Copyright Sociological Research Online, 2000

Helen Busby (2000) 'Writing about Health and Sickness: An Analysis of Contemporary Autobiographical Writing from the British Mass-Observation Archive'
Sociological Research Online, vol. 5, no. 2, <http://www.socresonline.org.uk/5/2/busby.html>

Abstract

In this paper, I explore some of the writing about health and sickness undertaken by volunteers writing for a British social history archive. The Mass-Observation Archive's commissioning of diaries and other forms of self- reportage has made it a prominent part of the landscape of sociology in Britain (Calder, 1985). Initiated during the 1930s, the Mass-Observation Archive's early work included the well-known worktown project. The early project was wound up in 1950, but interest in the archives eventually prompted a new project, initiated in 1981. The 'new project' is essentially a collection of writing on a range of issues by a panel of volunteers recruited through the media and other informal means.This paper represents a cycling through of ideas about the relationships between health, sickness, and work, via my reading of some of the writing held at the Archive. The writings with which this paper is centrally concerned are the responses to an invitation issued in the autumn of 1998 for writing about 'Staying well and everyday life'. In addition, writings on 'The pace of life' and on working life were consulted. Unlike much of the data about sickness in relation to work - which relies on documentation of sickness absence- these accounts show actions which are not taken. Some of them point to a phenomenon which I have termed 'shadow sickness, that is illness which exists without there being a mechanism to translate that experience into recognised sickness. Overall though it is the moral context of illness and of ideas about staying well which are prominent in many of these accounts and which are discussed in this paper.

Keywords:

Autobiographical; Health; Mass-Observation Archive; Narratives; Sickness; Work

Introduction

1.1

Narratives have featured prominently in the sociology of health and illness. Indeed, the development of work in this field owes much to peoples' accounts of illness. Inevitably though, many of these 'illness narratives' have been elicited in interviews undertaken within institutional frameworks close to those of medicine^[1]. In this paper, I explore some of the writing about health and sickness undertaken by volunteers writing for a social archive, which we might expect both to echo and to contest these kinds of interviews.

Narratives in Sociology of Health and Illness

2.1

An important contribution of the sociological literature in this field has been the making and underlining of the distinction between disease, the individual experience of illness, and the social framing of and response to both of these. Unpacking the ways in which the impact of symptoms and interventions is framed by their context in an individual life has lead to an emphasis on the timing and shape of narratives (Robinson, 1990). In addition, research based on interviews has contributed to the re/thinking of key areas such as ageing and the body, as well as drawing out the experience of illness both generally and specifically (Bury, 1988; Hinton and Levkoff, 1999; Scott, 1999; Williams, 1993). Indeed, it is fair to say that interview-based research has become something of an axiomatic method for the sub- discipline. Consequently, there are criticisms about the over-reliance on such a method and the 'widespread assumption that such data provides uniquely privileged means of access to the biographically grounded experiences and meanings of social actors' (Atkinson and Silverman,1997: 305).

2.2

Whilst interviews have been a prominent vehicle for eliciting such narratives, diaries and written accounts also feature, to a lesser extent. In particular, structured diaries have been used to draw out data on routine aspects of health and illness, on decision-making and help-seeking. (See Elliott, 1997, for an overview of the use of diaries in this context.) One of the more substantial examples of work using written narratives is Robinson's work with people with Multiple Sclerosis, which explores in some depth the kinds of shapes these narratives take (Robinson, 1990). Key to this analysis is the divergence and convergence of the points of the disease course, illness and sickness careers. Robinson finds that -in the case of people with MS- progressive personal narratives of illness are 'far more common than is anticipated socially and biomedically...' (Robinson, 1990: 1178). That is to say, that although there are accounts which are tragic, a greater number illustrate a process of shaping and a degree of (subjective) control over the illness and its consequences.

2.3

The unpacking of the values underlying concepts of health and illness is another key strand. As Herzlich's writes in her classic interview based study on 'Health and Illness': 'Because it requires an interpretation, illness conveys meaning: it becomes significant with a signifie that is the individuals relation to the social order.' (Herzlich, 1973). Subsequent work by Crawford (in the US) and Williams (in the UK) drew on individual narratives of health and illness to analyse social values: Crawford's analysis of his open- ended interviews about health elaborated pivotal themes of control and release as metaphors about health, and analysed these in relation to consumerism in contemporary North American society (Crawford, 1984).Williams interviewed people with rheumatoid arthritis, and placed their accounts in relation to ideological features of contemporary Western societies, notably individualism. Quoting Sennett and Cobb- 'To be an individual has historic connotations of self-reliance, confidence, self-affirmation.'- Williams explored the way such connotations run through the currents of political and economic life, with welfare services serving as an acid test of such values (Sennett and Cobb, 1973: 66; Williams, 1993).

The Axis of Sickness and Work

3.1

The importance placed on work and the obligations associated with it do permeate many of these narratives about living with illness. As Cornwell noted: 'There are obvious reasons why work and health should be connected in peoples minds, illness can incapacitate and prevent people from working.' (Cornwell, 1984: 127). But - in contrast to the prominent place of work in relation to (ill)health within sociological thinking -there is relatively little autobiographical writing focussing on this theme.

3.2

It is widely accepted that considerations of 'fitness for work' have been central to definitions of health in modern capitalist societies. (Gerhardt, 1989) The term 'the sick role' was coined to denote the essentially social and usually moral criteria which underpin the definition of sickness (Parsons, 1951; 1975). The concept of a 'sick role' is remarkably resilient. Perhaps what is most enduring about it is the idea of a deal that is made, between individuals and society, with the doctor as mediator. In this context, Bellaby has called for greater attention to the 'prehistory' of sickness-that is the aspects of the social processes of negotiating absence which are not reflected in formal documentation and certification (Bellaby, 1990). The classic 'sick role' literature provides a conceptual link between the domains of health and of work, and diverse theorists within sociology have been concerned with work as potentially integrating or alienating.

3.3

Whilst in practice the sociology of the clinic and the sociology of the factory have tended to be different domains, key questions currently being debated necessitate a linking of the two (Bellaby, 1990). Such questions include: how central is work in peoples lives; what is the significance of new forms of flexibility in employment practices; and in what ways does occupation affect peoples lives so as to influence how long they live and how much illness they encounter (Offe, 1985; Ferrie et al, 1998; Sennett, 1998; Blaxter, 2000). From my own previous research, I had the sense that the strategies people use to keep going at work can be prominent in accounts of illness; however, the phenomenon of keeping going can remain invisible in the shadow of a heightened rhetoric around sickness absence and benefits. (Busby and Williams, 1998). This paper represents a cycling through some of these ideas, via my reading of some of the writings held at the British Mass-Observation Archive (M-OA).

The British Mass-Observation Archive

4.1

The Mass-Observation Archive's commissioning of diaries and other forms of self-reportage has made it a prominent part of the landscape of sociology in Britain (Calder, 1985; Sheridan, 1993b). Initiated during the 1930s, the M-OA's early work included the well known worktown project. In that project a number of techniques inspired by scientistic concepts of social observation were deployed by paid observers during a study of the people of Bolton between 1937 and 1940. Alongside these methods, volunteers were recruited to write about their lives and those of their families and communities. Notwithstanding some controversy and criticism -for example during the 2nd world war, when the data collected through diaries were used in the monitoring of civilian morale by the British government- the use of diaries of volunteer observers continued. The early project was wound up in 1950, but interest in the archives eventually prompted a new project, initiated in 1981. The 'new project' is essentially a collection of writing on a range of issues by a panel of volunteers recruited through the media and a range of other informal means.

4.2

From its inception, the Mass- Observation Archive's ideal of using autobiographical writings to convey the experience of 'ordinary peoples' lives embodied a tension between using unstructured data based on writing and the drive to collect observational data based on a more scientistic model (Sheridan, 1993a). As Sheridan has noted, in the early years, no clear distinction was made 'between those required to observe others and those required to observe themselves...' (Sheridan, 1993a: 4). Critiques of the MOA's work have focused in particular on the epistemological assumptions underlying its early phase (N. Stanley, 1981; L. Stanley, 1996). The archive has continued to be a site for productive debate about the methodological issues associated with using written autobiographical accounts (Sheridan, 1993b).

4.3

Twenty years ago, Dingwall argued that the early data held at the Mass-Observation Archive (M-OA) had a considerable, and largely unrealised, potential, for sociologists concerned with health and illness (Dingwall, 1979). Unknown to Dingwall, the organisation was shortly to embark on a new phase of drawing on the accounts of volunteers to amass a collection of writings about their own lives and those around them. Since that time, although some health related research has been undertaken using the archive, the material remains less used in this field than in others such as education and women's studies.

Reading Contemporary Autobiographical Accounts at the Mass-Obervation Archive: Methodological Issues

5.1

The M-OA new project involves a panel of volunteer writers, who write about aspects of their everyday life, prompted by 'directives' which are sent out several times a year and request their thoughts on particular themes. These writings are maintained in anonymised form so that they can be consulted by researchers. The numbers of correspondents making up the contemporary MOA panel vary from about 1,400 in the mid 1980s, to a smaller panel of several hundred active at the present time. At present, three 'directives'-or requests for contributions are sent to its panel of volunteers each year. Each directive usually has a theme- although occasionally it is left open to the writer to define their own theme. More detail about the workings of the archive can be found elsewhere: several publications explore the relationships between the writers and the early and later M-OA (Shaw, 1998; Sheridan, 1993a, b and Sheridan et al, 2000; Stanley, 1981).

5.2

Although in one sense a genre of its own, the writing held at the archive can be seen as a 'form of collective or multiple autobiogaphy, which draws on a very wide range of existing conventions: letter writing, answering questionnaires, being interviewed, keeping a diary, writing a life story.' (Sheridan, 1993b: 34) Accordingly, the most frequently raised methodological issues are common to those concerning the relevance and validity of biography and autobiography within social research. Such questions are the subject of an intense debate. (See for example Bertaux and Kohli, 1984; Bourdieu, 1986). The place of these genres within sociology shifts according to the tides of wider debates, although they are more well-established within social history and womens studies. (Personal narratives group, 1989; Stanley, 1992).

5.3

As with the interview genre more commonly found in sociology, these narratives are inevitably fragmentary, selective, and often interpretive: In keeping, Brunner would argue, with autobiography more generally:

Some lives actually get written down, though a very small number. Most are accounted for 'locally' and patchily in the form of excuses for this act or justifications for that belief or desire. The local patches provide glimpses of a more general narrative about a life that is largely implicit-an implicit narrative that goes 'almost without saying'... (Bruner, 1995: 161).

5.4

Many of the issues raised by the use of written accounts or life documents- such as the fragmentary nature of the accounts, the questions of whether they are telling the truth, and of what weight to give them in the context of other evidence- are common to the wider domain of social research. (Platt, 1981) Alongside these there are questions about representativeness and accuracy. I consider some of the questions more specific to the M-OA below.

Why use the MOA Data? Representativeness, Accuracy, and Relevance

6.1

Thinking of 'representativeness' literally or rather numerically, that is looking at the proportion of a wider population and its features which are represented in the MOA panel, the current panel has major limitations: women and older people account for a higher proportion of the panel than men and younger people- a pattern which echoes that in voluntary work more generally. In addition, the panel is widely perceived to have a middle class bias, although little systematic work has been done to explore this. In some ways this is admittedly a disadvantage for the purposes of this research^[2]. However, as Herzlich noted in relation to her own work, it seems reasonable to attribute to these groups a significant role "in the genesis, transformation, and renewal of ideologies in our society" (Herzlich, 1973: 13).

6.2

It is unusual, even exceptional, to find a panel of volunteers writing for a social archive over a number of years; there was a possibility that for my purposes this distinctiveness might outweigh the disadvantages of its lack of literal representativeness. The motivation underlying writing of this kind is of interest in itself; it has been suggested that such writing may be linked to a sense of social duty, although there are of course more personal satisfactions to be gained from recording aspects of one's own life history (Sheridan et al, 2000). The case of 'witness writing' such as that of Primo Levi - arguably an extreme but not an exceptional case - has lead to discussion about the kind of work which such writers undertake. (Catani, 1995) In contrast to those who are 'agree to respond to questions, as cases drawn from a statistical universe, and those who recount because they have decided to do so, and for this reason accept first hand responsibility for the content of their accounts.' (Catani, 1995: 150) The suggestion that such informants take on some of the methodological work which is conventionally assumed to belong to the social researcher underlines the more general pointer to the work involved in producing narratives.

6.3

To measure or determine the accuracy of such accounts is difficult and contentious. However, in an interesting methodological aside from their recent research concerned with the accumulation of hazards over a lifetime, Berney and Blane (1997) explored the recall of relevant facts amongst a group of the early Mass-Observers and found it to be substantially accurate. For my own small study, the acid test was one of relevance. A dominant theme in the current literature about work is the importance of 'subjective' experience in relation to work; for example, it seems that the experience of control and of autonomy shapes outcomes of morbidity and mortality in relation to work. (Marmot et al, 1999) I had the impression that the M-OA writers would offer an unusual account of such experiences; other work drawing on the archive, such as that of Shaw, pointed to the richness of these accounts in terms of the subjective experience of work, of the pace of life, and of the inter-penetration of work and domestic spheres (Shaw, 1993). On balance, a reasonable starting point was to look to the strengths of the data in offering insight into the shape of subjective experiences of life events and processes. For the current project, the analysis of M-OA correspondents' accounts about the processes of staying well and going sick was seen as offering data which was contextualised, reflexive, and anonymised.

The Contours of Writing about Staying Well and Keeping Going

7.1

The writings with which this paper is centrally concerned are the responses to Part 2 autumn of the 1998 M-OA directive, a section headed 'Staying well and everyday life'^[3]. The writing of these questions and prompts emerged from a discussion between myself and the archivist about the existing data within the archive on health and illness. Having then decided to jointly write a new directive on this theme, we widened the focus from my initial emphasis on employment and health to the social context of health and illness more generally. The relevant section of the directive was introduced as follows:

7.2

'This section is about what you need to stay well, and what you think undermines your own health or other peoples. We are especially interested to hear about your recent experience over, say, the last year or so.' The first question or prompt asked people to write about 'the environments in which you live and work' and to say 'what aspects of your day to day life make you feel well or unwell.' They were asked to 'include things like relationships with other people, financial constraints or hardships, as well as your physical surroundings'. Other prompts asked people to write about how they decide when to stop and rest, and when to keep going, when they felt unwell. They were asked about the last time that you had to take 'time off' work (whether paid or unpaid): 'Was it a straightforward decision, and if not, what did you have to think about before taking time off? '

7.3

Although the M-OA eventually received 249 replies to this directive, the analysis on which this paper draws was undertaken during a time-limited pilot project and therefore could not include all of these writings. For this research, all the responses received prior to March 1999- an artificial cut-off point, 10 weeks after the sending out of the directive- were read and included in a thematic analysis. Common themes from this group are referred to below. In order to undertake a more detailed analysis which included the issue of sickness leave in relation to paid employment, a pragmatic sample was made up all the writers aged 65 or under who had responded by late January. This group comprised 13 men and 26 women.

7.4

For the men in the sample (as we shall call it from now on) full-time employment is the predominant pattern; but a number are retired on the grounds of ill-health or disability. Teaching and nursing are the commonest occupations listed. The majority of the women in the sample work on a part- time, freelance, or self-employed basis, often combined with caring or domestic responsibilities at home. Teaching, secretarial, media, and civil service are the occupations most frequently identified by these women.

7.5

In terms of the contours of the writing, the majority of responses are firmly structured around a narrative of keeping going. Not untypical was this response from a woman:

'I usually keep going unless I feel there is no choice..'.
[B 2197: female, mid-forties, working in the home and volunteer museum worker]

7.6

As might be expected, a whole range of influences on health and sickness were delineated by correspondents; these were often conceived of as interwoven and shifting. The commonest included the weather, particularly the British winter, and other aspects of the physical environment. Fending off colds and flu was a major preoccupation (presumably related to the timing of the directive), and there was much discussion about what constituted real or legitimate illness in this context. Often, caring responsibilities were seen as paramount in keeping going, whereas commitments of paid work were seen as more flexible; but where caring and paid work overlapped, there was little room for manoeuvre even when feeling quite unwell. These epidemics of colds and flu were often seen to be related to the work environment, either in terms of sick buildings, or waves of exhaustion which travel through, for example, a school community.

7.7

There are of course a whole range of other influences on or factors in health and sickness which were referred to in the responses to this directive- although analysing these would make an interesting project in itself, no attempt is made to list all of these or quantify them here. The idea of health as a state (or equilibrium) which had to be continuously strived for was prominent. Although this group of writers included a few stoics who had only taken a single day off in a decade, health was rarely taken for granted, or assumed, in these writings. A functional definition of health, rather than one based on feelings was common to both older and younger respondents (almost all of whom saw themselves as having pressing social duties or commitments, regardless of their employment status or age.) Of course, people's stance varied according to their age, their health, and their circumstances. Retrospective accounts looking back over a longer life have a very different tone from those of people in what is perceived to be the middle of their lives. Amongst older people in particular, good health was very often attributed to good fortune, luck, or being blessed. With the younger respondents, struggling with a way of life which is thought of as stressful was perhaps the commonest perceived obstacle to well-being.

7.8

In general, keeping on going, if necessary working through pain, discomfort and illness is a structure around which many of these accounts are built. Sometimes, the necessity of doing this appears as a bare statement. For many of the women with caring responsibilities, it was stated as a known fact, which was assumed to be relatively taken for granted. Sometimes the idea of keeping going appeared in the context of a kind of prescription for well-being, involving 'keeping busy'. Sometimes, the sense that work is intrinsically important, sacred even, is conveyed, and associated with strongly held views about keeping going :

'This of course is all very much touch wood territory but I cannot remember the last time I was off sick and would never stay away from work for trivial reasons, believing that if I pulled a fast one the fist of God would ensure that I came down with something really nasty... '
[W2174, male, mid-fifties; employed full-time; civil servant.]

7.9

Amongst those who viewed themselves as successful, working at being well through regimes of leisure and health care features prominently. Amongst these 'success' stories there is sometimes a striking emphasis on individual will power. Even though these writers are anonymous (except to the archive staff who receive the writing and anonymise it using a code number), the pressure to present oneself as virtuous and successful is palpable here^[4].

Sickness and Work

8.1

Based on the premise that decisions about sickness will often be tied up with ideas around obligations in a workplace, or a work ethic - as noted by Radley (1994) - a number of specific questions about taking time off were included in the directive. The majority of the sample did address the question about time off work. Within this admittedly unrepresentative group, it was generally the men who referred specifically to negotiations about sickness leave, whereas the women s accounts focused on the ways they strived to avoid being sick. A number of respondents analyse the ritual and significance of the sick role, and the contingencies of official sanctioning. The idea of trading and negotiation was prominent here:

...if it were a busy time at work, like a month end, or quarter end, then I would tend to go in... However... I would take sick days in lieu. That is, if I had gone in when I was quite ill I would take a day off at some other time when it wouldn't t be so difficult for my colleagues. This would be when I wasn't really ill enough to be off work...
[G2776, female, postgraduate student-late twenties]

A man in his mid-thirties, wrote:

If I'm off for a week, I have to totter off to the doctor for my sick line. This involves a charming little ritual when the doctor holds a finger over one nostril and instructs me to blow. On confirming the sound of resistance or the presence of mucus, he signs me off...
[C2722, male, mid-thirties, computer programmer employed full-time]

8.2

Interestingly, several correspondents do confess to that demotivation which according to current rhetoric about 'sickies' is often an element of deciding to withdraw from work into dependence. One man refers to being off work because of 'sickness and disinclination', and another to fabricating illness and even self-harming in order to take time off from unfulfilling work as a clerical officer:

I had spent ten years in this office, employed well beneath my capabilities doing clerical work of the most routine kind, with no career prospects, hope of promotion or the possibility of a transfer...As a result of working in an environment I hated I positively looked forward to becoming physically ill as this gave me an excuse for taking time off.
[K2721, male, unemployed, early fifties]

8.3

These accounts about the negotiating of sickness bracket the doctor-patient relationships and are characterised by an emphasis on processes associated with formal employment as a key to social sanctioning of the sick role. They also underline the experience of not being able to afford to be ill - an experience which is not exclusive to those in overtly unstable employment, although it is framed differently according to circumstances.

8.4

Some of the analyses by those in work, or recently in work, of the context of health and illness specify in some detail how circumstances relating to their employment had an impact on both their health and their ability to take time off work. For example, a woman who works as a supply teacher highlights pressures of having an occupation which is concerned with 'covering' for the unexpected, including illness: it becomes clear from her account that the structure of her occupation makes it very difficult to allow the possibility of illness, and she reports attempting to control symptoms to fit the demands of the unexpected in other peoples lives. Amongst the women in freelance work, having to work as and when if deadlines are there, and not being able to take advantage of the enforced break when work was not available were both described. These accounts, then, flesh out how a lack of social processes to negotiate sickness are concomitant with the lack of a call on society's resources. We might call this predicament 'shadow sickness' - after Illich's shadow work. (Illich, 1981)

Case Histories of the M-OA Writings

9.1

If M-OA correspondents look for clues about what a particular directive is seeking, they are likely to have found in this one a kind of multifactorial model of illness, and may have sought to reply in this mode. Certainly, the judicious and carefully considered answers to the prompts sometimes had a sense of a narrative interrupted by a question posed in a specific way. At the time I noticed this, I began to be interested in the possibility of tracking individuals through their views expressed over a number of directives on related themes. Accordingly, I selected two other directives which might have a bearing on the social and employment context of sickness. The themes of these additional directives, which had been sent out in 1992 and 1997 respectively, are: 'The pace of life')^[5] and 'Doing a job'^[6].

9.2

The pace of life directive begins with questions about whether the pace of life is 'about right, too fast or too slow', covers a range of questions about work and leisure, and leads to a section on control over the pace of life, and possible causes for it. The directive was designed by Shaw to explore the relationship/s between peoples subjective experience of the pace of life and their social circumstances, especially employment. In her analysis of the responses to this directive, Shaw notes with interest the acceptance, by many of the correspondents, of responsibility for processes which appears to lie outside their control- such as changing labour markets (Shaw, 1993). The autobiographical data of the M-OA is seen to be particularly relevant to the study of 'the apparent decomposition of boundaries between work and non-work.' (Shaw, 1993: 7) The directive on 'Doing a job' invites writing on the theme of the correspondents' own experience from early ideas of work to actual experience, comparisons with their parents working lives, and more general views about the world of paid work. It was clear to me from reading through some of these responses that this directive elicited a historical perspective from many respondents, a response grounded in the present but also taking a retrospective perspective. It seemed likely that looking at some of these accounts would complement the more fragmented narratives on 'staying well'.

9.3

Taken together, the three directives span a time period of some six years. The writings of six (out of the ten) correspondents within the sample who had written in response to all three directives were selected in order to undertake a case-history of the writings. This small purposive sample was selected in order to include a diversity of occupations and histories. Four of the 'case history' group are women and two are men. The approach here will be to look at the shape or dynamic of the writing, in order to explore how the perspectives expressed within the different directives complement each other, and shift across both time and subject matter. My reading of these writings is shaped by the research interests discussed above, and also by themes which emerged from the larger sample. These include the idea of shadow sickness and the moral imperative to keep going-and for others to do so. The names given for the correspondents are not their real names. The M-OA number given for each correspondent enables others to refer back to their more extensive writings, but not to their actual identity.

Mary [C 2053]

9.4

Mary, a woman in her forties, describes herself as a self-employed clerical worker; her work is based at her home, where she lives with her husband. In her initial writing in the 'Staying well' directive, the focus is on the physical environment - the weather, the room or house she is in, the lighting. Such aspects of the environment, she writes, can cause her headaches, and she prefers to be outdoors. The emphasis is on the natural, that is, the natural environment, or what is straightforward :

I don't generally find that relationships and financial constraints etc affect my health. If things are going wrong, then I can get a bit down which is only natural, but they don't generally make me feel ill.

9.5

Early on, she writes that ' I do try to keep going as much as possible when feeling unwell'. On the second of the two pages of writing for the 'Staying well' directive, she addresses the question of taking 'time off ': since she is self-employed, she can fit her work around her commitments. Mary continues: 'many people brood too much on their own health', suggesting that 'some even seem to enjoy having things wrong with them'. In the final paragraph, she notes that she is 'fortunate in having good health', points to the possibilities of illness in later life, and concludes that 'I may be middle aged, but I still want to enjoy life'.

9.6

Mary's account- individual though it is in the sense that it refers to the events of her own life- illustrates the emphasis on keeping going which recurs in most of the responses to this directive and which has a profoundly -though not usually explicit- moral undertone. The flip side of the expectation that people will endeavour to keep going is found in the suspicion that those who do succumb to symptoms may be responsible for or enjoy doing so. Mary's writing on 'Doing a Job' (undertaken some two years earlier) features an early fascination with and love of books, leading to a career as a librarian. But the experience of a local government re-organisation appears to have lead to a breaking down of coherence in her work environment. Health consequences are implied, though not detailed:

In the end, I and several other people decided that health and happiness were more important than stressful jobs, and resigned.

9.7

For Mary, unemployment followed, and she subsequently embarked on doing clerical work for her husband s business. The emphasis on the natural environment as primarily constitutive of health or sickness is overshadowed in these earlier writings by an experience of imposed change in the workplace impinging upon health and happiness. In the 'Pace of Life' directive, the writing broadens out to a commentary on a "way of life... firmly structured around time" with expectations of structured effort and activity extending to leisure as well as work. Mary writes about doing ' what has to be done to survive and prosper and then try to spend the remainder of my time doing what I want to do.' : The creation of a quasi subsistence economy for her immediate household has played a part in shaping a way of life in which she feels she has considerable control over her work.

9.8

The M-OA writings vary in terms of shape between narratives which are structured more as individual tales, and others which are more explicitly social. The following two examples, both from women, draw attention to the continuum between the more relational and the more individualistic narratives.

Vera [W633 ]

9.9

Vera is in her fifties, living with her husband and adult daughter, and working part- time as sub-editor on a newspaper. She opens her writing on 'Staying well' with a comment that she has already torn up two attempts as "self pitying"- a reminder of the emotional and intellectual demands of undertaking this kind of writing. She is, she writes, 'as fit as any other 55 year old I know', but at a later point writes of being 'so used to feeling not quite well'. Of her two health problems, migraine and panic attacks, one is described as 'familial', the other as the result of being over involved in caring for members of her family. She describes a role within her family of caring for a number of relatives at different times, in demanding circumstances. Despite experiencing tiredness and illness at times, she can't remember when she last took time off work. She relates this carrying on to not wanting to give in. The workplace is introduced as a secondary theme. As a newspaper editor, she used to work 'longer hours than anyone would now', but the sense of predictability of work demands then is contrasted with the unpredictability of a computerised workplace now.

9.10

The theme of a changing workplace is fleshed out in the writing on 'Doing a Job'. Having worked for one newspaper since the 1960s, with only a short break, she is well placed to observe and comment on these changes in some detail. Following her father- also a newspaper editor, into the business, she 'knew what to expect', but this known trade is contrasted with one changed 'out of all recognition' by the changes in working practices. Vera's writing on the 'Pace of life' features an 'unending battle with time- management', a sense of time pressure linked to 'sheer tiredness and stress'. Her description of her role within the wider family-as 'the family fire engine, called out in all emergencies'-conveys the difficulties in controlling the external and internalised demands of such commitments, whereas her professional work is seen as stressful but containable.

Andrea [G2089]

9.11

Andrea is in her late forties and employed full-time in the civil service. She lives alone in London. Opening her writing on 'Staying well and going sick', Andrea points to the pollution in central London, where she works, as a cause for concern. In terms of work, she points to an unnecessarily uncomfortable office environment and to an increase in expectations from employees. She seldom feels unwell, and has not visited the doctor or taken a day off in more than ten years. Yoga and exercise, walking holidays, and evening classes are a regular part of her lifestyle. A sense of control emanates from the writing, which refers to making 'a conscious decision that positive effort was necessary to maintain health and fitness for the rest of my life'. This is qualified with a statement that 'I am obviously lucky in having suffered no major disaster and earning a steady salary'.

9.12

The writing in response to the other two directives fills out how much this sense of control is contingent on being single and -in contrast to Vera - relatively free of unpredictable expectations to minister to and care for family members:

The general tenor of my life is calm and controlled. Presumably, the choices I have made, conscious and unconscious, avoid stress for me.

9.13

The sense of self-containment and sovereignty is striking here; the domain of illness and sickness is presented as by and large within the control of the individual writer, who is pre-eminent within the narrative. But no doubt it also relates to the nature of constructing an autobiographical account, which constitutes an act of creating, sometimes imposing coherence or control^[7].

Sarah [H 1745]

9.14

Sarah works part time as a freelance social researcher, a job which allows her to work at home some of the time. Sarah, also in her late forties, describes herself as widow, with no dependants. She introduces her writing on 'Staying well' by saying that she is not 'unwell', but seldom really 'well'. Her own speech marks around both words suggest definition of un/wellness which are 'out there', perhaps definitions which relate to acute rather than chronic illness. Sarah experiences more or less constant pain from a back problem, indigestion, and disturbed sleep. She writes that she routinely tries to carry on through these, with going to bed for a whole day being a last resort: only a few times a year goes to bed with ice pack, breaks for a day or two. Thus she is neither fit nor unfit for work, with consequent confusion about status in terms of sickness pay or benefits:

I think I'm probably entitled to sickness benefit when I really can t work, but the threshold between being able and not being able is very fuzzy and I usually try to work through my pain. I seldom feel fully fit for work, but can usually manage to do a little.

9.15

In 'Doing a job', Sarah describes her fourteen years working as a social researcher, in universities, think tanks, and voluntary organisations- a career characterised by sideways moves because 'there are no long term jobs in research these days' Currently, she is working freelance, a status which she relates to her disability and the scarcity of employment. Her writing for the 'Pace of life' directive offers a reminder of the impact of physical pain or disability on the whole experience of life: 'the level of pain' she writes, 'has to a large extent controlled my pace of life'. Sarah describes herself as 'lucky' to be able to work from home some days. An alternative reading of her story would highlight an interaction of the processes of disablement and casualisation within the middle class occupation of social research.

9.16

The two men who are included here (below) give accounts of working lives which appear to place them on opposite ends of a class spectrum: Rob is aged 64, and recently retired early due to his poor health. Frederick, who is aged 65, retired from work as a bank director in his mid-fifties, by choice and with sufficient capital to feel able to do so comfortably. However, the shared value which emerges from reading their responses to 'Staying well' is a belief in self-sufficiency and drive.

Rob [R 470]

9.17

Rob lives with his wife who is disabled with rheumatoid arthritis. His working life has been spent in the haulage industry, a choice he describes in 'Doing a Job' as '..the fate of the sons of a lorry driver: you go out with your dad as a young man, see the sights, experience the freedom and camaraderie, and you re hooked'.

9.18

Working life looms large in his response to all three directives, each of which set out in some detail the demands and expectation of working as a lorry driver: twelve hour days 'as common now in 1998 as when my dad started in the industry in 1928'. When Rob started in 1955, the work, involving loading and unloading had been very physical, in contrast to now when regulations and different technologies preclude drivers from doing this. He characterises his job as one which 'if you could stand up, you went to work'- although colleagues would 'muck in' to try and help. He writes that between 1971 and 1991, he never went to see a doctor. The tone suggests a sense of pride at this enforced working through - indeed he notes that younger drivers, whose working conditions are seen as less harsh, are the one who take time off sick. The symptoms of spondylosis, treated with chiropractic, did not stop him from working. Finally, symptoms of vertigo lead to a diagnosis of hypertension and the loss of authorisation to drive HGVs. These illnesses in later life are seen by both himself and his doctor as likely to have been caused at least in part by his working conditions.

9.19

In response to each of the directives, his narrative is inherently comparative, and social. It oscillates continuously between his own experience and that of his father and his son, both of whom work/ed as lorry drivers. In the 'Pace of life', the way he and his wife live is seen as being similar to the way their parents lived: differences are there, but overshadowed by common threads: 'There is not and never has been time for leisure, there is too much to do.'

Frederick [C110]

9.20

Frederick, who lives with his wife, describes his life as 'crammed with a variety of activities', and feels very well. From his account, 'the main reason for this fortunate state of health is my fierce determination to enjoy life...'.Common sense, and acting thoughtfully 'in everything' and therefore feeling 'in control of my life' are additional factors. Subsequent sections of this and other directives elaborate the underpinnings of this tenacious belief in individual willpower. With regard to his determination, he writes about a severe accident which left him with a determination to live life to the full. Working life emerges as the principle stage for a life long struggle to gain independence and success.

9.21

In 'Doing a Job', Frederick s journey to qualifying as a solicitor and then becoming banking professional is placed in the context of the sacrifices made by his mother and father, a shopkeeper and a captain in the merchant navy. Against a background of considerable hardship, hard work, personal sacrifice and financial acumen are seen to be the drivers of a leap from one social stratum to another. Frederick describes a conscious effort to increase his decisiveness and determination in order to succeed at the top ; this even encompasses choosing leisure activities which are frightening or dangerous, such as parachuting and motorcycling.

9.22

The writing on the 'Pace of life' further fleshes out these themes. (The response to this directive is a lengthy one -29 pages- and, as with many of the other writings, difficult to describe or analyse fully here.) Detailed descriptions of daily routines and regimens fill out and illustrate the meaning of a philosophy of 'never being idle' in daily life. Unusually, the availability of 'ample capital reserves' is made explicit as a factor in well-being. In discussing salary and remuneration, the writer comments that : 'Some readers will wonder how this can be justified..' and proceeds to explain the rationale for these payments.

Conclusion: M-OA Narratives and Ideologies of Work and Health

10.1

Self-justification is, arguably, a feature of many public accounts and of some autobiographical writing. However, the explicit and detailed justification of payment in this last account does confront us with the ambiguity of the Mass- Observers role. That ambiguity mirrors the status of 'lay knowledge' in sociology more generally, but is particularly pronounced here, because of the task of social observation accorded to the informants. As with other social researchers drawing on these writings, I had sought to elicit both elicit 'social facts' from them - hours which people work, how much time they take off work, and so on- and to explore the framing of those facts in the texts. By specifying the facts which I sought, it seems that in some cases I interrupted the narrative flow of these writers, steering them towards a case-history type reportage. The strongest data, qualitatively, was that which placed an issue in the context of an individual's life and that of their family and wider social circle, for example the writing in response to the more open-ended directive on the Pace of life.

10.2

It was the moral context of illness and of ideas about staying well which were prominent in many of these accounts. Ideas about (self) control over illness and the location of responsibility for staying well with individuals, whilst not universal nor immutable, were an overarching theme. The emphatic assertion of individual control over health exerted in some of these accounts can be looked at in a wider context. This 'sovereignty of self' -to use Dunnes phrase- is significant not so much for being exceptional, as for the resonances it contains of public rhetorics of individualism (Dunne, 1996). Williams has written of how personal accounts of illness intermesh with public ideologies of self- sufficiency and thence with debates about resources for health care in the UK (Williams, 1993). The Mass-Observation accounts are interesting because they draw explicitly on both the private experience and the respondents' observation and interpretation of wider social and public life.

10.3

In looking to the Mass-Observers' accounts of managing of illness in relation to work, I found the theme of 'keeping going' to be overwhelmingly present. The value placed on working did appear to have consequences for peoples' seeking of help: to an extent people reported disguising symptoms when clear avenues for negotiating time off were not available. Unlike much of the data about sickness in relation to work, which relies on documentation of sickness absence, these accounts also show actions which are not taken. Some of them point to a phenomenon which I have termed 'shadow sickness, that is illness which exists without there being a mechanism to translate that experience into recognised sickness.

10.4

Whilst the theme of working through illness which I have dwelt on in this paper encompasses material survival, it has a strong moral resonance. The link between work and a sense of social duty is not broken, in this group at least. Such a finding runs against the grain of much contemporary thinking about the de-centering of work in subjective terms and the weakening of the work ethic. There are likely to be consequences of this kind of ethic. For example, as Bauman has noted, the values underlying the work ethic can be powerfully deployed in relation to the exclusion of those who do not appear normal in relation to them (Bauman, 1998).

10.5

Returning to the idea of sick roles which prompted this research to be undertaken, what is striking here is less the negotiation of sickness, but the underlining of health as a kind of human capital which is needed in order to reap the rewards of the employment market. As others have noted, it is perhaps the well role which is more relevant to contemporary social and market conditions, with disciplines of maintaining health linked to economic imperatives (Frank, 1991). These writings, buttressed by profoundly moral concerns, are testimony to the complexity of the relationships between health and working. In my reading of them the sense of an investment of self in the economic fabric is perhaps the most powerful and contemporary theme.

Notes

¹Kleinman's work on 'Illness narratives' is an example both of the potential and of the institutional constraints of the genre. (Kleinman, 1988).

²The apparent middle class bias is complicated by the fact that many M-OA correspondents appear to have straddled class categories within a working life. Given that they also write about both parents and children in a range of directives, the 'new project' as a whole also contains a wealth of material on the experience of social mobility. Clearly, further work remains to be done using the archive to look at the shifting experience of class over time, although the scope of the current paper does not extend to this.

³These questions were included in Part 2 of the M- OA Directive for autumn 1998. Note that this Directive also contains other questions/prompts.

⁴Williams has written about the 'pursuit of virtue' in relation to (interview) accounts of illness and in particular of living with rheumatoid arthritis. (Williams, 1993)

⁵These questions were included in Part 2 of the M- OA Directive for Spring 1992. (Note that this Directive also contains other questions/prompts.)

⁶These questions were included in Part 1 of the M-OA Directive for Summer 1997. (Note that this Directive also contains other questions/prompts.)

⁷In his work on 'the storied self', Dunne has characterised the sovereign self as conveying, above all, 'a sense of a secure location or anchorage.' (Dunne, 1996: 138).

Acknowledgements

Parts of this paper are published as H. Busby (2000) Mass-Observation Archive Occasional Paper No. 11,Health, sickness and the work ethic, University of Sussex Library. My thanks to the Trustees of the Mass-Observation Archive for permission to cite the correspondents. Also to Dorothy Sheridan and Joy Eldridge at the M-OA, for their assistance, to Heather Elliott, Mike Sandys, and Gareth Williams for commenting on drafts.

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