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|Development Problems and
Reflections on the Management of the Aged in India
P. K. Misra
Humans are one. They belong to a single species. They have a long history. Even in prehistoric times there were migrations, near and distant, all over the world. Seas, rivers, lakes, mountains, deserts and forests have not been able to deter human beings moving from one place to another. Come to think of it, migrations of people like the Jarawa (a classic food-gathering and hunting Negrito group) to another island in Car Nicobar or of the Toda to the Nilgiris, or of the Ladakhi to the Ladakh region, speak about the immense capacities of human beings. Some such movements might have been prompted by compelling natural, social or economic circumstances, but many were not. Being mobile at one stage and sedentary at another is a part of human nature. It appears that human beings are restless in either state (Misra 1986). They are curious about themselves, about the things around and beyond them, and are ever eager to impose order on them. Apart from the immense capacity to endeavour, to learn, to innovate and to adapt to any ecological condition, they add to their cultural baggage by borrowing. Any attempt to characterise people in terms of indigenous and non-indigenous amounts to taking a very short perspective of history. Such categories, if anything, are basically political.
Dynamics of culture
If culture is ‘the way society formulates and deals with the basic problems of human existence’ (Heesterman 1972:97), people living in different environments are likely to develop different cultures. But the very fact that human beings have been restless and have been migrating should indicate that they have not been satisfied with either the way they had formulated the problem of existence or the way they dealt with it. Whatever may have been the reason, as a result of their migrations and through various means of communication people have been exposed to different cultures. Thus cultures have grown through a process of borrowing, retaining and inventing. The process is extremely complex, because even a thing like borrowing is not simple. The borrowed item goes through cultural processing and is only then adopted. The process is further complicated by the fact that human beings attach meaning to cultural items and meanings may be multiple depending upon the context. Culture is also not a loose assemblage of discrete items; there is some degree of integration in them. One can argue that perfect integration is never achieved, and if that should happen a culture would never change. But cultures do change, some change very rapidly and others slowly. It is possible to argue that change is to seek better integration in the culture. To achieve that, there has to be a scheme. This scheme has to be experimental, otherwise there would not be any necessity for borrowing or inventing. In a culture, what is seen is just like the tip of an iceberg, a lot in terms of ideas, values and morals remain submerged but directs actions. All cultural practices, beliefs, ideas, morals, values and the attempts to integrate them would be senseless if the culture does not have goals perceived and defined by it. There can be a debate about the goals, but to claim its non-existence would mean that each aspect of culture has its own autonomous and ad hoc existence. If that be so, all discourse about culture would be meaningless.
While working among the East Indian population in Trinidad, I noted that the Indians there have a separate identity of their own. The Indians there were an uprooted population — they were taken there as indentured labourers, separated from their people and villages. They were a subordinate people, coming as they did from a colonised country to another colonised country, and they had no voice. Their cultures, languages and religions were stigmatised. Those among them who changed their religion were the favoured lot. In spite of all these odds, they were able to reconstruct a culture of their own and establish their identity. This culture is certainly different from what they brought with them but very distinct from what the local culture is. Analysing these developments, I had written, ‘in order to do what a culture does, it may adopt several strategies. It may allow individuals and some groups within to play intervening roles of bridge or buffer between the dominant groups in a multi-ethnic situation. Then there may be some issues which may cut across the individuals and groups. Such groups, individuals and issues to some extent are responsible for the large systems to function and at the same time allow the specific cultures to play the roles they have defined for themselves’ (Misra 1994:11). Culture, in the long run, seems to be indestructible unless by some catastrophe. It has the capacity to regenerate itself around some ideas, some symbols, some institutions and activities. In the case of the Trinidad Indians I have shown that their population size, acquiring land, forming uni-ethnic villages, political actions to protect their interests, formation of the Indian association, struggling to get some of their rituals recognised, collecting contributions for the Bengal relief fund, arrival of Indian films and music, visitors from India, attempts at reviving rituals, performance of community worship, building temples and mosques, building networks through pandits and tharia-lota, were used to form a community of their own (ibid). Whatever they have constructed has to cope with external pressures and inner conflicts. It is not that culture resolves all conflicts. In fact, culture may regenerate itself, weaving its way through conflicts. In Trinidad, for example, the Indians have constructed a kind of duality of ‘inner’ and ‘outer’ lives to cope with the apparently contradictory Indian and Western values (Misra 1994:4).
A couple of decades ago Singer, in his study of the Indian joint family in modern industry, made a similar observation: ‘Structural change and structural persistence are not mutually exclusive phenomena, they both are occurring simultaneously’ (1968:438). In a detailed study of nineteen outstanding industrial families he found that there was a clear-cut separation of work and residence. The home becomes the sphere of religion and traditional values, while office and factory become the sphere of business and modern values. He calls this separation compartmentalisation. ‘Compartmentalisation is an adaptive process which permits the incorporation of innovative patterns of thought and behaviour associated with modern industry without too direct a collision with traditional modes of thought and behaviour’ (ibid., p.439).
A study of development programmes initiated by the Government of India among five tribal groups in south India indicated that the response of each group was different (Misra 1982). In another study it was noted that of the two tribes inhabiting the same ecological region, one tribe totally rejected most of the development programmes while the other accepted them with some enthusiasm (Misra 1970). It was found that acceptance and rejection of specific development programmes were correlated to the social structure and values of the respective tribes. This was significant because both the groups were very poor and barely managed their existence by food gathering, some agriculture and extraction of minor forest products. Yet both the groups were very concerned about their cultures and retaining their respective identities.
Even in a situation where there were enormous existential difficulties, Thorbek, in her study of a slum in Sri Lanka, found that the slum dwellers there were more concerned with their relations with spouses, children, mothers, relatives, neighbours, performance of rituals and what was right and wrong, than with money alone, in short with their culture and values (1994).
Elsewhere too, particularly in the emergence of ethnic conflict all over the world, it has been noted that cultures cannot be changed or preserved at will. The indirect evidence of the existence of the immense varieties of cultures all over the world in spite of powerful forces unleashed by modernisation supports the above hypothesis. Culture has its own internal dynamics. Each culture, in a way, is unique. In the process of its growth it develops its own emphasis. These emphases make each culture appear different. They allow people to feel ‘good’ and ‘satisfied’.
Thinking of the varieties of culture and their interrelations, the image that comes to mind is that of an unspoiled tropical forest where there are immense trees, plants and creepers, growing in and out of each other, together providing shelter and nourishment to innumerable varieties of creatures. The whole is a system but each element in it has its own identity and function. For obvious reasons this imagery cannot be pushed too far in understanding human societies, yet keeping it in view I would like to make the following points.
The individual culture is part of a larger system. The relevance and meaning of the individual culture can be appreciated and fully understood only in the context of the larger system. Deviation from this perspective leads to distortion in understanding, though it is true that big and strong societies have grown at the expense of small and weak ones. It is difficult to conceive of a world which has a uniform culture. None can deny that despite pressures even the small and weak have been able to maintain their cultural identities. By this I do not mean that they have remained static. Far from it, they too have been adapting and changing, and also influencing the larger system through a complex process of inter-culturation. The very fact that cultural variety has existed both in time and space shows that there are innumerable ways to formulate and deal with the problem of human existence. The larger system, if it is a system, has to be connected with its constituent parts — howsoever remote and thin these connections may be. This way the distinctions between endogenous and exogenous models of development, tradition and modernity, become dim. It is true that cultures cannot be kept isolated. It was not possible in the past and is much less possible now in the wake of the communications revolution.
Culture and development
This is the era of development. The world has been divided into developed and developing. The developing are exhorted to hasten and catch up with the developed. All kinds of packages have been created so that the developing world is able to meet at least the basic needs of its people. Meanwhile, in spite of all pious thoughts and plans, the gap between developed and developing within and between states has widened. This has increased anxiety the world over, particularly on account of the realisation that the world is an integrated system. The problems of one region, whether they are ecological, social, economic or political, are bound to affect the other regions too. There is yet another realisation, that development without intense humanism is self-destructive — it is the Hiroshima path. The situation now is far more dangerous than it was fifty years ago. Several countries have developed perilous capacities. Now the crucial question is whether it is possible to break or change the direction of development. One of the ways that has been suggested is to bring the required thrust of humanism into the development process. In this volume Kasai writes that tradition should continue to guide individuals and societies in their search for a just order and society, and development should supply more effective means for their search. But in Japan, he writes, tradition was exploited for just the opposite ends. There is enough evidence from all over the world that culture has been used for economic development and hegemonic tendencies. Even Kasai, after expounding the profoundest thoughts of Japanese tradition, ends by saying that the events of the past are the reminders of the violence of the development.
Why does this happen? It is seen that in practice development means material advancement. All the great thoughts about developing the finer aspects of human beings do not get translated into reality. They remain in the books. Even if it was intended, no one would know how to go about it. Therefore a peculiar situation prevails: while human beings can boast of tremendous material development, the same cannot be said about their own quality. They remain the same while they are expected to help in establishing a just order. For the same reason the matter of establishing a just order cannot be left to culture or tradition, as the context has considerably changed. Both traditional thought and modern experience will have to be focused on human development.
Right from the time human beings became cultural beings, they have been exploring the external universe and making internal arrangements of living. Over time such discoveries and arrangements have become part of the human heritage. It will be futile to argue whether fire or the innumerable varieties of food that we consume, or the various tools that we use, or the idea of counting, or the families in which we live, were found in east, west, north or south. What was found suitable was adopted with appropriate modifications by different cultures. In the same way modern discoveries are becoming part of the cultures of big and small countries. While such developments have apparently made life easier, they have thrown up many new, serious and urgent challenges before mankind, such as the phenomenal rise of human population, environmental pollution, demographic transition, etc. In this paper I intend to focus on the problems caused by demographic transition, resulting in the rise of the population of the aged. I argue that the management of the aged raises the issue of human development.
A significant change has been taking place in the demographic structure of various countries. Their populations have been ageing. It is a dynamic phenomenon. It means more rapid increase of the proportion of old people as compared to other age segments. Till recently it was thought to be a problem of the developed countries, but now it is becoming a problem of the developing countries also. ‘In 1985, there had been 427 million elderly persons (aged 60 and above) accounting for 8.8 per cent of world population. In relative terms, demographic aging was most advanced in the more developed countries where the elderly accounted for 16 per cent of total population as opposed to 7 per cent in the less developed countries’ (UN 1988:3). An international symposium on population structure and development recognised that population ageing was taking place in the context of a rapidly increasing total world population. ‘Growing from an estimated 2.5 billion in 1950, it had reached 4.8 billion in 1985 and was projected to reach 8.2 billion in 2025’ (ibid., p.3). In India, the ageing process of the population is yet to set in full swing since fertility has not come down significantly; but that is no relief as in absolute terms there were more than 43 million people above the age of 60 in 1981 (Guha Roy 1987:61). The percentage of persons in the age group of 60+ in 1961 was 4.57, in 1981 it was 5.14, and in 2001 it is likely to be 7.11 (Chowdhary 1992:30). That is, the population of the aged in the country is already large and is going to be larger still, which is a consequence of development. What problems and issues does this demographic change bring forth?
Problems and issues
The rise in the number of those who are ‘non-productive’ and who do not generate any ‘hope’ immediately raises an economic problem. It is also a social problem: Who is going to provide support to them and how? Apart from food and shelter, the old need care and medicines. They also crave love and tender care. They would like to interact, be heard, be visible, and would like a bit of space of their own and have a constructive and creative role to play in society. Among the old, the problems of old women, single, divorced and widowed, are different from those of old men. In a column in a newspaper an elderly male wrote:
In the same paper another old person wrote, ‘I am a single senior citizen and I feel there are many facets to the problems of single elderly people in our society. It concerns widowers, widows as well as bachelors and single women in advanced age groups. Harking back to past traditions and past family systems cannot be solutions’. Apart from the problems of the reasonably healthy elderly, the problems of the disabled and senile are of a very special kind.
There are not many studies focusing on these problems. A quick glance at the available literature indicates that Indian society does not even realise that a serious human, social and economic problem is at hand which needs immediate specialised attention.
The Western response to the problem has been liberating the old from various kinds of filial responsibilities, making them economically as viable as possible and handing over the problems of health and care to specialised institutions. In the United States of America, apart from schemes of pension, insurance and retirement benefits, the health care of the aged is linked with the social security system. Mobile home service for the aged has been devised in order to lessen the pressure on institutions and costly nursing homes. How exactly these institutions work and what problems the old people under these schemes face are a different matter. However, it is clear that while these institutions can meet the material needs of the aged, they cannot do much when it comes to love, warmth, and the desire to be heard and to be visible.
The Indian situation
In India the situation is far more complex. An overwhelming number of people live in rural areas but migration from rural to urban areas is substantial, which creates problems for the ageing at both ends. If children go to urban areas leaving behind the aged in the rural areas, that creates one set of problems, and if the old are taken along, it creates another set of problems. The growth of the urban population and urban centres have been haphazard, and there are acute shortages of housing and other facilities. The health care system is woefully inadequate and there is hardly any specialised agency focusing on the old. There are no programmes available to train people taking care of the aged. In other words, the entire responsibility of taking care of the old continues to be with the traditional institution of the family.
Biswas’s study of 13 villages in Giridih district of Bihar conducted at two points in time shows that an overwhelming number of the aged lived with their sons — 90.32 per cent in 1960 and 88.36 per cent in 1982. There were very few who decided to live with their daughters. Biswas writes, ‘In substance, therefore, sons were the first choice for old age care, and they were often referred to as old age insurance for which property was transferred to [them] as premium’ (1987:46). In the same study it is pointed out that 14.29 per cent old men and 57.78 per cent old women were dissatisfied with the care and service they got. Of those in ill health, a third of the men and more than half the women felt that they were not properly cared for (ibid., p.53). As regards the interpersonal relations of the ageing with the other members of their families, the study found that a majority of them were bound by bonds of reciprocal respect and love, irrespective of complaints about accommodation, food and care. Dissatisfaction was greater among those who were fully dependent on their supporters. It grew keener and more bitter with age. Ageing women as a rule were neglected (ibid., p.57).
The study highlights that in the rural areas the families of male children provide care and support to the aged. They are bound by traditional norms of respect and love. But now they are getting increasingly marginalised.
Ageing in urban areas
In urban areas the problems get further accentuated. Community support is weak and the kin network is diffused over a large area and relatively ineffective. The entire responsibility of support and care of the ageing falls on the male children with whom the ageing live. The composition of the family in urban areas is becoming nuclear and smaller, as a result of which there are fewer people available in the house to provide care and comfort to the ageing. Those who are available are torn apart by the stresses of urban living. Women too in the urban areas are now working outside the family. They have fixed schedules of work and have other pressures on them. Children are loaded with their studies, competitive examinations and concerns for making their careers.
The authority that the ageing exercised on their children in the past as a result of greater experience has almost vanished, and the aged are now told, ‘You don’t know’. There are several reasons for this admonishment. First, the children of the ageing are not in the same profession. Second, the quantum of information which their children claim to have makes the ageing look almost primitive. Third, the whole techno-economic situation has now completely changed, which leaves the ageing bewildered and redundant. When paucity of accommodation, high cost of living, general stress and tensions at all levels are added to these, the problems of the aged are extremely serious.
The ageing pose a serious human problem. Since they are considered ‘non-productive’ and as they also do not generate any hope, it is all the more necessary that serious attention be paid to them. They raise moral questions and direct our attention towards transcendental values. In the past, ageing was not a serious issue and societies did not give it priority. They dealt with it as a natural phenomenon. Family members were responsible for the care and management of the old. But now the situation is different. The size of the people in the ageing category is already bulging and it is growing very fast. The problems posed by ageing are by no means accidental and isolated. They have grown as a result of the development process itself. The entire emphasis of development is on individual success, career promotion, entrepreneurship, investment, capital building and profit. In such a scheme of things, there is hardly any scope for thoughts about human development. At family, community and government levels the problems of the ageing get no or very low priority. It is taken for granted that the problem will get solved on its own or that it is a problem of individual families, with communities and governments having nothing to do with it. The family, where the ageing are supposed to get care and comfort, is on the rocks and in any case shrinking. The members of the family are spread around in pursuit of their careers.
The old, on their part, are not getting detached either. They think that they are going to live for ever and that in any case this is not the time to quit. The ideas of vanaprastha and samnyasa are too remote and idealistic. They are bored looking after grandchildren, listening to religious discourses and devotional music, making rounds of holy places or just sitting before the small screen. They seek companionship, appropriate creative and constructive roles.
Modern societies are following an ostrich-like policy in this regard. The Western solution to the problem has been old age homes, pensions, social security and health care. No doubt these are important steps, but these programmes are caught up in the conceptual groove that the old have lived their lives and at best they need some material comforts. In any case the old are marginal, backyard people and come in the category of waste. This attitude is exactly what development has to avoid. Development that does not develop the sensitivities and quality of human beings is a potential monster, a Hiroshima. The management and care of the old illustrates this point very well. A concern for non-productive people, sparing a thought for those who have been consigned as waste, would resolve most doubts about development. Development in the last analysis should mean enhancing the capacity of people to establish a just society.
In India even systematic thinking as to what should be the policy towards the ageing has not begun. At this stage in history the country is caught up in the whirlpool of market forces and resultant consumerism. Consumerism thrives on waste and decay. Consumer as well as producer know very well that this kind of development is not sustainable. A shift from consumption to conservation, from individual to community, is bound to take place, which will be in keeping with the Indian ethos. It is possible to be modern with the emphasis on conservation and focus on the community. This point gets very well illustrated in the management of the ageing. Taking care of the aged means highlighting the importance of conservation and humanitarianism. It will also strengthen the community, for the aged can be best taken care of within the fold of the family, bound by filial rights, duties and obligations. There is no institution that can replace the family but there is room to build into it the ideas of equality, justice and freedom. All this will not happen automatically. The focus has to be human development. That will provide new strength to the family and further support from the community. The old and infirm may find loving care.
As far as the ageing of the disabled and senile is concerned, apart from giving them specialised attention through nursing homes and mobile health units, family members will have to be trained in their care. It is to be borne in mind that care cannot be given by mere emotions and a sense of obligation. There has to be proper understanding of the problem and of the remedial measures which can be provided by modern knowledge of health and medicine. Thus a combination of modern knowledge and intense feeling for those who are non-productive can provide physical and emotional comfort to the old.
©1997 Indira Gandhi National Centre for the Arts, New Delhi