Robert N Butler MD Visionary of Healthy Aging

by W. Andrew Achenbaum

Robert N Butler MD Visionary of Healthy Aging Robert Neil Butler 1927 2010 was a scholar psychiatrist and Pulitzer Prize winning author who revolutionized the way the world thinks about aging and the elderly One of the first psychiatrists to engage with older men and women outside of institutional settings Butler coined the term ageism to draw attention to discrimination against older adults and spent a lifetime working to improve their status medical treatment and care Early in his career Butler seized on the positive featur

Publisher : Columbia University Press

Author : W. Andrew Achenbaum

ISBN : 9780231164429

Year : 2013

Language: en

File Size : 1.49 MB

Category : Medical Books

Robert N. Butler, MD
“This is the biography of Robert N. Butler we’ve been waiting for. For those
who were privileged to know him, this book brings him vividly to life. For
those who recognize his influence, it will illuminate his legacy. For all who
expect to grow old, it will bring a lasting message of hope.”

Achenbaum

Praise for

Visionary of Healthy Aging

–Harry R. Moody,

Director of Academic Affairs, AARP

—Scott A. Bass,
American University

“This is not only a personal biography of an iconic figure in the field of aging
but also a biography of the discipline of gerontology. The stories fill in the
blanks for us and help make sense of our own professional lives as we see
more fully the role Butler played in the development of the field. Dr. Butler
was our hero, and he gave us courage. His story needs to be shared.”
—Leah Rogne,

Minnesota State University

“Considering the normous impact Butler had on gerontology, I am thrilled
that Achenbaum has taken on the very fitting and formidable task of depicting and commemorating Butler’s lifework. Butler’s career was marked by a
fundamental optimism toward the aged that brought talent, rigor, and legitimacy to the field of gerontology. I look forward to the insights I am certain
to gain from better understanding the life of this great pioneer.”

A scholar who knew Butler personally and
professionally, W. Andrew Achenbaum follows this pioneer’s significant contributions
to the concept of healthy aging and the
notion that aging is not synonymous with
physical and mental decline. Emphasizing
the progressive aspects of Butler’s approach
and insight, Achenbaum affirms the ongoing
relevance of his work to gerontology, geriatrics, medicine, social work, and related fields.

—Ken Dychtwald,

President and CEO of Age Wave

columbia university press | New York
Jacket Design:
Jordan Wannemacher
Jacket Image:
Robert Caplin/The New York Times/Redux

cup.columbia.edu
ISBN: 978-0-231-16442-9

9 780231 164429
p ri nted i n the u. s . a .

Columbia

Robert Neil Butler (1927–2010)
was a scholar, psychiatrist, and Pulitzer
Prize–winning author who revolutionized
the way the world thinks about aging and
the elderly. One of the first psychiatrists to
engage with older men and women outside
of institutional settings, Butler coined the
term “ageism” to draw attention to discrimination against older adults and spent a lifetime working to improve their status, medical treatment, and care.

Early in his career, Butler seized on the positive features of late-life development—
aspects he documented in his pathbreaking
research on “healthy aging” at the National
Institutes of Health and in private practice.
He set the nation’s age-based health care
agenda and research priorities as the founding director of the National Institute on
Aging and by creating the first interprofessional, interdisciplinary department of geriatrics at New York City’s Mount Sinai Hospital. In the final two decades of his career,
Butler forged a global alliance of scientists,
educators, practitioners, politicians, journalists, and advocates through the International Longevity Center.

Robert N. Butler, MD

“W. Andrew Achenbaum has crafted a biographical masterpiece about a significant contributor to the ideas and social ideals of the twentieth century. He
reconstructs the life and contributions of Butler—psychiatrist, foremost
authority on aging, Pulitzer Prize winner, and activist—and in the process
illuminates the practices, debates, and concerns surrounding aging in America and around the world. This book about a remarkable visionary is a mustread, reaffirming Achenbaum’s position as a leading scholar and historian of
aging in America.”

Visionary of Healthy Aging

W. Andrew Achenbaum is professor of social work and history at the Graduate School of Social Work, University of
Houston. He also holds the Gerson and Sabina David Professorship in Global Aging, and
is a fellow at the Institute for Spirituality and
Health and the John P. McGovern M.D.
Center for Health, Humanities, and the
Human Spirit at the University of Texas
Medical Center. His books include Social
Security: Visions and Revisions; Crossing
Frontiers: Gerontology Emerges as a Science;
and Older Americans, Vital Communities:
A Bold Vision of Societal Aging.

Robert N.
Butler, MD

W. Andrew Achenbaum

ROBERT N. BUTLER, MD

ROBERT N.
BUTLER, MD
Visionary of Healthy Aging

W. ANDREW ACHENBAUM

Columbia University Press
New York

Columbia University Press
Publishers Since 1893
New York Chichester, West Sussex
cup.columbia.edu
Copyright © 2013 Columbia University Press
All rights reserved
Library of Congress Cataloging-in-Publication Data
Achenbaum, W. Andrew.
Robert N. Butler, MD : visionary of healthy aging / W. Andrew Achenbaum.
pages cm
Includes bibliographical references and index.
ISBN 978-0-231-16442-9 (cloth : alk. paper) — ISBN 978-0-231-53532-8 (e-book)
1. Butler, Robert N., 1927–2010. 2. Gerontologists—United States—
Biography. 3. Gerontology—United States. I. Title.
HQ1064.U5B8733 2013
305.26092—dc23
[B]
2012048642

Columbia University Press books are printed on permanent
and durable acid-free paper.
This book is printed on paper with recycled content.
Printed in the United States of America
c 10 9 8 7 6 5 4 3 2 1
Cover design by Jordan Wannemacher
Cover image by Robert Caplin, courtesy of the New York Times/Redux
References to websites (URLs) were accurate at the time of writing. Neither the
author nor Columbia University Press is responsible for URLs that may have
expired or changed since the manuscript was prepared.

To Robert N. Butler’s daughters
—Cynthia, Carole, Christine, and Alexandra—
and to his grandchildren and great-grandchildren
And in memory of Myrna I. Lewis (1938–2005)

CONTENTS

Preface
Acknowledgments

ix
xvii

one LIFE REVIEW1
two THE FORMATIVE YEARS25
three A PROFESSIONAL APPRENTICE47
four FORGING WASHINGTON
CONNECTIONS69
five BUTLER AT THE NATIONAL
INSTITUTE OF AGING91
six EXPANDING THE SCOPE
OF GERIATRICS115

viiiCONTENTS

seven RECASTING THE NEW GERONTOLOGY
THROUGH THE INTERNATIONAL
LONGEVITY CENTER139
eight AMERICA’S AGING VISIONARY165
EPILOGUE189
Appendix: Prologue or Introduction to Life Review

199

References

219

Index

253

PREFACE
Robert Neil Butler, MD
(January 21, 1927–July 4, 2010)

Dr. Robert N. Butler became the “Visionary of Healthy Aging” here
and abroad by dint of his five decades of groundbreaking research, influential writing, prudent institution building, and diligent networking. He
helped to transform the study of aging from a marginal specialty into an
intellectually vibrant field of inquiry. Gerontology now attracts the attention of renowned scholars, emerging professionals, students, and other experts who are determined to understand the secrets of longevity and
healthy aging. Butler designed, underwrote, and conveyed perspectives on
aging rigorous enough to impress scientific peers and practical enough to
sway policy makers and politicians. A psychiatrist and geriatrician, Butler
also initiated changes in the training of physicians and other health professionals on how to care for the elderly. All this had a profound impact on
altering the lay public’s images of the aged: Butler gave people reason to
question stereotypes that demeaned late life and cause to focus on healthy,
productive aging.
With Butler’s death a formative chapter in the history of gerontology
and geriatrics ended: we are unlikely to see in our lifetimes anyone so

xPREFACE

adept at generating, championing, and communicating issues in aging. Butler exemplified the importance of interdisciplinarity in advancing research,
education, and policy making in gerontological practices. Geriatrics, he
stressed, was more than a medical specialty that complemented family
medicine; it offered a team approach to addressing older people’s resources
and resilience while attending to diseases and challenges of late life.
No contemporary gerontologist or geriatrician moved as deftly as Butler
from one domain of American life to another. He and his ideas became a
significant presence in medical schools and higher education, the media,
hospitals and laboratories, literary and cultural organizations, foundations,
and government agencies. He left an ambitious agenda for future work in
geriatrics and gerontology. Those who continue to work in these and related
fields would do well to capitalize on three of Butler’s remarkable strengths:
(1) his dogged determination to stimulate and refine scientific investigations concerning various dimensions of human aging, (2) his gifts for conveying images to the public that illuminate the meanings and experiences
of late life, and (3) his capacity for mentoring, in addition to his remarkable
generosity to those who aspired to improve the quality of late life.
Butler was an idea broker. In his twenties, when he was a fledgling investigator and physician, he saw potential for personal growth among
people advancing in years. Whereas most physicians and clinicians in the
1950s and 1960s focused on aging as a disease-ridden period of decline, he
extolled later years’ positive qualities. Eager to broaden and clarify scientific modes of gerontology, Butler devoted his career to promoting means
to enhance older people’s health, esteem, and social roles. He gleefully
crossed disciplinary frontiers to challenge and uproot disparaging views of
human aging; he endeavored to replace stereotypes with images that
accorded older individuals everywhere dignity and respect.
Butler envisioned a new millennium that held unprecedented opportunities for productive aging. “Many of our economic, political, ethical, health,
and other institutions, such as education and work life, have been rendered
obsolete by the added years of life for so many citizens,” he proclaimed in
the Longevity Revolution (2008:17). In the midst of the modern Longevity
Revolution, which was transforming individual ways of growing older and

PREFACExi

vectors of societal aging, healthy elders could and should use their talents
and experiences to benefit youth. Commentators in the United States and
abroad saluted Butler’s vision. “No one did more to change society’s perceptions of ageing and the aged than Robert Butler,” declared the obituary
writer of the G uardian in Britain (Carlson, 2010), “because his greatest
achievement was in changing the attitude that obsolescence was the inevitable product of the ageing process.”
Butler the idea broker also proved to be a masterful wordsmith. Over
the course of his career, Butler coined many words and phrases now used
to describe the meanings and conditions of being older. For instance, as a
newly minted psychiatrist, he developed the concept of the “life review,” a
technique to assist elderly men and women grappling with issues still unresolved from earlier in their lives as they came to face death’s inevitability.
Therapists fifty years later still use this technique to encourage clients to
journal their journey of life. And, as we shall see in chapter 1, Butler himself revisited his ideas about life review in his last weeks.
In his mid-fifties Butler introduced the idea of “productive aging” to
embrace the contributions elders made in their households, volunteer activities, and late-life careers. Others, taking cues from him, added “successful,” “vital,” “conscious,” and “positive” aging to the repertoire. Such themes
remain prominent in popular books, news reports, media releases, and research articles. They all underscore positive aspects of growing older.
Well past normal retirement age, Butler sought to broaden the range
and focus of aging studies. The consequences of demographic shifts associated with the Longevity Revolution, he believed, required scientists to develop fresh scientific constructs for studying societal aging and to create
new institutional arrangements and normative patterns to accommodate
individuals benefiting from extended years of maturation. Summing up a
rich career of exchanges with other idea brokers, he mapped out the parameters of what he called the “New Gerontology” in The Longevity Revolution, articulating a bold model with which to analyze and harvest the
fruits of extra years. While disappointed by the poor receptivity to his
ideas, he nonetheless exuded his hallmark self-confidence as he insisted
that he was on the right track.

xiiPREFACE

There were frustrations other than intellectual disappointments. Butler
well understood that ignorance, prejudice, and stereotypes clouded the vision of vital, productive, fruitful aging that he wished to promulgate. The
mistreatment of older patients in health-care facilities and the neglect of
geriatrics by the medical establishment had begun to anger him while he
was still an intern. Butler chastised colleagues for presuming that the depressed outlook and physical impairments common among the institutionalized aged represented the “normal” profile of older Americans. Butler
gave the odious prejudice a name: in 1968 he coined the term “ageism” as
an analog to “racism” and “sexism.” Ageism quickly entered everyday parlance. Ageism undermines the value and status of elderly men and women
in virtually every sector of American life—notably education, health care,
the labor market, and the media—and remains there to this day.
In late life Butler concluded that ageism was even more pernicious and
invidious than he initially had realized. In “Combatting Ageism: A Matter
of Human and Civil Rights,” his introduction to a report on Ageism in
America (2006:1), Butler opined that
the status of older persons and our attitudes toward them are not only rooted
in historic and economic circumstances. They also derive from deeply held
human concerns and fears about the vulnerability inherent in the later years
of life. . . . Older people are still being rendered invisible. Instances of this
invisibility occurred in the horrific aftermath of Hurricane Katrina when a
person’s class (impoverished) and race (black) were dominating factors in
survival. Older persons in their own homes and in nursing homes were often
abandoned.

Butler now called ageism a disease, a morbid fear of decline and death that
crippled individuals.
Outrage at the disregard and devaluation of older persons impelled him
to write Why Survive? Being Old in America (1975b), which won a Pulitzer Prize. “When we talk about old age, each of us is talking about his or
her own future,” Butler wrote. “We must ask ourselves if we are willing
to settle for mere survival when so much more is possible.” From a man

PREFACExiii

usually guarded about expressing feelings, this sentence reveals much
about Robert Butler and his raison d’être: the visionary of healthy aging
rarely hesitated to forcefully challenge conventional wisdom about aging
when he felt it was wrong or misguided.
Nor did Butler accept “mere survival” as the baseline for living, despite
moments in own his life history that tested his resilience and perseverance.
The Great Depression shaped his childhood, exposing him to poverty and
loss, material and familial. Grieving the death of his beloved wife, Myrna
Lewis, for the rest of his days, he nonetheless remained open to new love.
On top of his strenuous writing and travel schedules, he found time to
grant interviews and to support diverse cultural and political causes. Butler
invariably accentuated the positive, quick to note progress made. He championed causes for older Americans with unrelenting optimism. Sometimes
such an ebullient outlook blinded him to inconvenient truths in the marketplace of ideas and in his dealings with others.
Appointed in 1976 by President Gerald Ford to be the first director of
the National Institute on Aging (NIA), Butler took daring, sometimes controversial, steps: he made research on Alzheimer’s disease a priority at NIA
instead of earmarking incremental resources into basic biomedical mechanisms and processes of aging. After he moved to Mount Sinai Medical
Center in New York to establish the country’s first geriatrics department,
federal and local cost-cutting measures made it difficult for him to secure
budget increases for elder care. That he flourished so long in an era of superspecialization and zero-sum academic politics attests to Butler’s savvy
and leadership style. After initially playing to his strengths in basic sciences
at the International Longevity Center, he delved heavily into economics
and ethics, two areas where he was not trained.
The outpouring of affection in obituaries in the United States and
around the world demonstrates the respect and admiration bestowed on
Robert Butler. According to Catherine Mayer (2010), who interviewed him
for Time a few weeks before his death, “he proved a role model, right until
the end, as he was energetic and effective.” Christine Cassel, MD, president of the American Board of Internal Medicine, remembered her mentor this way: “Bob Butler [had] an amazing ability to keep both engaging

xivPREFACE

personal stories and attention-grabbing statistics on the tip of his
tongue. . . . For those of us who watched his effective presentations, these
speeches were themselves worthy objects of study. We realized that carrying the baton he handed to us required understanding the skills of persuasion just as much as the skills of being a good geriatric clinician or researcher” (Cassel, 2010).
Butler was a can-do, go-to guy, at once a cheerleader and a taskmaster
who expected the best from others and certainly nothing less from himself.
He was a loyal friend who routinely checked up on college roommates.
Butler traveled easily in the rarified circuit between Washington and New
York. Although received royally abroad, he remained hospitable to strangers, unfailingly courteous to all.
In November 2009 Robert Butler showed me a draft of a memoir he
said that he had written for his four daughters and grandchildren. Having
known Butler for thirty years, I suspected that he intended to publish what
he had written. When I told him bluntly that the text needed a lot of work,
he invited me to edit it. I replied that I preferred to write his biography. He
worried that my rendition would be too flattering; I assured him that that
would not be an issue.
I worked with Bob on this book until he died. Besides sharing his love
of history and ideas, I knew the names of most of his friends, and I interviewed key colleagues in geriatrics and gerontology. I enjoyed listening to
him ruminate about science and culture, revise his action plan for what he
absolutely had to accomplish within the next five years, and express his love
for and pride in his daughters. Two weeks after his death, to honor one of
Butler’s last intentions, I traveled with three of his daughters and his dear
friend on an itinerary he had planned—to Vineland, New Jersey, where
Bob spent his early years, and to Rehoboth Beach, Delaware, where the
family usually vacationed in August.
My main purpose in writing Robert N. Butler, MD: Visionary of
Healthy Aging has been to interpret how this éminence grise helped to
shape the history of gerontology and geriatrics in the United States during
a critical period of development. Butler’s life personified the ripening of
the greatest human possibilities into advanced age. His life work refracted

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