Lecture | Paper

Presence in the Caregiving Relationship: On Moral Subjectivity, or the Soul

Arthur Kleinman

Friday 15th March 2019

13:15 - 15:00

"This talk draws on my forthcoming book The Soul of Care (Penguin, September 2019) in order to explore the clinically important question, what is the relationship of subjectivity to moral sensibility, responsibility and practice? Following the Confucian tradition and based on my work over 50 years in Chinese society, I seek to challenge the established, largely Western understanding of both morality as well as subjectivity. From the perspective I will advance, morality is located primarily in the local worlds we inhabit. It becomes embodied in the individual as a reaction (either of support or resistance) to the values animated in the flow of social experience in those local worlds. Seen this way, the real subject of medical ethics, for example, is not abstract principles, but the local world of a clinic or a family and the relationships and inner life of the people who inhabit those worlds. Subjectivity in turn is not only about cognitive processes and emotions, but centers on the moral sensibility, responsibility and practices of the individual. The most deeply experienced moral concerns and commitments comprise what historically we have called the soul. That soul is embedded in social relations as well as the body of the person.

 

In caregiving, relationships, acknowledgements, affirmation, presence, and caring for memories are the moral-emotional foundation of caring acts and experience. Presence refers to the fullness of being when engaged with another or others in the acts of care: acknowledging the humanity of the other and their suffering, affirming their need for assistance and right to care, and protecting and assisting in practical physical and emotional acts of care. Presence is elicited from each of the participants in the caregiving relationship when that relationship is positive and beneficial. Even when carers are deeply burdened psychologically and economically, presence can be animated and shared. Ethnographically it can be modeled as a gift exchange relationship between individuals in a local world who are morally entangled. Developmentally, presence is about the moral cultivation of the person. Seen this way, presence involves the cultivation and expression of deeply felt moral bonds. These in turn can be thought of as the moral-emotional core of subjectivity. Subjectivity itself is now configured as intersubjectivity. What in the past many referred to as the soul is a soul that is both embodied and interpersonal. Caregiving not only elicits, but potentially can transform the souls of the caregiver and the receiver of care. I will illustrate these points using four sources: the research literature, my own research, my experiences as a professional carer and my own transformative experience of being a family caregiver."