What's Wrong With Care?

by Eleri Fowler

Rebecca Jagoe & Sharon Kivland (eds.), On Care
Ma Bibliothèque, 280pp, ISBN 9781910055717, £18.00

The Care Collective, The Care Manifesto: The Politics of Interdependence
Verso, 128pp, ISBN 1839760966, £8.99

Emma Dowling, The Care Crisis: What Caused It and How Can We End It?
Verso, 256pp, ISBN 1786630346, £16.99

‘I am writing this in April. By the time this book goes to print the world will have changed’. So begins On Care, an anthology edited by Rebecca Jagoe and Sharon Kivland. In a time of pandemic, the act of providing what is necessary to maintain someone’s life has taken on a new urgency. Covid-19 has also exposed how the ravages of austerity have left care systems stripped of the resources needed to deal with such a crisis. In turn, these conditions have compelled communities to find new ways of caring for each other, evidenced by the rise of the Mutual Aid movement. All this means that the concept of care has become especially pertinent. As the Care Collective note early on in the introduction to their Care Manifesto: ‘in sharp contrast to 2019, talk of care is currently everywhere’.

These prefaces are needed because all three books discussed here were conceived before the pandemic. Indeed, the changes wrought over the past year have only laid bare an already existing ‘crisis of care’. The demand for the vital activities that sustain and support life has long outstripped its supply due to factors such as women’s transition away from a primarily care-giving role to being part of the workforce, the exacerbation of the dismantling of the welfare state (ongoing since the 1970s) by the programme of austerity implemented after the 2008 financial crisis, as well as demographic shifts such as an aging population.

The recent publication of On Care, The Care Manifesto and Emma Dowling’s The Care Crisis, then, speaks to a rapidly growing consensus that, for a while, there has been something awry with the state of care. In varying ways, these books illuminate the breakdown of systems of care, detailing how people are not only being denied the care they need to survive, but also that the present conditions make the delivery of care unequal, difficult and oppressive.

The Care Crisis is a sociological account of the effects of the intertwining dynamics of austerity, financialisation and marketisation. For example, in a key chapter, Dowling skilfully elucidates the ‘perfect storm’ in adult social care. Austerity has slashed local authority care budgets, forcing more people to pay for care privately (if they can afford to) and councils to ‘sell off public infrastructure and contract care services out to the private sector’. This has led to ‘high-risk forms of financial investment’ where ‘expectations of high returns on capital are upheld at the expense of . . . quality of care’, as well as attempts to make care provision more profitable by increasing ‘output per unit of time’. Consequently, the ‘pressures of underfunding are offloaded onto care-workers’ who face dire working conditions, pay and job security.

The strength of On Care is that the creative and first-hand entries included within the anthology are able to attend to aspects of care that more systematic theory cannot account for. Care comprises the processes that underpin the progression of human life; these chapters show what a life looks like when deprived of the activities usually required to sustain it and testify to the personal consequences of being burdened with the work of care. For example, ‘Charms’ opens arrestingly with: ‘when they cut the lunchtime visit, Joan became aware of her own incontinence’. Tom Allen, informed by four years of working in an assisted living facility, describes the mutual oppression of both care-workers and residents in the contemporary privatised care home. The insights of these books emerge from a sense that care is in a critical condition. The visibility politics of care often work like this. You are only aware of the vestiges of care-work when you are confronted with the fact you need it. Precarias a la Deriva, a feminist collective based in Madrid, describe care as ‘that continuous line that is always present, because if it were not we could not continue living’. The persistence and banality of care serves to conceal it. Care is always there in the background; you don’t notice that it is keeping you alive. It is only when this line is broken and the flow is ceded that you realise how vital care is. But, crucially, these texts also ask: what caused this crisis? How do we go about solving it? And what place do we ideally want care to occupy in our society?

We may be viscerally aware from our lived experience that the infrastructures and relations that are supposed to look after people are not functioning as they should. But to fully understand the crisis, we first need to establish what care is. These books are immensely useful in helping us tease out what is actually meant by this now ubiquitous term. Care is a notoriously tricky concept to pin down; it is an activity that occupies a peculiar, contradictory and expansive position.

The act of care is both material and emotional. At its most basic level, care comprises the processes that, as Dowling puts it, ‘make, remake, maintain and contain and repair the world’. But the term care presupposes an affective investment in the delivery of these activities. Care demands the direction of sustained attention onto another being and consequently implies the attachment of concern, importance and interest. This dual quality of care is poignantly illustrated in a piece in On Care entitled ‘Hand Holding’, in which artist Oisín Byrne meditates on the significance of this small act of ‘pressure applied to the skin’ during a major operation (one that the nurse does not even remember when he returns to thank her). The dynamics of care are also both personal and structural. Care is inherently relational; it is provided by one individual to or for another. It therefore exists as ‘interpersonal intimacies’ but is also ‘active and necessary across every distinct scale of life’ as ‘particular configuration[s] of social relationships’ from models of ‘kinships’ and ‘communities’ to ‘global dimensions’ like ‘states’ and ‘economies’. The place of care within capitalist economies, too, is slippery. Care is not productive of value; it is premised on keeping what already exists going rather than creating something new. Yet, although it is actively unacknowledged and undermined by capitalism, as feminists have historically pointed out, care is fundamental to the continuing reproduction of that system.

This presents a further contradiction: care overlaps and is often used interchangeably with the term ‘social reproduction’ (‘a functional economic category’ which describes the processes that reproduce both human lives and capitalist social relations). Dowling argues that ‘what distinguishes the two concepts in essence, then, is that . . . ‘care’ has an explicit qualitative meaning’. It is clear that our current system is not set up in a way that prioritises care, in all its multifaceted meanings. But is this a moral failure caused by a collective shortage of empathy? Is the unprofitable activity of care undermined by the capitalist drive for accumulation? Is our current predicament due to the undervalued position of care in society and social arrangements that restrict it along familial and national lines?

Due to its fundamentally inter-relational character and requirement of an emotional commitment, care is often advocated as an ethical framework for organising the world, premised on relationality and the flourishing of all beings. Dowling notes that as the crisis becomes acute ‘the calls for people to care more grow louder’ but warns that ‘calls for everyone to . . . be considerate of others [will not] be enough to effect real change’. This is a trap The Care Manifesto can fall into. Its co-authors propose to treat the term ‘care’ capaciously, from ‘hands on care’ to ‘a social capacity involving the nurturing of all that is necessary for the welfare and flourishing of life’, arguing ‘we must first and foremost recognise our mutual interdependencies’ and ‘the intrinsic value of all living creatures’. This means that a structural critique often becomes a moral critique; the economic and social conditions which destabilise care are conflated with a general attitude of ‘carelessness’. For example, they diagnose ‘a systemic level of banality’ that permeates our quotidian attitude to care, that ‘over the past few decades, ideas of social welfare and community had been pushed aside’ meaning ‘for a long time we had simply been failing to care for each other, especially the vulnerable, the poor and the weak’.

Indeed, all three texts are clear to point out the ways in which the affective and moral implications of care have been co-opted. Justin Hogg writes a ‘resignation letter to care’, explaining how it has been ‘hijacked by the parasitic, capitalistic . . . systems of the western world’. Dowling outlines a provisional ‘care fix’ that depends on both ‘the labour market vulnerabilities of class, gender, ethnicity and migration status’ and the ‘mobilisation’ of ‘compassion’ and ‘responsibility’ to ‘keep care infrastructures afloat under adverse conditions’. Indeed, in On Care, a community midwife describes her attendance at a funeral for the baby of a refugee as a form of care that has ‘no boundaries’. Furthermore, taking the activity of care out of the public realm means that women are increasingly obligated to fill in the gaps. Helen Hester, noting how the burden of care-work is placed disproportionately on women, argues that ‘femininity might be viewed as a work-function that further ensnares one in unwaged domestic labour.’

Dowling also delineates how governments have capitalised on people’s goodwill to extract unpaid care, trying to mitigate diminishing state provision through initiatives such as the Big Society, volunteerism in the NHS and institutionalised food banks. As well as exploiting people’s caring ethical principles and emotions, capitalism has attempted to absorb the dynamic of care. From the rise of ‘social impact bonds’ to a process of rhetorical ‘care-washing’, ‘powerful business actors are promoting themselves as “caring corporations” while actively undermining any kind of care offered outside their profit-making architecture.’ In the service industry, a brand’s veneer of care must be embodied by its workers.

Accounts in On Care shed light on the draining, depersonalising effects (‘in my days off, something normal like a passer-by asking me for directions now becomes irritating’) of the obligation to perform being invested in, anticipating and fulfilling a customer’s needs, a façade that can never replace genuine care: ‘you can be paid to serve but not to care’. Finally, in ‘Aphorisms on Self Care’, Juliet Jacques claims ‘capitalism has proved so resilient because it can assimilate not just practically any challenge to it but also any tactic designed to mitigate its effects.’ Radical calls to preserve oneself in the face of oppression become another ‘care fix’, which according to Dowling is ‘congruent with financialised capitalism’: ‘take care of you, because you are your most valuable asset’ and ‘take care of you because nobody else will.’

If the implementation of a caring ethics is an insufficient and naïve solution, and one susceptible to corruption, more material propositions are required to resolve the crisis in care. Indeed, Dowling, insists that ‘there must be a transformation of the structural conditions for care. This will only happen if care has a different status and is organised differently’. The entire question on which The Care Manifesto rests is what ‘would happen if we were to begin instead to put care at the very centre of life?’ Care is crucial to keep society going, but its place within it is unappreciated; the act of care receives little support or recognition. Care is ‘often carried out against the clock and with insufficient resources to meet needs fully’ and workers are ‘subject to less pay and social prestige’. Instead, these books argue that we need to value care. If ‘Neoliberalism does not have a word for care’, as the Care Collective contend, we need to rebuild our states and communities not around the ‘interests of corporate-driven patterns of economic growth’, but instead reorient all their systems and capacities towards care.

Firstly, ‘we urgently need to push back against the reckless and destructive marketisation of all our care sectors and infrastructures’. We also need to forge adequately funded public caring infrastructures, restoring some of the functions of the former welfare state, while ‘working to eliminate the inherently sexist, racist, hierarchical premises and manifestations of that time’. Indeed, both Dowling and the Care Collective put forward ideas for a different social organisation of care, with the collective invoking Douglas Crimp’s notion of ‘promiscuity’: we have to ‘care more and in ways that remain experimental and extensive by current standards’. The writers suggest that we must resist the denial of care through exclusion by ‘caring across difference’ and attempt to widen the delimitations of how we provide care via ‘universal care’. They also advocate redistributing the delivery of care so that excessive burden is not placed on certain groups through initiatives such as ‘creating and defending the commons: collectively owned, socialised forms of provision, space and infrastructure’.

These proposals seem just as idealistic as vague appeals for a more caring society. The authors advance ways in which we could elevate the place of care in society if it was better acknowledged, resourced and organised. But, despite their sensitive analysis of the co-option of care, they do not account for the countervailing conditions that cause the strain on care in the first place. No one would deny that care must receive all the funding it needs and our tireless care-workers deserve far greater recognition and pay. But calls to ‘re-regulate’ the economy in line with the values of care and to create ‘caring markets’ seem naively irreconcilable with capitalism’s inherent drives. Will capital ever be anything other than reluctant to invest in care, given that it cannot be sped up and rationalised towards the production of surplus value? And while the texts show the need for expansion and creative thinking around social configurations of care, their plans do not allow for the economic conditions that determine the social relations that foreclose care in the first place.

We could pose a more fraught question: is such a valorisation of care something that we actually want? In On Care, Nat Raha argues that ‘recognition of caring labour on its own terms was never to be enough’. If care-work is overwhelmingly provided by a feminised population, then how does espousing the virtues of care not simply reinforce harmful gendered norms? Moreover, none of these books has an answer for the unfortunate question of the concrete character of the work itself: its difficulty, tedium and repetitiveness.

Indeed, although, the breakdown of care has lately become acutely visible, it’s tempting to wonder if it is actually possible to isolate the dynamic of care and propose to rehabilitate it, estranged from the wider system of capitalism. It is clear that society is not set up in a way that is amenable to the flourishing of life, but as Hannah Proctor asks in a review of The Care Manifesto, ‘is carelessness just another word for capitalism’?

In the closing of Du Bois’s Telegram: Literary Resistance and State Containment, Juliana Spahr comments ‘I have a friend who jokes that most books of political theory have five chapters that describe a crisis and then a six page conclusion of Keynesian suggestions for reform that the analysis in the previous five chapters have suggested are useless’. This familiar juncture between diagnosis and offered solution is certainly what these books suffer from. In ‘To Care Amongst the Cracks’ in On Care, Carolina Ongaro declares ‘I see the cracks of a moment of crisis’ and champions ‘turning cracking . . . into a set of possibilities, of situating, creating’. Similarly, the Care Collective claim that their proposals are built on examples of ‘care-impractice’ born in social struggles, such as the treaty camps at Standing Rock and the day-care centres established by the Women’s Liberation Movement.

Yet, these instances of radical survival cannot simply be extrapolated into a programme of reforms which compromise simply recasting our current infrastructures around care (propositions which, as we have established, are unlikely to be born out due to the incompatibility of care and capitalism). The authors would do well to take further inspiration from these grassroots formations of care which serve to meet communities’ needs in the present while simultaneously opening up horizons of possibility for different ways of making the world. Because if it’s not possible to fix what’s wrong with care within the confines of present structures, our demands and imagination need to go much further.