Search for mental health; Old age psychiatry

The Forest Hospital located in displaying the Illinois presents the search for mental health and exploration of the newest advances in psychiatry during this series physicians and other professional personnel are working in the area of mental health at Forest Hospital. A hundred bed Creek main facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental help. Your host for this series is Mr. Morris Squire administrator of Forest Hospital this is Morris Squire the American Psychiatric Association convention in Atlantic City New Jersey. Our. Special guest for today is Dr. Maurice the Linden who was an active psychiatrist in his own area. He's been so active he's

got about 4000 things going from among these However the most important. He's an assistant professor in the partner of psychiatry at the University of Pennsylvania School of Medicine and director of the division of mental health and Department of Public Health in the city of Philadelphia. And except when except for an exception Dr. Lynn then you've had lots of interest among these have been the aging This has been a this is how I know you really from your long time investments with the older person and how he gets along in society and what we can do to help him and within this. It was not a fight. Mario I've been in the field of psychiatric gerontology or geriatric psychiatry for over 17 years and a long time. Where are the aging today. I suspect I know there are more of them. Do they have more problems or are they just more people. Well both are true. I think that probably for the entire United

States at the present time pretty close to 10 percent of the total population would be in the category of 65 years of age and over. But some areas of the country as for example New England and parts of Pennsylvania the farming areas like the Midwest and they farm Midwest such as Iowa Nebraska and so on there's a greater preponderance of older people in some places as high as 12 to 14 percent of the local community. And of course. Population is aging which means that more people reach the later years than ever before in our history. And with that absolute increase of population there are simply more older people. Today they are approaching 20 million or over 19 million 20 million people who are over 65 65 and over. And I suspect the next few years half of our. Population will be under 25. So we have a very small group within the middle. Yes

the middle of the middle years and nobody's paying attention to it. Strange right. By 1975 we estimate they'll be about 23 to 24 million people 65 years of age and over. That's tremendous when you realize that the total population the United States was barely that a short time before the Civil War. We have. An ever increasing population. I know where we're going with this population explosion I know where we're going to see them all are housed in a mall or whatever have a lot of grass left for us to look at except in an enclosed so Lariam. Well when you travel of the United States you find there's an awful lot of room is there because people have to they will. And I think the ground can support us and we develop new techniques. I don't think that the principle of Malthus the so-called moth Lucianne law will apply until mankind almost crowds itself off the world. But there are areas that are of the world where the problem of aging and the problem of longevity

is a very great one as for example in China where I understand these are actually unofficial terms that they say on official statistics that they total number of people there is between 800 million and a billion. And at the present time yeah they speak of 600 million that facts seem to indicate that there are over 800 million and moving toward a billion I think productive in their society. Are they retired like our people are older people now. In China. Yes I think retirement is still relatively unknown among older people in China nursing homes were never known in China as far as I know even today. The placement of older people aged persons in mental institutions was not only not down it was unheard of it was unthinkable among the Chinese buys the pirate leads to the communist revolution. There has been some antipathy on the part of younger generations in the Orient against the older

generations which has created new problems. But we don't know what's going on there. Still there was an aspect of Oriental aging aging in the Orient that we could well and relate I think in our country which is the giving of respect to older people for no reason other than that that they are older people. Giving out an individual's status in the course of his growing up giving him a feeling of prestige Maybe because he's a senior citizen. We speak of these terms in this country rather glibly but I don't believe that anybody takes any of it seriously and as a consequence a lot of people in the United States not all by any means but I have very great proportion feel left out of the mainstream of living. I feel somewhat as we say culturally discarded and rejected. And even if the culture doesn't really actually discard them the feeling that they are discarded is in itself a psychological catastrophe. And many of them develop a rather serious psychological problem starting

with mental depressions which because they tend on the whole not to be treated move on to much more serious. Emotional distortions and complicated aging. And what a large number. Now what do you think about work for older people. You mean doing the job that they've always been accustomed to doing that are different. Well there is a nother fight in today and I'm sure in all your programs Maher you've had so many non-psychiatric physicians who pointed out how people retain their health as they grow older. And it is absolutely true that the older person today is biologic healthy person by which I mean that individual of 60 to 70. In our country today is not a person who has a lot of diseases or needs an awful lot of medical attention. He tends to be as healthy as people in the 40 to 60 range. By and large the real problems occur somewhat later. As a consequence people in their

seventh decade of life from 60 to 70 are very able to not only continue to work in their accustomed activities but to play and enjoy life and do things that younger people were accustomed to in the past. Now this of course brings up new problems because retirement practices in many industries and businesses. I stove stand and do in fact some people who could go on working but have to stop really. Why are we pushing then and I Society for retirement at 65. Why do we bring Medicare to bear 65. What drives us to believe that we have to retire people before they are ready for it. While there are lots of reasons for this. The fact of the matter is that despite more people reaching old age the length of human life is not changed materially since the dawn of mankind as far as I know. We're just now at a place where the average person can expect to live to

somewhere between 70 and 72 years of age. That is at the moment of his birth he can expect to reach 70. The longer we live the longer we may expect to have. That's the threescore and ten of a history that simply does mean then that retirement at 65 for the average individual will give him rather a few short years of fun as they are coming into the problems of seniority when he can reap the benefits of a life of work so that it's not so unreasonable. The real problem I think is that if people don't want to retire when they still want to have a good income and enjoy the fruit of such an income so that. The practice of retirement which was introduced in our country in about nineteen thirty four with the advent of social security and during the Roosevelt administration when retirement was necessary in order to make jobs for younger people. The advent of retirement into our society has become an institution which is sometimes.

An equitable and its effect on people. However the alternative is really much worse if you stop think about it. Suppose that a person was allowed to work until he was no longer able to work. Which is what most people ask for. The problem then is who is going to determine whether he's no longer able to work. He cannot decide that for himself in most instances so that the determination will come from somebody who's supervising him and the moment when he's tapped and told he cannot longer work is really a death knell for such a person being told that he is really too decrepit to want scaled or is deteriorating. Not to tell him the same thing at 65. No because at that time he still has the ability to get angry about it and the anger will support him. It's an emotional source of sustenance for him to feel he could be doing a job he isn't doing rather than to feel that he can no longer do a job he wishes he could do as I say so I in Europe ain psychiatrically it's appropriate to retire everybody at 65. Let's put it this way it's

not inappropriate. None of these sensors is really good. There's always some people get hurt by them. And what we find is that on the whole social practices are not so terribly unreasonable. The real problem is getting people to prepare for their own retirement so that when they start work let's say in the 20s they're looking ahead to a realistic moment. Some 40 years hence when they really will retire and have to move toward that and look at it with preparation beforehand I can I do that but I don't believe it. That's the first thing I want to say. Number two is what kinds of things I would prefer writing for people over 65 What do they do with themselves. Well that's still a great problem and I think there are two aspects of that one is what should society do in terms of its agencies its government its voluntary systems and watching the individual for himself and I think both are at fault probably because the tremendous number of older people have appeared on the scene almost suddenly in

the last few decades. We haven't prepared for them as a culture we haven't prepared. And also because they use psychological mechanisms of defense as we speak of them in psychiatry younger people tend to deny the realities of their own aging. Most people don't feel that they're aging as they age or even old people don't feel old. Then one of my greatest insights into the process of aging to discover that people in their 80s 90s and even into the hundreds. Do not feel old when you ask them what does it feel like to be a lie. What's this then I have ageing because I think most of aging is a physical thing. Most of it has to do with a change of joints in the joints raw thread of changes or heart changes the skin gets unsupported by connective tissue they flush and fullness and bloom of youth is gone and the only person these are physical changes eyesight diminishes hearing diminishes. I don't

mastication by teeth is not. And the longer real good and digestion is bad and so on. These are very physical things that are very real but the feeling of growing older almost doesn't take place because an individual's sense of himself who he is doesn't change. I'm always myself from the fans. First derive a consciousness and all through life. And that doesn't seem to age. You know I have the same appetites the same interests same lobs and so on there are some things I think that could be called a psychological concomitants of aging a feeling of increased responsibility obligation a feeling of increased seriousness of purpose a certain sense of sobriety and a dim admonition in the last days I think are characteristic of aging. Aside from that every person is the same as he always was. He never changes his own conception of who he is slightly but not

very great and I think as a consequence older people can be treated like anybody. If the therapist understands these things not to learn and use. I applied to the term adult health and recreation center What does this mean. Of course we have one in operation city of Philadelphia so I'm not just talking from theory. However I think that you're well acquainted with the. Older Americans Act which has several titles making a lot of programs and facilities. Reality is in the very near future one of those titles is in respect to the development of comprehensive geriatric centers which really means that we plan in all communities rural suburb and urban communities to develop centers and they can actually be a center in terms of a building containing many things or a group of services that are related in that sense. All of these areas are services that will relate to the needs of an aging population. Because we have not planned for a lot of

people we plan for children. We build schools we build playgrounds we do a lot for youngsters and they need it and they deserve it. But we've forgotten the aged. But now we are not forgetting the aged and progressive they were going to have such things as places where people in retirement can go to spend a profitable day where they can re socialize with friends where they can have activities that will serve as a bulwark against the stagnation that otherwise occurs where they can get therapy if they need it of any kind of physical or psychological where they can obtain medical care of all kinds in the sense of health maintenance where they can be useful they can be part of their own government. And when they have a place that they can call their own that they're members of a kind of a club so to speak. These are but it's also not a lot to me so it's nice to pull away what looks like the physical aspects. The health part of it. The dentistry and the food and

all that. Let's just go to what he's going to do with his time. Right well he can indulge a hobby or develop a hobby full time if he wishes. And in our center in operation in Philadelphia which is by no means the only place in the country that has such a nice person can come in at 9:00 in the morning and indulge many interests many activities many hobbies. So we have the shops while those purposes that we don't have them to you know bring them over you get them in time and they can spend seven or eight hours a day every day five days a week just as you know he went to his factory and we had been before and since then to take his weekend off as it were. Very profitable activities. He spent a full day if you wishes. He didn't come any part of any day any part of the week or all week and any number of times during the month himself. This takes the place of work or a place to go really. Yes. And really is very popular. This one center I'm talking

about one of five centers we have in say Philadelphia each under different auspices. This one center which opened in November 1950 eight now has well on to twelve hundred members. Tremendous. It's really an enormous organization they pay to come to the center. No no this is tax city tax supported city tax operates under my division of mental health under the Department of Public Health in the city because it cost a lot of money to run. Oh yes. Not a lot of money actually. It's probably one of the least expensive preventive services we have in any community and I think that the unit contact is for any particular activity the unit contact with one of our members is less than two dollars. It's very inexpensive. Course taken all together it amounts to many thousands of dollars. It was well worth it because we keep these people as community effectives. They don't require institutional care. I have always had the idea and this may be appealing to you that a manager retire at

40 and go back to work at you know at 55. It's an interesting idea. I suppose that's based on the notion that when a man is younger and able to retire he's also able to and enjoy more of the indulging of his fantasies such as boating or fishing or whatever he wants or what I would like to do. He could climb a mountain there and he could really boat and I could really water ski he could really go scuba diving. Or he could travel the world. If there is leisure time available why I had to work very hard at the beginning and work hard at the end. But in the Middle East have the enjoyment of having been on this earth with some sort of you know real time real bunch of time to develop some other kinds of interest. It would be different and work activities if work is not pleasing for itself or even of work is pleasing for itself. If we're planning for retirement at 65 why not plan for it at 40 and come back to work at 55.

Well that's not a bad idea really more except that I think that a prolonged chunk of time away from personal development in a certain sphere. Leads an individual to stagnation and regression in that sphere it wouldn't be a good worker at 55. He would not be a good worker if he had been away from it that long he wouldn't be a good scholar. I've been away from that for that long. Instead I think what we have to have is a balance of interests all through life. I think that a man should be able to retire from his work at five o'clock and he's retired until he goes back to to work at 8:30 the next morning or whatever time and I when he's away from his work he's got to be a different individual not to carry the cares the stresses the worries and so on with and this is the hardest lesson. Yeah because I think you don't really find things to do most people. This is the problem this is where we get to the psychiatrist. That's where a lot of our problems arise. You go to work takes an hour you're working eight hours you come back for an hour. You have your separate and then whacked.

I think we work too long. I think good our days too long. Well then you work a six hour day and you go to work. You work six hours you come back an hour you have supper and then what. Well I believe for example in the pre-dinner cocktail which sort of draws a curtain on the day and opens up the beginning of the evening. And then there are many things. There are concerts one can go to their books to read to children to talk to. Shows to attend school activities and PTA not only that today travel time is so quick to go to such places as resort areas near cities and you can actually go to your mom home for an evening. If you want to sit around a long while we were talking about you not talking about the average American since that is the average American citizen is a suburbanite when he used to work in this in the urban area. He'd take a half an hour to get to work and he'd work his eight hour day and half hour get back and he could have summer. Some of this family could probably afford the apartment but he lives in suburbia now. It

takes an hour to get to work. He works not only 8 hours but he may have two jobs and if he has only one job and I work 10 hours then he gets home takes another hour during heavy traffic time. If he's like you have to have supper with his family that's fine if not then he's exhausted by that time. He doesn't have time to recreate and who's going to recreate with. And if he does recreate it's not with his family. Well more I really think the fault lies not so much with the system but with the attitudes of people toward themselves. His expectations of themselves as a person you're describing as average citizen. All wrong. I think that he simply cannot relax. He's unable to relax. People are not to relax on a state of recreation even when they're working. But isn't this isn't what I'm describing more prevalent than what you're describing. Yes but you're describing a reality that should be changed. Well how are you going to change a doctor in the direction that I've just been talking about where the person draws a veil on the day. For example how I learned how to relax by a discovery of his inner

tensions and getting rid of those so that no matter what he's doing he's either in a state of living or you teaching mental health this way. Part of it I should say so how how can you teach this to people. It was not too easy. For example most of our mental health programs are one shot contacts with people you know give a lecture. You have got to be able to come back time after time to the same group and have a kind of a group therapeutic atmosphere in which the principles of mental hygiene are not only considered but felt and experienced by people then I think it can have an effect on people. They can change their way of life by virtue of what they've learned. Well you spend 17 years paying attention to older people you've got something going for them. We spent a whole lifetime paying attention to children that something going for them. What are you as a director in the nation of mental health and Department of Public Health and I see it so def you going to do about this population the working population about making their life

more meaningful. Well that's what we're doing as much as we as is humanly possible in primetime. One of the things that first needs to be done is being done is to isolate and identify that they are they up setting factors in a community a way of life today. So the once we know what those are and we begin to have some ideas how to counteract them. We do know what some of those factors are we know for example a vast group of underprivileged people. The absence of a significant father in the home is important. Now there are ways of coming back into this group of people and through teaching devices and learning devices on their part and experiencing trying to restore leadership in the male in the home in that group. That's one way. Well I think we can very well end with that thought. I'm very trying to store to our community in a positive way of life through mental health. We want to thank you very much Dr. Murray's Linden. A practicing psychiatrist and the assistant

professor of department of psychiatry University of Pennsylvania School of Medicine and director of the division of Mental Health Department of Public Health in the city of Philadelphia and I'm Laura Squire. You have just heard another in the series the search for a mental health produced by Forest Hospital in displaying zeal and I mean cooperation with this station during this series. The citizens and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed treatment facility. Well discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior marital problems problems of the aged and others will be presented on the search for mental health. Your host for the series Mr. Morris Squire administrator of Forrest hospital the search for mental health is produced and directed by Jack regarding this

program was distributed by national educational radio. This is the national educational radio network.