Care-as-Worry, or “Don’t Worry Be Happy”

Van Manen, M. (2002). Care-As-Worry, or “Don’t Worry Be Happy”
Qualitative Health Research: An International, Interdisciplinary Journal.
Sage publications, Vol. 12, No. 2, February 2002, 264-280

Abstract

“Care” or “caring” is one of the central concepts in North American health science and nursing theories. Yet, experiential accounts of caring show dimensions of meaning that have received little attention in the literature. The author compares the meanings of the terms care and caring with their counterparts in other languages. He explores the significance of care-as-worry embedded in lived relations of caring, and relates these concepts to ethical considerations surrounding health care. It is because of this felt “care-as-worry” that the life of care may be experienced as a complex moral-emotional relation of responsibility.

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In Margaret Laurence’s well-known novel The Diviners there is a touching incident of the mother caring for her sick child, Pique. The doctor has made a house call and tells the mother, Morag Gunn, that it is the flu:

“There’s always a lot of it about, it seems to me,” Morag says idiotically, angrily, as though this were in some way the doctor’s fault.

“Well, try not to be upset, Mrs. Gunn,” he says sternly. “That won’t help the child, will it?”

Oh God. True. True. She wants to ask the doctor, young and brisk, to forgive her, to stay for a while, have a cup of tea, reassure her, tell her Pique isn’t very ill and will be fine, and that it isn’t Morag’s fault for having sent her out unwell into the raw morning. There is, however, no external reassurance available, as she learns each time as though for the first time, whenever Pique is sick. (p. 362)

What the author Laurence seems to show here is the common experience of a parent fretting over a sick child. One worries about the “what ifs”—what if something more serious is wrong; what if my child gets sicker… Morag Gunn cannot help but worry as she thinks to herself:

I fluctuate like a pendulum. The terrible vulnerability of parents, though, your life bound up so centrally with this other one. (p. 363)

For many parents care seems to consist of fretting and fussing and worrying and generally making a nuisance of oneself for the sake of one’s children. Of course, kids may at times hate this in their parents, but in the back of their minds they also know that it would be much more terrible if there was no-one who would care to worry about you. Recently, CBC broadcast an interview with street children. One street kid said: “What is most terrible being on the street is that there is nobody who really worries about you. Ordinary kids have parents who worry about them and have dreams for them. Nobody, neither my father nor my mother, worries about me or ever had a dream for me.” Of course, we should not think that caring is something that comes naturally with being a mother or a father. Children may have parents but still end up in government care. One teacher described these children as “damaged.” A 14-year old girl had told her: “You know what I am afraid of? I am afraid that, if I would die, no-one would really care.”

However, Morag, the character in Margaret Laurence’s novel is a mother who cares and worries. She cannot help herself and she goes on to fret inwardly about her child:

If only there were someone to talk it over with. Someone to share the pain, I guess. That wouldn’t help Pique much. It would help me, though. Or would it? Look at Angie in Flat Two upstairs. When the baby is sick, she says to Dennis that she’s worried out of her mind, and he says she always worries unnecessarily and she’s inherited it from her neurotic mother and she had better snap out of it. And maybe she is indeed worrying unnecessarily. As probably I am. But you would just like somebody to say—God, love, I KNOW and I’m worried too. (p. 364)

You may notice that I am offering an experiential accounts of caring-as-worrying. My fear is that if we theorize too readily and limit ourselves to the main literature on caring then we run the risk of degrading a profoundly human phenomenon. This erosion of meaning of the unique significance of caring can easily happen when our understanding gets cut off from the ways caring is actually experienced. Therefore, I am first primarily interested in examining meanings embedded in lived relations of caring, not as we theorize caring but as we experience it before we conceptualize and abstract it into professional discourses.

It seems that when we try to recall particular moments of caring it is often the intense experiences that stand out. But the qualities of these experiences seem characteristic also of the more mundane and common moments of caring. I will turn to another fictional text to explore experiential or lived dimensions of caring. In her Diary Judith Minty (1992) writes about everyday situations with her children. The story could have been told by many parents:

My son, my middle child, the handsome one, the worst student, the one most admired by his peers, came home from football practice tonight sick, with a bellyache, half crying.

Thirteen years old, short for his age, he pedals off on his bike at 5 p.m. and drags back into the house around eight every night...

But tonight is different. He eats little, says he is sick. I tell him it was the peanut butter sandwich he ate before practice. I tell him that big Scott M across the street throws up after every practice if he eats less than two hours before. My son trudges upstairs to suffer alone.

After his shower he goes to his room, where he thinks no one can hear him. But I hear him crying. I don’t worry too much. He is the one who moans when he has a minor cold. Briefly, I think of appendicitis, but brush the thought away. I also think about those other times he has cried because something he couldn’t cope with what was gnawing at him. I will wait awhile, see what develops. (pp. 215, 216)

The mother is worrying and monitoring her worrying so that her needs or feelings are not fore-grounded over her son’s. She says she doesn’t worry “too much,” as if she knows that worry can be both a way of staying in touch with her child, and a way of projecting her own fears on to him. She chooses the former. She worries and waits.

When he comes downstairs, I ask him if the practice went badly today, was the coach after him? No, he just feels sick. I tell him no television—he needs to lie down in his room. The others come [his sisters].… [We talk but I] hear my son in the distance, still crying behind closed doors.

I am reading in my bed. He appears. I put my book down. He sits at the foot of my bed, still young enough to weep in public, and tries to start. The others hover, then vanish. They know this is his crisis.

“Lorie [his sister] is going to leave soon,” he finally manages to blubber out. I tell him no, that she won’t be going to college for years yet. [He says] “I don’t want anything to change.” (p. 216)

In this diary excerpt we see how the mother—while talking to her daughters or reading—at the same time remains aware of her son’s presence in the background.

When I shared this story in a workshop with some 70 parents, some found it very difficult not to pass judgement on the mother. Some felt that Judith Minty did wrong, that she should not have waited, that her son’s crying was an appeal to her, that she should have gone up to her son’s room when she heard him weep. This is, of course, a parental judgment that one makes on the spot. And it is interesting that readers of Minty’s story would feel this appeal by the child, as if it were made on them. But what matters for this discussion now is that it shows how worry is the active ingredient of parental attentiveness. Worry—rather than duty or obligation—keeps us in touch with the one for whom we care. Worry is the spiritual glue that keeps the mother or father affixed to the life of their child.

So when Judith Minty’s son finally comes to talk to his mother she notes how the crack begins to open.

“Do you want to stay just the way you are?” [I ask.] Of course he does, and nods, and then it all comes spilling, tumbling out, a waterfall full of worry and sadness and tears. As he tells it, I remember how, when he was ten, he worried about what would become of us when the sun burned itself out; how, when he was nine, he worried about having to fight in Vietnam. This tough boy-child, whom we worry about with his D+’s and C-‘s has a different depth to him than our others.

What will happen to him if his father dies, if I die? What will he do if he lives to be 103 and there is no family left? … (pp. 216, 217)

In the following paragraphs Judith Minty shows how an ordinary mother may deal with such common and yet always unique parenting situations. She narratively exemplifies how one can help a child by staying close and supportive. As she engages her son in conversation--laced with love and humor--the heavy things that were worrying him, now seem to become bearable. And as we read on, we notice how nicely the worrying mother takes away the worries of her child, how she indicates her caring worry as a mother (that he will eventually have a life of his own and that she will miss him), but that he need not worry about that either. Finally she reflects to herself:

Have I done a good job? I don’t know. He is not crying any more. He tells me he has been thinking about this for a week and hasn’t been able to eat much. We both laugh and agree that the not eating part was probably good for him. [He had put on too much weight.]

It is much later now. He is sleeping. Everyone is sleeping. I hope his spirit sleeps well. (p. 217)

When everyone is sleeping, the mother, Judith Minty, is still awake, thinking about her child. Her expression of hope again shows how her preoccupation with her son is a kind of worrying mindfulness. Now, what I will try to show is that the caring-worrying with which the parents Morag Gunn and Judith Minty are plagued is really a very human response to vulnerability that leading philosophers such as Levinas, Løgstrup, and Derrida have described as the moral ground of human existence. For the present I will put this in simple terms and suggest that, for mothers and fathers especially, care-as-worry tends to be experienced as an affliction.

Think about it: care-as-worry is like an illness, a chronic illness. Incurable. Untreatable. It may have its easy periods when it seems to go into remission, but then it flares up again, especially in cases of caring for a child in difficulty, sickness, or trouble; but also in ordinary situations where choices of consequence need to be made. The parent who is possessed by this caring response to his or her child cannot help but suffer this illness.

But, of course, not all parents are thus afflicted. For example, recall Dennis, the husband of Angie and neighbor of Morag Gunn. He does not seem to be burdened by fatherly worrying. On the contrary. He simply views his wife’s worrying as a troubled trait inherited from her own mother: a typically female ailment. But as readers we suspect that Dennis demonstrates what some see as a typically male view.

This exploration into the meanings of care is a kind of phenomenological puzzle for me. It concerns the question of the relation between the commonly accepted meanings of the term caring and the lived experience of caring, especially as in the primordial context of caring for someone who is vulnerable due to age, health, or circumstance. And I am thinking here especially in terms of the relation between parents and children. In Dutch language the equivalent term for care is zorgen. In German the word is almost identical, sorgen and in Scandinavian languages too there are similar terms.

Now, when I think of zorgen in the Dutch language then I have very different connotations than the term care or caring evokes in English. Yet, it is not so easy to articulate the difference. In the English language caring seems to be a nice and pleasant word and indeed many want to claim to be in the caring business, especially those who are in business: we can see advertisements for car care, lawn care, skin care, carpet care, and many other profitable caring practices. In contrast, the Dutch term for care, zorgen, seems to be a more ambiguous term carrying strong connotations not only of caring but also of being burdened by worries. These are not associations of meaning that business people find attractive for their advertisements.

I imagine a look that expresses zorg in the Dutch or sorgen in German language. This is a different and more ambivalent kind of caring look: it is literally a look that is not carefree, without worry. It may express affection, but it does not escape me that this face has worry-wrinkles. A parent who looks with caring-zorg at his or her child seems to be loving, yes, but also always in some sense worried.

Opening a Dutch dictionary (van Dale, 1986) we read that a zorgekind (literally a child who requires care) is a child who causes one to worry in an even more pronounced manner than it already usually implied in the term zorgen. It is curious, however, that when one consults the English-Dutch dictionary for the equivalent of the English term “worry” then one reads the Dutch term “zorg”; and when one looks for the equivalent of the English term “care” one again finds the Dutch term “zorg.” Thus where in English these two terms care and worry are kept separate, in Dutch, German and some other languages these meanings are inextricably wound up in the mode of life described by the term caring or zorgen. Even in the term verpleeg-zorg, meaning nursing-care, there are similar associations: there is a substrate of worry in this meaning. In general, zorgen for someone is to care for someone in a worrying kind of manner, that is not carefree.

As a person whose first language is Dutch, I have always been struck by this strangely different emphasis of meaning in comparing the terms “zorgen” and “caring.” It made me wonder about the significance of the experiential qualities of these terms. Does this mean that Dutch care-givers generally tend to experience caring in a somewhat different and more worrying modality than North Americans? It is interesting, of course, that in English language too the term worry is associated with care, as when we feel that young children should be carefree (and when adults purchase retirement property in Carefree, Arizona, they may want to do so because they want to be again like children, carefree, free of worry). So why has the meaning of care-as-worry survived in some expressions but it has been seemingly lost in most other usages? Has the meaning of caring changed over time?

The Klein Etymological dictionary indeed strongly associates the earliest meaning of care with sorrow and anxiety. Interestingly, the etymology of the term sorrow derives from the Danish, Swedish, Dutch, and German equivalents of sorge, zorg meaning anxiety and worry. Incidentally, the expression sorry, meaning “it causes me pain and regret,” also finds its origin in this development from sorge and sorrow. When we say “I’m sorry” then we actually say, “I care.”

Modern dictionaries too retain the reference to worry. So when we consult the concise Oxford Dictionary then the first equivalent of the noun care is listed as worry and anxiety; and the expanded Oxford Dictionary first lists the terms “mental suffering, sorrow, grief, trouble” and secondly “burdened state of mind arising from fear, doubt, or concern about anything.” Webster’s too lists the synonyms “care, concern, solicitude, anxiety, and worry.” So it is noteworthy that both the earliest and more recent dictionary explications of care are heavily invested with the sense of worry.

Why is this noteworthy? Because when we examine the indexes of recent texts on caring by authors such as Jean Watson (1985), Nel Noddings (1986), Debra Shogan (1988), Susan Ruddick (1989), and Peta Bowden (1997) we look in vain for the term “worry”; and in the body of these texts too the term “worry” is virtually absent. Bowden’s Caring: Gender-Sensitive Ethics is the most recent in this series, published in 1997. In her book she comments on the earlier works by Noddings, Ruddick, and others. She writes that she is less interested in theoretical explications of caring than in analyzing how caring actually occurs in the practices of everyday life—in mothering, friendship, nursing, and citizenship. And yet, in her text there seems to be no mention (as far as I could tell) of the pervasive sense of worry that seems to be associated with the caring act. Mostly she engages in argument with the earlier professional and feminist texts and pays less attention to empirical accounts or literary sources that may reveal how caring is actually experienced in everyday life.

In the early nineties Janice Morse and colleagues (1990 and 1991) published two studies presenting a “Comparative Analysis of Conceptualizations and Theories of Caring” (1991), using the categories of human trait, moral imperative, affect, interpersonal interaction, and therapeutic intervention. They also include 23 definitions culled from the studies they examined. Again the term “worry” does not occur in these definitions although some definitions contain related notions such as solicitude and concern.  Why this absence of the term “worry” in the caring literature? Does the sense of care-as-worry not fit well into frames of professionalized relations? Is worry too problematic a concept for theorists in the health sciences? Of course, I do not know the answer.

There is one health science context where the notion of care-as-worry is broadly discussed in both a practical and a theoretical way. I am referring, of course, to baby-care literature. It is interesting that in the weeks following the death of Dr. Benjamin Spock early in 1998, all across North America debates raged on radio and television about the legacy of Spock’s advice to young parents. Was his influence positive or negative? Apparently his book Baby and Child Care helped millions of parents with their inevitable anxieties and worries associated with caring for young children. Ironically, Spock’s main message has always been for parents to trust their own feelings and inclinations; and that there is no way to be a perfect mother or a perfect father. The first two sections of the opening chapter are entitled: “Trust Yourself” and “Parental Doubts Are Normal” (Spock and Rothenberg, 1992). However, critics have argued that, in stead of alleviating worries, Spock actually instilled worries and anxieties—especially in mothers—since his books implicitly suggest that some ways of dealing with children is more appropriate than others ways. Thus, feminist critics argue that young mothers may worry that they cannot live up to the idealized versions of the perfect mother that, because of Spock’s book, they may have constructed for themselves or that society may have constructed for them. However, it is important to note here that for these critics of Spock the issue of worrying has shifted from care for one’s child to care for one’s self.

Self-care

Of course, I am not arguing that self-care is unimportant. Caring for others is difficult if not impossible if in an obvious as well as a deeper sense one’s own house is not in order, so to speak. And yet I would like to place some question marks over the assumption that self-care must therefore have priority over care for others. I will use Michel Foucault as an example to problematize the priority of caring for one’s self (Foucault, 1986).

In his Technologies of the Self Foucault establishes ancient relations between caring and self-knowledge  (Foucault, 1988). He argues that the concern of “taking care of oneself” was one of the principles of practice in early Greek society. Even the oracular “Know Thyself” implied the requirement of knowing how to ask the right questions for the practice of self-scrutiny: the techne or practical wisdom of how to take care of one’s body and soul. These technologies that Foucault has inventoried include self-disclosure, letter writing, confession, self-training, the examination of self and conscience, and so forth.

Foucault finds a foothold for priorizing the question of self-care in Plato’s Alcibiades. In this dialogue Socrates becomes the spiritual teacher of Alcibiades in the latter’s quest for self-knowledge. And Foucault asks: “In that relationship, why should Alcibiades be concerned with himself, and why is Socrates concerned with that concern of Alcibiades?” (Foucault, 1988, p. 24). In Plato’s text we learn that Alcibiades wants to gain personal and political power over others but that Socrates is able to show him that power over others resides actually in power over self, which requires self-care for its edification. But what Foucault does not consider is that Plato’s Alcibiades can also be interpreted as a narrative wherein the meaning of care consists in a pedagogical concern for the other’s care as self-care. i]

In Plato’s Alcibiades the figure of Socrates is involved in care, namely care for his pupil. This is the story: Socrates is worried about Alcibiades since the latter does not know how to take care of his self or soul. Thus Plato shows, in the example of Socrates, that care as cultivation of self, finds its roots in care as concern for other. We can easily translate this idea in everyday pedagogical terms—as parent I care for my child’s care as self-care. My pedagogical concern is with the child’s taking properly care of his or her body and soul. If I do this not just out of mere parental duty but from a genuine sense of care-as-worrying, then I cannot help but be preoccupied with this other person’s welfare. In this childhood experience of having your parents worry for you and worry about you, the child (as future parent) in turn is encouraged to recognize that the source for understanding this self-care lies in the care for other. Thus teaching self-care also teaches care for the other. It is pedagogically desirable that the child not only demonstrates self-care but also, gradually, begins to demonstrate care-as-worrying for others. While Foucault advocated an archeology of knowledge, it appears that he was not interested digging for any originary roots of self-care in the pedagogical example of Socrates’ caring for other. For this kind of search we need to consult another French thinker, Emmanuel Levinas (1993; 98).

Caring responsibility

Language analysis and etymological sources can help us orient to the semantic variations and the meanings of possible human experiences of the term caring. But which of these meanings are helpful to our particular practice? And how can we approach the phenomenon of caring without already having become captive inside the limiting frames of the particular conceptualizations that we personally favor or that we find in the literature? This may seem a strange question. Is not every understanding of caring already a conceptualization and thus betraying a particular perspective or form of life? For example, Wittgenstein (1958, p. 77) has shown that the meaning of any term is always conditional upon the usage of that term within the social practices of the language games in which we are involved. Therefore, we should not confuse the meanings associated with parental caring with the way caring may be a term of the discourses of, for example, nursing, medicine, professional childcare, advertising, business enterprises, and so forth. One may argue that it makes little sense to try determine if there is any core or shared meaning to the idea of caring since the term obviously means different things in different contexts. Or one may argue that the field of caring is so confused that it is better to simply impose a certain definition or behavioral equivalents on the concept.

But there are dangers in either relativizing the meaning of caring to shifting language games, or, in actually stipulating functional definitions of caring and making it to mean whatever one wants it to mean. Either way, one stands the danger of becoming forgetful of the deeper human meaning of caring as the ethical demand, as the Danish philosopher, Løgstrup, called it (Løgstrup, 1997), and how the caring encounter may help us understand in a richer way the nature of our profession as a vocation and as a domain of ethical responsibility. The French philosopher Emmanuel Levinas has insistently proposed that caring responsibility can only be understood in its most basic modality if we can somehow transcend the intentional relation toward the world that accompanies all modes of being and thinking.

Levinas has aimed to show that it is only in the direct and unmediated relation to the other that we can gain a glimpse of the meaning of the caring encounter that he discusses as the human responsiveness to the appeal of the other who needs my care. Usually we think of other people as selves who are in the world just as we are in the world as selves.[ii] And so we are co-habitants, fellow human beings who live in reciprocal relationships. In these relations each of us cannot help but see others as objects of our personal perception and thinking. But this is not the only possibility. It also may happen that the other person bursts upon my world and makes a claim on me outside of my own intentional cognitive orientation. In other words, it is also possible to experience the other in the vocative: as an appeal that the other makes on me. This is especially true of situations where we meet the other in his or her vulnerability, as when we happen to be handed a hurt and helpless child, or when we suddenly see a person fall in front of us. What happens then is this: I have felt a response that was direct and unmediated by my intentions or thinking.

This is the originary caring encounter. And in this situation, says Levinas, thought comes too late. What happens is that this person in pain, this child in need has made an appeal on me already. I cannot help but feel responsible even before I may want to feel responsible. For Levinas, to meet the other, to see this person’s face, is to hear a voice summoning me. This is the call of the other. A demand has been made on me and I know myself as a person responsible for this unique other. Levinas states this predicament even more provocatively. He says, the other is not only someone I happen to meet but this person calls me to responsibility‚ stronger yet, this person accuses me and takes me hostage. In this gesture I have experienced also my own uniqueness because this voice did not just call, it called me, and thus took me hostage.

Hostage? Is this not just metaphorical philosophical speech? Not if we recognize this experience in our own life: Is this not precisely what happens to us when we are claimed by our sick child as in the stories we just read? Here is this vulnerable child who exercises power over me. And I, the big and strong adult, is being held hostage by this small and weak person who relies on me. If, as a parent, I am careless (meaning: if I do not worry about my child) then I may inadvertently expose him or her unduly to risk and dangers. For example, I fail to keep my eye on my child when he or she wanders astray. Thus a careless parent is not necessarily uncaring but unworrying. In George Eliot’s Silas Marner there is the moment that the child, Eppie, has managed to slip from under his watchful gaze. And now Silas is suddenly overcome by a strange sensation: he experiences the worried searching of a parent whose child has strayed:

poor Silas, after peering all round the hedgerows, traversed the grass, beginning with perturbed vision to see Eppie behind every group of red sorrel, and to see her moving always farther off as he approached.… (Eliot, 1861, p. 180)

When he finally finds her and knows that custom has it that one should punish a child who has willfully disobeyed by straying off when explicitly told not to he cannot help but demonstrate that he has been afflicted by this chronic illness of caring-worrying.

Here was clearly a case of aberration in a christened child which demanded severe treatment; but Silas, overcome with convulsive joy at finding his treasure again, could do nothing but snatch her up, and cover her with half-sobbing kisses. (Eliot, 1861, p. 180)

Of course, in a real sense every human being is vulnerable; every human being is mortal and subject to fears and dangers. And so every human being is my Other. Every other is actually or potentially weak and vulnerable—just as I know myself to be actually or potentially weak and vulnerable. However, the existence of Other does not merely manifest itself as my feelings of pity or compassion for the hurt or suffering of this other person. More importantly I experience the other as a voice, as an address, as an appeal to me. And this is what we mean when we speak of our living with children or caring for the sick as a vocation, as a calling.

Care for the other

The strange thing is that the more I care for this other the more I worry and the stronger my desire to care. By desire Levinas does not mean a personal want or need. Wants and needs differ from desire. I may always have wanted to buy a cottage at the lake and now that I finally am able to afford my dream I feel satisfied; or I may find that I am disappointed and that my want was not as worthwhile as I thought. At any rate, my want has been stilled. But, desire that lives in my relation of care reaches beyond anything that might bring satisfaction and thus acquiesce the desire. For example, love is desire in this sense. Think of the lover who asks his loved one: “Do you love me?” And his love says: “Yes, you are my love and only love.” The question is: What happened to desire? Chances are that a week later, a day later, or even five minutes later the lover may again feel the desire to ask and say: “Yes, but do you really love me?” And again his love responds, “Yes, I really do really love you.” This example illustrates that true desire cannot be stilled. No answer can ever forever satisfy. In fact, desire feeds on itself and fans itself—think of the great love tragedies. Similarly, caring responsibility increases in proportion to the measure that it is assumed. The more I care for this person the more I worry, and the more I worry the stronger my desire to care. 

Levinas points out that in relation to the face, we come closer to the other. At the same time, it is the face that makes the distance between the self and other irreducible, infinite. Indeed, it is especially the face that takes on caring meaning for us. “What is meaningful in the face is the command to responsibility,” says Levinas (Levinas in Rötzer, 1986, p. 61). Perhaps you have seen the recent commercial on television by the Save the Children’s Fund. In a telecommercial plea for support the woman, from the agency, holds up a child of poverty and then she says to you the television viewer: “Look into these eyes and do what you would do if you were face to face.” At this same moment the child turns and stares directly into the camera.

Now, if you really look into this child’s eyes and if you don’t just click to an other television station then you may experience an uncanny sensation. This is what Levinas talks about as being addressed by the otherness of the other. In this experience I do not encounter the other as a self who is in a reciprocal relation with me as a self. Rather, I pass over myself and meet the other in his or her true otherness, an otherness that is irreducible to me or to my own interests in the world (Levinas 1993, p. 44).

When the voice calls then it is no use to look around to see if it was meant for someone else. No, here is this child in front of me and I look this child in the face. Before I can even think about it I already have experienced my responsiveness. I “know” this child calls upon me. It is undeniable: I have experienced the appeal. And this experience is a form of knowing. I am called. I am being addressed—or to use a Levinassian phrase: I am the one who is charged with responsibility. Again, what Levinas offers us is not just some abstract conceptualization or ethical theory.

Any person who has experienced the otherness of the other knows that this sense of being addressed is undeniably real, experientially direct. What makes Levinas’ insights so unique is that he is the only philosopher who offers us an ethics of caring responsibility that is not founded in ethics. That is why Levinas calls it “pure ethics” (Levinas, 1993). In a sense this is not yet ethics, not yet philosophy, not yet politics, not yet religion, not yet a moral commitment. Levinas shows us that in the encounter with the other, in this greeting, in this face we experience and understand the purely ethical before we have involved ourselves in ethics as a form of thinking and reasoning. We have felt our caring responsibility even before we have made a commitment.

Ethics of care

Several authors have clarified and explored the ramifications of this distinction between caring as general ethics and caring as pure ethics. Some of these discussions have evolved around the biblical parable of Abraham and Isaac in Genesis 22. In his famous text Fear and Trembling Søren Kierkegaard (under the pseudonym of Johannes de silentio) portrays Abraham as the great God fearing man who was prepared to sacrifice his beloved son in the face of and in defiance of any ethical standard.

The time came when God put Abraham to the test. “Abraham”, he called, and Abraham replied, “Here I am.” God said, “Take your son Isaac, your only son, whom you love, and go to the land of Moriah. There you shall offer him as a sacrifice on one of the hills which I will show you.” (The New English Bible, p. 21)

Abraham is usually thought of and heroized in terms of his unshakable faith. But Kierkegaard is possessed by the “shudder of thought” that accompanies trying to understand Abraham predicament. What did Abraham think when he sat out on the journey to sacrifice his son? What would it have been like to be there with Abraham on the three day journey? How would we see Abraham raise his eyes to the hill in Moriah where the burnt sacrifice of his son was to take place? What did Abraham go through when he gathered the firewood and sharpened the knife? What possible horror did he experience when he bound his son, when he raised the knife? And what did he feel at that enigmatic moment when, as the Bible reports, he heard the second voice that called him:

Then he stretched out his hand and took the knife to kill his son; but the angel of the Lord called to him from heaven, “Abraham, Abraham.” He answered, “Here I am.” The angel of the Lord said, “Do not raise your hand against the boy; do not touch him…” (NEB, p. 21)

What did Abraham say to Isaac when he untied him? How did he live with himself after this event? How was the journey home? Was the trust between Abraham and his son Isaac irreparably broken? How did Abraham explain himself afterwards to his son? How did he speak to his wife Sarah? The Bible’s Genesis does not shed light on any of these questions. Therefore, this parable continues to draw interpretive efforts.

In Abraham’s predicament we may sense the tension between two demands of caring responsibility: the demand experienced in the call that has singled me out as uniquely responsible, and the demand of the community that we must always be able to give justification and account of our responsibilities in some kind of ethical manner.

Would it not have been easier for Abraham if he had at least tried to explain God’s strange command to his wife and son at the outset of the journey? But Kierkegaard shows that this would have been impossible. The absolute responsibility that Abraham felt towards God could not and cannot be justified in any system of ethics. If anything, child-sacrifice is a mad, murderous, and scandalous act and Abraham would only have met total scorn and disbelief. So it was Abraham’s fate that he had to carry this unbearable burden, this terrible secret, all by himself. Abraham had heard God’s call to duty and he felt himself responsible this call.

Even in our days, some authors simply find the whole situation apprehensibly incomprehensible and dismiss it with simplifying gestures. For example, in her book Caring, Noddings rejects the problem of Abraham with a sweeping gendered response. She says, “I suspect no woman could have written either ‘Genesis’ or Fear and Trembling” (p. 43). Noddings explains her claim as due to the difference between the natural caring of the woman or mother and the (not natural?) caring of the man or father: “But for the mother, for us, this is horrendous. Our relation to our children is governed not by the ethical but by natural caring” (p. 43). Thus, in Nodding’s text “natural caring” becomes the explanatory concept for a gendered critique. But, Noddings argument may unfortunately acquire essentialist overtones. What do we mean to say that women by virtue of their natural caring cannot do harm to their children? The problem is that making the idea of “natural caring” the final backstop to explanation prevents us from grounding the act of caring in a more originary human context.

Let us reread Genesis 22 and wonder what would have been the significance of the fact that it was a second voice, the voice of another, who called Abraham and who commanded him to stop and not raise his hand against his son, the son he loved so deeply. Abraham may have been confused. Why did not God call to him directly as he had done when he asked for the sacrifice? But then, the Bible says, the angel called from heaven a second time, as if to assure Abraham that it was indeed the Lord who sent him. “This is the word of the Lord: By my own self I swear…” And indeed the other, every other who calls upon me as true other, calls me with the voice of God says Levinas. And the voice says, “Thou shalt not kill!” (Levinas in Rötzer, 1995, p. 64).

The ultimate other is God. And so, without intending to be sacrilegious, I like to think that this is how it went: Abraham tied his son to the sacrificial stake. He sharpened his knife as he must have done. Then he raised the knife and, at that moment, as he looked Isaac in the face he heard the voice call his name. And the voice said: “Thou shalt not kill.” Of course, it was not Isaac who uttered those words, but they arose from Abraham’s originary acknowledgement of the otherness of this other, who happened to be his own son. The following lines from Levinas seem very apropos here:

For me, the originary acknowledgement of the other and the beginning of the meaningful resonates through the “Thou shalt not kill!” The word is very important: Care for the death of the other is the beginning of the acknowledgement of the other. (Levinas in Rötzer, 1995, p. 64)

So who called Abraham with the voice of the ultimate other? The point is that this is already an intellectual question, a religious ethical question perhaps. We might just as well say that pedagogy called him. Or that it was Isaac’s face, the face of any child for whom the parent holds a unique and inexpressible caring responsibility.

Both Caravaggio and Rembrandt have depicted the sacrificial biblical scene in their paintings. The treatment of Isaac’s face is especially striking. In Caravaggio, Isaac’s face is contorted with dread and fright, and the Angel’s face is expressive with appeal. But in spite of these very different expressions, what is most remarkable is the uncanny likeness of the two faces. Abraham is held from killing his son by staring into the face of his son. Strangely, in Rembrandt’s painting, Isaac’s face is completely covered over by the clutching grip of Abraham holding him down. It is as if Rembrandt, the famous master of portraiture, did not know what to do with the face of Isaac. And so he covered up the face completely.

But both Caravaggio and Rembrandt anticipate Levinas in their understanding of the significance of the face as the ethical experience of responsibility for the other, and in particular for one's child.

The reason that Caravaggio and Rembrandt could show us the ambiguous role of the face is that Abraham’s situation is not at all exceptional. In fact, it powerfully portrays a modern or postmodern predicament: our ambiguous relation to our own children. The French philosopher Jacques Derrida (1995) has put it very well: in a real sense we can kill our children [i.e., their uniqueness] in many different ways, and all of us, men and women, are like Abraham holding the knife over those who are dear to us. How do we do this? And what does Levinas mean when he says, “Care for the death of the other is the beginning of the acknowledgement of the other”? (Levinas in Rötzer 1995: 65).

The gift of death

In failing to be sensitive to the uniqueness of the other we cannot respond to the call of responsibility that grounds our own uniqueness. Levinas (1998), Heidegger (1962), Kierkegaard (1985), and Derrida(1995) have shown that the uniqueness of each person comes into sharp relief against the fact of his or her individual mortality. Ironically we are given this mortality right at birth. Therefore, Derrida calls this “the gift of death” since it is our own mortality that belongs to each of us more uniquely than anything else imaginable. Whatever can be taken away from us, there is one thing that belongs to us so essentially that nobody can take away and that is our own death. I may give my death in sacrifice to someone else, and yet even that supreme gift cannot be substituted for their own death. Thus it is the nonsubstitutional uniqueness of the other that I must preserve, and not kill, by betraying it to the general. And yet, says Derrida, this is precisely what we do every day:

By preferring my work, simply by giving it my time and attention, by preferring my activity as a citizen or as a professorial and professional philosopher, writing and speaking here in a public language … I am perhaps fulfilling my duty. But I am sacrificing and betraying at every moment all my other obligations: my obligations to the other others whom I know or don’t know…. also those I love in private, my own, my family, my son, each of whom is the only son I sacrifice to the other, every one being sacrificed to every one else in this land of Moriah that is our habitat every second of every day. (Derrida, 1995, p. 69)

It seems that the call of caring responsibility is constantly betrayed in our efforts perhaps to be caring in a general sense of duty as in our professional practice which can also mean a caring for the self. In other words, by writing about caring (even by writing about caring for my children) I am forsaking the call that my children make on me.

Derrida articulates the dilemma in such a way that his confession of failing to be responsive to the call of his own son becomes an unsolvable predicament. He says,

what can be said about Abraham’s relation to God can be said about my relation without relation to every other (one) as every (bit) other [tout autre comme tout autre], in particular my relation to my neighbor or my loved ones who are inaccessible to me, as secret and transcendent as Jahweh.… Translated into this extraordinary story, the truth is shown to possess the very structure of what occurs every day. Through its paradox it speaks of the responsibility required at every moment for every man and woman. (Derrida, 1995, p. 78)

In a way Derrida seems to let us off the hook in our unique responsibility to care for the other as other. On the one hand, he suggests that we need to heed this call and yet, on the other hand, his deconstructionist strategy aims to show that we must constantly fail since we cannot possibly be responsive to every other who is out there and also makes an appeal to our caring responsibility. Since we can only worry about one thing at a time we cannot worry about every one and everything.

Indeed, even as a teacher, as nurse, as doctor one would have to agree with Derrida. We cannot really see how we could worry for each child, for each patient in our charge. Does that mean that we flee into the ethical domain of professional responsibility which says that we must subsume our caring behaviors under a general moral code? The problem with Derrida’s approach is that he has already fled into language and ethics when he deconstructs reflectively the prereflective occurrence of the caring encounter. In every day life the experience of the call of the other, of care-as-worry, is always contingent and particular. It is the singularity of this person who addresses me in my singularity. 

Being afflicted with care-as-worry

I have suggested, somewhat tongue-in-cheek, that care-as-worry can be likened to an illness, a chronic condition of worrying for this other person who is dear to me, whom I love, or for whom I feel responsible. And indeed, this condition of care-as-worry is truly somewhat like an affliction. Existentially the vulnerability of the other tends to be experienced as, what we might call, ethical pain—ethical pain that is symptomatic of the worrying condition engendered in the encounter with this other person who has made a claim on me. Many parents, many nurses would readily agree that this worrying is painful and troubling. But it is also necessary. Because in this care-as-worry I experience the other who calls on me. Worrying keeps me in touch with the presence of this other. Or as Levinas says, “The presence of the other touches me” (Rötzer, 1995, p. 62). And now the ethical has entered my life, I feel I should do something, that something is demanded of me.

Again we can check the truth of care-as-worry against our own experience as parent where pain, fear, illness, discomfort, anxiety endured by my child may hurt me even more than it hurts the child. In other caring relations too, this can be our experience. A nurse in my phenomenology class at the University of Alberta tells me how she could not help but be deeply touched by the predicament of one of her patients who was tied to an artificial respirator. He could not move and could not speak. Only his eyes could speak. One day as Patricia went for a coffee break she bent over the patient and said: “I have to go down but I will scream for you.” Weeks later, after he had been taken off the respirator the patient reminded her of this moment. He said: “You have know idea how those words helped me.”

A teacher may feel a special responsibility for this or that child; a nurse may feel worried about this or that patient. And this care-as-worry is often expressed as, “I need to check on him.” “I hope she is okay.” Or, “I must make a personal effort.” Or, “I need to keep a special eye on her.” Administrators who regulate the caring practices of health care professionals need to understand that caring in a deeper sense can only occur in contexts, structures, and schedules where the nurse-patient contact provides opportunity for the occurrence of genuine encounters, even though these cannot be predicted.

Recently, a researcher in Edmonton has found that some nurses with a few patients (but not with all patients) will develop a special relation that contains an elusive element that the researcher dubbed the z-factor, an unspecified relational quality that she could not describe. Because of this z-factor, she says, these patients did better than the other patients in their convalescence. It seems to me that care-as-worry could be such mystery factor that more positivistic oriented research does not know how to describe or make comprehensible.

But effective practice is not the most important reason to remain open to the ethical demand. More important is that caring in this deeper sense is the source for understanding every other kind of caring. Of course, care-as-worry cannot be legislated, managed, or controlled. But the sporadic and spontaneous occurrence of this originary kind of care provides the basis for understanding the more practical caring responsibilities that we do expect from professionals on a routine basis.

Only by remaining sensitive to our sense of unique responsibility can we insert into our professional ethical practices the life blood of caring in all its various modalities, that our vocations require. For the pragmatically minded this may be a bit of a heavy idea. Caring as worrying is no doubt a burden of responsibility. It may not always be pleasant or delightful, but says Levinas (in Rötzer, 1995, p. 61), it is good: It’s the experience of the good, the meaning of the good, of goodness. Only goodness is good.

References

[i] In passing it may be noted that in Foucault’s main work The Care of the Self, there is no mention of care in the sense of parental sorgen. Children (sons and daughters) are only mentioned in contexts of convulsions and incest, and boys are primarily dealt with as objects of (sexual) pleasure.

[ii] Heidegger is often cited as giving a philosophic explication of caring as basic to human existence. But his notion of caring has primarily ontological import and little to do with our concern with the other. For Heidegger care is the response to the call of Dasein that finds itself thrown into a world without foundation on which to construct meaning. He stresses the condition of existential anxiety brought on by authentic existence of Dasein, the human being in the world. Therefore, for Heidegger care means involving oneself mindfully in one’s world. But, according to Dreyfus (1991, pp. 238-240), Heidegger quite emphatically refused to equate his special usage of the word sorgen or caring with what we commonly understand by caring in helping relations.

Against Heidegger’s notion of authentic being as existential anxiety, Levinas shows that our common existence in the world is governed by the desire for pleasure and happiness but that this desire is not at all inauthentic. This sense of being as a desire for pleasure is indeed our common experience that belongs to human life. However, Levinas too would say that ultimately this common existence can cause a sense of crisis when we come to the frightening realization that all there is is all there is (il y a). The there is of Heidegger’s Dasein finds its meaning not in Being (self) but in what is beyond being: otherness.