Category: Uncategorized

Reviewed by Marion Schmidt (Georg August Universität, Göttingen) Published on H-Disability (November, 2018)
Commissioned by Iain C. Hutchison (University of Glasgow)

Some years ago, I read Melanie Yergeau’s “autie- ethnographic” account of her experience of being invol- untarily committed to a psychiatric ward during her sec- ond week as a professor of English at the University of Michigan.[1] This was, she recounts, a surreal expe- rience, in which she faced various health care profes- sionals claiming that this was no longer Yergeau her- self acting and talking, but her condition—autism. As an autistic person, conventional theory and popular belief hold, she lacks insight into her own behavior and that of others. For Yergeau, this denial of agency and rhetoric has been a familiar situation ever since she was diag- nosed as a young adult. “Suddenly,” she writes, “with the neuropsychologist’s signature on my diagnostic papers, I was no longer my body’s author” (p. 1). Autism ac- tivists and scholars have long criticized that past and cur- rent theories of autism—from Bruno Bettelheim’s Empty Fortress (1967) to Simon Baron-Cohen’s theory of mind and mindblindess—deny autistic people subjectivity and personhood, in effect dehumanizing their very being. This leads to the ironic situation that autistic authors of- ten find their authorship questioned.

In the 2018 Authoring Autism: On Rhetoric and Neuro- logical Queerness, Yergeau challenges this denial of autis- tic authorship and, simultaneously, questions traditional definitions of rhetoricity and personhood. Chapter 1, “In- tention,” questions the “centrality of intentionality and purpose within rhetorical tradition” that is deeply in- grained in ableist traditions of humanity and subjectiv- ity (p. 32). Yergeau points out how “demi-rhetoricity”— the assumption that autistic people possess a not-quite rhetoricity—has been used to deny their agency and per-

sonhood. Yet she also suggests that such partial or residual rhetoricity can be a tool for reclaiming autistic agency, an approach she further explores in chapter 4. Chapter 2, “Intervention,” looks at the history of applied behavioral analysis (ABA) as the most common and per- vasive therapeutic intervention used with (on?) people with autism. ABA originated in behavioral psychology and breaks down behavior into small units, in which sub- jects are then repeatedly trained or taught and in the pro- cess are rewarded for success and punished for noncom- pliance. It is not concerned with the cause or nature of the condition in question, but “with reinforcing and ex- tinguishing antisocial (or inappropriate) patterns” such as autistic stimming, echolalia, or repetitive behaviors (p. 96). Consequently, as ABA does not aim at the causes of deviance, but only at its expression, the goal is not recov- ery, but merely “faking the becoming of normativity” (p. 105). It is a highly time-intensive form of therapy, ide- ally shaping all interaction. As Yergeau remarks, for “the neuroqueer child, ABA is life!” (p. 97).

This evokes, of course, the histories of other disabili- ties, where therapy claims a civilizing effect, and it would have been useful had Yergeau drawn from these histories of psychology, psychiatry, education, and disability, and, perhaps more generally, of society and civilization. Tapping into this larger scholarship also would have been relevant to her exploration of the overlapping history of ABA as a treatment for autistic and for non-gender- conforming children or, as she puts it, queer, and neuroqueer people. In the 1960s, clinical psychologist Ole Ivar Lovaas, a pioneer of ABA, ran both a Young Autism Project and Feminine Boy Project, both with the goal to normalize deviant behavior. Yergeau makes some valid and thought-provoking points about the overlap in ther- apy directed at those two groups. Yet her admitted col- lapsing of the “finer categories of autism or gender or sexuality under the broader banner of neuroqueer” evokes as many questions as it answers (p. 100). Not least—and this goes to my main point of criticism (and confusion) with Yergeau’s approach—the reduction of all kinds of difference and deviance to “neuro,” which is particularly problematic if applied to the past as in Yergeau’s explo- ration of the history of eugenics and stimming. Neu- rological identities certainly have become increasingly fashionable, yet to me their use brings up the question of the value of simultaneously deconstructing and con- structing neurological difference.

Chapter 3, “Invitation,” deals with the effects and con- sequences of disclosing autism diagnoses. Disclosure, Yergeau observes, is “both imperiled and politically gen- erative” (p. 140). Often, it is necessary for receiving services, yet it also renders an individual vulnerable to question and doubt, and to losing friendships or even jobs. It brings the potential to engender exchange and discussion, which are, as Yergeau argues from her own experience, “often agonistic, expectant of allistic refu- tation” (p. 33). Thus, the statement “I am autistic” or “disabled” is usually treated as “elliptic rhetoric,” a state- ment to be filled with meaning by the non-autistic per- son because the autistic speaker lacks the ability to do so. Chapter 4, “Invention,” finally, looks at the ways autistic communication can contribute to new understandings and definitions of (demi-)rhetoricity. Yergeau turns around the very traits that supposedly limit the agency and rhetoricity of autistic people—namely their partiality, residuality, and not-quite-rhetoricity, their use of em- bodied communication—as starting points for engagement. Such inventions, she emphasizes, need not al- ways be discursive, voluntary, or positive, to serve as “stimpoints” that trigger reactions from others. Autis- tic people, she writes, may, at times, live in “nondiscursive world[s]” that are “idiosyncratic or mutually unintelligible,” yet nevertheless, “these worlds hold value and meaning” (p. 34).

Overall, Authoring Autism provides many thought- provoking insights for disability scholars. This goes in particular for her engagement with disability theories, selfhood, and identity, and for pointing to the ways in which privilege is part of disability politics. It is a very dense book, packed with thoughts and observations that are perhaps best described as a meandering ambivalence, which is often a strength, and sometimes detracts. Here, it is Yergeau’s double perspective as a rhetorician and autistic activist that makes Authoring Autism valuable to a larger audience, on whom, as in my case, her finer points about rhetoric theory may be lost.

Note

[1]. Melanie Yergeau, “Clinically Significant Distur- bance: On Theorists Who Theorize Theory of Mind,” Dis- ability Studies Quarterly 33, no. 4 (2013), http:// dsq-sds.org/article/view/3876/3405.

Jennifer L. Lambe. Madhouse: Psychiatry and Politics in Cuban History. Envisioning Cuba Series. Chapel Hill: University of North Carolina Press, 2017. 344 pp. $32.95 (paper), ISBN 978-1-4696-3102-8; $90.00 (cloth), ISBN 978-1-4696-3101-1.

Reviewed by Michael Murphy (Mississippi State University)

Published on H-Disability (October, 2018)

Commissioned by Iain C. Hutchison (University of Glasgow)

In recent years, probably linked to the realities and stories concerning psychiatric and psychological disorders in today’s society, examinations of the history of mental health and illness have come from the historical profession at a rate not seen since the mid-1990s. Jennifer L. Lambe’s Madhouse: Psychiatry and Politics in Cuban History joins this renewed examination of this history, which reevaluates the place of mental health and illness in relation to society and the state while also weaving the agency of patients into the narrative. Mental health and illness and their institutions are no longer merely historicized. Works such as Lambe’s skillfully examine this topic in relation to society and the state over time. She details the history of Hospital Psiquiátrico de La Habana, Cuba’s most well-known state hospital, throughout the twentieth century. More specifically, Lambe shows how the hospital, commonly known as Mazorra, developed over time from the late nineteenth century, when Cuba was a colony, through to the end of the Cold War. Over seven crisply defined chapters, Lambe ultimately argues that “the history of Mazorra and madness in Cuba offers a unique stage to witness the evolution of the Cuban state” and “provides a window onto those populations, both Cuban or not, who remained maddeningly but also stubbornly outside it” (p. 15). After a succinct introduction, which includes an overview covering methodology and terminology, and chapter breakdowns, Lambe delves into Mazorra’s place in the unstable and unsure years of the Cuban War of Independence and the immediately preceding decades. During Spanish colonialism, the poor conditions at Mazorra became synonymous with the overall health of colonial Cuba; these conditions became worse with the start of war. Lambe details the inhumane conditions of Mazorra, concurrent with reports of suffering across Cuba during the late 1890s. At the end of 1896, the hospital housed 1,052 patients. By the beginning of 1899, nearly four years into the war, its population had plummeted to 393 patients due to “hunger, malnutrition, and gastrointestinal illness” (p. 19). With the United States’ occupation of Cuba by the early days of 1899, the promise of change and improvement came to Mazorra. At the time of the American occupation during the early twentieth century, a correlation existed between the newly liberated hospital and the establishment of the Cuban state. Lambe explains, “The hospital’s political import, forged at the nexus of colonial abjection, patriotic euphoria, and imperialist conceit, would become an enduring legacy of independence” (p. 21). She goes on to detail how the progressive movement in the United States influenced Cuba’s admission practices to the hospital. In the wake of Civil Order No. 57, initiated by the occupation government at the insistence of local native leaders, Mazorra opened its doors to a vast number of individuals with mental illness from across the island. Also during this time, standardization, dating back to the US reformist period of the mid-nineteenth century, known for uniformity and regularity under the Kirkbride Plan, came to the state hospital in the form of more civil orders. In both socially scientific and political senses, US progressivism played a major role in Mazorra’s transformation. This led to an embracement of the moral treatment theory in the treatment of the mentally ill, a practice that fell out of favor in the United States in the late nineteenth century.However, the condition of state-sponsored care for the mentally ill in Cuba held parallels to those in the United States in the early republic and early Age of Jackson. During and after the second US occupation, sanctioned under the Platt Amendment, Mazorra went through a period of uncertainty, and sharp shifts in policy, funding, and support. The second occupation brought paternalistic patronage to the people of Cuba and to the patients of the hospital, but faltered in the decades after the occupying forces left. Lambe explains that after the second occupation, the strategy of moral treatment was labeled a failure and it lost support. She notes that Cuban leaders who still supported moral treatment argued that Álvarez Cerice’s moral revolution for the hospital, linked to the revolutionary spirit of 1898, fell out of favor and became labeled a failure due to unsettling chaos and sharp changes in policy brought on by the occupations. Through the hard times in the decades after the second occupation, some began to push to criminalize blackness and Afro-Caribbean culture. Madness came to be linked to such classification and culture into the 1930s. Mazorra, known as the Inferno during this period, became what Lambe refers to as a cultural contact zone, “where new wealth met abject poverty, psychiatrists encountered mental healers of a religious bent, and nearly all national life met its shadow: the most marginalized constituents of the new Cuba” (p. 78). In the decades leading up to the Cuban Revolution of 1959, the hospital transformed into a catchall for political dissenters and became a model of the cronyism and nepotism associated with Cuba’s government under the rule of Fulgencio Batista. Much like the Cuban state during the last years of Spanish colonialism, Mazorra became synonymous with bedlam. Much like the ending and immediate outcome of the Cuban War of Independence, the Revolution of 1959 “would inherit” a failing Mazorra (p. 139). After the Cuban Revolution of 1959, the theme of revolution returned to Mazorra. The new government named Mazorra “the Hospital Psiquiátrico de La Habana,” and attempted to create an institution that represented the success of the revolution that it could show to the world. She goes on to note that “leftist and antiimperialist visitors to the island were invariably ushered to the institution” to laude its equivalence to facilities in non-Communist nations (p. 141). However, the cronyism that occurred during the Batista years continued into the Fidel Castro years. The first administrator of the Hospital Psiquiátrico under the new government, Celia Sánchez, came to this position not because of his qualifications in psychiatry but because Castro deemed him “the chosen one” (p. 143). Much as with the occupations of Cuba in the early twentieth century, the influences of the Soviet Union and United States on the treatment and classification of mental illness had lingering negative effects. Beginning in the 1960s, the treatment of mental illness became politicized. This became apparent with the criminalization and assumed treatment of homosexuality. At the Hospital Psiquiátrico, medical experts’ views fell into two camps that resembled party lines. Child psychologists drew on “socioeconomic factors and family dynamics” and antipsychoanalysts favored Pavlovian conditioning (p. 156). Lambe explains that while a campaign known as the Lavender Scare successfully led to the firing of numerous reported gay government employees in the United States and Nikita Khrushchev’s continuation of Joseph Stalin’s criminalization of homosexuality, Cuba sent purported homosexuals to labor camps. This politicization of the Hospital Psiquiátrico continued into the last decades of the Cold War. Lambe notes that under the banner of revolution, “it was the state rather than the mental health professionals” who would guide Cuba’s politicized treatment of mental illness (p. 157). By the last decade of the Cold War, Cuba began to experience worsening economic conditions that were linked to the economic downfall of the Soviet Union. Because of this, Cubans, with the blessing of Castro, began leaving the country for the United States on a dangerous trek across the Straits of Florida on what became colloquially known as the Mariel Boatlift. Upon their arrival in Florida, the refugees became the target of white nationalism and racism by citizens and sections of the press in the United States. Matters were made worse when it was revealed that a number of those sent on the boatlift were former prison inmates and state hospital patients in Cuba. This realization, as Lambe explains, “highlighted the shortcomings of deinstitutionalization” in the United States (p. 203). Beginning in the late 1960s, state hospitals in the United States began to release patients and cut rolls in the name of economic conservatism. By 1980, when the boatlift began, institutional psychiatric care in the United States could not wholly assist refugees who came from the Hospital Psiquiátrico. In the last pages of Madhouse, Lambe explains that “the madhouse has long served as a metaphor for the Cuban state,” especially after the Revolution of 1959, which she further explains in detail in the book’s epilogue (p. 230). In 2010, twenty-six patients at the Hospital Psiquiátrico passed away on a cold night. In response, the Cuban government swiftly placed the hospital’s director on trial and ultimately sentenced him to fifteen years in prison for “misappropriation” and “dereliction of duty” (p. 231). It is in this story that Lambe reminds the reader of the lasting power of revolution and its role in psychiatry in Cuba.

If there is additional discussion of this review, you may access it through the network, at: https://networks.h-net.org/h-disability

David M. Turner, Daniel Blackie. Disability in the Industrial Revolution: Physical Impairment in British Coal mining, 1780-1880. Disability History Series. Manchester: Manchester University Press, 2018. 264 pp. $115.00 (cloth), ISBN 978-1-5261-1815-8.

Reviewed by Pamela L. Dale (University of Exeter)

Published on H-Disability (October, 2018)

Commissioned by Iain C. Hutchison (University of Glasgow)

This is an interesting and ambitious book that should appeal to a wide range of readers. Nonspecialists will certainly appreciate the well-organized chapters and engaging narrative style. On one level, the book works perfectly well as an introductory text, yet there is also real sophistication here. The authors pose important questions about disability history and arrive at several surprisingly controversial conclusions. Alongside this analysis they offer a novel, and at times uncomfortable, reexamination of the British coal industry during an important phase of its development. The introduction clearly and convincingly sets out why the authors believe this time and place, and indeed industry, were so important. However, both the structure and content of the book encourage comparative analysis. Scholars with detailed knowledge of other industries in all parts of the world, from the first stirrings of industrialization to the present day, will find much with which to engage. I was certainly drawn back to a series of occupational health conferences I attended with my supervisor, Jo Melling, at the University of Exeter circa 2000-10, and was struck by the similarities and differences highlighted by contrasting this book with the range of case studies presented and explored in publications subsequent to the conferences. My personal research has concentrated on the period after 1880, but I studied the classic Industrial Revolution at school (General Certificate of Secondary Education [GCSE] level) and as an undergraduate. In both contexts, economic and social history provided the analytical framework. Social historians, in particular, tend to adopt a posture sympathetic to the working people, and the casualties of industrialization were and are very prominent in their accounts. However, issues relating to disabled people and the connection, or otherwise, between work and disability can easily be lost as other “victims” and “struggles” are highlighted. Indeed, a picture of almost universal suffering and exploitation can inadvertently marginalize the experiences of, and special difficulties faced by, disabled people. David M. Turner and Daniel Blackie make the important point that, despite the proliferation of academic studies examining aspects of the Industrial Revolution from a range of different perspectives, “disability history is absent from this intellectual endeavour.” They offer several convincing explanations about why this might be the case, but their most interesting conclusion is that “disability was central to the Industrial Revolution” (p. 2). In a comprehensive review of the literature, the authors use the introductory chapter to show how the neglect of disability issues impoverishes our understanding of the social and economic changes associated with the Industrial Revolution. They make the case for bold new approaches to better capture the experiences of disabled people. In doing so, they also challenge some of the ideas that underpin many leading disability studies publications. Scholars have previously noted the transformative nature of the Industrial Revolution but have tended to focus on the way technological change made disability more visible and more problematic for individuals and communities. Analysis then tends to concentrate on the exclusion of disabled people from lucrative types of employment and their increasing marginalization, stigmatization, and victimization. Poverty and ungenerous or inappropriate forms of economic support, including the mass, and in some cases forced, institutionalization of various groups of long-term sick and disabled people, become key narrative strands of research concentrating on the period circa 1848-1948. As activists have tried, and worryingly often failed, to make the British Welfare State more responsive to the rights, needs, and preferences of disabled people, both working and not, they have often deployed language that harked back to a pre-industrial golden age when disabled people were better treated. I share Turner and Blackie’s skepticism that this golden age ever existed, and appreciate their overall approach. This seeks to avoid generalizations and oversimplifications, and instead takes the lived experiences of disabled people, in and out of work, during a period of major industrial change as their starting point. The focus on the coal industry raised concerns that the study might unduly privilege the experiences of adult men. Male miners are certainly central to later nineteenth-century and twentieth-century discussions about, for instance, the disabling effects of silicosis, pneumoconiosis, and nystagmus. However, the study period embraces eras when women and children were also legally employed underground in coal mines. Turner and Blackie describe how campaigns to restrict and eventually end these practices shaped and reflected contemporary ideas about both disability and the “evils” of industrialization. The crucial 1842 Mines Act, which prohibited women and children under nine years of age from working underground, is rightly flagged, but the authors also usefully remind us that women and children continued to find employment in the coal mining industry after 1842. Some of these individuals were, or became, disabled. The authors suggest that “putting people with impairments at the heart of the story” changes our view of industrialization (p. 2). Disability history, compared to say the previously dominant occupational health history, helps develop new perspectives precisely because it extends analysis “beyond the worlds of work and medicine to include consideration of other important aspects of disabled people’s lives” (p. 13). I certainly welcome the development of a more holistic approach that offers assessments of family life and community roles as well as employment issues. It is a strategy that promotes inclusion and avoids the age and gender biases that might otherwise be inherent in a study of such a masculine industry. I was fully persuaded by the authors’ argument that a more rounded view of lives lived helps restore agency to the disabled people who appear in the study. The sick and injured miners suffered terribly, but rather than embrace victimhood they frequently asserted their rights, demands, needs, and preferences. Where the reader might expect passivity and dependency, Turner and Blackie highlight scope for complex negotiations with medical attendants, employers, co-workers, trade unions, friendly societies, and even the dreaded Poor Law officials. Even when completely unable to work, people are shown to have found ways to retain various cherished identities within part of the wider mining community. The authors obviously take human dignity very seriously. It is the value they place on both the work and the workers that makes their beautifully constructed vignettes come alive. These vignettes both illustrate and, in a sense, transcend the otherwise dense and depressing statistics that relate to the mighty and dangerous coal industry. From the perspective of today, when appalling mining accidents still blight the global industry, it is almost unbelievable that Turner and Blackie report: “In Benson’s estimation, during the second half of the nineteenth century, ‘a miner was killed every six hours, seriously injured every two hours, and injured badly enough to need a week off work every two or three minutes’ ” (p. 3). While major colliery disasters and mass fatalities understandably captured contemporary headlines and, in due course, the attention of historians, Blackie and Turner also usefully consider the devastating impact of far less noteworthy incidents that nonetheless had a terrible human cost. Implicit in this analysis is a concern with trauma, with psychological suffering given as much import as debilitating illnesses and injuries. The book does not dwell on psychiatric casualties and the formal diagnosis of mental illness, but gains much from wider study that embraces mental health in the coalfields from which discussion is drawn. One small omission is perhaps full consideration of fear as well as pain. The authors make very interesting use of several publications by Joanna Bourke, but at various points in the text I found myself pondering links to her uncited book, Fear: A Cultural History (2005). The introductory chapter includes a wealth of interesting detail as well as a guide to reading the rest of the book. A thematic approach helps address previously neglected topics as well as shedding new light on more familiar debates around medical care and welfare provision. Each chapter is important in its own right, although the full value of the book is only realized by reading it in its entirety. However, before considering the chapters in detail, it seems useful to discuss the way Turner and Blackie deal with three very problematic issues that appear at intervals throughout the text. A crucial problem is one of definitions. The language as well as experience of disability is very personal and it is easy to both unintentionally cause offence and be offended. Words, and the lived experiences they seek to capture, also vary significantly across time and place. Personally, I am comfortable to start from the position that anyone who self-identifies as disabled should be recognized as a disabled person, and other people, regardless of any impairment, who reject those labels, are entirely free to do so. However, we understand disability today not in its own terms but through a medico-legal language that evolved to restrict rights to compensation and determine access to health and welfare services. The authors usefully show how coal mining, as a key dangerous industry, was often at the forefront of these developments, and miners and their organizations were significant actors in campaigns around these issues. However, Turner and Blackie’s selection and discussion of cases nonetheless struggles at times to escape the artificial constructs of the contemporary medico-legal terminology deployed in the sources. This difficulty is compounded by the way the reader of today, willingly or not, views the evidence through the distorting lens of past and present medico-legal terminology. Understanding compensation schemes as we do, we can appreciate why the loss of say a finger was viewed as less serious than the loss of a hand. Yet, following Turner and Blackie, we also need to appreciate that the loss experienced by the individual would be highly personal to them, with a unique degree of physical and psychological pain experienced over the whole of the rest of their lives. I think Turner and Blackie have adopted the correct approach to the definition problem, but it never entirely goes away. This is especially problematic when contested definitions underpin disputed statistics deployed in contentious policy debates. The answers to superficially simple questions—such as how many or what proportion of miners were disabled—in their own assessment, that of their co-workers, their employers, or to some agreed definition, at any one moment in time, are elusive and ultimately unknowable. The difficulties only become worse if efforts are made to determine exactly what percentage of this “disability” among coal miners was directly workrelated. The second major problem is the question of how we should value the contribution, in and out of paid employment, of disabled people. My concern is that even thinking in these terms shows the insidious influence of the medico-legal terminology described above and its focus on the needs of a capitalist system of production. However, the question is inescapable in a book such as this and the authors handle it with sensitivity. Turner and Blackie draw on the work of feminist historians to underline the importance of viewing the labor of disabled people on its own terms. There are certainly benefits to this approach, but I would argue also some dangers. Many miners’ lives were ruined by work-related disability, and well-intentioned efforts to appreciate the way people coped as best they could after illness or injury must never be allowed to dissipate the anger necessary to challenge unsafe working practices and inadequate services for sick and disabled people. Turner and Blackie make frequent reference to these issues, and offer a particularly thoughtful discussion in the final chapter, but their conclusions provide as many questions as answers— which is presumably exactly what they intended. While the authors maintain a constant conversation in relation to the problems of definitions and valuing labor, they are perhaps less attuned to the difficulties for the general reader presented with other complex subject matter. The introductory chapter is detailed and informative, but in subsequent chapters the reader’s appreciation of the sources and analysis is dependent on a degree of prior knowledge about a whole range of topics. The thematic approach helps to make the material accessible, but it can weaken the chronological sense of developments. While it is important not to overstate the pace of change, this book does cover the whole period from 1780 to 1880. Testimony collected from and about eighteenthcentury and early nineteenth-century miners captures a rather different world from that of 1880. Specialists with knowledge of how technologies changed, industries developed, towns expanded, demographics shifted, medical knowledge advanced, welfare arrangements changed, and trade unions evolved will be better able to contextualize what this all meant for the sick and injured miners who rightly take center stage in this study. Students using this as an introductory text should read it in its entirety to fully appreciate how Turner and Blackie see the connections between issues discussed in different chapters. Even a history of British coal mining is complicated by the regional nature of employment practices and welfare systems. The authors usefully concentrate on a small number of geographical areas and, throughdetailed knowledge of these communities, provide the much-needed context mentioned above. Chapter 1 is titled “Disability and Work in the Coal Economy.” In a subsection, it discusses in some detail “the nature and conditions of mine work” (p. 23). The authors, drawing on earlier work by Blackie, strongly make the argument that it is necessary to rethink ideas about disability and the Industrial Revolution. The casualties of mining are extensively dealt with in the existing literature, but the continued participation of disabled mine workers has previously tended to be overlooked. Turner and Blackie assemble some very interesting case studies. Analysis of the pithead and coalfield community as well as the underground workers helps extend focus beyond adult men. Yet, even underground, different groups of miners were employed in a variety of tasks requiring different skill sets and attracting varying levels of reward. Such diversity could create a space for disabled mineworkers even if they were unable to return to their former roles. The authors discuss the apparent continuation of pre-industrial attitudes and practices but paint a realistic picture of the difficulties facing returning injured miners and the conditionality, requiring goodwill from workmates and others, of their acceptance. Turner and Blackie note the social as well as economic status that attached to different roles, with disabled miners risking losing more than pay as a result of illness or accident. Indeed, many miners had a working life that saw them initially advance to more valued work as they increased in skill and strength in early adulthood, but then, whether disabled or not, had to gradually retreat from these more challenging roles as they aged. This was not uncommon in other manual jobs throughout the study period and beyond, although white-collar workers could use continually gained experience to claim seniority and higher wages almost to the end of their working lives. This divergent career path introduced serious unfairness when calculating pension and benefit entitlements, a point that was finally, and imaginatively, dealt with by Barbara Castle and her officials in the 1970s.[1] In chapter 2, “Medicine and the Miner’s Body,” the authors start by confronting an interesting paradox where contemporary actors were struck by both the strength and vulnerability of the miners. A variety of actors promoted an image of a healthful industry and of workers whose courage and prowess marked them as an elite who were characterized by physical robustness. Such a narrative competed, and coexisted, with an alternative picture of the coal mine as a risky place where death lurked and the physical and, in some scenarios, moral health of miners was constantly under threat. As the authors show, these rival images shaped not only public perceptions of coal mining but also miners’ perspectives of themselves. The authors’ commitment to exploring experiences in mining communities as well as mines leads them to usefully explore the impact of reforms originating in public health and industrial health movements. The bodies and, increasingly, minds of miners and their wives and children then become an integral part of the narrative. My personal research in this field has concentrated on the 1930s and I was amazed by how pessimistic local and London-based officials were when discussing trends in mortality and morbidity in mining districts in this earlier period.[2] Turner and Blackie offer a more nuanced, though never rosy-colored, picture. A key theme highlighted by the authors is the expansion of medical knowledge that accompanied increasing state concern with, and surveillance over, all aspects of the coal industry. Consideration is given to the treatment and rehabilitation of accident victims and the links drawn between certain illnesses and working conditions. The brief discussion of women’s reproductive health is interesting, but the chapter really concentrates on the evolution of medical services, their organization and financing, and recent historiography on this and related subjects. The authors conclude that “the quality and effectiveness of the emergency treatment injured miners received from first responders, who were usually their workmates, was highly varied and largely a matter of luck” (p. 69). The patchy nature of medical care in other settings suggests this lottery continued throughout the treatment, recovery, and rehabilitation phases. Yet miners were far from apathetic about this. Collectively, they fought barriers to accessing decent care, and powerful doctors could find themselves under scrutiny when outcomes for patients proved disappointing. Turner and Blackie draw a very useful distinction between the growing confidence with which physical injuries were treated and the lack of certainty, and provision, in dealing with psychological trauma. In chapter 3, “Disability and Welfare,” the authors make excellent use of their extensive knowledge of the mixed economy of welfare. Attention to “the expectations of welfare claimants and providers” provides a particularly interesting perspective that revisits the tension between the rugged “independence” of the workers and the known risks of the industry (p. 94). A focus on the household as a locus of care and the support provided by family members offers a useful counterpoint to other accounts that have tended to focus on institutional solutions and welfare payments. The authors show how the wages of coalminers supported sick and disabled family members, making the loss of the main breadwinner all the more devastating. But older, or impaired, miners could also draw on familial networks of support. While many of the vignettes focus on families destabilized by illness and accidents, there is also discussion, expanded in chapter 4, of the way disabled people formed new partnerships and families. Opportunities for marriage clearly existed, although this theme is underdeveloped across all strands of the existing historiography. Yet the authors are not afraid to deal with difficult themes, including the deliberate exclusion of some disabled people from coalfield communities. In chapters 4 and 5, the authors repeatedly emphasize the conditionality of the acceptance of the disabled individual, with discretion, and discriminatory practices, exercised by kin, co-workers, and trade unionists as well as Poor Law officials. The authors have very interesting things to say about the regionality of the Poor Law and the importance of voluntary welfare schemes in the mining industry. Tension over the allocation of disaster funds is also usefully highlighted. The issues raised speak to twenty-first-century concerns over charitable initiatives that harness outpourings of public grief but struggle to maintain focus and accountability or demonstrate long-term effectiveness. The authors start chapter 4, “Disability, Family and Community,” by drawing a distinction between fatal and nonfatal accidents, again reminding the reader that, despite all the attention given to the former, the latter were the more common experience. In a particularly interesting narrative, they consider how risk in the industry influenced religious beliefs, social practices, and community relations. These themes are strong in the historiography exploring metal mining in Cornwall but can struggle to gain traction in accounts of the larger and more diverse coal industry. Important nineteenth-century changes in access to educational opportunities and changing leisure pursuits are shown to have positive and negative impacts on the image, as well as experiences, of miners. One troubling series of images links impairment with violence in a number of ways. While miners could all too easily fall victim to injuries from dangerous machinery and other pit hazards, they could also injure themselves and fellow workers. This could be through carelessness, even recklessness, at work, but also as a result of drunken brawls and less spontaneous violence associated with strikes. The authors use a number of prosecutions of men, who were both disabled and violent when drunk, to highlight the impaired miner’s continued participation in community activities and their alternative construction as dangerous outsiders or freakish figures of fun. Chapter 5, “The Industrial Politics of Disablement,” takes a rather different view of impairment, and the risks associated with mining, by discussing the industrial politics of disablement. Drawing on recent historiography of metal extraction as well as of coal mining, the book considers the many factors that pushed health and safety of mines up the political agenda. The authors explain the growth of trade unionism in terms of miners’ concerns about illness and injury. Yet collective action, and especially strikes, all too often led to employers putting pressure on disabled workers as a particularly vulnerable group who, the authors suggest, were often vindictively targeted. The disputes about “smart money” and its contested status as sick pay or gratuity are an important part of this story with the employers often painted as the villains. Yet, when funds were under pressure, miners’ organizations also showed a disturbing willingness to divert resources away from disabled members. Mutuality is shown to have had clear limits and an overt concern with “morality” too often served as a cloak for prejudice and discrimination. Interestingly the authors conclude that “unions … were not always useful, supportive or even sympathetic allies in the industrial politics of disability” (p. 172). It is this complexity, and highly nuanced analysis, that is the main strength of the book. I agree with the authors that more needs to be done to integrate both disabled people and a disability history perspective into the wider historiography of the Industrial Revolution. This can only add to the richness of our understanding of the lived experiences of different groups of workers. However, Turner and Blackie make the important point that the aim of this exercise is not to offer “inspirational” tales but to show the challenges that disabled workers faced and the impact of efforts made to ameliorate their difficulties (p. 206). The inadequacy of past arrangements not only debunks the myth of a golden age for the disabled but also acts as a necessary spur to future improvements.

Notes

[1]. Barbara Castle, Fighting All the Way (London: Macmillan, 1993), 466.

[2]. West Riding of Yorkshire Public Health Survey, 1933, MH 66/289, National Archives, London.

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