Week 2 Understanding Care: Contested definitions and perspectives

1. Week 2Understanding Care: Contested definitions and perspectives

2. Overview of lecture 1. Awakening interest in care 2. Defining care • Confused origins: Old English, Greek and Latin • Different meanings • Three core concepts 3. The ethic of care debate • Carol Gilligan: the different ethics of care and justice • Is Care Gendered? Noddings, Tronto, Sevenhuijsen. • Eve Kittay: Care as ‘dependency work’ 4. Social policy tradition • The burden of care • Critiques and development 5. Kittay: Care as a relationship of power 6. Conclusion • Care as physical and emotional work; • The right to give and receive care.

3. 1 Awakening interest in care • ‘Traditionally’ care understood as part of women’s domestic duties; remained hidden, relegated to the private domain of the household. • Care, like women, has gone public. ‘From private trouble to public issue’. (C.W. Mills, 1958) • Increasing number of programs assuming at least some degree of responsibility for care throughout OECD • Increase in public responsibility – but constant restructuring and devolution; • Expansion of private corporations; • New roles for voluntary sector, including small scale local initiatives (third sector). • Constant media attention – often story of ‘crisis’ in care provisions – at public level and in intimate sphere.

4. Social Care in the News Aged-care revolution Phillip Coorey Sydney Morning HeraldAugust 9, 2011 Sydney Morning Herald August 9, 2011 • http://www.smh.com.au/lifestyle/lifematters/agedcare-revolution-20110808-1ijbu.html Productivity Commission Report • http://www.pc.gov.au/projects/inquiry/aged-care/report

5. 2. Defining care How is care to be conceptualised and understood? Care is a concept currently coming to the fore in many contemporary debates (McKechnie and Kohn, 1999) e.g.: • to discuss new developments in social policy (the concept of social care and social care services; OECD (1998) A Caring World. The New Social Policy Agenda; • as a way of encapsulating women’s perspectives of care and nurturance, a mother’s love, the value of sustaining human relationships, opposition to violence and war; • to consider developments in health services and medical practice; • as a way of discussing changes in family life, and as a key term in debates about the work/life balance.

6. Care is socially defined and redefined – as both an activity and a value. • The meaning of the term ‘care’ is not fixed or easily defined. • What is understood by the term, its characteristics and the ideals it embodies, is currently being (re)constructed and refashioned, constantly fought over by various protagonists who seek to claim its mantle for their cause.

7. Confused origins of term: Old English, Greek or Latin? The term ‘care’ in English is often wrongly traced to words in Ancient Greek and Latin, meaning love and charity. • The Latin caritas derives from the Greek. It is translated as either ‘love’ or as ‘charity’. • Caritas has a number of meanings: 1. dearness or costliness; 2. regard, esteem, affection, love; and 3. charity, giving. • This (wrongly) suggests that ‘caritas’ or ‘care’ is a term linked to love and a benevolent disposition towards others.

8. Care and Cure • Care in Latin is the word ‘cura’ (care) (Margaret Dunlop, 1994, notes that in medicine males ‘cure’, females ‘care’.) • The word care in current English comes from the Old Englishcarian , a verb that denoted ‘to trouble oneself’. (ie to worry) (OED) Changing meanings over time • In nineteenth century English, ‘care’ referred to ‘the means by the conditions likely to produce danger [were] constantly monitored and kept under control’ (Dean and Bolton, 1980: 82 cited in Dunlop, 1994: 30). • Care for the sick referred to a form of public health intervention that involved preventing the spread of disease from the sick to the general population. • ‘To place in care’, ‘in the care of Her Majesty’. – place under involuntary control.

9. The term care appears to have taken on both sets of meanings: as • i. a worry or concern; and • ii. love/charity/ disposition towards others. New use of the word: The term ‘carer’ Modern use of the term refers to ‘a person whose occupation is the care of the sick, aged, disabled, etc.; one who looks after a disabled or elderly relative at home, esp. one who is therefore unable to work’. First use was in 1978 (Oxford English Dictionary). Prior to that (eg in 1691 and 1850), the term was used in a very different sense, as ‘one who cares’, that is a worrier, a ‘neurotic’.

10. Hilary Graham (1983): distinguishes between • ‘caring about’, a mental disposition; and • ‘caring for’, the work of providing care.

11. Three core concepts of care • A mental disposition, involving an emotional engagement with, and concern for, the wellbeing of self and others; • An activity, or form of work, concerned with nurturance, personal maintenance, assistance or support, involving the provision of attention and typically (although not always) requiring the performance of physical work and competence; and • An interpersonal relationship between individuals. In its most intense form, the parties may be referred to as caregivers (or carers) and care recipients. Extends also to: -professional relationships (health professional: patient), -community building/social capital. Shared care, concern for known others, strangers.

12. 3 The Ethics of Care Approach • Psychologist Carol Gilligan (1977, 1982), posited a different ‘voice’ in the moral development of young women than young men. • Approach developed by feminist writers and moral philosophers (Noddings, 1984; Tronto, 1993; Sevenhuijsen, 1998, etc..). • Sees care as primarily a disposition towards others, a concern for maintaining relationships and nurturing the world around us.

13. Care defined as: ‘a species activity that includes everything that we do to maintain, continue and repair our ‘world’ so that we can live in it as well as possible. That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web’. (Tronto, 1993: 103) Care not an occupational specialisation, but a moral orientation towards living in the world characteristic of, but not necessarily exclusive to, women. Positive value and approach to care.

14. 4The social policy tradition. Finch and Groves (1980), Land (1978), et al.. • Care portrayed as a burden - involves unpaid domestic household duties, from washing and cleaning to shopping, cooking and nurturing. • The ‘burden’ of care holds women back from careers in the paid workforce. Care = unpaid women’s duties. • By 1990s ‘paid care’ increasingly acknowledged as important. Care essentially negative concept: a burden

15. The Disability Critique • Disability activists (esp Jenny Morris, Lois Kieth) resented being described as a ‘burden’, • Contributed to reconceptualisation of the interpersonal aspects of care • Shift understanding from one-directional activity active caregiver and passive dependent, to an understanding of care as a more complex mutual activity. • Translated also into demands for direct employment of care staff by recipients.

16. Care or patronising dependency? ‘By taking the need for care for granted and by assuming the dependency of older and disabled people, feminist research and carers as a pressure group have not only failed to address the interests of older and disabled people but they have, unwittingly, colluded with both the creation of dependency and the state’s reluctance to tackle the social and economic factors which disable people. In doing so they have failed to challenge either the poverty of older and disabled people, or the discrimination and the social prejudice which characterises their interaction with individuals and social institutions.’ (Jenny Morris, 1993: 49)

17. Social Policy Theories - Recent developments Extension of concepts of care in social policy literature to include: • Men • Children • Paid staff • Concern for care workers (women, migrants) as exploited. Recognition of positive and negative elements of care. Positive: build social cohesion and express personal responsibility. Negative: capacity for exploitation and inequality.

18. Incorporation and development of a political ethic of care Sevenhuijsen (1998), Knijn (1997), Williams (2001), Morris (2001) Claims to recognise care as a series of rights • the right to give care, • the right to receive care, - the right to care for one’s self, (Fiona Williams, 2001)

19. Care in the literature from the ‘caring professions’ Nursing (an example) • Authors sought both to acknowledge importance of care in human affairs, and to claim the value for the nursing profession. • In the 1970s, Jean Watson: nursing the science of caring. • Leininger (1988) and Benner (1984, 1994) focus on care as ‘concern’, emphasis on listening, understanding, supervising… • Lawler (1991) Nursing seen as ‘dirty work’. • Nursing: increasing professionalisation, greater emphasis on counselling, management; less nurses, more low-paid careworkers.

20. 5. Eva FederKittay. Power and Care: ‘dependency work’ Kittay’s approach to care is based on an analysis of power and dependency. These relations of power and dependency are seen at two levels: • In the dyadic relationship between ‘dependency worker’ (the caregiver) and ‘charge’ (the recipient) The vulnerability of the care recipientcomes from her lack of physical or mental capacity. Caregivers may exert power over the recipient based on this. Domination of the charge by the worker faces moral and legal sanctions. • The vulnerability of the dependency workerarises for a large part from her readiness to assist, by her identification with the well-being of the charge and by her inability to express annoyance or vent frustrations in interacting with the vulnerable charge in ways that would normally be acceptable in human relationships between equals. Danger: that the carer becomes over-identified with the charge and is unable to assert an independent sense of self.

21. 2. Between dependency worker, the ‘provider’ and the broader society. • Women as dependency workers, as mothers, sisters, wives, nurses and care attendants … ‘have been made vulnerable to poverty, abuse and secondary status … and often suffer psychological, sexual and other physical abuse as well as economic exploitation’ as a result of taking on this work (Kittay, 1999: 40-41). ‘In the case of the dependency worker, the provider’s control of resources combines with a general social devaluation of the work of dependency to thwart the possibility of a comparable autonomy for the dependency worker. To speak of this diminished autonomy is another way of speaking of the dependency worker’s unequal relation to the provider’. (Kittay, 1999: 45)

22. Kittay therefore distinguishes two forms of dependency • Bodily dependency. ‘Inevitable dependency’ of infancy, extreme old age, disability, sickness. • Socially created dependency, affecting the charge (recipient) and the dependency worker (caregiver).

23. 6. Conclusion Analytic points arising from this discussion of current research and analysis of care. • Care can not be reduced to just a mental attitude, although a disposition towards others, an awareness of responsibility for the wellbeing of others, is fundamental. • Care involves physical as well as emotional work (Hochschild, 1983). The exertion and stress of this work needs to be recognised. • Care always takes places through a direct personal relationship that is, itself, part of a broader system of social relations.

24. Care – a value laden term • Care is neither inherently good or bad, but can be both/either. • It is important that it respected, but not reified i.e. put on a pedestal and treated as a sort of sacred matter. • The treatment of care recipients and of caregivers has often been seen as a sort of self-righteous act, hiding the exploitation of caregivers and the domination of care recipients. • Understanding social care and human services must recognise both the human relationships that underlie care, and the dilemmas of care (enabling or dependence).