>> From the Library of Congress in Washington, D.C.
[ Silence ]   >> Thank you.
To kick off this afternoon's session we're first going
to have some opening remarks by Mr. Lee Hammond,
the President of the AARP which we know how important an organization
and what wonderful work they've been doing having been a member there
myself for 19 years already.
And I turn the floor over to Mr. Hammond.
[ Applause ]
>> Well, good afternoon and welcome to the afternoon session.
As was mentioned, I'm Lee Hammond, President of AARP.
And in this capacity I've had the privilege of serving on the Library
of Congress Private Sector Advisory Council, the James Madison Council.
Our mission at the council was
to bring the library's remarkable collection of knowledge
and creativity to people across the United States and around the world.
Before we move on to what promises to be two very interesting panels,
I want to speak for just a moment about the strong and productive ties
between the Library of Congress and AARP.
AARP's national headquarters is not many blocks away.
We're almost a neighbor, a neighbor in sprits you might say in keeping
with the theme of today's symposium.   AARP Foundation's sponsorship
of today's event is an excellent example of the close connection
between our organization and the library.
I like to mention two other areas
where we've collaborated in recent years.
In 2004, AARP worked with the library
and the Leadership Conference on Civil Rights, on the "Voices
of Civil Rights" bus tour.
This was a 70-day tour from Washington, D.C. to Jackson,
Mississippi, following part of the route
of the historic 1961 Freedom Rights.
And AARP was the founding private sector sponsor
of the Veterans History Project,
a project of the American Folk Life Center at the library to collect
and preserve oral histories and documentary materials
from all the wars Americans have fought
from World War I to the present.
AARP continues to spread word about this project to our members.
AARP volunteers from a number of states record oral histories
from those who served on the military fronts and those who served
on the home front during the wars,
and we contribute these oral histories
to the library for archiving.   While the Civil Rights Project
and the Veterans History Project shine a light
on our national identity, as well as individual courage,
today's symposium is exploring new frontiers of individual identity
and growth in our later years.
Once again, AARP is proud to be working with the library
to expand our collective sense of the possibilities
of the human spirit, thank you.
And let's proceed now to the next panel.
[ Applause ]   [ Pause ]
>> Thank you one more order of business.
I don't want to deal with termination at this point
but in case any of you do end up leaving early, you found evaluation
and feedback forms on all of your chairs.
So hopefully, you'll be here right 'til the end
and you'll hand it in person.
But in case you have to leave early the organizers of the program would
like your feedback and your input.
And I can tell you as somebody who's been running conferences
for many years it's very important.
There's an old Jewish saying that here, this has been a great day
but there's an old Jewish saying if there's enough people tell you,
you don't look well maybe it's time to lie down.
So your feedback can be very important
to helping in future conferences.   [ Pause ]
Okay, first panelist this afternoon, it's a real--
we talked about expanding your horizons in later life
and I was very privileged to know all of the panelists this morning
from the Jungian world for years and last night I was able
to meet all the panelists, most of the panelists,
the rest I met this morning for the first time
and it's expanding my horizons and I can say
that from the Jungian perspective, we welcome the input
and the cross fertilization, people from different areas of expertise,
so it was a pleasure to get to know them.
I'm looking forward to hearing what they have to say as well
and I know we'll all be in for a very special afternoon.
Our first speaker will be Dr. Kelley Macmillan who's a clinical professor
of social work at the University of Maryland
at the School of Social Work there.
His area of focus is working with health, aging,
and social service agencies to develop services that build
on new practice opportunities in programs that serve older adults
which is really important, these hands-on work,
to carry out our ideas in the field.
Among his publications which include articles and refereed journals
and a chapter in an edited book, he has dealt with such important issues
as the role of the gerontological social worker in assisted living
and decision making in long-term care approaches used by older adults
and implications to social work practice.
Please join me in officially welcoming Dr. Macmillan.
[ Applause ]   >> Good afternoon.
It's a pleasure to be here and share some of my perspective.
My first career was as a medical social worker on a hospital setting
and has many good old fashions stories.
I'll share a few of them, not too many.
And then eventually moved on to do a PhD in the second part of my life
and now in a clinical role at the school of teaching.
I need to be transparent, I'm not a Jungian.
But I do think I have some pieces that will tie very well
into the theme today and I really find that this theme
of successful aging is very vital today.
I prefer to call it aging well but I think it's a very vital theme
as we recognize that there's an adult population
that will be using more and more services as they age.
Also, from a personal perspective, I find that my sense
of self is deepening and crystalizing more and more as I age
and that I recognize that I'm in the second half of life.
And for me it's about integration.
It's integration of my self in terms of wisdom and experience
and that I can use that in terms of my relationships with those
around me and I also do some mentoring as an elder.
And so I've moved into a space around eldership
and I think those are important places for us to recognize as well.
As I mentioned, the theme of successful aging
or aging well, I think is very timely.
There's a good amount of research and literature in that area.
And it has continued to sort of spawn projects and programs
and services in a variety of areas.
There are some folks that are looking
at what's called productive aging or civic engagement and they're looking
at how people are engaging in encore careers.
My focus today is really going to be looking at those health
and social services that older adults use as they age
and they experience physical disability.
Now, from my perspective, I want to go back to some of the things
that we talked about earlier today about this sort
of rise and decline in age.
And I think we all have firmly planted on our own mind the idea
that from infancy and youth we ascend to this pinnacle
of middle age, whatever that is.   And then there's this descent
and unfortunately they view it as a descent to death.
And I think we really need to begin to sort of change and challenge
that view that it's just not the staircase to death.
And what happens I think in that context is that we have a tendency
to equate age or aging with death
and I think it's just not an accurate sort of depiction.
In medieval times, one of the models
that I particularly liked was really a circle
and there are all the stages of life from birth to death in it
and the spokes went into a center hub
where there was a spiritual image that connected people
up to the physical and the spiritual world and that's one of the things
that we're talking about and I think there's a lot of merit in that.
Now I want you to realize
that I don't think we could ignore the physical aspects of aging
but there's more to old age if you ask older adults.
And I've had the privilege of working with a lot of older adults
in my career and they really have been my best teachers.
So I'm going to share some pieces from some of their stories as well
as what's occurring in the medical arena.
First of all, I believe that this staircase metaphor of rise
and descent is really firmly implanted in the medical model.
Now I want you to understand that I've worked with many physicians
and health practitioners and I have a deep respect for them.
But this model is fairly well has been historically entrenched,
I think, at how care is provided and that the real goal here in terms
of infusing this medical model with aging well, with successful aging is
to help begin to shift people's view.
The good news is that there are shifts that are occurring
and I want to talk about those.   The three areas that I want to focus
on are what we call personal social services, those services delivered
in the community, primary care practice
which is the physician practice,
and then also acute care and rehabilitation.
The trends in personal care really began around personal care services,
homemaker, and short-type services and some trends began to develop
in terms of the 1980s where they really began
to be an alternative to nursing home care.
And as those services began to develop,
there was the particular portion that were provided
to older adults, aging services.
And also, there are particular portions of services
that were provided to folks with physical disabilities.
And typically, those services didn't-- did not overlap.
They're very distinct and separate, however, over time,
the folks in the physical disability advocacy community really I think
began to influence those services for older adults
and personal social services.
And the goal for services today tends to be one supporting persons
to live in the community.   The older model typically was one
where older adults were taken care of.
People came in and did things to them.
And the disability rights advocates really said, "What we want is people
to assist us so that we can live independently.
We don't need people to do it for us."
So what's emerged is this person-centered model of care
which really begins with a conversation, a conversation
with the person receiving care to find out what's valuable to them,
what they're looking for in life, how they want to live their life.
And from that basis then, the care is delivered as opposed
to a professional coming in, assessing the person
as to what do they think you need as an older adult or a person
with disability and we're going to provide that care,
rather it's really more self directed in terms
of the care people receive.
These models of care are gathering more and more support.
In the State of Maryland, there's a pilot project at Howard County
where they're doing what's called some options counseling where again,
they're using a person-centered approach
and asking consumers what is it that they want in terms
of living their life in the future?
What kinds of things will be important for them in terms
of how they survive and age well in place?
So those-- that model eventually
as it gets fine tuned will be brought throughout the entire state
probably within the next year.
So these are exciting trends in the personal care side.
Another area of growth and change is in primary care.
I think a few of us can remember the day when we went
to our primary care physician
and that person directed all of our care.
Things have become a little bit more fragmented
and fractured, if you would.
It's easy for us to have a number of specialists and those people may
or may not be speaking to each other,
not because they're not friends,
but because the system is a little bit fragmented.
We don't have the electronic medical records
to transfer data back and forth.
And so, your primary care physician may not know exactly what's
occurring with you and your specialist.
Well, they're moving towards a model which really has been
around since the 1960s in pediatrics
and it's called patient-centered medical care.
And the care and focus is going back to the primary care physician
who will work closely with those specialists that you may see.
Another piece that's really a valuable adjunct to these patients
that are in medical home model is
that they're including other professionals.
There are people who are care coordinators, behaviorists,
et cetera, who in addition to working with the physician
around those medical issues will look at those kinds of behaviors
that need to be changed in terms of improving health.
It might be exercise, nutrition, smoking cessation.
Care coordinators will work with folks to identify those services
and needs people have before it becomes an emergency.
My experience in the hospital setting many times was
that people were hospitalized because there were some crisis
that occurred that might had been averted in some sort of way
if services are delivered in this primary care model.
So again, I think it's as a really important place,
it's a merging place in terms of where practitioners who work
with folks on a behavioral, mental health,
counseling perspective can really develop some expertise
and provide support to folks throughout the life course.
The other piece that I think really becomes helpful
in this primary care model is that with the care coordination,
there's really an attempt I think to reduce premature
or unnecessary hospitalizations because again, linking people
up early in the stage of care.
The final place I want to talk about has to do with hospitals and rehab.
I remember the day when a patient who came
in who had a fractured hip would be in the hospital for three weeks.
It's probably three days if they're lucky.
And these people are being-- going into rehab units,
care is much more specialized and intense.
And unfortunately, again because of this,
the focus of this medical model,
it's really on the physical conditions, diagnosis,
assessment and treatment.
And I think what's happened is that that person,
that patient has become a little bit lost in that medical model.
Hospitals, and again, we do want our physicians
and healthcare practitioners to focus on those biological things,
but how can we begin to help them recognize that in
that bed is a person, it's not the hip in 314
or the gallbladder down in medical surg.
Hospitals are developing age-friendly units
in their inpatient units as well as emergency departments.
And especially, in the inpatient units, one of the things
that they're doing is providing care
so that the individual can do what they can for themselves.
Gone are the days where they tell the older adult,
get in bed and stay in bed.
Don't do anything unless you get help.
We know that when that occurs, it just increases the level
of disability and frailty for the older adult.
And you all know this yourself when you've been ill for a couple of days
and you've been on bed, you really, it's really hard to get back
on your feet and when we do that on a hospital setting,
What's beginning to emerge is, again, some levels of teamwork
where the team is working with physicians.
One of my stories from times past was I had run
into our medical director for one of the hospitals I worked at
and Butch was telling me that it was not a good day
because the treatment goals he established with his patient
after several weeks were not being achieved.
And I asked him, I said, "Well, what does your patient want,"
[Laughter] The goodness was that Butch went ahead and talked
with his patient and he reported later on, he said,
"I met with that patient.   I found out what she wanted.
I told her what my goals were," and he said "We worked out of plan,"
and he said "I think it's achievable."
And what's beginning to emerge a little bit in the healthcare side
and the inpatient side is that teams are forming.
There are inter-professional practice teams
where you get the best of the medical team together
and a key player on that team is the patient and sometimes the family.
This fall, I was part of an educational program
up at Shady Grove where we worked with pharmacists, nurses,
respiratory therapists and social workers
to help them learn before they get into the field,
what it's like to work as a team.
And we used patients so they had a sense of including the patients.
So again, we're beginning to teach this model and we have a long way
to go I think because again, like I said, there's this notion of person
as disease, aging as disease, and that's a piece
of what we're trying to break out of.
In addition, in healthcare, because of this quick discharge,
transition care teams are being developed within the hospitals
to reduce repeat admissions.
And what these teams are going to do is help us link those folks
who are chronically disabled, have chronic health diseases
to be better linked up with their primary care practices,
with services, et cetera.
And I think that's going to be a tremendous impact in terms
of reducing hospitalizations and improving quality of care.
In summary, it's true that poor physical mental health can interfere
on older adult's ability to age well.
And the changes in delivery of personal care services
and home care can make a difference.
It's this partnering of older adults with the healthcare providers
that enhances these positive outcomes for older adults,
and ultimately, contributes to their ability to age well.
So this shift will occur when we train health
and medical professionals to see older adults
as the psychosocial spiritual beings that they are.
And so, I think from here, we just need to keep pushing this forward.
Thank you.   [ Applause ]
>> Thank you.   Thank you.
Again, we'll hold our questions until we hear
from all three panelists.
Our next presenter is Dr. Mary McDonald, she works full time
in the field of geriatrics serving on the home care practice.
She serves at the Division of Geriatric Medicine
at Washington Hospital Center and as Medical Director
at the Washington Home and Community Hospice,
as well as Associate Professor in the Department of Family Medicine,
the Division of Geriatrics at Howard University, College of Medicine.
Dr. McDonald has published numerous articles and books on the subject
of geriatric medicine including documenting competency
in the mini-mental state exam and the mini-mental state exam
of core geriatric competency, and it's a pleasure to welcome her here
and somebody who's again active in the field
and can tell us exactly what's going on these days.
Thank you.   Please join us.
[ Applause ]   >> Good afternoon.
It is a real pleasure for me to be here today with the true scholars
that you'd been hearing from throughout the day today.
I am a little tickled that I am your next speaker.
I don't consider myself a scholar so much as I am simply a gal that's
out in the field trying very hard to take good care of older adults.
I also work with teaching medical students, residents
and geriatrics fellows how to take good care of older adults.
So that's a little bit about what I am going to talk or all I'm going
to talk to you about is my observations out in the field.
I do want to give you a disclaimer.
Like any other qualitative observations,
all of these observations are filtered
through my personal experiences.
They're filtered through my moral compass.
They're filtered through my life story.
So, all I can share with you is some observations that I have and,
but they're very, very generalized and less scholarly perhaps
than things that we've heard throughout the day today.
So I do want to share with you what, very briefly, what I love so much
about geriatrics which honestly I could talk
to you about for about 7 hours.
I'll try to keep it to about 45 seconds.
What I like about geriatrics is taking care of older adults.
Older adults are so wonderfully diverse, exciting, different,
I never know what I'm going to get when I open
up the door to meet a new patient.   My background training was
as a family physician before I did a fellowship in geriatrics
and the diversity that you see in older adults is
so very different than at most age groups.
If I know that my next patient is a 40-year old man, I kind of know what
to expect before I walk in the room.
They might be different people but as far as disease state goes, it--
there's the 40-year-old man picture.
That all goes away when people get older.
If I know that my next patient is a 65 year old,
I have no idea what I'm going to see.
Some of my 65 year olds are frail.   They're dependent.
They are cognitively impaired.
I also have 89 year olds that are robust.
They are funny.
They are cognitively intact and very engaged
with their families and the community.
So the number starts meaning less and less and less
in the geriatric population.
They are also can be, geriatric patients can be very medically
complex which I find intriguing and that's very nice.
So my role as a physician is very different
than what I thought it was going to be in medical school.
In medical school, the focus was
on learning all the science and the minutia.
I had to learn the name of thousands of medications and how they work
and what doses to use and what this disease means
and what this lab value means.
And after all of that study, I remember a lot of it.
But I'll tell you that of everything that I do in my day,
my practice day, that is the most mundane
and the least professionally satisfying of anything that I do.
There are treatment algorithms that tell me
if your blood pressure is this, I should treat you with this.
If you have this lab value, this is what I should do to fix it.
And so, that to me is not so much the art of medicine as what I get
to do in my other roles as physician and one of the roles is
as a negotiator, and this is a little bit what we were talking
about with having your goals of care.
I negotiate with my patients as to what their goals of their care are.
I have some patients that want to capture every single minute
on this earth that they possibly can.
They want better living through chemistry and technology.
And I am to treat them with any medication that I think is warranted
and by golly, they'll have every CT test that is indicated.
And I'm okay with that, if that is their idea
of quality healthcare within reason.
I have other patients who think that's all that's wrong
with medicine is that there are doctors and that there is medicine.
[Laughter] And so when I meet them the first time they say,
"Really, I don't want you here."   [Laughs] So we have to kind
of negotiate what is each individual patient's goal
and if they are not cognitively intact,
I negotiate with their caregivers, with their powers of attorney
to find out not what they want 'cause truth to be told,
don't tell on me, I don't really care what they want.
What I'm asking the powers of attorney
to tell me is what would the patient want.
If the patient could talk to me, what would they want me to do,
and that's what's important.   I also worked as a tour guide.
I'm not sure.
Well, I'm guessing most of you have had some experience
with the medical field and you know that it's a crazy, confusing place.
So to be able to navigate your way through to get the care
that you need or to find access to what you're looking
for to get the answers you want can be very, very challenging.
If you're looking for social support,
it could be also very, very challenging.
So a lot of what I do is to help navigate, help my patients as my--
me and the rest of my care team which includes nurses,
social workers and a lot, physical therapists and the like is
to help people navigate to where they want to be.
I also work as a cheerleader,
although sometimes I would be described as a drill sergeant.
I have one patient who is completely socially disengaged.
She wants never to leave her house.
She doesn't care if anybody ever visits her and I--
we set a goal just this week that I want you to think of one activity
that gets you out of your pajamas every week.
I don't care if you're out of your pajamas for 20 minutes of one day
out of every week but that's our little mini goal
and it's her homework assignment and I will keep on her
to try to help her with that.
I also work as an advocate for my patients, when--
especially my patients who have a cognitive or physical decline
to the point that they can't advocate for themselves.
So, in all my observation, over 12 years of working with older adults,
I've been trying to come up with a recipe for healthy aging.
And I really think it's a self-centered quest
because I'm not getting any younger.
But I'm trying to come up what is it that makes healthy aging
versus my patients who are absolutely devastated by time.
And I don't know the answer yet.
But when I know the answer, I'm going to patent it.
I'm going to bottle it.   I'm going to compound it.
I'm going to put it in a pill and I'm going to sell it
and I'm going to be rich.
But I'll tell you what some of the ingredients that I'm seeing
and these are kind of seams that I see in my patients.
I have a very diverse patient population, ethnically diverse.
I have patients from you know, internationally diverse.
I have patients from-- of different religious backgrounds.
But despite all that, I see some consistent themes
which is what I want to share with you today.
The first theme I see is engagement.
And what I mean by engagement is people--
some of my older adults they tend to withdraw
and they lose their role in society.
They lose their role even in their-- within their own family.
And some of that has to do with family norms.
You know in our family, this is what we do.
When people reach a certain age and they're not able
to contribute actively with the family,
we put them in the back bedroom, we go and feed
and water them every once and a while,
but they stay back there, right?
So some of that is because of a family pattern, but I think a lot
of that is because of the societal expectations
that we have of older people.
When I was teaching at the University of Kansas,
I taught third year medical students,
175 of them a year for a four-week course.
And one of their assignments during that course was to find somebody
over the age of 65 that was not their family member and sit
and talk to them for an hour.
And to write not a paper, write a reflection piece of what the ex--
what they learned from the experience.
Oh my heavens, you would have thought that I'd ask them
to put a roof on my house.
I had students, so of the 175 patient-- students I had each year,
we did this three years in a row.
I had about a third of them who e-mailed me and said,
"I don't know anybody over the age of 65."
Are you kidding me?
Look at our demographics in our society.
How can you not know somebody over the age of 65?
And it turns out that well, one,
they don't hang out at the same places.
But besides that, there is this societal norm
that we see people who are older.
They tend to withdraw from society and they're not out there.
And so, my patients who tend to age well and stay engaged with society--
the two tend to have a lot to do with each other.
They stay very active within their family, within their society.
Another thing I see is resilience.   I love the word resilience.
I love the word resilience so much I say it almost everyday 'cause I'm
trying to figure out what it is.
There are-- I can give you 10 definitions of resilience.
I don't find the definitions very helpful.
But what I do know for a fact is I know resilience when I see it.
And I have patients who have been through lifelong trauma.
And they've been-- I mean, they have not been on the luck side of things
from the day they were born.
Be it their lives, their social situation,
their medical situation, yet they're happy.
And they're engaged with society and I want to know what causes that
and I want to be like them when I grow up.
And so I'm trying to figure out,
put my finger on what exactly is resilience.
I'm going to go overtime if you don't like put your hand up.
So-- [Inaudible Remark] Well, it depends.
So I do want to tell you, I'll just keep it to two more little stories.
I have a patient, I will call her Millie and she was one
of my patients for many, many years and she had a life that read
like something you'd hear on daytime yakky [phonetic] TV.
I mean she had this story.   It was rough.
She had a rough upbringing.
She was about in her mid-80s when I met her.
She told me when she was young, she was a dancer.
I don't think she meant like she was a ballerina.
I think that she was a dancer for money and not in a-- well, anyway.
She had many, I think six children,
was never married to any of the fathers.
She worked her tail off to support those children and they were very,
very good to her in her final days.
But what struck me about this woman was
that through everything she had been through,
including her horrible arthritis, her horrible lung disease,
her cancer diagnoses, she was the happiest,
funniest lady I have met in a long time.
I asked her one day, I routinely asked my patients,
what do you do for fun?   And half of them look at me
like that is the craziest thing they've ever heard in their life.
So I want you to be able to answer that question.
By the way, if you can't answer that question like that,
it's not voting real well for you having healthy aging.
[Laughter] Okay?
So I asked them, what do you do for fun?
And this lady said, "I take the bus."
All right.
[Laughter] I need some more, "What do you mean you take the bus?"
She said, "Dr. McDonald, 1 dollar, unlimited transfers
and there are some fine-looking men in this city."
[Laughter] It was then that I knew I had passed my relationship,
my boundaries with this relationship
with this patient were completely torn down and I loved her.
[Laughter] This same woman ended up going to the nursing home
because her arthritis got such that she couldn't transfer herself in
and out of her wheelchair.
And at the time she came to my nursing home,
so I was still her doctor.
I still got to see her and they were doing construction
on the third floor which was her floor.
And I said, "Millie, how are you liking the nursing home?"
Same thing.   "Dr. McDonald, I love it here.
There are some fine-looking men in this nursing home."
[Laughter] Anyway, so I want to know what makes for her [phonetic]
and when I find it, you'll hear about it
because I'll be all over the TV.
The last thing, I do want to talk about hope and spirituality.
Hope and spirituality, you know, hope can be spirituality.
I think the core of many patients' hope is their spiritual base.
But I take care of lots of patients who don't claim
to have any true spiritual base but they still have hope
and they still have inner beliefs
that they don't identify as spirituality.
I have spiritual conversations or inner belief conversations
with everyone of my patients.
I do not know how to take care of patients
if I don't know their belief system.
And so, the added bonus for this to me is that I talk
about spirituality everyday with my patients
and I have benefited tremendously from that.
I have an inner spiritual conversation
with myself all day long that I've never had before I spent time
with older adults and I've really benefited from that.
And lastly, I want to leave you with a quote that sounds a little
like a bumper sticker and I may have actually seen it on a bumper sticker
that says, "You don't stop having fun when you get old.
But you do get old when you stop having fun."
Thank you very much.   [ Applause ]
>> Thank you.   I thought I was funny.
This was [laughter]-- it's great.
We were talking about part of your talk mentioned about getting older.
I just, I had my own association.
I just finished the biography of the Rothschild family.
And one of the stories is when the older Rothschild reached about 98,
she refused to be going to doctors.
So her son brought doctors to her, to the examining.
He can afford it and he brought a doctor one day, the doctor comes out
and Rothschild asked him of "How was my mother doing?"
And he says, "Well, Lord Rothschild,
but your mother's not getting any younger."
And he said, "Look doctor, I'm not paying you to make her younger,
I'm paying you to make her older."   [ Laughter ]
Anyhow, our third presenter this morning,
somebody I had the pleasure of meeting last night.
I think the first person I met,
arriving at a good reception last night was that Dr. Gay Powell Hanna
and I enjoyed meeting her and looking forward
to hearing what she has to say.
She's also dealing with a very important subject
and creativity also in older people.
That's one of the areas that she specializes in.
She's an arts administration leader with over 30 years experience
in arts education and health-related services
and she is the Executive Director
of the National Center for Creative Aging.
That's NCCA, not NCAA.
[Laughter] Not to be confused at all with that.
It's an affiliate of George Washington University in Washington,
D.C. Previously, Dr. Hanna held faculty positions
at Florida State University and the University of South Florida
where she served as-- where she directed VSA Arts of Florida
which is an affiliate of the John F. Kennedy Center
for the Performing Arts,
a very important organization in our county.
As a contributing author to numerous books and articles,
among her publications are such topics as Arts
and Human Development: Learning Across the Lifespan
and Creativity Matters: Arts and Aging in America.
So please join me in welcoming Dr. Hanna.
[ Applause ]
>> Thank you so much and good afternoon everyone.
I want to sign up and be Mary's patient, don't you?
I'm so glad I'm in Washington, D.C where she works
and to all the panelists, it's just been such an invigorating experience
and inspiring, so thank you.
Thank you to our host and to all of you for coming.
Well, I feel like taking a deep breath now and embracing this moment
of really cultural change.
Dr. Corbett powerfully put it that creativity is essential
across a lifetime and then has such a powerful impact
at the very latter part of our life.   He eloquently linked creativity
to spirituality really to the divine gifts.
And as I've often heard, it allows us to be in the thin places
between heaven and earth, which we often feel when we're before a work
of art or when we're engaged in a creative practice in our home,
our kitchen, our gardens, with our loved ones and families and friends.
Well, I come from the visual arts
so you can be sure I need pictures to talk.
So I have so enjoyed hearing the eloquent presentations
but if I could just explore with you today productivity and vital aging
through the lens of creative expression and really
as was earlier said, talk to you about the hands-on landscape
that is now growing and thriving to carry out the ideas that we've heard
and the important concepts.   And I've got the clicker.
All right, thank you.
So just a little bit about the center.
I say, I'm from the National Center for Creative Aging
and of course eyes widen and I think many
of you have said, "And what do you do?"
Well, actually, we were created 10 years ago by Susan Perlstein,
founder of Elders Share the Arts in Brooklyn, New York,
a grassroots organization and formed by the National Endowment
for the Arts and the National Council on Aging.
So we're truly a bridging organization with a mission
to be sure that we can provide as much access to the experiences
in creativity and the arts and culture
as is available in our communities.
Now I'd like to just introduce you to the pair that you see
in the corner of the screen-- in the screen.
There's a gentleman playing the violin and this is our template.
He's playing to a young, I think a young girl and he is a resident
of Burbank Senior Artist Studio Residencies in Burbank, California.
These places of affordable housing are built around the arts.
In fact, I visited and people in the halls actually saying to each other
and they didn't even know I was there visiting
as a person in the arts.
But we're seeing models across the country.
In fact, there are 23 of these sites across Los Angeles,
but they're popping up in Washington, in Atlanta, Saint Louis,
of course New York and Boston.
So we're redefining our landscape of what it means to live
Again, the landscape includes research.
We need an evidence space to talk and communicate
with the other disciplines that are so important
to thriving an array of program services.
We need policy.
We need technical assistance and we need a place where you can come
and get more information and provide the information.
Now, a 97-year-old artist, visual artist, was asked,
"How are you doing today?"
And she said, well, I'm above ground.
[Laughter] And these turns out to be the title
of a very exciting research study done by Joan Jeffrey [phonetic].
I'm showing here the title page of the study.
And of course, it shows much of the ground
and above it is New York City.
So study of visual artists that have spent their lives
as professional artists in the City of New York.
Not the super famous ones, but the ones day to day
that have worked in their communities.
When this study was released in 2007, the New York Times said,
"Older artists, role models for successful aging."
So here, in fact, it resounds,
resonates with Dr. Corbett's presentation.
Average age, 73.   Income in New York, 30,000 dollars.
That won't take you very far.   Life satisfaction very, very high.
Self esteem, high.
Engaged with their community, not intending to move, have found a way
to have healthcare, retirement.
Of course, they are artists so they have an attitude.
[Laughter] And a strong social network,
this is especially true of visual artist.
In fact, Picasso once stated "As one grows older,
life and art become one and the same."
And I think that's what we've heard today.
And again, median income, oh I love it when they do this.
[Laughter] And know the major thing is
of course it's very good to live in the moment.
Visual artists often live at the moment, live in the future,
but much of their work is not taken care of.
So indeed there is policy being developed out of the study
where there are programs taking place in New York and Washington
to save the legacy of visual artists.
We're very proud at the National Center for Creative Aging
to actually have the Research Center on Arts and Culture with us.
It was given to us by Columbia University last September.
Now what does that mean to you and to me,
most of us that don't spend our lives in the studio?
I'd like to share with you another study and I know many of you
in this room have met and know Dr. Gene Cohen.
We lost Gene about two and a half years ago.
He was one of the founding directors of the Institute of Mental Health
and the National Institute on Aging.   He's really one of the founders,
was one of the founders of geriatric psychiatry.
And he spent his life truly working in the medical model
and then became convinced towards the end of his career again back
to Dr. Corbett's presentation of the Power of Creativity
and that what had been denied certainly was the potential
of aging.
So he spent the rest of his career like others looking at aging not
from deficit only but from asset to really shift the paradigm.
In fact, he said, you know, we almost have no choice
but to have stereotypes about aging.
He said, "All we see when the media presents older people is the three
Ws, they are wicked, they are weak or they are weird."
[Laughter] So what can we do to change that?
With these demographics, we certainly are changing it
and it is the culture change.
Well, I did a three-year longitudinal study,
a very small study but one of the first indicators where he looked at,
he measured mastery and social engagement
to see how community based the arts programs.
Arts program said, "All of us can be part of."
He looked at an art program in San Francisco.
He looked at creative writing and jewelry making in New York
and in Washington, he actually studied a chorus
out of the Levine School of Music.
Now what did he find, with the median age of 80,
people actually got better in the experimental group.
He found better health, less medication, fewer doctor's visits,
certainly an increase in activities and he modestly,
and we know this is a very small study,
projected that because arts programs are so inexpensive,
that the saving potential with using creativity
on healthcare cost could indeed be substantial.
This study was funded by the National Endowment for the Arts,
by AARP and in fact, I'm pleased to thank Rick Moody who's here
in the audience now for all of his support.
Rick is with AARP, the academies.
And then second, Aryeh mentioned a recent white paper
and this I call the big shift.
As Dr. Cambray mentioned, we've had individual pioneers coming
to this place for quite a while.
In fact, Robert Butler talked about why survive
in the '70s growing old in America.
But now we seem to really be moving towards that cultural change.
And I'm just delighted to share with you if you don't already know
that in March 2011, there was a convening of the National Endowment
for the Arts and Health and Human Services.
And they convened to really look at arts
and human development across a lifetime.
We were honored at the National Center for Creative Aging
to author this white paper.
It was produced by the National Endowment for the Arts.
It has resulted in a 16 governmental agency task force.
The task force knows that in this climate, there is just no new money.
But what we're finding is indeed there are resources
that can be compounded and shared in policies and funding descriptions
that can be opened and more ways to build an evidence base
to again encourage this lifelong productive and vital aging.
And in fact, I've given you the website
and in your resource book you certainly have ways to become a part
of this and there's actually webinars and convenings
and there'll be a call for papers from the National Academy
of Sciences later on in the year.
So I certainly hope that there is a core of you
who will certainly participate in this.
Now again, we're looking across the lifetime.
What does this do?
And Kelley, so wonderfully put the whole movement is towards whole
person's care.
Mary told you about the actuality how she does her practice based
on this but here we've got it in a larger conversation,
we're looking at it in terms of really starting not at 60
or 90 to figure out how we are and how we can actualize creativity
Now it's my privilege to take you almost into a garden,
a garden that's just blooming across this country.
Again, this movement started in the '70s and is now in full flower
with plenty of room to grow.
So here, I'm showing a picture of a teaching artist, Anthony Hyatt.
He's working here in Washington, D.C. at IONA Senior Services.
He is dancing with a person who has memory loss, dementia.
I think someone had a question about what is successful aging
when you have Alzheimer's and dementia.
Perhaps this picture can give you a glimpse.
It's still being engaged, it's still being
in community, it's still contributing.
IONA Senior Service Center calls itself not only a senior center.
In fact, they're distancing themselves from that name
but they call themselves an Arts and Wellness Center
and employ art therapists, which I know is very close
and important to Jungian therapy.   Again, a picture of a chorus.
I was talking to a few people at lunch.
Washington, D.C. is a very choral town.
There's extra-- I think it's because we talk so much that we burst
into song from time to time but there's congressional choruses.
There is of course the opera.
Every church there are so many gorgeous choirs and synagogues
and when Gene Cohen did a study, he actually put and add
in the newspaper for people to join a chorus at a senior center
and over 200 people responded that had never been to the senior center,
few had ever sung often, and they did very well.
Actually, they performed at the Kennedy Center and still do.
So people often ask us, you know "What happened to that chorus
that started with Gene's study?"
And how many of you would think all the study went,
Not so. It became a nonprofit.
It has 23 choruses across the country.
They hijacked the Queen Mary
and actually sing their way all the way to the UK.
In fact, they should be part of the Ireland program, I think.
[Laughs] So Jeanne Kelly is their director.
We might have people in this room actually that are part of the chorus
because there's one located in the Smithsonian Institute.
So again, it's vibrant.   It's productive.
CBS interviewed one of the singers that's 91 and she said,
I feel like my feet are a foot off the ground.
I am just so excited about performing and you know,
she wasn't thinking about her arthritis or knees or anything else
but giving a good performance.
Now, we actually see programming clustered in three areas.
Healthcare, the last slide, was about lifelong learning
and then very importantly, community engagement.
Another local program, I decided today you're in Washington,
we'll talk about a few local programs,
but this indeed is an international local program,
Liz Lerman Dance Exchange out of Takoma Park.
Liz Lerman started her dance with older people when her mother died.
She was a professional dancer and felt, "I have to make a dance.
I have to, to really be able to cope with the grief that I feel."
She lost her mother at a young age and so she went
to the senior center here in Lower Maryland and she says
at first time she went there, she said, she asked them
if they wouldn't just move their head back and forth.
And they just sat there.
So then she started leaping across the room and she leapt one way
and they turned their head that way.   And then she leapt the other way
and they turned their head the other way.
Pretty soon, she had everybody going back and forth.
[Laughter] And she created such a wonderful dance program
that actually and after it was over, she said "Oh, thank you very much.
This has helped me tremendously."   And they said "What?
You think that you're going to leave, no."
And so, she spent her career working with all generation.
She can see here different cultures, different ages.
They're all professional dancers.   They go into communities.
They create beautiful works.
They worked with the National Institutes
of Humanities on a genome project.
They've done programs that take on tough topics.
I just saw Liz at Harvard in November where she's getting ready
to premiere "Healing Wars" to commemorate the 200th anniversary
of this civil war and I must say all I did was cry.
It was just so powerful because she again used different ages,
different abilities, and she linked images of the civil war
with Afghanistan, Iran and I will tell you
if it comes near you, please see it.   Again, we have a resource.
We just launched this week from a generous donation
from the National Endowment for the Arts and Interactive Website.
We're looking for your stories.
We're looking for your programs, your advice,
and along with it goes a wonderful awards program
and a grants program and a speakers bureau.
So thank you again.
We look forward to working with you doing everything we can
to provide access for vibrant and productive aging.
I'll conclude, again, we honor Gene every chance we get
since he brought us to Washington, D.C. 5 years ago.
And he would use a surrealistic umbrella to express the blue sky
that we can hold with us as we make the journey, the arc that Carl Jung
so beautifully describes.
And just the last example of an artist, he was inspired
to do this by Georgia O'Keeffe.
Georgia O'Keeffe was terrified of flying
and the older she got the more in demand she was,
she was one of the greatest painters of the 20th century.
So the story goes that she's flying almost too afraid to look
out the window and when she does,
all she sees is blue sky over clouds.
So her last work is her largest body of work and a good portion happens
to be the blue sky over the clouds.   So again, thank you.
Thank you all.   >> Thank you.
[ Applause ]   Thank you.
Well, I'm sure all of you were as inspired as I was
from all our three panelists.
It's really wonderful, all three of you, thank you.
And we do have some time for some questions and discussions
and I had a good break over lunch.
One of the technicians came over and told me my job is now easier.
I don't have to memorize and repeat the questions.
So as long as you can hear them they can pick up the sound.
I'm going to open up the floor for any of you who have some questions.
>> Micro-- wait, microphone is coming.
>> So this-- the timing is everything.
It's not a question, it's a comment, because I wanted
to thank especially Dr. Hanna for sharing about the Dance Exchange.
My parents were in that dance of Liz Lerman's 35 years ago
and my father was in his late 70s and my mom in her late 60s.
And that dance was the most amazing.
I encourage everyone to go out and dance.
And the photograph of my parents playing Mr. and Mrs. God
in Liz Lerman's work is the photograph I look at every morning.
It's on my bookcase and we'd love to have everyone share that experience.
>> Thank you.
Right here, microphone.   >> Where am I going?
>> Right here, [inaudible].
>> Hi Dr. Hanna, I really enjoyed what you said.
I enjoyed everything of what you all said.
But I just wanted to introduce another layer of what you're doing
within the art therapy, performance and pictorial, et cetera.
The importance about being together and have a meaningful experience
with others, it gives a sense of a life beside the being creative.
So, they are in a group, they do things together
and that is really connected with the bond of humanity.
>> Thank you.
Also, I don't need to cut off the panelists.
If any of you have anything you want to add or questions for each other,
please feel free to interject.   [ Pause ]
>> I guess it's so important.
We've had a great time talking with each other
and what I gained once again is the importance
of the interprofessional teams and working and to certainly, you know,
speak to the role of, you know, social work
and if you think that's appropriate medical map [phonetic].
>> You had great stories.   >> Which ones?
I talk a lot.   >> Where your patient commented
about how good a social worker you are.
[Laughter]
>> So we-- we actually-- we have a house call program
through Washington Hospital Center.
I'm one of-- I am one of five geriatric physicians
and then there're five nurse practitioners.
We also have five social workers, coordinators, nurses,
and we work with all the community home health organizations
and so the model
of the interdisciplinary team is very important.
You know, we have 600 patients.
We can't possibly coordinate everything they need just amongst
the, you know, 25 of us.
And so, we really rely heavily on our colleagues out in the field.
We use wound care personnel who will come to the home.
Now, all of this is done in the home.
So, you know, if I have a patient who needs an X-ray,
I'll order an X-ray and they'd log it up the stairs
and take an X-ray in their living room.
So, this is-- it is a program that I've-- I'm relatively new to.
I've only been in the program for less than a year,
but it's pretty remarkable what they could do and what we find is
by using that kind of 360 cocooning approach to care.
It's very individualized, very much based on the patient's wishes
for the direction they want their care to take.
Our hospitalization rates
for our patients is well, well below the average.
Most of the time patients who end up in the ER, it's because they--
when they're sick they don't have access to the care they need.
And then when they don't need it, remember, you know,
you have that appointment of come see me every three months.
Well, I'm not sick today.   I don't need a doctor today.
Where were you two weeks ago when I couldn't breathe?
So, the whole idea is that we bring the services to the home
for routine purposes but also for acute care visits.
And most of the time we can nip it and keep them
from having to go to the hospital.
We-- I tell my patients, "You don't want to go to the hospital.
It's a horrible, horrible place."
I don't think Washington Hospital Center which is a fine,
fine place would appreciate me saying that
but for older adults it is.
We know that if an older adult walks in the door of a hospital,
any hospital, the best hospital in the world,
there is risk for bad outcome.
So, we try very hard to keep our patients out of the hospital.
>> I would just like to add that where some
of the shift is occurring is in education.
Historically, professional schools are separate buildings
and separate structures, separate timelines, and there are some models
where a social worker, a nurse and the physician student all go
out into the home and do the assessment together.
And not only do they get a larger picture of the person,
they also find out about their team member, who they are,
and understanding their role.
And I don't think that hurts also in terms of what they can share
in terms of expertise, skill sets, et cetera, and that's the joke
about the server piece that we're talking today and she was saying
that one of our patients said
that she was the best social worker she had ever met then I asked her
"you know, where did you go to medical school?"
And then she said, "The University of Kansas."
And so, synchronicity is that that's where I went to get my PhD
in the University of Kansas.
So, it's a good school, I think, don't you?
[Laughter]   >> Very nice.
They have a good basketball team too.
[Laughter]   >> And the NCAA, not the NCCA.
>> Go Jayhawks.   Claim it. [Laughter] So, I'm sorry.
I talk a lot and you can stop me whenever.
But, it is interesting that Medicare is actually looking at programs,
different models of providing care because we know
that the baby boomers are really booming [laughs]
and our oldest population in fact,
our over 85 population is the fastest growing part
of our population.
And so, how are we possibly going to provide care in all these people
and we want to provide care in all these people.
They deserve good care.
So, how are we going to do that in the best way?
And so Medicare is now working with several program, many programs,
across the country to say, you know what, you've got a unique program.
We want to see how you do it, and we want to see if you cost more or less
than our traditional program.
So, they're really looking to kind of expand the range of services
so that we can provide and it's not just cheaper care, it's better care.
So, they're looking, you know, if we can find a model
that has better outcomes than our traditional model
and it cost half as much, win, win.
So they are actually pouring money into program, pilot programs,
right now looking into just that.   [ Pause ]
>> Okay, right there.
>> Dr. McDonald, does your practice serve patients throughout the DC
area or only in the quadrant near the Washington Hospital Center?
>> So, right now, we cover about 10 zip codes,
mostly northeast, northwest in DC.   >> Thank you.
>> Yes. However, ask me if we get some big old Medicare money
and we start expanding.
So, keep your fingers crossed as we are.
>> Hi. I realized this may be a bit of a cheat,
but I have to meet my daughter at home after school today,
so I can't hear the next panel, but I just wondered if you all knew
of any studies using meditation in gerontological medicine
and whether you're seeing, if you're aware
of any impacts that are used there.
I was struck earlier by, for example,
the quality of equanimity being very valuable as we age
and that's something that's cultivated and, you know,
basic insight meditation or other simple forms
of meditation, thank you.
[Inaudible Discussion]   >> I'm sorry.
>> I think some of us have heard of people working in and I've heard
of it anyway and that is very valuable
but neither myself nor anybody here has an experience in it.
But certainly, all people working anecdotally I've heard is very
valuable in other tool, another tool, thank you.
[ Pause ]
>> Hello, thank you for some inspiring thoughts
and visions today.
I am thinking about the other-- the--
at, you know, at the end people die.
And so, in your programs I'm wondering if you are also,
or in your caregiving, if you're also involved in,
you know, end-of-life care.
I, for instance, I recently saw an advertisement for a workshop given
at the New York Open Center by a man who was a social worker
and it was called end of-- training
to be an end-of-life doula or caregiver.
And so, I was wondering if part-- if your programs--
and I know that nurses and other medical personnel in hospice used
to be able to give attentive individual care
in my understanding and, you know, is that people are too busy and,
you know, healthcare has changed and people are no longer able to sit
or be, or comfort people who are dying.
So, I'm wondering what that looks like from your end.
>> So, the role of the primary care physician, I'm very proud
to be a primary care physician.
And I think the role of the primary care physician is to take the lead
on those kinds of conversations.
And so, and all of my partners in my program agree with that.
So, what often happens is when a patient reaches the point
that there are no further options for cure, they are passed off
to another team to start their dying, I guess.
That-- to me, I don't think that's ideal.
I think if you work hard to form a relationship with a patient,
it is your duty but it's also your--
it should be your pleasure to see it through to the very end.
So we have advanced directives, living will.
You know the key is we start those conversations from day 1.
We don't wait until you're sick to talk to you about end of life.
You start talking about it
when you're healthy and cognitively intact.
I want to talk to you when your thinker is working.
I don't want to wait 'till you're mushy-headed to talk to you
about what your wishes are in life.
So yes, absolutely, and that's a core principle
of all geriatric training.
However, we do the actual hospice care.
We do consult in a hospice organization
to partner with us for that.   >> Yeah, April [phonetic].
>> May I just add that it's a huge area that's developing
in creative expression.
Most large hospice organizations have art therapist,
visual arts therapist, music therapist, poetry,
fine artist that are trained to work right at the bedside.
We have a contract with the Veterans Administration now
to really develop protocols for end-of-life care, palliative care.
And so it is vital to the very end as we've heard
from our keynote presentations, so yes,
>> Is, are any of your activities integrated with the aging
in place movement and if to the extent that they are not,
you think there's a potential there?   [ Pause ]
>> So the core to some of the work I do now or the gerontologists do is
with the idea of aging in place.
In terms of a movement, I think it's sort of, it's been in existence
for quite a few years and I think
in particular the community-based service programs,
really that's a primary goal of that.
There are alternatives to nursing homes such as congregate living
and assisted living, but the primary focus really has been
on community-based care and that's increased over the years.
And I think it has been successful in helping folks age in place.
>> And our program is home care.
That's not in nursing home so there--
that's 600 older adults that are in their homes.
>> We're indeed part of naturally occurring retirement centers,
in fact, one of the noted ones in Washington is Watergate, you know,
you can live right there, go to the Kennedy Center.
It's of course on the most high end but their efforts
across in the community, affordable housing across Washington, D.C.,
their choruses and actually, a theatre group
in Northeast Washington that's formed from aging in place.
So again, it's a new frontier.
You know, we actually think it's a renaissance of a whole new era
>> I guess you're addressing what I have in mind
but I was thinking of communities.   I've heard of the Watergate one.
Maybe it's the one you're referring to.
There's also the Golden Glovers in Glover Park of D.C.
And this is not just age related, people need assistance at all ages
and in these communities, they can call on the community,
say vetted construction people or whatever, you know, for assistance.
That's what I meant, that kind of a community
but I think the Watergate one is supposed to be that sort, so.
>> Okay. Thank you.
It's been a wonderful, wonderful day for me and I see by the enthusiasm
in the audience that you've all been enjoying and you're here,
which is the best vote of confidence and I just want to say one thing
because apparently, I've gotten report that some
of you have broken 1 of the 10 commandments
and that cellphones have been on.
Though, anyone, if you forget, that's understandable,
can you please make sure to turn off your cellphones.
It's only an hour and 15 minutes
to go then we can have the WiFi cellphone fixes again.
[ Pause ]
Okay, this is a subject that's obviously very dear to people
who are interested in Jung psychology and ideas
in the Jungian world, which is virtuality and the second half
of life which really is the second half of life issues in general,
I think was Jung's first major contribution to the field
of psychoanalysis and it's still something
that Jung is very well known for among other things.
And it's a subject that-- it's non-ending like a spirit,
it really is something we can continue exploring
and we're looking forward to having our panelists begin the exploration
with us this afternoon.
Our first presenter is Dr. Melanie Costello, Melanie Starr Costello,
who I've heard a number of times in the Hudson Valley.
I feel a lot of kinship with her.
She has a history background as do I,
my PhD was in history before I went on to Jungian psychology.
She studied in Zurich which I think is very important institution.
I graduated there and I'm looking forward
to hearing her this afternoon.
Dr. Starr is a licensed psychologist and a Jungian analyst
in private practice in Washington, D.C. She earned her doctorate
in the history and literature of religions
from Northwestern University, and is a graduate
of the Jung Institute in Zurich.
A former assistant professor of history, she has taught
and published on the topics of psychology and religion,
medieval psychospirituality and clinical practice.
Her publications include Imagination, Illness, and Injury,
Jungian Psychology and the Somatic Dimensions of Perceptions
and she really brings a multidimensional approach
to her practice and her work and her presentations.
So please join me in welcoming Dr. Melanie Starr Costello.
[ Applause ]   [ Pause ]
>> Thank you so much, Aryeh.
Well, it's a pleasure to be here with you, and I'm going to pick
up on several themes mentioned in Dr. Corbett's presentation.
Particularly, I'd like to look at spiritual potentials
of wise eldering as a kind of archetypal portrait
of real spiritual potential in human development.
And time does have meaning in terms
of the realization of this archetype.
But I'm going to do it by drawing as much as I can in a short time
on the voices of people who I consider as sages
or wise elders themselves.
Since if you haven't noticed, I'm not quite there yet myself.
[Laughter] And we've also mentioned some
of the cultural tasks associated with aging.
I'd like to add an essential feature what I believe is an essential
feature which regards task that are nature-oriented,
that I think creative aging, spiritual--
the spiritual dimension of aging involves both cultural
and nature-oriented tasks,
and contributions to the general society.
So I want also to emphasize how important I think it is for those
of us who aren't the oldest of the old to have exposure to people
who are aging in a creative way.
We've been focusing, I think, a lot on the aging person, him or herself.
But I think it's a good thing to think about what we need
from people who are aging as well.
And, you know, just a few weeks back when I was preparing
for this event today, which I've been looking forward to very much,
I consulted the "I Ching", the Book of Changes
in Ancient Chinese wisdom source,
which Dr. Cambray mentioned earlier in his talk.
So, you know, I pulled out the "I Ching"
and I said, speak to me of aging.   [Laughter] And immediately,
I was led to a chapter called the Preponderance of the Great.
And it concerns the urgent need
to approach a transitional period in a meaningful way.
Two parallel images were offered.
A withered poplar puts forth flowers.
An older woman takes a husband.   No blame, no praise.
These images portray actions that do not accord
with one's natural place in the life cycle.
And I'm hoping the book wasn't speaking directly to me.
The commentary suggests there may be no harm in responding
to later life callings with acts belonging to a more youthful age
but when doing so, little is really gained.
Jung was a bit more severe on the topic.
He said, "We could not live the afternoon of life according
to the program of Life's Morning.
For what was great in the morning will be little at evening.
And what in the morning was true will at evening have become a lie."
Nature commands cultural
and biological productivity in early adulthood.
But the principle of transformation is the motive force
of mid and later life.
In conscious aging, we reflect upon change as life's insignia.
We cultivate psychospiritual growth
who are [phonetic] sent to the ways of nature.
Conversing-- conversely unconscious aging, marked by the absence
of reflection, makes us vulnerable to consumer-driven,
youth-obsessed cultural stereotypes
that envisage aging in terms of loss.
From this perspective, we're victims of time and death,
shadows of our former selves and as time passes,
something to be cast aside, hidden from public view, outsiders.
So in response to Dr. Corbett's remarks, I'd like to speak
about conscious aging as a spiritual path, one that embraces aging
as a developmental process pushing us toward and not away
from something of great significance.
Jung attributed as was earlier said a cultural
and I think implicit evolutionary purpose to longevity.
He writes a human being would certainly not grow to be 70
or 80 years old, and now we could add 90 to 100 years old,
if this longevity had no meaning for the species.
The afternoon of human life must have a significance of its own.
I think the developmental goal of aging would be much more obvious
to us if we had daily access to people
who have lived to be a ripe old age.
Our society though is organized in such a way
that we don't often encounter our longest lived citizens
in public venues, and because many have lived in retirement enclaves,
even family members don't necessarily have daily access
to them.   And I think this is a loss to us.
I think we would all agree old age is no guarantee of wisdom.
But evidence suggests some individuals do realize the fullness
of their spiritual potential in entering into a state of sagehood.
So now, I'm going to move a little bit
into an archetypal picture of sagehood.
By their concerns, their breadth of insight,
the form of consciousness they have attained,
sages are those precious ones who convey a depth
of perspective that is cosmic in scope.
Marion Woodman who's considered by many of us a wise woman herself,
she's a Jungian analyst,
and she describes what she calls the crowning of age as a time
when one is relieved of personal desire,
ego strivings dissipate, and the heart is opened.
One tends the world's soul and carries this feeling function
to the community by caring for the young and for the Earth.
In his memoirs, Jung speaks of his 80s in these terms.
He says it's a time of freedom from individuality, essentially.
He describes a growing kinship with all things.
So I'll quote, "There's so much that fills me, plants, animals, clouds,
day and night, and the eternal in man.
The more uncertain I have felt about myself, the more there's grown
up in me a feeling of kinship with all things.
In fact, it seems to me as if that alienation
which so long separated me from the world has become transferred
to my own inner world, and has revealed
to me an unexpected unfamiliarity with myself.
[ Pause ]
Jung's describing how over time one's center of gravity shifts.
The personal identity gives way to a larger ground of being.
The natural world and one's internal landscape are contiguous.
The natural world and one's internal landscape are contiguous.
The sage's vision is unitive in the mystical sense of the word.
In her company, one feels a sense of belonging to the web of life.
One such person was the theologian Thomas Berry,
and he passed away just a few years ago.
Berry envisaged the wise elder as one who represents
and embodies the correspondence of the human process
with the natural process.
Their presence promotes the making of a healthy society which requires
that all its members experience themselves "in integral relationship
with the surrounding forces of the universe."
In other words, the gift of the sage brings to the world.
At this critical juncture in time, is that by her mere presence,
she fosters a reconnection with our roots in nature.
In this more contemplative, unitive form of consciousness,
is aging's potential-- oh-- in this unitive form of consciousness,
is this potential something that one has to cultivate deliberately?
And how do we get there?
If we're not intentionally spiritual,
Often as we've heard, a spiritual transition begins at midlife.
In practice, early intimations
of this transition can be quite disturbing.
After all, psychospiritual transformation's place is
at a threshold between the known and the unknown,
between loss and new discoveries.
Our Western cultural norms don't prepare us
for the developmental phases of aging
as the cliche midlife crisis makes clear.
We suffer a great deficit in our times
because progress is a dominant value in Western culture.
And it's understood as the trajectory,
moving continuously upward from a fixed point.
This paradigm puts us out of sync
with the way things truly are in nature.
And particularly impacts our attitudes toward aging
which naturally involves a great deal of letting go of things,
And even where we've brought a wealth of creativity
to building our profession, to raising children
and making meaningful contributions to society, the time may come
when these responsibilities no longer energize all that meaning,
but rather start to feel burdensome.
Great doubts about one's self and one's life choices are common
at these transition points.
One may suffer internal feelings of isolation or flatness.
And even spiritual or religious practices may no longer
prove enriching.
This is the time when people sometimes come into analysis.
In Christian tradition, the painful experiences associated
with transitions to mature spirituality have come
to be called the dark knight of the soul,
referring to a 16th century poem and treatise by Saint John of the Cross.
Here, the seeker having lost his connection
with the divine grace suffers feelings of despondency,
humiliation, and worthlessness, the kinds of feelings that we associate
Such intimations of a time
of psychospiritual transition can be very frightening
and the pharmaceutical industry has profited greatly
by our collective lack of understanding
of developmental needs in later life.
For where we don't meet these intimations
as meaningful communications from within and where we keep on going
as usual, depression, anxiety are a likely outcome.
We're bound to go through several transformations.
Times when we're called to lay down our lives as constructed,
to sacrifice an established self image, and make way for the truer,
less socially scripted self that is trying to emerge.
In this metaphoric death, one's known self is sacrificed in exchange
for what the poet Derek Walcott calls the stranger
who has loved you all your life., who knows you by heart.
A soul-filled life is one spent in conversation with the stranger.
This ever emerging self.
Conscious aging promotes this dialogue by means of dream work,
by applying the imagination through reflection and writing,
and relating to the natural world as a subject, rather than as an object.
In attending to our emotions and the images that spring
out of the depths, in meaningful conversation, storytelling, prayer,
ritual practices within or outside of a faith community,
and of course the beautiful examples we saw about what's happening
with aging and creativity in the arts.
In time, an individuating person may seem less a personality
and more a culture carrier, mentor,
defender of the community well-being,
and guardian of the biosphere.
We're talking about aging in the 21st century.
This portrait of an elder is presented
by ecopsychologist Bill Plotkin, if any of you know his work.
In Plotkin's formulation, the elder is one who surrenders his sense
of personal agency, strives less toward individual accomplishment
and more toward the common good.
Individuated elders report the sensation of moving deeper
into formlessness in that they are released to a sense
that something greater
than themselves is doing their life's work through them.
So again, this idea of being freed of a sort of ego-based orientation
and releasing one's self to a larger ground of being.
So now, to return to my earlier question, is the state of elderhood
or sagehood a potential that's realized only though
conscious intention?   Apparently not.
We frequently find in the literature of aging heartfelt acceptance
of the diminishments of the body and an affirmation
of the simple blessings of being alive.
The spiritual fruits of aging are found in Zen-like portraits
of the luminosity of a single moment.
In a letter to a friend, for example,
the agnostic E. M. Forster writes, "How peaceful it is here
with the West Hackhurst clock still ticking,
the Rooks Nest fire iron still warm in the hearth,
and the dog little master, his feet on the rug,
nodding toward the end of a successful career."
And then a few years on as he approaches 80 he writes,
"My great extension is not through time to eternity,
but through space to infinity here, now.
And one of my complaints against modern conditions is
that they prevent one from seeing the stars."
Forster's agnosticism was no barrier to the soul's journey.
He had arrived at a transpersonal ground.
He grasped infinity through an impassioned participation
in the natural world, in the very place he stood.
This phenomenon may relate to a study recently published
in the Journal of Psychological Medicine.
Contrary to the stereotype of the elderly as frequently depressed
in the face of loss and on coming death, the study shows the rates
of depression and anxiety in later life to be lower
than rates reported for working age adults.
In fact, the fear of aging and death seems much more common
in both early and late midlife.
I witnessed this natural movement into simplicity
as I watched my mother in her final years.
Uncharacteristic of her younger worrying self, she became a kind
of hybrid across between a sage and a comedian.
[Laughter] By age 80 and not withstanding recurring bouts
of illness and multiple hospitalizations,
my mother had become a kind of trickster.
Undermining serious moments with equipped
or raucous laughter continuing--
continuously and sometimes it was very irritating.
[Laughter] She took great pleasure actually in talking
about her night dreams in those last years of her life.
In fact, just a few weeks before she died, she repeatedly dreamed
that she was making love with some unknown beautiful lover.
Now she found this hilarious and we had many laughs about it
and the experience really made her joyful and a bit bawdy.
And I love seeing her in this state but it also made me sad for myself
because I at that point had enough exposure to archetypal imagery
to know that it meant she would die very soon.
We tend to see death as dissolution
but such dreams anticipate death as union.
Throughout the life cycle, death and renewal are inextricable.
Releasing themselves into identity with the larger web of life,
our wise elders make a passage into death long before dying
in the conventional sense.
And if you've known such a person and have had the privilege
to be present at their passing, there's an indescribable kind
of luminosity at the time of their leaving.
One is given a rare glimpse into life and death as a unity,
a parting gift from a life well lived, so.
[ Applause ]   Thank you.
Our next speaker, Dr. Christina Puchalski, has graciously agreed
to be sandwiched between two Jungians.
And we welcome her here and looking forward
to hearing her present today.
She is a pioneer and a leader in the movement to integrate spirituality
into the healthcare setting both
in clinical practice and medical education.
As founder and director of the George Washington Institute
for Spirituality and Health in Washington, D.C.,
she continues to break new ground in the understanding integration
of spiritual care in a broad spectrum of healthcare environments.
The spiritual assessment tool FICA, not the Social Security
that we pay every month, which she developed is widely used
in the clinical settings around the world.
Dr. Puchalski is professor of medicine in health sciences
at George Washington University School of Medicine
and an active board certified clinician
in internal medicine and palliative care.
She is published widely in many journals with a work ranging
from biochemistry research to issues and ethics, culture, spirituality
and healthcare, as you can see a very wide variety of topics
that she is a specialist in.
Among her many publications, books such as Time for Listening
and Caring: Spirituality and the Care for the Seriously Ill and Dying
and her most recent book Making Healthcare Whole.
Please join me in welcoming Dr. Puchalski.
[Applause]   >> Thank you.
Thank you so much.
It's a pleasure to be here today and I was very moved by your comments
and your beautiful poetic way of describing what is
that tender balance at the end when we let go but celebrate a transition
and I, I thought that was beautifully done, thank you.
And it so much speaks to the kind of issues that my patients face.
I am an active clinician.
I work in the Division of Geriatrics so I have,
I'm a primary care doctor.
One of my patients just referred her great granddaughters
and my youngest patient is 18 and my oldest is like 105 now.
So I have a pretty broad range.
And I really enjoy my work and I enjoy my patients
and I think that's probably the thing that gives me most meaning
in my life among other, among other things but it is the sages
in my life and maybe not technically the way you're describing
as Jung would describe the sage.
But the sages in my life that have resulted in some of the work that I
like to share with you briefly today.
And the first one was when I a researcher at NIH and I worked
in the arthri-- the then NIDD Care Arthritis Institute.
And for those of you that know about NIH,
people who have seriously ill illnesses and are not able
to somehow manage with the conventional treatment go to NIH
for [inaudible] protocols.
And so one of those patients that I ended
up visiting had very bad arthritis was an artist
and his hands were very badly deformed.
And so many of my colleagues said isn't this terrible, you know,
he has no life anymore and very much painted a hopeless picture.
And yet when I met this gentleman, that's not all what I found.
I found a man full of spirit, full of hope, full of life.
And full of creativity as Gay Hanna so beautifully talked
about in her work with her institute.
He really was able to continue to express his creativity,
even though the rest of us couldn't see it because we had
such a linear description of what meaning
and spirituality might be for that person.
And then after that, going to medical school, I was struck
and particularly in psychiatry class at how psychopharmacology,
certainly taking its impact on psychiatry,
but how little was addressed in terms of spiritual issues.
Lionel had written about gerotranscendence,
that term wasn't even used.
And then the notion that people would face very deep spiritual
issues that could impact their presentation of physical
and mental illness was not discuss at all.
It was all very biomedical.
So I was inspired, this is over 20 years, ago to start a course
for medical students on spirituality and health and have
since progressed with that.
Reflecting on the previous, what I heard in the previous plan on,
a little bit on the previous conversation today,
I think it is difficult to address spirituality.
It is difficult because the definitions are complex,
because it can be very philosophical,
people can think it's too much of an inner world
and so we can't really bring it into our healthcare systems.
And I have actually worked with a number of my colleagues
to fight that, that myth and to say that actually we can,
it is very accessible, it's accessible in our own lives
and it's accessible in all of healthcare.
So what I want to talk briefly about today is this notion of suffering
that I think if we want to talk about healthy aging we want to talk
about how people understand their suffering.
My dad is 90, almost 91.
He just moved here from California a couple of months ago.
He is in a wonderful senior community in Arlington.
He is a widower.
My mom died of dementia at the age of 93 about 4 years ago.
And my dad has bad arthritis and other things
but he doesn't let that faze him.
He continues going on, in fact, the image that I want to bring to you is
about 3 weeks ago, he and his new lady friend who's 92 took us
out dancing.
Now I don't know how to dance and I was like,
you know, what am I going to do?
And I saw my dad get up and very kindly he, you know, asked this lady
if she would dance and you know they did the usual kind of graciousness
and they did and out-- down with the canes and off
to the dance floor and I was blown away.
Real joy, you know and yet there are some of my patients
who a re just his age who have been World War II survivors as well
who come to me and say, you know, I want to address my spiritual issues.
I think I'm, I think something is wrong there.
And they're stuck in their suffering.
So what's the difference?
You think, you know, with my dad, he's a man of strong faith.
He's from Poland.   He was in a prisoner of war camp.
Family members were in the concentration camp,
he had lost many family members.
He was an artist, an opera singer, continues to sing.
He had to give up a lot of things along the way and his life.
He had to detach and he was able to do that through all his life.
He attended to spiritual issues throughout his life,
so no surprise now that he does it secondhand now.
He is a wise a person, he is a real sage in my life.
So how is it that we can help people who don't quite have the skills
that my dad has address some of those issues.
Well, let's look at the kind of suffering
that we face, particularly in aging.
There is the loss of a person's sense of independence.
The-- it wasn't that easy for my dad to give up managing the bills
to me but you know he did it.
There's life-limiting conditions, there's dementia,
there's memory loss, there's cognitive impairment,
there's financial stress, there's social isolation.
How do people come to understand that and also even though depression
and anxiety may be less in the older population,
the statistic about completed suicides is still
that that's the highest in the 65, actually, 85 and older,
but in the older age group,
not attempted suicides but completed suicides.
So, you know we have to look at why is that happening in our society
and where are most of these people getting their care.
They're not getting care always in the home-based practices we heard
about in the previous panel.
They're getting care in our healthcare systems.
They're meeting-- they don't always have the resources to see therapists
or have analyses, so how can we help people
and I believe spirituality is the answer to that.
So, what are some of the spiritual themes that you've heard about today
as resources of strength but that actually might cause suffering
and one is the lack of meaning, I am not the person I used to be.
Certainly hope.   What do I have to hope for?
Mystery. Why me, why now?
Part of the whole spiritual journey is not only the connection
to something outside of ourselves but the understanding
that we have no control, ultimately,
that we could die today, we could die tomorrow.
Science offers some answers but not all the answers and that's difficult
in this particular western society.
Helplessness, forgiveness is a huge thing and I think addressing some
of those issues is really important.
Now, I'm going to talk a little bit about our healthcare system.
All of us are sitting here today because of technology.
I am somewhat critical of the pharmaceutical industry and science
but I'm also very respectful of it.
We are living longer because of technology.
But I'd like to postulate
that technology has also perhaps increased our suffering.
Now look at our healthcare system now.
Most of us are in this healthcare system.
There's myriad of choices, myriad of options for patients to deal with.
So, as people are going through, they've been given a diagnosis
or they're trying to get some test resolved.
Very, very disease oriented.
It's not whole health oriented as Jung and others would have us want.
It's not that kind of a healthcare system.
It's all parceled out so, people then are faced
with which test should I have, so I continue this test.
Now there's a bad, you know, fetch from the test,
what am I going to do next.   What are my choices?
What do I really want?   What gives my life meaning?
And no one, no one in the healthcare system is asking them those kinds
of questions.
And so the journey continues and people just tumble in this kind
of needless I think suffering.
Now what does healing and what does spirituality in health offer?
It offers us an ability to integrate that suffering into our lives.
To find a sense of meaning and purpose in spite
of what may be happening to us physically or socially or otherwise.
That's the ultimate goal I think
of integrating spirituality into healthcare.
I've going to present a model where we talk about the importance
of relationship and how the relationship between the patient
and the doctor or other clinician is key to healing.
It's not so much all the things-- you know, we think that as a doctor
or a therapist, I give something to my patients.
It goes two ways.   We enter into a relationship.
We're both changed as part of our relationship.
And with-- it's within that compassionate caring relationship
that the potential for healing occurs and what is that.
The key thing that any of us can do
as healthcare professionals is to listen.
We have to let go of our agenda to try to fix something for a patient
or a client, however, people see that.
I like there word patient.
I think it's more than just a client.
But we're not going to fix something for some one.
They-- we can empower them to find some solution for themselves
but it's really in our presence, not in the kind of agenda
or the things that we do.
There's a quote that I-- when I was studying for my board certification
in palliative care, it was in the review book.
And I really was struck as I was going through all the facts
and then I came to this quote and it so beautifully describes our ability
to attend to the spiritual in others.
"Who is there in all the world who listens to us?
Here I am - this is me in my nakedness, with my wounds, my grief,
my despair, my betrayal, my pain, which I cannot express,
my terror, my abandonment.
Oh listen to me for a day, an hour, a moment lest I expire
in my terrible wilderness, my lonely silence.
Oh God, is there no one to listen?"
We've just heard a beautiful presentation where at the end,
you know, you were in full presence to someone who is dying,
to someone who is dealing with suffering.
That is really what is the key of spiritual care
in our healthcare systems.
There's also a lot of data and I don't have time to go through that.
Btu there is data that spirituality
and religion can affect healthcare outcomes.
Better coping, better understanding of the illness,
more informed decision making,
and of course an empowering and self healing.
For example, in end-of-life care, there's been a lot--
there was a question for the earlier panel about end-of life-care.
That people with advanced disease who have found greater meaning
and a purpose in their life have better quality of life,
less pain, better coping.
Gallup Survey, finding comfort in our final days,
general survey to the United States.   What were the 2 top concerns?
Number 1, I don't want to be alone, I want companionship.
Number 2, spiritual comfort.
Well, what is that spiritual comfort?
What can we help people live in regard to spirituality?
So I want to propose a model that we're working on based on a work now
in educating doctors but also in some of our research
and some national consensus that we've--
conferences that we've done to define sort of new parameters
to integrate into healthcare.
That is not really that new because I'm talking to an audience,
Jung talked about whole person care.
Whole person care is addressing the biopsychosocial
spiritual dimensions.
But traditionally in our healthcare systems those have been looked
at as separate boxes.
What we propose, which I'm going to guess is more Jungian
and whole person is that spiritually is fundamental.
It's the essential part of all of us.
And where spirituality interacts with the other parts
of our being is not so much the deep inner life
for that is very person, people.
But it's the outer part of our spirit, if you look at a circle,
our deep circle, the inner part of that circle is personal.
But it's that outer circle that interacts with the physical,
the emotional and the social.
And so if I have deep spiritual pain it may manifest as exacerbation
of my arthritis or whatever the person has.
It may present as physical pain and we can try to deal
with the physical pain with medication.
But unless we get down to the really deep spiritual issues,
the pain will not resolve.
Same with depression or emotional issues,
if it's really primarily a spiritual diagnosis, unless we can deal
with those spiritual issues, depression may not be well treated.
And so these are, these are very important sort of a reframing
of how we should think about healthcare systems from here on in.
I want to share a story of my patient Julie.
She's almost 60 years old and she's dying of colon cancer right now.
And Julie was a very vibrant human being.
On one visit she was very--
she was very focused on what was going on with her cancer.
Then you know I asked her well, tell me what's going on with your family.
Well, good things.
I just have my first, you know, first grandchild join the family.
And what about emotionally, how are you doing?
I'm sleeping well and not really depressed.
I'm not anxious.   I feel okay about all this.
You know, and as we went through, all of those different aspects
of her life spiritually, strong faith in God,
it is what is keeping her going.
So I drew that little model for her of why with the spirituality
in the center, and I said look,
you're actually pretty healthy spiritually,
emotionally and socially.
The physical of that, that might not be the healthy part
but the others are and it was--
she said, I never thought of it that way.
And all of a sudden she found a vibrant aspect to herself
in the midst of her dying.
So it's looking at how we can create a system of care
that integrates spirituality not just on the side, oh and by the way,
what is your spirituality.
It's central to our conversations with our patients.
So I'm going to just close with the model that we've developed.
It was called improving the quality of spiritual care
as a dimension of palliative care.
And palliative care, many of us define as the time from diagnosis
and actually all of life care.
It's a great model of care, it's not just hospice.
But in it there was already in palliative care a required domain
where spiritual, religious
and existential issues had to be addressed.
So we brought together leaders from around the country, clergy,
chaplains, spiritual directors, psychologists, doctors, nurses,
social workers, therapists and others.
And we came up with a definition of spirituality
and why do we want to define spirituality.
I'm probably talking to an audience that's going to say,
you really can't do that.
In some circles you can't, I agree, it's tough to define.
But what I found in my work unless we make this a little reductionistic
it's not going to get integrated.
Today, about 80 percent of medical schools have topics related
to spirituality in helping their curriculum.
We have this model I'm about to talk about.
But if we hadn't sacrificed a little bit
and leave the esoteric a little bit
to get practical, that wouldn't happen.
So here's our definition.
Spirituality is the aspect of humanity that refers
to the way individuals seek and express meaning and purpose.
And the way they experience their connectedness to nature,
to the moment, to self, to others, and to the significant or sacred.
So it's an internal ongoing journey of meaning and purpose
that continues through our life, it doesn't stop, it's not stagnant.
But it's also our ability to experience connectedness
to something outside of ourselves, which is broadly defined,
might be religion, might be other aspects.
And so a spiritual care model, everybody on the team is responsible
for addressing spirituality with patients.
It's a generalist specialist model.
In the earlier panel I heard interdisciplinary as doctor,
nurse and social worker but a huge piece of the team is missing
and that's the board certified chaplain.
The board certified chaplain is the expert in spiritual care,
the rest of us are generalists.   So we can bring up those issues,
we might even diagnose spiritual distress, but we always have
to think about working with the board certified chaplain
who is a discipline of healthcare as part of the team.
We need to diagnose spiritual issues.
I know that's controversial and I'm just going to put that out there.
If you're interested I can share some papers about that.
We proposed actually having diagnosis code
for spiritual distress.
But we also want to add the patient's spiritual resources
of strength.
So all the things you've been hearing about today in terms
of healthy aging, healthy life for that matter, what are beliefs,
values and practices that are supportive to the patient,
what are groups, spiritual, religious or other,
that might be supportive.
What about a person's ability to find hope?
What about resiliency, meaning and purpose?
And the model is really that as I as the clinician see a patient,
primary care clinician, and this is geared for those of us
that create treatment plans, if we identify the stress we have
to start thinking is this primarily physical,
emotional, social or spiritual?   And then who on the team do I engage
to help the patient reach their full selves.
And that's what spirituality is about, is about creating a system
where every single person has that potential
to reach their full authentic self, their full potential.
That's what's spirituality is about.
Where every person has the ability to find hope, meaning and purpose.
Where people have the ability to find that connection outside
of themselves and to integrate that as part of their understanding
of their whole health, with illness just being a part of that.
I want to close with saying that the basic message is love
and compassion.
A colleague of mine who is a very well known researcher
and who was dying was interviewed.
And he was honored for all his volumes of publication,
his research, his theoretical studies.
But in the end the question was asked
and what's the final message you want to give us, and he said,
it's about love, it's about presence.
We can't fix others but we need to listen and we need
to be loving and compassion.   Compassionate and compassionate,
think of it as it's not just two separate relationships
with huge boundaries between us.
But it's that enveloping the other person in love with the full intent
of only doing good for them.
It's a very, it's a spiritual practice really and a lot
of our work is geared in helping healthcare professionals understand
that their work is spiritual practice.
The FICA tool was mentioned, that's a spiritual history tool
which I would like to share with you as many of my patients use it
for themselves and that is very simple.
Are you a spiritual person?
I mean based on the conference today and what I've said everybody is
but do you see yourself in that way?   Well, what does that mean to you?
And what gives your life meaning?   I is important in influence.
How important is that in your life?
And does it influence your healthcare decision making?
How you take care of yourself?
Meditation, for example, does have benefits for people.
Is that a practice that you have that you might use in your life
as you deal with illness or in your life as you deal with health?
See, do you belong to a spiritual community and what is that?
It might be church, temple, mosque, it might be the nature group,
it might be another kind of a group, it might be people at your work.
But do you need to find a different community,
is that a good community for you.
And finally, how do you want your clinicians
to address that into your care.
So I want to just close 'cause I've had to share very important things
in a brief amount of time, that a lot of the work we're doing now
at GWish is to-- we're going to be working with people on the Hill
to integrate this into the healthcare policy,
to bring about more holistic systems of care and all
that work is published in making healthcare a whole of a book.
We also have the Summer Institute at the university where people from all
over the world come to learn practical models
of integrating spirituality into care.
But beyond models I just want to close with a quote
from the Dalai Lama which I think speaks to the essence of this work.
"When people are overwhelmed by illness,
we must give them physical relief but it is equally important
to encourage the spirit through a constant show
of love and compassion.
It is equally important to encourage the spirit
through a constant show of love and compassion.
It is shameful how often we fail to see
that what people desperately require is human affection.
Deprived of human warmth and a sense of value,
other forms of treatment prove less effective.
Real care of people does not begin with costly procedures
but with the simple gifts of affection, love and concern."
Thank you.   [ Applause ]
>> Thank you.
Our final presenter this afternoon and then we'll turn it over to all
of us in the audience, needs no introduction mainly
because he's been introduced already,
Dr. Lionel Corbett who's kindly agreed to bring us full circle.
He began the day with a wonderful presentation that served
as a backdrop for the rest of the day's presentations
in addressing the topic and has agreed to kind
of give his last closing remarks and thoughts on both today
and on spirituality, and then we'll turn the questions and answers
through all of us for the rest of the day, Lionel.
[ Applause ]
>> I was extremely touched by Dr. Puchalski's remarks
because it affected me, the approach affected me so much
because about 3 years ago I was in 2 hospitals for several months
and with a potentially fatal illness and it was very striking to me
that in all those months I was in the hospital, I think for a total
of 4 to 5 months, nobody ever asked me if I was afraid of dying
or if I had any spiritual practice or spiritual belief.
All they were interested in was my [inaudible] I think.
But they didn't want to talk about any of their concerns.
So I was so pleased to hear you talk about your approach.
Thank you.
And I'd like to just to try and focus this.
Talk about a small group of elderly people that I've seen who are
in a painful position because they have a serious life situation
and they feel that they're spiritually oriented people
but they're completely disillusioned with the Judeo-Christian tradition.
They don't get any help from their ministers
or rabbis or anything like that.
They can't tolerate the doctrine and the dogma
or the hierarchy of the tradition.
And so they are somewhat bewildered in this area.
They don't know-- they feel a sense of the sacred or a spiritual sense
but they don't know how to deploy it.
So I thought I'd like to just tell you how I address that group
which I've seen quite often and it's a particularly Jungian approach
and here I'm reminded of a quote of Jung's where he says,
there's no point in preaching about the light if people can't see it.
You have to show people how to see it,
so I would suggest some ways of talking about it.
How do you locate the sacred in your life?
If you're nicely contained in one of the major religious traditions,
this is not a problem for you.
But I'm particularly concerned with people who are not contained
in those traditions at all.
So let me tell you what the Jungian approach to this.
The first is to look at the person's dreams.
Because the Jungian theorists-- theory is that the dreams are made
by the self, by the transpersonal self.
And as Jung says, as you penetrate more and more and more
into the unconscious it becomes an illumination from above.
It really becomes a kind of teaching experience and I'd
like to give you an example of this about a lady of about 70 years old
who was terrified about her aging and I asked her if she would look
at her dreams and she came in the next time with a dream
in which she sees an image in which there are 2 heads on a single neck
and a voice says to her, these are the 2 heads of God.
One is the male head and one is the female head.
And the voice goes on to say, don't worry about aging.
The purpose of aging is the rejuvenation of God
because as we get older God gets younger.
And when we, and when we die God is reborn.
And neither she nor I have ever understood what that dream meant
but it's a marvelous [inaudible].
[Laughter] And its the kind of thing, when you hear those kind
of voices in dreams have such enormous authority
that it has a kind of settling effect, it's very calming.
So dreams are extremely important as a source
of spiritual advice and teaching.
Another very neglected area of the manifestation of the sacred is
in visionary experiences.
Now nobody likes to talk about visions because we're afraid
that if we say, we had a vision that people will think that we're crazy.
But I have found talking to people that lots
of people have had visions, a waking vision.
A waking vision is like a dream when one is awake and I'll tell you one
that I heard not long ago because I tell you the reason why.
This was a woman who I grew up with for some years in psychotherapy
and eventually she was dying.
And she came into therapy because her parents,
when she was a child her parents had fought with each other just
like cats and dogs the entire time of her childhood
and it made her whole life miserable and she was determined
to resolve this before she died.
And Jung actually says somewhere that people go
into analysis so that they can die.
Meaning that one sometimes wants closure on this kind of thing.
So we did all the usual stuff and I, in the last few days of her life,
I went to visit her in her house and she said I woke up this morning
with a sense of the presence of my parents by my bed
and the marvelous thing was I couldn't see them
but I knew that they were together.
And then she said, and I looked on the bed
and then I actually saw a golden bowl on the bed
and the bowl was full of oil and it was shooting off rays
of golden sparks and then my parents said to me in a kind
of soundless way, you want to use this experience to bless others.
And so she turned to me and she said well I'm dying so I'm going
to tell you about it so that you could tell
as many people as possible about it.
That is the kind of experience which if you ask
about I don't think is all that uncommon among people
in the last few days or few weeks of life.
So that's another important source, so in other word,
I'm trying to make the case of for the fact
that you don't need the Judeo-Christian tradition
to experience the sacred.
Another important source of sacred experience
that many people have told me about is in the natural world.
Many people have a profound sense of the sacred
in the natural world it fills them awe and mystery.
And if you're that kind
of natural-born-nature-mystique you shouldn't be sitting in a book --
in a building reading a book about what happened
to somebody else a long time ago.
That's what William James called secondhand religion.
It's not really very helpful.
You should be-- your temple is the natural world.
And there are other sources of sacred experience.
What about addictions or alcoholism?
You know at first sight we think this kind
of things are pathological.
What have they got to do with spirituality
but then we can remember Jung's dictum that the treatment
for alcoholism is spiritus contra spiritum, spirit against spirit.
The treatment of trying to get a kind of ersatz spirituality
from spirit in a bottle is to develop a more advanced,
more refined spirituality, a more advanced spirituality
and that's what helps people.
And that's why AA and groups like that are particularly helpful.
So your addiction can be another source of profound spirituality.
You don't have to go to a church or a temple.
Well, what if you are depressed or anxious?
Well in the Jungian tradition your depression
or your anxiety is a direct wake-up call from the self.
It's not a symptom of a low serum Prozac.
It's an indication that you need to pay attention
to something in your life.
That is a spiritual practice in its own right.
There's a big difference between the dark knight of the soul
when you feel miserable but you're aware
that there's a transpersonal process going on.
I'm just saying I'm depressed, give me the Prozac.
There's an enormous difference between those 2 approaches
to what looks on the surface like the same problem.
Another source of sacred experience I mentioned this morning is
creativity and here I was reminded of the artist Marc Chagall
who was asked by his granddaughter, do you pray?
And he said, of course, I pray.   I make art.
I think that sort of speaks for itself.
So I thought I might end with a story that I've heard recently.
Oh well, now before I end with them, I was, I wanted to--
we've talked a little bit about the importance of the poets
and I've often used as a model for successful aging in the face
of suffering Sophocles's play Oedipus at Colonus.
Here we see the old blind Oedipus led by his daughter Antigone back
to Colonus where he was born.
And Sophocles makes it very clear how much Oedipus has suffered.
But he tells us that the old man
because of his suffering has developed wisdom
that only suffering can bring.
And Apollo the God gives him a resting place at Colonus
where he can confer benefit on those who receive him.
He becomes a source of insight.
He's lost his physical sight but he becomes a seer.
He has insight, he's like Tiresias, you know the story of old Tiresias.
It's in the Metamorphoses of Ovid.
The story of Tiresias is that Zeus and Hera were having one
of their eternal arguments about--
and this one was about who enjoys sex more, do women enjoy sex more
or do men enjoy sex more.
And Apollo-- Zeus said that women enjoy sex more
and Hera said no, men enjoy sex more.
So they're decided to ask Tiresias and Tiresias was a man who had
for 7 years become a woman one day because he was walking in the woods
and he'd seen 2 snakes coupling and he'd hit them with a stick
and killed the female snake and so he had to lived for 7 years
as a woman to atone for this and then the same thing happened again
and this time he killed the male and so he was turned back to--
so anyway, so he's been both a male and a female.
Anyway, he agreed with Zeus that women enjoy sex more than men.
And for this Hera got enraged and she punished him with blindness.
And there was a rule on Olympus
that you couldn't undo what another god had done.
So the best that Zeus could do was to give him the gift of prophecy,
the gift of spiritual sight.
It's the same mythic theme that you find in Sophocles that suffering
and physical disability can lead to insight
and that one can overcome this kind of physical disabilities
and difficulties with the development of spiritual sight.
I wanted to end with a story that I just came
across about Itzhak Perlman, the violinist.
I'm not sure if this true or not but it's in the literature about him.
He had polio as a child and he walks with leg braces and crutches.
And there's a legend that he was in a New York concert.
In the middle of a piece a string broke and he had to finish the piece
on 3 strings instead of 4, rearranging the music in his head
as he went along 'cause probably only he could do that.
And they asked him afterwards how on earth do you managed do that,
and he says, well, it's the artist's task or the task of the artist
to make music with what you have left.
And I think that could be very nicely applied to aging
if we look at aging as an art.   Thank you.
[ Applause ]   >> Thank you.
Well, we have some time for a discussion, dialogue,
questions from either the panelists towards each other
or the audience to the panelists.   [ Pause ]
>> I have a question for I believe it was Dr. Puchalski.
Your definition of spirituality, is that on a website
or somewhere that I could get?
I'm a family doc and I would love to--
>> Yeah, it is.
Our website is G-W-I-S-H, gwish.org and also the report of that,
the consensus conference with the model and all that is in the Journal
of Palliative Medicine, October 2009 and it's a free download
on the website but I would be very happy to send you that copy
if you're interested so you could just e-mail me through the website.
Yeah, and I just want to piggyback a little bit
on what Dr. Corbett said too because you know, so much--
I really appreciated your definition of spirituality.
So much of our work with physicians and nurses and others is always
to keep in mind the broad nature.
You know the spiritual histories, what religion are you,
that's just such a small limited piece.
But even if someone is affiliated or not affiliated,
there are so many different expressions
of how people understand spirituality.
So I think it's important to keep that in mind.
>> I was surprised that not much of us said
about the importance of forgiving.
And I personally believe that the purpose of old age and especially
of dying is to forgive and to accept you know all these issues
in our life that bothered us.
And I think it's a very important part of the spiritual care.
>> Yes.
>> Of the dying to teach them the importance of forgiveness to go
over their life story and see that they have little black spots left
against people or situations you know that they have been upset
or angry about, and to see what purpose it served
in their lives and thus forgive it.
>> I completely agree with that and there are some ex--
if you're interested, there's excellent--
there's natural studies and there's literature.
Dr. Everett Worthington is kind of the grandfather
of forgiveness research that actually shows this,
not only is it an important probably developmental task but also in terms
of our health because holding
on to resentment actually can cause high blood pressure, heart disease--
worsen heart disease, et cetera.
I would-- just funny that you mentioned
that because I think this morning on a news program there--
I forget his name but the head of one of the big social--
I can't remember now but he's a minister, bishop who wrote a book
on just let it go, the importance of forgiveness.
And while it's not that simple,
you can't just let it go, there's a process.
But I t think more and more were recognizing the importance
of forgiveness of ourselves as well as others in our life
and there's some very interesting work on forgiveness interventions
that were done out of Stanford.
Again, we're looking at very short-term specific ways
that people can come to understand their resentments
and their forgiveness.   Yeah.
[ Pause ]
>> Do you have any idea whether most people facing death regret what
they've done in life?
Or is the larger regret what they haven't done?
>> So there's-- sure, there's surveys about that.
I can speak from my personal experience of walking
that journey with many people.
I think, you know, it's interesting, we talk about what--
sometimes the messages, these things we have to do as we're dying
or towards the end of life.
You know, the lesson that I learned actually from my dad is
that we should start practicing some of this self-forgiveness
and reflection kind of all through our life.
When I was in medical school I took take care of a woman in hospice
and she said boy, I wished that I had addressed these issues
when I was younger and just like you with, you know,
sharing your patients she said, please share that with your students
and I usually try to bring that up in my talks as well.
I think in term-- we're all going to have regrets,
we all have regrets today and you know, I think part of healthy living
and consequently, you know, dealing so that it doesn't pile
up right before-- when we're on the deathbed is to deal with some things
on an ongoing daily basis.
You know, what's the-- it's just like forgiveness, what's the benefit
of having a regret, you know, what or why are we holding onto it.
Can we just let it go?
We're not perfect, move on and continue to live.
John of the Cross, he mentioned he's-- I'm a lay Carmelite actually.
He's my-- one of my favorite saints.
And he talks about attachment to a hurt or I could extend
that to regret blocks the inflow of hope into our lives.
And to live, you know, fulfilled lives and have--
and now you're talking about dying, having a healthy dying,
is to be able to have hope even in the midst of and especially maybe
because of at the end of our life.
So it's best if we open ourselves up to that inflow of love and hope
into our lives which means letting go of regrets,
letting go of resentments, forgiving where we can.
I think that's where it's helpful.
So in my own experience to answer your question,
I don't know that I think most people have regrets at the end
of life, it's very individual.
Quite frankly, the most of the people that I've worked with,
that all kind of comes together at the end and it is what it is.
There's no perfect death but people kind of get through it
and some people hold on to regrets a little more and some people don't
but you really don't have much of a choice.
So you have to kind of move through it,
I'm a little bit pragmatic about that.
So I would say no, in my experience, not-- regret is not the main theme.
I think what the main theme might be is--
might be a little bit of a difficulty in letting go.
And that's where compassion and presence is so important.
Someone asked about the doula of the dying and all.
There's lots of programs where people just sit with another person.
You can't tell someone let go, let go.
But just that presence of love,
people are eventually able to do that.
>> I would just add in the question the term of regret
from a personal point of view.
The first Jungian analyst that I went to,
her name was Dr. Rivkah Scharf Kluger, she's a very wise woman
and she wrote books called Psyche and Bible,
Satan in the Old Testament, The Gilgamesh Epic, and she was one
of Jung's main students before they even had an institute.
And I worked with her for 5 years in Israel.
And one of the first things that she told me when I went into analysis,
we're talking about what I wanted to do for the next phase of my life.
She took out a book by Martin Buber and in it Buber tells a story
of a very famous rabbi, his name is Rabbi Zusya and he was
on his deathbed and he was crying.
And his students asked him why are you crying?
He says, "I'm afraid of dying and facing God"
and then they said "But why?
Why? "You've been the greatest rabbi since Moses.
You've lived like Moses, why would you be afraid to die?
What should we think?"
And he said, "I'm afraid that God is not going
to ask me why weren't you like Moses?"
He's going to ask me why weren't you Zusya."
>> I know, yeah, it's beautiful.
>> That is, why weren't you yourself and that's the biggest regret
that somebody could possibly have is that they weren't true
to themselves with a capital S, so.
>> Now I think, just to add to that, I'm going back
to what Dr. Puchalski was taking about in terms of relationship.
I'm reminded of something coming from Kathleen Raine who's a poet.
And she said something to the effect of only if you see a thing
in the light of love can you ever really see it at all.
And I think that's infinitely true and I think it's something
that sometimes we can't do alone.
And we need to be in the presence of a compassionate,
completely accepting other to do that kind of work to wrap up some
of the things that maybe we didn't tend to,
the wounds we didn't tend to earlier in our lives.
And that this is part of the process and I think this is one area
where it really helps to be within a religious community
that is spiritually vibrant to you.
Where, you know, the symbols as we say
in Jungian psychology are really operating in a way that, you know,
it's-- you're not in a field of thinking you know.
Well, you know, Jesus died for our sins.
But rather there's something alive still
in the way the community holds the tradition.
And so one feels held symbolically and you're in a community that you--
where you have a shared symbolic system and a shared language system.
And one example I think of where this can be
so meaningful is reflecting back to something that I heard a story
about my teacher, my old teacher Dana Greene [phonetic]
who I would say is a wise woman.
And she and another woman who are both very involved
in their Christian faith were talking
and the younger woman had just lost a breast
to breast cancer, she had a mastectomy.
And she turns to Dana and she says "Dana,
at the time of the resurrection of the dead,
[Laughter] And Dana who is a bit of a sage said
"Darling, you'll be beautiful".
So you see it's not really about whether they believe
in the resurrection of the dead.
But you can feel symbolically what's transmitted within that system,
within that common language system, you know.
And so, you know, a lot of us I think suffer a lost
by losing community whether it'd be religious community or other kinds
of community where there is shared meaning.
But I think if one has still a connection
to a vibrant spiritual community, there are real advantages,
particularly in light of some of the difficult passages one has
to make psychologically in the course of aging, you know.
>> Thank you.   Yes?
>> It's really interesting being here today
after a 2-day conference we just had at the library
in another building on stress.
And that, no-- that conference was a lot of biomedical researches looking
at this phenomenon and a few of the things that really stood
out was the-- one talk in particular talked about the placebo effect
and how the use of pharmacology
to solve certain issues could be enhanced or decreased based
on the relationship with a physician or certain rituals that the--
there were actually biomarkers for relationship that are beginning
to emerge so that the mechanism for why--
they wouldn't have said it this way, I'll just say it this way,
why love works clinically are beginning to emerge.
Studies of breast cancer patients with metastasized breast cancer
and the kind of support groups that extended life, so I think we're
at a point where the old wisdom is now beginning to show
up in the medical literature as people are able to do realtime MRI
and other kinds of markers as to how the brain lights up,
what's stimulated, and this intuition from the--
I shouldn't call it intuition but on intuitive, from the--
well, I'll call the Jungian side beginning to find its verification
in sort of double blind biomedical studies.
It's just quite interesting.
It's out there, obviously not there yet and it's just at the beginning
but I think it's amazing, a lot
of the ancient wisdom and the current wisdom.
Well, I think in the next-- sometime the sort of match to corroborate it,
not that it needs corroboration but in the biomedical field
and it's moving that way.   >> Thank you.
Time for one more question.   [ Pause ]
>> Hello, I wanted to thank you for your--
the panel for this discussion on biomedical
and how spirituality influences.
I'm a surgeon and I think surgeons have a lot to learn
from the auto mechanic world where when you take your car
into the dealer there's a customer service person that you talk
to that has people skills and empathy and you never really--
[Inaudible Remark] But you never really meet the guy who's trained
in the wrenches and all that.
But I want to just comment on, probably one of the most advances
that I've seen recently in medicine
that has really revolutionized the recovery
of patients has been a brand new bed.
And I'm not talking about a Tempur-Pedic or Craftmatic,
but in the patients' rooms, the hospitals that I work in,
instead of having 2 patients
in a room they now have 1 patient in the room.
And the second bed is for a family member.
And so you're there in the hospital,
in the middle of the night you have a family member.
I encourage the kids of the patients or adult grand kids
to take the night shift because they're
up all night text messaging anyway.   [ Laughter ]
But to have the support of someone and experience that love
in the middle of the night when you're worried
or you're concerned you can't get the nurse
to have someone there makes all the difference in the world.
And it also, I think it teaches the younger people, you know,
about family and how to take care of their older relative
and opens their eyes a little bit so that probably makes--
that's probably made more differences than all
of the technical advances is just having a family member there.
Thank you.   >> Thank you.
And you know, actually, you're talking about being a surgeon,
you know, the notion of relationship
and spirituality at our medical school.
The students wanted to hear not from a female internist
but a male surgeon so we got one of our heads of our surgery department
at that time came and spoke.
And the most powerful statement that he made was that as--
he does trauma surgery-- as a trauma surgeon he has a very short amount
of time to connect with the patient and the family,
and who knows what's going to happen in the OR,
I mean these are usually critical situations.
And by connecting from a base of compassion and concern
and by understanding the beliefs, you know,
connecting with the inner person, their belief systems,
asking a little bit about spirituality and he was open
about his own inner life and his own spirituality as connected
to his call to serve which is really what ultimately this is.
We don't have jobs, we have vocations,
that made a huge difference in helping the patient trust him,
share-- for him coming to a good diagnosis
because they were more open about sharing what was going on
and then also the care afterwards.
So I think that, you know, for all disciplines it's really important
to bring that aspect into it, yeah, as well.
>> But I just want to say, I don't think it's fair
to compare surgery with auto mechanics.
>> Yeah, you shouldn't.   [Laughter]
>> Because auto mechanics is quite a skilled job.
[ Laughter ]
>> Okay. Okay, I think if I add anything
at this point there's going to--
[Laughter] But I would like to end first of all
and I think it wouldn't be complete
without acknowledging a few people and a few things.
First of all, Lionel, thank you
for your wonderful presentation to set the tone.
[ Applause ]
And I want to thank our panelist Christina and Melanie but now all
of our [applause]-- all
of our panelists all day long, all day long.
We've really been blessed.
I feel with a wonderful group of panelists from the morning
to the early afternoon to now, we've all learn a lot,
it was really a pleasure and a privilege to be here and an honor
for me to serve as a moderator.
And I want to thank all of you for making this possible.
And last, but not least, the Library of Congress and the AARP
for having faith in this particular topic.
It's not something that every organization would put their
prestige on the line to back us and to allow us to do this,
and we know those of us in the Jungian world,
it's not always an easy sell so to speak.
And then last but not least, this is an expression
in Hebrew [foreign language], the most dear ones
who really made this possible, Leslie Sawin who really put all
of the work and management behind it.
[Applause] And Mike Carbine who-- [Applause] I know that Diana
and I have been putting on programs
for now 25-26 'cause we know what goes
into making this program possible.
It looks seamless up here during the day but we know what's gone
on to prepare for all of this taking place and it was a very,
very wonderful day and thank you both.
And thank you all for being such a wonderful audience.
Safe travels.   [Applause]
>> This has been a presentation of the Library