Irony, Resilience, and Late-Life Depression

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I recently read two fascinating articles by Bill Randall, professor of gerontology at St. Thomas University in New Brunswick, Canada: “Aging, Irony, and Wisdom: On the Narrative Psychology of Later Life” and “The Importance of Being Ironic: Narrative Openness and Personal  Resilience in Later Life.” Two quotes convey the core perspectives I took from Randall’s essays:

“If innocence characterizes childhood . . . and earnestness is the mark of adulthood, with all its striving to make our way in the world, then irony, as an over-arching orientation, goes more naturally with later life, the stage in which, more than any other, we are confronted by the limits of our being and the fog of mystery that surrounds it.” (emphasis added)

“While it is true that many aging jokes are blatantly age­ist, many are enjoyed–if not generated–by older adults themselves. Such humor sup­plies them with a welcome chuckle and puts things in perspective. It helps them rise above their situation by mediating the message that age is not the unmitigated tragedy which, physically, it can seem. As such, it reaffirms their dignity by affording them an affectionate detachment from their infirmity and mortality.” (emphasis added)

Why should “irony, as an over-arching orientation” fit so well with later life? I believe it’s because for those of us who find irony and humor congenial, they allow us to a) acknowledge the negative thoughts and moods the vicissitudes of aging may trigger while at the same time b) frame them as understandable “reactions,” not as necessary “truths.”

This combination of acknowledgment and reframing is the mechanism of cognitive behavioral therapy (CBT), which countless studies have validated as an effective treatment for depression (and other conditions). I found CBT enormously useful in my clinical practice. My patients and I would consider their depressive thoughts (“I’m no good,” “my future is hopeless,” etc.) as hypotheses that might be true but might be symptomatic distortions that could be corrected. When the latter was the case–and it usually was–learning to identify and correct the cognitive distortions often alleviated the depressive symptoms.

Applying irony/humor or CBT isn’t without risk. Patients (and friends) can feel we’re not taking them seriously. In my childhood, as a way or warding off self pity and despondency in circumstances that could have elicited these reactions, I developed an overly rigid determination not to whine. My two sons teased me about this and applied the term “poptimism” to my determination to see the brighter side of things. And a patient of mine, who did a written review of our work together when I ended my practice, wrote:

“For the most part it has been great to have your positive thoughts, but at times I have called you “PollyAndy” because you always see the good side. At times I just wanted you to see my negative side and to acknowledge my pain.”

In response, I owned up to my vulnerability to “poptimism,” and apologized for any pain I’d inadvertently caused.

As I discussed in an earlier post, research shows that resilience is a major ally in helping us roll with the punches we encounter in every phase of life. It’s still somewhat of a mystery as to how much the capacity for resilience comes from our genes, how much from experience, and how much from willpower. It’s probably all three. My guess is that the ability to use irony and humor is both a result of resilience and a contributor to resilience. But whether irony and humor are cause or effect, “laughter therapy” has become a recognized modality in medical practice!

Many years ago a patient I’ll call Mrs. Smith taught me about the limits of reframing and humor. Mrs. Smith was plagued by painful memories and profound resentment over events from 50-to-60 years in her past. She had a wry sense of humor, and fully understood that dwelling on resentments poisoned her life. But she was simply unable to stop doing it. As best we were able to understand the situation, her nervous system infused the memories with vividness and pain, akin to a painfully bright visual afterimage that won’t fade. Sadly, none of the medications or psychotherapeutic techniques available at the time produced any significant benefit for her.

We humans are faddists. We’re always on the lookout for a “Big Rock Candy Mountain” that will guarantee tranquility and happiness. As valuable as irony and humor may be, it’s important to be ironic about them. They aren’t panaceas. The half full glass is also half empty. A professional colleague made this point to me by observing that while he and I agreed on the fundamental facts of a situation, unlike me he interpreted the facts from a pessimistic stance. He asked me if I knew the difference between an optimist and a pessimist. I took the bait:

An optimist falls off the top of the John Hancock Tower (the tallest building in Boston). At the 20th floor he looks into the window, waves, and says “so far, so good!”

The “poptimist” in me responded that one way or another we’ll all ultimately do the equivalent of toppling from a Hancock Tower. Why not admire the optimist’s capacity to take some pleasure in the ride!

James Sabin, M.D., 74, is an organizer of Over 65 and a clinical professor of psychiatry at Harvard Medical School.

3 Responses to “Irony, Resilience, and Late-Life Depression”

  1. Peggy Sax

    Jim, I thoroughly enjoyed reading your reflections on irony, resilience and “poptimism.” Thank you. I wholeheartedly agree: the combination of humor, hope and humility can make all the difference. I am grateful to have found you and your column, as a companion to help usher me in the years ahead. Hey…You posted on my 61st birthday; reading your “Over 65 Blog” makes me feel very young and precocious! Can you help lead the way in getting MORE irreverent and ironic in the coming years?
    Peggy

    • Jim Sabin

      Hi Peggy –
      I’m sorry for the delay in responding – I was out of the country until yesterday. Earlier in the summer you pointed me towards the area of “narrative gerontology,” which in turn led me to Bill Randall’s articles. It’s a lovely coincidence that this post went up on your 61st birthday. I hope you might contribute thoughts and observations about moving towards the over 65 phase of life to our blog in the future.
      Best
      Jim
      Jim