Old Age: A Beginners Guide
Tim Duggan Books, Penguin, 2016, 160 pp., $18
How to Grow Old (Latin and English)
Marcus Tullius Cicero
Princeton University Press, 2016, 216 pp., $16.95
The world’s population is still growing, but it is aging rapidly. There are countries that are notable exceptions with very high birth rates—above all several in Africa—and these exceptions will probably pose the most difficult problems in years to come for the rest of the world. The two processes taken together—growing and aging—are creating demographic asymmetries unprecedented in history, and they are bound to cause a good deal of political, economic, and also psychological novelty.
Michael Kinsley is a well-known writer, mainly on politics, but his most recent book deals neither with demography nor with Africa, neither with politics nor history. Rather, it deals with the issue of how to manage old age and illness, interspersed with reflections on the fate of Baby Boomer generation to which the author belongs. His credential for writing on this particular topic is that he was diagnosed with Parkinson’s disease at the early age of 43.
For several years his was a story of denial based on a number of plausible reasons. Owing to the celebrities (ranging from Pope John Paul II to Muhammad Ali) who suffer or suffered from this disease, many assumed that priority might be given to research concerning this disease and a cure might be found in the not-too-distant future. This to a certain extent is what did happen. But it is also unfortunately true that the surgical procedure performed in such cases is not exactly inexpensive, nor is it as widely available as needed. Kinsley has been among the lucky ones: More than twenty years after the disease was first diagnosed, he enjoys reasonably good health and Old Age: A Beginners Guide is surely a sign that his mental faculties are unimpaired. He can look back on a lifetime of enormous achievements in his profession.
Kinsley’s prose, we are told, has given joy to a wide circle of admirers. He is “a favorite around here,” writes a colleague from the New York Times Book Review. “The most envied journalistic voice of his generation,” writes another. He was editor of the New Republic (twice), Harper’s, founding editor of Microsoft’s online journal Slate, editorial page editor of the Los Angeles Times, American editor of the Economist and the Guardian, a writer for the New Yorker and many other journals, a columnist for publications including the Washington Post, Time, Vanity Fair, and Politico, and a member of the editorial board of Bloomberg. He was also co-host of CNN’s Crossfire with Pat Buchanan and has even appeared in three movies.
It is difficult to think of anyone with a similar record, and it is easy to understand his fears at the time of his diagnosis. If his condition had become known, would the consequences not have been fatal from a professional point of view? According to the author, he was a candidate for becoming the editor of the New Yorker but quite possibly was turned down because he revealed his state of health to the owner. However, but for this one possible mishap, such fears as he may have had proved unjustified. His colleagues have only words of the highest praise for him and his new book, which is a collection of essays from which we learn a great deal about the author, his affliction, and his generation.
We learn, for instance, that the family name changed from Krinsky to Kinsley. We also learn that Hitler as well as Mao might have suffered from Parkinson’s. In Hitler’s case, the long-distance diagnosis could be mistaken: It is well known that his hands were shaking in his last year of life, but this could have been caused by the attempted assassination in 1944. We are told that patients diagnosed with Parkinson’s learn—on the basis of much evidence—that they are very unlikely to die of the disease. But Kinsley also makes it known that despite such reassurances he succumbed, quite understandably, to financial panic due to the potential cost of his treatment. As a result he started buck-raking, giving speeches at conventions that he had previously resisted attending. He was given (among other openings) a gig at the annual town hall session of the neurologists; by the end Kinsley and the neurologists became so chummy that he did not submit a bill.
Kinsley relates a chance meeting with a former judge in a swimming pool in California, and with former Secretary of Defense Robert McNamara on a plane. He shares with his readers his thoughts and recollections of Joe Kraft, a journalist prominent in the 1970s and now sadly forgotten. He also writes about who wins, or should win, the lifetime achievement award in the Baby Boomers Hall of Fame, and what yuppie careerists are and whether this is a good thing or not. What all this stuff is doing in the book is not entirely clear.
But above all, not surprisingly, we learn about Parkinson’s, which happens when the brain produces an insufficient quantity of dopamine. Kinsley’s symptoms were mild and disappeared after deep brain surgery (DBS). There is a description of this procedure, which in his case lasted nine hours. Much of the time he had to be awake. During the operation the head was screwed into a metal frame. Kinsley advises those likely to undergo the operation to request that their head be screwed to the operation table. To our relief we learn that in the years since passed, much progress has been achieved in the operation’s technique, and there is every reason to expect further improvements. Instead of implanting two batteries, the surgeons now implant only one.
In brief, it is a very wide-ranging book and Kinsley’s colleagues were struck by its profundity and wisdom. I would have stressed another feature—the author’s fortitude in adversity. Chapeau! Hut ab! Kol ha-kavod! I have known not a few people in roughly similar situations who gave in to the disease, among them a war hero. It was not fear of pain, or fear in general, that drove him to suicide, but above all, probably, the wish not to be a burden on those closest to him.
The story, however, does not end here, but instead takes a strange, unexpected, and to me inexplicable turn, yet one greatly approved apparently by many of Kinsley’s friends and acquaintances quoted by his publisher. They find it smart, even wise and profound, that Kinsley should treat his affliction more or less as a cause of merriment. As one admirer puts it, the book is “by turns funny and rueful,” but, as I read it, it is far more funny than rueful. Others use more emphatic terms with obvious approval such as: “wickedly funny,” “hilarious,” “delightful.” Is it a genuine attitude or a posture? Is it the philistinism of a reader not belonging to a certain generation if he finds it difficult to join this kind of jubilation, lack of sophistication, and sense of humor? I suspect the reasons have to be found on another level. One of Kinsley’s admirers quoted seems to be aware of it when he writes, “If a book about illness and death can be delightful…”—a big “if” indeed. But “wickedly funny” and “laugh-out-loud funny”?
Is the author not aware of his good luck—that he contracted the disease apparently in a relatively mild form (during the past decade a quarter of a million people died of Parkinson’s and many more suffered), and that he could afford the best treatment available? Of course, America is the country of positive thinking; I doubt whether a wickedly funny book about illness and dying could be equally acclaimed elsewhere.
There has been all kind of strange behavior of similar sort throughout history. Even Shakespeare’s tragedies have been transformed occasionally into comedies. In the 18th century King Lear was provided with a happy ending. General Macbeth could end if need be with the hero emigrating to America where his military experience would be put to good use. And the three witches could end up as ladies-in-waiting at the royal court. But to what use? It did not work. Suffering and death are not ideal subjects for witticism and hilarity, and funerals are not a good occasion for laughing out loud. That is why the first sentence in Old Age: A Beginners Guide—“This is not a book about Parkinson’s disease”—is about as true as saying the Bible is not about religion. How could it not be? It is a window “onto age and death,” and this is its value.
There have been many such inspirational windows before, Cicero being the most famous forerunner of Kinsley. Marcus Tullius Cicero’s book about growing old was published in 45 BCE, 2,000 years before Kinsley’s. Cicero, we learned in school, was a Roman politician, a consul at one stage. He was forgotten only to be rediscovered in the Middle Ages as a model of how to write Latin. Now he is being deployed in English translation as someone who knows how to write about old age. One can have many careers, it seems, even from beyond the tomb. (Nice to know.)
On old age there are basically two schools of thought. The one is reflected in the Russian proverb “starost ne radost”—“old age is no joy” or the Arab proverb, “Every ailment has its cure except al-Ahram”—the pyramids, here meaning old age. Cicero writes about old age as the age of wisdom. He tells the story of Fabius who had many admirable qualities, but none more striking than how he bore the death of his son. Plato had a peaceful and serene end of a life spent quietly, and was still writing when he died at 81. Isocrates was another example who tells us himself that he was 94 when he composed his Panathenaicus.
Foolish people, Cicero says, blame old age for their own faults and shortcomings, but Enius did not do so. He compared himself as an old man with a gallant and victorious racehorse. Nor does old age prevent an active life: Appius Claudius was not only old but blind when he gave a magnificent speech full of wisdom in the senate. People who say there are no useful activities for old age don’t know what they are talking about. He mentions the fact that among the Spartans the people who hold the most important offices are called the elders—which is exactly what they are. Cicero repeatedly makes the point that old people maintain a sound mind as long as they are eager to learn and apply themselves. This is true with regard to elderly lawyers, augurs, priests, philosophers—“what a multitude of things do they remember….” But it is true not only of public figures but of those leading quiet, private lives. Sophocles, he reminds us, composed his tragedies well into old age (his nineties). When he seemed to neglect his family’s finances because of his passion of writing, his sons took him to court. When in Colonus, Sophocles asked for permission to read out Oedipus, which he had just written. When he finished he asked whether this sounded like the work of a weak-minded person. The court acquitted him.
The lesson was that one should never stop learning, just as Solon boasted in his poetry that he learned something new every day. Cicero in his old age studied Greek.
Sometimes Cicero goes a little too far in praise of old age. For instance when he mentions the fact that the pleasures of flesh tend to fade away in old age. His conclusion is as follows: “If this is true I say it is indeed a glorious gift that age frees us from youth’s most destructive failing….” Cicero again seems a little harsh, arguing that where lust rules there is no place for self-control, and in the kingdom of self-indulgence there is no room for decent behavior. Cicero also tends to go overboard writing about the beauties and marvels of agriculture and its wonderful impact on old age and its enjoyment: “Nothing can be more abundantly useful and beautiful than a well kept farm. Not only does old age not impede the enjoyment of such a farm…” and so on and so forth. Cicero is also mistaken in arguing that being absorbed in some interesting work prevents the ill-effects of ageing and disease; one wishes this would be the case.
And yet with all the exaggerations and repetitions, with the boredom and the occasional priggishness, the generation of Quintus Maximus and Fabius Maximus, of Appius Claudius and Tuditanus and whatever their names, was impressive and served as a model for a long time to many people in many countries. The heroic posture may sound antiquated and even ridiculous, but it does not sound painfully wrong and out of place. Thus, in the end, Cicero’s advice I still find more useful than that provided by many of his successors. Such an attitude might be considered hopelessly old fashioned perhaps. But at 95 one will be forgiven for being old fashioned.
What about old age and its future? What to read and whom to trust? Life expectancy at birth (but not maximum life span) has been increasing worldwide and dramatically so—by five hours every day in Britain, to provide an example—the result of a better diet, less smoking, better surgery, and so on. But older people still have more diseases and more serious diseases (for example, heart disease, cancer, respiratory disease, osteoarthritis, dementia). Not only that, but they often have multiple conditions—heart disease, arthritis, and dementia all together, for instance. After an illness, they bounce back more slowly (so my son-in-law, who has studied the subject of old age, tells me).
The idea of living forever remains a chimera, a bad dream perhaps. There is the harrowing story of Tithonus, the son of a Trojan king. Eos, his goddess lover who had borne him two children, asked Zeus to confer immortality on him but forgot to ask for eternal youth. And so he lived on babbling endlessly in a room out of harm’s way where Eos had put him. Tennyson, writing about him in blank verse, pictures him looking down on the dim fields about the homes of the dead.
For most non-scientists (and most scientists, for that matter), it is difficult to decide whether there is more room now for pessimism than for optimism compared to forty years ago with regard to the future of old age. Soon, we are told, the average age of death will jump by a year every year. But what will be achieved if the decade (or more) gained is to be one of suffering? It is still true that muscles shrink and bones degenerate after the age of forty. The brain decreases in volume by 5 percent every decade after the age of forty, as well. There are new drugs and treatments dealing with the problems of old age, but are we closer to our aim that our health expectancy will be very close to our life expectancy?
Perhaps the most authoritative statement summarizing the consensus among the experts today was made by a leading biochemist, Nick Lane, in Life Ascending a few years ago: Some individuals enjoy a relatively disease-free and extremely long lifespan. The genetic mutations that underlie that good luck are small and we may soon be able to modify our cells to be able to achieve such benefits, or to find drugs that have the same beneficial effect. Amen. But of course that would be when the sociological and psychological problems just begin.