Some years ago, I spent a sabbatical year as a fellow at Stanford’s Center for Advanced Study in the Behavioral Sciences, doing research and finishing a book. A group of psychologists met each week at the center to discuss and (mostly) argue about stigmas and stereotypes, seeking to understand how the social responses to people with disabilities influenced their self-images.
Much of the dialogue had to do with differentness and what it means, particularly to those whose physical and/or mental personas are noticeably “unusual.” How do we view the freaks at the circus, and how do they view themselves and us?
For me—and for those of us who are older and hence “different”—a shifting self-image is based not only on the changed person I see in the mirror, but also on the behavior of those around me. “Let me help you cross the street.” “Why don’t you take my seat?” “Would you like to take a nap?” The solicitude is always heartfelt, but it reflects a stereotype.
We are characterized on the basis of a number of assumptions: we’re fragile, our memory is spotty, our energy is low, we’re anxious about the next DMV license exam, we fall more often. And to some extent, all of that is true.
I was 70 when I began to notice a change. My writing slowed, my work was less efficient, my alertness diminished. I was still skiing vigorously, playing tennis, exercising my body and brain, but as evening approached, I tired. I was no longer able to read until midnight or stay late at social gatherings. What is my problem, I asked myself? Ten years later, I’m still trying to assimilate this passage into a new and different me.
Many of us at this stage of life have a new awareness of fatigue, a state somewhere between good health and illness. With it comes a realization that our independent life of a few decades earlier was a radically different period. Our self-image, formerly set at 35 or 36 (more or less) and associated with our lifestyle at that time, is transformed into that of an older person. The fatigue of aging begins to merge with the aging from fatigue—the psychological effects of the onset of a new and less acceptable era. In short, we must adjust to “being old.”
Our concept of what is aged changes almost from the moment of birth. When I was a small child, my mother and dad, then in their 20s, lived on a distant and remote planet, separated from me by an infinity of time, presence, size, voice and authority. Soon 40 became the realm of the ancient; then 60; then 80. I can now say with the authority of an octogenarian that this notion works in the other direction, too—my grandson (whose commitment to snowboarding and skateboarding is unshakable) is very youthful; his 55-year-old father, my son, is merely young.
Although the likelihood of serious illness increases as we grow older, it may be casual infirmities that fill our days with discomfort. Not long ago, my wife and I had a wonderful time in Tucson, Ariz., shared with old friends, and with good tennis each day, although my elbow was somewhat uncomfortable. On our last day there, I banged that same elbow on the arm of a chair. The next morning, it had grown to the size of an orange, a red, hot ball of fluid, and swelling and inflammation ran down my arm to my wrist. My internist placed a needle in my olecranon bursa, withdrew a syringe full of fluid and counseled ice, Vioxx, elevation, compression and an antibiotic. A few days later, the surgeon added an extension cast to the list of remedies, and told me five weeks in the cast would clarify whether surgery was required.
Suddenly—with my right arm useless—I found myself unable to tie my tie, shave, button my shirt, use a knife and fork. I could no longer attend my 7:25 a.m. exercise classes and had to cancel my tennis matches. The soreness interrupted my sleep, and the sleep deprivation left me tired and spacy. Work? A few hours a day at most, and then with little of my usual enthusiasm. Fatigue? A constant.
Is the decline of aging and its accompanying fatigue inevitable? It’s hard to avoid except by premature death, a radical intervention. By 75, about 30 percent of our cells have died. Large amounts of muscle and bone have atrophied.
The good news is that life expectancy has increased strikingly during the past century, and more seniors are remaining in relatively good health longer than ever. The quest to slow aging is a priority in biomedical research, but the likelihood is small that any manipulation soon will significantly extend the human life span. Even if we could live longer, why would we want to?
Living on the Stanford campus, as my wife and I have for many years, provides the sense of renewal that comes from seeing bright young faces repopulate the University each year. It strengthens my conviction that the cycle of life has a profound inner logic to it. Why are we so concerned about our grandchildren’s lives if not because they are an extension of our own? Our DNA lives on into future generations, so we must help preserve the resources that ensure happy lives for them. Perhaps our efforts at lengthening life should be supplanted by a broad effort to better life in all its dimensions for older persons.
Some of us belabor our existential condition: our 70 to 80 years of excited living become submerged in apprehension that there are only 5 or 10 to come. Others savor the taste of each awakening and spend the day as though it may be the last, filling it with present satisfactions. It is a time when work may become synonymous with play, and play with work. Relationships with family and friends lift the veil of fatigue and are rich with the joy and emotional power of love and shared experience. The trick is to place the demands and vexations of this stage into a larger network of experience; one that allows us to step outside our “old” selves and renew the spirit that makes us truly “different.”
It takes some determination, especially when your back is bothering you; but doing so engages, distracts and connects. It keeps us living, not just alive.
Herbert Abrams is professor of radiology, emeritus.
