Courage

I have been thinking about courage lately.  The upcoming period may demand a great deal from us, each in his or her own way.  Opposition to Donald Trump and the Tea Party Republicans’ assault on freedom has required us to bring our resistance into the open, and there may be a price to pay.  Then, too, I am almost seventy five; and the challenge of aging with dignity and self respect will demand stamina and courage.  For me, the two challenges are intimately connected.

As a boy, I would wonder if I had the courage to jump into a lake to save a drowning friend, my sister, my brother, or my parents.  By the age of five or six, my buddies, David and Freddy and I would throw out challenges to one another: would you run in front of a car to save your mother? A stranger?  How far would your courage reach?  I still ask myself these questions, though I now know some of the answers.  My life for my child or grandchild?  Of course.  But some questions about my courage remain opaque.  I can hope that I’ll come through but I’ll only know about when tested.

At nine or ten, World War II and the Holocaust were still fresh and dominant in mind.  I would dream and daydream about being parachuted behind enemy lines to fight the Nazis.  So many people had already died;  and carrying on the fight might be left to us, the children.  It seemed a daunting prospect but I assured myself that I could overcome my fears because the danger was so present and the cause so strong. Here, the roots of courage were clear.

While I have lived a mostly privileged life, there have been moments that frightened me. When I was young, my parents canvassed for the American Labor Party, and FBI men in trench coats came twice to our apartment door in the Bronx.  “Where is your father,” they barked.  As a young teenager during the McCarthy era, there were plenty of bullies who took it upon themselves to watch over our national conscience.  I learned to watch what I said but I also girded my loins for a fight.

I’m no child now but these early images are still vivid and defining for me.  So, too, the images of courage from that period.  Most of all there was Joseph Welsh challenging Joe McCarthy on TV. The McCarthy-inspired Red Scare, had intimidated a nation, its people and its press.  McCarthy’s unrestrained efforts to uproot the Communist enemy in our midst represented the greatest witch hunt in American history.  During the 1954 Army-McCarthy hearings, broadcast for hours every day on TV, McCarthy threatened to release a list of 130 “Communists or subversives in defense plants.”

Actually it was his eager assistant, Roy Cohn—yes, the same Roy Cohn who Donald Trump counts as his greatest mentor—who was on stage at first.  Then McCarthy, himself, interceded. If Welsh was so concerned about people aiding the Communist Party, McCarthy taunted, he should check Fred Fisher, a young attorney in Welsh’s law firm.  Fisher was a progressive but hardly a Communist and certainly no danger to the nation.

“Until this moment, Senator,” said Welsh, “I think I have never really gauged your cruelty or your recklessness… . If it were in my power to forgive you for your reckless cruelty I would do so. I like to think I am a gentleman, but your forgiveness will have to come from someone other than me… Let us not assassinate this lad further, Senator. You’ve done enough. Have you no sense of decency, sir?”

At that moment, people were terrified of McCarthy, as they might soon be terrified by a rampaging, fact-free Donald Trump, contemptuous of the press and the judiciary and of anyone who stands in his way.  Those who defied McCarthy lost jobs, friends, freedoms.  Some were deported.  Welsh didn’t flinch.

I would like to believe that I would respond as Welsh responded.  I am surely not important enough to matter as Welsh, who represented the United States Army, mattered.  But I can imagine that there will be small moments that will call on me—and on many of us—to stand firm, as he did.  The image of his doing so will be with me as I do.  I hope to live to his standard.

Here’s the key point: having clear standards of morality and personal conduct, as Welsh did, makes it simpler to know when a line has been crossed and where you must take your stand.  Each of us need to determine for ourselves what that line is.

Anne Frank took a different kind of stand, one of profound psychological valor. This is another kind of courage: a refusal to let your life be defined by what you don’t have and to keep a disciplined focus on what you do have. In the face of the relentless Nazi onslaught and almost certain death, she wrote:

“I see the world being slowly transformed into a wilderness; I hear the approaching       thunder that, one day, will destroy us too. I feel the suffering of millions. And yet, when I look up at the sky, I somehow feel that everything will change for the better, that this cruelty too shall end, that peace and tranquility will return once more.”

Her heroism stands as a beacon to me.  I dearly hope that her ability to find grace and beauty in the ugliest of circumstances will guide me as I confront the lesser challenges of my life.

If I’m lucky enough to live another five, ten, even fifteen years, these challenges will touch almost every aspect of my being.  There will be pain and illness—and the inevitable fear of dying.  I see it every day among my older friends.  The stiffness when we walk, the waves of indeterminate, maybe undiagnosed feelings in our bellies and our limbs, the anxious anticipation of what almost seems like weekly reports from doctors, the suffering and loss of friends, the increasing uncertainty about so many things.

These pains and these uncertainties are not just my own.  There are others who care about me and whose lives are intertwined with mine.  I need to consider them when I chart my course.  There is my wife, above all, because our lives are inextricably joined.  There are my children, whom I have loved for thirty-eight and forty-six years.  They will suffer with my infirmity.  They won’t want to experience my weakness and decline.  They will ache when my time comes near, especially if my mind fades and I can’t share my grief with them.  There are my brother and my sister and my friends.  As they are for me, I am a pillar for them.  When one pillar falls, the world seems a much more precarious place.

Will we be brave as we face these days ahead?  How will I talk with them?  Will I be candid or stoic?  Will I permit myself to lean on them or will I hold to this foolish independence and pride of mine? Will we hold one another? Will I bemoan my fate or will I, with Anne Frank, see the beautiful blue sky above—I have had such an extraordinary life.  Much as I hope to stand firm with Joseph Welsh, I want to be my best when facing my own bodily and psychological assaults.  I want to be at my best, my courageous best, right up to the end.

Much as Joseph Welsh leaned on a set of standards to chart his political course, so I will need them to meet the physical and psychological challenges ahead.  Without these standards, I will flounder.  I will react to each problem as if it is unique.  And this would amplify whatever indecision and shakiness that ordinarily accompany crises.  I don’t want to live in constant crisis.  It would take me far from the dignity and self respect I aspire to.

I am inclined to see the world as a complex place and generally not given to right and wrong or good and bad answers to moral dilemmas.  But complexity is no great friend in during times of great struggle, and that is what is ahead.  So I have been winnowing my standards in search of the few that matter most.  Some stand as aspirations and may be beyond me.  I will live with that imperfection. For now, this is the best I can say. I will work to be clear eyed and realistic about the life I have.  I will try to accept that there is no other life.  And I will embrace whatever love and beauty I can find within the “approaching thunder.”

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Exhaustion: the Power of Narratives on the Experience of Health and Illness

This is the second installment in my weekly series, An Ordinary Journey Through Health, Illness, and Aging.

Those of you who read the introduction to my health and aging series already know that about three years ago, I began to feel weary.  My legs weighed two hundred pounds each.  My daily walks were more a struggle than a pleasure.  By the end, I felt stooped and out of breath.  Exercise felt more like tearing down than building muscles, and it left me exhausted.

I found myself skipping days and replacing my walk with a nap.  I had never been a napper.  In my family, napping was scandalous, almost sinful.  It represented laziness, nothing good to do, not caring, not trying, not anything.  It was bad.  And I was enjoying the naps all too much.  At heart, it felt like a withdrawal from myself, a betrayal of values as much as a physical experience.

I had always prided myself on my energy.  I could work and take care of my children, work out, run and play tennis, and take on building projects around the house.  Nothing thrilled me much more than the two summers and 100 weekends that I spent building a house in New Hampshire.  For vacations, I went backpacking in the Sierra Nevada Mountains, hiking mile after beautiful mile above tree line, with fifty pounds on my back and a feeling of freedom and serenity to keep me company.  I built organizations, wrote books, and took care of patients.  If I got five or six hours of sleep during the first fifty years of my adult life, that was plenty.  There was always much to do.  And I loved being the kind of guy to do it.

For most of my life, I was also healthy.  I felt almost invulnerable long after I should have, believing in some magical way that my immune system was a great friend and wouldn’t let diseases lay me low.  As a child, I had a couple of warts that embarrassed me no end. So I decided that I could get rid of them.  All I had to do was focus mental energy against the warts’ assault on my vanity—a bit of magic that came from some odd recess of my brain.  But the warts went away.  It was only as an adult, when I did a great deal of reading in mind-body interactions, that I learned that warts were particularly susceptible to the influence of the mind.  As a result of this proud or arrogant attitude, I didn’t wash my hands as much as I should have, I didn’t wear coats in winter.  Cold was a matter of mind, I told friends.  I ate and drank whatever I pleased and in gargantuan quantities.

It’s true that having cancer at fifty eight put a dent into the belief in my invulnerability.  And, to be honest, when my father had died at fifty, I imagined the same fate awaited me. I was really of two minds.  Certain that I would die young, probably of cancer, like my father, and equally certain that I was healthy as a horse who could fight off disease like swatting flies on a hot day.  These two belief systems didn’t seem to mingle very much.  They had pretty independent lives.  But I was hale and healthy most of the time, and that became the dominant story that I told myself.

Just before I began to weary, I was in the hearty frame of mind.  Cancer was now more than ten years in the rear view mirror.  I was in the midst of building the Institute for Nonprofit Management and Leadership, which trained young, active nonprofit leaders and emphasized both diversity and social justice.  My heart sang to its mission and to the great young people I worked with.  I got to know literally thousands of people in the Boston area and, finally, began to feel at home here, and not the transplanted New Yorker or isolated psychotherapist I had been .  I was feeling good, feeling at one with myself, feeling almost giddy with success.

Then, suddenly I tired.  What the hell was going on?  My first hypothesis was depression.  I lean that way.  I hadn’t been feeling depressed but, with a setback at work that coincided with the weariness, my disappointment married the weariness to form a story: I was tired because I was depressed.  Once this narrative settled in, I made up supporting stories about why I might be depressed.  For instance, maybe some of those skeptics were right: an old white guy like me couldn’t—shouldn’t?—try to build training programs for young people or people of color. That’s what one foundation president had screamed at me.  Maybe I’d reached my limits and needed to turn the organization over to others.  Maybe I was done.

There was another, reinforcing story that was available, as well: my children, then 42 and 34, had grown so damn independent.  They didn’t need me.  They loved me and we had formed wonderful adult friendships, but they didn’t depend on me.  That was rewarding but also sad. Then, too, a friend had died and another was hospitalized with dementia.  I might become a lonely old man.

You get the drift.  When you receive a blow, a shock, you often latch onto one of several stories that drift in and out of your mind just waiting for a catalyst to make them real.  It’s almost like a pathogen in the blood stream looking for red cells to carry it to vulnerable places.  If you think about it, there are only so many narratives—and themes—that define how you think about yourself.  Sometimes they combine and build power.  Sometimes they don’t and the power of the narrative to define your experience dissipates.  In this case, most of my life felt really good and the depression narrative didn’t stick.

The next and most compelling hypothesis readily leaped out of the dark: I must be weary because that’s what people feel as they get old.  I hadn’t even felt old before but there’s always a first time.  Each person probably tires at different paces but weariness is as inevitable as death.  There was a part of me that welcomed this narrative.  I had worked hard through my life.  I had striven.  I had tried to please and succeed.  Maybe it wouldn’t be bad to rest more, especially if it wasn’t me giving up but a natural condition that was limiting me.  Age sanctioned rest.  Amen.

Others noticed that I looked tired, that I wasn’t exercising, that I was missing a certain fire.  My children seemed to be growing a little solicitous.  “Dad, sit down.  I’ll do that.”  That felt wonderful and terrible.  I appreciated their concern and their help; but I’m a pretty independent guy.  I haven’t liked asking for help, or even being helped.  Still, I thought, I better get used to it.  I had better begin to adapt to being old.  I shouldn’t fight reality.  I should make the best of exactly who I am at any given time.  Isn’t that the mature thing to do?  I supposed that there were a whole lot of things I’d have to adapt to, including a different image of myself.

This narrative of age, maturity, and realism was very seductive, very hard to cast off.

Stepping back, I believe it is almost impossible to avoid conflating aging and illness.  There are so many moments when we are down or ill, moments that, at an earlier age, we would ride through—because we would tell ourselves a different story.  “I’m working too hard” or “I’ve had a rough go lately.”  But weariness fits my imagery about old age.  So does a degree of infirmity, waning memory, and increasing degrees of illness.  Certainly in our parents generation, seventy or so would be old.  AARP tells us we’re old or aging at 50 and lauds us for still being able to walk and talk reasonably.   At seventy one, I’d have to concede that old is old.

It is true that old age comes with limitations, but the stories by which we give meaning to the limitations are formed by a combination of our own and our culture’s narratives.  Sometimes, those narratives distort and limit our experience.

Some part of me fought to free myself of these limiting interpretations.  I searched for other ways to explain the weariness.  As often as not, we discover that the problem isn’t aging—or aging alone—but a specific, treatable problem.  In my case, it was iron deficiency anemia, which could be treated with intravenous infusions of iron, which added tremendous zest to my life.  More about that in our next discussion.

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.

Aging and Identity

Dear Michael,

During the last few years, I’ve wondered how I would feel when I no longer worked at my profession and was no longer part of the community of people I worked with.  Now that retirement is here, I am still wondering if I will feel uncomfortably isolated and untethered.  It’s far too early to tell, but, since you’ve also retired recently, I thought to share some of my immediate responses.

No doubt, there is a lot less stimulus.  It’s not just the level of noise and activity but, more importantly, people to interact with.  Of course, I see friends and family.  But the contact is less automatic and scheduled than my work day, less ritualized.  I don’t have a Finance or Strategy Committee meeting each month.  I don’t have staff people to hold accountable.

I feel relieved by the freer schedule.  There is less rush, fewer people to please, less need to perform, and fewer needs to fill.  That, in a nutshell, is a big part of why I retired.  I also love being by myself.  It’s quiet.  My writing, exercise, and conversations with friends aren’t interrupted.  I love being unobserved.  It gives me permission to be myself, no matter how strong or weak or goofy or serious I feel.  Invisibility is a kind of freedom and a protective veil to me.  I breathe easier.  My muscles relax.

I know that isolation is considered a problem in old age.  It has direct ties to illness and depression.  This is especially true for men.  Women do a much better job of building networks of friends and acquaintances; their lives don’t change as much with retirement.  Men, who are much more identified with their work and much less connected to friends and relatives—especially in intimate ways—have a harder time.  According to research into illness and social networks, for instance, when wives die husbands tend to get very ill or die themselves within the first year.  Not so after the death of a husband.  Women generally find enough compassionate support to sustain themselves.

Like most research, this speaks to the general person.  I’m not that person.  I do have people to turn to.  But the diminished volume and regularity will likely challenge my ability to adapt.  And the challenge that most interests me is that of identity: who I am in the world.  Who am I now that I’m not working and not with colleagues?  Most of every day, I’m not important to anyone but myself. People don’t seek me out as much, ask my opinion, await my agreement before acting. My sister-in-law tells me that this is mainly a man’s problem, and she’s probably right, but that’s ok.  There are enough of us to make this an interesting theme.

Throughout our lives, we know who we are partly through other people’s responses to us.  Do they think we’re nice or mean, interesting or dull, sexy, smart, funny, sane?  We can’t come to a completely independent opinion on these matters.  We don’t live in padded cells.  We don’t just take in other people’s opinions.  We try to influence them.  For example, we try to put our best foot forward, hoping that’s mostly what people see.  Over time, though, they see more than our best.  We try to act like we want to be, but we don’t always succeed.  We correct people who see us in the “wrong” light.  We work hard to live up to other people’s expectations.  We shy away from people who have poor or divergent opinions about us, and we gravitate to those whose responses to us are aligned with how we want to be known.

Eventually, we more or less come to an agreement about who we are.  That agreement forms the basis of stable relationships.  With time, these stable relationships tend to grow more plentiful and prominent.  They emphasize parts of our personality and deemphasize other parts.  As they grow stable, the relationships become more supportive of our identity, which is our public face, mediating between our deep character and our behavior.

Psychologists talk about negotiations between the story we tell ourselves—this is who I am—and the stories that others have. The net result of these negotiations is our identity.  Unlike character, identity is not immutable.  Every time we meet someone new or confront a new situation, we have to reestablish that identity, or try to reestablish it.  But it is never completely the same again.  The very act of trying to remain the same changes us because we have to adapt to places that fit the view of both others and ourselves.  It can be hard work, generally passing through periods of ease and stability and periods of instability.

During stable periods, our identity holds us, gives us the experience of a solid self.   This works a little bit the way that the psychoanalyst, Donald Winnocott, believes mothers hold their babies and, thereby, create children with the opportunity to build sturdy lives.  When we know who we are and we feel relatively pleased and safe in that identity, then our lives can proceed with some sense of security.  Other people see the consistency and think you authentic.  There isn’t much negotiation to do.

Unstable periods are different.  They take the form of what psychologists call identity crises, such as the periods we call adolescence and midlife.  In the midst of these crises, we often feel uncertain and needy.  We may not know how to break out of our confusion, how to convince enough people to see us how we want to be seen. Our actions careen all over the place.

Combined, retirement and old age often precipitate identity crises.  The only difference between aging and adolescence seems to be that we older folks have our eyes open.  Our bodies change; we gain freedoms; we feel like we are searching for something that isn’t yet clearly in sight.  We may want to take charge of this change, as we have during other crises, but it often feels like the changes are happening to us and out of our control.

I have a number of friends who seem quite content in retirement.  They cherish their freedom, the time for long-delayed activities, the absence of work-related tension.  I hope to be one of these lucky people.  But there seems to be unfinished business.  Getting to the other side of the identity crisis seems to require of me that I answer certain kinds of questions.

One set of questions has do with an assessment.  I have mostly completed my life’s work.  My children are on their own, doing well, and raising their own broods.  My professional career is behind me.  I’ve done what I’ve done.  But is it enough?  Did I do well enough?  Can I be proud?  Where should I tuck my failures?  What should I do with the remaining anxieties?  No one else is very interested in this report card.  So I often find myself in dialogue—and in negotiations—with myself.  And not just my current self.  I want to know how my younger self would evaluate me.  It goes something like this: “Did I fulfill those aspirations that you had for me?  Did I live according to the values that firmed up by the time you were a young man?  Would you be proud of me?”

Sometimes I seem to be in dialogue with a much younger, less filtered self.  When I am alone, which is more often these days, I day dream.  I muse about the child that I was, the way that I ran and laughed and swam in the sun.  Somehow, I feel that I need to bring that child back into my current identity.  I don’t have to work now, which means I don’t have to keep him at bay and I can play.  He’s not an interference.  But yielding to him can be confusing.  At such times, my identity grows a little chaotic.

So I’ve got work to do.  I need to complete my self-assessment, the good and the bad, and come to conclusions that leaves me at least somewhat at peace.  And I need to reintegrate the child in me.  I think then I will have navigated this developmental crisis and be prepared for a time of stability.