Framing age intends to analyse how “ageing” was apprehended as a social and political problem during the 19th and 20th centuries. It will follow the constantly changing lines of argument with regard to what is considered normal ageing, optimal ageing or pathological ageing (Rowe & Kahn, 1987). The project raises the question of what are the scientific and political elements in the construction and mobilisation of “old age” as a public problem. This project will thus help forging a new historiographical and sociological field in Luxembourg but it is also innovative on a European level. Its interdisciplinary and multi-scale view (local, national and transnational) will allow a critical re-questioning of and on the intersection of knowledge (gerontology), power (state) and practice (institutional care).
Beyond this specific disciplinary logic, the historical and sociological perspective, by taking a comparatively distanced perspective, also permits a broader reflection on a theme, which is now considered central to the organisation of societies, namely the challenges induced by an ageing population. In Luxembourg (Leduc, 2006) and in Europe, these challenges are considered particularly crucial for the evolution of the social cohesion and the financing of the welfare state. It will thus provide knowledge that will be of crucial importance to social policy for elderly people in Western societies, a particularly sensitive issue in the Grand Duchy of Luxembourg, based on its peculiar demographic structure (Fehlen, 2009).
The interest to study the link between institutional practice, public policy and knowledge production reflects the “performative” force of the latter in modern society. In the second half of the 19th century, an important transformation took place affecting all Western nations: the appropriation of the social by science (i.e., Verwissenschaftlichung des Sozialen (Raphael, 1996)). From this moment on, scientists aimed to identify, interpret, manage and resolve problems caused by social crises according to the rules and quality criteria of science. Especially medical knowledge had legitimacy to articulate old age in the early 20th century because it had already offered “answers” for other social problems such as dealing with diseases, industrialization, crime, urbanisation… With its vocabulary, with its expertise based on scientific legitimacy, it thus gave “meanings” to ageing as well. A “scientification” of the social sphere through (medical) knowledge is observed in its function of expertise, in its participation in the process of political articulation and finally through the dissemination of its categories and its paradigms in society.
The project will address the issues of “framing age” (Rosenberg, 1992) in an interdisciplinary manner – political science, sociology and history – and varying scales and chronology. Given the vastness of the subject, this project does not intend to present an overall image of the “invention of old age as a public issue” but provides three case studies:
1. A historical analysis on a transnational level (Germany and France) of the production of a particular theoretical knowledge.
2. A sociological and political analysis at the national level namely Luxembourg.
3. A historical analysis of local practices of care in a psychiatric hospital.
The project deciphers the “making” of age through an entangled history of spaces and temporalities.
1. Gerontology in Western Europe from the 1950s to 1980s
Geriatrics, gerontology, gerontopsychiatry… are all terms for a new scientific field that became essentially structured after the Second World War, and that documents the constitution of old age as a new scientific subject. It participated in an important redefinition of old age from pauperism towards “care”, a transformation initially accompanied by a certain pathologising.
Using a comparative approach, the project aims to analyse how ideas and practices have been developed in two countries, France and Germany, which have important but different scientific traditions and that have been largely neglected until now by historiography. The comparative approach implicit in the project (Kaelble, 1999) will attach a particular attention to the history of transfers (Espagne & Werner, 1988) and entangled histories (Werner & Zimmermann, 2004). It is not without reason that the synchronic comparative history has been criticized for its strong national framework, the comparison being often limited to a mere juxtaposition of national histories. The history of transfers and entangled history are variations of a common effort to bring greater reflexivity in this methodological choice and further treat exchange processes and interconnections, synchronic as well as diachronic. In a history of science, where the circulation of knowledge is a central part, the transgression of national boundaries is essential.
Based on the notion of “thought collective” introduced by Ludwik Fleck (Fleck, 1980) and “scientific paradigm” developed by Thomas Kuhn (Kuhn, 1996), the project will determine the conditions from which a particular theoretical and clinical knowledge arises, spreads and is challenged. Why psychologists, psychiatrists, biologists or sociologists call themselves at a certain moment “gerontologists”? How did gerontology become a profession (Freidson, 1970)? How are the methods for establishing “scientific knowledge” constructed and legitimised? What are the “boundary objects” (Loewy, 1992) that allow different disciplines involved in the invention of gerontology to share theories and practices? Finally, how does this knowledge circulate and how is it used (Cambrosio, Keating, & Mogoutov, 2004)?
The sources for this part of this project will be triple. First, scientific discourses published in academic journals and textbooks indicate an initial chronology of the emergence of gerontology. At the same time, the scientific criteria of this new discipline and the definition of this dynamic new field will emerge. Beyond these academic discourses, this project will also use the archives of major institutions often born in the second part of the 20th century and which moulded the creation of new knowledge: journals as the Revue de Gériatrie, organisations as the Deutsche Gesellschaft für Alternsforschung/Deutsche Gesellschaft für Gerontologie und Geriatrie or major research units such as the Institut für Gerontologie (Heidelberg).
2. Making policy for the elderly people today in Luxembourg
The issue of ageing is closely related to the creation of social policy initiatives whether private or public, among others in the early retirement schemes. As we have seen, the institutional care was primarily defined around a class approach: through the 19th and early 20th assisted seniors equal poor seniors. Over the last 100 years, we assist at an empowerment of age as a specific issue (Lenoir, 1979). This is reflected in all European countries by the establishment of specific ministerial departments that became important actors in the construction, the promotion and the treatment of the social problem of “ageing”.
The main goal of this constructivist sociological and socio-historical approach is to understand the mechanisms and to identify the actors that influence significantly the public problem and policy making in an European country, which has certainly various specificities (e.g., small size, multiculturalism, age structure…), but is also confronted to similar challenges than the rest of Europe.As in other countries (Bihan-Youinou, 2010), the policy for the elderly in Luxembourg is not a homogeneous public sector intervention but involves several state apparatuses (social security, employment, health…). However a ministry, namely the Ministry of Family, plays a major role.
This ministry that exists under that name since 1951 (Thewes, 2007) includes a specific section entitled “Service for older people”/“Policy for the elderly people” since 1989. This is the only department in Luxembourg that specifically address ageing. Thus, it occupies a nodal function in decision-making. Its central position is reinforced by the fact that it oversees the Superior Council of the Elderly, established in 1976. This administration must negotiate several inherent tensions in the “factory of social policies” (Lafore, 2010): between European, national and local level, between medicine, social intervention and public health, between private and public actors. Without neglecting the issue of the mobilisation of non-state actors, we aim to engage with the state as actor. In this context, Howard Becker’s work on “moral entrepreneurs” who define and promote social problems remains central contribution (Becker, 1966). Indeed, among “moral entrepreneurs”, state actors appear not only as objects put under pressure by politicians, NGOs and academics but as active subjects. From this specific point of view, this study will allow to determine how the department negotiates to impose its theme at a ministerial level, where it competes with other departments and how it is committed on a political and societal level to a “competition” from public scrutiny. This interior view claims that a state institution has also its own logic (B. Majerus, 2007) and interest to produce “public issues”.
3. From pauperism to medical care: elderly people at the Neuro-Psychiatric Hospital (19th-20th centuries)
Long before ageing became a public issue in the 1950s, institutions hosted within their walls elderly people who could no longer live in the community for various reasons (Gorsky, Harris, & Hinde, 2006) (Bridgen, 2001). During the 19th century and part of the 20th century, they were supported through a policy of assistance to the poor.
First, this research focuses on the discourses and practices used before ageing becomes a public concern. Second, it analyses changes in the daily practice of an institution due to changes in scientific paradigms – the creation of a specific medical field – and public policy – from the 1950s onwards in Luxembourg. This should allow a critical reappraisal of numerous sociological and historical narratives on gerontology that only start in the second half of the 20th century. This part is essential to give an historical depth to the two afore-mentioned projects.
As object of investigation, we chose the current Centre Hospitalier Neuro-Psychiatrique (CHNP) for two reasons. It is a central device in the social policy of Luxembourg and that as early as the mid-19th century. It is the only institution in Luxembourg that ensures an archival continuity for 150 years.
Created in 1855 as Hospice central, this institution enclosed and isolated in its beginnings various forms of marginality before being transformed in 1901 in a Maison de Santé. Despite this terminological change, Ettelbréck continued to be for a long time rather a hospice than a hospital. In 1931, the first open service was created. In 2005, the institution was transformed into three units: psychiatric rehabilitation centre, care centre for elderly people and home for people with intellectual disabilities (Centre Hospitalier Neuro-Psychiatrique: 150 Joër (1855-2005), 2005; J.-M. Majerus, 2009). If the CHNP has therefore recognized through its internal reorganisation the specificity of gerontology, it has done so only recently. From its beginnings, the CNHP was an institutional setting, along with other establishments, designated to manage an elderly population that no longer found its place within family structures. Several studies abroad have shown how central this particular institutional setting was for the “problematisation” of age from the second half of the 19th century onwards (G. Grob, 1983; B. Majerus, soumis; Vijselaar, 2010). From this perspective, the CHNP is a revealing case study for the various changes taking place at a national and international level: it reveals the local processes of the transformations taking place at other levels. The study can therefore answer the question that has recently attracted a particular interest in humanities i.e. how theoretical knowledge is applied in practice by professionals.
For this study, we propose to focus on an analysis of patients’ records kept since 1855 at the CHNP. Like the police, courts’ and prisons’ archives, patients’ records are considered as the royal road to access the “reality” of the unknown in history, although some disillusionment is palpable in recent years (Condrau, 2007; Porter, 1985). Keeping records of patients is relatively recent: it was not until the early 20th century that medical writing is structured around the individual patient. Intended for a “entre-nous professionnel” (Lae, 2008), these archives are especially rich: the heterogeneity of the records offers a view that allows a fascinating and multispectral gaze.
By combining these three gazes, Framing Age will provide a detailed picture of various developments by describing, analysing and especially confronting significant case studies which cover a wide geographical area and a large time line. The results will not only trace how different “ways of knowing” (Pickstone, 2001) meet, compete and/or reinforce themselves but will also allow to understand the demographic and societal changes, which applies to the European society and furthers the discussion on the methodological and theoretical construction of public problems.