by Sherwin B. Nuland
One evening a few months before my eightieth birthday, I found myself addressing an audience of approximately a hundred men and women on a topic to which I have devoted considerable study during the past decade or so. My subject was the process of aging, and the ways in which current gerontological research is teaching us to deal with it. It is hardly remarkable that such a theme would engage a group whose average number of years on this earth appeared to be approximately sixty-five, especially when the speaker is a rising octogenarian known to have written abundantly about such matters.
During the course of my talk, I focused—as does much of the recent scientific, clinical, and general literature—on the optimistic. I stressed the role of determination and conscious effort in combating certain of the ravages that nature inflicts on those of us in the latter decades of life. I spoke of the importance of physical exercise, the creativity that comes with continued intellectual exploration, the critical importance of a personal sense of closeness to family and the surrounding community. Such essential patterns of living are easily explained, and they were more or less familiar to the upper-middle-class audience of friends and benefactors of the university medical center to which I had been invited.
But I also described newer and more abstruse matters, such as our present understanding of the brain’s plasticity, which allows it to change and even to improve not only its ability to function but also its actual microscopic structure, and to do so regardless of chronological age. Even more remarkable, I pointed out, was the laboratory identification of protein substances produced during the exercise of mind and muscle, such as brain-derived neurotrophic factor (or BDNF), which acts to protect neural connections and to enlarge their number and strength while increasing blood supply to the cortex and encouraging the conversion of adult stem cells into cortical nerve cells. The message I delivered was this: the key to continuing productivity is continuing productivity. It is, as the late Ann Landers famously said about a particularly intimate problem of aging, “Use it or lose it.”
Not unexpectedly, following the delivery of such a buoyant message to such an audience, the applause was enthusiastic. But then a hand shot up, whose owner was a red-faced, chokingly angry man in the first row who appeared to be about sixty years old and to have deliberately disregarded the instructions on the event’s invitation that gentlemen wear business attire. Windbreaker askew, he was already halfway out of his seat and still impatiently rising before I was able to acknowledge him. I cannot recall the exact outpouring of words that he more spewed than spoke, but they were very much like the following, if a bit less organized: “What you’re saying is all very well, but don’t you realize that it applies only to men and women of means and education? The vast majority of the elderly don’t know about these things, and couldn’t afford them in any event. They often live alone and friendless or in some publicly subsidized care facility. Your ideas are suitable only for the more favored of older people. Society neglects everyone else and doesn’t care about them. Maybe you don’t, either.”
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All of this is by way of introducing Susan Jacoby’s disturbing and important book. Her focus is not at all on the advances that gerontological research has made in improving the health, happiness, and sometimes the longevity of much of our older population. She prefers to look into “the uncharted perils that lurk in the region of old age” and the self-delusion of “the expectation that things are going to turn out well if we only conduct ourselves well.” The notion that many of the elderly can postpone or even prevent much of the physical and mental deterioration associated with an increasing life span is, by Jacoby’s lights, the result of “myth and marketing.”
Never Say Die will stir up controversy, but it will also draw attention to social issues often ignored in our enthusiastic promotion of the health-sustaining values and behaviors in which we have placed so much faith in recent years. The book is in this way an important corrective to those of us who are so taken with the realization that conscious will and a determined approach are valuable resources that we forget the unpalatable fact that we live in a multi-tiered society in which the best will in the world, and the most determination, are limited by the reality of the actual circumstances of life.
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