Marin Medical Society

Marin Medicine


CURRENT BOOKS: Well Worth the Time

The Wonder of Aging: A New Approach to Embracing Life After Fifty, by Michael Gurian, 336 pages, Atria Books (2013).

I usually try to leave my medical background behind when reading a new book, unless of course the subject is medical in nature. In that situation I often find myself making a quick judgment as to the medical accuracy of the subject being discussed, and whether I think the author is qualified to draw accurate conclusions. If not, I will usually not make it past page 50.

I recently stopped reading a book written about future infectious pandemics. I felt the author, who was not a physician or an epidemiologist, was not writing at a level of medical accuracy and complexity that would expand my knowledge and keep me interested. I did not trust the conclusions that seemed to be made more on conjecture than fact. A book is like wine. Why continue to drink it or in this case read it, if is not worth the invested time?

My initial impression after reading the first few pages of The Wonder of Aging by was not good. Red flag #1: I find it difficult as a physician reader to hear how the author’s physician missed a diagnosis that apparently was obvious to others (we all do wish medicine was easy). Red flag #2: anecdotal dietary recommendations to relieve stress. Put those two, albeit short, sections together, and my mind began to drift to my next book or the football game on TV.

If I had stopped reading The Wonder of Aging at this point, I would have missed out on a profoundly important book. What kept me going? It did catch my attention that the author, Michael Gurian, has been a longtime practicing therapist of some note; that he has now written 27 books; that his mother was a gerontologist who was friends with Dr. Elisabeth Kübler-Ross (who was often at his dinner table); not to mention that I volunteered to review the book for Marin Medicine … all this was reason enough to push on. I’m glad I did.

I would say in retrospect, excuse the bias, that a physician would not have been the best person to write this book, contrary to what I have written above. We are experts in anatomy and physiology, but this book is so much more. In addition to looking at the anatomy and physiology of aging, it includes the interplay of family, work, religion, mental health and cultural values.

The book covers many complex issues of aging in a logical, easily understandable fashion. This is a book that can be enjoyed both by physicians and our patients. As I read the book, I could not help but see my patients, my family and myself being described in a unique fashion, with new insight and analysis of the aging process. It’s good to read that we are becoming “elders” and not just old.

What is the difference between being an elder and being old? An Elder is about being functional, mentoring, working, guiding the younger generation, staying engaged and keeping fit. Our culture does not presently support the routine engagement of elders in our society; it is focused on the young. We’ve been moved to the side, no longer required--we need to change this. Gurian asks us to, “consider becoming more visible as you age. … The world needs you as a person over fifty to guide it and shape it.”

Research shows that there are “blue zones” in the world where people live to great ages. In these regions, the elders are highly valued. They are expected to pass on traditions, teach the young, remain engaged with their community--not move to Phoenix or Boca Raton to live in an isolated retirement community.

One of the main themes of the book, presented in the opening chapters, is that aging can be divided into three distinct stages. Stage 1, the age of transformation, runs from approximately 50 to the mid-60s; Stage 2, the age of distinction, from the mid-60s to the late 70s; Stage 3, the age of spiritual completion, from about 80 to 100 and beyond. I found these divisions to be accurate and helpful in understanding the aging process. As Gurian observes, there will be age differences of 2-3 years for each stage, depending on your true physical and mental age vs. your chronologic age.

In Stage 1, the physiologic effects of andropause and menopause begin. This is a time to finally put to rest your feelings of anxiety and move forward as you transform to an elder. In Stage 2, andropause and menopause come to an end. Gurian writes that this is a time to “feel proud of what we have created, nurtured, and been through in life. … What will matter is not your success but your significance. … This ‘life that matters’ is your legacy.” He also notes that retirement should be “only economic, not spiritual.”

In Stage 3, your legacy is now defined. Completion does not mean “the end or death.” Gurian says it is important to detach from insignificant issues, to bring loved ones close, to reestablish bonds to those estranged, to seek out religion and spirituality if you are so inclined, and to stay active and engaged.

Subsequent chapters analyze “How Men and Women Age Differently,” “The Wisdom of Intimate Separateness,” and “The Amazing Grandparent Brain.” Each chapter is nicely laid out with supporting facts and experiences of the author, his patients, groups he leads, religious figures, research scientists and physicians, each commenting on their research or experiences. I particularly liked the wise commentary of the clergy.

The final chapter is “The Miracle of Dying and Death.” Gurian writes that “there is no right way to die, everyone dies in his or her own way.” He discusses a “better way--not morally better but experientially better.” He covers physician-assisted suicide in Washington State and our right to die as we choose. This section certainly made sense to me. He finishes with a discussion of our fear of abandonment and the anxiety it produces as we approach death.

In summary, I recommend you read this book for yourself and your family and for a better understanding of the aging process of our patients. I have already recommended it to several family members and friends. It will serve many of our patients well to read it themselves. I can see the book being used as a text for a course on aging and as a guide for discussion groups with intimate friends, reviewing together one chapter at a time. This process could establish a group of friends who know intimately how you feel about the last stage of aging and would allow them to be advocates for you if needed.

In retrospect, I am certainly glad I did not put this book down. It was well worth the time to read. I now wonder how many other books I should have finished reading.

Dr. Weitzman, an emergency physician at Marin General Hospital, serves on the MMS Editorial Board.