Care

Abstract

With global shortages of health-care workers, child care, eldercare and care for people with disabilities, news outlets around the world have reported a care crisis worsened by the COVID-19 pandemic. In The Care Manifesto (Verso Books, 2020), the authors observe, ‘Rhetorically at least, governments worldwide have responded [to the pandemic], and in sharp contrast to 2019, talk of care is currently everywhere’ (p.7). A glimpse into care's long history adds what Raymond Williams described as ‘just that extra edge of consciousness’ (Keywords, 1976) to understand the implications of care in contemporary English usage. The word's complexity arises not only from its status as a noun and a verb but also from its ability to describe, variously, an action, a feeling, supervision, paid or unpaid labour and the object of care itself, as well as from the word's strong association with conflicting ‘positive’ and ‘negative’ emotions.

The word care is inherited from Germanic and first attested before the eleventh century in its noun and verb forms. Care the noun derives from Old English caru, cearu, and the verb derives from Old English carian. OED includes quotations from Beowulf (c. 975–1025) documenting some of the earliest uses in the entries for both the noun care (‘Cearu wæs geniwod, geworden in wicun’ [sorrow was renewed, it had come to the dwellings]) and for the verb (‘na ymb his lif cearað’ [he never cared about his life]). OED sense 1 of the noun care denotes ‘Mental suffering, sorrow, grief, trouble’ and ‘Utterance of sorrow; lamentation, mourning’ and is now obsolete. OED sense 2b of the entry to care remains an active sense of the word today: ‘To feel concern (great or little), be concerned, trouble oneself, feel interest. Also in colloquial phrases expressing or implying lack of interest or concern: for all I care, see if I care, who cares?’

Beginning in the thirteenth century, to care for described an other-directed action or provision: ‘to take thought for, provide for, look after, take care of’. Still active today, this sense of the verb to care applies in many contexts, including parenting, eldercare, pet keeping, farming, and health care. OED sense 5 of to care, the most recent sense of the verb, indicates the addition of an affective meaning. This sense of to care denoting ‘To have regard, fondness, or attachment for’ dates back to the sixteenth century and could be used to describe one's feelings about a person or a thing. The most common collocation used when this affective sense of care is meant is to care about, whereas to care for typically describes an action, i.e. hands-on caregiving. While the OED notes that the verb was originally used only in negative constructions (e.g. he never cared to; they cared for nothing; I care not), affirmative constructions are common in contemporary English usage.

Although the earliest sense of the noun care denoting sorrow or grief is obsolete, this association of care with ‘negative’ emotions and mental suffering is palpable in two senses of the word that are still active. OED sense 2 of care denotes ‘Burdened state of mind arising from fear, doubt, or concern about anything; solicitude, anxiety, mental perturbation’, and sense 3a defines care as ‘Serious or grave mental attention; the charging of the mind with anything; concern; heed, heedfulness, attention, regard; caution, pains’. These two senses of care highlight possible negative perceptions of caregiving as a burden and emphasize the potential physical, mental, and emotional impacts on carers. Other senses of the noun care still active today include the meaning ‘Charge; oversight with a view to protection, preservation, or guidance’ (OED sense 4a) and the related phrase to take care of (OED sense 4b), which can mean not only ‘to look after, provide for’ but, interestingly, also ‘to deal with, dispose of’. From the late sixteenth century, in addition to the meanings of care as a state of mind, action, and oversight, care also denotes the object of care or concern itself and is often used in the plural, as in the idioms ‘not a care in the world’ and ‘to have all the cares of the world on one's shoulders’.

Although the adjectival form careless originally meant ‘Free from care, anxiety, or apprehension’, this sense of the word became archaic from the seventeenth century, and this meaning is now attributed to the more positively connoted adjective, carefree, while careless suggests ‘having no care about’ or ‘inattentive, negligent, thoughtless’. The sense of the adjective careful ‘Full of grief; mournful; sorrowful’ is now obsolete, and this antonym of careless commonly suggests ‘circumspect, watchful, cautious’ and full of care or concern for someone or something or applying care or attention to one's work.

As this concise outline of the word's semantic development illustrates, care, with its noun and verb forms, has had multiple competing strands of meaning over the course of its long history, and the word has become more challenging in contemporary English usage. Both noun and verb forms of the word care show a high relative frequency, with the noun being more frequently used than the verb (100–1000 times vs. 10–100 times per million words) in typical modern English usage according to the OED. The wide range of collocations and modifiers of care explains the higher relative frequency of the noun. Some of the most common collocations consisting of modifiers preceding care include health care, child care, foster care, intensive care, primary care, and medical care. In these collocations, care refers to either paid or unpaid work provided by individuals (e.g. doctors, nurses, care assistants, parents, or other family members) or an institution to meet the physical, material, mental, social, and/or emotional needs of the receivers of care. Among the most commonly used verb collocations are take care, provide care, and receive care, which reflect the transactional and relational nature of care. Frequent collocations consisting of words that follow care include the near-synonyms caregiver, caretaker, and care provider, in addition to care home, care pathway, care work, and care package.

The OED entry for the noun care features a number of draft additions from 2001 that comment on specific collocations mentioned above. In medical contexts, care is often synonymous with treatment given to a patient by a health worker, as suggested by the term care pathway, defined as the optimal sequence of steps in the diagnosis of a particular disorder and the plan of treatment for an individual. Care provided by health workers may be considered care work, but this subtype of work also includes child care, teaching, eldercare, and domestic work done in the service of others. Care work may be compensated in the case of teaching and health care, but as scholars in fields such as feminist economics, gender studies, and sociology have long recognized, care work often describes unpaid labour that is deeply necessary but undervalued and disproportionately performed by women, ethnic minorities, immigrants, and the poor. The British expression care in the community describes medical or social care for people with disabilities or individuals living with a mental health issue within a community or by relatives instead of in hospitals or other institutions as a result of a governmental policy aiming to reduce institutional provision of long-term care.

A similar shift away from provisions of care through social welfare or public assistance programmes and toward ideas of self-sufficiency and individualized responsibility for health and well-being is evident in current use of the word self-care. According to the OED, the term was first attested in the mid-sixteenth century and denoted ‘Concern or regard for oneself; self-interested behavior’ but in the mid-nineteenth century expanded to mean ‘The activity of taking care of one's own health, appearance, or well-being’, the sense commonly used today. Caring for oneself is undoubtedly important, and yet recent self-care rhetoric has rendered the term nearly meaningless, with companies, social media posts, and articles labelling almost everything from lighting a candle to applying a spa face mask #selfcare. This commodified, neoliberal version of self-care is a far cry from what writer and civil rights activist Audre Lorde envisioned when she wrote the following in A Burst of Light (1988): ‘Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare’ (p.131). The self-care industry has capitalized on the neoliberal shift of responsibility for well-being to individuals, and sales of self-care consumer goods have boomed in the absence of affordable and equitable access to medical and mental health care.

Care is a basic need essential for the survival of humans, other animals, and plants alike. Without it, societies would cease to function. Yet care is not provided equitably—it remains highly gendered in both the workplace and the home, with women accounting for 70% of the global health and social care workforce (World Health Organization). Early negative connotations of the noun and verb care still echo in words such as careworn, caregiving, care work, and caregiver burnout, implying that care is exhausting or even a burden. This fear that caregiving responsibilities could reduce work productivity or one's ability to compete is amplified by the ideal neoliberal vision of ‘every person for themselves’. Thus, even if talk of care and claims to value it are currently heard everywhere, the continued devaluation and marginalization of care work, of caregivers, and of the people most in need of care tells a different story.

See access, emotion, empathy, responsibility, well-being