Guggenbühl: Fear of Aging

FEAR OF AGING

ADOLF GUGGENBÜHL-CRAIG

After their sixtieth year, the Romans of Antiquity were permitted—or forced—to wear the “Toga senilis.” At about their sixtieth birthday, traditional Japanese celebrate a special feast during which the guest of honor wears a red vest such as is normally worn by children. From the practical point of view, it does not matter precisely at what year old age begins; after we have lived for about sixty years we have to acknowledge that we belong to the old. The percentage of old people has increased continuously during the last hundred years, particularly in Europe. The ratio between people under fifteen and over sixty-five in Germany was 7:1 in 1890, ninety years later it was 1:1. While in the last century usually one spouse—if not both—died before reaching the age of sixty-five, today couples spend years together following their sixty-fifth birthday.

People have different opinions about age as a curse or age as a blessing. Simone de Beauvoir tells a fairy tale where only man wants to live more than thirty years, and the donkey, dog and monkey give man some of their “superfluous” years, with the result that after passing thirty, man becomes a pack animal for the next eighteen years, during the following twelve he is as depressed as a howling dog, and the last years are given to him by the monkeys. Somerset Maugham, on the other hand, says that "old age has its pleasures which, though different, are not less than the pleasures of youth." Many proverbs complain about old age, only few praise it.

Old age is mainly characterized by death. Death is a specialty of old age so to speak. That was not always so, and today, too, it is not the case everywhere. In eighteenth-century Central Europe five out of ten children were confronted with death while in the full flush of youth. Today, one can live for sixty years without experiencing the death of a peer. The deaths of people our own age bring us much closer to it than that of older people. It is sad when grandparents die. Their death frightens the grand-children, but it is remote for them. Death can be repressed during childhood and during the periods of youth and middle-age. If we are agonized by the thought of death before the seventh decade, physicians come to the rescue. They alert us to risk factors, and by avoiding them, we can avoid death. An anti-smoking slogan in England said: “Give up smoking and live.”

Of course, this is nonsense. If we do not die of lung cancer, we die of a heart attack. And if we are cautious and avoid all risk factors and do not die from them, we will have a stroke in the end. And it we manage to avoid even that, we will still die anyhow. Death is clearly the end of old age. The nuclear threat we face cannot be compared with the nearness of death experienced by the old. One after the other of one’s peers over sixty-five dies—and soon we will die too. Nuclear war and the resulting death through nuclear bombs, on the other hand, is only a remote possibility and hard to imagine. In the last decades numerous books have appeared on death and dying. They try to remove the taboo that society attached to death: It is remarkable how many of these publications attempt to take the harshness out of death and try to sweeten it up. We fear death for two reasons: first because it might be painful, and second because we do not know what to expect afterwards.

We may believe in the resurrection of the soul, in hell, heaven, paradise, etc., but our faith is accompanied by an element of doubt. Even Christ cried out during his last minutes: “My God, my God, why have you forsaken me!”

One of the best-known authors who is concerned with death, Elizabeth Kubler-Ross, does not really deal with death but tries to lull our fear to sleep with illusions. She claims, that, as a scientist, she knows what awaits us after death, namely light, love, mercy and a reunion with our friends and relatives. She does not “believe” this, but she knows it because of her scientific studies. Dante’s Divina Commedia is a more genuine discussion of death. He describes everything that we project onto existence after death and all that we fear, the terror and the happiness, and also the nothingness. After-death remains the big unknown. People who were almost dead and tell about their experiences have not actually been dead, and if certain authors claim to have talked to people who have been dead for years, that may be so. However most people never talk to a dead person and therefore do not know what will be “after-death.”

Old age has to face two frightening realities. They are the reality of dying and that of death. We do not know what our way of dying will be. Dying can be slow or quick, painful or not. We may die comfortably in our rocking chair at home or lonely in a hospital room; full of fear and rebellion, in religious certainty or with agnostic doubt. We do not know anything about “after-death.” We can hope and believe, but we can never be certain. We do not know whether death will be a blessing or a curse, or just nothingness.

Our feelings toward death are very ambiguous. On one hand we fear death, on the other hand, we long for it. We try to push away this fear of and longing for death; fear since it is agonizing, and longing since it could tempt us to escape into death from every problem. Many people cannot cope with all these partly uncomfortable but mainly contradictory feelings, and thus they suppress the fact of death as long as possible, or they, suppress one polarity of the feeling. Christian martyrs faced death ecstatically, and modern terrorists blow themselves up “without fear.” One-sided mythologies have always assisted us in escaping the reality of death, or at least they have lessened the ambiguity of our feelings of fear and longing. The most courageous way to die is to be aware of all the contradictory feelings, to experience them to the fullest, to tremble with fear and longing in order to experience death fully. Death is a reality with which it is difficult to cope but which old people can hardly avoid.

Old people face another reality just as grim. The muscles become weak, the senses lose their sharpness, memory starts to fail, reflexes become slower, and sexual potency declines. The child and young person mature and grow. But the mental, psychological, and bodily abilities of old people decline. How much our vital functions can decline is shown in the following example. After a transatlantic flight an old man had to be taken to the hospital because he was completely “dried out.” In the hospital it was determined that there was nothing really wrong with him. He had just “forgotten” to drink during the flight. In a young person lack of liquid immediately leads to feelings of thirst. This old man did not even feel thirst anymore. It is not just our physical abilities that decline in old age but also our intellectual and emotional abilities, our memory and our ability to concentrate. It becomes more difficult to learn new things. We are slower in comprehending, and we forget names.

As far as physical and psychological aspects are concerned, old age is characterized by shrinking. Something is missing every-where, everything declines, although not always to the same extent. The ability for intense physical exertion for short periods of time diminishes considerably during old age, while physical endurance decreases less. Memory and psychomotor agility often decrease rapidly while vocabulary and judgment decrease more slowly.

So-called “fluid intelligence,” that is, the ability to combine, to get oriented in a new situation decreases rapidly, while the so-called “crystallized intelligence,” the ability to use words, general knowledge, and the ability to pass judgment remain rather stable. Until recently, old age has been regarded primarily as a deficiency state, one in which physical and mental abilities decrease. The balance comes out negative. In recent years this deficiency model has encountered opposition. It does not differentiate enough. It, for example, speed is excluded from tests for intellectual abilities, these abilities decrease much less. In old age one becomes mentally slower, but not necessarily less capable. Furthermore, general health plays a great role. The physical and especially the intellectual abilities of old people who are very healthy are much less deficient than those of sick people, This leads us to the third threat of old age, illness.

Illness is much more frequent in old people than in the young The older one gets the more some chronic or acute ailment plagues us. Arthritis obstructs the function of the joints, heart trouble occurs, the spine becomes crooked, and the digestive system does not function well. Therefore it does not help to say that old people are physically and mentally almost as capable as young ones as long as they are not ill. Were it not for illness the deficiency model of old age might be of less importance. But in fact old people are physically ill more often than young people. The last great threat in old age is that of complete physical and intellectual disability. Only a small percentage of all people suffer from senile dementia, but it presents a danger for all.

It is an interesting research question whether old age has to go together with mental and physical decline or whether ultimately an illness, which might be curable some day, causes this decline. Today it is assumed, for instance, that Alzheimer’s disease causes the mental decline of many old people. Should we succeed in fighting. preventing, or curing this disease, one of the most frequent causes for mental decline would be eliminated. It is the goal of medicine to let humans die quite rapidly after having been in complete mental and physical vigor. Maybe some day the average person will become ninety years old and then one day, without any prior signs of loss of vigor, sink painlessly into the grave.

But today we are not at that point. Death will always be the end of old age, and prolonged mental and physical decline, as well as illness, will at least in the next decades threaten us in old age.

Getting old means having to deal with death, with mental and physical deterioration and with illness. All well-meant advice and sayings, such as “one is as young as one feels,” “if one has a healthy lifestyle, one will stay fit till old age,” or “nowadays, old age has lost a lot of its negative aspects,” do not help much. There is only one issue where old age is underestimated and that is sexuality. Popular mythology separates sexuality and old age. Old age and sexuality simply seem not to fit together. Surveys in Great Britain showed that a quarter of rest home employees believed that sex between old people is disgusting. There exist rest homes where employees have to watch that the old men and women do not retire into a room and behave “immorally.” Sexual ability and sexual drive do in fact decrease with age but do not disappear totally: The picture is complicated by the fact that many people were never interested in sexuality. With increasing age these people do not feel obligated anymore to show an interest in it. For example, women who are not interested in sex after their menopause often did not show any interest in it in their youth.

Many couples put an end to their sexual life when they become grandparents. Often this is not done because sexual desire and capability diminish completely, but rather because many people have the idea that grandparents should have no sexual life. According to surveys, sexual life does continue during the seventh decade, and more than half of the people over seventy-five are still sexually active. Sexual possibilities and activities of old people are thus underestimated. A young women asked a seventy-five-year-old when sex stopped. She replied: “My dear child, you have to ask a much older woman than me.”

I talked about sexuality in old age to lighten up this sinister picture I have drawn of it, to make it a little more bearable. But that does not change the threatening aspects of getting old. Old age always means, no matter how much we resist, the threat or reality of physical and mental deterioration, the prevalence of illness, and an increasing dependence on one’s social environment. In the end a more or less painful death awaits us—feared by all, even if desired, for we do not know what it will bring.