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Autonomy


The challenges of the move I am in the middle of and the lessons learned are such a flood of energy fields emergent and encountered that I find myself rendered silent. This is not a troublesome silence, just an authentic one. OWLcourage has been a fallow field for a while now. Instead of blog posting, last week I flew to Santa Barbara, CA to participate in a ceremonial “move in” ritual, getting both the orientation and resources necessary to begin to live in my new “apartment home” …the term they use to describe my new residence. Although I had successfully opted out of an apartment for a “senior”, it was still a sizable shift in my living quarters. I was not actually moving in, simply preparing to do so.


The Uber driver who picked me up at the airport was a chatty one, and began quizzing me on where I had come from and why I was headed toward a hotel in Goleta, the neighbor of Santa Barbara. I told him I was moving to Goleta, and he seemed surprised, asking “Why?” with a marked degree of curiosity. Spontaneously, I responded “While I believe I still have the functionality for it, I want one last experience of autonomy where I am living the life I want to live.” He burst out in a whole-body laugh, and I felt a spurt of joy: finally, someone who “got it”. He reported he was 75, I reported I was 80. We compared life journey stories a bit, in broad strokes. He dropped me off and wished me well.


Searching for new housing at the age of 80, and acknowledging to myself that rental now makes better sense than the complexities of home ownership, I became fascinated by the language used to describe housing for “older people”. One of the strangest is “independent living”. Now anyone with roots in rural America learns early that no one is really “independent”; every time you buy eggs or milk you are entering a web of interdependencies. Actually, life is a web of interdependencies. I think being “independent” is at best an illusion: it proposes that one is not dependent. I believe that we are all dependent to some degree. The issue isn’t whether we are dependent: the issue is the consequences of dependency.


Which has activated my interest in the concept of “autonomy”. The dictionary definition of “autonomy” is “the right or condition of self-governance, freedom from external control or influence”. Some would posit that the concept of “autonomy” is a synonym for “independence” however I think for me the focus on self-governance shifts the meaning. For me, one of the most unsettling dimensions of aging is the realization that a significant portion of my human encounters do not assume the self-governance of the aging person, my self-agency. Indeed, there is often the implicit message that the capacity for self-governance has eroded to the point where the intrusion of others to evaluate, control and influence choices is appropriate or even necessary.


This last point is important. Is there a point of decline where the elderly person can no longer engage in self-governance? Experience would tell us yes. Interestingly, however, that point may or may not be determined by the self-governing older person, but by others. This decision is made on “behalf” of the aging person, who may have no voice in the decision. Those deciding may be of very good will, or be fearful of dreadful things happening to someone they love, or simply be trying to make life less complex and stressful. The motives are legion and cannot be assumed to be positive, negative or neutral. The outcome is always the same, however. The aging person is no longer engaged in self-governance. Autonomous is no longer a self-descriptor.


And I was being very honest with the Uber driver. I know that aging gradually erodes self-governance options. I also know aging activates the tendencies in others to intrude on the aging person’s self-governance, making judgments about its appropriateness, risks and benefits. One cannot assume respect for autonomy.


Which of course has me pondering my own life journey. I believe I have an over-developed sensitivity to messages that deny me autonomy. I recall endless meetings full of well-intentioned male colleagues who clearly did not think I had or should have self-agency and a scattering of female colleagues who were careful never to challenge this situation. As one who did challenge it, the cost was persistent and significant, both from the men and the women. I learned early to fight for an autonomy no one was inclined to award me.


I got divorced in 1988. After 20 years of full-time employment, sharing accounts, income, financial records, payments…all with the names of both partners in the marriage on every document…I learned that I did not have a “credit record”. I was stunned and kept trying to get someone to explain that to me. My former husband had our credit record; I had nothing. It was a nice concrete example for me of why fighting for autonomy was so often fraught with emotion. Self-governance was never assured; it was something to work toward.


These are merely examples, but validate for me my over-developed sensitivity. So, I find myself working to create the conditions for my engagement, ensuring that I take action. “While I believe I still have the functionality for it, I want one last experience of autonomy where I am living the life I want to live.”


While this actually may sound “odd” or “unusual”, my hunch is that I am pursuing a goal many aging persons would support. I think they want the same thing I want. And I have a further hunch that we as a society are far more comfortable confining aging persons to deplete autonomy than we are skilled at investing in ways to ensure and maximize their autonomy. Often our need to assure ourselves that others are safe leads us to confine them in ways that are both limiting and insulting.


It has been my experience that this commitment to autonomy on my part unveils many striking viewpoints in the words and behaviors of others. Thus, I find that my commitment to maximize self-governance and autonomy is no better understood now than when I was a very young nurse challenging the actions of a powerful surgeon. There are consequences to the insistence on self-agency and to saying “No” to the silencing of autonomy. And it is a painfully easy cop out to say that my resistance to the silencing of autonomy proves questionable judgment due to decline. WOW!


When I am not disappointed or frustrated or saddened by all this, I am at least deeply curious. How did we get this crazy and where is our exit strategy? We will not access the Wisdom Work of the elders in our society if we are busy evaluating them to determine how much we need to confine their autonomy. If their “decline” does not “require” that we “intervene” to limit their self-governance, why are we looking for ways and opportunities to do so. What is that about?


The final disturbing insight this entire adventure has highlighted for me is the limited understanding of autonomy, self-governance and self-agency that reveals itself in this strange situation we have created for aging members of our society. A long life usually, eventually reveals that I am accountable for my own life, for my choices, for my successes and my failures, for my missed opportunities and misperceptions. I can only be accountable if I am self-governing.


This is not rocket science. If I am not self-governing, then I have abdicated responsibility for my life to others. Why would the Wisdom Work of the elder exclude self-governance and autonomy? And what does it say about those who wish to “take over” that self-governance and autonomy from the elders? I have become fascinated by the proposition that respect and love of an elder manifests in creating all the conditions possible to prolong, maximize and support autonomy and self-governance. I wonder what that would look like!


“We want autonomy for ourselves and safety for those we love. That remains the main problem and paradox for the frail. Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.”


-Atul Gawande-


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