Materialities of Care

Encountering Health and Illness Through Artefacts and Architecture

Christina Buse, Daryl Martin, Sarah Nettleton, Christina Buse, Daryl Martin, Sarah Nettleton

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119499732
• eBook ISBN: 9781119499695
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Materialities of Care addresses the role of material culture within health and social care encounters, including everyday objects, dress, furniture and architecture.

• Makes visible the mundane and often unnoticed aspects of material culture and attends to interrelations between materials and care in practice
• Examines material practice across a range of clinical and non-clinical spaces including hospitals, hospices, care homes, museums, domestic spaces and community spaces such as shops and tenement stairwells
• Addresses fleeting moments of care, as well as choreographed routines that order bodies and materials
• Focuses on practice and relations between materials and care as ongoing, emergent and processual
• International contributions from leading scholars draw attention to methodological approaches for capturing the material and sensory aspects of health and social care encounters

1
Conceptualising ‘materialities of care’: making visible mundane material culture in health and social care contexts

Christina Buse, Daryl Martin and Sarah Nettleton

Introduction

[O]bjects are important not because they are evident and physically constrain or enable, but often precisely because we do not ‘see’ them. The less we are aware of them, the more powerfully they can determine our expectations by setting the scene and ensuring normative behavior, without being open to challenge. (Miller 2005: 5)

There is growing attention to the significance of materialities within the sociology of health and illness, situated within traditions of science and technology studies and new materialist approaches. The theme of this edited collection picks up on this interest, and also reflects our recent work on material culture in healthcare contexts. This research ranges from the significance of dress for supporting identity and personhood in dementia care (Buse and Twigg 2014) to the role of interior design in enacting care and comfort in cancer centres (Martin 2016, 2017), as well as ongoing work on the significance of architecture in health and social care contexts (Nettleton et al. 2018). Our interest in materiality is situated within a wider attention to material culture within sociological studies of health and social care. Science and technology studies (STS) approaches have been applied to thinking in the sociology of health and illness, highlighting the active role of technologies in healthcare practices, for instance; the metered dose inhaler (Prout 1996), the Cervical Smear Test (Singleton and Michael 1993), information and communication technologies (Lehoux et al. 2008), medical imaging technologies (Burri 2008), and technological innovations in areas such as genetic testing (Webster 2007). Other research within this tradition explored the role of assistive technologies in configuring caring relations (Schillmeier 2014), revealing the involvement of non-human actors or ‘things’ in care practices, including medical technologies, assistive technologies and bodily matter and fluids (Mol et al. 2010). More recently ‘new materialist approaches to health’ (Fox 2016), use the concept of ‘assemblage’ to situate the healthy or ill body within a network of material/physical, social and psychological relations and affects. ‘Health assemblages’, ‘ill-health assemblages’ (Fox 2016) or ‘diagnostic assemblages’ (Locock et al. 2016) may include a range of diffuse human and non-human elements – for instance, an organ, health technology, the arrangement of a room, a doctor, a letter, relatives and carers – and recognise such assemblages to be processual, relational and dynamic, shifting across time and context.

This body of work highlights the importance of attending to materiality and the co-constitutive role of technologies in health, yet the literature to date tends to focus on technological innovation. Other aspects of material culture remain unnoticed in the background, and yet they hold potential to shape encounters in health and social care, and the ‘experience and feel’ of care in practice (Abbots et al. 2015). Maller (2015) calls for a social practice based approach to thinking about materiality in the sociology of health and illness that can explore moments of ‘doing’ in health-related practices. She emphasises the importance of going beyond ‘obvious health technologies’ in order to explore more mundane aspects of materiality, such as the built environment – including car parks, pathways, roads and buildings – as part of infrastructures in health.

This emphasis points to the interdisciplinary field of material culture studies, which has long drawn attention to the significance of mundane materials as part of social practice. For instance, Miller (1987, 2005, Miller and Woodward 2012) argues for the importance of addressing ordinary objects – blue jeans, furniture, household objects – which can go unnoticed because they are so embedded in the tacit, embodied routines that underpin, but are nevertheless crucial to, everyday life. Research bringing a specifically material culture studies approach to sociology of health and illness therefore highlights the significance of often neglected objects. Scholars have explored the materiality of nursing, examining how mundane artefacts – sluice pans, towels, gloves, washing bowls, clothes, cotton balls – can illuminate nursing cultures (Nelson 2003, Sandelowski 2003). Latimer's (2003) ethnography of nursing, which she further describes in the afterword of this collection, illustrates hierarchies in classifications of work and patient that are articulated through privileging of technical or clinical materials by nurses over materials connected to washing and dressing. Pink et al. (2014: 432) address the importance of ‘taken for granted’ or ‘quiet’ materialities including hand gel, gloves, soap, wipes, carpets and shoes, as part of the ongoing negotiation of safety, contact and touch by health care workers. Historical research also draws attention to the significance of mundane materials to understanding the experiences of service users, social hierarchies and relationships. For instance, Hamlett (2015) explores experiences of Victorian asylums through historical analysis of material life, drawing attention to the importance of ‘small things’ – false teeth, glasses, jewellery, watches – in supporting classed and gendered identities and facilitating wider connections with the outside world (Hamlett and Hoskins 2013). These themes are pertinent for analysis of material cultures in contemporary health and social care institutions, and indeed we bring a focus on relatively neglected and mundane materialities to the fore of current debates in this collection.

Defining ‘materialities of care’

We use ‘materialities of care’ as a heuristic device, where mundane materialities act as a lens for (re)examining care practices in health and social care contexts. Attention to materialities can provide a way to make visible the ‘ordinary’, tacit and non-verbal aspects of care practices. As Sandelowski (2003: 196) advocates, this approach involves ‘paying close attention to objects and other features of the physical landscape of practice’, thus generating ‘new insights and new questions concerning practice’. This entails synergies between methods in museum studies, design and archaeology, and involves strategies of ‘material imagining’ (Woodward 2015) by starting with analysis of a concrete aspect of material culture as a way of exploring embodied practices. While analysis may focus on a particular aspect of material culture (e.g. dress, food) the use of the plural ‘materialities’ draws attention to the intersection of multiple materials within practices (Shove et al. 2012).

‘Materialities of care’ encompasses ideas of ‘materialities’ and ‘care’ which are diffuse and hard to define. The concept of materialities is contested and increasingly encompasses the immaterial (Miller 2005; Tilley 2006). Here we focus on materialities as physical ‘things’, encompassing not only artefacts which are artificially created and embed cultural scripts, but also composite materials – ‘everything from a stone, building or bench to the remains of an architectural artefact’ (Reichmann and Muller 2015: 14). However, we also recognise the intersections between the immaterial and material, and the materialities of bodies and ‘things’ so as to encompass more intangible qualities of materialities such as atmosphere and ambiance (Edensor and Sumartojo 2015; Bille et al. 2015). Materialities of care prompt consideration of the relationship between these mundane materialities and care practice. Materials are shared between people as part of practices of care, they sometimes ‘stand in’ for caring relations, and may shape, enable or constrain practices of caring. As argued throughout this collection, materialities are not merely a backdrop for care interactions, but play an active role in constituting relations of care.

Care is also a contested and diverse concept (Abbots et al. 2015), encompassing ‘caring about’ as an emotion or disposition towards someone, ‘caring for’ as a form of labour or physical work, and care as a social relationship. Here we focus on care as a practice, focusing on particular moments in the ‘doing’ of care in interaction with materialities (Puig de la Bellacasa 2011), as well as considering how these practices become sedimented or altered over time. This engages with debates about care as a mode of ‘bodywork’ (Twigg et al. 2011), although our definition extends to encompass paid, unpaid and self-care; distinctions which are often blurred in acts of caring. While focusing on practices of doing care, we recognise that the physical and emotional elements of care are difficult to disentangle (Rummery and Fine 2012), and that material practices and architectures of care are generative of, and imbued by, affect and emotion.

Crucially, a focus on mundane or taken for granted materials can unfix understandings of care, thinking beyond conventional care practices, and bringing to light acts of ‘caring through things’ (Puig de Bellacasa 2011). For us, the ‘materialities of care’ provide a novel way in to examining ‘practices of care’ as they unfold in a range of formal and informal settings, and in relational ways, whereby embodied, routine and often unnoticed actions of caring are constituted through and between the relations between bodies, objects and spaces. Such practices are spatially and temporally enfolded and, taken as a whole, the chapters in this collection reveal the importance of these spatiotemporal considerations. We therefore explore these three interlocking themes or strands of materialities of care (spatialities of care, temporalities of care and practices of care), before turning to consider the methodological implications for undertaking research within this conceptual and empirical terrain.

Spatialities of care

There is a close relation between the ‘materiality of the artefact’ and the ‘materiality of space’ (Miller 1987: 121), and so we maintain that the influence of space is crucial to considering how care is enacted and experienced (Martin et al. 2015). A spatial focus prompts us to consider how care is configured in particular settings, which caring practices are facilitated through different spatial contexts and what the implications are of arranging care and care settings as we do – for carers and those being cared for. The chapters collected here offer studies of care in very different locations, ranging from institutional buildings to informal spaces. The hospital acts as a site for three chapters: these are a micro-scaled ethnomethodological study of the intricacies of embodied action as instruments are exchanged between medical professionals in surgical procedures (Heath et al.); a meso-level ethnography in the United States that understands hospitals as ‘nodes in transnational networks of immigrant and refugee patients’ (Bell), and a macro-level analysis of a yet-to-be built hospital in the UK, whose planning through the Private Finance Initiative (PFI) illustrates wider politico-economic contexts of care (Jones). Latimer's afterword also draws on her own ethnographic research on classifications of materials in nursing work in hospitals, as well as Hillman's (2014) study of ‘thresholds’ in hospital waiting systems. Other contributions present ethnographies of care homes and hospices, and research how everyday material cultures, such as those of clothing (Buse and Twigg), food (Ellis) and furnishings (Lovatt) mediate social interactions and identity work in later life. In these contexts, everyday objects and their in-situ arrangement are integral to building a sense of being at home (Lovatt). In contrast, medical technologies may disrupt a sense of home, and require considerable work to integrate them into domestic spaces and routines, as explored in Weiner and Will's study of home blood pressure monitoring. Other chapters contribute to our understanding of how care is encountered outside of clinical environments, whether in institutions of a primarily non-medical type, such as the art museum and botanical garden (Mang...

Table of contents

• Cover
• Epigraph
• Title page
• Copyright
• Notes on contributors
• 1 Conceptualising ‘materialities of care’: making visible mundane material culture in health and social care contexts
• 2 Materialities of mundane care and the art of holding one's own
• 3 Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring:
• 4 The art and nature of health: a study of therapeutic practice in museums
• 5 Exchanging implements: the micro-materialities of multidisciplinary work in the operating theatre
• 6 Placing care: embodying architecture in hospital clinics for immigrant and refugee patients
• 7 Private finance initiative hospital architecture: towards a political economy of the Royal Liverpool University Hospital
• 8 Dressing disrupted: negotiating care through the materiality of dress in the context of dementia
• 9 Family food practices: relationships, materiality and the everyday at the end of life
• 10 Becoming at home in residential care for older people: a material culture perspective
• 11 Afterword: materialities, care, ‘ordinary affects’, power and politics
• Index
• Wiley End User License Agreement