Lisa Johnson - Seniors and Squalor: An Aging America’s Toughest Ethical Dilemma

Seniors and Squalor

Competency, Autonomy, and the Mistake of Forced Intervention

Lisa Johnson

Copyright 2018 by Lisa Johnson

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher.

Library of Congress Cataloging-in-Publication Data

Names: Johnson, Lisa

Title: Seniors and squalor : competency, autonomy, and the mistake of forced intervention / Lisa Johnson.

Description: Santa Barbara, California : Praeger, [2018] | Includes bibliographical references and index.

Identifiers: LCCN 2018024795 (print) | LCCN 2018025328 (ebook) | ISBN 9781440854002 (eBook) | ISBN 9781440853999 (hardback : alk. paper)

Subjects: | MESH: Social Problems | Aged | Mental Competency | Personal Autonomy | Public Policy | Independent Living | United States

Classification: LCC RA564.8 (ebook) | LCC RA564.8 (print) | NLM WT 30 | DDC 362.1084/6dc23

LC record available at https://lccn.loc.gov/2018024795

ISBN: 978-1-4408-5399-9 (print)

978-1-4408-5400-2 (ebook)

222120191812345

This book is also available as an eBook.

Praeger

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This book is printed on acid-free paper

Manufactured in the United States of America

Contents

CHAPTER ONE

This Strange Phenomenon

The As Yet Unpinned Subject

For quite some time, no one has seen the elderly woman who lives alone. Her house is shrouded with overgrown hedges, brambles, and all manner of weeds. The windows are impenetrable, blocked by heavy curtains, sheets, or piles of stuff, and they are smeared with the muck of timeinside and out. Mail and newspapers pile up for days or weeks. People might refer to her as a hermit or a recluse.

If she has family, they may not come around much; or, if they do, they cannot seem to help her regain her footing on the path of so-called normalcy. She steadfastly refuses help of any kind. She is not sociable. She may passively or actively collect useless items, including garbage, which might interfere profoundly with living areas. Her house might be verminous, but she is undisturbed by the infestations, whether they are mice, rats, roaches, or something else. Her skin is visibly dirty. Her hair is matted. She wont clean her living quarters. She may be suspicious, aggressive, and aloof. She displays no sense of shame about her state of being or her living conditions.

However, things werent always so. People may remember her back whenback when she held a jobperhaps even as a professional or with a high level of responsibility; back when she kept a tidy yard and home; back when she was well kempt. But, even back then, she may have been distrustful, excessively independent, and not particularly friendly. And, now, she really doesnt seem to care much what other people think about her or her lifestyle.

She has normal or above average intelligence. She is mentally competent. She has full capacity to make decisions. Collectively, her behavioral and personality characteristics do not fit within any diagnoses of any edition of the Diagnostic and Statistical Manual of Mental Disorders, and only loose and broad descriptors exist for her state of beingcollectively, they simply do not diagnose anything. Medical, social service, psychiatric, and legal communities have no standardized terms that might be used to describe her.

Family members, neighbors, and all who come into contact with her are at a loss, at once repelled and horrified, while wondering how they can help.

This vignette amalgamates real-life facts of particular usefulness to examine questions fundamental to our society, particularly in an age when people are increasingly polarized about the appropriate role of government in their daily lives and the norming power of the constant modern social gaze.

As we shall see, this type of situation is far from uncommon, yet it remains little studied. There are reasons for that, including lack of agreement on relevant terms within and between disciplines, and clinical and research difficulties in studying those who would be left alone. The drum beat heard in much of the literature that presents work in this area is that more research is needed.

In all of this, there is a presumption that a person who lives in such a manner is an appropriate object of study, and that such study requires the objectification of a subject waiting to be medicalized, a subject waiting to be treated.

The medicalization of individuals who would not be medicalized, and the summoning of law to pave the way for state intrusion provides examples of particular forms of power that can be endorsed or repudiated. Helpful to framing and conceptualizing this issue are certain of Michel Foucaults works and ruminations. For example, Foucaults explanation of power in the context of making individuals into subjects is relevant and useful to our understanding of the present topic:

This form of power applies itself to immediate everyday life which categorizes the individual, marks him by his own individuality, attaches him to his own identity, imposes a law of truth on him which he must recognize and which others have to recognize in him. It is a form of power which makes individuals subjects. There are two meanings of the word subject: subject to someone else by control and dependence; and tied to his own identity by a conscience or self-knowledge. Both meanings suggest a form of power which subjugates and makes subject to. Generally, it can be said that [one] type [] of struggle [] [is] against that which ties the individual to himself and submits him to others in this way (struggles against subjection, against forms of subjectivity and submission).

Although Foucaults remarks on subject making, subjugation, and power do not provide a methodology, It is simply one waya useful wayto think about these things. As such, it treats with suspicion unexamined assumptions that law or government should come to the rescue in these cases.

There is no intention to bend the present discussion intractably toward theory. Although Foucaults observations about power are useful, this work is not an exercise in theoretical development. Instead, the overall project should have great practical use to those interested in this topic, by examining the legal and political questions at play. However, it draws on a Foucaultian conceptualization of power as a lens through which we might view the strange phenomenon under consideration, and to consider the legal and political implications of action or inaction. At all times, the work was written with an eye toward practical accessibility, while attempting to recall the larger backdrop of issues that extend beyond an immediate focus on the facts.

This work is the first of its kind to address certain conditions of living of some of those that might be called to mind by the terms recluse or hermit through the lenses of applied law and political theory, rather than medicolegal, medical, or behavioral science. In doing so, it attempts to inform possible answers to certain questions that are suggested by the existence of these particular cases. These answers would perhaps have longer reaches than mere application to the facts at hand, were these answers, in fact, to appear. But these are difficult questions that require significant reflection on broad and deep pillars of our political landscape, our situatedness in time as rational actors whose currency is reason, and in the relatively simple matter of law. Certain questions point the direction of this project: