Negotiating the 'dirty work' of taking care of elders on an Aegean island
The support and care of elders usually comes from three main sources: the state, the community and the family (Doherty 1985; England 2005; Litwak 1985; Ward-Griffin & Marshall 2003). In Greece, the state provides health care and pensions which cover the population over 65. Low-end pensions however, are barely sufficient for meeting the basic needs of food, medication and housing for the elderly attempting to continue to live in their own home. Offspring are expected to assist aging parents both economically and physically, helping with daily activities such as accompanying them to the doctor, shopping for them and being on-call in times of need. According to Greek law, first-degree relatives (e.g., siblings, offspring, parents and spouses) are obliged to attend to the needs of family members who are unable to take care of themselves, a proposition which has a variety of interpretations.
The care of frail elders who need close attendance is traditionally provided by the nearest family, primarily daughters and daughters-in-law. This normative obligation theoretically begins from members of the nuclear family and extends to the kindred, e.g., cousins, aunts and uncles. Alternatively, this task can be assigned to a hired caretaker, usually a middle-aged woman with practical experience, but little to no formal training. This solution began to attract attention in Greece during the 1990s, when masses of immigrants from Central and Eastern Europe arrived in the country, providing a cheap workforce in a clandestine economy (cf. Van der Geest et al. 2004). For many Greek families today, it is a given that the care of an elder relative will involve paying outsiders to attend to daily care in the home (as well as in hospitals). Sending an elder to a nursing home is considered only as a very last resort. Elders resist being displaced from their homes, even though they may encounter difficulties and even dangers, and relatives may accuse offspring who leave a parent in a nursing home of abandoning the elder. Thus, the fate of elders is intimately linked to that of their families. A large proportion of Greece’s elderly live in insecurity, a situation which is much more common than it is publicly admitted. When resources are limited and kin are unable or unwilling to provide any help in times of need, an elder’s life may end in agony and misery.
During three years of anthropological fieldwork on Vouni[note 1]Vouni is a pseudonym, as are all the names of people and places in this article. The selection of the toponym is inspired by the rugged panorama of the island and is derived from the Greek word for mountain [vouno].
, a small Greek island in the northern Aegean Sea, I encountered numerous cases where the needs of a frail elder and the possible strategies of care became an arena of competing interpretations and negotiations between the members of the nuclear and extended family and kindred. From 2004 to the present, I have been employed as a local care manager for Help at Home, a national project for the elderly. For elders who do not have children or kindred to visit them, the local Help at Home programme is their main life line – their hope of somebody ‘opening our door’ Consequently, in the course of routine home-care visits and conversations with elders and their families, I have been allowed to witness and participate in otherwise guarded and veiled facets of family relations. Discussions with inhabitants of all ages in Vouni indicate that the domestic care of elders is mediated by the local system of economic, social, symbolic and emotional exchanges. The negotiation of these dimensions in providing care for elders is the focus of this article which will attempt to explore material (e.g., inheritance) as well as emotional obligations and reciprocities. The notion of capital in its various theoretical guises (social, symbolic, emotional) as a pivotal point in human relations is also explored.
Households, inheritance and informal social insurance for elders
Transfers of wealth from the older to the younger generation serve a number of goals – to show love and affection, as a declaration of duty, support of the younger generation(Finch 1989), a means of securing care in old age (Hetler 1990). Inheritance practices are assisted by and imbedded in kinship systems, residence patterns, marriage expectations and wedding dowries.
Property transfers and reciprocity
The kinship system and residence expectations following marriage on Vouni are similar to what is reported in Greek ethnography for other Aegean islands (Dimitriou-Kotsoni 1993; Kalpourtzi 2001; Vernier 2001). In contrast to the virilocentral and patrilocal residence patterns of mainland Greece (Campbell 1964; Danforth 1979; Friedl 1962; Vlahoutsikou 1997), in the Aegean islands, matrilocal or neolocal choices rule. Most newly-married couples set up a home near the wife’s family, and matrifocality is demonstrated by an enduring strong mother-daughter bond (Casselberry & Valavanes 1976; Dubisch 1974; 1976; 1993; Papataxiarchis 1995). The marriage dowry (proika) is the traditional institution for distributing parental and family inheritance to both daughters and sons. The agreement, designated in a legal document, is part of marriage negotiations, but more recently it has been replaced by a ‘will’, apparently to conform to family law changes in the early 1980s which outlawed the dowry. Even so, Vouniotes continue to give a major part of their holdings to their children at the time of the children’s marriage.
The major and most valuable portion of parental wealth is allocated to daughters in providing a house for them at the time of engagement and/or marriage. Social norms demand that a young woman from even the poorest family must be given at least a house as a dowry. Sometimes elderly parents manage to keep a small house and a kitchen garden for themselves; however, as one 80 year-old man describes, “In order to give a dowry to their daughters, the parents need to leave their home, put the groom inside and move to a hut.” As in many other insular regions of Greece, houses in Vouni traditionally belong to women (the deed is never transferred to the husband) and function as the centre of processing produce from the fields, preparing it for distribution, consumption and reposition of the surplus for future needs (Dubisch 1993). For the Vouniotes, the house is also a powerful symbol which attests to the success of the productivity and reproductivity of the family through the generations and the place where crucial decisions about the family’s future plans are discussed and decided.
‘Good’ marriages for their children ensures parents of assistance and a helping hand in future times of hardship – and when it comes to the care of the elderly, the helping hand is usually female. Families without daughters often provide one of the sons with a house so that he could bring in a ‘daughter’ for his parents, perhaps a young woman from a poor family with several other daughters (i.e., with no dowry of her own) or an orphan (common during and following several generations of war in Greece). Childless couples may adopt a young girl from the kin network, preferably a daughter from the wife’s family, initially to assist with the needs of the household, and later, with those of old age. Most of these adoptions are not legally registered but involve the same set of rights and obligations as in a biological parent-child situation, including providing a legally secured dowry as well as expectations of care for aging adopted parents. In the past, these strategies assured that parents would be taken care of in their old age by daughters – biological, by marriage, adopted – who lived nearby and were all obligated to return the favours they received.
From the 1950s to the 1990s, demographic, economic and social changes in Greece placed this familial and informal system of old-age insurance under considerable stress. Out-migration and depopulation of rural areas, an increase in the age of marriage and a decrease in number of children combined to create the present situation where helping hands for elders are becoming increasingly difficult to find. The creation of a national health care system which extends to the provinces and peripheral areas of Greece, along with the improvement of the standard of living has led to an increase in life expectancy. The proportion of elders among the general population has increased dramatically (National Statistical Service of Greece 2001), but their general health condition has declined. In the 1950s, the life expectancy of a person confined to bed due to a serious health problem (e.g., stroke, heart attack, hip-bone fracture) or simply because of old age would be a few months at best. Today, with modern biomedical technology and improvement in hygienic assistance, elders with these health problems can live for several years. Implementation of biomedical technology led not only to an increase of the number of frail elders among the general population, but also to an increased burden on caregivers from the family.
National-level socioeconomic and demographic changes have reached the island of Vouni and have affected the experience and expectations of growing old and the burden old age entails for both elders and their relatives. The majority of caregivers I talked with in Vouni agree that taking care of a failing family member can be destructive for the caregiver’s health and well-being, a consequence which is supported in the scientific literature (e.g. Vrabec 1997). However, the social matrix of a small community intercedes to negotiate care of elders by relying on old traditions and new methods of preserving the honour and good name of the family, and creating economic and social capital.
Family reputation as capital in Vouni
In a small island community of less than 2500 inhabitants, economic and social survival is dependent on the exploitation of all forms of capital available within a limited geographic and communal space. Daily interaction with others in the community requires constant attention to the maintenance of contacts with relatives and a network which often extend to economic and financial matters as well (Hionidou 2004; Kalpourtzi 2001: 55-56; Salamone 1987; Vernier 2001). Most Vouniotes spend a great amount of time, energy and thought on maintaining and expanding social capital which they rely on for a wide array of matters. They balance an on-going set of reciprocal economic exchanges, obligations and favours which range from lending money, offering a job, acting as a go-between for others (e.g., presenting a relative to a local council member) – to exchanging visits and gifts. Even the act of shopping at a particular store or exchanging a daily greeting or a ‘friendly hello’ may be imbued with dimensions of brokering social capital.
Individual and family symbolic capital, the most significant form of capital according to Bourdieu (1977), is formed by the public elaboration of personal stories through gossip. As the people of Vouni say, “reputation can open or close a door”, an expression applicable to a business agreement, a successful marriage, a helping hand in difficult times, or the authority to promote a claim to a wide audience. Building and maintaining a good name requires balancing actions to stand up to the expectations of a variety of audiences. Strategies of accumulation and maintenance of symbolic capital must be carefully orchestrated because every act can be loaded with ambiguity. In small local settings it is very common that someone will find the opportunity to make negative interpretations about the acts of others or even begin gossip based on rigorous exaggeration. As the residents of Vouni say, “A good name is hard to make and easy to spoil.”
The matrix of obligations from the interactions to create social and symbolic capital can be visualized as a map where past protocols and results function as reference points for the expected outcome of similar exchanges in the present (Appadurai 1987). The good name of the family is based on the honour of its men, the chaste behaviour of its women and the reliability of its promises (Campbell 1964; Friedl 1962; Gilmore 1982; Peristiany 1966; Pitt-Rivers 1977). In Vouni, these values are challenged by the family’s ability to impose, influence or control power and economic relations in the local setting. Thus, the issue of a good name is subject to change and flux. However, what has not changed is the ethical obligation to care for family members and the central place of women as the primary nurturers and caregivers in the home and for the family. Women play a crucial role both as representing the ‘inside of the family to the ‘outsiders’ as well as maintaining its internal harmony through their control of forces of disorder and pollution (Dubisch 1986; 1993). Even in previous generations, where they were expected to be auxiliaries to men, they were also appreciated for their skill in financial management, knowledge of community economics as well as the moral guidance of other family (Safilios-Rothschild 1976; Salamone 1987). As men in Vouni say, “A wife can fix or destroy her husband.”
The good family name is both the inheritance and the heritage of the offspring (Sutton 1997: 431), who will eventually fall heir to taking care of the elders. Family members are expected to be united in order to achieve the goals of the family and meet the needs of individual family members. When I asked locals what constitutes a ‘good family’, I would hear the immediate and emphatic reply, “Well, I’ll give an example. Our family is a good one!” People may describe other families as strong, capable or wealthy – but it is their own family which is the paradigm.
Care in the family as presented to an outsider
When specific family members are assisted throughout life by their parents, siblings and other kin, they are considered ethically obligated to return the care. Indeed, the way that the obligation is handled has consequences for the good name of the individual and the family, as supported in the following observations about how Eleni and Dimitra manage to provide 24-hour daily care for their aging and incapacitated mother.
Dimitra had lived in a nearby neighbourhood on the island of Vouni for most of her life. Eleni worked in Athens where she lived with her husband and daughter. A third sister worked in Athens and, unable to be present on the island due to other obligations, contributed to the care by sending money. She also used her leave-time from work to assist her sisters with hands-on care for their mother. During my visits to their home, both before and after their mother’s death, I was impressed by the fact that every interaction between the sisters, at least when I was present, was conducted so gently in spite of the stressful situation. Eleni explained to me in a private discussion with me that her mother “… always looked after us with love. I am returning that love to her now. I’m just giving back what I took from her.”
Property arrangements were never mentioned and there was no place for me to ask about them in this context. For the local ethos, it would be considered a meaningless imprudence. What was interesting in this case, where obligations were never questioned, is how Eleni justifies, indeed normalizes, the sacrifices she has made for her mother by referring to the ethics of reciprocity well acknowledged in Vouni. As she puts it, she simply returns what she was given in the past. Even though families may lack economic and political power to impose their goals, the fact that its members are ‘all right’ and proper with their symbolic and economic exchanges among themselves and with others indicates to residents of Vouni that it is a ‘good’ family. People who have not been right with their own people are diminished in social and symbolic capital. Although quarrels are common in families, Vouniotes want to keep their family problems concealed from outsiders.
In Vouni, the only situation love is expected to be offered unconditionally is from parents to their children. Vouniotes say that “True love comes not from words, but from actions”, meaning that apart from sentimental support and understanding, love includes offering assistance in solving practical and economic problems. Parents show their love to their children by trying to ensure that they will not lack for anything, either materially or emotionally. Acquiring landed property for the sake of one’s children attests to the wealth of the family; it is ‘forever’, tangible, visible to everyone and an uncontested means of offering love. It represents more than emotional support, presents or small gifts of money. Loving a child is an obligation because it is parents who bring children into the world. It also represents fulfilling an obligation to the kindred and past generations: “As their parents raised them, this is what they must do with their own children.” On the other hand, parents have a right to their children’s love, only when and if they have proven themselves worthy of it by being consistent to all of their ethical, emotional and economic obligations as a parent.
The concept of ‘struggling for’ or ‘fighting on behalf of’ is also used to describe the way that parents care for their children. Parents in Vouni put all their efforts in providing for their children’s emotional, economic and material well-being – sentiments deeply entrenched in providing dowries and inheritance of property which also create reciprocal obligations. These altruistic actions are counterbalanced by the possibility that parents will need their children’s support in the future. They often express concerns about who will look after by them when they are old and unable to take care of themselves – perhaps anticipating that they will have given away all their resources and will no longer have any lever to demand care.
Local categories for the practice of care
When residents of Vouni discuss the tasks of care for elders, the standard Greek term for care [frontida] is rarely used. Instead, the local expressions differentiate between light care (see Dressel & Clark 1990) and more demanding, intense care obligations. Small services and errands, light domestic work, follow-up on health care needs, emotional support and simply keeping company with the elder are designated by the verbs for ‘look’ [koitazo] and ‘see’ [vlepo]. Elders are ‘looked after’ or ‘seen to’; their offspring ‘keep an eye on’ them. It is mainly daughters who are expected to keep an eye on their aging parents, but sons (and their wives) are also involved. Even when relations are very strained between aging parents and their children, routine visits must be made for the ‘the eyes of the people’. Bourdieu would describe this as a strategy of protecting symbolic capital against the efforts of opponents to diminish it.
For aging parents, these occasional visits are better than nothing at all, even though others in the small community may question the true motivation; e.g., real concern, feelings of obligation, potential economic gain. Those who have children living nearby are looked after on a more regular basis. Elders express that the ideal would be to live close to one of their children but in a different house, preferably where a daughter (or less preferably a daughter-in-law) could visit them, look after them, clean, cook or bring lunch from her home, oversee their medication and keep them company. Problems arise when the fragile balance of this potentially ideal situation is lost due to the deterioration of an elder’s physical capabilities from a sudden illness or a gradual decline in physical and mental capacities due to aging. The kindred worry whether their elder(s), if left alone in their home, will ‘behave’, if they will comply with the directions of their doctors, check their blood pressure, take their medicines properly and not harm themselves. Elders who are heavily dependent on their family are considered by everyone, even themselves, to be a burden. When this happens, the routine of keeping an eye on them no longer suffices to balance their needs with the obligations to offspring, family and kindred. Someone must begin to ‘work on behalf of’ or ‘struggle for’ the elder.
The verb which is used in Vouni to convey the concept of work and struggle [polemo] is the same one used to refer to ‘fight’ or ‘battle’; as a noun, it means ‘war’. Indeed, the Vouniotes believe that work has all the characteristics of a struggle for survival, much like fighting in a war battle. The hardships of living on a small island with limited resources often lead to severe and prolonged antagonisms between residents. The doxa[note 2]The term ‘doxa’ is used to denote what is taken for granted in any particular society and what its members share as basic assumptions about ‘reality’ and the way the world works. In this view, doxa is the experience by which the natural and social world appears as self-evident, the “universe of the undiscussed” (Bourdieu 1977: 168).
of the inhabitants, their unquestioned, uncontested ways of thinking and acting are probably shaped by the fight to survive. Struggling on the behalf of an aging parent is an investment; it brings claims, a type of ‘interest’ in Bourdieu’s terms (1977:39-40). It may bring a monetary reward, or the satisfaction of work completed, or the expectation of future benefits. However, in the process, the elderly become transformed from agents (doing their own work, cleaning the house, tending the garden, etc.) to objects. No longer able to work for themselves, they become the objects of the work of others. This is exactly the type of situation abhorred by all elders in Vouni. They declare that they would rather die than become a burden on their family.
The boundary between keeping an eye on and struggling for is cloudy; both concepts contain colliding interpretations and negotiations. However, there are non-negotiable events which indicate when the needs of an elder can no longer be managed by occasional visits and the care level needs to move into the next phase of struggling for. Warning signs include lapses in remembering the way to the kitchen or bathroom, difficulties in getting out of bed, forgetting personal hygiene, and the most symbolically and practically loaded matter of personal toileting. The period between the moment when the problem is communicated and the moment that a sustainable arrangement is reached is full of stress and anxiety for all involved. It is time for the younger family members to meet their obligations of care for a frail elder and to capitalize on the value of fulfilling promises and parental expectations. It is also the time for last-minute alliances, confessions and the solidification of verbal contracts or written documents of commitment regarding finances and inheritance.
The accidents from incontinence challenge every caregiver and become a nightmare for family members who personally attend to their elder(s), and an even greater trauma for elders. The fear of not being able to control private bodily functions appears in deeply entrenched Greek expressions about urinating or defecating on one’s self out of fright [katouriemai / hezomai pano mou], making a big mistake or making a mess out of things (“I made shit out of everything!”), expressing contempt (“Let him shit on himself!”) or placing a curse (“Eat shit!”). Decisions about who undertakes the ‘dirty work’ in caring for incontinent elders are made according to past agreements, official or unofficial, regarding the distribution of parental holdings. It is an unspoken understanding in Vouni that the person who undertakes fighting on behalf of an elder (and taking on the dirty work) is already indebted by a prior property transfer, usually a dowry. Thus, daughters are first in line to commit to the struggle. If there are no daughters available daughters-in-law are also candidates for the struggle; even though their own dowries come from their own parents, they have obligations to support their husband’s inheritance.
Elders may offer hidden assets in exchange for protection and intimate bodily care; for example, a piece of land that up to that moment was promised on word to another family member. Those who do not believe they receive the at-home care they need may suddenly decide to leave their last belongings to the church. On the one hand, they may use this tactic in a genuine effort to bypass the waiting list for the church’s nursing home; on the other (probably more likely), they use this as a method to mobilize relatives to take action by providing more and better at-home care. Sometimes it is only an elder’s ultimate survival strategy, but for elders that have lived all their life at the bottom line of symbolic and economic hierarchies, even this last device may prove useless.
The following case study is an extreme example of the ways the family relations, and the socio-economic status may prescribe the last days of a Vounioti elder.
Without a family: Calliope and Panayiota
Calliopi never married nor had children. She reached old age without any significant health problems, an asset which allowed her to live on her own in her small one-room house. When she was 82 years old, she fractured her hip in an accident and required surgery. She never fully recovered from the fall and became unable to walk or get out of bed. No one had ever liked Calliope, perhaps because she had been diagnosed as mentally ill, and she was treated by everyone as an outcast. She was without any financial resources and everyone in the area knew that she would be unable to pay anyone to take care of her. No one felt obligated to her or willing to struggle for her either for monetary contributions or hands-on care.
When the situation became increasingly difficult, Panayiota the wife of one of Calliopi’s nephews was called upon to take care of her. Panayiota’s extended family on her husband’s side implied that she should take care of Calliope because she lived next door. She stated that she felt suffocated by the expectations of the relatives that she should be the one to undertake the ’dirty job‘ of cleaning and toileting Calliope and she rebelled: “We never were close anyway. Why should I be eating her shit now? I don’t owe this to anyone.”
As time passed, in spite of her negative feelings, Panayiota ended up giving Calliope some help, in particular in feeding her and administering her prescribed meditation. For this she gained considerable symbolic capital as a good and merciful woman. No one ever showed interest in undertaking bathing and diapering tasks, or in contributing financially to hiring a professional to attend to these matters. Nobody found a reason to do so, financially or emotionally. All the dirty work was conducted by the personnel of the local Help at Home programme, until, after a long struggle with paperwork, petitions and negotiations, a local social worker managed to find a philanthropic place in a nursing home run by the Orthodox Church in the port town. This was almost three months after the initial incident which caused the Calliope’s impairment. She died a few weeks after her arrival at the home.
The same coprophagic metaphors seemed to be always present in all of local’s conversations about Calliope. It seemed that suddenly her faeces had become an issue of public debate. Men and women would even stop me on the street asking if she was wearing diapers and how often they were changed, if she was smelly, how she was bathed, and so on. Eventually people would say to me “So, finally you have ended up eating her shit,” referring to the Help at Home personnel with sympathy. Even a priest expressed his reservations about the odds of Calliopi’s by-passing the waiting list of the church’s nursing home: “Why would they do that? Just to eat her shit?” The reason Calliope was not only left to her own fate but also unprotected against public vilification can be seen as a result of her inability to create social capital amongst people obligated to her at any level. Additionally, she had no considerable economic capital such as a house and her symbolic capital was so small that she could not expect being respected by anyone.
These comments are extraordinary in a culture where the bodily fluids of others are considered extremely disgusting, if not ritually polluting. The local verbal etiquette calls for adding ‘excuse me’ to any uttering words or phrases such as toilet, urine, underwear, etc. Even so, as mentioned earlier, coprophagic metaphors are frequently used to emphasize mistakes, show contempt or express a curse. There were several other cases before Calliope’s when the health aides from Help at Home needed to attend to dirty work, but there was never so much fuss about it. Besides, especially for women, who in Greece are primarily responsible for the material and symbolic purity of the household (Salamone 1987) cleaning up faeces of both babies and elders is a triviality of life well concealed behind house walls. It would be unthinkable for a mother in Vouni to complain about diapering her children, much less to use a copraphagic expression to refer to this care. In the case of a frail elder, however, various scatological thoughts might pass through a person’s mind, but they would rarely be stated in public. Panayiota was not keeping an eye on Calliopi because she loved her; indeed, relationship had always been bad. Rather, as she said, she helped because she was ‘feeling pity for her’. For the public eye this was a sign of ‘mercifulness’. She was abundantly praised for what she did for Calliopi. Mercy can be offered to anyone; it can be seen as giving without expecting a return (Sahlins 1972).
Care giving within the family has often been ‘sanctified’ in the care ethics literature as an arena encased in moral and ethical values that govern behaviour, influenced by a long tradition in Western thought which runs from Heidegger to Mayeroff (1971) and Tronto (1993).
Those who sincerely care for others act for particular others and for the actual relationship between them, not for their own individual interests and not out of duty to a universal law for all rational beings, or for the greatest benefit of the greatest number (Held 2002: 166).
While the concept of reciprocity is coherent and useful in the market economy, it could easily be argued that it is out of place and incompatible with the ethics and morality of ‘genuine’ care. However, the parameters of ‘generalized reciprocity’ as outlined by Sahlins (1972), offer resolution. In contrast to balanced and negative reciprocity where obligations are based in chronological and quantified measures, general reciprocity does not carry rules about the time, the quality and the quantity for the retribution of the obligation. Reciprocity in caregiving has these flexible qualities and, thus, resembles the mentality of gift-exchange reciprocity when the mutuality of the gift is concealed by the chronological delay in the ‘return’ (Bourdieu 1977; Carrier 1991; Malinowski 1983; Mauss 1989).
Social norms about what comprises ‘good caring’ in different social settings are always contested in practice by conflicting notions of needs and responsibilities and shortage of economic and social resources (Badini-Kinda 2005; Finch & Mason 1993; Risseeuw 2001; Van der Geest 2002; Vera-Sanso 2004: 79). Family solidarity in Vouni is also based upon such a scheme of reciprocal exchanges. The main question that arises is how the nature of the exchange is understood and treated by the key participants (Finch & Mason 1993: 57). As the next case shows, notions of morality regarding elder care in Vouni arise in relation to past family transactions in the form of dowry, the obligation of payback and the commitment of parents to help their children. Tensions emerge when decisions favouring one family member over another are made.
Reminder of an obligation – Maria, Georgia and Anna
Maria is an elderly widowwith a small pension and known to Vouniotes for her capacity to stir up relations between people. Anna and Georgia, Maria’s only children, have been living in Northern Europe for several years. Anna and her husband built a house in the island’s port town. Georgia was not so fortunate and has serious health problems. Perhaps this was the reason Maria gave Georgia her home – even if it is in a little isolated village house heated by a wood-burning stove and with toilet facilities outside of the house. Gossip says that Anna was not consulted in the decision.
Anna suggested to her mother that she could live in the new house built by herself and her husband. The house was a considerable improvement from Maria’s own village house, which she had already bequeathed to Georgia. Anna offered the house to Maria rent-free, a generous offer as she could rent the house to strangers which was a usual practice for islanders living abroad. After some years, Anna’s son, Kostas, formerly living abroad, came to live in the house in the town, a situation which caused a great deal of tension between the young man and his grandmother. Very soon, the two were not speaking. In Kostas’ view, Maria tried to undermine his relations with Anna, using false and unjust accusations. He considered the possibility of leaving and renting a room elsewhere. Suddenly, Maria had a stroke, leaving the lower part of her body paralyzed. Her daughters immediately returned to Vouni from abroad, but it soon became apparent that one of the two would assume the long-term care.
Georgia was the likely candidate as the social custom suggests that the person who inherits the maternal house is responsible for the care of the elders who formerly lived in it. But the village house was not compatible for the needs of a frail elder, thus Georgia needed to relocate to the house in town where both she and her mother would have to make do with Maria’s small pension. Georgia voices her concerns during a Help at Home visit; e.g., she has her own health problems, lacks money, the village house lacks facilities for the care of her mother. Reminding Anna that “She is your mother, too”, Georgia claims that Anna should contribute to their mother’s care by doing some of the work herself or giving money or allowing both Maria and Georgia to live in the house in town.
None of these options is acceptable to Anna. She has to weigh the cost to her son, Kostas – who is already stressed by the tension with his grandmother and if both Maria and Georgia will stay in the town house, he will have to rent somewhere else. Anna also says she cannot leave her life, her work and move to Vouni for the sake of their mother and she is not able to contribute money. It is Georgia’s job to work for Maria and both of them should move to the village house, in spite of its difficulties and lack of modern conveniences. She suggests that if Georgia cannot go through with this plan, their mother should be put to a local nursing home.
Georgia replies. “I won’t throw my mother away.” Anna answers in the same tone, “The way you two arranged things, now do what you may. You made your bed, now sleep in it.” Her statement implies that Georgia and Maria had a secret arrangement, including naming Georgia as the owner of the village house in Maria’s legal documents for her will.
Within two days Georgia and Maria moved to the village house. The entire situation created a great deal of comment from the local population. There were two focal points – sometimes used in arguments put forth by the same person, an indication of the complexity of the investments. The one was that Anna was unduly cruel, because “you cannot throw out your parent like this.” The other, that she was not obliged to do otherwise: “It’s Anna’s job” to manage the needs of her son with those of their mother: “Who should she look after, her mother, or her son?” The issue of Maria’s reputation to stir-up people and situations was also brought in: “Don’t imagine that she is blameless.” In the meantime, Georgia gained symbolic capital from the locals; she was praised by everyone for undertaking the burden and ‘doing what she had to do’ and for meeting her obligation as the heiress of the maternal property.
Anna’s strategy of forcing everyone to make his own choices was very effective in terms of the local value system. She pushed her sister to do the ‘right thing’ and to set aside her own difficulties. She also protected the interests of her own nuclear family – particularly those of her son – to care for him is a number one obligation of a ‘good mother’. She risked her own and her family’s symbolic capital by sending her mother back to the little village house and invited future comments of “Well, you reap what you sow” and might be kicked out of her own son’s home in her own old age. However, she consolidated her claims to receiving proper care from him in later years. Her son, according to the local ethics of exchange, became obligated to return the favour to his mother.
In closing …
A quick review of the relationship between the informal social insurance system as it functions for the care of elders in Vouni intertwines inheritance practices, kinship obligations, residence patterns, marriage expectations and wedding dowries. Threads of affection and concern, love and maybe even fear, run through these ‘traditions’ and the local doxa. Decisions over the distribution of assets may favour one child over another and cause severe family conflict (Titus, Rosenblatt & Anderson 1979) which can provoke tremendous complications in taking care of elders. For elder Vouniotes,keeping all their children happy and at peace with each other through a ‘just’ sharing is a strategy that gives a better chance for a safe old age. This lifelong strategy is easier to achieve for the more prosperous.
The duty of offspring, particularly daughters, to attend to the needs of aging parents is conceptualized as the repayment of long-standing debt to them. Its most unchallengeable proof of its existence in the public eye is the transfer of parental property to offspring – or if there are none, to another relative which automatically implicates them in the chain of payback when the time comes. The particular form of payment is publicly scrutinized and controlled through mechanisms of social sanction such as gossip. Levels of care are designated, not as ‘care’ per se, but by expressions which refer to ‘looking after’ or ‘seeing to’ and, when heavy-duty care becomes required, by ‘fighting for’ or struggling on behalf of’. The level of indebtedness (which can be emotional as well as material or economic) provides the context for both the type of care to be implemented and the particular family member(s) selected to carry it out.
In recent years, perhaps beginning a generation ago, this social insurance scheme has become increasingly vulnerable to snags, strains and even failure. The growth of the aging population places increasing expectations on family members as caregivers. Middle-aged women, and especially mothers are caught in the middle of two generations that need their help; their children and their parents. They struggle to prove themselves worthy of their elder parents’ by caring for them properly and assisting their own children.This is not unique to Vouni; in most societies throughout the world, women are called upon to be the caregivers, either informally in the family or in the official care system (nurses, health aides, medical social workers, etc.). Women are considered to be the ‘natural’ caregivers of choice due to their “adeptness to cultivate ties of personal affection” and their “capacity to express empathy, elicit mutual trust” (Held 2002: 166). It is not by chance that care ethicists derive paradigms from the experience of women in activities of care – particularly for children, the ill and the elderly (Gilligan 1982; Noddings 1986; Ruddick 1989).
Giorgos Kostakiotis received his Master’s Degree from the Department of Social Anthropology & History, University of the Aegean, in 2008 for the thesis: “Thank God we still stand on our feet”: Bodily capital, property transactions and obligation about elder care in an Aegean island. Currently he is conducting fieldwork for his PhD dissertation entitled Body and politics of care: Bodily, symbolic and emotional capital in the Greek family and society on the island of Vouni where he works as the coordinator of the local national “Help at Home” programme. Email: firstname.lastname@example.org
I would like to thank Winny Koster, Janus Oomen and other participants of the ‘Care & Health Care’ Symposium held at the University of Amsterdam, December 2009, for their constructive comments. This work would have never been possible without the encouragement and help of Deanna Trakas, whom I most deeply thank.
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