Trauma and Birth

September 26, 2016 by ublhid01 Leave a Comment

Whitney Wood

Birth is an event that has the potential to be both joyous and traumatic. Before the introduction of anaesthetics, births were often characterized by the pain and fear experienced during delivery. Following the discoveries of chloroform and ether in the 1840s, however, the biblical pronouncement “in sorrow shall thou bring forth children” was increasingly up for debate. After Queen Victoria gave birth to two children while under chloroform anaesthesia in 1853 and 1857 – events that did much to increase the respectability of anaesthetized birth – growing numbers of white, well-to-do, urban-dwelling women throughout the western world gave birth with some pharmacological pain relief.[i] Despite these shifting birth experiences, the advent and growing use of obstetric anaesthesia had little impact on ongoing associations between birth and trauma in the eyes of many women.

Woodcut. John Snow, On the inhalation of the vapour of ether in surgical operations (Churchill: London, 1847), p. 17. Wellcome Images, Rare Books, M0009621

Trauma can be and has been defined in various ways, with the majority of modern definitions offering at least some recognition of both the physical and the emotional or psychological components of traumatic experiences. While women giving birth without anaesthesia may have found the pain they experienced to be the most traumatic part of delivery, the use of medical interventions, including those intended to relieve pain, also had the potential to render birth traumatic. This was, and is, especially the case when women are unable to exert their own power in making choices about the events taking place in the birthing room.

Changing Childbirth Choices

By the first decades of the twentieth century, anaesthetized birth – or, at the very least, the provision of some analgesia or pain relief for the majority of white, well-to-do, urban-dwelling women during delivery – was increasingly commonplace throughout much of North America and Britain. The medicalization of birth reached new heights during the interwar period, with groups such as the British National Birthday Trust Fund advocating increased access to anaesthetics for all women. At the same time, however, the beginnings of natural childbirth movements represented some of the first significant and organized opposition to this medicalization.

Taking interest in the ideas of the British Dr. Grantly Dick-Read – and later, in the 1950s, the work of French obstetrician Fernand Lamaze – growing numbers of women sought a new type of birth experience in which they were conscious, confident, and active participants in their own deliveries. In seeking drug-free births, these women went against the existing trend in North American and British obstetric practice. As a result, many encountered difficulties in finding physicians who were willing to allow their expectant patients to attempt a so-called “natural” delivery. Women also voiced increasing criticisms of post-war obstetric practice.

“Obstetric Violence” and Trauma in the Birthing Room

In writing to Grantly Dick-Read and relaying their enthusiasm for natural childbirth, North American women also took the time to express their criticisms of medicalized birth to what they recognized as a receptive and sympathetic audience. Women regularly criticized the interventionist treatment that expectant mothers received at the hands of medical professionals. They described painful and humiliating preparatory procedures, as well as harsh treatment from both physicians and nurses, including slapping and other forms of physical abuse. Women also reported that on some occasions, the nurses who attended their confinements forced their legs together or administered anaesthesia without consent to delay birth and prevent ‘untimely’ visits beyond physician control. Many expressed regret and disappointment in reporting that, as a result of these actions, they had “failed” to achieve their ideal conscious and “natural” births.

“Childbirth: sinister obstetricians and anaesthetist extract the baby from the mother.” Drawing by R. Ennis, 2005. Wellcome Images, Iconographic Collection 2033548i

These abuses are by no means a thing of the past. Anticipating the arrival of her fourth child in 2012, Caroline Malatesta of Birmingham, Alabama chose the Brookwood Baptist Medical Centre based on the hospital advertising its willingness to “accommodate” mothers who sought “natural births.” When it came to the delivery, however, Malatesta’s experience overwhelmingly failed to live up to expectations. Though her doctor had assured her that she could freely move about during labour, Malatesta was ordered – and later, forced – by a nurse to remain on her back for fetal monitoring. With the baby crowning and no physician on hand, a nurse allegedly held the baby’s head in for an estimated six minutes until the on-call doctor arrived to complete the delivery. Experiencing lingering pain after the birth, Malatesta sought answers, and was later diagnosed with a nerve disorder called pudendal neuralgia. In 2014, she filed a lawsuit filed against Brookwood and its principal company, Tenet Healthcare Corporation, and in August 2016, a jury awarded Malatesta $16 million, finding the hospital responsible for both medical negligence during the delivery and “reckless fraud for its natural birth ad campaign.”

Prompted, in part, by popular attention to cases like Malatesta’s, other women who have experienced birth trauma have increasingly spoken out in recent years. Using the hashtags #BreaktheSilence and #ImprovingBirth, hundreds of women have voiced their criticisms of mainstream obstetric practice on social media, recounting their experiences of bullying and coercion at the hands of medical professionals, as well as unconsented procedures including episiotomy during birth.[i] Medical and legal professionals have recently categorized these practices as “obstetric violence”, a specific category of gender-based harm “exercised by health personnel on the body and reproductive processes of pregnant women, expressed through dehumanizing treatment, medicalization abuse, and the conversion of natural processes of reproduction into pathological ones.”[ii] While the structural dimensions of obstetric violence remain understudied, this categorization draws much-needed attention to the ongoing relationships between birth and trauma, as experienced by many women.

[i] Farah Diaz-Tello, “Invisible wounds: obstetric violence in the United States,” Reproductive Health Matters 24 (2016): 56-64.

[ii] See “Obstetric violence: A new legal term introduced in Venezuela,” International Journal of Gynecology and Obstetrics 111 (2010): 201-202, and Carlos Herrera Vacaflor, “Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina,” Reproductive Health Matters 24 (2016): 65-73.

[i] For more information see Stephanie Snow, Blessed Days of Anaesthesia: How Anaesthetics Changed the World (New York: Oxford University Press, 2008).

Whitney Wood is a postdoctoral research fellow in the Department of History, Classics and Archaeology at Birkbeck, University of London. Her most recent research project is a history of natural childbirth in postwar Canada. Her first book, Birth Pangs: Maternity, Medicine, and Feminine Delicacy in English Canada, 1867-1940 is currently under contract with McGill-Queen’s University Press. She tweets @whitneylwood.

Ireland’s Lost Lunatics

August 14, 2016 by ublhid01 Leave a Comment

Michael Robinson

Shell-shock is still a culturally and historically resonant metaphor of the Great War. Research into the post-1918 experiences of mentally disabled Great War veterans, however, remains under-developed. Two historians who have tackled this omission head on are Peter Barham and Fiona Reid who, respectively, have analysed the lives of Great War servicemen who were institutionalised within an English asylum and those who returned to civil society. Yet, no historian has devoted any focused attention to shell-shocked veterans outside of England and across the British Empire.

Over the past three years, I have been analysing the post-Armistice experiences of shell-shocked soldiers who returned to Ireland. In a revolutionary period lasting until 1923, these ex-servicemen received an unfortunate homecoming particularly in ‘South Ireland’ and in what was later defined as the Irish Free State. Here, shell-shocked men were viewed with suspicion due to their previous war service. Their sacrifice of ‘nerves’ elicited little sympathy or assistance from the government or wider society.

Some Great War veterans ended up being locked away inside an asylum. In order not to ‘taint’ the insane Great War veteran with the stigma of pauper lunacy, the ‘Service Patient’ scheme was introduced by the Ministry of Pensions throughout the United Kingdom. This enabled ex-servicemen to dress in private clothing, receive a small weekly allowance of pocket money, and to be buried outside the asylum walls if a man died whilst under treatment.

By 1931, 375 ‘Service Patients’ were receiving treatment within Irish Free State mental hospitals. In the absence of segregated facilities, insane Irish Great War veterans were housed alongside the general patient population. As a result, their experience depended almost entirely upon the conditions of the asylum that they were admitted into. Some were lucky enough to have a bed, entertainment facilities, and caring and attentive staff. Others seemingly lived in overcrowded, under-staffed, and filthy surroundings. In addition, not all ‘Service Patients’ were allowed to dress in their own private clothing until 1930, over a decade after the ‘Service Patient’ scheme was introduced in Ireland. Furthermore, they had little choice around how to spend their allowance, which would usually pay for extra food at mealtimes,

Indeed, in comparison to English asylums, the diet and recreational facilities available to Irish ‘Service Patients’ was deemed inferior by the Ministry of Pensions (who continued to inspect ‘Service Patients’ in the Free State throughout the inter-war period). Owing to nineteenth-century discriminatory perceptions of the Irish, little action was taken owing to the unfair stereotype that the Irish could rarely read or write, and largely ate only potatoes. Whilst the First World War was a seismic event in British and Irish history, these perceptions demonstrate how little some things had changed.

Michael Robinson

mjrob@liv.ac.uk

University of Liverpool (Institute of Irish Studies)

Whistle-blowers and Traumatic Institutions

August 14, 2016 by ublhid01 Leave a Comment

Jon Eilenberg

How do we know about traumas inflicted by harmful cultures in healthcare institutions? Well, somebody has to tell us. More often than not, healthcare institutions are hermetically closed to outsiders and any wrongdoing is kept within the walls.

That is unless someone on the inside decides to blow the whistle and lay bare the practices of the institution to public scrutiny. I have looked at the role of whistle-blowers in the Mid Staffordshire Hospital scandal, and there is a general pattern emerging from this. A pattern where whistle-blowers and transparency substitute authorities and secrecy in terms of defining institutional cultures.

A short history of blowing whistles

The term ‘whistle-blower’ is relatively new. Coined by the American political activist Ralph Nader during the Pentagon Papers scandal in the early 1970s, it was meant to replace negative labels such as ‘informer’, ‘traitor’ or ‘snitch’. The term caught on, and since then it has become widely used to describe people who go public with their concerns over practices at their workplace. Some of the most prominent examples outside healthcare include Edward Snowden and Chelsea Manning, both of whom have suffered severe consequences of their whistleblowing.

Whistle-blowing is basically divided into two categories: internal and external. In internal whistle-blowing, the exposure is kept within the institution, which then takes the measures it finds necessary. These instances rarely become public knowledge. External whistle-blowing, on the other hand, often happen via the media, which ensures a wide dissemination of the allegations.

In the healthcare sector, whistleblowing is only now becoming a point of concern, partly as a result of the Mid Staffordshire hospital scandal. But with the rise of whistle-blowers, more and more examples of wrongdoing in care institutions are coming to the fore.

Lying in soiled bed sheets

In the case of the Mid Staffordshire hospital scandal, which happens to be my area of expertise, whistle-blowers played a key part. The hospital’s known failures can be dated back to at least the early 2000s when patients died and suffered in the hands of a system that was supposed to care for them. These failings came to the attention of the media and the wider public with the publication of a series of inquiries and reports.

From the beginning of the scandal, the accounts of whistle-blowers were central to the narrative. They told harrowing stories of patients lying in soiled bed sheets, no food or water, and the staff’s fear of speaking out. Furthermore, the use of confidentiality agreements in the NHS, or ‘gagging clauses’ as the media dubbed them, came under scrutiny. The closed nature of healthcare institutions was questioned and the whistle-blowers became celebrated as heroes.

However, as the dust of scandals settles, whistle-blowers are often forgotten about. By blowing the whistle, they have alienated themselves from their former employers, and when the public attention fades few people care about their fate. As a result of the Mid Staffordshire hospital scandal there have been initiatives to protect whistle-blowers from repercussions, but the issue of whistleblowing in the healthcare sector is still a point of discussion.

A transparent society

The rise of the whistle-blower is a part of a new visibility in society. We are less likely to tolerate the secrecy of institutions and demand to have insight into how they work. The whistle-blowers help us achieve this. By telling us whenever something is wrong in the institutions they work for, they expose wrong and harmful practices. Usually, this is followed by placing accountability and institutional reform.

This development is a part of a general tendency of distrust in authorities and institutions. When harmful practices are exposed, they are often linked to other failings, thereby creating the impression that the entire healthcare system is failing. Whistle-blowers help reveal harmful practices, but the price for this transparency can be high, both for them personally and for healthcare institutions in general.

Suggested video for blog post: http://www.bbc.co.uk/news/health-21462085

Jon Eilenberg is a PhD researcher at the Centre for Law Justice and Journalism based at City University London, where he looks at institutional failings and mediatised scandal using the Mid Staffordshire hospital scandal as case study.

Email: jon.eilenberg.1@city.ac.uk

Twitter: @jon_eilenberg

Welcome

August 9, 2016 by ublhid01 Leave a Comment

Welcome to the Birkbeck Trauma Project blog.

We are interested in understanding how trauma and the medical conditions associated with it have been constructed and reconstructed over the modern period. We explore how ‘traumatic events’ are given cultural meaning. Particular interests include responses to abuse within medical institutions and during armed conflicts, as well as in the aftermath of violent events such as rape, assault, and disasters.

As a concept, trauma first began to attract interest in the 1860s. Passengers who had been involved in train accidents complained of physical injuries such as severe pain, paralysis and muscular spasms, even though there were no observable lesions that might explain their symptoms. Ferocious debates around the validity of these claims erupted in the courts. Eventually, the condition was given a name – ‘railway spine’ –which bolstered the medical case for prosecuting railways companies and led to improved safety.

At this point in history, biological explanations reigned supreme in medicine and the symptoms of railway spine were thought to be caused by undetectable lesions in the brain or nervous system following a physical reaction to a severe fright. It was around the turn of the century that well-known neurologists such as Jean-Martin Charcot, Joseph Breuer and Sigmund Freud applied a more psychological interpretation to the physical manifestations of trauma. As Ruth Leys has explained, trauma was increasingly understood as a ‘wounding of the mind brought about by sudden, unexpected, emotional shock’ (p. 4). Whilst Charcot sought to treat trauma with hypnosis, his former protégé Freud drew on psychoanalysis in an attempt to alleviate physiological symptoms by allowing the traumatic memory to rise into consciousness.

For many, trauma was a consequence of the rapid industrial and technological growth of the modern period. These commentators emphasized the need to alleviate the negative effects of modernity through diet, exercise, and relaxation, for example.

Over the twentieth century, concepts of what constitutes a traumatic experience expanded from shell-shock in the First World War to combat neurosis in the Second. Post-traumatic stress disorder (PTSD) was increasingly applied to veterans of wars and survivors of atrocities such as the Holocaust and Hiroshima, as well as to victims of rape and other forms of abuse.

As the anthropologist Allan Young has argued, PTSD ‘is not timeless, nor does it possess an intrinsic unity’. This is not to say that the suffering caused by traumatic events is not real. It is. But the way trauma is understood and employed as a diagnostic category has changed over time according to a range of interests, practices and technologies.

At the Birkbeck Trauma Project we want to stimulate conversations and debates around how the historical understanding of trauma can deeper our insights into what it means today.

Whatever your background and discipline, do share with us your thinking and research interests on this important topic. Email: trauma@mail.bbk.ac.uk with your contributions of 400-600 words.

Best wishes,

Joanna Bourke and Louise Hide

Important reading:

Joanna Bourke, ‘Sexual Violence, Bodily Pain, and Trauma: A History’, Theory, Culture & Society, 29 (2012), 25–51.

Peter Leese and Jason Crouthamel (eds), Traumatic Memories of the Second World War and After (2016).

Ruth Leys, Trauma. A Genealogy (2000).

Tracey Loughran, ‘Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and Its Histories’, Journal of the History of Medicine and Allied Sciences, 67 (2012), 94–119.

Mark S. Micale and Paul Lerner, Traumatic Pasts. History, Psychiatry and Trauma in the Modern Age, 1870-1930 (2001).

Allan Young, The Harmony of Illusions. Inventing Post-Traumatic Stress Disorder (1995).