Taking and Giving Care: For Whom and to What End(s)? (article)

In this current age, basic trust has broken down and rules and regulations increasingly take the place of what might otherwise be motivated by responsibility and integrity. Even in the United States, we no longer trust our government, our media, or even one another to have in mind a common good that includes alternative

Page 180

points of view. So, what is the place of care and caregiving in this world? How do we even define these terms, and toward what ends? Investigating these questions may help us move beyond a superficial vision of care that eases one’s conscience at the other’s expense, and move toward a more cogent conversation that takes diverse interests, needs, feelings, and desires into account.

To take on these questions, we must first consider what care actually means. Care presumes a particular kind of relationship in which, as defined by Merriam-Webster, there is concern, anxiety, or solicitude. Whereas caring is defined in terms of feeling or showing concern or kindness (presuming a possible parity in the relationship), to care for is defined in terms of doing things that are needed to help and protect another, presuming disparity in the relationship. Caregiving follows this latter track to presume responsibility for the object of one’s concern. Help and protection, however, can be variously construed. I would contend that care can only be defined in terms of a relationship in which there is respect for each person’s needs and feelings, even in relationships where there is some disparity of role and obligation. Any purported care that falls short in that dimension is in danger of becoming a type of pseudo-care, in which one might indulge in narcissistic self-indulgence at the other’s expense. It matters very much whether we can reflect upon our actions and motivations sufficiently enough to discover to what extent we are engaged in a mindless offering in deference to a supposed authority rather than a mindful offering to another being that is conditioned legitimately by the other’s response.

If we think in terms of D.W. Winnicott’s object usage—his emphasis on the importance of recognition of differences between the self and other as a precondition of care—then we have a useful marker to guide our exploration. His idea is that a true relationship depends on the recognition of two individual beings with different needs, desires, and perspectives (Playing and Reality, 1971). To move beyond a simplistic, narcissistic immersion in self-interest, one has to be able to recognize the legitimacy of the interests of the other-as-other and to recognize differences in values as markers of alternative perspectives that need to be taken into account and thought through.

I would also contend that one cannot be caring without the capacity—and the determination—to reflect on these questions. Reflection requires some distance from which to afford the perspec-

Page 181

tive to think about the ideas under scrutiny. Again, we need the thirdness afforded by the recognition that people legitimately see things differently, and that all human knowledge is limited and based upon personal experience. It is in difference that we find learning opportunities. If, however, we look for “right answers” rather than being respectful of whatever gaps the questions point to, then we are moving into an age of machines (which can be fixed, monitored, and managed) as opposed to people (who are capable of learning when treated respectfully). For those of us in socially-sanctioned positions of “care”—as one patient puts it, the designated knowers—there is an obligation to be responsible in some ways for others. In such instances, respect for others means guiding those in our care towards better recognizing and facing developmental challenges, while ourselves being open and authentic regarding our goals.

Ostensible caregivers are already ensconced in a divisive, mechanistic era. For example, as someone who consults college counseling centers, I have been interested in the current rhetoric that speaks of an alarming rise in “acute and chronic mental illness” on campuses today. Pushing back on this rhetoric in my own mind, I wonder about the social contexts in which this trend has arisen. Toward that end, I have been thinking about the implications of the current press toward finding solutions to the problems. That press, in the mental health systems, has resulted in a narrowing of definitions around human suffering that move toward simplistic assumptions and decision-making regarding how symptoms should lead to diagnoses and treatment. That pressure invites concerned parents to seek professional assistance for their children who are suffering from problems in living, and also invites the children to view their problems as outside their own dominion of control. By the time those children enter college, they are firmly ensconced in an identity that presumes deficits, which must be managed by others rather than seeing challenges as problems in living that can be faced, worked at, and worked through. What might have afforded experiences of mastery, as problems are more directly faced and worked through, instead results in experiences of self-as-problem to be solved and managed by experts and medications.

At what point did parenting turn away from ideas about developmental challenges and difficulties, and toward ideas about problems that require labels, diagnoses, management, and pills? Our children come to college often better armed with more

Page 182

reasons why they should not be expected to meet challenges than with methods learned, by experience, for meeting, mastering, or accommodating to life’s demands. Unfortunately, that creates a further array of problems for the young adult, who has learned to turn to the experts for the answers, whether that be in the realm of academics, politics, or problems in living. It is difficult, in such an era, for experts to stand firmly in their own positions, as human beings who have particular expertise that must be reflected upon to make decisions about how best to apply such knowledge. One could argue that this is the proper province of higher education: to help our young people learn how to face challenges with reflective engagement that further sharpens their ability to discern crucial aspects of problems and think through potential solutions. Similarly, I would argue that this is also the proper province of mental health services: to help individuals further their own reflective capacity to bear on living problems. Each domain is about learning as an active process that fuels itself.

From the alternative position of an aging adult, I listen with horror to commercials that invite my adult children to take on a caretaking role that I would never assign to them, as advertisers invite middle-aged adults to take over the executive functions of their ostensibly incompetent parents. As background, we have the debates that volley back and forth as to whether one might be afforded choices related to the quality and duration of one’s own life. Are there universally “right” answers when it comes to quality of life? Is the choice to die inevitably a sign of a diseased or disabled mind? When did our ideas about caregiving, giving care, turn into ideas about caretaking, tending to people as though they were estates or machines? In this instance, it is not just the professionals who are asked to make decisions about reflective capacity and the right to make one’s own decisions. Adults are also being enjoined to make decisions about their aging parents. What is perhaps most insidious about the latter is that the invitation comes from interested parties, people in a position to make a profit from the decisions being solicited. We are being invited, not to care for others, but rather to care about the standards being offered that seduce us into roles and behaviors that may do more to line someone’s pockets than to provide care for loved ones.

This brings us to an issue that has become quite salient in recent times: the mass marketing of the American mind. It is increasingly clear that opinions are being carefully formed and for-

Page 183

mulated through marketing techniques that often masquerade as news. We have seen that when the message is repeated often enough, the lack of reason can become irrelevant. Even blatant falsehood can be widely taken as truth. Capitalism rests on the ability to persuade people that they need more and other than whatever they have. Advertising and marketing have become so sophisticated that we are not only being sold new products, we are also being sold positions, values, and systems that we come to believe we need or want, whatever their actual value. It is often only at the back end that we see that a system created to solve one problem has instead made more and worse problems. But usually, that system has by then become so entrenched that we can’t get out from under it and end up creating more and more debris, making it difficult to sort through our actual responsibilities to those we love.

In such an era, it matters very much who gets put in charge of what or whom in the name of caretaking. For example, as a psychologist, I have watched my professional guild develop more and more bureaucratic structures and guidelines that obstruct good care rather than further it. The same thing is happening in the area of clinical training. It is as though, if there is sufficient bureaucracy and red tape, we are ensuring the public good, whereas from my perspective we are merely further and further obstructing it. The systems are becoming increasingly time-consuming and difficult to manage, increasing the time spent in administrative tasks that perpetuate those systems but do very little to further the quality of whatever services are being provided.

Perhaps, most notably, what’s needed is some way to define what it means to give and take care, to reflectively consider the balance between responsibility for others and responsibility to others. At what point does our presumption about the needs of others become an imposition of our values over and beyond their own? At the extreme, we have parents who decide to give life to their children and then legitimately bear responsibility for that life, to the extent that the child cannot be responsible for that life or speak to his or her own desires. But there is also the burden of care for that other on whose behalf one acts. As the child begins to show particular needs, feelings, and desires, it is the parent’s responsibility to try to recognize those messages as they evolve and integrate them into the decision-making. That model may be a useful one in other venues as well. The politician who is not interested in the experienced needs and feelings of constituents fails in a fundamental task

Page 184

of their role, much as the mental health professional who fails to take seriously the thoughts, feelings, and lived experience of those who seek assistance fails in the caregiving role. As we consider the meanings of giving and taking care, it is paramount to have our eye on who is being taken care of, and at whose expense, lest we obscure the needs of those who legitimately depend upon others for respectful, reflective, mindful care.

Page 185