Growing Old in a New China

Transitions in Elder Care

Rose K. Keimig

• Publisher: Rutgers University Press
• Year: 2021
• ISBN:
  9781978813939
• Topic: Sciences sociales
• Subtopic: Sociologie

Growing Old in a New China: Transitions in Elder Care is an accessible exploration of changing care arrangements in China. Combining anthropological theory, ethnographic vignettes, and cultural and social history, it sheds light on the growing movement from home-based to institutional elder care in urban China. The book examines how tensions between old and new ideas, desires, and social structures are reshaping the experience of caring and being cared for. Weaving together discussions of family ethics, care work, bioethics, aging, and quality of life, this book puts older adults at the center of the story. It explores changing relationships between elders and themselves, their family members, caregivers, society, and the state, and the attempts made within and across these relational webs to find balance and harmony. The book invites readers to ponder the deep implications of how and why we care and the ways end-of-life care arrangements complicate both living and dying for many elders.

1

Filial Children, Benevolent Parents

Profound was King Wen. With how bright and unceasing reverence did he regard his resting places! As a sovereign, he rested in benevolence. As a minister, he rested in reverence. As a son, he rested in filial piety. As a father, he rested in kindness.

—James Legge (Trans.), Great Learning

At Jade Hills, an elder care home I visited several days a week for nearly seven months, staff members typically greeted me with a shake of the head or a sigh and a scolding: “You’re here again.” I seemed to always arrive too early or too late, on a day that was too hot, cold, windy, rainy, or sunny. A well-connected local doctor had introduced me to the home’s director, Lu Wei, who seemed pleased by the prospect of future reciprocated favors. However, the overworked staff members struggled to understand why I kept showing up to just “hang out,” as they put it. During an early attempt to explain the purpose of my research, I invited Director Lu to review my interview schedule. Frowning and shaking his head, he pointed out a number of what he called “meaningless” questions, such as those about marriage (“everyone is married!”) or urban migration (“not interesting!”). I was surprised, however, when he dismissed the whole section on filial piety. He estimated that only three out of ten people would have any idea what filial piety was. I told him that I had not yet encountered that problem, and he replied that I must have been talking to old people. While he did have a point, I also interviewed dozens of younger people and found that middle-aged people were actually more interested in the topic of filial piety than elders were. Zhang Li, a thirty-one-year-old female doctor, said: “Is there anything more important than filial piety? As I see it, filial piety includes many, many things. I should say many things are contained in it, so it is relatively complete. Nothing is more important than it.”

The contradiction between the opinions of the director and the physician, both of whom worked in elder care institutions, highlighted an issue that nagged at me throughout this research. When I set out to study China’s “new” elder care homes, my theoretical orientation was similar to Dr. Zhang’s. Knowing that proper family relationships, which include younger generations’ care of their elders, formed the bedrock of Chinese ethics and traditional practice, it seemed to me that the recent phenomenon of middle-class elders living in elder care homes rather than with their healthy, adult children was in conflict with core values. Although I could understand the social, demographic, and economic factors driving these new elder care arrangements, the question remained: what are the moral implications for individuals, families, and society?

According to Yan Yunxiang, an eminent China anthropologist, “the most significant change with respect to elderly support, in my opinion, is the disintegration and ultimate collapse of the notion of filial piety” (2003, 289). In his analysis, he systematically showed how decades of socialist revolutions undermined filial piety’s institutional support in the mid-twentieth century and led to the “demystification of parenthood and filial piety” (ibid., 189). He pointed to marketization and individualization as the ultimate culprits in the destruction of filial piety. Yet despite the accuracy of Yan’s observations and the sound logic of his argument, filial piety stubbornly persists in very real ways at the social level. It is the foundation of new policies, including the Law on Protection of the Rights and Interests of the Elderly (Shum et al. 2015), and makes an appearance in every academic and popular conversation about elder care. Of course, one does not have to practice a tradition to make use of it. The early Chinese social scientist Fei Xiaotong, writing in the 1940s, observed that people tend to “justify social change by reinterpreting the old authorities,” which eventually leads to “a widening separation between the names of phenomena and their reality.” He goes on to assert that as long as people “pay lip service to the form, they may reinterpret and thereby change the content” (X. Fei 1948/1992, 89).

In agreement with Fei’s account, recent empirical research suggests that filial piety has survived social upheavals, but not without considerable effort from both children and parents to negotiate, interpret, and reimagine filial expectations and practices (D. Wang 2004; Whyte 2004; Zhan, Feng, and Luo 2008). However, most of these studies have focused on younger adults or independent elders. For example, one study, which analyzed survey results from 19,415 adults over sixty—95 percent of whom did not require instrumental support from their children—found that only 1.5 percent considered their children unfilial (Mao and Chi 2011). In Shanghai, Jeanne Shea and Yan Zhang found that even elders who did require care but weren’t receiving it from their own children felt not that their children were unfilial but that they were understandably “busy with their own lives” (2016, 375).

Heying Jenny Zhan, who has spent several years collecting qualitative data in urban elder care institutions, has also reported high levels of elderly satisfaction regarding adult children’s filiality (Zhan, Liu, and Guan 2006; Zhan, Feng, and Luo 2008). Similarly, in my research, all the elders I interviewed had adult children yet received paid caregiving services, whether at home or in an elder care institution. Some situations, from an outsider’s perspective, bordered on abandonment: a couple of elders reported seeing family members less than once a year. Nonetheless, while elders described varying levels of closeness with their family members, of the thirty-three who completed formal interviews, only one claimed that a child was unfilial.

On one level, these unexpectedly positive reports probably stem from a disinclination to acknowledge or share feelings of dissatisfaction and disappointment about one’s own family members with an outsider. For example, in a qualitative survey of 265 elders and 114 family members, Zhan and colleagues found that 49 percent of elderly respondents claimed to have initiated the move to an institution themselves, while only 28 percent of relatives reported that the elders actually wanted to make that move (Zhan, Liu, and Guan 2006). The authors question whether this discrepancy is the result of children’s guilt or parents’ retroactive face-saving responses to unfilial behavior. It is impossible to know with certainty the thoughts and feelings of other people, which they may conceal even from themselves. However, throughout my fieldwork, I was surprised to find very little verbalized discontent about children. Although institutionalized elders frequently reported missing their families and wishing they could spend more time with them, they did not articulate these desires in terms of filiality, nor did they demonstrate the “strong entitlement to support” that Yan observed among rural elderly (2003, 178).

Based on the literature I read before conducting my fieldwork, the experience of elderly institutionalization should be saturated with concerns about the breakdown of filial piety. However, according to my observations of and conversations with elders, this did not seem to be the case. How and why do these elders still view, or profess to view, their children as filial? Furthermore, considering that elders ultimately have the most at stake if filiality lapses, why do they seem less concerned about it than younger generations and social scientists are? And if elders do not see an association between filiality and institutionalization, then what moral dimension is involved in their experiences of major elder care transitions? Finally, how might these questions make sense of the contradiction between Director Lu’s assertion that filiality is no longer understood and Dr. Zhang’s belief that that nothing supersedes it?

In this chapter, I attempt to answer those questions by first describing the foundations of Confucian family ethics and how they have shaped collective consciousness and social structures in China for millennia. I then review existing perspectives on filial piety, both historical and modern, to demonstrate that although the literature is theoretically rich, discussions of filial piety tend to focus on the child’s role in the parent-child relationship. Scholars have explored the creative, flexible, agentive aspects of filiality, but often in the context of static, constraining structures of parental expectation and traditional obligations. The result has been an overlooking of parents’ continuing contributions and their active roles as morally creative agents.

With this in mind, in the second half of the chapter, I zoom out and look at filial piety as one part of a larger system of ethics centered on balance and harmony. Examining the roles of obligation, expectation, and reciprocity, I shift the lens to focus on intergenerational exchange from the parents’ perspectives. Rather than looking at duties and obligations, I emphasize the role of parental expectations, contributions, and understandings, especially as related to considerations of balanced reciprocity. I argue that for elders, the concepts of kindness, love, and benevolence might provide a more complete picture of the intergenerational relationship in practice. Finally, I demonstrate how a focus on younger generations’ moral shortcomings tends to overshadow elders’ individual experiences with aging and institutionalization and distract from the broader social processes involved in their physical, financial, or emotional struggles.

Filial Piety

In the introduction to their edited volume on the topic of filial piety, or xiao (孝), Alan Chan and Sor-hoon Tan argue that “it would not be an exaggeration to say that the concern with xiao pervades all aspects of Chinese culture, both past and present” (2004, 1). While this is no doubt true, I have found that using “filial piety” as shorthand for the value system it represents prevents many English speakers from truly understanding the moral and affective significance of the term—especially the deeper way it operates in the Chinese psyche. When I talked with my dad about this topic, he asked how filial piety in China was any different from what he witnessed growing up on a farm in rural Minnesota. He could recall many families, including his, living in multigenerational households and caring for their elders at home. In the United States, too, only the most destitute elders spend their final years in welfare homes, and factors like economic necessity, geographic mobility, and concern and affection for one’s blood relatives drive many caregiving decisions. However, the way filial piety shapes Chinese ethics and, by extension, all realms of individual and social life, is much more apparent and articulated than in Western cultures. Because of this uniqueness, following other scholars, I will use the transliteration xiao throughout this chapter rather than an English translation (X. Feng 2008a).

In the Analects, an anthology of Confucius’ words collected by his disciples shortly after his death in 479 BCE, xiao is described as the “root of all benevolent actions” (Legge 1861, 2). This centrality is “one of the most distinctive characteristics of Confucian ethics” and extends into all areas of life (Wong 2008). In fact, respect for elders is a defining characteristic not just of China, but of East Asia in general. In Filial Piety (2004a), Charlotte Ikels and contributors provide a comprehensive analysis of the historical and cultural context of this virtue. In the introduction (2004b), Ikels describes the structure of the character for xiao, which is the symbol for “old” above the symbol for “child” or “son.” As with many Chinese characters, this ideogram is at once obvious and ambiguous. From one perspective, the child below supports and holds up the old. Looked at another way, the old’s position above the young reflects generational hierarchy or lineage. Alternatively, the old and young are depicted in xiao as bound, interconnected and interdependent. In line with these multiple interpretations, most studies of xiao emphasize the variety of forms it can take as a practice, belief system, historical ideal, form of reciprocity, and more (W. Li, Hodgetts, Ho, and Stolte 2010).

In the introduction to his translation of a foundational Confucian text, the Classic of Filial Piety, Feng Xin-ming (2008a) describes xiao not as simply a guide for individual behavior but as the blueprint for the entire social order. He explains that the virtue, in its classical sense, is the very foundation of civil society and takes the place often reserved for religious mandates in other cultures (X. Feng 2008a). As Zhang Wei, an elder care home resident in his late eighties, explained to me: “You Americans say that God gives life. We say that parents give life. We must show them due gratitude.”

Xiao’s ubiquitous influence is also evident in the fact that few of my respondents could pinpoint how, when, or where they learned about it. “It has been passed down from ancient times,” one twenty-four-year-old nurse explained. “Everyone knows it from the time they are young.” Another female respondent, a twenty-nine-year-old Buddhist palliative care doctor, explained it this way: “I feel that xiao is not something that exists in ‘knowing’; it is one of China’s traditions. You see how past generations did it, and you know you should do it, and you know how you should do it. Just like: ‘what one generation does, the next generation sees.’ ”

While respondents were not able to recall their personal introduction to the concept, most historical evidence dates the emergence of xiao to the Western Zhou period (1045–771 BCE). By the Han period (206–220 BCE), it had become a focus of intellectual and political elites (Chan and Tan 2004). Along with other core concepts of Confucian ethics, including ren (仁), compassion or benevolence, and li (礼), ritual or etiquette, xiao emphasizes one’s moral interdependence with others, contributing to Confucianism’s categorization as a relational rather than individualistic ethical system (Wong 2008). While the earliest understandings of filial piety are attributed to Confucian classics such as the Classic of Filial Piety, the Great Learning, and the Analects, the concept has also had an impact on Chinese Buddhism and Daoism (Chan and Tan 2004). However, the far-reaching influence of these Confucian classics, and the virtues they expound, is largely due to the fact that for centuries—until the early 1900s—all male children with educational aspirations had to memorize them (Eno 2016).

But xiao is not simply an ideology or intellectual exercise; it is the paragon of ethics, the core of selfhood. According to the Classic of Filial Piety, xiao begins in self-care in the most bodily sense and ends in establishing oneself in the Way and honoring parents by passing one’s name to posterity. Because of the natural love between parents and children, “the teaching is not stern and yet it is successful” (X. Feng 2008b, 11). The teachings include provisions for bodily health, conflict management, family life, sickness and death, and mourning and sacrifices. However, they emphasize attitude over actions. As stated in the Analects, “it is the expression on the face that is difficult. That the young should shoulder the hardest chores or that the eldest are served food and wine first at meals—whenever was that what filiality meant?” (Eno 2015, 36). These Confucian classics, geared toward scholars and other members of the intellectual classes, also inspired more popular images of behavior, such as those found in The 24 Filial Exemplars (Jordan 1986). Research participants in my study frequently referred to this short, twelfth-century text, which describes extreme examples of conducted characterized by xiao. Since I am a native Minnesotan, I find the story of Wu Meng particularly exemplary: “When Wu Meng of the Jin dynasty was eight years old, he was very filial towards his parents. The family was poor, and the bed had no mosquito net. Every night in summer mosquitoes in droves nibbled at their skin and sucked their blood without restraint. Although there were many, Meng did not drive them away, lest in leaving him they bite his parents. So great was his love of his parents!” (ibid., 90).

Filial Piety and Power

Social scientists have long posited that the family, as the primary locus of socialization, plants the seeds of collective consciousness in individuals that both reflect and establish the social and moral ...

Table of contents

• Cover
• Series Page
• Title Page
• Copyright
• Dedication
• Contents
• Introduction
• 1. Filial Children, Benevolent Parents
• 2. Bodies in History, Embodied Histories
• 3. Place and Space, Rhythm and Routine
• 4. Entanglements of Care
• 5. Care Work
• 6. Chronic Living, Delayed Death
• Conclusion
• Acknowledgments
• Glossary
• Notes
• References
• Index
• About the Author