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Aging in Cultural Context and as Narrative Process: Conceptual Foundations of the Anthropology of Aging as Reflected in the Works of Margaret Clark and Sharon Kaufman

Margaret A. Perkinson, PhD,*,1 and Samantha L. Solimeo, PhD, MPH2

1NAPA-OT Field School in Antigua, Guatemala.2Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA

Healthcare System, Iowa.

*Address correspondence to Margaret A. Perkinson, PhD, NAPA-OT Field School in Antigua, Guatemala. E-mail: perkinson.p@gmail.com

Received January 8, 2013; Accepted September 24, 2013Decision Editor: Nancy Schoenberg, PhD

Although the discipline of anthropology has much to contribute to the understanding of the nature and experience of aging, it is a relative latecomer to gerontology. After briefly discussing why this is the case, the authors discuss the contributions of two anthropologists who brought a substantive anthropological voice to gerontological discussion of aging. Examining the “ancestral roots” of the anthropology of aging, we spotlight the intellectual heritage of Margaret Clark, arguably the “mother” of this anthropological subfield, and that of Sharon Kaufman, her student, colleague, and a pioneer in her own right. Clark and Anderson’s Culture and aging: An anthropological study of older Americans (1967; Springfield, IL: Charles C. Thomas) remains a touchstone for the concept of situated aging. This examination of value orientations and mental health of older San Franciscans is foundational for under-standing aging as an interactive, socially embedded process that is adapted to specific sociocultural con-texts. Research and therapies grounded in narrativ-ity and meaning benefit from Sharon Kaufman’s The ageless self: Sources of meaning in late life (1986; Madison, WI: University of Wisconsin Press), which articulated narrative thinking as a conduit for under-standing, performing, and constructing identity and meaning. Kaufman’s work has ongoing relevance to gerontological research on embodiment, chronic

illness, and later life social transitions. Their research has continued relevance to contemporary geronto-logical scholarship and practice, signaling both pre-vailing and emergent agendas for anthropologically informed gerontology.

Key Words: Cross-cultural studies, Culture, Narrative methods, Theory, Situated aging

In a relatively brief span of time, anthropologi-cal perspectives on human development and aging have coalesced to form a disciplinary subfield—the anthropology of aging. The formation of this subfield is well documented (Climo, 1992; Cohen, 1994; Ikels & Beall, 2001; Nydegger, 1981; Rubinstein, 1992; Sokolovsky, 2009), and it is neither our intent to review its historical anteced-ents nor to synthesize the entire field. Rather, we propose to examine Margaret Clark and Sharon Kaufman’s intellectual heritage through their key works Culture and aging (Clark & Anderson, 1967) and The ageless self (Kaufman, 1986), pro-vide an overview of anthropological and other gerontological works that extend their contri-butions, and suggest areas for future research. Many anthropologists consider Margaret Clark to be the “mother” of the anthropology of aging. Sharon Kaufman, her student and subsequent

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colleague, expanded upon Clark’s work in signifi-cant ways to become an early pioneer of the field in her own right. Our intent is to introduce the upcoming generation of gerontologists to forma-tive anthropological contributions to the study of aging and suggest a research agenda to further develop anthropologically informed gerontol-ogy. The continued salience of these early works for gerontological theory and practice deserve focused attention in this special issue dedicated to understanding (and preserving in our collective disciplinary memory) the “roots” of contempo-rary gerontology.

Intellectual Pioneers of the Anthropology of Aging

Margaret Clark: Situated Aging

Margaret Clark’s work reframed and expanded both gerontological and anthropological approaches to the study of human development and aging in ways that facilitated mutually benefi-cial cross-disciplinary discussions. Moving beyond the view of aging as a universal process of biologi-cal and psychological decline, her anthropological study of mental health and aging in contempo-rary U.S.  society offered compelling evidence for reframing aging as a situated phenomenon—an iterative, socially embedded process that requires adaptation to specific sociocultural contexts.

Clark’s major contributions came at a time when disengagement and activity theories, which assumed a direct and universal relationship between levels of activity and morale or life satis-faction of older adults, dominated gerontological scholarship. Culture and aging called gerontolo-gists to “bring culture into the foreground…as one of the active principles or forces in a psych-ocultural process (of adaptation to aging)” (Clark & Anderson, 1967, p.  393). (Culture and aging was coauthored with Anderson, but Clark further explicated the book’s central premises in her sub-sequent single-authored article, Clark, 1967, upon which our discussion is based.) The withdrawal or disengagement of the aged was framed as a cul-tural phenomenon, rather than an intrinsic and inevitable process. These findings resonated with the experience of older adults in the United States, given the age-unfriendly nature of dominant cul-tural models of that time.

Many early ethnographies documented cultural patterning of the life cycle; however, early anthro-pologists rarely examined the experience of later

life in a systematic way. Although proponents of “culture and personality,” an early subfield within anthropology, investigated the impact of cultural contexts on human development, they were heavily influenced by the claims of psychoanalytic theory that psychological processes or personality devel-oped and solidified at an early age. As a result, much of their work focused on early life stages such as cross-cultural studies of childhood and the implications of varied child-rearing practices for personality development (Whiting, 1963). By framing human development as an iterative, life-long process between an individual’s sociocultural world and inner life, Margaret Clark influenced the theoretical foundation of the “culture and person-ality” movement. In contemporary anthropology, “culture and personality” has given way to “psy-chological anthropology,” where human develop-ment is viewed in interactive and situated terms, no longer confined to childhood.

Clark’s pioneering book, Culture and aging, coauthored with Barbara Anderson (1967) and her article “The anthropology of aging, a new area for studies of culture and personality” (Clark, 1967) were based on data from the National Institute of Mental Health- and California Department of Mental Hygiene-funded Studies on Aging, which was housed in the Geriatrics Research Program of Langley Porter Neuropsychiatric Institute, University of California, San Francisco. Clark introduced an anthropological perspective to this interdisciplinary, mixed-methods, applied research on aging and mental health in contemporary U.S. society. Standardized measures of self-image, morale, social networks and interactions, social roles, and cognitive, emotional, physical, and psy-chological impairments were supplemented with focused interviews on self-image, self-esteem, and criteria used for self-evaluation. Inclusion criteria (i.e., San Franciscans aged 60 and older, half liv-ing in the community with no history of medical diagnoses for psychiatric problems and the other half hospitalized for late-onset psychiatric disor-ders) allowed Clark and her colleagues to examine a wide range of adaptations to aging. Clark based her analysis on the study’s follow-up round of data collection, supplemented by data from a subsample of 79 intensive case studies. Using a phenomeno-logical approach, she conveyed participants’ per-ceptions, attitudes, beliefs, problems, and strategies for dealing with everyday life in their own words.

Content analyses of the case studies revealed six personal goals widely shared by both community

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and hospitalized study participants: independence, social acceptability, adequate personal resources, ability to cope with external threats or changes, maintaining significant and meaningful goals, and ability to cope with changes in self. However, the two groups differed dramatically in the value ori-entations or criteria used to define desirable ways of achieving those goals. (It should be noted that Clark cautioned against the generalization of these goals and values as universals; rather, they were generated within specific sociocultural contexts.) Community participants evaluated themselves and the attainment of the six goals with values that were readily achieved by even the most frail (e.g., congeniality, conservation of resources, self-accept-ance, relaxation, and peacefulness). In contrast, the hospitalized participants continued to base self-evaluations on the attainment of increasingly elusive criteria, such as status, power, and recogni-tion. Remaining ambitious and competitive, hos-pitalized elders strained to acquire new resources rather than conserve what they already possessed.

Clark noted that the hospitalized elders’ value orientations reflected those of dominant contem-porary U.S.  culture. Although appropriate and attainable for most middle-aged persons in post-WWII United States, these values remained elusive for older adults with diminished resources. The status of U.S.  elders thus reflected “a dramatic cultural discontinuity” (Clark, 1967, p.  62), a fundamental dilemma that represented the major problem in adaptation to aging in U.S. society. The transition from adult to elder in the United States required “a critical period of socialization,” a reor-ganization of goals, values, and behavioral expec-tations, with emotional well-being hanging in the balance. Based on the contrasts between the com-munity and hospitalized elders, she concluded that adaptation to old age in the United States required a shift from dominant cultural norms to what she termed “secondary” value orientations. Values such as resilience, self-acceptance, congeniality, and concern for others would appear to be more compatible with late-life changes in functional capacities and available social roles and resources. Members of the hospitalized sample who did not make this shift in value orientations suffered the consequences.

Clark’s research inspired a generation of anthro-pologists to develop an anthropology of aging, whose proponents continue to advance the study of aging as a negotiated process situated in spe-cific sociocultural contexts. With George Foster,

she cofounded The joint University of California, Berkeley/UC San Francisco PhD Program in Medical Anthropology. She chaired the UCSF Program, which later became UCSF’s Department of Anthropology, History, and Social Medicine. (Kaufman now serves as its chair.) UCSF during Clark’s era (which overlapped significantly with Sharon Kaufman’s era) hosted a rich mix of faculty, students, and visitors who approached aging from a variety of disciplinary perspectives. The cam-pus provided a fertile setting for the development and refinement of seminal gerontological debates of that time, as reflected in the following works: Corbin and Strauss (1988), Eckert (1980), Erikson, Erikson, and Kivnick (1986), Estes (1979), Johnson (1985), Kayser-Jones (1981), Kiefer (1974), Lowenthal, Thurnher, and Chiriboga (1975), Nydegger (1983), Pearlin, Mullan, Semple, and Skaff (1990), Rosow (1974) and Strauss (1978). UCSF is a medical campus, which may explain why so many of Clark’s UC students focused on specific age-related diseases and disabilities in their work: Becker (1997), Heurtin-Roberts (1993), Kaufman and Becker (1986), Mitteness and Barker (1995), Perkinson (1995), Sankar (1999), and Stall, Catania, and Pollack (1989).

Clark’s work prompted investigations of aging in various sociocultural contexts within the United States, in small-scale social groups that were ame-nable to study using traditional ethnographic meth-ods, and resulted in analyses of the social dynamics and context-specific value systems of settings such as retirement communities (Keith, 1982), nursing homes (Gubrium & Holstein, 1999; Henderson & Vesperi, 1995; Savishinsky, 1991; Shield, 1988; Stafford, 2003; von Mering, 1996), board-and-care homes (Morgan, Eckert, & Lyon, 1995), neighbor-hoods (Francis, 1984; Shenk, 1987; Stafford, 2009; Vesperi, 1986), and aging in place (Rubinstein, Kilbride, & Nagy, 1992). Findings from these studies can be used to inform efforts to improve long-term care, such as the nursing home culture change movement (Rahman, Applebaum, Schnelle, & Simmons, 2012), and to inform national and global attempts to make cities and communities more “age-friendly” (Stafford, 2009).

Fields such as disability studies and health professions such as occupational science/therapy have adopted refined definitions of aging, disabil-ity, impairment, and function, viewing these phe-nomena not as characteristics or attributes of an individual, but as interactive processes involving individual capacities and environmental supports

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and demands. This conceptual refinement also is reflected in the WHO International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001). It would be overstat-ing the point to credit Margaret Clark alone for the growing tendency among gerontologists to view aging as an interactive and socially embed-ded process that requires adaptation to specific sociocultural contexts. Nevertheless, anthropolo-gists have been critically involved in these develop-ments, and the notion of situated aging underpins much of this work.

Clark called for cross-cultural comparisons of aging, especially in societies lacking the extreme cultural discontinuities experienced by U.S. elders. According to Clark, adaptation to old age should be less stressful in societies where core values were compatible with the abilities and resources avail-able to older adults. This call has been answered by a number of anthropologists, including Albert and Cattell (1994), Childs, Goldstein, and Wangdui (2011), Cohen (1998), Ikels (1983), Keith and cow-orkers (1994), Lamb (2000), Leibing and Cohen (2003) Sokolovsky (2009), Traphagan (2000), and van Willigen (1999).

Sharon R. Kaufman: Narrative, Meaning, and Identity

Sharon R.  Kaufman has made her own sig-nificant contributions, explicating the processes by which cultural contexts affect identity and adaptation across the life course in her ethnog-raphy The ageless self: Sources of meaning in late life (1986) and her related article in Ethos (1981). Kaufman conducted ethnographic field-work with 60 older Californians, from which she chose a purposeful subsample for in-depth life story interviews. The life stories take center stage in the ethnography, providing nuanced and often bittersweet reflections on the dissonance that emerges when comparing one’s own estimation of self with those made by others. The stories dem-onstrate Kaufman’s key theoretical insight that identity is performed through the formation, revi-sion, and linking of narratives to life events and contexts, constituting a self that is independent of chronological age.

Although Kaufman’s use of life history meth-odology was not novel among anthropologists, (e.g., Langness & Frank, 1981; Meyerhoff, 1978), Kaufman’s skillful use of extended interview pas-sages is particularly evocative because she allowed

her informants to speak for themselves. Extended interview passages, organized by case studies, were in turn structured around inductively derived themes. These themes, the narratives through which elders constitute their identity, were subsequently discussed in terms of overarching structural and value systems that shaped their importance at the individual level. The reader comes away with a sense of intimate relationship with these individu-als and the simple but profound insight Kaufman derived from their life stories: “The old Americans I studied do not perceive meaning in aging itself; rather, they perceive meaning in being themselves in old age” (1986, p. 6).

This notion that the self is ageless under-scored Neugarten’s earlier assertion that with-out culture age is an “empty variable” (1977), with both emphasizing the role of sociohistorical location in identity formation (Ferraro, 2013). Echoing Atchley’s notion of internal continu-ity (1989), Kaufman noted that “Continuous restructuring [of identity] allows individuals to maintain a feeling of unity about themselves and a sense of connection with the parts of their pasts they consider relevant to who they are at the present” (1986, p.  150). Further refining Clark’s prior work on late-life adaptations to cultural discontinuity, Kaufman demonstrated how discontinuity, an inability to make sense of one’s evolving enplotment in the world around them, could pose a loss. The broad, continu-ing impact of Kaufman’s work is illustrated by the proliferation of gerontological scholar-ship around three elements of The ageless self, namely narrative gerontology, identity, and the role of meaning.

Narrative theory across the social sciences and gerontology has examined (a) how the structure and function of narratives reveal their purpose (e.g., Garro & Mattingly, 2000), (b) how narra-tive can both constitute and revise experience, as in the context of major life transitions (e.g., Becker, 2001), (c) scientific rigor and narrative data in gerontological or health services research (e.g., Rubinstein, 1992), and (d) the use of narratives as therapeutic tools (e.g., Birren & Cochran, 2001; Clark, 2001; Ryan, Bannister, & Anas, 2009).

Gerontology’s engagement with identity has expanded exponentially, particularly with regard to embodiment and memory. Kaufman’s assertion that identity is an iterative process constructed both over time and in the context of contemporary social and somatic events is taken up again in the work

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of Featherstone and Hepworth (1991) and in part by Cohen (1998), who recognizes the importance of disconnecting the temporal experience of the self from that of the body but importantly cautions a consideration of cultural relativism. Epistemology notwithstanding, the role of the body as a central actor in age and identity discourse prevails. The relationships among body, mind, self, and other in mediating personhood, age, identity, and experience continue to be explored in such contexts as chronic illness (Laz, 2003; Roberto & McCann, 2011; Solimeo, 2009), disability (Luborsky, 1994), family caregiving (Breheny & Stephens, 2012), long-term care (Gubrium & Holstein, 1999), and memory loss (Leibing & Cohen, 2003; McLean, 2007).

Anthropological contributions expanding on identity and personhood research in dementia care have “highlight[ed] the role of sociocultural pro-cesses that influence the development, meaning, and experience of dementia” (Whitehouse, Gaines, Lindstrom, & Graham, 2005, p. 320) and have led to strategies to improve quality of life for persons with dementia, based on anthropological theo-ries of personhood (Herskovitts Castillo, 2011). Finally, the importance of meaning to understand-ing the life course is exemplified in gerontological research on retirement (Savishinsky, 2000), suffer-ing (Black, 2006), and residential issues (Roth & Eckert, 2011; Wiles, Leibing, Guberman, Reeve, & Allen, 2012).

Where Do We Go From Here? Research at the Intersection of Anthropology and Aging

The work of Clark and Kaufman raise numer-ous questions for future research. We suggest the following topics as points of departure.

Cross-cultural Study of Age Adaptions

To what extent are Clark and Kaufman’s find-ings generalizable to other cultural settings? As noted earlier, Clark urged future comparisons of aging in cultural settings in which “secondary value orientations” are mainstream across the life-course with her own findings of late-life adapta-tions to age-unfriendly community norms and mental health. These comparisons raise additional questions:

• Do all old-age cohorts face similar late-life adaptive tasks? Do they employ similar criteria

in defining desirable ways to accomplish those tasks?

• Do contemporary U.S.  older adults continue to face the “cultural discontinuity” of values described in Culture and aging? If so, how do they deal with it?

• Does a late-life shift to the value orientations Clark labeled “secondary” continue to be adap-tive for today’s older adults? Do those who undergo significant late-life value shifts continue to experience the self as “ageless”?

• What is the impact of accelerated culture change on the process and experience of situated aging and identity continuity?

Additional Exploration of “the Ageless Self”

Although Kaufman’s notion of “ageless self” has generated little systematic follow-up research, it has elicited considerable anecdotal evidence. It is not unusual for older informants to share reflec-tions that age was irrelevant to self-image until major life transitions or serious illness caused them to see themselves as society might—as old people. Additional systematic research on the “ageless self” is in order.

Anthropologically Informed “Successful Aging”

The study of “successful aging” has expanded beyond biomedical approaches, thanks in part to anthropological contributions (Lewis, 2010; Willcox, Willcox, Sokolovsky, & Sakihara, 2007). Although an emphasis on the role of culture in suc-cessful aging is not new, the rapid, international demographic transition provides unparalleled opportunities to examine the interaction of culture change and age-related adaption. Such interactions are particularly germane to understanding person–environment fit and related research on supportive housing, service environments, and informal elder-care. Key questions in this line of research include

• Is “successful aging” a relevant concept in other cultural settings? If so, do definitions vary across different cultural contexts?

• How do specific definitions of successful aging influence systems of eldercare and support?

• Are “person-centered care” and emerging mod-els of culture change in residential care environ-ments relevant in non-Western settings? What other models might inform age-adaptive long-term care?

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Technology as Mediator of Age, Identity, and Meaning

New technologies, such as digital social networks, have the potential to facilitate identity continuity in circumstances where retirement, outward appear-ance, and impairments traditionally foment dis-continuity. Along with these technologies, however comes complex methodological questions concern-ing narrative processes and identity performance. An anthropologically informed narrative gerontol-ogy could consider such emerging questions as

• How do virtual social interactions of older adults differ from their face-to-face communica-tions? What are the implications for the experi-ence of aging that is situated in virtual cultural contexts?

• As digital discourse exponentially increases, do cross-cultural or cross-national differences in communication styles coalesce?

• How do emerging technologies for memory training influence one’s sense of self or aging? Do they present viable tools for age adaption?

• How do technological advances in prostheses affect self-concept and the experience of the “ageless self”?

Conclusion

As noted earlier, Culture and aging concludes with a call to “bring culture into the foreground… as one of the active principles or forces in a psych-ocultural process (of adaptation to aging)” (Clark & Anderson, 1967, p. 393). A growing number of disciplines such as neuroscience and cognitive psy-chology (Cacioppo, Berntson, Bechara, Tranel, & Hawkley, 2011; Park & Gutchess, 2006), psychol-ogy and personality studies (Hooker & McAdams, 2003; Westerhof, Whitbourne, & Freeman, 2012), and more applied fields such as geriatric psychia-try (Whitehouse et  al., 2005) and gerontological occupational science/therapy (Rudman, 2006) are heeding that call by expanding their scope of inquiry to consider the impact of cultural factors on aging processes.

Funding

Dr. S. L. Solimeo is supported by the VISN 23 Patient Aligned Care Team Demonstration Lab, funded by the VA Office of Patient Care Services and the Center for Compressive Access & Delivery Research and Evaluation, funded by the VA Health Services Research and Development Service. Neither of these sponsors had any role in the study design, meth-ods, analyses, or interpretation or in the preparation of the manuscript and the decision to submit it for publication.

Acknowledgments

The authors gratefully acknowledge Robert Schrauf and three anony-mous reviewers for their constructive feedback on earlier versions of this article and Melissa Fox for her administrative support during the writing process. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.

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