How Does Aging Affect Mental Health

Hu, Charles
2011 How Does Aging Affect Mental Health and the Onset of Senility from a Chinese Medical Perspective
Final Paper, Anthropology of Chinese Medicine 98T, UCLA

It is an inevitable element of societies and cultures to evolve and innovate, improving technology and medicinal practices. Given the constant improvement of biotechnology, the increase in human lifespan has become an inevitable facet of our growing population. As a result, the number of senior citizens (over the age of 65) will continue to dramatically increase. In the United States, the proportion of elderly citizens has increased from 4% in 1900 to about 12% in 2000. This translates to approximately 3 million senior citizens present in 1900 and 35 million in 2000.
Experts estimate that in the year 2020, that number will increase to over 50 million—approximately 17 percent of the population (Meyer 2001). There is an even more rapid growth exhibited in the elderly population in China. In 1950, the elderly population amounted to approximately 7.5%, which grew to 10.9% in 2005. It is projected that in the year 2050, China’s elderly population will increase to a staggering 31% amounting to over 400 million people (Heilig 2010). As the growth of the elderly population persists, accompanied by the increase in human lifespan, an increase in chronic health issues will emerge. The emergence of health issues in the elderly will subsequently cause the necessity for more refined medicinal procedures and improved technology, thus bringing us full circle. Before we can explore and compare the Western and Chinese treatments associated with geriatric illnesses, we must first understand how each culture perceives the aging process.
Each culture has a unique perspective on aging that has helped shaped the way elderly are viewed and treated today. Some similarities are apparent, but many differences can be established due to the cultural disparities that arise in their historical backgrounds. By evaluating the views of each culture separately, we can expect to gain a better understanding of why the elderly are treated the way they are. Hopefully, through assessment of previous studies and anthologies of Traditional Chinese Medicinal (TCM) history, the basis behind the particular perspectives on aging and the theories of aging can be uncovered. With a better grasp on the process of formulating these theories, a considerable number of opportunities to comprehend the arrival to such theories should present themselves. In Western culture, the notion of progressing into old age has developed a generally negative connotation (Purnell 1998). Looking and acting young has become a popular fad in American culture. Because there is a general fear of growing old in Western culture, ageism is exhibited and the elderly are often times discriminated against. Elderly are frequently seen a sick, senile, and generally useless. To their surrounding youth, older individuals are considered a burden and overly dependent (Cook 2003). With advancing medical technology to improve health and longevity, Western culture focused on reducing the symptoms of old age. However, the introduction of Botox, implants, and liposuction has enhanced the proposal that looking and acting young is positively viewed. On the other hand, traditional Chinese cultural views toward the elderly are much removed from its Western counterpart. In fact, the Chinese place the elderly on a pedestal because of the idea that they have accumulated wisdom and knowledge over the years (Murray, 1998). Much of their moral system finds basis in the teachings of Confucius. In particular, Fairbank et al. (1959) stated that “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.” Respecting the elderly was part of the teachings of filial piety. They believed that it was necessary for the younger and more able to care for their parents, so that when the children reached old age, their own children would also care for them. Since, Confucianism was such an integral part of their lifestyle and culture, the development of Chinese medicine uniquely followed many Confucian ideals. Contrary to what many believe, Confucianism bases its teachings on materialistic views rather than superstitions. It was due to this mindset of intellectualism and rationalism that the development of Chinese medicine was fostered (Horne 2004). Similarly, the importance of respecting the elderly and maintaining their health has translated into how they are medically treated.
Although the aforementioned Western and Chinese ideologies are generally accurate, both cultures are constantly changing and their views have become less polarized. Elderly individuals in Western culture have an improved sense of stability in their old age. This is due to the fact that they are generally more educated and financially secure than previous generations (Purnell 1998). In the current China, many youth have begun to migrate to larger cities leaving the elderly behind in the rural areas instead of providing continual care, thus creating disconnect between the two generations. However, both of these recent changes have led to the improvement of the treatment of diseases associated with the elderly (Cook 2003). Increased education and financial sufficiency in western civilization along with the departure of the youth from farm occupations in Chinese society has helped spur the progression of technology and ultimately medicine.
In modern Western medicine, it is understood that as we age, our bodies will undergo a variety of significant changes. These changes include physical, personal, and emotional alterations that result from the deterioration of our biological selves along with long-lasting experiential situations. During our youth, the rapid pace of our cell growth overshadows the level of cell death that occurs. However, as age increases, the speed of cell growth gradually slows and our bodily functions diminish accordingly. Similar effects occur within our brain as it receives less circulation resulting in slower response times. These changes, although inevitable, can have an effect on our emotional well-being. The culmination of all of these aging issues can cause a variety of possible health concerns to develop including mental disorders characterized in the western world (Purnell 1998). The elements of aging, as portrayed in Chinese medicine, take on a noticeably unique form. In Traditional Chinese Medicine (TCM), each person is born with a certain amount of “essence.” This essence is stored within the kidney, which is the main proprietor for the growth, development, and eventually decline of an individual (Flaws 2001). The level of essence within our bodies remains constant and can be replenished by eating properly. As an individual reaches the age of forty, total essence begins to decline. An oversimplified analogy of the concept of the kidney as a repository for essence is that it is similar to the function of a rechargeable battery. This battery can be recharged many times, but sooner or later the battery will run out of energy and no longer be able to be used. Likewise, as we age, the amount of kidney essence declines until it is exhausted, at which point one’s lifespan comes to an end. Furthermore, mental disorders are viewed and categorized much differently from their western counterparts. The term “mental disorders” itself, is a misnomer. The categories found in Chinese medicine include, but are not limited to senility, feeble-mindedness, impaired memory, and withdrawal and mania (Flaws 2001). All of these concerns can be attributed to blood stasis and a hampered flow of qi—concepts that are seemingly abstract in comparison to western culture. Of all of the issues that arise with the progression of age, one of the most prevalent illnesses is senility. However, like many infirmities with similar names between each method of medicinal practice (Chinese and biomedical), senility is analyzed under very different lights. In biomedicine, senility is described as an overall decline in mental function. Impaired mental function usually involves deterioration of the ability to reason, memory loss, difficulty communicating, and loss of locomotor ability (Forbes 1993). Causes of senility include, but are not limited to, hardening of the arteries, poor nutrition, vitamin B deficiency, alcoholism, or strokes. Senility can also be a secondary symptom of destructive brain diseases such as Alzheimer’s, Lewy body dementia, and vascular dementia. It is unfortunate, but as senility progresses, an individual’s personality and ethical norms may deteriorate to the point of being unable to be recognized.
Although mental disorders are a relatively novel area of study in Chinese medicine, the concept of geriatrics and treating the elderly has been present for over twenty-five thousand years (Fairbank et al 1959). The attitude towards the elderly in Chinese culture can be traced back to the era of Confucius. As mentioned above, one of the primary ideals of Confucian beliefs that still remain today is the virtue of filial piety. Filial piety can be simplified to generally mean respecting one’s parents (xiao). However, filial piety also encompasses engaging in good conduct and benevolence toward elders (ren) (Fairbank et al 1959). Benevolence is at the foundation of many Confucian practices, which have shaped the development of ethics in Chinese medicine. According to definitions found in various English dictionaries, benevolence can mean kindness and altruism. However, the term benevolence is equivalent to the idea of loving all people (Lau 1992). In Lau’s (1992) translation of the teachings of Confucius, he continues to describe the basis of benevolence in the two moral traits of “shu” and “chung.” “Shu,” a word difficult to interpret without obscuring its true meaning, is most often translated into reciprocity or self-analogy. To clarify, “shu” embodies the ideology of recognizing one’s own obligations to others while using oneself as an analogy. For example, if you identify something as favorable to yourself, it may very well be favorable to others. Likewise, Confucius defines “shu” as “not impos[ing] on others what you do not wish imposed on yourself” (Lau 1992). However, Confucius recognized that not only is it important to understand the obligations one has with regards to others, it is also necessary to act on that understanding. Simply stated, one must not only talk the talk, but also walk the walk and put into practice the best of one’s abilities. Thus Chinese medical practitioners that are equipped with the knowledge of “shu” and chung” can better understand a patient’s situation and care for them with the best treatment possible. By doing so, physicians convey the ultimate expression of love by saving people’s lives through proper practice of medicine. Without love, one cannot appreciate the value of someone’s life. Without respecting the value of each person’s life, Confucians believed that more harm rather than good would come because rigor and detail were not sincere in the diagnosis of a patient.
Another important aspect of Confucian belief states the importance of universal treatment no matter a patient’s gender, race, mental ability, status, and even age. Interestingly, the Chinese medicine approach to medical ethics and equality was not based on engraving a set of standards into stone. Instead, it was individually developed through continued self-examination, and self-restriction by the physician. Moreover, Confucius believed that each individual had an inherent sense of right and wrong. By examining the self thoroughly, one can eventually learn to cultivate a more complete understanding of his/her conscience. When a physician has learned these qualities, they are able to successfully and correctly treat a patient while putting their own biases aside. Dr.
Yan De-xin, author of Aging and Blood Stasis examines the changes that occur as humans age and how senility manifests in the scope of TCM methodologies. Previous TCM geriatric specialists have reduced the cause of senility to vacuity detriment in the viscera and bowels. What exactly do the terms vacuity detriment and viscera/bowels encompass in regards to Chinese medicine? Wiseman and Feng (1998) describe vacuity detriment as “any form of severe chronic insufficiency of yin-yang, qi-blood, and bowels and viscera arising through internal damage by…excesses…or enduring illness.” To further elucidate the meaning of yin and yang, one may be able to understand it as the “bipolar manifestation of all things in nature” (Flaws 2001). Within nature and the body, there is a dynamic relationship between yin and yang. During times of normality, there is usually a balance between the two; however, this equilibrium is not static but constantly changing. Shifts in yin and yang are natural, but when one is consistently altered or dominates the other, health problems will
arise.
To fully comprehend the concept of the viscera and bowels, one must put aside the Western understanding of human physiology. According to Chinese medicine, the internal organs of the human body can be classified into five viscera organs and six bowel organs (Flaws 2001). The five viscera organs include the heart, liver, spleen, lungs, and kidneys while the six fu organs include the stomach, small intestines, large intestines, gallbladder, urinary bladder, and triple energizer. Each organ has a yin or yang characteristic. If an organ is yin, it will have an affiliated yang counterpart and vice versa. Without providing an overwhelming volume of information, each organ also has specific functions that are vastly different from biomedical principles. Of the more relevant organs most associated with aging and senility, the heart is an important player in control all activity and function of viscera. The heart is also responsible for blood and qi flow throughout the body. The facial blood vessels are used to determine underlying conditions of the heart. For example, a healthy functioning heart will manifest as rosy cheeks while a face that is blue-purple indicates blood stagnation (frequently seen in elderly patients). The regulation of qi flow is also important as it affects one’s emotions. When there is a disharmony of qi, physiological symptoms will manifest as cold hands or tiredness. Since emotions and mental activities are closely correlated, these disharmonies may also cause poor memory, indecision, and circulation problems, which are all associated with senility in the elderly (Flaws 2001).
It has also been found that vacuity occurs mostly in the kidney and spleen.
More importantly, the kidney is an essential component for maintaining balance within the body (Flaws 2001). Its importance lies in its function as the center of the body’s yin and yang, the origin of life. Kidney yin nourishes all other organs by providing them with energy while kidney yang is responsible for the storage of kidney yin to promote proper functioning of other organs. When yin and yang are in harmony, the body will exhibit harmony, whereas the dissociation of yin and yang will exhaust essence (the essential qi, which is the basis for growth/development and various other physiological activities throughout the body) and qi, two elements essential to the maintenance of health. Therefore, the phrase, “too much of anything is not a good thing” summarizes the perspective on yin and yang. Knowing how to balance yin and yang is crucial to preventing vacuity and stagnation of qi. Furthermore, the kidney and spleen are two of three organs responsible for the control of fluids within the body. When vacuity occurs in the kidney and spleen, a decline in their function will cause dampness leading to its congelation into phlegm. With the onset of qi vacuity, common symptoms are lack of movement and activity. However, this lack of locomotor activity will lead to qi stagnation, blood stasis, and phlegm congelation. Since the lifestyle of most elderly individuals is sedentary, it is not surprising to
see these symptoms arise more often in individuals in that age range. Dr. Yan (1995) further explains that through his own clinical experience, there is much more to senility than vacuity of the viscera and bowels. Yan continues by listing other significant avenues of thought. First of all, he believes all aspects of growth, development, and aging are related to the qi and blood including disharmony. Qi is responsible for producing tissue and organ function while blood nourishes and enriches the entirety of one’s body. Since one is unable to be mentioned separately from the other, a deficiency of disease in one will certainly affect the other. Over a course of a lifetime, the alterations that occur to the body will eventually lead to diminished function in the viscera and bowels, and subsequently, senility. Once again, before we can begin to fully understand how aging occurs through the TCM lens, the functions and qualities of qi and blood must be thoroughly illustrated. As mentioned above, qi and blood are intertwined, such that if both are working under normal circumstances, the body will experience great health and longevity (Yan 1995). Uninhibited and balanced qi and blood flow result in normal physiological functions. Normal physiological functions can occur because normal flow carries a plethora of constructing and nourishing substances to all tissues and organs in the body. Uninterrupted blood circulation further allows the possibility of successful transportation and transformation of these substances being carried to the entire body. Normal circulation has two key forces: the propelling force and the securing force. The propelling force is simply defined as the “motivating power for blood circulation” (Yan 1995). Movement of blood circulation is promoted through the proper discharge of the heart, lungs, and liver. The securing force is responsible for keeping the blood from flowing outside its confines. An insufficient securing force results in the blood spilling and exiting from its normal areas of affect. If either of these two forces are disrupted, normal function of the viscera and the bowels cannot occur, which leads to health deficits. Even if debility occurs in one of the viscera and a near fullness in the other, diseases can manifest. The principle cause of senility according to Yan (1995) is a condition known as blood stasis. It results from slowed or stagnated flow of the blood often due to an obstruction. Stagnated blood will separate itself from fresh free-flowing blood. However, it will also negatively affect the fresh blood preventing it from being transformed. Thus, various abnormal metabolic products can form, designating the presence of a physiological issue. Throughout one’s life, one is constantly fighting to maintain balanced qi and blood flow but its gradual degradation and decrease is a never ending spiral toward complete diminishment. This lends itself to the discussion of qi and blood vacuity weakness. Qi vacuity is the decline in the function of various tissues and organs important in senility causing decrease in the ability to fend off disease. The primary symptom of qi vacuity is fatigue. The body exhibits evidence of fatigue through diseases in the digestive system, a yellow skin tone, poor appetite, fat tongue, and a weak pulse (Yan 1995). Blood deficiency can be distinguished by a pale complexion, along with pale lips and nail beds. Central effects of blood deficiencies also include heart palpitations, vertigo, numbness in the extremities, possible amenorrhea or disrupted menstruation cycle, and a thin pulse. As a result, blood stasis can be asserted as the established root of the problem in many geriatric patients. Diseases most seen in elderly patients including arteriosclerosis, hypertension, coronary heart diseases, and senile dementia all lend their origins to the underlying issue of blood stasis (Yan 1995). However, treatment for senility cannot simply be solved with supplementation because it will result in continued, if not increased, stagnation. Increased stagnation paves the way to increased vacuity. Proper clinical treatment should involve quickening of the blood to transform the static blood encouraging fresh blood flow. Still, the inevitability of old age will eventually catch up to one’s body no matter the level of balanced lifestyle choices made. The human body will have increasing trouble in microcirculation, resulting in impairment of function in the movement of blood and qi. Not only do chronic diseases being to surface, physiological disturbances can occur in metabolic functions, organs, the immune system, and the endocrine system. Senility becomes the result of the culmination of these imbalances and abnormalities. Much has been mentioned about the causes of senility and the consequences that are associated with its onset. However, the daunting question every TCM physician must ask is, “how should senility be treated?” In order to treat senility, the disease must be recognized as an imbalance of yin and yang. Since qi and blood are the material bases of yin and yang in the body, regulating, coursing, and freeing the flow of qi and blood will alleviate the body of the diseases associated with senility. Regulation can be accomplished through external means, such as using medicinal substances. To determine the correct and most beneficial medicinal formulas to concoct, accurate pattern discrimination is essential. Pattern discrimination is the basic formulation of a diagnosis by evaluating the signs and symptoms exhibited by the patient. The evaluation will take into account the “eight principles,” which consist of four pairs of the fundamental qualities of all diseases. These pairs are divided into: exterior and interior, heat and cold, vacuity and repletion, yin and yang. When the evaluation is completed, and the cause and mechanism of the symptoms of senility are determined, an appropriate formula can be established.
There are many medicinal formulas that have the qualities of quickening the blood and transforming or dispelling stasis. These formulas all share common characteristics of freeing and disinhibiting the blood vessels while eliminating static blood (Yan 1995). However, they each have their own specific qualities such as the ability to nourish the blood, move qi, cool the blood, open network vessels, etc. Therefore, it is important to carefully decide on which formula to use in order to fulfill the goal of quickening the blood and transforming stasis while still treating the symptoms found in a patient’s pattern discrimination.
Yan (1995) provides sound evidence of the efficacy of many of the balancing methods in combating senility and preserving health. He recorded his observations in a manner more palatable to the biomedical community of the Western world. In one particular instance, Yan describes the clinical results of eighty cases using a balancing method to help prevent senility and treat hysteria, emotional depression, and neurasthenia. The symptoms that manifested ranged from insomnia and poor memory to fatigue and dizziness. The patients suffering from these symptoms had unsuccessful results with the previous use of sedatives. Therefore a treatment containing a variety of Chinese medicinal herbs was employed. Out of the eighty total cases, 46 of them showed a positive result. Most of their physical symptoms waned and their blood rheology returned to normal. Although there were cases where no change was exhibited, there did not seem to be any negative effects of the herbal treatment. Another clinical study compared the administration of yet another balancing method in 150 elderly patients. This particular method treated common geriatric diseases including arteriosclerosis, hypertension, insufficient blood supply to the cerebral vessels, and, most importantly, premature senility. The treatment resulted in the successful mitigation of many of the symptoms caused by the above mentioned diseases. Modern laboratory equipment was used to analyze microcirculation, capillary rheology, and blood rheology showed remarkable improvement. Not only was blood flow quickened, the viscosity of the blood plasma was also reduce. Furthermore, there was an increase in immunity, increase in the discharge of metabolic wastes, and normal physiological functions were maintained (Yan 1995).
In addition to these formulas to quicken and disinhibit, other forms of medical attention can improve qi and blood flow. Some of these techniques include acupuncture and moxibustion. Acupuncture focuses on stimulating points of stagnated blood and directing the flow of qi and blood. Moxibustion works in much the same way, except a burning stick of mugwort is used instead of a needle. Both are implemented to promote circulation and balance body temperature. These treatments, along with medicinal supplements, serve not only as treatment for already present illnesses but also as preventative measures against future symptoms of senility. Maintaining a healthy balance requires constant adjustment and tuning of qi and blood flow. In Traditional Chinese Medicine, there is a term known as yang sheng. When translated, it means to nourish, to support, or to prolong life; more specifically, to nourish and support that which is already healthy. When steps are taken to continually nourish a body that is already healthy, it becomes very difficult for illness and disease to disrupt or diminish one’s homeostatic balance. There is a saying that when translated into English can easily sum up the attitude of TCM with regards to yang sheng: “You can fight against something, but that will quickly wear you out, better to fight for something, that will give you inspiration” (Cook 2003). By constantly cultivating a healthy lifestyle, not only in diet selection but also in lifestyle choices, one can promote an overall sense of wellbeing as well as experience longevity. Contrary to popular belief, senility is not unavoidable. By implementing yang sheng into one’s daily routine, the deficiencies caused by blood stasis and stagnation can be remedied and reversed. Likewise, in Western medicine, there are treatments to help prevent and reverse the symptoms associated with senility. For example, establishing a routine can help make daily living more stable. Omega-3 fatty acids are important for brain functionality and can help to combat senility as well. Since the globalization of Chinese medicine, the introduction of herbs as a health supplement has become a regular part of many Western cultures. For instance, gingko biloba is thought to slow the progression of memory loss (Mahadevan 2007). Despite the gradual acceptance of some Chinese medicinal practices in the Western world, there is still much to be translated and understood. Each methodology by itself has its benefits and limitations. By promoting the integration of both systems, there is a greater possibility of eliminating the symptoms of senility more quickly and more effectively. However, this cannot be accomplished without continued dialogue between the two cultures. Since Chinese medicine has shown strong evidence of being an effective form of treatment, it may be beneficial for the biomedical society to continue to adopt Chinese medical procedures. With the diminishing contrast between the two cultures’ viewpoints on the elderly, it is feasible for both sides to achieve a mutual understanding of each other’s medical practices without excessive judgment. One can only hope that the successes of the two medical philosophies can fully integrate to tackle the issues of aging and senility accompanied with the growing population of the elderly.
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