Preparing to Be 80: Our Presidents and Ourselves
Key Takeaways
- Age-related neurocognitive risk becomes politically salient when presidents serve into their 80s, echoing historical precedent of cognitive decline during Reagan’s second term.
- Workforce patterns in psychiatry are shifting from late-life practice toward earlier retirement, driven by burnout, moral injury, and reduced autonomy amid business and regulatory constraints.
As US leaders and psychiatrists age past 80, Erikson’s ninth stage reveals how wisdom, burnout, and politics shape national mental health.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
“To grow old is a great privilege.” - Joan Erickson
As so many have noted, we are an aging society in America, and that will escalate as my boomer generation is turning 80. What might that mean for the mental health that can be influenced by politics and responded to by psychiatrists?
Aging in Presidents of the United States
Perhaps this is obvious, but in a way, we are having an unannounced referendum on age in our recent Presidents of the United States of America. There were years of middle-aged Presidents in the past—Presidents Clinton, George W. Bush, and Obama, who started their terms at age 46, 54, and 47 respectively. More recently, our Presidents have approached and passed age 80 in Trump and Biden. Trump has had rarity of 2 separate terms, starting in 2017 at the age of 70, and now turning 80 this year. Biden started his Presidency at the age of 78 and retired at age 82, being the first President to turn 80 in office. Of course, people live longer nowadays, but we also do not know exactly what age-related conditions may have contributed to his retirement.
Before these 2 long stretches of Presidents of different age groups, we had President Reagan in-between the younger Carter and H.W. Bush. Reagan was 70 when he started out but developed barely recognized symptoms of Alzheimer disease during his second term.
Aging in Psychiatrists
Psychiatrists in the past tended to work until death or very old age, mainly doing psychotherapy. Now they seem to be retiring earlier due to burning out, moral injuries, and the challenges of staying up to date about the psychopharmacology which is more often their main role. Here are some typical comments about earlier retirement1:
“I am really happy now.”
“Now I can read books that I didn’t have time to read, I can learn another language, I can develop a hobby… Now I am free.”
In psychiatry, we recently have a younger CEO of the American Psychiatric Association.
For myself, I retired from clinical and administration work when I was 66, as I felt that social circumstances in the business obstacles to potential healing prevented more work satisfaction.
The Erikson Model of Psychosocial Development
For the younger group of presidents of our country, they fit the seventh stage of Erik Erikson’s psychosocial developmental process and challenge. From age 40 to 65, the challenge is “generatively vs stagnation,” with the positive being creating a positive legacy through caring for others.
Working unto 80 or more clearly puts one in the ninth Erikson psychosocial stage of “integrity vs despair.” Beginning at age 65, it originally was supposed to last until death. However, his wife Joan added a ninth stage after Erikson died, one for the 80s and 90s in which one simultaneously can grabble with prior stages, especially the negative pole of the pairings like mistrust from the first stage.2 Moreover, in working through any significantly unresolved prior stages, there is the possibility of then moving toward a more cosmic and transcendent view that is associated with wisdom. To go forward toward transcendence beyond self-centeredness requires an increase of time with quiet reflection.
Concluding Thoughts
What, if anything, can we conclude about age in regard to political leadership and the work of psychiatrists? Age is a hard variable to isolate and no double-blind studies possible. Yet, we had President Reagan who developed the cognitive limitations of Alzheimer disease when he was still president. During Trump’s second term, he has already been more active in the sense of controversially using his power internally and in starting the war against Iran. Moreover, these last 10 years or so of presidents hovering around 80 years old have not been good for the mental health of our citizens nor work satisfaction for ourselves. New technical advances like AI are being done by our youth. If older age should bring the increase in wisdom that can overcome the likely increase in the drawbacks of aging for presidents, the evidence for that seems meagre.
Personally, now almost 14 years into retirement,3 I value the possibility of transcendence, but that does require time for contemplation in using our brain’s default mode network, time that presidents do not often have. If the vision for such contemplation can elicit more wisdom, that might be an important role for any elderly in a positive fulfillment of the last ninth psychosocial stage of life. Indeed, such transcendence can increase personal courage, the kind of elder courage that society seems to need from us psychiatrists and other elders for the ethical preservation of the world.4
Dr Moffic is an award-winning psychiatrist who specializes in the social, cultural, ethical, spiritual, and religious aspects of psychiatry, and since 2012 is in retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekdays column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He has been an advocate and activist for mental health issues related to climate instability, physical burnout, and xenophobia, among other social justice causes, serving on many related local and national community and professional Boards. He serves on the Editorial Board of Psychiatric Times.
References
1. Corvalan J.
2. Brown C, Lewis M.
3. Moffic HS, Kudler H, Moreira-Almeida A, Jeste D.
4. Bugajska B. The ninth stage in the cycle of life - reflections on E.H. Erikson’s theory. Aging & Society. April 11, 2016. Accessed March 23, 2026.
