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Role Reversal: You Don't Go HomeAgainMildred M. Seltzer PhD aa Scripps Foundation Gerontology Center; Department ofSociology and Anthropology, Miami University, Oxford, OH,45056Published online: 14 Oct 2010.

To cite this article: Mildred M. Seltzer PhD (1990) Role Reversal: You Don't Go Home Again,Journal of Gerontological Social Work, 15:1-2, 5-14, DOI: 10.1300/J083v15n01_03

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Role Reversal: You Don't Go Home Again

Mildred M. Seltzer, PhD

ABSTRACT. Role reversal is variously referred to in the literature as a conce 1, a perspeclive, a descri tion, and a viewpoint. Role revsrsaI re F e n to a particular view oFparent-child relationships in late life, one that emphasizes "parent~ng the parent." This paper takes the position that a role reversal orlentation is inaccurate and inadequate for describing parent-child relationships in late life. It further takes the position that role reversal is conceptually, ideologi- cally and therapeutically limiting.

This paper reflects the position that role reversal does not occur any more than does second childhood. Role reversal is variously referred to interchangeably as a concept about, a perspective of, or a viewpoint concerning a specific kind of parent-child relationship in late life. At times it will be apparent that I see the expression "role reversal" as reflecting a philosophical or ideological orienta- tion, a world view about parent-child relationships and about old age.

The paper begins with an operational definition of the expres- sion. It primarily concerns ways in which this orientation is concep- tually limiting because the perspective provides an inadequate base on which to build societal or individual interventions. As an ap- proach, the concept of role reversal is ideological rather than

Mildred M. Seltzer is affiliated with Scripps Gerontology Center and the De- partment of Sociology and Anthropology, Miami University, Oxford, OH 45056.

This paper was prepared for the Symposium: "Role Reversal: Is It a Valid Concept?" at the 41st Annual Scientific Meeting of the Gerontological Society of America, San Francisco, November 18-22, 1988.

Journal of Gerontological Social Work, Vol. 15(1/2) 1990 O 1990 by The Haworth Press, Inc. All rights resewed. 5

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thoughtfd. It reinforces the most negative and terrifying stereo- types about frailty and parent-child relationships in old age. It is related to and reinforces belief that there is a "second childhood." In doing this, the perspective blinds us equally to the positive as- pects and good intentions of both givers and receivers of care. This, in turn, detracts from understanding changes in structure and func- tion of caregiving/receiving processes over time. The givingheceiv- ing relationship is neither unique to late life nor is it necessarily unique to frailty. Further, change is not synonymous with reversal. Placed within a life cycle perspective, late life changes in the carel receiving balance are viewed as within role changes rather than changes of roles.

A role reversal perspective also limits research. This paper there- fore closes with suggestions regarding four areas that merit further attention: (I) the vocabulary of gerontology; (2) increased focus on relationships rather than roles related to this; (3) an examination of caregivingheceiving systems rather than structures; and, (4) contin- ued analysis of dimensions of caregiving accompanied by the use of a model that sees interaction of dimensions rather than the mathe- matics that adds one dimension to another, e.g., an interactive rather than an additive model.

DEFINITIONS, ORIGINS AND A P P W

Operationally role reversal refers to the relationship between an impaired old parent and hislher caretaking child. It assumes that the child becomes the caretaking "parent" with the frail parent as child. Born out of therapeutic orientations, Rautman's 1962 article delineated the issues of role reversal. He saw our problem of pro- viding care for old people as rooted in our helpless infancy, depen- dent upon a strong, independent adult. As we move through life stages becoming increasingly independent, the originally clear dis- tinction between roles of parent and child crosses. The parent, for- merly dominant, now becomes subordinate and dependent. Strength and the future rests with the child. This child assumes the parental role vis-a-vis hisher parent. This reversal in roles is diffi- cult for each to accept because, as Rautman writes, it requires ". . . an almost complete reorganization of their entire weltans- chauung" (p. 117). In psychodynamic terms, the child is hostile

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Mildred M. Seltzer 7

because of earlier dependence. This hostility gives birth to the child's wish to have similar control over the parent. That wish is now achieved. As with most wish fulfillment, there is guilt, shame and the inevitable ambivalence. (Whom the gods would punish they first let achieve their wishes.) This affective component is a heavy burden.

Rautman suggests a developmental view of role reversal, an in- evitable progression of role changes and changes in role content. Unless the role behaviors are "worked through" and resolved at each stage, the role player faces problems. Resolutions of personal ambiguities are particularly essential for practitioners. Their unre- solved problems make them incapable of helping others solve simi- lar problems.

In her classic, "Social work and family relationships in later life with some thoughts on filial maturity" (1965), Blenkner questioned the occurrence of role reversal. It may be useful in understanding neurotic or immature parents and children but not others. In fact, she asks whether we use the concept because it fits facts, or because it is the only theory therapists have (p. 57). Children are filially responsible. They can be depended upon and are dependable (p. 57). Blenkner draws attention to how the role is played rather than the role itself, to the interpersonal rather than the structural aspects of the relationship.

The persistence of role reversal in our gerontological lexicon brings to mind Shanas's lecture on "Social myth as hypothesis: The case of the family relations of old people" (1979), Nydegger's pa- per on the family (1983), Brody's "Parent care as a normative fam- ily stress" (1985), and the 1985 GSA session, "Old theories never die:" In all of these instances, it was noted that theories serve func- tions, among them, providing guidance for social policies, social services, and various kinds of interventions. They provide simplis- tic ways of looking at complex phenomena and thus are comforting. They. also can reinforce stereotypes; this is less comforting.

Role reversal is a simple and neat concept. It is implicitly an exchange andlor balance model in which the child's dependence on parents during infancy and youth is counterbalanced and "paid for" when the old parent is dependent upon the child. Often the repay- ment is in-kind so that being fed as an infant is now repaid by

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feeding the parent. The child's diapering is matched by the use of Attends. This approach to relationships reassures and satisfies those who believe there are no free lunches and you never get something for nothing.

LIMITATIONS OF THE CONCEPT

There are three major limitations to the role reversal perspective: ideological, conceptual and therapeutic. Matthews addresses one aspect of the ideological bias when she writes that the "burden" approach to providing care for old parents reflects a shift from an optimistic tone about filial responsible children to pessimism about the ability of children to deal with the burdens of parent care (1988, p. 657). This '%burden7' approach is implicitly reflected in the re- cently published spate of "How To" books dealing with how to care for your aging parents. (We Americans - e.g., U.S., are a pop- ulation in constant need of instruction-how to diet, how to have a successful sex life, Row to invest in the stock market, how to exer- cise without effort, and how to die.) The subject matter covered in these books reflects our current interests, values and concerns. I do not want to depreciate their importance nor their companion piece, support groups. Both are potentially useful. Each reflects our per- sonal and societal concerns and anxieties. Each builds on our need to be independent, to cope, and to learn about resources that will enable us to do both. And, each combats shared ignorance by build- ing ow awareness that others have the same problems. There is strength in knowing others are in the same boat; there is strength in unity and there is frequently political power in both. At the same time, both also reflect the Protestant Ethic emphasis on "work," "strive and succeed" and "cope." These values permeate our en- tire social fabric and reflect our ideological biases. kt us turn now to a discussion of why the term "role reversal"

is conceptually inadequate as a description of reality and, therefore, provides an inappropriate basis for research policy, programming, and intervention.

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Mildred M. Seltzer

POSITION AND ROLE

Social and behavioral scientists distinguish between position and role. A position is a unit in the social structure. There are positions of parent, child, wife, husband, teacher, salesperson, ad infinitum. The behaviors associated with the positions are roles. People oc- cupy positions and play roles. Descriptions of role behaviors are frequently "ideal" ones-this is how the role should be played. There are, however, other ways of describing role behaviors. We can describe how a specific individual plays herbis role (idiosyn- cratic), or how the role is typically played (normative).

Role behaviors are filtered by age, sex, social class and all of the other modifying variables. As we age, as we gain experience, as situations change, we change in how we play specific roles. Roles become highly personalized. The role itself becomes less relevant and relationships more. As personalization increases, the need for structural supports tend to decrease. These factors result in role changes, not necessarily changes of roles. Thus children remain children to their parents all of their lives despite the folk statement that distinguishes sons and daughters (a daughter is a daughter all of her life and son is a son till he gets him a wife). The son may change how he plays the role of son, but he continues to be a son. And, while the positions are the same, the relationships become increas- ingly adult/adult ones.

THERAPEUTIC LZMITA TIONS

For a number of reasons an inadequate concept should not be used as a basis for intervention. I will address three problems that relate to the concept-role reversal and these only briefly. They are that the perspective (1) builds on weakness, not strength; (2) rein- forces a stereotype of a second childhood; (3) and thus encourages toys, not therapy. I have already talked about Sarah Matthew's arti- cle regarding the "burden" approach to caring for parents. Such an approach assumes the old person's weaknesses and, to a large ex- tent, ignores or does not readily see strengths. Gadow deals well with the dialectic of strength and frailty in old age (1986). Interven- tion that builds on weaknesses rather than strength does a disservice

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10 JOURNAL OF GERONTOLOGICAL SOCIAL WORK

to people. It diminishes whatever autonomy and abilities individ- uals have. We are all powerless enough throughout our life cycle, without emphasizing that fact at the end of life.

An assumption of reversal equates extreme old age and child- hood, a second one. It places an old person in the position of subor- dinate child, one for whom toys are a source of comfort. This is sometimes reinforced by inadequate activities programs in some nursing homes. It is further reinforced by the childlike language we and others use with the very frail old person. We forget what St. Paul said, "When I was a child, I spoke as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things." Unlike St. Paul, role reversal presumes the paral- lel nature of childhood and frailty, infancy and senility. The as- sumed similarities are reinforced in literature and folklore persisting in the face of contrary data. We know that patterns of aging and of sicknesses do not mimic those of childhood and development. We may become dependent but that is not the same as being childlike. Dependence in old age is colored by a lifetime of experiences, by a history of having been independent. The dependent child has had neither.

The concept of role reversal calls our attention to the problems of the caregiving child and removes our concern about the old per- son-am easily ignored dependent. We see this in much of our re- search which focuses on the caregiver, the stress of caregiving, the need for the caregiver to learn about potential resources. We pay far less research attention to the difficulties of being a care recipient. We believe strongly that it is more blessed to give than to receive and given the role reversal perspective, it would be hard to argue with that statement.

Role reversal further assumes similarities between parenting a child and caring for an aged, frail parent. Caretaking and parenting, however, are not synonymous. Caring for dependent children is only one aspect of parenthood and perhaps not the most significant one. More importantly, parents are responsible for socializing chil- drew, [providing all forms of support and teaching children to make their own decisions. These activities are qualitatively different from managing decisions about another adult's life. Parents often con- tinue parenting activities of socialization, teaching, providing a role

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Mildred M. Seltzer 11

model into late life, frequently until death (and through wills, after death).

Contrast these activities with those connotated by the concept of role reversal. Unlike parenting where there is little ambiguity over what to do except perhaps when to give up responsibilities, children experience ambiguity regarding the assumption of responsibilities for a parent. And, if ambiguity is not enough, feelings of inade- quacy and guilt are added. Parenting a child involves the creation of history; caring for an aged parent rests on an already created his- tory. While becoming a parent provides the moral basis for "taking over" the care of another, there is no rite of passage nor role change that legitimates "taking over" for an aged parent. There is, indeed, an absence of structural supports. Role reversal does not adequately describe what occurs when it becomes necessary to "take over" the care of a frail and sometimes demented parent. Roles are not re- versed! Their content is different. Different is not necessarily rever- sal. If a parent is demented, heishe does not "revert" to a "second childhood." The concept of a "second childhood" is based on a particular view of dementia, not to mention the life cycle. And, unlike childhood, dementia is not always predictably patterned.

While there may be superficial similarities between providing parent care for a child and filial care for a parent, such similarities are not evidence of reversals. Providing care and giving advice are characteristics of many relationships. When the young socialize the old is this, by definition, role reversal? A focus on relationships between people rather than on their roles provides a more satisfying way of thinking about what occurs when children assume responsi- bilities for parents. It moves us from simplistic ways of conceptual- izing what takes place. We can begin to examine threads common to all interpersonal relationships.

RESEAlgCH LIMITATIONS

Acceptance of the role reversal perspective limits our research by its assumptions about relationships. These assumptions, in turn, shape our hypotheses and our questions. It focuses attention away from the care system and from the meaning of caregivinglreceiving interactions and relationships.

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Issues of caregiving in late life have become major concerns of ethicists, politicians, legislators, and various other publics. Because of this, the language through which the issues are expressed is im- portant. The vocabulary of role reversal and of caregiving in gen-, eral, reflects our world view and our motives. The terms "caregiv- ing7' and "caretaking" are treated synonymously. There is no word for the care recipient. If there were, I do not think it should be caretaker because that word is too action-oriented for what we think we are describing. The root of the word "care" is itself fascinating. It can be a noun or a verb. According to the dictionary, its Anglo Saxon origin is "caru." As a noun, "care" has its meaning rooted in sorrow, lament. Its dictionary definition is "(1) suffering of mind; grief; sorrow. (2) a burdensome sense of responsibility; trou- ble caused by onerous duties" (Webster, 1961, 405). Other mean- ings are in the same vein. As a verb, its definition is to grieve or to lament. It can also mean "to have or feel care or solicitude; now usually with, for, or about . . .; specif.:a. To feel troubled, anxious or fearful. b. To have or feel concern or interest" (op. cit., p. 405).

These definitions and synonyms make clear some of the dimen- sions of caregiving and complexities and effect in playing the care- giving role. These involve doing and feeling, liking, anxiety, trou- bles and wishes. It concerns the "good," the "bad" and the indifferences of relationships between people throughout the life cycle. With this in mind, let us turn attention to directions for future research.

Other analogies and models could be more useful than that of parent-child relationships. A systems model which emphasizes in- teractions and changes within the system draws us away from the stereotype of second childhood. It draws our attention from weak- nesses and stresses. It reminds us that caregiving changes over time. It changes as circumstances change. Relationships change. Motives change. A shift in research emphasis will draw us to exam- ining more fully the interactions between and among participants in the caregivingheceiving system. -

We need to learn more about the system's participants' attribu- tion of meanings to the changing circumstances. In the process of studying these, we can examine the strengths of the care receiver (caretaker), the other person in the interaction and how to build on

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Mildred M. Seltzer 13

these as well as on the strengths of the caregiver. All too often, we lose sight of the receiver.

Because caregiving is multidimensional, we should focus on the interactions of these dimensions, moving from an additive model in which we add one stress to another to another. The whole can be more than the sum of its parts. Shifts in research focus can enrich our findings and possibly provide a different foundation for inter- ventions.

Attention should be given to the lingua gerontologia in general and specifically to the caregivinglreceiving vocabulary. It is a kind of paternalistic/maternalistic language; it implies active and passive roles. There are caregivers, caretakers, and no receivers. It is lan- guage in which nouns become verbs and adjectives, nouns (e.g., "toileting" and "the elderly"). What word do we use for those who receive (or get or take) care? Caretaker is connotatively more active than carereceiver. Carereceivers are more malleable, more subject to behavioral modification as a form of treatment (see, for example, Simon, April, 1988). The person to whom care is given/ provided is an active participant in the caregiving/receiving system. The sphinx was wrong. The cycle does not begin and end with childhood and dependence. Oedipus did not become a dependent child, he was transformed into a demon and disappeared. He changed from human to a godlike condition (Whitman, 1966).

SUMMARY

The concept of "role reversal" is, like disengagement, "the- ory," an early way of looking at relationships. It characterizes a period in gerontological history when we spoke about old parent and adult children. It implied parents weren't adult. The persistence of this perspective reflects a gerontological bias, and an antiquated view of the life cycle. It takes attention from what is important in and about parent-child relationships in very late life. It emphasizes the deterioration of the old and the stress on the child. It ignores what we know about autonomy. It imputes the observer's realities into the relationship, and thus does not examine the participants' realities. It views this late life relationship as relatively static- waiting only for death of the parent as its conclusion. When rela-

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tionships between parent and child are neither known nor under- stood, the concept of "role reversal" provides a stereotypic, superficial description of those relationships-a quick fix. It gives the image of "second childhood" an importance it does not de- serve. The perspective focuses on the caregiver and on research of a dominant-subordinate relationship with particular emphasis upon the problems experienced by the dominant one. The perspective views parent care as a problem; old people as a burden. Lamm and Callahan take this problem to its ultimate conclusion and suggest th,e elimination of the subordinate. And, except for a touch of guilt, this solution could possibly eliminate the stress experienced by the superordinate child.

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Blenkner, Margaret (1965). Social work and family relationships in late life. Pages 46-59 in Shanas, E. and Streib. Social Structure and the Family: Genera- tional Relatiomhips. Englewood Cliffs: Prentice Hall, Inc.

Brody, Elaine (1985). Parent care as a normative family stress. The Gerontologist 25(1):19-29.

Gadow, Sally (1983). Frailty and strength: The dialectic in aging. The Gerontolo- gist 23(2):144-147.

I Corinthians U:lI (King James Version). Matthews, Sarah (1988). The burdens of parent care: A critical evaluation of

recent findings. Journal ofAging Studies 2(2):157-165. Nydegger, Corinne (1983). Family ties of the aged in cross-cultural perspective.

The Gerontologist 23(1):26-32. Rautman, Arthur L. (1962). Role reversal. Geriatrics Mental Hygiene XLWl16-

120. Janualy. Shanas, Ethel (1979). Social myth as hypothesis: The case of the family relations

of old people. The Gerontolo&t 19(1):3-9. Simon, Cheryle (1988). A care package. Psychology Today, April, 42-49. Special Symposium: Old Theories Never Die. 38th Annual Scientific Meeting of

the Gerontological Society of America, November 22-26, 1985, New Orleans, Louisiana.

Webster's (1961). Mew International Dictionary of the English Language. Springfield, Massachusetts: G . & C. Merriam Co., P,ublishers.

Whitman, Cedric H. (1966). Apocalypse: Oedipus at Colonus. In Woodward, Thomas (ed.), Sophocles: A Collection of Critical Essays. Englewood Cliffs: Brentice-Hall, Inc.

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