Specialist in Issues of Midlife & Older Adults

Nancy Rhine, MS, LMFT,CPG

Octogenarians Worrying About America

Alma and friendI am finding, as I continue my counseling work with older clients – those in their 80’s in particular – that there is a concern they express about the state of our U.S. government. These people have been raised with a sense of decorum, a respect for one’s character, integrity and good manners. My clients are a small pool so I don’t have a large study going on, however, their views make sense to me. That is, that the way our government behavior seems to be devolving into an angry, polarized, rude, dishonest style of treating each other and that this is something they have not seen to this degree in our country.

They express concern about this, yes. They worry about where the government is headed. They remember times when Democrats and Republicans disagreed heartily yet were able to work together, spend time together, even be friends despite policy differences.

The anger and polarization leads them to wonder whether our democracy can survive this. My octogenarian clients also talk about other major issues like climate change and health care and tax reform. They don’t all agree on what is to be done about these things – but they watch the behavior of America’s government and shake their heads.

They watch our president’s behavior towards leaders of other countries. Again, they were raised with the values of being courteous, polite and kind as well as strong. They are embarassed and sad that America is losing its standing in the world. Remember, this is the World War II generation – the “greatest generation” as Tom Brokaw labeled them. They have been through many years of watching American men and women fight and give their lives for these values, these truths that we hold as being “self-evident”. These are people who have studied *and lived* history. There are veterans amongst them as well.

Many of the baby boomer clients I see – in their 60’s and 70’s – are also afraid and worried. They tend, in general, to still be busy, though, with working, watching grandkids, traveling, hobbies and other distractions which take up much of their contemplative time. It is the older generation I find that is expressing the most grave and deep concern about our country.

Others may say “it was ever thus”, i.e. that older generations worry about younger generations. Although my older clients did report concern about issues during the previous administration, they are much more worried at this point.

Shouldn’t we be listening to our elders more? They remember the autocratic regimes of Hitler, Stalin, Mussolini and others. They remember the warning signs, the lead-up to widespread wars. They are heartened that Dan Rather, Carl Bernstein, many historians and people who served during the Watergate hearings are being brought out to educate and remind about those times, and to share their experiences and perspectives. Much more of that is needed.

 

Solutions to The Problem That Has No Name

Nancy-Rhine-Gerontologist-CounselorHere are, as promised, some tools that boomers are using to help keep their spirits afloat as they navigate the transition from their 60’s into their 70’s. They are simple and we mostly know about them. Putting them into regular practice is the key towards feeling better.

  • Mindfulness, contemplation and loving kindness practices

Sitting still and paying attention. Daily. That is the gist of mindfulness practice. It doesn’t have to be for a set length of time. One minute is fine. What tends to happen is that if you can stop the momentum treadmill of everyday life even for a moment by stopping, sitting up with good posture and paying attention to your breath for one minute, you might find yourself sitting for more than one minute. The hardest thing is simply to make the effort to stop. This can be pulling over on the side of the road, in a parking lot, in your office, at your home, wherever. The word for mindfulness in an Japanese is also the word for heartfulness. This is where loving kindness practice comes in. Sitting quietly with awake presence includes paying attention to our feelings and not judging them. Letting them be, and pass by. This is a big long topic but keeping it simple, it’s about being kind towards yourself before you can begin to be truly kind to others. Repeating the simple Metta Loving Kindness mantras can be a place to start: “May I be safe, May I be happy, May I be healthy, May my heart be filled with loving kindess.”

  • Exercise – aerobic; Yoga

Frank on his bicycleExercise is key, we all know that. Again, even a few minutes can make a big difference both in physical health and in mental health too. A short walk around the block. A few minutes on a stationary bike. Dancing to some music on the radio. A Youtube gentle yoga video to help build muscle but also to stretch your muscles out. Most people find the most challenging part of this is getting started. So, starting by just committing to 5 or 10 minutes a day is a great way to get yourself going. Don’t start with too much of a commitment so that you give up!

  • Understanding the link between nutrition and mental health

More and more research is coming out about the links between good nutrition and good mental health. We are what we eat, it’s true. So many of the neurotransmitters that govern our moods are produced in the “gut”. Paying attention to what we eat – backing down the processed carbs and the white sugar is paramount to good health. Complex carbs, protein, vegetables and fruit. Simple. Fortunately we live in a day and age when good quality organic foods are available. Counting calories is an important thing to watch too. You can eat good quality foods but eat too much of them. Paying attention to your weight and aiming for a strong body are things many of our grandparents and parents knew. We need to pay attention to them too as we get older.

  • Giving back to your community; volunteering

Mom and daughter turning forwardIt’s not a surprise that helping others makes us feel good. People that survey volunteers at various causes always say that people report that they feel better than the people they help! As we get older and probably are retiring when we can :), people sometimes feel like now what? Traveling and doing hobbies and socializing are great – but so is having purpose and helping out our friends, family and community.

  • Consciousness raising support groups

Since we are talking about a “problem that has no name”, being in a supportive peer group where we can compare notes, commiserate, exchange ideas, and yes, laugh!, can be sooo healing. There are meditation groups where people have discussions afterwards, support groups for caregivers, church/temple groups, groups that have to do with aging such as AgeSong in the Bay Area, and more. Many agencies that serve older people offer groups of various kinds, as do community centers. You might have to try one or two before you find one that feels just right.

  • Nature – renewing a commitment to spending time outdoors

path through woods purple flowersThere is a term in Japanese that translates as “forest bathing”. It turns out that trees release not only oxygen but also chemicals that contribute to the overall health of the forest. And, it turns out, these chemicals are very good for us humans! So, try to get out in nature, in the forest, or on the mountain, or by the ocean or river, or in the park. Anywhere where you can “forest bath” – meaning to simply stop and immerse yourself in the beauty of natural surroundings.

  • Counseling

Going to see a therapist who understands the journey of being in middle age and older years can be so healing and supportive. Any therapist might be helpful but particularly someone who understands that the challenges and opportunities and transitions we encounter in this adventure of growing older – can be very helpful in terms of you being able to understand what is common and normal in this part of your life. Understanding that you are not alone – you’re not doing something wrong most of the time – can feel like an unburdening. Yes you still have to figure things out and there are challenges. But the self-criticism, self-blame, and shaming can be *greatly* reduced with the power of a little education about what are called the “developmental tasks” of this age and the common landmarks of this territory. Plus, of course, learning about the many ways people like you are successfully dealing with a variety of issues is a huge help.

  • Using the Arts to reconnect with Self

Re-exploring one’s love of the Arts can be so healing at this time in your life. Reading, writing, journaling, reading and writing poetry, playing a beloved instrument, learning how to play an instrument for the first time, taking a balance stones and lakeclass, learning to dance, going to art exhibits, singing in a group, going to concerts, enjoying doing crafts, arranging flowers… – all of these feed the soul and, now that you may have more time on your hands, are a good way to relax and keep your mind engaged in beauty rather than on problems. Winston Churchill, for instance, suffered greatly from depression – what he called the Black Dog. Painting, for him, was a tremendously helpful therapy.

Please feel free to email me if you have questions or comment below.

 

The Problem That Has No Name – Part 1

lost confused direction signThe Problem That Has No Name – Part 1

This post is Part 1 of a series I’m writing about a phenomenon I notice in my work with midlife and older individuals and families as a mental health counselor. In this part, I’ll describe this surprisingly common situation and in Part II I’ll talk about some solutions that seem to help people get through it.

Before I get into that, though, I want to say that counseling is my third career. My first involved living in a spiritual community where our goal was to learn and practice skills that could make ours, and others’, lives better. I learned and practiced practical skills such as becoming a licensed EMT, teaching an EMT course on a Mohawk reservation in NY, helping with home births as a doula, providing medic services in a rural clinic, and selling books around the US and Canada including our vegetarian cookbooks and the well-known Spiritual Midwifery.

Later, my activism took a turn and I moved to California to raise my three daughters. There I became involved in creating and managing early online communities (starting at The WELL). What I learned while living in intentional community, I applied to the digital environment working always to provide people information, support ideas and fun. In those years very few women were online. In order to educate women about the potential benefits of what was to become the Internet, I founded the first commercial online service focused on women’s issues and interests: Women.com. We wanted women to be able to have convenient access to tools which could help them with their health, families, relationships, education and jobs.

After many years working in the technology field, I knew it was time for me to do something else. My attention turned towards counseling psychology and graduate school. Working originally with hospice patients, my practice evolved into a passion about learning about aging and empowering people as they go through older life. For the past decade or so, I’ve been focused on serving clients ranging in age from their 50’s up to their mid 90’s.

This “problem that has no name” has to do with a huge identity crisis I am seeing so often in my clients between the approximate ages of 68 to 72 years old. This age range makes up the majority of people who seek out my services. There appears to be a disturbing surge in anxiety and depression in these years. My clients report:  “It came on so suddenly!” “I feel like I am regressing, I never used to be like this!” “I don’t know what the matter is with me!” They typically then experience shame, self-criticism, insecurity and isolation from friends and family. They turn to doctors in hopes that prescription medications can “fix” them.

Why is this such a problematic time of life? Is it the number 70 and what that represents? Quite likely. Is it that people typically think well now I *am* old? My clients ask, “How will I get by?” “Who will take care of me?” “Will I be alone?” “What am I capable of doing and what do I have to or want to let go of?”  “Who am I now?!” One man calls it “How then shall we live?” Another male client says “Is this all there is?” And a 70 year old woman refers to this time as the “What’s it All About, Alfie” years.

For the first time in human history, people are living this long. Science has helped extend the quantity of life. However, we have been slower to catch up the issues of the quality of life. We are encountering a mass phenomenon – people running into the challenges of this transitional state that happens around age 70 – and one of our biggest contributing problems is that we pretty much have no language in our culture to describe it! It is “the problem that has no name”.

Betty Friedan coined this expression when she wrote about of the challenges facing women in the 1950’s and early 1960’s in her 1963 book The Feminine Mystique.  She explored and exposed the widespread depression and anxiety in women who, post WWII, were pressured by the culture and consumerism to try to fit into a fabricated feminine image which offered them sole identities as housewives and mothers.  With narrowed choices about work and roles, women became massively disillusioned, unhappy and self-critical. Then came what is called the 2nd wave of feminism which gave language to this phenomenon.

Similarly, today we are largely ignorant and seemingly uncaring as a consumer culture about the pressures and narrowing options available to us as we grow older. Negative stereotyping, messages about not being valued and feeling invisible is widespread. The result is a huge wave of disenfranchised, oppressed, aging individuals who are unaware of this bigger picture. Rather than understanding the ageist backdrop affecting their lives and moods, they fall into self-criticism, fear and depression.

The good news is that there is a groundswell happening in its early stages that is beginning to illuminate this 21st century problem. Because this is the first time in human history that we are living so long, as one of my clients put it “we (humans) haven’t had a chance to study it yet”. However, there are more and more activists who have been or are forging ahead.  Robert Butler, MD was one of the pioneers – he coined the word “ageism” and won the 1975 Pulitzer Prize for his expose Why Survive: Being Old in America. New York Times author Paula Span educates us regularly in her insightful column “The New Old Age”. Ashton Applewhite has a no-holds-barred bestselling book This Chair Rocks: A Manifesto against Ageism. And Dr. Bill Thomas, MD regularly travels the country to shake things up with his “Age of Disruption” tour.  People are beginning to wake up to the harm that perhaps the last “ism” – ageism – is causing in America. Naming it can only help.

In Part 2 of this article, I will describe some tools and ways I’m seeing people use to navigate the transitional passage from their mid to late sixties to early 70’s. Some of them include:

  • Mindfulness, contemplation and loving kindness practices
  • Exercise – aerobic; Yoga
  • Understanding the link between nutrition and mental health
  • Giving back to their communities; volunteering
  • Consciousness raising support groups
  • Nature – renewing their commitment to spending time outdoors
  • Examining and redefining roles
  • Counseling
  • Using the Arts, including journaling to reconnect with Self

happy-womanExcellent article from Business Insider on techniques for helping with happiness: practicing gratitude, labeling emotions particularly negative ones to diffuse them, making “good enough” decisions rather than stressing over perfection, and incorporating loving touch into our daily lives. The author, Alex Korb, of a new book called The Upward Spiral is a neuroscientist who cites the research and talks about what parts of our brains respond to these various practices. Also talks about how guilt and shame activate the brain’s reward center but of course are not good long-term habits.

Here’s an intriguing quote from his book:

Despite their differences, pride, shame, and guilt all activate similar neural circuits, including the dorsomedial prefrontal cortex, amygdala, insula, and the nucleus accumbens. Interestingly, pride is the most powerful of these emotions at triggering activity in these regions — except in the nucleus accumbens, where guilt and shame win out. This explains why it can be so appealing to heap guilt and shame on ourselves — they’re activating the brain’s reward center.

Here’s the link to the article called “A Neuroscience Researcher Reveals 4 Rituals That Will Make You Happier“.

Not Enough Geriatricians or Geriatric Psychotherapists Either

One of our old friends Katie Hafner just wrote an important article for the NY Times entitled “As Population Ages, Where Are the Geriatricians?”. Katie eloquently explains the situation which is that this country is woefully underserved when it comes to doctors who understand the myriad complexity of symptoms that older people encounter. Docs are under-reimbursed by Medicare and so many choose not to go into this field. Others find it too complicated, too difficult, maybe too sad for them. At any rate, treating older people is NOT the same as treating younger people – whether it involves the medical field or the mental health field! Here’s a top-notch quote from Katie’s article that speaks to that fact:

Dr. Eckstrom was a general internist who practiced in primary care for nine years before returning to Oregon Health and Science University to complete a geriatrics fellowship. “I thought I was doing a good job caring for my patients,” she said. “But I wanted to do more geriatrics teaching and research.” The fellowship opened her eyes. “I had no idea what I didn’t know,” she said.

I hope there will be more articles and education for the public about this critical lack of informed care for the rapidly growing aging population. Someone commented that the government should increase Medicare reimbursement rates for doctors – and I think for mental health professionals too – to encourage more people to go into this field. Someone even suggested the government should pay the student debt for medical students going into geriatrics. We have to do something!

Bringing Balance into Our Lives as We Grow Older

balance stones and lakeAs we get older, we are exposed to increasing loss and stressors. These can be deaths of loved ones and family members. Sometimes it’s illness, it may be chronic pain. Or watching people we care about encounter difficulties and running into more problems ourselves.

Joan Erikson, the renowned psychologist and wife of psychologist Eric Erikson, talked about needing to let go of things as we climb up the hill of getting older. Old habits, old concerns, old worries, old ways of being – we have to start looking at those and discarding those that have become too heavy to continue to carry. She said:

“Everybody says it’s a good idea to lighten your load. It’s like walking up a hill. And then you realize that the load that you’re carrying is not worth the trouble, it’s not worth the strength that it takes to keep it with you. And you begin to just gladly drop this bit here and this bit here and be freer to get up that steep hill.”

This “purging” effect as one of my therapist friends calls it, involves letting go of a range of things. It can be not eating as much and therefore extra weight. It can be possessions which we have accumulated and carried around with us in our homes. Those possessions which seem to multiply by themselves and we look around finding ourselves surrounded by too many things. Time to let go!older man backpacking

Sometimes it’s relationships we are looking at and letting go of. Old friends who were wonderful in one season of our lives may not feel nurturing or right anymore. This is not a blame and shame process. This is normal. Friends, colleagues and associates come and go. “Culling” and honing and winnowing are all practical terms having to do with earth and sometimes farming. They are good metaphors for how we are gardening through our lives.

To extend the metaphor, plants need room to grow and thrive. If they, or we, are too crowded, our growth is stymied. How much room we need as individual humans is a very personal journey and decision. It may differ at various times of our lives because numbers of relationships, too, have seasons.

A coping mechanism mentioned by many mental health practitioners and mindfulness teachers is bringing more of our attention to positive things in our lives. Big things, but also the small little day to day, hour to hour, minute to minute things that delight us. And by delight, I mean that bring light into our hearts. It might the sight of a beloved child, pet, the smell of a sweet sweet rose, the taste of something delicious, the feel of the warm sun on our face, the rays of sunshine filtering down through tall trees, the sound of the ocean, etc.

Those enjoyments can help bring us balance in and of themselves, and *especially* so when we pause and savor them for more than a second. In fact, brain research has shown that it takes the brain at least *10 seconds* to take a momentary experience and be able to register it into memory. 20 or 30 seconds is better.

So, for starters, a simple thing to do to move towards balance is to take the time to notice positive experiences in our lives, note them with all of our senses where possible, and stay with them for a few seconds. A regular practice of this will attune our brain to noticing more of these experiences and help bring balance into our perspectives and lives. Simple and powerful at the same time.

A New Year & A New Perspective

 

Nancy009-colorA New Year & A New Perspective

Dear friends and colleagues in the healing arts,

2015 presented me with some interesting challenges. After the death of my beloved mother and the near death and continued illness of my husband, I wondered how we healers can continue to serve our patients when we ourselves are in the midst of tough times. Maybe some of you have come up against this question too.

What I discovered is, as songwriter Leonard Cohen writes, “The birds they sang at the break of day. Start again I heard them say. Don’t dwell on what has passed away or what is yet to be. Ring the bells that still can ring. Forget your perfect offering. There is a crack in everything. That’s how the light gets in.”

It’s this last part that has surprised me. What an unexpected gift is the grace and light that can emerge out of adversity. What I am learned continually deepens both my work and my home life.

As we get older, we find ourselves adding to our toolkit of life skills. Mindfulness tools have reentered my life and work in a big way. And so has my intention to reach a much wider audience through teaching nationally about conscious aging.  The need and demand for navigation help is so great as the boomer generation enters the unfamiliar terrain of older life.lost confused direction sign

If you have friends, family or patients in these populations below who you think I might be able to help or if you have questions yourself, please feel free to reach out anytime:

  • People in their 50’s, 60’s and 70’s waking up to their own sense of aging – often through illness or other changes in themselves or their loved ones. They seek answers, solutions, and guidance.
  • Adult children of aging parents who feel confounded and frustrated about how to best help their parents through a myriad of difficult circumstances. They are the sandwich generation with aging parents, children and often grandchildren too.
  • Families where adult children and aging parents need to and want to come to some new understandings and find a closeness now to the extent they can while they can still can.
  • People in their 80’s and early 90’s who are facing their last years with all that that entails – memories, regrets, fears, peace and contemplation – all healthy parts of this stage of life. Having a genuinely caring nonjudgmental skilled listener is so valuable.

You might already know that there are very few psychotherapists in Marin who have advance training in gerontology. With my expertise in the fields of aging, communication, business, medicine and psychology, I am uniquely qualified to help your midlife and older patients, friends and family.

My offices are in Mill Valley and San Anselmo. Telephone appointments are also available for people who do not live close by.  I provide a free initial phone consultation. And if I can’t help, I can often steer people to other beneficial resources.

With warm wishes for a peaceful 2016,

Nancy Rhine, MS, LMFT, CPG

415-378-6577

nrhine@gmail.com

Starting with the Traditional (in housing)

Before I start to take a look at and write about the myriad of creative housing solutions that are cropping up these Pew chart number of multigenerational housedholdsdays for boomers and older people, I thought I’d give a brief nod to the traditions that have come before these modern days. The oldest traditional housing for older people is probably: living with family. And, now, the number of multigenerational families is on the rise again.

More and more people will be faced with that choice or are already living that scenario today because a) they want to do that, and/or b) the elders do not have the money to be able to afford live in their own homes and/or pay for their own in-home caregivers or live in residential assisted living locations. This choice is not without drawbacks. Sometimes older people are lonely living with adult children who are working and grandchildren who are away at school and with friends all the time. Sometimes the generations do not get along well. Older people can also feel they have no privacy in this setting or sometimes they feel like they do not want to be a burden to their adult children.

Nonetheless, this has been the way for centuries or millenia for older people and it’s a scenario that is coming back.

Del Webb Sun City signIn the interim, things took a different turn in the late 1950’s with Del Webb and his construction and promotion of the Sun City retirement community. With Del’s photo on the cover of Time magazine in 1962, there was an accompanying explosion of growth of these kinds of communities across the country in the decades to come. For the past half a century, his model of aging has essentially been the plan for millions middle class seniors. That is that they would retire at age 65 and move into one  of these kinds of retirement communities: independent living apartments, planned communities with a variety of housing choices for seniors 55 and older, assisted living facilities, and eventually skilled nursing facilities.

When faced with these choices and there is plenty of time, people can leisurely explore alternatives. When, however, as people are doing more these days, they stay living in their own homes longer and then there is a crisis which precipitates a move to an assisted living or board and care type situation, how do they, or often their adult children, find out information about alternatives and options?

One assisted living social worker who had worked for 28 years at a local retirement community told me the average move-in date when she first started at been about 75 years old. By the time she retired, the average move-in date was more like 85. People are staying longer in their own homes.

Back to the answer of where to find answers regarding options when living independently is no longer viable. Most counties have what’s called a triple A or Area Agency on Aging. They are often a good place to start for education about senior housing options. They often have published booklets describing housing resources in their county. And they can direct you to more print listings. The problem with print resources is that they become out of date quiet quickly in the shifting terrain of senior services.

You can go online and search in your county, too. You can look for reviews. You can then call the places that look good to you, weed out the ones you don’t like and make appointments to go visit the ones you think look appropriate.

Lucille's List logoIn my county – Marin County – north of San Francisco, I like a web service/site called Lucille’s List . The two women who founded this service did so because they had had such a hard time finding good assisted living homes for their aging mother and grandmother. You can search Lucille’s List by a variety of search criteria. And the information tends to be more up to date. They have a matching service where you can type in location, the kinds of services you’re looking for, a price range, etc and they will give you the results. It’s a useful tool.

Some people turn to a geriatric care manager who typically charges about $150/hour and up to look into your specific housing needs and the solutions available in your area. They may charge an initial set fee for assessment and then a lower ongoing fee to continue to work with you.

Next week, I’ll start to get into alternatives to the living with your kids choice and the moving into a retirement/assisted living community choice.

 

Boomer Shelter – the Zeitgeist is here

gallery_54f0d9d889efa_-_01-millertinyhouse-048-edit1-lgn

The zeitgeist (spirit of the times) is happening. There is a rising up of creativity we can see almost every day in the news. It has to do with the boomer generation coming to terms with how and where we are going to live as we grow old.

Most people I talk to in this age group do not want to move into retirement communities. The idea of moving to Del Webb like settings in the south like their snowbird parents does not sound attractive. They would like to stay independent as much as they can, retaining some control over their privacy and lives. and being part of a warm and friendly community.

multigeneration

Some of aging boomers think about eventually moving in with their adult children – if they have them that is and *if* they have good relations with them and *if* their children have room.

Some people are opting to stay in their own homes and are joining neighborhood support networks where they can both give and receive support as they age. Examples of these networks are the Village movement and Retirement Communities Without Walls RCWW(RCWW’s) which I have written about in earlier blog posts and will revisit.

expat 2Some are exploring moving to different countries as ex-pat’s where the costs of living and medical care are much more affordable than in the US. Some common countries older Americans are moving to are Mexico, Costa Rica and Panama.

Many boomers are revisiting the lifestyle of shared or co-housing – in effect exploring a return to a communal lifestyle we saw in the 60’s but with perhaps with their own bathrooms and kitchens.  😉

Others are looking at the “tiny home” movement. This is not a new idea for humanity. Prior generations did not live in or aspire to the “MacMansions” of today. There are tiny homes on wheels, mobile homes, some that can be pulled up to large screened-in outdoor porches – the ideas run the gamut!

I haven’t seen a central curated site online where there are articles about and links to the exploding number of projects around the world that address the new housing movement. I will be posting those I see here over the coming weeks and months in a series called Boomer Shelter. Feel free to comment and send more.