Last week the New Yorker magazine published an article describing the senior senator from California “seriously struggling” with cognitive impairment, titled “Dianne Feinstein’s Missteps Raise a Painful Age Question Among Senate Democrats.” The issue it raises isn’t a “painful age question.” It’s a painful competence question: is Senator Feinstein capable of carrying out her duties?
The brouhaha that followed centered on whether or when Senator Feinstein ought to step down, a legitimate question. At the heart of the matter is a deeper one: why do we avoid discussing and dealing compassionately with cognitive decline?
- because cognitive decline is so profoundly stigmatized
- because age-related losses threaten the illusion of autonomy. In fact we are interdependent from birth to death, and, in the words of Dutch gerontologist Jan Baars, “Autonomy requires collaborators.
- because internalized bias requires us to remain in denial—“My recall works fine.” “I’m safe behind the wheel.” “This’ll never happen to me.”—even in the face of overwhelming evidence to the contrary.
What do we fear most of all? Indignity. Public shaming. Precisely what Senator Feinstein now faces—because of her own denial, because her friends and colleagues colluded in that denial, and because an ageist and ableist culture gives them cover. That culture has to change, because the current climate of secrecy and complicity is a problem for everyone. As the article pointed out, “declining male senators, including Strom Thurmond, of South Carolina, and Robert Byrd, of West Virginia, were widely known by the end of their careers to be non-compos mentis.” Is Feinstein facing harsher criticism because of her gender? Probably. But competence is the issue, not age, or gender. When a seniority-based system like the U.S. Senate conceals incapacity, it discredits the system as a whole, and casts doubt unfairly on all its older members.
We have a right to know that our elected representatives are capable of carrying out their duties. This is not a partisan issue. Nor is it confined to politics. Ageist and ableist assumptions—that aging is awful and disability is tragic—harm every older and/or developmentally disabled person, no matter their age or place in the world.
Those assumptions are biased and misinformed. Most forgetfulness is not Alzheimer’s, or dementia, or even necessarily a sign of cognitive impairment. Even as the population ages, dementia rates are falling, significantly, and people are being diagnosed at later ages. Some twenty percent of the population escapes cognitive decline entirely; we all know some of those sharp nonagenarians. At the other end of the spectrum, up to five percent face early-onset Alzheimer’s. Most of us will end up somewhere in the middle, slowed but able to enjoy our lives and make our way in the world—like Feinstein, who is 13 days short of being the oldest member of Congress. (Rep. Dan Young is also 87.) People age well not by avoiding chronic illness and disability but by adapting to them. Had Feinstein not run for reelection, she could be going through this difficult transition out of the public eye. But hindsight is 20/20, and denial—cruel, dangerous, and enabled at every turn—is the default.
The necessary alternative—imperative, even—is to educate ourselves about cognitive decline, and learn to talk about it openly and accurately. Because the brain is where the self resides and the deepest terrors are the hardest to confront, neurological decline is a repository for our darkest fears. But those worries are hugely out of proportion to reality, and the dread itself puts us at higher risk. We know that attitudes towards aging affect how the mind and body function at the cellular level. People with fact- rather than fear-based attitudes towards aging are less likely to develop Alzheimer’s—even if they have the gene that predisposes them to the disease.
Cognitive decline does not mean the loss of personhood. It is not inevitable. It should not be shameful. And it’s not going away: we are living longer than ever before. Instead of trying to sweep this aspect of what it means to be human under the rug, we need to address it—openly, realistically, and compassionately. This means culture change: mobilizing against the dual stigma of age and disability, starting between our ears. It’s doable. It is also the work of a lifetime and must be engaged in with others. What are we waiting for?