Optimal Challenge and Maximum Inclusion
If I were running in the stadium, ought I to slacken my pace when approaching the goal? Ought I not rather to put on speed?
AS AN INTROSPECTIVE CHILD GROWING UP IN A blue-collar Catholic neighborhood, my curiosity and self-reflective nature were cause for suspicion. More than one concerned relative warned my mother to keep a careful eye on me. By my early teens, these musings evolved into a typical adolescent search for truth and my own identity, which led me to explore the world of lower Manhattan. Surrounded by the hippie culture of the late 1960s, I wandered through Greenwich Village, absorbing the sights and sounds of what I was told was a cultural revolution.
On one of these trips I discovered something unheard of in my neighborhood—vast used bookstores. Walking down the aisles of these dusty cathedrals, I marveled at the miles of sagging and overburdened shelves and imagined that truth must be hidden somewhere in one of these books. In contrast to the chaotic and youthful world of the streets, the folks inside these walls were seemingly at peace. They were perched on benches and leaned against walls, absorbed in thought, moving only to scratch an itch or turn a page. For some reason, I felt as if I had returned home for the first time.
My favorite bookshops came to be routine stops, and eventually the primary reason for my journeys to the city. I didn’t have much money, so finding an interesting book usually meant staking out a corner and settling in for the afternoon. Over time, I became acquainted with some of the regulars, mostly immigrants from Eastern Europe. I became increasingly curious about them and looked for opportunities to strike up conversations. As luck would have it, my curiosity was met with their desire to tell stories.
Despite their different nationalities, ethnicities, and occupations, they all shared a relentless love of learning. Over the years, they had taken classes at the YMCA or the New School for Social Research from the likes of John Dewey, Wilhelm Reich, Elie Wiesel, and Robert Frost. Most spent what little disposable income they had on tickets to the theater or opera. At their feet, I learned the political and intellectual history of the first half of the 20th century. They taught me about the idealism of the early Communist Party, described what it felt like to hear Enrico Caruso sing, and recounted conversations with Pablo Picasso while standing in line at the butcher shop. I listened as one story melted into another, all the while making mental notes of the books, plays, and pieces of music I would search out at the library. Somehow, these people had escaped the gossip of daily life that permeated my home. They possessed a set of values and source of meaning that I desperately longed for.
Two of the most memorable characters were a couple, Josef and Sarah. I clearly remember the afternoon I asked Josef about a number tattooed on his inner forearm. Sarah pulled up her sleeve to show me a similar marking. That was the day that I first learned about the Holocaust from two people who had somehow survived Hitler’s insanity. Although it had been many years since they were held in the camps, the pain and horror reflected in their eyes was still palpable and quickly found its way into my body and soul.
Later, I was befriended—adopted—by a retired theology professor who talked to me for hours on end about the history of religion and the many expressions of spirituality. He would attack the bookstore aisles with me at heel, tearing book after book from the shelves. Tossing them to me as I struggled to keep pace, he would say, “You have to read this, and this, and this,” as I followed him to the counter. He would pay for the books, hand me the bag, and say, “Come back next week and tell me what you think.” A priceless mentorship that I will never forget.
In stark contrast to my experiences with my family and neighbors, these wise elders validated and encouraged my love of learning. Through their kind attention, I learned that curiosity was not to be feared but cherished and nurtured. More importantly, I learned that there were other people in the world like myself. Although some of them had endured unfathomable suffering, they still held on to their passion for life, learning, and connection with others. Through their openness and generosity, I discovered the strength of the human spirit and began to discover my own inner strength.
The process of nurturance through sharing knowledge cascades across the generations, resonating in our spirits and souls until we die. Through my interactions with these wise elders, I somehow gained the confidence to stand up to external pressures and pursue my own passions. They passed on their courage and character, which inspired me to become a teacher and writer and to encourage others to follow their dreams.
SHARING OUR LIVES
When we die, there are two things we can leave behind us: genes and memes.
Richard Dawkins
Wise elders are storytellers. They use the evocative potency of their tales to create a state of mind in listeners that maximizes receptivity and remembrance. The sacred space created by the storyteller nurtures the development of the youngster and completes the elder—over, and over, and over again. I believe that the combination of emotional and cognitive intelligence embodied within the storyteller is a way in which information and wisdom have been transmitted throughout time and across untold generations. As we age, the maturation of our brains maximizes our storytelling abilities, and we are driven to implant our stories into young minds, just as, earlier in life, we were driven to pass on our genes.
Stories serve us in many ways. They give form to the inchoate series of momentary experiences we confront each day. Our stories bring the past and future into the present moment and can serve as blueprints for working toward our goals. They also support a coherent sense of identity, as we become the protagonists of the stories we continually write and rewrite about ourselves. And, as we have seen, by combining a storyline with feelings, narratives support and enhance the all too fragile integration of our left and right cerebral hemispheres. Without narratives, I suspect that we would often be overwhelmed and confused by moment-to-moment experience.
The moral of a story, the lesson intended to be taken from the tale, supports our morale—the experience of confidence, hope, and enthusiasm with which we take on a challenge. Morale is most often used in describing combat troops who must keep their spirits up in the face of death, but it also applies to children who feel lost in a world that they don’t understand. Many of life’s challenges can be demoralizing, and stories can “remoralize” us by connecting us with others, sharing emotions, and inspiring us to be more like the heroes of our stories who have overcome life’s challenges.1 Positive stories provide direction, purpose, and the tenacity to persevere in the face of trouble.
Through the millennia of human history, narratives, songs, and rituals have been transmitted by elders to the young of the tribe. In the face of rapid cultural and technological changes, these stories and the moral teachings contained within them are getting lost, as is the morale they once supported. Yet the young continue to forage for meaningful narratives and now discover them in movies. Some contain the moral lessons of traditional narratives (e.g., Star Wars, The Lord of the Rings, Harry Potter), while many others reflect and reinforce fear and anxiety (e.g., Friday the Thirteenth, The Living Dead) that stories have traditionally been used to counterbalance. These violent and bloody narratives along with the evening news do not build morale but instead offer more evidence of a hostile and frightening world.
Thinking back once again to our list of wise people, we see that these individuals were not simply storytellers. They actually edited the narrative of human existence in ways that redefined how people relate to one another. Why is Oprah Winfrey in the company of Christ and Socrates on our list of wise people? I suspect it is precisely because of her ongoing mission to confront aspects of human suffering (e.g., child abuse, prejudice, eating disorders) that have been considered taboo. Her personal struggles in these areas make her all the more credible and worthy of respect. Uncommon among today’s celebrities, Ms. Winfrey has gained her fame through a combination of business acumen and humility.
Throughout history, narratives told by elders were a primary means of transmitting knowledge and perpetuating culture. Over the last few millennia, our brains have changed little while society has changed a great deal. Elders still want to tell their stories, but few young people are listening. If elders surrender their position as storytellers, our children’s children will be at the mercy of the highest bidder; Hollywood, fundamentalist megachurches, or radical cults, for their understanding of the world. If older adults abdicate their responsibilities as storytellers, we will remain in a state where young adults won’t bother voting for president and when asked if they have a personal hero, they will answer “no one.” 2
WRITING OUR STORIES
Nothing that is worth doing can be achieved in a lifetime; therefore we must be saved by hope.
Reinhold Neibuhr
Creating a meaningful life story is a challenge at any age. Older adults, with more past than future, face a particular set of challenges. They ask themselves, “Have I used my time well? Have I accomplished what I had hoped to? Is there still something left that I want to do in order to complete my life?” Older adults depend as much as ever on the inclusiveness and coherence of their story for their sense of identity and emotional well-being.
Life can be seen as a series of stories we tell about ourselves, and as we age, these stories take on certain themes. One theme is the integration of loss—the loss of family, friends, physical abilities, and the places and times that only survive in our memories. These narratives are vital aspects of our ability to understand ourselves, grieve loss, and move on. Another theme is our emancipation from the unattainable and the unimportant. The powers of the body and the value of worldly accomplishments gradually move from center stage as the story of the self is rewritten around the heart and spirit. Just as in any good story, there needs to be an appreciation of the process—the victories and defeats, the loves and losses, and ultimately a sense of completion.
REVIEWING OUR LIVES
Life isn’t about finding yourself. Life is about creating yourself.
George Bernard Shaw
Instead of an indication of diminished capacity, the rumination of older adults may reflect the struggle to make sense of their lives.3 In response to this challenge, forms of therapy such as life review therapy have emerged to assist older adults in telling their stories.4 Originally proposed by Robert Butler, life review therapy was designed to support and enhance the naturally occurring process of reminiscence. Therapists participate in their clients’ storytelling and self-analysis by providing structure and guidance.5 An example of this might be highlighting how a client has faced and overcome past challenges or asking about experiences that are not spontaneously brought forth. The underlying purpose of this guidance is to organize past narratives in a manner that supports current functioning and boosts the client’s sense of confidence and efficacy.6
Life review can be carried out in individual or group settings and usually takes about a dozen sessions.7 Themes such as life transitions and changing roles within the family are often addressed, as are experiences related to work, health, turning points, life values, and existential issues.8 Participants are invited to bring scrapbooks, photographs, memorabilia, genealogies, and other objects to stimulate their memories.9 As memories are evoked, telling stories and the input of the therapist become the matrix for constructing memory and meaning. Typical life review questions include the following:
• What happened to you during this time of your life?
• Can you give me a detailed picture of your experience?
• How did you feel at these moments?
• Did this event bring forward new aspects of your self?
• What did you learn about yourself during that time?
• How did you learn to cope with a specific loss?
• Did you receive any consolation from others?
• Did the events result in any personal insights?
Through the examination and evaluation of the content of their memories, clients are able to restructure their thinking about their experiences and reshape their ideas about their own identity. This process can aid in integrating memories of their past into here-and-now awareness, making them applicable to current concerns and conflicts. Reviewing past experiences when difficulties were faced and successfully overcome can provide both confidence and strategies for facing challenges in the present. The exploration, deconstruction, and reintegration of memory can result in building more cohesive and meaningful narratives. Some sample prompts for life review include:
• You’ve told me about what happened, but can you tell me how you felt about it?
• How do you feel about it now?
• Have you discovered any new meanings in these past
experiences?
• How have these experiences contributed to the person
you are today?
• What were your goals in life as a child, as a young adult, now?
• What do you hope to achieve in the future?
• What do you think your legacy will be?
Life review therapy is a nonthreatening, patient-driven intervention, appropriate for use with all older people, especially those who are resistant to psychotherapy.10 As Hausman stated, “As events are thought out anew and are seen as part of an overall picture, they begin to assume a new and more comforting order.” 11 This sence of order can help older adults maintain their identity, stability, and integrity during the later stages of life. Life review therapy has been shown to result in improved cognitive functioning, mood, and self-esteem.12
REMEMBERING HOW TO REMEMBER
It is never too late to be what we might have been.
George Eliot
The fact that human memory evolved in the context of storytelling is reflected in our memory abilities. Although we can hold only five to ten bits of new information in mind at any one time, we are able to remember and access a seemingly limitless number of stories and songs. And while older adults may have very detailed memories for experiences from decades ago, the difficulty we have in new learning points to the fact that our multiple systems of memory have different strengths, vulnerabilities, and patterns of aging.
As we’ve discussed, declines in explicit memory for new information are natural, but we do much better if we put disparate facts into a story. Most of us have seen this strategy in action in the extreme when memory experts remember hundreds of objects or people’s names by creating a story in which the specific bits of information are placed. In essence, mnemonic techniques take information usually stored in low-capacity memory systems for discrete facts and store it in the much more powerful narrative memory networks. This strategy allows memory experts nearly infinite recall.
This is not a parlor trick; mnemonic techniques such as these have been shown to improve memory performance in people of all ages—including older adults.13 In one memory training study, older adults used an imaginary trip to the tourist sites around Sydney harbor to enhance their memory for specific activities and events. The memory enhancement techniques that have proven successful with older adults may also enhance hippocampal functioning and support flagging prefrontal attentional mechanisms.14
Although many types of memory enhancement techniques have proven effective, research has been focusing on what is called multifactorial memory training. This approach combines education about aging and memory loss, relaxation training, and memory skills training.15 These broad-based programs teach memory skills in the context of support and education, taking into account that pessimistic beliefs about aging and memory can increase anxiety, decrease motivation, and have a negative impact on all aspects of cognition.
A newer trend in memory training focuses on the benefit of group-based interventions. Several studies have shown these groups to improve attitudes and beliefs about personal memory while giving participants an increased sense of self-efficacy.16 In a fascinating study, adults ages 65 to 82 were trained in acting techniques, followed by rehearsals and the performance of a theatrical scene.17 Although the training was in no way targeted to memory, participants had significantly higher memory scores after these acting exercises. The cognitive challenge of learning lines coupled with the physical activity were thought to be supportive of new learning.18
Although the researchers primarily attributed the participants’ improved memory to the mental effort involved in learning and performing the role, I wonder if the participants’ social and emotional involvement in this enterprise may not have been just as important. The authors gave some credence to the role of social factors near the conclusion of their work:
Undoubtedly, the facilitative effects of socializing were also involved; the experimenters frequently observed the participants playfully interacting with one another during breaks, openly revealing their feelings in the same way that their assigned characters did during the play. Thus, theatrical training involves not only cognitive factors, but emotive, social, and physiological ones as well.19
The fact that social interaction can create an atmosphere that enhances self-esteem and memory performance harkens back to the evolutionary foundation of memory as an interactive process of storytelling. Mutual support, encouragement, positive personal engagements, and getting up and moving around, in and of themselves, activate biochemical processes that enhance protein synthesis, brain growth, and new learning.
HELPER’S HIGH
If you forget who you are, serve someone else until it comes to you.
Anonymous
For almost everyone, helping others feels good. Of 1,500 female volunteers, 88% reported a pleasurable physical sensation in reaction to helping others. They alternately described the feeling as a high, a warm feeling, a sense of increased energy, or some combination of all three.20 These sensations are akin to those we experience during exercise or when we fall in love and only occur when we are face-to-face with those to whom we are giving. Mailing checks to your favorite charities is a good thing to do, but it likely doesn’t activate the same biochemical processes.
Older adults who volunteered to give massages to infants demonstrated lower postmassage levels of stress hormones and an enhancement of immunological biochemistry.21 Even witnessing the altruistic behavior of others can boost our immune systems, as demonstrated by an increase in protective antibodies in subjects after watching a film about Mother Theresa caring for the poor in Calcutta.22
As in so many other instances, it appears that nature reinforces human connectedness by utilizing the same oxytocin, endorphin, and dopamine systems it employs for bonding and attachment. And because higher levels of these chemicals correlate with well-being and enhanced immunological functioning, altruism can be good for your health. This has been shown in a number of studies where altruism and volunteering correlate with indicators of physical and emotional health. Altruistic and caring acts correlate with lower levels of stress, anxiety, depression, and hopelessness and a greater sense of well-being. They also support increased immunological functioning, greater health, and less pain from a variety of illnesses.
This is all good news for older adults! According to the 2000 U.S. Census, 42% of 65- to 74-year-olds and 26.6% of those over 75 volunteer their time to a wide array of community services and activities. The number of hours that older adults volunteer each year is almost double (96 vs. 52) the national average for all ages.23 This indicates that older adults are naturally drawn to generative and altruistic behavior and are well aware of the benefits they receive by giving. Typical older volunteer are individuals who value the welfare of others, spend their own money in order to be of service, and display psychological well-being.24 Furthermore, they have higher self-esteem and a healthy sense of social integration.
Volunteering has long been associated with positive psychological effects, a higher degree of life satisfaction, and decreased levels of depression and anxiety.25 Studies have also suggested that providing social support and volunteering reduces the risk of mortality.26 So why does altruism have a positive effect on longevity? The social reasons include a sense of structure, purpose, and expanded social networks. Other reasons related to self-efficacy include feeling useful, increased self-esteem, and enhanced self-identity. Providing support to others was shown to reduce the risk of mortality in a sample of 1,532 older married adults.
So if you want to live a longer and healthier life, put in some time volunteering in your community as soon as you can. Start by contacting organizations such as Senior Corps, Retired and Senior Volunteer Corp (RSVP), or Service Corps of Retired Executives (SCORE). If you decide to “unretire” or want to learn new skills, contact SeniorNet, ReServe, or Experience Works to explore ideas for career opportunities. If this sounds too involved or more than you are interested in, go to your local library and volunteer to read to children. You may even want to slip in some stories of your own while you’re at it.
EXPECTATION IS DESTINY
My father planted for me, and I planted for my children.
Hebrew Proverb
Although all animals have an instinct to live, humans also need a reason. The themes of optimal challenge and maximum inclusion need to be embedded within a set of ideas that lead us to maintain healthy brains. In fact, Okinawan centenarians attribute their unusually long life spans to having ikigai—a purpose for living. When older adults are respected, depended upon, and needed, most respond in a positive and life-affirming way that benefits all generations. The isolation and exclusion of older adults is a great tragedy for them, our children, and ourselves.
We lose many people on the way to old age. Grandparents, parents, beloved mentors and teachers, friends and lovers, sometimes even our children leave us behind. The experience of loss is as natural as our continued need for attachments. Maintaining an openness to making new attachments and finding new sources of meaning is important for a vital life. Instead of becoming the sum of all we have lost, we have to continue to learn, love, and keep our eyes on the horizon.
It’s clear that our brains are organs of adaptation, embedded in a body, and fundamentally social in nature. In order to maximize the brain’s functioning, we require proper physical, intellectual, and interpersonal stimulation. This means that everyone at every age should be encouraged to be active, engaged, and challenged to the limits of their capabilities. Our brains need to receive the message that adaptation is still necessary and that neural growth is still required.
The predictors of sustained cognitive health, such as education, intellectual stimulation, and a sense of self-efficacy, all point to the importance of continuing to take on challenges, reduce stress where possible, and enjoy living and loving. After decades of exploring mental health throughout the life span, George Vaillant suggested that those who stay most vital and alive are those who are capable of learning from the next generation.28 He added that these are the same people who are best able to care for their children, grandchildren, and other younger people. This is a wonderfully human description of both the miracle of ongoing neural plasticity and the process of becoming a wise elder.
From the perspective of social neuroscience, full retirement may be inappropriate for many of us, just as full-time employment may not be in the best interest of parents with young children. A MacArthur Foundation study of aging suggested that older and younger adults learn to share jobs so that each could work half days and cover for the other when fatigue or emergencies arise. Older workers could mentor younger ones, while younger workers could help their elders keep abreast of newer technical developments. More flexible employment programs could also allow a series of steps on the way toward full retirement that would continue to keep older adults challenged to the limits of their changing capabilities.
Another potential solution to elder isolation communities called NORCs (naturally occurring retirement communities). These are organizations of elders who want to remain in their homes but require one or more support services in order to do so. NORC members receive discounts on everything from in-home care to medication management as well as access to free exercise classes and walking groups. The contact and support that emerge from these organizations create a social network that works against isolation and the types of problems that lead elders to lose their independence and become institutionalized.
Another wonderful idea is to combine retirement developments and nursing homes with nurseries, day care centers, and preschools to allow older adults to participate in child care. This has practical as well as emotional benefits for everyone involved and is already occurring in some retirement communities associated with universities, such as the Kendal community at Oberlin College. One foster care facility in California created a living situation where children and senior citizens share land and resources. Although no formal agreement was established about the children and older adults interacting, they gradually became interwoven into each other’s lives. One former gang member adopted a frail senior, checked in on her regularly, and helped her with difficult chores. Another couple became so attached to a young basketball player that they attended each of his games throughout the season. The success of this program has been reflected in the improved well-being of both the children and adult participants.
A LIFELONG MEDITATION
Your sacred place is where you can find yourself again and again.
Joseph Campbell
Our ideas, beliefs, and myths about aging determine how we view others and ourselves. If we go through our lives with positive ideas about aging, we will have better memories, have better health, and live longer than those who have accepted negative stereotypes about aging.29 Thus, our first order of business in creating and maintaining a healthy brain is to change our beliefs about what it means to age: creating narratives and images of a positive and participatory adulthood. The second is to work diligently to propagate these positive ideas throughout our culture and across the generations. My hope is that the ideas and feelings expressed within this book are a small step in the right direction, one of many steps still ahead of us.
Many years ago I spent an evening talking with a Zen priest at his monastery north of Mt. Fuji. As part of his religious training, he had spent 10 years slowly walking across Japan. This decade-long walk consisted of taking a step, ringing a bell, and saying a prayer. Through 40 seasons, a number of illnesses, and what sounded to me like occasional hallucinations, he continued to take a step, ring his bell, and say a prayer. As I tried to fathom the enormity of this amazing accomplishment, the obvious question struck me—Why?
What was the purpose of such an incredible act of will and self-denial? What could be so important? I struggled to think of a respectful way to ask such a brazen question. I finally asked, “Sensei, what was the goal of your act of discipline? What did you hope to accomplish?” Matter-of-factly, Sensei told me that it was a way to learn to pay attention to what was around him and to become less burdened by the prejudices of his mind. Amazed by the simplicity of his response, I clumsily asked, “But why so long?”
Without missing a beat, he replied, “Because that’s how long it takes.”