Cicourel (2013) - Origin and Demise of Sociocultural Presentations of Self from Birth to Death

http://soc.sagepub.com/Sociologyhttp://soc.sagepub.com/content/47/1/51The online version of this article can be found at:DOI: 10.1177/0038038512456779 2013 47: 51 originally published online 17 December 2012 SociologyAaron V CicourelSustaining Communal Social Structure Throughout the Life CycleDeath: Caregiver 'Scaffolding' Practices Necessary for Guiding and Origin and Demise of Socio-cultural Presentations of Self from Birth toPublished by:http://www.sagepublications.comOn behalf of:British Sociological Association can be found at: Sociology Additional services and information for http://soc.sagepub.com/cgi/alerts Email Alerts: http://soc.sagepub.com/subscriptions Subscriptions: http://www.sagepub.com/journalsReprints.nav Reprints: http://www.sagepub.com/journalsPermissions.nav Permissions: by guest on September 11, 2014 soc.sagepub.com Downloaded from by guest on September 11, 2014 soc.sagepub.com Downloaded from What is This?- Dec 17, 2012 OnlineFirst Version of Record - Feb 28, 2013 Version of Record>> by guest on September 11, 2014 soc.sagepub.com Downloaded from by guest on September 11, 2014 soc.sagepub.com Downloaded from Sociology47(1) 51 73 The Author(s) 2012Reprints and permission: sagepub. co.uk/journalsPermissions.navDOI: 10.1177/0038038512456779soc.sagepub.comOrigin and Demise of Socio-cultural Presentations of Self from Birth to Death: Caregiver Scaffolding Practices Necessary for Guiding and Sustaining Communal Social Structure Throughout the Life CycleAaron V CicourelUniversity of California, San Diego and San Francisco, USAAbstractTheemergence,socialdifferentiation,andreproductionofhumancommunitiesrequire socializationoftheyoung.Socializationpracticesrequirecaregiversandsociallydistributed, intuitive, normative knowledge systems to enable progeny to acquire and sustain habitual, socially organized skills and belief systems.Neurobiological,cognitive,emotional,andsocio-culturalevolutionenabledandparalleled theacquisitionofcommunicativeandsocio-culturalskillsindispensablefortheemergenceand reproduction of a sense of others. Stable adult capacities differentially weaken over the life cycle. Thisreversesocializationmeansgraduallossofself,senseofothers,anddeclineofroutine practices necessary for reproduction of communal life.A modest corpus of data (10 minutes of discourse between six couples, two deemed normal, and four where one spouse diagnosed with Alzheimers Disease or Frontotemporal Dementia) isusedtoillustratecaregiverscaffoldingsimulationofappropriatesocio-culturalinteraction, illuminating the origin and demise of socio-cultural presentations of self from birth to death.Keywordsdementia, discourse analysis, representational re-descriptions, scaffolding, social self, socialization practicesCorresponding author:Professor Emeritus, Aaron V Cicourel, University of California, San Francisco, The Institute for Health and Aging, Department of Social and Behavioral Sciences, Laurel Heights, Suite 340, 3333 California Street, San Francisco, CA 94118, USA. Email: [email protected]/0038038512456779SociologyCicourel2012Article by guest on September 11, 2014 soc.sagepub.com Downloaded from 52Sociology 47(1)IntroductionThe article examines why socio-cultural processes cannot be reduced to, yet are neces-sarily enabled by, neurobiology, cognition, and emotion. The simultaneous evolution of neurobiology and the human genome enabled cognition, emotion, and culture to evolve, and for contemporary human groups to create culturally derived concepts called intelli-gence, belief systems, religion, philosophy, literature, art, myths, and science. Sociology, therefore, need not look inside the human brain and genome for social structure, but to contemporary documentation of socio-cultural processes and structure using a variety of theoriesandmethodologies.Thepresentworkreliesondiscourseanalysis(Brown, 1995) and linguistic anthropology (Hanks, 1990; Duranti, 1997; Sapir, 1949[1933]). The methodologyencouragesthereadertofollowthediscoursematerialandethnographic settingsdepictedtodiscerntheplausibilityoftheauthorsinterpretationofdifferent speech events and their substantive relevance.The ubiquitous necessity of communication skills embedded in ethnographically con-firmed settings underscores their fundamental role in creating human communities and socially organized activities or social structure. Native speakers are expected to display appropriate communication through normative, locally evolved dialectical speech (or sign language) patterns, gestures, facial expressions, and body movements. Formal and informalspeecheventsareshapedandconstrainedbysociallyorganizednormative expectations. Ignoring such expectations can invite sanctions.The article hypothesizes that dementia and related illnesses can be diagnosed using socio-cultural discourse data as evidence. Further, that the emergence, social differentia-tion,andreproductionofhumancommunallifeisnecessarilylinkedtosocialization practicesoftheyoungandcaregiverpracticeswithagedpersons,especiallywhenthe lattergroupisdiagnosedashavingmodestoradvanceddementia.Theempiricalevi-dence for the hypothesis identifies differences in social interaction among spousal cou-ples diagnosed as normal in contrast to couples where one spouse has been diagnosed with either Alzheimers Disease (AD) or Frontotemporal Dementia (FTD). The author was unaware of the diagnosis of the six cases prior to his analysis of 10 minutes of vide-otaped interaction between the spouses. The results of the empirical section suggest ways that socially organized discourse material may improve the diagnosis and treatment of patients with dementia.The practices called scaffolding (see below) are hypothesized to be constitutive of the emergence, sustenance, and reproduction of human communal life. Socializing theyoungtoadulthoodandtheagedtodeathrequiresthesimulationofnormal socialinteractiondespitethevariablelackofsocialcompetenceofthoseattended. Thescaffoldingpractices(simulationofnormalsocialinteraction)bycaregivers enablethemtomaintaintheirownidentityandsenseofsocialstructureduring exchangeswithsocially,cognitive,andemotionallycompromisedconsociates. Scaffolding practices presuppose normatively evolving communicative skills across different human communities.Childrenacquire,andelderlyadultsbegintolose,thenecessaryproblem-solving skills,communicative,andsocio-culturalpracticesconstitutiveoftheemergenceand persistence of a sense of social structure we associate with the acquisition of a social self necessary for socio-cultural stability and change over the human life cycle. by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel53Communalliferevolvesaroundtheindividualspossessionofagency,orasocio-cultural self. The notion of a social self and the awareness and ability to take others into accountrequirescollectivelivingconditionsonlysustainablethroughcollaborative socialinteractionbetweenconspecifics.Whereasneurobiologists(SeeleyandSturm, 2007)speakcogentlyofthebiologicaloriginsofthenotionofsocialself,thepresent worktakesasself-evidentthepropositionthathumancommunallifecouldonlyhave emerged had there been simultaneous evolution of neurobiological, cognitive, emotional, and cultural processes and structures.The theoretical perspective followed in the present work is indebted to the work of George Herbert Mead (1934). According to Mead (1934: 135): the language process is essential for the development of the self. The self has a character which is different from that of the physiological organism proper [and] arises in the process ofsocialexperienceandactivity,thatis,developsinthegivenindividualasaresultofhis relations to that process as a whole and to other individuals with that process.Mead (1934: 154) continues: The organized community or social group which gives to the individual his unity of self may be called the generalized other. The attitude of the generalized other is the attitude of the whole community. Socially organized activi-ties, therefore, are constitutive of social structure.The following pages begin with a discussion of neurobiological aspects of a social self to give readers a sense of how neurobiology enabled the possibility of socio-cultural life forms. Despite the clear relevance of the brain and the human genome for the human acquisition of a social self, the study of the brain and genome cannot explain the evolu-tion of human communities. Going beyond neurobiology requires specifying elements of the cultural origins of cognition; the unavoidable interaction between culture and cogni-tion, and their essential role in the socialization of infants and children into socio-cultural environments (Tomasello, 1999).Thefollowingsectionincludesliteratureoncaregiverpracticesandthenecessary development of a communicatively competent social self required for the reproduction of human communal life. The conditions viewed as necessary for communal reproduc-tion parallel observable aspects of the gradual deterioration of social and communicative competency evident in the patients with dementia discussed below.Neurobiological Aspects of Self Seeley and Sturm (2007: 317) ask: How do our brains build the self as we know it? I assume brains and genes can only understand and build [and conceive] the self as we know it within an evolutionarily emergent, socio-cultural community of others noted by Mead.Theneurobiological,emotionalandcognitiveconceptionsofselfpresuppose the necessary role of culturally organized others and essential daily social interaction constitutive of human group survival.SeeleyandSturm(2007:317)refertoself-representationasaneuralaccomplish-mentthatemergesfromadynamicsetofcomponentprocesses. Theauthors stressthatself-representationinvolvesdiverseprocesseswithinbroadlydistributed, interacting neural networks at many biological levels. Further (2007: 318), the notion of by guest on September 11, 2014 soc.sagepub.com Downloaded from 54Sociology 47(1)self includes recyclable mental representations of objects, including the self [and] permanentothers(her,him,perhapsthem)[thatprovide]predictabilityand security in competitive social environs.How did the anterior insula cortex (AIC), and anterior cingulate cortex (ACI) noted by Seeley and Sturm emerge and guide the development of an infant social self, interact with other areas of the brain to enable memory systems to emerge and sustain the notion of a human primate self?Seeley and Sturm (2007: 318) also refer to the necessary human ability to reflect on ones representations of self and thus develop an awareness of awareness. The reflexive notion of self by Seeley and Sturm, therefore, acknowledges the existence of locally organized, socio-cultural environments (the social realm), but does not refer to norma-tive, cross-cultural socialization practices needed for the survival and development of an infant social self.Taking the role of ones self reflexively is part of an essential cultural accomplishment (Mead,1934)whoseassumedneurobiologicalsubstratesareunavoidable,butwhose emergent functional accomplishment in daily life remains unclear and which the present work seeks to explore with socio-cultural evidence.If the notion of self emerges as an embodiment of neurobiological, cognitive, emo-tional, and socio-cultural systems, then it must consist of constantly renewable, cultur-allycoherent,sequential,temporallyordered,interacting,sociallyfunctionalmemory systemswhichnourishaselfobservableinitiallyininfancy,thenadulthood,andit declineswithage.Normativelyorganizedhumancommunities,therefore,areanuna-voidableevolutionarynecessityforsocializingtheyoung.Theevolutionaryprocesses whereby group social interaction, patterned socio-cultural activities or structure emerged remain a mystery, yet their variable, cross-cultural, present-day existence is an incontro-vertible material fact.Childhood Socialization and EvolutionSix million years are said to separate human beings from other great apes (Tomasello, 1999: 2); a brief period of evolutionary time. Yet despite a 99 percent overlap in their genetic composition, Tomasello notes: there has not been enough time for normal biological processes of evolution to have taken placeintermsofgeneticvariationandnaturalselectioninordertohavecreatedonebyone each of the cognitive skills necessary for modern humans to invent and maintain complex tool-use industries and technologies [much less] complex forms of symbolic communication and representation, and complex social organizations and institutions. The problem is magnified by the claim of paleontologists; for most of the 6 million years, no new cognitive skills emerged.Tomasello continues (1999: 45): (b) the first dramatic signs of species-unique cognitive skills emerged only in the last one-quarter of a million years with modern Homo sapiens. Even if 6 million or 2 million or 250,000 years,therewouldnothavebeenenoughtimetoaccountforcognitiveevolutionasthe biological mechanism responsible for the rapid evolution. Hence the only possible solution to by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel55thepuzzlewouldbesocialorculturaltransmission.Henceculturalevolutionworksmuch faster than organic evolution.Cultural evolution is species-specific, and could only occur with species-unique modes of cultural transmission. Humans are unique because of so-called cumulative cultural evolution or the modification of accumulated cultural traditions and artifacts over time not shown by other species. The invention of a primitive version of an artifact or practice and its modification or improvement enabled others to adopt it, perhaps without change for several generations. Tomasello calls this the ratchet effect.Creative invention and faithful cultural transmission are essential to prevent slipping backward, and holding on to the new and improved form until modifications or improve-ments came along.Akeyissueofprimateculturesistheintentionalsignificanceoftooluseorsome symbolic practice, what it is for, and what others do with. Thus (1999: 6):Processes of cultural learning are especially powerful forms of social-collaborative creativeness andinventiveness,thatis,processesofsociogenesisinwhichmultipleindividualscreate something together that no one individual could have created one another, she identifies with that other person and his intentional and sometimes mental states [The suggestion is] that onlyhumanbeingsunderstandconspecificsasintentionalagentsliketheselfandsoonly human beings engage in cultural learning (Tomasello, 1996b, 1998; Tomasello and Call, 1997; see Chapter 2).Tomasellos discussion provides a sociological basis for cognitive processes. Hence, the focus of psychologists on individual cognitive skills always presupposes socio-cultural structures and processes for their identification and study.Culture, Information and the Emergence of Social StructureFollowingRoberts(1964:4389),culturescanbeviewedasinformationeconomies whereby information is received or created, stored, retrieved, transmitted, utilized, and even lost. Socialization to adulthood and death, therefore, requires an information econ-omy that is stored in the minds of its members and, to a greater extent, in artifacts.Socialization of infants and children through adulthood requires essential scaffold-ing (Vygotsky, 1978). The labour-intensive role of scaffolding practices after birth paral-lels the social interaction employed during socialization of the aged to death. Socialization to adulthood and to death sustains human communal systems and their variation across cultures and functional specificity in different settings.Vygotskys (1978: 81) notion of the zone of proximal development, adult guidance ofchildren,suggestsneurobiologicalmaturationinvolvingasimultaneousfusionof learning and development. A key notion of his work (1978: 85) is that what children can dowiththeassistanceofothersmightbeinsomesenseevenmoreindicativeoftheir mental development than what they can do alone. Scaffolding, the assistance of other isembeddedinsocio-culturalconditionstacitlypresupposedbutnotaddressedby Vygotsky. by guest on September 11, 2014 soc.sagepub.com Downloaded from 56Sociology 47(1)For Vygotsky (1978: 86), the zone of proximal development refers to the dis-tancebetweentheactualdevelopmentallevelasdeterminedbyindependentproblem solving and the level of potential development as determined through problem solving under adult guidance or in collaboration with more capable peers [Thus,] what a child can do with assistance today she will be able to do by herself tomorrow.Vigotskyszonereferstolocalsocialsettingscreatedorstructuredbyparentsor caregivers or teachers in which a peer or adults guidance and collaboration (scaffold-ing) can enable the child (or a patient) to succeed at (or simulate) a given task or prob-lem-solving activity that is not as likely to occur if the child or patient were left to her or his own devices or capabilities.Thescaffoldingusedbycaretakersofpatientswith AlzheimersDisease(AD)and Frontotemporal Dementia (FTD) enables the reproductive simulation of routine socio-cultural contexts essential for communal stability; for example, enabling patients, tem-porarily,toaccessmemoriesofpastsocio-culturalexperiencesand/oreventstheycan hopefully recognize as relevant to an existing here and now framed by a caretaker. The extenttowhichscaffoldingcanimprovethepatientscognitive,linguistic,orcultural skills is doubtful, but scaffolding can enable caregivers to simulate a needed social sense of self to sustain normal cultural stability. The extent to which caregivers differentially maintain a sense of denial vis-a-vis their scaffolding activities is an empirical issue.Social Structure and CognitionSocialstructurecanbeviewedaslocalandabstractpatternsofinstitutionalized,often bureaucraticallyorganized, developmental, cultural, and cognitively devised beliefsys-tems and activities, empirically grounded in daily life practices. Such practices invariably consist of representational re-descriptions (Karmiloff-Smith, 1992); memory-dependent re-descriptivelanguagewhichgoesbeyondthelimitationsofourimmediatesensory capabilities.Socio-cultural childhood socialization activities and practices expose the young to an activelife-worldanddifferent,overlappingformsofnormativecommunalexistence. Between the end of adolescence, and the early or late onset of aging, adults experience various forms of apprenticeship practices associated with a wide variety of task environ-mentswhoselocusofauthorityresidesinfamilial,interpersonal,andbureaucratically organized institutional settings of power. Roberts (1964: 4389) structural view of cog-nitionandculturenotesthattribalcommunitiesaretoolargeforsingleindividualsto absorb and store overlapping, distributed, elements of socio-cultural life.An explicit, related, real-time cognitive view of culture can be found in DAndrades (1989) notion of culture as an immense, distributed, self-organizing productive system. AnessentialaspectofDAndradescognitiveperspectiveofcultureincludesexplicit references to daily life encounters faced by human groups, and memory systems consist-ingoflargecollectionsofsustainable,partial(re-descriptive)solutionsforproblems. The work of Roberts and DAndrade underscores a constitutive element of culture: the necessity of human memory systems and artifacts for addressing distributive systems of learning and practice. by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel57BuildingonRobertsandDAndrade,Hutchins(1991:284)hasproposedtheexist-ence of socially distributed cognition in locally cooperative efforts of humans working insociallyorganizedgroupswithinavarietyoftaskenvironments.ForHutchins,a socially organized task environment: involves the distribution of two kinds of cognitive labor: the cognition that is the task, and the cognition that governs the coordination of the elements of the task. In such a case, the group performingthecognitivetaskmayhavecognitivepropertiesthatdifferfromthecognitive properties of any individual.The integration of cognition and culture, therefore, is a socio-cultural accomplishment of social interaction.Caregiver Practices and the Development of a Social SelfThe literature on child language acquisition, cognitive development and socio-cultural socializationsuggeststhatearlyexposuretosocio-culturalactivitiesandpractices includescommunicationskillsthatbeginafterbirthandarelinguisticallyacquired between10and44monthsformostlanguages.In Westerncultures,parallelfindings exist between middle-income adults speech to young children, and how four-year-olds speaktotwo-year-olds(GelmanandShatz,1976;Shatz,1975;ShatzandGelman, 1973). Routine conversational practices reveal the caregivers role in simulating a com-munityofothersduringspeecheventswiththeyoung.Thesamekindsofspeech eventsoccurbetweencaregiversandagedpersonswithcognitiveandsocio-cultural deficits (Cicourel, 2010).Elissa Newports (1977: 177) research in the United States on motherese begins with the recognition that others must speak with the infant or child and the child acquires whatever language is spoken to him [sic]. I summarize Newports (1977: 178) succinct review of the literature about a special speech register motherese. For example, the child limits its language environment by repeating (parsing) utterances that go beyond herorhisspeechproductioncapabilities(Shipleyetal.,1969),andignoreslanguage perceived to be too difficult or unfamiliar. As noted by Newport, the nature of the selec-tivity of utterances suggests the child does not rely on innate preprogramming abilities and is probably incapable of processing complex speech. Caregivers are presumed to be sensitivetoconstraintsonthechildscapabilities,includingtheirshort-termmemory limitations. Adults, in this view, become selective in their use of speech acts assumed to be appropriate less complex lexically, and structurally simplified. Similar to Vigotskys zone of proximal development, the child reacts to utterances somewhat beyond its cur-rent rule system.Newport notes (1977: 179) even 3- and 4-year old children, who in some cul-tures are the primary caretakers of younger siblings (Slobin, 1968a), produce this type ofspeechtoyounglanguagelearners(SachsandDevin,1976;ShatzandGelman, 1973).NewportconcludesherreviewbydescribingahypothesisbyGelmanand Shatz(1973:33)thatspeakersselectutterancesperceivedasrelevantforparticular by guest on September 11, 2014 soc.sagepub.com Downloaded from 58Sociology 47(1)contextsbyassessingappropriateconversationalmeaning.Newportandothersshe cites acknowledge leaving the problem of [cultural] meaning untouched.Child development research on adult speech to young infants and children refers to interpretative frames imposed by the caregiver (Ochs, 1988: 21) often viewed as self-evident. Ochs (1988: 23) continues:Whileallresearcherswillreadilyadmitthatexoticpeopleshaveaculture,veryfewsee themselvesashavingacultureandevenfewerseetheirmiddle-classresearchsubjectsas having a culture (but see Lock 1981; Shotter 1974). As noted in Ochs and Schieffelin (1984), middle-classlanguageacquirersandcaregivershaveaninvisibleculture(seePhilips1983). Their culture is not usually perceived because the researcher usually speaks the same language and participates in the same cultural system as the children and caregivers and/or because the researcher does not have a heightened awareness of his or her own orientations and behaviors, and does not look for these underpinnings in interpreting the behavior of others.Ochs (1988: 23) also raises questions about missing cultural implications of the notion of simplification in caregiver speech:We do not see, for example, that the speech of caregivers to and in the presence of young children is organized by cultural expectations regarding the status and role of children and caregivers and regarding relative incompetence (see Ochs and Schieffelin, 1984) Simplified caregiver speech is one kind of caregiver speech that exists in the worlds societies. It is a social register. It is not universal and not a necessary environmental condition for language acquisition to take place.The above remarks suggest we are missing data showing different socio-cultural set-tings in which variable scaffolding conditions can be said to exist or in which the claim could be made that such conditions can be minimized yet can result in normal language acquisition, cognitive skills, and socio-cultural problem solving. Ochs (1988: 24) sug-gests that:American caregivers indulge the egocentric tendencies of children, whereas traditional Samoan caregiversresisttheseegocentrictendencies.Americanwhitemiddle-classcaregivers compensate for the inability of infants and small children to meet the informational and social need of others by carrying out a lot of the work for them and caregivers will often fill in missinginformationorparaphrase(expand)whatthecaregiverinterpretstobethechilds intended message.Ochsremarksparalleltheculturalproblemsexistingwhencommunicatingwiththe aged.The work of Miller (1994) also provides convincing data on the emergence of a socio-cultural self in early childhood (approximately at 2 years of age). Citing work by Basso (1984), Sapir (1949[1933]), Herdt (1981), and Malinowski (1984[1926]), Miller (1994: 158) refers to the essential role of myth for preserving the culture of a community by the use of narratives. She underscores the socializing potential of: informal, mundane, and often pervasive narrative accounts that people give of their personal experiences.Theverbalactivityoftellingotherpeopleabouteventsthathavehappenedto by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel59oneself may well be a cultural universal: Versions of this type of storytelling occur in diverse cultural traditions within the United States and around the world. (Miller and Moore, 1989)Thechildsearlyfamilialsocializationexperienceswithsystemsofmeaningoccur within specific kinds of discourse, especially personal storytelling. For Miller, the three-year-olds storytelling reflects a self-construction process notable for its revision and reconstruction.Incontrast,amongtheagedwithdementia,spontaneousstorytellingdiminishes sharply and becomes a diagnostic marker for the study of patients with AD and FTD.Comparing Normal and Diminished Displays of Self and Social StructureThe materials presented below are from white middle-income adult patients diagnosed with AD and FTD. The six pairs of patients and spouses were initially seen at the Memory and AgingCenter(MAC)(DepartmentofNeurology)attheUniversityofCalifornia, San Francisco (UCSF), and subsequently tested for their emotional displays and psycho-physiologicalcorrelatesatthePsychophysiologyLaboratoryattheUniversityof California, Berkeley (UCB). I was not told the diagnosis of the relevant spouse of the six casesselectedbytheDirector(RobertLevenson)oftheUCBLabwhereIconducted most of my analysis.A key empirical issue is the extent to which we can assess the ability of patients with ADorFTDtosharetheimmediatesocialenvironment,andprospectivelyandretro-spectively assess and anticipate relevant motivations, intentions, and emotional states of others. Amongearlyonset ADpatients,partialislandsofstorytellingwithcaregivers occur,butpatientswithmoderatelyadvancedstagesofADandFTDhavedifficulty articulating spontaneous storytelling.Ten minutes of focused discussion by six couples enabled the author to identify nor-mal and clinically relevant speech acts and discourse, and infer a differential diagnosis suggestiveofaninabilitybythepatientstopresentaviablesocio-culturalselfbefore others.The dyads were asked to discuss marital conflict situation(s) (Gottman and Levenson, 1992) experienced prior to the initial neuropsychological and clinical assessments at the MAC. All subjects engaged in the requested social interaction about a conflict situa-tion,butdifferencesquicklyemergedbetweenpatientsdesignatedashaving ADand FTD, and those perceived as normal controls.The videotaped sessions were examined independent of the patients clinical diagno-sis,prioroccupationalhistory,publiccontacts,participationinactivesocialnetworks and routine social activities at home. Ten minutes of discourse proved sufficient to infer which of the couples were normal. The couples in which one spouse was presumed to haveFTDalsoappearedself-evident.Buta10-minutesessionprovedpuzzlingfora misdiagnosed case of AD. The problems associated with the misdiagnosed case are dis-cussed below.The study of speech events during staged but surprisingly spontaneous social inter-action in the Berkeley Lab provided a valuable source of information about the couples by guest on September 11, 2014 soc.sagepub.com Downloaded from 60Sociology 47(1)awareness of self when communicating with each other and others about daily life topics, planningactivities,problemsolvingorcarryingouttasksoractivitiesathomeandin their community.Inthetwoassumednormalcases,thesubjectsreadilyinitiatedspeechactswith detailed elements of past family relationships, social activities and work experiences, or along-standingmaritalproblem.The10-minutesessionscouldbeviewedasmicro-cosms of normal marital life for these articulate subjects.Tenminutesofdiscourse,however,lacktheecologicalvalidity(Bronfenbrenner, 1977;Brunswik,1956;Cicourel,2004;Cole,1996;Neisser,1982)ofhomevisitsin which audio and videotapes of patients initiating and sustaining a sense of self during discoursecoulddifferfromsemi-controlledclinicalandcontrolledpsychologicalset-tings. Subsequent research by the author addresses these issues.Two Normal CasesThe discourse fragments discussed below were first examined and reported in Cicourel (2010). The expanded analysis addresses how spousal social interaction reflects cogni-tive problem solving, and complex, essential patterns of culture or social structure and their reproduction. As in Cicourel (2010: 2), the focus of analysis is on the role of scaf-folding practices in both control (normal) discourse and caregiverpatient social inter-action. For example:1Can each spouse initiate and pursue a topic?2Can subjects use metaphors and related semantic constructions typical of every-day discourse?3Does one spouse dominate the discourse and provide leading questions and tag statements to sustain the speech event?4Can subjects sustain a reciprocity of perspectives or consistent theory of mind (Gopnick and Meltzoff, 1997; Mead, 1934; Schtz, 1962)?5Can subjects remember and conceptualize a future event, and plan an activity?Normal Discourse Case 7142Theopeningmomentsconsistoftwoadults(W=wife,H=husband)facingeachother, theireyesopeningandclosingduringaprior,designatedperiodofsilence. Afterfive minutes of silence, the voices of the lab assistant (LA) and couple follow:Excerpt 1 Case 71421LA: Please begin your conversation.2H: I was just going to say that the um that we used to go off about is the 3you contend that I put my mom first and um I contend I dont.4W: Im not sure thats the case anymore and my frustration is that you 5you tend not to see some of your mothers manipulative tactics6and you bought into the whole story about, you know, by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel617she wanted you to believe over the years8and yet your sister and brother have seen it very clearly.9I just think possibly being the oldest child and having been doted on the10most. I think you just feel like you would be betraying your mother11if you admitted that you saw those things.12Thats the part that frustrates me.The couple recreates a long-time conflict in their marriage; the wifes view of the hus-bands domineering mother. The husband subsequently acknowledges the wifes view; hissubmissivebehaviorindealingwithhismother,buthesubsequentlyreferstoher agingyearstojustifyhismothersbehavior.Thehusband(line3)contextualizesthe conflict by using a metaphor (we used to go off about) alluding to prior occasions of conflict, and the metaphoric, alleged claim by the wife that I [the husband] put my mom first and um I contend I dont. The husband presumably favors his mother over his wife and did not (line 5) recognize his mothers manipulative tactics. The wife (line 4) initially retracts her presumed earlier claim by stating Im not sure thats the case any-more The remainder of her remarks in lines 411 demonstrates her ability to articu-late a long-standing conflict in their marriage by underscoring the frustration she cites in line 4, but does not provide substantive details about what manipulative tactics were used by her mother-in-law.Thelanguageusedbyeachpartyremainedarticulateandsubstantivelyconvincing throughout the session. Each spouse appeared to engage in animated social interaction withnosignofapathy,aswellasastrongcommandofEnglishsyntax,phonology, semantics, paralinguistic skills, and task-oriented cognitive reasoning. The couple used appropriate metaphors and deictic lexical items such as pronouns like I, we, them, they, you, and spatiotemporal adverbs like that, there, these, those, and this (Hanks, 1990). They referenced substantive conditions of a normal conflict consistent with research by Gottman and Levenson (1992) on social interaction in normal long-term marriages.Normal Discourse Case 1416At the end of a scheduled silent period, the lab assistant tells the couple they can now speak.Excerpt 5 Case 14161H: This kind of reminds me of Saturday Night Live. (both laugh)2where Kurtland would say something to Jane,3insults like (unintelligible, both laughing).4W: Um, I voted to approve a strike vote at uh, Peninsula Hospital5and theyre in negotiations now.6And the reason I voted to uh approve a possible strike is that7they uh, I feel the nurses should have better retirement and health care8when they retire. They want to change it to a thirty-two thousand dollar by guest on September 11, 2014 soc.sagepub.com Downloaded from 62Sociology 47(1)9fund that you get when you retire,10but you have to pay your premiums and they give it back from that.11/And thats not going to be enough to, to 12/H: My, my; the questions not on the specifics,The opening three lines reflect small talk, but in line 4, the wife introduces a topic (astrikevoteatuh,PeninsulaHospital).Apparentlysheisanurseandnota patient. The wife seeks to justify the strike (lines 69); better retirement conditions fornursesandhealthcareafterretirement.Thehusband(line12)challengesthe wifesremarksusinganindexicalexpressionthespecifics,implyingthereisa problem to be found in unstated details of the negotiations, suggesting a conflict between them.My commonsense interpretation of the husbands facial expressions and initial com-mentsalsosuggestsheisnotapatient.Bothhusbandandwifeengageinexpected presentations of self and marital conflict. The next section of discourse appears to clar-ifytheseinitialimpressionsbyanarticulatepolarizationoftheirviewsaboutunions. For example:Excerpt 6 Case 141613H: my question is on the benefits of having a labor union negotiate14for you under the conditions that, that they dont negotiate.15W: Well, the fact that theres 5000 nurses from eight or ten, I think its16eight, Peninsula Hospitals, carries more weight with the negotiations.17I think theyll find, in the long term, that universal health care,18itll make the hospital and the medical, hospital communities more19receptive to universal health care, which /is the real solution to the20problems.21H: /This is, its not,22its not an argument about universal health care,23its an argument about the unions and how the unions represent you.23Its uh, its an argument about the unions tactics,24are, to get a bunch of people to threaten to strike,26and not a bunch of people that are willing to negotiate.Thehusbandsanti-unionperspective(lines2123)seekstorefocustheissues raised by the wife (better retirement benefits for nurses) on the unions tactics. The wife,meanwhilealsointroduces(lines1719)thenotionofalong-termgoalof universal health care, which for the wife is the real solution to the problem. The husband disagrees (lines 2126). The wife and husband appear to be in good control of their views and consistently reveal an ability to express them clearly. The remain-der of the discourse continues in a spirited vein with the wife defending her position and husband doing likewise but without any appearance of rancor or irritation. The coupledidnotmasktheseriousnessoftheirdifferentperspectives,yetremained civil throughout the discourse, perhaps motivated by the public (recorded) nature of the social interaction. by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel63Two Possible FTD CasesCase 5692 In the opening moments of Excerpt 7, the husbands face appeared expressionless. The wife revealed slight smiles during the five minutes of silence. The lab assistant (LA) asks them to please stop sleeping while the wife mouths I love you to her husband.Excerpt 7 Case 56921LA: We want the two of you to talk about anything you want and then?2W: [to Husband] do you have any idea of where we disagree?3H: No. [Wife smiles, Husband begins to smile [not clear]]4LA: Pick something youd like to talk about, something you can agree?5W: [fairly animated] Oh, I know! We have differences of opinion on6how were going to be buried.7H: [smiles and seems to chuckle]8W: [Wife smiles] but we resolved that.9Did you think of something you could talk about?10You dont want to talk about that?11H: Nope.12W: We already decided on that. Ah uhm, about this weekend.13H: wh oh (?) [flat affect]14W: What were doing.15H: Were going to play some tennis.In the present and subsequent case, the wifes scaffolding simulates a socially stable speech zone, thus giving the patient access to a limited set of current and past events. The patient does not introduce his own topics. My initial impression suggested the hus-bands face consistently lacked expressive features, in contrast to the wifes immediate animation even during the silent period. The husband seemed subdued, not motivated toengageindiscourse,andpresupposesmyhavingviewedthevideotapeandprior familiarity with FTD patients. The wifes scaffolding practices simulate a speech event about future events involving both spouses. The husbands speech acts were limited to occasional, appropriate, truncated, limited views about the wifes reference to activities. He did, however, remember their plans to play tennis on the weekend.In lines 911, the wife asks a leading question which provides a scaffolding frame for the husbands negative response. In lines 1630, the wife (not shown) again asks leading questions to sustain the conversation. The husband responds appropriately in lines 18, 20, and 22, and expands on the topic in line 20. The husband employs deictic pronouns but the speech events do not contain speech acts that use spatiotemporal deictic expres-sions (those, here, that, there, these). There appears to be a lack of affect and emotional lexical items and phrases in the husbands responses.Speecheventsthatfollow(notshown)makereference(bythewife)toapossible pending suspension of the husbands driving license and her claim that she can drive an RV with his guidance. The husband insists she should not drive the RV. There are other by guest on September 11, 2014 soc.sagepub.com Downloaded from 64Sociology 47(1)indications that the husband is the patient. The wife suggests that she and her husband do little socializing, and she refers to a trip to Paris that apparently had been planned and alludes to not taking the trip because of the husbands medical condition.Case 7162The wife begins the exchange with winks and chuckles. The husband moves his fingers to his lips, suggesting comprehension of lab assistants remarks to observe silence. The wife smiles broadly. The husbands head drops to his chest and then up again. The hus-bands facial expression appears frozen and barely animated when communicating. The husband says something and the wife puts a finger to her lips to signal dont talk. Brief non-verbal facial expressions follow and husband smiles slightly. Wife closes her eyes. Husbandlooksaround.Wifeputsfingersonhereyestoindicatethehusbandshould close his eyes but he doesnt and looks around. The silent period ends with the laboratory assistant asking the couple to begin the problem conversation.The wifes immediate reference to clutter appears to presuppose a prior, long-standing problem. The wife immediately begins to control the exchange by providing the initial scaffolding needed to initiate the exchange. I assumed the wife believes the husband is not likely to initiate the discourse.Excerpt 10 Case 71621W: We can talk now. So, I have one question.2Thegarageandthehousewherewelivenow,wevelivedtherefor3years, where3we live now, and the day that we moved in you persuaded4me to lets just throw it in, because well organize it later.5H: Okay.The wife (lines 15) immediately asks a question, which turns into a prolonged com-plaintaboutthehusbandsapparentlong-termdisregardforcleaningthegarage.The wife uses several deictic and indexical terms including one fragment (line 4) of alleged unreported speech attributed to the husband whose reported usage we cannot confirm. Thedeictictermitreferstounidentifiedentitiesthatwereplacedinthegarage. The husbands response is a flat Okay. The husband makes no attempt to refute the wifes allegationsandshebeginstoelaboratetheproblem.Theopeninglines,therefore, resembles a caregiver monologue I assume is typical.Excerpt 11 Case 71626W: And then 3 years have past, and I was angry at you various times,7for not going out in the garage and making an attempt at organizing it,8cause today, its just as bad as the first day we moved in.9And you promised me you would help me organize it.10And uh, basically there were lots of opportunities for you to do it,11because you would be watching TV, football, whatever, and by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel6512You had nothing else to do but watch TV.13You could have gone out to possibly do a little bit.14Start a few things here and there.15And, I dont think you ever made any movement towards organizing16the garage. Now, today, the garage is still undone.The wife (lines 69) continues the monologue by reference to the indexical term clut-ter. Thewifeaccusesthehusbandofmakingnoattempttoorganizetheclutterand notesthesituationremainsthesamenowaswhentheyfirstmovedintothedwelling. Instead of taking advantage of many opportunities to organize the garage, the wife notes (lines 1112) her husband would watch TV. The wife pursued the allegation through lines 1316. The scaffolding provided by the wife is clear and closely resembles the prior case. In the next fragment, there is a shift to the patients present problem.Excerpt 12 Case 716217W: I, I understand why I cant expect for you to do the garage any more,18is that you are incapable of it because of the new prognosis we have19on you. But, it was true 2, 2 years ago that you also had the problem20and when you dont do it now it is the same reason as 2 years ago,21You think so?22H: could be.23W: OkayThewife(lines1718)statesIunderstandwhyIcantexpectforyoutodothe garage any more, is that you are incapable of it because of the new prognosis we have on you. The direct reference to the new prognosis is stated as a self-evident fact, and the wife (line 19) associates the husbands inaction with clutter to be a consequence of the new prognosis apparently identified 2, 2 years ago. The wife (line 20) asks the hus-bandtoreflectonheranalysisofthereasonforhisnotorganizingtheclutter.The husbands response is brief and semantically ambiguous, but perhaps could be viewed as appropriate,giventheinformationaboutthenewprognosisandthelackofamore elaborate response by the husband. The husbands answer, however, is not self-evident. Should we assume he is not capable of understanding the wifes linking of clutter to his newprognosis?Subsequently(notshown),thehusbandappearstorevealaminimal sense of self and comprehension and the wife persists with her view of the problem.Two Possible AD CasesCase 5733Excerpt 16 Case 57331H: We can talk, lets just talk, well talk about that.2LA: about the clutter?3H: Yah, cause then shell talk a lot. (husband and wife smile) by guest on September 11, 2014 soc.sagepub.com Downloaded from 66Sociology 47(1)4LA: Well, the two of you talk. But uh, so then what I am going to do,5talk about this issue of getting the clutter in the basement for 10 minutes.6LA: First, though,7H: (refers to something about eating)8W: (laughs) I dont have a problem with eating.9H: I know. You have a problem with my eating.10W: Yah.The speech event begins with a response to the lab assistant asking the couple to discuss a conflict situation and specifically refers to clutter. A few minutes later, the husband (lines 13) refers to the deictic expression that (clutter), used by the LA, and he notes the topic will motivate his wife to talk a lot, implying his wife might otherwise not say much, suggesting she is perhaps the patient. Thus, early on, the husband seemed to be informingthelabassistantofthekindofscaffoldingappropriatefordiscussion.The wifes animation appeared appropriate when she did speak. The wifes facial expression, however, appeared to be periodically fixed and she frequently lowered her eyes after speaking.Herfacialappearanceseemedsubduedandlackedexpressiveness,except when speaking. The reference in lines 810 to a problem with eating seemed appropri-ate. After five minutes of silence, the official session began.Excerpt 17 Case 57331LA: You can begin your conversation.2W: About what? (laughs as does husband) I dont think we have3I think we have (animated and smiling) a lot of clutter.4H: Mmhm5W: But I dont know what to do in terms of getting the stuff6OUT of the house. I?? know??, I cant manage to pick up all the,7all the stuff. Id like to take the, the band stuff to the storage space,8(H: Mm) but you dont want to do that.9H: I havent/10W:/And I cant drive (said loudly).11H: I know (laughs) I, I, um, I have/ you know what?12thats the first time you mentioned about the band stuff13going in the storage space, but, yeah, we can take it to the storage space.14W: And I think we could have the,15I really think that we dont need the one storage space, whatever.16I mean we have three storage spaces and one of them is hardly full.17H: I know. Actually, I think I want to try to, well I want to18get a hold of (first male name) and see if I can get some of the stuff19out of there. (W: Mm)20H: Sooner the better.The wife (line 2) expresses doubt about clutter as a topic, yet in line 3 seems to claim they have a lot of clutter. In lines 58, the wife expresses concern about getting the stuff OUT of the house, suggesting she cannot be the one who can remove all the stuff by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel67to a storage space, and tells her husband (line 8) but you dont want to do that. Is the wife saying the husband opposes moving the band stuff to the storage space? In line 9, the husband seems about to negate something, and the wife cuts him off (line 10) by not-ing And I cant drive. There is no way to know if the wifes drivers license has been suspended or if she has never driven. The husbands reply (I know (laughs)) suggests but does not confirm a suspended license. The remarks suggest the wife has been diag-nosed with AD.Inlines1113,thehusbandseemedsurprisedbythewifesreferencetotheband stuff, and states it was the first time you mentioned about the band stuff going to the storage space. Perhaps this is an example of memory difficulties. Yet, the wife remem-bers their having more storage space than needed. The dialogue appears appropriate for both spouses; the wife by reference to the band stuff and unneeded space, and the hus-band(line1719)suggestinghewillcallsomeone(name),presumablytohelphim remove the stuff. The husband suggests a way to solve their problem.Although the case seemed somewhat perplexing, I viewed the husbands expressions ofplanningactualactivitiestofacilitatethemovementofclutterasindicativeofhis creative scaffolding role for the wife despite her periodically competent remarks.Several of the wifes initial remarks appeared appropriate in lines 2126 (not shown). The husbands remarks, however, seemed more appropriate, especially his reference to using email to contact (first male named) to have him help move the stuff.In lines 3242 (not shown), the husband states I want to sell that drum set and the wife (line 33) agrees. The husband suggests the wife call (first female named) to see if shell come and take some of our stuff. Thus both spouses initiate possible plans and suggest ways of achieving solutions. But the husbands remark that he will email (first male named) suggests an ongoing, complex cognitive skill.In lines 6973, 7779, and 8890 (not shown), the wife laughs and changes the topic, butappearstoexperiencedifficultyarticulatingherconcernwithourfinances.She continues by stating her desire to consolidate their finances. An awkward use of syntax, lack of semantic clarity, and the use of many confusing deictic expressions (And you know, I dont, it, I, Im, I, I, our, Id, I, I, I, it). The husband (line 74) remains supportive and does not question the wife as she continues expressing uncertainty about financial matters.In lines 7779, the wifes confusion about her funds (we just dont know what, how to deal with it) could be viewed as a common problem among the aged but this wife appeared to be in her fifties (and I subsequently learned she was 60 years old at the time of the session). The husband (lines 8081) provides a scaffolding response that legitimizes the wifes remarks by noting this would be a good time to recon-sider doing something about mutual funds not identified by the wife. After the wife murmurs apparent agreement with the husbands remark, the husband continues by implying (line 83) an unstated possible solution (Actually, I feel that, you know, we could figure out). The husband then states his own doubts (I dont even [line 83] knowwheretobeginwithyourstuff).Thehusbandsuseofthemetaphoryour stuff is followed by the wife (line 86) stating With my stuff? as if to question its meaning. Perhaps she forgot what was said a few lines earlier. I decided the wife was the patient. by guest on September 11, 2014 soc.sagepub.com Downloaded from 68Sociology 47(1)The Puzzling AD Case 5268 After making presentations to the UCB psychophysiology laboratory and a seminar at the Memory and Aging Center at UCSF, I was told I had misdiagnosed one of the two AD cases. I was not surprised; the videotapes of the AD cases proved difficult. I subse-quently returned to the tape I suspected was the problem case for an additional review. The case alerted me to a problem about which I needed reminding: non-verbal and emo-tional displays and the word-by-word analysis of the videotape require repeated (neces-sarily filtered) representational re-descriptions of what are presented as data. I asked myself: What knowledge about antecedent ethnographic conditions would be helpful to the research analyst before beginning her or his analysis? The conceptual/methodologi-cal issue is how do analysts decide intuitively and factually what elements are indicative ofbringingintoexistenceadefiningorexplanatoryframeofreference(toparaphrase KahnemanandMiller,1986).Theproblemofbehavioralindicativeelementsisalso paramount for the families or caregivers who must decide when a referral to a physician appears necessary, and is also a deep concern of clinicians during their initial interaction with caregivers and interviews with patients.Initially,Iassumedthewifewasthepatient;herappearanceseemedsomewhat disheveled for someone who appeared to being in her fifties and at a formally arranged session in a university laboratory. Her glasses were sitting on the lower part of her nose, and her hair seemed un-combed. The husband appeared to be well groomed, and his face seemed to be somewhat fixed, with an occasional smile, but no laughter.The wife appeared to initiate the conversation, but the husband intervened immedi-ately, yet he seemed odd to me because of his serious facial expression, lack of anima-tion,andrigid,controlled,directmanner.Thewifesvoiceappearedclearand moderatelyanimatedwithappropriateprosody.Ibeganthinkingthehusbandwasthe patient,yetthehusbandwasactiveintheconversation. Thediagnosisof ADforthe husbandappearednottobesubstantiated.Thehusbandseemedquitearticulatein expressinghisviewsaboutreligion,yetsomeviewersmightsuggestthatthehusband seemed to be somewhat dogmatic about his religious views. On the other hand, his views could also be based on prior, well-rehearsed discourse known to the wife.As the discourse continued, the wife, unsurprisingly, seemed to know the husbands previous views on religion. She wanted the husband to address his religious beliefs. The initial exchange follows.Excerpt 22 Case 52681H: Hi2W: You are hi and where (laugh)3H: Would you like to start or would you want me to?4W: Oh, you can start.5H: Yes. Why do you always want me to go to /church?In lines 15, the husband initiates the conversation and refers to a viable topic: Why do you always want me to go to church? The question presupposes the topic of going to church was a source of past conflict. by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel69Excerpt 23 Case 52686W: /ok. Oh because I 7I felt like you are not giving yourself a chance. You dont know as far as,8I dont understand why you dont want to try to go to church.9It is almost like maybe you are afraid to go, but 10I just dont understand it even if just even if you went 11I mean, of course I like you [to] go with me a lot more but just12give it a chance.13H: But you already know my views on it. Right?14W: Mm. I want to hear them again.In lines 614, the wife begins with several false starts and finally (lines 910) uses the deictic term it (line 12) and the metaphor give it a chance to refer back to line 8 (try togotochurch). Thewifesremarksseemedconfusing.Iviewedherdifficultyin topicalizing the source of conflict, coupled with my initial perception of her appear-ance,asindicativethatthewifewasthepatient.Thehusbandseemedimpeccably groomed and his opening remark seemed articulate. The wifes remarks in lines 913, however, revealed a moderate ability to first frame, and pursue the husbands reluctance to attend church with her. The wife suggests he is afraid to go, and sounds frustrated withthisreluctance. Thewifesremarkscouldbeviewedasscaffoldinginorderto motivate the husband to address an apparently long-term, contentious issue in their mar-riage. The husband (line 13) insists his wife already knows his views. The wife, how-ever, insists the husband tell his views again.Excerpt 24 Case 526815H: You know I dont believe in religion. It doesnt mean that I dont believe in God.16It just that I dont believe in religion. I think there/17W: /So you do believe in18god?19H: Of course I do.20W: Ok.Inlines1520,thehusbanddisplaysaclearself-conceptionofhisreligiousviews,and states It doesnt mean that I dont believe in god. He reiterates this view in line 19. The husband did not appear to be the patient; his speech acts appear to reveal a strong sense of self-awareness about his dislike of organized religion. The wifes interrogation appeared deliberate and suggests an equally strong sense of self. Husband and wife seemed obsessed with their conflict over religion and church attendance. The case appeared confusing.Thewifeappearstouseasubtlebutorganizedformofadultmotherese.Isthisa strategy to entice the husband to speak about his views and perhaps satisfy the request ofthelabteam?Thehusbandspreoccupationwithhisdescriptionoftheevilsof organized religion is difficult to assess given the paucity of ethnographic observation and only a 10-minute, staged speech event. by guest on September 11, 2014 soc.sagepub.com Downloaded from 70Sociology 47(1)Afterre-examiningthevideotapesofCase5268,anddespitefindingbothnegative and supportive evidence for perceiving the woman and her husband alternatively as the patient or as normal, I decided the husband was probably the patient.Discussion The article attempts to build on and extend the innovative research of scholars who have focused on developmental issues by applying some of their insights to social interaction amongtheaged. Theanalysisofthesixcasessoughttoidentifyanddocumentsocio-cultural scaffolding practices necessary for understanding the emergence and stability of a social self, and coping with the decline of human communal life among the elderly.The empirical materials presented above are a modest beginning. Current research by the author explores the diagnostic process, including the role of bureaucratic constraints faced by the neurology clinic with their patients, and then obtains audio and videotapes of the patients in their home environments.Making diagnostic inferences using videotapes of staged 10-minute discourse ses-sionsaboutanelicitedproblemthatspouseshadexperiencedappearedtobeself-evident for the two controlled cases and two FTD patients, but daunting in the analysis of one AD patient. I attribute my diagnostic difficulty to not having access to more than 10 minutes of discourse given that the two cases were diagnosed as early onset AD. For example, the wife of the misdiagnosed case was 59 years old at the time of the session whilethefirstcaseof ADwas60yearsold.Ibelieve30minutesofopendiscourse between the misdiagnosed AD case and her husband would have suggested the wife was the patient.The empirical data suggest social research methods can contribute to our understand-ing of human development and decline. Further, that normal, sustained social interac-tion is the hallmark of socially organized, normatively constrained social structures. The patients revealed both fairly self-evident and subtle problems for maintaining expected normal presentations of a social self during social interaction.Sociological studies of local social interaction in which patients and others engage in problem solving and social exchanges can help caregivers and clinicians understand the significanceofroutineandcomplexdailylifeactivitiesfordiagnosingearlysignsof socio-cultural-cognitivedeterioration,andconditionswhichledthespouseorfamily members to consult health care professionals. The early observations and inferences of familymembers,friends,neighbors,andworkcolleaguesremainclinicalempirical issues, and are difficult to document. Within clinical settings, such data are seldom trans-parent and their discourse properties are seldom self-evident.Theauthorscurrentresearchexplorestheinitialclinicaldiagnosticprocessand asks: How do health care personnel obtain evidence about when, with whom, and to what extent patients with signs of dementia begin to exhibit aberrations or alterations in their behavior with others? When do patients show signs of having difficulty engag-inginroutineandabstracttasks,re-conceptualizingmemoriesofpastevents,and coping with everyday social interaction? Recorded home visits are being pursued to obtainindependentevidenceondailylifecommunicationskillsandproblem solving. by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel71The modest corpus of data examined above underscores the relevance of necessary moment-to-moment communicational skills ubiquitously present in local communal liv-ing, including the useful staged 10-minute exchanges presented above. The data iden-tify aspects of appropriate and inappropriate communication skills among the couples studied and reveal aspects of the normative expectations participants expect if they are to perceivesociallyorganizedactivitiesaslifeasusualornormalorunexpectedor inappropriate displays of social interaction. The results support the hypothesized differ-ences in social interaction among spousal couples diagnosed as normal in contrast to coupleswhereonespousehasbeendiagnosedwitheitherAlzheimersDiseaseor FrontotemporalDementia.Normativelyexpectedsocialdiscourse,therefore,proved useful in distinguishing communicational differences among normal couples and those in which one patient was diagnosed with dementia.AcknowledgementI am grateful to Bruce Miller, Director, Memory and Aging Center, University of California, San Francisco, and Robert Levenson, Director, Psychophysiology Laboratory, University of California, Berkeley,forallowingmetousetheirdata.Theresearchreportedbelowcouldnothavebeen undertakenandcompletedwithouttheiressentialsupport.RoyDAndrade,TroyDuster,and Howard Schwartz provided useful suggestions for revising the manuscript.FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.ReferencesBassoK(1984)Stalkingwithstories:Names,places,andmoralnarrativesamongtheWestern Apache.In:BrunerEMandPlattnerS(eds)Text,Play,andStory:TheConstructionand Reconstruction of Self and Society. 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Cambridge, MA: Harvard University Press.Aaron V Cicourel is Research Professor Emeritus of Cognitive Science, Pediatrics, and Sociology at the University of California, San Diego; Professor Emeritus at the University by guest on September 11, 2014 soc.sagepub.com Downloaded from Cicourel73ofCalifornia,SanFrancisco,andVisitingScholarattheUniversityofCalifornia, Berkeley(InstitutefortheStudyofSocietalIssues).Hiscurrentresearchactivities includethestudyoffamilialandinstitutionalsocio-culturalcaregiverpractices(scaf-folding)byindividualsandgroupscaringforpatientsdiagnosedwithAlzheimers Disease,SemanticDementia,andFrontotemporalDementia(Cicourel,2010).Anew project was completed recently on the diagnostic processes of a neurological clinic with new patients suspected of being afflicted with dementia.Date submitted June 2011Date accepted March 2012