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Transcript  Progress in Human Geography online version of this article can be found at: DOI: 10.1177/0309132510364556 2010 34: 736 srcinally published online 23 April 2010 Prog Hum Geogr  Christine Milligan and Janine Wiles Landscapes of care  Published by:  can be found at: Progress in Human Geography  Additional services and information for Email Alerts: Subscriptions: Reprints: Permissions: Citations: What is This? - Apr 23, 2010OnlineFirst Version of Record - Dec 10, 2010Version of Record >>  by iwan saputra on October 1, 2012phg.sagepub.comDownloaded from    Article Landscapes of care Christine Milligan Lancaster University, UK  Janine Wiles The University of Auckland, New Zealand Abstract The term ‘landscapes of care’ has increasingly taken hold in the lexicon of health geography. As the complexsocial, embodied and organizational spatialities that emerge from and through relationships of care,landscapes of care open up spaces that enable us to unpack how differing bodies of geographical work might be thought of in relationship to each other. Specifically, we explore the relation between‘proximity’ and ‘distance’ and caring for and about. In doing so, we seek to disrupt notions of proximity asstraightforward geographical closeness, maintaining that even at a physical distance care can be sociallyand emotionally proximate. Keywords caring about, caring for, distance, landscapes of care, proximity I Introduction Care and care relationships are located in,shaped by, and shape particular spaces and  places that stretch from the local to the global.Geographers thus have the potential to make acrucial contribution to interdisciplinary debatesaround care. A significant number of geogra- phershaveengagedwithideasaroundcare,froma range of discourses and perspectives. This isimportant for advancing the subject but it is alsoimportant to explore the threads that connectthese discussions. In our view this undertakingwill facilitate the visibility of this geographical project beyond the discipline. We believe thata useful way of capturing the complex spatial-ities that care and care relationships entail isthrough‘landscapesofcare’,atermthathasseengrowing popularity in recent years. Too often,however, itisusedasaratherloosespatialmeta- phor with limited attention paid to its potentialusefulness as a framework for unpacking thecomplex relationships between people, placesand care.Inthispaperwe attempt tomap out what sucha framework might look like. In doing so weengage with a wide body of work on care withinhuman geography, teasing out the interplay between those socio-economic, structural, and temporal processes that shape the experiencesand practices of care at various spatial sites and scales, from the personal and private through to public settings, and from local to regional and national levels, and beyond. First, we outlinewhat we understand by care and landscapes of care. We then critically discuss issues of  Corresponding author: Christine Milligan, Division of Health Research, LancasterUniversity, Bailrigg, Lancaster LA1 4YT, UKEmail:  Progress in Human Geography34(6) 736–754 ª The Author(s) 2010Reprints and 736  by iwan saputra on October 1, 2012phg.sagepub.comDownloaded from    proximityanddistancewithinlandscapesofcareand how they relate to questions of caring for and caring about. Third, we consider work around geographies of care and responsibilityand how these may be framed within debatesaround ‘care-ful’ and compassionate geogra- phies. In the final section we reflect on the con-tribution that one subdiscipline, healthgeography, is making to landscapes of carethroughanilluminationofthechangingtopogra- phiesandspatialitiesofcare.Weseektodrawonand further current geographical debate around care and suggest how this rapidly growing areaof interest might be further developed. II Landscapes of care From cradle to grave, we give and receive care.It enriches our lives and bolsters our ability tofunctionsuccessfully.Quitesimply,without carewe would fail to thrive. Yet, despite its centralityto all aspects of our lives, it is remarkable howmarginalized care is (Lawson, 2007). Hence, before engaging with landscapes of care, we dis-cuss what we mean when we talk about care. 1 Defining care Care is the provision of practical or emotionalsupport. Critically, as geographers we must con-sider whether we should even use the terms careand care-giving. Some carers see all caring as‘work’; others strongly resist such a definition,seeing care less as work and more as ‘somethingyou just do’ as part of a reciprocal and lovingrelationship (Rose and Bruce, 1995). For othersthe term ‘care’ has become imbued with patern-alism reinforcing notions of dependency (eg,Tronto, 1993; Oliver, 1998; Sevenhuijsen,1998; Shakespeare, 2006). Within disabilitystudies, commentators have argued that termi-nology should move away from care toward ideas of independence and personal support(Oliver, 1998; Shakespeare, 2006; Thomas,2007; Kro¨ger, 2009). While this argument may be justified, such debates also arise as aconsequence of how we think about care itself.There is a tendency, for example, to view careas a unidirectional activity (ie, from activecare-giver to passive recipient) but, as Fine and Glendinning (2005) point out, it involves reci- procal dependence in which both recipients and  providers are involved in the coproduction of care. Care entails a complex network of actorsand actionsinvolvingmultidirectional flowsand connections (Tronto, 1993; Milligan, 2000;Wiles, 2003a; 2003b). It is ‘necessarily rela-tional’ in that it involves ongoing responsibilityand commitment toan object (orsubject)of care(Tronto, 1989: 282).Hence it is probably more useful to think of care in terms of interdependency, reciprocityand multidirectionality (Wenger, 1987; Tronto,1987; Kittay, 2001; Watson  et al.,  2004). Multi-directionality can occur in several overlappingsenses: (1) care often involves networks rather than dyads; (2) even within dyadic relationshipsdifferent kinds of care, including physical and affective, are frequently exchanged; (3) care can be expressed as delayed or extended reciprocity(eg, care for an ageing parent may reflect reci- procity for care received in childhood); and (4)care providers frequently derive significant ben-efits such as new perspective, a sense of pride or satisfaction, learning new skills or developing avocation, a sense of power, or alleviation of guilt. Many of the care-workers in Meintel et al  .’s (2006) study expressed a ‘love’ of their work and describe it as a vocation rather than a job. Reflecting on the instability of the power relationships between paid care-givers and care-recipients,Kittay(2001)furtherpointedoutthatwhiledependencyisfrequentlycastintermsof the care-recipient, the low pay received for care-work means that paid care-workers are fre-quently drawn from groups who are already rel-atively powerless and occupy a lower socialstatus than that of the person they care for. Para-doxically this can lead to interlaced frameworksof power and powerlessness where the care-recipient may be dependent on the care-worker  Milligan and Wiles  737 737  by iwan saputra on October 1, 2012phg.sagepub.comDownloaded from   to meet their fundamental needs, but thecare-worker may also be vulnerable not only tothe actions of the care-recipient but to theinterests of their employer as well (Kittay,2001: 561).Caring is also frequently emotional. Held (2006) and Kittay (2001) both maintain that anaffective component is critical to good care.WhileTwiggandAtkin(1994:8)donotgoquitethis far, they do suggest that ‘caring relations if not defined by love, are frequently associated with and energized by it, although in more com- plex and ambiguous ways than the normative picture might suggest’. Care-givers do not sim- ply do things for people; they also support themwith encouragement, personal attention, and communication in ways that endorse a  mutual  sense of identity and self-worth. By rethinkinghow care is conceptualized, some of these dis-empowering narratives about care and depen-dency lose their authority.How care is understood and experienced isshaped by social and political-economic con-texts operating at the level of the individual or wider society, and in public or private spheres(Wiles and Rosenberg, 2003; Milligan, 2009).The decision to give care, and who provides thatcare, can be based on a wide range of factorsincluding need, close kinship bonds, norms and values around gender and kinship, ability tocope, proximity, labour and employment rela-tions, the availability and cost of alternativesourcesofsupport,andfinancialandopportunitycosts. Thus any attempt to understand caremeans that we need to consider not just thecare-giver or care-recipient but all thoseinvolved in the care relationship. Critically, thenature,extentandformoftheserelationshipsareaffected by  where they take place . For geogra- phers, then, care involves not just interpersonalrelations but also people-place relationships. Itis important to recognize ‘the thoroughly spatialways care [is] structured and practiced’, empha-sizingtheintricacyandrichnessofthatspatiality(Brown, 2003: 849) and the relationship between place and well-being (Poland   et al., 2005; Wiles, 2005; Wiles  et al  ., 2009). 2 Defining landscapes of care ‘Landscapes of care’ echoes and builds onearlier geographical work around deinstitutiona-lization and those ‘landscapes of despair’ cre-ated by restructuring processes (Dear and Wolch,1987;GleesonandKearns,2001).Italso buildsonthehealingpropertiesandculturalgeo-graphies intrinsic to ‘therapeutic landscapes’(Gesler, 1992; Williams, 2007). In doing so,geographical work has begun to articulate carethrough the differing, and sometimes surprising,social spaces that enable caring interactions(Conradson, 2003a; 2008a); as individualspace-time trajectories through varied sociallandscapes of care, care-giving roles, employ-ment and social policies, and gendered and gen-erational expectations of care and work (McKie et al.,  2002); through the entanglements of exclusion and inclusion, dependency and inde- pendency that can manifest within and acrossformal and informal spaces of care (Power,2009); and through the emotional landscapesthat underpin care and care interactions (Brown,2003; Milligan, 2005; Milligan  et al  ., 2005).Such landscapes can encompass the institu-tional, the domestic, the familial, the commu-nity, the public, the voluntary and the privateas well as transitions within and between them(see, for example, work by Cartier, 2003;Skinner and Rosenberg, 2005; Carolan  et al  .,2006; Skinner   et al., 2 008).Engagingwithlandscapesofcareasananaly-tical framework requires an understanding of macro-level governance or social arrangementsthat can operate at either (or both) the nationalor international scales as well as the interperso-nal. This may include such issues as local,national and international migration patterns;cross-national work arrangements; changingnational andinternationalpolicies; andideologi-cal beliefs about the arrangements of care – for  738  Progress in Human Geography 34(6) 738  by iwan saputra on October 1, 2012phg.sagepub.comDownloaded from 
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