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A death in our street
PERGAMON
Health & Place 5 (1999) 119±124
Viewpoint
A death in our street Tony Walter Department of Sociology, University of Reading, P.O. Box 218, Whiteknights, Reading RG6 6AA, UK Received 1 October 1996; received in revised form 6 January 1997; accepted 8 June 1997
Abstract How do neighbours relate to the dying, and what eect does a death have on a neighbourhood? After brie¯y reviewing related literature, the article explores the concepts of reciprocity and solidarity, using the recent work of Michael Young to highlight limitations in the work of Philip Abrams. The potential of suering to generate neighbourhood solidarity in an increasingly auent and private society is considered. # 1999 Elsevier Science Ltd. All rights reserved. Keywords: Neighbours; Death; Reciprocity; Solidarity; Cohesion
A few years ago I wrote the following: I live in Bath in a cul-de-sac square of two dozen Regency houses, many of them converted to ¯ats; many of us are professionals and academics, most are middle-aged or elderly; there are rather few children and almost all of us are incomers to the city. We're the kind of auent and fairly mobile neighbours you might expect not to have much to do with one another. This is not actually the case. In the early 1980's, several of my neighbours successively contracted terminal cancer, and visiting them seemed natural, because `they were there' and could not be ignored. Though one of the younger residents in the street, I found talking with them particularly enriching: facing death, they had a clarity about what is important that I found enriching. Previously rather super®cial acquaintances
turned into friendships. In turn, care for these people has greatly strengthened relations in the street between the living Ð visiting the dying has transformed not only my own life but also the life of the street. I used to think it was just my funny little street, but I have since met a number of people with similar experiences. This article is a sociological re¯ection on this, as yet unresearched, phenomenon: the eect of a death on the neighbours and on neighbourhood solidarity.
1. The literature A literature search on the topic of caring for dying neighbours reveals very little. There are research literatures on neighbourhoods (e.g.
1353-8292/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved. PII:
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Viewpoint / Health & Place 5 (1999) 119±124
Young and Willmott, 1957) and neighbouring (e.g. Bulmer, 1986), on care of the dying by professionals and families (e.g. Kellehear, 1990; Seale and Cartwright, 1994; Young and Cullen, 1996), on coresident carers of the severely handicapped and frail elderly (e.g. Walker, 1982; Finch and Groves, 1983; Twigg and Atkin, 1994), on the totality of support networks for the frail elderly and others needing care `in the community' (e.g. Sinclair et al., 1984; Wenger, 1984; Willmott, 1986). However, there is nothing speci®cally on care of the dying by their neighbours, or on the eect of death on the social life of the street. Soap operas probably cover this more eectively than academic research. A number of surveys on care of the dying (Cartwright et al., 1973; Bowling and Cartwright, 1982; Seale and Cartwright, 1994; Addington-Hall and McCarthy, 1995) con¯ate `friends and neighbours' as though these were similar kinds of relationship; in fact, friendship (chosen, potentially lifelong Ð at least in ideology) and neighbourliness (relatively unchosen, sundered by moving house) are dierent. These literatures do, however, demonstrate the following: 1. For the mobile middle class, reduced contact with kin is compensated by increased contact with friends and neighbours. Neighbouring is increasingly middle class (Abrams et al., 1989). 2. Care of the elderly in `the community' is typically care by kin Ð most often wives, followed by daughters (Walker, 1982; Parker, 1990). 3. Neighbours are less involved in long-term care than in crisis assistance and in errands outside the house such as shopping (Lewis and Meredith, 1989, pp. 193±4; Twigg and Atkin, 1994, pp. 59, 105±106), not least because of the one-sided invasion of privacy entailed in hands-on care in the other's home (Bulmer, 1986, p. 30). As the person deteriorates, the role of neighbours vis-aÁ-vis kin may decline, but the crisis of death itself may prompt relatively more involvement than during the preceding illness or subsequent bereavement.
4. Neighbours are most likely to be directly involved in caring for a dying or bereaved neighbour when there are no kin nearby (Cantor, 1979). With increased longevity and mobility, this situation is on the increase. Harper (1987), Wenger (1989) and Wenger and St Leger (1992) have documented how the geography of the sick person's kin network can have important eects on his or her need, and receipt, of help from neighbours. 5. A series of studies retrospectively interviewing the main carer in representative samples of deceased people found 6±7% of main carers to be `friends or neighbours' (Cartwright et al., 1973, pp. 13, 144; Seale and Cartwright, 1994; Addington-Hall and McCarthy, 1995), but this proportion rose to 20% when the dying person was living alone (Seale, 1990, p. 419). This is in line with the hierarchy of responsibility of Quereshi and Walker (1989); neighbours are willing to care, but keep their distance if there are kin available. 6. Isolation of the dying and bereaved is therefore most likely among the underclass, where kin live elsewhere, transport is poor and fear reduces contact with neighbours. 7. Though informal carers (family, friends and neighbours) may ®nd caring stressful and injurious to their own health, around half retrospectively say it was rewarding, with only 7% describing it as a burden (Seale, 1990, p. 421; Addington-Hall and McCarthy, 1995, p. 301). In the rest of the article, I will discuss might theorise the modest amount of neighbours that exists, drawing on the Philip Abrams, Zygmunt Bauman and Young.
how one help by work of Michael
2. Reciprocity, solidarity and mortality Abrams (Bulmer, 1986, Chap. 6) argued that substantial care for a neighbour occurs only when there has already been built up a relationship of trust, and/or when lack of mobility means that the neighbour is likely to repay the
Viewpoint / Health & Place 5 (1999) 119±124
carer in future Ð it takes time for two neighbours to establish a mutually acceptable degree of reciprocity. A common complaint about bad neighbours is that they are always asking for things without giving anything back. Thus, neighbours, like other assistants to a main carer, tend to reduce their help as an elderly person becomes more frail and less able to reciprocate (Lewis and Meredith, 1989). What though about those instances of care where there is no immediately obvious reciprocity? Should we count this as altruism? Abrams argues not. He notes that neighbours often refer to what they get out of caring for someone to whom they are not indebted Ð `Anyway, I like talking with the old lady'. If there is not some direct payo of this kind, then there is a generalised reciprocity over the lifespan Ð `My mother was always very good to me, so I've always felt a debt to help others'. This is what Abrams terms `as if altruism' Ð altruism that turns out, on closer inspection, to be a form of reciprocity. I do not ®nd Abrams convincing at this point. He reads as one who assumes that all chosen social relationships must be reciprocal in some way or other, and who therefore has to argue against pure altruism. To do so, he has to treat statements such as `anyway, I like talking with the old lady' at face value. He fails to mention the British tend to self-deprecation and understatement and will not admit to religiosity or saintliness; they go out of their way to rationalise other-regarding behaviour and are highly unlikely to admit to altruism. Britons are likely to face informal censure if they present themselves as a do-gooder or a holy Joe. Is there anything about a neighbour dying that is likely to prompt care that cannot be characterised as reciprocity? I argue that there is, ®rst because they are a neighbour and second because they are dying. First the neighbour. Bauman (1989) has argued that in modern industrial societies the chain of command between those who take decisions and those aected is typically very long. The Minister for Social Security never meets the angry single mother whose bene®t has not been sorted out and who has no money to feed the children. The
121
human and ethical consequences of actions can be ignored by those in power, while those who are aware of the human consequences have no power. Bauman's analysis prompts us to identify those situations in a modern society in which there is physical proximity between those who take decisions and those who are aected by them. Two such situations are coresidence within a household and neighbours. One may be able to ignore the confused elderly as a general social problem, but one cannot ignore the confused elderly person living in your own home or in the ¯at next door. They may drive you around the bend, or they may bring out extremes of selfdenying care, but they cannot leave you unaffected. One may have good neighbours or bad neighbours, but one cannot be indierent to neighbours as one can to someone the other side of town. This raises the question as to the ethic involved when one neighbour cares for another. Take the example given by Croft and Beresford (1993) of their being good neighbours to the confused old woman next door. They do not feel obliged to help; they owe her nothing; she is unlikely ever to be able to repay. They are not driven by religious motives; they feel aection for her, but not self-giving love. However, when she rings their doorbell in the middle of the night, they do not ignore her. Why? If we asked them, they'd probably say `what else could we do?' One can ignore the starving child in Ethiopia or the Oxfam appeal that plops onto the door mat, but one can hardly ignore human suering when it is literally on the doorstep. I do not know what to call this phenomenon, but it seems clear to me (a) that it has a lot to do with the physical nearness of the suering, and (b) that Bauman is correct when he says that it entails a principle alien to the organisation of large scale industrial societies. It also underlies the unstinting eorts of many coresident carers of the handicapped, elderly and dying Ð the suering is there, not on the television, not down the road, not at their aunt's the other side of town, but right there just across the hallway or in one's own home. Second, the neighbour is dying. At the very simplest, people may be more willing to care for
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Viewpoint / Health & Place 5 (1999) 119±124
a ®nite period of time for a neighbour who is dying than to care for an inde®nite period for a neighbour who is chronically ill. An intensive interview study of 14 people dying of cancer in the East End of London by Young and Cullen (1996, pp. 199±201), however, suggests something more than this. They suggest that terminal illness may be characterised by something very dierent from everyday self-interestedness, self-love and reciprocity: For most ordinary people, unsaintly but not totally self-centred, the approach of death, or the contemplation of it after it has occurred, does at least raise the great question about where self-love has got them... If self-love becomes more pointless when there will soon be no self to love, what is there left but fellow-feeling?... Death is the common experience which can make all members of the human race feel their common bonds and their common humanity. The presence of death, for all its terror and bitterness, can generate the mystical sense of unity with other people which transcends the boundaries of the body and of the self. This passage sheds light on my own experience of caring for dying family, friends and neighbours, whereas Abrams' attempt to explain altruism in terms of reciprocity seems to miss the mark. Caring for the dying is often in retrospect deemed to have been rewarding (Seale, 1990, p. 421), but that is a far cry from saying that anticipation of emotional reward is why people engage in it. Young and Cullen's point is that contact with the dying transcends the individualistic weighing of costs and bene®ts (even though an outside analyst might be able to weigh it in such terms). The meaning of contact with the dying to the actor may be obscured by an imposed analysis of reciprocity. Many social scientists have highlighted the denial, hiding or sequestration of death in modern society (Gorer, 1955; ArieÁs, 1981; Elias, 1985; Giddens, 1991; Mellor and Shilling, 1993), though others have questioned or at least nuanced this formulation (Parsons and Lidz,
1967; Dumont and Foss, 1972; Kellehear, 1984; Walter, 1991a). If, for most practical purposes in everyday life, people ignore their mortality, it is perhaps not surprising that they show considerable interest when they ®nd themselves close to a fellow human facing his or her own imminent demise. How will he cope? How does he deal with the advance of the Grim Reaper? There is little empirical research available here, but we do know that terminal hospital and hospice patients observe the deaths of those in neighbouring beds with interest, and the observation of those deaths may in¯uence their own fear of death Ð for better or for worse (Honeyburn et al., 1992; Walter, 1994, pp. 124±5). When I have myself made social calls to friends and neighbours who are dying I have often felt to be in touch with something `more real'. Perhaps what I am in touch with is my own mortality, something I share with all other humans but which I normally suppress or even repress Ð hence the sense of connection to reality and/or a common humanity. There is, of course, no guarantee that this sense of connection will occur. It is likely to depend upon the circumstances of the death. It may be more likely to occur with the 30-year old making social visits to a dying neighbour than to the 70-year old exhausted by the grind of months cleaning, toiletting and feeding her dying mother. It is not likely with someone who has personal reasons for perpetuating psychological denial of their mortality even when confronted with it Ð it may, for example, to be easier for a neighbour than for kin to accept the impending death. Young and Cullen's argument links with two other sociological theories, in addition to Bauman's. The thesis of Durkheim (1915) that religious ritual is grounded in communal solidarity, and vice versa, drew speci®cally upon studies of Aboriginal funeral rituals. Death can lead not only to fragmentation, but also to the armation of human and communal bonds, an armation which crucially sustains people as they face the death of others (Walter, 1990). A number of studies of nations, ethnic groupings and even football clubs show how communal identity can be rooted in memory of the dead (Reader and
Viewpoint / Health & Place 5 (1999) 119±124
Walter, 1993). There is no reason why this may not apply also at the street level. Young and Cullen's perspective links also with the theory of structure, antistructure and communitas of Turner (1974), developing the work on rites de passage of Van Gennep (1960). Turner argues that rites of passage reverse everyday relationships and hierarchies, creating a social form he calls `communitas' Ð a temporary net of relationships in which people relate to each other directly, unmediated by authority and hierarchy. This analysis has been applied to funeral and mourning rituals Ð time out from society, when mourners are `betwixt and between' (see Walter (1991b) for an example of communitas during mourning in contemporary Britain). If Young and Cullen are right, then this reversal, or at least suspension, of ordinary values can occur also in the terminal period before death. The dying and those who care for them become aware of the futility of an individualistic approach to human relationships that is always counting the costs and bene®ts. In other words, the way to understand relationships with those who are dying is not to stretch the analysis of everyday life (as does Abrams), but to view relationships with the dying as a liminal reversal or suspension of everyday life. A temporary experience of communitas may have no lasting in¯uence Ð witness the relationships forged with strangers on holiday that fail to survive dierences of status or residence on return home, or the communitas between strangers ®ghting for their lives in some emergency. However, where those involved in temporary communitas are neighbours, there is a greater possibility that temporary communitas may foster long term community. Death is a fateful moment for social cohesion. It may rupture relationships among the living, it may reveal or generate extreme isolation, it may create a temporary community, or it may foster new and enduring relationships. Only empirical research will ascertain the circumstances in which each response is likely.
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3. Conclusion If urban neighbourhoods were more socially cohesive during the process of industrialisation, it was because of the need for people to band together in the face of poverty, suering and sickness (Abrams et al., 1989, p. 7). In mature industrial connurbations, characterised by auence and the welfare state, this basis for community has collapsed: though some yearn for urban community, no one wants the poverty and suering that earlier this century underlay it. Dying and bereavement, however, are forms of suering which will never go away Ð could they become a basis for community, even in an auent society? Acknowledgements I acknowledge Sophie Bowlby, Tank Waddington and this journal's anonymous reviewers for their comments on earlier drafts of this paper; and Linda Challis, David Clark, Dawn Clarke and Jane Littlewood, among others, for their encouragement. References Abrams, P., et al., 1989. Neighbourhood Care and Social Policy. HMSO, London. Addington-Hall, J., McCarthy, M., 1995. Dying from cancer: results of a national population-based investigation. Palliative Medicine 9, 295±305. ArieÁs, P., 1981. The Hour of Our Death. Allen Lane, London. Bauman, Z., 1989. Modernity and the Holocaust. Polity, Oxford. Bowling, A., Cartwright, A., 1982. Life After a Death. Tavistock, London. Bulmer, M., 1986. Neighbours: the Work of Philip Abrams. University Press, Cambridge. Cantor, M.H., 1979. Neighbours and friends: an overlooked resource in the informal support system. Research on Aging 1, 434±463. Cartwright, A., Hockey, L., Anderson, J., 1973. Life Before Death. Routledge, London. Croft, S., Beresford, P., 1993. Neighbours. In: Bornat, J., et al. (Eds.), Community Care: a Reader. Macmillan, London, pp. 52±59.
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Dumont, R.G., Foss, D.C., 1972. The American View of Death: Acceptance or Denial? Schenkman, Cambridge MA. Durkheim, E., 1915. The Elementary Forms of the Religious Life. Unwin, London. Elias, N., 1985. The Loneliness of the Dying. Blackwell, Oxford. Finch, J., Groves, D., (Eds.), 1983. A Labour of Love: Women, Work and Caring. Routledge, London. Giddens, A., 1991. Modernity and Self-Identity. Polity, Oxford. Gorer, G., 1955. The Pornography of Death. Encounter, October. Harper, S., 1987. The kinship network of the rural aged: a comparison of the indigenous elderly and the retired inmigrant. Ageing and Society 7, 303±327. Honeyburn, J. et al, 1992. The impact of a death on fellow hospice patients. Brit. Jnl of Medical Psychology 65, 67± 72. Kellehear, A., 1984. Are we a death-denying society?A sociological review. Social Science & Medicine 18 (9), 713±723. Kellehear, A., 1990. Dying of Cancer: the Final Years of Life. Harwood Academic, Chur. Lewis, J., Meredith, B., 1989. Contested territory in informal care. In: Jeerys, M. (Ed.), Growing Old in the Twentieth Century. Routledge, London, pp. 186±200. Mellor, P., Shilling, C., 1993. Modernity, self-identity and the sequestration of death. Sociology 27, 411±432. Parker, G., 1990. With Due Care and Attention: a Review of Research on Informal Care. Family Policy Studies Centre, London. Parsons, T., Lidz, V., 1967. Death in American society. In: Shneidman, E. (Ed.), Essays in Self-Destruction. Science House, New York, pp. 133±170. Quereshi, H., Walker, A., 1989. The Caring Relationship: Elderly People and Their Families. Macmillan, London. Reader, I., Walter, T. (Eds.), 1993. Pilgrimage in Popular Culture. Macmillan, London. Seale, C., 1990. Caring for people who die: the experience of family and friends. Ageing and Society 10, 413±428.
Seale, C., Cartwright, A., 1994. The Year Before Death. Avebury, Aldershot. Sinclair, I., Crosbie, D., O'Connor, P., Stanforth, L., Vickery, A., 1984. Networks Project: a Study of Informal Care, Services and Social Work for Elderly Clients Living Alone. Nat. Inst. of Social Work Research Unit, London. Turner, V., 1974. The Ritual Process. Penguin, Harmondsworth. Twigg, J., Atkin, K., 1994. Carers Perceived: Policy and Practice in Informal Care. Open University Press, Buckingham. Van Gennep, A., 1960. The Rites of Passage. University of Chicago Press, Chicago. Walker, A. (Ed.), 1982. Community Care: the Family, the State and Social Policy. Martin Robertson/Blackwell, Oxford. Walter, T., 1990. Funerals: and how to Improve Them. Hodder, London. Walter, T., 1991a. Modern death: taboo or not taboo?. Sociology 25 (2), 293±310. Walter, T., 1991b. The mourning after Hillsborough. Sociological Review 39 (3), 599±625. Walter, T., 1994. The Revival of Death. Routledge, London. Wenger, C., 1984. The Supportive Network: Coping with Old Age. George Allen & Unwin, London. Wenger, C., 1989. Support networks in old age: constructing a typology. In: Jeerys, M. (Ed.), Growing Old in the Twentieth Century. Routledge, London, pp. 166±185. Wenger, C., St Leger, F., 1992. Community structure and support network variations. Ageing and Society 12, 213± 236. Willmott, P., 1986. Social Networks, Informal Care and Public Policy. Policy Studies Institute Research Report 655, London. Young, M., Cullen, L., 1996. A Good Death: Conversations with East Londoners. Routledge, London. Young, M., Willmott, M., 1957. Family and Kinship in East London. Routledge and Kegan Paul, London.
Health & Place 5 (1999) 119±124
Viewpoint
A death in our street Tony Walter Department of Sociology, University of Reading, P.O. Box 218, Whiteknights, Reading RG6 6AA, UK Received 1 October 1996; received in revised form 6 January 1997; accepted 8 June 1997
Abstract How do neighbours relate to the dying, and what eect does a death have on a neighbourhood? After brie¯y reviewing related literature, the article explores the concepts of reciprocity and solidarity, using the recent work of Michael Young to highlight limitations in the work of Philip Abrams. The potential of suering to generate neighbourhood solidarity in an increasingly auent and private society is considered. # 1999 Elsevier Science Ltd. All rights reserved. Keywords: Neighbours; Death; Reciprocity; Solidarity; Cohesion
A few years ago I wrote the following: I live in Bath in a cul-de-sac square of two dozen Regency houses, many of them converted to ¯ats; many of us are professionals and academics, most are middle-aged or elderly; there are rather few children and almost all of us are incomers to the city. We're the kind of auent and fairly mobile neighbours you might expect not to have much to do with one another. This is not actually the case. In the early 1980's, several of my neighbours successively contracted terminal cancer, and visiting them seemed natural, because `they were there' and could not be ignored. Though one of the younger residents in the street, I found talking with them particularly enriching: facing death, they had a clarity about what is important that I found enriching. Previously rather super®cial acquaintances
turned into friendships. In turn, care for these people has greatly strengthened relations in the street between the living Ð visiting the dying has transformed not only my own life but also the life of the street. I used to think it was just my funny little street, but I have since met a number of people with similar experiences. This article is a sociological re¯ection on this, as yet unresearched, phenomenon: the eect of a death on the neighbours and on neighbourhood solidarity.
1. The literature A literature search on the topic of caring for dying neighbours reveals very little. There are research literatures on neighbourhoods (e.g.
1353-8292/99/$ - see front matter # 1999 Elsevier Science Ltd. All rights reserved. PII:
120
Viewpoint / Health & Place 5 (1999) 119±124
Young and Willmott, 1957) and neighbouring (e.g. Bulmer, 1986), on care of the dying by professionals and families (e.g. Kellehear, 1990; Seale and Cartwright, 1994; Young and Cullen, 1996), on coresident carers of the severely handicapped and frail elderly (e.g. Walker, 1982; Finch and Groves, 1983; Twigg and Atkin, 1994), on the totality of support networks for the frail elderly and others needing care `in the community' (e.g. Sinclair et al., 1984; Wenger, 1984; Willmott, 1986). However, there is nothing speci®cally on care of the dying by their neighbours, or on the eect of death on the social life of the street. Soap operas probably cover this more eectively than academic research. A number of surveys on care of the dying (Cartwright et al., 1973; Bowling and Cartwright, 1982; Seale and Cartwright, 1994; Addington-Hall and McCarthy, 1995) con¯ate `friends and neighbours' as though these were similar kinds of relationship; in fact, friendship (chosen, potentially lifelong Ð at least in ideology) and neighbourliness (relatively unchosen, sundered by moving house) are dierent. These literatures do, however, demonstrate the following: 1. For the mobile middle class, reduced contact with kin is compensated by increased contact with friends and neighbours. Neighbouring is increasingly middle class (Abrams et al., 1989). 2. Care of the elderly in `the community' is typically care by kin Ð most often wives, followed by daughters (Walker, 1982; Parker, 1990). 3. Neighbours are less involved in long-term care than in crisis assistance and in errands outside the house such as shopping (Lewis and Meredith, 1989, pp. 193±4; Twigg and Atkin, 1994, pp. 59, 105±106), not least because of the one-sided invasion of privacy entailed in hands-on care in the other's home (Bulmer, 1986, p. 30). As the person deteriorates, the role of neighbours vis-aÁ-vis kin may decline, but the crisis of death itself may prompt relatively more involvement than during the preceding illness or subsequent bereavement.
4. Neighbours are most likely to be directly involved in caring for a dying or bereaved neighbour when there are no kin nearby (Cantor, 1979). With increased longevity and mobility, this situation is on the increase. Harper (1987), Wenger (1989) and Wenger and St Leger (1992) have documented how the geography of the sick person's kin network can have important eects on his or her need, and receipt, of help from neighbours. 5. A series of studies retrospectively interviewing the main carer in representative samples of deceased people found 6±7% of main carers to be `friends or neighbours' (Cartwright et al., 1973, pp. 13, 144; Seale and Cartwright, 1994; Addington-Hall and McCarthy, 1995), but this proportion rose to 20% when the dying person was living alone (Seale, 1990, p. 419). This is in line with the hierarchy of responsibility of Quereshi and Walker (1989); neighbours are willing to care, but keep their distance if there are kin available. 6. Isolation of the dying and bereaved is therefore most likely among the underclass, where kin live elsewhere, transport is poor and fear reduces contact with neighbours. 7. Though informal carers (family, friends and neighbours) may ®nd caring stressful and injurious to their own health, around half retrospectively say it was rewarding, with only 7% describing it as a burden (Seale, 1990, p. 421; Addington-Hall and McCarthy, 1995, p. 301). In the rest of the article, I will discuss might theorise the modest amount of neighbours that exists, drawing on the Philip Abrams, Zygmunt Bauman and Young.
how one help by work of Michael
2. Reciprocity, solidarity and mortality Abrams (Bulmer, 1986, Chap. 6) argued that substantial care for a neighbour occurs only when there has already been built up a relationship of trust, and/or when lack of mobility means that the neighbour is likely to repay the
Viewpoint / Health & Place 5 (1999) 119±124
carer in future Ð it takes time for two neighbours to establish a mutually acceptable degree of reciprocity. A common complaint about bad neighbours is that they are always asking for things without giving anything back. Thus, neighbours, like other assistants to a main carer, tend to reduce their help as an elderly person becomes more frail and less able to reciprocate (Lewis and Meredith, 1989). What though about those instances of care where there is no immediately obvious reciprocity? Should we count this as altruism? Abrams argues not. He notes that neighbours often refer to what they get out of caring for someone to whom they are not indebted Ð `Anyway, I like talking with the old lady'. If there is not some direct payo of this kind, then there is a generalised reciprocity over the lifespan Ð `My mother was always very good to me, so I've always felt a debt to help others'. This is what Abrams terms `as if altruism' Ð altruism that turns out, on closer inspection, to be a form of reciprocity. I do not ®nd Abrams convincing at this point. He reads as one who assumes that all chosen social relationships must be reciprocal in some way or other, and who therefore has to argue against pure altruism. To do so, he has to treat statements such as `anyway, I like talking with the old lady' at face value. He fails to mention the British tend to self-deprecation and understatement and will not admit to religiosity or saintliness; they go out of their way to rationalise other-regarding behaviour and are highly unlikely to admit to altruism. Britons are likely to face informal censure if they present themselves as a do-gooder or a holy Joe. Is there anything about a neighbour dying that is likely to prompt care that cannot be characterised as reciprocity? I argue that there is, ®rst because they are a neighbour and second because they are dying. First the neighbour. Bauman (1989) has argued that in modern industrial societies the chain of command between those who take decisions and those aected is typically very long. The Minister for Social Security never meets the angry single mother whose bene®t has not been sorted out and who has no money to feed the children. The
121
human and ethical consequences of actions can be ignored by those in power, while those who are aware of the human consequences have no power. Bauman's analysis prompts us to identify those situations in a modern society in which there is physical proximity between those who take decisions and those who are aected by them. Two such situations are coresidence within a household and neighbours. One may be able to ignore the confused elderly as a general social problem, but one cannot ignore the confused elderly person living in your own home or in the ¯at next door. They may drive you around the bend, or they may bring out extremes of selfdenying care, but they cannot leave you unaffected. One may have good neighbours or bad neighbours, but one cannot be indierent to neighbours as one can to someone the other side of town. This raises the question as to the ethic involved when one neighbour cares for another. Take the example given by Croft and Beresford (1993) of their being good neighbours to the confused old woman next door. They do not feel obliged to help; they owe her nothing; she is unlikely ever to be able to repay. They are not driven by religious motives; they feel aection for her, but not self-giving love. However, when she rings their doorbell in the middle of the night, they do not ignore her. Why? If we asked them, they'd probably say `what else could we do?' One can ignore the starving child in Ethiopia or the Oxfam appeal that plops onto the door mat, but one can hardly ignore human suering when it is literally on the doorstep. I do not know what to call this phenomenon, but it seems clear to me (a) that it has a lot to do with the physical nearness of the suering, and (b) that Bauman is correct when he says that it entails a principle alien to the organisation of large scale industrial societies. It also underlies the unstinting eorts of many coresident carers of the handicapped, elderly and dying Ð the suering is there, not on the television, not down the road, not at their aunt's the other side of town, but right there just across the hallway or in one's own home. Second, the neighbour is dying. At the very simplest, people may be more willing to care for
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a ®nite period of time for a neighbour who is dying than to care for an inde®nite period for a neighbour who is chronically ill. An intensive interview study of 14 people dying of cancer in the East End of London by Young and Cullen (1996, pp. 199±201), however, suggests something more than this. They suggest that terminal illness may be characterised by something very dierent from everyday self-interestedness, self-love and reciprocity: For most ordinary people, unsaintly but not totally self-centred, the approach of death, or the contemplation of it after it has occurred, does at least raise the great question about where self-love has got them... If self-love becomes more pointless when there will soon be no self to love, what is there left but fellow-feeling?... Death is the common experience which can make all members of the human race feel their common bonds and their common humanity. The presence of death, for all its terror and bitterness, can generate the mystical sense of unity with other people which transcends the boundaries of the body and of the self. This passage sheds light on my own experience of caring for dying family, friends and neighbours, whereas Abrams' attempt to explain altruism in terms of reciprocity seems to miss the mark. Caring for the dying is often in retrospect deemed to have been rewarding (Seale, 1990, p. 421), but that is a far cry from saying that anticipation of emotional reward is why people engage in it. Young and Cullen's point is that contact with the dying transcends the individualistic weighing of costs and bene®ts (even though an outside analyst might be able to weigh it in such terms). The meaning of contact with the dying to the actor may be obscured by an imposed analysis of reciprocity. Many social scientists have highlighted the denial, hiding or sequestration of death in modern society (Gorer, 1955; ArieÁs, 1981; Elias, 1985; Giddens, 1991; Mellor and Shilling, 1993), though others have questioned or at least nuanced this formulation (Parsons and Lidz,
1967; Dumont and Foss, 1972; Kellehear, 1984; Walter, 1991a). If, for most practical purposes in everyday life, people ignore their mortality, it is perhaps not surprising that they show considerable interest when they ®nd themselves close to a fellow human facing his or her own imminent demise. How will he cope? How does he deal with the advance of the Grim Reaper? There is little empirical research available here, but we do know that terminal hospital and hospice patients observe the deaths of those in neighbouring beds with interest, and the observation of those deaths may in¯uence their own fear of death Ð for better or for worse (Honeyburn et al., 1992; Walter, 1994, pp. 124±5). When I have myself made social calls to friends and neighbours who are dying I have often felt to be in touch with something `more real'. Perhaps what I am in touch with is my own mortality, something I share with all other humans but which I normally suppress or even repress Ð hence the sense of connection to reality and/or a common humanity. There is, of course, no guarantee that this sense of connection will occur. It is likely to depend upon the circumstances of the death. It may be more likely to occur with the 30-year old making social visits to a dying neighbour than to the 70-year old exhausted by the grind of months cleaning, toiletting and feeding her dying mother. It is not likely with someone who has personal reasons for perpetuating psychological denial of their mortality even when confronted with it Ð it may, for example, to be easier for a neighbour than for kin to accept the impending death. Young and Cullen's argument links with two other sociological theories, in addition to Bauman's. The thesis of Durkheim (1915) that religious ritual is grounded in communal solidarity, and vice versa, drew speci®cally upon studies of Aboriginal funeral rituals. Death can lead not only to fragmentation, but also to the armation of human and communal bonds, an armation which crucially sustains people as they face the death of others (Walter, 1990). A number of studies of nations, ethnic groupings and even football clubs show how communal identity can be rooted in memory of the dead (Reader and
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Walter, 1993). There is no reason why this may not apply also at the street level. Young and Cullen's perspective links also with the theory of structure, antistructure and communitas of Turner (1974), developing the work on rites de passage of Van Gennep (1960). Turner argues that rites of passage reverse everyday relationships and hierarchies, creating a social form he calls `communitas' Ð a temporary net of relationships in which people relate to each other directly, unmediated by authority and hierarchy. This analysis has been applied to funeral and mourning rituals Ð time out from society, when mourners are `betwixt and between' (see Walter (1991b) for an example of communitas during mourning in contemporary Britain). If Young and Cullen are right, then this reversal, or at least suspension, of ordinary values can occur also in the terminal period before death. The dying and those who care for them become aware of the futility of an individualistic approach to human relationships that is always counting the costs and bene®ts. In other words, the way to understand relationships with those who are dying is not to stretch the analysis of everyday life (as does Abrams), but to view relationships with the dying as a liminal reversal or suspension of everyday life. A temporary experience of communitas may have no lasting in¯uence Ð witness the relationships forged with strangers on holiday that fail to survive dierences of status or residence on return home, or the communitas between strangers ®ghting for their lives in some emergency. However, where those involved in temporary communitas are neighbours, there is a greater possibility that temporary communitas may foster long term community. Death is a fateful moment for social cohesion. It may rupture relationships among the living, it may reveal or generate extreme isolation, it may create a temporary community, or it may foster new and enduring relationships. Only empirical research will ascertain the circumstances in which each response is likely.
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3. Conclusion If urban neighbourhoods were more socially cohesive during the process of industrialisation, it was because of the need for people to band together in the face of poverty, suering and sickness (Abrams et al., 1989, p. 7). In mature industrial connurbations, characterised by auence and the welfare state, this basis for community has collapsed: though some yearn for urban community, no one wants the poverty and suering that earlier this century underlay it. Dying and bereavement, however, are forms of suering which will never go away Ð could they become a basis for community, even in an auent society? Acknowledgements I acknowledge Sophie Bowlby, Tank Waddington and this journal's anonymous reviewers for their comments on earlier drafts of this paper; and Linda Challis, David Clark, Dawn Clarke and Jane Littlewood, among others, for their encouragement. References Abrams, P., et al., 1989. Neighbourhood Care and Social Policy. HMSO, London. Addington-Hall, J., McCarthy, M., 1995. Dying from cancer: results of a national population-based investigation. Palliative Medicine 9, 295±305. ArieÁs, P., 1981. The Hour of Our Death. Allen Lane, London. Bauman, Z., 1989. Modernity and the Holocaust. Polity, Oxford. Bowling, A., Cartwright, A., 1982. Life After a Death. Tavistock, London. Bulmer, M., 1986. Neighbours: the Work of Philip Abrams. University Press, Cambridge. Cantor, M.H., 1979. Neighbours and friends: an overlooked resource in the informal support system. Research on Aging 1, 434±463. Cartwright, A., Hockey, L., Anderson, J., 1973. Life Before Death. Routledge, London. Croft, S., Beresford, P., 1993. Neighbours. In: Bornat, J., et al. (Eds.), Community Care: a Reader. Macmillan, London, pp. 52±59.
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Viewpoint / Health & Place 5 (1999) 119±124
Dumont, R.G., Foss, D.C., 1972. The American View of Death: Acceptance or Denial? Schenkman, Cambridge MA. Durkheim, E., 1915. The Elementary Forms of the Religious Life. Unwin, London. Elias, N., 1985. The Loneliness of the Dying. Blackwell, Oxford. Finch, J., Groves, D., (Eds.), 1983. A Labour of Love: Women, Work and Caring. Routledge, London. Giddens, A., 1991. Modernity and Self-Identity. Polity, Oxford. Gorer, G., 1955. The Pornography of Death. Encounter, October. Harper, S., 1987. The kinship network of the rural aged: a comparison of the indigenous elderly and the retired inmigrant. Ageing and Society 7, 303±327. Honeyburn, J. et al, 1992. The impact of a death on fellow hospice patients. Brit. Jnl of Medical Psychology 65, 67± 72. Kellehear, A., 1984. Are we a death-denying society?A sociological review. Social Science & Medicine 18 (9), 713±723. Kellehear, A., 1990. Dying of Cancer: the Final Years of Life. Harwood Academic, Chur. Lewis, J., Meredith, B., 1989. Contested territory in informal care. In: Jeerys, M. (Ed.), Growing Old in the Twentieth Century. Routledge, London, pp. 186±200. Mellor, P., Shilling, C., 1993. Modernity, self-identity and the sequestration of death. Sociology 27, 411±432. Parker, G., 1990. With Due Care and Attention: a Review of Research on Informal Care. Family Policy Studies Centre, London. Parsons, T., Lidz, V., 1967. Death in American society. In: Shneidman, E. (Ed.), Essays in Self-Destruction. Science House, New York, pp. 133±170. Quereshi, H., Walker, A., 1989. The Caring Relationship: Elderly People and Their Families. Macmillan, London. Reader, I., Walter, T. (Eds.), 1993. Pilgrimage in Popular Culture. Macmillan, London. Seale, C., 1990. Caring for people who die: the experience of family and friends. Ageing and Society 10, 413±428.
Seale, C., Cartwright, A., 1994. The Year Before Death. Avebury, Aldershot. Sinclair, I., Crosbie, D., O'Connor, P., Stanforth, L., Vickery, A., 1984. Networks Project: a Study of Informal Care, Services and Social Work for Elderly Clients Living Alone. Nat. Inst. of Social Work Research Unit, London. Turner, V., 1974. The Ritual Process. Penguin, Harmondsworth. Twigg, J., Atkin, K., 1994. Carers Perceived: Policy and Practice in Informal Care. Open University Press, Buckingham. Van Gennep, A., 1960. The Rites of Passage. University of Chicago Press, Chicago. Walker, A. (Ed.), 1982. Community Care: the Family, the State and Social Policy. Martin Robertson/Blackwell, Oxford. Walter, T., 1990. Funerals: and how to Improve Them. Hodder, London. Walter, T., 1991a. Modern death: taboo or not taboo?. Sociology 25 (2), 293±310. Walter, T., 1991b. The mourning after Hillsborough. Sociological Review 39 (3), 599±625. Walter, T., 1994. The Revival of Death. Routledge, London. Wenger, C., 1984. The Supportive Network: Coping with Old Age. George Allen & Unwin, London. Wenger, C., 1989. Support networks in old age: constructing a typology. In: Jeerys, M. (Ed.), Growing Old in the Twentieth Century. Routledge, London, pp. 166±185. Wenger, C., St Leger, F., 1992. Community structure and support network variations. Ageing and Society 12, 213± 236. Willmott, P., 1986. Social Networks, Informal Care and Public Policy. Policy Studies Institute Research Report 655, London. Young, M., Cullen, L., 1996. A Good Death: Conversations with East Londoners. Routledge, London. Young, M., Willmott, M., 1957. Family and Kinship in East London. Routledge and Kegan Paul, London.