Emotional Management and Stress: Managing Ambiguities

Alexander Styhre, Anders Ingelgård, Peder Beausang, Mattias Castenfors, Kina Mulec & Jonas Roth

Report No 5:2003

SALTSA – JOINT PROGRAMME FOR WORKING LIFE RE SEARCH IN EU RO PEThe National Institute for Working Life and The Swedish Trade Unions in Co-operation

© National Institute for Working Life and authors 2003SE-113 91 Stockholm, SwedenTel: (+46) 8-619 67 00, fax: (+46) 8-656 30 25Web: www.arbetslivsinstitutet.se/saltsaPrinted at Elanders Gotab

SALTSA is a collaboration programme for occupational research in Europe. The Natio-nal 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 com-mon 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 expe-rience in and research on matters relating to working life. SALTSA conducts problem-oriented 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 SALTSALabour Market ProgrammeLars Magnusson, National Institute for Working Life, Tel: +46 8 619 67 18, e-mail: lars.magnusson@arbetslivsinstitutet.seTorbjörn Strandberg, LO, Tel: +46 8 796 25 63, e-mail: torbjorn.strandberg@lo.se

Work Organisation ProgrammePeter Docherty, National Institute for Working Life, Tel: +46 8 619 69 59, e-mail: peter.docherty@arbetslivsinstitutet.seMats Essemyr, TCO, Tel: +46 8 782 92 72, e-mail: mats.essemyr@tco.se

Programme for Work Environment and HealthPer Malmberg, National Institute for Working Life, Tel: +46 8 619 67 10, e-mail: per.malmberg@arbetslivsinstitutet.seAnders Schaerström, SACO, Tel: +46 8 566 136 55, e-mail: anders.schaerstrom@foi.se

Abstract

Emotions and stress are inextricably entangled: being stressed has bodily as wellas emotional implications for human beings. The widespread distinction betweenmind and body in organization theory, following the Cartesian doctrine, blocksthe sufficient theoretization of stress. In general, there is a preference in organi-zation theory toward linguistic, literary, and semiotic interpretations of organiza-tional practices. Consequently, notions such as culture and discourse have beenlargely favoured. The limits of this tradition in Western thinking, Cartesian overSpinozist philosophy, are that mind is favoured over body, thinking overemotions, mind over matter. This paper presents a study of the experience ofstress in a pharmaceutical company. It suggests that stress is to be conceived ofas a bodily phenomenon while incorporating the emotional qualities of humanbeings. Being an outcome of a set of ambiguities, stress is produced in a socialsetting but has immediate bodily effects on employees.

Descriptors: Stress, Emotion management, Embodiment, Pharmaceuticalindustry.

Contents

Abstract

Introduction 1

Emotions and stress: Bodily experiences 3

Emotions, stress and deviant behaviour 5

Dealing with Stress: Managing Ambiguities 8

Methodology 8

PharmaCorp and the pharmaceutical industry 9

Stress Embodied 10

Work- pressure 11

Lack of control 13

Interpersonal relationships 15

Discussion 17

Conclusion 20

References 21

1

Introduction

Recent organization theory is characterized by an increased degree of self-reflection (Weick, 1999; Burrell, 1996). The positivist tradition, which hasserved as the norm for organization theory, has been challenged by variousperspectives 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 post-structuralism (Hassard and Parker, 1993; Chia, 1996; Kilduff and Mehra, 1997),narrative approaches (Pentland, 1999; Van Maanen, 1988), discourse analysisapproaches (Keenoy, Oswick and Grant, 1997; Fairclough, 1995), or feministperspectives (Kerfoot and Knights, 1998; Cálas and Smircich, 1999). Organiza-tion theory has also been characterized by a preference for linguistic, narratologi-cal, and semiotic analyses of organizational practices and activities. Notions suchas culture, language, and symbols have been used to make sense of variousphenomena. Therefore, organizational activities unfold as a text, following apivotal idea of much poststructuralist writing. The textualization of organiza-tional life has two major implications; Broadhurst (1999: 27) writes: “traditionalways of interpretation have been dominated by the transference of linguisticinterpretation of the non-linguistic. This has a double effect. It makes the body asecondary 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 corpo-reality as a variable in organization studies. Both postmodern feminism andpoststructuralism are rejecting essentialism (Butler and Singer, 1992), the beliefin stable, innate qualities of human beings, but feminism acknowledges thehuman 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 in-scriptions and serves as the nexus between the private and the public (Trethewey,1999; Lykke and Braidotti, 1996); since the human body is the most obviousmanifestation of differences between male and female, it is subject to problemati-zation. Human bodies matter, but they do also differ across populations andacross the narrow binarism of male and female (Butler, 1993).

This paper presents a study of the experience of stress in a pharmaceuticalcompany. This study is based upon a narrative methodology (Czarniawska, 1999;Boje, 1995; Tovey, 1998; Nicholas and Gillett, 1997) and draws on interviewswith employees doing clinical research studies in a major pharmaceutical com-pany. It addresses stress as a major problem in terms of the efficiency of theclinical research activities and personal well-being. In the paper, stress is de-picted as both a bodily problem and an emotional problem. Since it is ontologi-cally and epistemologically complicated to distinguish emotions from physical

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functions of the body, stress is fundamentally seen as a physical, embodiedexperience emerging from a set of interrelated circumstances and processes. Theexperience of stress is a complex phenomenon; it is complicated to separatemental and bodily experiences into discrete domains (Shilling, 1993: 115-124),and stress is complicated to think of in linear cause-effect schemes. Stress couldbe 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 andunambiguous positions; stress is an indeterminate experience, set in-between thebody and the mind, the self and society. Stress is without centre, appearing in themiddle of human lives, outside of linear cause-effect relations. Thus stress can beseen as being based on what Julia Kristeva calls intertextuality, the innate rela-tionship and mutual dependency between various texts. Kristeva writes: “Everytext takes the shape as a mosaic of citations, every text is the absorption andtransformation of other texts” (cited in Culler, 1975: 139). Stress is a fluid,decentred, and continuously evolving bodily and emotional experience that isgrounded in the life-world of the stressed human being. Stress is thus not centredin body or emotions (mind), but includes and connects both in the same manneras the text is made up of diverse, scattered textual elements.

The paper draws on literature that discusses emotions, stress and burn-out, andorganization theory that subscribes to an embodied view of organizations(Meyerson, 1994, Daniels and Guppy, 1994). To (re)embody organizations is toopen up new possibilities for organization theory (Barry and Hazen, 1996;Hassard, Holliday and Willmott, 2000). The point of departure for the study isthat organizations have a problem dealing with emotions such as stress if thesefeelings are complicated to interpret or decode, or if the causes of stress arecomplex. In short, organizations do have a problem handling ambiguous feelings,emotions, and experiences.

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Emotions and stress: Bodily experiences

Poststructuralism and postmodern feminism are equally hostile towards the ideaof essences. This position implies that the human subject is depicted as beingcontextually and historically grounded, meaning is distributed through inter-textuality, and truths are conceptualized as social conventions and preferences. Inshort, 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 radicalcritique (cf. Derrida, 1994; Armitage, 1999: 39) calls the demise of themetanarrative, the loss of legitimate, all-encompassing, totalities of meaningfrom which science and politics could legitimize themselves. To postmodernfeminism — which shares a great deal with, and to some extent, is entangledwith poststructuralism — the experience of the individual body is of specificinterest. McNay (1998) writes:

The concept of embodiment is central to feminist thought, because itmediates the antinomic moments of determinism and voluntarism throughpositing of a mutual inherence or univocity of mind and body in Cartesiandualism. As the point of overlap between the physical, the symbolic and thesociological, the body is a dynamic, mutable frontier. The body is the thres-hold through which the subject’s lived experience of the world is incorpo-rated and realized and, as such, is neither pure object nor pure subject. It isneither 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 resistsincorporation into dominant symbolic schemes. (McNay, 1999: 98)

Bodies are never things in themselves, but always serve as representations, sitesof inscription and modification, and a nexus of inner and outer activities, andprivate and public objectives (Butler, 1993; Olkowski, 1999; Haraway, 1997).The human body is problematic inasmuch as it constitutes the centre of manysocial and managerial practices. Therefore, one of the most important contri-butions of feminist thought in organization theory is the idea of corporeality.

Turner (1996) discusses various perspectives on the body in social theory. Oneof the generic qualities of human beings in everyday life is being able to havewhat Husserl called “intimate rulership” over one’s body. As a consequence, “aperson cannot be excused by saying ‘my body did it’ because we are thought tohave intimate rulership . . . over our bodies.” (Turner, 1996: 81). This perspectiveis problematic to Turner because this rather common sensical idea ignores thepolitics inscribed into the body. Turner says that “to talk about our phenomeno-logical rulership of our bodies is to miss the crucial sociological point, namelythe regulation of the body in the interest of public health, economy, and politicalorder” (Turner, 1996: 81). This primarily Foucaultian view emphasizes the nexus

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theory of the body: bodies are always in-between, connecting and aligning thepolitical and the practical, the individual and the collective. The position of thebody between structures and actors is mostly taken for granted, but comes intofocus when the body deviates from its own standards, e.g. when the body issubjected to illness. Turner writes: “The concept of illness in particular bringstogether three fundamental debates which have shaped sociology from itsinception, namely the relationship between nature and culture, individual andsociety, and mind and body” (Turner, 1996: 179). Therefore, Turner says, “thediscovery of a new disease is not . . . epistemologically equivalent to discoveringa new butterfly; a new disease is the product of a shift in explanatory frameworksor the identification of a new niche” (Turner, 1996: 200). One illness that isbecoming a prominent problem in organizations is the experience of stress. It isplausible to think that the pathological effects of stress have been further empha-sized throughout the 1990s, today being of considerable concern in contemporarysocieties.

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Emotions, stress and deviant behaviour

In the following, the notion of stress is related to what is referred to as emotionalmanagement (Hochschild, 1983, Fineman, 1991; Sutton, 1991; Brown, 1997;Nguyen, 1999). The idea that the emotions of employees of interest to organi-zations to manage as a resource was first formulated by Charles Wright Mills(1951). As opposed to Maxist theory, where labour is fundamentally conceptua-lized as physical labour (cf. Castoriadis, 1997: 18), Mills argued that the white-collar 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 manyplant psychologists or personnel experts around, the factory worker is free tofrown as he [sic] works. But not so the white-collar employee. She [sic] must puther 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 contri-butions of Mills, emotional work and emotional labour are distinguished. Emo-tional work is the effort human beings make to ensure that their feelings andemotions are in harmony with socially-accepted norms (e.g. the suppression ofsmiles and laughter at a funeral. See Goffman, 1959), while emotional labour isthe commercial exploitation of this ability. Mumby and Putnam (1992) defineemotional labour as “the way individuals change or manage emotions to makethem appropriate or consistent with a situation, a role, or an expected organiza-tion behavior” (Mumby and Putnam, 1992: 472). Emotions are thus a resourcethat the individual can make use of when carrying out work-assignments. Never-theless, Martin, Knopoff and Beckman (1998: 429) claim that emotions havebeen a “largely deemphasized, marginalized, or ignored” quality in human beingsin organization theory. Much organization theory rests upon the idea of rationa-lity in various forms; in a modernistic conception of human beings, rationalityand emotions are binary opposites, cognition versus emotion. In addition, incases when emotions are acknowledged, a specific set of emotions are favouredat the expense of others: “Some emotions, such as anger and competitiveness, aregenerally 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 emotionallabour operate through the exclusion of “negative” emotions, i.e. emotions thatneither 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 scholarsbecause, as Martin, Knopoff, and Beckman (1998) say, “women are more likelythan men to engage in self-disclosure, express a wider range of emotions, andseek ways to acknowledge the inseparability of work and personal lives withoutletting work concerns take priority over family needs” (Martin, Knopoff, andBeckman, 1998: 433). It is problematic to claim that women are naturally more

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inclined toward emotions and emotional reactions than men are, but it could bethat emotions which are more often expressed by women are excluded from thedomain of legitimate emotions. Stereotypical “female” emotions are deferred,excluded, or subsumed while corresponding “male” feelings (anger, competitive-ness) are demonstrated without negative consequences. Emotions which indicatethat the individual are “out of control” is of specific interest in terms of experien-cing of stress and burn-out. Meyerson (1998) writes that “the dominant discoursedoes not include a vocabulary for engaging emotions or for talking about ‘beingout of control’ as a legitimate human experience” (Meyerson, 1998: 112). Inaddition, Meyerson thinks that “complex” feelings with “fluid meanings” arecumbersome 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 (atleast not when the individual finally, after strenuous work, demonstrates andexperiences the negative effects of stress), nor simple in terms of causes andsymptoms. Stress and stress-related illnesses are socially produced deviancesfrom bodily and social standards of behaviour. In addition, stress operates acrossindividuals and social systems. It is, as a consequence, complicated to deal withstress. Meyerson (1998) addresses the inherent problem of science handlingambiguities. Most scientific inquiries, evaluations, management tools and tests,operate through binary positions that effectively exclude ambiguous events andphenomena: “Psychological and managerial tests, feedback sessions, and inter-vention strategies are based on clear and universal definitions of the normal andthe abnormal. The reliance on universal standards and classifications reflects thereverence for scientific-like typologies and a general disdain for ambiguity, or asLevine (1985) has termed it, a ‘flight from ambiguity’ in social science” (Meyer-son, 1998: 109). Moreover, the individual is ususally held accountable for thepathological effects of stress. For instance, Kunda’s (1992) study of engineersworking at a high-tech company suggested that the experience of burn-out wasan everyday work life problem that the individual was expected to deal with.Martin, Knopoff, and Beckman (1998) studied the use of personal counselling asa method of reducing the negative effects of stress. They concluded that “how-ever helpful such a counsellor may be, the implicit message is that work stress isan abnormal response that must be controlled, with the blame for the problemand the responsibility for fixing it resting primarily with the individual experien-cing the stress” (Martin, Knopoff, and Beckman, 1998: 456). Being able to haveintimate rulership over one’s body and handle stressful situations and a stressfullife are thus seen as the mark of the professional: Tina, a clerical employee inter-viewed by Martin, Knopoff, and Beckman (1998: 458) stated that: “professionalsget it done without being frazzled and bothered.”

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So far, two models of stress have been invoked. On the one hand, we canexamine stress as an embodied phenomenon; i.e. a set of physical responses tounfavourable work-conditions. Headaches, illness, sleeping problems are exam-ples of such embodied experiences. In this perspective, stress is not seen as beingdifferent from any other form of illness. Stress is simply a matter pertaining tothe body and needs to be treated as such. On the other hand, stress is seen as anemotional response to perceived problems. In this case, stress is conceived of asbeing an intellectual reaction to external demands and expectations. The problemof stress operates within this dichotomization; on the one hand, stress is em-bodied — on the other hand, it is emotional. It is complicated to base, once andfor all, the experience of stress in either of these two entities. It is experienced inthe 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, em-bodied as well as emotional, personal as well as social. Stress is not based onlogocentric categories.

To conclude, there are three characteristics concerning stress in organizationsthat can be formulated: (1) Organizations have a problem handling ambiguousemotions and experiences, (2) Stress is an ambiguous, indeterminate “illness” inwhich bodily disorders and complex or contradictory emotions are entangled, (3)Organizations do have a problem handling stress unless it is formulated as apersonal problem to be solved through individual activities (e.g. counselling,yoga, breathing exercises).

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Dealing with Stress: Managing Ambiguities

MethodologyThe study was undertaken from a case study approach (Yin, 1994; Eisenhardt,1989) inasmuch as one single company (subsequently referred to as Pharma-Corp) was investigated. Interviews were conducted with the aim of making theinterviewees tell as openly as possible of their experiences of stress and of theirwork-situation in general. It is therefore pertinent to speak of a narrative app-roach (Bruner, 1986; Polkinghorne, 1988; Van Maanen, 1988; Czarniawska,1993). The narrative methdology can be seen as one method in the totality ofmethodologies following from the linguistic turn in social science (Rorty, 1998;Edwards, 1997, Potter, 1996). As Czarniawska (1999: 15) has argued, the narra-tive form of knowing is “close to the tradition of research known as case stu-dies”. However, as the case study approach normally gives the researcher theprerogative to choose the data presented in the text, the narrative approach aimsto present the interlocutors’ accounts of their experiences and day-to-day acti-vities in the final written text. A narrative approach does not seek what Bruner(1986) calls a “logico-scientific mode of knowledge” wherein an explanation isachieved through the recognition of an event or utterance as belonging to acertain category, or following a general law. In short, a narrative approach doesnot aim to present nomological knowledge (Habermas, 1968), but rather topresent contextualized narratives as human endeavours in order to make sense ofcomplex, ambiguous, and fluid realities (Guignon, 1998). Narrative studies givepriority to the interviewed subject’s account of his or her own life-world andexperiences (Frank, 1995; Nicholas and Gillett, 1997). Narrative methods havebeen used in organization studies by, for instance, Sköldberg (1994), Boje(1995), Boyce (1995), Fine (1996), Barry and Elmes (1997), Crane (2000), andKurland and Pelled (2000). In the field of health care, narrative methods havebeen suggested within medical care (Tovey, 1998; Nicholas and Gillett, 1997)and psychotherapy (Guignon, 1997). These studies problematize the relationshipbetween embodied experiences and narrative. For instance, Frank (1995: 27)writes: “The body is not mute, but it is inarticulate; it does not use speech, yetbegets it. The speech that the body begets includes illness stories; the problem ofhearing these stories is hearing the body speaking in them. People telling storiesdo not simply describe their sick bodies; their bodies give their stories their parti-cular shape and direction.” Telling stories of embodied experiences such as ill-ness is, Frank says, “giving voice to the body.” The embodied experience isarticulated and can thus be given meaning beyond the mute suffering of the sickbody. The body is enabled to speak through the narrative.

This study investigates the experience of stress in clinical research activities ata major pharmaceutical company, here referred to as PharmaCorp. The clinical

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research process at PharmaCorp is arranged in project teams, called studyworking teams (SWTs) which work on detailed substudies within the comprehen-sive research programme. Each SWT consists of a number of experts such asClinical Research Leaders, Clinical Research Assistants, Medical Advisers(consulting medical doctors with specialist expertise in particular fields ofmedicine), Data Coordinators, safety personnel (analysts of so-called adverseevents or serious adverse events, i.e. potentially undesirable and unanticipatedeffects on patients caused by the tested drug) and secretaries. In the study, allcategories of clinical researchers and employees were interviewed. The majorityof the clinical researchers at PharmaCorp were, however, either Clinical Re-search Leaders or Clinical Research Assistants. The median duration time of theinterviews was approximately 90 minutes. During the interviews, the inter-locutors were asked open-ended questions such as “what does a normal workingday look like for you,” “what do you think is good/bothers you about yourwork,” “do you ever feel stressed at work,” and so forth. It was a pronouncedambition to put as many open-ended questions as possible to the interlocutors inorder to enable a discussion on how stress was conceived of, experienced, verba-lized, and dealt with at PharmaCorp (cf. Nicholas and Gillett, 1997). In total,more than 30 hours of interview material was recorded. All interviews weretranscribed in detail by two independent persons who did not participate in theinterviews. The transcriptions produced close to 400 pages of empirical material.Three researchers examined the empirical material independently and suggestedhow the material could be structured and categorized. The analysis of the mate-rial generated a number of categories that roughly correspond to the headingsused below. It is noteworthy that the categories “stress embodied,” “work-pressure,” etc. (see below) were not used prior to the interviews but were con-structed on the basis of the interviewees’ stories and utterances. After appropriateanalysis of the data material, some findings were reported to the interviewees atPharmaCorp. The findings were subject to a discussion with the interviewees andwere received in favourable terms. In addition, two researchers participated in anumber of SWT meetings and a two-day off-site seminar. These participativeobservations enabled more detailed insights into day-to-day clinical researchactivities.

PharmaCorp and the pharmaceutical industryThe competitive advantages of the pharmaceutical companies are based upon acompany’s ability to generate new knowledge that can produce patents and newmedicines which become marketable profit-generating products (Yeoh and Roth,1999: 639). Yeoh and Roth (1999: 637) write that “the industry is noted for itstechnological intensity and studies suggest that research and development (R&D)is an important source of competitive advantage.” Documenting the effects of a

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new drug is very resource-demanding and time-consuming, and only a fraction ofthe molecules (i.e. the active substance of the drug) tested are finally launched onthe market. The pharmaceutical industry has, perhaps, the longest developmenttimes of all industries (5-15 years) and invests between 9 and 50% (PharmaCorparound 20%) of its sales profit in R&D. When successfully providing evidencefor the positive effects of a certain drug, the performance of the company couldbe considerably affected. Roberts points out that “the profits earned within thepharmaceutical industry are consistently well above those earned in the nexthighest earning industry” (Roberts, 1999: 668). These profits derive very muchfrom the ability of pharmaceutical companies to innovate (Roberts, 1999: 656).

PharmaCorp is one of the largest pharmaceutical companies in the world. Thecompany is a provider of medicines in many therapeutic areas, where the threelargest are cancer, cardiovascular and gastrointestinal medicine. The R&Dcentres are located in Europe and the U.S. and had more than 10,000 employeesand a turnover of USD2 billion in 1999. Today, following a merger with onelarge competitor, the company has more than 50,000 employees world-wide. Theproduct development process in the pharmaceutical industry is complex andconsists of a number of stages: (1) laboratory scientific work where a substancethat promises to affect human health in desirable ways is identified, (2) clinicaltesting on laboratory animals such as rats, (3), clinical tests on voluntary partici-pants such as students or inmates, and finally (4) clinical tests on a population ofpatients. If the drug passes all the stages and proves to be successful in terms ofpositive health effects on patients, the substance can be registered and thereaftersold on the market. The entire product development process is governed byvarious international research and clinical testing standards, and a number ofnational and international committees and boards have to approve the testingprocedures before the product can be launched. Product development is thereforeheavily monitored, controlled, and standardized.

Stress EmbodiedThe experience of stress was pointed out by the interviewees as being manifestedin physical, embodied effects as well as in inabilities to master the work situationbecause of problems focusing on the right priorities and communicating adequa-tely with colleagues. One of the clinical research assistants said: “I think it isbecause 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 afterthat you think, no problem. But when you are stressed, then these two are mixedup . . . It’s hard to find a good word for that.” Another interviewee describedthings thus: “…then something dark comes over me . . . everything becomes acage, and I lose my perspective on things. I do only what is absolutely necessary

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. . . I lose my memory. That is serious, but that’s how it is.” A third intervieweereferred to both bodily and emotional responses to stressful situations: “…well Iget this rush in my heart, and I have this thing in my belly, and I’m generally in abad mood.” The physical effects included a variety of responses such as fatigue,headaches, tensions, cadiac arrythmia, and dizziness, or longer periods of illnessbecause of too much work. These pathological effects are well documented andreported in the medical stress literature (Lazarus and Folkman, 1984; Kahn andBoysiere, 1990; Cox and Ferguson, 1991; Brannon and Feist, 1992). Besidestheir bodily malfunctionings, the interviewees pointed out the psychologicaleffects arising from a work-situation characterized by stress. The inability toconcentrate on a single work-assignment, the unwillingness to talk to colleaguesand other people, general feelings of insufficiency and vulnerability, and experi-ences of depression were mentioned as outcomes of strenuous work situations. Ingeneral, stressful work-situations produced more or less long-term bodily effectsin the employees, which negatively affected their ability to do a good job. Thissituation was produced by (1) work pressure being too high, (2) a lack of controlover the individual work-situation, (3) unsatisfying interpersonal relationships.

Work- pressureThe clinical research activities at PharmaCorp were designed in accordance witha multiplicity of national and international standards, called Good ClinicalPractice (GCP). It is necessary to comply with GCP if the drug is to be acceptedfor registration and launched on the market. In general, clinical testing shouldpreferably be undertaken as fast as possible at the lowest costs given the frame-work that is defined by external medical and ethical committees and monitoringorganizations. As a consequence, the clinical testing of a drug is a continuousattempt to shorten the time to market; “time is all that matters,” as one ClinicalProject Leader put it. Working toward new deadlines was pointed out as beingvery stressful by some of the employees. In PharmaCorp, deadlines were not, asone of the interviewees put it “sacred,” but you certainly had to come up with avery convincing explanation to give the Project Leader if you could not deliveradequate results prior to deadlines. What was especially cumbersome to the inter-viewees was the continual recurrence of deadlines; there were new ones comingall the time. This turned work into a never-ending effort. One assistant said: “Ithink it is more satisfying when I can evaluate my results, right . . . If you finishsomething 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 ofovertime. For instance, one of the clinical project leaders was asked about herovertime:

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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 ofthe work in terms of it being broken down into pieces either through a number ofmeetings spread across the entire week, or interruptions to their work by collea-gues who wanted information, help, or advice on various topics. This produced asituation wherein the clinical researchers never had the time to deal with moredetailed or complex problems. Clinical research is composed of a multiplicity oftests, evaluations, and observations of how a specific drug (or placebo whichsome of the patients in a study are given in order to serve as a reference group forcomparisons) affects the state of health of thousands of patients in, at times, up to30 countries worldwide. Clinical research is, on the bottom line, aimed at pro-viding credible information to medical authorities which will make it possible toget the drug registered. The vast body of information that has to be handledmakes it necessary to have a forum for ongoing information and discussionregarding how the clinical research project is proceeding. Therefore, a con-siderable part of the working week was dedicated to meetings, which were seenas a cause of stress. One of the interviewees said: “My working days could bebooked for meetings up to 80 or 100 percent. Then, if you have made your mindup 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 isstressful to me.” In addition, the need for ongoing information among the clinicalresearchers 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 clini-cal researchers were apt to think of it as undesirable disturbances that eliminatedquality-time aimed at clinical research. As a response, some intervieweesreported that they had tried to cut down on coffee and lunch breaks. One inter-viewee said: “we do eat lunch, but I come back here as fast as possible. Other-wise [when not under stress or work-pressure], when not much is going on, youcould stay in the restaurant for a while, resting and having a cup of coffee, havinga chat with people. But that is just not possible now.” Another intervieweeargued: “Many of our senior bosses encourage us to take breaks and have somecoffee and all that, but I just use my breaks for eating. It is very rare that I take acoffee break. That is stupid because I believe that everyone needs that littlebreak, just to talk about anything but work.” The time-pressure eliminated allpossibilities for reflection. One of the medical doctors argued: “At times, I thinkthat one should stop work and say ‘No, now we need to calm down. We have to

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talk for a while and think about things . . . Is it really realistic to assume that weshould 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 backhome. If I did not have to be concerned about my family, then I would beless stressed, but now I have this double loyality, and which one shouldreceive priority? Should I stay at work or should I go home? I don’t feelthat I am very pleased with myself: I am simply not good enough. (ClinicalResearch Assistant)

The interviewees highlighted a number of problems emerging due to the lack ofcontrol over their individual work-situations and various forms of role ambigui-ties. One of the Clinical Project Leaders said: “It is primarily the people whohave fewer opportunities to determine their own work that are the most stressed.For instance, the Clinical Research Assistants are suffering from stress becausethey are not the ones managing the projects, they do not make the decisions, butthey are the ones who are expected to carry out the practical work.” One of themost stressful problems was the inability to satisfactorily distinguish and separatework and family life. Most of the interviewees had families and the majoritywere women in their thirties and forties who had school children at home. One ofthe clinical researchers illustrated her inability to separate work and family lifeduring a particularly stressful period:

We were working here together, and she's got a family as well, just as Ihave. We were working here the entire day, and then we went back home tofix dinner for our families, took care of things, checked that the homeworkhad been done, did the laundry, and then went back to work again. Then weworked until, say, 10 o'clock and then we went home, slept, got up in themorning, and then did the same thing again. When I came home on the thirdor fouth day, rushing out of my car, I felt something in my stomach, and Ithought to myself ‘what am I actually doing here’.

Another interviewee said: “I think a lot about my job [at home] . . . I bring myjob home . . . both mentally and physically . . . and then I am tired . . . becausethere is always so much going on . . . What has been prioritized less during recentweeks 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, butno longer.” One Clinical Project Leader described her problems separating workfrom family life as particularly stressful: “I noticed that I could not relax. Duringweekends, I did not feel very well until I could sit down with my laptop and dealwith things. That was really a warning signal to me.” Work pressure producedfeelings of insufficiency, a bad conscience, and a very stressful life situation. In

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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 anotherinterviewee put it, “double loyality.” Loyalty problems caused role ambiguitiesbetween both work and family, but also between priorities within the clinicalresearch project. The interviewees thought it was complicated to know how toprioritize their own work since they thought that the vertical communication inthe project was unsatisfactory. One of the interviewees claimed thatcommunication between the project teams and management was assumed to beused only in the event of a problem or an emergency: “It is very much like inschool. Unless you hear about a problem, everything is just fine. I believe it is thesame situation here. I think one [the managers] should have a deeper sense ofcommitment.” Another interviewee responded “never: I have met my boss oncefor one hour,” on the question whether she had regular meetings with her boss. Itwas, in short, not very easy to know how management evaluated the specificproject 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 whatis 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 thatthey just don’t understand what it is like to be sitting in front of the computerscreen being in charge of this database; they simply don’t know how we workand how much work is needed. We are trying to point this out, but it is notalways the case that they understand.” Secondly, it was not unproblematic todecide upon how the individual work assignments were to be prioritized vis-à-viswork done by colleagues. One Clinical Project Leader said: “my job descriptionis 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 worktime was to be allocated was always a source of reflection and discussion. Theinterviewees thus experienced stress as an outcome of role ambiguities arisingfrom the clash between family and work, individual work and the aims of theproject. However, the general attitude and culture at PharmaCorp promotedmutual help. One of the interviewees said that her colleagees were willing to joinforces when needed: “It does not really matter what position you have or whatyour 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 Pharma-Corp was in general egalitarian and there was, the interviewees argued, a cordialand warm atmosphere among colleagues. This was highly appreciated by theinterviewees, but it may also be that the egalitarian attitude and ethos providednew sources of stress. If employees are sharing virtually all the work-assign-ments horizontally, it is increasingly complicated to distinguish between theindividual's work and non-work. In this situation, there is no real control over theindividual work-situation since most work is part of mine. Another source of

15

stressful experiences was technostress. When there were computer problems, itwas impossible to keep up with the work, and consequently, it lagged behind.When work lagged behind, new priorities had to be made. One intervieweeremarked “…quality assurance is the first casualty [in times of stress] . . . wehave to skip quality checks and stop asking some [critical] questions.”

Interpersonal relationshipsA 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 thereis a problem between two people, I ask them as fast as I can to take time out andsolve their conflict. In most cases, conflicts are about a lack of communication.”Some of the interviewees pointed out that they had a problem expressing nega-tive suggestions and comments on how the clinical research projects were beingundertaken. One interviewee said: “there is always this competition between usbecause once a project is finished the next one starts; You want them [colleaguesand managers] to think that you are doing a good job and that you won't rock theboat. [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 thesecretaries claimed they had a problem pointing out deficiencies in researchdesign and other concerns. Another interpersonal relationship that causedundesirable effects was the newcomer. Since the members of the Study WorkTeams 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 — anewcomer changed the existing work procedures: “If you have been workingvery closely with a person for a long time and you know one another and every-thing is fine, then someone else is hired who is supposed to help you. Well, thenall of a sudden there are three of us . . . It may be that the person that I used towork with gets this feeling of being marginalized” (Clinical Research Assistant).Newcomers need direction, training, and help, and therefore cause stress in termsof taking time away from day-to-day activities: “One of the problems is when werecruit new employees. First, every new person slows down everyone else be-cause we have to teach this person. This project has hired too many people in avery short time, and that is not good for us” (Clinical Research Assistant).

The third source of interpersonal stress is the relationship and interaction withmanagement and project leaders. Communicating with leaders/managers andcooperating were the two main problems pointed out as being stressful. Onefemale Clinical Research Assistant said of her female boss: “It can be reallystressful when you have a boss who you can’t get along with. Or have a problemcommunicating with, for instance, someone who says one thing and meansanother, and when she shows up in the morning, you do not know whether she’ll

16

be shining like the sun or whether she will ignore you completely. That is stress-ful.” Another problem with managers was that it could be the case that they donot have appropriate knowledge and experience of working with certain worktasks. In such a situation, it is complicated to convince the manager of the needfor 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 thecompany when you are having a crisis.”

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Discussion

The clinical reseachers at PharmaCorp experienced stressful situations on a dailybasis. Yet, they were very dedicated to their work and saw their efforts as beingpart of a broader health care ideology emphasizing the pathos to help humanbeings to live better and happier (i.e. healthier) lives. Most of the intervieweesdescribed the specific clinically-tested medical substance they were working onat the moment as having a true potential for reducing human suffering, pointingout the financial and market potential for the medicine. The interviewees werewilling 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 theend, since this was dependent on the outcome of the clinical study. As a con-sequence, the clinical researchers worked under ambiguous conditions. Therewas neither a self-evident outcome of their work, nor was the outline of the workitself too clear-cut or obvious to them. The entire work-setting was pervaded by anumber of ambiguities. The ability to handle and accept ambiguities is an out-come of a combination of experience, personality, preferences, cognitive abili-ties, and self-efficacy (Woods and Bandura, 1989). To some individuals, ambig-uity is a potential for new ways of thinking and acting, whereas others approachambiguity with anxiety. At PharmaCorp, ambiguities had to be dealt with on adaily basis and the most prominent (negative) outcome of this was the experienceof stress among the employees. Even though the experience of stress was notequally distributed among the interviewees — for instance, medical doctors whoserved as advisors and experienced Project Leaders did not acknowledge stress asa major problem — stress was always present in some respects. Stress literaturepoints out factors such as role ambiguities and lack of control over the work-situation as influential stressors. The findings from PharmaCorp support thesepropositions.

Meyerson (1998) addresses the inability to handle ambiguous situations,feelings, or problems in organizations, and claims that bodily and emotionalresponses are separated into what is seen as normal and what is seen as abnormal(cf. Canguilhem, 1991; Frank, 1995). At PharmaCorp, there was a generalinability to handle ambiguous responses to work conditions. Even though theoverall work situation was good — e.g. good opportunities for ongoing trainingand education at the company, the workplace was very modern and even a littleextravagant, the employees were highly dedicated to their work, and the com-pany’s performance was (as in the pharmaceutical industry in general [cf.Roberts, 1999]) outstanding — stress remained a key issue to be dealt with. AtPharmaCorp, stress was a broad, general problem, yet there were few oppor-tunities to discuss, deal with, and highlight its impact on personal well-being aswell as interpersonal relations. Even though it was acknowledged as a problem,

18

stress was continuously swept under the carpet. Attempts to handle stress wereprimarily aimed at individual proactive exercises in the same vein as thosepointed out by Martin, Knopoff, and Beckman (1998). At times, lectures onindividual stress management practices were arranged by PharmaCorp, but asone of the interviewees ironically remarked “I didn't have the time to go thereanyway.” These endeavours were appreciated by the interviewees but as one ofthe Clinical Researchers said, “I can always do those Yoga exercises, but it won'tget the job done for me.” The problem was, on the bottom line, the intervieweesargued, 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 problemdealing with ambiguous or non-legitimate embodied responses to externaldemands and expectations: Emotions either have to be familiar (e.g. anger) orthey have to contribute to the production processes of the company (e.g. thesmile 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 aconsequence, it is at times rejected as being a personal problem derived frompersonal shortcomings, or, at other times, when acknowledged, as being anabnormal response to normal demands. Experiences of deviant responses such asstress, burn-out, strong emotions (e.g. love or envy), and so forth, are perfectlynormal responses to the way complex social formations or systems, such asorganizations, operate. If a number of individuals are subjected to strenuouswork-pace, forced to cooperate in an organic work structure, and continuouslymade to change their work-conditions (e.g. newcomers, new directives andobjectives, etc.), then sooner or later some of the employees will be likely toexperience this situation as stressful. That is a normal response to what areincreasingly becoming standard work-conditions (cf. Hochschild, 1997). Theexperience of stress is a social response, surfacing on the individual body, toambiguities produced in a specific setting. In general, PharmaCorp had a poorcapacity to deal with embodied reactions; the indeterminate nature of stress wasdealt with through reducing it to the individual, bodily level. The ClinicalResearchers were, in short, expected to master their “stressed bodies.” The com-plexity 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 thelevel of the individual. In short, stress was personalized. The personalization ofstress is an attempt to capture this complex, fluid phenomenon in fixed cate-gories.

Organizations have to be able to deal with and manage bodily as well asemotional and emotionally-laden activities. In much organization theory, bodily

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and emotional responses and experiences are separated and theoretized upon asbeing of different orders. Nevertheless, it is not meaningful to isolate embodiedexperiences and emotions; mind and body co-exist and interact as one singleentity (Frank, 1995). At least, there is a certain degree of proximity between mindand body (Shilling, 1993). For instance, the experience of stress, burn-out, andother forms of job-related illnesses and problems is neither an entirely bodilyphenomenon, nor an emotional experience, but both simultaneously. Much stressliterature is reductionistic, i.e. it conceives of stress as being either an emotionalproblem or a corporeal problem, and fails to satisfactorily acknowledge stress asbeing socially embedded. Stress is embodied, experienced as a bodily disorder,although inextricably entangled with emotions and caused by extra-corporealfactors. Today, we have neither the tools nor the practices to be able to dealsuccessfully with stress, nor do we have an understanding or theoretical frame-work that can provide such practices. In Jex’s (1998: 91) words: “The study ofoccupational stress is really in its infancy.”

A partial explanation for the shortcomings in dealing with stress lies in thepreference in the stress literature for a Cartesian mind-body dualism rather than aSpinozist parallellism where mind and body are not essentially divided or sepa-rated (Hayden, 1998: 59; Deleuze, 1988). Western thinking, characterized bywhat Luhmann (1990: 22) calls the “transcendental tradition,” has often favouredthe mind over the body, thinking over emotions. This tradition of logocentricthinking is dominant in organization theory (Hassard, Holliday & Willmott,2000; Gergen and Whitney, 1996; Turner, 1996). Organization theory demon-strates a preference for the intellectually-based properties of organizationalactivities; culture, attitude, communication, symbols, and so forth have beeninvestigated and studied at the expense of organizational operations on indivi-duals’ 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 musttake its role alongside other human capabilities such as love fear, pain, andhope.” Hopefully, future attempts to theorize and understand stress and itsimplications for organizations and their employees will be able to depart fromlogocentric models based on reductionism and linear causality.

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Conclusion

At PharmaCorp, the Clinical Researchers experienced stress as an outcome ofextensive work-pressure, an experience of lack of control over the work situation,and as an outcome of unsatisfactory interpersonal relationships. All these con-ditions produced ambiguities that caused more or less stressful work-life experi-ences. However, PharmaCorp provided few mechanisms or techniques fordealing with this situation. It is not unlikely that the situation at PharmaCorp isrepresentative of contemporary work-life situations in terms of stress. If that isthe case, there is a great need to identify and formulate methods and tools fordealing with these problems and rethinking the notion of stress.

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