INTRODUCTION

In Australia occupational health has emerged as a major "quality of working life" issue. In the 1970s state legislation was introduced to promote more humane working environments and to replace an anachronistic regulatory system based on the "social conscience" of the nineteenth Century. In their zeal to secure improved working conditions legislators required of employers that their working environments be adapted for the physiological and psychological needs of employees. Now for some managers the oxymoronic nature of "psychological needs" was obvious and they proceeded to ignore this intrusion into their work. For others it provided an opportunity to attend to employees' personalities as well as, or instead of, their performance. The dangers of management by personality have been noted by Thomas Szasz who argued that in such situations superiors not only tolerate but often subtly encourage inadequate task performance by their subordinates; what they want is not a competent subordinate but a subordinate they can dominate, control and "treat"(Szasz, 1974). Szasz's argument can be supported empirically by the many Australian work organisations whose managers secure psychological profiles on their subordinates despite overwhelming evidence that psychological (especially personality) tests have consistently and strikingly failed to predict work performance (Spillane, 1994). That managers and employees are (or should be) judged on performance hardly needs saying. Yet for more than 30 years Peter Drucker, the doyen of management theorists, has had to defend the practice of management against the 'psychological despots' who use psychology to tyrannise subordinates. 'Using psychology to control dominate and manipulate others is self-destructive absence of knowledge. It is also a particularly repugnant form of tyranny. The master of old was content to control the slave's body. (Drucker, 1977, p 230).

Although occupational health is an acknowledged issue in the Australian industrial agenda, there is surprisingly little evidence of constructive improvements in the quality of working life. This state of affairs seems paradoxical given the historical and contemporary influences on Australian working life which might be expected to have facilitated work reform. These influences include: a tradition of research into work fatigue and monotony that dates from the early 1900s; the introduction of occupational health legislation that places the onus upon employers to provide for employee well-being; and substantial increases in the number of workers' compensation cases in which "occupational stress" is considered a major cause of health problems (Spillane, 1984).

The paradox disappears if occupational health legislation and practices medicalise moral conflicts at work and so re-direct attention from work performance to workers' personalities and their inadequacies. Two examples will have to suffice.

The notion of 'personal injury' which is the basis for compensation claims covers problems caused by trauma resulting in damage to some part of the body. In Australian law the damage includes 'psychiatric illness'.For example, in Federal Broom Co v Semlitch a worker who had a previous history of 'schizophrenia' had injured herself at work by straining her side which incapacitated her for work. Her employer argued that she was not entitled to compensation because her pain was a delusion of pain which was, in turn, a new manifestation of her pre-existing, non work-related condition. The court took the view that schizophrenia and the 'delusion about pain' were manifestations of a disease and concluded, in part: 'Where an untoward occurrence in a worker's employment causes a pre-existing mental disorder to manifest itself in a new delusion, it seems to me proper to say that there is exacerbation of the mental disorder'(Marks, 1983, p 173).

In the case of Anderson Meat Packing Company v Giacomantonio, a worker in the packing plant "saw" God in the cool room of the meatworks, fell in a faint, said he was terrified and confused and was diagnosed as suffering from nervous shock which arose wholly in the course of his employment. He was judged to be incapacitated for work whilst "demoralised" (Bennett and Hely, 1982).In this case the employee obtained an award despite an appeal by the company to a higher court. The use of the word 'demoralised' is significant and says more than generally appreciated. These and many other Australian cases point to the medicalising or demoralising of moral conflicts at work.

In the 1980s the legitimacy of local work reform strategies and their unintended consequences was severely questioned and the resulting debate was widespread and often acrimonious. The field of Australian occupational health was (and is) dominated by conflicting ideologies, clashes between expert witnesses in litigation proceedings and unpalatable recommendations from government advisory bodies, particularly with respect to two controversial phenomena: Repetition Strain Industry (RSI) and occupational stress.

The Australian phenomenon known as RSI, reached epidemic proportions in the middle 1980s.Predictably it was interpreted so as to support professional interests within a highly charged industrial environment. The same happened to "occupational stress" in the 1990s.

This paper aims to analyse the phenomenon known as RSI from a Szaszian perspective. I argue, that the Australian work environment has witnessed a progressive medicalisation of work behaviour - a form of therapeutic paternalism - in which notions of 'illness', 'treatment' and 'patienthood' feature prominently.

MEDICALISATION OF WORK BEHAVIOUR

The history of occupational medicine records many instances where the quality of working life has been compromised (Weindling, 1985). For example, the conflictual nature of employment relations and the 'careless worker myth' inhibit constructive work reforms, whilst more conspirational accounts highlight the subservience of occupational medicine to broader corporate and even national interests. The same subservience has been noted among occupational psychologists who have acted as 'servants of power' (Baritz, 1960).

A different trend, equally disturbing and more widespread, has been the progressive medicalisation of work behaviour which has fostered the dependant role of patienthood and promoted heteronomous work practices, ostensibly in employees' interests. Work reform as a social movement that aims to liberate employees from coercive work practices has yielded to policies that enslave by treating moral conflicts (behaviourally manifested) as if they are illnesses (physically or psychiatrically manifested) in need of therapeutic control. Hence, the principle of responsible autonomy at work has been eroded by therapeutic paternalism. This movement toward the 'therapeutic state'(Szasz, 1984) in Australian work relations is not attributable to political, medical or legal conspiracies. Rather it is an unintended consequence of complex social processes, especially medico-legal, within an occupational environment characterised by adversarial relationships between the parties.

The phenomenon known as Repetition Strain Industry (RSI), a 'functional pain syndrome' which reached epidemic proportions in Australia during the mid 1980s, provides an excellent example of the medicalisation of work behaviour and so of therapeutic paternalism.

CASES:PAIN, PRETNECE AND PATIENTHOOD: RSI

What is RSI? Or rather what was RSI, since it is now called Occupational Overuse Syndrome and whilst the epidemic associated with RSI has waned, continuing payment of compensation to the majority of complainants testifies to its longevity. It has been described as an 'Australian disease (sic) (that) has become the largest and most prolonged such epidemic in (Australian) history' (Lucire, 1986).

Throughout the 1970s the number of new cases of 'musculoskeletal disease' recorded each year showed no tendency to increase. But in five years from 1979 to 1984 the number jumped (in one state-New South Wales) from 980 to 4550 new cases per year, an unparalleled increase. By 1983-1984 RSI cases represented nearly 30% of total disease cases in compensation statistics.

Large organisations, particularly in the public sector and in other Australian states, recorded similar increases. Unofficial estimates placed the national total in excess of 20,000 workers and almost 4,000 cases were recorded in Australian Government organisations in the December 1985 quarter alone. However, the incidence pattern was inconsistent with exposure to repetitive tasks. Some organisations remain 'unscathed' whereas others with similar work patterns reported outbreaks of epidemic proportions (eg Telecom, Commonwealth Bank of Australia). Of those organisations affected by the RSI epidemic some noted a pattern which suggests a contagion effect in that workers were affected in quick succession (Deves and Spillane, 1989). Australians were clearly involved in an epidemic which until 1982 did not have a name - RSI had not yet been invented.

Clearly, Australians in the 1980s were involved in an epidemic of compensation claims. But what were individuals seeking compensation for? Did the extraordinarily rapid rise in claims correspond to an underlying incidence of musculoskeletal injuries? Or was the epidemic one of mental illness? Or of malingering?

THE INVENTION OF RSI

Historically workers' compensation cases recorded under the classification 'Synovitis, Bursitis, Tenosynovitis' affected, in the main, blue-collar, factory workers. But by the early 1980s a new incidence pattern emerged. No longer were these injuries exclusively associated with semi-skilled blue-collar workers on production lines. Keyboard operators and clerical workers in traditionally 'safe' white-collar jobs began reporting these injuries in increasingly large numbers. As claims for compensation mounted and 'test cases' were decided in favour of complainants, insurance premiums skyrocketed. A notable feature of litigation proceedings was conflicting expert medical evidence.

In 1982 the National Health and Medical Research Council published an occupational health guide on RSI and this appears to be the first reference to the term. This was soon followed by guidelines advocated by the Australian Council of Trade Unions. Importantly, this document is critical of endeavours medically to screen individuals to determine susceptibility to RSI. It was noted that: 'the degree of success attained by medical treatment of the various types of repetition strain injury remains unimpressive and in some cases depressingly poor.' (Australian Council of Trade Unions, 1982, p1.)

In 1983 the Medical Journal of Australia published a paper that helped legitimise RSI as a medical condition (Stone, 1983). In the following year another paper suggested guidelines for the diagnosis and management of RSI (Brown, Nolan and Faithfull, 1984).

National concern resulted in the Australian Government establishing two independent enquiries into RSI. Both reported in July 1985 and recommended as the major preventive strategy substantial changes to the design of work.

Whereas earlier approaches to the prevention of RSI concentrated on biomechanical factors (eg posture, speed etc) the RSI Committee report makes the following important observation:

'…preventive strategies based solely on the biomechanical approach and in particular on a disease model have limitations. In Australia, some organisations have spent large sums of money on work-stations and equipment only to find that the problem remains. On the other hand, broader strategies which focus on the way systems of work are organised are more likely to succeed' (National Occupational Health and Safety Commission, 1985, p 15).

By 1986, RSI had been called 'Repetition Strain Injury', 'Retrospective Supplementary Income', 'Runaway Social Invention', 'Golden Wrist', 'Kangaroo Paw', occupational neurosis (Spillane and Deves, 1986). It had entered the workers' compensation arena to such a degree that in the March and June quarters of 1985 no Australian government employee who applied for compensation for RSI was refused.

What, then, is meant when an individual is said to have RSI?

The RSI debate produced four competing perspectives (Spillane and Deves, 1989).

1. Medical perspective. RSI is a medical condition that can be diagnosed since workers are physically injured. The inquiry is attributed to biomechanical factors, (such as inadequate work practices) which must be rectified to prevent further injury. Injured workers are subjected to a range of conservative (eg rest) and active (eg physiotherapy, surgery) treatments. This model was endorsed by the National Occupational Health and Safety Commission which was criticised extensively because it ignored the influence of psychosocial factors and gave RSI a medical legitimacy that was unwarranted because of the absence in the majority of cases of the necessary clinical signs.

2. Psychiatric perspective. RSI is not a physical condition but a psychiatric problem (occupational neurosis, conversion hysteria). Such psychogenic illnesses closely mimic physical illness and have been known to occur en masse in industrial settings. Attribution is independent of the physical work environment. Rather various psychosocial factors within and external to the work environment result in 'intra-psychic' conflict which manifests in this symbolic functional disorder. Consequently, workers require psychotherapeutic assistance to resolve their personal conflicts. This perspective was promoted by various psychiatrists, orthopaedic surgeons and rheumatologists who were employed by insurance companies to give evidence in legal proceedings. Clearly, to be of use to insurance companies, experts had to argue not only that the complaint is a neurosis but also that it is not occupational in origin for otherwise it might be compensable. This is exactly what they did argue (Lucire, 1986; 1988).

3. Malingering perspective. RSI is neither a medical nor a psychiatric condition, but malingering. It is a phenomenon based on bad faith-faking illness and thus cheating society. RSI is therefore a hoax consciously used (though not invented) by workers to gain concession (compensation payments, sick days etc).This perspective caused a public furore because it simultaneously impugned both the motives of workers and the diagnostic skills of the medical profession. Be that as it may, it is not unknown for people to feign illness to achieve personal ends (Anon, 1985).

4. Pain-Patient perspective. RSI can be characterised as a social movement built upon a changing set of behaviours toward the experience of pain at work. People who are in essence healthy but experience pain choose and are encouraged to become patients with pain. By capturing the fears, traditions and prejudices of Australian industrial life, the movement built upon RSI re-defined self form a state of health to one of illness. Leigh Deves and I defended this perspective (Spillane and Deves, 1987) which was labelled social constructionist and criticised because 'the intervention of the social constructionists has tended to support the insurance companies in their efforts to blame the victim'(Hopkins, 1989, p 250) and 'their analysis lends considerable support to the interests of employers and insurers attempting to deny the existence of a physical injury and also avoid the payment of workers' compensation.'(Quinlan and Bohle, 1991, p 217) Such comments were made as part of a discussion of the politics of RSI: issues of the validity of our analysis were of secondary importance.

Whilst these models cannot be reconciled, because they differ on fundamental assumptions about the causes of RSI, the one theme that links the models is that of pain - its presence and behavioural manifestations. The reporting of pain is, as Szasz reminds us, intimately bound up with patienthood, the analysis of which cannot be ignored in this debate (Szasz, 1988).

RSI AS A PAIN-PATIENT PHENOMENON:A SZASZIAN ANALYSIS

The accepted medical criteria for diagnosing illness are signs (eg demonstrable physicochemical alterations of the body), with or without symptoms (eg experiences of pain).

The notion of RSI derives its main support from known medical conditions, such as tenosynovitis or carpal tunnel syndrome with which it is often erroneously equated. A condition such as tenosynovitis can be diagnosed by its objective signs (for example, inflammation) and symptoms (for example, pain). However, in the majority of cases of RSI (perhaps in as many as 90% according to some medical experts) (Lowy, 1985; Owen, 1985), diagnosis is made on the basis of symptoms alone (that is on the basis of a communication or complaint).

The idea of RSI is thus firmly rooted in the notion of complaint, unlike established diseases (for example, carpal tunnel syndrome) which are based on independent signs. A sore arm is a complaint, 'it' might be a lie. Symptoms without signs are communications not diseases, complaints not 'conditions' until proven otherwise.

It is obvious that we are dealing here with a pain phenomenon. It should be equally obvious that one individual cannot experience another's pain. Pain cannot be observed directly, although it is often inferred from an individual's communications: the experience of pain is private and the expression of pain is public. Therefore, when people say they have pain we may believe them because they appear to us to be distressed. However, we may on occasions believe that the person does not have 'pain' but is merely pretending to have pain for some unstated end. The point is that we can only guess. Conversely, when someone experiences pain they may communicate it, complain about it or conceal it.

Those who complain of pain generally define themselves or are defined by others as patients. Thus, one can have pain but not choose to be a patient. However, should there be incentive (psychosocial, economic) to become a patient, it is understandable that large numbers of people with pain will choose to become patients with pain. This, we believe, is a plausible account for the dramatic increase in RSI-related workers' compensation cases reported in Australia in the 1980s.

Some people who are diagnosed by medical practitioners, psychiatrists or others as sick patients, do not in fact suffer from an illness and do not want to be patients. There are serious psychosocial consequences when people with discomfort in the arm are told that they may have a crippling disease which demands urgent medical treatment and cessation of physical activities. Both disease and patient role are thereby applied to an inexorable human condition called pain. Furthermore, turning people into patients exposes individuals to a medical/legal game that few understand or escape from happily. If they are not labelled as medical patients they risk being labelled as psychiatric patients or malingerers. A humane approach to this problem is difficult when one party claims the other made him or her sick and the latter retaliates with company doctors, lawyers and accusations of malingering.

To be human is to face a world of problems with preferences. One of the strongest human preferences is the avoidance of pain. Yet pain is inexorable and the causes of much chronic pain remain largely a mystery. When working people suggest possible causes of their pain their views should be considered seriously and constructive action taken. However, when people with pain believe their views are not considered, and where no workplace changes are forthcoming, they are likely to communicate their dissatisfaction in various ways, for example, by resigning, striking, becoming patients, malingering. Where the social climate encourages striking, some individuals are easily induced to strike. Where the climate encourages the medicalisation of work behaviour, some individuals are easily induced to become patients. Thus, morals are confused with medicine, values with valium, behaviour with bodies.

RSI was a social movement and not a medical epidemic. It was characterised by a significant increase in the number of people with pain who chose to become patients.

The following table summarises the argument.

1 Signs are present(+), symptoms are present(+), the person is a patient(+). An example is: Patient with illness

2 Signs are present(+), symptoms are present(+), the person is not a patient(-). An example is: Non-patient with illness

3 Signs are present(+), no symptoms are present(-), the person is a patient(+). An example is: Patient with symptomless illness

4 Signs are present(+), no symptoms are present(-), the person is not a patient(-). An example is: Non-patient with symptomless illness

5 No signs are present(-), symptoms are present(+), the person is a patient(+). An example is: Patient with symptoms (of pain)

6 No signs are present(-), symptoms are present(+), the person is not a patient(-). An example is: Non-patient with symptoms (of pain)

7 No signs are present(-), no symptoms are present(-), the person is a patient(+). An example is: Malingerer

8 No signs are present(-), no symptoms are present(-), the person is not a patient(-). An example is: Healthy

It is not possible, given the subjective nature of symptoms, empirically to allocate people to these categories. Thus, whilst the majority of 'RSI sufferers' appear to be in category 5, the attitude is nevertheless maintained that they should be treated as if they are sick patients (ie no 1) or malingerers (no. 7). Whilst categories 1 and 5 can be determined empirically by the presence of signs, we are simply not in a position objectively to allocate people to categories 5 and 7. The actual rate of malingering can never be known.

THERAPEUTIC PATERNALISM

Throughout the twentieth century, Australian researchers noted the widespread distribution of pain, discomfort and functional disorders of a transient nature. Amelioration of these problems was relatively straightforward and rarely required medical intervention. Despite the prevalence of these industrial complaints there were few examples of large numbers of individuals entering the medical system for protracted periods or seeking claims as compensation for 'damage'. Workers who were experiencing pain directed their energies to overcoming their symptoms and their assumed causes. They were neither inclined nor encouraged to adopt the helpless and dependent role of patient. And neither did they seek to use their personal experience of pain in a political arena, despite the availability of this line of redress, either because their problems were dealt with locally or because they risked penalties for complaining.

In the 1980s, this historical pattern adopted in the 1980s changed from consultation and cooperation to confrontation and stand-offs. All parties invoked the advice of medical and legal authorities to justify an adversarial stance.

In the absence of clinical signs to substantiate the diagnosis of somatic disease workers were accused of malingering or were labelled mentally ill. Having had their motives impugned and personal experiences invalidated, workers (and their trade unions) retaliated through medical certification. RSI complainants were thus judged to be ill and were removed from the workplace for indefinite periods.

Armed with certification, Australian workers have medically sanctioned access to a compensation system that does little to encourage recovery and penalises people who actively seek to regain health. Personal activity is discouraged because insurance companies, facing large payouts, employed private investigators whose evidence, admissible in industrial courts, could prove embarrassing to plaintiffs. Faced with the prospect of jeopardising their claim, workers were inclined to adopt the patient role and assume a state of dependency, thus leading to iatrogenic consequences (depression, anxiety). These secondary conditions required further medical/psychiatric intervention. Hence dependency was required and promoted through medico/legal intervention and this probably accounts for the persistence of symptoms beyond reasonable expectations.

RSI is not and never has been medically recognised for clinical purposes. The term is a residue constructed from differential diagnostic practice. It was invented by occupational health physicians in the early 1980s for convenience and was never intended for use in proceedings allied to, or arising from, litigation. It gained legitimacy upon usage in government reports and more particularly during investigations conducted by government authorities.

That 'RSI' escaped from this limited context to gain widespread acceptance in medico-legal proceedings is the result of injudicious medical (and psychiatric) practices. Consequently RSI was routinely referred to as a 'crippling disease of epidemic proportions' and management's efforts to substitute malingering or mental illness served only to stiffen trade unionists' resolve to combat this 'disease'. Subsequent government reports further institutionalised RSI by issuing codes of practice and dicta that failed to take account of psychosocial factors even though researchers had emphasised their importance (Spillane and Deves, 1988).Worse still, the guidelines offered by the National Occupational Health and Safety Commission, though ostensibly aimed at constructive work reform, resulted in establishing coercive work routines, standardising work practices and scrutinising workers, in their own interests as it were. These guidelines are almost the complete antithesis of work reform strategies that emerged from occupational research during the twentieth century and which were based on the principle of responsible autonomy for all members of the workforce.

The real victims of the RSI phenomenon are both employers and employees. By failing to take constructive local action and by allowing important work issues to go unresolved and escalate into formal and industrial disputes leading ultimately to government intervention, both parties lost an important opportunity to work cooperatively towards the constructive reform of work conditions and practices.

The legally sanctioned use of the medical model in Australian working life has had unfortunate consequences. By medicalising conflicts in work relations, constructive work reform has given way to therapeutic paternalism which fosters the dependency of patienthood.

To paraphrase Thomas Szasz (1983) who wrote in a similar vein about mental illness, the notion of RSI has outlived whatever usefulness it may have had and it now functions as a convenient myth. It is, of course, the function of myths to act as social tranquillisers. The concept of RSI served mainly to obscure the fact that work environments contribute to life's pleasures and pains. Repetitive work, like any form of stimulation, may contribute to the private experience of pain. Its public expression, in the absence of demonstrable signs represents psychosocial communications about personal preferences and problems. Our adversary is not a medical epidemic or psychiatric disorder. It is the dogmatism of those who, for whatever purpose, want to reduce human problems to medical theology and thereby rob individuals of their autonomy and dignity.

REFERENCES

Anon, (1985) 'Chronic Fake Patients Cause Real Pain to Casualty Wards', The Australian (8 December).

Australian Council of Trade Unions, Occupational Health and Safety Unit, (1982) 'Guidelines for the Prevention of Repetitive Strain Injuries (RSI)', Health and Safety Bulletin, 18.

Baritz, L. (1960) The Servants of Power: A History of the Use of Social Science in American Industry, NY: Wiley.

Bennett, M. and Hely, K. (1982) 'Stress as an Occupational Health Hazard', In J. Sheppard (ed) Advances in Behavioural Medicine, Vol 2, Sydney: Cumberland College of Health Sciences, pp215?225.

Brown, C., Nolan, B. and Faithfull, D., (1984) 'Occupational Repetition Strain Injuries: Guidelines for Diagnosis and Management', Medical Journal of Australia, 140, 6, 329-332.

Deves, L. and Spillane, R. (1989) 'Occupational Health, Stress & Work Organisation in Australia,' International Journal of Health Services, 19, 2, 351-363.

Drucker, P. (1977) Management, London: Pan.

Hopkins, A., (1989) 'The Social Construction of Repetition Strain Injury', Australian and New Zealand Journal of Sociology, 25, 2, 239-259.

Lowy, A., (1985) 'What is Repetition Strain Injury?', Submission to National Occupational Health and Safety Commission, Sydney.

Lucire, Y. (1986) 'RSI: When Emotions are Converted', Safety in Australia, (Feb).

Lucire, Y., (1986) "Neurosis in the Workplace', Medical Journal of Australia, 145, 323-327

Lucire, Y., (1988) 'Social Iatrogenesis of the Australian Disease 'RSI', Community Health Studies, 12, 2, 146-150.

Marks, F. (1983) Workers' Compensation Law and Practice in New South Wales, Sydney: CCH.

National Health and Medical Research Council, (1982) Occupational Health Guide:Repetitive Strain Injuries, Canberra: Department of Health.

National Occupational Health and Safety Commission, (1985) Interim Report of the RSI Committee, Canberra: Australian Government Printing Service; (1986) Repetition Strain Injury:A Report and Model Code of Practice, Canberra: AGPS.

Owen, E., (1985) 'Instrumental Musicians and RSI, Journal of Occupational Health and Safety, Australia and New Zealand, 1, 2, 135-139.

Quinlan, M. and Bohle, P., (1991) Managing Occupational Health Safety in Australia, Melbourne: Macmillan.

Spillane, R. (1984) 'Psychological aspects of Occupational Stress & Workers' Compensation', Journal of Industrial Relations, 26, 4, 496-503.

Spillane, R. and Deves, L., (1986) 'RSI: Medical Mythology?' In M. Wallace (ed.) Occupational Pain (RSI) Melbourne: Brain Behaviour Research Institute. La Trobe University, 5-8.

Spillane, R. and Deves, L., (1987) 'RSI: Fact or Fiction? In J. Sheppard (ed.) Advances in Behavioural Medicine, Vol. 4 Lidcome, N.S.W.: Cumberland College of Health Sciences, 217-228.

Spillane, R. and Deves, L., (1987) 'RSI: Pain, Pretence, Patienthood', Journal of Industrial Relations, 29, 1, 41-48.

Spillane, R. and Deves, L., (1988) 'Psychosocial Correlates of RSI Reporting', Journal of Occupational Health and Safety - Australia and New Zealand, 4, 1, 21-27.

Spillane, R. (1994) 'Personality or Performance? The Case Against Personality Testing in Management.' In A.R. Nankervis & R.L. Compton (eds) Strategic Human Resource Management, Melbourne: Nelson, Ch 14.

Stone, W., (1983) 'Repetitive Strain Injuries', Medical Journal of Australia, 2, 12, 10-24, 616-618.

Szasz, T. (1974) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, (Revised edition) NY: Harper and Row.

Szasz, T., (1983) Ideology and Insanity: Essays on the Psychiatric A Dehumanisation of Man, N.Y: Marion Boyers.

Szasz, T.(1984) The Therapeutic State: Psychiatry in the Mirror of Current Events, NY: Prometheus.

Szasz, T., (1988) Pain and Pleasure: A Study of Bodily Feelings, (Revised ed.) Syracuse: Syracuse University Press.

Weindling, P. (ed) (1985) The Social History of Occupational Health, London: Groom Helm.

Professor Robert Spillane, Graduate School of Management, MACQUARIE UNIVERSITY, North RydeNSW2109, AUSTRALIA Phone: 612 9850 8995 Fax: 612 9850 9019 Email: rspillan@laurel.ocs.mq.edu.au

Copyright 2000, Robert Spillane.