One hand on the reins

My mother used to call it autonomy… having none herself, she gradually sank into a pit my father later characterized as Alzheimer’s. And that may well be, but it was his tyranny, not some physical cause, that triggered it. She simply had nothing to do. He shopped, he cooked, he gardened.

We've known for some time that having choice…and something or someone to care for…enriches life experience at any age; and for people in nursing homes, even a plant to water and feed themselves is an asset for healthy living.

When others do everything for you, bathing you, feeding you, preparing your meals, doing your laundry, and someone, such as an adult child, makes financial decisions for you that you may not agree with, it helps to have one or two things you can do for yourself.

It’s about finding a balance; as with most things related to health, a mental and physical state of proportion (as the Greeks called it) or equanimity, as the Buddhists do, is critical.

A widely quoted study (summary below) concluded in 1986 that some control is advised, especially for the younger elders, but as life advances, too much responsibility becomes overwhelming with too much stress associated with it.

Like children, the very old may want to be cared for; not to be robbed of our autonomy, mind you, but nurtured, attended, considered and included. I'm not there yet, but I can relate. The other day as I was getting ready to attend a meeting at a local church I fancied myself being escorted there. I had a mental picture of being dropped at the door while someone, my husband, boyfriend or friend, parked the car. It wasn’t the chore of driving or parking that I so wished someone else would take care of, it was the attention to my well-being. Old people like that. And younger ones, too! I chuckled thinking, How can you feel like a Queen unless somebody serves you?

But we have a negative idea of service in our society. Service is something that illegal Mexicans do, and we don’t have to grant them citizenship for doing it, cheap labor to weed the orchard, wash up the dishes, or care for the sick elderly. We hire it, and we don’t even pay very much for it, unless we are very kind and rather rich. But we don’t value it.

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I remember in the 70s when so many of us were following Indian gurus, we were trained in seva, which means, service. Our service was not considered lowly, but divine. It was our gift, our offering.

In our spiritual family, we took care of babies, including those that weren’t our own, and we tended the elder members until they died. 

Now we are the elder members, and there’s no one to care for some of us! Our society has trended back to its traditional self-reliance. You can hear the Midwestern accent, the gravelly voice saying, I don’t owe nobody nothing. Right?

Now self reliance has morphed into narcissism. It’s just all-about-us! It’s about my health, my diet, my radiant skin; my career, my healing, my self-empowerment. And I do include you in that. But I’m not going to wait on you!  

In such an environment, it’s critical to be independent; that’s the key value. We've got to make the effort to survive on our own. When true self reliance is not available to us, we are typically stripped of all responsibility and dumped in a care home.

That complete loss of control – of autonomy – is bad for our health. We need to let the next generation know that while we do love to sit down at the dining table for the family dinner, we can still make toast.

Science 19 September 1986:

Vol. 233 no. 4770 pp. 1271-1276

DOI: 10.1126/science.3749877

ARTICLES

Aging and health: effects of the sense of control

J Rodin

ABSTRACT

The relation between health and a sense of control may grow stronger in old age. This could occur through three types of processes: experiences particularly relevant to control may increase markedly in old age; the association between control and some aspect of health may be altered by age; and age may influence the association between control and health-related behaviors or the seeking of medical care. Studies show that there are detrimental effects on the health of older people when their control of their activities is restricted; in contrast, interventions that enhance options for control by nursing home patients promote health. With increasing age, however, variability in preferred amounts of control also increases, and sometimes greater control over activities, circumstances, or health has negative consequences including stress, worry, and self-blame. Mechanisms mediating the control-health relation include feelings of stress, symptom labeling, changes in the neuroendocrine and immune systems, and behavior relevant to health maintenance.