The intensity and frequency of threatening events over the past few months has affected me as well as my patients.  We are all humming at a higher level of stress and anxiety that reflects a growing feeling that the world we once thought predicable and stable may not be that way at all.

I work exclusively with elders in my psychology practice.  For the most part, the work I do with them centers around managing feelings of loneliness, purposelessness, being invisible, and dealing with physical pain and loss of functioning.

Recently, though, the conversations have turned to seeking safety.  It seems that quite a few of my patients are experiencing different levels of vulnerability.  Several of them are worried about finding and keeping a safe place to live.  One or two are doing their best to stay independent by keeping their old cars running so they can make it to doctor’s appointments and do marketing.  Many are afraid to walk in their neighborhoods because of the possibility of being attacked.  All of them express sadness and regret over the lack of quality relationships with their children and grandchildren.

Maslow’s Hierarchy of Needs

Back in the 1940s, Abraham Maslow came up with a theory he called the “Hierarchy of Needs”.  This theory explained motivation for change and personal growth.  The foundational need is biologic and physiologic (sleep, food, sex, shelter).  Next to that is “safety” which Maslow suggested includes protection from exposure to the elements, a sense of security, order, law, stability, and freedom from fear.  The third level need he called “love and belongingness”.  If these foundational needs are not met, the result is a deep sense of deprivation.


Short-term deprivation impacts our self-esteem and belief about how effective we are in getting our own needs met.  Long-term deprivation can so destabilize a person that s/he becomes unable to make decisions, take care of him or herself, or function at all.

To a person, my patients are experiencing both short-term and long-term deprivation in each of these levels.  The consequence of which is that they are unable to get their basic, foundational needs met without help.

Four Freedoms

The help that they need isn’t in short supply.  It isn’t missing from the basic framework of our government systems.   As a matter of fact, it is at the foundation of our nation, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Expanding on this, President Franklin Delano Roosevelt outlined in his State of the Union address in 1941 what he called the Four Freedoms.

Remember that in 1941 our country was still working its way out of the worst depression it had ever seen.  When he gave this speech, it was before the US entered the war.  There was no Social Security.  There was no Medicare.  Roosevelt’s intent was to address the vulnerability felt by our nation at a time of destabilization throughout the world.

FDR_Memorial_wallThe four freedoms he identified were: freedom of speech, freedom of worship, freedom from want, and freedom from fear. While his goal was political, his speech elevated these freedoms to a loftier notion that has resonated in many different ways over the decades, and resulted in enshrining these values in programs such as Social Security and Medicare.

Four Freedoms Today

What does it mean to be able to speak freely in our Country today?  A number of my patients are afraid to talk honestly about abuse they have experienced at the hands of their children.  They are afraid they will be put in a nursing home.

One is afraid to let her physician know how much pain she is in because she uses Oxycontin and doesn’t want to be labeled as an addict.  She is afraid they will take away her pain medication and she will be unable to endure the pain caused by multiple chronic conditions.  She would rather die.

Another is afraid to speak up about the harassment from her building manager because that person can have her evicted.  She believes that her manager purposely schedules unnecessary inspections just to wield power.

What does it mean to be able to worship freely?   According to the Pew Research Center, Americans have become less religious since Roosevelt’s time.  But we are seeing a resurgence of religious intolerance and a labeling of people based on who they choose to pray to.  For many elders, it is not about stigma, but about access.  Getting to the church, synagogue, ashram or mosque is problematic because of lack of transportation or accommodation for hearing and sight-impaired members.

Probably the greatest concern for my patients is their worry arising from economic insecurity.  So many of them subsist on Social Security alone and depend on housing vouchers, food distribution, and medical care that comes in the form of government services.   Threats to their monthly stipend now come regularly.  Limitations on services, underfunding of programs and personnel, complicated and obtuse requirements for qualification all are barriers that undercut their freedom from want, leaving them feeling hopeless and alone.

Finally, while Roosevelt was speaking about our country being attacked in declaring his freedom from fear, I would like to suggest that the enemy we now face is ourselves.  Because of the increasing wealth gap and marginalization of elders, there is little access to the corridors of power to persuade legislators to increase funding for programs for aging Americans.  My patients fear for their future because it can be taken away so easily.


We would rather spend billions of dollars on building walls to keep caregivers and food producers out of this country rather than invest in ways to secure their services and provide a safety net for our elders.  Several of my patients are unable to hire caregivers because they are in short supply.  In my part of the country, these services are provided by hard working individuals who care deeply about elders, but who are without proper paperwork.

We would rather spend billions of dollars on building up our military rather than securing the safety of our neighborhoods, creating communities where people live without fear of harassment or attack.  One of my patients is afraid to walk in her neighborhood because there are drug dealers opening selling drugs.  Local Sheriff and police are aware of this, and have offered to increase frequency of driving through the neighborhood, but can’t offer anything else because they are occupied elsewhere.

We would rather see that corporations receive tax benefits and defund or eliminate programs that have a proven record of providing food, clothing, shelter, and nutrition to those who are no longer able to secure these things for themselves.

Shame On Us!

Simply put, what is needed is affordable housing, access to nutritional food in sufficient quantities to support health and well-being, the ability to engage in purposeful activities with others who are supportive and loving, freedom to move within one’s home, neighborhood, and extended community, access to transportation, and opportunities to interact with peers and across generations.

The Center for Aging & Values has a matrix that outlines these components of what we call an “elder friendly community”.  More about that in future posts.

Thanks for reading.

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