Does self-tracking increase the healthicization of everyday life?

Some years ago I have suggested to think life-style centred health promotion as phenomenon that mirrors the regimen designed to manage chronic illness (matching the chronic patient with a chronic proto-patient), and therefore call it “chronic health”. Although I have tried to understand this a temporal delimitation of the Parsonsian sick role, I have not paid much attention to the temporal dimension of the practices involved – the regularities and rhythms these disciplines entail. This highly interesting reflection by Chris Till not only highlights such temporalities, but also shows up how with new technological developments in consumer electronics they are intensified and fine-tuned, truly chronifying the healthy body…

This Is Not a Sociology Blog

Self-tracking has been talked up a lot over the last few years as a potential component of e-health or m-health. It has been proposed as a tool of public health and particularly health promotion because of the ways in which it can blend in with the daily life of users. For instance, self-tracking can easily generate data on behaviour change for researchers without bothering users too much, provide automated “nudges” to users (“you’re near the park why not go for a run?”) and potentially form a feedback system to users who will respond to the “gamification” of their daily activities (by trying to beat their previous week’s step count perhaps).

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The ability of self-tracking devices to blend into everyday life and make exercise easier and more fun has been one of the big drivers for optimism in their potential. While I can see that this could be a…

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The instability of the modern middle class family: alienation for progress

08.15.2010 · Posted in Uncategorized

When talking about the importance of the family for a society, one most often thinks in terms of it in terms of a “bedrock”, an anchor of stability and security in a rapidly changing world. While there certainly is a lot of plausibility to the idea that the family is a counter world to and retreat from a capitalist society that thrives on alienation, and that this retreat is functional in the reproduction of balanced personalities who contribute to and survive in that less-than-balanced economy, I would like to suggest that the importance of the middle class nuclear family and its successors in the production of economically successful innovative subjects lies not just in the stability it provides (other family models could do better…) but in the inbuilt element of instability – or at least in a precarious combination of stability and instability. [i]

It is a well-rehearsed theme in conservative social politics from New Labour to Tories and featured high in the current rhetoric of a “broken Britain” that needs mending – here’s just one example (randomly googled – this is from the Daily Telegraph, 29thMarch 2009)

‘Families would be put at the fore-front of the Government’s policy making, with Mr Cameron stressing his belief in the importance of marriage and supporting parents. He said: “We want to see a more responsible society, where people behave in a decent and civilised way, where they understand their obligations to others, to their neighbours, to their country. And above all, to their family.’

I always thought that a nicely working argument against a Thatcherite “who-is-society-?-there-is-no-such-thing-!-there-are-individual-men-and-women-and-there-are-families” rhetoric would be the Marx/Engels[i] and Schumpeter line that bourgeois and middle-class family values are undermined by the very liberal market economy which is said to be so much dependent on – values of loyalty and commitment that are not sustained by the entrepreneurial cost-minimising and profit-maximising self encouraged by the workings of capitalist relations of production and exchange:

‘As soon as men and women learn the utilitarian lesson and refuse to take for granted the traditional arguments that their social environment makes for them, as soon as they acquire the habit of weighing the individual advantages and disadvantages of any prospective course of action – or, as we might put it, as soon as they introduce into their private life a sort of inarticulate system of cost accounting – they cannot fail to become aware the heavy personal sacrifices that family ties and especially parenthood entail under modern conditions and of the fact that at the same time, excepting the cases of farmers and peasants, children cease to be economic assets. These sacrifices do not consist only of the items that come within the reach of the measuring rod of money but comprise in addition an indefinite amount of loss of comfort, of freedom from care, and opportunity to enjoy alternatives of increasing attractiveness and variety – alternatives to be compared with joys of parenthood that are being subjected to a critical analysis of increasing severity.’ (Schumpeter 1942: 157f.)

Which is problematic as at the same time family commitment is a main motivator of economic achievement:

‘the family and the family home used to be the mainspring of the typically bourgeois kind of profit motive. Economists haven’t always given due weight to this fact. When we look more closely at their idea of the self-interest of entrepreneurs and capitalists we cannot fail to discover that the results it was supposed to produce are really not at all what one would expect from the rational self-interest of the detached individual or the childless couple who no longer look at the world through the windows of a family home. Consciously or unconsciously they analyzed the behavior of a man whose views and motives are shaped by such a home and who means to work and to save primarily for wife and children.’ (Schumpeter 1942: 160)

Parsons (applying a Durkheimian figure of thought) saw the vital function of decidedly non-economic attitude in family life for the functioning of (male) subjects in the market economy to which the family vitally contributes and from which it receives its sustenance, but to which it is defined as radically external. The economicisation of family life hence would disable that function; it’d be detrimental to its economic contribution. So that would close the case with a “you’re doing it to yourself”.

However, with all the changes in contemporary family life (see  Allen (1999) for a good overview of the end-of-century situation in the UK) – any attempts of active imposition of economic rationality onto family life or even only economic calculi seeping into the realm of the family have come to no avail. The semantics of love prevail (even if they are commercialised – they are still a main source of legitimacy). And, looking at Schumpeter’s emphasis on the motivational role of working for the children, there isn’t much to worry about:  children wield an impressive purchasing power, and surely that comes from their parents giving them money rather than from a return of child labour. Family income is generated for and spent on loved ones, shopping remains, as Daniel Miller (1998) found in his seminal study of North Londoners’ consumption, essentially driven by love.

Familiar motivations to consume (and hence to seek income) are thus not scarce; and nobody really worries about families’ propensity to spend. The main concern is about the family no longer providing the safe and caring environment to produce offspring who become reliable, emotionally balanced (i.e. self-controlled) economic subjects, producers. The whole issue of loss of values, rising crime and rising teenage pregnancies, loss of entrepreneurial spirit, discipline, respect are all tangled up in the idea that we are, over the centuries, moving from a large, multigenerational, rural, patriarchal family to ever more fragmented and disintegrated forms – a development/degeneration in which the middle class nuclear family is only a stage (Parsons (1956) already had to defend the nuclear family, which we now view as the traditional form that’s slipping away, against the charge that it is basically a damaged left over of the traditional larger familiy). And crucially, that with this decline comes a steady decline in work ethics and discipline. Mitterauer and Sieder (1982) expose this as an ideological construct – mainly by dismantling the historical evidence for such a story. In fact, they show that the average family size in previous centuries in North West Europe wasn’t much greater than in the 20th century.  Given their picture of the pre-industrial family as already quite dynamic one could speculate that maybe such instability is not an economic obstacle but a driving force – particularly against the background that, while acknowledging the function of the family as provider of a secure and loving environment to grow up in, for the allegedly conservative theorists Hegel and Parsons the fact that it is designed to fall apart is equally important:

‘It clearly has to be a group which has relatively long duration – a considerable span of years. But it is not of indefinite duration. One o fits most important characteristics is that the family is a self-liquidating group. On attainment of maturity and marriage the child ceases in the full sense to be a member of his family of orientation ; instead he helps in the establishment of a new one.’ (Parsons, 1954: 104)

In the bourgeois liberal ideal marriage is a total commitment, a merging of two people into one legal person – but resulting from the free will of two persons mutually recognising each other as that: free subjects.

‘Marriage is but the ethical Idea in its immediacy and so has its objective actuality only in the inwardness of subjective feeling and disposition. In this fact is rooted the fundamental contingency of marriage in the world of existence. There can be no compulsion on people to marry;’ (Hegel, Philosophy of Right, para176)

The contradiction is obvious: this is an expression of freedom that consists of freely giving it up in mutual trust that this surrender will not be exploited. The contradiction is resolved by that fact that this mutually recognised freedom is materialised in the production of new, essentially free persons (children as pure potentiality, if you like) – and because they are expressions of freedom they must cannot be retained in the family where there is full recognition of two free persons and their decision to become one… but no room for the freedom of a third person: they need to be released into the world – and the family thus must be dissolved:

‘The ethical dissolution of the family consists in this, that once the children have been educated to freedom of personality, and have come of age, they become recognised as persons in the eyes of the law and as capable of holding free property of their own and founding families of their own, the sons as heads of new families, the daughters as wives. They now have their substantive destiny in the new family; the old family on the other hand falls into the background as merely their ultimate basis and origin, while a fortiori the clan is an abstraction, devoid of rights.’ (Hegel, Philosophy of Right, para177)

The liberal market society (“civil society” in Hegel) results from those individuals propelled out of the communal context in which they were recognised as full personalities (but in such recognition also limited in further self development) into an arena where individuals acknowledge each other as fully free but only abstract individuals whose concrete being is met with general indifference. While this is alienating, it also enables and enforces creative and innovative development of self (producing, in turn, an urge to seek recognition of those selves in intimate relations, leading to further marriages…).

Inspired by Freud, Parsons also highlighted the particular (Oedipal) dynamics of the identifications within the family and their preprogrammed frustrations that propelled particularly middle class sons into careers that on the one hand aspired to satisfy paternal expectations, but on the other hand also needed to reaffirm non-identity and hence fuelled innovation (the inbuilt sexism of this arrangements has often been highlighted – what has been overlooked is that it is a sexism that differs from traditional patriarchy in that structurally represents its illegitimacy – see my argument at the end of the post on romantic consumerism. I would suggest that it may not be a specifically Oedipal constellation that does it, but any constellation which encourages full identifications… and then frustrates them in one way or another). Allert (1998) demonstrates how the dynamics of the triad operating in the nuclear family spawns literary, scientifically and social scientifically innovative subjects, reconstructing in case studies the family histories of Kempowskis, the Einsteins and the Webers. While certainly the nuclear family is not the only family form from which innovative characters can emerge, but it is also quite obvious that it is, historically, the most likely and as Allert showed, structurally very plausible.

If that is the case – and if the crucial factor is the presence of an inner contradiction that drives the intensified emotional bond of the middle class family to a breaking point that necessitates the establishment of a distance between offspring and parents after adolescence – then one can ask whether not the conservative utopia of a harmonious and stable family that maintains control over and responsibility for all relatives, children, grandparents etc. wouldn’t just put the brakes on capitalist cultural and economic development?

Whatever the real composition and size of the pre-capitalist family, there is one feature that makes it an unlikely candidate for producing the kind of personality that could provide the capitalist economy with the kind of innovative and enterprising subjects that the conservative advocates of family harmony so desire – and it is entirely down to cohesion and togetherness. In the words of Philippe Ariès (1962: 398):

‘The historians taught us long ago that the King was never left alone. But, in fact, until the end of the seventeenth century, nobody was ever left alone. The density of social life made isolation virtually impossible, and people who managed to shut themselves up in a room for some time were regarded as exceptional characters: relations between peers, relations between people of the same class but dependent upon one another, relations between masters and servants – these everyday relations never left a man by himself. This sociability had for a long time hindered the formation of the concept of the family, because of the lack of privacy.’

The success is not due to an inherent traditionalism and conservatism of that family form but, I would argue, to a combination of gemeinschaft type total inclusion and an inbuilt tendency for that gemeinschaft to break up and propel its members into its opposite – an individualistic gesellschaft. Conservatives are right to stress that an initial atmosphere of harmony and stability (“ontological security”). As Giddens argues:

‘Creativity, which means the capability to act and think innovatively in relation to pre-established modes of activity, is closely tied to basic trust. Trust itself, by its very nature is in a certain sense creative, because it entails a commitment that is a “leap into the unknown”, a hostage to fortune which implies a preparedness to embrace novel experiences. However, to trust is also (unconsciously or otherwise) to face the possibility of loss: in the case of basic trust, the possible loss of the succour of the caretaking figure or figures. Fear of loss generates effort; the relations which sustain basic trust are “worked at” emotionally by the child in conjunction with learning the “cognitive work” that has to be put into even the most repetitive enactment of convention.’ (Giddens 1991: 41)

What Giddens here fails to acknowledge is that, while this might be a universal condition of growing up a human being, the situation is accentuated considerably by the fact that as Hegel, Freud and Parsons acurately observed, in the modern family the initial “leap into the unknown” is not just made under the possibility of a future loss: that loss is certain and the next leap into the even more unknown is inevitable.

Crucially, the conservative concern isn’t about the middle classes at all – it is about the working classes, it is about the people on the council estates… and here creativity and innovation isn’t really what we’re looking for. It’s disciplined work ethic to be displayed in rather monotonous, low pay jobs. Tony Blair’s former political secretary John McTernan, in an obituary for trade unionist Jimmy Reid in the Daily Telegraph takes the opportunity to also mourn the bygone world of austere working class culture:

The world of mass working- class employment in mines, factories and shipyards went. These had been rough and ready places with, certainly in mining, real risks as well. But they had also spawned a set of social institutions, from working mens’ clubs to trade unions, which gave form and meaning to lives. Adolescents learnt a job or a craft and saw how to be a man. Formal and informal mentoring created social discipline. Talents were spotted and nurtured. One might make a shop steward, another would benefit from a spell at Ruskin College, another would make an elected official. In such a way, quietly and proudly, the British working class made and remade itself. Valuing hard work, thrift, education and getting on. Fashioning institutions that reinforced those virtues. All gone now. A world swept away, and in its place, what? Council estates that are ghettos of worklessness. Feral youths. Gun crime. Parents unable to bring up their own children, and helpless when those very kids have their own babies.

A central element in this culture was the working class family… and that family did indeed provide mutual support, values of solidarity and workmanship, homeliness … but it also stifled aspiration and innovation.  It was just too tightly knit – in the words of Richard Hoggart:

‘The hearth is reserved for the family, whether living at home or nearby, and those who are “something to us”, and look in for a talk or just to sit. Much of the free time of a man and his wife will usually be passed at that hearth; “just staying-in” is still one of the most common leisure-time occupations. It is a cluttered and congested setting, a burrow deeply away from the outside world. There is no telephone to ring, and knocks at the door in the evening are rare. But the group, though restricted, is not private: it is a gregarious group, in which most things are shared, including personality; “our Mam”, “our Dad”, “our Alice” are normal forms of address. To be alone, to think alone, to read quietly is difficult. There is the wireless or television, things to be done in odd bouts, or intermittent snatches of talk (but rarely a sustained conversation); the iron thumps on the table, the dog scratches and yawns or the cat miaows to be let out; the son, drying himself on the family towel near the fire, whistles, or rustles the communal letter from his brother in the army which has been lying on the mantelpiece behind the photo of his sister’s wedding; the girl bursts into a whine because she is too tired to be up at all, the budgerigar twitters.’ (Hoggart 1957: 22f.)

Notably, this engulfing sociality does not only discourage individual expression – there is no retreat, physical or mental –  it makes it difficult for children to let go:

‘Is it to be wondered that married sons and daughters take a few years to wean themselves from their mother’s hearth? Until the needs of their own children make evening visits practically impossible, and this will be a long time after the mother with views on the healthy rearing of children would think it reasonable, the son or daughter with whatever children they have will be around in the evenings.’ (Hoggart 1957: 23)

Michael Young and Peter Willmott confirm this in their study of family life in Bethnal Green published in the same year. (1957: 73)

Needless to say that gun crime and teenage pregnancy are a smoke screen here (there was no shortage of destitution and crime in the olden times – and knife crime isn’t new… remember straight razors and why they were also aptly called “cut throat razors”?). The real issue is with the production of an austere (non-consumerist) workforce whose tendency to strike seems to be judged a minor evil compared to today’s council estate youth’s reluctance to go on their… bicycles? … to find work in the first place. Only there isn’t much work for loyal labourers any more..

Which leads me to conclude: Shouldn’t we be more concerned about tendencies in the other direction? It is all very well to worry about broken families in the inner cities and it would be a good thing to enable less disruptive childhoods there (which probably have as much to do with material resources, educational opportunities, quality of housing stock etc. as they have with family life or its absence) – but if it’s about “keeping the country going”: maybe it’d more appropriate to worry about the trend to curtail children’s freedoms beyond their parents’ immediate control, overwhelming parental involvement in everything from free time to school…

Maybe – just maybe – the  increased messiness of family structures is a natural antidote to the otherwise ever more stifling emotional intensity of nuclear family life, a reaction to the pressures of a culture of intimacy and does not so much endanger as preserve the bourgeois subject.

Allen, Graham (Ed.) (1999): The Sociology of the Family, Oxford: Blackwell

Allert, Tilman (1998): Die Familie: Fallstudien zur Unverwüstlichkeit einer Lebensform, Berlin: DeGruyter

Ariès, Phillipe (1962): Centuries of Childhood, London: Jonathan Cape.

Giddens, Anthony (1991): Modernity and Self-Identity. Self and Society in the Late Modern Age, Cambridge: Polity Press.

Hoggart, Richard (1958) [1957]: The Uses of Literacy, Harmondsworth: Penguin

Miller, Daniel (1998): A Theory of Shopping, Cambridge: Polity.

Mitterauer, Michael/Sieder, Reinhard (1982): The European Family: Patriarchy to Partnership from the Middle Ages to the Present, Oxford: Blackwell

Parsons, Talcott (1954): ‘The Incest Taboo in Relation to Social Structure and the Socialization of the Child’, in: British Journal of Sociology, Vol.5, No.2, pp.101-17.

Parsons, Talcott (1956): ‘The American Family: Its Relations to Personality and to the Social Structure’, in: Talcott Parsons, Robert F. Bales (Eds.): Family. Socialization and Interaction Processes, London: Routledge, Kegan & Paul, pp.3-33

Schumpeter, Joseph A. (1942): Capitalism, Socialism and Democracy, New York: Harper

Young, Michael/Willmott (1957): Family and Kinship in East London, Harmondsworth: Pelican.

update 21st august

yes – of course there’s working class creativity and innovation! (as anyone who either happens to have met working class people knows – if you haven’t, reading Willis’ (1990)Common Culture may help). Here’s just one piece of evidence…

madness: our house

which happens also to illustrate nicely the dense description by Richard Hoggart quoted above – NB that one line they smuggled into the nostalgic portrayal of home goes

“something tells you that you’ve gotta get away from it”

And getting away is not easy – partly, as Jimmy Reid kept pointing out, as there’s not much freedom to get anywhere if you haven’t got the money to pay for it… and partly because it’s so difficult to be alone and retreat into yourself. For some reason Reid was able to pull that trick and expand his universe through.. books – as Sir Alex Ferguson recalls

“Our education was football, his education was the Govan Library – he was never out of there. That education gave him an intellect far beyond what we ever thought we could achieve.”

Education was one of Reid’s central concerns and great hopes – as he said in his Glasgow rectorial address

‘The untapped resources of the North Sea are as nothing compared to the untapped resources of our people. I am convinced that the great mass of our people go through life without even a glimmer of what they could have contributed to their fellow human beings. this is a personal tragedy. It is a social crime. The flowering of each individual’s personality and talents is the precondition for everyone’s development.’ (Reid 1972: 11f.)

Reid didn’t reflect on family life here – he saw the main evil in social inequality and the lack of opportunity. But there is a link between the lack of resources and family life: It’s space. And space is a scarce resource – as a commodity it is the nexus between cash and liberty, as I argue in elsewhere

The freedom of the less well off is a much smaller one than that of those with greater spending power. If such a negative concept of freedom implies that its only limit is the obligation of “not injuring the interests of one another; or rather certain interests, which, either by express legal provision or by tacit understanding, ought to be considered as rights”, then in a society with hugely unequal property rights the freedom of the poor is squeezed into what little space is left by the liberties taken by the rich.’ (Varul 2010: 59)

One reason why there is no retreat from the stifling omnipresence of family is that there is not enough room in the house – or rather: not enough rooms. It’s not just middle class women who need, as Virginia Woolf famously called for “a room of one’s own”  (though that’s important as well!) – working class kids  need their own rooms.

Reid, James (1972): Alienation: Address delivered to the University of Glasgow on Friday 28th April 1972, Glasgow: University of Glasgow Publications

Varul, Matthias Zick (2010): ‘Reciprocity, Recognition and Labor Value’, in: Journal of Social Philosophy, Vol.41, No.1, pp.50-72

Willis, Paul (1990) Common Culture, Buckingham: Open University Press

ps

madness are nice – the specials are nicer

[i]The proletarian is without property; his relation to his wife and children has no longer anything in common with the bourgeois family relations” and “Our bourgeois, not content with having wives and daughters of their proletarians at their disposal, not to speak of common prostitutes, take the greatest pleasure in seducing each other’s wives.

[i] This is as much based on what I have learned as an undergraduate in the seminars of Tilman Allert at Tübingen some 15 years ago as it is on my subsequent readings of Hegel, Parsons and contemporary family sociology.

John Stuart Mill Utilitarianism, Liberty, and Representative Government (London: J. M. Dent, 1910), 132

 

Talcott Parsons, the Sick Role and Chronic Illness

(originally titled “Chronic Parsons: the obsolescence and persistence of the sick role in the face of chronic illness and chronic health”)

now published in Body & Society

Abstract

Parsons’ sick role concept has become problematic in the face of the increased significance of chronic illnesses and the growing emphasis on lifestyle-centred health promotion. Both developments de-limit the medical system so that it extends into the world of health, fundamentally changing the doctor-patient relationship. But as the sick role is firmly based on the reciprocities of a resiliently capitalist achievement society it still informs normative expectations in the field of health and illness. The precarious social position of chronic patients between being governed by and being consumers of medicine, I will argue, can only be adequately understood if one involves, as Parsons did, the moral economy surrounding health and illness.

open access pre-publication accepted manuscript