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Time, Space and Touch at Work: Body Work and Labour Process (Re)Organisation

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With 'efficiency savings' the watchword for health and social care services, reorganisation and labour rationalisation are the order of the day. This article examines the difficulties involved in (re)organising work which takes bodies as its object, or material of production. It shows that working on bodies ('body work') systematically delimits possibilities for labour process rationalisation which, in turn, constrains reorganisation of the health and social care sector. It does this in three main ways. First: rigidity in the ratio of workers to bodies-worked-upon limits the potential to increase capital-labour ratios or cut labour. Secondly: the requirement for co-presence and temporal unpredictability in demand for body work diminish the spatial and temporal malleability of the labour process. Thirdly: the nature of bodies as a material of production--complex, unitary and responsive--makes it difficult to standardise, reorganise or rationalise work. A wide-ranging analysis of body work in health and social care, as well as other sectors, fleshes out these three constraints and shows that attempts to overcome them and reorganise the sector in pursuit of cost savings or 'efficiency', generate problems for workers and the patients, whose bodies they work upon.
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Time, space and touch at work:
Body work and labour process (re)organisation
Rachel Lara Cohen
Department of Sociology, City University London
Rachel.cohen.1@city.ac.uk
Cite this paper as:
Cohen, R.L. (2011) Time, space and touch at work: body work and labour process
(re)organisation, Sociology of Health & Illness, 33, 2, 189205
Abstract:
With ‘efficiency savings’ the watchword for health and social care services, reorganisation
and labour rationalisation are the order of the day. This article examines the difficulties
involved in (re)organising work which takes bodies as its object, or material of production. It
shows that working on bodies (‘body work’) systematically delimits possibilities for labour
process rationalisation which, in turn, constrains reorganisation of the health and social care
sector. It does this in three main ways. First: rigidity in the ratio of workers to bodies-worked-
upon limits the potential to increase capital-labour ratios or cut labour. Second: the
requirement for co-presence and temporal unpredictability in demand for body work
diminish the spatial and temporal malleability of the labour process. Third: the nature of
bodies as a material of production complex, unitary and responsive makes it difficult to
standardize, reorganise or rationalise work. A wide-ranging analysis of body work in health
and social care, as well as other sectors, flesh out these three constraints and show that
attempts to overcome them and reorganise the sector in pursuit of cost savings or
‘efficiency’, generate problems for workers and the patients, whose bodies they work upon.
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Time, space and touch at work:
Body work and labour process (re)organisation
Introduction
The present ‘austerity’ period is witnessing the emergence of new political mantra: the
realisation of ‘efficiency savings’ in health and social care without degradation of frontline
services. This mantra shows naiveté about the work involved in delivering such services.
Specifically, since health and social care services require workers to work on, with and
sometimes inside the bodies of others, bodies are both the object of labour and the material
of production. As this article will show, human bodies are a peculiarly intractable material of
production. This intractability constrains the (re)organisation of work, especially labour
rationalisation. Consequently, realising ‘efficiency savingsis comparatively difficult and
unlikely to occur without degradation in the treatment accorded to both workers and the
bodies they work upon.
Increasingly, the sociology of health and illness has paid attention to embodiment (Williams
1996; Corbin 2003). There have also been excellent studies of the working lives and labour
process experiences of health and social care providers, and of the consequences of
structural (re)organisation for work in the sector (c.f. Doherty 2009; Armstrong and
Armstrong 2010). These two trends have, however, not been well integrated.1 Sociological
analysis of the labour process tends not to focus on patients’ or workers’ bodies, nor the
requirement for bodily manipulation (Wolkowitz 2006). Conversely, sociological analysis of
the sick or medical body has paid little heed to the structural organisation and
reorganisation of paid work on the body. This article suggests that conceptualizing health
and social care work as ‘body work’ (Twigg 2000; Wolkowitz 2002; Twigg 2006; Wolkowitz
2006; Gimlin 2007) enables us to bridge that gap. In so doing it also provides a lens through
which to compare work in health and social care with work in other sectors.
Over 10 percent of UK jobs involve ‘body work’: the touch, manipulation or physical
constraint of bodies (see Table 1, below). These jobs are in expanding sectors: personal
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services and security, as well as health and social care. The workforce involved in ‘body
work’ is therefore likely to increase over the foreseeable future. Consequently
understanding the social organization of body work is of growing importance to our ability to
make sense of not only the health sector, but wider labour process conditions.
Conceptualizing work as ‘body work’ highlights an overlooked aspect of work: that bodies
form the objects or materials of production for a range of jobs. Understanding the ways that
working on bodies systematically delimits possibilities for the (re)organisation or
rationalisation of the labour process the ways in which these limits may be
circumnavigated as well as why we may want them to be reinforced suggests a novel and
useful agenda for labour process analysis. It also provides a way of understanding why
labour process (re)organisation in health and social care is difficult and contentious, and,
why it rarely disappears from the socio-political agenda.
[Table 1 here]
Organisation and Reorganisation of the Labour Process
Notwithstanding professional or compassionate commitment to patients, work and
employment in health and social care settings is played out on the same territory as other
work in capitalism. This territory is marked by persistent, albeit not always predictable,
conflict and constraint (Thompson and Smith 2010) and shaped by the imperative on capital
to continually increase productivity and, to this end, engage in ongoing reorganisation and
rationalisation of the labour process (Marx [1867] 1967). When organisations are in the
public sector this imperative is somewhat altered, but increasingly the public sector is also
subject to pseudo-market mechanisms, incorporating targets, audits and rewards for cost-
cutting (Nettleton, Burrows et al. 2008). Moreover, all workers, in public and not-for-profit as
well as private organisations, sell their labour-power on the market, making it available only
for a limited time (for instance 9 to 5). Profit, or efficiency, therefore depends on the output
of these workers within this time period. This provides managers with the incentive to
substitute labour with capital (often in the form of technology), extract the maximum effort
and decrease the ‘porosity of the working day’ by minimizing gaps or non-working time
between tasks (Green 2001).
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Whereas the above imperatives are general and abstract, any particular labour process, be it
banking or nursing, involves specific tasks and specific constraints on the possibilities for
(re)organisation. This article examines a space between these two poles. Three constraints
on labour process organisation and reorganisation are identified. These are not general to all
work, yet they span occupational divides as they are produced when work takes the bodies
of others as its object. They are:
1. Rigidity in the ratio of workers to bodies-worked-upon limits the potential to increase
capital-labour ratios or cut labour.
2. The requirement for co-presence and temporal unpredictability in demand for body
work diminish the spatial and temporal malleability of the labour process.
3. The nature of bodies as a material of production complex, unitary and responsive
makes it difficult to standardize, reorganise or rationalise work.
The main body of the article expands on these three constraints, exploring ways in which
each might be overcome, in whole or in part. The paper begins, however, by proposing a
working definition of body work, and introducing the concept of body labour.
Defining ‘Body Work’/‘Body Labour’
Setting aside (for the moment) differences between paid and unpaid work, if body work is
work ‘on the bodies of others’ what exactly is included? Possible responses include work on
conscious bodies, work on live bodies, work on intact bodies2, work on body parts and work
on bodily excretions. These responses are nested: work on conscious bodies necessarily
encompasses all that follows work on live, intact bodies, body parts and usually some
excretions but the reverse is not true; bodily excretions can be examined without
encountering any live, intact bodies, or even body parts. In her overview of body work,
Wolkowitz (2002) is ambiguous about how wide a conceptual net to cast. Her empirical
examples involve direct and sustained contact with live, and usually conscious, bodies
(nurses, care-workers, beauticians, sex-workers). She suggests, however, that body work
might also encompass ‘occupations that, even if they do not involve direct touching, deal
with body fluids and wastes, [for example] hospital ward cleaners’ (2002). Notably, this
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includes those whose central purpose is the manipulation of body parts or emissions (for
example, workers in a sperm bank or stem-cell scientists) and workers who encounter bodily
emissions as debris out of place (hospital ward cleaners, but also any cleaner encountering a
dirty toilet, human hairs, vomit or simply domestic dust). Such an expansive definition nicely
highlights the centrality of others’ physical bodies and their excretions to numerous jobs.
Nonetheless the treatment of bodies as a material object like any other, physical, malleable
and ultimately divisible, obviates that which makes bodies a theoretically interesting object
of labour and a fruitful subject for labour process analysis: that bodies are unitary,
communicative and mindful. A clearly delineated conceptual boundary nonetheless remains
elusive because, in practice, bodies slip between consciousness and unconsciousness and
work on live bodies may involve prone, unconscious, immobile or inarticulate bodies or
bodies going between life and death. The definition adopted here is therefore pragmatic,
rooted in a specific analytic goal developing labour process analysis of body work.3 It is:
body work involves the manipulation or touch of another’s intact body.
Body work has been used to describe paid work on the body of another (Twigg 2000;
Wolkowitz 2002; Twigg 2006; Wolkowitz 2006; Gimlin 2007). In this article, however, I follow
Kang (2010), and by ‘body work refer to all work on the body of another, reserving body
labour for body work that is sold for a wage or commodified. This conceptually parallels the
dichotomy made by Hochschild (1983) between emotional work’ and ‘emotional labour’,
and therefore establishes a framework for analysing the interrelationship between
emotional work/labour and body work/labour. The body work/labour distinction also
recognises the difference between the work itself (the tasks) and the commodified form of
these tasks. Whereas the tasks may be the same (for instance massaging a back), when
these tasks are performed in commodified relations the end is not principally intrinsic or
embodied but exterior and disembodied: profit or output targets rather than a relaxed back
(although there are exceptions/qualifications). The following sections examine the social
organisation of paid body work, or ‘body labour. The focus is health and social care, but
examples from other body work sectors extend and situate the analysis, while contrasts with
non-body work provide context.
1. The ratio of bodies to labour to capital
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Body work is labour intensive. A single worker can only in exceptional circumstances work on
multiple bodies concurrently: bodies are simply too large, complex and contrary. A nurse
bandaging one patient cannot simultaneously take blood from another. A manicurist filing
one client’s fingernails cannot polish another’s toenails. Notwithstanding worker dexterity,
these scenarios are improbable. Accordingly, during the time that they work on any one
body, the relationship between worker and body is minimally one-to-one. Where several
workers work on a single body, for instance a surgical team clustered round a patient in an
operating theatre, the relationship is many-to-one. Scale increases do not therefore directly
produce efficiency gains; an increase in the number of bodies worked on requires a
proportionate increase in labour. To cut costs, or increase profits, either the body must
receive less attention (discussed below) or a division of labour introduced, with parts of the
labour process assigned to lower skilled, or at least lower paid, workers. The latter has
occurred over and again in health services (c.f. Armstrong and Armstrong 2010) as, for
example, nurses are assigned tasks that were previously doctors’ prerogative (Doherty 2009)
and health care assistants take on nurses’ tasks (Bach, Kessler et al. 2010). It is also found in
other fields. For example, larger hairdressing salons employ a high ratio of trainees to
stylists. Paid less than half the wage of a stylist, trainees wash and blow-dry clients’ hair,
enabling (higher paid and higher skilled) hairstylists to ‘see’ more clients (Cohen 2005).
As simple tasks get sloughed off to lower paid workers the number of workers attending to
any one body increases. Although bodies remain unitary, this fractures institutional
interactions with the body into multiple interactions, often each with a different body part at
a different time. This undermines efforts to treat the body/person holistically; this is not the
‘continuity of care’ sought by patients, nor is it ‘holistic nursing’. It also runs counter to the
‘personalisation’ that commercial sellers of body work foster (Toerien and Kitzinger 2007).
Reorganisation involving labour substitution may therefore be a sign of patient/client
relative disempowerment. Additionally, as each worker’s embodied engagement with a
patient’s/client’s body is reduced their reliance on notes from co-workers or oral
communication with the body-worked-upon increases. In this way an unintended by-product
of labour substitution in body labour is increased reliance on workers’ abilities to coax out,
and offer, cogent verbal and written explanations of embodied states. Yet labour substitution
simultaneously undermines workers’ ability to build the relationships with patients/clients
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that would smooth these interactions.
Reducing the ratio of workers to bodies without labour substitution and without decreasing
the attention paid to any one body may be possible where body labour is applied
discontinuously; with gaps, or times when bodies are present but not being worked on. Such
gaps occur, for example, while a patient waits with a thermometer under her tongue or a
hairdressing client sits under the dryer while her perm ‘takes’; patients/clients are in the
workplace, but temporarily not being worked upon. Some gaps are brief; however others are
sufficient for workers to move to work on another body. This facilitates either one-to-many
or many-to-many relationships. A single worker or group of workers is able to work on
multiple co-present bodies if not simultaneously then at least serially. Unfortunately, relying
on labour process gaps to improve efficiency requires that workers can predict their
periodicity and length. Bodies and their temporality are, however, frustratingly
unpredictable (discussed further below).
Not all workers who do body labour spend all of their time doing it. Table 2 estimates the
order of selected occupations on the basis of the proportion of total labour time spent
engaged in body labour. At the top are jobs involving almost constant touch. A masseur
spends the vast majority of income-producing time physically engaged with a client's body;
similarly a sex worker or manicurist. Turning to medical occupations there is clearly a
difference between a dentist and a General Practitioner. Whilst a dentist physically engages
with every patient (Nettleton 1992), a General Practitioner’s interactions with some patients
will be entirely discursive. Similarly, whereas home-care workers are often called upon to
perform general household tasks, including cleaning or even cooking (see England et al., this
volume), care-workers in residential homes spend more of the working day dealing with the
bodily needs of residents, due to clearly delineated work roles and dedicated cooking and
cleaning staff (Diamond 1992).
[Table 2 here]
At the foot of Table 2 are occupations involving relatively infrequent touch or bodily
manipulation. For example an airport security guard sometimes, but infrequently, restrains
or 'pats down' bodies. Similarly a psychiatrist may occasionally conduct physical
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examinations, but spends significantly more time talking to patients, writing up notes or
discussing cases with colleagues. Of course the amount of body labour performed varies
between psychiatric specialties, just as it does between security guards located in different
environments.
In jobs where body labour is a smaller part of total labour (such as those at the foot of Table
2) or where the objects of body labour are present but do not require constant attention, it
may become possible to lower the ratio of workers to bodies, thereby easing labour process
reorganisation. It is not necessary to have one security guard for each body entering a
nightclub or one care worker for every residential home occupant. The unpredictability of
bodies means, however, that reductions in the worker-body ratio increase the likelihood that
there are sometimes too few body workers. For example, if a nightclub fight breaks out
requiring the restraint of several people, the need for body labour will suddenly spike.
Similarly, several care-home residents may require toileting or to be taken to dinner
simultaneously. Thus, critical in the organisation of body labour is determining the balance
between sporadically inactive labour and sporadically unattended bodies. In some cases (for
example when someone is having a heart attack or a fire has broken out), making bodies
wait is harmful, but in other cases (a medical check-up or a manicure) delay produces little
more than patient/client frustration. This suggests that an important dimension in
determining how easily body labour can be reorganized is the ability or not of the body-
worked-upon to wait or its relative neediness. Where bodies are needier, and where there
are social arguments for addressing that need, sufficient labour must be employed to cover
peaks. This means that during ‘slack periods’ labour is ‘baggy, at work but not working. For
instance it is socially acceptable that sometimes fire-fighters have little to do or that during
(perhaps rare) quiet times hospital casualty ward staff will be unoccupied because their
presence during rush times is essential.
Of course the ‘neediness’ of bodies is not purely physical. It is also social, political and
economic. As already suggested, where services are publically managed neediness is
concretised as public policy. This prioritizes particular bodies. For example the UK
government has introduced strict waiting time targetsfor cancer patients but not for other
seriously ill patients, thus implicitly prioritising the former. De-prioritisation of need and the
normalisation of some bodies’ discomfort is exposed by Diamond (1992), who details the
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habitual inattention care-home residents suffer.
Given the staff-resident ratio, it was deemed most efficient to have diapers put on
many of the residents, so that their bodily cleaning could be attended to after the
fact. By the time we reached some residents to change diapers, it might have been
several hours after they had first called us. Residents had to learn to sit or lie in bed
after an accident waiting for clean to be restored. (Diamond 1992)
Lacking socio-economic power, residents are unable to characterise their bodily needs as
important. Instead, in the context of labour shortages, residents are forced to ‘learn’ to cope
with a situation most adults would find intolerable, effectively recalibrating bodily need.
The structural relationship between worker and body also affects the calculation of need.
For instance, self-employed body workers, such as hairstylists, complementary and
alternative medicine (CAM) practitioners and sports therapists, depend on repeat custom
and as such have a structural incentive to be available when clients ‘need’ to see them, even
at their own inconvenience. In contrast, waged workers are structurally independent from
clients and less willing to accommodate (or legitimate) client need (Cohen 2010).
2. Temporal and spatial malleability
Co-presence is tangential to much service work, a by-product of the need to communicate,
transfer goods or display a corporate aesthetic in, respectively, business meetings, retail
transactions and the cultural industry. Co-presence is, however, essential when the object of
work is the physical manipulation of the body of a customer, client, or patient. Workers and
bodies must inhabit the same time-spaces. This means that centralisation or wholesale off-
shoring of body labour is infeasible, notwithstanding pressures to cut costs by employing
cheaper or fewer workers.4 Regions have nonetheless emerged as both body work
destinations (Argentina for plastic surgery; Eastern Europe for dentistry (Connell 2006); the
Gulf Coast for care-homes) and as centres for body work training (whether Filipino nurses
(Romina Guevarra 2006) or Cuban doctors (Feinsilver 2010)).
In non-body work service industries the need for co-presence has decreased with the
expansion in remote or virtual interactions mediated by information and communication
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technologies (ICT). Similarly attempts are being made to substitute co-present body labour
for tele-presence. For instance, ‘telemedicine’ (Dyb and Halford 2009), which involves virtual
links between patient and clinician or between multiple clinicians. Telemedicine enables
cost-cutting, for example by centralising primary healthcare advice or reducing demand for
home-visits and out-of-hours doctors (Lattimer, George et al. 1998). It may be democratising,
as expensive specialist medical expertise, such as surgeons, can be dispersed without
dispersing specialists, although evidence for this remains scant. More pertinently,
telemedicine barely reduces demand for geographically proximate body labour. Rather,
advice-giving is separated off or body labour performed by cheaper workers with fewer or
less specialist skills (the generalist or nurse practitioner, acting on the specialist’s remote
advice5). Hence, telemedicine barely diminishes the demand for body labour. The success of
this strategy may instead be the distillation of body labour in the health sector into ‘manual
workin juxtaposition with ‘mental’ advice or direction. This is consequential for both
patients and workers. Geographically remote surgeons may be more prone to objectifying
patients (van Wynsberghe and Gastmans 2008). While, if it becomes denuded of decision-
making capacity, the status of body work will further erode, intensifying the ‘stigma’
attached to close physical proximity with bodies (Isaksen 2002). This will only exacerbate
current employment trends in body labour which relies heavily on ultra-exploitable
migrant female labour (McDowell 2009; Kang 2010). Meanwhile extension of the
mental/manual divide may increase the obstacles faced by patients who want control over
their own physical care but whose embodied interactions are principally with workers
lacking agency.
Telecare’ (Hibbert, Mair et al. 2003; López and Domènech 2008) has achieved more
reduction in the demand for body labour than telemedicine. Telecare often requires the
patient (or body-worked-on) to self-monitor. Service users may operate an alarm
themselves, sending information to a central location; alternatively the process may be
entirely mechanized, for example involving devices that automatically record blood pressure
and electronically trigger alarms. In both instances the requirement for a carer (paid or
unpaid) to physically monitor the body is reduced. Nonetheless, once alerted a worker is
dispatched. Thus telecare does not eliminate the need for body labour but may make it
possible to rationalise and allocate this from a centralised hub with monitoring used to
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determine which bodies are (most) at need. Accordingly it somewhat concentrates work
without spatially centralising bodies-worked-upon. It also remains dependent upon an
adequate bank of staff able to travel to bodies when required, something made difficult by
the unpredictability of bodily need.
The intersection of the requirement for co-presence with the unpredictability of bodies’
social and physical demands makes spatio-temporal organisation of body labour particularly
tricky. As Twigg (2006) notes it is hard to schedule work on the body: ‘care tasks cannot be
accumulated and dealt with efficiently in one go: you cannot save up going to the toilet for a
week and then do it just once. The body has its own timings.This makes bodies a contrary
material of production. Moreover the biological unpredictability of bodies is exacerbated by
consciousness and autonomous mobility (in contrast unconscious or immobile bodies are
less contrary and more easily ‘trained’, with a corpse the most manipulable of bodies).
Accordingly, those who work on bodies often find it difficult to delimit working times and are
disproportionately required to work outside of the ‘normal’ working week. For example, as
Table 1 shows, workers who do body labour are about 1.75 times as likely as other workers
to work Saturdays and over twice as likely to work Sundays.
A closer examination of weekend working hints at several distinct patterns for the
temporality of body labour. The first encompasses workers engaged in bodily adornment:
hairdressers, beauticians, tattooists and, to a lesser extent, personal trainers. These workers
must ‘enchant’ (Korczynski 2005) and temporally accommodate their ‘customers’. As such,
almost all workers performing body labour for adornment work Saturdays. Since the need
for adornment is unlikely to arise with extreme unexpectedness or urgency most of these
workers do manage one weekend day, Sunday, without work. In contrast, workers
responsible for the health or control of bodies nurses, emergency room doctors,
paramedics and care assistants, as well as prison warders and security staff are almost as
likely to work on Sundays as Saturdays. For instance, over half of the workers classified as
‘healthcare and related personal services’ work on each of Saturday (57 percent) and Sunday
(53 percent). The figures for ‘protective service occupations’ are similar (62 and 59 percent).
Three types of body worker are, however, under substantially less pressure to extend their
working time into the weekend. The first is undertakers. Working on dead bodies,
undertakers are able to exercise some schedule and workplace control. The second is child-
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care providers. This is an interesting case in which workers’ body labour is a direct (paid)
substitute for unpaid (usually familial) body work. As such, the temporal need for the former
depends on the employment or other commitments of the latter. Consequently, child-care
workers’ hours closely coincide with the ‘normal’ working week. The third group with little
pressure to extend their working hours comprises workers providing non-urgent medical
care, including for example, salaried primary care physicians, district nurses, dentists and
therapists. Non-urgent medical care occupies a quite specific position with regard to the
temporality of social need, on the one hand non-urgent and so not provided around the
clock. On the other hand it is accorded sufficient social importance that patients are (usually)
able to secure leave from employment or education and schedule appointments during
‘normal’ working hours, thereby allowing this group of body workers to enjoy relatively
regular working hours.6
If the temporal contrariness of bodies produces pressure to extend hours, it also makes it
difficult to distribute work evenly across the working day. A constant work pace requires
bodies be ready at the place and time that workers finish work on a previous body. Without
bodies to work, on time hangs baggily. Thus one of the features of much body work is
moments, even hours, of baggy time, followed by periods of intensive work. When rewards
to labour are based on time at work (for example hourly pay) baggy time is costly for
employers. Thus there is an incentive to reorganise body work in order to overcome this and
decrease the ‘porosity of the working day’. In some respects this drive is no different to that
found more generally (Green 2001). However, as discussed below, the elimination of baggy
time may have additional consequences and be especially tricky when bodies are the
material of production being reorganised.
One way that a continuous stream of work can be achieved and baggy time eliminated is
through the spatial concentration of ‘needy’ bodies. Residential care-homes are exemplary
here: bodies are proximate and the productive use of gaps in bodily need is possible. Thus
Lopez (2007) describes care-workers leaving residents alone on the toilet (despite formal
rules prohibiting this), in order to use the brief temporal in-betweens to attend to other
residents. Care-home residents are, however, not only clustered but also lack mobility and
are, as suggested above, relatively powerless. Their powerlessness is additionally important
to the temporal management of body labour. Thus hard-pressed residential care-workers
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systematically ignore residents’ requests to sleep late in the morning, in order to manage the
intense work demands involved in getting all residents up and to breakfast on time
(Diamond 1992). In a similar vein, self-employed mobile hairstylists may seek out elderly
clients, who are immobile and dependent, precisely in order to gain control of their
schedules and the spatial and temporal organization and ordering of work (Cohen 2010).
Thus, as the dependence or powerlessness of the body-worked-upon increases temporal
control shifts to the worker and, when the worker is an employee, the employing
organisation.
Where it is not possible to reorganise the working day or spatially concentrate bodes-
worked-upon self-employment, especially own-account work or ‘self-employment without
employees, is common. Since the hours of work of the self-employed worker are not valued
on the market there is no requirement to recoup a specific hourly return. Consequently
although baggy time may slow down the earnings of own-account-workers, therefore
requiring additional hours to achieve a given return (or ‘self-exploitation), it does not make
labour costs uneconomic; as it would if body labour were performed by hourly paid waged
employees. Accordingly, there has been relatively little concentration of private capital in
body work sectors and, as Table 1 shows, a proliferation of self-employment in body labour
occupations in the UK outside the two large nationalised sectors (health and protection).
The dominant role played by large scale capital in the US health sector, for instance in HMOs,
initially contradicts this. Yet even in the US sites of body labour have undergone relatively
little concentration. For instance a study of US private physicians, found that 47 percent
practiced solo or with one other physician, with a further 35 percent based in practices of 3-
9 physicians (Casalino, Devers et al. 2003). Generally HMOs have exerted control over body
labour via contracting rather than direct employment relationships. Partial explanation for
this may be found in the difficulty of consistently utilising labour.
3. Standardisation and reorganisation
Bodies’ temporal unpredictability is indicative of the difference between body time and the
abstract clock-time of capitalism (Adam 1993). Bodies are not unique in adhering to a
temporality at odds with capitalist production. Indeed related arguments have been made
about other organic materials, perhaps most persuasively by Susan Mann (1990) in an
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examination of the (relatively) slow entry of capital into agricultural production. In
agriculture, however, capital investment has increasingly standardised production times and
inputs, minimizing the impact of organic phenomena, from seasonality to insect predators.
This section examines the extent to which such standardisation and rationalisation of bodies
has been able to remake bodies as predictable materials of production, including refitting
body time to capitalist time.
Standardisation is desired because it enables the predictable allocation of resources. This
facilitates a division of labour whereby parts of the process (and eventually perhaps the
whole process) are performed by cheaper (unskilled) labour or are mechanised, increasing
efficiency and profitability. Standardisation alone may not however improve efficiency. A
case in point is the standardisation of appointment times common to upscale hair salons.
These, for example, specify that a restyle must occupy an hour-long appointment. This is
sufficient time to accomplish most new styles at a measured pace, thereby indicating the
‘quality’ of the service, while allowing time for stylists to suggest extra treatments and
products (possibly earning commission). Since however the complexity of a restyle and the
thickness, texture and condition of hair vary there is actually little standard about these
timings. This means that should, clients have thin hair or request easy restyles workers resort
to ‘drying’ or ‘styling hair that is already thoroughly dry and styled simply to fill time (Cohen
2005). This is a form of ‘standardising up’ setting standard timings at maximums. It is
notable that standardising up, which appears a paradoxical way to rationalise labour use,
since it reduces labour efficiency, occurs primarily where ‘service’ premiums are sought.
Thus it indicates the relative power of the body-worked-upon in this sector and the related
requirement to represent body labour in terms of both quality and value.
Caesarean birth provides a contrasting instance of bodily standardisation, which
demonstrates the intersection of temporal standardisation with definite structures of
employment and compensation. The World Health Organisation estimates that caesareans
are medically ‘appropriate’ in between 5 and 15 percent of births (Althabe and Belizán 2006)
yet all OECD countries except the Netherlands have rates exceeding this maximum
(MacDorman, Menacker et al. 2008). Rates in Latin America are especially high, however a
study of Latin American eight countries (Villar, Valladares et al. 2006) found that ‘the
proportion of caesarean delivery was always higher in private hospitals.For example, in
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Brazil, caesarean rates in private clinics were as high as 90%, with, ‘higher caesarean
delivery rates mostly due to an increase in elective caesarean delivery. The times and
personnel involved in performing caesareans also differ between private and public
hospitals. For instance, one comparative study showed that deliveries in a public clinic were
performed by the doctor on duty, whereas in a private clinic 96 percent of deliveries were
performed by the doctor who had performed prenatal care. At the public clinic deliveries
occurred on all seven days of the week at relatively similar rates; at the private clinic only
10% of deliveries occurred on Saturdays and 5% on Sundays. At the public clinic deliveries
were equally likely over the four quarters of the day; at the private clinic only 10.4 percent of
deliveries occurred during the night (0:00 to 5:59) with the greatest number (36%) in the
shift immediately prior to this (18:00 to 23:59) (de Almeida, Bettiol et al. 2008).7 These
figures describe a gradual standardisation of body time within (especially) private medicine.
In this case a medical intervention, elective caesarean, is used to overcome the temporal
unpredictability of childbirth despite costs to the bodies being standardised: increased risk
to the health of mother and foetus. Generally caesareans are compensated at the same rate
as natural birth, but are quicker and can be planned. Thus, doctors save much time and fit
in many more activities by scheduling caesareans’ (McCallum 2005).8 Employment relations
and the wider structures of social healthcare also influence incentives for, and the form
taken by, standardisation. For example, private prenatal healthcare in Brazil uses a ‘single
named obstetrician model’. Care is personalised and doctors have an interest in producing
and retaining a ‘clientele’. Because a single doctor is given sole responsibility for each
patient’s obstetric work, care must be fit within this doctor’s working (and waking) hours.
This is only realisable by exerting temporal control over patients’ bodies (Murray and Elston
2005).9
A recent Royal College of Physicians (RCP) report (2010) revealed another medical
intervention aimed at the standardisation of bodies: the fitting of artificial feeding tubes. The
report caused quite a stir in the UK media. Most reports concentrated on anecdotal evidence
of residential care-homes making it a condition of admittance that residents be fitted with
feeding tubes, ‘because staff shortages mean there is not enough time for conventional
feeding’ (Lister 2010). Artificial feeding tubes enable feeding to occur efficiently and
whenever required. Feeding tubes also circumvent two otherwise time-consuming and
16
unpredictable body labour activities: the intensive palliative support necessary to overcome
temporary swallowing difficulties and ongoing mealtime support. Since the mealtime body
labour may be required by several residents simultaneously, it is especially difficult for
workers to manage. The fitting of feeding tubes is thus a ‘rational’ solution; a way of
physically and temporally standardizing and managing bodies. As US studies have found, it is
one that is also most common where there are staff shortages and care-homes are run on a
for-profit basis (c.f. Mitchell, Teno et al. 2003; Lopez, Amella et al. 2010). When the RCP
report hit the headlines, it was, however, greeted with outrage, with articles appearing
across the print and broadcast media highlighting that, ‘the technique [artificial feeding]
risks infections and also deprives patients of the pleasure of taste, and social interaction that
come with normal eating’ (Lister 2010). As this discussion, from The Times newspaper,
indicates, bodies are not and cannot be treated as a material of production, like any other.
Feeding is understood as more than a simple biological requirement to be managed
‘efficiently. The example therefore demonstrates both the ongoing attempts to mechanically
standardize bodies and the ongoing resistance to this.
Body work sectors outside of health and social care have also seen attempts to mechanise
and standardise interactions with bodies. For example, scanning machines at building
entrances automate bodily searches, which would otherwise require a security guard
performing a ‘pat down’. Coin-operated massage chairs, common in airport lounges, obviate
the need for a masseur, while, mechanical seat and pillow ‘massagers’ are increasingly
popular retail items. Yet, unlike a trained masseur mechanical massagers cannot easily adapt
to different bodies. Safety requires settings appropriate for the frailest of bodies, meaning
bodies cannot be vigorously pummelled. Similarly, since automated body technologies are
designed for the ‘average body’, they inevitably fit some bodies poorly, as evidenced by a
customer review for a ‘shiatsu massager’ available at British retailer Argos.com:
I am quite tall and would have preferred it if the massage could have gone a little bit
higher, it stopped between my shoulder blades and I wanted it to keep going all the
way to the back of my neck.
While most reviews are positive, these above highlights the difficulties involved in producing
a standardised mechanical device suitable for all bodies. An ill-fitting massager may be
17
uncomfortable, but in other bodily interactions, for example a dental extraction, misfit could
be bloody. Unsurprisingly wholesale standardisation and mechanisation has made few
inroads into body labour.
More often standardisation is piecemeal, barely apparent and subject to little resistance. Yet
across body work sectors and in manifold ways bodies are prepared and made predictable in
preparation for being worked upon. This frequently disempowers and, as Wolkowitz notes, is
designed to constrain the body-worked-upon.
Even when the worked-on-body is not physically weakened through disability, old age
or the humiliation of double incontinence, it is frequently anaesthetised, supine or
naked, or rendered immobile by gown or facial mud pack, making it difficult for the
patient, customer or client to just get up and leave. (Wolkowitz 2006)
The above examples of standardisation describe in various guises the enforced
transformation of the body-worked-upon in order to produce a more predictable and
malleable material of production. Collectively these might be typified as standardisation by
transformation. A second set of practices also involve standardisation, but not
transformation. Collectively they may be characterised as standardisation by selection.
Standardisation by selection can also take various forms, but because it does not require
remaking the body, it has faced considerably less resistance than standardisation by
transformation. The first selection point is body type. It is notable that a lot of body labour is
delimited by the age, sex or other physical or social attribute, of the bodies-worked-upon
(old bodies; babies’ bodies; female bodies), which in turn diminishes both the physical and
social variability of the work. For instance, some branches of medicine are defined by the
age of the body-worked-upon (geriatrics, paediatrics) whereas other specialties involve only
female bodies (obstetrics and gynaecology). Similarly, prison guards tend to work with only
male or only female bodies; most sex workers work primarily with men; many hair salons
specialise in men’s or women’s or afro-Caribbean hair; while child-care and care-home
workers work with young and old bodies respectively. A second form of standardisation by
selection involves focusing on a single body part, whether hair, eyes, nose, feet or spine.
Finally, most body workers carry out specific and limited procedures on those body parts
with which they are concerned. For example, an optometrist and an ophthalmologist will
18
approach and engage with the eye differently. Equally a manicurist and podiatrist may both
specialise on feet but have different foci.
The result of standardisation by selection is that the live body is effectively divided into parts
and functions rather than being treated as an organic and social entity. As such it
exacerbates tendencies towards dividing the body that emerge from the use of a division of
labour to cheapen labour (discussed in section 1, above). That bodies-worked-upon (patients
or clients), recognise the medical and social limitations of this is seen in recurring pleas for
‘joined up’ health services, which are effectively calls for the recombination of the body-
worked-upon. There seems, however, little evidence that these will be heeded, partly
because standardisation by selection increases the speed with which bodies can be assessed
and managed by limiting the number of, and variation in, the bodily functions of concern. It
also facilitates the relatively cheap production of specialist workers and, increasingly, stand-
alone centres with extensive knowledge in one body type, part, process or aesthetic, but
little knowledge or interest in others. Perhaps unsurprisingly, many of the inroads made by
private companies into the UK’s National Health Service depend upon this form of
standardisation; contracting to perform a single common operation (such as cataract
surgery) at high volume.
Standardisation by selection appears less brutal than standardisation by transformation;
however neither recognises the body as holistic nor less mindful. This highlights a final
tension: when body work takes the form of body labour paid work on the body of another
there is inexorable pressure to standardise and reorganise the labour process. While some
standardisation by selection is perhaps inevitable, standardisation is inherently
dehumanising, because human beings are not standard, not temporally and not physically.
Yet whether (and how) resistance to standardisation from the body-worked-upon, in the
form of patient, user or client groups, may intersect with and potentially reinforce resistance
to labour standardisation and deskilling on the part of body workers, remains to be seen.
Discussion
Body labour does not involve a single set of practices, nor a single set of workers or bodies-
worked-upon. Despite the diversity of forms taken by body labour there are, however,
19
important commonalities. Amongst these is a set of labour process constraints that occur
when work takes the human body as its object. These constraints arise out of the
intersection between the dynamics of capitalist employment relations and the properties of
the body-worked-upon. Bodies are complex, labour intensive materials to work with. They
are indivisible and located. They do not keep to industrial time and are frustratingly contrary.
They are also varied, physically and socially. Lastly, they can respond in multiple ways:
physically (hitting out, clenching teeth, walking away, following or not following
instructions), verbally (complaining or with geniality) and, most uniquely, collectively (in
social or political movements, or through the state). As such, bodies-worked-upon can
demand more or different body labour be applied and direct or resist body labour.
Different bodies are differently able to make demands for, or resist, body labour. Their ability
to do this depends on their physical power or frailty, nakedness or exposure (Twigg 2000).
The power to demand or resist body labour also depends upon the structural relationship
between body worker and body-worked-upon. This relationship may (A) be mediated by
various other actors. For example, care work is funded by the state, coordinated by a private
organisation/employer, carried out by an employee, negotiated with a relative, and
performed on a body. Alternatively the relationship may (B) involve the body-worked-upon
and body worker only. For example there is a direct and unmediated relationship between
the self-employed masseur and her client; as there is between the disabled employer of a
home-care-worker. In both scenarios B the body worker is directly financially dependent
upon the body-worked-upon, albeit employed within different formal structures (self-
employed and employee). In scenario A the body worker’s income is entirely independent of
the body-worked-upon; yet both may be structurally disempowered vis-à-vis a private
employer, the state or other actors. These scenarios highlight variation in the distribution of
power, dependence and interdependence between body-worked-upon and body worker.
Finally, the power of body-worked-upon vis-à-vis body worker depends on the relative socio-
economic position of each. While, in the close confines of body labour gendered, racialised
and sexualised power structures can become tangible (c.f. Wolkowitz 2006; Kang 2010).
For sociologists of work and the labour process examination of body labour serves a
reminder that the concrete tasks that workers do matter. Partly because these set limits on
capitals capacity to transform the labour process at will. Body labour is not necessarily
20
better, nor worse, than other work. It is, however, perhaps uniquely difficult to rationalise,
not least because transformations of the labour process directly impact the body-worked-
upon. In this context struggles between the capital and workers over labour process
(re)organisation cannot but include other actors: firstly the body-worked-upon, but also the
state, whether as regulator or employer of last resort. In this context struggles over labour-
use, the reorganisation of the day, or the standardisation of the body are not predictable,
and their resolution will depend upon a series of intersecting struggles, over issues as
diverse as resource allocation, regulatory frameworks, working conditions and the bodily
violability and will mostly likely involve the collective organisation of both body workers and
bodies-worked-upon (in patient or user groups).
The organisational constraints’ discussed herein, may or may not be problematic when body
work is performed in extra-economic social relations, subject to different rationalities and
temporal logics. For instance, when body work is carried out by a friend or a family member,
gaps between tasks may not signify inefficient time use’, but rather facilitate conversation,
TV-watching or other activities of the life-world. Governments readily understand and
exploit this (albeit perhaps implicitly) and increasingly provide social welfare in the form of
direct payments to family members to provide care (Simonazzi 2009) thereby circumventing
problems associated with commodified, especially waged, body labour.10 It might be the
case that this will in turn extend pressures to standardise and reorganise body work to extra-
work spaces and social relations, concomitantly extending the systematic transformation
and fragmentation of the body-worked-upon.
21
Tables
Table 1: Body labour, schedule and employment status. Labour Force Survey, Spring 2005
Schedule
Employment Status
Total
Mean
weekly
hours
% Work
Saturday
% Work
Sunday
% Self-
emplyd
No emps
% Self-
emplyd
W, emps
Not body labour
32.8
25.6
15.5
9.9
2.9
25,171,130
Body labour*
30.0
44.8
36.4
9.0
3.2
2,932,679
Health professionals
40.6
29.0
19.2
9.3
23.4
223,994
Health associate
professionals
29.9
47.5
44.8
2.2
0.4
613,011
Healthcare and related
personal services
28.1
56.9
52.9
1.8
0.1
898,364
Childcare and related
personal services
25.8
5.4
2.9
20.2
1.1
330,882
Therapists
25.7
12.0
6.1
30.1
2.8
139,739
Sports and fitness
occupations
22.5
39.1
25.0
30.5
0.7
85,759
Hairdressers & beauty
salon managers
32.1
81.2
3.8
27.4
52.6
30,919
Hairdressers and related
occupations
26.4
66.6
6.1
37.8
6.6
189,914
Undertakers and
mortuary assistants
30.5
21.2
18.8
8.6
1.8
16,173
Protective service
officers
39.8
32.4
31.2
0.0
0.7
68,498
Protective service
occupations
35.8
62.1
58.8
0.2
0.0
335,426
*Body labour’ occupations were selected at 3-digit level. Therefore where workers within these 2-digit
occupational groups were judged as not directly involved in body labour (for example radiologists) they were
coded as ‘not body labour’ and excluded from tallies for the occupational group (list of body labour by 3-digit
occupation available on request from author). Reliance on standard occupational codes excludes some work,
including work occurring on the interstices of legality such as sex work. Workers performing body labour in a
second job are also omitted. A fuller version of this table was first produced by the author for a presentation to
the ESRC seminar series on Body Work (see www.go.warwick.ac.uk/bodywork).
22
Table 2: Body labour as estimated proportion of total labour
Labour/capital reorganisation more difficult
Hairdresser, Masseur, Manicurist, Sex worker
Dentist, Tattooist, Chiropractor
Surgeon, Nurse, Orderly
Paramedic, Residential care worker, Physiotherapist
Home-care worker, Childcare worker, Nightclub bouncer
General Practitioner, Yoga instructor,
Psychiatrist, Airport security worker, Prison warden, Fire fighter
Police officer, Football coach
Labour/capital reorganisation easier
23
Acknowledgements
I am grateful to Sarah Nettleton, Julia Twigg and Carol Wolkowitz for their comments and support, to
the anonymous reviewers for their helpful suggestions and Simon Kirwin for his editing. Many of the
ideas presented here were developed during the ESRC funded Body Work Seminar Series. I would like
to thank everyone who participated in these seminars.
24
Endnotes
1 Nettleton, Burrows et al. Nettleton, S., R. Burrows, et al. (2008). "Regulating medical bodies? The
consequences of the 'modernisation' of the NHS and the disembodiment of clinical knowledge." Sociology
of Health & Illness 30(3): 333-348.
are an exception.
2 Intact body is contrasted here with the separated body (or separable body parts and excretions), not the
‘disabled’ or ‘damaged’ body.
3 Where the focus is body work as ‘dirty work’ Twigg, J. (2000). "Carework as a form of bodywork." Ageing
and Society 20(4): 389-411.
, Isaksen, L. W. (2002). "Masculine dignity and the dirty body." NORA - Nordic Journal of Feminist and
Gender Research 10(3): 137 - 146.
, Twigg, J. (2006). The body in health and social care. Basingstoke, Palgrave.
, McDowell, L. (2009). Working Bodies: Interactive service employment and workplace identities.
Chichester, Wiley-Blackwell.
a broader definition (including work on bodily emissions), may be preferable, as this nicely links the
‘dirtiness’ of work on bodies, especially messy bodies to demeaning and distasteful cleaning work.
4 Centralisation may have benefits beyond cost-cutting. For instance centralisation of infrequent surgical
procedures facilitates skill acquisition and resource concentration, potentially improving patient outcomes.
Changes in labour allocation do not however simply reflect ‘technical’ advantages (such as surgical
effectiveness). They also reflect economic or other social logics; logics which determine the parameters by
which ‘technical advantage’ is calculated.
5 Telesurgery, where a distant surgeon is sole surgeon, may become more common as robotics advance. This
however requires massive development and dissemination of technology and, critically, improved
telecommunications reliability.
6 The political, and economic, strength and professional organisation of primary physicians and other non -
urgent care providers may have contributed to the construction of this model of social need.
7 A US study similarly found that caesarean rates were highest where women had private insurance Stafford,
R. S. (1990). "Cesarean section use and source of payment: an analysis of California hospital discharge
abstracts." Am J Public Health 80(3): 313-315.
. Therefore these patterns of medical intervention into labour are not confined to Latin America.
8 There is relatively little evidence of women choosing caesareans for non-medical reasons despite
widespread media hyperbole about being ‘too posh to push’ McCallum, C. (2005). "Explaining caesarean
section in Salvador da Bahia, Brazil." Sociology of Health & Illness 27(2): 215-242.
, Weaver, J. J., H. Statham, et al. (2007). "Are There "Unnecessary" Cesarean Sections? Perceptions of
Women and Obstetricians About Cesarean Sections for Nonclinical Indications." Birth 34(1): 32-41.
9 A UK move to make a single midwife responsible for a woman throughout her pregnancy was quickly found
to have “such dire implications for the predictability of midwives’ working hours ...that it made recruitment
and retention of midwives increasingly difficult” Wolkowitz, C. (2006). Bodies at Work. London, Sage.
. This exemplifies the problems of individualised body work.
10 Recent Conservative Party (UK) proposals for a ‘Big Society’, where non-waged (voluntary) labour is used to
provide social and, potentially, health care can similarly be read as an attempt to circumvent inflexibilities in
the absolute quantity of labour required to deliver these services.
25
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... Body work is not an undifferentiated whole but, like care, has two polar meanings: work on the body and work with the body. In general, body work involves the co-presence of bodies (Cohen, 2011;McDowell, 2009;Twigg et al., 2011): the body of the professional and the body of the user. However, in the first (ideal) type of body work, which is closely associated with the meaning of care as therapy, the two different bodies involved do not equally come into play, and the encounter between the two is, so to speak, limited: the professional intervenes on the body of the other (the user) reducing bodily exposure as much as possible, using only a distal part, usually the hands or even a single finger, adopting emotional, cognitive and behavioral distancing devices and strategies (Twigg, 2000). ...
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The gender-professionalism nexus is the source of persistent inequalities in our society. Its continuing relevance emerges even more in the pandemic crisis as a revealing context of social dynamics, showing a "differential in visibility" among welfare professionals, associated with gender, status and power. The attribution of "masculine" and "feminine" connotations (re)produces structures of inequality: there are male/dominant and female/subordinate professions. The exploration of this nexus reveals the existence of two polar meanings of care and body work, as well as two conceptions of professionalism and citizenship. Caring as "therapy" is related to "work on the body" and reflects a classical conception of professionalism aimed at client-citizens; whereas caring as "to care for" is related to "work with and between bodies" and meets better new professionalism aimed at active citizens. Considering gender as professional practice ideology highlights how "gender commonality" is not a solution to inequalities. Furthermore, it can contribute to the deconstruction of the dominance structures. In a such research agenda, narratives of professionals are the key to open the black box. Taking up the challenge to open the gender-professionalism black box is not just a matter of research, but of political action, starting from academia itself.
... They described days filled with arbitrary tasks, which were often felt to be more focused on accreditation and satisfying management rather than providing care. Care time in similar facilities is often divided arbitrarily and simplistically into tasks and this kind of categorisation sits awkwardly alongside bodies and people who respond and require support unpredictably or in ways which are challenged by the needs of the systems that support them (Cohen, 2011;Twigg, 2006). At Bardo House many staff members alluded to a hope that their caring could be embodied through how they were with residents and through "small things", moments of kindness and consideration, within the busy, task-based working days that they lived. ...
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It has become commonly expected that the “personhood” of people with dementia should be recognised, understood in the relational sense that is now widely adopted in healthcare practices. Despite its broad acceptance, however, the concept of personhood remains problematic in dementia care, as a result both of the theoretical challenges it poses and the practices that arise from it. This work employs the technique of ethnographic observation of residents, family members, and care staff of an aged care facility to explore the ways in which various modalities of the “self” are displayed in persons with dementia. The results provide insights into the moral and ontological impact of personhood on the systems that structure and influence interactions involving people with dementia. We conclude that privileging a preserved identity in dementia, and delivering care that conforms to contemporary “person-centred” expectations may limit recognition of the fluid, ongoing selfhood of people with dementia and that a reconsideration of this focus may enable us to expand our understanding of, and our responses to, their changing experiences.
... Hence, both parts of these relationships drifted apart.To reveal the emotions, tensions and estrangement among homeless people and outreach workers the concept of touch appears useful. Touch is a form of affective care that speaks to the 'body work' evident in various caring professions, such as healthcare practitioners, beauticians, therapists and childcare personnel(Cohen, 2011). Most importantly, it is an embodied form of emotional care resulting from a desire to connect, communicate and to show compassion, support and empathy -all of which are exceptionally relevant within an ethics of care approach. ...
Thesis
This dissertation explores the intersection of care, homelessness and urban space in a context of austerity and a profound lack of resources. Based on an eight-month urban multi-sited ethnography in Athens (July 2017- February 2018), this research draws upon data collected through observation, visual methods and interviews with frontline staff, outreach workers and homeless people. Conducted at a time of multiple crises for the Greek capital, this ethnography offers a grounded analysis of urban marginality, vulnerability and care. It focuses on the urban landscape of care for homeless people. In exploring this landscape, this research unravels the different social, spatial and institutional relations that shape the interconnection of homelessness and care. It considers both macro-level and contextual factors affecting the socio-spatial formation of this landscape in the city and micro-level manifestations of care through relationships and spaces of care. Paying attention to both homeless people and care workers, I position care relationships at the epicentre of a landscape unfolding on an interpersonal, organisational, local and national level. In this regard, this dissertation provides both a panoramic view of the city and a close-up analysis of an array of spaces: from exterior, public spaces to interior, mundane spaces where care meets homelessness and other forms of vulnerability. These include the city’s Municipal Centre for the Homeless (the Municipality), its hostels and a night shelter, a drop-in centre and various public locations including a central Park. The dissertation demonstrates that the landscape of care was a space of shared vulnerability and fragilities, not just for the homeless people seeking care, but also across the organisations and workers committed to care. Revealing different dimensions of being deprived of a home, I reconceptualise homelessness as a condition of ontological insecurity. I argue that homelessness was perpetuated by the complex landscape of care as it played a role in pushing homeless people from conditions of marginality to extreme psychological and material marginality. Bringing together theories of care, care ethics and geographical perspectives on care, I analyse various encounters between homeless people and their care workers, which were shaped by an array of obstacles, adverse conditions and insufficient resources – financial, human, material, emotional and spatial. Ultimately, I show that the efforts of care workers to provide more tailored care, and of homeless people to receive it were undermined to such an extent that care workers and homeless people drifted apart, leaving care in limbo.
... This ethnography builds on a substantial history of work on the sociopolitical consequences of technological development by turning attention to "the body" and its relationship to labor (Cohen 2011;Shilling 2011;Tarr 2011;Wolkowitz 2006). Specifically, the design draws on the concept of "body work" (Shilling 2011) to explore the changing dialectical relationships between body, technology, and labor. ...
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“Industry 4.0” marks the advent of a new wave of industrial robotics designed to bring increased automation to “extreme” touch practices and enhance productivity. This article presents an ethnography of touch in two industrial settings using fourth generation industrial robots (a Glass Factory and a Waste Management Center) to critically explore the social and sensorial implications of such technologies for workers. We attend to manifestations of dirt and danger as encountered through describing workers’ sensory experiences and identity formation. The contribution of the article is two-fold. The first is analytical through the development of three “filters” to grasp the complexity of the social and sensorial dynamics of touch in situ while tracing dispersed mediating effects of the introduction of novel technologies. The second is empirical, teasing out themes embedded in the sociosensorial dynamics of touch that intersect with gender, ethnicity, and class and relate to the technological mediation of touch.
... The gendered aspect of care work is widely recognized, as is its relationship to class and race (Duffy, 2011;Meyer, 2000). Here one finds analysis of the frequent assignment of caring tasks to marginalized workers as well as analysis of how these tasks appear to be the target of labour process (re)organization (Cohen, 2011). This connection to labour is often seen in rhetoric around the promise of technological developments for care provision, such as telemedicine (Mort et al., 2006) and robotics (Sparrow, 2016;Wright, 2019), technology which would claim to complement or potentially replace care workers. ...
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This article is about the feelings-affect-induced by the digital rectal exam of the prostate and the gynaecological bimanual pelvic exam, and the care doctors are or are not instructed to give. The exams are both invasive, intimate exams located at a part of the body often charged with norms and emotions related to gender and sexuality. By using the concept affective subject, we analyse how these examinations are taught to medical students, bringing attention to how bodies and affect are cared for as patients are observed and touched. Our findings show both the role care practices play in generating and handling affect in the students' learning and the importance of the affect that the exam is (or is not) imagined to produce in the patient. Ours is a material-discursive analysis that includes the material affordances of the patient and doctor bodies in the affective work spaces observed.
Article
The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system ‘work’. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers.
Article
Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the “hospice gaze”. We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services.
Article
Abstract: This study examines “body work” in the context of home‐based substance abuse care in Finland, which is provided to adults with intoxicant problems and needing short‐ and long‐term support in their everyday lives. This article is concerned specifically with body work, which can be defined as care work focusing directly on the bodies of others. Through a twofold analysis of 13 audio‐recorded home visits and ethnographic field notes, it examines what body work is in home‐based substance abuse care, how close body work is and how workers and clients negotiate about it. The study shows that home as a site of care has an impact on substance abuse care. The worker’s home visit settles into a tension relation between private and public even if the care is a part of weekly routine. Body work is holistic care work necessitating slight, medium, and extreme bodily intimacy in taking care of and supporting client’s well‐being. During the home visit, worker and client negotiate the body work and its content. Worker and client communicate verbally and non‐verbally by gaze and body movements. Often the workers have to balance between disciplinary, participatory, and caring approaches to support the client living in the best possible way. https://www.cogitatiopress.com/socialinclusion/article/view/4310
Article
New materialist applications in ‘dirty work’ studies have rightly emphasised the importance of materiality alongside symbolism. However, these approaches have neglected important themes irreducible to the material world, such as temporality, reflexivity and social structure. This article develops an alternative critical realist perspective on socio-materiality in dirty work which emphasises these themes. It draws on 2016–2017 ethnographic data on the work of clinical photographers of wounds in a UK specialist outpatient wound healing clinic. First, it shows how photographers’ reflexivity mediates the relationship between their embodied materiality and their agency in the physical domain. Second, it highlights the temporal dynamics between reflexive agents, their material environment, and the context of their operation. Finally, it emphasises the non-conflationary relationship between the social structures of the medical hierarchy and photographers’ agency in dirty work. Together, these contributions highlight the utility of an emergent, realist ontology in understanding the dynamics of dirty work.
Book
‘After reading this book it will be more difficult to "do" the sociology of work and the sociology of the body in the absence of the other. In some quite exquisite ways it throws down a challenge which practitioners in both fields will find difficult to ignore’ - Paul Stewart, former editor of Work, Employment and Society, University of the West of England Bodies at Work provides the first full-length, accessible account of the body/work relation in contemporary western societies. Bringing together fields of sociology that have hitherto developed mainly along separate lines, the book demonstrates the relevance of concepts developed in the sociology of the body for enriching our understanding of changing patterns of work and employment. Bodies at Work begins by establishing key concerns in both the sociology of the body and the sociology of work. Drawing on existing research, the author proceeds to examine a wide range of employment sectors: industrial employment; customer relations; health practice; care work; the beauty industry; and sex work. The contribution of feminist theory and research is highlighted throughout, and analyses of photographs help the reader conceptualise the changing nature of the body/work relationship over time. Bodies at Work helps readers think more clearly and creatively about how work relations shape bodily experience.
Article
Two women, virtual strangers, sit hand-in-hand across a narrow table, both intent on the same thing-achieving the perfect manicure. Encounters like this occur thousands of times across the United States in nail salons increasingly owned and operated by Asian immigrants. This study looks closely for the first time at these intimate encounters, focusing on New York City, where such nail salons have become ubiquitous. Drawing from rich and compelling interviews, Miliann Kang takes us inside the nail industry, asking such questions as: Why have nail salons become so popular? Why do so many Asian women, and Korean women in particular, provide these services? Kang discovers multiple motivations for the manicure-from the pampering of white middle class women to the artistic self-expression of working class African American women to the mass consumption of body-related services. Contrary to notions of beauty service establishments as spaces for building community among women, The Managed Hand finds that while tentative and fragile solidarities can emerge across the manicure table, they generally give way to even more powerful divisions of race, class, and immigration.
Article
Through a series of case studies of low-status interactive and embodied servicing work, Working Bodies examines the theoretical and empirical nature of the shift to embodied work in service-dominated economies. Defines 'body work' to include the work by service sector employees on their own bodies and on the bodies of others Sets UK case studies in the context of global patterns of economic change Explores the consequences of growing polarization in the service sector Draws on geography, sociology, anthropology, labour market studies, and feminist scholarship.
Article
Context Empiric data and expert opinion suggest that use of feeding tubes is not beneficial for older persons with advanced dementia. Previous research has shown a 10-fold variation in this practice across the United States.Objective To identify the facility and resident characteristics associated with feeding tube use among US nursing homes residents with severe cognitive impairment.Design, Setting, and Participants Cross-sectional study of all residents with advanced cognitive impairment who had Minimum Data Set assessments within 60 days of April 1, 1999, (N = 186 835) and who resided in Medicare- or Medicaid-certified US nursing homes.Main Outcomes Measures Facility and resident characteristics described in the 1999 On-line Survey Certification of Automated Records and the 1999 Minimum Data Set. Multivariate analysis using generalized estimating equations determined the facility and resident factors independently associated with feeding tube use.Results Thirty-four percent of residents with advanced cognitive impairment had feeding tubes (N = 63 101). Resident characteristics associated with a greater likelihood of feeding tube use included younger age, nonwhite race, male sex, divorced marital status, lack of advance directives, a recent decline in functional status, and no diagnosis of Alzheimer disease. Controlling for these patient factors, residents living in facilities that were for profit (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06-1.12); located in an urban area (OR, 1.14; 95% CI, 1.11-1.16); having more than 100 beds (OR, 1.04; 95% CI, 1.01-1.07); and lacking a special dementia care unit (OR, 1.11; 95% CI, 1.07-1.15) had a higher likelihood of having a feeding tube. Additionally, feeding tube use was more likely among residents living in facilities that had a smaller proportion of residents with do-not-resuscitate orders, had a higher prevalence of nonwhite residents, and lacked a nurse practitioner or physician assistant on staff.Conclusions More than one third of severely cognitively impaired residents in US nursing homes have feeding tubes. Feeding tube use is independently associated with both the residents' clinical characteristics and the nursing homes' fiscal, organizational, and demographic features.