With sexologist-turned-gerontologist Dr. Alex Comfort
Dr. Alex Comfort seems to be all that he admires most in men—feisty, intellectually probing, possessed of a liberal if rambling wit, and downright bloody-minded about anything he considers to be a social fault begging for resolve. The British-born physician is a man of many parts: a Cambridge classics scholar, poet, writer of more than 40 books, anarchist and political radical, as well as a world-recognized leading gerontologist. His best-selling titillators, The Joy Of Sex and More Joy Of Sex, gave graphic recipes for a gourmet guide to sexual mores of the Seventies. After 25 years of research on the aged, Comfort has concluded that oldness is a political institution that falls squarely under his jurisdiction of social ills. In his book, A Good Age, he says leisure is a con, retirement equals unemployment, and that the old should pull rank and become militant to fight for their needs. Interviewed in Toronto, Comfort served coffee and English muffins to journalist Ellie Tesher, while maintaining an inexhaustible line of chatter.
Maclean’s: Why do you say aging has no effect on you as a person, when in fact we all know that visibly it does have an effect on you and physically it does have effects even without illness?
Comfort: Aging has an effect on you as a person, but what I’m implying is that when you get to be 80 you won’t feel a different person from what you are now, but you will be horrified to find that other people treat you quite differently where they didn’t do so before.
Maclean’s: Then why are we all afraid of old age?
Comfort: We project our own fear—often illusory—of what will happen in old age. Maclean’s: Is it because of our youth cult as well?
Comfort: Well this is mostly a hype because when the last consumer population was young the hypes were directed to them. In all the societies where the old themselves are regarded in high esteem, they’re usually fairly unnumerous. Maclean’s: The old now are a growing population.
Comfort: Well they’re going to be around 14% or so of the population. That’s a lot of old people. Also, because we have got a society in which rate of change has got to be a lot higher, the whole concept of builtin obsolescence has been spread to include people.
Maclean’s: Do you think caring for the aged is an ethnic thing?
Comfort: I don’t think that it’s entirely ethnic. I think for some reason ethnics had an interest in the aged; the Chinese, for instance, and the Italians have always tried to do a lot for old people. It’s partly I think because the Jewish community had a very big stake in medicine. It’s always been a
The right to die? It’s usually the relatives who clamor for eutha-
nasia, not the patient
highly regarded Jewish profession and ever since Maimonides himself the Jewish community has contributed an immense amount to medicine and that, combined with their attitude toward the old, has probably explained why they’ve just done this and done it properly, and a lot of their trouble has been when families were really stricken with guilt if they had to put an old person in the hospital. They reckon they ought to have kept him at home. I’ve had this problem when I’ve had to explain sometimes that there was a point at which the older person would be better looked after by the experts.
Maclean’s: Do you think that is why they built better homes, in order to make sure they didn’t have to feel guilty?
Comfort: I don’t know about that, it may have been a very healthy guilt. I wish we saw a little more of it in Anglo-Saxons, but all I can say is the result, wherever it arose from, has been that this body of expertise does exist and I would hope that they could be encouraged to link up with teaching hospitals so that the expertise that exists there gets transmitted outside just that community and gets around to the medical profession as a whole.
Maclean’s: In your book, you refer often to the term “ageism,” a phrase intended to pack the same kind of gut response as racism and sexism. How can you equate these two concepts?
Comfort: Although nobody is putting the old in concentration camps, nobody is killing off the old, nobody is overtly expressing hatred against the old, it is possible to have effects that are similar in the long term to those of overt persecution by putting them, for instance, in atrocious nursing homes where they are treated in a far less than kmane way.
Maclean’s: You refer repeatedly to nursing homes as being the absolute worst possible solution to what to do with old people. Comfort: Let me stress that I’m talking about the United States exclusively. This does not refer to Canada. The book was written for the United States audience. Now here in Toronto—where you have, I suppose, one of the best geriatric hospitals in the world at Baycrest—you know a great deal about providing medical services for the old. But in America we have been hearing in California that the exploitation of the old through nursing homes and through some in-home services is the most rapidly growing branch of organized crime.
Maclean’s: What alternatives are there for older people who need some kind of care? Comfort: Well the alternatives are in properly conducted in-home care of the sort that doesn’t depend on semi-gangster contractors, as it often does in the United States, who have been paying minimum wages and receiving minimum subsidy and providing very poor services. What I’m saying is, although only 4% of older Americans are in nursing homes, it’s generally agreed, and it’s documented, that many of them are quite disgraceful and we have had cases in Britain, before we reformed them, where old people used to have their teeth and their spectacles brought around in a basket and they were expected to choose from the basket. Maclean’s: I thought Britain had the highest geriatric care.
Comfort: It has now. It didn’t always. At first we had to fight for it. We’ve got very good geriatric service now.
Maclean’s: In Canada, close to 7% of our elderly are in institutions. Some people are afraid that we are getting the dubious credit for having more people in institutions than any other industrialized society.
Comfort: I would be very slow to generalize about Canada. You have some very special problems not the least of which is climate, and it may not be possible to do it on the basis entirely of in-home care and in that case one would have to do whatever one could. So it would I think be wrong to criticize the way it is done here until one has an alternative. So far as Britain is concerned and so far as, for instance, the warmer parts of the United States are concerned, it would be both more economical and much better for people if they could be kept in their homes by what I would term “minimum subvention.” There’s a pattern seen in Scandinavia where people live in protected housing and they have available some in-home services such as a nurse who can look after them when they’re sick and a refectory where they can eat if they don’t want to cook and a homemaker service if they’re feeling bad that day and don’t want to clean up. But they have the option of remaining self-supporting and doing these things. Now this in America only exists for the rich in most cases. There are institutions like this but the problem there is to find a way of getting the type of service for lower income groups. I simply don’t know whether that is true of Canada or not. Maclean’s: Does an old person have the right to choose to die? When do we trust that he has made a lucid and soundjudgment and • not one that is influenced by confusion or depression that could be treated?
Comfort: This sounds more difficult than it is because it’s not a real problem as a rule in medical practice with many old people and with younger ones. It’s the relatives who clamor for euthanasia, not the patient. Maclean’s: Is there not a point at which an old person simply gives up?
Comfort: There is a point at which they give up and in which they very often die expediently as a consequence, but it isn’t the doctor’s job to assist people to commit suicide. He very rarely is in a position of doing that. The doctor’s job, where dying is taking place, is to make the dying as painless as possible and not to do meddlesome treatment to extend the life that is becoming onerous for the person who lives it. We used to be taught that you shall not make the treatment more grievous than the disease, and I think that’s what the Pope meant when he said that one shouldn’t adopt extraordinary measures to keep people alive beyond the quality of the life. Maclean’s: I’d like to talk to you about women. Do you think that the women’s movement, particularly in its expression in the United States and Canada, has affected and will affect the upcoming generation of people who are becoming old?
Comfort: I sincerely hope it will and the people it most needs to affect are men, because men have actually laid on themselves an even bigger trip than they’ve laid on women, as you will find if you try to do sex counseling. But the male, who has got this incredible unphysiological and unreal image of what maleness is ingrained in his mind, now finds he can’t deal with a normal woman as it is too demoralizing. So really men are succeeding in persecuting themselves as well as persecuting women. Maclean’s: He cannot deal with an old woman,you say.
Comfort: A normal woman. I think that’s one important thing—that perhaps women’s lib will lead to people lib. And I
A lot of young girls project powerful sexual Images, but aren’t very sexual people
think the old are bound to benefit from this. There’s a certain spillover from every movement for greater recognition of people as people, whether it’s civil rights or whether it’s any other libertarian movement. It’s not entirely self-serving. It tends to lead to a more humane society gradually and the old would benefit greatly from this. Maclean’s: You disdain the use of cosmetic aids for the woman as she is getting older, the silicones, the wigs and the makeup and what have you; by the same token you strongly admit that a woman has a sexual boycott as she gets older. . .
Comfort: I don’t think that wigs are the way to deal with it because an old woman
in a wig still doesn’t look like a young woman, and if you’re going to try to bait them that way you are not going to get anywhere. I think that I didn’t actually disdain them entirely. I said that a sane and rational use of these to make yourself look your best is not done to attract the other sex so much as to make you feel good about yourself.
Maclean’s: How can an old woman compete sexually? Or an old man?
Comfort: I think it can only happen when men’s evaluation of women becomes seriously altered. I think mine is. I would be very hesitant now to get involved with the 16to 18-year-old chick of the type one had held up as a sexual ideal because one learns by experience that very often the young girls who project a very powerful sexual image are not actually very sexual people. That is the fault of the advertising and the wrap-up. And there was an old Cockney saying that you don’t have to look at the mantelpiece clock when you’re building a fire. Personal appearances have been boosted as the great sexual turn-on. We have this terrific advertising hype of what makes you beautiful, everything from toothpaste to eyelashes. It really is a hype.
Maclean’s: How much can the acceptance of masturbation in older people which you speak about so freely be filtered down into institutions and places where old people actually live and socialize... ?
Comfort: We need to give older people in institutions the same option of sexual behavior that ordinary adults in society have. Whether they choose to engage in it with other people or not, whether they choose to form sexual connections or not, we all have that option and we are not normally interfered with provided we do it in a reasonably civilized way. But once you get into the custody of somebody else and put into an institution, there nearly always is an attempt to stop you from doing anything except sitting around all day and watching television.
Maclean’s: I want to touch on the question of bereavement. For the elderly, bereavement is such a serious subject; if a person of that generation had married at 20, they may never have lived alone in their entire lifetime. Should people who are suddenly left alone at an older age reconsider their living arrangements, move to smaller quarters, start planning a new life for themselves? Is that possible?
Comfort: They must plan a new life and the community and their friends can give them support in so doing. One of the troubles is, if you are ever bereaved, you find you get suddenly boycotted by all your friends who don’t know how to talk to you or what to say and they haven’t acquired the custom of merely presenting themselves silently and giving their regrets and leaving. We have very little ease in dealing with the reality of death and that applies equally to professionals.
Maclean’s: How do you reckon that an old
person can make an easy adjustment to living alone?
Comfort: How on earth can you make an easy adjustment to losing someone you loved all your life? Nobody can. I’m not in the business of trying to prove one can remove all sorrowfulness from the human condition. Now 1 think you have to remember that in any age bereavement depresses the survival of the relic partner for at least three years, as a surprise even to youngsters when one of them dies, and you’ve got to offset the fact that when persons die in old age in a sense their death is more expected than if a 28-year-old, for instance, died suddenly and left his wife and family alone. So there are checks and balances, the woman who loses her husband at 28 has got more life ahead of her; on the other hand she suffers an unexpected bereavement which seems less fitting in the order of nature. She has less time to prepare for it.
Maclean’s: Do you look forward to old age?
Comfort: Well to be quite honest, I’m not thinking in terms of looking forward to old age, I’m thinking merely in terms of getting through the program, and how much more there is to do that I would like to do. Maclean’s: Did you write for the United States because it is a great place to sell books or did you write for the United States because you feel the situation is worse there? Comfort: I think because the situation is worse there and also because, having gone there to work on the scientific side of this, I realized that we wouldn’t be any good doing much for the scientific side until we turned attitudes around a little in the public at large. I felt they were ready to have their attitudes turned around about it. Now it’s also true to some extent in England; the old still have problems there but, as I say, there are a good many back-up mechanisms that are lacking in the present American scene.
Maclean’s: Is there any fun to getting older?
Comfort: There can be a heck of a lot. I don’t know if you ever saw a movie about a marvelous photographer who lived in San Francisco and she made a film when she was 94. It was this wonderful old lady wearing sort of hippie weeds and a stovepipe flowered hat going around taking photographs in a supermarket and then ducking down behind the goods so as not to embarrass the people she was photographing. She was still working as a photographer. She was inherently a young woman, and was full of humor and zing and obviously getting a lot of fun out of old age.
Maclean’s: You suggest that older people should clamor for their entitlement, that they should be feisty and obstreperous and fight for their rights.
Comfort: And bloody-minded because they’ve been generally over-quiet.
Maclean’s: Is the strategy of being bloodyminded and obstreperous a really effective
way of changing the relationship between a person, perhaps one you depend on such as your doctor, or perhaps someone who is helping you in a nursing home?
Comfort: Let’s take it at its face value. We have seen the merit of social training in other contexts and this is really what we’re talking about. To some extent I’m joking about being obstreperous, but on the other hand there is an element of seriousness in it. There is an instance, as I say, of the Quakers who always managed to do that. They had a genius for being firm without being offensive, which we all would do well to cultivate. I always remember the man who, when the mole invaded his house, appeared at the top of the stairs with
Once in Britain I saw an old man die—
with ants walking in and out of his nose
a blunderbuss and said very gently, “Friend thou art standing where I am about to shoot.” That’s the way to deal with people.
Maclean’s: Do you fight personal windmills when you suggest aggression and assertiveness in old age? Is it really your own personality coming out?
Comfort: Oh yes, 1 think so. I’m a nasty, bloody-minded person.
Maclean’s: Have you always been? Comfort: Oh yes, rather. It runs in my family. The family motto is “Take comfort or take heed.”
Maclean’s: And so isn’t it just a fact that those who are will continue to be, and those who aren’t can’t be, and not only that they might lose their dignity by trying to be?
Comfort: Well don’t do it if you feel undignified about it, but some of them would obviously like to; but again some feel that it’s out of character and they need to be given permission. Just in the same way as with sex education, some of them would like to have it off. but they were a bit scared to. I think it’s the same thing! I think a lot of them bottle it up to their hurt you know. It’s terribly disabling to have to be sweet all the time.
Maclean’s: Dr. Comfort, how old are you? Comfort: I’m 57.
Maclean’s: And do you consider 57 a “good” age?
Comfort: Well, I’m getting on fine. I’ve no complaints about my age. I shall never get through all the things I want to get through. Maclean’s: And do you anticipate that the years, say 20years down the line, can be as satisfying for you as they are today? Comfort: Well if I can keep all my marbles, yes. One can’t of course guarantee oneself against illness and the liability to illness increases with age. but my father just died at 94 and he had only two months of old age out of the whole of that time. He was reasonably fit even then.
Maclean’s: What do you mean that he had only two months of old age?
Comfort: Well for two months he couldn’t see to sign cheques and he had to let the bank manager do it; although he could see to watch cricket, he couldn’t see to ride very well. It was sort of like having a permanent migraine attack with a spot in the middle of the visual field, and he was beginning to feel a little weaker I think than he had done. It was because he broke a rib and he went up to London by subway in a temperature of near 100 degrees with a broken rib and he felt pretty poorly when he got back, and he never really rallied after that. He could still walk around the house singing Handel at the top of his voice and he still sounded about 65 on the telephone.
Maclean’s: Is he the inspiration for your outcry against ageism?
Comfort: Not really, no, because I never really thought of him as an old man. I sort of turned around and found he was now 94. It wasn’t really persecution that turned me on to geriatrics. During the war in Britain, I remember an old man dying in hospital with ants walking in and out of his nose. This struck me as absolutely disgusting and it also struck me that we ought to be able to do better for the old than that.
I gave a bit of thought to it and I realized the next thing we had to tackle in medicine was the question of degenerative diseases.
I actually got out of clinical practice and devoted my whole last 25 years to research and documentation of the fundamental nature of the underlying aging processes. But in the meantime while I was doing that, other physicians had been developing geriatrics as a specialty, and in a sense now I think that it’s unlikely that one would find that sort of neglect of an old person except in a very, very bad institution,