A New Modal for Later Life Mental health

Kenneth R Lakritz, Ph.D.

2023

A Whole person Approach

Mental health systems serving aging populations tend to have an overly narrow

lens through which to consider the needs of elders. We often view aging as a disease

rather than a season of new possibilities and tasks, failing to appreciate later life as an

essential phase with its own unique developmental landscape. Understandably, it has

only been within the past 50 years that human beings have been living into advanced

ages in large numbers. This demographic shift is allowing more and more individuals

to experience the gifts and opportunities of unfolding fully and consciously into the

winter years. Framing this as a new model of mental health for later life opens the

possibility for an ongoing dialogue about the nature and needs of late life emotional

health, purpose, and generativity. Furthermore, outlining the parameters of later-life

psychology allows us to explore the multiple dimensions of what it means to age

successfully as we look toward life’s crowning years.

A whole-person model of late life development includes all of the dimensions that

characterize this subtle and not particularly well understood period of life. We tend to

focus on the maladies of aging and declining health functions rather than appreciate

the richness and meaning that emerges as egoic attachments and physical capacities

fade. As with all life phases, there are tasks, challenges, learnings, and gifts. The terrain

of later life is no different, yet brings with it an emerging awareness of an impending

sense of finality, and raw confrontation with the realization that life is coming toward an

imminent close. It is the palpable awareness of our finitude and coming end of life that

reveals the coordinates of the path we each must walk as we bring our life toward its

final crescendo. It is these coordinates that I would like to explore and make explicit so

we have a road map for meaning, activity, needs, and supports. I’m in no way

suggesting that there is a complete model of late life. We can, however, begin to reveal

the scaffolding and start to place the flesh on the bones as we weave a holistic imageof elderhood. I’d like to begin by, first, addressing the dimensions of later life, and then

second, addressing ways of supporting the needs of later life development and mental

health.

Dimensions

Tasks

An older colleague of mine once said to me that “we start dying long before we

die”. As I have grown into my sixties I have realized the wisdom in this statement. The

tasks of later life aging are punctuated by a realization of limited time and the

awareness that more fully entering life and preparing to leave life are two sides of the

same coin. End of life preparation on the practical level involves the logistics of estate

planning and advanced directives, and, on the personal level, the consolidation of life’s

memories and a deeper experience of self-acceptance as we clarify the meaning of our

human journey. After retirement, my father once said to me “ I don’t know how I ever

had time to work”. Not only was this a time of reframing his sense of role, but also a

moment for what I refer to as “downloading” the unique wisdom that had crystallized

from a life lived with purpose and intention. Legacy becomes the foundational

consciousness that is passed from generation to generation, either overtly in the form

of teachings and stories or unconsciously through direct transmission and shared

experience. The tasks of aging are no less important than the those of earlier life

phases. How we come into this world and how we leave it are special and significant

in their own rites. As with support for early development, later life unfolding benefits

also from a culture that supports the needs for a successful completion of our journey.

Developmental tasks

• Generativity/ service

• End of life preparation

• Individuation/ integration/ integrity

• “Downloading”

• Legacy

• Estate planning

• Advanced Directives

• Reframing purpose and roles

• Self acceptance

• Friendship/ maintaining community

Challenges

The second half of life is replete with developmental challenges, some that are

anticipated and some that are unimagined. The current pandemic, as an example, has

presented the unanticipated, and has significantly amplified the isolation that older

adults often experience.

Mental and physical health are interconnected. Social isolation’s adverse health

consequences range from sleeplessness to reduced immune function. Loneliness

is associated with higher anxiety, depression, and suicide rates. Isolation and

loneliness are also linked to poor cardiovascular health and cognitive function.

(Tulane University 12/8/2020)

Challenges that are anticipated often involve the later life crisis of meaning and

purpose that often face the elderly as they begin to experience a sense of invisibility

and devaluation. These feelings become compounded as loved ones die and new,

intimate relationships become harder to develop. Furthermore, as physical and

cognitive decline take hold, one’s relationship to the world may change drastically

creating new stresses in navigating family relationships, the healthcare system, and

tasks of daily living. The struggle to keep up with technology, maintain a feeling of

value and relevance, and stay above water financially are frequent concerns also

voiced by older adults. These challenges are brought further into focus as one copes

with changes in roles, regrets for choices not made, and the fear of death that looms

ever-large as we grapple with life’s meaning. The risk of regression and despair is high

at these times as the work of later life integration transitions us into a new level of

relationship with our existence. During the period following a massive stroke and

realization of his new level of dependence on others, a well known spiritual teacher,

Ram Dass, was able to reframe his new state of being as an opportunity for others to

learn about serving as he was learning how to be receptive to the service from others.

Finding a way from doing to being, from serving to becoming receptive to others’

service is one of the tasks that emerge when independence begins to decline. In this

transitional state of releasing as the ego wanes and deeper being becomes more

emergent, we strive to discover a quiet and private sense of dignity that reflects a

deepened relationship to life and death. We also hope that there are respectful others

present who are committed to serving us during these sacred moments of life’s closing

chapter.

Developmental Challenges

• Isolation and depression

• Repetitive story telling

• Invisibility

• Openness to learning and new l

• Fear of death

• Loss of purpose

• Stresses of navigating life tasks

• Staying engaged and current

• Regrets

• Sexuality

• Technology

• Finances

• Risk of ego centricity

• Mobility and brain health

• Coping with loss of identity, loved ones, physical and intellectual abilities

Gifts

Conventional models of mental health are usually not as focused on health as they

are the absence of symptoms and disease. Approaches that focus exclusively on

symptom management, stability and adaptation fail to consider the deeper, core needs

and opportunities of having the privilege to live into the winter years of life. From a

depth psychological perspective, the burning away of the outer dross (ego) over the

course of a long life reveals what the alchemists refer to as the “pure” substance, the

inner gold, the authentic Self. Similarly, Michelangelo was quoted as saying that

“every block of stone has a statue (or Angel ) inside it, and it is the task of the sculptor

to discover it.” This view reflects what psychologist, C.G. Jung, referred to as the

process “individuation”, the journey toward the wholeness and uniqueness of the true

Self.

The undivided Self that Jung recognized lives at the core of each one of us. It is

not until the latter phase of life, however, that the full depth of who we are tends to

become fully realized. The foundation of wisdom that emerges in old age derives not

only from a depth and breadth of experience but also from from full alignment with the

essence of being. The “harvest years”, as rabbi Zalman Shachter-Shalomi framed

them, are a time of gathering ourselves, of liberating from earlier psychological

struggles, and embracing the freedom to engage our deeper purpose after years of

tilling and cultivating the fields of life. Along with the losses and challenges (outlined

above) also arise deepening sensibilities about life’s gifts that become revealed within

the transformational process of aging. Historical perspective brings larger views of

life’s patterns and cycles into focus, and, paradoxically, accentuates the importance of

the present moment in which resides realization of the blessings and miracle of life.

Furthermore, many would agree that gratitude is the crowning experience of successful

aging, the pinnacle of the awareness of the grace that carries us across the lifespan.

Releasing old patterns and opening to new levels of being, the journey of aging also

ripens consciousness in a way that deepens discernment, opens compassion. and

enlarges our capacity to bless those who follow in our footsteps. Moreover, an

appreciation of the aforementioned gifts of living later into the lifespan is a requirement

for health practitioners to sufficiently recognize the subtle and profound qualities that

are naturally emergent as aging progresses.

Gifts

• Wisdom/ Discernment

• Harvesting from life investment

• Historical Perspective

• Self acceptance

• Authenticity

• Humor

• The ability to bless

• Freedom

• Being vs doing

• Letting go of ego identity• A greater capacity to appreciate the present moment

• Becoming whole

• Deepening spiritual alignment

• Importance of the moment

• Gratitude for life

• Appreciation for the miracle of life

• Equanimity

Supporting later life mental health needs

To adequately support later life mental health it is crucial that we appreciate bio-

psycho-social-spiritual landscape of both clinical and sacred aspects of aging. We

often strive to generate a whole person approach to later life health but frequently fall

into a low common denominator that leaves older adults with inadequate services and

supports to engage a fulfilling and conscious end of life phase. I have outlined above

the parameters of later life mental health that requires a system of care and support

that matches the full dimensionality and depth of the tasks, challenges and gifts of

aging. Below is a beginning scaffolding of a model that meets these requirements. The

challenges ahead will be to build upon this structure and organize wellness in late life

mental health in such a way as to create a standard model for mental health care

delivery. I invite others to continue to build upon this and continue to bring light and

value to the crowning phase of the life span.

Partnership for:

• Healthcare advocacy

• Help with daily tasks

• Help with end of life preparation: estate planning/ advanced directives

• Navigating Family dynamics

Emotional

• Emotional/ behavioral coaching/ movement

• Stress reduction / Heart Math/ Mindfulness Meditation / Emotional Freedom

• Technique / EMDR

• Yoga/ tia chi/ reiki/ qigong

• Personal training

Social

• Social networking/ connection

• Family support and communication

• Cultivating community and inter generational experiences/ dialogue

• Community participation and contribution

• Mentoring

Leisure

• Learning

• Travel- road scholars

• Book clubs

• Writing groups

• Dancing

• Art and music

• Sports leagues

Geropsychiatry

• Integrative psychiatry

• Psychedelic therapies

• Hyperbaric Oxygen Therapy

• Brain fitness coaching

Psychological

• Aging support groups and workshops

• Living and dying project

• Psychotherapy / opportunities to reminiscence

Spiritual

• Spiritual Eldering

• Inclusion preferred Spiritual modalities

• Chaplin support

• Meditation retreats

• Spiritual