Abstract
Reviewed by: Annika Mayer & Roberta Mandoki, Heidelberg University, Germany
Bianca Brijnath’s elaborately written ethnography, Unforgotten, is a valuable contribution to the literature on dementia care in India as well as to medical anthropology and aging studies in South Asia. Primarily focusing on urban middle-class families who provide care for their relatives, the study elucidates both challenging and valued aspects of domestic and professional elder care for dementia patients in India. One of this ethnography’s greatest strengths is its sensorial approach, which allows Brijnath to include aspects neglected in research on dementia, such as the loss of control over bodily functions, resulting in shame and disgust, but also the emotional meaning of food and feeding someone. Brijnath’s rich ethnographic material illustrates these close observations and makes her study an important contribution to the still largely Western-centered research on dementia.
A major achievement of this ethnography is that it carefully describes cultural specificities of dementia care in India, such as the multiple layers of care (sevā) being the center of intergenerational relations, and the search for cure (ilāj) where families combine different medical sources or practice “doctor shopping” as part of middle-class consumption patterns. Different types of institutions and the power of biomedical discourse shape these dynamics and impact middle-class health seeking behavior. Another aspect concerns the social consequences that Indian families encounter when a family elder becomes a dementia patient, such as the possible loss of influence in their community, setbacks in social agreements like wedding negotiations or gradual isolation from the gaze of other community members. Within the private sphere, Brijnath describes the significance of Indian homemade food for the senses and memories of both receivers and providers of care, and how this both alters and reestablishes intimacy between care-giving children and their parent or feelings of romance and love between spouses.
As Brijnath stresses, this ethnography has to be understood as documentation of current dynamics in care practices and professional support of middle-class families. Since most families she studied had sufficient financial means, they were able to access multiple kinds of medical treatment as well as to employ domestic care workers from lower classes. In this context, notions of caste difference and symbolic purity are challenged, and complex interclass relations involving dominance and dependence emerge. Furthermore, normative gender roles of care takers and dementia patients are often no longer sustainable and responsibilities can shift, such as when women take over finances and men do household work and cooking.
Brijnath offers the reader multiple perspectives on dementia care in urban India. Recognizing the challenge of representing the often disrupted voices of persons with dementia, Brijnath decided to include them in a nonlinear way following the structure of a Bollywood drama. Due to the great variety of issues covered, some parts would have benefitted from more detailed theoretical framework and analysis of the questions raised. For example, the topic of love in care which runs through the entire ethnography could have been elucidated in more depth.
What sets this impressive ethnography apart from the dominant literature on aging studies in India are its close ethnographic look at family processes of care and its eloquent writing style, paired with many sections where Brijnath reflects on her role as an ethnographer. Unforgotten is not only suitable for a scholarly audience, but also more generally for people with an interest in the care of dementia patients in India.