The problem of work stress and the need to re-imagine the bio-psycho-social model

Abstract

The popular discourse of work stress adopts a realist ontology derived from bio-medicine. Stress is viewed as a set of adverse physiological responses to objective characteristics of work. More sophisticated approaches admit that ‘appraisal’ mediates the relationship between stressor and stress response, but appraisal is viewed largely as a function of individual traits and characteristics. The ‘epidemic’ of work stress is thus explained as an inevitable response to a putative intensification of labour which has pushed an increasing number of workers beyond the ‘natural’ limit of human endurance. Social constructionists have challenged the popular discourse of work stress, arguing that what appears to be a universal and natural category is in essence an historically and culturally specific construct-it is the phenomenal form through which antagonisms at work are experienced and explained in contemporary Western societies. This radical critique sparked the ‘stress-wars’ around the turn of the century, but despite subsequent skirmishes little has changed either in the public imagination or scientific discourse. There are many reasons for the impasse, but the embodied nature of stress is in our opinion the most significant. For the stressed worker experiencing the fight or flight response, and for the physiologist clutching cortisol swabs and fibrinogen counts, work stress cannot be magicked away by deconstruction. The critique of work stress has had little traction, not because it lacks empirical support but because it contradicts the lived experience of the stressed body. While many can accept that social factors such as poverty can impact on the body, the belief that narratives can be written on the body is harder to accept. This incredulity stems from the weaknesses of the ways in which the dominant bio-psycho-social model is currently conceptualised. Our argument is that the critique of work stress is unlikely to succeed without a more critical engagement with the bio-psycho-social model. When the bio-psycho-social model emerged in the 1970s, it was heralded as a necessary correction to the dehumanising biological reductionism claimed to typify medical practice at the time. By recognising the social origins of illness and the role of psychological factors in mediating illness behaviour, the new approach would open the doors to forms of practice that were more humane and more effective. Much empirical work has been done on the intersections of the model, yet it remains under-theorised; three separate perspectives, overlapping peripherally, rather than a truly unified general theory. Substantial obstacles lie in the way of such a synthesis, not least the mind/body problem and the structure/agency debate. The bio-psycho-social model offers no route out of these culs-de-sac. Our aim is to critique the bio-psycho-social model, but also to transcend it, by formulating a new theoretical framework that draws upon post-dualist ontology and social constructionism. The latter is a much more hubristic project and a work in progress. Here, we present our current conceptualisation. We have named this the triple-helix theory of the self, because it replaces static notions of the biological, psychological and social with a more dynamic conception of the corporeal, discursive and environmental, spiralling around each other across the life course, giving rise to a uniquely human self.