Friday, June 29, 2012

Care Really is Like Water

Continuing the metaphor of water: How we studied Care

Science and reason are ways that we humans guard against self deception.   True scientific experiements control for everything besides the variable that is being tested including the biases of the experimenters. Scientific studies are used to determine cause. For example, Does penicillin kill bacteria?  After a study is completed it is published in a journal that is reviewed by other scientists who are familiar with the field of study who can evaluate the study method and results. Science is a community process in which one study builds upon another. These studies comprise a body of work on a particular topic. These methods work well in physical, chemical and biological sciences. However in social, behaviorial, psychological and anthropological studies of human individuals and communities we have to use different methods. Usually we can demonstrate a correlation between two things. For example, shoe size and reading ability are positively correlated. This means as your shoe size increases most often your reading ability also increases. However, no one would argue that shoe size causes reading ability or vice versa. Both are correlated with advancing age in infancy and childhood. Yet neither is actually caused by advancing age.

Before scientists can study things they first need to define and identify them. Because care is so much a part of our daily lives, we hardly notice it. There are no rituals or rites for caring. No cultural markers that identify it. There is no beginning of the job of housework, there is no retirement party as there is for a career in the marketplace. Care is continuous and everlasting. Much of a woman’s life is consumed with giving care, planning care and recovering from care work.

Care is like water nurturing all life. Like water, care takes its shape, speed, form from the circumstances in which it finds it’s self. Water in the frozen north, is ice, in the mountains it rushes down stream, in the ocean it laps on the shore or rolls and heaves, in massive waves.
When I began my research, I new a great deal about how to give care but very little about how we humans think about care. What for one was compassion, for others was a days work.  I also knew very little about the extent to which it varies from person to person, setting to setting, need to need. Most of all, I wanted to know why there was so much variation in pay between the work done in the homes and nursing homes,  and that done in hospitals.  We anthropologists are used to studying humans by living with them and learning their ways. We observe, make friends, and ask questions. However like other scientists, we use checks and balances to avoid putting our own biased interpretation on what we see. One way we do this is by using statistical methods to test our observations.  My methods were developed by Louanna Furbee and Robert Benfer, my mentors and professors at the University of Missouri, Columbia where I did my research. Furbee and Benfer used these methods to understand expert knowledge of the people who actually did the work. For example they studied kinds of soil known to farmers  in Peru, and terms for illness used by Mayans in Chiapas, Mexico. These methods produces a map of the universe of the concepts, soil, illness, in which all of the differences in the ways the people think about things 'live'. So when I wanted to know how Americans think about care I studied people who are involved in caring for elders. I studied 5 nursing homes and asked the staff, the elders, and their family members what people who are caring for another do for them, who needs it, and who does it.

Picture a phone booth full of water like the one in the picture. Now picture the front and back of the booth. The front and back of the booth are made up of two lines or dimensions. The first dimension extends across the front of the phone booth. Our statistics show us that the care acts will vary along this dimension based upon how able the person is to care for their own lives. The person can be very able a young or middle-aged adult or they can be very dependent – an infant or a person in a coma. So across the front of the cube we can locate all of the possible degrees of ability inbetween those two extremes.  This dimension is shared by the bottom and top.

The second dimension that defines the front and back sides, surfaces or planes of the cube goes up and down.  Points along this line or dimension are more or less serious or critical.  A wound to the heart would be among the most acute or major threats to the life of the person. Dropping ones glasses would be among the least serious threats to the life of the person or organism.

This dimension is shared with the two side surfaces.

Now, picture the sides of the phone booth. The sides of the booth extend from the top to the bottom.

This side represents the need. How serious or life threatening is the need? Does the newborn need to be kept alive in an intensive care unit? Does the infant need a smile or a game of peek a boo? The range of variation of the threat to the life is mapped along the side of the cube. In health care this term is sometimes called acuity. How acute is the problem?

The third dimension is the distance from front to back and defines both the side surfaces, and top and bottom.  This dimension varies in terms of distance from self. How close is the care giver to the care receiver's home and heart. The recognition of mother, father, family kin, kith, clan and stranger is an ancient concept.  Intimacy between the care giver and care receiver is measured along this dimention.  Is the caregiver a stranger ? He might picks up the glasses of an older person who dropped them? Or is it a mother who is breast feeding ; daughter who is bathing an ailing parent, or a nurse who is caring for a patient? 
These three dimensions were created by a statistical method called multidimensional scaling.  Three dimensions were produced when we poured our data into a computer program that took all of the individual's questionaire responses and created a map of the universe of care, and we could make some predictions about how different people think about care and the values they place on it.  By using a computer program we are able to determine relationships among the responders to our questionaire and by thinking about how these responses differed from one another we were able to hypothosize that these are the three dimensions  that describe the shape the universe of care in the minds of Americans.  

Not only did multidimensional scaling give us the three dimensional map it plotted responses within the space. Thus, we could identify different kinds of care.  Some of these kinds of care have names: Pregnancy, Homemaking, Child care, Nursing care, Mothering, helping, kindness, compassion.  Others do not have names. They are so ubiquitous that they have never been named.  

This has been an exciting time for me. While this research was completed in 1991, I only recently understood how to explain it to you, the reader, who is unaccustomed to these methods of study,  in ways that are interesting, accurate, and understandable. So for the next few months I'll be posting the lessons learned from my research about care.