Bioarchaeology and Social Theory

Series Editor Debra L. Martin Professor of Anthropology University of Nevada Las Vegas , USA

More information about this series at http://www.springer.com/series/11976

Lorna Tilley

Theory and Practice in the Bioarchaeology of Care Lorna Tilley Australian National University Canberra, Australia

Bioarchaeology and Social Theory ISBN 978-3-319-18859-1 ISBN 978-3-319-18860-7 (eBook) DOI 10.1007/978-3-319-18860-7

Library of Congress Control Number: 2015942688

Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www. springer.com) For Tony & Dedicated to the memories of my mother, Gwyneth Tilley, and my father, Derek Tilley.

Foreword

This volume kicks off a new book series, Bioarchaeology and Social Theory, in a grand and illustrative manner. The series highlights the application of social theo- ries in interpreting data derived from bioarchaeological research. Social theory bridges data with explanation and focuses on cultural processes such as power, ide- ology, symbols, meaning, social structures, agency and identity. The series pro- motes studies that link past understandings with present-day problem solving. These studies emphasise ethical and critical considerations of bioarchaeological research. Disease is a perennial topic of interest to a broad range of social and natural scientists and the public. Being able to systematically place disease within a broader framework to understand its impact on individuals, communities and societies can only be done utilising a framework that is integrative across environmental, biological and cultural domains. Traditionally, bioarchaeological approaches to disease have focused more on the pathology itself. From this, generalisations are made about the effects of disease or temporal/spatial changes in the disease. This volume provides a scientiﬁ cally based and theoretically enriched model for how to go from descrip- tions of disease to a discussion of possibilities for what that disease meant for caregiving and caretaking. This model stresses the need for careful and considered analysis of the disease process across life history. Differential diagnosis, medical and clinical understanding of the disease, and the complexities of the biocultural context within which the individual was living are utilised in a systematic and straightforward manner. This study covers a new area of research in which it becomes possible to discuss disease processes, disability and impairment with speciﬁ city and attention to the appropriate clinical and medical literature. Extending this baseline data into an interpretation of care and caregiving as well as the role of agency by the person with the health problem and by their kinfolk or extended family are all carefully considered. The author provides, at every step, the published criticisms of moving beyond the realm of the empirical data derived from the skeleton into more ideological and cultural behaviours involved in caregiving. Providing a point-by-point counter to the general criticism that caretaking can never be empirically proven for past

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peoples, a sound counter-argument is made for how to approach reconstructing caregiving and caretaking behaviour. Not only does this volume link social theory with bioarchaeology, but it provides a hands-on how-to manual for carrying this research into ever-expanding regions and time periods. This work can be used by anyone interested in palaeopathology and bioarchaeology to test drive the model to see if it improves upon older methodo- logical approaches to disease. This volume also speaks to the growing interest in scale, that is, in moving between individual, population and regional analyses. It addresses important health issues that have implications for enriching and expanding our understanding of human behaviour into new areas of study. An argument can be made that these kinds of carefully analysed case studies may be useful in con- temporary settings to explicate where resources or public policies might be better aimed to provide better care for people living in places where health care is less than optimal. The value of the case study approach while utilising a range of social theory about dimensions of human propensities and behaviours cannot be stressed enough. This work represents the wave of the future and the direction that bioarchaeological studies are beginning to take. This kind of integrative, contextualised and compre- hensive approach to the topic of disease and care is groundbreaking and it has potential to add new dimensions to bioarchaeological research in the future.

Debra L. Martin Acknowledgements

I think of this book as both an end and a beginning. An end, because it is the refi ned version of the Ph.D. thesis (submitted in 2013) in which I fi rst laid out the bioarchaeology of care approach I spent years of study developing—fi nally, here is my public exposition of theory and practice! A beginning, because I know that this new approach has the potential to go further than I have gone with it, and I can only hope that other bioarchaeologists will take what speaks to them about the theory and practice of the bioarchaeology of care as presented here—and make it their own. It is diffi cult to know where to start acknowledging the support I have received. But I will begin with a general expression of gratitude for the acceptance and gen- erosity of spirit in relation to my research that I have encountered both among prac- titioners of (bio)archaeology, palaeopathology and anthropology, and—which surprised me more—among members of the general public. I have received mes- sages expressing interest and encouragement from people from different walks of life and from all parts of the world, and their enthusiasm has kept me going even when frustration threatened to overwhelm endeavour. Some people have been invaluable in making my work possible, however. Firstly, I must thank Marc Oxenham (Australian National University), who was my Ph.D. supervisor and with whom I have co-authored a number of papers. As my supervisor, Marc gave me complete freedom to develop my own ideas and directions without attempting to impose limits, and as my colleague he has been unfailingly encouraging and fi ercely supportive of my research. Without Marc, I may never have undertaken the work that led to the realised bioarchaeology of care approach— and to this book. Next, I must thank Tony Cameron, on two counts. It is convention to thank one’s partner in the fi nal paragraphs of the “Acknowledgements,” and Tony certainly deserves my deep gratitude—and admiration—for putting up with me dur- ing my research for, and writing of, my thesis and this book; more than this, he has been loving, patient, understanding and supportive—and what more could one ask for? However, I must also formally acknowledge Tony’s role in producing the Index of Care, the online instrument supporting the bioarchaeology of care methodology. While I am solely responsible for the design and contents of the Index, and any criticism must fall on my shoulders, Tony, an information technology professional, must

ix x Acknowledgements take all credit for converting this design into a user-friendly application. And fi nally, my deepest gratitude goes to Jane Buikstra (Arizona State University) and Debra Martin (University of Nevada, Las Vegas), giants in the fi eld of bioarchaeology and indefatigable in furthering this most exciting of disciplines. Jane and Debra have mentored and motivated me with an entirely selfl ess grace and patience from the time that I fi rst went public with the bioarchaeology of care to this day, and without their continuing constructive, critical and very practical support and encouragement I am not sure how far this new approach would have gone. Development and testing of the bioarchaeology of care methodology (and subse- quently the Index of Care) relied on access to skeletal remains. Many institutions (and many curators) cooperated in this regard, and I am very grateful to the follow- ing for allowing me to work with their collections: Gail Boyle, Bristol City Museum and Art Gallery (UK); Alison Brookes, Corinium Museum (UK); Steve Burrow, National Museum Wales (UK); Ann-Rachael Harwood, Cheltenham Art Gallery and Museum (UK); David Rice, Gloucester City Museum and Art Gallery (UK); Jiří Svoboda, Paleolithic and Paleoethnology Research Centre, Dolní Věstonice (Czech Republic); Petr Veleminsky, Prague National Museum (Czech Republic) and Amélie Vialet, L’Institut de Paléontologie Humaine (France). In relation to Chap. 8 case study, I wish to thank the Institute of Archaeology, Hanoi, Vietnam, Hirofumi Matsumura of the Sapporo Medical School, Hokkaido, Japan, and Damien Huffer (then Australian National University) for their roles in the excavation of Man Bac Burial 9 (part of this research was funded under an Australian Research Council Discovery Grant). In relation to Chap. 9 case study, I wish to thank Philippe Mennecier and his team from Le Musée de l’Homme, Paris, France, for granting access to the very precious remains of the Neandertals La Ferrassie 1 and La Chapelle-aux-Saints 1; I also thank Jarvis Hayman (Australian National University) for his help in analysing the impacts of their pathologies. Finally, in relation to Chap. 10 case study, I wish to thank the Duckworth Laboratory, University of Cambridge, UK (and Mercedes Okumura in particular), for permitting access to the remains from the north-west chamber of the Lanhill Long Barrow, and Paul Robinson, Wiltshire Heritage Museum, Devizes, UK, for providing access to the remains from the south chamber of this long barrow. Martin Smith (Bournemouth University) directed me towards the Lanhill south chamber remains and joined me in examining the north-west chamber remains, and I am grateful for his company and his observations. There are many others I could name, had I the space. Among them, I wish to give special thanks to Charlotte Roberts, for her early and continuing interest in my research and for her hospitality; Peter Hiscock, for his encouragement in the early stages of research development; Ladislav Nejman, for facilitating my access to skeletal materials in the Czech Republic (the Dolní Vĕstonice remains were a highlight of my research); Virginia Esposito, for being a “study partner”-cum-sounding board in the Ph.D. and book writing processes; Robert Tilley (my brother), for his feedback on drafts of Chap. 4 and general faith in my topic; David Mennear, for his promotion of bioarchaeology of care research on his archaeology blog These Bones of Mine, his correspondence generally and his feedback on Chap. 2 in particular; Acknowledgements xi and Gary Campbell, who provided a stimulating and confi dence-boosting commentary on most of the draft chapters of this book. A very heartfelt “thank you” is due to my sister, Myfanwy Tilley, who read through all drafts of my thesis (often more than once) in the guise of “intelligent lay reader”; my thesis is the foundation of this book, and her comments—which were always relevant and very highly valued—inform the content of all chapters. Finally, I would like to thank Teresa Krauss and Hana Nagdimov, both members of the Springer editorial staff, for their good humour and their patience—indispensable qualities for dealing with authors.

Contents

1 Introducing the Bioarchaeology of Care ...... 1 Establishing Boundaries ...... 2 Deﬁ nitions, Qualiﬁ cations and Provisos ...... 3 Parameters of Research and Development ...... 4 The Narrative of Care … ...... 6 A Guide to Book Structure and Content ...... 6 Objective vs. Subjective: Some Preliminary Words on Challenges to a Bioarchaeology of Care ...... 8 References ...... 10 2 Setting the Scene for a Bioarchaeology of Care ...... 13 Health-Related Caregiving in the Archaeological Literature ...... 13 Failure to Infer Care Despite Evidence of Likely Disability...... 29 Treatments and Technologies ...... 31 Surgery ...... 32 Pharmacology ...... 34 Challenges to the Inference of Care ...... 36 Dangers of Overstating the Role of Care ...... 36 Non-human Primate Comparison: The Case Against Inference of Care ...... 39 Dettwyler, and the Impossibility of Identifying Care and Compassion in the Archaeological Record ...... 43 Health-Related Care in Archaeological Theory ...... 48 If Not an Archaeology of Care, then an Archaeology of Disability? ...... 50 The Current Status of ‘Care’ as a Subject for Archaeological Research ...... 52 References ...... 54

xiii xiv Contents

3 Context for a Bioarchaeology of Care ...... 65 Defi ning Health, Disease and Disability ...... 66 Health and Disease ...... 66 Disability ...... 69 The Limitations of Skeletal Analysis for Identifying Disability ...... 71 Constraints in Analysis ...... 72 Implications for Identifying Cases of Care in the Archaeological Record ...... 74 The Demand for Health-Related Care in Prehistory ...... 76 Identifying ‘Constants of Care’ ...... 79 Care as ‘Direct Support’ ...... 80 Care as ‘Accommodation’ ...... 84 Implications for a Bioarchaeology of Care ...... 85 References ...... 87 4 The Origins of Care ...... 95 Health-Related Care: The Product of Selection? ...... 96 Non-human Primates: Disputed Evidence for Health-Related Care Practice...... 96 A Biological Basis for Human Healthcare Behaviours? ...... 99 Altruism: Contested Identity, and Role in Relation to Care ...... 102 Altruism, Expectations of Reciprocity and Health-Related Care...... 104 Altruism, Social Learning (Altruism Is Its Own Reward?) and Health-Related Care ...... 105 Cooperation, Empathy and Care ...... 107 Emotion and the Origins of Care ...... 111 Defi ning Emotions and Exploring Their Origins ...... 111 Emotion, Empathy and Altruism: And Their Roles in Care ...... 112 Archaeology, and the Recovery of Emotions from the Past ...... 114 Implications for a Bioarchaeology of Care ...... 116 Emotions and the Bioarchaeology of Care: A Final Observation ...... 118 References ...... 119 5 Agency, Identity and the Bioarchaeology of Care ...... 127 Evidence for Care Seen as Evidence of Agency ...... 127 Defi ning Agency for a Bioarchaeology of Care ...... 129 Principles for Approaching Agency in Care Provision in the Past ...... 130 Deconstructing Caregiving Through the Lens of Agency ...... 131 A Matter of Choice: Tracing the ‘Decision Path’ in the Provision of Care ...... 133 Caregiving, Agency and Group Identity...... 136 Revealing the Person at the Heart of Care ...... 137 The Individual in Archaeology: Still Searching ...... 138 Seeking the Individual Through the Lens of Disability and the Lens of Care ...... 141 Reading Relationships Between Givers and Receivers of Care ...... 144 Contents xv

Summing Up: Interpreting the Giving and Receipt of Care in the Past ...... 146 References ...... 148 6 The Bioarchaeology of Care Methodology: Stages 1–3 ...... 153 Stage 1: Documenting the Individual, Their Pathology, and Their Lifeways Context ...... 157 Corresponding Index of Care Protocol: Step 1 ...... 159 Stage 2: Establishing the Case for Care ...... 160 Stage 2 (Part 1): The Clinical Implications of Pathology ...... 160 Corresponding Index of Care Protocol: Step 2 (Part 1) ...... 161 Stage 2 (Part 2): The Functional Implications of Pathology—Activity Limitations and Participation Restrictions ...... 164 Corresponding Index of Care Protocol: Step 2 (Part 2) ...... 165 Assessing the Probability of Health-Related Care Provision ...... 169 Stage 3: Developing a Model of Care ...... 169 Corresponding Index of Care Protocol: Step 3 ...... 171 Producing a ‘Model of Care’ ...... 173 References ...... 174 7 The Bioarchaeology of Care Methodology: Stage 4 ...... 177 Stage 4: Interpreting the Implications of Care ...... 178 Stage 4 (Part 1): Group Agency and Identity ...... 179 Corresponding Index of Care Protocol: Step 4 (Part 1) ...... 182 Stage 4 (Part 2): Individual Identity – The Subject as ‘Agent’ ...... 184 Corresponding Index of Care Protocol: Step 4 (Part 2) ...... 187 The Bioarchaeology of Care Methodology: Some Final Comments ...... 188 Reference...... 190 8 Survival with Severe Disability: A Case of Long-Term Care in Neolithic Vietnam (Case Study 1) ...... 191 Man Bac Burial 9: The Individual and His Context (Stage 1) ...... 192 M9: Description and Diagnosis ...... 192 The Context for Care ...... 196 The Clinical Implications and Functional Impacts of Pathology: Assessing Probability of Care Provision (Stage 2) ...... 199 M9 and His Experience of Disease: Clinical Impacts ...... 199 Determining the Need for Care: Functional Impacts ...... 200 Developing a Model of Care (Stage 3) ...... 204 Interpreting Care: Implications for Group and Individual Agency and Identity (Stage 4) ...... 210 Man Bac: Clues to Community Through the Analysis of Care ...... 210 M9: Seeking the Subject of Care ...... 213 A Final Word … ...... 214 References ...... 214 xvi Contents

9 Care Among the Neandertals: La Chapelle-aux- Saints 1 and La Ferrassie 1 (Case Study 2) ...... 219 Lifeways Context: La Chapelle-aux-Saints 1 and La Ferrassie 1 ...... 220 Neandertal Cognition and Behaviour: The Continuing Debate ...... 223 Neandertals and Health-Related Care Provision ...... 226 La Chapelle-aux-Saints 1 and the Case for Care ...... 227 Pathologies Experienced by La Chapelle-aux-Saints 1: Clinical and Functional Implications ...... 228 Modelling the Care Received by La Chapelle-aux-Saints 1 ...... 235 La Chapelle-aux-Saints 1 and His Community: Interpreting the Signiﬁ cance of Care ...... 236 La Ferrassie 1 and the Case for Care ...... 238 The Immediate Context ...... 239 Pathologies Experienced by La Ferrrassie 1: Clinical and Functional Implications ...... 241 Modelling the Care Received by La Ferrassie 1 ...... 246 LF1 and His Community: Interpreting the Signiﬁ cance of Care ...... 247 Care in the Upper Middle Palaeolithic: Some Wider Implications ...... 249 References ...... 251 10 Adjustment and Inclusion in the British Neolithic: Lanhill Burial 7 and His Community (Case Study 3) ...... 259 Lanhill Burial 7: His Context and His Pathology ...... 260 Context (i): Lanhill and the Cotswold-Severn Tradition ...... 261 Context (ii): LB1, LB2 and LB5—Health Challenges to Others in the Lanhill Community ...... 266 Lanhill Burial 7: Description and Diagnosis ...... 271 Lanhill Burial 7: The Long-Term Repercussions of Injury ...... 275 Lanhill Burial 7: The Options for Care ...... 277 Caregiving at Lanhill, and What It May Reveal ...... 278 LB7: The Individual ...... 281 Some Final Observations … ...... 282 References ...... 283 11 Where to from Here? Current Status and Future Directions for the Bioarchaeology of Care ...... 289 The Bioarchaeology of Care: A Work in Progress ...... 291 Caregiving in the Past: Claiming a Place in Modern Public Discourse ...... 294 Last Words ...... 298 References ...... 298

Appendix ...... 301

Index ...... 311 About the Author

Lorna Tilley, a latecomer to archaeology, graduated in 1981 with fi rst class honours in psychology from Flinders University, South Australia (awarded the University Medal), and has worked in areas of social justice, health practice, health status and health outcomes assessment, and health policy development. In 2013 she was awarded a PhD by the Australian National University (ANU) for her thesis, Towards a Bioarchaeology of Care: A contextualised approach for identifying and interpreting health-related care provision in prehistory, on which this book is based. Since 2011 she has been sole or primary author of articles, essays and national and international presentations introducing and applying the bioarchaeology of care approach and its dedicated online instrument, the Index of Care; her fi rst case study illustrat- ing application of bioarchaeology of care theory, co-authored with Marc Oxenham and titled ‘Survival against the odds: modeling the social implications of care provision to seriously disabled individuals’, was recently awarded Most Infl uential Paper (2011–2015) by the International Journal of Paleopathology. Lorna Tilley has taught at graduate and postgraduate levels at the ANU, and is currently a Visiting Fellow at the School of Archaeology and Anthropology, College of the Arts and Social Sciences, ANU.

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