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H o m e as trading post: Attachment factors in elders’ decisions about living arrangements
Copenhaver, Mary Maclay, Ph.D.
The Ohio State University,1994
Copyright ©1994 by Copenhaver, Mary Maclay. All rights reserved.
UMI 300 N. Zeeb Rd. Ann Arbor, Ml 48106 HOME AS TRADING POST:
ATTACHMENT FACTORS IN ELDERS' DECISIONS
ABOUT LIVING ARRANGEMENTS
DISSERTATION
Presented in Partial Fulfillment of the Requirements for
the Degree of Doctor of Philosophy
in the Graduate School of The Ohio State University
By
Mary Maclay Copenhaver, R.N., B.A., M.A.
* * * * *
The Ohio State University
1994
Dissertation Committee:
Erika Bourguignon Approved by
Dorothy Jackson
Richard H. Moore Adviser Amy Zaharlick Department of Anthropology Copyright by
Mary Maclay Copenhaver
1994 To My Family
ii ACKNOWLEDGMENTS
I would like to express my deepest gratitude and
respect to the members of my committee: To my adviser,
Professor Erika Bourguignon, for mentoring that insists
on challenging dogma and assumptions and for her
friendship; to Professor Dorothy Jackson who teaches
that old age flows from the stages that go before--how
artificial are etic categories imposed by members of
younger "cultures"; to Professor Richard H. Moore for
opening up a window on another culture in the throes of
rapid change and highlighting both the similarities and
differences to the American experience; to Professor Amy
Zaharlick for emphasizing the importance of practice
grounded in theory and the necessity for ongoing
dialogue between the two.
It is never possible to acknowledge all the help
provided by one's family--from gentle encouragement to
goading. For ably fulfilling all kinship roles and more, I thank my husband Henry, daughters Lauren, Jody,
Wendy, and Cindy, their spouses and children. Special
thanks to Jody for invaluable computer assistance. VITA
June 12, 1934...... Born, Huntingdon, Pennsylvania
1955...... Diploma, Nursing, Huron Road Hospital School of Nursing, Cleveland, Ohio
1981...... B.A., Ohio State University Columbus, Ohio Major - Social Sciences (Psychology, Sociology, Anthropology)
1986...... M.A., Ohio State University Anthropology
1990...... Admission to Candidacy Ph.D.
9/1955 - Present...... Nursing Practice
PUBLICATIONS
1986 A Career For All Reasons. Nursing Management, vol. 17, no. 5, Pp. 42-44.
1989 Hospital Privileges for Physicians: A Law Within or Without the Law? Abstract of paper given at the session: New Aspects of American Law; Interwoven Diversity, 88th Annual Meeting of the American Anthropological Association, Washington, DC, November 15-19, 1989.
iv FIELDS OF STUDY
Major Field: Anthropology
Psychological Anthropology Anthropology of Aging Developmental Psychology
v TABLE OF CONTENTS
DEDICATION...... ii
ACKNOWLEDGMENTS...... iii
VITA...... iv
LIST OF TABLES...... ix
CHAPTER PAGE
I. INTRODUCTION...... 1
The Problem...... 1 Type of Study...... 3 Sample Selection...... 5 A Brief Introduction...... 8 Value of the Study...... 15 The Question...... 16 Attachment...... 17 Living Arrangements...... 20 Choice...... 21 Notes to Chapter I...... 27
II. LITERATURE REVIEW...... 2 9
Introduction...... 2 9 Cul ture...... 30 The Individual in Culture and Vice Versa....35 Enculturation...... 38 Attachment...... 41 Aging Theory...... 51 Attachment into Old Age...... 59 Decisions...... 66 Notes to Chapter II...... 79
vi III. METHODOLOGY...... 81
Introduction...... 81 Formulation of the Question...... 81 Selection of Method...... 82 Personal Characteristics of Researcher...... 87 Selection of Informants...... 91 The Research Process...... 93 Method of Analysis...... 99 Notes to Chapter III...... 105
IV. THE ELDERS...... 106
Introducti on...... 106 Fern...... 108 Toddy...... Ill William...... 116 Ducky...... 120 Dinah...... 123 Doris...... 126 Gertrude...... 129 Lyon...... 133 Nancy...... 136 Francesca...... 139 Notes to Chapter IV...... 144
V. HOUSING CHOICES AND CHOOSING HOUSING...... 145 Historical Factors...... 145 Considerations in Housing Arrangements Now.148 Open Market.--Unsorted by Age...... 151 Open Market--Sorted by Age...... 155 Packaged Services--Independent 1y-chosen. .. .158 Packaged Services--Def aul t ...... 169 Notes to Chapter V ...... 176
VI. SCOREKEEPING...... 178 Int roduct i on...... 178 Dependency...... 179 Characteristics of Scorekeepers...... 182 Characteristics of Non-Scorekeepers...... 184 Contrasts...... 185 Attachment and Scorekeeping...... 191 Notes to Chapter V I ...... 197
vii VII. CONCLUSIONS 198
Review...... 198 The Ten Informants--Reprise...... 200 Further Research...... 211 Notes to Chapter VII...... 223
APPENDIX...... 224
BIBLIOGRAPHY...... 225
viii LIST OF TABLES
TABLE PAGE
1. Informants' Situation (1994)...... 26
2. Early Childhood...... 77
3. Total Population by Age and Sex: 1980-1981.... 78
4. Interview Schedule...... 104
5. Demographic Characteristics...... 143
6. Informants in a Continuum of Housing Choices.175
7. Early Childhood Revisited...... 196
8. Core Dependency Patterns...... 222
ix CHAPTER I
INTRODUCTION
The Problem
What are the attachment factors in elders' decisions about living arrangements? The question first occurred, to me while carrying out a series of interviews for a term paper a few years ago. The interviewee was an eighty-four-year-old widow, newly established in a
"retirement village." She spoke with obvious regret about leaving her home and friends of forty years in another state. She and her husband had been charter members of a church in which she was still active until the move. They had raised three children there and all those memories of their triumphs and tribulations in the process were situated in that place. She had not worked outside the home but had been a dedicated volunteer worker for both the YMCA and YWCA. None of the children remained in that city but numbers of friends and church members expressed willingness to assist with errands and transportation if she would stay. But she would not.
She moved to the retirement "village" in the city where 2
a son and his family lived. It was an anticipatory move because the village included a nursing home and the woman did not want to be totally relocated again if nursing care became necessary.
Another woman was widowed after she and her husband had already scaled down twice from the original family home; the second time involved a move to Florida.
Although her friendships in Florida had not the time depth of the first woman's, nevertheless friends rallied round and offered the same kinds of support. Instead she moved back north to a city other than her original home, in this case to be near a daughter. She lived independently in subsidized rental housing for elders.
What were the variables leading to the choices these women made if indeed they thought they had chosen?
There were hints of sacrifice. "I hated to be so far away if I get sick. My son would worry. He would have to interrupt his work to come visit," said the first woman. The second woman said, "I know that [names several friends in Florida] have offered to get me groceries and take me anywhere I want to go but I don't feel right imposing." Rules of reciprocity enter into it. Apparently there are appropriate services for kin 3
to perform and different ones for friends. The
dissertation question began to take shape.
Type of Study
This was to be an exploratory, descriptive study.
If I already knew what variables led to the choices of
living arrangements, I could survey large numbers of
people who had made these choices and establish what
influential mixture of variables pertained in what
proportions. But I did not. I did not have a list of
the right questions to ask to exhaust the universe of
possibilities. I would collect ten life histories and
analyze them for critical decision variables. Life
histories promised a wide range of experiences of aging
and decisions about living arrangements. They would
project backwards in time to take in ever-enlarging
circles of people who influenced these ten people, in
effect, giving us an opportunity to "hear from" hundreds
of others. Although I found my ten informants within a
small area (three counties in the midwest), their places
of origin and peregrinations since represent two foreign
countries and a considerable portion of the United
States. Adding the stories they heard from parents and grandparents about other places and times considerably enlarges the scope of the cultural influences brought to
bear on their lives. The rationale for using life
histories is elaborated in Chapter III (Methodology).
The method of data collection involved taking
life histories in an informal (but guided) interview
format. I conceived of the life history falling into
four or five sittings of two-hour duration--each treating a life stage, such as early childhood. I shared with informants that I had ten foci or aspects of their lives that were particularly interesting to me.
One example is their relationship with their grandparents and others in that generation (See the
Appendix for list of topics). I was interested in anything they wished to divulge and made it clear that they should not tell anything that would cause them discomfort. For this study I would use no other sources of information apart from that which is available to the general public, such sources as: retirement home brochures, census data, newspaper and other media stories. It was important to me (and I attempted at every opportunity to convey this importance to the informants) that I get an individual life history from the person who lived it. I would not be "checking up" on the story for veridicality of detail or consensus of opinion.
A word about what this study is NOT is in order here. It is not an experiment in which the investigator manipulates variables or assigns subjects to treatments.
It is exploratory. One must be clear, however, about the areas over which the investigator does have control and forthright about how that control was used. I had latitude about, (1) choice of informants, (2) methods of data collection, (3) what types of information to gather, and (4) the conceptual framework for analysis.
How I exercised these choices makes this a study in cultural anthropology based on methodology (participant- observation and ethnography) and a conceptual model of human organization that comprises biological, social, environmental, and cultural influences.
Sample Selection
The sample of informants would neither be random nor representative. I had five criteria for inclusion:
(1) placement on independence of living arrangements relative to services, (2) age, (3) alone in household,
(4) approximation to national sex distribution, and (5) sensory and cognitive competence equal to the task of giving a life history.
I would want to find five each in two different
"treatments": one independent living, such as staying in place or choosing an apartment or condominium that was not in an age-homogeneous development and the other, age-homogeneous^ retirement "villages" with support services available (whether or not they were used). The purpose for this distribution was to assess the relative contributions of various factors (besides attachment) to the choice of living arrangements. For instance, how much would elders say that considerations of health, finances, safety, transportation, entertainment, and other factors that I had not thought of, entered into their selection of living arrangements?
Other requirements for participants included that they be over sixty-five years of age and be essentially alone through being widowed, divorced, or never married, and not currently living with someone. The reason for this latter stipulation was so that I might elicit a single version of this individual's life history and decision process. In the fieldwork encounter, two informants had another person in the household. One man had his wife, a victim of Alzheimer's disease, who was away from home at adult day care during our interviews.
One woman had her grown son move back in with her after
his divorce but he stayed away from our interviews (when
he was home) except when she called him into the room to
confirm a date or some other fact.
I purposely sought the approximate proportions of
men and women who are found living alone in this age
group in the United S t a t e s . 2 My interview outline does
not ask for information about financial status. I felt
that asking for financial information might deter some
otherwise willing informants from participating. For
that reason I do not have comparable economic data.
Nevertheless, all informants volunteered considerable
information in passing, especially about housing costs.
I did not select for a range in educational experience but got a nice one anyway as well as a goodly age range: from sixty-nine to eighty-seven. The only other restriction on participation was that informants not have such a degree of sensory or memory impairment that would restrict their full involvement in the study.
This caveat excluded residents of nursing homes. The selection of informants is discussed in Chapter III
(Methodology). Biographical summaries are given in 8
Chapter IV (The Elders) but as a brief preview, let me
introduce the ten elders.3
A Brief Introduction
I never asked for a life summing up of any of the
ten--a statement about whether it was a good life or not--but I got one spontaneously in every case and, in
every case, life was said to be good (or at least,
challenges were adequately handled). But there the similarity ends.
Fern is seventy-seven years old.4 She frequently calls herself fortunate and points out pieces of good luck throughout her life and how sad episodes (a divorce in her first marriage and later the death of her second husband) were survived--refining her character, as it were. One anecdote about her childhood with three brothers in Texas is typical of the tone of her story:
I really feel like a very fortunate person because both Daddy and Mother cared about us a whole lot, you know, and looked after us a whole lot and my Daddy and Mother, you know, at night--once all the chores were done--they'd both read--take turns reading aloud . . . we'd all sit around the dining room table or we went up to Mother and Daddy's room; we'd all sort of move up there . . . because, you know, we didn't have any central heat [1augh].
Toddy tells the clearest example of a coherent life story that is best described as satisfying--not just in summary, but in process as well. Toddy is a fit sixty-
nine-year-old woman who has dealt with some childhood
dislocations but who considers finances her only current
problem. She describes her day-to-day life now as it
falls short of the one envisioned by her and her
husband:
I guess I just kinda slid into everything, you might say. There's a lot of unhappy days, you know, a lot of sad times. I miss my husband so much 'cause we were really good friends [about their plans before his sudden death at age 52] . . . Well, that was our plan. See, I was gonna retire in May and we were gonna go to Hawaii for our 28th wedding anniversary and it just didn't work out that way. But, you know, other than the sadness or the missing of him, well, I--I just, you know, made up my life \sic]--mind. life goes on and you can't sit around and feel sorry for yourself all the time. . . . I've got two wonderful children and, it's like I told my children after Marshall died, I said, "You know, we had--you might as well say twenty-eight years-- and a lot of people never had that."
Wi11 jam is eighty-one years old, a retired physician. His speech pattern is measured, modulated, and shows great circumspection of thought, (perhaps) a reflection of his Quaker upbringing. He is a widower with two sons who shows the greatest animation when describing the varied activities and successes of his wife first and then his sons. He speaks proudly of her involvement in local politics. William describes himself as "more organized and Sarah was the creative 10
one." He says that it was a good life that they had
together (she died two years ago) but he sounds wistful
about one thing: "We tried not to duplicate each
other's interests--she would stay away from my interests
like the computer--but we had respect for each other's
areas of expertise." The wistfulness seems related to their two different life styles--his methodical planning had earmarked the retirement years as the time that they would enjoy life together and then she was gone.
If Toddy's statement of her life satisfaction seemed consonant with her full life history, Ducky1s is a stark contrast. Ducky's story in my field notes consists of page after page of hardship in every sector-
-from childhood abuse, marriage at age fourteen (she is now sixty-nine), divorces, constant financial problems, to the sensational murder .of a grandchild. Ducky does not summarize her life as happy but she often says that everything in her current situation would be wonderful if only .... The blank is usually filled in with only one proviso, such as, "If I could only move out of
[county home] and live in [the town she came from]" or,
"If only I could handle my own money." The few positive summative statements that Ducky makes about time periods in her past are also the most difficult to credit in 11
light of specific reported episodes from the same times.
For example, her family of origin was "very close" and
her own children were not prepared to deal with other
adults (like spouses) who were not accustomed to a
childhood of "hugs and kisses" as they were.
Dinah is seventy-nine years old but looks much younger. She is tall and prepossessing as befits a second grade teacher of almost thirty years. She never married. The hard times of her childhood, youth, and early adulthood may not seem (objectively) any tougher than those of a number of other informants but must be viewed against a backdrop of very insecure early attachments. When Dinah was two and a half years old, her mother died under tragic circumstances. Dinah was the middle of three children who suffered a decade of makeshift "mothering" until the children got a step mother. Dinah has a unique way of managing her environment--both human and inanimate; she takes charge.
She can finish a long litany of sad events and failed relationships with: "But I have no regrets." Dinah is perhaps the least sensitive to social cues and least empathic of the ten informants.
Doris is a very young seventy-three. She is a self-professed "person who needs people" and has always 12
been gratified by appreciative audiences during her
career as a piano entertainer. Doris says that she had
"a very lonely childhood" and two brief marriages that
contribute little to her life satisfaction. What
satisfaction she claims (tentatively) for her life as a
whole is rather bought through great instrumental effort
on her own part. Her pace of activities is frenetic and
her willingness to reflect long on any affect connected
with her life events is limited.
Gertrude is eighty and lives on the rural property
that her father bought seventy years ago. Gertrude speaks with a slight, undefinable European accent. She was brought up in an enclave of many eastern European immigrants to her mid-sized city. Gertrude is a very good storyteller. Her stories are rich with detail and told with relish and wit but many have a sad side. She has worked hard and overcome financial, marital, and employment difficulties. Her regrets are all in the interpersonal realm where she was estranged from her mother, a sister, and her only daughter. She always thought that if you just worked hard and performed services for others, you would be appreciated automatically. This turned out not to be true for her.
Pride has always prevented both her and the other in 13
each contested dyad from retreating from an adversarial
position although she says that she has tried with her
daughter. She says, "I've had a full life but I must
have done something wrong."
Lvon is seventy-seven years old. He is an entrepreneur who has maneuvered and strategized jobs and investments since age nine when his father died. His own interests have always included mechanical things-- especially boats. Most of the details that Lyon remembers vividly revolve around money and other measurable facts, such as, length of boat, size of engine, type of car, house building materials--not grandmother's maiden name or birth dates outside the immediate family. He has used his obvious organizational skills for the past ten years in caring for his wife who has Alzheimer's disease. A lot of thought goes into molding his efforts in complementary fashion around what she can still do. He has no complaints; his self-concept includes competence in using available resources, such as day care for his wife which he pays for. In other words, he eschews such public social services as would be provided by a "case manager"; after all, that is what he himself does for his wife. About the seven years of "good retirement" 14
that they had together: "It was like being turned loose
in a candy store in '75 when she retired."
Nancy is my oldest informant at eighty-six. She
has outlived three husbands, has three children, five
step-chi1dren, and many grandchildren. She is a little
vague on numbers and even where family members live
because her memory is failing but one of her most
endearing characteristics is that she forgives herself:
"I can go look it up in my address book if you want."
Nancy appears to have the greatest physical limitations
among my informants but is confident about the future
and serene about the present. She is much in demand by her children (and step-children whom she does not distinguish in a separate category). She moved from out of state to be near one daughter and flew to New York to visit another during our series of interviews. All three marriages were reported to be happy--the first and second each lasted twenty years and the third, fifteen.
She says of the third husband, "I always tell him he owes me five years." She continues "talking to him."
She says, "I don't think that makes me crazy."
Francesca is seventy-six. Her story has many parallels with Gertrude's in detail (i.e., eastern
European parentage, poor relations with mother and with 15 her only child) but her interpretation of how life has
treated her is almost unremittingly gloomy. Ironically, her summary statement about her life is one of a handful of relatively positive statements in her entire interview material. We were talking about who among her extended family had the "best life" and she put forth one of her sisters as candidate but with many caveats.
Then she said (about her own life):
We didn't have money but we urn loved the Lord and we worked together and I--to me--that is a million dollar thing . . . like I took Brett [her son] to church but then Neal [her husband] could only go . . . and uh you don't have to have money if--if you have enough togetherness.
Value of the Study
The value of this study is two-fold: one in research and one in practice. Future researchers
(including myself) will find leads along various avenues coming from this study. The influence on living arrangements of kinship, locus of control, reciprocity, cultural values along a dependence-independence continuum, perceived health in old age, perdurance of personality, the impact of class, education, and money, are only a few of the interesting questions raised for further study. 16
The second area of benefit is practical; there is a
practice application for this study. Seeing how ten
people have coped with their own changing needs in a
changing environment--both in a personal environment and
in whatever level of larger environment each may take
account of (whether local or global)--suggests uses for
this information to workers in the fields of applied social science. I do not speak prescriptively, as in,
"When you locate someone like Francesca with her housing problems, do this . . . ." Ten life histories do not generalize. That is the point. I restate the principle that people become less alike--rather than more so--with age (Kimmel 1990). With this in mind, workers providing services to the elderly would profitably invest time in honing their interviewing skills to the end of individualizing services.
The Question
The question as finally formulated is: What are the
Attachment Factors in Elders' Choices in Living
Arrangements? In the remainder of this chapter I will define the three underlined segments of the question and discuss the scope of my inquiry into them. I will 17
describe the other chapters and how they expand the
three elements of this question.
Attachment
At the most basic level, humans are social animals.
They are to be found in social groups everywhere. What
varies across societies and within societies is the make-up of the social groups. Many are based on
kinship, some on friendship, some are organized around
work or other activities. The groups--often as small as dyads--that interest me for this study are those that are formed or continue due to attachment factors.
Attachment theory is credited to John Bowlby and Mary
Ainsworth. Their original formulations have stimulated considerable interest and research (discussed in Chapter
II-Literature Review).
Bowlby's premise is that the human infant--of all animals, the most dependent for the proportionately
longest time before reaching reproductive maturity (and arguably, for the life span)--forms the first attachment bond with a consistent caregiver (usually mother). This first attachment is characterized by the infant's greater dependence on a strong other, comfort in her presence, and distress if she is not available in 18
fearsome situations. Bowlby (1969) speculates that this primary dyadic relationship was retained through
evolution because infant survival was thereby enhanced.
Mary Ainsworth contributed the further observation that, depending upon the attunement or responsivity between mother and infant, the toddler is able to move on to explore and master his^ environment (Ainsworth and
Wittig, 1969; Bretherton, 1985). Early research was cartied out with infants and followed up with children and, more recently, with adolescents. If attachment is so important for the altricial human infant and child, the question can be asked: What happens to the need for attachment as the organism ages, especially into old age? What might attachment behaviors look like in old age and what reciprocal features might we note in their exchanges? Little is written about this but I will review the extant literature in Chapter II as well as theories about the life course and aging in general.
In addition to differences in the nature of attachment over the life course, we may find variation cross-culturally. Enculturation^ is the term used in anthropology to denote the transmission of a group's culture to its own young. Even before the infant has language, he is imbibing information about what is 19
proper to believe, think, do, and eat; appropriate
behaviors with people who stand to him in what degree of
kinship and status; and a beginning grasp of the
predictability in his environment. Although the human being is indivisible, it is possible to speak of a biopsychosocial being as though--at least for discussion purposes--we could examine the three separate aspects of the individual and their interactions.
The nascent personality develops in what Hallowell calls the "culturally-constituted behavioral environment" (Hallowell 1955:87). Exchange of information and affect occur in an interpersonal milieu and that milieu is informed by the cultural backgrounds of the actors. Not even identical twins experience the same behavioral environment because humans interact with the environment, thus changing it for themselves.
Further, culture is not somehow evenly distributed in the environment. Each individual carries around his own
"idioverse" (Schwartz 1978, after Rosenzweig)--his own personal representation of his culture which intersects variously with the idioverses of his fellows. What is more, the representations change over time which brings us to the problem of memory. Schwartz noted this when he wrote of his informants' memories, "And with each 20
return to the field, I found my informants having not
only a different present but a different past" (p.421).
In Chapter II, I further spell out my conceptual
framework from assumptions about culture, personality,
and self.
Living Arrangements
For purposes of this study, the rubric "living arrangements" will include geography, lifestyle, available services, social activities, safety, finances, and proximity of significant others. In order to somehow establish the importance of affective ties on decisions about where and how to live, it will be necessary to place the elders' choices in a decision matrix that includes at least two elements: knowledge about what is available and freedom to make the choice.
One of my informants (Ducky) was "put here by my daughter." Lyon purports to make all decisions using a logical process.
We must interpret this information with caution.
For instance, the fact that Toddy has not moved away from Manchester may be because she has most of her family there or because she could not afford to move to
Florida. Lyon has not left Manchester either although 21
his only child lives in another state with no prospects
of moving back. But, if Lyon's wife (with Alzheimer's)
preceeds him in death, will he move then? Doris moves
frequently in the capital city but has no close
relatives there or anywhere else. How shall we
interpret her moves? Motivation for moving or staying in place is part of each elder's story. Information that I gathered about what is available for living in the three county area (as opposed to what the informants themselves knew about it) is contained in Chapter V
(Housing Choices and Choosing Housing). Also included is some information on the same topic from other parts of the United States and abroad. Variations on
Australia's "granny flats" (Lazarowich 1990) are being tried out in the U.S. and the old "Rooms for Let" signs are going up with a new twist--trade-offs of rent for services in various proportions (Danigelis and Fengler
1990).
Choice
When I speak of choice and decision-making in the context of this study, it will not be in terms of formal logic or an algorithmic decision process? although, for all I know, such may have occurred. I take at face value the claims of informants to have planned or not to have had an opportunity to plan for the living arrangements in which they now find themselves. Nor do
I assume that their current situation will not change again. In an informant's narrative I look for that part of his or her world view that addresses locus of control . Does he think that he is a free agent to act
(the much-vaunted American individualism) or is he embedded in a family network that defines and/or constrains his decisions? Does she wish to enroll an affectively significant other (consciously or unconsciously) in the decision process in order to guarantee continued attention (either positive or negative) from that person?
It will be interesting to find out whether elders say that they actively made choices or had only forced choices; if only forced choices, whether the restrictions were due to health, money, or affective concerns. In the literature review (Chapter II) I will explore several notions that are peculiar to (or ,at least, found more frequently among) Americans. One has to do with the "right" to a certain level of retirement life style--usual1y well above the maintenance level of food, housing, and health care. Another is a 23
superstitious fear of acknowledging (to oneself or
others) firm plans both for retirement and for living
arrangements. I have often heard variations on the
following theme: "Joe and his wife were going to take a
6-month cruise and, don't you know, he dropped dead the
week before they were to leave!" or, "The Smiths were
all set to sell the big house and move to Arizona when
their daughter got a divorce and moved back home with her two kids."
Finally, I will follow up on a phenomenon that emerged into my awareness during the interviews: Do some people have a sense that there is a finite store of affectivity out there? Foster (1965) applied his theory of Limited Good to material goods in peasant society.
He described the peasant's vi.ew as that of a zero-sum game; anything that he wrested for himself led to diminishment in his neighbor's portion. One could expect jealousy on the part of the one who won for that which he won and envy on the part of the one who lost
(Foster 1972).
It struck me forcefully during the interviews that three (and to some extent, four) informants kept careful accounts of both material and affective exchanges between themselves and significant others in their environment. I call them Scorekeepers. In sharp contrast, three other informants appeared quite cavalier in this department--implying that balanced reciprocity is either unimportant or undesirable. I call them Non-
Scorekeepers. I extend the concept of Limited Good to the affective domain and explore the inferred behavioral outcomes in Chapters II and VI. The idea of Limited
Good ramifies into "inheritance rules" for both material and non-material goods--discussed in Chapter VI
(Scorekeeping).
Summarizing to the present, Chapter II is the
Literature Review; Chapter III is Methodology; Chapter
IV (The Elders) contains biographical sketches of the informants.
Chapter V (Housing Choices and Choosing Housing) is a survey of types of accommodations in the three county area included in this study. Tables display services and features garnered from brochures and from informants' information. I describe kinds of accommodations that I have visited or that I have been involved with as a volunteer as well as those occupied by the current informants. The discussion includes elders’ choices and defaults among their known options. 25
Chapter VI introduces the concept of Scorekeeping-- the surprise central issue in the decisions of some of the informants. Chapter VII summarizes Conclusions.
Table 1 (p.26) shows some elements of informants' current situations on first interview. 26
TABLE 1
INFORMANTS' SITUATION (1994)
Age Number of 0=0w n Birth First Moves After or Final Name Year Interview Age 65 R -R e n t' Move7
Fem 1913 77 3 R •Yes"
Toddy 1921 69 0 R "Hope so"
William 1910 81 1 R "Hope so"
Ducky 1922 69 4 ~ R "Hope not" :
Dinah 1911 79 2 R "No" “
Doris 1918 73 3 o "Maybe"
Gertrude 1910 80 0 o Yes"
Lyon 1914 77 0 o Yes"
Nancy 1905 86 3 R “Maybe"
Francesca 1915 76 0 R "Maybe" ! Source: 1994 fieldwork
Legend: * Ducky unsure about number of moves, but she has been at County Home for 2.5 years.
* Included in the "Rent" category are: 1) all living arrangements for which a monthly payment is made, including retirement villages where an entry fee was also required and 2) where the occupant does not have right of disposal, i.e.. to sell or bequeath.
~ At the time of interviews. Dinah had secured an apartment in an independent living complex under construction on the grounds of her retirement village. It has since been completed and she has moved in. 27
CHAPTER I NOTES:
1. "Age-homogeneous" would better be called age- restricted in this context as it refers to a range of ages above some minimum--usual 1 y somewhere between ages 50 and 65. On the other hand, average age of residents in such communities tends to increase with the age of the community itself reflecting the influx of the "young-old" to an appealing new community and the lengthened life expectancy (providing fewer vacancies by death) as they age together. (See Coni, Davison, and Webster 1986 for life expectancy data).
2. The household composition data from the 1990 U.S. census show that 8.8 million Americans over the age of sixty-five live alone in various types of quarters including mobile homes and rented apartments (U.S. 1992a:17). Not included in this figure are "institutionalized persons" and "other persons in group quarters" (U.S. 1992b:50). Women are represented in a 7:2 ratio to men. If one looks at the breakdown by decades of age, the ratio hovers around 3:1 for the first two decades past sixty-five but jumps to 9:2 for those over eighty-five. My group of ten at the ratio of 8:2 nearly satisfies the national sex ratio but not the "living alone" criterion of the Bureau of Census. In the first place, one man has his wife in the household and a woman has her son living with her. In the second place, it is difficult to establish the demarcation line between living alone and in group quarters for retirement "villages" (the definitions provided by the census are not clear concerning all the levels). Nevertheless, we seem to have approximated the overall average statistics with our group of ten.
3. Pseudonyms are used throughout--for people and places. The study area is a three county area in central Ohio but fictitious names are given to the towns, cities, and facilities. Some minor changes are made in the background facts of informants' stories where I have been satisfied that it does not do violence to the story. The primary concern is always to protect the anonymity of the informant. Informants are introduced in the order in which they were interviewed.
4. Ages are given for informants that represent age at first interview. The present tense (often called the "ethnographic present") is used in reporting interviews 28
just as though quoting directly from my field notes. Reference to Table 4, p.104 for interview dates will give the reader an opportunity to match each informant's interview dates and age at interview to recreate his or her "ethnographic present."
5. I will use male gender designations for infants and toddlers throughout in order to avoid awkward constructions, e.g., (s)he, her or him, he or she. The denotation intended is to all infants and toddlers so that the female pronouns can be reserved for "mother" as the usual primary caregiver.
6. Enculturation is Melville Herskovits' term for "the aspects of the learning experience that mark off man from other creatures, and by means of which he achieves competence in his culture" (1955:326). I prefer this term to "socialization" because it connotes greater length (life-long learning) and greater breadth (all that is encompassed by one's culture--more than roles). Enculturation is also distinguished from acculturation which denotes transmission of culture between two groups or parts of groups that come into fresh contact.
7. In utility theory, "utility" stands for satisfaction and marginal utility "is the additional utility obtained from consuming one more unit of the good when the quantities of all other goods are unchanged" (Craven 1990:55). Utility theory analysis assumes (for a perfect market economy): (1) material motivation, (2) freedom of action, (3) perfect information, (4) smallness, (5) no external effects, (6) prompt market clearing, (7) minimal government interference, (8) no foreign influence. This framework is not useful in the present context because the informants' situations do not satisfy most of the assumptions. CHAPTER II
LITERATURE REVIEW
Introduction
A review of the literature relevant to a question
about attachment factors in elders' decisions about
living arrangements must start with background on such
broad concepts as culture, individual psychology, and
the commerce between the two, including enculturation.
Next I will review some of the body of literature on
attachment, as it was first construed as satisfying a
basic need of human infants and further, as researchers
have followed attachment through the life course. This
section includes treatment of less obvious attachments,
such as attachment to places, inanimate objects, and memories of significant others who have died or are
otherwise inaccessible.
Literature addressing attachment into the latter part of the life course is sparse. Therefore, I will prepare for a fuller treatment of that issue by next discussing theory clusters on aging. Much of the theory and model-bui1 ding on aging is American or Western in
29 30
origin but I will include some cross-cultural examples
where theory has been applied and seems to fit and also
where it has been found inappropriate.
Information on living arrangements (preferred and
actual) is found widely in popular magazines,
newspapers, and books, as well as in journals for
applied anthropology, social work, gerontology, and
sociology. But "living arrangements" (for me) has a
larger meaning than housing and contracted services
(Chapter V). It also comprises human relations,
including the exchange of goods and services.
Literature on decisions is found under that heading
as well as in writings about locus of control, "rights,"
reciprocity, and cross-cultural comparisons of who are
the appropriate actors in the decision process.
Culture
. . . that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society. (E. B. Tylor, 1924 [orig. 1871], p.l).
Tylor's definition of culture remains a good place to start in exploring the relationships among culture, the individual, and society, at whatever levels of abstraction each is viewed. Tylor included in his 31
definition all of the beliefs, knowledge, custom and
habits acquired as a member of society, thus emphasizing
content, transmission, and social milieu. Reifying
culture is a semantic pitfall. Anthropologists have
variously said that people "share it," "participate in
it," and hold "shared symbols" and "shared meaning." We
even use the word "it" as though culture were a
substantive entity.
Theodore Schwartz (1978) rightly asks "Where is the culture?" and proceeds to theorize a distribution of a particular culture among those who are identified with it. Each individual carries his own unique version or translation of the culture called his "idioverse." An overlay of all idioverses would show some elements in common and some other elements shared by various collectivities. But there are also unique elements and possibly rare elements held by the few. Schwartz insists that a culture includes all these elements because they are available for sharing.
Another common use of the word culture is to say "a culture" to designate a bounded society. For example, especially in earlier ethnographies, anthropologists referred to the Tallensi, the Trukese, or the Alorese, as though the society and their culture (in Tylor's 32
sense) were coterminous. This usage can be traced to
Franz Boas, who decapitalized Culture in order to remove
it from its status as a Western ideal and designate,
instead, plural ways of life created by various peoples
in the context of their environments (Stocking 1968).
In Boas' time, perhaps, a culture and a named society could still be thought of as almost synonymous. It is no longer possible to make such an assumption (if it ever was) as anthropologists study segments of heterogeneous industrial and post-industrial societies.
There are no encapsulated societies left and the amount of influence due to contact with other outside societies is difficult to gauge. Ross (1975) speaks of social borders or "boundedness" as being the negotiated boundaries of group self-identification that, however, shift circumstantially. One individual may variously define himself as Polish-American, a Chicagoan, resident of a particular neighborhood, old, retired cab driver, grandfather, and so forth, depending upon the audience.
Spiro (1993) bemoans the many uses of the term and urges that each writer set out his or her intended use.
I will use the term in Tylor's sense for culture content and Schwartz's sense of distribution. I will take a common sense position about who shares a culture on the 33
most encompassing level of abstraction by asking whether
or not some cultural element is comprehensible (not
agreeable) to the person in question. For instance, I
doubt that a Trobriand Islander would comprehend the
abortion issue in the United States any more than an
American economist would understand the kula exchange
(Malinowski 1984 [1922]). On some issues or culture
elements it is possible to lump the Frenchman, Briton,
and Swede with the American and call it Western culture.
On other levels it is not possible or useful to speak of a culture as homogeneous even at the national level.
Kelly (1991) speaks about the necessity in writing ethnography of attending to dimensions of time, space, and context in a culture. Perhaps the time dimension in modern complex society deserves more attention than it has received.. To illustrate, Fern and Lyon started life in small towns--she in 1913 in Texas and he in Ohio in
1914. To say that they share "American culture" is not very illuminating, to a great extent due to their separate experiences in the intervening 80 years. The same degree of experiential divergence can be seen in the cases of Lyon and Francesca, born in the same town
(place), a year apart (time), different gender. On the other hand, they have shared awareness of many larger historical events from an American perspective: two world wars and several others, the "Great Depression"
and several recessions, and much popular culture--from
Model Ts to faded jeans. With the worldwide spread of various forms of news media (e.g., print media, radio, and television), the case could be made that the world shares a culture because the world knows about faded
jeans. But, at another level of abstraction, the world may "know about" hand guns but it is unlikely that they have the same meaning in Singapore, Tokyo, Copenhagen,
Addis Ababa, New York City, and Kelley's Island in Lake
Erie.
Nor does being a member of the same cohort in the same country during some universal phenomenon, such as the United States' "Great Depression," guarantee the same experience in spite of the oft-heard declarations:
"We were all in the same boat," or, "We didn't know any different; we'd never been rich before the depression."
Glen Elder in Children of the Great Depression (1974) uses some of the Berkeley Study data (gathered for a different purpose) and United States census material to debunk the notion of a homogeneous experience of that depression. Pre-depression class and status proved to be significant variables in family relations and 35
redivision of labor when a third of employable American males were without jobs. Kertzer (1983), in an effort to unravel the overlap in usages of "generation" and
"cohort," points out that a presumed cohort effect may as well be attributed to aging within the cohort or the wide distribution of ages of the parents and grandparents (and hence, their differential historical experiences) of the cohort's members.
My informants ranged in age from eleven to twenty- eight in 1933--the lowest point of the depression in terms of jobs and the economy in general. Their life histories demonstrate that they were not "all in the same boat."
The Individual in Culture and Vice Versa
Culture is not static. If, with Schwartz (1978), we accept the postulate that culture is distributed among its members with some unique and some redundant elements, then we must acknowledge that there is exchange among members and between members and "their culture."The idea of rare concepts available for transmission is analogous to genetic mutations in the gene pool--ready for expression in the right environment. 36
A human infant begins learning his culture at birth through the process called enculturation. (The effects of early attachments on this process will be postulated
later in this chapter under the subheading of
Attachment). The ongoing exchange between a culture and the developing personality^ which is incremental and transforming to both is the subject matter (in part) of psychological anthropology. As Bourguignon (1990) points out, as long as anthropology as a discipline has existed, anthropologists have exercised themselves over the question of just how much culture can influence personality. This question takes the form of the limits to cultural variation (if there are any) and the universal characteristics of personality (if they exist). Neither cultural determinism nor biological determinism holds up to the test of how individuals and their aggregates--social groups--are formed. Evidence accumulates for the genetic influence on personality, especially in the studies of identical twins reared apart (Juel-Nielsen 1980). At the same time, the impact of various, culturally influenced, child-rearing practices is demonstrated in personality characteristics
(Harrington and Whiting 1972). How much the individual owes to his culture at any point on his life's 37
trajectory and how much his culture has, in turn, been
influenced by his actions is a matter for continued
debate but is outside the scope of this study.
Setting aside the apportioning impact of cultural
and personality influences, I start with the minimal statement that learning (enculturation) takes place in a
cultural milieu. The culturally-constituted behavioral environment visualized by A.I. Hallowell (1955) seems to expand the culture and personality dyadic relationship to three dimensions, where the actors' space for acting
(the behavioral environment) is forever imbued with their own versions (plural) of their culture. If individuals do not have duplicates of some culture template in their heads, how did they get different versions?The answer seems to lie in the notion of enculturation.
Enculturation
Having established to my own satisfaction that there exists a many-dimensioned relationship between any given culture and the personalities of its participants, we look to the literature for theories about the process
(or processes) involved in transmitting or perpetuating culture. 38
Early ethnographies were attempts to describe entire small scale societies with all their customs, cosmologies, languages, and institutions. The ethnographer might have a particular interest, such as kinship terminology, but the custom among ethnographers in the first few decades of the twentieth century was to give full treatment to the studied cultures.
This era of the exhaustive ethnography was succeeded by one of cross-cultural comparisons of aspects of culture among two or more societies.
Margaret Mead, for example, compared Samoan and American adolescent girls on the dimension of role transition through the pubertal years (Mead 1928). She pointed to contrasting United States and Samoan adult attitudes toward sexual activity among adolescents as the probable source of the girls' differing anxiety levels during this period. Wallace (1969) later offered a connection between certain child-rearing practices or attitudes and the adult personality among the Iroquois circa 1800.
His sources were variable in reliability and obviously not gathered for his purposes but he made interesting conjectures about permissive early childhood treatment, the aloof detachment expected of the adult male warrior, and institutionalized torture of captives. The first systematic, statistical comparison of
child personalities itself was carried out by the
Whitings in their well-known Children of Six Cultures
(B. B. and J. W. M. Whiting 1975). This was a most ambitious project (first of its kind), that compared whole cultures and attempted to uncover associations among features. For example, what differences in aggressive play of 3-year-olds are associated with care given by "nurse maids" (older siblings) VS mother- mothering? or, what variations of independent function among children (at different ages and either gender) are found associated with various economic systems?
Before the six teams set out to study in depth their respective groups, they spent time together standardizing methodology and outlining the topical parameters. The working hypothesis was that a child enters a "going concern"--an operation already in progress. If we look at the group's history, environment, and current background (what the Whitings call "maintenance" factors), such as subsistence patterns and social structure; if we observe the child's learning environment (including who the caretakers are and what tasks are assigned to the growing child, when, and by whom), then we might "read" the results of the 40
enculturation process in the group's adults and their
elaborated expressive systems, such as religion, art,
and magic beliefs.
Six Cultures is an example of the confluence of at
least two streams of thought. The first is the stress
on naturalistic observation of people going about their
business--the observation of what they actually do as a
datum as significant as what they say they do or believe
should be done. The second is the acknowledgement of
dynamic interplay among cultural and individual
influences over time and mechanisms for assessing them.
Some fruitful collaborations that cross
disciplinary boundaries in this common interest area preceded Six Cultures. Sigmund Freud, founder of the psychoanalytic method, read ethnographic materials written by anthropologists and missionaries and generated theory about connections between culture and personality, as he did in Totem and Taboo (1950 [1911]).
Abram Kardiner (a psychiatrist) collaborated more closely with anthropologists Cora DuBois and Ralph
Linton in formulating theory about the culture and personality connection (Kardiner 1963 [1945]). Whether or not we agree with their conclusions is not as important as noting that there was a growing recognition 41
of the value of observing people in their natural
environments, over relatively long periods of time, if
one were to draw conclusions (however ephemeral or
temporary) about mutual influences.
Attachment
The place for attachment theory (which has mainly
been worked out with infants and toddlers) in a study of
old- age deserves some explanation. If strong
attachments between helpless infant and strong,
providing adult (usually m o t h e r ^ ) fills primari1v a
survival need, as Bowlby (1969) supposes, there is no
reason to believe that such a need, in the same form, persists into adolescence, let alone old age.
Certainly, the configuration of such relationships and
the personnel filling roles as attachment figures would have to change. The defining behaviors of infant toward mother to secure proximity are vocalizing, reaching,
clinging, following (first with eyes and, when able, crawling and walking), crying and otherwise showing distress on separation, and two kinds of reunion behavior: a show of joyful excitement or aloof detachment (Bowlby 1969). Recognition of mother begins well before six months but the onset of separation 42
distress begins around six months and wanes by about
three years when the toddler is well able to follow her.
Obviously these are not the attachment behaviors we must
expect to find through adolescence and adulthood into
old age. We may wonder whether effects of the quality
of this first attachment can be seen at later stages.
I first noted phenomena attributed by psychiatrists
and clinical psychologists to faulty infant attachments
among adolescents in a long-term psychiatric s e t t i n g ^ .
The histories of adolescents having been taken from
parents4 at an early age and the memories of the same
period recounted by the adolescents often supported the
notion of a chaotic period. Of course, memory is
suspect over even the short term. Multiply the
difficulties if a search for antecedents is extended
into old age. The informant may be the only surviving historian for the period. But for all the pitfalls of
retrospective reconstruction, something can be said for
the significance of memories that persist into old age and the preserved perception--either pleasant or unpleasant (See Table 2, p.77).
Gerald Edelman (1989) proposes that memory is made up of perceptual categorization and recategorization based on ability to generalize, learning from novel 43
elements in changing contexts, and recall of motoric and
other sensory or affective states associated with past
"similar" instantiations.
It is for this reason that one can consider memory a form of recategor'ization--in various instances of recall, a memory almost never appears completely unchanged (p.112).
John Bowlby (1969, 1973, 1980, 1988) insisted on an
evolutionary function for attachment; attachment
behavior increased the chances of survival (specifically
through protection from predators) for the infant who,
in turn, would reproduce. Beyond its evolutionary value,
Bowlby saw a secure attachment as the prime factor ensuring the individuation and separation of adolescents
from the nuclear family so that they might take on adult roles. Using different language, Erik Erikson (1963,
1982) spoke of developmental stages during which successive, cumulative tasks are accomplished by the growing individual.
Bowlby (Ainsworth 1991; Bowlby 1969; Bretherton
1992) developed the idea of attachment out of an interest in family relations, especially those between parents and young children. He coupled the interest with a technique borrowed from ethology, VIZ, observing behavior under naturally occurring conditions (Ainsworth and Bowlby 1991). When young children were reunited 44 with parents after the child's hospital s t a y , ^ there was a range of behavior displayed by the children. Some of it was surprising to Bowlby, such as children ignoring or rebuffing the parent(s).
While studying weaning phenomena in Uganda, Mary
Ainsworth was also struck by the infants' behavior in the presence of a stranger (Ainsworth 1982). Her observations led to development of the Strange
Situation^--a quasi experiment that permits the investigator to see reunion behavior. Ainsworth's particular contribution to attachment theory was the concept of the mother as a secure base from which the child can explore his environment (Bretherton 1985). If his "internal working model" of the dyadic relationship is secure--if mother has been dependable in protecting him and in assessing his needs--he will sally forth and gain confidence and competence. Because mother has been responsive when he felt unsafe and in need of soothing in the past, he has begun to develop the sense of his own worthiness. The opposite is true when she has not been responsive. The attachment system is posited to be operative throughout life with changes in personnel and alterations in attachment behaviors. 45
What happens in that first dyadic attachment
experience is variously described as affect attunement
(Stern 1985), empathy (Kohut 1978), mirroring (Lacan
1977), or just satisfying dependency needs in the
service of safety (Bowlby 1969). De Vos (1990) outlines
the importance of a balance in coping mechanisms, begun
in infancy, while identifying kinesthetical1y with
others' feeling states in facial expressions.
In these early dyadic exchanges, the baby is
developing RIGs, "Representations of Interactions that
have been Generalized" (Stern 1985:97)--ever larger, more inclusive, predictive models of interpersonal
relations to entire behavioral systems, such as the
attachment behavioral system. He is learning how physiological stimuli (e.g., hunger), behaviors of an
Other, feelings, and his own instrumental responses are packaged together. Taken together, they constitute an accumulation of expectations for the participants in the dyad. Expectations lead to some degree of predictability for both, although there are still surprises in store.
The investigation of attachment has been extended to the early school years with a continuing sample in a longitudinal study by Main, Kaplan, and Cassidy (1985) 46
that shows maintenance of the same attachment patterns
(i.e., secure, avoidant, or ambivalent) to age six
years. But there is also evidence for alteration in
pattern (for good or ill) based on changing conditions
in primary relationships and increased numbers of dyadic
relationships.
Egeland and Sroufe (1981) compare the effects on
the child at twelve and at eighteen months, of abuse,
neglect, and psychological unavailability of the mother
and find psychological unavailability to have the
greatest negative effects. Mother's unavailability
through depression is documented by Brown and Harris
(1978) as contributing to her parenting difficulties.
These researchers carried out a study of 458 women in a
suburb of London. The. factors in a woman's own upbringing and present situation that they found associated with her current depression were that she:
(1) suffered loss of her own mother before the age of eleven, (2) had more than three children under the age of 14 years, (3) lacked a close confidant (especially husband or boy friend), and (4) had no job. Still, among women with all four variables in place, only one in five was clinically depressed. 47
Freud (S. Freud 1949 [1940]) suggested that the
pattern of the mother-infant relationship became the
prototype for all intimate relationships for the life of
the developing child. Two of the criticisms of Bowlby's
version of attachment theory are that it unnecessarily
narrows effective caregivers to one (mother) and views
first attachment as template for future attachments,
including parenting (Lewis and Feiring 1991). This
interpretation of both Freud's and Bowlby's positions is
overdrawn. Sroufe and Waters (1977) and Marris (1982)
convincingly refute the notion that Bowlby insists on the exclusivity of the mother-child dyad.
Along the same lines, other therapists and researchers have seen some evidence that a behavioral path can be altered. The intergenerational transmission of this parenting pattern is evocatively described as
"ghosts in the nursery" by Fraiberg (1987). In psychoanalytic terms, she reports on the characteristics of some parents who are aware of the pattern from their own childhoods and want to break it by seeking help in resolving their issues with their own parents without using the current nursery as stage and their own children as actors in a replay. Mary Main (Main,
Kaplan, and Cassidy 1985) puts it a different way. She 48
sees evidence that a woman can avoid repeating her own
mother's pattern if she can tell a coherent story about
her mother's difficulties, such as mother's living with
depression or an abusive husband.
In a biological-evolutionary vein, Chisholm (1993)
reviews some of the hypothesized connections between
early attachment security and reproductive "strategies,"
such that insecure or anxious attachments are associated with the r_ reproductive pattern*? of having more progeny
and/or starting reproduction earlier than their fitness
"competitors" rather than investing more energy in a smaller number of offspring--the K strategy. This pattern is not said to be tied directly to mortality
rates but to the stress-producing conditions (e.g., poverty, poor health, poor nutrition) that underlay both
low parental investment and high mortality.
LeVine (1980) compares very different parenting strategies among some African agriculturists and middle class Americans. The strategies are based on accurate goals for the children when they become adults from the parents’ understanding of cultural expectations. In the
African case, the need to be obedient and filial is emphasized as preparation for adult roles; in the
American case, it is self-sufficiency. He calls the 49
African intergenerational exchange "serial reciprocity"
(p.22) and the American, "concurrent reciprocity" (p.22)
for the time frames involved. LeVine (1988) later
wondered if these strategies were realistically tracking
the rapidly changing socioeconomic conditions in both
societies.
The difficulty of projecting entailments of the
security of the earliest attachments into old age is
obvious on several grounds. Longitudinal studies have
the problem of participant attrition even when
"longitudinal" is counted as twenty years. We are
considering four times that amount of time in a life
span. The theory being tested will have changed during
that time, possibly several times. Finding researchers
interested in continuing the study and standardizing on
the original methodology would be problematic.
Depending on retrospective reconstruction of events is also risky. Nevertheless, I intend to suggest that four of my informants tell stories of lives that look like histories of unempathic communication begun with the first attachment and continued with age-mates and a repetition of the pattern with their own children. All four are women and three of them have had children.
They are the Scorekeepers of Chapter V I . 50
There is some support in the literature for the notion of the ramification (but not determination) of
later relationship patterns from earlier ones (Parkes
1982; Ricks 1985). Much of the reporting comes from clinicians and, thus, is given in clinical terms. We will not concern ourselves here with the whole area of pathology and how that is defined in various cultures.
However, we will investigate similarities in the reported early attachments of the four Scorekeepers and, conversely, the three Non-Scorekeepers.
We have said that humans are enculturated and continue to be enculturated throughout life in three- dimensional space, that is, the culture interacts with the personality in a behavioral environment that changes over time. Parenting is but one example of this dynamic; aging is another. Aging in America, even when narrowly-conceived as aging among the "dominant culture"
(neglecting ethnic and Black minorities), has changed at a phenomenal rate during the lifetimes of my informants.
For instance, the very fact of attaining their ages is one of the changed conditions. United States citizens over age sixty-five now (1991 figures) make up 12.6 percent of the population (See Table 3, p.78). In 1980 51
they accounted for 11.3 percent (U.S. Bureau of Census
1992c). In a 1986 publication, Coni, Davison, and
Webster, using 1980 population figures, projected for
the year 2000 that this age group would comprise 12.2
percent of the total population. As we see, this figure
has already been exceeded. Compare this to the 4.1
percent in 1900. Of course, birth rates, mortality
rates, and infant survival rates inter alia contribute
to the proportions of living people in each age group
but absolute life expectancy at birth has lengthened dramatically in this century also.
For this study, we are less interested in how
this longer life came about (e.g., eradicating many communicable diseases) than we are in how it is being
lived. We will consider theory about aging in general terms next before proposing an extension into old age of attachment theory as a useful explanatory device for explicating decisions about living arrangements.
Aging Theory
Simmons (1945) is usually credited with a groundbreaking anthropological study on aging, followed by a long period during which little attention was again directed to this stretch of the life course by 52
anthropologists. Early ethnographies often included a
society's elders as a status group or age set and elders were especially valued as informants for their memories.
But, as a topic for cross-cultural comparison or for study within segments of a complex society, aging has only recently been taken up again in anthropology
(Holmes 1976).
In the meantime, facets of old age have been studied by mostly psychologists and sociologists in
Europe and the United States. A considerable amount of research has been done on physical aging by physiologists, geriatricians, and other medical professionals. To name only two, the Duke Longitudinal
Studies have traced physical, social, and psychological changes since 1955 (Busse and Maddox 1985); the Chicago
University "Kansas City Studies" began in 1952 (Bischof
1976). The 1960s saw a burgeoning interest in aging research in psychology and sociology. From the field of developmental psychology, heretofore primarily concerned with infants and children, arose the glimmerings of organic ("unfolding") models for aging into the older years. David Gutmann (1977) exemplifies this position.
At the same time, some sociologists concentrated on societal structures and the processes involved in 53 progressing through them, especially in groups, such as, generations and cohorts. Their efforts fall broadly into two categories: the sociocultural approach and the age-stratification approach (Keith & Kertzer 1984). The former is usually attributed to Bernice Neugarten and
Chicago's human development perspective and the latter to Matilda White Riley and her associates. Perhaps the differences between these two approaches are overdrawn by Keith and Kertzer to force closer inspection of their separate histories, methods, foci. Once that is done, however, it seems safe to reassemble them into the
"life-course perspective." I submit that the entity-- old age, the process--aging, and the model of integrated bio-psycho-socio-cultural influences, are the same for both approaches. The sociocultural approach may have more sharply focussed on the "figure" of the individual, aging in a sociocultural milieu, while the age- stratif ication approach brought the "ground" of social structure more sharply into focus, but neither disclaims the existence of the other nor the interaction of the two. The concern of anthropology with cross-cultural comparison adds a horizontal dimension to the other two that promises a dynamic view of aging. 54
Theories about what happens in old age are reviewed
now as background for this study. Reports of a
pervasive sense of decline in old age--both physical and
cognitive--characterized the pre-theoretical literature.
The Duke Longitudinal Study (and others) tested separate
hypotheses and found much variation among people and
among distinct functions. For instance, while there may
be decline in one memory function, another is unchanged.
An individual's self-report (as opposed to the
physician's evaluation) about physical health status
tends to minimize any difficulties posed by the
individual's "conditions."
Erikson (1982) proposed a framework of psychosocial
development in eight stages. He suggests that at each
stage there is a dialectic between two tendencies--
syntonic and dystonic--both of which are necessary to
produce that stage's purpose or outcome. In his eighth
stage (Old Age), the tendencies are between integration
of the life as lived and despair. The optimal outcome
is wisdom. He goes on to develop this idea to include
the reworking of all earlier (stage) tensions in light
of the final stage (Erikson, Erickson, and Kivnick
1986). Levinson (1978) focusses on the transitions between stages and assigns an age range to each. His 55 observations are only of men, while Gilligan (1982) deals with women and insists that their developmental experience differs markedly from men's.
Disengagement theory (Cumming & Henry 1961) in its original form posited universal, mutual withdrawal by the old person and society. Although it has few, if any, adherents today it was an impetus to much further research (Keith 1980). Gubrium and Wallace (1990) review disengagement and other proposals in the field of aging theory. Activity theory claims that remaining
"active" leads to a longer and/or better life through returning the organism to a homeostatic state
(Havighurst, Neugarten, and Tobin 1963). Continuity theory, on the other hand, says that people show a perduring but evolving pattern of personality (including preferred activity level) into old age (Atchley 1989).
The foregoing are conceptions about aging that I will call the "tools and tasks" group. They seem to point to a universal purpose for elders' performing certain tasks with the tools they have (physical and cognitive, financial and material). In such a case of universal (or task) purpose, the variation we see must only be based on differences in available tools. The 56
"tools and tasks" theories also appear to be entirely based on aging in Western society.
Keith (1982) takes a different approach. She carried out ethnographic fieldwork among retired elders in new, age-homogeneous housing in a suburb of Paris.
She was observing the formation of a community in which people extended their old roles and statuses or set up new ones. Myerhoff (1978) found a shared purpose among
Jews attending a California senior citizens center.
They sought to preserve memories of their childhoods in pre-holocaust, eastern Europe before they emigrated.
They felt tremendous pressure to transmit their memories as the towns and villages, people, and way of life had been destroyed. It could almost be described as salvage anthropology as these elders believed that they alone could remember those times and places. Vesperi (1985) followed the coping careers of urban, poor elders in a
Florida city. Halperin in The Livelihood of Kin (1990) and Howell in Hard Living on Clay Street (1972), while considering elders in context rather than as an age set, illustrate variations in aging experience based on class and economics.
This latter group of theorists that I will call
"phenomenologists," adopt fewer assumptions about 57
universal tasks for this age group across cultures.
There is an acknowledgement that variation comes from
not some biological imperative alone, not personality
alone, and not culture alone, but some unique,
culturally-constituted, historical brew of all those
ingredients. Does this mean that the experience of old
age is hopelessly atomized then? No, it means that the
experience of old age is the dependent variable.
Some theorists look to the effects of larger,
social phenomena that have been experienced (albeit differentially) across many societal groups. Examples of these phenomena are to be found in rapid social change, such as happens during "acculturation," "culture contact," "development," "industrialization," or
"modernization."
Modernization theory as set out in Cowgill and
Holmes (1972) posits that old people lose status and value under industrialization. It is a version of the
"rosy past" notion that anything older or simpler was better. There are examples from anthropological fieldwork that are instances of better status for elders, worse status, and arguments for a better-framed hypothesis (Amoss 1981; N. Foner 1984). Cox (1990) uses anthropological and historical data to counter a linear 58
relationship between status and modernization with an S-
shaped curve, culminating in a projected, future upswing
in elders' status in the post-industrial period. But
Foner (1984) suggests that anthropologists, for the most part, have not systematically analyzed the model and brought ethnographic examples to bear.
The main problem is that status of the elderly is multidimensional. Nydegger (1985) even questions one of the pieces of evidence that is often cited to demonstrate that elders have low status--that of separate housing apart from their children. She points to historical examples of a preference for separate housing when it was affordable and balances that alongside the assertion that elders today may live a little further from their children but have much better means of communication. Kawamura (1988) argues from the example of the Japanese modernization experience that industrialization has not led to convergence with
Western social structure. On the contrary, as Bethel
(1992) discovered during fieldwork in a home for elders in rural Hokkaido. Although the building itself was modeled on American-sty1e homes for the elderly and a mixed (Japanese and American) menu served, residents were able to transform some of their shared living space 59 into "traditional" uses, such as providing hospitality.
Snacks and tea were laid out on a low table in sleeping rooms in anticipation of residents'/guests' visits.
Status and roles for elders are clearer where they are ascribed in "simple" or "traditional" societies by some combination of age, gender, lineage, wealth, good deeds, or heroic acts. But all these ingredients are at work in "complex" societies as well. One of the tasks of phenomenologist theorists of aging is to discover how the entrepreneurial elders have put together their own packages of status and role.
Attachment into Old Age
There are three areas of interest about attachment in old age that may be contrasted with earliest attachments: (1) functions, (2) forms, and (3) personnel. In regard to functions, attachment in infancy and early childhood serves to keep the child safe (survival for the species) and embedded in a social group where he learns (cognitive function) how to be a functioning human (sociality function). This role for attachment is presumably realized by old age.
While it is obvious that the eighty-year-old will not be getting many more genes into the next generation, 60
he or she may be providing care and nurturing those of
varying degrees of genetic affinity already living and
reproducing, thereby conferring a form of survival or
fitness on this octogenarian (Gould 1980; Hamilton 1963,
1964).
In addition to genetic and species survival, there
is another form of survival or immortality--getting
one's ideas into the next generation--whether or not one has children. Wengle (1984) speaks of the mentor role as fulfilling this purpose. The mentor and mentored dyad permits an attachment interpretation wherein there is a reciprocal exchange: useful information (donor cognitive function) for immortality, not unlike the
Japan iemoto relationship of mutual dependence between master and disciple (Hsu 1975).
Regarding individual survival of the elder, there is evidence that the presence of even one attachment figure promotes longevity (Lowenthal and Haven 1968).
There remains the sociality function for attachment that persists throughout life with some alterations in form and personnel. While adolescents are socialized to individuate and separate from the natal group, it is only to take on additional social roles, not to discard 61
the old. Parent-child attachments usually persist
throughout life (Levitt 1991).
Interpersonal relations or objects relations are
defining activities of humans. Antonovsky (1987) points
out that even interpersonal theorists and psychoanalytic
(object relations) theorists can claim common ground in
the sentiment expressed by Barbra Streisand in song:
"People who need people are the luckiest people in the
world" (p.538) and, we might add, share one of the
commonest attributes of humans.
But not all human relationships are attachment
relationships. If the purposes served by early
attachments (i.e., survival and cognitive) are long
since met for the elder and if a sociality need could be
fulfilled in generic, interchangeable social groups, is
there a function for attachment in old age? Literature
abounds with incommensurable terminology for the forms
relationships take and the functions they perform.
There are friendships, affiliations, consociations, support networks, attachments, confidant relationships, exchange relationships, and probably many others.
Rather than be a purist and insist on only considering attachments (the criteria for which are not agreed upon), I will review the literature in its own language. 62
David Plath (1980b), in an effort to overcome the
synchronic sense of "support network," uses the term
"consociation" to convey longer lasting associations and
"convoy"*5 to indicate the circle of intimates
(necessarily changing composition from time to time) who
accompany one through life. Further, he says, the
influence of some consociates begins before one's birth
and definition of one's life by others goes on after
one's death.
Kahn and Antonucci (1980) identified Plath's proposal as the confluence of attachment and role theory. Affective sentiment and normative role behavior contribute to (if not balance) the resultant cast of personnel in one’s convoy. They fault much of the research on social support, stress, and role for neglecting the simultaneous consideration of two dimensions: context and history. While some studies look at episodic support variables, others consider the histories of relationships, such as the shifting role positions of parent and child as both age.
In order to test the hypothesis that role, affective history, and present circumstances have salience in support system membership, Kahn and
Antonucci (1980) devised a convoy model of three 63
concentric circles around the target individual. They
supposed that while all persons included in the three
rings may have originally been inducted due to their
roles, staying power is more likely related to an affective component. For example, parents and spouse
(in Western culture) may start in the first (most intimate) circle due to role designation and remain for affective reasons. But some parents and spouses are placed in other circles or left out altogether. By the same token, a co-worker could be a member of the third circle or disappear altogether upon the target person's retirement. On the other hand, the co-worker could be moved to one of the inner circles based on perceived affinity.
Research was carried ou.t with 718 elders, 9 asking them to place an unrestricted number of people in the three circles according to the degree of current importance to them (Antonucci and Akiyama 1987). The general instructions given to respondents included:
think about "people to whom you feel so close that it is hard to imagine life without them." Such persons were entered in the innermost circle of the network diagram. The same procedure was followed for the next circle, described as including "people to whom you may not feel quite that close but who are still very important to you," and for the outer circle, described as including "people whom you haven't already 64
mentioned but who are close enough and important enough in your life that they should be placed in your personal network." (p.520)
I have often thought that "attachment" is the best descriptor for the continued relationship between the
living and dead in some cases. This is confirmed by
Levitt (1991) when she finds that some widows retain the deceased spouse in the inner circle. At life's other
"boundary," a few mothers do not include infants as old as a year in any circle. Attachment may be too strong a term for the continued influence of the dead on the living in so-called "ancestor worship" (Morioka 1984;
Smith 1974).
In Western culture, at least, it appears that social support of all kinds operates on the target person by promoting the belief in self-efficacy
(Antonucci and Jackson 1987). Using a variety of terminology to name the relationships and the results, it seems that health (including reduced mortality rates) and well-being are enhanced by some form of connectedness (Blazer 1982; Cobb 1976; Cohen, Teresi, and Holmes 1985; Kiecolt-Glaser and Glaser 1987). The critical difference in number of alliances is between zero and one, such that even one friend or confidant 65
(Lowenthal and Haven 1968) is a hedge against depression and despair.
There are different expectations for kin and non kin alliances in that kin are supposed to provide support even when there is no immediate expectation of reciprocity (Ainsworth 1991; Dykstra 1990). Kin are more often called upon to provide financial and personal support while friends give emotional and social support.
Weiss (1982; 1991) describes two types of loneliness: absence of attachment figure and loss of the relationships of community. Adult loneliness resembles the separation anxiety of the child whose attachment figure is temporarily out of sight but it is "separation distress without an object" (Weiss 1982:178). It is only somewhat relieved by others. On the other hand, lack of "community" with a larger identity group cannot wholly be relieved by a single attachment figure. It appears that there are two separate types of relationships with the possibility of some individuals operating in both with reference to the target person.
It is often asserted that humans develop attachments to places and things. Oliver-Smith (1986) describes the strong will of a whole village in the
Andes to rebuild on the site destroyed by an earthquake 66
and avalanche in spite of the offer of land in a safer
spot. Howell (1983) suggests that places form a part of
a person's identity and that "relative deprivation" is
involved in the forced relocation of elders. Rowles
(1983) broadens the sense of place from house to
geographic area when elders (especially the homebound)
envision remembered landscapes through continued social
support--often by telephone--from people who live in
those landscapes. But we are cautioned not to assume
that all elders resist relocation or change in general
(Kahana and Kahana 1983). One variable implicated in
willingness to relocate is individual choice.
Decisions
This study involves decisions or choices made by
individuals with or without assistance from others. In
fact, the argument turns on just what combination of
influences from family, friends, memories, and places
has led to the living arrangements in which we find
these informants (See Note 7, p. 28). It is a Western notion (and especially so in the U.S.) that living arrangements in old age require decisions, that is, that they are not automatically decided by prescribed social structure and rules. The "right" to make decisions is 67
based on ideas of dependence, independence,
individualism, and control. Bowlby did not want his
readers to conflate attachment with dependency because
dependency has pejorative connotations in Western
society (Bowlby 1969). I say, all the more reason to
examine that connection.
Especially in the United States, there is a
tradition of individual independence. In early America, both the need for and opportunities for the exercise of independent judgment seemed boundless. The very word
"frontier" meant exciting possibilities to an American while it meant boundary or different jurisdiction to a
European (Bourguignon, personal communication). The idea of individual responsibility for decisions
(internal locus of control) carries with it a certain tension (Lefcourt 1980). In societies such as those of
Japan, China, and much of the Eastern hemisphere, interdependence for decisions among variously defined kinship groups is the norm. In Japan, the kinship obligations of the ie were extended to include prescribed dependency relationships throughout the society, based on fictive kinship with the emperor (Befu
1971; Long 1987) or the non-kinship-based relationship of iemoto (Hsu 1975). 68
Doi (1973), from the insider vantage point of
Japanese psychiatrist and outsider perspective of some
training in the United States, gives an illuminating personal example of "culture shock." It gradually dawned on him that what any Japanese took for granted-- amae--had no lexical equivalent in English for a very important reason: it was not a working concept among
English-speakers. Amae is the right to presume on certain others (especially parents) for care and comfort. It is legitimized (and hence not disguised) dependency. Although it is particularly associated with the parent-child relationship, different grades and manifestations of amae are expected throughout life.
We can point to examples of such automatic, prescribed, dependency relationships being called into question. Scheper-Hughes (1979) observed in western
Ireland the collapse of intergenerational relations that had been based on a certain configuration of farming and inheritance when that infrastructure changed. Economic growth and paid employment for women in Japan has likewise been noted to alter a pattern of intergenerational living arrangements that involved a sequence: intergenerational, nuclear, intergenerational, with the last phase involving care of the elders by a 69
daughter-in-law under the same roof (Lebra 1984; Plath
1980a).
Although there have certainly been times, places,
and conditions in the United States that led to
intergenerational living, that has not been the
tradition. Nor is automatic, ascribed status and role
part of the American ethos. In the meantime, frontier
has come to mean boundary and the expansive "American
Dream" (anyone can become whatever he or she wants, with
enough effort) has constricted. All of this just when
the middle class American was getting used to the idea of retirement as a rite of passage to a different status. The "rights industry" (Morgan 1984) collides with "limited good" (Foster 1972). Now the older
American really does have choices to make but, I submit, constrains his own choices in new ways--some conscious and some unconscious. I extend the concept of Limited
Good to include an affective dimension and claim that some elders manipulate kinship obligations in the decision process, such that they wrest a commitment from relatives to be involved or concerned with their condition. Since "dependency" is not valued positively in American culture, the phenomenon itself (call it interdependence or attachment) must be cloaked in new 70 verbiage, just as "disabled" has been converted to
"differently abled."
How came dependency to have such low esteem in the
United States? Hsu (1961) proposes that self-reliance, even more than its predecessor--the English individualism--has given rise to guilt in situations of dependency. Here is a telling contrast:
A man in traditional China with no self-reliance as an ideal may not have been successful in his life. But suppose in his old age his sons are able to provide for him generously. Such a person not only will be happy and content about it, but is likely also to beat the drums before all and sundry to let the world know that he has good children who are supporting him in a style to which he has never been accustomed. On the other hand, an American parent who has not been successful in life may derive some benefit from the prosperity of his children, but he certainly will not want anybody to know about it. In fact, he will resent any reference to it (pp.218-219).
My observations in this connection are that
American elders distinguish between the provision of basic sustenance by their children and the gifts that raise the elders' status in others' eyes. In other words, there is an effort to conceal when one is totally dependent on children for financial support while there may be bragging about opportunities to travel and other indications of enhanced status and (perhaps more importantly) esteem provided by affluent children. 71
Some forms of dependency (in the U.S.), such as
those based on illness (Talcott Parsons' "patient role"
[Parsons 1975]), are more acceptable than others, to the
extent that "learned helplessness" (Abramson, Garber,
and Seligman 1980) permits negotiation for help where pure "crotchitiness" would not. One of the contributing
factors toward the pejorative regard for adult dependence in the United States is the sense (possibly gotten from psychoanalytic theory) that it is regression to a juvenile dependence, at which time it was
"appropriate." But that is confusing the psvcholoaical dependence of an adult with the biological dependence of an infant and the social dependence of all ages
(Kohut 1978).
We have said that humans are almost limitlessly clever at developing cultural permutations on universal themes: the surface institutions based on "deep structure" (Spiro 1978) being one way of expressing this relationship. We can envision a very general equation.
On one side are human needs and on the other side are expressions of need fulfillment. Or, for Freud, on one side are drives and on the other, frustrations and compromises with perfect fulfillment. For object relations theorists (Antonovsky 1987), on one side are 72
needs and on the other, objects (people) through whom
the needs are satisfied to varying degrees. From the
perspective of self psychology, there is traffic back
and forth in the equation in aid of developing the self.
At least two principles are held in common among
these perspectives. First, needs are experienced
universally. While it is true that the number and
naming of needs is argued as well as their ranking as
primary and secondary, at some level there is agreement
on this point. Second, there is great variation in
cultural expressions of needs. I suggest that among my
informants I see personality characteristics that
express dependency needs--however camouflaged.
Expressions of dependency needs (as with all needs)
are culturally-defined. Cultural legitimacy is based on
such variables as age, gender, status, physical and mental health, class, and role. A healthy 2-year-old or
a 6-year-old Downs' syndrome child may legitimately
demand to be picked up in our culture; a healthy 6-year-
old may not. One hears almost unexceptional 1y from
American elders some version of, "I want to be independent as long as I can. I don't want to be a burden on my children/sister/niece [less often, spouse]." Of course, this is not a value held by all 73
"American" ethnic groups, as we noted in Hsu's example
of Chinese elders.
If we look outside the United States for legitimate
cultural expressions of dependency, we find a variety of
examples. Where roles are ascribed by age, gender, and
the other descriptors, the degree of allowable
dependency is part of the ascription. The same may be
true where roles are achieved through effort. Japan seems to have both in the sense that care of dependent elders once automatically carried out by daughters-in- law (Brown 1988) is now sometimes "earned" by trading child care of the grandchildren (Lebra 1979) or by giving the house to the grown child who provides the care (Long 1987). In western Ireland there are experiments whereby public agencies pay family members to provide elder care (Scheper-Hughes 1979).
All societies have institutionalized some religious forms in which dependency needs can be expressed through turning over control and responsibility to a "higher power." This may take the form of dealing directly with a supernatural being or using the offices of an intermediary, such as a priest or shaman. Where control of the person is seized by the supernatural (Posession
Trance or PT), that is, where the cultural explanation for an altered state of consciousness (ASC) is one of
"possession" (Bourguignon 1973), the possessed person is
legitimately dependent--she did not seek (consciously) to be controlled. However, where the cultural explanation for an ASC is that the supplicant is taking the initiative in seeking help from a supernatural (an example of Trance without a possession belief), it is possible to view the situation as one of independence
(Bourguignon 1979). Bourguignon and her research team found institutionalized ASCs to be quite widespread, involving ninety percent of 488 societies studied
(Bourguignon and Evascu 1977).
The onus of making (independent) decisions about various of life's passages is often shared in creative ways cross-culturally. Whom a daughter should marry may be prescribed by clan exogamy rules, by the eldest male member of the family, by interpreting tea leaves, tossed bones, or a Bible passage picked at random. Or, the daughter may make her own independent choice.
Dependency needs are met through identification with larger groups as well as through dyadic relationships. We see age sets going through initiation together (Herdt 1987), adolescent gangs meeting a 75 preadolescent need to avoid an educative process (Bios
1962), and religious cults--with or without charismatic leaders (Turner 1974; Wallace 1966). These groups have in common that members are relatively anonymous and have diluted responsibility for the actions or decisions of the group.
Support groups (12-step or other) are special cases of identity groups in that they depend on other members to support them through the kinds of- crises that brought the group together in the first place, such as alcohol dependency (Fallding 1974; Rudy 1986). Membership in a support group is the antithesis of "self-help" in which the individual is identified as self-reliant and independent.
Finally, there are variations on the acceptability of dependence on experts--usually healers of all ilks.
Dependency in matters of health and illness may be one of the most universally accepted categories for dependency (outside of infancy) that we have although there is a recent movement in the United States to "be responsible" for one's own health. Examples abound of transferring responsibility to healers. Healers in Iran
(Good 1977) and India (Nichter 1981) must be able to correctly interpret a supplicant's idiom of distress 76
through shared conventions in order to prescribe the
right treatment. Often, as in the India case, social
relations are strained and dependency needs are not being met. Classic examples of tacit shifting of dependence are seen in Western psychoanalysis (Stein
1986).
My informants have witnessed considerable change in the areas of dependency in all its forms, from financial to affective. Their parents may have been among the first to benefit from Social Security. Job security and guaranteed pensions came and, some say, are now fading.
Medicare was a boon to elders to cover their health care but is now facing increasing restrictions. Retirement to the "sun belt" (Jacobs 1974) or annual migrations
(Sullivan & Stevens 1985) for the middle class were an option that has peaked and troughed.
In the area of affect expression, my informants have witnessed considerable change in family form, social organization, and activity groups. The invention of age-homogeneous "villages", with all that implies in terms of novel social organization, occurred during their life times. In my analysis (Chapter VII), I hope to show how they have reconciled their needs with changing conditions as they maneuver into old age. 77
TABLE 2
EARLY CHILDHOOD
Position Proximity Proximity Valence Separated in Birth to Extended Detailed of from Mother? Name Order G'Parents Family Memories Memories What Age?
Fem 3/4 yes yes yes pos. no
Toddy 3/3 no yes yes pos. no
William 1/1 yes yes yes pus. no
Ducky 6/7 no yes no unclear no
Dinah 2/3 no yes no neg. 2.5 yrs.
Doris 3/3 no no no unclear no
Gertrude 3/11 no yes yes unclear * no
Lyon 1/3 yes yes yes unclear no
Nancy 1/6 no no yes pos. no
Francesca 2/3 no yes yes neg. 4 vrs. ~ Source: 1994 fieldwork
Legend: * Positive for Father, negative for Mother.
~ Early start in school. See Francesca’s life history. TABLE 3
TOTAL POPULATION. BY AGE AND SEX: 1980 - 1991 U.S. BUREAU OF THE CENSUS
• « Am i. on* M naai «M y i. mouoMArmeototem aoroad.to t derivationor esumaiee. teM e il, secaun I. rorim m h u ii cm iiw u m, ii m u u n u to Tabular ftaeantadnn. - Cotorml Ttmm to 1970, series A23-20 and A2941|
ToM t Under • 10 10 90 20 90 90 40 45 00 00 00 00 70 0 14 10 10 65 Me ID Id to VEAMANDKX ao • to to to to to to to to to to years to to to yean years dian • m fa n * • 14 10 24 20 94 90 44 40 04 00 94 74 and 13 17 24 and and age Mara yean yaan yaan yean yean yaan yean years yaan years years yean osar years yean yean over over »MI 19440 14700 1044221490 21420 10420 17420 14410 11400 11900 11,711 10474 11410 10.000 14001 0.000 31.150 10440 30400 171.711 25.540 304 MUM 10904 17.101 17.700 10400 21400 21400 20991 17414 19420 114M 10.479 10410 10900 14127 32,000 14912 27.030 102.45031424 32.0 MUM 1 M M 10 4)7 17471 1744210472 20444224422 M 7 9 1477014101 11440 10,429 10402 14200 1447434600 1442320.000 10440631,764 33.1 110430 MM 4 M 0 0410 10400 10402 0400 0.742 4000 0.720 0 4 M 4 0 2 2 4402 4.070 4707 9,049 10.023 0400 16400 02441 10,305 20.7 12 2 9 0 0 MOT 0447 4000 4141 4007 14704 10474 4 M 1 0400 101491 4702 0421 4 0 M 4.M 7 7992 4424 14304 4049 14003 02.024 12.007 31.0 MM 0407 0401 0400 0401 14000 11.M7 10490 0402 M 1 9 4007 4407 4,040 4092 4.700 I4 M 1 4001 13444 03,017 14701 31.0 1104OT 7400 4101 4090 10410 10477 0490 0407 7.100 0401 4702 0900 4199 0.410 0424 0.420 10437 7400 14.000 00.470 31.2 WOT MM U 1 7 4900 0440 15.245 saeaey 4400 10402 11410 10900 0914 7949 0447 4400 0471 10.100 0402 10410 4400 13.170 00434 10.000 34.0 MM 4000 0490 0470 4440 10441 11.190 10440 0,400 7.100 4000 4490 4037 10400 4706 10.900 4022 14060 100.740 10.002 34.3 IOOjO 7 4 7.4 0 4 9.9 o o 0 4 7 4 0 4 0.1 1009 4.0 0 4 0.1 4.4 0.9 4.4 13.7 7 4 13.3 70.0 11.3 7 4 7 4 4 4 7.1 7.7 0.0 0 4 0.0 7.1 0.0 4.0 4 4 4 4 7 4 0.3 124 MM 4 9 100 77.0 12.6 7 4 7 4 7 4 0 0 7.7 0 4 0 0 41 7.4 0.0 4 4 4.1 4 4 7 4 0.3 12.9 0 4 10.0 70.0 12.0 1 >009 7 4 7.7 4 4 0 4 0 4 0 4 7.0 4 2 0 4 4.0 0.1 0.0 1 0 M 4.2 0.1 3.2 14.4 7.0 130 744 0 3 7 4 7 4 7 4 7 4 0.1 0 4 9.0 4 2 7 4 0 4 4.0 4.1 41 4 0 3.0 13.4 MM M 7 4 0 4 114 790 10.3 7 4 7 4 M M 9.0 4 9 7 4 0 4 4.0 4.0 4.0 4 0 3.0 13.0 0 4 11.1 754 10.4 1 1000 4 9 7 4 7.7 0 0 0 4 0.4 7.0 41 1009 0.1 4.0 0 4 0.9 4 4 7.0 0.5 13.1 4 0 12.0 704 13.1 7 4 0.0 0 9 0 9 7.4 4 9 0.0 7.0 7.0 0.0 4.0 4.9 7.0 1 0 M 7 4 0 4 4 7 0 0 4.4 0 4 12.2 41 10.3 70.1 144 7 4 M 9 4 9.0 7 4 0 4 4.0 4 4 4.4 7.0 0.7 12.3 0.0 10.0 77.0 14.7 s X N o li • ■ * •» Oawam. n w i x M ryiitot o i rnpam. i i N J , No. 1MB; and uipuMafMd data. CD 79 CHAPTER II NOTES; 1. I am using the term "personality" imprecisely as the whole set of descriptors that others use to designate an individual. D'Andrade (1990) insists that it must be defined in relation to a system of functioning, in which case, it "consists of affective, motivational, and cognitive systems which enable human beings to maintain and regulate themselves as individual organisms" (p.151). The "self" I take to connote one's own private awareness of one's personality. Both self- awareness and interpretation of others' personalities are culturally-constituted (Hallowell 1955). 2. For simplicity, I have spoken of "mother" because, worldwide, mother is the most primary caregiver--primary in the sense of first and in the sense of primacy in influence during the first few years. Cross-cultural1y one finds examples of father's caregiving role (Demos 1982; Wei 1es-Nystrom 1988) and a role shared by various others, such as grandmothers, aunts, older siblings, and young girl "nurse maids"--both concurrently and sequentially (Howrigan 1988; Morelli and Tronick 1991). 3. This reference is to my psychiatric nursing experience of more than three years associated with adolescents in a psychiatric hospital . The population was made up of adolescents who had typically been tried on out-patient treatment modalities and had frequently had several short-term hospitalizations prior to their current longer one. 4. My informal observation of "late adoptions" (after age three or four), especially when the child has had a series of foster caretakers, is that the child professes little memory of those years. There is a corresponding interest on the part of the adoptive parents in "finding out what happened" to the extent of making that their focus in treatment. 5. During the time period (late 1940s and the 1950s) and place (London and environs) of these studies, it was customary to have children in hospital or institutional care for long periods of time with little or no contact with parents (Bowlby 1969:xii). 6. The Strange Situation is a "test" under some control in which a child is exposed to eight situations, e.g., the introduction to a play area with mother and 80 stranger, mother only, stranger only, mother's return, etc. The dependent variable is reunion behavior. Of great importance but often overlooked (to Ainsworth's chagrine) is that the Strange Situation is the smallest part of the data base contributing to her theory of a differential experience of attachment as providing a "secure base." The infants are categorized as having secure, anxious (or ambivalent), or avoidant attachments. Note that these labels speak of the dyadic relationship. The reader interested in details of the Strange Situation is referred to Ainsworth et al (1978). For the broader implications of early attachment behaviors, consult Bowlby (1969, 1973, 1980, 1988) and Bretherton (1985). 7. MacArthur and Wilson (1967) use r and K to indicate different strategies for species' survival in populating an area. The strategies are based on the carrying capacity of the environment (K) and the intrinsic rate of increase (r) for a particular species. A species newly-introduced or freshly populating an environment tends to reproduce beyond replacement rate while an environment close to "crowded" for that species leads to strategies that concentrate on fewer offspring that more efficiently use the environment. LeVine (1980, 1988) speaks of human parental "strategies" that attempt to track the environment in terms of what are the survival potentials for their offspring. 8. Plath attributes the term "consociates" to Alfred Schutz (Plath 1980) and "convoy" to Loki Madan (Kahn and Antonucci 1980). 9. For this study (Antonucci and Akiyama 1987:521), elders are divided into the young-old (50-64), the middle-old (65-74), and the old-old (75-95). In general, age ranges and definitions form a dizzying array. Neugarten and Neugarten (1986) on the subject of the modern difficulties in demarcating between "ages" say, "... we are less sure where to put the punctuation marks in the life line" (p.34). They speak of shifting among markers of role (e.g., retirement from work), chronological age, health, social characteristics, and vigor as the "blurring of life periods" (p.33). CHAPTER III METHODOLOGY Introduction This chapter will be in six parts: (1) formulation of the question, (2) selection of methods for answering the question, (3) salient characteristics of the researcher, (4) selection of informants, (5) the research process itself and, (6) methods of analysis. Formulation of the Question The evolution of the question has been outlined in the first two chapters. It was a process of about ten years' duration, distilled from observations in the field of nursing practice, anthropological theory derived from formal course work, and opportunities to practice selected methods of data collection and analysis in anthropology methods courses. Armed with a question, what follows seemed the best way to answer it. 81 82 Selection of Method Over the aforementioned ten year period, I alternated among survey, participant-observation, and life history methods of data collection and analysis. Informal observations were made of elders among family and friends, particularly around health and safety issues when elders lived alone or, when with a spouse, at some distance from their children. I noted how often there was a discrepancy between what kind of "help" the elders wanted from their children and what the children thought was needed or that they were willing or able to offer. Additionally noted was the great effort usually put forth by elders and children alike to remain engaged (not to confront the differences) in what seemed to demonstrate the importance of these ties. There were marked differences between the ways elders as hospital patients and their visitors acted in that setting as opposed to their behavior at home, such as their marked formality and deference to each other in the hospital . I was persuaded by this finding not to use hospital or nursing home patients as informants in the current study. A survey of elders living in age- homogeneous, subsidized housing--using a questionnaire distributed by young, bearded men (a son-in-law and 83 friends) resulted in over eighty percent participation, convincing me that this was a very cooperative population. Several term-length projects involved single interviews or short series of interviews with elders in several situations. For example, I followed up with one woman from a long convalescent stay (eighteen months) in intermediate care to visit her in her mobile home. A valuable source of "natural" participant-observation experience came from volunteer activities. I gave health educational programs for elders during their lunch periods at congregate eating sites, made visits to lonely residents in assisted living apartments as assigned by the chaplain's assistant, and took social histories in a county home.l There were many opportunities at irregular intervals to take blood pressures, staff health fair booths at malls, and present topics at seminars for elders. [Keith (1986), Spradley (1980), and Powdermaker (1966) represent three good examples of the use of participant-observation with very different populations and carried out in disparate settings. In each case, there is an emphasis on opportunities to be seized and the flexibility to change pians ]. I claim to have been "doing ethnography" all this time--as opposed to using "ethnographic method." Zaharlick (1992) draws the distinctions between these terms very well. Briefly, carrying out ethnographic study in anthropology (where it originated) implies the study of groups of people and their life-ways or culture in as comprehensive a fashion as possible. The assumption is that culture elements and their systematic interactions will be comprehensible. Unfortunately, the term "ethnographic method," when used in other disciplines, has come to connote particular methods, such as participant-observation, divorced from theory. Agar (1980) places ethnographic methods back in context when he outlines their purpose as adding "to the procedures used by the ethnographer to transfer observations into accounts that group members say are possible interpretations of what is going on" (p.81). Birdwhistell (1977) found himself becoming impatient with a seminar student one day for asking if Margaret Mead and Gregory Bateson had a. methodology while studying Balinese trance and dance forms. He snapped, "Of course not. They are experienced ethnographers and not technicians" (pp.103-104). He mulled over his annoyance for a time and finally located 85 its possible source. The new generation of ethnographers were given classes in theory and separate ones in methodology, which tended to comprise techniques. Time for fieldwork was sharply constrained by available funds so that they were encouraged to have a problem in hand, gather only data that would address it, come home and analyze the fit. Contrast the experience of Mead, Bateson, and others of an earlier generation for whom funding may have been just as short but time in the field was not. These ethnographers entered the field armed with a broad liberal education but less sharply defined research question. They refined theory and approach in a continuous process. While I cannot claim such breadth of liberal education, I believe that my ethnography has been a long time developing and benefits from this time factor. An early assumption in formulating this research question was that ei ther kinship oir some other relationship (e.g., friendship) would be more influential in the choice of living arrangements for elders. Gradually, it began to appear that the informants, at least, were able to accommodate to whichever category of personnel was available and that 86 they could redefine their situation as necessary (Howell 1983). This last conclusion came about through the experience of taking life histories. The uses of life history in general are well expounded by Langness (1965), Frank (1979), Langness and Frank (1981), and Shaw (1980). Life histories, biographies, or case studies of individuals--both public figures and "unknowns"--i1lustrate in practice how illuminating this form can be. Mandelbaum's life of Gandhi (1973), Crapanzano's (1980) Tuhami about a Moroccan man, Oscar, Wilson's character study of a "marginal” Caribbean male (1992[1974]), and the collaboration with a Haida woman elder by Margaret Blackman (1982), are a few examples of this genre. Life history writing specifically with elders has come to be recognized by some writers to have more virtues than its original one which was to preserve knowledge of disappearing cultures--knowledge which was only held by the elders. Little (1981) and Myerhoff (1980) both look to the expressed motivation of the elders themselves in telling their stories, whether it be summarizing their lives or attempting to make an earlier time understandable to their audience. I will restrict my analysis of my informants' life histories 87 within these same bounds, that is, what they claim as motivation and how reported events appear to support their claims. This is admittedly subjective but with a continuous process of reflecting back to the informant for clarification or confirmation what I thought I heard (Rubinstein 1988). Personal Characteristics of Researcher Since subjectivity is probably unavoidable, it behooves the researcher to strike a balance between glorying in it and denying it. To that end I will disclose what I believe to be salient facts and characteristics about myself, specifically: age, family history, nursing career, and modus operandi. I am a fifty-nine-year-old, American woman from Pennsylvania with European family origins. Aside from being ten years younger than the youngest of my informants, I have a lot in common with them and share many similar memories. But there are differences as well. Although we "share the same culture," there was never a sense in our interviews that I knew what they were going to say before they said it; I was definitely a student or learner of each one's story. 88 It seems to me that the perspective from a thirty- eight year career in nursing is my most defining characteristic. Nursing and cultural anthropology call for quite similar observational and technical skills and this is never truer than when psychiatric nursing and psychological anthropology are the subdisciplines in question. Most of my nursing career has been in psychiatric nursing (all age groups) with digressions into maternity, medical-surgical, physician's office, gerontology, community, and continuing education. Like the anthropological view that cultures make available (but do not determine) different ways to solve universal problems, nursing teaches that patients have unique assortments of similarities and differences in their approaches to their health. Similar to anthropology's emic and etic perspectives is the notion in nursing that patients should be heard on their own terms--that we must find out what are the important conditions for their lives in the here-and-now. Most careers in nursing or anthropological ethnography give practitioners a life course or diachronic perspective. Few in either discipline restrict themselves to one age group or one synchronic slice of time, even if that were possible. The 89 influences of family and others on any studied group are ubiquitous and must be taken into account. One apparent difference between the nurse's (especially psychiatric) interview and the ethnographer’s interview is that the former's goal is "therapeutic." In addition to making observations of the patient's speech content, mood, and mannerisms to share with psychiatrists and other members of the treatment team, the nurse is also teaching by example how the patient can verbally explore behavioral options. But is that so different from the ethnographic interview? Engaged, interested listening is therapeutic in its own right, with or without conscious intention. As a technique, listening to elders or guiding their recall has evolved into "reminiscence therapy" and proponents claim benefits to elders in well-being (Gothoni 1990). But setting technique aside, ethnographers are by nature a rapt audience. A nursing background is almost an automatic passport into all the venues that have interested me for this dissertation and for all the settings for studies over the last ten years or so. Although I have never misrepresented myself or my purposes in seeking access to various facilities and populations, that is, I have said that I am a student in anthropology who happens also to be a nurse; the latter factor seems to have been the more persuasive in gaining entry. This may be true with health and human service agencies because of the tacit understanding that nurses are well-versed in the requirements for confidentiality. Another possibility is that a reciprocal role can be worked out for a student "who happens to be a nurse." On several occasions, administrators of retirement villages or agencies "turned me loose" to gather facility data or interview individuals for my purposes and visit "shut- ins" or take social histories as a service to the facility. I feel certain that these forms of reciprocity made it easier for administrators to comply with my requests to use their facilities for my own educational benefit. The last personal characteristic that seems salient to report is that my learning style can best be described as slow with complete immersion in the subject. The approach to this dissertation topic has been just that. While being desultory in pace and thorough in coverage, it is also a pattern of using the moment. If I must wait to see an informant in her assisted living apartment, I will spend the time sitting 91 in the clinic waiting room and observing how the nurses and physicians treat the patients. When an informant and I go out to lunch and break our usual pattern of interviewee and interviewer with note pad, I note how the waitress addresses me for the informant's order, as though the informant's age precludes the possibility that she can order for herself. These time-saving or time utilization economies come from psychiatric nursing, I am convinced, where several levels of interaction are attended to simultaneously and note- taking must be postponed for a later time. Selection of Informants Ten people said "Yes" and five said "No" to a request to become an informant. Indirectly I heard of additional volunteers after all ten candidates had been chosen. Reasons for declining (when stated) were just as interesting as reasons for participating. The process of choosing candidates and beginning interviews was a sequential affair as it did not make sense to request participation many months in advance. In other words, although I might start interviewing a second person while finishing with the first, I would not have solicited a third yet. 92 Since approximation to the national sex distribution of elders living alone was sought, I wanted two or three males among my ten. I hoped for an African American (one of the refusals). In the broadest sense of the term "sample," this is nonprobability judgment sampling. It is nonprobability because predictions or generalizations cannot be made from the findings (Bernard 1988). It is judgment in the sense that the researcher decides what purpose the data from a particular group of informants will serve. My research proposal included the stipulation that five people would be living independently and five would be in retirement "villages" or other arrangements with available services. This mix certainly does not reflect the proportions of elders' actual living conditions but provides an opportunity to compare equal numbers of people in the distinct situations of having formal services available or not--a preliminary to a hypothesis about the salience of some variable (Mitchell 1984). With those preconditions having been met, it remained to choose informants by "opportunistic" or "chunk" sampling (Honigmann 1973:269). Contacts through friends and through various professionals met during earlier researches led to proposed names; the approach 93 was up to me and the decision to participate or not was up to the elder. The Research Process With seven of the ten informants, the initial contact about participating in this study was made by telephone (detailed descriptions of contact will follow in this section). At that time, I would say how I got the person's name or who referred him or her. I would briefly outline the project in terms of subject, criteria for inclusion (e.g., age), time involvement, my flexibility in terms of time distribution and locus for interviews, modes of my recording (note-taking with one hour of tape recording), and confidentiality. The most frequent comments were demurrals about being an "interesting enough" subject and about being able to fill the proposed ten or twelve hours distributed in as many sessions as they liked. If the person agreed to a meeting in person to further discuss the particulars (without commitment), we set up a time and place. At the first meeting I further detailed the study and entertained questions. The informant should make a fully informed decision before signing the permission form but I reiterated that, even after signing, they 94 must feel free to withdraw at any time without prejudice and I would tear up the permission and destroy the data. They were also informed that the hour-long audiotape would be given to them after I transcribed it. Most often this first meeting had the informant signing the permission and beginning the interview process at once. Lyon talked for over two hours about his many occupations but had not signed the permission until the end of that time so that I would not take notes prior to his signing. One woman signed permission but had second thoughts and phoned the day before our first full session to decline so I destroyed the permission slip and data. The only African American prospective informant had me visit twice while she considered participating but without having signed so I took no notes. She called later to decline. I suspect that both of these women were worried about confidentiality issues because they had established that we had some acquaintances in common. The prospect of the taped hour produced much anxiety; Dinah prepared a "script." For my purposes, I explained, it was merely a sample of speech pattern and an opportunity to match my notes from the same hour with the transcribed hour. For their benefit, it was a 95 record of some slice of time in their lives. I asked the informant to pick the hour and the subject matter. Several informants said that their children had been urging them to write memoirs and that this would be a good method for doing a little of that. One woman suggested that she might use this vehicle for letting her daughter know how miserable she had made her. Others thought that they might just "put it away." Most meetings were at informants' homes but other sites included: restaurants, my house for lunch, an art gallery, car rides, meeting room in retirement facilities, a banquet with travelogue, and househunting. Three informants were not able to accept a trip out to lunch for one reason or another. The meetings were as frequent as weekly or as far apart as a month. [Table 4, p.104 shows the interview schedules for the ten individuals. Follow-up "social" visits are represented by number only and, in fact, are still going on. Not shown on the table are visits to agencies for background information and visits to individuals who later declined to participate]. Fern was my first informant. Her daughter, a colleague in a cognate profession, heard me describing my research plan and suggested that I call her mother 96 who lives in one of the retirement vi 11 ages--one in which I had no prior contact. A phone call got a positive response. Toddy is the maternal aunt of a nurse friend of long standing who proposed Toddy and later, Gertrude, an aunt on the paternal side. There seemed no difficulty in interviewing both of these women because they have very little social contact between them and would not be "comparing notes." My nurse friend mentioned to both aunts that I might be calling but, when I saved Gertrude for later, she said, "I was beginning to think you forgot me." William was third. I had visited the facility in which he had an apartment many months before contacting him. On that occasion, the manager had included William at the luncheon to tell us guests about the place and he graciously toured us through his apartment. When I called to ask him to be interviewed he remembered the previous encounter and agreed. Ducky is a resident in a county home in which I was taking social histories in the capacity of a volunteer. Ducky had written a brief biography for the home's newspaper about one of the women from whom I was taking a history. The woman insisted on staying in the 97 television room to watch her "soaps" during my history- taking so it turnedinto a group effort in which Ducky was the most vocal . When it came time to pick my ten informants, Ducky sprang to mind and she was more than wi11ing. Dinah was also met earlier when I did a short interview of several women in her particular facility-- women who had moved far from their habitual homes to be near kin or co-religionists. In Dinah's case, both reasons were operative and she was available to contribute to my study. Doris was featured in a neighborhood newspaper in a picture story about two women who were facing retirement housing arrangements in contrasting ways. Doris's was the example of the entrepreneur who tailors her housing to suit and finds her own services. When I called, she was willing but very busy. After some setting and resetting of appointments, we finally got together. Gertrude ("the other aunt") was next chronologically followed by Lyon. By now I was more specific in the criteria for the last three informants. I wanted a male informant living alone. Two men turned me down--one because he did not want to be identified as "over sixty-five." I turned to a friend who works at an Alzheimer's day care center for help in finding a man who is caregiver for his wife and who does not himself go off to work during the hours his wife is at day care. She had three likely candidates and Lyon agreed by phone to listen to my request. It happened that on the appointed day there was a snow storm. I made it to Lyon's house but day care was cancelled and his wife was home (the only time this happened during our interviews). She napped intermittently while he spent two hours talking and not signing. She woke up at the end to tell us both that he would not be a very good informant and he promptly signed. During an interview with the administrator of another retirement facility, I was wondering aloud how I might meet another candidate. He suggested that he and I go straightaway to join a table of five women having coffee and I could present my case. Nancy was the newest to have moved in and a nurse; she said, "I don't know how I could refuse another nurse." Finally, I was looking for rent subsidized "metro" housing for elders with no services provided. One set of such apartments had been part of my previously mentioned survey ten years before. I looked on mail boxes for names of anyone who might still be living 99 there ten years later. Francesca was one who fit that description and agreed to be the tenth informant. Method of Analysis My field notes were converted to narrative form on a word processor usually within a week. Included in the notes were summaries of speech content, some quotes, "stage directions" such as, "leaves to search for embroidery to show me" or "sits in position to see out into the hall and comments on the motivation for the women residents' walking by," and notes on nonverbal behaviors such as, "tears in eyes" or "hand-wringing." Each taped hour was transcribed directly including my comments, both our laughters, and other parenthetical comments about metacommunication. At first it appeared that I might fruitfully use a a tool such as the computer program ETHNOGRAPH to aid in analysis but after a brief trial, I discarded that idea in favor of doing it "by hand." It seemed to me that if the data were categorized and clustered by theme that (given my style) two unfortunate things would happen. Once I identified themes in one informant's account, I might try to fit other accounts into the same themes. In fact, I think that the notion of Scorekeepers and 100 Non-Scorekeepers emerged because of not prematurely categorizing material. Rowles and Reinharz (1988) support the claims for in-depth interviews in collecting life histories that, "Great skill is needed to preserve not only the substance of what was communicated but also the aura of the context in which it was communicated" (p.17). The other problem relates to loss of nonverbal context in handling and rehandling written content. An example follows. Informants consistently rated themselves to be in good health despite varying chronic health conditions. Their health concerns and feelings about death were expressed in very different ways and in (by my interpretation) different contexts. As a physician and knowing that I am a nurse, William described his and his wife's sometimes rare health conditions and surgeries in some clinical detail. On paper this appears to be professional detachment. In fact, in his own personal health history, I interpret it to be so. But in his wife's case there is an overwhelming sense of the loss of his best friend and only the partial compensation he felt for having been able to devote time and attention to her at the end of 101 her life. I did not see a concern for his personal health here. How was this material to be coded? Ducky's situation is much different but would not appear so on paper. She has a marked interest in clinical detail as well but without, of course, a physician's knowledge or sophistication. She can relate extensive detail about emergency health crises of other county home residents, when the "squad" had to be called, how long it took to arrive, and exactly what measures were carried out by the home staff in the meantime. Her expressed point in telling me these stories was that other residents "stood around and gawked the whole time; it was disgusting." Yet Ducky must have been among the watchers because she tells the detail in first person. Although, strictly speaking, this should not be coded as Ducky's concern about her own health, I interpret it to be just that. Her voice and facial expression of dread led me to believe that she greatly feared having people who did not care about her more than a morbid curiosity being onlookers if she should be in extremis. In other words, I used principles from psychiatric nursing, psychoanalysis, and short term focal psychotherapy in categorizing and analyzing the data. 102 Heinz Kohut (1978) emphasizes the value of using intuition (empathic understanding) at least in the first stages of analyzing a problem. Paul and Anna Ornstein (Balint, Ornstein, and Balint 1972) discovered something interesting about timing and disclosures. When the mental health care reimbursement picture changed such that only a small number of visits to the therapist were allowed, the analyst and patient had to begin collaborating on a schedule. Both had to work harder to focus on what really mattered to the patient. At each session they would review how far they had come and what remained to be covered. The Ornsteins discovered (to everyone's surprise) that imposing discipline on the process meant accomplishing the same goals as in the longer open-ended process. The goals were more restricted but were chosen by the patient and agreed to (as realistic) by the therapist. While taking life histories by my research design is a far cry from doing therapy, there are some similarities in session structure. We had four or five sessions to cover about the same number of life stages. At the beginning of each session we reviewed where we were. The informant chose the order and which hour would be tape recorded. The "goal" (which is agreed 103 upon between client and therapist in therapy) was to transmit a story and its interpretation from informant to me. I assume that some events and interpretations were changed or left out. At the first session and often after that I reminded informants that they should not tell me anything against their will or anything that gave them pain. Another similarity to short term focal psychotherapy is in the timing of revelations. The Ornsteins note that patients often save "bombshells" until the end of a session or till the last session. Nurses have seen this phenomenon for ages in the patient who calls for a specific service or medication and, just as the nurse is about to leave the room, says, "Oh, by the way .....", followed by revealing some fear that has been preying on the mind. On several occasions informants would watch me put the notes, pens, and other paraphernalia back in the briefcase and prepare to leave before adding something like, "Oh, by the way, I was married another time but it was very brief." I have taken timing and other imponderables into consideration in my analysis. TABLE 4 INTERVIEW SCHEDULE Name 01-91 02-91 03-91 04-91 05-91 06-91 07-91 08-91 09-91 10-91 11-91 12-91 01-92 02-92 03-92 04-92 05-92 Fem (1) X X Toddy (0) XX X X X William (1) X X X X Ducky (2) xxxx X Dinah (1) X X X X Doris (1) X X X X X Gertrude (1) X X X Lyon (0) X X X X X Nancy (1) X X X X Francesca P) xxxx Source: 1994 fieldwork Legend: Number in parentheses after name indicates number of follow-up visits carried out after series of interviews 4 0 1 Each X represents ar interview of c. 2 hours in the designated month. 105 CHAPTER III NOTES: 1. All of these projects led to term papers for field methods courses or were incorporated into independent topical papers. The network of contacts thus accumulated also provided informants for later papers and this dissertation. CHAPTER IV THE ELDERS Introduction Information was gathered from informants for this study around the foci outlined in the Appendix. On some subjects there was so much conformity that the data (negative findings) are not reported individually in the biographies that follow. For instance, no informant seems to have attributed much significance to childhood friendships and no one has continued high school or college friendships into the present. There was amazing (to me) uniformity of experience among some of the demographic and historic data reported. Although informants did not always know about their grandparents' migrations, they did know about their parents' and only one informant could report no migrations in either ascendent generation. Three informants did not move beyond a fifty mile radius. Children of four of the eight informants who had children have remained close to home^. 106 107 The most surprising facts of all have been that each informant has worked for some period of time (often the majority of those usually considered "employment years") and each has been sole support for some period of time. It appeared to me that only four of the ten identified strongly with their work personae--both men, Fern and Doris. The tenor of the others’ narratives about work emphasized work out of financial necessity as opposed to following planned career trajectories. These and other demographic similarities are displayed in Table 5, p.143. From the remainder of the interview outline topics, I was particularly interested in assessing two things. The first was the presence, absence, or degree of continuity over the generations (represented in the narrative about ascendent and descendent generations) of the value of elders. The second was to trace, if possible, informants' attachment patterns over the life span. I expected secure attachment patterns to be evidenced by reports of competent performance of duties at least by adolescence and by "social consciousness," for lack of a more precise term. What I mean by this is that the informant will have developed a sense of responsibility or accountability to a group of humans 108 larger than his immediate family or friends. The salience to attachment patterns of these two informant characteristics is discussed in Chapter VI (Scorekeeping). The following biographical sketches include comparable information collected from informant interviews based on the interview outline. Fern Fern is a seventy-seven year old woman of imposing "presence." One remembers her as taller than she probably is due to a combination of Texas drawl and self-assurance. She has an angular build and dresses nicely but it is clear that people and conversation are more important to her than appearances. She is artistic and has some background in gallery management--obvious in her apartment appointments. Of all ten informants Fern is able to relate the greatest number of stories about the most numerous relatives in ascendent generations. There is evident pride in a lineage that includes pioneers of both genders in settling Texas and in professional as well as commercial trai1blazing. She tells about a physician grandfather who knocked out some windows at the home of 109 a tubercular patient. It seems that the patient's family would not leave the windows opened, as he advised, to let fresh air in. Her nuclear family of parents and three brothers was surrounded by extended family in the same small town, other nearby towns and, ultimately, around the country. One widowed grandmother lived next door to Fern’s family and then with them. Extended family returned for holidays and stayed for days to weeks. Family values included sharing and "face-saving." Charitable acts were redefined as reciprocal situations. Fern interrupted her college career to help her mother take care of Fern's father when he developed cancer. After his death, a cousin insisted that Fern was "needed" to help with her children. Coincidentally, the cousin's husband was on the board of a large university in the same city and Fern was to stay with them as she finished her undergraduate degree. Fern grew up amid expectations of competence and service from the "advantaged" (of which she was one) toward the "disadvantaged." Early in her married life in South Carolina, she found the condition of Black country schools deplorable and put her efforts into gathering books and supplies for them. The same social 110 awareness translated into such political activity as university students' right to demonstrate peacefully, Amnesty International, and, for the Grey Panthers, organizing services such as home-delivered meals for the elderly, and numerous other causes through adulthood. Fern says that the philosophy of her mother's family was that women were expected to be educated and to work at least equally with the men of the family. "Grandpa W. always said that it was more important to get the women to college than the men in the family. The men didn't need as much education just to work in the family business." She taught for a while in a community college before going to another state for a master's degree. For another time period she taught elementary school and still later reached ABD status while teaching sociology at university level. She retired from university teaching soon after the campus unrest of the 1970s-- especially the Kent State killings. She was deeply troubled by what her students reported their parents' attitudes were about those ki11ings--that they were fully justified. Fern and her first husband had an amicable divorce after their daughter and son were in their teens. Fern's Ill second marriage ended after three years when her husband died unexpectedly. All of her relationships with surviving family members--brothers, children and grandchildren, first husband--appear to be friendly and supportive without being intrusive. For instance, Fern's daughter lives in the same city and helped Fern find her living accomodations but played the role of helping her to explore options rather than prescribing what was "best" for her. Fern has lived at Salisbury Downs for about two years but had moved to the city twelve years before that. Her daughter only moved to the same city a few years ago but it is unclear whether the move was to be closer to her mother or not. Salisbury Downs is a retirement community that includes a nursing care unit. In fact, Fern said that its availabilty was an important factor in her choice: "This is to be my last move." But in the meantime she enjoys many social and cultural activities and shows little inclination toward slowing down. Toddv Toddy embodies a multitude of contradictions or unexpected outcomes. At sixty-nine she is one of my 112 youngest informants and probably the fittest of all but she has a history of several acute and chronic health problems and surgeries. She is slender and athletic--an avid swimmer, golfer, walker, and dancer--but performs all these activities for enjoyment rather than as a prescription to stay fit. Toddy has a strong sense of family and continuity in her life although, at first glance and only looking at an event history, one might believe that her early years would have led to very different outcomes. Her parents and older sister and brother moved several times in a general eastward direction from the Midwest-- "following the [steel] mi 11s"--unti1 they settled on the East Coast where Toddy was born. She grew up around few relatives and no grandparents. Her parents were divorced from each other twice by the time she was twelve years old, at which time Toddy stayed with her mother on the East Coast and her siblings (who were out of school by then) stayed in the Midwest. Toddy tells of childhood memories when the family were still all together. Both parents were interested in politics, art, music, and nature. They were not rich so their family outings were almost always day trips to visit historical sites or museums and to attend 113 concerts. The parents seldom went out with friends in the evening without the children but when they did, children of all the couples were "pooled" at one home and taken care of by the eldest. Toddy's older sister was much sought after as the supreme teller of ghost stories on these occasions. There is a sense in her stories of communal concern that extends beyond the immediate family to the neighbors, townspeople, the nation, and (later) the world. There was always food-sharing with friends and neighbors in her childhood. Whoever had a good seafood catch shared it. When a garden produced an abundance, the surplus was shared. Later, when Toddy and her mother lived alone, they eked out what money Father was able to send with Toddy's earnings from working at her school cafeteria and donations of leftover food. -The butcher gave them meaty bones for the "dog" that both knew was imaginary. Toddy was always a fully-participating member of this team. She and Mother stayed in the big house and rented out two floors. Besides her cafeteria job, there was the work of upkeep on the house. Toddy says that her mother was an early proponent of good nutrition without excess which led to some innovative, low-budget 114 recipes. Mother later took a job as car salesperson-- very unusual for a woman at that time. It is easy to follow the behavioral effects of parental principles throughout Toddy's life. She remembers the many tales Father brought home from work of arbitrary dismissals of steelworkers because of illness or because the boss's nephew needed a job. There was no union at the East Coast mill. Later when Father moved back to the Midwest, he was instrumental in union demands for rule-based treatment of workers, in spite of the fact that it meant that he would lose his job (based on seniority). The principle's the thing. Toddy resigned (rather than claim disability) from her last job. She rejected a chance to "milk the system." Her purpose was only to protect the employer from the unpredictability of her health. Toddy considers herself lucky to have had a mother who enjoyed children while not considering them to be the centerpiece of the family. Their house was usually the center of homegrown entertainment and activities but stopped for afternoon naps and seven-thirty bedtimes. Those were times for adult pursuits such as reading or conversation. This is a thread through Toddy's philosophy for her own children's upbringing and for 115 their children's. Toddy laughs when she remembers disappointed neighbor children asking why Toddy's children had to nap while they had the "privilege" of staying up. She would say, "That's fine but mine do. But you come back after they're up." Reluctance to make judgments about other people's lives is a strongly-held value with Toddy. Perhaps because her own parents were divorced in a time when it was uncommon and disapproved, she casts no aspersions on others' decisions to part. She says that her parents did not "use us children as pawns" in their decision and she has followed that principle in dealings with others. When her own sister was divorced (apparently another "no-fault" parting), it was reasonable to have the two nieces come to live with Toddy and Marshall for a couple years for some family continuity. After high school graduation, Toddy had moved back to the Midwest and that is where she married and raised a daughter and son. The tragedy of her husband’s unexpected death left her a widow at forty-eight; she has not remarried. Marshall was very important to the whole family. Daughter Christy always said that she waited until she was thirty to get married because it took that long to find as good a man as her father. 116 Christy and son Doug consulted and cooperated on Christy's wedding, Doug's college education, and Toddy's eventual sale of the house. She has rented half of a double house for the past twelve years. Christy and Doug live in the same area with their families and there are regular get-togethers. There is a sense of easy interdependence without any notion of "ought" or duty. Wi11iam William was born on a midwestern farm eighty-one years ago. He was an only child in a Quaker family. His nuclear family moved several times and worked a sequence of farms as well as moving for a time into a closeby town but they were always near his paternal grandfather's farm. Grandfather had been an organizer of the first Quaker "Meeting" in the area and had grown up in a house that was a station on the Underground Rai1 road. William dresses well whether in a suit for going out or sweater and slacks for home. He has lost some stature through collapsed vertebrae over the past few years but compensates for a forward angling of his shoulders by tilting his head to make eye contact. The most notable first (and lasting) impression I have of 117 William is his measured, thoughtful manner. He gives every question thorough consideration and treatment. It is tempting to attribute his manner to a Quaker upbringing, his choice of medical specialty (pathology), or both, but it might as well be a temperamental predi1ection. William grew up near his paternal grandfather and at least one uncle--his grandfather's youngest son who remained on the farm. William's parents changed farms twice before moving into town for a few years to allow his father to work in a cabinet factory. When his father missed farming after a while, they moved back to a farm but William remained in town to finish high school. He was a junior at the time and stayed at the YMCA where he also worked. He tells me that this situation was uncommon but his parents thought that he could handle the responsibility and indeed he did. Thus prepared, he went on to undergraduate and medical degrees while always holding down at least one job. He earned a master's degree in bacteriology along the way as well rather than waste some idle time during internships. The family value manifested by this apparent work ethic is that time and talent are not to 118 be squandered. He does not seem to expect credit for performing to expectations. William's youth sounded so placid that I asked, "Did your parents have strong objections to anything you did?" He said, "Oh, yeah. At the time, it seemed as though they objected to almost everything." They objected to drinking alcohol and smoking. He was surprised when he asked parental permission to be taught to dance by some girl cousins. He says that his request "called for a family council" and he was given permission. It seems that on both sides of his extended family the rules were about the same--young people were held responsible for their decisions after they were given all the "facts" and parental advice. William and his wife tried to do the same with their two sons although the conditions of city living and a certain affluence made the situations noncomparable. He was recently gratified to have one son tell him that he was non-judgmental as a father. William says that his own father was a victim of: "That's not the way we do things." After Sarah and William's first son was born, Sarah did not work outside the home again except for a later career in politics. It seems that this couple did not 119 duplicate each others efforts. William was involved in practicing his specialty and managing its business aspects. For some of his sons' early years he had the business at home so that he could help raise them. William certainly has global humanitarian concerns but seems almost to have had Sarah ("the extrovert") represent him in public arenas to express those concerns. It was she who worked for civil rights in their mid-South city from her position in elective office. In addition to their separate interests, Sarah and William had a love of travel in common. They were enjoying his retirement greatly in spite of their combined health problems before she died two years before my interviews began. Her loss was devastating to him and he soon agreed to move to another state to be close to one son. He saw during Sarah's illness that both sons would have liked to have lived closer in order to be available quickly. William moved to Kerr Hall--a converted dormitory on the campus of a small college. Living at Kerr Hall is a unique situation of autonomy in a congregate setting. There are few social activities organized just for the hall residents but all the physical and cultural activities on the campus are 120 available to residents. Housekeeping, health care, transportation, shopping, and cooking are arranged independently (see Chapter V, Housing Choices and Choosing Housing). Ducky Ducky is sixty-nine years old and lives at "The Fields"--a county residence of the type that is neither a nursing home nor a home only for the aged. It is certainly home to people in reduced circumstances. Of those whose only income is Social Security (which includes Ducky), that income, less thirty dollars for personal spending, pays for room, board, and care. Ducky has lived here for two years and considers it a temporary placement "until I get on my feet." Ducky is barely five foot tall with a trim frame. She looks younger than her age, uses make-up sparingly, and is well-groomed. She manages to pick very nice items from donated clothing and alters them to fit when necessary. She sees herself as "self-made" in many ways. With only a ninth-grade education and a correspondence course to become a nurse aide, she has managed to work most of her adult life. I specify "adult life" because she was married at fourteen and 121 worked at home for a few years while her two children were young. At the time of her marriage, she and her husband lived with his parents on a farm. Ducky learned housekeeping skills, farming, and animal husbandry from her mother-in-law (a grudging teacher). As the sixth of seven children in her childhood home, she remembers learning little and having no responsibilities to the family--just looking out for herself. Two brothers were "mildly retarded" and several members of each of the generations she knows about have been alcoholics. There were hardships at home and Ducky was sent to live with an aunt and uncle for a few summers--a solution that she found more distasteful than being in the disruptive home. There are hints of abuse. Although Ducky still lives in the same area where she was born and although she grew up amid three generations of extended family, she can only point to one person (a brother) for whom she had any attachment. This holds true to the present when she and her sisters "don't get along." She believes that the only real closeness in her life has been with her two children but there are indications that her son and daughter may not share her appraisal of "closeness." 122 She and her first husband were divorced when the children were grown. This husband later suicided. Ducky's second marriage (and later dissolution of marriage) was to a man whom she supported through the years they were together. She has formed several friendships with men at the county residence, hoping that one will eventuate in her being able to leave and set up housekeeping again with a man. "I just like to have someone to have a conversation with and go out to eat and go shopping." Ducky has always had enough in the way of immediate problems to hold her attention and use her problem solving skills. She has little information and no discernable interest in the larger world. Her daughter repeated Ducky's "mistakes"--leaving high school to enter an unhappy marriage. Her son has broken away by getting a college education and lives in a western state where he seems to be financially successful. He is married but Ducky says that there will be no children: "He has seen enough of the trouble that his sister has with kids; that cured him." One of Ducky's granddaughters was recently murdered by her husband in a lurid, much-publicized case. Ducky was hospitalized at 123 the time and overheard a criticism of herself for "not crying enough." Dinah Dinah experienced very different results from a disruptive childhood. At seventy-nine years of age she is still quite tall, strong, and forceful. It is not difficult to picture her teaching second grade as she did for nearly thirty years. Everything about her appearance is sensible--from a controlled hairdo to walking shoes. In contrast to her childhood, everything is planned and orderly. Dinah remembers very little detail of the early years. Her nuclear family lived on a small farm near a large steelmaking city while each set of grandparents and many aunts and uncles lived near the same city but in other directions. Whether due to inadequate public transportation or a disinclination on the part of the adults to visit, Dinah did not see much of her relatives during those years. At two and a half Dinah was between an older sister and younger brother when her mother self-aborted a fourth, unwanted pregnancy. She died of blood poisoning. A newlywed aunt and uncle came to stay 124 (reluctantly) for a year and moved on. The paternal grandmother commuted for a while to help with the children but her husband found that inconvenient. A long line of housekeepers came and went--some staying less than a week. Dinah thinks that they were put off by the primitive living conditions. There was no indoor plumbing or central heat; the walk to the pump was several hundred feet. At last a housekeeper arrived who was willing to stay. She married Father when Dinah was about twelve. Dinah welcomed her eagerly as "Mother" while her brother and sister were more reserved. Mother brought with her a son from an earlier marriage who was about Dinah's age. Dinah always assumed that he would marry her. He showed no interest along those lines and gradually Dinah came to deny any wish to marry. "All they [boys] want to do is roll around with a girl anyway." Dinah was still living at home when, a few months after her stepmother's death, her father killed himself with his gun. It was Dinah's twenty-eighth birthday and she was teaching school when the principal brought her the news. One uncle always blamed her: "You knew he was depressed and had a gun in the house." Her step-brother 125 was sleeping in the house when it happened but no blame fell on him. Dinah's older sister Maude was much favored by Father, according to Dinah. Dinah had wanted to become a missionary but that idea was squelched by Father. Both daughters were sent out of state to a church- sponsored college to become teachers. Each was supposed to take the two-year normal school certification but against orders, Maude signed up for the four-year course which caused considerable financial hardship for the family "but she got away with it." Then Maude "had to get married" and did not put her education to use for some years--just another example of Dinah's failure to win Father's approval for her obedience. Dinah only completed a baccalaureate years later when her school system required it of their teachers. A few years after she retired from teaching, Dinah moved to the area where Maude lived. By now Maude was a widow with children, grandchildren, and great grandchildren. Dinah lives in the independent section of a church-affiliated retirement faci1ity--Emmaus Community--about twenty miles from her sister. Maude is not in good health. Dinah feels that Maude has betrayed an unspoken agreement to see more of Dinah who (from her 126 point of view) was coerced to move under false pretenses. Dinah performs small services for residents of her retirement community in what appears to be a perfunctory, mechanical fashion more than out of any sense of personal concern let alone any larger humanitarian consideration. She expresses very little interest in national or world events unless they can be interpreted to have personal impact on her life. Doris Doris looks younger than her seventy-three years, a studied effect gotten through hair color, make-up, and clothes in part. Her blonde, ivory, and pale blue color scheme is continued into the formal French interior furnishings of her condominium apartment. She is one of the three informants who was born and has always lived in the area of her birth but she has lived in forty different accommodations during that time. Doris loves to buy, sell, refurbish, supervise building, and speculate in real estate. It is not only her hobby but has reputedly been financially rewarding. She claims to have made her last move when she supervised the building of her apartment in a four-unit 127 condominium--one of forty-eight (subdivision called Stagecoach Run) in a suburb of the large city where she has always lived. She says that it is the last move because "my friends are getting tired of helping me move." In the next breath she speculates on what she will do if she becomes disabled and needs nursing care since Stagecoach Run is not a retirement community and has no health care component--she will move within the complex to a two-story unit. She will hire a live-in caregiver who will have a small apartment on the second f1oor. Doris has no close living relatives. She has a few close friends and a larger circle of acquaintances and associates from the various clubs and organizations of which she is a member. Besides turning a profit in her moves, she has small paying positions as secretary or treasurer for some of these organizations. She has also been a piano entertainer in various clubs and dining rooms in the area for almost thirty years since she gave up "regular work" to manage her own varied careers. Doris seems to enjoy the risks involved in her lifestyle. The self-identity she projects is one of entrepreneur--independent woman. Although she had two brief marriages, they were mentioned almost as 128 afterthought or footnote to her career personae. Her waking and sleep cycle ("just like my father's") seems to her to have ordained piano entertaining as her career. She is up most of the night, having her third meal of the day after midnight. She sleeps from five or six in the morning until noon. Doris's nuclear family was cut off geographically (and apparently affectively) from the extended family bilaterally. Doris remembers very little contact with grandparents or other relatives with the exception of some visits to an uncle in Atlanta during her teen years. Doris was the middle child of three and the only girl. Both brothers died in middle age. The younger brother was mildly retarded and became Doris's responsibility after the deaths of her older brother, Grant, and both parents. Grant ("Mother's favorite") died tragically in his thirties. Casting about for someone to blame for something, Mother could not forgive Doris for failing to call her to the hospital in the night before he died. Doris was at his bedside but his parents had gone home for some sleep. This was another example put forward by Doris to support her belief that she could never win her mother's approval no matter how hard she tried. 129 After Doris had graduated from high school , her family moved into the city so Doris could attend business college--a more practical alternative to her first choice of a liberal arts education which the family could not afford. She was employed after six months at school and held a series of traditional secretarial jobs until her risk-incurring venture into the entertainment business. She has taken little interest in social issues beyond her purview. Gertrude Gertrude at eighty looks closer to sixty-five. She has a spare build and is not tall but very agile. There is no evidence in her walk or movements of the arthritis that causes some pain. She has always worked hard both in employment and at home with little expectation that that situation would (or should) change now. She was the third child of the eleven born to her parents but the first to survive infancy. The first three were born in the (then) Austro-Hungarian Empire before the parents emigrated with the infant Gertrude to the United States. They settled in a small city in the Midwest where there was a sizable enclave of Eastern 130 European immigrants. Gertrude has always lived in the same city. In fact, she again lives in the house that her father bought seventy years ago. At that time, the house had enough acreage to supplement Father's wages with produce and meat. The house is in some ways symbolic of this family's successes and troubles. Over the years the property grew to the proportions of a "compound" as the original house gained accretions. One son married and had a small house next door. Another small addition was then literally grafted to the first. Two larger houses were added to the property. After Gertrude and a brother were each divorced, they and their combined children and occasionally another cousin lived in the original house. Gertrude remembers hard feelings among her siblings with alliances forming, dissolving, and re-forming in different configurations. All the turmoil seemed to revolve around Mother and her perceived differential and preferential treatment of the children. One thing is clear: Gertrude was nobody's favorite. She was never able to please Mother. The hurt feelings extended to Mother's death and (one might say) beyond, from Gertrude's point of view. 131 Gertrude also remembers working hard as a child but having fun in the larger group of family, friends, and the church. She finished her schooling with the ninth grade when it became too difficult to find transportation into town to the high school from their home on the rural outskirts of town. She had a series of household service jobs, restaurant and catering jobs, and was in service to a wealthy family for some years-- traveling with them in their private jet to their second home in Florida. She was home for some years when her two sons and one daughter were growing up. Most of her full-time work occurred after her divorce and the children were still surrounded by grandparents and other relatives in the "compound." The inter and intragenerational strife that started with Gertrude's and her parents' generations continued to the next generation. Gertrude's greatest regret is the lack of rapprochement between her and her daughter. Gertrude feels a "coolness." We are not told whether they are able to talk directly about their differences or if they can only indirectly show their displeasure. Gertrude speaks of omissions of expected familiarities. They 132 communicate in an idiom that remains obscure to this observer. Gertrude continues to keep a spotless house, cook, do needlework, garden, and take care of two dogs. A son has moved back home after a divorce. It appears that he does much of the heavy work around the house and grounds while Gertrude frets about what he should be doing. There is an element of regret in her dialogue that revolves around the things that she is no longer able to do herself although it taxes me to find any diminution in her activities. Her son takes the criticism in stride. No one mentions that Gertrude's failure to be competent in her mother's opinion is now being repeated with Gertrude's children. Gertrude expresses little interest in the affairs of the world or nation other than to deplore "the messes." She makes acute observations about human nature within the scope of her experience. A case in point is taking note that the wealthy family she served had as great a list of problems as her own and money had not solved them. 133 Lyon Lyon is a seventy-seven year old man with some chronic health problems but they are not immediately evident. He is of average height and build and dressed casually for our meetings. He and his wife have sailed for years and he has also bowled for as long but has given up golf in recent years. His wife, Darlene, attends an adult day care program all day every week day. One must say that Lyon's chief activity at this point in his life is caring for Darlene and it looks like an all-consuming job. He shops, cooks, cleans, and does the laundry while she is at day care. He also regularly monitors his investments and handles all the finances. His "break" comes in his regular bowling league. If this all sounds unrewarding that notion is not gotten from listening to him talk. He seems stimulated by the challenges in dealing with her illness (Alzheimer's disease). He views his role as that of entrepreneur who must allow her to do all that she can safely do while keeping abreast of the changes in her condition over time. Lyon's experience of competence and satisfaction in caregiving echos Motenko's findings with six men in similar circumstances (Motenko 1988). 134 Viewed against the background of his childhood experience, it is fairly easy to see the continuity in terms of competence and enjoyment in problem-solving. When Lyon and his twin brother were nine and the younger brother three, their father died. Mother had not worked since she married but was pressed by financial considerations to find work immediately. Through some connections she found a position as kitchen manager at a very large orphanage some sixty miles from home. She took the boys and moved there where she was promised separate housing for her family but it never materialized. The youngest shared a room off the kitchen with her but the twins were placed in a boys dormitory. Mother became impatient with the housing situation and, after a year, she moved back home and brought the younger son. She was to return for the twins in a few weeks (Lyon is not sure why the delay but perhaps school was not dismissed yet). In the meantime, Lyon became ill and was hospitalized. Mother returned and took him out of the hospital and brought the twins home. Lyon had diphtheria. The boys essentially became household managers while Mother worked and especially a couple years later 135 when Mother had a "nervous collapse" and was in bed for three months. She may have had a gastric ulcer because the boys gave her cream to drink every hour or so. One memorable occasion was when the boys made Thanksgiving dinner by themselves. Another for Lyon was when he drove his mother home from the hospital when he was twelve years old. One gets the picture of numerous extended family members within a several mile radius of this nuclear family--helpful but not intrusive. There was a family norm of independence until help was requested--then it would be forthcoming. Lyon's paucity of information about family names and even numbers of aunts and uncles does not appear to be any sort of animosity toward relatives but rather a neutral unconcern with those details. Lyon related with awe a story of a family with whom he and Darlene shared many boating summers on Lake Erie: "They are so close." Boating and all its related activities such as, buying, painting, outfitting, living on, sailing, selling, was this couple's passion for over thirty years. They still have a scaled-down model that is safe for Darlene but the upkeep is mostly delegated--another 136 example of Lyon's unobtrusive management of Darlene's illness and a need to track her environmental needs. Lyon is proud of his abilities in the work, financial, and home worlds. He is proud of their son's achievements as an editor in New England. He likes to keep up with world news especially as it confirms his predictions (mostly gloomy) but does not express much social or humanitarian concern. He is content to maintain the home they have owned for thirty-five years for Darlene and for himself. Nancy At eighty-six, Nancy is my oldest informant. She is large-boned but spare. She is fairly agile and only complains about "tired feet" after long days out on social excursions from her retirement village. Nancy complains about very little in general. She has some memory loss for which she apologizes to others ("I can look it up if you want") but forgives herself. She finds herself in the Midwest for the first time at the behest of two daughters who wanted her closer to them although she was enjoying life in Santa Fe very much. Her philosophy seems to be that things will take care of themselves if you let your children make the decisions. 137 Nancy is the most traveled of my informants. She was born in Scotland, the first of six children. Father came ahead by two years to the United States to work the steel mills. The family followed when Nancy was seven. She has lived in Pittsburgh, New York, and Santa Fe. She has traveled four continents. Through some combination of wide exposure to the world and native predisposition, Nancy has a broad social and ecological awareness and concern. She points out examples of what resource conservation measures would be helpful without taking a blaming posture toward others who do not follow them. She recalls war efforts such as "victory gardens," donating land to the church for a senior citizens center, her third husband's donation of some of his musical compositions, and volunteering at hospitals and nursing homes. There is a strong element in her character of an abhorrence of wasted resources whether or not she is paying for them, "I pee twice before I flush." Nancy was in a three-year nursing program when her mother became ill with cancer. She stayed home to care for mother until her death and then she completed her education. She worked at nursing over the years 138 (interrupted by marriage and three children) and later sold real estate. After she was widowed the first time, Nancy married a man with triplets and another child. The triplets and two of Nancy's children were teen-agers at the same time. She laughs about those "adventures." After she was widowed for the second time, she married again and that marriage brought one adult child. In all, Nancy has eight children. She does not distinguish between "biological children" and step-chi1dren nor, apparently, do they. When she moved to this city several months ago it was into American Village--a member of a national chain of retirement homes. This particular village does not have a nursing home component but one is planned for the future. After our series of interviews was completed and I made a follow-up visit, I found that Nancy had broken a hip, been hospitalized for its repair, and been several weeks recuperating in a nursing home--all arranged by the daughter who lives in this city. Nancy was back at American Village in a different apartment for "assisted living." The change did not seem to bother her at all. 139 Francesca Francesca is seventy-six and also looks younger than her age in spite of the fact that it has only been a few weeks since she had a major surgery when we begin the interviews. She is short, of average build, and dresses nicely. One notices immediately how vigilant she is: attending to what the neighbors are doing and looking for clues in the newspaper that will indicate what tragedies are occurring in others' lives. She alternates between unctuous concern and glee in reporting tragedies. Francesca believes that she has had more than her share of tragedies in her own life. Both parents came to the United States from Yugoslavia when they were in their teens. They barely met before they married. Some aunts and uncles arrived around the same time and formed an extended family made up of competitive, mean-spirited kinfolk, by Francesca's characterization. Francesca, her two sisters, and their parents spent most of their years together in a city sixty miles from their original home but Francesca moved back when she was seventeen-- after high school graduation. Her childhood memories are singularly unpleasant. She was the middle child of the three girls and 140 "nobody's favorite." Sometimes she thought the oldest was favored by both parents and at other times it was the youngest but it was never Francesca. Mother started her in school at the age of four against the teacher's advice; Francesca kept falling asleep in class. This was the same teacher who hit her hand with a ruler to discourage left-handedness. Francesca says that she understands now that her mother sent her to school so that Mother could get the endless work done at their home/public bar. She did not then or later have time to teach the daughters how to do chores such as ironing because "she said we were too stupid to learn." Their home also provided room and board and the family confined themselves to only a few rooms. The girls slept lightly at night in case Father would be drunk and beat Mother that they might get up and try to protect her. Disasters followed into adult life. Although Francesca claims that her own marriage was good, both sisters had tragic endings. One was abused by her husband and died in her thirties of pneumonia. The other was murdered by her second husband. Francesca's father died unloved: "It was so sad to hear that death 141 rattle. He never had a life. He just didn't know how to be a father." Francesca and her husband Neal always worked while trying also to improve their housing situation, including a stint on a farm and their last place together at the time of his death--a mobile home. She worked as a practical nurse prepared on the job and "grandfathered in." Their only child, Brett, "never wanted for anything and we did everything with him and went to watch all his activities." He had almost finished his undergraduate degree when his father died suddenly. Francesca cannot bring herself to blame Brett for her feeling of being unappreciated and snubbed--it is all the fault of Brett's wife. They only live fifteen miles away "but you don't dare drop in; you have to make an appointment." Francesca lives in government-subsidized apartment housing (Gerhart Road Apartments). When it was built about twenty-five years ago, it was only for elders. The builder-landlord is now allowed to rent to younger people--a source of real concern to Francesca because she fears that some of the single mothers have male callers who may deal in drugs. The rent ceiling that may be charged is one-third of adjusted income from all 142 sources which, I think in Francesca's case, is Social Security. Francesca shows little interest in world affairs beyond judging other cultures by TV evangelist moral precepts. Besides watching several TV talk shows, she has a close friend who phones every evening and they talk for at least an hour. This seems to be her chief (perhaps only) comfort. TABLE 5 DEMOGRAPHIC CHARACTERISTICS Geographic Mobility of: Ever Ever G'parents Has Been Sole Ever Car Current Ever Name &/or Parents Informants Children * Employed Support Married Driver Driver Homeowner Fem (77) yes yes yes yes yes yes yes no yes Toddy (69) yes yes no yes yes yes yes yes yes William (81) yes yes yes yes yes yes yes yes yes Ducky (69) yes no yes yes yes yes yes no yes Dinah (79) yes yes N/A yes yes ■ no yes yes no Doris (73) yes no N/A yes yes yes yes yes yes Gertrude (80) : yes yes yes yes ■ yes : y>es no N/A yes Lyon (77) no no yes yes yes yes yes yes yes CO Nancy yes yes yes yes ■; yes ; yes yes no yes Francesca (76) yes yes no yes yes yes yes yes yes Source: 1994 fieldwork Legend: Number in parentheses after name indicates informant’s age at start of interviews. ’ At least one child has moved away. 144 CHAPTER IV NOTES: 1. This statement requires clarification on two counts. First, "close to home" has two interpretations. When it means that informants' child(ren) stayed in the area where they grew up, Toddy's, Ducky's, Gertrude's, and Francesca's fall into this category. (It may be significant that they all live in or near Manchester). When "close" means close to the informant's present home which may have involved an informant's move, then seven of the eight informants with children fall into the category (Lyon is the only exception). William and Nancy moved to be close to a child. Doris and Dinah have no children but Dinah moved to be closer to a sister. Second, where there is more than one child, one may be close and another at some distance. Fern has one of ea^h; Ducky has one of each; William has one of each; Nancy lives close to one and at varying distances from seven. Francesca's only child, Toddy's two, and Gertrude's three all live close. Lyon only has one and he is at a distance. CHAPTER V HOUSING CHOICES AND CHOOSING HOUSING Historical Factors The idea that housing for elders is an issue is a fairly recent phenomenon. It seems to go along with the notion of retirement--another recent phenomenon. The picture a hundred or more years ago in the United States was quite different. Although then--as now--the preferred living arrangement was separate housing for the nuclear family, a nuclear family might include fourteen children born over a twenty year or more period. The youngest might not yet be independent nor some of the older unmarrieds left home yet by the time their parents died. Nuclear family housing resembled sequential family occupancy. Most of American life was rural life then. The economic unit of production was a group of people (usually family) sufficient in number to work a farm (Blau 1973). Some Americans were mobile then as now but even migration patterns typically involved family members. A familiar migratory pattern has a "leapfrog" 145 146 appearance, that is some members of successive generations moved (usually westward) from the original eastern colonies to the next rank of states or territories and so forth. Whether elders were among the migrants or stayed at home there was no notion of retirement except for health or disability reasons. Elders stayed in place with the younger generation doing most of the farm work or moved in with children. In either case, men continued to do what they had always done but with reduced output. Women continued doing household chores. To the extent that the younger generation were doing the same work and living in the same area, the advice and expertise of the elders was useful. Medical science was at the stage of dealing with acute conditions, such as communicable diseases, accidents, difficult births. Safe surgical procedures developed only slowly and many died before surgery could be performed and many following surgery. Preventive medicine, health promotion, and managing chronic illnesses were things of the future. When necessary, elders received personal care, such as bathing and nursing care, such as administering medicine doses and applying compresses, by female family members. Cure was 147 often not possible but palliation was and it was carried out in a commonsensical fashion. The health care/housing connection for elders had not been made and neither had been "medicalized" yet (Tilson and Fahey 1990). All that has changed now. Separate housing for the nuclear family is still a strongly-held value but it too has taken on a new sequential quality with retirees sometimes changing both locale and housing type more than once after retirement as conditions change. An increasing majority of homeowners living alone are women as the ratio of women to men over age sixty-five has continued to grow since 1930 when there were 102 men to 100 women in that age group (Streib 1982). A majority of women of employment age are employed outside the home (Treas 1982) leaving care for elders to combinations of informal services (still the most common), such as those provided by kin, friends, and neighbors, and the paid services of the formal system, such as home health nurses and aides. Tilson and Fahey (1990) report figures taken from the 1982 Long-Term-Care Survey prepared by the Bureau of the Census that showed 74 percent of those receiving home care received it from the informal network, 21 percent had a mix of formal and 148 informal, and only 5 percent received services entirely from the formal network. In addition to friends and family, informal exchanges and support services may be set up among neighbors, making it possible for all to remain in the neighborhood longer (Sykes 1990). Housing accommodations have taken on additional meanings including economic investment (based on actuarial tables), the site of health care, and social base of operations. Considerations in Housing Arrangements Now In recent times housing arrangements and retirement from work have become less an automatic situation and more a matter of choice, albeit choice with restrictions. A composite list of some of the considerations brought to bear in the choice are finances, safety, maintenance of physical plant and grounds, transportation, social activities, proximity of kin, health (including functional capacity at present and projected for the future), dependents (spouse, mentally-incapacitated adult children), locale (familiar neighborhood and services), and continuity in church membership. Many issues are cross-cutting. Safety can mean getting on and off a bus (transportation) without 149 falling (health) and a neighborhood that is safe from muggers (locale). Moving away from long-held church membership can seriously limit the support network provided by church members in terms of health, social, and transportation services. The primary limiting factors in choice of housing arrangements--either in moving or staying put--are finances and health. There may be an attraction to living in a retirement community in Palm Beach but an inability to pay for it. An elder with limiting health conditions may have a strong desire to stay on in the two-story home but not be able functionally to do so. For some fortunate elders, choices are made from among several appealing options. For the less fortunate, the "choice" may be by default to the affordable only or the choice may be made for them by relatives or a court- appointed guardian. I suspect that Maslow's hierarchy comes to bear at some point in housing choices: basic biological needs must be met before "higher" needs, such as social or self-actualizing needs can be addressed (Maslow 1970). Although, one sees examples of elders willing to make what most of us would view as serious compromises with basic needs in order to stay in familiar surroundings 150 with even one preferred social contact. As indicated in her story, Ducky left such a situation only at the strong urgings of her daughter. Various initiatives have been taken in the past fifty years in the United States to offer combinations of housing needs and/or amenities for the older age segment of the population (Morris, Gutkin, and Ruchlin 1990; Streib 1990). Early examples were housing developments (often in the South) that offered street maintenance and some shared "community" space for activities planned by ad hoc groups. A post office, beauty shop, and a few stores gave the illusion of a village. Jerry Jacobs in Fun City (Jacobs 1974) describes a later, more ambitious project that involved the development of a city for middle-class elders-- looking very much like an affluent suburb anywhere except for the age-segregation. They had a nursing home for those who were no longer "independent" and an early example of "garden apartments"--apartments on one floor with internal hallways and dining room service. Thus began the multiple naming of housing types, included services, and euphemisms that make up today's elder housing scene, such as "congregate housing." Congregate housing has meant at one extreme, multi-unit 151 apartment buildings with individual kitchens and bathrooms and no on-site prepared meals to a meal program, a health monitoring program, and personal care services, at the other extreme. The current situation is one in which at least one meal per day is prepared, security is provided, and some other services, such as housekeeping are available (Streib 1990). The addition of personal services for the basic ADLs^ (summarized as bathing, toileting, and dressing) is covered by the rubric of "residential care" (Newcomer and Grant 1990). I will impose a four cell grid over this profusion of housing choices: Open Market--Unsorted by Age, Open Market--Sorted by Age, Packaged Services--Independently- Chosen, and Packaged Services--Default. This is admittedly an arbitrary categorization and does not permit of much overlap but imposes some order on a confusing field of study. Open Market--Unsorted by Age In this category are the elders who choose the housing they can afford after considering and ranking the features that are important to them, such as proximity to kin, familiar neighborhood, transportation, and so forth. Often it is a matter of staying put and 152 adjusting to changes in the neighborhood, relatives who move away, and negotiating for home maintenance and repair. People in this option seem to redefine their situation as needed and sort priorities anew as compromises become necessary (Marris 1991). Among my informants, Toddy, Doris, Lyon, and Gertrude are in this category. Toddy rents half a double house where she moved twelve years ago. She left an owned two-story home that was "too big and too expensive to keep up." She located the rental through friends and solicited opinions about its features from her two children. She has only changed neighborhoods (to a safer one) in the move--f riends, church, kin network are all intact. She has a spare bedroom for her brother to use for a couple summer months when he comes from Florida to visit. Doris recently purchased a condominium apartment in a new development--Stagecoach Run--an example of "naturally occurring retirement communities (NORCs)". These communities come about in two ways (Sykes 1990). Some occur when a large proportion of couples or widowed elders remain in the homes that they have occupied for a long time. In the second case, new developments are built to include many of the features that are preferred 153 by elders, such as one-floor plans, 1 ow-maintenance exteriors, and built-in safety features. While there are no age restrictions on who may buy these (usually) attached units, those who are near retirement age find them particularly appealing and plan to "age in place" there. Stagecoach Run opened with forty-eight units in twelve 4-unit buildings. Another forty-eight units will be constructed next. This development has a swimming pool and "community building" for the use of owners. Owners pay a monthly fee for maintenance on individual and community property. The only community activities are those planned by the owners themselves and the promotional activities given by the contracting company when the units are first being offered for sale. Buying, selling, and moving hold no terror for Doris--she has done so "about forty times." In fact, she considers herself a housing entrepreneur and uses this side line as a source of income. She paid about $90,000 for her two-bedroom unit with a double garage. She sold her former condominium for about $15,000 more than that. Lyon and Darlene have lived in the same house since 1957. It was built around 1930 and is situated on the 154 edge of the "best" old established neighborhood in Manchester. It is a two-story brick house and, at this point, neither of them has difficulty with the stairs but if it should develop, they can convert the formal dining room into a bedroom. They have never considered selling the house and moving out of state or even to a different house in the same town. At one time before the development of Darlene's Alzheimer's, they had thought of having a boat large enough to live on in Florida or at Lake Erie and spend part of the year doing that--the rest of the year in their permanent home. That plan is now superseded by a more modest one. They have a smaller boat on Lake Erie and make shorter trips that Darlene can safely accomplish. Gertrude lives in the house that her father bought and moved the family into in 1921.2 it is still a rural area just outside Manchester in the only direction that has remained rural. The property was originally measured in acres but Father sold off some for an orchard. Over the years three other houses and a swimming pool were added to the property giving it the appearance of a "compound" as some of Gertrude's siblings married and lived nearby. 155 The house itself has been enlarged and improved over the years. Gertrude does not face directly the possibility that she might have to confine herself to one floor at some time in the future. She has had an episode of "rheumatism" when she had to sit on each step in turn to come downstairs. She has no handrail and does not intend to put one in. She laments all the things that she can no longer do but it is an assertion without substance as far as a visitor can see--the house is spotless. The AARP telephone survey of 1992^ found that eighty percent of persons over sixty years of age own their homes and of those, two-thirds own mortgage-free (AARP 1992). Lyon and Gertrude own their homes without mortgage. I am not aware of Doris's situation in this regard. Open Market--Sorted by Age Several kinds of housing are available only to restricted populations, such as the elderly, handicapped, mentally retarded, veterans, or members of certain religious groups. We are interested in that which is sorted by age but freely chosen. Where there is a minimum age requirement for residence and 156 government funding for construction, there is usually a rent subsidy involved. This is true in Francesca's case at Gerhart Road Apartments. Francesca moved into her apartment eighteen years ago. It is one of about thirty similar apartments on a two-story plan without elevators. In fact, the wooden stairs to the second story (where Francesca lives) are exterior stairs. The private owner who constructed the apartments twenty-five years ago did so with Housing and Urban Development (HUD) monies. His contractual responsibilities were to guarantee renting only to those elders who were certified to him and to provide maintenance and upkeep of grounds. A metropolitan housing authority negotiated the rent with the owner and acted as certifier and annual recertifier of residents' eligibility by income to remain in the apartments. Residents are assessed rent equal to thirty percent of their adjusted income. They do not pay for water or trash removal . One apartment unit has been set aside as a "community room" which can be scheduled by residents to be used for their own purposes, such as parties. It is also outfitted with coin-operated laundry equipment. Activities among resident/neighbors are no more likely to occur than in 157 any neighborhood and appear to be nonexistent at Gerhart Road Apartments. Francesca came here after several moves. When her husband died, she had unpaid debts and was unable to retain their mobile home. One of her moves was into an apartment building owned by her then employer and probably involved a rent adjustment. The Gerhart Road apartment owner has now fulfilled his contractual liability for the number of years he was required to rent only to elderly. He may now accept all ages sent by the metropolitan housing office. Francesca finds this very disturbing as she fears violence associated with young, single mothers and their male friends. Francesca has other housing options but none which satisfies all her needs, such as affordability, locale, and safety. She feels isolated from any kin-based support. Although her only child--a son--lives a mere fifteen miles away, she is essentially estranged from him and his family. She blames this state of affairs on his having been "turned against me by that woman [his wife]." She has two friends: one is a niece who lives some distance away and another is a female friend with whom she shares a telephone conversation every night. 158 Neither of them is in a position to offer any material support. If Francesca were to pay full price for her apartment, it would cost her $248.00 per month. As it is, she pays 30 percent of her adjusted income. Income adjustment allows an annual $400.00 deduction to the elderly, about $200.00 deduction for Medicare contributions, and another deduction for her electricity. She cannot duplicate that price (to say nothing of the relative security of her present locale) even in the few remaining SRO (single room occupancy) units in Manchester or the lower-priced apartments in town.^ Her apartment building is in a nice residential neighborhood on the edge of Manchester but her worry is about the changed criteria for admission to this apartment complex. Packaged Services--Independent 1v-Chosen This category comprises a great profusion of housing types and creative labeling. What differentiates this category from the first two is the method for procuring services. Toddy, Doris, Gertrude, Lyon, and Francesca can locate (probably in the Yellow Pages) all the services that are available to the 159 residents of retirement villages and they can purchase the ones they want individually. In doing so, they face the inherent risks of dealing with many (often unknown) repairmen and service agencies. The advantage seen by residents of retirement villages is that the hiring and certifying of such services is handled by the village management and paid for in the base monthly fee or by surcharge. In the early days of retirement communities, occupants owned their units and paid membership fees for community upkeep, use of swimming pool and golf course. In other words, a homeowner's relationship to his housing development's owner or manager was no different than that of a homeowner in a similar development not age-segregated. There might be a nursing home in the community (e.g., at Fun. City) but it would be a private business on a par with the grocery store or beauty shop. Retirement communities were planned for the "active older citizen" and little thought seems to have been given to what would happen as people aged and became vulnerable through failing health of one or both of the retired couple. The great majority of occupants were couples and, in fact, when one became incapacitated or 160 died (usually the male), the widow often sold and moved closer to grown children (Jacobs 1974). The idea of including covered nursing home care in a package with retirement housing led to the development of continuous care retirement communities (CCRCs). The earliest ones were church-sponsored or otherwise non profit and offered lifetime care. Occupants who were widowed or otherwise alone made up the majority of those buying into this arrangement. I say "buying into" because the entrance fee was not a purchase. In addition to an entrance fee was the monthly fee. This arrangement appealed to those who could afford it (about one percent of elders live in CCRCs) because it included guaranteed long term care in the community's nursing home. In fact, the guarantees stood up even if the occupant could no longer pay the monthly fee (Sherwood, Ruchlin, and Sherwood 1990). There was still a gap to be filled between independent living and nursing home care--arguably where most patients were when first entering a nursing home twenty or thirty years ago. Many did not require nursing care; they needed some assistance with personal care, transportation to the doctor, cooking, and cleaning, remembering to take their medicine--al1 161 functions once performed by a combination of family and friends. In much of western Europe and in Canada, this level of assistance in home or residential setting is still labeled "social" rather than "medical" or "nursing" care (Doty 1990). The stage was set for "assisted living" under all its various names. Some demonstration projects added a few services--notably a cooked noon meal--to elder housing originally construed for the "active older citizen" who had now developed some needs for assistance. Some new retirement housing incorporated features and services that would allow "aging in place," at least for a longer time period. They would include a kitchen and communal dining space and, often, office space for intermittent physican or nurse visits, and office and housing for a resident manager (Lanspery 1992; Tilson and Fahey 1990). The latest phase in this progression toward a continuum of service is the incorporation of "assisted living" between independent living and nursing home in the CCRCs. CCRCs are a growth industry in the private sector (for profit). The trend is away from including life time care in the entrance fee and toward including long term care insurance costs in the monthly fee. In 162 this way the owners are able to purchase insurance from a commercial company and enlarge the risk pool. Another new wrinkle is the CCRC without an entrance fee in which the monthly rent is greater but which satisfies the resident who does not want to make a commitment of perhaps his or her life savings on an entrance fee. Increasingly, CCRCs are offering both payment options (Sherwood, Ruchlin, and Sherwood 1990; Tell and Cohen 1990). Fern and Dinah live in CCRCs with all levels of services. Fern has been at Salisbury Downs for two years. She greatly regretted having to leave her combination home and art gallery but, once decided, she wanted to make it her final move. She evaluated several CCRCs in the capital city before settling on Salisbury Downs which was the second most expensive that she visi ted. The attributes of Salisbury Downs that Fern found most appealing were its location close to the "downtown action" and a university, the high rise apartment building with swimming pool on top, the affinity she expected toward the other residents in educational and cultural terms, and the availability of nursing home care closeby but not too closeby as to constitute a 163 constant reminder. The assisted living and nursing home components of this CCRC are in another high rise next door. Fern fits the profile of elders who want to live alone but not be. alone (AARP 1992). Once the affordability factor is established for these people, the sociality factor moves up among priorities. Dinah moved to Emmaus Community four years ago. She moved from another state to be close to her sister but the capital city was not entirely unfamiliar to her; she had attended college there many years earlier. Once the decision to relocate was made, she did not consider any CCRC other than Emmaus Community because it is affiliated with her main line church just as her college was. Church membership is one of Dinah's defining characteristics. When Dinah arrived at Emmaus it was to take a studio garden apartment in one of the the "independent neighborhoods." It seems that, as the residents and building aged together, there was an increasing need to reallocate space--nursing home beds and assisted living space were encroaching on the independent sections. Plans were drawn for Bloomfield, a four-story independent-living apartment building in a wooded area next to Emmaus--sti11 part of Emmaus but detached 164 somewhat. This segregation of less dependent from more dependent parallels Fern's situation at Salisbury Downs. Dinah was one of only four current Emmaus residents to elect to move to Bloomfield which costs more but offers greater independence. Most new Bloomfield residents (many of them couples) came from private homes or apartments in the community or elsewhere--presumably for some of the same reasons influencing Dinah, such as church affiliation , availability of health services if needed, and Bloomfield's appearance as a "normal" apartment building. Bloomfield and Salisbury Downs are similar in attributes. In each case there is security of all entrances, a lobby, elevators, and maintenance of building and grounds. What distinguishes them from ordinary apartment buildings is that there is a central kitchen and dining room where a noon meal is available. Housekeeping and transportation services are available. Group activities are available at the nearby assisted living housing. Nancy moved only recently from out of state to American Village in the capital city. It differs in two ways from Salisbury Downs and Bloomfield. There is no entrance fee and no long-term commitment; it is entirely 165 a matter of paying monthly rent under several plans (related to how many daily meals a resident wants and how many other services). There is currently no nursing home option although one is planned for the future. Apartments for independent living are entered from a communal hallway only or, in their garden apartments, one entrance each from the hallway and from outdoors. One section of the main building is reserved for assisted living. All apartments are on the ground floor. There is rather more participation in activities (trips, exercise group, current events discussions) by main building residents than by residents of the garden apartments, possibly because the latter are more often couples and have their own cars. Nancy can hardly be said to have "chosen" American Village; she let the decision up to the daughter who asked her to move to the capital city. Nancy declares herself quite pleased with the activities and seems to be involved in most of them "when I remember to go." She uses the van transportation for weekly scheduled trips to the grocery store and bank. She can no longer do many of the things that gave her pleasure over the years, such as volunteering but treats each life stage as satisfying in itself. 166 William’s living situation is difficult to categorize because it is unique--apparently in the country. An old dormitory on the campus of a small college has been converted to an apartment house--Kerr Hall. Strictly speaking there is no minimum age limit and there are a few residents under the age of sixty- five who are staying close to older relatives or anticipating their own need for retirement housing. In addition, the proprietors (it is college-owned) allow about twenty selected students to live in shared apartments as well in an experiment in intergenerational living. Many of the residents are retired faculty and staff from the college. There is a resident manager who handles any building or grounds problems but there is no Kerr Hall van or activities director. A residents' committee (including student representation) organizes pot luck suppers, recitals, and informal get-togethers. There is no main kitchen or diningroom but each of the four resident floors has a large living room-library combination that can seat a score of diners for catered affairs. Adult residents have access to all the college's athletic facilities, dining halls, cultural activites, and classes--everything but the dining halls, 167 free. Many residents have cars but some shop and eat out locally in this small college town without using their cars much. After his wife died, William looked at Kerr Hall when it was newly-renovated while on a visit to his son in the same town. He signed an intent to lease at the time and went home to settle his affairs. He likes the autonomy. He participates in some of the ad hoc social activities of the hall but does even more individual activities on his own. Like the other residents, he must find his own medical and health care on the open market of this town or the capital city--about twenty miles away. In addition to my informants' housing in this category, I have visited several others that illustrate some of the range of possibilities. Covenant Village is the most expensive CCRC that I visited in the capital city but there are several others in the same price range. Covenant Village is the one that Fern rejected on price and location. It is on the city bus lines and also provides van transportation but does not have the feel of being "in the heart of it all"--a feature that Fern values. 168 Covenant Village strives against size odds (over 400 apartments) to provide a sense of community. It was (and is) the culmination of the efforts of one church rather than one member of a national denomination, to be a self-contained community yet part of the city. Much of the volunteering is done by church members. Its large nursing home includes one of the few special care units for Alzheimer's patients in the city. Such units are designed to make it possible for patients to wander without coming to harm (the "least restrictive environment" called for in the law in most states). Other CCRCs in the capital city are in the same price range. The distinguishing features that appeal to some prospective residents involve locale in the suburbs, church affiliation, and upper social class clientele implied in the advertisements. The final inclusion in this category (Packaged Services--Independently Chosen) is Autumn Leaves. Autumn Leaves is a group home^ in Manchester. It is privately-owned and in a converted family home. There is a staff member present at all times but the person does not live in. Staff members cook, clean, do laundry, and assist residents in dressing or bathing as necessary. The home can accommodate seven or eight 169 residents. Several of the residents have kept ownership of their own homes but have come to Autumn Leaves as renters. They must look for other arrangements if they should develop a need for nursing care. Packaged Services--Default In this category I have included residential arrangements that provide services but in which the resident has not chosen to live or in which the services are not preferred ones. These facilities are available to be chosen by the public in general but, in fact, are most often default "choices." County homes, "special needs" group homes, old soldiers and sailors homes, and some "board and care" homes fall into this category. States, counties, and municipalities differ widely both in the naming of such facilities and in the requirements for regulation, as well as the responsible regulating bodies (Newcomer and Grant 1990). Ducky has been at The Fields (a county home) for two and a half years. It is not a nursing home and the law does not require nurses on staff although The Fields does have nurses to monitor residents' medications and general health. It has no age restriction for admission although slightly more than half are elderly. It was 170 originally meant to house the destitute of all ages from one county--referred to in early documents as "the poor house." Room, board, laundry, activities, and transportation are provided. Residents pay as much of the (approximately) $700.00 monthly fee that they can and the remainder comes from county monies. Many residents' sole source of income is Social Security in amounts far short of the monthly rent. In those cases, they still receive $30.00 per month for personal use before the rest goes for rent. Ducky (or any resident) is free to check out at any time and seek other accommodations. The problem is that Ducky has exhausted most, if not all, of her other options. Her most recent housing before coming to The Fields had been an inexpensive motel room without cooking facilities. Her financial situation made it difficult for her to find a physician for health maintenance and she took care of acute health problems by presenting herself at hospital emergency rooms. Her daughter had grown weary and frustrated from being called to emergency rooms to come get Mother--her condition did not warrant admission to the hospital. 171 The Fields seemed to be the ideal solution to the "problems" of housing, nutrition, and health maintenance. She has become more resigned to her situation since she arrived and said that she was "not like those people [mildly mentally retarded]." She has made do with a few alliances with residents and staff and by taking advantage of the activities that take her away from the facility but she remains dissatisfied in the face of so few options. Residential homes, both licensed and unlicensed, are at the center of a controversy now over the issue of licensure and control (Hawes 1994). On the one hand is the concern that "nursing care" is being delivered in unlicensed residential homes, making them substitute for nursing homes while escaping regulation of standards. However, the services provided (except medication administration) are often non-nursing assistance with ADLs. On the other side of the controversy is the regret expressed by some if the many small (one to ten beds) homes are lost through being regulated out of existence (Eckert, Namazi, and Kahana 1987; Newcomer and Grant 1990). Those close to the financial break-even point would be unable to make the questionable structural changes called for by some oversight bodies. 172 Welcome Home is a "board and care" or "adult foster home" (depending on changing licensure categories) that I visited during data gathering on housing types. Like Autumn Leaves, it is an enlarged and converted private home. Unlike Autumn Leaves, the resident family constitute the staff. Pull charges for room, board, and family activities (e.g., trips to the state fair, the zoo, or picnics) are $800.00 per month. For elders accepted from the state mental health department or human services department, the owners must agree to payment of only $500.00 per month. The first four residents came when a rural county home closed. Four others make up the rather stable group at Welcome Home. The owner, her husband, and a married daughter who -lives nearby, make up the "staff." The resident ladies (mean age of eighty) help set the table for family meals and help with the dishes. State rules proscribe the use of residents for "work" which causes the owners at least one difficulty. One elderly man insists on working in the garden; he was a farmer all his life. The owners make sure he has a large-brim hat against sun stroke and hope that there is no surprise state inspection during gardening season. 173 We have not discussed some other housing options, such as homesharing and "granny flats." Homesharing is an arrangement wherein an elder provides housing for another person (usually in the same age category) in return for rent, shared expenses, or services (Danigelis and Fengler 1990). Sometimes the renter is much younger--a college student who trades considerable service for a reduced rent. The notion of "granny flats" started in Australia (Lazarowich 1990). They are portable, detached housing units placed on the property of (usually) a family member for the duration of need (Sykes 1990),enabling the family to provide utilities and care as needed to the elder. Table 6, p.175 shows the informants' housing among examples of other housing options in rank order of cost. Several caveats are in order for interpreting this information. The costs involved are based on informants' volunteered information, brochures and price lists provided by administrators or government offices (metropolitan, county, and state). All figures are based on the time at informant interview and on the type of accommodation (e.g., studio, one-bedroom apartment) and on the included or selected services applicable to the individual . In several ways the data are non comparable but fit fairly well in rank ordering. The greatest difficulty comes in ranking home ownerships. While Lyon and Gertrude own their homes free of mortgage, I have still ranked their costs (e.g., taxes, food, and maintenance) ahead of Ducky's. TABLE 6 INFORMANTS IN A CONTINUUM OF HOUSING CHOICES Entry Monthly Monthly House Personal Housing Type Name 3urchase Fee Rent Fee Upkeep Security Meals Utilities keeping Laundry Care Covenant Village * 50-90,000 1,100 Incl. Ind. Incl. - i/d Ind. Avail. S. Serv. Salisbury Downs Fern 87,500 640 Incl. Incl. Some Avail. S. Serv. Emmaus Community Dinah 2,200 : 1.225 Incl. Incl. In d .-1 /d Ind. Ind. S Serv. American Village Nancy 1.100 Incl. Ind. Incl. - 1/d Incl. Incl. S. Serv. Stagecoach Run Doris j. 88,000 unknown Kerr Hall William 685 Incl. Ind. Some S. Serv. Autumn Leaves 1.950 Incl. Ind. All Ind. Ind. Ind. Ind. Assist Rental Toddy 375 Welcome Home 800/500 Incl. Ind. All Incl. Ind. Ind. Incl. Assist The Fields Ducky 700 Incl. Ind. All Incl Incl. Incl. Incl. Assist Own Home Lyon '• * Own Home Gertrude * Gerhart Rd. Apts. Francesca 2 4 8 “ Incl. ■ Elec. S. Serv. SROs 80-100 Incl. Incl. Source: 1994 fieldwork Legend: Figures based on Independent Garden Apt ’ Home owned mortgage-tree. Market price rent; subsidized to 30% adjusted income 176 CHAPTER V NOTES: 1. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are scales that are intended to assess an individual's capabilites for self- care (Lawton and Brody 1969). With minor variations, ADLs comprise bathing, dressing, grooming, feeding, toileting, and locomotion. IADLs are more complex behaviors: housekeeping, laundry, meal preparation, shopping, telephoning, taking medications appropriately, using transportation, and handling money. These are weighted scales in that the ability to live independently is compromised more rapidly by inabilities in the ADL range than by those in the IADL range. Amelioration of some deficits by the availability of supportive living environments (e.g., "handicapped housing") dilutes somewhat the predictive value of these scales. The HRCA (Hebrew Rehabilitation Center for Aged) Vulnerability Index adds a mentation functional dimension in an eleven-item scale that assesses elders' abilities to live alone with or without services (Morris, Sherwood, and Mor 1984). 2. Gertrude's ownership of this family home is not as straightforward as it might seem. The family dynamics that continue through at least three generations will be outlined in Chapter VI but briefly, the house changed hands within the family two or three times. When one of Gertrude's brothers died in an accident, her mother could no longer stand to live there. She and Gertrude's father built a new house next door. The original house was used by various family members and then rented to Gertrude. She and her widowed (by then) mother contested with each other over Gertrude's eventual purchase of the house with much hard feeling on both sides. 3. The American Association of Retired Persons (AARP) has commissioned telephone surveys of Americans 55 years or older in the years 1986, 1989, and 1992, to assess influential variables in housing choices. The telephone interviews averaged 22 minutes in length and the reported data are from 1,507 interviews. Two trends are noted here. One is that there is a steady increase in proportion of those who live alone and prefer to live alone (now 49 percent). Second, contrary to Disengagement Theory, it appears that this population does not want to be alone--just live alone. "The most 177 useful service cited by older Americans was companionship/home visitation. The most popular housing alternative was shared housing" (AARP 1992:3). 4. It is very difficult to pin down prices for the few remaining SROs and slum apartments in Manchester. They are not in the class of housing that is advertised or handled by a rental office. Hearsay has it that SROs and apartments both rent by the week for $20-$30. The YMCA rents rooms for $148 per month including laundry of sheets and towels. There are no YWCA rooms for women. 5. When I visited Autumn Leaves in 1991 there were three existing rooms--each able to house two residents-- and two single rooms being added on, creating a potential for eight residents. The current state rules and definitions called a home with six or fewer residents a "family home" (no regulations except local fire laws), between six and sixteen residents a "group home" (with regulations including a sprinkler system), and more than sixteen a "rest home" (different/stricter regulations). These definitions and regulations are by no means uniform across states or in the same state for very long. CHAPTER VI SCOREKEEPING Introduction The idea of scorekeeping developed out of observations of my informants for this study. During the eighteen months of taking life histories, a particular personality dimension possessed by a few informants began to emerge. They were the Scorekeepers and their behavior served to isolate them socially. I began to notice in sharp contrast the Non-Scorekeepers whose behavior operated as a social magnet. A review of other life histories and case studies gathered by me for various research papers revealed similar phenomena. Years of nursing practice and history taking contribute illustrative background material along the same lines. It seemed to me that the Scorekeeper's behavior had the paradoxical effect of isolating him or her when the intended outcome was social affiliation. In other words, dependency needs were being frustrated leading to greater dependency needs leading to more intense (but ineffective) efforts toward social affiliation or, in 178 179 some cases, withdrawal and depression.1 Sears (1982:410) remarks that, "...depression is unusually common when the 1ove-attachment-dependence system suffers interference". Dependency needs were not labeled as such by Scorekeepers; rather they became a need for "fair play" or "returned favors" for all that the Scorekeeper had done for others. Non-Scorekeepers dealt far more overtly with dependency needs. They named the people with whom they shared interdependent relationships and indicated that those relationships were mutually satisfying. When misunderstandings developed among friends or family, they were usually mended through forthright communication. My argument that scorekeeping is related to dependency and that management of dependency needs is ultimately related to early attachment patterns is traced in this chapter. Dependency If American elders were to be placed on a continuum based on a dependency dimension (with decreasing dependency from left to right), my informants as a group would fall to the right of center. This is true partly 180 because they were selected for the fact that they are living alone at present (if in congregate situations in some cases) which implies some level of independence. Having excluded nursing home residents from my sample presumably meant excluding the most dependent population of all. It should be an easy matter to measure dependency by some yardstick and indeed there are two--ADLs (Activities of Daily Living) and IADLs (Independent Activities of Daily Living). Ability to perform ADLs measures the most basic elements of personal care such as, bathing, toileting, eating, and walking about in the home. IADLs are more complex and include such skills as shopping, cooking, using the telephone, doing the laundry, and paying the bills (See Note 1, p.176). Assessing an individual's abilities to perform ADLs and IADLs and matching those skill levels with objective physical conditions, such as strokes, congestive heart failure, or arthritic conditions, should make accurate placement of people on the dependency continuum a simple project but it does not. (See Baltes and Werner-Wahl 1987 for treatment of the types of dependent behavior encouraged and discouraged by the behaviors of 181 caregivers in a nursing home). There are some surprises. Some people with severe physical limitations function nearly autonomously with some aids. One woman may call for a wheelchair van service, help herself from that conveyance to a golf cart type shopping cart, use her portable oxygen tank, and go grocery shopping. She reverses the process to go home and there she prepares dinner. The opposite situation is also seen. A woman is physically capable of carrying out all the functions on both ADL and IADL lists but is immobilized in her apartment by numerous dreads and fears that the casual observer cannot imagine. She is profoundly dependent. It would be tempting to view these two kinds of dependence as separable and definable--dependent for physical needs and dependent for emotional needs--but in fact, they are intertwined. Sears (1982) hypothesizes that in an expectancy model of adaptive aging, those who adapt best to unwanted physical changes do so through anticipatory rationalization and goal substitution. In various sectors of American culture each kind of dependence carries a different burden of shame but physical dependence is usually better accepted. I will 182 set aside physical dependence as straightforwardly e v i d e n t ^ and deal only with emotional dependence. Characteristics of Scorekeepers Perhaps because emotional dependence is less well tolerated among us, it wears many disguises. One disguise that I have found striking among some of my informants and in some clients of various nursing services over the years is the phenomenon that I will call Scorekeeping. Scorekeepers trade goods and services for emotional rewards. Scorekeepers "buy" affect or attention from others--not always positive but perhaps better than no attention at all. Such attention is usually not voluntarily forthcoming or is not sufficiently abundant to satisfy the Scorekeeper's need. The women (they have all been women among my ten informants) whom I call Scorekeepers (Dinah, Ducky, Gertrude, and Francesca) have all of the following characteristics. They are vigilant and controlling. They do not trust that people will deal fairly with them unless they monitor every exchange for advantages and disadvantages. They barter and exchange but seldom give outright without calling attention to the gift. In 183 other words, they collect witnesses to their "generosity." One informant gave household items to a niece who was not sufficiently, publicly grateful, so she asked for the items' return. Their focus or talking point is on material objects but their preferred coin of return exchange is expressive. This is never said directly (and perhaps is not consciously known) but is noted in the contrast drawn, for instance, by one informant when she tells about a special thank you phone call from one family bride and only formal acknowledgement from another. Their relations with "friends," family, caregivers, service workers, and people in general (especially if considered socially equal or inferior), are usually adversarial in nature while they can be quite obsequious to superiors such as physicians and clergy. They often point out contrasts between their own behavior and that of others. Dinah says of her sister: She got away with everything. I did the right thing [taking the shorter teacher-training college course] and she just did what she wanted to. I can tell you, it put my parents in a big financial bind at that time but my father didn't say anything. She [sister] is just plain selfish. It is perhaps not surprising that people do not prefer Scorekeepers' company. They appear to be visited by family as a joyless duty. The Scorekeeper sees no 184 connection between her own behavior and the way she is treated; it is incomprehensible--an unearned punishment imposed randomly from the outside. Expectancy may play a role in the sense that the Scorekeeper as a child did not have dependable succor from the primary caregiver (Sears 1982). Characteristics of Non-Scorekeepers Non-Scorekeepers are just the opposite on every characteristic. They are trusting. They have a general expectation that people are well-disposed toward them and, whether self-fulfilling prophecy or redefinition of reality, their expectation is usually supported in fact. Although they are generous in both material and expressive idioms, their primary focus is on the expressive. They treasure and repeat kind and funny things that were said to them and gave delight. Rather than collect witnesses to their generosity, they perform anonymously. I "caught" one Non-Scorekeeper (she forgot our appointment) reading one of the children's classics to a fellow resident in their retirement center. This was Nancy. She read a chapter or two a day to the woman who was nearly blind. 185 The Non-Scorekeeper lets her behavior speak for itself. She does not call one's attention to her own positively judged behavior versus someone else's negatively judged behavior. One Non-Scorekeeper (Toddy) for example, said, "Well, abortion wasn't for me but I wouldn't presume to tell someone else what's right for them. How can we possibly know what someone else's circumstances are?" The Non-Scorekeeper is cooperative rather than adversarial. This characteristic helps to account for this person's being sought after for company--not avoided or given the "duty call." This person is socially sensitive--empathic. She has a broader scope of interests in people (usually national or global) than the Scorekeeper does. Fern always remembered what pleasure she and her cousins got from sharing books in the extended family. When she found herself in the segregated South as a new bride, she took on the voluntary job of finding books to supply Black elementary schools. Contrasts Whereas the Scorekeeper says that there was a "favorite child" in her family and it was not she, the 186 Non-Scorekeeper does not report that there was such a preference in her family. The Non-Scorekeeper had at least one experience as a child or adolescent of being given responsibility, receiving parental support and encouragement, and feeling that she carried it out well. No Scorekeeper reported having had such an experience. In fact, they told stories of demoralizing attempts to help parents and being told how poor their efforts were. Francesca said that she and her sisters never learned how to cook or sew in spite of the fact that their mother was overwhelmed with work. "Mother said that we were too stupid to learn anyhow and just got in the way. " The Scorekeeper's insistence on arbitrary rules and her strict monitoring of the carriage (or miscarriage) of "justice" is particularly apparent in congregate living arrangements. It appears that the Scorekeeper is willing to accept even-handed dealings by administrators or paid caregivers as a substitute for positive attention freely given. However, equity is never achieved from her point of view. Her efforts to be treated kindly are directed toward "legislating" kindness rather than "earning" it. It is tragic in the sense that the Scorekeeper does not understand why it 187 never works and has no alternative strategy. I have witnessed several examples of this phenomenon in nursing homes, assisted living arrangements, and retirement villages where there is a governing administrative body to make and appeal decisions. One woman (not an informant) was given notice to find other living accommodations when, by this Scorekeeper's strict, punitive interpretation of the rules for others (for which she was a very vocal champion), she was no longer an appropriate resident in that facility. For two Non-Scorekeepers of my acquaintance (also not informants), the rules were considerably bent without their requesting it. One was no longer consistently able to walk to the dining room for meals--a defining requirement for her facility's eligibility. Trays were taken to her room on a "temporary basis." Another was experiencing some urinary incontinence in an assisted living facility in which housekeeping services, such as bed linen changing were offered weekly only. Housekeepers surreptitiously changed linens as often as necessary for "such a lovely lady." Scorekeepers are "stuck" at the level of dyadic exchange even when scores on many dyads must be 188 accounted for simultaneously. This is balanced reciprocity that equates social and material exchange and where there is an expectation of repayment without delay (Sahlins 1972). In "simpler societies," this form of exchange measures distance in kinship. Generalized reciprocity, on the other hand, emphasizes social over material exchange and generates a diffuse obligation for return without time limits (Sahlins 1972). Generalized reciprocity is characteristic of closeness of kinship-- expecially in the parent-child axis. The earliest attachment can be construed as the child's first experience of generalized reciprocity in the role of recipient. Failure to experience receiving may make it difficult or impossible later to perform in the complementary role of giver. If the presence of generalized reciprocity is often an indicator of kinship closeness, I am suggesting that Non-Scorekeepers confer some degree of kinship on enlarged groups of humans indicated by their concern for and involvement in humanitarian issues. Or, put another way, if we superimpose the three circles of the convoy model over kinship circles, Non-Scorekeepers would show large numbers of unnamed and unknown people in the third circle. 189 By contrast, Scorekeepers practice balanced reciprocity principles in all relationships regardless of kinship. They may trade in material objects while assigning them affective meaning indicative of the individual *s worth (especially in competition with siblings' worth)--giving new meaning to the concept of inheritance rules.3 Gertrude remains angry at her deceased mother for the personal slights implied (to Gertrude) by Mother's distribution of some items very small in monetary value. Francesca carries a bitterness for her father for selling three empty city lots along with his tavern/home--the lots were to have gone to each of the three daughters. Francesca was a teen-ager at the time. She conveys a sense of loss in her value rather than her lost value i,n the lot. I get a different sense of value from Non- Scorekeepers relative to the meaning of inherited material items regardless of monetary value. Fern prizes an old kitchen hutch, not because her possession of it reflects her personal worth but because it gives continuity to the lineage through an artifact. It is the only piece of furniture salvaged when fire destroyed the grandparents' farm house. 190 Nancy and her third husband donated his musical compositions and transcriptions to the church--foregoing her rights of financial gain from their publication. It seems to me that secure early attachment breeds the possibility of extending generalized reciprocity well beyond kinship boundaries while insecure early attachment leads to the withholding of same from even close kin in some instances. The final distinguishing characteristic between Scorekeepers and Non-Scorekeepers is self-defined loneliness. Scorekeepers can be lonely in crowds. This loneliness is always the fault of others who do not make overtures in their direction or, on the contrary, make efforts to exclude them. People who could be considered eligible to become friends are almost interchangeable. Non-Scorekeepers can be alone without being lonely but significant others are not interchangeable. Widowed Non-Scorekeepers continued enjoying friends but had an irreplaceable void left by the spouse's death--a spouse often characterized as "my best friend." Scorekeepers and Non-Scorekeepers are at extreme ends of a continuum. I have cited here archetypic, defining examples of each extreme. The majority of my 191 informants for this study and for other studies as well as my clients for nursing services would be placed in the middle of the continuum with a mixture of characteristics from both ends. Attachment and Scorekeeping We have said that human attachment is so important to the developing organism that it is, in some sense, overdetermined. While the mother-infant attachment pattern is prototypic of attachments to follow, some form of surrogate mothering is found to be an effective substitute in all cultures. The effects of insecure early attachments have been ameliorated by later "remedial" attachments in some cases. In fact, learning how to form attachments is one of the primary goals of treatment for troubled adolescents (Kernberg 1984). Being able to trust another person and finding that person trustworthy is the cornerstone of remedy. I am suggesting that Scorekeepers were not able (or did not have the opportunity) to develop trust in the first or subsequent attempts at attachment. Some of the conditions of early childhood that held promise (for me) as enhancers or deterrents in attachment formation are shown in Table 7, p.196 (an 192 expanded version of Table 2, p.77). The first three conditions (position in birth order, proximity to grandparents or to other extended family) do not appear to correspond to Scorekeeping--either positively or negatively. Detailed childhood memories of positive valence are present for every Non-Scorekeeper. Scorekeepers Ducky and Dinah do not have detailed memories of that time period but they have a general sense that it was "unhappy." Scorekeeper Gertrude recalls details but the valence is sharply drawn between positive for father and negative for mother. Francesca has detailed recall that is negative. Some of the caveats about memory in general and retrospective reconstruction of events were reviewed in Chapter II. Stern (1985) details the difficulties involved in reconstituting a "lived moment" only minutes after its occurence. Edelman (1989) insists that all memories occur only in the present--that they are not stored as a total package somewhere in the brain. Like a hologram, an element of memory calls up some element of accompanying affect. Both the elements and affect must surely be modified in some ways over the years. Fern talked about the smell and feel of freshly-ironed cotton evoking the image of her grandmother's apron, 193 sewing supplies in one of the pockets, "scraped" apples, and happy times spent with her. Francesca remembers the fear associated with her mother's treatment for colds: leaving Francesca alone with a blanket over her head and a bowl of boiling water as a steam treatment. Dinah was two and a half years old when her mother died of a self induced abortion but all that Dinah "remembers" is that her mother just did not come home (from the hospital) and that her father did not offer an explanation. Ducky's parents do not figure in her few, pleasant, spontaneous childhood memories. Yang and Rehm (1993) note that present mood-- depressed or nondepressed--casts a consonant valence on early memories such that the depressed elder now has more negative memories and the content elder now recalls more pleasant memories. At least two interpretations for this phenomenon can be put forth: present mood acts as a lens for viewing old memories in the same light or the present mood is a perduring personality feature since those early times--perhaps both. Separation from mother during early childhood is considered by many attachment theorists, such as Bowlby (1969, 1973, 1980) to be the primary contributor to faulty attachments. The four Scorekeepers in this study 194 had some form of separation loss of mother. Dinah's loss was by mother's death. Francesca was sent to school at the age of four because her mother "had so much work to do." Ducky and Gertrude both describe mothers who were psychologically unavailable to all the children or to them particularly. The notion of a "favorite child" in the family (or the absence of such a notion) correlates very well with both Scorekeepers and Non-Scorekeepers. All four Scorekeepers volunteered the information that there was one favorite child in the family or that each parent had a different one but in no case was it the informant. Doris ( a "Neutral"4) discovered in adulthood what she interprets as her mother's preference for a brother. No Non-Scorekeeper brought up the subject and when I did so seemed to explore it as a novel thought. After review, each one decided that they and their siblings were valued for different characteristics and were therefore noncomparable. The thought had never occurred to Lyon-- the older of twin boys with a younger third brother. Their mother was widowed and "we were all pretty busy." William was an only child. There is no satisfactory claim in the literature of having made a clear connection between inadequate early 195 attachments and adult adjustment pathology nor do I make such a claim. However, clear "cases" of both Scorekeepers and Non-Scorekeepers correspond to informants' memories of their quality of attachment to mother. TABLE 7 EARLY CHILDHOOD REVISITED Score Position Proximity Proximity Valence Separated keeper in Birth to Extended Detailed of from Mother? Favorite Name Status Order G'Parents Family Memories Memories What Age? Cnild? Fem N m yes yes yes pos. no X Toddy N 3/3 no yes yes pos. no X William ■ o ; 1/1 y*s yes yes pos. no N/A Ducky s 6/7 no yes no unclear no no Dinah s 2/3 no yes no neg. 2.5 yrs. no Doris o 3/3 no no no unclear no no Gertrude s 3/11 no yes yes unclear * no no Lyon o 1/3 yes yes yes unclear no X Nancy N 1/6 no no yes pos. no X Francesca S 2/3 no yes yes neg. 4yrs.~ no Source: 1994 fieldwork Legend: Scorekeeper Status: * Positive for Father, negative for Mother. S=Scorekeeper Early start in school. See Francesca's life history. N=Non-Scorekeeper x No notion of "favorite child" in the family. 0=Middie range on scorekeeping continuum 196 197 CHAPTER VI NOTES: 1. The term "depression" in this context carries the lay meaning of "blue" mood, poor appetite (or over eating), low energy level, tiredness and need for more sleep, and sad affect. 2. Conditions such as stroke, heart failure, degenerative arthritis, or progressive neurological conditions may not in themselves constitute physical dependence. Family members may or may not be direct caregivers in these situations if specialized services are not required. However, if a condition leads to the state of being bedfast or if the condition is accompanied by urinary or bowel incontinence, caregiving is often given over to "experts" as being beyond the capabilities of family to deliver. There appears to be less guilt associated with transfers of this type. 3. I am indebted to Professor Richard H. Moore for the insight into inheritance of both material and non material goods as expressions of value. 4. Four Scorekeepers and three Non-Scorekeepers are separated on a scorekeeping continuum by three Neutrals. Placement on the continuum is highly subjective and is a function of amassed characteristics that I have said constitute each archetype. Neutrals have mixed characteristics that do not trend strongly in either di recti on. CHAPTER VII CONCLUSIONS Review In considering the attachment factors in elders' choices of living arrangements, I have emphasized the influence of the earliest attachments on subsequent attachment patterns. Another emphasis has been on time and change, particularly the changes over time in one's convoy of consociates. Personnel move among the circles in the convoy model and (I suspect) the definition of adequacy changes--both in quantity and quality. Elders begin to make choices about preferred living arrangements for their old age long before they reach it but earlier choices are based on ambient conditions. A couple in their thirties may say one year on vacation, "This is ideal. We should retire to Florida. We,11 buy a building lot now so we'll be ready when the time comes." Long before the time comes, they have sold the lot because they cannot imagine being tied down to one spot. Still later they have decided that they will not want to leave "home" because that is where the 198 199 grandchildren are. Finally, a widowed spouse may feel more comfortable moving closer to a grown child who has removed at some distance. Not one of my ten informants is currently living as earlier predicted, planned, or hoped for. Decisions are based more on ambient conditions than wishful thinking as people age and living situations tend to be more sequential than permanent. Ambient conditions include affective relationships, especially with kin. Actual time spent with kin may be much less than with friends or acquaintances but proximity to kin seems to have a value all its own. Elders distribute their needs and practice reciprocity with kin and friends by some unique (to them) formula that may be difficult for the ethnographer to uncover except with extended observation under varying conditions. Housing itself is of only passing importance to people like Nancy but the other features of 1iving arrangements. such as proximity to family and opportunities to socialize are high priority. Housing in its own right appears to be very important to Doris. In my opinion, none of my informants lives in inadequate 200 housing although Ducky and Francesca fault theirs for deficiencies in one or more areas. It seems safe to suggest that, if given a choice, most people would opt for all three positive factors in living arrangements: affective and geographic closeness to family, affective and geographic closeness to friends and some sort of "community," and self-defined "nice" housing. When circumstances make it impossible to have all three, the ten informants have made their own compromises, substitutions, and redefinitions--no two alike. The Ten Informants--Reprise Were I to start these ten life histories again, I would ask the informants to place the important people to them in the three circles devised by Kahn and Antonucci (1980) to display attachment closeness. It would still be necessary to amplify their responses with other elements of the life history. For instance, there is the danger of having people say what should be true as prescribed by their culture. Dinah might place her sister in her inner circle as her only close relative or move her in and out of that circle based on her mood-- 201 not the definition of an attachment figure. In fact, Dinah may have no attachments. I take great liberty now in giving my impressions in summary form of ten lives relative to attachment histories and current status of close relationships, community (belonging to larger social groups involving reciprocity), and housing as part of living arrangements. Fern has a long history of secure attachments against a background of social consciousness. There is not the sense in her history of having to choose one focus to the exclusion of the other. Housing described in detail is remembered for the people and events inside the walls--not for the walls themselves. Her second husband died after only three years of marriage. Fern does not recall that they had discussed where they would reti re. Her 'last home before moving to Salisbury Downs was the combination home and gallery. One brother had the duty of telling her that she was going into debt there and would lose the stake for any such safe retirement housing as Salisbury Downs unless she made a move. She did so regretfully: "They [son and daughter] wouldn't let me ride back with them to get the last loads of my 202 things to bring here. [Laugh]. They were afraid I would plunk down there on the curb and want to stay. So I stayed here and started to put things away." She recovered her balance quickly. She knew personally a few people at Salisbury Downs and knew by reputation others living there. She was especially pleased with others' reputations for working in causes, such as the Gray Panthers, other political action groups, and services for elders--causes that she espoused. Pern takes pride in the accomplishments of her antecedents, her own generation, children, and grandchildren but she is hardly the grandmother who "lives for those visits." She has an enlarged space for affectionate relations and finds a great number of current events and issues worthy of her attention. Housing is only a place to hang your hat which (by the way) she could not locate on one of my visits because it was not in its accustomed pi ace--thrown in the "coat chair." Toddy had a similarly strong start on early attachments in spite of her parents' divorce. She and her husband have been able to reproduce that family configuration (without divorce) for their children. She 203 was widowed early before she and her husband had given any thought to how they would live after retirement but moving away from Manchester had not occurred to either. Toddy, her children and their spouses, and her grandchildren, have a very close relationship. Family functions both in family roles and in many social roles but Toddy also has time for friends. Housing now is viewed as functional but houses of memory are full of rich meaning: where Mother sat on the porch with lemonade and a book in the afternoon or where the piano that Father gave Mother--the piano that cost more than the house--sat in the front room; the house where Toddy's children were raised, told stories in the back yard, came home from successive schools with their friends. Leaving houses of memories can be traumatic but is said to be ameliorated by three factors: when the elder makes the decision, when there is enough time to get used to the idea of moving, and when it is not immediately coupled with some other crisis, such as being widowed (Sears 1981). Of course, "enough time" must be a subjective assessment but Fern, Toddy, and Nancy appear to have fit the criteria. 204 Nancy relates little detail about any of the places she has lived--they are only shadowy background for people. She can report conversations and sequences of events with humorous touches but housing appears to have been unimportant to remember. About her last house and (later apartment) with her third husband in Santa Fe: "Oh, just the usual--nothing out of the ordinary." But she regaled me with minutiae of his garden and how much enjoyment he got from it as well as their combined volunteer activities when they lived there. Nancy's present situation is similar to Fern's in that she seems pleased with all kin and friend attentions and activities that come to hand. She retains a broad interest (but is no longer active) in national and world affairs--less in political matters than humanitarian and ecological ones. William and Lyon share in common that both appear to have developed a strong sense of competence from early secure attachments. It is interesting that both extended their competence into caregiving for a wife. Motenko (1988) found similar patterns among six men giving or arranging and monitoring the care of their wives. The men seem to find satisfaction in being able to extend their "employment" into this new role. 205 Gutmann (1987) sees evidence of gender role exchanges between men and women as they age, such that women become more instrumental and men more expressive. But I suggest that Lyon and William represent a more expressive way of carrying out instrumental activities-- the love is implied in the competence. William's wife, Sarah, had a series of rare health problems. His concern for her was demonstrated on several occasions by clinical detachment--his area of competence. At one point Sarah's physicians had "given her up." She was on a respirator and not expected to live. William persisted with suggestions following research and phone calls to experts in Sarah's rare conditions until she recovered to go on living for several years. Sarah was always his best friend. He left housing, political action, and the cultivation of friendships for both of them up to her over the years. He fulfilled the role of father well if not demonstratively. He cherishes remarks from his sons now that indicate that he did a creditable job. His natural reserve makes it difficult to assess his current affective relations but it appears that his manner to sons and their wives and grandchildren is an extension of his parenting pattern. 206 His friends (more proper1y--acquaintances) are engaged over common interests and activities. Lyon still cares for Darlene. It almost seems that he cares for the Darlene of today because of the memory of the Darlene that was. Theirs is another case of best friends. Lowenthal and Haven (1968) found that men in all age groups named wives as their closest confidants while women were more likely to name children, siblings, and friends over husbands. Lyon does not mention individual friends of his--only friends who are mutual to Darlene and him. There is no sense of relative deprivation in his reporting that his only activity without Darlene is bowling in a league. Nor is there personal regret related to their altered retirement plans (given in Chapter IV)--only pride in being able to provide a modified plan for both of them. Although Dinah and Doris may be unlike in many attributes, they share a strong focus on housing for its own sake. Doris has friends/acquaintances with whom she does various activities and who individually overlap some of her interests. Houses of her past are not remembered for people and events within their walls but for the walls themselves and how she altered them. She recalls the alteration and decorating skills that she 207 has polished over the years and forty or so residences. There is also an element of status involved. She tells the story of her being welcome in the very elegant home of neighbors when she was about five. "They [parents] always told their daughter, 'Now watch Doris--she has the most polished manners we've ever seen.'" She recalls nothing about the friend--only the house. Doris denies having planned what her final housing arrangement would ,be and, in spite of the fact that her friends refuse to help her move again, she does not reject outright the possibility of relocating again. According to Kahana and Kahana (1983) there are those who change residence and/or location in order to reduce discomfort or incongruence (escape motivation) and there are those who seek to enrich their lives in opportunities to serve (future-oriented). The former are found to be more often disappointed in the results of moving than the latter. Both Doris and Dinah seem to fall into the former category. Doris calls to mind Sharon Kaufman's "Millie"--the subject of a case study (Kaufman 1981). Millie had three disappointing marriages, worked hard, provided care for others, and found herself in "a home" with infrequent visits from her children. But she had a 208 theme to her life that gave her def inition--she identified and admired successful people and tried to be in their company. Doris does the same and outfits a house worthy of entertaining them. Dinah and I once counted her apartment moves as thirteen. When she tried to combine social connections with housing arrangements, the results were disappointing. Dinah and another teacher, Ruth, shared a series of apartments over several years. The reason expressed by Dinah for this arrangement had nothing to do with a wish for companionship--it was only to save expenses and donate more to the church. Toward the end of their time together, Ruth was experiencing some emotional upheavals over illnesses and other problems in her family of origin. When a downstairs neighbor expressed concern over Ruth's crying at night and the shocking increase in number of empty wine bottles in their trash, Dinah, who had been dealing with the first problem by covering her head with a pillow to get to sleep, now asked Ruth to move--her problem had become visible to others. Dinah's move to be close to her sister has met with disappointment also. Like Doris, Dinah takes great pride in her housing. She has improved her financial and housing situation 209 over the years by dint of hard work and frugality. In fact, the details of that frugality are also a source of pride. Dinah's reciprocity with friends/acquaintances in her building takes the form of exchanging goods and services with little apparent affect or involvement. Although she believes that the reciprocity is unbalanced (and not in her favor), her conscience is declared clear and she continues "to do for others." Ducky and Francesca are both dissatisfied with some aspects of their living arrangements. The blame falls on the housing itself but one suspects that it may be displaced somewhat from the other two areas involved in our definition of living arrangements: relations with friends and family. Both women find deficiencies in their treatment, especially by children or the spouses of children. They seem not to have found the compensation in housing that Doris and Dinah have but Doris and Dinah have no children to disappoint them. Ducky remembers a couple past houses very fondly. One was pre-cut and mostly assembled by her and her first husband when the children were small. She remembers many details of that job and one of its greatest attributes was that it constituted an escape from the in-laws. Another house was hers alone after 210 she was divorced and the children were grown. She speaks nostalgically about that one as her planned retirement home but she sold it when the second husband came along. She now harbors the (probably unrealistic) plan of finding another man at the county home--one who will move out with her and start again. Her requirements for a relationship at this time are not more ambitious than that. Francesca's tales of houses in the past are gloomy. She recalls at least two moves to satisfy her husband's whims: once to a farm and once to their mobile home for which they had no furniture. She and her husband had not made plans for their old age. He died before retirement age but she says that the main reason they had not planned was that they "lived from hand to mouth." They did not take vacations and expected to work past retirement. Francesca is torn between pride about her grandchildren's accomplishments and finding fault with them. She once found a newspaper item about a traffic violation involving a grandson and tried to get her daughter-in-law to acknowledge it during a family dinner. 211 Much of Gertrude’s living arrangement situation involves the house she now lives in. It was her childhood home; the small house next door was hers for a while; she came back to the present house as a renter from her mother and later as owner. She is satisfied with her housing but not with family relations. No friend relations outside the extended family are discernible. Her troubles with her daughter have already been mentioned. Other family members fall short of her expectations or receive strong animosity (one sister). Further Research The process of carrying out this research as much as the findings suggest avenues for further research. I will cluster the suggestions under three headings: theoretical studies, methodological considerations, and some combinations of empirical research and practice. Theoretical studies. Several definitions of "cross-cultural" come to mind in studies of elders and their living arrangements--ranging from independent living in owned housing to the physically dependent in nursing homes. There is first, the comparison of similar arrangements among countries or other 212 geographic, political, or cultural divisions, which ultimately reflect the value that society places on its elders. Within the "same" culture area there are distinctions to be drawn along financial and other class lines. Finally, there are cultural differences at the individual level, such as those between service or care providers of every stripe and the consumers of the services. I have pointed out how care for elders is differently conceived in the United Kingdom and the United States. A social worker friend is matron of a 50-bed (soon to double in size) residential facilityl for elders in the industrialized north of England (personal communication from Lorna Carter). The home, like others of its type in England, Scotland, and Wales, is operated on a "social model" rather than the more familiar (to Americans) "medical model". No one would presume to regiment breakfast time. Residents get up when they like and some breakfast can be gotten until the noon meal. Staff members assist with personal care by individual preference rather than in "batches." When nursing services are needed, the district visiting nurse comes into the home the same as she would into the 213 resident's private home--a critical difference in boundary control terms. Kayser-Jones (1981) compared a nursing home in Scotland with one in California on the dimension of attitude of staff members toward the residents. She concluded that attitudes reflected the method of payment for care. In the United Kingdom, all members of society over the life span receive care paid out of taxes. The elderly are not conceived of as having preferential treatment. In the United States, independence in seeking and paying for health care has been the expectation. She found general resentment among typical staff members toward "Medicaid patients" that they were getting something for nothing. The possibility of being able to trade little gifts and favors t_o staff members for special kindnesses put the Scots patient on a social par with the staff--uni ike the American case. Booth and Phillips (1987) report on a large number of pilot studies and controls in group homes in northern England. The pilot studies tested the premise that creating smaller living pods (housing about eight people each) within group homes would encourage greater independence and satisfaction among the residents. The results were that deterioration was slowed but that 214 improvement in function was not significant. The "surprise result" was that residents were not more content--in fact, they were given to fault-finding. The investigators suggest that the smaller groups limited choices for social interaction. In the United States, Langer and Avorn (1985) argue for the efficacy of even perceived control on the part of nursing home residents for health outcomes. Care that is given in excess of what is needed is a cue to the resident that he is "helpless"--the basis of "learned helplessness." In a nursing home in "Amish Country" in Pennsylvania, many of the staff are Amish or Mennonite but (to my knowledge) none of the residents is (personal communication from Lois Leatherman). There is a strong belief among the Amish and Mennonite community in "taking care of your own" and a natural respect for elders that is not contingent on their behavior. What is subtly communicated to residents and their families? Several investigators have looked at attachments and roles under notions of change and continuity. Keith saw more continuity than change in the social structure set up by retired labor union members in a new retirement center in a suburb of Paris (Keith 1982 [1977]). Ducky and some others at The Fields maneuver 215 to form alliances with staff to be in the "gossip network" and thus create new roles for themselves. Jonas (1979) in research in two housing projects found continuity in role styles as people moved from the larger community into the projects such that those who sustained a large network of kin and friends before the move continued to make new friends. Those who were more reserved did not attempt to substitute large numbers of new friends to augment their smaller networks. Culture is accommodating. Just as the United States has adjusted to new concepts of "family," it is almost daily adjusting to new concepts of "community." At this stage there is a need for old-fashioned ethnography with possibilities for comparison--both narrowly and broadly--but without generalizations. One ethnographer spending a year in one group home, housing project, or nursing home would contribute a one-of-a- kind profile of variables leading to some level of consumer satisfaction. It is unlikely that size, organizational structure, or method of payment will account for all outcome differences. I would particularly like to see the attributes of staff factored into the equation. 216 In considering both continuity (perduring core personality) and change (accommodation to ambient conditions), it lately occurred to me to take a final look at informants' dependency p r o f i l e s . 2 I claimed in Chapter VI that my informants tended to be to the right of center (independent) on a continuum of dependency based on their combined physical and emotional dependence. But that placement is based on their current situations which owe much to their abilities to adjust with what physical and emotional supports are available to them. What of their "natural inclinations" toward being dependent or independent or the ability to operate in the interdependent range? I exercised great license in placing the ten informants on a dependency continuum based on my assessment of their "natural inclinations" or core dependency patterns (Table 8, p.222). Themes noted in the life histories contributed to placement decisions. For example, Ducky and Francesca both have stories that speak of attempts to be taken care of while finding themselves repeatedly in roles of support givers. Dinah and Doris, on the other hand, have avoided commitments to interdependence. I claim that Fern has a tendency toward independence but has willingly adopted an 217 interdependent role. William tends to the dependent side of interdependence. It appears that life events considerably alter core inclinations. As Erikson (1982) has pointed out, it is not as though the issues of any stage are permanently retired. His dialectic between Intimacy and Isolation (associated with Young Adulthood) recurs as an issue during subsequent stages as well as being the hallmark of young adulthood. Further study has the potential to illuminate other aspects of this relationship. For instance, is life satisfaction related to how consonant one's real dependency situation conforms to one's preferred arrangement? Does a secure early attachment enable the adult to form interdependent relationships? Methodological considerations. At some level we are all aware that the ethnographer is not "a fly on the wall" during the research process but that fact merits more attention. It may be especially true when long interviews or life histories are involved because a dyadic relationship is begun to be formed between interviewer and interviewee. This phenomenon was recently brought into my awareness in another connection in the role of psychiatric home health nurse. 218 I had been making weekly visits to an older woman in her home. The woman saw her psychiatrist at longer intervals. After the latest visit the psychiatrist said to me, "I thought you said that she was feeling more optimistic and getting involved more in activities." I said that I certainly had. He replied, "Well, she tells me that she doesn't feel better at all but she can't tell Mary because 'Mary would worry about me.'" Allowing for a certain amount of wishful thinking on her part to create new meaning for the relationship, we are still faced with the "ethnographer's" sense of transparency while she pursues her own goals. Joy Hendry (1992) discovered that a long friendship with a Japanese informant and assistant suffered misunderstanding when Hendry presumed that the friendship could be translated into other social settings without alterations in their two status posi tions. Jylha and Jokela (1990) report on two of the eleven country survey of factors contributing to a sense of loneliness among elders living alone. They focus on the northernmost study site in Finland and the southernmost in rural Greece. The findings are interesting in their own right but a factor involving the data gatherers' 219 possible influence on the findings was even more interesting. In Finland since the 1940s the interviews have always been carried out in a professional manner by graduating social science students. The interviewees would be unlikely to ever see them again. In the Greek situation, on the other hand, the interviewers were visiting nurses, living in the same community as the informants, well-known to them and engaged in a continuing relationship. It is suggested that higher reports of loneliness among the latter population may (in part) be due to discrete bids for sympathy. Without proposing how to make the ethnographer's part in the data exchange manifest, I am calling for more attention to it. Perhaps a starting point is the realization that it is_ an exchange and the local rules of reciprocity are in effect. It now occurs to me that I was bringing the outside world in to my patient mentioned above as my part of the tacit agreement. She was furnishing the evidence that my visits were effective for her part. I join Hartranft (1992) in discovering the transforming effects (to the ethnographer) of life history-taking. The ethnographer who completes this process is not the ethnographer who started it. The 220 life history itself is the product of a relationship that can most accurately be called a friendship--it is more than a casual acquaintance. Informants, in their willingness to become vulnerable through personal disclosure, have given much more in the exchange than has the ethnographer. It would bear studying what each believes he or she has gotten out of the experience. Some combinations of empirical research and practice. On the one hand we have scattered research about a multitude of aspects of elders' living arrangements from the practical financial considerations to the elements of isolation and loneliness. On the other hand we have policymakers in government and in private business (e.g., builders of CCRCs) who need the research information in a useful idiom. Social scientists in the gerontology field, especially anthropologists with a broad definition of cultural awareness that goes far beyond ethnic differences, are best prepared to get the two together. An anthropologist is needed at all stages of development of projects having to do with elders' living arrangements: needs assessment, design, evaluation, reporting to the paying body and to the research community. I suspect that it is not uncommon for useful 221 information, such as Fry's study of structural differences in two retirement communities (Fry 1979) to sit on a shelf while decisions/blunders continue being made in an information vacuum. TABLE 8 CORE DEPENDENCY PATTERNS Score keeper Name Status Dependent Interdependent Independent Fern N xxxxx XX Toddy N xxxxxxx William XX ' o xxxxx Ducky s xxxxxxx Dinah s xxxxxxx Doris o xxxxxxx Gertrude S ■ ; ■■ XX xxxxx Lyon o XXX xxxx Nancy N xxxxxxx Francesca s xxxxxxx Source: 1994 fieldwork Legend: Scorekeeper Status: S=Scorekeeper N=Non-Scorekeeper 0=Middle range or. scorekeeping continuum 222 223 CHAPTER VII NOTES: 1. No account is being taken here of the different terms used for various housing and service schemes in the United Kingdom as they differ from American terms. I have tried to continue using the terms used in Chapter V in a close approximation to the same entities. 2. I am grateful to Professor Dorothy Jackson for raising the question about the range in informants' dependencies and the relationship to core personality. APPENDIX FOCUSSED INTERVIEW OUTLINE 1. Worldview/life guides/locus of control--how informant conceives of influences or controls operating on human behavior. 2. Turning points/significant stages/rites of passage, including old age--in informant's own life or examples from his repertoire of others. 3. History of friendships--their importance and what purposes they serve. 4. History of family of origin--genealogical connections as well as anecdotes about relationships and their importance. 5. 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