Is Aging a Disease?
Women hunch over an autumnal bacchanal of color in the foreground of Vincent van Gogh’s The Red Vineyards near Arles. It is the harvest season and the leaves on the vines riot in spasms of color and light as a last hurrah before they brown and depart the stems that held them up, that gave them life. To the right, a creek meanders past, reflecting the evanescent glow of the setting sun. A mysterious figure backlit by the evening sky’s luminescence wades in the creek apart from the grape pickers, staring straight out of the painting, ominously responding to our gaze. I cannot help but think that in this vibrant scene of decline the figure must be death manifest, standing in the river of time, waiting for us to transport our aging selves from our august lives to the great beyond.
On the 4th of August, 1977, not far from where Van Gogh painted this landscape, Jean Louise Calment took her final breath. She was 122 years old. When she was younger, she recalled meeting van Gogh during this productive period of his life, but he failed to charm her. She thought he was a rude drunk. She bicycled around Arles until she was 100. She ate two pounds of chocolate a week. When she was 117, she finally gave up cigarettes and her daily glass of port.
What does it mean to age? From the perspective of natural selection, aging begins when we can no longer procreate, but one problem with this definition is that women undergo menopause decades earlier than when a man loses virility, an incongruent gender differential. Thinking of aging as entropic decay that threatens survival is insufficiently utilitarian, failing to account for what a given old person is physically able to do. The ninety year-old who merely has arthritis that limits trips to the grocery store certainly carries a lower functional age than the seventy year-old in a nursing home on a mechanical ventilator for a stroke and on dialysis for kidney failure. A microscopic perspective is simply too myopic and disregards the forest for the trees. We know that a paucity of the DR1 allele is related to a shorter life span. We recognize that cells are susceptible to senescence with impaired cellular integrity, telomere attrition, and DNA degradation amongst the events that precede death, but when do the compendium of these microphenomena reach some threshold wherein we can affirm that an organism is aged enough that death is nearly out of the shadows? And what about the cultural and psychological stakes in calling a person aged? In our society, to call someone aged is to be met with a mix of denial and despondency, but rarely delight. It is a pejorative, a public declaration that you are disposable, that your societal uses have extinguished.
Juvenescence is a newer term to describe the state of being young, but what has prompted us to dichotomize life when aging so often finds itself on a nebulous continuum? Certainly, we all feel the effects of aging as the years pass on, as the joints stiffen and ache, as the visual acuity diminishes, as the mind becomes awash in faulty memory and waning cognition, but why should these normal changes become a disease? It is a fact that our bodies will decay unto death. Yet cells begin their wayward march toward entropy years before this feeling, this sensation that we are aging, sets in. Certainly, the diseases of aging must be investigated, classified and treated. Our current system of treating the elderly relies too much on a whack-a-mole approach, stunting individual diseases as they arise, but not treating the biochemical events that lead to diseases of aging. But the current enthusiasm seems far-fetched, as if thousands of cellular events that precipitate aging can be countered by an elixir we’ve yet to discover.
My reluctance stems from my fear that embracing the idea of pathologizing aging has a lot to do with commodifying a process that is natural. What are we if we don’t decay and die, like every other thing in the universe? There’s enough death denialism in the culture as it stands. Imagine how bad it will be when at the age of 140, your doctor promises yet another 5 years of life with the latest slurry of pharmaceuticals.
Van Gogh never saw a long life like Jean Calment. He never witnessed the wonder the world would feel upon viewing his creations. The Red Vineyards near Arles was the only painting he ever sold in his lifetime. The piece is such a wonderful contemplation of that last hour of the day in that season of harvest, just before the death bell knells, that beauteous moment when our lived life is behind us to celebrate and reflect upon, a moment of programmed acquiescence, an undeniable tryst that finds us all.