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The Internal Struggles of Aging
When people age, internal struggles or conflicts (perhaps best defined as forces of opposing meanings) emerge that heretofore have not existed. These struggles are stimulated by the aging itself and all the related implications, such as physical challenges, mental impairment, out-of-home residential placement, and the ultimate approach of death. And the struggles arise in the aged themselves, their loved ones, their caretakers, their therapists and anyone else with whom they cross paths. Much of the struggle is culturally stimulated, as we internalize value systems that put old-age, physical and mental impairments, and nursing home placement at odds with American life as we have come to know it. More and more, American living, until something like illness or death visits nearby, has become more commonly colored by materialistic achievement and Hollywood images.
Indeed, the smell of fresh cut lawns surrounding pristine rose gardens and the vision of playing children and dancing athletic adolescents typically align the vision of American values. We steer away from thoughts of silent hallways lined with wheelchairs containing the shrunken wrinkled shadows of children and adolescents from decades ago. Their sullen gazes send shivers to hearts while the faint smell of urine lingers beneath our noses, reminiscent of death and everyone's ultimate lack of control. Shapiro suggested that Freud himself focused on this view of death as an ultimate separation and withdrawal of love from loved ones, excluding a relational one centered on "the resolution of grief as the recreation of a new enduring relational bond" (547).
This is a particular challenge for those working with the elderly as it appears, from my experience, that they are often struggling between a view toward living and a view toward death. This can be central to the elderly in Nursing Homes and the behavior of those who interact with them. As Levin noted, "elderly individuals tend to become progressively 'disengaged' (Cummings and Henry, 1961) and self-centered" (202). As they suggest, and as I have seen for myself, it becomes the task of their caregivers to help these elderly to reverse the disengagement. Levin advised that this reversal could be accomplished more easily than one might think, even with patients who have "organic brain disease" (202) and not necessarily just with those patients who have more therapeutically amenable psychological conditions. He described how elderly women with " organic brain disorder" (202) in a psychiatric facility became socially re-engaged through their attendance at hospital parties to which young male alcoholics were also invited.
This is highly related to how caretakers and loved ones face the conflicts of aging revealed by their beloved elderly, along with the reflection of their own ultimate aging process. Everyone appears to grapple with the view toward living and the view toward death, struggling with the extremes of immortality and ultimate separation from loved ones.
This ambivalence seems to especially present itself in an elderly person's adjustment to a nursing home placement and the frequency of visitation by family. For example, due to the guilt experienced by the loved ones, they might visit every day, or with extreme infrequency. Thus, the viewpoints toward living and toward dying can be operative and limiting toward adjustment. The family might feel upset about their loved one residing outside the family and about the possibility that the loved one will actually accept this residence as his or her new home. Yet they might have little knowledge or understanding about their upset. Halpert suggested that many middle-aged children experience fears of "abandonment and murder" (426) connected to the placement of their elderly parents in [End Page 258] nursing homes. He also described a common occurrence of a "narcissistic threat posed by seeing one's own future in a parent's deterioration" (426). The more aged the middle-aged child the " harder to distance oneself from the evidence of mortality presented by one's enfeebled parents when one is already feeling a sense...