Keywords

Introduction

As the previous chapter reinforced, to explore the birth of the biomedical model, it is necessary to historically recall the changing social conditions out of which it came. The biomedical model was born out of the re-emergence of natural philosophy in the form of modern science. The anatomical experiments of Bichat, Paracelsus, and Harvey on which it is grounded are in turn a product of, and so are conditioned by, “the Enlightenment” (King, 2001). Thus, the “problem orientation” to aging is historically configured in the biomedical sciences and discourses that specialize in one terminology of gerontology (Powell & Biggs, 2000). For biomedicine perceives of aging as a pathological problem tied to discourses of decline and dependency (Achenbaum, 1978; Phillipson, 1998). The medical science “problem” approach to aging can be related to how human subjectivity was structured as occidental modernity crystallized, when, beginning in the seventeenth and eighteenth centuries, the “social sciences,” industrial capitalism, and bureaucratic politics simultaneously developed novel ways of objectifying individuals and populations in Western societies (Biggs & Powell, 2001). The emergence of Western rationality was accompanied by a growth of scientific traditions such as positivism, each intellectualizing the nature and extent of individuality. Empirical observation, reason, and science are major themes of the modernist project. This is a set of beliefs about validating knowledge that has consolidated modernism. It arose from the intellectual diagnosis of society during and after the Enlightenment. It was the Age of Reason, in the second half of the eighteenth century, with the idea of progress elaborated by Immanuel Kant, Turgot, Condorcet, which gave rise to modernity (May, 1996). The French Revolution in 1789, a revolution based on reason, both expressed and gave momentum to this new consciousness, and the Industrial Revolution provided its material substance (Giddens, 1991). This modern world, this new social order, was characterized by a new dynamism, a rejection of earlier traditions, a belief in progress, and the potential of human reason to promote freedom. Increasing rationality would enhance social understanding, order and control, justice, moral progress, and human happiness. Coupled with this was Rene Descartes’s metaphysical axiom, “Cogito, ergo sum” (I think, therefore I am), which extolled the capacity of individual reason as the foundation of awareness and the locus of knowledge (May, 1996). As a rationalist philosopher and mathematician, Descartes forcefully separated “mind” and “aging body” and thereby articulated a Cartesian dualism that has long provided a pivotal feature for the hegemony of Western culture. As part of this, the search for longevity is hardly new. Before recent times, advocates for longevity fell into two general time periods. From the sixteenth century to the eighteenth century, individuals worked to extend the lives and vitality of elderly people; they believed senescence was a time of considerable worth. From the nineteenth century through the early twentieth century, however, anti-age advocates generally depicted old age as a time to be feared and despised, devising myriad procedures in order to eliminate it entirely. While sharing little with the advocates of the early modern period, the recent anti-age movement clearly mirrors many of the beliefs of the longevity advocates of a century ago. Both groups not only see old age as a disease to be eradicated through injections and operations but also argue that the old constitutes an enormous economic burden. These so-call rationalist beliefs reveal that the new anti-age movement, like its early twentieth-century precursor, is based on more than simple hair dyes, hormones, or diet. Rather, their ideas and actions ultimately serve to marginalize the very process of growing old and under the guise of science attempt to legitimise its long held narratives.

Central to this Cartesian epistemology is a systematic belief in the supremacy of logical reason over the illogical nature, as such; Enlightenment philosophy assumes that the rational self has an “inner” relationship with the mind and an “outer” relationship with the body. Therefore, the body is conceived of as not a part of “who we are” but part of nature and, hence, an object to be controlled (Powell, 2001e). With the Kantian philosophy of ethics, reason is identified with morality, for it provides the a priori principles for knowledge, certainty, and universal law, whereas the body is identified with feelings and emotions, which are, according to Kant, external forms of determination; they imply a lack of freedom that takes individuals away from the path of pure reason (May, 1996).

Indeed, this very attitude of inflation toward the mind and deflation toward the body has long set the stage for transcendental ideals, in an attempt to articulate the order of the “empirical” world beyond its particularities and peculiarities and beyond its “immanence” (May, 1996).

Indeed, the notion of transcendence went on to act as a basis for objective and universal knowledge, reinforcing the Cartesian “method” of existence and cognition and ratifying the need for disembodied experience, yet dialectically espousing a synthesis of mind and body in which the latter became the servant rather than the prison of the former. In fact, this disdain for the body entails a disdain for anything relating to it, such as emotions, feelings, and subjectivity.

As such and in the episteme of transcendence, experience is deemed to be “real” only if deeply entrenched within consciousness and entirely detached from the corporeal. Personal subjectivity is thus regarded as a threat to the credibility and validity of experiential knowledge, and it can be transcended only if thawed into the crucible of “unity,” in other words into the realm of Kant’s unified “transcendental subjectivism” (May, 1996). This transcendental idealism becomes the legacy of the androcentric, white, Christian, heterosexual culture (Powell & Longino, 2001, 2002), in which reason and rationality are regarded as the source of the taken-for-granted superiority.

The causes and consequences of modernity are cultural, social, and metaphysical; but as Tim May (1996) points out, another driving force was capitalism, with its constant quest for new raw materials, new sources of labor power, new technologies, and new applications that might attract new consumers. From the outset, modernity promised to change the world in the name of Reason, and each innovation spawned another. However, alongside this, differentials, in terms of who may have access to and be able to deploy “reason,” may also be seen to have served as a sophisticated legitimization function between scientific “experts” and the “subjects” of knowledge. For example, given the dichotomous relationship between repression and freedom, individuals will tend to define themselves via their position or identity within a power relationship, such as those of doctor to patient, judge to judged, or aged-care nurse to elderly patient.

With the Renaissance, the idea of prolongevity itself also developed out of the belief that individuals could control both the length of their time on earth and the quality of their existence. One of the most influential of these advocates was Luigi Cornaro, an Italian nobleman who in 1550 wrote The Art of Living Long. Translated into English, French, Dutch, and German, the book became the bible of prolongevity advocates who asserted that a long and healthy life was a very real possibility. By the nineteenth century, the English version of Cornaro’s book had gone through more than 50 editions. In his study, the author argued that individuals were not destined to die at 60 or 70, but with care and a good constitution, they could live extremely long lives. The key to this survival, he believed, lay in a simple life based on the principle of moderation in all things. His own life served as an ideal illustration of his philosophy. Suffering at age 35 from a variety of illnesses including gout, fever, and dehydration, he reformed his behavior and lived happily and healthily until his death at 98.

Yet, comparative research on aging in Eastern cultures has highlighted a path rather different from the conceptualization of aging as a scientific process developed by Western rationality. For example Powell and Cook (2001) observe that traditional Chinese society placed older people on a pedestal. They were valued for their accumulated knowledge, their position within the extended family, and the sense of history and identity that they helped the family to develop (Powell & Cook, 2001). Respect for elderly people was an integral part of Confucian doctrine, especially for the family patriarch:

The mixed love, fear and awe of the children for their father was strengthened by the great respect paid to age. An old man’s loss of vigour was more than offset by his growth in wisdom. The patriarch possessed every sanction to enable him to dominate the family scene. (Fairbank, 1959, in Powell & Cook, 2001, 55)

This was a view that was also prevalent in ancient Greece with the notions of respect for older people, especially regarding gendered issues of patriarchy (Bytheway, 1995). Prior to industrialization, in India, it was understood that older people had responsible leadership roles and powerful decision-making positions because of their vast “experience,” “wisdom,” and “knowledge” (Katz, 1996). It seems that, with the advent of Western science and rationality, aging began to be viewed in a context that was different from and more problematic than the Confucian doctrine of aging epitomized in China and traditions of respect for aging in India. Jacques Derrida (1978) makes the similar point when he spoke of the westernization of the world through the principles of Western science and language. Coupled with this, the idea of modernity evokes the development of capitalism and industrialization, as well as the establishment of nation-states and the growth of regional disparities in the world system. The period has witnessed a host of social and cultural transformations. Significantly, age categories emerged during this epoch as two fundamental axes along which people were exploited and societies stratified. A hallmark of modernity is the expansion of America and Europe and the establishment of Western cultural hegemony throughout the world. Nowhere is this more profound than in the production of scientific-technological knowledge about human behavior.

Indeed, the technological developments due to industrialization, westernization, and urbanization, under the purview of distorted forms of modernity, have neglected these statuses of aging by downgrading its conceptualization. Part of understanding individuality in Western culture, the birth of “science” gave legitimate credibility to a range of disciplines that were part of its umbrella. In particular, the biomedical model has become one of the most controversial yet powerful of both disciplines and practice with regard to aging (Powell & Longino, 2002).

The biomedical model represents the contested terrain of decisions reflecting both normative claims and technological possibilities. Biomedicine refers to medical techniques that privilege a biological and psychological understanding of the human condition and rely upon scientific assumptions that position attitudes to aging in society for their existence and practice. As Arthur Frank (1991, 6) notes, the biomedical model occupies a privileged position in contemporary culture and society:

Bio-Medicine [occupies] a paramount place among those institutions and practices by which the body is conceptualized, represented and responded to. At present our capacity to experience the body directly, or theorize it indirectly, is inextricably medicalized not sociologized.

The end product of this process in Western society is the biomedical model. Indeed, the mind-body dualism has become the location of regimen and control for emergence of the scientific in a positivist methodological search for objective “truth” (Longino & Powell, 2004). By developing an all-encompassing range of biomedical discourses, many forms of social injustice, such as mandatory retirement and allocation of pensions, could be justified as “natural,” inevitable, and necessary for the successful equilibrium of the social whole (Phillipson, 1998).

The next section of this chapter addresses the question as to how the biological body and psychological mind acquire meaning through the guise of science. If we focus on two models of gerontology, we can see the key assumptions that lie at the heart of biomedical definitional explanations of aging: biological and psychological dimensions. It must be stressed that biological and psychological gerontology has traditionally been articulated as the “biomedical model.” While this is analytically useful, there is also a need to probe the similarities between biological and psychological aging and map out some of their main assumptions of human aging. Such a dual biological-psychology typology may have inclusions and omissions which may differ from other commentators, but the broad aim is to provide a view of approaches to aging and the assumptions upon which they are based. Yet, it must be stressed the ambiguity within biomedicine in recent years in talking about a cure for aging as though it is a medical problem and needing to be reversed. This contentious point is about “turning back the clock.” The critical question is whether this is real or a myth to sustain funding and the hegemony of the biomedical model. With the Enlightenment, this philosophy of life extension was espoused by a number of the philosophes. From Condorcet to Benjamin Franklin, leading thinkers believed that, in the centuries ahead, science would solve the problem of debility in old age. Individuals who followed the simple rules of nature could then exist until their deaths with the vitality of adulthood and the wisdom of their advanced years. Most notably, many of these rationalist thinkers did not believe that the decreasing strength of the aging body implied an equal weakness of the mind. Benjamin Rush, for example, was convinced that most aged individuals—and especially those who were temperate in their daily habits—would retain full use of their mental powers until they reached the grave. In 1797, in a study of a group of octogenarians, he found that, although some elderly individuals had faulty memories of the recent past, their intellectual, moral, and religious powers were completely unimpaired. His recommendation for a happy old age, therefore, was not to overcome the laws of nature but to understand them in order that the aging individuals remain productive members of society (Powell, 2022).

Biological and Psychological Aging

There has long been a tendency in matters of aging and old age to reduce the social experience of aging to its biological dimension from which are derived a set of normative stages, which overdetermine the experience of aging. Throughout the nineteenth century, however, this notion of a vital and meaningful senescence was challenged by scientific discoveries that defined old age as a disease to be feared. Based on studies first done at the hospitals in Paris, elite physicians began to link old age to specific physiological changes in the body. By tracing lesions in the tissues, and later changes in the cell, they concluded that old age was not simply a decline in vitality that could easily be controlled through a regime of diet or exercise. Examining the aging eye, the loss of hearing, or the development of arteriosclerosis, they asserted that aging, like many disease entities, appeared to cause numerous pathological transformations that were both progressive and inevitable. As a result, clinicians agreed that illness and old age were inseparably intertwined, if not quite synonymous. Accordingly, being “old,” for example, would primarily be an individualized experience of adaptation to inevitable physical and mental decline and of preparation for death (Biggs, 1993). The paradox, of course, is that the homogenizing of the experience of old age compelled by such reliance on the biological dimension of old age is in fact one of the key elements of the dominant discourse on aging and old age.

Biological aging is a major facet of gerontology across and through US, European, and Western society as a whole (Katz, 1996; Freund, 1988). Before we assess the ramifications of biological aging and the way it colors particular discourses that have social implications for aging, it is important to contextualize its main assertions.

Biological approaches to aging have focused on searching for the reasons why and how human beings change over time in terms of physical and physiological characteristics. Bromley (1988, quoted in Hughes, 1995, 29) suggests that aging is a degenerative process and contends that “aging can be conveniently defined as a complex, cumulative, time related process of biological and psychological deterioration occupying the post-development phase of life.”

Furthermore, according to Biggs (1993) and Kunkel and Morgan (1999), the passage of time for human organisms is related to physical changes in and on the body: “hair loss” or “graying of hair,” “decrease in reproductive system,” and “cardiovascular functioning” are examples. These processes have been called “physiological changes” that are designed to contribute to the body’s ability to function as it traverses the aging process.

Such bodily processes are designed to maintain a balance of internal working conditions called homeostasis (Kunkel & Morgan, 1999). A key example of this scientific assumption is the relationship of oxygen to the blood system. Oxygen is transported by hemoglobin in the blood system to the body’s 100 trillion cells (Kunkel & Morgan, 1999). According to Timiras (1997), the inability of the body to maintain homeostasis compromises “normal functions” and “survival.”

The key issue here is one of internal body functions; however, there is another, wider question whether changes to the body exemplify “decline.” Kunkel and Morgan (1999) suggest that aging is often associated with a reduced ability to maintain homeostasis. According to Morris (1998), the potential of oxygen to all body cells decreases with age. However, changes outside the body, such as social factors or environmental pollution, may also disturb homeostasis (Phillipson, 1998). However, the dominant narrative in the biological explanation of aging is that the ability to perform bodily functions will affect an individual’s survival. The causal factors of the breakdown of these functions are essentially contested. Major causes of death at the turn of the twentieth century were infections and diseases, whereas major deaths in Western societies at the turn of the twenty-first century are chronic diseases: cardiovascular disease, cancer, and stroke (Powell, 2001b). A posing question is whether these changes to the body are inevitable and natural consequences of aging. Aging, it seems, is linked with increased “risk” of illness and disease (Biggs, 1993). The relationship is not necessarily causal: aging does not cause disease and disease does not cause aging.

According to Timiras (1997), biological aging affects every individual, evidencing itself overtly and covertly at different ages and in different organs and systems, depending on a whole series of cascading effects (Timiras, 1997).

Secondly, Timiras (1997) sees aging as a “deleterious” process, involving the functioning of cells and therefore organs and the organism itself. We also know that age-related changes that do occur have a limiting effect on a number of bodily functions. Changes in the lens of the eye lead to presbyopia; changes in the cochlea of the ear lead to presbyacusis; a reduction in the accuracy of maintaining posture increases the amount of sway in the standing positions. (Timiras, 1997, 55).

Another prominent example of biological gerontology is a focus on the pathological formation of “impairment in the body” (Bromley 1966, quoted in Hughes, 1995, 25). It is partly assumed to be due to the aging process but it may be made worse by a “dementing process” such as Alzheimer’s disease (Hughes, 1995). According to Timiras (1997), “postural hypotension” is another of those problems that are age related. In age-related vulnerabilities, physiological systems decline with age, resulting in a shift in the competence of the body to control the chemical and cellular environment, thus leaving individuals more prone to so-called diseases of aging. In other words, the biological facet of aging is related to internal problems of the body as a person grows older. Coupled with this, there are certain biological viewpoints that suggest that older people have many “inevitable medical problems”:

In fact, if one were to look at the presenting medical problems of the elderly, six symptoms would stand out: mental confusion, respiratory problems, incontinence, postural instability and falls, immobility and social breakdown. While they are problems of the elderly, no one has definitively shown robust evidence that they are age-related. It is mainly beyond the age of 75 and more particularly 85 years that frailty and the dependence associated with chronic illness becomes apparent. Yet, generally, these changes were going on for many years, at levels below which we are able to detect and associate conclusively with the age-related deterioration process. Conversations with medical personnel suggest that healthy elderly people quite often have laboratory test results which are slightly abnormal, but are not deemed significant. While there are many chance factors that may account for these “abnormalities,” they may be precursors of cell or system age-related changes leading to expression of disease at a much later date. The sooner we identify signs of a disorder, the more likely treatment will be effective. (Timiras, 1997, 54)

Despite the question of “inevitable” aging, in the USA, the average life expectancy is approaching 80 years (Cook & Powell, 2003); the fastest-growing segment of the US population consists of persons aged 85 and over (Cook & Powell, 2003). A key question for physiological theories is why bodies do not function eternally. Recently, authors such as Aubrey De Grey have argued anti-aging medicine could be created to provide the conditions of anti-aging whereby individuals could live until they are 5000 years old. While this is speculative and lack an evidence base, it is popularized in popular culture through “life extension” models within biomedicine. The problem with the approach is that this is based on chronological aging and has never been proven. Until it has, it remains a speculation rather than a scientific fact. The highest age a human has lived to is 122, so to add 4878 years on top raises ethical issues: what is the retirement age? When does an individual stop having children? Is this universal? What about life expectancy in lowest countries in the world, would they have access to this so called anti-aging treatment?

Yet within the mainstream thinking of biomedicine, Biggs (1993) has suggested the following assumptions impinge on biological aging: that the human body is a machine, and overworked machines and human bodies “wear out” and “decline”; the human body grows but “decays” with time; “abnormal cells” are formed as a result or damage to DNA from “internal problems,” all future cells are marked to be different, “in error,” and “inferior” to the original intact parent cell; human skin “wrinkles” over time with passing of pigment cells; aging and death are built-in programmed events that result from genes “turning on” and “turning off” (for example, Timiras (1997) suggests there is gendered evidence for this among females such as menopause events); and bodily aging causes problems of vision, hearing, and sensory function and balance.

Healthy living and diet are seen as key shields to curtail the problems of biological aging (Gilleard & Higgs, 2000). The individualized notion of aging as espoused by biological aging suggests that the body is in decline as an individual ages but declines especially sharply in “old age.” The term terminal decline or terminal drop has been defined by Riegel and Riegel (1972, quoted in Kunkel & Morgan, 1999, 33) as “a sudden drop in performance occurring within 5 years prior to death.” As a phenomenon, terminal decline has been observed in the area of intellectual functioning in old age (Hughes, 1995). An interesting question is whether these physical changes are inevitable and “terminal” consequences of aging. The perceptions of aging through biology not only has postulated perspectives about aging but also there has been the psychological approach that has helped to coalesce particular discourses about aging.

Historically, the study of aging and old age was dominated by a Freudian paradigm that suggested that as individuals age and reach “old age,” they are structured and regimented and not amenable to development or change. Psychology as a discipline of study had been much more concerned with childhood development (Hughes, 1995). Like its biological counterparts, it saw the aging process as a decline in psychological well-being and adaptive ability as people enter old age. The framing of the psychological argument was that human functioning followed the biological journey of positive development in childhood, reaching a peak in early adulthood that was followed by inevitable decline, senescence, and loss of functions into old age.

Furthermore, according to Hughes (1995), psychological aging processes include changes in personality and mental functioning. According to Kunkel and Morgan (1999, 5): “changes are considered a ‘normal’ part of adult development, [and] some are the result of physiological changes in the way the brain functions.”

However, there are psychologists such as Erik Erikson (1980) who see aging as development rather than as a degenerative process. Erikson (1980) hypothesized that each person’s life progresses through a series of psychological stages, each of which is important in determining how an individual is able to meet the challenges of subsequent stages of life: infancy, childhood, adulthood, and old age.

This was also influential to the development of “successful aging” that has dominated psychological views of aging in recent years. Successful aging attempts a strategic understanding of late-life issues, grounded in psychological behavior that arises spontaneously among older people in particular (Baltes & Baltes, 1990; Baltes & Carstersen, 1996). It sidesteps the issue of prescribing contents by engaging with psychological processes, and thus moving from questioning the “what” of aging to the “how” (Baltes & Carstersen, 1996).

This theoretical platform is based upon the observation that older people are in the main content with their lives, in spite of increasing “disability” or “hardship” (Hughes, 1995). Baltes and Baltes (1990) suggest a “meta-model” of selective optimization with compensation to explain how older people negotiate both gains and losses that manifest with aging with such “psychological success.” It is claimed that older people are satisfied because they have found personal and existential strategies to minimize the losses and maximize the gains encountered as individuals age. Nevertheless, as Baltes and Carstersen claim, we cannot predict any given individual’s successful aging using this model unless “we know the domains of functioning and goals that the individual considers important, personally meaningful and in which he or she feels competent” (Baltes & Carstersen, 1996, 399).

According to Baltes and Carstersen (1996), this model has the advantage of acknowledging socioemotional dimensions of aging and multiple possibilities for self-development and is based on the metapriority of mastering the challenges of aging, while allowing wide variety in the ways mastery can be achieved. Everyday existence is converted into successful activities, which are converted into life-satisfaction through techniques applied to the self. Harry R. Moody (1998) has quipped that the approach divides the population into the “wellderly” and the “illderly” and that successful aging is essentially about “surviving.” Fundamentally, successful aging emerges as a normalizing identity approach, masking a decline model of aging. Ian Hacking (1990) claims that the notion of the “normal” identity provides a powerful framework for everyday life and individuals. As he states:

The normal stands indifferently for what is typical, the unenthusiastic objective average but it also stands for what has been, good health, and for what shall be, our chosen destiny. That is why the benign and sterile sounding word “normal” has become one of the most powerful ideological tools of the twentieth century. (Hacking, 1990, 23)

An analysis of successful aging reveals that a distinctive and normalized category of aging has been created out of a psychologically defined “success.” The category of aging and its coherence derives primarily from the exclusionary treatment on the basis of their psychological categorization and classification.

The Construction of “Problems” of Aging

Biological and psychological characteristics associated with aging have been used to construct scientific representations of aging in modern society. The characteristics of biological aging as associated with loss of skin elasticity, wrinkled skin, hair loss, or physical frailty perpetuate powerful assumptions that help facilitate attitudes and perceptions of aging. It may be argued that rather than provide a scientific explanation of aging, such an approach homogenizes the experiences of aging by suggesting these characteristics are universal, natural, and inevitable. These assumptions are powerful in creating a knowledge base for health and social welfare professionals who work with older people in particular medical settings, such as a hospital or general surgery, and also for social workers (Powell & Biggs, 2004). These new forms of social regulation were also reflected in the family and the community (Donzelot, 1979; Delanty, 1999).

Hence, modern systems of social control have become increasingly bifurcated (Ignatieff, 1978; Cohen, 1985; Schrag, 1980). Increasingly, modern society regulates the perception of the aging population by sanctioning the knowledge and practices of the new human sciences—particularly psychology and biology.

These are, to prarphrase Foucault, the gerontological “epistemes,” “the total set of relations that unite at a given period, the discursive practices that give rise to epistemological figures, sciences and possibly formalised systems” (Foucault, 1972, 191). The “psy” complex (or biomedical epistemes) refers to the network of ideas about the “nature” of individuals, their perfectability, the reasons for their behavior, and the way they may be classified, selected, and controlled (Howe, 1994, 33–47). It aims to manage and improve individuals by the manipulation of their qualities and attributes and is dependent upon scientific knowledge and professional interventions and expertise. Human qualities are seen as measurable and calculable and thereby can be changed and improved. The new human sciences had as their central aim the prediction of future behavior (Ignatieff, 1978).

This reductionism was inadequate in explaining the complexities of various local group uprisings within society during the past hundred years. It was particularly weak in explaining the mentalities behind the masses of people who united as one individualized group to revolt against existing structures that had been suppressing both the individual’s sense of “self” and the distinct groups with which they identified. For example, elderly people can be seen as such a distinct group labeled by the health assessments made of them to classify their existence into care by the state and by the care institutions that regulate and disseminate the authority to care staff to “manage” the elderly people (Powell & Biggs, 2003).

Individuals who are subjected to multiple discourses are individuals with neuroses such as “dementia,” “schizophrenia,” or even “Alzheimer’s disease” who are considered incapable of governing themselves and are subjected to the highest levels of control and surveillance.

Biggs (1993) suggests that a prevailing ideology of ageism manifests in the biomedical model by its suggestion that persons with such biological traits have entered a spiral of decay, decline, and deterioration. Along with this goes certain assumptions about the ways in which people with outward signs of aging are likely to think and behave. For example, assumptions that “older people are poor drivers” or that older people have little interest in relationships that involve sexual pleasure are all explained away by the “decline” and “deterioration” master narratives that comprise a culture of aging. The effects of the decline- and-decay assumptions can be most clearly seen in the dominance of medico-technical solutions to the problems that aging, and even an “aging population” (discussed below) (Phillipson, 1998), is thought to pose. Here, the biomedical model has come both to colonize notions of age and to reinforce ageist social prejudices to the extent that “decline” has come to stand for the process of aging itself (Powell, 1999).

The French social historian Michel Foucault has provided a shattering critique of medical sciences that can be used to assess the biomedical models of aging. Foucault (1967) was particularly interested in the limits and possibilities of discourses from “human sciences” (biology, for example) because of their attempts to define human subjectivity. Foucault (1977) shows the extent to which medicine objectifies the “sick” body, once it has been medicalized. For Foucault (1977), the body is thus not “natural” but “created” and reproduced through medical discourse. In The Birth of the Clinic, Foucault illustrates how the medical gaze opened “a domain of clear visibility” (1973, 105) for doctors, by allowing them to construct an account of the condition of the patient and to connect signs and symptoms with particular diseases. The space in which the gaze operated moved from the patient’s home to the hospital. This, too, became the site for social work with older people, as well as the acquisition of knowledge; the object was the “elderly” body of the client. Similarly, the body of the “madman,” according to Foucault, was viewed as “the visible and solid presence of his disease.” Hence, the gaze focuses upon the body and “normalization” involved “treatment of the body” (Foucault, 1967, 159–72).

Biomedicine became a disciplinary strategy that extended “control over minutiae of the conditions of life and conduct” (Cousins & Hussain, 1984, 146) of individuals and understanding of bodies. Biomedical gerontology became an institution in its own right, in which the advice and expertise of biomedical professionals were geared to articulating “truths” about bodies (Armstrong, 1983). Medical domination through observation and scientific discourses objectified bodies appropriated through the aging process as “diagnoses began to be made of normality and abnormality and of the appropriate procedures to achieve the norm” (Smart, 1985, 43). In this way, examining the body and mind of older people was intrinsic to the development of power relationships in contemporary society: “The examination is at the center of the procedures that constitute the individual as effect and object of power, as effect and object of knowledge. It is the examination which by combining hierarchical surveillance and normalizing judgement, assures the great disciplinary functions of distribution and classification” (Smart, 1985, 49).

The technique by which biomedicine has developed knowledge of aging is a slender aspect of disciplinary control and power (Katz, 1996). This knowledge formation legitimizes the search within the individual body, for signs, for example, that he or she “requires” forms of surveillance and processes of medicalization (Powell & Biggs, 2000). This legitimation permeates an intervention into older people’s lives, because professional practices of surveillance are said to be appropriate for older people—because of the discourse of “declining” and pathological aging (Powell & Biggs, 2000).

Biomedicine, hence, constructs the identities of older people as objects of power and knowledge: “This form of power applies itself to immediate everyday life which categorises the individual, marks him by his own individuality, attaches him to his own identity, imposes a law of truth on him which he must recognize and which others have to recognise in him. It is a form of power which makes individuals subjects” (Foucault, 1982, 212).

Thus, Foucault (1973) has argued persuasively that the birth of the medical profession brought with it a different way of seeing illness and well-being related to structural and personal spaces. Most notably, the older people who became sick became an object to be modified (Powell & Biggs, 2000). Under the “biomedical gaze,” people become their bodies, bodies disaggregated into a series of dysfunctional parts. This is useful for the biomedical scientific analysis of function and remedy but severely limits any perspective that takes into account interpersonal and wider social factors. The dominance of the biomedical model has engendered negative conceptualizations pertaining to aging. It has also sought to reinvent itself as the “savior” of the aging via the biotechnological advancements that foster reconstruction of the body and to prevent the aging process (Wahidin & Powell, 2001; Powell & Biggs, 2004).

It appears that: established and emerging master narratives of biological decline on the one hand and consumer agelessness on the other co-exist, talking to different populations and promoting contradictory, yet interrelated, narratives by which to age. They are contradictory in their relation to notions of autonomy, independence and dependency on others, yet linked through the importance of techniques for maintenance, either via medicalised bodily control or through the adoption of “golden-age” lifestyles. (Biggs & Powell, 2001, 97).

Biomedical gerontology has attempted to legitimize its existence by playing “games of truth” (Foucault, 1980), claiming aging is a “universal” problem but, on the other hand, aging could be “cured” by biomedical intervention for potential “aging consumers” (Biggs & Powell, 2001; Powell, 2001b; Gilleard & Higgs, 2000). Such intervention could include swapping organs from one body to the next; by paying for expensive forms of surgery and modification: plastic surgery; hip replacements; cyborgic facilitation of bodily parts and functions.

Indeed, the anti-aging industry has boomed in recent years with regard to such reconstruction, but the boom is premised on consumerism. Science itself has suggested that secrets of eternal youth can be found in genetic codes and that using stem-cell research could curtail the aging process. Aging becomes governed by regiments of exercise in which individuals become the object of their own gaze in order to maintain their commitment to achieving a particular body project generated through discourses from science. Biomedicine may make people “healthier” and “live longer,” but they are still not freer from the structures imposed upon them within their society. Biomedicine may allow older people to live longer and may be even empower them with new technologies and interventions and an awareness of how to encourage healthy aging (Gilleard & Higgs, 2000). However, biomedicine still struggles with the notion that being old is positive, in relation to the ideology of aging, especially old age as “decrepit,” from decades of negatively stereotyping senescence. These structures change within biomedicine in order to reconstruct narratives of aging, but their dominant discourse of decline is still their master narrative of legitimacy. In order for individuals to survive within contemporary society, the argument espoused is that they must change their attitudes to enjoy the “benefits” of healthy aging professed by biomedical expert powers; aging needs modification as though it were a medical problem to begin with.

Research by Powell and Biggs (2000) indicates that medical discourses of power play a key interventionist role in societal relations and in the management of social arrangements. That is, medical “experts” pursue a daunting power to classify, which has serious consequences for the reproduction of knowledge. The power to classify also serves to maintain power relations (Powell & Biggs, 2000). Likewise, we must “challenge the hermeneutic belief in deep meaning by tracing the emergence of sexual confession and relating it to practices of social domination” (Dreyfus & Rabinow, 1983, xxv). The significance of biomedical practices reveals an interesting transition in attitude and inward approach to the psyche in both the personal and professional realm of care for older people. The “subject” of biomedicine becomes an “object” when these “speaking subjects” proliferate discourses or narratives that can be analyzed once again for the power relations embedded in their language. As Dreyfus and Rabinow (1983, xxv) assert, this demonstrates that “deep meaning is a cultural construction” accessible by analysis of the culturally constructed language used by subjects.

The individual once again is not a free or liberated individual, but one who is culturally regulated by the social order and under surveillance by biomedical powers that can repress individuals with their diagnostic classifications.

Following Powell and Biggs (2000), a dense form of biomedical discourses, containing alleged universal truths, totalizing views, and master narratives with which to explain and understand almost every aspect of social life, plays a central role in the construction of physical and symbolic boundaries, and it is through them that both expert groups and individuals come to know and understand the social world and constitute their social identities. As part of this process, certain powerful voices, such as those of geriatricians, increase their legitimacy, while other, often dissenting, voices of older people become delegitimized (Biggs & Powell, 2001).

Embedded is a relationship of power in that the classifier or medical expert doing the diagnosing would have the upper hand over the person being classified or diagnosed. The diagnostic knowledge they possessed placed them in an empowered position of authority, affirmed by their expert titles, to exert claims over their patients and police their welfare.

Aging: A Social Foreground

Estes and Binney (1989) have used the expression “biomedicalization of aging,” which has two closely related narratives: (1) the social construction of aging as a medical problem and (2) ageist practices and policies growing out of thinking of aging as a medical problem. They suggest:

Equating old age with illness has encouraged society to think about aging as pathological or abnormal. The undesirability of conditions labeled as sickness or illness transfer to those who have these conditions, shaping the attitudes of the persons themselves and those of others towards them. Sick role expectations may result in such behaviors as social withdrawal, reduction in activity, increased dependency and the loss of effectiveness and personal control—all of which may result in the social control of the elderly through medical definition, management and treatment. (Estes & Binney, 1989, 588)

Estes and Binney (1989) highlight how individual lives and how physical and mental capacities which were thought to be determined solely by biological and psychological factors are, in fact, heavily influenced by social environments in which people live. This remains invisible to the biomedical approach because these biological and psychological factors stem from the societal interaction before becoming embedded and recognizable as an “illness” in the aging body of the person. For example, in the “sociology of emotions,” the excursion of inquiry has proposed that “stress” is not only rooted in individualistic emotional responses but also regulated, classified, and shaped by social norms of Western culture (Powell & Biggs, 2003). This type of research enables the scope of aging to be broadened beyond biomedical individualistic accounts of the body.

On this basis alone, sociology has invited us to recognize that aging is not merely a socially constructed problem, as viewed by biomedical sciences, but is also the symptomatic deep manifestation of underlying relations of power and inequality that cuts across and through age, class, gender, disability, and sexuality (Powell & Biggs, 2000; Powell, 2002). At this level of analysis, sociology addresses biomedicine as one of the elements of social control and domination legitimated through power/knowledge of “experts” (Foucault, 1972, 1982; Biggs & Powell, 2000; Powell & Biggs, 2000, 2004). Such expert formation has also been labeled as ageist (Bytheway, 1995). Ageism is defined as negative assumptions made about old age that treat older people not as individuals but as a homogenous group that can be discriminated against on the basis of their age (Bytheway, 1995).

Every society uses age categories to divide this ongoing process into stages or segments of life. These life stages are socially constructed rather than inevitable. Aging, too, is a production of social categorizing. At any point in the life span, age simultaneously denotes a set of social constructs, defined by the norms specific to a given society at a specific point in history. Thus, a specific period of life—infancy, childhood, adolescence, adulthood, middle age, or old age—is influenced by the structural entities of a given society. Therefore, aging is not to be considered the mere product of biological-psychological function but, rather, a consequence of sociocultural factors and subsequent life-chances.

Modern society has a number of culturally and socially defined notions of what Thomas R. Cole and associates (1992) calls the “stages of life.” Historically, the stages of life were presented as a religious discourse that formed the basis for the cultural expectations about behavior and appearance across the life-course into old age. As Andrew Achenbaum (1978, 2) perceptively claims:

[P]eople at the end of the life-cycle continuum have constantly been described as ‘old.’ Old age is an age-old phenomenon.

Indeed, the life-stage model, still used in taken-for-granted popular usage in our society, influences how our lives are structured, albeit by means of biomedical discourses of “decline” (Jefferys & Thane, 1989). As Thomas (1977, quoted in Powell & Biggs, 2000, 17) points out succinctly:

Of all divisions in human society, those based on age appear the most natural and the least subject to historical change. The cycle of infancy, youth, maturity and decline seems an inexorable process.

In all societies, an individual’s “age” is counted on a chronological or numerical foundation, beginning from birth to the current point of age, or when an individual has died. Chronological aging is a habit individuals engage in: “birthdays” and “wedding anniversaries,” for example. Counting age can be seen as a social construction because it is a practice underpinned by the development of industrial capitalism (Phillipson, 1998). Hence, what is critical about aging, then, is how a society uses it to socially construct people into “categories.” As a classificatory tool, age is important in three ways. First, like sex, age is an ascribed status or characteristic, based on attributes over which we have little or no control. Second, unlike sex, a specific age is always transitional—constantly moving from one age to another, beginning life at zero and ending with a certain number at death. These transitions also assume that conformity is rewarded, whereas deviance is punished; they are regulated by societal expectations of age-appropriate behavior. Third, although in every society some age groups are more powerful, rich, and respectable than others, the unique aspect of aging is that everyone can expect to occupy various positions throughout life on the basis of his or her age. Coupled with this, ideas that centered on social aging coalesced as a theoretical orientation on aging during the 1960s and 1970s. In 1974, Bernice L. Neugarten wrote an influential essay marking a distinction between what is now referred to as the third and fourth ages, the early years of retirement and the later ones. Neugarten (1974) referred to persons in these stages of later adult development as the “young-old” and the “old-old.” The young-old are like late- to middle-aged persons. They generally have good health and they are about as active as they want to be. The old-old, however, tend to be widowed and are much more likely to be living dependently. Consequently, the concept of old age, with its attending miseries, was only pushed later into the life-course by this reconceptualization. The first decade after the beginning of Social Security retirement benefits seem like “the second middle age,” but the biomedically framed “declining body” remains an issue in the fourth, old-old age (Longino & Powell, 2004). Unless, anti-aging from biomedicine can be brought in as its “fix” which will require enormous funding.

The Demographic Construction of Aging: Comparing the USA, UK, and China

Since the turn of the last century, the life expectancy of people born in the USA has increased by approximately 25 years, and the proportion of persons 65 years or older has increased from 4% to over 13%. By the year 2030, one in five individuals in the USA is expected to be 65 years or older, and people age 85 and older make up the fastest-growing segment of the population. In 2000, there were 34 million people aged 65 or older in the USA who represented 13% of the overall population. By 2030, there will be 70 million over 65 in the USA, more than twice their number in 2000. Distinguished scholar and former president of the Gerontological Society of America, Charles F. Longino (1994), believes that, thanks to better health, changing living arrangements, and improved assistive devices, the future may not be as negative as we think when we consider an aging population. Thirty-one million people, or 12% of the total population, are aged 65 and older. In another 35 years, the aging population should double again. The aging population is not only growing rapidly, but it is also getting older: “In 1990, fewer than one in ten elderly persons was age 85 or older. By 2045, the oldest old will be one in five. Increasing longevity and the steady movement of baby boomers into the oldest age group will drive this trend” (Longino, 1994, 856).

Comparatively, the population structure of western European countries including the UK has changed since the turn of the twentieth century. Whereas in 1901, just over 6% of the population were at or over current pension age (65 in the UK for men and women), this figure rose steadily to reach 18% in 2001 (Powell, 2001b). At the same time, the population of younger people under age 16 fell from 35% to 20%. The United Nations estimates that by the year 2025, the global population of those over 60 years will double, from 542 million in 1995 to around 1.2 billion people (Krug, 2002, 125).

Alan Walker (1985) argues that the demographic situation for “the population aged 65 and over is set to increase steadily (by one fifth overall) between 1983 and 2021. However the largest rises are due to the numbers aged 75 and over and 85 and over: 30% and 98% respectively. By the end of this period women will outnumber men in the 85 and over age group by around 2.5 to 1” (Walker, 1985, 4). Thus, the age structure of the population has changed from one in which younger people predominated to a society in which people in later life constituted a substantial proportion of the total population. While the biological and psychological models of aging describe it as an “inevitable” and “universal” process, such terms cannot apply to the aging of an entire aging population.

Transformations in the age profile of a population are a response to political and economic structures. This has been coined as an “aging population” by governments of left and right persuasion and indicative of Eastern and Western cultures. Earlier, we examined the biomedical model and its theoretical assumptions of “decline.” Not only has the aging process been viewed as a medical problem but it has also been viewed as a social problem: a “burden” population group. As we discussed earlier, the central focus of modern social systems of regulation is the classification of the “aging population” based on the scientific claims of different experts in the “psy” complex (Biggs & Powell, 2001).

Older people in particular constitute a large section of populations in Western society, but the percentage of pensionable age is projected to remain at 18% until 2011, when it becomes 20%, and to rise to 24% in 2025 (Phillipson, 1998). In relation to public services that have to be paid for by younger working people, the burden is expressed in alarming percentages. Nor are only older people seen as dependent but also children under school-leaving age and people over the retirement age are similarly classified. Dependency rates, that is, the number of dependents relative to those of working age, have altered little over the twentieth century, and yet the notion of a “burden” group retains its currency. The reason for its persistence is that during a period of rapid growth of aging populations, there has been a fall in the total fertility rate (the average number of children that would be born to each woman if the current age-specific birthrates persisted throughout her childbearing life).

Changes in the age structures of societies also affect total levels of labor force participation in society, because the likelihood that an individual will be in the labor force varies systematically by age (Walker, 1985; Phillipson, 1998).

Concurrently, global population aging is projected to lead to lower proportions of the population in the labor force in highly industrialized nations, threatening both productivity and the ability to support an aging population (Krug, 2002).

Meanwhile, the young adult population in developing countries has been growing rapidly. The World Bank foresees growing threats to international stability as different demographic-economic regions are pitted against one another. The United Nations recognizes important policy challenges, including the need to reverse recent trends toward decreasing labor force participation of workers in late middle and old age, despite mandatory retirement in certain Western countries such as the UK (Powell, 2001c). Social welfare provisions and private-sector pension policies influencing retirement income have a major impact on retirement timing.

Hence, a major concern for organization such as the United Nations and World Bank centers on the number of such “dependent” older people. Using evidence from the UK, the percentage of people of working age, that is, 16–64, will drop from 64% in 1994 to 58% in 2031 (Powell, 2001a). As the number of workers per pensioner decreases, there will be pressure on pension provision. This is evident now, in such areas as pensions and long-term care; the retreat of the state made evident in the erosion of State Earnings Related Pay (SERPS) is forcing people to devise their own strategies for economic survival in old age (Alcock, 1996). In the British context that also impinges on Western societies in general, private pensions are slowly being introduced in order to prevent the “burden” of an aging population. These are ways in which the state continues to use “apocalyptic projections” such as a “demographic time bomb” about aging populations in order to justify cuts in public expenditure (Warnes, 1996). The British newspaper, The Guardian, has echoed such fears of a moral panic of old age by stating:

A demographic time bomb to tick into the next century—This year, Britain will be attempting to grapple with the implications of the … time bomb—the decline of the British teenager, and the rise … in the proportion of old people in the community. (Guardian, 2 January 1989, 17)

This type of “moral panic” (cf. Cohen, 1985) has knock on effects and reflects profoundly rooted ambivalence toward older people that can lead to an exaggeration of the size of resources required to meet their needs or of the sacrifice required by the 16–64 age group via taxation (Harper & Laws, 1995). Hence, it is not simply that governments and researchers have belatedly recognized “the graying” of populational constructions and policy implications; it is that they continue to look for knowledge of aging as the power to define old age as a social problem. An aging population, like that of an individual being studied by biomedical models, is seen as a “burden” problem in terms of economic management of Western economies.

It could be argued, when looking at the effects of a so-called demographic time bomb across the USA, Europe, and Asia, that it may have been grossly exaggerated (Powell & Cook, 2001). Such a negative perception of old age has developed via a process of ageism—stereotyping older people simply because of their chronological age. Ageist stereotypes such as “aging populations” act to stigmatize and consequently marginalize older people and differentiate them from groups across the life-course who are not labeled “old” (Bytheway, 1995).

One of the ways to interpret social aging, whether it be in individual or populational terms, is by theorizing about what it means to age in a society; that is, what concerns and social issues are associated with aging and how these themes are influenced by, and at the same time influence, the society in which people live. Thus, to understand the process of aging, looking through the lens of the “sociological imagination” (Mills, 1959) is not to see it as an individualized problem but, rather, as a societal issue that is faced by both the developed and underdeveloped nations as a whole.

We do need to ask, “How has age been theorized by social theories of gerontology?” Different sociological theories of old age are concerned with the social significance of age. Some are concerned with the individual’s adjustment to growing older and others are concerned with the relative distribution of the material disadvantage of older people. There is a somewhat heterogeneous bundle of theoretical disciplines, each with a differentiation of concerns, strengths, and weaknesses. Modernist social theories in social gerontology have been the major explanations of what forms of social activity take place in Western society and in a given historical time. Such modernist theories have shaped perceptions about aging and the nature of the relationship of the individual to modern society related to function, conflict, and gender. The next chapter focuses on these concerns.