This article first appeared in the July/August 1998 issue.
THE 75-YEAR-OLD MAN in the hospital bed looked at me with a flat, unfocused gaze. Ted made it plain to me with a few curt answers and a doleful face that his life was over, finished off by his recent, devastating stroke that had totally paralyzed the left side of his body. His physical rehab doctor had pressed me to meet him out of concern that depression was sapping his efforts in physical and occupational therapies and dooming his recovery.
Ted was like many older men I’d seen who, after suffering sudden medical catastrophes, figured they had no other choice but to surrender to their dire circumstances. He hadn’t asked to see a psychologist; in fact, he had never in his life dreamed of speaking with one. Yet I was supposed to march into his hospital room and sound some battle cry, compelling him to fight to live again.
Instead, after five minutes of painfully one-sided conversation, I asked Ted a question that I’ve found to be effective with other men of his generation in states of late-life debilitation and despair: “Were you in World War II?” Ted’s gaze sharpened as if he’d only just become aware of my presence. ‘Yes, I fought in the war,” he declared in a voice suddenly clear and strong. This was the beginning of a dialogue in which he allowed me a view of his life and shared his past and present struggles against death.
In my work as a medical family therapist during the past 10 years, I’ve seen that geriatric crises in men often evoke powerful memories of war. It’s as if these older men instinctively connect their experiences of coming under enemy fire with being embattled by strokes, heart attacks and spreading tumors. The sense of pro-found danger and helplessness they undergo in each circumstance is similar. I’ve found that explicitly exploring these connections with them in psychotherapy enables them to draw on the survival lessons they learned from the war of their youth to persevere through the late-life war they’re fighting.
Ted was a rangy, handsome man with chestnut-and-gray hair for whom success had come readily. He enlisted in the U.S. Army in 1943, just after graduating from engineering school, and had seen extensive, brutal combat as a lieutenant in a small infantry at the Battle of the Bulge, to which he attached no great gallantry. Approaching his duties as though he were methodically solving some engineering problem, he’d done what he had to do marching, shooting, ordering men to risk their lives in order to achieve his objectives. Achieving them, even at great personal sacrifice and human cost, lent him quiet confidence and the conviction he could control his own fate. After the war, he’d gone on to become a successful businessman in a high-tech company, had married and had raised three children in an affluent, conservative suburb. I imagined that he spent the 1950s as the starched-shirt Organization Man and the 1960s as the Establishment figure against whom his children rebelled. Even after his wife died two years earlier, following a long bout with cancer, he’d managed to continue to care for himself and maintain a generally optimistic outlook on life.
None of this had prepared Ted for his stroke. Unable to dress himself or walk because of his paralysis, he was utterly dependent upon others to help him get into and out of his wheelchair or take him to and from the bathroom. He frequently soiled himself. His face was contorted by the drooping left corner of his mouth from which he steadily drooled. These conditions would be difficult for anyone to cope with, but seemed to especially incense Ted, as if his current disabilities struck at his long-held sense of himself as supremely capable. Stripped of his accustomed power over his body, environment and future course, he turned combative as a last-resort means of asserting himself. I heard him angrily telling staff members that he just wanted them to leave him alone so he could live out his days and die.
My clinical task was to help him regain some sense of self-efficacy, to instill realistic hope that he could learn to do more for himself and to foster the belief that his life had worth even if it entailed some degree of dependence upon others.
As with other men in his position, merely raising the subject of the war with Ted brought a light to his face and a focused intensity to his thoughts. Like many men who’d fought, his experiences in combat were some of the most powerful of his life. He related them with relish while other staff members attempted to instruct him and he rejected them, my interest in his war stories established our relationship as one in which he’d be teaching me about something of great importance. As a consequence, he spared me the anger he meted out to my colleagues and seemed to look forward to our half-hour talks every few days.
As with other older veterans, he also seemed to undergo a change in his sense of himself while speaking about the war. After a few moments of reminiscence, he was a steely soldier again, fit of limb and exuding prowess. As he’d emerge from these reveries, his face would be more relaxed, his voice more sure. Even briefly reconnecting with this younger, more vital, part of himself reminded him of his own power, regardless of his feeble condition now.
I purposely used the war as a metaphor for what he was currently facing. I described rehab as “boot camp,” referred to his residual stroke deficits as “wounds” and frequently asked him, “How goes the battle?” By our fourth meeting, I told him that 1 imagined that if the Bulge was the first great battle of his life then the stroke must rank as the second. With a slow nod, he agreed. I then asked just what it felt like to be a soldier facing the enemy. While the battle swung violently in the balance, he admitted, he’d felt scared. I directed his attention to the men he was with. They worked as a team; they helped each other survive. The fact that he survived while others didn’t attested to his strengths and blessed luck, but also to the efforts of his comrades to watch his back. Remembering this, Ted welled up.
I said that in the midst of the second great battle of his life, it made sense for him to be scared again. I added that, as with the first battle, there would be no sense of security for him until some outcome became evident, and that would likely take months. I also said that, as with war, outcomes are sometimes equivocal many losses are incurred as gains are made. But I reminded him that once again he had a team now made up of professionals and family members watching his back to help him through. And I pointed out that heroism was not feeling in control in the face of danger, but finding it within oneself to take action in the face of fear. That was what he was struggling with now, with his stroke.
Ted responded to all this by becoming morose and testy for the rest of that session. But when I saw him in the physical therapy gym a few days later, he was exerting himself strenuously to maintain his body upright in the parallel bars. His physical therapist stood behind him urging him on. I walked over and commented that he was “hanging in there like a trooper.” He knew what I was getting at and smiled.
Two weeks later, Ted was transferred to a nursing home, where he would continue with a therapy program designed to meet his slow pace of recovery. His anger and depression had largely dissipated. He worked hard at his exercises and drew on the encouragement of his therapists and nurses. This old soldier wasn’t fading away. He’d found a new will to fight.
Barry J. Jacobs, Psy.D. is a Philly area-based clinical psychologist, healthcare consultant, and coauthor (with his wife, Julia L. Mayer, Psy.D.) of AARP Meditations for Caregivers (Da Capo, 2016) and AARP Love and Meaning After 50 (Hachette, 2020). He writes a monthly self-help column for family caregivers on AARP.org.