THE LEGACIES OF MEMORY: WHAT ELDERS BRING TO THE FUTURE
Paul
Kleyman, Editor
Aging Today
The turn of the millennium in an aging world has turned the world's attention to the eyewitnesses of the past century. In this "In Focus" section, Aging Today examines techniques, such as oral history, guided autobiography and reminiscence theater, that can not only preserve the legacies of the longevity revolution for future generations, but can enable members of the third age to reconnoiter in order to realize dreams for their own tomorrows.
This section begins with a review of life review in gerontology. Almost four decades ago, a young physician named Robert N. Butler, who is now the president and CEO of the International Longevity Center, New York City, published groundbreaking articles in the professional literature that would cause health and mental health researchers and practitioners to recognize that individuals review their lives as an essential part of healthy, normal aging. At the recent American Society on Aging 46th Annual Meeting, Butler was asked to revisit his role in the development of life review. Butler, whose own life review includes receiving a Pulitzer Prize and becoming the founding director of the National Institute on Aging, agreed to summarize his presentation for Aging Today.
BUTLER REVIEWS LIFE REVIEW
By ROBERT N. BUTLER
Life
review, a normal developmental task of the later years, is characterized by
the return of memories and past conflicts. Life review can result in resolution,
reconciliation, atonement, integration and serenity. It can occur spontaneously,
or it can be structured. Reminiscence, simply recalling events or periods of
one's life, is only one aspect of a life review; although it can be therapeutic,
it is usually not evaluative.
In 1955 I had the great privilege of coming to the National Institutes of Health (NIH), where I worked with James Birren, now known for his work in developing guided autobiography workshops. Our group, along with another led by Ewald Busse at Duke University, Raleigh, N.C., was virtually alone in recognizing the significance of studying healthy aging. Instead of conducting cross-sectional, one-time studies of patients institutionalized in chronic-disease hospitals and nursing homes, we embarked on a long-term longitudinal, comprehensive study of healthy community-residing older adults.
In the 1950s, psychology, psychiatry and gerontology textbooks devalued reminiscence and memories. Reminiscing was condescendingly called "living in the past," and phrases like "wandering of mind," "boring" and "garrulous" were used to describe elders who looked back. Actually, reminiscence was thought to be an early diagnostic sign of senile psychosis--what is known today as Alzheimer's disease. However, I was seeing a different picture in vibrant, healthy individuals who were engaging in a fascinating inward journey. With some trepidation I presented these observations to my colleagues at the NIH Laboratory of Clinical Science, which focused on "hard" neural science. To my relief, the presentation was warmly received.
In 1961 I wrote a preliminary article, "Recall and Retrospection," in which I postulated that elders universally undergo an important inner experience, and proposed that we should understand the frequency and significance of reminiscence in old age as a process of life review. Between 1961 and 1975, I worked with volunteers and patients in both individual and group therapy sessions. After thinking about the role memory and life review play in the course of individual human development and how they relate to creativity, I devised a questionnaire to study creativity and conducted extensive interviews with notable creative Americans, among them B. F. Skinner, a pioneer of modern psychology. The unguided autobiographies that resulted from these sessions will be kept confidential until they are unsealed by the American Psychiatric Association in 2030.
COMPLEX AND NUANCED
I began to distinguish the process of life review from the act of reminiscence, and to understand that life reviews are extremely complex, nuanced, emotional, often inchoate and contradictory, and are frequently filled with irony, comedy and tragedy. I was struck by the extent to which individuals need to synthesize and integrate the life they have lived.
In reviewing their lives, people often evaluate their pasts based on their set of moral values. Not all outcomes are favorable; sometimes life review results in a major depression or a depressive trend. It is often hard to tap into the life review of a person who wishes to be silent or who is psychologically isolated. Individuals who conduct their life reviews alone are at much greater risk for depression than are those who allow another person to share in the process. Approximately 19% of older people show significant depressive trends, which might relate to the inner turmoil some experience in the course of the life review. Individuals who share their experiences are more likely to feel increased self-esteem and be spared feelings of depression and isolation.
The goals of life review include the resolution of past conflicts and issues, atonement for past acts or inaction, and reconciliation with family members and friends. People often reunite after years of separation or estrangement and return to their birthplace for a final visit.
ORAL HISTORY
When I was studying life review, I was struck by the importance of oral history and realized that history is more than the actions of politicians and generals. Prior to the 1976 bicentennial celebration of the founding of the United States, I met with anthropologists Margaret Mead and Wilton Dillon to discuss how we might record the experiences of ordinary people for posterity. That summer, we set up tables in the mall outside the Smithsonian Institution and invited people visiting Washington, D.C., to tell their stories. Americans from all over the country, from small farms and big cities, came to our tables and shared their lives.
It is obvious that younger people who are facing death or a significant crisis may well engage in life review, but as the 19th-century philosopher Schopenhauer noted, it is only at the end of life that one has the opportunity to deal with life as a whole. "Truth and poetry" was the phrase that Goethe, the great German writer, used to describe his own autobiography. He recognized the degree to which he was reinventing himself by altering reality and explaining misdeeds. Memoirs, autobiographies or life reviews do not necessarily represent the unvarnished truth, but they are the last possible edition of the volume each of us has spent a lifetime creating and amending. Written or spoken, life review is a last effort to integrate and reconcile one's public and private selves.
In the end, the construction--and the reconstruction--of each life can become an act of celebration. As our life story nears completion, each of us has the opportunity to try to come to terms with its moral, personal and emotional dimensions.
Marcel Proust wrote in In Search of Lost Time, "If we mean to try to understand this self, it is only in our innermost depths, by endeavoring to reconstruct it there, that the quest can be achieved."
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