(Editor's note: The Rev. David McCaughey, a former governor of Victoria and
master of Ormond College, University of Melbourne, has contributed much to
public life since his official retirement. He has influenced many Australians
through his university work and the formation of the Uniting Church in
Australia. Selections from his speech at the 7th Congress banquet have been
edited for publication and appear below.)
In the Ireland in which I was born over 80 years ago, they did not speak
much about psychogerontology, although I suspect that the need for what you
have to offer was all around us. Elderly people are your concern, and mine, as
citizens; and, as we have already been reminded, in the near future there are
going to be a lot more of them - of us. And if the proportion of those
suffering from extreme frailty and dementia of various sorts remains constant,
you are going to have many more patients.
Health, I take it, is the context in which we learn what disease is. For
many, fortunately, as G. K. Chesterton put it:
There is good news yet to hear And fine things to be seen Before we
go to Paradise By way of Kensal Green.
I must, however, move from that cheerful note to draw your attention to a
complicating factor. It is not only true that there are going to be more older
people; it is also the case that they will be found in different places. Eric
Hobsbaum, in the central section of his important book Age of Extremes, which
he subtitles "a short history of the 20th century," draws attention to two
phenomena relevant for our purposes. The first he calls "the death of the
peasantry," saying, "The most dramatic and far-reaching social change of the
second half of this century ... and the one which cuts us off forever from the
world of the past, is the death of the peasantry. For since the Neolithic era
most human beings had lived off the land and its livestock or harvested the
sea as fishers." That is no longer the case. Hobsbaum brings forward figures
to show how strikingly this is true of the developed countries of Europe and
North America, of Latin America; and of Japan, where in 1947, 52.4% of the
population were farmers. By 1985, that was reduced to 9.0%.
Not all countries have experienced such an enormous reduction; but in all
countries it has been a revolutionary shift. Only three regions of the world
have remained essentially dominated by their villages and fields: sub-Saharan
Africa, south and continental southeast Asia, and China. Admittedly they
represent half the human race, but even there they are, as Hobsbaum puts it,
crumbling at the edges. When we talk glibly about the globalization of the
world's industrial economy, we should remember what it is doing, and what it
is likely to continue to do: it is emptying the land and filling the cities
with people. The implications of this for your areas of interest are enormous.
In the past, older people, whether healthy, frail, or somewhat demented, were
(by and large) looked after and never ceased to belong to the communities into
which they had been born. They had their places in rural communities or
fishing villages, and they were part of the life of extended families. No
doubt there was in these communities much suffering that was hidden: cases of
old men and old women whose mental deterioration was ignored or denied. But,
without romanticizing, there was also some hidden kindness, and support was
taken for granted as a natural obligation, a respect of the young and
middle-aged for the old. They were still part of the family.
Today - as we empty the land and fill the cities - there is little place
for the absorption of older citizens in the homes of urban dwellers, very
little for suburban dwellers. On a massive scale we have to find ways, less
personal ways, of looking after them in hostels, nursing homes, and hospices;
the last-named in particularly short supply. In the part of Australia where I
live, we are closing country hospitals and bush nursing homes, compelling
older people to move to where they can no longer be readily visited by members
of their families or by neighbors, and where much is strange and unfamiliar.
This is but another instance of how public policy (like, if I may say so, much
of the practice of medicine) sees people as to be treated in the same way, and
ignores the social context to which they belong.
"What we owe the old is reverence, but all they ask for is consideration,
not to be discarded and forgotten," wrote philosopher Abraham Joshua Heschel.
"What they deserve is preference, yet we do not even grant them equality." By
that he means equality of attention, each according to his or her needs. At
one hospice in Melbourne - a big one which cares greatly for its patients -
there are several patients who never receive a visit, I am told. On the other
hand, there is still an immense amount of family care in Australia, but it
needs to be augmented. This leads me briefly to Hobsbaum's second phenomenon.
"Almost as dramatic as the decline and fall of the peasantry and much more
universal," he writes, "was the rise of the occupations which required
secondary and higher education, i.e., basic literacy was indeed the aspiration
of virtually all governments."
It is a little puzzling to know quite why this should be the case. I
suspect that if you asked most politicians and almost all industrialists why
we put so much store by education, you would receive as answer the suggestion
that it would give us a more skilled workforce and help economic growth; and
no doubt that is desirable.
But the purpose of education has to be more than crassly utilitarian. Its
aim must be to make young people interested in and compassionate towards the
world around them; and it must aim to equip them to meet social as well as
economic needs. Moreover, if we are to employ more and better-educated young
people, a substantial number will have to be in the service of their fellows
in health, in welfare, and in education.
The practice of medicine, as you know better than I, has become very much
more sophisticated than ever was, or could be, the case in the past. We have
more elderly citizens and greater power of diagnosis of their ailments than
before, and we shall need a variety of people with a diversity of
specializations to serve them: doctors and medical scientists, nurses and
social workers, psychologists, pharmacists and physiotherapists, all bent on
providing the best health possible for the elderly, enabling them to live
tolerably comfortably and interestingly until they make the transition from
living well to dying well. Such a service will not come cheaply, either in
financial terms or in personal costs to those offering it. It won't come at
all unless we see the service of the old less as a problem and more as a
privilege.
We need a change in community attitudes to these fundamental services. We
won't get it if the professions remain silent.
It is a mark of a learned profession that its members have access to a body
of knowledge and skills not possessed by other members of the community. It is
knowledge that must be used in service of others. With knowledge goes
authority and responsibility: the authority of knowing and the responsibility
to speak out. We may hope that as your association meets here, and moves
around the globe, your presence in every country will draw attention to the
needs of a section of the community once hidden, ignored or denied, but now
evident, demanding the care of all.
The Rev. David McCaughey Melbourne, Australia
Reprinted from IPA Bulletin, Volume 12, Number 2
Copyright 2012 International Psychogeriatric Association
