Two sets of conversations come to mind, the first with a longstanding friend and colleague, an academic in social and health policy who served as chair of important NHS Trusts; and the second an academic in social epidemiology who conducts research and leads national and international efforts to reduce health inequity. Both dialogues reflected tensions, at least as I saw them.
The underlying tension can be characterised as the scholar versus the reformer. In my conversations with them I repeatedly said ‘but you are doing an injustice to your role as scholar in order to be a reformer even though: (1) your scholarship tells you that you are avoiding the most telling constraints on reform, and (2) your attempts at reforming policy are being systematically undermined.
Let me call the first colleague X and the second Y. X found himself from Thatcher onwards trying to make sense of and facilitate NHS reforms in which, as a scholar, he had neither sympathy nor faith in their fairness or effectiveness. In other words his job was essentially one of damage limitation. But he couldn’t quite bring himself to admit this. Rather he found himself, at least from where I was sitting, offering a rationale and something of a defence for obviously regressive reforms.
I think a distinction is important at this point. In my opinion it is entirely commendable for X to chair NHS Trusts in the hope of ‘doing what he can in difficult circumstances that are not of his choosing’. What is more questionable is X compromising his scholarship in the process. In other words, I didn’t expect X to defend the indefensible. ‘We are doing what we can’ is fine; ‘we are doing the right thing’ is not.
What about Y? Y prioritises converting scholarship into policy reform and has won an international reputation for doing so. He alludes to enduring ‘structural’ as well as political inequalities; but, wearing a comfortably fitting public health hat, he does not engage with issues around the changing nature of post-1970s capitalism, and he generally eschews theorising. Sociologists, he has said, will doubtless have their own questions. Fair enough.
Again, I find Y’s work and contributions praiseworthy. However, as an ‘insider’ academic hoping to influence policy, he calculatingly avoids issues that an ‘outsider’ academic, a sociologist for sure, might judge critical. Why, for example, are health inequalities getting worse despite all his efforts? Can he credibly not want to go further than ‘governments at the moment are not listening, we must continue to document, inform, disseminate, lobby’.
There are different ways of conceptualising the tensions involved here. One might say, with Merton, that we all have complex, diverse status and corresponding role sets and there are often tensions within them. There will often be tensions too between doing professional, policy, critical, public, foresight and action sociology.
I have put forward two middle-range theories that are relevant. The first I called ‘ego adjustment’, which asserts that people’s definitions of self, situation and orientation to social order and change mirror the Mertonian state and role sets they occupy. In short, people ‘rationalise’ their definitions to fit their circumstances. The second I termed ‘activity reinforcement’. What over time becomes familiar ‘matters’ more, more insistently structures agency and is more causally efficacious than is often appreciated.
Obviously this all applies to me as much as to X and Y.
So how does rather long-winded introduction bear on responses to COVID-19? In my own responses to this global pandemic I have focused on macro-sociological issues. It constitutes, I have maintained, a ‘perfect storm’ that has: (1) exposed the existing fractures of financial capitalism and a governance oriented to the interests of the few, and (2) afforded a once-in-a-generation opportunity for a social transformation. Specifically, I have agreed with the line that the Cummings/Johnson axis opted for a Social Darwinist ‘survival of the fittest’ strategy – never properly abandoned – that has inevitably led to a ‘culling’ of vulnerable segments of the population. This is nowhere more true than in relation to care homes. Social care has been privatised and was decimated by the Tories post-2010; and the government were warned before we were hit by COVID-19 about the vulnerability of the elderly occupants of care homes, many of them with co-morbidities.
Now, sociologically speaking, it is right and important in my opinion that the Tories’ purposeful, strategic abandonment of people in care homes is denounced as what it is, namely, state homicide. The government was reconciled to many of these homes becoming warehouses for the dead and dying; and of course many carers in homes have died too.
This is strong language, and other sociologists might prefer to pull their punches. But it catches and holds a searchlight up to what is occurring. Now say you are yourself engaged in the protection of elderly people in care homes, maybe as a member of staff – a nurse, a carer or a local GP – or as a social worker or public health officer. You are likely striving all hours to secure PPE and tests and to alleviate anxieties and suffering. Like X above, you are doing your best. Neither you, nor indeed those living in care homes or their relatives, want to read about ‘state homicide’ or ‘warehouses for the dead and dying’. It may not be that you disagree, but it runs counter to everything you are trying to do day-in day-out; and you are tired and stressed, worried about yourself as well as those you are charged to help.
The point of this blog, when push comes to shove, is to highlight these tensions between statuses, roles, stances and/or rationales that appear to be in contradiction (contradictions of praxis rather than logic). My theories of ego adjustment and activity reinforcement are explicitly sociological, but they have psychological dimensions too. We all need mechanisms or devices to cope with the kinds of tensions I have tried to define and illustrate. We need, I used to say to students, to learn to keep several balls in the air at the same time. This is often none too easy.
Let me end with a concept or two. I am not thinking of cognitive dissonance, or social representations, for all the importance of those psychological notions. I am sticking with sociology here. We all have multiple statuses, roles, stances and/or rationales, or as many sociologists would prefer to call them ‘identities’, and it is empirically rare that there are no contradictions or, as I have referred to them in this blog, tensions between them. Sometimes there exists contextual or situational specificity: different thoughts and talk by audience, circumstance setting or time. But not always.
We need, it seems to me, a concept to somehow represent/stand for ‘keeping several balls in the air at the same time’. Given that I’ve been reading Lefebvre, I’m tempted to draw on his idea of rhythms, but it would take another blog to clarify that. It’s the concept that matters, though it’s helpful to have a word or a phrase that pins it down. Maybe heterogeneity of selfhood will suffice for now. I am sure I can do better, and others certainly will.