Who cares? Care and society in the modern world.

GLOBAL HEALTH WRITES

Citizen Journalist: Ian Hodgson

Speaking in March at the Royal College of Physicians in Dublin, Ireland, Arthur Kleinman and Iain Wilkinson shared details of their new text, ‘A Passion for Society: How we think about human suffering’. Essentially a critique of how ‘care’ is in danger of slipping off the radar of modern medical practice and social science, the book aims to remind us of the importance of social science in promoting ‘better’ society. This event coincided with the book’s launch in Ireland, and the evening covered a range of topics, concluding with one important message: the search for objectivity in health care specifically, and more broadly in society, risks blinding us to the real needs of people and threatens our ability to care for our fellow humans.

Arthur Kleinman (Harvard University) addressing the meeting at RCPI.

As someone with more than a passing interest in medical anthropology, I was keen to attend this gig. Kleinman’s work is extensive and his ideas always shaped by personal experiences (he supported and cared for his wife in the last 10 years of her life). Academically, his discussion of mental health in China (1980s) and critique, with Paul Farmer, of the suffering caused by AIDS (1990s) drove my own enthusiasm to research relative perceptions of HIV (late 1990s). His work is always rooted in the personal –rare for an academic, and a source of inspiration for others.

This Dublin meeting was attended by around 200 people, and hosted by the Royal Academy of Medicine in Ireland, and in collaboration with Trinity College, the Irish Medical Anthropology Network, and the Anthropological Association of Ireland. It was an evening of many shades –indomitable sociological and anthropological theory, seasoned with discussions of the role of ‘care’ in society, its diminishing focus in modern medicine (as a practice) and social science (as a discipline).

Arthur Kleinman (at centre) and colleagues (L-R) Jamie Saris (Maynooth University), Fiona Larkan (Trinity College Dublin), Iain Wilkinson (University of Kent), and Patrick O’Sullivan (RCPI).

Kleinman launched the evening with a 30-minute discussion of the current state of ‘care’, particularly in the context of social science. This discipline, though it has the potential to be beneficial to society is, for Kleinman, losing sight of the human experience through an increasing focus on theory and evidence gathering. He faced up robustly to medicine too, where he suggests, “The suffering of patients has become less significant.” The field has become populated by practitioners blinded by technology and bureaucracy, “Where is the care for ‘real’ people?” He suggests we need a “humanitarian social imaginary,” a vision focusing solely on society and enhanced care, especially within family structures that provide 70% of personal care. He proposes that, whilst “caregiving is the social glue of society,” this is often taken for granted. Indeed, for Kleinman, care is also a form of “social knowledge,” offering moral and practical wisdom for the “art of living socially.” With a nod to researchers, Kleinman suggests caregiving can also be a “methodology on the significance of social life,” and by extension how to understand the place of ‘meaningful’ care.

For Kleinman, there is urgent need to revitalise care. In medical practice, caregiving should be incentivized, with medical staff educated in core skills that go beyond bureaucratic protocols, and trained in a moral approach.  The economic lexicon of healthcare systems should be complemented with “clinical caregiving language,” Kleinman says.  For the family, caregiving should be better resourced, and we must work towards valuing care outside of a neoliberal model. Taking a swipe at our ‘austere’ Western economies, Kleinman suggests spending more on welfare programmes.

Kleinman closed with a picture, Picasso’s 1907 portrait ‘Head of the Medical Student’. With one eye open and one closed. For Kleinman, this illustrates ‘distancing’ in the doctor-patient interaction (Why are both eyes not open? What happens if the second eye begins to close?).

Following Kleinman, a range of academics (including co-author Iain Wilkinson) and public health experts responded. The discussion was wide ranging, including forays into social theory (prominently Max Weber who, with Durkheim and Marx, probably invented sociology), and the role of social science in using social history to critique modern political movements and the current challenge to western welfare systems (this from Liverpool University’s Ciara Kierans, who for this writer gave the best response).

Discussions with the panel of speakers (L-R): Jamie Saris, Iain Wilkinson, Ciara Kierans (University of Liverpool), Arthur Kleinman, and Patrick O’Sullivan.

Wilkinson’s emphasis on the need to be “moral in our thinking” whilst at the same time avoiding the “tortuous” nature of sociological theory was refreshing here, and this is exactly the point. This was highlighted during the audience Q&A, when someone near the meeting’s close brought us full circle and posed a question: if social science is all about improving society, then how come it is “so impenetrable and inaccessible” to non-academics? Kleinman’s response was reasonable, that there are other approaches – often metaphors – to understand human experience (he cited Paul Kalanithi’s well-received recent end of life text, ‘When breath becomes air’).

But this does demonstrate the very challenge Kleinman and Wilkinson’s text is posing. In our modern world we need new and accessible ways of thinking about how to promote ‘moral’ care, a skill that seems to be diminishing within an increasingly technocratic approach to medicine and – more broadly – a society that seems to be losing interest.

I left vaguely satisfied that notions of ‘moral thinking’ in care were being explored in such a robust way (underpinned by comments from Wilkinson). But I also left vaguely unsatisfied. How will social science ever make a useful contribution to improving our lot if we can’t escape its arid theory? And how can we promote moral (and meaningful) care in an age of austerity?

-Ian Hodgson, Dublin, March 2016

Ian Hodgson is a development consultant working mainly on HIV project evaluations and capacity building for country level advocacy. He’s especially interested in HIV stigma, cultural determinants of HIV prevention,and promoting access to health and sexual health services for key populations.

To contact Ian, please email info@globalhealth.ie

Featured images are reproduced from the Irish Medical Anthropology Network‘s Facebook page, where more pictures of the event can also be found.