Learning from Our Elders

A recent phone call led me to reflect on how over 65ers can help younger folks learn about aging.

Three months ago I received a call from Langley Danowitz, daughter of Emily Lublin, a long time patient of mine, who had died in 2000 at age 84. (Langley had seen me quoted in a New York Times column. I use names with her permission.) Emily and I had a warm, friendly relationship and very much enjoyed working together on various vicissitudes of her 70s and 80s. At one point Emily said, “You have to promise not to retire before I die.” I was sad when she died, but happy to have been able to keep my promise.

Langley and I reminisced about her mother’s sense of humor and curiosity about the world. We’d both admired Emily’s resilience and felt we’d learned from her about coping with the slings and arrows of aging.

In my psychiatry residency, when we overly intellectual twenty-somethings asked our training director what we should read to become wise psychiatrists, he said, “Listen to your patients . . . they will be your best teachers!” In the same vein, when I was dealing with a not very communicative “elderly” man (probably 10-to-15 years younger than I am now) who became depressed after losing his job at a beer factory, my clinical supervisor advised me to “have him teach you about what it’s like to work in a beer factory all your adult life.” It worked. I learned and his depression lifted.

Throughout my entire clinical career I tried to follow the precept about learning from patients. In retrospect it seems clear that the domains in which I learned most about life, human nature, and myself have been family and clinical practice.

When my father was 80 he lost his vision due to macular degeneration. He lived in Florida. I lived in Massachusetts. My mother had died three years earlier and I was his only child. We spoke on the phone every day. I realized that I was – in effect – doing a form of short-term psychotherapy focused on loss and resilience. My father ultimately adapted to legal blindness remarkably well.

While he never described it as “teaching,” I believe he used my visits to Florida to instruct me about aging and dealing with adversity. His somewhat apologetic comment that “people my age aren’t trying to set the world on fire” helped me understand that while future-oriented ambition was diminished for him, he still assessed himself in terms of what he contributed to the world. Another time, when we went out for a cheerful lunch after a friend’s funeral, he said: “Don’t think we old folks are unfeeling. If we dwelled too much on the death of people we know we’d have to stop living ourselves.”

Towards the end of his life he taught me his major lesson. Twice a widower, he married again. Shortly after the wedding, my new stepmother, whom he had known for only a few months, began to show signs of dementia. It was extremely difficult for a blind person to care for a spouse with dementia. I gently asked him if he felt obliged to care for someone he’d known for such a short time. He reproached me for being stupid. “If I don’t care for her, her son will put her into a nursing home and she will die,” he said. “How many ways are there for a blind 87 year old to be useful? Of course I’ll take care of her!”

I went back to Erik Erickson’s work to review his interpretation of the stages of life. I discovered that I misremembered his famous schema. I mistakenly thought Erickson named the healthy approach to aging “generativity.” Erickson actually posits that as the virtue for adulthood. “Wisdom” is what he ascribes to the successful 65+ folks. Its opposite is despair.

Erickson may have been on target when he formulated his views 50 years ago, but I think he’s wrong for the present. “Wisdom” as he conceptualizes it involves reflecting on the meaning of one’s life. That sounds passive and somewhat narcissistic. What I saw in my father, and see among many in the 65-to-85 group, is much better described as a quest for “generativity.” The question many pose for themselves is, what can I contribute to the world at this phase of life?

When I discussed these ideas with a young friend, he taught me an aphorism I’d never heard: “The true meaning of life is to plant trees under whose shade you do not expect to sit.” (The aphorism comes from the title of a book Wes Henderson (1928 – 2003), a third generation Canadian, wrote about his father Nelson. It’s the advice Nelson gave Wes when Wes graduated from high school.)

In different ways I was caring for my father (as a son) and for Emily Lublin (as a doctor). But at the same time, both were caring for me, by helping me prepare for the stage of life they were at. They were planting trees under whose shade they would not sit. I’m very grateful for what they did.

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





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