Coming Out about Age

When I was growing up, every 12 months I got one year older. But my mother, who turned 39 three months after my 7^th birthday, remained 39. That puzzled me. My mother explained that for women, by magic, their age never clicked past 40! The French have long dealt with my mother’s reluctance to come out about advancing age with the decorous phrase – “d’un certain âge.”

Some years ago, a distinguished physician-colleague a few years younger than I am now, told me he’d experienced three phases in his medical career. Early on, potential patients would say “Who is Dr. X and what does he know?”  At mid-career they would say “I want to see Dr. X – he’s the best!” Then, in when he got to the over-65 phase, they asked “Oh – is Dr. X still alive?”

Teen agers worry about looking too young to get in to R rated films or the popular clubs. For over 65ers like Dr. X, the worry is about looking too old to be seen as relevant to ongoing life.

I recently conducted a small, unplanned experiment with “coming out” about age. I lead the Ethics Advisory Group at Harvard Pilgrim Health Care (HPHC), a not-for-profit New England health plan. The group includes HPHC staff, employers who purchase HPHC insurance for their employees, physicians who practice in the HPHC network, consumers (folks who have HPHC insurance), and public policy representatives. Our topic was HPHC’s inclusion and diversity program. Our aim was to identify values that would support the program and values that might impede its success.

The meetings are open, and the topic drew 45 participants, including a lot of “diversity.” I try to make the discussion informal, engaged, and personally meaningful. As a white male professional I wasn’t accustomed of thinking of myself as “diverse.” But in the run-up to the meeting I realized that age, like race/ethnicity, LGBT status, and other characteristics, is part of the concern with inclusion.

I made an enquiry to the human resource department, and confirmed my guess that I’m the oldest employee in the organization.

Prior to the meeting I’d circulated an article by Eric Schultz, the CEO, about his personal commitment to inclusion and diversity. After Eric opened the discussion, a staff member recounted how, as a newly out lesbian, she cried at her orientation session, when the speaker made clear that LGBT folks were genuinely welcome. I followed her comment by saying that perhaps I should have cried when Eric included age in his opening remarks. (I like our meetings to include laughter, and was happy that the group laughed.) Later in the meeting I commented that a friend in his 80s, who is there in the consumer role, and I, represented “chronological diversity” much as African American, Latino, LGBT, and folks with disabilities, who were participating, represented other forms of “diversity.” (The group laughed again.)

After the meeting some of the participants said they’d enjoyed my comments about age and asked me how old I am. In terms of the climate of openness I want to encourage in the ethics meetings, I took the direct question as a good sign. But later I felt some discomfort. What if some of those at the meeting had “ageist” attitudes? Was I relegating myself into a ghetto? I know from the lesson my mother taught me early in life that I’m not the only one with a concern of this kind.

When I did a Google search under “elderly people coming out about age,” all the links were about LGBT coming out, except for one to the Beatles, who nailed my concern in the Sgt Pepper’s Lonely  Hearts Club Band with their song “When I’m 64”:

When I get older losing my hair,
Many years from now,
Will you still be sending me a valentine
Birthday greetings bottle of wine?

If I’d been out till quarter to three
Would you lock the door,
Will you still need me, will you still feed me,
When I’m sixty-four?

In my psychiatric practice, I saw many gay & lesbian patients who were conflicted about coming out. Over the years, I got better at helping them distinguish between genuine external risks and internalized homophobia. Since the ethics committee meeting I’ve been doing the same differential diagnosis with myself. To what extent is my concern about losing respect in my work environment realistic, and to what extent does it reflect internalized “ageism”? I believe it’s largely the latter. But time will tell.

James Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.