Wednesday, April 8, 2015

A radical experiment tried to make old people young again — and the results were astonishing


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The idea that getting old means getting frail and forgetful is so embedded in our cultural understanding of aging that it can be hard to tease apart medical realities and simple biases about the elderly. But Ellen Langer, a Harvard psychologist, has long wanted to try.

"Social conditions may foster what may erroneously appear to be necessary consequences of aging," Langer suggested in "Old Age: An Artifact?", a 1981 book chapter. So-called senior moments, after all, are not only the purview of seniors. "Young nonsenile people also are often forgetful."

How many of aging's negative effects could be manipulated and even erased by a psychological intervention?

In a radical experiment in 1979 that was featured in a New York Times Magazine cover story last fall, Langer and her grad students decided to take this question as far as they possibly could.

The results were extraordinary — but the research was also so unorthodox, so small, and so lacking in rigor that interpreting exactly what those results mean requires caution.

The 'counterclockwise' study

Imagine, for a moment, living in a nursing home. Your meals are in a cafeteria, your recreation is at scheduled times, and you're surrounded by other old people, mostly strangers. You've been robbed of your autonomy, maybe even your identity — the very things that make you you may be more tied to your past than your present, and nobody expects very much of you anymore.

No matter your age, this is not an environment in which most people thrive. But Langer thought that maybe, just maybe, if you could put people in a psychologically better setting — one they would associate with a better, younger version of themselves — their bodies might follow along. "Wherever you put the mind, you're necessarily putting the body," she explained many years later, on CBS This Morning.
 
Since Langer couldn't actually send elderly people into the past, she decided to bring the past into the present. "We would recreate the world of 1959 and ask subjects to live as though it were twenty years earlier," she wrote, in her 2009 book "Counterclockwise."

How exactly did that work? Here's how Bruce Grierson described the beginning of this experiment in The New York Times Magazine:
Eight men in their 70s stepped out of a van in front of a converted monastery in New Hampshire. They shuffled forward, a few of them arthritically stooped, a couple with canes. Then they passed through the door and entered a time warp. Perry Como crooned on a vintage radio. Ed Sullivan welcomed guests on a black-and-white TV. Everything inside — including the books on the shelves and the magazines lying around — were designed to conjure 1959.
The men didn't just reminisce about what things were like at that time (a control group did that). They were instructed to behave as if it were actually 1959, while the control group lived in a similar environment but didn't act as if it were decades ago.

They discussed historical events as if they were current news, and no provisions were made that acknowledged the men's weakened physical state; no one carried their bags or helped them up the stairs or treated them like they were old.

"Nothing — no mirrors, no modern-day clothing, no photos except portraits of their much younger selves — spoiled the illusion that they had shaken off 22 years," Grierson wrote.

A week later, both the control group and the experimental group showed improvements in "physical strength, manual dexterity, gait, posture, perception, memory, cognition, taste sensitivity, hearing, and vision," Langer wrote in "Counterclockwise."

And according to Langer's account, most of those improvements were much more significant in the group told to live as if it were actually 1959; a full 63% of them had better scores at the end of the experiment than they did at the beginning, compared to 44% in the control group. Four independent volunteers, who knew nothing about the study, looked at before-and-after photos of the men in the experimental group and perceived those in the "after" photos as an average of two years younger than those in the "before."

On the last day of the study, Langer wrote, men "who had seemed so frail" just days before ended up playing "an impromptu touch football game on the front lawn."

In some ways, the results should not be surprising. Grierson writes that Langer actually said to the participants that "we have good reason to believe that if you are successful at this, you will feel as you did in 1959."

When you believe that something will affect you in a particular way, it often does. That's why placebo controls are baked into every rigorous clinical trial.

Your own expectations, and the expectations of others, are powerful. And expectations of the declining cognitive and physical abilities that come with age are pervasive.

But as Rebecca Tuhus-Dubrow noted in The Boston Globe Ideas section, in a story about the power of placebos, "there are limits to even the strongest placebo effect. No simulation could set a broken arm, of course, or clear a blocked artery. As a rule, placebos appear to affect symptoms rather than underlying diseases."

Still, Langer seemed to take the "counterclockwise" results as further confirmation of her theories about the power of the mind over the body, even as fuel for her argument that — as she wrote in 1981 — "many of the consequences of old age may be environmentally determined and thereby potentially reversed through manipulations of the environment."

Years later, she remained convinced. "These findings are in some ways astounding," Langer said, in a 2010 BBC documentary. "Remember, old people are only supposed to get worse."

Science... or stunt?


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Langer has talked and written about her "counterclockwise" experiment many times in the decades since it happened. She offered the most detailed record of it in a chapter of an Oxford University Press book she co-edited.

The findings, however, were never actually published in a peer-reviewed journal. And they were never replicated, except as made-for-TV stunts.

"Langer’s sensibility can feel at odds with the rigors of contemporary academia," Grierson wrote, in The New York Times Magazine article. "Sometimes she will give equal weight to casually hatched ideas and peer-reviewed studies."   

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In an interview about his cover story, Grierson acknowledged that while Langer's unorthodox techniques may inspire wonder, they should also provoke skepticism. "She’s still pretty far out there on a limb with some of this work," he said. "People won’t be convinced until it has been replicated under strictly controlled conditions. Nor should they be."

James Coyne, a longtime University of Pennsylvania psychologist and an indefatigable skeptic, goes even further.

"Ellen Langer’s identification as an eminent, well-published Harvard psychologist is an important part of her branding and the promotion of herself.... Yet, she assumes none of the responsibility that goes with being a scientist," he argues, in a critical response to Grierson's article on the blog Science-Based Medicine. "She does not consistently submit her work to peer review. She makes references to unpublished studies, even those that have remained so for many years... Langer has published in scientific journals, but she is not otherwise acting like a scientist."

Coyne takes issue not only with the unpublished counterclockwise experiment, but also with some of Langer's other work — especially her plans to test her theories in an upcoming study of cancer patients, who will be told to live as if it is 2003, before they had any signs of illness.

As Grierson writes, "positive psychology doesn't have a great track record as a way to fight cancer."

Looking forward

The media and general public seems to be especially captivated by the counterclockwise study — intuitively appealing in a society so fearful of aging — but it's of course just one part of Langer's decades-spanning career.

While there are plenty of compelling reasons to be skeptical of her most famous experiment (and, Coyne argues, many others too), the takeaways from most of Langer's work remain compelling: Mindfulness (conscious awareness of and focus on the present moment) is important; placebo effects cannot be discounted; and evidence supports the benefits of making sure people maintain agency and independence as they get older.

So what if we can't actually turn back the clock? Our lives need not be dictated by it.

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A radical experiment tried to make old people young again — and the results were astonishing

1 comment:

StandUp said...

Amazing! And I am so glad to see more and more attention on the terrible disease.