Anthropology NewsletredMarch 1995 48

Commentaries

Out on the Floe By Jeanne Simonelli (SUM-Oneonta)

Long before I ever knew that there was a field called anthropology. or exactly what it involved, I heard tales of what the Eskimo did to (or for) their elderly when they could no longer be called contributing members of society. As the story went, Grandma would be put out on an ice floe, to drift with the winds until she reached her final desti- nation. Even as a child-where I watched my grandpa live out the last five years of his life in a wheel chair, talking to a wide array of characters not even visible to the children-the Eskimo solution seemed like a wise idea. But in that era of large extend- ed families there were enough unmarried daughters and sons living in the patriarchal residence to provide long-term, in-home care, and Grandpa died in the chair at the age of 102.

Forty years have gone by since Grandpa passed. With medical advances, i t is not unusual for many Americans to live as long as he did, but the world that they are grow- ing old in is a very different one. The extended family has been dismantled, with dwindling branches scattered across the nation. living in nuclear isolation. far from their aging parents. The elderly are indeed old, and sometimes their bodies outlive their minds. Unable to care for themselves any longer, they are the population of peo- ple who end their days in repositories for bodies, away from the families who would have either cared for them as their time drew near.

The Right to Die

When I entered the study of anthropolo- gy, I never looked for the origins of the Eskimo story, but frequently told my chil- dren that when the time came they had my permission to put me out on one version of the floe or another. To be fair, the State of New York has made it easier for them to do so, by recognizing the legality of living wills, health care proxies and DNR (do not resuscitate) orders. In the case of terminal illness, one can preelect to refuse chemotherapy. hydration. artificial feeding and even antibiotics. But we are tied to legally recognized, medically generated definitions of terminal disease. We acknowledge the impending death of vital organs-or of the brain's capacity to do more than habitual acts-as "terminal." But what of the death of reason? What about the millions of elderly sitting in nursing homes with conditions defined as "dementia"? What is the nature of the lives they continue to live out?

This past November, the State of Oregon passed a right to die law. allowing physi- cians to take part in assisted suicide provid- ing that a terminally i l l patient requests help three times and is judged to have only six more months to live. Thus, we are provid- ing for those whose reason outlasts their systems. or for those who enter a coma which is judged to be irreversible. Oregon's law has yet to be tested. It was immediately challenged by opponents and brought intn the courts. I n t h e n icnn r imc . .I t c ~ K c v o r k i d r i - I i kc p h j \ i c i : i i i \ . ind i i i i n t\ici \ continuc to act quie t ly on b c h n l l nl' hunirrri dignity. For !he nioqi part t iowcvcr . t h o k c uh(i rcniain p h ~ s i c . i l l ~ "tic;iltti) ." h i i i i c i i 1.111) coniproiniscd . I I C I)UI 01 l u ~ l

day. That means the total cost of long-term care per day in the US is from $2.74 million to $4.34 million. About half of this is paid for privately; the rest funded by govem- ment programs such as Medicare (skilled care only) and Medicaid. To be Medicaid- eligible, you must have little or no resources. If you have a spouse who remains in the community, he or she must "spend down" to acceptable levels. The pri- vate payers are those whose savings and incomes make them ineligible for govern- ment aid. They are not the truly wealthy. any more than they could be called the truly needed. Frequently, they are the American Dream. Hardworking. two-income couples who squirreled away savings for 50 years so that they might provide for their children and grandchildren through inheritance. Sorry, folks. Not only can you not take i t with you. according to Uncle Sam, you can't give it away either!

Anthropology Comes of Age By Maria D Vesperi (New College) and Jay Sokolovsky (FMHIIUSF)

I n primitive culture there is a certain parsimoniousness about m e n w r y w h a t is remembered by the aged seems to be what sustains the culture. On the other hand. much that might enter communication between rhe old and the young in our cul- ture becomes obsolete and is of little or no consequence to the culture. . . . Thus, if primitive culture is an unchanging moun- tain. ours is an avalanche falling into a Sea ofNonexistence. Who can remember it? IJ in primitive society, one's personal commu- nity is a rope fastened in a mythic past and continuing into ajuture without end, ours is a bir of string that falls from our hands when we die.

Ethnographies are filled with the voices of older people, though the aged themselves were not widely acknowledged as fieldwork

-Jules Henry (1963)

Our Subjects whither- and -

Why am I writing about this? I was cata- pulted into the morass of Medicaid and long-term care on the day classes ended in December. My mom, aged 78. had been traveling in and out of this reality for the last three years. Diagnosed with dementia as a result of final stage (but not terminal) Parkinson's disease, she was also legally blind. She and my dad lived together. alone, on the other side of the state. and for a num- ber of years I'd been pushing Dad to sell the house and move closer to what little family he had left. Knowing that change is all but impossible for many of the elderly, I knew he wouldn't take the initiative. All that could be done was to wait for the crisis.

Mom fell and broke her hip on December IS. Since then. I've brought her to a nursing home in my town. and brought dad up to live with me. All of the financial, health care and household arrangements that we talked about for three years were accom- plished in three weeks. Our lives have been turned upside-down. I've learned, belatedly, that my mother's living will asked that we not provide some of the care that kept her alive after the surgery. Indeed, in some of her few lucid moments, she took us to task

See Out on the Floe on page 46

Ourselves

subjects unt i l the 1970s. Anthropologists traded heavily on the sound memories and goodwill of the old throughout the colonial period; the "wizened survivors" of devastat- ed cultures provided much fodder for eth- nological speculation. Contemporary read- ers are stunned by such presentations. devoid of comment about the circumstances of these informants' lives.

Equally striking, however, is the absence of attention to what old folks said and did as representatives of a culturally and bio- logically constructed stage of life. Leo Sim- mons brought this issue to the fore in The Role of the Aged in Pr imir ive Society (1945). the first systematic effort to identify and categorize aspects of aging cross-cul- turally. It is notable that Simmons, a sociol- ogist, was also among the first to utilize the Human Relations Area Files in his survey of 7 I cultures.

Medical anthropologist Otto von Mering made early use of the ethnographic approach as a valuable tool for understand- ing the relationships among aging, local culture and well-being. In the late 1950s he conducted fieldwork in the geriatric wards of psychiatric hospitals, illustrating how the cultural devaluing of old age led to a with- drawal of psychosocial care for older patients. Anthropologists who wrote about

Photo by Charles D Winters

aging did not receive widespread public attention until 1963, however, when Jules Henry presented a vivid ethnographic account of life in three American nursing homes. A new generation of anthropology students was deeply influenced by the moral imperative of Culture Against M a n , and by the possibilities i t offered for research among the aged in western cul- tures. Five years later. Margaret Clark offered leadership and direction for anthro- pological research on aging with her influ- ential article. "The Anthropology of Aging, A New Area for Studies of Culture and Per- sonality," plus a book coauthored with Bar- bara Anderson, Culture and Aging: An Anrhropology Study of Older Americans (1967). It is significant that Clark's article, and others she wrote in 1969 and 1971. were published in The Gerontologist rather than in anthropological journals. Similarly, "An Anthropological Profile of Aging- Retirement from Life into Active I l l Health" by von Mcring was published by the Journal of Geriarric Psychiatry in 1969.

The appearance of Aging and Moderniza- tion (Cowgill and Holmes 1972) marked the first comprehensive use of knowledge from modem ethnographies to test geronto- logical theory. In this volume, detailed studies of 14 societies were compared to examine the impact of industrialization. urbanization and westernization on the sta- tus of the aged. The theoretical propositions developed by Cowgill. a sociologist, and Holmes, an anthropologist, in Aging and Modernization served as controversial stim- ul i to subsequent work.

The anthropological study of aging took hold during the 1970s. as increasing num- bers of graduate students pursued primary fieldwork in this area. In 1975 the federal Administration on Aging began to offer dis- sertation grants; support came also from the National Science Foundation and the National Institute of Mental Health. How- ever. few departments of anthropology offered courses in aging, and-with some notable exceptions-few academic advisors were comfortable with such research.

Instead. anthropologists who studied aging began to discover each other. We scoured interdisciplinary journals for new publications and attended meetings orga- nized by scholars from other disciplines, hoping to find fellow anthropologists. We critiqued. reviewed and taught each others' work. In 1978 we formed the Association for Anthropology and Gerontology (AAGE). a multidisciplinary society devot- ed to national and international research and publication about aging. An association of several hundred members, most of whom are anthropologists. AAGE publishes a quarterly newsletter which includes a bibli- ography of new publications in the socio- cultural and biomedical study of aging. A membership directory and a guide to teach- ing interdisciplinary and cross-cultural courses about aging are also available.

The Margaret Clark award, an annual competition for the most outstanding gradu-

See Aging on page 46

AN Comnttntaries are designed to expiola diverse views of the disciylzne from an anthropological perspeclive. Commentaries re$ect the views of the authors: their publication does not .rignifj cndarsernent by the Anthropol- o g y Ncwslcttcr or the A m e r i c a n htliropologicaI .4 nociation. Authors arc crpccted to vc>ri,fy all factual infornrrrtrori included t r r (he tex t . Alarrrt.wrprc rlroriltf hc Iesr than 2 0 t x w d J i l l IFnrth m d must he .Wb??tt!. red ott 60th &.sk i ir trf in double-spaced hard copy.

46 Anthropology NewsletterAMarch 1995

Out on the Floe Continuedfrom page 48

for saving her life and putting her into a home.

The nursing home she entered is as good as it gets. The staff is gentle. caring and patient. Yet, in the final analysis, the place is grim. Sixty-three old women and 17 old men sit parked in their wheelchairs near the nursing station, or lie alone in bed-growl- ing. whining, incontinent. living in worlds to which we have no access. Some beg to “go home,’’ others cry quietly. As death is hard- est for those who survive, long-term care is hardest for those who get to leave. In the final analysis, I have put my mother out on the ice floe, while the federal government asks my dad to pay for the refrigeration.

Two Old Women Having used the ice analogy enough

times, I finally got out a copy of Franz Boas’s ethnography The Central Eskimo (1964). There was no documentation of that mode of dealing with the aged, but there was reference to a type of euthanasia. According to Boas, the souls of those who die by violence are said to go to Quidlivun, the happy land. For this reason, i t was con- sidered lawful for a man to ki l l his aged parents.

Another variation on this theme appears in the book Two Old Women by Velma Wallis (1993). Described as an Alaska leg- end of betrayal. courage and survival, i t tells the tale of two old women whose tribe abandons them during a period of starva- tion. Faced with the prospect of impending death, the women make a decision to sur- vive, finally reuniting with their tribe. According to the legend, the tribe decides never to abandon any elder again.

1. too, would like to never abandon an elder again. I would like to never abandon the “demented” into indefinite terms of existence in custodial care. I would like to never abandon their spouses into having to expend their life’s assets for two or three years of watching in helplessness. I would like to never abandon the terminally ill-be it of body or mind.

As a society, we are responsible for the shape of aging in the US. We have allowed our extended family networks to be broken apart in our quest for jobs and careers. We have championed a medical profession that offers a flawed shot at immortality. The end-product is a growing population of the elderly with a need for long-term care, without a plan to provide for it in a rational and humane fashion. It is time that we took a long look at what life will we be like in the 21st century. and come up with some realistic plans for dealing with what we have created. 4

For anthropologists, this is a pressing issue: it is in the domain of our interests and it will be part of all of our lives; it is an issue of ethics and i t is one of practicality.

[Simonell i , Associate Professor of Anthropology at SUNY-oneon fa and Secre- tary and Contributing Editor for the Sociery of Humanistic Anthropology, originally submitted this thoughtful piece for her col- umn this month. Her field experiences are united by the broad theme of change and its

Anthropology Begins in High School

Semifinalists in the 1995 Westing- house Science Talent Search include 4 high school students who designed and carried out anthropological projects:

m Aryn Elisaberh W Barrley (Okemos High School, Okemos, MI) , “Cluster analysis of late Woodland sites contain- ing Mississ ippian pot tery along the Lower Illinois River Valley;”

Roxana M a r i a Gonzalez (Our Lady of L o u r d e s A e a d e m y , M i a m i , FL) . “Identification of a new mutation for Laron Syndrome in a Bahamian popula- tion and its relationship to 17th century ancestral remains;”

So0 Yuen Kim (Jericho Senior High School. Jericho, NY) “Taphonomy of a Neanderthal cave: comparative analysis of bone breakage patterns to discern hominid behavior: two-year study;”

Amy Rosemary White (Ft Madison Senior High School, Ft Madison. IA).

repercussions in Mexico, Oklahoma, rural New York and or Canyon de Chelly, Ari- zona. Concerned wuh the human condition and the literary expression of anthropologi- cal knowledge, Simonelli’ s publications are directed at both rhe anthropological audi- ence and the general public.]

“Mobility vs availability: lithic organi- zation at the Evie site.”

This is the 54th year of the annual contest, which is administered by Sci- ence Service, Inc in partnership with Westinghouse Corporation. This year a total of $205,000 will be awarded to 41 finalists, chosen from the 300 semifinal- ists. Contestants must be seniors in high school and are judged on their 20-page report of a completed research project. Final awards are determined at a meet- ing i n W a s h i n g t o n , DC. i n M a r c h , where contes tan ts wil l present their research to a panel of judges. According to spokesperson Karen Richardson, both So0 Y u e n K i m a n d A m y Rosemary W h i t e were selected as finalists this year. Regrettably, So0 Yuen Kim was killed in a car crash in November 1994, before learning of her achievement.

For funher information, contact Sci- ence Service, Inc, 1719 N Street NW, Washington, DC 20036; 202785-2255,

Aging Continuedfrom page 48

ate or undergraduate student paper in anthropology and gerontology, was estab- lished by AAGE in 1993. Today, it is not uncommon for anthropology programs to offer courses and graduate-level specializa- tions in aging studies. Two texts. 0:her Cultures, Elder Years (Holmes and Rhodes. 2nd edition 1995) and Old Age in Global Perspective (Albert and Cattell 1994). were developed to meet these demands.

AAGE is affiliated with the quarterly Journal of Cross- Cultural Gerontology, established and edited by anthropologists who specialize in international ethnograph- ic research on aging issues. AAGE mem- bers have also been active since 1985 in creating and maintaining an international Commission on Aging and the Aged within the International Union of Anthropological and Ethnological Sciences.

The establishment of a National Institute of Aging (NIA) within the National Insti- tutes of Health has provided new avenues of support for anthropologists interested in the cultural and biological study of aging. Two recent NIA supported projects stand out in terms of significance. Project AGE (Age, Generation, Experience), co-directed by Christine Fry and Jennie Keith. repre- sents the most sophisticated cross-cultural study of aging. Two recent NIA supported projects stand out in terms of significance. Project AGE (Age, Generation. Experi- ence), co-directed by Christine Fry and Jen- nie Keith, represents the most sophisticated cross-cultural study of aging ever undertak- en. Using a common methodology. com- plex ethnographies of age and aging were conducted at 6 sites around the world between 1982 and 1990. The research shows how both “system wide” community features (such as social inequality) and “internal mechanisms” (such as values) cre- ate distinct contexts for conceptualizing the life cycle, establishing age norms and influ-

encing the perception of well-being in old age. Key results of this project can be found in The Aging Experience: Diversity and Commonality Across Cultures (Keith, Fry et al 1994).

The second project dealt with elden liv- ing in unlicensed board and care homes in Cleveland, OH, and throughout the state of Maryland. Anthropologist Kevin Eckert led this longitudinal study by a multidisci- plinary team. The research demonstrated the viability of small, unlicensed private homes in providing care for the frail aged, even those with dementia and highlighted the critical place of such “informal” resi- dential environments in building an effec- tive system of long term care in the US. A book resulting from this project. Small Board and Care Homes: Residential Care in Transition, will be published this sum- mer by the Johns Hopkins Press.

Institutionalization, housing options for the elderly, community-based long term care and homelessness have been the con- sistent focus of much research on aging conducted within North America. Book- length treatments of nursing home life by anthropologists include The Caregiving Dilemma: Work in an American Nursing Home (Foner 1994); The Ends of Time: Life and Work in a Nursing Home (Savishinsky I99 1 ); The Nursing Home in American Sociefy (Johnson and Grant 1985); Uneasy Endings: Daily Life in an American Nurs- ing Home (Shield 1988); and Limbo: A Memoir of Life in a Nursing Home by a Survivor (Laird 1979). Anthropologists have also written many articles on this sub- ject. An edited collection. The Culture of Long Term Care: Nursing Home Ethnogra- phy (Henderson and Vesperi). is currently in press. In November, the School of Amer- ican Research will sponsor an Advanced Seminar on “Nursing Home Ethnography,” led by Philip Stafford.

Coping with the final stages of physical existence is one of the most vexing chal- lenges faced by any culture. What seems distinctive about the US is the patterned dissociation of death from the rest of the life course. Not surprisingly, one of the few examples which come to mind when most

of us think about growing old in other cul- tures is the reputed habit among Inuit peo- ple of abandoning or killing the elderly. The anthropological literature on this sub- ject makes it quite clear that there were such occurrences. but so-called “death has- tening” practices were not found in many parts of the arctic region and, in a majority of actual cases. the ending of life occurred at the insistence of the older person (Guem- ple 1987). Significantly. the ethnographic evidence from the Inui t corresponds to global analyses focusing on the issue of assisted suicide and other forms of death hastening. Two anthropological teams have used the HRAF files to explore this issue in depth. One set of studies, led by Anthony Glascock (1990), found that a majority of the societies in a random sample exhibited some form of death hastening behavior. with less than a third providing uncondi- tional support. However..few societies enforced a single treatment of their elderly and i t was commonly found that both sup- portive and death hastening behavior coex- isted in the same social setting. Glascock’s study revealed cultural distinctions between “intact,” fully functioning older people and “decrepit” individuals who find it difficult to complete basic tasks. Persons identified as members of this latter category were the most frequent subjects of geronticide or death hastening.

The other HRAF study was a compara- tive examination of reasons for showing contempt toward the elderly. Maxwell and Maxwell (1980) isolated 8 types of com- plaints against the aged as rationales for the display of culturally variable negative treat- ment. Physical deterioration was a signifi- cant factor, but it lagged behind “loss of family support system” and “devalued appearance” in accounting for the vagaries of negative behavior toward the elderly. The authors suggest that changed physical image may be more important than expect- ed in understanding the construction and deconstruction of personhood in late life.

Comparative approaches to the study of aging and ethnographic methods are emerg- ing as critical tools in the crafting of social welfare policy for the 21st century. Public

awareness of the “graying of America.” debates over health care and euthanasia. and the demand for community-based alter- natives to institutionalization for the frail elderly have focused interest on aging poli- cy and further increased the perceived rele- vance of anthropological research in this area. In medical schools and research insti- tutes throughout the US, anthropologists are increasingly seen as active members of multidisciplinary teams that study Alzheimer’s disease, immune responses, drug interactions. cardiovascular disorders, alcoholism and numerous other health issues associated with the aging process.

[Resources suggested by the authors include: Nusberg. C and J Sokolovsky. International Directory of Research and Researchers in Comparative Gerontology, Washington: AARP, 3rd edition 1994. (Also available on IBM compatible disk). Schweitzer. M. Anthropology of Aging: A Partially Annotated Bibliography. Green- wood, 1991.

For information about the Association for Anthropology and Gerontology, contact Maria Cattell. AAGE Treasurer, 543 Bayard Rd, Kennett Sq. PA 19348.

Vesperi teaches anthropology at New College. the honors campus of the Florida State University system. Her publications include City of Green Benches (1985). and The Culture of Long Term Care, coedited with J Neil Henderson (in press). She is a former president of AAGE ond currently serves as AN Contributing Editor for the Society for the Anthropology of North America.

Jay Sokolovsky is Professor of Anthro- pology at the U of Maryland Baltimore County. Currently, he is a National Institute of Aging Senior Fellow at the Florida Men- tal Health Institute at the U of South Flori- da. He is co-aurhor, with Carl Cohen, of Old Men of the Bowery (1989). and editor of Growing Old in Different Societies (1987) and The Cultural Context of Aging (I 990, 2nd edition available early 1996). A former president of AAGE and former chair of the IUAES Commission on Aging, he has conducred research in the US, Mexico, Croaria and England.]