Tag Archives: ageing

Antonio Capurso, Gaetano Crepaldi and Cristiano Capurso, Benefits of the Mediterranean Diet in the Elderly Patient (Cham: Springer, 2018)

Although ageing is a natural process, it has been heavily politicised in recent years. The growing ageing population has impacted healthcare costs and economic planning worldwide. Where consideration of whole populations is essential, however, this approach is not necessarily helpful to individuals who are concerned for their own ageing and for that of their loved ones and patients.

We all want to know what best to feed ourselves for optimal health. As a British GP, I not infrequently have to advise people to stop taking their medical advice from Facebook. In an age where, increasingly, nutritional trends are being taken from the latest social media influencers, nutritional science is more important than ever.

This is where wonderful texts like Benefits of the Mediterranean Diet in the Elderly Patient come in. Spoiler alert – The Mediterranean Diet is really good for us. I’m sure the authors Capurso, Crepaldi and Capurso will not mind the spoiler, given they’ve indicated the slant of their conclusions in the title of the book.

This book illustrates the role of the Mediterranean Diet in connection with wellbeing in nutrition. They approach the subject of ageing with the aim of preventing frailty – where ill health, social limitations and loss of confidence combine to reduce quality of life. The authors set high standards for living into old age too. Citing potential for new careers, education, opportunities and directions as being achievable for those who can retain their health into old age.

The book is broken down into sections for each foodstuff element in the diet: extra-virgin olive oil, cereals, fruit, vegetables, nuts, legumes, pulses, fish, herbs and red wine, outlining the relevant seminal and more recent relevant research for each.

It begins with extra virgin olive oil – the jewel in the Mediterranean crown – its composition and effect on cardiovascular disease, diabetes, neurodegenerative diseases and cancer.

Where extra-virgin olive oil has been relatively uncontroversial in its perceived nutritional benefits in recent years, cereals have had less of a stellar reputation. Some of the Western world seems to have all but abandoned cereals completely in recent years, which, given the antioxidant and fiber effects, seems somewhat reactionary. This chapter made for the most interesting reading for me, as a result.

In stark contrast to the popular cultural view of carbohydrates as a path to obesity and type II diabetes, Capurso et al meta-analysed the studies associated with high-quality grain-based foods to demonstrate the nutritional benefit that can be harnessed. In particular, they point out that, traditionally, Southern Mediterranean population diets contained sourdough leavened bread rather than white or whole-wheat bread. It is sourdough bread in particular which has a lower glycaemic index and gives a less pronounced glucose response in the blood relative to other, more processed forms of bread. The authors did not disagree with the notion that low-quality, high-volume carbohydrates lead to an increase in cardiovascular diseases, type II diabetes and obesity. However, rather than conclude that carbohydrates should be excluded from the diet, as in the currently fashionable low-carb high-protein diets, they instead advocate for reasonable portions of high-quality sourdough breads, which give the benefits of fibre and oligosaccharides, reducing inflammation and giving protection against chronic metabolic disease.

Alcohol, similarly, is a controversial topic worldwide when it comes to healthcare. This topic too was dealt with in a sensible and practical manner. The authors acknowledge that when it comes to assessing the relative benefits of drinking alcohol, any study is difficult because of the difficulties in gaining a true picture of consumption. Still, people do not necessarily tend to drink wine exclusively, wine being the traditional alcoholic drink of the Mediterranean Diet. Their meta-analysis showed that a moderate consumption of alcohol, particularly red wine, is beneficial to health and in particular protective against cardiovascular disease (CVD). Though this effect appears to be particularly prominent in the consumption of red wine and shows most benefit to high-risk middle-aged men and women, the benefits seem to extend beyond these groups and are not limited to red wine. In addition, red wine has been linked to the prevention of numerous degenerative diseases and cancer.

Although this is an academic text at its core, I very much enjoyed the inclusion of cultural context. Each chapter included the cultural context of each element of the Mediterranean Diet and how it was incorporated into everyday life. For example, in the context of alcohol, the authors address ancient Rome, where wine was diluted with water in a ratio of 1:3. As a British and Scottish GP, I always have to treat studies on the benefits of alcohol with caution. Where I trust the science, as with all science, it must be applied correctly. The authors correctly state that all of the evidence for the benefits of alcohol in the improvement outcomes in primary prevention of cardiovascular disease occur in the context of moderate drinking. All too often, these studies are converted into press articles which are used as an excuse to drink far more than is healthy.

This brings me back to my original point. Quality of information matters when it comes to nutritional advice. How we feed our vulnerable matters – both our young and our elderly. This book represents a solid reference text for anyone looking to educate themselves on the scientific basis for recommending the Mediterranean Diet and I’ll be keeping it on my bookshelf. I can’t promise it will prevent the rise of the next online influencer-based fad, but fads come and go. Where a social media influencer fad will fade into obscurity, science will endure well into retirement age, remaining fit enough to take on new adventures with a warm plate of pasta al pesto and a good glass of red wine.

Democracy Put to the Test of Age: A Case Study Concerning the Dysfunction of Modern Democracy

« Il y a deux sortes de maladies. L’une est produite par une cause étrangère qui apporte le désordre, l’autre par une partie trop vigoureuse qui jette le trouble dans la machine, c’est un citoyen trop puissant dans la démocratie. La matrice est saine, mais son action est trop forte pour le reste ».

Diderot D., Éléments de physiologie, Paris, Honoré Champion, 2004, p. 349.

 

A dysfunction is not only something that goes wrong. It is not just about not knowing how to implement rules, misusing them or enforcing them wrongly. It is not about contravening the rules; it is rather about how the function of rules provokes a deadlock and impossibilities, such as the jamming of a mechanism in accordance with its own rules. So technical objects dysfunction when they fight against themselves and each other, and they do this as long as they have not reached their equilibrium point; as long as the crisis of these struggling principles is not yet resolved. There are illnesses where the organism of the patient fights against itself and obstructs its own life while working according to the principle or the principles that sustain its life processes. The same is the case in states considered as  societies, though in accordance with the analyses of Stuart Mill, these can be taken neither as machines nor as living beings.[1]

My aim in this paper is to consider the dysfunction of democracy in relation to the generation gap. I will do that with a case, abstractedly singled out, that is really interlinked with all sorts of phenomena and which has – to use a causalist vocabulary, which is not necessarily accurate – sundry effects. Democracies are sensitive to what is often called the generation gap and this makes them vulnerable, perhaps they will be more and more vulnerable. Here we encounter a difficulty: what do we mean when we speak about generations? Do we point to a reality or are we faced with a sort of illusion that makes us consider older people as an indistinct mass we are neither close to nor anxious to join one day? The other way around, when we become old, it is the turn of the younger people to be considered as a mass on which we depend for our livelihood, particularly when we are no longer working, and they are not supposed to be hostile, but at least an uncertain and precarious support. It may, of course, be said that democracy, because of its political structure, evens out such dissensions: is there not a tacit underlying contract in which everybody promises to contribute to the life and well-being of others when they are unable to do so by themselves, since they have contributed to the conditions of life and well-being of those who could not – or which society esteemed could not – provide for themselves? This contract draws its value from the principle and the fact that, in a democracy every vote or every opinion counts as one vote or as one opinion; and it draws its chances of being accepted from exactly this fact or this principle. But, as we shall see, it might be just this contractual ideology, through which we envisage democracy and believe it to be effective, that constitutes the very difficulty making the older generations fear the younger and the younger generations envy the older while feeling at the same time a hatred or anger that is not necessarily ill-founded.

 

I.

David Hume was the first to demonstrate in a very subtle way a relative incompatibility between a contractual conception of democracy and the demographic realities. In his famous essay, The Original Contract, he showed that generations of butterflies may draw up contractual relations, because all the full-grown butterflies come out of their chrysalises practically at the same time, and that, if these insects had to contract forms of government, they could do so in committing themselves to the others, without contradictorily constraining those who could not negotiate the contract before entering into it; whereas human beings, entering diffusely into mixed generations, are forced, by the very structure of their birth, to negotiate with everyone what they enforce the younger generations to recognize, on pain of being obliged, every day, to renegotiate the contract. Hume drew the consequence that a state can neither be thought nor lived in a contractual way and that, for this reason, democracy is nothing but an illusion. It is not possible, in his opinion, that political links may be thought of or lived as a game between freedom (understood as autonomy) and equality. Mutatis mutandis, our societies have made the reverse ideological choice and they believe or pretend to believe in the possibility of democracy and in its reality; but they cannot escape the problem they will thus encounter.

Indeed, the constant and diffuse transition from one age to another blurs for every individual any contractual relation between one age bracket and another. For greater convenience, these age brackets are called generations. A state may decide, at a given moment, by law, that everyone has the right to retire or even the obligation to cease to work at a definite age that may be fixed by mutual consent, as it is proper in a democracy. In other words, a middle generation may and must accept to take care of other generations; both, the younger generation that has not yet worked, but is learning trades, and the older generation that has already worked and that is no longer fit to work or is considered unfit to work, and having, in any case, no longer the duty to do so. This middle generation accepts this caretaking because its members know that they will be treated in the same way afterwards by the upcoming generation and because they also know that the older generation they are committed to support has already supported a generation older than itself. If the law is sufficiently precise and definite, and if no disaster erupts and massively kills a great part of the population, whatever be this part, one may predict the number of transitions in the category of those who will be supported after having supported others and being helped by themselves by paying a contribution to a pension fund. But what is difficult to insert into a law, what is difficult to foresee and to take into account – because that would amount to making the contract too vague and volatile – is, for instance, the increase in human life expectancy.  Thanks to medical progress, for which everyone may be delighted, though not without reservation[2], women’s and men’s life expectancy has become longer and has increased rapidly, more rapidly for women (whose life expectancy is about 85in France and, more generally, in most of European countries) than for men (nearly 80) – and this phenomenon inevitably increases the responsibility on the part of those working compared to what it was for previous generations who are now under their care. Furthermore, the members of our hedonist or eudemonist societies – at least ideologically hedonist or eudemonist, but this ideology is not of little consequence – know that it is better, in order to be happy, that a family should not have too many children. Thus the population pyramid in many societies looks like a sort of ace of diamonds whose base is narrower and narrower, the middle stages more and more filled and the summit higher and slender. In other words, the basis of those who have the responsibility – and moreover, of those who will have the responsibility – of the generations that do not work, or that will not work, is more and more narrow, while the responsibility they assume becomes heavier. The hedonism of some might be painful for others.

We can see where the dysfunction is: contracts, even drawn up with full legitimacy between generations, quickly lapse because of the obstinacy of facts themselves (the increase of life expectancy, for instance). The observance of drawn up contracts, the fulfilment by the state of its commitments, may be the reason for an aggravation of this phenomenon. Indeed, a generation may negotiate with another regarding its members’ comfortable pensions in order for them to lose no advantage compared with the salaries received when they were actively employed; it may regard as justified, when the time comes, that the contract should be honoured, because of the promise given in the past. However, the reality itself may invalidate the fulfilment of contracts when a generation becomes crushed by taxation, by other burdens (payment for old people’s homes, payment for the education of children that stay a longer time in the family because of the increase in time of study) or when obliged to give up what constituted its reasons for working. When a generation claims its happiness, another is pressured to pay the price for it.

Here I notice – and this is the point where Hume was right when he criticized a pure cultivation of equality to the detriment of all other considerations – that the best principle may, purely and solely cultivated, become the worst in certain circumstances, if it is not limited by other principles. But, on the one hand, by which principles? And, on the other hand, in what way? By Rawlsian lexicality? By a vector product? Furthermore: even if the principles were rightly bound together, there would remain a gap between this synthesis and the fact that it happens in circumstances which are always different.[3]

 

II.

It may be said, however, and to a certain extent with good reason, that the benefit and strength of democracies are precisely their capacity for posing these problems and attempting to solve them through negotiations between citizens that unceasingly envisage the questions and deal with them in the best interest of everyone as equals. I agree, but they might very well encounter the difficulty well highlighted by Hume in his challenge of democracy.

If, in a democracy, every citizen has one vote and if no vote counts more than another, it is clear that the majority of elderly people in comparison with the working generations may crush the ballot of those working generations and reduce to nothing the well-founded will to renegotiate contracts,[4]particularly when we know that non-voters are recruited from young people. Those who support the heavier charges, because they are of an age to work, may have most difficulty in being heard in the cacophony of interests. They may even have the feeling that democracies, because of their majority vote, are nothing but authoritarian machines that silence them, preventing them from participating in the happiness they mainly contribute to producing for others by their efforts. They feel it like an unjust sacrifice that constrains them without the least hope of benefiting from the same advantages they give to others because they are not encouraged to have children; so they despair of politics. The only place where they could have found a solution is spoiled by the problem itself.

This is a concrete place where a well-grounded distinction may be found that, abstractly considered, would seem pointless. It is well known that Rousseau distinguished between the will of alland the general will; the former being the addition of everybody’s interests and of the group’s interests (families, churches, corporations, companies, trade unions, syndicates, parties), while the latter is supposed to associate the thoughts that everyone has conceived, not in his own interest, but in the interest of the whole collectivity. So laws are valuable only when they are laid down from that latter point of view. A bundle of interests – be it the majority – can never lead but to a disaster. A decision may engage the collectivity, not only when it is the majority decision, but also when it is made by every citizen with full knowledge of the matter. In democracy, in order to be valuable for the entire collectivity, a decision must be understood by everyone and discussed among its members; it must not merely be the effect of the weight of the greater number.[5]Such a ballot is dangerous and only feigns democracy when it replaces discussion. This is perhaps the specific contribution of Stuart Mill to the distinction Rousseau drew between the two types of will. It is only through discussion among well-informed people that an acceptable position may be arrived at, provided everyone agrees that what seemed to be well-balanced at the moment might be changed when it becomes unbalanced.

Moreover, I shall here sketch a proposal that perhaps will be taxed with egalitarianism. Of course, many people admit that unequal working conditions are scandalous, even though most democracies suffer from too large a disparity in wages or from other social inequalities. But these inequalities become more flagrant and unacceptable, where they are imposed by a majority consisting of non-workers on retirement. How could one accept that some people should work for others who, although they do not do anything anymore that could be assimilated to paid work on the marketplace, receive sums of money which are much higher than the former’s wages? How could one accept that the non-work of some be better paid than the non-work of others? It is as if a sort of inertia principle is absurdly at work where the inequalities of the time when men were working pass on to the time when they have ceased to work.

Objections will be raised that the issue here is not one of inertia, but a contract formed by the will of the parties; that the forecasting of this time of non-work is included in the wages or salaries paid to those still at work, and that, consequently, it is not abnormal that this contribution to a pension fund during the work period sets off the inequality regarding the period of non-work by which we are presently scandalized. But this should not prevent us from raising the question of the justice of such a transfer: Why should the time of non-work not be a time to lessen the inequalities, since they are then much less acceptable? The fate of those who need the most help, even if they have worked for a time as long as the others, is much more cruel during the time of powerlessness, because they are old and ill, than the destiny of the well-to-do that are better cured and cared for, even though they might be struck down by the same diseases. I only touch on the subject here of the long search for a decent retirement home for dependent elderly people (what is called EHPAD[6]in France), when they must wait in a hospital for a nursing home to accommodate them. The accommodation in these nursing homes is extremely varied depending on the level of wealth of their inhabitants, and it may be disastrous, as it is presently denounced in France, both by the staff and the directors of such establishments.

Perhaps there is a more outrageous phenomenon than the economic inequalities and one which reinforces them: it is inequality faced with illness and death. Those who have worked hard, being physically exposed to the elements, tribulations and abuses, lose health and life sooner than those who have worked with their intellectual and imaginative faculties. The feelings of injustice are necessarily heightened in those who must work under more painful conditions than others – and for others – that are already favoured by economic conditions and over a longer time. Even though there may be attempts to hide inequalities between “classes” – in a Marxist sense – by speaking of “generations”, there is no avoiding the discourse of “classes”.

So, the mere application of true democratic principles may provoke dysfunctions that check and deregulate democracy. Indeed, the observance of contracts, even if the implementation of those contracts is very remote from the day when the parties drew them up, is a principle of democracy and also a mere principle of the commonwealth; but it must not be, in this regard, a heavy burden of worries for those who, having not directly negotiated the contracts or having merely inherited them, take them upon themselves thus honouring a state worthy of the name. The fiction of the legitimacy of the unequal share of what is paid after retirement is acceptable only, on the one hand, in an individualistic perspective in which every individual leans on the community only to settle a personal destiny, and on the other hand, in the no less dubious prospect of a steady course of time. Following such a prospect, in contracting to do something at a given moment, it must be possible to find, under the same conditions, what was decided, many decades earlier, as if the state should warrant civil laws as steady as pretended laws of nature of the classical age; in other terms, as if it could promise a world without any accidents, risks, probabilities, or dissymmetry between past and future. When the world of laws is expected to be pure thought and without any unforeseen event, it has the chance to be in the position of the Procrustean bed whose pretence is to measure a reality which does not care about those fantastic rules that might be maleficent for men and lure them into ideological traps.

 

III.

These latter remarks concerning differences and conflicts of temporality allow us to gain a new characteristic in comparison with the implicitly or explicitly quantitative approach we have so far assumed for defining the notion of a generation and taking another point of view upon the dysfunctions that have appeared to us.

Certainly, the qualitative and modal approach to the notion of generations, of their limits and of their possible conflicts, goes back a long way. Mannheim and many other sociologists, before and after him, have sketched the outlines of such a notion, where the first-mentioned speaks about “the generation of 1914”, while later sociologists speak about “the Baby Boomer generation” (The “Sixties”), the generation of the thirty years following the Second World War (of which I am a specimen), or the “Millennial Generation” (The 9/11 generation) if it is right to say that the terrorist attacks on the World Trade Center in 2001 “may form the immediate source of a new global generation”.[7]

The former lived between two disasters, one that had already taken place, the other about to take place and opening up a tragic horizon. The second generation, ignoring war, living with hedonistic norms, taking on an air of egoism rather than altruism, without caring much for the condition in which it leaves the world to the generation of its children.[8] The third generation, finally, that arrived in demographic conditions that could have been anticipated, but which had not been planned, being left in economic conditions more chaotic than the previous ones received from their elders, and being constrained to inscribe their existence into the framework of uncertain – perhaps tragic – times. These are only sundry examples; so the slicing of the last generations in three or four pieces have many chances of being fallacious; but they give a direction we must not neglect on the pretext that only what is quantitative and countable would be real.

In parallel with many books written within sociology attempting a definition of what a generation is, I was struck by a dialogue that has the air of a monograph, though it was written by two authors. A retired professor of the University of Besançon converses with one of her former students. They are separated by four decades and following themes split into conventional units; they faithfully take stock of their differences in their conception of the family, the part of work in their lives, their mode of sexuality, their labour union and political commitments; the social-class difference never seems to be the most dividing split between them. Among the less expected matters in this exciting exchange, the reader finds the opposition between two ways of thinking about time and of living in it, so that it is difficult to separate ideology from reality. The elder, who belongs to my generation, speaks in praise of a course of time that seems to be built straight ahead, evolving smoothly on a single path, seeming to deepen unceasingly, without any nostalgia or troubles. While listening to this narration, the younger, usually caustic in his critiques, was enthralled by this time to which he had, has and will have no access and he seems to feel guilty about it. This course of life looks for him as if it were the sort of time in which he would have enjoyed to live, without realizing it could be a secondary elaboration, quite imaginary, dependent on the age of the narrator and on the ways that every epoch defines for us how we live with and think about time. There were epochs where time appeared to those who lived in them as perfectly linear; and others that cannot be lived in such a way. This guilt, unconsciously imposed by the elder onto the younger, gives the book its darkest pages;[11] it makes us think about the way one generation may extort from the other promises to which it has no right. If they have lived and thought the time as they ought to have lived and thought it, how would those who cannot succeed in doing so refuse a service or an advantage to them, who have found the right vital tempo? But why did the younger not present another temporality in the same positive light as the elder, although it might be extremely different? Had not many English thinkers already given way to a thought of non-linear times?[10]

 

 

IV.

This last point allows us to focus, among other theories, on the advantages of a theory of fictions, provided it may be deepened, to think about the reciprocal games of generations. How to give, in this reflection, the right share to reality and fiction? We may be tempted to claim that the population pyramid tells the truth about reality and, consequently, tells the truth about the ideological processes that necessarily come along with it and for which one of the best illustrations is the thought of a temporalization that, instead of leading to a revolt against a one-sided conception of time, blames itself for being unable to identify itself with it; but why would reality not chose the side of the clashes of temporalities that radically frame our lives without any room for manoeuvres in order to change them? In this case, it is the demographic pyramid that would be a fiction which does not stand for things themselves, but represents a sort of snapshot that has no more truth than the instantaneous speed of the physicist. A theory of fiction does not allow us an arbitrary choice between the first or the second option; but it is possible for it to adopt each in turn, without the former claiming to be more real than the other. Many situations which seem impossible when we consider them as graphs are perfectly bearable in reality: B. Vernier showed in the same way that the very improbable kinship structures of the Karpathos island could have reached our days through many centuries precisely because those structures, improbable to the extent of seeming impossible, become bearable when they are supported by affects and sentiments; there is no less reality in a play of affects than in the structure that seems to tell things and, sometimes, makes the demographer sound the alarm.

However, I do not want to give reasons to postpone the moment when the democratic dialogue must make possible the best decisions concerning what people at work must pay to others, and what those who are no longer at work are in the right to expect from them without referring themselves to obsolete contracts of which nobody – except erudite historians – knows why, how and with whom they were entered into in former times. Far from inscribing contracts in eternity, it is, on the contrary, necessary to accept temporality, not forcibly only when it goes off smoothly, in order to attempt by all the means given to intelligence to control its course. In this respect, it is not impossible that the pension system must be radically reformed, if not in all the countries of the European Community, at least in France where the authoritarian system of a legally decided retirement date at the same age has no sense. It is right indeed that the share of work from which the younger generations were so long excluded – up to being pauperized – will become problematic if everybody could choose freely to retire. Here, we find again the same necessity to limit one principle by another; the pure cultivation of unlimited principle – be it a component of a democratic regime – or, by the way, principles filtered in Rawlsian lexical order, are making democracy dysfunction. However, it is not, as Hume concluded, with less democracy, but with more democracy, that problems could be solved.

 

 

V.

Finally, the impossibility of separating one generation from another, which may seem dangerous, because of the confusing situation it generates, due to the paradoxical issue of the deepening gap between one generation and another, also gives the means to move them closer by another turn. For instance, it is quite possible, as Irene Hardhill showed in a beautiful article on Intergenerational Space,[11] that a use of ICT (Information and Communication Technologies), even elementary ones, by older people puts off the dependency, decline, passivity and obsolescence which are the principal causes of the placement in retirement homes. So, the repentant moroseness of a conflict of temporalities from which certain young people could not choose the best, stamped by ontology and phenomenology, may be countered with intergenerational teaching, which does not always function in one way, from the elder to the younger, but conversely, as M. Mead showed, from the younger to the elder.[12] We see that, even if digital technologies would have delineated generations, as M. Serre said in a talk quoted by Marie-France Castarède,[13] that delineation must not be interpreted as a dividing line, because generations merge into one another, one unceasingly modifying the other. So techniques, detested by a certain phenomenology, far from working to divide men, to vulgarize them in preventing them from thinking and feeling, would rather have the reverse function.

 

Endnotes

1 This is the matter of the first chapter of Mill’s Considerations on Representative Government.

2 Not without reservation: because the increase in life expectancy makes diseases emerge that could not have time to develop so massively before. So Alzheimer’s disease is as yet incurable, though it does not directly jeopardize the patient’s life.

3 That is a point G. Simondon highlighted in Du mode d’existence des objets techniques, Aubier, Paris, 1958, p. 35 : « L’objet technique est un système physico-chimique dans lequel les actions mutuelles s’exercent selon toutes les lois des sciences. La finalité de l’intention technique ne peut atteindre sa perfection dans la construction de l’objet que si elle s’identifie à la connaissance scientifique universelle. Il faut bien préciser que cette dernière connaissance doit être universelle, car le fait que l’objet technique appartienne à la classe factice des objets répondant à tel besoin humain défini ne limite et ne définit en rien le type d’actions physico-chimiques qui peuvent s’exercer dans cet objet ou entre cet objet et le monde extérieur ». A politics may be drawn out from this reflection on historicity and the becoming of technical objects.

4 C. Marchal could write in 2003 : « En France, un bulletin de vote sur deux est aujourd’hui issu d’un citoyen ou d’une citoyenne de plus de 49 ans et le vote de plus de quarante ans dépasse 65 % » (La démocratie déséquilibrée. La démographie au secours de la démocratie,L’Harmattan, 2003, p. 39).

5 The will of all is very different from the general will; the latter looks only to the common interest, while the former looks to private interest and is no more than a sum of particular wills: but remove from these same wills the pluses and minuses that cancel one another and what is left of the particular wills adds up to constitute the general will. If people held its deliberations (on the basis of adequate information) without the citizens communicating with one another, what emerged from all the little particular wills would always be the general will, and the decision would always be good. But when plots and deals lead to the formation of partial associations at the expense of the big association, the will of each of these associations—the general will of its members—is still a particular will so far as the state is concerned; so that it can then be said that as many votes as there are men is replaced by as many votes as there are associations. The particular wills become less numerous and give a less general result. And when one of these associations is so great as to prevail over all the rest, the result is no longer a sum of small particular wills but a single particular will; and then there is no longer a general will, and the opinion that prevails is purely particular.”(The Social Contract, Book II, Chap. 3)

6 Établissement d’hébergement pour personnes âgées dépendantes (nursing home for dependent elderly people).

7 Edmunds and Turner, quoted by J. Bristow, The Sociology of Generations. New directions and challenges, Palgrave, Macmillan, 2016, p. 61.

8 In The Pinch: How the Baby Boomers Took Their Children’s Future and Why They Should Give It Back, David Willetts (2010), then Minister of State for Universities and Science, insists that the central problem with British social policy today lies in its failure to attach ‘sufficient value to the claims of future generations’. His argument is praised on a particular diagnosis of the problem of the Baby Boomer generation, which, he claims, has monopolized economic, social, and cultural resources, and thereby “weakened many of the ties between the generations” (p. 260).

9 To Marie-France Castarède who has just described, not without a certain Proustian complacency, the time lived by her generation, Samuel Dock answers, charmed, but also bitter about his own generation : « Plus je vous écoute, plus je suis touché par ce temps, passé, présent, futur (…). Aujourd’hui je vois ma génération aux prises avec une temporalité accélérée mais évasive, perdue dans un flux indigeste et abscons où les événements ont tous perdu de leur importance, qu’il s’agisse de l’histoire individuelle ou de l’histoire collective. La mémoire se languit et se traîne, s’égare et ralentit ; les événements passés nous échappent et ont perdu de leur chair ; nous les observons de loin, désincarnés, fantomatiques, passablement vains. Nous oublions que nous ne savons plus. Nous méprisons quand nous ignorons. Nous vagabondons à travers ce nihilisme nouveau dans lequel même les forces du temps se révèlent sans conséquences sur la pensée ». Follows a particularly harsh description whose bitterness that pervaded its words looks to be borrowed from Heidegger’s philosophy of Sein und Zeit; he concludes it with these words : « Comment grandir sans racines ? Ma génération ne peut se sentir exister qu’à court terme » (Castarède M-F. & S. Dock, Le nouveau choc des générations, Plon, Paris, 2015, p. 215). Then, after this great mea culpaworded by her bouger interlocutor, M-F. Castarède speaks again with a view to describe how days and years were passing, not only in her life, but also through the demarcation line between life and death, conferring sense on all mourning ceremonies, Samuel Dock, as a character in his own book, starts telling in a Schopenhauerian way: « Nous avons peur de mourir parce que nous ne savons pas vivre ; nous allons trop vite et nous ignorons comment nous lester d’assez d’existence pour un jour envisager de la quitter, accomplis et heureux d’avoir bien vécu, aimé, rêvé, de nous être liés. Oui, la quitter heureux de nous libérer de notre individualisme insensé et de passer notre tour aux générations d’après, appréciant notre chance, louant les êtres aimés et les quelques moments beaux qui auront su être appréciés, pleinement vécus plutôt que survolés et superficiellement éprouvés. (…) Narcisse, attaché à lui seul ne veut pas se quitter ; il veut s’aimer et s’aimer encore, fallût-il vivre tétanisé dans son reflet. (…) » (pp. 218-219).

10 Is it not in this way that David Hume thought history was a collection of facts or events? The definition by Giele and Elder of “lifecourse” as “a sequence of socially defined events and roles that the individual enacts over time” (1998, p. 22) recalls Hume’s definition.

11 ‘The international help desk. Encouraging ICT use in older adults in England’, in Intergenerational Space, ed. By R.M. Vanderbeck & N. Worth, Routledge, London & New York, 2015, pp. 273-285: “For older people, ICTs can be powerful assistive technologies, helping them to maintain their independence, social connectedness and sense of worth in the face of declining health or limited capabilities, but they can also offer new and empowering opportunities to improve an individual’s quality of life”. Anglo-Saxons (New Dynamics of Ageing [NDA] Research Programme) and Canadians (Canadian Institutes of Health Research [CIHR]) have forwarded research teams that have much progressed in those fields.

12 Margaret Mead, in Culture and Commitment. A Study of the Generation Gap(published for The American Museum of Natural History, Natural History Press / Doubleday & Company, Inc. Garden City, New York, 1970), wrote that there are “three different kinds of culture –postfigurative, in which children learn primarily from their forebears, cofigurative, in which both children and adults learn from their peers, and prefigurative, in which adults learn also from their children” (p. 1). Margaret Mead had noticed that, “in this new culture it will be the child – and not the parent and grandparent that represents what is to come. Instead of the erect, white-head elder who, in post figurative cultures, stood for the past and the future in all their grandeur and continuity, the unborn child, already conceived but still in the womb become the symbol of what life will be like” (p. 88). It is the adults who need of the new knowledge of their children. “The Future is Now” (p. 97).

13 In Le nouveau choc des générations, p. 13, Marie-France Castarède writes : « Je me référerais à une conférence de Michel Serres où il montrait avec pertinence que la vraie différence intergénérationnelle aujourd’hui se situait entre les adultes et les enfants qui sont nés dans et avec le numérique. Les personnes de ma génération ou de celle de mes enfants se servent de l’ordinateur et d’Internet en tant qu’instruments précieux pour des applications diverses. Samuel, lui, à l’instar de mes petits-enfants, appartient à la génération née dans cette nouvelle manière d’être au monde, l’ère du numérique ». M. Serre repeated an idea of M. Mead who said in 1970, op. cit., p. 64: “Today, suddenly, because all the peoples of the world are part of one electronically based, intercommunicating network, young people everywhere share a kind of experience that none of the elders ever have had or will have. Conversely, the older generation will never see repeated in the lives of young people their own unprecedented experience or sequentially emerging change. This break between generations is wholly new: it is planetary and universal”.

Pävi Naskali, Marjaana Seppänen & Shahnaj Begum (eds.), Ageing, Wellbeing and Climate Change in the Arctic. An interdisciplinary analysis (London: Routledge, 2015)

The rationale behind this book is that little has been written and limited sources of information are currently available about ageing, wellbeing and climate change in the Arctic region. The Arctic is defined in political terms, not in terms of geographical, ecological, or climatic criteria. “The region is seen as both a direction and a location; the definition varies according to the describer’s position” (2). The editor’s also point out that men and women are not affected equally by climate change and there exists a knowledge gap on this issue of the ageing population (4). The book addresses this and explores three important main discussion areas: “first, various political issues that are currently affecting the Arctic, such as the social categorization of elderly people; second, the living conditions of the elderly in relation to Arctic climate change; and third, the wellbeing of elderly people in terms of traditional knowledge and lifestyles” (1).

Continue reading Pävi Naskali, Marjaana Seppänen & Shahnaj Begum (eds.), Ageing, Wellbeing and Climate Change in the Arctic. An interdisciplinary analysis (London: Routledge, 2015)

Zbigniew Wozniak, The Elderly in Social Policy. Towards a New Architecture of Gerontological Programmes (Development in Humanities, Volume 4, Lit Verlag, 2013)

 

 

As a British General Practitioner, it was with great interest I read this book. While the concepts under discussion are familiar to me, approaching these from a humanities point of view brought a fresh and positive perspective.

 

Wozniak begins by detailing the various factors under consideration when developing social policy for older adults. A global shift towards an older population and lower birth rate is well documented and is well summarised here. The escalating economic difficulty in funding social policy, as it currently stands, informs the urgency with which the author approaches the subject.

 

  He goes on to detail normal biological changes associated with human ageing in general, while at the same time, emphasizing the wide variation in functionality between individuals of the same chronological age.  He correctly identifies that there can be a tendency to over-medicalise what is, in fact, a normal ageing process. He emphasises the importance of mental health, social interaction and proposes that identifying “isolators”- factors isolating individuals from their community – should form part of the assessment of an individual’s care needs. The author asserts that in doing so, we can empower an individual to access resources of all types around them. Developing this empowerment, contributing to maintaining an individual’s independence, is a key-factor in Wozniak’s new model.

 

In Chapter II of the three-chapter book, the author outlines some predictions of scenarios of the possible social consequences of population ageing. For example, considering technology, computers could be a positive connection to the outside world, contributing to a sense of community even for the housebound. For those without access to technology, however, an obvious opportunity gap arises. Also, a move toward a society of more inter-generational solidarity is postulated, widening the age ranges involved in the workforce, education and family life. Mentoring and resource exchange between generations could lead to a “society for all ages”, increasing the wellbeing of all.

 

These first two chapters form the basis for the author’s three-layer framework: A holistic view of social policy concerning the elderly, outlined in Chapter III.

The author correctly suggests that the current model of care is based on that of “solving problems” as they arise. Interventionist and emergency-based, we are simply lurching from event to adverse event, attempting to serve each individual, allocating increasingly squeezed resources only when a crisis occurs. Thus, he suggests that a move away from an emergency/interventionist model of care, towards greater expenditures on prevention, increasing awareness and sensitivity to the problems and needs of the ageing population.

 

Included in the book are detailed frameworks of the sectors involved and how each (for example, the labour market, housing, health, family and culture) might be inter-generationally structured to promote primary, secondary and tertiary prevention. He argues that the complexity of existing individuals points to the need for a complex and flexible set of structures on which to base care of the elderly promoting a society based on empowerment of both the elderly and younger generations, whilst allowing each to support the other. The principles are a move away from measuring policy by a single paramount outcome, such as “added years of life” for example, towards a broader process of developing a more robust intergenerational solidarity.

 

For example, employment and workplace policy must exist to adequately support family care of the elderly, in the same way that maternity and paternity employment rights have been developed to support employment and the care of young children. Similarly, policy which supports older adults’ contribution to childcare, mentoring and education contributes to the intergenerational exchange Wozniak is seeking to support.

 

Wozniak’s arguments confirm my fears that there are no easy answers to the “problem” of an ageing global population, though it is refreshing to read such positive writing on the subject. Though the aims here are lofty, he argues well, calling for a rise above the traditional solution of simply increasing funding to the current structures.  The models described reprsent a well-grounded basis for a change in approach to the organization of the Welfare State.

 

The structure of the prose can be complex at times, for those, like me, outside the field of philosophy, but it may help readers to begin at the summary chapter. This gives a helpful overview, not detailed enough to negate the benefit of the main chapters, but making them easier to digest.

 

I would recommend this book to undergraduate medical students as a companion to medical sociology studies. For postgraduate medical and GP trainees, I would suggest that the positive discussion of care of the elderly is not like anything I have read elsewhere, perhaps because of its non-medical approach. Regardless, I hope this work serves to inform European policymakers of an alternative approach to the formation of future social policy.