Editor’s note—Please see the response to Dr Ghaemi’s essay, “The Older Psychiatrist in an Era of ‘Unprecedented Change,’” by James L. Knoll IV, MD.
John Tyndall (1881) on opposition to anesthesia during surgery: “It is interesting and indeed pathetic to observe how long a discovery of priceless value to humanity may be hidden away, or rather lie openly revealed, before the final and apparently obvious step is taken towards its practical application.”1
We should respect our elders, if for no other reason that we will all (we hope) one day be old. I come from an Islamic culture that is much more generous in its veneration of elders than Western culture. I share that perspective. I am now neither young nor old, and so, in the middle of my passage, I have become increasingly preoccupied with what it means to age, and—unfortunately—I’ve come to the unwelcome conclusion that age frequently brings with it many drawbacks, not so much for those aging, but for everyone else. I say this without intent to criticize others, but as a true problem in human affairs. So, knowing that political correctness would require otherwise, I’d like to address the question of how the young and the old compare in their approaches to knowledge.
An initial insight comes from the great German physicist Max Planck, who said: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”2(p150) I’ll simplify Planck’s Law of Generations: scientific change doesn’t happen by changing minds, but by changing generations. This is an immensely wise, and depressing, thought—a thought most of us are afraid to discuss explicitly. Let’s do.
In America, our democratic heaven, we citizens find it easy to moralize against injustice. We, justly, defame racism, and sexism, and stigma against mental illness, and discrimination by sexual orientation, and—we can now add—“ageism.” We especially dislike ageism, because, unlike the other categories, where we might moralize out of abstract sympathy, we know we will all age, and one day, being aged, we should dislike being disdained.
So we call it ageism if any of us should criticize another on the basis of his or her age, whether old or young. It used to be that the young were discriminated against; it still is the case in some parts of the world, such as my homeland of the Middle East, or in the Far East. Ancestor worship was formal, and still is informal. In that part of the world, men (usually) in their 60s and 70s are more trusted than those youngsters in their 30s and 40s, not to mention the postadolescents in their 20s.
The situation is reversed in Western cultures—or so we think. We like our presidents to be in their 40s or 50s; rarely are they elected in their 60s, and almost never older. Our tabloids and magazines celebrate our virile young celebrities, usually in their teens and 20s; the magazines mention 30-something celebrities less frequently, and those unfortunate enough to be 40 or older even less. Ours is a young nation, and a young culture; so, we are told, be on guard against ageism.
This is so, but the problem of ageism should not prevent us from understanding the problem of generations, which has both scientific and historical evidence for it.1
Here’s the science.3 In the early 1980s, randomized clinical trials (RCTs) began to show the falsity of the common belief that vitamin E supplementation was beneficial for cardiovascular disease. Yet for 15 years, most authors of scientific articles continued to claim benefit for vitamin E, and during that period, despite accumulation of evidence from multiple RCTs to the contrary, about half of scientific articles still claimed efficacy for that disproven treatment. Similarly with β-carotene for cancer prevention and estrogen for Alzheimer dementia prevention, RCTs showed inefficacy 20 years before the authors of scientific articles began to admit that fact.
1. Wootton D. Bad Medicine: Doctors Doing Harm Since Hippocrates. New York: Oxford University Press; 2007.
2. Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press; 1970:150.
3. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007;298:2517-2526.
4. Osler W. Aequanimitas. Philadelphia: The Blakiston Company; 1948.
5. Agronin ME. How We Age: A Doctor’s Journey Into the Heart of Growing Old. New York: Da Capo Lifelong Books; 2011.
6. Ghaemi SN. The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry. Baltimore: Johns Hopkins University Press; 2009.
7. Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar Disord. 2008;10:957-968.
8. Frances AJ. DSM5 should not expand bipolar II disorder. http://www.psychologytoday.com/blog/dsm5-in-distress/201004/dsm5-should-.... Accessed November 15, 2012.
9. Ghaemi N. Mood swings. DSM 5 and bipolar disorder: science versus politics. http://www.psychologytoday.com/blog/mood-swings/201004/dsm-5-and-bipolar... and http://www.psychiatrictimes.com/mood-disorders/content/article/10168/164.... Accessed November 15, 2012.
10. Pound E. Hugh Selwyn Mauberley. Whitefish, MT: Kessinger Publishing; 1920 (2010).
11. Lewis A. The problem of ageing. Lancet. 1944;ii:569.
12. Shorter E. The history of lithium therapy. Bipolar Disord. 2009;11(suppl 2):4-9.
13. Simon S, ed. William James Remembered. Lincoln, NE: University of Nebraska Press; 1996.