By: Richard Gunderman, MD, PhD
IU School of Medicine 

One of the biggest problems with new books and articles is this: They prevent us from reading the old ones. New things are not necessarily better than old things, and in some cases, it is the old things to which we most need to attend, a truth that applies equally well when it comes to physician wellness. In some cases, in fact, if we really want to gain the deepest possible understanding of the key sources of physician anxiety, we need to go very far back indeed.

Consider aging. Some physicians, no less than other people, fear growing old. They worry that their physical and mental powers will wane, their looks fade and their independence fail. Of course, people of every age have bemoaned the fact that living things grow old and die. Yet, what might seem to some a purely biological problem – and therefore a biologically delayable or even reversible one – is also philosophical in nature, and it is to an ancient philosopher we need to turn to gain insight and guidance.

Marcus Tullius Cicero, known to most simply as Cicero, lived from 106 to 43 B.C. He was a Roman statesman, scholar, philosopher and essayist, and in the year before his death at the hands of political assassins, he composed one of his best-known works, “On Aging.” This work features a discourse by a highly regarded Roman statesman of the prior century, Cato the Elder, addressed to two younger men who have asked how he bears the burden of aging so easily. Instead of bemoaning aging, the 84-year-old Cato praises it.

Specifically, Cicero addresses four common concerns about aging: that it makes it more difficult to engage in worldly affairs, that it impairs the fitness of the body, that it reduces the enjoyment of pleasures of the senses, and that it brings us closer to death. In each case, he argues, what are widely thought to be curses turn out to be blessings, and he adduces many examples of prominent figures who enjoyed life, were held in great esteem, and made important contributions in their later years.

As to the first concern, that aging calls us away from worldly affairs, Cicero points out that the contributions of the aged often surpass those of the young. The captain of a ship may play no part in climbing the masts or going to and fro on the gangways, yet it is he who charts the course and holds the helm. Although he no longer does what he could when he was young, he does greater and better things, which are accomplished not by speed and strength, but by knowledge and counsel, areas in which seniors can excel. 

While aging may undermine physical capabilities, the second concern, it can also direct our attention to more important matters. Each age has its own character, but only the later years bring full maturity. Instead of longing to return to what we once were, we should embrace each age, allowing exercises of the mind to play a greater role as the exercises of the body become shorter and milder. The young are not fit to teach their elders, but the old have a great deal to teach the young.

Regarding the waning of bodily pleasures, Cicero argues that we should recognize that such appetites often lead us astray. So long as urgent pleasures dominate our priorities, virtue has difficulty gaining a foothold, but as their urgency abates, opportunities open up to direct our attention to more important matters. A strong tension between desire and duty is replaced by easier accommodation, in which life’s pleasures no longer pose such threats to reason and good counsel.

Finally, the fact that aging brings us to the verge of death should not distress us. The wise are not the hubristic ones who prize their own lives above all else, but those who are content with the time allotted to them to live. They regard each of life’s acts as a role to be played well, seeing life’s later phase not as a disease to be cured but as ripeness, like an apple that is ready to fall. Old age is simply the fitting final chapter of a life well lived, and no part should be prolonged beyond its due length.

The key distinction between those for whom life becomes a burden and those who enjoy their later years, Cicero holds, lies not in age but in wisdom. For the foolish person, every phase of life from youth to old age is problematic, while the wise person is able to make the most of life’s every act. What matters is knowledge and the practice of ethical virtues, which enable the wise to fully enjoy the fruits of every time of life, drawing on past life experiences to enrich the present.

In short, the wise see themselves as parts of larger wholes – friendship, family, profession, community, nation, and perhaps even divine creation. To suppose that good things can happen only during our tour of duty is to grossly overestimate our own importance, while embracing aging and contributing as much as we can through it puts us in harmony with the created order. Death is as natural and as necessary a part of life as birth, and the wise person turns the gift of life over to succeeding generations with love and hope.
 
Richard Gunderman, MD, PhD, is the chair of the ISMA Wellness Steering Committee.