Fifteen years later, when she was a scholar, the experience led her to formulate a hypothesis: how we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever. You do not worry about losing any of your capabilities. People tell you “the world is your oyster,” “the sky is the limit,” and so on. And you are willing to delay gratification—to invest years, for example, in gaining skills and resources for a brighter future. You seek to plug into bigger streams of knowledge and information. You widen your networks of friends and connections, instead of hanging out with your mother. When horizons are measured in decades, which might as well be infinity to human beings, you most desire all that stuff at the top of Maslow’s pyramid—achievement, creativity, and other attributes of “self-actualization.” But as your horizons contract—when you see the future ahead of you as finite and uncertain—your focus shifts to the here and now, to everyday pleasures and the people closest to you.
Carstensen gave her hypothesis the impenetrable name “socioemotional selectivity theory.” The simpler way to say it is that perspective matters. She produced a series of experiments to test the idea. In one, she and her team studied a group of adult men ages twenty-three to sixty-six. Some of the men were healthy. But some were terminally ill with HIV/AIDS. The subjects were given a deck of cards with descriptions of people they might know, ranging in emotional closeness from family members to the author of a book they’d read, and they were asked to sort the cards according to how they would feel about spending half an hour with them. In general, the younger the subjects were, the less they valued time with people they were emotionally close to and the more they valued time with people who were potential sources of information or new friendship. However, among the ill, the age differences disappeared. The preferences of a young person with AIDS were the same as those of an old person.
Carstensen tried to find holes in her theory. In another experiment, she and her team studied a group of healthy people ages eight to ninety-three. When they were asked how they would like to spend half an hour of time, the age differences in their preferences were again clear. But when asked simply to imagine they were about to move far away, the age differences again disappeared. The young chose as the old did. Next, the researchers asked them to imagine that a medical breakthrough had been made that would add twenty years to their life. Again, the age differences disappeared—but this time the old chose as the young did.
Cultural differences were not significant, either. The findings in a Hong Kong population were identical to an American one. Perspective was all that mattered. As it happened, a year after the team had completed its Hong Kong study, the news came out that political control of the country would be handed over to China. People developed tremendous anxiety about what would happen to them and their families under Chinese rule. The researchers recognized an opportunity and repeated the survey. Sure enough, they found that people had narrowed their social networks to the point that the differences in the goals of young and old vanished. A year after the handover, when the uncertainty had subsided, the team did the survey again. The age differences reappeared. They did the study yet again after the 9/11 attacks in the United States and during the SARS epidemic that spread through Hong Kong in spring 2003, killing three hundred people in a matter of weeks. In each case the results were consistent. When, as the researchers put it, “life’s fragility is primed,” people’s goals and motives in their everyday lives shift completely. It’s perspective, not age, that matters most.
Tolstoy recognized this. As Ivan Ilyich’s health fades and he realizes that his time is limited, his ambition and vanity disappear. He simply wants comfort and companionship. But almost no one understands—not his family, his friends, or the stream of eminent physicians whom his wife pays to examine him.
Tolstoy saw the chasm of perspective between those who have to contend with life’s fragility and those who don’t. He grasped the particular anguish of having to bear such knowledge alone. But he saw something else, as well: even when a sense of mortality reorders our desires, these desires are not impossible to satisfy. Although none of Ivan Ilyich’s family or friends or doctors grasp his needs, his servant Gerasim does. Gerasim sees that Ivan Ilyich is a suffering, frightened, and lonely man and takes pity on him, aware that someday he himself would share his master’s fate. While others avoid Ivan Ilyich, Gerasim talks to him. When Ivan Ilyich finds that the only position that relieves his pain is with his emaciated legs resting on Gerasim’s shoulders, Gerasim sits there the entire night to provide comfort. He doesn’t mind his role, not even when he has to lift Ilyich to and from the commode and clean up after him. He provides care without calculation or deception, and he doesn’t impose any goals beyond what Ivan Ilyich desires. This makes all the difference in Ivan Ilyich’s waning life:
Gerasim did it all easily, willingly, simply, and with a good nature that touched Ivan Ilyich. Health, strength, and vitality in other people were offensive to him, but Gerasim’s strength and vitality did not mortify but soothed him.
This simple but profound service—to grasp a fading man’s need for everyday comforts, for companionship, for help achieving his modest aims—is the thing that is still so devastatingly lacking more than a century later. It was what Alice Hobson needed but could not find. And it was what Lou Sanders’s daughter, through four increasingly exhausting years, discovered she could no longer give all by herself. But with the concept of assisted living, Keren Brown Wilson had managed to embed that vital help in a home.