Caring for the People of the Clouds : Aging and Dementia in Oaxaca

<jats:p>n/a</jats:p>


Book Review
In Caring for the People of the Clouds, psychologist Jonathan Yahalom utilizes socio-anthropological research methods to shed light on the cultural specificities of dealing with dementia in Teotitlán, Oaxaca. He provides caregivers' perspectives on Alzheimer's Disease while also highlighting how the community of Teotitlán understands forgetfulness in the process of aging, such as if and when forgetfulness is interpreted as a disease and how and why it should (not) be cared for. Based on indepth interviews and observations, Yahalom proposes that the reflexive potentialities of anthropological theory and ethnographic method can help alleviate the social ostracism dementia caregivers may experience and foster psychologists and other health professionals' understanding of life with dementia from an emic perspective. Yahalom incorporates social constructivism in part of his analysis, considering illness experiences and trajectories as social phenomena, and also relies on pragmatism to defend the multiplicity of lived realities. In the book, Yahalom's main objective is to urge psychologists, doctors, and other health professions to recognize the culturally and historically contingent spaces of and for dementia, alongside and together with biomedical approaches.
Based on interviews with family caregivers and analysis of local newspapers, street art, and public campaigns on aging, Yahalom argues that older adults in Oaxaca are traditionally admired and respected for being carriers of cultural knowledge. Becoming forgetful, however, they begin to lose this status. For citizens of the community, forgetfulness in older adults can indicate the disintegration of kinship ties and a general decay of traditional ways of living. In Oaxaca, Alzheimer's is a disease mainly related to stress and modern life. Most of Yahalom's interlocutors would say that Alzheimer's is caused by a stressful way of life associated with the country's modernization, and some would even add that families that do not preserve the traditional way of life are most at risk of developing the disease. Caregivers manage these tensions between the traditional and the modern, as it plays out in the bodies they care for and are at risk of being held responsible for the decay of tradition. Following the current literature on care (e.g., Buch 2015; Parreñas 2015; Yarris 2017), Yahalom insists on the ambiguous, "segre-social" (20) character of caregiving: it's an activity that reproduces and maintains social cohesion but is similarly entwined with social transformation, isolation, and conflict. In Yahalom's words, segresocial is "an admittedly clumsy term that attempts to capture how caregivers are simultaneously drawn into new familial relations centered on dementia but, in doing so, risk becoming misunderstood by and segregated from the larger community" (20).
The introduction to the book's five chapters contextualizes the community and the city and gives an overview of Yahalom's research methodology. Chapter 1 discusses local perspectives on aging and forgetfulness: normally, an older adult will be treated as a mature and respectable member of society; experiences of forgetfulness, however, can change that perception and relegate older persons with dementia to the social space of children. Yahalom argues that the ethics of caregiving in the region is rooted in social values of communitarianism and familism; referentially, care is done at home by family members. Chapter 2 explores how forgetfulness among older adults is normalized when kin relationships are not endangered. On the other hand, however, caring for kin becomes problematic when those who suffer from memory loss forget who they are or stop recognizing their kin.
In Chapter 3, Yahalom further explains the modern/traditional dichotomy in the etiology and treatment of diseases. Since in Teotilán, Alzheimer's is a disease associated with modernity and stress, it is thought to belong to the field of expertise of modern medicine. Other episodes of forgetfulness are treated as traditional diseases, such as susto, a condition related to encounters with spirits. This chapter also mentions how historical and contemporary power relations, as well as structural inequalities, influence the choice between traditional healing or modern biomedicine. Believing in traditional knowledge, for example, can be an act of resistance since those practices have a history of public persecution. Seeing a specialist, on the other hand, is unsettled by the fact that health care provision in the community is limited to basic care; a specialist that could diagnose Alzheimer's is too expensive for most families.
Chapter 4 further explores this tension between traditional and biomedical treatment and observes caregivers' strategies to negotiate 'good care' for forgetful older adults, caregivers tinker different values through socio-material practices (e.g., how to care, when to see a doctor, and how to divide the care tasks among family members) (Mol, Moser, and Pols 2010). Chapter 5 reflects on caring for people with memory impairment and the vulnerable position of caregivers in the community. Those caring for older adults with memory impairment are constantly investigated by neighbors and are frequently targets of gossip. As forgetfulness might be viewed as the decay of social values such as supporting the family and the community, caregivers can be held personally accountable for the worsening of dementia symptoms in older adults and at the same time for the general decay of social cohesion. In the Epilogue, Yahalom synthetizes his plea for a pragmatic approach to dementia (research). According to him, doctors and psychologists must work to understand cultural concerns and disease categories and the social suffering of caregivers.
This work provides interesting insights on forgetfulness and aging in dialogue with current literature on the cultural specificities of caring in Mexico. Particularly powerful, is this book's attempt to open up a dialogue between anthropological research and clinical interventions. Nonetheless, some aspects of this book leave room for further exploration. For example, the status that "familism" is given as a cultural aspect of social cohesion is problematic. Of course, the centrality of family care is prominent in the interviews and literature about care in Latin America, but "familism" is also a term used in critical Latin-American literature on care to express a state ideology that justifies improperly investing care infrastructures (see for example Debert 2012). The social and political implications of the centrality of family in caring for dementia are thus far more complex than that of a cultural characteristic that reproduces social cohesion in the region. Perhaps, a critical cultural sensitivity for the present politics of care in Latin America could have steered the analytical attention away from social cohesion as a cultural concern towards more realist and speculative approaches to care for dementia in Oaxaca. Something that could have prevented this shortcoming is a more reflexive attitude towards the ethnographic methodology itself. In Chapter 3, for example, Yahalom describes the difficulty of accessing a specialist that could diagnose Alzheimer's. Nevertheless, the author does not draw any conclusions from it for the everyday enactment of dementia.