Defending a Husband's Role Identity Against Memory Loss Effects

1. Behind Closed Doors: Defending a husband’s role identity against the effects of memory loss DINAH BISDEE, DEBBIE PRICE, TOM DALY BSG 2009, 3rd SEPTEMBER INSTITUTE OF GERONTOLOGY dinah.bisdee@kcl.ac.uk debora.price@kcl.ac.uk thomas.daly@kcl.ac.uk

2. Background – ‘Behind Closed Doors’ Project How do the financial resources of men and women differ within and between older couples? What are the drivers of difference? Quantitative Study How do older couples view, manage and negotiate about money? What (if any) are the implications of within-couple unequal ownership of financial resources for the well-being of older people and their families? Two Qualitative Studies – focus groups and couple/individual interviews What ageing and ageist discourses and practices are prevalent in the formulation of government policy relating to money? How do these relate to the money practices of older couples? Policy Study

3. Identity and Older Couples Our qualitative research has thrown light on many questions, but has also suggested many additional research questions. Here we deal with issues of identity and role identity raised by declining cognitive powers. We look at cases in which memory loss/ dementia have impaired a spouse’s ability to manage household money, and led to the other spouse’s taking on aspects of that role Yet doing this in a surreptitious way so as not to undermine the self-esteem of the person whose traditional role that was.

4. What is Role Identity? Arose from symbolic interactionism: Mead, Stryker The concept of ‘role’ emerged to explain the relationship between social structure and individual behaviour (n.b. McCall & Simmons, 1966) “The self…is composed of various identities (or role identities) and is lodged in roles, relationships and statuses that develop as the self reflects upon itself as an object.” (Adler & Adler, 1989) Role Identity: a kind of idealised view of one’s social role “…the character and the role that an individual devises for himself as an occupant of a particular social position….such a role identity is his imaginative view of himself as he likes to think of himself being and acting as an occupant of that position.” (McCall & Simmons, 1966, p.67, their italics)

5. Threats to Role Identity Actions not consonant with one’s imagined role, may be regarded as threatening in some way, e.g. embarrassing or shaming. “The contents of a person’s role identities provide him with criteria for appraising his own actual performances.” “Men seek to live their lives and to live them in the light of their role-identities.” (McCall & Simmons, 1966) Family roles include: husband, wife, father, mother, grandparent…… these lead to “familial role expectations”(Stryker, 1968). To ‘enact’ and maintain perceived role identity, a person looks for ‘role support’ from self and from others. If threats are not dealt with, may lead to loss of self-esteem, feelings of failure, despair, even self-destruction.

6. Example: Christopher Foster Financial losses threatened his view of his role as husband and father. He shot his wife, daughter and their horses then burned their house and shot himself. “A millionaire in severe financial difficulties told friends of his suicidal intent and fears that his wife and daughter would not cope if they were forced to downgrade their lifestyles, an inquest heard yesterday.” Guardian report of inquest, 3rd April 2009.

7. Dealing with Threatened Role Identities Peter Burke with his ‘Identity Control Theory’ postulated a feedback system whereby people would compare their role performance with their ‘idealised’ role, and make modifications to behaviour to try to ensure a match. Threats to role identities may be dealt with in a variety of ways, e.g. selective perception, selective interpretation such as overvaluing one’s own performance ‘leaving the field’ – abandoning that role identity or reducing its salience to oneself finding excuses/ causes of particular failures, i.e. externalising them Role identity includes the imagined reactions of other people to one’s performance of that role: thus, the role of husband implies the reactions of a wife. “Expectations of others define roles and enter the structure of the self.” (Stryker & Statham, 1985, p.324)

8. Identity, Older Couples and Money Burke recognised that the idealised role might change over time (e.g. Burke 2006; Burke & Cast 1997). Stryker proposed a ‘hierarchy of salience’ of roles. The relative salience of roles and role identities may develop and change as people age. In particular, familial roles may become relatively more important, as the salience of work-related identities declines. In our research, we have found that traditional gender roles in an older household seem often to be reflected in their money practices men dealing with expenditure commitments (e.g. relating to property and cars) women dealing with items liable to short-term variation (grocery shopping, gifts, clothing) men often controlling, though women may ‘manage’ (cf Pahl, 1989)

9. Couple Identity and Dementia Our sample included 2-3 couples in which the husband was apparently developing memory loss, dementia or Alzheimer’s, though this had not necessarily been fully diagnosed Growing recognition among researchers that the couple and their relationship have been omitted from thinking about dementia. The couple’s marriage “.. creates a biography with a shared view of reality that is altered by dementia, creating new social relations in marriage referred to in symbolic interactionism as ‘joint production of meaning’.” (Davies & Gregory, 2007, p. 486) “Couples actively ‘work together’ to manage the ‘awareness’ of dementia in their external relationships….. there is a case for considering that, for spouses at least, the ‘couple’ might be the primary focus.” (Hellström et al., 2005, p.19). Might someone help their spouse in ‘shoring up’ their identity in the face of threats from illness or just from ageing? Clear evidence of this in case study reported by Hellström et al. 2005: ‘Mr. Svensson’ helping to maintain his wife’s valued identity as a home baker, when her dementia prevented her managing to bake on her own.

10. Our Qualitative Research 10 focus groups (men and women separately) 45 older couples (one 65+) interviewed, together and separately Maximum variation sampling (in and close to London) Three different geographical areas – different points on scale of deprivation Ethnic mix Variation in age, health, disability, children & kin, living arrangements, relationship status (cohab/married; 1st, 2nd, subsequent) Fieldwork completed, findings still being analysed. This is ‘work in progress’!

11. The Case of Alfie and Susan Both aged 71-75 Former occupations: Alfie was in Army, then insurance salesman; Susan was a catering manager White British Susan, their daughter and their doctor believe Alfie has early stage Alzheimer’s Alfie has not been told this Alfie still manages the household bills to the extent that he can: Susan insists that he is still capable of that although she feels she should keep an eye on it.

12. What Susan says Important to Alfie to fulfil his family role – and to Susan to ‘respect’ him in that role “I mean he’s the sort of person that he always puts himself last, and he’s…y’know, makes sure that we would be all right. I mean it hurts him a little way now that he can’t do it quite so much, you know, but… we all respect him…” But he is developing memory problems “Unfortunately, you know, between you and I, Alfie is in the very early stages of….his memory and everything like that’s going. So ummm, it’s a matter of keeping an eye on things a little bit at the moment.” Both Susan and their daughter try to behave so as to protect him from knowledge of his condition “…you try and be respectable about it and not disrespect him for it…..You know, and he’s still a person isn’t he?... But he is in the early stages of it unfortunately….He doesn’t know that we’ve been to the doctors or anything, you know….He’s absolutely fantastic really for his age, but he hasn’t, his memory bank is very bad at the moment.” “He’s not aware, so you just have to respect that, don’t you really.”

13. What Susan says (2) While he still manages aspects of their finances, she keeps a watchful eye on things. He still looks after utility bills etc. “He would do that. He’s quite capable of doing that.” “Now, at this point in time, I would sort of umm, y’know, I would sort of perhaps remind him or watch what…But then, when he’s got to do it, he’s quite capable of doing it. Y’know. Something that’s presented in front of him immediately, he’s perfectly all right.” Susan insists Alfie is still capable of looking after the bank account: “Alfie would do that. He, y’know, he’s, at the moment he’s quite capable of doing that.” If she can reduce his responsibilities, he may feel less anxious “… that will probably take a lot of pressure off of him, and he wouldn’t have to worry quite so much.” She is hoping they will move so that she has less to take care of if he gets worse: “I was just trying to…narrow things down as much as possible, but…obviously he doesn’t want to move….. you’ve got to approach it in a right way, because they’re not aware that these things are happening to them, you know. And you, you mustn’t lose the respect for them, you know.”

14. The Case of Naresh and Devika Naresh is 65, Devika is 62 Former occupations: Naresh was lab technician, Devika was seamstress Both are Indian, brought up in Tanzania Naresh had had heart attack and heart bypass operation. Since then he has suffered from memory loss and increased anxiety. It appears that Devika is trying to reduce his anxiety and mitigate the effects of the memory loss by gradually and tactfully taking on more of the financial organisation. She and their son believe that if Naresh knew this was happening, he would feel even more stressed.

15. What Devika says Changes since Naresh had the heart attack/ bypass More stressed “He doesn’t like to spend sometimes, you know…. he get’s worried so I don’t put him a lot of stress on him because I’m worried, but it’s hard…Sometimes when the necessity is, he is just scared.” Memory loss – she is gradually taking on more responsibility “ He forgets, he forgets loads of things….he won’t remember things. He gets angry when I tell him but I can see, I can see…. he knows it but he won’t ask me….there’s a lot of difference” Int: And do you feel you’re having to take more responsibility? “Yeah definitely, after the heart attack…..He gets angry, he gets angry… that’s why I don’t tell him now, you know. … But I can cope with it.” She and their son protect Naresh from the knowledge of his memory loss, and the extent to which they are relieving him of stressful responsibilities “I tell my son, he said ‘Don’t tell him, don’t tell him.…don’t mention or he’ll be more stressed.’ He says, don’t say anything.”

16. What we found The study was designed to investigate older (65+) couplehood and money management We found dementia/ memory loss to present interesting cases in which couples apparently act to support each other’s identity and family role. We had 2-3 cases of couples where the husband had, or was apparently developing, dementia. Evidence of ‘collusion’ between wife and (adult) children to defend family roles Looking through the lens of management of household money, it appeared that some important identity issues have been raised Money management is usually seen as an important part of the ‘husband’ role identity Inability to manage money may undermine the enacting of this role Wife seemed to want to help him keep this role, or at least keep the illusion of fulfilling it, so that his self-respect can be maintained within the family context. In supporting their husbands thus, did these wives also want to preserve their own identity as ‘wife’?

17. Implications and Further Questions It is striking that it is only recently that the issue of couplehood has been considered in the context of dementia. Yet the importance of family role identity has been recognised for many years. The evidence discussed here raises issues: the extent to which a person with dementia (or other similar illness) may suffer the loss of their family role and associated self-respect the extent to which a spouse’s dementia may undermine their partner’s identity and family role whether the family of a person with dementia may behave to preserve the integrity of family roles thus supporting not only the affected person, but the whole family. It seems likely that there would be policy and practice implications, in terms of the carers and families of dementia victims. As always, further research is needed!

18. Thank you! dinah.bisdee@kcl.ac.uk debora.price@kcl.ac.uk thomas.daly@kcl.ac.uk http://www.householdmoney.co.uk/

19. References Adler, P. & Adler, P.A. (1989). The gloried self: the aggrandizement and the constriction of self. Social Psychology Quarterly, 52 (4), 299-310. Burke, P.J. & Cast, A.D. (1997). Stability and change in the gender identities of newly married couples. Social Psychology Quarterly, 60 (4), 277-290. Burke, P.J. (2006). Identity change. Social Psychology Quarterly, 69 (1), 81-96. Davies, J. & Gregory, D. (2007). Entering the dialogue: marriage biographies and dementia care. Dementia, 6 (4), 481-488. Hellström, I., Nolan, M. & Lundh, U. (2005). ‚We do things together’: a case study of couplehood in dementia. Dementia, 4 (1), 7-22. McCall, G.J. & Simmons, J.L. (1966). Identities and interactions. New York: The Free Press. Mead, G. H. (1934). Mind, self and society. Chicago: University of Chicago Press. Pahl, J. (1989). Money and marriage. Basingstoke: Macmillan. Stryker, S. & Burke, P.J. (2000). The past, present and future of an identity theory. Social Psychology Quarterly, 63 (4), 284-297. Stryker, S. & Statham, A. (1985). Symbolic interaction and role theory. In G. Lindzey & E. Aronson (Eds.) The handbook of social psychology. New York: Random House. Stryker, S. (1968). Identity salience and role performance: the relevance of symbolic interaction theory for family research. Journal of Marriage and the Family, 30 (4), 558-564.