The Art of Aging

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by Sherwin B Nuland


  The great secret of morals is love; or a going out of our own nature, and an identification of ourselves with the beautiful which exists in thought, action, or person, not our own. A man, to be greatly good, must imagine intensely and comprehensively; he must put himself in the place of another and of many others; the pains and pleasures of his species must become his own. The great instrument of moral good is the imagination.

  The putting of ourselves “in the place of another and of many others” is a road toward caritas well worth the traveling. We nowadays call it “empathy,” but perhaps it can mean a little more than that; perhaps it can mean to imagine not only seeing the world through the eyes and feelings of others but more specifically seeing ourselves that way—to look into the eyes of another and see ourselves reflected there; to live up to the best expectations of those closest to us, and by such means come nearer to caritas, to mature reflection, and to principled living. To be wise, one must first be good.

  To deal with such complexities requires equanimity, the acquired talent of being imperturbable, defined by William Osler in 1889 as “presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril,” and elsewhere by him as “firmness and courage, without, at the same time, hardening ‘the human heart by which we live.’…How difficult to attain, yet how necessary, in success as in failure!”

  Real imperturbability is, in fact, so difficult to attain that it is beyond the reach of most—and perhaps all—of us, in addition to being one of those several qualities that exist as a matter of degree rather than complete achievement: In any given situation of stress, there is some greater or lesser element of perturbation; one would have to be an inhuman paragon not to feel it. More important than being imperturbable, therefore, is the way we deal with stress. When we admit to ourselves that we are anxious, and understand that it is the natural outgrowth of the particular situation we are in, such an acknowledgment renders it more acceptable to us and makes it less likely that we will think ourselves inadequate for feeling it. The result is a lessening of anxiety’s hold, sometimes just enough to help with the clarity of thinking that permits finding a way out of the difficulty being faced.

  In a long surgical career, I have found myself terrified—scared out of my wits—in the operating room on about four or five occasions. Each time, it was because a sudden and life-threatening hemorrhage of high-pressure arterial blood had occurred under circumstances so unforeseeable that I was completely unprepared for the possibility that it might happen. A surgeon is faced with massive blood loss frequently, but the only times I ever felt this sort of fear were when I thought it had been caused by my own error, as by overly hasty dissection, clumsiness, or some similar inadequacy. What saved me—and the patient—when these episodes occurred was my years of residency training, during which I had occasionally seen some of my most respected teachers get into this kind of trouble. As a result, I could summon the emotional wherewithal to immediately forgive myself when such things happened to me, rather than giving in to the intense self-reproach that might stand in the way of doing what was instantaneously needed in order to get out of the desperate difficulties engendered by my own hands. If the finest of my mentors had had such problems, I could hardly condemn myself.

  During those many years of surgery, I had a whole catalogue of ways to restore equanimity when it threatened to leave me. Perhaps there are lessons in them that might be generally useful to others as well for the kinds of agitations that threaten the calm so badly needed to make good decisions under extreme stress. Humor, even clumsy humor, helped. On more than one occasion when immersed in a dissection so complex that it seemed insoluble, I would stop working for a moment, lift my concentrated gaze from the operative field, look up at my assembled team with what I hoped was a mischievous bit of twinkle in my eye, and act like I was tongue-in-cheek kidding when I said, “Do you suppose we’ll ever get out of this?” It was a subterfuge that relied on the residents’ and nurses’ assuming that I would not possibly say such a thing if I really meant it. Their amused responses always lightened the atmosphere, added to the team’s solidarity, and allowed me to go back to work with renewed confidence.

  Or, of course, there was the other line that always did the trick when I could sense that my assistants or the scrub nurse were becoming overly tense concerning the danger of what was being done, or about some incipient disaster that they believed might be on the immediate horizon. When their transmitted tension reached the point where I felt it affecting my calm, I would say, “You know, folks, after I do a case like this I always send the pants of my scrub suit to the Monarch Laundry. They don’t wash things too well, but they’re very discreet.” This seemed to acknowledge to members of the team that there was justification for their understandable fear, but that things were so well under control that the surgeon was relaxed enough to make jokes about the situation.

  The underlying purpose of all these little bits of subterfuge—none of which, incidentally, were original with me—was to cut tension and restore the air of equanimity so necessary for detached thought, without which decision is impossible and action is paralyzed or worse. Even in the midst of one’s own perturbation, doing something to lessen the general atmosphere of tension has the effect of blowing away, at least in part, the incipient panic that inhibits rational thought. Panic is contagious, but so is a calming influence.

  I have been writing here of acute problems, but the same sort of thinking applies to any long-standing situation in which the level of stress is such that it threatens the detachment so essential to judgment and wisdom. The mere acknowledgment of the unavoidable nature of the anxiety inherent in certain circumstances removes the self-condemnation that may complicate it, and makes matters more relaxed for all concerned. Taking away blame and granting oneself permission to be less than imperturbable may be the best path toward the very imperturbability we seek.

  Like several of the other characteristics of wisdom, equanimity appears to become easier with age. Studies of large numbers of the elderly indicate, assuming mental health, that effective regulation of emotional response is more likely to be found in older men and women than in younger. They are less prone to anger, impatience, bitterness, and negativity than their sons and daughters, and are accordingly able to approach problems with a more balanced attitude. Not only that, but when such undesired moods do appear, they are better managed by older individuals. The restraint that characterizes maturity of mind grows with maturity of years.

  Aging can be a process of learning to filter, of choosing to avoid or remove those aspects of response that the years have shown to be counterproductive or even harmful. “The Aristotelian sage,” wrote Montaigne, “is not exempt from the emotions: he moderates them.” As we grow older, it seems to become less important, for example, to assert the rightness of every position we take, or to express displeasure with every person whose opinions or character do not suit our fancy or measure up to our expectations. “One of the first essentials in securing a good-natured equanimity,” wrote Osler, “is not to expect too much of the people amongst whom you dwell. ‘Knowledge comes, but wisdom lingers.’” When impatience is less, so is the frustration that leads so quickly to anger. Anger especially has been found to be less frequent, less explosive, and less sustained among the elderly. “The growth of wisdom,” wrote Nietzsche, “may be gauged exactly by the diminution of ill temper.” Ill temper, aggressiveness, the driving need to win at all costs—they man the barricades against wisdom, and stiffen the resistance to the judicious persuasion so necessary if good judgment is to win the day.

  Though nothing can be more important to good judgment than equanimity, equanimity is not the same as being placid, a condition against which older men and women must be on guard. Though few would not admire Miriam Gabler, for example, for the contentment that has been the reward of her later years, contentment can, inappropriately applied, be the enemy of wisdom. Complete peace of mind does not exis
t, nor would we want it to, especially as it sometimes slides dangerously close to passivity. Wisdom needs a measure of constructive discontent.

  The motivating power of discontent is the subject of a chapter in Man Is Not Alone, the most highly acclaimed of the religio-philosophical books of the eminent theologian Rabbi Abraham Joshua Heschel. Heschel writes of the importance of a chronic state of dissatisfaction of a particular sort: Man, he proclaims, must “be content with what he has, but never with what he is.” (Italics in the original.)

  Self-satisfaction, self-fulfillment is a myth which panting souls must find degrading. All that is creative stems from a seed of endless discontent. It is because of men’s dissatisfaction with the customs, sanctions and modes of behavior of their age and race that moral progress is possible. New insight begins when satisfaction comes to an end.

  In no aspect of wisdom is restraint more necessary than in the manifestation and uses of discontent. Unrestrained discontent can be querulous and quarrelsome, and bears the danger of falling into self-righteousness, another of the enemies of wisdom. The wise travel along the golden mean; they are restrained by caveats of humility spread out like so many signposts along the lengthy road to their goal. “Thus said the Lord,” proclaimed Jeremiah, “Let not the wise man glory in his wisdom.”

  To be smugly self-righteous is to be rigid, resistant to the openness so crucial to the ongoing search for wisdom, in which so much humility is needed. But openness to change comes with its own caveat: the danger of the impermanent. The capacity to deal with change is the capacity as well to distinguish between the transitory and the steadily evolving culture of a society, an advantage that accrues to age, which has seen so much. Older men and women know that most changes are of the moment. The wise are sensitive to the difference between the ephemeral and the enduring, and seek clues to help them distinguish between the two.

  The restraint of the wise keeps them grounded when others are jumping too early onto flashy bandwagons. At the same time, a wise person’s openness to change allows a willingness to give up old ways even before they become super-annuated. The most quoted poet in the English language chose precisely this subject for one of his most quoted couplets. Alexander Pope wrote in two-lined aphorisms for those who would get wisdom.

  Be not the first by whom the new are tried,

  Nor yet the last to lay the old aside.

  And true wisdom lies also in allowing for context. Though wisdom has about it a necessary timelessness, it must also be a thing of its time, place, atmosphere, and circumstances. And here we return to the notion of adaptability. What is wise in one situation may be folly in another. The wise man has traditionally been thought of as a rock of solid dependability, but he is only dependable and his judgment is solid only insofar as his thought is supple.

  None of us is born with the inherent gift of wisdom. “Wisdom is the principal thing,” we are told in the Book of Proverbs, “therefore get wisdom.” But how are we to get it? The question was addressed by Marcel Proust: “We do not receive wisdom; we must discover it for ourselves after a long journey that no one can take for us or spare us.” And so, it may again be asked, “But how are we to discover it?” How does a man or woman come to the knowledge, the equanimity, the restraint, the detachment, the caritas, the fairness, the foresight, and all those other qualities without which there is no wisdom?

  The very fact of wisdom’s incompleteness catalyzes the motivation to further the pursuit, as Heschel would certainly advise us. Knowing that an undertaking can never be completed is no reason to turn away from it. The Talmudic sage Rabbi Tarphon is known for having admonished anyone who would hesitate to take on an obligation that by its very nature is impossible to completely fulfill. His oft-quoted exhortation is recorded in the “Pirke Avoth”: “The day is short and the work is great, and the laborers are sluggish, and the wages are abundant, and the master of the house is demanding. It is not necessary that you complete the work, but neither are you free to desist from it.”

  Though we are not free to desist from the hard work of pursuing wisdom, we should never allow ourselves to forget that the wages are abundant—the reward is great. That the process takes more time than is granted by the human life span cannot be doubted, but here the advantages—and the obligations—are all with those who are older. To be wise, one has to have lived, though it must be acknowledged that some men and women, even when young, extract a lot more living from their years than do others.

  But wisdom increases with age only for those who never lose their receptiveness to change, and to progress within themselves. For this, an inquiring mind is needed, along with the necessary humility and the conviction that one can never know enough. Wisdom demands unending skepticism, the constant questioning of one’s own assumptions and conclusions, and the determination to become better than we are, until the day of our death.

  Equanimity is wisdom, caritas is wisdom, beneficence is wisdom, and so are all those other qualities so crucial to wisdom’s existence. Each of them can be found—can be strengthened, too—at any stage of life. But the long habit of living can make them stronger still. For each of them there is a caveat, a warning against its own overabundance; for the aggregate there is a balance, which in general terms is the balance between expansiveness and restraint. It is for such reasons that the ancient Greeks spoke of the golden mean, and this too is wisdom.

  Wisdom means having a certain steadiness of ongoing personal philosophy that is consistent while it is open to change; it means insisting on the primacy of reliable knowledge and truth, while aware that all knowledge should be questioned because there is no absolute truth; being skeptical always, while never cynical; having a justifiable confidence in one’s own knowledge and judgment, while granting that they are far from perfect; knowing oneself, while conceding the bias and insecurities that may distort such insight; relying on conscious and unconscious modeling after those whom we believe to be wise, while recognizing that everyone is fallible; feeling a sense of personal involvement and caritas for others, while retaining sufficient detachment to aid in fairness and objectivity; transcending one’s own needs, while using perception of those needs as a prism through which to see the world; being reflective, while committed to decision and action; being idealistic, while remaining grounded in what is; building peace of mind, while being sufficiently discontented to fuel the engines of necessary reform; anticipating the consequences of one’s choices and actions, while conceding the uncertainty of such predictions; accepting cultural change, while being aware of the kind of change that is only ephemeral; thinking timelessly, while being of the time; taking account of the values of one’s society and era, while not allowing oneself to be restricted by them; appealing to the best in others while not expecting more of them than they are capable of giving; maintaining a vision of a better tomorrow, while living in the reality of today.

  And even with all of it, there is no wisdom without humility. Humility assures that there is never wisdom enough, assures Heschel’s “seed of endless discontent,” assures that wisdom’s pursuit never slackens or ceases. Perhaps because he had so much less of it within himself than he might have wished for, T. S. Eliot expressed his conviction of humility’s primacy in his memorable “East Coker”:

  The only wisdom we can hope to acquire

  Is the wisdom of humility: humility is endless.

  And there is no wisdom, either, without the constant reevaluation of ourselves—the constant rethinking on all that we have been, all that we are, and all that we can be, regardless of age. Absent that, absent wisdom. Not surprisingly, it is Plato who has the last word, reminding us once more that “the unexamined life is not worth living.” A long life of not hesitating to look inward is the key to understanding all that can be seen when we look outward.

  A CODA FOR AGING

  I want Death to find me planting my cabbages, neither worrying about it nor about the unfinished gardening.

  —Michel de Montaigne, Essays: T
o Philosophize Is to Learn How to Die, 1580

  There is no fountain of youth, but we have nourishing water fonts of a different sort, much better and more realistic. These others are the wellsprings all along the course of our lives, to enrich the flowing current that gradually grows into the fullness of age. Like the moving water itself, our aging is a continuity with everything we have become since a much earlier stage—everything that has entered the slowly maturing stream of our being. Self-assurance, optimism, productivity, attachments of caritas to others, pride in our physical selves—these are all philosophies that enhance living. They are wellsprings largely of our own making, and they can grow in significance as we let their energies pour into the ever-widening, deepening channel of experience and wisdom.

  Because such qualities become increasingly consequential as the decades pass, we need to begin in youth consciously to think about them, and seek ways to encourage the sources from which they feed the ongoing stream. Even when the flowings that have come together to form our lives are not all we might have wished them to be—whether because of heredity, upbringing, illness, or circumstance—we can knowingly seek the new ones that are to be found along the way, and dig deeply into their sources so that their refreshing influx brings with it the ongoing progress we need if we are to continue being carried forward.

 

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