Science, Medicine, and Anthropology
What is Care?
The conversations at this symposium critically engaged with care to consider what the parameters of care are and how the concept can help us to interrogate the connections between kinship, medicine, exchange, and power. A question posed numerous times was ‘what does care mean?’ In the roundtable discussion, Stefan Ecks pointed out that the meaning of care as a word was tied to grief, pain or sorrow, and that these words denoted a pain or vulnerability that called for a responsive action. Discussion in this direction positioned care as a response to human circumstances and led to a group conversation about the intentions of people who care. Both panel and audience comments offered many examples illustrating that ‘care’ carries quite different meanings across languages, and that in some contexts, there are many words that mean ‘to care’ and express the nuances of types of care. It was noted that our expectations of care change when we add words to it, such as ‘quality care’, ‘social care,’ ‘professional care,’ ‘medical care’ or ‘self-care’; thus definitions of care shift depending on what is specifically needed and expected in particular contexts.
Lucy Lowe suggested using the word ‘protection’ in place of ‘care.’ She observed that in certain examples the word protection may often feel equally appropriate, such as ‘care order’ or ‘protection order’ for child welfare. While drawing on her experience working with Somali refugees living in Kenya, this suggestion was echoed in many other attendees’ work and emphasises that across contexts, care is closely connected to vulnerability and need. It also underscores that the intentions and expectations of care are not uniform, but instead construct different types of care, which emerge within different contexts. A recurring theme of these discussions seemed to coalesce around the idea that care is meant to do/fix/heal something via certain practices. Here then, care emerges as a responsive practice containing particular contextualised acts.
Such an idea is almost equal parts definitive of what care is, while also frustratingly broad. Within this symposium’s talks, this problem was named many times. Many felt that while looking at and questioning care within their research, it did not always seem to be a decisive topic or category that could be conclusively assigned to ‘things that were going on between people in my field site.’ Instead, care leaks to other realms of human life and is a difficult topic on which to put parameters. The difficulty ‘care’ poses to work that seeks to explicitly define it as topic and term lies in its prevalence. Care is everywhere, but as many remarked over the course of the symposium, ‘it can’t be everything’. Another task to consider as anthropologists when labelling our observations as ‘care’, is whether the people with whom we are working use this term, and to closely examine what care really means for them. In an effort to address this task, we move to examinations of kinship, transactional exchange, and power. In addressing each of these themes, we highlight the ways in which symposium discussions worked to map out the parameters of care within these themes, but also the ways in which ‘care’ was used in the field to help describe these different social dynamics.
Kinship
One topic of discussion, prompted by several of the papers, was how explorations of care illuminate understandings of relatedness. This is highlighted by Koreen Reece’s comment that care is “useful in terms of tracing the tensions that you sometimes find in kinship.” Commentary from roundtable members and attendees demonstrated that in investigating who cares for whom and ways in which care is done also reveal hierarchies of relatedness within social contexts. This echoed the feedback Hannah Lesshafft received about her work showing levels of relatedness created between Candomblé practitioners and their personal orixás. Alice Street described how in Papua New Guinean, international ‘state-building’ work has become focused on the need to ‘make state bureaucrats care’ at the level of the population, while public servants’ expressions of interpersonal care are interpreted as symptoms of state failure.
Further, these discussions also underscored how attention to particularities of relatedness highlights which pressures within distinct contexts mould practices of care. Koreen remarked that “holding on to the notion of care as an analytical tool actually allows you to trace changes and transformation” in practices of health across local and global social contexts in which differing notions of health treatment and care “interact with each other and change each other…our notions of care are creating social realities in the way they interact, and move” (Koreen Reece).
Taking these points into account, care as a dynamic relationship – a verb – rather than a noun eluding to a static act, emerges. Many people at the symposium reflected that people choose to perform acts of care for other people as a way to maintain or foster types of relationships, because “what people care about are relationships that have history and have a future” (Lucy Lowe). Considering this, Lucy also posed the question, “What difference does it make to care about a relationship rather than a person?” This linked to an earlier question posed by Beckie Marsland after Lilian Kennedy’s presentation, “Do you have to be a person to be an object of care?” Both these questions highlight that investigations of care reveal ways in which people actively position themselves and others within maps of relatedness.
Finally, investigations of care also call for examinations of the more intimate details of people’s lives. The topic of love was also raised in discussions about care and kinship, because often, we care for those we love, and care is motivated by, obligated to and creates love in moments of intimacy. Love is often raised in the same conversations as care, and indeed love was often spoken about in many of symposium attendees’ field experiences. This sparked a conversation about how love is a difficult term to use comfortably in academic anthropological settings due to its multiple relative meanings, but that this does not negate the need for love as a topic to be included. Investigations of care can point to what is at stake in the ways that people relate to one another, both within the intimate settings in which love is referenced, but also within larger societal context in which change may be prominent.
Exchange
While kinship and love are important factors to consider when investigating the social relations surrounding care practices, we were reminded from the roundtable discussion that these relationships also ask us to consider the role of exchange in care work. A notion that ran throughout the discussions of the entire symposium was that care denotes investment. In reference to his own work, Alex Nading said, “if I use this term [care], I like to use it in terms of a mutual responsibility, and that responsibility and action we might call care.” Describing his fieldwork, Alex Nading explained that he witnessed small exchanges that might initially appear to be forms of bribery or corruption among food producers and food safety inspectors in Nicaragua. However, under further examination, he realised that these exchanges are instead a type of care and mutual responsibility between citizens and the state that add meaning to both parties’ work.
The PhD presentations also made references to care relationships founded on practices of exchanges or transactions, as raised in Bridget Bradley’s paper, where hair stylists take on caring responsibilities for people living with trichotillomania. But here we see that care relations based on exchange can be called into question when a monetary transaction takes place. In the context of Bridget’s field, while stylists were cast in caring roles, they received pay for their work, which created confusing boundaries between stylists and trichotillomania sufferers. In these relationships, expectations for support and the high costs of stylist services created tensions that illuminated expectations of care felt from both the ‘trich’ community and professionals. The same dilemma was cited in relation to NHS staff, who are expected to care above and beyond their own job limits, and personally feel this pressure. This instigated a lively discussion about the tensions that monetary exchange can create within practices of care, which are often cast as moral dilemmas. One conclusion was that simply because people are being paid for services, does not mean that care is absent. Often, care surfaces and moulds to fit transactional circumstances in contextually particular ways.
Power
When considering ‘who cares’ and the people involved in care practices, the conversations at this symposium also considered who sets the expectations of care. Further, discussion delved into the ways in which power relations change the ways we understand everyday notions of care. Power was a theme that we returned to and named frequently, particularly when speaking of obligations and responsibilities to care. Much time was spent considering the role of the state, and types of care that are often determined or framed by bureaucratic structures. It was clear from panel examples that states are often accused of ‘not caring’ for their people. In Alice Street’s panel discussion she described how international efforts to institute biopolitical forms of care in the Papua New Guinean state, are coming into conflict with emerging ideals of ‘humanitarian’ care in global health, that impose very different expectations about what a state is. Biopolitical forms of care were also highlighted in Sandalia Genus’ paper. For participants within the clinical trials she investigated in Tanzania, many used their clinical visits as primary and immediate health care, and there were no guarantees of long-term health services from the clinical trial team. This points to the ways in which care becomes highly politicised, and that those in positions of power are able to define what kinds of care are offered, and how.
It was also noted that power relationships may always be implicit in acts of care, and that the transactional nature of care generates a kind of inequality between the care-giver and receiver. The discussio picked up on forms of ‘bad care’ which might demonstrate these inequalities. Interestingly, examples of ‘bad care’ were tied to circumstances in which power relations between parties were considered uneven and unfair. In considering contexts in which power and care were significant themes, uneven power relations were then often cast as dangerous. It was posed that the opposite of care might be oppression or neglect and that violence or harm associated with care requires more immediate attention. It was also pointed out that too much care can be harmful, with the discussion focussing on paternalistic forms of care wherein people in positions of power can ‘care too much for’ others.
Our panel and audience also raised the question of gender when discussing the ways in which power relations mould care and care practices in the field. A few of the presenters within the roundtable admitted that they felt a sense of obligation or responsibility to take on caring roles during their fieldwork experiences. Some also commented that because of their position as foreign researcher with access to certain resources, they were also asked to ‘help get someone care.’ It was also noted that these obligations were gendered, and that female ethnographers might be expected to take on these roles more so than their male colleagues. Moving toward a more reflexive lens, this points to an interesting consideration about the field of medical anthropology more generally, and the question was asked, “Does this have something to do with why there seem to be more female medical anthropologists?” It was also remarked that our entire PhD researcher panel was female. Therefore, our positionality as researchers is an important factor to consider and also responds to the question, ‘who cares?’
Conclusion
And why should we, as anthropologists, care?
Ian Harper commented that in thinking of care, notions of interdependency – be they kinship, exchange, or power – and what connects human beings across contexts are key to a study of what it is to be human. This is central to anthropology and our history as a discipline. In reflection, PhD researchers and the panel touched on the difficulties the fieldwork experience presents, often precisely for the reason that researchers can become entangled by caring and being cared for by those whom we seek to better understand. Particularly for the SoMA researchers contemplating recent fieldwork, this was most personally felt in the nuanced ways in which we became enmeshed in care roles, even responsible for the people with whom we work, but who we undoubtedly have to leave in ‘the field’, which can create a great sense of guilt as we embark on the new responsibility of their representation. For this reason, we as anthropologists care about ‘care’ because the ways in which we ‘care’ are moulded by conditions of kin, exchange, and power. Moreover, the ways in which we care and practice acts of care also affect kinship, exchange, and power relations.
Most importantly however, an attention to care as a theme unto itself is vital – because in investigating care and following its ‘leakages’ into other themes, intricacies within those themes become illuminated. We close with a commentary that care cannot be succinctly defined, but instead only specified by its particular examples of practice. This then underscores the analytic power a lens of care has: it reveals both the complex nuances within diverse realms of social life and what is at stake within our relationships with one another.
SoMA would like to thank the EdCMA members for their support and contributions, and all those who attended the symposium for their discerning feedback. This event has helped us to delve more deeply into our research and has opened up new and intriguing avenues of thought about the importance of a discussion of care in our theses.