Mutualism as a Caregiving Model

Thinking more about Clint Eastwood’s movie, Gran Torino...also scenes from Witness where Amish farmers come together first to build a barn and then to defend Harrison Ford and the Amish family from corrupt cops.

Mutualism is custom designed for each species partnership. It can’t be legislated. It has to grow out of the specific needs of the participants. It evolves. It might be qualitative and/or quantitative.

Why do I think that mutualism is the best model for caregiving and especially for providing long-term care?

• There is less paternalism and co-dependence because all parties are interdependent in ways that can be observed and measured.

• It is possible to maintain self-respect no matter how dependent one is for services.

• It is possible to maintain self-respect no matter how menial the caregiving tasks are.

• Mutualism as a relationship process can be developed, strengthened, and repaired as required.

• Mutualism offers a way to talk with family members about caregiving realities in a way that temporarily transcends habitual family communication patterns (family history, the various family trances).

Place is a major factor in mutualism. The characters in Gran Torino are next door neighbors---Walt won’t move and the Hmong families can’t. The Amish farmers In Witness depend on each other---come running when the alarm bell is rung.

We saw a real-life example of this in San Francisco during the worst of the AIDS crisis. Many elderly Irish Catholic residents in the Castro were leery of the young gay men pouring into (and changing) “their” neighborhood. As more and more of these interlopers became sick from this strange new illness many of these neighbors provided all sorts of care. What made it mutual?

Caring flowed both ways.

Why Don’t We Plan

I just finished A Long Bright Future, An Action Plan for a Lifetime of Happiness, Health, and Financial Security by Laura L. Carstensen, PhD. The book offers a comprehensive overview of the current realities, possibilities and challenges presented by our changing demographics.

Each chapter is rich in suggestions to individuals, employers, agencies, policy makers, etc. The basic message: the tsunami of aging baby boomers is upon us. How are we going to cope? What does coping look like?

Much of my work the past 15 years has been trying to get people to plan for their end-of-life---with very little success. I was curious to see how Dr. Carstensen handled the issues of planning for the future.

First she warns us: “retirement could revert to what it once was before the prosperity, leisure time, and health gains of the mid-twentieth century…a brief, unenjoyable period of sickness and infirmity that buffers the time between work and death.” Then she encourages us: “Thinking about what might go wrong helps us to prepare, so that we can avoid calamities…”

In Chapter 7: What Might Go Wrong, she describes obstacles to planning. I now understand much better how difficult it is for humans to imagine and then intentionally create different kinds of futures. She got me thinking---how many of us are children and grandchildren of people who came here reactively---fleeing misery---focused on survival? Many of us are recent descendants of peasants---where almost everything is out of the individual’s control: weather, war, sickness. Perhaps a one-generation veneer of middle-class security isn’t enough to rewire brains. I think of my grandmother intoning “Don’t borrow trouble.” Or the King James Version of Matthew 6:34: Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient unto the day is the evil thereof.

Depending on Your View

Last week I was walking through a city near where I live---strolling along, enjoying the beginning of Fall, fending off the normal amount of requests for money. I had taken the afternoon off to wander around and visit some used bookstores.

Gradually it dawned on me that there was something different about the requests for money. For one, there were a lot more people sitting with signs and cups. For another, there was a lot less of the usual banter and funny signs (lwill work for beer). But the stunner was the number of elderly men and women sitting on the sidewalk with cups and signs. These were men and women in their sixties (my age) and seventies. What made them look elderly?

Ironically the book I had with me to read on the train was A Long Bright Future, An Action Plan for a Lifetime of Happiness, Health, and Financial Security by Laura L. Carstensen, PhD. Dr. Carstensen is the founding director of the Stanford Center on Longevity. She encourages the reader to “envision the possibilities of a longer life; design your future with smart choices you make today; diversity your social, civic, and leisure pursuits; and, invest in yourself, your family and your community.

The contrast could not have been more ironic, more bitter. How many of these people had been proactive?---envisioning, designing, diversifying, investing---only to find that events over which they had no control (like an economic meltdown or critical illness) had made a shambles of their plans for a long, bright future.

Dr. Carstensen makes some very good points from her 50,000 foot view. But what about the person on the ground whose best-laid plans have blown up in his/her face?