Tag Archives: Lorna Tilley

Tips for Best Practice Bioarchaeology Blogging

8 Sep

In something of a cannibalized post, and one that I have been meaning to write for a while now, I discuss here some general ideas that may be useful for bioarchaeology bloggers when writing and presenting blog entries for both the general public and the interested researcher.  Primarily the focus is on the Bioarchaeology of Care theory and methodology, one which considers the archaeological and osteological evidence for caregiving in prehistory on a case study basis (Tilley 2014, 2015i).  However, there may also be some use for the general bioarchaeological and osteological blogger.  The first part of this post (the context) is taken from one of my previous posts on the publication here.  The second part is taken directly from my own chapter.  Enjoy!

Bioarchaeology of Care Context

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.

The four main step of the index of Care tool used to evaluate the archaeological and osteological evidence for caregiving and receiving. Click to enlarge. Image credit: Index of Care site.

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 below).  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.

Best Practice Bioarchaeology Tips

The following work has been quoted from the section of my chapter discussing and promoting possible best practice for bioarchaeology bloggers:

‘It is evident that the skeletal remains of historic and prehistoric populations and individuals remain a potent symbol of a tangible link to humanity’s ancestors and of mortality more generally. Caregiving, and the evidence for compassion, is a subject that is close to the heart of humanity – one only needs to realise that rarely are any individuals untouched by immediate family members needing caregiving, be it social, daily and/or medical care; it is a topic which is inherently easy to relate to. As such it is recommended that researchers integrate the archaeological and bioarchaeological evidence between the prehistoric and historical worlds to the present. No discipline is better placed, or more uniquely positioned to do this, than bioarchaeology . . .

The 2016 Springer publication edited by Tilley & Shrenk. Image credit: Springer.

. . . Yet what are the suggestions for aspiring bioarchaeology bloggers, microbloggers, communicators and outreach workers with regards to best practice in public engagement and communication? How do we, as practitioners of bioarchaeological research, integrate good communication practices within the discipline?

These are challenging questions for a new and developing digital medium, one that is constantly changing and updating. Both Bertram and Katti (2013) and Meyers Emery and Killgrove (2015) indicate a number of gaps in the current social media representation of bioarchaeology, as well as suggesting a number of approaches that would develop best practices across the social media range. Some of their suggestions are particularly relevant in terms of how, and why, we should consider public engagement (using all media mediums) as a relevant, ethical and productive factor in bioarchaeological research, and these are discussed as follows.

Making Yourself, and Others, Visible

Bioarchaeologists are a tough breed to find online, due to the conflicting terminology used within bioarchaeology and related disciplines. Make your professional online presence visible by clearly defining the focus of your work and by indicating your interests in a clear and informed manner for visitors (Meyers Emery & Killgrove, 2015). It is also recommended that researchers citing digital and social media sites in academic articles, or on other social media applications, should properly reference the authors, title of post, address, and indicate the date accessed, as routine.

Exploit a Variety of Approaches

Vary the approach taken. Videos, for example, are particularly rare phenomena in bioarchaeological outreach, but have the potential to reach a vast audience – much more so than an academic article. It is well-known that serialisations (such as Kristina Killgrove’s Bones reviews or this author’s Skeletal Series posts) keep the reader interested, whilst providing structured content. Joint posts, interviews, guest posts and video entries can also help reach different and varied audiences online and in-print (Bertram & Katti, 2013).

Provide Information on Latest Research and New Techniques

Bioarchaeology uses a range of different techniques, and new methodologies and approaches are also developed every year to investigate the archaeological record. The use of these techniques and methodologies can, and should, be discussed and contextualised in terms of, or in relation to, their use and limitations within the discipline. The majority of bioarchaeological research is published in journals in which the article itself is locked online behind a subscription block, a so-called pay wall, thus preventing interested but non-academic based readers the opportunity to learn about the detail of the latest innovations. Blogs, such as Bones Don’t Lie by Katy Meyers Emery for example, offer the reader concise summaries of the latest published articles in a timely and free-to-access manner. Edited volumes such as this are out of the reach of the casual reader who lacks access to a specialist research or university-based library.

Three of the best bioarchaeology bloggers. Katy Meyer Emery’s Bones Don’t Lie, Kristina Killgrove’s Powered By Osteons, and Jess Beck’s Bone Broke. Image credit: respective sites as linked.

Try Bi, or Even Trilingual, Entries

The majority of online bioarchaeology social media content is in English. Using a second language (Spanish, Mandarin, Persian or French, for example) alongside an English translation would enable readers from different areas of the globe to gain access to the content. This could be achieved through transnational projects and international academic partnerships; for example, sponsored online content or conference workshops, spanning both national and language borders, might investigate ethics ‘case studies’ or develop ways of promoting research best practice. Benefits would include greater exposure of research to a wider audience, achieving an increased understanding of the importance of this research, alongside the building of ethical frameworks across cultural divides. It could also lead to a more integrated approach to the physical and cultural analysis of osteological material.

Discuss Your Pedagogy and the Dangers of Digital Media

The methods by which anthropology, archaeology and bioarchaeology are taught are rarely discussed on social media sites. A pedagogical approach, such as an introduction to the elements of the human skeleton and the importance of their study, would enable the public and researchers to understand how, and why, the topics are taught in a particular manner, and the expected outcomes of this. For instance, an introduction to the terminology used in osteology designed for the lay public can help to break down the ‘ivory tower’ view of academia (Buckberry, Ogden, Shearman, & McCleery, 2015). Furthermore, there should be open lectures and discussion at university level alongside engagement on the pros and cons of digital and social media use, including understanding the impacts and dangers of online sexism and trolling (Armstrong & McAdams, 2010). The ethics of public communication should be considered – what are the support frameworks for the digital advocacy of bioarchaeology online?

Define Disability and Highlight Differential Diagnoses

With reference to the bioarchaeology of care methodology, discussion must be focused on the available archaeological and osteological evidence and, where the material evidence is available, the cultural context for the understanding of what a disability would entail (Battles, 2011; Doat, 2013; Spikins, Rutherford, & Needham, 2010). Due to inherent limitations in osteological evidence, a specific disease diagnosis cannot always be determined (Brothwell, 2010). Therefore in bioarchaeology of care analysis differential diagnoses must be included when examining possible disease impacts on function and the need for caregiving. Each candidate diagnosis should be considered, as these may have different effects in different cultural, geographic and economic environments.

Factor Public, Social and Digital Media Engagement into Bioarchaeological Projects

Blogging, microblogging and engaging with newspaper reporters and television producers take time and effort. Factor this into the initial research as a plan of engagement from the beginning. Identify key communication aims and develop strategies for how to achieve these aims over the course of the research project. Do not be afraid to contact bioarchaeology bloggers or other social media users with details of the project that the research team wishes to make public at a given time (this will depend on client or other stakeholder agreement and timing for release of the research via academic journals and conference presentations). Engage with users and produce content that is in line with both professional and personal ethical standards, state possible conflicts of interest if necessary, and, when discussing original research, indicate the funding bodies that have supported the work.

Meyers Emery and Killgrove (2015) indicate a number of best practice suggestions that are pertinent to repeat here. They are: to write for an educated public, to write or produce content regularly, be sensitive to your own bias and the biases of others, and to repudiate the hysteria and hype of the media in a clear, productive and informative approach. There is a responsibility on a part of all bioarchaeologists who partake in public engagement to educate and inform on the standard approaches practiced in bioarchaeology and the ethical considerations that inform this, particularly to counter sensationalism and ethical misconduct. The above are all important aspects that each bioarchaeologist should use in their approach in disseminating and discussing bioarchaeological content and approaches to public audiences.’ (The above is taken from Mennear 2016: 356-359).

So there you go, a few general tips on bioarchaeology blogging best practices.


This chapter would not have been possible without last-minute editing, endless nights and bottomless coffees. All mistakes are, of course, my own. Image credit: imgur.

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 of 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.  Previous Bioarchaeology of Care focused posts can be found here.

Bibliography & Further Reading

Armstrong, C. L., & McAdams, M. J. 2010. Believing Blogs: Does a Blogger’s Gender Influence Credibility? In: R. Lind, ed. Race/Gender/Media: Considering Diversity Across Audience, Content and Producers. Boston: Pearson. 30–38.

Battles, H. T. 2011. Toward Engagement: Exploring the Prospects for an Integrated Anthropology of Disability. Explorations in Anthropology. 11 (1): 107–124. (Open Access).

Bertram, S. M., & Katti, M. 2013. The Social Biology Professor: Effective Strategies for Social Media Engagement. Ideas in Ecology and Evolution6: 22–31. (Open Access).

Brothwell, D. 2010. On Problems of Differential Diagnosis in Palaeopathology, as Illustrated by a Case from Prehistoric Indiana. International Journal of Osteoarchaeology. 20: 621–622.

Buckberry, J., Ogden, A., Shearman, V., & McCleery, I. 2015. You Are What You Ate: Using Bioarchaeology to Promote Healthy Eating. In K. Gerdau-Radonić & K. McSweeney, eds. Trends in Biological Anthropology. Proceedings of the British Association for Biological Anthropology and Osteoarchaeology. 1. Oxford: Oxbow Books. 100–111.

Doat, D. 2013. Evolution and Human Uniqueness: Prehistory, Disability, and the Unexpected Anthropology of Charles Darwin. In: D. Bolt, ed. Changing Social Attitudes Towards the Disabled. London: Routledge. 15–25.

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).

Meyers Emery, K., & Killgrove, K. 2015. Bones, Bodies, and Blogs: Outreach and Engagement in Bioarchaeology. Internet Archaeology. 39. doi:10.11141/ia.39.5. (Open Access).

Spikins, P. A., Rutherford, H. E., & Needham, A. P. 2010. From Hominity to Humanity: Compassion from the Earliest Archaics to Modern Humans. Time and Mind(3): 303–325. (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. 2015i. Theory and Practice in the Bioarchaeology of Care. Zurich: Springer International Publishing.

Tilley, L. 2015ii. Accommodating 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.


Publication of ‘Theory and Practice in the Bioarchaeology of Care’ by Lorna Tilley

23 Nov

There is a new publication out by the bioarchaeological researcher Lorna Tilley, a PhD graduate from the Australian National University in the School of Archaeology and Anthropology, which introduces the theory and practice in the bioarchaeology of care methodology.  The methodology aims to investigate and identify instances of care provision within the archaeological record through case study analysis of individuals who display evidence for physical impairment, either through disease process or acquired trauma, of a disabling nature which may have required care in order to survive to their age-at-death.  Focused, for the moment, on the prehistoric periods, the publication introduces a number of case studies spanning the Palaeolithic (including Homo neanderthalensis) to Neolithic periods from a variety of geographic and cultural contexts.  An introduction to the model, the background and the four stages of analysis, can be found here.

As a matter of disclosure I should add here that I helped to (briefly) edit the second chapter of the publication for Lorna and that my name, and this site, are mentioned in the acknowledgment section.  (I have to admit it is pretty awesome seeing my name in print!).

Tilley Book cover

The cover of the publication, as a part of the Bioarchaeology and Social Theory series published by Springer, and series edited by Debra L. Martin, is now available. The hard back volume retails for the sum of £90.00 and in ebook form for £72.00. A paperback version will be released at some point and will be cheaper. Image credit: Lorna Tilley/Springer.

Without further ado here is the abstract to the volume:


‘Characteristics of the care given to those experiencing disability provide a window into important aspects of community and culture.  In bioarchaeology, health-related care provision is inferred from physical evidence in human remains indicating survival with, or recovery from, a disabling pathology, in circumstances where, without such support, the individual may not have survived to actual age at death.  Yet despite its potential to provide a valuable perspective on past behaviour, caregiving is a topic that has been consistently overlooked by archaeologists.  Theory and Practice in the Bioarchaeology of Care presents the ‘bioarchaeology of care’ – a new, case study-based approach for identifying and interpreting disability and health-related care practices within their corresponding lifeways context that promises to reveal elements of past social relations, socioeconomic organisation, and group and individual identity that might otherwise be inaccessible.  The applied methodology, supported by the Index of Care (a freely-available web-based instrument), consists of four stages of analysis, with each stage building upon the content of preceding one(s): these stages cover (i) description and diagnosis; (ii) assessment of disability impact and the corresponding case for care; (iii) derivation of a ‘model of care’ provided; and (iv) interpretation of the broader implications of the provision and receipt of this care.

This book looks first at the treatment of health-related caregiving in archaeological research, considering where, and why, this has fallen short.  Succeeding chapters establish the context and the conceptual foundations for undertaking bioarchaeological research into care provision, including defining and operationalising terminology surrounding ‘disability’ and ‘care’; examining debate around social and biological origins of care, and considering the implications for addressing caregiving motivations and practice; and presenting a theoretical framework for exploring the collective and individual decision-making processes involved in caregiving.  Two chapters then detail the four stages of the bioarchaeology of care methodology and application of the Index of Care, and these are followed by three case studies that illustrate the methodology’s application.  These chapters explore, respectively, the care given to Man Bac Burial 9 (Neolithic Vietnam), the Neandertals La Chapelle-aux-Saints 1 and La Ferrassie 1 (European Upper Middle Palaeolithic), and Lanhill Burial 7 (early British Neolithic), and they demonstrate the variety, richness and immediacy of insights attainable through bioarchaeology of care analysis.  Most importantly, these studies confirm that the bioarchaeology of care’s focus on caregiving as an expression of collective and individual agency allows an engagement with the past that brings us closer to those who inhabited it.  The final chapter discusses some future directions for bioarchaeology of care research, and considers how research findings might inform modern values and practices.’

Next Steps

As exciting as the above publication is I can also confirm that there will be a multi-authored edited volume, which is presently titled as New Developments in the Bioarchaeology of Care: Further Case Studies and Extended Theory, to be published mid next year by Springer.  The volume is the culmination of a session on the topic held at the Society for American Archaeology annual meeting back in April 2015, which was held in the beautiful city of San Francisco (see the list of presenters, and their topics, here).  I have also contributed a chapter to this volume on the topic, and the importance of, public communication within bioarchaeology of care research.  I am pretty excited to read the other contributions from a range of bioarchaeologists, historians and philosophers.  So keep your eyes peeled for that!

If there are any potential bioarchaeological researchers out there that are interested in analyzing the evidence for care provision, then I’d recommend checking out the above publication and utilizing the Index of Care tool within your own research (see also Tilley & Cameron 2014).  Only by other researchers incorporating the above methodology, and improving upon it when and where possible, are bioarchaeologists going to be able improve our own understanding of care in the archaeological record as a response by past populations and individuals to instances where care may have been provided.  Care, and the archaeological and osteological evidence for care provision, has been, and continues to be, a contentious issue within the discipline (Tilley & Oxenham 2011).  However it is also an area where a range of investigative research strands and new scientific techniques can be brought together to provide a fuller holistic approach, to both the archaeological record itself and to the individuals who populated it.

Further Information

  • The online non-prescriptive Index of Care tool produced by Lorna Tilley and Tony Cameron can be found here.  Researchers are very much welcome to use the step by step process during the analysis of case studies and are asked to provide critical feedback that will help improve the tool for future users.
  • Read an interview here with Lorna and myself, which was conducted back in 2013, where we discuss her work with the bioarchaeology of care model and the importance of using it to deduce the evidence for care provision in the archaeological record and the importance of recognising this.

Bibliography and Further Reading

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. 2012. The Bioarchaeology of Care. SAA Record. 12 (3). (Open Access).

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. New York: Springer.

Help Wanted: Call for Feedback on the Online Index of Care Application

14 Mar

Any regular reader will know that I am particularly interested in physical impairment in the archaeological record, and the implications of this for the individual themselves and for the society that the person lived in.  Too often in the archaeological and osteological literature the individual care needs of those with physical impairments are cast aside.  As such it is with great pleasure that I highlight here the launch of a new online application entitled the Index of Care, as a key part of Tilley’s new Bioarchaeology of Care methodology (2011).

A recent article (1) by Tilley (2014) in the International Journal of Paleopathology introduces the Index of Care – an instrument still in the early testing phase which has been designed to help people think through the identification and interpretation of skeletal evidence for health-related caregiving in the archaeological record.

The Index, which leads the user through the four stages of bioarchaeology of care analysis, is the brainchild of Australian National University researcher Lorna Tilley (who was interviewed on the methodology for this blog last year).   Tilley says that, while she has tried to embody the theory of the bioarchaeology of care approach in the instrument and has found it useful in her own work (2011, 2012), she considers the Index itself an experiment.  ‘As far as I’m aware, this is the first time in bioarchaeology that an instrument for examining a behaviour as sophisticated as caregiving has been attempted.’  This is, in my eyes, what is very much needed when the osteologist considers what implications evidence of pathology may mean for the individual and society.

Man Bac Burial 9 in situ

The individual who helped kick start it all: the burial of M9 in-situ at the Vietnamese Neolithic site of Man Bac.  This male individual, who has been diagnosed with juvenile-onset quadriplegia, is indicative of an active caregiving environment during his lifetime. (Tilley & Oxenham 2011: 37).

In particular Tilley emphasises the fact that the Index offers a framework for analysis –  it is not a formula.  The researcher works through the stages of the Index to help produce a framework of care.

Tilley states that ‘the Index is designed for flexibility, users decide what parts of the Index are relevant to their specific case study – and ignore the rest.  They decide how they want to use the Index – whether as a prompt to remind them of variables they could be considering in their research, or for detailed recording of evidence and conclusions reached, or anything in-between.’

The  Index of Care can be found online here and Tilley encourages all archaeological researches to give the Index a go.  The Index of Care is currently in active development and feedback is highly sought after to improve its design and operation.  Those contributing to this project will be acknowledged in subsequent versions for their help and efforts.


(1). It should be noted that I am named in the acknowledgments of the article for providing some early feedback on the article.


Tilley, L. & Oxenham, M.F.  2011.  Survival against the odds: modeling the social implications of care provision to seriously disabled individualsInternational Journal of Palaeopathology. 1: 35-42.

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

Tilley, L., & Cameron, T. 2014. Introducing the Index of Care: A web-based application supporting archaeological research into health-related careInternational Journal of Palaeopathology. 6: 5-9.

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.