A notable aspect of this shift from state welfare to volunteer labor in both Italy and the United States is the way that services once considered to be the right of citizenship are encountered in this new version as a privilege, a “gift”—albeit ideally an emotionally resonate one, the product of a fraternal sentiment between citizen-donor and recipient. Marcel Mauss, in the conclusion to his famous essay on the gift, highlights connections between the emergent welfare state in early twentieth-century France and the reciprocal moral obligations that he views as emblematic of gift exchange.19 In his idealized description, the interconnections among labor unions, workers, employers, and the state create a web of obligations that ensures security and solidarity for all. But in its late twentieth-century iterations the “gift” of compassion becomes both highly personalized and one-directional. The emphasis on volunteerism reimagines the gift of social services as unrequited, a demonstration of care in the face of abject need, seemingly given without expectation of compensation or reward. As much as the language of compassion sought to empower and mobilize American and European volunteers, it also undermined the agency of those who received aid. The needy were not partners in such works of compassion, viewed as members of a broader interdependent society, but instead were characterized as recipients of their neighbors’ benevolence and care. The “right” to health care, safe housing, and food is reinterpreted in conservative language as a problem of “entitlements,” a system that emphasizes the dependency, rather than the productivity, of the poor.
The context of international aid shifts the dynamic of the relationship of citizen and state to one of donor and recipient, but many of the effects of this rhetorical turn remain. The idea of compassion may be contextualized as part of the broader emergence in recent years of a “politics of care” that has shaped contemporary responses to humanitarian crises worldwide.20 Erica James describes the “political economy of trauma” in Haiti as a “compassion economy,” one that “can transform pain and suffering into something productive.”21 As Miriam Ticktin points out in her study of French asylum policies, the emergence of care as a platform for governance has shaped the subjects of the state’s concern in particular ways.22 The compassionate response is provoked by images of suffering, the recognition of a “morally legitimate” subject whose abject physical need compels our action. Drawing on Michel Foucault’s notion of “biopower,” a term he coined to explain the mechanisms through which life becomes the object of the state’s “explicit calculation,” Ticktin, James, and others have highlighted how the suffering body has emerged in recent years as the dominant platform upon which claims to state and nonstate resources may be made—a platform that has in many instances displaced and closed off other possibilities for collective political action.23 This trend has perhaps been nowhere more evident than in the realm of international AIDS relief, where the ability to convey abject suffering to nongovernmental agents with the power to provide access to scarce medical resources may mean the difference between life and death.24
This recent work has brought about a question: When care or compassion becomes the central focus of international governance, what forms of subjectivity and political advocacy gain leverage? In the wake of policy reforms like PEPFAR, which infused major American global aid programs with the ethic of compassion and mercy, this question took a new shape: What kinds of “healthy” subjects and behaviors were made recognizable by the language of compassion, and why? Moreover, what effect did an emphasis on compassion have on long-standing and successful local efforts to prevent the spread of HIV in Uganda?
For President Bush and his advisers, the compassionate response was driven not only by the recognition of the suffering of others but also by the effect compassion itself was believed to engender. Bush described the compassionate approach as “outcome based, driven by results” and called for “compassionate results, not compassionate intentions.”25 He wrote in his administration’s Armies of Compassion policy overview that “government should help the needy achieve independence and personal responsibility.”26 Compassion was viewed as a gift of redemption, a personal sentiment that when deployed enabled the social transformation of needy communities and individuals into accountable, responsible—but not “entitled”—persons.
These ideas were informed not only by a neoliberal orientation to governance but also by a distinctly Christian understanding of the nature of compassionate sentiment. For American Christians, Bush’s language resonated strongly with familiar lessons about charity and the transformational effects of what evangelical Christians call the “selfless love” that characterizes demonstrations of mercy for the poor and suffering. Evangelical and born-again Christians believe that compassion “invokes an ideal of empathetic, unconditional benevolence,”27 the demonstration of care in a context in which it may be least expected. Compassionate acts are selfless gifts but, perhaps paradoxically, they also engender an expectation of evidence of the transformational power of God’s love. As Omri Elisha has discussed in his study of American evangelicals in Tennessee, charitable compassion is dialectically linked to an ideal of “accountability,” the expectation that recipients of care demonstrate or reflect godly virtue.28 The gift of compassion is on the surface understood as an act of selfless mercy, but it is also a gift capable of radical change, affecting personal conduct and, by extension, the moral fabric of society. In the eyes of conservative Christians at the turn of the twenty-first century, domestic welfare programs were redeemed by their transformation into programs of individual and community charity that were driven by the personal sentiment of compassion. Compassion in this American context was believed to address the problems of state welfare not only because the state became more efficient but because compassion combined care with the unstated expectation of personal change among recipients. A sense of empathy generated such Christian compassion, as did the possibilities for self-transformation that such a worldly (and spiritual) gift was thought to enable. By applying compassion to his global political agenda Bush signaled a similar emphasis on the transformational power of humanitarian mercy.
The idea that compassion was a transformational gift, one that engendered accountability in needy recipients, was a powerful tool in enabling the American conservative embrace of AIDS relief work, and for Bush’s evangelical base this idea suddenly brought popularity to AIDS as a cause. Compassion was a sentiment driven not only by moral obligation but also by the “moral ambitions” for social change that extended from American ideals of volunteer and humanitarian work.29 This was an orientation to charity and donor aid that was shaped in particular by evangelical Christian notions of what a demonstration of compassion meant and what response it should invoke. As I noted above, compassion in this instance was embedded not only in an idea of ethical obligation to those suffering but also in the notion of the work God’s love does for and on the suffering subject. In American endeavors to show mercy, there was a parallel expectation that subjects would become accountable and empowered in return.
The language of compassion placed the onus on recipients of aid to demonstrate the transformational effects of their care. In the case of PEPFAR, such demonstrations were