Crucial Conversations #2

What are some of the factors that inhibit these crucial conversations?

I suggest there are four major factors:

1. We equate being an adult with being in the public sphere, independent and self-sufficient.
2. Bodily functions are considered to belong to the private sphere, the private self. If we talk about these at all we do so with professionals in private offices.
3. Weakness and disability are considered abnormal, almost aberrant. Never let them see you sweat!
4. For our ancestors roaming the savannah, the desert, the forest---the old and the weak become prey when they fell behind or looked weak---we still have that deep memory and the instinctive drive to keep up, hide disabilities.

As a consequence:

~We hide aging and illness in the private home and denigrate dependence on others.
~We don’t know how to communicate about our disabilities in a way that furthers respectful interdependence.
~Like many behaviors that used to be pro-adaptive, the instinct to hide needs and weaknesses can sometimes be mal-adaptive.

I think that hearing aids are a perfect example of the potential for maturing from independence (often a cover for hiding a disability) to respectful interdependence.

There is nothing wrong with my hearing. People these days just don’t speak up. My TV is not too loud---and anyway---My house! My rules!

Vs.

I will wear a hearing aid so that I can better communicate. I trust the people around me enough to reveal my disability. Also I can contribute to their quality of life by not assaulting them with the noise from my TV.

Crucial Conversations

There has been a much-needed push in the media to get people to talk about end-of-life issues with their doctors and with family members. As important as these conversations are I suggest that conversations about aging are more crucial. Why?

The dying process is hugely important but relatively short-term (weeks or months). Much of the sequence and rhythm of events is dictated by the illness that is now terminal. Family and friends are called upon to provide company and care in this highly charged atmosphere. Lots of drama and adrenalin.

The aging process is more of a decades-long marathon. Most everyone who ages will experience some combination of

various chronic conditions, for example, arthritis, hearing loss, diabetes, memory deficits, etc.
acute illnesses at intervals, for example, cancer, stroke, heart attack, broken hip, knee surgery.

Almost everyone will eventually need some assistance with the normal activities of daily living ranging from food preparation to transportation to personal hygiene.

We may not know exactly what will go wrong and when but we do know that there are going to by these kinds of problems. My questions is---how do we begin to talk with each other about these probable futures?

So much is at stake!

It isn’t until we start to talk honestly that we can discover to ourselves and to each other our current condition, probable futures, values, assumptions, ignorance, fears, hopes. Especially we need to talk to the people on whom we will be depending---whether we like it or not; whether we want to or not---so that the partnership can be as informed and consensual as possible.

Suicide as a Long-Term Care Plan #2

While I was venting my frustration with the suicide-as-a-long-term-care-plan strategy, my colleague, an investment counselor, remarked that these folks should “put that in writing and give it to their kids.”

For once I was speechless. I really had to think about the ramifications of what he said.

At some point everyone who is aging will need services, equipment, and medical treatment---long-term and/or short-term.
Somehow these have to be paid for or donated---individual resources, family, friends, local organizations, government.
When I think about all the people I know who do not have kids to notify---do they send their intentions to their siblings, friends, and people at church?

How would this notice read? For example:

“This is to let you know that I have decided to make no provision for my needs as I age. I am opting to commit suicide at the point when I can no longer take care of myself. I do not want to be a burden. I am not expecting you or anyone to take care of me. You are all officially off the hook.”

We are really dealing with two groups. One, the huge number of people (70+) who could never have imagined living so long let alone amass the resources to fund these decades given the realities of today’s aging milieu. For example, my oldest client just died at 102.

The second group, to which I belong, are the 40-70 group. We have to face up---longevity will be the norm, an expensive norm. For us, planning and providing for old age is not just about taking care of ourselves---in my opinion it’s a much more life-affirming way to let others “off the hook.”