Cross-disciplinary Conversations on Caring in a Crisis

In the second of our posts on the ‘Old Age Care in Times of Crisis’ Symposium back in April, Amie Bolissian considers how the conference highlighted the polysemic nature of old age care, the different ways researchers approach the bio-psycho-social health of older people, and the cross-disciplinary nature of the field. 

Being a pre-modern historian of ageing health can be a little lonely. There are not very many of us, and we tend to be spread out across the globe. Perhaps this is what gave me the courage to submit an abstract to an event on older adult care this year that looked very exciting, but was intimidatingly cross-disciplinary.

Sociologists, anthropologists, healthcare professionals, literary scholars, and historians of different regions and periods attended the online ‘Old Age Care in Times of Crisis: Past & Present’ Symposium held by London School of Hygiene and Tropical Medicine & Birkbeck, University of London this spring. Sharing the musings of long-dead, seventeenth-century English diarists in this context was daunting to say the least, but it was one of the best decisions of my PhD.

Old Age Care in Times of Crisis Online Conference

Exposure to the diverse methodologies, theoretical frameworks, and styles of other disciplines is now my key piece of advice for other PhD researchers: consume other stuff within the broad boundaries of your themes, especially when writing up. The connections that can be made, both conceptually, and with real, live, curious people who are working with similar questions to your own are invaluable – whether the research is based hundreds of years, or thousands of miles apart.

The symposium – which was deftly and engagingly convened by Louise Hide, Janet Weston, Anna Jamieson, and Judy Lieber – contained such a wealth of fascinating and cutting-edge research that it is impossible to summarise in one short blogpost, so I will focus here on two key themes which resonated strongly with my own work. Short videos of the presentations, as well as abstracts and information about the speakers, are now available to view on the symposium website here, and I highly recommend checking them out.

The first theme that stood out for me was that during a crisis such as a pandemic, war, or cultural upheaval, previous advances in the care of older adults could be eroded, and existing problems exacerbated. We saw how homecare and care homes in India, U.K., Canada, Italy, Indonesia, and Australia were adversely affected during the Covid-19 restrictions of 2020 with older adults suffering from social isolation and neglect.[1] There were papers examining changes to alms-house and workhouse management and funding during the English reformation, English civil war, and eighteenth-century reform of the poor laws – all impairing the quality of ageing care.[2] The challenges caused by the collapse of the Soviet Union, and the disruption of the newly established State of Israel in 1949, among many others, were all carefully and sensitively investigated.[3] Sudden changes, such as displacements or lockdowns, as well as unthinking continuities, evident in car-based suburban planning, were seen to impact upon older adults’ quality of life, health, and sense of identity.[4]

Orazio Borgianni, (after 1610), Head of an Old Woman, Wikimedia Commons.

What particularly struck me was how often failures in old age care seemed to stem directly from flattening perceptions of ‘the old’ into one homogenised group, stripping them of their individuality. The necessity for decisive action in a crisis can compromise not just transparency and oversight, but complexity and nuance. In times of crisis, the features of an older person with a long biography, social networks, cultural traditions, complex needs, and ambitions and opinions of their own, can blur to the extent that the individual becomes a mere avatar of ageing need. Yet, as the conference highlighted, this is not inevitable.

My own research into the life-writings of those who self-identified as old in early modern England showed how important careful monitoring and management of their chronic illnesses was to some people, even during raging epidemic outbreaks of plague and smallpox. This demonstrates the importance of not making assumptions about people’s priorities in times of crisis.[5] Some of the most successful responses to upheaval that were revealed in the papers were those that asked detailed questions of the caregivers and older adults as people, and kept a flexible attitude towards what individuals might want or need.[6] We saw this in the isolated ageing Italians who were found to embrace new technology to the benefit of their social health, and specific German, Canadian, and U.K. care homes that provided valued support by implementing ‘locally specific response mechanisms’ to crisis measures.[7]

These examples lead to the second theme which struck a chord with my own investigations of caring for ‘the aged’ in early modern England: that of the polysemic nature of care. Vital studies into the opinions and experiences of paid and unpaid carers highlighted aspects of caring for older adults that have been previously overlooked, to build a broader picture of the practice of care as a process.[8] Imaginative ways of fulfilling social and emotional needs, such as the use of technologies seen above, flexibility about boundaries and protocols, and applying ‘the ethics of the everyday’, were some of the strategies discussed.[9] In my own research, life-writings such as diaries and letters have shown how important a wide variety of care was to the older infirm 300 years ago.

Elements of what historian Mary Fissell has defined as the ‘bodywork’ of care, such as washing, feeding, and administering medicine, were often taken for granted and barely mentioned in the sources.[10] But the layered intricacies of care which allowed an older person to continue familiar activities, such as reading or writing for them, carrying them in a chair, or advocating for them in various situations, were described with appreciation.

When 78-year-old grocer William Stout was crushed by a horse in the street in the 1743, his nephew visited to, as Stout put it, ‘take care of my house, and to provide what was necessary’. Stout described in his diary his lying ‘insensible’ while his nephew was ‘careful about’ him – the term ‘careful’ at this time meaning ‘full of care’, rather than ‘cautious’. He explained that his nephew ‘took the keys of my desk and drawers, and overlooked my attendants that nothing should be wasted; being at such times too many take opportunities to make weiste’. For this life-long merchant, whose business acumen and success had meant the opportunity to financially support many in his family, this practical assistance was valuable enough to be recorded in his diary as a ‘careful’ act.[11]

There are obvious gender implications in the division of these two types of care. The former was largely performed by women and under-appreciated, while the latter kind was often performed by men and deemed worthy of note; but the inclusion of both these types of assistance into broader definitions of care is important. It helps to uncover the components of a person’s lifestyle that were a priority for wellbeing and sense of self as they aged, and to investigate why.

Whether the symposium papers touched on the two themes highlighted here or not, they all opened my eyes to different ways of approaching questions around the care of older people, and researching and defining their bio-psycho-social health. The ambition is to continue the stimulating conversation begun during the event, so do visit the website and contact the organisers if interested, or maybe seek out other cross-disciplinary events you can find in your own chosen subject areas!

Amie Bolissian is a Wellcome-funded doctoral researcher at the University of Reading, specialising in the history of health, medicine, and emotions. Her PhD study, ‘The Aged Patient in Early Modern England c.1570-1730’, investigates medical understandings of old age, and the experiences and feelings of older patients, and those that cared for them.

References

[1] Panels One, Two, Four, Five, and Seven.

[2] Panel Three.

[3] Panels One and Four.

[4] See Note 1.

[5] Panel Six

[6] Ibid.

[7] Miranda Leontowitsch, ‘Doing Time in Care Homes: Insights into the Experiences of Care Home Residents in Germany during the Early Phase of the COVID-19 Pandemic’ Panel Six. And Panels Seven, Four, and Two.

[8] Panels Two and Seven especially.

[9] Jane Dickson, ‘Giving and Taking Care in a Pandemic’, Panel Two.

[10]Mary E. Fissell, ‘Introduction: Women, Health, and Healing in Early Modern Europe’, Bulletin of the History of Medicine, 82/1 (2008), 1-17, 10.

[11] William Stout, Autobiography of William Stout, of Lancaster, Wholesale and Retail Grocer and Ironmonger, J. Harland ed. (London, 1851), 143.

Fissell, Mary E., ‘Introduction: Women, Health, and Healing in Early Modern Europe’, Bulletin of the History of Medicine, 82/1 (2008), 1-17.

Stout, William, Autobiography of William Stout, of Lancaster, Wholesale and Retail Grocer and Ironmonger, J. Harland (ed.) (London, 1851).

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