Atwood D. Gaines

Sustained personal autonomy: A measure of successful aging

Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period? Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years. Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes “favors family or self over agency assistance” and “does not expect filial obligation” were also independently associated. Discussion: The results are consistent with previous studies of successful aging and showthat attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years.

Physicians of western medicine : anthropological approaches to theory and practice

Section I: Introductions.- 1. Among the Physicians: Encounter, Exchange and Transformation.- 2. Including the Physician in Healer-Centered Research: Retrospect and Prospect.- Section II: Core Medicine.- 3. A World of Internal Medicine: Portrait of an Internist.- Section III: Medical Specialties.- 4. Models and Practice in Medicine: Menopause as Syndrome or Life Transition?.- 5. Mary Patient as Emergent Symbol on a Pediatrics Ward: The Objectification of Meaning in Social Process.- 6. How Surgeons Make Decisions.- 7. Gentle Interrogation: Inquiry and Interaction in Brief Initial Psychiatric Evaluations.- 8. Reflexivity, Countertransference and Clinical Ethnography: A Case From a Psychiatric Cultural Consultation Clinic.- 9. The Once- and the Twice-Born: Self and Practice Among Psychiatrists and Christian Psychiatrists.- Section IV: Interrelations of Medical Specialties.- 10. Discourses on Physician Competence.- 11. Consultation-Liaison Psychiatry: Medicine as Patient, Marginality as Practice.- 12. Disease and Pseudo-Disease: A Case History of Pseudo-Angina.- List of Contributors.- Author Index.

Cultural Definitions, Behavior and the Person in American Psychiatry

This paper extends work presented earlier (Gaines 1979b) on the relation of psychiatric actors’ definitions of mental illness, seen as folk theories, to professional behavior. A summary of earlier work sees American psychiatry as ethno-psychiatry and examines the role of cultural assumptions in psychiatric theory and emergency room practice. The paper then shows how actors’ definitions affect not only cognitive behaviors such as diagnosis, but also the temporal dimension of interaction with patients themselves. It is shown that differences in etiological definitions affect the length of time a resident spends with a patient before making a disposition. The next section of this paper does two things: First, it suggests that it is useful and possible to distinguish two major “Great” cultural traditions in the West. For each tradition, aspects of world view are sketched. Second, two conceptions of person which correspond to the cultural traditions distinguished, the indexical and referential, are delineated. Lastly, some implications of these differing conceptualizations for psychiatric practice are presented with reference to case material considered in the second section of the paper.

Physicians of Western Medicine

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Visible saints: Social cynosures and dysphoria in the Mediterranean tradition.

Abstract“Visible saints” are individuals in the Mediterranean culture area who lead lives of heroic, exemplary and public suffering. This paper offers an analysis of visible saints as social cynosures as a means of exploring critical cultural psychiatric issues. We examine the changing nature of saintly suffering in the culture area and look at the media through which familiarity with the saints and their passions is developed and maintained. A detailed clinical case study is presented of “Madame Lorca,” identified by her peers as a “saint.” We focus on a particular illness episode which proved to be an amplification of symptoms of long standing. Psychiatric diagnostic instruments were administered and indicated the presence of severe clinical depression. However, our research suggests that Mme. Lorcas symptomatology reflects culturally specific methods of coping with dysphoric affects and chronic, illness. The paper concludes with an exploration of the nature of personal illness as it relates to a wider cultural system of meaning. The findings demonstrate that the visible saint and her symptomatology are part of a cultural system which generates, promotes, patterns and frames the experience of dysphoric affect in a cultural complex quite distinct from that of clinical depression.

Effect of Giving Care on Caregivers’Health

This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health.

Culture-specific delusions : sense and nonsense in cultural context

It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it. For these reasons, the determination of delusional or normative ideation can only be effected properly within particular cultural contexts. The cross-cultural record suggests that it is difficult to separate the delusional from the cultural; a belief that is patterened and culturally specific is, by definition a cultural, not a delusional belief. One must rely upon particular, relevant local cultural understandings to ascertain when the bounds of culture have been transgressed and meaning has given way to unshareable nonsense.

Among the Physicians: Encounter, Exchange and Transformation

Anthropologiests and colleagues have entered a new territory in the heartland of their own society, the Domain of Biomedicine.1 They have returned with accounts both strange and strangely familiar. Practitioners of Biomedicine assume as essentially and exclusively true their own theory and practice, their “science” which professes the cellular, even biochemical basis of pathology. Anthropologists and medical critics have been struck by this reductionism which excludes alternatives and which asserts a biological universalism and individualism (idiopathic etiologies) which ignore, if not deny, basic anthropological understandings which see cultural and social forces as wellsprings of human behavior, including healing and suffering. Anthropologists have been further challenged by the barriers to communication built into the complex edifice of Biomedicine. At the same time they have also recognized in practitioners of biomedicine values and premises which they share, parts of a common culture. Anthropologists looking at Biomedicine, thus, have seen versions of themselves as well as alien elaborations of their own culture.

Anthropological contributions to the understanding of age-related cognitive impairment

Medical anthropology has not only helped us to understand the social, political, and ethical foundations of modern biomedicine, but also improved the identification and treatment of patients in various geographic, sociological, and medical contexts. In this article, we present an anthropological perspective on the understanding, diagnosis, and treatment of age-related cognitive impairment. The ubiquity of cognitive changes in the growing number of elderly people around the world, and the many diverse responses that human communities have taken to such challenges, require biocultural approaches. Anthropology can serve as an ally in accomplishing the goal of improving the quality of life of those with cognitive impairment by highlighting the role of sociocultural processes that influence the development, meaning, and experience of dementia. So too can it serve as a framework for criticism of biomedical research, theory, and practice.

Attitudinal Influences on the Elderly's Use of Assistance

This research examines the use of informal and formal assistance with personal and instrumental activities of daily living and the amount received by a randomly selected sample of urban older persons. A modified version of the Andersen behavioral model is used to organize explanatory factors that include the elderlys attitudes toward service use and filial expectations. Findings underscore the important influence of attitudes on assistance use in contrast to self-designated race, which had no influence either independently or in interaction with attitudinal variables. Elderly persons more likely to receive assistance were women of older age with lower incomes, who expressed more concerns about using services and were more physically disabled. Those receiving larger amounts of help had fewer concerns about using formal services and lived with their primary caregivers.