Abstract
Introduction
Karen Messing begins her latest book with the stories that must be told. The accounts that she shares in Bent Out of Shape loosen the wheels for everyone to tell as well—and to break their silence. Secrets keep the systems rolling, bodies hurting, and psyches broken along with its path.
Karen Messing's voice matters. She has been a critical contributor and feminist lens, globally, on the plight of women performing at work, in nontraditional as well as traditional jobs, and a guidepost for the engagement of workers’ voices and knowledge in occupational health research and intervention. New Solutions readers may be familiar with her prior ground-breaking works about why research conclusions based on male workers don't apply to women, 1 why scientists must talk to and learn from workers when conducting occupational health research, 2 and the urgency to unpack the myths of “safe” and “light” women's work through ergonomic analyses. 3
In this remarkably personal and important book, Messing gleans stories from a 17 year-long collaboration between research scientists, legal scholars, and the members of Canadian trade union women's committees. She brings us back to a time when the male gaze was unrelenting and ubiquitous, where men were entitled to comment, judge, and assess any aspect of women's bodies, brains, and potential, especially at work. Although presenting a number of carefully detailed examples, Messing reflects on the gendered manipulations, humiliations, trickery, groping, and assaults that are institutionalized in so many low-wage or traditionally male workplaces. Shame excels at its primary goal: to maintain power relations and to sustain the status quo. Each generation has its own sickening version of these abuses and Messing shares hers. The mortar for the tiles of shame is laid early, reinforced everywhere, and residue remains despite a lifetime of intentionally routing it out and scraping it off with force.
We know that poorly designed jobs often lead to injury and illness, and that such design can be physical, psychosocial, or economic. Shame about work-related injuries and illnesses—and the resultant silence—is only possible when workers are blamed, afraid of job loss if they leave or are fired, or fear retaliation and humiliation if they stay. The silence is compounded when complaints feed the external myths about women's inability to perform the work as assigned, often work that shouldn't have been designed that way for ANY human. Internalized beliefs that women's bodies are “different, abnormal, weaker” contribute to such silence. Although acknowledging the grave injustices men face in unsafe workplaces, Messing reminds us “it is most often women (and gender non-conforming men) who experience a forced choice between gender equality and their health” 4 (p. xvii). And why does Messing describe only cisgender women in this book? Messing clarifies in her introduction that “… in the unionized, low-paid workplaces (where her research was conducted), trans and non-binary women have not been visible.” Given the documented harassment and discrimination of gender nonconforming workers, it is reasonable to hypothesize that a nonbinary or transidentity in similar work environments would add layers of additional risk in terms of psychosocial hazards and misfitting job design.
The remedy to these ills? Solidarity, of course; but we learn it is easier said than done, with multilevel challenges, tensions between collective and individual needs, with varying levels of support and recognition from union leaders, employer representatives, research scientists, and government officials. Sometimes it works beautifully, in examples that Messing celebrates. Sometimes it doesn't work and Messing gets big points for her rare honesty.
Ladders, Tool Belts, Caregiving, and Dirty Toilets
Messing carries us through her narrative with the steady, honest perspective of workers who perform that work. In Part I—Shame in the Workplace we uncover the context behind the higher injury incident rate of women in nontraditional jobs. The poor design of tools, equipment, and tasks and other ergonomic factors is crystal clear, as is the lack of training and lack of solidarity. Women entering these jobs arrive in a design environment built for men's anthropometry and needs. These risk factors are exacerbated, exponentially, by the intolerable psychosocial jungle of harassment, mistrust, threat of assault, and social exclusion; these risk factors are often invisible to (male) union leaders who could otherwise have wielded influence. Women get together to talk about it. Messing notes that it takes until the “3rd hour” of close conversations for women to stop blaming themselves. She notes that women are silent because having a “need” equals admitting that they are inferior, thus unable to perform. The silence hurts in three ways: physically, psychologically, and economically.
The chapter about personal support workers (PSWs, equivalent to Certified Nursing Assistants in the US) illustrated perfectly how gender assignments and perceptions are distorted for a physically demanding job where everyone has a high risk of injury. Shame and denial are on full display when women understate their unsustainable workloads and when they are silent as observational results are presented. Men were assumed to be burdened with the majority of heavy work due to gendered task delegation, but the results—wholly contrary to myth—were of no interest to union leaders. Positive change occurred when gender was not mentioned, and the solutions were administratively executed.
Messing asks: “What does this tell us about biological difference? Are male–female differences in physical strength and the extra pain women suffer important enough that we should go back to explicitly gender-segregated job titles?” 4 (p. 30). This reviewer thinks that jobs that are too physically demanding for women also injure men, and that the gendered dynamic prevents everyone from reporting, complaining or advocating for change. Similar conflicts brew in many hazardous workplaces while the deep root cause—work that is too hazardous for humans, period—remains obscured.
Hospital cleaners at the bottom of the food chain are also segregated by gender. Messing's study of “Light work” (women cleaners) “versus the often higher-paid ‘heavy work’ (male janitors/custodians).” Researchers observed that the physical challenges of so-called “light workers” were underestimated with excessive bending, stooping, reaching, and other musculoskeletal risk factors. Pay equity can equalize salaries but concentrate musculoskeletal task demands. In this interesting example, merging of gender roles of hospital cleaning work resulted in a departure of older women, worsening working conditions for the younger women, and troubling injury rates. Management didn't notice that women were being injured more often, older women lost their gendered but secure landing spot in hospital employment, and women remained silent about their pain, concerned that their ability to perform the (poorly designed) job would reflect poorly on them.
How do you balance the fundamental equity goal of desegregating tasks by gender within a job title, and the observations from several disparate workplaces that these changes might be shifting risk and harming women's health? A range of studies concluded that female wait staff walk much more, are assigned more extra tasks and are tipped less than male counterparts with same job titles. Women cleaners bend, crouch, and reach more. Women's work is faster and more repetitive; static standing jobs are more prolonged. These imbalances occur in allegedly desegregated jobs. And women report more musculoskeletal injuries. The reasons are complex, but the repercussions result in sustained taboos that protect sex-segregated work, fed by an underlying belief in a biological basis.
The Biological Is Personal and Political
Messing maps the efforts of feminist researchers who are grappling with the tension between job segregation as potentially protective of women and also an equity setback, and with arguments for “sameness,” which chooses not to highlight biological differences but to bury them. “Sameness” inadvertently places women in traditionally male-designed jobs with documented health effects (injury, illness). Arguments for “difference” are “… conditioned by data on biological vulnerability, proposing that men and women should be assigned to jobs and tasks suited to their sex-specific strengths.” 4 (p. 64) Messing, trained as a biologist, is compelled to examine the biological mechanisms, anchored within an astute social content.
The question remains, for this reviewer, if the biological differences don't matter as much as the chasm between safe and unsafe work. “Sameness” helps no one when women are inserted in job tasks that are inherently unsafe for the majority of people regardless of gender identity or assigned sex at birth. Unsafe “men's” jobs—whose physical requirements exceed human limits—just happen to break women's bodies, first, and other bodies later.
Women may be the sentinels for unsafe work; their condition is worsened by the inadequate design of tools and equipment, sheer lifting requirements, anthropomorphic differences, overt and covert mistreatment, psychosocial risk factors, and scheduling nightmares, all exacerbated by the double duty of domestic work and familial caregiving. Men break too, just later, as evidenced by the widespread masking of pain so as to continue working. This often results in dependence on opioids and alcohol among other substances. High-hazard male-dominated trades (with construction and extraction industries at the lead) have the highest opioid-related death rate among working people. 5
Looking at Dragons, Feminist Interventions in the Workplace and in Science
The reader delights in Messing's personal narrative of her migration from fungal genetics to the cofounding of a prominent and multidisciplinary occupational and environmental health research center. Her leadership resulted in the mentoring of students to embody the intersection of biology, psychology, and social forces in their work. Their Institute's work demonstrates how a collaboration between ergonomists, legal experts, biomedical researchers, feminist union committees, and nonprofits can translate research into positive policy and practice, and real changes in people's lives. We are also disheartened by the frequent remnants of an old boys’ club in the natural sciences, which can be seen in “ignorance and obfuscation” when addressing women's occupational health, especially where women have been “excluded from study or badly studied” 4 (p. 152).
This Is What Solidarity Looks Like
Messing names the powerful forces that prevent women from bonding together to address these workplace injustices. Sometimes the people most hurt and affected by the adverse circumstances don't feel safe enough to make waves. Sometimes the intentions are thwarted when people with power don't use that power for change. Messing reminds researchers and do-gooders to deploy great care when assuming feminist solidarity where it may not exist, or when initiating interventions that fail to consider the difficult trade-offs that workers often make.
Success stories are peppered throughout the second half of the book reflecting thoughtful planning, pivoting, active listening, and a buffet of facilitation skills from the research team. Case studies from France, Quebec, Chile, and elsewhere provide proof of concept. When an employer of women's shelter workers cares deeply about the well-being of workers, recommendations are implemented. Messing reminds us that how we collect information from workers about their working conditions is central to the research and the role of interdisciplinary teams.
Solutions are possible when solidarity is nourished, and even small gains are celebrated. Messing writes, “We have not been able to kill the dragon, but we have become aware of its enormous size and put a little water on the flames from its mouth” 4 (p. 124). Messing names the paradoxes of this work without fear and reminds the reader that facing down the dragon and overcoming shame are foundational realities in this work.
All efforts to build solidarity between workers must name, and not permit, divisive management practices. These efforts should undermine the creation of unrealistic jobs with onerous musculoskeletal demands. The research, itself, must create safe spaces where the worker experiences and truths can come out, even if it takes three hours. Solidarity creates the space to make this possible.
Pain and Technology
A poor overall understanding of musculoskeletal pain, in general, and women's pain, in specific, clouds progress on hazard recognition and injury compensation. Differences in work-related exposures, pain perception, access to care, diagnosis, and treatment strategies play into the equation. Messing demonstrates to us that men and women with the same job title have very different job content, and that work that looks “easy” often contains risk factors known to be associated with work-related musculoskeletal disorders. During data analysis, “adjusting” for gender may obscure the disparate biological or other mechanisms behind the differences. Diagnostics and treatment frameworks within medicine were built on a “default male” model, where results from male mice, male subjects and male biological responses to treatment are applied to everyone 6 with disastrous consequences for women's occupational health recognition. Messing wraps up with a research agenda for working women that includes examining variables beyond size, shape, agility, and strength and including considerations such as cold tolerance, urinary function, work breaks, schedule design, and integration of women into male-dominated/gender-segregated jobs. The mechanisms behind the differences are critical to understand, Messing argues, with the intent of driving work design that can accommodate all people.
Conclusion
In sum, Bent Out of Shape is compelling, engaging, upsetting, and hopeful. Solidarity requires building upon existing groups (e.g., union women's committees) and supporting the organizing of groups focused on fighting gender inequality. Solidarity requires effort, insight, patience, taking risks, and uniting across lines often not crossed. Messing ends the book with a call “… stop being ashamed of our bodies and our conditioning, and fight for equality and health. Come join us” 4 (p. 206).
This book would illuminate any women's or gender studies curricula interested in biology, legal action, the role of occupation in shaping lives, class studies, environmental health, the labor movement, and organizing for equity and social change.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
