Four Phases of Caring

9 We noted that, as an ongoing process, care consists of four analytically separate, but interconnected, phases. They are: caring about, taking care of, care-giving, and care-receiving. Let me describe each of these phases in turn.

10 Caring About. Caring about involves the recognition in the first place that care is necessary. It involves noting the existence of a need and making an assessment that this need should be met. Caring about will often involve assuming the position of another person or group to recognize the need. Recognizing that people who are debilitated with AIDS might have difficulty with mobility creates a need: how will they be able to eat? to shop? Caring about is culturally and individually shaped: some people ignore panhandlers who ask for change; the graphic pictures of starving children on the television news might make one consider a contribution to an international relief agency. In the United States, we often think of caring about in highly individualistic terms: several scholars have argued that what we care about defines who we are as people and as unique individuals. [14] Nonetheless, we can also describe caring about on a social and political level, and describe society’s approach to homelessness, for example, in caring terms.

11 Taking Care of. Taking care of is the next step of the caring process. It involves assuming some responsibility for the identified need and determining how to respond to it. Rather than simply focusing on the need of the other person, taking care of involves the recognition that one can act to address these unmet needs. If one believes that nothing can be done about a problem, then there is no appropriate “taking care of.” If we believe that it is too bad that children starve in the third world, but since any food sent there will be stolen, there is no point in sending money to buy food; then we have suggested that this need cannot be met, and no “taking care of” can occur. Taking care of involves notions of agency and responsibility in the caring process. Having recognized the needs of people with AIDS, a number of service-providing agencies have appeared, such as Gay Men’s Health Crisis, Project Open Hand, and the Shanti Project. Obviously, the task of “taking care of” the needs of people with AIDS goes beyond simply driving up to the door of someone with AIDS, knocking, and offering a hot meal. A reliable source of food must be found, volunteers coordinated, and funds raised. All of these tasks are part of “taking care of.”

12 Care-giving. Care-giving involves the direct meeting of needs for care. It involves physical work, and almost always requires that care-givers come in contact with the objects of care. Delivering food to camps in Somalia, volunteers arriving with culturally appropriate meals for AIDS patients, someone washing his laundry, are examples of care-giving. So too are the examples of care that spring most quickly to our minds: the nurse administering medication, the repair person fixing the broken thing, the mother talking with her child about the day’s events, the neighbor helping her friend to set her hair.

13 It would be possible to conceive of giving money as a form of care-giving, though what this form of giving usually does is to enable someone else to do the necessary care work. If I give money to a homeless person on the street, she or he must convert that money into something else that will satisfy a need. In this regard, providing money is more a form of taking care of than it is a form of care-giving. The reason to insist upon this distinction is important. Money does not solve human needs, though it provides the resources by which human needs can be satisfied. Yet as feminist economists have long noted, there is a great deal of work that goes into converting a pay check, or any other kind of money, into the satisfying of human needs. [15] That we quickly equate in the United States the provision of money with the satisfaction of needs points to the undervaluing of care-giving in our society.

14 Care-receiving. The final phase of caring recognizes that the object of care will respond to the care it receives. For example, the tuned piano sounds good again, the patient feels better, or the starving children seem healthier after being fed.

15 It is important to include care-receiving as an element of the caring process because it provides the only way to know that caring needs have actually been met. (Until this point in our description, we have assumed that the definition of a caring need that was posited in the first phase of caring by the one(s] who “care about” a need was an accurate one.) But perceptions of needs can be wrong. Even if the perception of a need is correct, how the care-givers choose to meet the need can cause new problems. A person with mobility limitations may prefer to feed herself, even though it would be quicker for the volunteer who has stopped by with the hot meal to feed her. Whose assessment of the more pressing need–the need for the volunteer to get to the next client, or the meal recipient’s need to preserve her dignity–is more compelling? Whose account of children’s needs in inadequate schools will direct how schools spend their funds, how much money they will receive, and so forth? Unless we realize that the object cared for responds to the care received, we may ignore the existence of these dilemmas, and lose the ability to assess how adequately care is provided.

Caring Well

16 Now that I have described care, it will be useful to keep in mind several more crucial aspects of good care.

17 Practice. Care is perhaps best thought of as a practice. The notion of a practice is complex; it is an alternative to conceiving of care as a principle or as an emotion. To call care a practice implies that it involves both thought and action, that thought and action are interrelated, and that they are directed toward some end. The activity, and its end, set the boundaries as to what appears reasonable within the framework of the practice. This notion of practice is described by a number of contemporary moral thinkers, [16] and is ultimately derived from Ludwig Wittgenstein. Among contemporary feminists, Sara Ruddick has insisted that we understand care as a practice as a form of practical rationality. [17]

18 What kind of end guides the practice of care? I suggest that the four phases of care can serve as an ideal to describe an integrated, well-accomplished, act of care. Disruptions in this process are useful to analyze. Providing an integrated, holistic way to meet concrete needs is the ideal of care.

19 Conflict. Nevertheless, the fact that care can be a well integrated process should not distract us from the fact that care involves conflict. While ideally there is a smooth interconnection between caring about, taking care of, care-giving, and care-receiving, in reality there is likely to be conflict within each of these phases, and between them. Nurses may have their own ideas about patients’ needs; indeed they may “care about” a patient more than the attending physician. Their job, however, does not often include correcting the physician’s judgment; it is the physician who “takes care of” the patient, even if the care-giving nurse notices something that the doctor does not notice or consider significant. Often in bureaucracies those who determine how needs will be met are far away from the actual care-giving and care-receiving, and they may well not provide very good care as a result.

20 Care is fraught with conflict in other ways as well. Often care-givers will find that their needs to care for themselves come in conflict with the care that they must give to others, or that they are responsible to take care of a number of other persons or things whose needs are in conflict with each other. How a care-giver mediates these conflicts will obviously affect the quality of care. Care-receivers might have different ideas about their needs than do the care-givers. Care-receivers may want to direct, rather than simply to be the passive recipients, of the care-giving that they receive. [18]

21 Particular and Universal Aspects of Care. Conceptually, care is both particular and universal. The construction of adequate care varies from culture to culture. The notion that “mothering” is the paradigmatic act of caring, for example, is part of our cultural construction of adequate care. [19] Adequate care may also vary among different groups within a society as distinguished by affinity group, class, caste, gender, and so forth. These cultural constructions of “well cared-for” serve to mark class, caste, and gender groups. [20]

22 Yet despite the fact that the meaning of care varies from one society to another, and from one group to another, care is nonetheless a universal aspect of human life. All humans need to be cared for, though the degree of care that others must provide depends not only upon culturally constructed differences, but also on the biological differences that human infants are not capable of caring for themselves, and that sick, infirm, and dead humans need to be taken care of. Once again, care is not universal with regard to any specific needs, but all humans have needs that others must help them meet.

23 Resources. Good care will also require a variety of resources. Lest the description of care as a practice mislead our thinking, care depends upon adequate resources: on material goods, on time, and on skills. Resources for adequate care will generally be more scarce than those engaged in caring might like; one of the large political questions to consider is the determination of which caring needs receive which resources. Again, the matter of resources is complicated by the existence of conflict within care, by the cultural diversity of what constitutes adequate or good care, and by the scarcity of material and other resources.

24 Care as a Standard. Finally, caring as a concept provides us with a standard by which we can judge its adequacies. One way to begin to judge the adequacy of care is to consider how well integrated the process of caring is. The absence of integrity should call attention to a possible problem in caring. Given the likelihood of conflict, of limited resources, and of divisions within the caring process, the ideal of an integrated process of care will rarely be met; although this ideal can serve us analytically as we try to determine whether care is being well provided.

How Care Is Contained: Care As Weakness

25 Care work is devalued; care is also devalued conceptually through a connection with privacy, with emotion, and with the needy. Since our society treats public accomplishment, rationality, and autonomy as worthy qualities, care is devalued insofar as it embodies their opposites.

26 Care as a Disposition versus Care as a Practice. Many of the thinkers who have written about care describe it as an attitude or disposition. [31] Jeffrey Blustein even talks about “second order caring” as caring about caring. Separated from all particular acts of caring, Blustein argues,

27

to care about caring is to care about one’s ability to care deeply about things and people in general, to invest oneself in and devote oneself to something ( or someone) or other.... The person who cares about caring... is emotionally invested in being a caring person, that is, a person who takes an interest in and devotes him or herself to things, activities, and people in his or her world. [32]

28 For Blustein, and for other thinkers as well, caring is not so much about the activities of care, but about the emotional investment that has been made in order to care. The problems with this way of understanding care should, by now, be obvious. To think of care solely in dispositional terms allows us to think of care as the possession and province of an individual. It makes any individual’s ideals of care fit into the world view that the individual already possesses. This perspective allows care to be sentimentalized and romanticized, permitting the divisions in care previously described.

29 As Sara Ruddick has suggested, the way to avoid over-idealizing care is to think about it in terms of a practice. [33] When we think of care as a practice, with all of the necessary component pieces, then we must take into account the full context of caring. We cannot ignore the real needs of all of the parties; we must consider the concerns of the care-receiver as well as the skills of the care-giver, and the role of those who are taking care of.

30 To think of care as a practice rather than as a disposition changes dramatically how easily care is contained. As a disposition or an emotion, care is easy to sentimentalize and to privatize. When we retreat to the traditional gendered division, we support the ideological construction that women are more emotional than men, and men are more rational than women. Since women are more emotional than men, then, women are more caring; men’s “caring” is limited to their achievement of their rational plans ( one of which is taking care of their families). This traditional ideology thus reinforces traditional gender roles and the association between women and caring. What is lost in this association is the reality of the complexity of caring, and the fact that caring is intertwined with virtually all aspects of life. What is gained in this association is a division of spheres that should serve to placate women and others who are left to the tasks of caring.

31 I am not arguing that care has nothing to do with dispositions or emotions. What I do assert, though, is that these dimensions are only a part of care. Unless we also understand care in its richer sense of a practice, [34] we run the risk of sentimentalizing and in other ways containing the scope of care in our thinking.

32 Care as Private Activity. In addition to care being associated with the emotional as opposed to the rational, care is also devalued in its meaning through its related association with the private sphere. Care is usually conceived of in our culture as, ideally, a private concern. Care is supposed to be provided in the household. Only when the household fails to provide care in some way does public or market life enter. For example, ideologically, mothers should care for their children; the use of day care facilities is seen as a fall-back option. That day-care should be private is a major resistance to the establishment of more formal day-care policy in the U.S. [35]

33 The private provision of care takes an enormous toll on women. Susan Faludi reports that, despite the conventional wisdom that single women are unhappy, the burdens of being married make married women more depressed and less healthy than single women. [36] This result makes sense when we realize that women are expected to care for those in their household. Married women suffer from the fact that they are expected to care for their husbands but that no separate provision is made for their care. At least single women know that they must care for themselves (and/or the others in their households), and it is probably less likely that greater care-demands made by others prevent them from caring for themselves.

34 Women who work outside of the house in occupations that require that they give care, and who face large caring burdens at home, are often adversely affected by their situation. When we acknowledge that care-givers often lack adequate resources to accomplish their caring tasks, it is easy to see how care continues to be a burden in our culture. [37] Yet the view that care must be private, and the privatizing of the difficulties women encounter as care-givers, further supports the perception that care is not a social concern, but a problem of idiosyncratic individuals.

35 Disdain For Care-Receivers. To make matters worse, care-receivers are viewed as relatively helpless. On the most general level, to require care is to have a need; when we conceive of ourselves as autonomous, independent adults, it is very difficult to recognize that we are also needy. Part of the reason that we prefer to ignore routine forms of care as care is to preserve the image of ourselves as not-needy. Because neediness is conceived as a threat to autonomy, those who have more needs than us appear to be less autonomous, and hence less powerful and less capable. The result is that one way in which we socially construct those who need care is to think of them as pitiful because they require help. Furthermore, once care-receivers have become pitiful by this construction, it becomes more difficult for others to acknowledge their needs as needs. This construction further serves to drive distance between the needs of the “truly needy” and regular people who presume that they have no needs. Those in the disabled rights movement have long acknowledged how difficult it is to get so-called able-bodied citizens to recognize them as people who are equally deserving of dignity and respect.

36 Care As Privileged Irresponsibility. There is one last consequence of the unbalanced nature of caring roles and duties in our culture. Those who are relatively privileged are granted by that privilege the opportunity simply to ignore certain forms of hardships that they do not face; I suggest that we call this form of privilege “privileged irresponsibility.” [38]

37 Recall that logically, in order to accept responsibility for a problem that requires care, “to take care of,” there must first be a recognition of the problem: caring about, and recognizing the problem. Thus, our analysis of the phases of care exposes the mechanism by which ignorance serves to prevent the relatively privileged from noticing the needs of others.

38 Generically, those who are responsible for “taking care of” a problem, and perhaps spend money to alleviate a problem, do not feel that they need to supervise the interaction of care-givers and care-receivers. If care-receivers feel aggrieved, they cannot complain to those who have not provided the direct care, because that is not their responsibility. Dividing up responsibility privileges those who are excused by not needing to provide care; thus the privileged avoid responding directly to the actual processes of care and the meeting of basic needs.

39 Racism, for example, continues because people with “white skin privilege” benefit from a system that accords them more opportunity. [39] But people who are the beneficiaries of white skin privilege need not recognize that privilege, and by not thinking of the needs of people of color, they may ignore the existence of white skin privilege. Further, they need feel no responsibility for the continued existence of racism, because they themselves do not believe that they are prejudiced. Thus, because those with privilege need not take responsibility, either for their own privilege, or for the absence of privilege for others, the problem persists without anyone deliberately refusing to assume responsibility.

40 Thus, the other side of care’s distribution to maintain privilege is that it is next to impossible to discuss this distribution in these terms. “I pay my maid the going rate,” we might imagine an upper-middle class person asserting. What is not acknowledged in that situation is that the maid may not be able to meet the needs of her own household on this salary, and may have to scramble to arrange for her own child care needs as she cares for some other children. [40] Because we do not discuss the entirety of caring needs within a single framework, there is no way to make the privileged, who would ignore others’ needs in order to meet their own, change this way of looking at the world.

41 I have portrayed care as a marginal aspect of our society. Surely, a critic might argue, my reading must be wrong; we accord great importance to mothers, for example. I have suggested, however, that even those aspects of care that do receive value in our society receive a value that is tainted by an association with lesser social values: with emotion, the private household, and the relatively weak. Care has little status in our society, except when it is honored in its emotional and private forms.