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Ciênc. saúde coletiva vol.17 n.8 Rio de Janeiro Aug. 2012
Waiting for nothing
Ligia Py I; José Francisco Pinto de Almeida Oliveira II
I Comissão Permanente de Cuidados Paliativos (SBGG). email@example.com
IIComissão Permanente de Cuidados Paliativos (SBGG)
A person's lifetime, each individual's personal history, is also a social creation that integrates with the history of human collectivity. For elderly individuals this process occurs most of the time through ageing governed by an understanding of negative meanings used by the social aspect to describe old age.
Within the inexorability of change, elderly individuals perceive themselves in successive loss of capacity and confront their psychosocial condition as elderly. They often neglect their autonomy and feel discouraged to make new investments; they let social stereotypes that abhor older people and their self-image overlap. When translated into the social context as negativity, old age worsens what is felt as loss in elderly individuals and weakens their internal resources built throughout an entire lifetime.
When an incapacitating illness and dependence affect an elderly individual, which is not uncommon as one becomes older, the feeling of loss can transform into unfathomable fantasies and intensify tension before threatening limitations that press on overwhelmingly. Therefore, this individual tends to arrive at a subjective place where they are no longer able to dominate tension, delving deep into them and into an irreversible state of abandonment.
Alone and tormented by the threat, they see themselves before something inevitable where there is no possibility of investing in life with a project providing them with a way out1.
In those circumstances, we hear an `almost' voice, muffled and fading, that eloquently expresses the significant universe of solitude of an elderly individual.
In fact, way before the notion of loneliness stated by anthropologists and scientist of the soul, we are touched by the experience of daily solitude similar to that of the poet's José: "alone in the dark / with no black horse / that will gallop away". A José just like any of us, who "with the key in his hand / he wants to open the door, / there is no door". And the question remains: "What now, José?2"
Each one of us has their own `rock bottom', a dark and empty tunnel that hides plenty of stories, countless secrets and much resentment. The idea of rock bottom is very close to Plato's `Analogy of the Cave'. The Cave is where the real world as perceived by our hands and under constant transformation converges with the ideal world unchangeably engraved in our minds. This Cave hides and at the same time reveals the profound truth of reality, oscillating between truth and illusions. No answers.
At this level loneliness can be an experience that produces silence and reflection, or an experience of failure that pushes us into nothingness.
It is also worth highlighting another aspect of loneliness, maybe the most cruelly experienced in the ageing process. That which expands the abandonment horizon and places man within the perspective of nothingness. That of "José", "alone in the dark". That which makes us plead, with little hope of being given a helping hand. That which comes from how "pain and physical suffering play an important role in making elderly individuals more fragile and triggering suicide, associated with worsening physical disorders", such as pointed out in Fátima Cavalcante and Maria Cecília Minayo's study: that which assails elderly individuals "affected by illnesses, disabilities and chronic pain"; that which indicates that "men and women are at equal risk when they become isolated, when they shut people out and remain silent, depressed, introspective, lonely and sad".
We are discussing loneliness that does not compel someone to seek liberation or promote encounters; rather that which makes elderly individuals realize they are out of their family circle, out of society's bosom. This loneliness expresses the most fragile remains of their humanity and will only show through the fragments of suffering. Loneliness that is connected to the feeling of painful and useless waiting for something: waiting for nothing3.
Deep into hopelessness, this loneliness slips dangerously into the limits of despair. It takes over the elderly individual when they no longer have anyone or anything to latch onto. When all reference points vanish. When there are no signs to show the way. When the shoulders weakened by age are no longer able to bear the weight of abandonment. So the elderly individual gives up. They lose their critical strength and the power to react.
Thinking about elderly individuals mentioned in this study, Delia Goldfarb's4 words invite us to think about abandonment and dependence: "The greatest threat will then be the weakness of bonds and possible loss of someone else's love, which will leave him abandoned and unprotected from danger and suffering".
We believe that the challenge of moving on with their lives will become greater for elderly individuals tormented by hopelessness. Beliefs will be shaken and the meaning of existence will become more vulnerable. The ruin of their internal world exposes weakness and neutralizes possibilities. When faced with the unbearable, elderly individuals reveal the truth that sheds light on our existence: we need one another, in the safety of affection that brings us together in family, community and social bonds. This is how José Carlos Rodrigues5 translates our precarious condition of human beings: "the rupture of emotional bonds is the most believable metaphor of nothingness".
If we perceive old age as a curve in human history that enables us to recover dreams and interests, we also see the biological dimension as a time during which the body becomes more vulnerable to diseases, because elderly individuals become more vulnerable as their organism grows older6.
In any case, healthy or not, elderly individuals remain what they make of themselves, never defined or definitive. Their freedom involves the need to respond to the fact that they are alive and must satisfy their wishes, in a world where structures are forever unfinished waiting for persistent creation7.
Yes! But what if he is "alone in the dark", waiting for nothing? Who looks for him? Who finds him? Who welcomes him? Who helps him? Who will guide him to where he can reclaim his own path to travel down his own road?
The isolation elderly individuals are insistently forced into refers to the ultimate loneliness of human beings. In their lonely and tense search for meaning in life, where will they go if there is no solidary reference of another who will welcome and understand them? How will they confront the lack of meaning in the work which, unshaken and cold, shows human disappointment when confronting emptiness, nothingness? Beyond all truths there is that which asserts man as a being of relationships. Our greatest original ethical commitment is to understand living as living together.
A crucial issue of phenomenology is considering human life as "being-in-the-world", "being-with-others". In the background of letters of principle, there is an appeal for a new ethical view: nobody is ethical for themselves; one is ethical when lending a helping hand. Here the view of suffering through the eyes of those in pain stands out: we need to look at loneliness, pain, suffering, abandonment, uncertainties felt by others, aiming to look at things from their perspective, from the point of view of their suffering.
No one can make decisions for another. None of us will make decisions about an elderly individual's life. A helping hand, however, will support or even ground a decision. Human crises are part of the history of human time. The old age is a time of crisis. It is the unique time of an elderly individual, waiting for those who are destined to fraternally share with him ways to escape the crisis.
A human encounter expresses a sacred level that can be experienced by man, for in this encounter each perceives the limits of their humane capability and finitude. By reaching our hands out we can help one another transcend desolation and move out of the dark well of abandonment.
We say that an encounter with the elderly individual tormented by desperation is sacred and a violation of this encounter happens when we accept negligence, scorn, humiliation, exploitation, physical and verbal abuse, untreated illness, unmitigated pain, mental decay, disability, social isolation, family abandonment, oppressive silence.
We have before our eyes the reality of an elderly individual who lives the concrete reality of an old body, upset, lonely, hopeless. A body detached from possibilities to overcome the horror that annihilates it. Weakened by illness, shattered by suffering, giving up on life. In their look, there is only an expression of despair. It is worth remembering when the body no longer responds the heart must be touched.
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4. Goldfarb DC. Demências: clínica psicanalítica. 2ª ed. São Paulo: Casa do Psicólogo; 2006. p. 36. [ Links ]
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7. Py L, Pacheco JL, Oliveira JFP. Morte na velhice. In: Santos FS, organizador. Cuidados paliativos: discutindo a vida, a morte e o morrer. São Paulo: Atheneu; 2009. p. 179-191. [ Links ]