Usage

This post explores the usefulness of alienation theory in bridging between the insights of political economy and the concerns of public health (Crinson and Yuill 2008).

Alienation is not a real thing, out there; it is a conceptual framework for making sense of human experience.

The term comes to contemporary usage from Roman law via Christian theologians and then a network of nineteenth century scholars, most notably Hegel (Baum 1975), Marx (1844/1975, from p322) and Tonnies (Papenheim 1959). The Roman lawyers used the term to refer to the separation of the owner from his or her possession associated with the act of sale. The theologians saw man [sic] as alienated from God, his fellow man, from nature, and from himself. Marx saw alienation in capitalist society as arising from the circumstances of the wage labour relationship.

During the 1960s alienation was referred to commonly in scholarly commentary and activist analysis. Since then, it has gone out of fashion, tainted by the crisis of communism, eclipsed by post-modernism, and buried by neoliberalism (Yuill 2011). However, it is a robust theory and remains useful.

Work in the present era is different from the factories and manual labour which typified the industrial revolution in Europe when Marx was writing. However, alienation remains a useful way of understanding the experience of work under capitalism notwithstanding changes in the organisation of work.

Four facets of alienation

The Marxist account of alienation recognises four closely related facets of alienation (facets as different ways of approaching the same idea).

Alienation from the process of production

The idea of being alienated from the process of production is well illustrated by Braverman (1974) who traces the loss of autonomy associated with Taylorism: from a craft worker (who chooses their tools, selects their materials, decides how to sequence their work) to the assembly line operative who is assigned a narrow range of tasks to be repeated through innumerable timed cycles. Braverman describes how product design and production control are moved from the ‘shop floor’ to the engineers in the ‘front office’. In the degradation of the employment relationship the worker is themself commodified.

The Fordist assembly line and Taylorist division of labour are no longer seen as emblematic of the ‘post-industrial’ society but it is alive and well in low wage platforms in developing countries: iPhone assembly line in China, Bangladesh garment making, and Indian and Philippines call centres. It is also alive and well in ‘service’ industries, such as fast food, and the gig economy generally. The digital technologies which allow for closer surveillance and control of workers, associated with increased precarity of employment, allow for increased exploitation and alienation in a wide variety of service industries, including teaching, academia and aged care. An extreme example is from flight attendants who told Hochschild (1983, cited by Crinson and Yuill, 2008) that they felt that their obligatory smile, a key element in the production process, was in a sense expropriated by management. In this respect they were alienated from their work process.

Waitzkin (2011) has described the proletarianization of doctors working in large for-profit ‘health systems’ in the US, including close monitoring of medical care and managerial pressures to speed up. See Medscape report on physician burnout 2023.

Karasek’s demand, control, support model of work stress and job strain is an empirical model which corresponds closely to Marx’s concept of alienation from the labour process (Karasek and Theorell 1990). This work combines the use of survey instruments to measure work stress and epidemiological methods to document health outcomes. Work stress includes ‘demand’ (both intensity and difficulty), ‘control’ (or ‘decision latitude’ which includes decision authority and skill discretion), and ‘support’ (which may come from management and/or peers). ‘Job strain’ refers to the combination of higher demands with lower decision latitude.

Alienation from the product of labour

The concept of being alienated from the product of labour is closely associated with the idea of ‘commodification’. Instead of the product expressing a social relationship between maker and user (a relationship where need is recognised and satisfied, and appreciation is manifest), the product is appropriated by the capitalist and reduced to a commodity for sale in the market place. Any relationship between maker and user is greatly attenuated (or lost entirely).

The neoliberal drive for the marketisation of human services (including health care) illustrates this process of commodification of the service, so that it can be bought and sold in the market place as a commodity, and the exploitation of the proletarianized service worker can be intensified. The model of universal health coverage currently promoted through WHO and the World Bank is structured around the concept of the ‘benefit package’: essential items of service which shall be paid for (Legge, 2021).

Alienation from fellow humans

Alienation from fellow humans is closely linked to process and product alienation. Production is generally a social process, involving collaboration. At best, as in a string quartet, the quality of collaboration involves a rich inter-subjectivity. However, where collaboration is structured and controlled by management the workers are alienated from each other.

Likewise, the commodification of the product of labour involves the rupture of the relationship between maker and user. The commodification of product and the privileging of exchange value over use value contributes to the alienation of maker from user. The other side of commodification is consumerism; the product is valued in the market place and the purchaser is valued because of their ownership of the product.

Alienation from self

Marx proposed that creativity is a defining characteristic of humanity and hence, when avenues for creativity in work are blocked, the worker is alienated from (cut off from) an alternative creative way of being.

Titmus and Maus have also emphasised the exchange of gifts as a defining characteristic of human societies. Accordingly, where the worker is alienated from the product of their labour they are also alienated from an alternative way of being, where relationships with others are associated with giving and receiving.

In these respect ‘alienation from self’ refers to work settings where people’s scope for creativity, autonomy and self-determination, and the experience of giving and receiving, are denied.

Alienation and the capitalist wage relation

Marx denounced the dehumanising effects (‘mortification’) of powerlessness and degradation of the worker under capitalism. He also denounced the appropriation by the capitalist of the surplus value produced by the worker. However, alienation is not the same as exploitation (FoxConn in China) or oppressive working conditions (Rana Plaza in Bangladesh) or dangerous unpleasant work (ship breaking in India).

Marx’s use of ‘alienation’ points to a degradation of social relationships which is a consequence of the capitalist wage relationship (Crinson and Yuill 2008). Marx’s usage starts from an idealised scenario, communism foreshadowed (Ollman 1976):

• where the organisation of work provides scope for creativity and autonomy, and for learning for the worker;
• where collaboration at work helps to enrich the relationships between workers;
• where the use value of the product of work expresses a gift relationship between the workers and the users;
• where the capital accumulation required for the inputs and equipment is collectively organised in such a way as to strengthen the quality of relationships within the collective; and
• where the transactions between the enterprise and the natural world are constructed so as to minimise and repair any disruption of natural ecosystems.

The capitalist wage relation despoils these relationships; this is the core of Marx’s conception of alienation (Øversveen 2022).

Alienation adds to the mortification of the worker attributable to exploitation, oppression and toxic exposures. However, even in the most enlightened employment settings, the wage relation despoils in some degree the relationships with self, colleagues, customers, financiers and the non-human children of Mother Earth. 

Implications for health

Alienation is a theory, a conceptual framework; it is not a thing. It is a theoretical framework which can help in making sense of what we know about population health and health care (Yuill 2005). It is a way of making sense of the realities of work and health, of capitalism and neoliberal health policy, and of the more empirical research of Marmot, Karasek, Berkman, Lynch, Coburn, etc.

Alienation theory provides a narrative that casts new light on the social class mortality gradient and the Foxconn suicides. It suggests causal links between the social relations of capitalism and the health of workers. Crinson and Yuill (2008) review the debate between psychosocial versus neo-materialist explanations of the mortality gradient and points towards the usefulness of alienation theory to deconstruct this dichotomy. Crinson also suggests that low levels of ‘social capital’ can be a reflection of alienation where ‘human intersubjectivity is reduced to exchange value’.

Alienation theory provides a narrative which suggests an approach to strategy as well as explanation; a narrative that points to the importance of linking the challenges of public health to the wider challenge of reforming / replacing capitalism.

Alienation theory extends the critique of marketisation and privatisation of human services under neoliberalism. It locates the commodification of the ‘item of service’ and the ‘benefit package’ within the wider corporate structures of capitalist health care.

Globalisation, with giant monopoly corporations sitting astride global value chains has had the effect of strengthening the hand of the corporate strategist vis a vis the worker: weakening unions, dispersing gig workers, exploiting precarity (from technological unemployment), and forcing social safety nets lower through austerity. Globalisation also extends the physical distances between the management decisions the work setting.

Alienation theory also offers insights into society and culture more generally. A society where the experience of work stultifies creativity, reduces personal autonomy, and denies the gift relationship has implications for drug and alcohol use, for mental health, for interpersonal violence, and for community sentiment and political choices.

Lavalette and Ferguson (2018) comment that “In few areas of life are the destructive effects of alienation and commodity fetishism more keenly felt than in the area of sexuality” and “neoliberal capitalism takes our sexuality and sells it back to us as a commodity in ways that are highly destructive of our health and relationships”.

Much of the commentary around alienation describes alienation in terms of the individual experience. However, the consequences of a widespread experience of alienation for different parts of society and for the culture more broadly are profound. These include the cultivation of materialism and individualism and the attenuation of solidarity.

Social mobilization and convergence (or fascism)

The grievances associated with exploitation, oppression and toxic exposures can also be expressed in fear, blame and hostility directed to ‘the other’: racism, misogyny, ethnic division, religious bigotry and homophobia, etc. Where the quality of our relationships with ‘the other’ has been degraded by the various aspects of alienation, fear, blame and hostility provide a fertile soil for fascism with misogyny and racism. The fascist response to alienation takes us towards war, increasing inequality and accelerated environmental degradation.

The alternative to fascism involves a convergence of social movements; a mobilisation of communities against the mindless demand for gated, growth oriented, transnational capitalism with accelerating environmental degradation. A critical element in this struggle involves addressing the drivers of human alienation, including in particular, the capital wage relationship.

References

Baum, G 1975, ‘Religion as source of alienation: the young Hegel’, Religion and alienation: a theological reading of sociology, Paulist Press, New York, Paramus, Toronto, pp. 7-20.

Braverman, H 1974, Labor and monopoly capital: the degradation of work in the twentieth century, Monthly Review Press, New York.

Crinson, I & Yuill, C 2008, ‘What can alienation theory contribute to an understanding of social inequalities in health?’, Int J Health Serv, vol. 38, no. 3, pp. 455-70.

Hochschild, AR 1983, The Managed Heart: The Commercialisation of Human Feeling, University of California Press, Berkeley.

Karasek, R & Theorell, T 1990, Healthy Work: Stress, Productivity and the Reconstruction of Working Life, Basic Books, New York.

Lavalette, M & Ferguson, I 2018, ‘Marx: alienation, commodity fetishism and the world of contemporary social work’, Critical and radical social work, vol. 6, no. 2, pp. 197-213.

Marx, K 1844/1975, ‘Economic and philosophical manuscripts’, Early writings, Penuin Books, Harmondsworth, pp. 279-400.

Ollman, B 1976, ‘The theory of alienation’, Alienation: Marx’s conception of man in capitalist society, Cambridge University Press, Cambridge, London, New York, New Rochelle, Melbourne, Sydney, pp. 131-5.

Øversveen, E 2022, ‘Capitalism and alienation: Towards a Marxist theory of alienation for the 21st century’, European journal of social theory, vol. 25, no. 3, pp. 440-57.

Papenheim, F 1959, The alienation of modern man, Monthly Review Press, New York.

Waitzkin, H 2011, Medicine and public health at the end of empire, Paradigm Publishers, Boulder and London.

Yuill, C 2005, ‘Marx: Capitalism, Alienation and Health’, Social Theory & Health, vol. 3, no. 2, pp. 126-43.

——— 2011, ‘Forgetting and remembering alienation theory’, Hist Human Sci, vol. 24, no. 2, pp. 103-19.