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Desmond O’Neill: A gerontological fear of missing out

18 Nov, 14 | by BMJ Group

desmond_oneillFaced with a gerontology conference with 30 parallel sessions over five days, the texting argot of teenagers comes in handy. To LOL and YOLO has been added FOMO: Fear of Missing Out! Effective FOMO management strategies involve several ingredients. The first is not change between sessions as invariably the timetable has changed in the other room, undermining the experience of both sessions.

The second is reassurance that repeated scrutiny of the programme book to choose sessions bestows a flavour of the hot issues in gerontology. Mixing during coffee breaks and receptions to hear what other delegates found interesting is equally important.

Finally, the poster sessions offer the best opportunity to pick and mix, as well as for serious discussion. Platform presenters are as moved by fear of looking foolish as by science, so dialogue at oral sessions tends to be correspondingly less free-ranging.

At last week’s Gerontological Society of America meeting in Washington DC , the leading annual scientific congress on ageing, the choice was again awesome, from cell biology through geriatric medicine to transport and policy. The ever increasing profile of ageing in society was highlighted by the keynote address of Dr Francis Collins, the director of the US National Institutes of Health (NIH).

Ageing is now integral to the work of many of the 42 constituent institutes of the NIH, particularly the Brain Project and the Cancer and Genetics institutes, and not just to the National Institute on Ageing. The clear enthusiasm and focus of Dr Collins’ presentation was invigorating, and will have gained many new readers for his excellent NIH blog .

Blending in with more than 4000 delegates, I chose sessions largely related to the humanities and ageing, and in particular the philosophy of ageing, which proved very rewarding.

Analogous to the relation between the medical humanities and medicine, these aspects of gerontology seek to illuminate the deeper and wider meanings of ageing through engagement with scholarship in the humanities and the arts. As outlined by Thomas Cole , three ingredients are intrinsic. Through compassion we recognize our vulnerability and emotional, moral and spiritual response to others; we acknowledge the relationship between knower and the known; and we seek an emphasis on moral and spiritual aspects of growing old, especially meaning.

The parallel with the medical humanities was underlined by a marvellous presentation by Rita Charon, the doyenne of narrative medicine, in a lecture celebrating the late Gene Cohen, whose pioneering insight was that late-life creativity occurred not in spite of old age, but because of it.

Charon illustrated her gentle delivery with a series of slides of Rothko paintings, underlining her key message that listening is an active and skilful process, yielding great dividends in patient care and clinician satisfaction.

The impact of the sessions on the philosophy of ageing gained particular impact from wide publicity given to an article in the October edition of the Atlantic Monthly by Ezekiel Emmanuel, “Why I Want to Die at 75.”

In presentations ranging from Aristotle to Martha Nussbaum , as well as an excellent discussion on the challenge (or futility!) of trying to quantify concepts such as gerotranscendence in quantitative studies, we were drawn into reflecting on wisdom and virtue through the prisms of gerontology, classical studies, and philosophy.

A particularly effective and gentle riposte to the Emmanuel piece was delivered by Hanne Laceulle from Utrecht , outlining its contamination by three pernicious and persistent popular narratives of ageing. These include that of Active Ageing, highly productivist and with little room for our existential vulnerability; the decline narrative of ageing; and the age-defying narrative, with its emphasis on staying young, not acknowledging growth, a self-effacing strategy doomed to fail and in denial of our existential vulnerability.

Turning to virtue ethics, we are reminded that what makes life good is intrinsically fragile: the emphasis on “control” in modernization can conceal this from us. Strategies to liberate us from this require a better articulation of living well and actuating the Aristotelian virtue of practical wisdom, in particular for dealing with the inevitable unexpected contingencies of life.

With ageing we can become our truest selves if we allow ourselves to embrace an alternative notion of activity, that of practicing the right attitudes. Virtue ethics aims at self-realization and flourishing while acknowledging the vulnerability of this striving. It also incorporates our fundamental social embedding, with its benefits and challenges.

Building resilience towards fragility requires a lifelong process of development and practice of relevant attitudes and qualities, balancing the demands of self and the world in a way that is flexible and context-dependent. In this way we can see practising virtue as trumping the unhelpful tropes of passively surrendering or actively fighting ageing.

It is tremendously reassuring to see such profound and often challenging debates embedded in mainstream gerontology, and bodes well for liberating the gift of ageing from the tired, negative, and limiting attitudes that persist in public life.

Desmond (Des) O’Neill is a geriatrician and cultural gerontologist in Dublin. He is also the local lead for the IAGG-ER Congress in 2015

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