Conceptualizations of Care
Tronto (1993) offers an analysis of care that illustrates how the values we associate with care are gendered, hierarchical and cross the public/ private binary. Tronto conceptualizes care in four ways (see also Fisher and Tronto, 1990) (see Table 5.1). The first stage of caring is caring about. This is the initial recognition of a care need. Tronto notes that
Table 5.1 Four forms of care
Source-. Developed from Fisher and Tronto, 1990; Tronto, 1993
there is a perceived link between what it is that we care about and what sort of person we are. In addition, the division between what we care about and who has the responsibility for this initial recognition is crucial. For example, if we are responsible for caring about the public issues of state and economy, we are within the spheres of the most powerful. As those who care about such issues are accorded high value, so these activities are similarly given a high valuation. Conversely, caring about one’s children or one’s partner are primarily the spheres of the least powerful. Caring about these issues, and those who undertake this care are, in consequence, of low value.
The second stage of care is that of taking care of. This draws on ideas of agency and responsibility. This means that one has taken responsibility for a need and has decided how to respond to it. For example, we may decide that we will take care of Third World debt by lobbying parliament and we may decide that we shall take care of the dietary needs of our sick parent by consulting a dietician. What we find here are the same divisions in terms of value and power. When taking care of is associated with the public spheres of life, it is viewed as relatively prestigious. When it is associated with the private realm, it is viewed as relatively trivial. Moreover, the form through which we take care of influences our judgement of its importance. Men take care of their families through being in paid employment. Women take care of their families through, for example, housework.
The third phase in the process of care is that of care giving. This is the direct meeting of care needs and involves physical work and coming into contact with those who need care. This is the work of cleaning, dusting and cooking, of giving medicine to the sick and of counselling students. Tronto notes that primarily the giving of care is the work of slaves, servants and women. When men do undertake this work, we find a pattern of exceptionalism. Doctors have higher status than nurses and men who enter the caring professions, such as social work and teaching, are more likely to reach the top of them.
Care receiving is the final stage and this is where care needs are met. This has the lowest status of all because the acknowledgement that one has care needs is a threat to one’s sense of autonomy. To receive care is to place oneself in a position of dependency and those with most needs are perceived to be the most dependent. In addition, we are either pitying or disdainful of those who need care. Importantly, Tronto notes that those with most power are able to define their needs in ways that maintain rather than undermine their privilege. In these ways the identification that to have care needs is to be less autonomous, to be disdained or to be pitied is avoided. This is accomplished in two main ways. First, their care needs are met by those who are in positions of greater dependency than they are. Second, their care needs are redefined in terms of freedom to pursue higher order activities. Thus, men’s needs for care of themselves and their children are primarily met through the invisible and unpaid work of women. In the sphere of paid work, managers delegate care needs to others in order that they have more time to manage and senior consultants delegate the lower care needs of patients to junior doctors and nurses.
Tronto’s depiction of the four phases of care illustrates something of the range of activities that come to describe care. In the field of community care F. Williams (1993) depicts this range in terms of five groupings. These are:
1 Process of care: for example, the day-to-day experiences of those who are involved in caring for someone.
2 Context of care: for example, domestic service, institutional care, mothering, neighbouring, caring for a gay partner. These contexts would demonstrate the varied historical, cultural and social sites and relations of care.
3 Struggles of care: for example, a focus on the difficulties and problems that arise in situations in which the person caring and the person cared for find themselves.
4 Dilemmas of care: for example, the conflicts and constraints facing those who seek to provide the best possible care.
5 Rights of care: for example, voicing the right that those in need of care can determine the kind of support they need.
Williams’s depiction of these groups demonstrates that those who use the term care are referring to process, context, struggle, dilemma and rights. In this respect we can extend Williams’s analysis to say that these issues are relevant to care in any setting. In each of these groupings a further wide range of features would also be significant and would draw on a host of values and other concepts. For example, Williams points out that care should not only be considered in terms of ‘different contexts and relationships, but as a manifestation of different feelings and motivations: control, responsibility, obligation, altruism, love and solidarity’ (ibid.: 81).
Thomas (1993) explores the broad nature of care through a consideration of seven key variables that impact on the different ways in which care is conceptualized. These are:
1 The social identity of the carer.
2 The social identity of the care recipient.
3 The inter-personal relationships between the carer and the care recipient.
4 The nature of care.
5 The social domain within which the caring relationship is located.
6 The economic character of the care relationship.
7 The institutional setting in which care is delivered.
Thomas argues that these seven dimensions are the building blocks that interlock to make up the total concept of care. For Thomas, therefore, ‘the variable definitions at the level of these seven dimensions which, in combination, result in quite different concepts of care’ (ibid.: 651). However, Thomas points out that although we might contrive to include every variable as part of our total construct of care, without adequate theorization we are left at the level of empirics and description. For example, we could certainly argue that ‘care is both paid and unpaid provision of support involving work activities and feeling states. It is provided mainly, but not exclusively, by women to both ablebodied and dependent adults and children in either the public or domestic spheres, and in a variety of institutional settings’ (ibid.: 665). This may be a useful working description but it does not explain why, for example, it is mainly women who undertake care work. It is to the realm of explanation that I now turn.