Community and Society Archive

Professor Robert J. Neborsky, M.D. participated in "The Future of Family and Tribe" seminar. He is a Clinical Professor of Psychiatry at UCSD School of Medicine. He is also Medical Director of Lifespan learning Institute and Director of the Lifespan Foundation for Research and Training in Psychotherapy. He is on the editorial board of the International Journal of Short term Dynamic Psychotherapy. He is co-author of Short-term Therapy for Long Term Change, Norton 2001 along with numerous articles and book chapters. His contribution to the JPF Seminar follows below.

The Changing Us 

By Robert J. Neborsky, MD

We are in the midst of a shift in evolutionary biology with unpredictable psychological and social consequences. At present, as you read this, there are 10,000 physicians who are certified to practice anti-aging medicine, but only about one thousand engaged in the full-time practice. Let’s say that each physician has two hundred patients in his or her practice. That means that 200,000 people in the US are in anti-aging therapy. Up until just a few years ago, the only thing someone could do about aging was diet, exercise, and treat diseases in a timely and effective manner. With the spread of anti-aging practice, the degenerative aspects of aging can be halted, and not only can we live longer, but also we can remain healthy and functional. 

Even without the benefits of anti-aging therapy, lifespan and functional capacity have increased remarkably.  In my psychiatric practice alone (I’m not an anti-aging practitioner), I observe people in their eighties approaching me for psychotherapy for neurotic problems.  Even at this age they want to address these problems so that they can improve the quality of their lives.  What will be the psychological implications of people living not only longer, but also substantially better lives?  Because I work at the level of individual psychology, I have become sensitive to how critical this question is.  We might well be in the midst of an astounding change, and the existing paradigms of theory and our expectations for adult development might no longer apply.   

The early psychological norms for adult development were based upon post-World War II life expectancies of sixty to seventy years.  Gradually and imperceptibly, there has been a shift in the length of our productive life spans.  Americans are living longer and healthier lives.  The reasons for this are multifaceted. Significant segments of the public have assimilated the benefits of diet and exercise, and medical treatments for chronic conditions that impair health and function have improved.  

We can also begin to see dramatic changes beyond the level of individual psychology.  The expansion of functional life span will affect such important institutions as the intergenerational family and our economic assumptions about retirement.  We need to develop institutions and therapies that address the impact of longer life spans on individuals, on family and on society as a whole.  

Since the time of Freud, we have been aware that emotional traumas and conflicts are either repressed or dissociated from consciousness and stored in an unconscious filing system. This filing system can either present itself as symptoms of anxiety or depression or in relationship disturbances that re-enact certain early developmental problems. Given the possibilities for dramatically expanding a person’s life span, it seems inevitable that these files will be activated in different ways and at different times throughout a person’s life. For instance, the longer we live the more possible losses we face, and bereavement frequently leads to depression. Some studies of depression in older populations already show a prevalence of 20%.  We will be faced with more emotional challenges, and these challenges can also be opportunities for growth throughout our extended lives. Here are a few vignettes which suggest the types of emotional challenges a longer and healthier life span will present.  

Ages Fifty to Sixty: The Gauguin Syndrome 

Judy, 56, was a successful business executive. She called me sobbing profusely. Her husband of thirty years, Bob, told her he wanted his freedom. He had experienced a mid-life depression, during which he had had two affairs. He fell in love with the second woman and wanted to leave Judy to live in Europe with his new lover. She asked me if I would be willing to work with Bob. He came to see me. A tall, handsome, somewhat shy and reserved 62-year-old college professor, he told me he had gradually fallen out of love with Judy and this was why he believed he got depressed. He wanted me to work with him to help him make a decision: whether to stay with Judy or go to Europe with a younger woman named Erica. He described Judy as very competent, enormously effective and highly capable, and admitted that he grew to resent those very qualities on which he depended, and by which he felt diminished. He admitted he was also paralyzed to leave Judy, and afraid to be on his own. He believed that if he could only leave her and live out his fantasy with Erica, he would be free of all depression. Therapy revealed that Bob had an incomplete separation and differentiation from his own family of origin, and that he married a woman who could replace his own powerful mother. Thus his own sense of self was compromised within his marriage, and he needed a trophy wife to feel whole. He felt stifled and unmanly in his marriage and was struggling to become his own person at the age of 62.

The Seventies:  “Who’s Afraid of Virginia Wolff?” 

John was a retired college professor living in a suburb with his wife of forty years, Ann. Both were in their seventies. Ann and John had a stormy, bickering, blaming relationship mixed with times of deep love and passion. Ann’s chief complaint about John was that she sensed remoteness and a distance that suggested to her that he was keeping part of himself separate from her. Both were on anti-aging therapy from John’s doctor. John saw me in individual therapy and disclosed to me that he was bisexual. He disclosed that he had had ongoing affairs with men for many years, but that he kept these relationships secret from Ann out of fear and anger. He linked his homosexuality to his father’s emotional aloofness, and he sought closeness via sexual encounters with men. Eventually, he disclosed his secret life to Ann. After much anguish, and because he truly loved Ann, John left Ann and lived a fully gay lifestyle.

The Eighties: “Little Orphan Annie” 

Claire, a slim, attractive woman with sparkling dark eyes, called me because she was experiencing unsettling jealousy in her relationship with her husband of ten years. She found herself angry, depressed, and preoccupied with his relationship with his daughter from a prior marriage.  So she sought psychotherapy. Claire was 83 years old. She had been married previously and reported that she had never been this way before. She was always content in her marriages, but reported that Jim stirred her in ways she had never felt before, and that this jealousy was a new emotion. She knew how much the daughter meant to Jim. She herself was a doctor who maintained a small active practice. Jim, her husband, was the same age—he was a businessman and was starting a web-based business to sell a product he also manufactured. I accepted Claire as a patient and took her into intensive psychotherapy.

 Claire’s mind was keen, and she was certainly psychologically minded. We explored her anger at her daughter in law, and it led to memories of her own mother who died when she was eleven.  She had not properly grieved this devastating loss at the time. Next it was revealed that Claire’s father had drowned in a boating disaster when she was 16, and that she had been raised by an aunt. Remarkably, she had not grieved this loss either. If that were not enough, Claire’s prior husband drowned in a swimming accident years before. She was a widow until she fell in love with Jim. The therapy helped her grieve the loss of both parents. The highly defended grief came through consciously as jealousy for the closeness she saw Jim and his daughter share—the closeness she had never been able to share with her mother or her father.

These three vignettes may be representative of a larger societal trend. As far back as 1953 Leo Rangell, a noted psychoanalyst, asserted that the major conflictual unconscious themes of our life ebb and flow throughout our life cycle. In the above vignettes we are observing the unfolding of these love conflicts in patients in their 50s, 60s, 70s and 80s.  A rigid category of stages of adulthood is no longer tenable because of changes in health technology, and the ways in which the upper classes are assimilating them into their lives.  

This change raises some concerns, but also some new possibilities. Traditionally, mid-life is 35-55. This is classically thought of as the time of maximum intellectual and creative prowess.  It is also thought of as the period when we realize that time is a limited commodity, and the illusion of immortality begins to give way to anxiety about death.  What will be the limits of mid-life with the extension of functional life span?   

The examples of Claire, Bob and John call into question our expectations about the typical progression of psychological development: Their concerns were neither generative, as we would expect from people in childbearing years, nor were they seeking cosmic perspective on life (as we would expect from old age).  Instead, they had the typical concerns of mid-life: personal, passionate, seeking self-fulfillment. 

Our brains are magnificent organs. They have awesome powers to grow. Recent evidence from the work of Allan Schore at UCLA demonstrates that our capacity for empathy and compassion is located in specific centers of our brain above our eyes (orbito-frontal gyrus). This center of our brain is formed by early attachment experience with our parents, and malformed by attachment failures. New research shows that transformative life experience (marriage, parenthood) can expand this area of a traumatized brain. So we now have evidence that profoundly intimate life experiences can transform the brain. Will the gift of expanded youth allow us to tap this capacity to expand our powers of compassion and empathy?  If so, we may well be in the middle of an evolutionary shift that will allow us extra chances to correct psychological struggles and limitations developed earlier in life.   

But clearly this is not the only scenario. Another possibility is that we would simply use our extra years to satisfy unmet narcissistic needs, such as those described by Goethe in Faust. 

Our narcissistic side pushes us to acquire more of some “thing” to fill a void within us. This is an attempt to display with objects what we would like people to believe is our true self-worth. This can be in the car we drive, in the house in which we live or in the partner we bring to a party.  But clearly this attempt to bolster self-worth demonstrates the underlying fragility of the self (narcissism). Satisfying some of our narcissistic needs is an important aspect of mental health.  But this is only true when it is balanced by an equally important sense of empathy and compassion for the psychological needs of others. Because attachment failure from childhood is so common, the capacity for empathy and compassion is, more often than not, underdeveloped. This is why so many modern relationships fail. 

With the gift of prolonged youthful maturity, each individual could have an expanded opportunity to transform him or herself, to overcome the limitations of his or her developmental past, and to live life in a deeper more satisfying way. Only time will tell if we will be able to realize this potential.  

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