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How We Think of Old People

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A review of Elderhood: Redefining Agind, Transforming Medicine, Reimagining Life, by Louise Aronson, M. D.. New York: Bloomsbury Publishing, 2019.

On a Friday evening in June, driving home from a week at church camp, I tuned into a random radio program where the interviewee grabbed my attention with compelling stories of her geriatric practice and her care for old people. She both critiqued how we care for old people, and offered a hopeful vision for what needs to change. At the conclusion of the interview, I pulled off the road and wrote down the name of the author and her book. The physician was Dr. Louise Aronson, and the book was Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life. Reading this book as a guide for reflection on how we grow old and how we care for the aging has been for me like a still picture in grayscale develop color and spring to life. It has fundamentally changed the way I understand that last third of life that we call growing old.

As life expectancies extend, generally speaking we’re spending more time in that part of life we call old age. What used to be a few years can now easily be thirty, fully a third of our lifespan. While we treat childhood, not as a single span of time, but as a complex multiplicity of developmental stages, as a society, as a medical care community, and I would add as a church, we tend to treat old age monolithically as if it’s one uniform span of time. As a leader in the church, I have attended to the pastoral care needs of individual persons, but haven’t thought very carefully about the different needs of the specific stages of old age. This book has pushed me.

Aronson dives deep into a reflection on old age. As a practicing geriatrician, it’s not surprising that she critiques the way the medical community treats (or doesn’t treat) old people. At the heart of her assessment is that middle age adulthood is seen as the norm for what a healthy human looks like. Fair enough. Something has to be the baseline. Yet, when our bodies begin to age and we change physically, mentally, emotionally, and socially, the changes are seen as pathological rather than as part of normal development. What often makes things worse is that medicine tends to treat the maladies of old age the same way it treats a healthy 40 year old, even though administering the same treatments in old age often have much different outcomes, are more dangerous, and routinely lead to a decline in health rather than an improvement. As I think back to my accompaniment of scores of people interacting with the medical community in their old age, other than the effects of chemotherapy, it simply never occurred to me that a treatment that is routine in middle age could be harmful in old age. In addition, the medical community tends to neglect the social setting of the aging person, a factor that becomes more and more important as we age, and a factor for which there is great potential for meaningful, purposeful congregational ministry.

Aronson doesn’t confine her critique to the medical community, even though much of the book is about just that. She draws on philosophy, sociology, history, and personal experience to give a comprehensive picture of how our society regards old age. The richness of her experience makes the book read almost like a memoir, offering vulnerable glimpses of her own mistakes and learnings and of the complexities and oft-time failings of the medical system. Yet she also offers both hope and guidance for how we as a society and as individual persons can reimagine this significant span of life. We can do better.

As a pastor, I have been thinking about the content of this book a lot. We lament that the church is aging, and we wonder what that means for the future viability of the church. Youth remains a dominant metaphor for American culture, and for the church as well. We collectively look to family programming, energetic youth ministry, and comprehensive children’s ministries as the salvation of congregations. Yet for many of us, that’s not our reality. We look out on our congregations on Sunday morning to a sea of gray hair. By and large, I serve an aging congregation in an aging denomination. Honestly, I have not seen the aging congregants as the focus of my ministry, even though they are the people I spend most of my time with. What if I (and we) spent as much time and effort thinking creatively about how we might use the gifts of our elders and how to serve with and to the aging population of our communities? After all, as Dr. Aronson points out, the aging years are not just a time of maladies and diminishing capacities. They are also a time of joy, meaning, and fulfillment.

I found this book provocative in the best sense of the word. It has stayed with me and pulled me back into multiple readings. It is prompting a creative reassessment of my own rapidly approaching elderhood, and my ministry to and with the elders of my community and my congregation. There’s not much more I could ask of a book.

When Silence Is not Golden

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troubled mindsA review essay of “Troubled Minds: Mental Illness and the Church’s Mission,” by Amy Simpson

You might think that I would be that pastor who is out in front, leading the charge to make the church a safe place to talk about mental illness, that guy who makes sure that my congregation carries out effective ministry to those with mental illness and their families. After all, I have been closely connected to mental illness my entire life.

I think both of my parents spent much of their adult life suffering from depression. My father’s depression was never diagnosed, at least as far as I know, and consequently, he never received any treatment. My mother’s depression was diagnosed, and some medication of the early generations of anti-depressants were prescribed — I remember her talking about Prozac —  though I have no idea how faithful she was in taking her medication. When I was a pre-teen, my mother attempted suicide twice. An uncle went through decades of electro-convulsive therapy (ECT). An aunt had what my parents referred to as “a nervous breakdown.” Just what that was, we never really talked about. In the brief year between college and seminary, I spent a short time working at a university research hospital on the pysch floor as a pshychiatric technician; one of my responsibilities was to assist with ECT. Throughout my pastoral ministry, I have walked with and ministered to many families facing significant mental health issues. When approached, I have tried my best to be helpful.

Yet, despite all this, I have been complicit in the church’s silence about mental illness.

That’s the conclusion I have come to after reading Troubled Minds: Mental Illness and the Church’s Mission, by Amy Simpson.

Ms. Simpson begins by telling her own story of growing up as a preacher’s kid and of her mother’s descent into psychosis and the decades long impact that disease has had, not only on her mother, but the entire family. In fact, the entire book is peppered with firsthand accounts of mental illness in her own family and in the families of people she interviewed in writing this book.

After beginning with her own family story, she goes on to make the argument that mental illness is mainstream; nearly every family has to deal with it in some fashion. Yet as common as it is, there is a cultural code of silence, and still, there is a sense of shame about its invasive presence into our lives. I have found the same thing to be true in my own experience. As I start down the list of active families in the congregation I serve, it is remarkable how many of them are touched by diagnosed mental illness (not to mention the many more whose illness goes undiagnosed.) Yet somehow, still we operate in the church under the cultural code of silence.

The rest of the book is a systematic deepening of our understanding of mental illness and the variety of ways in which the church might be a beacon of hope for individuals and families dealing with mental illness. In no place does Simpson go into a lot of detail, but at every turn, I found helpful information that has broadened my understanding. From thumbnail sketches of the varieties of mental illness, to first hand accounts of what its like to suffer from mental illness, to the ways both individuals and families forge mechanisms for coping, to the extraordinarily difficult task of navigating the healthcare system to get proper treatment, the book provides the basics for individuals and congregations to be inspired and empowered to take action. I came away from this book with a renewed commitment that I am no longer going to be that pastor whose silence contributes to the stigma that mental illness carries. By my own commitment to speak, I am resolved to make the congregation I serve a safe place for those who suffer from mental illness and their families. By coming out of our silence, I’m hopeful that we will also begin to take action.