The Time of Care: Conference Review

In the final post of the Waiting Times takeover, Kelechi Anucha and Stephanie Davies reflect on discussions emerging from the Time of Care conference.

An image of one person standing and two people sitting in front of a projector screen. The person standing is holding a microphone and speaking with their right hand raised close to their face.
Lisa Baraitser speaks at the Time of Care Conference in March 2023. Source: Waiting Times Project

Towards the end of March 2023, around seventy people gathered virtually and in person at the Friends Meeting House on Euston Road (London) to mark the end of the five-year, Wellcome-funded research project Waiting Times. They included historians, activists, psychosocial researchers, artists, anthropologists, housing association residents, psychoanalysts, social scientists, general practitioners, and friends, many of whom also collaborated in the research project. This was a true reflection of the reach and interdisciplinarity of the project, attesting also to the wider appeal of waiting as an analytic device for thinking critically about time and care during an ongoing crisis of waiting times in the NHS, successive rounds of lockdowns in a global pandemic, national strikes in the public sector, and the more general, lethargic waiting for things to get better, that shows no sign of ending soon.

In this final post of the Waiting Times takeover of The Polyphony, we distil some of the pressing questions and discussions emerging from conference panels organised around three research strands of the Waiting Times Project: Waiting in Late Times, Watchful Waiting, and the Psychic Life of Time. These responses to the findings of the project helped to deepen and extend understandings of waiting, not just as a marker of service inefficiency and abandonment, but potentially also as a time of care.

Waiting in Late Times: the “Meanwhiles” of Healthcare

What might it mean to wait in a post-war period of intensifying hierarchies sometimes characterised, through a Marxist lens, as ‘Late Capitalism’? What does it mean to be suspended in this “meanwhile”, anticipating a threshold of change?

Two images of speakers from the 'Waiting in Late Times' Panel, speaking in front of an audience and behind a microphone on an angled stand.
Speakers from the ‘Waiting in Late Times’ panel. Source: Waiting Times Project

Responding to Kelechi Anucha’s paper on fugitive care, Dr Lara Choksey acknowledged the potential for coercive and forced return contained in the premise of flight. Thinking about Saidiya Hartman’s reimagining of W. E. B. Du Bois’ short story ‘The Comet’, examined in Salisbury’s paper on doomscrolling, Choksey utilised the New Testament story of ‘The Prodigal Son’ to frame a question about the stakes of going back to “normal”, and how narratives of return (as redemption, or rehabilitation) lend credence to the paternalism of historical time.

Dr Christine Okoth placed Anucha’s concerns about the uses and politics of fugitivity in the context of recent work by Rinaldo Walcott, who calls for careful consideration of why the concept is now so compelling (Walcott, 2018). Responding to Anucha’s formulation of the experimental dimensions of fugitive care, developed through a reading of Jacqueline Roy’s The Fat Lady Sings (2021), Okoth makes a helpful distinction between the aestheticised experimentalism recently historicized by Natalia Cecire (2019) and a fugitive space of radical connection formed under environments of control that mirror the restrained conditions of the (scientific) experiment.

Professor Adam Piette responded to papers by Martin Moore and Michael Flexer on the waiting room, by presenting the idea of the existential waiting room of mass care endured by refugees in camps in Europe. Through readings of Anna Segher’s novel Transit (1944) and Samuel Beckett’s short story ‘Lessness’ (1969), Piette makes connections between the plight of migrants in the post-war past into the present.

Picking up on Laura Salisbury’s evocation of ‘doom’, Professor Ghassan Hage drew on his work on decay to think about the relationship between waiting and death (Hage, 2021). Hage reminded us of the old Heideggerian theme in the idea that every act of waiting can be thought through as an avoidance of the ultimate act of waiting for death. Responding to the theme of racialisation and inequality in healthcare running through this panel, Hage also drew on his ethnography of white Australian supremacy to analyse the temporal politics of extreme right-wing views (Hage, 1998).

Watchful Waiting: Frequent Attenders, Care and Repetition in General Practice

What is at stake in continuing to offer care to people and situations in healthcare that seem to demand the most time and attention, and the least promising outcomes and satisfaction? How is this tension embodied by the NHS “frequent attender”?

A collage image of four speakers from the 'Watchful Waiting' panel. Two speakers are appearing via video call and two are in-person.
Speakers from the ‘Watchful Waiting’ panel. Source: Waiting Times Project.

Professor Felicity Callard (University of Glasgow) invited us to think about how the phrase “frequent attender” obscures other categories – such as the frequent unattender and the infrequent attender – with their own needs and anxieties, producing their own affects. Responding to Flexer’s conceptualisation of how the attender is increasingly problematised as the ‘offender’, Callard marks the incursion of disciplinary procedures into spaces of care. Picking up a source Moore examines, in which one GP complained that the NHS was reconfiguring doctors as ‘errand boys’, Callard drew attention to relations of power which position certain subjects at different times as variously problematic, susceptible, or valued within systems of healthcare.

Reflecting on Stephanie Davies’ description of her work as an ‘interrupted ethnography’, Professor Todd Meyers (McGill University) asked productive questions about how the ethnographer, like the physician, might struggle to stay in the moment. In this vision, the picture of ethnography starts to look like the picture of the patient in the clinic. ‘A nonprogressive temporality of care’ and ‘a cultivated practice of going nowhere’ (Davies, 2023), could be the kinds of non-prescriptive postures taken by the social scientist, who cares enough to be in the single moment without the promise of a moment to come.

Professor Femi Oyebode (University of Birmingham & former Consultant Psychiatrist), highlighted the importance of recognising individual subjective experiences of time, which gain context and meaning in relation to other temporalities – such as the end-of-life.  He notes that another way of referring to the frequent attender is the ‘heartsink’ patient, a term that persists despite its derogatory connotations. For Oyebode, this term captures a certain truth about the situation of the frequent attender, through its acknowledgement of the difficult feelings that these encounters can sometimes engender in clinicians; maintaining reflexivity and honesty leads to an understanding which enables them to continue to do the work, as modelled in the Balint Groups, without becoming unduly callous or detached. Dr Jonathon Tomlinson (GP), echoed this view, emphasising the ability to learn to notice discomfort and sit with it, as key.

The Psychic Life of Time: Gender, Care and Psychoanalytic Practices of Waiting

Can a practice of waiting be understood as a psychoanalytic form of care? How can psychosocial models offer ways of breaking out of the static, capitalist, White time of permanent crisis?

The Psychic Life of Time strand of the project considered these questions partly in relation to gender. What does it mean to care now for young people, as they explore their gender identity in the context of an NHS service in the throes of different forms of chronic and acute crisis?

An image of speakers from 'The Psychic Life of Time' panel. One speaker is standing, reading from a piece of paper into a microphone on a stand. Two other speakers are sitting at a table in front of a projector screen.
Speakers from ‘The Psychic Life of Time’ panel. Source: Waiting Times Project.

Responding to work by Lisa Baraitser, Jocelyn Catty and Raluca Soreanu on the temporalities of psychoanalytic care, Professor Katie Gentile (CUNY) asks, if ‘care of the possible’ (Stengers, 2015) requires holding temporally dense inheritances of violence, what are the politics of suspending time? She suggests that, just as John Cage’s ‘silent’ piece 4 minutes, 33 seconds isn’t without music, waiting is not without temporal motion. Can practices of waiting for others in the form of (psycho)analytic listening maintain revolutionary potential in the context of social and political upheaval, amidst material and ontological conditions of violence?  Gentile suggests that in exploring these questions, the Waiting Times project, to paraphrase Jane Bennett (Bennett, 2009), attempts to create multiple channels for communication and the emergence of the conscious and the unconscious.

Picking up on Osserman’s work on multiplicity, Dr. Avgi Saketopoulou (NYU) notes that

‘we need to sidestep the fiction that gender is an internal truth that clinical work can accurately unveil if given time. Time, whether provided or withheld, will not answer the question of what gender one is. To work, then, with gender complexity as psychoanalysts we have to remember that gender is one of many ways all subjects (cis, trans, and genderqueer) craft a self, that we all experiment with who we become throughout the lifetime – though not all experiments come under the same scrutiny or enjoy the same object relational and institutional support’.

Rather than focusing on whether such trials are “valid” (corresponding to a true self, or “real” gender identity), or failed endeavours (which is how de-transitioning is nowadays misleadingly read), Saketopoulou suggests we recognise how debates about time delay us: from improving our theorizing and from taking the challenge of difference and singularity seriously.

Professor Zoë Playdon (University of London) also takes up the problematic of untimeliness in relation to gender identity, suggesting that a fantasy of cisgender temporality overlays real trans lives. Critically historicizing problematic medical discourses of ‘gender’ and ‘gender identity’ emerging from the US in the 1960s, she demonstrates how trans care within the NHS has been shaped by US models. Playdon emphasises importantly the stakes of delay in relation to the average wait of over two years for admission to the Gender Identity Development Service (GIDS). For Playdon, the challenges facing us now include finding a language that refuses cis-centric temporal anxiety: ‘perhaps the longest waiting time for trans kids and their families has been for their history to be told, for without it they are subject to an epistemic injustice, not least of which is the testimonial inequity in which cis “competent knowers” gatekeep against trans “incompetent knowers”’.

Conclusion

The roundtable session at the day’s end was an opportunity to hear from members of the Waiting Times Steering Committee. In his concluding thoughts, Professor Mathew Thomson (University of Warwick) reflected that the proposal to connect waiting with care, while potentially ambitious and interesting, was also risky: it was not immediately clear how the idea would work out. However, this risk had a generative dimension, enabling forms of thinking outward, yet also pulling thinking from different disciplines back in to focus on care and time, in ways that have proved timely in relation to COVID-19.

As a historian, Thomson reflected on the assumption that historians are the researchers who “do time”, yet acknowledged the project’s outcome of an expanded toolkit of temporal concepts – such as ‘waiting with’, Late Times, the “Meanwhile” and grey time – offered potential for historians and others to think richly with.

We ended by thinking together about one of main tensions the project highlighted: the idea that satisfaction with the NHS is the lowest it has been for a long time, due in part to extended waiting lists. Yet, waiting has been part of NHS care since its inception and is built into its DNA. What is worth thinking about now is the question of inequality, and how it shapes the changing mobilisation, politics and experiences of waiting, in all of its forms and valences.

References

Bennett, Jane. 2010. Vibrant Matter: A Political Ecology of Things. Durham: Duke University Press.

Cecire, Natalia. 2019. Experimental: American Literature and the Aesthetics of Knowledge. Baltimore: Johns Hopkins University Press.

Hage, Ghassan, ed. 2021. Decay. Durham: Duke University Press.

———. 1998. White Nation: Fantasies of White Supremacy in a Multicultural Society. Annandale, NSW: West Wickham, Kent, U.K: Pluto Press ; Comerford and Miller.

Hartman, Saidiya. 2020. ‘The End of White Supremacy, An American Romance’. BOMB Magazine, 5 June. https://bombmagazine.org/articles/the-end-of-white-supremacy-an-american-romance/.

Walcott, Rinaldo. 2018. Freedom Now Suite: Black Feminist Turns of Voice. Small Axe: A Caribbean Journal of Criticism 22 (3), pp. 151–59.

About the Authors

Kelechi Anucha completed her PhD in English at the University of Exeter as part of the Waiting Times Project. She is an associate of the Wellcome Centre for Cultures and Environments of Health and a member of the Black Health and Humanities Network. Her project examined the relationship between time and care in contemporary end-of-life narratives. Twitter: @DrKelechiAnucha

Stephanie Davies completed her PhD in Psychosocial Studies at Birkbeck, University of London as part of the Waiting Times Project, investigating the ‘watchful waiting’ of general practitioners as a practice of care. She is currently a postdoctoral research fellow within the department of Social, Therapeutic and Community Studies (STaCS) at Goldsmiths, University of London.

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