GUEST: Dr. Robert Michels
I’m Richard Heffner, your host on THE OPEN MIND. And this program is about the later years of our lives…important to me, now, of course, but important, too to those who have yet even to dream about them, and occasioned by an intriguing Daniel Goleman article in The New York Times, related to new studies showing “a sharp rise in people’s altruism at midlife”. Of course, some see these studies as refining Erik Erikson’s earlier speculation that “’Generativity’, a concern with nurturing others or contributing to the general well-being, is the hallmark of psychological growth in mid-life”. As Daniel Goleman further reports the theory, “Those who did not find a way to nurture (in the later years of their lives) or somehow contribute to the future were left in a state of psychological stagnation…”
Well, in his article, Goleman quotes, at length, my OPEN MIND guest today, Dr. Robert Michels, Chairman of the Department of Psychiatry at Cornell University Medical College and Psychiatrist-in-Chief at New York Hospital.
Dr. Michels has joined me before to discuss medical education, medical ethics, and a whole host of subjects relating to the healing arts in America. Today I want to press him on this matter of growing altruism in our later years…particularly his explanation that ”you gain a kind of symbolic immortality by furthering a group you belong to or a cause you identify with”.
And I would begin today by asking Dr. Michels if we are then mostly buying our way into heaven…or even immortality? Is that what accounts for this growing altruism in our mid-life years?
Michels: Probably the shortest answer to that is “yes”. I suspect we are. One of the important sources of pleasure and pride for most of us is having an impact on the world, and when you reach a point in life when you begin to be aware that you’re in sight of the end of it, one of the things that’s really rewarding is the notion that that impact will persist after you. And for most of us there are two ways that happens. There’s the biologic route…our children and our children’s children, and the lasting impact we have like any other biologic species, and for humans, the cultural route. Our ideas, our contributions for the welfare, or thinking, or identity of others, and the lasting impact we have because of the cultural equivalent of our genes.
Heffner: But, you know, on thinks generally of, let’s call it idealism as being a function of youth, and now we seem to be saying, for whatever reasons, selfish or altruistic totally, this altruism, this idealism is manifested, if not more, than increasingly in our later years.
Michels: I don’t think idealism is a function of youth. I think it’s a theme of life. And it may have different manifestations at different developmental epics. So we think of adolescence, or youth as being fiercely invested in ideals. But we also sometimes recognize that their investment is in the abstract ideal, and they’re sometimes less sensitive to its embodiment in people’s lives or social institutions. And we often recognize that in middle age or later life people’s enthusiasm may shift from the abstract ideal, the noun, if you will, to the way it influences real people’s actual experiences or lives, to the embodiment of the ideal in a cultural group or a social group.
Heffner: You know, I frequently on this program, particularly when we’re talking about larger social and economic issues, ask a guest whether indeed we are our brother’s keeper. And the answers I get, as you can imagine, vary all over the place. How would that question be answered in terms of the dynamics that Goleman descried and that you’ve described?
Michels: Well, again, the meaning of that phrase may vary with different people and at different points in development to a kind of typical or stereotypical adolescent or young adult. “You’re your brother’s keeper” in the sense that you have an obligation to mankind. When one gets more mature, the definition of who’s your brother may shrink somewhat. It may not be all of mankind, but one’s community. But the nature of the obligation may become more embodied in real things, in concern and care that makes a difference to the people who are the target of it.
Heffner: What do you think the impact will be then of the fact that we are a society, here in this country, that has grown older and older? What will be the impact of this perhaps more widespread altruism?
Michels: Well, certainly it would be immense, and certainly we’re not totally sure what it will be. The striking change in our demography that we’re just at the beginning of is going to continue well into the next century and a larger percentage of us are going to be older, retired, and past our peak productive years. Some are concerned that there will be a move toward a kind of political conservatism because of it. Others that people will become excessively concerned with providing for their future retirement or their welfare at some later point in their lives and turn away from the other needs of the community. I think those are risks that are possible. But the same time it seems to me we have to develop strategies for using older people so they’re productive to society. The notion that one stops working at 65, retires and no longer serves a role for the community isn’t going to work and probably shouldn’t work. Probably never worked very well.
Heffner: Well, but, but let me, let me focus again on the question of…the American people in terms of their social consciousness…would the fact that aging, in your estimation, heighten that social consciousness as we become more aware perhaps of the desire to be altruistic to others? Not to permit a society that has quite so many homeless, that has quite such an inadequate plan for providing for those who have not themselves?
Michels: Again, I think it’s hard to predict and I would predict it would both heighten it and maybe reduce it. I think older people have a different kind of altruism. Not more, not less, but a different kind. It’s more likely to be closer to home. It’s more likely to be with members of their family, their community, the group that they identify with. And it might be a little less enthusiastic, for the abstract concerns of distant groups or cultures for a country as heterogeneous as ours.
Heffner: I, I wondered which end of that spectrum you would grab hold of. You’ve indicated that young people are idealistic about humanity generally. But as we grow older our beneficial attitudes, or our beneficences are visited upon those who are close to us, which seems to put the point that Erikson made and the point that Goleman made in something of a different perspective. I mean altruism being limited to your family, or even your immediate community?
Michels: It’s not that altruistic then. It doesn’t have quite the same ring. Maybe one thing that we want to all accomplish, and are beginning to accomplish is the education and socialization so that a broader and broader community feels like family. So that we’re identified with more than people who share our language or our religion, or our ethnic background, and the notion of who the family is becomes a little bit more extensive than was once the case. But that’s an educational job for the young to prepare them for a broader altruism later in their lives.
Heffner: Is it a function of socialization, meaning then that it…what we’re describing is not a function simply of years, it is not universal?
Michels: Well, we don’t know. But there’s certainly a suggestion that different people age in different ways, and that some people in aging draw a narrower and narrower circle around what people and what interests are important to them. And others don’t. And we would at least speculate that early experiences influence that. That the attitudes one learns toward who one cares about in first decades of life, influence who one’s concerned about in the last decades of life.
Heffner: So you’re not talking about something that is biological. You’re talking about something that is a function of education and socialization.
Michels: I suspect it’s both. I suspect that the notion that one’s concerned about one’s own group is biologically built in and has immense survival value for the species. And certainly going back a few thousand years, that group might be very, very small. It might be a breeding community, or a small town or a village and the people in the next village were outsiders, were the enemy and one’s altruism didn’t extend to them. Well, one of the questions for our world is “Now that we live in a world where if our altruism stops at the boundaries of our town, in the long run we’ll be in danger. How do we raise our children so the people in the next village are part of their community?
Heffner: What…which raises the question in turn, of course, is the question must be “How does this pattern differ from culture to culture? From nation to nation?” Or does it?
Michels: Well, we’re beginning to learn things about that, I think. Some cultures, some nations are far more homogeneous than others. Others have many more mixed groups in them. And one of the advantages of a homogeneous community where everyone shares the same background, the same ideals, the same beliefs is that people have no conflict or doubt about what they believe. One of the disadvantages may be that it’s awfully easy to develop stereotypical views of outsiders and to disown them from the moral community. So we’ve seen some of the most terrifying things that happen in our world, happening because of the strong ideologies of very homogeneous communities. We have been very lucky in the United States, living in a rather heterogeneous community where there are lots of forces that impact on you early and in making you interested and curious about other kinds of people, and a little less complacent in thinking that only your own kind are right.
Heffner: Well, or course, there are those who say now that the economics of out times are forcing parents and grandparents and children, even as they grow, to live together again, which was a much more forceful, well-established pattern in the past. But to the degree that that hasn’t yet happened, and to the degree that we’ve dispersed in our family life, what do you think the impact of that dispersal has been upon the potential for altruism in our society? After all, if our elders are not there to pass on what seems to be their message, at their age, to the young…then by definition we would assume that there would be less altruism in our society.
Michels: Maybe. But on the other hand…the mobility of our society means that you know people from other worlds, and other cultures. The media, particularly television, and even the ease of travel, jet airplanes, means that people know people from other countries, other nationalities, other cultures, other worlds. It’s harder to have a stereotype view of someone as being an outsider to be hated if you have dinner with them once, or go to the movies with them, or spent a week living in his hometown and visiting his museums and his cathedrals. And more and more people in the world have had that kind of opportunity. The “global village” notion may mean that the lines around the village will be around the glove, rather than inside of it.
Heffner: That’s, that’s a nice thought. I presume that it’s a nice thought, because there must be a downside to this growing, increasing altruism in the mid-years, and later years. What is it? Or are you going to say, “This is the one psychological or personal movement that has no downside to it.”?
Michels: Well, as you know well, there are many people worried about the burdens on our society that are represented by the growing umber of older people. And that seeing an image of the society where the average citizen is post-productive in his or here own developmental life, and a consumer of resources, as being a society that might stagnate and stop developing, and there’s all kinds of discussion about whether healthcare should be rationed for such people, whether they should, as a part of their altruistic contribution to the younger generation, disappear…quietly, without protest, and not consume our resources in the last years of their life. This is a dialogue that’s been a rather heated one in this country around the issue of the cost of healthcare for the elderly.
Heffner: And when you enter in to that dialogue, Dr. Michels, where do you enter it from? And where do you exit? What’s your position?
Michels: It’s a difficult set of questions. The easy out is the technologic one.
Heffner: What do you mean?
Michels: It’s the out that suggests we should find a scientific solution to the problem so people will live longer without requiring more expensive healthcare and won’t have lingering, expensive, painful ends to their lives, so in the long run, the resources won’t be consumed by the problem. And certainly there will be some technologic and scientific “fixes”.
Heffner: Excuse me…are, are you serious…that given the dimension of the problem that there will be meaningful technological fixes?
Michel: I think so. If you look at the statistics and the cost of healthcare for the elderly, you find that people use a large percentage of their total healthcare in the last year of their life. That’s not surprising, if you think about it, because very frequently life ends with illness, disability and then death. You find as people live longer, they still use their healthcare in the last year of their life, of their lives, but just that the life ends later, and so that last year starts later. It isn’t so much that total healthcare used by the elderly is that much greater, it’s that it starts later in their life cycle. We think we can keep people reasonably healthy for a longer period of time, and then not extend the duration of time in which they decline before death. If we can do that, so they stay well, productive and useful into their 70s and 80s and then get sick and die with the same speed with which they used to in their 60s, we won’t greatly have increased the cost to the health system of the larger group of older people.
Michel: That would be a goal.
Heffner: …would you translate that for me, please, into the practical terms that I’m sure our viewers would want you to translate that?
Michel: It means that the idea that we have a world of older people doesn’t necessarily mean that we have a world of sicker people. It means that we should aspire for a world in which the average person may be a little older, and expect to live longer, but expect to have that a healthy and productive phase of life.
Heffner: Now, wait a minute. You say, “…and productive phase of life”…
Heffner: …isn’t that the fallacy there? Will that gap that increases…can it be truly productive?
Michel: I think so. Our citizens used to be productive by the use of their muscles. More and more they’re productive by the use of their brains. Our economy has moved so that we require fewer people to use their muscles for our community, and more of them to think, to do things that require mental activity. If your health is good, and with reasonable scientific advances, and our understanding of the diseases that are common in aging, people should be able to be productive far longer in their life span, than when their productivity revolved around their muscles.
Heffner: But wouldn’t you have to assume then, too, that what you call “the last year”…maybe it’s extended just a bit, maybe foreshortened just a bit…would have to be a little more certain that it is the last year? Aren’t you…wouldn’t you eventually come to the point where you’d have to say, as a trade-off, for allowing us to live longer, or helping us to live longer, or the technological assistance that would bring the end to a more resolute conclusion… Without question that we don’t continue to do battle and try to preserve life as long as we do now?
Michel: Some have argued that. But for most people it’s a kind of chilling notion that when your time is up the plug will be pulled because you’re no longer a productive citizen. I’d rather think that as medicine advances we’ll be able to give people a clearer understanding of what the possibilities are for their living one kind of life or another and helping them make up their mind what they want their last year to be like, and how long they want it to last. It isn’t at all clear that most people want to live beyond a certain level of their ability to enjoy their life and their relationships and their experiences and if we can give them a good idea what they’re going to expect and a choice, it seems to me that most people will make choices that make the world work rather smoothly.
Heffner: “Work rather smoothly” in terms of bringing a more expeditious conclusion to what we consider that last period.
Michel: A more human, appropriate conclusion. Not necessarily faster or more expeditious. But one that means the end fits the meaning of the life appropriate. That people die with the sense that their death is appropriate to what their values in life were. Sometimes now citizens complain that it’s as though modern medicine extends their life beyond its meaningful values.
Heffner: Now, you’re suggesting, I gather, that increasing numbers of us will be willing to look at that formulation and accept it, indeed welcome it.
Michel: I think if we, today, were able to provide people with a good estimate of what kinds of experiences were in store for them, they would make choices that wouldn’t always opt for the longest possible biologic survival, regardless of the nature of their experience during that period of time.
Heffner: Now I hear what you’re saying. You’re saying “wouldn’t always opt…”
Heffner: …for that kind of extension…
Heffner: …of living, breathing…
Heffner: But I think we’re, we’re talking b out a social question that can’t be answered in terms of people who won’t always “opt” for that. In terms of percentages, and impossible question to answer, I know, but your own guess as a diviner of public attitudes and private attitudes…how large will that population be in a decade from now? Two decades?
Michel: Stepping back form the question a bit…it seems to me that our society has placed such immense importance on choice rather than coercion, on the sense of voluntary decision-making when it affects something as personal to one as one’s health and one’s body and one’s life, that the important issue isn’t how many opt, but that there is an option, and that what we should strive for is helping people make the best possible choice by telling them what the options are, and what the implications of each choice is. We don’t want to live in a world where you have the sense that someone else is going to make that kind of choice for you.
Heffner: No, but, but the implication of what you’re saying is that if we educate well enough, if we make…first place make these options available, and then inform larger and larger numbers of people that the options are available, your assumption is that still larger and larger numbers will opt in that direction. Free choice.
Michel: I think people will choose lives that are as rich and pleasureful and meaningful as possible, and I think for many, probably most people, that won’t mean as long as possible.
Heffner: Do you think that our social institutions will permit us to make those choices available to increasing numbers of people…significantly large numbers of us?
Michels: I think they already do. I think when we choose to drink a fine wine, eat a food which is a little richer than our bodies would be best with, but which brings us pleasure, when we choose to share with friends and loved ones and perhaps to take a vacation that involves some light exposure to danger because of the opportunity for seeing something unusual, or having a special experience in an athletic event, we’re taking risks with our lives because the meaning of life is more important than maximizing its longevity. I think we’ll continue to do that.
Heffner: Now, now, you’re saying that as though we really make those choices, not that they were made willy-nilly, that they are not real choices, that we’re just not aware of the dangers in which we place ourselves with that bottle of fine wine, or those many bottles of fine wine, or the adventuresome vacation. Seriously. Now you’re saying “we take chances”, but the question is do we know the nature of those chances?
Michels: I think some of us try to deny them. Some don’t know them, but more and more we’re being educated about them, and appropriately so. I don’t think the product of that education is to minimize any conceivable risk for longevity. I think the rational result is to make reasonable choices that involve reasonable risks and at the end of life to pick a pattern for that end which will maximize the meaningfulness of our life, rather than the number of heartbeats in it.
Heffner: Beautifully put. But the question I would still raise, Dr. Michels, is whether…let’s…step back a moment…you and the medical community are able wonderfully, beautifully, to present that choice to us. Are we as a people ready, able, well enough educated, fearless enough? Because fearlessness to some extent is required. Are we well enough equipped to make use of the choice that you will present us?
Michels: Not fully, perhaps, but moving that way, and one of the, one of the corollaries of the greater life expectancy, the aging of our population, the demographic change that we’ve been talking about, is that we need to educate people differently and prepare them to make such choices comfortably. I think that one of the corollaries of the world in which people live longer, is they have to know more about their health and the kinds of health and life choices they’ll be asked to make later in their lives.
Heffner: Do you think that the traditional forces in our society will permit our schools, for instance, and you’re talking about an educational process, to make available to our young people those choices, to educate them to the choices that you’re talking about? That’s a matter of social policy.
Michels: I assume that there will be those who will be greatly opposed to this, and there will dialogue and debate about it. And I also presume that the powerful realities of the changes in our demography and our life expectancy will lead those “traditional forces” as you put it, to evolve in their attitudes over the years. I think as long as certain “no-nos” are avoided, such as an individual causing the death of another, I think the traditional value systems in our world are very comfortable with discussing the merits of trying to extend one’s life compared to trying to increase its meaningfulness. I don’t think most have a problem with that as being as reasonable dilemma that can be discussed from both sides.
Heffner: In 15 seconds, do you think that altruism of later years that we began to talk about will extend to that understanding of the choices we can make and save society so much by way of trouble and problems?
Michels: I think some of the people who have lived into their later years have already greatly enriched their understanding of the meaning of those years, and have indicated their attitudes in the way that will serve as models for the rest of us.
Heffner: Dr. Robert Michels, thank you so much for joining me today on THE OPEN MIND. And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as an old friend used to say, “Good night and good luck”.
Continuing production of this series has generously been made possible by grants from: The Rosalind P. Walter Foundation; The M. Weiner Foundation of New Jersey; The Mediators and Richard and Gloria Manney; The Edythe and Dean Dowling Foundation; The New York Times Company Foundation; The Richard Lounsbery Foundation; and, from the corporate community, Mutual of America.