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Why aren’t they screaming? A counselor’s reflection on aging

Judith Gusky April 1, 2012

When I was younger, I often wondered how it was possible that elderly people weren’t consumed with fear of the inevitable. But Erik Erikson seemed to have a “good enough” theory to settle my inner turmoil. As an undergraduate back in the early 1970s, I surmised from Erikson’s theory that as we successfully move through each stage of development, our “reward” is our inauguration into the next stage. Each success in turn opens the next opportunity to successfully negotiate life’s challenges and conflicts until we reach the penultimate — an old age of peaceful integrity, not one of despair or fear of death.

Failure to meet challenges at any stage along the way can always be addressed by going back under the safe tutelage of the therapeutic relationship. If necessary, we might even go back to the beginning, to find that “good enough” mother and a sense of trust, autonomy, initiative, identity, intimacy or generativity — whichever it might be. The key, I found, is in our resiliency.

But I wonder, even still, does old age give us the time we need to renegotiate life’s failed challenges? And what about “late old age” (80-something or 90-something)? What are the challenges of a developmental stage that people rarely attained until recent times?

The ‘ninth stage’

The Eriksons made it. Erik was 91 at the time of his death in 1994, and his wife and collaborator, Joan, died in 1997 at the age of 95. What might they have had to say about old age as they were living it?

In a videotaped interview in 1993, while Erik was in a nursing home, Joan Erikson said she felt a responsibility to rethink their eighth and final stage of human development — integrity vs. despair. She thought they owed an apology to people for theorizing that wisdom and integrity were so great.

In retrospect, she found that other people might see wisdom and integrity in an old person, but that’s not what that old person was feeling. “We shouldn’t have made it up,” she admitted. “We hadn’t been there yet. Maybe we should have talked to a lot of old people.”

The Eriksonian “ninth stage” emerged from her reflections. In a second interview in 1995, a year after Erik’s death, Joan conceptualized the newer, final stage of development by way of a metaphor — that of a woven fabric. She called it the Woven Cycle of Life. Erikson saw the warp, the lengthwise threads attached to a loom before weaving, as a person’s “indomitable core.” Throughout life, everything that was in utero is there — all our potential.

The weft, the thread that is woven back and forth to complete the fabric, represents life’s experiences and the challenges and conflicts along the way. When our strength wanes, the fabric’s color becomes grayer, colorless. But our strength keeps coming back, and when it does, our fabric’s colors are bright.

Erikson believed that the strength, the warp, is always there. Nothing is ever completely cut off. “You can always go back,” she said. You can make up for it anywhere along the line. This is the resiliency of human beings.

Providing a little more meat to the metaphor, Erikson theorized that the ninth stage is where we begin to see things from the other point of view. The eight stages of development are always presented in a syntonic-dystonic order (trust vs. mistrust, autonomy vs. doubt and shame, integrity vs. despair and so on). In old age, the order is reversed. The dystonic takes precedence. For example:

Mistrust vs. trust: When you get older, you realize there are certain things you cannot do. You may become mistrustful. But you have to draw on the trust, forgive the weakness (the failing memory, the slowing gait) and trust the rest.

Guilt vs. initiative: You may become insistent about taking on a particular project or challenge. You make people do things your way. You overestimate your physical competence. Your decision turns out to be wrong. The guilt comes not only because you didn’t have the physical capacity but also because you shouldn’t have made the choice in the first place.

Role confusion vs. identity: When you become dependent, when others are taking care of you, you question who and what you are.

Isolation vs. intimacy: In old age, isolation comes first. If you are isolated, you may yearn for intimacy.

Stagnation vs. generativity: How far do you go along with the stereotype of yourself as an old lady or an old man? To what extent will you choose to go on being a productive, contributing human being? To what extent will you withdraw?

In short, all of life’s conflicts and challenges are reexperienced in old age. From Erikson’s point of view, success in the ninth stage of life allows the older person to assert the Self by saying, “Don’t take away from me what I have. Let me choose.” It is all about maintaining our indomitable core.

Is it gerotranscendence?

Joan Erikson remained productive even in the last few years of her life. Among other things, she devoted the last chapter of her 1997 revision of Erik’s book The Life Cycle Completed to the concept of gerotranscendence.

Swedish sociologist Lars Tornstam coined the term gerotranscendence in 1989 in part to revive an interest in the “disengagement theory” of aging. This psychospiritual theoretical concept posits an alteration of consciousness in old age, a redefinition of the Self in relationship to others and a new understanding of fundamental existential questions, including:

  • Increased feelings of a cosmic communion with the Spirit of the Universe
  • Redefinition of the perception of time, space and object
  • Redefinition of the perception of life and death and a decrease in the fear of death
  • Decreased interest in superfluous social interaction
  • Decreased interest in material things

I’m not sure this is exactly what Joan Erikson was thinking about when she wrote about the ninth stage of human development. It would be nice to believe that, provided we can hold on long enough to our physical and cognitive health, we might have this tidy little process to look forward to. I think life is perhaps a bit too messy. But some may be so blessed to experience good aging and a “good death.”

What good can counseling do?

I love Ann Orbach’s 1996 book Not Too Late: Psychotherapy and Ageing. Orbach is a British psychotherapist, now retired. I relate closely to her account of herself as a 50-something therapist working with aging adults. The difference, of course, is that I am just at the beginning of this career, while she was already a well-seasoned psychoanalyst when she saw her first elderly client.

Each chapter in the book is like a literary adventure, and it offers a challenge to the ageism inherent within Western society and the counseling profession. For example, we laud the “wellness” model of mental health as counselors but tend to return to the medical model and pathology when working with aging adults.

Orbach’s perspective is personal and humane, inspirational and refreshing. She has helped me look at myself as an aging counselor and the aging clients I counsel in a different way.

One of her chapters, titled “Why Aren’t They Screaming?” begins: “For someone who is young and healthy enough to expect long years ahead, it is almost impossible to grasp what it would be like to have to accept a shrinking future in which there will be little further change or achievement or drama.”

As counselors, we want to help each client to live more fully and to pursue the same life-enhancing goals we desire for ourselves. But inevitably, Orbach tells us, the aging adult’s life is diminishing, and the ultimate goal will be that of facing death.

Facing such a reality is not easy, regardless of whether our clients enthusiastically embrace the existential challenge. As counselors, we might be as uncomfortable (or even more uncomfortable) as our clients are with the topic of death and dying. And so we resist, offer moral support and encouragement, and turn a blind eye to pharmacological dependency when challenge and rigor may be what is called for. Orbach is mindful that what we resist looking at in our clients is likely what we resist examining in ourselves.

Most counselors are not trained in long-term psychoanalysis. Brief, solution-focused therapy predominates in the field. Yet, why should the elderly regularly be singled out for short-term therapy? Is it the element of time, the stereotypical belief that perhaps it is simply too late to expect significant change?

Most elderly clients today probably are seen by mental health professionals for depression and anxiety, which is usually diagnosed by a primary health care provider after the older adult has lost a spouse, battled an illness or struggled with physical or cognitive incapacity. The medical model seems the only reasonable model to follow. So, we leave much of the work of counseling the elderly to those in the social work profession who dominate mental health care in the arena of nursing homes, hospitals and hospices.

Yet, if we entertain the notion, as did Joan Erikson, that personality and identity continue to evolve and develop even in the very advanced stages of life, then we owe the elderly much more.

Old age is an important stage of development. The strengths a person has achieved and demonstrated throughout the life cycle will be challenged as that person encounters a decline in physical and mental abilities in old age. But in this stage of life, whether we label it a ninth stage or gerotranscendence or something else, whether our clients look backward or forward, a successful outcome is possible. This outcome is one in which the final years can be lived to the fullest, in harmony with one’s past life and without fear of death, or at least with the acceptance of life’s existential limitations.

In one of her final interviews, Joan Erikson said she was uncertain of how to advise people concerning what to do as they reached old age. If nothing else, she said, the thought that came to her was that they should go on “becoming.”

It was a very existential response for a developmental psychologist. It reminded me of Viktor Frankl’s admonition that there is meaning in life, available to everyone, and that life retains its meaning under any condition and until its final moment. We owe this much to each elderly client who crosses our path.

 

Judith Gusky is a licensed professional counselor in Pennsylvania who came to counseling as a midlife career changer. Contact her at judithgusky@gmail.com.

Letters to the editor: ct@counseling.org

 

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