Book Review: Just care: Messy entanglements of disability,dependency,and desire

How can academic researchers provide insight into crises of care, such as the ongoing COVID-19 pandemic, and what can they reveal about broader power structures operating in the realm of public health? One trenchant example of such scholarly insight can be found in Akemi Nishida's recent book, Just care: Messy entanglements of disability, dependency, and desire . In Just care, Nishida explores the multifaceted essence of “care,” indicating the intricate and insidious nature of our current healthcare system in the United States while also suggesting that care can function as an unexpected mode of activism. Over the course of the text, Nishida deftly accomplishes her stated goal of “connecting [the] dots of homemade and academically driven theories to offer one way to understand the structure and everyday practice of care, care activism, and visions emerging in the sites of care” (p. 32). She illuminates how care can both enforce dominant power structures and be instrumentalized as an expression of resistance against these power structures.

Nishida's “homemade and academically driven theories” referenced above encompass not only auto-ethnography and collaborative, community-oriented research, but also interdisciplinary theorization drawing from disability studies, affect theory, and feminist theory. Her predominant methodology is what she refers to as “relational analysis,” which builds on feminist disability studies in analyzing and dismantling the assumed dichotomy between care workers and care receivers, in the hopes of fostering “a more holistic understanding of care formation” (p. 12). This disassembling of binaries is one of the most crucial interventions in the book. Nishida brings in an (at times overwhelming) assortment of philosophers and scholars, as well as examples from her interviews with care workers and Medicaid enrollees, to elucidate the nuanced and ever-evolving notion of “care.” Just care demonstrates that care is not unidirectional, and moreover, that care circulates affectively, in the form of transitive orientations and energies and encounters. Nishida's text challenges the typically unquestioned divide between care workers and those who receive care; or in other words: the binary of giving versus receiving.

In this vein, Nishida asserts that “care” is a multiplicity, and that the commoditization thereof—but particularly the increasingly exploitative and profit-driven public healthcare apparatus—has resulted in the continual de/valuation of both disabled people and people who administer care. Nishida does not deny the positives of Medicaid in the U.S., but convincingly argues that Medicaid has been transfigured into an “assemblage” that reduces people to mere numbers through capitalist calculations. As evidenced by Nishida's central claims, this healthcare assemblage manages and (further) marginalizes underserved populations. Above all, this assemblage reinforces “responsibilization” narratives and acts as a tool for perpetuating poverty since care “has been deployed as a mechanism to maintain and further enforce social stratification” (p. 167). With prose that is often virtuosic, Nishida makes a compassionate case for new methods of care that would no longer function to further debilitate already-debilitated communities.

The book's central drawback, to my mind, is that it is trying to do so many things at once. Its lengthy introduction and five chapters are threaded together via Nishida's problematization of the caregiving/receiving binary; yet there is so much philosophical, ethnographic, and advocacy content packed into each chapter that it can be difficult to hang onto this thread. Over the course of the book, Nishida discusses numerous concepts and key terms, including care justice, care injustice, relational analysis, affective collectivity, necropolitical care (which she defines as the “constant debilitation” intrinsic to the current U.S. public healthcare system), bodyminds, interdependency, bed activism, and crip wisdom. Nishida's brand of crip wisdom—which comprises knowledge and theoretical frameworks put forth by disabled individuals and communities—is grounded not only in heavy philosophical ideas, but also in her lived experiences as a disabled person. I wished that Nishida tethered the abstract concepts more firmly to the more accessible (auto-)ethnographic content; at times the jargon and dense prose clouded her impassioned vision for care justice, activism, and interdependency.

Despite these shortcomings, Just care is a compelling text, especially for those endeavoring to deepen their understanding of disability studies. In the realm of social work, readers might particularly appreciate how Nishida rethinks what “care work” is (and should be) within pervasive conditions of “shared vulnerability” manufactured by hegemonic power structures. Through Nishida's disruption of binaries, readers can glean new possibilities for care itself. Under neoliberal capitalism, “care” has mutated into a necropolitical assemblage: a technique for governance and management. Yet Nishida makes it clear that care is, above all, “ambivalent, contradictory, and a site of multiple affections, intentions, and effects” (p. 107). It is crucial to disentangle our contemporary perspectives on disability, debility, and inter/dependency to better navigate our way through the healthcare assemblage that has relegated so many of us to states of precarity. Reframing our notion of “care” will assist us in grasping the power dynamics embedded within this assemblage, including how it has steered the trajectory of the COVID pandemic. And even more importantly, this reframing will bolster our capacity for accountability, collectivity, and liberation.