Bureaucracy has long shaped how societies care for bodies—both physical and symbolic—yet few examine how administrative systems define what counts as worthy of care in the first place. In his 2022 book Philosophy of Care, Russian-born philosopher and media theorist Boris Groys argues that modern institutions do not simply deliver care; they first determine who or what qualifies as a subject deserving of it. This prerequisite—what Groys calls the symbolic body—acts as a gatekeeper to physical care, raising urgent questions about autonomy, recognition, and power in healthcare and cultural systems.
Groys, a professor at New York University’s Faculty of Arts and Science, builds his analysis on a long philosophical tradition stretching from Plato to Foucault, Hegel to Bataille. His operate reframes care not merely as an act of healing or preservation, but as a biopolitical mechanism through which modern states exert control. In secularized societies, he contends, medicine and hospitals have replaced religion and churches as the primary institutions entrusted with safeguarding life—turning health into a secular form of salvation. This shift, he argues, transforms individuals into perpetual patients, monitored from birth by systems that already realize the outcome of their treatment.
Central to Groys’ thesis is the distinction between the physical body—the tangible, biological entity—and the symbolic body, which encompasses identity, recognition, and social legitimacy. He observes that access to physical care often depends on first being recognized as a worthy subject through symbolic validation. For instance, one may only receive medical treatment after fulfilling administrative requirements, proving legal residency, or conforming to societal norms of productivity or compliance. In this way, bureaucracy does not follow care; it precedes and conditions it.
The philosopher further notes that what benefits the symbolic body may not align with the needs of the physical body—and can even harm it. Recognition, visibility, or legal status might improve one’s standing in the eyes of institutions whereas doing little to alleviate suffering or illness. Conversely, efforts to sustain the physical body—such as rest, pain management, or withdrawal from public life—may be interpreted as non-compliance or lack of symbolic engagement, thereby jeopardizing access to care. This tension reveals a core contradiction in modern care systems: the very mechanisms designed to preserve life can require individuals to perform wellness in order to receive it.
Care as a Tool of Institutional Control
Groys draws a compelling parallel between the hospital and the museum—two spaces devoted to preservation, yet both prone to stripping away the essence of what they seek to safeguard. In the museum, an artwork is often reduced to its material presence; its spiritual, historical, or disruptive power is muted in favor of curatorial order and display protocols. Similarly, in the hospital, the patient’s lived experience of illness can be overridden by standardized procedures, diagnostic categories, and treatment algorithms that prioritize systemic efficiency over subjective reality.
This analogy extends to how both institutions manage time and permanence. Museums preserve objects outside the flow of time, presenting them as timeless artifacts. Hospitals, meanwhile, often aim to extend biological life indefinitely, resisting death as a natural conclusion. In both cases, Groys argues, the drive for preservation leads to a kind of embalming—where the living, dynamic quality of bodies (physical or symbolic) is sacrificed for the appearance of continuity and control.
He identifies a revolutionary potential in self-care: when individuals reject institutional definitions of health and legitimacy, they reclaim agency over their own bodies. Self-care, in this view, is not merely personal wellness but a political act—a refusal to let bureaucratic systems dictate when one is worthy of attention, treatment, or recognition. By insisting on care on one’s own terms, individuals challenge the assumption that institutions must mediate all forms of preservation.
The Expanding Sphere of Care Work
Recent discussions in journals like Il Tascabile have echoed Groys’ concerns, noting that care work has become the most widespread form of labor in contemporary societies. From childcare and eldercare to artistic conservation and digital archiving, vast networks of paid and unpaid labor sustain the maintenance of both physical and symbolic bodies. Yet this expansion coincides with increasing privatization and financialization of care, where access depends on one’s ability to pay rather than need.
Groys traces this trend to the erosion of collective responsibility, arguing that when states fail to provide universal, accessible care, individuals are left to navigate complex markets of private services. In response, mutual aid networks and community-based reciprocity models have emerged—not as alternatives to systemic reform, but as adaptations to its failures. These grassroots efforts, while vital, underscore a deeper issue: the delegation of care to individuals and communities often relieves institutions of their obligation to guarantee universal access.
The philosopher insists that care—of self, others, objects, or art—has always been a central theme in philosophy. His book revisits this tradition to request a simple but radical question: who should be the subject of care? Should we rely on ourselves, or delegate it to others, to the system, to institutions? For Groys, the answer lies in redefining care not as a service dispensed by authorities, but as a practice rooted in autonomy, reciprocity, and mutual recognition—one that resists the bureaucratic imperative to pre-approve worthiness before offering support.
As debates over healthcare access, mental health recognition, and digital identity continue to evolve, Groys’ framework offers a lens for examining how symbolic validation—whether through medical diagnosis, legal status, or cultural visibility—shapes who gets cared for, and under what conditions. His work reminds us that in systems where care is contingent on prior approval, the act of caring begins not with treatment, but with the power to decide who counts.