Ageism, a form of prejudice and discrimination based on age, was originally formulated by the psychiatrist Robert Neil Butler in 1969 to refer specifically to prejudicial attitudes towards older people, old age, and the ageing process; discrimination against older people; and the stereotyping of older people. Nowadays, ageism applies as a general term for prejudices about – and discrimination against – people based on age, so children, adolescents, and young people can feel the brunt of it as well. However, ageism is particularly pronounced among older people and this is why Butler originally devised ageism to refer to discrimination against seniors.
This essay aims to illustrate that fears about ageing and old age are the root cause of ageism towards older people. This has important implications for geriatric psychiatry, which focuses on the mental health of older people.
Fears about ageing and old age are some of the most common and enduring fears that exist. Here, it is useful to introduce the terms gerontophobia (the fear of ageing, the fear of older people, or the fear of age-related self-degeneration) and the related term gerascophobia (the fear of getting old). The main difference between the two terms is that gerontophobia can also include the fear of older people, whereas gerascophobia does not include this; it’s more about the individual’s anxieties about growing old.
Both phobias are considered to be abnormal and irrational, and for this reason, we may determine that the phobias are, indeed, uncommon. I propose, conversely, that these phobias are common, to some degree at least, in the wider culture. I believe that the signs of our phobic attitudes towards ageing and old age are reflected in our cultural attitudes towards older people, which then concretely manifests in terms of our cold and discriminatory treatment of them. I am not here necessarily referring to a phobia as a pathological disorder, but more in the sense of homophobia, whereby we have an irrational fear that leads to discriminatory thinking and behaviour.
To understand the fundamentals of this process taking us from fear to discrimination, we first have to get to the heart of our fears about ageing and old age. What underlies them? There does not appear to be a single basis for these fears, but a multiplicity of anxieties, including the fear of disability, disease, pain, loneliness, dependence, and – perhaps most crucially – death. The reason that the fear of death stands out as a particularly noteworthy fear is that it is one of the ultimate concerns that humans have about life. The recognition of our mortality is one of the most unsettling aspects of life we have to contend with and it is no surprise that it is so strongly associated with our fears of ageing and old age, for both point closer to the finality that we so dread.
Thanatophobia (or death anxiety) is a term commonly used to refer to the fear of death (which may be based on the dread of non-existence or fear of the unknown); but we can also use thanatophobia to signify the fear of the process of dying, and this fear likewise can be triggered by thoughts about ageing and old age, as well as be triggered by the sight of older people. Gerontophobia can include the hatred or fear of older people because they are a reminder of death (memento mori), or a reminder of our inescapable biological vulnerability and degeneration. And these fears form the basis of ageism, whereby we avoid, segregate, and older people, as these attitudes and behaviours act as coping mechanisms, allowing people to avoid confrontations with their mortality. However, while ageism may stave off memento mori, this cultural trend is harmful for two reasons.
First of all, it is the avoidance of the fear of death that feeds it. You cannot avoid the fear forever, as soon the reality of death will make itself known (either through life-threatening situations, the ageing process, or the dying process), and it is better to come to terms with the fear of death before such events take place, otherwise distressing thanatophobia could exist alongside the difficulties associated with ageing and dying. Secondly, and this is more of an obvious point, ageist attitudes based on widespread fears lead to worse outcomes for older people. These outcomes include the isolation that older people experience (through their segregation into care homes and/or the way that family members and the general public avoid them), as well as effects like the abuse of – and hostility towards – older people.
It is easy to explain away such repellent behaviour as the acts of a cruel minority. But we have to keep in mind that the abuse of older people is extremely common, with the World Health Organization (WHO) estimating that 1 in 6 people aged 60 and older experience some type of abuse. Like other forms of discriminatory abuse, ageist abuse is driven by negative attitudes towards the ‘othered’ group in question; and like many forms of hostility towards othered groups, the hostility is based on fear. In this particular case, the fear is underpinned by some of our deepest anxieties about the trajectory of our life.
In Ageism: Stereotyping and Prejudice Against Older Persons (2004), a collection of papers edited by psychologist Todd Nelson, one chapter by the psychologists Jeff Greenberg, Peter Helm, Molly Maxfield, and Jeff Schimel underscores that people protect themselves from “death thought accessibility” by shunning “senior citizen centers, bingo parlors, nursing homes, golf courses, Florida, and Rolling Stones concerts.” The authors of this chapter also conclude “Another way to avoid older adults is to keep them out of the workplace.” And this may be, then, why ageism is so common in the hiring process. Even when older people are highly experienced and well-equipped to work, HR leaders and hiring managers will – often unconsciously – exclude older people from positions.
Tad Friend, in a New Yorker piece on this topic, writes: “Ageism is so hard to root out because it allows us to ward off a paralyzing fact with a pleasing fiction. It lets us fool ourselves, for a time, into believing that we’ll never die.” In his bestseller, The Denial of Death (1973), a book on our innate fear of death and the strategies we use to avoid facing it, Ernest Becker notes: “The irony of man’s condition is that the deepest need is to be free of the anxiety of death and annihilation; but it is life itself which awakens it, and so we must shrink from being fully alive.”
In the context of fears about ageing and old age, then, death anxiety causes us to avoid being fully alive since we restrict life, meaning, and joy to the sphere of youth and pre-senescence, with ageing, old age, and older people being sectioned off as the end of life, the absence of meaning and joy. But in doing so, we may miss out on the positive aspects of ageing, old age, and relationships with older people, and thus we “shrink from being fully alive,” just as Becker says.
In addition, as this discussion has hopefully shown, this ageism prevents older people from being fully alive, as well, as culturally widespread gerontophobia and gerascophobia results in poorer life outcomes for older people, creating lives marked by unnecessary, chronic isolation. All of which makes me wonder how much of the complaints received by geriatric psychiatrists are problems to do with deep cultural and existential issues in society. For instance, social isolation is common among older adults (with nearly one-quarter experiencing it), and we know that isolation increases the risk of mental health issues, such as depression, addiction, anxiety, sleep problems, and suicide.
Then, of course, there’s the mental health impact of real-life discrimination, abuse, and neglect, whether that be from family, the general public, or care home workers. Moreover, we should ask: how much of older people’s distress and low self-esteem is related to an internalised hatred of ageing and old age? I suspect that many geriatric psychiatrists – like psychiatrists in general – are dealing with psychological distress that has social and cultural causes, and without addressing these root causes, the issues will remain.
It’s also a myth that ageism is more of a problem in Western societies than Eastern ones (although it is true that some cultures, not necessarily Eastern ones, do view senior care as the responsibility of the family, rather than the responsibility of the state or paid caretakers). Negative attitudes towards older people exist in all kinds of societies. In a meta-analysis by the academics Michael S. North and Susan T. Fiske, findings show that Eastern societies – surprisingly – have more negative attitudes towards ageing and older people compared to Western societies. The highest levels of negative attitudes exist in East Asia (compared with South and Southeast Asia) and non-Anglophone Europe (compared with North American and Anglophone Western regions).
The prevailing belief, of course, is that collectivist traditions of filial piety lead to more positive attitudes towards older people, but as North and Fiske’s research demonstrates, cultural individualism actually predicts relatively better treatment of older people. The authors argue that the rise of global ageism is not due to modernisation or capitalism but from the increase in older people – and they conclude that “for generating elder respect within rapidly aging societies, collectivist traditions may backfire.”
What we might be seeing then is gerontophobia, gerascophobia, and our obsession with youth coming into conflict with the rapid growth of the world’s older population (a demographic change caused by rising life expectancy – made possible by advances in public health and medicine – and declining fertility rates). We are being confronted with ageing and older people more and more, and thus it should be no surprise if ageism too is on the rise since more exposure to our fears would trigger more feelings of hostility.
So what can be done about the problem of ageism? Greenberg and others suggest a threefold solution: integrating older people into our lives and developing respect for them, increasing self-esteem throughout the culture so we are less afraid of ageing, and calmly accepting the inevitability of death. However, they pessimistically describe these areas of improvement are “pie in the sky, particularly when we think of them at a society-wide or global level of change.”
In some respects, there is realism to such a prediction, as can we honestly expect a global shedding of the fear of death, which is perhaps the oldest, most common, and deepest fear that exists. Yet even if global ageism is likely a pattern that will continue in some shape or form, this does not make individual efforts to combat it worthless. By actively confronting fears about ageing, old age, and death, you can significantly enhance the quality of your life and gain healthier attitudes towards older people, which will improve the quality of their lives as well.