In this blog-post I will briefly discuss chapter 6 of Buntings book Labours of Love. In chapter 6 Bunting discusses home care from the point of view of care workers, owners of home care companies, and people who are receiving home help. I will begin by describing the methodology which Bunting uses to arrive at her conclusions. And will then evaluate Bunting’s diagnosis of the current state of the social care provision before explaining some disparities in the treatment of social care and health care that Bunting noted. Because Bunting’s book is not intended to be an academic piece; she doesn’t explicitly delve into the philosophical and sociological theories underlying her discoveries. I will, therefore, interpret some of Buntings claims in light of some current philosophical and sociological theories. A key claim of this blog-post will be that a possible explanation for the disparity between the way social care and health care is treated is because of an implicit denial of our humanness and vulnerability.
Methodological Preliminaries
Bunting’s empirical methodology is four-fold. (1) Qualitative Data: She relies on case-studies to detail how the workers and owners experience working in the social care system in the UK. These case studies give us a phenomenological description of the lived experiences of the people working in a social care setting. Her focus includes voices from people working in social care, and people who own care homes (2) Quantitative Data in the form of studies which detail the financial arrangements of care companies. The funding available for social care in England. (3) Historical Data which aims to illustrate past trends of literary, scientific, and political perceptions of the elderly and speculation on how these views have influenced the current state of play in the UK re-social care. (4) Reports of her direct experiences when visiting the care home facility, home care provision etc. This can be best described as introspective reflections on her feelings as well as phenomenological reflections on her experiences in these centres.
The empirical evidence Bunting provides demonstrates that social care is criminally underfunded and that this underfunding results from an underlying ethical philosophy of individualism. In chapter 6 of her book Bunting describes historical attitudes towards the elderly throughout history; demonstrating that politicians and historians viewed the elderly with distain and as a burden on society. The elderly were described as burdens on society, who were unproductive, and therefore a drain on the system. As a result of these attitudes when people became older, they were sent to dank unhomely institutes where they were stripped of their individuality and freedom.
This general attitude towards those elderly, mirrored treatments for the mentally ill, people with intellectual disabilities. People who were deemed to be of no use to society were hidden away from the public in institutions. Given the attitudes towards the people being cared for; it is no surprise that the quality of people providing the care was not deemed an important matter.
The Devaluing of Care Work
In her interviews with homecare workers, they noted that home care work was in general viewed through a negative lens. Over fifty percent of the carers Bunting interviewed noted that their friends and family looked down on the type of work they did[1]. Baker and Lynch (2012), cite further studies which indicate that Carers feel that their work is looked down on by both politicians and society. Bunting didn’t delve into why people viewed care work as something to feel embarrassed about. On the face of it one would think that care work; a job that involves helping the vulnerable would be viewed in a positive light. However, the anecdotal reports from the care workers indicate that some people in their lives view care work as low status work. One of the care workers even said she was deeply ashamed of being a care worker (Bunting 2020 p. 205).
Another complaint which is made by the care workers is that they are extremely poorly paid. It is difficult to isolate the causal structure in this sphere; are care workers low paid because they are not respected or does society does not respect care workers because they are poorly paid and hence are categorised in a particular socio-economic class? We can see on Buntings historical analysis that the subjects of care; the elderly and the disabled are generally viewed under the guise of an economic burden. When the elderly are described as consumers who do not produce (Bunting 2020 p. 207) they are being conceptualized in a particular manner. The language we use to describe people has effects on how we conceptualize them (Lakoff and Johnson 1980 p. 3). When thought of primarily as an unproductive economic unit, as opposed to individuals with dignity who happens to need help, the quality of help we provide will be affected.
This viewing of people as economic units who are either productive members of society or are not; may explain the disparity between social care funding and NHS funding that Bunting notes. People who have a temporary sickness still have the potential to re-enter society and engage in productive work. Whereas on this extreme socio-economic thinking people who could no longer work were deemed a drain on society. This could explain why even arch conservatives like Thatcher were forced to safeguard the NHS but let social care become privatised. A substantial proportion of those in need of social care fell into the category of people who could not work because of disability[2], or the elderly who could no longer work. On the conservative world view such people were not productive members of society and hence were not the governments problem. The burden fell to families to care for those people in their families who needed help.
If families were incapable of providing the necessary care they expected to try and access the care through home-care companies. Buntings’ descriptions of these companies are derived from interview with owners, care work, and admin staff. These interviews tell the story of time pressed workers moving from job to job with little time to engage with the people whom they are supposed to support.
Buntings’ analysis points towards a severe lack of funding for Social Care in comparison to the funding available to those in the healthcare sector. This divergence in funding is on the face of it hard give a rationale for. As Bunting correctly points out people pretheoretically would expect to have social care available for a parent who has dementia in the same way they would expect to have health-care available if they had Cancer. But the reality is very different; social care funding in the UK and Ireland is severely depleted. Bunting doesn’t develop an analysis of why this divergence occurred; she merely points to the fact that Thatcher safeguarded the NHS while she privatized social care.
As we discussed above a possible explanation between the disparity with which Thatcher treated the NHS and the Social Care system was that the NHS’s primary focus was on getting economic units back out working; it was deemed good for the economy to have a fully functioning NHS[3]. Social care on the other hand was associated with aging and disabled people, and on rabid individualism with its underlying philosophy where people were portrayed as; atomistic freely choosing agents, those who were dependent on others to meet their daily needs were deemed as radically other. These radical others were viewed the responsibilities of their families, or recipients of charity[4], not as citizens with rights owed to them by society.
At the heart of this ideology, which leads to the poor social care system Bunting documents; is a kind of false consciousness. This false consciousness comes from the denial of our human animal nature. Dependency isn’t something that happens to others; it is a fact all human lives from the moment we are born. Eva Feder Kittay correctly notes that while independence is often valorised in our society this valorisation is very dubious:
“Is it not better to recognize and create conditions that foster relationships of dependency replete with affective bonds and a sense that each participant has received her due; relationships which can transform otherwise unpleasant intimate tasks into times of trust and demonstrations of trustworthiness, gratifying and dignifying to both caregiver and the recipient of care? A truly independent life-one in which we need no one and no one needs us-would be a very impoverished one even if it were possible. The person with an impairment who requires the assistance of a caregiver is not the exception, but a person living out a frequent occurrence in any human life, our inevitable dependency” (Kittay 2019 p 161)
Dependency is inevitable for every human at some point in their lives and a society which downplays this fact is a deeply unhealthy one.
Philosopher Martha Nussbaum illustrates our dependent nature using references from the point of view of developmental psychology, with help from history, literature, and psychoanalysis. Nussbaum’s story begins in childhood (Nussbaum 2018 pp 17-60). Humans, unlike most other species are born almost entirely helpless, for the first year of our lives we are entirely dependent on our mother for everything; if we defecate ourselves, we need our mother to clean us, if we are hungry, we need our mother to feed us, we are innately social and need our mother’s[5] social feedback to survive. We eventually develop the sensory motor skills to partially gain freedom from our parents but for the first ten years of our lives we are small with little power and very dependent on our parents. Post our teen years we slowly gain independence and eventually become a citizen of our society with some degree of autonomy. But no matter how free we are, at the back of our minds we still remember how vulnerable we once felt. But while our memory of our abject humility of being entirely controlled by another, implicitly terrorises our consciousness, the reflective part of our mind is looking towards another terror, the terror of future or potential present vulnerability.
Religious and philosophical fantasies may be 100% consciously believed but we know from our experiences how vulnerable our bodies are. We know from experience that people can become vulnerable through brain tumours, brain damage through a car crash, neurological disorders like MS, MMD etc. We know that at any minute we can slip from being able bodied to being disabled in the space of a few weeks. We also know that if we are lucky enough to not die young; if we are to be in the top 1% of lucky people in history, we will live to become old enough to be as disabled as we were in infancy. To steal a line from a comic movie; “run from it, deny it, there is no escaping your destiny”. The only possible escape is to die at the prime of your life.
Individuals with memories of their childhood, with the capacity to think of possible diseases, or to reflect on the limits of old age; all know we are only temporally able bodied. But we stick this fact to the back of our minds; this is probably why Superhero films are so popular; better to identify with a fantasy of being invulnerable than face the radical vulnerability. Nussbaum’s philosophy asks us to reflect on our humanness. But furthermore, she offers a corrective to the procedural views of rationalistic philosophy. Our emotional nature as humans clouds our thinking about the type of society, we want to live in.
Individualistic philosophies such as the conservative philosophy Thatcher; inspired by Hayek, adhered to when she was privatising social care was implicitly influenced by an unconscious denial of our dependency and humanity. Once this denial is made then social care seems to be a problem for individual families instead a universal problem which faces all humans.
This denial of our humanness and vulnerability infects all aspects of our social care provision. In Buntings case studies her subjects all complain about the quantitative nature of their work. In the top end home care provision people are given more time to provide their care (between thirty minutes and an hour). While at the lower end of the scale people are given 15 minutes to provide their care. The carers at all ends of the scale complain that they cannot always guarantee to provide sufficient care within a specific time frame. Partly this time frame is simply the result of working within a capitalist system in a privatised sector; care must be quantified into discrete measurable units to guarantee a profit.
But it is only partly because of this capitalist system that this quantization occurs. Another, reason is a failure to appreciate the human nature of the job. When you think of care as a series of jobs that need can be quantified you are thinking of care as a series of abstract tasks. Washing could be one task, giving meds another task etc. The reality is that care tasks are not abstractions that occur in a void. Rather they are tasks that occur in the contexts of human relationships. Even when a home care worker enters a house for the first time to provide care for person whom they have never met before; as soon as they step through the door, they are immersed in a human relationship. They are dealing with individuals with time and context specific needs and not an abstract set of tasks that must be finished within a particular time. It is through abstracting away from interpersonal relationships and humanity of people being cared for that one loses the essence of the human relationship that underlies all care work.
Bunting’s book is extremely valuable because she puts human relationships at the centre of all aspects of her book. She notes her own feelings when caring for the extremely old and aged, she reveals the world of people in care, and relates this world to the world of people providing care. The overall tenor of the book is to exemplify the human nature of the care work and how this work is relational and human work that cannot be reduced to time sheets and fixed tasks squeezed within set periods of time.
Bibliography
Baker, J, and Lynch, (2012) “Inequalities of Love and Care and their Theoretical Implications”. Social Justice Series. Vol. 12. No 1.
Bunting, M (2020) Labours of Love: The Crisis of Care. London: Granta
Fine, D. (2014) “Dependency work: A critical exploration of Kittay’s perspective on care as a relationship of power”. Health and Sociological Review.
[1] Baker and Lynch (2012) p. 12 cites a different set of studies which supports the contention that care workers feel their work is undervalued by both employees and politicians.
[2] In the case of disability a substantial proportion of them were indeed capable of working but society didn’t deem it worth its while to make environmental adjustments which would make accessing work possible.
[3] Subsequent history has shown that health care services are less and less considered off limit as the push to entirely privatize them continues apace.
[4] Rawls social contract theory though championed by liberal philosophers similarly held the view that people with intellectual disabilities are recipients of charity not subjects of justice. See Nussbaum 2006)
[5] I am speaking of mothers feedback because it is particularly important for the first 6 months of a child’s life; particularly for things like breast feeding
Philosophical Naturalism 