So social Darwinist practices certainly aren’t confined to the macro-economy — that much is clear. Nor are they confined to the business sector. To think this, as I stated earlier, is an equally dangerous fallacy. Meritocratic thinking now shapes almost every aspect of life and, with it, our identity. And that’s where the danger lies because, as a result, it meets with scarcely any opposition. By way of illustration, I look next at the impact of a neo-liberal meritocracy on sectors where it has absolutely no place: higher education and health care.
Universities as knowledge businesses
In October 2011, the University of Antwerp launched a hip new magazine and invited prominent alumni to contribute a column. Journalist Sven Speybrouck gladly took up the offer, but was amazed when the editorial board subsequently refused to publish his article. Why was that? He had named various large concerns that were evading corporate tax, and this had made the university authorities quake in their boots, fearing dire consequences. Just for the record, the University of Antwerp is an independent body subsidised by the state. What price academic freedom?
It wasn’t so long ago that higher education was valued largely for its social relevance. The aim was to produce critical, highly educated citizens who could place their talents at the service of society. But these days the notion of serving society is considered hopelessly old-fashioned. Universities have been reinvented as knowledge businesses, whose task is to equip students with competencies that enable them to stream straight into the business sector.
In 2011, the financial crisis prompted some alarming proposals from on high concerning the Flemish higher-education sector. One was to increase tuition fees for all courses that did not dovetail with the business sector, and reduce them for all those that were deemed profitable. Another was to punish anyone pig-headed enough to opt for a non-profitable course by reducing their unemployment benefit, or even removing their right to it entirely. The most extreme suggestion was to screen infants’ skills so that they could immediately be pushed in the right vocational direction. The writer Marc Reugebrink examined these ideas in a critical article that was symbolically published on Holy Innocents’ Day (De Standaard, 28 December 2011). A week later, he was reprimanded by the science editor of the same newspaper, who set him straight on a few issues: the humanities contributed nothing to society, social scientists were well-advised to read Darwin, and there was nothing wrong with neo-liberalism.
The fact that proposals such as these are made by people in power makes me shiver — I imagine that this must be how things started back in 1930. The lack of protest is equally disturbing: have we lost our ability to speak up for what we believe in? To understand what is going on, we need to take a look at the recent history of academia.
For a long time, universities were static societies in microcosm, where appointments to chairs were largely determined by background and party politics, and where professors stayed put. In the last quarter of the previous century, the introduction of a meritocratic personnel policy fortunately brought about sweeping changes. To the dismay of older academics, a vote was no longer sufficient for appointment or promotion. Selection procedures became much more rigorous: good reasons had to be advanced for selecting candidates, and CVs were scrutinised. In the early days following the change, academics’ careers became dependent on their teaching abilities, social contribution, and academic efforts, as testified by their publications, lectures, and participation in conferences. Universities became dynamic environments where younger lecturers, especially, thrived; finally, their efforts were appreciated.
The success of the reform wasn’t just due to the fact that hard work ensured relatively rapid promotion and pay rises — because, from a certain level on, salary ceases to be an incentive.7 From a psychological perspective, academics mainly felt good because they finally had control over their own careers, being protected from nepotism, backroom deals, and other shady practices. This did wonders for their self-esteem, which in turn increased their motivation to work, along with their job satisfaction. On top of that, they identified with and felt loyal towards the organisation that made this possible.
Within the span of a single generation, however, this situation changed dramatically, with the result that, nowadays, university staff, especially if they are young, feel that they have very little influence over their careers. Instead, they are compelled to dance to the music of an invisible administration. They work flat out, but don’t find their jobs satisfying. They no longer identify at all with the organisation, and solidarity among colleagues has largely disappeared. The reason lies in the evolution of what started out as a meritocracy but turned into a neo-liberal evaluation system. I call it neo-liberal because the emphasis is entirely on quantitative production.
In the space of 15 years, the nuanced assessment of employees’ qualities and efforts was gradually replaced by a system in which their production — or ‘output’, as the new jargon had it — was literally measured and counted. Things that were tricky to measure were left out of the picture. The importance attached to educating and contributing to society plummeted, with the focus now almost exclusively on research and ‘projects’. A bottle-factory mentality came into being, in which academic publications were the unit of production. And the bar was continually raised. In my own country, articles in Dutch or Flemish no longer counted; to qualify they had to be international publications. ‘International’ proved to be a euphemism for ‘English’. The focus then shifted from English publications in general to a handful of top journals (known as A1 journals), then to the bibliographical-impact factor and citation indices. The current rule is that an academic must publish in journals with the highest international (that is, Anglo-Saxon) ranking. Meanwhile, a new criterion reveals an important shift: the best academic is he (rarely ‘she’) who can secure the most international funding, preferably crowned with patents. It is here that the link between education and the economy is most clearly visible.
There is nothing coincidental about this type of evolution. On the contrary, it is structurally determined and thus inevitable. A meritocracy can only function through a centrally directed and rigidly planned system that measures ‘production’ and individual contributions to it. The nature of the system limits the number of ‘winners’; only the best can be boss.8 So every appointment or promotion necessarily entails competition, with career growth being an option only for the few. A cut–throat contest ensues, which in turn causes the criteria for success to be tightened yet further. The same competition takes place on a larger scale, leading to all kinds of mythical rankings for universities (such as the Shanghai Ranking, or CHE excellence ranking). These take on the quality of the stock market, causing administrators sleepless nights.
This is the academic version of the Rank and Yank system, and the consequences are the same: production continues to increase on paper; an atmosphere of personal frustration, envy, fear, and paranoia is created; and creativity is effectively stifled. Anything that doesn’t fit within rigid parameters doesn’t count anymore. Thinking out of the box — that precondition for innovation and discovery — has become impossible. So it looks like it’s back to that garage.*
[* Since October 2011, my own university (Ghent) has drastically changed its personnel policy, so that promotion is no longer based on competition, and the criteria determining promotion can both be widened (not just A1 publications) and made more specific (a professor of linguistics is rather different to a professor of experimental psychology). This will undoubtedly benefit relations in the workplace. And no one will lose any sleep about the Shanghai Ranking.]
It’s worth referring here to the historian and philosopher Michel Foucault and his notions on discipline: in the current academic world, everyone gets bent under the yoke of an anonymous, global Evaluator, who looks down from the Mount Olympus of the top journals, disciplining all and putting them in their rightful place. Fearful of his Jovian eye, no one dares protest. Paradoxically enough, this quality-monitoring
system fosters fraud, just as in the case of Enron, ranging from the Stapel affair in the Netherlands to the fraud with PhDs at German universities. (Not so long ago, a Dutch professor of social psychology, Diederik Stapel, was an authority in his field, renowned for his extensive empirical research and numerous publications in top journals. But his career came to an abrupt end when it turned out that he had fabricated and manipulated data on a massive scale. Nearly every newspaper found an explanation for such practices in the enormous pressure to publish, and the hyper-intense competition for jobs and promotion. In Germany in August 2009, mass fraud with doctoral titles came to light, in which various universities and hundreds of professors were involved.)
Many senior academics are convinced that this is only the tip of the iceberg, but hardly anyone dares voice such views. Meanwhile, besides these instances of actual fraud, a much greater problem looms: the bulk of research findings are false, and that, too, is entirely down to competition and the pressure to publish. Scientists and academics aren’t given enough time these days to investigate and consider issues properly. John Ioannidis, a renowned epidemiologist at Stanford University, wrote a pioneering article on this subject in 2005 entitled Why Most Published Research Findings are False. Six years later, nothing had changed, he claimed, during a lecture at Radboud University Nijmegen in April 2011.
This kind of control — a disciplinary straitjacket — is inherent to the neo-liberal meritocratic system, along with the harm it causes. It shoots down the myth of the free market: a neo-liberal ‘free’ market depends on mutual agreements between businesses and global policy decisions, a fact that Jeremy Bentham was already aware of, and whose truth in this day and age has been convincingly demonstrated by both Hans Achterhuis and Richard Sennett. I shall come back to this in the next chapter, when I discuss my own field, psychotherapy.9
As far as universities are concerned, if the current trend continues, two potential scenarios emerge. One is that higher education will become a research centre for multinationals — a cheap one, being funded from the public purse — with the added bonus of turning out graduates ideally equipped to join the staff of these concerns (by being competitive, flexible, etc.). The other is that universities will simply be bought up and transformed into listed companies whose input (students) and output (employees) are at the mercy of market forces. We are not so far from this as people think.
Hospitals as care businesses
A psychiatrist whom I met at a symposium told me indignantly that his hospital, in the biggest city in Flanders, had done away with all its psychiatric beds, replacing them with cardiology beds. The reason was simple: cardiology beds were three times as profitable. What’s more, they were mainly occupied by patients from the Netherlands, which was even better from a financial perspective.
This is by no means an isolated example. In an attempt to control spiralling health costs, quite a few governments have imposed a market model on the healthcare sector, believing this would lead to cheaper and more efficient care. The result has been exactly the opposite, as many newspaper articles have shown in recent years. Like any other ‘market player’, hospitals opt for what is most profitable, and axe those tasks that are least profitable. The main focus is no longer on patients. Instead, they are increasingly regarded as a means to an end, and this situation is getting out of hand. In Flanders, in particular, the combination of a staggering work overload, competition between various medical disciplines, Kafkaesque regulations, and the need to generate yet more profit means that patients are better off staying away from hospitals these days — that’s what many doctors have privately told me. Besides maximising profits through an exponential increase in diagnostic scans and numerous unnecessary interventions, the care sector, like any other business, seeks to minimise costs. Saving money on staff is a standard part of this process, but institutions are also increasingly opting for cheaper and therefore substandard material, from potentially toxic breast implants that tear easily to defective artificial hips.
An important part of any free-market process is the recruitment of customers. At present, advertising is not considered acceptable in the medical sector, but there are ways of getting around this. The trick is to convince people that they might have something wrong with them or that their health is at risk, and that they really need to take steps to protect themselves. Over the last ten years we have been deluged by health fads and health recommendations: make sure you go to all your screenings and have your jabs; get your blood pressure and cholesterol checked regularly; and have regular mammograms, heart tests, and cervical smears. By the way, are your bowels in order?
This modern variation of physical harassment is carefully orchestrated by a largely American medical industry. Their tactics range from advertorials (commercials disguised as journalism) in newspapers, and spots on radio and television (‘Erectile dysfunction? Talk about it!’), to setting up fake patient organisations that buy advertising space in bus stops to generate public awareness of a particular ‘disorder’ and, subsequently, of a particular medicine.* This kind of thing is definitely bad for our health — at the very least, we will all end up hypochondriacs. The fact that healthcare costs have become prohibitive has a lot to do with this process.
[* In the United States, this technique was used very successfully to rebrand shyness as the ailment ‘social phobia’. Christopher Lane describes this and other startling cases in a chapter tellingly entitled ‘Direct to consumer’. His book painfully reveals how psychopharmaceutical companies in the West are currently setting the agenda of clinical and academic practice.]
The surrender of academic and clinical independence goes hand in hand with an increase in supervision. In the United States, the days when doctors would make independent decisions are long gone. Health insurers and administrators now call the shots. I was made personally aware of this in 2008, when my wife and I were in Philadelphia. On the very first day of our visit, she slipped on a loose manhole cover and fell, injuring herself. She was in such severe pain that she clearly needed medical attention. An American colleague was adamant that we should go to a particular hospital, warning us that the others were no good. On arrival, the first thing to be examined was my credit card; only after that had been scrutinised intensely were we allowed past hospital reception. As we came from Europe, it took a long time to establish our insurance status, which crucially determined the treatment options. Only once all this had been settled did we get to see a doctor. My wife turned out to have a complicated fracture of the elbow; I shudder to think what would have happened had it been a heart attack. Finally, in view of the cause of the fall, we were advised to sue the city authorities: we were bound to win the case and would be able to claim substantial compensation. We did not take this advice.
Supervision by health insurers of what is these days called ‘performance’, even in the medical sector, requires extensive management. This is the second cancer to have blighted the sector (the first being its transformation from a public utility into a free-market enterprise), and it continues to spread. An increase in top-down management is inherent to all neo-liberal processes, by the way: a neo-liberal organisation invariably creates a non-productive top layer whose main task is to maintain its position by monitoring others, resulting in ever-proliferating rules and regulations. Performance measurement is fostered in the name of ‘transparency’, the idea being that the criteria are clear and apply equally to all. However, studies show that they only apply to those who do the actual work, not to those who do the measuring — that’s the difference between the worker ants and the manager queens.
Zygmunt Bauman, one of the most eminent living sociologists, devised a good metaphor to challenge the so-called transparency of those measurements. The famous pane of glass on the work floor, through which everyone can supposedly see and thus monitor everyone else, is in fact much more like the one-way mirror used for covert observation. On one side, they are transparent; on the other, they are regular mirrors. The meas
uring voyeurs watch the workers from behind the mirror, themselves hidden from view. Meanwhile the workers themselves can only see, in the mirrors that surround them, their own misery multiplying.10
And thus we stumble on a consequence of neo-liberal organisation that is unexpected, given the emphasis on deregulation and allowing market forces free rein. And that is the inevitable proliferation of rules and regulations it creates, along with an unseen monitoring system and a heavy burden of administration. This combination is lethal to creativity and productivity, and consequently often sparks calls for … more neo-liberalism. In his Open brief van een arts (Open letter from a doctor), Marc Desmet sets out four management symptoms that he diagnosed in his work as a hospital doctor. All four apply seamlessly wherever market forces have been given free play.
The first entails non-stop changes, ranging from continuing structural alterations to the installation of the latest computer software, new partnerships with other hospitals, or the umpteenth merger between services, involving constant assessment and steering by third parties. Strikingly, those who do the actual work have little if any say in these processes.
That leads to the second symptom: the ‘Big Brother’ feeling. It is not the changes themselves, but the staff who are being constantly evaluated, through performance interviews, audits, and suchlike. This does nothing for the working atmosphere, and in many departments you’d be hard put to find any team spirit. Here, too, measuring and counting goes on, and here, too, it has a perverse effect. In no time, staff at all levels adapt their behaviour, ceasing to do things that ‘don’t count’. Everything is sacrificed to the juggernaut of measurability. Unfortunately, the unquantifiable nature of care can’t be demonstrated through figures, so actual care is fast vanishing.
Which brings us to the third, even more paradoxical symptom: less and less focus on the work itself and more and more on administration, management, and monitoring. Hospitals would undoubtedly function much more efficiently if there were no patients. Once, after a faculty meeting which seemed to be one long session of gripes, I suggested abolishing teaching altogether. Students take up too much of our precious time, as do patients, and they are well aware of that: ‘Professor, I know you’re very busy, but if I could just trouble you for a moment, could you …’ ‘Nurse, when do you think that I might see the doctor?’ We’d be best off without them — and we’d save on heating costs into the bargain.
What About Me?: The Struggle for Identity in a Market-Based Society Page 11
