Caregiving is a role that involves a lot of giving. Unfortunately, there is none to provide them with emotional support and help them avoid exhaustion and psychological disintegration. In India caregiving has been worked into our cultural milieu and consciousness through effective role models.
Shravan Kumar, from the Hindu mythology, enjoys the highest recall in the ambit of role models in the discourse. Shravan, a young boy, carried his aged parents in two baskets which he looped over a single beam. He shouldered the baskets and captured the imagination and conscience of a society that coagulated normative behaviour towards elders in line with Shravan Kumar’s own sense of duty.
Shravan Kumar appears as a vital subtext in the Ramayana. Dasaratha, the father of the protagonist Ram mistakenly hunts down Shravan Kumar with his poison tipped arrows mistaking him for a deer. As the youth breathes his last in front of his hapless parents, looked on with remorse and helplessness by the distressed king, it leads to the curse – the first among the chain of events which eventually lead to Ram’s exile to the forest and the great war. As Ram, shorn of his princely attire, comes to bid him adieu, Dasaratha visualises the prospect of old age minus the loving care and devotion of his eldest son. Half deranged with sorrow, his mind takes him back to the blind and ageing couple whose devoted son he had unintentionally killed. The Shravan Kumar subtext is not just vital to the story, but it also hands down value lessons to a society that learns from such mythological constructions. Shravan Kumar is the ideal son, his duty to his parents, an unquestioned moral obligation that every son needs to imbibe and execute.
Ramayana is about ideal characters and even the Shravan Kumar archetype touches the hallowed and idealistic markers. The other epic, Mahabharata, is less about ideal characters and their idealistic pursuits. Characters in the Mahabharata are both flawed and faultless, with virtues and with vices, and therefore reflects a truer version of society. Even here we find caregiving woven into the social fabric. As the war ends, a distraught Dhritarashtra and his wife Gandhari go away into the forest. By then they are old and the destructive war had added to their years and infirmities. They are accompanied to the forest by Kunti and Vidur, bound together by the complexities of their relationships.
Many research findings have put out supportive evidence that more women than men are primary caregivers.
Vidur, the brother now stands in for the son for the aged couple and it is Kunti who looks after the ageing couple for a long time. Never once does she leave their side. She stays by them, childless as they are, as their companion, devoted in her caregiving efforts. In the end, as Dhritarashtra and Gandhari wilfully enter into the forest fire to seek their heavenly abode, Kunti accompanies them. In the final lap of the Mahabharata, Kunti’s selfless caregiving adds several dimensions to her character. Of course in a patriarchal society, Shravan Kumar lends to higher recall than Kunti, but for the audience, the lessons are unmistakable – that caregiving is part of filial duty, it is a moral obligation, a compulsion that necessitates acceptance.
Caregiving is thus worked into the mainstream Indian cultural tradition. For a while, it did not command too many insightful investigations and flourished in an informal way. It is only in recent years that there have been serious attempts to address the issue of caregivers and the caregiver-recipient relationship as a whole.
Think caregiving and you are likely to think of women members of the family. Sift through advertisements announcing caregiving services to the ill or to the elderly, and you are likely to see more images of women cast in the role of caregiver. And now a growing number of studies has highlighted on the gendered aspect of caregiving, corroborating the rush of informal cognitions in this direction. Many research findings have put out supportive evidence that more women than men are primary caregivers.
Also, the work done by family-based caregivers is in line with the gender-based division of labour. This has contributed to keeping women well within the traditional role. Men and women show different patterns of assistance where care giving is concerned. Therefore for hands, on care and personal assistance, it is women who are likely to be seen in that role, whereas arrangement of services, care management, transportation, financial arrangements and sometimes in intermittent tasks like taking the patient out for a stroll, remain in the hands of men. Bhavana Issar, Founder and CEO of Caregiver Saathi, an organisation committed to addressing the needs of caregivers in India, emphatically states, “ Since caregiving tends to be a gendered role, there are stereotypes of both – caregiving and women which make the challenges of a woman caregiver complex and difficult. Caregivers are the invisible warriors who are under-recognised, under-appreciated and underserved. This caregiver stress lead to caregiver depression, especially in the case of terminal illness”.
In the changing scenario where women are not physically restricted to domestic spaces, caregiver stress continues to affect women in a disproportionate way. Women employees report more stress while at their workplace and have to resort to the effective management of the environment even while they are in professional spaces. Work options for many are singularly dictated by physical proximity to, availability of flexible hours of work and work from home options. This muzzling of talent and sweeping of aspirations under the proverbial carpet, this living a life of compromises, of exacting standards, long time hours, high physical and emotional investments, leaves many a woman embittered and open to mental health consequences in the final run-up.
The socio-cultural and religious norms come together in a way that transfers the burden of caregiving on women members.
In India, the family continues to be the focal point of social and group dynamics. The joint family system may have today died out due to practical considerations, yet in spirit it continues to dominate the socio-cultural discourse. Elderly couples are supported by their families in both rural and urban India. The family as a social organisation is characterised by a high degree of relatedness, through filial and marital bonds, as well as a high degree of interdependence. In its attempt to providing support to all members of the unit, the family draws into itself all available resources, securing it, conserving it, distributing it to the individual member as and when required.
Economists in India therefore, are of the opinion that in India large families spell social security, especially for the elderly members. Parents provide care to their children in their young years. Later on, as adults, the children looked after their elderly parents. Sociological discourses codified these rules, with religious texts and popular media constructions fortifying this setup. A person’s Dharma has always been to look after his/her parents in their twilight years. So symbolic interpretations of Shravan Kumar and a host of others help preserve the function and utility of this unit and define the role of young adults. Caregiving is a duty, dharma, and all members are expected to be participants.
However, things are not so straight-aced and the largely deflated status of women lends a certain kind of complexity to the arrangement. While it is the son’s dharma to look after his parents, it is mostly affected through the physical contributions of the wife. The socio-cultural and religious norms come together in a way that transfers the burden of caregiving on women members. Primary caregivers emanating from within the family are often untrained, only schooled in the ideological underpinnings of caregiving. That is why they are tutored to looking at behavioural problems of the elderly or the infirm as ‘ part of hassle of life’ or ‘ part of the ageing process’. There is no real attempt to find professional solutions to cope with mental health problems associated with ageing. This adds and complicates the ambit of caregiving putting women members as primary caregivers at decided risk of depression, anxiety-based disorders, and mental and emotional exhaustion.
Curiously, this aspect has remained largely outside mainstream gender talk. For all the innumerable initiatives seeking to change the status of women in India, the fact that caregiving within Indian families continues to have women in the central role, is slightly lopsided. This role is but an extension of the traditional role of nurturer, feeding off from the glorified ideals of sacrifice and unconditional love that have come to be associated with the ideals of the feminine self.
So what is the need of the hour?
Caregivers need appreciation and recognition. As gendered roles undergo change, there is a need to realistically assess their ability to provide the emotional demands of caregiving. Home support must be revised on lines of gender parity and an equitable distribution of the workload. Community resources must be tapped so that nurses, paramedical personnel can take over much of the bathing, feeding, dressing duties leaving women in a more managerial than menial tasks.
A mix of formal and informal care practices merged seamlessly can translate into a win-win situation for all. Organisations as Caregiver Saathi are trying to effect these changes, even as they strive to push forward for more effective policy initiatives that can help both the caregiver and the recipient of care. After all both sides deserve their due and dignity.
Featured Image Source: Elder Care Resources Albany