Report No 5:2003
Emotional Management and Stress:
Managing Ambiguities
Alexander Styhre, Anders Ingelgård, Peder Beausang,
Mattias Castenfors, Kina Mulec & Jonas Roth
SALTSA – JOINT PROGRAMME
FOR WORKING LIFE RESEARCH IN EUROPE
The National Institute for Working Life and The Swedish Trade Unions in Co-operation
SALTSA is a collaboration programme for occupational research in Europe. The National Institute for Working Life in Sweden and the Swedish confederations of trade unions
SACO (the Swedish Confederation of Professional Associations), LO (the Swedish Trade
Union Confederation) and TCO (the Swedish Confederation of Professional Employees)
take part in the programme. Many problems and issues relating to working life are common to most European countries, and the purpose of the programme is to pave the way
for joint research on these matters from a European perspective.
It is becoming increasingly obvious that long-term solutions must be based on experience in and research on matters relating to working life. SALTSA conducts problemoriented research in the areas labour market, employment, organisation of work and work
environment and health.
SALTSA collaborates with international research institutes and has close contacts with
industry, institutions and organisations in Europe, thus linking its research to practical
working conditions.
Contact SALTSA
Labour Market Programme
Lars Magnusson, National Institute for Working Life, Tel: +46 8 619 67 18,
e-mail: [email protected]
Torbjörn Strandberg, LO, Tel: +46 8 796 25 63, e-mail: [email protected]
Work Organisation Programme
Peter Docherty, National Institute for Working Life, Tel: +46 8 619 69 59,
e-mail: [email protected]
Mats Essemyr, TCO, Tel: +46 8 782 92 72, e-mail: [email protected]
Programme for Work Environment and Health
Per Malmberg, National Institute for Working Life, Tel: +46 8 619 67 10,
e-mail: [email protected]
Anders Schaerström, SACO, Tel: +46 8 566 136 55, e-mail: [email protected]
© National Institute for Working Life and authors 2003
SE-113 91 Stockholm, Sweden
Tel: (+46) 8-619 67 00, fax: (+46) 8-656 30 25
Web: www.arbetslivsinstitutet.se/saltsa
Printed at Elanders Gotab
Abstract
Emotions and stress are inextricably entangled: being stressed has bodily as well
as emotional implications for human beings. The widespread distinction between
mind and body in organization theory, following the Cartesian doctrine, blocks
the sufficient theoretization of stress. In general, there is a preference in organization theory toward linguistic, literary, and semiotic interpretations of organizational practices. Consequently, notions such as culture and discourse have been
largely favoured. The limits of this tradition in Western thinking, Cartesian over
Spinozist philosophy, are that mind is favoured over body, thinking over
emotions, mind over matter. This paper presents a study of the experience of
stress in a pharmaceutical company. It suggests that stress is to be conceived of
as a bodily phenomenon while incorporating the emotional qualities of human
beings. Being an outcome of a set of ambiguities, stress is produced in a social
setting but has immediate bodily effects on employees.
Descriptors: Stress, Emotion management, Embodiment, Pharmaceutical
industry.
Contents
Abstract
Introduction
1
Emotions and stress: Bodily experiences
3
Emotions, stress and deviant behaviour
5
Dealing with Stress: Managing Ambiguities
8
Methodology
PharmaCorp and the pharmaceutical industry
Stress Embodied
Work- pressure
Lack of control
Interpersonal relationships
Discussion
8
9
10
11
13
15
17
Conclusion
20
References
21
Introduction
Recent organization theory is characterized by an increased degree of selfreflection (Weick, 1999; Burrell, 1996). The positivist tradition, which has
served as the norm for organization theory, has been challenged by various
perspectives such as social constructivism (Gergen and Thatchenkery, 1996),
critical theory (Jermier, 1998; Alvesson and Deetz, 1996; Deetz, 1992),
ethnography (Czarniawska, 1992; Putnam, 1993), postmodernism and poststructuralism (Hassard and Parker, 1993; Chia, 1996; Kilduff and Mehra, 1997),
narrative approaches (Pentland, 1999; Van Maanen, 1988), discourse analysis
approaches (Keenoy, Oswick and Grant, 1997; Fairclough, 1995), or feminist
perspectives (Kerfoot and Knights, 1998; Cálas and Smircich, 1999). Organization theory has also been characterized by a preference for linguistic, narratological, and semiotic analyses of organizational practices and activities. Notions such
as culture, language, and symbols have been used to make sense of various
phenomena. Therefore, organizational activities unfold as a text, following a
pivotal idea of much poststructuralist writing. The textualization of organizational life has two major implications; Broadhurst (1999: 27) writes: “traditional
ways of interpretation have been dominated by the transference of linguistic
interpretation of the non-linguistic. This has a double effect. It makes the body a
secondary phenomenon and reduces the fundamental temporality of meaning.”
The “textual view” of organizations is here contrasted with an embodied view.
One of the most important contributions of feminism is the emphasis on corporeality as a variable in organization studies. Both postmodern feminism and
poststructuralism are rejecting essentialism (Butler and Singer, 1992), the belief
in stable, innate qualities of human beings, but feminism acknowledges the
human body as a key social “object” to a larger extent than poststructuralism
(Braidotti, 1997). To feminism, the human body is the site of regulations and inscriptions and serves as the nexus between the private and the public (Trethewey,
1999; Lykke and Braidotti, 1996); since the human body is the most obvious
manifestation of differences between male and female, it is subject to problematization. Human bodies matter, but they do also differ across populations and
across the narrow binarism of male and female (Butler, 1993).
This paper presents a study of the experience of stress in a pharmaceutical
company. This study is based upon a narrative methodology (Czarniawska, 1999;
Boje, 1995; Tovey, 1998; Nicholas and Gillett, 1997) and draws on interviews
with employees doing clinical research studies in a major pharmaceutical company. It addresses stress as a major problem in terms of the efficiency of the
clinical research activities and personal well-being. In the paper, stress is depicted as both a bodily problem and an emotional problem. Since it is ontologically and epistemologically complicated to distinguish emotions from physical
1
functions of the body, stress is fundamentally seen as a physical, embodied
experience emerging from a set of interrelated circumstances and processes. The
experience of stress is a complex phenomenon; it is complicated to separate
mental and bodily experiences into discrete domains (Shilling, 1993: 115-124),
and stress is complicated to think of in linear cause-effect schemes. Stress could
be seen both as the cause and the effect of specific bodily malfunctionings.
Therefore, the experience of stress is seen as a category escaping logocentrism
(cf. Derrida, 1974), the will to fix a phenomenon in specific meanings and
unambiguous positions; stress is an indeterminate experience, set in-between the
body and the mind, the self and society. Stress is without centre, appearing in the
middle of human lives, outside of linear cause-effect relations. Thus stress can be
seen as being based on what Julia Kristeva calls intertextuality, the innate relationship and mutual dependency between various texts. Kristeva writes: “Every
text takes the shape as a mosaic of citations, every text is the absorption and
transformation of other texts” (cited in Culler, 1975: 139). Stress is a fluid,
decentred, and continuously evolving bodily and emotional experience that is
grounded in the life-world of the stressed human being. Stress is thus not centred
in body or emotions (mind), but includes and connects both in the same manner
as the text is made up of diverse, scattered textual elements.
The paper draws on literature that discusses emotions, stress and burn-out, and
organization theory that subscribes to an embodied view of organizations
(Meyerson, 1994, Daniels and Guppy, 1994). To (re)embody organizations is to
open up new possibilities for organization theory (Barry and Hazen, 1996;
Hassard, Holliday and Willmott, 2000). The point of departure for the study is
that organizations have a problem dealing with emotions such as stress if these
feelings are complicated to interpret or decode, or if the causes of stress are
complex. In short, organizations do have a problem handling ambiguous feelings,
emotions, and experiences.
2
Emotions and stress: Bodily experiences
Poststructuralism and postmodern feminism are equally hostile towards the idea
of essences. This position implies that the human subject is depicted as being
contextually and historically grounded, meaning is distributed through intertextuality, and truths are conceptualized as social conventions and preferences. In
short, there is an increasing lack of stable universals (Laclau, 1996; Said, 1994:
92). This lack of universals corresponds to what Lyotard (1984), in a most radical
critique (cf. Derrida, 1994; Armitage, 1999: 39) calls the demise of the
metanarrative, the loss of legitimate, all-encompassing, totalities of meaning
from which science and politics could legitimize themselves. To postmodern
feminism — which shares a great deal with, and to some extent, is entangled
with poststructuralism — the experience of the individual body is of specific
interest. McNay (1998) writes:
The concept of embodiment is central to feminist thought, because it
mediates the antinomic moments of determinism and voluntarism through
positing of a mutual inherence or univocity of mind and body in Cartesian
dualism. As the point of overlap between the physical, the symbolic and the
sociological, the body is a dynamic, mutable frontier. The body is the threshold through which the subject’s lived experience of the world is incorporated and realized and, as such, is neither pure object nor pure subject. It is
neither pure object since it is the place of one’s engagement with the world.
Nor is it pure subject in that there is always a material residue that resists
incorporation into dominant symbolic schemes. (McNay, 1999: 98)
Bodies are never things in themselves, but always serve as representations, sites
of inscription and modification, and a nexus of inner and outer activities, and
private and public objectives (Butler, 1993; Olkowski, 1999; Haraway, 1997).
The human body is problematic inasmuch as it constitutes the centre of many
social and managerial practices. Therefore, one of the most important contributions of feminist thought in organization theory is the idea of corporeality.
Turner (1996) discusses various perspectives on the body in social theory. One
of the generic qualities of human beings in everyday life is being able to have
what Husserl called “intimate rulership” over one’s body. As a consequence, “a
person cannot be excused by saying ‘my body did it’ because we are thought to
have intimate rulership . . . over our bodies.” (Turner, 1996: 81). This perspective
is problematic to Turner because this rather common sensical idea ignores the
politics inscribed into the body. Turner says that “to talk about our phenomenological rulership of our bodies is to miss the crucial sociological point, namely
the regulation of the body in the interest of public health, economy, and political
order” (Turner, 1996: 81). This primarily Foucaultian view emphasizes the nexus
3
theory of the body: bodies are always in-between, connecting and aligning the
political and the practical, the individual and the collective. The position of the
body between structures and actors is mostly taken for granted, but comes into
focus when the body deviates from its own standards, e.g. when the body is
subjected to illness. Turner writes: “The concept of illness in particular brings
together three fundamental debates which have shaped sociology from its
inception, namely the relationship between nature and culture, individual and
society, and mind and body” (Turner, 1996: 179). Therefore, Turner says, “the
discovery of a new disease is not . . . epistemologically equivalent to discovering
a new butterfly; a new disease is the product of a shift in explanatory frameworks
or the identification of a new niche” (Turner, 1996: 200). One illness that is
becoming a prominent problem in organizations is the experience of stress. It is
plausible to think that the pathological effects of stress have been further emphasized throughout the 1990s, today being of considerable concern in contemporary
societies.
4
Emotions, stress and deviant behaviour
In the following, the notion of stress is related to what is referred to as emotional
management (Hochschild, 1983, Fineman, 1991; Sutton, 1991; Brown, 1997;
Nguyen, 1999). The idea that the emotions of employees of interest to organizations to manage as a resource was first formulated by Charles Wright Mills
(1951). As opposed to Maxist theory, where labour is fundamentally conceptualized as physical labour (cf. Castoriadis, 1997: 18), Mills argued that the whitecollar worker needed to control his or her feelings and that facial expressions
(e.g. a smile) become a matter of professionalism; “if there are not too many
plant psychologists or personnel experts around, the factory worker is free to
frown as he [sic] works. But not so the white-collar employee. She [sic] must put
her personality into it. She must smile when it is time to smile” (Mills, 1963:
271-272). In a seminal work by Hochschild (1983), acknowledging the contributions of Mills, emotional work and emotional labour are distinguished. Emotional work is the effort human beings make to ensure that their feelings and
emotions are in harmony with socially-accepted norms (e.g. the suppression of
smiles and laughter at a funeral. See Goffman, 1959), while emotional labour is
the commercial exploitation of this ability. Mumby and Putnam (1992) define
emotional labour as “the way individuals change or manage emotions to make
them appropriate or consistent with a situation, a role, or an expected organization behavior” (Mumby and Putnam, 1992: 472). Emotions are thus a resource
that the individual can make use of when carrying out work-assignments. Nevertheless, Martin, Knopoff and Beckman (1998: 429) claim that emotions have
been a “largely deemphasized, marginalized, or ignored” quality in human beings
in organization theory. Much organization theory rests upon the idea of rationality in various forms; in a modernistic conception of human beings, rationality
and emotions are binary opposites, cognition versus emotion. In addition, in
cases when emotions are acknowledged, a specific set of emotions are favoured
at the expense of others: “Some emotions, such as anger and competitiveness, are
generally condoned in bureaucratic organizations, while others such as sadness,
fear, some forms of sexual attraction, and vulnerability are taboo” (Martin,
Knopoff, and Beckman, 1998: 434). Emotional management and emotional
labour operate through the exclusion of “negative” emotions, i.e. emotions that
neither contribute to the productivity of the activities, nor are easy to deal with
(e.g. fear). Thus, the suppression of feelings is troublesome to feminist scholars
because, as Martin, Knopoff, and Beckman (1998) say, “women are more likely
than men to engage in self-disclosure, express a wider range of emotions, and
seek ways to acknowledge the inseparability of work and personal lives without
letting work concerns take priority over family needs” (Martin, Knopoff, and
Beckman, 1998: 433). It is problematic to claim that women are naturally more
5
inclined toward emotions and emotional reactions than men are, but it could be
that emotions which are more often expressed by women are excluded from the
domain of legitimate emotions. Stereotypical “female” emotions are deferred,
excluded, or subsumed while corresponding “male” feelings (anger, competitiveness) are demonstrated without negative consequences. Emotions which indicate
that the individual are “out of control” is of specific interest in terms of experiencing of stress and burn-out. Meyerson (1998) writes that “the dominant discourse
does not include a vocabulary for engaging emotions or for talking about ‘being
out of control’ as a legitimate human experience” (Meyerson, 1998: 112). In
addition, Meyerson thinks that “complex” feelings with “fluid meanings” are
cumbersome to deal with in organizations. When feelings are acknowledged,
they should either be productive or uncomplicated to decode and interpret.
The experience of stress and burn-out in organizations is neither productive (at
least not when the individual finally, after strenuous work, demonstrates and
experiences the negative effects of stress), nor simple in terms of causes and
symptoms. Stress and stress-related illnesses are socially produced deviances
from bodily and social standards of behaviour. In addition, stress operates across
individuals and social systems. It is, as a consequence, complicated to deal with
stress. Meyerson (1998) addresses the inherent problem of science handling
ambiguities. Most scientific inquiries, evaluations, management tools and tests,
operate through binary positions that effectively exclude ambiguous events and
phenomena: “Psychological and managerial tests, feedback sessions, and intervention strategies are based on clear and universal definitions of the normal and
the abnormal. The reliance on universal standards and classifications reflects the
reverence for scientific-like typologies and a general disdain for ambiguity, or as
Levine (1985) has termed it, a ‘flight from ambiguity’ in social science” (Meyerson, 1998: 109). Moreover, the individual is ususally held accountable for the
pathological effects of stress. For instance, Kunda’s (1992) study of engineers
working at a high-tech company suggested that the experience of burn-out was
an everyday work life problem that the individual was expected to deal with.
Martin, Knopoff, and Beckman (1998) studied the use of personal counselling as
a method of reducing the negative effects of stress. They concluded that “however helpful such a counsellor may be, the implicit message is that work stress is
an abnormal response that must be controlled, with the blame for the problem
and the responsibility for fixing it resting primarily with the individual experiencing the stress” (Martin, Knopoff, and Beckman, 1998: 456). Being able to have
intimate rulership over one’s body and handle stressful situations and a stressful
life are thus seen as the mark of the professional: Tina, a clerical employee interviewed by Martin, Knopoff, and Beckman (1998: 458) stated that: “professionals
get it done without being frazzled and bothered.”
6
So far, two models of stress have been invoked. On the one hand, we can
examine stress as an embodied phenomenon; i.e. a set of physical responses to
unfavourable work-conditions. Headaches, illness, sleeping problems are examples of such embodied experiences. In this perspective, stress is not seen as being
different from any other form of illness. Stress is simply a matter pertaining to
the body and needs to be treated as such. On the other hand, stress is seen as an
emotional response to perceived problems. In this case, stress is conceived of as
being an intellectual reaction to external demands and expectations. The problem
of stress operates within this dichotomization; on the one hand, stress is embodied — on the other hand, it is emotional. It is complicated to base, once and
for all, the experience of stress in either of these two entities. It is experienced in
the body, the stressed body, but it is equally experienced as an emotional state.
There is thus a certain degree of indeterminacy in stress; it is in-between, embodied as well as emotional, personal as well as social. Stress is not based on
logocentric categories.
To conclude, there are three characteristics concerning stress in organizations
that can be formulated: (1) Organizations have a problem handling ambiguous
emotions and experiences, (2) Stress is an ambiguous, indeterminate “illness” in
which bodily disorders and complex or contradictory emotions are entangled, (3)
Organizations do have a problem handling stress unless it is formulated as a
personal problem to be solved through individual activities (e.g. counselling,
yoga, breathing exercises).
7
Dealing with Stress: Managing Ambiguities
Methodology
The study was undertaken from a case study approach (Yin, 1994; Eisenhardt,
1989) inasmuch as one single company (subsequently referred to as PharmaCorp) was investigated. Interviews were conducted with the aim of making the
interviewees tell as openly as possible of their experiences of stress and of their
work-situation in general. It is therefore pertinent to speak of a narrative approach (Bruner, 1986; Polkinghorne, 1988; Van Maanen, 1988; Czarniawska,
1993). The narrative methdology can be seen as one method in the totality of
methodologies following from the linguistic turn in social science (Rorty, 1998;
Edwards, 1997, Potter, 1996). As Czarniawska (1999: 15) has argued, the narrative form of knowing is “close to the tradition of research known as case studies”. However, as the case study approach normally gives the researcher the
prerogative to choose the data presented in the text, the narrative approach aims
to present the interlocutors’ accounts of their experiences and day-to-day activities in the final written text. A narrative approach does not seek what Bruner
(1986) calls a “logico-scientific mode of knowledge” wherein an explanation is
achieved through the recognition of an event or utterance as belonging to a
certain category, or following a general law. In short, a narrative approach does
not aim to present nomological knowledge (Habermas, 1968), but rather to
present contextualized narratives as human endeavours in order to make sense of
complex, ambiguous, and fluid realities (Guignon, 1998). Narrative studies give
priority to the interviewed subject’s account of his or her own life-world and
experiences (Frank, 1995; Nicholas and Gillett, 1997). Narrative methods have
been used in organization studies by, for instance, Sköldberg (1994), Boje
(1995), Boyce (1995), Fine (1996), Barry and Elmes (1997), Crane (2000), and
Kurland and Pelled (2000). In the field of health care, narrative methods have
been suggested within medical care (Tovey, 1998; Nicholas and Gillett, 1997)
and psychotherapy (Guignon, 1997). These studies problematize the relationship
between embodied experiences and narrative. For instance, Frank (1995: 27)
writes: “The body is not mute, but it is inarticulate; it does not use speech, yet
begets it. The speech that the body begets includes illness stories; the problem of
hearing these stories is hearing the body speaking in them. People telling stories
do not simply describe their sick bodies; their bodies give their stories their particular shape and direction.” Telling stories of embodied experiences such as illness is, Frank says, “giving voice to the body.” The embodied experience is
articulated and can thus be given meaning beyond the mute suffering of the sick
body. The body is enabled to speak through the narrative.
This study investigates the experience of stress in clinical research activities at
a major pharmaceutical company, here referred to as PharmaCorp. The clinical
8
research process at PharmaCorp is arranged in project teams, called study
working teams (SWTs) which work on detailed substudies within the comprehensive research programme. Each SWT consists of a number of experts such as
Clinical Research Leaders, Clinical Research Assistants, Medical Advisers
(consulting medical doctors with specialist expertise in particular fields of
medicine), Data Coordinators, safety personnel (analysts of so-called adverse
events or serious adverse events, i.e. potentially undesirable and unanticipated
effects on patients caused by the tested drug) and secretaries. In the study, all
categories of clinical researchers and employees were interviewed. The majority
of the clinical researchers at PharmaCorp were, however, either Clinical Research Leaders or Clinical Research Assistants. The median duration time of the
interviews was approximately 90 minutes. During the interviews, the interlocutors were asked open-ended questions such as “what does a normal working
day look like for you,” “what do you think is good/bothers you about your
work,” “do you ever feel stressed at work,” and so forth. It was a pronounced
ambition to put as many open-ended questions as possible to the interlocutors in
order to enable a discussion on how stress was conceived of, experienced, verbalized, and dealt with at PharmaCorp (cf. Nicholas and Gillett, 1997). In total,
more than 30 hours of interview material was recorded. All interviews were
transcribed in detail by two independent persons who did not participate in the
interviews. The transcriptions produced close to 400 pages of empirical material.
Three researchers examined the empirical material independently and suggested
how the material could be structured and categorized. The analysis of the material generated a number of categories that roughly correspond to the headings
used below. It is noteworthy that the categories “stress embodied,” “workpressure,” etc. (see below) were not used prior to the interviews but were constructed on the basis of the interviewees’ stories and utterances. After appropriate
analysis of the data material, some findings were reported to the interviewees at
PharmaCorp. The findings were subject to a discussion with the interviewees and
were received in favourable terms. In addition, two researchers participated in a
number of SWT meetings and a two-day off-site seminar. These participative
observations enabled more detailed insights into day-to-day clinical research
activities.
PharmaCorp and the pharmaceutical industry
The competitive advantages of the pharmaceutical companies are based upon a
company’s ability to generate new knowledge that can produce patents and new
medicines which become marketable profit-generating products (Yeoh and Roth,
1999: 639). Yeoh and Roth (1999: 637) write that “the industry is noted for its
technological intensity and studies suggest that research and development (R&D)
is an important source of competitive advantage.” Documenting the effects of a
9
new drug is very resource-demanding and time-consuming, and only a fraction of
the molecules (i.e. the active substance of the drug) tested are finally launched on
the market. The pharmaceutical industry has, perhaps, the longest development
times of all industries (5-15 years) and invests between 9 and 50% (PharmaCorp
around 20%) of its sales profit in R&D. When successfully providing evidence
for the positive effects of a certain drug, the performance of the company could
be considerably affected. Roberts points out that “the profits earned within the
pharmaceutical industry are consistently well above those earned in the next
highest earning industry” (Roberts, 1999: 668). These profits derive very much
from the ability of pharmaceutical companies to innovate (Roberts, 1999: 656).
PharmaCorp is one of the largest pharmaceutical companies in the world. The
company is a provider of medicines in many therapeutic areas, where the three
largest are cancer, cardiovascular and gastrointestinal medicine. The R&D
centres are located in Europe and the U.S. and had more than 10,000 employees
and a turnover of USD2 billion in 1999. Today, following a merger with one
large competitor, the company has more than 50,000 employees world-wide. The
product development process in the pharmaceutical industry is complex and
consists of a number of stages: (1) laboratory scientific work where a substance
that promises to affect human health in desirable ways is identified, (2) clinical
testing on laboratory animals such as rats, (3), clinical tests on voluntary participants such as students or inmates, and finally (4) clinical tests on a population of
patients. If the drug passes all the stages and proves to be successful in terms of
positive health effects on patients, the substance can be registered and thereafter
sold on the market. The entire product development process is governed by
various international research and clinical testing standards, and a number of
national and international committees and boards have to approve the testing
procedures before the product can be launched. Product development is therefore
heavily monitored, controlled, and standardized.
Stress Embodied
The experience of stress was pointed out by the interviewees as being manifested
in physical, embodied effects as well as in inabilities to master the work situation
because of problems focusing on the right priorities and communicating adequately with colleagues. One of the clinical research assistants said: “I think it is
because my brain just doesn’t keep up . . .When I am supposed to do something,
then there is just no co-ordination. There is some kind of discrepancy there
[between acting and doing]. When everything is normal, then you work and after
that you think, no problem. But when you are stressed, then these two are mixed
up . . . It’s hard to find a good word for that.” Another interviewee described
things thus: “…then something dark comes over me . . . everything becomes a
cage, and I lose my perspective on things. I do only what is absolutely necessary
10
. . . I lose my memory. That is serious, but that’s how it is.” A third interviewee
referred to both bodily and emotional responses to stressful situations: “…well I
get this rush in my heart, and I have this thing in my belly, and I’m generally in a
bad mood.” The physical effects included a variety of responses such as fatigue,
headaches, tensions, cadiac arrythmia, and dizziness, or longer periods of illness
because of too much work. These pathological effects are well documented and
reported in the medical stress literature (Lazarus and Folkman, 1984; Kahn and
Boysiere, 1990; Cox and Ferguson, 1991; Brannon and Feist, 1992). Besides
their bodily malfunctionings, the interviewees pointed out the psychological
effects arising from a work-situation characterized by stress. The inability to
concentrate on a single work-assignment, the unwillingness to talk to colleagues
and other people, general feelings of insufficiency and vulnerability, and experiences of depression were mentioned as outcomes of strenuous work situations. In
general, stressful work-situations produced more or less long-term bodily effects
in the employees, which negatively affected their ability to do a good job. This
situation was produced by (1) work pressure being too high, (2) a lack of control
over the individual work-situation, (3) unsatisfying interpersonal relationships.
Work- pressure
The clinical research activities at PharmaCorp were designed in accordance with
a multiplicity of national and international standards, called Good Clinical
Practice (GCP). It is necessary to comply with GCP if the drug is to be accepted
for registration and launched on the market. In general, clinical testing should
preferably be undertaken as fast as possible at the lowest costs given the framework that is defined by external medical and ethical committees and monitoring
organizations. As a consequence, the clinical testing of a drug is a continuous
attempt to shorten the time to market; “time is all that matters,” as one Clinical
Project Leader put it. Working toward new deadlines was pointed out as being
very stressful by some of the employees. In PharmaCorp, deadlines were not, as
one of the interviewees put it “sacred,” but you certainly had to come up with a
very convincing explanation to give the Project Leader if you could not deliver
adequate results prior to deadlines. What was especially cumbersome to the interviewees was the continual recurrence of deadlines; there were new ones coming
all the time. This turned work into a never-ending effort. One assistant said: “I
think it is more satisfying when I can evaluate my results, right . . . If you finish
something every day, then you are pleased because you know ‘I did this’ today.
But here [at PharmaCorp], that is not possible. You can’t measure your work.”
As a consequence, some of the clinical researchers worked extensive amounts of
overtime. For instance, one of the clinical project leaders was asked about her
overtime:
11
Q: How much overtime do you work?
A: I am already above the maximum permitted amount.
Q: That is 200 hours?
A: Yes, my strategy right now is, therefore, not to report it [the overtime].
In addition to deadlines, the interviewees addressed the discontinuous nature of
the work in terms of it being broken down into pieces either through a number of
meetings spread across the entire week, or interruptions to their work by colleagues who wanted information, help, or advice on various topics. This produced a
situation wherein the clinical researchers never had the time to deal with more
detailed or complex problems. Clinical research is composed of a multiplicity of
tests, evaluations, and observations of how a specific drug (or placebo which
some of the patients in a study are given in order to serve as a reference group for
comparisons) affects the state of health of thousands of patients in, at times, up to
30 countries worldwide. Clinical research is, on the bottom line, aimed at providing credible information to medical authorities which will make it possible to
get the drug registered. The vast body of information that has to be handled
makes it necessary to have a forum for ongoing information and discussion
regarding how the clinical research project is proceeding. Therefore, a considerable part of the working week was dedicated to meetings, which were seen
as a cause of stress. One of the interviewees said: “My working days could be
booked for meetings up to 80 or 100 percent. Then, if you have made your mind
up to use these two spare hours on a Friday afternoon for one of your own things,
of course that has to be postponed [because of unforeseen problems]. That is
stressful to me.” In addition, the need for ongoing information among the clinical
researchers produced the same stressful effects. Rather than thinking of meetings,
and the help given to colleagues, as being an integral part of the work, the clinical researchers were apt to think of it as undesirable disturbances that eliminated
quality-time aimed at clinical research. As a response, some interviewees
reported that they had tried to cut down on coffee and lunch breaks. One interviewee said: “we do eat lunch, but I come back here as fast as possible. Otherwise [when not under stress or work-pressure], when not much is going on, you
could stay in the restaurant for a while, resting and having a cup of coffee, having
a chat with people. But that is just not possible now.” Another interviewee
argued: “Many of our senior bosses encourage us to take breaks and have some
coffee and all that, but I just use my breaks for eating. It is very rare that I take a
coffee break. That is stupid because I believe that everyone needs that little
break, just to talk about anything but work.” The time-pressure eliminated all
possibilities for reflection. One of the medical doctors argued: “At times, I think
that one should stop work and say ‘No, now we need to calm down. We have to
12
talk for a while and think about things . . . Is it really realistic to assume that we
should deliver all this?’ I believe that is important”
Lack of control
I would be able to spend all my time here if it wasn’t for my duties back
home. If I did not have to be concerned about my family, then I would be
less stressed, but now I have this double loyality, and which one should
receive priority? Should I stay at work or should I go home? I don’t feel
that I am very pleased with myself: I am simply not good enough. (Clinical
Research Assistant)
The interviewees highlighted a number of problems emerging due to the lack of
control over their individual work-situations and various forms of role ambiguities. One of the Clinical Project Leaders said: “It is primarily the people who
have fewer opportunities to determine their own work that are the most stressed.
For instance, the Clinical Research Assistants are suffering from stress because
they are not the ones managing the projects, they do not make the decisions, but
they are the ones who are expected to carry out the practical work.” One of the
most stressful problems was the inability to satisfactorily distinguish and separate
work and family life. Most of the interviewees had families and the majority
were women in their thirties and forties who had school children at home. One of
the clinical researchers illustrated her inability to separate work and family life
during a particularly stressful period:
We were working here together, and she's got a family as well, just as I
have. We were working here the entire day, and then we went back home to
fix dinner for our families, took care of things, checked that the homework
had been done, did the laundry, and then went back to work again. Then we
worked until, say, 10 o'clock and then we went home, slept, got up in the
morning, and then did the same thing again. When I came home on the third
or fouth day, rushing out of my car, I felt something in my stomach, and I
thought to myself ‘what am I actually doing here’.
Another interviewee said: “I think a lot about my job [at home] . . . I bring my
job home . . . both mentally and physically . . . and then I am tired . . . because
there is always so much going on . . . What has been prioritized less during recent
weeks is my personal exercise programme; at the moment I’m experiencing the
‘degeneration of my muscles’ [laughter]. It’s rather sad; I used to be very fit, but
no longer.” One Clinical Project Leader described her problems separating work
from family life as particularly stressful: “I noticed that I could not relax. During
weekends, I did not feel very well until I could sit down with my laptop and deal
with things. That was really a warning signal to me.” Work pressure produced
feelings of insufficiency, a bad conscience, and a very stressful life situation. In
13
addition, the interviewees argued that it was impossible to maintain a satisfying
“quality-level” in their work when they were too mixed up between, as another
interviewee put it, “double loyality.” Loyalty problems caused role ambiguities
between both work and family, but also between priorities within the clinical
research project. The interviewees thought it was complicated to know how to
prioritize their own work since they thought that the vertical communication in
the project was unsatisfactory. One of the interviewees claimed that
communication between the project teams and management was assumed to be
used only in the event of a problem or an emergency: “It is very much like in
school. Unless you hear about a problem, everything is just fine. I believe it is the
same situation here. I think one [the managers] should have a deeper sense of
commitment.” Another interviewee responded “never: I have met my boss once
for one hour,” on the question whether she had regular meetings with her boss. It
was, in short, not very easy to know how management evaluated the specific
project in relation to other clinical studies. One interviewee argued: “[Managers]
sit in another place, and you don’t see them very often . . . They don’t know what
is going on in the projects. They don’t see what these people do, how they do it,
and how they set things to proceed.” Another interviewee said: “It may be that
they just don’t understand what it is like to be sitting in front of the computer
screen being in charge of this database; they simply don’t know how we work
and how much work is needed. We are trying to point this out, but it is not
always the case that they understand.” Secondly, it was not unproblematic to
decide upon how the individual work assignments were to be prioritized vis-à-vis
work done by colleagues. One Clinical Project Leader said: “my job description
is really too unclear to me,” and another held that “One thing that is so stressful .
. . is that I don’t really know my responsibilities [in the project].” How the work
time was to be allocated was always a source of reflection and discussion. The
interviewees thus experienced stress as an outcome of role ambiguities arising
from the clash between family and work, individual work and the aims of the
project. However, the general attitude and culture at PharmaCorp promoted
mutual help. One of the interviewees said that her colleagees were willing to join
forces when needed: “It does not really matter what position you have or what
your formal education is: if we need [for instance] something from the archives,
we all go down there and search until we have found it.” The culture at PharmaCorp was in general egalitarian and there was, the interviewees argued, a cordial
and warm atmosphere among colleagues. This was highly appreciated by the
interviewees, but it may also be that the egalitarian attitude and ethos provided
new sources of stress. If employees are sharing virtually all the work-assignments horizontally, it is increasingly complicated to distinguish between the
individual's work and non-work. In this situation, there is no real control over the
individual work-situation since most work is part of mine. Another source of
14
stressful experiences was technostress. When there were computer problems, it
was impossible to keep up with the work, and consequently, it lagged behind.
When work lagged behind, new priorities had to be made. One interviewee
remarked “…quality assurance is the first casualty [in times of stress] . . . we
have to skip quality checks and stop asking some [critical] questions.”
Interpersonal relationships
A third source of stressful experiences was interpersonal relationships, or rather,
unsatisfactory interpersonal relationships. One Clinical Project Leader argued:
“Conflicts between colleagues are stressful for all of the team. If I feel that there
is a problem between two people, I ask them as fast as I can to take time out and
solve their conflict. In most cases, conflicts are about a lack of communication.”
Some of the interviewees pointed out that they had a problem expressing negative suggestions and comments on how the clinical research projects were being
undertaken. One interviewee said: “there is always this competition between us
because once a project is finished the next one starts; You want them [colleagues
and managers] to think that you are doing a good job and that you won't rock the
boat. [If you do that] they might say that ‘no, not that person, she is so negative,
we don't want her.’” As a consequence, the Clinical Research Assistants and the
secretaries claimed they had a problem pointing out deficiencies in research
design and other concerns. Another interpersonal relationship that caused
undesirable effects was the newcomer. Since the members of the Study Work
Teams worked very closely and informally during a fairly long period of time —
some interviewees had been in the same project for more than four years — a
newcomer changed the existing work procedures: “If you have been working
very closely with a person for a long time and you know one another and everything is fine, then someone else is hired who is supposed to help you. Well, then
all of a sudden there are three of us . . . It may be that the person that I used to
work with gets this feeling of being marginalized” (Clinical Research Assistant).
Newcomers need direction, training, and help, and therefore cause stress in terms
of taking time away from day-to-day activities: “One of the problems is when we
recruit new employees. First, every new person slows down everyone else because we have to teach this person. This project has hired too many people in a
very short time, and that is not good for us” (Clinical Research Assistant).
The third source of interpersonal stress is the relationship and interaction with
management and project leaders. Communicating with leaders/managers and
cooperating were the two main problems pointed out as being stressful. One
female Clinical Research Assistant said of her female boss: “It can be really
stressful when you have a boss who you can’t get along with. Or have a problem
communicating with, for instance, someone who says one thing and means
another, and when she shows up in the morning, you do not know whether she’ll
15
be shining like the sun or whether she will ignore you completely. That is stressful.” Another problem with managers was that it could be the case that they do
not have appropriate knowledge and experience of working with certain work
tasks. In such a situation, it is complicated to convince the manager of the need
for help or assistance, or it is unclear how to explain unfulfilled expectations.
One interviewee remarked: “You don’t feel that you are being supported by the
company when you are having a crisis.”
16
Discussion
The clinical reseachers at PharmaCorp experienced stressful situations on a daily
basis. Yet, they were very dedicated to their work and saw their efforts as being
part of a broader health care ideology emphasizing the pathos to help human
beings to live better and happier (i.e. healthier) lives. Most of the interviewees
described the specific clinically-tested medical substance they were working on
at the moment as having a true potential for reducing human suffering, pointing
out the financial and market potential for the medicine. The interviewees were
willing to work hard and be ambitious because of the outcome of their work.
Still, it was very unclear whether a drug would be launched on the market in the
end, since this was dependent on the outcome of the clinical study. As a consequence, the clinical researchers worked under ambiguous conditions. There
was neither a self-evident outcome of their work, nor was the outline of the work
itself too clear-cut or obvious to them. The entire work-setting was pervaded by a
number of ambiguities. The ability to handle and accept ambiguities is an outcome of a combination of experience, personality, preferences, cognitive abilities, and self-efficacy (Woods and Bandura, 1989). To some individuals, ambiguity is a potential for new ways of thinking and acting, whereas others approach
ambiguity with anxiety. At PharmaCorp, ambiguities had to be dealt with on a
daily basis and the most prominent (negative) outcome of this was the experience
of stress among the employees. Even though the experience of stress was not
equally distributed among the interviewees — for instance, medical doctors who
served as advisors and experienced Project Leaders did not acknowledge stress as
a major problem — stress was always present in some respects. Stress literature
points out factors such as role ambiguities and lack of control over the worksituation as influential stressors. The findings from PharmaCorp support these
propositions.
Meyerson (1998) addresses the inability to handle ambiguous situations,
feelings, or problems in organizations, and claims that bodily and emotional
responses are separated into what is seen as normal and what is seen as abnormal
(cf. Canguilhem, 1991; Frank, 1995). At PharmaCorp, there was a general
inability to handle ambiguous responses to work conditions. Even though the
overall work situation was good — e.g. good opportunities for ongoing training
and education at the company, the workplace was very modern and even a little
extravagant, the employees were highly dedicated to their work, and the company’s performance was (as in the pharmaceutical industry in general [cf.
Roberts, 1999]) outstanding — stress remained a key issue to be dealt with. At
PharmaCorp, stress was a broad, general problem, yet there were few opportunities to discuss, deal with, and highlight its impact on personal well-being as
well as interpersonal relations. Even though it was acknowledged as a problem,
17
stress was continuously swept under the carpet. Attempts to handle stress were
primarily aimed at individual proactive exercises in the same vein as those
pointed out by Martin, Knopoff, and Beckman (1998). At times, lectures on
individual stress management practices were arranged by PharmaCorp, but as
one of the interviewees ironically remarked “I didn't have the time to go there
anyway.” These endeavours were appreciated by the interviewees but as one of
the Clinical Researchers said, “I can always do those Yoga exercises, but it won't
get the job done for me.” The problem was, on the bottom line, the interviewees
argued, the lack of resources that could help to sort out the ambiguities.
However, rather than seeing stress as an outcome of organizational or job design,
the problem of stress was reduced to the level of the individual.
The point of departure for the study was that organizations have a problem
dealing with ambiguous or non-legitimate embodied responses to external
demands and expectations: Emotions either have to be familiar (e.g. anger) or
they have to contribute to the production processes of the company (e.g. the
smile of a flight attendant). In situations where these prerequisities are not met,
organizations are likely to demonstrate an inability to deal with these responses.
The experience of stress is an ambiguous phenomenon and experience. As a
consequence, it is at times rejected as being a personal problem derived from
personal shortcomings, or, at other times, when acknowledged, as being an
abnormal response to normal demands. Experiences of deviant responses such as
stress, burn-out, strong emotions (e.g. love or envy), and so forth, are perfectly
normal responses to the way complex social formations or systems, such as
organizations, operate. If a number of individuals are subjected to strenuous
work-pace, forced to cooperate in an organic work structure, and continuously
made to change their work-conditions (e.g. newcomers, new directives and
objectives, etc.), then sooner or later some of the employees will be likely to
experience this situation as stressful. That is a normal response to what are
increasingly becoming standard work-conditions (cf. Hochschild, 1997). The
experience of stress is a social response, surfacing on the individual body, to
ambiguities produced in a specific setting. In general, PharmaCorp had a poor
capacity to deal with embodied reactions; the indeterminate nature of stress was
dealt with through reducing it to the individual, bodily level. The Clinical
Researchers were, in short, expected to master their “stressed bodies.” The complexity of stress was reduced to a number of propositions: stress is personal;
stress derives from the individual’s modus vivendi; stress is dealt with on the
level of the individual. In short, stress was personalized. The personalization of
stress is an attempt to capture this complex, fluid phenomenon in fixed categories.
Organizations have to be able to deal with and manage bodily as well as
emotional and emotionally-laden activities. In much organization theory, bodily
18
and emotional responses and experiences are separated and theoretized upon as
being of different orders. Nevertheless, it is not meaningful to isolate embodied
experiences and emotions; mind and body co-exist and interact as one single
entity (Frank, 1995). At least, there is a certain degree of proximity between mind
and body (Shilling, 1993). For instance, the experience of stress, burn-out, and
other forms of job-related illnesses and problems is neither an entirely bodily
phenomenon, nor an emotional experience, but both simultaneously. Much stress
literature is reductionistic, i.e. it conceives of stress as being either an emotional
problem or a corporeal problem, and fails to satisfactorily acknowledge stress as
being socially embedded. Stress is embodied, experienced as a bodily disorder,
although inextricably entangled with emotions and caused by extra-corporeal
factors. Today, we have neither the tools nor the practices to be able to deal
successfully with stress, nor do we have an understanding or theoretical framework that can provide such practices. In Jex’s (1998: 91) words: “The study of
occupational stress is really in its infancy.”
A partial explanation for the shortcomings in dealing with stress lies in the
preference in the stress literature for a Cartesian mind-body dualism rather than a
Spinozist parallellism where mind and body are not essentially divided or separated (Hayden, 1998: 59; Deleuze, 1988). Western thinking, characterized by
what Luhmann (1990: 22) calls the “transcendental tradition,” has often favoured
the mind over the body, thinking over emotions. This tradition of logocentric
thinking is dominant in organization theory (Hassard, Holliday & Willmott,
2000; Gergen and Whitney, 1996; Turner, 1996). Organization theory demonstrates a preference for the intellectually-based properties of organizational
activities; culture, attitude, communication, symbols, and so forth have been
investigated and studied at the expense of organizational operations on individuals’ bodies. However, this belief in mental properties, and more specifically,
mental properties embedded in rationalism, pushes aside other human qualities.
In the words of Gephart, Thatchenkery, and Boje (1996: 364): “Rationality must
take its role alongside other human capabilities such as love fear, pain, and
hope.” Hopefully, future attempts to theorize and understand stress and its
implications for organizations and their employees will be able to depart from
logocentric models based on reductionism and linear causality.
19
Conclusion
At PharmaCorp, the Clinical Researchers experienced stress as an outcome of
extensive work-pressure, an experience of lack of control over the work situation,
and as an outcome of unsatisfactory interpersonal relationships. All these conditions produced ambiguities that caused more or less stressful work-life experiences. However, PharmaCorp provided few mechanisms or techniques for
dealing with this situation. It is not unlikely that the situation at PharmaCorp is
representative of contemporary work-life situations in terms of stress. If that is
the case, there is a great need to identify and formulate methods and tools for
dealing with these problems and rethinking the notion of stress.
20
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