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Reflections on being a recipient of care:

vexing the concept of vulnerability
a
Janine Wiles
a
Social and Community Health, School of Population Health, The University
of Auckland , Auckland , New Zealand
Published online: 24 Aug 2011.

To cite this article: Janine Wiles (2011) Reflections on being a recipient of care: vexing the concept of
vulnerability, Social & Cultural Geography, 12:6, 573-588, DOI: 10.1080/14649365.2011.601237

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 Social & Cultural Geography, Vol. 12, No. 6, September 2011

Reflections on being a recipient of care: vexing the

concept of vulnerability
Downloaded by [Universidad Autonoma de Barcelona] at 03:48 09 December 2014

Janine Wiles
Social and Community Health, School of Population Health, The University of Auckland,
Auckland, New Zealand, j.wiles@auckland.ac.nz

Focusing on the experiences of older people, I argue that geographers could contribute to
understanding what it means to receive care. I explore some geographical literature that
does focus on older care recipients, which emphasises both the experiences of changing
care provision in different spatial contexts and affectual aspects of care relationships.
Emphasising older peoples perspectives and experiences of being a care recipient may
illuminate new understandings of care. For example, there may be much to be understood
about concepts such as vulnerability from older care recipients. Vulnerability is often seen
as fragility or weakness, but it may also be conceptualised as openness, susceptibility, and
receptiveness. Ideas about vulnerability as inherent to the self and as formative might be
usefully applied to the experiences of older care recipients. To experience and
acknowledge ones vulnerability may be a process of renegotiation of ones sense of
embodied self and relationships to people and places. More work is needed on what it
means to experience vulnerability, and on the meaning of being a recipient of care.

Key words: care, older people, care recipients, vulnerability, spatiality of care.

Introduction Parr 2003; Popke 2006). Through attention to

Geographers have made helpful contributions
to contextualising and locating care and
caregiving, for example by exploring the
production and reproduction of spaces for
care such as homes, communities, clinics,
institutional spaces, and regions. Geographers
have made links between the very local and
regional or even global scales at which care
takes place, and considered the spatialisation
and contextualisation of care and care
relationships across space (Cartier 2003;
Conradson 2003; Milligan 2009; Milligan
and Power 2009; Milligan and Wiles 2010;
place, and particularly through connecting our
understanding of localised, specific experi-
ences to more general and/or abstracted scales,
geographers could also potentially contribute
to a better understanding and contextualisa-
tion of receiving care, which is under-
represented in the care literature.
Focusing primarily on the experiences of
older people and the family or friends who
care for them, I argue that more attention
needs to be directed towards understanding
the meaning and experience of receiving care,
to complement the rich and nuanced literature
on caregivers. I explore some literature that

ISSN 1464-9365 print/ISSN 1470-1197 online/11/060573-16 q 2011 Taylor & Francis

DOI: 10.1080/14649365.2011.601237
 574 Janine Wiles
does focus on older care recipients, which
emphasises both the experiences of changing
care provision in different contexts and
affectual aspects of care relationships. Finally,
I suggest that it could be helpful to add to this
small literature on care recipients by placing
more emphasis on how older people them-
selves experience receiving care.
While it is important not to lose sight of the
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problems associated with giving and receiving
care, understandings of the meaning and
experience of both giving and receiving care
could be reframed with more complexity and
fluidity of meaning, or by being more attentive
to the complex social, symbolic, and physical
contexts in which care is received (Beard,
Knauss and Moyer 2009). For example,
though it may be provocative to explore
concepts of vulnerability because of the
negative connotations often associated with
the term, there may be much to be understood
about this concept from care recipients
themselves. We could also learn much about
resilience and strength from those who have
the courage to engage with their vulnerability
(Nakashima and Canda 2005). Recognising
the transformational effects of acknowledging
and living with vulnerability might also help to
challenge negative stereotypes associated with
ageing and decline. Experiencing vulnerability
often leads to a renegotiation of relationships
to people and places, and geographers are
well-placed to contribute to understandings
about this.
Research on care
Focus on giving care
The care experience is a process of negotiation
between two (or more) embodied selves. Care,
often defined as the provision of practical or
emotional support, is part of many social
relationships and interactions (Graham 1991;
Tronto 1993). In research and policy, the term
care is usually used to mean more specific
forms of commitment exceeding the normal
reciprocity between adults (Twigg and Atkin
1994). Thus caring includes help with per-
sonal and intimate activities such as bathing,
toileting, or dressing, and activities such as
preparing meals, shopping, arranging travel,
or managing finances. Care also includes
everyday acts of practical and emotional
support (Milligan and Wiles 2010). Some
authors argue care is perhaps better explained
as an ethics of encounter, a proactive interest
of one person in the well-being of another and
the articulation of this stance in practical ways
(Conradson 2003: 508), or as a fully political
set of relations, an emotional and subjective
orientation . . . often linked to action (Brown
2003: 835). That is, emotional and practical
relations often intersect in the provision of
care.
Care research in geography, in gerontology,
and more broadly, has tended to focus almost
exclusively on the provision of care. Such
research either focuses on the broad strategies
and political issues around the allocation and
distribution of resources for providing care at
global, regional or national, urban, or local
levels, or more specifically on the experiences
and issues facing caregivers, whether paid or
unpaid, lay or professional, or voluntary.
Work on how care is valued and perceived
collectively and individually is often described
under the umbrella term of an ethics of care.
Research investigates questions of who should
be responsible for providing care, whether it
should be collective groups, such as the state or
community, or family members; in particular,
much of this work has critically engaged with
the intersection of gender, care, and personal
and collective politics (e.g. Gardiner 1997;
Held 2006; Svenhuijsen 1998). Others have

focused on how care should be paid for, in
terms of who should pay whom for care, and
how much (Glendinning, Schunk and
McLaughlin 1997; Kittay 2001; Ungerson
1997, 2003, 2004), or on where care should be
provided and how the context of care shapes
and is shaped by that care (Brown 2003;
Conradson 2003; Cutchin 2005; Milligan
2003, 2009; Twigg 1999; Wiles 2005).
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There is also an extensive literature on what
it means to provide paid or unpaid care for an
older family member, friend, or neighbour at
home or in the community. Topics have ranged
from measures of caregiver burden, stress, and
impacts on health, employment, or other
social relationships (Barusch and Spaid 1989;
Pinquart and Sorensen 2003; Son et al. 2007;
Zarit, Reever and Bach-Peterson 1980), to
stages in the caregiver career over time (Bar
David 1999; Coe and Neufeld 1999; Pearlin,
Mullan, Semple and Skaff 1990; Skaff, Pearlin
and Mullan 1996), and an interest in the
personal and collective experiences of care-
givers and best practice in supporting them
(Duggleby et al. 2010; Rubinstein 1989; Wiles
2003a, 2003b).
Many researchers have tended to assume
caregiving for older people is primarily a
burden and thus tried to measure and
understand this burden or how to mitigate it.
Yet a growing body of research supports the
argument that the experience of caring for an
older person at home or in the community is
far more nuanced than models focused on
burden imply (Chappell and Reid 2002;
Seltzer and Li 2000), and that not all
caregivers experience all care as a burden
(Abel 1990; Robison et al. 2009; Wiles
2003a). Most families and non-kin carers are
motivated by a sense of obligation to care
(Aronson 1990; Barker 2002; Finch and
Mason 1990; Health Canada 2002), but it is
not necessarily the obligation itself that leads
Reflections on being a recipient of care 575
to a sense of burden. Many people also want
to provide care to older people at home, a
point not lost on policy makers and service
providers who often see this combination of
affect and obligation an opportune context for
shifting care to the home and thus cutting
health system costs (Aronson 1990; Ungerson
2003; Wiles and Rosenberg 2003).
The caregiving role may have some positive
effects though it is less frequent for researchers
to ask about these (though see McIntyre 2003;
Tauiliili, Delva and Browne 2001). For
example, McIntyre (2003) offers alternative
views of caregivers beyond that of burdened
victim, suggesting that caregiving offers
opportunities for appreciating personal
relationships, being in the present, and for
enhancing the dignity of both caregivers and
recipients. Other research shows that care-
givers may experience a sense of pride or
satisfaction, a strong sense of vocation or of
identification with the caring role, new skills
and personal growth, increased closeness with
the care recipient, alleviation of guilt, a sense
of power, or of altruism, and a heightened
sense of well-being or achievement (Aronson
1990; Lewinter 2003; Meintel, Fortin and
Cognet 2006; Wiles 2003a). Too frequently,
however, formal support resources are poorly
co-ordinated with informal care provision,
leading to unpaid caregivers feeling unsup-
ported or out of their depth, while at the same
time formal systems tend to place too much
emphasis and pressure on family support
systems (Johansson, Sundstrom and Hassing
2003; Larragy 1993; Wiles 2003b). Numerous
researchers document the increasingly techni-
cal tasks passed to family members, often with
little support or training. Without adequate or
appropriate support for caregivers and reci-
pients, the caregiving role can indeed rapidly
become burdensome (Wiles 2003b).
 576 Janine Wiles
For caregivers too, the care experience may
render vulnerability more explicit; Kittays
(2001) work on the complex webs of power
between care providers, employers, and
recipients highlights the potential vulnerabil-
ities of all parties, and others have also
illustrated how the context of care can render
family caregivers susceptible to the norms and
practices of formal care services (McKeever
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1999; Wiles and Rosenberg 2003), or expose
formal workers to abusive employers or even
clients (Meintel, Fortin and Cognet 2006).
Thus what is notable about this well-
developed literature on care is that, beyond
their biomedical problems or conditions, older
care recipients (and indeed care recipients in
general, see Parr 2003: 216) receive little
attention as thinking, feeling, changing sub-
jects. They are often represented simplistically,
as passive, dependent, frail, and at-risk or
vulnerable objects of care, whose behaviour or
physical impairments create additional stress
for caregivers (Pinquart and Sorenson 2003;
Son et al. 2007). They tend to be objectified as
the dichotomous other to the category of
caregiver, or caregivers perceptions may be
used as a proxy for recipients ratings of issues
such as symptoms, well-being, or quality of
life (Aronson 1990; Clarke 1999).
Care recipients
Where the experiences and voices of older care
recipients are considered, research indicates
that they often vehemently resist the categor-
isation of recipients as dependent, frail, or
vulnerable. For example, Beard, Knauss and
Moyers (2009) narrative study of people with
dementia shows how some challenge biome-
dical reductionism and normative victim-
orientations and consciously incorporate
manageable disability into their identities.
This resistance is also evident in work by and
with others who might be said to occupy the
position of care recipient (e.g. Frank 2001;
Thomas-MacLean 2002). Concern often
centres on the difficulty and complexity of
conceptualising the experiences associated
with illness and care, and the negative and
reductivist ways that ideas about vulnerability,
fragility, and dependence are typically pro-
jected on to recipients by others discussing the
context of receiving care.
The small amount of research which does
focus on older care recipients tends to focus
primarily on relational aspects of caregiving,
which is unsurprising given the relational
nature of care. Two major themes predomi-
nate.
The first is the practical and political impact
of care services and policies on care recipients,
their relationships with care providers, and
their social and living environments. Some
researchers have shown how structural changes
to the provision of care at the political
institutional level, or shifting care from
institutions to homes and communities, directly
impact on those receiving care (Cartier 2003).
Inadequate funding for home care dispropor-
tionately affects women (who are the majority
of care recipients as well as providers). Though
many prefer home care over institutional care,
often only because it was seen as being the
lesser of two evils, poor working conditions for
home care workers leads to problems with
continuity for recipients, and the financial costs
of cuts to home-based care are often absorbed
by recipients and families (Morris et al. 1999).
Service restructuring creates uncertainty for
elderly care recipients, particularly with respect
to continuity and the sense of flux and change
brought on by reform (Cloutier-Fisher and
Joseph 2000).
In some jurisdictions resources are aimed
directly at care recipients who pay care

workers, or at care providers (e.g. as Direct
Payments, cash transfers, or routed wages).
Sometimes this is an attempt to empower
recipients by increasing their choice and
relative power, at others it is a way to
empower those providing care or to address
inadequate formal systems or concerns about
cost-containments (Ungerson 1997, 2004).
Direct Payments to older people, in particular,
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offer opportunities for increased control,
continuity, quality of life, but come with
many risks including impacts on privacy and
the difficulties of being an employer (Glendin-
ning et al. 2000). People need support to be
good employers and maintain relationships,
and for safety.
A second theme is the affectual aspects of
receiving care. The study by Angus et al.
(2005) of the physical, symbolic, and experi-
ential aspects of receiving care includes clients
and families as care recipients, and describes
the disruption and reconfiguration of home as
a result of professional care being provided
there. They observe how both illness and
home care provision disrupt the intimate, co-
constitutive relationship between self and
home (Angus et al. 2005: 182), and impact
on clients and families sense of home,
aesthetics, and cleanliness. Their research
shows how the negotiation of the meanings
of homes and bodies are part of the production
of caring spaces, but that these are constrained
by policies (such as restrictions to funds for
home care services and limitations on what
services can be provided) constructed at a scale
beyond home (Dyck, Kontos, Angus and
McKeever 2005). Brown (2003) likewise
highlights the paradoxical spaces of care
provided at home, including not only the
blurring of public and private boundaries, but
also normative paradoxes of home as a good
and a bad place to die, the paradox of patient
control challenging territorial ideas about
Reflections on being a recipient of care 577
care, and the relational paradox between
autonomy and dependency.
Aronsons (1990) work with mothers and
daughters on their perspectives on care high-
lights how older women experience tension
between not wanting to be a burden on their
daughters and anticipating needing more
support. Aronson emphasises how their
individualised experiences and verbal
accounts intersect with social contexts and
norms about older people and the need to
appear self-reliant and undemanding. Older
people in a study by Qureshi and Walker
(1989) were also reluctant to ask for
help because of a desire not to impose further
burden on their families. Qureshi and Walker
point out that even though families often
perceived the care as delayed reciprocity for
help received much earlier, older people were
less likely to remember this (1989: 169). Their
sense of reluctance, guilt, and anxiety about
asking for help, and the perceived necessity to
show appropriate gratitude and respect for
help, mirrors many studies of caregivers which
show that a good relationship and not being
taken-for-granted have an important impact
on caregiver well-being and sense of burden
(e.g. Lewinter 2003; Wenger 1990). Lewinters
(2003) work highlights the nuances and
importance of reciprocity both as long-term
give-and-take and immediate forms of
appreciation. Like Qureshi and Walker
(1989), many of the family members providing
care in her study stress their caregiving in the
context of generalised reciprocity in contrast
to the older care recipients emphasis on
immediate reciprocity and the need to express
gratitude and maintain good relations. Family
members underscore the help they have
received from the older care recipient in the
past, as well as normative expectations that
they should provide care. Paid home helpers
also felt they received a lot from the elderly
 578 Janine Wiles
people receiving care, stating that they felt
appreciated and welcome and that the work
they were doing was valued, as well as seeing
potential role models for their own old age
(Lewinter 2003: 370).
Litwin (1998) explores the factors that
facilitate the provision of support by older
people to other members of their social
network, underscoring the importance of
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reciprocity around support and challenging
the over-emphasis in research on older people
as care recipients and younger people as
providers of assistance to the old. Based on
work with older people living independently
but in need of assistance, he illustrates that
care is rarely just received and that it is
strongly governed by ideas of exchange.
Indeed, his findings suggest that the greater
the perceived availability of support was, the
more was given back (Litwin 1998: 243 245).
He argues that this crucial importance of
reciprocity is important for policy-makers
who are keen to utilise informal supports for
older people, as it suggests people who lack the
means or capacity to give support to members
of their network may well be disinclined to
seek or accept support from them. Wengers
(1990) work on older people as care providers
emphasises that a high proportion of those
providing care to older people are themselves
elderly (often spouses), and in this role were
less likely than younger carers to ask for
help or complain of stress. They also tended to
be highly committed and take on more
onerous caregiving roles, perhaps because of
the high degree of mutuality. Wenger (1990:
211) points out that most research on care has
focused on middle-aged women as caregivers
and hence most policy interventions around
care have focused on the needs of middle-aged
women and their conflicting family roles (such
as providing daycare or respite care). For older
caregivers and recipients, issues may be more
related to anxiety about separation or loss of
spouse than the caregiving burden, or they
may have different support needs (Wenger
1990: 213 216).
These findings emphasise the contribution
of older people as carers as well as care
receivers, and strongly support critiques of
ageist views, challenging both apocalyptic
demographies (rhetoric to the effect that an
increasingly ageing population is an unmiti-
gated crisissee Gee and Gutman 2000), and
taken-for-granted assumptions that older
people are unproductive and dependent.
Some suggest such negative views of ageing
are based on narrow and myopic definitions
of both productivity and dependence (Angus
and Reeve 2006: 140). These inflexible
constructions of ageing and dependence
stand in the way of more tolerant and
differentiated responses to older people and
care recipients, fixing those who are stereo-
typed into a marginalised, discriminatory
position (Angus and Reeve 2006; Minkler
and Robertson 1991). Although older people
are frequently labelled as dependent, this
ignores the contributions older people make
in terms of supporting each other, family, and
community through financial means and
voluntary work of all kinds (Albertini, Kohli
and Vogel 2007). Indeed older people may be
net givers, rather than receivers, of assistance.
Many researchers have thus argued for
reconceptualising care as interdependence
between complex networks of actors in
various contexts (Milligan 2000; Minkler
and Robertson 1991; Power 2010; Tronto
1993; Watson et al. 2004; Wiles 2003a). Fine
and Glendinning (2005) point out that both
recipients and providers are involved in the co-
production of care, wherein different kinds of
physical and emotional care are exchanged.
Indeed one could argue that all of us receive
and depend on care, but a key distinction is

between those who are able to successfully
deny this and render care invisible or normal-
ised, and those who are not (Thomas 2004).
Wenger (1987) draws attention to the recipro-
cal and interdependent nature of care relation-
ships at home amongst older people.
Financially, care recipients and care workers
may exist in complex webs of dependency and
power in relation to each other and possibly to
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third parties who may pay for care, which in
turn may lead to complex patterns of
exploitation (Glendinning 1990; Kittay
2001). Elderly recipients of care often give
social and emotional support to their paid and
unpaid care providers (Lewinter 2003; Litwin
1998), and older people themselves frequently
value interdependence, especially in social
relationships (Biggs, Bernard, Kingston and
Nettleton 2000).
Vulnerability
Having highlighted the need for more atten-
tion to care recipients, and explored some of
the key themes in that literature which does
address them, I now want to suggest further
avenues for exploration beyond the (albeit
important) focus on relationality of caregivers
and recipients. In particular, one useful
possibility for research might be to explore
with older people receiving care the meanings
and constructions they associate with the
experience of care itself, and in particular with
vulnerability.
Vulnerability is a vexed subject, a provoca-
tive term often associated with negative
images of weakness and passivity, particularly
when associated with negative images of old
age. Vulnerability may be conceptualised as
fragility and (or) weakness, but I suggest that it
could also be conceptualised as openness,
susceptibility, and receptiveness. It is the
Reflections on being a recipient of care 579
meanings within the latter conceptualisation
with which I wish to engage, whilst renego-
tiating the former in the context of older care
recipients. Those whose vulnerability is in a
sense marked out through the need to receive
care, which means their vulnerability cannot
be normalised, hidden, or denied, must
negotiate with these pervasive social norms
that vulnerability is weakness. (dis)Ability
activists particularly have emphasised how
narrow ideas about care and dependence are
dis-empowering, and resisted care as a term
precisely because the negative connotations
associated with being a (supposedly exclu-
sively) dependent recipient of care are so
oppressive and exclusionary (e.g. Hughes,
McKie, Hopkins and Watson 2005; Watson
et al. 2004). Some have tried to shift the
discourse away from care and care recipient
altogether, promoting more power-ful but
nevertheless problematic stances such as
client or service consumer.
Twiggs (1999, 2000) work on bathing and
bodies in the context of receiving care explores
the ways frail older people experience embo-
diment in the context of receiving intimate
help at home and in daycare centres. She
points out that receiving care may be
associated with incontinence and other aspects
of the unbounded body. Not being in control
of ones bodily functions can be embarrassing,
humiliating, and even threatening, especially
in western cultural contexts where person-
hood rests on the possession of a clearly
defined, separate, and bounded body (Twigg
2004: 66). In this context, she argues, older
people are often reduced to being only about
their bodies as their fundamental social status
is challenged due to such loss of control. In an
attempt to reassert the subjectivity associated
with the body, she suggests the need to better
understand the meanings and constructions
older people associate with their bodies and
 580 Janine Wiles
with the ambivalent forms of closeness and
transgression engendered by receiving per-
sonal care (Twigg 2000).
Jones (2006) suggests the useful idea of
positioning to understand some of the ways
older people talk about subjects such as being
old, especially when engaging with negative
social norms about these ideas. Positioning
refers to the concept of social positions (a more
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dynamic conceptualisation than more fixed
ideas of social roles or relations) which are
ascribed with particular, collectively accepted
rights and responsibilities (see also Allen 2009;
Harre and van Langenhove 1999). A nurse or a
teacher, for example, has tacit rights and
responsibilities to speak and behave in
particular ways and places such as a classroom
or a hospital ward or health clinic or when
giving home care, but may have very different
rights and responsibilities in other positions in
their lives (such as being a son or daughter, or a
neighbour). Positioning is thus inherently
geographical and situated; the rights and
responsibilities, and cultural storylines, avail-
able to or associated with a nurse will be
different in a hospital ward than they are in
different home care settings (Angus et al 2005).
Even care recipients are differently positioned
in these different spaces, for example as a
patient in the hospital or daycare, but as a
client at home, with attendant different rights
and responsibilities (Dyck, Kontos, Angus and
McKeever 2005; Twigg 2000).
Positionings are related to dominant cul-
tural and social storylines or resources which
people are able to negotiate, resist, or accept.
Old people, for example, are frequently
positioned by others (and sometimes, them-
selves, though often in more complex ways) as
frail (Grenier 2005), asexual (Jones 2002), and
vulnerable (Hurd 1999). Jones work (2002,
2006) highlights how older people negotiate
these positions either by simultaneously
drawing on and resisting cultural stereotypes
of old age such as the supposed asexuality of
older women, or by denying they occupy the
position of being old at all. Given the limited
and negative scope of the social storylines
associated with these positions (for example,
one of the few rich and generally positive
positions available to older people is that of
grandparent), it is not surprising that many
people who might be viewed as older will
frequently deny that they are old (see also
Angus and Reeve 2006; Hurd 1999; Wiles and
Allen 2010), perhaps trying to resist the
position altogether. Similarly, care recipients
denial of the idea of being dependent is
hardly surprising given the reductive and
negative ideas associated with this positioning.
Older care recipients, in particular, are often
implicitly positioned as being dependent and
vulnerable, and these positions are in turn very
narrowly framed within disempowering, nega-
tive storylines. These tend to ignore the richness
of intergenerational exchange or interdepen-
dence described above, and the contributions
made by older people including those receiving
care. Dependence is associated with being
disempowered or passive, for example, and
vulnerability is frequently associated with
weakness, helplessness, and defencelessness,
as well as susceptibility, and exposure.
What if we (as researchers, or as service
providers) could enrich our re-presentations of
these positions (old person, care recipient,
vulnerable person), with more complex social
resources and storylines? The concept of
interdependence is already a way to rethink
or reposition the meaning of being either
caregiver or recipient. For older care recipients
the issue of age and growing older is often very
much a problematic one, and receiving care in
the context of growing older has been shown
to heighten anxiety about being perceived as
dependent or needy. Exploring, and where

necessary, challenging and renegotiating the
meaning of different storylines around the
position of being old, is a helpful way to
address these issues. It may be possible to go
further than this and also re-invigorate
concepts such as dependence or even vulner-
ability, particularly through talking with older
people themselves.
Grenier (2005), in a sensitive study of older
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womens everyday experiences of disability
and decline, points out that there is a need to
avoid totalising experiences whereby one
aspect of a persons appearance or experience
(such as appearing frail, or being a recipient of
care) comes to stand for their whole identity.
The older women in her study negotiate the
storylines available to them by distinguishing
professional medical functional views and
classifications of a person being frail from
their personal experiences of feeling frail
(Grenier 2006). She argues that frailty is
socially located and connected to the contexts
in which disability and decline are experienced
(Grenier 2005). She emphasises the human
feelings and emotions that exist beneath the
surface of the human body (Grenier 2006:
306), as the women in her study adjust to the
physical changes in their bodies and the
meanings associated with those changes, and
the emotional aspects of impairment, trau-
matic events, and threats. She highlights the
importance of accounting for the personal
meaning of frailty, and vulnerability, in
organisational practices of care.
These are interesting ways in which to
rethink frailty, and likewise vulnerability as an
element of embodied subjectivity, which might
make broader social and cultural resources
available to those who are positioned as being
vulnerable. It may be that older care recipients
distinguish between clinical views of vulner-
ability, and their own feelings of vulnerability,
for example when they are marked out as
Reflections on being a recipient of care 581
other or as fragile. Alternatively, we might ask
more specific questions about what it means to
receive care. For example, how does the highly
vulnerable (open, susceptible, receptive)
experience of being bathed by someone else
change a persons relationship to their own
body and to the bodies of others? How is a
persons symbolic and practical relationship to
parts of their home changed through care
practices such as having someone else cook
meals in their kitchen, or someone else
cleaning their private bathroom? How does
receiving care at home impact on peoples
relationships to the communities and neigh-
bourhoods they inhabit including their own
contributions to those places (such as their
voluntary work or place-based advocacy)?
What are the transformative effects of the
openness or receptiveness required to accept
such personal acts of help?
Alternatively, perhaps it may be more
helpful to explore how all persons are
vulnerable. For example, Harrison (2008)
takes issue with the way those interested in
subjectivity and being give precedence to
activity, agency, intention and productivity
over passivity, stillness, inertness and suscep-
tibility. By normalising activity and agency in
this way, we thus tend to see passivity and
vulnerability as abnormal and problematic. In
contrast, Harrison suggests, vulnerability is
not simply the antithesis of vigour and
strength but rather an intrinsic and non-
eliminable aspect of corporeal existence
(2008: 436). It is a fact of the body as matter.
Vulnerability, passivity, and stillness are as
much a part of our subjectivity as activity,
intent, or action. He thus argues that loss or
wounding are not necessarily in themselves
tragic, because vulnerability:
lies at the origin of the self . . . exposure,
subjectivity, receptivity, these are not attributes
 582 Janine Wiles
which are added to the subject later on, as it were;
even less are they abilities to be flexed. Rather, they
define the subject in its incipient natality. (Harrison
2008: 440)
Vulnerability is not something new that befalls
the self through crisis or mishap, nor is it an
extrinsic attribute or condition. Instead, the
self begins from a position of vulnerability,
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which he defines as both susceptibility and
receptivity, exposure to the unchosen and the
unforeseen, to what exceeds [the bodys]
abilities to contain and absorb (Harrison
2008: 427). Vulnerability:
cannot be willed, chosen, cultivated, or honed, and
neither, therefore, does it necessarily or even
primarily denote a weakness or a misfortune;
rather, it describes the inherent and continuous
susceptibility of corporeal life to the unchosen and
the unforeseen. (Harrison 2008: 427)
The inherent vulnerability of the body is
frequently made obvious in the face of disaster.
Clark (2007) also engages with the revelatory
effect of crisis to illuminate otherwise-hidden
ways of understanding the self and social
relationships. Also, musing on disasters such
as tsunami, earthquakes, or hurricanes (but
perhaps just as applicable to personal disasters
such as severe illness or emergencies or
challenges to embodied subjectivities), he asks:
What if we were to view shock, loss, and
disorientation not simply as what might happen to
a fully-fledged self or a subject, but as part of the
formationthe adventof selves or subjects?
(Clark 2007: 1133, my emphasis)
Crisis is not only a forcible revelation of our
inherent vulnerability, but also of our capacity
for caring and exchange. It may be formative,
not just something that happens to people,
places, or relationships but also a part of
growth and ongoing development of subjectiv-
ity. Clark argues for a reframing of vulner-
ability, susceptibility and receptiveness: not as
weaknesses to be overcome but as transforma-
tive and defining characteristics of the self. For
Harrison, embodiment originates in the
exposed and susceptible nature of the body
and the self, rather than in will and intention.
At moments of crisis and difficulty the
vulnerability inherent to all bodies is made
visible and named, it can be more difficult to
deny such vulnerability or to render it as
normalised. Whether care is accepted or not,
or even named as care or not, we become more
aware of our relationships to others and our
dependence on them. We are also made aware
of our relationships to our social and physical
environments, whether because we are forced
to adapt to them in new ways as our physical
competencies change or because of new
perspectives and changed sensitivity towards
them (e.g. Dorn 1998; Lawton 1998). For
those experiencing illness or the aftermath of
trauma, or for many older people and their
long-term caregivers, time and space is
ruptured and disrupted: periods of calm and
even boredom are marked out by crisis (Wiles
2003a); seemingly endless appointments with
health professionals and extended periods of
waiting in sterile waiting rooms mark out new
ways of experiencing time and place (see
Vannini 2002); or the experience of prolonged
or intense pain or trauma forces realignments
of our relationships to time and place in
fundamentally embodied (and non-linear)
ways (see Adey 2009).
Concluding thoughts
For older people experiencing vulnerability
through living with chronic or long-term

illnesses or injuries and receiving care, there is
thus ongoing re-negotiation of sense of self,
past and future experiences and relationships
with others and with places, and of embodied
subjectivity. Stillness, inactivity, passivity,
resting, acceptance of ones limitations and
acknowledging ones connected-ness to others
may turn out to be as important parts of the
experience and meaning of receiving care as
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are struggles to resist and challenge normative
negative stereotypes about the experience and
its meaning. Though it may incorporate
fragility or dependence, the process of
recognising and accepting vulnerability may
also be a potentially transformative process
incorporating collective and individual jour-
neys of change as well as more corporeal and
material changes to people, places, and
relationships. Given the research findings
discussed above about how older peoples
reception of support is intimately linked to a
sense of reciprocity, the relationship between
vulnerability and receiving care may need to
be thought of both in long-term as well as
short-term time frames, in both personal and
collective ways, and in terms of the capacity to
give as well as to receive support. Rather than
reducing care recipients in a totalising way so
that their receipt of care (or their vulnerability,
or their old age, or their changing bodily
functions) comes to stand for their whole
identity, we might instead seek to better
understand the experience and meaning of
care from the perspective of different recipi-
ents as well as caregivers.
Geographers have made substantial contri-
butions to understandings about care in
general, and for older people. Yet much of
the geographical and other literature on care
has focused on the providers of care and
systems for provision of care. In this paper
I have argued the need for a greater focus on
care recipients, in general, and on older care
Reflections on being a recipient of care 583
recipients, in particular. Too often they are
either absent from the literature on care, or
represented as static subjects who exist only
in a relationship of dependence on caregivers,
or the focus is only on their physical
characteristics as if the social and symbolic
aspects of their personhood were somehow
diminished. The small amount of research
that does focus on older care recipients tends
to examine their relationships with care
providers or political institutional systems of
care provision.
A greater emphasis on older peoples
perspectives and experiences of being a care
recipient may be helpful for opening up other
new understandings of older care recipients
and a better understanding of care itself. A
number of researchers have already high-
lighted the concept of interdependency, a
useful concept for challenging simplistic
ideas about older recipients of care and
dependency, which instead emphasises that
there are few times when one is not a recipient
(as well as a giver) of care. Others have argued
for greater emphasis on the personhood of
care recipients and the myriad contributions
made by older pople, or older peoples own
interpretations of concepts such as frailty.
In this thought piece I have focused on the
difficult, even provocative, concept of vulner-
ability, arguing that vulnerability in itself is
not necessarily negative. Instead, drawing on
recent work on how older people re-negotiate
concepts such as frailty or old age, and other
work exploring the meaning of vulnerability in
the context of large-scale disaster which
suggests that vulnerability may be inherent to
the self and that experiencing vulnerability
may in itself be formative, I suggest that these
more complex ideas about vulnerability might
be usefully applied to the experiences of older
care recipients, and to more nuanced and
spatialised understandings of care. Such
 584 Janine Wiles
reconceptualisations might help us to ask new
questions: what are the intersections between
the emotional as well as the practical aspects
of receiving care as well as giving care? How
might different ways of looking at and
positioning being a care receiver help us to
uncover more detailed understandings of care
and vulnerability, such as appreciation of
personal relationships, new ways of under-
Downloaded by [Universidad Autonoma de Barcelona] at 03:48 09 December 2014
standing embodiment, personal growth, or
tensions between feelings of guilt and power?
What are the spatial implications of receiving
personal care? Given what we learn from
research with caregivers about the potential
disruptiveness of care provided at home or
lack of continuity of home care, or the risks of
increased difficulty with accessing and using
formal support, we might also learn much
from care recipients about what it means to
receive care in different places. This could
have impacts on how we do care and on our
spatial as well as our organisational practices
of care. To experience and acknowledge ones
vulnerability is a process in itself which
requires much personal and interpersonal
renegotiation of ones sense of embodied self
and relationships to people and places. More
work is needed on what it means to experience
vulnerability, and on the meaning of being a
recipient of care.
Acknowledgements
My thanks to Dr Sarah Atkinson for organ-
ising and hosting the workshop on Care of the
Body: Spaces of Practice, and to the Depart-
ment of Geography at Durham University for
funding and supporting this workshop. Thanks
also to participants in the workshop, and to
anonymous referees from this journal for their
helpful and constructive criticisms on the ideas
in this paper. Any shortcomings are my own.
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Abstract translations
Reflexions sur la reception du soin: en contrariant le
concept de la vulnerabilite
En me focalisant sur les experiences des personnes
agees, je soutiens que les geographes pourraient
contribuer a une comprehension du sens de la
reception du soin. Jetudie une partie de la
litterature geographique qui se focalise effective-
ment sur le recipients plus ages du soin, ce qui
souligne en meme temps les experiences dune
provision du soin en voie de se transformer dans de
differentes contextes spatiaux aussi bien que les
aspects affectueux des rapports du soin. Insister sur
limportance des perspectives et des experiences des
personnes agees davoir ete un recipient du soin
peut illuminer de nouvelles comprehensions du
soin. Il pourrait y avoir par exemple beaucoup a
comprendre au sujet des concepts tels que la
vulnerabilite dapres les recipients du soin plus
ages. La vulnerabilite est souvent consideree comme
de la fragilite ou de la faiblesse, mais on pourrait
aussi la considerer comme de la franchise, de la
sensibilite, et de louverture de lesprit. Les idees
traitant la vulnerabilite comme propre au soi
et comme formative peuvent etre utilement appli-
quees aux experiences des recipients du soin plus
ages. Connatre et admettre sa vulnerabilite peut
etre un processus de renegociation de son sens de soi
incarne et des rapports aux autres personnes et les
lieux. Il faudrait encore detudes au sujet de la
 588 Janine Wiles
signification deprouver la vulnerabilite et de la
signification detre un recipient du soin.
Mots-clefs: soin, personnes agees, recipients du
soin, vulnerabilite, spatialisation du soin.
Reflexiones en ser una recipiente del cuidado:
desconcertando el concepto de vulnerabilidad
Enfocando en las experiencias de gente mayor,
discuto que geografos puedan contribuir al enten-
Downloaded by [Universidad Autonoma de Barcelona] at 03:48 09 December 2014
dimiento de que significa recibir cuidado. Exploro
algunas literaturas geograficas que se enfocan en
recipientes de cuidado mayores, del cual enfatiza
ambos las experiencias del cambio de la provision
del cuidado en contextos espaciales diferentes y
aspectos afectivos el las relaciones del cuidado.
Enfatizando las perspectivas y experiencias de gente
mayor siendo recipientes del cuidado se puede
iluminar nuevos entendimientos del cuidado. Por
ejemplo puede ser que hay mucho que entender
sobre conceptos como vulnerabilidad de los
recipientes del cuidado. Con frecuencia vulnerabil-
idad esta percibida como fragilidad o debilidad,
pero tambien puede ser entendido como inherente
al s mismo y como formativo puede ser aplicado
utilmente a las experiencias de recipientes mayores
del cuidado. Experimentar y reconocer la vulner-
abilidad de uno mismo puede ser un proceso de
renegociacion de la percepcion de uno mismo
encarnado y las relaciones con gente y lugares. Se
necesita mas trabajo en lo que significa experi-
mentar vulnerabilidad, y en el significativo de ser un
recipiente de cuidado.
Palabras claves: cuidado, gente mayor, recipientes
de cuidado, vulnerabilidad, espacialidad del cui-
dado.