Intimations of Mortality

Those of us who enjoy good health don’t give a moment’s thought to the prospect of growing old and frail. Making a will should be a wake-up call but is all too quickly forgotten. I sometimes wonder if my inability to even start the process of applying for the pension which was rightfully mine some years back is not a sign of psychological resistance to the very notion that I am “getting on in years”!

The face that stares back at me from the mirror has still some resemblance to my old passport photos (the body doesn’t). When my mother made the decision at age 95 to transfer from the independent flat she had in a small and lightly ”supported accommodation” I vividly remember her looking around at her new neighbours – most of whom were considerably younger than her – and remarking (quietly) that there were a lot of old people around!

It is indeed all in the mind…..It’s almost 50 years ago that The Coming of Age by Simone de Beauvoir burst on the world 

In 1967, Beauvoir began a monumental study of the same genre and calibre as “The Second Sex”. La Vieillesse (The Coming of Age, 1970) met with instant critical success. “The Second Sex” had been received with considerable hostility from many groups who did not want to be confronted with an unpleasant critique of their sexist and oppressive attitudes towards women; “The Coming of Age” however, was generally welcomed although it too critiques society’s prejudices towards another oppressed group: the elderly. This masterful work takes the fear of age as a cultural phenomenon and seeks to give voice to a silenced and detested class of human beings.

What she concludes from her investigation into the experience, fear and stigma of old age is that even though the process of aging and the decline into death is an inescapable, existential phenomenon for those human beings who live long enough to experience it, there is no justification for our loathing older members of society – nor should the “aged” merely resign themselves to waiting for death or for younger members of society to treat them as the invisible class.

Rather, Beauvoir argues…. that old age must still be a time of creative and meaningful projects and relationships with others. This means that above all else, old age must not be a time of boredom, but a time of continuous political and social action. This requires a change of orientation among the aged themselves and within society as a whole which must transform its idea that a person is only valuable insofar as they are profitable. Instead, both individuals and society must recognize that a person’s value lies in his or her humanity - which is unaffected by age.

Thanks to campaigning efforts of bodies such as Age Concern (in the UK) and the efforts of prominent older people such as retired trade union leader Jack Jones and Joan Bakewell, I noticed signs about a decade or so ago of such positive developments….but the media and entertainment industry (which still tends to set the tone) is still remarkably “ageist. On Golden Pond was unusual for 1981 (with Henry Fonda and Katherine Hepburn as the elderly couple) but was a one-off - presumably the studios calculated they needed more upbeat messages.

More recently we have had the French film “All Together” with Jane Fonda and Geraldine Chaplin and, in early 2013,  another (more harrowing) French film. In the same year a Japanese politician was caught telling the elderly to hurry up and die but British think-tanks offered some reasoned discussions about housing options for the elderly in the UK and good material on the whole issue of images and perceptions of old age.

And the writer Penelope Lively had a more celebratory piece - 

So this is old age. If you are not yet in it, you may be shuddering. If you are, you will perhaps disagree, in which case I can only say: this is how it is for me. And if it sounds – to anyone – a pretty pallid sort of place, I can refute that. It is not. Certain desires and drives have gone. But what remains is response.

I am as alive to the world as I have ever been – alive to everything I see and hear and feel. I revel in the spring sunshine, and the cream and purple hellebore in the garden; I listen to a radio discussion about the ethics of selective abortion, and chip in at points; the sound of a beloved voice on the phone brings a surge of pleasure.
 I think there is a sea-change, in old age – a metamorphosis of the sensibilities. With those old consuming vigours now muted, something else comes into its own – an almost luxurious appreciation of the world that you are still in.

Spring was never so vibrant; autumn never so richly gold. People are of abiding interest – observed in the street, overheard on a bus. The small pleasures have bloomed into points of relish in the day – food, opening the newspaper (new minted, just for me), a shower, the comfort of bed. It is almost like some kind of end-game salute to the intensity of childhood experience, when the world was new.
It is an old accustomed world now, but invested with fresh significance; I've seen all this before, done all this, but am somehow able to find new and sharpened pleasure.

The following year, Jenni Diski had a much nastier take on old age in a piece called “However I smell”

Atul Gawande – author of the book I wrote about yesterday – may be a surgeon and Professor but is not your normal medic. In this interesting interview earlier this year in Guernica magazine he explains how he came to be able to give voice to his own uncertainties and to celebrate by example the importance of “listening” – something which medical training has apparently come round to only recently……  (this critical section of the interview is toward the end)  

The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people’s priorities are, besides just living longer, is to simply ask. And we don’t ask. 

Guernica: How did your research on end-of-life care change how you behaved as a doctor? 

Atul Gawande: As a doctor, I felt really incompetent when trying to understand how to talk to patients and their loved ones about an illness that we were not going to be able to make better. We might be able to stave off certain components of it, or maybe we couldn’t even do that. And I felt unprepared when it came to having those difficult conversations and helping patients make those decisions.

I found that these end-of-life care experts were making me feel much more competent. They were giving me the words that I could use, and I began to use those words. I’d simply say to a patient, “I’m worried about how things are going.” I’d ask questions like, “Tell me what you understand about your health and your prognosis.” “Tell me what your goals are, if time is short.” “Tell me what your fears and worries are for the future.” “Tell me what the outcomes are that you would find unacceptable.”

This little newsletter also carries a useful overview on the subject

The photograph is, coincidentally, one of those from Australia's recent national photographic awards