Care is no longer personal. Care is political. [PODCAST]

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“To care for dependents, the carer must be cared for, both for the sake of her charge and for her own sake. Without such basic infrastructure, we have anxiety, confusion, and chaos.

Contagion knows no independent individuals.  Its boundaries are not the boundaries of our skin. It relies on the inevitable sociality of human beings. But our vulnerability is also our defense: bonds of care minimize, and can even defeat, the power and reach of COVID-19.

Care must move out of the private domain, out of the recesses of hospital rooms and nurseries, nursing homes, and day-care centers. We seem to recognize now that a leader of a nation is entrusted with its care.

Care is no longer personal. It never was. Care is political.”

Eva Kittay is a philosopher and author of Love’s Labor: Essays on Women, Equality, and Dependency (Routledge) and Learning from My Daughter.

She shares her story and discusses her KevinMD article, “Care is no longer personal. Care is political.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Eva Kittay. She is a philosopher and the author of Love’s Labor: Essays on Women, Equality, and Dependency and Learning from My Daughter. She wrote the KevinMD article “Care is no longer personal. Care is political.” Eva, welcome to the show.

Eva Kittay: Thank you so much, and thank you so much for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Eva Kittay: Well, I began, I guess, as a child of two survivors of the Holocaust. I was born in Sweden, and we came to the United States when I was six years old. As a child growing up with that background, I always thought about issues of morality, questions of right and wrong. When I discovered philosophy in college, I discovered I’d been thinking as a philosopher all my life, and it was a natural home for me. I wasn’t entirely sure I was going to pursue philosophy at first, and I was interested in political questions. I’ve always been interested in political questions.

But I had a daughter at that time, and we learned when she was about four months old that she was very disabled, that she would have intellectual disabilities. It wasn’t clear exactly what she could do, what she couldn’t do, but the chances were that she couldn’t do very much on her own, and that turned out to be true. She is very, very significantly disabled, entirely dependent, a wonderful, wonderful woman of 50, now almost 51. Trying to deal with that rather difficult piece of information made me want to return to philosophy and pursue it, do a lot of hard thinking, because it’s always a way for me to be distracted from the immediate concerns of my life.

So I taught philosophy at Stony Brook for nearly 40 years, 35 years, and I was writing quite a bit. Before Love’s Labor, I had a book on metaphor. I was working on philosophy of language, and I was basically doing philosophy to sort of distract me from the questions of the difficulties my daughter was having. But at a certain point I realized that I really needed to think about what I was learning from my daughter that challenged a lot of dominant views in philosophy. So the idea that man is a rational animal, you know, rationality takes pride of place, and it had for me as well. But when I had my daughter, I realized that there were things that were still more important, and that was the love and attachment to one’s child.

It took me quite a while to decide to write about Sesha, but that’s her name, Sesha, and she’s a figure now in philosophy. It’s become a very central part of my thinking about issues of morality, about issues of politics, about issues of meaning. Love’s Labor is, in part, some of my experiences from my daughter, in particular her dependency. The idea of us being independent and productive citizens as being, you know, what makes us worthy was, in my mind, no longer the case. Sesha was as worthy of her life as anyone, and Sesha could have a meaningful, wonderful life, OK, if we attended to what it was she needed.

And her dependency made me realize that the idea that we’re all independent is a fiction. We’re not independent, really; we’re all interdependent. And sometimes in our lives we are dependent, completely dependent. When we’re ill, totally helpless, we are entirely dependent on others. My daughter has had the condition of total dependency all of her life, so I saw dependency up close, and also the centrality of care, because with good care she could live a good life.

At the same time, there were some very important developments in an area of philosophy, which has now become an area of philosophy, feminist philosophy, that became very important to my thinking. It was a time when Carol Gilligan wrote a book, Different Voice, and she made the case that there was a voice in our thinking about moral questions that wasn’t being attended to, and she called that the voice of care. So she talked about an ethic of justice, which was the predominant one, and the ethic of care. I took that very seriously and looked at it very carefully, and part of my project has been to work on developing what an ethics of care is and what its relationship is to our political life. So I think that brings you pretty much up to date.

Kevin Pho: You delve more into these topics in your KevinMD article, “Care is no longer personal. Care is political.” Now, for those who haven’t read the article, can you walk my audience through it and share the story of why you decided to write it?

Eva Kittay: I watched the Democratic convention, and I was really struck by how often people talked about care and presented Biden as a caring figure. There was this undercurrent through the convention that a leader needs to be caring for and about the people that he was governing, and it really struck me, because it’s so rare that you hear care talked about in a political context.

Care, I think, is always political, even though much care is done in private domains. Who does the caring, what kind of resources are devoted to caring, how we value that caring: These are really political questions. These are questions about how we organize society, how we govern ourselves. And too often care has been relegated to the private sphere, where mostly women do the caring. But I want to think of caring more broadly, also to include medical care, health care. I think one of the things that is really important is that we think of health care as care. It’s a branch of caring, so that is less privatized; it’s in more public situations.

But now, of course, we see it has a very public face. COVID has brought the issues of care to the forefront. Our carers are the heroes: our doctors, our nurses, our health care providers of all sorts, and the people who do caring for other vulnerable people. When you talk about care, you can’t just talk about social distancing. Here, you’re putting yourself in danger, in possible danger. You become the heroes. You become the soldiers who decide to go out on the battlefield. So it was this recognition in a public way that really struck me, and I thought, “Ah, maybe this is a moment to recognize the extent to which how we deal with issues of care, whether it be personal care or whether it be medical care, are political issues as much as personal issues.”

Kevin Pho: Now, what do you anticipate the future to bring when it comes to care? In other words, do you think that the pandemic will have any lasting impact on the meaning of care and what care is going forward, after the pandemic concludes?

Eva Kittay: That’s a question. And it’s very disturbing to see how parts of our population don’t even see it now, as sick as we are as a nation, as needy as we are as a nation, where freedom, personal freedom, is opposed to care. I think we need to understand freedom differently. We don’t have freedom if we’re not cared for. We don’t have freedom if we can’t care for those we love.

And the notion of freedom that is paraded about when we say, you know, “It’s my personal freedom to put on a mask or not to put on a mask,” that really feeds off the myth of independence, you know, what I do is just about what I do. But what I do is not just about what I do. We are interdependent. What we do has an impact on other people, and it has an impact on the freedom of other people. We need to find ways to bring this out, to squash the myth of the lone actor who should be unimpeded in their ability to act.

Whether it’ll have a lasting impact is a question. I think that there are more attempts to organize carers, to bring the issue into the open and into the public, than I have ever seen. I think we have to see how the next few years go, what the uptake is. But what we need to recognize is that we need public support for care. A caregiver cannot do the care that they’re doing for a very vulnerable person without supports, without public supports. You need supports as medical caregivers, you need supports as personal caregivers, and caregiving can’t just be about the work that women do. Women are now out in the workplace. The stress on women through this pandemic is, of course, enormous, and people have been writing about it and talking about it, and perhaps that kind of stress might be an impetus to let us see all the things we haven’t been seeing, all the things we’ve been pushing out of the public, off the stage.

Kevin Pho: We’re talking to Eva Kittay. She is a philosopher, and she’s the author of the book Love’s Labor: Essays on Women, Equality, and Dependency and Learning from My Daughter, and she wrote the KevinMD article “Care is no longer personal. Care is political.” Eva, the United States has always been an individualistic society, and you said earlier that sometimes puts it in tension with the importance of care. Now, what kind of changes need to be made to reconcile our individualistic history with the emphasis on care going forward?

Eva Kittay: We need to see what we see now in the pandemic, that that individualism doesn’t hold. If we go along with this kind of individualism, we die a quarter of a million deaths, and untold numbers of people who have been ill and will have these illnesses that continue long term. As I said in the article, the virus doesn’t know individuals. It doesn’t know independent individuals, right? It just moves around. It doesn’t care, and we have to respond to that, right? We have to understand that interconnection, and only by understanding that interconnection, bringing it to the floor, can we battle something like this virus: organization, leadership, and compassion and empathy, and a true understanding of what is involved in caring for another, that we don’t care for one another as individuals. Hillary Clinton, we said we need a village, and it does take a village.

So as far as clear policies go, I don’t have them right now, but I would like to see policies that provide more resources to caregiving. That’s certainly one. We need more public discourse about what is involved in caring, what it means to be in a society with others that is sustained by caring. We need a care infrastructure. We talk about infrastructure; there’s a care infrastructure that is very broken, and that’s why our country, which is the richest in the world, is doing the worst, because we have let our care infrastructure fall to pieces.

Kevin Pho: And my final question, Eva: What is your take-home message that you want to leave with the KevinMD audience?

Eva Kittay: No one is disposable. People such as my daughter, who’ve been dependent all their lives, are as valuable as anyone else. We are all indispensable, and we need to treat each other as indispensable. It’s not about our accomplishments; it’s about our right to be in this world, and we all have the right to be in this world. So I’m very much against triage policies that would put people with intellectual disabilities at the end, or take those who are most vulnerable and put them at the end. Our vulnerability is not a sign of our worth.

And the other thing I think I would say is that physicians also, physicians, hospitals, medical personnel, need to understand that caregivers and family caregivers are partners in caring, are partners in the medical care of people. It’s really unfortunate that we have been left out, put to the side, when we need hands on. But when people are very sick, when people are very dependent, they need their caregivers. They need people to speak for them, because they can’t speak for themselves in that condition.

Kevin Pho: Eva, thank you so much for sharing your time and insight, and thanks again for being on the show.

Eva Kittay: And thank you so much for having me.

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