I just finished proctoring the geriatric psychiatry station of the comprehensive examination that second-year students take at the Harvard Medical School. Serendipitously, I also viewed Sari Gilman's Academy Award–nominated Kings Point, a 30-minute documentary covering 10 years in the life of an age-restricted community in Florida, that's set to premiere on HBO on March 11. While the doctors-to-be all did well in interviewing and diagnosing a "standardized" geriatric patient, it occurred to me how their interactions could have been enhanced by viewing Gilman's film.
Kings Point takes the viewer into the lives of five aging-in-place residents who are extremely insightful into their own circumstance. They accept with equanimity the true horror of aging alone, sundered from family and community. They all bought the Florida dream and left New York City for what they believed to be the Promised Land. The promise of home ownership, eternal sunshine, and companionship with like-minded people lured them into a desperate trap. For as they aged and developed infirmities, as their spouses died off, they were left alone and frightened. As one of the elders noted, "Nobody gets too close here; they are afraid." And Kings Point elucidates these fears all too clearly and poignantly. They desire connection but are so afraid of loss that they shy away from closeness and commitment, two essential aspects of our human nature.
The result is isolation and a focus on simple self-preservation. As Gert, one of the elders, notes, "I'm taking care of myself." The cinematographers—Daniel Gold, Gabriel Miller, and Toby Oppenheimer—manage to capture both the surface beauty of the setting with its pink houses, lush lawns, bubbling brooks, and tall palm trees and contrast it with a glimpse into the residents' sense of living in a prison they cannot escape from. Filming through windows with protective bars on them, down long, empty, and sterile corridors—all reinforce the loneliness and despair of the individuals living there.
And therein lies the importance of this film. As we have long known from Eric Erickson, the last crisis in life is one of ego integrity vs. despair. We see here what most of the aging are up against. And they are up against an environment and society that makes it very difficult to resolve this conflict in any manner other than depression, loneliness, and despair.
Elders in America are the fastest-growing segment of our population and as baby boomers "age out," we approach a very human crisis of significant proportions. In the near past, it was not unusual for three generations of a family to live under one roof (in Boston, this was the reason for the ubiquitous three-decker house). The mobility of the current generation has forced parents to rely on "the kindness of strangers" for what was formerly the care of the family, and they are left with choices labeled independent living, assisted living, or nursing home. It is imperative that the caregivers of the elder population truly grasp the position that elders have defaulted to and the issues they are up against.
It is imperative that the caregivers of the elder population truly grasp the position that elders have defaulted to and the issues they are up against.
In training psychiatry residents and postdoctoral psychologists, I am impressed by the breadth and depth of the trainees' technical knowledge. What is lacking in their training is a way for them to develop an emotional understanding of the elders' predicament. It is our challenge as the teachers of this next generation of caregivers to help them identify the needs of the elders for whom they will be caring. It is only through understanding the painful losses and limited choices that this elder generation of Americans must inevitably endure that will help these future caregivers to provide the necessary therapeutic interventions to optimize their quality of life. Ultimately, it must be our goal to help elders resolve that last Ericksonian crisis in favor of ego integrity and satisfaction in the lives they have led. Trainees as well as current health-care professionals must learn (to paraphrase Walt Kelly'sPogo) that they have met the elderly and they are us.
Kings Point should be required viewing for all medical students, residents, physicians, social workers, psychologists, and nurses. It conveys, as no other film or teaching tool does, the major challenges of aging in our society. As America continues to turn increasingly gray, health professionals need to empathetically understand the needs, the crises, and the losses of our elders. Kings Point is a moving start in the right direction.
