Psychiatric Annals

Retirement: Psychology and Psychopathology

Lionel Corbett, MD

Abstract

1. Fries JF. Crapo LM: Vitality and Aging. San Francisco. WH Freeman & Co. 198 L

2. Atchley RC: The Sociology of Retirement. Toronto, John Wiley & Sons Inc. 1976.

3. Dressier DH: Life stress and emotional crisis: The idiosyncratic interpretation of life events. Compr Psychiatry 1976; 17:549.

4. Hirschowitz RC: Crisis theory: A formuiation. Psychiatric Annals. 1973; 3(12):36.

5. Wasylenki D. McBride A: Retirement, in Howells JG (ed): Modern Perspectives in the Psychiatry of Middle Age. New York. Brunner/ Mazel Inc. 1981.

6. Riley M. Fouer A: Aging and Society. New York, Rüssel Sage Foundation. 1968.

7. Shanas E: Health and adjustment in retirement. Gerontologist 1970; 10:19.

8. Shanas E: Adjustment to retirement, in Carp FM (ed): Retirement. New York. Behavioral Publications. 1972.

9. Breed W, Huffine CL: Sex differences in suicide among older while Americans: A role and developmental approach, in Kaplan OJ (ed): Psychopathology of Aging. New York, Academic Press inc. 1979.

10. Appleton WS: Effect of retirement on marriage. Medical Aspects of Human Sexuality 1981: 15:10. 73.

11. Corbett L: The last sexual taboo: Sex in oldage. Medical Aspects of Human Sexuality 1981; 15:14. 117.

12. Braceland FJ: Man's work and what it means, in Usdin G (ed): The Psychiatric Forum. New York, Brunner/ Mazel Inc. 1972.

13. Whitmont EC: The Symbolic Quest. Princeton. New Jersey. Princeton Univ Press. 1969.

14. Rosow I: Socialization to Old Age. Berkeley, California. University of California Press, 1974.

15. Neugarten BL: Age groups in American society and the rise of the young old. Annals of the American Academy of Political and Social Science 1974; 415:187-198.

16. Van Gennep A: The Rites of Passage. Chicago, University of Chicago Press, 1960.

17. Jung CG: The stages of life, in Collected Works, Princeton, New Jersey, Princeton University Press. 1976.…

INTRODUCTION

Such is the increase in vigor and longevity among older people that, for those who live to retire, the years after work are now likely to last as long as childhood and adolescence. Unfortunately, however, this important period of life is still sometimes regarded as one of remorseless decline rather than one of continued development. For example, it is not generally recognized that the degree of variability among some important psychological and physiological attributes actually increases with age. Indeed, such enormous plasticity is possible that the elderly are, in many ways, less alike than other homogeneous age groups. In particular, psychological differences of all types - both healthy and problematic - are enhanced by age, so that personality characteristics become exaggerated. Rather than being a totally predetermined deterioration, it now seems that some control of the aging process is achievable by personal decisions and activity. Exercise, nutrition, weight control, not smoking, continuing intellectual and creative activity and consistent social interaction all tend to postpone certain manifestations of aging. These activities are increasingly popular in our culture. Thus, contrary to the prevalent stereotypes, increasing numbers of older people maintain good health, emotional flexibility, energy, and creative potential.' In spite of these facts, we do not yet possess an adequate and widely accepted developmental psychology for this period of life. Accordingly, clinicians tend to make judgments about the elderly in terms of developmental criteria which are really only appropriate to mid-life. Thus, many people who are considered to be successfully retired are only so according to norms relevant to a previous period in their life cycle. Our overvaluation of youth and devaluation of old age is such that society at large, and the elderly themselves, tend to assume that perpetually behaving like the young is desirable at all ages. There is then a tendency to avoid dealing with the specific developmental tasks demanded of the post-retirement years in favor of the pursuit of youthfulness. Such denial can be viewed as a developmental arrest.

PHASES OF RETIREMENT

Retirement should not be seen as a single type of life event which precipitates a specific, acute psychosocial crisis. It is, rather, a prolonged process consisting of at least seven phases. Atchley" describes the following: I) a remote phase, several years before the event; 2) a near phase, when retirement becomes an approaching reality; 3) a honeymoon phase of new freedom; 4) a disenchantment phase when the retiree has to cope with the multiple losses of old age, such as inadequate income, loss of friends, health and status; 5) phases of reorientation, and 6) phases of restabilization, when the new-status and new routines of living are established; and finally, 7) the termination stage, that of the final illness leading to death. Of these, the near and disenchantment phases are the most stressful and require considerable adjustment. Dressier3 has pointed out the importance of appraisal in such stressful situations. When he experiences a sense of loss, threat or attack, the individual evaluates whether or not his usual defenses and coping strategies will be effective. Appropriate affects of sadness, anxiety or anger are mobilized. These affects are cognitively elaborated and either dealt with using healthy coping mechanisms in psychologically flexible people or they may be denied, projected or expressed destructively. External social supports, especially help from family and friends, are extremely valuable in attenuating the impact of the stress. Adequate pre-retirement planning also mitigates its severity.

By contrast, unexpected and unplanned retirement forced on the individual by circumstances outside his control is acutely and intensely stressful and does produce the sequence of events described by classical crisis theory.4 The impact and recoil are followed by turmoil and dysphoria with temporary emotional disequilibrium. This is followed by cognitive uncertainty often with psychophysiological symptoms. There is then an attendant opportunity for personality growth - if the crisis can be mastered, new adjustment begins, but inappropriate defenses lead to the onset of psychopathology.

COMPULSORY RETIREMENT VS. CONTINUED WORK

There is now widespread opposition to the imposition of a compulsory retirement age. This is seen as discriminatory, since there is often no loss of the ability to work at age 65. For many, continued work is important and such individuals resent any criteria other than ability and willingness as determinants of their right to work. Forced obsolescence of large numbers of healthy old people creates economic as well as humanitarian difficulty. By the year 2031, there will be 55 million elderly Americans, and only three workers for every retired person5 - this will clearly produce enormous strains on an already overburdened Social Security system. In this context, it is important to point out that there are many misconceptions about older workers. Contrary to popular belief, their reliability, emotional stability and sensitivity to others tends to be higher than among the young. Motivation to make a good impression often increases with age. Their work habits are steadier, they waste less time, have less absenteeism, are more responsible, have less outside distractions, and often exceed the average efficiency and output of the young. Older employees are often very flexible, adjust to change well and can transfer skills from previous jobs to the new one. Although there are increased pension costs when hiring the elderly, these are offset by the quality of their work. There is no increase in health insurance or workmen's compensation costs.'1 Thus, instead of seeing the increasing numbers of older people simply as a threat to social services, we could see them as an important national resource which must not be wasted or allowed to remain unintegrated into society. Many are experienced, willing and able to participate. More investment in the elderly, producing options which recognize their large potential as producers and consumers, will both alleviate some potential social difficulties and reduce the possibility of anomie among those elderly who need or wish to work.

However, it should be recognized that the predominant work ethic of earlier generations is now less powerful, and many people do not wish to continue to work after 65. 7 A flexible, individualized approach to retirement is therefore clearly needed.

THEORIES OF ADJUSTMENT TO RETIREMENT*

Activity Theory

Activity theory suggests that for satisfactory adjustment in retirement, people must make substitutions for what they have lost in work by replacing it with other sets of activities which give equal satisfaction. Whether this can be done depends on the meaning of work for the person and the extent to which leisure activities can replace these values. This theory may presuppose an obsolete work ethic, since many people today prefer leisure time activity to work, which is only a source of income. If this can be assured, retirement is often preferred.

Disengagement Theory

Disengagement theory suggests that retirement is a part of a necessary mutual withdrawal of the individual and society, resulting in decreased interaction between people and the social system. This is seen as functional because it involves a realistic acceptance of the fact that the disengaged person does not perform any useful function. This theory risks making the rejection of older people by society seem acceptable and is potentially discriminatory. Disengagement should be selective and accompanied by re-engagement. It is important to accept necessary disengagement, but not to the extent of complacency or indifference. We should retire to something, not simply from something.

Accommodation Theory

Accommodation theory views adjustment to retirement as a process beginning with the first thoughts of retirement which only abates when the individual redistributes his energy in non-work roles which are entirely new modes of behavior. Adjustment to retirement depends on the nature of the life changes caused by retirement. During different times within the retirement period, adjustment varies with circumstances. The factors which influence it are those such as commitment to a work ethic, preparation for retirement, psychological health, geographic mobility, income, social support, and physical health.

RELATIONSHIPS BETWEEN RETIREMENT AND MENTAL AND PHYSICAL HEALTH

Retirement has a negative social stereotype. However, it is important to point out that retirement does not usually lead to serious physical or psychological changes. Wasylenki and MacBride have exhaustively reviewed the literature in this area, and conclude that impressions to this effect were based on mistaken extrapolations from studies of psychiatric populations of retirees, who obviously are not typical of most people experiencing retirement. Early reports that retirement increases the likelihood of death were also misleading. The disproportionately higher percentage of death among those who retire voluntarily is probably due to the fact that preexisting poor health influences their decision to retire. In fact, several studies suggest that retirement actually improves physical health. Poor physical health is, therefore, a major cause rather than an effect of retirement and also adversely affects psychological adjustment. There is no support for the notion that retirement precipitates mental illness in most people. Where this does occur, it tends to be a function of many other deprivation factors associated with retirement, such as poor economic status, poor physical health, poverty and social isolation. Such situational factors powerfully effect psychological adjustment. Further, retirement does not usually decrease general life satisfaction. Most retired people are satisfied as long as they have adequate money and health, provided that their pre-retirement attitude indicated a willingness to retire. It seems that the level of importance of job satisfaction in a person's value system influences the effect of retirement; when work is a key organizing factor in an individual's life, there tends to be an inverse relationship between work satisfaction and attitude to retirement.

Socioeconomic factors also have some influence. Blue collar workers initially adjust more successfully than white collar workers, but in the long run do less well. White collar workers with high job satisfaction may initially resent retirement but later tend to enjoy it. Higher socioeconomic classes have a lower incidence of postretirement suicide than lower classes, probably because they have more varied interests, more outlets and money which mitigate its stressful effects. It has also been suggested that working class individuals are socialized to depend on external authority, making retirement a particularly stressful loss.9

SEX DIFFERENCES

It has been suggested that, by comparison with men, women in their development experience more varied role changes and more lifestyle variations, all of which reinforce their adaptability to a greater degree than occurs in men. However, reluctance to retire is particularly high among widowed and divorced women, possibly because of a fear of isolation. In general, there is a paucity of good studies of retired women, the older literature suggesting the obviously outdated view that work is unimportant to women who mainly derive life satisfaction from husband and family.

RETIREMENT AND MARRIAGE10

Retirement tends to highlight strengths and weaknesses in marriage. When work is used to avoid intimacy, its absence emphasizes marital problems in such a way that bad marriages become worse. Marital distress typically arises in the following situations:

* Recently retired men who have difficulty adjusting to the role change may interfere with or criticize their wives. Having lost authority at work, the individual may try to order his wife around, leading to discord.

* Different expectations of retirement may lead to distress when a wife feels deprived because she was expecting her husband to spend time with her, but he wishes to spend his leisure in pursuits which exclude her. If he does not enjoy his wife, he will make increasing efforts to avoid her, leading to a cycle of recrimination and increased avoidance on his part.

* The wife may resent her loss of privacy because her husband is at home too much. Some men may resent being asked to do housework.

* When the forced distractions of work and children no longer keep the couple apart, they may be unable to spend time alone or with other people because of their difficulty telling the spouse that this is something they occasionally prefer. Elderly couples may eventually become lonely and feel trapped and bored, especially if they are isolated because of poverty or ill health.

* A spouse may respect a husband less if he is not working and communicate to him directly or indirectly that he is less useful and that she respects him less. This may further wound his self-esteem and sense of identity. Sometimes, this leads to hypochondriasis -increased preoccupation with the body serves as an unconscious source of gratification from wife and doctors.

Retirement can be a time of renewal of sexual interest because of increased leisure, but it is extremely important in this context to explain to older couples the normal effects of aging on sexual performance." Ignorance and guilt about what is physiological at this age may be disastrous. It is important to remember in this context that 75% of men and women in their 70s retain sexual desire. Its absence may be due to depression, or to misinformation, and may be remediable. A good sex life should continue to provide warmth, intimacy and pleasure for an older couple.

RETIREMENT AND ALCOHOLISM

Individuals who are overinvested in work, with few outside interests, who drink both at work and to relax afterwards, are particularly vulnerable to becoming alcoholic after retirement. Often, the demands of work itself provide sufficient structure to prevent loss of control; when these restraints are gone, alcoholism supervenes.

THE PSYCHOSOCIAL FUNCTIONS OF WORK

Post-retirement depression is sometimes understandable in the light of the many psychological functions of work in our culture.1" Loss of work is felt as a major deprivation when work was highly significant in the maintenance of the individual's emotional well-being. There are several ways in which this may occur. Work can be a major source Of self-esteem, self-validation and acceptance. The individual can exercise skill, selfexpression, receive plaudits from co-workers, obtain prestige, authority and recognition. Thus, lifelong difficulty in maintaining self-esteem may be managed by an emphasis on success at work. When this is no longer possible, problems of maintaining narcissistic equilibrium may surface with attendant depression or anger. Work may also help to ward off feelings of insecurity and helplessness by constantly promoting a sense of mastery. Loss of this outlet may lead to feelings of profound helplessness and of being burdensome and useless with attendant depression. For some people, work may serve to channel aggression and provide a socially acceptable outlet for such impulses. For others, loss of work means loss of one's social network and chief source of companionship and necessary feelings of belonging to a group.

DEPRESSION AS A CAUSE OF PREMATURE RETIREMENT

Unrecognized depression may lead to premature, unnecessary retirement. Such difficulties as selfdepreciation, fatigue, and poor concentration may lead the individual to feel inadequate to perform. If the preexisting affective illness is unrecognized, instead of the depression being seen as the cause of the retirement, the reverse is thought to be the case. Conversely, relief of depression may follow retirement from a monotonous, meaningless or stressful job which has long since been only a burden.

SEQUENTIAL ROLE CONFLICTS9

The successive developmental stages of the worker each prepare him for his next role in a sequential process of advancement. Before the new role is fully developed a period of learning and practice takes place, sometimes with a prolonged anticipatory period. Importantly, each role helps one's performance in subsequent roles, and all the stages before retirement are characterized by increased social gains, autonomy, authority and income. However, none of these obtain after retirement. The retiree is uncertain about the exact nature of his new role and its social expectations. His work skills do not help him; there is no need to struggle and be competitive, no new job skills to master, no one to recognize his work, and no promotion for which to aspire. This change in adaptation necessitates the unlearning of years of behavior and the relearning of new patterns, which may cause considerable conflict. There are few studies which identify the characteristics of high-risk groups, but retirees with a rigid, isolated personality who are overly committed to the work role and who subsequently experience failure and shame, may be especially at risk for suicide.9 This might be called the Willy Loman syndrome.

PERSONA

Jung's concept of persona (Latin, mask) refers to the role played by an individual in accordance with social expectations. It includes wearing a white coat or other uniform and the adoption of behavior generally characteristic of a particular occupation. It does not reveal the person underneath, but is a compromise between the individual and society. A developed persona is essential for social adaptation, and a normally developed ego uses it appropriately. However, we may become too identified with the persona so that we are always the doctor or lawyer and never the human being.

It is important for us to differentiate from our social persona so that we know ourselves as individuals apart from our jobs. Otherwise, we develop a "pseudoego" based on dutiful performance of and overidentification with a particular role." Such an individual has little inner development and decompensates when the persona is no longer available because of retirement.

PRE-RETIREMENT PLANNING

Pre-retirement counseling programs are typically given six or 12 months before retirement in an attempt to prepare the potential retiree for what lies ahead. Unfortunately, this is often too short a time to prevent distress - this particular period is often a phase of denial. The optimum timing is not really known, but earlier planning is probably necessary. Preparation should involve discussion of psychological factors, such as the implication of loss of the work role for that person, together with economic, health cafe and educational planning. It is important to explain to potential retirees the current social attitudes toward retirement, so that they do not anticipate rejection by society. Care should be taken not to convey the impression that retirement will be a social catastrophe and to deal with this prejudice if they share it. Emphasis on such factors as community integration and finding fulfillment in leisure is very important.

SOCIALIZATION INTO THE POST-RETIREMENT YEARS

Our culture rewards economic productivity, with its attendant need for striving and competitiveness. This behavior is not possible or appropriate in late life. Old age still has an inferior status, so that there is resistance to being thus labelled. Transition to old age has no clear demarcation or mechanism. Its first rather startling intimation may be that other people comment on one's appearance and level of activity, suggest that we slow down and label us as old. A de facto process of socialization thereby occurs in which the individual has to accept a role which he often dreads and which society devalues.14 He must adopt new norms and values and a new lifestyle with its fall in prestige and potentially damaging effects on self-esteem. Thus, many of the "young old"15 who retire in their early 60s dislike being called old and, socially remain, vigorously engaged well into their 70s. They resist the negative social stereotype of deterioration because their personal experience is so different from it. Personally, they still depreciate aging and believe that, although the stereotype is correct, they happen to be exceptions. For this group, the transitional crisis is simply postponed. It should be remembered that role transition is always eased when non-work roles (such as that of parent, grandparent, or mentor) remain unaltered, providing a sense of continuity.

AN ANTHROPOLOGICAL PERSPECTIVE

The study of pre-technological societies teaches us something about the fundamental psychological characteristics of our species. Accordingly, it is worth briefly contrasting the mechanisms of major changes of status in our society with those of simpler cultures, particularly small stable groups in which change is related to biological epochs and not technology.

Van Gennep'* described the clear rites of passage provided in primitive cultures to help people through critical life periods which are potentially dangerous in terms of social decompensation. He delineated three phases in the ceremonies which accompany these rites.

1. A period of separation or detachment which may lead to depression because of loss of a familiar role and identity.

2. A process of "liminality" or transition which is confusing and leads to distress because of ambiguity, helplessness and anxiety about the future.

3. A period of resolution or incorporation when new roles and values are found.

In these situations, the society provides a validating experience using rituals which impress the significance of the change on the person and on his social group. During these rites, the individual becomes "sacred" in relation to others. The rites offer protection, are predictive, give specific symbols for the next part of life, and connect the individual with the history and larger traditions of his culture. Their ultimate effect is to reincorporate the person into the group, with newly defined rights, duties and behavioral norms.

Contrast this with the paucity of social provisions we provide for helping people into the transition to retirement and old age. Our culture does not provide clear expectations about behavior at this epoch, and little help with its ambiguity and emotional turmoil. The retiree is not sure what is expected of him, and the instrumental skills he learned during the work years are suddenly of no help in the new role.

Retirement is a critical period in the life cycle, while secularization has reduced the importance of ritual for us. However, it should be possible to develop a culturally acceptable celebration of retirement which expresses its transitional importance, clarifies its psychological meaning and helps with the re-establishment of new equilibrium. Ideally, it would prepare the person to tackle the exacting developmental tasks which lie ahead, with their enormous claims on the personality. It would reward older people for what they are doing developmentally so that they would experience continued selfesteem and feelings of competence in their new role. They would then emerge as a social group with specific expectations.

For many people the role of worker has been a major determinant of adult identity; any alternative role must be equally valued by the person and by society. Attempts to propose new roles for older people would only be successful if the roles were perceived as socially legitimate. Jung suggested that people would not grow into their 70s and 80s if longevity had no meaning for the species.7 The discovery ofthat meaning may be one of the most socially challenging tasks of the next few decades.

REFERENCES

1. Fries JF. Crapo LM: Vitality and Aging. San Francisco. WH Freeman & Co. 198 L

2. Atchley RC: The Sociology of Retirement. Toronto, John Wiley & Sons Inc. 1976.

3. Dressier DH: Life stress and emotional crisis: The idiosyncratic interpretation of life events. Compr Psychiatry 1976; 17:549.

4. Hirschowitz RC: Crisis theory: A formuiation. Psychiatric Annals. 1973; 3(12):36.

5. Wasylenki D. McBride A: Retirement, in Howells JG (ed): Modern Perspectives in the Psychiatry of Middle Age. New York. Brunner/ Mazel Inc. 1981.

6. Riley M. Fouer A: Aging and Society. New York, Rüssel Sage Foundation. 1968.

7. Shanas E: Health and adjustment in retirement. Gerontologist 1970; 10:19.

8. Shanas E: Adjustment to retirement, in Carp FM (ed): Retirement. New York. Behavioral Publications. 1972.

9. Breed W, Huffine CL: Sex differences in suicide among older while Americans: A role and developmental approach, in Kaplan OJ (ed): Psychopathology of Aging. New York, Academic Press inc. 1979.

10. Appleton WS: Effect of retirement on marriage. Medical Aspects of Human Sexuality 1981: 15:10. 73.

11. Corbett L: The last sexual taboo: Sex in oldage. Medical Aspects of Human Sexuality 1981; 15:14. 117.

12. Braceland FJ: Man's work and what it means, in Usdin G (ed): The Psychiatric Forum. New York, Brunner/ Mazel Inc. 1972.

13. Whitmont EC: The Symbolic Quest. Princeton. New Jersey. Princeton Univ Press. 1969.

14. Rosow I: Socialization to Old Age. Berkeley, California. University of California Press, 1974.

15. Neugarten BL: Age groups in American society and the rise of the young old. Annals of the American Academy of Political and Social Science 1974; 415:187-198.

16. Van Gennep A: The Rites of Passage. Chicago, University of Chicago Press, 1960.

17. Jung CG: The stages of life, in Collected Works, Princeton, New Jersey, Princeton University Press. 1976.

10.3928/0048-5713-19821001-10

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