Dependence, choice and trust

A number of questions have appeared, more or less explicitly, within thepreceding chapters pertaining to a tension between processes of trustformation and the extent of choice involved within these. One example ofthis was in Chapter Three where we followed Barbalet in noting a‘forced option’ (Barbalet, 2009: 372) aspect to trust, as wasmade evident in comments by participants such as ‘You have to [trust]in some ways’. In Chapter One, we suggested that some degree ofchoice was intrinsic to trust (following Luhmann, 1988) and that this,therefore, presents us with an apparent contradiction. A number of questionsthus emerge as to how we deal with the limited agency involved in trust and,where this is apparent, whether we are being accurate in referring totrust.

These concerns are latent within a number of empirical studies into thenature of trust, not least within healthcare contexts, though few studieshave set out to grapple with these difficult issues. One noteworthyexception to this is a paper by Meyer and Ward (2009), which rendersexplicit a number of the tensions touched upon here. At the centre of theseauthors’ concerns, and seemingly of this issue, is the notion ofdependence. High levels of dependence limit choice and, thus, make trustless relevant, leading Meyer and Ward to argue for a clearer distinctionbetween when researchers are referring to trust and when – in theabsence of choice – they are referring in fact to dependence.

While this would seem prima facie a very suitable,Luhmannian answer to this conceptual problem, there are many aspects oftrust that we have visited in the previous chapters that suggest things arenot quite so straightforward. The first concern with this solution is thatdependence, far from being separate from trust, is in many senses apre-condition of trust as a result of vulnerability. As was also establishedin Chapter One, actors only need to trust when they are vulnerable. Thisposition of vulnerability makes salient certain power dimensions that renderthe vulnerable more or less inevitably dependent on certain other actors.For example, the social experience of illness within modern societies meansthat those experiencing morbidity are normatively oriented towards dependingon those apparently able to understand, diagnose and alleviate illness– typically, healthcare experts.