An Age-Old Old Age Debate
AN AGE-OLD OLD AGE DEBATE
An article by Emily Andrews, PhD student, Department of History
With a new cap of £75,000 due to be introduced on the amount that individuals will be expected to pay towards their own social care, Warwick PhD candidate Emily Andrews takes a closer look at the plights of the old, particularly those suffering from dementia. What can history tell us about the long-standing debate over individual and community responsibility when it comes to caring for the aged, and how have people categorised such diseases as Alzheimer’s in the past?
As an historian, I have become interested in how dementia was understood, responded to and dealt with before it became a 'national challenge'; before the apocalyptic demography of the ageing society added the weight of a national crisis to the meaning of this long-acknowledged form of mental distress. Jeremy Hunt’s announcement is the latest intervention into the long-standing debate over individual and community responsibility for the care of the aged. The old have often been viewed as the ultimate 'deserving poor', worthy beneficiaries of our collective resources. Thus, under the 1834 New Poor Law - which primarily sought to make the recipients of state support as uncomfortable as possible - Guardians of the Poor were encouraged to allow the aged to 'enjoy their indulgences'. Throughout the 19th century, however, some commentators and policy-makers worried that an ‘indulgent’ attitude towards the old would discourage prudence, and allow families to shirk their financial responsibilities towards their elders. By the 1870s, this more restrictive attitude towards poor relief came to hold sway in central government. A number of measures were introduced to assess the needs of indigent cases, and to squeeze support from reluctant relatives, in an attempt to discourage all but the most deserving of the deserving poor from falling back on the state.
In practice, however, the administration of relief and support at a local level remained varied and inconsistent. Those older people who required not just financial support, but physical care, could be found in publically-funded workhouses and infirmaries, or in charitable homes and almshouses. The majority, we can assume, remained in the community, being supported informally (and thus, undocumented) by family and friends. Those whose behaviour became intolerably disruptive to those around them sometimes ended up in county lunatic asylums. Just over 2,000 people over 65 were admitted to county lunatic asylums in England and Wales between 1853 and 1858. By the turn of the century, almost that many over-65s were being admitted every single year. While this represented only 10 per cent of the total number of admissions, the over 65s were more heavily represented amongst asylum admissions than amongst the general population. Asylum medical officers seemed acutely aware of this fact.
In public, asylum doctors declined responsibility for the care of the ‘senile’. In their meetings and official reports, journals and newspapers, they railed against the practice of sending older people to the asylum, accusing families and workhouse officials of trying to offload difficult people and shift the financial burden. This complaint from the 1881 annual report of the Lunacy Commissioners (the central government body which oversaw and inspected the county asylums) is typical:
[T]o most public asylums in the present day, [are sent] aged persons who are not properly lunatics, but suffering only…from the decay of faculties incident to old age… because they become somewhat troublesome and difficult to manage.
Old people were arriving at the asylum in increasing numbers. By making statements which decisively differentiated ‘aged persons’ from ‘lunatics’, asylum administrators sought to exclude the ‘senile’ from their domain of responsibility. These patients were not insane, they argued, but were suffering ‘simply from decay of nature’, and were thus not suitable for asylum care. Workhouse officials saw the matter rather differently. According to a representative of the (Workhouse) Infirmary Medical Superintendents’ Association, senile dements were noisy, restless and wandering. They ‘terrified’ other inmates, he claimed, with their ‘incoherent chattering… screaming and vituperations’. People who behaved in such a way were manifestly insane, he suggested, and thus it was the legal duty of workhouse officials to certify them as lunatics, and send them to the asylum3. In the case of senility, workhouse and asylum doctors used a definition of insanity which accorded to their interests: asylum doctors defined it by its cause, while workhouse doctors defined it by its consequences.
In Victorian Britain, the debate surrounding the provision of care for mentally distressed older people had implications for the way in which that mental distress was medically and legally classified. Senility, I argue in my thesis, was one category through which the burgeoning profession of psychiatry defined itself and the object of its endeavors. Senile dementia was thus a politically charged subject in the 19th century, though not in the same way it is today. Indeed, as historians of Alzheimer’s disease have argued, researchers and campaigners in the mid-20th century found it politically expedient to emphasise that dementia is not caused by ‘decay of nature’, but by diseases for which cures can and should be found. If Jeremy Hunt’s statements can be taken as indicative of a trend, then we can expect the 21st- century discourse on dementia to focus again on issues of responsibility and political economy. The meaning of dementia is perhaps no longer at stake; the experience of dementia very much is.
1‘Inheritance gap freeze to fund social care gap of £75,000’, The Guardian (10 February, 2013)
2Department of Health, Prime Minister’s Challenge on Dementia (26 March, 2012)
3T. Parsons, ‘Senile dements in London’, British Medical Journal, 2 (1908), pp. 1720-1.
Thane, P., Old age in English history : past experiences, present issues (Oxford ; New York, 2000)
Ballenger, J. F., Self, senility, and Alzheimer's disease in modern America : a history (Baltimore, 2006)
Scull, A., The most solitary of afflictions : madness and society in Britain 1700-1900 (New Haven ; London, 1993)
Emily Andrews is a PhD student based at the Centre for the History of Medicine in the Department of History. Her Wellcome-funded project is titled ‘Senility before Alzheimer: Old age in British psychiatry, 1830-1910’. On the 23rd February, she is hosting an interdisciplinary conference entitled 'What is Old Age? New Perspectives from the Humanities', funded by the Humanities Research Centre here at Warwick. Further information can be found on the HRC website.