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The articulation of identity politics: "carers"

The concept of identity has come to encompass a wide range of social and psychic issues that address the constitution of self as a constructed, continuing, never-completed process. So open are modern possibilities of "active citizenship" and "lifestyle maximisation" that we are encouraged to think that we can make and remake ourselves at will, seize the opportunities "out there", and realize our core ambitions (Giddens, 1991; Rose, 1998). The world is our oyster, or so it seems. Social groups likewise are encouraged to think in terms of collective identities, based on shared "natural interests" and/or to "own" identities that were previously maginalised. This is often described in terms of "identity politics", and sociologists have explored interesting links between identity-formation and proliferating small-group affiliation (Wuthnow, 1994).[1] In the UK, with governmental emphasis on "social inclusion", everyone, it is said, deserves to "have a voice"; no person, group, in short, no constituent of identity, should be left out.

It is commonplace to think of self as a composite, a polity of formations—for example, husband, carer, parent, citizen, doctor, higher-tax earner, middle-aged person, church goer, etc. Group analysis is quite at home with plural views of selfhood, engaged and constructed as we are in the crowded "traffic" of human connection. It is not that people have not always been conceivable as a "collection" in these terms, but that the distinction between various properties seems to have become more explicit and differentiated in contemporary society. Identities are everywhere. A person's ability to "own" and assert a particular identity is celebrated and many modern social movements (e.g., the women's movement, gay/lesbian liberation, survivors, etc.) were forged on the basis of identity struggles, opposing other, dominant identities. To "have a voice" and to express "an identity", increasingly coincide. To explore this paradox, consider the rapid rise to prominence of the "carer".

Carers have always existed, in the sense of individuals or groups of persons who spend a significant proportion of their time helping others, aiding the sick, whether in an occupational or a personal ("private") capacity. Until recently, however, such agents seldom defined themselves as carers. Carers have come to be identified as bearers of rights, as legal, social, psychological, if often burdened, agents. A person who introduces themselves in a group or conversation with "and I am a carer", is readily understood as making a socially legitimised claim to a core identity and we "know" what they mean.

The relatives group

In the 1990s, I established a relatives group for carers who live with or "support" someone with substance misuse issues. Hosted within a substance misuse service, I drew upon group-analytic thinking as an aid to negotiation and practice. The substance misuse service was aware of a large, neglected relative population; that for every one individual drug/drink user, many others, particularly nearest and dearest, are deeply affected. In group-analytic or systems terms, the addict creates major dissonance within their relational network, generating helplessness in others and anxiety that everyone will be sucked into the chaos; in response, carers might blame themselves, try to control the addict, or believe that if only the user was taken from them and "put somewhere" (e.g., detox, rehab), the problem would be solved.

What seemed a rational proposal—to set up a service for these carers—met with resistance: "Will we be swamped?", "Won't they interfere with the treatment of the user?", and so on. The service was anxious about the prospect of moving away from an individual model of treatment. I presented audit evidence, confirming the fact that relatives did indeed feel treated "second best" twice—at home, with the user, but also by lack of provision by our service. Careful listening to service resistances or concerns, as expressed by different organisational subgroups—drug team, alcohol team, managers, nurses—paid dividends and I was charged with the task of delivering the service for carers.

The relatives group service was a slow-open, weekly group, strongly influenced by group analysis and which could accommodate newcomers at short notice. The group was a "unilateral intervention" for carers, regardless of whether their loved one was in treatment. Thus, the ticket for entry was simple, in so far as any "affected" partner, spouse, son, daughter, sibling, or friend could join. The aim was to help relatives examine their own, submerged and neglected needs and to gain more "say" and protection in their lives. The group worked actively to improve self/other differentiation; one member spoke of the importance of the group in supporting "healthy detachment" from her alcoholic spouse, enabling her to establish boundaries, limits, and to safeguard her health. The group was a maelstrom of acute emotions, such as anger, shock, fear, and chronic feelings of depletion, demoralisation, bereavement—an impotent sense of "What can I do?" But it also fermented hope and clarity. Carers could, in time, gain more choice in their lives and freedom to decide how best to cope, with or without the direct presence in their lives of the problem drug user.

Reflections

The contemporary carer identity emerges in at least three domains; (a) carers constitute a social and legally protected constituency, in the UK, whose contribution and burdens are recognised in, say, the Carers Recognition Act, 1995; (b) in its idea of a "patient-led" National Health Service, the Department of Health promotes the involvement of carers as well as service users (Simpson & Ramsay, 2004); (c) carers occupy a role that whilst at some levels is applauded—for example, is selfless, devoted, dependable, heroic even—has a shadow side, for example, is a burden, source of guilt, overlooked misery, suppressed need, and so on. If group analysts, like sociologists, are centrally interested in the formation of group identities, then the rise of the carer is a remarkable phenomenon, involving the creation and mobilisation of an entire new constituency as well as a field of psychological subspeciality.

The relatives service not only met an important clinical need but helped to ferment an influential constituency, expressive of the "carer voice". The relatives group paved the way for diversifications, such as family and couple therapy, that had not existed before. As a consequence, carers had an extended menu of choices within the substance misuse service. Not only this, but the "carer awareness" that grew through participation and practice lead to the formation of a lobby group. At one point, for example, when the group was felt to be under threat (the reality was hard to discern), members took up an active campaigning role and made sure managers knew their concerns.

It is one of the paradoxes of identity that people can become constrained by the identity envelope in which they have come to define their position. "Identity" both helps groups to fight for positions, rights, etc., and to cohere, but can also entrap, confining groups to an enclave and creating stereotypes. Butler (1999) suggests that over-emphasis on identity creates a "metaphysics of substance", in which subjects are unable to move out of the "property" that is said to constitute them. Consistent with this, some members of the group increasingly objected to the term "carer", on the grounds that it implied a particular role, suggestive of certain relational obligations. "Being a carer" could trap individuals in the very thing of which they complained, especially as the group encouraged autonomy. Consequently there was much (unresolved) discussion about alternative names to that of "carer", and obvious evidence of a greater sense of authority in their negotiation and requests. There was certainly far less passivity and resignation in their lives and outlooks. In the institutional transference, perhaps I was seen as "caring for the carers", ensuring their provision within the service as a whole. In this way I held a certain "power" in the very act of trying to give it away—one of the many paradoxes of group analysis conceived as a form of therapeutic, democratic association.

  • [1] Robert Wuthnow (1994) researches the rapid spread of small-group membership in modern America, which he interprets in terms of a search for bearings and community affiliation, opportunities to make sense of one's life and "journey". He estimates that around forty per cent of Americans (75 million) belong to at least one small group that meets regularly, including church groups, hobby groups, recovery groups, political groups. Such research is a helpful corrective to the simplistic idea that we are more isolated and alienated than ever.
 
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