Experience Seamless Full Ebook Downloads for Every Genre at textbookfull.

com

The Positive Side of Occupational Health

Psychology 1st Edition Marit Christensen

https://textbookfull.com/product/the-positive-side-of-
occupational-health-psychology-1st-edition-marit-
christensen/

OR CLICK BUTTON

DOWNLOAD NOW

Explore and download more ebook at https://textbookfull.com

 Recommended digital products (PDF, EPUB, MOBI) that
you can download immediately if you are interested.

The Wiley Blackwell Handbook of the Psychology of

Occupational Safety and Workplace Health 1st Edition
Sharon Clarke
https://textbookfull.com/product/the-wiley-blackwell-handbook-of-the-
psychology-of-occupational-safety-and-workplace-health-1st-edition-
sharon-clarke/
textboxfull.com

Positive Psychology The Basics 1st Edition Hart

https://textbookfull.com/product/positive-psychology-the-basics-1st-
edition-hart/

textboxfull.com

The Wiley Handbook of Positive Clinical Psychology 1st

Edition Alex M. Wood

https://textbookfull.com/product/the-wiley-handbook-of-positive-
clinical-psychology-1st-edition-alex-m-wood/

textboxfull.com

Measures of Positive Psychology Development and Validation

1st Edition Kamlesh Singh

https://textbookfull.com/product/measures-of-positive-psychology-
development-and-validation-1st-edition-kamlesh-singh/

textboxfull.com
Positive Psychology: The Science of Happiness and
Flourishing 3rd Edition William C. Compton

https://textbookfull.com/product/positive-psychology-the-science-of-
happiness-and-flourishing-3rd-edition-william-c-compton/

textboxfull.com

Positive Psychology The Science of Wellbeing and Human

Strengths 3rd Edition Alan Carr

https://textbookfull.com/product/positive-psychology-the-science-of-
wellbeing-and-human-strengths-3rd-edition-alan-carr/

textboxfull.com

Virtual Reality and Virtual Environments: A Tool for

Improving Occupational Safety and Health (Occupational
Safety, Health, and Ergonomics) 1st Edition Grabowski
https://textbookfull.com/product/virtual-reality-and-virtual-
environments-a-tool-for-improving-occupational-safety-and-health-
occupational-safety-health-and-ergonomics-1st-edition-grabowski/
textboxfull.com

Positive Balance A Theory of Well Being and Positive

Mental Health M. Joseph Sirgy

https://textbookfull.com/product/positive-balance-a-theory-of-well-
being-and-positive-mental-health-m-joseph-sirgy/

textboxfull.com

Creek s Occupational Therapy and Mental Health

Occupational Therapy Essentials Sixth Edition Wendy Bryant

https://textbookfull.com/product/creek-s-occupational-therapy-and-
mental-health-occupational-therapy-essentials-sixth-edition-wendy-
bryant/
textboxfull.com
Marit Christensen
Per Øystein Saksvik
Maria Karanika-Murray Editors

The Positive Side

of Occupational
Health Psychology
The Positive Side of Occupational Health
Psychology
Marit Christensen Per Øystein Saksvik
•

Maria Karanika-Murray
Editors

The Positive Side

of Occupational Health
Psychology

123
Editors
Marit Christensen Maria Karanika-Murray
Department of Psychology Department of Psychology
NTNU Nottingham Trent University
Trondheim Nottingham
Norway UK

Per Øystein Saksvik

Department of Psychology
NTNU
Trondheim
Norway

ISBN 978-3-319-66780-5 ISBN 978-3-319-66781-2 (eBook)

https://doi.org/10.1007/978-3-319-66781-2

Library of Congress Control Number: 2017954466

This is translated into the English language, enhanced and heavily revised from the Norwegian
Arbeidshelsepsykologi på norsk, published by Fagbokforlaget in 2015, Authors: Per Øystein Saksvik &
Marit Christensen. This translation has been published with the financial support of NORLA.

© Springer International Publishing AG 2017

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained herein or
for any errors or omissions that may have been made. The publisher remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword

The aim of this book is to present the positive side of occupational health psy-
chology. Research within the field of occupational health psychology has
traditionally focused on investigating risk factors like job demands and stressors in
the workplace and the resulting health impairment process. However, it is difficult
to understand the dynamics behind the factors promoting well-being, health and
meaning through studies of illness, dissatisfaction and suffering. A positive focus
provides new and interesting approaches to challenges and opportunities in today’s
work life. Positive occupational health psychology has been influenced by positive
psychology, positive organizational behaviour and positive occupational
scholarship, which contribute to complement occupational health psychology. The
positive occupational health movement promotes an integrated and comprehensive
approach that we are discussing in several of the chapters in this book. This requires
a perspective where we understand and promote positive factors at work, while
continuing to investigate risk factors and occupational ill health (Bakker & Derks,
2010).
The world of work is continuously changing, and change is often described as
the only stable factor in organizations. This imposes high demands on employees
not only in the form of high workload and time pressure but also in the form of
more psychological demands as to how to cope with the social and technical
innovations. In times of insecurity regarding professional future and the growth
of the global economy, the importance of occupational health issues becomes even
more significant. Organizations are also increasingly more aware of how the
quantity and quality of employee contributions are essential business matters.
Modern organizations have therefore begun to have more focus on how to manage
human capital rather than an emphasis on control and cost reduction. Positive
occupational health psychology has a lot to offer regarding well-being and health of
employees, and a focus on obtaining and promoting job resources can also ensure
sustainable performance and productivity.
Most of the authors of this book have a background in the Scandinavian context,
where they have conducted most of their research. The history of occupational
health psychology highlights a key role for the Nordic countries (mainly Norway,

v
vi Foreword

Finland, Sweden, Denmark and Iceland), with pioneering research on the alienation
of work and the dangers of Taylorism and a broader concern for the impact of work
on health and alternative ways of work organization. This can be traced back to the
Nordic model of work organization (Gustavsen, 2011; Hasle & Sorensen, 2013),
which emerged in the 1930s and
“was based on the idea of reducing conflicts in working life though pooling the measures
available to, respectively, the employers, the unions and the government resulting in
substantial packages covering a broad range of measures and institutions. With less con-
flicts productivity would increase, making room for wage increases, reduction in working
time, and welfare programs” (Gustavsen, 2011, pp. 466).

We would like to use the foreword to discuss positive occupational health

psychology in relation to the Nordic model and to argue that it might add some new
insights in addition to what we already know. We seek to demonstrate how work
and health and the discipline of occupational health psychology can be understood
from the more positive and collectively oriented Nordic perspective, with the aim of
promoting good work and yielding healthy, stimulating and productive work
environments.
Although the Nordic model and Taylorism have shared the same aim of maxi-
mizing productivity at work and rebuilding collapsed post-war economies, the two
traditions were in stark contrast in terms of the process by which this could happen.
The Nordic model has, at its core, “a cooperation between organized labour market
parties, and between these parties on the one hand and the state/the public on the
other” (Gustavsen, 2011, p. 464) and defines the elements of good work such as
autonomy, variety, learning and participation in decisions. Taylorism, on the other
hand, advocated specialization and rationalization of work. Alternatives have
emerged, including the human relations movement, the quality of working life
movement and the lean enterprise movement (Gustavsen, 2011), resulting in a
substantial number of research and national initiatives that have played a crucial
role in setting a course or direction in work organization. Distinguished figures have
emerged, most notably from Norway (e.g., the work of Lysgård in the 1960s;
Thorsrud and Emery in the 1970s; and Ursin in 1970s; see also Emery and
Thorsrud (1976); Thorsrud & Emery, 1970) and Sweden (e.g., the work of Theorell,
Gardell and Levi separately in the 1970s), whereas in Finland the first occupational
health psychologist was appointed at Kymmene paper mill in 1974, and in Sweden
we had the first scientific studies of ‘alienation’ of workers, monotony and par-
ticipation (by Gardell in the 1970s).1 This tradition is also reflected in the European
social model which combines the aims of economic growth with the aims of good
working conditions and living standards, and the 1989 European Framework
Directive (89/391/EEC, https://osha.europa.eu/el/legislation/directives/the-osh-
framework-directive/1) which was transposed into national law by 1992 by
European Member States. A number of cultural, social and economic characteristics

1
For a broader overview of the history of occupational health psychology, please see Schonfeld
and Chang (2017), Occupational Health Psychology: Work, Stress, and Health. Springer.
Foreword vii

have been linked to the Nordic model, underlined by a belief that individuals have
the ability to take control of their own future (social constructivism; Gustavsen,
2011). With variations within the Nordic countries group, these contextual char-
acteristics have been institutionalized as shared attitudes towards work, the
responsibility of organizations towards employees and the focus on worker health
and productivity. The benefits are tangible: “So far, this has placed he Nordic
countries in the lead in making the idea of good notion come real. In fact, in
practically all types of international comparisons—ranging from economy to health
and well-being—the Nordic countries come out with high scores, and if a broad
range of such studies are combined, they come out on top as a group of their own”
(Gustavsen, 2011, p. 479). Correspondingly, research also reflects a widespread
agreement on good work and essential principles such as autonomy, variety,
ownership and participation, learning and positive work relationships.
The question then becomes whether and how we could implement these prin-
ciples outside of the unique context from which they emerged. At the broader level,
this tradition has counterparts in, but has not necessarily directly influenced, a range
of practical mechanisms and tools. Examples are the tripartite model of social
dialogue, social innovation and more specifically, workplace innovation and local
examples of organizations explicitly built on the principles of employee partici-
pation and workplace democracy. Notable examples are Semco in Brazil, Sekem in
Egypt, SMUD in the USA and Vaude in Germany (Bal & de Jong, 2016). Although
the Nordic countries are leading on new work organization (e.g. shorter work week,
participation), it is possible for organizations and perhaps other countries to apply
elements of the Nordic model of work organization without going through the same
process of social construction, as these example organizations demonstrate. This
book is inspired by the Nordic model and built on the positive, comprehensive and
collective perspective, which also underlies the movement of positive occupational
health psychology.
In conclusion, there is a growing movement among researchers and practitioners
in occupational health psychology to have more integrated and comprehensive
approach to workplace health. This approach aims to have a balance between
prevention of illness at work and promotion of well-being and health by
enhancement of strengths, resources and optimal functioning in the workplace. We
hope this book will contribute to build a bridge between knowledge and practice
because an evidence-based approach to positive occupational health could con-
tribute to psychologically healthy workplace practices that foster employees’ health
and well-being while enhancing organizational performance. This book offers some
lessons aimed for researchers, organizations, employees and HR-professionals and
seeks to show how work and health and the discipline of occupational health
psychology can be understood from the more positive and collectively oriented
perspective inspired by the Nordic model.
viii Foreword

References

Bakker, A.B., & Derks, D. (2010). Positive occupational health psychology’, In S. Leka &
J. Houdmont (Eds.) Occupational Health Psychology pp. 194–224. Oxford: Wiley-Blackwell.
Bal, P. M., & de Jong, S. B. (2016). From human resource management to human dignity
development: A dignity perspective on HRM and the role of workplace democracy. In M.
Kostera & M. Pirson (Eds.), Dignity and Organizations. Palgrave MacMillan.
Emery, F. E., & Thorsrud, E. (1976). Democracy at work. Leiden, Martinus Nijhoff Publishers.
Gustavsen, B. (2011). The Nordic model of work organization. Journal of the Knowledge
Economy, 2(4), 463–480.
Hasle, P., & Sørensen, O. H. (2013). Employees as individually and collectively acting
subjects-Key contributions from nordic working life research. Nordic Journal of Working Life
Studies, 3(3), 9–30.
Thorsrud, E., & Emery, F. E. (1970). Industrial democracy in Norway. Industrial Relations: A
Journal of Economy and Society, 9(2), 187–196.
Thorsrud, E. (1970). A strategy for research and social change in industry: A report on the
industrial democracy project in Norway. Information (International Social Science Council), 9
(5), 64–90. Chicago.
Acknowledgements

We are deeply grateful for the support and feedback from colleagues when writing
this book. Our special thanks go to Øystein Indergård and Karianne Kvalheim for
your invaluable feedback and contributions regarding proof reading. We would also
like to thank Edona Zilkiqi for working with the translation of the book. This
translation has been published with the financial support of NORLA.

ix
Contents

1 What Is the Meaning of the Concept of Work from an

Occupational Health Perspective? . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Per Øystein Saksvik
2 What Is Health from an Occupational Health Perspective? . . . . . . 9
Marit Christensen
3 Explanatory Models in Occupational Health Psychology . . . . . . . . 19
Per Øystein Saksvik
4 Facilitating a Meaningful Work Situation—A Double-Edged
Sword? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Thomas Christian Espenes and Fay Giæver
5 Authentic Leadership, Psychological Capital, and Employees’
Well-Being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Oyeniyi Samuel Olaniyan
6 Work, Family, and Leisure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Karoline Grødal
7 Work Engagement and Job Crafting . . . . . . . . . . . . . . . . . . . . . . . 79
Marit Christensen
8 Constructive Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Per Øystein Saksvik
9 Coworkership and Prolific Behaviors in Modern Work Life . . . . . 99
Martin Schrøder, Marit Christensen, Siw Tone Innstrand
and Anette Fjeld
10 Successful Aging at Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Karianne Kvalheim, Marit Christensen and Siw Tone Innstrand

xi
xii Contents

11 From Sickness Absenteeism to Presenteeism . . . . . . . . . . . . . . . . . . 125

Per Øystein Saksvik, Karoline Grødal and Maria Karanika-Murray
12 Healthy Change in Intervention Research and Reorganization . . . . 135
Per Øystein Saksvik and Maria Karanika-Murray
13 Healthy Individuals in Healthy Organizations: The Happy
Productive Worker Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Marit Christensen
Contributors

Marit Christensen Department of Psychology, Norwegian University of Science

and Technology (NTNU), Trondheim, Norway
Thomas Christian Espenes Department of Psychology, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
Anette Fjeld Department of Psychology, Norwegian University of Science and
Technology (NTNU), Trondheim, Norway
Fay Giæver Department of Psychology, Norwegian University of Science and
Technology (NTNU), Trondheim, Norway
Karoline Grødal Department of Public Health and Nursing, Faculty of Medicine
and Health Sciences, Norwegian University of Science and Technology,
Trondheim, Norway
Siw Tone Innstrand Department of Public Health and Nursing, Faculty of
Medicine and Health Sciences, Norwegian University of Science and Technology,
Trondheim, Norway
Maria Karanika-Murray Department of Psychology, Nottingham Trent
University, Nottingham, UK
Karianne Kvalheim Department of Psychology, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
Oyeniyi Samuel Olaniyan Norwegian School of Hotel Management, University
of Stavanger, Stavanger, Norway
Per Øystein Saksvik Department of Psychology, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
Martin Schrøder Department of Psychology, Norwegian University of Science
and Technology (NTNU), Trondheim, Norway

xiii
Chapter 1
What Is the Meaning of the Concept
of Work from an Occupational Health
Perspective?

Per Øystein Saksvik

To have an occupation has always been crucial for the survival of the human
species. This can be defined differently depending on which era we are talking
about. Before the industrial revolution, and in some societies, people thought of
work with disgust and contempt (Kildal, 2005). The ancient Greeks shared this view
and did not have much respect for what was then considered to be manual work.
This included the preparation of what was harvested from nature and was made
beneficial for humans. It was only through Adam Smith’s political–economical
writings in the 1700s that workers could disengage from preparing natural products
and instead could bring about wealth (Kildal, 2005). This, in turn, gave working a
new status, as something valuable and as an abstract quantity. The contrast with the
ancient Greeks, who viewed labor as near slavery, is striking. Working for our
survival, driven by our needs, was not something that distinguished us from the
animals, and therefore working was not considered important in a spiritual sense. It
was also seen as a disadvantage to be under the control of others, i.e., not to have
independence. In our part of the world, Christianity (in particular the various forms
of Protestant religion) has played an important part in the consideration of the value
of work. According to Christianity, our task on earth is to prepare ourselves for the
eternal afterlife, by fulfilling our duty on earth in a good and worthy manner and by
accomplishing the soul’s immortality. “By the sweat of your brow shall you earn
your bread” from the first book of Genesis is a motto for the Norwegian labor
movement. In this way, work becomes a duty, as something you have to do to earn
material wealth. Work is now a necessary tool for obtaining something else, and yet
it has no real value in itself. Throughout the middle ages, work had mostly negative
connotations. Priests and monks would perform tasks as punishment, to obtain
nourishment, and to avoid idleness. As Kildal (2005) puts it: “The word (read work)

P.Ø. Saksvik (&)

Department of Psychology, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
e-mail: [email protected]

© Springer International Publishing AG 2017 1

M. Christensen et al. (eds.), The Positive Side of Occupational Health Psychology,
https://doi.org/10.1007/978-3-319-66781-2_1
2 P.Ø. Saksvik

had originally a passive and negative content, and covered a large number of
conditions and activities.” According to the same author, humans didn’t think of
work as attractive and positive until the 1500s. Then, work was viewed as “humans’
purpose of engagement and activity” (Johansen, 1980, p. 396 in Kildal, 2005).
Work was still primarily considered as beneficial to God, not to man.
It was primarily through the writings of the father of capitalism, Adam Smith,
that work was elevated to a meaning in itself, and the economic self-interest of the
individual was given its power (Dahl, 2003). Marx supported working as a means
for self-actualization and was opposed to the idea of capitalism which stated that
work should be truly free and attractive (Kildal, 2005). A normal opinion in
Norway has been that work is synonymous with paid labor. This gives rise to
confusion since work is both an abstract category and a social reality that are mixed
together in “The white paper on welfare (Velferdsmeldingen) 94–95” (Heen, 2008).
There are many activities that are important to the individual, which are not, strictly
speaking work, in the sense of employment. Moreover, it is important that the
frameworks for employment are developed in today’s working conditions.
The function and role of work are in constant change, and this book aims to
understand how work defines itself today, and what changes we may see in the
future. As the book is based on the Norwegian workforce, the definition of work
will be based on where we are as a nation today, that is, what we define as the
postindustrial workforce. This concept includes a movement from a place where
working life has been dominated by an industrial logic toward something else
(Gershuny, 2003). What this “something else” entails, is not precise, but it can
involve knowledge, service, leisure, art, and culture, or a combination of these
themes that will distinguish our working life in the years to come. It is, for example,
only recently that we have seen Norwegian crime fiction becoming a commodity for
export, making the profession of author more lucrative and allowing multiple
authors to make a living even though only a few enjoy international success.
Even though the meaning of work in past years will become something else in
the society of the future, we cannot deny that working has a distinct function in our
society: to secure an income. The whole of western society is built upon the notion
that the individual has to contribute to the community through effort and taxes. Up
to 1949, a housewife’s added value was a part of the national budget in Norway.
This shows that the national income and an economical active population are
historically negotiated (Hagemann, 2007). In modern working life, wealth creation
will also have an extended role in terms of understanding what the value of work is.
Creating value has been given a long-term perspective. People, for example, tend to
invest in education and qualifications to get a “pay off” at a later time and to give
rise to new activities and products. The same applies to what is termed as green
values. Preserving the ecosystem is not achieved by having short-term profit, but
rather it happens by investing in future creations. Thus, future jobs will increasingly
be found within sectors which do not immediately create monetary values, but
rather are linked to long-term-based competence assets.
In the Norwegian and Nordic relations, we are known internationally for having
cooperation models amongst the parties in working life (Sørensen, Hasle, &
1 What Is the Meaning of the Concept of Work … 3

Hesselholt, 2012). This does not mean that a traditional model of work involving
employer and employee, with the function of a guiding state as a third part, will be
the dominant model for the future. Even though the number of self-employed people
is not high in Norway (less than 10% of the total work force), the country has a large
number of small companies operating in a state of turbulence (Karlsen & Lie, 2001).
These small businesses change more often than other businesses, and the future of
the workers is increasingly unpredictable. This book will discuss whether this is a
wanted or unwanted development from an occupational health perspective.
The idea that work has a greater function for the individual than merely securing
an income and ensuring survival, has been known for a long time. The classic study
of Jahoda between 1930 and 1950 concluded that work, in addition to its manifest
function, in terms of wages and benefits also has the latent function of providing
structure in life, social contact, status, and meaning (Newell & Newell, 2002). The
fact that work has a meaning beyond the creation of economic wealth was also an
important point for Thorsrud, one of the major working life research pioneers on
Norwegian working life (Emery & Thorsrud, 1976). He is especially known for
having included work in the democratization efforts in Norway after WW2. He
thought that working contributed to fulfilling a larger sum of needs, which included
meaning and the development of society. These needs were on an individual level,
but the idea was that they would contribute beyond the individual. Interestingly, in
this context, is not that work contributes to something beyond income and wealth
for the individual worker, but that these values are not only related to the economy,
but also to psychological values on an individual level and higher.
Today’s view of the concept of the value of work is, therefore, much more
differentiated. The thought that working gives life meaning becomes a natural
consequence of the historical precursors. From around the time of the new mil-
lennium, the meaning of work has assumed an important place in Danish working
life research (see for example Ravn, 2008). The concept becomes differentiated and
associated with individual, collective, and social meanings, but with the individual
as a point of departure. Seen from this perspective, this is not all that different from
the view of Thorsrud, only that “need” has switched places with “meaning.” The
idea that working in many ways changed identity and signification is important
when talking about occupational work psychology. Now, working plays a different
role, and the concept of work becomes more fluid. It is a fact that about 10% of the
inhabitants of Norway get a disability benefit, when, based on their age, they should
really be working. It is also true that some citizens retire before the age of retire-
ment. In spite of all the efforts put in place for people to work beyond their
retirement age, the value of not having a job has to be recognized. Many of those
without a job, still work voluntarily in organizations that are dependent on these
voluntary workers. Those taking early retirement could also be grandparents and
this could lessen the effects of the working-home conflict (see Chap. 6). The fact
that a great many people have relatively high education contributes to the changes
in working life. A number of people choose studies that do not necessarily end up in
a defined occupation or profession. Although many still end up in the established
workforce, they bring with them values and skills that can contribute to a better
4 P.Ø. Saksvik

understanding of the profession they eventually chose, and that will raise their own
and others’ self-awareness and sense of meaning. In an example from our field, the
M.Sc. in Organizational Psychology, it may be that the majority of those we
educate want everyday work with health, a good working environment, and safety.
However, in any future job, most people will benefit from the expertise acquired
from the courses we provide. In a project about temporary work, we found that a
consequence of an increasing number of temporary employees is that the standard
of occupational health and safety goes down (Eiken & Saksvik, 2009). If educa-
tional programs such as ours strengthen these qualifications, this will no longer be
an issue with temporary employment.
One of the best illustrations of the modern working world is Charles Chaplin’s
movie, “Modern Times” from 1937. In the movie, we follow a little man who is a
small part of a much bigger machine. The movie can be viewed as a critique of
Scientific Management, which still had an impact on industry. The message of the
movie is also valid in today’s modern workforce where achievement still is a key
concept. Sometimes, human labor is presented as something that is needed, but still
something that we could do without. The production line should not be so lean that
all unnecessarily slack is out of the question (Skorstad & Ramsdal, 2009). In their
book, Skorstad and Ramsdal (2009) implement a critical analysis of the notion that
lean production is the solution to problems and, at the same time, it gives the
workers more developing working tasks. They claim that it is rather the opposite,
and that the costs of these alterations are transferred to the employees who expe-
rience higher stress, bullying, and disempowerment. Nevertheless, a feature of the
development of automation and innovation at work can be a decrease or a change in
the number of people needed for jobs (Bain et al., 2007). This gives rise to fewer
routine-based tasks and decreased manual work, which entails a transition to a
highly skilled labor force, but also, maybe involuntarily as a consequence, that
work must be created in new areas to maintain employment. This also increases the
gap between rich and poor countries. In poorer countries, created wealth is still
associated with commodities and their processing, while in the richer parts of the
world there is more talk of expertise and increased technology. It is perhaps a
paradox that Norway is so dependent on natural recourses such as oil, and some
people claim that this limits the development of new employment in Norway.
These days we face a value debate on work. This concerns which values are
brought about by work, as well as what value working has for the individual. In
both areas, a lot is happening. Some years ago, only a few people thought there
could be a value in communications technology, like the Internet and cell phones.
Now, we see a great deal of occupations and wealth creation all around the world in
association with this technology, and the trend is moving increasingly faster. What
work is and what it means for the individual is also in rapid development. For
many, working is no longer just a restricted activity. Life becomes about working.
Naturally, this influences the consequences of the understanding of occupational
health. It is perhaps this major differentiation that becomes the most problematic. At
one end of the scale, we have those with marginal contact with working life: the
unemployed, the recipients of disability benefit, some of those in temporarily jobs,
1 What Is the Meaning of the Concept of Work … 5

and others who have difficulties with getting and keeping jobs (and in periods do
not want to work, who in Norway survive on the social security granted by the
state). Tanum interviewed unemployed subjects, who were considering working.
For several, it was not a given that they would choose an occupation. They could
live their lives without engaging in the workforce (Tanum, 2013). This phe-
nomenon is still new and has not yet been examined all that much, and the
long-term effects have not been researched. It could be that the need for social
contact and developing an identity is now filled by social media and that blogging
can be a form of creative expression that also gives meaning to people’s lives.
The other extreme in relation to work also requires further investigation. The
attitude can be illustrated with the concept of “Always present,” used as a slogan in
occupational groups, for example, real estate agents. This means that one is almost
never off work. You could get questions or be approached at all hours and in all
situations. A large number of occupational groups have the freedom to regulate
working hours and effort, such as musicians, artists, or professional athletes. Even
those relatively regulated occupations, like doctors, can have life involving working
situations. These occupations have what we call boundless careers (Bertelsen, 2011;
Sullivan & Arthur, 2006). Boundless refers to both psychological and physical
mobility, implying that it is difficult to categorize this kind of work as a threat or as
something that gives life value and content. Research done on doctors shows, for
example, that they experience circumstances that make them vulnerable to presen-
teeism (Løvseth & Saksvik, 2014; Thun, Fridner, Minucci, & Løvseth, 2014).
Presenteeism as a phenomenon will be discussed later on in this book (see Chap. 11).
This book is about the relationship between occupation and health, and when the
work has changed as much as it has, it should indicate that occupational health has
changed equally. Bain et al. (2007), after a thorough analysis of nine case studies,
concluded that: “Work today is the same mixture of satisfaction and unpleasantness
as it has always been, but the contemporary workplace is perhaps a more unstable
environment that we have been used to for some time (p. 1).” Based on these
researchers, what has changed in today’s working life is instability and uncertainty.
The implications of this are numerous, amongst others, the need to understand why
and how change happens. Furthermore, is it possible to initiate measures/
interventions that improve work and health, and generally, how can we develop
a greater sense of security in the workforce? However, this does not mean that
feeling secure is a basic premise for positive occupational health. Rather, that there
are some changes in relation to security in that today’s workers are more concerned
with competence—or what can be labeled professional security than security based
on a current position (Danielsen, Nordvik, & Saksvik, 2011).
This introduction to work has shown that work had diversity and variety. This
affects the picture of how work is today, and how it likely is to develop in the
future. This means that we cannot use the same set of norms for a cook employed at
a hotel as for a freelance journalist. This also implies different rules for marginal
workers, actively choosing to live on the state through social security, than for those
working in boundless careers by choice. Freedom, boundlessness, and diversity are
of course dependent on economical conjunctions and a functioning welfare state. In
6 P.Ø. Saksvik

our introductory book on occupational and organizational psychology, we wrote

that a future model for working life may be that when one ends education and until
the age of retirement one can receive a fixed salary, a citizen wage (Danielsen et al.,
2011). Those who, for different reasons are not capable of working, could poten-
tially live off these wages, while others could choose to work as much as they
would like (of course within some boundaries, defined by, for example, contract or
the government). The model is not that far from today’s reality, but has some
difficulties regarding politics and wealth variables. The model can lead to a larger
gap and greater inequality in society, but it addresses the issue of poverty. Some
might fear the possibility that not enough people will choose to remain employed,
and especially not chose what is considered hard and demanding work or low-status
work. The same debate is applicable to pension reforms. Our thinking in writing
this was that the future occupations all need to be upgraded in terms of becoming
more stimulating and motivating, and that easy routine job will become more
automated. The future will tell if this is about to become a reality. Throughout this
book, we frequently discuss the theme of the development of the concept of work.
Ideas on how work should be in the future, and how this is important for the
occupational health, have received a lot media attention from a Danish institution
(Max Planch Odense Center on the Biodemography on Aging) (http://www.sdu.dk/
en/om_sdu/institutter_centre/maxo). They claim that, in a week, 25 h should be the
optimal working hours and that we should not retire until the age of 80. The reason
given for that is that a shorter work day benefits all ages. For example, parents would
have more time with their children and would exercise more. From a preventable
perspective is it claimed that the elderly would have a job to go to (see also Chap. 10
). The debate about the length of the workday is not a new one. For example, there
exists an international movement that tries to implement a six-hour workday (http://
www.6hourday.org). This has not received huge support amongst the politicians in
Norway, but still there are examples from Norway of successes in this area (Kico &
Saksvik, 2015). These successes can also be found in Sweden http://www.
huffingtonpost.com/2014/06/05/sweden-working-hous_n_5446579.html), and the
debate is still going on in Norway. What is optimal from an occupational health
psychology perspective would be to reduce working hours for all throughout a career
and aim to prolong professional life. However, it is not occupational health that
governs these developments. Political constraints have a greater significance. We
will examine in detail some aspects of occupational health psychology that will
make us revise our views on work.

References

Bain, P. M., Baldry, C. J., Bunzel, D., Gall, G., Gilbert, K., Hyman, J. D., et al. (2007). The
meaning of work in the new economy. Future of work. Basingstoke, United Kingdom:
Palgrave.
Bertelsen, T. (2011). En grenseløs karriere?: En studie av enkelte arbeidstakeres karriereen-
dringer innen norske kunnskapsintensive sektorer [The boundaryless career?: A study of some
1 What Is the Meaning of the Concept of Work … 7

employees career changes in Norwegian expert-knowledge sectors] (Master Thesis). University

of Oslo, Oslo.
Dahl, T. (2003). Hvilken moral for dagens marked og miljø? [What kind of moral for to-days
market and environment]. In H. Brattebø (Ed.), Program for industral ecology. Report no:
3/2003.
Danielsen I. H, Nordvik, H., & Saksvik, P. Ø. (2011). Individuell karriere og lojalitet til bedriften
—motstridende interesser? [Individual career and loyalty to the enterprice—contradictory
interests?]. In P. Ø. Saksvik (Ed.), Arbeids- og organisasjonspsykologi [Work. And
Organizational Psychology]. Oslo: Cappelen Akademisk Forlag.
Eiken, T., & Saksvik, P. Ø. (2009). Temporary employment as a risk factor for occupational stress
and health. Policy and Practice in Health and Safety, 07, 75–93.
Emery, F. E., & Thorsrud, E. (1976). Democracy at work. Leiden: Martinus Nijhoff Publishers.
Gershuny J. I. (2003). Changing times: Work and leisure in postindustrial society. Oxford: Oxford
university press.
Hagemann, G. (2007). Reciprocity and redistribution: Work and welfare reconsidered. Edizioni
Plus: Pisa University Press.
Heen, H. (2008). Om bruken av begrepet arbeid [On the use of the concept work]. Sosiologi i dag,
38, 29–50.
Karlsen, J. E., & Lie, T. (2001). Et Nordisk grep på arbeidsmiljøregulering [A Nordic grip on
work environment regulation]? Nordic Council of Ministers.
Kico, E., & Saksvik. P. Ø. (2015). Derailed, but implemented. In M. Karanika-Murray & C. Biron
(Eds.), Derailed organizational stress and well-being interventions: Confessions of failure and
solutions for success. Netherlands: Springer Education.
Kildal, N. (2005). Fra arbeidsbegrepets historie: Aristoteles til Marx [From det history of the
work consept. Aristoteles to Marx]. Stein Rokkan senter for flerfaglige samfunnsstudier.
Bergen: Universitetsforskning Bergen. Notat 3.
Løvseth, L., & Saksvik, P. Ø. (2014). Prevalence, determinants and interventions to prevent
sickness presenteeism among physicians in Academic Medicine. Preliminary results based on
the HOUPE study and Nordic NOS-HS study. Paper presentation at the 11th EAOHP
Conference, London.
Newell, S., & Newell, S. (2002). Creating the healthy organization: Well-being, diversity and
ethics at work. Psychology at work. Cengage Learning EMEA: Boston.
Ravn, I. (2008). Mening i arbejdslivet – definition og konceptualisering [Meaning at work—
definition and conceptualization]. Tidsskrift for Arbejdsliv, 10(4), 59–75.
Skorstad E. J., & Ramsdal, H. (Eds.) (2009). Flexible organizations and the new working life: A
European perspective. Farnham: Ashgate.
Sullivan, S., & Arthur, M. B. (2006). The evolution of the boundaryless career concept: Examining
physical and psychological mobility. Journal of Vocational Behavior, 1(69), 19–29.
Sørensen, O. H., Hasle P., Hesselholt, R. R., & Herbøl. K. (2012). Nordiske Perspektiver på
Arbejdsmiljø - Mening, Indflydelse og samarbejde [Nordic work environment perspectives—
mening, control and cooperation]. NMR-rapport, Det Nationale Forskningscenter for
Arbejdsmiljø. Nordisk Ministerråds rapportserie.
Tanum, M. S. B. (2013). Arbeid? Ikke for enhver pris: En narrativ studie av arbeidslediges
hverdag [Employment? Not for any cost: A narrative study of the ordinary day of unemployed
people] (Unpublished master’s thesis). Universitetet i Oslo, Oslo.
Thun, S., Fridner, A., Minucci, D., & Løvseth, L. T. (2014). Sickness present with signs of
burnout: The relationship between burnout and sickness presenteeism among university
hospital physicians in four European countries. Scandinavian Psychologist, 1. doi:10.15714/
scandpsychol.1.e5.
Chapter 2
What Is Health from an Occupational
Health Perspective?

Marit Christensen

In understanding and explaining what the phenomenon of occupational health

revolves around, we have to take a closer look at the concept of health, as well as
asking the question: what is health? Answering this question is almost impossible
because health is a highly complicated, complex, and context-dependent concept.
Most of us agree that this concept is much more than simply the absence of illness,
yet health is also dependent on culture and experience since health is something that
changes throughout the entire life course. If it is so difficult to define health, then we
could be asking what is the point of writing this chapter? The aim is to help the
readers to be attentive to the complexity of the concept of health so that it can be used
to reflect on various issues in terms of the challenges facing occupational health.
In this chapter, we first introduce a short historic view on the concept of health,
starting from the early philosophers. We then focus on developments in the field of
health from concern with infectious diseases to the focus on lifestyle diseases, that
is, a shift from a biomedical explanatory model to a biopsychosocial explanatory
model. Finally, we will discuss the differences and overlap with regard to different
approaches to a health-promoting perspective. In addition, the focus will be on the
health concept and how we should understand it. Here, we will make an attempt to
reflect on how we define, operationalize, and measure health.

2.1 Challenges

Health issues create major challenges and costs for society. At the same time, they
cause major losses for employers in terms of sickness absenteeism, sickness pre-
senteeism, and production losses. The state of Norway annually spends 37.7 billion

M. Christensen (&)
Department of Psychology, Norwegian University of
Science and Technology (NTNU), Trondheim, Norway
e-mail: [email protected]

© Springer International Publishing AG 2017 9

M. Christensen et al. (eds.), The Positive Side of Occupational Health Psychology,
https://doi.org/10.1007/978-3-319-66781-2_2
10 M. Christensen

kroner on illness benefit, that is, about 14,500 Norwegian kroner for every
employee in Norway. If all the losses are taken in account, the cost was estimated to
be around 61.4 billion kroners in 2013, or 23,600 Norwegian kroner for every
employee. In addition, the employer’s losses have to be considered. In a report on
the cost to industries (Hem, 2011), it was estimated that employers pay 13,000
Norwegian kroner every week (Hem, 2011). As an agenda in the workforce health
issues should not be seen as a burden, since they produce increased opportunities
and advantages. These can be in the form of reduced costs, reduced risk, and lower
absenteeism and turnover. For employers, health issues can contribute to them
establishing a good reputation for protecting their employees, which is favorable
when collaborating with partners and for future employees. Last, but absolutely not
least, placing health issues on the agenda could lead to higher productivity if the
employees are healthier, happier, and more motivated.

2.2 History

The question of what health really is has been on people’s minds since the dawn of
time. The early Greek philosophers were later convinced that maintaining good
health and fighting off disease was related to natural rather than supernatural factors.
These included both physical and social health determinants and defined health as a
state of dynamic balance between inner and outer surroundings. Thus, they oriented
medicine toward a more scientific and humanistic perspective. The Greek
philosopher Plato (428–348 B.C.) said that when looking for the reasons and
treatment of disease, we should look at the human as a whole rather than focusing
only on parts of the body.
Hippocrates (ca. 460–377 B.C.) is viewed as the western father of medicine and
is thought to be one of the most influential people in the history of medicine. He
rejected the supernatural and set the foundation for medicine as a science. Illness
was not necessarily a result of the wrath of the gods, rather it was caused by
environmental factors, diet, and lifestyle.
Aristotle (384–322 B.C.) believed that one should be careful when dealing with
anything one could not measure. The physical is easily measurable, but the mind is
not so easily measured. Based on this view, we have numerous important studies on
diseases and their treatment, but the understanding is that a disease can be explained
as a lack in the human’s physical apparatus. Aristotle introduced eudaimonia as the
highest of all human needs, that is, self-realization and the realization of one’s
potential.
The lack of concurrence between the philosophical thought and how to live the
good life, and how human health is constructed, probably stems from the scientific
revolution, where health was related to biological science. This conceptualized
health in relation to the human body. Descartes (1596–1650) introduced the mind
and body dualism. This means that humans consist of two separate parts: the body
and the mind. Medical technology escalated this trend. Descartes suggested that the
2 What Is Health from an Occupational Health Perspective? 11

body and mind do connect at one point, “pineal gland” (later called epiphysis), but
that they did not affect each other. The biomedical model is based on such thoughts.
The biomedical model of health focuses only on biological factors and excludes
psychological, environmental, and social explanations. This model explains health
as being the absence of disease or illness. Its main focus is on physical processes
that influence our health, such as biochemical factors, physiology, or pathology.
The assumption is that disease has an underlying cause; if the cause is removed, one
will be healthy again (Engel, 1977; Espnes & Smedslund, 2009). This health model
is closely attached to a disease model that is often described as being reductionist.
This is because of the claim that it reduces disease to smaller body parts or limiting
biological processes. Reductionism has become the big success of biomedical
medicine. Development in this field is excessive, and its detailed knowledge is
becoming even more extensive. The biomedical model emerged in the
mid-nineteenth century and focuses on the physical body when diagnosing and
initiating treatment which, at that time, was closely related to the challenges of
infectious disease such as influenza and tuberculosis. The causes of these diseases
were identified and the treatment implemented. The big breakthrough came with the
discovery of penicillin. Large vaccination programs were carried out, and this led to
a massive decline in the number of cases of such diseases (Engel, 1977). Based on
this, the popularity of the biomedical model is understandable.
During the 1950s, there was an explosion of what were commonly referred to as
lifestyle diseases (diabetes, cardiovascular diseases, cancer, etc.). These diseases
compensate for the earlier infectious diseases as the main cause of death in western
countries. We have also witnessed an increase in psychosomatic diseases, which
include stress, burnout, back, and neck problems. Based on this development, it
would be correct to assume that the existing method of medical treatment using the
biomedical model is no longer adequate, and there has been a growing need for a
greater focus on psychological and social processes in addition to the biomedical
perspective.
The biopsychosocial model was launched as a reaction to biological reduc-
tionism and tried to build a bridge between the physical–biological and the psy-
chological aspects of health. George L. Engel introduced in the 1970s the
biopsychosocial model (Engel, 1977). Engel acknowledged the enormous contri-
bution to the understanding of disease, but he disagreed with the view that diseases
only had physical causes. He emphasized the importance of the psychological and
social aspects of human illness (Matrazzo, 1980). Using the biopsychosocial model
of health, Engel proposed that a more holistic understanding of the patient’s bio-
logical, social, psychological, and behavioral background should be considered
when reaching a diagnosis and identifying treatment. The biopsychosocial model
assumes that an individual’s own sense of how they feel will have great conse-
quences for their health (Suls & Rothman, 2004) (see Fig. 2.1).
Biological influences continue to play a key role in the biopsychosocial model,
where the physiological cause is identified and examined. However, biological
factors are only one component of the whole picture of an illness. Psychological
influences are viewed as another of the main components that can contribute to
12 M. Christensen

physical health

genetic vulnerabilities disability

BIOLOGICAL

temperament
drug effects

IQ
peers Mental self-esteem
Health
SOCIAL PSYCHOLOGICAL
family
relationships
family circumstances coping skills
trauma

school social skills

Fig. 2.1 Biopsychosocial health model

understanding the picture of an illness. This could, for example, include depression,
health behavior, and negative thought patterns. The third key component is soci-
ological influences, where we examine illness from a sociological perspective. Here
we include, for example, economical relations, religion, and technology as
important contributors to the development of disease. This model is based on the
treatment of illness but it also includes health promotion as an essential component
due to its focus on how to maintain and promote health throughout the lifecycle.

2.3 Health Promotion

The approach on how one act in accordance to health and treatment of health can be
separated in three distinguished phases. Treatment/rehabilitation stands for treating
and relieving injury that is already emerged. Discovering means and interventions
for removing risk factors for disease is the aim of preventional work. Whilst health
promotional work is to bring awareness to behavior that maintain and encourage
health by advancing skills that gives control over the environment and increase the
energy level. In real-life health promotion and preventive work are interacting and
2 What Is Health from an Occupational Health Perspective? 13

Illness Health

Sence of
Illness Quality of life
coherence

Engagement

Treatment/
Prevention Promotion Participation
rehabilitation

Well-being

Health factors
Injury Functional hindrance Health-risk Creativity

Diagnose Risk zone Target zone

Fig. 2.2 Model of rehabilitation, prevention, and health promotion (Idébanken). Source Idébanken,
http://www.idebanken.org/innsikt/artikler/helsefremmende-arbeidsplasser

complement each other, and different interventions can include the same elements
(see Fig. 2.2).
WHO defines health promotion as “process of enabling people to increase
control over, and to improve, their health” (WHO, 1986). The Ottawa charter for
health promotion is an international agreement, elaborated and approved on the first
international conference of health promotion, organized by WHO in Ottawa,
Canada in 1986. Here they made an effort in supplementing WHO’s definition by
adding that health is a recourse in a humans’ life, and not the object of the human
existence. The Ottawa charter was the first document, which emphasized on health
promotion and focused on making a conceptualization of health so that it could be
more useable in health-related work and research. This was achieved when they
realized which conditions had to be fulfilled for maintaining and achieving good
health. In this agreement, it is stressed that health promotional work is closely
associated with politics, all levels of the society and with the local environment.
Through this, the aim was to achieve “health for everyone” within 2000. In
Norway, one can, for example, see the effects of this through the Working
Environmental Act, which in § 1-1 states that the act’s purpose is to ensure a work
environment that provides the basis for a healthy and meaningful working situation.

2.4 Definition of Health

As we can see from this discussion of its historical development, health has tra-
ditionally been defined as the absence of disease (Nelson & Simmons, 2003). In
light of this understanding, one can ask questions about the definition and the
14 M. Christensen

understanding of health and about its approach to causal explanations for the
development a disease. Is it possible for one to enjoy good health while dealing
with a chronic disease? If someone does not have a disease but is feeling low, can
we define them as having good health? The understanding of health has been
debated for a long time, and today there is agreement that health is a complex
concept that extends far beyond the absence of disease. The Central Bureau of
Statistics reporting on Norway’s (SSB) health research concluded that the absence
of disease did not correlate with the main criteria for health. Ninety-six percent of
individuals without chronic illnesses and seventy-one percent of those with chronic
illnesses reported having either good or great health (Lunde, 1999).
The severity of a disease, and in particular, the reduction in functional ability,
has an influence on the experience of health. Only thirty percent of those experi-
encing difficulties related to illnesses in everyday life reports good health. One
explanation may be that the disease plays a part in the whole understanding of
health. The most celebrated definition of health comes from the WHO, which sees
health as a condition of entire physical, mental, and social well-being (WHO,
1948). This definition has been the subject of considerable criticism, especially
because of the notion that absence of disease is a condition for obtaining good
health and that good health is obtained through complete well-being. The chal-
lenges are based on three assumptions contained in the definition. Without
exception, disease and health cannot coexist. Disease is disease; there is no room
for differentiating between a mild and a more serious illness, such as cancer. The
definition gives the impression that it is universal. The form it takes includes all
humans without considering individual and social characteristics. Despite these
criticisms, there is still value in this definition because it includes the notion of a
positive well-being and gives the health concept a multidimensional character.
A definition of health that claims health to be more that the absence of disease
gives rise to obstacles when defining and dealing with a positive health concept
(Nelson & Simmons, 2003). Health has been described as a continuum between two
end points where we find positive health on one side and disease on the other. It is
not only medics that are interested in the definition of health today; the concept is
also of great interest amongst philosophers. In their paper, Ryff and Singer (1998)
compared different approaches from both a medical and a philosophical standpoint.
The two disciplines have approached the concept of health in largely different ways.
The focus of medicine has been disease, treatment, and the prevention of disease,
whereas the focus of philosophy has been on well-being and mind–body interac-
tion. Ryff and Singer’s argument for the interaction between the mental and soma
has been neglected for the last hundred years. They emphasize that having a goal in
life, a social network, self-confidence, and the sensation of mastering your envi-
ronment are important predictors for good health. Furthermore, the interaction
between the mind and the body is important when we interpret and master obstacles
within ourselves to obtain our physical health status. Ryff and Singer concluded that
positive emotions contribute to a restitution and prevention of a disease. In this
definition of positive health, they introduce three key principles: (1) Health is more
of a philosophical question rather than a medical one, and therefore there is a need
2 What Is Health from an Occupational Health Perspective? 15

to articulate the good life, (2) well-being explains the relation between the mind and
body in both mental and physical components and in how they affect each other,
and (3) positive health is best understood as a multidimensional dynamic process
rather than a scale that moves from bad health to good health. Interestingly, the
discussion here might be framed by the question of whether health and disease are
located at each extreme of the scale or whether they belong to two qualitative
different scales. Positive psychology claims that qualitatively different results will
be gained by analyzing positive health and negative health. Furthermore, they claim
that by taking this research approach, new or additional predictors will be found for
positive health. Below, we mention some of the studies that have examined this
relationship.
Various empirical studies have focused on the concept of positive health. As
early as 1994, Mackenbach, van den Bos, van de Mheen, and Stronks asked what
were the health determinants for good and bad health, and whether these two
conditions qualitatively differ from each other. Their study took an important step
toward understanding health as a condition of well-being rather than being the lack
of illness. Mackenbach, van den Bos, van de Mheen, and Stronks (1994) focused on
socio-demographic variables that had earlier been used to predict disease, and they
showed that these variables explained more of the variance in poor health than in
good health. The researchers emphasized that the examined underlying variables
were usually used in explaining the absence of disease and poor health. The results
were explained within a model that was a better fit for examining poor health than it
was for examining good health. The conclusion stated that the processes for gen-
erating good health have a lot in common with those that generate bad health; still,
there is a distinct difference. Taking this into consideration, they recommended
future research to examine other determinants, such as psychological, social, and
cultural aspects, that consider the difference between pathogenesis and salutogen-
esis (Antonovsky, 1987).
In their study, Aronsson and Lindh (2004) argued that one could not understand
factors that shape illness, discontent, and disorders. They suggested that by
focusing on long-term healthy workers, one would identify areas for improving and
intervening in the workplace, finding a common denominator to identify and
improve constructive aspects. A study by Aronsson and Blom (2010) defined health
using a behavioral-oriented or an action-oriented notion. They operationalised
long-term health as a combination of low-level presenteeism and low levels of
sickness absenteeism. They asked questions about which work-related and personal
factors would increase the chances of workers remaining healthy. The results
showed twenty-eight percent of the workers reporting being healthy throughout a
long period of time. Furthermore, this study included other health benefit variables,
such as management support, satisfaction with the work carried out, and clears
goals. They also found that huge quantitative demands (e.g., workload and time
pressure) hindering the satisfaction while working (Aronsson & Blom, 2010).
Research conducted on positive mental health suggests that mental health is a
dynamic process that indicates more than the simple lack of disease. Seligman
(2008) operationalised health as a combination of utmost status on each biological,
16 M. Christensen

subjective, and functional intention. Positive health is related to a “person–envi-

ronment fit” kind of thinking, and an optimal adaptation between physical capacity,
demands, and an individual’s life resources. On its own, a positive mental health is
seen as a goal in itself, as well as indicating a general health and high life expectancy.
Seligman (2008) suggests that there is a logical explanation or rationale for studying
positive mental health since it had earlier been a neglected field of study compared
with the focus on poor mental health. The fundamental goal behind positive psy-
chology lies in its close relation to health promotion, which is concerned with a
change in the psychological focus toward building on strengths (Seligman, 2008).
Seligman claims that when clinical illnesses come to an end, one does not simply end
up with a positive mental health, including positive emotions, motivation, meaning,
or positive relationships. Seligman (2008) mentions two main reasons for examining
positive mental health in combination with poor mental health. First, humans con-
tinue to seek well-being while experiencing problems or/and disease. Second, the
predictors of positive mental health, such as positive emotions, motivations,
meaning, and positive relations, can protect against mental issues.
Another argument for shifting away from the “repairing and avoiding perspec-
tive” and toward a health promotion perspective is based on research that concludes
that the medical objective of the search for disease does not show the expected
significant association with the subjective health. The predictors used to explain
poor health are failing when measuring subjective general health (Barsky, Cleary,
& Klerman, 1992; Manderbacka, Lundberg, & Martikainen, 1999). Earlier research
supports the notion of explaining more of the variance in subjective general health
by using predictors related to both positive and negative health (Barsky et al.,
1992). Several researchers agree on the need for more variables when researching
the positive end of the health continuum (Aronsson & Blom, 2010; Aronsson &
Lindh, 2004: Benyamini, Idler, Leventhal, & Leventhal, 2000; Mackenbach et al.,
1994). Benyamini et al. (2000) examined other predictors for positive physical and
psychological functioning, for example, engagement, positive affect, and social
support. They found that the positive indicators were among the most important
predictors for subjective health, both now and in the future. Happy and energetic
people had a higher probability than others for maintaining a positive assessment of
their health (Benyamini et al., 2000).
The discussion above has underlined the need to include both ends of the health
continuum if we are to fully understand human subjective health. Equilibrium and
balance are two qualitative different dimensions. Mind and body are not indepen-
dent of each other, neither are they independent of the context around us.

2.5 Occupational Health

Health is closely related to function, and people tend to define their health in terms
of how they function around their tasks. Here we find that occupational and health
psychology deal with physical and mental health and well-being. The purpose of
2 What Is Health from an Occupational Health Perspective? 17

occupational health psychology is to develop, maintain, and promote workers

health directly, as well as the health of their families (Quick et al., 1997). The earlier
strong focus on negative factors concerning work (demands, stress, and lack of
motivation) has more recently been balanced with a greater attention placed on the
positive factors concerning occupational health, such as a focus on resources,
well-being, and motivation (Bauer & Jenny, 2012). Today, we find a growing
agreement on the need to include both demands and resources in understanding the
underlying processes.

2.6 Conclusion

In conclusion, it is necessary to reflect on the important question of who is in charge

of our health. Is it the individual, or is it the society? This is a difficult, but an
important political discussion. We know that lifestyle has an important impact on
health, and hence we have some control over improving our health, such as through
diet and exercise. We also know that health is influenced by social differences,
something that is explained by determinants from social positions. The strong focus
on lifestyle, as well as the individual’s behavior, has been criticized as a search for
scapegoats. People are blamed for behavior over which they have little or no control
(Fugelli & Ingstad, 2009). The line between individual and society is unclear, and it
is less likely that individual changes can rise without the society also changing. This
view was agreed upon and became dominant in the World Health Organisation’s
first world conference with health promotion on the agenda. The conclusion noted a
reciprocal commitment. The aim of this chapter has been to capture the complexity
in the notion of health; when faced with difficulties in society, the importance of
understanding this complexity is important, both for the employers and, not least,
the employees.

References

Antonovsky, A. (1987). Unravelling the mystery of health: How people manage stress and stay
well. San Fransisco: Jossey-Bass.
Aronsson, G., & Blom, V. (2010). Work conditions for workers with good long term health.
International Journal of Workplace Health Management, 3(2), 160–172.
Aronsson, G., & Lindh, T. (2004). Långtidsfriskas arbetsvilkor - En populationsstudie [Long term
health at work—a study of the population]. Arbete och Hälsa: 10. Stockholm:
Arbetslivsinstitutet.
Barsky, A. J., Cleary, P. D., & Klerman, G. L. (1992). Determinants of perceived health status of
medical outpatients. Social Science and Medicine, 34(10), 1147–1154.
Bauer, G. F., & Jenny, G. J. (2012). Salutogenic organisations and change. Heidelberg: Springer.
Benyamini, Y., Idler, E. L., Leventhal, H., & Leventhal, E. A. (2000). Positive affect and function as
influences on self-assessments of health: Expanding our view beyond illness and disability.
Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 55(2), 107–116.
18 M. Christensen

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196
(4286), 129–136.
Espnes, G. A., & Smedslund, G. (2009). Helsepsykologi [Health psychology]. Oslo: Gyldendal
Norsk Forlag.
Fugelli, P., & Ingstad, B. (2009). Helse på norsk – god helse slik folk ser det [Health in Norwegian—
Good health the way people see it]. Oslo: Gyldendal akademisk.
Hem, K.-G. (2011). Bedriftenens kostnader ved sykefravær. En undersøkelse blant NHO- bedrifter
[Costs of an organization when sickness absence—A survey among NHO-organisations].
SINTEF-rapport A19052. Oslo: SINTEF Teknologi og Samfunn.
Lunde, E. S. (1999). Helsetilstanden i befolkningen [The state of health in the population]. Notater
33–1999. Oslo: Statistisk Sentralbyrå.
Mackenbach, J. P., Van Den Bos, J., Van De Mheen, H., & Stronks, K. (1994). The determinants
of excellent health: Different from the determinants of ill-health? International Journal of
Epidemiology, 23(6), 1273–1281.
Manderbacka, K., Lundberg, O., & Martikainen, P. (1999). Do risk factors and health behaviours
contribute to self-ratings of health? Social Science and Medicine, 48(12), 1713–1720.
Matrazzo, J. D. (1980). Behavioral health and behavioural medicine: Frontiers for a new health
psychology. American Psychologist, 35(9), 807–817.
Nelson, D. L., & Simmons, B. L. (2003). Health psychology and work stress: A more positive
approach. In J. C. Quick & L. E. Tetrick (Eds.), Handbook of occupational health psychology
(pp. 97–119). Washington, DC: American Psychological Association.
Quick, J. C., Camara, W. J., Hurrell, J. J., Johnson, J. V., Piotrkowski, C. S., Sauter, S. L., et al.
(1997). Introduction and historical overview. Journal of Occupational Health Psychology, 2
(1), 3–6.
Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9
(1), 1–28.
Seligman, M. E. P. (2008). Positive health. Applied psychology: An International Review, 57, 3–
18.
Suls, J., & Rothman, A. J. (2004). Evolution of the psychosocial model: Implications for the future
of health psychology. Health Psychology, 23(2), 119–125.
World Health Organisation. (1948). World Health Organization constitution. Geneva: WHO.
WHO Ottawa. (1986). Report of an International Conference on Health Promotion, 1986, Ottawa,
Ontario, Canada 17–21 November 1986. Health Promotion: An International Journal, 1:4 i–v,
405–460.
Exploring the Variety of Random
Documents with Different Content
granted, not inquired into, that love itself might have failed, perhaps—but
Cara never thought of it as possible. It was like the sunny house it dwelt on,
always open, due not to anything in her, but to the mere fact that she was
Cara. They would have loved any other kind of girl, she said to herself,
under the same name just as well. Poor child! she was like Hamlet, though
unaware of that sublimity. Friends, lovers, relations, all had failed her.
Every soul thought of himself—no one truly or unfeignedly of others. Her
head swam, her heart sank, the firm ground gave way under her feet
wherever she turned. It might not cost the others much, but it cost her a
great deal; even she herself in her own person: did she love more truly than
they did? No; she was not devoted to her father, nor to Oswald, whom she
was supposed to care for; and if to—anyone else, then they did not care for
her, Cara said to herself, and fled from her thoughts with a beating heart.
That evening there was an interchange of visits, something in the old
fashion. Edward thought he might come in, in the evening, when the public
about would not be scandalised by the idea that he was able to visit his
friends so soon after his father’s death; and Mr. Beresford said to himself
that, surely he might go for a little to comfort his neighbour who was in
trouble, and who had not herself been out of doors for these two long days.
The young man and the older man crossed each other, but without meeting;
and both of the visits were very pleasant. Miss Cherry was as kind to
Edward as she had been cold to his mother. She got up to meet him and
took his two hands in hers. She called him, inarticulately, her dear boy, and
asked after his health tenderly, as if he had been ill. As for Cara, she did
nothing but look at him with a wistful look, trying to read in his eyes what
he felt; and when her aunt entered into the usual commonplaces about
resignation to God’s will, Cara broke in almost abruptly, impatient even of
this amiable fiction.
‘You forget what you were saying to-day,’ she said: ‘that Edward did not
know his father, and therefore could not grieve as—I should.’
‘That is quite true,’ he said, ‘and therefore it is a different kind of
feeling. Not the grief that Cara would feel; but that painful sense of not
being able to feel, which is almost worse. I never thought of my father—
scarcely knew him. Some time, of course, we were to meet—that was all;
and gratitude to him, or any attempt to repay him, was not in my thoughts.
And now it is impossible ever, in any place, were one to go to the world’s
end—or at any time, were one to live as long as Methuselah, to say a kind
word to him, to try to make up to him a little. This is more painful than
Cara’s worst grief would be, knowing she had done everything, made
everything bright.’
‘Oh, no, no!’ she said, putting up her hands.
‘Ah, yes, yes!’ he said, looking at her with melting eyes, softened and
enlarged by the moisture in them, and smiling upon her. Cara, in her
confusion, could not meet the look and the smile.
‘Oh, Edward,’ she said, ‘it is you who are the best of us all. I am not
good, as you think me. I am a sham, like all the rest; but if there is one that
is true——’
‘Cara is foolish,’ said Miss Cherry. ‘I don’t know what is come to her,
Edward. She talks as if nobody was to be relied upon; but I suppose she is
at the age of fancy, when girls take things into their heads. I remember
when I was your age, my darling, I had a great many fancies too. And I am
afraid I have some still, though I ought to know better. I suppose you will
take your mother away somewhere, Edward, for a little change?’
‘I have not heard anything about it, Miss Cherry; but there will be one
change, most likely, very important to me, if I settle to do it. I need not go
out to India now—unless I please.’
‘Oh, Edward, I am so glad; for, of course, you would not wish it—you
did not wish it?’
‘No,’ he said, slowly. ‘I did not wish it; but, after all, if that seemed the
best way to be good for something—to make some use of one’s life——’
He spoke to Miss Cherry, but his eyes were on Cara. If she had said
anything; if she had even lifted her eyes; if she had made any sign to show
that even as her brother—her husband’s brother—he could be of use to her!
But Cara made no reply either by word or look. She put her hand nervously
upon the book which lay on the table—the book he had been reading.
‘Oh, Cara, you must not think of that,’ said Miss Cherry; ‘we can’t be so
selfish as to ask Edward to read to-night.’
‘Yes; let me read,’ he said. ‘Why should not I? I am glad to do anything
after these two days. It seemed unkind to him, not to make some break in
life—though I don’t know why; and there is nothing within reach to do. Let
me read.’
 Then Cara looked at him, with eyes like his own, suffused; her heart was
melting, her mind satisfied. ‘But this is the one who does not care for me,’
she was saying to herself.
Next door there was less conversation between the elder people. Mr.
Beresford tried, indeed, to take upon him the part of consoler—to talk to her
and lessen her burden; but that change of all their relations did not answer.
He fell silent after a while, and she dried her eyes and began to talk to him.
The maid who brought up tea announced that Missis had picked up
wonderful; while the other servants in the kitchen looked at each other, and
shook their heads.
‘Anyhow, that’s better than the other way,’ the cook said, oracularly,
‘and we knows what we has before us—if the young gentlemen don’t find
nothing to say.’
 CHAPTER XXXIII.

LITTLE EMMY’S VISITORS.

Oswald had found his particular pursuit interrupted by his father’s death.
He could not go that day, which happened to be the hospital day, to meet
Agnes at the gate; indeed, for once, his own inclinations were, for the
moment, driven out of his head; and, in the many things there were to think
of, from hatbands upwards, he forgot that this was the day on which alone
he could secure a little conversation with the object of his thoughts. When
the recollection flashed upon him in the evening, he was more disturbed
than was at all usual to his light-hearted nature. What would she think of
him? that he had deserted her, after compromising her; an idea equally
injurious to his pride and to his affection; for he had so much real feeling
about Agnes, that he was not self-confident where she was concerned, and
shrank from the idea of appearing in an unfavourable light. Ordinarily,
Oswald did not suppose that anyone was likely to look at him in an
unfavourable light. And then there was the fear which sprang up hastily
within him that this day which he had missed might be the last hospital day.
Little Emmy had been gradually getting better, and when she was
discharged, what means would he have of seeing Agnes? This thought took
away all the pleasure from his cigar, and made him pace back and forward
in his room, in all the impatience of impotence, ready to upbraid his father
with dying at such an inconvenient moment. Yesterday would not have
mattered, or to-morrow—but to-day! How often, Oswald reflected, it
happens like this in human affairs. Given an unoccupied day, when an
anything might occur without disturbing your arrangement—when, indeed,
you have no engagements, and are perfectly free and at the command of
fate—nothing, even under the most favourable circumstances, happens; but
let it be a moment when something very urgent is on your hands, when you
have an opportunity that may never occur again, and immediately earth and
heaven conspire to fill it with accidents, and to prevent its necessary use. At
that hour, however, nothing could be done. It was nearly midnight, and the
House, with all its swarms of children and kindly attendants, must be
wrapped in the sleep of the innocent. Would Agnes, he asked himself, share
that sleep, or would any troubled thoughts be in her mind touching the
stranger who had so sought her society, and who had exposed her to
reproof, and then left her to bear it as she might? This, it is to be feared,
drove out of Oswald’s mind any feeling he might have had for his father. In
any case, such feeling would have been short-lived. He had no visionary
compunctions, such as Edward had, though it was Oswald, not Edward,
who was supposed to be the poetical one of the brothers; but then Edward
was not ‘in love,’ at least not in Oswald’s way.
A week had to elapse before the day on which he could hope to see
Agnes again, and this contrariety made him more earnest in his
determination to let nothing stand in his way a second time. He was so
eager, indeed, that he neglected what would otherwise have been so
important in his eyes—the arrival of the mail, which brought definite
information as to Mr. Meredith’s property, and must settle what his own
prospects were to be.
No man could give a warmer evidence of his love than this he felt within
himself as he took his way towards the hospital. During the intervening
week he had seen the little teacher almost daily, accompanying the
procession of school-girls, and she had, he thought, been conscious that he
was there, though she would not look at him. Naturally, Oswald made all he
could of his deep hatband, his black gloves, and even the black border of
his handkerchief, as he crossed the line; and once he felt that Agnes
perceived these indications of woe in a quick glance she gave at him,
though she avoided his eyes. This then was a point in his favour—if only
little Emmy were still at the hospital. This time he was more bold than
usual, and asked to be admitted to see the child, explaining who he was, and
what was his connection with the accident. In this respect he took upon
himself more than was necessary, blaming himself for being the cause of it
—and at length got admittance, his mourning naturally standing him in
stead with all the officials. Little Emmy had been by this time transported
into the convalescent ward, and was lying on a sofa there, very bright-eyed
and pale, looking eagerly, as Oswald saw, with a leap of his heart, for some
visitor. When she perceived him a cloud of disappointment passed over her
little face, then a glimpse of surprise and recognition, then the swift-rising
colour of weakness.
‘Do you know me?’ said Oswald, taking the chair the nurse offered him.
 ‘Oh, yes!’ cried the child, with a mixture of awe and delight. No further
preliminaries were necessary.
He listened, with patience, to an account of all the stages of her recovery,
and delicately introduced his own inquiries. The ladies at the House had
been very kind to her; had they not? They had come to see her?
‘Oh, yes, sir,’ cried little Emmy. ‘Miss Burchell came every week, and
Sister Mary Jane has been twice. Miss Burchell is the kindest of all. I
thought she was coming to-day; oh, isn’t she coming to-day?’ the child
added, after a pause, looking at him with rising tears. ‘Did she send you
instead, please?’ and though Oswald was so grand a gentleman, and his
inquiries filled her with pride, yet his possible substitution for her more
beloved visitor made Emmy ready to cry. Oswald did not like to be thus
thrust into a secondary place, even with a child. A momentary irritation
arose in his mind; then he laughed and forgave Emmy, remembering who it
was that she preferred to him.
‘Don’t be afraid,’ he said; ‘I have not come instead of Miss—did you say
Burchell? Is she one of the Sisters?’ he asked, hypocritically. ‘I thought you
called them by their Christian names.’
‘Oh, sir, Miss Burchell is not a Sister. She is the teacher. I am in the third
division,’ said the child, with pride; ‘and she teaches us. She is a lady—not
like Miss Davies, in the infant school, you know; but a real, real lady. And
all the Sisters are ladies. It is for goodness they take care of us, and not
because they are obliged. Such a trouble as they take!’ said little Emmy,
with the naïve surprise of her class, ‘and for nothing at all! And Miss
Burchell is the kindest of them all.’
‘She has come to see you very often?’
‘Oh, sir, every open day! and she told me that—that—you had come to
ask for me. She said it was so good and kind. She said, sir, as you were a
very kind gentleman, and took an interest in poor children—especially
orphans like me.’
‘Yes; I take a great interest in you, my poor little Emmy,’ said Oswald,
blushing with pleasure. ‘I think you ought to have change of air after your
long illness. Is there not a place where the children at the House go to when
they have been ill?’
‘Oh!’ cried the little girl, with eyes as round as her exclamation, ‘Nelly
Brown went to Margate after the fever. She used to tell us about the sands
and the shells, and riding on donkeys; but Nelly had a kind lady who took
an interest in her,’ said Emmy, her countenance falling, ‘and paid for her.
There are such a many orphans, sir,’ she added, with a wistful look at him.
‘Such a many! They would do more for us, if there wasn’t such a many of
us, Sister Mary Jane says.’
A certain half-aggrieved and serious wonder was in the child’s eyes.
Why there should be so many orphans puzzled little Emmy; and she felt
that it was a special grievance to her, as one of them, debarred from the
privileges which a smaller number might have shared.
‘And you have a kind gentleman, Emmy,’ said Oswald. ‘I hope it comes
to the same thing. This is what I came to talk to you about——’
‘Ah, there she is!’ said little Emmy, growing red with delight.
Oswald got up precipitately from his chair. What would she say to find
him here already installed before her? She came up, light-footed, in her
nun’s dress; her face looked doubly sweet, or so, at least, her young lover
thought, in the close circle of the poke-bonnet, to meet the rapture in the
child’s eyes.
Agnes had no thought that Oswald was likely to penetrate here;
therefore, she did not see him or think of him as she came up to the child,
and he was a witness of the clinging to the little orphan’s arms, the tender
sweetness of the salutation. Agnes could not have said anything more
homely than the ‘How have you been, dear?’ but it sounded like the very
softest utterance of loving kindness—maternal, dove-like murmurings,
tender and caressing, to Oswald’s ear.
‘Oh, I am well—almost well; and here is the kind gentleman come to see
me!’ cried little Emmy.
Agnes turned quickly, and looked at him. She thought it was the surgeon,
who was young too, and had shown an almost unprofessional eagerness to
explain to her all the peculiarities of this interesting case. When she saw
who it really was she turned crimson, gave him a look which was half
reproach and half satisfaction, and went away to the other side of the sofa,
keeping the little patient between them. This suited both parties very well:
for while Agnes felt it at once a demonstration of displeasure and flight out
of a dangerous vicinity, it brought her face to face with him, and gave him a
favourable point of view for all her changes of countenance. And who could
object to his visit here, which charity—only charity—could have brought
about? By little Emmy’s sofa, Oswald felt brave enough to defy all the
Sisters in the world.
‘I came to inquire into Emmy’s prospects of convalescence,’ said
Oswald, insinuatingly; ‘and she tells me there is some place in Margate
where children are sent to from the House. If the Sisters will let me pay for
the child—she wants sea breezes, I think,’ and he looked at her in a serious
parental way, ‘before she can be fit for work again.’
‘Oh, I think they will be very glad!’ said Agnes, somewhat breathless.
She did not want him to know that she had as much as remarked his
absence; and yet, in spite of herself, there was a slight tone of coldness and
offence in her voice.
‘May I ask you to arrange it for me? I don’t know when she will be able
to be moved; but when she is—summer is coming on, and the weather is
quite genial already.’ (The weather is quite genial generally, one time or
other, in April, to take the unwary in.)
‘Oh, yes,’ said Agnes again, assenting out of sheer timidity and
embarrassment. Then she said, hesitating a little, ‘Perhaps it would be better
to send word to the Sister Superior yourself.’
‘Is it necessary? I have been in great trouble lately, which is why I could
not ask for poor Emmy last week,’ he said; and so managed as that the deep
hatband should catch the eye of Agnes. Her face softened at once, as he
saw, and her eyes, after a momentary glance at the hatband, returned
inquiring and kind, not furtive or offended, to his face.
‘I am very sorry,’ she said, looking again at the hat, and in an eager, half-
apologetic tone. ‘I will speak of it, if you wish. It is very kind of you to
think of her—very kind.’
‘Kind! How can I be sufficiently grateful to Emmy?’ he said, low and
quickly, in a tone which the child could not hear; and then he took the little
girl’s thin small hand into his, and folded the fingers on a gold coin.
‘This is to hire donkeys on the sands, Emmy,’ he said, ‘but mind you
must tell me all about it when you come back.’
‘Oh, sir! Oh, Miss Burchell! look what he has given me,’ said the child
in ecstasy. But Oswald knew how to beat a retreat gracefully. He gave a
little squeeze to Emmy’s fist, keeping it closed over the sovereign, and,
bowing to Agnes, went away.
 Was that the last of him? Better, far better, that it should be the last of
him, poor Agnes felt, as her heart contracted, in spite of herself, at his
withdrawal; but the surprise, and that pang of disappointment, which she
would have gone to the stake rather than acknowledge, made her incapable
of speech for the moment. It is very wicked and wrong to speak to a
gentleman to whom you have never been introduced; but, then, when that
gentleman has a legitimate opportunity of making a little acquaintance in a
natural way, how strange, and rather injurious, that he should not take
advantage of it! This failure of all necessity for resistance at the moment
when she was buckling on her best armour to resist, gave an extraordinary
twist to Agnes Burchell’s heart. It almost would have brought the tears to
her eyes, had not she started in instant self-despair—though she would not
have shed such tears for all the treasures of the world.
‘Oh, look what he has given me!’ cried little Emmy, ‘a sovereign, a
whole sovereign—all to myself!’
‘He is—very kind,’ said Agnes, stiffly, and she was restrained even in
her intercourse with Emmy, not saying half so much to her as she did on
ordinary occasions, which was wrong; for, in fact, Emmy could not justly
bear blame for anything committed, neither for his coming nor his going
away. The child was quite cast down by Miss Burchell’s coldness. She
began to inquire if Agnes was ill, if she was tired, if she thought the Sisters
would object to let her go to Margate; thus plainly showing that she
perceived her visitor’s abstraction, which was, of all things in the world, the
last thing which Agnes wished to be remarked. And poor Agnes could not
conceal how worried she was by these questions; she could not account for
the discouragement, the sickness of heart, that had come over her. She was
tired all at once—overcome by the heat or the cold; which was it?
‘It is the spring, miss,’ said the nurse.
And she was very willing to allow that it must be the spring.
‘I will send you word as soon as I have spoken to the Sister,’ she said,
kissing little Emmy as she went away; ‘and forgive me, dear—for I have a
headache. I have not been able to talk to you to-day.’
‘Oh, have you a headache?’ cried poor little Emmy, ready to cry for
sympathy. What perverse things hearts are when they are young! Agnes
walked away through the wards the emblem, of peaceful quiet, in her black
bonnet, her soft face breathing serenity and ease, as one sufferer and
another thought as she passed, but under that conventual drapery a hundred
thoughts rustling and stinging, so that the girl was afraid lest they should be
heard. Oh, she was glad that he was gone! Glad to be spared the struggle
and the necessity for telling him that he must haunt her steps no more. Glad
to be let alone, to do her work in peace; her work, that was what she lived
for, not absurd romances which she was ashamed even to dream of. Her
mind was brimful and running over with these thoughts. It was like carrying
a hive full of bees, or a cage full of birds through the place, to walk through
it like this, her heart beating, and so many voices whispering in her ears.
But suddenly, all at once, as she came out of the great doors, they all hushed
in a moment. Her heart stopped (she thought); her thoughts fled like
frightened children. She was stilled. Why? It was all for no better reason
than that Oswald Meredith was visible at the gate, in his black clothes,
looking (the hospital nurses thought) like an interesting young widower,
bereaved and pensive, yet not inconsolable. He had put on a look in
conformity with his hatband, and stood there waiting for her as she came
out, claiming her sympathy. Agnes grew still in a moment, the tumult and
the commotion ceasing in her mind as by magic. She tried to look as if she
did not see him, and then to pass him when she got out beyond the gate; but
he stepped forward quickly into her path.
‘May I ask if you will speak for me about little Emmy?’ he said. ‘The
child looks weak and rather excitable. I should like, if the authorities will
permit me, to pay her expenses to the sea.’
‘Oh, yes, they will permit you,’ said Agnes, smiling in spite of all her
terrors. ‘You are very kind. I will speak—if you wish it.’
‘And write to me,’ said Oswald, eagerly. ‘It will be necessary to write to
me to let me know.’
But Agnes demurred to this easy settlement of the matter. ‘Sister Mary
Jane will write. She manages these things herself. But she will be pleased.
Good morning,’ she said, making am attempt to quicken her steps.
‘I am going this way,’ said Oswald. ‘I could not come last week. We had
bad news.’
She looked up at him, half alarmed, half sympathetic. She was sorry,
very sorry, that he should suffer. It was not possible (she thought) to be like
the priest and the Levite, pass on on the other side, and pretend to care
nothing for one’s neighbour. But then she ought to tell him to go away. So
Agnes compounded with her conscience by uttering nothing; all she did was
to look up at him with tender brown eyes, so full of pity and interest, that
words would have been vain to express all they were able to say.
‘My father is dead in India,’ said Oswald. ‘You may fancy how hard it is
upon us to hear of it without any details, without knowing who was with
him, or if he was properly cared for. I have not had time for anything since
but to attend upon my mother, and see to what had to be done.’
He felt that this was a quite correct, description; for had he not sacrificed
the last hospital day to the shock of the news, if not to the service of his
mother; and there had been things to do, hatbands, &c., which had kept him
occupied.
‘I am very sorry,’ said Agnes, with downcast eyes.
‘You who are so tender and sympathetic, I knew you would feel for—my
mother,’ said Oswald; upon which name the girl looked up at him again. To
feel for his mother—surely there could not be anything more natural, more
right, than this.
‘You would like my mother—everyone does. It is amusing the way in
which people run after her. Not that there is any room for amusement in our
mournful house at present,’ said Oswald, correcting himself. ‘This is the
first day the sun has seemed to shine or the skies to be blue since I saw you
last.’
‘I am very sorry,’ said Agnes again; and then, after a pause, she added
nervously, ‘It is not that I think anything—and, oh, I hope you will not be
vexed now that you are in trouble!—but you must not come with me. The
Sister thinks it is not right, and neither do I.’
‘Not right!’ said Oswald, with an ingenuous look of surprise.
Agnes was driven to her wit’s end. ‘I do not want to seem absurd,’ she
said, trembling, ‘and indeed there is no need for explanation. Please, you
must not wait for me at the hospital, or walk back with me any more.’
‘Alas! have we not been planning to send little Emmy away? That means
that I shall not have the chance, and that the brightest chapter in my life is
almost over. Must it be over? You don’t know what it has been to me. You
have made me think as I never thought before. Will you abandon me now,
just when I feel on the threshold of something better?’
 ‘You must not talk so,’ said Agnes, roused to something like anger. ‘You
know very well that, meeting me as you have done, it is wrong; it is not the
part of a gentleman to talk so.’
‘Is it not the part of a gentleman to admire, to reverence—to love?’
Oswald said the last words almost under his breath, and yet she heard them,
notwithstanding the noises in the street.
‘Mr. Meredith!’ She gave him an indignant look, but it ended in a blush,
which ran like a warm suffusion all over her, and checked further words on
her lips.
‘I know your name, too,’ he said. ‘And it is not love only, but reverence,
that is in my heart. Oh, Agnes! don’t turn me away! May not my mother
come, when she is well enough to go anywhere, and plead my cause? She
might speak if I may not.’
‘Oh, go away, please, go away,’ said Agnes, in distress. ‘We are almost
at the House again.’
‘And why should not we be at the House, if you will let me hope?’ cried
Oswald. ‘I don’t want to skulk away! Yes, I will go and hide myself
somewhere if you will not hear me. I shall not care what becomes of me.
But Agnes——’
‘Oh, Mr. Meredith! Go, please. I cannot think it is right. I—don’t
understand you. I ought not to listen to you—in this dress; and I have only
begun the work.’
‘There are other kinds of work. There is the natural work. Is not a wife
better than a sister?’
Agnes lighted up with the sudden flash which was characteristic of her.
She raised her eyes to him glowing with indignant fire, her face suffused
with colour. ‘Better?’ she said; ‘better to live for one’s self and one other
than for the poor and helpless and the miserable! Oh! do you know what
you say? You are a tempter; you are not a true Christian! Better! when there
are so many who are wretched and friendless in the world, with no one to
care whether they live or die? Do you think a woman does better who tries
to make you happy than one who gives herself up for them?’
In the heat of this sudden burst of controversial eloquence, she turned
aside into another street, which led out of the way of the House. Nothing
else would have tempted her to such a curious breach of decorum; but the
argument did, which filled her with indignant fervour. She did it only half
consciously, by impulse, burning to know what he would answer, what plea
he could bring up against her. But here Oswald’s cleverness failed him. He
was not wise enough to see that a little argument would have led her on to
any self-committal. He answered softly, with mistaken submission.
‘I will retract. I will say anything you please. No, not better; only
happier. You would make me the most blessed of men; and what can you do
for the poor? So little; everybody says, so little! But for me there would be
no limit to what you could do. I have the most need of conversion. Ah! let
your mission be me!’
Agnes started and came to herself. She looked round her, alarmed and
scared, when she knew, yet only half knew, that she had left the direct road.
‘I have taken the wrong turn,’ she said, with confusion. ‘Mr. Meredith, let
us forget that we have ever met. How could I turn back, having just put my
hand to the plough? Oh, it is very weak and wicked of me, but I do not want
the Sister to see you. She will think—but you have been kind, and I will say
good-by here.’
‘Do you want to say good-by? Why should we forget we have ever met?
Tell me to forget that I am born!’
‘Oh, no, no; it is not like that. Mr. Meredith, we have only known each
other four or five—a few weeks.’
‘Six—I have kept closer count than you.’
‘And what does that matter in a life?’ said Agnes, looking up at him with
a courageous smile. ‘Nothing! no more than a moment. We have not done
any harm,’ she added, collecting all her strength. ‘We have not neglected
our work nor wasted our time. And we never meant anything. It was all an
accident. Mr. Meredith, good-by. I shall pray that you may be happy.’
‘Ah! that is like what the world says of saints,’ he said, sharply. ‘You
make me wretched, and then pray that I may be happy.’
‘Oh, no, no,’ she cried, the tears coming to her eyes. ‘How can I have
made you wretched? It was only an accident. It has been only a moment.
You will not refuse to say good-by.’
Foolish Agnes! she had nothing to do but to leave him, having said her
say. But, instead of this she argued, bent upon making a logical conclusion
to which he should consent, convinced, though against his will. On the
whole she preferred that it should be against his will—but convinced she
had determined that he must be. They walked away softly through the little
street into the sunset, which sank lower every moment, shedding a glory of
slant light upon the two young figures so sombre in garb, so radiant in life.
Where they were going they did not know, nor how the charmed moments
were passing. Every shade of the coming evening lay behind them, but all
the glory of the rose tints and glowing purple, the daffodil skies and gates of
pearl, before.
 CHAPTER XXXIV.

THE WIDOW.

The full particulars of Mr. Meredith’s death and Mr. Meredith’s will came
by the next mail; and this information acted as a kind of funeral ceremony
and conclusion to the melancholy period. All his affairs were in order; his
will unassailable, the provisions sufficiently just. There was more money
than anyone expected, and it was divided into three unequal shares—the
largest for his eldest son, the second for Edward, the least of all for their
mother. This arrangement took them all by surprise, and it was with some
little difficulty that Mrs. Meredith was brought to see how it affected
herself. That there would be any difference to her had not occurred to her.
She had thought only of her children. ‘They certainly will not be worse off
than they have been,’ she said five minutes before the contents of the will
were communicated to her; but any question as to how she herself would be
affected had not entered her mind. Even after she had heard it she did not
realise it.
‘I am afraid you will scarcely be able to keep up this house unless the
boys stay with you, which is not to be expected,’ said old Mr. Sommerville.
She looked at him, taking her handkerchief from her eyes. ‘My house?’
she said, faltering. Mr. Beresford was present and one or two other old
friends.
Oswald was playing with a paperknife, balancing it on his finger, and
paying no attention. He was thinking of something else with a vague smile
on his face. He was as rich almost as he had hoped—made an ‘eldest son’
of, in so far at least that his portion was the biggest; and he was thinking of
a house of his own, taking no thought for his mother, and a wife of his own
soon to be beguiled out of poke-bonnets and convent cloaks, yet all the
more piquant from the comparison. Naturally this was more interesting to
him than his mother, and the house that he had been used to for years. But
Edward, who, whatever he was himself doing, managed somehow to see
what Oswald was about, and who thought he knew what that preoccupation
and absorption meant, interposed hastily. ‘Of course my mother will keep
her house. It is quite unnecessary to enter into such questions. The economy
of the household is unchanged,’ he said.
‘But, my lad, I don’t agree with you,’ said old Sommerville. ‘You may
both take to chambers, your brother and you. Most young men do now-a-
days, so far as I can see. I will not say whether it’s better for them, or worse
for them. Anyhow, your mother must be on her own footing. You must not
be dependent on the whimsies of a boy. I would advise you, my dear
madam, to look out for a smaller house.’
‘A smaller house?’ she repeated again, in dismay. ‘Why a smaller
house?’ Then her eyes fell upon Oswald. ‘Yes, I understand. Oswald will
perhaps—marry. It is quite true; but I have lived in this house so long—I
am used to it. I do not wish to change.’
‘You will not be able to afford it—on your income, madam,’ said old
Sommerville, watching her keenly. He was fond of studying mankind, and
to see how a fellow-creature encountered a change of fortune was keenly
interesting to the old man.
She looked at him, opening her eyes wider with a curious gaze of
surprise; then paused a moment, looking round her as if for some
explanation. ‘Ah,’ she said, ‘I begin to understand.’ Nobody spoke to her;
the other two old friends who were present turned aside and talked to each
other. Mr. Beresford looked over a photograph book as earnestly as if he
hoped to find a fortune between the pages; only the old spy watched the
new-made widow, the admired and beloved woman to whom in this distinct
way it was becoming apparent that she had not been so much beloved after
all.
And her face was worth a little study—there came over it a momentary
gloom. She had been thinking with so much tender kindness of him; but he,
it was evident, had been less tender in his thoughts of her. But then, he had
died, and she lived. No doubt, if it had been she who had died, his mind too
would have been softened, and his heart grown tender. The cloud lightened,
a soft smile came into her eyes; and then two tears sprang quickly over the
smile, because he had slighted her publicly in these last settlements; he had
put her down willingly and consciously out of the position she had held as
his wife. She felt this sting, for love and honour were the things she prized
most. Then her courageous spirit roused up, and this time the smile
descended softly, seriously, to touch her mouth.
 ‘What does it matter?’ she said, with her habitual sweetness. ‘My
husband knew I had a little of my own. If I am not able to keep up this
house, I must get another house, Mr. Sommerville, that I can keep up.’
‘Madam,’ said Mr. Sommerville, ‘that is the way to take it. I respect you
for what you say; many a woman now would have raged at us that cannot
help it, would have abused the maker of the will, and made a disturbance.’
‘Made a disturbance?’ said Mrs. Meredith. The smile brightened into a
momentary laugh. It was the first time she had allowed herself to stray
beyond the gloomy pale of memory which she considered her husband’s
due. But the sound of her own laugh frightened her. She shrank a little,
saying hastily, ‘Oh, Edward, my dear boy, forgive me!’ He was not her
favourite son, or at least he had thought so; but he was the one to whom she
clung now.
‘I thought you knew my mother,’ said Edward, proudly, ‘after knowing
her so long. That is all; is it not? We can settle among ourselves about
houses, &c. I think my mother has had enough of it now.’
‘No,’ she said, ‘oh, no; whatever ought to be done, I am quite able for; if
there is any stipulation as to what I must do, or about the boys—if the boys
should marry; but to be sure they are of age, they are their own masters,’
she added, with once more a faint smile. ‘Whether their mother is
considered wise enough—oh, Edward! no, I am in earnest. Perhaps there is
some task for me, something to do.’
This was the only little resentment she showed; and even the sharp-
witted old Sommerville scarcely took it for resentment. The friends took
luncheon with the family at an early hour, and departed, carrying away the
unnecessary papers, and leaving everything as it had been; the blinds were
all drawn up, the sunshine coming in as usual. Oswald, with his hat brushed
to a nicety and his cigars in his pocket, went out just as usual. The usual
subdued domestic sounds were in the house, and in the course of the
afternoon four or five visitors were allowed to come in. Everything was as
it had been; only Mrs. Meredith’s pretty ribbons, all soft in tint as in texture,
her dove-coloured gown, her lace, her Indian shawls and ornaments, were
all put away, and crape reigned supreme. There was no further conversation
on the subject until after dinner, when Edward and his mother were alone.
Oswald was dining with one of his friends; it was hard to hold him to the
etiquette of ‘bereavement.’ ‘Besides,’ Mrs. Meredith said, ‘no one thinks of
these rules with a young man.’
‘It will be strange to have to leave this house,’ she said, when the
servants had left the dining-room. ‘It was the first house I had in England,
when I brought you home. Some people thought the country would have
been best; but I liked the protection of a town, and to see my friends, and to
be near a good doctor; for you were delicate, Edward, when you were a
child.’
‘Who, I, mother? I don’t look much like it now.’
‘No, heaven be praised—but you were delicate; two little white-faced
things you were, with India written in your little pale cheeks. That was the
first thing that brought me home. You could not have stayed in India; and
then the question was, Edward, to leave your father, or to leave you—and,
oh—you seemed to have so much more need of me!’
‘Do not go over the question again, mother. You did not do it, I am sure,
without thought. Let us think of the future now. You are to stay in the house
you like, and which is all the home I have ever known; as for a smaller
house, or for what you are able to afford, that is simple nonsense. It appears
I have a separate income now, not merely an allowance. You don’t mean to
turn me out, do you, to the streets?’
‘My dear boy!—of course, wherever I have a roof, there is a place for
you.’
‘Very well, mother; this is the place. You don’t want me to go off and
live in chambers?’
‘Not unless—you think it necessary; unless—you would like it better,
Edward. Oh, I hope not, my dear!’
‘So do I,’ he said, smiling. ‘I hope you don’t mean to turn me out for the
sake of something you can afford. We must live together, mother, you and I.
I can’t be idle; you know, I must do something; and all the pleasure I shall
ever get out of life,’ he added, with the solemnity of youthful conviction,
‘will be to find my home always the same—and my mother. I look for no
other happiness.’
‘My dear,’ she said, ‘that is all very well at present, till you see someone
who is dearer to you than either your mother or your home. That will come
some time; but in the meantime, dear——’
 ‘The meantime will be always, mother—the other time will never come.’
Mrs. Meredith gave him a sudden look—then checked herself when
about to say something, sighed a little, and made a pause; and then she
began to talk on another subject between which and this there seemed little
connection, though Edward perceived the connection easily enough.
‘We shall have it all to ourselves apparently,’ she said, with a faint smile.
‘Oswald, I suppose, will be thinking of a house for himself; and why should
he wait? There is no reason why he should wait. To be sure, they are young.
Has he said anything to you, Edward?’
‘Nothing, mother.’
‘Well; they must have their reasons, I presume. One does not like to be
left quite out; but it is the thing one ought to expect as one gets old. Old
people are supposed not to sympathise with youth. It is a mistake, Edward
—a great pity; but I suppose it will be the same as long as the world lasts. I
did the same, no doubt, when I was young too.’
He made no reply. So sure as he was that he never could have such
secrets to communicate, how could he say anything? and she went on.
‘I am not finding fault with Oswald. He has always been a good boy—
both of you,’ she said, smiling upon him. ‘You have never given me any
great anxiety. And everything has turned out well hitherto. They will have
plenty of money; but so long as Oswald does not say anything, how can I
speak to her father, as I should like to do? Men do not notice such things;
and it seems uncandid with so good a friend; but till Oswald speaks—I hope
he will be an attentive husband, Edward. He will be kind; but there are
many little attentions that a fanciful girl expects—and feels the want of
when they fail her.’
Edward said nothing to all this; how could he? He winced, but bore it
stoutly, though he could not make any reply. It was better to accustom
himself to have it talked about; but he could not himself enter upon the
subject. ‘Will you mind if I leave this evening, for a little?’ he said.
‘No, dear; certainly not—but, Edward,’ she said, coming round to him as
she rose from the table, and laying her hand on his arm, ‘are you sure it is
good for you, my dear boy? are you not making it harder for yourself?’
‘Let me alone, mother—so long as I can,’ he said, hoarsely. ‘No; it does
not make it harder; and it can’t last long now.’
 ‘No—there is no reason why they should wait. I wish—I wish he may
not be a careless husband, Edward. Why should he spend all his evenings
away? There is something in it I cannot understand.’
‘He has always been the happy one, mother. Whatever he has wished for
has come to him. He does not know what it is to be so fortunate—nothing
has cost him any trouble—not even this.’
‘Still, he should not be away every evening,’ said the mother, shaking
her head; and she drew him down to her and kissed his cheek tenderly. ‘My
boy! we must comfort each other,’ she said, with soft tears in her eyes. Her
heart bled for him in the troubles she divined, and she was one of the
women who never lose their interest in the trials of youthful love. Yet,
sympathetic as she was, she smiled too as she went upstairs. He thought this
would last for ever—that he would never change his mind, nor suffer a new
affection to steal into his heart. She smiled a little, and shook her head all
by herself. How short-lived were their nevers and for evers! She went up to
the drawing-room, where she had spent so many quiet evenings, pleased to
think that her boys were happy, though they were not with her; where she
had thought of them at school, at college, in all the different places they had
passed through, trying to follow them in her thoughts, anxiously wondering
what they were doing, often pausing to breathe out a brief, silent prayer for
them in the midst of her knitting, or when she closed her book for a
moment. This had become so habitual to her, that she would do it almost
without thinking. ‘Oh, bless my boys; keep them from evil!’—between how
many sentences of how many books—in the pauses of how many
conversations—woven through and through how many pieces of wool, had
those simple supplications gone!
By-and-by she heard the door close of the next house, the bell ring in her
own, the familiar step on the stair, and the neighbour came in and took his
usual place. They sat on each side of the fireplace, in which still glimmered
a little fire, though the season was warm. It irked her that she could not
continue with him the conversation she had been having with Edward; but
till Oswald spoke what could she say? and they had plenty to talk about.
‘I wonder,’ he said, ‘if it was a bad dream when I was sent away—not
knowing why, or where to go?’
‘Where were you going? I never wished it. How I should have missed
you now! It is in trouble that we want our friends most. Edward has been so
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

textbookfull.com