Self-Care as Social Crafting: Transnational Narratives During COVID-19

ABSTRACT

Contrary to public health framings of self-care as individualized bodily regulation, people’s transnational COVID-19 narratives revealed self-care to be a means of crafting social relatedness. In their self-care practices, interviewees drew on their richly structured field of relations, exercised dexterity and discernment in attending to them, and forged new webs of relatedness. Moreover, some recounted moments of radical care when they disregarded bodily boundaries in co-isolating with and caring for infected friends or relatives. These narratives of caring with rather than in isolation from one’s social entanglements provide an alternative imaginary through which we can consider future pandemic responses.

KEYWORDS:

• Care
• COVID-19
• illness narratives
• self-care
• sociality
• transnational

Public health narratives implicitly acknowledge the inextricability of self-care and social care. In public health messaging from the World Health Organization (WHO), regular exhortations were made for people to “stand together,” be responsible for the sake of others, and display global solidarity. Actions ranging from “personal protective measures” (e.g. mask-wearing, hand hygiene, social isolation) to national measures (e.g. vaccine and personal protective equipment (PPE) resource sharing) were encouraged on the basis of protecting national and global others. As the WHO’s Director-General expressed in his COVID-19 media briefing on March 11, 2020: “let’s all look out for each other, because we need each other” (World Health Organization 2021). Yet, in the policy guidelines and suggested measures that followed, the WHO and multiple national governments proceeded to effectively separate the self from its social locus, seeking instead to govern and maintain individualized bodies.

Within this paradigm, self-care has emerged as a growing trend and popular concept in biomedicine that denotes “taking care of ones’ physical health, mental and emotional well-being” (National School for Healthcare Science 2022). Under the banner of self-care, individuals are “empowered” to assume moral responsibility for optimizing an ever-expanding host of vital properties, from nutrition (Guthman 2009; Schüll 2018) and mental health (Reveley 2016) to fitness (Markula 2004; Lindner 2020; Schüll 2016), genetic risk and reproductive fecundity (Rabinow and Rose 2006; Rose and Novas 2005). It is a view of self-care which heavily draws on Foucault’s (1978, 2002) claim that networks of power, from the seventeenth century onwards, have increasingly drawn from and intervened with human existence, that is, life itself, bringing this to bear on the dual poles of the regulation of populations and the disciplining of individual subjects. Rabinow and Rose (2006:197) have extended Foucault’s arguments into contemporary life, identifying strategies for collective intervention and subjectivation through which individuals are “brought to work on themselves.” Under the auspices of biomedicine and public health, vitality has become a matter of individual risk and personal moral responsibility, prompting Braun (2007:1) to comment that health optimization has become “our life’s work.”

COVID-19 pandemic measures were no exception. In fact, a commentary in The Lancet’s January 2023 issue went so far as to posit that self-care was a “cornerstone” of the global pandemic response, stating that it “gained visibility and prominence during the COVID-19 pandemic as people all over the world started to practise hand hygiene, wear a mask, and perform self-tests at home” (Narasimhan et al. 2023). Indeed, messaging around mask-wearing, personal hygiene, vaccination, and social distancing reveal this heavily individualized framing of care. Described as “personal protective measures” (World Health Organization 2021), individuals were expected and encouraged to enact self-care for the minimization of personal and public viral risks. Public health slogans like “do your part” (Centre for Disease Control 2022) or “stay alert and safe” (Cabinet Office 2020) as well as national advice for individuals to reduce “your risk of catching COVID-19 and spreading it to other people” (National Health Service 2021), placed heavy emphasis on individual self-regulation and risk minimization. This is particularly evident in the vilification of the “super-spreader,” recklessly flouting social distancing rules. The positioning of these individuals as uncaring and immoral – encapsulated in UK Health Secretary Matt Hancock’s morally charged message to young people “don’t kill your gran” (Shirbon 2020) – created a potent symbol for COVID-19 deviance, and by contrast, normativity, that set the heavy burden of transmission regulation on individual actors. Particularly amidst the early collapse of national healthcare systems and the inundation of government institutions, institutional care largely gave way to self-care, with individuals expected to take on moral responsibility for transmission by vigilantly regulating their health and reducing viral risks.

This individualized bent to COVID-19 subjectivity and pandemic morality can be better understood when we consider the foundations of individuation upon which public hygiene and germ theory rests. Latour ([1984] 1988) has famously related the above processes of individuation to a purification process: through pasteurization and sanitization, food and people are cleansed of their microbial contaminants to engage in “pure” social relations, taking as their goal bodily individuality – individual human bodies, objects and microbes that do not intermingle. Yet, as ecologically grounded theorists emphasize (Haraway 2016; Hsu and Lim 2020; Ingold 2000; Latour 2021; Tsing 2015), human selves cannot be disentangled and “purified” from the embodied socioecological relations that constitute their being. Humans are always and everywhere, already socio-ecologically related beings.

Anthropologists researching care, informed by feminist care ethics and kinship, have explored the inherent sociality of self-care. Yates-Doerr’s (2012) ethnographic work with Guatemalan nutritionists and patients, for instance, reveals that even in the seemingly individualized domain of nutritional “self-care,” Foucauldian notions of biopower and their corollary implications of internalized self-monitoring are insufficient ways of thinking about the affective and attentive social relationships that are enacted while eating, feeding and caring. The self-body of the patients in Yates-Doerr’s ethnography inevitably encompassed their nutritionist, family, and wider community. As recent inquiries into self-care practices amongst Mexican diabetes patients (Seligman et al. 2015) and elderly chronic HIV patients in Mombasa (de Klerk and Moyer 2017) reveal, self-care is an inherently social form of care. As Mol puts it, in her study of diabetes patients in the Netherlands, “the logic of care is attuned to people who are first and foremost related” (Mol 2008:62).

Drawing on interviews with people from various countries¹ who experienced COVID-19, my argument in this article extends previous work on the sociality of self-care by foregrounding the ways in which self-care practices during COVID-19 were a means of crafting social relatedness. I thereby seek to unsettle dominant public health notions of COVID-19 self-care as efforts to regulate the individual body-self. I aim to show that in their self-care practices, interviewees drew on the richly-structured social relations they were embedded in, exercised care, dexterity, and discernment in attending to these relations, and forged new webs of relatedness in the process – characteristics that bring self-care closer to skilled craftsmanship than to normative regulation regimes. Moreover, in speaking about their COVID-19 experience, some interviewees recounted moments of great care when they co-isolated with, hosted, and cared for infected friends or relatives, which suggests that their social relatedness was built on an understanding of an entwined self and other, rather than on a notion of purified bounded selves. In this article I therefore offer hopeful narratives of caring with; providing – in contrast to the government-imposed directives of isolation – an alternative imaginary through which we can consider future pandemic responses.

Methods

I this article I draw on data elicited through a wider study interested in the illness experiences of everyday folk during the COVID-19 pandemic². Four collaborators conducted 60 in-depth semi-structured interviews (15 each) with people who considered themselves to have been infected by the coronavirus SARS-CoV-2. 70% of the interviewees had tested positive on a PCR, lateral flow, or antigen test, but in consideration of the limited availability and reliability of testing during the early phases of the pandemic, self-diagnosed interviewees were also included. Furthermore, in recognition of the role biological subjects play in shaping medical knowledge pertaining to diagnostic categories and symptomologies (Rabinow 1996; Rose and Novas 2005), self-diagnosed participants were also included. Apart from that, anthropological research on complementary and alternative medicine (Hsu 2013, 2016) makes clear the importance of valuing diverse experiences and approaches to illness, disease and healing. Pressure to expand the medical literature and research on the long-term symptomatology of COVID-19 in the UK has, for instance, been heavily influenced by intersubjectively crafted illness reports of long-COVID patients shared in patient groups and by the media.

The interviews centered on eliciting people’s illness narratives and included questions on their signs and symptoms, emotional experience, dynamics of transmission, networks of support, techniques for managing their illness and medical treatment. Interviews were held on Zoom, for 40 minutes to an hour.

Participants were recruited from a purposive sample that reflected the social field of each research collaborator: each researcher recruited interviewees from their social networks and asked interviewees to connect the researcher, in a snowball-like fashion, with other people they knew who had COVID-19 (including people whom they knew and believed had transmitted COVID-19 to them). Although alternative sampling methods, primarily random or purposive sampling based on demographic factors like age and class, were considered, this socially contingent sampling method, which took as a starting point the interviewer’s social field and the social fields of the interviewees, sought to “follow” the social connections between individuals. This method can be compared to Chuengsatiansup’s (2022:16) “following method,” which encourages researchers to follow objects as they move across boundaries, paying attention to the shifts that occur in boundary-crossing. Rather than follow objects, the study followed the social connections between interviewees, foregrounding how illness experiences forge social relatedness and how they formed part of the everyday connectivity of life during COVID-19. Some interviewees had contracted COVID-19 from another, while others had relied upon the other for support and care. As a result, the illness narratives elicited were sometimes mutually interwoven, referencing each other in ways that highlighted interviewees’ interrelatedness through common illness experiences, even when they were physically in isolation.

Location & research participants

Ironically, the hardening of borders during the pandemic required the researchers to adopt a transnational approach. Unable to conduct in-person interviews and travel, the researchers relied on their social networks to recruit participants digitally. Although the researchers were based in Oxford, they were citizens of Switzerland, the USA, Australia, and Singapore. Their diversity resulted in a sample of recruited participants that reflected their transnationalism. Apart from European citizens (United Kingdom, Austria, the Netherlands, Germany, France, Switzerland, as well as, in smaller numbers, Sweden, Greece, Hungary, and Portugal), participants included citizens from North America (USA, Canada), South America (Peru, Ecuador, El Salvador), the Caribbean (Jamaica, Trinidad), South Asia (India, Bangladesh), Southeast Asia (Malaysia, Indonesia), the Pacific (New Zealand, Australia) and Turkey.

As students of a medical anthropology master’s course, the researchers recruited mostly representatives of the intelligentsia – students, professionals, or academics – who were largely below 35 years old or in their mid-50s to 60s. Their gender was evenly distributed between males and females (as self-identified by interlocutors). In the analysis that follows, all names are pseudonyms and interview excerpts are presented in vignettes of people’s narrativized COVID-19 experience. Narratives do not claim to be records of truth or fact, rather, they offer a view into the world-making projects people are a part of and actively partake in (Kleinman 1988). They are hence interpreted here as lived stories that signal what is important and at stake to the interviewees.

Self-care as a form of social crafting

I argue here that self-care can be understood as a form of social crafting. Although the term “craft” has typically focused on the process by which craftsmen and artisans (Ingold 2000; Paxson 2012) make material forms, the insights from anthropological investigations into craft offer useful conceptual frameworks through which we can better understand the sociality of self-care. Ingold (2000) delineates five intertwined dimensions to skilled craftsmanship, which include the socio-ecological embeddedness of the craftsmen, the immanence of intentionality and functionality in skilled practice, the involvement of care, dexterity and judgment, the “hands-on” learning process by which skill is acquired, and the generation of new forms in the process. Although the scope of the interviews conducted prevents me from exploring the pedagogical and non-human ecological aspects of craft, I nonetheless use the term “social crafting” to foreground the socially embedded nature of self-care, the involvement of judgment and dexterity, and the creative generation of new social relations in the process.

Self-care as a form of social crafting: drawing on fields of social relations

I begin my exploration of self-care as social crafting with Ingold’s (2000:353) key formulation – that skilled craftsmanship “is a property not of the individual human body as a biophysical entity, a thing-in-itself, but of the total field of relations constituted by the presence of the organism-person … in a richly structured environment.” Crafting, therefore, involves and emerges from one’s richly structured field of relations.

When asked what they did to treat their illness, interviewees discussed diet, multiple medicines, herbal remedies, yoga, and other meditative postures. This was for alleviating symptoms, “tackling the virus” or making themselves “feel better.” Although seemingly individualized choices that interviewees made to optimize their health – a notion that might ostensibly play into individualized notions of self-care – these remedies drew deeply from and involved complex webs of social relations. Frequently, people utilized remedies they heard of from friends and family as well as online social communities, revealing the contours of their social lives: who they were close to, whom they trusted, and who they were distant from. Often, these fault lines implicated gendered and class-based structures immanent in their field of relations.

Ryan, a Canadian academic with a global reach of friends, details the cornucopia of herbal remedies he drew on from his cosmopolitan base when isolating alone in his home in Canada:

The doctors had prescribed medicines and I took them. And sometimes I had friends say, in our country we do this and this and this and this and sometimes if I had those ingredients, or friends would say here’s a concoction that we make in the old country and they would send it to me and I would drink it faithfully.

As Ryan’s quote illustrates, the multiple “concoctions” he took in caring for himself not only emerged from his transnational social networks but also from the class structures within which he was embedded. Ryan was supercilious about the alternative remedies his friends suggested, which he describes as “concoctions” from the “old country.” The crucial thing was to believe in them, as they worked by the “placebo” effect on the mind, and not on the body. He spoke of drinking these concoctions “faithfully,” implying an emphasis on belief rather than factual knowledge. By framing his self-care practices as traditional beliefs lacking in scientific reason, Ryan drew on the discourses and hierarchies of knowledge embedded in his class position, reinforcing the superiority of scientific medicine and signaling his belonging within Western academia. In this way, self-care for Ryan was a form of skilled craftsmanship involving and emerging from his class-structured field of relations.

This is further evident in the self-care practices of other interviewees, which both emerged from and reinforced gendered and familial tensions within their relational webs. Rachel, an Ecuadorian student who was isolating alone in her accommodation in Oxford, recounts drawing on home remedies utilized by her mother and grandmother as a child. She failed, however, to ask some of her other relatives for advice and recounts how her uncle, a doctor, was offended by this:

When I was a kid, if I would get sick, there’s just things that my mum would do that her grandma did, that her grandma did … but definitely just kind of figured it wouldn’t hurt to do that here as well, even though it’s not my mum doing it for me, it’s just myself. Retroactively I think my uncle found out and he’s a doctor, and he was really angry that I didn’t reach out to him, because he would’ve prescribed me some like, just things to make sure your immune system is high.

For Rachel, her mother, her grandmother, and her uncle, self-care meant more than an individuated body technique. Rather, self-care practices were known to emerge from and shape a whole web of kin relations. Evidently, the potency of Rachel’s remedies drew from her mother’s presence and practice, as she qualified that they “wouldn’t hurt … even though [emphasis added] it’s not my mum doing it for me.” Rachel’s closeness to her mother and grandmother, and the physical proximity they normally had, invested their generational remedies with therapeutic power and value. Conversely, her non-seeking of biomedical advice suggested and created distance in her relationship with her uncle. This sense of choosing between the home-based remedies of her female kin and the institutionalized biomedical knowledge of her male kin hints at competitive tensions between the two domains. In this way, Rachel’s self-care practices directly drew from and implicated the vitality of her kin relations and the gendered structures immanent in them.

In another interview, James, a British social media influencer who had just moved to Oxford and had a difficult relationship with his family, describes reaching out to social media for therapeutic advice and support while isolating alone:

Family were not really useful … I definitely went on social media and asked some of the people like: what do I expect? … so, I got some advice on social media which I think actually helped me more than-than anything.

In practising self-care, James drew on the fraught and complex social relations he was embedded in. Family had been disappointing, as they had frequently been to him – in another part of the interview, James spoke of seeking help from his family only to find they were unable to offer it – whereas social media had given him what he needed, drawing on and reinforcing the underlying familial fault lines that structured his social environment.

As they drew upon techniques from certain friends and cherished family traditions, neglected help from relatives and sought advice from others, interviewees drew on the gendered, class-based, and sometimes fraught kin relations they were embedded in, strengthening some and weakening others. Contrary to the individualized biophysical entities that COVID-19 subjectivity both assumes and seeks to instantiate, self-care practices hence emerged, as crafts do, from the richly structured web of relations that constituted people’s selfhood.

In the second part of this article, I focus on the dexterity and discernment involved in self-care practices, which brings them closer still to a skilled crafting of sociality than a technical optimization and regulation of bodily processes.

Self-care as social crafting: dexterity and judgment

As Ingold’s (2000:153) notes, skilled craftsmanship entails more than the mechanical application of one’s body in the process of doing. Rather, it involves dexterity, care, and judgment implying a watchful, sensorial engagement with the forms and beings immanent in one’s craft. Crafting is “done with” rather than to, and Paxson (2012:62) makes this particularly clear in her ethnographic examination of artisanal cheesemaking, where an intimate engagement with livestock and microbials as “co-laborers” is a necessary part of the craft. Similarly, the self-care practices of the interviewees entailed a careful engagement with their social relations that involved dexterity and judgment. In managing their transmission risks, deciding what personal protective measures to take, isolating, and sharing information on their illness, interviewees actively attended to the needs of their social relations, carefully watched and assessed their responses, and deftly attuned their self-care practices in response.

In narrating how they dealt with their illness in isolation – who they talked to and what they did to cope – many interlocutors recounted measures they took to manage the potential effects of their illness on family members. For instance, Naveen, a Kashmiri student living in England and isolating alone, did not tell his sister and mother of his illness to avoid worrying them at a time when the death toll in India was particularly high. He recounts moments of careful deliberation, coordination, and attenuation of who and when to tell to minimize his family’s sense of worry:

I told my father, but I didn’t tell my mother … he [my father] can put on a brave face and be like: Okay, fine. Everything’s okay. And he can sort of keep things to himself. So, perhaps my brother wouldn’t be able to. He would, he would feel compelled to tell other people, but I knew that my father wouldn’t. So I told him. He [my father] would call me at his nighttime to avoid leaking information to other members of the family … they would be a little worried … because there were a few things that my mother was busy with around that time. And my sister was also busy with her kids. So, I didn’t want them to feel too worried. Especially because COVID is such a – it’s such a dark part of our lives now … And once I started to feel better. I think like day 8, day 9, I told them that I had COVID… In between, I did talk to them. I used to put on like a really: Oh, yes, I have a bit of a cough and a bit of a flu. So I’m just staying in today I’m not going into my department. But, I mean, they were obviously concerned at that time as well, even with the minor flu.

The careful deliberations and calibrations Naveen made in sharing information about his illness reveal an attentiveness to his kin relations and dexterity in engaging with them. When to tell, who to tell, and how much to tell were all carefully considered with keen attention to the personalities, tendencies, and life circumstances of his kin. His father was seen as stoic and silent but his brother was less so. His sister and mother were facing personal worries and would have been unnecessarily burdened. The flu was alright to mention but not COVID-19, and when he got better, he would tell them. At each turn, coping and caring for himself required dexterity and judgment in tending to kin relations through varied communicative strategies.

This is further evident in the watchful practices that Karen, a British student, engaged in when she fell ill with COVID-19 and had to isolate at home with her family (in the UK). Unable to interact with her family, Karen worried that her parents would contract COVID-19 from her and suffer. When asked what she did while isolating at home, Karen recounts:

I was really worried about my parents … and when they did – when they tested positive, I sort of, I would go outside their bedroom and I’d listen to see if they’re like sleeping, if I can hear them breathing. My dad snores. So, I would literally put my like [ear], why is he not snoring today?!

For Karen, caring for herself in isolation involved an embodied attentiveness to her kin. Pressing her ear against her parents’ door, listening intently, noticing patterns in their breathing – each of these practices entailed a sensorial engagement with her parents that went beyond a mere technical regulation of her individuated body. In a similar way to Naveen, the elision between Karen’s illness experience and her family’s experience of COVID-19 reveals the inextricability of the self from the web of social relations that constitute it. As she dexterously attended to her whole experience of COVID-19, including in it the bodily rhythms and breathing patterns of her parents, Karen’s self-care practices hence emerged as a form of skilled social crafting.

This elision between self and other, and the dexterous skill and judgment needed to attend to these social entanglements is further evident in Mary’s account of the precautionary self-care measures she took while moving house during the pandemic. Mary, a Canadian researcher living in the United States, recounts the relational difficulties she faced in negotiating where to stay, how much risk to take in moving house, and the kinds of precautions she should take to avoid infecting others. At each point, she reveals careful consideration of the relations she was caught in – relations with friends, movers, and hotel staff – and an adept calibration of her precautionary measures to attend to these:

There were a couple of times, like there, there was one group of movers who showed up and they weren’t wearing masks. And I was like: what? Come on, like you need to, you need to do this. And they were sort of begrudging but they did. Yeah, I mean, it, it absolutely was clear to me that it was a really crazy time to have all this stuff going on. But when I sort of slow down and thought about it, I’m like, I’m legally bound to do these things [move house] now, so I can’t change them. … I had to spend, I had a few days in between leaving my house and being able to move in here. Because there wouldn’t have been a toilet. So, I had to go to a hotel. And there were very few hotels – well I was supposed to go and stay with a friend and then my friend who was older than me … she said, I don’t think you should come here. And my kids are nervous. And I’m like, I totally understand like, that makes sense. I will book a hotel. And then that seems strange too and risky. But the hotel had all the social distancing things, and I just said [to the hotel staff], you know, don’t clean the room or anything. I’ll just… and I was really careful there.

Although COVID-19 guidelines frame transmission regulation as an individual responsibility, assuming individual control over one’s body and viral susceptibility, Mary’s narrative reveals multiple moments beyond her control, when the social relations she was inevitably caught in shifted or changed in unexpected ways – when the movers who came to her house failed to wear masks, when the friend she was supposed to stay with could not let her stay, when she unexpectedly had to book a hotel room in the middle of a pandemic. At each turn, Mary’s precautionary measures entailed more than an application of social distancing rules or mechanical regulation of her body. Rather they emerged as dexterous and discerning negotiations with her shifting social relations. Asking the movers to wear a mask, responding to her friend in an understanding manner, and telling the staff they need not clean her room – each of these caring responses emerged from social entanglements beyond Mary’s individual control. In this way, Mary’s self-care practices elucidate the unavoidable entanglement of her self with other selves in social relations, and the keen dexterity needed to negotiate these. Mary’s example unsettles dominant biomedical notions of individual control and responsibility in transmission regulation, instead revealing the skilled social crafting that self-care entails.

Self-care as social crafting: creative generation

A final and crucial aspect of crafting is the creative generation of things or forms, which vary with the medium and practice of the craftsmen. For some interviewees, this involved the creation of new social relations in their accounts of what they did to care for themselves and manage the illness. While crafting need not always entail novel creation, I foreground examples of novel relations in interviewees’ narratives to highlight the creativity of self-care practices more succinctly.

For instance, Jason – a Jamaican student isolating with family in London – felt responsible toward the people he encountered when he traveled while being infected and sought to establish relations of responsibility with them after testing positive. When asked if he had sought any medical advice from the NHS, Jason said he had not. Instead, he recounted trying to warn people about their potential risks after having had close contact with him:

So, I told you I was feeling real bad about like the prospect of infecting other people. So, I called British Airways to try to let them know that I was on this flight and I tested positive subsequently … I called so many times, they just refused to answer … And I tried to call the Uber driver who took me from the airport to my cousin’s in London. I don’t know if he thought I left something in the car and was trying to get it back, he just didn’t answer either …

For Jason, fleeting social contact with strangers became, in the context of an infectious disease pandemic, relations of responsibility that he hoped to forge. In reaching out to them, he hoped to establish new relations of care that might extend beyond himself into further webs of relatedness. If the Uber driver had answered one of his phone calls, the driver might have let other people he was in contact with know about this potential infection, promoting more cautious behavior. If the representative of British Airways had picked up Jason’s calls, they might have informed the people on the flight with him, who might have then been more careful about their interactions with others. Although this chain of responsibility and caring relations did not materialize, Jason had attempted to forge them. It is this intention alone which suggests an attempt at creating relations. While they might not have been particularly deep relations, at a minimum, they would have involved a connection (at least a call) and a sense of responsibility.

A few interviewees also spoke of establishing new social networks by joining COVID-19 Facebook groups or sharing information about their experiences on social media as part of their recovery. They framed these new digital relations in terms of wanting to know about people’s illness experiences and wanting to provide clarity for others. Ryan, a Canadian academic, for instance, describes sharing his experience and joining a COVID-19 Facebook group:

At that time I thought there was just so much confusion, people asking on Facebook if COVID even exists. So, I thought, you know what? I can share my story! I can’t give you all the answers but I can tell you what my experience is … I did [also] join a COVID group on Facebook, just to kind of get a sense of what was going on for other people. And in fact another friend here, this family got COVID, so they contacted me to kind of say, ok, what was your experience? And, actually, it was someone I didn’t really know all that well, but we became good friends out of the ordeal.

For Ryan, caring for himself inevitably involved caring for others in a generative way akin to social crafting. By joining Facebook groups and sharing his story as part of his self-care process, Ryan initiated new modes of contact, interaction and relationality – stories shared, queries answered and a friendship made.

By drawing on their structured field of social relations, exercising dexterity and discernment in navigating complex social entanglements, and attempting to generate new social relations, interviewees skillfully crafted sociality in their self-care practices, unsettling dominant biomedical assumptions of COVID-19 personhood that assume individuated bodily-selves in control over and separable from their social environment. In the final section of this article, I explore moments of radical care, when interviewees spoke of co-isolating with, hosting and caring for infected friends during the pandemic. By disregarding notions of individual risk and instead following the unavoidable social entanglements of their relational lives, interviewees revealed the inextricability of self and other, and hence the inherent difficulty of separating the two. Although previous sections on self-care as social crafting also explore this argument, the following vignettes of radical care for social relations more pointedly provide an alternative image of what pandemic care might look like when we follow our social entanglements.

Radical care: enhancing social relatedness

In talking about their experience of COVID-19, interviewees occasionally spoke of instances where they co-isolated with or hosted friends and relatives with COVID-19. Naturally, the transmission risks of each situation varied – some interviewees had contracted COVID-19 before and felt less susceptible, while others had never caught it but felt it was inevitable. In either case, interviewees and their relations regarded their lives as unavoidably intertwined and acted in ways that blurred neat boundaries between their biophysical selves and others. Jenna, for instance, recounts falling ill while on holiday with a friend in France. They had been on a road trip and were intending to spend a few days at her family’s holiday home when Jenna tested positive for COVID-19. Although her friend, who had not tested positive and displayed no symptoms, officially had to practice social distancing while isolating with Jenna, she chose to intermingle freely with Jenna, figuring that cross-transmission was unavoidable. Jenna describes this experience:

In that moment, honestly it was – it was very nice because when I tested positive she said: okay well I still, now that I’m a person of contact, I’m gonna have to stay with you anyways for like two weeks and a half, so may as well get it. That’s basically her mindset and I was like: okay perfect. So then, we had no barriers, we acted as if I was normal. I mean, I was with COVID and she didn’t put on a mask and we just lived in those two weeks and a half as if she was going to get it too. What is really surprising is she didn’t … At least inside the house it didn’t feel like I was going to die because we were still having dinner, we were making lunch, you know, she was going to work online. It was a completely normal setting. And it was amazing to have someone to share the experience with. More than sharing, having someone to accompany you a bit in the process. Yeah, that was very nice.

For Jenna’s friend, their shared trip, space, and relationship made co-transmission inevitable. Rather than police the blurred boundaries between their selves, she chose to act as if they were one – “as if she was going to get it too.” This elision of her bodily self with Jenna in a common pool of viral risk allowed for the mixing of normalcy and sickness in their daily routines, enabling a sense of calm for Jenna – not feeling like she was “going to die” – and vital companionship that would otherwise have been precluded. In embracing the unavoidable intertwinement between herself and Jenna, Jenna’s friend, therefore, enabled an experience of COVID-19 that was “amazing,” “nice,” and nourishing – a stark contrast to the loneliness and fear that most interviewees described in their experience of isolating and caring for themselves alone.

The final vignette concerns Sarah, an administrator in British Higher Education, who recounted that she had hosted a friend who had caught COVID-19 from nursing and caring for her aged mother infected by COVID-19 before she was delivered into hospital care where she passed away. Knowing that she was unable to return to her own home to isolate as her husband was shielding, Sarah and her husband offered Sarah’s friend their home – they had already contracted COVID-19 earlier (although they never got tested) and said they were hence less at-risk:

My friend had been nursing her mother, caring for her at home – she [the friend] tried to social distance where possible but it just wasn’t really practical – up until she [the mother] had to be admitted [to the hospital] … On the day that she [the mother] died, my friend developed her first symptoms of COVID-19, which was kind of inevitable … and she was stuck in her mother’s flat surrounded by her mother’s things, she couldn’t go back home because her partner was shielding… We said, we think we had COVID so come and stay with us. And I look back now and I think, knowing what we know about COVID-19 would I still have done the same thing – I really hope I would. My husband fetched her in the car which was of course risky because they sat side by side. We had plenty of space [in our home], she had her own bathroom, we tried as much as possible with the self-isolating – trays in and out, washing hands and things – but I’m sure we weren’t as rigorous as we should have been … when her oxygen levels dropped, I drove her to the hospital and that was hard as well because I couldn’t stay with her, and just having to drive away not knowing what would happen to her. But I’m so glad that were able to be there for her cause she was so frightened in her mother’s flat, knowing what had happened to her mother. I think on her own it would have been different, but we were able to keep feeding her, reassuring her, and bringing her where she needed to go.

In the same way that Sarah’s friend was inextricably bound to her mother – caring for her, nursing her, and longing to be with her when she passed away in the hospital – so was Sarah to her friend. As Sarah narrates the experience, she seamlessly weaves between her friend’s emotional state and her own, what her friend did and what she did, what her friend felt and what she felt, blurring the narrative boundaries between her story and her friend’s in the same way that her deeds had blurred the physical boundaries between them. As Sarah talks about bringing her friend to the hospital when her COVID-19 infection had reached a stage that required hospitalization, she recounts not the fear of close contact and viral transmission in the car but of not knowing what might happen to her friend, and whether they would ever see each other again. Subsequently, she shifts to telling the interviewer about her friend’s fear of being in her mother’s flat and how different it would have been if she had experienced COVID-19 alone. This interconnected narrative between Sarah’s fear and her friend’s fears, which were themselves bound to her friend’s mother’s painful and lonely last hours in intensive care at the hospital, reveals the deep emotional and relational entanglements that constituted their interwoven experiences of COVID-19. For them, COVID-19 was an unavoidably relational experience where neat biophysical boundaries gave way to blurred social relations and entangled lives. In embracing this entanglement and tending to it, Sarah enabled a very “different” COVID-19 experience for her friend and herself – one that was nourishing, reassuring, and which brought her “where she needed to go.” Hence, three days after dropping her friend off at the hospital, wheezing and in need of intensive care, Sarah returned to pick up her friend and brought her back to Sarah and her husband’s home to further recover there.

These final vignettes of radical caring during COVID-19 offer an alternative imaginary through which we can conceive of future pandemic responses. Specifically, they prompt us to consider what might look different if public health responses were to embrace the interwoven relationship between self and other, developing practices and frameworks that draw on and tend to fields of socio-ecological relations with dexterity and discernment.

Conclusion

Amidst the intensely individualizing calls from dominant biomedical and governmental institutions to isolate, social distance, and exercise hypervigilance over one’s bodily boundaries (Couch et al. 2020; Jayasinghe et al. 2021), self-care in the era of COVID-19 nonetheless revealed the intrinsic entanglement between the “self” and its social relations. Some interviewees drew on their richly structured field of relations in nursing themselves to recovery, some deftly tended to and navigated complex social webs they were embedded in, while others attempted to reinforce and forge new webs of relatedness. In each attempt, their practices reflected greater proximity to skilled craftsmanship than to dominant public health notions of self-care as a regulation of individualized bodies.

Thinking through the lens of crafting offers a useful frame for medical anthropologists interested in the study of care, particularly self-care, as it foregrounds not only the socio-ecological relatedness of therapeutic practices but also the embodied dexterity and skill it involves. Rather than limit us to thinking only about actions directed upon the individuated self – the self-body (Yates-Doerr 2012) – crafting enables us to study self-care with keen attention to practices that engage the multiple beings and bodies entangled within one’s “self.” Moreover, contrary to Foucauldian (Foucault 2002) technologies of the self, which assume the body to be a technical instrument of the interiorized, cognitive self, skilled crafting involves the body-and-mind, directing our study of self-care toward embodied practices and engagements. Although an emphasis on embodiment was outside the scope of this research project, further anthropological research on self-care might benefit from investigations into people’s embodied attempts at tending to and negotiating other-than-human ecological entanglements. For instance, how might self-care entail and involve caring for and with microbial bodies and animal “vectors” in embodied ways?

Asking this question also necessitates asking the normative and ethical question of how we, as societies and polities, might craft future pandemic responses with rather than in isolation from the socio-ecological webs that constitute our locus of becoming. As biosocial anthropologists have pointed out, preventing another global pandemic like COVID-19 will require a paradigm shift in our relationship with local ecosystems, from one of mere purification and separation to responsible co-habitation and co-evolution with non-human microbial and animal “others” (Fuentes 2020). Similarly, as the final interview vignettes on radical care in this article aim to demonstrate, future pandemic responses would benefit from the adoption of a radically different social paradigm that acknowledges the inherent entanglements between self and other. Embracing such a paradigm prompts us to consider regulatory flexibility in determining caring arrangements during future pandemics as well as the reorientation of pandemic policy goals toward maintaining and even enhancing relationality beyond mere economic exchange.

Ethical approval

Ethical approval for “Illness Narratives of COVID-19 Patients” was obtained from the University of Oxford’s School of Anthropology and Museum Ethnography Research Ethics Committee (SAME REC), under the ethics reference number: SAME_C1A_20_101.

Acknowledgments

I would like to sincerely thank my fellow collaborators on the project “Illness Narratives of COVID-19 Patients”: Professor Elisabeth Hsu, Sonora English, and Yasmynn Chowdhury, whose ingenuity, dedication and tireless research made this project possible. I would also like to thank all the interviewees who participated in our project, thank you for sharing your stories with us. This project and article would not have been possible without you. I would finally like to thank Professor Elisabeth Hsu for her guidance and advice in publishing this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research leading to this article received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Notes on contributors

Gillian Chan

Gillian Chan is a researcher based at the Institute for Global Prosperity at UCL. Her work focuses on participatory research, engaged anthropology, care, and health inequality. She currently works with citizen social scientists and cross-sectoral partners in east London to embed novel ways of collaborative working for equitable urban prosperity.

Notes

1. Interviewees were European citizens (United Kingdom, Austria, the Netherlands, Germany, France, Switzerland, as well as, in smaller numbers, Sweden, Greece, Hungary, and Portugal), citizens from North America (USA, Canada), South America (Peru, Ecuador, El Salvador), the Caribbean (Jamaica, Trinidad), South Asia (India, Bangladesh), Southeast Asia (Malaysia, Indonesia), the Pacific (New Zealand, Australia) and Turkey. Most of the interviewees were living in the UK or the USA, at the time of the interview.

2. The wider study investigated the illness narratives of people who believed they had COVID-19 and aimed to identify themes of concern in these narratives. The research consisted of semi-structured interviews conducted by each of the 4 co-collaborators with a total of 60 participants recruited through the snowball method. Interviews were conducted from December 2020 to May 2021. Interviews were conducted online, via Zoom, in accordance with social distancing guidelines at the time, and were audio-recorded. Interviewees were first asked to talk about their experience of having COVID-19, after or during which, they were asked more specific questions about their signs and symptoms, emotional experience, dynamics of transmission, networks of support, techniques for managing their illness and medical treatment. Beyond the findings presented in this article, preliminary observations on a wider range of themes that emerged from the study were presented at the SIEF2021 15th Congress Panel on “Heal 02 COVID cultures: disentangling emerging viral assemblages” (Hsu et al. 2021).