Ahmed Awadalla: Contours of Care – Transnational Reflections on Care Work

For the past year, I have been on sick leave.

Many people respond in disbelief to this news, not only because I am sick but also since I have been on leave on such grounds for that long, including my friends. «It must be a world record!», one of them said. I don’t blame them. My emotions about my illness being officially recognized for such a long duration oscillate between disbelief and gratitude, especially as it is due to a mental health condition: I am burnt out.

For well-deserved and much-needed work breaks to be granted and recognized is unthinkable in most parts of the world. In contemporary times of post-pandemic late capitalism, burnout is almost ubiquitous, as we tow our bodies through different sorts of labor, repetitive and exhausting beyond what we can really endure. Getting a chance to have a burnout sabbatical feels like I have broken the hidden code to an essential life hack in the German system.

After my return from another visit to my doctor’s office where I was deemed invalid to work for an extra four weeks, I sat down to think about where it all began.

Who heals the healer?

The Berlin sun conveniently hid behind thick layers of clouds, as I tuned to a work meeting over Zoom. My wage labor entailed working as a psychosocial worker and educator in a Berlin sexual health center, i.e., my labor was predominantly intellectual and emotional in nature. Social workers are those whom people turn to for guidance, but we need it all the same. These monthly supervision meetings, which took place over Zoom due to the Covid-19 pandemic, allowed us to vent and receive counsel from one another. We brainstormed about difficult cases, the expression we use for clients who bring complex issues or dynamics to the counseling room. Sometimes, we attempted to sail the murky waters of dysfunctional office dynamics.

I carried the burden of burnout for a long time, but I never dared to express it. I felt constantly drained and overwhelmed; my cynicism and negative worldview were growing. However, I hesitated to share my feelings. Part of that hesitation stemmed from the racial dynamics at work. I was the only person of color in the organization, I was afraid that coming out about my burnout would confirm the stereotype of the lazy migrant. I worried my feelings won’t be taken seriously, that I would be minimized or ridiculed.

While much ink has been spilled to understand the interrelation between gender and care work, less attention has been given to its connection to race and migration. In an aging society like that of Germany, more and more migrants are being employed, and in some cases imported, to perform formal or informal care work. At the same time, many migrants contend with an invisible set of social concerns, depriving them of the luxury of taking breaks or collapsing under pressure, due to precarity and the pressure to support families and intimates across borders in their home country. This is known as transnational care. For racialized people, factors such as minority stress, racial microaggressions, and the emotional labor of maintaining peace at the workplace complicate workplace dynamics. These dynamics affect help-seeking behaviors. As Karla Holloway points out, «the reality of racism and sexism means that we must configure our private realities to include an awareness of what our public image might mean to others. This is not paranoia. It is preparedness»[1].

It was also hard to admit that I needed support. Reaching out for help can be extremely difficult, especially if people turn to you when they need help. It felt like an admission of defeat, a white flag, a stepping down from the throne. I also worried that the quality of care I provided the clients would be affected. So, I eventually came out. My colleagues’ reactions were better than my anxious expectations. They were largely sympathetic, offering support as well as suggestions and recommendations. A colleague suggested psychotherapy. Another confided that she was «a fan of antidepressants», and would highly recommend them, and so on.

I needed the affirmation but wasn’t prepared to engage with the suggestions. Advice presumes that one doesn’t know or hasn’t already tried. A suggestion can feel like a demand for an explanation. A German idiom goes, Ratschläge sind auch Schläge: Advice is like punches, or advice is not always nice, or something along these lines. Questions can be more helpful than immediately giving advice, but it is a mistake we make often, even social workers.

Indeed, I had had my share of attempts at seeking therapy and trying out medical treatments. Navigating the mental health industrial complex in Berlin proved trying as I slowly made the realization of how white, German-centric, ableist, and heteronormative its structures can be. The quality of services depends on how much money one is willing to invest in private therapy since therapies covered by health insurance hardly meet the needs of marginalized social groups. I was disillusioned and often thought of Audre Lorde’s words; we were never meant to survive. So, when a colleague suggested taking a sick leave, I was immediately convinced. Perhaps what I needed was rest.

It has been months and I am still not sure how exactly to explain my burnout. Perhaps it was the nature of the work, engaging in emotional and intellectual labor that is underpaid and undervalued, and perhaps the Covid-19 pandemic was taking its toll on my well-being, and perhaps it had to do with the environment I was working in. Or all of them combined. In any case, one thing most people who suffer from burnout have in common is that we push ourselves beyond our limits, ignoring our needs for rest and care. We forget that asking for help is a sign of strength.

The wellbeing of others

As a child, I wanted to do something related to health and well-being. I was a sickly child and was often taken to doctors. I was also a fan of medical dramas on TV, of which ER was my favorite, partly because George Clooney was so incredibly charming. For a while, I wanted to become a doctor. I didn’t end up becoming a doctor, but I still wanted to do something related to health, so I got a degree in pharmaceutical sciences. Then I moved to Cairo, escaping the limits of my small hometown. A pharmaceutical career would have been lucrative, but I longed for something else, something fulfilling. Having a health background was an excellent entry point to engage with matters of sexuality and gender. In other words, I added a queer twist to the formula of health and wellbeing.

Life in Cairo, its grotesque inequalities, and its endless human encounters politicized me. I lived in Cairo in the years leading up to and following the 2011 revolution, a grand and life-changing event. The revolution, its highs and lows, sharpened my lived experience and added new meanings to what solidarity and resistance look like.

Only later was I able to reflect on how my queerness played into my life choices. Being a queer and feminine child made me sharply aware of my difference. My difference also made me experience how it feels to be silenced, ridiculed and ostracized. I knew much about suffering from a young age but also that my suffering wasn’t singular. I wanted others to feel well, too.

As Sara Ahmed notes, choosing a queer path can mean breaking away from a support system. My family never understood the work that I do. With no family support in Cairo and bills to pay, I had to work nonstop to survive, sometimes two or three jobs at a time. I think it was then that I internalized the idea that taking a break could never be an option.

Queer communities have long histories of alternative care practices. We know what it is like to have nobody to turn to other than our own. Queer care has been largely untheorized since most feminist studies of care systems have historically focused on a gender lens. As a vocal member of the queer community, people reached out to me, sometimes in prosperity but often in adversity; when somebody wanted company for an HIV test, when someone was outed to their family, when someone had a mental health crisis, or when someone was arrested in a police raid.[2]

I didn’t know it back then, but I now understand that community care is an important part of my political practice. Caring is usually thought of as generating well-being in other people while remaining invisible to those not doing the work and therefore its scope is largely underestimated. It was no surprise then that I gravitated toward working in psychosocial counseling. The ability to listen, to keep discretion, and to provide a sense of safety were qualities people identified in me and held onto. It felt like falling into place. This ushered in a stage of my life characterized by a more formalized type of care, which began with my job as a social worker and counselor at a Cairo-based refugee aid organization.

I don’t believe that good nature is sufficient to take on this job. After years of working in the field, I also realized that a professional qualification alone wasn’t sufficient to perform this work. Being a caregiver requires a combination of personality and training. The training and experience I received during that period shaped who I am today. I owe that to my instructors as well as the clients I worked with. Care seldom moves in one direction. This may be evident in intimate relationships where emotional and instrumental forms of support are exchangeable but are not limited to this context. Even if we don’t immediately see it, something returns, though we shouldn’t count on it, and perhaps we don’t even recognize it when it does. I often worked with the most marginalized groups and was able to witness the power of people rebuilding themselves and their lives, which left an endurable mark on me.

Possessing social skills and engaging in emotional labor is seen as «good manners» in Egypt, a sign of sound parenting. In my journey through mental health institutions, I encountered an entirely different narrative. My previous therapist posed that my upbringing through unpredictable parents sharpened my communication skills. My childhood was difficult; I was left alone with the weight of the potentially destructive secret of being queer. I had to fend myself off against bullies and perpetrators on my own. Nevertheless, I was imprinted with positive values while growing up such as responsibility, commitment, relatedness, and responsiveness to others. I don’t feel the need to romanticize trauma, yet the remarks of Carl Jung about woundedness could ring true, «it is (the analyst’s) own hurt that gives the measure of his power to heal.»

Perhaps I have been sick for much longer, or rather made sick by society. Or perhaps we need to allow pain to yield us softer toward each other. As Ursula Le Guin writes, «It is our suffering that brings us together. It is not love. Love does not obey the mind, and turns to hate when forced. The bond that binds us is beyond choice. We are brothers. We are brothers in what we share. In pain, which each of us must suffer alone, in hunger, in poverty, in hope, we know our brotherhood.»

I eventually had to leave Egypt because of who I am and what I do. Being exiled to Berlin constitutes a rupture in the care systems I had; family, friends, and community, which in turn affected my ability to do care work, partially accounting for my eventual burnout. Caregiving is rewarding in many ways, but can also be exhausting and draining, which calls for limit-setting. As Silvy Khoucasian notes, «Empathy without boundaries is self-destruction.» For both givers and receivers, care work isn’t free of messy and dark aspects, the latter being in a more vulnerable position to have their boundaries infringed upon.

The politics of care

By sharing this account of my journey as a care worker, I don’t intend to idolize the helping professions. Living in Germany led me to perceive this field of work in a different light, as I grappled with the material conditions of social work in Berlin as well as the profession’s present and past. Like other helping professions, social work’s emergence in the western world had to do with oppressive roots, as it built on already existing institutions to manage the poor, distinguishing those worthy from the unworthy for help along moral lines, while simultaneously attempting to remove them from public space. This calls to mind medicine’s dark history of exploitation and experimentation on bodies with less agency and privilege and psychiatry’s incarceration and inhumane treatment of «the mad». As such, these professions have roots in hierarchical control of the other, which invites us to reexamine social work’s mandate and its vision for society today.

Care, initially perceived as a private matter, has become entrenched within the domains of politics and power. The question of gender played a central role in the emergence of social work as a profession in Europe in the second half of the 19th century. Bourgeois women, who belonged to wealthy families, were still not allowed the right to education and work. Therefore, they found in social work an ethical commitment to improve the conditions of those affected by poverty and war in the post-industrial society while simultaneously emancipating themselves as women with agency. To achieve that, women leaders in Germany drew on gendered notions of «Mütterlichkeit» i.e., motherliness, wherein women’s emotionality, adaptability, and affection made them apt for such a profession. The professionalization of social work contributed to the formation of the current welfare state in Germany. However, such rhetoric was eventually critiqued as women were eventually left out of administrative positions as the welfare system further developed. The gendered reality of care (and domestic) labor underpins the persistent notion that care work is economically low in value.

The women’s movement at the turn of the 20th century was also divided around class issues. A rift around the appropriate path of social change and reform marked the divide between radical/socialist versus moderate/bourgeois social work. While recognizing the disastrous impacts of the capitalist economy, the latter didn’t believe that revolution or socialism was the proper avenue to achieve social justice. Alice Salomon, a pioneer of social work in Germany, distanced herself from the demands of socialism, yet in the wake of the 1918 revolution, had to cede to the limits of social work. Although most social workers opposed the revolution, Salomon admitted that history had another say:

«All those who had found their life’s work in social work would have to recognize today that they had been too ‹lukewarm,› too ‹weak,› that we had made far too little impact on the public conscience, that we had protested far too little against a social order whose damage we could recognize better and more impartially than many others» (Salomon 1919, p. 187).

These questions haunt social work until today. Salomon’s reflections on social work’s mandate resonate with my transnational experience with care work. In Cairo, the NGO I worked for was shut down by the government, which perceived our work as a threat to national security. Social work with refugees was rendered illegal amid a crackdown on civil society groups following the revolution of 2011. This stands in stark contrast to my work in Berlin, where most organizations in the care field received direct funding from the state. It was safe to practice my work in Germany, but I found myself contending with other ethical considerations.

Working as a state beneficiary, in my opinion, confines the radical potential of social work. It runs the risk of turning care from a matter of community solidarity to one of social control. I would clarify through the context of refugee support where social workers find themselves working within the limits of German law, which, at times, violates the human rights of refugees in terms of accommodation, right to movement, or the right to non-refoulement.[3] Indeed, there were instances of conscientious objection such as refusing to collaborate in cases of deportation or refraining from providing the true age of clients who are deemed minors.[4] Yet these cases of rebellion remain seldom, isolated, and little documented. What I experienced was much different. Being part of the refugee community made me witness different degrees of infantilization and condescension toward beneficiaries in addition to numerous incidents of racism and sexual exploitation at the hands of social workers. Such is the complicity of the helping professions in reproducing power and fostering disenfranchisement.

The institutionalization of care runs the risk of abiding by the technological logic of effectiveness, which reduces clients to numbers for statistics. This could manifest itself by lacking attention toward clients’ specific needs. In my observation, this problem appears in rules and regulations which are intended to organize workloads but instead result in limiting the scope of work. For example, care workers in certain settings are given predetermined timeslots for each client to ensure a good workflow. However, this resulted in turning clients away, citing the lack of capacity, while in my view, this could have been addressed by better communication and adaptability. I was used to working in a more volatile setting in Egypt, always ready to adjust to emergencies, but I found that more challenging in German settings. Exercising flexibility and extending empathy towards clients was rendered objectionable because of such technological logic, which fails to see clients in their full.

I invoke the dark sides of care work to highlight the need to refocus and reorient care as a community responsibility. This requires us to investigate the predominant modes of contemporary care systems. What is at stake in the institutionalization and professionalization of care? How do we avoid perpetuating the status quo and fight hierarchies of injustice as we do our care work in a state-organized system? How to engage in liberatory practices of care? I find the notion of promiscuous care[5] useful to think through the contours of care.

«Promiscuous care means caring more and in ways that remain experimental and extensive by current standards. It means multiplying who we care for and how. Building on historical formations of ‹alternative› care giving practices, we need to create the capacity for a more capacious notion of care. This is challenging because neoliberal capitalism’s underfunding and undermining of care have often led to paranoid and chauvinist caring imaginaries – looking after only ‹our own›. With adequate resources, time, and labour people can feel secure enough to care for, about and with strangers as if they were kin.»

Closure: A Return

The diagnosis on my sick note was neurasthenia which literally means weak nerves. When I first read it, I thought, that sounds very Victorian era. It reminded me of the female characters in 19th-century novels of Charles Dickens or Jane Austen’s character Marianne, who fainted when her ex-lover ignored her at a party.

I was quite young the first time I saw someone faint, perhaps 8 or so. We were lining up to buy bread at the government-subsidized outlet, the cheapest bread you could find. One queue was for men and another for women. It was very crowded, and people kept pushing forward, bodies squeezing each other. I was looking at the girl in the women’s queue who looked my age. The only children were surrounded by big people. Her suffering eyes started twitching and then slowly closed. Her body eventually leaned slowly on that of other women nearby. When they noticed, they revived her using some cologne.

This talk of fainting seems like a digression, but I find a sense of irony when a doctor of a privileged background uses a dated diagnosis to define me as possessing weak nerves. Who gets to be strong and who gets to be weak? This medical encounter mirrors the colonial one since holding the power to label and define others is a central feature of colonialism. Am I weaker because I am burnt out? Or am I stronger because I survived violences that global north subjects are protected from?

However, I don’t want to romanticize the resilience of global south subjects. «Resilience is a term borrowed from physics that describes how certain materials behave. I am made of flesh. Steel doesn’t memorize trauma. The flesh does,» said Berlin-based Brazilian artist Lux Venérea. She refers to how notions of resilience and strength are used to normalize structural and daily violence against gendered, racialized, and displaced bodies. I got to read accounts of fainting and witnessed it several times after that bread queue incident, but I never experienced it firsthand. Sometimes when I get overwhelmed and overburdened, when my soul feels too heavy, I wish I could faint, too.

We often see sickness as an act of betrayal from the body, as in fainting, where consciousness is lost, and the body simply tumbles down. This view is rooted in the belief in the supremacy of the mind over the body. In her essay on being ill, Virginia Woolf wonders why illness hasn’t occupied the same position in literature as much as jealousy or love. She writes: «Those great wars which the body wages with the mind a slave to it, in the solitude of the bedroom against the assault of fever or the oncome of melancholia, are neglected. Nor is the reason far to seek. To look these things squarely in the face would need the courage of a lion tamer; a robust philosophy; a reason rooted in the bowels of the earth.»

Burnout doesn’t mean the end of care work for me. Care comes in myriad shapes and forms. From simple daily life interactions with strangers to long-term engagement with partners. I am exploring how care can be extended to artistic practices, whether writing or other forms. Burnout is a call from the body to rest and rethink practices of care.

[1] Holloway, Karla (1995): «The Body Politic.» In Codes of Conduct: Race, Ethics, and the Color of Our Character. New Brunswick: Rutgers University Press, p. 15–71.

[2] Homosexuality is not illegal in Egypt, however, a postcolonial law banning sex work is used to prosecute gender and sexual non-normative people in the country. A sentence for the crime of debauchery, however, could amount to up to three years of jail time.

[3] The principle of non-refoulment is codified in Article 33 of the 1951 Convention relating to the Status of Refugees.

[4] Because of the special rights provided to unaccompanied refugee minors, many politicians in Germany demanded medical age assessments for younger asylum seekers, a practice that involved the genital examination of the claimants. Other experts have deemed the age assessments, such as the Central Commission for Ethics (Die Zentrale Ethikkommission, ZEKO), as dubious and unethical.

[5] Hakim, J., Chatzidakis, A., Littler, J., Rottenberg, C., & Segal, L. (2020): The Care Manifesto. Verso Books.

→ Ahmed Awadalla is a writer and health practitioner based in Berlin.
Illustration: → Joaquina Garotte Gasch