February 08, 2018


The End of Old Age: Living a Longer, More Purposeful Life. By Marc E. Agronin, M.D. Da Capo. $27.

     The Age of Enlightenment, roughly coinciding with the 18th century in Europe, was a time in which reason and rationality came to dominate intellectual and philosophical thinking, overcoming the emotion-and-religion-driven thinking that had largely dominated earlier discourse. Now, argues geriatric psychiatrist Marc E. Agronin, we are in need of enlightenment of a different type and for a different purpose: it is time to realize the many positive elements of growing old and to use the rational understanding of those elements to overcome ageism in society and allow older people to be happier, more productive and more respected right up until life’s end.

     This is a somewhat utopian viewpoint, but it is certainly well-meaning and, in The End of Old Age, often well argued – although the book’s title is a bit of a problem, since many readers will likely (and understandably) think the end of old age is simply death. What Agronin really wants is the end of a certain type of thinking about old age, just as 18th-century philosophers wanted a change in thinking about life and humanity in general. Agronin takes nearly as broad a view in his field as those philosophers did in theirs, stating that the issue of aging is no less than “a question that taps into the meaning and mission of our life.” He includes a wide variety of arguments for a more-meaningful old age, and to his credit does not omit quotations from various scholars, ethicists, doctors and others who primarily see the inevitable losses of old age and the shrinking of the world as one’s abilities and health diminish. Yet Agronin ultimately discards those views of old age as, in Shakespearean words that he does not include, “sans eyes, sans teeth, sans taste, sans everything.”

     Agronin cites evidence that “people with positive self-perceptions about aging…demonstrate median survival rates 7.5 years longer than do those with negative self-perceptions,” but this is scarcely surprising. Yes, there may be causality here: psychosomatically, the mind can and does influence the body, and ongoing mental positivity has a salutary effect on one’s physical being. But the reverse is also true: a generally healthy body leads to an improved mental/psychological outlook. So it is reasonable to assume that people whose physical condition predisposes them to a longer, healthier life are more likely to have positive self-perceptions about aging. In other words, it may be that the perception influences life length, or it may be that those whose lives will be longer develop more-positive self-perception. Incomplete arguments and citations like this one undermine some of Agronin’s generally thoughtful discussion about the aging process.

     Where that discussion works best is in the author’s attempt to connect it with the life-cycle theory of Erik Erikson. Originally an eight-stage construct, this was changed to a nine-stage one in an attempt “to capture this final stage of life.” And it is this ninth stage that Agronin explores and suggests his readers explore with him. He argues, for example, that far from inevitably diminishing with age, creativity can increase because “with life experience, we accumulate facts about multiple situations and familiarity with how to deal with problems.” This makes sense – although applying one’s creativity requires an understanding of context, and while, for example, many corporations might agree that older people are a source of great knowledge and theoretical problem-solving ability, they might also say the elderly lack the high-tech training and super-fast response times needed to implement their knowledge in a contemporary context.

     Likewise, Agronin talks about people in the ninth stage of life becoming “seers,” with “extraordinary vision and insight, although not for what will be but for what could be.” And he approvingly cites the example of the spiritual leader of “a close-knit group of Hasidic Jews,” a man with significant infirmities but “so revered by his followers that his very presence was transformative,” a man who “could still place his hands on a supplicant’s head and emote a blessing, leaving the person nearly ecstatic.” Some readers, however, may think this scene smacks of cultic adoration rather than a positive attitude toward old age – and certainly the response of the supplicants can be scientifically explained by the placebo effect, which often (although not necessarily always) comes into play with the laying-on of hands.

     Again and again, Agronin makes points about the positive elements associated with Erikson’s ninth stage, and again and again he brings his philosophical arguments down to earth by citing examples – both positive and negative – of people whose aging has gone very well and others whose older years have brought unhappiness and even clinical depression. Some of the latter are Agronin’s patients, and part of what he tries to do in The End of Old Age is to show how he managed to help them turn around their attitudes toward their older selves and thus turn around the negative elements of their lives. These are positive and often uplifting stories, although their usefulness will depend on the extent to which individual readers see themselves and their lives paralleling those of Agronin’s patients.

     Agronin eventually arrives at a prescriptive chapter called “Redefining and Re-Aging,” in which he recommends a five-step process of what he labels Reserve (“fully appreciate the scope of your wisdom”), Resilience, Reinvention, Legacy and Celebration – the last of these being done after “you’ve reexamined your own aging in a positive light.” This formulation can be a useful starting point for a better attitude toward aging, and the grids and charts that Agronin provides for each element make it easy to follow. What is not so easy is figuring out how to follow them if one is significantly compromised by the common (if scarcely inevitable) circumstances of old age – that is, by infirmities that may be physical, mental, emotional, psychological or some combination thereof. Readers who are essentially healthy and in command of their bodies and minds will draw a great deal of benefit from the positive thinking that underlies The End of Old Age. But neither this book nor any other can be reasonably expected to offer people with significant physical and/or mental compromises a reason to celebrate the exigencies of their daily lives.

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