Social worker Silke Jacobi MA considers in the summary of her care-ethical thesis (2019) the possibilities of more impact and (political) participation of the institutional care-worker in an ambiguous neo-liberal context.

The Dutch government introduced policy changes in 2015 (the long-term care act known as Wlz) and in 2017, formally upgrading the position of the institutional care-worker in residential long-term care for citizens with a mental disability. However, in practice the intended purpose to facilitate care-workers’ participation in policy matters seems to face a deadlock, as the (counter)voices of the care workers are very scarcely heard.

Whereas inequalities of power are long-time issues for care ethics, my assumption is that the late-modern, neo-liberal contexts of care seem to involve also a very subtle, complex dynamic of power, which we would come to understand better through the specific concept of power developed by historian and philosopher Foucault.

Based on Foucault’s political analysis of power, sociologist Bröckling went on to investigate contemporary social practices. The central question in my thesis is: do the analyses of these two authors give us a better understanding of power relations in current institutional care, also opening up views of possibilities to increase real influence from the workplace, dispelling or at least uncovering systemic obstructions on the go?

Power issues in contemporary institutional care

Nowadays, the Dutch residential long-term care for the mentally handicapped is executed in semi-public care organizations. Care processes are systemically framed and standardized, to the extent that mentally handicapped citizens typically are not seen and heard in their uniqueness. Although person-centered care is the policy ambition, in many places it has not been achieved as of yet.

Criticism on the part of the operational care-worker on these matters has been suppressed, as finally stated by the care-employers’ association themselves (Governance Code by the employers, 2017). Recent governmental policy aims to reduce the impact of the administrative-oppressive system and level out the obstructing institutional hierarchical orders.

By giving more attention to the morally involved voice of the care-provider on the work floor, the personalized character of care would be guaranteed more. After all, the directly involved care-professional is closest to the individual citizen with a mental disability. At the same time, although an inclusive society is obviously high on the socio-political agenda, according to empirical research it has not yet got off the ground by far, certainly not in institutionalized contexts of residential care.

The policy ambitions aimed at hierarchical leveling and more extensive participation of the morally involved professional care-provider, appear to run parallel with care-ethical insights concerning the relevance of relationality. Listening to the voice of those involved in concrete care practices is part and parcel of these insights. The term ‘professional expert witnesses’ (Kolen, 2017, see also ethicsofcare website) expresses this in the same vein, implying that a professional care-provider should engage politically, with his or her witnessing inextricably linked to fully involved ‘citizenship’ within a ‘civil society’. This voicing ‘bottom up’ should potentially establish an improved political ordering, with social correlations more flattened and therefore more responsive.

According to empirical research and media reports, the recent policy ambitions described above often cannot be realized in the practices of the long-term residential care. There is even mention of institutional anxiety cultures. Care ethicists like Tronto suggest that the absence of power inequality is the most important prerequisite for inclusive relations. Which analytical approach is applicable when still too little progress is made in the desired direction, when more equality is proclaimed, yet only appears to be achieved? To what extent do current late-modern and neo-liberal tendencies affect these dynamics?

Types of power and the historical context

Philosopher and historian Foucault explicitly places power issues in the broadest possible, and therefore especially historical and political, context. In accordance with care-ethical insights, his object of study is the concrete (social) practice. He identifies the origination of diverse types of power, emerging at turning points in Western history.
The hierarchical type of power of modernity, characterized by asymmetrical interrelationships and disciplinary (social) arrangements, became insufficient in late-modern pluralistic and flexible societies. Late-modern power operations run parallel with postulates of emancipation, participation, hierarchical leveling and individual subject-orientation. However, Foucault’s, and later Bröckling’s (2005), diagnostics also reveal ‘invisible’ underlying regimes, unnoticeably holding the citizen captive.

Today, the citizen is no longer an ‘object’ of clear, rigid disciplinary and hierarchical – social – organizing forces. However, the grip on the citizen nowadays consists of compelling, ambiguous – economic – dynamics: the citizen, now as a subject, has to fit in with unpredictable dynamics of change. These operate under the heading of ‘innovation’. As a subject, the citizen has to invest in an ‘authentic’ inner self, paradoxically enough in order to manifest him/herself in a competition for ‘uniqueness’, which in turn becomes the social standard. In this sense, the currently established professional practices of ‘coaching’ are an example of this dynamic.

The ‘self’ is risk capital, and at the same time the only investment object now available to the citizen as an ‘entrepreneurial self’ (Bröckling, 2005). The urge to become an ‘entrepreneur’, with oneself as the only object of investment, leads both the care organization and the employee to an unfortunate discordance between self-improvement and self-preservation, fostering, above all, the compulsion to self-preservation within the unpredictable dynamics.

In the context of these analyses of the late-modernity, it has to be emphasized that the semi-public (care) organization is object of the same underlying dynamics of the ‘entrepreneurial self’. Foucault uses the term ‘microphysics of power’ to describe this phenomenon: seemingly all entities on micro-, meso- and macro-level gain strength through being enabled to become ‘entrepreneurs by themselves’, i.e. citizens, institutions and government itself.

The economic terminology cited here is not necessarily used in this social and political process, yet the dynamics extend to social spheres where economic principles do not seem to be in the foreground. From a neo-liberal point of view the dynamic is considered to be a moving, curative force for the overall development of the human being. However, the idea that human development is only possible when mankind has to assert itself in uncertain and unpredictable existential conditions, is also connected with this concept. This worldview suggests an anthropology. It comes with powerful visible and invisible implications.

On the one hand each agent on the mentioned micro-, meso- and macro-levels gets intentionally deeply involved in the attractive ownership of their own ‘enterprise’. Taking the neo-liberal anthropology into account, this intense involvement can only be developed further by exposing oneself ‘voluntarily’ to the external driving forces as described above. Given these complex and threatening coherences, extrinsic and intrinsic motives cannot be distinguished from each other when it comes to matters of self-preservation.

The risk of unnoticed internalization of the basic idea that comes with the neo-liberal anthropology, is continuously present. The external dynamics transform into intrinsic suppositions and subsequently into internalized content. This subtle, ongoing process of self-adaptation, keeping alive the ‘entrepreneurial self’, may not be revealed.
In fact, it stimulates exhausting self-defense and self-control, disguised as pragmatically straightforward targeting to achieve authentic and unique content. The result is an illusionary world that must be defended In terms of self-preservation, being threatened by the nuances and ambiguities of practice and long-term reflection. Regarding these dynamics of internalization, the former promised individual strength finally works out as a weakening force on the micro-, meso- and macro-level.

This ambiguity is part of the power play, which ends up in individualization on all levels, even if targets such as life-long learning, participation (in work-processes) and equality are at stake. Despite the viewpoints on neo-liberalism propounded by other authors, Foucault analyses the government in a neo-liberal context not as withdrawn from political and social involvement. On the contrary, the government is a driving force to keep these dynamics going, being object of these dynamics at the same time. Foucault’s conception of power as dynamics, and not as possession, appears here once again.

Differences in perspective – and agreements

The care-ethical heuristic approach does not rely on universalist, objectivist ethical principles, which, detached from reality, were developed from a meta-position, supporting standardization and objectification. Similarities with the Foucauldian critique are apparent. Foucault specifically pointed out the power effect of generalizing scientific analyses. He also analyzed morality as a potential power tool.

The care-ethical heuristic notion of ’empirical exploration from within’ attempts to circumvent this problem by focusing on the specific situationality of social practices. From the inside out, one can discover what emerges as the ‘intrinsic moral good’ from the ‘bottom up’. This subject-orientation aims to make the voice of the concrete person heard in order to answer the care needs of the “Other”. Relationality, understood as an intersubjective process, is a central term here.

Foucault has a contrasting or rather much broader notion of relationality, which excludes, for the reason stated above, morality as a human motive, but includes the political context. His concept provides insights into intensive interactions between ‘micro-, meso- and macro-levels’. Foucault analyses the entire bandwidth of the interactions by not only pinpointing the inequality of power ownership in the analytical field of view.

When it comes to the current, late-modern era, his genealogical research reveals subtle, implicit power dynamics. Foucault’s basic definition of power entails its ‘invisible’ implicit character. This invisibility is the result of the underlying ambiguity as shown above. Even if he analyses power dynamics in a broad relational, more political perspective, he also defines power features on the micro level: power ‘works’ where certain behaviour (action) is able to modify certain other behaviour (action), in spite of possible and available alternatives. (Foucault, 1983).

From a political perspective, care-ethical insights concerning relationality and inter-subjectivity (would) lead to the politico-ethical postulate of a caring ‘civil society’, which refers to bottom-up political processes. This indicates a view of power that focuses on hierarchical social arrangements and unequal power distributions. From this, a conception emerges that understands power as a possession from an individual, group of class. The care-ethical attention for power (im)balances in the care-relation implicates also asymmetry as a (visible) phenomenon of destructive power. Occupying a power position might also enforce the owner(s) to take responsibility for the powerless. In all of these care-ethical views power can be (personally) possessed.

In contrast, Foucault and Bröckling describe power and relationality in contemporary force fields with ambiguous and invisible implications and dynamics. Their research results could supplement care-ethical distinctions of relationality and of power only perceived as possession and domination. The force fields presumed by Foucault and Bröckling would be at work even when hierarchical orders seem to be less present.
In this complementary analytical perspective, the possibilities for the voice of the morally involved institutional care worker being raised can be reconsidered. Care-ethically conceptualized, relational responsibility arises from intrinsic cognitive-emotional evaluation (Van Heijst, 2005) from ‘within’. In the following chapter this is reconsidered in the Foucauldian, political perspective.

The voice of the ‘work floor’ in the analytical power field

As noted above, although the policy changes in the Dutch institutional care for the mentally handicapped have a hierarchy-leveling appearance, nevertheless the voices of the care professionals concerned are yet unheard more often than not. The policy changes have not shown to have effect. Against the background of the internalized dynamics analyzed by Foucault, causes are getting identifiable. Not asymmetric positions are hindering, but the internalized power relations working on all levels.

In a context where one’s right to exist is constantly under pressure, being (more or less implicitly) exposed to market forces, the semi-public organization has ‘to give itself away’, which remains unnoticed by those involved. Self-preservation in terms of self-control is primarily at stake, and policy, which was meant to improve the position of the work floor, turns into a means of power against the work floor. Employees who criticize the illusions thus created, are seen as threatening to self-preservation, i.e. to the preservation of an illusionary world, and also of the semi-public institution.

Returning to care-ethical starting positions, one can still, even against this background, rely on the operating power of moral involvement. Care ethics regards this involvement as a result of moral-cognitive evaluation from the involved subject itself. However, despite policy changes to the contrary, morally involved criticism cannot be dealt with as soon as it threatens the institution’s self-preservation and thus its right to exist.

Anxiety cultures can therefore be interpreted as a result of the comprehensive individualization strategy that affects the critically-moral employee involved. Foucault and Bröckling focus on the underlying dynamics and ‘illusionary content’ that arises within the described force fields in the contemporary era. Care-ethically explored relational-moral involvement is also situated within this frame, because the analyzed dynamics actually penetrate the personal life-world of the individual.

Conclusion and discussion

In Foucault’s and Bröckling’s work, morality is not a starting point for their methodology which uncovers universalist (moral) claims as means of power. For the same reasons, in the care-ethical literature universalia are passed over by adopting a specific heuristic approach, as described above. With the Foucauldian vision of internalized power relations, it is possible to comment on the exploration ‘from the inside out’: the internalization of external dynamics may come to light in previously undiscovered appearances.

This brings various forms of self-manipulation and manipulation of the other – also within forms of relationalism – into a sharper analytical focus. For instance, social technology, as a form of subtle manipulation with a ‘relational appearance’, can be more clearly detected in the context of the broad Foucauldian political analyses.

This provides new perspectives on instruments which are supposed to enhance the participation of the care-worker in the care-work processes, whilst not really achieving the desired goals. Foucault’s focus on power activities, other than those which are visible, makes clear how political micro-, meso- and macro-levels are linked to one another in specific situations. These junctures are more subtle than the common care-ethical terms of relationality, responsibility, moral involvement and distribution of power are able to convey.

In his analyses of the hidden impairment of subject-orientation, Foucault traces how contemporary non-disciplinary, hidden power strategies can traverse visible power distributions and thus political orders. The relationally involved subject is a care-ethical key concept, often linked to terms as – from inside out evolving – responsive and responsible (Tronto) engagement for the counterpart. Inherent to this frame is the idea of voicing and citizenship as basic implications for political arrangements. In a broader perspective this leads to the political concept of a ‘civil society’, relying on ‘bottom-up’ political processes (Dingler, 2016).

The fundamental care-ethical assumptions concerning the citizen as a committed and therefore active subject in a hierarchy-levelling society run, to a certain extent, parallel to neo-liberal incentives. In the beginning of this article I mentioned the notation of the political engagement of the ‘professional expert witnesses’ (Kolen, 2017, see also ethicsofcare website). The findings of Foucault and Bröckling highlight the rather intangible fragility of the intrinsic, responsible involvement of the citizen.

The neoliberal ‘microphysics of power’ weakens institutions, which – according to the Foucauldian analysis – abuse their power in a disciplinary way, in times of modernity up to the 1960s. The answer to this was the de-institutionalization promoted in the Netherlands since the 1970s. Presumably alternative forms of institutionalization could make a difference – for example facilitating long-term inter-subjectivity between the institutional worker, the mentally impaired and the ‘un-impaired’ citizen.

Only then it could become clear whether the mentally handicapped citizen experiences him- or herself as ‘included’ and what that really means to him of her. In any case, disproving the neo-liberal ‘illusionary worlds’ seems the first step in this direction.

References (a selection)

Bröckling, U. (2016). Das unternehmerische Selbst. Frankfurt (a.M.), Germany: Suhrkamp

Dingler, C. (2016). Relationele Subjectiviteit. Zur Theoriegeschichte der Care-Ethik. In Conradi, E. & Vosman, F. (Eds.), Praxis der Achtsamkeit. Schlüselbegriffe der Care-Ethik (pp. 93-114). Frankfurt/New York: Campus

Foucault, M. (1983) “The Subject and Power.” In Beyond Structuralism and Hermeneutics The University of Chicago Press, 1983.

Foucault, M. (2017a). Analytik der Macht. Frankfurt (a.M.), Germany: Suhrkamp

Foucault, M. (2017b). Sicherheit, Territorium, Bevölkerung. Geschichte der Gouvernementalität 1. Frankfurt (a.M), Germany: Suhrkamp

Kolen, M., Vosman, F., Timerman, G., Baart, A. (2017). Alledaagse omgang tussen zorg-professionals en zorgontvangers als vindplaats voor goede (LVB) zorg. Journal of Social Intervention: Theory and Practise. Volume 26 -3, 28 – 49

Kolen, M. (2017). De ongekende mogelijkheid van het alledaagse. Een kwalitatief-empirisch, zorgethische studie naar morele betekenissen in de alledaagse omgang tussen jongeren met een lichte verstandelijk beperking en zorgprofessionals. Dissertation University Humanistic Studies, Utrecht, The Netherlands

Mans, I. (2016). Het hart van de zorg. Idealen en praktijken in de verstandelijk gehandicaptenzorg bij de Hafakker (1960-2010). Stichting Uitgeverij Papieren Tijger

Sayer, A. (2011). Why things matter to people. Cambridge, UK: Cambridge University Press

Tronto, J. (1993). Moral boundaries. A political argument for an ethic of care. New York, VS: Routhledge

Van Heijst (2005). Menslievende zorg. Kampen, The Netherlands: Uitgeverij Klement