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Emotional management and stress: managing ambiguities.

Abstract

Emotions and stress are inextricably entangled: being stressed has bodily as well as emotional implications for human beings. The widespread distinction between mind and body in organization theory, following the Cartesian doctrine, blocks an adequate theoretization of stress. In general, there is a preference in organization theory for linguistic, literary, and semiotic interpretations of organizational practices. Consequently, notions such as culture and discourse have been largely favoured. The limitations of this tradition in Western thinking, Cartesian over Spinozist philosophy, are that mind is favoured over body, thinking over emotions, mind over matter. This paper presents a study of the experience of stress in a pharmaceutical company. It suggests that stress is to be conceived of as a bodily phenomenon while incorporating the emotional qualities of human beings. As an outcome of a set of ambiguities, stress is produced in a social setting, but it has immediate bodily effects on employees.

Descriptors: stress, emotion management, embodiment, pharmaceutical industry

Introduction

Recent organization theory is characterized by an increased degree of self-reflection (Weick 1999; Burrell 1996). The positivist tradition, which has served as the norm for organization theory, has been challenged by various perspectives such as social constructivism (Gergen and Thatchenkery 1996), critical theory (Jermier 1998; Alvesson and Deetz 1995; Deetz 1992), ethnography (Czarniawska 1992; Putnam 1993), postmodernism and poststructuralism (Hassard and Parker 1993; Chia 1996; Kilduff and Mehra 1997), narrative approaches (Pentland 1999; Van Maanen 1988), discourse analysis approaches (Keenoy et al. 1997; Fairclough 1995), or feminist perspectives (Kerfoot and Knights 1998; Calas and Smircich 1999). Organization theory has also been characterized by a preference for linguistic, narratological, and semiotic analyses of organizational practices and activities. Notions such as culture, language, and symbols have been used to make sense of various phenomena. Therefore, organizational activities unfold as a t ext, following a pivotal idea of much poststructuralist writing. The textualization of organizational life has two major implications; Broadhurst (1999: 27) writes: 'traditional ways of interpretation have been dominated by the transference of linguistic interpretation of the non-linguistic. This has a double effect. It makes the body a secondary phenomenon and reduces the fundamental temporality of meaning.' The 'textual view' of organizations is here contrasted with an embodied view. One of the most important contributions of feminism is the emphasis on corporeality as a variable in organization studies. Both postmodern feminism and poststructuralism are rejecting essentialism (Butler and Scott 1992), the belief in stable, innate qualities of human beings, but, to a larger extent than poststructuralism, feminism acknowledges the human body as a key social 'object' (Braidotti 1997). For feminism, the human body is the site of regulations and inscriptions and serves as the nexus between the private and the pu blic (Trethewey 1999; Lykke and Braidotti 1996); since the human body is the most obvious manifestation of differences between male and female, it is subject to problematization. Human bodies matter, but they do also differ across populations and across the narrow binarism of male and female (Butler 1993).

This paper presents a study of the experience of stress in a pharmaceutical company. This study is based upon a narrative methodology (Czarniawska 1999; Boje 1995; Tovey 1998; Nicholas and Gillett 1997) and draws on interviews with employees doing clinical research studies in a major pharmaceutical company. It addresses stress as a major problem in terms of the efficiency of the clinical research activities and personal well-being. In the paper, stress is depicted as both a bodily and an emotional problem. Since it is ontologically and epistemologically complicated to distinguish emotions from physical functions of the body, stress is fundamentally seen as a physical, embodied experience emerging from a set of interrelated circumstances and processes. The experience of stress is a complex phenomenon; it is complicated to separate mental and bodily experiences into discrete domains (Shilling 1993: 115-124), and stress is complicated to think of in linear, cause--effect schemes. Stress could be seen as both the cause and the effect of specific bodily malfunctionings. Therefore, the experience of stress is seen as a category escaping logocentrism (cf. Derrida 1974), the will to fix a phenomenon in specific meanings and unambiguous positions; stress is an indeterminate experience, set in-between the body and the mind, the self and society. Stress is without centre, appearing in the middle of human lives, outside linear cause--effect relations. Thus stress can be seen as being based on what Julia Kristeva calls intertextuality, the innate relationship and mutual dependency between various texts. Kristeva writes: 'Every text takes the shape as a mosaic of citations, every text is the absorption and transformation of other texts' (cited in Culler 1975: 139). Stress is a fluid, decentred, and continuously evolving bodily and emotional experience that is grounded in the life-world of the stressed human being. Thus stress is not centred in body or emotions (mind), but includes and connects both of them, in the same way as the text is made up of diverse, scattered textual elements.

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

Emotions and Stress: Bodily Experiences

Poststructuralism and postmodern feminism are equally hostile towards the idea of essences. This position implies that the human subject is depicted as being contextually and historically grounded, meaning is distributed through intertextuality, and truths are conceptualized as social conventions and preferences. In short, there is an increasing lack of stable universals (Laclau 1996; Said 1994: 92). This lack of universals corresponds to what Lyotard (1984), in a most radical critique (cf. Derrida 1994; Armitage 1999:39) calls the demise of the metanarrative, the loss of legitimate, all-encompassing, totalities of meaning from which science and politics could legitimize themselves. To postmodern feminism -- which shares a great deal with, and to some extent, is entangled with poststructuralism -- the experience of the individual body is of specific interest. McNay (1999) writes:

'The concept of embodiment is central to feminist thought, because it mediates the antinomic moments of determinism and voluntarism through the positing of a mutual inherence or univocity of mind and body in Cartesian dualism. As the point of overlap between the physical, the symbolic and the sociological, the body is a dynamic, mutable frontier. The body is the threshold through which the subject's lived experience of the world is incorporated and realized and, as such, is neither pure object nor pure subject. It is neither pure object since it is the place of one's engagement with the world. Nor is it pure subject in that there is always a material residue that resists incorporation into dominant symbolic schemes.' (McNay 1999: 98)

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

In social theory, Turner (1996) discusses various perspectives on the body. One of the generic qualities of human beings in everyday life is being able to have what Husserl called 'intimate rulership' over one's body. As a consequence, 'a person cannot be excused by saying "my body did it" because we are thought to have intimate rulership ... over our bodies' (Turner 1996: 81). This perspective is problematic to Turner because this rather common sensical idea ignores the politics inscribed into the body. Turner says that 'to talk about our phenomenological rulership of our bodies is to miss the crucial sociological point, namely the regulation of the body in the interest of public health, economy, and political order' (Turner 1996: 81). This primarily Foucaultian view emphasizes the nexus theory of the body: bodies are always in-between, connecting and aligning the political and the practical, the individual and the collective. The position of the body between structures and actors is mostly taken for granted , but comes into focus when the body deviates from its own standards, e.g. when the body is subjected to illness. Turner writes: 'The concept of illness in particular brings together three fundamental debates which have shaped sociology from its inception, namely the relationship between nature and culture, individual and society, and mind and body' (Turner 1996: 179). Therefore, Turner says, 'the discovery of a new disease is not...epistemologically equivalent to discovering a new butterfly; a new disease is the product of a shift in explanatory frameworks or the identification of a new niche' (Turner 1996: 200). One illness that is becoming a prominent problem in organizations is stress. It is plausible to think that, throughout the 1990s, the pathological effects of stress have been emphasized even further, so that today they are of considerable concern to contemporary societies.

Emotions, Stress and Deviant Behaviour

In the following, the notion of stress is related to what is referred to as emotional mangement (Hochschild 1983; Fineman 1993; Sutton 1991; Brown 1997; Nguyen 1999). The idea that the emotions of employees are of interest to organizations to manage as a resource was first formulated by Charles Wright Mills (1951). As opposed to Marxist theory, where labour is fundamentally conceptualized as physical labour (cf. Castoriadis 1997: 18), Mills argued that the white-collar worker needed to control his or her feelings and that facial expressions (e.g. a smile) become a matter of professionalism: 'if there are not too many plant psychologists or personnel experts around, the factory worker is free to frown as he [sic] works. But not so the white-collar employee. She [sic] must put her personality into it. She must smile when it is time to smile' (Mills, 1963: 271-272). In a seminal work by Hochschild (1983), acknowledging the contributions of Mills, emotional work and emotional labour are distinguished. Emotional w ork is the effort human beings make to ensure that their feelings and emotions are in harmony with socially-accepted norms (e.g. the suppression of smiles and laughter at a funeral -- see Goffman 1959), while emotional labour is the commercial exploitation of this ability. Mumby and Putnam (1992) define emotional labour as 'the way individuals change or manage emotions to make them appropriate or consistent with a situation, a role, or an expected organization behaviour' (Mumby and Putnam 1992: 472). Emotions are thus a resource that the individual can make use of when carrying out work assignments. Nevertheless, Martin et al. (1998: 429) claim that emotions have been a 'largely de-emphasized, marginalized, or ignored' quality in human beings in organization theory. Much organization theory rests upon the idea of rationality in various forms; in a modernistic conception of human beings, rationality and emotions are binary opposites, cognition versus emotion. In addition, in cases when emotions are acknowledg ed, a specific set of emotions are favoured at the expense of others: 'Some emotions, such as anger and competitiveness, are generally condoned in bureaucratic organizations, while others such as sadness, fear, some forms of sexual attraction, and vulnerability are taboo' (Martin et al. 1998: 434). Emotional management and emotional labour operate through the exclusion of 'negative' emotions, i.e. emotions that neither contribute to the productivity of the activities, nor are easy to deal with (e.g. fear). Thus, the suppression of feelings is troublesome to feminist scholars because, as Martin et al. (1998) say, 'women are more likely than men to engage in self-disclosure, express a wider range of emotions, and seek ways to acknowledge the inseparability of work and personal lives without letting work concerns take priority over family needs' (Martin et al. 1998: 433). It is problematic to claim that women are naturally more inclined towards emotions and emotional reactions than men are, but it could be that emotions which are more often expressed by women are excluded from the domain of legitimate emotions. Stereotypical 'female' emotions are deferred, excluded, or subsumed while corresponding 'male' feelings (anger, competitiveness) are demonstrated without negative consequences. Emotions which indicate that the individual is 'out of control' are of specific interest in terms of experiencing stress and burn-out. Meyerson (1998) writes that 'the dominant discourse does not include a vocabulary for engaging emotions or for talking about "being out of control" as a legitimate human experience' (Meyerson 1998: 112). In addition, Meyerson thinks that 'complex' feelings with 'fluid meanings' are cumbersome to deal with in organizations. When feelings are acknowledged, they should either be productive or uncomplicated to decode and interpret.

The experience of stress and burn-out in organizations is neither productive (at least not when the individual finally, after strenuous work, demonstrates and experiences the negative effects of stress), nor simple in terms of causes and symptoms. Stress and stress-related illnesses are socially produced deviances from bodily and social standards of behaviour. In addition, stress operates across individuals and social systems. Consequently, it is complicated to deal with stress. Meyerson (1998) addresses the inherent problem of science handling ambiguities. Most scientific inquiries, evaluations, management tools, and tests, operate through binary positions that effectively exclude ambiguous events and phenomena: 'Psychological and managerial tests, feedback sessions, and intervention strategies are based on clear and universal definitions of the normal and the abnormal. The reliance on universal standards and classifications reflects the reverence for scientific-like typologies and a general disdain for ambi guity, or as Levine (1985) has termed it, a "flight from ambiguity" in social science' (Meyerson 1998: 109). Moreover, the individual is usually held accountable for the pathological effects of stress. For instance, Kunda's (1992) study of engineers working at a high-tech company suggested that the experience of bum-out was an everyday work life problem that the individual was expected to deal with. Martin et al. (1998) studied the use of personal counselling as a method of reducing the negative effects of stress. They concluded that 'however helpful such a counsellor may be, the implicit message is that work stress is an abnormal response that must be controlled, with the blame for the problem and the responsibility for fixing it resting primadly with the individual experiencing the stress' (Martin et al. 1998: 456). Being able to have intimate rulership over one's body and handle stressful situations and a stressful life are thus seen as the mark of the professional: Tina, a clerical employee interviewed by Martin et al. (1998: 458) stated that: 'professionals get it done without being frazzled and bothered'.

So far, two models of stress have been invoked. On the one hand, we can examine stress as an embodied phenomenon; i.e. a set of physical responses to unfavourable work conditions. Headaches, illness, sleeping problems are examples of such embodied experiences. In this perspective, stress is not seen as being different from any other form of illness. Stress is simply a matter pertaining to the body and needs to be treated as such. On the other hand, stress is seen as an emotional response to perceived problems. In this case, stress is conceived of as being an intellectual reaction to external demands and expectations. The problem of stress operates within this dichotomization: on the one hand, stress is embodied; on the other hand, it is emotional. It is complicated to base, once and for all, the experience of stress in either of these two entities. It is experienced in the body, the stressed body, but equally it is experienced as an emotional state. There is thus a certain degree of indetenninacy in stress; i t is in-between, embodied as well as emotional, personal as well as social. Stress is not based on logocentric categories.

To conclude, three characteristics concerning stress in organizations can be formulated: (1) organizations have a problem handling ambiguous emotions and experiences; (2) stress is an ambiguous, indeterminate 'illness' in which bodily disorders and complex or contradictory emotions are entangled; (3) organizations have a problem handling stress unless it is formulated as a personal problem to be solved through individual activities (e.g. counselling, yoga, breathing exercises).

Dealing with Stress: Managing Ambiguities

Methodology

This study was undertaken from a case-study approach (Yin 1994; Eisenhardt, 1989) inasmuch as one single company (subsequently referred to as PharmaCorp) was investigated. Interviews were conducted with the aim of making the interviewees tell as openly as possible of their experiences of stress and of their work situation in general. It is therefore pertinent to speak of a narrative approach (Bruner 1986; Polkinghorne 1988; Van Maanen 1988; Czarniawska 1993). The narrative methdology can be seen as one method in the totality of methodologies following from the linguistic turn in social science (Rorty 1998; Edwards 1997; Potter 1996). As Czarniawska (1999: 15) has argued, the narrative form of knowing is 'close to the tradition of research known as case studies'. However, as the case-study approach normally gives the researcher the prerogative to choose the data presented in the text, the narrative approach aims to present the interlocutors' accounts of their experiences and day-to-day activities in the final written text. A narrative approach does not seek what Bruner (1986) calls a 'logico-scientific mode of knowledge' wherein an explanation is achieved through the recognition of an event or utterance as belonging to a certain category, or following a general law. In short, a narrative approach does not aim to present nomological knowledge (Habermas 1968), but rather to present contextualized narratives as human endeavours in order to make sense of complex, ambiguous, and fluid realities (Guignon 1997). Narrative studies give priority to the interviewed subject's account of his or her own life-world and experiences (Frank 1995; Nicholas and Gillett 1997). Narrative methods have been used in organization studies by, for instance, Skoldberg (1994), Boje (1995), Boyce (1995), Fine (1996), Barry and Elmes (1997), Crane (2000), and Kurland and Pelled (2000). In the field of health care, narrative methods have been suggested within medical care (Tovey 1998; Nicholas and Gillett 1997) and psychotherapy (Guignon 1997). These studies problematize the relationship between embodied experiences and narrative. For instance, Frank (1995: 27) writes: 'The body is not mute, but it is inarticulate; it does not use speech, yet begets it. The speech that the body begets includes illness stories; the problem of hearing these stories is hearing the body speaking in them. People telling stories do not simply describe their sick bodies; their bodies give their stories their particular shape and direction.' Telling stories of embodied experiences such as illness is, Frank says, 'giving voice to the body'. The embodied experience is articulated and can thus be given meaning beyond the mute suffering of the sick body. The body is enabled to speak through the narrative.

This study investigates the experience of stress in clinical research activities at a major pharmaceutical company, here referred to as PharmaCorp. The clinical research process at PharmaCorp is arranged in project teams, called study working teams (SWTs) which work on detailed sub-studies within the comprehensive research programme. Each SWT consists of a number of experts such as Clinical Research Leaders, Clinical Research Assistants, Medical Advisers (consulting medical doctors with specialist expertise in particular fields of medicine), Data Coordinators, safety personnel (analysts of so-called adverse events or serious adverse events, i.e. potentially undesirable and unanticipated effects on patients caused by the tested drug) and secretaries. In the study, all categories of clinical researchers and employees were interviewed. The majority of the clinical researchers at PharmaCorp were, however, either Clinical Research Leaders or Clinical Research Assistants. The median duration time of the interviews was approximately 90 minutes. During the interviews, the interlocutors were asked open-ended questions such as 'what does a normal working day look like for you', 'what do you think is good/bothers you about your work', 'do you ever feel stressed at work', and so forth. It was a pronounced ambition to put as many open-ended questions as possible to the interlocutors in order to enable a discussion on how stress was conceived, experienced, verbalized, and dealt with at PharmaCorp (cf. Nicholas and Gillett 1997). In total, more than 30 hours of interview material was recorded. All interviews were transcribed in detail by two independent people who did not participate in the interviews. The transcriptions produced almost 400 pages of empirical material. Three researchers examined the empirical material independently and suggested how the material could be structured and categorized. The analysis of the material generated a number of categories that roughly correspond to the headings used below. It is noteworthy that the categories 'stress embodied', 'work-pressure', etc. (see below) were not used prior to the interviews, but were constructed on the basis of the interviewees' stories and utterances. After appropriate analysis of the data material, some findings were reported to the interviewees at PharmaCorp. The findings were subject to a discussion with the interviewees and were received in favourable terms. In addition, two researchers participated in a number of SWT meetings and a two-day off-site seminar. These participative observations enabled more detailed insights into day-to-day clinical research activities.

PharmaCorp and the Pharmaceutical Industry

The competitive advantages of the pharmaceutical companies are based upon a company's ability to generate new knowledge that can produce patents and new medicines which become marketable profit-generating products (Yeoh and Roth 1999: 639). Yeoh and Roth (1999: 637) write that 'the industry is noted for its technological intensity and studies suggest that research and development (R&D) is an important source of competitive advantage'. Documenting the effects of a new drug is very resource-demanding and time-consuming, and only a fraction of the molecules (i.e. the active substance of the drug) tested are finally launched on the market. The pharmaceutical industry has, perhaps, the longest development times of all industries (5-15 years) and invests between 9 and 50 percent (PharmaCorp around 20 percent) of its sales profit in R&D. When successfully providing evidence for the positive effects of a certain drug, the performance of the company could be considerably affected. Roberts points out that 'the profits earned within the pharmaceutical industry are consistently well above those earned in the next highest earning industry' (Roberts 1999: 668). These profits derive very much from the ability of pharmaceutical companies to innovate (Roberts 1999: 656).

PharmaCorp is one of the largest pharmaceutical companies in the world. The company is a provider of medicines in many therapeutic areas, where the three largest are cancer, cardiovascular and gastrointestinal medicine. The R&D centres are located in Europe and the United States and had more than 10,000 employees and a turnover of 2 billion US $ in 1999. Today, following a merger with one large competitor, the company has more than 50,000 employees world-wide. The product development process in the pharmaceutical industry is complex and consists of a number of stages: (1) laboratory scientific work where a substance that promises to affect human health in desirable ways is identified; (2) clinical testing on laboratory animals such as rats; (3) clinical tests on voluntary participants such as students or inmates; and finally, (4) clinical tests on a population of patients. If the drug passes all the stages and proves to be successful in terms of positive health effects on patients, the substance can be regist ered and thereafter sold on the market. The entire product development process is governed by various international research and clinical testing standards, and a number of national and international committees and boards have to approve the testing procedures before the product can be launched. Product development is therefore heavily monitored, controlled, and standardized.

Stress Embodied

The experience of stress was pointed out by the interviewees as being manifested in physical, embodied effects as well as in inabilities to master the work situation because of problems focusing on the right priorities and communicating adequately with colleagues. One of the clinical research assistants said: 'I think it is because my brain just doesn't keep up When I am supposed to do something, then there is just no co-ordination. There is some kind of discrepancy there [between acting and doing]. When everything is normal, then you work and after that you think, no problem. But when you are stressed, then these two are mixed up. . . It's hard to find a good word for that.' Another interviewee described things thus: '... then something dark comes over me... everything becomes a cage, and I lose my perspective on things. I do only what is absolutely necessary... I lose my memory. That is serious, but that's how it is.' A third interviewee referred to both bodily and emotional responses to stressful situation s: '... well I get this rush in my heart, and I have this thing in my belly, and I'm generally in a bad mood.' The physical effects included a variety of responses such as fatigue, headaches, tensions, cadiac arrythmia, and dizziness, or longer periods of illness because of too much work. These pathological effects are well documented and reported in the medical stress literature (Lazarus and Folkman 1984; Kahn and Boysiere 1990; Cox and Ferguson 1991; Brannon and Feist 1992). Besides their bodily malfunctionings, the interviewees pointed out the psychological effects arising from a work situation characterized by stress. The inability to concentrate on a single work assignment, the unwillingness to talk to colleagues and other people, general feelings of insufficiency and vulnerability, and depression were mentioned as outcomes of strenuous work situations. In general, stressful work situations produced more or less long-term bodily effects in the employees, which negatively affected their ability to do a go od job. This situation was produced by (1) work pressure being too high, (2) a lack of control over the individual work situation, (3) unsatisfying interpersonal relationships.

Work Pressure

The clinical research activities at PharmaCorp were designed in accordance with a multiplicity of national and international standards, called Good Clinical Practice (GCP). It is necessary to comply with GCP if the drug is to be accepted for registration and launched on the market. In general, clinical testing should preferably be undertaken as fast as possible, and at the lowest costs, given the framework that is defined by external medical and ethical committees and monitoring organizations. Consequently, the clinical testing of a drug is a continuous attempt to shorten the time to market; 'time is all that matters', as one Clinical Project Leader put it. Working towards new deadlines was pointed out as being very stressful by some of the employees. In PharmaCorp. deadlines were not, as one of the interviewees put it 'sacred', but you certainly had to come up with a very convincing explanation to give the Project Leader if you could not deliver adequate results prior to deadlines. What was especially cumber some to the interviewees was the continual recurrence of deadlines; there were new ones coming all the time. This turned work into a never-ending effort. One assistant said: 'I think it is more satisfying when I can evaluate my results, right... If you finish something every day, then you are pleased because you know "I did this" today. But here [at PharmaCorp]. that is not possible. You can't measure your work.' Some of the clinical researchers felt obligued to work extensive amounts of overtime. For instance, one of the clinical project leaders was asked about her overtime:

Q: How much overtime do you work?

A: I am already above the maximum permitted amount.

Q: That is 200 hours?

A: Yes, my strategy right now is, therefore, not to report it lithe overtime].

In addition to deadlines, the interviewees addressed the discontinuous nature of the work in terms of it being broken down into pieces, either through a number of meetings spread across the entire week, or interruptions to their work by colleagues who wanted information, help, or advice on various topics. This produced a situation wherein the clinical researchers never had the time to deal with more detailed or complex problems. Clinical research is composed of a multiplicity of tests, evaluations, and observations of how a specific drug (or placebo, which some of the patients in a study are given in order to serve as a reference group for comparisons) affects the state of health of thousands of patients in, at times, up to 30 countries worldwide. Clinical research is, on the bottom line, aimed at providing credible information to medical authorities which will make it possible to get the drug registered. The vast body of information that has to be handled makes it necessary to have a forum for ongoing inform ation and discussion regarding how the clinical research project is proceeding. Therefore, a considerable part of the working week was dedicated to meetings, which were seen as a cause of stress. One of the interviewees said: 'My working days could be booked for meetings up to 80 or 100 percent. Then, if you have made your mind up to use these two spare hours on a Friday afternoon for one of your own things, of course that has to be postponed [because of unforeseen problems]. That is stressful to me.' In addition, the need for ongoing information among the clinical researchers produced the same stressful effects. Rather than thinking of meetings, and the help given to colleagues, as being an integral part of the work, the clinical researchers were apt to think of it as undesirable disturbances that eliminated quality time aimed at clinical research. One response reported by some interviewees was that they had tried to cut down on coffee and lunch breaks. One interviewee said: 'we do eat lunch, but I come back here as fast as possible. Otherwise [when not under stress or work pressure], when not much is going on, you could stay in the restaurant for a while, resting and having a cup of coffee, having a chat with people. But that is just not possible now.' Another interviewee argued: 'Many of our senior bosses encourage us to take breaks and have some coffee and all that, but I just use my breaks for eating. It is very rare that I take a coffee break. That is stupid because I believe that everyone needs that little break, just to talk about anything but work.' The time pressure eliminated all possibilities for reflection. One of the medical doctors argued: 'At times, I think that one should stop work and say "No, now we need to calm down. We have to talk for a while and think about things ... Is it really realistic to assume that we should deliver all this?" I believe that is important.'

Lack of Control

'I would be able to spend all my time here if it wasn't for my duties back home. If I did not have to be concerned about my family, then I would be less stressed, but now I have this double loyality, and which one should receive priority? Should I stay at work, or should I go home? I don't feel that I am very pleased with myself: I am simply not good enough.' (Clinical Research Assistant)

The interviewees highlighted a number of problems that emerged due to the lack of control over their individual work situations and various forms of role ambiguities. One of the Clinical Project Leaders said: 'It is primarily the people who have fewer opportunities to determine their own work that are the most stressed. For instance, the Clinical Research Assistants are suffering from stress because they are not the ones managing the projects, they do not make the decisions, but they are the ones who are expected to carry out the practical work.' One of the most stressful problems was the inability to satisfactorily distinguish and separate work and family life. Most of the interviewees had families and the majority were women in their thirties and forties who had school children at home.

One of the clinical researchers illustrated her inability to separate work and family life during a particularly stressful period:

'We were working here together, and she's got a family as well, just as I have. We were working here the entire day, and then we went back home to fix dinner for our families, took care of things, checked that the homework had been done, did the laundry, and then went back to work again. Then we worked until, say, 10[pm] o'clock and then we went home, slept, got up in the morning, and then did the same thing again. When I came home on the third or fouth day, rushing out of my car, I felt something in my stomach, and I thought to myself "what am I actually doing here".'

Another interviewee said: 'I think a lot about my job [at home] . . . I bring my job home.. . both mentally and physically and then I am tired... because there is always so much going on . . . What has been prioritized less during recent weeks is my personal exercise programme; at the moment I'm experiencing the "degeneration of my muscles" [laughter]. It's rather sad; I used to be very fit, but no longer.' One Clinical Project Leader described her problems separating work from family life as particularly stressful: 'I noticed that I could not relax. During weekends, I did not feel very well until I could sit down with my laptop and deal with things. That was really a warning signal to me.' Work pressure produced feelings of insufficiency, a bad conscience, and a very stressful life situation. In addition, the interviewees argued that it was impossible to maintain a satisfying 'quality level', in their work when they were too mixed up between, as another interviewee put it, 'double loyalties'. Loyalty problem s caused role ambiguities between both work and family, but also between priorities within the clinical research project. The interviewees thought it was complicated to know how to prioritize their own work, since they thought that the vertical communication in the project was unsatisfactory. One of the interviewees claimed that communication between the project teams and management was assumed to be used only in the event of a problem or an emergency: 'It is very much like in school. Unless you hear about a problem, everything is just fine. I believe it is the same situation here. I think one [the managers] should have a deeper sense of commitment.' Another interviewee responded 'never: I have met my boss once for one hour', to the question of whether she had regular meetings with her boss. It was, in short, not very easy to know how management evaluated the specific project in relation to other clinical studies. One interviewee argued: '[Managers] sit in another place, and you don't see them very often . . . They don't know what is going on in the projects. They don't see what these people do, how they do it, and how they set things to proceed.' Another interviewee said: 'It may be that they just don't understand what it is like to be sitting in front of the computer screen being in charge of this database; they simply don't know how we work and how much work is needed. We are trying to point this out, but it is not always the case that they understand.' The second point raised was that it was not unproblematic to decide upon how the individual work assignments were to be prioritized vis-a-vis work done by colleagues. One Clinical Project Leader said: 'my job description is really too unclear to me', and another held that 'one thing that is so stressful ... is that I don't really know my responsibilities [in the project]'. How the work time was to be allocated was always a source of reflection and discussion. The interviewees thus experienced stress as an outcome of role ambiguities arising from the clash betwe en family and work, individual work and the alms of the project. However, the general attitude and culture at PharmaCorp promoted mutual help. One of the interviewees said that her colleagees were willing to join forces when needed: 'It does not really matter what position you have or what your formal education is: if we need [for instance] something from the archives, we all go down there and search until we have found it'. In general, the culture at PharmaCorp was egalitarian and there was, the interviewees argued, a cordial and warm atmosphere among colleagues. This was highly appreciated by the interviewees, but it may also be that the egalitarian attitude and ethos provided new sources of stress. If employees are sharing virtually all the work assignments horizontally, it is increasingly complicated to distinguish between the individual's work and non-work. In this situation, there is no real control over the individual work situation, since most work is part of mine. Another source of stressful experien ces was technostress. When there were computer problems, it was impossible to keep up with the work, and consequently, it lagged behind. When work lagged behind, new priorities had to be made. One interviewee remarked '... quality assurance is the first casualty [in times of stress] ... we have to skip quality checks and stop asking some [critical] questions'.

Interpersonal Relationships

A third source of stressful experiences was interpersonal relationships, or rather, unsatisfactory interpersonal relationships. One Clinical Project Leader argued: 'Conflicts between colleagues are stressful for all of the team. If I feel that there is a problem between two people, I ask them as fast as I can to take time out and solve their conflict. In most cases, conflicts are about a lack of communication.' Some of the interviewees pointed out that they had a problem expressing negative suggestions and comments on how the clinical research projects were being undertaken. One interviewee said: 'there is always this competition between us, because once a project is finished, the next one starts. You want them [colleagues and managers] to think that you are doing a good job and that you won't rock the boat. [If you do that] they might say that "no, not that person, she is so negative, we don't want her".' Consequently, the Clinical Research Assistants and the secretaries claimed they had a problem pointing o ut deficiencies in research design and other concerns. Another interpersonal relationship that caused undesirable effects was the newcomer. Since the members of the Study Work Teams worked very closely and informally during a fairly long period of time -- some interviewees had been in the same project for more than four years -- a newcomer changed the existing work procedures: 'If you have been working very closely with a person for a long time and you know one another and everything is fine, then someone else is hired who is supposed to help you. Well, then all of a sudden there are three of us... It may be that the person that I used to work with gets this feeling of being marginalized' (Clinical Research Assistant). Newcomers need direction, training, and help, and therefore cause stress in terms of taking time away from day-to-day activities: 'One of the problems is when we recruit new employees. First, every new person slows down everyone else, because we have to teach this person. This project has hired too many people in a very short time, and that is not good for us' (Clinical Research Assistant).

The third source of interpersonal stress is the relationship and interaction with management and project leaders. Communicating with leaders/managers and cooperating were the two main problems pointed out as being stressful. One female Clinical Research Assistant said of her female boss: 'It can be really stressful when you have a boss who you can't get along with, or have a problem communicating with. For instance, someone who says one thing and means another, and when she shows up in the morning, you do not know whether she'll be shining like the sun or whether she will ignore you completely. That is stressful.' Another problem with managers was that it could be the case that they do not have appropriate knowledge and experience of working with certain work tasks. In such a situation, it is complicated to convince the manager of the need for help or assistance, or it is unclear how to explain unfulfilled expectations. One interviewee remarked: 'You don't feel that you are being supported by the company when you are having a crisis'.

Discussion

The clinical reseachers at PharmaCorp experienced stressful situations on a daily basis. Yet, they were very dedicated to their work and saw their efforts as being part of a broader health-care ideology that emphasized the pathos to help human beings to live better and happier (i.e. healthier) lives. Most of the interviewees described the specific clinically tested medical substance they were working on at the moment as having a true potential for reducing human suffering, pointing out the financial and market potential for the medicine. The interviewees were willing to work hard and be ambitious because of the outcome of their work. Still, it was very unclear whether a drug would be launched on the market in the end, since this was dependent on the outcome of the clinical study. For this reason, the clinical researchers worked under ambiguous conditions. There was neither a self-evident outcome of their work, nor was the outline of the work itself too clear-cut or obvious to them. The entire work setting was pervaded by a number of ambiguities. The ability to handle and accept ambiguities is an outcome of a combination of experience, personality, preferences, cognitive abilities, and self-efficacy (Woods and Bandura 1989). To some individuals, ambiguity is a potential for new ways of thinking and acting, whereas others approach ambiguity with anxiety. At PharmaCorp, ambiguities had to be dealt with on a daily basis and the most prominent (negative) outcome of this was for employees to experience stress. Even though the experience of stress was not equally distributed among the interviewees -- for instance, medical doctors who served as advisors and experienced Project Leaders did not acknowledge stress as a major problem -- but stress was always present in some respects. Stress literature points out factors such as role ambiguities and lack of control over the work situation as influential stressors. The findings from PharmaCorp support these propositions.

Meyerson (1998) addresses the inability to handle ambiguous situations, feelings, or problems in organizations, and claims that bodily and emotional responses are separated into what is seen as normal and what is seen as abnormal (cf. Canguilhem 1991; Frank 1995). At PharmaCorp, there was a general inability to handle ambiguous responses to work conditions. Even though the overall work situation was good -- e.g. good opportunities for ongoing training and education at the company, the workplace was very modern and even a little extravagant, the employees were highly dedicated to their work, and the company's performance was (as in the pharmaceutical industry in general [cf. Roberts 1999]) outstanding -- stress remained a key issue to be dealt with. At PharmaCorp, stress was a broad, general problem, yet there were few opportunities to discuss, deal with, and highlight its impact on personal well-being, as well as on interpersonal relations. Even though it was acknowledged as a problem, stress was continuously swept under the carpet. Attempts to handle stress were primarily aimed at individual proactive exercises in the same vein as those pointed out by Martin et al. (1998). At times, lectures on individual stress management practices were arranged by PharmaCorp, but as one of the interviewees ironically remarked 'I didn't have the time to go there anyway'. These endeavours were appreciated by the interviewees, but as one of the Clinical Researchers said, 'I can always do those Yoga exercises, but it won't get the job done for me'. The problem was, on the bottom line, the interviewees argued, the lack of resources that could help to sort out the ambiguities. However, rather than seeing stress as an outcome of organizational or job design, the problem of stress was reduced to the level of the individual.

The point of departure for the study was that organizations have a problem dealing with ambiguous or non-legitimate embodied responses to external demands and expectations. Emotions either have to be familiar (e.g. anger) or they have to contribute to the production processes of the company (e.g. the smile of a flight attendant). In situations where these prerequisites are not met, organizations are likely to demonstrate an inability to deal with these responses. The experience of stress is an ambiguous phenomenon and experience. Consequently, it is at times rejected as being a personal problem derived from personal shortcomings, or, at other times, when acknowledged, as being an abnormal response to normal demands.

Experiences of deviant responses such as stress, burn-out, strong emotions (e.g. love or envy), and so forth, are perfectly normal responses to the way complex social formations or systems, such as organizations, operate. If a number of individuals are subjected to strenuous work pace, forced to cooperate in an organic work structure, and continuously made to change their work conditions (e.g. newcomers, new directives and objectives, etc.), then sooner or later some of the employees will be likely to experience this situation as stressful. That is a normal response to what are increasingly becoming standard work conditions (cf. Hochschild 1997). The experience of stress is a social response, surfacing on the individual body, to ambiguities produced in a specific setting. In general, PharmaCorp had a poor capacity to deal with embodied reactions; the indeterminate nature of stress was dealt with through reducing it to the individual, bodily level. The Clinical Researchers were, in short, expected to master th eir 'stressed bodies'. The complexity of stress was reduced to a number of propositions: stress is personal; stress derives from the individual's modus vivendi; stress is dealt with on the level of the individual. In short, stress was personalized. The personalization of stress is an attempt to capture this complex, fluid phenomenon in fixed categories.

Organizations have to be able to deal with, and manage, bodily as well as emotional and emotionally laden activities. In much organization theory, bodily and emotional responses and experiences are separated and theoretized upon as being of different orders. Nevertheless, it is not meaningful to isolate embodied experiences and emotions; mind and body co-exist and interact as one single entity (Frank 1995). At least, there is a certain degree of proximity between mind and body (Shilling 1993). For instance, the experience of stress, bum-out, and other forms of job-related illnesses and problems is neither an entirely bodily phenomenon, nor an emotional experience, but both simultaneously. Much stress literature is reductionistic, i.e. it conceives of stress as being either an emotional or a corporeal problem, and fails to satisfactorily acknowledge stress as being socially embedded. Stress is embodied, experienced as a bodily disorder, although inextricably entangled with emotions and caused by extra-corporea l factors. Today, we have neither the tools nor the practices to be able to deal successfully with stress, nor do we have an understanding or theoretical framework that can provide such practices. In Jex's (1998: 91) words: 'The study of occupational stress is really in its infancy'.

A partial explanation for the shortcomings in dealing with stress lies in the preference in the stress literature for a Cartesian mind-body dualism rather than a Spinozist parallellism where mind and body are not essentially divided or separated (Hayden 1998: 59; Deleuze 1988). Western thinking, characterized by what Luhmann (1990: 22) calls the 'transcendental tradition', has often favoured the mind over the body; thinking over emotions. This tradition of logocentric thinking is dominant in organization theory (Hassard et al. 2000; Gergen and Whitney 1996; Turner 1996). Organization theory demonstrates a preference for the intellectually based properties of organizational activities; culture, attitude, communication, symbols, and so forth have been investigated and studied at the expense of organizational operations on individuals' bodies. However, this belief in mental properties, and more specifically, mental properties embedded in rationalism, pushes aside other human qualities. In the words of Gephart et al. (1996: 364): 'Rationality must take its role alongside other human capabilities such as love fear, pain, and hope'. Hopefully, future attempts to theorize and understand stress and its implications for organizations and their employees will be able to depart from logocentric models based on reductionism and linear causality.

Conclusion

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

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Alexander Styhre

Alexander Styhre is Assistant Professor in the Department of Project Management of Chalmers University of Technology. He gained his Ph.D. in Business Administration from Lund University in 1998. At present, Alexander Styhre is participating in a knowledge management project within the pharmaceutical industry.

Mailing Address: Fenix Research Program, Chalmers University of Technology, Aschebergsgatan 46, Vasaomradet Hus 3, S-412 96, Gothenburg, Sweden.

E-mail: ALEXANDER.STYHRE@FENIX.CHALMERS.SE

Anders Ingelgard

Anders Ingelgard is Assistant Professor in the Department of Project Management of Chalmers University of Technology. He gained his Ph.D. in Psychology from Gothenburg University in 1998. Anders Ingelgard is interested in human resource management, change management, and quality of work-life issues.

Mailing Address: Fenix Research Program, Chalmers University of Technology, Aschebergsgatan 46, Vasomradet Hus 3, S-412 96, Gothenburg, Sweden.

E-mail: ANDERS.INGELGARD@FEIX.CHALMERS.SE

Peder Beausang

Peder Beausang is a Ph.D. candidate at the Gothenburg Research Institute (GRI), Gothenburg School of Management and Commercial Law, Gothenburg University.

Mailing Address: Gothenburg School of Management and Commercial Law, Gothenburg University, Box 610, SE405 30 Gothenburg, Sweden.

Mattias Castenfors

Mattias Castenfors, M.Sc., is a research assistant in the Department of Project Management of Chalmers University of Technology.

Mailing Address: Fenix Research Program, Chalmers University of Technology, Aschebergsgaten 46, Vasaomradet Hus 3, S-412 96, Gothenburg, Sweden.

Kina Mulec

Kina Mulec, M.Sc., is a research assistant in the Department of Project Management at Chalmers University of Technology.

Mailing Address: Fenix Research Program, Chalmers University of Technology, Aschebergsgaten 46, Vasaomradet Hus 3, S-412 96, Gothenburg, Sweden..

Jonas Roth

Jonas Roth is a Ph.D. candidate in the Department of Project Management of Chalmers University of Technology. He is currently working on a knowledge management project in the pharmaceutical industry.

Mailing Address: Fenix Research Program, Chalmers University of Technology, Aschebergsgatan 46, Vasaomradet Hus 3, S-412 96, Gothenburg, Sweden.

E-mail: JONAS.ROTH@FENIX.CHALMERS.SE
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Author:Styhre, Alexander; Ingelgard, Anders; Beausang, Peder; Castenfors, Mattias; Mulec, Kina; Roth, Jonas
Publication:Organization Studies
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Date:Jan 1, 2002
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