Abstract
‘Ageing is a disease, disease is suffering, and suffering should be minimized.’ Old age as an equivalent of suffering to be eliminated, is a well-known scheme of thought in contemporary culture. This ‘suffering from old age’ argument, however, as is argued in the first section of this article, obscures and denies the reality and complexity of the human condition and the place of suffering in it. Old age is to be understood as the radicalization and intensification of the human condition. Suffering in old age, as argued in the second part, can therefore best be conceived in terms of existential threats to the integrity of the self. It entails the embodied experience of the broken dialogue between the self and the world, often perceived as a lack of control and as loss. Suffering, perceived in this way, seems to be permanent to the human condition. It induces the search for meaning. In the context of unavoidable suffering, a ‘presence approach’, instead of an interventionist attitude, is required.
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Notes
This is not meant in an exclusive way. Other penetrating reflections on old age and the end of life from philosophers like the Stoa, Cicero, Montaigne or Spinoza are enriching gerontology as well.
Half a century ago, Ivan Illich (1926 – 2002) made already the same point: “Professionally organized medicine has come to function as a domineering moral enterprise that advertises industrial expansion as a war against all suffering. It has thereby undermined the ability of individuals to face their reality, to express their own values, and to accept inevitable and often irremediable pain and impairment, decline and death.” (Illich, 1976, 12).
For a sophisticated assessment of the pro’s and contra’s of a classification of ageing as a disease, however without the transhumanist agenda that it finally will be curable, cf. Caplan, 1992.
Undoing Aging. May 26 – 28, 2022, Berlin. Conference Announcement. https://www.undoing-aging.org/ Accessed 22 February 2021.
Transhumanist Declaration. (n.d.) https://humanityplus.org/philosophy/transhumanist-declaration/ Accessed 4 December 2020.
Pearce 2012.There also the expectation: ‘If a technological Singularity really is near, the abolition of suffering is feasible this century.’.
Transhumanist Ray Kurzweil, technical director at Google, has already invested in immortality research for decades. Cf. his personal website, https://www.kurzweilai.net/pbs-news-hour-inventor-ray-kurzweil-sees-immortality-in-our-future.
Fries 2005. In his seminal article, Fries predicted that the compression of mortality towards older ages could be followed by a ‘compression of morbidity’ – i.e. a rectangularization also of the morbidity curve. He postulated that chronic diseases and markers of aging (such as raised blood pressure and cholesterol levels as well as lowered vital capacity) could be postponed through changes in lifestyle, thus raising the age of first disability or major infirmity to very near the end of life, which he set at an average maximum length of 85 years.
The prevalence of dementia increases dramatically for the oldest old. In longitudinal surveys, almost half of the 90-year-olds suffer from some form of dementia (Baltes & Smith, 2003,7) Cf. the alarming statistics of Alzheimer’s Disease International at www.alz.co.uk.
“If reflexivity is the marker of modern social relations empowering the agency of the third age, then the fourth age is marked by its negation. There are no chosen choices in the fourth age” (Gilleard & Higgs, 2010, 126).
Cf. the critical question posed by Baltes and Smith, “whether the continuing major investments into extending the life span into the fourth age actually reduce the opportunities of an increasing number of people to live and die in dignity,” and their suggestion of “some reorientation of aging policy” (Baltes & Smith, 2003, 129). Cf. also McHugh, 2003, 180, 181: “So-called positive views signify cloaked denials and repressions of the facts of human ageing and old age, are rife with happy delusions that adulate youth and productive adulthood, and fail to accord meaning to the third age and beyond.… Embedded in the ideal of successful ageing is a deep-seated fear of our decline and erasure, projected outward in the form of disdain and disgust for ‘old’ people who do not ‘measure up’ and who tumble down the spiral of ‘bad’ old age.”.
In existential psychotherapy the work of Victor Frankl (1905 – 1997) and his seminal book Man’s Search for Meaning (1946) has been groundbreaking. Cf. for the psychological mechanisms that deal with death anxiety in particular Solomon et al., 2015.
Though rigorously phenomenological, Waldenfels’ philosophy reveals a theological touch by taking up the same strong appeal-response-character recognizable in the anthropology of the Hebrew Bible (Chrétien, 2004).
“The infusion of the experience of suffering into daily chores and thoughts, and as narrated by the sufferer in old age, has rarely been addressed as a central focus of study.” (Black, 2006, 10f.).
Black (2006, 188) emphasizes that “suffering as loss was ultimately relational.”.
This shows itself in particular in the fear of dementia. “[A] person’s experience of their dementia is characterised by a series of existential threats: the extent to which a person sees their life as meaningful may be compromised; their independence will be eroded; their identity is threatened; their relationships altered; and, inevitably, even their most basic abilities will be taken away from them over time.” (Cheston and Christopher, 2019, 136) According to these authors, the threat of losing oneself in dementia is literally ‘existential’, because our fear of mortality and personal extinction under ‘normal’ circumstances is kept away by an esteemed self-identity and a sense of meaning and purpose (as contended by the Terror Management Theory).
‘In old age man [sic] experiences fundamental paradigms of existence in a new and different way; some of them are accentuated. They were all present in former periods of his life’. (Längle, 2001, 211). Cf. also the remarkable observation that the five sections (Existence and the Passage of Time; Stranger to Oneself; The Look of Others; Not to Understand the World Anymore; To Live with Dying] of one of the most penetrating phenomenological analyses of ageing by Jean Amery (1994) “are concerned with concepts and theories that are not specific to aging—that in a certain sense disregard aging, neglect its specificity, and, in the end, need to rely on concepts whose incomprehensibility Améry himself consistently exposes: death and dying.” (Goebel, 2014).
In the ‘ethic of care’, developed in the context of professional health care, the ‘presence approach’ is opposed to ‘the repertoire of intervention’. Van Heijst (2011, 121) observes that “[h]ealth care professionals are so focused on healing that they tend to focus too much on the intervention and show little interest in the painful things that they cannot solve. They are alert to what is curable, but absent for the rest.” Also: “By concentrating on what can still be done instead of accepting what cannot be resolved, professionals try to overcome their own feelings of powerlessness.” (Van Heijst, 2011, 88). The presence theory takes its starting point instead in the intuition “that professionals should carry out their work in such a way that people in their care experience the professionals as ‘being there for them’.” (Van Heijst, 2011, 91). Both repertoires are needed. “The repertoire of intervention seems to be specially appropriate when someone’s suffering is not multi-causal and is curable, while the repertoire of presence is more suited to cases where the distress is complex, chronic, or terminal, or when the cause of the suffering is hard to find.” (Van Heijst, 2011, 118).
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de Lange, F. Suffering from or in Old Age? The Existential Gravity of Ageing. Population Ageing 14, 357–371 (2021). https://doi.org/10.1007/s12062-021-09334-6
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DOI: https://doi.org/10.1007/s12062-021-09334-6