Pioneering Gerontologist Promotes Respect for “Our Future Selves”
Published as Alumni Profile, Fall 2005 Issue, P&S Journal
By Peter Wortsman
Vintage wines are cherished. Historic buildings are accorded landmark status. But aging humans fare less well. They are sentimentalized and desexualized, ignored, scorned and sometimes abused, and, finally, warehoused in sub-standard nursing homes till they have the decency to die. Pioneering gerontologist Robert N. Butler’53 first outlined the bleak picture in his Pulitzer Prize- winning book, “Why Survive? Being Old in America” (1975). “In America,” he wrote, “childhood is romanticized, youth is idolized, middle age does the work, wields the power and pays the bills, and old age, its days empty of purpose, gets little or nothing of what it has already done. The old are in the way...”
No way! insists Dr. Butler, who has staked his career on the premise that older people not only deserve better, but also are an invaluable resource society can't afford to waste. Founding director of the National Institute on Aging at the NIH, founding chairman of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center (the first academic department of its kind in a U.S. medical school), and founding president and CEO of the International Longevity Center, a policy research and education center, Dr. Butler has spent his professional life proving age a rich opportunity, not a foregone defeat. In landmark research conducted at the NIH, he and his colleagues debunked the myth of the inevitability of senility as a function of aging and, thereby, helped liberate an ever growing segment of the population from the stigmas associated with age.
This profile is based on an interview conducted with Dr. Butler in March 2005 at the Manhattan headquarters of the International Longevity Center. A photograph on the wall of his office shows a beaming Dr. Butler down on the ground doing push-ups. Glancing from the photo to the man, an interviewer, himself well into middle age, cannot help but be struck by the youthful mien and bountiful energy of his subject. Topped by a thick white mane of hair, he has an undeniable glee and “can-do” confidence to his open face and trim physique, coupled with a fierce resolve undiminished by time. It’s as if the years had merely put a patina on the simple truth he learned long ago from his maternal grandparents, who raised him on a chicken farm in South Jersey: that life is what you make of it at whatever age. At 78, Robert N. Butler continues to make much of it.
Grandson of Feisty Chicken Farmers Cries Fowl on Ageist Prejudice
The sudden death of his adored grandfather troubled him deeply as a young boy. But the care and caring of a family physician, someone he knew simply as Dr. Rose, helped muffle the blow and provided a focus to the grief. “I decided that doctors do all they can to keep people alive and give them the best possible life, so I made up my mind I was going to be a doctor.” Two bouts with scarlet fever, one in childhood and one as a young man, and the skill and devotion of the physicians who treated him, strengthened his resolve.
That dream survived the Depression and the loss of the family farm, thanks in large part to the fighting spirit of his grandmother, who worked at multiple jobs to put food on the table and keep hope in the heart.
“Seeing my grandmother in action,” Dr. Butler recalls, “I saw the indomitable spirit and the survivability and the fact that older people are not dependent and creaky and nonfunctional, but can be very effective.”
Following a tour of duty in the U.S. Maritime Service and a solid undergraduate education at Columbia College, where he relished, above all, his grounding in the great books in the Core Curriculum, he entered P&S. His grandmother lived to see him earn his M.D.
“Older People Were Seen as Archives, Museums of Pathology”
Spurred on and inspired by such outstanding members of the medical faculty as Robert Loeb, Dr. Butler initially leaned toward a career in hematology. But in the hospital setting, as in society at large, he found himself increasingly surprised and dismayed by the general attitude toward older people. “When we did see older patients, sometimes in Group Clinic, but more often in the chronic disease hospital, Goldwater,” he winces at the memory, “we saw them as archives, museums of pathology.” Lamenting the thickness of their medical charts, insensitive residents would refer to them disdainfully as “crocks,” or sarcastically allude to their “porcelain levels,” implying that “they were more complainers than really sick.”
Pursuing his internship at St. Luke’s Hospital, he got to thinking: “We know very little about what makes people tick. And we know very little about aging. Why shouldn’t I go into something that nobody knows much about?”
Dr. Butler switched to psychiatry, pursuing a residency in neuropsychiatry, from 1954 to 1955, at the University of California Langley Porter Clinic. There he got involved in early research on the tranquilizers bromazine and chlorpromazine (more popularly known as thorazine), and reserpine, a derivative of the rauwolfia root.
His work at UCSF brought him to the attention of Seymour Kety, the first scientific director of the National Institute of Mental Health at the NIH. One of the fathers of neuroscience in the United States, Dr. Kety was known above all for his development of a technique for measuring blood flow to and oxygen consumption in the brain. The senior scientist interviewed the young investigator in the course of a long walk up and down the hills of San Francisco and recruited him to join what would become a landmark research project on aging in Bethesda, Md.
The Human Aging Project: First Stint at the NIH
Dr. Butler points fondly to a photograph on his office wall of Dr. Kety and Lewis Sokoloff, another scientific giant credited with establishing the scientific basis for PET scanning, who were “dear friends and mentors” and fellow principal investigators on the study on aging. In yet another vintage black and white photograph on the wall, a very serious-looking and bespectacled Dr. Butler, age 28, is seated with colleagues beside the massive, old fashioned, reel-to-reel tape recorder used in the study. With the aid of that robot-like device straight out of a 1950s science fiction flick, the team set out to dispel a set of insidious fictions.
The project that encompassed more than a decade, 1955-1966, was, as Dr. Butler proudly points out, “the first interdisciplinary, comprehensive, longitudinal study of healthy community-residing older persons.” Earlier studies of aging had always involved ailing subjects residing in chronic disease hospitals and nursing homes and, consequently, the results were inevitably skewed by the associated factors of disease. “Our work,” he says, “led to the revision of stereotypes that once had been attributed to aging, which we found had not to do with aging at all, but had to do with disease, social adversity, even personality.” What the study proved beyond any doubt was that “senility is not inevitable with aging but is, instead, a consequence of disease.” The research findings were published in an influential two-volume work, “Human Aging.”
In 1961, once again skewering a negative cliché, this time of older people's perceived pathological obsession with the past, Dr. Butler established the importance of what he called “life review,” a normal healthy process of looking back, whereby the older individual takes stock of his life.
And in 1968, he coined the term "ageism" in the course of an interview with the then-fledgling Washington Post reporter Carl Bernstein (later of Watergate fame). Reflecting on community resistance to a program to establish housing for older people of moderate income in Chevy Chase, a posh neighborhood bordering the District of Columbia, “I was struck,” says Dr. Butler, “by the parallel to sexism and racism in terms of negative attitudes toward age. ‘You know, it’s really an outrage,’ I told Carl, ‘it’s like racism, it’s ageism!’” His outrage and the term he coined to describe it made it to a cover story in the Post. He subsequently wrote a paper, “Ageism, Another Form of Bigotry.” The term stuck and has since found its way into the dictionary. “Of course, we still see plenty of it,” he laments, “in the work place, in the health-care system, and elsewhere in society.”
In the meantime, Dr. Butler completed his residency, dividing his training time between the National Institute of Mental Health and Chestnut Lodge, a health-care facility in Maryland, and earned his board certification in psychiatry and neurology.
While pursuing a private psychiatry practice in Washington, D.C., he taught on the faculties of Howard University School of Medicine and George Washington University School of Medicine and served as a research psychiatrist and gerontologist at the Washington School of Psychiatry.
In 1975, he was offered the job of founding director of the newly created National Institute on Aging of the NIH, a position in which he served with distinction until 1982. The year 1975 proved a propitious year for Dr. Butler.
A Pulitzer Prize and NIA Leadership
On his first official day on the job at the helm of the new National Institute on Aging, he learned he won a Pulitzer Prize for his book “Why Survive? Being Old in America.” The news came in a phone call from a journalist who had previously scheduled an interview on the institute. “It certainly helped enhance my profile at the NIH!” Dr. Butler acknowledges.
The Pulitzer Prize helped him when it came time to sell his drafted plan, “Our Future Selves.” Directors and other high level scientists who had previously been skeptical of the need for an institute specifically devoted to aging – no doubt threatened by the diversion of funding – were more amenable to productive dialogue with a Pulitzer Prize winner. “Before I left the job,” he says, “I had a study or project going on with every other institute.” Notable among these collaborative projects was a cancer treatment trial. Investigators had previously given lower dosages of chemotherapy to women over age 50, based on armchair estimates rather than clinical findings. The study confirmed Dr. Butler’s suspicion that older women receiving a lower dosage were not getting the same benefit. Another collaborative study identified osteoporosis as a major issue. And yet another, with the Dental Institute, created an incentive for dentists willing to learn more about the care of older patients.
Among his proudest accomplishments at the NIH was an increase in public awareness of the devastating effects of Alzheimer’s disease. Thanks to interdisciplinary studies he spearheaded, and with the help of a patient advocacy group he helped found, the National Alzheimer’s Disease Foundation, the disease became a household word and a national research priority.
Another photograph on the wall of his office shows Dr. Butler with his good friend and fellow activist, the late Congressman Claude Pepper, of Florida, with whom he worked on the drafting and passage of the historic Age Discrimination in Employment Act. Congressman Pepper remained a staunch ally and friend.
A Call from Mount Sinai to Chair America’s First Department of Geriatrics
In 1982, the Mount Sinai School of Medicine approached him, in his capacity as director of the National Institute on Aging, to advise the school on its plans to establish an Institute of Gerontology. In the course of discussions, Dr. Butler suddenly blurted out: “You know, you could really make history, breakthrough history, if, instead of an institute, you created a Department of Geriatrics at Mount Sinai!” The idea found fertile soil. That very weekend he was invited by telegram to serve as the founding chair of such a department. And though he initially declined, reluctant to leave the NIH, he ultimately leapt at “the chance to have a direct impact on medical education, in terms of curriculum development in the care of older people.”
Confronting the same initial resistance from colleagues at Mount Sinai that he had faced at the NIH, Dr. Butler held sway and ultimately built strong interdisciplinary programs and helped raise a considerable endowment for the support of research, including chairs in molecular biology of aging, Alzheimer’s disease, and the neurobiology of aging. At Mount Sinai, he established a number of “special emphasis clinics,” including the first osteoporosis clinic in New York City. He is particularly proud of the cadre of young clinical investigators he helped recruit and nurture.
The International Longevity Center: A “Think and Do Tank”
At Mount Sinai in 1990, Dr. Butler founded the U.S. branch of what would later become the International Longevity Center, devoted to the study of “the impact of longevity upon society and its institutions.” The center, now a Mount Sinai affiliate, has offices in Tokyo, London, Paris, and Santo Domingo. In 1995, while maintaining his academic appointment, Dr. Butler relinquished the chairmanship of the Department of Geriatrics at Mount Sinai and committed himself heart and soul to the Longevity Center as its president and CEO.
When asked about the center’s mission, he likes to quote the late nonagenarian jazz pianist Eubie Blake: “Had I known it would have taken me so long, I would have taken better care of myself!”
“I’d had the wonderful and varied experiences of working in a lab, teaching, running things, conceptualizing, pursuing my own research,” he reflects. “What I felt we really needed now was an educational policy research center, a think and do tank, to identify the consequences of an aging population, the long-term economic, cultural, social, political, and health consequences of this unprecedented increase in longevity.” The center also is committed to “mobilizing the productive capabilities of older people...and to optimizing the use of our resources toward that end.” Another priority is “combating ageism, prejudice with respect to age.”
The “Declaration of Human Rights for Older Persons,” which Dr. Butler was invited to draft in 1982 for the United Nations World Assembly on Aging, has since become a widely disseminated and accepted standard worldwide and a blueprint for the center’s efforts.
“Love and Sex After Sixty” and Life’s other Enduring Pleasures
Meanwhile, Dr. Butler and his wife and co-author, Dr. Myrna Lewis, kept on challenging cliché in print. Their 1976 landmark study of the vitality of the mature libido, “Love and Sex After Sixty,” for which, when it first appeared, a newspaper in Florida refused to accept an ad, was recently declared a classic by Time Magazine.
“Older people were regarded as sexless,” Dr. Butler explains. “‘Well, we didn’t find that in our studies at NIH; sex was still going on,’ I said to my editor at Harper & Row. And Myrna said, “Why don’t we do a book on this and all of those vestiges of ageism?’” Among other then radical notions, the book called for a new idea of beauty.
As the authors eloquently put it, “The idea of beauty desperately needs to be revised to include character, intelligence, expressiveness, knowledge, achievement, disposition, tone of voice and speech patterns, posture and bearing, warmth, personal style, social skills – all those personal traits that make each individual unique and that can be found at any age.
Dr. Butler is currently at work on a new book, “The Longevity Revolution,” in which he weighs in on controversial issues, including America’s private health insurance system – “in my judgment, a true disaster!”– private pensions, and Social Security. He favors a balanced economic approach, including raising the ceiling on taxable Social Security wages and, given today’s longer life expectancy, he recommends raising the age at which workers become eligible for benefits.
A co-founder of the Alzheimer’s Disease Association, the American Association of Geriatric Psychiatry, and the American Federation for Aging Research, he is a founding Fellow of the American Geriatrics Society and founding vice chairman of the Alliance for Aging Research. He served as chair of the Advisory Committee to the 1995 White House Conference on Aging and continues to consult to national and international bodies, including the U.S. Senate Special Committee on Aging and the World Health Organization. Dr. Butler has received honorary degrees from the University of Gothenburg (Sweden) and the University of Southern California and has received many other encomia.
Having covered all the bases in his varied medical career, including public health, biomedical research, academe, private medical practice, and administration and management, he offers a tongue-in-cheek prognosis: “Just can’t stick with anything for very long!”
Now a proud grandfather himself, he has, in fact, stuck through thick and thin with the firm conviction, instilled in him by his own grandparents, of the value of life at all its stages. Or as he put it in the original preface to “Why Survive?”: “When we talk about old age, each of us is talking about his or her own future. We must ask ourselves if we are willing to settle for mere survival when so much more is possible.”