The demise of repetitive strain injury in sceptical governing rationalities of workplace managers

The embodied liminalities of occupational overuse syndrome: Medical anthropology quarterly

Drawing on interviews with sufferers of OOS (occupational overuse syndrome) in Aoteraoa/New Zealand, this article explores the liminalities associated with OOS and the ways in which this liminality is embodied. While successful rehabilitation could lead back to employment, the respondents' fragility while living with OOS and its accompanying social stigma render such rehabilitation both literally and symbolically "out of reach". Their situations reveal social isolation, loss of identities, pain, and functional disability that have been incorporated into renegotiated identities and biographies in which respondents have become exquisitely self-absorbed, exercising constant bodily surveillance and discipline in order to manage their symptoms. We suggest that this problematic extends beyond biographical disruption to encompass the concept of injury to an embodied sense of integrity for people who were notable prior to their affliction for their reputations as extremely competent and conscientious workers. The embodied meaning of OOS in this environment is not so much to have fallen "out of culture" as Hilbert (Ewan et al. 1991) suggests, but to be liminal in Turner's sense of "threshold people" (Turner 1969:56) "ground down to a uniform condition to be fashioned anew."

Occupational overuse syndrome: moral ambiguities of New Zealand health professionals

In this article we examine the moral ambiguities expressed by New Zealand health professionals regarding their clients and patients who have occupational overuse syndrome (OOS). Workers with OOS were described as being hard working and dedicated, but also undisciplined in their work and personal lives. The goal of rehabilitation in such cases is a return to full work duties and to this end, health professionals represent the disciplinary and normalizing technologies of the neoliberal state which, in New Zealand, provides financial support and treatment for injured workers. According to the health professionals in this study, the disciplinary technologies exercised through rehabilitation require that clients and patients internalize key values associated with the rhetoric of healthism; primarily self-discipline, self-control, self-denial, and willpower. These underpin successful rehabilitation and ongoing management of OOS, and at the same time represent the central values of the neoliberal capitalist workplace.

Embodying occupational overuse syndrome

This article explores the ways in which embodiedness has become problematic for New Zealand sufferers of occupational overuse syndrome (OOS). While successful rehabilitation could lead back to employment, this was based on the biographical continuity of a bodily hexus that ignored persistent pain. The reality of OOS involved a liminal fragility associated with social isolation, loss of identities, pain and functional disability that was incorporated into re-negotiated identities and biographies with the result that respondents became exquisitely self-absorbed, exercising constant bodily surveillance and discipline in order to manage their symptoms.

The lived political economy of occupational overuse syndrome among New Zealand workers

In New Zealand, as in other industrialised nations, rates of work-related gradual onset injuries increased during the 1980s and 1990s. The perspectives and experiences of workers suffering what became known as occupational overuse injuries in New Zealand offer insights into local lived political economies. Here, we explore the dominant metaphor, 'battling', in participants' narratives. On the face of it, battles were fought over diagnoses, over occupational health and safety in the workplace, and over entitlements to therapy and income compensation. However, participants were also battling to maintain their identities as hard workers, while resisting and challenging normalising technologies of self and morally charged negative identities offered them by employers, state-funded accident and injury insurance agencies, and the medical profession. Inherent in their narratives is a critique of the neo-liberal capitalist political economy that allows workers' bodies to be exploited (and sacrificed) for employers' profits.

The "toxic dose" of system problems: why some injured workers don't return to work as expected

Introduction Most workers who incur an injury on the job follow a relatively straightforward path through a workers' compensation claim, recovery and return to work. However, a minority of compensation claims is prolonged and can be disproportionately costly. We conducted this qualitative study in order to gain an understanding of systemic, process-related problems affecting injured workers who had failed to return to work as expected. Method A total of 69 in-depth interviews were conducted with injured workers with complex and extended workers' compensation claims and with return-to-work (RTW) providers such as health care providers, insurers, legal advisors, and workplaces. The study was based in Ontario, Canada. A modified grounded theory analysis led to the identification of common mechanisms in RTW problems. Results We identify problems with return to work and extended workers' compensation claims in dysfunctions in organizational dynamics across RTW systems including the workplace, healthcare, vocational rehabilitation and workers' compensation. These system problems are difficult to identify because they appear as relatively mundane and bureaucratic. These appeared to have damaging effects on workers in the form of a 'toxic dose' affecting the worker beyond the initial injury. Conclusions Worker's problems with extended claims were linked to RTW policies that did not easily accommodate conflict or power imbalances among RTW parties and by social relations and processes that impeded communication about RTW situations and problems. Avenues for intervention are located in a shift to a critical lens to RTW process that addresses differences of knowledge, resources, and interests among different parties.

The 'actualities' of knowledge work: an institutional ethnography of multi-disciplinary primary health care teams

This study is set against the backdrop of the evolving order of a health care system in a province implementing a set of concurrent reforms. The study investigates how 'knowledge work' of multi-disciplinary health care teams is actually done and how it is co-ordinated across sites. Knowledge work involves three processes: the creation of new knowledge during the transfer of knowledge, in the context of the application of knowledge to their collective clinical decision-making. Institutional ethnography is used to explore the social and institutional forces that shape the knowledge work of health care providers in and across multi-disciplinary teams by way of examining how the texts trans-locally organise the formation and functioning of multi-disciplinary teams. The study confirms that in the course of their collective clinical decision-making, teams' dialogical exchange facilitates the articulation of tacit knowledge and opens up the communicative space for the creation of new knowledge. In addition to this confirmatory finding, the study contributes to the existing health-related knowledge management by illustrating the importance of the social, communicative aspects of the knowledge processes, and in particular, the relationship between knowledge and the social organisation of power.

Are you sitting comfortably? The political economy of the body

The aim of this paper is to examine the relationship between the mass production of furniture in modern industrial societies and lower back pain (LBP). The latter has proven to be a major cost to health services and private industry throughout the industrialised world and now represents a global health issue as recent WHO reports on obesity and LBP reveal. Thus far there have been few co-ordinated attempts to deal with the causes of the problem through public policy. Drawing upon a range of sources in anthropology, health studies, politics and economics, the paper argues that this a modern social problem rooted in the contingent conjuncture of natural and social causal mechanisms. The key question it raises is: what are the appropriate mechanisms for addressing this problem? This paper develops an analysis rooted in libertarian social theory and argues that both the state and the capitalist market are flawed mechanisms for resolving this problem. There remains a fundamental dilemma for libertarians, however. Whilst the state and the market may well be flawed mechanisms, they are the dominant ones shaping global political economy. To what extent can libertarians work within these structures and remain committed to libertarian goals?

"You are free to set your own hours": governing worker productivity and health through flexibility and resilience

Flexible work is now endemic in modern economies. A growing literature both praises work flexibility for accommodating employees' needs and criticizes it for fueling contingency and job insecurity. Although studies have identified varied effects of flexible work, questions remain about the workplace dimensions of flexibility and how occupational workplace health is managed in these workplaces. This paper presents findings from a qualitative study of how managers in the computer software industry situate workplace flexibility and approach worker health. In-depth interviews were conducted with managers (and some workers) at 30 firms in Ontario, Canada. Using a critical discourse analysis approach, we examine managers' optimistic descriptions of flexibility which emphasize how flexible work contributes to workers' life balance. We then contrast this with managers' depictions of flexibility work practices as intense and inescapable. We suggest that the discourse of flexibility, and the work practices they foster, make possible and reinforce an increased intensity of work that is driven by the demands of technological pace and change that characterize the global information technology and computer software industries. Finally, we propose that flexible knowledge work has led to a re-framing of occupational health management involving a focus on what we call "strategies of resilience" that aim to buttress workers' capacities to withstand intensive and uncertain working conditions.