I awoke today preoccupied with thoughts about aging and its place in a life—Thoughts about aging as a phenomenon and as my experience and how it came on me as a surprise. I then moved to an obvious question: When does aging begin? (I know well enough when it ends.) My assumption is that it’s primarily a physical process with each step linked to mental accompaniments: emotions, interpretations, anxieties… I never think of our physical and mental dimensions as unlinked but one or the other may take the lead according to situation. With aging, it seems to me clear that it is body first, even if ultimately it turns out that feelings and attitudinal responses become paramount. Initial physical losses begin shockingly early, during one’s thirties and even twenties, but they are marginal and incipient, too early and insubstantial to be of interest here. My working definition will be that aging begins with the first significant physical changes, losses the person considers noteworthy or that alter previous patterns of physical activity noticeably and that are reasonably attributable to the years. For me, this began when I was about 70. I had been a regular and enthusiastic jogger for 40 years and had run a few marathons, many 10K races, and multitudinous daily miles amounting, I estimate, close to 1,000 per year. In a short period, after all those years and miles, I found my pleasure in the exertion waning and that a walk/run pattern suited me better. I note in retrospect that this was not due to leg or joint problems but felt attitudinal and natural. Then at 72 I developed atrial fibrillation (A-fib) and the effects of that on my stamina soon brought my pace down to walking only, less frequently and shorter distances. What had been a habit of the decades became desultory, a shadow of its former self. And so it still is. I recently turned 79. I mark the natural change to my running pattern followed rather soon by the unnatural one (as it seemed to me) imposed by the heart malady as my entry into aging. This may be emblematic as much as anything since I was not previously unaware that diminishments were slowly occurring. Still, it feels like a fitting marker.
Whenever the precise date of onset was, I am more interested now in considering aging alongside its better-known siblings: dying followed by death, or in the popular parlance, Death and Dying (I always wondered why they had them out of order). The pattern of transit out of my natural form of existence, unless interrupted by calamity, would be aging and then suffering (dying) and then death. Suffering should not necessarily be treated in overwrought fashion—It can mean simply experiencing intensely, enduring, accepting such losses as forecast a likely imminence of death. Or, being frank, it can be agonizing, physically and/or mentally, but not always. All clear enough conceptually. In my case, though, and that of a couple of other elders with whom I compared notes, all of my earliest attention focused on steps two and three, dying and death. Beginning in my thirties I became aware of them as treatment issues in my work as a clinical social worker and psychotherapist and followed that with what I considered existential querying of death as an assured event in my life—who knew when? —asking what that should mean to me and how I lived. Also, how would this exploration affect the anxiety that often attends death’s serious contemplation, and more to the point, the anxiety of its indisputable appearance. The knowledge of eventually and ineluctably passing (back) into nothingness can be strong drink but has to be swallowed somehow. I drank via much reading in philosophy, and autobiographical sketches of a number of individuals’ own dying process, and through working as therapist and hospice volunteer with dying patients. I felt I accomplished a lot and was, and still am, comfortable with “the work” and with the reality of my life’s conclusion hovering nearer and nearer, even though I’ve not entered dying territory yet.
It seems odd to me now that I didn’t pay more attention to aging, the first step and the one I have come to think of as perhaps the most crucial. I’m sure that’s at least partially due to the paradoxical fact that aging is virtually impossible for a healthy man in his thirties to imagine while death is not. How could these strong legs carrying me up the mountain not always be strong? he says to himself. Yet we hear about people dying all the time, are aware of accidents and mortal illnesses, see obituaries, but where are exploratory accounts of aging and who, when young or even youngish, would read them or believe they applied to themselves? They can be depressing stories with few wins and many losses. Wisdom is offered as a sop but it’s less often encountered than spoken of. We do know more things, how could we not, but that does not amount to wisdom. I recommend taking what portion you have and being grateful (few but you will find it engaging) and seeking instead for equanimity. There is much to relinquish, much for adaptation and acceptance, a new form of loss around too many corners; there will be deaths of those you know, and in the 21st century, I say sadly, the death of hope for a better world bequeathed in part by you. Aging is, in short, a largely unpleasant process of losing capacities and gaining vulnerabilities. But by no means must it be miserable or even altogether aversive (despite aging’s toll, I’m still usually content). Equanimity will be a reliable friend and one hopes there are a few others, including a life partner, good books, satisfying avocations, and for me, large doses of Nature, preferably daily. We are required to die and should do it well, with integrity and dignity insofar as possible. But there’s more to the story.
Gaslight is the name of a 1940s movie starring Charles Boyer, Ingrid Bergman, and Joseph Cotten. It is well worth watching. As far as I know, it’s from there that the term came to be used as a label for behavior by one person intended to engender self-doubt in another, doubt not grounded in reality but fabricated by the gaslighter. As a former therapist and present elder, it is a term of particular interest to me. My observation has been that there is much in the situation of those aging that can gaslight them. Meaning their existing, though perhaps only beginning and still realistic, concerns about what they see aging doing to them can become exaggerated to the point of over-caution and self-doubt.
Coming from friends and family, it is mostly well-meaning. They want to ensure you don’t get hurt and to demonstrate care and they overdo it, not realizing that in so doing they can plant seeds of doubt unless you are vigilant. “Who said I’m so damned fragile,” you mutter to yourself, and then, but now in doubt, “Have I become fragile and not known it and am therefore at risk? Do they see things I don’t?” I suggest telling them to lay off until after your first fall, and maybe well beyond that.
From clerks and such met in the course of going about your business at banks, restaurants, doctor’s offices, and so forth it may be unconscious but nonetheless pernicious. It is nothing more than fake concern demonstrated through a tone of voice that suggests you may be dribbling on yourself like a child or doddering. These are offensive people and usually young and vacuous (or so they act). I ignore them, unless the falsity comes out in the now common form of “Do we need help with that?” or similar nonsense, in which case you might ask if they’re seeing double or if they themselves need help.
From one’s general situation and often from publications aimed at the aging, it is intrinsic and predictable and can be more readily fended off by being more attentive to circumstances or, in the case of publications, taken for what they are worth (thus not being gaslit), which I acknowledge is sometimes a lot. The fact is that those aging wouldn’t be aging if they weren’t facing losses and deficiencies compared to former abilities. Therefore, a bit more caution is often warranted. There is, after all, illumination without gaslight. While I was without much fear, although not foolhardy, when in addition to those miles running, I hiked frequently in the mountains, there are surfaces and trails and downed snags across streams and much more that I won’t undertake anymore. I don’t sufficiently trust my leg strength, reflexes, or balance. I worry that I may become too conservative but also at the consequences of imprudence, always a balancing act (in both senses of the term).
From oneself as a result of the onslaught just described, gaslighting can be doubly dangerous. As I just said, one can overdo the caution piece. Sometimes a bit of risk is worth it. I think that as long as I can have discussions with myself about whether to do or not to do something, and not know the answer beforehand, I’m holding my own against self-gaslighting. The truth is there are real-world changes that I don’t like but am required to accept, and it behooves me neither to minimize nor exaggerate them.
An abiding concern of mine since I was young has been self- and other-awareness, the ability to penetrate somewhat the veils that obscure ourselves and our perceptions of others. I’ve had times of painful revelation when what I thought I knew about myself was wrong or more limited than I had realized, and similarly toward others. It seems always a slippery business and my particles of wisdom have as often come through ignorance revealed as from anywhere else. The process grows more complicated with age. I often have occasion to ask, for example, whether something like the lost stamina I mentioned is a consequence of age or of poor conditioning or of the heart arrhythmia. I’ve not found an answer and it leaves me perplexed and frustrated, but knowing I can control only one of the three possibilities: I can improve my conditioning and see what the effects are. Belaboring the age or dysfunction factors only distracts. Strangely, it seems we may be more complicated, or just more difficult to read, than when younger. Self-awareness is almost always good (if not overdone to the point of self-absorption), and I’ve come to believe it is more important as an elder than ever.
But often more difficult to trust. The same connection that’s always existed between body and mind processes has no reason to change now. I believe that the mind is not only a brain function but a brain plus whole body one. With the physical diminishments of aging, I lose confidence in my body and for good reasons. The damned thing isn’t as reliable and capable as it once was. It seems that along with that goes confidence in accuracy of self-awareness, acuity of judgment, and perception of the social and political worlds. I think it may be one of our more fraught challenges to get on top of this. There’s little beyond mitigation, and not always much of that, and adaptation when it comes to managing physical losses, but I don’t see why the parallel mental function has to follow, though I allow that it can hardly be oblivious; they’re too closely linked. But this is a time when I want the mind to help compensate for the body’s losses, to assess ramifications of the changes, and to rely on wisdom, experience, and good sense to sustain me. This is a time when second chances are far fewer, decisions made are decisions I must either live with or live with the consequences of changing but can rarely make a really new beginning. I sometimes think of those projects or excursions I had assumed I would do and see now there’s not the time or the physical ability to do them. Disappointments. Accomplishments. Life for an elder is on a deadline. Making mistakes or hurting someone now feels worse than it used to. I sometimes feel as if I’ve moved into a new country where I don’t understand the locals (What the hell gives with millennials anyway?), but know it’s just altered rules, same country. I adapt.
Such thoughts bring the dimension of time before me. It seems rare to find people at any age who use their time consciously and well, and it’s a habit that can easily carry to one’s end. I tend to think without evidence that I didn’t adequately use far more of mine than I should have, but did I? Am I doing better now when there’s less of it left in the store room? One thing for sure about aging’s losses is that they can serve as decisive reminders of brevity. I used to say humorously that illness and dysfunction were Nature’s way of making death less aversive, which I now think is actually true. But short of stage three, those events that don’t kill me but slow me down or cause me pain should help to stimulate alertness of where time is taking me and it’s best I pay attention not only to that but to the possible stops and journeys along its way that could matter to me, both positively and negatively. Dying will take care of itself without my help, but what I do until I reach that point is up to me, even facing serious illness, where attitude and interpretation make a great difference. Aging is not just losses but call after call to take life more seriously, more wonderingly and gratefully and fully.
Who could talk about aging without including doctors? I avoid them as much as I possibly and responsibly can. A friend once told me he’d seen a doctor who told him that if he wanted to stay healthy, he should stay away from medical people. Ironic, but point taken. I give immense credit for the good they do when they do it, but there is a sort of medical morass one can fall into that can begin to seem like the safest place to be when it’s just the opposite. In the years before my parents’ deaths, I saw them retreat into what they thought of as medical protection against their mortal anxieties and failing health. They oriented their lives around medical appointments and since I delivered them to many of these, I saw how they were shuffled from specialist to specialist not seemingly according to a carefully organized treatment plan but rather to keep trying by passing the buck (let somebody else do it this time). Corporate medicine in particular tries to squeeze the time-consuming drops of the more compassionate forms of medical care-taking dry while encouraging quick billable procedures and encounters. Even aside from that there is a well-intended internal force within most medical practitioners that aims to try-try-try, go for broke, never say die, in the hope of cure or mitigation. The notion that hopes should never be allowed to lapse is irrational and insensitive when what is called for is letting alone or palliation and acceptance. Most of all, I intend to stay out of hospitals, which are good places to get sick(er), to lose control of your fate, and to be truly in the belly of the beast of medical practice. One cannot always avoid them (although I have so far) but be clear if the time comes, I say to myself, why you’re going in and for how long and why your need can’t be met as an outpatient. And by the way, do they have my end-of-life documents in hand and will they respect them?
Aging’s deprivation of much-loved earlier activities like mountain hiking is sometimes discouraging but I have been more likely to get depressed when I’ve had to spend excessive time in medical facilities. The road of losses is necessarily rough and pot-holed, and occasional raging at necessity can be gratifying, but not a productive and satisfying place to hang-out for long. And neither would be effectively turning myself over to medical supervision.
I don’t doubt that for many of us who are aging the issue of control over the management and direction of our remaining life is among the paramount concerns. For me, it’s as important as any other matter, except perhaps food and water, and not far back there. After a lifetime of autonomy, while allowing for chosen or accepted obligations and duties, the prospect of having someone else, even if well-intended rather than bent on other motivations (increasingly profit after modern corporate moves into what should be “helping” or service fields)…someone else making my choices is anathema. I have witnessed, and on rare occasions of physical distress even come close to feeling, the pull of dependency, which in some cases becomes a street of no return, and I will resist it until death, necessity, or dementia. This is one reason, by way of comparison, why I object to excessive state restrictions on abortion—I imagine what it feels like for a woman to have her autonomy in such a deeply personal sphere of existence snatched away, or her life perhaps endangered, by those who think they know best, or as likely, merely enjoy the practice of power. (Which is not to say that I don’t find abortion about the most challenging of ethical quandaries.) To exist is to exist as a solitary unit, in one aspect, and as a participant in circles of membership and obligation in others. The communal dimension is altogether as vital as the individual, perhaps more so, but there are a few regions within each realm that are sacrosanct. In areas of conflict, needs that can be met in no ways other than relinquishment of a minimally necessary degree of autonomy have to be accounted for but the presumption is always for leaving well enough alone and respecting and supporting autonomy. I value this all the way up to and including a decision about whether my life continues being worth the trouble of living it after I’ve entered the stage of dying, a stage that can easily become onerous, humiliating, and meaningless. It would be amusing if it were not so offensively intrusive to observe our country, which has little true regard for life, suddenly become ever-so-vigilant when it comes to “protecting” people who are ready to self-euthanize from doing as they choose after thoughtful deliberation. Ironically, it seems to me just one more case of our society interfering with expression of the life-force, in this case acting for its own good at its own end, while imposing society’s own death denial and anxiety on those who don’t feel them. So, I have been sure to assemble all the available documentation related to end-of-life decisions, even knowing how possible it is that prejudiced, recalcitrant “protectors” may not be cooperative, in the hope my preference under certain circumstances for death over impaired life will be respected. Respect and kindness are essential to both give and receive life-long, but at its late stage it seems all the more crucial and fitting. I have given up many of my early romantic notions of a good or dignified death, having learned how rare these are owing to the frailties of the body (not to mention these days the perseveration of medical interventions when allowed to take charge), but I insist on doing it my way as long as possible, and benefit of the doubt should be mine.
Is aging unrelentingly dismal, or should dismal be seen as a good day under the circumstances? As I see it, the first proposition is surely false while the second sometimes makes sense. There are rare occasions when I have a poignant sense of missing an activity I once cherished (too thoughtlessly I think now) and remember the feeling of doing it and, afterwards, of having done it and am indubitably saddened. But they pass swiftly. Everything in its time, the saying goes, and it is not time for that anymore. One of my perduring questions as an elder is suggested by that recognition. What is it time for now? Since I reject the notion that aging is only loss and misery and find that its satisfactions are just as common and meaningful as they were in earlier stages, even while the choices are fewer, I want to answer that. To help, I begin with mentioning what has been gained through aging. It is not uncommonly spoken of among men, and even appears early in Plato’s Republic in conversation between Socrates and an elder, that at last the fires of lust have dimmed. (Or, as Leonard Cohen put it more colorfully in his song “Leaving the Table”: “I don’t need a lover/The wretched beast is tame”.) Other fires, too, have quenched or moderated and I am more readily at ease. Drives and tensions and needs to stand out or accomplish this or that have lost their tang, their motive-force. One can relax, if they have welcomed or at least accepted the change. Pleasures come in different forms. I spoke lightly of gains in wisdom but didn’t mean to imply that it is not sometimes real in some people and valuable when present. Wisdom is perspective, a longer view, broader context, deeper understanding, appreciation and tolerance of differences, knowing better what to care about and when and how much. For many years I have found reading the old Roman Stoics valuable. Self-mastery, interpretation and moderation of emotion, acceptance of necessity, equanimity—All invaluable, particularly for elders. We gain, if we choose to, time, freedom, leisure, better judgment. If we’re determined and fortunate we pay attention better than before, although it’s hard to break old habits, to see the details and frequent beauty. When I was a young therapist, I once sat with an elder man next to his depleted fall garden, both of us knowing he wouldn’t be there to see it next year. Thinking to be wise, I noted the sad look of the mostly dead garden, to which he demurred and reminded me that when spring came it would start its seasonal course again.
So what is it time for now? Well, it could be time to close up the mobility shop and read quality literature and nonfiction, listen to music that moves you, and watch your favorite teams playing on television. I say that seriously if a person’s losses have taken them to the point where that’s what makes most sense physically according to their best judgment. Most of us aren’t there or aren’t there yet. I think it’s not usually time to set off on a brave new course except occasionally following critical thought about it. Those parents of mine I mentioned earlier, when they retired and thought it adventurous, bought an RV and headed out of town—This despite never having had a particle of interest in camping before but liking the image. Within a year the RV was sold and they were at loose ends. My direction, not necessarily based on any conscious insights, was to continue what I had long been doing but in altered forms. As I have for 40 years I still camp, nowadays 2-3 months/year, always alone because my wife doesn’t enjoy it and we both have no objection to time to ourselves. I hike but at different elevations and for different distances; instead of covering the miles I find spots that speak to me, or that seem as if they might, and sit and contemplate the scene. I’ve always read a lot and still do, but have tilted more toward fiction (preferably from the 19th century) and less toward political and cultural analysis and history (there’s nothing new under the Sun and humans continue making a mess of it). I’ve not grown misanthropic but certainly deeply skeptical of the human enterprise. I enjoy watching sports but less than before. And I live on the North Coast of California, a beautiful region, and have easy access to many wonderful parks and conservation areas and try to visit them several times a week for a couple hours’ walk and sit. Based on my experience and observation of friends, I suspect this sort of continuity with modifications is a way that works well for many elders—Changes but moderate and within the context of what’s been meaningful and satisfying before.
I begin to feel I’ve said my piece—the one on my mind when I woke up and began writing yesterday morning. But I suppose I can’t not say a word about the dreaded dementia, which is so much on people’s minds (or what’s left of them?). I admit to ambivalence, obviously not about its relevance but whether, in the three-stage picture that begins with aging and ends in death, dementia belongs with aging or more properly falls into dying. People may live up to ten years after diagnosis so I am inclined to see it as a bridge between the two, although it is perhaps unique in the nature of its impacts. I know not everyone will agree but it seems to me that loss of mind is in effect loss of life. That we allow it to fall within the Catch-22 trap of my not wanting to self-euthanize while still alert and compos mentis and then, after onset, not being taken seriously about wanting death because no longer competent to choose (which, of course, is the reason I’d want to die), strikes me as a great failure of compassion and moral imagination. Once dementia has delivered a person into “incompetence” they won’t be taken seriously, but they certainly should be for what they proclaimed when competent. A complex matter, I don’t deny, but our moral obligations to one another preclude escape into complexity and staying there.
I sometimes make light of my dementia prospects (whistling past the graveyard?), but I too think about it and watch for signs. As things often go in this reeky, rankly capitalist society, dementia has become an industry and as usual when that happens it isn’t a pretty sight, except on the surface. Commonly naming its institutions “memory care” when memory is one of the first of dementias deprivations strikes me as bad taste and lying euphemism. More to the point, however, like all my fellow elders I would dread its definitive appearance on my mental horizon, but have chosen not to worry about the possibility. My memory has gone to hell but that’s an inconvenience more than anything. I also notice a bit more difficulty retaining facts as I read and have to attend more deliberately for full conceptual understanding. And to be honest with myself, I’m probably not as “smart” as I once was, meaning not as quick, retentive, associative, and likely more, but I get along. One of the worst things about it for me would be that Catch-22 I spoke of. My horror would be life as an elder with the mind of a deliriously happy two year old. Life like death is most seriously diminished when it lacks dignity and much possibility for self-respect. At any rate, I had to bring dementia up and now I have. It would surely be a bitch, but for now is more an inspiration for my earlier self-admonition to live well as long as I can.
As I’ve said, aging caught me unawares while I was focused on eventual dying and death. No longer. In a way, it has become my second to last project.
Craig Brestrup, PHD
October 2024
