Associate Professor of UAM, Madrid.
Senior Lecturer of Sechenov University, Moscow.
President of The Doctor as a Humanist
- Death comes to us all
- Ageism according to the World Health Organization
- Evolution vs. medical progress
- Healthcare Taboos
- Death: something we deal with but not talk about
The Clowes self-portrait in Indianapolis is one of the earliest of the over 75 known self-portraits by Rembrandt and is probably his first attempt to capture the features of the human face accurately in a life-sized work. Painted when he was only 23.
Death comes to us all
When asked to write this text about ageism a few images and words came to mind; not least the poem by Dylan Thomas, Do not go gentle into that good night written in 1947 but later published in 1951. It has been suggested that the poem was written about the death of the poet’s father, however, he did not die until 1952. Nevertheless, it is a poem written by a young man urging defiance against death,
“Do not go gentle into that good night,Thomas D. The Collected Poems of Dylan Thomas 1934-1952. New York: New Directions Books; 1971.
old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Its power also comes from the fact that Dylan Thomas was only 33 when he wrote the poem and died only six years after writing it.
Death comes to us all, death cannot be escaped, even by the Silicon Valley millionaires searching for a Dorian Grey potion, since if there is one thing, we know for sure it is that we are born and that we die or in the words of another Celtic writer, Samuel Beckett, “They give birth astride of a grave, the light gleams an instant, then it’s night once more.”
Ageism according to the World Health Organization
But what is ageism, and is it the new taboo? The WHO defines ageism as “the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age.” The same organisation states that between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22%. This is an enormous increase and will indeed increase the burden on healthcare systems around the world since getting older is associated with the emergence of different geriatric symptoms, often the consequences of different underlying factors, including frailty, urinary incontinence, falls, delirium, and pressure ulcers.
Doctors and health care professionals need to deal with these problems of ageing, in which patients often need to take dozens of tablets a day. Indeed, ageism is perhaps a direct result of the great advances in medicine in the last 50 or 60 years, at least in the western world. It is a vicious circle; we live longer and because we live longer, we are prone to have a wider variety of molecular and cellular damage, i.e., diseases.
Evolution vs. medical progress
Danielle Ofri says, “Our bodies evolved to live about 40 years,” I always explain, “and then be finished off by a mammoth or a microbe.” Thanks to a century of staggering medical progress, we now live past 80, but evolution hasn’t caught up; the cartilage in our joints still wears down in our 40s, and we are more obese and more sedentary than we used to be, which doesn’t help.
But are we living in a society (I refer predominantly to the western society I live in) where older people are discriminated against? This is possibly true; we are living in a world that continues to run at full tilt, and even the pandemic, which I thought might lead us to reset our priorities and values and begin to look towards the critical issues of the day; our relationship with nature, how wealth is distributed etc., seems to have been forgotten with great speed. We seem to be running faster but the only problem is nobody knows where we are running to or perhaps, they do, but do let on. Oblivion?
And what about ageism is it the last taboo? And what is taboo? The term “taboo” comes from the Tongan tapu or Fijian tabu (“prohibited”, “disallowed”, “forbidden”), related among others to the Māori tapu and Hawaiian kapu. Its English use dates to 1777 when the British explorer James Cook visited Tonga and referred to the Tongans’ use of the term “taboo” for “anything that is forbidden to be eaten or made use of”. Some argue that contemporary Western multicultural societies have taboos against tribalisms (for example, ethnocentrism and nationalism) and prejudices (racism, sexism, homophobia, extremism, and religious fanaticism).
In healthcare there have been many taboos, cancer was a taboo word – named the “C” word. That is not the case now, and mental health was seen as taboo; perhaps it still is but to a lesser degree. Fortunately, mental health is now beginning to be seen as another disease, and not a taboo subject. This is, in part, could have been helped by the COVID-19 pandemic, where the virus was quickly followed by lockdowns and a plethora of cases of mental illnesses due to loneliness and the fact that it was impossible to say goodbye to one’s dying family members with dignity and love.
Death: something we deal with but not talk about
This brings me to what I believe to be the main issue here, and that is death. Death, or talking about death is STILL a taboo. I remember a few years ago dedicating a whole class on death with Spanish doctors, and one of them, an experienced A&E consultant, came up to me afterwards and said, “Thank you, Jonathan. Even though we deal with it daily, it is not something we usually talk about.” I was surprised, to say the least, but his words came back this year when I read Rachel Clarke’s beautifully moving book on palliative care and death, called Dear Life (6). I will end with a quotation from this book in which she quotes Oliver Sacks, when she is dealing with, and consoling, her dying father.
In an attempt to salve my anticipatory grief, at night I read a collection of essays by the late neurologist and author Oliver Sacks. Published posthumously and written shortly after his own diagnosis of terminal cancer, sacks’ final thoughts, on looking back over eight decades of living and loving, are overwhelmingly those of thankfulness. Entitled Gratitude, the book concludes,
‘I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved. I have been given much and I have given something in return; I have read and travelled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers. Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and this in itself has been an enormous privilege and adventure’.Sacks Oliver and Bill Hayes. Gratitude. First ed. Alfred A. Knopf ; Alfred A. Knopf of Canada 2015.
- Thomas D., The Collected Poems of Dylan Thomas 1934-1952. New York: New Directions Books; 1971.
- Beckett, S., Waiting for Godot. London, England: Faber & Faber; 2006.
- WHO Fact sheet: Ageing and health; 1 October 2022.
- Danielle Ofri, ‘The Conversation Placebo’, in New York Times January 19, 2017.
- “Taboo” in Wikipedia.
- Clarke, R., Dear Life: A Doctor’s Story of Love and Loss. New York: Thomas Dunne Books; 2020.
- Sacks O. and Bill H., Gratitude. First ed. Alfred A. Knopf. Alfred A. Knopf of Canada; 2015.