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What's in a word?
Defining care

care health soundness attention well-being oversight healthcare

Contrasts and Contradictions

Care is a word of diverse meanings and curious contrasts. The first apparent contradiction is that three of the four verb definitions (Table 1) listed by the American Heritage Dictionary are based on nouns or adjectives, while all seven nouns (Table 2) are derived from verbs. Thus care* names a kind of activity, but (by virtue of being a verb with certain characteristics) care also describes a special relationship. Said another way, some definitions of care specify a kind of mental activity, while others describe a state of mind.

The second contrast is that while many definitions of care are cerebral in nature (as in paying close attention), all have an underlying visceral, emotional quality. A close analogy is the way in which cortical functions of the central nervous system overlie those of the limbic system. Yet a third contrast is that the feelings catalogued range from affection to anxiety and from comfort to grief. A mother, for example, cares for her infant, providing love, protection, nurture and comfort. Yet because of her concern for the child, she worries over its safety and grieves when it is harmed, a tension familiar to all. Out of these assorted definitions and apparent contradictions emerges a portrait of care as rich as the store of human experience.

Table 1.
Verb Sense
1. to be concerned or interested
2. to provide needed assistance
or watchful supervision
3. to object or mind
4a. to have a liking or attachment
4b. to have a wish, be inclined
(Emphasis mine: indicates
  predicate adjective or noun.)
Table 2.
Noun Sense Verb Form
1. burdened state of mind; worry to worry; to be burdened
2. mental suffering; grief to suffer; to grieve
3. an object or source of
worry, attention or solicitude

to worry; to attend to
4. caution in avoiding harm or danger to use caution; to avoid
5a. close attention;
painstaking application
to attend;
to apply
5b. up keep; maintenance to keep up; to maintain
6. watchful oversight,
charge or supervision
to oversee;
to supervise
7. attentive assistance or treatment to assist; to treat

Who Cares? (And for what, or for whom?)

To fully appreciate the variegated mural that is care, we must first inspect its grammatical surroundings, the backdrop against which the various shades of meaning appear. This setting, which all definitions of care have in common, is the subjective nature of the word. (a sentient subject) cares (for an object)Every verb requires a subject, an agent to carry out the action, in this case the activity of caring. Grammatically, any noun would do, a hat or a boa constrictor, for example, but for the sentence to make sense, the verb care requires a special subject, one with unique characteristics. In ordinary discourse the subject of to care is never an inanimate entity. On rare occasion it may be a plant or lower animal, but typically the subject is a higher animal or a person. In short, caring implies the presence of a sentient subject.

At the other end of the sentence, the verb to care implies the presence of an object, the entity (or entities) for which, or about which, the subject cares. With the exception of an unusual construction requiring an infinitive as the direct object [Would you care to dance?], the verb to care is intransitive and thus does not require a direct object. Nevertheless, most uses of this (intransitive) verb imply the presence of an indirect object, even when it is not explicitly stated. Although care does not do anything to the object directly, care is always about something or for something. The upshot is that the verb to care conveys a type of relationship between a sentient subject who cares and some (indirect) object of such caring. It is the nature of this relationship that we are beginning to explore here.

inter- between, within
esse to be
interesse to be between
to take part in

Regardless of their differences, then, the definitions of care all have this in common: the participation of a sentient subject and the presence of an indirect object. The first verb sense, to be concerned, interested, for example, demonstrates this point admirably. The word interest* (concern) comes from a set of Latin roots that, taken together, literally mean to be in between, to participate in. This kind of participation is no mere happenstance, but implies active involvement through perception and conceptualization.

com- together, with
cernere to sift, separate
concerne to mingle together

The word concern* (interest), in turn, stems from Latin roots meaning to sift together, to mingle. The base cernere (to sift, separate, decide, determine, perceive) is the source of many other English words including discern*, certain*, ascertain, and secret*, all of which clearly imply sentience. To be interested in or to be concerned about a given situation requires a subject capable of participating in the situation through the senses and through the mind. And it is the given situation that is the object of interest or concern.

Sentient* is an interesting adjective in its own right, coming from the Latin sentire, to perceive by the senses. Other English words derived from the same source include: sentence, sentiment, assent, consent, sensation and sense* itself. The prehistoric root [sent-], from which the word send also comes, means to head for, go. Etymologically, then, to be sentient is to reach toward through the senses, to go mentally. The subject must be sentient in order to reach toward the object of care through the sensory/mental faculties. The words subject and object both come from the Latin iacere, meaning to throw. An object is literally thrown "against", while a subject is thrown "under". The operative metaphor is this: a subject and an object are distinct, apart at some distance, but at a distance that is overcome mentally by virtue of the subject being sentient.

A noun or a verb?

One of the paradoxes of the verb care is that three of its four definitions (Table 1) derive their meanings from nouns or adjectives. The exception is Definition 3, to object, which itself implies the need for an indirect object to which the subject objects [Do you care if I tag along?]. The other verb definitions rely on nouns (or adjectives) for their primary meanings as follows:

IS concerned, HAS a liking (for an object)

Definition 2 is to give some kind of service. Otherwise to care means that the subject is in a given state of mind (predicate adjective) or has a certain mental or emotional characteristic, and this particular state of mind is in regard to a particular object (whether abstract or concrete).

(a sentient subject) gives/exhibits cares (for an object) Precisely the same kind of subject-object relationship is implied by the noun care as for the verb. In the case of the noun, however, care is typically the direct object of a transitive verb. When care names an activity, the verb is active, such as to give or to provide, and the pertinent subject becomes a caregiver or care provider. When care names a state of mind (such as worry or grief), the verb preceding it is more passive (usually meaning to exhibit). In the latter case, the exhibited mental state is a state of mind related to some indirect object; thus the subject-object relationship is preserved. Every use of the word care in ordinary conversation requires the participation of a subject that is capable of going mentally or emotionally toward an entity beyond itself. In other words, some type of relationship between a sentient subject and an indirect object is taken as a given. What remains to be unfolded here is the nature of this subject-object relationship in its many and varied aspects.


So, what does care actually mean?

Having demonstrated the unique grammatical relationship between a sentient subject and the (indirect, but ever-present) object of care, we are now ready to begin exploring the various meanings associated with this relationship. In surveying the four verb senses Table 1 and the seven nouns found in Table 2 above, the first observation is that essentially two different kinds of sentience are implied: (1) sentiment (visceral), and (2) intellect (cerebral).

In later chapters I will argue that the care in healthcare is an intellectual or cognitive activity. Specifically, we will investigate the cognitive functions found in two noun definitions:

On the other hand, the visceral-emotional undertones of care offer one a unique appreciation for the human condition, which in turn deepens our understanding of healthcare. What we find is another stark contrast, in which care speaks of worry and concern, but also of hope and desire. Before moving on to our study of health, therefore, we will first explore:


Cares and burdens (a tale of worry and woe)

The first definition for the noun care is a burdened state of mind, and the second is mental suffering, grief. It so happens that the words burden and suffer have a common prehistoric root [bher-]* (to carry, bear). A burdened* state of mind, therefore, is the condition of being weighed down, oppressed; loaded or overloaded. To suffer*, by the same token, is to endure or bear* something painful or unpleasant. Suffer also reflects the prefix sub-, meaning under. In both cases, the metaphor is one of laboring under a hardship, carrying a heavy load. This metaphor is reinforced by the word grief (mental anguish) found in definition two. Grief* and its verb form, to grieve*, both arise from the Latin gravis, which means heavy. From the same Latin root we get gravity* (seriousness) and grave* (requiring serious thought). Again the image of heaviness (weightiness) applies.

An entirely different metaphor is suggested by worry, found in the second half of definition one. Worry* (uneasiness, anxiety) comes from the Old English word wyrgan, which meant to strangle. Anxiety, in turn, stems from the prehistoric root [angh-] (painfully tight), the source of anguish, angst, anger and angina. Any number of distressing images come to mind, from uncomfortable clothing to a perilous noose about one's neck.

Although its lineage is not entirely certain, the etymology of care suggests these notions of suffering, grief, burden, worry and anxiety. It is first found in Middle English, coming from the Old English cearu (sorrow), which is related to cearig (sorrowful), also the source of our word chary* (very cautious, wary, but originally sad). These Old English words are possibly derived from the Germanic [karo], from the Indo-European [gar-] (to cry, to give voice), source of garrulous and slogan (originally war cry). From a whimper to a wail, vocalization is a common response to sorrow of all kinds. It should also be noted that the English word sorrow is etymologically related to the German word for care, which is sorge.

Why should sorrow be such a prevalent part of human experience? The answer has to do with the essential nature of the universe in which we live, a universe subject to the inexorable law of entropy. Now, entropy* is a concept I broach with trepidation because it is an idea that begs to be oversimplified (hence misunderstood). Nonetheless, this concept can hardly be avoided, so I offer my own oversimplification with a promise to unpack it later. In a nutshell, the notion of entropy leads to the Humpty-Dumpty phenomenon: we would that he had not fallen, because putting Humpty together again is difficult, time-consuming and expensive. Humpty's fall leads to increasing disorder and it is irreversible (see note). The notion of entropy is also related to the concept of gravity in the fact that water always tends to run downhill (unless energy is used to pump it uphill).

To see how entropy (or gravity) might be related to worry or sorrow, merely think of your favorite vase or dish that has fallen to the floor and been smashed. We are admonished not to "cry over spilt milk" because by then it is too late to do anything about. (It is irreversible or "water under the bridge" so to speak.) But we do mourn lost or damaged possessions and squandered opportunities all the same. Incidentally, the words to mourn and to remember come from a common root.* The connection to healthcare will become apparent in the section on Defining soundness, soundness being one aspect of health. The loss of soundness due to injury or disease is an example of irreversibility and hence a manifestation of increasing entropy.


Inclinations and likings (a tale of hope and gratitude)

In contrast to the doom and gloom just discribed, the fourth definition of the verb to care (Table 1 above) is positively cheerful. To care for someone or something is:

definition example
4a. to have a liking to have an attachment "Darling, I care for you with all my heart."
4b. to have a wish to be inclined "Yes, I would care for some dessert."

This definition of caring is one of hope and desire, of wanting and wishing on the part of the subject toward the object of inclination. In a sense, this type of process is precisely the opposite of increasing entropy. Instead of increasing disorder, a liking is the tendency to increase order by finding a given object or situation more pleasant or attractive than other objects of situations. Instead of dispersion, we have here attachment. Instead of gravity tending to pull everything downhill, inclination means leaning toward or leaning upward. To wish comes from the same root as to win, in other words to seek; to gain; to strive for.

This is not to imply that the second law is violated by wanting or wishing, for the entropy of the system as a whole increases with all effort. But what caring means (in this sense) is that by expending energy allowing entropy (disorder) to increase globally, it is possible to increase order in a specific location or situation. To have a liking or an inclination is to be selective, to choose, hence to increase order. A synonym for liking is affection. To affect, in turn, comes from ad-, toward, and facere, to do; make. Thus affection is a powerful motivating force. Similarly, the word appetite comes from ad-, toward, and petere (also impetus), to seek, most often the seeking of food, but possibly other objects of desire as well .

It is a paradox that a single word, care, can be used to mean suffering or worry in one setting and a liking or a wish in another. And yet, perhaps the paradox is not so great. Without affection, there would be no grief, without wishing, no disappointment, without attachment, no worry. Appetites (a good thing) easily become addictions (potentially harmful). And for what it's worth, our word sad comes from the same root as that of satiated and satisfied.


Care in a Nutshell

Care is a verb (or a verbal) that requires a sentient subject and an indirect object toward which the activity or the relationship of caring is directed. Sentience implies that the subject reaches out through the senses to become an active participant in a situation from which the subject is otherwise distinct. Sentience includes intellect (to be discussed later) and sentiment. The sentiment of caring reflects the human condition of living in a world where spontaneous processes are irreversible. This irreversibility leads to worry and sorrow and grief. Yet the human condition is also one of hoping and wishing and striving, the flip side of the sentiment of caring. We are now ready to examine the indirect object of care, namely health.

 

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