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Australian e-Journal for the Advancement of Mental Health (AeJAMH), Vol. 2, Issue 2, 2003 - 1 - ISSN: 1446-7984

Mental health and workplace : The role of power, and ‘on the ’ *

Lyn Turney

School of Social & Behavioural Sciences, Swinburne of Technology, Victoria, Australia

*First published in: Morrow, L., Verins, I. and Willis, E. (2002). Mental Health and : Issues and Perspectives. Adelaide, Auseinet: The Australian Network for Promotion, Prevention and Early Intervention for Mental Health. Chapter 9.

Abstract

Study of the professions, and the process of professionalisation as an occupational strategy, has mainly concentrated on investigating structures of power, rather than individual and deliberate use of power. This chapter provides a microanalysis of power relations by examining professional power and hierarchy in interpersonal relations within the workplace. It makes links across the spectrum of workplaces in which bullying occurs – from those where physical and threat of violence is experienced, to the professions and quasi-professions where legitimate power becomes the vehicle for invisible bullying practices. Arguably, it is within the professions that bullying occurs in its most rarefied form and, to understand the phenomenon, I argue that we should closely examine instances of where there is no one tangible or definable act but clearly an ongoing threat to an individual worker’s health and safety. In particular, I explore the positionality of the traditional professions within new organisational structures. The paper concludes with recommendations for the promotion of mental health at work that focus on both environmental and individual strategies.

Keywords workplace bullying, professions, professional power, managerialism, workplace culture

Introduction

Workplace bullying is fundamentally a health frequently. Insights are drawn both from and safety issue and can be defined as a practice participant observational work within the health separate from, but related to, other forms of and human services sectors and from an in- bullying. In this chapter I challenge the primary progress study involving in-depth interviews focus on individual victims and perpetrators as with people who have experienced workplace sites for change through processes of mediation bullying. Examples are used to make broad links and instead analyse power relationships and across the spectrum of workplaces within which workplace structure and non-structure. In bullying occurs – from those where physical particular, I examine the professions – where intimidation and threat of violence is workplace bullying reportedly occurs more experienced, to the professions and quasi-

Contact: Lyn Turney, School of Social & Behavioural Sciences, Swinburne University of Technology, Victoria, Australia [email protected] Citation: Turney, L. (2003). Mental health and workplace bullying: The role of power, professions and ‘on the job’ training. Australian e-Journal for the Advancement of Mental Health 2(2) www.auseinet.com/journal/vol2iss2/turney.pdf Published by: Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet) - www.auseinet.com/journal

Turney professions where legitimate power can be the of self-harming behaviours and who may be vehicle for invisible bullying practices. dismissed, miss out on promotion opportunities or quit their without having a new job to go Defining workplace bullying to (Bernardi, 2001; Strawbridge, 2001). For employers, workplace bullying can lead to In the last decade, workplace bullying has been absenteeism, high staff , decreased identified as a significant occupational health morale, loss in productivity and payment of legal and safety issue both in Australia and costs to defend claims of unfair or constructive internationally. The Australian literature reveals . In Australia, the financial cost to considerable problems with definition and the industry has been estimated to be between A$3 categorisation of bullying behaviours, with the and A$36 billion per year (Richards & Freeman, result that definitions are generally broad and 2002). , an anti-workplace bullying inclusive of a range of behaviours (e.g. Ellis, campaigner, sums up the workplace effects of 1997; Queensland Workplace Bullying bullying in this way. Taskforce, 2001; The Wallis Group, 2001; Victorian WorkCover Authority, 2001). An all- Bullying is not tough management. Its purpose is encompassing approach though is problematic to hide inadequacy and [it is] a form of thuggery which prevents people from doing their job. Where because, as Einarsen and Mattieson (2002) note, bullying exists [you will] find disenchantment, de- if everything is defined as bullying then nothing motivation, demoralisation, disenfranchisement, dis- constitutes bullying – that is, by being all empowerment, disloyalty, disaffection, dysfunction, inclusive, the term loses its meaning and its inefficiency, cynicism, alienation and an ‘us-and- usage instead serves to trivialise and negate the them’ culture, constant conflict, an unpleasant serious impacts of workplace bullying on the atmosphere, misery, unhappy staff, a climate of fear, mental health of workers, on worker output and high staff turnover, high sickness absence, low on the health and safety of the workplace itself. productivity, impaired performance, stifled creativity, Workplace bullying is sufficiently different from low morale, zero team spirit, poor customer service, schoolyard bullying and other bullying and mistakes in delivery of products and services. The cost of these is rarely accounted (Field, April 29th, behaviours, exemplified in sport (The Wallis 2002). Group, 2001) to be considered a separate and actionable practice because, in its most severe The mental health effects of workplace form, ongoing exposure to it can cause severe bullying similar to that experienced by victims of and The effect of workplace bullying thus clearly (Einarsen, 1999; Field, E. 2002). Workers so manifests as an injury sustained in the process of exposed report feeling angry, helpless, stressed doing one’s job; a central and, in many ways, a and depressed and sometimes are unable to captive activity in the life of most people. It is return to work (Richards & Freeman, 2002). the centrality of work to an individual’s life and

sense of self that is at the core of the harm Workplace bullying can be defined as workplace bullying does to those who are inappropriate interpersonal behaviours that targeted. Continual criticism, unmanageable workers are subjected to by virtue of their workloads, and the uncertainty afforded by employment. It includes such things as persistent ongoing lack of security and support in the and unjustified criticism, constant scrutiny of workplace undermine self-esteem and the ability work or unfair allegations of incompetence or to perform everyday work tasks. This then insubordination (Bernardi, 2001), or ongoing affects mental health and ultimately the ability to criticism, threats or behaviour towards a person do the job. One lawyer reported saying ‘he was that intimidate, humiliate and/or undermine their so browbeaten by a bully that he could not capacity to do their work (Victorian WorkCover compose a basic letter without fear of reprisal; Authority, 2001). The consequence of bullying is he felt that he had lost the capacity to complete a that it undermines the dignity and self-worth of basic task’ (Toop, cited in Richards & Freeman, individuals who become less productive, may 2002, p233). If workplace bullying has been suffer trauma-related illnesses, be at greater risk experienced by 50% of Australian workers as 2 Turney reported by Morgan and Banks (1998), then loss semi-professional contexts, it is rarely connected of productive time, both in the workplace and in with physical violence and is only sometimes dealing with and recovery from trauma related related to . Arguably, it is within the injury, is a substantial social cost. In most professions that workplace bullying occurs in its people’s lives work itself is mandatory, essential most rarefied form and a focus on the for survival and not always where individuals professions, particularly medicine, provides the would choose to spend most of their time. So possibility of a unique window into bullying when a worker experiences the traumatic effects practice. of bullying, financial constraints often make it difficult to speak up in self-defense or to escape The professions, professional power and the workplace (Einarsen, 1999). workplace bullying

Workplace bullying and violence The study of the professions has mainly concentrated on investigating structures of Bullying in the workplace first came to notice in power, rather than individual and deliberate use what could be described as apprentice bullying of power. The power of the professions is seen through high profile case studies, presented in as structural and organisational, having been the media (e.g. South Australian Employees achieved through systematic and strategic Bullied Out of Work, 2001). In cases that have manoeuvres to gain monopolistic and prestigious been litigated, it has been the associated physical market positions (Freidson, 1986; Turner, 1987; violence that has been highlighted and Willis, 1989b; Daniel, 1990; Daniel, 1998) In prosecuted rather than the trauma associated this view, individuals within the professions are with loss of self-esteem and employment. In seen as inheriting prestige and power by virtue fact, violence or its threat is a key feature of both of their occupational choice rather than schoolyard and apprentice bullying, while it is individually seeking or exercising it. To date usually absent in professional organisations. there has been no critical investigation of the And, although it would seem the workplace micro interaction of professionals nor their cultures in trade and professional organisations interaction with subordinates. Yet it is clear that are qualitatively different, I will make some hierarchy exists in any interaction with links that promise to be elucidatory. Rayner and professionals in the work context. What has been Hoel (1997) outline several categories of investigated within the of medicine is intimidating behaviour at work, unrelated to the doctor-patient relationship (e.g. Katz, 1986; violence but directly relevant to job specific Barbour, 1998) and these studies have identified threats: threats to professional standing; threats two main issues. The first is a clear imbalance of to professional status; isolation; overwork; and power and professional distance manifest in destabilisation. Examples they provide include: what is commonly referred to as the ‘empathy belittling comments, public professional gap’ or fundamental lack of understanding of the , shifting goalposts and undue lived experience of ‘the other’ – what pressure to produce work. When these and anthropologist Clifford Geertz (1993), in similar activities are ongoing they constitute referring to the relationship between himself and workplace bullying and are likely to have the native subjects of his research, terms as deleterious effects on the mental health of the being ‘profoundly other to each other’. The person who is subjected to such treatment. second and related concept is that the professional and the lay person inhabit different So, in order to understand and address the worlds and do not even share the same phenomenon of workplace bullying, there is a understandings of common sense terms (Boyle, need to closely examine instances of workplace 1970) – what educational researcher Bernstein bullying where there is no one tangible or (1974) refers to as having differing linguistic definable act but where there is clearly an codes. These analyses provide insights relevant ongoing threat to individual workers’ health and to professional power in its interface with the safety. Workplace bullying always occurs within patient, but it is what happens in the shared a power relationship and, in professional and world of work within the professions and with

3 Turney their subordinates that has largely gone (White, 2000). In fact, it uninvestigated. seems socialisation into the professions through training frequently incorporates and fosters Vertical workplace bullying and the behaviours that easily translate into workplace professions bullying practices. However, because they are intricately entwined with the process of training, There have been several recent reports of they are particularly resistant to identification bullying in medical settings that provide rare and intervention. insights into the closed world of health professionals (Quine, 1999; Editorial, 2000; Learning power and hierarchy – [anon.] 2001; Dyer, 2001; Strawbridge, 2001; professional training and practice Sunderland & Hunt, 2001). The practices discussed can usefully be divided into two main In examining the process of professional analytical categories: horizontal workplace training, I use two case studies to illustrate my bullying and hierarchical workplace bullying. analysis. The first was an interview with a young The former has been written about in a number man who, after six months, had quit his job in a of nursing related publications (Duffy, 1995; very eagerly awaited apprenticeship as a in Lee, 2001; Strawbridge, 2001; Hockley, 2002) a top regional restaurant. The second is an and refers to workplace bullying that occurs anonymous account of the experience of a young between workers or professionals on the same woman trainee surgeon published as a level, in the same occupation. Whilst a full commentary in the British Medical Journal. Both discussion of this type of workplace bullying is experienced ongoing unfair and unreasonable beyond the scope of this chapter, it is worth criticism undermining their work and their noting that it is a practice engendered within a abilities from a single person who held a formal broader culture of bullying. The main focus of position of power over them. this analysis is the bullying that occurs within hierarchy and by virtue of an individual’s Although, at first glance, we might see these structural location both within a specific cases as completely different, there are workplace and within the broader world of work. similarities that are explanatory in understanding the structure of power that enables its individual It is within the professions that interpersonal and deliberate use. In both these cases the young hierarchy is arguably most obvious and where people were undertaking practical, on-the-job power disparity is greatest. A recent study of training – a hands-on approach in the form of 5000 Australian employees reported the legal ‘learning from the master’. profession to be the worst bully with 33% of respondents in the sector saying they had CASE STUDY 1 – the apprentice chef experienced regular intimidation at work (TMP The apprentice explained that the head chef would Worldwide, 2002; The Age, 2002). In Britain, a constantly find fault with his work, tell him that he would never make a proper chef, often throw the dish he was study of the public hospital sector, an NHS working on in the bin in a flight of rage, continually Community Trust, reported 38% of health sector criticise and, on several occasions, ‘clipped him round the employees experienced workplace bullying in ears’ (read: hit him across the head). At the same time, the the previous year (Quine, 1999). The same study chef refused to sign the apprentice’s indenture papers over reported specifically on junior doctors, 37% of the six-month period, ensuring that the apprentice was not in a position to stand up for himself and affirming that he 594 who identified as having been bullied in the was dependant on the good will of the chef. Episodes of past year (Quine, 2002). In the United States bullying were, however, frequently followed by an several studies have shown medical students invitation to join the chef in a drink after work, at which suffer high levels of job related bullying during time he would apologise and say he did not mean the things he said – he was just trying to make a good chef out of him. training that escalates with progression through The apprentice finally resigned from this position. When training (Daugherty, Baldwin & Rowley, 1998; asked why he resigned – was it the physical violence or the Kassebaum & Cutler, 1998). The only available criticism – without hesitation, he answered that it was report in Australia identifies high levels of definitely and unequivocally the latter. bullying during medical training but names it as

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CASE STUDY 2 - the trainee surgeon that are, in the main, overt and more likely to be The tears ran down my face, hidden by my surgical mask. accompanied by violence or its threat (and My consultant continued relentlessly, ‘Why can't you do therefore more actionable); whereas professional this? It really isn't hard. Are you stupid? Can't you see how workplace bullying occurs in the form of verbal to help me?’ … The criticism continued, if not with words, then with sighs and angry tutting. The atmosphere in the or non-verbal criticism and intimidation that is operating theatre was tense. The staff had all seen this subtle, insidious and almost impossible to detect happen many times before – hard working, pleasant from outside the interpersonal relationship. Both trainees reduced to non-functioning wrecks in the space of forms threaten mental health and wellbeing. an operation. I looked helplessly at the scrub nurse, another trainee. She saw my distress immediately and gave me a supporting glance. But she too was suffering. ‘No, not that The master-apprentice relationship is sacrosanct one. Why do we have to have trainees in my operations? and immune to intervention. This is particularly Not like that,’ she lashed out at the scrub nurse. Another the case in medicine, which is an autonomous, hard working, competent trainee, now shaking and anxious, individualistic and largely competitive practice, her self-confidence fast diminishing. … I felt uncomfortable continuing in such distress. … I wondered where there is no allowable margin for error. what would happen if I asked to leave and decided that it The master cannot be wrong. Internal regulation would probably just make things worse for me. I stayed. of individual members is integral to the Three hours of hostility and criticism. … Her behaviour maintenance of professional power. As Daniel was always the same – on the ward rounds, in clinics, and argues in relation to the legal profession: in theatre. She was hostile, critical, and discouraging. I continued in this post for the complete six months, becoming increasingly anxious and depressed. I left my Disciplinary practices are about learning and loyalty, post feeling suicidal. …The bullying I endured has left me standards, sanctions and the solidarity of the group. traumatised. Despite being told that she treated everyone Whatever might threaten from outside is vigorously this way, I believed it was all my fault … I couldn't believe resisted and what might corrupt from within is to be that this was the basis of basic surgical training ([anon.] cut out. Maintenance of identity, public face and 2001, p1314). reputation can become its paramount good (Daniel, 1998, p3).

They are their masters’ apprentices, and the Daniel (1998) uses the notion of ‘’ methods of formal training in the professions of to explain how a lawyer was sanctioned by her medicine and law (and also, to a lesser extent, in profession. She refers to ‘professions as nursing, social work and teaching) incorporate community’, as tight-knit, exclusive, collegiate the practicum, the and the article- and closed groups that are both self-serving and clerkship, all of which parallel trade self-regulating. As a bonded group with shared apprenticeship training. In the professions, but beliefs and practices, doctors and lawyers have a also in the trades, the master controls common interest in perpetuating their knowledge, the work itself and has inordinate considerable advantage and prestige, so they do power over results and future job prospects. The not tolerate individual resistance and those from master elicits perfection and precision – there is their ranks who transgress are punished and no place for the mediocre. But the trainees are penalised. Hierarchy and power is learned, high achievers, top ranking, successful and reinforced and reproduced within the master- disciplined students who put long, hard and apprentice relationship. It is redeployed and solitary hours into their achievements. This duplicated in other workplace relationships, such makes them extremely vulnerable. They are not as the nurse-doctor, nurse-nurse and in a position to jeopardise their by administrator-doctor, and professional speaking out about of power nor to dominance over other workers becomes a contest the mythical notion that tough discipline necessary occupational mode of operation. And, and cold, unemotional interpersonal at a broader societal level, professional power is relationships make them better practitioners. sustained in professional autonomy and authority (Willis, E., 1989) and protected and In terms of workplace bullying, the main institutionalised within ‘sheltering institutions’ difference between the trade apprentice and the that ‘support the position of the professions in trainee professional is that the former is the political economy’ (Freidson, 1986). subjected to working-class bullying behaviours

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Professional power, ‘non-structure’ and any of the margins; and from internal managerialism contradictions (Douglas, 1988, pp96, 99, 102). These four sites can be examined as danger In the last two decades it has been argued that zones for the of power in organisations professional power has been challenged by and as sites of alienation, and economic and managerialist reforms in the workplace bullying. The key sites in new health sector, but analysts have, in general terms, managerialist organisation relevant to the present refuted any overall decline (Willis, D. 1989; discussion are first, in the occurrence of Hafferty & McKinlay, 1993; Willis, 1993; Gabe, interstitial or ambiguous roles where individuals Kellehear & Williams, 1994). Analysis at a – middle managers or workers – are confronted micro-level however, reveals some outcomes of with the conflicting demands of two groups market-driven health sector reforms that, rather (managers and professionals) who often do not than undermine professional power, may understand each other’s purpose. actually increase the potential for its exercise in the form of workplace bullying practices. The The second danger zone is located in internal move of the professions from ‘cottage industry’ contradictions, where the two groups clash and (Willis, E., 1989; Bates & Linder-Pelz, 1990) to bystanders can be targeted as scapegoats. The within formal organisational structures has not third is in the direct transgression of internal been accompanied by a breakdown in the lines where a professional person is appointed to interpersonal hierarchy endemic in professional- the highest administrative level, such as CEO, other interactions. Rather, power and hierarchy whilst continuing professional practice. Here has become further entrenched in what has professional power dominates and, in being emerged as dual power systems – administrative frustrated by managerialism and managerialist and professional. The former is highly structured systems, can easily translate into oppressive with clear lines of power formalised in management practices. And finally, in the bureaucratic management, and the latter a exploitation of marginal groups such as trainees powerful and somewhat amorphous group that and those outsiders who are new to the system, could be characterised as ‘threatening non- or peripheral labour in the form of part-time, structure’ (Douglas, 1988, p123.). The threat contract and casual staff who are products of the inherent in non-structure, where there are no new flexible workforce. It is worth noting that, formal lines of authority, is in the informal in systems of non-structure, professionals can power systems that emerge. Where there are and do become the unwitting instrument of professionals as partners and/or colleagues in an workplace bullying practices where their power organisation (such as lawyers, pathologists or is appropriated and/or manipulated by others. radiologists), there is danger for the workers both within and below. Such non-structure Workplace bullying is thus endemic in the creates the potential for the occurrence of culture of organisations where hierarchical workplace bullying within individual relations exist within systems of non-structure, hierarchical professional-worker relationships. and such systems appear to be resistant to And when it does occur there is no formal change even, and particularly when, they are structure or channel for reporting and redress. brought within bureaucratic control. This situation has not been resolved by the move of these groups to within bureaucratic Recommendations for policy organisations – particularly with the external imposition of new performance measures (such The above analysis of the professions and as ‘casemix’ in hospitals). Rather, it could be professional training should not be read as argued extant tensions have been exacerbated. criticism of all or even most professional people. Rather, it is intended it provide an understanding To use Douglas’ analysis of social systems, of the particular frameworks, pathways and sites danger at any of four locations within any within some workplaces that enable individual organisation: at the extreme boundary of the people to misuse and abuse power. To address system; in transgressing internal lines; within the issues raised here requires a tripartite

6 Turney approach that targets three levels: the societal, bully is the boss, there needs to be an the workplace culture and the individual. independent body with power to investigate and take action. Finally, the targeted person has the At the societal level, there is a need to change fundamental right to report instances, of being the discourse that informs our understanding of heard, to be believed and not to face reprisals as appropriate behaviours at work to enable new a result of speaking out. discursive consciousness and practices. This is already happening in Australia with most states At an individual level, it is clear from the above introducing either legislation or codes of practice analysis that in most circumstances where around workplace bullying to ensure that hierarchical workplace bullying occurs, that workplaces implement policies and procedures individual counseling and mediation sessions to address the issue. The challenge here is to will not adequately address the issue. We need to provide a clear definition that is narrowly recognise some people who bully do so in full focused on those practices directly threatening a knowledge of the power they exercise and the person’s ability to do their job. This approach knowledge their actions enjoy immunity from will, at a minimum, reduce the instances of scrutiny or reprisal because of their location people thoughtlessly engaging in or ‘buying within the system and because they understand into’ bullying practices, and who are unaware of and manipulate the system to their advantage. the consequences of their enjoinment in such There is a need for that behaviours. Training within the workplace will privileges the account of those who have been tackle organisational culture that engenders disempowered and degraded by virtue of simply conformity to normative behaviours and thus doing their job. In addition, the individual who blindness to the activity of workplace bullying. It has been targeted needs to be encouraged to de- will require a degree of re-socialisation in some link serial episodes of workplace bullying, for to instances. But most of all, in the very process of see them as cumulative inevitably leads to self- naming workplace bullying as a serious threat to and recrimination (Namie, 2002). mental health and an important occupation health and safety issue, the problem will, in part, In conclusion, it is crucial to acknowledge a begin to be addressed. person has a right to dignity at work and indeed, ‘work should not hurt’ (Namie, 2002, pers. At the workplace level, an approach is needed comm.). Rather, it should provide an that lays bare workplace bullying practices environment conducive to mental health as a occurring within hierarchical interpersonal work minimum standard. An individual should not be relationships. If a type of training encourages subjected to ongoing threats to their health and ‘learned helplessness’ and passive acceptance of safety in the closed environment of work, in the inappropriate criticism of ones’ work, then its course of earning their living. pedagogical value needs to be questioned. Intense forms of ‘on the job’ training need close References monitoring. Those workplace relationships enshrined in the guise of mentor rather than [anon.] (2001). . British Medial st master-apprentice form remain sacrosanct and Journal, 323, 7324, p1314, Dec 1 . immutable unless there is the possibility for Barbour, A. (1998). Caring for Patients: A Critique intervention. It seems an extension of the of the Medical Model. Stanford, California: Stanford multidisciplinary team approach and University Press. interdisciplinary interchange (implemented in various areas of diagnosis and treatment) has Bates, E. and Linder-Pelz, S. (1990). Health Care nd potential for application in training in a way that Issues, 2 edn. North Sydney: Allen & Unwin. could prove beneficial for both the trainee and Bernardi, L.M. (2001). Management by bullying: the the mentor. There also needs to be a clear system legal consequences. Canadian Manager, 26, 3, pp13- for reporting abuses of power or experience of 15. victimisation. Where formal structures to enable nd this do not exist within an organisation, or if the Bernstein, B. (1974). Class, Codes and Control, 2 edn. London: Routledge & Kegan Paul. 7 Turney

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