall asylum population had been declining steadily since its peak in 1954 – still in the early 1990s deinstitutionalisation remained an unfinished project. By the time of the book’s second edition in 1997, with the majority of hospitals open a decade previously now closed, this seemed harder to argue, yet by this point characterisations of ‘care in the community’ as a failure were already becoming mainstream. This new edition, published in 2020, arrives in the wake of the 2018 Independent Review of the Mental Health Act amidst ongoing debates about the extent of coercion and legal compulsion within the mental health system.

Barham’s original text, reissued here with a new prologue and preface, situated twentieth-century debates over deinstitutionalisation within the longer history of how modern societies have dealt with the ‘problem of insanity’. This has always been a social question at least as much as it has been a medical one. In nineteenth-century Britain, and particularly after the New Poor Law of 1834, the public asylum emerged – alongside the workhouse and the prison – as a means to deal with surplus populations produced by industrialisation. Idealistically imagined by their founders as spaces of care and rehabilitation, the Victorian asylums quickly became little more than overcrowded repositories for incurables and undesirables. The segregation of the mad was given legitimacy by an emerging psychiatric profession whose own optimism about the possibility of cure quickly ceded to essentialising views of mental patients as inherently ‘broken’ or ‘flawed’ individuals, who for the most part would remain incapable of participating in society and undeserving of recognition as fully human. While such conceptualisations were never without their critics, Barham argued, the eventual movement towards asylum closure that emerged in the twentieth century failed to seriously challenge the underlying ideological structures which continued to produce madness as a social problem and the mental patient as a second-class citizen.

The resulting story of deinstitutionalisation was one in which the hopes held by many for the full liberation of hospital inmates would always be secondary to more cynical policy motives. Focusing primarily on mental health law and policy in England and Wales, and weaving historical and sociological analysis with the views of service users and campaigners, Closing the Asylum described how hopes entertained by reformers from the mid-twentieth century for progressive alternatives to the authoritarian psychiatric hospital were repeatedly frustrated or co-opted. Too often, talk of patient freedoms or more enlightened approaches to care functioned as little more than ideological cover for governments eager to cut expenditure by avoiding the costs associated with long-term custodial care. Hospitals emptied, but the services which would allow former inmates to live meaningfully independent lives fail to materialise, with new developments in psychopharmacology enabling the management of symptoms without the need for costly social or psychological therapies. For some who would formerly have been hospitalised, the institutions of the criminal justice system expanded to fill the vacuum (a growing prison population since the 1990s includes an increasing proportion of inmates identified as suffering from a mental health condition). For many more, especially those already from deprived backgrounds, newfound freedoms were undermined by persistent poverty, insufficient welfare support, and the stigma of illness leading to discrimination in housing and employment. Where the mental patient is still viewed by society as a problem to be solved rather than a full political subject, Barham demonstrated, ‘community care’ can function just as effectively as the asylum as a technology of social exclusion and marginalisation.

Another aspect of the old regime which failed to disappear along with its physical architecture was its use of force and legal compulsion. While it might have been expected that the move away from the rigid hierarchy of the asylum would lead to greater liberty for patients, evidence from the last three decades, which Barham details in the prologue to the new edition, shows that the opposite is true. The use of constraint and coercion, justified by the supposed risk posed by patients to themselves or others, has not only persisted through deinstitutionalisation but is increasing. Despite falling numbers of long-stay patients, the total number of people being detained involuntarily almost tripled between 1988 and 2015. This combined with drastic reductions in the overall number of psychiatric beds through years of austerity means that half of all psychiatric inpatients are now detained under the Mental Health Act  – compared to around 10% in the 1970s. Moreover, with the arrival of Community Treatment Orders (CTOs) in 2008, mandating compulsory outpatient treatment under threat of detention, formal coercion is now no longer limited to the hospital setting. The violence of the system, it might be added, is not evenly applied: black patients are more than four times more likely to be involuntarily detained than their white counterparts, and more than ten times more likely to be subject to a CTO. Nor is the ‘shadow of coercion’ (8) which extends over the mental health system limited to those against whom the provisions of the Mental Health Act are directly mobilised. As service user activists (and some psychiatrists) have argued, in a system where patients and doctors know that the threat of compulsion is always available, it becomes difficult to see any treatment as fully voluntary.

While sharply critical of the way deinstitutionalisation has played out in practice, Barham has remained neither nostalgic for the asylum nor pessimistic about the prospects for more progressive services in the future. As he makes clear in the prologue to the new edition, ‘though the book is consistently critical and questioning of the way in which policies of community care have been implemented, it nonetheless holds steadfast to a positive view of the capabilities of the diverse range of people who are assembled under the banner of the “mentally ill”, and to the promise of community-led, above asylum-led lives for enhancing their life prospects.’ Deinstitutionalisation in this context should be seen not as an irrecoverable failure but as an unfinished ‘emancipatory project’ (28).

The ‘real questions’ that societies need to answer, as Barham maintained in 1992, have never been ‘about dismantling the mental hospitals as such, but about the prospects for manufacturing the social and political will adequate to the task of bringing back and reassimilating into society what had been thrust into the mental hospital’ (151). For Barham this means reaching a point where individuals are treated not primarily as ‘patients’, defined in law by their diagnosis, but as ‘persons’ entitled to full rights as citizens. Drawing on ideas advanced by the psychiatric survivor movement (the new edition includes a preface from the veteran campaigner Peter Campbell) he advocates a shift from managerial or paternalistic conceptions of care, underpinned by coercion, towards a focus on empowerment and autonomy for service users. This will not be achieved through legal or medical fixes, but only by reckoning with the centuries-old legacies of a system which has created the ‘mentally ill’ as a class apart.