Positive Psychiatry has been defined as the science and practice that seeks to understand and promote well-being through assessments and interventions aimed at enhancing positive psychosocial factors (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). It broadens the mandate of Psychiatry from treating psychopathology to enhancing the well-being of patients. Cultivation of wisdom is critical for personal growth because it can offer meaning and purpose to older adults who are forced to live with limitations.
I wrote this essay based on my conviction that working to strengthen the wisdom of our older patients can augment their treatment, enrich their experiences, and improve the quality of their lives. Below, I outline concepts of contemporary philosophers to highlight the multifaceted nature of wisdom and to stimulate the development of evaluation and therapy strategies aimed to facilitate the growth of wisdom in our patients.
Quantifying wisdom
There have been various conceptualizations of wisdom. According to one definition, wisdom is a personality trait comprised of empathy and compassion, emotional regulation, self-reflection, acceptance of uncertainty and diversity of perspectives, and perhaps spirituality (Jeste and Vahia, Reference Jeste and Vahia2008). Another definition encompasses factual and procedural knowledge, the ability to put things in the context of one’s lifespan, an appreciation for diverse perspectives and of uncertainty, and the use of this knowledge for the well-being of oneself and others (Baltes and Staudinger, Reference Baltes and Staudinger2000). Baltes and Staudinger proposed the “Selective Optimization and Compensation Model” in which older adults selectively focus on areas in which they have strength and find fulfilling (Napolitano and Freund, Reference Napolitano, Freund, Gu and Dupre2019). During the ensuing optimization process, they strategically apply their accumulated experience to refine their skills and strategies and to compensate for their physical and cognitive changes. These definitions allow measurement and study of wisdom. However, contemporary philosophers identified other aspects of wisdom that can offer a rich understanding of its complexity.
Moral development
Building on Aristotle’s concepts, the political philosopher Ronald Dworkin (2031–2013) saw moral development as the cornerstone of wisdom both at the individual and the community levels. He introduced the concept of “interpretive integrity” according to which moral growth depends on the ability of individuals and societies to interpret their values and norms coherently and consistently over time (Dworkin, Reference Dworkin1986). Like the classic Greeks, Dworkin considered active involvement in the community essential for individual and societal growth. Older adults who had participated in society’s evolution are a critical resource because their moral insights strengthen their ability to use critical thinking and reflection to inform their actions and to guide the younger generations during ethical challenges. Another asset of older adults is the experience of facing their own imminent death. Insight gained from this experience can enrich the perspective of younger generations by making them aware of their own finitude and prompting them to live a meaningful life. Recognizing the value and the agency of older adults is necessary for society to benefit from their contributions.
The role of narrative
Phenomenologists focused on the subjective nature of the lived experience through which each individual interprets and interacts with the world. Paul Ricoeur (1913–2005) thought that individuals understand themselves and the world through a process of “interpretation” and the creation of a “narrative,” which connects past, present, and future into a coherent whole (Arthos, Reference Arthos2019). The narrative is enriched with meaning through “imputation,” a hermeneutic action by which individuals assign motives and responsibility for actions. Objective interpretation cannot exist because one’s understanding is always mediated by pre-existing views and experiences, occurring in various cultural contexts. In late life, reflection on one’s narrative, assembled from rich lived experiences and awareness of one’s limited future, often increase the focus on what truly matters and paves the way to wisdom. Ricoeur viewed the “self” as a dynamic, “relational” entity, formed by “intersubjectivity,” a dialogue with others in many cultural contexts. Accordingly, wisdom in late life can be gained both from introspection and from sharing knowledge and experiences with younger generations and from learning their perspectives. This process transcends the older person’s experience and contribute to collective wisdom.
Subjectivity and wisdom
Existentialists view human existence as subjective and personal. Accordingly, wisdom is a continuous process of “creating meaning” out of one’s life and place in the world. A concept central to existentialism is the striving for an “authentic life,” consistent with one’s own unique values without yielding to external social or cultural pressures. “Living authentically” is central to moral development and a prerequisite of wisdom. Heidegger (1889–1976) stressed individual freedom and self-discovery even in the face of late-life’s challenges (Heidegger, Reference Heidegger1962). His term “Dasein” (being there or being in the world) denotes that individuals exist in a dialectic relationship with the world around them and influence their environment with their presence.
The freedom of making own choices can be both exciting and formidable as people are confronted with the weight of their decisions. Jean Paul Sartre (1905–1980) emphasized the role of “existential angst,” which emerges upon the realization of the individuals’ “radical freedom” to shape their lives and be responsible for their choices (Santoni, Reference Santoni1995). “Authentic living” in late life entails confronting past decisions based on self-deception and actively deciding to live according to one’s true values. Existential angst can promote mature wisdom by forcing older adults to create a personal meaning and purpose that aligns with their values. Wisdom increases the focus (“look”) on others and deepens one’s capacity for empathy and compassion. Awareness of one’s own mortality creates the urgency to live authentically and deepens the appreciation of what is accessible. Albert Camus (1913–1960) thought that one’s existential crisis results from the realization that life and the world are “absurd” and lack innate meaning. Awareness of the meaninglessness of life can cause despair (Camus, Reference Camus1965). But individuals have the capacity to “rebel” and generate personal meaning and value in the face of meaninglessness.
Like the existentialists, the libertarian philosopher Robert Nozick (1938–2002) viewed wisdom as unique to the individual, realized in the practical pursuit of a person’s actions influenced by one’s understanding about life. “Living reflexively,” having constant awareness of oneself and reevaluating and realigning one’s own values, goals, and choices is essential for the growth of wisdom, especially when confronting the uncertainties of late life (Nozick, Reference Nozick1989). “Living reflexively” may cause discomfort but contributes to a sense of clarity and purpose. Nozick rejected the notion that the pursuit of pleasure is a person’s principal motivating factor. This view was illustrated in his “experience machine” experiment, in which a machine can stimulate the brain and induce pleasurable experiences indistinguishable from those of real-world experiences. However, the person is disconnected from the real world and is unable to act or form relationships. Nozick argued that most people eventually reject the “experience machine” because they value their connection with the world, their agency and responsibility, and their interpersonal connections.
The problem of evil
The moral philosopher Susan Neiman (1955-) focuses on the “problem of evil,” expressed daily in cruelty and indifference. She argues that understanding evil offers a link between metaphysics and ethics and provides an intelligible basis for understanding the world (Neiman, Reference Neiman2015). Instead of relying on religion and other fixed definitions of evil, she argues that a person’s experience of evil is most relevant. Understanding evil through its context, consequences, and unintended developments, and confronting evil in everyday life can serve as a catalyst for wisdom. Wisdom, then, can be gained through reflection on past positive and negative experiences and through active engagement with the world with curiosity, playfulness, and a willingness to entertain diverse perspectives. Neiman regards aging as a period of enrichment and vibrant existence founded on a rich tapestry of experiences and perspectives and on acceptance of death leading to appreciation of the present moment and freeing individuals from anxiety.
Social experience
Most philosophers consider engagement with one’s community as critical for the development of wisdom, a view consistent with empirical findings on the importance of social support (Solomonov et al., Reference Solomonov, Lee, Banerjee, Chen, Sirey, Gunning, Liston, Raue, Areán and Alexopoulos2023). The Frankfurt School thinkers argued that modern society “alienates” individuals from themselves and from their community and inhibits growth and wisdom. Max Horkheimer (1985–1973) pointed out that modern society favors “instrumental reason,” a reductionistic rationality that values effectiveness for reaching an outcome, regardless of the value of that outcome (Abromeit, Reference Abromeit2011). Consequently, people and objects are treated as means to an end, leading to a sense of detachment from reality and from essential social processes. “Negative dialectics,” a concept advanced by Theodore Adorno (1903–1969), highlights the contradictions and flaws of prevailing ideas and social systems that suppress individuality and critical thought. He advocated for “constellation thinking,” which focuses on interconnected relationships and associations among concepts and objects and fosters a dynamic understanding of reality (Adorno and Horkheimer, Reference Adorno and Horkheimer2016). Adorno thought that older adults’ positive and negative experiences (“negative knowledge”) enable them to understand what is impermanent and flawed, reinforces critical reflection on social and personal limitations, and offers a realistic perspective on their life’s possibilities, an important facet of wisdom.
Pragmatic view of community
The pragmatist philosopher Richard Rorty (1931–2007) argued that the perspectives of an individual are intertwined with the evolving beliefs and perspectives of one’s own community. Accordingly, individuals should understand that their perspectives are revisable through continuous conversation and negotiation within their community (Rorty, Reference Rorty1989). Rorty’s “liberal ironism” urges “solidarity,” defined as the recognition and response to the suffering of others. Solidarity is built upon shared human experiences and is central to understanding and developing one’s morality within one’s own community’s context. Wisdom grows from the collective learning and understanding that emerges from ongoing conversation within a community. Consequently, it depends not only on individuals but also on the ability of their community to reflect on its history, to learn from its successes and failures, and to continually refine its understanding of shared values.
Fluid view of self
Postmodernists suggest that subjective experiences are fragmented and discontinuous, and the person’s sense of self is constantly reshaped by daily social and cultural interactions perceived in the context of one’s own history and aspirations (Lyotard, Reference Lyotard1984). Culture is biased and favors some dominant views while it downgrades others (Foucault, Reference Foucault and Rieder2010). Individuals, as they age, are forced to confront their changing identities and roles while they attempt to adapt to the new infirmities of aging. Challenging the traditional notions of objectivity, and stability, and emphasizing the “constructed nature” of self can be liberating because it allows older adults to disregard fixed identities and reintegrate the multiplicity of their experiences. Acceptance and embracement of the fluidity and multiplicity of identities and reinterpretation of past experiences in later life is key to wisdom and to psychological well-being.
Conclusion
I had argued that philosophical concepts can enhance our understanding of psychosocial determinants of mental health (Alexopoulos, Reference Alexopoulos2023a), of neuroimaging observations (Alexopoulos, Reference Alexopoulos2023b), and of the clinical usefulness of new technologies (Alexopoulos, Reference Alexopoulos2023c). Here, I propose that contemporary philosophy offers rich perspectives, which clinicians can use to assess their older patients and to design interventions aiming to promote wisdom and fulfill the mandate of Positive Psychiatry to enrich patients’ lives. Below are examples of questions that may be part of such an assessment:
Do patients have a coherent view of their values? Are they aware of their continuity and change during their lives? (interpretive integrity).
Do patients have a narrative about themselves that connects their present with their past and future (interpretation). Are they aware of their motivation and responsibility for their actions (imputation)?
Do patients have the sense of acting according to their own values or feel that they often yield to social pressures (authentic life)?
Did injustices done to patients or to others influence their perspective and how (problem of evil)?
Can patients identify what in their experience is flawed or irrelevant (negative knowledge) and understand what is a worthwhile course of action during their remaining life?
Can patients point out changes in their values triggered by changes in the culture of their community changes? What is their response to the misfortunes of others (liberal ironism, solidarity)?
Are patients aware that they are free and able to decide what is important and meaningful in their lives (constructed nature of self).
I hope this essay will start a conversation that will lead to guidelines for the assessment and interventions aimed to promote wisdom and to enrich the experience of late life.
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Access
Positive Psychiatry has been defined as the science and practice that seeks to understand and promote well-being through assessments and interventions aimed at enhancing positive psychosocial factors (Jeste et al., Reference Jeste, Palmer, Rettew and Boardman2015). It broadens the mandate of Psychiatry from treating psychopathology to enhancing the well-being of patients. Cultivation of wisdom is critical for personal growth because it can offer meaning and purpose to older adults who are forced to live with limitations.
I wrote this essay based on my conviction that working to strengthen the wisdom of our older patients can augment their treatment, enrich their experiences, and improve the quality of their lives. Below, I outline concepts of contemporary philosophers to highlight the multifaceted nature of wisdom and to stimulate the development of evaluation and therapy strategies aimed to facilitate the growth of wisdom in our patients.
Quantifying wisdom
There have been various conceptualizations of wisdom. According to one definition, wisdom is a personality trait comprised of empathy and compassion, emotional regulation, self-reflection, acceptance of uncertainty and diversity of perspectives, and perhaps spirituality (Jeste and Vahia, Reference Jeste and Vahia2008). Another definition encompasses factual and procedural knowledge, the ability to put things in the context of one’s lifespan, an appreciation for diverse perspectives and of uncertainty, and the use of this knowledge for the well-being of oneself and others (Baltes and Staudinger, Reference Baltes and Staudinger2000). Baltes and Staudinger proposed the “Selective Optimization and Compensation Model” in which older adults selectively focus on areas in which they have strength and find fulfilling (Napolitano and Freund, Reference Napolitano, Freund, Gu and Dupre2019). During the ensuing optimization process, they strategically apply their accumulated experience to refine their skills and strategies and to compensate for their physical and cognitive changes. These definitions allow measurement and study of wisdom. However, contemporary philosophers identified other aspects of wisdom that can offer a rich understanding of its complexity.
Moral development
Building on Aristotle’s concepts, the political philosopher Ronald Dworkin (2031–2013) saw moral development as the cornerstone of wisdom both at the individual and the community levels. He introduced the concept of “interpretive integrity” according to which moral growth depends on the ability of individuals and societies to interpret their values and norms coherently and consistently over time (Dworkin, Reference Dworkin1986). Like the classic Greeks, Dworkin considered active involvement in the community essential for individual and societal growth. Older adults who had participated in society’s evolution are a critical resource because their moral insights strengthen their ability to use critical thinking and reflection to inform their actions and to guide the younger generations during ethical challenges. Another asset of older adults is the experience of facing their own imminent death. Insight gained from this experience can enrich the perspective of younger generations by making them aware of their own finitude and prompting them to live a meaningful life. Recognizing the value and the agency of older adults is necessary for society to benefit from their contributions.
The role of narrative
Phenomenologists focused on the subjective nature of the lived experience through which each individual interprets and interacts with the world. Paul Ricoeur (1913–2005) thought that individuals understand themselves and the world through a process of “interpretation” and the creation of a “narrative,” which connects past, present, and future into a coherent whole (Arthos, Reference Arthos2019). The narrative is enriched with meaning through “imputation,” a hermeneutic action by which individuals assign motives and responsibility for actions. Objective interpretation cannot exist because one’s understanding is always mediated by pre-existing views and experiences, occurring in various cultural contexts. In late life, reflection on one’s narrative, assembled from rich lived experiences and awareness of one’s limited future, often increase the focus on what truly matters and paves the way to wisdom. Ricoeur viewed the “self” as a dynamic, “relational” entity, formed by “intersubjectivity,” a dialogue with others in many cultural contexts. Accordingly, wisdom in late life can be gained both from introspection and from sharing knowledge and experiences with younger generations and from learning their perspectives. This process transcends the older person’s experience and contribute to collective wisdom.
Subjectivity and wisdom
Existentialists view human existence as subjective and personal. Accordingly, wisdom is a continuous process of “creating meaning” out of one’s life and place in the world. A concept central to existentialism is the striving for an “authentic life,” consistent with one’s own unique values without yielding to external social or cultural pressures. “Living authentically” is central to moral development and a prerequisite of wisdom. Heidegger (1889–1976) stressed individual freedom and self-discovery even in the face of late-life’s challenges (Heidegger, Reference Heidegger1962). His term “Dasein” (being there or being in the world) denotes that individuals exist in a dialectic relationship with the world around them and influence their environment with their presence.
The freedom of making own choices can be both exciting and formidable as people are confronted with the weight of their decisions. Jean Paul Sartre (1905–1980) emphasized the role of “existential angst,” which emerges upon the realization of the individuals’ “radical freedom” to shape their lives and be responsible for their choices (Santoni, Reference Santoni1995). “Authentic living” in late life entails confronting past decisions based on self-deception and actively deciding to live according to one’s true values. Existential angst can promote mature wisdom by forcing older adults to create a personal meaning and purpose that aligns with their values. Wisdom increases the focus (“look”) on others and deepens one’s capacity for empathy and compassion. Awareness of one’s own mortality creates the urgency to live authentically and deepens the appreciation of what is accessible. Albert Camus (1913–1960) thought that one’s existential crisis results from the realization that life and the world are “absurd” and lack innate meaning. Awareness of the meaninglessness of life can cause despair (Camus, Reference Camus1965). But individuals have the capacity to “rebel” and generate personal meaning and value in the face of meaninglessness.
Like the existentialists, the libertarian philosopher Robert Nozick (1938–2002) viewed wisdom as unique to the individual, realized in the practical pursuit of a person’s actions influenced by one’s understanding about life. “Living reflexively,” having constant awareness of oneself and reevaluating and realigning one’s own values, goals, and choices is essential for the growth of wisdom, especially when confronting the uncertainties of late life (Nozick, Reference Nozick1989). “Living reflexively” may cause discomfort but contributes to a sense of clarity and purpose. Nozick rejected the notion that the pursuit of pleasure is a person’s principal motivating factor. This view was illustrated in his “experience machine” experiment, in which a machine can stimulate the brain and induce pleasurable experiences indistinguishable from those of real-world experiences. However, the person is disconnected from the real world and is unable to act or form relationships. Nozick argued that most people eventually reject the “experience machine” because they value their connection with the world, their agency and responsibility, and their interpersonal connections.
The problem of evil
The moral philosopher Susan Neiman (1955-) focuses on the “problem of evil,” expressed daily in cruelty and indifference. She argues that understanding evil offers a link between metaphysics and ethics and provides an intelligible basis for understanding the world (Neiman, Reference Neiman2015). Instead of relying on religion and other fixed definitions of evil, she argues that a person’s experience of evil is most relevant. Understanding evil through its context, consequences, and unintended developments, and confronting evil in everyday life can serve as a catalyst for wisdom. Wisdom, then, can be gained through reflection on past positive and negative experiences and through active engagement with the world with curiosity, playfulness, and a willingness to entertain diverse perspectives. Neiman regards aging as a period of enrichment and vibrant existence founded on a rich tapestry of experiences and perspectives and on acceptance of death leading to appreciation of the present moment and freeing individuals from anxiety.
Social experience
Most philosophers consider engagement with one’s community as critical for the development of wisdom, a view consistent with empirical findings on the importance of social support (Solomonov et al., Reference Solomonov, Lee, Banerjee, Chen, Sirey, Gunning, Liston, Raue, Areán and Alexopoulos2023). The Frankfurt School thinkers argued that modern society “alienates” individuals from themselves and from their community and inhibits growth and wisdom. Max Horkheimer (1985–1973) pointed out that modern society favors “instrumental reason,” a reductionistic rationality that values effectiveness for reaching an outcome, regardless of the value of that outcome (Abromeit, Reference Abromeit2011). Consequently, people and objects are treated as means to an end, leading to a sense of detachment from reality and from essential social processes. “Negative dialectics,” a concept advanced by Theodore Adorno (1903–1969), highlights the contradictions and flaws of prevailing ideas and social systems that suppress individuality and critical thought. He advocated for “constellation thinking,” which focuses on interconnected relationships and associations among concepts and objects and fosters a dynamic understanding of reality (Adorno and Horkheimer, Reference Adorno and Horkheimer2016). Adorno thought that older adults’ positive and negative experiences (“negative knowledge”) enable them to understand what is impermanent and flawed, reinforces critical reflection on social and personal limitations, and offers a realistic perspective on their life’s possibilities, an important facet of wisdom.
Pragmatic view of community
The pragmatist philosopher Richard Rorty (1931–2007) argued that the perspectives of an individual are intertwined with the evolving beliefs and perspectives of one’s own community. Accordingly, individuals should understand that their perspectives are revisable through continuous conversation and negotiation within their community (Rorty, Reference Rorty1989). Rorty’s “liberal ironism” urges “solidarity,” defined as the recognition and response to the suffering of others. Solidarity is built upon shared human experiences and is central to understanding and developing one’s morality within one’s own community’s context. Wisdom grows from the collective learning and understanding that emerges from ongoing conversation within a community. Consequently, it depends not only on individuals but also on the ability of their community to reflect on its history, to learn from its successes and failures, and to continually refine its understanding of shared values.
Fluid view of self
Postmodernists suggest that subjective experiences are fragmented and discontinuous, and the person’s sense of self is constantly reshaped by daily social and cultural interactions perceived in the context of one’s own history and aspirations (Lyotard, Reference Lyotard1984). Culture is biased and favors some dominant views while it downgrades others (Foucault, Reference Foucault and Rieder2010). Individuals, as they age, are forced to confront their changing identities and roles while they attempt to adapt to the new infirmities of aging. Challenging the traditional notions of objectivity, and stability, and emphasizing the “constructed nature” of self can be liberating because it allows older adults to disregard fixed identities and reintegrate the multiplicity of their experiences. Acceptance and embracement of the fluidity and multiplicity of identities and reinterpretation of past experiences in later life is key to wisdom and to psychological well-being.
Conclusion
I had argued that philosophical concepts can enhance our understanding of psychosocial determinants of mental health (Alexopoulos, Reference Alexopoulos2023a), of neuroimaging observations (Alexopoulos, Reference Alexopoulos2023b), and of the clinical usefulness of new technologies (Alexopoulos, Reference Alexopoulos2023c). Here, I propose that contemporary philosophy offers rich perspectives, which clinicians can use to assess their older patients and to design interventions aiming to promote wisdom and fulfill the mandate of Positive Psychiatry to enrich patients’ lives. Below are examples of questions that may be part of such an assessment:
Do patients have a coherent view of their values? Are they aware of their continuity and change during their lives? (interpretive integrity).
Do patients have a narrative about themselves that connects their present with their past and future (interpretation). Are they aware of their motivation and responsibility for their actions (imputation)?
Do patients have the sense of acting according to their own values or feel that they often yield to social pressures (authentic life)?
Did injustices done to patients or to others influence their perspective and how (problem of evil)?
Can patients identify what in their experience is flawed or irrelevant (negative knowledge) and understand what is a worthwhile course of action during their remaining life?
Can patients point out changes in their values triggered by changes in the culture of their community changes? What is their response to the misfortunes of others (liberal ironism, solidarity)?
Are patients aware that they are free and able to decide what is important and meaningful in their lives (constructed nature of self).
I hope this essay will start a conversation that will lead to guidelines for the assessment and interventions aimed to promote wisdom and to enrich the experience of late life.
Conflicts of interest
Dr. Alexopoulos has served in an advisory board and on the speakers bureau of Otsuka Pharmaceuticals.
Acknowledgements
This work was supported in part by NIMH grant P50 MH 113838.