BSG Annual Conference 2006 The Ageing Jigsaw: Interdisciplinary approaches to understanding old age 7th-9th September 2006, University of Bangor, Wales.

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BSG Annual Conference 2006The Ageing Jigsaw
Interdisciplinary approaches to understanding old
age 7th-9th September 2006, University of
Bangor, Wales.

• The language and symbolism of death and old age
  in bio-gerontology
• by
• John A. Vincent

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Introduction

• Recent scientific interventions have achieved
  dramatic increases in longevity amongst nematode
  worms, fruit-flies and mice. It is suggested that
  these experiments open the possibility of greatly
  extended human longevity.
• We are now in the era of emerging ability to
  control our actuarial destiny in response to the
  desire in humans throughout history to live
  comfortably and to delay death (Holliday 2001
  Preston et al 1978). (Carey 2003220)
• This paper examines the impact of the culture of
  science on the meaning of old age. In particular
  it examines developments in understanding cell
  death and their potential impact on the meaning
  of old age.

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The sociological relevance of the issue

• Social constructionism has played a key role in
  dismantling old age and exploring the
  possibilities that there are alternative ways to
  live a good old age. Old age not simply a matter
  of biological determinism.
• But what are the limits to social
  constructionism? Surely death and the frailties
  of the fourth age are not social constructions?
• We can see that different cultures approach death
  in very different ways there are many myths and
  rituals that re-enact denials of death. But every
  one dies. Similarly experience tells us that
  everyone ages.
• However, it is a false distinction to see social
  constructions as merely the products of a
  cultural imagination as opposed to scientific
  facts which represent the truth about nature. Two
  ways around this
• Psychological W. I. Thomas if people believe
  that something is real it is real in its
  consequences
• Phenomenological We cannot observe the world
  without cultural framework to name and categorise
  it.

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Accessing meanings of old age

• Cultural concepts are necessary with which to
  understand and make sense of the world. But those
  cultural concepts are produced in historical and
  continuous process in which the social and the
  natural environment are critical components.
• Cultural categories are established through
  boundaries - contrasts which mark semantic space.
  
• To understand old age it is necessary to know its
  boundaries, how to recognise it, and thus the
  markers which indicate the boundaries between
  what is old age and what is not.
• Meanings cannot be established in isolation,
  categories are part of historical and cultural
  meaning systems which interlock.

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Life and death

• Death contrasts with life. What is alive and what
  is dead and how do we know? This boundary is
  highly contested and fraught with moral dilemmas
  as to what is human and what is not. The medical
  definition of death has shifted in recent history
  contemporary medical protocols for establishing
  death tend to use a concept of brain death. Death
  has ceased to be a natural event.
• Old age is the stage of life next to death. It
  takes it place in developmental cycles of
  organisms from conception and birth to decay and
  extinction. Ageing is then a concept parallel to
  maturation defined by contrasting life cycle
  stages. It is worth noting that many species
  dont die. Mortality comes with sexual
  reproduction. But death is a necessary boundary
  marker for the cessation of old age and which is
  an important component in its meaning.
• At the level of the cell, cells were thought to
  be capable of immortality until the discovery of
  the Hayflick limit. Thus cell senescence came to
  mean reproductive senescence the inability of
  the cell to divide and replicate itself. There
  was the belief that old age was programmed at the
  cell level. If we could modify that programme
  perhaps we would not need to age. However, it
  turns out to be much more complicated than that.

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Cell death

• In the course of these relocations of life,
  disease, and death processes, the relationship
  between life and death has not remained constant.
  Through analysis of the morphology, genetics, and
  temporality of the bodys continuous cellular
  dying, the oppositional relationship between life
  and death that existed for Bichat and those who
  came after him was displaced by the vision of a
  multiplicity of death that maintains tissue
  homeostasis, shapes development, regulates the
  formation of the immune system, and serves as a
  protective mechanism against oncogenesis. Thus,
  with the localization and spatialization of death
  in the cell, death has become for biomedicine not
  necessarily that which life is opposed but is
  many cases, that on which life is dependent, or
  at least that with which life and disease are
  inextricably bound p.55
• H. Landecker On beginning and ending with
  Apoptosis in Sarah Franklin and Margaret Lock
  2003 Remaking Life and Death pp.23-60 James
  Currey Oxford.

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Interview data

• In the small number of interviews I have
  conducted with scientists, particularly
  bio-gerontologists I have systematically asked
  about three processes maturation, senescence,
  and apoptosis. The differences in the manner of
  response are illuminating.
• With maturation there is a dismissive approach,
  respondents invent something plausible but
  without interest or connection, they do not see
  it as a relevant and important part of their
  lexicon perhaps it might be more relevant to
  biologist concerned with whole organisms and
  developmental process but for the cell
  scientists it was irrelevant.
• Apoptosis on the other hand was responded to
  immediately and with standard textbook answers.
  This was planned cell death. Many respondents
  even quoted the standard textbook example of the
  apoptotic removal of webs between the fingers in
  embryos.
• However, the response to senescence was
  interesting because there was not a standard
  answer but the respondents thought there should
  be and perhaps they were being caught out. The
  responses were full of linguistic devises such as
  hesitation, circumlocution, restatements which
  indicated unease or uncertainty from the
  respondents. Clearly the term was less well
  institutionalized. Most produced the idea of
  cessation of cell division but were uncertain
  whether that was sufficient and complete.
• It was also clear from conversations with the
  scientist that many particularly non English
  speakers were aware of the non-scientific origins
  and use of the term senescence (c.f. Katz).

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Faragher RG. (2000) Cell senescence and human
aging where's the link? Biochemical Society
Transactions. 2000 Feb28(2)221-6
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Ageing and disease

• There is another critical contrast that between
  natural processes and disease. If old age is
  thought of as a natural process like puberty,
  childbirth, or the menopause, it stands in
  contrast to disease.
• Thus a successful old age is to die of old age
  and not one of the pathological risk factors
  associated with old age. Hence many
  gerontologists talk about extending the health
  span
• Indeed many social constructionist medical
  sociologists have shown how particular phenomena
  come have the disease label attached and come
  under the scrutiny and control of medical
  institutions (Katz and Marshall 2004).
• Bio-gerontologists are undermining this
  distinction between old age and disease. These
  revisions come from two directions one from
  evolutionary theory, the other from cell science.

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Evolutionary approaches

• Evolutionary theories of ageing were developed by
  Medewar. His insight was that the pressure for
  selection came in the early years of the life
  span enabling species to successfully reach
  breeding age and produce offspring. The selective
  pressures in older age, particularly beyond
  reproductive age (but note grandmother
  hypothesis) were not so strong and hence it was
  possible that genes for survival in youth also
  carried traits for decline and senescence in old
  age. Modern genetics of old age indeed suggests
  that particular genes have a range of functions
  which have positive and negative impacts on risk
  factors and survival rates at different ages.
• Tom Kirkwood using the sophistication of modern
  maths and computer modeling to simulate
  evolutionary processes has developed the
  disposable soma theory. This is the idea that
  there is a trade off between the energy an
  organism expends on sustaining itself and the
  energy it puts into reproducing the next
  generation. If it fails to develop an optimum
  balance it will either wear itself out before it
  has a chance to produce maximum progeny or it
  will live so long as to present a competitive
  threat to its own offsprings survival. He
  suggests that in the wild specific genetic
  mechanisms to die at a specific age are unlikely
  as rates of predation would render such a
  mechanism unnecessary.
• The logical consequence of this position is that,
  if people can avoid predation and eliminate the
  risk factors of specific diseases, there is no
  natural limit to the human life span.

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Cell science

• From the perspective of cell science it turns out
  the ageing is pretty much indistinguishable to
  the standard metabolic processes that happen in
  cells. In addition to the enormously complex
  bio-chemical processes of the cell cycle and or
  metabolism, there is a also highly complex repair
  and maintenance processes which clean up,
  police, protect the cell from routine and
  accidental bio-chemical products of living.
• When these mechanisms fail we can get disease in
  the form of tumours, or when they are overactive
  we get diseases in the form of autoimmune
  diseases (arthritis). Organ specific failures to
  repair which form the risk factors in old age are
  related to declining efficiency is some of these
  processes perhaps due to accretion of metabolic
  residuals over the life span, which in turn of
  course might be related to life course and
  environment factors.
• The logic of this position is that if we could
  find ways to sustain the efficiency of the
  processes which keep cells on the bio-chemical
  straight and narrow we would both cure the
  diseases of ageing (and most others) and prevent
  death. Indeed model programmes for researching
  such a regime for immortality have been produced
  and are being advocated by a minority with the
  biogerontological community. Thus this new
  biology within cell science holds out the
  prospect that upregulating the metabolic process,
  or repairing the damage it routinely does, will
  inhibit ageing and thus also avoid the diseases
  of old age.

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Biology and the certainty of old and death.

• Harry Moody and Leonard Hayflick ask Has any
  one died of old age?i Moody makes the
  significant point that if you answer yes to
  this question it means ageing is a disease so a
  cure can be found for it and people potentially
  will live for ever, and if you answer no it
  means people die of some other disease for which
  cures can be found and thus people potentially
  will live for ever.
• Mykytyn (2006)ii does an excellent job of
  deconstructing the Presidents Council on the
  Bio-ethics of ageing demonstrating the rhetorical
  uses of natural life spans as necessary to the
  separation of ageing from disease and how
  anti-ageing medicine challenges this
  distinction by treating ageing as the subject of
  therapy.
• Thus we reach a position where the certainties of
  death, disease and ageing as they are popularly
  understood (in both the general public and in
  social gerontology) disappear under close
  examination.

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Fragmentation of biogerontology

• Thus what can be observed with the developments
  in contemporary bio-gerontology is an undermining
  of the key categories through which we understand
  ageing and old age. This is highly significant
  for the future given the importance of biology
  and medicine in setting the cultural meaning and
  the institutional framework within which ageing
  is lived in Western society.
• But also what is going on is a fragmentation of
  biology. The biology of ageing has moved from a
  minor non-prestigious corner of biology, to
  become centre stage in the new biology which
  focuses on genetics, cell process and the
  bio-chemistry of complex proteins.

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Genomics of ageing

• The major recent advances in bio-gerontology have
  resulted from an increased knowledge about cell
  processes which stem in turn from the genomics
  revolution and from the complex bio-chemistry of
  cell processes.
• But it is important to appreciate that the
  contemporary science is a considerable distance
  from popular understanding of genetics and even
  that commonly found in popular science.
• Biological ageing is not all in the genes. There
  is no single gene for ageing, or even a
  combination of genes. There are a large number of
  genes with some association with longevity, or
  processes which appear to lengthen or shorten the
  life spans of particular species. But single
  gene, single trait models of the genome are
  obsolete. There are enormously complex pathways
  by which genes get turned on, express themselves,
  interact with one another, and initiate hugely
  complex chains of protein synthesis and
  transformation.
• Sheer complexity creates a demand for new models
  and methods of analysis.

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Ageing moves centre stage

• A leading biologist at the ICFGA said that
  ageing turns out to be about living basically
  it is metabolism
• As a symbolic statement it tells us, the life and
  death are the same thing, while culturally they
  may be conceptually opposites, in biology the
  basic process of living is also dieing. The basic
  process of consuming energy to stay alive creates
  the conditions for ageing and death.
• However, for biology it means that ageing is no
  longer a distinctive process for which there is a
  distinct sub-branch of biology and reflecting
  that knowledge base, gerontology as a single
  medical specialism is having its exclusivity
  challenged. Understanding the genetics and
  bio-chemistry of cell processes is at the
  fundamental core of biology.
• This fragmentation is evident in my attempts to
  map the attendees at the ICFGA in terms of their
  disciplines. It proved immensely complex and the
  following diagrammes illustrate

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Venn diagramme of mirco-biology disciplines at
ICFGA
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Venn diagramme of medical disciplines at ICFGA
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The possibilities of life extension undermine the
contemporary cultural value of old age and old
people.

• Bio-gerontology largely positions itself in
  categorizing old age as a failure. In defining it
  in terms of the body, it specifically foregrounds
  bodily failure as the essential nature of old
  age.
• In looking for ways in which a cultural
  revaluation of old age might occur, my argument,
  developed elsewhere is that a healthy death is
  necessary for a good old age (meaning the final
  part of life before death), otherwise old age is
  always defined by its failure, i.e. dying.
• In this work I have drawn on the social
  constructionist traditions out lined at the
  beginning of this paper. If dying cannot be a
  positive event then nor can old age.
• The notion of a healthy death one which escapes
  the apparatus, technical and institutional, of
  the medical professionals and disease control, it
  has been met with incredulity and
  incomprehension. The power of the medical model
  is such that it is difficult to think about old
  age outside its frame.
• But here I have argued that the biology of ageing
  is fragmenting. There is no longer a single
  biological story of ageing. Does the biology
  offer possibility of more positive models of
  ageing and old age? Does the fragmentation leave
  space for other new perhaps liberating models of
  old age? Here we come to the interesting
  metaphor of apoptosis which I will develop
  below.

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H. Landecker On beginning and ending with
Apoptosis in Sarah Franklin and Margaret Lock
2003 Remaking Life and Death pp.23-60 James
Currey Oxford.

• Although many commentators call the insistent
  presence of narratives of human death in cell
  death science anthropomorphism and comment on its
  danger to the practice of science (Clark 1996
  Debru 1998 Friedman and Brunet 1995), I believe
  that these narratives and their tensions point to
  a more complicated and more interesting role for
  the cell in contemporary biomedical culture than
  that of an irrational being incorrectly endowed
  with human qualities. The cell is a site through
  which all kinds of changing material, semantic,
  economic, and conceptual relationships are played
  out cell to body, cells to one another,
  scientists to doctors, patients to laboratories
  It is a site in which what it is to be cellular,
  in life, death, and disease, is constantly being
  produced. p.57

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Cell death

• Biology defines a limited number of ways a cell
  can age and die
• Senescence
• Apoptosis
• Necrosis
• Like most things in contemporary biology, this
  including the terminology is challenged. Some
  others associated with cancer and disease
  function (oncosis etc.)

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One model of the relationshipSoti C, Sreedhar
AS, Csermely P.(2003) Apoptosis, necrosis and
cellular senescence chaperone occupancy as a
potential switch Aging Cell. 2003
Feb2(1)39-45.,
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Senescence

• Senescence is the cell in old age. That is how it
  is thought of as metaphor even if the belief that
  there is a specific direct link to organism
  ageing is contentious. Variously in biology its
  meaning has shifted from senescence as specific
  form of decline, loss of efficient function in
  all aspects, including the accumulation of
  junk. But increasingly it is specifically used
  in the sense of replicative senescence - the
  cessation of mitosis (cell division). This links
  to telomere theories. But recent research
  evidence suggests that revival from senescence
  can occur.

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Senescence imaged

• A new test developed by LBL researchers uses blue
  stain to detect the presence of senescent cells.
  The assay top left shows young tissue with no
  presence of blue top right is young sunburned
  tissue, also negative. Older tissue cells,
  pictured in the bottom four assays, contain blue
  areas revealing evidence of the existence of
  senescent cells.

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Necrosis

• Necrosis is accidental death. The cell is injured
  ruptured and spills it contents to the detriment
  of other cells in its vicinity and causing
  inflammation. The damage can be mechanical but it
  might also be poisoning or other fatality. Act
  of God in the insurance world. The purveyors of
  immortality always point out that mortality can
  never be reduced to zero, there will always be
  fatal accidents. Some biologists have suggested
  the boundary with other forms of cell death may
  not be as clear cut as this definition suggests.

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apoptosis

• But what about apoptosis? The biology text books
  and popular science media have it off pat as
  suicide. Sometimes called murder when it occurs
  as a result of extra cellular stimuli, but I
  found only one use of the term euthanasia.
  However, Apoptosis is clearly good death. It is a
  vital part of life and the continued health of
  the organism. Here is a model of good death. It
  is the individual (cell) playing its part in the
  overall life of the body. Its death at the right
  time and the right place is a necessary and
  desirable outcome for the health of the
  multi-cellular soma (peoples bodies).
• The metaphor is clear, death is an essential part
  of life. Conversely universal immortality or
  systematic attempts to increase the life span
  will transform life and essential human
  qualities. This may or may not be desirable but a
  radical departure from humanity, as it is
  currently understood and experienced, is
  inevitable with the elimination of old age and
  death. It will not be more of the same experience
  of age but frozen in time, but rather an
  essentially different semi-natural entity of
  uncertain meaning.

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The final stage of apoptosis cleaning up after
the death
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Death defines the category old age

• Age is both a verb and a noun it stands for
  both a process and also a set of categories. Some
  parts of the trajectory of social and biological
  change over time are identified as ageing. It
  is understood as a sequence of stages and
  statuses to which specific age based normative
  expectations are attached. The specific content
  of those processes and categories are contested
  their meanings are not fixed. The future life
  course may have different life stages new
  divisions in the 20C have included teenager, and
  third ager. There may also, in addition or
  instead be a breakdown in the structure of the
  life course with less definite stages or
  sequences.
• As old age becomes increasingly biologised it
  is in fact, in parallel to biology, becoming
  fragmented and loosing coherence as a concept.
  There are many biological stories of ageing, and
  more are being produced, - there is not a single
  story of the biology of human ageing.

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Positive images of ageing from the new biology

• Negative cultural constructions of old age spill
  into biology but are transformed biological
  concepts become transformed when used in popular
  discourse to legitimate ageist practice.
• This has been illustrated by the way the concept
  of senescence entered and has been transformed in
  biogerontology along with the way debates over
  different kinds of cell death apoptosis, and
  necrosis form a repertoire through which ageing
  and death can be imagined.
• With the fragmentation of biology and the
  concomitant lack of single authoritative
  biological voice telling us what ageing is, there
  become room for alternative visions for the
  nature of old age and the future possibilities
  for ageing. There are at least two possible
  contenders.
• Firstly, the good old age as a positive final
  stage in life concluded by a healthy death. And
  we now have a model of healthy death from
  biology, namely apoptosis.
• Secondly there is the good old age as an
  enhanced/super human being/ cyborg with death
  defying capabilities.

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• A copy of the paper and the power point
  presentation is available on my personal website.
• http//www.people.exeter.ac.uk/JVincent/Bangor/