By Judith Gusky, MSEd, NCC

Click here to contact Judith and/or see her GoodTherapy.org Profile

The Challenges and Hopes of Aging

The population is aging. I am aging. Yet here I am starting a new career as a counselor. One of my interests is in end-of-life issues. I am not the Grim Reaper. I don’t have a morbid fascination with death, even as I find myself on the far side of middle age. Maybe it’s just that I haven’t quite been able to let go of Erik Erikson’s eight-stage model of human development and the hope that it offers.

When I was younger, I often would wonder how it was possible that elderly people weren’t consumed with fear of the inevitable. 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 offers 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 and fear of death.

Deprivation or failure at any stage along the way could always be rectified by going back, under the safe tutelage of the therapeutic relationship, and renegotiating each challenge. 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, was 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-somthing? What are the challenges of a developmental stage that people rarely have attained until recent times?

The “Ninth Stage”

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

In a 1993 videotaped interview, 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 believed that they owed an apology to people for theorizing that wisdom and integrity were so great.

In retrospect, she found that wisdom and integrity are something that other people may see in an old person, but it’s not what that old person is 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. It may not stand up to rigorous empirical testing. I don’t think it was meant to.

The metaphor was that of a woven fabric—the Woven Cycle of Life. She 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.” 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, for example, trust vs. mistrust, autonomy vs. doubt and shame, integrity vs. despair. 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), but 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 because you shouldn’t have made the choice in the first place.
•    Role Confusion vs. Identity. You question who and what you are, when you become dependent, when others are taking care of you.
•    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 re-experienced in old age. It is here that the aging person may feel rigid or withdrawn, willing to accept or at least willing to say, “No, that is not for me.” In either case, from Erikson’s point of view, the older person is saying, “Don’t take away from me what I have got. Let me choose.” It goes something like that. 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.

I haven’t yet read this chapter, but I have done a little research on the topic of gerotranscendence. The term was coined in 1989 by Swedish sociologist Lars Tornstam in part to revive an interest in the disengagement theory of aging. This psycho-spiritual theoretical concept posits an alteration of consciousness in old age, a redefinition of the Self and relationships to others, and a new understanding of fundamental existential questions, including:

•    An increasing feeling of a cosmic communion with the Spirit of the Universe
•    A redefinition of the perception of time, space, and object
•    A redefinition of the perception of life and death and a decrease in fear of death
•    A decrease in interest in superfluous social interaction
•    A decrease in interest in material things

I’m not sure that this is exactly what Joan Erikson was thinking about in her videotaped interviews. But it would be nice to believe that, provided we can hold on long enough to our physical and cognitive health, we may have this tidy little process to look forward to. I think maybe life is a bit too messy. But some may be so blessed—to experience good aging and a “good death.”

Counseling and Aging

I love Ann Orbach’s book, Not Too Late: Psychotherapy and Ageing (1996). Orbach is a British psycotherapist, now retired. I relate closely to her account of herself as a fifty-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 at the time she saw her first elderly client.

Each chapter in the book is like a literary adventure, and yet a challenge to the ageism inherent within Western society, and within the counseling profession. We laud the “wellness” model of mental health, 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 differently at myself as an aging counselor and the ageing clients that I counsel. One of her chapters entitled “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 of achievement or drama (1996, p. 40).

As counselors, we want to help each client to live more fully and to pursue the same life-enhancing goals we want 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, whether our clients enthusiastically embrace the existential challenge or not. We may be as uncomfortable as our clients with the topics of death and dying, perhaps even more uncomfortable. And so we resist and 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 to be what we resist 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 just too late to expect significant change?

Most elderly clients today probably are seen by mental health care professionals for depression and anxiety, usually diagnosed by a primary healthcare provider after loss of a spouse, illness, or 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.

But if we entertain the notion, like 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 achieves throughout the lifecycle will be challenged by the decline in physical and mental abilities encountered in old age. Yet, 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—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 the acceptance of life’s existential limitations.

In one of her final interviews, Joan Erikson was uncertain how to advise people what to do as they reach old age. The thought that came to her was that, if nothing else, they should go on “becoming.” It was a very existential response by 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, literally up to its last moment, up to one’s last breath.

This much we owe each elderly client that crosses our path.

References

Davidson Films, Inc. (1993). “On Old Age I: A Conversation with Joan Erikson at 90.”
Davidson Films, Inc. (1995). “On Old Age II: A Conversation with Joan Erikson at 92.”
Erikson. E. (1997). The Life Cycle Completed: Extended Version with New Chapters on the Ninth Stage of Development by Joan M. Erikson (W.W. Norton).
Orbach, A. (1996). Not Too Late: Psychotherapy and Aging. Jessica Kingsley Publishers.

©Copyright 2008 by Judith Gusky, MSEd, NCC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Judith and/or see her GoodTherapy.org Profile