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Vile Bodies: Understanding the neglect of personal hygiene in a sterile society Peter Bates The most recent version1 is available here Contact [email protected] This document started 2011, last amended 16 August 2021 1 Preface Why do some citizens in the affluent West neglect their personal cleanliness and how can relatives, friends and care professionals provide effective support? In its mildest form, self-neglect forms the topic of arguments between mothers and their teenage children, but at its most severe it kills people. Television audience figures reveal that the topic is fascinating, while it remains under-researched and poorly understood. Self-neglect is of interest to neighbours and relatives, the media and legal specialists as well as health and social care agencies2, housing and environmental health, psychologists and community development workers. As Robert Francis QC commented3, hygiene is a concern for everyone, whether in hospital or in the wider community: “Cleanliness is also the responsibility of every member of staff. Everyone from the chairman and chief executive downa is capable of picking up and disposing of waste and of alerting staff to spillages and they need to be seen doing so. Patients and visitors should be encouraged to point out any need for cleaning that has been left unattended.” It is difficult to define what counts as self-neglect, hard to identify who is at risk and tricky to decide whether to intervene. While all behaviour is perhaps a form of communication, self-neglect raises challenging issues of legal and moral freedoms and responsibilities. This book explores these themes, considers what might be happening, and indicates how effective support can be offered. Who is this book written for? No systematic literature review, formal sampling or distinct methodology directed the work, but rather a networking process by which one contact or journal article naturally prompted an email inquiry, dialogue and more reading. As an unfunded spare time occupation, this was written for myself, to tidy up the accumulated hoard and clutter in my head. I sincerely hope it will be useful to anyone who is in touch with a relative or friend who neglects their hygiene, appearance or home, as well as helping people who work in caring services and are trying to understand what makes another human being behave in these ways. I hardly dare wonder if it will be of any use to someone who is trying to understand their own self-neglecting behaviour. I hope that as you browse these pages with that person in mind, something will resonate and shed fresh light on the situation you both find yourselves in, so that you recognise more of yourself in them, feel more potential for change in both of you, a Elsewhere in his report, Francis includes Consultants in this list. This document started 2011, last amended 16 August 2021 2 and know more compassion for the dirty jewels of humanity that we all see when we look out of a window or into a mirror. Love has pitched his mansion in the place of excrement; For nothing can be sole or whole that has not been rent. W.B Yeats How is this book arranged? This book is extensively referenced in endnotes (shown in superscript numbers), so that previous authors are fully credited for their work and current readers can explore sources for the assertions made here. Occasional footnotes (shown as superscript letters) add extra detail. Case studies are fully anonymised accounts from real life that were shared with me by practitioners I met during the writing of this work. Each chapter ends with a box of questions for further reflection, addressed to people and helpers alike, to help us all reflect on our attitudes and actions. It is published online so that corrections and improvements can be added from time to time, so you may wish to check the date on the cover and use the most recent version. In addition, you may have expertise and knowledge that would improve this book – please contact me so that it can be added, along with an acknowledgement of your contribution. A note on language All labels are political, and there is no sterile way to refer to the people who are the subject of this book. The title, ‘Vile Bodies’ is borrowed from Evelyn Waugh’s 1930 satire on the emptiness of wealth and fame, in order to emphasise the emotional response that is evoked by our topic and the underlying questions about what constitutes a ‘well-lived life’. In the remainder of the book, an attempt is made to avoid stigmatising labels by referring to the self-neglecting person simply as ‘the person’ and attaching labels to neighbours, friends, work colleagues, relatives or professional care staff as needed. This can be too clumsy to use all the time, but the point of the book is to seek a respectful understanding of the person, rather than resorting to stereotypes and critical assumptions. Acknowledgements I am grateful to the many people who have shared their experience with me, engaged in discussion and allowed me to test my ideas on them over the past three years. In particular, Virginia Smith’s ground-breaking work has been an inspiration, along with her commitment to move this topic forward in the context of mental health services. Alex Ruck Keene guided me through the legal issues and Jeremy Patton This document started 2011, last amended 16 August 2021 3 helped with discussions of mental capacity. Linda Offord and Steve Stickley helped with stories, while Desmond Graham and Dorothy Grace helped with overall editing. Much of the work was done during the time I was on the payroll of the National Development Team for Inclusion and I gratefully acknowledge their encouragement and support. This document started 2011, last amended 16 August 2021 4 Contents Preface .................................................................................................................................................... 2 Who is this book written for?.......................................................................................................... 2 How is this book arranged? ............................................................................................................. 3 A note on language ......................................................................................................................... 3 Acknowledgements ......................................................................................................................... 3 1. Introduction .................................................................................................................................... 8 Why does self-neglect matter? ....................................................................................................... 8 Is there a standard definition? ........................................................................................................ 9 Seven components of self-neglect ................................................................................................ 10 2. Hygiene in context ........................................................................................................................ 14 The history of personal hygiene .................................................................................................... 14 Equipping the modern home ........................................................................................................ 17 Building the private bathroom ...................................................................................................... 19 Beliefs have always affected hygiene ........................................................................................... 21 Contemporary culture ................................................................................................................... 24 Challenging the cult of hygiene ..................................................................................................... 27 3. Who is at risk? ............................................................................................................................... 31 Older people .................................................................................................................................. 32 People with mental health issues ................................................................................................. 33 People with sensory differences ................................................................................................... 34 Homeless people ........................................................................................................................... 36 Children and Adolescents .............................................................................................................. 37 Sick, injured and disabled people ................................................................................................. 39 4. The Consequences of Self-Neglect ................................................................................................ 42 Disgust ........................................................................................................................................... 43 Exclusion ........................................................................................................................................ 45 Disease and death ......................................................................................................................... 46 5: The

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