Richard Smith: “Longevity is one of the greatest curses introduced by the scientists”

Richard Smith“Longevity is one of the greatest curses introduced by the scientists,” wrote Evelyn Waugh in a letter to Harold Action in 1961, a few days after his 58th birthday. I read this a few days after I had given a talk on the pandemic of NCD (non-communicable disease) where I emphasised that the pandemic was the result of “success” in extending life expectancy. But could Waugh be right?

Minutes after reading Waugh’s statement I read Matthew Arnold’s bleak poem on growing old, written in 1867, when he was 45.

Growing Old

What is it to grow old?
Is it to lose the glory of the form,
The lustre of the eye?
Is it for beauty to forego her wreath?
Yes, but not for this alone.

Is it to feel our strength –
Not our bloom only, but our strength -decay?
Is it to feel each limb
Grow stiffer, every function less exact,
Each nerve more weakly strung?

Yes, this, and more! but not,
Ah, ’tis not what in youth we dreamed ‘twould be!
‘Tis not to have our life
Mellowed and softened as with sunset-glow,
A golden day’s decline!

‘Tis not to see the world
As from a height, with rapt prophetic eyes,
And heart profoundly stirred;
And weep, and feel the fulness of the past,
The years that are no more!

It is to spend long days
And not once feel that we were ever young.
It is to add, immured
In the hot prison of the present, month
To month with weary pain.

It is to suffer this,
And feel but half, and feebly, what we feel:
Deep in our hidden heart
Festers the dull remembrance of a change,
But no emotion -none.

It is -last stage of all –
When we are frozen up within, and quite
The phantom of ourselves,
To hear the world applaud the hollow ghost
Which blamed the living man.

Why, I wonder, did Arnold have such a bleak view of old age at 45? But as a poet he’s by no means alone in his view. Philip Larkin expresses similar thoughts in The Old Fools, referring to old age as “The whole hideous inverted childhood.”

What do they think has happened, the old fools,
To make them like this? Do they somehow suppose
It’s more grown-up when your mouth hangs open and drools,
And you keep on pissing yourself, and can’t remember
Who called this morning?

Larkin was 46 when he wrote that poem. Arnold died aged 66, Larkin at 63, and Waugh at 62. Waugh was a devout Catholic and may have been looking forward enthusiastically to the afterlife. In a letter written in 1962 he objects to a “turncoat” being elected to parliament and writes:  “It shows there is no justice in this world and that one must look to a life beyond the grave to regulate the accounts.” Lady Marchmain in Waugh’s Brideshead Revisited makes clear that what happens in this life matters little, it is the next life that matters.

I don’t believe in an afterlife, and I’m 61, close to the age at which all three writers died. Two weeks ago I walked a hundred miles along the Devon coast with others in their 60s, and none of us found it much of a difficulty. I can’t say that I feel old, so far I’ve been remarkably lucky with my health—my greatest suffering being homesickness when I was 10.

But I have a profound respect for poets, perhaps too profound, and I thought of Waugh’s statement on longevity as yesterday I visited a residential home that might take my mother. She is 83 with no short term memory, but remarkably jolly. I think I know that my 45 year old mother, who at that age used to visit her demented mother in a home, would not have wanted to be as she is now. But is that relevant now she’s 83? She is as she is, but does anybody enjoy being in a residential home? There is singing, painting, eating, and disjointed conversation, but the main occupation is waiting for death, a wait that can seem long. “Who benefits,” asks Lewis Lapham, another great writer, “from the inventory of suffering gathered in the Florida storage facilities?”

Anthony Trollope, one of my favourite writers, wrote in The Fixed Period about an imagined new colony that recognised the uselessness of the old, how they cost much, but contributed little. So at age 67 they were “deposited” in a college where they reflected on their life for a year before being compulsory euthanased and then cremated, itself controversial in 1862 when Trollope published his book. The debate in the book is that the first person to enter the college, he who proposed the system, has second thoughts. Trollope was himself 67 when the book was published, and he died while still 67.

The great doctor William Osler referred to Trollope’s book in his farewell speech at Johns Hopkins, was misunderstood as having advocated euthanasia (at 60), and received worldwide condemnation.

What is the “right” age at which to die? WHO agreed with the Bible last week at the World Health Assembly when it defined premature death as death under 70, but some militants, like Iona Heath, former president of the Royal College of General Practitioners, have suggested 60. (She is, I guess, at least as old as me and possibly older.)

Perhaps even Waugh might agree that what matters is healthy life expectancy, which is unfortunately and unsurprisingly not as easy to measure as total life expectancy. At the moment, according to the Office of National Statistics, healthy life expectancy for men in England is 64, meaning that a fifth of life is spent in ill health. At the last count the proportion of life spent in good health was rising in England and Wales but falling in Scotland and Northern Ireland. The pandemic of obesity and diabetes could well mean that the proportion of healthy life will fall.

So perhaps Waugh is more right than wrong, but, as a Mexican friend reminded me while I was writing this blog, Susan Ertz noted that “millions long for immortality who don’t know what to do with themselves on a rainy Sunday afternoon.”

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.