Helen Hester: You dedicate a chapter of this book to what you call the ‘self-care fix’ – an approach to individual wellbeing which has two sides: ‘First of all: take care of you, because you are your own most valuable asset – a form of human capital that will yield high economic returns if you look after it. Second: take care of you, because nobody else will.’ You describe this expectation that people nurture themselves through things like clean eating, exercise, and sleep hygiene as the ‘unpaid labour of self-care’. I wondered if you could elaborate on this. How might self-care be considered a form of labour?

Emma Dowling: The unpaid labour of self-care is a response to the care crisis, it’s a technique of crisis management. The last years have seen a rise in a new imperative to ‘take care’ of ourselves. Against the backdrop of welfare state retrenchment and labour market deregulation, we are each our own best assets – assets that we need to invest in. This becomes quite existential when we consider how this assetisation of our selves is not only a result of the ways in which financialisation remakes economy and society in its image, but that those of us who merely have our labour power to sell don’t have much else to rely on other than our ability to work for an income. There is a fear that underlies this condition: what might happen to us if we can no longer work?  At the same time, the contemporary capitalist economy demands of us our psychic investment in growth, not just abstractly in relation to the economy as a whole, but with regard to our own selves, couched in personal development. The flipside of this is of course is inadequacy – we are never never enough as we are.

I was concerned about the ways in which the new imperative for self-care is undergirded by anxiety, as well as being shaped by consumer markets for lifestyles and products. Phenomena like clean eating, clean cosmetics, clean sleeping and so forth that I discuss in the book are forms of work on the self. In fact, we should be more precise, they are forms of work on the body and its functions.  There is here a busyness with the self that is very inward-focused – even as someone might check in with others on social media and perform their busyness, at the same time clocking in with the many companies who sell services and products developed that are in turn optimised through the information provided. In short, the unpaid labour of self-care is a twofold idea of self-care that we orientate towards the reproduction of our labour power for capitalist valorisation at the same time as we also consume products and services that help us to do so. This is a process that feeds off fears and anxieties.

Helen Hester: So, you view this as one way in which the particularly affluent try to manage anxieties about a generalised crisis of  care. It builds up an illusion that if one does enough work on oneself, one may never have to deal with the systemic effects of the care crisis. One can stave off death, stave off vulnerability, stave off illness, as long as one does the right things to and with one’s body and mind. And at the same time, there is the suggestion that anybody who finds themselves in crisis does so because they haven’t followed the guidelines of self-management. There is this busyness with the self that diverts attention away from structural conditions and implies that any need for care from others stems in some way from a personal failure to take care of oneself, maintain one’s productivity, and generally be a good and healthy citizen. Personal agency and individualised blame go hand in hand in hand.

You use crisis as a framework for the book. The term crisis suggests something exceptional – a situation coming to a head or reaching a peak. The word itself was originally most commonly used in English to describe the crisis of a disease – the turning point, after which the sufferer would either recover or die. Certainly it feels like the circumstances around care in this country are reaching a kind of decisive point – that things really can’t go on like this for much longer. And yet at the same time, I recall Nancy Fraser’s words in her essay ‘Contradictions of Capital and Care’, in which she argues that the present strains on care “have deep systemic roots in the structure of our social order”. Her argument is that “the present crisis of social reproduction indicates something rotten not only in capitalism’s current, financialised form but in capitalist society per se.” So, the situation we find ourself in is simply the current, distinctive expression of a tendency that is in fact inherent to capitalism itself. To quote Fraser, “My claim is that every form of capitalist society harbours a deep-seated social-reproductive ‘crisis tendency’ or contradiction: on the one hand, social reproduction is a condition of possibility for sustained capital accumulation; on the other, capitalism’s orientation to unlimited accumulation tends to destabilize the very processes of social reproduction on which it relies. This social-reproductive contradiction of capitalism lies at the root of the so-called crisis of care.”

You use the term crisis quite carefully and advisedly in the book – you write early on that “to speak of crisis is to ask the question, a crisis for whom?”, and a little later you quote Kathi Weeks making a similar point to Fraser’s – namely, that “The competing requirements of creating surplus value and sustaining the lives and socialities upon which it depends form a political fault line through capitalist political economies.” So, we’re talking about a crisis tendency within capitalism, about a state of permanent crisis – a patient that neither dies nor recovers but is forever stalled at that turning point. I’m interested in your thoughts about the ways in which the current situation lends itself to a crisis framework – but also, about how the framing of crisis itself can act as a kind of political tool. Why “the care crisis”? What do you see as the possibilities and the limitations involved in thinking about our current moment in these terms?

Emma Dowling: The relationship between capitalism and social reproduction is crisis-prone, yet there have also been moments in the history of capitalism where the particular regime of social reproduction (the arrangements through which care and social reproduction take place) has been more stable than at others and has then can come into crisis and changed. Paradigmatic for the feminist analysis of social reproduction was the relatively stable post-war period of Fordism-Keynesianism with its male breadwinner model stabilised at the expense of the unpaid domestic and care work of women in the home (as well as colonial exploitation).  Since the 1970s the crisis of care has been growing. There has been a rise in female labour market participation without a fundamental transformation of the sexual division of labour, while at the same time globalisation and financialisation have undermined the reproductive deal of Fordism-Keynesianism with regard to capital’s reliance on any one particular national labour force and hence investment in its reproduction. There has also been significant wage stagnation such that households require the income of two workers to make ends meet, but this of course means that more waged work has to be done outside of the home, which at the same time takes away time from being able to care. Add to this austerity and welfare state retrenchment, i.e. the chipping away of public infrastructures (especially in areas not conducive to augmenting the productivity of the workforce) and the rise of privatisation and the marketisation of care as an investment opportunity for capital. The consequence is a situation in which those who can afford to pay for privatised services do so and those who cannot simply have to fit the work in themselves or go without. All of this is underscored by a politics of personal responsibility for care. Moreover, the crisis is exacerbated by the rise in the need for care due to demographic changes, in particular ageing. All in all, societal resources for care are depleted, while care needs are rising.

In my book, I focus on the decade or so after the Global Financial Crisis of 2008 and the increasing inability of people to access the care they need to live well, but also the incredibly difficult conditions under which people are providing paid and unpaid care. Since 2008, the combination of austerity and regressive recovery post-2008 has severely entrenched the care crisis and inequalities have risen. The omnipresence of crisis talk can indeed be numbing, but I wanted to amplify the voices of the scholars, activists and practitioners who have been alerting us to its urgency now for some time and point to the worsening of the crisis post-2008. And I wanted to ask what the economic crisis looks like when we look at it from the perspective of care.

I do think we are indeed at a turning point. On the one hand there is abandonment, on the other hand there is a huge interest on the side of capital in the whole area of care markets as new avenues for investment, where care is sought out as a fix for new drivers of capital accumulation. What will be the consequences of this? Will there be some form of stabilisation? And if so, at whose expense? My wager is that care cannot solve capital’s current accumulation problems, but neither can capitalism solve the current problems we face with regard to care. Will it be possible to affect radical change?

Helen Hester: You make the point that “a component element of the assistive labour of care is that it is – if done properly – positively supposed to go unseen.” There are some types of care work that are not supposed to be visible as work, in other words, or which culturally are not recognised as work, because they are naturalised in some way – the work itself becomes a kind of behavioural surplus; the tenderness, the thoughtfulness, the tact, the cleanliness, the love – all are supposed to emanate as a kind of inevitable by-product of the carer’s personality or social being. We are dealing here with caring as an adjective rather than a verb; a disposition rather than an activity. And while a disposition might warrant a celebratory clap on the doorstep, it’s not the kind of thing that one can usually expect to get paid for. Perhaps the most apparent vector of naturalisation here is gender – the idea that care work is simply the judicious mobilisation of a feminine propensity to care, which is in turn some kind of circuitous marshalling of maternal instinct (even in the case of those who have not, cannot, or will not ever gestate a foetus or care for an infant). Feminists from the 1970s onwards have spilled a considerable amount of ink trying to challenge this idea.

You make the point, however, that there’s another vector of naturalisation that’s proving increasingly influential in an era of the commodification of care and of global chains of reproductive labour. You discuss a “smokescreen of culturalisation”, in which migrant workers are designated as especially suitable carers for the elderly because they hail from ‘other’ cultures, which unlike Western individualism show deep respect for the elderly and attending to them is considered a prestigious activity.” Once again, care is naturalised and in the process devalued here. How does one resist this form of naturalisation? Can second wave feminist strategies offer us any tools – are there lessons to be learned?

Emma Dowling: There are all sort of ways in which the moral register is invoked in order to obfuscate the exploitation of labour. We should be attentive to how ideologies of caring function and also how they shape shift over time. Feminism has long been concerned with deconstructing the ‘labours of love’ attributed to women. The understanding that there are ideologies of caring is another analytical tool I use in the book to unpack and challenge the instrumentalisation of care work, whether in calling on volunteers to plug gaps in public provision or ascribing caring dispositions to particular social subjects as a way of devaluing this work, be this women or migrant workers, whose labour market vulnerability is exploited. The extent to which care deficits have been sought to be met by migrant workers, often for very low pay and in precarious conditions, has been part of neoliberalism’s care fix.

Helen Hester: Your account of the crisis of care encompasses waged and unwaged, domestic and non-domestic, directly market mediated and indirectly market mediated forms of care work. You talk about how these different kinds of working relations, these different contexts for the delivery of care, inform each other and are shaped by some of the same factors. What are the connections between different kinds or conditions of care, and can these connections be brought together in an integrated struggle? How might we build worker power and solidarity between different kinds of care workers?

Emma Dowling: Drawing on different empirical sources, in the book I discuss how cuts due to austerity measures have increased the amount of unpaid care work done in the home, in communities and neighbourhoods. At the same time, the working conditions of paid care workers have also been affected by austerity, while privatisation and marketisation have taken their toll with regard to working conditions, low pay and precariousness. Plus, there are links between the world of paid care work and that of unpaid care work. An example I discuss  is the 2016 junior doctors’ strike when junior doctors struggled against changes to their contracts that would have meant a rise in out-of-hours-time and less training opportunities. One of the issues was the knock-on effect for those with caring responsibilities, particularly childcare. Working more evenings, nights and weekends in what effectively amounted to a pay cut meant facing their own care crisis at home and having to find (and pay) someone to do childcare in their absence.

Building solidarity between different care workers certainly requires respect for the differences between types of care work, while also recognising the common conditions as a basis for collective political demands. Building solidarity also requires thinking across paid and unpaid work when building a care infrastructure for the common good. So, active support for care workers’ struggles must be combined with the struggle for free time for care. Think also of the increasing commodification of our lives and how this means that we need more and more money to pay for the things we need to live. Yet, if we had more solidarity and more collective efforts to care for one another and more of an infrastructure outside of commodified relations, this would strengthen not only our ability to care for one another, but also our capacity to struggle for change. However, the latter will also require new forms of organising care that don’t reproduce problematic power dynamics and divisions in care work.

Helen Hester: I think that an expanded understanding of care across paid and unpaid domains is really important, as well as the idea of reclaiming time to care for ourselves and each other. The other constituency to think about in terms of building solidarity, though, are the cared for – the person in receipt of care, the loved one, the ‘client’, the service user, however they are positioned. You note at one point that a move away from providing social care in the form of a service in favour of giving people direct cash payments so that they can commission their own care fundamentally changes the dynamic between carer and cared for. Does that kind of relationship undermine the possibility for solidarity? And what can we do about that?

Emma Dowling: Within disability rights movements in particular there is an awareness of the power dynamics of caring relations and the ways in which care recipients can be rendered passive, especially if others are making decisions about their care. The way personalised budgets are implemented harmonises with ideas of consumer power. Personalised budgets are supposed to give care recipients more autonomy, by enabling them to make their own decisions about their care. With the cash allocated to them they can buy the services or equipment they need.  Not only are personalised budgets still subjected to needs assessments carried out in the context of austerity, they also create much more adminstrative work for those in receipt of care and those supporting them. In this sense, they are another way of individualising and privatising responsibility, while expanding a privatised model of commodified care.  Personalised budgets introduce another kind of power dynamic, because they mean that care recipients become direct employers (e.g. of personal assistants) and have to implement the rules and regulations that come with being an employer and ensuring adequate working conditions for the employee in their home. Moreover, commodified service relations have the structural tendency to pit the two sides of a service relationship against one another.

Yet, care relationships are not a simple one-way service from care giver to care receiver, but involve more complex social relations between those who receive care, those who provide care in a professional/paid capacity, as well as unpaid care givers and supporters, often referred to as informal carers who care for loved ones or friends. All involved have needs and wishes that have to be attended to in order to ensure good care. This is where more holistic ideas of co-production or collaborative care could be useful.

Helen Hester: In the book you note that homecare workers increasingly find themselves having to cut out the relational, emotional, and affective aspects of care work altogether in order to save time. As you say, those forms of support – along with many other ‘basic, unspecialised’ caring tasks, like shopping, tidying up or cleaning – then instead fall to friends, relatives, and neighbours as care work is redefined as the physical provision of support and assistance. Affective, relational and emotional dimensions of caring are increasingly relegated to unpaid realms. You note that the boundaries between what counts as work and what doesn’t are redrawn, and it’s unpaid labour that is relied upon to plug any gaps.

What I found quite striking about your analysis is that you emphasise that this unpaid work doesn’t just come from loved ones or volunteers of some kind. It’s also the extra work that paid care workers do. Homecare workers simply cannot complete the work that they’re expected to do in the time that’s allotted to them – which is often just a 15 minute visit. As such, they end up going above and beyond their paid jobs. In effect, the compassion and sense of responsibility felt by workers is enlisted in order to keep homecare services functioning. The whole situation is dependent on the goodwill and the unpaid work of women, either as paid service providers or as family members and friends. In my own work, when I discuss the issue of unpaid domestic labour, I tend to be thinking in terms of intra-familial or otherwise informal care and maintenance work. So, your point that unpaid domestic labour can also be the result of wage theft and the hyper-exploitation of those who work for money in other people’s homes is well taken. In terms of this question of solidarity, then, I wonder if this expanded sense of unpaid domestic labour might be an idea of around which people can rally. Is there perhaps a way that we can use this broader sense of unpaid work within the home as part of our struggle to address the care crisis?

Emma Dowling: The mechanism you point to here is another key analytical point of the book, namely that boundaries between what counts as care work and is hence paid and what does not and is hence unpaid are redrawn as a way of exploiting this work. A lot of the time this is to squeeze more work out of people, many a time it is to keep things going against the odds and in the face of scarce resources – whether this is social workers compensating for cuts by with their overtime, or homecare workers exceeding 15 minute visits, or not being paid for travel time. This is because work can’t be done without those caring capacities. So, the capacity to care and the sense of responsibility and compassion for those cared for and about, as well as the fear of what will happen to those left without care, are exploited. Another example is volunteering in hospitals to alleviate the pressures on staff. Volunteers read to people, bring them cups of tea, keep them company, guide them around the hospital, all sorts of nonmedical tasks. It is another way in which unpaid work is drawn on in the context of scarcity.

Helen Hester: What is your understanding of the role of the family in terms of care under capitalism? During the pandemic, cross household support networks have been established to help manage the care crisis. The very need to allow specific dispensation for care and support bubbles attests to the fact that, for many of us, the resources needed to take care of ourselves and our dependents cannot be located exclusively within the home. In the book you state that, “While the heteronormative family still constitutes the basic unit of social organisation that informs much of social policymaking. Not everyone lives in traditional nuclear family arrangements, receiving and providing care in this context. Over the last thirty years there has been a rise in single households (including single-parent households) and in childless families, but also in institutionalised living (such as care homes) and queer or other family and kinship relations of choice. Moreover, due to increased mobility, many more people live away from their families.

Even in the context of the heteronormative family, friendship, neighbourhood and other informal community networks are part and parcel of the care infrastructure within which an individual is embedded. Here, support and mutual aid are activated through choice and on voluntary terms, founded on shared values and shared social experiences. While ties might be loose or quite close, a sense of interdependency and reciprocity informs them. Consequently, these everyday relations of friendship and mutual aid are important sites of care, too.” You note that, while unpaid, unrecognised care work may take place in locales beyond the nuclear family, capitalism still draws upon such work in whatever form it takes. That is to say, capitalism continues to rely on unpaid reproductive labour, even as the specific ways in which care is configured and organized are made subject to change. How does this relate to the idea of ‘care in common’ which you advocate for in your conclusion?

Emma Dowling: I think that it’s absolutely necessary to think care and social reproduction beyond the nuclear family and challenge and transform both the explicit and implicit ways in which the  family is assumed to be the main locale of caring, with all of the assumptions that go with the privatised and gendered responsibilities for care. This is very much about the way that we actively design the fabric of social reproduction to suit our needs as opposed to those that arise from being posited as labour power for capital. In my view we need to think the commoning of care through mutual aid, care collectives, care cooperatives, multigenerational living arrangements and so forth together with the political demand for a universal care infrastructure that includes professionalised care and is based on principles of solidarity, where the responsibility for all is held in common through institutions that are publicly funded, for example through progressive taxation and higher corporation taxes. In short, we need to address questions of access, entitlement and commitment, as well as those of  autonomy, liberation and affinity.

While affinity is a good basis for establishing relations of care, and mutual aid is an important aspect of integrating care in our everday lives, affinity alone cannot be the basis for a care infrastructure. Access to care cannot be based solely on whether someone happens to like someone else, acts out of charity, or acquires a sense of responsibility through kinship. One problem is how volunteers are enlisted to plug gaps in public provision. Think how in less than a decade thousands of charity food banks have sprung up across the UK. Activist networks of mutual aid  often remain quite subcultural and exist in contexts where people are able to make the time to be involved or who share common cultural or political codes. There is a need move beyond the nuclear family, by creating different kinds of living arrangements, different kinds of ways to care for each other. However, this cannot be reliant on those people who happen to have that day the inclination to get together or have a kind of ideological predisposition towards that kind of way of organising. How might something like this be exciting and make sense to more people? How might mutual aid be sustainable over time and not in times of emergency?

Helen Hester: I’m wondering how we can retain what is politically radical in the idea of mutual aid – I’m thinking here of things like cooperation beyond the state, autonomous organising, working together not just for survival but for collective flourishing – while also avoiding the pitfalls of a ‘Big Society’ model which represents an abdication of responsibility on the part of the state and pushes the demands of social reproduction onto individuals and communities without providing suitable support. Is there some kind of filleting operation we can perform here, in terms of trying to take what’s most emancipatory about the idea of mutual aid without capitulating to these external pressures which are pushing us toward volunteering as a means of dealing with the crisis?

Emma Dowling: What is the context in which mutual aid occurs and on whose terms is it conducted? An interesting point I came across in a study on volunteering in NHS hospitals is that respondents stated they would not be happy to volunteer in a private hospital, but would be happy to do so in a public one. The former would feel like exploitation of their unpaid labour for private gain, whereas the latter feels like doing something out of solidarity for the common good. The question is, on whose terms are we engaging in these activities? Where are the points of conflict with the interests of capital? The answers to these questions have implications for how movements organise and what political demands are developed: struggling for a shorter working week without a reduction in pay; struggling for more public funding for the care sector; struggling for deprivatisation and democratisation.

Helen Hester: It seems that the kinds of activity that potentially make care roles fulfilling and that may attract people to these roles in the first place are what are being ‘recoded’ as not being work at all. This would seem to risk a potential impact on job satisfaction. The rewarding elements of the work are what attract volunteers, but are surely also crucial to the engagement of those who are employed to care, particularly given that there’s often so little financial ‘reward’ attached to the role.

Emma Dowling: Yes – that’s why I think it is important to think about the organisation of care work and what definitions exist with regard to the tasks and the skill that is considered intrinsic to performing this work. Care work was to be recognised as involving complex tasks that require sophisticated social and communicative competencies as well as expertise, along with empathetic, interpretive and intuitive skills. It is also work that cannot be done without the affective, emotional and interpersonal components.

Helen Hester: You talk about how the division of labour between paid staff and volunteers “has a lot to do with what is considered to constitute expertise and skill.” You use the example of hospital volunteers providing comfort and company, and facilitating self-help and peer-support. If the care work of managing, maintaining, and using information and biotechnologies is ‘high tech’, and that of physical assistance (washing people, lifting them, changing dressings and so on), is ‘high touch’, then the kind of work you are referring to here might be described as being ‘high talk’ – it is the affective or relational side of care. We’re talking about the kinds of social interaction and other-directedness that still shape much of our understanding of what constitutes good care. As you point out, though, it’s what I’m calling the high talk side of care that tends to be “externalised when time is scarce”. Paid workers are seen to be too busy doing the more specialist and “essential” parts of care – the high touch and high tech parts – to provide high-quality time and attention, the provision of which is increasingly outsourced to volunteers. This is obviously problematic in a number of ways. In your words, “A care fix is required to maintain standards of care on a tight budget. This care fix not only relies on recoding caring activities as unpaid work, it potentially transforms the nature of what staff do, by emptying its role of many of its caring dimensions.” What are the consequences, for workers and patients, of this transformation? What does it mean to disentangle high talk, high tech, and high touch in this way, rather than conceiving of care as a more holistic or integrated process? It’s a way of splitting these different aspects as a form of de-skilling, isn’t it?

Emma Dowling: Yes, it is a way of maintaining that care work does not require skill, training or qualification.  The splitting that results from ideas of what constitutes “actual care” that are formulated in the context of scarcity and bare necessity, not only plays into the low value and low status attributed to care and it also plays into ideas about the role of technology in care work and ideas that care work can be reduced to the routinised and standardised physical tasks, when actually it’s much more complex. This important implications for employment conditions in the care sector. The kinds of affective, emotional and social activities that make care roles fulfilling, are integral to its meaning and are what attract people to the roles. High staff-client ratios and lack of time mean these aspects of the job are  recoded as not being a necessary, but rather an add-on part of the job. All the while actually relying on care workers finding the extra time and scope for care and compassion against the odds.  Reintegrating these different aspects of care and insisting on the time necessary to provide care in this way would also be an important vision for what care work can look like in the future. In the Buurtzorg community nursing model for example, nurses routinely carry out simple and more complex tasks, intentionally subverting hierarchies of expertise. Such reintegration should not, however, be the basis for a kind of affective remuneration that replaces the wage – or part of it – in that well-known trope of people doing meaningful work at the expense of financial reward.  

Helen Hester: You have some very interesting material in the book about technologies of care, which you divide into ICTs and assistive technologies. Again, you argue that many of these technologies are playing into the recoding of care, and changing the very character of the labour processes into which they’re being integrated. You state that “technological developments throw up questions about the meaning of care. […] When a machine takes on a task, it does not simply do the same thing a human did beforehand. The task is transformed in the process. The idea that robots could replace care workers relies on a conception of care encapsulated in the reductionist notion of ‘actual care’ […] – as if ‘actual care’ were merely assistance with basic physical tasks. Indeed, attempts to rationalise care work and raise productivity give that exact impression: the activity of caring is broken down into repetitive and standardized tasks, which care workers perform at ever more breakneck speeds, leaving little time for the relational, affective, and emotional dimensions of care.”

This paragraph is suggestive of what I think is a particularly telling inversion. Social robots, as you note in the book, are taking on some crucial aspects of social reproduction – interaction, play, companionship, and so on. These activities make up that portion of reproductive labour which, for many of us, edges closest to the realm of autonomous activity – the kind of high talk work that paid care workers report being loath to sacrifice due to time pressures. At the same time, human workers are becoming more machine-like as they engage in repetitive, routine care work with little space for precisely things like interaction, play and companionship – the activities that social robots are performing. Of course, not all care workers are attracted to the high talk components of the work, and not everybody in receipt of care will particularly desire the emotional and relational element of caring interactions – some people will find these uncomfortable, unwanted, intrusive, or unnecessary; nevertheless, it strikes me as a rather painful irony that the elements of care and of our collective social lives most commonly associated with the potential for human freedom and self-determination are the ones being most effectively outsourced to machines. Given this rather bleak analysis – and the critical eye that you yourself bring to technologies throughout the book – I think it’s really interesting that you leave space in the chapter for a more positive reading of technology.