Summary of the impact

Helen Small's research into the meanings and value ascribed to old age has assisted policy consultation groups to frame their debates about the implications of an ageing society, enabling participants to reflect critically on, and move beyond, standard conventions limiting discussion of old age (such as dramatic statistical predictions from demography, or the emotional appeal of the carer's testimony). Her work has also refreshed the terms of debate about ageing within gerontology, and has set a new interdisciplinary agenda for university researchers seeking to engage with non-academics involved in the care and support of the elderly.

Underpinning research

Helen Small's book The Long Life (2007) (Ref. a below, see also Ref b & c) is an extended consideration of old age in Western philosophy and literature (the first such consideration since Simone de Beauvoir's The Coming of Age in 1977). It takes the form of comparative treatments of philosophical and literary writings from Plato through to recent work by Derek Parfit, Bernard Williams, and others, and from Shakespeare's King Lear through to Philip Roth and J. M. Coetzee. The main claim made is that if we want to understand old age, we have to think more fundamentally about what it means to be a person, to have a life, to have (or lead) a good life, to be part of a just society. So, instead of concentrating on representations of the old, as the great majority of literary critical work in the field has done, it poses a series of philosophical questions or problems and pursues answers to them via (first) close readings of the philosophical literature, and (secondly) extending and refining the answers through readings of literary texts. The primary topics addressed are: whether there is wisdom to be found in old age; how the understanding of the good life derived from Aristotelean virtue ethics is affected by the inevitable loss of biological fitness in old age; the narrative continuity or discontinuity to be expected from a long life; the problem of defining a just distribution of social resources between young and old; the role of old age in some thinkers' contemplation of the boundaries between physical experience and metaphysical speculation; how long a life is long enough; and whether recent developments in evolutionary theory should have any impact on our answers to these questions.

The major contribution this book has made to the field is that it has brought fundamental philosophical considerations back to the centre of a debate dominated, in recent decades, by the statistical analysis of ageing populations, economic concerns about the affordability of retirement given the growing proportion of the dependent old, and dilemmas within medical ethics. Although it touches on all those subjects, The Long Life places them within larger deliberations about morals, reasons and, values. As one reviewer (Hughes) put it, `old age raises a mixture of legal, ethical, metaphysical and other conceptual issues that need to be considered in more detail. [Helen Small has] shown how literature can contribute to these discussions and, thus, she has advanced the cause of medical humanities.'

Articles and lectures given since 2007 have extended the range of The Long Life's treatment of old age by considering in greater detail the `double standard of ageing' with respect to gender (Ref. d) and the phenomenology, or situated experience, of everyday life for the very old as it is described and put to political work in the late writings of Edward Upward (Ref. e).

References to the research

Publications:

Indications of quality:

The core period of researching and writing The Long Life (2001-4) was funded by a Leverhulme Major Research Fellowship (2001-4). Total value of the award £64,489.

Prizes:

The Long Life was awarded

— the Truman Capote Award for Literary Criticism, 2008. (http://news-releases.uiowa.edu/2008/april/043008capote-award.html)

— the British Academy's Rose Mary Crawshay Prize, 2008 (http://www.britac.ac.uk/about/medals/Rose_Mary_Crawshay_Prize_2008.cfm)

Selected Reviews:

Frank Kermode, `Not Just Yet', London Review of Books 29.24 (13 December 2007), reprinted as the final essay of his Bury Place Papers (2009): `she has argued tirelessly, written an impressively researched book, and commanded the interest of sceptics more than twice her age.' Julian Hughes, Journal of Applied Philosophy 26/1 (2009),112-14: There is so much richness in Helen Small's book, it is difficult to know where to start. ... There is no doubt in my mind that she has achieved her aim of broadening our thoughts about old age. She has also thrown the gauntlet down for philosophers.'

Details of the impact

The Long Life has most directly improved the quality of public debate about our ageing society through its impact on two leading UK consultation groups on ethics and public policy. Small was invited to contribute to a consultation at St George's House, Windsor Castle, 10-11 November 2011, chaired by the President of Age UK. What is Successful Ageing: Responding to an Ageing Population in the 21^st Century was the first in a series of St George's House consultations on ageing, aiming to reset the parameters for policy discussion in the UK. Participants included the Group Chief Executive of Age UK, the Director of the Henry Smith Charity, the Older People's Commissioner for Wales, the Director of Policy and Research at the Joseph Rowntree Foundation, the head of End of Life Care and Dementia for NHS West Midlands, Midlands and East England, a Senior Fellow of the King's Fund, and senior representatives from the fields of gerontology, social policy and practice, health care consultancy. The discussion assessed the challenges of an ageing population, including the costs and benefits to the economy, and the social, medical, and psychological implications of old age dependency. Small gave the starting address, her brief being to reflect on how the subject of ageing has conventionally been treated in our culture, and how it tends to be treated in public policy discussions today, then to identify ways in which the conversation might be improved. She drew in part on The Long Life's considerations of philosophy. A summary of her starting address forms the opening part of the subsequent official report, What is Successful Ageing?: Responding to an Ageing Population in the 21^st Century [i] - an open access on-line publication, sent out to many of the most influential participants framing social policy for ageing in the UK, including the Equality and Human Rights Commission, the International Longevity Centre, the Henry Smith Charity, the NHS Institute for Innovation and Improvement, and leading medical educationalists and gerontologists. The programme director, Gary McKeone comments that "Professor Small's book `The Long Life' was central to the thinking behind the event... By setting the topic in a broader cultural and intellectual context [she] added real ballast to the discussion." [1]

As a direct consequence of speaking at St George's House, Small was invited to join a second consultation, on Changing Expectations of Death, held at the Queen's `think tank', Cumberland Lodge, 23-25 November 2012. Participants included the Chief Executive of the National Council for Palliative Care, the Chair of the All Party Parliamentary Group on Dying Well, the Director of BME Cancer Communities, and the Medical Director of the Marie Curie Hospice, Hampstead. Small spoke in response to James Woodward, Canon of Windsor Chapel, drawing on material from The Long Life about the definition of a good life and the ends of life. On this occasion she was asked to reflect specifically on the autobiographies of three writers (Christopher Hitchens, Tom Lubbock, Philip Gould) for whom medical extension of life came at heavy cost to quality of life. Her remarks, summarised as part of the official open-access report, prompted close debate about a `crisis in secularism' [ii]. She worked closely with the consultation report's author, editing the draft text and making additions and suggestions for improvements. The report was sent to 306 recipients known to have an interest in the subject. The Dying Matters Coalition (a growing coalition aiming to `change public knowledge, attitudes and behaviour towards death, dying and bereavement') requested and received permission to tweet it (10,782 Followers). The Association of Hospice and Palliative Care Chaplains was also given permission to post the report on their website. The associate director of programmes observes that `Professor Small was invited to speak ... on the basis of her recognised expertise in considering old age and death through the lens of both philosophy and literature. As Cumberland Lodge seeks to promote cross-disciplinary discussion for this conference we brought humanities academics together with scientists, doctors, psychologists and religious leaders. The contribution of Professor Helen Small was crucial and pivotal: her prepared paper raised several vital questions which were then explored in discussion, and those with alternative areas of expertise were able to support and add to the case made [regarding a crisis in secularism]. Professor Small's contributions to discussions throughout the conference were equally valuable. Although we operate under the Chatham House Rule and therefore do not generally attribute comments in our reports [we can say that] Professor Helen Small's contributions make up a significant part of the final summary report.' [2]

A review of The Long Life for the journal of the Centre for Policy on Ageing and The British Society of Gerontology brought the book to the early attention of gerontologists and geriatricians and led on to many invitations for Professor Small to expand the debate within their field. Thomas Cole (historian of old age, and director of the McGovern Center for Health, Texas) described the research as "a powerful searchlight which can help us illuminate contemporary moral questions that call out for theoretical reflection, social and cultural study, and practical engagement ... The Long Life is a superb contribution to philosophy and literary criticism and will become an indispensable landmark for understanding longevity in ...humanistic gerontology." [iii]. In March 2012, Helen Small was asked to address old age health care professionals and graduate students at the Staffordshire University Centre for Ageing and Mental Health. The director, Paul Kingston, commented on the stimulus given to their group of c. 40, for whom the "usual intellectual diet is evidence based medicine": the "contribution was most valuable in expanding our thinking in gerontological studies." (Letter, 21.3.12) [3]. The Centre for Policy on Ageing Information Service lists The Long Life among its recommended `Selected Readings' on ageing [iv]. It is a further mark of her growing influence within the medical/gerontology community that she was invited to give a plenary lecture to the British Society of Gerontology for the Society's Annual Conference, September 2013.

An indication of The Long Life's impact on how old age specialists in other universities are engaging with health care workers and those involved in the community support of the elderly is the invitation to Small to be keynote guest speaker at the launch of Keele University's New Dynamics of Ageing Programme `Ages and Stages Project' in November 2010. This event brought humanities specialists together with practising gerontologists, social workers, people working in community education and theatre, and members of the general public. David Amigoni, co-director, confirms that `The Long Life helped us to define and locate the critical philosophical and historical commitments of the project as an integral part of the interdisciplinary conversations we have held with literary critics and art historians, composers and musicians, care practitioners, psychologists, medics, community workers etc.' [4].

Further impact in the way of helping to shape a public debate about ageing is evidenced by the reception of Small's contributions to media and festival debates about old age. The Thomas Hobbes Festival (Malmesbury), 2008, devoted a session to The Long Life, with Small in conversation with the philosopher Jonathan Rée (c. 60 attendees) - an event which stimulated lively audience discussion about what we can expect from a philosophy of old age. Radio 3 Nightwaves asked her to participate in a discussion of the meaning of old age, with novelist Lynne Reid Banks and the historian Pat Thane (broadcast 19.2.13) [v]. The Long Life's exploration of philosophical frames for thinking about old age has also influenced two writers' autobiographical reflections on ageing. Jane Miller's Crazy Age: Thoughts on Being Old (2010) [vi] draws on The Long Life's account of the difficulty of fitting old age into standard notions of the good life (see also her article for the US online news magazine, In These Times [vii]), as does Penelope Lively's Ammonites & Leaping Fish: A Life in Time (2013) [viii].

Sources to corroborate the impact

Testimony

[1] Corroborating email from Programme Director, St George's House 3.9.13.

[2] Corroborating email from Associate Director, Cumberland Lodge 4.9.13.

[3] Letter of thanks from Director of the Centre for Ageing and Mental Health, Staffordshire University, 21.3.12

[4] Correspondence with Co-Director, New Dynamics of Ageing Programme `Ages and Stages Project', Keele University.

Other evidence sources

[i] St George's House Consultation Report, What is Successful Ageing? http://www.stgeorgeshouse.org/consultations/social-and-ethical-consultations/recent- consultations/what-is-successful-ageing/

[ii] Cumberland Lodge Consultation Report. http://www.cumberlandlodge.ac.uk/Resources/CumberlandLodge2011/Documents/Programme/Re ports/Changing%20Expectations%20of%20Death%20Summary.pdf

[iii] Thomas Cole, Review of The Long Life, Ageing and Society 28 (2009), 328-30.

[iv] The Centre for Policy on Ageing Information Service `Selected Readings' recommendation list 2013: http://www.cpa.org.uk/information/readings/longevity.pdf

[v] BBC Radio 3 Nightwaves: http://www.bbc.co.uk/iplayer/episode/b01qqsft/Night_Waves_A_Chorus_Line_Shlomo_Sand_What_is_Old_Age/

[vi] Jane Miller, Crazy Age: Thoughts on Being Old (London: Virago, 2010), 5, 193-5

[vii] `Growing Old Reconsidered', In These Times 9 March 2011 http://www.inthesetimes.com/article/6956/growing_old_reconsidered/

[viii] Penelope Lively, Ammonites & Leaping Fish: A Life in Time (London: Penguin, 2013), 25.

Indicative references for the book's take-up in current literature on gerontology and geriatric care include Julian C. Hughes, Thinking Through Dementia (Oxford: OUP, 2009); and Ian Stuart- Hamilton (ed.), An Introduction to Gerontology (Cambridge: Cambridge University Press, 2011).