Mindcrafting: How to mentor your ageing mind

by Declan Lyons, Deirdre Hussey, and Sinead O’Sullivan

Later life is frequently seen as a time of entitlement and an opportunity to reap rewards and translate the gains of well lived years into an annuity of quality living. After long years of working or child-rearing the retiree is presumably entitled to abundant leisure, an ample or at least an adequate pension and discounts or subsides such as free travel or a TV licence, not to mention good health and access to quality public services when required.

Expectations and reality tend to collide frequently in life though and old age is no different. Most of the privileges associated with the age of “pensionhood” are in reality poor compensations for the devalued status of older people, who have struggled to emerge from the crisis of Covid-19 and rebuild networks and social connections. The pandemic brought into focus layers of vulnerability from loneliness and isolation to the growing role of technology for the execution of many aspects of daily living tasks, leading to frustration and alienation from a disconnected world that not even serial vaccination could render safer or more inviting.

The notion that older people have anything useful to contribute to society is seldom entertained and because we fear our own demise intensely, indicators of the often cosmetic aspects of ageing worry many who perceive unwanted reminders of our own mortality. The morale and status of older people is frequently devalued, even scorned, when many of the older generation are devoid of power or gainful employment, as older workers are rarely perceived as useful in a volatile and changing gig economy. Society tends thus to distance itself from older people whether by failing to support older people’s independence through adequate home care - thereby leading to institutionalisation in nursing homes, or by dismissing and stereotyping all older people as being a burden or decrepit, dependent and infirm. The age stratification of society also runs very deep and contact between generations may be driven by obligation rather than a desire to learn from the other.

Older people often sadly collude with this stereotype and gracefully withdraw from many areas of life to make way for younger blood, but by doing so are they putting the dividend of their extra years of life expectancy at risk? Meanwhile, the years available to us continue to grow as humans have effectively doubled average life expectancy over the last 200 years which represents a great triumph for humanity as a whole.

Survival of the wisest
There is little doubt that older persons experience scapegoating for many of society’s ills such as hospital overcrowding or scarce social welfare provision and additionally may have to endure multiple losses that can accompany later life. Whether this is a decline in physical health, sensory impairments, the death of long-time friends or the loss of role and status since retirement and diminishing physical attractiveness - these losses may be encountered simultaneously and seem to validate the statement “getting old is not for sissies”. Some older people resort to melancholy and complaint in response to these insults on their selfhood and in revenge for society’s efforts to render an entire section of the population irrelevant and invisible.

It does not take too much of an imaginative stretch to see how these losses stack up and accumulate, each threatening to chip away at our psychological defences and self-image. Mental illnesses such as major depressive disorder not infrequently affect older people in the context of this extreme discouragement and such ensuing depression threatens to strip away quality of life, not just from the individual but also from those closest to them. Compulsory retirement also threatens the sense of purpose and meaning that we are primed to extract from life at all ages, never mind to deny the person an appropriate level of cognitive stimulation and challenge, crucial to staving off dementia and memory and cognitive decline.

While acknowledging the reality that later life can be a testing time, in writing the book Mindcrafting (Lyons, 2022) we wanted to showcase the benefits of continued activity and engagement and consequently the sense of meaning and pleasure that is attainable in later years. Opportunities for full participation by older people in society depend on their ability to remain hopeful and at the same time accepting of change and loss with grace and determination. It is still possible to thrive despite the presence of illness (which is neither inevitable nor untreatable) and older people have demonstrable depths of resilience that have seen them survive many crises and struggles as they flexibly adapt to stressors and changing circumstances. No illness or loss of function however should be accepted as a normal part of ageing. The demonstration of continued zeal to reach out and try new things (even ‘the dreaded technology’) that might improve their lives and above all to remain enthusiastic and committed, is for many the secret sauce of successful ageing.

The key emotional and psychological needs
Despite all the fears of and efforts to fight off the ageing process, on many levels remarkably little changes as we grow older. We are not evicted from our bodies, nor from our passions and interests and most people still feel largely the same on the inside, even if the exterior wall paint is cracking a little. Key components of human happiness are quite simple and they are something to do, something to look forward to and someone to love. If these and other key emotional and psychological needs are met and balanced in a healthy way, it is my view that much emotional and psychological distress and even clinical depression is either absent or significantly reduced in intensity.

Throughout the book Mindcrafting (Lyons, 2022) we refer to the set of organising ideas known as the Human Givens originally devised by Joe Griffin and Ivan Tyrrell in the 1990s (2013). The Human Givens approach has provided clinically useful list of human needs that are frankly directly applicable to many situations, whether the relevant issues relate to status, legitimacy or autonomy. This framework is a useful and practically applicable description of how humans function in terms of meeting key emotional needs and how our innate resources such as intuition, memory and enhanced awareness to name but a few, are deployed in meeting these needs. As a clinician working with older people, I have found that patients relate well to the therapeutic explanations and language of this approach which promotes insight and engagement, and this sets the scene for behaviour change and breaking of patterns. Meeting our universal emotional needs healthily and sustainably, such as the need for autonomy and status, among many others which may be especially imperilled during later years, is akin to living off a well- balanced diet for the mind. In fact, this foundation of needs and resource awareness is a sound basis for flourishing in old age - not just for individuals - but also for wider society. If older people could begin to appreciate that many of their higher order brain abilities such as reason, empathy skills and intuition actually improve with age, they may regain the confidence to stave off loneliness and isolation through active reconnection with and involvement in their communities.

Invest in your future self
As humans we tend to think of our future selves as different people and combined with a tendency to underestimate the pace at which time passes, we may be suddenly disorientated when confronted with the reality of our chronological score. Rarely do we creatively plan for our later years, our personal evolution and becoming – instead, denial, distraction and indulgence in youthful fantasy tends to prevail. Yet this stance may be abruptly shattered, and we can suddenly be confronted with reality as we realise all that we love and cherish and even our own existence is finite. This may happen when we are politely offered a seat on a bus or a train or finding ourselves meeting criteria to be admitted to under “geriatric” services in hospital, or even the shock of a health event when all those assumptions we had about our bodies standing up to years of punishment are finally imploded.

All is not lost, however, and old age does not have to be equated with inevitable disability and disease. Nor are our later years invariably fraught with grief and the stress of ageing. Older people can recover from many acute illnesses, in reality just as well as younger people, when given adequate time to do so. The development of many specialist services for older persons is all about restoring independence and optimal functioning through intensive rehabilitation and the bringing together of expertise from many healthcare disciplines. Sophisticated, person-centred healthcare, of which older people as a group are the main beneficiaries, will increasingly reduce disability and morbidity. Altered lifestyles and habits such as healthy eating, movement and exercise even undertaken in later life can significantly improve one’s quality of life. Appropriately adapted technology will allow greater independence for an older generation who will be able to ‘age in place’ rather than be admitted to a continuing care facility. There will be ever increasing future research about the forms of intellectual stimulation that will be relevant in relation to improving brain neuroplasticity, with all the potential to delay or prevent memory loss and even dementia.

Older people are an increasingly diverse, heterogenous grouping in society and will look for role models and desirable reflections of their own potential in contemporary culture, to challenge any growing invisibility imposed upon them by younger cohorts. Older people will realise their considerable economic leverage as one of the great untapped markets of the twenty first century and will use this to design services, supports and experiences tailored to their own needs as they recast the third act of their lives as a time of opportunity, potential and personal reinvention. Their ability over many years to selflessly contribute to the welfare of others and to identify with fairness, equity and justice will be an important moral resource for the next generation, and consequently many have justifiably benefitted from universal state supports and entitlements which sadly are increasingly eroded in many economies. Although ageing involves a variety of processes, namely biological, psychological and social, the ultimate challenge is to move away from overcoming the inherent nature of old age and its association with death, and to transcend any infirmity through our attitude, our behaviour and especially our social institutions.

Charter for action
In essence the idea that motivated the book Mindcrafting (Lyons, 2022) was to encourage older people to take controlled risks in their lives rather than adopting a safety-first approach, to continue to view their lives as an adventure and to commit to see what was around the next corner by remaining interested, enthusiastic and engaged in as many aspects of life as possible. Setbacks in the form of illness and loss are inevitable to some extent but for those who struggle to define themselves in the absence of a career and paid employment, over identification with illness and disability can block the attributes of resilience and wisdom which allow us to retain good humour and interest in other human beings. Even as the curtain closes, the example of dignity and tenacity that older people can display is of inestimable value to the next generation. Stoicism can be the very essence of survival during the ups and downs of life and older people, by definition, have cultivated this in spades, but guarding and maintaining independence is equally key to that positive self-perception as a competent and responsible adult, as opposed to being a dependent and helpless object that has to accept exclusion and marginalisation. The search for meaning and the meeting of key emotional needs, against a backdrop of an affirming social environment and the recasting of the idea of community, are surely the best ways to ensure our elders can squeeze every last drop out of life.

Dr Declan Lyons is a Consultant Psychiatrist at St. Patrick’s Mental Health Services, James’s St, Dublin 8, and Clinical Associate Professor in Psychiatry at Trinity College Dublin.

Dr Deirdre Hussey is a Registrar in Psychiatry at St Patrick’s Mental Health Services Dublin.

Dr Sinead O’Sullivan is a Registrar in Psychiatry at St Patrick’s Mental Health Services Dublin.

References

Griffin, J. & Tyrrell, I. (2013) Human Givens – the new approach to emotional health and clear thinking. HG Publishing

Lyons, D. (2022) Mindcrafting: How to mentor your ageing mind. Beehive Books.

IAHIP 2023 - INSIDE OUT 100 - Summer 2023