Emotional styles in Russian maternity hospitals: juggling between khamstvo and smiling

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  • 1 European University at Saint-Petersburg, , Russia
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This article explores emotional styles of Russian maternity hospitals and their recent changes. We focus on two emotional practices that characterise different emotional styles: the Soviet-associated emotional practice of khamstvo (rudeness) and the post-Soviet neoliberal practice of smiling. Emotional styles in healthcare in Russia have been transformed under childbearing women’s consumer demands and new professional standards. However, maternity care in Russia has not been changed entirely into a neoliberal capitalist one. It is ruled by both bureaucratic paternalist (including direct state control) and consumerist logics simultaneously. The hybridisation of these logics has led to numerous problems in the coordination of institutional inconsistencies, which in turn cause emotional dissatisfaction of healthcare recipients. Doctors and midwives are expected to cope with these interactional and institutional challenges and consequences. They juggle emotional practices that refer to repertoires of different emotional styles, performing one or another according to their reading of the situation and type of patient (‘extra demanding and aggressive’, ‘miserable’, ‘ignorant and noncompliant’, ‘service-oriented’). We argue that the shift from one emotional style to another is nonlinear and leads to the appearance of a hybrid form that makes both emotional practices of khamstvo and smiling coexist in maternity care.

Abstract

This article explores emotional styles of Russian maternity hospitals and their recent changes. We focus on two emotional practices that characterise different emotional styles: the Soviet-associated emotional practice of khamstvo (rudeness) and the post-Soviet neoliberal practice of smiling. Emotional styles in healthcare in Russia have been transformed under childbearing women’s consumer demands and new professional standards. However, maternity care in Russia has not been changed entirely into a neoliberal capitalist one. It is ruled by both bureaucratic paternalist (including direct state control) and consumerist logics simultaneously. The hybridisation of these logics has led to numerous problems in the coordination of institutional inconsistencies, which in turn cause emotional dissatisfaction of healthcare recipients. Doctors and midwives are expected to cope with these interactional and institutional challenges and consequences. They juggle emotional practices that refer to repertoires of different emotional styles, performing one or another according to their reading of the situation and type of patient (‘extra demanding and aggressive’, ‘miserable’, ‘ignorant and noncompliant’, ‘service-oriented’). We argue that the shift from one emotional style to another is nonlinear and leads to the appearance of a hybrid form that makes both emotional practices of khamstvo and smiling coexist in maternity care.

Introduction

This article explores how emotional practices in post-Soviet Russian maternity care institutions have been reflexively negotiated, shifting from the dominant Soviet emotional style (characterised by khamstvo – rudeness) to the capitalist service style (signified by smiling). We understand an ‘emotional style’ as a repertoire of performed emotional practices, which are ultimately shaped by cultural and institutional contexts.

In this article we focus on emotional styles of maternity hospitals and their transformation within an institutional setting that is neither socialist anymore, nor entirely transformed into a neoliberal capitalist one. Therefore, we conceptualise the post-Soviet context as a hybrid: it combines the legacy of Soviet paternalistic bureaucratic logic (including direct, strict state control and sanctions), with following neoliberal market logic. The hybridisation of these logics has led to numerous problems in both inter- and intra-organisational coordination in maternity hospitals, which consist of contradictory rules and systematic miscommunication. Assertive healthcare recipients (patients) often respond emotionally to such organisational inconsistencies when their expectations are not met. In order to navigate institutional and organisational inconsistencies in hospitals produced by the post-socialist healthcare reforms, to prevent patients’ outbursts and complaints, and following sanctions and fees, healthcare providers systematically mobilise emotional practices from both Soviet and post-Soviet repertoires. Interactions with patients and with each other are managed in a ‘manual way’ (ruchnoe upravlenie). Such ruchnoe upravlenie manifests itself as a personified mode of communication, which involves particular kinds of emotional practices drawn from different emotional styles.

Previously, Soviet doctors often communicated with patients in a distinct rude style, to assert their authority vis-à-vis their patients as an appropriate way of ‘disciplining’ them. This style was identified as humiliating khamstvo and negatively evaluated by patients. In an age of post-Soviet neoliberal reforms, growing demands for consumer-oriented practices are coming from patients (especially from childbearing women), and healthcare providers are required to display a different style of emotional practices, expressed in the metaphor of smile. The neoliberal culture in Russia constitutes a new style of smiling in maternity care, which presupposes that patients are consumers who need to be attracted and therefore that their needs as individuals (as mothers and healthcare recipients) should be taken into account.

It might be argued that under the sway of commercialisation and the consequent capitalist emotionalisation of post-Soviet society, the new consumer-oriented emotional style of smiling simply comes to displace the previous style of rudeness. However, our research problematises such a linear account. In contrast, we argue that these styles coexist in contemporary Russian health institutions. Khamstvo as an emotional practice is still there, but its meaning has changed, and it no longer constitutes the dominant style.

The aim of this article is to explore what happens on the organisational level and how emotional styles are changing in the medical settings of maternity care – in our case, in a highly technologically equipped perinatal centre – during the first two decades of the 21st century. Focusing on maternity care is particularly interesting and relevant for understanding this change in emotional styles. Women are not ‘sick people’; in most cases they are healthy recipients of prenatal, postnatal and delivery services who find themselves in the liminal process of transforming into mothers. However, in Russia they are by default treated as sick patients due to the medicalisation of the reproductive experience and illegal status of independent midwifery practice and homebirth. Moreover, not only are pregnant and labouring women placed into a system of hospital-based maternity care, they also quite often still receive negative experiences there. Therefore, it is important to grasp the background of the Soviet paternalistic state-sponsored system of healthcare and its dominant emotional practice of khamstvo.

The article proceeds as follows. First, we develop the conceptual framework for our research by exploring the connections between institutional contexts and emotional styles/practices in maternity care in post-Soviet Russia. Second, we analyse the dominant emotional practice of khamstvo in the Soviet paternalistic system of maternity care, and its legacy in post-Soviet institutions. Third, we explain how mothers-to-be in their new role as consumers and the new organisational structures in maternity care have caused changes in the repertoire of emotional practices of maternity care, and show how, according to our research, new smiling practices have emerged. Fourth, we analyse how emotional styles have been hybridised in maternity care, and how healthcare providers choose and perform certain emotional practices during interactions with patients.

Conceptual framework for researching emotional styles in maternity care

Post-Soviet neoliberalisation has led to changes in emotional styles and practices in healthcare institutions. However, both Soviet (khamstvo) and post-Soviet (smiling) emotional practices coexist in contemporary Russian healthcare, which is characterised by the hybridisation of Soviet paternalistic bureaucratic and post-Soviet neoliberal market logics. Here we refer to the concepts of ‘emotional capitalism’ and ‘emotional socialism’ as broader contexts in which these emotional styles are being formed and inscribed.

The conceptual tools that we use (for example, ‘emotional styles’, ‘emotional practices’ and so on) have been developed in different traditions by such authors as Stearns and Stearns (1985), Reddy (2001, 2008), Plamper (2010) and Rosenwein (2010). These studies examine the social norms, standards or values imposed on the expression and use of emotions in a specific historical period, context, culture, or subgroup. In addition, more attention is given to the emotional styles in public institutions nowadays, where emotions are more articulated and negotiated. The institutional theory also attempts to explore noticeable changes that emotions can produce in institutions (Friedland, 2018). In our research, we use the conceptual apparatus of these studies to create a framework that would establish links between institutions and emotions.

The connection between communities and spaces with emotional styles can be explored differently (Gammerl, 2012). In our case, we understand emotional styles as the repertoires of emotional practices not limited to, but characteristic of certain types of interaction in institutional contexts in medicine, the service sector and public spaces. A person can simultaneously belong to communities or institutional settings that adhere to different emotional styles and can therefore perform emotional practices from the repertoires of different emotional styles.

Emotional styles historically replace one another (Reddy, 2001; Illouz, 2007). However, we emphasise that the shift from one emotional style to another can be nonlinear, and multiple styles can coexist. By exploring the repertoires of emotional practices at the level of medical institutions, we discover the hybridisation of emotional styles, which is related to the hybridisation of organisational logics in the institutional field.

We conceptualise the emotional practices of khamstvo and smiling as the dominant signifiers (in other words, the most notable parts of the repertoires) of Soviet and post-Soviet emotional styles in maternity care respectively. These practices are culturally and institutionally embedded, sensitive to the settings in which they are performed, are experienced both discursively and bodily, can be named, and serve communication needs. In this sense, our description of emotional practices approaches the notion of habitus (Sheer, 2012), if we conceptualise them more as ‘internalised emotional dispositions’ (cf. Illouz, 2007; Sieben and Wettergren, 2010: 5).

As Middleton (1989) points out, ‘emotional style connects individual experience with historically derived group cognitive and moral structures which, in turn, supply the meaning and motivation by which individuals enact and interpret style and self in their daily lives’. Researchers show that historically specific economic, cultural and political conditions constitute emotional styles (or emotional regimes) and repertoires of emotional practices within them (Middleton, 1989; Reddy, 2001; Illouz, 2007; Gammerl, 2012; Lerner, 2015). To define the emotional styles that we refer to, we use the concepts of ‘emotional socialism’ (Lerner, 2015) and ‘emotional capitalism’ (Illouz, 2007), which could (or could not) replace each other as corresponding changes occur in the economic, political and cultural life of the region.

‘Emotional capitalism’ (Illouz, 2007) is a broad concept that describes the translation of emotions into the language of the market economy as well as the incorporation of emotions into the capitalist labour market. The commodification of emotions and other effects of emotional capitalism vary according to institutions – for example, from marriage to the workplace – in Western neoliberal societies. Emotions have become a subject of reflection, control and rationalisation, which are constitutive elements of ‘emotional capitalism’ (Illouz, 2007; Lerner, 2015). This concept is sensitive to context, and these emotional models can be applied to post-socialist societies only to a limited extent. Julia Lerner (2015: 6) uses the term ‘emotional socialism’ as more appropriate for the post-Soviet Russian context than ‘emotional capitalism’:

As emotional capitalism is rooted in principles of capitalist structure and is strengthened by features of American culture, the socialist regime was crucial for shaping emotional style, but it was also reinforced in Russian and Soviet cultural authoritative powers such as the Russian literary tradition, the Russian Orthodox faith, and later the Soviet ideology.

The partial shift from emotional socialism to emotional capitalism has been accompanied by the emergence of a consumer society in Russia. The repertoires of emotional practices within institutions change together with the large-scale changes of emotional styles.

The ongoing shift in Russian institutional settings can be characterised as changing towards ‘the display and embrace of “positive” emotions […] while it requires the control and management of “negative” ones’ (Sieben and Wettergren, 2010: 4). This process requires special ‘emotional labour’ (a term introduced by Arlie Hochschild) – the part of a paid job that includes following certain feeling rules and which is especially common in professional spheres requiring face-to-face communication (Hochschild, 1983). At the level of intra-organisational interactions, the concept of ‘emotional labour’ further refers to situations in which communicational competencies and the management of emotions are ‘required to be a good manager and a competent member of a corporation’ (Sieben and Wettergren, 2010: 18)

The shift to ‘positive emotions’ (smiling) in the Russian healthcare is taking place amid the confusion of new (post-Soviet) consumerisation and remaining (Soviet) bureaucratised and paternalistic relations and the confusion of different emotional styles as well. Here we focus on maternity care as an institution which incorporates emotional practices that characterise competing emotional styles – both khamstvo and smiling at the same time.

The structural changes taking place after the Soviet collapse have not only affected the formal rules and order, regulating and redesigning the arrangement and provision of healthcare services, but have also shaped the rules and repertoires of emotional practices in these settings. But how do actors (healthcare providers/professionals) choose which one to apply? How are emotional practices shaped by institutional settings (maternity hospitals)? In the latter part of this article, we will explore this in more detail, showing how providers juggle with different emotional practices, whose repertoire is institutionally shaped, but could also be situational and intentional.

We hereby aim to explain the complex repertoire of emotional practices as medical providers opt to manually borrow different practices from multiple emotional styles as tools to achieve agreement, prevent patients’ complaints and solve institutional problems. The new demands of childbearing women, combined with the institutionally limited possibilities for clinicians to meet these demands, produce multiple modes of emotional expression in the organisations we study. Emotional work has to be performed by providers in order to mitigate recipients’ structurally determined inconveniences.

Research methods and data

This article is based on qualitative empirical data collected by the authors between 2019 and 2020 in a maternity care institution located in St Petersburg, Russia. Our main source of empirical data are ethnographic observations and in-depth interviews with women who received maternity care in last three years. In 2019, we implemented an intensive ethnographic work, which consisted of 33 observational sessions (249 hours of observation). Finally, in 2020, we conducted 15 in-depth interviews with women who had received maternity and child services in the hospital within the last three years.

In order to frame the problem more broadly, in this article we also refer to other sources of data from maternity care-related projects that we conducted in 2015–18 in different locations: 18 interviews with maternity care providers and eight patients in 2018; 24 interviews with maternity care providers in 2015–17; 35 interviews with women who paid for maternity services, and 24 women who received it for free (that is, used only mandatory healthcare insurance to cover the cost of the services) in 2015–17. Our methodological reasoning for including these datasets in the current analysis is to verify our findings and to provide more anonymity to our participants.

In every project, we conducted our research under the following ethical principles. We obtained informed consent (written or verbal and audio-recorded) from our interlocutors for their participation in the study; described to them the objectives of the study and our professional status (who we were and what we were doing); and explained the terms and conditions of using the data we gathered. We provide anonymity for all our interlocutors and confidentiality of the information during the public presentation of results in articles or publications, with anonymisation of personal facts and personal data. We worked to protect research data from unauthorised access and to prevent the dissemination of personal facts that could potentially identify research participants.

The project ‘Patient-centered care in Russian healthcare: organizational challenges and professionals’ opportunities’, which is the key source of data for this article, was approved by two ethical committees. The first one is sociological and located in the Saint Petersburg Association of Sociologists (SPAS); the other one is medical and is located at our fieldwork site.

Our analysis has certain limitations. First, our main field site is a highly technological maternity hospital which provides best practices for its patients. The hybridity of emotional practices in this organisation can be imbalanced towards smiling more than in some other spaces. Our interviews and analysis of media in other projects shows that khamstvo can remain very strong in some settings or as a peculiarity of a certain subject. Second, our analysis can be cautiously extrapolated to other healthcare sectors in Russia, because of specificity of maternity care in terms of state control, emotional expectations of women and so on.

Emotional practice of khamstvo in maternity care

We suggest conceptualising khamstvo here as a particular and widespread Russian-Soviet emotional practice which was taken-for-granted in maternity care as a way of performing professionals’ (healthcare providers’) situational power over childbearing women (healthcare recipients). Khamstvo can be described as emotional and verbal abuse, performed in imperative or declarative ways. According to Tomas Matza (2009: 518),

khamstvo is a flexible term, having either a pejorative meaning of a lack of culture and manners that is linked to Stalin’s answer to the intelligentsia – kul’turnost’ – but also a positive meaning of soulful authenticity that resists Western forms of false politeness. In either meaning, the term is often associated with the sovok, or quintessential boorish Soviet person.

Leaving aside the second meaning, we agree with M. Rivkin-Fish (2005) that khamstvo used to be an important tool to control women, placing them under clinicians’ authority, and shaping the attitudes of all participants, including the clinicians themselves, who often claimed to feel helplessness in the rigid state paternalistic hierarchies.

Khamstvo represents a special type of communicative practice, which emotionally and verbally performs status and authority in institutionally based interactions. It signifies a Soviet type of emotional style which was, and still is, widely used in post-Soviet culture, and especially applied to the style of behaviour found in service and public institutions, including health and maternity care. Khamstvo thus possesses symbolic weight, pointing to a particular Soviet style of communication.1 On the one hand, khamstvo can be expressed to highlight the lower status or more deprived position of the interlocutor. On the other hand, khamstvo often appears in circumstances in which actors obtain situational power over people with generally more privileged social status. Consequently, we suppose that this phenomenon is more widespread in authoritarian contexts and situations where rigid governing in a top-down manner is combined with a deficit of access to institutions and resources. In planned Soviet economies, khamstvo was employed routinely by service workers in situations where they acted as gatekeepers to scarce resources and their mode of communication could rarely be challenged.

In maternity care, khamstvo takes the form of interactions between women and healthcare providers, in which the latter can legitimately neglect women’s emotional needs for care and subordinate these needs to the clinical and organisational conditions. In contrast to Western healthcare systems, where doctors have obtained high social status, Soviet healthcare practitioners (mostly women) were quite deprived of professional autonomy, social position and recognition. They were considered to be the state’s representatives rather than an independent professional group with power to set its expertise and withstand challenges from bureaucratic bodies (Field, 1957; Saks, 2015). In healthcare institutions, this could, and continues to, dominate some organisational settings and result in paternalistic attitudes geared toward controlling and correcting patients who were/are considered to be ignorant and wayward.

Because pregnancy and childbirth in Soviet times – as well as in contemporary Russia – were highly medicalised (Temkina, 2014), women normatively became patients of maternity care, reflecting other trends in the healthcare system. In particular, Soviet women, as patients of maternity care services, were expected to trust the medical state institutions and clinicians working there. The objectification of women in medicalised childbirth is a common topic in feminist critique (Martin, 1987; Davis-Floyd, 2001). However, this objectification in the Soviet context was not associated with autonomous medical power and medicalisation by themselves, but rather with the political power of the state and the statist authoritarian discourse (Field, 1988). While obstetricians and midwives were often reluctant to see themselves as representatives of state power (Rivkin-Fish, 2005: 30), they nonetheless lacked professional autonomy, which led them to try to preserve their status at the level of interpersonal communication with patients.

Khamstvo was – and, as will be discussed further, sometimes still is – applied in maternity care as a sort of manipulation of emotions by base power and control. ‘Ignorant’ and ‘infantile’ women were forced to cooperate and behave in the right way during delivery for the sake of the mother’s and child’s health. Paternalistic clinical and psychological obstetric aggression was used to generate shame as a way to change patient behaviour. Doctors justified their behaviour as an effort to prevent patients from acting in a way considered wrong or shameful during the medical encounter and therefore did not see it as khamstvo (as opposed to the women, who did).

Patients in the late Soviet era had no other options than to use state medical services, which were nonetheless short of resources, unified, rigid and ignorant about personal needs. Absence of options to choose the hospital, doctor and midwife, bring a partner, or even have access to personal belongings (including underwear), considerably shaped the relationships between authoritarian state employees and the powerless obedient childbearing women (patients of hospitals). Soviet maternity hospitals were closed to any visitors and could be characterised as quasi-total institutes in Goffman’s (1961) terms, with opaque rules and practices resistant to challenges from the outside. Consequently, there was unlimited space for healthcare providers to exercise direct power and control over women through the subordination of the latter to medicalised procedures and disregard for their feelings (Rivkin-Fish, 2005).

The low status of patients, the dependence on healthcare providers as gate keepers to the care and limited resources of maternity services generated a rude power style that sought to discipline and subordinate women to organisational rules and clinicians’ convenience. Because women were totally dependent on clinicians, they had to accept these rules and conditions as their inevitable fate, and, hence, beyond women’s control or opportunity to challenge it (Temkina, 2016). To feel bound by fate is considered by scholars as a constitutive element of ‘emotional socialism’ (Lerner, 2015), while the emotional practice of khamstvo can be considered an intrinsic part, reproduced in institutions at the organisational level.

Women in our and others’ studies who had experience of childbirth in Soviet or early post-Soviet periods, endlessly repeat stories about the doctors’ and midwifes’ boorishness and neglect of their individual needs in a conveyer-like service, in which overloaded wards and ignorant, brusque and overburdened personnel were common (Schepanskaya, 1999; Rivkin-Fish, 2005).

Some women describe their experiences of the medical services as unacceptable. In particular, they refer to these experiences as ‘just horror’, pointing out the poor material conditions, inattention and khamstvo of staff, insufficient qualifications of doctors, outdated equipment and so on. Thus, khamstvo comes to convey the general atmosphere of non-patient-friendly maternity services, which becomes a general condition of dependency and helplessness:

‘I had a boy (first child) in 1999. In an ordinary, one might say, Soviet maternity hospital, where there used to be ten people in the ward. And the approach to a woman, you know … I don’t know … not as one appropriate for a woman experiencing suffering, torment, some kind of pain … Everything is managed as in [a conveyer line]. … Doctors shouted at me, and … they delivered my baby, but they did not provide any anaesthesia! I was very … I was giving birth for a very long time; it was so painful. So, in general, I was so tormented, that I decided not to give birth again ever in my life.’ (interview, mother, age 44, 2015)

Our study in 2010–2020s reveals that women still face khamstvo. A woman we interviewed said, “Yes, they are boors. They yell, damn it, but they don’t just yell, they discipline” (30-year-old, 2017). Another claimed, “The midwives were so angry, so conniving and insolent … and I asked her, ‘Well, what about the test results?’ She snapped at me then: ‘How do I know, it’s none of my business,’ and so on” (25-year-old, 2017).

Those who did not have such personal experience would refer to their mothers’ experiences, applying the frame of ‘horror stories’ and a general atmosphere of neglect. Thus, even recently, women giving birth in state-funded maternity facilities refer to the ‘Soviet approach’ in childbirth, describing rude communication from the medical personnel. Maternity care seems to be a specific case in relation to khamstvo, since it represents a setting in which a patient finds herself particularly vulnerable and sensitive to the lack of care and rude behaviour. A common refrain was articulated by one interviewed woman: ‘I read a lot about the horror of delivery in a corridor and with the khamstvo of obstetricians’ (mother, age 34, 2015). As a result, women of the post-Soviet generation have tried to avoid these ‘Soviet-style’ types of maternity care, and act strategically to obtain a childbirth experience, which is not, as one of our participants put it, ‘as in a conveyer, being alone and neglected in the corridor, when all the wards are over capacity and there is no place’ (interview, 28 years, 2015).

This authoritarian way of disciplining women in childbirth and the emotional style of khamstvo have been transformed with the structural changes of maternity care, and has begun to compete with another emotional style, that of smiling. While healthcare providers still take for granted their decision-making authority and power, including khamstvo, in order to fit patients into contradictory organisational logics, especially when patients do not want to cooperate, Soviet-style khamstvo is no longer unquestioned as being routine.

A new repertoire of emotional practices: service smiling in maternity care

As our and others’ research reveals, maternity care is shaped by the hybridisation of this new neoliberal managerialism and marketisation, on the one hand, and the Soviet-type state paternalism, on the other hand (Temkina, 2016; Cook, 2017). Khamstvo as a dominant practice has been challenged in post-Soviet times by childbearing women who see themselves as consumers. Post-Soviet reforms opened up space for the commercialisation of healthcare, the consumerisation of healthcare recipients’ behaviour, the growth of women’s demands, and, consequently, the emergence of a new emotional client-oriented style. Consumer-patients have become more assertive and vocal of their needs, as well as demanding new supportive care and professional standards – smiling or ‘service with a smile’ emerges as a response to these demands (Sturdy, 1998; Söderlund and Rosengren, 2008).

We use the term smiling both as a metaphor and emic term, although it covers broader processes of polite attentiveness representing a whole new emotional style in Russia. By the emotional practice of smiling we understand intentional and prescribed bodily and verbal practices which are aimed to perform attentiveness to women’s emotional needs and implement a new kind of ‘positive’ emotional work (in terms of Sieben and Wettergren, 2010) in medical institutions.

For doctors and midwives, this shift has been quite challenging, because it hardly correlated with their conceptions of professionalism and required extra emotional labour to satisfy the needs of this new type of healthcare recipient: service-oriented childbearing women. This meant constantly providing personalised care and working on women’s dissatisfactions as clients.

A new type of post-Soviet subject has emerged: a woman who considers herself to be independent, assertive and aware of her needs. The growth of women’s demands is connected to the new consumer and gendered practices of ‘intensive motherhood’ (Temkina, 2019; Temkina and Rivkin-Fish, 2020). The new conceptions of motherhood presuppose intensive consumption and investment of resources in child-rearing. Contemporary Russian women have sufficient knowledge about pregnancy and delivery, hospitals, and clinicians, as well as certain ideas about good care, and expectations of the emotional work they want to receive in their maternity facility. Today, childbearing women are significantly less prone to suffer or just accept their fate and khamstvo, and are more likely to actively pursue their own initiatives. Young parents are becoming a particular kind of service consumers, who actively seek the best care for themselves and their children, engaging multiple resources (including social media and networks) in order to avoid khamstvo. Forums and media have become important sources of information for navigating the various forms of maternity care. In particular, childbirth experiences with particular doctors and midwives and their styles of communication and emotional support are frequently discussed in detail. Mothers-to-be thus make their choices between multiple options, and so expect high-quality medical care that is ‘warm,’ ‘positive’, professional and personal. According to our data they desire respectful attention, support and comfortable conditions, and also expect that professionals will not be ‘impudent’ and will fulfil the emotional work of ‘holding by hand’ women during labour. As such, childbearing women have become freer and more open in the expression of their emotional needs. In fact, mothers act much more actively than recipients of other healthcare services; they have become active agents in the constitution of a new institutional order and emotional style (Borozdina and Novkunskaya, 2019; Temkina, 2019).

Many women make their choice of paid service in maternity care in order to receive a certain kind of smiling (or to avoid khamstvo). The commercial sector of maternity care, paid for out-of-pocket by clients, has developed considerably during the last two decades. Affluent women who pay for such services are more interested in receiving ‘good care’ (including emotional work) than in challenging the medicalisation of their condition (Borozdina, 2016; Temkina, 2019; Temkina and Rivkin-Fish, 2020). Childbearing women frequently repeat in interviews that they chose to pay for healthcare in order to ensure their ‘emotional security’ and support. Women are afraid of being mistreated and want to ‘avoid some boorish [khamsky] hardship … the things that happen in our [state-funded] maternity hospitals’ (mother, age 35, 2015). Many informants say that by paying for maternity services, they expect to receive more attention from healthcare providers: “Everyone who participated in this process there, everyone did it with a smile, everyone was very kind, polite, pleasant” (mother, age 29, 2015). In these cases, emotional work is an additionally paid labour, and women describe it as follows:

‘It [payment] gives a good attitude and respect, you buy respect for yourself during childbirth.’ (mother, age 28, 2015)

‘In principle, that’s why I paid, in order to have … a respectful attitude … I read and was told [that labour] is not always a positive experience … emotionally [...] I decided that we should pay for my emotional safety as well.’ (mother, age 20, 2015)

Childbearing women in general increasingly consider themselves to be consuming a service and so insist on being treated as clients, not as ignorant and vulnerable patients. Service-oriented women create a new set of challenges for healthcare providers. In particular, the growing number of official complaints and negative feedback has started to shape professional practices and communications in medical settings. According to our findings (Temkina, 2019; Temkina and Rivkin-Fish, 2020), women have gained a sense of control through being able to choose the hospital and – at least for those who pay – a particular doctor and midwife as well. The possibilities of increased earnings by attracting affluent patients have motivated clinicians to undertake this emotional labour, providing women individually with emotional care, relevant explanations and politeness as a part of medical care. As a result, there is much more ‘positive’ emotional work done in maternity hospitals today, and politeness and smiling are promoted as a preferable and even demanded practices. However, this new kind of smiling not only reflects sensitivity to the expressed needs of consumers, but forces providers to learn and implement additional psychological work (for example, emotional labour, negotiations, explanations) in order to mitigate the inconvenience caused by the systemic institutional and organisational challenges.

Hybridisation of emotional styles in Russian maternity care

Continuous reforms and multiple efforts to improve the system of maternity care in post-Soviet Russia have resulted in hybridisation of paternalistic bureaucratic and neoliberal market logics of regulation. This hybridisation has led to numerous organisational challenges for maternity care provision: contradictory rules, systematic miscommunications and patients’ complaints. As complaints constitute not only institutional, but personal threat (numerous state inspections, fees and sanctions) health providers have to cope with women’s emotional outbursts and discontent individually, in a ‘manual mode’ by mobilising practices from both Soviet and post-Soviet emotional repertoires.

Clinicians routinely make many efforts to implement emotional work for the sake of clients, and try to learn the new interactional skills of consumer service. These new efforts are aimed not only at consumers’ demands, as such, but also at mitigating the inconveniences of recipients’ maternity care, which are caused by the uncertainties of rules and norms. Formal rules and orders often contradict even the given infrastructure of maternity care, while multiple controlling bodies are both demanding and inconsistent in their requirements. Hence, conditions and rules of health organisations often do not meet neither assertive patients’ demands, nor requirements of controlling bodies. Clinicians have to navigate these multiple challenges within non-flexible institutional settings. They rarely have enough autonomy to negotiate treatment with women, have no resources or formal protocols (or scripts) to overcome contradictory bureaucratic rules and to withstand women’ growing demands, so they use different emotional practices in order to solve problems through personified ways of coordination and communication, managed in a manual mode.

In such conditions, women can routinely find themselves in situations whereby something goes wrong for them, and because they do not understand the often contradictory healthcare rules and practices, they attribute their negative experiences to failings by the professionals. Doctors and midwives expect emotional outbursts from patients; therefore, they now act more politely and smile in order to prevent clients’ complaints, repeating that it is necessary to do everything they can to reduce women’s discontent. Clinicians try to cope with and solve multiple nonstandard problems caused by organisational challenges through additional emotional work: both smiling and khamstvo are means of achieving agreement and workable conditions.

In interviews, healthcare providers tell of the expanding set of emotions they face in their work nowadays. They note how childbearing women can behave differently. Some are considered to be more demanding and inclined to emotional outburst, while others are more calm and passive. During our hospital fieldwork we observed different communicative situations, including emotionally saturated encounters.

Clinicians state that nowadays they should manage their own emotions in order to avoid or solve conflicts. The navigation of feelings has also become more complex, providers display both ‘positive’ and ‘negative’ emotions, acting as emotional jugglers, operating with practices from repertoires of different emotional styles according to their reading of the situation. Nowadays they are much more aware and reflexive about the emotional dimension of these encounters. One midwife (2018) said, “We also have conflict situations. They need to be smoothed somehow.” And as a nurse administrator (2018) put it, it is necessary to “control your emotions”. Control over emotions (‘emotional labour’ in terms of Hochschild, 1983) has thus become a required and regulated part of professional display in maternity hospitals.

Clinicians have to implement emotional labour when women express their griefs, fears and demands to clinicians. Such expressions are often accepted as reasonable and legitimate. Clinicians say that they fully understand the reasons for women’s sufferings and emotional outbursts, and they try to do what they can in order to support them and help to cope with the unfavourable conditions. The head of one department explained in what way her work becomes similar to the work of a psychologist or a priest. ‘They [women] are very unhappy. They often cry, just cry, here. They consider themselves very unhappy … Yes, we ourselves have already become psychotherapists’ (senior doctor, 2018). She says that it is very important to speak with the women, to explain their health condition, and try to calm them down by listening or addressing the problems. But not all clinicians are ready for such work. And there is no special training. Consequently, more experienced, senior doctors are left with this burden.

Smiling has become another emotional tool to manage relations with ‘service-oriented’ clients, who, according to providers, typically have consumer-oriented demands – often unrealistic in the settings of state-funded maternity facilities. Providers assert that such women will routinely treat them as personal servants and can humiliate them (Temkina, 2019). While scholarship has proven that ‘the service worker produce[s] a higher level of customer satisfaction when she/he smiled compared to when she/he did not’ (Söderlund and Rosengren, 2008: 564), the clinicians we observed are ambivalent about this. Doctors often resent the market rhetoric of women and express feelings of deprivation at being turned into ‘service workers’ instead of ‘high-ranking experts’. They consider the market-based system to have been imposed on them, that clinical work is based on medical knowledge and differs significantly from a ‘service’, and they try to insulate themselves from consumer behaviour and the demands for artificial smiling at patients. They are required, both by clients and the hospital administration, to adopt such practices, but at the same time, they try to maintain a symbolic boundary between providing medical expertise and customer service.

One doctor complains: “Some already perceive medicine as a service system,” and adds with irony “Should we smile to all of them, then?” (field note, 2019). A childbearing woman recounts the advice she received to pay if she wants a smile (25-year-old, 2017). But, in general, smiling practice is becoming more accepted among healthcare professionals. A midwife tells of how she has learned to ‘close her mouth’ to prevent conflict. She explains,

‘Usually women who pay are more demanding and capricious. In general, we can identify them by sight, and there should never be any conflicts with these women in principle … we are trying to pay more attention to them. Although … you go directly to the cooler and bring them water [if that is their demand], and you do it in a nice way. True, it’s not my job to go to the cooler and serve them. But we close our mouths and go to the cooler. [...] Conflict prevention.’ (midwife, 2018)

When dealing with ‘demanding’ or ‘miserable’ women, doctors and midwives are more likely to express ‘positive’ emotions with a smile.

While smiling has become a required emotional work to be accomplished, khamstvo is still reported as a familiar emotional practice. Khamstvo remained a practice of obedience in medical settings conditioned by structural inconsistencies and the lack of autonomy and authority in medical professions. These structural prerequisites and communicational practices have been partially inherited from the Soviet style of communication of contemporary medical institutions and specialists in Russia (see Litvina et al, 2020).

Emotions are strongly expressed in communications with those maternity care recipients whom clinicians name ‘extremist’ or ‘terrorist’ patients. In such encounters doctors feel powerless, and they try to control situation and defend themselves as a response to patients’ khamstvo (cf Matza, 2009: 510), sometimes in a rude way. In these cases, both sides accuse each other of khamstvo. According to healthcare providers, ‘extremist patients’ overreact, complain a lot to the organisation’s administration and different controlling bodies, and accuse clinicians of incorrect treatment, care and inappropriate communication. As a result of these accusations, the administration has to communicate extensively with such patients by doing a lot of extra emotional work and ‘explanatory memorandums’ (ob’yasnitel’niye zapiski). Doctors consider accusations by such ‘extremist patients’ to be totally unfair. They all feel they are doing their best for all their patients, and, because of the accusations and their consequences, feel themselves vulnerable to the khamstvo of demanding women as well as state inspectors.

Clinicians explain that some consumer women’s demands are unrealistic, but women insist on them, sometimes in a rude way:

‘She was so … she considered that she was the smartest, she knew better than everyone around. She was conflictual and aggressive, she recorded everything on a tape-recorder, nobody knew for what reason. She criticised everything here. But our possibilities [for treatment] were really limited by the child’s health conditions.’ (Senior doctor, 2018)

Furthermore, the senior doctor explains, women’s complaints of khamstvo from medical personnel is leading to numerous legal trials and discontent among clinicians: “A woman after surgery … complained about the nurse in intensive care that … the nurse reacted negatively, somehow, she was khamski, somehow she was rude to her … [She wrote complaints]”. And as the doctor continues, the term khamstvo can be used by both healthcare providers and recipients: “He [the women’s husband] wrote such a devastating complaint against a doctor, generally ‘What a khamka [boor]!’ ... She [the doctor] had already had such complaints, in general … She is a good specialist, but she is, well … sometimes very ... well, a little bit bitchy” (senior doctor, 2018).

In this case, the senior doctor accuses not only a client, but another doctor as well of khamstvo, which appears to be a category that can be subjectively attributed to any participant of the communication. Both recipients and providers can feel a legitimate ‘right’ to discipline the other side, as the distribution of power in their interactions is quite complicated (more on that in Litvina et al, 2020). Doctors and midwives explain the reason for khamstvo as resulting from the ‘inappropriate’ reactions of women. In order to calm such situations, clinicians can be rude in some cases or polite in others depending on the particular circumstances and context. In order to cope with the stress caused by such situations, doctors and administrators try to seek legal protection, but often they feel themselves to be completely unprotected (Litvina et al, 2020) in the face of regulatory agents.

Emotional work in a rude manner is performed by medical professionals towards ‘irresponsible ignorant’ women, who, according to them, do not want to follow instructions, quarrel with doctors and midwives, have no relevant knowledge, are not ‘prepared for childbirth’ (in other words, do not meet the expectations of health providers), do not want to take personal responsibility, and articulate irrelevant demands. In general, doctors are convinced that, as experts, they are the only ones possesing reliable knowledge, and hence, consider rudeness as one of the appropriate tools to convince women to follow instructions for their own good. In such cases, doctors consider themselves as paternalistically implementing discipline and quasi-parenting. Clinicians emotionally express confusion when a woman’s demands do not fit the organisational rules and do not correlate with the limitations of the maternity hospital or clinical possibilities. Health providers often tell us with indignation that women do not understand that there are rules, orders and norms. In these cases, clinicians see themselves as simultaneously knowledgeable and responsible, while being assertive (which some patients would frame as khamstvo) to correct and teach the ‘ignorant’ (childlike) women how to behave properly.

Here is one example of an interaction we observed at our field site. The woman in labour screams while the doctor manually opens her cervix. The doctor speaks in a raised voice.

Doctor:‘[Ira], what are you doing? You are an adult.’
Ira:‘It hurts!’
Doctor:‘It’s not that painful.’
Ira:‘Please, don’t press like that!’
Doctor:‘I am not pressing. You are the one trying to find a way out.’
Ira:‘I can’t!’
Doctor:‘You can, you can. Now the anaesthesiologists will come and they will save you [give anaesthesia]. If you do not obey me, then none of this will work. You don’t have to resist.’
Ira:‘I understand. But I cannot.’
Doctor:‘“I can’t” are the wrong words. You must say “I can.”’

(field notes, 2019)

In this case the doctor was constantly balancing between different emotional styles. Sometimes she was using denominations and displayed care in order to make a woman cooperate (“kitten”, “you can do than”, “you my princess”, “a smart girl”). In other situations (like the one above) she required obedience instead of cooperation (she didn’t explain the details about the procedure) and tried to understate the patient’s suffering (“not that painful”). This is not pure khamstvo, but a hybrid mix of both khamstvo and smiling, paternalism (doctor knows best) and consumerism (‘but you can use the ball/ shower/ anaesthesia and have a husband next to you’ – from field notes). In a private discussion after that, the doctor explained that this patient required special attention and actions due to some medical complications, and also assured us how much she loves her job.

We observed other situations in which doctors raised their voices and expressed threats when clients refused to follow instructions or insisted on their own opinions. One woman insisted on leaving hospital, even though doctors considered the situation to be risky. The doctor threatened to kick her husband out of hospital after numerous explanations, which were given to the family (field notes, 2019). One of the authors recorded in the field notes: ‘Doctors exert pressure (on the woman). They raise their voices. Then the doctor tells me, “they [the woman] will go to complain …” (field notes, 2019). Or the doctor says, ‘What can I do, how can I not raise my voice and not shout if she does not listen and does not obey me?’ In such situations, when clinicians try to persuade women, they perceive a degree of khamstvo to be a legitimate technique.

We could interpret the smiling as being performed on the surface of interactions (drawing on ‘role distancing’ at the institutional level in Goffman’s terms, or ‘surface acting’ in Hochschild’s terms), while the power imbalance and paternalism do not change in any systematic way. In this sense, clinicians have become ‘emotional jugglers’, moving between women’s demands, requirements imposed by the organisation’s administration, state officials and institutional limitations. ‘Back stage’ (to continue with Goffman’s terms, or ‘deep acting’ according to Hochschild), khamstvo continues to be seen as a legitimate mechanism for coercing ‘infantile’ women to cooperate. Clinicians assume that in taking legal and professional responsibility and acting for the sake of their clients, they can legitimately neglect women’s emotional care needs and subordinate them to clinical and organisational conditions through direct rude orders and ‘negative’ emotional work. Khamstvo is a way of influencing women to cooperate when they are too demanding, act as ‘aggressors’, or disobey clinicians. In turn, this emotional style of khamstvo is structurally reproduced through attitudes of paternalism and an asymmetrical balance of power. Importantly, in these situations, professionals rarely consider this as khamstvo.

New emotional style does not change radically the balance of power, the structural norms, and contradictory rules that beleaguer medical organisations. In fact, doctors typically reaffirm medical paternalism as a foundational part of expert authority, which ultimately legitimates their power over childbearing women. Nonetheless, our data proves that the emotional practices associated with khamstvo are recruited in such situations, even if it is not the dominant style of communication and fully accepted as routine anymore. Today, different and contradicting emotional styles coexist in maternity care in Russia, and it is up to the participants – doctors, midwives, women, their partners and administrators – to juggle them and navigate the complex emotional landscape that constitutes maternity care in contemporary Russia.

Conclusion

We aimed to combine here institutional theory with the conceptual apparatus of the sociology of emotions to explain how new emotional practices emerge under institutional changes in Russian maternity care. Emotional practices are shaped by institutional rules and norms and at the same time they are being promoted by actors on the interactional level.

Our research shows that emotional practices of maternity care in post-Soviet Russian hospitals have partially changed, shifting from the Soviet emotional style (characterised by khamstvo) to the neoliberal consumer style (signified by smiling). Soviet healthcare providers often interacted with childbearing women in a rude manner of khamstvo, ‘disciplining’ and making women obedient to them and organisational rules. In post-Soviet institutions these practices have partially lost their legitimacy. Mothers-to-be in their new ‘consumer’ and ‘intensive mothering’ roles have become assertive and expect more ‘positive’ emotional work to be done in maternity care. Clinicians are required to display service-style smiling, which presupposes that childbearing women are consumer oriented, whose needs should be taken into account.

However, the modern system of maternity care in Russia is a hybrid of Soviet paternalistic bureaucratic and post-Soviet neoliberal market logics, and is consequently a hybrid in terms of institutional and emotional patterns. The shift in emotional style has proceeded together with numerous organisational problems resulting from inconsistencies in the healthcare reforms. Emotional repertoires in maternity care include practices which are situationally borrowed from different styles. When childbearing women as consumers became assertive, but their demands were not met, health providers had to manage problems ‘manually’ (ruchnoe upravlenie) in order to cope with women’s emotional outbursts and their complaints (which can lead to sanctions from the state regulatory structures).

Ruchnoe upravlenie involves different kinds of emotional labour. Khamstvo as an emotional practice still exists. Doctors feel vulnerable when in communication with patients defined as aggressive ‘extremists’, sometimes trying to control situation in a rude way, with both sides accusing the other of khamstvo. Providers accuse not only patients, but also some of their colleagues of khamstvo – while still perceiving it as something wrong. However, they continue to be rude when ‘irresponsible ignorant’ women do not want to follow instructions and express ‘irrelevant’ demands.

Smiling has become another emotional tool to manage relations with ‘service-oriented’ clients, who, in the perception of the clinicians, often have unrealistic demands of state-funded maternity facilities. In such cases, providers have to manage their own emotions to avoid patients’ complaints, emotional outbursts and conflicts. Clinicians also have to implement additional emotional labour when they face women’s sufferings. The navigation of feelings in maternity care settings becomes more complex, embracing both ‘positive’ and ‘negative’ emotions, and providers have to act as emotional jugglers who perform practices from repertoires of different emotional styles according to their understanding of the situation.

Note

1
Discussion of khamstvo is widespread in fiction and literary essays. One of the best known is Sergei Dovlatov’s (2005): ‘This untranslatable word – ‘khamstvo’. The phenomenon itself is described as an untranslatable term, which incorporates boorishness, rudeness, impudence and impunity. According to Caroline Humphrey (2018),

a lack of smiles is no problem for Russians, while directness, a forceful tone, and mild aggression signal mateyness or normality. In contrast, courteous formulae and polite words, especially when accompanied with the ‘stupid American smile’, can be experienced as hostile. The response is likely to be an unfriendly stare, since it felt that such a speaker is showing excessive politeness, that is, setting a distance by displaying lack of sincerity and absence of trust (Rubtcova, 2014).

Khamstvo was embedded into the fabric of Soviet everyday life. Multiple examples of khamstvo can be found in literary descriptions of early Soviet times: in Alexey Tolstoy’s Road to Calvary (which covers the period 1914–19) and Mikhail Bulgakov’s Dog’s Heart (written 1925), which depict the aftermath of the early 20th-century revolutions in Russia.

Acknowledgements

Our deep gratitude to the doctors, nurses, midwives, administrators and women for participation in this research. We are also thankful to Michele Rivkin-Fish, Julia Lerner and Zachary Low Reyna for their helpful comments, in-line editing and proofreading of this text. And Alena Ledeneva and Petra Matijevic from the Global Informality Project for inspiring us to elaborate on khamstvo (Novkunskaya et al, 2020).

Funding

The research was funded by the Russian Science Foundation (Project No. 19-78-10128).

Conflict of interest

The authors declare that there is no conflict of interest.

References

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    • Search Google Scholar
    • Export Citation
  • Borozdina, E. and Novkunskaya, A. (2019) The patient’s perspective on institutional logics in Russian maternity care, Zhurnal Issledovanii Sotsialnoi Politiki [The Journal of Social Policy Studies], 17(3): 43952.

    • Search Google Scholar
    • Export Citation
  • Cook, L.J. (2017) Constraints on universal health care in the Russian Federation: inequality, informality and the failures of mandatory health insurance reforms, in Y. Ilcheong (ed.) Towards Universal Health Care in Emerging Economies, London: Palgrave Macmillan, pp 26996.

    • Search Google Scholar
    • Export Citation
  • Davis-Floyd, R. (2001) The technocratic, humanistic, and holistic paradigms of childbirth, International Journal of Gynecology & Obstetrics, 75(S5): S5S23.

    • Search Google Scholar
    • Export Citation
  • Dovlatov, S. (2005) Eto neperevodimoe slovo – khamstvo [This untranslatable word – khamstvo], in Sobranie Sochineniy v 4-h Tomah, Tom 4 [Collected Works, Volume 4], Saint Petersburg: Azbuka-klassika, pp 32327.

    • Search Google Scholar
    • Export Citation
  • Field, M.G. (1957) Doctor and Patient in Soviet Russia, Cambridge, MA: Harvard University Press.

  • Field, M.G. (1988) The position of the Soviet physician: the bureaucratic professional, The Milbank Quarterly, 66(Supp 2): 182201. doi: 10.2307/3349922

    • Search Google Scholar
    • Export Citation
  • Friedland, R. (2018) Moving institutional logics forward: emotion and meaningful material practice, Organization Studies, 39(4): 51542. doi: 10.1177/0170840617709307

    • Search Google Scholar
    • Export Citation
  • Gammerl, B. (2012) Emotional styles – concepts and challenges, Rethinking History, 16(2): 16175, doi: 10.1080/13642529.2012.681189.

    • Search Google Scholar
    • Export Citation
  • Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, New York: Anchor.

  • Hochschild, A.R. (1983) The Managed Heart: Commercialization of Human Feeling, Berkeley, CA: University of California Press.

  • Humphrey, C. (2018) To smile and not to smile. Mythic gesture at the Russia-China border, Social Analysis, 62(1): 3154, doi: 10.3167/sa.2018.620104.

    • Search Google Scholar
    • Export Citation
  • Illouz, E. (2007) Cold Intimacies, Cambridge: Polity.

  • Lerner, J. (2015) The changing meanings of Russian love: emotional socialism and therapeutic culture on the post-Soviet screen, Sexuality and Culture, 19(2), doi: 10.1007/s12119-014-9261-2.

    • Search Google Scholar
    • Export Citation
  • Litvina, D., Novkunskaya, A. and Temkina, A. (2020) Multiple vulnerabilities in medical settings: invisible suffering of doctors, Societies, 10(5): 109125. doi: 10.3390/soc10010005

    • Search Google Scholar
    • Export Citation
  • Martin, E. (1987) The Woman in the Body: A Cultural Analysis of Childbirth, Boston, MA: Beacon Press.

  • Matza, T. (2009) Moscow’s echo: technologies of the self, publics, and politics on the Russian talk show, Cultural Anthropology, 24(3): 489522. doi: 10.1111/j.1548-1360.2009.01038.x

    • Search Google Scholar
    • Export Citation
  • Middleton, D.R. (1989) Emotional style: the cultural ordering of emotions, Ethos, 17(2): 187201. doi: 10.1525/eth.1989.17.2.02a00030

  • Novkunskaya, A., Litvina, D. and Temkina, A. (2020) Khamstvo (USSR, Russia), Global Informality Project, https://tinyurl.com/en4ku3as.

  • Plamper, J. (2010) The history of emotions: an interview with William Reddy, Barbara Rosenwein, and Peter Stearns, History and Theory, 49(2): 237365. doi: 10.1111/j.1468-2303.2010.00541.x

    • Search Google Scholar
    • Export Citation
  • Reddy, W. (2001) The Navigation of Feeling: A Framework for the History of Emotions, Cambridge: Cambridge University Press.

  • Reddy, W. (2008) Against constructionism, in M. Greco and H. Stenner Paul (eds) Emotions: A Social Science Reader, London: Routledge, pp 7283.

    • Search Google Scholar
    • Export Citation
  • Rivkin-Fish, M. (2005) Women’s Health in Post-Soviet Russia: The Politics of Intervention, Bloomington, IN: Indiana University Press.

  • Rosenwein, B.H. (2010) Problems and methods in the history of emotions, passions in context, Journal of the History and Philosophy of the Emotions, 1(1): 132.

    • Search Google Scholar
    • Export Citation
  • Saks, M. (2015) Professions, State and the Market: Medicine in Britain, the United States and Russia, Oxfordshire: Taylor and Francis.

  • Schepanskaya, T.B. (1999) Mifologia Sotsial’nyh institutov: rodovspomozheniye [Mythology of social institutions: maternity care], in Mifologia I Povsednevnost’ [Mythology and Everyday Life], Saint Petersburg: IRLI RAN, pp 383423, http://www.poehaly.narod.ru/repr-1.htm.

    • Search Google Scholar
    • Export Citation
  • Sheer, M. (2012) Are emotions a kind of practice (and is that what makes them have a history)? A bourdieuian approach to understanding emotion, History and Theory, 51(2): 193220. doi: 10.1111/j.1468-2303.2012.00621.x

    • Search Google Scholar
    • Export Citation
  • Sieben, B. and Wettergren, Å. (2010) Our research agenda, in B. Sieben and Å. Wettergren (eds) Emotionalizing Organizations and Organizing Emotions, London: Palgrave Macmillan, pp 120.

    • Search Google Scholar
    • Export Citation
  • Söderlund, M. and Rosengren, S. (2008) Revisiting the smiling service worker and customer satisfaction, International Journal of Service Industry Management, 19(5): 55274.

    • Search Google Scholar
    • Export Citation
  • Stearns, P.N. and Stearns, C.Z. (1985) Emotionology: clarifying the history of emotions and emotional standards, American Historical Review, 90(4): 81336. doi: 10.2307/1858841

    • Search Google Scholar
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  • Sturdy, A. (1998) Customer care in a consumer society: smiling and sometimes meaning it, Organization, 5: 2754. doi: 10.1177/135050849851003

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