the written word and the elderly:
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This article was downloaded by: [McMaster University]On: 05 December 2014, At: 06:01Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK
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The Written Word and theElderly:Teresa Jordan Tuzil MSW aa formerly with the Jewish Association for Services forthe Aged, New York, 11783Published online: 25 Oct 2008.
To cite this article: Teresa Jordan Tuzil MSW (1979) The Written Word and the Elderly:,Journal of Gerontological Social Work, 1:1, 81-87, DOI: 10.1300/J083V01N01_08
To link to this article: http://dx.doi.org/10.1300/J083V01N01_08
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THE WRITTEN WORD AND THE ELDERLY: Adjunct to Treatment
Teresa Jordan Tuzil, MSW
ABSTRACT. Bibliotherapy and psychodrama have gained increasing acceptance over the past few years and may prove especially helpful to those who work with the elderly. Older persons seeking help may, because of stereotypic self-images which they have be- gun to accept, be more defensive and resistant to treatment. The nonfhrealening nature of the written word-read, recited, oracted out-isa medium through which olderpersons can begin to examine themselves more closely, understand the dynamics of their emotions and behavior, and learn to makepositive changes.
The literature is filled with material dealing with the benefits of poetry therapy and psychodrama for groups (Almond, 1974; Brown, 1975; Greenberg, 1974; Jones, 1939; Kaminsky, 1974; Leedy, 1973). Some elderly clients, however, either because of long- standing patterns of isolation or introversion, mental or physical im- pairment, or simply the inability to relate on a multiple level, are un- able to benefit from a group experience. These clients often seek help through the one-to-one relationship. As Edna Wasser (1966, p. 6) points out, techniques of working with the elderly represent adapta- tions made in casework practice based on intimate knowledge of what the older person is like. With this in mind, the present author at- tempted to adapt some of the principles and techniques of poetry ther- apy and psychodrama to the individual casework situation. The setting for this adaptation was the Jewish Association for Services for the Aged, a voluntary social agency offering a full range of programs to the elderly in New York City and on Long Island. The adaptation used was a combination of bibliotherapy and selected dramatic reading.
Bibliotherapy is defined as the treatment of a patient through se-
~ ~p
Ms. Tuzil was formerly with the Jewish Association for Services for the Aged, New York. Reprint requests should be directed to the author at 3859 Tiana Street, Sea- ford, New York 11783.
JaurnalofCcrontologi~alSoeinl Work.Vol. Kl). Fa11 1978 01978 byThcHawonhPrn~. Allrishtr rcrcrved. 81
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lected reading (Brown, 1975, p. 9). The rationale for this type of treat- ment stems from the belief that the symbols and "metamessages" found in literature can penetrate clients' defenses and rationalizations in a very nonthreatening way and help them to experience those feel- ings they are attempting to deny (Hayakowa, cited in Leedy, 1969, pp. 269-270). Bibliotherapy makes use of a wide variety of materials rang- ing from newspapers and magazines to scholarly and/or highly scien- tific work. The type of literature selected should be based on the cli- ent's intellectual capacities as well as his or her psychosocial diagnosis (Brown, 1975, p. 14).
Psychodrama is the extemporaneous dramatization of an event ( Webster's Seventh New Collegiate Dictionary, 1971, p. 689), or an emotion drawn from the client's life. I t can provide catharsis, rehearsal for real life situations, and/or the opportuhity for social relearning. Psychodrama, which involves "the most universal of all ways of com- munication . . . the body language" (Marcus, cited in Greenberg, 1974, p. 47), seeks to help the individual undergo a certain personality trans- formation the end result of which it is hoped will be both insightful and functional (Kobler, cited in Greenberg, 1974, p. 39). Both bibliother- apy and psychodrama provide the client with a device which, as Marc Kaminsky (1974) points out, "becomes a means of safe passage into the darkness and back again into the light. . . auseful pretext which can be dropped at any time or, if that leaves one of the participants stand- ing there too naked, buckled back on" (p. 69).
CASE ILLUSTRATIONS
Mr. M. Mr. M. is a 75-year-old retired entertainer who, until his
70th year, made regular appearances as a comedian and storyteller in resort hotels. After an accident that left him only semiambulatory and with minor brain damage, he was unable to continue performing. He became increasingly depressed and withdrawn, threatening suicide on a number of occasions. h i - tially, Mr. M. was highly resistant to casework services, insisting that no young social worker could possibly understand the degree of his despair.
I agreed with Mr. M, that it was difficult for someone of my age and back- ground to appreciate fully the losses he had sustained and asked him if he would share with me some of his scripts or other show business materials. Pleased at my suggestion, Mr. M. brought in not only some of his material but reviews as well. He also offered to lend me a copy of a book about vaudeville, and was delighted at my acceptance. In accepting the book, and being able to
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discuss it during our next meeting, I was attempting to illustrate to Mr. M. that I was interested in getting to know him better. This helped to reassure Mr. M. and make him moreopen to intervention. Throughout the treatment expe- rience, Mr. M. continued to bring in books and other material relative to his show business days. On occasion, he would actually do parts of some of his old routines. Ipointed out that in spite of his handicaps, he still had the ability to make people laugh and wondered aloud if he ever did any of his "bits" at theold age home where helived. Although heis still somewhat reluctant to ap- pear before a large group, Mr. M. has begun some plans to start a small story- tellers group in his residence.
Mr. L. Mr. L. was a 66-year-old retired photographic assistant
who suffered from severe Parkinson's disease since adolescence. Because of his severe tremors, stammering, drooling, and generally gnarled appearance, he always avoided contact with other people. His physical handicap and its re- - - . .
sulting emotional consequences prevented him from having positive interper- sonal relationshi~s. s~ecifically sexual ones. Too. his handica~ limited his - . - ability to be successfully employed for any length of time. ~ o t h b f these fac- tors contributed to the formation of a very Door self-image which was accom- - - - panied by a great deal of rage. In his isolation, however, Mr. L. had become an avid reader, and this provided a vehicle for casework.
Mr. L. had, to a certain extent, attempted to substitute books and maga- zines for sexual relationships, and although this was successful to some de- gree, it prompted many guilt feelings. Hebrought copies of Playboy and a few "blue" novels to the office purportedly to demonstrate what types of books he thought were "dirty." As welooked through them together, I pointed out that some of the pictures were genuinely attractive. Although initially sur- prised at my reaction, Mr. L. eventually acknowledged that he enjoyed look- ing at the pictures. From this we began discussing how frustrating it was to see such perfect bodies when he had an imperfect one, and how unfair it was that people were often judged by appearances rather than personalities. This intel- lectual discussion of what might be deemed "controversial" reading material helped Mr. L. to begin to open up about his feelings and, in a sense, gave him "permission" to begin toexplore themingreater depth.
Mr. L.'s rage at people who judged him superficially was expressed by his selection of the novel The Lodger1 in which the protagonist is a mysterious, withdrawn man to whom a series of brutal "Jack the Ripper-like" crimes is attributed. Through this character, Mr. L. was able to talk about the depres- sion, frustration, and anger that filled his own life. Vicariously, through the
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'The Lodger is currently out o f print. Reference data were unavailable to theauthorat this writing.
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behavior of the lodger, Mr. L. was able to experience some of the catharsis that was soessential to his treatment (Almond, 1974, p. 303).
A third book, selected by the worker, was Sybil, Flora Rheta Schreiber's (1973) case history of a woman with multiple personalities. Through this book, Mr. L. becamemore awareof thevariousaspects of his own personality (the little boy in need of care, the mischievous adolescent, the sophisticated bon vivant). By exploring Sybil's various unintegrated personalities and fol- lowing them to their ultimate integration, Mr. L. Learned to become more comfortable with the vast gamut of needs and emotions he felt within his one self. Ultimately, he became comfortable enough with his own feelings to dis- card his book characters and bring himself directly into the casework relation- ship.
An interesting side effect of Mr. L.'s treatment was the establishment of a mini lending library in the office's waiting room. Through his donations and his administrative role in planning and setting up the library, Mr. L. was able to socializevicariously with other clients. Too, it provided him not only with a meaningful work experience he has so long lacked but also a lasting memorial to andvalidation of his existence.
Mr. D. Mr. D. was a 78-year-old retired railway employee who
had long-standing marital difficulties with his wife of 30 years. After experi- encing a devastating divorce from his first wife, Mr. D. entered into this sec- ond marriage with the hope that it would provide him with the comfort and emotional security the first had lacked. Unfortunately, his second wife had little affection for him and acknowledged that she had only married him to avoid being labeled an "old maid." Unable to face another separation,Mr. D. had endured years of physical and verbal abuse which ultimately took their toll both physically and emotionally.
When Mr. D, first came in for counseling (by himself, as his wife refused to accompany him) he was totally distraught. He did not wish a separation, but felt that he could not remain passive any longer. Because of his lack of ego strengths, it was all but impossible to help Mr. D. become directly moreasser- tive. Even hypothetical situations seemed to intimidate him. I suggested to Mr. D. that we temporarily shelve his particular situation and begin to look in- to some fictitious ones. For our next session, I suggested that Mr. D. take his mind off his own problems by reading Shakespeare's (1966, p. 271) Taming of the Shrew, and when we next met I selected some readings from Act 11, Scene 1, in which Katherine's waspishness and assertiveness are pointed out. With Mr. D, reading Petrutio to my Katherine, we began to play out the scene. In the second half of our session we discussed how Mr. D. had felt playing the domineering and sarcastic Petrutio and how Katherine might have felt being confronted for the first time. This reading-discussing pattern continued for
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several weeks and included our exchangingparts and talking about how it felt to be the other character. In this way, Mr. D. not only had the opportunity to "play" at being the assertive Petrutio, but could, as Katherine, respond to this character. Most poignant was his reading of Katherine in the final act (p. 284) whereinshe is the gentle, subdued (tame) wife.
The dramatic reading of sections of this play was an attempt to help Mr. D. become safely assertive in a benign, artificial setting. It gave him the oppor- tunity to express a side of himself that had always remained hidden. The ex- change of roles was an attempt to help him see how he appeared when he was being more assertive and to play out how he (and possibly others) might re- spond to this other self. This theme continued as we spent the next several ses- sions reading sections of Edward Albee's (1969) Who's Mraid of Virginia WOO^?
Like Mr. L., Mr. D. was gradually able to drop the artificiality of the liter- ary device. We soon began to select episodes from his everyday life-both present and anticipated-which we would dramatize in the office. The pur- pose of this was twofold. For those episodes that had already taken place, the dramatization served as a cathartic, analyzing, and evaluating device. For those that were anticipated, they served as a preparation or rehearsal. Gradu- ally.Mr. D, was helped todevelop the moreassertiveside of his character and, over a period of months, becamkincreasingly able to achieve more balance in his relationship with Mrs. D. Their marital relationship is far from ideal, but Mr. D.'s increase in self-esteem has helped him deal more appropriately both with crises and with everyday situations. This change in Mr. D.'s attitude and coping skills hasprompteda corresponding, albeit not overwhelming, change in his wife's behavior toward him.
DISCUSSION A number of questions arise regarding the treatment
methods described above. Is there a risk of increasing a client's isola- tion by encouraging reading, which is basically a solitary activity? Will deviant behavior be validated o r even encouraged? What kinds of books are good for what kinds of clients? H o w can a worker keep u p with many clients reading different types of material? The answers are neither simple nor effortless.
Books and other materials must be carefully selected not only in terms of accessibility and readability, but so as t o invite clients into a n ongoing dialogue. Although workers may select imaginative literature in order t o stimulate a vast array of feelings andideas, they must also be aware of the importance of nonfiction in helping clients t o identify with veryreal people and problems. Selection and progression requires
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an intimate knowledge of clients and their world. "Bibliotherapy is positive and active. Not content with the distribution of recreational and harmless books, it seeks to supply those which may actually change for the better a patient's viewpoint or philosophy of life" (Jones, 1939, p. 3). Sufficient time to explore the material within the treatment session must be guaranteed so as to avoid misinterpretation of the material. This gives rise to the question of whether the biblio- therapist should be a clinician trained in library methods or a librarian trained in clinical methods. The general agreement seems to be that either is satisfactory so long as the standard of intimate knowledge of both client and subject matter is maintained (Brown, 1975, p. 286). The concept of allowing clients to choose some of the material for dis- cussion, although seemingly contraindicated by this maxim, is in reali- ty an attempt to increase the client's involvement in the treatment expe- rience. It is both an ego-enhancing device and a motivational tech- niaue.
As does bibliotherapy, psychodrama raises certain questions among critics and practitioners alike. Will previously submerged feelings and behaviors be unleashed in an uncontrolled fashion, and will these be- haviors be acted out to the detriment of the client? Again, as with the bibliotherapist, if the drama therapist is able to assist in the cathartic experience and help the client to recognize the internal and external dynamics of the experience, the treatment should be successful.
Neither bibliotherapy lior psychodrama is meant to be a shortcut through treatment. They are not suitable for all clients or even for all workers. However, when appropriately applied, both give credence to the inscription used by the ancient Greeks and Romans to describe their library and theater-"Place of Healing" (Brown, 1975, pp. 13- 28).
REFERENCES
Albee, E. Who'safraidof Virginia Woolj? (Pocket Cardinal ed.). New York: Simon & Schuster. 1969.
Almond. R. The healingcommuni?y'. New York: Jason Aaronson. 1974. Brown, E. F. Bibliotherapy and its widening applications. Metuchen, N.J.: Scarecrow Press,
1975. Greenberg, I . A . (Ed.) Psychodrama lheory and therapy. New York: Behavioral Publications.
1974. Jones, E. K . Hospitallibraries. American Library Association. 1939. Kaminsky.M. What'sinsideyouilshinesoul ofyou. New York: HorizonPress, 1974.
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Leedy, J . J. (Ed.)Poetrylherapy. Philadelphia: J . 8. Lippincott, 1969. Schreiber. F . R . Sybil. New York: Warner Books, 1973. Shakespeare, W . Thetamingof Iheshrew. In Thecomplele worksof WilliarnShakespeare. Lon-
don: Spring Books, 1966. Wasser, E . Creo!iveapproachesin casework with rheoging. New York: Family Service Associa-
tion of America, 1966. Webslerer'ssevenfh new collegioledi~lionary. Springfield, Mass.: G. &C. Merriam, 1971.
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