Sky Above Clouds: Finding our Way Through Creativity, Aging, and Illness

By Wendy L. Miller and Gene D. Cohen (with Teresa H. Barker)

The following is an excerpt from Sky Above Clouds: Finding Our Way Through Creativity, Aging and Illness. Oxford University Press; $27.95; ISBN 9780199371419, 352 pages, reproduced by permission of Oxford University Press.

The book Sky Above Clouds explores the power of creativity in facing challenges and managing loss and adversity in later life. The book is written by the late Gene Cohen and his wife, Wendy Miller. Cohen is a renowned expert on growing older and on creative potential in later life. Few knew that in his life, aging was by no means a theoretical or professional experience alone—he aged through the biological process of a metastatic cancer to his bones, which he faced from age 51 to his untimely death at age 65. Sky Above Clouds is about the challenge and the aliveness of both cancer and creativity, how they fight one another, grow, intertwine and, ultimately, how they change us and change our relationship to how we see ourselves. The book is a conversation between husband and wife, with Cohen’s writing in italics, and Miller’s in roman text.

Excerpt from Preface

This book tells the story of what happens when life’s challenges open a new quadrant of existence in our lives. I experience this opening as an existential crack in the personal universe that we have understood up to this point: a crack where both the light and the darkness of vulnerability appear; a crack that reveals the thin veil of another world we may or may not have a desire to enter or even know. Sometimes this crack occurs through a new opportunity; more often, we face it by way of loss or grief, illness, injury, accident, age, or death. At other times we are thrown into this shift in awareness by the pressures of developmental growth or healing, courage or resilience.

When we face challenges of health and age, the light that comes through this crack in the universe can appear reflective or unfamiliar, even as it holds the potential for new discoveries. What pathways of understanding will we discover through this new light? What other qualities accompany the empathy and compassion which so often seem to shine through the light of this existential crack? This book illuminates both the shadowy depths and the safe harbors of this experience.

One of our favorite artists was Georgia O’Keefe, who, although she loved to travel, did not fly until later in her life. That new aerial perspective appears to have been especially significant as a visual experience for O’Keefe. In the 1960s she painted first a river series, and later, in her 70s, her cloud series. Each painting in the cloud series was titled “Sky Above Clouds,” along with an identifying number, color, or year. These works are dramatic—in size, color, abstraction, and image.

In his talks and presentations on creative aging, Gene frequently referred to O’Keefe’s “Sky Above Clouds” paintings as the new metaphor for aging. This was the way we should envision aging, and approach it. As O’Keefe indicated in her paintings, even with her fears of flying, even in spite of her age or any illnesses, there is always sky above clouds.

I have chosen to title our book Sky Above Clouds to honor Gene and his vision, to honor O’Keefe and hers, and to honor—in each of us—our own process of creative aging.

Even as Gene’s cancer grew, as did his struggle, his focus was not on his illness but on his career-long push for the paradigm change in our view of aging. One of his final formal “presentations” was as an expert witness in a court battle that was historic in this regard: a fight for the dignity—and fortune—of one of the nation’s most celebrated philanthropists of the twentieth century. The elderly matriarch, Brooke Astor, had been dead two years, and the verdict that would decide the fate of her multibillion dollar estate would rest heavily on Gene’s expert testimony about nuances of aging, illness, and mental acuity. In a larger sense, he was there on a mission to protect a vulnerable population, the elderly, from exploitation. What we did not know in those three dramatic days on the witness stand was that his testimony, which represented a culmination of his life’s work, would become his closing argument for life as he confronted his own death. On the witness stand, as in his life and work, Gene’s intellect, his courage, and his resilience ultimately ruled the day.

Most of all, though, this book is the story of a miracle. Gene’s story is in clinical fact a medical miracle evidenced in the years, the statistics, the prognosis, the outlier status, the going beyond the predicted and the unexpected. Outliers are by definition medical miracles, living outside, beyond the time that the clinical calculations would suggest for a person with a terminal illness.

Cover of the Book titled Sky Above CloudsThis miracle put to the test every bit of the theory, research, and science to which we had devoted our careers in the fields of creativity and the brain, adult development, and human potential. In essence, we were granted a unique opportunity to observe, cultivate, and experiment with our own capacity for creativity in meeting adversity, navigating the inner life and outer complexities that illness or loss present: creativity not solely in the conventional sense of making art but creativity in what we make of our circumstances and how we respond to them. Creativity as the catalyst for human resilience is the real miracle story, and it does not have our names alone on it. This way of living into life does not require a medical miracle, but it may contribute to one, as science is beginning to show in the study of the brain and the mind, as well as creativity, illness, and healing.

Excerpt from Part III, New Landscapes, from Chapter 9, “Mirror, Mirror”

At some point, we begin to see or perhaps sense in other ways an emerging awareness of the multiple selves that we are. The metaphorical mirror is the tool we use to integrate all the images of all these selves: past, present, and future, ours and others, the self as the disease’s reflection, the healing self’s reflection, and the reflections of aging and the living with age. The mirror is the container of the entire phenomenon of self-recognition.

Gene held the mirror up to the process of aging to think about his role and responsibilities as a physician in these processes. He used the idea of the mirror reflection explicitly to talk about how society’s view of aging had been distorted for so long, and his desire to call attention to that and, through his work, help bring about a shift in that perception.

I was a very young-looking 30-year-old when I was appointed the first chief of the newly created Center on Aging at the National Institute of Mental Health in 1975—the first federal center on mental health and aging established in any country. I was self-conscious about holding such an important position on aging with such a prominent appearance of youth. So a make-over went into gear—I grew a beard, donned a bowtie, and purchased a professorial-looking pair of glasses. Now, 34 years later, as the Beatles’ song goes, “When I’m 64,”my appearance because of the cancer has changed beyond that of normal aging.

Gene reflected on the power of a medical prognosis to affect the way people see us and make assumptions about us in so many ways—just as the hotel clerk in Costa Rica had done in assuming that Gene was my father. This reflection of ourselves as others see us in the medical mirror presents a new challenge to the self, particularly if we are by nature an emotionally open and sharing person, as Gene was.

I think back to the several weeks following my initial diagnosis in 1996. Several health personnel involved in my treatment and close friends asked me what my plans were. In my mind, my reflex reaction to that repeating question was “I’m not dead yet, so I choose to live,” meaning I certainly don’t plan to withdraw or give up on what has been important to me. I learned that was a good choice when I was misdiagnosed with ALS. I figured to follow the same formula here.

… I felt I had to pay attention to my prognosis, at the same time recognizing that any statistic is accompanied by variation in the form of what statisticians and physicians refer to as outliers. Reality and hope are not incompatible.

I returned to work with nobody knowing my diagnosis. Only very close family, a few very close friends, and those involved in my treatment knew my health status. This was the same strategy I adopted when I thought I had ALS. For the time being, I wanted the opportunity to know my own thoughts and come up with a strategy without being overwhelmed by irritating comments, no matter how well intentioned they were.

Knowing that I would pay a heavy emotional price for being less open than I would have liked to, I also was wary. ... Would … grantors really be as interested, I thought, if they knew I had metastatic prostate cancer along with its bad prognosis? At the same time I took steps to protect the grants and the funders by working with a very talented team that could certainly maintain the same quality of effort if I had to step back or drop out.

The mirror darkened as Gene began to experience the deep “dips” into terror-filled darkness. And yet, as he reflected on his experience he became aware of a dual nature of these episodes: both gripping him with fear and releasing in him a sense of relief and possibility … .

I returned to work very shortly after my diagnosis, and tried to resume activities, filling the day with them. It went well each day until I left the university to go home. When all the stimuli of the day that also served as distractions to my cancer thoughts waned, a darkness began to slowly descend on me. Sometimes it was so powerful, that I would have to pull over to the side of the road as the darkness completely engulfed me, feeling in total blackness sensing no life, light, or beauty around me. I would have sought psychiatric help then, but the descent into darkness though extremely intense was also brief—usually for about 15 minutes. It would then be followed by a steady emergence out of the darkness and a new feeling that there was something I might be able to do, accompanied by intense mental exploration of possibilities. And the mental exploration felt good, like a creative pursuit. This feeling was more engagingly powerful than any related prior positive feelings I had experienced, and I didn’t want to do anything to lose it.

I did wonder if I was becoming bipolar, but the deep dark dips, though dreadfully awful while in them, were transient and lifted into an elevating feeling that was focused. If the feeling had moved in a manic direction, disrupting my family life and work, I would have sought professional help. Instead, out of those elevated feelings came the realization that what I needed to do was something akin to my experience with developing a game to cope with the dark moods that followed my misdiagnosis of ALS.

Now Gene’s passion for his work filled the mirror. He intended to create a new mirror on aging for society and for individuals to see themselves anew with inherent value and vast possibility.

It was then that I realized my work had become all about creativity and aging, and no book had been written totally focused on that topic.

This strategy of creative immersion in my writing and work, combined with my strong circle of love at home, helped me to maintain a positive mood most days, despite the clouds that hovered around me and the circumscribed free-fall mood dips late in the day. This period of my life following the diagnosis of cancer has proved to be my most creative in the research I have conducted and the books I have written—a powerful and poignant illustration of the influence of adversity on creativity, and in the second half of life.

Up until the last quarter of the 20th century, aging was largely equated with a series of decremental, unalterable changes with the passage of time. Significant decline with advancing years was seen as inevitable our destiny. Dementing disorders were collectively viewed as “senility,” a term than connoted the natural course of growing old. But by 1975 what the allegorical mirror revealed was the stirring of a fundamental conceptual change in how negative events with aging were being interpreted. The first of two major sea changes in thinking about aging in the last quarter of the 20th century was in process. There was an emergence of new hypotheses that attempted to explain decrements that accompanied aging not as representing normal aging, but instead reflecting age-associated problems [as] modifiable disorder[s].

The transition from seeing progressive, unalterable negative changes with aging as being one’s destiny with growing old to a new view of modifiable age-associated problems was a huge leap in itself. The culmination of the problem view of aging came with the concept of “successful aging,” defined in 1988 as aging that reflected the minimum number of problems—the minimum degree of decline—as opposed to “usual aging” that reflected more problems, more decline. While this was happening it was too big a leap to go to the next step—to see that aging could be accompanied by potential and growth beyond problems and decline. But by the end of the 20th century, the view that aging could be accompanied by potential beyond problems was emerging. The “potential” focus of aging reflected the emergence of the second major conceptual sea change about aging and is documented in my book The Creative Age, the first book totally focused on creativity and aging, published at the start of the 21st century. The ultimate manifestation of potential with aging is creativity. By the start of the 21st century, the allegorical mirror was reflecting aging as one of the fairer of the fields in medicine.

Four major factors in particular stand out as affecting the changing image of aging in the allegorical mirror:

  1. The discovery of positive changes in the aging brain and mind that occur because of aging, not despite aging;
  2. The increasing awareness that aging adds as it takes away;
  3. A new view of aging as perhaps the best example of the whole being greater than the sum of its parts;
  4. Growing recognition and understanding about what we ourselves can do to promote brain development.

For so long science and society focused only on what was taken away with aging—that’s all they saw in the allegorical mirror. But as our understanding of aging progressed, what was observed in the “mirror” changed.

All of Gene’s reflections in the metaphorical mirror culminated in greater clarity about his life purpose and passion. The images emerging in the “mirror, mirror on the wall” had continually changed in response to how others perceived him, and that had challenged his own perceptions of himself. It was clear that he was joyful to rediscover the man he knew looking back at him.

Finally, I came to appreciate what so much of my life and professional career have been all about teaching, sharing information, and helping to improve the quality of life of others. This is what I do as a researcher and as a doctor. It is what excites me, fulfills me, and affords me the chance to make a difference for others.



Editor’s Note: This excerpt accompanies the “In Focus” section of the January/February 2017 issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.