In 1972 our family had moved into a spacious unfurnished flat in Epsom, 45 Sandown Lodge. Unbeknown to me before the event, Anthony Hopkins had exaggerated my income to satisfy our new landlords, Freshwater. Freshwater symbolised greed and we were to be subject to repeated attempts over the next twenty years to raise our rents, often by 100% or more. Fortunately, Labour’s Rent Act of 1965 had afforded new protections to tenants, and we were able to appeal to a Rent Officer, who invariably sided with us, restricting any increases to much more modest increments. When Thatcher succeeded Labour’s Callaghan in 1979 things began to change. As tenants departed from Sandown Lodge the flats were sold off. The result was a refashioned community of affluent, middle-class ‘third-agers’. Moreover, their contracts differed from and were in contradiction to ours: no children should play in the grounds, insisted theirs, while ours proscribed pets. Petty disputes involving our four daughters followed in the wake of the new gulf in status between ‘owners’ and ‘tenants’.
It was only in 1991 that we were able to purchase our first property, just round the corner from Sandown Lodge. I was 43 years old by this time. Our home from 1991 to 2004 was to be 58 South Street, Epsom. It was a two-bedroom terraced house, so our sextet had some spatial compromises to make, but it was characterful. When our daughter Rebecca undertook a school project, she invited the local history society to inspect it. ‘1690’ said the plaque on the front of the trio of terraced properties, but this date was to be revised by the local history society. It transpired that our house, number 58, was the oldest of the three, dating back to Queen Elizabeth I. There were signs accessible to the connoisseur: late mediaeval joints and horse-hair stuffing behind the plastered walls. So our new home – likely a farm-worker’s abode – was constructed around 1590-1600. It was the front abutting the A24 into Epsom that was the oldest part. Behind this was a Victorian addition and, twisting around a small courtyard, there was a second and much more recent reception room. We were just able to maintain the mortgage and pay our bills, but it was tight: I taught through much of this period four evenings a week to enhance our combined incomes, traveling to teach philosophy of education on the PGCE at South Bank Polytechnic by Borough Road tube station, and topping this up with an extra-mural sociology course at Surbiton. Many of us babyboomers didn’t always find life as easy as some might now imagine.
Returning to the arena of work, for a decade at the Middlesex teaching sociology to its annual intakes of 80 medical students and my occasional publications got me by without much need to fight off potential predators. When Ray Fitzpatrick left for Nuffield College, Oxford, in 1986, I taught on my own for a while, becoming a senior lecturer in 1987. Ever since I had come to the Middlesex in 1978, the ethos had been a relaxed one, but this changed when John Hinton retired as Head of Psychiatry and was replaced by Rachel Rosser, whom I had briefly known as a consultant at Charing Cross. Highly strung and ambitious for herself and the department, she sought rapidly and successfully to appoint additional psychiatrists and generally tightened up on decision-making. To be fair, I recall one departmental meeting where she said she would not harry us for enhanced performances: it was down to us to self-motivate, but we should know that promotion would depend on an ongoing scrutiny of our performances under her leadership. I thought this was fair enough. For a while I was charged with organising and advertising the departmental seminar programme. This went well enough until the programme for one term was not distributed. It was a secretarial error, but Rachel held me personally responsible and stormed into my office to tell me I had no future in the department unless I improved my performance. I was not going to blame the secretary, so it became another ‘Steve Hirsch moment’. Resentful but surprisingly unflustered, I replied: ‘you can’t intimidate me, Rachel. Sod off!’ She slammed the door, ignored me for two weeks, then grinned at me as we passed in the corridor. I’d taken a risk once more, but I’d made my point. Another sign of the times: worried about the possibility of Rachel noticing that we paid our loyal group of sociology tutors out of ‘her’ departmental funds, I spoke in confidence to the finance officer who agreed to hide this sum from her, an inconceivable happening today.
Rachel Rosser’s tenure was towards its end marred by health issues. She found it increasingly difficult to function in a job that demanded of her a high level of energy and commitment. Word filtered through that she was struggling, not least with her clinical load. This presented a problem: the usual mediator-cum-arbiter in situations where a clinician is unable to execute his or her duties because of poor health is precisely the Head of the Department of Psychiatry, but Rachel herself occupied this post. In the event the situation dragged on for far too long. I was receiving regular informal second-hand reports of her distress and its negative impact on her duties, but no action was being taken. In the end I rang the senior consultant in psychiatry, Oscar Hill, and told him the situation was untenable and not fair on Rachel. It would be crazy, I said, if it had to be me, a sociologist, who rang the Dean! I know only that action was indeed taken shortly after this conversation, and she went on to take early retirement. Tragically, Rachel was to die prematurely aged only 56.
But by this time several institutional changes were afoot. The Middlesex and Royal Free Medical Schools had merged. This was a significant change, not least for those doctors who had obtained their medical credentials from one or other of them. After all, the Middlesex dated back to 1746, and the Royal Free to 1828. Complex negotiations took place around syllabi, and I was destined to talk it all through with sociologist Charlotte Humphrey and epidemiologist Jonathan Elford at the Royal Free, who had developed their own excellent course. More and more challenging complications were to arise, however, when what was seen as a neighbour with a voracious appetite, the multi-faculty University College London, bid to take over our combined medical schools. The result, in 1987, though it was not fully formalised until 2008, was interpreted by many at the Middlesex as something of a ‘takeover’. This sequence of disruptive events represented a rationalisation of medical education and training in London: 13 independent medical schools had become four increasingly devolved and autonomous multi-faculty universities, namely, UCL, Imperial College, King’s College and Queen Mary College, leaving only St George’s Hospital Medical School in Tootjng in South London as an independent outlier (St George’s has since formed a link with Surrey University). The attitude among some academics on the Middlesex site had been very much opposed to being subsumed by UCL. I recall Peter Campbell, Professor of Biochemistry, calling a meeting to argue that this ‘takeover’ should be resisted, only for Peter Semple, Professor of Medicine, to appear at the back of the hall, like the ghost of Banquo, to insist that a campaign of resistance was destined to fail, and to do so rapidly and with deleterious consequences: it was a done deal as well as the only route out of institutional isolation and vulnerability.
As far as the ‘combined/unified’ Middlesex/Royal Free/UCL contingents of psychiatrists were concerned, we were perhaps fortunate in that the Middlesex had by far the largest compliment of staff. Rachel’s eventual successor as Head of the Department, in 1993, was to be Stan Newman, a psychologist and David Mulhall’s replacement from many years before. Stan had risen rapidly through the ranks and his was a logical appointment, though not one readily accepted by the Royal Free contingent of psychiatrists led by Mike King. A psychologist heading up a department of psychiatry! I now found myself a member of the Department of Psychiatry and Behavioural Science (psychologists, I have found, have never quite grasped the identification in non-psychologists’ minds of behavioural science with psychology, and not with sociology or anthropology, or perhaps they have). This period of the early 1990s were marked by three developments. As far as the teaching went, we found ourselves on the cusp of what I earlier called the ’rationalisation phase’ of 1995-2006. This was characterised by retrenchment and consolidation. Gone were the relaxed, extensive and liberal courses in medical sociology we had grown accustomed to at both the Middlesex and the Royal Free. Our course at UCL had acquired a new set of properties. It was part of a ‘Society and the Individual’ programme, incorporating sociology, psychology and epidemiology that eventually settled into a first- rather than a second-year slot. There was neither the money nor the rooms available to hire tutors for small group teaching for an intake of 360 students. The substitute was stand-up lectures to the whole year, plus episodes of private study and ‘self-paced learning’ (otherwise known as time off). The sole means of assessment was a norm of two short-answer questions, subsumed in a general end-of-year examination, with model answers constraining more creative or independent-minded candidates. The ideal form of assessment, lurking barely hidden at the back of many a crass mind in London’s medical schools, was one that could be machine-marked.
A second, very welcome, episode during these years was the appointment to a lectureship of Paul Higgs. Ray Fitzpatrick’s post had been frozen on his departure for Oxford, and it was Stan Newman’s initiative to agree to advertise for a replacement. I was of course delighted. Paul, who had been lecturer at St. George’s, was appointed in 1994, against strong rival candidates like short-listed James Nazroo (a doctor and sociologist whom I had taught on the intercalated B.Sc several years before and whose Ph.D I was subsequently to see through to completion), and Gill Bendelow, both of whom have since forged impressive careers. Paul’s background was unusual. He had failed his 11+ examination but accomplished the rare feat of a transfer to the local grammar school in its aftermath. Attending North London Polytechnic as an undergraduate he went on to secure his Ph.D at Kent University. Paul’s wide-ranging intellectual interests diverged from those of my previous colleagues, David Blane and Ray Fitzpatrick, and were more closely allied to mine, While I did not then, and have not since, abandoned my predilection for solitary study, I found myself visiting cafes with Paul and enjoying thoroughly discussions of theory and politics. Okay, I often struggled to get in a word in edgeways but life is full of compromises. Paul’s range of knowledge and the reach of his intellectual convictions are as impressive as his memory for textual detail. Paul’s established expertise lay, and lies, in the field of ageing, though he was as interested in social and sociological theory as I was. Much of his published work has been with psychologist Chris Gilleard, and they were to go on to write a series a volumes developing themes introduced in their very successful Cultures of Ageing, published in 2000. Their working relationship can appear chaotic to anyone not amongst those in-the-know, those Goffman would call the ‘wise’, yet it somehow works and they have been an exceptionally productive pairing.
Paul and I were to collaborate on several academic ventures, the first of which was to co-edit a book entitled Modernity, Medicine and Health, published in 1998. Bringing together a formidable group of contributors – including Bryan Turner and Zygmunt Bauman – this enterprise allowed me to pursue select themes from Habermas, like the underlying neoconservatism of relativistic postmodern thinking and theories, the potential salience of the public sphere of the lifeworld for engagement and change, and to publish an inaugural piece, with Paul, on a critique of routine socio-epidemiological health inequalities research. Incidentally, this was to be the first time I used the term ‘high modernity’ instead of the increasingly popular ‘late modernity’, which I found too presumptuous. I will restrict myself to commenting on the chapter on health inequalities here, because it represented a departure from my previous studies and was one that was to endure until and beyond my retirement. The gist of our message was, first, that medical sociologists had missed a trick by failing to devise their own research agendas, sometimes because they seemed overly indebted to the undoubtedly superior fund-raising potential of socio-epidemiologists, who were almost universally committed to forms of simple-to-sophisticated multivariate analysis inimical to the delivery of sociological explanations rooted in causal mechanisms addressing social structures and relations, culture and agency. I have since had numerous exchanges with UCL’s best known epidemiologist of health inequalities, Michael Marmot, about this. Always a charming discussant, I have gradually come to accept that he remains firmly committed to what he sees as the primary task of epidemiologists like himself, that is, to stick to the discipline’s brand of quantitative research, to eschew qualitative study as a largely unhelpful superfluity, and to leave theorising to people like sociologists.
Second, and relatedly, Paul and I argued that medical sociology’s contributions to research and debates on health inequalities were detached from theorisations of class in the mainstream of the discipline. The result had been a protracted under-theorisation of class in studies of health inequalities. We distinguished between ‘class analysis’, which derived largely from the theories of Max Weber and focused on occupation-based class schema, and ‘class theory’, which often favourably referenced Marx but also encompassed insistent postmodern announcements of the ‘death of class’ that privileged concepts of identity instead. Our emphasis presaged my own continuing thoughts and writings for some decades: this was the importance of identifying the ruling class, the significance of which for any credible sociology of health inequalities was that its members’ decisions effectively determined the health-damaging material and psychosocial circumstances of the poorer segment of the population. Latent, but yet to feature, was my subsequent spelling out of a greedy bastards hypothesis. Interestingly, on revisiting our chapter I can see that this was the first time we had mentioned Bhaskar’s critical realism in print: our interest in his work had begun. Shortly after Modernity, Medicine and Health saw the light of day Paul and I published a follow-up paper in Sociology (in 1999) that drew more explicitly on Bhaskar to maintain that ‘given the marked social patterning of many causes of ill health, which have – together with congruent social patterning in rates of morbidity and mortality and in many domains other than health – been documented in terms of nominal, weakly and strongly relational class schema, there must exist real class relations resting on the ownership/control of the means of production.’ We added that the poor health of people experiencing material and social disadvantage might be seen as the largely unintended consequence of the behaviours of members of the ‘capitalist executive’ supported by the power elite of the state.
In addition to our perambulations around social and sociological theory, Paul and I took two significant institutional initiatives around this time, both of which might conveniently be registered now. The first was to set up a new M.Sc in ‘Sociology, Health and Health Care’. I wrote to Mike Bury at the time to reassure him that we did not intend to compete with the pioneering and longstanding M.Sc established by Margot Jefferys and George Brown at Bedford College/Royal Holloway and now overseen by him and taught with colleagues Jon Gabe and Mary Ann Elston; we were intending rather to appeal to a narrower band of students via a strong focus on sociological theory. We negotiated the piles of paperwork in which UCL took such pride. We offered modules in classical and contemporary social theory; social determinants of disease, illness and illness behaviour; comparative health policy and health systems; and philosophy and methods. It was available either one year full-time or two years part-time and we looked to recruit 8-12 students. We had a few guest lecturers, but Paul and I bore the brunt of the teaching since we were reluctant to sacrifice continuity by drafting in a heterogeneous assembly of colleagues to run seminars. James Nazroo, by now based in Michael Marmot’s department, joined us to teach quantitative and qualitative methods. For a while we held our own in terms of recruitment, two of my daughters, Sasha (a Bristol sociology graduate) and Miranda (a Warwick sociology graduate), took the course, the latter having the dubious pleasure of being taught by her father, her mother and her older sister! Naturally, this required careful precautions around assessments.
We were to encounter one interesting hiccup. We organised our own local unseen examinations to make for informality and to take pressure off the students. One of our students, an excellent one, decided half way through one of the papers that his mind had gone blank and that he could not continue. I was invigilating and escorted him outside the room to try to persuade him to hang in there; as there was a window in the door I was able to observe the other students whilst talking to him. It was to no avail and he ultimately left: my attempt to calm and reassure him had failed. Later, however, he lodged a formal complaint that the examination had been improperly conducted: on the grounds that the invigilator had left the room in the middle of the examination, leaving the candidates to their own devices. I was disappointed and unimpressed and told him so, while at the same time affirming his right to make a complaint. The upshot was an independent inspection of our procedures and, though we were not criticised, the assimilation thereafter of our M.Sc examinations into UCL’s more formal system. Such are the vagaries of academic life.
One other incident is worth recording since it represented – indeed caricatured – the changing context of academic life. The threat of internal and external audit hung over us. Neville Woolf, a somewhat aloof pathologist and no friend of sociology in his Middlesex days, was put in charge of a UCL programme of audit preparations. He was clear and thorough and visited the Department of Psychiatry and Behavioural Sciences to set out his bureaucratic stall. It was not enough to replace a blown light bulb in the department toilets, he averred; there must be a paper trail, an email record of any student complaint of the hazards of darkness and how this was remedied. His prescription failed to strike a chord. Unsatisfied with the two bulging ring binders of documentation I had compiled with regard to our M.Sc, we were also instructed to prepare aims and objectives for each of our seminars in each of its modules. I’d done this for each module, but I categorically refused to comply with this additional requirement and there was no comeuppance. A more telling and more symbolic event occurred when external auditors visited UCL, one of whom entered the room, flung his papers onto an appropriately polished long table, and exclaimed that a lot of questions needed answering. The shoot-from-the-hip combustible UCL Provost at the time, Derek Roberts, apparently told him that that if that was his attitude, he could pick up his papers and leave the campus: UCL was open to interrogation but not to gross and foolish attempts at intimidation. Autocrats have their moments.
The M.Sc was an enjoyable and worthwhile experience, if a tiring one for Paul and I – we often taught a full six hours on M.Sc days – but it was not to last; and the final year, 2003, is a study in its own right. Eight students accepted and confirmed their places in writing. Of these, six were from outside the European Union. None of them turned up, or indeed let us know they did not intend to do so. Feeling morally committed to the other two candidates we offered to go ahead if they were still up for it. Yes, they said. One of the two, however, later changed her mind and withdrew, leaving us with a single student. Fortunately, this was Suzanne Moffatt; already in possession of a Ph.D, she travelled down from the far north, teabag at the ready (her refrain in cafes, ‘just a cup of hot water please’), and proved an exceptional student. Suzanne now holds a senior academic post at Newcastle University. But why did things unfold in this way? I think it was because we offered an unapologetically academic, indeed theoretical, experience which did not lead to obvious employment qualifications at a time when employers as well as aspirants were focusing on the pragmatic attainment of credentials. As I shall argue in later sketches, the capitalist imperative to work gained significant momentum, and was more effectively facilitated and policed by the state, in this neo-Thatcherite, neoliberal rentier phase. Universities were seeing their philosophies and purposes refashioned.
The second initiative Paul and I took in combination came to fruition in the same year the M.Sc withered and died, 2003. This was the founding of a new peer-review journal, Social Theory and Health. This was both a natural articulation of our shared interest in social and sociological theory and the recognition that the leading extant international journals in the sociology of health, illness and health care attracted relatively few theory-oriented papers. Journals like Social Science and Medicine, Sociology of Health and Illness and Health in the UK had won their spurs as repositories of medical sociological scholarship, and US journals like Journal of Health and Social Behaviour lapped up its more quantitative exemplars, but few outlets existed for those focused mostly on theory, or for those explicitly oriented to the building of bridges between what too often seemed independent discourses, social theory on the one hand and empirical research on the other (a pet theme of mine by this time of course). We recruited my old US friend Dick Levinson as a third editor to give our plans an international element. We were open to submissions too from outside sociology. In Palgrave McMillan we found a sympathetic publisher, and in our inaugural issue in May of 2003 our editorial included the following statements:
‘It is the lively interplay of theory and research that lends point and credence to any attempt to grasp the nature of both social and natural phenomena. Theory unchallenged – or worse, unchallengeable – by rigorous empirical investigation is likely to degenerate into mere speculation. Research undertaken for its own sake, detached from the refinement or revision of theory, can be little more than suggestive. Biological, behavioural and social curiosity and enquiry into the health domain is unexceptional here. Theory, logically, should inform research, which in turn should inform theory. Systematic or scientific attempts to describe, understand and explain should, again logically, fall somewhere between the American sociologist C. Wright Mills’s ‘grand theory’ on the one hand and his ‘abstracted empiricism’ on the other. Or that, at least, is the perspective that underpins Social Theory and Health.
Social Theory and Health has been conceived as a vehicle for at least three related tasks: to support, stimulate and foster the dialectic between theory and research in the field of health and health care; to encourage and disseminate innovative contributions leading to the advancement of social theory in this same substantive area; and to throw new light on global, national and social structures and processes through the lens of health.’
I fear that I was a somewhat alarming presence to Palgrave McMillan’s dedicated personnel since I professed little interest in marketing. I did, however, take my editorial responsibilities seriously. In fact, for an initial period of seven years or so I took personal responsibility for steering and gauging its content. I wonder whether my approach and methods would stand scrutiny today. I understood the role of editor to be to edit, and we needed to hit the ground running as well as to maintain a good quality of authors and inputs! What this meant in practice was that I personally invited well-known sociologists and allied academics to submit their work; I occasionally overruled our referees, though only to accept – innovative, even controversial – papers they had wanted to reject and not to reject papers they recommended to us; and I quite often acted as a second referee myself to hasten a reviewing process that was becoming too lengthy. The journal grew steadily during this time, approximately 2003-2010. After 2010, however, we recruited Ruth Graham from Newcastle University, and Paul and Ruth have overseen accelerated interest from the international community and the establishment of Social Theory and Health as a major player in the health field. More recently the editorial group has expanded further and its impact factor ‘improved’ significantly. I reflect on the underlying issue of metric assessment of persons and products in academia in some detail in later sketches.