FEST Writing Group

I will be discussing the decline in functioning one experiences eventually in aging, and how that interacts with one’s conception of self.  Sooner or later an aging person experiences decline of the practical effectiveness of different areas of functioning.  I contend that this necessitates the revision of one’s beliefs about self regarding those areas of functioning which have been affected.

Declines in functioning

I have been aging and I certainly have had declines in functioning in at least six areas.  Car accidents, episodes of short term memory loss, episodes of disorientation, episodes of incontinence, balance problems, declines in muscle strength.

Beginning in 2020, I had three car accidents in four years after having had no accidents prior to these, going back to my beginning as a driver.  The first two were similar.  I made a lane change to the left.  In both cases, I didn’t see the other car coming from behind in that lane to my left.  In thinking through both these accidents, I remembered other recent instances of not seeing something in my peripheral vision.  After having begun brain exercises, I noticed difficulties in spotting objects away from a primary object in a brain exercise. 

I have ended up doing two things.  Making less lane changes, unless absolutely sure there are no cars coming from

 behind.  Second, do the brain exercises that challenged ability to make switches from one object to another.

The third accident.  I was sitting in a line of cars at a stoplight when a dashboard warning light came on.  I began trying to identify and correct the problem.  But in the course of doing that, I apparently lifted my foot off the brake and rolled into the Jeep ahead of me.  My hood was smashed, with no damage to the Jeep.

Rightly or wrongly, I later concluded that I shouldn’t be multitasking while driving.  It doesn’t work if one has a potentially vulnerable brain.

In addition to these car accidents, I had had incidents of loss of short term memories for several years.

These car accidents and the memory loss incidents suggested brain problems of some kind.  This is significant since my mother and her two siblings had gradual onset of Alzheimers’s Disease before dying. 

Incontinence.  I began having urinary incontinence problems 2019-2020.  I was not able to effectively control it.  Neither my PCP nor the internet offered any effective suggestions.  Many people suggested scheduling urination and/or using adult diapers.  Scheduling is a good idea but it doesn’t address the unpredictable losses of control.  Adult diapers is a last resort; it is not an effective remedy.

So, I developed a treatment for it, inspired by my reading about brain plasticity. 

Incontinence is lack of effective control.  I guessed that I might be about to devise a way of learning effective control.  That would require intentional practice of effective control, the same as repeated practice of your tennis serve.

A starting point for that I took to be beginning to practice initiating control of urination.

One way I worked it out is to respond to perceived urgency to urinate with the following.  Stand at the toilet ready to urinate.  Pick a number between 5 and 12.  Then count to that number.  Upon reaching that number, initiate urination.  That is stupidly simple.  Practice initiating urination.  It has worked for me.  In addition, do anything else which would be likely to increase the chances of successful control.

Brain plasticity teaches us that skills you acquire must continue to be practiced, in order to retain the skill.  If you don’t practice them, the skill will become weaker and weaker.  For me, that has been true.  I am committed now to practicing the control of urination for the rest of my life.

There are additional practices one can use, but I will leave it, for now, to repeating practice of controlled urination.  

For other of the declining capacities I have not yet figured out effective remedies.  These include episodic loss of peripheral vision, episodic loss of short term memory, loss of balance episodes, and loss of muscle strength.

For loss of balance and loss of muscle strength, I have used exercises suggested by my physical therapist.  They have improved my balance and muscle strength, but I still have episodes of loss of balance.

For the memory loss and peripheral vision problems, I have used brain exercises from Posit Science and Michael Merzenich.    These also have helped somewhat, but are far from effective solutions.  The brain exercises have helped with attention and focus.

I have named some of the challenges I have experienced.  I am sure there will be more.  It appears to be advantageous to be vigilant about recognizing new challenges and to be active about trying to find responses which will make me more adaptive to the difficulties.  It appears to be beneficial to have an active attitude toward working on them.

This obviously is a work in progress for a life in decline, my little chronic illness.  My current belief is that I can learn to manage this chronic illness better, but I will never recover from it.

The necessary changes in self

I have noticed that these realistic features of decline demand changes in self, specifically beliefs about self.

1.  I noticed that during some of the experiences of decline I didn’t feel like my self.  As I worked on the practical challenges of the decline, I regained my sense of self.

2.  Some of these losses of abilities led me to realize that it was a necessity to revise my beliefs about my self in ways more consistent with current reality.  The driving challenges are a good example.  I had always believed myself a good and skillful driver.  That is no longer true, and perhaps not so true in the past as well.  I am no longer skillful and my bad driving habits have been exposed.  This requires revision of my self beliefs and driving practices.

3.  These changes in the realities of who I am impact my relationship systems and my functioning in those systems.  For example, my relationship with my wife.  She too has had some declines in abilities.  That combined with mine has necessitated changes in long-standing practices in our life together.  These are not easy changes to make, but necessary.

4.  The decline will continue in unpredictable ways.  As a result, I can expect that this will require continuing revision of self.  That is not a posture I familiar with, but it will probably be necessary.

5.  I have concluded that it is preferable to take on these necessary challenges with good spirit.  That good spirit may even help the problem solving and the thinking about new self.  It doesn’t seem to have any benefit to hang on to discouragement about these declines.  Get on with the work of these realistic challenges.

     Declines in competence of one’s functioning eventually become a real part of aging.  Not only does one need to find practical ways of coping with that decline but also one needs to revise beliefs about self that are consistent with the new realities.