Senescence, the Last Half of Life

by G. Stanley Hall

In his dealings with such cases the physician needs a special sagacity. He must realize the great satisfaction it gives his aged patients to have him listen patiently and sympathetically to all their ills and should encourage them to trust him fully and with no reservations. This not only shields others but by humoring the wise doctor can not only gain full confidence but may be able to bring such patients to see their own selfishness and thus effect a real cure even in their physical condition. I have known cases where such ministrations were a benediction to the family. Where old patients have thus built up a system of half-fancied ailments, placeboes may work wonders, the therapy being in fact chiefly mental. Such insidious dangers to which the aged are exposed cannot be reached by medicaments but rather by pithiatism in the sense of Babinski or persuasion in the sense of Dubois, Merchenowsky, Rosenbach, or Herbert Hall, who heal by prescribing activities, physical and mental, found possible after painstaking analysis. The old often feel a falsetto invalidism that may be cured by a vigorous appeal to their moral sense or, again by changes in their daily program or regimen or by exposing them to fresh streams of rich outer impressions that correct the mental stagnation to which they are prone or keep their attention from themselves by giving their minds a larger field and a far-off focus, as against their inveterate tendency to mental short-sightedness.

In youth erotic fetishes and pet, instinctive aversions are now known to play an important if half-unconscious rôle in love between the sexes. Eyes, hair, lips, cheek, neck, or any of her little ways of movement or speech may become a focus of special charm to the young amorist. Conversely, other or even the same features, traits, automatisms, or habits may mediate no less unconscious dislike.[196] Some of the same rapports or repulsions exist between the old and the young. The former may even have their favorite children or grandchildren and dislike others in ways they themselves could only inadequately justify. This partiality is most pronounced between fathers and daughters, mothers and sons. It is the chief factor not only in what is called love at first sight but of first impressions of strangers, which are proverbially so hard to efface. Thus what we deem trifles may loom large.

The old are particularly prone to develop peculiarities which, if they do not unconsciously alienate those nearest and perhaps dearest to them, are real handicaps to their devotion. Of this the old are rarely aware, and if attention is called to them they minimize their importance. These might be listed and weighed like their analogues in the erotic field. The roster of them on the negative side would be long. There are faults in table manners, modes of eating and drinking, using table utensils from the napkin on, etc. Mastication may be noisy or otherwise subtly disagreeable, or there is slobbering, clumsiness, or neglect of common conventionalities once observed. The toilet may be neglected, the attire soiled or spotted or imperfectly put on, and so a look-over needed before we go out. We do things or make noises in the presence of others that once we only permitted ourselves when alone and there is a new indifference to personal appearance. The voice is impaired in volume, richness of inflection, and articulation; our face or form are no longer æsthetic objects; we mislay things and invoke those about us to help find them; and are tediously slow in mind and body. If, in addition to all this, we become pryingly overcurious, fault-finding, exact, and forgetful, we give our friends more to put up with than we realize, and the best of them would be shocked if they became conscious of how much they repress in their psychic attitude toward, if not in their treatment of us. On all such matters we should make frequent self-surveys. On the other hand, if we cultivate not only order and control but, above all, the poise and repose of those seeking the Great Peace, striving always to do, be, and say only our best things, we may make ourselves not only respected but loved in a new way, so that we shall be turned to not only for advice but for companionship and help in emergencies and make some of even the most obtrusive signs of physical decay attractive by association with the higher qualities of soul, as the ugliness of Socrates came to be almost loved by his disciples. Art understands this and many of its masterpieces depict old age in its glory. The same is true of literature and even of the drama, despite the fact that actors who specialize in old women’s and particularly old men’s parts so often make age repulsive and ridiculous, for it has always been a most attractive field for caricature.

The old are subject to certain fluctuations, new in kind, degree, or both. Sleep is less regular. They have good and bad nights, one or more of each alternating, which make the next day clear or cloudy with dregs. If fatigue comes more quickly, so does recuperation by rest. They are often refreshed by a very brief nap or by recumbency, or even by a period of solitude during the day. Thus on the periodicity of day and night is superposed one of less amplitude or briefer duration, perhaps after one or each meal. Thus the distinction between the sleeping and waking state comes to be less sharp, slumber is not so deep or long, and the dreamy states of reverie invade mentation by day. The great restorer does not quite make losses good and the accumulation of these deficits explains very many of the phenomena of old age, which might be characterized as sleepiness for death, the rest that is complete and knows no waking. Capitulation to the siesta habit is marked in some by a distinct improvement of condition. They speak of a new balance between activity and repose and sleep all the better nights, while others resist such tamperings with nature’s rhythm and if they acquire the midday habit find themselves nervous or less refreshed the morning after. Some retire and rise with the sun and find a certain elation of spirits in this reversion to nature and praise the morning hour or even sunrise, of which the urbanized world about them knows little and ever less; while others find a virtue in lying abed late. While we know too little of the hygiene of the aged to prescribe, it is certain that they tend to break with the old regulations and really need some of the indulgences they are often too inclined to permit themselves.

The appetites fluctuate and may readily become capricious. Some would eat more and less often than before and love to experiment with new viands. Some think some items of diet once beneficial become harmful and so eliminate them, while some like and can digest things impossible before. Sometimes they indulge for days or even weeks in a favorite dish that at intervals they cannot touch with impunity, as if there were spells of immunity broken by intervals during which the same article produces deleterious results. One says that what is at one time a food becomes for him at another time a poison. This seems particularly true of certain fruits, while the acid balance seems very liable to upsets. Most tend to overeat and are always struggling with their appetite. Yet they often have periods when foods lose their attraction, as if Nature decreed a fast. Here she is often right and a day or more of relative or even entire abstinence may prove helpful. So the former diet periods do not need to be observed; nor need the old be coaxed at such times with tempting food.

Springtime is hard on the assimilative processes of all but especially on those of the old. This is partly because the tides of life everywhere set toward genesis rather than toward individuation but still more because the calorific elements of food need to be essentially reduced and also because winter’s supplies grow a little stale before summer ripens her produce. So, too, with the abated activity that years bring the need of food is reduced and hence the old can often thrive on a small percentage of what they formerly needed. Most, too, not only learn to avoid hearty meals at night but find it best to lay in most of their rations earlier in the day. Very many find in diet their chief center of interest and solicitude and the most active theme for theorization, so that in many cases more and more mentation seems to center about alimentary functions. There are very active inductions from experience and constant modifications of views hard to change in other fields. There does seem to be often a change toward either increased sensitiveness or torpidity of the alimentary tract. A few grow especially susceptible to seasoning, condiments, flavors, and even confectionery. They may become even connoisseurs in wine, tea, coffee, tobacco, while others grow indifferent and insist that they like and can eat almost anything. Nutritive ups and downs are thus more marked than before. Tendencies to decrease in weight are distinctly more favorable for prolonged life than the opposite tendency to obesity. Indeed, the former seems normal.

There are alternations of mood. Depression may be acute to-day and vanish to-morrow, depending not only upon sleep and nutrition but the weather and incidents, perhaps trivialities, in the environment. Irritability may alternate with apathy and the old may lose self-control and anon exercise a high degree of it. Some days they feel comfortable and even vigorous and on others are miserable. Now weak organs or functions, heart, stomach, bowels, rheumatism, or whatever be the besetting troubles, are much in evidence and symptoms may grow dangerous until the old have a new sense of the fragile hold they have upon life, which may end suddenly in some of these weak moments. Then these symptoms intermit and they feel well and take heart again till the next “spell.” A few never allow themselves to be caught without some one or more trusted drugs kept handy for immediate use in emergencies and much, too, might be written of “warnings” and their sometimes epochal effects upon both the inner and outer life. Thus the old may sometimes give way to their feelings and become stormy, lachrymose, perhaps even violent, and they may react from this to a state of almost philosophic poise, which passes upon even their own outbreaks with objective detachment and psychological interest, phenomena that we may call the “apologetics” of old age. Thus emotivity and reason may succeed each other.

The old are very dependent upon weather, climate, and seasons. Winter is hardest on them. Not only does it mean more indoor life and less activity but cold is one of the chief enemies of the old and winter is also supercharged with subtle and profound symbolisms of their own stage of life which deploy more beneath than above the threshold of their consciousness. What old person does not shudder at the thought of being buried in snow and ice. Even the autumn is for them full of somber analogies of the stage of the sere and falling leaves, of the ripening and garnering of the fruits of the earth, of the first blighting frosts. All the old long for the rejuvenation of springtime and perhaps daydream of it when nature is snowbound. Some keep diaries of wind, temperature, and storm and become weather-wise, while those who can, seek warmer climes, especially when winter begins to break, a season statistics show is most fatal for the old. The poet who sang that he could endure anything but a series of bad days must have had the psychic barometry of old age. Thus we draw nearer to nature, our source and our home.

Even sex often does not decline and die without terminal oscillations in its course and in extreme cases apathy and aversion may alternate with abnormal erotic outbreaks dangerous alike to the health of the individual, to domestic happiness, and even to public morals. Those who have led lustful lives may resort to unnatural and illegal forms of vice and thus illustrate the various perversions of this function. While only a few indulge in orgies, very few fail to note occasional spontaneous but transient calentures here suggestive of potency long after it was deemed “closed season.” Such recrudescences, though they seem to be nearly always only partial, are very prone to deceive and may lead to follies. Instead of being indulged, cultivated, or even welcomed, as by an inveterate fallacy too prevalent with the young they too often are, the old should rigorously ignore and suppress all such manifestations in this field. While the full realization of impotence brings a psychalgia all its own, it also has physiological and psychological if not conscious compensations, while belated and, especially, stimulated activity of reproductive functions not only can never result in offspring of value to the world but saps vitality and accelerates the decay of every secondary sex quality of mind and body, so that complete chastity, psychic and somatic, should be the ideal of the old. They should be not only embodiments of purity but the wisest of all counselors in this field. Only to those in whom asceticism and sublimation have done their perfect work will there come an Indian summer of calentures for the higher ideals of life and mind, while those who fail here can never know the true and consummate joy of old age.

For myself, I frankly confess that the longer I live the more I want to keep on doing so. Hence in the last two years of retired leisure I have given far more time and attention to personal hygiene, regimen, and diet than ever before and have mildly experimented with myself in many ways. I have tried eating two and four meals daily, going early and late to bed, forcing myself to lie there a fixed number of hours and at certain times again retiring and rising with no regularity as I felt like doing. I have tried systematic rub-downs, self-massage; cold and warm, frequent and infrequent baths, have equipped a modest gymnasium and taken mild but systematic exercises with various apparatus and then abandoned all this or done nothing of it without an inner prompting. I have followed prescribed diets and tried many special foods, interested myself in vitamines, beginning with Eddy’s manual and trying out vegex preparations, although no one has as yet studied the effects of any of the three species of vitamines upon old age, as has been done for other stages of life. I even used olive oil, which so many of my correspondents praise both for internal and external application, stopped smoking for a week, which seemed greatly to prolong each day after thirty years of mild addition to nicotine, corrected for a time and then yielded to the senescent’s tendency to constipation, experimented with alcohol in several forms, even with Pohl’s spermine tablets and minimal doses of phosphorus, etc. But out of all these moderate hygienic adventures I have so far found no topping specific. It would be interesting to try out the gland-grafting experiments which seem to have regenerated the famous Vienna surgeon, Lorenz, and others, and I think I would gladly offer myself as a corpus vile for the Steinach operation to study its psychological effects at first hand. Although I have found in the above experiences a few things that I so far believe helpful to me, I have derived from them all no advice to offer others except, if time and inclination favor, to try out all things for themselves. Plenty of moderate exercise out of doors, active intellectual interests, both just to the point of healthy fatigue but no more, are fundamental. One must have insight and considerable power of self-observation to profit therefrom. But the main thing is to develop and maintain at its highest possible morale a rigorous and unremitting hygienic conscience that will never let down but always enforce the doing of what we know to be best. Otherwise we may eat, sleep, work, and generally do or not do what seems best as we list. I am even skeptical about the almost universal counsel for tranquillity and against worrying, for more or less anxiety is not only the normal lot of man but it gives a tonic sense of responsibility which we all need.