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Origin and Demise of Socio-cultural Presentations of Self from Birth to

Death: Caregiver 'Scaffolding' Practices Necessary for Guiding and
Sustaining Communal Social Structure Throughout the Life Cycle
Aaron V Cicourel
Sociology 2013 47: 51 originally published online 17 December 2012
DOI: 10.1177/0038038512456779
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456779
2012

SOC47110.1177/0038038512456779SociologyCicourel

Article

Origin and Demise of Sociocultural Presentations of

Self from Birth to Death:
Caregiver Scaffolding
Practices Necessary for
Guiding and Sustaining
Communal Social Structure
Throughout the Life Cycle

Sociology
47(1) 5173
The Author(s) 2012
Reprints and permission: sagepub.
co.uk/journalsPermissions.nav
DOI: 10.1177/0038038512456779
soc.sagepub.com

Aaron V Cicourel

University of California, San Diego and San Francisco, USA

Abstract
The emergence, social differentiation, and reproduction of human communities require
socialization of the young. Socialization practices require caregivers and socially distributed,
intuitive, normative knowledge systems to enable progeny to acquire and sustain habitual, socially
organized skills and belief systems.
Neurobiological, cognitive, emotional, and socio-cultural evolution enabled and paralleled
the acquisition of communicative and socio-cultural skills indispensable for the emergence and
reproduction of a sense of others. Stable adult capacities differentially weaken over the life cycle.
This reverse socialization means gradual loss of self, sense of others, and decline of routine
practices necessary for reproduction of communal life.
A modest corpus of data (10 minutes of discourse between six couples, two deemed normal,
and four where one spouse diagnosed with Alzheimers Disease or Frontotemporal Dementia)
is used to illustrate caregiver scaffolding simulation of appropriate socio-cultural interaction,
illuminating the origin and demise of socio-cultural presentations of self from birth to death.

Keywords
dementia, discourse analysis, representational re-descriptions, scaffolding, social self, socialization
practices
Corresponding author:
Professor Emeritus, Aaron V Cicourel, University of California, San Francisco, The Institute for Health and
Aging, Department of Social and Behavioral Sciences, Laurel Heights, Suite 340, 3333 California Street, San
Francisco, CA 94118, USA.
Email: aaron.cicourel@ucsf.edu

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Introduction
The article examines why socio-cultural processes cannot be reduced to, yet are necessarily enabled by, neurobiology, cognition, and emotion. The simultaneous evolution of
neurobiology and the human genome enabled cognition, emotion, and culture to evolve,
and for contemporary human groups to create culturally derived concepts called intelligence, belief systems, religion, philosophy, literature, art, myths, and science. Sociology,
therefore, need not look inside the human brain and genome for social structure, but to
contemporary documentation of socio-cultural processes and structure using a variety of
theories and methodologies. The present work relies on discourse analysis (Brown,
1995) and linguistic anthropology (Hanks, 1990; Duranti, 1997; Sapir, 1949[1933]). The
methodology encourages the reader to follow the discourse material and ethnographic
settings depicted to discern the plausibility of the authors interpretation of different
speech events and their substantive relevance.
The ubiquitous necessity of communication skills embedded in ethnographically confirmed settings underscores their fundamental role in creating human communities and
socially organized activities or social structure. Native speakers are expected to display
appropriate communication through normative, locally evolved dialectical speech (or
sign language) patterns, gestures, facial expressions, and body movements. Formal and
informal speech events are shaped and constrained by socially organized normative
expectations. Ignoring such expectations can invite sanctions.
The article hypothesizes that dementia and related illnesses can be diagnosed using
socio-cultural discourse data as evidence. Further, that the emergence, social differentiation, and reproduction of human communal life is necessarily linked to socialization
practices of the young and caregiver practices with aged persons, especially when the
latter group is diagnosed as having modest or advanced dementia. The empirical evidence for the hypothesis identifies differences in social interaction among spousal couples diagnosed as normal in contrast to couples where one spouse has been diagnosed
with either Alzheimers Disease (AD) or Frontotemporal Dementia (FTD). The author
was unaware of the diagnosis of the six cases prior to his analysis of 10 minutes of videotaped interaction between the spouses. The results of the empirical section suggest ways
that socially organized discourse material may improve the diagnosis and treatment of
patients with dementia.
The practices called scaffolding (see below) are hypothesized to be constitutive
of the emergence, sustenance, and reproduction of human communal life. Socializing
the young to adulthood and the aged to death requires the simulation of normal
social interaction despite the variable lack of social competence of those attended.
The scaffolding practices (simulation of normal social interaction) by caregivers
enable them to maintain their own identity and sense of social structure during
exchanges with socially, cognitive, and emotionally compromised consociates.
Scaffolding practices presuppose normatively evolving communicative skills across
different human communities.
Children acquire, and elderly adults begin to lose, the necessary problem-solving
skills, communicative, and socio-cultural practices constitutive of the emergence and
persistence of a sense of social structure we associate with the acquisition of a social
self necessary for socio-cultural stability and change over the human life cycle.

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Communal life revolves around the individuals possession of agency, or a sociocultural self. The notion of a social self and the awareness and ability to take others into
account requires collective living conditions only sustainable through collaborative
social interaction between conspecifics. Whereas neurobiologists (Seeley and Sturm,
2007) speak cogently of the biological origins of the notion of social self, the present
work takes as self-evident the proposition that human communal life could only have
emerged had there been simultaneous evolution of neurobiological, cognitive, emotional,
and cultural processes and structures.
The theoretical perspective followed in the present work is indebted to the work of
George Herbert Mead (1934). According to Mead (1934: 135):
the language process is essential for the development of the self. The self has a character
which is different from that of the physiological organism proper [and] arises in the process
of social experience and activity, that is, develops in the given individual as a result of his
relations to that process as a whole and to other individuals with that process.

Mead (1934: 154) continues: The organized community or social group which gives
to the individual his unity of self may be called the generalized other. The attitude of
the generalized other is the attitude of the whole community. Socially organized activities, therefore, are constitutive of social structure.
The following pages begin with a discussion of neurobiological aspects of a social
self to give readers a sense of how neurobiology enabled the possibility of socio-cultural
life forms. Despite the clear relevance of the brain and the human genome for the human
acquisition of a social self, the study of the brain and genome cannot explain the evolution of human communities. Going beyond neurobiology requires specifying elements of
the cultural origins of cognition; the unavoidable interaction between culture and cognition, and their essential role in the socialization of infants and children into socio-cultural
environments (Tomasello, 1999).
The following section includes literature on caregiver practices and the necessary
development of a communicatively competent social self required for the reproduction
of human communal life. The conditions viewed as necessary for communal reproduction parallel observable aspects of the gradual deterioration of social and communicative
competency evident in the patients with dementia discussed below.

Neurobiological Aspects of Self

Seeley and Sturm (2007: 317) ask: How do our brains build the self as we know it? I
assume brains and genes can only understand and build [and conceive] the self as we
know it within an evolutionarily emergent, socio-cultural community of others noted by
Mead. The neurobiological, emotional and cognitive conceptions of self presuppose
the necessary role of culturally organized others and essential daily social interaction
constitutive of human group survival.
Seeley and Sturm (2007: 317) refer to self-representation as a neural accomplishment that emerges from a dynamic set of component processes. The authors
stress that self-representation involves diverse processes within broadly distributed,
interacting neural networks at many biological levels. Further (2007: 318), the notion of
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self includes recyclable mental representations of objects, including the self [and]
permanent others (her, him, perhaps them) [that provide] predictability and
security in competitive social environs.
How did the anterior insula cortex (AIC), and anterior cingulate cortex (ACI) noted
by Seeley and Sturm emerge and guide the development of an infant social self, interact
with other areas of the brain to enable memory systems to emerge and sustain the notion
of a human primate self?
Seeley and Sturm (2007: 318) also refer to the necessary human ability to reflect on
ones representations of self and thus develop an awareness of awareness. The reflexive
notion of self by Seeley and Sturm, therefore, acknowledges the existence of locally
organized, socio-cultural environments (the social realm), but does not refer to normative, cross-cultural socialization practices needed for the survival and development of an
infant social self.
Taking the role of ones self reflexively is part of an essential cultural accomplishment
(Mead, 1934) whose assumed neurobiological substrates are unavoidable, but whose
emergent functional accomplishment in daily life remains unclear and which the present
work seeks to explore with socio-cultural evidence.
If the notion of self emerges as an embodiment of neurobiological, cognitive, emotional, and socio-cultural systems, then it must consist of constantly renewable, culturally coherent, sequential, temporally ordered, interacting, socially functional memory
systems which nourish a self observable initially in infancy, then adulthood, and it
declines with age. Normatively organized human communities, therefore, are an unavoidable evolutionary necessity for socializing the young. The evolutionary processes
whereby group social interaction, patterned socio-cultural activities or structure emerged
remain a mystery, yet their variable, cross-cultural, present-day existence is an incontrovertible material fact.

Childhood Socialization and Evolution

Six million years are said to separate human beings from other great apes (Tomasello,
1999: 2); a brief period of evolutionary time. Yet despite a 99 percent overlap in their
genetic composition, Tomasello notes:
there has not been enough time for normal biological processes of evolution to have taken
place in terms of genetic variation and natural selection in order to have created one by one
each of the cognitive skills necessary for modern humans to invent and maintain complex tooluse industries and technologies [much less] complex forms of symbolic communication
and representation, and complex social organizations and institutions. The problem is magnified
by the claim of paleontologists; for most of the 6 million years, no new cognitive skills emerged.

Tomasello continues (1999: 45):

(b) the first dramatic signs of species-unique cognitive skills emerged only in the last onequarter of a million years with modern Homo sapiens. Even if 6 million or 2 million or 250,000
years, there would not have been enough time to account for cognitive evolution as the
biological mechanism responsible for the rapid evolution. Hence the only possible solution to

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the puzzle would be social or cultural transmission. Hence cultural evolution works much
faster than organic evolution.

Cultural evolution is species-specific, and could only occur with species-unique modes
of cultural transmission. Humans are unique because of so-called cumulative cultural
evolution or the modification of accumulated cultural traditions and artifacts over time
not shown by other species. The invention of a primitive version of an artifact or practice
and its modification or improvement enabled others to adopt it, perhaps without change
for several generations. Tomasello calls this the ratchet effect.
Creative invention and faithful cultural transmission are essential to prevent slipping
backward, and holding on to the new and improved form until modifications or improvements came along.
A key issue of primate cultures is the intentional significance of tool use or some
symbolic practice, what it is for, and what others do with. Thus (1999: 6):
Processes of cultural learning are especially powerful forms of social-collaborative creativeness
and inventiveness, that is, processes of sociogenesis in which multiple individuals create
something together that no one individual could have created one another, she identifies with
that other person and his intentional and sometimes mental states [The suggestion is] that
only human beings understand conspecifics as intentional agents like the self and so only
human beings engage in cultural learning (Tomasello, 1996b, 1998; Tomasello and Call, 1997;
see Chapter 2).

Tomasellos discussion provides a sociological basis for cognitive processes. Hence, the
focus of psychologists on individual cognitive skills always presupposes socio-cultural
structures and processes for their identification and study.

Culture, Information and the Emergence of Social

Structure
Following Roberts (1964: 4389), cultures can be viewed as information economies
whereby information is received or created, stored, retrieved, transmitted, utilized, and
even lost. Socialization to adulthood and death, therefore, requires an information economy that is stored in the minds of its members and, to a greater extent, in artifacts.
Socialization of infants and children through adulthood requires essential scaffolding (Vygotsky, 1978). The labour-intensive role of scaffolding practices after birth parallels the social interaction employed during socialization of the aged to death. Socialization
to adulthood and to death sustains human communal systems and their variation across
cultures and functional specificity in different settings.
Vygotskys (1978: 81) notion of the zone of proximal development, adult guidance
of children, suggests neurobiological maturation involving a simultaneous fusion of
learning and development. A key notion of his work (1978: 85) is that what children can
do with the assistance of others might be in some sense even more indicative of their
mental development than what they can do alone. Scaffolding, the assistance of other
is embedded in socio-cultural conditions tacitly presupposed but not addressed by
Vygotsky.

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For Vygotsky (1978: 86), the zone of proximal development refers to the distance between the actual developmental level as determined by independent problem
solving and the level of potential development as determined through problem solving
under adult guidance or in collaboration with more capable peers [Thus,] what a
child can do with assistance today she will be able to do by herself tomorrow.
Vigotskys zone refers to local social settings created or structured by parents or
caregivers or teachers in which a peer or adults guidance and collaboration (scaffolding) can enable the child (or a patient) to succeed at (or simulate) a given task or problem-solving activity that is not as likely to occur if the child or patient were left to her or
his own devices or capabilities.
The scaffolding used by caretakers of patients with Alzheimers Disease (AD) and
Frontotemporal Dementia (FTD) enables the reproductive simulation of routine sociocultural contexts essential for communal stability; for example, enabling patients, temporarily, to access memories of past socio-cultural experiences and/or events they can
hopefully recognize as relevant to an existing here and now framed by a caretaker. The
extent to which scaffolding can improve the patients cognitive, linguistic, or cultural
skills is doubtful, but scaffolding can enable caregivers to simulate a needed social sense
of self to sustain normal cultural stability. The extent to which caregivers differentially
maintain a sense of denial vis-a-vis their scaffolding activities is an empirical issue.

Social Structure and Cognition

Social structure can be viewed as local and abstract patterns of institutionalized, often
bureaucratically organized, developmental, cultural, and cognitively devised belief systems and activities, empirically grounded in daily life practices. Such practices invariably
consist of representational re-descriptions (Karmiloff-Smith, 1992); memory-dependent
re-descriptive language which goes beyond the limitations of our immediate sensory
capabilities.
Socio-cultural childhood socialization activities and practices expose the young to an
active life-world and different, overlapping forms of normative communal existence.
Between the end of adolescence, and the early or late onset of aging, adults experience
various forms of apprenticeship practices associated with a wide variety of task environments whose locus of authority resides in familial, interpersonal, and bureaucratically
organized institutional settings of power. Roberts (1964: 4389) structural view of cognition and culture notes that tribal communities are too large for single individuals to
absorb and store overlapping, distributed, elements of socio-cultural life.
An explicit, related, real-time cognitive view of culture can be found in DAndrades
(1989) notion of culture as an immense, distributed, self-organizing productive system.
An essential aspect of DAndrades cognitive perspective of culture includes explicit
references to daily life encounters faced by human groups, and memory systems consisting of large collections of sustainable, partial (re-descriptive) solutions for problems.
The work of Roberts and DAndrade underscores a constitutive element of culture: the
necessity of human memory systems and artifacts for addressing distributive systems of
learning and practice.

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Building on Roberts and DAndrade, Hutchins (1991: 284) has proposed the existence of socially distributed cognition in locally cooperative efforts of humans working
in socially organized groups within a variety of task environments. For Hutchins, a
socially organized task environment:
involves the distribution of two kinds of cognitive labor: the cognition that is the task, and
the cognition that governs the coordination of the elements of the task. In such a case, the group
performing the cognitive task may have cognitive properties that differ from the cognitive
properties of any individual.

The integration of cognition and culture, therefore, is a socio-cultural accomplishment of

social interaction.

Caregiver Practices and the Development of a Social

Self
The literature on child language acquisition, cognitive development and socio-cultural
socialization suggests that early exposure to socio-cultural activities and practices
includes communication skills that begin after birth and are linguistically acquired
between 10 and 44 months for most languages. In Western cultures, parallel findings
exist between middle-income adults speech to young children, and how four-year-olds
speak to two-year-olds (Gelman and Shatz, 1976; Shatz, 1975; Shatz and Gelman,
1973). Routine conversational practices reveal the caregivers role in simulating a community of others during speech events with the young. The same kinds of speech
events occur between caregivers and aged persons with cognitive and socio-cultural
deficits (Cicourel, 2010).
Elissa Newports (1977: 177) research in the United States on motherese begins with
the recognition that others must speak with the infant or child and the child acquires
whatever language is spoken to him [sic]. I summarize Newports (1977: 178) succinct
review of the literature about a special speech register motherese. For example, the
child limits its language environment by repeating (parsing) utterances that go beyond
her or his speech production capabilities (Shipley et al., 1969), and ignores language
perceived to be too difficult or unfamiliar. As noted by Newport, the nature of the selectivity of utterances suggests the child does not rely on innate preprogramming abilities
and is probably incapable of processing complex speech. Caregivers are presumed to be
sensitive to constraints on the childs capabilities, including their short-term memory
limitations. Adults, in this view, become selective in their use of speech acts assumed to
be appropriate less complex lexically, and structurally simplified. Similar to Vigotskys
zone of proximal development, the child reacts to utterances somewhat beyond its current rule system.
Newport notes (1977: 179) even 3- and 4-year old children, who in some cultures are the primary caretakers of younger siblings (Slobin, 1968a), produce this type
of speech to young language learners (Sachs and Devin, 1976; Shatz and Gelman,
1973). Newport concludes her review by describing a hypothesis by Gelman and
Shatz (1973: 33) that speakers select utterances perceived as relevant for particular

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contexts by assessing appropriate conversational meaning. Newport and others she

cites acknowledge leaving the problem of [cultural] meaning untouched.
Child development research on adult speech to young infants and children refers to
interpretative frames imposed by the caregiver (Ochs, 1988: 21) often viewed as selfevident. Ochs (1988: 23) continues:
While all researchers will readily admit that exotic peoples have a culture, very few see
themselves as having a culture and even fewer see their middle-class research subjects as
having a culture (but see Lock 1981; Shotter 1974). As noted in Ochs and Schieffelin (1984),
middle-class language acquirers and caregivers have an invisible culture (see Philips 1983).
Their culture is not usually perceived because the researcher usually speaks the same language
and participates in the same cultural system as the children and caregivers and/or because the
researcher does not have a heightened awareness of his or her own orientations and behaviors,
and does not look for these underpinnings in interpreting the behavior of others.

Ochs (1988: 23) also raises questions about missing cultural implications of the notion
of simplification in caregiver speech:
We do not see, for example, that the speech of caregivers to and in the presence of young children
is organized by cultural expectations regarding the status and role of children and caregivers and
regarding relative incompetence (see Ochs and Schieffelin, 1984) Simplified caregiver speech
is one kind of caregiver speech that exists in the worlds societies. It is a social register. It is not
universal and not a necessary environmental condition for language acquisition to take place.

The above remarks suggest we are missing data showing different socio-cultural settings in which variable scaffolding conditions can be said to exist or in which the claim
could be made that such conditions can be minimized yet can result in normal language
acquisition, cognitive skills, and socio-cultural problem solving. Ochs (1988: 24) suggests that:
American caregivers indulge the egocentric tendencies of children, whereas traditional Samoan
caregivers resist these egocentric tendencies. American white middle-class caregivers
compensate for the inability of infants and small children to meet the informational and social
need of others by carrying out a lot of the work for them and caregivers will often fill in
missing information or paraphrase (expand) what the caregiver interprets to be the childs
intended message.

Ochs remarks parallel the cultural problems existing when communicating with the
aged.
The work of Miller (1994) also provides convincing data on the emergence of a sociocultural self in early childhood (approximately at 2 years of age). Citing work by Basso
(1984), Sapir (1949[1933]), Herdt (1981), and Malinowski (1984[1926]), Miller (1994:
158) refers to the essential role of myth for preserving the culture of a community by the
use of narratives. She underscores the socializing potential of:
informal, mundane, and often pervasive narrative accounts that people give of their personal
experiences. The verbal activity of telling other people about events that have happened to

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oneself may well be a cultural universal: Versions of this type of storytelling occur in diverse
cultural traditions within the United States and around the world. (Miller and Moore, 1989)

The childs early familial socialization experiences with systems of meaning occur
within specific kinds of discourse, especially personal storytelling. For Miller, the threeyear-olds storytelling reflects a self-construction process notable for its revision and
reconstruction.
In contrast, among the aged with dementia, spontaneous storytelling diminishes
sharply and becomes a diagnostic marker for the study of patients with AD and FTD.

Comparing Normal and Diminished Displays of Self

and Social Structure
The materials presented below are from white middle-income adult patients diagnosed
with AD and FTD. The six pairs of patients and spouses were initially seen at the Memory
and Aging Center (MAC) (Department of Neurology) at the University of California,
San Francisco (UCSF), and subsequently tested for their emotional displays and psychophysiological correlates at the Psychophysiology Laboratory at the University of
California, Berkeley (UCB). I was not told the diagnosis of the relevant spouse of the six
cases selected by the Director (Robert Levenson) of the UCB Lab where I conducted
most of my analysis.
A key empirical issue is the extent to which we can assess the ability of patients with
AD or FTD to share the immediate social environment, and prospectively and retrospectively assess and anticipate relevant motivations, intentions, and emotional states of
others. Among early onset AD patients, partial islands of storytelling with caregivers
occur, but patients with moderately advanced stages of AD and FTD have difficulty
articulating spontaneous storytelling.
Ten minutes of focused discussion by six couples enabled the author to identify normal and clinically relevant speech acts and discourse, and infer a differential diagnosis
suggestive of an inability by the patients to present a viable socio-cultural self before
others.
The dyads were asked to discuss marital conflict situation(s) (Gottman and Levenson,
1992) experienced prior to the initial neuropsychological and clinical assessments at the
MAC. All subjects engaged in the requested social interaction about a conflict situation, but differences quickly emerged between patients designated as having AD and
FTD, and those perceived as normal controls.
The videotaped sessions were examined independent of the patients clinical diagnosis, prior occupational history, public contacts, participation in active social networks
and routine social activities at home. Ten minutes of discourse proved sufficient to infer
which of the couples were normal. The couples in which one spouse was presumed to
have FTD also appeared self-evident. But a 10-minute session proved puzzling for a
misdiagnosed case of AD. The problems associated with the misdiagnosed case are discussed below.
The study of speech events during staged but surprisingly spontaneous social interaction in the Berkeley Lab provided a valuable source of information about the couples

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awareness of self when communicating with each other and others about daily life topics,
planning activities, problem solving or carrying out tasks or activities at home and in
their community.
In the two assumed normal cases, the subjects readily initiated speech acts with
detailed elements of past family relationships, social activities and work experiences, or
a long-standing marital problem. The 10-minute sessions could be viewed as microcosms of normal marital life for these articulate subjects.
Ten minutes of discourse, however, lack the ecological validity (Bronfenbrenner,
1977; Brunswik, 1956; Cicourel, 2004; Cole, 1996; Neisser, 1982) of home visits in
which audio and videotapes of patients initiating and sustaining a sense of self during
discourse could differ from semi-controlled clinical and controlled psychological settings. Subsequent research by the author addresses these issues.

Two Normal Cases

The discourse fragments discussed below were first examined and reported in Cicourel
(2010). The expanded analysis addresses how spousal social interaction reflects cognitive problem solving, and complex, essential patterns of culture or social structure and
their reproduction. As in Cicourel (2010: 2), the focus of analysis is on the role of scaffolding practices in both control (normal) discourse and caregiverpatient social interaction. For example:
1
2

Can each spouse initiate and pursue a topic?

Can subjects use metaphors and related semantic constructions typical of everyday discourse?
3 Does one spouse dominate the discourse and provide leading questions and tag
statements to sustain the speech event?
4 Can subjects sustain a reciprocity of perspectives or consistent theory of mind
(Gopnick and Meltzoff, 1997; Mead, 1934; Schtz, 1962)?
5 Can subjects remember and conceptualize a future event, and plan an activity?

Normal Discourse Case 7142

The opening moments consist of two adults (W=wife, H=husband) facing each other,
their eyes opening and closing during a prior, designated period of silence. After five
minutes of silence, the voices of the lab assistant (LA) and couple follow:
Excerpt 1 Case 7142
1
2
3
4
5
6

LA: Please begin your conversation.

H: I was just going to say that the um that we used to go off about is the
you contend that I put my mom first and um I contend I dont.
W: Im not sure thats the case anymore and my frustration is that you
you tend not to see some of your mothers manipulative tactics
and you bought into the whole story about, you know,

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7
8
9
10
11
12

she wanted you to believe over the years

and yet your sister and brother have seen it very clearly.
I just think possibly being the oldest child and having been doted on the
most. I think you just feel like you would be betraying your mother
if you admitted that you saw those things.
Thats the part that frustrates me.

The couple recreates a long-time conflict in their marriage; the wifes view of the husbands domineering mother. The husband subsequently acknowledges the wifes view;
his submissive behavior in dealing with his mother, but he subsequently refers to her
aging years to justify his mothers behavior. The husband (line 3) contextualizes the
conflict by using a metaphor (we used to go off about) alluding to prior occasions of
conflict, and the metaphoric, alleged claim by the wife that I [the husband] put my
mom first and um I contend I dont. The husband presumably favors his mother over his
wife and did not (line 5) recognize his mothers manipulative tactics. The wife (line 4)
initially retracts her presumed earlier claim by stating Im not sure thats the case anymore The remainder of her remarks in lines 411 demonstrates her ability to articulate a long-standing conflict in their marriage by underscoring the frustration she cites
in line 4, but does not provide substantive details about what manipulative tactics were
used by her mother-in-law.
The language used by each party remained articulate and substantively convincing
throughout the session. Each spouse appeared to engage in animated social interaction
with no sign of apathy, as well as a strong command of English syntax, phonology,
semantics, paralinguistic skills, and task-oriented cognitive reasoning. The couple used
appropriate metaphors and deictic lexical items such as pronouns like I, we, them,
they, you, and spatiotemporal adverbs like that, there, these, those, and this
(Hanks, 1990). They referenced substantive conditions of a normal conflict consistent
with research by Gottman and Levenson (1992) on social interaction in normal longterm marriages.

Normal Discourse Case 1416

At the end of a scheduled silent period, the lab assistant tells the couple they can now
speak.
Excerpt 5 Case 1416
1
2
3
4
5
6
7
8

H: This kind of reminds me of Saturday Night Live. (both laugh)

where Kurtland would say something to Jane,
insults like (unintelligible, both laughing).
W: Um, I voted to approve a strike vote at uh, Peninsula Hospital
and theyre in negotiations now.
And the reason I voted to uh approve a possible strike is that
they uh, I feel the nurses should have better retirement and health care
when they retire. They want to change it to a thirty-two thousand dollar

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9
10
11
12

Sociology 47(1)
fund that you get when you retire,
but you have to pay your premiums and they give it back from that.
/And thats not going to be enough to, to
/H: My, my; the questions not on the specifics,

The opening three lines reflect small talk, but in line 4, the wife introduces a topic
(a strike vote at uh, Peninsula Hospital). Apparently she is a nurse and not a
patient. The wife seeks to justify the strike (lines 69); better retirement conditions
for nurses and health care after retirement. The husband (line 12) challenges the
wifes remarks using an indexical expression the specifics, implying there is a
problem to be found in unstated details of the negotiations, suggesting a conflict
between them.
My commonsense interpretation of the husbands facial expressions and initial comments also suggests he is not a patient. Both husband and wife engage in expected
presentations of self and marital conflict. The next section of discourse appears to clarify these initial impressions by an articulate polarization of their views about unions.
For example:
Excerpt 6 Case 1416
13 H: my question is on the benefits of having a labor union negotiate
14 for you under the conditions that, that they dont negotiate.
15 W: Well, the fact that theres 5000 nurses from eight or ten, I think its
16 eight, Peninsula Hospitals, carries more weight with the negotiations.
17 I think theyll find, in the long term, that universal health care,
18 itll make the hospital and the medical, hospital communities more
19 receptive to universal health care, which /is the real solution to the
20 problems.
21 H: /This is, its not,
22 its not an argument about universal health care,
23 its an argument about the unions and how the unions represent you.
23 Its uh, its an argument about the unions tactics,
24 are, to get a bunch of people to threaten to strike,
26 and not a bunch of people that are willing to negotiate.
The husbands anti-union perspective (lines 2123) seeks to refocus the issues
raised by the wife (better retirement benefits for nurses) on the unions tactics. The
wife, meanwhile also introduces (lines 1719) the notion of a long-term goal of
universal health care, which for the wife is the real solution to the problem. The
husband disagrees (lines 2126). The wife and husband appear to be in good control
of their views and consistently reveal an ability to express them clearly. The remainder of the discourse continues in a spirited vein with the wife defending her position
and husband doing likewise but without any appearance of rancor or irritation. The
couple did not mask the seriousness of their different perspectives, yet remained
civil throughout the discourse, perhaps motivated by the public (recorded) nature
of the social interaction.

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Two Possible FTD Cases

Case 5692
In the opening moments of Excerpt 7, the husbands face appeared expressionless. The
wife revealed slight smiles during the five minutes of silence. The lab assistant (LA)
asks them to please stop sleeping while the wife mouths I love you to her husband.
Excerpt 7 Case 5692
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

LA: We want the two of you to talk about anything you want and then?
W: [to Husband] do you have any idea of where we disagree?
H: No. [Wife smiles, Husband begins to smile [not clear]]
LA: Pick something youd like to talk about, something you can agree?
W: [fairly animated] Oh, I know! We have differences of opinion on
how were going to be buried.
H: [smiles and seems to chuckle]
W: [Wife smiles] but we resolved that.
Did you think of something you could talk about?
You dont want to talk about that?
H: Nope.
W: We already decided on that. Ah uhm, about this weekend.
H: wh oh (?) [flat affect]
W: What were doing.
H: Were going to play some tennis.

In the present and subsequent case, the wifes scaffolding simulates a socially stable
speech zone, thus giving the patient access to a limited set of current and past events.
The patient does not introduce his own topics. My initial impression suggested the husbands face consistently lacked expressive features, in contrast to the wifes immediate
animation even during the silent period. The husband seemed subdued, not motivated
to engage in discourse, and presupposes my having viewed the videotape and prior
familiarity with FTD patients. The wifes scaffolding practices simulate a speech event
about future events involving both spouses. The husbands speech acts were limited to
occasional, appropriate, truncated, limited views about the wifes reference to activities.
He did, however, remember their plans to play tennis on the weekend.
In lines 911, the wife asks a leading question which provides a scaffolding frame for
the husbands negative response. In lines 1630, the wife (not shown) again asks leading
questions to sustain the conversation. The husband responds appropriately in lines 18,
20, and 22, and expands on the topic in line 20. The husband employs deictic pronouns
but the speech events do not contain speech acts that use spatiotemporal deictic expressions (those, here, that, there, these). There appears to be a lack of affect and emotional
lexical items and phrases in the husbands responses.
Speech events that follow (not shown) make reference (by the wife) to a possible
pending suspension of the husbands driving license and her claim that she can drive an
RV with his guidance. The husband insists she should not drive the RV. There are other

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indications that the husband is the patient. The wife suggests that she and her husband
do little socializing, and she refers to a trip to Paris that apparently had been planned and
alludes to not taking the trip because of the husbands medical condition.

Case 7162
The wife begins the exchange with winks and chuckles. The husband moves his fingers
to his lips, suggesting comprehension of lab assistants remarks to observe silence. The
wife smiles broadly. The husbands head drops to his chest and then up again. The husbands facial expression appears frozen and barely animated when communicating. The
husband says something and the wife puts a finger to her lips to signal dont talk. Brief
non-verbal facial expressions follow and husband smiles slightly. Wife closes her eyes.
Husband looks around. Wife puts fingers on her eyes to indicate the husband should
close his eyes but he doesnt and looks around. The silent period ends with the laboratory
assistant asking the couple to begin the problem conversation.
The wifes immediate reference to clutter appears to presuppose a prior, long-standing
problem. The wife immediately begins to control the exchange by providing the initial
scaffolding needed to initiate the exchange. I assumed the wife believes the husband is
not likely to initiate the discourse.
Excerpt 10 Case 7162
1 W: We can talk now. So, I have one question.
2 The garage and the house where we live now, weve lived there for 3 years,
where
3 we live now, and the day that we moved in you persuaded
4 me to lets just throw it in, because well organize it later.
5 H: Okay.
The wife (lines 15) immediately asks a question, which turns into a prolonged complaint about the husbands apparent long-term disregard for cleaning the garage. The
wife uses several deictic and indexical terms including one fragment (line 4) of alleged
unreported speech attributed to the husband whose reported usage we cannot confirm.
The deictic term it refers to unidentified entities that were placed in the garage. The
husbands response is a flat Okay. The husband makes no attempt to refute the wifes
allegations and she begins to elaborate the problem. The opening lines, therefore,
resembles a caregiver monologue I assume is typical.
Excerpt 11 Case 7162
6
7
8
9
10
11

W: And then 3 years have past, and I was angry at you various times,
for not going out in the garage and making an attempt at organizing it,
cause today, its just as bad as the first day we moved in.
And you promised me you would help me organize it.
And uh, basically there were lots of opportunities for you to do it,
because you would be watching TV, football, whatever, and

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12
13
14
15
16

You had nothing else to do but watch TV.

You could have gone out to possibly do a little bit.
Start a few things here and there.
And, I dont think you ever made any movement towards organizing
the garage. Now, today, the garage is still undone.

The wife (lines 69) continues the monologue by reference to the indexical term clutter. The wife accuses the husband of making no attempt to organize the clutter and
notes the situation remains the same now as when they first moved into the dwelling.
Instead of taking advantage of many opportunities to organize the garage, the wife notes
(lines 1112) her husband would watch TV. The wife pursued the allegation through
lines 1316. The scaffolding provided by the wife is clear and closely resembles the prior
case. In the next fragment, there is a shift to the patients present problem.
Excerpt 12 Case 7162
17
18
19
20
21
22
23

W: I, I understand why I cant expect for you to do the garage any more,
is that you are incapable of it because of the new prognosis we have
on you. But, it was true 2, 2 years ago that you also had the problem
and when you dont do it now it is the same reason as 2 years ago,
You think so?
H: could be.
W: Okay

The wife (lines 1718) states I understand why I cant expect for you to do the
garage any more, is that you are incapable of it because of the new prognosis we have on
you. The direct reference to the new prognosis is stated as a self-evident fact, and the
wife (line 19) associates the husbands inaction with clutter to be a consequence of the
new prognosis apparently identified 2, 2 years ago. The wife (line 20) asks the husband to reflect on her analysis of the reason for his not organizing the clutter. The
husbands response is brief and semantically ambiguous, but perhaps could be viewed as
appropriate, given the information about the new prognosis and the lack of a more
elaborate response by the husband. The husbands answer, however, is not self-evident.
Should we assume he is not capable of understanding the wifes linking of clutter to his
new prognosis? Subsequently (not shown), the husband appears to reveal a minimal
sense of self and comprehension and the wife persists with her view of the problem.

Two Possible AD Cases

Case 5733
Excerpt 16 Case 5733
1
2
3

H: We can talk, lets just talk, well talk about that.

LA: about the clutter?
H: Yah, cause then shell talk a lot. (husband and wife smile)

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4
5
6
7
8
9
10

Sociology 47(1)
LA: Well, the two of you talk. But uh, so then what I am going to do,
talk about this issue of getting the clutter in the basement for 10 minutes.
LA: First, though,
H: (refers to something about eating)
W: (laughs) I dont have a problem with eating.
H: I know. You have a problem with my eating.
W: Yah.

The speech event begins with a response to the lab assistant asking the couple to discuss
a conflict situation and specifically refers to clutter. A few minutes later, the husband
(lines 13) refers to the deictic expression that (clutter), used by the LA, and he notes
the topic will motivate his wife to talk a lot, implying his wife might otherwise not say
much, suggesting she is perhaps the patient. Thus, early on, the husband seemed to be
informing the lab assistant of the kind of scaffolding appropriate for discussion. The
wifes animation appeared appropriate when she did speak. The wifes facial expression,
however, appeared to be periodically fixed and she frequently lowered her eyes after
speaking. Her facial appearance seemed subdued and lacked expressiveness, except
when speaking. The reference in lines 810 to a problem with eating seemed appropriate. After five minutes of silence, the official session began.
Excerpt 17 Case 5733
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

LA: You can begin your conversation.

W: About what? (laughs as does husband) I dont think we have
I think we have (animated and smiling) a lot of clutter.
H: Mmhm
W: But I dont know what to do in terms of getting the stuff
OUT of the house. I?? know??, I cant manage to pick up all the,
all the stuff. Id like to take the, the band stuff to the storage space,
(H: Mm) but you dont want to do that.
H: I havent/
W: /And I cant drive (said loudly).
H: I know (laughs) I, I, um, I have/ you know what?
thats the first time you mentioned about the band stuff
going in the storage space, but, yeah, we can take it to the storage space.
W: And I think we could have the,
I really think that we dont need the one storage space, whatever.
I mean we have three storage spaces and one of them is hardly full.
H: I know. Actually, I think I want to try to, well I want to
get a hold of (first male name) and see if I can get some of the stuff
out of there. (W: Mm)
H: Sooner the better.

The wife (line 2) expresses doubt about clutter as a topic, yet in line 3 seems to claim
they have a lot of clutter. In lines 58, the wife expresses concern about getting the
stuff OUT of the house, suggesting she cannot be the one who can remove all the stuff

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to a storage space, and tells her husband (line 8) but you dont want to do that. Is the
wife saying the husband opposes moving the band stuff to the storage space? In line 9,
the husband seems about to negate something, and the wife cuts him off (line 10) by noting And I cant drive. There is no way to know if the wifes drivers license has been
suspended or if she has never driven. The husbands reply (I know (laughs)) suggests
but does not confirm a suspended license. The remarks suggest the wife has been diagnosed with AD.
In lines 1113, the husband seemed surprised by the wifes reference to the band
stuff, and states it was the first time you mentioned about the band stuff going to the
storage space. Perhaps this is an example of memory difficulties. Yet, the wife remembers their having more storage space than needed. The dialogue appears appropriate for
both spouses; the wife by reference to the band stuff and unneeded space, and the husband (line 1719) suggesting he will call someone (name), presumably to help him
remove the stuff. The husband suggests a way to solve their problem.
Although the case seemed somewhat perplexing, I viewed the husbands expressions
of planning actual activities to facilitate the movement of clutter as indicative of his
creative scaffolding role for the wife despite her periodically competent remarks.
Several of the wifes initial remarks appeared appropriate in lines 2126 (not shown).
The husbands remarks, however, seemed more appropriate, especially his reference to
using email to contact (first male named) to have him help move the stuff.
In lines 3242 (not shown), the husband states I want to sell that drum set and the
wife (line 33) agrees. The husband suggests the wife call (first female named) to see
if shell come and take some of our stuff. Thus both spouses initiate possible plans and
suggest ways of achieving solutions. But the husbands remark that he will email (first
male named) suggests an ongoing, complex cognitive skill.
In lines 6973, 7779, and 8890 (not shown), the wife laughs and changes the topic,
but appears to experience difficulty articulating her concern with our finances. She
continues by stating her desire to consolidate their finances. An awkward use of syntax,
lack of semantic clarity, and the use of many confusing deictic expressions (And you
know, I dont, it, I, Im, I, I, our, Id, I, I, I, it). The husband (line 74) remains supportive
and does not question the wife as she continues expressing uncertainty about financial
matters.
In lines 7779, the wifes confusion about her funds (we just dont know what,
how to deal with it) could be viewed as a common problem among the aged but this
wife appeared to be in her fifties (and I subsequently learned she was 60 years old at
the time of the session). The husband (lines 8081) provides a scaffolding response
that legitimizes the wifes remarks by noting this would be a good time to reconsider doing something about mutual funds not identified by the wife. After the wife
murmurs apparent agreement with the husbands remark, the husband continues by
implying (line 83) an unstated possible solution (Actually, I feel that, you know, we
could figure out). The husband then states his own doubts (I dont even [line 83]
know where to begin with your stuff). The husbands use of the metaphor your
stuff is followed by the wife (line 86) stating With my stuff? as if to question its
meaning. Perhaps she forgot what was said a few lines earlier. I decided the wife was
the patient.

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The Puzzling AD Case 5268

After making presentations to the UCB psychophysiology laboratory and a seminar at
the Memory and Aging Center at UCSF, I was told I had misdiagnosed one of the two
AD cases. I was not surprised; the videotapes of the AD cases proved difficult. I subsequently returned to the tape I suspected was the problem case for an additional review.
The case alerted me to a problem about which I needed reminding: non-verbal and emotional displays and the word-by-word analysis of the videotape require repeated (necessarily filtered) representational re-descriptions of what are presented as data. I asked
myself: What knowledge about antecedent ethnographic conditions would be helpful to
the research analyst before beginning her or his analysis? The conceptual/methodological issue is how do analysts decide intuitively and factually what elements are indicative
of bringing into existence a defining or explanatory frame of reference (to paraphrase
Kahneman and Miller, 1986). The problem of behavioral indicative elements is also
paramount for the families or caregivers who must decide when a referral to a physician
appears necessary, and is also a deep concern of clinicians during their initial interaction
with caregivers and interviews with patients.
Initially, I assumed the wife was the patient; her appearance seemed somewhat
disheveled for someone who appeared to being in her fifties and at a formally arranged
session in a university laboratory. Her glasses were sitting on the lower part of her nose,
and her hair seemed un-combed. The husband appeared to be well groomed, and his face
seemed to be somewhat fixed, with an occasional smile, but no laughter.
The wife appeared to initiate the conversation, but the husband intervened immediately, yet he seemed odd to me because of his serious facial expression, lack of animation, and rigid, controlled, direct manner. The wifes voice appeared clear and
moderately animated with appropriate prosody. I began thinking the husband was the
patient, yet the husband was active in the conversation. The diagnosis of AD for the
husband appeared not to be substantiated. The husband seemed quite articulate in
expressing his views about religion, yet some viewers might suggest that the husband
seemed to be somewhat dogmatic about his religious views. On the other hand, his views
could also be based on prior, well-rehearsed discourse known to the wife.
As the discourse continued, the wife, unsurprisingly, seemed to know the husbands
previous views on religion. She wanted the husband to address his religious beliefs. The
initial exchange follows.
Excerpt 22 Case 5268
1
2
3
4
5

H: Hi
W: You are hi and where (laugh)
H: Would you like to start or would you want me to?
W: Oh, you can start.
H: Yes. Why do you always want me to go to /church?

In lines 15, the husband initiates the conversation and refers to a viable topic: Why do
you always want me to go to church? The question presupposes the topic of going to
church was a source of past conflict.

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Excerpt 23 Case 5268
6 W: /ok. Oh because I
7 I felt like you are not giving yourself a chance. You dont know as far as,
8 I dont understand why you dont want to try to go to church.
9 It is almost like maybe you are afraid to go, but
10 I just dont understand it even if just even if you went
11 I mean, of course I like you [to] go with me a lot more but just
12 give it a chance.
13 H: But you already know my views on it. Right?
14 W: Mm. I want to hear them again.

In lines 614, the wife begins with several false starts and finally (lines 910) uses the
deictic term it (line 12) and the metaphor give it a chance to refer back to line 8 (try
to go to church). The wifes remarks seemed confusing. I viewed her difficulty in
topicalizing the source of conflict, coupled with my initial perception of her appearance, as indicative that the wife was the patient. The husband seemed impeccably
groomed and his opening remark seemed articulate. The wifes remarks in lines 913,
however, revealed a moderate ability to first frame, and pursue the husbands reluctance
to attend church with her. The wife suggests he is afraid to go, and sounds frustrated
with this reluctance. The wifes remarks could be viewed as scaffolding in order to
motivate the husband to address an apparently long-term, contentious issue in their marriage. The husband (line 13) insists his wife already knows his views. The wife, however, insists the husband tell his views again.
Excerpt 24 Case 5268
15 H: You know I dont believe in religion. It doesnt mean that I dont believe in
God.
16 It just that I dont believe in religion. I think there/
17 W: /So you do believe in
18 god?
19 H: Of course I do.
20 W: Ok.
In lines 1520, the husband displays a clear self-conception of his religious views, and
states It doesnt mean that I dont believe in god. He reiterates this view in line 19. The
husband did not appear to be the patient; his speech acts appear to reveal a strong sense of
self-awareness about his dislike of organized religion. The wifes interrogation appeared
deliberate and suggests an equally strong sense of self. Husband and wife seemed obsessed
with their conflict over religion and church attendance. The case appeared confusing.
The wife appears to use a subtle but organized form of adult motherese. Is this a
strategy to entice the husband to speak about his views and perhaps satisfy the request
of the lab team? The husbands preoccupation with his description of the evils of
organized religion is difficult to assess given the paucity of ethnographic observation and
only a 10-minute, staged speech event.

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After re-examining the videotapes of Case 5268, and despite finding both negative
and supportive evidence for perceiving the woman and her husband alternatively as the
patient or as normal, I decided the husband was probably the patient.

Discussion
The article attempts to build on and extend the innovative research of scholars who have
focused on developmental issues by applying some of their insights to social interaction
among the aged. The analysis of the six cases sought to identify and document sociocultural scaffolding practices necessary for understanding the emergence and stability of
a social self, and coping with the decline of human communal life among the elderly.
The empirical materials presented above are a modest beginning. Current research by
the author explores the diagnostic process, including the role of bureaucratic constraints
faced by the neurology clinic with their patients, and then obtains audio and videotapes
of the patients in their home environments.
Making diagnostic inferences using videotapes of staged 10-minute discourse sessions about an elicited problem that spouses had experienced appeared to be selfevident for the two controlled cases and two FTD patients, but daunting in the analysis
of one AD patient. I attribute my diagnostic difficulty to not having access to more than
10 minutes of discourse given that the two cases were diagnosed as early onset AD. For
example, the wife of the misdiagnosed case was 59 years old at the time of the session
while the first case of AD was 60 years old. I believe 30 minutes of open discourse
between the misdiagnosed AD case and her husband would have suggested the wife was
the patient.
The empirical data suggest social research methods can contribute to our understanding of human development and decline. Further, that normal, sustained social interaction is the hallmark of socially organized, normatively constrained social structures. The
patients revealed both fairly self-evident and subtle problems for maintaining expected
normal presentations of a social self during social interaction.
Sociological studies of local social interaction in which patients and others engage in
problem solving and social exchanges can help caregivers and clinicians understand the
significance of routine and complex daily life activities for diagnosing early signs of
socio-cultural-cognitive deterioration, and conditions which led the spouse or family
members to consult health care professionals. The early observations and inferences of
family members, friends, neighbors, and work colleagues remain clinical empirical
issues, and are difficult to document. Within clinical settings, such data are seldom transparent and their discourse properties are seldom self-evident.
The authors current research explores the initial clinical diagnostic process and
asks: How do health care personnel obtain evidence about when, with whom, and to
what extent patients with signs of dementia begin to exhibit aberrations or alterations
in their behavior with others? When do patients show signs of having difficulty engaging in routine and abstract tasks, re-conceptualizing memories of past events, and
coping with everyday social interaction? Recorded home visits are being pursued to
obtain independent evidence on daily life communication skills and problem
solving.

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The modest corpus of data examined above underscores the relevance of necessary
moment-to-moment communicational skills ubiquitously present in local communal living, including the useful staged 10-minute exchanges presented above. The data identify aspects of appropriate and inappropriate communication skills among the couples
studied and reveal aspects of the normative expectations participants expect if they are to
perceive socially organized activities as life as usual or normal or unexpected or
inappropriate displays of social interaction. The results support the hypothesized differences in social interaction among spousal couples diagnosed as normal in contrast to
couples where one spouse has been diagnosed with either Alzheimers Disease or
Frontotemporal Dementia. Normatively expected social discourse, therefore, proved
useful in distinguishing communicational differences among normal couples and those
in which one patient was diagnosed with dementia.
Acknowledgement
I am grateful to Bruce Miller, Director, Memory and Aging Center, University of California, San
Francisco, and Robert Levenson, Director, Psychophysiology Laboratory, University of California,
Berkeley, for allowing me to use their data. The research reported below could not have been
undertaken and completed without their essential support. Roy DAndrade, Troy Duster, and
Howard Schwartz provided useful suggestions for revising the manuscript.

Funding
This research received no specific grant from any funding agency in the public, commercial, or
not-for-profit sectors.

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Aaron V Cicourel is Research Professor Emeritus of Cognitive Science, Pediatrics, and

Sociology at the University of California, San Diego; Professor Emeritus at the University

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of California, San Francisco, and Visiting Scholar at the University of California,

Berkeley (Institute for the Study of Societal Issues). His current research activities
include the study of familial and institutional socio-cultural caregiver practices (scaffolding) by individuals and groups caring for patients diagnosed with Alzheimers
Disease, Semantic Dementia, and Frontotemporal Dementia (Cicourel, 2010). A new
project was completed recently on the diagnostic processes of a neurological clinic with
new patients suspected of being afflicted with dementia.
Date submitted June 2011
Date accepted March 2012