The Gerontologist Advance Access published November 22, 2013
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The Gerontologist
Cite journal as: The Gerontologist
doi:10.1093/geront/gnt128
Margaret A. Perkinson, PhD,*,1 and Samantha L. Solimeo, PhD, MPH2
1
NAPA-OT Field School in Antigua, Guatemala.
Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA
Healthcare System, Iowa.
2
*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, 2013
Decision 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 understanding aging as an interactive, socially embedded
process that is adapted to specific sociocultural contexts. Research and therapies grounded in narrativity 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 understanding, 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 gerontological scholarship and practice, signaling both prevailing 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, anthropological 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 antecedents 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), provide an overview of anthropological and other
gerontological works that extend their contributions, 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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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
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 beneficial cross-disciplinary discussions. Moving beyond
the view of aging as a universal process of biological and psychological decline, her anthropological
study of mental health and aging in contemporary 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 satisfaction of older adults, dominated gerontological
scholarship. Culture and aging called gerontologists to “bring culture into the foreground…as
one of the active principles or forces in a psychocultural 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 subsequent single-authored article, Clark, 1967, upon
which our discussion is based.) The withdrawal or
disengagement of the aged was framed as a cultural 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 cultural models of that time.
Many early ethnographies documented cultural
patterning of the life cycle; however, early anthropologists 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 developed 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, lifelong process between an individual’s sociocultural
world and inner life, Margaret Clark influenced the
theoretical foundation of the “culture and personality” movement. In contemporary anthropology,
“culture and personality” has given way to “psychological anthropology,” where human development 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 psychological 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 living in the community with no history of medical
diagnoses for psychiatric problems and the other
half hospitalized for late-onset psychiatric disorders) 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 phenomenological approach, she conveyed participants’ perceptions, 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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colleague, expanded upon Clark’s work in significant ways to become an early pioneer of the field
in her own right. Our intent is to introduce the
upcoming generation of gerontologists to formative anthropological contributions to the study
of aging and suggest a research agenda to further
develop anthropologically informed gerontology. 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 contemporary gerontology.
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 campus 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 amenable to study using traditional ethnographic methods, 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), neighborhoods (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, disability, impairment, and function, viewing these phenomena not as characteristics or attributes of an
individual, but as interactive processes involving
individual capacities and environmental supports
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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 orientations 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-acceptance, 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 recognition. Remaining ambitious and competitive, hospitalized 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 contemporary U.S. culture. Although appropriate and
attainable for most middle-aged persons in postWWII 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 reorganization of goals, values, and behavioral expectations, with emotional well-being hanging in the
balance. Based on the contrasts between the community 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 anthropologists to develop an anthropology of aging,
whose proponents continue to advance the study
of aging as a negotiated process situated in specific sociocultural contexts. With George Foster,
Sharon R. Kaufman: Narrative, Meaning, and
Identity
Sharon R. Kaufman has made her own significant contributions, explicating the processes
by which cultural contexts affect identity and
adaptation across the life course in her ethnography The ageless self: Sources of meaning in
late life (1986) and her related article in Ethos
(1981). Kaufman conducted ethnographic fieldwork 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 demonstrate Kaufman’s key theoretical insight that
identity is performed through the formation, revision, 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 methodology was not novel among anthropologists,
(e.g., Langness & Frank, 1981; Meyerhoff, 1978),
Kaufman’s skillful use of extended interview passages 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 individuals 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 underscored Neugarten’s earlier assertion that without 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 continuity (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, continuing impact of Kaufman’s work is illustrated
by the proliferation of gerontological scholarship 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 narrative 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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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 overstating the point to credit Margaret Clark alone for
the growing tendency among gerontologists to
view aging as an interactive and socially embedded process that requires adaptation to specific
sociocultural contexts. Nevertheless, anthropologists have been critically involved in these developments, 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 available 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 coworkers (1994), Lamb (2000), Leibing and Cohen
(2003) Sokolovsky (2009), Traphagan (2000), and
van Willigen (1999).
Where Do We Go From Here? Research at the
Intersection of Anthropology and Aging
The work of Clark and Kaufman raise numerous 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 findings 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 lifecourse with her own findings of late-life adaptations 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 adaptive 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 reflections 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 successful 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 eldercare. 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 models of culture change in residential care environments relevant in non-Western settings? What
other models might inform age-adaptive longterm care?
•
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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 processes 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 theories of personhood (Herskovitts Castillo, 2011).
Finally, the importance of meaning to understanding the life course is exemplified in gerontological
research on retirement (Savishinsky, 2000), suffering (Black, 2006), and residential issues (Roth &
Eckert, 2011; Wiles, Leibing, Guberman, Reeve, &
Allen, 2012).
Technology as Mediator of Age, Identity, and
Meaning
Acknowledgments
New technologies, such as digital social networks,
have the potential to facilitate identity continuity in
circumstances where retirement, outward appearance, and impairments traditionally foment discontinuity. Along with these technologies, however
comes complex methodological questions concerning narrative processes and ­identity performance.
An anthropologically informed narrative gerontology could consider such emerging questions as
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 psychocultural process (of adaptation to aging)” (Clark
& Anderson, 1967, p. 393). A growing number of
disciplines such as neuroscience and cognitive psychology (Cacioppo, Berntson, Bechara, Tranel, &
Hawkley, 2011; Park & Gutchess, 2006), psychology and personality studies (Hooker & McAdams,
2003; Westerhof, Whitbourne, & Freeman, 2012),
and more applied fields such as geriatric psychiatry (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, methods, analyses, or interpretation or in the preparation of the manuscript and
the decision to submit it for publication.
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The authors gratefully acknowledge Robert Schrauf and three anonymous reviewers for their constructive feedback on earlier versions of this
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