To the Keyboards, Elders

GRAY MATTERS: Dr. Robert Butler

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

My friend and mentor, Bob Butler, liked to tell the story about the old man who went to his doctor complaining of pain in one of his knees. When the doctor told him that it was a sign of old age, the patient told the doctor, “My other knee is just as old. Why doesn’t it hurt?”

The lesson, of course, is one of the simple truths about aging which marked Dr. Robert N. Butler’s long career: Old age, he taught us, is not an affliction but a blessing and a vital part of a life to be lived.

People don’t die of old age, he said, nor do they inevitably decline into senility. They die of diseases, some of which can be prevented and cured. And it so it was with Butler, who died earlier this month at 83 of acute leukemia. But he worked until three days before the end. And what work he did.

He came to fame winning an unlikely Pulitzer Prize for a book on, of all subjects, aging. But the book, Why Survive? Being Old in America, gave new hope and publicity to the fastest growing group in the nation’s population, Americans over 60. The book described the plight of older people, nearly 20 percent of whom were struggling in poverty which was much higher than the 9.7 percent rate today. It was just ten years after Medicare and Medicaid, and the practice of geriatrics was relatively primitive.

Butler had been a research psychiatrist, but became a geriatrician promoting the specialty in medical schools throughout the country. According to The New York Times, the Mount Sinai School of Medicine in New York asked Butler’s advice on whom to hire for a new geriatrics chair. He proposed successfully that the school create a department devoted to gerontology; it was the nation’s first.

Geriatric medicine has not been a popular specialty, partly because most patients end up sick and/or dying and the practice is not as rewarding as, say, orthopedics or pediatrics. But as Butler wrote in his book, he learned about the strength of the elderly from his grandmother:

“What I remember even more than the hardships of those years was my grandmother’s triumphant spirit and determination. Experiencing first hand an older person’s struggle to survive, I was myself helped to survive.”

But he has taught the current generation and millions of older Americans, who have never heard of Butler, that mere survival is no longer the goal of old age. It’s a new time to live as well as you can.

Butler’s book and his rather revolutionary approach to aging made him the natural to become, in 1975, the first head of his creation, the National Institute on Aging which is part of the National Institute of Medicine.

He held that post for six years, during which he wrote and spoke against what he called “ageism,” the mostly legal discrimination against people because of age. At the Institute, he established research on aging as a legitimate field. He helped found the National Council on Aging, and numerous federal and state laws have erased much of that discrimination and have given older people special help, like handicapped parking.

As a result of the Butler revolution, organizations promoting healthy aging and the political, cultural and social aspects of aging have become important parts of American life. AARP is the largest and most influential membership organization of its kind in the nation fighting for Medicare and Social Security as well as how to live the good life after 50.

And there are at least a dozen other groups lobbying and advocating for older Americans. If aging has been transformed so that 60 is the new 40, Bob Butler is at least partly responsible.

After his first book, he wrote Sex After Sixty, in 1976, with his second wife, Dr. Myrna Lewis, who died in 2005. And he’s written dozens of articles, papers and books since.

But his most definitive work, two years ago, was The Longevity Revolution, The Benefits and Challenges of Living A Long Life. As Butler was fond of noting, life expectancy in the United States and most nations of the has gained an average of more than 30 years in the last century, more than had been attained in the preceding 5000 years of human history. And it’s still growing rapidly, as a result of medicine, genomics, revolutionary drugs and preventive health techniques like tests for cancer.

Butler has called these great advances in longevity the Age Boom. And his final life work has been the creation of the International Longevity Center in Manhattan, a superior think tank on aging.

He established an annual Age Boom academy for journalists and researchers and in 2001, I was privileged to attend the first of these intensive, week-long seminars on the latest research into aging, where I learned of new drugs, new discoveries on brain function.

It was there that I learned that, contrary to a long-held belief, that the older person’s brain does not necessarily deteriorate, but continues to grow neurons and synapses almost until death. Dementia is not the inevitable result of aging.

Butler and another writer, Theodore Roszak in America the Wise, called on all of us to celebrate, rather than fear, the growing population that is living longer, healthier, more productive and rewarding lives. Yet, as Butler wrote,

“Despite this great human achievement, one of the most striking demographic events of all times, some politicians, pundits and economists respond to this revolution in this longevity with gloom and doom.”

Butler was an ardent advocate for Social Security, Medicare, Medicaid and, eventually, universal health care. But he and Roszak condemn those forces, mostly Republicans, headed by former hedge fund billionaire and Nixon Commerce Secretary, Pete Peterson, who believe the nation’s social insurance cannot afford longevity. So now they seek to privatize Medicare and cut Social Security benefits.

Although Social Security is sound for another 30 years but could be extended even further with minor adjustments (a one percent raise in payroll taxes or removal of the $106,000 cap on the income subject to taxes), Peterson, most Republicans and some conservative Democrats are talking about raising the Social Security retirement age to 70.

They do not take into account the workers in heavy industry or the coal mines who cannot wait until then to quit working. Raising the retirement age is an automatic cut for millions of workers in their fifties or sixties. And who can estimate how many workers will die after they are 65, waiting for their Social Security checks.

Peterson, who once suggested that the United States was becoming a “nation of Floridas” with unproductive older people laying about, has been in the forefront of those who wished to privatize Social Security. Now, he’s using longevity and the debt and economic crisis that he and his Wall Street buddies helped create to get their hands on the $2.5 trillion in Social Security trust funds.

Would that Butler were still alive to continue his fight to preserve the social insurance legacy that helped give this century the longevity revolution he celebrated.

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Thank you very much for this wonderful portrait. We all grow older with greater dignity because of him.

Bless Dr. Butler, for without his courageous fight I, and thousands like me, would probably not be alive today.

It is so easy for a wealthy person like Pete Peterson to demean anyone who might need a helping hand. I wish they had to walk in a poor person's shoes for one week before doing harm.

Thank you for providing this elegant and inspiring profile of Dr. Butler, whose work and life I continue to admire and refer to. What an example he set for older adults in his own life and with the work he has done. How fortunate that you had such a long friendship and mentoring with him.

The positive shift in our cultural perspectives regarding aging still has a way to go, but Dr. Butler was the pioneer in pointing out the value and potential of aging as a stage of life. Thanks again for this profile.

For what it is worth, today Senate Majority Leader Harry Reid spoke strongly in support of Social Security.

On Social Security, Reid blasted the GOP myth that Social Security is in peril of going broke. "Social Security is the most successful social program in the history of the world." He says that that to strengthen Social Security for the long-term, the trust fund needs to be repaid and fraud within the program needs to be reduced.

Now we have to hold these people to their words!

Excellent tribute highlighting Dr. Butler's accomplishments. Thanks for the reminder of the ongoing issues we need to which we need to attend so Social Security and Medicare can be available to our children and future generations. I might also mention we need to be on guard against efforts to scapegoat elders in the name of continued health care reform.

It's important to remember that age is not a disease. It's really unfortunate that western culture is so focused on success of the individual. Many other cultures still value their elders and taking care of them is their number one priority, because they sacrificed so much for us. It's too bad that that cycle continues in America.

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