Philosophy, Psychiatry, & Psychology

Waterman's clinical anecdote highlights several important concepts related to aging, as his own journey with chronic pain leads him to explore an "unconventional" craniosacral therapy (CST). He draws important connections between epistemic humility and wisdom, and he touches on related topics of cognitive neuroscience and ageism. In particular, his comment that, "Perhaps one hallmark of successful aging is when the growth of wisdom outpaces the depletion of mental plasticity" is ripe for further discussion.

Waterman asks the question of whether epistemic humility results from wisdom. While I surmise that the answer is yes, these concepts present interesting questions related to the nature of wisdom in the context of aging. Wisdom is thought to develop as knowledge accumulates with time and life experience. Baltes describes wisdom as an "expert knowledge system in the fundamental pragmatics of life" (Gugerell & Riffert, 2011, p. 227), and other definitions include knowledge as an essential element of wisdom (Montgomery, Barber, & McKee, 2002). This definition of wisdom fits well with neurocognitive studies of aging, which show that crystallized knowledge is relatively preserved even into advanced age (Park & Reuter-Lorenz, 2009). The idea of preserved and solidified knowledge may fuel the often quoted – albeit ageist – assertion that older adults are "set in their ways." As Waterman reflects on knowledge gleaned from an evidence-based psychiatric practice, one might predict that this knowledge base would prevent exploration of modalities that fit outside of the paradigm.

However, more complete definitions of wisdom emphasize not the factual knowledge itself, but rather the nuanced process of making sense of available information and navigating the intricacies of that knowledge to come to an enlightened conclusion (Lim & Yu, 2015). Baltes also describes the expert knowledge system as "permitting exceptional insight, judgment, and advice involving complex and uncertain matters of human condition" (Gugerell & Riffert, 2011, p. 227). Wisdom is not about knowing as much as it is about reasoning and judgment.

This definition raises questions about the neuroscience of aging, which shows that fluid cognitive abilities—which would be thought to impact judgment and reasoning—actually decline over time. Statistically speaking, older adults are likely [End Page 117] to experience decreased speed of processing, difficulty tuning out distractors, and reduced executive functioning (Park & Reuter-Lorenz, 2009), all of which may impact decision-making.

In an exploration of practical decision-making abilities, Tentori, Osherson, Hasher, and May (2001) compare older and younger adults who are faced with a choice about a shopping discount card. Study participants were offered one of two scenarios: 1) A choice between discount card "a" and "b" or 2) The same choice between "a," "b," or a new choice "c." They found that in scenario one, older adults and younger adults were equally likely to choose "b." However, in scenario two, the younger adults were more likely to choose "a," whereas this did not change for older adults. Therefore, the introduction of a third choice influenced the younger adults' decision-making to a greater degree than the older adults. One could say that this is because the older adults lacked cognitive flexibility to incorporate and adapt to the additional information, but a more likely explanation would be that the older adults have the wisdom of years of experience in the marketplace, such that they were not distracted by the third choice, and they continued to choose the option that best met their needs.

In this sense, the practice of epistemic humility, or the willful and open-minded consideration of new options, does not threaten the integrity of decision-making. Waterman demonstrates this as he interviews, and draws insights from, the CST medical director and massage therapist. While recognizing the limitations to the evidence base of CST therapies, Waterman nevertheless appreciates the "clinical wisdom" of the practitioners and uses this experience to expand his own conceptualizations of patient care.

Revisiting the ageist notion that older adults are "set in their ways," cognitive neuroscience demonstrates that the brains of older adults adapt to the cognitive challenges of aging. Park and Reuter-Lorenz describe "compensatory scaffolding" that develops as a response to neural insult or injury that happens due to aging. Simply...