Molly was 88 years old and in good health. She had outlived two husbands, her siblings, most of her friends and her only son.
“I don’t have any meaningful relationships left, dear,” she told me. “They’ve all died. And you know what? Underneath it all, I want to leave this world too.” Leaning a little closer, as though she was telling me a secret, she continued:
Shall I tell you what I am? I’m strong. I can admit to myself and to you that there’s nothing left for me here. I’m more than ready to leave when it’s my time. In fact, it can’t come quickly enough.
I’ve interviewed many older people for research. Every so often, I’m struck by the sincerity with which some people feel that their life is completed. They seem tired of being alive.
I’m a member of of the European Understanding Tiredness of Life in Older People Research Network, a group of geriatricians, psychiatrists, social scientists, psychologists and death scholars. We want to better understand the phenomenon and unpick what is unique about it. The network is also working on advice for politicians and healthcare practices, as well as caregiver and patient support.
Professor of care ethics Els van Wijngaarden and colleagues in the Netherlands listened to a group of older people who were not seriously ill, yet felt a yearning to end their lives. The key issues they identified in such people were: aching loneliness, pain associated with not mattering, struggles with self-expression, existential tiredness, and fear of being reduced to a completely dependent state.
This need not be the consequence of a lifetime of suffering, or a response to intolerable physical pain. Tiredness of life also seems to arise in people who consider themselves to have lived fulfilling lives. One man of 92 told the network’s researchers:
You have no effect on anything. The ship sets sail and everyone has a job, but you just sail along. I am cargo to them. That’s not easy. That’s not me. Humiliation is too strong a word, but it is bordering on it. I simply feel ignored, completely marginalised.
Another man said:
Look at the condition of those old ladies in the building opposite. Gaunt and half-dead, pointlessly driven around in a wheelchair … It has nothing to do with being human anymore. It is a stage of life I simply don’t want to go through.
A unique suffering
The American novelist Philip Roth wrote that “old age is not a battle, old age is a massacre”. If we live long enough, we can lose our identity, physical capabilities, partner, friends and careers.
For some people, this elicits a deep-rooted sense that life has been stripped of meaning – and that the tools we need to rebuild a sense of purpose are irretrievable.
Care professor Helena Larsson and colleagues in Sweden have written about a gradual “turning out of the lights” in old age. They argue that people steadily let go of life, until they reach a point where they are ready to turn off the outside world. Larsson’s team raises the question of whether this might be inevitable for us all.
Of course, this sort of suffering shares characteristics (it’s depressing and painful) with anguish we encounter at other points in life. But it’s not the same. Consider the existential suffering that might arise from a terminal illness or recent divorce. In these examples, part of the suffering is connected to the fact that there is more of life’s voyage to make – but that the rest of the journey feels uncertain and no longer looks the way we fantasised it would.
This sort of suffering is often tied to mourning a future we feel we should have had, or fearing a future we are uncertain about. One of the distinctions in tiredness of life is that there is no desire for, or mourning of, a future; only a profound sense that the journey is over, yet drags on painfully and indefinitely.
The global view
In countries where euthanasia and assisted suicide are legal, doctors and researchers are debating whether tiredness of life meets the threshold for the sort of unceasing emotional suffering that grants people the right to euthanasia.
The fact that this problem is common enough for researchers to debate it may suggest that modern life has shut older people out of western society. Perhaps elders are no longer revered for their wisdom and experience. But it’s not inevitable. In Japan, age is seen as a spring or rebirth after a busy period of working and raising children. One study found older adults in Japan showed higher scores on personal growth compared with midlife adults, whereas the opposite age pattern was found in the US.
Surgeon and medical professor Atul Gawande argues that in western societies, medicine has created the ideal conditions for transforming ageing into a “long, slow fade”. He believes quality of life has been overlooked as we channel our resources towards biological survival. This is unprecedented in history. Tiredness of life may be evidence of the cost.