Tag Archives: BIoarchaeology of Care

Publication of New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory

28 Oct

As I have recently discussed on a blog post about recently published or forthcoming bioarchaeology books, I too have had a book chapter published in a new edited volume for the Bioarchaeology and Social Theory series, as produced by Springer.  The volume is titled New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory (£82.00 hardback or £64.99 ebook) and it is edited by Lorna Tilley and Alecia A. Shrenk.  The volume presents new research regarding the bioarchaeological evidence for care-provision in the archaeological record.  Using the associated Index of Care online tool, bioarchaeological researchers can utilize the four-stage case study approach to analyze and evaluate the evidence for care-provision for individuals in the archaeological record who display severe physical impairment likely to result in a life-limiting disability, or to result in a sustained debilitating condition which limits involvement in normal, everyday activities.  (For further information see a full book description below).

In short, my chapter investigates the public reception and engagement of the bioarchaeology of care theory and methodology as proposed by Lorna Tilley in a slew of recent publications (see bibliography).  As an inherent part of this the chapter discusses the ethical dimensions within the approach used for analyzing physically impaired individuals in the archaeological record, and the potential evidence of care-provision as seen on the osteological remains of the individual and contextual archaeological information.  Proceeding this is a walk-through of traditional and digital media formats, presented to provide a contextual background for the communication of the theory and methodology which is subsequently followed by two bioarchaeology of care case studies, Man Bac 9 from Neolithic Vietnam and Romito 2 from Upper Palaeolithic Italy, which help to summarize the public perception and importance of the research conducted to date within this new area of investigation and analysis.  In the conclusion best practice advice is provided for researchers conducting education outreach with regards to publicizing the bioarchaeology of care research and its results via both traditional and digital media formats.

The following information is taken from the Springer press release (and is used with the permission of Lorna Tilley) regarding the volume, both its aims and its content:

Book Overview

Only in the last five years has the topic of health-related care found acceptance as legitimate subject matter for archaeology.  In 2011, a case study-based ‘bioarchaeology of care’, designed to provide a framework for identifying, analysing and interpreting evidence for likely disability and associated care response, was proposed; the approach generated academic and wider public interest, and from this time on it has continued to evolve as bioarchaeologists apply it to cases of likely caregiving and broader theoretical questions of care provision within their areas of specialisation.’

New Developments in the Bioarchaeology of Care: Further Case Studies and Extended Theory 

The volume ‘marks an important milestone in this evolutionary process.  Its origins lie in a symposium entitled ‘Building a Bioarchaeology of Care’, held during the Society for American Archaeology 2015 annual meeting, which brought together an international, cross-disciplinary group of scholars to explore this theme.  This book contains 19 chapters, most based on symposium presentations, the first substantive chapter providing an overview of the bioarchaeology of care methodology and last situating the bioarchaeology of care approach, and the chapters in this book in particular, within the discipline of bioarchaeology more generally.  The 16 chapters that comprise the core of this volume offer content which is always original, often methodologically innovative, and frequently challenging, and are organised under three headings.

In the first section, Case studies: applying and adapting the bioarchaeology of care methodology, Chapters 2-9 focus primarily on the care given to one or more individuals who experienced (variously) a congenital disorder, acquired disease, accidental or intentional injury and who date to prehistory (Bronze Age, United Arab Emirates), through later Pre-Columbian (southern United Sates and Peru) and Mediaeval periods (United Kingdom and Poland), to relatively modern times (late 18th century London).  These chapters also contribute to bioarchaeology of care theory, however, because each one, in some way, has implications for how we conceptualise past caregiving or for how we might improve current research methods.


The volume cover piece, published as a part of the Bioarchaeology and Social Theory series by Springer. The paperback version will be released at some point in the near future, but it is available now as a hardback and as an ebook. Image credit: Lorna Tilley/Springer.

In the second section, New directions for bioarchaeology of care research, Chapters 10-16 explore alternative perspectives for illuminating past health related care behaviours.  Respectively, they address the scope for applying the bioarchaeology of care methodology to mummified remains; the potential for research into past caregiving to focus on demographic sectors of the population which are often overlooked – specifically children and the aged; the prospects for acknowledging psychological, spiritual and/or emotional forms of support in bioarchaeology of care studies; the modification of the bioarchaeology of care model to allow an assessment of institutional healthcare efficacy at both an individual and a population level; the development of a biocultural model for examining the origins of health-related caregiving; and the potential relevance for bioarchaeology of care studies of an online application supporting research into clinical and social implications of living with disease.

In the third section, Ethics and accountability in the bioarchaeology of care, Chapter 17 interrogates the principles, assumptions, values and beliefs that are likely to influence carriage of bioarchaeology of care research, and Chapter 18 considers ethical responsibilities involved in communicating bioarchaeology of care research findings in the public domain, and discusses some practical ideas for information-sharing.’

The volume isn’t cheap by any stretch of the imagination, so if you are a student or a researcher interested in this topic I highly recommend that you advise your university or institution library to order a copy.  If you are a member of the public I recommend again that you use your local library and order a copy in or use the inter-library loan system in order to source a copy of the volume.  Alternatively individual authors of the chapters may upload their sections of the volume to their own respective academic social media websites, such as on ResearchGate or Academia.edu, if they have a profile.  For instance you can read my chapter here.  It also always worth emailing the researcher in question if you are interested in accessing their work and are unable to locate the writing online.  From a quick internet search it seems Google Books also has the book scanned and it is partially available here.

Further Information

  • The online non-prescriptive tool entitled the Index of Care, produced by Tony Cameron and Lorna Tilley, can be found at its own dedicated website.  The four stage walk-through is designed to prompt the user to document and contextualize the appropriate archaeological and bioarchaeological data and evidence in producing the construction a ‘bioarchaeology of care’ model.
  • Kristina Killgrove has, in her Forbes bioarchaeology reportage, recently discussed one of the chapter case studies of a Polish Medieval female individual whose remains indicate that she had gigantism, or acromegaly.  Check out the post here.
  • My 2013 These Bones of Mine interview with Lorna Tilley, of the Australian National University, can be found here.  The interview discusses the origin of the bioarchaeology of care and the accompanying Index of Care tool and the surrounding issues regarding the identification of care-provision in the archaeological record.

Bibliography & Further Reading

Killgrove, K. 2016. Skeleton Of Medieval Giantess Unearthed From Polish Cemetery. Forbes. Published online 19th October 2016. Available at http://www.forbes.com/sites/kristinakillgrove/2016/10/19/skeleton-of-medieval-giantess-unearthed-from-polish-cemetery/#476236b6413b. [Accessed 28th October 2016]. (Open Access).

Mennear, D. J. 2016. Highlighting the Importance of the Past: Public Engagement and Bioarchaeology of Care Research. In: L. Tilley & A. A. Shrenk, eds. New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory. Zurich: Springer International Publishing. 343-364. (Open Access).

Tilley, L. & Oxenham, M. F. 2011. Survival against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.

Tilley, L. & Cameron, T. 2014. Introducing the Index of Care: A Web-Based Application Supporting Archaeological Research into Health-Related Care. International Journal of Palaeopathology. 6: 5-9.

Tilley, L. 2015. Theory and Practice in the Bioarchaeology of Care. Zurich: Springer International Publishing.

Tilley, L. 2015. Accommodation Difference in the Prehistoric past: Revisiting the Case of Romito 2 from a Bioarchaeology of Care PerspectiveInternational Journal of Palaeopathology. 8: 64-74.

Tilley, L. & Shrenk, A. A., eds. 2016. New Developments in the Bioarchaeology of Care: Further Case Studies and Expanded Theory. Zurich: Springer International Publishing.

Brief Updates: A Possible Publishing Rule of Thumb, Socio-Sexual Lives in Bioarchaeology & Memories of Fractures

8 Aug

I’ve been thinking a bit recently about the power of the written word, and of the associations with both personal jottings and more wider ranging long form pieces such as academic text books or investigative journalism.  Partly this has been guided by the growing number of books on my bedside, but also by a personal milestone in the publication of a bioarchaeology chapter by yours truly.  I’ll try not to mention this too much but it has been, and it will be, the realisation of a dream of mine to become a published author and particularly so in a topic that is close to my professional and personal interests.  But more on that below.


Two of the texts discussed in this entry below are Ann Oakley’s part memoir and part sociology study in Fracture: Adventures of a Broken Body and Pamela Geller’s research into socio-sexual lives in the archaeological record, which investigates past human sexuality.

Publishing: The Invisible Researchers

The term Publish or perish is a popular and well-known academic phrase that highlights the fact that research that isn’t published appropriately, or in a relatively timely manner, can easily become lost to the archives and the relevancy of the researcher to their discipline to disappear.  Any academic employed at an educational institute and conducting research will likely regularly produce articles, chapters, and books as appropriate, and actively take part in conferences giving papers or leading workshops to disseminate and communicate knowledge.  This is a normal part of the workload (heavy though that can be) of a research position.

Whether that phrase is helpful or stressful depends on the context – rushed research can lead to false or doctored evidence and the increased pressure to publish, along with the normal duties of lecturing, likely being a course or module tutor, and the administration accompanying such positions, can indeed lead to a hefty work load.  My interest in this though is the invisible researchers who are not employed within academia but are located on the fringes, those such as myself who work full-time in other sectors and publish and research in our own free time.  This blog is a prime example of that, but also of the mixing of the boundaries between the personal and the academic which would not normally be found within journals or published volumes.  Rather this is space to inform, educate, and communicate the interests and experiences of the individual.  The published work, of which I have only a few examples currently with more emphasis currently on specialist reports, requires a change of tone and, often, of approach.

Publishing Date Rule of Thumb?

I’ve also recognised a relatively reliable rule of thumb for academic book publishing.  For instance, I’ve been eagerly awaiting the publication of my own chapter within an edited volume titled New Developments in the Bioarchaeology of Care: Further Case Studies and Theory, to be published as a part of Springer’s Bioarchaeology and Social Theory series.  The edited volume builds upon Lorna Tilley’s 2015 Theory and Practice in the Bioarchaeology of Care publication in identifying and interpreting cases of care provision in prehistory through osteological and contextual analysis, and by furthering the theoretical framework.  It is exciting to a part of such a volume as a result of the SAA session in 2015 and I’m keen to hold a copy of the finished work and to read the other authors contributions.  I’m also intrigued by the reception that the volume will hopefully receive and the criticism too, with the opportunity to learn from others in the field of bioarchaeology.

But the rule of thumb!  Springer obviously mentions their forthcoming volumes on their site as do other commercial online retailers, however I’ve noticed they tend not to add a specific date for publication whereas some retailers, such as Amazon, do under the title release date (1).  This is useful to know as the publishing date tends to change depending on when the individual chapter and volume editing and proof-reading tasks have been completed, and as to when the publishing production units can start to print.  In my case I’ve noticed the dates shift around a few times due to various factors but I’ve always known when roughly publication and release date should be, sometimes ahead of emails from the volume editors.  Of course this won’t really be a rule of thumb until the volume is published and collaborates my theory, but you can expect another blog post then!  If you have noticed the same trend please let me know below.

Socio-Sexual Lives In Bioarchaeology

Through serendipity I happened to come across Pamela Geller’s 2016 book The Bioarchaeology of Socio-Sexual Lives: Queering Common Sense About Sex, Gender, and Sexuality, published in the same Bioarchaeology and Social Theory series by the above and due for release shortly.  I am very tempted to order a copy of this volume as it seems to challenge the binary orthodoxy of sexuality and identity so prevalent within bioarchaeological analysis of past individuals and populations.  That is an interrogation of the assumption of stability with regards to the values of hetero-normative relations within today’s Western world that is so often projected onto past populations and cultures.

The wide range of cultural case studies and the deep chronological scope of the volume also promises to make it be an invigorating and exciting read.  As with the Bioarchaeology of Care publication, this volume probes the archaeological record into areas of research that have rarely been investigated in-depth, thus potentially opening up the record to a far greater scrutiny of the lived experience of sexual identity and gender.  As such, it is very much on my bioarchaeological books to read next list (you know, after I’ve read this other pile of books by my bedside table!).  It isn’t very often that I purchase bioarchaeology volumes as they can be quite expensive if they are not available in paperback or second-hand (2), but I’ll think I’ll make a change for this volume.  If I do I’ll be sure to write-up an entry for the blog.

Memories of Fractures

And so to bring this post to a timely conclusion I return to my opening paragraph.  One of my favourite books that I’ve had the pleasure of reading within the past few years remains the sociologist Ann Oakley’s (2007) Fracture: Adventures of a Broken Body, an essay on the impact of the author’s traumatically fractured humerus that covers much ground within a relatively slim volume.  I largely adore this book because it is so relatable and so readable, the descriptions of the personal and professional impact of her fracture is something that I can very much sympathize and empathize with.  However the strength is also the breadth of the book, through the historical, medical and sociological musings on the frailty, health and image of the human body and entwined identity.  This volume then represents a fine mix of the personal and the academic, never afraid to speak freely on the issues and challenges that face society in accepting the differences in human form and the obstacles.

The Great Questions of Bioarchaeological Research

To me then bioarchaeology and its associated disciplines offers the chance to investigate on a fundamental level one of the central facets of our existence; what does it mean to be human? How is this represented and approached in the archaeological record?  How were individuals treated within their respective populations, and what were the lived experiences of these populations and individuals like?  The ability to answer some of these questions, in part at least, endlessly fascinates me.  Some of the publications named above aim to answer these questions and may do just that.


(1).  I have just rechecked this and sadly my thumb of thumb can seemingly be thrown out of the window.  It appears that Amazon does seem to have a better rough date for volumes in preparation, but that by the final month or so within publishing and release date Springer also update their website.

(2).  Joining local or university libraries, where possible, can be great to order books in or to borrow books that are otherwise un-affordable or rare to find.  I generally only purchase bioarchaeology manuals that can be used in osteological analysis or are otherwise handy reference books, but otherwise some books can make great presents!


Geller, P. L. 2016. The Bioarchaeology of Socio-Sexual Lives: Queering Common Sense About Sex, Gender and Sexuality. New York: Springer.

Oakley, A. 2007. Fracture: Adventures of a Broken Body. Bristol: Policy Press.

Tilley, L. 2015. Theory and Practice in the Bioarchaeology of Care. New York: Springer.

Interview with Lorna Tilley: The ‘Bioarchaeology of Care’ Methodology

10 Sep

Lorna Tilley has just completed her PhD studies in the School of Archaeology and Anthropology at the Australian National University in Canberra.  Her PhD thesis focused on the behavioral and social responses to the individual experience of disability in prehistoric communities.  Lorna has developed a methodology titled the ‘bioarchaeology of care’ that contextualises, identifies and interprets care-giving in the archaeological record.  Lorna can be contacted at lorna.tilley@anu.edu.au.

These Bones of Mine: Hello Lorna and welcome to These Bones of Mine! Firstly could you tell us a little about yourself and your research interests? 

Lorna Tilley: Hello David – and thanks for having me.

I’m a latecomer to archaeology.  Ten years ago I decided I needed a change in life direction, so I returned to university to  indulge a long-held passion for prehistory.  I studied for a Graduate Diploma in Archaeology at the Australian National University (this was a ‘bridging course’ for people with qualifications in another field), and was then awarded a scholarship to undertake the PhD research which resulted in the bioarchaeology of care approach.

Stepping back, my first degree (1981) was in behavioural and social psychology – in other words, a focus on the study of human behaviour in the present, which from the very beginning provided an invaluable perspective for addressing questions about behaviour in the past – because, for me, archaeology is fundamentally about understanding people and their agency.  My background in psychology made a major contribution to constructing the conceptual foundations for the bioarchaeology of care.

I’ve had the usual range of mundane to exotic jobs, all of which are part of the life history I bring to interpreting evidence from the past.  But it’s my work in the healthcare sector that’s most immediately relevant to my archaeological research into the implications of healthcare provision in prehistory.

For example, after leaving school and through part of my first go at university I did quite a bit of nursing – in public and private hospitals and in nursing homes, including work in general nursing, care of the intellectually disabled, rehabilitation and aged care.  While I didn’t go on to qualify as a registered nurse, this hands-on experience clearly helped to inform development of aspects of the bioarchaeology of care methodology.

I’ve also helped develop public health policies and programs, and for almost a decade before beginning archaeological studies my job included advising on, monitoring and disseminating research on health outcomes assessment and health status measurement. All this fed into my work in developing a bioarchaeology of care methodology that, while qualitative and – inevitably – restricted to individual cases of care-giving, nonetheless provides a level of standardisation that allows review and replication by others.

My PhD thesis is titled Towards a Bioarchaeology of Care: A contextualised approach for identifying and interpreting health-related care provision in prehistory, so it’s fairly obvious where my research focus lies – the provision and receipt of health-related care in prehistory, and what such instances of care can reveal about both the community in which care occurred and the agency and identity of those involved in the care-giving relationship.

Being insatiably curious, however, my interests are even wider – any evidence of superficially anomalous behaviour in the past grabs my attention.  Why did the people of this community make pots in this way rather than that?  Why are people in one cemetery buried in seemingly random orientations and positions, when people in a contemporary neighbouring cemetery are all buried supine, extended and with heads to the east?  Why are stone tools found in a certain site made from materials sourced over a hundred miles away, when there is perfectly serviceable stone available in the immediate vicinity?  And so on.

TBOM: Could you explain your methodology, the ‘bioarchaeology of care’, and a bit of background as to why you thought it was necessary to produce such a method?

Lorna: Firstly, the methodology itself.  I won’t go into a lot of detail here (this would take pages), but for readers wanting more I’m attaching the text version of an invited article describing the bioarchaeology of care approach for the theme issue ‘New Directions in Bioarchaeology’, published in the Society of American Archaeologists’ journal The Archaeological Record, May 2012

In brief, the bioarchaeology of care is an original, fully-theorised and contextualised case study-based approach for identifying and interpreting disability and health-related care practices within their corresponding lifeways.  Its goal is to reveal elements of past social relations, socioeconomic organisation and group and individual identity which might otherwise slip below the radar.  And that would be our loss.

Before describing the applied methodology, some scene-setting is necessary.

In archaeology, the experience of pathology during life may be expressed in human remains through anomalies in either bone or preserved soft tissue.  Health-related care provision is inferred from physical evidence that an individual survived with, or recovered from, a disease or injury likely to have resulted in serious disability.

Following from this, I define ‘care’ as the provision of assistance to an individual experiencing pathology who would otherwise have been unlikely to survive to achieved age-of-death.  This care-giving may have taken the form of ‘direct support’ (such as nursing, physical therapy, provisioning) or ‘accommodation of difference’ (such as strategies to enable participation in social and economic activity) or a mixture of both.

I use the term ‘disability’ in the same way as the World Health Organisation – to refer to a state (temporary or longer-term) arising from an impairment in body function or structure that is associated with activity limitations and/or participation restrictions, and – very importantly – given meaning in relation to the lifeways in which it is experienced.

The central principle driving the bioarchaeology of care approach is that caring for a person with a health-related disability is a conscious, purposive interaction involving caregiver(s) and care-recipient(s).  Care is not a default behaviour – care giving and care-receiving constitute expressions of agency.

Neither does care take place in a void – understanding the context of care provision is absolutely essential in trying to understand (i) what constitutes ‘health’, ‘disease’ and ‘disability’ in the first place; (ii) the options available for care and the options selected; and (iii) what the likely choices made in relation to care reveal about the players involved.  If we can deconstruct the evidence for care within this framework, then we may be able to achieve some insights into aspects of culture, values, skills, knowledge and access to resources of the society in which care-giving occurred.  And if we can draw out some understanding of how the person at the receiving end of the care equation responded to their experience of disability we can even, perhaps, achieve some feel for aspects of this individual’s identity.

If you think this sounds deceptively easy, you’re right.  There are important caveats, and some of these are identified in the attached article.

The bioarchaeology of care methodology comprises four stages of analysis: description and diagnosis; establishing disability impact and determining the case for care; deriving a ‘model of care’; and interpreting the broader implications of care given.  Each stage builds on the contents of preceding ones.

Stage 1 is triggered by human remains showing evidence of living with, or following, a serious pathology.  It records every aspect of the remains, the pathology, and the contemporary lifeways.

Stage 2 considers the likely clinical and functional impacts of the pathology on the subject.  Modern clinical sources are used to consider likely clinical impacts.  This is legitimate because human biology is a constant; tuberculosis, for example, would elicit the same potential range of physiological responses in the past and present (it’s important to remember that each individual with this disease will respond in their own way, and that we can never recover this level of individual detail).

Estimating functional impacts involves considering likely demands, obstacles and opportunities in the contemporary lifeways environment, and evaluating the probable effects of clinical symptoms on the subject’s ability to cope with these.  For example, could the individual have carried out the most basic tasks necessary for personal survival – such as feeding or toileting themselves – often referred to as ‘activities of daily living’?  Or an individual may have been independent in this regard, but could they have fulfilled all the requirements of a ‘normal’ role (whatever that might have been for someone of their demographic) in their community?

The second stage establishes whether, on balance of probability, the individual experienced a disability requiring either ‘direct support’ or ‘accommodation’.  If the answer is ‘yes’, then we infer care.

Stage 3 identifies what – in broad terms – this care likely comprised, producing a ‘model of care’ within the parameters of the possible and the probable in the contemporary context.  The fine details of care will always be inaccessible, but basic practices – such as provisioning, staunching bleeding, massage and manipulation – don’t change.  Sometimes there may be evidence of treatment intervention in the remains themselves, but most often the practical components of treatment will be deduced from knowledge of the likely clinical and functional impacts.

Stage 4 unpacks and interprets the model of care developed over the first three stages.  It explores what the constituent elements of care-giving – singly or in combination – suggest both about contemporary social practice and social relations and about group and individual (care-recipient) identity.

I’ve presented the case of the Burial 9 (M9) so frequently over the last few years that I almost feel I know him personally – M9 was the young man from Neolithic Vietnam who lived for around a decade with total lower body paralysis and limited upper limb mobility following complications of a congenital condition (Klippel-Feil Syndrome).  His survival with (partial) quadriplegia for approximately 10 years, under very physically and psychologically challenging conditions, provides an indisputable example of past health-related care. There is simply no way that he could have survived without constant and often intensive care provision.

In the graphic that follows I’ve mapped the analysis of M9’s experience against the four stages of the bioarchaeology of care methodology described above.  More detailed information can be found in ‘Tilley, L. and Oxenham, M.F.  2011  Survival against the odds: modeling the social implications of care provision to seriously disabled individuals.  International Journal of Paleopathology 1:35-42.’ (anyone having difficulty obtaining the article can email me).


Source: Tilley (2013: 3).

You also asked me why I thought it necessary to develop the bioarchaeology of care approach.

Researching my thesis I found at least 35 publications, dating back over more than 30 years, that explicitly identify the ‘likelihood of care provision’ in respect of archaeologically-recovered individuals.  But none has analysed the evidence for care in a structured, systematic manner capable of providing access to the sort of information illustrated in the case study of M9.  It was obvious to me – particularly given my pre-archaeology experience – that a very rich source of information was being overlooked.  True, the bioarchaeology of care only allows us to look at individual instances of care-giving (this is elaborated in the attached article) – but this case study focus provides a very intimate look at broader aspects of past lifeways.  Not quantity, perhaps, but quality.

TBOM: Are there any boundaries as to when the ‘bioarchaeology of care’ model can and can’t be applied to individuals in the archaeological record?  Could you apply it to historic and prehistoric contexts, or is it mainly a tool for prehistoric cultures and periods?

Lorna: In developing the bioarchaeology of care I concentrated exclusively on evidence for health-related care-giving in small groups up to, and around, the period of the ‘early Neolithic’ – in other words, the time before the establishment of larger, more socially and economically complex, settlements.  This was entirely pragmatic – to make my task simpler, I wanted to deal with lifeways contexts in which it would be justifiable to assume that an individual with a disability would likely be known to all community members, and where it would also be justifiable to assume that, if care provision entailed substantial cost, that cost was likely to have been an impost born by the group as a whole.  This made it easier to figure out how analysis and interpretation might work.

I don’t see any reason why the bioarchaeology of care couldn’t be applied to later prehistoric and even historic settings – and actually, I’d love to do this.  It would obviously involve looking at some additional and/or different questions – for example, how might individual status within the group be related to need for, and receipt of, care?  What happens to care-giving when healthcare provision is outsourced to ‘specialist’ carers?  And how do documented approaches to healthcare (particularly in early historic periods) tally with what the archaeological evidence suggests?  Exploring such questions will be a lot more complicated than I’ve made it sound here.  But how challenging to look for possible answers!

TBOM: As stated in your 2011 article in the International Journal of Palaeopathology, the ‘bioarchaeology of care’ models the social implications of disability for the impact on not just the individual afflicted but the society as a whole, why is that such an important part of the model?

Lorna: I hope that I’ve already answered this question – at least implicitly – in what I’ve written above.  Perhaps it would be acceptable to limit bioarchaeology of care analysis to teasing out the impact of disability on the individual alone, but it would only be part of the story – and it seems to me that to stop at this point would be a criminal waste of the sparse evidence we have about  past lives and lifeways.

I think it’s quite possible that some archaeologists dealing with evidence of likely care-giving may have to stop at Stage 3 of the methodology, because not enough is known about the social, cultural and physical environment in which care was provided to enable an attempt at further interpretation.  That’s fair enough.  However, I also think that some researchers may be so uncomfortable in attempting the interpretive analysis demanded in Stage 4 that they’ll decline to do so, on the grounds that such analysis is merely ‘speculation’.  I think that’s a shame.

I don’t think there’s ever 100% certainty in archaeological interpretation. But what matters is that we approach the task of interpretation systematically, rigorously and transparently, presenting arguments in such a way that others can follow the steps taken and, where appropriate, challenge both the evidence and the reading of the evidence – refining and even recasting conclusions reached.

Even putting forward possibilities later shown to be improbable opens our minds to considering a broader vision of the past.  This sounds a bit abstract, I know – but I’d invite readers to return to the graphic summarising the bioarchaeology of care analysis of M9’s experience.  M9 comes from the Man Bac community.  Before the bioarchaeology of care analysis we knew quite a lot about how this group lived in general terms – their diet, economy, demography and mortuary customs.  But we didn’t know anything about who they were – and now I think we do.  I think the bioarchaeology of care analysis revealing the agency of caregiving can pay rich dividends.

Man Bac Burial 9 in situ

An in-situ photograph from the early Vietnamese Neolithic site of Man Bac displaying the individual known as M9 immediately before removal. Man Bac burials were typically supine and extended, but M9 was buried in a flexed position – this may reflect muscle contracture experienced in life and unbroken in death, or a deliberate mark of difference in mortuary treatment. M9’s gracile limbs show extreme disuse atrophy, a product of quadriplegia resulting from complications of Klippel-Feil Syndrome (Tilley & Oxenham 2011: 37).

TBOM: Dettwyler, in her 1991 article ‘Can palaeopathology provide evidence for compassion?’, questioned the assumptions underlying the inferences of archaeologists and human osteologists, and famously stated “what, then, can we learn of compassion from a study of bones and artifacts?” The answer must be, “practically nothing”.  How does your own methodology change or challenge this view?

Lorna: While it’s true that the title of Katherine Dettwyler’s article is ‘Can paleopathology provide evidence for compassion?’, the real argument in this article is that archaeology can tell nothing meaningful about individual experience of disability in its entirety.  The author questions whether archaeological evidence for disease can be used to infer a disability requiring care in the first place, and uses ethnographic analogy to support this position.  I’ve probably said enough about the bioarchaeology of care approach to make it clear how strongly I oppose this view.

While I greatly admire Dettwyler’s passionate support for the modern disability rights agenda – which I see as the sub-text of her writing – I disagree with almost every point she makes in her article about archaeology’s (lack of) ability to identify care and compassion in the past.  I’ll just make a couple of general observations here.

I think one of the most fundamental problems with this paper is that it doesn’t provide clear definitions of concepts central to its argument.  Disability (or ‘handicap’, a more commonly used term twenty years ago) is referred to as a purely social construct throughout, and this allows the proposition that what constituted disability in prehistory must forever be unknowable because the social values that determined disability are inaccessible through archaeological analysis.  But this ignores the reality of the at least partially ‘knowable’ clinical and functional impacts that people with health-related disabilities also have to manage in their lives.  Discerning social disadvantage may be problematic, although arguably not always completely impossible, but – as demonstrated by the bioarchaeology of care methodology – given adequate contextual information it’s possible to identify some of the likely barriers to participation in cultural, economic and physical activities that required a care-giving response.

The paper also conflates ‘care-giving’, which is a behaviour, and ‘compassion’, which is a motivation, and fails to define either.  This is of significant concern, because these terms have very different meanings.  It is undeniably easier to infer the likely provision of care-giving from physical evidence in human remains than it is to identify the motivation(s) underlying this care, which are always going to be multiple and messy – because this is simply how life is.  I believe that this semantic confusion, allied with a lack of consideration of the clinical and functional implications of disease, invalidates both the five ‘implicit assumptions’ presented by the author as underlying archaeological interpretations of disability and the paper’s criticisms of the three studies (Shanidar 1, Romito 2 and the Windover Boy) used to illustrate supposed deficiencies in archaeological claims for care.

Katherine Dettwyler’s 1991 article has had a powerful negative influence on archaeological research into health-related care-giving, and it’s widely cited in explaining why such research is ‘impossible’.

I think the bioarchaeology of care approach shows the exact opposite – not only is research into past care-giving eminently possible, but in terms of getting an insight into complex, interpersonal dynamics operating in prehistory it’s potentially one of the most rewarding areas of focus available.

TBOM: Having now completed your PhD study at the Australian National University, what is the next step for yourself and your research?  Are you continuing projects in South East Asia, with on-going excavations in Vietnam?

Lorna: I’ve got a couple of projects in mind.

Firstly, I’m hoping to turn ‘Towards a bioarchaeology of care’ into a book.  There’s already been some interest in my dissertation from (bio)archaeologists as well as from researchers in other disciplines, so I’m hoping that such a book would have an audience.  Anyone interested in exactly what my thesis covers can email me (lorna.tilley@anu.edu.au), and I’ll send you my thesis abstract.

Secondly, my thesis introduces the Index of Care, which is a non-prescriptive, computer-based instrument intended to support ‘thinking through’ the application of the four stages of the bioarchaeology of care methodology.  I describe the Index as a cross between a prompt and an aide-mémoire, and I’m planning to develop it as a web-based application freely available to anyone who wants to use it.  The present Index is in the very early beta version stage – I’m responsible for the content and interface design, and I’m open in saying that these require a lot more work!  (My partner did the actual IT production, so I take no credit for this aspect – which actually works!)  I’ll be calling for volunteers interested in helping to test and provide feedback on the Index in the near future, and I’d love to hear from anyone interested in learning more about this project.

Regarding excavations – well, immediately after submitting my thesis for examination I went out to dig for four weeks in the Northern Vietnamese pre-Neolithic site of Con Co Ngua (~6000BP).  It was great to get my hands in the dirt again after the extended dissertation-writing vigil in front of the computer!  However, analysing the over 140 remains recovered from this site will likely take years – so, even as we speak, I’m chasing up other options for expanding on the bioarchaeology of care work done to date.

The Man Bac landscape looking southwest - excavations centre right

The Man Bac excavation site in Vietnam where the individual M9 was found and excavated. The archaeological site can be seen centre right, whilst a modern cemetery takes precedence in the foreground.

TBOM: That brings us to the end of the interview Lorna, so I just want to say thank you very much for your time!

Lorna: David – and any readers that have made it this far – thank you for asking me along and for being interested.  I can’t sign off without saying how much I value this website – it is dangerously seductive in coverage and content.

Select Bibliography:

Dettwyler, K. A. 1991. Can Palaeopathology Provide Evidence for “Compassion”? American Journal of Physical Anthropology84: 375-384.

Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to the Seriously DisabledInternational Journal of Palaeopathology1 (1): 35-42.

Tilley, L. 2012. The Bioarchaeology of Care. The SAA Archaeological Record: New Directions in Bioarchaeology, Part II12 (3): 39-41.

For further Information on SE Asian Archaeology and it’s Bioarchaeology:

Oxenham, M. & Tayles, N. G. (Eds.) 2006. Bioarchaeology of Southeast Asia. Cambridge: Cambridge University Press.

Oxenham, M., Matsumura, M., & Nguyen, D. Kim. (Eds.) 2011. Man Bac: The Excavation of Neolithic Site in Northern Vietnam (Terra Australis 33). Canberra: Australian National University E Press.