December, 2001 Issue 9
The Positive Aging Newsletter
Friday, December 28, 2001
by Kenneth and Mary Gergen
Dedicated to Productive Dialogue Between Research and Practice
In this issue:
Collaborative Caring as a Research Goal
For many people it is a season of giving. And in Western culture we placeenormous value on acts of sharing - especially to those in need. Muchthis same value pervades the health care professions. Many entergerontology, for example, with the hope that their work - whether clinicalpractice, research, or policy making - will benefit the elderly. There isdeep fulfillment in this vision of one's life.
Yet, the traditional vision "giving to others" is also flawed. The hero ofthis story of helping others is the giver. He or she derives symbolicnourishment from the act; the recipient may draw benefit, but the act ofreceiving is scarcely esteemed. And, in fact, to be "in need" is itself amark of undesirability, of being less than properly capable. The adage,"It is more blessed to give than receive" speaks to the point.
In earlier issues of this newsletter, we have touched on ways in whichcaregiving practices can be fashioned in a more collaborative way. We haveemphasized the importance of working WITH as opposed to ON the elderly, ofenabling their voices to help fashion the act of caring. It is not onlythat such practices replace unilateral and often injudicious "help" withgiving that really matters to the recipient. In collaborative practice,the recipient too is an active giver, in this case to the deep nourishmentof the provider.
It is time for collaborative goals to energize research practices as well.Each month we review the pages of many journals to locate research thatspeaks to the potential of aging positively. Yet, some 90% of what we readfocuses on deficit and deterioration. While such research is not withoutvalue, we must also be aware that it is not obviously a contribution tothe welfare of those we might wish to serve. Such research consistentlypaints a picture of aging as inherent decline, thus fostering anguish forthose approaching or participating in later life. The elderly are createdas "the other," not quite right, less than properly capable. Further, muchof the research is focused on microscopic changes in reaction times, wordproduction, and the like, processes that are not likely to be central inthe daily life of the elderly person.
In our view, research programs would provide far more nourishment to allinvolved, if the voices of "the subjects" entered - either directly orindirectly - into deliberations on research goals, methods of study, andrelevance to the participants. It is our bet that for one, there would befar more research on growth than decline. Research demonstrates that bothcognitive and bodily decline can be reversed (see, for example, Fiataroneet al, 1990; Schaie, 1994). As Carstensen (1988) proposed, "It is anillusion that irremediable psychologic deterioration is the modal courseof old age." We suspect that if research moved substantially in thedirection of opening up possibilities for the elderly - as opposed topreparing nails for the coffin - that research would become truly a giftfor the recipients.
We complete this final newsletter of the year with the hope thatin the coming year your pursuits may bring deep nourishment to you and toall those with whom you engage.
Ken and Mary Gergen
References:Carstensen, L.L. (1988) The emerging field of behavioral gerontology.Behavioral Therapy, 19, 259-281.Fiatarone, M. Marks, E., Ryan, N., Evans, W. (1990) Strength training innonagenarians. Journal of the American Medical Association. 263, 329-334.Schaie, K.W. (1994) The course of adult intellectual development. AmericanPsychologist, 49, 301-313.
- Positive Illusions, Meaning and Longevity
What if people cling to the idea that they will have a long life, knowingfull well that their medical history predicts just the opposite? Willtheir positive illusions add to their years, or is death simply abiological necessity, that foolish wishes cannot change? According toShelly Taylor and her colleagues, the positive illusion may be far lessthan an illusion.
This research focused on men infected with the HIV virus. Facing a bleakfuture, what good were positive illusions to these men? In one study, doneprior to the availability of life-prolonging drugs, the researchers foundthat those who accepted the realistic appraisal of the medical professiondied more quickly than those who were unrealistically optimistic abouttheir fate. A later study was done with men who were diagnosed with HIV,but were asymptomatic. In this study as well, negative, but realisticexpectations of death, predicted both the onset of symptoms and an earlierdeath than those who clung to the unrealistic belief in continuing life.Interestingly this research also showed that if the infected individualexperienced the loss of a close friend or lover, the disease alsoprogressed more rapidly. Again, it seemed that reminders of one's ownimpending death hastened its arrival.
Such findings suggest that the meaning we assign to biological events mayhave significant implications for the course they take. To illustrate,some victims of a heart attack draw meaning from the event; for example,they come to have a deeper appreciation of life. Others are simply glad toget past the assault, and go on with life. This difference may becritical. Affleck and his associates (1987) found that men who were ableto find some positive meaning in their heart attacks were less likely tohave a subsequent one than those who did not. They were also less likelyto die of a heart related cause.
Taylor and her colleagues applied the same reasoning to HIV sufferers whohad also been bereaved. By studying the meaning that they gave to the lossof a close friend or lover, researchers were able to analyze whether itmade a difference to the health of these participants. They found thatthose who had succeeded in finding meaning, were healthier, in terms ofmaintaining CD4 T helper cells over the 2-3 year follow-up period. Also,only 3 of the 16 men who had found something meaningful in their lossesdied in the study period, while half of the other group, of about equalsize, had died.
The reason for the linkage between meaning and biology remains open. Tolocate a causal connection between psychological meaning and physiologicalprocess would be equivalent to solving the mind-body problem. Yet itseems that if one is able to reconstruct the world in a meaningful way,physical health seems to be positively influenced. In any case thisresearch seems to support the old saying: "When the world gives you alemon, make lemonade."
Reference: Affleck, G., Tennen, H. Croog, S., & Levine, S. (1987). Causalattribution, perceived benefits, and morbidity after a heart attack: Aneight-year study. Journal of Consulting and Clinical Psychology, 55,29-35.
From: Psychological Resources, Positive Illusions, and Health by ShelleyE. Taylor & Margaret E. Kemeny, Geoffrey M. Reed, Julienne E. Bower, &Tara L. Gruenewald. American Psychologist, 2000, 55, 99-109.
Related article: Join the Aging Revolution by Edward L. Schneider, MD(Dean, Leonard Davis School of Gerontology, University of SouthernCalifornia)
- Distress and the Life Giving Potential of Reframing
If one is distressed - angry, frustrated, worried - what is the bestoption? Should one stoically sit on his or her emotions, give them fullexpression, or something else? And what difference does it make? Considerrecent research on heart attack survivors: The survivors were divided intofour groups, depending on their distress and their tendency to suppressemotion. Those high on both distress and suppression had significantlyhigher death rate (27%) than the other patients (7%). Just ignoring theworry, trying to act tough in spite of it all, may be detrimental to longlife. There are other less devastating consequences of emotionalsuppression. People who suppress their emotions often find that theycannot get their mind off them. They may pay less attention to theimportant events around them. When suppressing negative emotions it isalso more difficult to express positive emotions. If one is tryingdesperately not to explode, for example, it is more difficult to laugh.And if someone is emotionless, he or she becomes less attractive toothers.
Yet, venting one's rage, frustration, or suffering can also beproblematic. Norms of civility tend to rule against such displays. It isbetter in most sectors of society to "keep cool," "don't act like a baby,"and "be strong...take it like a man!" As we have also described inearlier issues of the Newsletter, people who express intense suffering areoften avoided, thus receiving less support than if they were not soexpressive.
According to Stanford researcher, James Gross, the best option may be aprocess of reappraisal, or what therapists typically describe asreframing. In reappraisal, one attempts to change the definition of thesituation - is there another way to understand what has happened, is itnecessary to blame someone - including myself, who might benefit fromthis, and so on. Thus, if one is almost struck by another driver on abusy highway, before giving over to an attack of "road rage" one mightrecast the event such that the driver was not intentionally trying tocause an accident, that the driver had poor visibility due to thesunlight, the traffic was so intense the driver had no choice, or that youmight be overreacting because you read about a drunk driving accident inthe morning paper. People who are able to make sense of their situationsin a non-blaming, non-aggressive, non-hurtful, perhaps even humorous, wayneither suppress nor express. In terms of therapeutic interventions, thisresearch suggests that when one is being burned up with anger, shut downwith fear, or debilitated with depression, the best move may be to locatealternative ways of understanding what has happened, such that the intenseemotion is no longer warranted.
For details: Emotion Regulation in Adulthood: Timing is Everything byJames J. Gross. Current Directions in Psychological Science, 2001, 10,214-219.
Related article: What to do when you feel scared, anxious or excessivelyworried by Shachi D. Shantinath, PhD
- Mattering as an Insulation Against Depression
What does it matter if we matter to others? A great deal, so propose theseauthors. As they define mattering to others, it is the "feeling thatothers depend on us, are interested in us, are concerned with our fate, orexperience us an extension of themselves." If we matter to others, theygrant value to our lives. And this valuing is a significant progenitor ofour own sense of value or well-being. Mattering to others should not onlyenhance the sense of well-being, but provide important insulation againstdepression.
These ideas were born out in a study of over 3,000 individuals between theages of 18-55 in Toronto, Canada. The individuals were interviewed in twowaves - a year apart. To assess mattering, the participants were asked arange of such questions as, "How important are you to others?" "How muchwould you be missed if you went away?" and "How much do other peopledepend upon you?" The measure of depressive symptomatology was developedin 1977 by the Center for Epidemiologic Studies.
Using factor analysis, the researchers found that independently of otherrelationship-factors, mattering stood out as powerful predictor ofdepressive symptomatology. Those who felt they mattered were lessdepressed. Most interestingly, if one's sense of mattering to othersincreased over the year's period, depression decreased; and likewise, ifone ceased to matter, depression was on the rise. Yet, it is important tonote that these results were most prominent for women. Men's sense ofwell-being seems much less affected by whether others' care about them.Possibly, the male sense of well-being in Western culture is far moredependent on task success - making money, promotion, winning, and thelike. Whethermattering gains a place in the male life in the later years remains to beexplored. Because people in a depressed mood are also likely to say thatthey don't matter to others, future research must locate ways of guardingagainst response bias.
For details: John Taylor and R. Jay Turner, A Longitudinal Study of theRole and Significance of Mattering to Others for Depressive Symptoms.Journal of Health and Social Behavior 2001, vol. 42 pp. 310-325
Related article: Brief therapies for depression by Lawrence Rudiger, PhD
- Physical Activity and Quality of life
The motto of the Gerontological Society of America, "Adding life to years,not just more years to life" could serve as the banner for research on thequality of life. This particular article offers a broad review of theliterature on the ways in which the active bodily engagement contributesto the life quality of the elderly. The review will be especially usefulto researchers in this area, as it avoids simple-minded conclusions aboutthe relationship. One of the more interesting outcomes of the review isthe authors' emphasis on the meaning given to physical exercise. Whilephysical engagement does contribute to quality of life, its effects areenhanced when value is derived from the exertion. Highest levels of lifesatisfaction are found among people who actively participate in physicalactivities that they enjoyed. Exercising "merely because it is good forme" is limited in its value.
For details: W. Jack Rejeski and Shannon L. Mihalko, Physical Activity andQuality of Life in Older Adults. Journal of Gerontology, Series A, 2000.Vol. 56A (Special Issue II), pp. 23-35
Related article: Physical Activity : Antidote To Aging by Tufts University
- The Encyclopedia of Elder Care, by Mathy D. Mezey, Editor-in-chief(2001) New York: Springer Publishing.
This volume fills an important need for current information that may speakacross diverse groups - including families, health professionals, andinstitutions for the elderly - on issues of elder care. The volumecontains some 300 entries, drawing from multiple disciplines, includingtherapy, nursing, medicine, social work, counseling, and physical therapy.While the entries are not extensive, many do offer a unique addition tomost encyclopedias: excellent references to key words for web searches andprimary internet resources. No surprise to us, the vast share of theentries are concerned with elder deficits - in health, mental condition,agility, and so on. There are, however, some refreshing entries thatemphasize positive aspects of aging. Entries on adult education, autonomy,creativity, life review, grandparenting, recreation, social support,spirituality, and voluntarism all move in the positive direction. Toillustrate the kinds of resources provided, the entry on creativitydirects readers to The University without Walls, a telephone conferencecall program for home-bound adults, emphasizing poetry, drama, opera,film, and more (http://www.dorotusa.org/seniors/uwow_frameset.shtml
).Several arts programs for the elderly are also described, and web-basedresources for expression are referenced. See, for example, a site onelders sharing the arts (http://www.artswire.org/
) and on the poetry ofaging (http://www.gen.umn.edu/faculty_staff/yahnke/poetry/poetry6.htm
- Books on working positively with Alzheimer's
For positively oriented books on caregiving we recommend the HealthProfessions Press (http://www.healthpropress.com
/), where one can find:
* Creating Moments of Joy, by Jolene Brackey. A book that provides storiesand tools to help focus more energy on creating meaningful interactionswith Alzheimer's disease so that less time is spent on daily struggles.
* The Positive Interactions Program of Activities for People withAlzheimer's Disease, by Sylvia Nissenboim, and Christine Vroman. This bookprovides more than 90 upbeat activities customized to the special needs ofpeople with Alzheimer's disease.
* The Best Friends Approach to Alzheimer's Care, by Virginia Bell andDavid Troxel. Emphasizes an approach to giving care to those sufferingfrom Alzheimer's that is based on essential elements of friendship:respect, empathy, support, trust, and humor.
Related web-site: Help for Caregivers by Alzheimer's Disease International(ADI) at:
- For Better or for Worse (film, 55 mins). This film is a presentationof 5 couples who have lived together for over 50 years. Each of thecouple talks in intimate detail about their lives together, how they met,how they created their relationships over the many years together, howthey faced tragedy and triumphs, and how they look forward to the future.One couple is African-American, working as musicians. Their relationshipis facilitated by music. One couple is gay. Over time one has succumbedto Alzheimer's disease, and the other is a loving caretaker. One couplehas had a long standing open marriage, which seems to have beenstrengthened by their extra-marital adventures. One couple has survived asthey have followed the roles they were expected to play and have built asimple and harmonious relationship, and another has energetically playedat the edges of their differences. As one reviewer comments, "Aging is notsimply an accumulation of losses to be accommodated; these couplesprovide compelling evidence that through a long marriage or relationship,old age can be a vital, secure, and exciting stage in their lives."
Distributed by Terra Nova Films, Email : [email protected]
In reply to the last issue on appreciative aging, Robert Jacobs provided agood image with which to begin 2002:
In two days I pass my 77th anniversary and I have yet to find a day that'sdull, uninteresting or not worth investigating. Even a visit to thedentist to me is a learning experience - both for the clinic and the humancontact. I was a medical illustrator during my earning years. That meantbeing within walls. As I retired, over ten years ago, I resigned the cityand found a place with openness where I could enjoy the earth and sky. Nowit is my pleasure to raise vegetables and fruit in addition to my wife'sflowers. For the past ten years I've joined the community life, takenextra education courses at community college, celebrate the heavens withother avid amateur astronomers, probe the WEB for answers, bowl with myequals and even helped establish and build a church congregation andschool (physically). I don't have time to get old with my eyes to thehorizon seeking new ideas while clinging to the tried and true.
If you have material you wish to offer to newsletter readers, please writeto Mary Gergen at [email protected]