Dying of old age or the disease we all wish to suffer from

In the middle of the last century, the World Health Organisation (WHO) - that agency specialising in the management of global health prevention, promotion and intervention policies that everyone has been hearing about for over a year now - turned us all into chronically ill people by defining health as a state of complete physical, mental and social well-being in its 1948 Constitution. Since then, the concept of health has referred to little more than an unattainable chimera, thus spreading its counterpart: illness. 

Who can remember a single moment in his or her life when he or she was not experiencing some kind of physical, psychological or social discomfort, or even several of them at the same time? I myself, at this very moment, have an eyelid injury in my left eye, I am in the midst of mourning the death of my sister and I feel very stressed professionally. If I look closely, I notice that my stomach is starting to hurt because I haven't eaten anything yet. And I'm certainly upset after reading the political section of the current newspaper. 

Well, according to the WHO definition, I am far from what could be considered a "complete" state of physical, mental and social well-being. That means I'm not healthy, and if I'm not healthy, then I'm sick! I know I'm not... I have my little things, but I'm not sick and I'm not sick at the moment. However, I must admit that some ailments do accompany me as I write these words, but I don't think that's enough to put the weight of such a diagnosis on me. 

The daily discomforts that deprive us of a complete state of well-being cannot be the symptoms of the disease, unless we are willing to pay the price of devoting ourselves all to this nonsense which, unfortunately, never goes out of fashion and which seems to come out of an indigestible reading of Arthur Schopenhauer's The World as Will and Representation. That price is none other than that of ending up submitting ourselves to what comes after the diagnosis, i.e. treatment. 

The treatment! If we are really ill, we do not hesitate for a moment to surrender to its authority. But it is not infrequently applied in a way that exceeds the demands of the suffering, naive and trusting person, as Michel Foucault warned in the 1970s, in his talk in Rio entitled "The crisis of medicine or the crisis of anti-medicine". This is especially so when illness derives from the absence of complete psychological and social well-being which, realistically, rather than pessimistically, accompanies us throughout our lives with few occasional moments of healthiness.   

Recently information has leaked out that the WHO has decided to bless humanity with another of its eccentric occurrences. This time the focus is on the elderly, the main protagonists of the social scene since the pandemic began, who will now become doubly ill. On the one hand, they will suffer the physical, psychological and social tortures that make us all sick. On the other hand, they will be victims of a new disease that will come into force next January. I am talking about the recently announced "old age disease", which all elderly people will officially suffer from simply because they are old, as a correlate of the passage of time.

On 15 June 2021, on the occasion of International Elder Abuse Awareness Day, the Latin American and Caribbean Committee of the International Association of Gerontology and Geriatrics (COMLAT-IAGG) announced that the WHO would classify old age as a disease in the eleventh edition of the International Statistical Classification of Diseases and Related Health Problems (ICD), an inventory used to record causes of death and collect morbidity data. 

There has been widespread displeasure, with a deep impact in Latin America, but also in Spain. Lourdes Bermejo, vice-president of gerontology at the Spanish Society of Geriatrics and Gerontology (SEGG), was one of the first to speak out in an interview for 65Ymás, describing the WHO's audacity as "a total break with the paradigm". Representatives of recognised associations such as the Fundación Pilares and the Fundación Edad&Vida, among others, soon joined the protest. 

And things have gone further. Convinced that the inclusion in the ICD of old age as a disease causing death will encourage discrimination, the Spanish Confederation of Organisations for the Elderly (CEOMA) has called for the head of the Director General of the WHO, Tedros Adhanom Ghebrejesus, for encouraging gerontophobia, stressing that "ageing is a natural process in living beings, not a disease", according to 65Ymás. 

All agree in denouncing that this move by the WHO is at the antipodes of the route marked out at global level towards the achievement of person-centred care models, the eradication of ageism, ableism and paternalism and the replacement of the biomedical model of care that still prevails in the health care sector.  

Old age will now be a disease capable of causing death, along with cancer, heart failure or stroke, which will add to the lack of health resulting from our inability to maintain ourselves in an optimal state of physical, mental and social well-being for a prolonged period of time. So now you know: if you are going to cross the threshold of old age soon, it is time to start putting your affairs in order because all that lack of health accumulated over a lifetime will soon materialise in the disease known as "old age". If no other affliction remedies it, you will eventually die of old age. 

But to die of old age is a privilege! How can you call a disease what is in fact a good fortune? It is strange. Since I was a little girl, I always heard the expression "so-and-so died of old age" from my parents, but it did not mean dying of illness, but the opposite: when someone died of old age, it was the natural course of life, without suffering, without pain, without illness. My grandparents died "of old age", and this was something that offered a certain comfort to the whole family. My sister died of brain metastasis. It is very clear to me who died of illness and who did not, who suffered and who went to sleep peacefully and never woke up again. 

There is nothing wrong with dying of old age, in principle. But considering old age as a disease on paper is a bit scary because of the impact that something like this can have on the collective imagination, which, as far as the consideration and appreciation of the elderly is concerned, is already quite damaged. The WHO has not acted in bad faith; on the contrary, its intention has been none other than to eliminate a word such as "senility", which is laden with negative connotations, and change it to "old age". But he has nonetheless blundered with a manoeuvre that experts believe could jeopardise many years of work on equality and respect for the elderly. 

In the end, it is not that the WHO considers old age to be a disease that can cause death, although it is obviously the period of life prior to death when the fuse runs out without any other setbacks (i.e. real diseases). The WHO intends to include "death in old age" in its catalogue for statistical purposes, i.e. to know the volume of people who die in this idyllic condition. The problem is that the catalogue is one of diseases and this makes old age one among many, at least as far as the death certificate is concerned.

Perhaps it would have been easier to replace "senility" with "non-disease" to classify those who die of old age. This would at least have avoided a tense atmosphere. Or maybe what we need to achieve is to reduce the susceptibility to tension. Can't we understand that this is a procedural issue that has nothing to do with the real consideration of the elderly as sick? Aren't we ourselves, those who write about it, twist it and give it fuel, the ones who make this administrative association transfer to society? What ordinary citizen would have noticed this detail if we were not making such a big deal of it? Sometimes our causes are laudable, but our methods lead to the opposite of what we are aiming for. 

I don't know about you, but I want to die of old age. I don't care whether this is considered death by disease or not in practical terms. However, what I would not like is to get to that point under the condition that during the last years of my life I will be considered sick (even more than anyone else) because I am in the stage of old age. Whether this can happen because of a change of nomenclature in ICD-11 is not at all clear to me. 

I understand the fear that this clumsiness on the part of the WHO will help to entrench an already negative perception of old age, which is taking a lot of effort to dispel in our society. But I also believe that we need to take a deep breath from time to time in this crusade against language. Including the word "old age" in a catalogue of diseases does not in fact make it a disease. Giving sovereign power to words can end up putting us in that predicament. 

Think again. The WHO brought us all closer to the plane of disease seventy years ago by defining health as the total absence of discomfort and the absence of deprivation. However, we know that this does not make us chronically ill and that a simple definition does not legitimise a diagnosis and its consequent treatment. In the following decade, the DSM elevated us all to the status of mentally ill and, despite this, most of us continue to differentiate between a passing malaise and a real problem that demands professional attention. Despite what the concepts say, we are able to distinguish what is illness from what is not. A little education, instead of so much convulsion, should be enough to separate fact from fiction.