'I ought to do it myself' : conceptualizations of ageing and care in a responsibilization regime

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University of Amsterdam MSc Sociology, Social Problems and Social Policy

‘I ought to do it myself’

Conceptualizations of Ageing and Care in a Responsibilization

Regime

Master’s Thesis: June 2016

Rachel Gifford Student Number: 11137185 Contact: Reg9787@gmail.com

Supervisor: Barbara Da Roit 2nd Reader: Patrick Brown

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Abstract

This thesis examines the way in which third sector professionals and elderly service-‐users conceptualize age and the ageing process. Focus is placed on how these particular

conceptualizations come to being; how broader discourses about age and ageing and technologies of government come to structure individual feeling, behavior, and eventually form particular subjectivities which align with larger narratives of healthy and positive ageing. This study implements and analyzes in-‐depth interviews with third sector

professionals and elderly service-‐users who were targeted for a ‘well-‐being’ pilot program in the UK. The pilot aimed to improve overall health and wellbeing of individuals while also reducing the overall burden on health and social care. The program coordinator directly supported individuals who were struggling with at least one long-‐term health condition and who were diagnosed as pre-‐frail to determine unmet needs and support them

appropriately. Through analysis, it has been shown that the way individuals come to

conceive of age impacts their identity and dictates what strategies they implement to either resist or accept care. Older individuals tended to show a reluctance to asking for help as a result of stigmatizing forces and the current sociopolitical context around a strained health service and a booming ageing population. Strategies of emotion management, comparisons, downplaying, acceptance, and ‘presentation’ were utilized as a means to resist admitting a need or reliance on care, despite physical realities. Individual narratives were seen to be influenced largely by current policy discourses around the ageing population as a ‘social problem’ which warrants a solution, and the crisis discourse of a strained health service unable to keep up with increasing demand. Healthy and active ageing discourses alongside a move toward responsibilization in UK society more generally, were seen as strategies

encouraging self-‐management and a governmental strategy to help overcome this crisis. Unfortunately, these discourses tended to show a counter-‐productive outcome which encouraged individuals to take more risks, be less likely to engage in preventative care, and to downplay actuality of need rather than successfully seeking care.

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Acknowledgements

I would like to thank all the professionals and service-‐users who gave their time and who spoke candidly and honestly with me about their personal experiences. I especially thank the service-‐users who welcomed me in their homes and shared their stories. Additionally, I would like the thank the organization which granted me the opportunity to act as both intern and researcher to conduct my own study. I learnt a great deal during my time with this charity, and am grateful for the opportunity I had to learn more about the organization and the professionals who carry out the daily work. I thank Professor Patrick Brown for agreeing to be my second reader and for offering his continued advice and support. Finally, a huge thank you to my supervisor, Professor Barbara Da Roit, who provided guidance and insight from the beginning of this project, and who has supported me throughout.

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1. Introduction ... 1-‐5 2. Theoretical framework ... 5-‐16 2.1 Discourse & Governmentality ... 5-‐8 2.2 Emotion ‘Work’ ... 8-‐10 2.3 Connecting the two: Citizenship Regimes ... 11-‐13 2.4 Technologies of the self ... 13-‐14 2.5 Stigma ... 14-‐15 2.6 Conclusion ... 15-‐16

3. Research Aims and Methodology ... 16-‐23 3.1 Research Aims ... 16 3.2 Methods ... 17-‐18 3.3 Data Collection ... 18-‐21 3.4 Ethics ... 21-‐22 3.5 Considerations & Limitations ... 22-‐23 4.Conceptualizations of Ageing and Stigmatizing Forces ... 24-‐40 4.1 The physical presence of age ... 25-‐27 4.2 Stigma and ‘Social Lag’ ... 27-‐29 4.3 The embodiment of illness ... 29-‐35 4.4 Loss of/Independence ... 35-‐38 4.5 Conclusion ... 39-‐40 5. ‘At what point do you decide you are old?’: Problems of reconciliation ... 40-‐47 5.1 Age Matters ... 40-‐42 5.2 Mask of Ageing ... 42-‐43 5.3 Stigma and Identity ... 43-‐45 5.4 Conclusion ... 46-‐47 6. Responsibilization and Conceptualizations of Care ... 47-‐58 6.1 Responsibilization and Top-‐down Affects ... 47-‐49 6.2 Acceptance of Hardship & Generational Factors ... 49-‐51 6.3 Comparisons as a mechanism of resistance ... 51-‐54 6.4 ‘I ought to do it myself’ ... 54-‐57 6.5 Conclusion ... 57-‐58 7: Self-‐regulation, Discourse, and Reinforcing effects ... 58-‐70 7.1 Technologies of the Self ... 58-‐60 7.2 Funding Dilemma & the Translation of Social Value ... 60-‐63 7.3 A ‘Strain on the System’ ... 63-‐66 7.4 ‘Successful’ Ageing ... 66-‐69 7.5 Conclusion ... 69-‐70

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8. Discussion & Conclusion ... 70-‐75 8.1 Conclusion ... 70-‐72 8.2 Looking forward: issues to address ... 72-‐73 8.3 ‘Factors for future consideration ... 73-‐75 8.4 Final Thoughts ... 75 Bibliography ... 76 Appendices

Appendix A ... Participant Nicknames & Demographics Appendix B ... Interview Guides & Vignettes

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“To me there is one word at the heart of all this, and that is responsibility. We need people to take more responsibility. We need people to act more responsibly, because if you take any problem in our country and you just think: ‘Well, what can the government do to sort it out? That is only ever going to be half of the answer. (David Cameron, 2011; in Verhoeven & Tonkens 2013)

1. Introduction: The Problem

As governments change, powers shift, and societies progress, the way in which social issues are prioritized, problematized and conceptualized within the dominant discourse also evolves. Throughout history, these dominant discourses come to structure social behavior, treatment of particular groups, and the way in which individuals conceive of their own identity and role within society. As the current demographic makeup of UK society is changing drastically, edging towards an unprecedented number of post-‐retirement age individuals, old age itself is becoming problematized in new ways (Powell and Halsall 2015). Recent governmental shifts in the UK, toward a Conservative leadership and more entrenched neoliberal motivations, have also impacted the way in which this particular ‘problem’ is conceptualized at a governmental level, and how it ought to be dealt with; perpetuating a particular top-‐down discourse around age and ageing. Currently, the dominant narrative around ageing within the UK is theorized as the ‘successful ageing paradigm’ (Rowe and Kahn 1998; see also Butler et al 1990) but also reflective of ‘active aging’ and ‘positive aging’ (See Formosa 2013, Asquith 2009) and that conceptualized as the ‘third age’ (Higgs & Gilleard 2014). Coupled with this move towards a narrative of ‘active ageing’, the government has shifted policy strategies and political agendas which structure how care for the aged and ageing should be [and is] delivered, and consequently how it should be received.

Considering recent governmental strategies and political rationale we see that the neoliberal agenda embedded in recent social policies also drives a ‘personalization agenda’ as well as ‘responsibilization’ (Barnett 2003; Lister 2014; Powell and Halsall 2015) encouraging older people to be responsible for choosing and coordinating their own care while simultaneously promoting the value of being independent. This neoliberal agenda driving a more individualistic approach to care and ‘active citizenship’ can be traced back to the eras of Thatcher and Blair leadership (see Rose 2006; Verhoeven & Tonkens; Formosa;

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Biggs 2004; Cabinet Office 2000) however we continue to see a political agenda today which is consistent with ‘active citizenship’ (Tonkens 2012). I argue that this active citizenship regime is inclusive of the successful or ‘active’ ageing discourse, and reflective of larger governmental strategies which attempt to solve the ‘social problem of ageing’ by means of encouraging self-‐reliance and management through what have become seen as ‘positive’ and ‘anti-‐ageist’ discourses. One outcome of this agenda has been the creation of social policies which decentralize health and social care, encouraging a more localized and community centered approach to care. These policy discourses work by means of increasing individual responsibility, self-‐regulation, and promoting community based care (see Bulley and Sukhi-‐Bulley 2014). This rationale attempts to solve such social problems as the increasing ageing population by implementing policies which call for decentralization and increase responsibility at a community and local level, calling on citizens to take a more active role in self-‐management (Powell and Biggs 2000).

This shift has also been conceptualized as part of a move toward active citizenship, or as Tonkens labels the ‘active citizenship regime’ in which citizens are increasingly responsible for arranging care themselves and includes a ‘devolution of care and support services to the municipalities’ (2012, 203). However, considering recent changes and shift in attitude towards care in the UK today, this may more appropriately be categorized as a ‘responsibilization regime’ which is focused more on individualization of care and self-‐ management of health and wellbeing. This research examines the way in which old age comes to be conceptualized in the specific regimes of active citizenship and responsibilization by analyzing narratives of elderly users of localized care themselves, as well as professionals at a local level. Particular focus will be given to how individuals engage in emotion-‐management based on prescriptive framing and feeling rules (Hochschild 1979) as dictated by the current regime as well as wider discourses around ageing. These ‘rules’ as described by Hochschild dictate what meanings individuals should give to situations and how they ‘ought to’ feel in given situation based on these interpretations (Hochschild 1979, Tonkens 2012). As citizens are increasingly encouraged to adhere to a regime of activism in which self-‐management and ‘responsibilization’ are defining factors, and subsequently as care budgets are cuts, healthcare is decentralized and the population continues to age, it is salient to consider the ways in which this comes to influence the experience and

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conceptualization of ageing and care for older people themselves.

As the current mode of governance promotes responsibilization and self-‐ regulation, and also an ageing discourse which divides older people and the ageing process itself into two categories-‐ successful/positive and unsuccessful/ negative -‐ it is important to consider the effects on the lived experiences of older people. As Powell and Halsall assert, the discourses of managerialism and responsibilization ‘penetrate deep into family and personal relationships regulating behavior by locating individuals in a network of obligations towards themselves and others (2015, 91). I believe investigating the impact of these forces will provide unique insight into the translation and impact of governmental strategies and discourse into localized care relationships; particularly the way older people feel about and approach asking for and receiving care. Similarly, to theorists who have employed a governmentality perspective in considerations of healthcare (see Powell and Biggs 2000; 2001) I investigate the ‘subtle mechanisms through which the behavior of individuals is shaped, guided, and directed without recourse to coercion’ (Foucault 1991, Rose 1999; in Powell and Halsall 2015, 91). Specifically, I explore ‘how deep’ the rhetoric of activism and responsibilization runs in terms of impacting on individual behavior and emotion management. Analyzing narratives of elderly service-‐users and third-‐sector professionals delivering social care, I first explore the dominant conceptualizations and feelings about ageing expressed by respondents and see how these correspond to the dominant ageing discourses as well as the framing and feeling rules as dictated by current and past citizenship regimes. The influence of stigma will also be addressed here. I then consider this in terms of its impact upon identity formation and emotion management of older people and professionals themselves. Finally, corresponding strategies of emotion and self-‐ management will be considered in the context of technologies of the self. I employ a Foucauldian analyses to uncover the ways in which discourses of ageing and care become part of the knowledge/power axis and create ‘technologies of the self’ turning individuals into self-‐regulating subjects (Powell 2001) whom must engage in emotion management (Hochschild 1979) and manage their own care.

To conclude, I consider how these forces come to structure the delivery and reception of care at the point of the most localized and direct interactions between these two groups.

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Purpose

The objective of this research is to explore the way in which individuals come to conceptualize age and ageing, and the way in which these particular conceptualizations come to impact on [the current] elderly population’s relationship and behavior towards asking for and receiving care. Through analysis it became clear that individuals engaged in strategies of emotion management and identity formation in order to regulate behavior and align with wider discourses and framing rules around ageing and care. Even when individuals resisted particular notions of ageing or did not subscribe to associated ‘feeling rules’, there remained a sense of responsibility towards their own care needs and evidence of [government directed] self-‐management. Thus, the relationship between technologies of government, aging discourse and individual’s identity formation and emotion management becomes interesting and timely to explore. This study investigates how even the most ‘positive’ and ‘anti-‐ageist’ discourses come to operate as technologies of government and produce counter-‐effects, particularly for the existing population of elderly who face long-‐ term illness. Additionally, this study attempts to fill a gap in the literature by drawing on lived experiences and personal narratives of older people themselves, highlighting the impact of emotion management on the way older people ask for and receive care. As prevention has become a key ingredient in dealing with the impending population boom of elderly citizens (Oliver et al 2014), the way in which older people feel about asking for and receiving care must be considered when trying to implement preventative measures and address individual need. Furthermore, placing individual feeling in the context of wider aging discourses and governmental technologies allows us to explore the potential counter effects that particular strategies and discourses have on reception and delivery of care.

This research is of an interactionist nature, utilizing three key concepts from Hochschild (1979), Tonkens (2012, 2014), and Foucault (1982;1988) to draw empirical connections between structures of power, self-‐regulation, and resistance to care. Exploring the ways individuals may come to be influenced on a micro, meso and macro level, I hope to build an empirical basis which provides insights into the complexity of health and social care delivery for the elderly as well as the heterogenic and multi-‐layered reality of individuals who enter into the social space of ‘old age.’ This research hopes to contribute meaningfully not just to

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fill gaps in academic literature, but to offer insights for support services and programs targeting the elderly. It is my hope that by exploring individual narratives we can come to recognize that caring for the elderly in many ways must be shifted to empower, legitimate, and support individuals in a way which understands the difficulties of reconciling the ageing body within an ageist society. Additionally, it is my hope that this paper has shed light on the influential and powerful role language and discourse plays in identity formation and care reception, and that a more critical approach be taken even to discourses and strategies which appear to positively progress causes of vulnerable groups.

2. Theoretical framework

This research draws on the work of three key theorists, utilizing and integrating key concepts from each to build a framework which allows for a multi-‐level analysis of ageing discourse and its effects on individuals and care relationships. Key concepts used are that of emotion management (Hochschild 1979), citizenship regimes (Tonkens 2012) and technologies of the self (Foucault 1982;1988); these are used in concordance with one another working to build connections between individual feeling and management, social/group norms and expectations, and then finally at the level of governmental influence and power. My framework builds from the phenemological level, looking at personal narratives of age and ageing, and feelings towards care, taking into consideration subjective feelings and experiences. Moving then to the meso level I explore considerations and normative expectations at the group level of society, focusing mainly on prescriptive framing and feeling rules of citizenship which focus on age and care. Finally, I move to considerations at the macro level analyzing the relationship between government, governmental strategies, broader power structures and effects and rules at the group and individual levels.

Discourse & Governmentality

Throughout the twentieth century aging has been problematized, particularly through policy narratives (Powell 2001) but also in politics and media more generally. In the last decade so called ‘crisis discourses’ regarding the ageing population have referred specifically to ‘state spending in the context of anticipated increases in health care costs heightened as a result

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of the global financial crisis’ (Jacobs 2013, in Oster et al 2016). Thus, ageing and old age has become increasingly problematized as a result of the recent financial crisis and the subsequent population boom as large birth cohorts enter into old age [this will be referred to as the ‘crossover effect’]. However, the way in which ageing and old age become problematized in policy reflects ‘existing governmental rationalities’ and offers insights into the way the issue is constructed on a broader scale (Oster et al 2016). Although narratives of old-‐age and aging have shifted through time, alongside policy changes and welfare reforms, ageing and old-‐age itself has continued to be categorized as a ‘social problem’ (Powell 2001) needing to be solved. Despite age and aging being biologically based, their ‘meanings are socially and culturally determined’ (Featherstone & Wernick 1995, 27) and warrant further investigation in terms of their problematization and resulting effects. As age and ageing have become problematized through governmental discourse, and this discourse is disseminated through policy, it is relevant to explore the current discourses that exist, the potential effects of these particular conceptions, and the policy solutions that follow. Following Foucault (1980), discourses are believed to create ‘regimes of truth’ which constitute conceptualizations of, and acceptable solutions to, the problem itself. Thus, in order to understand the way in which older people conceptualize their own age and ageing at an individual level we must also consider how the ‘problem ‘of old age ‘is discursively produced and rendered governable’ (Oster et al 2016).

By analyzing current ageing discourses, we can also analyze the way in which political rationalities, modes of governance, and social and cultural forces interact in a particular socio-‐historical moment to create value systems and provide ‘acceptable solutions’ to the ‘problem of ageing’. Taking a governmentality perspective, discourse can be considered as a technology of government [or governmental strategy (Robertson 2001, 294 in Crawshaw 2012)] and a structure of power dictating norms and creating moral frameworks in which there are ‘right and wrong’ ways to approach issues of age and ageing. As governmentality refers to ‘the relationship between government and thought (Foucault 1991, in Oster et al 2016), employing a governmentality approach to link rationalities and strategies of government, such as discourse, to individual thought and processes of subjectification is useful. Particularly in trying to understand the identity formation of individuals experiencing old age in the context of recent shifts to ‘positive’ or healthy ageing, but also under the push

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towards more neoliberal rationalities in Western societies (Lemke 2000; Crawshaw 2012). Additionally, exploring the ways in which power operates in daily interactions and behaviors, [such as between older people and health professionals], and the resistance to care of the elderly despite the reality of need, we also can begin to uncover effects of ‘bio-‐ politics’ which come to discipline at a distance and influence individual behaviors and interactions (Gilleard and Higgs 2013). What is useful here is the consideration of how issues of embodiment and identity come to ‘be understood as examples of the micro-‐politics of such disciplinary bio-‐power’ (Sawicki 1988, in Gilleard & Higgs 2013), particularly as the elderly come to reconcile with their ageing bodies and try to formulate socially acceptable identities.

There are barriers to employing a full governmentality perspective, as inherent in its use is the need for reflection upon sociohistorical conditions which ‘render a certain historical knowledge of society ‘real’ “(Lemke 2001), and requires a historical approach which given the constraints of this study is not fully possible. Thus, while I will refer to concepts which structure the governmentality framework, a full governmentality analysis is beyond the scope of this research. Rather, utilizing key concepts of Foucault’s’ governmentality framework such as technologies of the self, and considering the connections between governmental technologies and individual subject formation and behavior, I am able to refer to his larger concepts but consider the effects at a more local level and through additional lenses of emotion management and citizenship regimes. Additionally, viewing emotion-‐ management and identity formation of older people in the ‘active ageing regime’ as ‘examples of micro-‐politics’ allows for a multi-‐level analyses which speaks to the effects of ageing discourses on individual identity and behavior. Considered in the framework of health and social care delivery, and given the current population shift, this issue becomes increasingly salient if we are to structure successful and preventative care for the elderly in a way which empowers individuals to accept support in spite of competing narratives or lingering regime effects (Tonkens 2012). To do this effectively, I build from an individual level and connect larger structures of power and governance in order to allow for a fuller exploration of identity management in the context of the turn toward positive/active ageing. Additionally, as there “have been little serious attempts by sociologists to understand comparatively and historically, the interaction between various forms of human

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embodiment, the physiological process of ageing, and the socio-‐cultural definitions of aging” (Turner 1995, 29) this study intends to fill a gap by offering a multi-‐level analyses which pertains to these specific interactions.

Emotion ‘Work’

Emotion ‘can be and often is subject to acts of management’ (Hochschild 1979, 551). Employing an interactive account of emotion, Hochschild creates a framework which considers the relationship between subjective experience and emotion management. This is done mainly through considerations of framing and ‘feeling rules’ and the effects of larger ideologies. According to Hochschild, emotion management is the work that is undertaken in order to ‘cope’ with feeling rules. (1979). Feeling rules, according to Hochschild are ‘guidelines for the assessment of fit and misfits between feeling and situation’ (1979, 566); essentially, feeling and framing rules ascribe ‘situational appropriateness’ to the way we display, interpret, and internalize emotion. Certain emotions are appropriate in some situations (sadness at a funeral) and inappropriate at others, and these change according to framing rules which relate to the dominant ideological stance. Hochschild’s work builds well upon a more Goffmanian approach [which remains limited by focusing on the way individuals conform ‘outwardly’] by considering the way in which individuals conform inwardly (Hochschild 1979, 556). Additionally, Hochschild combines elements of Goffman’s dramaturgical approach with Freud’s’ psychoanalytic notions of ‘unconscious and involuntary emotion management’ (1979, 559) to create an interactive framework of emotion management which advances both theories by adding in the element of feeling rules. Building from an interactive perspective which incorporates outward and inward management, I am able to consider Goffman’s theory of stigma and notions of embodiment (1970; 1971) without falling victim to the same limitations. As Goffman was charged with placing too much emphasis on the way in which individuals ‘conform outwardly’ and ‘underestimating the social’ (Hochschild 1979, 558) I instead examine the act of altering appearance in the context on internalized notions and emotion management while analyzing these strategies within the wider social context. Additionally, using Hochschild, I am able to examine the inward impact of stigmatizing forces and further elaborate on the impacts of ‘deep acting’ in terms of behavior regulation and emotion management. In this study, external forces of stigma in interactions can be seen to lead to ‘deep acting’ which

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has significant effects on individuals’ ability to reconcile internal feelings with external identity.

Applying emotion management not just to professionals, but to individuals receiving care, offers a different perspective from the majority of literature in which the theories of emotion labor and work are applied; we come to see the significance this has for individuals not just delivering care but those receiving it. For older people the concept of emotion management is salient, as they appear to manage their emotions in line with larger framing and feeling rules which assert they should be healthy, active, and self-‐manage their own care. Due to stigmatizing forces around age and aging, emotion management is used as a social strategy to achieve positive social outcomes, however the impact of such emotional labor was also seen to have negative health and emotive consequences for individuals. Many theorists point out the emotive nature of health and social care work for professionals, but few have worked to investigate the emotional labor that is embedded in receiving care (see Cranford and Miller 2013 for a notable exception incorporating care receivers). Hochschild’s own work often revolved around looking at service work and the way in which emotions played a part, with particular emphasis on gender (see Hochschild 1982, 1993). I instead turn to look at emotion work of a vulnerable group by analyzing the way they choose to present in line with larger discourse/influences to appear self-‐reliant and healthy. Making a link between governmental strategies, discourse, and emotion regulation creates a unique perspective from which to critically consider the impact of discourses around ageing and care that emerge in current contexts where ageing has become increasingly problematized.

As Hochschild concepts have largely been explored and applied to organizational settings, the way in which emotional labor comes to be performed by non-‐professionals is left largely uninvestigated. I refer more broadly to emotion management, but address this in a way which is inclusive of emotional labor and work, choosing to move away from the distinction made by Hochschild between the two. Hochschild has been criticized of dichotomizing the line between emotion management in the private ‘self’ sphere and the ‘public-‐self’ realm (see McClure and Murphy, 2007; Wouters, 1989, in Brook 2009, 532), and she indeed draws a line in her conceptualization between the two. Current scholarship has progressed past

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‘emotional labor’ to differentiate various types of emotion management (see Bolton, 2000a; Bolton and Boyd, 2003; Lewis, 2005; Lopez, 2006, in Cranford & Miller 2013, 2), however the concepts of emotion work and labor still remain distinct. Emotion work is seen as management and presentation of emotions in private realm, whereas emotional labor is management of feelings and emotion to make a ‘publicly observable facial and bodily display’. (Brook 2009, 532) For the elderly respondents in this study both forms of emotion work and labor appear to be employed, however the ‘labor’ [as conceptualized by Hochschild] is seen to be enacted around family and friends as well as around professionals and in public. Moving away from Hochschild’s original distinction, I work to investigate the way in which non-‐professional, particularly care recipients, do in fact engage in emotional labor to resist appearing ‘in need’. Indeed, individuals in my own presence enacted facial and bodily displays to downplay their own pain and physical struggles, as well as the [physical display and exploration of] depth of their emotions. Thus, this research chooses to use a conception of emotion management which includes Hochschild’s concepts of both work and labor, purposely moving away from the distinction and towards a more holistic view of emotion management and the negative consequences it can have. Additionally, individuals can be subject to ‘management’ which exist outside the labor market, which as I attempt to show here, stems from social norms and technologies of government.

Regarding the processes of emotional labor rather than referring to workplace orientations and how management ‘strive for workers to internalize the feelings they are required to display’ (Hochschild 1979) I argue that by incorporating a governmentality perspective, ‘management’ can be effectively replaced by ‘government.’ Individuals as ‘subjects of government’ come to engage in emotional labor to align with the demands and normative expectations of citizenship [including the consistently reformulated requirements place on old-‐age.] Emotion management thus comes to be seen as part of the citizenship regime in which individuals live, but more broadly as a technology of government using discourses and strategies to push particular ‘truths’ about the way the ageing body should appear, behave and the way in which older people should feel about ageing and care.

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Connecting the two: Citizenship Regimes

Tonkens’ work builds directly upon Hochschild’s theory of emotion but expands the theory by creating a link between the ‘micro level of framing and feeling rules’ and ‘macro-‐level phenomena’. Tonkens’ introduces the concept of citizenship regimes into the theory of emotion in a way that allows for exploration of influential factors at the meso level, which she argues is where framing and feeling rules originate. To create this link Tonkens’ builds on Jenson and Phillips (2001) theory of citizenship regimes by incorporating framing rules and Hochschild’s central focus on ‘dimensions of power and emotions (feeling rules)’ (Tonkens 2012). She argues that citizenship regimes effectively replace Hochschild’s conception of ideologies by moving beyond ‘mere ideas’ and helping us to understand ‘tangible material practices’ such as regulations on who is entitled to receive care (Tonkens 2012, 194). This theory is particularly useful here as citizenship regimes create a tangible link and provide a basis to analyze influences at the group [meso] level, which stem from more macro processes [such as technologies of government] and effect individual behavior. Although there is some overlap between what is considered the meso and macro, I assert society, or citizens as a group, exist at the meso level. The regimes which govern citizens and set the ‘rules’ and normative expectations also coexist at the meso level, although the formative influence stems from the macro level of governmental power and influence. Citizenship regimes, as conceptualized by Tonkens, incorporate the institutional arrangements and power relations that guide and structure policy, relating also to discourse and including government more broadly. In this way citizenship regimes provide a stepping stone from individual behavior to governmental influence, allowing us to consider each element as well as the space in between.

Within this conception, governmental processes and outputs, such as policy, come to build upon, but also act as part of the citizenship regime, structuring individual behavior. However, as the concept of citizenship regimes becomes complex and somewhat unclear given the possibility of lingering influence and overlapping/contradictory rules (see Tonkens 2012), incorporating a governmentality approach allows us to consider citizenship regimes but place it in the current context of recent governance and political rationale. This also allows us to see how framing and feeling rules can come to be considered in their own right as ‘technologies of government’ in creating certain self-‐regulating subjects.

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The concept of citizenship regimes is not without fault. Although it advances the idea of emotion management beyond the individual, it also remains somewhat ambiguous. Considering how citizenship regimes set in place certain framing and feeling rules, citizens are said to be influenced by these rules and structure behavior accordingly. However, Tonkens (2012) argues that subjects are also influenced by past regimes which they may have passed through at any stage of life. This makes it difficult to discern between influences and to say concretely if individuals’ behavior and emotion management are a result of particular framing rules or a myriad of other factors. Additionally, Tonkens does not discuss stages of life at which citizenship regimes may come to have the most impact. Thus, for individuals like the elderly service-‐users in this study, they may subscribe to any combination of framing and feeling roles associated with regimes ranging from the community, welfare recipient, the citizen consumer, active citizenship, [and now arguably] the responsibilization regime. This makes concrete analysis difficult and convoluted, and also leaves a certain amount of ambiguity around the direct impacts of citizenship regimes on individuals.

Although the concept remains useful, particularly in defining distinct sociohistorical periods and the associated institutional and social context in terms of care and citizenship, I feel making an argument based on this alone would leave a lot of analysis open to re-‐ interpretation. Instead, I choose to connect citizenship regimes to the current and recent political rationale and governmental strategies that are seen to be present and effect individuals now. In this way, although individuals may be seen to subscribe to additional framing rules of former regimes, the impact of the current climate remains central and emotion management can be considered in this effect, enabling for a concentrated focus and cross-‐case analysis. Introducing the concept of governmentality still pays credence to the multitude of influential factors, but focuses us on the current sociohistorical moment and allows consideration of the particular effects which are unique to this time period, for all individuals, regardless of which regime rules they subscribe to. By drawing a direct link between citizenship regimes and governance, mainly the reigning political rationale, policy discourses, and overarching governmental strategies, we are able to more concretely discuss and analyze the way in which citizens are explicitly directed and encouraged to

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behave. Particularly, by analyzing the discourse surrounding ‘good’ and bad’ behaviors around health, care, welfare, and ageing and the institutional arrangement that currently support this. Giving credence to the influence of past regimes on individuals, but consistently drawing back analysis to the current regime and governmental strategy, we are able to give weight to individual’s subjective experiences but also place this a specific socio-‐ historical and political context.

Technologies of the self

Drawing on Foucault’s ideas of ‘technologies of the self’ we can see how emotion management may operate as a technology of government, and further uncover the effects of conceptualizations of ageing and policy discourse on individuals.

As Foucault states,

‘IN THE END, WE ARE JUDGED, CONDEMNED, CLASSIFIED DETERMINED IN OUR UNDERTAKINGS, DESTINED TO A

CERTAIN MODE OF LIVING OR DYING, AS A FUNCTION OF THE TRUE DISCOURSES WHICH ARE THE BEARERS OF THE

SPECIFIC EFFECTS OF POWER’ (1980, 94).

Foucault illuminates the level of influence and power that discourse can have on individual life trajectory and identity formation. As he points out, individuals are ‘judged, condemned, classified,’ highlighting a moral element of the effects of discourse production; resulting in a ‘right’ and ‘moral’ way to age and a ‘wrong’ and ‘irresponsible’ way (Foucault 1980). Here, the moral way aligns with the constitution of ‘healthy’ and therefore ‘successful’ ageing which is conceptualized as the result of ‘prudent self-‐care’ (Powell and Biggs 2004, 20). Those who remain healthy in old age represent the living of a ‘moral life’ which brings particular benefits and also ‘relieves others of any obligation of care’ (Powell and Biggs 2004, 20). As discourse is not ‘merely contemplative or justificatory, it is performative’ (Rose & Miller 2010, 275) this narrative of self-‐care and responsibility sends a message, creating particular values and structuring behaviors to align with the ‘right’ way, which becomes internalized by older people [shown in narratives of self-‐care]. The political rationality deriving from market principles and a broader neoliberal push, and the creation of an ‘active citizenship regime’ [inclusive of responsibilization] mobilizes through discourses and encourages individuals to play an active and engaged role not just in the community but in terms of their own health and care (Tonkens 2012). Individuals are simultaneously expected

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to make care choices based on individual conceptions of their own need, and required to play an active [or ‘preventative’] role in their own health-‐management. In this current regime if individuals become unhealthy or needing of care then they have subsequently ‘failed’ at this project of self-‐management. Further, there exist notions that they have not led a ‘moral’ life and become undeserving of additional support and care. In this fashion, Foucault points out how such ethical framing leads to individual subjectivity, producing in a sense, technologies of the self-‐ ‘this requires him to act upon himself, to monitor, test,

improve and transform himself’ (Foucault 1987: 28, in Powell and Biggs 2004, 21).

I argue that the process of subjectivity and creation of technologies of the self through internalization of discourse further entail elements of emotion management (Hochschild 1979). As ageing discourses specify how older people ‘should’ age, it also sets feeling frames of how they should feel; healthy, happy, fulfilled, positive, energetic, engaged. It also includes ways of being and presenting to the world, as individuals are told success is being healthy, positive and active (Dillaway and Byrnes 2009; Formosa 2013). Additionally, as discourses and policies around ageing push a responsibilization agenda, individuals are subject to further framing rules which dictate that they should self-‐manage, ‘take care of things themselves’ and feel happy and proud of being able to do this. For individuals who are seen to ‘rely’ on care, feelings of shame, guilt, and frustration are activated. In this way policy goes beyond defining which activities are permissible or not, it also functions to create and furnish particular ‘visions of experience, such as later life which legitimize a place in which social subjects are able to form publicly acceptable identities’ (Biggs 2001, 305). In order to maintain a socially ‘acceptable identity’ within this particular framework, individuals must ‘appear’ to be these things; arguably at the cost of being forthcoming about care needs and ailments.

Stigma

As Goffman asserts, individuals construct a conscious appearance and try not only to conform outwardly but inwardly (1971). As individuals manage emotions, they consequently [albeit subconsciously] construct identities in line with dominant discourses, such as positive aging; they internalize social pressures to conform, and feeling frames dictate how one should appear and present emotions and self in an ‘acceptable way’. This refers more

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generally to ‘emotion work’ and the suppression and evocation of particular feelings, which can happen simultaneously and often. As Goffman (1970) argues, this is partially the result of stigmatizing forces. As the social environment of the individual, inclusive of the discourses and stigmatizing forces pertaining to age and ageing, influences individuals’ behaviors, feelings, and their self-‐management, the effect of broader power structures on conceptions of age and ageing becomes undeniable. As Cole (1992) reminds us,

‘[AGING AND OLD AGE] ARE CERTAINLY REAL, BUT THEY DO NOT EXIST IN SOME NATURAL REALM, INDEPENDENTLY

OF THE IDEALS, IMAGES AND SOCIAL PRACTICES THAT CONCEPTUALIZE AND REPRESENT THEM’ (IN FEATHERSTONE

& HEPWORTH 1995, 249).

Thus, it is at the individual level of experience and feeling where we can begin to explore the interactions and influences of broader forces on individuals’ conceptualizations of ageing, identity, and the consequential health and care-‐ related behaviors. Here is also where we may begin to explore the potential paradox of more ‘positive’ discourses and policies around ageing. For example, policies are seen to encourage more personalized care and promote independence with importance placed on helping individuals remain at home longer, yet the discourse is one which may encourage individuals to present a ‘mask’ of health rather than seek care [which may act preventatively and help avoid hospital/care-‐ home admission] and potentially increase in-‐home risk. (See Powell & Longino 2001; Turner 1995 for expansion on theories of mask of ageing and somatic society). In this way, such technologies of the self ‘reveal politics as inscribed in the texture of everyday life and outside solid institutional forms” (Brodwin 2015). Particularly, this shows the effect of governmentality with policy discourse managing to ‘govern at a distance’ and create subjects which self-‐regulate to fit in line with socially defined ‘norms’ of aging. For this research, focus has been given particularly to the ‘reluctance’ of asking for and receiving care which, I argue, both results from and works counterproductive to the current discourses around ageing.

Conclusion

This study draws together key concepts from three strategic theories to create a comprehensive framework for understanding and analyzing individuals’ behavior and feelings towards care reception. Concepts are selected and incorporated in order to conduct

'I ought to do it myself' : conceptualizations of ageing and care in a responsibilization regime