This blog is about outrage against stereotypes of age, sex and marital status. I also rant about the medical profession and talk about comedy. When you put these together, being old, single and female completes the perfect trifecta, making you a target for society in general and the medical profession in particular.
I’m not amused when a fifty-something author jokes about not remembering her ATM pin number. I know my pin number. I also know my library card number and my credit card numbers. It makes life easier.
I’m even less amused when someone asks me if I use email. I tell them I build websites.
I don’t laugh at jokes about old people. Google “old people having fun funny.” Now try, “black people having fun funny.” We laugh at children, cats, and older people who are just being themselves.
It’s time to stop accepting a second place, subservient role just because you’ve had a birthday. Instead of quiet acceptance, let’s belt out the old George Jones anthem, “I don’t need no rocking chair.” Let’s recite Dylan Thomas: “Do not go gently into that good night. Old age should rave and burn at close of day …”
This is a blog for raving, for gym memberships instead of rocking chairs, and replacing calm acceptance with a few well-chosen four-letter words. I want to be blown out like a candle, while I’m still burning.
Why sneakers? I’ve worn nothing but sneakers for the last fifteen years (with a few brief exceptions for dress-up occasions). Sneakers are associated with having fun, relaxing and being yourself. Stilettos have become associated with female success; books have titles like “Success in stilettos.”
The idea is that people, especially women, should accept pain and discomfort in exchange for beauty. In the 21st century, when women are landing fighter planes on Navy carrier decks and running major companies, this idea seems a little dated, to say the least.
Associating high-heeled shoes with success incidentally associates beauty with success, and for most people, beauty equals youth. Part of the pain of aging does indeed come from looking in the mirror. Even worse is the experience of being judged by one’s appearance. Compliments are conditioned by “for your age,” as in, “It’s impressive to see a woman your age who is bungee jumping, running a marathon, doing stand-up comedy or simply surviving without medications.”
Aren’t those accomplishments impressive at any age?
I may have to go down for the count but I don’t have to go there quietly.
Writing for BBC Smithsonian, Ellen Barry (“It’s the Ultimate TV Prize: An Unscripted Queen Elizabeth” Jan 14, 2018) opens with:
“In the annals of television interviews, a drawing-room chat with a 91-year-old woman, watching home movies and offering occasional droll remarks, would not seem like edgy stuff.”
“But that all changes when the woman is Queen Elizabeth II.”
Those two sentences show a great deal about the world view of aging. If you’re of sufficiently high status, age becomes irrelevant. I’ve been saying this for awhile. Good things in age come from continuity. You can’t begin a new career, but some careers allow you to continue and even embellish on what you’ve done before. You can cement your status. You can’t build it from scratch.
Occasionally you’ll see news stories about older people who did things that seem to defy stereotypes of aging. Those stories rarely come across as respectful of the person. They’re patronizing. They’re saying, “Oh, how cute!”
Nobody says the Queen is cute. She’s royal. Even the Corgis aren’t cute.
A Review of Natural Causes by Barbara Ehrenreich
I wanted to like this book because I share some of Barbara’s attitudes toward health. Like her, I exercise for fun and even more for vanity. I eat what I want and forego medical screenings. Unfortunately, as other reviewers noted, the book turns into a rant that gets a little annoying. Overall the book suffers — on a larger scale — from the same flaw that undermined Bait and Switch. Ehrenreich takes a particular example from her own experience, generalizes, and editorializes.
For example, Ehrenreich says that people in gyms work out alone, listening to their headphones, each in his or her own world. That may be true for some people in some gyms. I’ve belonged to gyms my entire adult life and they’ve always been a source of social life. But of course I don’t just walk into any gym; I choose one where I’ll feel comfortable, and I don’t go to the top-tier high-priced fitness clubs. I talk to the women — and men — in my classes and on the floor. Once you’re known around the weight room the trainers will joke around. A few times — admittedly rare — friendships develop that go beyond the gym.
Ehrenreich also dismisses yoga and meditation. People of all ages practice yoga; I’m not crazy about it, but I see how it helps me enjoy aerobic dancing and weight-lifting more. As for meditation, she cites one meta-analysis that finds little evidence for the benefits. The best response to studies like this can be found in an article on Huffington Past 2/7/2014 by a physician named Robert H. Schneider. As he notes, many studies support meditation in general and Transcendental Meditation in particular (in full disclosure, I learned TM in 1975 and have practiced it for most of my life — and have been surprised at the benefits I personally experienced).
The best parts of this book — the medical skepticism — can be found elsewhere, presented more clearly and more systematically. Read Gilbert Welch’s book, Overdiagnosed, Christiane Northrup’s Goddesses Never Age, and Ezekiel Emanuel’s article in the Atlantic, “I Want To Die At 75.” It’s a shame the publishers didn’t see fit to give us an index so we could see if any of these were mentioned.
Northrup in particular would dispute Ehrenreich’s argument (p 167), “..Aging is above all an accumulation of disabilities…” Menopause is not a disability; many women sail through without medical assistance, especially if they exercise. Not all women have “knee and lower back pain” in their “forties and fifties.” And in my gym, we don’t mutter to each other, “It’s on — thing after another.” We’re too busy going to zumba classes.
As she herself notes, the US Census Bureau “reports that nearly 40% of people aged sixty-five and older suffer from at least one disability…” That means just over 60% do *not* suffer those disabilities.
On p 166, she notes, “There are bright sides to aging, such as declines in ambition, competitiveness and lust.” The first two qualities support an unfortunate stereotype that reinforces the cruelty of age discrimination and keeps people out of the workplace. Does anyone think 70-year-old Hillary or 84-year-old Dianne (Feinstein) are lacking in ambition and competitiveness? Lust is none of our business, but I’d read Northrup’s book before assuming that the over-65 set doesn’t care anymore.
Perhaps the single most important point Ehrenreich makes — not particularly original, but critical — is presented almost as an aside on page 168: “”But the goals of a healthy, active life followed by a fairly quick death may not even be compatible without the intervention of avalanches and altitude sickness. The truly sinister possibility is that for many of us, all the little measures we take to remain fit — all the deprivations and eetions — will only lead to a longer chance to live with crippling and humiliating disabilities. As a New York TImes columnnist observed, ‘The price we’re paying for extended life spans is a high rate of late-life disability.’ There are no guarantees.”
Instead of expanding on this crucial point, Ehrenreich goes on to attack the bizarre promises of anti-aging products, including those proposed by celebrities. Yet this fear of a long, miserable span of helplessness, living at the mercy of caretakers (who are at best indifferent, at worst cruel and abusive) is the biggest concern of many people over 65.
Ehrenreich oversimplifies when she writes (p 208) about a conversation with people “over 60” who were more afraid of suffering than of dying “I did my best to assure them that this could be minimized or eliminated by insisting on a nonmedical death, without the torment of heroic interventions to prolong life by a few hours or days.” She refers to “the means to make the end of life more comfortable if not actually pleasant — hospices, painkillers, and psychedelics, even, in some places, laws permitting assisted suicide.”
What’s missed is that it’s very difficult to hold off the “heroic interventions,” even with a proxy holding a signed document. For many people — those without children and those whose children aren’t up to the task — no advocate will be present. In the 21st century, there’s no reason not to store permissions in the cloud, so people could wear a tattoo or bracelet with a link to their final wishes.
Her last paragraph, about facing death, is quite beautiful and I appreciated Berthold Brecht’s poem about dying.
In summary, Ehrenreich is on the right track here but leaves lots of loose ends. However, I’m very happy to see a prominent author take on these issues and state uncomfortable truths. If we hear them enough, maybe we’ll see some action.
The Third Chapter: Passion, Risk, and Adventure in the 25 Years After 50
This book seems to be about preparing for the years right at midlife — the fifties and early sixties — and just past midlife, which Mary Pipher characterizes as the “young old.”
As I’ve noted in reviewing other books, I often think it’s impossible to write a really helpful book about this stage of life because (a) there just aren’t a lot of choices for everyone and (b) there’s such a variety of people, health levels, skills, aptitudes, background and more. Sara Lawrence-Lightfoot deals with (b) by focusing on a small slice of the population: educated, healthy people without financial worries. Within that group, she finds common patterns: a yearning for something that can’t always be named, a resistance to change (possibly because successful people tend to resist changing a cherished identity) and finally a learning that differs from previous classroom experiences.
It is insights like this one that led me to give the book a 4-star rating rather than 3-star on Amazon. I agree with reviewers who complained about the length of interviews, details of subjects’ lives and narrowness of subject range. I also agree that the book doesn’t present as many original ideas and frameworks as readers might expect from extensive research. But as a former academic myself, I think it’s appropriate to work with a narrow sample, as long as you make it clear upfront, preferably in the book’s title. There’s value in asking explicitly, “If money were no object, how would people choose to enter their sixties and seventies?” At the same time, these people are insulated from many consequences of aging.
I also liked the author’s review of the way the notions of aging and retirement have changed. I would have liked to see more on this topic. When I lived in New Mexico I met people who lived in those “55 and up” communities, including one woman who took care of her aging parents. When her mom died, she was in her early fifties: too young, according to the community, and she was booted with no place to go. I also met people who wondered why I didn’t want to live with my age-mates, an idea that makes me feel suffocated. It’s good to have the historical perspective.
The best part of the book was the author’s interview with economist Matthew Gladstone. Gladstone’s perspective makes sense to me, possibly because I have a b-school background and enjoyed my economics courses. Gladstone suggests that as we continue doing work, the law of diminishing returns sets in. If I understand him correctly, he suggests that a successful lawyer might get enormous joy out of winning her first case, then her second…but at some point, she will be less joyful. It’s like eating a meal when you’re hungry; as you start feeling satisfied you don’t enjoy the food as much. I call this phenomenon the “been there, done that” effect, which often is confounded with aging.
We could extend economic thinking even further. When you reach a certain age, you certainly can invest whatever time, energy and money you have to learn something new or start a new venture. But your ROI – return on investment – will be limited. You might write one novel and maybe you will even sell it, but you won’t have time to go on and write a series that would bring you the real rewards that come to authors after a long career.
I don’t agree with reviewers who claim that the book reads like an academic article or a dissertation; I’ve seen too many examples of the real thing. In fact, I think the book would be stronger if the author had introduced more sociological concepts to frame many examples. For instance, the interviewees made transitions from high-level professional or organizational settings to a more right-brained, artistic and/or spiritual focus. I know many people, even those well past midlife, who never want to stop working. Volunteer work and the arts will never be enough for them (and I feel that way myself). The author notes that one interviewee, Pamela, feels frustrated because there are structural and institutional limits to her contribution. Yet anyone over 50 who wants to continue earning money faces much bigger challenges.
Finally, I admit to being jealous of those who found their new artistic callings at midlife or later. I wish I’d thought of singing lessons, but suspect I will still be advised to tap along to the songs rather than try to sing them. Over the past ten years, I’ve taken pottery classes in two different states. Each time I had less talent than anyone in the class. It was fun, though, and I resumed classes when I moved to Philadelphia. After some frustrating classes in throwing, I discovered ceramic sculpture, and now I mostly make objects — especially sneakers! I still have less talent than anyone but I’ve learned to compensate by choosing original subjects.
Still, I resonate to the experience of the interviewee, Josh, who was learning the piano: trying to aim for a higher level does bring psychic rewards. At the same time, unless you become a serious artist who sells work to an audience, it’s not nearly as satisfying as a professional career where you can be competitive and evaluated by the harsh criteria related to monetary rewards.
Someone posted on Facebook:
“My husband gave advice to a guy who’s feeling discouraged in dating. I overheard him advising the guy, ‘You can practice by talking to women in their 70s, just to learn how to relate to women as real people, and maybe get some advice on how to approach younger women.'”
So now the role of an “older” woman is to be an unpaid relationship coach to a clueless guy. And of course she’s filled with advice on how to deal with women in their twenties, since it’s been awhile and dating norms have, um, changed just a little.
And of course she’s a wise old crone. Never mind that she had a string of affairs throughout her life, most of which ended badly, mostly with guys with drinking problems who left her broke.
Or she’s always been an uptight lady who believed women should “save it for marriage.”
Or she’s wary of casual dating because she remembers the vulnerability she experienced growing up in the days before birth control pills were readily available just for the asking.
Or she’s a gay woman who isn’t quite the expert to advise men of a certain age.
Nope…she’s in her 70s. That makes her wise. A truckload of books supports the notion of wise old people. There’s even a whole book called “Replace Aging with Saging.”
When I think of “sage” I tend to think of spice you use on poultry; according to some spiritual healers, saging your home is a way to drive away the bad spirits.
And speaking of spirits, I’m not crazy about comparisons to wines that grow better as they age. Remember these wines must be kept under special conditions so they won’t go sour.
What’s wrong with this picture?
(1) Why is “aging” a verb now?
We don’t talk about “adolescenting” or “youthing” or even “midlife-ing.” We don’t talk about “health-ing” or “sick-ing.” The implication is that adding years to your life calls for some action on your part. If you’re healthy and active along the way, you’re “aging well.” If you’re happy and you demonstrate a positive attitude, you’re also “aging well.”
This concept takes responsibility away from your environment and your genes. Dealing with ageism every day? It’s up to you to be bright and cheerful. Your doctor says, “What can you expect at your age?”
Well, you’re not aging as well as you thought … or you’ve chosen a doctor who deals in stereotypes. Catch pneumonia or fracture a bone in a fall? Definitely not aging well.
But let’s get back to being a sage. When you think about it, assuming you’re a sage can be just as stereotypical and destructive as assuming you’re a technological idiot.
(2) When do we ascribe good things to a demographic group, universally?
Hopefully we’re beyond saying, “White men can’t jump,” or “Black people have rhythm.”
And hopefully we realize that not all Asians are natural mathematicians and engineers.
A lot of people – including the late Joan Rivers – joked about the stereotype of gay men and fashion. Hopefully we know that’s not true. I had a gay neighbor who wore plumbers-crack jeans and oversize sleeveless t-shirts with holes.
So let’s look at this one: “Older people …say, over sixty … are filled with wisdom.
For one thing, not all people over a certain age are wise. Just take a look at some politicians around the world.
People of all ages can make poor decisions. Once they’re outside their areas of experience, competence and expertise, they’re like everybody else.
A sixty-plus person can deny climate change, insist that abstinence is the cure for teen sex, and believe fervently that anyone who doesn’t share her beliefs will go straight to hell — literally. A sixty-plus person can believe that we’re too puritanical and we should make sure teenagers get initiated into intimacy with experienced women. Conversely, another person the same age might have trouble naming the part of the body the British call the “naughty bits;” they might think the sex act is something inherently nasty — something women endure for the sake of marriage.
And who hasn’t met lots of women whose mothers delivered awful advice about child-rearing based on their own background. Someone who grew up in the forties and early fifties might respond to a misbehavior incident with, “That kid just needs a good swat.” Wisdom? More like a wrong-headed expression of values.
One problem with the “elder as sage” stereotype is that it’s hard to joke about. A famous female basketball player once joked, “I can’t dance. People tease me about it – my assistant coach asks, ‘Are you sure you’re black?'”
My gay neighbor used to joke, “People ask, ‘Are you sure you’re gay?'”
But who’s going to joke, “Are you sure you’re old? You’re so dumb!”
(3) Giving people pseudo-respect comes across as patronizing.
“You’ve got experience. You have so much to offer!” resembles the way people speak to a five-year-old who stumbles across the stage in an ill-fitting ballet costume: “Wow – you’re such a good dancer, honey!”
Finally, a lot of people over 60 would like to remain in the workplace. They want to take ordinary jobs. They may not be qualified to be Supreme Court Justices or Minority Leader of the US House of Representatives or coaches on basketball teams (both Paul Westhead and Marynell Meadors were in their late sixties when their teams competed for the WNBA championship in 2007).
But who wants to hire a sage? Who wants to work alongside a sage? Businesses want to hire competent people who can pull their own weight and make a good colleague. They want someone who will be just another person, so age doesn’t enter the conversation.
Bottom line: If you want to to talk to a wise person about your dating problem, hire a relationship coach and pay the fees. Don’t bother some 70-year-old who’s probably on her way to zumba class after spending a day as a basketball coach, politician, or self-employed, income-earning business consultant.
This article by Dhruv Khullar was published in the NYTimes.
Jan. 10, 2018 – https://www.nytimes.com/2018/01/10/upshot/youre-sick-whose-fault-is-that.html
The author writes: “Behavior contributes to nearly half of cancer deaths in the United States, and up to 40 percent of all deaths.”
The first citation refers to a popular news magazine with no links to the actual study. The second refers to a NEJM article that draws the 40% statistic from yet another article, this one appearing to be a summary in JAMA, associating numbers of deaths with specific behaviors, with virtually no info dabout how that number was calculated.
How do we assign causes of death? I knew an 80yo woman who smoked a pack a day, with no symptoms of heart or lung disease. Got checked regularly. When she dies in her 90s, will her death be attributed to cigarette smoking?
Thin, fit people get diabetes. Non-smokers get lung cancer. Donald Trump avoids exercise, eats junk and remains free of heart disease and diabetes.
From that NEJM article: “Smoking is increasingly concentrated in the lower socioeconomic classes and among those with mental illness or problems with substance abuse.”
Missing from the discussion are (a) medical error: a heart surgeon’s fatal mistake gets recorded as death from heart disease; (b) assuming longevity as desirable outcome, when an early death might be kinder than a long period of painful illness
Perhaps we should encourage a new form of health behavior: learning to interpret statistics in a medical report.
Milestones is a tabloid type newspaper published by the Philadelphia Corporation for Aging and distributed free in Philadelphia and downloadable online. It’s the usual party line pep talk stuff.
Their November 2017 issue included an article about suicide. Here’s how I responded.
I was appalled by your article on suicide among the elderly. Milestones reaches a large, diverse audience with a tabloid type newspaper. You have a rare opportunity to share accurate information and raise concerns. Instead, you present a simplistic view of a complex subject, in a way that could actually harm the very people you are targeting for help.
(1) The article conflates suicide with depression. The truth is, not all suicidal people are depressed, and not all depressed people are suicidal. Yet following an opening paragraph on suicide, the article segues into a discussion of depression, without making this distinction.
For many people, suicide can be viewed as a rational response to a diagnosis of Alzheimers or any other condition that removes the person’s opportunity to live pain-free and with dignity. Pain is not always responsive to treatment and side effects of medications can be so horrific as to take away all quality of life. The view of all suicide decisions as irrational is based on values, not medicine or science.
Last year, the New York Times Magazine reported the suicide of Sandy Bem, a distinguished research psychologist diagnosed with Alzheimers. She was perfectly sane; she just wanted to avoid the miserable life that lay ahead. In her book Never Say Die, Susan Jacoby describes a man who could no longer live alone, after living in solitude for many years and valuing his privacy; he stole his caregiver’s car keys, drove to a bridge and jumped. She argues that he should have had easier access to death, not psychiatric treatment.
To put this in context, at one point the CIA gave cyanide tablets to spy pilots who were in danger of crashing into POW camps. For many innocent elderly people, a nursing home will resemble a POW camp, but with no possibility of rescue and no opportunity to live a good life afterward. About 1/6 of nursing home residents are subject to abuse, and that’s a conservative estimate, omitting behaviors that deprive people of their peace and dignity; tying someone to a chair in front of a television set is considered normal.
Your article totally ignores this issue, suggesting that people want to die to avoid being a burden. Some just want to live a life free of pain and misery. Think of Patrick Henry’s “Give me liberty or give me death.”
(2) In lieu of Patrick Henry, the article quotes someone named Patrick Arbore, an Ed.D. Apparently he says, “depressed older adults often respond positively to intervention,” and, “In most cases their depression can be treated.”
“Often” and “most” aren’t exactly scientific terms or precise quantifications. Often could mean 51% or even “not rare,” i.e., 10-30%. Why aren’t you quoting statistics, which are easily available on the Internet?
Anything can be treated, but not all treatments have good outcomes. The truth is that only the most severe cases of depression respond to medications. There’s a strong placebo effect. Treating depression isn’t like giving someone aspirin for a headache; you have to work with the medications, trying one and then making modifications. Talk therapy has been indicated as more desirable for sadness associated with life events, such as bereavement.
(3) The article suggests that older people avoid therapy because of the stigma. People who came of age in the sixties — who are now in their sixties and seventies — grew up with therapy. They know that therapists differ widely in skill and experience. And they can’t find the good ones, let alone pay the going rate.
The New York Times has reported that only 55% of mental health professionals accept Medicare, compared to 86% of other medical professionals. Anyone seeking treatment faces an uphill battle to find a provider, let alone someone who’s competent and experienced with the relevant age group.
Another NY Times article found that 27% of people with depression were not receiving treatment. At the same time, about 29% of those being treated for depression were not clinically depressed; they were receiving unnecessary, potentially harmful treatment.
When readers get exposed to simplistic articles like this one, they may be tempted to push healthy people into treatment that’s at best a waste of time and at worst leading to side effects that would make anyone depressed. I personally know two people who presented with physical illness, yet were misdiagnosed as mentally ill, leaving them traumatized from receiving unnecessary treatment and suffering from delayed intervention in their genuine medical conditions. And according to Steven Hatch, MD, author of Snowball In A Blizzard, psychiatric diagnoses are prone to systematic flaws that can be summarized in one word: Rosenhan.
Practical measures should include fighting to make assisted dying more widely available. We need more awareness of the difference between depression-related suicide and the desire to die with dignity. And if someone truly is depressed, they need access to competent professionals, instead of the bottom of the barrel therapists willing to accept Medicare.
Simplistic articles like this one do a lot of harm. The elderly are abused because they’re not taken seriously. Many are depressed because there’s no place for them in society; that can be cured with a pill or a year of talk therapy. Writing in a simplistic tone about a complex, challenging situation can be viewed as dismissive, exacerbating the problem. I hope you’ll reconsider your editorial policy and start to do some good.
Here’s what I sent to the author of Milestones, a tabloid for “seniors.”
The story on “elder orphans” raised several questions for me.
The term “elder orphans” is deeply offensive to many people who are aging without family. An orphan is a child without parents. We’re talking about adults without children. The term is infantilizing.
Additionally, the problem of planning for end of life as well as care during illness is not limited to elders. Anyone’s spouse could die or decide to leave; I know a woman who was “dumped” in her mid-fifties. Children can be unreliable, far away, or estranged. There’s no guarantee that children will carry out your wishes; we’ve all heard stories of the grown children who fly in and start making decisions even when they haven’t seen their parents in years.
As for care, something like 90% of elder abuse comes from family.
Your story also implies that older people who live alone are lonely. Many of us would rather be dead than share our living space. In her book, Never Say Die, Susan Jacoby describes a man who’s forced to start living with a caretaker. He steals the caretaker’s car keys, drives to a bridge and jumps off. Many older people can relate.
What’s needed are three things:
1 – A way to allow the elderly to see meaningful employment — something that gets rewarded for good performance. Not every elder wants to leave a legacy Many older people are isolated because of age discrimination in the workplace. One of Trump’s lawyers is 84 years old. Nancy Pelosi is in her late 70s. Most people their age would be considered too old for any job except greeter in a big box store. Getting paid means being recognized and valued. Many older people have trouble reaching out and getting involved because they don’t have money — and because working creates bonds.
I’m older than the people you mentioned in the article. I work on the Internet; there’s no way I could get a meaningful face to face job. And when I meet people, they don’t ask what I do; they ask, “Are you retired?”
2 – Currently age discrimination is not considered politically incorrect. Older women are disrespectfully addressed as “Gramma” or referred to as “grannies.” Jokes about older people needing diapers don’t help. Think of the song, “Grandma got run over by a reindeer.” Imagine a similar song about black people or gays.
3 – Everybody – not just the elderly – needs to be able to set up advance directives for end of life care, stored in the cloud. Those who set this up could get a bracelet or tattoo with the URL holding these wishes. We need strict laws to prevent overeager medical people from violating these wishes. This is the 21st century. I did my last mortgage without touching a piece of paper. Our ability to die as we wish should not depend on a live medical proxy.
And we need assisted dying. There’s no way to maintain quality of life in most nursing homes. Without constant vigilance by a capable advocate, the inmates will be abused.
Good article here: