The story of aging is a story about what it means for us to be human and is a must for all of us. It is both an eternal story and one that changes rapidly with the advancement of science, technology and society.
All people will grow old. With the extension of modern human lifespan, old age has become the third and final stage of life after childhood and adulthood. In modern society, this stage can occupy 40 years or more of our lives. But whether in the United States or China, we are living longer than ever before, but it is easier to metaphor old age as a disease, a condition of fear, despised, neglected and denied. Youth and efficiency are the sonata of the times, because we always try to avoid the signs of aging and death.
In Generation Silver: Redefining Aging, Rethinking Health Systems, and Reimagining Aging Life, Louise Aronson, a geriatrician, educator, and professor of medicine at the University of California, San Francisco (UCSF), presents a revolutionary view of aging and discusses societal and medical attitudes toward aging. Aronson pointed out that we need to redefine "old age" and give it more meaning, more positive meaning.
The following content is selected from "The Silver Generation: Redefining Aging, Rethinking the Medical System, and Reconstructing the Life of Old Age", which has been abridged and revised from the original article, and the subtitle is added by the editor, not the original text.
"The Silver Generation: Redefining Aging, Rethinking the Medical System, and Reconstructing Old Age", by Louis Aronson, translated by Jiang Yiqi, Zhang Guanglei and Zhou Zhe, CITIC Publishing Group, July 2022.
Nowadays we all know how old we are, but in Western societies before the 18th century, not everyone knew their birthday and age — except for Greek or Roman writers and others who knew their exact age. People are called "youth" or "old people" based on looks and behavior, not on chronological age. Therefore, both terms may be used to describe a person whose actual age is 40.
It doesn't have to span centuries to find changes in perceptions about stages of life. In the early '50s, my mother was in her early 20s, and my grandfather was worried that she would become an old girl. Seeing that the friends around me were all married, but my mother was still dating and breaking up with one perfectly acceptable marriage partner after another, my grandparents became more and more anxious. It wasn't until my mother got engaged to my father at the age of 24 that they breathed a sigh of relief. In my generation, there are very few friends who married in their 20s, and most of my peers get married in their 30s. In fact, in the past few decades, my family's social situation has not changed, what has changed is the so-called "normal".
Extending the longer span will see a more dramatic change in perception. If my mother and I had been born in Europe in the late Middle Ages or the beginning of the Renaissance, we would probably have married at 12. In those days, menarche meant female maturity, and the concept of puberty simply did not exist, let alone higher education, career development and intimacy not for the purpose of marriage in adult life; If she is lucky enough to live into her 30s, women will surely become grandmothers, and it is impossible to have only two children in her 30s like my mother did, or to be an unmarried female doctor in her 30s like me. Normal standards depend not only on the context of the era, but also on your identity and status in that era.
The human brain automatically classifies itself. Chinese, Iranian and Greek writers have all written about boys, men and the elderly. In recent years, the age distribution of human beings has changed too rapidly, and the social language and mechanisms of people aged 50 and over 60 have not yet been formed. Nor have the individual diversity of this group been recognized to maximize their individual and social potential on this newly magnified canvas of human potential.
Laslitt recognizes that prejudice is being universally imposed on people over the age of 60
The French seem to have an innate ability to discern different stages of life. As early as the 70s of the 20th century, they designed educational and social activities for retirees, which they called "third stage universities" or "universities for the elderly". These two concepts spread to England very early, after which historian Peter Raslett popularized the term "third stage", arguing that the term "fills in the desire to find a word to describe the long-term needs of the elderly population, and the word has not yet been misinterpreted".
Laslitt also made what he himself considered "radical" to say that the third stage is the highest point in life. Laslitt explains that life stages are divided sequentially, not by age. It is possible for a person to be in the first, second, and third stages of life at the same time, such as young people (such as female gymnasts) who have reached the highest point in life while working to support their families. Laslit stressed that there could be no overlap between the third phase and the fourth stage. There is a hole in Laslitt's theory here: he defines the first two stages of life in terms of age-related behavior; Define the third stage in terms of personal achievement, and believe that the behavioral meaning of the third stage should transcend the age level; And the fourth stage is defined in terms of biology. This way of defining people of different ages with different measures loses clarity, fairness and fairness.
Stills from the movie "Flying House Travel" (2009).
The age difference between the third and fourth stages does exist, the younger and older people, respectively, but the main differences should be in health, social activities and consumer roles. The third stage means "smooth aging", while the fourth stage means weakness and dependence. Laslitt refers to the stages of life after work and after childhood as "the crown of life" and "the period of self-actualization and fulfillment." He argues that the third stage is a concept that has only recently been added to the stage of life, and should therefore be used to "establish, shape, maintain, and expand" social responsibilities and functions.
Laslit also defined five challenges posed by the third phase: recognizing changing demographics, supporting a large non-employed population, developing social attitudes and social morality in the face of false stereotypes, developing the corresponding social perspectives, mechanisms and organizations that give this new phase of objectives, and addressing the problems of the fourth phase. Although Laslitt does not thoroughly explore the impact of a person's economic and social situation on their third stage experience, he does recognize that stage four can suffer from a variety of prejudices that are being universally imposed on people over 60. Laslitt believes that the ultimate goal of dividing the third and fourth phases is to maximize the use and enjoyment of these two periods.
Some say that too much attention has been paid to stage III than to stage IV, but the current situation in the geriatric community is very different: the field has paid more attention to stage IV from the beginning to the present, both good and bad.
The third stage of the population is the mass consumer group active in society. Although many are near-or completely retired, they remain active – in fact, their autonomy is one of the two key characteristics of this group. The luckiest seniors at this stage are buying anti-aging products, joining gyms and social clubs, traveling everywhere, and volunteering. Their behaviors, attitudes, and lifestyles are more in line with the lifestyles of the middle and wealthy classes in the culture of consumerism and the history of society. It seems to be the "adult version" of the social culture of the 60s of the 20th century: the emphasis on youth, beauty, personal choice and self-expression reflects their relentless efforts to move away from the label of "elderly".
However, not everyone who crosses middle age can enter the third stage, and there are many people who, although subjective, have subjective initiative, but their behavior does not fall within the scope of the third stage. The concept seems universal because it includes the people most likely to write, express, and create art and markets, and it is these people who define the "third stage."
Raslitt believed that the fourth stage was determined by biology and was an eternal concept. As long as you live long enough in human history, you automatically enter this stage and experience inevitable decline and shame. Chris Girard and Paul Higgs argue that the fourth stage is "a combination of a pervasive failure of self-management and the consolidation of this failure through institutionalized care," with the result being "stripped of its most valuable social and cultural capital." They assert that "the emergence of Phase IV is the result of the development of health and social policy in the 20th century" and the "bitter fruit" of the efforts of Phase III to manage attractive, useful, and socially engaged older persons.
Raslitt's goal is to resist malicious and demeaning evaluations of older people that deny their social status and self-esteem. This goal is certainly valuable, but limited to "helping all older people gain social status and self-esteem." If it allows relatively younger, healthier older people to easily achieve this goal at the expense of "older, less healthy old age," all efforts will backfire.
Advanced age always makes people have negative associations
On June 16, 1858, Abraham Lincoln said in his speech that "a house divided in half cannot stand." In this half-century, dividing the stage of old age into the third stage and the fourth stage has done little good except to actually provide some false help to the elderly in the third stage, thereby worsening their suffering in the fourth stage. Prejudice and division nourish regression. When we think that some lives are more valuable than others, we are also putting ourselves at risk. Morality should be the bottom line of ideas: do we treat all people equally? Do you despise some people? The so-called "inability to achieve absolute fairness" is by no means an excuse to ruthlessly belittle any individual or group.
Advanced age always evokes negative associations: resistance to physical aging, fear of losing bodily functions, a life of poverty and a humble social status, and a sense of detachment from real human groups with subjective initiative. In this situation, they cannot define or defend themselves in any way. Some old people may be able to express their preferences, while others have lost the ability to express, obviously they cannot achieve most of the things they want to do in their hearts. In those bad scenes that happen frequently, all they can do is scream and cry, or spend time in bed, kick or bite things. Given the above, people will say they are "bad" or "difficult to get along with." They are punished, abandoned, kidnapped by the system, neglected, literally tied up and even sedated. Even if they prepare for these beforehand, they cannot ensure that in the end their wishes will be respected. In fact, how they are seen, how they are treated, and every aspect of their lives is controlled by others. The only relief is death.
Stills from the movie "Flying House Travel" (2009).
My use of "they" to refer to the people of the fourth stage is somewhat accurate. Because I am not currently one of "them," and we will become "them" for some time in the future, maybe days, weeks, months, or years, unless we think about and respond to Phase IV in an innovative, unprecedented way and make it normalized, institutionalized, structured, and universalized. We thought we could find this way, and if we were to manipulate aging biologically, then we might actually be able to do it. But what if you can't? Why not turn these efforts into attention, funding, and creative investment at this stage of life? Even if stage four is really the black hole described by Girard and Higgs, which can only be described by its effect on other things, at least we can make its effects more positive and make this description more accurate.
My mother said she would rather die than live an advanced age with dementia or disability. If there are such signs in her life, then no matter what problems occur in her body, she will not want treatment again. Her words were not "even if this disease kills me", but she did not want to treat it, hoping that this disease would kill her. She was also worried that she would live to that day without any illness, but only survived in a body similar to her but not at all like her. She may not be quite aware of the differences between these situations, but she thinks this future is terrifying, not only for herself, but even for us, her family. She feels that these care costs are not as good as those who feel "value for money". I thought, happy dementia people are there; But I also think that more people are in a situation where they can be said to be "surviving" in a life without any obvious benefits. Most expressed pain and even more so appeared to be tormented. But some families do not think so, and some religions assert that life is sacrosanctity under any circumstances, which leads to difficult decision-making, even if it is crucial to the discussion of this stage of life.
My father once said that if he had dementia, he didn't want to live. But after he did suffer from dementia, he was still happy that he was still alive. "My life is very happy." When he said this, he felt both proud and satisfied, and sat on the hospital bed and gushed, becoming the focus of the audience. At this time, he was as kind as ever, forgetting all the unpleasantness. "But I don't mind being happier." He agreed to undergo various medical procedures and surgeries, but when he did enter a state of life that he did not want to accept—a state in which he was pretty sure he would not feel happy—he could no longer express his feelings or discuss any abstract concepts such as "the meaning of life" and "at what moment one might lose what matters most."
As my mother said those words, she probably also thought of the bad last years of my father's life, and the years before that, of the impact on other family members. It is true that caring for a sick father is difficult in many ways, but at the same time it is very important because it defines what "family" means. If I had to choose, I would again take care of my father without hesitation and willingly. My mother knew this, and she knew I was willing to do the same for her. Still, she fervently hopes that there won't be such a day.
"Typical opposition of normality and pathology": is old age a disease?
What we know about aging depends on who we turn for information. Approaches to the study of aging involve medical approaches, developmental approaches (biopsychology), institutionalization approaches (socioeconomics), and cultural approaches (stereotypes and perceptions). Sociologist Carol Estes has studied the medicalization of aging in the United States, which originated in the 19th century and continues to this day.
Before the 19th century, aging was seen as a natural process, while advanced age was considered a life achievement. With the development of the medical process, medicine has the right to define normal and pathological, and human behavior, physical function, and physiological state are all reinterpreted. Natural and cultural phenomena that were previously conceptual have become easy to diagnose, manage and treat. Popular magazines no longer talk about longevity, but publish articles about aging and its medical symptoms. People from all walks of life define old age as a social problem and shift their focus to "pathology": physical and mental limitations, poverty and dependency.
Stills from the movie "Flying House Travel" (2009).
While medicalization has in some ways created opportunities in the field of old age, creating jobs to treat the "disease" by portraying the authority of medicines, and legitimizing the problem of aging, it also limits the response of individuals and societies to the problem, and this is the problem. It is not uncommon to pursue more medical treatment without focusing on the needs of patients.
The medicalization of old age is normal in the eyes of those who take it for granted, and most of them are not old (regardless of biological age, they do not see themselves as elderly). Others argue in good faith that the pathological consequences of the medicalization of geriatric problems should be avoided, claiming that the elderly group should follow different standards of treatment. The skin of the elderly is thinner than the younger and more susceptible to tears, abrasions and breakages, which is a very common phenomenon in the elderly group. But the question is, can these normal phenomena (such as decreased vision in the dark, difficulty in hearing sharp sounds) not be counted as medical challenges or pathological phenomena? Is it normal for the vast majority of older men over the age of 80 to have an enlarged prostate? Most people's answer is no: everyone wants to be deaf and clear, they all want to excrete smoothly, and if they can't do this, it means that it is abnormal, that is, a pathological problem.
In The Journey of Life, an astonishing book on the cultural history of older Americans, insightful Thomas Cole calls this "the quintessential opposition between the normal and the pathological."
I understand and can cite this idea now because I finally read the work he sent me and can ask more meaningful questions.
For thousands of years, scientists and philosophers have noted the blurred line between the "normal" and the "sick" of the elderly. As early as about 161 BC, there is this dialogue in Terrence's play "Formione":
Demifu: "How did you stay there [in the hospital] for so long?" ”
Coleman: "Because I'm sick. ”
Demifu: "What's the situation?" What is the disease? ”
Coleman: "What disease?" Old age is a disease in itself. ”
If old age itself is a disease, then medical intervention is naturally needed.
If the concepts of old age and disease cannot be clearly distinguished, is it the problem of old age, or is there a deeper problem behind it? Such as the social classification system and our habit of always distinguishing ourselves from others in various forms. In this case, does the so-called normal and abnormal opposing model still apply?
Old age, to some extent, does mean illness, but it is also a natural, normal part of life. However, if we want to further understand the "learning" of old age, we must look beyond the narrow field of medicine and look farther and wider, encompassing all human thoughts and experiences.
Support and celebrate old age in all situations
When she was 100 years old, Sadie Delani described her life with her sister Betsy (who is also a centenarian): "You know, living to our age, you don't know if you'll wake up the next morning, but Betsy and I don't worry about death. Our hearts are at peace. She added: "We have buried many loved ones, and this is how difficult it is to live to this age." Most of the people we know have been reduced to dust. Roger Angel agrees: "In the tenth decade of my life, I found that old age is unbearable because it is full of decaying pasts. ”
But then again, there is always more than one side to the old age story, there is a second, third, fourth... As Angel says, "Most people over the age of 75 are pleasantly surprised to find themselves happy, and I'm one of them." This view echoes that of doctor and author Oliver Sachs, who published in the New York Times on his 80th birthday titled "The Joys of Old Age (Not Self-Mockery)." This title reflects the essence of the article, and there is also this paragraph in the text: "My father lived to be 94 years old, and he often said that the 10 years of 80~90 years old were the 10 years he enjoyed the most in his life." He felt that his spiritual world and vision had not only not shrunk, but had become wider, and I gradually began to feel the same way. A person who lives long enough will have a rich life experience, which comes not only from his own life, but also from the lives of others. ”
These writers' statements about old age dovetail with the descriptions of my patients, whether they are educated, wealthy, immigrant, or native-American. The real problem, more than aging itself, is that older persons are stigmatized, isolated from interpersonal communication, social architecture, social activities, threatened by institutionalization, and deprived of autonomy and human rights. What was originally a somewhat difficult normal life has transformed into despair and misery, and we always attribute these two points to aging itself.
Stills from the movie "Flying House Travel" (2009).
Let's take a look at how the so-called "microaggression" of everyday life demeans the elderly: "You can even get up and walk around like this!" "Where are you old?" "Are you really all right?" Or "That old lady is so cute!" "What can we do for him today?" "Hello, young lady!" "I know it's not polite, but how old are you?" Think again, there are many non-verbal microaggressions against the elderly: contempt, ignorance, arrogance, condescending attitude; unasked "help"; pushing and shoving on the street; stairs without handrails; chairs without handles; ill-fitting clothes; Technology tailored to young people's fingers, vision, hearing and preferences; ridicule from others; Supercilious; increase the volume; not looking directly; Talk to them like children.
If we don't like aging, of course, we don't want to get old, and we don't want to be associated with the old age that means "old". We are afraid of aging in our young adults, lament the lost body functions, colleagues and friends in old age, lament that we are eliminated in the workplace, despised and marginalized by society, and finally we truly feel the "loneliness" that accompanies old age. We don't want to argue or argue endlessly, because it's all futile. But equally, we don't want to be dependent on others, helpless, desperate, and institutionalized, which most of us eventually experience.
However, if we only see the bad part of old age, then it is tantamount to seeing parents taking care of unwell, crying babies and staying up at night, only seeing parents worry that their adolescent children are becoming more and more rebellious and alienated and lose sleep until the early hours of the morning. These are indeed true, but they are only the tip of the iceberg.
A little bit of cartoons or famous aphorisms about human lifespan gives you the illusion of two things: first, nearly half of life is spent transitioning from infancy to adulthood; Secondly, life is interesting before entering middle age, but after that it becomes frustrating, serious, confusing, and always downhill. These evaluations and descriptions of middle age are quite accurate, but they are completely applicable to the old age of Americans.
To most people's surprise, a large study in the United States showed that middle age is the period when men and women have the lowest happiness index, highest anxiety index, and lowest life satisfaction, and the situation does not begin to improve until they reach the age of 60. This phenomenon is not the result of human effort. The Gallup World Poll looked at all types of countries around the world – large, small, poor, rich, agricultural, industrialized – and showed that life satisfaction in rich countries is U-shaped with age, while the situation varies in other countries. Data from the United States and Western Europe confirm that most people are happier in their 60s than in their 20s, and have continued to climb since then.
The increase in the happiness index of old age seems to be a combined result of a decrease in negative factors and an increase in positive factors. A recent study shows that people's anxiety has steadily climbed since adolescence, peaked at the age of 35~59, began to decline at the age of 60, continued to decline at the age of 65, and then reached the lowest value of the life anxiety index. Compared with people aged 20~59, people aged 60~64 are happier and more satisfied with life, but less happy than people aged 65 and over. Even people over 90 years old are better than middle-aged
People are happier.
As the poet Marie Ruffler said, "Do not be afraid of aging, for you have not yet tasted the absolute freedom that old age brings, which is shocking and intoxicating." You no longer care what other people think. Once you become 'invisible', which usually happens to women earlier, you have a shocking freedom. All the authority figures in life are gone. Your parents have passed away one after another, and yes, it's heartbreaking indeed, but it's also a wonderful relief. "All in all, based on different measures, seniors around the age of 70 outperform younger people in every way, experiencing less stress, frustration, worry and anger and enjoying more joy, happiness and satisfaction. Various similar studies have shown that the happiness index of life peaks at the age of 65~79, followed by the 80s, and finally 18~21 years old.
Stills from the movie "Flying House Travel" (2009).
These findings are so high in generality and so different from social common sense that they are compelling. Ironically, those who are considered to have the most social power and influence are often the least happy and least satisfied. This may not be a coincidence, after all, these people are also to blame for spreading false information about old age.
Human old age is very different. For most people, it is not aging itself that brings suffering, but rather a range of social behaviors that threaten and harm, such as lack of purpose in life, poverty, exclusion, and isolation. How to create a better old age? The answer to this question lies in bridging the gap between hard data and entrenched social biases. At the beginning of Plato's Republic, the elder Kfalos describes his peers to Socrates:
Some friends sigh and complain about the misfortune of aging. But it seems to me that they did not identify the core problem. If aging is the root of the problem, then I and other elderly people should be in the same pain. But in fact, many elderly people I know have completely different feelings about old age.
This is good news for the elderly. Human limbs, skin, heart, and brain all change with age, and the ancient Greeks must have experienced the same changes, which is an irreversible fact. But we can turn beliefs, emotions, actions, and policies that support and celebrate old age in all situations.
Originally written by Louis Aronson
Excerpt / Ho Ye
Editor/Zhang Jin
Proofreader/Liu Baoqing