Time as an instrument of domination and liberation: four reasons why we need a time revolution in the healthcare sector


How can we merge all the things that are happening right now, on Lesbos, in Kabul and in Ahrweiler, and map them on our own timeline? How do we know what is important for our present time? Melanie Wilke and Hannah Gruber ellaborate on the societal contexts behind the ever-present lack of time, particularly in relation to health and healthcare.


Three times clockwise

Three times anti-clockwise

Don't breathe in until there's no air left in your lungs

Keep moving

Don't move

Keep moving

Don't move

Kae Tempest


When we are at one with what we are doing, time seems to cease. If you immerse yourself in reading this text, the minutes will seem to stop ticking by and you will experience a moment of abandon. We encounter time in many different dimensions. How can we merge all the things that are happening right now, on Lesbos, in Kabul and in Ahrweiler, and map them on our own timeline? How do we know what is important for our present time? 

We, the women who wrote this text, got to know each other in the field of critical psychology and in feminist contexts. We became interested in the human relationship with time. Minutes, clocking on and off and daily appointments matter so much in everyday life, in relationships, paid employment and even within activist groups. We want to know the societal contexts behind the ever-present lack of time. 

Feminists like the economist Mascha Madörin and care expert Tove Soiland, who look at the connections between the economy and (un)paid care work, refer to the discussion on care work and the “time movement” as central political demands of feminist movements. The shortage of time makes itself particularly felt in the paid care sector; staff have only a few minutes to take care of people’s essential needs. To ease their confusion. Just as long as they do so efficiently. 

This article is an attempt to usher in changes in our relationship with time. We intend to discuss four reasons we need a revolution in the healthcare sector and beyond.

1. Because care work and time shortages stand central in current political battles

Doctors and nursing staff are deeply critical of the fact that all activities are timed, documented and billable. Shortages of time do not occur in a vacuum, but are called into being by neoliberal developments. The roundly criticised economisation of the healthcare sector, in other words orienting it towards economic objectives, forces staff to work ever more efficiently – to the detriment of their patients. The pressure is particularly great in care work, a field in which human relationships and thus emotions are pivotal. There is a limit to how much these can be optimised and standardised. 

The insistence on increasing productivity comes in a context of massive staff shortages in the care sector. This does not come as news to anybody, but it has never been tackled at political level. It appears as if timing and streamlining everything is here to stay. Healthcare policy groups have been warning us for decades that health cannot be allowed to be reduced to a product. Industrial disputes on the part of care workers call for good working conditions for themselves and a dignified level of care for their patients.

2. Because time has been instrumentalised to disguise other abuses  

In the interviews on patient autonomy carried out by one of us for her Master’s thesis, doctors invariably cited a lack of time as a main problem. Frequently, there is not enough time for proper consultations. One doctor, however, put forward a very interesting argument: a proper consultation might only take a couple of minutes. What is actually lacking are the emotional skills and willingness to really engage with the situation. It is about more than just a lack of time. 

Time can serve as a pretext to avoid dealing with the real issue. If we don’t want to meet our friends, it is far easier to say that we’ve got too much on at the moment. But this is at the cost of honesty. We are surrendering our responsibility to time. 

In hospitals, schedules worked out to the last minute obstruct personal responsibility and make it impossible to identify individual needs. Taking longer than prescribed over care duties or carrying out additional consultations that are technically “unnecessary” on every level save the interpersonal makes you vulnerable. This massively restricts healthcare professionals’ ability to build relationships and set priorities in various situations and really understand what the patient is saying. 

Time has been used again and again throughout history as an instrument of discipline, for instance as a measure of colonial dominance or against workers in factories. Time allows people to be assessed as punctual or unpunctual and therefore controllable and punishable. In this context, the employment sociologist Silvia Federici refers to the mechanisation of bodies. Today, this acts principally through our internalised self-discipline through time. People must organise themselves and function in such a way as to comply with externally dictated timescales, which have become virtually indispensable to live a successful life in our modern-day society. 

3. Because the pandemic has thrown the shortcomings in our relationship with health into sharp relief

The coronavirus pandemic has thrown the spotlight onto the subject of health. However, we have chosen to see nothing but case numbers, while the mental and societal aspects of health have been woefully neglected. Responsibility for collective health was pushed onto individual responsibility by asking people to withdraw, right up to self-isolation. Suffering from the social consequences of lockdown was individualised and, for instance, dealt with through individual therapies, rather than seeking a collective approach of solidarity. Existing issues such as lack of care and insufficient consideration of the social factors influencing care have spiralled. 

Individuals were required to plan and structure their time more than ever before. Between working from home, university lectures going online, digital political meetings and digital socialising, we were expected to be available at all times and to function in the digital sphere without a hitch. Our yearnings for actual human encounters were sidelined. Anxieties were fuelled by loneliness, instead of being negotiated collectively. 

4. Because we as a society need to deal with grief and death with dignity 

One doctor and health care professional with whom we discussed our article told us that most people in Germany die in hospital. The decision as to when and how people die is thus made chiefly by healthcare professionals, rather than relatives or the individual in question. There is precious little societal exchange over death and grief. Illness, death and, therefore, what goes on in hospitals make people deeply uncomfortable. 

With coronavirus, the emphasis was principally on saving lives and we were told that people were dying in care homes. We find that socially important and beneficial. But the bitter pill is that protecting human lives is frequently mixed in with economic motives. What is missing is any concern for the way in which these people actually died, frequently alone and abandoned by society. 

Conclusion: time revolution?

In the current political discourse, ideas and discussions on an emancipatory relationship with time are few and far between. At party-political level, even talking about a 30-hour week instead of a 40-hour week seems to be quite out of the question. People have to wait 18 months for appointment with a psychotherapist, but the time to support them ought to be as soon as they ask for help. Not a year and a half later. 

The ancient Greek language has two different words for time, Chronos and Kairos. Chronos refers to measurable, chronological time in units, while Kairos, named after the god of opportunity, means the perceived timing of an event. As Alexander Neupert-Doppler, among others, has argued, a shift towards Kairos offers an opportunity for political movements. Political commitment and intellectual performance cannot be measured in minutes, but depend far more on the maturity of internal processes, human connection and the opportune moment. 

In our bodies and in nature, time is cyclical. As regards activism, our paid work and our relationships, there are times when we need our own company and a bit of peace, so that we can engage with energy and enjoyment at other times. Instead of measuring and planning time, we should give organisational processes time.

Personally and politically, we believe in the power of an alternative understanding of time. It is clear that this is an enormous challenge, in view of systemic constraints in specific contexts, such as the healthcare system.