Chia Yu Lien // In the past century, aging and old age has become widely recognized as one of the most important medical and social problems. This recognition has been accelerated by multiple factors, including demographic change and the institution of retirement. In addition to all these factors, in the last three decades aging as a problem has been exacerbated by another trend: neoliberalization.
Although people often think that one hallmark of neoliberalism is market deregulation, some scholars argue that governmental intervention in the market implemented policies that enabled people to engage with the neoliberal concept of agency. With regard to health, neoliberalism has been implemented through managed care reform. Good citizens are morally obliged to take care of their health. If they fail, they are regarded as lazy, irresponsible, ignorant, or out of control (LeBesco 2010). Neoliberalism obscures problems caused by social inequalities, such as racism, and shifts the responsibility for health from the state’s welfare program to the individual, the family, and the market. Individuals are presented with the choices provided by the private sector.
The successful aging paradigm is situated within the intersection of the 20th century hostility toward aging and the late 20th century neoliberalism. Successful aging is not a new concept. It was proposed by Robert Havighurst in 1961, taken up by Paul Baltes and Margret Baltes and other scholars in 1990, and by John Rowe and Robert Kahn in 1998. Although the concept attracted great attention in academic circles every time it emerged, it was not until recently that it attracted the attention of academics and non-academics alike.
Each version of the idea of successful aging has taken a different form. In the first version of successful aging written in the 1960s, Havighurst tries to resolve the problem of whether successful aging means maintaining middle-age activities and attitudes or disengaging from active life (1961). In the second version of successful aging, Baltes and Baltes review academic writings in psychology, sociology, and medicine to discover what aging successfully means (1990). Although they mention the individual’s role in designing one’s own process of aging, they present information with an objective and often indifferent tone.
Unlike Havighurst and Baltes and Baltes, Rowe and Kahn use a provocative rhetorical strategy. In their book, Rowe and Kahn eliminate technical terminology and in-text citations and replace correlational relationships with causal ones. As a result, the last successful aging paradigm was easily digested by the general public, as well as by older adults themselves. In addition, Rowe and Kahn included examples of human agents in the text to make the information relevant to the readers. They argue that to age successfully, older adults should: (1) avoid disease and disability; (2) maintain mental and physical functions; and (3) continue engagement with life. They urge readers to change their lifestyle today and guarantee that any changes could lead to salvation. For example, regarding lifestyle changes, they suggest: “Certainly, it’s better to start healthy habits early and sustain them for a lifetime. But for those who have strayed—that is, most people!—nature is remarkably forgiving” (1998, 23). This concept of aging hinges on the proposition that older adults should be encouraged to exercise significant control over what they eat and how they train their bodies and minds.
Rowe and Kahn’s version of successful aging exemplifies the neoliberal shift of health responsibility from the state to individuals. Individuals (not state, society, or even biology) are responsible for their aging process. How Rowe and Kahn allocate responsibility resonates with insurance companies. Under the managed care model, insurance companies cultivate a particular kind of good patient who is “predictable, seek good health, and participate in their own recovery. They act to maximize health and minimize harm” (Lester 2017). As they uncouple aging from diseases and disabilities, aging healthily becomes a default and a moral calling, while suffering from any form of disease or disability, or even dying, indicates some personal or moral failure. Writing on cancer, anthropologist Lochlann Jain argues that overemphasizing patient agency “propagates the myth that everyone has the potential to be a survivor, deaf to the reality that survivor implies, in the final analysis, dier” (2013, 54). The consequence of survivorship is that sick people are expected to “beat cancer.” They often get terrifying denial of their real situation.
Rowe and Kahn’s concept of successful aging has been widely adopted but also widely critiqued. Anthropologists and feminists alike have criticized its inability to adequately theorize age-related declines, its overemphasis on independence and social engagement, and its ignorance of the intersection of age with gender, sexuality, class, and ethnicity. Despite a great number of resources related to nurturing and managing bodies and minds, aging successfully means not aging at all. Rowe and Kahn refer to the statement “to be old is to be sick” as a myth, though half of older adults have arthritis, a third have hypertension, a third have hearing impairments, and many have diabetes, cataracts, and muscular degeneration. Aiming to correct pervasive ageism, paradoxically, they redirect the hostile attitude toward older adults who live with diseases and disabilities and who comprise the majority. As anthropologist Lawrence Cohen states in his critique, gerontologists and geriatrics “differentiate Alzheimer’s [or any diseases] from old age by virtue of the former being fatal and incurable, as if death did not linger on the horizons of old age and as if aging, like pseudodementia, were reversible” (1998, 60). To eliminate ageism, Rowe and Kahn uncouple aging from diseases and disabilities and point their finger to the latter, despite the fact that most older adults experience some sort of age-related decline.
Cohen, Lawrence. No Aging in India: Alzheimer’s, the Bad Family, and Other Modern Things. Berkeley, Calif.: University of California Press, 1998
Baltes, Paul B., and Margret M. Baltes. Successful Aging: Perspectives From the Behavioral Sciences. Cambridge [England] ; New York: Cambridge University Press, 1990.
Havighurst, Robert J. “Successful Aging.” The Gerontologist, 1, no.1 (1961): 8–13.
Jain, Lochlann. Malignant: How Cancer Becomes Us. Berkeley: University of California Press, 2013.
LeBesco,Kathleen. “Fat Panic and the New Morality.” In Against Health: How Health Became the New Morality, edited by Metzl Jonathan M. and Kirkland Anna, 72-82. NYU Press, 2010.
Lester, Rebecca J.. “Self-governance , psychotherapy , and the subject of managed care : Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center.” American Ethnologist, 44, no. 1 (2017): 23-35.
Rowe, John W., and Robert L. Kahn. Successful Aging. New York: Dell Pub., 1998