The Poignancy of Old Age

Old age is hard, filled with pain, loss, and humiliation.  Shakespeare famously wrote, in “All the world is a stage”

” …The sixth age shifts

Into the lean and slippered pantaloon,

With spectacles on nose and pouch on side,

His youthful hose, well saved, a world too wide

For his shrunk shank; and his big manly voice,

Turning again toward childish treble, pipes

And whistles in his sound.  Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion,

Sans teeth, sans eyes, sans taste, sans everything.”

 

Walt Whitman, among many others, followed suit:

“As I sit writing here, sick and grown old,

Not my least burden is that dullness of the years, querilities,

Ungracious glooms, aches, lethargy, constipation, whimpering,

Ennui,

May filter in my daily songs.

 

Worst of all, says Kelly Sherry, “It is the loss of possibility that murders us.”

Still, some of us hope that these trials will be balanced by the achievement of wisdom through extensive meditation, contemplation, study, and just plain experience.  To me wisdom means keeping the world and our own experience in perspective and being able to accept both as they are.  And, with that acceptance, finding a greater sense of calm and contentment.

Erik Erikson, the great psychologist of human development, characterizes the last stage of life as a battle between Integrity and despair.  We generally enter this battleground when we confront our own mortality, often following the death of a spouse or close friend or the onset of our own illness, or, more mundanely, with retirement.  The entrance can be sudden and terrifying or gradual, an ineluctable movement towards death’s door.  For some, the time to wrestle with this challenge is brief; for most of us, it may begin in our 60s and extend for decades.

Faced with our mortality, we review our lives; and if we can find a way to affirm the totality of it—without ignoring problems and failures—then we may achieve a sense of wholeness and well being and wisdom, which Erikson describes as “informed and detached concern with life itself in the face of death itself.”  Failure to resolve this final life crisis manifests itself as a fear of death, a sense that life is too short, and a fall into depression.

I remember a moment, 15 or 20 years ago, when my friend David and I, steady, if desultory, meditators in search of wisdom, decided that it wasn’t coming quickly enough and wasn’t likely to be ours.  Instead, through nervous laughter, we imagined an old age closer to adolescence, filled not with calm, but with intense and fluctuating feelings about almost everything in life.  Just the other day, after yet another meditative moment, we recalled that day and concluded that we may have been right.

It seems that my journey towards the shores of wisdom has been just that: a journey with great hopes and enough glimpses of the promised land to keep us working, but almost no chance of making a lengthy landing.  That has been disappointing.  But, to our surprise, we don’t find ourselves in despair.  Instead, we find ourselves fully engaged by the continual challenges that confront us in our 70s.

While our own culture generally paints old age in tones of gray, I have discovered vibrancy.  While poets write about the invasion of lethargy and despair, I have discovered a period that is alive with challenge. There is an intensity and urgency about it.  It is a time when many of us try to find the sense in, or meaning of, our lives.  We wonder how our children and grandchildren will turn out, whether we have made a difference to others, whether we might still be able to repair personal and social wrongs.  It is a time to be brave and as independent as possible in the face of difficulties.  All of these experiences command our attention.  We are alert.

Here’s how my friend, Harry, put it in a note he shared with me recently:

“The integrity pole pulls me toward self-scrutiny, sometimes regret for omissions and commissions/sometimes pride of experience if not of accomplishment. The feelings associated are more rounded: luck, love, sadness, patience, perspective, and good stories to tell. The despair pole brings the realization that no one wants to listen! I think a lot about identity these days (big topic), and realizing how much age is as core an identity as race, gender, and all the rest. Despair feelings are much more pointed: anger, hopelessness, suffering, and dark humor. Of course mortality is the energy beneath both.”

When I wrote about the vibrancy of old age, my brother challenged me, thinking that I was painting too rosy a picture.  Fair enough…so let me clarify.  I don’t mean that life is always good or easy.  There is pain and sorrow and fear, galore.  I do mean that so much is new, and in its newness offers opportunities for excitement, increasing depth, further understanding.

Take retirement.  Suddenly, you have lost your crowd—the people who surround and hold you, even if not always comfortably.  Your identity  is challenged.  Who are you, separate from your professional roles?  How will you fill your time?  Are you at ease just resting, not doing things that are productive?  Will hobbies suffice?  Will volunteering fill your need to “repair the world?”  Where does family come in?

If retirement brings on the chaos of new freedoms, the loss of a spouse brings another, more devastating kind of freedom.  Virtually everyone I speak to tells me how the loss tears their world asunder.  They don’t know who they are, how to spend their time.  For some, not just the future but the past become cloudy.  There is no one to hold them, comfort them, make them feel part of something beyond themselves.  And yet the struggle is also animating, bringing out the resources of these survivalists, bringing some of us relief, even liberation.  The fight to survive is far from fun but it is possible that you get to know yourself better and, with pluck and luck, come to respect yourself, at a deeper level..

Almost all relationships change during old age — sometimes dramatically.  Take the relationships that are forged with one’s children.  I am thrilled that my children have found their way, glad for the pride and freedom that development has brought them, and yet I also hate that I am not closer to the center of their lives.  I have had to absorb these new terms.  I have to stretch to embrace them.

Then, of course, there is the nearness of death itself.  The idea that we live in the shadow of death is nothing new.  Philosophers have spent lifetimes in this precarious place, seeking ways to live well within it.  Almost all of us have premonitions of the end and think to hurry our work and pleasures while there is still time.  Bucket lists, simple as they are, attest to this urgency.  For those who don’t want to be defined by decline and depression, the urgency to make something of these last years tends to increase exponentially when we reach our 60s and 70s.

Dylan Thomas urged his father not to “go gently into that good night.”  Instead he advocates rage “against the dying of the light.”  I don’t think it’s rage that most moves us but a strange combination of fear, urgency, and defiance—the sense of urgency that propels us to squeeze what we can of the life that remains.

Here’s how my friend, Pat, evokes the impact of impermanence:

“I distinctly remember when I was in my mid-20s and my children were around 4 and 2 years old.  They “were as fresh and lovely as the morning dew. I felt the desire to freeze the frame and hold onto it.  I also knew that I couldn’t.  Instead I said to myself ‘be with this as deeply as you can because this precious time will never come again.’  There have been many times since then when the same thing has happened but I notice that I am having many more of them now that I am older.   When I was younger it had to be something extraordinary or amazing that made me super aware and able to stretch out my presence.  Now just ordinary events bring on the inner voice saying, “This is it!”   I am increasingly aware of the poignancy of impermanence.”

And I am increasingly aware of the need to embrace this poignancy.

Meeting the Five Challenges to Aging Well

After posting essays on aging for fifteen months, I decided to see if there is a common thread that binds them together, a set of ideas, a personal philosophy.  What I discovered is a sequence of challenges.  In the Eriksonian spirit, I believe that we have to meet one challenge after another in order to move with energy and integrity to the next.

Together, the sequence of challenges forms a map.  The value of a developmental map is that it creates order out of our messy, complex lives.  The danger is that the map oversimplifies.  As Gregory Bateson insisted, “the map is not the territory.”  But even though we travel in the territory in our own distinctive ways, I believe that we share a general course.  That’s the idea, anyway.  It will be up to you to determine if my map clarifies or muddies your own journey.

The first challenge begins before old, old age sets in.  It concerns the vulnerability that is always there and simply increases with aging, the decline of our bodies, the fear that our minds will soon follow, and our uneasy place in the social fabric.  The decline is inevitable. The experience of vulnerability, anxiety, and confusion almost as certain.  In the face of our vulnerability, we are tempted to deny it—I’m fine, just the same as ever—or, in the opposite direction, fear it and yield to what we think are its implications too soon and too completely.  The first response leads to superficiality.  The second makes us old and disabled before our time.

To meet the challenge, we must learn to look at life as it is, not as it might be.  We must meet difficulties without denial and with a clear, unblinking gaze.  And we must meet pleasures with the same simplicity.  This is the baseline for the honesty and authenticity required of aging well and to begin a journey towards wisdom.  We cannot meet the other challenges until we learn to eliminate most of the distortions we have grown accustomed to.

The second challenge comes with retirement and the empty nest.  These are powerful developmental passages that presage a time of unrivaled freedom and spaciousness but, almost invariably, they also demand an assessment of the life we have lived so far.  Many of us are judgmental to our bones, others less so; but self-evaluation is never easy.  The challenge here is examine our lives with that same clear gaze that we have learned to bring to our vulnerabilities, and to find ways to say “yes, it has been good enough.”

I may have been an imperfect parent, for example, but my children are good people and I am proud of them.  That assessment means I have been good enough and I can move on.  My career may have been more modest than my dreams would have had it, but it has also been “good enough” to free me from a life colored by regrets and recriminations.   I might add that, whatever my life has lacked, my last fifteen years felt redeeming.  During those last professional years, my focus on social justice permitted me to bring my values and my skills more closely together.

In my essay, Completing a Career, I wrote: “It was like completing a circle, from childhood to old age:  living my values more deeply, more immediately, and to some effect.  My parents might be proud.  At last, I did too.  I felt at one with myself, peaceful and fierce in my work.  And ready to let it go, ready to enter the post-retirement stage of life.”

Once you have learned to see clearly and to put the past mostly in the past, the next and most enduring challenge is transform even great difficulties into positive, sometimes triumphant experience.  This is the third challenge.  My essays on loneliness, physical and mental decline, fear of irrelevance, and fear, among others search out pathways to such transformations.

In almost every case, I ask myself and my readers to begin by allowing themselves to fully experience their pain or confusion.  The paradox here is that by resisting pain, we are stuck in it, like Brer Rabbit in molasses.  The more we resist, the more it becomes an impenetrable barrier.  Yielding to the pain, on the other hand, enables us to move through it into relief and joy.  That was the message of “Singing the Blues,” “How Do I Know Thee: Relations With Adult Children,” and “Through the Dark and Into the Light.”

In The Freshness of Old Age, I wrote about a deep acceptance of our own, not our culture’s idea of old age.  “When we slip off the strait jacket of cultural narratives and family expectations, of social prescriptions and proscriptions, even for a while, we enter a world of radical possibilities.  In that world, we can experience the sunshine on our faces and the scent of the forest, the smiles of friendship and the embrace of lovers as if for the first time.  That is the possibility of freedom in old age.”

You may have noticed that the map I have drawn is almost entirely about individuals, and that makes it incomplete.  We are not isolated beings.  Our experience of each challenge and of the entire journey is profoundly influenced by the company of others, husbands and wives, children, siblings, and friends.  The experience of our vulnerability, for example, depends in part on how others respond to it.  Do they worry?  Do they ignore it?  Do they care or not?  In response, we might emphasize our ills, protect ourselves from unsolicited concern, isolate ourselves or seek the company of fellow stoics or sufferers.

So, too, retirement and empty nests take on the character of our relationships.  Our ability to transform pain into triumph will depend on the attitudes of our intimates.  Even dying can be as much a collective as an individual experience.  Do we, for instance, let our spouses, our children, our friends know our thoughts?  Will they hold us or will we insist that they “respect” our need for separateness, even as we pass away from them.

The fourth challenge, then, is, at every stage, to square away our relationships with those most important to us.

Finally, there is the fifth challenge, the great existential conundrum presented by the imminence of death, which becomes increasingly present in old age. We avoid it at the risk of becoming alienated from our selves.  In the end we must make our peace with dying.

A year ago, I wrote: “That I have already lived the great majority of my life is a fact.  That I am declining and, soon enough, will find myself infirm—that’s for damn sure.  And I’m pretty sure that I will die one of these days.  If the obituaries that I now find myself reading more closely are to be trusted, that day will come sooner than I would like.

“How I respond to these ‘facts’ though, that’s partly up to me.  It’s a state of mind that can shade many ways: gloomy, sunny, ironically, matter-of-factly.  I believe that I have some control over this.  Victor Frankl, writing of his time in a German concentration camp, put it this way.  “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”  I can at least try.”

There it is, then.  A sequence of four challenges, each accompanied by the challenge of relationships, presenting a mighty and unavoidable obstacle course, with its pitfalls and triumphs.  Do they shine a light for you?  I am thinking about expanding on these thoughts in a longer piece of writing, maybe a short book, and would like to have your guidance.

Who is that old guy in the mirror

The other day, as my grandson, Eli, and I crossed Mass. Ave in Cambridge, on the way to a shop where children select and paint pottery for firing, he took hold of my hand. We let go when we reached the other side. For reasons I can’t explain, I looked down at my hand, now gnarled and misshapen, and wondered what Eli’s thought of it. As a child, as I recall, I was put off by the wrinkles of elderly bodies. Eli didn’t seem to notice or care. But that got me thinking about aging and body imagery.

For the longest time, I liked the effects of aging on my body, especially my hands. They looked strong and weather beaten to me, signs of physical labor and a life well-lived. Recently, the weather has battered them even more. Not that I find them ugly. I still like the look but now I’m pretty sure others don’t.

That got me looking for clues about how common my experience was. I began reading in the psychological and sociological literature on body imagery, where I found pretty much what you’d expect. The aesthetics of bodily decline, for example, is profoundly influenced by culture. In a youth-oriented culture, smooth looks good and wrinkled looks bad. African Americans are more comfortable with large “body mass” than are Caucasians. Men bemoan growing guts and loss of muscles. Times are changing: Looking soft is unmanly even if you are slim. Women focus their displeasure on fat. As they age, their wrinkled, droopy, and heavy bodies damage their egos and they resent that comparable changes seem to make men look distinguished.

All of us—men and women, Black, White, Brown, and Tan—are encouraged to look young. We are taught to exercise, to make ourselves up, to cover unsightly parts of our bodies. The popular literature on staying young or looking “ageless”—and, by the way, looking ageless is supposed to make us feel ageless—has grown beyond the fondest corporate imaginations. Pop psychologists encourage the pursuit of agelessness, but more politically attuned psychologists tell us that agelessness is a pernicious form of “internalized agism.”

Most of us already know what the experts are saying: that our self-image is heavily influenced by cultural preferences, or, if you like, by cultural bigotry. But this knowledge does not help us to shed the cultural stigma. They are deeply ingrained. My hands are my hands. And the loose skin on Nora Ephron’s neck is hard to affirm. I could go on about my knees, after two surgeries and thousands of miles of hiking, tennis, and basketball. My legs just don’t look so good.

I have written numbers of essays whose core strategy is turning lemons to lemonade, finding new and affirming ways to understand experiences that have troubled us. But I don’t think that approach applies here. I know that some people try. For instance, there is a lovely article in the Huffington Post: 8 Artists Who Explore the Beauty of the Aging Body. And I see the beauty in Joan Semmel’s nude self portraits. I do. But they feel like exceptions to me.

Aside from culture, there is a second influence on body image that may point a way out of my dilemma: functionality. As long as our bodies do what we want, as long as we can trust them, they remain more temple than burden, and they are easier to affirm. “It may not look great,” we can say, but, through long practice, “it still works just fine.” There is research to show that sexual interest and activity continues for many of us well into old age. So it seems that we may look good and feel good to someone. Maybe there’s a kind of visceral imagery that can supersede the visual.

That’s an inspiring idea but let’s admit it, mostly our physical capacity declines over time and, at some point in old age, the decline is precipitous. That’s when it becomes harder to convince ourselves of our body’s beauty.
If I can’t find some smart or quirky way of affirming this old body, what’s left? Acceptance. That’s what I’ve always invoked when I couldn’t seem to change some aspect of my personality or social interaction. I try to relax deeply into whatever difficult reality I’m confronted with. I look at it straight on. No denial. No effort to make it any different than it is. And eventually, I grow less critical and more at ease with what I see.

Sometimes I feel skeptical about acceptance, wondering if it is any more than numbness. And numbness seems like an illegitimate solution. Aren’t we supposed to experience our feelings in all their intensity? Not necessarily. Why shouldn’t we permit ourselves the protective embrace of feelings like resignation and acceptance.

There is one further destination to this journey, though. The older I get, the more I seem to replace what I look like with who I am. I don’t think this is merely convenient, though the timing is clever. very good. I find that I am more reflective these days, that I spend more time think about the meaning of life and other such themes. In other words, I haven’t stopped looking in the mirror—heaven forbid—but the mirror that holds my attention has changed. If I am self-conscious, it is mostly about the state of my mind or the legacy I might leave. My vanity is more focused on the wisdom I have and have not achieved. In that light, this wrinkling body of mine seems like the right one to have.

On Being Adaptable

We can’t be blind to the deficits of aging, but we needn’t wallow in them.  The important question is how best to deal with decline in ways that bring satisfaction.  The eminent psychologist, Paul Baltes, loved to tell a story about the very eminent pianist, Arthur Rubinstein, that points the way.

Just in case you are too young to remember, Rubinstein may have been the greatest concert pianist of the twentieth century.  He played to sold-out houses well into his eighties, dazzling audiences with his virtuoso renditions of Mozart, Beethoven, Chopin, Stravinsky, and others.  He was known for his extraordinary vitality.  At an age when most musical artists slow down, Rubinstein was giving two concerts a week.  Even in his dotage, one critic wrote, he could “transmit the joy of music.”

One day, when Rubinstein was eighty-one, an awestruck young TV interviewer asked him how he had sustained his virtuosity so far into old age.  First, said the maestro, he plays fewer pieces, and not just fewer: he limits himself to those he loves and is still able to master.  This kind of Selection, Baltes tells us, is the first of a three-part strategy for successful aging.

The second part of the strategy is called Optimization.  Rubinstein practiced each of the selected pieces much more than in the past, and much more than he could if he continued to play a larger repertoire.  At an old age, he could prepare his chosen repertoire better than in his youth.

The third strategy required a kind of slight of hand.  “…to counteract his loss of mechanical speed he now used a kind of impression management, such as playing more slowly before fast segments to make the latter appear faster.”  This is Compensation.

Selection asks us to develop and commit ourselves to obtainable goals.  The goals vary from person to person.  You might want to paint landscapes, to construct a Japanese garden, or to visit exotic, distant places. The key is to carefully align your desires and your resources to attain your goals.  Once you identify your goals and decide you have a reasonable chance of reaching them, you have to commit to them.

There are two types of selection: elective and loss-based.  “Elective selection aims at achieving higher levels of functioning. In contrast, loss-based selection is a response to the loss of previously available resources that are necessary to maintain functioning.” For instance, I now walk to get in shape where once I ran.  Unless we want to give up, all of us need to accept the loss of some goals.  No matter how I dream, I’m never going to play basketball again, to take one absurd example. But I can take long walks and I can write for hours, and they take up the room once occupied by more demanding activities.

Baltes’ emphasizes elective selection. “Selection promotes successful aging in a number of ways. To feel committed to goals contributes to feeling that one’s life has a purpose. Furthermore, goals help organize behavior over time and across situations and guide attention and behavior.”  The very act of committed activity is health promoting.

As with Selection, we each seek optimization in varied and distinctive ways.  To take a simple example, we each need to figure out how best to train our aging bodies to hike a favorite trail or learn to dance the Tango.  We each decide how much time and energy we want to invest to optimize our chances of success.  I say, be realistic—you don’t want to fail and discourage yourself too much—but generally, aim high.

Research does too. “Trying to achieve growth-oriented goals is associated with a higher degree of self-efficacy and leads to positive emotions and enhanced well-being. In old age, when losses are prevalent, it might be of particular importance to sustain growth-related goals for promoting well-being, rather than focusing primarily on losses.”

Compensation need not be as tricky as Rubinstein made it.  It’s about finding alternative methods to achieve your goals.  Let’s say you want to build a beautiful Japanese garden.  When young, you might haul all of the rocks and soil by yourself.  When older, you can hire some young people to do the heavy lifting.  You’d still be the creative force behind the project.  Or, you still want to run a 10K race.  To do so, you might cut down on the training miles and increase the time on the yoga mat.

Compensation requires mental flexibility.  It asks you not to confuse the goal with the method of achieving the goal.  While keeping your goal in mind, think as freely as you can about all the possible routes to get there, and then choose the one that will most likely lead to success.

Baltes urges us not to compromise on our goals too quickly.  “…it might be more adaptive to maintain one’s goal by acquiring new resources or activating unused internal or external resources for alternative means of pursuing goals.”

The SOC model isn’t magic but it’s a damn good project design for living well during our later years.  It asks us to be thoughtful and open minded about what we want to do and what will give us satisfaction.  I’d bet that most of us have kept a lid on our own potential.  Take the lid off for a while, at least in your mind.  Then experiment before committing to goals.  Even the initial commitment may require a leap of faith.  If you’re going down uncharted waters, you can’t be sure about the outcome, but you do put yourself in position to learn what is possible and to grow in certainty.

Eventually, your new path will feel natural.  It will be easier to place your full resources behind it.  We all know how great it feels to put doubts behind and to go full bore towards some goal, however imperfect.  Engaged in that way, we literally lose self-consciousness.  As Arthur Rubinstein is when playing Chopin, we are at one with what we are doing.  We become timeless and ageless.  There is nothing better.

Introducing Time Goes By

Dear Readers,

I’d like to break precedent.  Instead of discussing my own ideas, I’d like to introduce you to a wonderful new friend and resource.

I’ve recently gotten to know Ronni Bennett,  who a mutual acquaintance calls the Empress of Aging.  Her Time Goes By,  http://www.timegoesby.net/ , is the most delightful and informative blog on aging that you will find on the net.  She keeps you up to date on news and strategic thinking about aging, health care, and the politics of both.  Her blog often takes the form of moving, hilarious, and personal essays, written with a light and deft hand, through links to tv programs, webinars, John Oliver-type humorists, and music to remind us of the nineteen fifties, sixties, and seventies.  In a recent conversation, Ronni confessed that she was imprinted by Ed Sullivan and her blog does, in fact, serve as a variety show for our generation—and others.  You’ll love it.

Barry

Introduction to an Ordinary Journey Through Health, Illness, and Age

This is the first of a series of essays on health, illness, and age that will be posted weekly.

I’d like to talk with you about the intermingling of health, illness, and aging.  They have become inseparable for me and, I imagine, for many of you.  I spend more time than I’d like or ever thought possible going to doctor’s appointments, trying to decipher what they are telling me, and making decisions that sometimes feel like shots in the dark.  My moods swing with the visits, the reports, and the outcomes.  Family and friends are almost always compassionate but they also have their own needs, fears, and schedules, and it is only right to attend to them, too.

For the last few years, I’ve been dealing with a hiatal hernia—my stomach moving through my diaphragm and up into my chest—and the hullabaloo that it has created in my life.  It has required tests and surgery and recoveries, speculation about how the treatment will go, sometimes obsessive observation of the outcomes, and trying to make meaning of those outcomes.  Will I be more limited?  Will pain become chronic?  Is my aging accelerating?  What and who can I depend on?  I don’t like all this attention to bodily functions but I don’t know what the alternative is.

Let me offer an example.  A few years ago, I began to feel tired, not sometimes but most of the time.  My legs felt like they were weighted down.  Walking felt effortful instead of easy and joyous as it had for most of my life.  It certainly didn’t feel like it was toning my muscles or any other part of my body.  It left me exhausted, and I began to nap instead.  The weariness was not so dramatic that I thought I was ill.  So I turned to the most obvious explanation: I had passed my seventieth birthday and I must be getting old.  “I guess this is what it’s like,” I thought, “and I had better begin to adjust to this reality.”

As it turned out, I had iron deficiency anemia.  Not good but, treatable through infusions of iron.  Within a few weeks of beginning the infusions, I felt like my old—or my prior—self.  What an unbelievable relief.  Not just that I hadn’t marched too far into old age but that I could do something to effect my health.  At least in this case, I could have some say in the matter.  I was not a passive victim but an active contributor to my well being.  I had conflated aging with ill health, which is easy to do, especially as we grow old.  We really don’t know how to interpret changes in our bodies, but we can surely learn to do it better.

For the last three years, I have been writing in my journal in an effort to make sense of the hernia, anemia, and aging processes.  I have needed the privacy and perspective that my journal offers.  But now I feel a little more comfortable with myself, and have begun a series of brief essays that trace my journey with illness, doctors, hospitals, family, and my own psyche in order to raise a number of themes that I believe we share.

In the spirit of Charles Dickens and all those wonderful nineteenth century novelists,  who serialized their work in weekly newspaper columns, I’m going to post these essays over the course of time as an unfolding story.  My hope is that this will permit readers to take some pleasure in their own detective work.   You have all had direct or indirect experience with illness, injury, doctor’s visits, surgery, gratitude, and frustration with the health care system.  When you learn, for instance, that I have been anemic, I imagine that you will bring your own associations to feeling weak or slow or blue.  I would expect you, like the Google-infused medical detectives we have all become, will use your own knowledge and experience to begin building a diagnosis.  What causes anemia?  What impact does it have on the rest of your body and your emotional life?  We will travel this path together.

Woven into the narrative, there will be discussions of general themes.  How easy it is, for example, to conflate illness and aging.  How do we lay people navigate the complexity and, often, the impersonality, of the medical system.  The difference in passive and active approaches, acceptance and fighting, “realism” and hope.  What is the story we tell and the story we are told about a particular problem?  The intersection of personal and medical narratives profoundly affect how we experience illness, health, and aging.

Then there are times when we are caught between the choice of “solving” something once and for all—let’s say, through surgery—or patiently observing the course of a problem in order to build a stronger hypothesis about what’s going on. There are many times when doctors are indirect or disagree among themselves; and we are left to push towards clarity or to make decisions that we are unqualified to make.  What to do in these tense circumstances?  Sometimes family members, because of their own temperament or schedules, want matters resolved quickly or want to hold off to the last possible moment; and you have to decide how ‘self-centered’ you want to be or how decisive you can be in the face of opposition.

Over the last several years, I’ve gotten to know the routes to the Massachusetts General Hospital and the Newton-Wellesley Hospital at least as well as the route to pick up my grandchildren at school.  I know the side routes, the ones that avoid traffic, the ones that feel more relaxing.  I know the best places to park, the best way to reach medical assistants.  I’ve gotten pretty good at reading my medical reports over my internet portal, where I have my own special password.  In short, I’m becoming quite the expert on negotiating the practical side of of the medical system.

I’ve also come to know myself better—probably the main reason I am writing about my experience.  What strengths to call on in myself and in others, or which anxieties I can anticipate and not double down on.  Getting anxious about the prospect of anxiety, for example, can worsen matters immeasurably.  I have learned to let some fears to just flow by, paying them very little mind, and never letting them capture me.    I have learned a good deal about the tendency to conflate illness with aging, which sometimes robs me of the capacity to make firm decisions and to thrive in difficult times.  There is some wisdom to be had by paying attention during this journey.  I want to share it with you and to have you, in turn, share your own wisdom.  Let me know what you have learned.

In Praise of the Aging Mind

When I was a child, I would float in the ocean while my mind wandered to far off lands.  I am not so different now.  I often quiet myself in meditation-like trances, in the shower with water soothing sore places, or on slow walks under low skies.  It seems that my mind touches down wherever it chooses, and when it returns, it comes with the solution to a problem that I had posed.  To this day, I am amazed by the magic, which has grown richer with age.

When I am with friends, we talk about our aging brains.  We can’t do math as well, we lament.  We have trouble learning new languages, especially the technical languages that our children and grandchildren absorb with breakfast.  Our memory isn’t as good.  We can’t find words or remember names.  We are absent minded.  How often do we walk into a room to find something only to find that we don’t remember why we had come?

We worry about our decaying and betraying minds with foreboding and fear, as though we are already in a steady and soon-to-be debilitating decline.  In contemporary America, fear of Alzheimer’s disease seems second only to fear of cancer in its reach.  The big C and the big A.  Even when the fear of dementia is out of consciousness, it seems to be lurking nearby.  We’ve watched our parents fall to it.  We’ve seen friends falter.  We wonder when our time will come.

But most of every day I don’t feel that way.  I learn every day and I revel in the play of my mind.  I trust my mind.  When faced with a problem or an opportunity, there are so many reservoirs of knowledge and experience to draw upon, so many cognitive and emotional templates that I didn’t have when I was young.  I feel less constrained by conventional ideas.  Why worry about convention at this point in life?  Freedom and creativity are far more alluring.

There is a name that the pioneer of psychometric researcher, Raymond Cattell, has given to the type of intelligence that wanes in old age: “fluid intelligence” is the ability to reason and solve novel problems, independent of accumulated knowledge.  It’s the ability to analyze problems that you’ve never seen before, to identify patterns and relationships that underpin these problems and to extrapolate from these patterns by using logic. This is the stuff of logical problem solving, as well as scientific, mathematical, and technical problem solving.  It is the form of intelligence tested by I.Q. exams and generally peaks in the twenties.

Cattell has also given a name to the type of intelligence that most guides me at seventy four: Crystallized intelligence, which is acquired through experience and education.  It shows up in verbal skills, inductive reasoning, and judgment. While fluid intelligence is often considered largely a product of genetics, crystallized intelligence is much more dependent on “a bouquet of influences, including personality, motivation, opportunity and culture.”

Richard E. Nisbett, a cognitive psychologist at the University of Michigan, has long argued that “when it comes to intelligence, experience can outrun biology… Older people,” he argues, “make more use of higher-order reasoning schemes that emphasize the need for multiple perspectives, allow for compromise, and recognize the limits of knowledge.”  Despite a decline in fluid intelligence, complicated reasoning that relates to people, moral issues or political institutions improves with age.  The brain’s most powerful tool is its “ability to quickly scan a vast storehouse of templates for relevant information and past experience to come up with a novel solution to a problem. In this context, the mature brain is especially well equipped, which is probably why we still associate wisdom with age.”

Modern society has virtually jettisoned the idea of wisdom, preferring knowledge and the rapid advance of technological skills.  But I am entranced by the idea of wisdom and consider it the great gift of healthy aging.  If you strip from wisdom its mystical side, it can be defined as the quality of having experience, knowledge, perspective, confidence, and good judgment.

By perspective, I mean the capacity to see events and ideas from a bird’s eye view.  We see and recognize patterns of action and thought in ourselves and in others.  “Oh,” we might say, “I’ve tried that approach before and it never works” or “It only works when combined with kindness or firmness.”  Or with certain kinds of people.  We might note an idea keeps intruding or dominating our thinking but know from long experience that it is more a habit of mind than real problem solving or creative thinking.  Through experience—and reflection—we know the mental and social territory that we dwell in; we know its travails, its traps, its challenges.  And we know the way through the thickets to open spaces.

By perspective, I also mean calm.  A frequent advantage of age is the quieting that comes with experience.  The anxious, internal chatter that clouds the thinking of so many younger people, tends to dissipate.  The intensity dims, too.  This is both loss and gain.  The gain is that you see even difficult or dangerous situations without panic or impetuousness or competitive urges. The idea is to solve a problem not to be the best.  In old age, the focus is less on you, more on solutions.

Let me illustrate my point by observing its opposite.  Take a look at Donald Trump’s failure of wisdom.  He lacks knowledge, perspective, and judgment.  His intellectual style has bogged down in adolescence. He is self centered.  He needs to ‘win’ at all costs, even if winning leads to failure, which it often does.  Most of us, to our great advantage, grow out of this phase

We build our confidence not out of bravado but experience.  You have traveled many pathways in your life, sometimes with success, sometimes not, but you have come to know the territory.  You know it so well that, even when you diverge from your regular pathways, you are pretty sure you can find your way to safety.  The confidence we feel is more realistic, more solid.  We are clearer and more forthright about both our strengths and our limitations.  We don’t need to hope and pretend as much.

I have the good fortune to have many former students, now leaders of nonprofit organizations, who come for advice.  The pleasure that I take in sharing what I’ve learned over the years is hard to express.  The acuity and confidence I feel when helping to advance their careers and their lives is a gift that I have given to myself as much as to them.  It is the gift of giving and it is the gift of play.  I love thinking with others.

I am hardly unique in having knowledge and experience to share.  There are vast amounts of untapped wisdom among my peers, needing only to be recognized and utilized, if only our culture will grant aging intelligence its imprimatur.

 

 

Resilience and Aging

Last week my grandson, Eli, and I were tossing a ball around. The sun bathed the lawn and the little pond beside it.  We were laughing and teasing and sweating.  He would try to catch balls on the full run.  I would reach for high and low balls so that I didn’t have to run.  If Eli threw it too far away, I insisted that he get it.  No reason I should have to move because of his poor aim.  If he threw it over my head, I’d reach up but stop short of leaping, twisting, and turning.  Why risk hurting myself.  As the ball flew over my head, I’d make a mock angry face and we would both laugh.  These are such good times.

That evening I thought about my refusal to twist and leap.  It marked a change in life, a loss.  Just one more way that I was never again going to thrill to my strength and agility.  I had been a very good athlete as a youth, free and easy, quick and powerful.  I thought there were virtually no limits to what I could do if I tried. The joy of movement may have been my greatest friend.  That relationship lasted, in modified form, well into my sixties.  I ran and played tennis, hiked for weeks on end in the high mountains, jumping defiantly from rock to rock as we crossed rushing streams.  With a friend, I built a house without power tools, cut out acres of trees to dig a pond—all for the pleasure of it.

At the time, my ability to pursue these activities seemed invaluable.  I felt I couldn’t live without them.  And there have been substantial losses.  But here’s the interesting thing.  Mostly I don’t mind.  The sorrow is gentler than anticipated, and I find so many things to do that engage me just as fully. It might look like  my life is more limited now, but it doesn’t feel that way.  It is filled with friends and families, and activity, thoughts, reading, writing, and sharing what I have learned with younger people.  I love as deeply as ever.  I follow my enthusiasms as avidly as I did when young and unformed.

These good experiences don’t feel compensatory, and generally, I am not aware of anxiously struggling to replace the old ones.  For instance, now I walk for exercise.  During my decades of running, walking looked paltry.  I had to lecture my pompous young self not to feel superior and contemptuous of the walkers.  Now I don’t feel humiliated by “just” walking.  I “just” do it and feel pretty satisfied when I’ve had a good walk.  As far as I can tell, I like what I’m doing.  I feel as pleased now as I did a year or a decade ago.

I don’t fully understand my internal experience of losses.  Do I say, oh well, I can live without this or that?  Do I simply forget the joys of the past?  To some extent, I do.  Is it a matter of focus?  I simply focus on what I have?  I think that’s a big part of it.  Do I grieve and then recover because I have grieved?  Maybe.  Do I adjust my expectations?  Surely I do.  But after saying all these things, I still don’t really understand.  I am more comfortable saying that there is some form of alchemy going on, some unconscious process, working on my behalf, that puts the losses behind.

Maybe the alchemy is best expressed through the more modern concept of resilience.  While resilience is commonly applied to children—the “resilient child”—and to victims of trauma, it may tell us as much about aging.  Resilience is variously defined (Google) as “the ability to recover readily from illness, depression, adversity…”  or “to adjust easily to misfortune or change.”  It is “springing back” and “rebounding.”  But I like the original meaning:  “the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress.”  As we compress, our abilities are diminished.  As our shape changes—literally in very old age—resilience represents our ability to regain our essential form.  This is important: not our physical or mental form but the essence of our being.

There are two qualities of resilience that I especially want to focus on: optimism and self-determination.  Let’s begin with self determination, or what psychologists call an “internal locus of control.  “From a young age, resilient children tend to meet the world on their own terms.”  They tend to be independent and able to mobilize whatever skills they need to solve problems.  “They believed that they, and not their circumstances, effected their achievements.”  I have never understood why people blame others for their failures.  I don’t mean this in a moral ,but rather a psychological, way.  I feel the same about losses. They upset me at first but, if I pay attention to whatever I’m doing—say playing catch with my grandson—then they don’t stick.  As my attention turns to the present, the losses sort of disappear into my current activity.

I have been fortunate enough to not have suffered terrible, debilitating losses, and can’t imagine how I would respond to them.  But I have struggled with cancer and other illnesses.  And I have come to believe that the ability to move on, to not obsess about what is wrong, represents an intentional, attentional discipline.  I’d like to claim that it is a discipline that I have achieved after years of meditation, and maybe that has played a role.  But it is less conscious than that, a quality of mind long ago ingrained in me, so automatic, that I don’t hold onto losses.

I’m pretty sure that self determination is not enough.  It needs a partner: optimism, a belief that things will work out if you work hard enough.  There is plenty of scientific support for the relationship between resilience and positive feelings.  Studies show that “maintaining positive emotions while facing adversity promotes flexibility in thinking and problem solving.”  How you perceive events is critical.  Do you conceptualize an event as traumatic, or as an opportunity to learn and grow? “Events are not traumatic until we experience them as traumatic.” In other words, what is traumatic to one person is not to another.  So it is with losses.  The power that loss has over you depends on how you conceive it.  The way you conceive it depends on your discipline.

There were two things I have always wanted for my children, now 45 and 37.  First, to feel loved.  With that feeling, they would be free to approach the world with security and an open heart. That would make them resourceful.  Second, to believe that with hard work, almost anything is possible.  You have to put the work in but first comes the belief that things will come out right if you do.  It never occurred to me that the same lessons would be the ones I would lean on myself as I grew older.  But I do.

Do Something!

As old as I get, and as much perspective as I have gained on myself, there are still ancient voices from my past that regularly push into consciousness, sometimes with some  urgency.  I can’t seem to ignore them.  One of them—my mother’s voice—is a call to action and a virtual dismissal of all else.

Let me tell you a story about the first time I heard her clarion call.  I was a boy of seven.  We had driven from Levittown, Long Island, into The City.  My father was driving our brand new, gray, four-door Studebaker, our first car, and I was very proud of it.  We had just come into a run down part of the city that was called The Bowery.  As we stopped for a red light, several men dressed in rags trudged over to the car and began rubbing dirty rags on our windows.  They may have meant to clean it, but instead they made the windshield filthy.  My parents were annoyed, especially when the men reached out for money to pay for their efforts.  I was confused and upset.  Scared, too.  My little sister began to cry and my brother burrowed deeper into the corner of the back seat.

“Who are they,” I asked.

“Bums,” said my mother.

That’s what they were called at the time.  There were no words like homeless men to

describe them.

“I feel really sorry for them,” I continued.  “Why are they doing this?”

“Because they don’t have jobs and they need to eat,” my mother said with seeming

appreciation of their plight.

“That’s terrible,”

“Yes it is, but don’t just feel sorry for them.  That won’t help them.  Do something about it!”

What I could do wasn’t exactly clear to me.  I was seven years old.  But her commanding and scolding voice made it clear that I had already done something wrong.  That’s the ancient voice that I hear, even now at seventy-four.  It tells me that action is the most important, maybe the only important thing.  Feeling and thinking, alone, are self indulgent, a cop-out.  I should keep my mouth shut unless I was willing to work at changing things.  Preferably at a world-wide level.

To say that I felt powerless is a massive understatement, and it took me years to begin putting that feeling on the back burner.

But that was not the only impact of my mother’s injunction; and over time, there was another that gained traction.  The call to action was also instructive and enabling.  It pointed me in a direction and a basis for decision making that has lasted a lifetime.  When, for example, at 26, I found myself wondering how the life of an historian—I was completing a PhD in Intellectual History—would help anyone but me, I left academia.  The voice then pointed me inexorably towards social justice work at the Massachusetts Law Reform Institute.

When I chose to do psychotherapy, I did not choose psychoanalytical psychotherapy because it was passive and focused on internal and unresolved issues from the past.  It seemed pretty clear to me that families, communities, and economic, social, and medical conditions, played a large role in individual well being.  This ‘radical’ position was just common sense but seemed outrageous to the insiders of the time.  With an intrepid band of rebels, I focused on an action-oriented therapy that took the social context into account.  It also led me to require that my patients do something.  Understanding your situation isn’t enough, I would intone, act differently.  Otherwise, like Woody Allen, you will remain stuck in the systems that hold you prisoner.

My mother’s injunction had also invaded many other spheres of my brain in less enabling ways.  It interrupted my relaxation.  It invaded and shortened my pleasures.  “Enough,” said the voice.  “Do something worthwhile.”  And it got me to measure almost everything I do: is it good enough, practical enough; will it have enough impact on people’s lives?  Self evaluation according to the ‘do something rule’ has long been my name, and never have I gotten better than a B-.

Now, in retirement, that voice, that insistence on doing worthwhile things, still commands too much of my attention.  I don’t believe that moderate amounts of volunteer work, alone, will do the trick.  I am on a few boards of directors already and continue to mentor numbers of my old students who lead nonprofits.  But these activities don’t create a sufficient buffer to the voice.  I’m pretty sure—and this is a sad admission—that increasing time with my grandchildren won’t muffle the voice enough, no matter how much I love them and I believe in the importance of ushering the next generation into healthy adulthood.  Even those lovely children can’t drown out the injunction.  But I don’t want to go back to full-time work just to appease that need to always be doing something worthwhile.

What to do?  I know that reflection, therapy, and sharing with friends haven’t worked as well as I’d like, not in the sense of muting the voice to the point of near extinction.  What really seems to help is the truce that I am closing in on.  I have learned to live with it the way I do with my creaky knees and weakened shoulders, with the losses I’ve experienced—and the way I might live with a slightly cranky family member.  The voice is just part of me.  It is me as much as my arms and my smile. It is me, not my mother.

Maybe most importantly, I am no longer trying to cure myself, to rid myself of all that ails me.  It won’t happen.  And I don’t feel like a failure just because the voice remains.   That is a condition I share with all people.  I no longer judge my life by the absence of struggle.  Instead, I ask myself, has the struggle enlivened me, and will it continue to enliven me in old age.   This one has and does.

Aging invariably includes lots of accounting, coming finally to terms with who you are, how your life has gone, how much you like and respect yourself.  Accounting goes a great deal better when done by a good friend, which is what I am trying to be for myself.  And that includes being a good friend to ‘the voice.’

On loneliness

One sunny day, Franny and I were walking along a tree covered boulevard. The air was crisp; our steps were too.  We were chatting happily, noting how fortunate we were to have lived this long and this well.  Yet I was lonely.  I thought to tell her, and I knew that she would smile and wonder what she could do to help.  But I knew that even her most compassionate efforts wouldn’t make things appreciably better.  It might placate but never completely banish the ache.  She loves me. We are married for forty years.  We have shared children and grandchildren, laughs and hard times.  We are very close.  But I still felt incomplete.

When I was young I began to seek a cure for this loneliness.  First, I sought love.  I was sure that having a girlfriend would do the trick.  Each of my early girlfriends were lovely and loving.  They helped but not completely.  When there was no strong relationship, I would prowl the streets of Cambridge, searching, searching, and feeling empty as I searched.  Then I married, more than once, and found a great love but it was not enough.

So I turned to the spiritual life, studying Buddhism and Sufism, and living in a Sufi commune, which was lively and full of company.  I found solace in the idea that loneliness, like other feelings, was a construct of mine—just a thought—that would flow by, like a river, if I didn’t get too nervous about it.  I learned to meditate and to observe this river of feelings; when I did, the loneliness did, indeed, flow by.  But not so much at night, when I was alone on the river.  I hoped that, with discipline and tenacity, I would I would eventually lift myself above all the petty human feelings that oppress me: envy, for example, hurt and defensiveness.  I loved William Butler’s image of wise old men, hoping it mirrored my own journey:

There, on the mountain and the sky,

On all the tragic scene they stare.

One asks for mournful melodies;

Accomplished fingers begin to play.

Their eyes mid many wrinkles, their eyes,

Their ancient, glittering eyes, are gay.

But I never climbed to the top of that spiritual mountain, never freed myself from the slings and arrows, and, eventually, the image grew cold in my mind, leaving me lonely still.  Much as I tried to transform loneliness into solitude and peace, I succeeded only some of the time.  I came to accept the truth of Joseph Conrad’s Heart of Darkness: “We live as we dream—alone…”

Now seventy-four, I know that I will never fully lose that ache, and I know that I am not alone.  Though I have rarely discussed my loneliness with others, I believe that almost everyone shares this condition.  It is a part of the human condition.  Philosophers have noted it over the millennia.  I remember, especially, the despair of the Existentialists, Camus, Sartre, and Simone de Beauvoir, who I read avidly in my youth.  I loved Camus best, particularly his advice: carry on in spite of the pain because it is the only thing we human beings can do.  I have carried on.

Don’t get me wrong.  There are many times with Franny, with my family and friends when I lose myself in play and love.  But I also accept that old philosophical saw that we are ultimately alone, ultimately encapsulated in our individual bodies.  The older I get, the more this simple truth becomes just that: a simple truth.  There is nothing to fight.  I live with it as I might an old friend.  When it comes to consciousness, I greet it with some affection.  “I see that you have come to visit me tonight.  Rest.  Stay a while.”

This is the great value of aging: that you let go of the idea that you can ‘cure’ everything, that you can make yourself better and better, if only you work at it; that you accept your limitations, including your singularity and your loneliness.  And that brings rest.