27 Professional projects

The ideology that is capitalism does not instrumentalise people and turn subjects into objects. Capitalism does not make business owners treat their workers as commodities. Capitalism is a way of thinking and acting, albeit a hegemonic one. For capitalism to work, it needs individuals and groups to put its principles into practice. And a range of Neo-Marxian sociologists, over the last 50 years, have looked at the role the professions play in enacting it. Magali Larson, Anne Witz, and Terry Johnson are perhaps some of the best known Neo-Marxists writing in the latter half of the twentieth century. Larson’s work, particularly, focuses on the idea of ‘professional projects’.

Professional projects are the ‘more or less self-conscious efforts of members of an occupation to work collectively to improve their status and their economic prospects’ ^[1], and, in so doing, promoting the values and beliefs of the culture that nurtures them. For Western professionals, that culture is capitalistic.

Larson was interested in the ways the professions defended, maintained, and improved their market position, by tying their identity with a distinctive ‘commodity’ ^[2][3]. Larson was interested in the way this commodity was inextricably ‘bound to the person and the personality of the producer’ ^[4]. The goal in doing this, Larson argued, was to create a distinctive service that demanded ‘the prior training, socialization and public establishment of a recognizable producer’ ^[5].

Crucial in this process was the ability of the profession to standardise the commodity, and attribute to it a stable set of criteria that established what constituted expertise in the field. Larson thought commodity standardisation was important because it helped to eliminate alternative criteria for evaluation, and through this, ‘professionals may impede the rise of new professions… to protect their monopoly power’ ^[6].

Commodification also fed directly into a capitalist mentality because it supplied the market with one more ‘product for sale’ ^[7]. The idea that fields like healthcare can become marketplaces for commodities now penetrates so deeply into people’s psyche that health professionals now actively sell services; market therapies; compete to offer lifestyle advice, exercise regimes, and mindfulness courses; and price their own time and labour in a way that is indistinguishable from other forms of industrial process and capitalist production. (Writing on Jürgen Marschukat’s new book The Age of Fitness, Lola Seaton recently wrote that ‘Part of what seems awry with contemporary fitness culture is its artifice, symptomatic of the wrongness of modernity, prior to which, one imagines, real life was excessively challenging and exercise blissfully inadvertent. Condemned to an “active” lifestyle, pre-modern humans would surely never have dreamed of inventing excuses to expend extra energy for the sake of it. Like the ubiquitous food products that advertise how little calorific sustenance they supply, confecting occasions for physical exertion seems to symbolise our alienation from a more natural, integrated, rational way of living’ ^[8][9]).

John Owens has suggested that the new language of personal choice, convenience, and independence — such a touchstone for physiotherapy in recent years — has introduced to healthcare ‘a transactional set of norms more typically found in commercial activities into the consultation and care process which subjects patients and professionals to a form of commodification’ ^[10]. Or as Lindy Edwards puts it;

‘Whether people are seeking help in the welfare, health or education sectors, they have become customers and clients rather than patients, students and people in need. The market-based reforms have replaced relationships bound by trust, loyalty and reciprocity with ‘client service’. Our innate obligations to our fellow human beings have been usurped by commercial obligations’ ^[11].

Because healthcare is such an important tool with which to distribute resources in society, it is vulnerable to the kinds of economic exploitation and class oppression that are the hallmarks of capitalism ^[12]. It has been customary to think of public welfare institutions like the National Health Service in the UK as bulwarks against such concerns. But the NHS has played an enormous role in consolidating the power of biomedicine, and created a ‘closed shop’ in which hegemonic medicine could control the way people are encouraged to think about the possibilities and limits of orthodox healthcare. The NHS helped Western medicine commodify health as something that can be linked to personal choice and behaviour, and entrenched inequalities in healthcare provision ‘not just [as] an unfortunate bi-product of health work but an integral part of the logic of provision’ ^[13].

Professions play a crucial role in perpetuating hegemonies, then. And from a Marxian perspective, professionals sit alongside consumer culture, mass media, the education system, and traditional notions of the nuclear family, in inducing a slow cultural fragmentation, and increasingly passive, psychological dependence in people ^[14]. They reinforce our compliance in the face of aggressive monopoly capitalism, with the inevitable result being our growing sense of alienation, anxiety, and disconnection from our ‘species being’.

Rather than resisting hegemonic discourses, Gramsci concluded that ‘on some level people consent to subservience, even take it for granted, when the order in which they live comes to seem like common sense’ ^[15]. For the professions at least, a critical part of that consent stems from the promise of prestige and social capital that flow from being the ones to standardise the commodities that relate to their work. To be able to be the principle, state-supported, and legally sanctioned ‘face’ of physical rehabilitation, for instance, may be enough for a profession to conform to a hegemonic view of health and illness.