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BOOK REVIEW |
School of Aging Studies, College of Arts and Sciences, University of South Florida, Director, Florida Policy Exchange Center on Aging, USF 30437 – 4202 E. Fowler Avenue Tampa, FL 33620
Older Americans, Vital Communities: A Bold Vision for Societal Aging, by W. Andrew Achenbaum. The Johns Hopkins University Press, Baltimore, 2005, 202 pp., $40.00 (cloth).
Social Theory, Social Policy, and Ageing: A Critical Introduction, by Carroll L. Estes, Simon Biggs, and Chris Phillipson. Open University Press, Berkshire, UK, 2003, 191 pp., $110.95 (cloth), $30.96 (paper).
Critical gerontology, with its dual emphasis on macro and micro levels of analysis and theory construction, its energetic endorsement of interdisciplinary perspectives, and its activist agenda for emancipatory social and economic change, emerged in the 1970s. Since then, it has slowly gained a presence within the broader community of social gerontology. Current trends within the global political economy—the rapid aging of both developed and developing countries and the efforts of global economic and political elites to privatize (dismantle) governmental income support and health care programs—are likely to make critical gerontology increasingly important and influential over the next several years.
Social Theory, Social Policy, and Ageing is a timely text that succinctly summarizes developments in critical gerontology over the last 20 years. The book also provides several suggestions for the kinds of research and theoretical work that will help achieve critical gerontology's potential to describe and explain the political, economic, and cultural trajectories of global aging more accurately than conventional gerontology and the other social sciences. Although the book is subtitled A Critical Introduction and is probably the best single text for readers new to the perspectives of critical gerontology, it also offers numerous insights for those who have followed developments in the field over the years, including the important contributions of each of the three authors, Carroll L. Estes, Simon Biggs, and Chris Phillipson.
Race, Class, Gender, and Theory
Conventional gerontology has produced a lot of important research in a number of areas over the last several decades. Most of this work, however, is done without much regard for larger theoretical considerations, interdisciplinary connections, or political and public policy implications. This rather narrow empiricism hardly distinguishes gerontology from the other social and behavioral sciences in the United States, where the results of statistical or qualitative analyses rarely rise much beyond the straightforward reporting of findings. There have been some interesting theoretical contributions, including disengagement and life course theories, as noted in the work of Vern Bengston, James Birren, and others. No one, however, could convincingly claim that gerontology is theory rich.
For the authors of Social Theory, Social Policy, and Ageing, this lack of compelling theory is the result of gerontology's failure to formulate themes, topics, and research that reflect the most important forces at play in the aging experience at both the macro and micro levels of social organization and human behavior. The central organizing principle of critical gerontology is that the aging experience is most fundamentally influenced by the variables of socioeconomic class, race/ethnicity, gender, and their interactions.
People grow old and experience aging differently, according to the resources available to them throughout the life course; race, class, and gender are the major variables governing access to resources. The critical gerontologist's task is to interpret the effects of these variables and their interrelationships on the lives of older people. These variables, of course, are commonly included in gerontology research, but their larger theoretical significance and political implications are most often left unaddressed. The assumption seems to be that if sufficient empirical evidence is accumulated and low-level hypotheses tested, higher level theoretical explanations of findings will gradually become clear. The big picture will eventually emerge from a long series of snapshots. This approach is not without merit. Gerontology has generated a number of interesting and useful snapshots of several aspects of the aging experience. They do not, however, add up to much in the way of theoretical frameworks that explain fundamental differences in the aging experience.
The authors offer a quotation from Hagestad and Dannefer (2001) that describes the reluctance of gerontologists to address macrostructural factors such as class, race, and gender in their research:
Microfication refers to a trend in the substantive issues and analytic foci, what we might call the ontology of social research in aging. Increasingly, attention has been concentrated on psycho-social characteristics of individuals in microinteractions, to the neglect of the macrolevel. Apart from the population characteristics, macrolevel phenomena of central interest to social scientists, such as social institutions, cohesion and conflict, norms and values, have slipped out of focus. (p. 23)
Knowledge and Action
If the focus on class, race, and gender as the fundamental forces that shape the political, economic, and cultural dimensions of aging constitute the ontology of critical gerontology, two other organizing principles constitute the epistemology and ethics of critical gerontology. Social behavior, though embedded in the physical world and bounded by social structures, is not governed by immutable laws grounded in human nature that can be discovered by the proper use of scientific techniques. Research may reveal empirical regularities about social behavior, but these inherently contingent regularities must be interpreted in order to give them meaning. The dialectical relationship between regularities or "facts" and interpretive meanings constitute the socially constructed realities of aging, which are fundamentally influenced by power relationships among groups organized by class, race, and gender. Carroll Estes (1999) has written:
The conceptualizations of old age as an illness and as an economic crisis for society are socially created in the sense that they are not determined solely by objective facts. Two processes create these constructions: first, the interpretation and ordering of perceptions of "facts" into ways of thinking, and second, the relative power and influence of those who interpret and disseminate the facts. (p. 27)
The interpretative process is substantially shaped (guided) by an ethical framework based on a mix of liberal and communal values—on a commitment to structures (laws and programs) of moral obligation designed to ensure that whole categories of people defined by class, race, gender, or age are not excluded from the provision of resources needed to support an identity based on dignity and freedom. This consciously ethical framework provides a means of using research results to identify sources of deprivation and oppression and develop political strategies and public policies to ameliorate them.
Critical gerontology also draws on the interpretative powers and moral imagination of the humanities and the arts in efforts to understand the cultural and existential dimensions of aging. Social Theory, Social Policy, and Ageing includes an outstanding chapter on age and identity, which integrates a humanities sensibility with social theory, including postmodernist theory and psychological research to interrogate the relationship between "structure and agency" in the construction of identities across the life course. This chapter demonstrates the potential of an interdisciplinary approach to finding the links between macrolevel and microlevel variables that influence how people at any age maintain or change their identities.
Postmodern Theory and Society
Identity is fundamentally unstable and subject to change. This understanding of identity reflects the recent influence of some strands of postmodern theory in critical gerontology. This positive focus on the freedom of older people to choose from an expanding range of new identities created by the stereotype-busting, decategorizing boundary transgressions of postmodern culture is offset by some serious doubts about the advantages of postmodernism and postmodern culture for the old. The deinstitutionalization of the life course and the destabilization of traditional sources of identity which Phillipson and other critical gerontologists associate with the emergence of the neoliberal political economy and postmodern culture (Gilleard & Higgs, 2000) hold the potential to undermine the economic and cultural foundations that have so substantially improved the quality of life for elderly people during the modern era. Darryl S. L. Jarvis (1998) notes the pessimistic arguments of those who fear the "postmodern age" and its potential consequences for the moral culture.
Those very processes otherwise identified as "liberating," some argue, are leading to greater misery, dehumanization, and cultural disintegration. Dick Hebdige, for instance, sees postmodernism as nihilistic, and the "post-modern age" as modernist but "without the hopes and dreams which made modernity bearable." For Hebdige, postmodernity is what comes after an age of illusion, optimism, and certitude; an age where the omnipotence of Faustian technology and its grounding in reason, science, and industry, made possible the writings of grand narratives and emancipatory projects: Marxism, Freudianism, Liberalism, new moral and social orders. (p. 112)
Seen from this perspective, the emergence of the postmodern era threatens to erode the cultural and ethical foundations of the liberal welfare state and expose elderly people, or at least the less affluent among them, to unprecedented economic and existential hazards.
This book demonstrates that a critical appreciation of postmodern perspectives has something to contribute to the work of critical gerontologists who recognize that the erosion of the welfare state, cultural traditions, and foundational beliefs are especially salient for elderly persons. Any effort to prevent these postmodern trends from undermining sources of meaning in old age and devaluing elderly people must be informed by a careful analysis of their origins and trajectories and their relationship with the development of a neoliberal political economy and public policy regime. The results of this analysis could then be used to create a moral framework and political strategies to protect the interests of elderly people and other vulnerable groups likely to be hurt by the growing selfishness of a neoliberal postmodern society centered on hyperindividualism, consumerism, and blind faith in the "market," while taking advantage of the new freedoms that may emerge from the "decategorization" of old age.
Feminist Influence
Feminist research and theory in the social sciences and humanities is among the most important intellectual and political sources of critical gerontology. Carroll Estes has featured feminist thought in her work for many years, especially in her critique of income, health care, and long-term care policies which still reflect the profound effects of patriarchy. The chapter on feminist perspectives in critical gerontology provides a fine summary of the effects of gender bias and institutional discrimination on the life changes of women in old age. The chapter concludes with a call for a stage-three feminism centered on a "care movement" and organized around these three rights described by Deborah Stone as:
1) The right of families to care for and be helped to care for their members; 2) the right of paid caregivers to give humane, high-quality care without compromising their own well-being; and 3) the right for people who need care to get it (Stone, 2000, as quoted in Matthaei, 2001: 483). In Matthaei's words, such a movement would reaffirm care as a value ‘while striving to distance it from the negative feminine self-subordination and dependency ... and revaluing unpaid caring work as an activity for both sexes, as combined with independence and self-actualization,' while also transforming ’the paid workplace so that it allows individuals time to care for themselves and their loves ones' (Matthaei, 2001: 483). (p. 61)
Productive Aging and the Medical Model
The authors devote a chapter to the critical analysis of the concept of productive aging and the neoliberal push to raise the eligibility age for Social Security and Medicare in order to make older people work longer. Productive aging, of course, can include a very broad range of lifestyles and activities, but, too often, it tends to get reduced to working longer and delaying the use of retirement benefits. This notion of productive, active, or useful aging is too focused on work or work-related activities as legitimized forms of aging and is expressly discriminatory toward many women and working-class people without careers that can be rewardingly cultivated well into old age.
An exclusive emphasis on work-based concepts of productive aging leaves those elderly persons with functional impairments, or who have chronic illnesses, essentially roleless and without a source of meaning in old age. Older people can find meaning and generate value for others through a broad range of activities, including volunteer activities, which have the potential to revitalize whole areas of social life; the deepening of intergenerational relations within the family and the community; the initiation of new careers that may involve little, if any, pay; and the opportunity to simply contemplate the events of one's life, discern their meaning, and use this knowledge to play a quietly mentoring role in the lives of others. These activities represent social resources as valuable as paid labor and could become bulwarks against the neoliberal view of retirement as wasteful dependence.
A chapter on the biomedical–industrial complex and aging summarizes and ratchets up the relentless critique of the medicalization of aging that has been a part of critical gerontology since its inception. Little has changed over the last several years in the way medicine tends to reduce older people to their medical status and then fails to recognize and effectively treat the chronic conditions for which most older people need care. The most important change during this period is the enormous expansion of the medical–industrial complex, much of which has grown up around the steady growth in the Medicare population. The latest example of this expansion is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and the many profit-enhancing privatization provisions that are included in the law; the drug companies and managed-care companies will receive billions in additional profits, while many beneficiaries will continue to pay for most of the drugs out of pocket. The authors of Social Theory, Social Policy, and Aging note that:
Symbolically, biomedicine has become so powerful that it may effectively exclude other perspectives, such that illness comes to stand ever more forcefully for old age in the popular imagination, and that solutions to the problems of adult ageing are seen as being solved exclusively through biomedical intervention. This is in spite of clear evidence of the much larger contribution of 'social' factors (including race, class, gender and other environmental and behavioural influences) in explaining the relationship between health, illness and ageing. The individualizing dynamic of technical fixes contributes to the trends, noted in Chapter 3, characterizing old age identity as a battle between individuals and their ageing bodies. Symbolically, biomedicine transforms its object and the experience of ageing and therefore modifies what old age is perceived to be. (p. 101)
Globalization and the Political Economy of Aging
The book includes chapters on aging, globalization, and the politics of aging, which, I think, most clearly demonstrate the capacity of critical gerontology to interpret the trajectories of current tendencies in the domestic and global political economies. The focus on political economy and the cumulative, interacting effects of class, race, and gender on what becomes of people in old age puts critical gerontology in a good position to analyze and theorize the emerging neoliberal threats to retirement security in the United States and other developed countries. It also brings into focus the destructive effects of neoliberal structural adjustment policies of privatization, deregulation, and cuts in public expenditures on the capacities of many developing countries to meet the economic and health-care needs of their rapidly growing populations of older people, most of whom are extremely poor.
Retirement security for most workers in the United States has been eroding for several years. Defined benefit pension plans have been replaced by riskier defined contribution plans with lower pension payments, wages have stagnated, living costs have increased (especially for education, health care, and housing), and savings have declined. These trends are likely to continue for years to come, making retirement security increasingly less certain for the baby boomers than it has been for their parents. Stagnant wages and declining benefits are justified by the neoliberal rationale that employers are operating in an increasingly competitive global economy, forcing them to shed as many costs as possible. The same rationale is used to justify cutbacks in funding for Social Security, Medicare, and Medicaid, the pillars of the publicly funded retirement system. These cutbacks and the neoliberal push to privatize Social Security and Medicare are necessary in order to reduce taxes on the investor class to protect their profits in a competitive global economy—never mind that these policies could eventually make it impossible for workers and retirees to maintain their consumption spending at levels necessary to support growth.
Efforts to privatize Social Security and Medicare and make future retirees assume far greater responsibility for meeting their income and health-care needs are occurring even as the retirement wealth (private and public pensions, savings, and investments) of most baby boomers has stagnated over the last 20 years and actually declined between 1989 and 2001 for African Americans and Hispanics aged 47 to 64 (Weller & Wolfe, 2005). The projected cumulative shortfall in the amount of resources baby boomers will need in 2030 to keep their incomes at 75 percent of their earnings at retirement is over $400 billion (VanDerhei & Copeland, 2003).
The neoliberal economic and public policy agenda is not the only threat to the future of retirement security in the United States. The neoconservative foreign policy agenda of expanding U.S. political and military dominance in the post 9/11 world also threatens to undermine retirement security. The neoconservative vision of unchallengeable U.S. control of the global political economy is dependent on shifting fiscal resources from social welfare programs, mainly retirement support programs, to the military and other programs designed to make the United States a virtual global government. "The greatest threat to the American international position in the twenty-first century seems more likely to come from the competing costs of social welfare programs within the U.S., which threaten to reduce public support for any and every other public purpose" (Mandelbaum, 2005, p. 186).
The future of retirement security in developing countries is even less promising than in the United States. The International Monetary Fund, with the support of the World Bank and the World Trade Organization, has forced the governments of many Latin American and Asian countries to reduce public expenditures for pension and health care and move toward privatization. Many of these countries have also signed trade agreements that will allow private health-care corporations in developed countries (primarily in the United States), to sell insurance and managed-care services that will almost certainly make health care less affordable, especially for the masses of poor elderly people (Zarrilli, 2002). These policies undermine the capacities of states to meet the income and health-care needs of their elderly populations, which are projected to double over the next 20 years across the developing world.
Everyone interested in gerontology and the future of older populations has a stake in the efforts of critical gerontologists to examine these threats to the economic and health-care security of older people and to develop effective political and public policy alternatives. As the authors note in their concluding paragraph, critical gerontology has spent the last 20 years generating evidence of the injustices and inequalities that damage the lives of many older people. The years ahead, however, will require:
... the development of a clearer vision about ageing relevant to a global community that is characterized by massive economic divisions and complex forms of political oppression .... For the twenty-first century, the key issue will be studying ageing as a global phenomenon while at the same time incorporating older people as participants into the processes of research and theorizing. Achieving these goals represent both a major task and an opportunity for critical gerontology in the years ahead. (p. 154)
As noted by Scott Bass (2006) in a recent Gerontologist review essay, this effort to identify the effects of large-scale changes on the economic and psychological well-being of older people could stimulate the development of broader, more creative theories in gerontology. As Bass notes, critical gerontology can help:
... encourage discourse and disagreement as larger world events and pressures assert themselves. For a robust theory to exist there must be critical theory operatining in a crucial struggle for a conceptual understanding of human experience. Through arguments and counterarguments a pattern of gerontological imagination will emerge that is not static or entrenched. The social gerontology theory that is about to emerge must be dynamic and embrace a sustained dialog with critical gerontology if a unified theory is to grow, evolve, and change. (p. 143)
A Historian Looks Ahead
Although W. Andrew Achenbaum probably would not describe himself as a critical gerontologist, he does address many of the same issues as Estes, Biggs, and Phillipson from a critical perspective in his far-ranging meditation on the future of aging, Older Americans, Vital Communities: A Bold Vision for Societal Aging. Achenbaum brings a historian's sensibility to his analysis of the "interplay between aging cohorts and institutional contexts" and his discussion of how "social institutions can generate new structural incentives, enabling people to contribute throughout their lives" (p. 8).
Achenbaum begins by describing the major trends that have transformed American society and the lives of older people since World War II. These changes include increasing longevity and population aging, increasing tolerance and expanded opportunities for women and minorities, the rapid growth of minority populations, especially Hispanics, the increasing diversity of family structures, rising levels of educational attainment, and greater economic security. These changes have occurred at a faster pace than most American institutions have been able to accommodate, and the gap is likely to become increasingly visible with the huge growth in the older population over the next 40 years. This future population of older people will be more culturally and socially diverse than past cohorts of older people, as well as better educated and in better health, more inclined to maintain active lifestyles, and less inclined to accept uniform and stereotypical notions of what it means to be old. Achenbaum thinks that many changes will be needed in our institutions if they are to catch up with the social trends that have shaped the emerging cohort of older people.
Changes in the nature of our economy, especially the movement from manufacturing to services, labor market shortages, and the increasingly higher educational achievement levels of older people should substantially enhance the employment opportunities for older people who need or wish to work. Providing more opportunities for older workers would generate a wide range of social and individual benefits, from increased productivity to higher life satisfaction among those who want to continue working, which appears to be a growing percentage of those in their 60s and 70s. As Achenbaum points out, however, the greatest barrier to increased employment of older people is ageism, which "insinuates itself into the organizational structures and policies of corporate America" (p. 31) and remains impervious to the growing body of research on the productive potential of older workers. As he does in each of his chapters on U.S. institutions and older people, Achenbaum offers a number of policy recommendations, including age-specific benefits for workers and new work arrangements that would increase employment of older persons if they were implemented.
Achenbaum's chapter on (re)creating networks is a rich discussion of learning and creativity in the later years of life and the virtually infinite range of volunteer activities, with a focus on intergenerational initiatives that are available to older people. This includes a fascinating analysis of the history of adult education from Benjamin Franklin (yes, him again) to the theories of John Dewey. He also provides a brief review of the research literature on cognition and aging, which generally shows that people have considerable capacities to learn and create well into old age; capacities often complemented by a growing sense of altruism. Achenbaum's description of several programs across the U.S. that involve older people in a wide range of volunteer, educational, and creative activities provides concrete examples of the kind of vital aging that goes far beyond the narrow notion of productive aging criticized by Estes, Biggs and Phillipson, and Achenbaum as well.
Achenbaum's analysis of the U.S. health care system and its (mis)treatment of older people is probably the most passionately critical chapter in the book and is largely consistent with the views of Estes, Biggs, and Phillipson and the decades-long efforts of Robert Butler and others to make health care more responsive to the chronic and long-term care needs of older people. For Achenbaum, the agonizingly slow shift from an acute-care, curative model of medicine, to a model more consistent with the chronic-care needs of older people reflects the same ageist attitudes that have limited employment opportunities for older workers. In order to accelerate this necessary shift in the focus of care, Achenbaum offers a number of recommendations, many of which Butler first put into play years ago. They include increased geriatric training, education, and research, the involvement of older people in clinical trials, the wider use of proven procedures for older patients, and greater efforts to inform and empower older patients. He also points toward more systemic changes, including a nonhysterical consideration of national health insurance and a thorough reform of medical education so that more physicians are prepared to provide good primary care for those of all ages. This change in medical education is needed to remedy what Achenbaum thinks is the fact that:
The extent and virulence of ageism in the U.S. health care system exceeds that found in the marketplace or educational institutions. The prejudice against age among all participants is deep. Despite improvements in the health of senior citizens ... we persist in the negative, nihilistic attitudes and practices that characterized the American way of medicine 30 years ago. (p. 102)
Achenbaum's treatment of religion, spirituality, and aging is one of the most informed and sophisticated that I have read. It encompasses a discussion of the literature on the effects of religious beliefs and practices on health and psychological well-being, a brief history of religion in the United States, a description of current efforts to serve older parishioners, an analysis of the growth of "spirituality" over the last several decades, and what all of this might mean for the spiritual and social lives of the baby boomers in their later years. I could not help but think after reading this chapter that Achenbaum, Thomas Cole, and Rick Moody should consider the possibility of writing a book together on the future of religion and old age that could help provide a counter-narrative to the hard-line fundamentalist view of the role of religion in human affairs.
In the book's penultimate chapter on extending civic engagement, Achenbaum addresses several topics, some of which are raised in previous chapters, in the context of global aging trends and domestic politics and policy making. He doesn't provide an overarching theoretical framework for his analysis, but he does discuss a number of issues central to critical gerontology.
In the epilogue, Achenbaum acknowledges that he "does not call for radical change." Rather, he wants us to overcome our "myopia" and recognize the importance of population aging for our collective and individual future, to eradicate the ageism that permeates our society and colonizes our minds (however enlightened we may think we are) to decompartmentalize the life course and allow education, work, and leisure to become more integrated parts of life, and to nurture the growth of a spirituality that altruistically engages the world as well as cultivates the self.
I have been able to suggest only some of the richness of Achenbaum's book that provides a clear demonstration of the author's narrative and descriptive powers as a historian and his moral passion as a social critic and policy advocate. The book also demonstrates how more conventional gerontological scholarship and social criticism can complement and contribute to the more broadly theoretical and political concerns of critical gerontology.
References
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