Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 1-1-2016 Social Dimensions of Alzheimer’s Disease Among Caregivers in Oaxaca, Mexico Jonathan Yahalom Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Yahalom, J. (2016). Social Dimensions of Alzheimer’s Disease Among Caregivers in Oaxaca, Mexico (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/94 This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE AMONG CAREGIVERS IN OAXACA, MEXICO A Dissertation Submitted to the McAnulty Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Jonathan Yahalom May 2016 Copyright by Jonathan Yahalom 2015 SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE AMONG CAREGIVERS IN OAXACA, MEXICO By Jonathan Yahalom Approved November 13, 2015 ________________________________ ________________________________ Roger Brooke, Ph.D. Leswin Laubscher, Ph.D. Professor of Psychology Professor of Physical Therapy (Committee Chair) (Committee Member) ________________________________ ________________________________ Paola M. Sesia, Ph.D. Leswin Laubscher, Ph.D. Professor of Anthropology Chair, Psychology Centro de Investigaciones y Estudios Professor of Psychology Superiores en Antropología Social (CIESAS), Oaxaca, Mexico (Committee Member) ________________________________ James Swindal, Ph.D. Dean, McAnulty Graduate School of Liberal Arts Professor of Philosophy iii ABSTRACT SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE AMONG CAREGIVERS IN OAXACA, MEXICO By Jonathan Yahalom May 2016 Dissertation supervised by Roger Brooke Ph.D. This dissertation provides an analysis of the social construction of Alzheimer’s disease within Teotitlán del Valle, a rural Zapotec-speaking community in Oaxaca, Mexico. It explores how Alzheimer’s disease is locally understood, how this understanding reconfigures traditional meanings of old age, and how broader social issues are negotiated through this reconfiguration. Through 10 months of fieldwork this dissertation draws on ethnographic observations and interviews with 22 family caregivers across 9 households. This study is noteworthy for being the first known investigation in Teotitlán whose primary data was collected in the Zapotec language. Further, this dissertation integrates methods across psychology, gerontology, and anthropology, resulting in a unique interdisciplinary approach and a novel interview technique called “locally-focused interviewing.” iv Results are ethnographic in nature and provide insight onto local caregivers’ experience of attending to elders with Alzheimer’s disease and other dementias. Further, these results show how caregivers’ experience is situated within multiple local discourses – different medical systems, power structures, socioeconomic parameters, norms and traditions. In so doing, this dissertation advances a number of observations. First, this dissertation leverages anthropological insights about medical pluralism – the existence of multiple medical systems in a single location – and demonstrates how Alzheimer’s disease is socially constructed via medical theories and broader social dynamics. Second, this dissertation analyzes how caregivers make decisions on behalf of dependent elders, and how these decisions are made within a medically pluralistic landscape. Although medical decisions are based on concern for elders’ wellbeing, they also invoke dynamics between local traditions and contemporary changes. Third, this dissertation traces caregivers’ daily experience as an instance of what anthropologists refer to as social suffering by attending to caregivers’ challenges, strategies, and perceptions of elders. These features disclose how the caregiving relationship is situated within a tension between local values about aging and the reality of caregiving. Lastly, this dissertation explores how and why caregivers feel responsible to care for dependent elders, and illustrates the way that the broader community is involved in shaping caregivers’ daily experience. As a whole, this dissertation contributes to the fields of psychology and medical anthropology by highlighting the social dimensions of Alzheimer’s disease and how these dimensions shape the experience of providing care for dependent elders. v For Tommy Sage Hand (1985 – 2012) Because we don’t stop trying vi Acknowledgements/Agradecimientos Seven years ago, in Northern California and on the way to wine country with my mother and stepfather, I debated whether to pursue a career in psychology. I had the option to remain at my current job, yet something seemed amiss. As we made our way through the curves of the California countryside my parents did what I will always appreciate them for – they listened and told me that they’d support me on whatever path I would come to choose. And so, months later in San Francisco I announced to my father, Aba, at our favorite restaurant that I would be moving to Pittsburgh to study for my doctorate in psychology. Soon enough we were explaining the reason for our celebration to the restaurant owner and he responded by gifting us with double magnum bottle of wine – stipulating that we could only open it together, when I returned with a degree in my hands. This dissertation marks the final step towards fulfilling that promise, and the conclusion of the conversation I’d had with my other parents even earlier. I am beyond indebted to all my parents – my mom, Aba, Glen, Sylvia and Luisa – for their understanding, support, and love. May we keep having more wine to open and more occasions to celebrate – l’chaim! Working for my degree at Duquesne University has been a privilege. I would first like to thank Dr. Roger Brooke for having faith in my capacity to carry out this project, providing the encouragement to pursue it, and being the first person to call my attention to the importance of conducting a study on aging. Dr. Leswin Laubscher has led me by example in demonstrating what passionate scholarship looks like. I have been fortunate to call him a mentor, advocate, and friend – throughout my time in Pittsburgh and during vii research in Oaxaca. I am indebted to Dean Swindal for his generous moral and financial support for this project, which motivated me by having the honor to represent the University from abroad. This project was made possible through the McAnulty Dissertation Fellowship, the Dean’s Small Research Grant, and a grant from the McDowell Committee. Nearly every faculty member in the Department of Psychology has contributed in some way to this project, but I would specifically like to mention Drs. Russ Walsh, Elizabeth Fein, Jessie Goicoechea, and Melissa Kalarchian for their support during my research. Marilyn Henline and Linda “the Boss” Pasqualino have made daunting tasks more manageable and fun. The Gumberg Library staff has also been helpful and patient by providing technical assistance and help tracking-down nearly any obscure book or article I had hoped to acquire. Lastly, I would like to thank my peers who gave me confidence to study what I was passionate about. I was challenged and grew from conversations with every graduate student, but I would like to specifically thank Teal Fitzpatrick, Chris McCann, Denise Mahone, Katie Wagner, Rachel Gottlieb, and Camille O'Connor – I am grateful for your friendship. I am extremely fortunate for the partnerships I forged in Oaxaca. I conducted this project as a guest scholar under Dra. Paola Sesia at Centro de Investigaciones y Estudios Superiores en Antropología Social (CIESAS). Partnering with Dra. Sesia was an honor: not only did she develop my anthropological gaze, she taught me the true, collaborative spirit of academic inquiry. Additionally, my residency at La Biblioteca de Investigación Juan de Córdova provided an inspiring space to reflect and write. I would like to thank Dr. Michael Swanton for his hospitality, enthusiasm, and guidance. También viii – y definitivamente – necesito agradecer a Janet Chavez Santiago, mi maestra de Zapoteco y de todo lo relacionado con Teotitlán además de ser una muy querida amiga. Quisiera igualmente expresar mi gratitud a todas las demás personas de la biblioteca – Omar López Rocha, Claudia Ballesteros, y Leticia García – por su hospitalidad y ayuda. This project would not have been possible without the help I received in Teotitlán del Valle. I would like to thank Taurino Alexandro (“Alex”) Mendoza Martínez and family for so warmly welcoming me into their home, teaching me about local customs, and helping me establish local contacts. As subsequent pages of this dissertation elaborate, Alex is in many ways the hero of this study and I am sincerely grateful for his willingness to take it on as his own personal endeavor. Asimismo quisiera mencionar a Domingo Gutierrez Mendoza quien me ha ayudado a entender las experiencias de los adultos mayores en Teotitlán, al municipio, y al resto de mis amigos teotitecos. Finalmente quisiera dar las gracias a todas las personas que me ayudaron a hacer posible este proyecto – especialmente a cada familia que me recibió en su casa con todo su cariño. Espero que esta investigación le haga justicia a su historia. I would