Commentary: Troubling care.

It’s spring 2022. Russia has invaded Ukraine, and the war there continues to have disregard for human rights, life, and community. The global pandemic of COVID-19 has killed 6.2 million people worldwide (World Health Organization, 2022) with more people dying every day. The Governor of Florida has signed a law known as the “Stop WOKE Act,” that prevents schools or workplaces from, among other things, engaging in training or talking about privilege and oppression based on race, gender or national origin, lest it lead to feelings of “guilt or psychological distress” on the heels of signing the “Don’t Say Gay” bill (Reilly, 2022). The climate crisis continues. Anti-Blackness, anti-immigration, and a rise in xenophobia signal a return of nationalism, highlighting white supremacy worldwide. The world is in desperate need of care, and yet to “care about” the world, often elicits a sense of helplessness, sorrow, rage, and grief. Those who have the privilege of looking away or of choosing what to care about are often oblivious to their privilege, which begs the question, what does it mean to care?

Many creative arts therapists (CATs) are motivated to pursue a career in the arts therapies out of a desire to “help” or “be of service,” and to use the arts in service of relieving distress, because they “care.” Yet, intersectional feminists (Collins and Bilge, 2016, Crenshaw, 1989, Keller and Kittay, 2017, Raghuram, 2019, Robinson, 2020), disability justice advocates (Clare, 2015, Piepzna-Samarasinha, 2018, Sins Invalid, 2019), and proponents of social justice (Dutt and Kohfeldt, 2018, Wright and Wright, 2022) have asked us to think critically about this word “care,” and to think about an “ethics of care” that is intricately linked to one’s social location within specific political, economic, and environmental contexts, whether one be the “caretaker” or the person in need of care. This special issue calls for revisiting intersectionality and the ethics of care in the CATs. Working across the disciplines within the CATs, this call represents a way in which we can consider complicated, at times overwhelming, and multiple perspectives, that supersede our individual professional identities.

All of us, by virtue of having been infants and young children, have needed to be cared for extensively (Held, 2006), and before we die, will likely need to be cared for again. The dominant narrative creates a binary of being either a caretaker or one in need of care, not recognizing that we all play both roles. Even as “therapists,” many of us have on-going continued needs for care despite our field’s promotion of an ableist vision of its “professionals” and providers, and despite stigmatization and marginalization of those amongst us who “need” care. A few authors (Ehlert, 2020, Roots and Roses., 2020) have bravely started to question this attitude.

The act of “caring for” has often been denigrated and dismissed, even as “acts of helping have been increasingly professionalized following the dictates of capitalist engagement” (Watkins, 2019, p. 1). For many, the decision to enter a “profession” which centers care, also distinguishes those same professionals from “direct care” staff, who are even further denigrated and dismissed. Helping “professions” often perpetuate racialized breakdowns of labor, where “professional” translates into “middle-class and white” and “direct care” often translates into “immigrant and persons of color.” In addition, our societies often relegate the work of therapy to “women’s work” (Brown, 2017) – for which we get paid women’s wages (a fraction earned by men). Still, many CATs continue to work out of love, even as loving the work of care requires acknowledging our complicity and the hardship of working under oppressive systems that isolate and denigrate both the caretaker and those for whom they care.

How do we complicate our notions of “helping” and “care?” How do we think critically about these concepts? How do we question our desires to “help,” “care for” or our “good intentions,” when those qualities are so often both exalted and demeaned by the dominant narrative? Critical reflexivity can offer us a means of complicating concepts of helping and care, and questioning our desires to “help” as CATs. In discussing the critical reflexivity necessary for reframing community research and working in a transdisciplinary practice, Atallah et al. (2021) state,

In this light, we require critical examination of our ontologies and epistemologies, especially learning from critical scholarship and decolonial critiques that argue for thorough deconstruction of the normative discourses and practices within which researchers tend to create their partnerships with communities, by recognizing how racism and other forms of discrimination may be carved into even the most well-intentioned studies, interventions, policies, and efforts by academics to increase research participation. (pp. 885–886)

This invitation seems to be for us all working in the helping professions. However, thinking about words like “ontology” and “epistemology” requires that we tolerate more complexity in thinking about the “why” and the “how” of what we do. We are asked to consider how discrimination and the mentality of domination are often “carved” into our theory, training, research, and practice, despite our good-intentions.

It is often difficult to reconcile the hard work of becoming a CAT with the downsides of the professionalization of helping. The training and roles of CATs too often based on models which assume expertise, and promote individualism, and unidirectional helping without acknowledging needs for mutuality and interdependence, and “too often usurp the understandings and agency of those they intend to help” (Watkins, 2019, p. 1). Many of us are conflicted by the ways our roles as CATs and those of caretakers have reproduced “heteropatriarchal, racialized, capitalist structures” (Wright & Wright, 2022) – even as we hesitate to think too much about it.

At our current socio-political juncture, and after decades of work by marginalized theorists and practitioners within the fields of CAT (Bain et al., 2016, Baines et al., 2019, Gipson, 2015, Gipson, 2017, Hadley and Norris, 2016, Jorden, 2022, Kawano and Chang, 2019, Napoli, 2019, Norris, 2020, Rachel and Lee, 2016, Sajnani, 2012, Sajnani, 2013, Sajnani, 2016, Stepney, 2019, Swamy, 2014, Talwar, 2010, Talwar, 2015, Talwar, 2019, Talwar et al., 2004), we are once again being asked to take a transdisciplinary approach to understanding our work. While multiple arts therapists have added their voices to a reassessment of the paradigms which shape CATs practice (just look at the bibliographies within the articles in this issue), many of us are still new to the language of disability justice, global anti-racist feminism, and even the notions of “making good trouble” (John Lewis) or “staying with the trouble” (Haraway, 2016) in the context of “care.” It is time to look beyond initial theories grounded in universalist, individualist, apolitical, and decontextualized frameworks, and look towards ideas that will help us unpack the harm we do, sometimes by our very desire to “help,” even if that journey is painful, even if this complexity sometimes shifts our definition of "care" to connote concern, anxiety, and trouble. Even if it leaves us with the “care of the world” on our shoulders.

Many arts therapists work within systems with harmful histories of helping. Allegiance to the medical model, just because jobs are structured within that model, causes us to forget that our job is not to “fix” or “cure.” In the United States, many CATs rely on the insurance industry for reimbursement and pay, even as that reliance reinforces our connection to the Diagnostic Statistical Model (DSM) – its reification and reduction of dis-ease, its troubling history, and its connection, albeit complicated, to access. Our obligations to rely on the language of goals, objectives, treatment plans, and measurable outcomes to justify our practice, all come at a cost (Brown, 2021, Frances, 2014). Our theory, training, research, and practice are bound up with systems that have been and are inequitable, harmful, and violent, even while promoting “care.”

It is time to complicate our history, our training, our research, and our current practices, not only about helping, but also about art. We must continue to complicate both our received societal ideas about our professions’ conceptions of and what constitutes art. We must reckon with the history within the CATs of appropriating non-western ideas about the use of art. And we must recognize, with our clients, the power of the arts to tell stories.

Aurora Levins Morales (2015) in her introduction to Eli Clare’s book, Exile and Pride, states,

Skin of our bodies and skin of the world. This is how to understand the land as well as the flesh. To be unsingular, fractured and whole, grieving and proud, in universal solidarity and difficult alliance, never to allow urgency or burning injury to keep us from demanding the whole, intricate, inclusive story.

Exile and Pride doesn’t provide us with answers, but neither does it only pose questions. Instead it keeps issuing this challenging invitation: to bring our whole broken selves to these problems within which we struggle and engage them with all of our beings. Search your pockets. Start jotting it down, your own map of contradictions. (p. xix)

Here is where we come in – we welcome the story, we accompany the storyteller, we offer the third hand in shaping through the materials of our craft. We bring our whole broken selves as we struggle within and engage these problems with the folks with whom we work. And we must do so, Morales suggests, with “all of our beings.”

It is time to complicate our notions of “care.” These complications call to us to live in contradiction, in multiplicity, to hold ambivalences and to not rush to simplification, to see ourselves and those with whom we work from an intersectional lens that recognizes the many identities and contexts in which we live. The good news is that we value growth. We want to grow, to change, to become our best selves. We are already committed to self-reflexivity, which is a crucial aspect of working through intersectionality (Kapitan, 2015, Kuri, 2017, Talwar, 2010). Self-reflexivity and building community across disciplines are the hallmark of many of the writers, thinkers, and practitioners calling for a recontextualization and reconceptualization of “care.” One example from this issue describes Wright and Wright (2022)’s collaboration with other critically engaged arts therapists, in which they study intersectional feminist texts, practice self-reflexivity, and support one another in the pursuit of a social-justice praxis.

In preparing for this commentary, I felt the call and invitation to be self-reflexive. I was compelled to make art. I found myself going to the sources – reading many of the texts with which I was unfamiliar, talking with others about it, and free writing about “care.” What does “care” look like for me? What does it sound like? What shape would it take? What texture? What character? How would I define it in my practice? When given an invitation to use free writing, and asked the question, “In your practice, what does care mean to you?” my answer was:

In my practice, I am always looking for ways to meet the person [or people I am working with] where they are with respect and an understanding of their multiple ways of being in the world. I believe that attending to, caring for and about, and “showing up” for them is “care.” “Caring for” means approaching their physical, emotional, cognitive, and spiritual experience with openness, concern, curiosity, and compassion. “Caring about” means holding those experiences as precious - as gifts/invitations to be in relationship (with me, themselves, and others) in specific ways. I also am inviting my imagination and theirs to consider empathy, metaphor, artistic expression and/or remembrance as a way of relating to these invitations. I bring [or see] my “difference” [just who I am as a separate person] as a reminder that there is no “singular” experience - that there is always a “we” happening.

How does “care” show up in your practice? What would your free-write about “care” include? What might it look like if you painted it, sang about it, danced it, or created a scene with it? Try it.