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Despotic leadership and ideological manipulation at Theranos: Towards a theory of hegemonic totalism in the workplace

Tourish, D. & Willmott, H. ORCID: 0000-0003-1321-7041 (2023). Despotic leadership and ideological manipulation at Theranos: Towards a theory of hegemonic totalism in the workplace. Organization Studies, 44(11), pp. 1801-1824. doi: 10.1177/01708406231171801


This paper addresses despotic leadership and ideological manipulation in the workplace, and explores their detrimental consequences for employees and other stakeholders. The notion of ‘hegemonic totalism’ is advanced to account for how employees are often subordinated to the will of powerful elites. Our argument is illustrated through a case study of Theranos, a high prolife Silicon Valley biotech company that promised a revolution in healthcare diagnostics but which was declared bankrupt in 2018. Its once much-feted founding CEO, Elizabeth Holmes, has been sentenced to eleven years in prison for fraud. Analysis of empirical material on the company illustrates how business leaders may engage in despotic practices, while simultaneously invoking apparently positive ideals to enforce the performance of consent by employees. Following an exploration of the paradoxes and pathologies of hegemonic totalism, our study identifies three primary countervailing forces that act to limit its effects.

Publication Type: Article
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
H Social Sciences > HV Social pathology. Social and public welfare
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Bayes Business School > Management
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