Is retirement good for us? Reflections.

“Alarm clocks kill dreams” ~The Work Less Party (worklessparty.org)

Retirement is a loaded word that evokes a variety of images: elderly, wealthy, poor, decline, golden years, celebration, loss, and the list continues. It represents a highly complex physical, emotional, and psychosocial transition in one’s life. This change is experienced in unique ways dependant on a multitude of contextual and moderating factors. Is it possible for research to pare down the primary active ingredients that determine how an individual will experience retirement and life following this tremendous transition? Is it possible to provide a simple answer to the question, “Is retirement good or bad for subjective well-being?”

It is particularly interesting to compare retirement experiences between people who have reached the usual “age of retirement” to those who transition through non-typical retirement, for example termination of a career in elite sport. There appears to be some similarities in terms of moderating factors that predict a successful transition through the process. For example, a sense of personal control (e.g. voluntary retirement, self-efficacy), and adequate resources (e.g. finances, education, social support) seem to correlate to well-being and/or the quality of the retirement process itself. However, it appears that the questions being asked of the two groups differ tremendously in the literature and I wonder if we are missing vast amounts of information that might more adequately explain the array of emotions reported or experienced by retiring individuals.

In my personal experience, I still find my dreams at night often take me to a previous life where I find myself dusting off my musical instrument and rushing off to an important gig. Despite nearly 20 years since I “retired” from my classical music “career”, the memories, joy, hard work, mastery and regrets often pay me visits and I very clearly remember the uncontrollable tears as I played my last performance, a Tchaikovski symphony, amongst close colleagues and before an appreciative full house hidden behind bright lights. I believe the experiences of skilled musicians parallel that of elite athletes in many ways, and imagine these elements are similarly experienced by late-middle aged adults as their working careers come to an end. I believe, therefore, that the key to understanding the retirement process lies for many within the career itself, across the life span.

How much do you enjoy your work? How long have you worked in this field? How much specialized knowledge, skills and abilities are required of this position? Do you enjoy the company of your co-workers? Did you spend your life in the career of your choice and/or passion? Did you accomplish what you had hoped to in your career? Do you feel you were successful? Was there any “unfinished business” remaining when you stopped working? What were your work conditions like? How many hours a week did you work? Did you get paid for all the overtime? Did you take your lunch breaks regularly? Did you like your boss? Did your boss like you? Did you feel you were fairly compensated in terms of income, benefits, vacation? Did you “climb the ladder” to your wishes? How strongly do you identify with the role of “insert name of profession”?

Then, of course, there is the investigation into the retirement process amongst different professions. What would happen if you compared people working amongst the top 10 careers in terms of job satisfaction (which includes physical therapists and psychologists¹) with those amongst the bottom 10 (including labourers and food preparation workers)? Would we be able to tease out the factors that influence the retirement process by stratifying this way? Or would education, income, or any of the other factors possibly confounded by the term “job satisfaction” preclude such an analysis?

I fully agree that personal resources, social-relational resources, economic resources, and gender are important factors to investigate in explaining the retirement process from a developmental and life-span perspective. However, I wonder if we were to delve more fully into the nature of the career itself, would we gain some richness in our current understanding that may be missing? For example, I suspect that career-specific factors may moderate beliefs that may currently be incorrectly attributed to gender. If a person has the good fortune of a life spent in a nourishing, creative, passionate environment where they are fully satisfying their personal desires for knowledge, personal growth and service to society, will the transition to retirement be equally fulfilling, or on the other hand will the person lose themselves when they no longer have a reason to get up in the morning? A bittersweet symphony indeed.

1. http://www.superscholar.org/features/the-10-happiest-and-10-unhappiest-professions/

The influence of negative family dynamics on rehabilitation outcomes: reflections

 “Negative emotions may trump positive ones” – Laron and Almeida (1999)

 Dynamics within an immediate family are complex and immensely powerful, influencing an individual’s moods, behaviours, and even their physical health. Wearing the hat of both a physical therapist and a human being, I am acutely aware of the influence of family dynamics on an individual’s well-being.  However, from the perspective of a physical therapist, I often find it challenging to incorporate this knowledge into my practice.

 Working within a biopsychosocial model of care, I do my best to gather as much information as possible about an individual’s environment, in the back of my mind always wondering how each factor might influence a person’s ability to cope and indeed thrive despite an ongoing injury, chronic condition, pain or disability. I try to phrase our education sessions within the context of that individual’s life, looking for “teachable moments” so my words might have some positive impact in this person’s life. I have experienced many great successes and shared teary triumphs with people who genuinely wanted to make their lives better, put in the work, and pulled through. However, there remain many who never achieve their goals, some in fact who never even set goals, despite the energy I pour into them.

 Is there a simple way to assess an individual’s permeability to the emotions of others? Is there some kind of outcome measure, a questionnaire to complete, that would indicate that my patient is an empath and carries the weight of their world, or at least their families, on their injured shoulders? And as a physical therapist, do I even have the skills to risk asking such questions? I recognize that I am ill-equipped to deal with issues that can arise when I delve into the realm of emotions, and have certainly experienced moments like this in my career where crisis has suddenly made an ankle injury pale in importance to the crystal clarity of a human being’s heart or life in danger. Nonetheless, a person’s emotional resilience seems to be intricately related to their ability to adhere to a physical rehabilitation program so it is not something I can afford to skirt around as their therapist.

 Current paradigms of health care do not afford time or compensation for including family members in the rehabilitation process. Aside from inviting family members to an educational session, or the rare occasion where a patient brings a spouse along to an assessment, I am not generally given a chance to meet or treat at a family dynamic level. Are there ways to glean the important information in a timely way without including the family members? I truly believe that “seeing is believing” and more information can be obtained from 10 minutes with a spouse, than can likely be found between the lines of a likert scale.

 In the absence of the ability to investigate an individual’s current family dynamics, does behaviour modification in any of its myriad forms even have a chance at success? If negative emotions are more powerful than positive emotions, and spousal bonds stronger than therapist bonds, will an hour of cognitive behavioural therapy even put a dent in the 23 hours of dysfunction, loneliness, and contempt that ensues?  And is it possible that this is the primary reason why some treatments fail?

 So this contemplating leaves me curious. In the martial art of Aikido, the aim of the individual is not to stand up and fight against his opponent. Instead, he allows the opponent to enter his personal space, invites him in, in fact. Then he absorbs the energy of the attack, and in a series of circular movements, the energy of the attacker is redirected and unexpectedly returned to him.  I wonder, if negative emotions are more powerful than positive ones, then maybe as therapists we are simply throwing pebbles at an elephant. Perhaps we would be more effective if we could meet our patients in those dark places, and use that negativity as a motivation for change rather than trying to make them “think positively”.  It comes down to the current debate on messaging tactics. Would negative messaging be a stronger motivator for individuals in a negative emotional environment than positive messaging?  Perhaps in a twist that does not make sense to a happy person, the fear of a negative consequence might actually be more powerful than the promise of something better.

“Depressive Symptoms Can Be Useful” – really?

Depression is a loaded word. It has a multitude of meanings to different people based on their personal experiences, the media, colloquial use of the word, and any formal academic training they have had. To further complicate things, add in the concepts of depressive symptoms, depressive syndromes, affect, well-being, life satisfaction, and hedonic tone. Then try and explain it all in terms of one basic characteristic, goal seeking behaviours in the quest for happiness. It’s a quagmire of epic proportions.

I have a sibling who often likes to joke, tongue in cheek, that “stereotyping saves time”. The truth is, he is not wrong. A nomothetic approach to understanding the human psyche really is attempting to do just that. When it comes to depressive symptoms (let’s stick to one word for simplicity’s sake), can we stratify groups of people in order to better understand this phenomenon?  Does depressive symptomology change by age category, gender, or “objective physical attractiveness”? To a certain extent, and much to my dismay, the answer is a simple “yes”. However, it is never really that simple. Let’s tackle the category of age.

Adolescence is by all accounts a challenging period of development. Wrosch and Miller (2009) have attempted to find virtue in the emotional turmoil of adolescence by suggesting that depressive symptoms can lead to enhanced goal adjustment capacities. However, the results of their study suggest that goal disengagement is the dominant outcome of depressive symptoms, and that it does not tend to make goal reengagement any easier. My personal interpretation of this? Depression leads to disengagement. Granted I wear a Western lens, but I find it difficult to see “giving up” as the best alternative when the going gets tough, and to word this as “an adaptive process that enables a person to manage difficult life circumstances”? It’s a stretch.

Let’s look a little further into what makes an adolescent tick. Riediger et al. (2009) looked across the lifespan at variability in momentary affect, and how individuals chose to behave in order to maintain, enhance, or diminish said affect. Results suggest a high prevalence of contra-hedonic motivations amongst adolescents, regardless of momentary affect, current social circles, or activities. So, if adolescents are motivated to seek out negative affect, does it really seem plausible that goal disengagement, as a result of depressive symptoms, is actually an adaptive strategy? Alternatively, would it not also be possible that they are disengaging from their goals in an effort to seek out negative affect? And, in the long run, would this result in the “mixed affect” that Riediger et al. identified as more common in this age category? And could Wrosch and Miller mistakenly have interpreted this as a positive change in score on the Beck Depressive Inventory (BDI)? Perhaps some adolescents are disengaging because they simply enjoy being miserable.

Wrosch and Miller discuss goal disengagement within the context of abandoning “unattainable” goals. There seems to be an assumption that this would be the only reason for disengaging from a goal during adolescence, and that through the experience of repeatedly failing to achieve unattainable goals, and experiencing associated depressive symptoms, that adolescents develop their ability to self-select more appropriate goals. I would like to argue that people of all ages change goals for a variety of reasons, and a poorly-established goal is just one of those reasons. Depression may be another reason unto itself, regardless of how appropriate the original goal was. Completing high school for example, can become more challenging when faced with depression. Dropping out of school may accomplish several benefits in the short term. They will not be faced with many daily challenges, so their affect may improve. However, if reengagement capacities are not improved by depressive symptoms, that individual may stay at home. This might be captured on the BDI as an improvement. Clearly, in the long run, this may not be an adaptive strategy that has a positive outcome. Riediger et al references several studies that suggest that adolescents often engage in risk-taking behaviours, likely as an important component of developing into autonomous beings. In my opinion, setting goals based on establishing autonomy or seeking negative affect may threaten the well-being of an individual in the long term, depending on how well they pull through this difficult time of their life. Many a worried parent has wiped their brow and let out a deep exhalation when their teen successfully transitions to adulthood. Not all parents are so lucky.

In fairness, there is mostly good intention behind this nomothetic drive towards identifying “laws of behaviour”. However, it is clear that these laws can only take our understandings of each other so far, and are inherently dangerous in that they create space for “stereotyping”. Beyond the limits of laws, the idiographic approach is vital in more fully appreciating individual behaviours and motivations. Assumptions about what motivates people are potentially dangerous in that we may miss vital contextual information that is unique to that individual. Assuming that goal disengagement is healthy for an adolescent who feels symptoms of depression may “save time”, but it may not serve the individual in the long run.

“The best tunes are played on the oldest fiddles.” ~Ralph Waldo Emerson

Ageism is a form of prejudice, like sexism or racism, which unfortunately has not received the awareness it deserves. Thus, it continues to pervasively influence societal values, to the extent that it is even seen throughout scientific circles. For example, the very natural event known as menopause has been described as ovarian “failure” or “dysfunction” in many medical publications, with a subsequent drive to find the right pill to “fix” the “problem”. Our tendency towards dualism (defining things as good or bad, right or wrong) often leads us down a path that focuses on negativity, disease, dysfunction, or, in the case of aging, decline or loss. With this in mind, it is instantly clear why patients are often resistant to ideas such as using a cane, installing a monitoring program in their homes to detect a fall, or even to admitting a problem or seeking out help in the first place. People’s own views on aging can influence their willingness to accept events in their life, and this might ultimately affect their choices when their wellbeing goes awry. The result of denying themselves care (for fear of admitting they are aging) may put people at higher risk of future adverse events or decline in health and wellbeing.

Fortunately, a paradigm shift in societal and medical views on aging is currently in its infancy. Recent progress in psychology reflects this shift. Specifically, there exists an opportunity within the context of lifespan developmental psychology to view aging as “an integral part of lifespan ontogenesis” (Baltes PB, 2000). In this context, it is acknowledged that development occurs not only in childhood and adolescence but continues throughout the life of an individual (Baltes PB 2004). This provides a framework within which one can view aging as a stage of maturity, and is ideally one that gives us the ability to transcend dualistic viewpoints surrounding the natural process of living a life. In addition, it may also provide a model that allows the blending of cultural ideas regarding aging. For example, among our First Nations, the process of aging is of itself viewed as an important rite of passage, and Elders are honoured for their wisdom, vision, and significant contributions to families, community and indeed the nation. Within the umbrella of lifespan developmental psychology, we are able to learn from and apply models of aging that are healthier for individuals and society at large.

Within the field of gerontology, Baltes suggests two possible frameworks for study. The first is a static view, literally “the study of being old”, seeing old age as an independent phenomenon. The second, influenced by the concept of lifespan psychology, suggests that our understanding of aging will be greatly enriched if we study aging as a dynamic process that is intimately related to the entire process of living one’s life. This second viewpoint seems to be gaining momentum in healthcare initiatives today. For example, as research reveals more about bone health and aging, programs are being put in place at elementary school levels to ensure adequate exercise aimed at optimizing bone health with long term trajectories of preventing osteoporosis for our younger generations. Learning about healthy behaviour choices at a young age clearly empowers children to take ownership of their wellbeing within an obvious biopsychosocial context. Never before has such a clear link been made between youth and old age. This could never have happened without a shift towards viewing development as a life long process.

The initial discomfort of learning a new language (psychology) is passing, and in its place comes a warm sense of hope. I can see how adopting this psychological framework provides opportunities to change the way we currently view and describe aging. It is clear that through the lens of lifespan psychology, there lies opportunity for improved research methodology, more effective knowledge translation, and ultimately improved health and wellbeing of people of all ages. Gerontology will benefit tremendously from this small yet monumental shift in perspective.

First Impressions

When I grow up…

…I wanna be a thinker.

It’s really all I’ve ever wanted to be. Since highschool, I remember going to UBC and seeing the students there and wishing, wishing so hard, that I could be a university student! Everything about them was so cool, the casual dress, the slightly tired yet consumed-in-some-far-off-and-very-important-world expression on their face, the random conversations about…well…about stuff! They could have been talking about anything, it all sounded so clever and eloquent and passionate to me!

Since finishing my last degree, I have frequently contemplated returning to Academia. It would come to visit me in my dreams, slip into my thoughts during the day, and occasionally tap me on the shoulder then just look at me with that big playful grin that said “still here!”.

So one day back in Kuala Lumpur I was perusing the internet, and decided to contact a well known researcher at UBC, just to enquire. In my mind, I was headed home soon, would work to pay off my debts, and in a year or two would consider returning to school on a part time basis. No commitments just yet.

Within 2 weeks, I was accepted into the Experimental Medicine program, had an offer of a full time research job, and was about to embark on a fantastic new journey into the world of academia under the supervision of a world renowned researcher and sports medicine physician.

So things have changed quite a bit since my last blog. I’ve been home now for almost 3 months, so you can imagine I’ve missed some large chunks of bloggable moments whilst rooting down into my new environment (including a life changing month at Burning Man). However, it has taken this long to do just that. Like a re-potted plant, I’ve been in need of some time to myself to adjust and root in. Having done that, it’s time to reach out and grow again. And I think I’ve found the direction I wish to take.

When I grow up, I wanna be a thinker:

Mahuika, PhD

prayers

As I reflect on a magical weekend of serendipitous bliss and abundance, I come home and look at a friend’s blog.

He has been told he has 14 weeks to live.

He has posted his Bucket List.

My own post is merely a recognition that I witness his love and life, and his intentions.

Love to you, my friend and teacher.