Care: Integration

Integration is an interesting provocation for thinking about care. Rooted etymologically in oneness (integer, integrity), the word posits it not as origin or essence, but as an outcome, an accomplishment, the end of a process.  In this sense, integration resonates well with care, which—however we may define it, whatever specific forms it may take—is purposeful activity that seeks to restore wholeness in another. Care involves an act of reaching out, in a gesture that seeks to comfort, to connect, to heal—to make whole. To integrate.

For me as for many others, engagement with the topic of care has entailed an effort to integrate scholarly work with everyday life.  Such efforts owe much, in content and form as well as in inspiration, to feminist scholars who have long fruitfully insisted on “thinking from women’s lives” (Harding 1991), including their own—lives in which care often occupies an important place. Informed and inspired by such work, I was moved to try to integrate the scholarly approaches in which I have been steeped as a medical anthropologist with what I was learning through my experience as a daughter responsible for caring for an elderly mother with advanced dementia. My own research on care has, thus far, been mostly “of the decidedly unchosen variety, thrust on me by life-changing losses that I would have avoided if I could, but from which I have learned a great deal nonetheless” (Taylor 2008:314). 

From this unchosen “fieldwork,” two conversations stand out in my mind, as resonating with the theme of “integration.”  

One took place in the assisted-living facility where my mother was living at the time. Kathleen, one of the aides who worked there, was telling me about a training session that she had attended, where she had learned a new method for helping people with very advanced dementia drink out of a cup. 

“You know, sometimes the person may be thirsty, and you can put the glass there on the table in front of them, but they just don’t know how to pick it up and take a drink. So you take the person’s hand, and you put it around the cup like this…” Stepping in close to me, she took my right hand in hers and curled it around an imaginary cup. 

“And then, you put your own hand right over it,” said Kathleen, laying her right hand on top of mine, “and you start moving the cup up, like this.” Our arms moved together, the imaginary cup approaching my mouth. “Once you get them started, the muscle memory kicks in and then, they’re able to do it.” 

Kathleen turned to me, her eyes alight. “So I came back, and I tried it, and it worked!” She gave a little shiver of delight. “It was so amazing, it just gave me chills!”

The other conversation took place on a different day, at a street corner a few blocks away.  It was late morning on a lovely spring day, and my mother and I were walking, very slowly, hand-in-hand, around the neighborhood. We walked by a busy café on a corner; the tables inside were all full, and a few customers sat on metal chairs at small tables on the sidewalk outside, enjoying the sun. One of them, a woman in her forties, caught my eye and smiled. She said to me, “I miss your mother.” 

Startled, I stopped.  “…Do you know my mother?”

“Yes, I used to work at  ________,” she answered, naming the place my Mom lived. 

“Oh…” I said, “Thank you. Thank you for taking care of her.” 

“I don’t work there anymore,” she responded. “I got fired. I was responsible for eight residents, and one of them had diarrhea, and while I was busy cleaning him up, one of the other ladies walked out of the building and got lost. So they fired me.” 

“Oh…” I said, “I’m sorry.” 

Taken together, these two stories speak to me of how care itself poses challenges of integration. Both conceptually and practically, care is split, segregated – the arduous and tedious physical tasks separated off from the spiritual and nurturing element, and assigned to different groups of women (Glenn 2012).  In the U.S., as in many places, the hard physical work of caregiving labor is often shouldered by low-wage workers, many of them women, most of them poor and/or immigrants (Browne and Braun 2008, Degiuli 2007, Eckenwiler 2012, Stacey 2011). My conversation with the woman at the café was remarkable mostly for how rarely situations arise in which people are called upon socially to acknowledge the embeddedness of their lives in the political economy of caregiving labor—to meet the stranger to whom one is unknowingly indebted, and to say both “Thank you,” and “I’m sorry.” Speaking these words does not cancel out the debt, of course; but the conversation need not end there. Working to document and analyze the social and economic inequalities surrounding care can make a modest contribution to broader efforts to change them. As such, scholarly work on care itself involves an effort to make whole—it involves a form of care.

At the same time, these two stories also remind me that care, even in its most mundane and practical aspects, is never only a burden or cost to be more equitably borne, it is not just a matter of “doing the dirty work” (Stacey 2011; Kostakiotis 2012; Jervis 2001). Care, this reaching out toward another human being in need, is also fundamentally creative and deeply human endeavor.  It can give one “chills!”  In intervening to make things better, through the tinkering that care entails (Mol 2008), people also create selves and others and relationships—the world is made anew. What kind of world it is that gets made, of course, is not predetermined; real politics are enacted in the very practicalities of care (Pols 2006).

While pointing toward oneness, integration begins in its opposition: division, difference, disintegration. Care, similarly, begins in gaps that it strives to bridge: the terrible distance between present suffering and hoped-for well-being, as well as the experiential gulf separating caregiver from the object of care, whose suffering can never be fully shared. Care is, in this sense, a “critical sociality based on incommensurate experience” (Garcia 2010:50).  Indeed, it is as a response to this “acknowledged, structural inequality between caregivers and care-receivers” (Livingston 2012:166) that the care has moral force. As “a brave and noble response to the shared human condition of being both mortal and compassionate creatures” (Taylor 2003:175), caregiving is “a moral practice that makes caregivers, and at times even the care-receivers, more present and thereby fully human… even as we experience our limits and failures…” (Kleinman 2009:292-293).

One final thought: to engage with current scholarly work on care is to enter several different discussions unfolding at once, from somewhat different starting points, in different directions, partly in conversation with each other and partly not. Some offer fresh and perspectives on the textures and specificities and the enormous stakes of care in practice (Mol, Moser and Pols 2010), some trace the lived consequences of discourses of care as mobilized by the state (Ticktin 2011), and some show us how a neoliberal political economy is lived through relations of care (Han 2012). A creative task lies before us, as scholars who care about care: to make new kinds of sense from these disparate insights. To make whole, to integrate.

References

Browne, Colette V. and Kathryn L. Braun. 2008. “Globalization, Women’s Migration, and the Long-Term-Care Workforce.” The Gerontologist 48, no. 1: 16-24.

Degiuli, Francesca. 2007. “A Job with No Boundaries: Home Eldercare Work in Italy.” European Journal of Women’s Studies 14, no. 3: 193-207.

Eckenwiler, Lisa. 2012. Long Term Care, Globalization, and Justice. Baltimore: Johns Hopkins University Press.

Garcia, Angela. 2010. The Pastoral Clinic: Addiction and Dispossession along the Rio Grande. Berkeley: University of California Press.

Glenn, Evelyn Nakano. 2012. Forced to Care: Coercion and Caregiving in America. Cambridge: Harvard University Press. 

Han, Clara. 2012. Life in Debt: Times of Care and Violence in Neoliberal Chile. Berkeley: University of California Press.

Harding, Sandra. 1991. Whose Science? Whose Knowledge? Thinking from Women’s Lives. Ithaca: Cornell University Press.

Jervis, Lori L. “The Pollution of Incontinence and the Dirty Work of Caregiving in a U.S. Nursing Home.” Medical Anthropology Quarterly 15, no. 1: 84-99.

Kleinman, Arthur. 2009. “Caregiving: The Odyssey of Becoming More Human.” The Lancet 373, no. 9660: 292-293.

Kostakiotis, Giorgos. 2010. “ ‘Why Should I Eat Shit?’ Negotiating the ‘Dirty Work’ of Taking Care of Elders on an Aegean Island." Medische Antropologie 22, no. 1: 77-92.

Livingston, Julie. 2012. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham: Duke University Press.

Mol, Annemarie. 2008. The Logic of Care: Health and the Problem of Patient Choice. New York: Routledge.

Mol, Annemarie, Ingunn Moser, and Jeannette Pols. 2010. Care in Practice: on Tinkering in Clinics, Homes and Farms. Bielefeld: Transcript Verlag.

Pols, Jeannette, 2006, “Washing the Citizen: Washing, Cleanliness and Citizenship in Mental Health Care.” Culture, Medicine and Psychiatry 30: 77-104.

Stacey, Clare. 2011. The Caring Self: The Work Experiences of Home Care Aides. Ithaca: Cornell University Press. 

Taylor, Janelle S. 2003. “The Story Catches You and You Fall Down: Tragedy, Ethnography, and ‘Cultural Competence.’” Medical Anthropology Quarterly 17, no. 2: 159-181.

Taylor, Janelle S. 2008. “On Recognition, Caring, and Dementia.” Medical Anthropology Quarterly 22, no. 4: 313-335.

Ticktin, Miriam. 2011. Casualties of Care: Immigration and the Politics of Humanitarianism in France. Berkeley: University of California Press.

Photo Credit: Studio Grafico EPICS.