You shall rise before the aged and show deference to the old; you shall fear your God: I am the Lord. (Vayikra 19:32)
You shall rise before the aged
even when his face is wrinkled,
his mouth caved-in, his speech unclear
and his answer to your loudly spoken question,
if it comes at all,
is tortuously wrested
from the far-off reaches
of his mind.
You shall show deference to the old
for holiness adhered
to the fragments of the tablets:
they were reverently sited
inside the sacred ark,
together with the flawless
and more newly written version.
In a document produced by the TAG Institute, http://taginstitute.org/wp-content/uploads/2012/03/JewishPerspectiveAgeing.pdf, addressing the Jewish perspective on ageing, the former Chief Rabbi of Haifa, Rabbi Shear Yashuv Cohen is quoted (from a paper he delivered): “Is old age a blessing or a curse?” Although he replies that old age is clearly a blessing, he also demonstrates that the loneliness, loss of dependence and decline in faculties associated with age were recognized by the sages, and they related openly to these issues. He concludes that the Jewish perspective on ageing is that long life is a great blessing as long as the person also enjoys mental clarity and physical health.
The Torah is replete with references venerating the elderly, especially relating to their experience and wisdom. Seventy elders escorted Moses on his way to the summit of Mt. Sinai, and subsequently served as counselors and judges for the people as they traversed the desert. The word used, “zekeinim” denotes experience and wisdom and is used as a term of veneration in the Mishnah and Talmud, and the Rabbis are often referred to as “zekeinim“. Even someone young, but preternaturally wise, is given the title of “elder.”
We find in Pirkei Avot – The Ethics of the Fathers (5:24) this depiction by Rabbi Judah ben Teima of the stages of life: “He used to say: At five [one should begin the study of] Scriptures; at ten, Mishnah; at thirteen [one becomes obligated in] the commandments; at fifteen, [the study of] Talmud; at eighteen, the wedding canopy; at twenty, for one’s life pursuit, at thirty for authority, at forty for discernment, at fifty for counsel, at sixty to be an elder, at seventy for gray hairs, at eighty for special strength (Psalm 90:10), at ninety for decrepitude, and at a hundred a man is as one who has already died and has ceased from the affairs of this world” “. Rabbi Judah describes a certain peaking of intellectual attainment, but he then suggests a deterioration which despite centuries of medical advances, is still a common phenomenon today.
In a collection of articles addressing Jewish attitudes to ageing, http://www.jewishvaluesonline.org/595, we find a commentary by Rabbi Reuven Bulka, who says,”Not everyone who ages becomes wiser, intellectually or behaviorally. Dementia is a plague that affects close to 10 percent of the population. The rules of respect govern all the aged, including those afflicted with dementia.
“The shattered tablets containing the Ten Statements were placed in the ark together with the intact second set, as if to accentuate that one whose reality is shattered remains holy.”
On the same website, there is a further commentary by Rabbi Jonathan Biatch who notes that “Jewish tradition is suffused with sacred obligations regarding the aged.” The best-known mandate is perhaps the verse cited above that appears in this week’s Parasha, Kedoshim. Rabbi Biatch says, “The implications of this law are clear: recognition of the place of the aged, and demonstration of respect for age and life/world experience.” He suggests that the two different instructions, however, are not identical. “Rising” could be an empty charade whereas “showing deference” involves taking action.
In his book Being Mortal: Illness, Medicine, and What Matters in the End, Dr Atul Gawande describes how old age has changed: “In the past, surviving into old age was uncommon, and those who did survive served a special purpose as guardians of tradition, knowledge, and history. They tended to maintain their status and authority as heads of the household until death. In many societies, elders not only commanded respect and obedience but also led sacred rites and wielded political power. So much respect accrued to the elderly that people used to pretend to be older than they were, not younger, when giving their age…The dignity of old age was something to which everyone aspired.”
He continues though, that living to old age is no longer rare. Furthermore, the knowledge and wisdom of which the elderly were once the sole repositories, has expanded exponentially and become available to all as technologies of communication, starting with reading and extending to and beyond the Internet. He says, “New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment. At one time, we might have turned to an old-timer to explain the world. Now we consult Google, and if we have trouble with the computer we ask a teenager.”
Dr Gawande describes, too, how increased longevity, coupled with global economic development, has brought about a transformation in the structure of the family. This has involved a drastic shift from the extended family, comprised of several generations living under one roof, in which the elderly were venerated and cared for until the end, to the nuclear family in which young adults, often moving as job opportunities arise further afield, set up their own small unit separately from their parents. Modernization has brought much-prized independence to both young and old. He cites some statistics that reflect the effects of this: whereas in the early 1900s in America, sixty percent of those over sixty-five lived with a child, by the 1960s the figure had dropped to twenty-five percent and by 1975 it was below fifteen percent. Dr Gawande says “Only ten percent of Europeans over age eighty live with their children, and almost half live completely alone without their spouse. In Asia, where the idea of an elderly parent being left to live alone has traditionally been regarded as shameful…the same radical shift is taking place.” But, he says, all this ignores one critical problem, “Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunset. And then a new question arises: If independence is what we live for, what do we do when it can no longer be maintained?” The answer that society came up with, as Dr Gawande relates throughout his book, is the “nursing home” or “old age home”. And in the vast majority of these, as he describes, residents have traditionally undergone “infantilization” as they are required to surrender their autonomy in the interests of their safety. Their lives are regimented in order to facilitate ensuring the physical well-being of a large number of people at once. They are required to drastically down-size their belongings in order for them to be accommodated into a much smaller space. They may end up sharing a room. They are woken up, dressed (if necessary) and eat (canteen-type food) according to the rigid pre-ordained schedule of institutionalized life. Dr Gawande wonders at “…the idea that just because you can’t walk anymore or you can’t eat the food you used to eat, that therefore you don’t have a contribution to make or you can’t be the leader of your own life? ” His book is a plea to society to re-think the goal that matters most to the elderly and debilitated: “How to make life worth living when we are weak and frail and can’t fend for ourselves any more.”
Even in the case of individuals suffering from dementia, the evidence is coming in that there are many ways to help them retain connection. Dr Oliver Sacks, the neurologist and author describes the positive effect that music has on dementia patients.
Dr BJ Miller the palliative care physician suggests in his TED talk: What Really Matters at the End of Life* “As long as we have our senses – even just one – we have at least the possibility of accessing what makes us feel human, connected. Imagine the ripples of this notion for the millions of people living and dying with dementia. Primal sensorial delights that say the things we don’t have words for, impulses that make us stay present – no need for a past or a future.”
Dr Gawande describes some new initiatives that are beginning to address this goal of prioritizing individuals’ dignity and desires, fostering their connection with the world outside, and enabling them to continue to “write their own story”.
*Link to the talk and the transcript: https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life/transcript?language=en