AFTER THE LIFE CYCLE: THE MORAL CHALLENGES OF LATER LIFE
By Thomas Cole
"Men die because they cannot join the end to the beginning."
--Alcemeon of Groton
INTRODUCTION
In almost 30 years of reading and writing about later life,
my favorite book is still a slender volume by the Catholic theologian
Henri Nouwen and Walter Gaffney, entitled Aging: the Fulfillment of
Life. (1974)1 . Like
many books on aging in the 1970's and 80's, Nouwen struggles against
negative stereotypes and attitudes toward older people, offering images
and ideals emphasizing our shared humanity in the universal process of
growing older. The book's central motif is a large wagon
wheel leaning against a birch tree in the white snow. The photo
invites each of us to think of ourselves as a spoke on the great wheel
of life, part of the ongoing cycle of generations. It also implies
that each of us has our own cycle to traverse, a moving up and a going
down, moving forward, yet also somehow returning to the beginning.
Nouwen's wagon wheel resembles the Christ-centered circular life cycle,
which his medieval forbears rendered on stained-glass cathedral
windows.
But while medieval Christians considered earthly time as a mere shadow
of eternity, the late 20th-century Catholic theologian
asserts that "we have only one life cycle to live, and that living
it is the source of our greatest joy."2 Modern Western culture since the
Reformation has placed great emphasis on the affirmation of everyday
life, on relief of suffering, and on respect for the dignity and rights
of individuals.3
As a modern, Nouwen sets the issue of a good life squarely in the
province of ordinary living. Leaning heavily on Erikson's work, Nouwen
writes that our "greatest vocation" is to "live carefully and
gracefully." Aging, then, becomes the gradual fulfillment of the life
cycle, "in which receiving matures in giving and living makes dying
worthwhile."4 With
elegant simplicity, he describes the three-stage life cycle as it
cogwheels with previous and future generations:
"The rest full accomplishment of the old wheel tells us the story of
life. Entering into the world we are what we are given, and for many
years thereafter parents and grandparents brothers and sisters friends
and lovers keep giving to us, some more, some less, some hesitantly,
some generously. When we can finally stand on our own feet, speak our
own words, and express our own unique self in work and love, we realize
how much is given to us. But while reaching the height of our cycle,
and saying what a great sense of confidence, "I really am," we sense
that to fulfill our life we are now called to become parents and
grandparents, brothers and sisters, teachers, friends, and lovers
ourselves, and to give to others so that, when we leave this world, we
can be what we have given." 5
I love the lyrical beauty of this passage, and its view that an
individual's personal development naturally entails self-transcendence
and moral responsibility in later life. As Nouwen puts it, "receiving
matures in giving." But contemporary American culture seems to
emphasize individual development without a clear consensus-even a rich
debate--about the meanings of later life and the responsibilities of
older people to future generations. With the rise of mass
longevity--and ever lengthening life expectancy--the roles,
responsibilities, virtues, vices and meanings of an extended old age
take on new urgency in both private and public life. Strangely, there
is virtually nothing written on this subject.
There is a plethora of literature focusing (appropriately) on the
ethics of care giving, on private and public responsibilities to older
people, and on the rights of older people. But there is virtually no
discussion of the reciprocal responsibilities of older people. In the
bioethics literature, older people (or their proxies) are viewed solely
as bearers of rights, as individuals entitled to make their own choices
regarding health care. But there is precious little work on the content
of those choices-or on the larger issues of accountability,
responsibilities, virtues and vices of older people.
To address these issues, I will first provide a brief interpretation of
Nouwen and Erikson, focusing on the normative dimension of their views
on aging and the life cycle. Next, I will offer a historical argument
that we are living "after the life cycle" both normatively and
structurally. Finally, I will tentatively sketch the moral
challenges of later life--both for healthy active older people and for
those who are frail, sick, and dependent.
Moral Norms and the Life Cycle
Let me begin with a brief analysis of Nouwen's perspective and that of
his more famous counterpart Erik Erikson. Philosophically, Nouwen's
view rests on an ancient doctrine shared by Greeks, Romans, and
Christians alike---that the human lifespan constitutes a single natural
order and that each stage possesses its own characteristics and moral
norms. "Life's racecourse is fixed," wrote Cicero in De
Senectute, "nature has only a single path and that path is run but
once, and to each stage of existence has been allotted its appropriate
quality."6 With the
rise of Christianity, this normative life cycle was set within a
divinely ordained natural order--and the Stoic ideal of rational
self-mastery was replaced by a journey toward salvation.
While Nouwen writes as a Catholic, his view of the life cycle is
couched mostly in secular psychological terms which echo Erik Erikson's
famous psychoanalytic formulation of the eight "Ages of Man," each with
its own psycho-social conflict and its corresponding virtue. First
formulated at mid-century, Erikson's version of the life cycle
virtually dominated American academic thought and public imagination
for over twenty-five years. Erikson's theory is actually a restatement
of the Stoic ideal, supplemented by evolutionary and psychoanalytic
theories. Like the Stoics, Erikson argued that the cycle of human
life contained its own stages, each with its own moral virtues and
norms. Erickson saw virtues not as "lofty ideals" formulated by
theologians and moralists, but rather but as essential qualities rooted
in human evolution. As he put it, ". . . man's psychosocial survival
is safeguarded only by vital virtues which develop in the interplay of
successive and overlapping generations, living together in organized
settings."7
According to Erikson, the central psycho-social conflict in old age is
Integrity versus Despair. Wisdom is the corresponding virtue arising
from successful resolution of that conflict. Integrity for Erikson is
"an experience which conveys some world order and spiritual sense. No
matter how dearly paid for, it is the acceptance of one's one and only
life cycle as something that had to be and that, by necessity permitted
no substitutions."8 Wisdom is described as "detached concern with life itself, in the face
of death itself. It responds to the need of the on-coming generation
for an integrated heritage and yet remains aware of the relativity of
all knowledge."9
Erikson understood that the life cycle itself does not biologically
generate the prescribed virtues, values, and behaviors associated each
stage. Rather every version of the normative life cycle is created by
the combined forces of biology, culture, demography, history, social
structure and patterns of family life. While many of Erikson's
followers have treated the "Eight Ages of Man" as if it were a
universal paradigm of human development, I belief that Erikson's model
represents culmination of the ideal life cycle in modern Western
culture. This ideal of a long, orderly and secure life cycle first
emerged durng the Reformation and became fully realized in the middle
third of the 20th century.10 Ironically, modernization removed the traditional
structural underpinnings of the normative life cycle
and replaced it with the life course.
In both modern and postmodern society, old age emerges as a
historically unprecedented, marginal and culturally unstable phase of
life. Herein lies the poignancy of our situation. We are living
"after the life cycle."11 In this context, Erikson's extensive life cycle writings take
on an almost numinous quality. They offer hope for an ideal of the
life cycle we desperately want to believe in.12 But however attractive, Erikson's ideal
cannot accommodate the social, cultural, and demographic complexities
of our era. To say that we are living "after the life cycle" means in
part that we are living "after Erikson."13 We need a richer, pluralistic dialogue about
how to live the ever lengthening years of later life. But first, let
me sketch the historical context of our uncertainty about the roles,
responsibilities, purposes, and meanings of old age.
MODERNIZATION: FROM THE CYCLE OF LIFE TO THE COURSE OF LIFE
The modern life course began to take shape with the rise of urban,
industrial society. Set free from older bonds of status, family, and
locality, aspiring individuals increasingly came to view their lives as
careers -as sequences of expected positions in school, at work, and in
retirement. In the twentieth century, this pattern of expectations
became both statistically and ideologically normative, constituting
what Martin Kohli aptly calls a 'moral economy of the life course.' By
the third quarter of the twentieth century, Western democracies had
institutionalized this 'moral economy' by providing age-homogenous
schools for youthful preparation, jobs organized according to skills,
experience, and seniority for middle-aged productivity, and employment
based and publicly-funded retirement benefits for the aged who were
considered too slow, too frail, or too old-fashioned to be
productive.14 This stable
sequence is sometimes referred to as the three boxes of life: education
for youth; work for adulthood; and retirement for old age.15 Old age was roughly divided
into a period of active retirement supported by Social Security and
pensions, and a period of frailty supported additionally by the
Medicare, Medicaid, and private insurance.
During this transition to modernity, the cycle of life was effectively
severed from the course of life. In pre-modern society, when
generations of people lived on farms, in villages and small towns,
local traditions of practice, belief, and behavior provided external
moral norms as each generation visibly cycled into the next; the
problem of identity as we know it did not arise. In Germany and
Austria, for example, the burial plot of the older generation (even
today) was often reused when their children died, just as houses,
farms, and businesses were passed down. "The idea of the 'life
cycle,' writes Anthony Giddens ". . . makes very little sense once the
connections between the individual life and the interchange of the
generations have been broken."16 In a modern, mobile society life stages of life are
disembedded from place; the individual "is more and more freed from
externalities associated with pre-established ties to" family,
individuals, and groups.17 Under these conditions, the life course becomes a career, a
trajectory in which individuals choose their projects and plans;
segments of the life course are marked by 'open experience thresholds'
rather than ritualized passages. Life course transitions are often
accompanied by crises of identity; individuals are socialized to
confront and resolve such crises, and identity becomes an ongoing,
reflexive project.
For many older people in an urban, mobile, and rapidly changing
society, achieving a stable identity, knowing one's obligations, one's
place in the cycle of generations and in a worldview of ultimate
meanings-these things became problematic. At a practical level for
example, "Many skills that parents and grandparents knew are no longer
useful in the information age, although emotional balance, love, and
wisdom are still in short supply. Grandmothers have little need to
tell granddaughters how to bake bread . . . except as a story of the
past. There is little utility in having a grandfather" show his
grandson how to sharpen a tool on a grindstone."18
Even as older people in the last half of the 20th century
experienced vastly improved medical and economic conditions, they
encountered a culture with no clear consensus about the meanings and
purposes of later life. For the first time in human history, mass
longevity became the norm in developed countries. People who retired
often surprised themselves and the rest of us by living an additional
20 or 30 years. Continued increases in life expectancy now permit
four-and even-five-generational families. What were we to do with this
abundance of life? 19
This incredible gift of human longevity?
I do not mean to imply that all or even most older people were or are
unable to live morally coherent lives by drawing on the resources of
religion, family, community, and personal conviction. My point is that
the dominant social identities available to older people have been
narrowly confined to the roles of patients, pensioners, and consumers.
Consumer culture, the leisure industry, the welfare state, and the
medical establishment each had their own interest in shaping the
culture of aging.
In the last quarter of the 20th century, this relatively
stable institutionalized life course began to unravel. The 1970's
witnessed a powerful movement of older people and their advocates to
overcome negative stereotypes of older people as frail and dependent.
Mandatory retirement was challenged under the banner of
age-discrimination. The 1980's initiated a rebellion against the
bureaucratized life course and against restrictive age-norms. Writers
and scholars called for an "age-irrelevant" society that allowed more
flexibility for moving in and out of school and the work force. At the
same time, serious doubts about the proportion of the federal budget
devoted to old people were voiced in the name of "generational
equity". Others voiced specific fears of an unsupportable public
obligation to sick and dependent older people. Political support for
the welfare state began to erode.
And finally, the transition to an "information economy"--spurred by the
rise of computers and decline of industrial manufacturing--accelerated
the pace of life and the speed of technological and social change.
Amidst a globalizing economy, declining corporate commitment to long
term employment, seniority and defined pension benefits undercut
expectations for income stability during retirement. Postmodern or
late modern society confirmed with a vengeance Marx's famous
observation about capitalism: "All that is solid melts into air."
Zygmunt Bauman characterizes the resulting ontological insecurity in
terms especially apt for older people: ". . . the boundaries which
tend to be simultaneously most strongly desired and most acutely missed
are those of a rightful and security place in society . . . (a place
where) the rules do not change overnight and without notice . . . It is
the widespread characteristic of men and women in our type of society
that they live perpetually with the "identity problem" unresolved.
They suffer, one might say, from a chronic absence of resources with
which they could build a truly solid and lasting identity, anchor it
and stop it from drifting."20 Identity is not a purely personal issue; it is crucial to the
development of wisdom and to knowing one's responsibilities.
AFTER THE LIFE CYCLE: THE MORAL LIFE OF OLDER PEOPLE
When we begin to think about the issues of identity and morality in
later life, we immediately run into an obstacle articulated by Erikson
himself in 1964: "Our civilization," he wrote, "does not really harbor
a concept of the whole of life, as do the civilizations of the East. .
. . As our world-image is a one-way street to never ending progress
interrupted only by small and big catastrophes, our lives are to be
one-way streets to success-and sudden oblivion." 21 The absence of a culturally viable image
of the life cycle set within a larger frame of transcendent meaning
makes it difficult for many people to grasp the possibilities of
spiritual growth and moral purpose amidst physical decline.
In his seminal work After Virtue, Alasdair MacIntyre
argues that we no longer possess a commonly shared moral language; in a
world of moral strangers, MacIntyre claims that the only alternatives
are Aristotle or Nietzsche-that is tradition or chaos.22 By analogy, I think that we are living
"after the life cycle"--after the collapse of widely shared images and
socially cohesive structures and experiences of the life cycle. But I
do not think we are forced to choose between idealized tradition or
exaggerated chaos. First of all, the lack of a scholarly literature
or articulated norms does not imply that most older people are leading
morally incoherent lives. And second, the very search for identity
itself holds important moral promise. Here I am drawing on the work of
Charles Taylor, who argues that despite the moral limitations of
liberal individualism, the biblical tradition lives on as a kind of
background cultural inheritance. For Taylor, selfhood or identity is
inextricably bound up with some historically specific (and often
unarticulated) moral framework or notion of "the good." The quest to
become one's authentic self need not degenerate into self-indulgence,
emotivism or moral relativism. It can (and logically does) entail
becoming aware of and articulating the implicit moral framework of
one's family, community, or religious tradition, which provide
standards of conduct against which the fully developed person must
measure herself.
In Taylor's view, human life and identity are fundamentally
dialogical.23 We become
full, self-aware, and responsible human persons by engaging with
others. Our identities must be confirmed or recognized in dialogue and
negotiated with others. Self-definition is not possible in isolation,
apart from social forms of expression and the expectations, needs, and
values of others. Taylor acknowledges that the contemporary culture of
authenticity often encourages a purely personal understanding of
self-fulfillment. But he calls on us to retrieve the full moral
potential of authenticity.
A person in search of identity always exists within a "horizon of
important questions" which transcend the self. Attempts at
self-definition and self-fulfillment that ignore questions and demands
outside the self suppress the very conditions of meaning and purpose.
As he writes, "Only if I exist in a world in which history, or the
demands of nature, or the needs of my fellow human beings, or the
duties of citizenship, or the call of God, or something else of this
order matters crucially can I define an identity for myself that is not
trivial.24
We should not, in other words, view the search for identity in old age
as a narrowly personal quest. Of course we are all familiar with
examples of late life narcissism. Yet the effort to live an authentic
life is itself a moral ideal--an attempt to understand and fulfill the
uniqueness of each human life. Older people trying to make sense of
their past through various forms of life review, spiritual
autobiography, reminiscence, storytelling, lifestory writing groups,
are often doing important moral and spiritual work with genuine
implications for others. And those who are passionately involved in
the arts, in public service, religious communities and new forms of
self-exploration exemplify models of elderhood. As Erikson puts it at
the end of Childhood and Society, without elders who possess
integrity, children will be unable to trust.25
Authenticity in itself, however, cannot provide standards of conduct
and character to guide moral development in later life. Authenticity
alone provides no reasons to restrain the person who authentically
chooses selfishness or evil. It contains no intrinsic moral norms or
prohibitions. The dominant ideal of late life today seems to be what
the Austrian sociologist Leopold Rosenmayr calls Die Spate
Freiheit - or "the late freedom."26 Free from social obligations, retirement-for
those who possess good health and adequate income--is equated with
leisure activities (visiting family or friends, golf, mahjong, bridge,
travel, taking up new hobbies, attending classes at Elderhostel or
Institutes for Learning in Retirement, visiting family and friends).
The problem here is not that these activities are wrong or bad. Rather
they are based on the concept of freedom from-i.e. the
obligations of mid-life---with little or no attention paid to what the
freedom is for--i.e. which principles or commitments should
govern the choices being made. Today, senior marketing and
advertising specialists have a primary influence on activities,
programs, and products for seniors looking for ways to spend their free
time. While maintaining one's health necessarily occupies more time
and energy as one ages, the commodification of the body has elevated
health from a means to and end in itself.
Services, products, and programs for healthy aging are perhaps the most
lucrative segment of the senior market. Health is increasingly
construed as physical functioning divorced from any reference to
human meaning or purpose. The reduction of health to physical function
fits hand-in-glove with the notion of freedom as unfettered free
choice. In the 1970's, for example the biologist Alex Comfort wrote
two popular books-The Joy of Sex and A Good Age.27 In both cases, Comfort
celebrated technique, functioning, and achievement. In the early
1980's, I invited Comfort to participate in a conference on "Aging and
Meaning," where Bill May gave his prescient paper on "The Virtues and
Vices of Aging." 28 Comfort bluntly declined to participate on the grounds that he had no
interest in "grannyology." His response revealed an obvious disdain
for frail older women, a single-minded focus on control and
functioning, and a (common but rarely expressed) discomfort or
contempt for existential concerns embedded in most contemporary
discussions of "successful aging." More specifically, by implicity
linking sex, aging and achievement, Comfort anticipated the
contemporary redefinition of sexual decline and impotence--which occur
in individuals--into treatable sexual dysfunctions, which occur in
organs. In contrast, our culture needs to revision the notion of
health along lines suggested by the American Association of Medical
Colleges: "Health is not just the absence of disease but a state of
well-being that includes a sense that life has purpose and meaning"29
In today's consumer culture, drug companies, peddlers of
over-the-counter products, and anti-aging hucksters make billions of
dollars selling the false hope that aging is an option or a treatable
disease. Before the 20th century, health was understood as
a means to an end-living a good life according to the standards
embedded in religious traditions. After "the triumph of the
therapeutic," health was transformed from a means to an end in itself.
Rarely does one hear the question: "what do we want to be healthy
for?" A medicalized consumer society crowds out the cultural
space necessary for grappling with the most important questions of
all--to whom am I accountable? What makes life worth living? Am I
living a life I can look back on with pride and satisfaction? What
legacy am I passing on to my family? How can I prepare for my death in
ways that minimize disruption and give hope to my children?
Given the limitations of authenticity, individual freedom, and health
as adequate ideals, how should we begin to explore the moral challenges
of aging? Ronald Blythe offers a penetrating, if harsh, starting
point:
Perhaps, with full-span lives the norm, people may need to learn how to
be aged as they once had to learn to be adult. It may soon be
necessary and legitimate to criticize the long years of vapidity in
which a healthy elderly person does little more than eat and play
bingo, or who consumes excessive amounts of drugs, or who expects a
self-indulgent stupidity to go unchecked. Just as the old should be
convinced that, whatever happens during senescence, they will never
suffer exclusion, so they should understand that age does not exempt
them from being despicable. To fall into purposelessness is to fall
out of real consideration.30
Learning to grow old is an important and relatively
neglected concern in our aging society--one that calls for human
development policies (job retraining, creative use of leisure time,
lifelong learning, volunteer networks, self-help groups) that help
people develop the strengths and skills to solve their own problems.
As Harry R. Moody has pointed out, aging policy that responds only to
problems intensifies "depreciation of the strengths and capacities of
older people," and may inadvertently increase dependency rather than
try to prevent it.31
Falling into purposelessness is not only a matter of individual will
and character but also a matter of culture and public policy. Older
people-like all people-need to be needed.
In approaching the moral challenges of aging from the
individual's point of view, I have always appreciated Rabbi Hillel's
ancient three questions: "If I am not for myself, who will be for me?
If I am only for myself, what am I? If not now, when?" I take these
each of these questions to stand for a phase of the life cycle,
harkening back to Nouwen's formulation. As children and adolescents,
there is a natural tendency to see the world as one's oyster. In
mid-life, we realize that to mature we must attend to the needs of
others. And in later life, with time running out, we must learn to how
balance our own needs with the needs of future generations.
Interestingly, whereas Nouwen speaks only of giving as we age, Hillel
speaks of balancing competing needs and interests.
If we take Hillel's questions and apply them to later life today, we
can begin to specify key questions which demand careful and balanced
responses:
1) As citizens, what responsibilities do we have to our community, the
larger society, the environment? To the poor and vulnerable? To our
communities of faith? How do we balance these against our personal
interests?
2) What are our responsibilities to our children, grandchildren? What
level of caregiving and economic support do we owethem? How do we
balance these against our own needs and interests?
3) What responsibility do we have for older parents who may be in their
80's or 90's? How do we balance these against responsibilities to our
children? To our own personal interests and well-being?
4) What responsibilities do we have to future generations to minimize
the national debt they will pay? to help safeguard the environment, to
work for sustainable sources of energy?
5) What responsibility do we have for a spouse who is permanently
disabled, perhaps by the later stages of dementia? Can we say, this
isn't the person I married and I need to live my own life? Do we owe a
degree of loyalty that includes daily visits and care?
6) What responsibilities do we have to shoulder, depending on
circumstances, the burden of our economic support?
7) What responsibility do we have for our own health? For exercising
prudence in using limited health care resources?
8) What responsibility do nursing home residents have to assist each
other?
9) What responsibility do we have to pursue a path of continued growth
and spiritual development which aims at self-transcendence, compassion,
commitment to others, acceptance of physical and mental decline, and
preparation for death?
I will not here attempt to answer these questions. But I believe
they are urgent and call for personal wrestling, public debate,
academic inquiry, and perhaps public policy. A careful study, for
example, advice literature about aging32 over time would reveal much about the
changing values and norms conveyed to a reading public of older
people. We need a great deal of social and behavioral study of what
older people think about these issues as well as how they act. We need
studies of the moral and spiritual lives of older people in various
geographic, ethnic, racial, gender, and class situations. We need
diverse religious reflections and their translation into practical
programs in congregational life. We need philosophical inquiry and
public conversation. And we need to listen carefully to the life
stories of both ordinary and exemplary old people.
I do not think we can expect universally true, decontextualized norms
and values to which all elders should be held accountable. In a
pluralist society, we need to hear from various religious, ethnic,
racial, political, groups. We need to hear, for example, from the
AARP, which is often perceived merely as a powerful lobbying group for
older people. I think we need new models and ideals. One example is
Rabbi Zalman Schacter's "spiritual eldering" program, which sponsors
a series of workshops around the country for older people who would
like to grow in genuine elders.33 Another is the "Civic Engagement" project currently
underway in the Gerontological Society, or Marc Freedman's efforts to
generate strengthening voluntary movements of older people offering
their care and their skills with underprivileged urban youth.34
The complexity and nuance required to grapple with these moral
questions were aptly described by John Cowper Powys in his book, The
Art of Aging (1944): "If by the time we're sixty we haven't learnt
what a knot of paradox and contradiction life is, and how exquisitely
the good and the bad are mingled in every action we take, and what a
compromising hostess Our Lady of Truth is, we haven't grown old to much
purpose."35
In other words, we need to strive for the wisdom and spiritual
development to understand and respond to the moral challenges of
aging. (Sadly, our dominant culture lacks the very awareness needed to
begin this personal, cultural, and social "work".) As Powys points
out, life is a "knot of paradox and contradiction." What are the
paradoxes and contradictions one faces on the way to wisdom (one is
always on the way of course, one is never there)?
One prominent paradox is that wise people know that they don't know;
they can tolerate uncertainty because they understand the limits
(especially their own) of any attempt to grasp the entire truth and the
need for multiple points of view. As Florida Scott Maxwell puts it:
"I cannot speak the truth until I have contradicted myself."36 Wise people cultivate habits
of self-examination and self-awareness; they do not attempt to impose
their will on the world but learn to observe and accept reality as it
is and acceptance changes the reality. Consider the paradox that loss
is gain: failed expectations are a precondition for acquiring
experience which reflection may turn to growth. Or the paradox is that
unless a person accepts her own limited subjectivity and projections,
she will be unable to work on transcending them. Likewise, until a
person understands and accepts the transitory illusions of their
self-image, they cannot develop a higher understanding of themselves.37
These paradoxes and contradictions are not solvable problems to be
mastered with competence and expertise. They must be worked through by
each individual in search of spiritual growth; yet this rarely happens
without guidance and community. Our society, therefore, needs to
support various multicultural contemplative practices including prayer,
meditation, self-reflection, yoga, tai chi, new religious rituals,
etc. And then we run up against the ancient problem of the active
versus the contemplative life--another contradiction which needs
revisiting.
One of the most difficult and important the paradox of physical decline
and spiritual growth. How can we learn to work hard maintaining our
physical health, while at the same time preparing for our own decline
and death? How do we learn to hold on and let go at the same time? One
of the central obstacles to wrestling with the challenges of old age
lies in the intractable American hostility toward and denigration of
physical decline, decay, and dependence. Rather than acknowledge these
harsh realities, we pretend that we can master them and we feel like
failures when we don't. Hence the elevation of physical functioning to
the criteria of "successful" aging and the virulent fear and denial of
frailty and dependency. Let me turn next to the moral and spiritual
aspects of dependency.
THE MORAL CONTOURS OF DEPENDENCY
Dependency raises a special range of moral challenges for older
people. There are no guidelines about how to be a "good" dependent
person, and I doubt that such guidelines would be a worthwhile goal.
We must first enter dependency's inner workings before we can
understand its moral challenges. Imagine a life in which you cannot
walk, cannot carry out your accustomed activities of daily living, are
perhaps blind, demented, or incontinent--a world where you must wait
for others to bathe you, take you to the grocery store or the doctor.
Time stretches before you like a desert, shame and self-loathing
lacerate for the loss of your independence. You are tempted both to
false displays of self-sufficiency and to letting yourself go, lapsing
into pure passivity. Your family relationships become strained,
especially when givers and receivers of care are dutifully playing
their proper roles, without acknowledging their own and each other's
emotional turmoil.
When my grandmother became demented in 1986, I asked if she would
consider going into an excellent Jewish home for the aged. "What do
you think I am" she replied, "a no-goodnik?" she replied. This woman,
who had postponed marriage to care for her own mother, lost her husband
and her only son, had still managed to scrape together enough money to
leave her grandchildren an inheritance. Stripped of an acceptable
identity and the ability to be useful, she tried to jump off her
twelfth story balcony. Before slipping into deep dementia, she
agonized as the money intended for her grandchildren was spent on her
round-the-clock health care.
It is often a terrible burden to be a burden to others. What Wendy
Lustbader calls "the alchemy of successful frailty," depends on finding
ways to turning "the 'nothing' of empty time into the 'something' of
good days.38 The
possibilities of "successful frailty" depend on innumerable factors,
not the least of which is reciprocity.
In her book Counting on Kindness: the Dilemmas of Dependency,
Lustbader makes an unusual and controversial point about mercy. The
word in old French, merci, originally meant compassion and
forbearance toward a person in one's power. In Latin, merces,
signified payment or reward, referring to aspects of commerce. "Mercy"
writes Lustbader, is based entirely on exchange. "Giving help
eventually embitters us, unless we are compensated at least by
appreciation; accepting help degrades us, unless we are convinced that
our helpers are getting something in return. As much as we might
prefer to reject this stark accounting, we discover in living through
situations of dependence that good will is not enough. [There is] a
delicate balance at the heart of mercy . . . reciprocation replenishes
both the spirit of the helper and the person who is helped".39
We seem to lack language to acknowledge the difficulty of receiving.
Hence the dependent person may feel doubly burdened-- "disliking the
help that cannot be repaid and feeling guilty for the dislike."
Increasing frailty shrinks the opportunities to be useful, eliminating
external obligations: "no one expects our presence and no one needs our
efforts."40 Finding ways
to be useful requires imagination and will power, for example, among
nursing home patients who figure out ways to look after one another.
For a resident to feel useful sometimes require special sensitivity of
the caregiver.
As a geriatric social worker and therapist, Wendy Lustbader spent many
years going to the homes of frail elders who were ashamed of their
needs and struggled to conceal them. Lustbader once visited a woman
who allowed her in only because of a sudden illness. The woman's light
bulbs had burned out. She was reading by daylight and sitting alone in
the dark. Having nothing to offer her neighbors in return, she decided
not to ask them for help. The woman refused to allow Lustbader to
stand on a stool to change her light bulbs; Lustbader said she hated
thinking of the woman unable to sleep, tossing fitfully in her bed, and
unable to read. At last the woman's pride relented and Lustbader
changed the bulbs. "As I left, I thanked her for giving me the honor
of helping her. She understood what I meant, for it was she who was
carrying the burden of uselessness and I who was being granted
satisfaction."41
Despite an extensive literature search in English, I have been able to
find only two contemporary articles on the virtues and vices of
dependent older people. One by the theologian, culture critic, and
ethicist William May; and the other by the feminist, secular
philosopher Sally Ruddick. Before I turn to the topic of virtue and
age, I want to offer three words of caution: 1) although I'll be
discussing ideals of virtue in a relatively decontextualized way, any
full exploration must take in account differences in culture, gender,
race and ethnicity, and social class; 2) contrary to Cicero's
exclusive emphasis on character, exercising virtue is not simply a
matter of individual will; virtues occur amidst social conditions and
relationships which foster or inhibit them; and 3) a given person's
capacity for exercising virtue (especially the more subtle and
demanding virtues) also depends on her prior level of emotional and
spiritual development. For some people, obeying the "thou shalt nots"
of our society may be a more reasonable expectation. Such important
caveats lie beyond the scope of this paper.
In "The Virtues and Vices of Aging,"- an elegant essay written over
twenty years ago --William F. May contextualizes his discussion by
reminding us of the power imbalance between older patients and health
professionals. He observes that caregivers who unwittingly display
their health and youth are "like a bustling cold front that moves in
and stiffens the landscape." They cannot see that their vocation
depends on patients, which compounds the power imbalance, and obscures
the moral the significance of reciprocal dependency.
Writing across the boundaries of psychology, ethics, and theology, May
warns against the common confusion of infirmity with moral failure. He
emphasizes that virtues do not emerge automatically with age; rather,
they "grow only through resolution, struggle, perhaps prayer, and
perseverance."42 May
begins with four virtues appropriate to later life: Courage, Public
Virtue, Humility, Patience. One needs Courage to rise to
the occasion of loss and the certainty of death. Aquinas defined
courage as "firmness of soul in the face of adversity."43 Courage requires
"keeping one's fears, one's dislikes, one's laziness under control for
the sake of the good as well as one's own good."44 Public virtue requires
older people (as well as others) to temper pursuit of self-interest for
the sake of the common good.
Care-givers and care receivers alike need the virtue of
humility. Humility restrains the arrogance of
care-givers' power, even as it removes the sting of humiliation from
those assaulted by disease and disability. Like humility,
Patience, is a desireable response to anger, frustration, and
bitterness; but patience, on May's account, is not a form of passivity
or detached Stoic endurance. "Patience is purposive waiting,
receiving, willing; it demands a most intense sort of activity." For
May, the moral is never far from the spiritual: "precisely when all
else goes out of control, when panic would send us sprawling in all
directions. . . . [patience] requires us once again to become centered
in the deepest levels of our lives as purposive beings."45
Drawing from the Benedictine tradition, May adds three more virtues:
simplicity, benevolence, and integrity. The aged
pilgrim learns to travel light, to cast off the extraneous and embrace
the path to God. "Benevolence opposes the tightfistedness of
avarice, not with the empty-handedness of death but with the
open-handedness of love."46 May sees integrity not as a particular virtue of old
age but as an all-inclusive virtue that binds all other virtues
together in a unity of character.
Character is a moral structure that has integrity when it is at one
with itself. Integrity requires a re-collection of the self
which is not fragmented or dispersed. Creating a unity of inner and
outer, word and deed, depends upon the spiritual work of
autobiography. In Augustinian terms, one can commune with God only
after the disciplined work which yields integrity, which itself rests
on conviction of forgiveness for sin. May also believes that integrity
in old age requires that one's death be framed in a context of
transcendent meaning or ultimate concerns. These however, are not mere
abstractions but rather patterns of ritual and behavior woven into the
fabric of everyday life.
To Erikson's rather vague definition of wisdom, May adds three
additional virtues originating in medieval Christianity. Integrity and
wisdom are made possible by prudence, which consists of the temporal
virtues of memoria, docilitas, and solertia. A person who
resists nostalgia and regret--as well as the temptation to airbrush her
past--earns the virtue of memoria. In contast, many
contemporary approaches to psychotherapy, life review, and life story
work, are not so much interested in the historical truth as in
achieving a narrative truth which may enable a person to achieve a
healing that comes from new meanings of old events. Docilitas
does not connote the meanings of docility; rather it "signifies a
capacity to be silent," to be alert, attentive to the present moment.
Solertia is a characteristic of those who "learn to sit loose to
life;" it signifies openness to the future, readiness ready for the
unexpected.
The Stoic grounds wisdom on rational self-mastery and detachment. The
Biblical tradition on the other hand, grounds wisdom "through a
primordial attachment . . . to the divine love [which] sustains, but
also orders and limits all other attachments and fears. In the
Christian tradition, attachment to God makes possible the virtues of
nonchalance and courtesy. Nonchalance signifies the
capacity to take life's gifts and assaults in stride; courtesy is the
capacity to "deal honorably with all that is urgent, jarring, and
rancourous."47 The evils
and tragedies of life are understood to be "real but not
ultimate." Love rather than death has the last word.
Hilaritas is the final virtue handed down by the
Benedictine monks. Or in common parlance, humor is a "saving grace,"
allowed by the capacity to see life's experience from a more spacious
perspective.
May aptly criticizes academic ethicists who focus chiefly on moral
dilemmas and provide critical guidelines to professionals. It has been
over twenty years since he since he observed that ethics "does not
offer much help to patients facing the ordeal of fading powers. [The
aged] need guidelines for action, to be sure, but more than that they
need strength of character in the face of ordeals." 48
I have been able to find only one significant essay that takes up May's
challenge. In her essay "Virtues and Age," Sara Ruddick (who does not
cite May) argues that there are indeed virtues especially salient in
the lives of people "situated between a lengthening, unalterable past
and short future, where loss is predictable, but its timing and form is
not."49 Ruddick writes
as a secular, feminist philosopher who is quite wary of articulating
ideals that become burdensome to those who are meant to be governed by
them. She states, quite convincingly, that the elderly, like people
at any age, "struggle to maintain conceptions of themselves as good
people. Many also try both to preserve relationships and to do well by
the people to whom they are importantly related. These efforts of
virtue are intrinsically rewarding for the elderly themselves,
confirming their sense of agency, accountability, and moral standing."
These efforts also benefit "they people they care for and who care for
them." 50
Ruddick's account of virtue focuses particularly on the vulnerable,
needy elderly and those who care for them. She draws not only on
philosophical reasoning but also on her experience of care-giving and
witnessing in nursing homes. Ruddick acknowledges that being virtuous
is sometimes beyond the control of demented elders, but she insists
that mental deterioration which occurs slowly allows time for
adaptation and rarely makes efforts of virtue impossible.
She lists a set of five virtues especially appropriate for those in
their 70's and older, people "whose future is dwindling, and who will
likely experience multiples losses and decline." These include:
curiosity; a capacity for pleasure and delight; concern for near and
distant others; capacities to forgive and let go, to accept, adjust,
and appreciate; and 'wise independence" which the ability to plan and
control one's life as well as the ability "to acknowledge one's
limitations and accept help in ways that are gratifying to the helper.
Wise independence also includes "the ability to manage pain, to mourn
and integrate the loss of people dear to them, to handle, without
bitterness, their increasing disabilities, and to prepare for death and
its effect on those they care about."51
Ruddick criticizes theories which characterize virtue primarily as a
characteristic of individuals, a charge which may be leveled against
May. Such theories, she argues, show little tolerance for "outlaw
emotions" such a righteous anger, and they are conceptually unable to
guide the moral challenges facing receivers and givers of care.
Ruddick is also wary of the stereotypical vices which shadow any list
of virtues. She therefore speaks of "ongoing efforts of virtues"
(rather than achieved dispositions or traits) that individuals strive
to acquire and maintain.
Reversing traditional theological arguments, Ruddick argues that "being
virtuous is something one sometimes does, not something one
is." She not only focuses on process rather than achievement, she also
believes that virtue is created between and among people, and is
therefore inherently relational.52
Ruddick also takes pains to avoid creating an unrealistically
burdensome account of virtues that requires continuous and unremitting
effort, which she criticizes another form of the masculine Protestant
work ethic-perhaps another challenge to May. She reformulates her
definitions this way: "So being virtuous is something people
sometimes do together. . . . there are days when one isn't up
to creating virtue alone or with others. Hours, days, even weeks of
sadness, sloth, and apathy are an integral part rather than an
interruption of ongoing efforts to be virtuous. They do not mark a
person as bad; processes of doing virtue are marked by vicissitude, not
failure. Over a period of time, a virtuous person may do more rather
than less. . . . But no one needs to be counting or judging."53
Ruddick, then, presents a secular feminist account which is rooted in
experience. She emphasizes process over achievement, relationships
over individual virtue, behavior over character. She avoids discussion
of the vices by waiving off surveillance or the moral judgement of
others. May on the other hand, offers both secular and theological
theories of virtue, emphasizes individual character, and does not
shrink from light-handed and contextually sensitive moral judgement.
To the analyses by May and Ruddick, I will add only two brief
suggestions (to be developed in further work). First, I believe that
moral development in mid-life and later life must include cultivating
reverence for the human life cycle and especially for future
generations-a reversal of the "reverence upward" tradition. Second, I
believe that human beings at all ages have a basic spiritual need for
expansion and liberation of the self. This universal human need for
transcendence has implications for human development amidst frailty and
the process of dying. By consciously and actively working toward an
embrace of loss and death (when they are unavoidable), we may be able
to embody beauty and spiritual development amidst decline. In Rilke's
words:
"For beauty's nothing but the beginning of Terror we're still just able
to beat, and why we adore it so is because it serenely disdains to
destroy us"
What can we expect from this kind of analysis of character and action
among the frail elderly? What is missing from these accounts? Can we
educate care-givers on the importance of acknowledging reciprocity and
fostering relationships which allow their patients to be useful? What
would relationships look like if moral language and reciprocity of
dependent patients was introduced in nursing homes or home care?
How can we educate clergy, both in the pulpit and at the bedside, in
the moral challenges of aging? Seminaries have only recently begun to
provide some gerontological education to their students, focusing
entirely on the needs of older people. What should be added to
revitalize religious understanding of older people as moral agents?
Finally, with the proliferation of lifelong learning through
Elderhostel and Institutes for Learning in Retirement, can older people
be engaged in seminars and workshops about moral issues in their
lives? (I am skeptical about this later idea, since older people
notoriously avoid classes in aging. But the use of Biblical material,
films, fiction, and theatre might slip behind psychological defenses
and open up new moral and spiritual horizons. Think of the old King
Saul, or King David, King Lear, Oedipus at Colonnus, or Driving Miss
Daisy, Cocoon, and the Trip to Bountiful approached through the lenses
of ethics and the human spirit).
CONCLUDING THOUGHTS
Where do these thoughts about life cycle norms, mass longevity,
postmodernity, moral obligations, spiritual development, vices and
virtues leave us? Personally, I feel a sense of awe and amazement at
the sheer abundance of life made possible by the gift of mass
longevity. But what is the price of that gift? Perhaps, as
Theodore Roszak argues in America the Wise,54 the wisdom of a maturing population
promises to be our richest resource. Or perhaps, as a voice from the
Talmud suggests, a man who is a fool in his youth is also a fool in his
old age; while a man who is wise in his youth is also wise in his old
age.
I believe that the answer to the "gift" vs. "burden" of mass longevity
will depend in no small measure on how well we learn to identify,
support, and accomplish the moral and spiritual work of aging in our
era. As Plato understood, one of the best ways to learn is by
listening to those who have traveled this road ahead of us. Let me
close by listening again to one of my favorite elders, Florida Scott
Maxwell. Writing in her 80's as a Jungian analyst, she encourages us
to learn "that life is a tragic mystery. We are pierced and driven by
laws we only half understand, we find that the lesson we learn again
and again is that of heroic helplessness. Some uncomprehended law
holds us at a point of contradiction where we have no choice, where we
do not like that which we love, where good and bad are inseparable
partners to tell apart, and where we-heart-broken and ecstatic, can
only resolve the conflict by blindly taking it into our hearts. This
used to be called being in the hands of God. Has anyone any better
words to describe it?"55
_______________________
ENDNOTES
1. Henri Nouwen and
Walter Gaffney, Aging: The Fulfillment of Life (New York:
Bantam Doubleday Dell Publishing Group Inc.,1976).
3. Charles Taylor.
Sources of the Self (Cambridge: Harvard University Press
1989), 11-14
4. Nouwen and Gaffney,
Aging,, 14.
6. Thomas Cole. The
Journey of Life: A Cultural History of Aging in America (New
York: Cambridge University Press 1991), xxxii.
7. Erik H. Erikson.
"Human and Strength and the Cycle of Generations." Identity,
Youth, and Crisis. New York: Norton (1968): 142, 114. Not
correct but not clear on the book.
8. Erik Erikson.
Childhood and Society (New York: W. W. Norton & Co.,
Inc., 1986).
9. Erikson, "Human and
Strength and the Cycle of Generations," Identity, Youth, and
Crisis, 133 (needs redone see above)
10. Cole, The Journey
of Life, Ch. 1
11. Alasdaor MacIntyre.
After Virtue: A Study in Moral Theory (Notre Dame, Indiana:
University of Notre Dame Press; 2nd ed. 1984).
12. Harry R. Moody.
"The Meaning of Life and the Meaning of Old Age," in Thomas R. Cole
and Sally Gadow. Eds What Does It Mean to Grow Old?
(Durham, N.C.: Duke University Press, 1986), 11-40.
13. In her own nineties,
Joan Erikson began to address these issues by adding short chapters
on "The Ninth Stage" and "Gerontranscendance" to a new edition of
Erikson's The Life Cycle Completed (New York: Norton, 1998),
chs. 5,6.
14. Cole, The Journey
of Life,, 240.
15. Richard Nelson
Bolles. The Three Boxes of Life and How to Get Out of Them: An
Introduction to Life-Work Planning. (Berkeley,CA: Ten Speed
Press,1978).
16. Anthony Giddens.
Modernity and Self-Identity: Self and Society in the Late Modern
Age (Stanford, CA: Stanford University Press,1991).
18. James and Betty
Birren, "Our responsibilities for our old age" in Kimble and McFadden
. . .8
19. Harry R. Moody.
Abundance of Life: Human Development Policies for an Aging
Society ( New York: Columbia University Press, 1988).
20. Chris Phillipson.
Reconstruction Old Age. (London, Sage Publications, 1968), p.
49.
21. Erikson. "Human and
Strength and the Cycle of Generations." Identity, Youth, and
Crisis., 132 (per above)
22. Alasdair MacIntyre.
After Virtue: A Study in Moral Theory. Notre Dame, Indiana:
University of Notre Dame Press; 2nd edition (June 1,
1984).
23. Charles Taylor,
Ethics of Authenticity (Cambridge: Harvard University Press,
1992), 28-29.
25. Erickson,
Childhood and Society, p. 380
26. Leopold Rosenmayr.
DieSpate Freiheit,. Paris, France: Edition Atelier
(1990).
27. Alex Comfort.
The Joy of Sex (New York: Crown,,, 2002).
28. William F. May, "
The Virtues and Vices of Aging," in Thomas R. Cole and Sally Gadow.
Eds., What Does it Mean to Grow Old? (Durham, N.C.: Duke
University Press, 1986), 45.
29. AAMC Task Force,
1999, Report 3.
30. Ronald Blythe,
The View in Winter (New York: Harcourt, Brace and Jovanovich,
1979), 22-23
31. Moody, Harry R.
Abundance of Life: Human Development Policies for an Aging
Society (New York: Columbia University Press, 1988), pp.
4-5.
32. Carole Haber and
Brian Gratton, Old Age and the Search for Security: An American
Social History, (Bloomington: Indiana University Press, 1994),
ch. 6; Thomas R. Cole, The Journey of Life, ch. 7
33. Rabbi Zalman
Schacter Shalomi and Ronald S. Miller, From Age-ing to
Sage-ing, (New York, Warner Books, 1995)
34. Marc Freedman,
The Kindness of Strangers, (New York: Jossey Bass, 1996); find
his newer book.
35. John Cowper Powys,
The Art of Aging (place, pub. 1944) , page number unavailable
36. Florida Scott
Maxwell, The Measure of My Days, (London, Penguin Books, 1978)
p. ??
37. I have borrowed
heavily here from an excellent forthcoming paper by Monika Ardelt and
W. Andrew Achenbaum, "The Paradoxical Nature of Wisdom and Its
Relation to Human Development".
38. Wendy Lustbader,
Counting on Kindness: the dilemmas of dependency (New York:
Free Press, 1991), 15.
41. May, "The Virtues
and Vices of Aging," 50.
48. Sara Ruddick,
"Virtues and Age," in Margaret Urban Walter, ed., Mother Time
(New York: Rowman and Littlefield, 1999), 45. Interestingly, Ruddick
does not cite William May's piece on "The Virtues and Vices of
Aging."
53. Theodore Rilke,
Dueno Elegies (1921), p. 12
54. Theodore Roszak,
America the Wise: The Longevity Revolution and the True Wealth of
Nations, (Boston, Houghton Mifflin, 1998).
55. Maxwell, p. 24-25.
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