Old age is the stage of life that ends with death.

1. Old age, sickness, death and immortality:A cultural gerontological critique of bio-medical models of old age and their fantasies of immortality.by John A. Vincent

2. Old age is the stage of life that ends with death. • The meaning of social categories is established in the process of transition. • It is through the practices, symbols and rituals which mark inclusion in and removal from social categories – including life stages – that the meaning of the category is established.

3. Social constructionist approaches have concentrated on the transition to old age • The markers and social processes by which old age is distinguished from middle age have been examined. • Excellent historical work has identified the establishment of retirement as a key marker of old age at 60 or 65. • Much less researched is the transition out of old age. There is only one way to leave old age (at the moment) and that is through death.

4. Old age has always ended in death but in the past death was not the exclusive domain of the old. Death by ‘act of God’, or at the hands of our fellow man, or through disease before we are old happens, but is increasingly unlikely Thus premature death takes on new meanings and death is marked by spectacle, horror, outrage and hysteria

5. There are two academic traditions from which to understand modern death and its significance for old age. • We can use the sociology of science and specifically the medicalisation of old age as an aid to understanding the cultural construction of death. • The sociology of the body has become an important part of modern sociology and can make a contribution to understanding the modern meaning of death.

6. Medicalisation of death and old age. • Western scientific medicine transforms old age from a natural event to a disease. Successful old age is not seen as it was in the 18th and 19th century as the outcome come of a moral life but as the absence of disease. Old Age has become an object of scientific and rational knowledge controlled by experts. • You are not “only old as you feel” – when there is a scientifically trained expert waiting to tell you the basis of your feelings, your probabilities of survival, and which drug will make it all bearable.

7. Science is the principle method through which old age is understood Modern death means: • Death of the body • Caused by biological failure • Unredeemed by medical intervention • Certified by a medical practitioner

8. What is the link between science as culture and the search of anti-ageing medicines and bodily immortality? Are attempts to achieve immortality the result or the cause of the medicalisation of old age? Are the research efforts to avoid the devalued status of old age the cause of the medicalisation of old age. Or, does science as progress and perfectibility medicalise old age and thus lead to its low status? Is the immediate cause of the cultural de-valuation of old age its association with bodily failure? Or, does this devaluation stem from the failure of science understand and control old age?

9. What cultural processes are involved in bio-gerontology? • The model for looking at this question is the feminist history of science, particularly Haraway (1991, 1997) • Her work deconstructs gendered discourses on reproduction within bio-medical science. • Ageist metaphors are replete in the literature and mission statements of the biology of ageing. They use imagery in which some cells and their bio-chemical components appear as personalised images of old age and senescence.

10. adult,[proteins, cells, organs, bodies] aging [proteins, cells, organs, bodies] young senescent integrated disordered development failure, loss, decline normal abnormal, maintained altered invest run down accurate incorrect, damaged, mistakes, mutant, defective, errors, unstable, fitter disposable, diminished, unwanted, healing, repair, detoxified breakdown, dangerous, harmful, deleterious, ‘Aging and the biochemistry of life’ Robin Holliday (2001)

11. “The paradox of evolution is that those forces which gave rise to animals with all their adaptations for successful life also gave rise to aging and the ending of that life.” • One reading of this sentence draws its meaning from an equivalence: Success :: Ageing Life :: Death. i.e. ageing is the opposite of success - a failure. • An alternative reading of the same sentence might be: successful life = successful ageing = successful death. i.e. ageing is not contrasted with life, it is life, and thus evolution makes sure all parts of life are successful. However, the paradox is only present if you intend the first reading – that ageing is failure.

12. Science fiction imagines the future of old age as immortality. • fantasies of super-longevity and immortality reflect the technology of their time. • immortals are inevitably imagined as being the age that is the appropriate cultural ‘prime of life’. • the development of super longevity and immortality are only a matter of time.

16. Ageing is a process, old age a category. • Attractiveness, health, and youth are linked and contrasted to old age, disease, and repulsion. Hence the distinctions between techniques to preserve youthful appearance and techniques to control biological ageing become problematic. • The enterprises selling youthful appearance are highly lucrative. • There is no shortage of scientific research into ageing and there is a plethora of anti-ageing medicines. So many that there are ‘wars’ raging within bio-gerontology as to legitimate practice and the boundaries of genuine science

17. The Juvensa Group say that their “…For the first time in history we have an increasing understanding of the fundamental biological processes of aging and how to mitigate their effects. The market opportunity for new ventures to address these needs will be measured in the billions of dollars.” " …all the key components of mammalian aging are indeed amenable to substantial reversal (not merely retardation)." Aubrey D.N.J. de Grey, Ph.D. (et al), Department of Genetics, University of Cambridge

18. The Alcor Life Extension Foundation has been providing immortality since 1972. “Cryonic suspension is an experimental process whereby patients who can no longer be kept alive by today's medical capabilities are preserved at low temperatures for medical treatment in the future. Although this procedure is not yet reversible, it is based on the expectation that future advances in medical technology and science will be able to cure today's diseases, reverse the effects of aging, and repair any additional injury caused by the suspension process. These superior technologies could then resuscitate suspended patients to enjoy health and youth indefinitely.”

19. The debate about the efficacy of ‘anti-aging medicine’. Three key papers are • (i) “No truth to the fountain of youth.” by S. Jay Olshansky, Leonard Hayflick And Bruce A. Carnes published in the Scientific American; • (ii) “The War on ‘Anti-Aging Medicine’ by Robert H. Binstock in the Gerontologist and • (iii) ‘Who’s afraid of life extension?’ by Harry Moody in ‘Generations’. They raise the issue of whether the objective of Gerontology should be life extension.

20. Old age is denied by the construction of bodily immortality • The sociology of the body tell us preservation of the body in perfect/ youthful/ healthy condition is a supreme modern value. • The cultural dominance of science tells us death is a medical problem solvable by the techniques of science. If it cannot do so now, it will do so in the [near] future.

21. What would a successful mature bio-medical gerontology achieve? • The cultural dominance of medical knowledge which is seen scientific truth and an infallible practice aligns medicine with the goal of defeating of death. A goal which implicitly devalues old age and turns it into a realm of failure. Success becomes the use of science to create immortality.

22. Alternative cultural tools for a good death At the point that we can celebrate death, we will know a good old age preceeded it. The cultural tools for a good death may be anti-modern, post-modern or traditional • Traditional = theocratic, life’s duty fulfilled • Postmodern = going out with a bang – original, creative and spectacular • Anti-modern = humanistic, celebration of social relationships

23. Old age as a problem waiting for a solution Science plays a key cultural role in modern society in authenticating knowledge and is presumed in modern cultures to be an omniscient problem solver. Hence reports of dramatic new discoveries on ageing reinforce the view of old age and death as technically soluble problems. However this set of understandings inevitably condemns old age and older people to the status of failure and to meaningless social roles.

24. Fantasies of immortality are bad for older people. The great investment of time, resources, and cultural ingenuity to find ways to live longer and if possible for ever, have consequences for old age. These attitudes: • postpone action on current problems of old age; seek technical solutions to cultural problems • waste resources in pursuit of undesirable goals • inhibit research into death as a natural event and the final stage of the life course as a positive meaningful coda.

25. The presentation, and two papers can be viewed at: http://www.exeter.ac.uk/~JVincent/Tampere Symposium