Neither heaven nor hell: staking out the radical middle

Susan Jacoby writes cogently on all kinds of topics dear to my heart, including feminism, anti-intellectualism, and the separation of church and state. Her new book, Never Say Die, is a tirade against “The Myth and Marketing of The New Old Age.” I think she’s got a lot of stuff right, especially when it comes to the grim economic prospect of the baby boom –  and the ethical and logistical challenges of caring for an aging population.  I agree that the notion of the “wisdom of old age” is politically expedient claptrap. But I take issue with the book’s central premise that life after 80 holds little but horrors.

In her introduction, Jacoby quotes Mikhail Baryshnikov on the mind of the older dancer: that of “a mediator between your memories and your [current] abilities as a human skeleton.” She continues, “This unromantic description of successful aging is applicable to anyone whose intense desire for meaningful experience remains undiminished by a realistic recognition of time’s indelible, deepening imprint.”  Lovely and true, and it certainly describes Jacoby herself, whose fierce intellectual appetite will serve her well in the years to come. The key word for Jacoby is “realistic”:  she argues that blind faith in science and self-help has blinded baby boomers to the grim facts of life for the old old.

But is it really news that the odds of disability and dementia increase in our eighth and ninth decades? (Alzheimer’s affects close to 50% of the 85+ population.) That it’s harder to balance safety and autonomy? That losses mount up? I don’t think so.  Just the opposite: it’s a persistent drumbeat, a distinct awareness — from which I think most boomers are in full flight.

It’s precisely that awareness that keeps us trapped in the delusion that Jacoby decries: that growing older can be bought off by exercise and red wine, or overcome by anything but death.  As the years pile up, this denial stops working as well. Mortality approaches in the rear-view mirror, where sure enough, “objects may be closer than they appear.”  Apprehension turns into self-reproach: how could we have let this happen, become the thing we stiff-armed at every turn? We blame ourselves.

Fueled by fear, the blame becomes self-loathing. Ageism, after all, is the “ism” practiced against oneself — one’s future self. So unless or until we come to terms with the transition, it is internally consistent to hate what we have become.  This internalized distaste, especially as we get on in years, is ageism at its most pernicious and paradoxical.  It blinds us to ageist attitudes, in both ourselves and others (starting with the absurd aversion to the word “old” itself, unless applied to furniture or Masters).

It’s just not that bad
Here’s the crucial and counter-intuitive point: screw up our courage and face what old age actually looks like, and we see a landscape very different from the scorched earth of our nightmares.  I think of it as looking for monsters under the bed; no getting away with the running leap from the doorway that worked so well when I was six. There are monsters under the bed, formidable ones: disability and death.  But just looking  — the act alone — renders less fearsome whatever we encounter. For me, there was refuge in scientific observation. I’m still afraid of dying, but none of the octo- and nonagenarians I interviewed were, and geriatricians anecdotally confirm this mindset on the part of the very old. The odds are that I’m going to join these men and women in the “not-scared” chunk of the pie chart, and that comforts me.

There are plenty of other demons under the bed: walkers, Alzheimer’s, the chin thing. But even a cursory glance down a city block or supermarket aisle (scientific observation!) turns up older people in all kinds of shape, from dapper to doddering.  As geriatricians say, “If you’ve seen one 80-year-old, you’ve seen one 80-year-old.“ Blindingly obvious in hindsight, that new awareness freed me to see the terra ahead as less incognita than I had  imagined. I started to envision the Home for Superior Women of which I hope to be the cranky doyenne. It’ll be a while before it comes into focus, but the garden is going to be gorgeous. Geriatrician Joanne Lynn described herself as an “old person in training,” and I think this inner reckoning is what she’s talking about. It loosens the grip of the exhausting illusion that the old are somehow not us — future us, that is. It derails the “otherness” that powers ageism, just the way differences in skin color or gender fuel racism and sexism. It opens our eyes to ageist biases in ourselves and others, and frees us to take aim at it. And the facts themselves are far more nuanced than Jacoby suggests.

“I believe that an honest look at the prevalence of bad, worse, and worst-case scenarios is a precondition — the precondition — for figuring out how to improve those scenarios,” writes Jacoby. Agreed. But an honest look at the better- and best-case scenarios is crucial too. No sane 90-year-old is likely to believe that “the best years are still to come,” she writes. Duh. But although that old guy on the park bench might appreciate some company, that doesn’t mean he’s miserable. “Endlessly cheerful portraits” do older people no favors, but neither does the presumption that even highly circumscribed lives are not worth living. From the outside, what we lose as we age is more obvious than what we gain, so we presume that older people are worse off than they themselves experience.

Jacoby sees all the pitfalls and none of the promise.  The individual reality is often far less grim, and the collective one would be far less so if we summoned the political will to ensure that most Americans make it through the ends of their lives with decent healthcare and a modicum of financial security – a case that Jacoby makes and sustains brilliantly. But we boomers aren’t going to get there collectively without some inner reckoning along the way.

The “new old age”
In her very first sentence Jacoby takes aim at “the media blitz touting the ‘new old age’ as a phenomenon that enables people in their sixties, seventies, eighties, nineties, and beyond to enjoy the kind of rich, full, healthy, adventurous, sexy, financially secure lives that their ancestors could never have imagined.” Two paragraphs later she acknowledges that there’s “considerable truth” to that assertion — for those who aren’t poor, ill, or demented. That’s a serious qualifier. But sixty is different from what sixty used to be, and so, for the fortunate, are the decades that follow. Eighty’s not “the new sixty,” but it is to a considerable degree a new eighty.

“The idea that there is a new kind of old age, experienced in a radically different way from old age throughout history, is integral to the marketing of longevity,” Jacoby writes.  I’m with her 100% when it comes to the immortality hucksters, as well as the profound complicity of their customers. Bill Stein and great-grandaughter Penny
There’s no “new kind” of aging. But there’s a lot more of it, and it’s healthier: Americans have gained an average of ten healthy years in the second half of life.  This is a remarkable accomplishment, as is the fact that four living generations is becoming commonplace — an evolutionary threshold.

The shameful counterpoint, as Jacoby would confirm, is the fact that although the black/white life expectancy gap narrowed between 1970-84, it has since steadily declined. The next generation may see the first-ever decline in American lifespan, triggered by growing rates of obesity. Both temperament and circumstance stand between many Americans and old age, not to mention a good old age. Not everyone ages well, because of who they are (depressed, reckless, extremely self-involved) or what they are (poor, frail, isolated, African American, female) — or lives long enough to grow old. (For the best crack at a long life, become a wealthy Asian-American man.)

Nevertheless, the longevity boom represents an impressive accrual of experience and productivity.  This profound demographic shift, which is playing out on a global scale, has positive as well as negative implications, and we need to keep both in mind in order to make the most of it.

The notion of “successful aging”
Jacoby writes that successful aging often “means only that a person has managed to put on a happy face for the rest of the world.” In fact no one, except maybe your mother, is all that interested in your pains at any age. Or your achievements, for that matter. Not long ago my acupuncturist asked one of his older patients, “Is the secret of aging gracefully never telling anyone how you feel?” Astonished, she said, “How did you know?”

I’ve never been graceful, though the aspiration comes to mind when I lurch for the doorknob to help me straighten up first thing in the morning.  Stenosis!  L4/L5 badness! What my mother and grandmother called “stiffness” that turns out to be arthritis!  I try to shut the fuck up about it because I don’t want to bore and because that helps keep it from ruling my thoughts. Cranky whiners — and I am cranky — are cranky in youth and middle age as well.

Aging with grace does take courage and forbearance, but so does every stage of life. Those qualities don’t materialize in late life if we haven’t drawn on them earlier. I think of my friend Les, who spent months on crutches in agony from a femur pancaked as a result of avascular necrosis.  When I pressed him as to how he coped, he said, “I forced myself to smile. I was really tired of everyone feeling sorry for me, and it shifted my frame of reference. It worked, it gave me a feeling of agency.” Les is no Mr. Sunshine, by the way; he’s a gloomy anarchist.

Am I far too young and able-bodied for my aches and pains to count, as Jacoby would argue? It’s true that none of it keeps me from doing what I want to do, at least not seriously, at least not yet. I hope that the circle will shrink so slowly that I won’t really notice, or when I do it won’t matter too much. Perhaps that’s delusory.  But with a little help from Advil, gin, and Ecstasy, I do stay vertical, not just because it’s more fun but in order to hold my own against the tide.  It doesn’t feel like staying young, it feels like getting older, but somewhat on my own terms.

Jacoby is right to challenge the “media’s focus on healthy, well-off sixty-somethings as models of what aging can and should be like for everyone.” Escapist thinking does help obscure the physical frailties of the old old, and the economic challenges that confront a graying generation with little in the bank. The “successful aging” model, which promotes active engagement, now predominates in geriatrics, and I’ve embraced it on this blog. But who is Jacoby vesting with authority when she writes of “successful aging awards” that go only to “those who have managed . . . to avoid, or convince others, that they have avoided the arduous uphill fight that eventually consumes all who live too long to retain control over either the mundane or the important decisions of everyday life.”  That rules out pretty much everyone over 80. Yes, skydivers get their names in the papers, but so do centenarians, just for traveling that far. My heroes include the housebound, like my friend Lily who died at 101. “Successful aging,” by one key measure, is simply not dying.

Jacoby dismisses the many studies that show people happiest at the very beginning and ends of their lives because few respondents are over age 80, but my interviews and reading support the data. Isn’t belief in that “U-shaped happiness curve” equivalent to Les’s smile – an optimistic act that has the potential to affect the nature of the experience? Not an act of faith, but a rational choice. Jacoby would probably call this as denial, a delusion bolstered by knee replacements  and our generation’s faith in endless self –transformation. For sure I hope for exemption, first and foremost from the ravages of dementia, but that’s different from denial.

A new ageism, really?
Ageism, writes Jacoby, is “a charge that will inevitably be leveled against anyone who questions the unrealistically cheery image of old age” promoted by life-extension hucksters and cruise ship promotions. The charge, however, could just as easily be leveled against anyone who buys into those pitches. I don’t agree that celebrating sky-diving oldsters constitutes “a new, more subtle, but no-less pernicious form of ageism.” It’s OK to exalt the exceptionally active outliers as long as we do keep in mind that they are outliers, and that there’s nothing wrong with aspiring to the same status.

Prejudice against older people is pervasive, but it’s the same old ageism: discrimination on the basis of age. The recession has brought it to the fore, with age-related discrimination claims rising sharply and people as young as 40 finding their years an obstacle to employment. By 2025 the number of Americans age 65 and older will nearly double, and the over-80 segment is the fastest-growing piece of the pie chart. Concerns over Social Security and Medicare shortfalls (the first unjustified, the second utterly legit) generate much grumbling about greedy geezers. “It is undeniably worse to be poor and sick at eighty than at fifty,” Jacoby writes, “but the reasons why it is worse have little to do with ageism and everything to do with more general issues of racial and economic inequality.” Why the distinction? Paired with racism, compounded by gender, and enforced by segregation, ageism reflects a society that overlooks its poorest and weakest citizens, who are also its oldest and youngest.

Ageism runs both ways. It drives me nuts when older people complain about school taxes. Don’t they want the guy delivering their oxygen tank to be able to read the instructions?  And which voters were the vocally opposed to government-mandated “Obamacare?” The ones on Medicare, who were worried about their own entitlements — evidence, as Jacoby writes, that “prejudice based on age and on the interests of one’s own age group can cut both ways.” People are scared and angry about vanished savings, worthless house, and disappeared dreams of early retirement. This fear makes it hard to be altruistic or farsighted.

Conflict sells papers, so the media perpetuates the myth of intergenerational competition, a zero-sum scenario in which the old benefit at the expense of the young.  Twenty- and thirty-somethings don’t actually want to throw Granny to the wolves – at least not their grannies. But caring for lots more grannies than ever before is going to be expensive, and will require forging all kinds of new and imaginative intergenerational contracts.

The “bull looks different” problem
Jacoby writes that the most common response to her “skepticism about the virtues of promoting longevity” is that she’ll change her mind if she lives to be 90.  Her sorrowful touchstone is the “reality-based view of aging” represented by her mother, now disabled by the severe pain of advanced osteoporosis (my disease!). Her mother’s mother  “lived too long to live well.” Jacoby’s experience is fraught and authentic. It’s terrible to witness those we love diminish.

Yet what Henry James called “the psychologist’s fallacy” (the false assumption that we can ever really know what someone else is experiencing) is strongly at play here, magnifying both our pity and admiration for the old. At a journalism seminar on longevity, Dr. Thomas Finucane of the Johns Hopkins Berman Bioethics Institute put it in terms that have really stuck with me. He quoted a Mexican proverb: “The appearance of the bull changes once you enter the ring.” (Some of his compelling examples in this post.) Now, instead of the once-reflexive, “Put me out of my misery,” I mutter, “The bull looks different, the bull looks different …”

My guess is that Jacoby finds being 66 way less wretched than it looked at forty. At that age, as she recounts in Never Say Die, she wrote a magazine article “proving” that ‘Old women aren’t troubled by the loss of their physical allure.’”  (Our aesthetic standards are certainly in desperate need of an overhaul. If we can readily see beauty in weathered wood or a tulip exploding as its petals dry, why not in wrinkled faces and work-swollen hands?) This is territory Jacoby has yet to enter, so might it not follow that 85 won’t suck quite as much as she fears today?

Yesterday my chiropractor described re-encountering an old family friend at a wedding. Now in his late 80’s, the friend had been a local wheeler-dealer and an avid golfer, and my doctor was dismayed to find him hunched over a walker.  Gesturing at the walker and braced for the worst, he asked, “Other than this, Sam, how are things?”  With a big smile, the older man responded, “I can do everything except walk!” Did he wish he could still play 19 holes? Undoubtedly. Was he far happier with his lot than my doctor had presumed?  That too.  Or take gerontologist Marc Agronin’s assumption about the a new admission to the nursing home, a wheelchair-bound 93-year-old who had just lost her husband of 73 years. In response to his condolences, she told him “It’s heaven,” and proceeded to take advantage of her newfound freedom by throwing herself into new activities.

I’m “only” 59, but it sure is different from what I thought it would be (if I ever really tried to envision it), better in most ways though not without its set of terrors.  Jacoby quotes from The Dying Animal, Philip Roth’s novel about the affair of a professor in his 60s with a former student in her 20s. “Far from being youthful…” writes Roth, “you feel even more than you ordinarily do the poignancy of her limitless future as opposed to your own limited one …  You note the difference every second of the game. But at least you’re not sitting on the sidelines.” That’s just how I feel when I’m out at a dance club, almost always the oldest person in the room by a decade or two unless my partner’s there too. (The average age of the rest of our dancing crew is mid- to late 30s – a little long in the tooth for the club scene themselves, truth be told.) I’m preoccupied and conflicted, wanting to be invisible yet wanting to represent, happy to tweak these club kids’ notion about what older people might be up to, but worried about appearing foolish. I wonder if I’m doing myself a favor or a disservice. But my friends keep inviting me and it’s just so much fun. No one ever went to her grave saying she wasted too much time dancing. And I know my presence on the dance floor is a strike against age segregation.

One of the paradoxes of aging is that, somehow, it sneaks up on us. We’re perpetually taken by surprise by the incremental changes that face us in the mirror: it’s not how we feel, nor how we think we look. My mother used to talk about spotting some “little old lady” on the bus, followed by the realization that the decrepit passenger was probably younger than her. “How on earth can I have a boyfriend who’s 65 years old?” I wonder, as if I weren’t pushing 60 myself. Jacoby ascribes the fact that she doesn’t usually think of herself as old to having come of age in the “forever young” decade. But the tendency to conceive of ourselves as younger than our chronological age isn’t a boomer trait, it’s a human one.  The “thirty-nine syndrome” peaks around 50 but never entirely disappears. Yes, it’s wishful thinking, but it’s also a function of being rooted in our personal histories. The future, on the other hand, gives us no foothold. “The inability of most thirty-year-olds to imagine what it might feel like to be eighty is a major factor in promoting the myth of young old age,” Jacoby writes.  Um, how about a major factor in the human condition?  Youth is wasted on the young! It always will be, and that can’t be blamed on soulless virtuecrats or shortsighted policymakers.

The personal is political (to borrow from feminism)
I salute Jacoby for beating the drums about the massive political and economic challenges that the longevity revolution will pose in coming years. Congress is plundering Medicare in lieu of genuine healthcare reform, and those boomers not in a fetal position seem to be busy getting botoxed.  We need to wake up, organize, and make trouble, just as we did in the 60s.

Jacoby acknowledges that it’s easier to battle the myth of the new old age when it comes to large social issues (e.g. Alzheimer’s research, Federal standards for caregivers, workplace discrimination) and that arguments are “more difficult to make…on an individual basis, against the elixir of hope for a new old age of sexy skydiving centenarians.” Yes, hope is necessary — that I won’t lose my marbles, that someone kind will make wiping gestures when gunk collects in the corners of my mouth, that my bones won’t crumble until somewhere near the end. False hopes? Perhaps, but different from denial, and like Les’ smile, they make me feel more in control. My broader optimism is based on solid scientific data and on getting to know a slew of 80- and 90-year-olds.  In her outright rejection of others’ depictions of late life as anything other than grim, Jacoby practices what she decries in her conclusion:  the imposition of an external value system – in her case, undue pessimism — on the utterly personal and wildly heterogeneous experience of aging.

A good year after the publication of Cutting Loose, my book about women who end their marriages, I realized that I’d had my consciousness raised. Writing about divorce in a society that values men’s and women’s experiences very differently turned out to require an understanding of the political and economic context in which marriage takes place. I had to understand where sexism takes root, and how both women and men perpetuate it. The catalyst for Cutting Loose was the discrepancy between our notion of women’s lives after divorce and the reality, and I found myself doing some very analogous head-scratching as Staying Vertical took shape. My consciousness has a ways to go, but I’m beginning to understand how ageism works and I’m hoping that others will make the leap.

Collective political action is essential, but the movement has to begin with self-awareness because ageism is a form of self-loathing. When we’re young, it’s people whom we can’t imagine ever resembling whose faltering gait or quavering speech repel. Later, unnerved by our aversion, we relegate these men and women more consciously to the zone of Different from Me. But they aren’t Other. They are us — the aspirational selves of all but the suicidal. As Robert Butler wrote in The Longevity Revolution, “Prejudice against age is a prejudice against everyone. We all chance to become its ultimate victims as longevity increases.”

My 26-year-old daughter took me by surprise in a comment on the blog last week, in which she sums up where all my thinking, over all this time, has led to: “Growing old is scary and strange, but that’s why we need to think bravely and creatively about it – confront our fears and think about how we can work with, and not against, the inevitable. It seems to me that this effort has to start with us throwing away that initial yuck/ pity factor that takes over when we think about old age.” We reinforce this prejudice when we lie about our age, when we avoid sitting next to an older person at dinner, when we superstitiously avert our eyes from that old guy on the park bench, when we curse under our breaths at the “little old lady” holding up the checkout line. (Oh, wait, I do that – but I’m working on it.) We’re patient with old dogs, for god’s sake. I’m still scared of dying, but the getting older part’s been looking better ever since I started this project. Confronting that “initial yuck/pity factor” is smart and compassionate — and necessary.