Social Dimensions of Alzheimer's Disease Among Caregivers in Oaxaca, Mexico

330 Pages·2017·3.32 MB·English

Duquesne University
Duquesne Scholarship Collection
Electronic Theses and Dissertations
Summer 1-1-2016
Social Dimensions of Alzheimer’s Disease Among
Caregivers in Oaxaca, Mexico
Jonathan Yahalom
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Recommended Citation
Yahalom, J. (2016). Social Dimensions of Alzheimer’s Disease Among Caregivers in Oaxaca, Mexico (Doctoral dissertation, Duquesne
University). Retrieved fromhttps://dsc.duq.edu/etd/94
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SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE
AMONG CAREGIVERS IN OAXACA, MEXICO

A Dissertation
Submitted to the McAnulty Graduate School of Liberal Arts

Duquesne University

In partial fulfillment of the requirements for
the degree of Doctor of Philosophy

By
Jonathan Yahalom

May 2016
Copyright by
Jonathan Yahalom

2015
SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE
AMONG CAREGIVERS IN OAXACA, MEXICO

By

Jonathan Yahalom

Approved November 13, 2015

________________________________ ________________________________
Roger Brooke, Ph.D. Leswin Laubscher, Ph.D.
Professor of Psychology Professor of Physical Therapy
(Committee Chair) (Committee Member)

________________________________ ________________________________
Paola M. Sesia, Ph.D. Leswin Laubscher, Ph.D.
Professor of Anthropology Chair, Psychology
Centro de Investigaciones y Estudios Professor of Psychology
Superiores en Antropología Social (CIESAS),
Oaxaca, Mexico
(Committee Member)

________________________________

James Swindal, Ph.D.
Dean, McAnulty Graduate School of Liberal Arts
Professor of Philosophy

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ABSTRACT

SOCIAL DIMENSIONS OF ALZHEIMER’S DISEASE
AMONG CAREGIVERS IN OAXACA, MEXICO

By
Jonathan Yahalom
May 2016

Dissertation supervised by Roger Brooke Ph.D.
This dissertation provides an analysis of the social construction of Alzheimer’s
disease within Teotitlán del Valle, a rural Zapotec-speaking community in Oaxaca,
Mexico. It explores how Alzheimer’s disease is locally understood, how this
understanding reconfigures traditional meanings of old age, and how broader social
issues are negotiated through this reconfiguration. Through 10 months of fieldwork this
dissertation draws on ethnographic observations and interviews with 22 family caregivers
across 9 households. This study is noteworthy for being the first known investigation in
Teotitlán whose primary data was collected in the Zapotec language. Further, this
dissertation integrates methods across psychology, gerontology, and anthropology,
resulting in a unique interdisciplinary approach and a novel interview technique called
“locally-focused interviewing.”
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Results are ethnographic in nature and provide insight onto local caregivers’
experience of attending to elders with Alzheimer’s disease and other dementias. Further,
these results show how caregivers’ experience is situated within multiple local discourses
– different medical systems, power structures, socioeconomic parameters, norms and
traditions. In so doing, this dissertation advances a number of observations. First, this
dissertation leverages anthropological insights about medical pluralism – the existence of
multiple medical systems in a single location – and demonstrates how Alzheimer’s
disease is socially constructed via medical theories and broader social dynamics. Second,
this dissertation analyzes how caregivers make decisions on behalf of dependent elders,
and how these decisions are made within a medically pluralistic landscape. Although
medical decisions are based on concern for elders’ wellbeing, they also invoke dynamics
between local traditions and contemporary changes. Third, this dissertation traces
caregivers’ daily experience as an instance of what anthropologists refer to as social
suffering by attending to caregivers’ challenges, strategies, and perceptions of elders.
These features disclose how the caregiving relationship is situated within a tension
between local values about aging and the reality of caregiving. Lastly, this dissertation
explores how and why caregivers feel responsible to care for dependent elders, and
illustrates the way that the broader community is involved in shaping caregivers’ daily
experience. As a whole, this dissertation contributes to the fields of psychology and
medical anthropology by highlighting the social dimensions of Alzheimer’s disease and
how these dimensions shape the experience of providing care for dependent elders.

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For
Tommy Sage Hand
(1985 – 2012)

Because we don’t stop trying

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Acknowledgements/Agradecimientos

Seven years ago, in Northern California and on the way to wine country with my
mother and stepfather, I debated whether to pursue a career in psychology. I had the
option to remain at my current job, yet something seemed amiss. As we made our way
through the curves of the California countryside my parents did what I will always
appreciate them for – they listened and told me that they’d support me on whatever path I
would come to choose. And so, months later in San Francisco I announced to my father,
Aba, at our favorite restaurant that I would be moving to Pittsburgh to study for my
doctorate in psychology. Soon enough we were explaining the reason for our celebration
to the restaurant owner and he responded by gifting us with double magnum bottle of
wine – stipulating that we could only open it together, when I returned with a degree in
my hands. This dissertation marks the final step towards fulfilling that promise, and the
conclusion of the conversation I’d had with my other parents even earlier. I am beyond
indebted to all my parents – my mom, Aba, Glen, Sylvia and Luisa – for their
understanding, support, and love. May we keep having more wine to open and more
occasions to celebrate – l’chaim!
Working for my degree at Duquesne University has been a privilege. I would first
like to thank Dr. Roger Brooke for having faith in my capacity to carry out this project,
providing the encouragement to pursue it, and being the first person to call my attention
to the importance of conducting a study on aging. Dr. Leswin Laubscher has led me by
example in demonstrating what passionate scholarship looks like. I have been fortunate to
call him a mentor, advocate, and friend – throughout my time in Pittsburgh and during
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research in Oaxaca. I am indebted to Dean Swindal for his generous moral and financial
support for this project, which motivated me by having the honor to represent the
University from abroad. This project was made possible through the McAnulty
Dissertation Fellowship, the Dean’s Small Research Grant, and a grant from the
McDowell Committee.
Nearly every faculty member in the Department of Psychology has contributed in
some way to this project, but I would specifically like to mention Drs. Russ Walsh,
Elizabeth Fein, Jessie Goicoechea, and Melissa Kalarchian for their support during my
research. Marilyn Henline and Linda “the Boss” Pasqualino have made daunting tasks
more manageable and fun. The Gumberg Library staff has also been helpful and patient
by providing technical assistance and help tracking-down nearly any obscure book or
article I had hoped to acquire. Lastly, I would like to thank my peers who gave me
confidence to study what I was passionate about. I was challenged and grew from
conversations with every graduate student, but I would like to specifically thank Teal
Fitzpatrick, Chris McCann, Denise Mahone, Katie Wagner, Rachel Gottlieb, and
Camille O'Connor – I am grateful for your friendship.
I am extremely fortunate for the partnerships I forged in Oaxaca. I conducted this
project as a guest scholar under Dra. Paola Sesia at Centro de Investigaciones y Estudios
Superiores en Antropología Social (CIESAS). Partnering with Dra. Sesia was an honor:
not only did she develop my anthropological gaze, she taught me the true, collaborative
spirit of academic inquiry. Additionally, my residency at La Biblioteca de
Investigación Juan de Córdova provided an inspiring space to reflect and write. I would
like to thank Dr. Michael Swanton for his hospitality, enthusiasm, and guidance. También
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– y definitivamente – necesito agradecer a Janet Chavez Santiago, mi maestra de
Zapoteco y de todo lo relacionado con Teotitlán además de ser una muy querida amiga.
Quisiera igualmente expresar mi gratitud a todas las demás personas de la biblioteca –
Omar López Rocha, Claudia Ballesteros, y Leticia García – por su hospitalidad y ayuda.
This project would not have been possible without the help I received in Teotitlán
del Valle. I would like to thank Taurino Alexandro (“Alex”) Mendoza Martínez and
family for so warmly welcoming me into their home, teaching me about local customs,
and helping me establish local contacts. As subsequent pages of this dissertation
elaborate, Alex is in many ways the hero of this study and I am sincerely grateful for his
willingness to take it on as his own personal endeavor. Asimismo quisiera mencionar a
Domingo Gutierrez Mendoza quien me ha ayudado a entender las experiencias de los
adultos mayores en Teotitlán, al municipio, y al resto de mis amigos teotitecos.
Finalmente quisiera dar las gracias a todas las personas que me ayudaron a hacer
posible este proyecto – especialmente a cada familia que me recibió en su casa con todo
su cariño. Espero que esta investigación le haga justicia a su historia.
I would also like to thank other friends made in Oaxaca. Thank you to Sebastian
Pillitteri, Andreyet Gilly, Eric Fanghanel, Sophie Langridge, and Kat Black for
inexhaustible fun, personal inspiration, and help reflecting on my work; Nan “Lola”
Newell for encouragement and being my strongest local advocate; Holly Worthen and
Whitney Duncan for teaching me about local ethnography; Karen Rasmussen for her
work serving Oaxacan elders and invitations to participate in her program; gracias a
Leidy Jarquin Saucedo y Eduardo Sánchez García por su amistad; a Leticia Gomez
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