BOOKS JANUARY 27, 2011
One evening a few months before my eightieth birthday, I found myself addressing an audience of approximately a hundred men and women on a topic to which I have devoted considerable study during the past decade or so. My subject was the process of aging, and the ways in which current gerontological research is teaching us to deal with it. It is hardly remarkable that such a theme would engage a group whose average number of years on this earth appeared to be approximately sixty-five, especially when the speaker is a rising octogenarian known to have written abundantly about such matters.
During the course of my talk, I focused—as does much of the recent scientific, clinical, and general literature—on the optimistic. I stressed the role of determination and conscious effort in combating certain of the ravages that nature inflicts on those of us in the latter decades of life. I spoke of the importance of physical exercise, the creativity that comes with continued intellectual exploration, the critical importance of a personal sense of closeness to family and the surrounding community. Such essential patterns of living are easily explained, and they were more or less familiar to the upper-middle-class audience of friends and benefactors of the university medical center to which I had been invited.
But I also described newer and more abstruse matters, such as our present understanding of the brain’s plasticity, which allows it to change and even to improve not only its ability to function but also its actual microscopic structure, and to do so regardless of chronological age. Even more remarkable, I pointed out, was the laboratory identification of protein substances produced during the exercise of mind and muscle, such as brain-derived neurotrophic factor (or BDNF), which acts to protect neural connections and to enlarge their number and strength while increasing blood supply to the cortex and encouraging the conversion of adult stem cells into cortical nerve cells. The message I delivered was this: the key to continuing productivity is continuing productivity. It is, as the late Ann Landers famously said about a particularly intimate problem of aging, “Use it or lose it.”
Not unexpectedly, following the delivery of such a buoyant message to such an audience, the applause was enthusiastic. But then a hand shot up, whose owner was a red-faced, chokingly angry man in the first row who appeared to be about sixty years old and to have deliberately disregarded the instructions on the event’s invitation that gentlemen wear business attire. Windbreaker askew, he was already halfway out of his seat and still impatiently rising before I was able to acknowledge him. I cannot recall the exact outpouring of words that he more spewed than spoke, but they were very much like the following, if a bit less organized: “What you’re saying is all very well, but don’t you realize that it applies only to men and women of means and education? The vast majority of the elderly don’t know about these things, and couldn’t afford them in any event. They often live alone and friendless or in some publicly subsidized care facility. Your ideas are suitable only for the more favored of older people. Society neglects everyone else and doesn’t care about them. Maybe you don’t, either.”
To buy a breath of time, I looked out at the audience, which quite obviously consisted of only “the more favored,” and for the briefest of moments thought to point out that the people to whom I was speaking were indeed among those who could benefit from my message, which was precisely why I was delivering it to them. But there was something about the man’s self-righteously accusatory tone and hyperbolic outrage—as well as the puzzled looks on the faces of more than a few audience members—that stopped me from taking so apparent and obvious a tack. In that briefest of instants, a long-forgotten image flashed across the screen of my mind, of a paved outdoor space in lower Manhattan to which my father had taken me as a small boy on more than one occasion. It may or may not have been Union Square, but it was that kind of open arena where men and sometimes women literally stood on soapboxes or orange crates to exhort a crowd with shouted attacks on “the bosses, the bankers, and the scabs.”
Other fathers took their seven-year-old boys to the circus in those simpler days, but mine was determined to have me learn only about the real world of the less privileged—in which, incidentally, my family lived—by attending union rallies where Eastern European immigrant Jews and their Italian-born equivalents in the lower echelons of the garment industry demanded improved working conditions and debated the best way to get them. By the time of my ninth birthday, I had become a bit of a socialist, as I am said by conservative colleagues to be to this day. I went on within the next few years to volunteer as an envelope stuffer for the American Labor Party, and my political thinking has not shifted measurably since that time. All this social awareness fell into place as naturally as the receding hairline I inherited from my father, and has been related in no way to the various socioeconomic stages in which I have lived my life.
As my very brief flight into memory was coming to a close, so was my attacker’s tirade. He finished with a flourish: “Your talk is an exercise in deception typical of people like you. What we need for the fragile elderly are changes in our society, not useless prescriptions for exercise and crossword puzzles, which don’t work anyway.” I had been presented with a mini-version of the classic soap-box oration of my childhood, overflowing with an excess of bile and somewhat contrived, holier-than-thou spleen. Very much like that of the stump spellbinder of yore, my antagonist’s diatribe was in no way responsive, save for its final four words (and those erroneously), to what I had said, just as each succeeding speaker in that remembered New York version of Hyde Park Corner had his or her own carefully rehearsed variety of axe to grind, regardless of what had been declaimed or shouted only minutes before by previous incumbents of the hustings. The purpose of the lightning bolts of verbiage was to make an argument obviously presented by its author many times before in this or other venues; it was not tailored to any specific occasion or opponent. In sum: the man’s point, regardless of its general accuracy, was beside the point.
Still, being beside the point does not of itself vitiate the rightness, or the righteousness, of an argument. My challenger had a point which was as valid as the one I had just presented, even though it did not address my specific message. He was correct, but so was I. Just as I had spoken only of the good that I believe to justify optimism in the contemplation of aging, he had spoken only of the bad that has not yet been overcome or so much as addressed.
Since I had to respond to his statement, I made it clear that it took little means to carry out any of the recommendations I had made, beyond the less crucial ones such as travel, museumgoing, and a few others. But I did take pains to acknowledge, as I have done in these paragraphs, what I know to be true: my message that evening was for those who can use it, and is for the most part inapplicable to many others—primarily the socially, financially, and educationally disadvantaged—who number far more than can be seen through the rose-colored glasses being worn by me and so many gerontologists, geriatricians, and science observers—glasses with far too little peripheral vision.
All of this is by way of introducing Susan Jacoby’s disturbing and important book. Her focus is not at all on the advances that gerontological research has made in improving the health, happiness, and sometimes the longevity of much of our older population. She prefers to look into “the uncharted perils that lurk in the region of old age” and the self-delusion of “the expectation that things are going to turn out well if we only conduct ourselves well.” The notion that many of the elderly can postpone or even prevent much of the physical and mental deterioration associated with an increasing life span is, by Jacoby’s lights, the result of “myth and marketing.”
Never Say Die will stir up controversy, but it will also draw attention to social issues often ignored in our enthusiastic promotion of the health-sustaining values and behaviors in which we have placed so much faith in recent years. The book is in this way an important corrective to those of us who are so taken with the realization that conscious will and a determined approach are valuable resources that we forget the unpalatable fact that we live in a multi-tiered society in which the best will in the world, and the most determination, are limited by the reality of the actual circumstances of life.
Too many of the elderly do not have the family or the communal attachments necessary to feel valued; too many are widowed or otherwise alone; too many live in surroundings where they are essentially without the companionship necessary to stimulate a mind in danger of deteriorating. Too many are so poor or unable to obtain social services that they cannot remain in their own homes, and are certainly without the wherewithal to live in an upscale retirement community or assisted-living facility. Too many have passed their entire lives without the level of education and general knowledge necessary to take advantage of what is available to their peers raised in circumstances of greater awareness. For the vast majority of such men and women, so often socially and even physically more or less isolated, modern gerontology and its discoveries might as well not exist.
Where autonomy is made impossible by the dependence on others necessary to live through each day, the exercise of conscious will is a useless suggestion to make. Where nothing in a person’s earlier years lends itself to an old age devoted to continuing intellectual and physical pursuits, a late-life interest in Tolstoy or even crossword puzzles is unlikely to appear, no matter the urging by well-intentioned social workers or people like me who write books about it. Where the despair of loneliness and poverty haunts every hour, the optimism to embark on new projects cannot find a place to alight on the brain’s cortex.
Poverty itself is an enormous obstacle to an enlightened and enlightening—not to say healthy—old age. Jacoby informs us that “only one-fourth of Americans over sixty-five have incomes of more than $33,677 a year. Another quarter have incomes under $11,139. Household income drops precipitously with every decade ... [and] many lower-middleincome women slip below the poverty line almost as soon as they are widowed as a result of leftover medical bills and funeral expenses.” Those are chilling numbers. And quite obviously, the families and individuals with the lowest incomes are most likely to have always been among the economically disadvantaged, and as a result to have been inadequately educated and therefore less than wellinformed at every phase of their lives.
Such are the lessons taught by Jacoby’s book. We live in an era of cockeyed optimism, she tells us, about the gains that have been made in the prospects of elderly people. Our media serve up one promise after another of forthcoming medical and societal miracles that will increase longevity and provide sturdy good health for the added years, not to mention financial security, wisdom, and continued sexual vibrancy. The onrushing hordes of baby boomers are constantly being told that “seventy is the new fifty” as medical and pharmaceutical aids to “successful aging” become available by prescription, over the counter, and perhaps by means of corrective space-age surgical techniques that are the products of current research in stem-cell applications, organ transplantation, and even bionic technology. We read of the new “regenerative medicine” that will revitalize our tissues, and imagine its benisons to be imminent, plentiful, and soon available for the asking.
It is Jacoby’s mission to deflate the exaggeration and to expose all that she considers humbug. She wants to be sure her readers are aware that—hope as we might—aging inevitably brings on a series of gradual, and sometimes rapid, debilitations that are physical, mental, financial, and social, especially for the great majority of Americans who do not fall into the category known as upper middle class or higher. Very appropriately and with forceful emphasis, she points out that “inflated expectations about successful aging, if the body imposes a cruel old age, can lead to real despair.” She argues convincingly and correctly in favor of collective action to address such problems, including those in which the social welfare of the older population stands in danger of conflicting with that of the younger, leading to a worsening of the inter-generational conflict that is currently just beginning to be felt. In such matters she is an articulate advocate for all of us, regardless of age.
Statistics supporting Jacoby’s viewpoint pour forth from the pages of her book, sometimes so relentlessly on the heels of one another that they make for difficult reading and tempt one to skim sections of the arguments that she presents. The result, unfortunately, is a volume far less powerful than it should have been. Bolstering a case with figure after figure, study after study, does not necessarily strengthen it. The dulling recitation of facts makes the crisis less vivid; too many of Jacoby’s chapters seem more like diatribes than like well-formed presentations of the topics that she brings to our attention or the conditions under which too many Americans live.
Only rarely do we read of actual people and actual circumstances, or of an actual experience that Jacoby herself has had when speaking with an aged man or woman who might bring human meaning to certain of her perspectives, and empathy to the mind of the reader. If she has walked among the elderly and the real men and women of whom she writes in such collective numbers, there is precious little evidence of it. Virtually no one appears in her pages with whom she or the reader can identify—there is only a structure of inanimate and joined population-based data and the conclusions based on them. Except when writing of family members and a few others to whom she was especially close, Jacoby puts no recognizable human souls into her narrative, which is consequently not really a narrative at all but more a succession of feature articles written on assignment and illustrated by the story of no one.
Over and over I visualized Jacoby with a file of index cards on her desk, industriously transcribing the scribblings on one after the other into her manuscript, to fulfill her notion of the requirements of documentation. She is by profession a science writer, and she seems unable or unwilling to shed her mantle of impersonal objectivity and distance sufficiently to illustrate the terrible dilemmas to which she rightly calls our attention. She treats them like so much sociology and statistical proof rather than as the drama of human lives that we might expect in the presentation of such a potentially affecting subject.
To read Never Say Die is like being taken on an airplane high over a city that one would much prefer to visit in leisurely and more intimate fashion on the ground. And this city is one about whose nature Jacoby yields no quarter in her determination to show that its scenario, for all but the most privileged of its citizens, is one of unrelieved gloom and pessimism, made worse by “a creeping realization of the ultimate ineffectiveness of the defenses—the ‘positive’ measures—by which all of us attempt to keep the demons of old old age at bay.” It is precisely in this part of her argument that she loses those of us who have carefully followed or participated in the scientific and general literature that each year tells of new triumphs in the campaign against the debility that has until recent decades been presumed to be the wages of time’s passage.
Jacoby should know, she must know, that there is no longer any doubt of the effectiveness of such “positive measures” as exercise programs, intellectual stimulation, creative projects, and the closeness of community to ward off the deteriorations visited on the structure and functioning of the aging human body. To deny this certainty, as she does so dismissively, is to vitiate both her thesis and the thesis that she should be presenting, which is that we nowadays recognize how much can be done to ameliorate the problems of aging individuals across social classes, and our responsibility must therefore be to make certain that every American has access to the remedies available to relatively few.
For the undeniable fact is that things will very likely “turn out well if only we conduct ourselves well,” and to deny it is to do a great disservice to the very population that Jacoby means to benefit. And she does seem to be aware of this, though nowhere to the point of acknowledging (except obliquely) that such things are possible, as when she cites research showing “that walking not only increases life expectancy but that the faster people walk, the longer they live.” And what about the huge body of research showing that weight loss, vigorous exercise in addition to walking, family support, and even the much-abused crossword puzzle not only add to the quality of that longer life, but may increase its duration? Surely poor people, too, need to be told to walk a lot and watch their diet and engage in mentally sharpening activities, none of which are necessarily class-based remedies.
For far too many Americans, Jacoby’s hazard-strewn road through later life is an accurate depiction, and she hammers that point home in chapter after evidence-supported chapter. She shines a glaring spotlight on the consequences of social inequality, and on the huge group of the elderly and soon-to-be elderly who have indeed been deluded by a modern concept of aging that ignores the reality of the disabilities, the restrictions, and the losses that the years inevitably bring if they are not actively fought. It is a concept that denies the decade-by-decade increase in frequency of disease, poverty, and loneliness among the old, which may—when heaped on top of cultural handicaps—prevent any useful and proven measures from being so much as attempted.
Civic planners, makers of public policy, sociologists, geriatricians, cultural historians, and advocates of the elderly should make their way through Jacoby’s book. And so should every one of the many others whose moral philosophy is offended by the knowledge that social disparities stand in the way of providing known remedies for the depredations of aging, whether of mind, body, or soul. It will be many decades, if ever, before the 50 percent of those over age eighty-five who suffer from dementia can be afforded some relief or prevention of that dreaded plague of the final years, but in the meantime there is so much that can lighten the burden that they impose, and justice cries out for its universal implementation. There is nothing false or cold-hearted about such “privileged” measures. Compassion for the aged can take many forms.
Regardless of their studied outrage and air of sanctimony, Susan Jacoby and the fulminating fellow who engaged me at the medical center deserve the gratitude of the rest of us, who might otherwise continue in our own form of self-righteousness without stopping to consider that privilege has its responsibilities. Paramount among those responsibilities is to support the sweeping societal changes without which the bodily benefits accruing to us are unavailable to men and women who have not had our good fortune. One wishes only that Jacoby’s call to our public and individual consciences had been couched in more personalized, more human, terms.
Sherwin B. Nuland is a contributing editor for The New Republic. This article ran in the February 17, 2011, issue of the magazine.