Supporting the Elderly

In this column, we historically have focused much of our attention on a potential reconfiguration of aging. Such a profound cultural shift seems to be on the agenda as our predominantly baby boomer generation approaches those incontrovertible milestones of seniority.

However, the previous generation that fostered this huge demographic has long since passed over that threshold. Many have been consigned to, or voluntarily incarcerated themselves in, rest homes and assisted care facilities around the country. Consequently, their children already have begun to confront the unpleasant realities of the present Western paradigm of aging, characterized by a profound marginalization of the elderly.

Even more disquieting is the docility with which this generation of our elders has chosen to acquiesce to this model. In the past few years, I have seen my mother and her sister (both formerly active, creative octogenarians) fearfully surrender their autonomy and their family homes in order to receive protection in the bosom of the elder care system. Each has embarked resolutely on that inevitable pilgrimage toward the next world, their steady progress abetted by liberal doses of "corrective" Western medications and immersion in an environment which might be described, at best, as minimally stimulating and, at worst, stultifying. Here, the omnipresent drone of television sets in room after room functions as a poor substitute for interaction with the outside world - the realm of the more youthful and vital. In the sterile precincts of "God's waiting room," even if the body remains somewhat hale, the mind quickly atrophies.

As an Oriental medical practitioner, it is more than a little frustrating to witness this latest downward trajectory of their lives. Some of their symptoms might be alleviated in time by our medicine and enable them to live out their remaining years to their fullest. However, neither will permit me to intervene. Their faith in the infallibility of Western medicine is absolute and acceptance of their lowered social status within our youth-besotted culture is by now a foregone conclusion.

I offer these observations by way of contrast with what my colleague, Kelly Clady-Giramma, contributes in the following article. With a viewpoint acquired during her recent sojourn in China, she presents a culture not unlike a variety of others around the world, both advanced and indigenous, where the wisdom and experience of the elderly is both honored and celebrated and they remain a valued part of society.

Aging: A Cultural Construct

"Youth is the gift of nature, but age is a work of art." - Stanislaw Lec

"When grace is joined with wrinkles, it is adorable.There is an unspeakable dawn in happy old age." - Victor Hugo

When Americans think about what it means to grow old, they often have negative associations such as wasting away in loneliness in a convalescent home, having limited financial resources, being in constant pain, suffering from memory lapses or even Alzheimer's - being generally unwell and unhappy. Ask a typical Chinese person what they associate with aging and they likely will paint a much different picture: being surrounded by family members of all ages, being respected by family and society, enjoying playing cards every day with neighbors their own age, having a certain amount of aches and pains but not being incapacitated, taking grandchildren to school by bike and enjoying leisure time that they didn't have in their youth.

These contrasting stereotypical pictures of aging do not always mirror reality. They do, nonetheless, illustrate the large influence society can have on an individual's aging process. Having spent most of the past three years living in China, I was affected deeply by the love and adoration people have there for the elderly. Although many Chinese have adopted more Western, quick-paced lifestyles in the past 10 to 15 years, they still adhere to the Confucian ideal of honoring their elders. They don't merely just give up their bus seats to older folks, they integrate them into every aspect of life. I believe it is this attitude in large part that accounts for the fact that seniors in China, often with deep wrinkles and weathered faces from years of struggle and hardship, still have vibrancy and serene contentedness I've rarely observed in their American peers.

Young people in China seem much less assured and confident than their parents and grandparents despite the fact that most of them have grown up with material comfort previously unknown to past generations. These fortunate young Chinese, unfortunately, rarely have the time to enjoy themselves. From the time Chinese children begin preschool, life is all about passing various exams and pleasing parents and teachers. There is little time for true relaxation until college which, according to all my Chinese friends, is far less stressful than their elementary and high school years. After college, they begin the serious business of finding work in China's ever-competitive job market, next comes a spouse and then that long-awaited grandchild who will be doted on and sacrificed to the nth degree by both parents and two sets of grandparents. If these goals are not fulfilled by age 30 or so (earlier for women), they will be looked down upon a bit by all but the most liberal-minded families.

Fast-forward to retirement. Assuming that a person in their 60s in China has at least one responsible adult child on whom to rely, they can finally live a little. (It should be noted, however, that childless Chinese run a similar risk to their American counterparts, in that governmental and pension support is not as much as it used to be in the old days of Communism. The proverbial Chinese "iron rice bowl" has indeed been broken by current-day capitalistic economic practices.) Old people are seen in China as offering a lot of experience and wisdom and they are respected for having survived so long.

The Race Does Not Necessarily Belong to the Swiftest

Survival is a concept not taken lightly throughout Chinese history. This probably is the reason why Chinese traditionally didn't mark birthdays until they turned 60 years old. To this day, grandparents get big parties with a lot of to-do and children usually are just given a bowl of special noodles (a sign of long life) to mark their far less auspicious birthdays. The attitude is "Anyone can be young; it takes talent to be old!" A person's 80^th birthday is believed to be the pinnacle of life that everyone aspires to and every birthday after that becomes more and more special.

What a contrast this is to our own adrenaline, youth and speed addicted society. To slow down here in any way, even temporarily, implies weakness and inferiority. It is interesting to note that, according to TCM medical theory, children are "pure yang," a fact that anyone who has tried to chase a toddler around can attribute to! It is a misnomer, however, to assume that old people must be "pure yin." The whole point of life, according to Chinese medicine, is to try to retain as much of your yang energy, vitality and health as possible throughout every stage of life. (This is why those same hyperactive toddlers need to sleep so much!) What may perplex some adrenaline junkies is that the only way to have any yang (warm, energetic, active) energy left over when you get old is by balancing it with yin (restorative, cooling) activities and behaviors before you get old. Rather than the theory "use it or lose it," we might substitute instead with "abuse it (your body) and lose it!"

The intention of Chinese medicine is to provide tools for cultivating healthy yang qi and vitality. The Taoist sages who originally laid down the precepts for Chinese medicine wanted a way to achieve immortality. They weren't concerned with remaining young per se, they simply wanted to remain healthy and live a long, and possibly indefinite, life. The three main ways to do this, they believed, were through proper diet, using medicinal herbs and learning to strengthen inner qi through mind-body exercises such as tai chi and qigong.

There are numerous references to longevity and good health for the old in contemporary TCM curriculum. The herb wei ling xian (Clematis root) is well-known for its ability to treat wind-damp-type arthritic pain. Its name in Chinese literally means "Awesome Spiritual Immortal." Then there is the Yang Lao point (SI 6) which means "To Nourish the Old" (hence, the title of this piece), and which is famous for treating low back, neck and shoulder pain in the elderly.

In China, beauty is not something which is merely confined to the young, though there is tremendous pressure on young women and men to be attractive. In fact, it often is a requirement for gainful employment these days. Older generations are seen as having inner strength and beauty which gives them a sense of pride and dignity.

Older Chinese people preserve their vital qi with many health-promoting strategies. They frequently take tonic herbs such as ginseng (ren shen), reishi mushroom, cordyceps (dong chong xia cao) or the formula jin cui shen qi wan to preserve their kidney qi. Another phenomenon, which anyone who has traveled to China has witnessed, is that many older people do tai chi or other outdoor exercise for an hour or more per day, come rain or shine. The idea of being fit is not reserved for the young. In fact, exercise is a luxury for which most Chinese in their 20s and 30s cannot find the time, whereas their grandparents have ample time to while away the hours stretching and doing qigong or tai chi in the public parks. Many Chinese people in their 70s and 80s can put young American yoga enthusiasts to shame with their muscular strength and joint flexibility. I commonly saw people two generations older than me kick one leg up to their nose with grace and ease I haven't personally experienced since I was 25!

In contrast to China's reverence for the old, America's obsession with youth comes in large part from an inability to accept the impermanence of life. TCM theory states that human beings are merely one aspect of nature and thus go through the same phases of birth, growth, decline and death. The Chinese know this and don't fight tooth and nail against getting older the way Americans are prone to doing. It would be unthinkable for a Chinese woman in her 60s to contemplate plastic surgery to erase facial lines. The face throughout Chinese culture has been thought of as the canvas for character and personality. To artificially take away these character lines, which elderly people in China often view as their badge of experience, would be absurd. They are far more likely to be concerned with maintaining a healthy head of hair which, in keeping with Chinese medical theory, shows their good blood and kidney essence. This is why both older men and women often take he shou wu (literally "black-haired Mr. He") to nourish their hair, and why it's not uncommon for people to color their hair with black shoe polish! Vanity, as with beauty, would appear to also affect all generations.

Hopefully more and more Americans can learn to appreciate these Chinese ideas about graceful aging. The Chinese seem to understand that by taking care of their health in their younger years - staying socially involved with friends and family, taking time on a daily basis to rest and relax, and finding stimulating ways to use their minds and bodies - it is indeed possible to achieve a kind of longevity. It may not be the immortality sought by the Taoist sages, but it seems a much better quality of life than what's often practiced in the West. I'd like to think that I'll be taking my grandkids back and forth to school by bike like the Chinese when I'm in my 70s. If not, maybe I'll move to China so I can play Mahjong, do tai chi with my friends and get a little respect!

Afterword

The ancient world, in many ways infinitely more wise than our own, acknowledged that the entirety of creation was in a process of ebb and flow, from un-manifest potentiality to manifest existence. Our planet exhibits this dynamic to us in the perennial cycle of the seasons (the five phases) in periods of birth, growth, maturity, decline and quiescence. We, too, according to the precepts of Chinese medicine, participate in this same rhythm of being and non-being in our individual lives. The Western world seemingly has harnessed its wagon to the stars, ever looking upward and outward from terra firma. Nevertheless, we are rooted here, and it is to that native soil - that nourishing feminine matrix - that each of us must, in due course, return.

Can we here in the West learn to acknowledge, like the Chinese, that each step of the journey is of equal significance? Can we learn from them how to mature gracefully, with dignity, embracing a way of life that supports the elderly, respects wisdom and celebrates aging? Most importantly, can we surrender our fear of impermanence and our desperate grasping after an eternity of youth?