Finally, there’s the symptom that Desmet calls ‘dispiriting contradictions’. Everyone is constantly urged to cut costs, yet they see vast amounts being spent on items that serve no real purpose. Like hiring a consultancy to devise a new name and slogan that should, above all, not be taken literally (‘We’re here for you!), or ordering accounting software that’s considered useless by those in the know and ends up costing twice as much as predicted. Another creeping symptom is bombastic use of language. Besides ugly terms such as ‘service users’ for patients and ‘disinvestment’ for cuts, health-sector documents are bursting at the seams with claims to excellence. An individual who blew his or her own trumpet so loudly would risk being diagnosed with narcissistic personality disorder.
Impact on quality
The expectation is that a meritocracy will produce better results than a business run on non-meritocratic lines. If the best people who make the greatest effort are given the highest positions, then surely the quality of the organisation’s products or services will be optimal? There is nothing wrong with this reasoning in theory, but in practice two factors get in the way. First, it isn’t easy to express quality in figures, the consequence being that the reasoning is often turned on its head: only that which can be expressed in figures classifies as quality. Second, the sole aim of a neo-liberal market economy is to make a profit; quality is not an aim in itself. Despite all the triumphant brandishing of figures, it’s clear to most of us that under the influence of market forces, the old public utilities, from the railways to the electricity companies, have become more expensive and less efficient, and that the quality of many consumer durables has declined, so that they have to be replaced more often.
In the case of tangible products (such as cars), it is possible to measure quality in a uniform way. When aesthetics and taste are involved, however (as with, for example, foodstuffs), it becomes less straightforward. And when it comes to knowledge and the provision of services (in, for example, research, education, and healthcare), it becomes very hard indeed. Here the meritocratic measuring system provides its own solution: quality is determined by measurability; anything that can’t be measured doesn’t count. In other words, measuring is not just passive registration; it has an active impact. Any alteration to the yardstick signals an altered perception of quality, affecting the behaviour of those involved. A form of tunnel vision is created: this, and only this, is quality. Anything that falls outside the measuring system is deemed unproductive, and so no time should be wasted on it. If viewing figures determine the ‘quality’ of a television programme, you create hamburger TV. The relative nature of this kind of quality is most apparent when the measuring method and criteria change — which happens faster and faster everywhere. In the twinkling of an eye, all that has gone before is forgotten, and the new yardstick provides the latest definition of quality — once again changing the behaviour of all those concerned.
On top of this, a meritocratic system of quality measurement cannot take account of local and contextual factors. The yardstick must apply equally to all, and measurement must be ‘standardised’ — otherwise the comparison will not be deemed ‘objective’. Thus the proponents of this system, with a view to silencing any critical opposition, base their practices on the very narrow vision of science discussed in chapter three.
It is striking how often measuring systems of this kind are imposed by an anonymous head office and conceived by external taskforces and consultants who have little affinity with the work that they are told to measure. They receive a fat fee into the bargain, which only increases the frustration on the work floor. What’s more, the real professionals have to spend part of their time registering those measurements, which does nothing to improve the quality of their work.
Hospitals have been re-branded as care businesses, and universities as knowledge businesses, whose workers have to maximise their production. Work content is less important than whether a certain performance or activity ‘counts’ or not. The need to score well means that employees constantly adapt their work to reflect changes in the scoring system. The most successful researchers are those who go with the latest academic hype. And since hypes are necessarily short-lived, any expertise that is built up is about form rather than content. When I asked a younger colleague at the university how he had been able to change his research field several times within a decade or so, he answered: ‘It’s just a question of new software.’ Unconsciously, he was echoing the answer given to the American sociologist Richard Sennett when he asked workers in an industrial bakery (whose jobs, like their previous ones, amounted to not much more than clicking on computer-screen icons) what skills they had. They told him: ‘Baking, shoemaking, printing, you name it, I’ve got the skills.’ A quarter of a century earlier, he had met Italian bakers in that same company who were proud of their mastery of their trade.11
The same tunnel vision is to be found in the healthcare sector, where quality is currently determined by a specific interpretation of the term ‘evidence-based’. There is a belief within mental-health care and social services that quality can be measured using methods copied from pharmacological research: which medicines work best for a particular disease? This approach reduces the effect of psychotherapy to that of a pill, and mental disorders to an organic disease. As a result, it can only be applied to a few forms of psychotherapy and a few mental disorders. Instead of realising that they cannot therefore pronounce on all the other methods of treatment, the evaluators conclude that only this limited category of treatment is effective. Things have got to the stage where the legitimacy of other therapy models is increasingly being questioned, and they are even disappearing from university courses, leading to more tunnel vision and uniformity.12
Wherever quantitative yardsticks are used to measure quality, behaviour soon adapts to the system, invariably leading to a loss of diversity. This creates a problem for meritocratic policymakers: the fewer differences there are between candidates, products, or services, the harder it is to rank them. Don’t forget that in a meritocracy, the number of ‘winners’ is limited by definition. As a result, candidates are beginning to focus on external factors in an attempt to overshadow the competition. A shift in emphasis is taking place from content to packaging: results are presented in glossy reports drawn up by specialised consultancies. Propaganda and nepotism have made way for the expensive products of spin doctors and lobbyists.
This latter trend is the final step in efforts to belong to the winning group. Initially, any poorly performing ‘production unit’ — whether it’s a car factory, university, or hospital — will try to pep up its ‘production’. The focus is on turning the figures around as soon as possible: ditch those psychiatry beds, and split that publication in two; that way, it counts double. This affects both the way work is carried out and the way it is measured. People stop doing work that doesn’t count sufficiently, and focus on activities that rank as high-scoring. And figures are massaged where possible. From there, it’s only a small step to falsifying. In the Stalinist era, there was a name for the subtle manipulation and, ultimately, falsification of statistics in order to reach the desired norm: tufta. Exactly the same thing is happening in our day to what management jargon calls ‘the stats’. A paper reality is being created that has less and less to do with actual reality.
Indeed, the efficiency of education, research, and healthcare isn’t easy to measure, however much the new buzzwords (such as educational performance, output, ranking, and benchmarks) might create that impression. Ponder the following: does the number of patient deaths per month say something about the quality of a hospital — or does it reflect the kind of patients being treated? Does the number of pupils who pass their school-leaving examinations say something about the quality of a school — or does it say more about the neighbourhood in which that school is located? Does the number of students obtaining master’s degrees say something about a university — or does it reveal more about that university’s output-based finan
cing?
If figures such as these are made part of an evaluation system, therefore affecting funding, some hospitals won’t hesitate to place terminal patients elsewhere, just as some schools will refuse to admit certain pupils, or will modify their pass criteria. In all cases, quality will be enhanced — at least on paper.
Social consequences
The principle of a capitalist meritocracy founders on the inheritance of wealth: those who inherit capital stay at the top of the ladder; those who inherit debt remain at the bottom. The principle of an educational meritocracy founders on social inheritance: highly educated parents instil in their children interests and knowledge that almost automatically places them in the top echelon at school; the reverse applies to the children of poorly educated parents.19 A neo-liberal meritocracy combines both forms of inheritance, and installs a new, static class society based on a combination of qualifications and money — a society whose upper layer not only carefully guards its own privileges, but also significantly extends them. A rapid increase in inequality between the various groups results. This is now a universal phenomenon, not just in organisations and businesses, but in society in general. In hospitals, the most profitable department will expand while others shrink; in universities, departments that fit best with the measuring system will flourish at the expense of departments that have fallen out of fashion.
In a social context, the consequences are worrying. The middle class is disappearing, making way for a small group at the top and a large underclass at the bottom. Social relations are becoming increasingly embittered. The top group looks down on the underclass, believing that the latter only has itself to blame if it ends up in the gutter. Its ‘fault’ lies in a lack of effort and talent. If the top group offers any assistance, it is in the form of welfare, because in its eyes the underclass does not deserve to be helped. In other words, along with the re-emergence of social Darwinism, we are seeing the revival of another 19th-century concept: charity. The rich should help the poor through donations. The poor, meanwhile, are expected to remain poor. Assistance is confined to the alleviation of material need; social emancipation is not part of the plan. A charitable mindset — heavens, those poor people — redefines social problems as problems of poverty.
Just as in the 19th century, people conveniently tend to forget the important role that pure chance plays, as well as the social effects of ethnicity, class, age, ill-health, adversity, and even gender. With regard to the latter, in August 2009 the British newspaper The Observer reported an increase in discrimination against pregnant women and mothers in the workplace, and experience shows that it is very hard to combine a career with motherhood. Universities are absolutely no exception to this rule: how many of them have adequate childcare facilities? Meritocracy ties in perfectly with phallic competition. It’s no coincidence that the bloody social revolution at the end of Michael Young’s book The Rise of the Meritocracy is organised by highly educated women.
The underclass, of course, isn’t blind to what is going on; it accuses the top layer of arrogance, a lack of self-criticism, and, increasingly, self-enrichment. The message conveyed to the losers conflicts with their own experiences. They are told that their failure is their own fault, yet they feel powerless to remedy their situation. A cycle of continuing humiliation ensues. In his The Geopolitics of Emotion: how cultures of fear, humiliation, and hope are reshaping the world, which explores relations between Europe, China, Muslim countries, and the United States, Dominique Moïsi applies this reasoning to world politics. It’s a theory that applies at all levels: whether you’re a country, a social class or an individual, it really doesn’t take much for feelings of humiliation and despair to be transformed into violence.
The static nature of these social relations causes the losers to feel hopeless, leading in turn to pointless violence when those who are powerless revolt to no avail. This type of insurrection differs from the revolution at the end of Young’s book; from my clinical perspective, it reminds me more of the self-mutilating behaviour of those who have lost all control over their lives.
Take the riots that flared up in French suburbs in 2005, incited by sectors of the population who had nothing left to lose and who destroyed their own neighbourhoods in an impotent rage. Their lack of future prospects was underlined by the reaction of president Nicolas Sarkozy, who called them racaille (scum), who needed to be swept from the streets with high-pressure hoses.
A few years later, the British prime minister, David Cameron, responded similarly to riots in London: the perpetrators were born criminals whose behaviour could not be excused. Tough punishment was called for. Unconsciously, he was echoing the 19th-century theories of the criminologist Cesare Lombroso about ‘born’ criminals, who could be recognised by their widely spaced eyes and bushy monobrows. When it became clear that many of the looters were youngsters from privileged backgrounds, Cameron was forced to revise his opinion.
Where did we get to again with identity?
SIX
IDENTITY: POWERLESS PERFECTIBILITY
Every 15 years or so, I re-read East of Eden, and each time I’m impressed by the way in which Nobel Prize–winner John Steinbeck manages to raise all kinds of fundamental issues almost without the reader noticing, thanks to his skill as a storyteller. The issue of heredity and environment is one of them: are our lives decided at birth, or does our environment have a finger in the genetic pie? Is there such a thing as moral choice? One of the book’s characters is convinced that heredity determines everything: ‘You can’t make a racehorse of a pig.’ The other replies, ‘No, but you can make a very fast pig.’
In chapter one, I explained how our psychological identity is a product of our environment. Of course, this doesn’t mean you can take a baby and mould it into anything you like: the genetic blueprint is there. But that blueprint still allows a lot of room for manoeuvre. That’s why, in chapter four, I went in search of what is innate. I find field biologists are a better source of information than self-proclaimed experts on the brain when it comes to this question. Frans de Waal has demonstrated convincingly that primates, to whose family we belong, possess empathy and are geared to co-operation and solidarity — as long as the environment fosters this behaviour. In a completely different environment we can develop into exceedingly cruel and egotistical beings. This confirms what Steinbeck already knew and what he describes so beautifully in his novel: environmental factors are highly influential, but individual choice and responsibility still have a role to play.
In chapter one, I briefly described the processes (mirroring and separation) that shape our identity. It’s time to take a more detailed look at the way this happens.
Identity develops optimally in a stable environment where clear authority figures ensure secure bonding. In other words, a child flourishes when people take decisions on its behalf in a consistent way (‘First I’ll tell you a story, then it’s time for bed’), until such time as it can do so itself. Once this secure foundation is in place, content is transferred smoothly via the mirroring processes, the child develops confidence in itself and in others, and is able to distance itself and make its own choices. In this way, it gradually acquires a robust identity. The content of someone’s identity depends on the broader group in which they grew up, and particularly on dominant communal notions, the ‘narrative’ shared by the group. Those notions are invariably moral in nature, consisting largely of norms and values that determine the way we view ourselves and others. They are reflected in mores or ethics and, by extension, laws.
Up to two generations ago, these influences largely came from the family in which someone grew up and their own immediate social circle. The explanation is simple: people spent most of their time in their own small orbits; the impact of the outside world was fairly limited. The railway network, which still functioned perfectly in those days, mainly served — as the writer Erwin Mortier so beautifully formulated it — to keep everyone in their place. These days, new methods of communication ha
ve made partings almost impossible. The final scene of Casablanca (‘We’ll always have Paris’) has become unthinkable. Nowadays, the aeroplane carrying Ingrid Bergman away would hardly have taken off before she and Humphrey Bogart would have been furtively texting each other. As a result of all this technology, parental influence on child development has unquestionably declined. The border between the internal and external world has disappeared, and the external world dominates.
The way in which our identity develops has not changed: we still mirror ourselves in the dominant narrative, with its embedded norms and values. But these days we mirror ourselves far less in our parents, and far more in the flat screens from which we cannot escape, now that they also pollute public spaces. This is the millennial version of the constantly repeated hypnopaedic messages in Brave New World, and its efficacy exceeds even Huxley’s worst nightmares. The advertising world and the media bring us glad tidings against which we have little defence. Their hidden, sophisticated strategy is to convince us that they have our own interests at heart. This usually involves us buying a particular product, ‘Because you’re worth it.’
There’s nothing wrong with flat screens as such, nor with the media. The problem lies in the messages that they convey and, more broadly, in the dominance of free-market processes. The explicit message is: everyone can be perfect; everyone can have anything they want. But there’s also an implicit caveat: as long as you try hard enough. And that ties in perfectly with the pre-eminent modern myth of the perfectible individual. Note that advertising, the source of contemporary ethics, never contains any prohibitions — at most, an obligatory warning (‘Alcohol can damage your health’) that is overshadowed by the dominant message to seek pleasure, to enjoy as much as you can.
What About Me?: The Struggle for Identity in a Market-Based Society Page 12