Literary perspectives on ageing.

Literature and ageing--the theme for this first Lancet supplement on literature and medicine--was chosen in conjunction with the United Nations designation of 1999 as the International Year of Older Persons. The challenges and opportunities of human ageing have never been greater than they are now, as we enter what is being called the "longevity revolution", z Scientists predict that human life expectancy, already many years longer in most countries than it was at the beginning of this century, will increase even more in the future? As we prepare to move into the next millennium, this International Year of Older Persons invites us to take stock of what we think about ageing, and why, and what this longevity revolution will mean to us, individually and culturally. The ancient Greek myth of Tithonus reminds us that extended biological life is not necessarily a boon. Aurora, goddess of the dawn, asked her father Zeus to grant immortality to her mortal husband Tithonus, and Zeus agreed. But Aurora had forgotten to ask for eternal youth for Tithonus, and as the years passed he grew older and older, and more and more frail, but could not die. Eventually, having lost his mental faculties as well as his physical strength, Tithonus was shut up in a room and left alone to babble incoherently forever. In another version, the gods took pity on Tithonus and changed him into a skinny, noisy grasshopper? This myth reflects one of the most powerful fears of ageing: losing the attributes and faculties that make life worth living. Echoes of Tithonus' story persist in literature. In the 18th century, Swift wrote of how Gulliver is cured of his "keen Appetite for Perpetuity of Life" by his observation of the ravages that ageing inflicted on the immortal Struldbruggs in the Kingdom of Luggnugg. 4 In the 19th century, Tennyson retold the myth of Tithonus in his own poem of that name: "And after many a summer dies the swan", but Tithonus lives on, wishing he could die? In the 20th century, Kurt Vonnegut and Samuel Shem have each given the myth a contemporary scientific and medical context in their works "Fortitude ''6 and The House of God, 7 respectively. Vonnegut wrote in his play of a woman whose life is extended against her will by a mad scientist who keeps replacing the failing parts of her biological body with artificial organs. In his novel, Shem wrote of the fate of the gomer, defined as "a human being who has lost--often through age--what goes into being a human being" (ref 7, p 424). It is the first law of The House of God that "Gomers don't die" (ref 7, p 420). The myth of Tithonus, in all these permutations, reflects the dark side of ageing, outliving one's capacities to find meaning and purpose in life. In his famous poem "The Man with the Blue Guitar", 1 inspired by Pablo Picasso's 1903 painting The Old Guitarist (cover), Wallace Stevens explores the power of the imagination to shape, and thereby change, reality. In the poem, Stevens quotes Picasso's saying that a painting is a "hoard of destructions" and asks if it is also an image of a destroyed society. Yet the old man transcends physical "destructions" by creating music upon his guitar, symbolic of the power of the human imagination. In complex and subtle ways, this painting and this poem represent the brightest hope for human ageing--that it may be a time to consolidate artistic and spiritual strengths, a time to see and say and sing what could not be seen or said or sung before, a time to transcend the physical reality of"things as they are" through the truth and beauty of the blue guitar. Not everyone can be a great painter or a blue guitarist or a great poet. But many people have the capacity in old age to free themselves from the societal expectations and roles that may have confined them earlier in their lives and to become more fully who they are. The goal for the longevity revolution should not be simply to extend the quantity of human years lived on this earth but to enable the inherent quality within human lives.