Would You Want to be a Centenarian?

I was surfing Yahoo! News earlier today. Buried among the usual tabloid fodder, half-baked political articles, and random recipes for food you can make in less than 30 minutes, was an amazing human interest story: Mrs. Besse Cooper, of Monroe, Georgia, just turned 116 retaining her position as the world’s current oldest person. She is ranked 10th on the all-time longest living human being list. 116? How is that even possible?

Cooper was born August 26, 1896. She saw the Progressive Movement, World War I, the roaring 20’s, Women’s Suffrage, the Great Depression, World War II, The New Deal, J.F.K.’s assassination, the Civil Rights Movement, Vietnam, both Gulf Wars, September 11th, and the election of the first black president of the United States. Mind you, she was born just prior to William McKinley’s presidential election victory on November 3, 1896. When she took the title of oldest person, she was naturally asked how she did it. According to Guiness World Records, she stated: “I mind my own business. And I don’t eat junk food.”

Cooper’s family said the more years she has tallied, the wittier she has become. Her statement sounds like a parental platitude, except at 116 she can also educate her numerous great-great-grandchildren. In fact, her simple advice is probably something everyone can heed. After all, she was born long before the gossip industry and junk food craze existed. If you want to make it to her age, you’d better be good to those around you and maintain a healthy diet!

Naturally, one asks, “Do I want to live to 100”, or more realistically, “Can I live until 100?”. It’s just a number, a chronological measure of time, but it represents a fascinating culmination of life events that demand further exploration, both scientifically and philosophically.

I suppose one point worth stating is that most Centenarians – including Supercentenarians – didn’t necessarily set out to live past 100 at birth. They lived normal lives, enjoyed good health, had happy relationships, and of course had incredibly resilient genetics. You also have to consider the fact that some luck played into their longevity. Many people have great genes, a happy disposition, and take dutiful care of their bodies, yet fall victim to accidents, become casualties of war, or develop terminal illness unusually early in their life. Mrs. Cooper and her fellow Supercentenarians obviously dodged these bullets, and it’s to their credit.

This also brings an interesting philosophical question to the fore: If I want to live to a ripe old age, shouldn’t I just isolate myself from the world and keep out of harm’s way? I suppose someone could greatly extend their lifespan if they lived in a mini-paradise, free from the world’s troubles. Unfortunately, such an existence is neither pragmatic nor realistic; at some point we all have to interact with society and contemplate its trials and tribulations. Maybe the more important question is not “How should I avoid misfortune?”, but “How do I tolerate misfortune?”. Clearly, Mrs. Cooper hasn’t lived in a vacuum, and yet through it all, she managed to persevere to 116 years of age and counting. Perhaps she should be asked about how she dealt with life’s most difficult moments, and how she mentally picked herself back up and soldiered on?

THAT is what I want to hear from these incredible people. I’ve struggled with mental illness for years now, and sometimes I wonder whether or not it will shorten my lifespan, simply because miserable people don’t feel the need to postpone their eventual demise. It’s also a well established scientific fact that people who live longer have an optimistic view of their own world, bolstered by a strong social support system and the guts to stick it out through thick and thin. Maybe it takes a village, but it might also take a positive outlook on life to crack the 100 year barrier. If you’re not happy with yourself, there’s not much impetus to stick around.

So, all things considered, I’d love to make it to 100; however in doing so, I would want to live a full life. When I excuse myself from social activities to work, or take a nap instead of going out to the movies, I’m certainly preserving myself for posterity, but I might not be truly enjoying the moments I have right NOW. Does a long life equate happiness, or does happiness equate a long life? Again, you could leave me in a mini-paradise at age 33 with all bills paid forever, and I might still croak at 75. Immediately before I expire, I would naturally ask myself if spending the balance of my adult years locked away from the rest of the world – liberated from its good and bad – was truly worth it. My answer would most likely be “No”.

Maybe the real wisdom to gain from Mrs. Cooper’s story is how she balanced the “live life in the moment” desire with the “take care of yourself for the future” axiom. Some of us party like there’s no tomorrow, while others squirrel away their resources for use later on. Neither is right, neither is wrong, it really comes down to individual choice. Our society should study and interview Supercentenarians more closely, instead of excusing them as genetic anomalies or just “extremely lucky”. I think their advice, gleaned over the course of more than a century, would be words to live by in a world currently plagued by uncertainty, perhaps the most damning force we will ever combat during our Earthly existence.

Interesting Facts:
Source: Wikipedia “Oldest People”

  • The current world record for the world’s longest living person is held by Ms. Jeanne Calment of France born February 21, 1875 and dying on August 4, 1997, at the astounding age of 122 years, 164 days. She is the only documented human being to have lived more than 120 years.
  • The current world record holder for world’s oldest living man is held by Jiroemon Kimura of Japan, born April 19, 1897 with 115 years, 130 days to his name. Prior to his retirement to a small farm, he worked in the post office for 40 years.
  • ALL of the top 10 longest living human beings of all time have been female.
  • 50% of the top 10 all time longest living human beings are from the United States, despite our healthcare troubles and obesity epidemic.
  • Of the top 10 current oldest living people, 50% (5) are from Japan, 40% (4) are from the USA, and 10% (1) is from Italy.

Can People With Borderline Personality Disorder Live Productive Lives?

Is a BPD diagnosis a death sentence, or just an order for a lifetime of emotional torture? For those that eventually commit suicide, BPD IS most certainly lethal. For those that don’t, do they truly live fulfilling lives, even if they get the best treatments available?

I’ve wondered about this as I progress into my 30’s, most often when I come to “take inventory” moments. In just over a month, I’ll be leaving Costa Rica and returning to the United States to continue my life. I’ve lived somewhat productively in San Jose, Costa Rica, for 8 years now, and I think it is time to move on. Recent changes in Costa Rica’s immigration policies and the need to take full control of my healthcare have necessitated the move: I can no longer live here “as a tourist” and pickup meds shipments from my parents each month at the post office (I pay in full for all my meds, shipping costs, and compensate them for their time). Furthermore, as my parents grow older, it will be important for my brothers and I to orbit closer to home, in order to provide for them in their later years (even if there were times in the past when I could have cared less what happened to them).

The move-out process has given me considerable anxiety, amplified by the fact that my business income has decreased substantially, mostly due to my own sloppy web marketing tactics. At the same time, I feel I need to do something more productive for the world other than run websites that promote online gambling. Ideally I’d like to change careers once I return to the USA, but this may not be possible if the money isn’t there. My new apartment in Florida will cost more than my current abode in Costa Rica. Couple that with increased health care costs and insurance premiums, and changing careers is almost an impossibility.

I went over all my fears with a psychiatrist I’ve been seeing in Costa Rica. My initial visit in the Spring was for a consultation about my medication. Since then, I’ve returned on a monthly basis in order to quell some of my nerves about moving back home.

Sometimes we don’t communicate effectively because expressing my innermost thoughts in Spanish is challenging. Equally, he doesn’t understand my USA English colloquial expressions. We end up speaking “Spanglish” on occasion and it’s rather entertaining, except when I’m trying to seek serious advice. In my most recent visit, he understood the crux of my current level of anxiety and said emphatically, “One change, one time”. That is exactly the mantra I need to keep in mind over the coming weeks.

He also made an interesting point: “People with Borderline Personality can live productive lives”. In my head, my immediate reaction to this statement was “Really? Is he trying to give me a pep talk or actually convey a medical fact?” I smiled and nodded and didn’t really challenge him on it. Perhaps he thinks my BPD is less obstructive than I think it is? Should I educate him more about how I actually got the diagnosis and the struggles I’ve faced since then? As a practical matter, it isn’t worth my time because I’m only visiting his office once before I leave the country, but his assertion gave me pause and a need to contemplate my life more closely.

I have no meaningful romantic relationship at the moment, and all past endeavors in that realm have never lasted more than four or five months. Admittedly, choosing to spend the bulk of my 20’s in a foreign country obviously made things more challenging in the relationship department, especially since I’m already shy and introverted. Trying to meet that special someone with prominent language and cultural barriers in the way only complicates matters. More to the point, BPD usually takes a dramatic toll on one’s relationships more than any other demands in life. Since I’ve not committed myself to a long term relationship and have never really been tested in this regard, I wonder if my BPD has simply gone dormant and ignored, opposed to tested and improved.

In reality, I’m not going to land in the USA and have a date every Saturday night. I still have to get out and about and meet people even though I work at home. In some ways, my social isolation has saved me from the stress of dealing with BPD in a serious relationship, but now that I’m 8 years older and well past 30, it’s high time I get my personal life together. Once settled in Florida, I should probably test myself inside the rigors of a full fledged relationship to determine how much my BPD symptoms have improved or worsened. Hopefully, my eventual girlfriend will be understanding if things go South.

The extent to which someone with BPD can have a “productive” life is determined by treatment, medication, and how often their BPD is “tested” on a daily basis. If I lived in a cave by myself and never interacted with the outside world, BPD wouldn’t be too much of an issue. Unfortunately, I don’t think resigning myself to life in a cave would be a good move. Despite being shy and having BPD, I would love to have a romantic relationship with a woman and maybe get married. Underneath all the hurt and disappointment that BPD has dropped on me, I still have basic social needs that need to be met.

Over the past few years, I’ve ignored some of these needs so that I can focus on my business and getting through each day in one piece. Now it might be time to reach out and take my recovery to the next level: put myself in more demanding situations and develop ways of coping with my BPD effectively so that I can live a more “normal” life, much like other people enjoy. Otherwise, I risk isolating myself further and getting in the way of my own emotional needs.

Can you have BPD and productive? That depends largely on the way you live your life and the way in which you are being treated. My Costa Rican doctor might have a point, or he may have been trying to make me feel better about myself. Either way, it was a compelling statement and extremely thought provoking.

A Borderline Case for Socialized Health Care

As an individual suffering from Type 1 Diabetes and Borderline Personality Disorder, I rely heavily on my health insurance for my therapy, treatments, and medications. Over the past few years, my health care costs have steadily risen. When combining health insurance premiums, deductibles, co-payments, diabetic supplies, and visits to doctors’ offices, I wind up spending over $10,000. This amount of money is a huge expense for me – as it would be for most people – but I have few alternatives.

Before I go any further, let me state a couple important points about my chronic health problems.

First, I’m NOT a Type 1 diabetic because I sit on the couch all day and eat Big Macs. I was diagnosed my senior year in High School and weighed about 155 pounds at 5′ 10″. I exercised nearly every day because I was running track and cross country. If anything, I probably looked like I needed MORE food, not less. Although the cause of Type 1 Diabetes is still in debate, many doctors suggest it could be caused by genetic predisposition, the result of a viral infection, or some sort of auto-immune disorder in which the body attacks the cells of the pancreas that naturally produce insulin, rendering them useless. So before you suggest I was a useless slob who didn’t take care of himself, think again. Even after my diagnosis I could still outrun the entire school football team. I even achieved all conference honors on my team’s 4×800 meter relay team.

Second, no one chooses to get Borderline Personality Disorder. Again, its cause may be rooted in genes, but there are also environmental factors that clearly exacerbate the condition. My parents did not create an environment conducive to my personality and did not suggest seeking psychiatric care until I exploded in college. Is it all THEIR fault? No. Please remember – as any sufferer of BPD will tell you – that no matter what happened in my childhood, it’s still up to me to get better and be productive on my own. It is a well documented process that takes years and requires immense effort on the part of the BPD sufferer and his or her physician. Recent progress in DBT (Dialectical Behavioral Therapy) has also proven effective. Again, like Type 1 Diabetes, this just happened, there was nothing that could be done to prevent it short of my parents putting me in therapy as a grammar school kid, which was all but unheard of in the late 1980s unless you had extremely serious mental health problems.

So, I’ve got my work cut out for me and it won’t be cheap. Do I expect all you healthy people to pay for it? No, but that’s not my suggestion. Instead, I believe that the USA would be much better served utilizing more socialized health care that engenders both personal responsibility and a national attitude towards taking care of ourselves AND our neighbors.

In the age of bumper sticker politics and sound bytes, there are a few rebuttals to a system of health care that can support everyone: rich, poor, sick, or healthy.

1. Why should I pay for your problems? If you’re sick, tough luck, I’m not paying your medical bills or subsidizing your therapy sessions. I have bills of my own to pay.

My thought: Stop thinking about yourself and start thinking about the greater good of the society you live in. Under such austere thinking, those who are perfectly healthy would happily go about their lives in a good-luck based utopia, while the sick lacking the economic wherewithal to help themselves would die in the streets or jump off bridges due to mental anguish.

The result? Suddenly, a national health crisis of epic proportions would erupt, because communicable illness would be rampant and the bodies of dead poor people would be rotting in the gutters. Our first world existence would plummet to third world status almost overnight. Who’s going to pay for all this mess? If you’ve got half a brain, the answer is YOU.

I won’t engage in further hyperbole and will make a simple point: would you rather pay a buck towards preventative care and safety nets for your neighbors, or be faced with a crisis that costs an inordinate amount of money to cleanup? Be careful, we’re getting close to that cliff already!

2. Leave it to the private sector to work out. Insurance companies have expert actuaries working for them who can determine risk and keep the government out of it.

My thought: The motivation of the private sector to produce profits will exceed its desire to provide adequate health care. When health care becomes an issue of creating returns for investors, corners will be cut in the name of better business. It’s an understandable motive given the mostly capitalist economy we embrace. Unfortunately, leaving it to private insurance companies would only worsen the problem of denying those with pre-existing conditions health care coverage. It would be exponentially more profitable to insure healthy people over sick ones, so why bother taking an unnecessary risk? Moreover, why risk company profits on the poor or those facing temporary hard times, when insuring those in the upper echelons of society is eminently safer and a steadier cash flow?

Another thing to consider: even the best insurance risk models can fail, and when they do, everyone insured under a faulty model loses. Anyone remember AIG? Predicting the future is impossible. There is no mathematical algorithm that can adequately account for ALL possible outcomes. This thought is better described as the Ludic Fallacy. Chiefly – as stated in the Wikipedia link – “theories/models based on empirical data are flawed, as events that have not taken place before cannot be accounted for”.

Ultimately, when problems arise in the private sector, the government has to step in as a check. Therefore, to provide for the well-being of society at large, a purely privatized health care system would never work, whereas one with government safety nets and fail-overs would.

3. We don’t need socialized medicine, we need more affordable care. If health care was cheaper, there would be no need for the government to act as a backstop for the less fortunate.

My thought: This point encompasses a wide range of issues including, but not limited to: tort reform, mal-practice insurance, costs associated with becoming a doctor, pharmaceutical company profits, and the uninsured/poor using the emergency room as their doctor’s office, fobbing off their medical bills for someone else to foot.

There’s a running joke that getting a single tablet of aspirin in the hospital might cost more than $20 when one could easily go to a chain pharmacy and spend 1/3 as much on a container of 50 tablets. Many posit that the reason hospital costs are so outrageous is because the books are balanced by overcharging those who pay their own way against those who get their medical care for free. An alternative theory: maybe big pharmaceutical companies gouge hospitals because they know they have few competitors to bid the price of medicine lower.

Doctors take a Hippocratic oath to provide care for all patients, regardless of their financial capabilities. This is part of what makes our country great. I would agree, however, that this loophole can be exploited and abused, putting undue stress on the rest of the system.

What’s the solution? We can only minimize costs so much. We can’t walk back the price of medical school to 1950s levels because it is economically and practically impossible. Equally, turning uninsured people away from the emergency room would be a moral crisis for health care professionals and would ultimately hurt the rest of society as the sick would only get sicker, creating even greater problems and financial woes.

Instead, the government needs to step in and efficiently manage health care by offsetting the fundamental costs and financial problems that plague the system. Aspirin should not cost $20 a pop for someone with insurance while someone uninsured walks in for free. This problem would be avoided if the government provided hospitals and emergency rooms with a stipend to counterbalance the expense of providing “free” care, which would ultimately relieve stress on budgets. Additionally, reining in the greed of pharmaceutical companies with strong regulation would curb their never ending desire to rip off the consumer who they know has limited alternatives other than to pay whatever price point is set.

In conclusion, I’m sure there are other points to debate, but the point of this blog is to provoke thought, not solve the nation’s health care troubles in 2000 words or less (just passed 1400 on the word count). I firmly believe that preventative health care is the most efficient and cost effective way to ease the financial tensions we are facing. Next, while private insurance companies have a right to exist and offer their services, a purely privatized health insurance industry would not serve the greater interests of EVERYONE in society. The government can and should pick up the slack when private insurance companies refuse to provide insurance to people they perceive as “high risk”. Finally, the fundamental costs involved with providing care itself must be reexamined and regulated. Hospitals strapped for cash because emergency room lines are full of the non-insured should not turn patients away, but instead get a fixed stipend from the government for basic treatments. Similarly, the price of medicine should not be so exorbitant that it becomes out of reach of most consumers. The government must regulate big pharmas closely – yet fairly – to encourage further research and development of new treatments, while not bankrupting the citizenry with ridiculous costs in the process.