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Cutting Edge
Robert N. Butler, M.D. (1927-2010):
A Visionary Who Understood and Promoted the Value of Older Age
British gerontologists rightly chide their American cousins for (too) often presenting a U.S.-centric, intellectual overview of the aging enterprise. Hence with trepidation I came to Plymouth to participate in the British Society of Gerontology’s 40th anniversary meeting; I had chosen to talk about Dr. Robert Butler’s significance to our field. My country’s most distinguished gerontologist and geriatrician died on 4 July 2010, one year before this BSG conference. His was the quintessential American success story, yet his impact was global. Brains, grit, luck, connections, gumption, and charm guaranteed Robert Butler’s worldwide influence on the field of aging.

Robert Butler had deep U.K. ties. Dr. Butler worked closely with Baroness Sally Greengross at Age Concern and later at the International Longevity Center. In our conversations Dr. Butler shared fond recollections of Peter Laslett and Peter Townsend. He repeatedly told me that he learned much from advising several British charities on priorities in aging, and monitoring your delivery of geriatric health-care.

There is value in reviewing the life, modus operandi, and unfinished business of this visionary who understood and promoted the value of older age. Robert Butler’s legacy challenges gerontologists on both sides of the Atlantic to consider how much one person’s imagination and dedication transform a domain—and, alas, how cultural and political impediments can overwhelm gallant crusades.

R. N. Butler’s Biography

Robert Butler endured poverty, loss, and death as a child of the Depression. Through it all, Butler said, he felt special and loved. After World War II, Dr. Butler was intellectually challenged at Columbia University where, as editor-in-chief of the newspaper, he learned how to write. Appalled at the way elderly patients were treated, Butler decided as an intern to become a gero-psychiatrist.

A year’s residency at San Francisco’s Langley Porter Institute introduced Dr. Butler to psychopharmacology. He then moved to the National Institute of Mental Health (NIMH), where he spent the happiest years (1956-63) of his career. He collaborated with James Birren on Human Aging, one of the first interdisciplinary studies (along with investigations at Duke) empirically to document that aging entailed more than declining. Dr. Butler also developed “The Life Review” (1961-63), using late-life reminiscences to help patients resolve conflicts as death approached. (As Peter Coleman has noted, Butler early on acknowledged risks in encouraging people with depression to do life reviews.)

After leaving NIMH, Dr. Butler practiced psychiatry at home in Washington, D.C., where he and his wife raised three daughters. He taught in medical schools, coined “ageism” (1969), and consulted for the U.S. Senate Committee on Aging. As one of the few U.S. psychiatrists seasoned in science, policy, and practice, Robert Butler quickly emerged as the Capitol’s Can-Do, Go-To Gerontologist.

Robert N. Butler won the Pulitzer Prize for Why Survive? Being Old in America (1975) the day he assumed duties as the founding director of the National Institute on Aging. Over the next six years, Dr. Butler set an agenda for bio-medical and psycho-social investigations into processes of aging, invested in research on Alzheimer’s, and built partnerships within the National Institutes of Health and among U.S. researchers to advance geriatrics and gerontology scientifically and pedagogically. He generated demographic and epidemiological evidence to justify national legislation to end age discrimination in employment and to shore up Social Security financing.

In 1983, Dr. Butler accepted the challenge of creating the first U.S. department of geriatric medicine at N.Y.’s Mount Sinai Medical Center. He accomplished most of what he intended to do, but internal and extramural budget cuts and personnel changes quickly created difficulties. So Butler turned to other projects. With his second wife, Myrna Lewis, he updated editions of Mental Health and Aging and Love and Sex after Sixty. And Robert Butler used his bona fides to recruit partners in Europe, Japan, and Latin America as well as to generate funds to establish an International Longevity Center (1990), which focused on consequences of societal aging on health care, employment, and social relations.

Portrait of a Medical Scientist as a Visionary

Over the next two decades, Butler invited economists, sociologists, journalists, corporate executives, politicians, and idea brokers to join him in formulating what he called “the new gerontology”, a conceptually ambitious, policy grounded paradigm determining how population aging affected everyday life globally. He presented his model in The Longevity Revolution (2008), a book fifteen years in the making that failed to have the impact of Why Survive? In retrospect, it is easy to suggest why Butler’s message fell flat. In 1975 conservatives had not yet imprinted their ideological and fiscal stamp on America’s political economy; thirty years later liberals rarely mustered support to increase investments in basic science or appeal for greater access to preventive care. Academic tribes resisted the interdisciplinary boundary-crossing presupposed by Butler’s Longevity Science. And Robert Butler’s optimistic images of aging did not persuade Americans who preferred to ignore or deny its onset as they spent time and money to prevent its signs.

That said, Robert Butler was Aging’s Visionary. He did more than any other physician/scientist/policymaker/advocate to frame gerontology during the last half-century. His intellectual style parallels the breadth of Sarah Harper, Chris Phillipson, Malcolm Johnson, and Alan Walker. Butler was a critical thinker who studied the past and imagined our future selves, often defying conventional wisdom. And more than most scholars, he knew how to connect people with ideas. Michael Carlson’s effusive obituary in the Guardian (18 July 2010) underscores Dr. Butler’s impressive network of friends and colleagues, his extraordinary kindness to strangers and neophytes with good ideas and fresh approaches to the opportunities, challenges, and paradoxes inherent in societal aging.

The Challenge

Much remains to be done. Geriatric fellowships go unfilled; there are not enough health-care professionals with sufficient training or commitment in the U.S. and U.K. to listen to and care for women and men living into the Third and Fourth ages. Lawmakers here and abroad are keener to reduce budget deficits than to empower mature citizens with new skills to utilize (compensated or not) in matters that give them satisfaction and, ideally, contribute to others’ well-being.

Gerontologists, who like me admire Robert Butler’s achievements, can find meaningful work in rounding out his unfinished business. I propose a three-fold agenda:

1. We need to adopt life-course perspectives. Butler tended to concentrate on the resilience and decrements of people over 50. He made few references to childhood and early adulthood and (except for his interest in dementias and nursing homes) said little about people in the Fourth Age. Insofar as the Longevity Revolution distributes extra years over the life course, gerontologists must broaden their field of vision.

2. We need to differentiate among individual, population, and societal aging. Surely one of the great contributions of Ageing & Society, compared to a-theoretical U.S. journals, has been to insinuate terms such as “structural dependency” into the gerontological lexicon. We need to integrate gerontology into other major issues. Immigration, global climate issues, and everyday ethics of life and death demand framing through the lens of gender, race, ethnicity, region, and age.

3. Ageism is more than a prejudice; it is a disease. Work by Bill Blytheway, Margaret Morganstern Gullette, and Andrew Blaikie among others document a virulent ageism unimagined by Robert Butler when he gave a name to the phenomenon in 1969. Ageism afflicts young, old, and those in between--albeit in different ways. Until we extirpate obsolete, stereotypic modes of thinking, we cannot produce theories, policies, and practices essential to comity across generations in aging societies.

I doubt that laying the foundations for Robert Butler’s “new gerontology” will be accomplished in my lifetime. Still, as BSG prepares to observe its 50th anniversary, attending to these three issues is essential legacy work that fittingly builds on the bold agenda by Aging’s Visionary.

W. Andrew Achenbaum is professor of history and social work at the University of Houston, where he holds the Gerson and Sabina David Professorship in Global Ageing. He is completing a biography of Robert N. Butler, M.D. and working with Harry R. Moody on Leaving a Legacy.
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