Following a lead from Bill Gardner I’ve been reading >The Status Syndrome: How Social Standing Affects our Health and Longeivityby Michael Marmot[1]. The core of Marmot’s book, which is fascinating in itself is his empirical work showing that, as you move up any kind of hierarchy (Marmot looked at British civil servants) your health status improves. I’ve done a little bit of work myself relating to the links between health, education and life expectancy at the national level, and Marmot’s micro findings fit very neatly with mine.
What’s even more interesting though (to me and to Bill, I think) is the general idea of autonomy as a source of good health[2]. He debunks, for example, the long-discredited, but still widely-believed notion of executive stress and shows that the more control you have over your work environment and your life in general, the less likely you are to suffer the classic stress-related illnesses, such as heart disease.
It seems to me that autonomy, or something like it, is at the root of many of the concerns commonly seen as part of notions like freedom, security and democratic participation. I’m still struggling with this, but reading Marmot has crystallised some thoughts I’ve had for a long time. I’ve put some thoughts over the page – comments appreciated.
The points are clearest in relation to employment. Early on, Marmot debunks the Marxian notion of exploitation (capitalists taking surplus value from workers) and says that what matters in Marx is alienation[3]. He doesn’t develop this in detail, and the point is not new by any means, but he’s spot on here. It’s the fact that the boss is a boss, and not the fact that capitalists are extracting profit, that makes the employment relationship so troublesome. The more bossy the boss, the worse, as a rule is the job. This is why developments like managerialism, which celebrates the bossiness of bosses, have been met with such hostility.
So part of autonomy is not being bossed around. But like Berlin’s concept of ‘negative liberty’, this is only part of the story. Most of the time it’s better to be an employee with a boss than to sell your labour piecemeal on a market that fluctuates for reasons that are totally outside your control, understanding or prediction. This is where a concept of autonomy does better than liberty, negative or positive. To have autonomy, you must be operating in an environment that is reasonably predictable and amenable to your control.
Of course, the environment consists largely of other people. So one way of increasing your autonomy is by reducing that of other people, for example by moving up an existing hierarchy at their expense. But autonomy is not a zero-sum good. Some social structures give more people more autonomy than others.
In modern market societies, everyone but the very poor has quite a lot of autonomy in their role as consumers. There’s nothing much more autonomous than a supermarket where you can take a cart or trolley round shelves stocked with a vast variety of items, pick whatever you want and take it away, swiping a credit card on the way. On the other hand, Marx’s corresponding vision of a society where you might “hunt in the morning, fish in the afternoon, rear cattle in the evening, write literary criticism after dinner just as I have a mind, without ever becoming hunter, fisherman, shepherd or critic” seems as hopelessly utopian today as it did 100 years ago. This is partly because of some unavoidable technical realities – someone who did all these things would probably not be very good at any of them – but much more so because of the social structures required to manage work. These can be changed, though not easily.
As Robert Shiller pointed out very effectively, one of the roots of the dotcom bubble was the way the Internet gave new users an incredible feeling of mastery (which might more properly be parsed as autonomy). I don’t think this was entirely illusory and I continue to believe that the Internet has genuine potential to generate the kind of social transformation that will enhance autonomy for everyone.
I’ve got a lot more to say about this, but that’s enough for now. Go ahead and pull it to pieces. After that, I’ll try to put it back together in something like working order.
fn1. In the same order, I bought “The Working Poor : Invisible in America” (DAVID K. SHIPLER), which I may talk about later.
fn2. Marmot also talks about social participation and makes a lot of sense, but that’s a topic for another day.
fn3. This is, I think, reflected in the old joke. “Capitalism is the exploitation of man by man. Communism is exactly the reverse”.
John Quiggin 
[…] d by this post by Elizabeth Anderson which I’ll come back to towards the end and the following exchange on John Quiggin’s blog on the […]
Spot on, John. And this is reinforced by the access of those with higher incomes to things like health insurance which increase autonomy and control – ie deciding when a non-urgent operation is most convenient rather than waiting on a list and then getting a phone call to say “you’re in theatre tomorrow morning”.
The work of people like Cornelius Castoriadism in recasting Social Theory by rejecting Marxian determinism and imagining a future society where autonomy is maximised rather than a utopian vision such as Marx’ might be interesting if you’re planning to go down this track further.
I have Marmot’s book but have not read it yet. I’m not sure if it covers it, but one autonomy related health theme is not just control over your environment but self-control. This is to with things like maintaining a healthy diet, getting exercise, and taking medications correctly. Educated people, who are often higher status, are much better at these things.
Shipler, whose book I’ve just finished, covers the point you raise, Andrew, with some nice case studies, and Marmot also mentions it.
Andrew’s comment raises an interesting point – how much of the socio-economic gradient in health is due to differences in the environment and how much is due to differences in indivduals.
I think Andrew is aware of what psychologists call the ‘fundamental attribution error’ – a tendency to overestimate the effect of individual traits on success and failure and to underestimate the effect of situations. Many of those on the right seem to think that the purpose of society is the same as a sporting competition or competitive examination – to separate the strong from the weak. On the left people are more likely to think of it as a garden bed – if too many people don’t flourish then there’s something wrong with the environment.
Psychologist Peter Warr has a model of the connection between work and well-being which focuses on the environment. He lists 9 important environmental features:
1. Opportunity for control
2. Opportunity for skill use
3. Externally generated goals
4. Variety
5. Environmental clarity
6. Availability of money
7. Physical security
8. Opportunity for interpersonal contact
9. Valued social position
Warr argues that these features are like vitamins. More isn’t always better. Once we have enough of a feature its contribution to well-being either plateaus or becomes negative. For example, after a certain point more money doesn’t help much but does no harm. Too much vairety, on the other hand, can become stressful.
The model helps explain the difference between good jobs and bad jobs as well as suggesting why unemployment is usually more harmful than retirement.
Another study, this one in the US, looked at the issue of ‘control factors’, or autonomy, from a differnt perspective.
It followed a group of patients that recieved a particular diagnosis but differing treatments. One group was given the entire works, treatment wise, while the other were informed of their problem and left to it.
The results were surprising. The group that received intensive intervention and follow-up, showed little or no improvement compared to the control group. One suggestion was that the control group became more actively involved and motivated in the management of their condition. An interesting implication, but there are other possible explanations for such an outcome.
The problem of social stratification has two aspects:
sociological: authoritarian hierachies
psychological: status disparities
Even if one replaces social authority with individual autonomy natural inequalities still generate top-dogs and under-dogs. This is human societies most prized goods (a desirable mate) are distributed according to disparities in social rank through pervasive and perpetual sexual selection.
In general complex societies require more, not less, social organisation. This usually means more, not less, social ranking.
Thus archy subjugates anarchy.
Thus catallaxy substitutes autarchy.
Thus authority subsumes autonomy.
Some top-dog individuals are becoming more empowered: the owners of internationally tradeable resources and charismatic individuals whether secular (celebrities) or sacred (terrorists) .
Jack’s comments ring so true to one who spent time in a hippy community.
I was waiting for a more learned and consistent Marxist to jump into the argument and say that you can’t just co-opt alienation into your analytical mix and leave out expropriation. The two go together. The ‘sovereign-consumer-in-the-supermarket’ metaphor teems with examples of both.
On the face of it, it evokes a far more effective and satisfying form of social organisation that Marx’s improbable character, who with his dead rabbits, stinking fish and boots heavy with cattle dung would probably not be up to more than a critique of Piers Akermann’s column.
But if you look at it from the perspective of a Walmart checkout operator, on US$7 an hour, doing her own shopping at the end of a long shift, passing the row of runners made in Indonesia, the electrical goods made in China (under what conditions?) knowing she’ll have a two hour bus journey back to where she lives, past the factory she used to work in…
oops! I think I meant ‘appropriation’ (the process whereby surplus value is knocked off by the bosses) not ‘expropriation’
There’s a novel by political scientist Steven Lukes “The curious enlightenment of Professor Caritat” in which the main character, a professor of political science, is sprung by partisans from his prison in the land of Militaria, given the code name “Dr Pangloss” and sent on an inspection of other lands to determine the best political system.
He first visits the Benthamite land of Utilitaria and has adventures in which the political references come thick and fast and which point up the contradictions inherent in that concept. He escapes and visits a couple of other lands – one of which was the free market society of Libertaria, and esapes from them, writing his reports back to his partisan sponsors. Then something different happens.
He finds himself in a field on a sunny afternoon by a pond talking to two chaps named Fred and Karl who explain how they fish in the afternoon, the state having withered away, etc. He stays for a surreal day or so and then wakes up – for he has been having a dream.
My point is, that in writing this allegorical novel Lukes had room to set up all kinds of improbable situations yet there was not room to set up communism. Communism was too surreal even for his fantastic structure to accommodate and he had to get the character to fall asleep and dream it.
It’s worth a read.
JQ – I don’t have any references here but whilst the autonomy argument is attractive to some I’m almost certain the more enduring correlation with good health is income. Autonomy is only a by product of the independence acquired by income,or even better by family or generational or inherited income.
The daughter of financially comfortable educated middle or upper middle class family, whose uncle has a holiday house at the sea, they use as suits around the family, and granny has provided an endowment to help with education and an aunty has given you an old Datsun 180B to drive and you are living low rent in Dad’s investment flat is a lot more autonomous even when working the holiday job at Hungry Jack’s (the worst mob of them all) than is her workmate, the son of a divorced single mum who has 2 other younger kids and a casual job at the local meat packing plant and drives a 180b as the family car and needs the son’s income to help survive.
Its not too hard to see in the above example who has the greater real autonomy in the Hungry Jack’s job.
Being bossed around by some teenage jumped up untrained manager is a lot less upsetting if you know you don’t HAVE to have this job even for your own pocket money let alone to get money to assist your mother pay the rent and food bills for the rest of the family.
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mmh a post of mine appeared in the RECENTLY COMMENTED on but not in the comments. Black Hole somewhere?
FXH – I’ve noticed some blogs occasionally update the last poster on the index page before they update the number of posts or the post itself. Sometimes there’s enough delay that the hiatus and discrepancy can be spotted.
WordPress randomly asks for authorisation on some comments. I’m looking into this problem.
About the autonomy/good health link: The ANU Centre for Mental Health is currently running a big longitudinal study, studying- well, a number of diverse things. (I am one of the subjects). Looking at those of their subjects who were Canberra public servants, they _didn’t_ find this link. As I recall it, they DID find a (negative) link between mental stress and good health.
Autonomy
Also from the Christian Medical Fellowship this month: CMF file No 29: Autonomy This articel looks at the ‘right to choose’. It is relevant to mental health since many would argue that mental illness makes you LESS able to make