Friday, October 23, 2015

How We Age: Book Review

Published 1 February 2011.
I very much enjoyed reading How We Age: A Doctor's Journey into the Heart of Growing Old. (2011).

Dr. Marc E. Agronin graduated from Harvard and then Yale Medical school before becoming a psychiatrist at the Miami Jewish Health Systems.

Agronin possess a great blend of intellect, spirit and emotion as he moves from describing very specific incidents with patients to describing very general observations about the process of aging.

He combines viewpoints from the sciences, social sciences and the humanities while working with people in their 70s, 80s, 90s and 100s.

Agronin does focus a great deal on what he labels "The Four Horsemen of Old Age": depression, dementia, delirium, and destitution.

But his book is not all gloom and doom. He also describes older adults experiencing laughter, healing, restoration, intimacy, legacy, and insight in their final chapter of life.

As a psychiatrist, he is trained to heal both the mind and the body.  He does use talk therapy and shows a great understanding of the interplay among overlapping constructs of the brain, the mind, emotions, identity, and memory.

Agronin also describes the delicate nature of treating older adults with prescription medications. Because their bodies are frailer and because they often have many chronic diseases if not terminal diseases, a change in prescriptions or even a small change in dosing can disturb the precarious homeostasis of an aging body.

Agronin also describes other realms of living such as physical health, social support systems, living arrangements, finances, spirituality, personal history, and identity.

His book contains 25 chapters in the body of the book with some front matter and back matter.

The book is too rich for me to summarize thoroughly, so let me just highlight a few chapters:

In "Old Pickled Brain," we meet a very wealthy man who achieved great success in his vocation by being narcissistic and aggressive.  He also had problems with mental illness, infidelity and substance abuse. He was completely out of control when Agronin met him as a patient. Things only got worse. I won't spoil the ending by telling you how everything unfolds--except this cranky old business man insisted that Agronin write up his case study for the benefit of others.  I was riveted with every detail about his case.

In "The Elders," Agronin describes the phenomenon of achieving wisdom in advanced age. There are a lot of details and concepts in this chapter. In order to give shape to his ideas, Agronin organizes his observations around the life, career and aging process of George S. McGovern.  The ideas transcend this one man's experience, but it's an interesting anchor.

In "The Seamstress," we meet Emma, a woman who had a very difficult life and a very difficult death. Despite his training as a physician and his far-ranging reading in the humanities and social sciences, Agronin struggles to connect with Emma.  He yearns towards her in attempt to treat her.  As he aches for her when his efforts fail, we see tenderness and poignancy. We can't always connect with others or make others' lives fit into a prefabricated ideal.

I have read more than a hundred books about aging in the last few years, and How We Age is a clear member of my "Top 10 Reads on Aging" for its mix of story and science, detail and concept, hardship and hope.


Books on Aging
Books about the Brain
Theft of Memory: Book Review
Is It Dementia or Delirium?


  1. This sounds like a very thought provoking book. I'm wondering if Dr, Algronin delves much into the differences between how men and women age? For example, why women seem to be more susceptible to dementia.

    1. Kim: That's a great question, one that I've seen explored in various news stories, but without really satisfying answers. He doesn't take that on. He shares a number of case studies and then contextualizes them in philosophical meditations. He doesn't go through evidenced-based clinical trials much (but does gesture to some of the science here and there; he reads these things to inform his practice, but his book is for the general, college-educated or autodidact reader).

  2. As I begin to H and as I help my aging parents this is something I really really need to read.

    1. All my best you Carla and to your parents. Aging is so interesting. The more I regard it, the more complexities emerge--both challenges and opportunities. Hugs!

  3. I must read this book! I love your description of it and the mix sounds quite fascinating. Thanks! Carol

    1. I had no idea going in that I would enjoy it so much. And I can't believe it took me 4 years to learn about it when I read quite a bit on the topic. Thanks for reading the review and commenting!

  4. Thanks for this timely book review. Dr. Algronin's four "horseman of old age" really caught my attention. Iwas looking for my next book. I think I found it!

  5. You always introduce me to such interesting books. Adding this one to my reading list right now!

  6. Thanks for introducing me to this book. Good to know it's out there.