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BOOK REVIEW |
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Gerotranscendence: A Developmental Theory of Positive Aging, Lars Tornstam. Springer Publishing Company, New York, NY, 2005, 210 pp., $39.95 (cloth).
The Mature Mind: The Positive Power of the Aging Brain, by Gene D. Cohen. Basic Books, New York, NY, 2005, 288 pp., $24.95 (cloth).
What Are Old People For?: How Elders Will Save the World, by William H. Thomas. Vanderwyk & Burnham, Acton, MA, 2004, 384 pp., $24.95 (cloth).
More than a generation ago, psychologist Abraham Maslow (1971) coined the term "self-actualization" to describe a higher level of human functioning, a goal of fulfillment that rang a bell for millions of seekers in the 1960s who were looking for something more in life than conventional material success. Like William James a century ago, Maslow called for concerted inquiry into what he called "the farther reaches of human nature." He didn't fill in many of the details, but a school of humanistic (later transpersonal) psychology took up the challenge he set forth. Maslow died in 1971, so it's hard to know what he might have thought about the progress of gerontology in the years since then.
In the early 1970s, gerontology was hardly on the map of public attention, but that would soon change. Yet the changes might not have made Maslow very happy. In the 1970s, aging began to command wider public attention. Robert Butler (1975) won a Pulitzer Prize for a book with the gloomy title Why Survive? Being Old in America. The National Institute on Aging was founded, putting aging on a level with other "diseases" deserving attention from researchers. Budgets for the Older Americans Act began to increase. All these things happened in response to what Richard Kalish would decry as the "failure model" of aging, a "decline-and-fall" story about later life.
Research seemed to support the claims of the failure model. Everywhere psychologists looked, they seemed to find only a downhill curve (e.g., fluid intelligence) or, at best, stability (e.g., personality). Sociologists followed the same track, focusing on losses that seemed to fulfill a larger agenda of what Robert Binstock (1983) termed "compassionate ageism," in which elders were depicted, more or less, as victims. The idea of positive aging, of genuine growth or development over the life course, attracted little interest. After all, it was easier to command public attention (and budget dollars) if everyone focused on aging as a problem.
In the decade of the 1990s, a different view, a more favorable approach to "positive aging," began to take shape, especially among popular writers about aging. For example, Deepak Chopra (1994) won a huge readership with claims of "ageless body and timeless mind"; Betty Friedan (1994) looked for positive aspects of aging in her book The Fountain of Age. Among academic gerontologists during the 1990s, a parallel shift to positive aging took place. The new image appeared under the rubric of "successful aging" in Rowe and Kahn's (1998) book of that title, or "productive aging" in the book by Morrow-Howell, Hinterlong, and Sherraden (2001) of that title.
The key point here is that the new ideals of old age "success" and "productivity," whether in popular or academic writing, seemed largely to reinforce widely held American values. The implicit message was that elders could be among the "healthy, wealthy and wise," provided only that they maintained the same qualities and strengths manifested in mid-life (e.g., exercise, social networks, activity, employment, and so on). A good old age, in short, would be pretty much "more of the same" as earlier in life. The recommended game plan for later life thus becomes one of playing defense all the time: for example, stay active and socially connected and maybe, just maybe, you can delay the inevitable decline in cognition.
It is the great merit of the three books reviewed in this essay that they pick up this banner of positive aging but carry it forward in directions very different from the "more of the same" philosophy that has dominated our discourse to date. Gene Cohen's Mature Mind assures us that the acquisition of wisdom, along with late-life creativity, truly represents one of the "gifts of age," and the gift is not to be understood merely as a continuation of mid-life mentality. Lars Tornstam's GeroTranscendence demands that we look more deeply at those admirable qualities of character found among those who have lived the whole course of life, people who have attained a level of freedom and spiritual fulfillment that can be a goal for us all. Finally, William Thomas's What Are Old People For? asks us to grapple with far-reaching questions of evolutionary biology and social policy. Instead of unconsciously viewing growing numbers of elders as a disaster, Bill Thomas invites us to consider that advanced age is, finally, what makes us human after all.
The Mature Mind
Gerontologists or not, we're all familiar enough with nervous jokes about "senior moments" and also accustomed to grim statistics about the incidence of Alzheimer's disease. But behind the jokes and the fear, there is a substantial body of research in gerontology that documents that a wide range of cognitive capacities tends to decline with age. Indeed, a generation of researchers (e.g., Timothy Salthouse) have patiently documented this slow decline of performance on memory, standardized intelligence, and other measures in the laboratory. Science, it seems, has confirmed our worst fear about old age. Is it any wonder, then, that most Americans have come to believe that as we get older we all more or less go "down the tubes" when it comes to mental function?
Now along comes Gene Cohen, director of the Center on Aging, Health and Humanities at George Washington University. He has a different story to tell, a story that parallels neurological findings described by another recent book, The Wisdom Paradox. (Goldberg, 2005). Cohen, as former Director of the Center on Aging and Mental Health at the National Institute of Mental Health, has strong scientific credentials to give us the latest on neuroplasticity. The news he brings us is welcome. Drawing on well-established research by investigators such as Marian Diamond, as well as the psychological ideas of Erik Erikson (Cohen's own teacher at Harvard), we are given something remarkable, namely, a "progress narrative" for the fate of cognition in later life.
With 10,000 Boomers turning 60 each day, Cohen's book could not come at a better moment. As literary critic Margaret Gullette (2004) demonstrated in her book, Aged by Culture, those Boomers are treated to a nonstop "decline narrative" about aging that has become pervasive in contemporary American culture. Gullette's own critique was grounded in the "unmasking" tradition familiar in cultural studies. Her critical stance is powerful as far as it goes but it will not persuade everyone. Americans who are looking for a more positive vision of later life are more likely to turn to science and medicine than to literature and critical theory in order to support their hopes for something good in the second half of life. Cohen's book will give them what they're looking for.
Cohen's analysis is much more than a "Don't worry, be happy" message about late-life cognition. He offers us a detailed analysis of how the mature mind changes and unfolds throughout life. Cohen argues that there are four phases of psychological development in later life: (1) midlife reevaluation, "a time of exploration and transition"; (2) liberation, an experimental mode which some have termed the "late freedom"; (3) a summing-up phase of "recapitulation, resolution, and review"; and (4) "encore," understood as the desire to go on, perhaps with no obvious limit.
Cohen also defines what he calls "developmental intelligence" and claims that these key dimensions of the mind actually improve as we get older:
It is evident that these three dimensions are part of what might colloquially be described as "wisdom." Some distinguished researchers in gerontology (Birren, e.g., Birren & Feldman, 1997; Baltes, e.g., Baltes et al., 1995; Ardelt, 1997, and others) have made a point of probing just how the multiple dimensions of wisdom change (and perhaps grow) in later life. But their work has not been accessible to a broad readership. Cohen's book will be widely read and be influential in offering scientific grounding for a positive vision on growth in the second half of life.
Gerotranscendence
Tornstam's book is heavier reading than the volumes by Cohen and Thomas, but it will be rewarding reading for academic gerontologists in important ways. Some years ago, Tornstam published a stimulating essay in The Gerontologist in which he asked the entire field "Quo Vadis?" (i.e., Where are you going?). It's a question we don't ask ourselves often enough. In the years since then, Tornstam has done more than ask provocative questions. He has embarked on an ambitious research program developing an idea he calls gerotranscendence, and his current book amounts to what he calls a developmental theory of positive aging.
To understand what Tornstam is getting at, I recall an incident that happened to me a while ago when I was serving as Chairman of the Board of Elderhostel. At that time an 85-year old lady wrote me a letter complaining that our Elderhostel insurance policy didn't cover bungee jumping. The complaint set me back and made me think, not so much about "Olympic Grannies" as about what we admire and honor in our society. Whenever I mention the 85-year-old bungee jumper, I get responses that range from laughter to "Why can't I be like that?" Such responses should remind us of the aphorism "What is honored in a country is cultivated there." What is it that we honor among our elders? When I go to a gym, I, too, look with admiration at those who are older than me who are valiantly running on treadmills and pumping iron, making heroic efforts, like my bungee-jumping correspondent. I remember, too, that Elderhostel has long given award recognition for what we call "frequent hostelers." No free trips came with the award; it's not like the airlines. There's just the honor of being "extra busy" and being recognized for that hyperactivity. Whether in the physical gym or the mental gym, it seems that in our society we believe that a good old age is an active old age.
This is exactly the value system that Tornstam wants to challenge. He does so in the same spirit as psychologist James Hillman (2002), who once remarked that we live in a hyperactive society. Anything less than mania is considered a possible case of depression. Like Hillman, Tornstam is urging a rather drastic shift in our thinking about what's valuable in life: away from the materialistic in favor of something transcendent or spiritual, even "sitting quietly, doing nothing" (as Zen masters might put it), away from activity in favor of contemplation. Tornstam's message, obviously, will not be acceptable to everyone, certainly not to gerontologists who subscribe to an "activity" theory of aging (the more the better) or a "continuity" theory of aging (it's OK to continue being the self you've always been). Tornstam wants to jar us out of our shared contemporary cultural prejudices that privilege activity and materialistic fulfillment, including the attractive ideals of "successful" or "productive" aging.
An admirable feature of Tornstam's book, and his larger project over the past decade, is that he resolutely ties his agenda for gerotranscendence to the methods and framework of the behavioral sciences. Gerotranscendence is rich with quantitative documentation supporting Tornstam's goal of mapping "the farther reaches" of aging. He has set a standard that will inspire both scientific investigation as well as practice in the professions. More questions will undoubtedly be asked as others are inspired by Tornstam's ground-breaking work.
What Are Old People For?
Some questions are so fundamental that they're never asked. The title of Bill Thomas' book asks what must be seen as a teleological (or purpose-driven) question: "What are old people for?" Thomas couches his answer in evolutionary terms: old age is what made us a species, what created our humanity. At one level, this answer goes back to the so-called "Grandmother Hypothesis" discussed by anthropologists: that is, food-sharing and child care by grandmothers, for their grandchildren gave Homo sapiens a decisive survival advantage. On that score, the numbers tell a story of victory: human beings = 6 billion; chimpanzees = 50,000. But there's more to the book than promoting intergenerational solidarity. Bill Thomas wants to answer a deeper question about how advanced industrialized societies should respond to the historically unprecedented arrival of population aging, a condition that, in demographic terms, makes Italy today look like the State of Florida. Over the next few decades, parts of the globe such as Japan and Western Europe seem destined also to become one big retirement community. Our policy-makers and pundits are terrified of the prospect, invoking metaphors like "iceberg," "trainwreck," and "tsunami." If older people are just an expense item on entitlement budgets, then we can understand such alarm about the future. But what if we've missed something fundamental? What if our thinking about youth and age is deeply flawed?
Bill Thomas is anxious to disabuse us of our contemporary celebration of young adulthood, which he believes has displaced other stages of life (childhood and old age) and favored certain values (activity, instrumental mastery, and so forth) over others. Gerontological critics of ageism have long criticized the not-so-subtle ways in which we diminish or demean the last stage of life. But very few critics of ageism have truly explored its historical, anthropological, even ontological roots, which make ageism so pervasive in the modern world. Thomas wants to take on directly what he dubs the "cult" of adulthood and offer us instead a fresh map of life, to use a phrase developed by British historian Peter Laslett (1991). Like Gene Cohen and Lars Tornstam, Thomas wants us to cultivate a positive vision of later life: "It is time to enjoy what aging has to offer us, and actually welcome it into our lives." He wants to criticize the "failure model" of aging: "The old way of seeing old age, as a time of relentless decline, ignores the value of the last half of life."
Dr. Thomas has certainly identified one of the big problems of the present historical moment, namely, the hysterical hostility to age and aging, on both the individual and population level. On the individual level, ageism and fear of an aging society have never been stronger. For example, so-called "anti-aging medicine" has become a multibillion dollar industry, far outpacing the growth of geriatrics, despite disapproval by mainstream gerontologists. Policymakers look at the graying of advanced industrialized societies with dismay but seem paralyzed in offering constructive solutions, other than cutting the budget or displacing costs onto individuals. At this historical moment, we are desperately in need of a positive vision not just of the aging mind but of old age within the larger society.
William Thomas' book is dramatically subtitled, "How Elders Will Save the World." With new attention focused on aging Boomers, we are clearly in need of such a message of hope. A Baby Boomer himself, Dr. Thomas is optimistic about what aging Boomers can do to transform our vision of later life. In this, he joins hands with writers such as Marc Freedman (2002) or Theodore Roszak (2001), who are also optimists about what will happen when "the Boomers reach Golden Pond," as Robert Butler phrased it.
But Thomas' argument is not merely theoretical. As we would expect from the man who created the Eden Alternative and the Green House Project in long-term care, Thomas has in mind some practical steps toward his "Eldertopia" ideal. His strategy comes down to the idea of "intentional communities," celebrated by hippies in the 1960s. But Thomas is shrewd enough to know that it doesn't make a lot of sense to propose communes for aging Boomers, who themselves are mostly wise enough to know many things that went wrong in the 1960s. Bill Thomas is now actively at work creating a prototype of such an intentional community, one that would be age-integrated and provide a balance of public and private space. But this utopian prototype isn't the only version of what he has in mind. Thomas' idea of an intentional community could include anything from intensified Naturally Occurring Retirement Communities (NORCs) to enriched Continuing Care Retirement Communities (CCRCs). But our thinking about NORCs and CCRCs would have to change way beyond what our current ideas of long-term care administration suggest. If the answer to "What are old people for?" entails contribution by the old to all generations, then we can't plan a residential community that is based on the idea of "service delivery," no matter how efficient.
Concluding Thoughts
It is significant, perhaps, that Gene Cohen and Bill Thomas are both MDs, following in the path of another physician, Robert Butler, as "public intellectuals" capable of communicating their message to a wide audience beyond academia. Like Lewis Thomas, the work of these two is about much more than medicine. The aspiration of these healers is toward what Jewish tradition calls "Tikkun Olam" (healing the world). Moreover, their healing work is solidly grounded in a research base, whether the "Grandmother Hypothesis" of anthropology or the latest findings from neuroplasticity and brain anatomy. Tornstam's work, too, is based on a thoroughly scientific foundation.
What distinguishes all three books is that the authors are willing to build on science in order to engage public issues of the widest importance. Behind all three books is a message of extraordinary hope and optimism, and that message has never been more needed. One hundred fifty years ago, Karl Marx wrote that "A specter is haunting Europe," namely, the specter of class conflict and proletarian upheaval. Today, in Western Europe, Japan, and America, there is also a specter haunting the aging Boomers and the policymakers who peer into charts mapping our demographic future. The specter is the fear of an aging society, the gloom that old age is nothing but decline. The French demographer Alfred Sauvy (1976) put it best when he expressed his fear that an aging society would result in a "population of old people ruminating over old ideas in old houses."
The answer to Sauvy's fear is given brilliantly by Gene Cohen, who reminds us that the mature mind is much more than the measurement of decline; by Lars Tornstam, who has mapped a level of personal growth that goes beyond the magnified ego of middle-age; and of William Thomas, who has a positive answer to the question of "What are old people for?" The answer is that the elders are "our future selves," and the future is not something given to us but something to be created.
References
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