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Generativity for the Cognitively Frail

2015; Wiley; Volume: 63; Issue: 6 Linguagem: Inglês

10.1111/jgs.13445

1532-5415

Daniel R. George,

Resilience and Mental Health

Generativity versus stagnation is the seventh stage of Erik Erikson's theory of psychosocial development—during this time, healthy patients find ways to create or nurture things that outlast them. This sentence roused me during an otherwise somnolent morning lecture on human development for our second-year students at Pennsylvania State College of Medicine, where I teach. It also got me thinking about a woman I had once known. As a doctoral candidate in medical anthropology last decade, I spent a year among a group of nursing home residents with dementia who volunteered weekly at The Intergenerational School (TIS) in Cleveland, Ohio, which invites persons with memory loss as “mentors” for elementary-aged children.1 One of the volunteers was an 88-year-old woman named Jane B. Jane was a former schoolteacher whose fun-loving spirit belied a failing body. The first time I met her, in October 2007, she beckoned me into her room from her bed and pointed at a googly-eyed Halloween pumpkin on her television. When touched, the crown of the pumpkin would flap up and down to the '80s popsong “I Want Candy,” as if singing. Each time I tapped it, Jane would laugh and urge me to do it again. Despite her extroverted nature, Jane had been moved into a locked unit and was not responding well. Over the previous 2 years, she had buried her husband, son, and sister, and the grief from those losses had precipitated her decline. Most days, chronic pain kept her in bed, and she was frequently agitated with care staff, finding respite only in visits from therapy pets and children. Erikson might have termed Jane's nursing home existence a textbook case of “stagnation”—a feeling of being disconnected and unable to contribute meaningfully,2 but whereas Jane was a “patient” on the locked unit, she was a “mentor” at TIS. Classroom activities were structured to foster this role. With kindergarteners, the elders became reading mentors; with older students, they participated in 20th-century history lessons that drew upon their long-term memories and capacity for storytelling. Jane delighted in working with younger children, who greeted the volunteers with songs that never failed to get her smiling and clapping along. When reading books, she made sure to position students alongside her wheelchair so that their arms were touching. With the older students, Jane assumed a more didactic manner. She would often launch into stories that deviated from the prompt and spoke in garbled sentences. Yet despite her disjointedness, Jane possessed an air of confidence. The assertive sweep of her hands, the confident forward lean in her wheelchair, and the almost moralizing timbre in her voice were suggestive of a former educator who still felt she had something to impart to students. Because I often visited the locked unit before trips to TIS to convince Jane to come along—thereby witnessing her meek and cantankerous behavior—it was fascinating to observe her transformation into a generative force with kids. The weekly ritual of “creating and nurturing” was not lost on Jane. During one visit, she pulled me aside and said, “This is an education every time I come here—the kids really need people like us. For heaven's sakes, we're trying to help children, and we can still be doing this! It helps both sides of the picture!” However transformative those visits to TIS may have been, their ameliorative effects faded each week as the locked unit returned Jane to ruts of dependency, helplessness, depression, and fixation on physical discomforts. The constant presence of care staff and the objects, sounds, smells, and signposts of a medical institution seemed to reinforce this “stagnant persona.” In contrast, TIS was free of those elements, and their absence fostered a greater sense of self-efficacy. Indeed, once people are labeled with dementia, it is rare for them to be asked to help another person. For those who have spent their lives pursuing meaningful goals to find themselves segregated in a locked unit, being bereft of purpose can be overwhelmingly saddening. “Stagnation” sets in, and there is little opportunity to feel reciprocity, share personal stories, realize goals, or establish a meaningful social identity. In short, our cultural positioning of cognitively frail individuals stifles their generativity. Even Erikson limited his “Generativity” stage to those aged 40 to 64. When the lecture ended, I immediately dashed off an e-mail to a colleague at the home where Jane lived. I learned that she had tried to volunteer for about another year, but her physical ailments prevented her generative visits to TIS. Soon after, she passed away. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: Daniel R. George conducted his doctoral fieldwork at TIS. The author was solely responsible for the conceptualization, authorship, and preparation of this manuscript. Sponsor's Role: None.