Individualization, risk and the body: sociology and care.

The emerging sociology of care

Although the notion of 'care' has a long history in Western philosophy and culture (Reich, 1995) the social phenomenon of care has only recently begun to receive the serious attention it deserves from social researchers. This neglect appears to be the result of care being understood primarily as a family responsibility, the tasks routinely falling to women for whom it was seen as a natural, taken-for-granted behaviour (Graham, 1983). Care seems to have been subsumed under the general topic of social support, with the personal devotion and duty involved being implicitly attributed to gender, operating through the primacy of kinship and marriage. Under these conditions, the fundamental importance of care for social life was easily ignored. But in the latter part of the 20th century care was brought into the public domain as the cumulative effect of a series of fundamental changes reached a point where the availability and provision of care became an ever more contentious aspect of modern life. I argue in this article that the move of care from what C. Wright Mills termed a 'private concern' to 'a public issue' (Mills, 1959), has significance for social theory just as it does for social life.

The rise in care as a public issue seems to be the inevitable result of historic processes of social and cultural change. Foremost is the rise of feminism and the associated social and economic changes, of which the large-scale entry of married women into the paid workforce and the changing domestic forms of late modernity are perhaps the most significant. Demographic developments, especially population ageing and the decline in fertility, as well as a variety of medical and bio-technological developments, have served to accentuate the attention given to care, raising political, financial and ethical issues and dilemmas that seem to reach into every corner of modern life. These changes are not simply questions of perception or cultural meaning. The provision and availability of care has become a practical problem as existing responses prove inadequate or unsustainable and new solutions are sought. Whatever the underlying cause might be, demand for formal care in recent years has been increasing just as the sources of supply of unpaid care at home have been most under pressure.

As concerns about what is commonly termed the 'work-life' or 'work-care' balance suggest (Hakim, 2000, 2001; Pocock, 2003; Watson, 2003), recognition of the significance of care is vital, not just for understanding women's lives but for social life in its entirety, and has the potential to be the most telling of all public issues in the 21st century. This is heightened by the impact and anxiety surrounding developments in medicine and bio-technology, by the effects of demographic changes such as population ageing and fertility decline, and by changing patterns of social policy that are continually redefining the boundary between personal and social responsibility. Care is no longer simply a question of private household preferences. It has become instead an arena for social conflict, both implicit and explicit, marking out important new social divisions and underlying tensions.

Until the mid-20th century, formal and informal forms of care were relatively clearly separated. For example, informal care, provided at home, was quite distinct from the formal care provided in institutions. Families relinquished their claims to provide care only when they were no longer able to manage, and institutional care took over. In this form of care family members had no real place and their involvement was discouraged. De-institutionalization, the new technologies of care and the emergence of community care approaches have broken down these divisions, with the result that formal and informal have gone from being alternatives (either/or) to partnerships, hybrids, new forms of mixed care.

Developments in the patterns of the delivery of care have been accompanied by renewed interest in the meaning and importance of care (Chamberlayne and King, 2000; Daly, 2002; Daly and Lewis, 2000; Feder and Kittay, 2002; Tronto, 1993). Seen in this new light, care is increasingly understood as a topic of such fundamental social importance that its neglect or marginalization within sociology and related disciplines can no longer be defended. The concept of care also provides a perspective that cuts across a number of topics and levels of analysis, linking micro interactions and macro structures, drawing together formal and informal aspects of social relations rather than treating them as distinct, specialized topics. Commenting on the analytic problems arising from state- and policy-focused studies of social welfare, for example, Chamberlayne and King elaborate:

   Caring offers a doorway to the study of informal systems of welfare,
   to the extending of comparative social policy to that level, and to
   the transcending of the welfare regime approach. (2000: 8)

Yet despite the potential that such a care-based perspective offers, there is still little in the way of a sociological literature that sheds light on either pre-existent practices or the transformation of care and its social importance. Meanwhile, in the face of the new demands made upon them, health and social care services are portrayed as being in almost constant crisis in virtually every advanced society. The result is an ongoing and unsettling process of political crisis management at the local, regional/state/provincial and national levels.

While there has been a strong interest in care from feminists and others writing from a sociological perspective (see, for example Abrams, 1989; Arber and Gilbert, 1989; Daly and Lewis, 2000; Freidson, 1970; Hochschild, 1983; James, 1992; Thomas, 1993; Waerness, 1987) none of the major contemporary theorists in sociology identifies care as a core topic. Since it is impossible to imagine a social world without care, this must be regarded as serious shortcoming and distortion of their approaches. Yet, as demonstrated by Selma Sevenhuijsen's recent rejoinder to Giddens's (1998) political analysis in The Third Way, it is possible to identify elements in the general approach that resonate with the theme of care and in turn, to show that addressing the theme of care will enhance the possibilities of the social analysis advanced (Sevenhuijsen, 2000).

Sociological interest in care must manifest an interest in the larger processes of social change and their effects at the level of personal experience. If care is an expression of intense social support (Chappell, 1992) and is to be recognized and accorded centrality in social and political theory (Tronto, 1993), it is also important that it no longer be seen as a marginal or specialist topic within the discipline. Instead, I argue in this article that it needs to be made central to the sociological enterprise, which means, effectively, that it must be taken up at the level of social theory. It is also important that research in the broad field of care draw on developments in the broader field of social theory.

Drawing critically on the work of major contemporary theorists, in particular that of Giddens, Beck, Castells, Turner and Rojek, this article considers the contribution that sociological theory can make to the study of care. In doing so I focus on the perspectives provided by four major themes in contemporary sociology. The first concerns care and the body: this provides a useful starting point as it reflects not only the recent emergence of interest in the body in sociological theory, but is also an acknowledgement of the immediacy of vulnerability and physical contact that underlies the hard work involved in providing care. Moving from the immediate and micro to the abstract and macro level of analysis, I then discuss, in turn, the themes of individualization and the transformation of personal and domestic life; risk and the new organizational logic. Gender also presents a fundamental point of intersection between social theory and research on care (Blattel-Mink and Kuhlmann, 2003; Connell, 2002; Graham, 1991; Ungerson, 1990, 2000), an issue I have recently touched upon in a related article (Fine, 2005). Although it cannot be fully explored in this article, it is important to acknowledge that gender serves as a basic structural principle for organizing of care; in turn, as Kittay (1999) has shown, the organization of care provides a particularly powerful lens through which to examine the question of gender.

Care and the sociology of the body

The recent 'rise of the body' in popular culture as well as in sociological theory, closely parallels the emergence of care as a public issue. According to Chris Shilling (1995), interest in the body reflects a number …