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260 THE ISA HANDBOOK IN CONTEMPORARY SOCIOLOGY

of the care relationship. Where caregiving a ‘long apprenticeship’ (James, 1989: 37)
takes the form of wage labour in a formal or which predisposes them both to enter into
institutional setting (hospital, long-term care open-ended relations of giving and to under-
facility, community care), the care relation- take the emotional and physical labour of
ship is subordinate to, and limited by, the care, then gender mediates giving and
employment relationship. This means that exchange, and hence mediates the class rela-
the institutional goals may come into conflict tion between employer and employee. In
with the right to care (both to give and to Twigg’s words, care is seen as stemming
receive care) and the development of care as from women’s nature: ‘It is not what they do
reciprocity. It also means that when such but who they are. Extras thus represent work
relations of reciprocity develop, they may that is extracted on the basis of the traditional
either be regarded as a nuisance by the gender contract, but not officially recognized
employer or as a source of profit in the form or recompensed in the formal one’ (Twigg,
of work done for free by the employees, 2000: 171). In the picture presented here, the
which might otherwise need to be remuner- ‘traditional gender contract’ is not so much a
ated. The caregiver’s gifts to the person for contract as a particular form of habitus.
whom she is caring may end up constituting A Marxist analysis would suggest that the
a gift to the employer, work done for free. workers perform both ‘necessary’ and ‘sur-
Thus relations of giving mediate relations of plus’ labour even when they work to rule,
exchange, making it possible for managers in because the value of their labour power is
the public and private sectors to get more less than the value that their labour produces.
work out of the workers than they need to It would also recall that the problem does not
pay for. Workers are owed debts for their reside in the gift relationship as such, but in
labour which are never repaid, because the the division of labour which separates out
existence of these debts is concealed and men’s from women’s work, wage relations
denied. The gift relationship functions as a from gift relations, formal from informal
mediation of workers’ exploitation in the work, and so on, giving rise to the reification
health care system. 4 of specific social practices and relationships
From the standpoint of those who have as women’s nature, as superfluous and so on.
designed the labour process, the separation
between formal, rational and visible care on
the one hand, and informal, ‘irrational’ and
invisible care on the other, is in a sense a dis- CONCLUSION
tinction between necessary and surplus
labour, understood respectively as work that To sum up, a trend in the institutional and
must be accomplished because it is mandated professional side of health care today is to
by the employment contract and additional compress the time of work in formal health
work that the workers may do on their own services, reducing the possibility of building
time and out of their own will. From the stand- the relations of care. Meanwhile, the work of
point of the gift relationship, this so-called forging deeper, more open-ended relation-
‘surplus’ is in fact necessary, the indispensable ships of reciprocity is increasingly trans-
giving back and creation of debt. ferred to volunteers and family members,
A feminist analysis would reject the notion because paid health care workers do not have
that giving this ‘surplus’ is a matter of indi- time for such work (except in the form of
vidual choice, and would point to the habitus ‘extras’) or because it is no longer considered
shaped by patriarchal relations of oppression, appropriate for them to do it – except in
as well as the pressures to which caregivers the context of high-priced private services.
are subject in precarious, low-wage employ- One result of this trend has been the grow-
ment. To the extent that women pass through ing exploitation by private entrepreneurs and