The Meaning of Care

The Social Construction of Care for Elderly People

Bernhard Weicht

• Publisher: Palgrave Macmillan
• Year: 2015
• Print ISBN: 9781137274939
• eBook ISBN: 9781137274946
• Topic: Politics & International Relations
• Subtopic: Physiology
• Index: Politics & International Relations

Bernhard Weicht provides a multi-layered analysis of how we understand and construct care in everyday life, the meanings it has for ourselves, our families, our relationships, identities and our sense of society and what is right and proper, making an original contribution to the discussion of the nature of care ethics and its political potential.

1

Introduction

Two retired music teachers in their 80s are enjoying their highly cultured life together in their refined apartment in Paris when their world dramatically changes after Anne has a stroke and suffers subsequent progressive dementia. Complying with her demand to promise never to put her into a hospital or care home, her husband George lovingly starts to care for her, protect her and comfort her. Dissatisfied with professional caregivers and disappointed by their daughter and son-in-law’s reactions to the situation, the couple gradually turn the apartment into a temporary hospice in which they try carefully to adjust to all the changes and consequences that Anne’s illness throws at them. Both George’s strength and the couple’s interactions become increasingly challenged by Anne’s deteriorating health, and eventually George decides to relieve his wife of her suffering by suffocating her with a pillow. This story, beautifully depicted in Michael Haneke’s film Amour (2012), which, besides other prizes, won an Academy award and a Palme d’Or, identifies several crucial aspects of the meaning of old age, care and dying. The changes in the relationship of George and Anne and the latter’s increasing dependence on her husband are powerfully illustrated as essential and inevitable parts of human existence and people’s bonds with each other. Watching it in the cinema, I asked myself whether the film could equally be called Soin (care) instead of Amour. What is the essential difference between love and care, between relating and caring for the other? How much does care depend on loving relationships and do these relationships change during the experience of giving care? The film, which takes place almost entirely in the couple’s apartment, also raises questions about home, belonging and feeling safe. Care is ultimately depicted as an inseparable part of the love that two people feel for each other, and at the same time love motivates, guides and restricts George’s care practices.

This book engages with these issues, questions and challenges in order to investigate the different aspects, associations and images that constitute the meaning of care for elderly people in society. What role do concrete relationships and concrete places of living play in shaping people’s understanding of care? How do people imagine and situate ideal care for themselves, their loved ones and the general public? What are the consequences of the widespread fear of becoming dependent on others, for both carers and care receivers? Do professional carers and/or services bought in the market change the inherent meaning of care? While these are some of the questions that guided the research for this book, they are ultimately also very personal questions. In that sense, this book is also about me. When I started the research and writing process, I gradually realised that the topic of care cannot be studied in a strictly abstract and generalised way. Engaging with issues of relating, belonging and imagining one’s ideal life in old age strongly touches one’s moral and ethical disposition, ideals and feelings. Does this, however, imply that the meaning of care differs for every individual? In this book, I will try to demonstrate that while care is experienced as something deeply personal, its meaning is constituted by particular societal constructions. Ideologies, ideas and attitudes about care play an important role in defining the situation and people’s understanding of giving and receiving care. Additionally, notions of caring change over time (Jamieson, 1998), and Bowlby et al. (2010: 15) rightly state that

[the] ways in which we experience care reflects our age, gender, ethnicity, health and social status, and will be influenced by our beliefs and values about families and relationships, and hence by where and when we live.

This book mainly focuses on the construction of informal care for elderly people. The term ‘informal care’ is to some extent problematic, as it might suggest that informal care involves less work than ‘formal care’. While recurrently used, there is, ultimately, no accepted definition of the term itself. In my usage, ‘informal care’ refers to practices of elder care characterised by informal arrangements, personal relationships and intimate bonds. Informal care in that sense is usually unpaid and provided in domestic settings in an unregulated way. Hochschild (2003a: 214) describes care as ‘an emotional bond, usually mutual, between the caregiver and the cared-for, a bond in which the caregiver feels responsible for others’ well-being and does mental, emotional and physical work in the course of fulfilling that responsibility’. However, these ideal-type characteristics are (often discursive) associations and neither exclusive nor conditional. Even paid arrangements, such as the live-in arrangements of migrant care workers in people’s homes, can demonstrate characteristics of informal care (see chapters 2 and 3 and Weicht, 2010). In contemporary Western societies, care is a much debated issue in academia, politics and everyday discourse. Almost everyone will be concerned with care at some point in their life, either as a carer or as someone needing care by others. Yet, care needs are generally seen as an inherently negative aspect of a particular period in someone’s life course. The way we think about being old and being in need of care is characterised by anxiety about becoming dependent and having to rely on someone else’s commitment. Responsibility for elderly family members or elderly members of the community is a defining feature of how contemporary societies understand processes of ageing, family, social cohesion and mutual duties of dependence and support. Several social analysts claim that we live in a de-traditionalised society (Beck and Beck-Gernsheim, 2001; Giddens, 1998) in which old traditions, structures and authorities make way for new moral questions and answers. This suggests that in all European countries ageing societies and changing family structures require a rethinking of traditional family-based arrangements. Professional care, both provided publically and on the market, has been an important substitute and/or complementary offer to family-based solutions. However, in most settings, informal care arrangements continue to dominate the situation, and in some countries, for example the Netherlands, even a process of de-professionalisation can be noticed and is, not least out of financial considerations, promoted by policymakers (Da Roit, 2010). Williams (2004), in this context, holds that while the longevity and configuration of relationships have changed, people’s sense of commitment has not (for a similar observation, see Fine, 2005). Still, informal arrangements based on family relationships or other close bonds are obviously not the only type of care provision for elderly people. Particularly in the Nordic countries, informal arrangements are accompanied by a diverse and far-reaching net of professional care provision (Pfau-Effinger and Geissler, 2005), while various countries have also experienced the increasing influence of private market arrangements (Meagher and Szebehely, 2013). While professional care arrangements are not the core focus of this book, they will feature in particular in their discursive construction in separation from informal care (see, for example, chapters 2 and 6). Publically provided care or marketised versions of care might challenge traditional meanings of care, and Hochschild (2012) in particular investigates the changes in people’s intimate lives and (emotional) relationships as a consequence of increasing marketisation. For care that is fundamentally based on close relationships, the question is, what aspects of its meaning need to remain and what aspects can change? While Hochschild (2012) describes fundamental changes in people’s intimate relationships and, in particular, the increasing penetration of the market into personal lives, I want to focus on the underlying meaning of those practices. In other words, I ask what is left of the core meaning of care and what defines this core in the first place? Has this meaning changed because of trends of marketisation, professionalisation and commodification?

Values and constructions usually linked to informal care continue to play a big role in shaping the meaning of professional care in society too. While important differences between professional and informal care exist, both can be and are characterised by close, often personal and intimate relationships (for a distinction between professional and informal care, see Anttonen and Zechner, 2011). As care for elderly people continues to be linked to moral associations with the labour of love and personal relations, even countries with more extensive professional provision of care are confronted with these discursive constructions. Therefore, care must not be reduced to being an answer to particular needs; rather, it is a fundamental part of all human existence. Judith Phillips (2007: 1) in her book Care states the following:

Care is fundamental to our individual identity as this is played out in our social interactions and relationships. [ … ] It is fundamental to who we are and how we are viewed in both public and private spheres of life. [ … ] In many ways it is a nebulous and ambiguous concept and a part of everyday life which is taken for granted.

The way care is constructed has very real, immediate consequences for all those involved in the process. Firstly, people involved in providing or receiving care face substantial ideological and material consequences, which entail possible vulnerability to exploitation and domination (see Bubeck, 2002; Kittay, 1999). Secondly, care work is actually not distributed equally among all members of society; in fact, particular groups carry the main burden. Women, elderly people, volunteers or care workers represent segments of society that are, because of their particular relation to care, in an economically marginalised position. The experiences of everyone involved in care feed into and are fed by societal discourses on ageing, disability and care. At the same time, care is a representation or manifestation of people’s moral desires and ideals. Care for elderly people is therefore at a crucial point, which I hope to identify in relation to broader moral ideals, desires and opinions. I agree with Fine (2005: 249) and accept his suggestion that ‘[s]ociological interest in care must manifest an interest in the larger processes of social change and their effects at the level of personal experience’. The moral construction of care, however, also plays a crucial role in constituting the real experiences of care for elderly people. In several countries, political discourses have emphasised the existence of ‘care emergencies’ (Weicht, 2013), arguing that society finds itself in a challenging situation in which the care needs of elderly people cannot be sufficiently met (often as a prediction for the future) (Mullen, 2002). These ‘emergencies’ are constructed as direct, logical consequences of an ageing society and changing family structures. I want to demonstrate in this study that these discourses (and their conjoined political decisions) are based on a specific moral construction of care. Political decisions, such as the public provision of care, the use of private market companies or the provision of cash benefits to people to pay for their individual care arrangements all require in-depth knowledge and understanding of the various moral, social and cultural associations embedded in the meaning of care. When Österle and Hammer (2004), for example, state that in order to sustain the historically developed system of care provision, the question of how to keep and raise the willingness of relatives and others to take over care services is one of the most significant issues; knowledge about people’s understanding of idealised care is essential. Importantly, the arrangement of care for elderly people depends on political processes and decisions. Public services (as strongly promoted in the Nordic countries), marketised systems (as, for example, in the United Kingdom) and also the reliance on informal care (as, for example, in Austria or the Mediterranean countries) all are reflections of a political agreement on how to deal with elderly people’s care needs (see Vabø and Szebehely, 2012). Political decisions, however, are influenced, shaped and given meaning by what is considered the right way to act. While Chapter 6 and the epilogue focus explicitly on the politics of care, the topic needs to be understood as closely linked to all the various moral constructions discussed in the book. The different social spheres such as family, state or markets, within which societies’ arrangements of care are situated, all involve and are constituted by different ethical associations (Sayer, 2011).

Understanding care

Thus, care cannot be reduced to particular practices as reactions to certain needs; rather, care forms a feeling, an identity, a commodity and a way of thinking (Phillips, 2007). Understanding the construction of care helps to understand aspects of people’s ideals, motives, attitudes, imaginations, aspirations and desires in life. An impressive insight into carers’ motivations and situations in relation to gender is offered by Ungerson’s (1987) influential analysis of qualitative interviews with informal carers, in which she describes the process of ‘becoming a carer’ and the negotiation of this role. She identifies differences in the self-understanding of care between men and women and notes gendered differentiations between the notions of duty and love as the reasons for someone becoming a carer. The self-understandings, motivations, attitudes and ideas that Ungerson describes constitute a discursively constructed moral framework. Hence, an analysis of how we understand and construct care in everyday life, the meaning it has for ourselves, our families, our relationships, identities and our sense and understanding of society and what is right and proper is crucial for an understanding of the possibilities and consequences of any social, political and cultural intervention.

The meaning of care has important gender connotations. Hughes et al. (2005), for example, emphasise care’s meaning as both an activity and a culture in order to explain its feminised status and the subordination of carers. A similar argument is presented by Winch (2006: 6–7) who states that carers are ‘produced by an interplay of political structures and ethical attitudes and practices’, which is based on a carer discourse and a ‘morality of caring’. Also, Paoletti (2001, 2002) takes a discursive approach and places care ‘as part of the social and moral order’ (2002: 815), which is produced and reproduced through ordinary talk. She furthermore argues that the vulnerable situation of carers needs to be explained by the moral context and its gendered nature. Elsewhere, Ungerson (2000) speaks of an ideology of ‘natural’ traits, practices and identities of women, which ‘bear such a close resemblance to the practices based on the experiences of mothering and hence are construed as “natural” aptitudes of women’ (2000: 636). Similarly, Guberman et al. (1992) identify ‘feelings of closeness and interconnectedness with family, gender-role conditioning, and life situation’ as determining a (gendered) caring role. In this context, paid and unpaid care are designed to be based on the specific construction of care ‘as a hybrid of love and instrumentality’ (Ungerson, 2000: 627).

In order to understand the fundamental meaning of care, I will investigate several aspects of its social construction:

• Firstly, I will explore the moral and ideological underpinnings of the process of caring. What are people’s associations with care? What desires, wishes and hopes are related to the social practice of care and its imagination? I will also sketch out the various discourses people refer to in order to organise care for elderly people. What are the possibilities for the contestability of these discourses and their moral constructions with respect to care? Focusing on an enduring paradox, I will investigate how it can be explained that while those who care are continuously valued very highly, care is, at the same time, politically and economically only an issue of marginal concern.

• These questions and issues lead to my second focus of investigation: On the basis of the moral construction of care, what do people define as the ‘proper thing to do’ (Williams, 2004)? Individuals are confronted with very personal immediate demands in their lives. Care needs do not only require the fulfilment of certain tasks, they also trigger answers in an emotional, intimate way. How are responsibilities, duties and commitments constructed in both family contexts and the broader societal framework? How do carers and non-carers experience and reflect the social discourse on care(rs)?

• Thirdly, picking up Hochschild’s (2012) discussion, I want to base care’s social and moral construction within current societal developments by asking how care is positioned within a neo-liberal construction of modern society. I want to explore to what extent the concept of care is seen as being contradictory to the economisation of society. I will therefore also challenge popular conceptions of late modernity by authors such as Giddens and Beck. The investigation of the moral conception of care demonstrates the importance of ‘traditional’ ideals such as family, home and community. Giddens, in his conception of the ‘Third Way’ (1998: 36) for social democracy, argues for example that the ‘new individualism [ … ] is associated with the retreat of tradition and custom from our lives, a phenomenon involved with the impact of globalization widely conceived rather than just the influence of markets’. He argues that we live in an age of ‘moral transition’ (Giddens, 1998: 3) in which mutual obligation and individual responsibility become more important features. I will investigate how care is positioned in relation to traditional conceptions of moral living and the developments in and demands of modern society.

For all three interlinked fields of enquiry, it becomes obvious that ethics and morality play an important role in constituting what could be described as the meaning of care. This, however, does not imply the construction of an all-encompassing moral theory; rather, I focus on people’s negotiations and ethical existence in everyday life (see Sayer, 2011). People in their daily lives do not rely on grand theories of morality or moral actions but rather apply some form of practical reasoning or judgement, which Sayer (2011) calls ‘phronesis’. This practical reasoning is characterised by a concern with concrete objects or particulars and is based on an individual’s character, rather than universal rules. The concrete other becomes the focus of people’s actions and ethical concerns. Secondly, phronesis includes practical, embodied and tacit or intuitive elements, which focus on ends rather than means. Thirdly, ethical being must be understood as a relationship of interest between individuals and the broader context or, as Sayer (2011: 20) puts it, ‘our relation to the world is not merely causal and interpretative, but one of concern’. Care in that sense must be understood as a particular, long-lasting relationship with an interest in the quality of the very relationship and the particular possibilities of flourishing and suffering (Sayer, 2011). Finally, ethical beings act within specific historical, social, political and cultural structures and circumstances, which shape their actions and understandings of their actions. In the following sections of this introduction, I want to sketch out a theoretical framework that tries to capture and elucidate the different elements of this ‘everyday morality’ that the construction of care is based on. The framework starts from a micro perspective on individual’s practices and is eventually based within the larger societal context. Since imagination of the meaning of a moral practice is usually directed at people’s behaviour, ideas and motives, the discussion starts with a focus on the ethical individual and their moral motivation. I will then bring the other and people’s responsibility in the presence of the other into the equation. As I have pointed out, care is fundamentally based on concrete, particular relationships. I will hence draw on the ethics of care perspective to suggest taking relationships as the starting point for understanding morality. Finally, ...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Acknowledgements
• 1. Introduction
• 2. Who Should Care? The Construction of Caring Relationships
• 3. Where Should Care Be Given and Received? The Geographies of Care
• 4. How Should Communities Care? Nostalgia and Longing for the Ideal
• 5. Who Is Seen to Be Cared for? The Construction of the Care Receiver
• 6. Buying and Selling Care? The Intrusion of Markets and Bureaucracy
• Epilogue
• Notes
• Bibliography
• Index