In “Letting Go of My Father,” Jonathan Rauch presents an honest look back on time spent taking care of his aging, and ailing father, in the spring of 2009.  Jonathan’s story starts with the day that his then eighty year old father moved to D.C., from Phoenix, where his worsening Parkinson’s Disease had made it nearly impossible to live alone.  At first Jonathan finds himself feeling optimistic about his father’s move.

“… I imagined checking on him by phone every day, stopping by his apartment several times a week, and regularly going out with him to restaurants and theater. It could work!”

Within a few days, hope gives way to reality, as Jonathan quickly realizes that taking care of his father is a full time job.  As time goes by, and his father becomes increasingly more debilitated,  responsibilities start to wear away Jonathan’s emotional resolve, and he begins to feel isolated.  On a particularly bad day, after  his father collapses in a supermarket but still refuses help, Jonathan’s anxiety triggers anger at his father for being a burden, and not wanting to move into an assisted living home.

“That was the day I realized that he could not cope and I could not cope and, emotionally, he could take me down with him. And I discovered in myself an awful determination not to let that happen. From that moment, I was determined to get him out of his apartment and under professional eyes, or, failing that, to protect myself. How to protect myself, I didn’t know. Hire help over his objections? Take him to court and seek to have him declared incompetent? Report him to Adult Protective Services? Use my ownership of his apartment to force him out? All I knew was that, at that point, I believed myself capable of doing such things, or even of washing my hands of the situation if he would not listen to reason. I imagined telling an indignant world that I had tried my best and could do no more. You have no idea what a thing it is to have that sort of conversation with yourself about a parent.”

In turn, Jonathan’s anxiety is further magnified by the anger. Feeling like he has nowhere to turn to, his coping mechanism becomes talking.  Talking about his travails to anyone that will listen. Unprompted or not.  He finds a surprising number of people willing to patiently listen;  other people like himself, middle aged adults either taking care of elder parents or already having taken care of them, who themselves badly want to talk about their experiences.

He realizes that he is far from alone.  Rather, he is a member of a large and invisible American group.

“As I walked the streets, did interviews, conducted business, I took to wondering which of the middle-aged people I encountered were quietly struggling to cope with their own crisis. How many of them felt utterly out of their depth? How many others, having come through an ordeal, had experience that they had no ready opportunity to share? According to the National Alliance for Caregiving, about 50 million Americans are providing some care for an adult family member. I was swimming in an invisible crowd of caregivers every day, but, like streams of photons, we passed through each other.”

From here Jonathan describes his search for answers about why if the population of caregivers is so big, everyone seems to  “pass through each other”, and no one knows where to turn to.  The answer he hints at is that everyone, both the caregivers and the parents receiving the giving, are too used to being independent.  His father finally agrees to enter an assisted living community only after being told, in so many words, that he is impeding on his son’s independence.

The retirement facility turns out to be very good.  And, Jonathan finds, high quality is no longer an unusual feature of long term care.  His father dies shortly thereafter, in December of 2009.

On the face of it, having ensure that his father received high quality end of life care, the matter seemed solved, and Jonathan, socially, was absolved.  But, the struggles that led up to this point still demanded an explanation.

How can it be that so many people like me are so completely unprepared for what is, after all, one of life’s near certainties?

It is at this point that Jonathan gives his most powerful insight. He  draws on an analogy with the invisible housewives of the 1960s;

What we need even more than that, though, is for our nameless problem to be plucked out of the realm of the personal and brought into full public view, where help can find us. In the years after Betty Friedan named their problem, women who work in the home (formerly “housewives”) demanded and got a new infrastructure for support: opportunities to study and work at home, part-time job opportunities, public and private help with child care, social networks, and so on. Perhaps more important, they demanded and got society’s recognition that they were providing an indispensable public good. As a result, they are not isolated or silent anymore, and they do not need to put up with being lonely or bored. Keeping today’s invisible infrastructure of caregivers out of sight is as stressful and wasteful and pointless as leaving millions of women feeling stranded at home once was. My mother’s friend and the feminists of her generation fundamentally had it right. There should be no need for anyone to go through this alone, and no glory in trying.

Through advocating for the empowerment of caregivers and for greater social recognition of their burden, Jonathan realizes that there is  not just a need for a strong medical infrastructure but also for a social infrastructure to help the caregiver.

There is a need, in effect, to lessen the obligation American’s feel to be independent. An over reliance on independence encouraged Jonathan’s father to refuse help even while he could barely dress himself, and a similar sense of obligation drove Jonathan to feel isolated with his burden because sharing his experience somehow felt as if it violated the freedom and independence of other people.  Only when he started sharing did he realize that everyone who shared his experience in some way, needed support.

The debate of what qualifies as an American value is better left for the college campus, so suffice it to say that independence is a core aspect of the American mythology any way you cut it. Jonathan’s insight is critical because it cuts through the myth of independence as it pertains to how we live our lives surrounded by other people; it’s not advisable to live life independent of everyone else, and the nuclear family is really part of a greater organic whole.  Sooner or later we all need help.

Boiled all the way down to its core, Jonathan’s argument is  that our cultural values shift from the self to the family; and that we embrace care giving for our parents, and, conversely, one day being care for by our children, as a cultural value, precisely because it is.

Confucious would be proud of Jonathan’s epiphany, albeit disdainful that all of America doesn’t share the view. He might also note how nice it would be if China’s medical facilities for elderly parents were as nice as those in the United States.

Chinese adults caring for parents have, in all likelihood, anticipated this time their whole lives, owing in no small part to the ailing parents who, when healthy, were careful to steadily remind them of the obligation.  Filial piety is a cultural staple of Chinese life that’s survived multiple cultural revolutions and/or national rebirths.  The value was enshrined in Confucius’s dialects from nearly two and a half millenniums ago, but is likely far older.

These principles have since then permeated throughout the world, and saturated Asia, so that it is no overstatement to say that all Asian countries have a culture of filial piety.

But, as this excellent four part series by Samuel Green points out (Part 1, Part 2, Part 3, Part 4) modernization, and a rapidly aging population, is taking its toll on China’s ever more extended filial networks, and what’s needed now is a safety net of medical infrastructure for the elderly.

Instead of looking up China and others in the developing East, and scoffing at their lack of medical infrastructure, Americans would be wise to look at  the family strength that the East does have.  Meanwhile, the Chinese, and their Asian neighbors who share both their reverence of filial piety and rapidly growing populations, shouldn’t waste any time in studying the blue prints of American assisted living facilities.

Both sides have much to learn from each other.