Page 284 - The ISA Handbook in Contemporary Sociology

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SOCIAL DIVISION OF HEALTH CARE 255

the creation of debt in the gift relationship or constitutive of her’ (Radin, 1996, cited by
in kinship may be bound up with asymme- Himmelweit, 1999: 36). In Marxist terms,
tries of power, redistribution and exchange one could speak of this as objectification and
can seem to offer advantages over reciproc- alienation, understanding that ‘labour’ in
ity. State redistribution governed by a Radin’s usage (or alienation as presented by
citizen’s right to public services incurs no Marx in the 1844 Manuscripts) is an ideal
debt. Market purchase of a service liquidates type, since the separation between work and
debt in the very instant that it occurs. This life, and the instrumentalization of the
may offer the greatest freedom to consumers former, are rarely so absolute. Bolton (2005)
with purchasing power and many options stresses this point as well, criticizing
among which to choose (Godbout, 1987). Hochschild (unfairly, in my view) for having
For those who need care, either the state or too reductionist and pessimistic understand-
the market routes may restore balance and ing of the alienation of emotion work in the
some semblance of symmetry to a relation- modern economy. Bolton argues that workers
ship made intolerable by one-sided indebted- as social actors have much greater latitude
ness. The parties to a care relationship must than Hochschild recognizes in determining
constantly maintain a delicate and precarious the emotional dimensions of the relation-
balance, in order to avoid the Scylla of ships within which they work.
oppression and the Charybdis of dependency The notion of incomplete commodifica-
(Gagnon et al., 2000). A public-sector tion implies that remunerated service only
agency acting as a third party can provide a truly becomes care within hybrid relations of
framework of rules and expectations that production, in which the logics of exchange
provides stability and a measure of protec- and/or redistribution combine with the logic
tion to all involved. The state and market are of reciprocity. To be sure, in a situation of
conducive also to the development of capital- complete commodification, the worker might
intensive curative systems predicated on a perform the emotional labour required to
high volume and intensity of specialized produce feelings of trust and ease within the
activities (e.g., surgeries). care recipient. But this hardly qualifies as co-
Unfortunately, the market and the state production, as I have defined it here, for the
offer no panaceas. One may simply escape worker’s relationship to the work and to the
the frying pan of personal dependency by person needing care is purely instrumental.
falling into the fire of alienation. Himmelweit In the light of the previous section, of course,
(1999) suggests that care ceases to be itself one might regard ‘full’ and ‘incomplete’
and becomes a mere service when it is com- commodification as different levels of
pletely commodified. Following Radin abstraction, that is, a moment of analysis
(1996), she posits a process of ‘incomplete that strips away layers of complexity to show
commodification’ in care, where workers do the pure workings of the commodity form,
not exhaust their effort in the tasks they are and a moment that more closely represents
contracted to perform, but give time beyond the concrete phenomena.
these tasks, out of love for their work and
pride in what they do.
‘Work’ contrasts with ‘labour’ in Radin’s
and Himmelweit’s usage of those terms. THE TOTAL SOCIAL ORGANIZATION
Labour to them means an activity which is OF LABOUR IN CANADIAN HEALTH
completely commodified and consists only CARE
of the contracted tasks; work differs, because
money does not ‘exhaust’ its value and it ‘is A vast array and diverse range of practices
understood not as separate from life and self, and organizations exist within the total social
but rather as part of the worker and indeed organization of care work. What appeared in