10.6092/issn.2038-3460/16996
In recent years many STS scholars have dealt with care practices in different fields. Starting from Care in Practice. On Tinkering in Clinics, Homes and Farms [Transcript-Verlag, Bielefield, 2010, 325 pp.], a book edited by Annemarie Mol, Ingunn Moser and Jeannette Pols, this debate aims to discuss the meaning and development of the concept of care and its accomplishment in practice. Mauro Turrini, Enrico Maria Piras and Alberto Zanutto wrote two commentaries on the book, while the editors answered to their observations. The result is a vibrant discussion that goes beyond the care to address issues such as the need / refusal to define and delimit concepts in doing social research and what these boundaries mean / do.
application/pdf
2038-3460
16996
1
en
Alberto Zanutto
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
situated practices
Care in Practice. On Normativity, Concepts, and Boundaries
Text.Serial.Journal
https://tecnoscienza.unibo.it/
2
Debates
2011-06-27
2023-05-22
2011-06-27
2023-07-03
73-86
TS
Alberto Zanutto
2011/06/27
10.6092/issn.2038-3460/16996
73
University of Trento
2038-3460
1
situated practices
en
86
Care in Practice. On Normativity, Concepts, and Boundaries
https://tecnoscienza.unibo.it/article/download/16996/15896
2
                                                                                 Debate
Care in Practice. On Normativity, Concepts,
and Boundaries


Annemarie Mol, Ingunn Moser, Enrico Maria Piras, Mauro Turrini,
Jeannette Pols, and Alberto Zanutto




      Abstract In recent years many STS scholars have dealt with care practices in dif-
      ferent fields. Starting from Care in Practice. On Tinkering in Clinics, Homes and Farms
      [Transcript-Verlag, Bielefield, 2010, 325 pp.], a book edited by Annemarie Mol,
      Ingunn Moser and Jeannette Pols, this debate aims to discuss the meaning and de-
      velopment of the concept of care and its accomplishment in practice. Mauro
      Turrini, Enrico Maria Piras and Alberto Zanutto wrote two commentaries on the
      book, while the editors answered to their observations. The result is a vibrant dis-
      cussion that goes beyond the care to address issues such as the need / refusal to
      define and delimit concepts in doing social research and what these boundaries
      mean / do.

      Keywords care in practice; normativity; concept boundaries; situated practices.




The Normativity of Care
Mauro Turrini

   Looking after those people who, for reasons of health, disability or isolation,
require continuous attention is a growing concern of our contemporary societies.
The ageing of population, a major sensitivity to impaired people and other social
changes have increasingly focused the attention on care and its bodies of expertise,
organizations and technologies. However, social sciences, maybe due to an intellec-
tual bias towards repetitive daily routines, have so far paid scant attention to these
topics. Care in Practice: On Tinkering in Clinics, Home and Farms is an important




TECNOSCIENZA
Italian Journal of Science & Technology Studies
Volume 2(1) pp. 73-86 - ISSN 2038-3460
http://www.tecnoscienza.net                       © 2010 TECNOSCIENZA
74   DEBATE



     attempt to inaugurate innovative questions and areas of research oriented towards
     the multiple sites and aspects of the care work.
         Drawing on the pioneering enquiries of the so-called “nursing theory”, which is
     oriented to empower and elevate the nursing profession, as well as other ap-
     proaches, predominantly feminist, which have investigated the invisible, domestic
     work usually carried out by women, the book tries to rethink the work of care in
     the light of its social expansion, cultural centrality, irreducible specificities and
     normativity. Assembling 13 empirical studies carried out by well-acknowledged re-
     searchers, among whom John Law and Mary Winance, a wide range of situations
     are explored. They span from the intimate relationship between a daughter and a
     mother who suffers from progressive dementia (J. Taylor) to the personal memo-
     ries of animal farm stories drawn from the author’s childhood (H. Harbers); from
     new technologies of care – such as wheel chairs (M. Winance), an Internet-based
     service for information sharing among patients and professionals in Denmark (B.R.
     Winthereik & H. Langstrup), diverse telecare services (D. López, B. Callén, F.
     Tirado & M. Domènech; J. Pols) and high-tech home care devices, among which
     pulmonary ventilators (D. Willems) – to several programs for improving care prac-
     tices – including a program for increasing nourishing practices in Dutch nursery
     homes (A. Mol), a British computerized system for tracing cattle movement to con-
     trol and prevent any epidemics spread (V. Singleton) and Marte Meo, a Swedish
     video-recording system used by nurses to improve the quality of dementia care (I.
     Moser). The heterogeneity of the contributions points out the importance of a col-
     lective effort aimed at developing analytical concepts and problems to unravel care
     practices in a wide range of situations. The great variety of the case studies consid-
     ered is not integrated into a unitary theoretical framework. In my opinion, the au-
     thors’ main goal is not to put a theory in practice but rather to put practice into
     theory. Not by chance, the book does not offer a univocal definition of care, but
     multiple formulations defined each time according to the specificities of the situa-
     tion scrutinized. The theoretical introduction written by the editors offers the
     reader a very open meaning of “good care” as a “persistent tinkering in a world
     full of complex ambivalence and shifting tensions” (Mol et al. 14). This extremely
     broad definition refers to a double meaning that is implicit in the book, according
     to which care does not only consist of those professions, organizations, technolo-
     gies and expertise committed to look after diseased or impaired people, but also
     involves all those daily activities that are in to some kinds of care such as, for ex-
     ample, the provision of food and shelter. In other words, the care work we see in
     nursing houses, clinics and farms can be potentially found everywhere. This defini-
     tion, thus, leads to some of the most intriguing and, at the same time, problematic
     aspects of the book.
         Firstly, I will mention the extensive and fuzzy definition of care in relation to
     the private/public dichotomy. Care is here understood as a complex, ambivalent
     and shifting phenomenon, and, thus, there is no distinction between the provision
     of formal care through the public, private or not for profit sectors, and that pro-
     vided informally by relatives or friends. In this way, the very dichotomy between
     public and private is questioned: according to the authors, the care work should be
                                                                 TECNOSCIENZA – 2(1)         75



considered of public relevance, but without loosing the specificities that are inher-
ent to its (good) practices. The crucial role attributed to contextual nature of care is
a point that can not be undervalued. From a methodological point of view, it cor-
responds to an eminently ethnographic approach particularly interested in the de-
tails and subtleties of practices that are local, embodied and responsive to a variety
of heterogeneous and unpredictable elements. Theoretically, it poses the necessity
to rethink the carer/cared relationship. Other recent approaches on this theme
have shed light on the asymmetries between caregivers and cared people in order
to criticize the paternalist role of caregivers (doctors, nurses, farmers and so forth)
and propose that also impaired people should claim individual rights, the free of
choice and so forth. On the contrary, Care in Practice does consider people who
need care not in light of their autonomy or abstract categories, but of their bodily
failures and fragilities and their collocation in collectives. Rather than limiting itself
to recognize the public relevance of the care work or to claim rights, the approach
of care intends to analyze carefully any singular situation in order to let their speci-
ficities surface. By analogy with the feminist critique, bringing public attention to
care should not imply losing its distinctive aspects, which, in the case of care, basi-
cally consist of the bodily needs, the lack of autonomy and the necessity of contin-
uative relationship.
    To better understand this point, we should go back to the studies that antici-
pated and introduced a new research on care (Pols 2003; Moser 2008) and recall,
in particular, the most important volume issued on this topic, Annemarie Mol’s
last monograph, The Logic of Care (Mol 2008). A sort of manifesto, it offers a suc-
cinct, critical engagement with the current, predominant model of patients as con-
sumers or citizens who have both a right and a responsibility to care for the self by
making informed choice. Differently from this “logic of choice”, which relegates
the patient’s involvement to some individual, intellectual or, in the case of market
transactions, even economic choices, “the logic of care” is focused on the broader
process of diagnosing, informing, injecting, encouraging and so forth, of which the
patient is not only the object but one of its principal actors. In this sense, caring is
constituted by collectives, uncertain practices shared by doctors, nurses, patients,
relatives and friends, and even technologies.
    Care is thus foremost described as a work of arranging, modulating and resolv-
ing bonds. Anyway, it is not presented only as a matter of good sentiments and
warm relations between people. This consideration leads us to a second aspect of
the book I would like to highlight: even if the ethnographic descriptions and sto-
ries presented are rich, moving and, sometimes, touching, the book is not senti-
mental at all for many reasons. First, the networks here investigated include the
crucial role of “cold” non-human elements, such as farm animals (which, different-
ly from pets, are usually seen as economic means) as well as machines and artifacts,
i.e. telecare or wheelchairs. Not by chance all the contributions, although draw on
and are addressed to multiple disciplines such as medical anthropology, medical
sociology, disability studies, assume a typical Science and Technology Studies pos-
ture in recognizing the sociality of animals and technologies. Most of the authors
have a background in STS and, even if they have moved out to study other practic-
76   DEBATE



     es, they take in serious consideration the pervasive role of technology. Second, the
     silent, “cold” process of attuning bodies, technologies and knowledge that consti-
     tutes care does not necessarily implicate empathy-with-the-other, but also distance
     and separation. As John Law shows in his article on the huge cattle slaughter after
     the spread of foot and mouth disease in England, “the choreography of care […]
     necessarily depends on the organization of separation” (Law 2010, p. 68). In a sim-
     ilar way, Mary Winance in her study describes how disabled people attempt or re-
     fuse to acquire autonomy observing wheelchairs tests and rehabilitation programs.
     She concludes that “the aim of care as shared work is to construct a person who is
     both attached and detached, “dependent” and “independent”, moving on his/her
     own and being moved by others” (Winance 2010, p. 111). This aspect is very im-
     portant in that it distinguishes this book from other approaches on care and, in
     particular, from the so-called movement of the “ethics of care”, according to which
     the normativity of care lies in the relations of dependency implicated in care activi-
     ties. Instead of interpreting care as a unitary, monolithic phenomenon based mere-
     ly on the mutual dependency among human beings, this book is focused not only
     on the organization of closeness and distance, of dependency and autonomy
     among bodies, technologies, organization, knowledge and so forth, but it also
     points out the incompatibility among the values of care. This last point is argued in
     Mol’s article on food provision in nursing homes for dementia people, where
     sometimes the attention towards nutritional values related to the quantity of the
     food provided interferes with the cosiness of eating practices. Or the choice about
     food can worsen the taste of food. These tensions can be solved by an artful way to
     accommodate specific individuals and circumstances. As Janelle Taylor concludes
     about her personal experience as a daughter who cares for her mother who suffers
     from Alzheimer’s disease, the most important question about caring is how to keep
     together all the complexities and frictions involved in care. While at the mention of
     her mother’s memory loss everybody responds with the question: “Does she rec-
     ognize you?”, she thinks that the right question to ask to a person who cares for
     someone else is a different one.

                I wish that just once, someone would ask me a different question […]
                «Janelle, are you keeping the cares together?»
                «I’m doing my best», I will answer.
                «And you?» (Taylor 2010, p. 53).

         This consideration leads us to a third, crucial aspect of Care in Practice, namely
     the normativity of care. The subtle deconstruction of all the elements, aspects and
     values is not here considered a mere intellectual exercise, but it is aimed at identi-
     fying what “good care” is and where to find it. All the contributions in different
     ways seem to try to answer the question: what do we care about deconstructing
     things? Of course, there is no attempt to construct an ethical paradigm based on
     universal principles, but rather to explore specific modalities of handling questions
     to do with the good. The approach focused on practices makes space for ambiguity
     and ambivalence and, thus, it is impossible to predetermine what is good, but it is
                                                                   TECNOSCIENZA – 2(1)          77



possible to achieve it contextually through “a persistent tinkering” of the elements.
What is emphasized is a reflexive and experimental nature of care that comes from
all members involved in the process. This interpretation of ethics resonates with
what John Law has recently termed the “ontological politics” inherent to the
method of social sciences:

There is no general world and there are no general rules. Instead there are only specific and
enacted overlaps between provisionally congealed realities that have to be crafted in a way
that responds to and produces particular versions of the good that can only ever travel so
far (Law 2004, p. 155).

    Social analysis is thus embedded in reality and attempts to be engaged with it
under multiple levels. From this eminently political point of view, one of the most
interesting aspects of Care in Practice is the opposition to the systems of control
that are pervading many areas of work and the care work in particular. Exerting a
control on care activities through the proliferation of checks, rules and regulation
is a strategy that is not innocent, in that it implies the objectification, centraliza-
tion, disembodiment, formalization and standardization of work practices. On the
contrary, the quality of care may only be improved through the recognition of the
generative and creative nature of care practices.
    All these three aspects mentioned constitute what is not only an object of study,
but also a coherent research approach, which, to be unequivocally normative, is
promising and brilliantly sketched in this book. Whilst the care approach has ob-
vious merits, it also raises important and unresolved questions. Firstly, the book
offers a very broad and fuzzy definition of care, according to which care can be an-
alyzed everywhere, not only in clinics, houses and farms, but also, for example, in
places that are not usually seen as places of care. Think for examples to scientific
laboratories and the practices to “seed”, “culture”, “staining” and “harvesting”
these cells to be observed under microscope. In my opinion, this can be seen as ac-
tivities that have to accommodate bodies, cells, technologies and knowledge within
complex and specific circumstances. Can these practices be considered part of
care? Again, what about the practices of breeding and sacrificing animals in labor-
atories? Can be these considered care practices? To which extent is it possible to
consider as care the treatment reserved to farm animals or guinea pigs? If care and
instrumentality are not inseparable entities, can we find care also, for example, in
the relationship between brokers and their clients? An extensive definition of care
giving, however, does not only raise these problems, but it also offers new oppor-
tunities. According to this meaning, care seems to sketch an innovative scrutiny to
reality. It can be almost considered an alternative, more normative, that arrives
when the relativism of science studies is being accused of having aided the politi-
cized treatment of science (which was adopted, for example, by the George Bush
administration).
    Moreover, if this definition of care, on the one hand, can be potentially found
everywhere, on the other hand, in the book, there is not actually very much on
clinics in the foucaldian sense of clinics. The contributions investigate a wide range
78   DEBATE



     of institutions that are not clinics in a narrow sense, whose complexity, however,
     would be important to highlight. In a moment when the one-on-one doctor-patient
     relationship of clinical medicine is increasingly replaced with a science-based ra-
     tionalization and standardization of health services, the care approach seems to
     suggest an alternative solution, which avoids to formalize and reduce the complexi-
     ty of clinical decision making or to fragment the expertise of medical professionals
     and, at the same time, proposes a contemporary vision of care embedded in tech-
     nology and science. Yet, no contributions deal with this topic and, aside from the
     case of the on-line, clinical records for pregnant women, no medical practices are
     discussed. So, what are the implications of care for individual professional respon-
     sibility? From an organizational perspective, the creative, experimental and incre-
     mental care approach does not seem to be able to give an answer to the crucial
     question of professional as well as juridical responsibility of physicians. Perhaps,
     the care approach is to be understood as part of the recent paradigm shift in terms
     of thinking about errors, where the lens of responsibility is being refocused away
     from people and towards organization. However, if care practices seem to be the
     most efficient way to improve the quality of care and avoid failures, systems of con-
     trol are undoubtedly more attuned in allocating the responsibility in the case of an
     error occurrence. Another still more important question, the relationship with risk,
     in the last decades, has become a central question not only for societies, but also
     for organizations, especially for health services. I argue that the logic of risk is at
     the very antipodes of the logic of care. Typically, the ways to increase the patient
     autonomy of choice – i.e. informing him/her about the dangers of a surgical opera-
     tion or handling to him/her an informed consent to sign – are an obstacle in the
     construction of the care team whose elements participate with different roles in the
     relentlessly adjustment of the treatment to adopt. To put it briefly, risk is intrinsi-
     cally part of a subjectivity oriented towards an entrepreneurial maximization of
     health through rational assessments based on scientific data. Belonging to the dis-
     embodied, abstract “logic of choice”, it has nothing to do with the activities of per-
     sistent, shared tinkering involved in care. At the same time, I also think that the
     normative aspect of care, which is interesting to consider and to explore, can not
     avoid to be compared with the normative aspect of risk, whose discourse is well
     articulated in the clinics including informed consents, patients’ rights, medical in-
     surances, physicians’ organizations and so forth.
          Meaningfully, in the introduction of The Logic of Care, Mol describes three epi-
     sodes where the mobilization of the logic of choice leads to poor care. Among
     them there is one about the author’s experience of amniocentesis. Prenatal diagno-
     sis is a medical practice deeply embedded in risk: pregnancies at risk are invited to
     carry out amniocentesis for the risk of fetal anomalies, even if this practice implies
     an increased risk of abortion, of which every woman is informed by means of the
     informed consent. In the author’s episode, Mol is disappointed by the rude reac-
     tion of the nurse who reacts to the preoccupation of nurses replying rudely: “Well,
     it is your own choice” (Mol 2008, p. xi). According to the author, this episode wit-
     nesses the lack of care determined by the logic of choice. I would like to add that
     the logic of choice seems to be inherent to certain medical practices that raise
                                                               TECNOSCIENZA – 2(1)        79



question on how difficult it is to keep together the relentless work of care and the
management of risk, which includes crucial decisions to make and medical respon-
sibilities to take care of.

References

Law, J. (2004) After Method: Mess in Social Science Research, London, Routledge.
Mol, A. (2008) The Logic of Care: Health and the Problem of Patient Choice, Lon-
   don, Routledge.
Moser, I. (2008) Making Alzheimer’s Disease Matter: Enacting, Interfering, Doing
   Politics of Nature, in “Geoforum”, 39 (1), pp. 98-110.
Pols, J. (2003) Enforcing Patient Rights or Improving Care? The Interference of Two
   Modes of Doing Good in Mental Health Care, in “Sociology of Health and Ill-
   ness”, 25 (3), pp. 320-347.


                                         ***

What exactly are “Care” and “Practice”? Some Notes
on Concepts and their Boundaries.

Enrico Maria Piras and Alberto Zanutto

    It is not uncommon to describe a book as a must-read for different audiences.
In reviewing Care in Practice, though, it is hard to limit the potential academ-
ic/practitioners community that might benefit from it. Care in Practice is an edited
collection that speaks to different audiences and it does so by freeing care, tearing
down the walls the confined it in the domains of the sociology of family and nurs-
ing studies. These two communities might certainly be interested in the essays, but
also scholars in the field of social services, organization studies and farming could
find interest in (at least some of) the essays proposed. Moreover, Science and
Technology Studies theoretical underpinnings are a common background for most
of the authors, a reason for their colleagues in the fields to become interested in
the book.
    The main reasons to read it, though, are more basic than its ability to cross aca-
demic boundaries. The first is simply the overall high quality of the essays. The se-
cond is the possibility offered to the reader to explore many different social con-
texts only by following the thin red line of care and the diverse material forms in
which they occur. The third is that the whole volume and some essays in particular
are infused with a passion for the care practices described that perfectly fits the po-
litical scope of the book, which is to rescue them from the private realm and show
their public relevance.
80   DEBATE



         The aim of the editors and authors is twofold. Firstly they want to look closely
     at the care practices, analyzing the assemblage of professionals, family members,
     and low or high tech artifacts that need to be aligned in the process. Processes that
     involve tinkering, mediations and frequent reshaping of the care collectives. These
     fine grain descriptions (most of the works are based on ethnographical research)
     take the reader in contexts where care practices are never accomplished once and
     for all but are precarious compromises that are always in need of fine tuning. Sec-
     ondly, the book aims at “opening” the care practices themselves; the book does
     not ask the reader to investigate deeply the contexts for themselves but rather to
     deconstruct and analyze the practices to explore their richness.
         The essays on the one hand highlight what makes every care practice unique, its
     situatedness and its being tailored to the setting in which it occurs, and on the oth-
     er they underline the intertwinement of the elements they are made of, being it eth-
     ical values, technical dimensions, social routines and collective representations.
         The stories portrayed highlight that caring means keeping together the hybrid
     collective made of knowledge, artifacts and people, and how it cannot be managed
     to reach a perfect and stable alignment but rather implies to keep working careful-
     ly (with care) around the details. It is this attention in acting without taking “the
     heart out of care” (introduction) that turns the actions described into care practic-
     es.
         As said before, one of the strengths of the book is that “typical” care practices,
     those that deal with humans in need of assistance, are alternated with other stories
     in which the subjects of the careful attention are animals. John Law, for instance,
     describes the work of vets in the case of a mass killing of animals under the policies
     to reduce the spread of a possible epidemic, stressing the fact that caring means to
     provide a cure in some cases and to make sure the animals have a decent death in
     others. Hans Harbers recalls his memories as a child in a Dutch farm discussing
     the forms of attention for the different animals, practices that ranged from allow-
     ing them into the house to killing them, providing rich evidences that care is multi-
     faceted rather than uniform.
         Among the essays that deal with care aimed at people, there are some interest-
     ing works that are focused on practices of assistance in nursing homes and health
     institutions. In these contexts, an increasingly important reality especially in the
     urban areas, some works allow to observe how providing care to the people in
     need intersects with values, ethics, and the choices about welfare policies. This in-
     tricacy creates an ambivalent and somehow ambiguous context in which caregivers
     and the ones who receive care are constantly called to tinker to adjust to the con-
     tingencies at hand. This happens when care practices are about feeding people
     (Mol) or they are questioned in order to evaluate the indicators of quality of service
     (Moser).
         Some works deal more explicitly with the relationship between care practices,
     people and technologies. Care for the artifacts and care for the people are indistin-
     guishable when the latter live and move only thanks to machines (Willems,
     Winance). In these extreme situations becomes clear that caring is not only provid-
     ing a one-way attention to the “people in need” but rather to take care of the hy-
                                                              TECNOSCIENZA – 2(1)        81



brid networks that sustain them. A final group of works explores practices of care
mediated by information and communication technologies showing how both pro-
fessionals and people receiving care do not limit themselves to the scripts in the ar-
tifacts but rather exploit them in unanticipated ways (Lopez and colleagues,
Winthereick and Langstrup, Pols).
    One aspect that distinguishes the book is the desire that it may contribute not
only to the scientific debate but also serve as a stimulus to a broader reflection on
the importance of care practices in various social contexts explored. Far from
keeping a neutral stance, in fact, the editors hope that the care practices (in gen-
eral, not only those described here) get more visibility and recognition in the pub-
lic debate in which they are currently underrepresented. “Perhaps care practices
can be strengthened if we find the right terms for talking about them”, claim the
editors in their introduction (p. 11). We can only agree with this statement. How-
ever, it is precisely these “right terms” we would like to focus on in the conclusion
of this review. More specifically we argue that authors could have taken more care
of the words “care” and “practices”.
    Show care, through words, photographs (see Law; Harbers) or drawings (see
Xperiment!) is what is done by each individual author. Readers are led by the hand
from farms to big rooms where wheelchairs are tested, from memory clinics to pri-
vate houses, they are shown the tinkering through which care is enacted, the ongo-
ing and ever-changing remodeling of the hybrid network of actions, living beings,
spaces, artifacts, rules of which care is made up.
    The words of the writers reshape the reader’s idea of the concept of care, offer-
ing new grips and new visual experiences through which reading it again. This
constant change of scenery invites readers to a radical exercise of comparison, in a
constant search for common ground between practices radically different at first
sight. In a provocative way, offering the same volume of care practices that take
place in farms and or memory clinics, in the treatment of dementia and pregnancy,
the volume as a whole suggests the reader that even though there are differences in
these experiences, these are nonetheless similar in many respects.
    However, the process is only partially completed. Neither in the introduction
nor in the individual essays there is a definition of what is meant by care. Defining
etymologically means putting a limit, drawing a line to tell something from some-
thing else. Accepting a boundary, no matter how temporary and precarious it
could be. The decision not to give a definition of the concept is a rhetorical strate-
gy used by editors and the authors to appropriate “care” and “steal” it to nursing
studies and sociology of the family, the disciplines that “own” the concept, show-
ing how care is relevant in other social and institutional contexts.
    At this point, however, one would expect an examination of the effects of the
abolition of definitional boundaries. This additional step is absent in the book: the
care is not in any way “re-defined” and it remains a concept of an uncertain status.
Care appears like an intuitive construct, a “natural” and self-evident concept. This
is not (obviously) the intent of the editors and authors of this book who, in fact,
dedicate their efforts to describe in detail the hybrid collectives involved in imple-
mentation of care practices. However, if care can be found everywhere and it is not
82   DEBATE



     defined in any way, what is left of it? The risk is that the care appears more a style
     than a practice, a vague label that could be associated with any activity and conse-
     quently poorly defended.
         Practice, the other word used in the title, requires a different approach. In the
     book practice is more a word rather than a concept and it is generally used to refer
     to “what is opposed to theory” or as a synonym of “mundane activity”. In academ-
     ic literature, though, “practice” is a concept that has gained a considerable interest
     in the social analysis (e.g. “communities of practice”) and in particular in the field
     of organization studies. Among the many “turns” (postmodern, linguistic, narra-
     tive) proposed in the last decades, there is also a claim for a “practice turn” in so-
     cial theory (Schatzki, Knorr-Cetina, von Savigny 2001). While practice has been
     defined in different ways, all the conceptualizations share the assumption that it
     refers to materially mediated activities that require a shared practical understand-
     ing (id.). Practices hold together socio-material arrangements, discourses and clas-
     sification systems, understanding and learning; they are, to put it into Silvia Gher-
     ardi’s words, “[modes] relatively stable in time and socially recognized, of ordering
     heterogeneous items into a coherent set” (Gherardi, 2006).
         The care practices described and analyzed in the essays fit quite well in this def-
     inition of practice, except that the relative stability and the social recognition are
     not much stressed. We do not mean to superimpose a theory or a definition, still
     we believe that these two features of “practices” could have been of some use in
     the re-definition of the concept of care by stressing the patterns of action, the pro-
     duction of practical knowledge involved and the social effects of practicing care.
         In conclusion, in our reading the major merits and limits of the volume derive
     from the same editorial decisions, first and foremost by the lack of an explanation
     of what is meant by care. Not only the editors do not provide a definition of the
     concept of “care” but even individual authors do not venture into definitional is-
     sues preferring a description and analysis of the observed activities. The absence of
     boundaries produces a wide and varied discussion that is certainly a strength of the
     volume.
         This richness, however, is likely to become a weakness if the detailed descrip-
     tions and analysis proposed are not followed by a re-conceptualization of the care
     itself. There is a risk that care, without semantic boundaries, becomes a fluid label
     to describe any process or simply a style rather than a situated practice.
         “Words can only say so much” when it comes to care, state the editors in the in-
     troduction. This is true but the lack of new words to reframe care is likely to weak-
     en the political effort that is one of the aims of the book, namely the stated empha-
     sis on the need to “strengthen care practices – and whoever is involved in them”
     (introduction, p.11). This would require a redefinition of care aimed at providing a
     conceptual support to the articulated, changing, and hybrid network of relation-
     ships between living things, technical artifacts, living spaces and nursing profes-
     sions, and rules that constitute the care for us as it is presented in the book.
                                                                TECNOSCIENZA – 2(1)        83



References

Gherardi, S. (2006) Organizational Knowledge: the Texture of Workplace Learning,
   Oxford, Blackwell.
Schatzki, T., Knorr Cetina, K., and von Savigny, E. (Eds.) (2001),The Practice Turn
   in Contemporary Theory, London, Routledge.


                                           ***


Authors’ Response
Annemarie Mol, Jeannette Pols, and Ingunn Moser


    We are obviously very happy that the book we recently edited, Care in Practice,
gets such detailed attention by concerned commentators. And we gratefully accept
the opportunity to respond to the comments that have been made. This offers us
the occasion to reflect on one thing in particular: the question of what it is to de-
fine a term that is crucial to one’s academic work. For this is a concern that both
comments share: that, while writing about “care” we have not defined it. Neither
the editors, nor the authors of the various contributions, our reviewers remark, lay
boundaries around “care”. Thus, or so we read in the comments, it might be eve-
rywhere, this care. It loses its distinctiveness, is all too fluid and cannot be defend-
ed. Turrini quotes what we say about “good care” in our introduction, that it is a
matter of: “persistent tinkering in a world full of complex ambivalence and shifting
tensions”. But this does not seem to count as a “definition” because it is “too
broad”. Please, pause for a moment to look at the spatiality implied in this “too
broad”. It evokes a regional kind of space – we should apparently have delineated
a smaller turf. Piras and Zanutto draw on a similar regional imaginary of space
when they remind us that to define is “to put a limit, drawing a line to tell some-
thing from something else”. This is my land, there is the boundary and beyond it,
dear neighbour, is yours.
    Interestingly, in the case at hand the question of what may (or may not) be
bounded in this regional way, emerges at two levels at once: first that of care “it-
self” and then that of words, terms such as “care”. Let’s look at each of these in
turn.
    First care. Is this a regional phenomenon, that is a field, a terrain that may be
delineated? Our critics seem to think so when they write that: “There is a risk that
care, without semantic boundaries, becomes a fluid label to describe any process
or simply a style rather than a situated practice”. What we are being asked here is
to understand care for what it really is, namely a “situated practice” – something
that is somewhere, somewhere bounded, and not somewhere else, beyond its de-
84   DEBATE



     fining boundaries. The danger evoked is that of falsely taking care to be “simply a
     style”. Thus, not a region, a terrain, but a way of working, a mode of doing things.
     Somehow we must have been unclear. For understanding care as “a style” (or an
     assemblage of different but related styles) is exactly what we aim to do in Care in
     Practice. We thought we were explicit about this when we specified caring styles,
     their logic, as: “persistent tinkering in a world full of complex ambivalence and
     shifting tensions.” But given our critics’ way of wording, we have not been explicit
     enough. So let’s try to be more explicit here. We did not seek to ask where-
     questions, as in where is care – and where is it not? Instead, we sought to ask a
     how-questions: how is “care” being done? Which modes and modalities of “car-
     ing” may we trace in various practices? How can each of these, different as they
     are, shed light on and help to specify the others? Or, in other words, in the essays
     that we assembled, “care” was a verb, and not a noun.
         This takes us to the second level, that of words. For verbs, like nouns, may be
     defined or left unbounded enough to adapt them to local needs and circumstances.
     What is wisdom? There is an impressive theoretical tradition that takes it that
     while in daily life words may be vague, in the social sciences one should use them
     in a thoroughly disciplined way. That is to say: bounded. Science, or such is the
     presumption here, should build on and mobilise not just words, but well delineat-
     ed words. Only such well delineated words get the honorary status of “concepts”.
     Measured against the standards of that tradition, our work fails. But that tradition
     is not self evident. We disagree with it. Thus we do not “fail”, but try to foster an-
     other set of standards. Here, words should be fit to sensitise research, but not close
     it down prematurely. This, or so we take it, allows for another type of research. Let
     us try to elucidate this with an example. If you would want to count apples, you
     would first have to define “apple” so that you would know which entities to count
     and which others to exclude from your calculations. Again, if you would want to
     know about the colour of apples, you would first have to define the entity “apple”
     whose colour you are curious about. But what if you want to know what an “ap-
     ple” is? Then you need to have a sense of where to go look for it, but starting out
     by clearly defining “apple”, is not the way to go. For then you answer you own
     question before you have asked it and kill your curiosity before you have learned
     anything new.
         The apple example may seem somewhat simplified, as the term “apple” is strik-
     ingly stabilised in most practices. However, this isn’t true for worlds were apples
     are being cultivated and traded. There, questions rise about them: is this sour fruit
     still an apple, should it be marketed as such, what about wild apples, etc. This is
     typically the case: where objects are tinkered with, where ways of working are de-
     veloped, boundaries get contested, instable, take a variety of shapes. This is why
     we are weary of definitions. If we were to define, say, “autonomy” then we would
     be able count it, or at least wonder if people in this or that situation are granted
     enough of it. However, if we abstain from defining “autonomy” we may yet learn
     new things about “it” when researching practices where people try to find a wheel-
     chair that is appropriate for the bodies they live with and the situations they live in.
     And which shape, we may then wonder, does “autonomy” take in situations where
                                                                TECNOSCIENZA – 2(1)        85



people live at home but have an electronic guardian angel? If we do not set out by
knowing what “subjectivity” is, but keep this open, then we may yet encounter “it”
– and learn strikingly new things about it – among people with dementia and even
in a ward for people who are living in a vegetative state. So it goes with “care”. It is
what we study. We would have killed our curiosity had we defined it before going
out in our various fields!
    It is also possible to frame this in a slightly different way and ask the philosoph-
ical question what a language is. The words of a language may be taken to refer in
a stable way to an objects or a process – and in that case they can be defined. Such
defining depends on explicating the link between a term and the objects or pro-
cesses that it is supposed to refer to. A first problem is that such explications in
their turn have to make use of others words and how to define those? The activity
is potentially endless. But there is another problem as well: this understanding of
language as a collection of labels, does not fit with the way words are being used in
practices. For in daily life, but also in writing, words are not tightly linked to spe-
cific objects and processes. They are not labels, but move around, they slide and
shift. And if a researcher sets out by tightly defining her terms, she is unable to
move along with the way words are being used in the practices she studies.
    Practices: there they are. Piras and Zanutto deplore it that we have missed the
“practice-turn” in “social analysis” (as they call it). They conclude that we have
done so because, again, we have not defined the term “practice”. But the quintes-
sence of the practice turn is to study practices – not to define the term. It is to fol-
low objects and/or processes, like autonomy, subjectivity, respect, killing, tagging,
buying, tasting, filling in forms, using a webcam, and so on, without beforehand
fixing what these things and activities are. Or, more specifically, without fixing
their essence in a definition to then restrict one’s research efforts to studying their
extra, accidental attributes. The quintessence of the practice turn is to abstain from
such fixing and to stop making the division between essential and accidental char-
acteristics. Even one’s central concerns, especially one’s central concerns, deserve
to be opened up, rather than defined. Opened up, that is, for study. After the prac-
tice turn, words are tools within a practice rather than labels that may be firmly
circumscribed. This is why our “editorial decision” to not define our terms is not a
failure of our work, but a precondition for it. It is what has allowed us to contrib-
ute to the collective, ongoing, study of care in practice.
We engage in this study, or so we said, to strengthen care. Which brings out the
question if “care” is good. Is it? Well, that depends. Turrini suggests that “care” is
not a proper way of ordering ways of working in situations where there are risks,
because when things may go wrong it is better to be able to point out responsibili-
ties. Is it? Again, that depends. If some doctor denies responsibility for a medical
fault because he was off playing golf while letting a students do the medical work,
casting some blame may be in order. But what if a care assistant is blamed for er-
rors she made while she had only five minutes for a task that can be done in five
minutes under test conditions, but not in conditions where people are afraid or
start yelling – and while lots of other tasks are waiting to be done? We would hope
86   DEBATE



     that an analysis in terms of care might help to ask such questions. There are no def-
     inite answers, for the complexities are endless. Different settings, different people,
     different goals, different frictions, different materials, different concerns, different
     goods. They may all be studied and analysed in their specificities, but not in gen-
     eral. Instead, different ways of caring and different care practices deserve to be
     held in tension. The art is to compare and contrast different situations of care and
     to wonder which lesson might transport between them. Between farms and clinics;
     between care for eating and care for breathing; between care with webcams and
     care depending on patient files; between counting newborn piglets and wiping
     away tears. Investigating a broad variety of cases in detail, trying to learn from all
     of them on their own terms, while juxtaposing them comparatively, does not pro-
     vide a sense of security. It does not provide definite facts, let alone definite norma-
     tive conclusions. It has an altogether different aim: to contribute to strengthening
     and improving care, while searching how to do so. The chapters that we assembled
     in Care in Practice seek to be caring.




         Annemarie Mol University of Amsterdam
         AISSR
         Kloveniersburgwal 48, 1012 CX Amsterdam - The Netherlands
         Email: A.Mol@uva.nl
                                                ***
         Ingunn Moser Diakonhjemmet University College
         P.O.Box 184 Vinderen, N- 0319 Oslo - Norway
         Email: moser@diakonhjemmet.no
                                                ***
         Enrico Maria Piras Fondazione Bruno Kessler
         e-Health unit
         Via Sommarive 18, 38123, Trento - Italy
         Email: piras@fbk.eu
                                                ***
         Mauro Turrini University of Padova
         Department of Sociology
         Via M. Cesarotti 12, 35123, Padova - Italy
         Email: mauro.turrini@unipd.it
                                                ***
         Jeannette Pols Academic Medical Center / University of Amsterdam
         Section of medical ethics
         Postbus 22700, 1100 DE Amsterdam - The Netherlands
         Email: a.j.pols@amc.uva.nl
                                                ***
         Alberto Zanutto University of Trento
         Research Unit on Communication, Organizational Learning and Aesthetics
         Department of Sociology and Social Research
         Via Verdi, 26, 38122 Trento - Italy
         Email: alberto.zanutto@unitn.it
