Conjecture: some people, through some psychological quirk, interpret "opposition to X" as "not wanting any instance of X to exist" - so if you're opposed to aging, you must want to eliminate all instances of aging in the world, i.e. kill old people.
Conjecture 2: some people conflate judgments about the desirability of traits or states with judgments about the inherent worth of people with those traits/in those states. Evaluating aging as bad is tantamount to evaluating aged people as worth less than the young.
I've been thinking about these conjectures since yesterday, and I really do think Nick has hit the proverbial nail on the head here. While the people who oppose longevity medicine obviously vary in terms of their reasons for doing so, I am wondering now if perhaps some of that opposition is rooted in a sense that it is wrong to "medicalize" aging. And as someone who generally prefers the social model of disability to the medical model, I can understand, if not sympathize completely, with this viewpoint.
Here's why: if I take Nick's conjectures above and re-word them thusly:
Conjecture: some people, through some psychological quirk, interpret "opposition to X" as "not wanting any instance of X to exist" - so if you're opposed to autism, you must want to eliminate all instances of autism in the world, i.e. kill autistic people.
Conjecture 2: some people conflate judgments about the desirability of traits or states with judgments about the inherent worth of people with those traits/in those states. Evaluating autism as bad is tantamount to evaluating autistic people as worth less than the nonautistic.
...they start looking eerily familiar. I've seen very similar arguments coming from people who insist that yes, of course they value their autistic child (or brother, or sister, or neighbor, etc.) as a person, but that they would "remove the autism" from that person if they could. And that if they'd known of a way to prevent the autistic person from being born autistic, they would have chosen it "in a heartbeat".
Often, the people who make these arguments have a terrible time seeing how there could possibly be anything offensive about what they are saying. And when autistic self-advocates tell these folks that they find the notion that they ought to be "cured" (for their own good, for the good of society) insulting -- let's just say that the conversations don't always end with hearts and flowers.
I've stayed out of most of the major flamewars I've witnessed on the advocacy pages I read, but I've certainly read enough of them to get a sense of the common arguments that get made (and how those arguments fit in with my own various philosophical and ethical leanings).
And overall, I've gotten the distinct sense that there's a pretty clear difference between "disability" and "disease", as well as between "things that kill you" and "things that make you different". Put in those terms, autism and aging fall into very different categories, since while autistic people might be more vulnerable than nonautistic people in various ways, autism will not kill you. Aging, however, will.
But: on the other hand, there is a framing system in which autism and aging do fall into the same category -- and that is the one in which both "states" (aged, autistic) grant a person membership in a group devalued by those in society who hold the majority of the political and effective power.
Autistic and elderly people also share some common fears ("will I be institutionalized?") and common problems (employment discrimination, etc.). From within this framing system, it seems obvious that reducing the degree to which persons in the disenfranchised groups are treated as pathologies will help improve the lot of such people.
Have you ever been pathologized?
I have, and believe me, it's no fun. Not helpful, either. There was a professional who tried to insist that I needed to "work harder at being normal", and who refused to note any of the progress I'd made in learning to communicate more effectively and take care of myself physically at one point.
This was not only disparaging to my efforts, but dangerous -- if I'd had less presence of mind, or if I'd let this person intimidate me, I might have ended up returning to prior, unhealthy patterns of forgetting to eat and neglecting important aspects of self-care (because I was channeling too much energy into trying to maintain a facade of "standard" operation).
It was really only when I came to a point of self-acceptance -- as in, I started becoming better able to see myself as a healthy autistic-spectrum person as opposed to a "damaged" version of a neurotypical person -- that I started really branching out in my activities. I used to spend my weekends wandering in circles in the living room or fretting over the fact that I still couldn't manage driving a car at my age, but now I spend them writing, researching, editing, and even attending the occasional seminar or conference.
So, on the basis of that experience (and others, when I was growing up, in which certain teachers decided to single me out as a Behavior Problem rather than a kid who was simply developing atypically) I am very, very reluctant to think in "medicalized" terms when it comes to things that don't directly hurt or kill people.
I think that medicalizing things that shouldn't be medicalized can make people end up in worse condition than however they started out prior to seeking (or being put into) "treatment". And I think that treating any person as a "walking disease" and failing to see the person past whatever their challenges might be means you're running the risk of losing your ability to perceive the person at all.
Which is where the need for semantic clarification comes in.
When some people say "aging", they mean, "getting older" in the sense of accumulating birthdays.
When put in those terms, I am definitely "pro-aging" because I most certainly think that people should be enabled to experience as many birthdays as possible!
But when others refer to "aging", they mean, "the underlying bodily processes that lead to stroke, heart disease, immune collapse, dementia, and death".
When put in those terms, I am "anti-aging". (And those processes -- the nasty ones that kill you -- are the ones discussed in Ending Aging, which I highly recommend for anyone who wants to learn more about the science of SENS.)
So basically, I see aging as both a pathology and not a pathology, depending on the context in which it is used and on how it is defined.
I don't think old people are a pathology -- I think that the things that kill old people are pathologies. And I think it would be unfortunate indeed if people coming across longevity advocacy saw the whole thing as an attempt to pathologize the elderly and define them as "gross" and "scary".
I don't know if that's actually the impression people get or not, but if it is, I would like to know so I can work on explaining longevity advocacy better and emphasizing the fact that the goal is to help people survive and maintain their preferred health-state (defined according to individual criteria, not some arbitrary "optimality" measure) for as long as possible.
Now, returning back to the subject of autism for a moment, I want to make it clear that I do not think that autism can be defined (as I think aging can) as simultaneously, or alternately, "a pathology or not a pathology, depending on context".
Despite the similar social and political challenges faced by elderly and autistic people, and the common experience of lacking power as compared to the young and/or neurotypical (which should certainly be acknowledged), autism does not share with aging the "it'll kill you if you don't do something about it" component. And that's a very important component -- one that cannot be trivialized or argued away as a social construct.
You can, after all, be happy, healthy, and autistic.
You cannot be healthy, happy, and dead.
There is no "social model" for death, and I think that anyone who claims to champion the rights of any given group cannot seek to define that group as "obligated to die"!
Longevity advocates, therefore, have a very interesting challenge -- one that entails both discouraging age discrimination (especially with regard to health care) and at the same time, promoting the idea that we ought to develop treatments allowing older people to make their bodies function more like younger bodies.
I can see the political thorniness here and I'm frankly not sure what to do about it at the moment, except perhaps to say that I don't think that older people should be made to feel as if they have to embrace their own age-related death in order to accept themselves as people. To define "not being near death" as the exclusive province of the young seems a rather horrid proposition.
11 comments:
While I think this is an interesting thought experiment, I feel it may have strayed a bit off course in examining what the basic problem is when it comes to medical advances. Namely, the presumption on the part of people in the medical professions that any given condition is unwanted by the person in question before they even ask!
I think this hubris, "know-best" attitude is the underlying issue you are looking at. Some people look at their lives and are satisfied with the notion that they will age, get wrinkles, become the gray venerable member of their clan before being removed from the stage by death. If they lived in a society where this is still an acceptable choice, even where others are capable of looking like they are in their 20's for centuries, I don't think this is a big issue.
Personally I find when reading about efforts for greater longevity the thing I always find off-putting is the idea of extending *length* of life at any and all costs. This is what longevity amount to today. You see people in decrepit conditions dragging out a life in which they are no longer able to be active and participate to the fullest living on in a sort of limbo for decades.
This, and the general tones of radical materialism and atheism, I think are far bigger issues when people start looking at the advocacy of longevity. Certainly I, being of a more spiritual bent, find that simple length of life has very little appeal. What I am far more interested in is the prospect of medical advances bringing me true morphological freedom. The chance to be even healthier, smarter, more active and more beautiful at 80 than I was at 20 is far more exciting and I think if more emphasis was made in this direction things like SENS would have a much broader appeal.
Chris said:
While I think this is an interesting thought experiment, I feel it may have strayed a bit off course in examining what the basic problem is when it comes to medical advances. Namely, the presumption on the part of people in the medical professions that any given condition is unwanted by the person in question before they even ask!
Doh! You caught me leaving off an important disclaimer, it seems. I'm really, really big on consent and morphological liberty and would of course put "what the person wants" at the forefront of any set of decision-making criteria.
But still, I think I'd much rather live in a society in which it was presumed that most people, all other things being equal, would choose to live another day rather than die.
I think this hubris, "know-best" attitude is the underlying issue you are looking at. Some people look at their lives and are satisfied with the notion that they will age, get wrinkles, become the gray venerable member of their clan before being removed from the stage by death. If they lived in a society where this is still an acceptable choice, even where others are capable of looking like they are in their 20's for centuries, I don't think this is a big issue.
Sure, why not? Though I'd still like to encourage people to question the attitudes that make them feel as if they are obligated to "leave the stage", as you put it.
A lot of older and disabled people who commit suicide, for instance, do so because they feel burdensome and unwanted. And regardless of the fact that some people might be perfectly okay with kicking off at 80 or 90, I don't think it's okay to just assume that there aren't any pernicious attitudes in society which tend to encourage older people to feel guilty for existing. Nobody should feel guilty for existing!
Personally I find when reading about efforts for greater longevity the thing I always find off-putting is the idea of extending *length* of life at any and all costs. This is what longevity amount to today. You see people in decrepit conditions dragging out a life in which they are no longer able to be active and participate to the fullest living on in a sort of limbo for decades.
See...that actually sounds kind of discriminatory to me. No offense. Of course it would be best if people could live to whatever age they liked in whatever condition they preferred (which, for most people, would almost assuredly be one in which they did not have to deal with heart disease, cancer, arthritis, diabetes, etc.)
But I think it's a mistake to assume that people with disabilities (including those that tend to come with age) are better off dead. I think that the idea that someone is in "limbo" due to being physically disabled, etc., is wrongheaded and damaging.
There are, after all, people who live their entire lives paralyzed but who are able to find joy in things, and I'm sure the same is possible for those who become disabled in their old age.
Given the choice of living with severe disabilities or dying, I'd choose living every time.**
Still, though, I don't actually think that there is any grounds for fear among those who worry that we will somehow achieve a Tithonus error situation -- more likely, advances that let people live far longer than they generally do today will need to address the bodily processes that lead to frailty and illness in old age.
Otherwise, they aren't likely to work at all.
I think that present-day medicine has been pretty much stretched to the limits with regard to how long people can be kept alive -- at a certain point, systems just start breaking down faster than they can be repaired, which means that any truly effective intervention will need to extend the "healthy period" rather than the period of extreme frailty that often precedes death.
If SENS-type therapies end up being developed, they're going to be geared toward cleaning up "pre-pathology" damage -- not waiting until pathology has already set in. In short, biological realities favor a "compressed mortality" period rather than an extension of this period.
** The only semi-exception I make to this is the case of irreversible brain degeneration -- e.g., if I had Alzheimer's, I'd much rather be cryonically suspended ASAP following diagnosis than just let the disease take its course.
That way I'd at least have a (slim, but better than zero) chance of maintaining my brain structures and possibly being "restarted" at a future date. (Sort of an atheist's Pascal's Wager, I guess.)
"Fighting aging" is indeed a thorny semantic issue, and quite similar to what goes on with charitable groups that want to "fight autism." Some of these groups are well-intentioned and genuinely want to help autistic people (rather than wiping out autistic people through eugenics), but their language is inherently prejudiced.
Instead of "anti-aging," I would say something like "in favor of developing effective treatments for age-related degenerative conditions."
But unfortunately, that suffers from the same linguistic clunkiness that has derailed efforts to redefine "disabilities" (also an unnecessarily negative term) as different abilities.
I quite agree that aging, in the sense of growing older and gaining more maturity and wisdom, is a positive thing. Modern society has lost much of the respect for elders that our tribal ancestors once had.
I have to disagree, though, with your argument that autism is not a pathology because it won't kill you. Lots of things that are highly unlikely to kill you are nevertheless considered to be pathologies, such as the common cold.
We need to keep in mind that the concept of pathology is itself a socially constructed perspective. There are some tribal societies that don't view bodily discomforts and differences in terms of illness, but see them as changes bestowed by the gods to teach various lessons or to enable a person to carry out different tasks. I'm not arguing that we all ought to adopt their perspective, but it illustrates the fact that whenever we are talking about pathology, we are necessarily in the realm of cultural anthropology.
Ultimately this issue is one of self-determination. If an individual is unhappy with a particular trait (or set of traits) that he or she has, then it can be considered a pathology or disease in the literal sense of the word: something that results in lack of ease, dis-ease. Such a person should be able to make whatever changes he or she feels are necessary without being condemned by others for making that choice, even if others don't see a need to change anything. Conversely, if someone is happy with his or her particular configuration, other people shouldn't demand that it be changed for reasons of conformity. I believe that respect for self-determination should be just as important whether we are talking about aging, autism, or even the common cold -- if some tribesman believes that it is spiritually enlightening to catch a cold once in a while, I'm not going to argue the issue with him!
Hi abfh, I was hoping to get your feedback in particular on this one.
You said:
I have to disagree, though, with your argument that autism is not a pathology because it won't kill you. Lots of things that are highly unlikely to kill you are nevertheless considered to be pathologies, such as the common cold.
You're right...I was clumsy with my language there. Good catch.
I agree that self-determination should be a primary objective of course -- I just have some qualms about some of the rhetoric of the "right to die" movement (since I think sometimes people are pressured into accepting euthanasia, etc.). So I was trying to sidestep getting into that debate for the time being.
Yes, cultural pressures are almost impossible to avoid when making decisions about one's appearance, health, etc., because society is so judgmental. If we had more acceptance of differences in our society, I expect the right-to-die rhetoric would disappear because people wouldn't feel that they were worthless burdens if they needed care from family members or were not able to work.
As I've mentioned on my blog, I feel conflicted about the simple decision to color my hair. I like the way it looks, but I wonder if I would have thought about it at all if we didn't have so much social pressure to avoid showing even a few gray hairs or any other sign of aging.
I am curious, what would you say about a parent who uses genetic engineering to introduce "disabilities" such as deafness or autism into fetuses lacking those traits? Should that be legal? Is the choice of giving your unborn child green eyes morally equivalent to giving them autism?
Interesting that my comment got posted as "Chris" instead of "Ananda". Hmm, I will have to look into that sometime or other.
Responding to several different parts...
Yes! The Tithonus error is what I was referring to. Nice to find out it has its own name and everything. In any case I stumbled a bit in putting too many things into one clump there. What I meant to express is that the current reality in living a very long time is that a great deal of that time is spent in a body which has long since lost much of its health and strength and, often, mental capacity. So this is not really an error in someone's thinking but an obvious extrapolation from current conditions.
And I'm not suggesting that someone should feel they "have" to get old and die. Far from it. Rather that this is an issue of self-determism as well, and a valid value, especially among those of us that consider being born and dying and being born again cyclically a typical mode of existence.
Anyway, I think now I wandered off *your* point. To get back to it I don't think many people look at longevity or "anti-aging" advocacy and consider that it is somehow recommending we eliminate or devalue the aged. I think it is quite the opposite - people get turned off by thinking that their mother-in-law may end up hanging around the house and bothering them for the next thousand years, or the same group of politicians may stay in power for the next ten thousand. In other words, they *already* feel the aged have been around too much and think longevity would bring even more of it. They *already* devalue the aged.
I'm sure this falls into another category of fallacy on the Fight Aging site, I'm just expressing that these are, in fact, the issues which people contend with in considering much longer lives.
I agree with your central idea. We should continue to push for greater acceptance of the idea that people can *choose* to be the way they are, and not just think they are different because they have no choice. I have struggled with this in my own life too. Too much of the authenticity of a state of being is assigned based on people being "victims" of their conditions.
I don't think this has especially much to do with longevity advocacy.
Ian said...
I am curious, what would you say about a parent who uses genetic engineering to introduce "disabilities" such as deafness or autism into fetuses lacking those traits? Should that be legal? Is the choice of giving your unborn child green eyes morally equivalent to giving them autism?
Ian, I've addressed many bioethical issues such as those you bring up in prior posts:
- On Bioengineering, Modification, and Motivation
- The Future Is For Everyone (Or At Least, It Should Be)
- Your Brain, My Brain, and the Posthuman Rub
- Progressive Dialogue and Procreative Freedom
- Yes, Difficulties are Real -- Can We Move On Now?
- Why Progressives need to Get a Clue About Disability
- Neurodiversity, H+, and the Naturalistic Fallacy
- Of Boxes and Bias
There isn't exactly a "short answer" to your questions. But those posts might at least let you know how I tend to think about such things.
Chris/Ananda(?)
Hehe, I think my original post is quite an example of trying to put too many things into one clump. So don't worry about your comment being similar in that regard; it fit the tone of the thread.
You said: To get back to it I don't think many people look at longevity or "anti-aging" advocacy and consider that it is somehow recommending we eliminate or devalue the aged. I think it is quite the opposite - people get turned off by thinking that their mother-in-law may end up hanging around the house and bothering them for the next thousand years, or the same group of politicians may stay in power for the next ten thousand. In other words, they *already* feel the aged have been around too much and think longevity would bring even more of it. They *already* devalue the aged.
You're talking about two different groups of people here, I think. The people likely to see longevity advocacy (or at least some formulations of it) as "devaluing the aged" probably tend to be what might be referred to as bioconservatives. Bioconservative folks seem to at least think they hold the aged (and the disabled, for that matter) in high regard, but at the same time, they tend to defend the "value of death" and the value of going through the "natural course of human development" as more important than, say, a person's right to choose for themselves whether they want radical longevity or not. They basically think that longevity advocacy goes against the "natural order of things" and devalues the age by placing a premium on youthfulness, etc. (I'm generalizing extensively here -- feel free to read up on these folks yourself if you're curious as to how I developed these impressions).
However, the group of people who already devalue the aged are probably not folks who spend a lot of time thinking about who and what to value one way or another. They're less focused on how older people experience life than they are on how they experience life as a result of the presence of older people. See the difference?
You said: I agree with your central idea. We should continue to push for greater acceptance of the idea that people can *choose* to be the way they are, and not just think they are different because they have no choice. I have struggled with this in my own life too. Too much of the authenticity of a state of being is assigned based on people being "victims" of their conditions.
Yeah. See this and this for some additional thoughts on that subject.
You said: I don't think this has especially much to do with longevity advocacy.
Well, it doesn't yet, at least not in a concrete sense, because "radical" longevity treatments of the sort I'd like to see don't actually exist yet. So any discourse that attempts to speculate on the social dynamics associated therewith is, in a word, speculative. But that doesn't mean I'm not going to sit here and occasionally wonder how, if a radical longevity treatment were available, it would be dealt with if someone claimed to not want it.
I'm guessing at this point that it would probably be dealt with socially the same way we now deal with people who refuse kidney dialysis, etc. -- that is, people will be informed of the consequences of refusing treatment, and perhaps encouraged to take it on the grounds that they might just be depressed (meaning they might recover from the depression at some point and decide to take up a new hobby instead of waiting around to die), or that they might just be going through an adjustment period of sorts to the notion of living longer.
But ultimately, they cannot be forced to accept treatment, and I'm leery of "forced" anything.
Fear of death...
When presented with the choice of living or dying right now - would all people choose to live? I believe that any person would choose to live instead of die but then I have never faced long term pain and ongoing agony.
Even the vast majority of luddites will choose life over death even when faced with being preserved by the technology they so ardently fight against. Simply due to their existing fear of death. Even if that life is somehow reduced in quality.
We are living in a world where people fear death, what happens when when we no longer fear death, where we see death as a choice to be made when we are ready? Amazing things happen when we remove fear from our choices. As an example, extreme sports are dangerous, debilitating and can negatively affect your qualtiy of life yet millions of people pursue extreme sports for the experience because the fear of death and permanent disability has been greatly reduced due to modern medicine. Eventually death will be veiwed the same way; as something to be recovereed from as opposed to a permanent end. becuase while we are also overcoming aging we will also overcome death by accident and injury within the same timeframe. I envision a day where a sports figure dies in the pursuit of thier sport, is taken to the hospital and recovers over time and returns to their sport or profession as simply as a broken bone in handled today.
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Anne:
Thanks for the posts. I believe I better understand your point of view on this matter. I consider your writing on this matter very enlightening. Thanks again.
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