Albert Schweitzer’s Advice about Aging

Bookmark and Share

A friend recently quoted a saying from Albert Schweitzer that was especially meaningful to him as he approached his 70th birthday:

The meaning of maturity which we should develop in ourselves is that we should strive always to become simpler, kinder, more honest, more truthful, more peace-loving, more gentle and more compassionate.

 This advice captured my aspirations for the over 65 phase of life eloquently. To me it seems obviously true. But the skeptic in me asks – “Why should these be our goals?” Didn’t Dylan Thomas urge us not to “go gentle into that good night“?

 Here are some of my initial thoughts about Schweitzer’s advice. I hope readers will add their own.

1. I don’t believe in a personal afterlife, but a Pew Foundation study of religious life in America found that 74% do, with 59% believing in hell. For people who believe that after death we will be punished and rewarded in accord with our lives on earth, the last laps of life may be seen as especially influential for our afterlife fate, just as the final years of salary determine the pension level in some retirement schemes!

2. Ever since Horace counseled Romans to “seize the day,” innumerable gurus have advised their contemporaries to cherish the present and even to live each day as if it was our last. These glib clichés tend to go in one ear and out the other unless something makes the words come to life for us. It’s common for people who’ve been diagnosed with a terminal condition to report that – in  Schweitzer’s words – they feel “simpler, kinder, more honest, more truthful, more peace-loving, more gentle and more compassionate.” Passing symbolic birthdays – 65, 70, 75, 80… – is  not unrelated to receiving a terminal diagnosis. The shortened time horizon that comes with age or with illness encourages us to cherish the people we care most about, and, for some, to cherish all living things. As Dr. Johnson said, “when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.”

3. Age (and illness) challenge us to respond to the “diminutions” that come with age. One response is denial and pursuit of eternal youth, as Steve Moffic discussed in his recent post on anti-aging nostrums, and Dan Callahan discerned in some AARP Magazine articles and images. Philip Roth has great sport showing old men trying to act like young bucks. But although “denial” gets a bad rap in psychiatric circles, in its mildest  form – seeing the glass as half full, not half empty – it can serve us well by encouraging the kind of welcoming enthusiasm we may have been lucky enough to have had as children.

4. Some people may be hard-wired to have the temperament Schweitzer urges us to strive for. But I believe that for many, perhaps most, achieving Schweitzer’s vision of maturity takes work. For me, Yeats’s Sailing to Byzantium dramatizes this aspect of aging memorably. In the poem, the aging poet (Yeats wrote the poem when he was 60 or 61) starts in a depressive mood:

“This is no country for old men…”

The second stanza opens with a dismal image of age:

“An aged man is but a paltry thing,
A tattered coat upon a stick, unless
Soul clap its hands and sing, and louder sing
For every tatter in its mortal dress…”

But educating the soul isn’t easy. To do it, the poet must sail to “the holy city of Byzantium” where his heart

“…sick with desire
And fastened to a dying animal”

is consumed in “God’s holy fire,” transforming the aging poet from the sorry state of being a “tattered coat upon a stick” into a golden bird

“…set upon a golden bough to sing
To lords and ladies of Byzantium
Of what is past, or passing, or to come.”

Early in my psychiatry training, a wise clinical supervisor advised me not to be so determinedly cheerful with my depressed patients, but rather to dip into their depressive moods in order to understand them better. I found this hard to do, and eventually came to recognize that in growing up I’d put in a lot of “psychological work” to ward off gloom. When my sons were young they teased me about my “the glass is half full” approach to life, which they called “poptimism.”

Except for those who are suffering from a true depressive illness, responding to the slings and arrows of aging with bitterness is best understood as a choice. It’s not an error that can be corrected by logical argument. As a resident I saw a woman who had lost her parents, husband, and children in the holocaust. She felt that relinquishing her bitterness would mean forgiving the Nazis, and she was determined to accuse them until the day she died. But for me and many others, following Schweitzer’s urging to strive to become “simpler, kinder, more honest, more truthful, more peace-loving, more gentle and more compassionate,” seems like the wise, life-affirming choice to make.

Jim Sabin, M.D., 75, is an organizer of Over 65, a clinical professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.

6 Responses to “Albert Schweitzer’s Advice about Aging”

  1. Carol Eblen

    Yes! Agreed! But advanced age, unfortunately, doesn’t ensure the propensity of some human beings to be simpler, kinder, more honest, more truthful, more peace loving, more gentle, and more compassionate.

    We see the latest HATE crime in the news was committed by a 73 year old man who lived to hate Jews and who apparently wanted to make the evening news by (mistakenly)killing innocents, not even the Jews that he hated, in front of Jewish institutions at the time of Passover. He didn’t realize the reality of interfaith commitment to the public good and that Jews and those of other faiths or no faith in God communicate and socialize with one another in their communities. What a vile and disgusting and stupid human being. How did he get that way?

    It must be that many human beings, even in old age, all over the world, are falling short and committing horrible crimes and will never achieve maturity. They will never reach their potential and become intelligent and moral human beings. It is what it is — but is it getting worse? Are we regressing into another kind of darkness instead of progressing into greater light and understanding? Are we no more than are five senses and our ego?

    Are we born with moral instincts or are we taught morals in our environment? Of course, the morals of The Ten Commandments in the Judea/Christian traditions and law are reinforced by the specter of Hell and Heaven –reward and punishment, if you will, and the teachings of all of the great religious faiths of the world embody morals and laws that produce a collective public good.

    But, as the public good is defined now more often under secular law and economic realities and there are more non-believers in any kind of God or punishment in any kind of an afterlife, and there is NO GOD —no policeman within the heart/mind of men–and not enough police on the outside to enforce the secular laws –will the baser instincts of human nature take over and threaten our extinction? Are we really not exceptional?

    I have had friends who are “humanists” and who believe that human beings are exceptional because of their intelligence but do not believe in an afterlife or in any God or a son, Jesus Christ, who died for our sins. Yet, for thousands of years Christianity, Judaism, Buddhism, Muslimism , etc.. have survived.
    As for the polls that you cite, I know that you know that many of the responders who identify themselves as believers in God and an afterlife WANT to believe in God and an afterlife in order to make sense of a world in which there is no defense to random senseless violence and death that takes away those that we love. One of the best books I ever read that comforted me was, I believe, written by a Jewish Rabbi, and was entitled “Why Good Things Happen to Good People.”

    I once worked for a “fallen” Methodist minister who was in sales of church insurance to ministers (a terrific top salesman) who responded to me when I asked him “What do you believe in?” –He responded: ” I believe in the immortality of my seed.” He had left his large and prosperous Church and his children and his wife for a new love who remained in her Church, in another city, because, I believe, he knew that it was likely he would die prematurely as had so many of his family with an incurable disease, and he had a crisis of faith and a new love at the same time! I liked him very much but his response troubled me because all of my life I have had to pray for faith. I abandoned the intellectual approach to religion many decades ago and approach my faith like a child praying to my heavenly Father. I would imagine there are many like me. I thank God for the good things and I plead with him to take the bad things away or to give me the strength to accept the bad things in life over which I have no control. I do believe that “he who helps himself helps God.” and I do believe that, as someone said? “Praying may not change God (or God’s mind) but it changes me.” I have never been able to “join” a church as I could never sign the paperwork in good faith.

    As for this desire and fight to live and the desire and fight to die and the beautiful poetry and public policy surrounding the inevitable and final act of dying as proposed by The Hastings Center, do you consider it immoral and or illegal for hospitals to shorten the lives of elderly patients without their knowledge and informed consent for fiscal reasons when medical futility is not a factor?

    Your prior response to me was unsatisfactory. I know you are a good human being but it is enough to respond that “standards” have been set that may be ignored but that’s none of your business.

    Thank you, Jim!

    Carol

    Reply
    • Carol Eblen

      Mistake” “Why BAD Things Happen to Good People” Sorry! —but glad that it is at least true, also, that Good Things DO Happen to Good People!

      Reply
    • Jim Sabin

      Dear Carol
      A while back one of your comments suggested that your focus on “shorten[ing] the lives of elderly patients without their knowledge and informed consent for fiscal reasons when medical futility is not a factor” comes from a personal experience with your husband’s care. I’m sorry about that experience. There’s no disagreement within the clinical and ethics communities that unilaterally shortening a patient’s life without consent is not an acceptable practice. The more common fear among over 65ers is the opposite – that life prolonging technologies will be imposed when they’re not desired by the patient or family. No nurses or doctors I know have reported seeing examples of unilaterally imposed shortening of life. Unfortunately there’s been a lot of public preoccupation with the lies about “death panels” perpetrated by Sarah Palin and others who were trying to block the health reform effort that led to the Affordable Care Act. Sadly, the duplicitous “death panel” claims undermined an effort to compensate physicians for having discussions with their patients about the values should guide the patient’s future care.
      Best
      Jim

      Reply
  2. Carol Eblen

    Thank you, Jim, for your kind response.

    It’s all about one’s perspective! You, as a prominent and respected retired clinician, apparently believe that there is no conflict of interest for the nation’s hospitals (who receive public funds) because of reimbursement protocols developed by CMS, the Congress (both political parties) in the budgets passed since 2005? You don’t believe, as I do, that the 27 Adverse Hospital Events that are legally not now reimbursed to hospitals by CMS, many of which the elderly/disabled patients on Medicare/Medicaid are especially prone to experience, has unintentionally produced insidious disparate discrimination against the elderly/disabled on Medicare and Medicaid.

    Therefore, you honestly believe that my painful experience with the unilateral DNR in three different hospitals in two states was an isolated event! I assure you that I would not have pursued this matter of the unilateral covert/overt DNR for fiscal expediency if I were not sure that it is a systemic problem that brings shame to our country and to both political parties as involuntary euthanasia of the elderly becomes a reality in our public hospitals.

    I disagree with your assessment and view that standards have been established and that there is really no problem. I would suggest that the hospitalists and other medical personnel, nurses, etc., who are employed by hospitals who do engage in extrapolating unilateral, influenced, covert or overt DNR code status into the hospital charts of elderly/disabled Medicare/Medicaid patients for fiscal expediency would NEVER report the unilateral DNR for fiscal expediency to anyone; not you, not the hospital administration, not the state or federal authorities, not the general public and not the patients or their families. If and when the unilateral covert DNR is ever discovered (unlikely) by the patient, it is, of course, reported to the in-hospital ethics Committee, as necessary, to be resolved — if and when the apology of the hospital physician for the unilateral DNR isn’t accepted by the patient and family, The hospital ethics committee also has a conflict of interest.

    Obviously, the unilateral DNR for fiscal expediency is immoral and a crime or a tort under law if “medical futility” as established by some due process procedure is NOT a factor in the hospitalists’ judgments and actions to “compassionately” hasten the death of elderly Medicare/Medicaid patients by way of extrapolating unilateral covert or overt (influenced) default DNR code status into the hospital charts.

    I’m sure that the Hospitals KNOW that the premise of “medical futility” — even when applied to the elderly/disabled on Medicare/Medicaid — has to be defined very narrowly under existing federal and state law. I’m sure that compassionate “medical futility” is a factor/motive on which the hospitalists and nurses prefer to hang their white hats. However, when so often life saving and life-extending treatments of elderly Medicare/Medicaid patients will NOT be reimbursed by CMS and the private insurers to the hospitals, the financial conflict of interest in the real world for the hospitals and the employees of the hospitals cannot be avoided.

    This! in my mind is not purely a political problem because both political parties over the years have contributed to the current policies on Medicare/Medicaid reimbursement to hospitals, The problem is that they will NOT tell on each other. They won’t join together to clarify the provisions of the 1991 PSDA.

    I am for Obama Care and the ACA. The problem of over treatment of Medicare/Medicaid patients for the profit motive is being addressed by the ACA and the Obama administration. The recent criminal lawsuits filed by The Department of Justice and the HGS will certainly put an end to non beneficial over treatment of all patients and of Medicare/Medicaid patients for the profit motive. The concept of non beneficial medical treatment and lack of patient informed consent as possible under the premise of “therapeutic privilege” will be a thing of the past.

    As for paying physicians to have end-of-life conversations. I am opposed to this on the basis that ONLY the actual “treating” physician who delivers the “educated terminal prognosis” should already, under law, have the legal obligation to inform the terminal patient about the other standard of care, i.e. Hospice/palliative care that is reimbursed by Medicare.

    I’m sure that if the President were aware of the epidemic of unilateral DNRs, he would do something about it. Obviously, the initiative in the ACA that was removed by the Republicans, i.e., the payment to physicians for having end-of-life conversations, was an effort by the Democrats to support and achieve the goals of the 1991 PSDA ( law passed by a Republican dominated Congress.) Two of the most important goals of the PSDA, according to Professor Thaddeus Pope, a foremost expert on medical futility and the law, are to (1) prevent cruel over treatment of the elderly/disabled on Medicare/Medicaid for the profit motive and (2) to save money for Medicare and private insurers when elderly/disabled patients with terminal diseases voluntarily agree to die on the less expensive Hospice Entitlement as a means of shortening their suffering unto a certain death.

    This epidemic of unilateral covert/overt DNR Code policy would have not been possible if the bioethicists hadn’t influenced public policy and our Courts to treat unilateral DNRs as merely an ethics violation. Isn’t this true?

    Don’t you feel any responsibility for this current state of affairs?

    Talk to me! Thank you!

    Carol

    .

    Reply
  3. Robert Ritzema

    As a fairly conventional Christian, I do believe in an afterlife and would like to become kinder, more honest, and the like, but don’t see my success at the latter as some sort of ticket that I can then redeem in the former. Faith does play a role in becoming more virtuous, but it is about becoming more like the God I love than about avoiding his wrath. And my relationship with Him helps me change. It’s not that I choose to become good so that I can eventually be with God; I choose to be with him now and that helps me become good.
    I’m struck by the similarity between the characteristics that Schweitzer lists and the Apostle Paul’s list of the characteristics that God’s Spirit develops in those who follow Christ–”love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control.” I would suggest that, by striving to achieve the qualities Schweitzer lists. you are also striving to acquire virtues advocated by the Christian scriptures.

    Reply
    • Jim Sabin

      Dear Robert
      Thank you for your very thoughtful and illuminating comment. I’m especially interested in your point about becoming more like God. Albert Schweiter said that role models are THE crucial influence in developing virtue. I hadn’t thought about the point that you make so clearly – that God can be thought of as an exemplar of the way we should want to be.
      Your description of the process of choosing to be with God now is probably the active ingredient of the process by which faith-based programs often help people in the grip of addictions or other destructive patterns turn their lives around.
      Best
      Jim

      Reply

Comment