The politics of pick’n’mix

‘Choose life. Choose a job. Choose a career. Choose a family. Choose a big fucking television. Choose washing machines, cars, compact disc players and electrical tin openers. Choose DIY and wondering who you are on a Sunday morning….’ So says Renton, the heroin-addled anti-hero of Trainspotting, Irvine Welsh’s Edinburgh-set tale of drugs, sex and crime, in a rant against the tedium of everyday consumer life. As anyone who’s read the book or watched the film will know, Renton chooses ‘not to choose life. I chose something else’: drugs.

You don’t have to be a junky living on the edge in an edgy novel to believe that, while modern life is full of choices, it can also be unfulfilling. Barry Schwartz is Dorwin Cartwright Professor of Social Theory and Social Action at Swarthmore College near Philadelphia (about as far removed from Renton as you can get), and author of The Paradox of Choice: Why More Is Less. He argues that we’re so inundated with choices today – whether we’re buying a pair of shoes, ordering a cup of coffee, or signing up for a college course – that everyday decisions are becoming increasingly fraught, causing individuals to suffer from ‘decision-making paralysis, anxiety and perpetual stress’. No wonder some people choose to choose ‘something else’.

Schwartz tells me that one of his major concerns is that the ‘choice ethic’ has extended from the shopping mall to politics, healthcare, education, family life, lifestyle and ‘just about everywhere else’. Today we not only have decisions, decisions to make about what kind of food, cars or clothes to buy (with choices between 285 varieties of cookies (21 of them chocolate chip), 61 varieties of suntan oil or sunblock and 230 kinds of soup, if you frequent the same American supermarket as Schwartz does), but also in areas of life not traditionally defined by the consumerist ethos.

So ‘student choice’ is the buzzphrase in universities, with students encouraged to pick’n’mix their modules and sometimes even to choose their preferred ‘learning styles’; Schwartz describes the modern university as ‘a kind of intellectual shopping mall’. ‘Patient choice’ is all the rage in healthcare; in his book Schwartz reports that his wife compares going to the doctor to going to the hairdresser, after she discovered that her doctor’s ‘philosophy’ is to carry out examinations that are ‘guided by the desires of the patient’ (1). In Britain the Labour government and the Tories clash over who is most pro-choice, desperately trying to out-commit each other on giving parents choice over schools and patients choices over hospital treatment (Labour prime minister Tony Blair is currently in the lead, having mentioned the C-word eight times in his conference speech in Brighton this week).

Meanwhile, other areas of life that were once defined by tradition or authority – work, religious affiliation, marriage – are now reposed as ‘lifestyle choices’, with an emphasis on individuals picking the kind of work, life and work/life balance that best suits them rather then doing What Is Expected. As the subheadings in the chapter on ‘New Choices’ in Schwartz’s book have it, not only do we choose between consumer goods today; we also choose how to work, choose how to love, choose how to pray, choose who to be….

Yet Schwartz tells me that, ‘all these choices can be overwhelming for people’. In his book he goes so far as to claim that today’s ‘overwhelming abundance of choice’, in a ‘culture that tells us there is no excuse for falling short of perfection’, can lead to clinical depression (2). He seems rather down on the idea of choice, describing his book as an attempt to ‘help individuals identify whether they have a problem with choice, and to simplify their psychological choice space’. Surely having more choice is a good thing? Isn’t it better to have 21 varieties of chocolate chip cookies rather than one? More importantly, isn’t it good that we can choose whether and when to get married, whether or not to have kids, whether to believe in god and what kind of god to believe in, and what sort of job to have?

Schwartz claims that he agrees. He says choice is ‘essential to our autonomy, to being able to control our destinies’, and insists that his book is not a call for returning to a pre-choice past. Rather, he is concerned that the rise of choice today is often motivated less by a positive impulse to give individuals more autonomy, than by an attempt to lumber individuals with more responsibility.

‘In some of these areas, like education and healthcare, the reason to say “Let’s have choice” is if there’s real doubt about the authority-imposed course of action’, he says. ‘So rather than trying to argue down the doubt they say “let people choose”, and we don’t have a public debate anymore.’

He cites the example of schools – on both sides of the Atlantic officials have been talking up the importance of ‘school choice’, promising parents more choices over which school to send their kids to and, in some instances, over teaching styles, lesson programmes and the rest. For Schwartz, this kind of choice is really a way for the education authorities to avoid taking responsibility for determining what a good school is and what the role of education ought to be. ‘Instead of figuring out what we need to do to recapture high-quality education and then getting on with it, they say: “Okay, we don’t know any better than you do about how to teach kids, so let’s get together, start a school and see what happens.”’

He sees a similar process at work in medicine, where promoting ‘patient choice’ has become a way for doctors to avoid ‘making hard decisions’, such as ‘what kind of medical treatment should this person take?’ Following his wife’s trip to the doctor who, by leaving all the big decisions to the customer (patient), behaved more like a hairdresser, Schwartz writes in his book that: ‘The tenor of medical practice has shifted from one in which the all-knowing, paternalistic doctor tells the patient what must be done – or just does it – to one in which the doctor arrays the possibilities before the patient, along with the likely plusses and minuses of each, and the patient makes a choice.’ (3)

The rise of patient choice is something we have discussed many times on spiked, particularly in relation to the decline of medical authority. In recent years the medical authorities have been accused of aloofness and arrogance for daring to claim that they know what’s best for sick people. In Britain, part of the New Labour government’s modernising agenda (or its war against the ‘forces of conservatism’ as some ministers fancifully describe it) has been to promote patient empowerment against medical paternalism. In this case, ‘patient choice’ is not some positive push to give people a real say; after all, most non-medically trained people are not in the best position to decide how their multiple sclerosis should be treated or how many courses of chemo their cancer growth needs. Rather, the emphasis on choice in the GP surgery and the hospital ward reflects the erosion of the men of medicine’s decision-making authority.

The promotion of this kind of choice can easily backfire, as it did over the MMR vaccine. Many in political and medical circles found it tough-going to argue against the supporters of Dr Andrew Wakefield, the gastroenterologist who in 1998 first made the unfounded claim that the measles, mumps and rubella vaccine can cause autism. Wakefield supporters demand that parents should be able to choose between having the triple MMR vaccine and a course of three single vaccines (which are more expensive and, because they’re given over a period of time, ultimately less protective). Having put choice at the heart of healthcare, the authorities are not best placed to put the case for the benefits of mass vaccination against the demands of a minority for choice.

Following the MMR debate from across the water, Schwartz says that both sides seem to be avoiding responsibility. He reckons the authorities have avoided ‘having a hard discussion about immunisation, or insisting on it as a matter of public health for which they should try to win widespread public support’. And on the other side, ‘those who oppose the vaccine say “just let us have a choice” because they also are avoiding having a hard discussion – in their case making the case that children shouldn’t get the MMR vaccine’.

In education and healthcare, says Schwartz, what is promoted as individual choice is often really the authorities shirking responsibility. ‘The state puts the responsibility on the individual’, he argues. ‘But in these cases, individuals are not in a position to accept that responsibility. They don’t know enough. It’s a rare parent who knows the ins and outs of pedagogy or medical treatment.’

It strikes me that the rise of ‘lifestyle choice’, surely one of the most over-used and under-interrogated phrases of our age, is also driven more by a sense of indirection at the heart of society than by a positive desire to break the rules and experiment with new ways of living, working and believing. Just about anything can be defined as a lifestyle choice these days, from getting married to having children, from having your nipples pierced to undergoing a sex-change op; at the more extreme end, even such activities as self-harm can be presented in terms of choice (albeit ‘unhealthy’ ones) (4). It is society’s inability to say what is a good life and what isn’t – to integrate individuals and provide them with a coherent sense of identity – that gives rise to this flourishing of ‘lifestyle choices’. Indeed, the common riposte ‘This is my lifestyle choice!’, intended as a way of seeing off any heavy or judgemental criticism, reflects this climate of moral relativism. Who is society, or anybody else for that matter, to pass judgement on how an individual chooses to live, work or play?

Schwartz says that the notion of ‘what a good life for a human being is’ is often absent from contemporary debate. ‘Nobody talks about that anymore. Well, the only people who talk about it are the religious right – and their idea of a good life is not my idea of a good life.’

The argument that the rise of these hollow choices reflects a relativist climate is a pertinent one. But surely the way to challenge this is not to argue that we have too much choice, but to put the case for real, meaningful choices? Schwartz’s book interrogates what lies behind the choice mantra, but it almost leaves you feeling that choice, or certainly a lot of choice, is potentially a bad thing. He lists the numerous choices we have in supermarkets, schools, colleges and hospitals, arguing that just because ‘some choice is good doesn’t necessarily mean that more choice is better’ (5).

This could be interpreted as an argument for limiting choice, in order to protect people from becoming depressed. Instead of challenging a society that can only promote paltry choices rather than offering true autonomy, Schwartz focuses too much on the individual, on helping us to ‘cope’ with having, apparently, ‘too many choices’. Yet choice, as it is discussed today, is a symptom of a larger, societal problem; shouldn’t we focus on that, rather than problematising the idea of choice itself?

In many ways, the purchase given to ‘choice’ today can be seen as officialdom’s attempt to give a positive spin to what is in fact an identity crisis in Western society – to make a virtue of a vacuum, if you like. So doubt at the top of society about medical wisdom and the importance of education is reposed in terms of granting ‘patient empowerment’ and ‘parental choice’; the failure of society to put forward a vision of a Good Life is transformed into the rise of endless, seemingly positive ‘lifestyle choices’.

That these kind of choices are driven more by official indecision than by a clamour for liberation is clear from the fact that choice today coexists with creeping conformism. So a pregnant woman, as an all-powerful patient, has choices over what kind of birth to have – whether natural, home, water or whatever. But if she chooses to smoke a cigarette or quaff some wine during her nine months with child she can expect to be denounced as reckless and irresponsible. Likewise, we have more lifestyle choices at a time when official intervention into personal relationships – between husband and wife, or parent and child – has rarely been greater. Society celebrates certain kinds of choice, while chastising and reprimanding others. Rather than too much choice being a bad thing, the problem today is that we don’t have enough real choices – in private life, politics and society.

Schwartz argues that a big problem is the spread of consumerist mentality into an area where it doesn’t belong – public life. ‘In an earlier book I looked at how taking the market as a model for all things is an unmitigated disaster’, he says. ‘In education or social relations or politics – once you start talking about these things as consumer goods and start reshaping these institutions so that they work like markets, you take almost everything that is good about them away.’

In effect we are reduced to consumers, not only in the supermarket, but in politics too. Our relationship to pressing public issues becomes the same as our relationship to those 21 varieties of chocolate chip cookies – a passive one, where our role is to pick things off the shelf, try them out and decide whether we like them, rather than an active role where we make real decisions and shape the world around us.

Schwartz says there is a ‘paradox’ in this extension of consumerist choice – it can actually undermine true public participation rather than increase it. He cites the work of ‘the very distinguished economist’ Albert Hirschman, who in 1970 wrote a book called Exit Voice and Loyalty: Responses to Declines in Firms, Organisations and States (6). ‘Hirschman argued that when people are dissatisfied with something in the market their response is to “exit” – they stop shopping there or they boycott a product’, says Schwartz. ‘When they’re dissatisfied with something in the public domain, however, the appropriate response is “voice” – like with a school, they would start yelling and tell people why they don’t like it. They didn’t “exit” the school and go somewhere else.’

Today, says Schwartz, as consumerism extends ever-further, ‘exit’ has become a common response in public life as well as in the shopping aisles. ‘So there’s no idea of a neighbourhood school anymore’, he says, as an example. ‘If you don’t like the school, why not pull your kid out and “choose” one of the others, rather than doing the hard work of changing the problem school?’

Faced with such hollow choices in a conformist age, we should avoid arguing that choice itself is a bad thing and rather reclaim the C-word from those who have co-opted it. Perhaps we should follow Renton’s advice after all and ‘choose something else’ – not his downward spiral, but a new pro-choice campaign for keeping consumerism where it belongs, and for individuals to be able to make real choices and exercise real autonomy in both their private lives and public life.

spiked-conference: Whose Choice Is It Anyway? Challenging the New Conformism. On 11 March 2005, spiked is hosting a conference interrogating the meaning of choice in the age of the new conformism, at a venue in central London. For more information, email Helene Guldberg.

The Paradox of Choice: Why More Is Less by Barry Schwartz is published by HarperCollins. Buy this book from Amazon (UK) and Amazon (USA).

(1) p30, The Paradox of Choice: Why More Is Less, Barry Schwartz, HarperCollins, 2004

(2) Introduction, The Paradox of Choice: Why More Is Less, Barry Schwartz, HarperCollins, 2004

(3) p30, The Paradox of Choice: Why More Is Less, Barry Schwartz, HarperCollins, 2004

(4) See Self-harm: cut it out, by Josie Appleton

(5) p3, The Paradox of Choice: Why More Is Less, Barry Schwartz, HarperCollins, 2004

(6) Exit Voice and Loyalty: Responses to Declines in Firms, Organisations and States, Albert Hirschman, Harvard University Press, 1970