While I was writing this section of the book, my family received a visit from my wife’s uncle, Prem, who flew in from New Delhi. Prem Uncle, as he would be called in India, is very dear to us. Now 75 and retired from his corporate job, he bounds up and down the stairs much more agilely than I do. Prem Uncle was a star tennis player in his youth, and he still plays every day. Simple in his pleasures and satisfied with his lot, he looks on life with enviable serenity and happiness.
I set aside my reference books and asked him how he kept so young, and this is what Prem Uncle replied: “Well, you know, I never push to extremes. I was just born that way. I never got in the habit of overeating. This morning I had a banana and cereal, and that is about as much as I ever want. I eat lightly at night and never drink more than a little brandy once in a while.
“Second, I sleep very well. That’s due to my diet, because if I eat a big dinner, my sleep is disturbed. Third, I don’t bother about trivialities. I leave that to my wife”—he laughs—“you know, whose birthday it is and when we are due someplace. Fourth, I play tennis and love it.”
Prem Uncle is living proof of his method, but, more important, he doesn’t really have a method. The way he has aged is just the result of who he is. Someone else with utterly different habits but the same easy acceptance of himself would age just as well. In our society we pick up hundreds of external cues about how to live, yet experience teaches us over and over that internal cues are the ones we must heed. Prem Uncle did not derive his lifestyle from an outside authority. He evolved a moderate, sane, healthful way of life on his own. Most people who age successfully do the same: They follow their instincts, finding out what works for them.
The fact that successful survival is so individual is not an incidental factor—it is among the most important. For in a society where we are automatically trained to look to outside authority for expert advice, where inner cues from our bodies are drowned out by a flood of external directives, the isolated individual who beats the system is a rarity. Social scientists have set out to take the measure of such people, and the results disclose some striking similarities. In 1973, at a major gerontology conference at Duke University, three papers were delivered describing the type of person who can expect to live to a healthy old age—between 85 and 100 years old (such people amount to less than 5 percent of the current population). In her psychology research at the University of Chicago, Bernice Neugarten concentrated on “life satisfaction,” which entails five factors. The person:
1. Takes pleasure from daily activities
2. Regards his life as meaningful
3. Feels he has achieved his major goals
4. Holds a positive self-image and regards himself as worthwhile
5. Is optimistic
From his research at Harvard, psychiatrist George Vaillant took a second but similar perspective (as we have seen), that of mental health. The longest-lived individuals, he believed, are also the best adapted in their psychological life, a state characterized by:
1. Having a stable family life
2. Regarding their marriages as satisfying
3. Rarely living alone
4. Continuing to grow in their careers
5. Having no disabling mental illness
6. Not being alcoholic
7. Having fewer chronic illnesses
The third perspective came from Eric Pfeiffer, a psychiatrist at Duke who for many years was project director for a long-term study on older Americans. In keeping with the first two papers, Pfeiffer pointed out that using one’s physical and mental abilities to the fullest was the best way to age well. People who age successfully, he found, were those who “stayed in training” throughout their adult lives in three major areas: physical activity, psychological and intellectual activity, and social relationships. If we translate all these findings into larger terms, a profile emerges of people who age well psychologically and therefore biologically.
Growing old happens in the mind; it is therefore uniquely variable in humans. After twenty years, any dog is an old dog; after three, any mouse is an old mouse; after one hundred, any blue whale is a very old blue whale. In all these creatures, biological age is the only number that counts, yet everyone knows people who are young at 80 and others who seem old at 25. The great Renaissance man Sir Francis Bacon held a caustic opinion of old people “who object too much, consult too long, adventure too little, and repent too soon.” This is the kind of old age everyone wants to avoid. Fortunately, nothing in our physical makeup forces it upon us. If you don’t want to grow old, you can choose not to.
Belinda, an 80-year-old patient of mine, is the product of long New Hampshire winters and rocky farms. She grew up with parents who had no time to grow old and who lived actively into their eighties. They raised their daughter to cherish inner qualities such as self-reliance, trust, faith, honesty, and dedication to family. Belinda has escaped many typical miseries of old age. She isn’t on drugs for hypertension, as more than half of old people are (or should be—blood pressure medication, even since “water pills” have been improved, is greatly disliked and often not taken); she hasn’t had a single mild stroke or heart attack; there is no sign of diabetes.
As Belinda’s doctor, I don’t believe any of this is an accident. Today is the youth of your old age, and what you do today affects an outcome thirty or forty years from now. Belinda’s good health is the direct result of her lifestyle in the days before she saw the first wrinkle. This is medically confirmed by evidence that old-age diseases like hypertension, heart disease, and atherosclerosis arise from microscopic alterations in our tissues beginning as early as age 10, if not younger.
“Why do you think you’ve aged so well?” I once asked Belinda.
“I stayed out of trouble,” she shot back, “and I worked hard every day of my life.”
Many old people have a longevity “secret.” Belinda’s belief in hard work is shared by many old people, but in truth almost every “secret” of longevity comes down to invisible traits in the person’s awareness. Some people are nourished at the most basic level of their awareness, others are not. In purely physical terms, Belinda’s life of grueling farm labor out in the sun and rain, enduring the harsh climate of New England, could just as easily have aged her before her time. Some people are worn down by hard work, while others thrive on it. The difference lies in complex social and psychological factors to which our bodies are constantly responding. We need to look deeper into these areas before the three ages of man—chronological, biological, and psychological—fall into a coherent picture.
Because so much of our internal programming is unconscious, we miss the fact that the most powerful influence we have over how we age comes simply from our awareness. To gain control over the aging process, one must first be aware of it, and no two people share the same awareness. What is outside our awareness cannot be controlled, obviously, and because aging happens so slowly, it remains outside most people’s awareness except in those isolated moments of recognition when we realize that youth is slipping away: Something jogs our awareness to tell us that we don’t feel as vigorous or as strong or as sexually attractive as we once did. However, these distressing moments aren’t aging. It is in the absence of being aware, when we don’t see anything happening, that physiological processes slip out of our control.
Not being aware doesn’t mean that a bodily process has stopped. Your conscious awareness is matched by unconscious awareness—the brain’s ability to oversee functions you aren’t thinking about at the moment. In Nature’s scheme, provisions have been made for our lapses of conscious control. The human nervous systems are designed so that critical functions such as breathing and heartbeat can run by themselves or be controlled voluntarily. I previously mentioned Swami Rama, the Indian adept who displayed remarkable control over bodily functions that were thought to be totally automatic. In one instance, he caused the skin temperature on one side of his right hand to grow warmer while the other side became colder. The rate of change proceeded at about 4 degrees F. per minute, until one side of his hand was flushed red with warmth and the other was pale gray with cold; the total temperature difference was approximately 10 degrees.
What power was being displayed there? In the Indian spiritual tradition there is a branch of esoteric practice called Tantra, which teaches elaborate exercises for controlling involuntary responses. Tibetan Buddhism contains similar teachings; young monks are expected to demonstrate their bodily control by such feats as sitting on a frozen lake and melting the ice around them with the warmth they generate in an intense meditational state. Native Americans, Sufis, and all shamanist cultures around the world contain such practices, yet no matter how esoteric these exercises become, the power being called upon is not mystical: It is the same power of awareness that you use when you decide to switch from involuntary to voluntary breathing, blinking, balancing, or any other autonomic function.
This switch-over happens in your awareness without your having to think about it; therefore, we miss the implicit power being expressed. In fact, as soon as you pay attention to any function, a transformation takes place. For example, if someone puts a five-pound weight in your hand and lifts it up and down for you a hundred times, your arm won’t gain any muscle strength. However, if you perform the same action voluntarily, completely different signals are sent from the motor cortex in your brain. Not just your biceps but your heart and lung tissues will receive increased stimulus, as will specific areas of your brain that control motor coordination. The activity of having your arm passively moved is analogous to unconscious, unwilled behavior; the activity of exercising represents conscious, willed behavior. The second mode of activity engages the intricate process called learning, which is at the root of growing, as opposed to growing old. Thus, every time you exercise your biceps, you are teaching it to be stronger, and your brain, lungs, heart, endocrine glands, and even immune system are adapting to a new mode of functioning. Conversely, if you move your body without awareness, passivity takes the place of learning. Biceps, heart, lungs, endocrine glands, and immune system eventually lose function instead of gain it.
When you start to assert control over any bodily process, the effect is holistic. The mind-body system reacts to every single stimulus as a global event; i.e., to stimulate one cell is to stimulate all. There is a parallel in quantum terms, since a reaction anywhere in space-time, including past, present, and future, causes a shift in the entire quantum field. As one Nobel laureate put it, “If you tickle the field here, it laughs over there.” The fact that awareness behaves like a field is now deemed crucial to understanding aging.
On a wider scale, Walter M. Bortz, a senior Stanford physician who specializes in aging, has coined the term disuse syndrome to describe how negligence in paying attention to the body’s basic needs, particularly the need for physical activity, can destroy health and lead to rapid premature aging. It is a well-known principle in physiology that any part of the body that falls into disuse will begin to atrophy and wither away.
Bortz took the next step and discovered that this effect was body-wide, spreading beyond the cardiovascular system. When a person decides to give up physical activity, he essentially invites his entire physiology to atrophy. As a result, a constellation of problems appears: (1) heart, arteries, and other parts of the cardiovascular system become more vulnerable; (2) muscles and skeleton become more fragile; (3) obesity becomes a high risk; (4) depression sets in; and (5) signs of premature aging indicate that the body is biologically older than its calendar years. These are the five components of Bortz’s disuse syndrome, which can be observed in countless older people today.
The physical deteriorations on this list are not surprising, but it seems unusual that being inactive, in and of itself, would lead to depression, long considered a disorder of mood or personality. However, studies from the Russian space program have found that young cosmonauts subjected to the forced inactivity of space flight fall prey to depression; when put on a schedule of regular exercise, this depression is avoided. The brain mechanism that controls depression appears to lie with a class of neurochemicals called catecholamines. In depressed patients, whose levels of catecholamines are abnormally low, healthy levels can be restored by giving antidepressant drugs, but the natural way to accomplish this is through regular exercise.
Being holistic, exercise sends chemical messages back and forth between the brain and various muscle groups; part of this flow of biochemical information stimulates the production of catecholamines. Thus, whenever a doctor writes a prescription for an antidepressant, Bortz declares, he is handing out a proxy for the body’s own inner prescription, which is filled by exercise. The news that exercise offsets aging has been well publicized, although its preventive effect on depression may not be as well known. What is far more fascinating, however, is that the underlying logic—function precedes structure—can be extended to say that awareness precedes function. In other words, the parts of the body that age (losing structure) are not just the ones that are not being used enough (losing function); the person has also withdrawn his awareness from them.
Let me show how the learned and the biological components of aging form a personal pattern that defines how a person will age. A patient of mine named Perry, age 67, is a retired realtor whose wife became worried when he began to seem “different from his usual self.” When she brought him in for examination, Perry was listless and unresponsive to questions. His wife commented that when she came home late from shopping or visiting a friend, she often found her husband staring at the television, barely noticing that she had walked into the room.
When I asked Perry how he felt, he was noncommittal. “I’m just getting old,” he said. “There’s nothing wrong with me that being twenty years younger wouldn’t fix.” But in fact the Perry of twenty years ago was already cultivating the seeds of habit and belief that grew into what he is today. Like many people of his generation, Perry has outlived both his parents, who died at 70 and 72 respectively after a lifetime of hard work in Boston shoe factories. His expectations for himself are probably strongly marked by having seen them age. His father was “put on the shelf” at 65 and retired to a rocking chair. Taking little interest in making a new life for himself, he gained weight, drank a little more than before, and read newspapers. Within three years of getting his gold watch he suffered a heart attack. His doctors advised him to give up all activity, resigning him to an invalid’s life. Within a year, however, a second coronary followed, this one fatal.
Perry’s mother, on the other hand, remained active all her life. Like many working women in the past, she also took care of her husband and family, doing all the cooking, housework, and laundry while at the same time holding down an accounting job. Whatever else can be said about such a life, it kept her in much better physical condition than her husband; she had no heart or blood pressure problems and was fortunate not to smoke (a habit she considered unladylike). However, she drifted into apathy and loneliness after her husband’s death and seemed to lose her purpose in life. With no one to care for and not wanting to be a burden to her children, she became semireclusive. Eventually she died after a series of strokes.
Perry’s outlook on aging had been programmed by these two life stories, and although he probably did not consciously see himself winding up like his parents, he appeared to be on the threshold of duplicating how they aged by unconsciously adopting their beliefs. He had lost control of the aging process by losing touch with his own awareness.
Because my medical specialty is endocrinology, Perry and his wife sought my advice in case he had a thyroid condition; among the disorders that can mimic aging is thyroid deficiency (hypothyroidism), which causes an abnormal decrease in metabolism, making its victims slow and dull, their hair gray and skin wrinkled. This imitation of natural aging disappears once normal levels of the missing hormone, thyroxin, are supplied. Perry exhibited adequate thyroid levels, however, throwing the burden of explanation back upon other influences.
Whenever anyone seems to be aging so badly that signs of senility, feebleness, and disability are present, it’s important to investigate his lifestyle. Problems crop up in a person’s daily routine that are too often ignored, especially when he is only “showing his age.” It is estimated that between a third and half of senility cases result from the following treatable factors:
Malnutrition
Side effects from drugs
Smoking
Alcohol abuse
Dehydration
Depression
Inactivity
All these factors begin in awareness, stemming either from neglect or from habit. Alone or in combination, any of these factors can dramatically affect how a person looks and acts. In the “old” old age of Perry’s parents, most people would have paid scant attention to the destructiveness of these factors. Elderly people forgot to eat well, neglected fluids, took up smoking and drinking to assuage their loneliness, and sat around in withdrawn silence because that was what being old meant.
Doctors once routinely prescribed blood pressure medication, sleeping pills, and tranquilizers in combination to old patients, knowing full well that most of them were probably mixing these drugs with alcohol or taking wrong doses. Smoking was medically condoned (or even recommended; a man recently told me that when he was a child, his grandmother went to her family doctor with sinus congestion and was advised to smoke menthol cigarettes! Dutifully following doctor’s orders, she smoked her first cigarette at 60 and remained addicted until her death fifteen years later.). Giving nutritional advice did not fall under the scope of a doctors’ work, and older patients had to be seriously malnourished or dehydrated, sometimes to the point of coma, before medical intervention was sought. Even today, when it is known that lack of essential vitamins can create symptoms of senility, particularly lack of vitamin B12, this information is not relayed to many of the elderly.
Now consider Perry’s condition with the above list in mind. Since his wife had already told me that he sat around the house most of the day, physical inactivity was already a given. On being questioned, Perry revealed that he had started drinking more since his retirement and often began early in the day. When he worked he had set himself a rule never to pour a drink before five, but, as he ruefully said, “My self-discipline is shot. I guess it happens.”
Being borderline hypertensive, he was taking blood pressure medication, exactly what kind he wasn’t sure (it turned out to be a beta blocker); he had not had the dosage changed in two years. “I try not to take the pills unless my pressure’s gone up,” he confided. I asked how he knew when his blood pressure was up. “You know, if I feel tense, or the wife is nagging me,” he replied. In fact, hypertension, despite its name, does not coincide with being tense and indeed has no overt symptoms; and medication, in order to be effective, must be taken every day. This is particularly true of beta blockers, which require a break-in period while the body adjusts to them.
A huge number of preventable aging problems can be traced to the indiscriminate use of prescription drugs. Unless one is alert to this danger, mixing medications becomes a growing habit with many people as they age. Sleeping pills and diuretics (widely prescribed for high blood pressure) are among the most common drugs used by older people. Tranquilizers are also extremely common, along with aspirin and assorted other painkillers taken for arthritis.
Besides abusing these drugs by taking too many too often, older people often become careless about having their dosages monitored regularly by a doctor; many tend to forget when to discontinue a medication and which drug is meant for which condition. Many older Americans drink, and the combination of drugs and alcohol is almost always dangerous. Therefore, a person’s medication should always be thoroughly reviewed at the first sign of physical or mental symptoms of abuse or misuse.
In Perry’s case I also strongly suspected hidden low-level depression—someone who watches television all day and pays no attention when his wife walks into the room could easily be mildly or clinically depressed. The typical old person sitting quietly in his corner, once accepted as an image of normal aging, was probably depressed. To become silent, withdrawn, apathetic, anxious, and childishly helpless are common signs of this condition. Chronic fatigue is often a physical outcome of depression, accounting for up to 50 percent of cases. Certain severe depressions (called involutional depression) specifically afflict older people, for reasons not yet known. However, many cases of depression can be linked directly to social and personal problems. A person who feels useless, discarded, uncared for, or burdensome to his family can hardly help but fall into depression.
In these cases, the ultimate solution doesn’t lie with medicine but with personal change. Harvard psychologist Ellen Langer has demonstrated that people in nursing homes improve remarkably after altering their lives in the simplest ways—giving them a potted plant to tend, allowing them to make up their own menus and take charge of tidying their rooms. Instead of being passive, lonely dependents playing the role of “old folks in a nursing home,” these people regained a sense of usefulness and worth.
For Perry, the last hidden factor in his condition could be dehydration, which starts to impair a person’s judgment before he realizes that there is a problem. Not drinking enough water every day is one of the commonest conditions in old age, and although it has received almost no publicity, chronic dehydration is a major cause of preventable aging. Some authorities go so far as to count dehydration among the leading causes of death in old age. It is certainly an avoidable complication that leads to many problems.
When body fluids fall below a certain level, the physiology begins to enter a toxic state; vital electrolyte balance is thrown off, and eventually so is the balance of brain chemistry. A host of difficulties can result—literally anything from kidney failure and heart attack to blackouts, dizziness, lethargy, and full-blown senile dementia. As the person becomes less alert and more forgetful about drinking water, a vicious circle gets set up. The same is true for almost all these causes of false senility—the longer they go overlooked, the harder it is for the person to see the problem.
But Perry’s wife was concerned, even if he wasn’t, and she promised to remind him about these things. Some would be easier than others: Since she did all the cooking, she could be more careful with his diet (adding a multiple vitamin pill can’t hurt and on the off chance might help); she could see that he drank more water and used his medications properly. This extra attention could help lift his spirits, too, but I was most concerned about the alcohol and the depression. In my mind, Perry was walking a thin line. His prevailing self-image was contained in two disquieting words: “I’m old.” It would be hard to imagine a phrase that is more crippling, or more likely to lead someone into the escape of alcohol or the dead end of depression.
Aging as a whole is a vicious circle. When someone expects to be withdrawn, isolated, and useless after a certain age, he creates the very conditions that justify his beliefs. Our deepest assumptions are the triggers for physical changes. It would be naïve, then, to think that just listing a few preventable causes for aging could actually prevent it. What good does it do to tell someone like Perry to quit drinking if he feels despair? The whole business of growing old is a morass of hidden feelings that people find too difficult to face—if anything, drinking is a merciful anesthetic compared to living with dread and lost hope. It is far easier to follow one’s internal programming than to break through into new territory. But, over time, our hidden programming robs us of choice more and more, making it harder to break the bonds of self-destructive behavior. In this regard aging is much like addiction: The person feels that he is still in control when in fact the behavior is controlling him. From the outside, I could see this in Perry. He was transforming himself into a dying man before my eyes, and the tragedy was that he could not see that he was doing it to himself. Awareness, once it becomes conditioned, assumes the shape of habit; unconscious repetition reinforces the destructive patterns, and unless new learning takes place, inertia will carry the body downhill year after year.
The bright side of Perry’s case was that almost everything happening to him could be corrected by creating a new mode of awareness. To do that, we take advantage of the fact that awareness is always generating biological information. With even the slightest change of awareness, energy and information move in new patterns. The reason old habits are so destructive is that new patterns aren’t allowed to spring into existence—conditioned awareness is therefore synonymous with slow dying.
On the other hand, by increasing someone’s awareness, bringing it into a new focus and breaking out of old patterns, you can alter aging. A brilliant demonstration of this was offered in 1979 by psychologist Ellen Langer and her colleagues at Harvard, who effectively reversed the biological age of a group of old men by a simple but ingenious shift in awareness. The subjects, all 75 or older and in good health, were asked to meet for a week’s retreat at a country resort. They were informed in advance that they would be given a battery of physical and mental exams, but in addition one unusual stipulation was placed upon them: They were not allowed to bring any newspapers, magazines, books, or family photos dated later than 1959.
The purpose of this odd request became clear when they arrived—the resort had been set up to duplicate life as it was twenty years earlier. Instead of magazines from 1979, the reading tables held issues of Life and the Saturday Evening Post from 1959. The only music played was twenty years old, and, in keeping with this flashback, the men were asked to behave entirely as if the year were 1959. All talk had to refer to events and people of that year. Every detail of their week in the country was geared to make each subject feel, look, talk, and behave as he had in his midfifties.
During this period, Langer’s team made extensive measurements of the subjects’ biological age. Gerontologists have not been able to fix the precise markers that define biological age, as I noted earlier, but a general profile was compiled for each man using measurements of physical strength, posture, perception, cognition, and short-term memory, along with thresholds of hearing, sight, and taste.
The Harvard team wanted to change the context in which these men saw themselves. The premise of their experiment was that seeing oneself as old or young directly influences the aging process itself. To shift their context back to 1959, the experimenters had their subjects wear I.D. photos taken twenty years before—the group learned to identify one another through these pictures rather than present appearance; they were instructed to talk exclusively in the present tense of 1959 (“I wonder if President Eisenhower will go with Nixon next election?”); their wives and children were referred to as if they were also twenty years younger; although all the men were retired, they talked about their careers as if they were still in full swing.
The results of this play-acting were remarkable. Compared to a control group that went on the retreat but continued to live in the world of 1979, the make-believe group improved in memory and manual dexterity. They were more active and self-sufficient about such things as taking their own food at meals and cleaning up their rooms, behaving much more like 55-year-olds than 75-year-olds (many had become dependent on younger family members to perform everyday tasks for them).
Perhaps the most remarkable change had to do with aspects of aging that were considered irreversible. Impartial judges who were asked to study before-and-after pictures of the men detected that their faces looked visibly younger by an average of three years. Measurements of finger length, which tends to shorten with age, indicated that their fingers had lengthened; stiffened joints were more flexible, and posture had started to straighten as it had in younger years. Muscle strength, as measured by hand grip, improved, as did hearing and vision. The control group also showed some improvements (Langer explained this by the fact that going on a trip and being treated specially made them feel younger, too). But the control group actually declined in certain markers such as manual dexterity and finger length. Intelligence is considered fixed in adults, yet over half of the experimental group showed increased intelligence over the five days of their return to 1959, while a quarter of the control group declined in I.Q. test scores.
Professor Langer’s study was a landmark in proving that so-called irreversible signs of aging could be reversed using psychological intervention. She attributed this success to three factors: (1) The men were asked to behave as if they were younger; (2) They were treated as if they had the intelligence and independence of younger people (unlike the way they were often treated at home—for example, their opinions were elicited with respect and actually listened to); (3) They were asked to follow complex instructions about their daily routine. Because all three factors overlapped, Langer ultimately was not certain which of them was the most important. She speculated that a similar reversal of aging might have resulted if the men had been given any complex task to perform, such as composing an opera—a task Verdi set for himself in his late seventies.
I have been pondering Professor Langer’s results for several years, ever since I first wrote about it in the context of personal time. The old paradigm tells us that time is objective, but in fact our bodies respond to subjective time, as recorded in memories and internal feelings. Langer enabled these men to be inner time travelers; they journeyed back twenty years psychologically, and their bodies followed. The simplest way I can explain this is that two aspects of awareness were being shifted: attention and intention. Awareness always has these two components. Attention focuses awareness to a local perception. Intention brings about a change in that localization. In Langer’s experiment, the subjects had their attention sharply localized on the context of the year 1959; this started a new flow of biological information, because everything they saw, heard, or talked about had to relate to that one specific localization. At the same time, they had to act on an intention—intending to be just as they were twenty years earlier. There is no magic in either factor; we all pay attention to various things throughout the day; we all carry out various desires and intentions.
The magic is in how the body follows this change of awareness across the barrier of time. It’s not feasible or realistic to try to live in the past, but there are valuable clues that can be followed here: Again we see that the quality of one’s life depends on the quality of attention. Whatever you pay attention to will grow more important in your life. There is no limit to the kinds of changes that awareness can produce. In our society, we do not use the flow of attention to produce results; we are not clued in to the energy and information that starts to be generated inside us anytime we experience a change of awareness. In the following exercises, we will explore how to consciously call upon the power of awareness and use it to our benefit, for if we do not use it consciously, our awareness will be trapped in the old conditioning that creates the aging process.