Changing the Face of Aging

Using the youthful body as a measurement stick against which we judge our well-being at different ages is based on an overly simplistic understanding of the human being. This standard is predicated on the belief that biological strength, speed, and performance in terms of actual biologically measurable numbers – muscle mass, blood values, bone density, calcium levels, and the like – are superior over other aspects of being human, actually determines our humanity. This myopic, bio-centered viewpoint ignores, as stated before, the deeper dimensions of being human. Our ability to make choices, to fight for causes, to stand-up for beliefs, to be altruistic, generous, kind, and loving such a simplistic view does not consider. For example, is not our ability to discern the value about what presents itself before us at least as important as our ability to take in the particulars with our senses? This issue parallels the debate about our information age where we begin to question the value of information. If it remains data, we simply cannot process, cannot understand, and cannot act upon it.

A biological view of the older adult that measures itself against a youthful body also dominates our attitude towards eldercare. As such we enter a “declinist” view of the human lifespan: the older we get, the more we decline. We emphasize losses and have no vocabulary and concepts to speak of the gains we experience as we age. This is why we are in need of an existential-humanistic, process-oriented approach to eldercare. Such an approach will introduce concepts such as meaning, purpose, mystery, maturity, wisdom, creativity and beauty. Being guided by these concepts, we will begin seeing more completely, will notice when these so very important aspects of human life are present or absent.

The Centrality of Meaning

The existential-humanistic view emphasizes that a fulfilled life is inextricably linked to a life grounded in meaning. In other words, human beings need to create meaning in their lives if they are to live a life that is worth living. The importance of meaning-creation becomes even more pronounced in the so-called second half of life. Whereas the social and economic obligations of the first half of life are often quite circumscribed with education, family, and career, the second half of life can offer more freedom in terms of thinking and feeling into questions of what is important to be and to live now. These questions are also pushed to consciousness by an increased awareness of the finitude of life, an awareness that makes us wonder about our primary considerations, our priorities – whether those are based on individual and/or global concerns.

In the Indian tradition, the second half of life begins at sixty. The question of how to create meaning in our second half of life is moving to the forefront of our consciousness today. The demographics are shifting speedily away from the outdated pyramid structure of age distribution. As will be remembered, in such a structure the old comprise only a small percentage on top and the younger a much bigger percentage on the bottom. This old pyramid shape is now giving way to a cylindrical shape, where in the next thirty years – world-wide – the older over sixty will be as numerous as the young under fifteen. Such a shift, combined with the continued increase in life-expectancy and longevity, will place much more focus on meaning and purpose of the second half of human life. William Thomas, geriatrician and Eden Alternative founder, faces this issue head-on with the title of his book: What is Old Age for? As a physician, he opposes the idea of the youthful body as the standard against which we measure the continued aging process. He writes that society views the youthful body as optimal and that “scientific theories about how we age nearly all accept without question the doctrine of youth’s perfection. They focus on decline and pay little heed to the steady emergence of new gifts and capacities.

What if we could not wait to be an elder, like a child can’t wait to be an adult?

An Existential-Humanistic, Process-Oriented Approach to Eldercare

As someone who has developed and operated eldercare places for close to twenty years ranging from independent to assisted living to so-called “dementia” care communities, I witness an attitude to elders and eldercare in the continental United States very much imbedded in a quantitative perception of life. Though there are always many exceptions, most operators of elder communities, especially large-scale companies, look at aged adults as customers whose biological health and longevity – measurable statistics – are of primary concern to them. As good a beginning as this might be, such a mindset must be augmented with a deeper understanding of aging and old age if we are to do justice to our elders and our true humanity.

In contrast to a “numbers and figures” approach to eldercare, stands a humanistic attitude that understands the importance of the subjective, the psycho-spiritual dimensions of the human being. An existential-humanistic approach to eldercare emphasizes that human beings at any age or stage of life, including those who are forgetful, need to ‘feel’ themselves as valued and important, as meaningful contributors to people and causes. This approach understands that relationships and relationship building are at the core of what makes human beings feel alive and content. It also recognizes that human beings are highly individual; they have different viewpoints and must be allowed to make choices that fit their own perception. As such, techniques and otherwise fixed or mechanical procedures are counterproductive to capturing the diversity of the human spirit and will invariably lead to the creation of an oppositional force – the many revolutions and uprisings in human history are examples of this dynamic.

An existential-humanistic perspective of elders and eldercare starts foremost with the belief that elders are immensely valuable members of our societies. In their last phase of life they continue to deepen and give back to those ready to listen. They have much to offer those younger in years in terms of guidance and experience as well as in terms of a different perspective on life that allows other, deeper human values and attitudes to surface. For from the perspective of the elder, the existential-humanistic mindset truly encompasses the depth and richness of life in that it acknowledges all of its many dimensions. In addition, the last phase of life constitutes the necessary conclusion of each person’s life and contains all too important messages for our societies in terms of creating a more sustainable and loving world.

Humanistic Eldercare: Toward a New Conceptual Framework for Aging and Care

As family members, friends, professionals and care-partners, we will need to face our own aging, as well as the aging of those elders for whom we might need to care. These elders can be our own parents, siblings, or other relatives, can be friends or acquaintances. Elders might also be part of our professional clientele, as therapy clients, as people for whom we are responsible as guardians or conservators, as care-partners, staff, managers and directors of eldercare communities throughout the country.  How we face aging and eldercare is largely based on the mindset with which we approach these challenges. This mindset frames how we apply our knowledge, skills, and passion, how we assist and partner with elders in all aspects of their care. The mindset we use also informs our attitude towards how we understand our meaning of life, what we understand to be important and of value.

To honor elders as wisdom keepers and social contributors sets the stage to look at elders from their needs in terms of connecting, feeling valued, that they can give and receive – like all of us.   The question becomes: what can we do to remind ourselves of the fundamental needs they and all of us have? How can we live in a deep relationship with our elders – including our own inner elder – and receive their wisdom so important in terms of us living a meaningful and sustainable life?

Re-visioning Aging and Elder Care

The present conceptual framework used in the way we look at aging and the way we care for our elders is demeaning and harmful to our elders and to the well-being of our societies at large.  Yet, this outdated framework and understanding continues to disgrace and devalue our elders. In contrast to this outdated and harmful attitude stands an existential-humanistic, process-oriented approach. Such an attitude regards aging and old age as purposeful. It understands caring – whether it is receiving or giving care – as essential to our humanity; and it regards the many symptoms of aging and old age as meaningful guideposts to be understood rather than made into problems and/or pathologies.

This attitude opposes the present mainstream idea of aging, old age and care for elders where aging is understood as a disease, old age as a phase to be avoided and basically useless, and the many symptoms associated with aging and old age as meaningless problems in need of treatments and cures. Even recently added concepts, such as successful and healthy aging, use longevity and physical health as basic measures of what are deemed successful and healthy. These concepts of aging and care are most often based on biologically quantitative and normative measures of human life. This means that measurements and standards to which those measurements are compared form the basis of evaluating a human being’s life; that is, whether a person, for example, is performing, declining, successful, smart, healthy, or diseased.

In many ways, we have turned our understanding of human beings and their needs upside down: rather than measurement and quantification being in the service of human beings’ well- being, the quantifying mindset increasingly demands that human beings fit into measurable categories and labels. We have become the servants of the very tool we have created to help and serve us.

Sept 30, 2013 – AgeSong to Host Upcoming Existential-Humanistic Institute Conference

A process-oriented, existential-humanistic philosophy and therapeutic approach to being with fellow human beings lies at the heart of AgeSong eldercare. This is the reason that AgeSong is proud to sponsor the annual Existential-Humanistic conference within its Hayes Valley eldercare communities.

This year, 2013, marks the 7th annual EHI conference with a rich potpourri of presentations and experiential discoveries.

Through a quick perusal of the topics and abstracts, any initiate and non-initiate will quickly glean the core precepts of the existential-humanistic approach: an emphasis on experiential learning, being present, therapists’ personal understanding of themselves, the importance of meaning and meaning-making, the body, community, the centrality of the relationship between therapist and client, and the focus on helping clients’ unfolding of their personal processes.

Besides these core precepts, a hallmark of the existential-humanistic approach is its openness to other approaches, such as the many expressive arts, the research in mindfulness and neuroscience, and the discoveries from other theoretical orientations including those of psychoanalysis, somatics and cognitive-behaviorism.

Research shows again and again the central significance of therapists’ personal understanding of themselves and, connected to that understanding, their ability to relate to their clients’ world. Yet, it continues to amaze those of us of the existential persuasion that the academic and practical training of student and seasoned therapists have yet to catch-up to embracing an existential-humanistic attitude in their therapeutic work. Granted, we existential-humanists are not an easy group of people to classify and categorize. Nor are our manifold theories easily grasped, let alone comprehended.

The question of what makes an existential therapist does not have a ready answer. Rather, referencing Rilke, it is the continued questioning of who we really are as people and practitioners that make us existential therapists “existentialistic” in nature and attitude. We might even go as far as stating that the therapist who claims to be an existential therapist is not an existential therapist. For the point is this: human beings are simply too mysterious and complex, too unfathomable and peculiar, as that word, any word or plurality of words, can begin to apprehend who we are. The moment we try to describe ourselves, we understand the limits of our description.

Comfortable with paradox, mystery, the uncanny, existentialists try to stay aware of the illusion of knowledge.

For eons humans have struggled to become conscious of themselves, and have endeavored to reach an awareness of the meaning of their existence. Even those who claim that life is meaningless express their meaning through the idea that life has no meaning. We cannot escape our drive for meaning, acknowledged or not as may be the case.

This conference seeks nothing but the continuation of meaning-making and the sharing of our personal journeys along this path, to have us connect with and relate to one another, enjoy each other’s company, and to share our joys and pains, struggles and achievements together.

The 7th annual conference of the Existential-Humanistic Institute promises no universal techniques, only experiences of what worked for us under specific circumstances. It offers no anxiety reduction around what to do and how to be, only an honest sharing of our vulnerability as we continue to live with our struggles every day.

Finally, our conference offers no simple answers, but promises to leave each of us with even more questions – this, alas, we can be sure of!

Nader R. Shabahangi

President

Nader’s Musings | The Inner Elder: Imagining Myself as a 90 year Mature Person

Some ten years ago I first performed this exercise: imagining myself as a mature person, ninety years mature, to be precise. This elder would be able to give me an idea of this person called Nader Shabahangi, who he might be essentially, without all the fluff, the superficialities such as titles, degrees, and material status. The story below is what I wrote after I completed my imagery to the future, to my inner elder. I was in my mid-forties at the time.

“I am sitting in a small outdoor café, somewhere on the Mediterranean coast. I am in my nineties, relaxed, taking in the sun and sipping on tea. I am writing on another small book of therapeutic anecdotes. It is in the middle of the afternoon.
Suddenly Francois comes by and stands at my small, round table. I interrupt my writing and ask him to sit down. “What is the matter, Francois?” I ask full of curiosity. Francois is exasperated. He tells me of the fight his parents are having, how he is getting drawn into it and how difficult it is for him to be in the field of such a conflict. Francois is a 14 year old boy, very French looking with his dark hair, eyes and mannerisms. Francois and I have known each other for almost ten years and I know his parents and most of his relatives and friends very well.
I encourage Francois to speak and listen intently to his account of the situation at his home. After a while I invite Francois over to my home where we sit in the garden. An hour has gone by and I promise Francois that I will call his parents and will see if I can talk to them. I also think about visiting Francois in his school, talk there to his teacher, perhaps his friends. I am wondering about how Francois is doing in school. And as I am thinking about Francois and his school I am thinking about offering to the principal of the school that I could be teaching a small afternoon session on “Communication Skills” and “The Art of Being Human.”
The above image came to me as I am contemplating and visualizing myself in old age. What appeals to me is the following:
The environment is one where I feel warmth – warmth in terms of weather and in terms of people around me. I feel a certain peace of mind and still much creative spirit. Yet, I am open to what presents itself at any given moment, am open to what the moment brings. Even though I was busy writing, I would like to be open to an event as the one described above: Francois, a young teenager, needing my attention, perhaps help. The event that transpired with Francois also shows that I imagine myself being led by events and not afraid to get involved in people’s affairs – such as talking to the parents, to the teachers. And being open to new discoveries, new tasks to be done, such as teaching at Francois’ school.
Important in the image seems to be my continued involvement with the world, with the many generations around me. I also sense that a certain independence of thought and spirit, an ability to listen and communicate, seem to be part of myself as I am an old man. In other words, relationship and being deeply present for and to others continues to give me real deep satisfaction. How am I paying attention to that need now? Is what I am doing now serving that deep need?”

Nader’s Musings | Our Earth, Our Elders

Our earth – our world and home – needs elders. It needs to know who elders are and what they do. It needs the wisdom they afford us, the teaching they can give us. Elders are not only those who are old in years. Rather, an elder is a role that lives in all of us at any age. Still, this role appears mostly in people who have matured through the many years and much effort.

Elders turn to values that have endured the test of time. These timeless human qualities are expressed through words such as equanimity, acceptance, patience, compassion, kindness, thoughtfulness, gentleness, calm, empathy, and mindfulness. These words describe an attitude, a disposition towards the world, towards people and events, often hard-won through experiences spanning ecstatic moments of joy to deep, often extended periods of suffering.

Timeless qualities speak to those who humans are essentially. They speak to what we often call the soul of the human being, to what is immutable, transcends time, trends and culture. In today’s global world with its multiplicity of attitudes and approaches to life, its unprecedented access to information and knowledge, timeless human qualities can help us navigate through the thicket of offerings and help us remain close to what matters most. For more than ever, we humans need a compass to guide us so we can stay true to our essential selves and feel that we are living a life of meaning and depth. Such a life many a great thinker has referred to as a life worth living.

Nader’s Musings | ElderCare Aphorisms

It is a gift to care for elders. Entrusted in our care, elders afford us the opportunity to deepen who we are as humans. In being able to care for others we stand in service of the greater Good. Being in service of the Good brings us closer to wholeness and contentment.

In forgetting we remember what is true. Staying close to truth, we stay with what matters. What matters is what makes us deeply human. Being kind to others we live in gratitude. Compassion means we are with the suffering of others. How we live our lives is how we will die.

Caring for others means to look after their needs. Often forgetful people do not speak our everyday language and do not move in our everyday ways. So we try to understand their way of speaking and of acting. In learning their language and movement, we become richer ourselves.

Different or unusual behavior always points to unmet needs. Not those who act or behave differently need to be normalized. Rather, we, who desire to care, need to understand the meaning behind people’s expressions. In learning their language, we discover ourselves. In learning about their movements, we learn to dance.

 

Nader’s Musings: Introduction to Humanistic Eldercare – Toward a New Conceptual Framework for Aging and Care

SONY DSCConsider the following. We humans are social beings. We come into the world as the result of others’ actions. We survive here in dependence on others. Whether we like it or not, there is hardly a moment of our lives when we do not benefit from others’ activities. For this reason,  it is hardly surprising that most of our happiness arises in the context of our relationships with others.

– Dalai Lama

 Concepts without percepts are empty; percepts without concepts are blind. 

– Immanuel Kant

Introduction

As family members, friends, professionals and care-partners, we need to face our own aging, as well as the aging of those elders for whom we might need to care. These elders can be our own parents, siblings, or other relatives, can be friends or acquaintances. Elders might also be part of our professional clientele, as therapy clients, as people for whom we are responsible as guardians or conservators, as care-partners, staff, managers and directors of eldercare communities throughout the country.  How we face aging and eldercare is largely based on the mindset with which we approach these challenges. This mindset frames how we apply our knowledge, skills, and passion, as well as how we assist and partner with elders in all aspects of their care. The mindset we use also informs our attitude towards how we understand our meaning of life, what we understand to be important and of value.

As an example, a daughter in her late thirties spoke of how she had been taking care of her forgetful father for some eight years. She remarked that in the first six years she envied her peers who were pursuing careers, family, travel, and other more mainstream pleasures. Only in the last two years of her care-taking did she recognize that she was the lucky one, that she had been privileged with the profound experience that came with the task of having to care so deeply for her dad, who had become increasingly forgetful. She spoke glowingly about all that her dad was teaching her every day, as she bathed, dressed, groomed, and fed him. She said that she was learning about love,  about being in the moment with him and herself, about going slowly, about being kind and caring, and about being attentive to the little things. After the room had fallen quiet, she stated that caring for someone else felt like the most precious gift she could have been given in life.  Indeed, this attitude can be said to be antithetical to our societal value that emphasizes looking out for one’s own good, whereas going out of one’s way is pathologized as co-dependency.

To honor elders as wisdom keepers and social contributors sets the stage to look at elders from their needs in terms of connecting, feeling valued, that they can give and receive – like all of us.   What can we do to remind ourselves of the fundamental needs that they and all of us have? How can we live in a deep relationship with our elders – including our own inner elder – and receive their wisdom so important for us to live a meaningful and sustainable life?

 This is a brief excerpt of a chapter to be published in a humanistic psychology book.