James Carey

Accounts of meaningful work often identify some feature of lives that makes them meaningful and then look for that feature in work. These are what I call derivative accounts. They explicitly derive an account of meaningful work from a theory of meaning in life. I argue that this approach is flawed in ways that have been overlooked and instead explore an alternative approach to theorising about meaningful work. On my intrinsic account, work’s distinctive features explain what makes work meaningful without problematic appeal to a theory of meaning in life. I develop a definition of work as activity primarily intended to produce interpersonal use-value, with which I substantiate the intrinsic account: work can be meaningful when the production of interpersonal use-values reflects an individual worker's skills and capabilities; or when a worker values contributing to said interpersonal use-values. Though my intrinsic account has a somewhat revisionist upshot, I argue this price is worth paying for a finer-grained understanding of meaningful work without the flaws of derivative accounts. I conclude with additional reasons to adopt my account, suggesting it can provide a political basis for the choiceworthiness of meaningful work.

Background Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave. Objectives To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals. Methods We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science – Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility. Results Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie. Conclusion Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.