The boundaries of care
The boundaries of care

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The boundaries of care

3 Silences and concealment

Anthropologists and psychoanalysts use the term ‘taboo’ to describe forbidden activities, feelings or relationships. All societies seem to have particular rules and rituals to deal with bodily functions, sexuality and death, sometimes expressed in terms of hygiene or religion, and these keep them separated off from everyday life. When social rules function well they are invisible. We only notice them when we have committed a faux pas and caused embarrassment.

Marie very quickly and correctly learnt the rules in this establishment: from the lack of acknowledgement of this aspect of the job she picked up that it was not an oversight that no one had spoken about it. It was not to be spoken about. In another care home down the road a friend of Marie's complained to the proprietor that one of the (male) residents tried to grab her in a sexual way. He told her quite sharply that ‘if she couldn't stand the heat she should get out of the kitchen’. In other words, she was being told not to complain and that her only option, if she didn't like it, was to leave. She found she was working in an occupational subculture where only certain things are permitted to be discussed.

This kind of silence tends to be produced when there are hierarchies in which tasks are delegated to some people rather than others. Dealing with intimate care tends to be a low-status task. It is often referred to as ‘basic’ care as opposed to the more technical tasks within nursing and the planning, educational or therapeutic tasks within residential services. The sociologist Goffman referred to it as 'backstage work'. Hughes, another sociologist, writing in 1971 coined the term ‘dirty work’, which is the work within any society or profession which is delegated downwards and/or concealed (Hughes, 1971). Caring for people's bodies could be regarded as the ‘dirty work’ of care, as well as ‘backstage’ work.

While nurses are taught procedures for carrying out personal care tasks, they are rarely explicitly ‘taught’ how to deal with the emotions these tasks occasion. Learning ‘on the job’ produces a kind of knowledge based on practice rather than theory which is literally difficult to put into words. This helps to keep the work and the skills it involves invisible.

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