In 1 982, my 80-year-old mother spent her last Christmas with me. On Christmas Eve she awoke with a persistent cough. After lunch I said to her, "Mama, I think we'd better take you to someone to see about that cough. You don't want to be sick on Christmas day."
She replied, "You're crazy if you think I'm going to spend my good money, or yours, on a little cough. If you just had some kerosene I'd be all right."
"Kerosene? What are you talking about?" I exclaimed.
"You should remember perfectly well that the best cure for a cough is a few drops of kerosene on a teaspoonful of sugar. I dosed you children with that every winter."
I did remember. After my mother died, I began to wonder about the ways that people in the South cared for themselves and their families in the first half of the 20th century. The resulting study of those self-care practices provided unanticipated secondary gains. The material that the subjects provided, the intensity with which they told their stories, and their own comments about the value of putting voice to their memories were too powerful to ignore.
The result is this article. It provides a brief overview of the literature as it pertains to the use of reminiscence in historical research, as a source of cohort understanding, and as a therapeutic tool. The article focuses on the value older people place on being able to share their memories with an interested person, using vignettes as illustrations. A discussion of implications for the use of reminiscence in nursing practice is included.
Reminiscence is common among the elderly, and it has traditionally been perceived as a negative characteristic of old age (Bramwell, 1984; Coleman, 1986). This perception began to change, however, with Butler's (1963) work on the life review process. Butler defined life review as a therapeutic process through which the older person evaluates past experiences and comes to terms with old conflicts to find satisfaction with the life course and thus, in Erickson's (1950) terms, achieve integrity. Butler postulated that reminiscence is a mechanism for accomplishing a life review that begins with the individual's acceptance of the inevitability of approaching death.
In the years since Butler's work, the terms "reminiscence" and "life review" have often been used interchangeably (Baker, 1985; Lappe, 1987; Price, 1983). The terms "life history," "oral history," and "retrospection" have also been used to describe the process of tapping the memories of older persons (Bramwell, 1984; Keddy, 1988). The overlapping and confusion in terminology were compounded by LoGero (1980), who delineated three types of reminiscence and defined one of these, evaluation reminiscing, as use of the life review process to come to terms with one's life.
Although LoGero's intent was to provide a clear operational definition of reminiscence, his use of the term "life review" as a process or tool for evaluating life (evaluation reminiscence) conflicts with Butler's use of the term "reminiscence" as a process or tool for use in accomplishing a life review. Although a number of authors have used Butler's definition of reminiscence as a function of life review (Burnside, 1988; Froelich, 1986; Haight, 1988), Lieberman and Tobin (1983) write of reminiscence thus: "Like the life review, it involves considerable effort and reorganization, but rather than reconciliation with one's personal past, such reorganization is the creation of an image."
The conclusions of Lieberman and Tobin fit well with those of McMahon and Rhudick in their classic study of older veterans (1964). They found that reminiscence was positively correlated with successful adaptation to old age through the maintenance of self-esteem, reaffirmation of a sense of identity, and the working through and mastery of personal losses. They also suggested that it is positively related to freedom from depression and personal survival. Moreover, they found their best adjusted subjects to be adept storytellers, a valued role for elderly people from prehistory until the recent past.
Reminiscence can clearly be viewed from a number of different perspectives. The varying views of the functions of reminiscence can be reconciled, however, if reminiscence is defined with a broad brush, encompassing a variety of functions.
Using just such a broad brush, Coleman (1986) lists the functions of reminiscence as life review, storytelling, creation of a meaningful myth, and maintenance of selfesteem.
Reminiscence as a Source of Historical Data
The historian, including the nurse historian, is concerned with historical events and developments and is seeking to answer questions or cast new light on the past or trends rooted in past events to provide a different perspective on present behaviors or practices (Neuenschwander, 1976). The historian values the firsthand accounts supplied by those who lived through the event under study, for such subjects provide the historical researcher with greater latitude than other methods of data collection. Subjects who have lived through an event or a period are considered to be primary sources. Although there are other sources of primary data, people can expand, modify, and provide content - in short, breathe life into history as no written record can. Moreover, such subjects, because they are primary sources, facilitate the processes of external and internal criticism that are critical to the historical researcher's evaluation of the truth of data (Christy, 1975).
The meticulous, in-depth process of oral history can bring greater understanding to past events and how those events shaped the lives, values, attitudes, and expectations of those who lived through them. The historian, then, focuses on the storytelling function of reminiscence as a means of unearthing or verifying facts or trends, and any benefit to the subject or understanding of that individual or cohort of individuals is serendipitous.
Reminiscence as a Source of Cohort Understanding and Personal Growth
The gerontologist and the gerontological nurse are interested in tapping the reminiscences of the elderly primarily to benefit or understand the individual or cohort of individuals. They may focus on any one or all of the functions of reminiscence - life review, storytelling, creation of myth, maintenance of self-esteem - depending on the objective they wish to achieve. They know that the reminiscences of older people can provide a means of understanding the problems of the group as well as the individual's success in aging and degree of life satisfaction. Moreover, recalling those memories enhances the elderly person's self-esteem for, as Keddy (1988) has noted, telling their stories gives the elderly "a sense of pride and accomplishment" as they realize "that they can live on by passing their experience and knowledge to future generations."
This article focuses on the value of reminiscence for personal growth. In a larger study of self-care practices in the South from 1900 to 1945, reminiscence was used by subjects as a therapeutic acceptance of the past. Samples of the material contributed by subjects illustrate the various aspects of reminiscence: life review, storytelling, creation of a meaningful myth, and maintenance of self-esteem.
Mary was a 96-year-old woman who, as a 7-year-old, traveled with her family in a covered wagon to homestead in West Texas. At the time of the interview, she had been living in subsidized housing for the elderly for 3 years, but she was active in her church and a bridge club and she still drove.
Mary recalled driving the cows to pasture as a child: "I toted a big stick so's to drive off the rattlesnakes." She also recalled raising her own children in the dust bowl that West Texas became in the '3Os - fighting the everpresent sand, watching the land blow away, praying for rain that never came. Mary could describe the sod house in which they lived. When asked what they used for earaches, she replied immediately, "Why, fresh urine, of course. Honey, on a cold winter's night in a sod house in West Texas when a Blue Norther blows, ain't nothing warm but fresh urine!"
Mary was a natural storyteller She was comfortable with herself and obviously enjoyed telling her tales, contributing to the pioneer myth that is so much a part of the American heritage. Listening and, perhaps even more, audiotaping seemed to verify to her the worth of her memories to society.
I had met Bessie, a 68-year-old black woman, several months earlier at the home of a friend where Bessie worked as a maid. As I began my search for subjects, my friend assured me that Bessie would be happy to be interviewed and suggested that I come to her house the following Saturday.
When I arrived, Bessie was obviously not "happy" to be interviewed. Fearing that she might be in trouble with her employer if we did not at least do a cursory interview, I asked, "Bessie, do you really have time for this?"
She replied, "Oh yes, if I can do my ironing at the same time. You sit here," and indicated a chair against the wall. Then she set her ironing board up so that her back was to me.
I began. As we got into the interview, Bessie became interested. She gradually "walked" her ironing board around until she was facing me, and she told me about her son.
Bessie's son awoke in the middle of the night with a severe headache and stiff neck, screaming in pain. Bessie and her husband had lost a child from pneumonia a few years before "because we didn't have no money to carry him to the doctor." They decided they must try to save this child, so at first light they started out for town, 20 miles away. Because their only means of transportation was a mule and cart, the trip took all day.
When they arrived at the hospital, they were told their son had spinal meningitis and would have to be put in isolation. There was no waiting room for blacks; they were told to go away and come back at visiting hours the next day to inquire about their son. As a black couple in a small Mississippi Delta town in the 1930s, there was no room for them at the inn; they camped out in their wagon on the edge of town. Three days later, when they went to ask about their son at visiting hours, they were told he had died at 6 o'clock that morning.
As this story poured from Bessie, so did rage, impotence, and despair. I am sure that she had relived the experience with other people; I do not think she had ever before opened up so fully with a white person. The object of the interview was not to elicit a life review, but its focus gave Bessie sanction to remember and to talk about those memories.
Herbert and his wife were residents of a North Carolina facility; he in the "rest home" area, she in skilled care. He was delighted to share his memories with me and proved to be an able narrator. Herbert had spent his early years in the pine barrens of coastal Carolina and recalled vividly the common health problems in that area: "ground itch" (hookworm), typhoid fever, and malaria. He provided a graphic account of his family's attempts to avoid malaria by "smoking out" the house on summer evenings. Window screens were unknown, so in an attempt to rid the house of mosquitoes, his parents would build a smoky fire in the two fireplaces at twilight, filling the house with smoke. Nevertheless, Herbert's father died of malaria when the boy was 13, leaving a wife and seven children.
Herbert left home that summer "because my mama couldn't afford to feed me," and went to work in a cotton mill. There he met the girl who would become his wife; they both worked at the mill for 50 years.
The story of Herbert's years in the mills came out as we explored his memories of raising his four children: their births at home, their illnesses and accidents, the hopes and plans he and his wife had for them. "All of the time we saved; if we couldn't save a dollar, we saved a nickel. Our children worked and got scholarships and finished college. I was born poor and I grew up poor and I lived poor most of my life. My wife and me - we've been in this place almost 2 years now and we've paid out almost $100,000. If we keep living, in spite of all our savings, we're gonna die poor too. It just ain't right and it ain't fair!"
Herbert's stories of his early life in the pine barrens and his years as a mill worker during the Great Depression provide an image of an era that established the basis for the mores and values of many Southerners. His distress as he mourned the loss of the dollars so painstakingly accrued over many years, which he perceived as the loss of his children's legacy, mirrors that of many elderly people who have been caught by the spindown syndrome. Herbert is unquestionably a storyteller. Recognition of his talent by recording his tales helped him to shore up his self-esteem, a self-esteem beginning to be badly battered by the gradual loss of his treasured role of provider for his children's future.
Mary Lee was a nurse trained in a small rural hospital in North Carolina in the 1920s: "Three years of hard work, 12 hours a day, 6 days a week. When I finished I did private duty. Most all of it was in the home those days, and most of mine were contagious cases - meningitis, diphtheria, whooping cough, polio."
Nursing in the home often included cooking for the patient or, when the family was the patient or the mother was ill, for the whole family. Mary recalled that she sometimes cleaned and washed "in self-defense" and even "fumigated." When she was on a contagious case, she would go home, strip off her clothes at the laundry tub her husband had installed for her in their garage, and bathe before going into her own house and around her own children.
Mary Lee saw her practice move from the home to the hospital in the 1940s. She continued to practice until the advent of intensive care units and the proliferation of medical technology in the 1960s. "I came to think that I wasn't any good. Everything came to be rush, rush. Everybody seemed so impatient, there didn't seem to be time or interest in nursing as I knew it - comfort, caring, tenderness, and solace. So I quit. But, you know, talking today puts a different light on things. I know I did save lives. There were no cures for so much those days, so it was good nursing care and the help of the Lord that pulled folks through. Talking today has given me something to study on."
Mary Lee's practice was the practice of most nurses of her era. There is no way to document the lives they saved, but they did save lives. Our conversation about her practice provided Mary Lee with an opportunity to reminisce about a most important part of her life and thus begin to come to terms with those years and to recognize and esteem her work.
IMPLICATIONS FOR NURSING PRACTICE
The value of reminiscence to capture the memories of older adults provides a valuable tool to historians, gerontologists, and gerontological nurses. Those memories give a richness and diversity to cold history; they frequently are full of the pathos and humor of high drama. This personalization of history can provide insight, information, and clarification that otherwise is at risk of being lost forever. More importantly, from the perspective of the gerontological nurse, the involvement of the older person in welldirected reminiscence has been demonstrated to be therapeutic to many people (Baum, 1980; Bramwell, 1984; Burnside, 1984; Menninger, 1975; Myerhoff, 1975; Ryant, 1981). The opportunity to reminisce may be considered a tool for health promotion in that its use may prevent depression, hopelessness, and a general failure to thrive (Barkman, 1989; Newbern, 1992). Its use may thus result in an elderly person coping at home, perhaps avoiding hospitalization or institutionalization. The savings in real dollars, as well as in emotional well-being of the elderly, can be significant.
The opportunity to reminisce gives older people sanction to remember as they will - to play the roles of storyteller and image maker, to engage in life review and, perhaps, to see their memories as a valuable contribution to society and their own lives as worthy. The most common use of reminiscence has been group work devoted to a particular topic or as a formal part of a structured life review. Some elders, such as Florida Scott Maxwell, have come to terms with their life by publishing their memories and insights. Others have kept journals that were only found after their death.
Still, anyone who has been around older people knows that, too often, they have no listener. Can we not find time to listen, perhaps 15 minutes at a specified time each day? How about classes in journal writing? Could older adults tell stories at the local library or in an activity room while other residents work on crafts? Could memories be audiotaped by the patient or caregiver or put on a word processor? If not, why not? These sessions could promote selfrenewal, accrue a wealth of information, and offer insight into the hardwon wisdom, problem solving skills, and coping abilities that might provide direction for dealing with an everincreasing population of older adults. Reminiscence, then, is a tool for life review, storytelling, creation of a meaningful myth, and maintenance of selfesteem that gerontological nurses cannot continue to neglect.
- Baker, N. Reminiscing in group therapy for self-worth. Journal of Gerontological Nursing 1985; 11(7):21-24.
- Barkman, B., Foster, L., Campion, E. Failure to thrive: Paradigm for the frail elderly. Gerontologist 1989; 5:654-659.
- Baum, N. Therapeutic value of oral history. lnt J Aging Hum Dev 1980; 12(1):49-53.
- Bramwell, L. Use of the life history in pattern identification and health promotion. Annals of Nursing Science 1984; 7(l):37-44.
- Bumside, I. Nursing and the aged, 3rd ed. New York: McGraw-Hill, 1988.
- Burnside, I. Working with the elderly: Group process and techniques. Monterey, Ca: Wadsworth Publishing Co, 1984.
- Butler, R. The life review. An interpretation of reminiscence in the aged. Psychiatry 1963; 26(3):65-76.
- Christy, T. The methodology of historical research. Nurs Res 1975; 24:189-192.
- Coleman, P. Aging and reminiscence processes. Chichester, England: John Wiley & Sons, 1986.
- Erickson, E. Childhood and society. New York: WW Norton & Sons, 1950.
- Froelich, J., Nelson, D. Affective meanings of life review through activities and discussion. Am f Occup Ther 1986; 40(l):27-33.
- Haight, B. The therapeutic role of a structured life review process in homebound elderly subjects. J Gerontol 1988; 43(2):40-44.
- Keddy, B. The benefits of oral histories. Geriatr Nurs 1988;9:170-171.
- Lappe, J. Reminiscing: The life review therapy. Journal of Gerontological Nursing 1987; 13(4):12-16.
- Lieberman, M., Tobin, S. The experience of old age: Stress, coping and survival. New York: Basic Books, 1983.
- LoGero, M. Three ways to reminiscence in theory and practice. Int J Aging Hum Dev 1980; 12(1 ):39-48.
- McMahon, A., Rhudick, P Reminiscing: Adaptational significance in the aged. Arch Gen Psychiatry 1964; 10:292-298.
- Menninger, R. Some psychological factors involved in oral history interviewing. Oral History Review 1975; 34: 68-75.
- Myerhoff, B., Lufte, V. Life history as integration. Gerontologist 1975; 15:541-543.
- Neuenschwander, J.A. Remembrance of things past: Oral historians and longterm memory. Oral History Review. 1976; 35: 4553.
- Newbern, V.B. Self care practices in the South, 1900-1945. In A. Bushy (Ed.), Rural health nursing. New York: Springer Publishing, 1991.
- Newbern, V.B. Failure to thrive: A new tool for gerontological nursing. 1992; in press.
- Price, C. Heritage: A program design ior reminiscence. Activities, Adaptation & Aging 1983; 3(3):47-52.
- Ryant, C. Comment: Oral history and gerontology. Gerontologist 1981; 21:104-105.