For nearly fifty years, the psychiatrist Robert Neil Butler was an eloquent advocate for older Americans. An ideas broker, he could flip out proposals as quickly as a “Las Vegas blackjack dealer” according to a Washington Post reporter (Kernan, Reference Kernan1976). This was coupled with uncommon political instincts and leadership abilities that he used to good effect in guiding the National Institute on Aging (NIA), the Gerald and May Ellen Ritter Department of Geriatrics and Adult Development (as it was then called) at the Mount Sinai Medical Center in New York, and the International Longevity Center during their early years. Butler was a charismatic communicator with a fact-filled, “stream-of-statistics” (from a New York Times reporter; Henig, Reference Henig1975) style who is credited with coining short and memorable terms for key concepts in gerontology such as life review, ageism (in a Washington Post interview with Carl Bernstein; Bernstein, Reference Bernstein1969), and productive aging. In addition to being blessed with manifold talents, Butler seemed to have lived a charmed life. Who else had a day like May 3, 1976? This was his first day as the inaugural director of the NIA, and it was also the day he won the 1976 general non-fiction Pulitzer Prize for Why Survive? Being Old in America (Harper & Row, 1975).
The historical gerontologist (or gerontological historian, depending on your perspective) W. Andrew Achenbaum is an ideal choice to be Butler’s biographer. He knows the field intimately and is personally acquainted with many of Butler’s important collaborators. The two were friends for thirty years. In fact, the biography started out as a joint venture. After Butler’s death in 2010, Achenbaum completed the book on his own with much of it written while serving as a visiting chair in gerontology at St. Thomas University in Fredericton, New Brunswick. The finished product is a thorough and well-written description of the public accomplishments of Butler. It starts and ends (in an appendix written by Butler) with an exploration of life review, which along with ageism was Butler’s most important conceptual contribution to gerontology. In between, Achenbaum utilizes a temporal structure with chapters that cover Butler’s early years, training, professional development, time spent building the organizations noted in the preceding paragraph, and final years, before ending with reflections on the man and his accomplishments. In the Preface, Achenbaum wrote that the book concentrates on “Butler’s evolving ideas about aging and his professional modus operandi” (p. xv). That is a fair description of what is covered.
Vern L. Bengtson noted in his review of the Visionary of Healthy Aging for The Gerontologist that there is little here about what made Butler “run so hard and so fast” or the “costs of his prodigious efforts to advance his career and the field of geriatrics and gerontology” (Bengtson, Reference Bengtson2014). Some of these deficiencies are dealt with in the memoirs of his youngest daughter, Alexandra Butler, about the last months of the life of his second wife, Myrna I. Lewis, and then of Butler himself (Butler, Reference Butler2015). The two books complement each other and, read together, lead to a better understanding of both the public and the private man. In Walking the Night Road, we appreciate his relationship with his family, particularly with Myrna.
Part of the answer to what drove Butler has to derive from the challenges faced during his childhood. Born in 1927, his parents separated shortly after his birth. Until he was fourteen, his maternal grandparents brought him up. When Butler was just seven, his grandfather died (initially, this was hidden from Butler who was told that he had gone away to visit relatives) leading to Butler and his grandmother losing their home and requiring relief. Butler publicly said that what he remembered most from this time was his grandmother’s determination to overcome adversity whereas the death of his grandfather fired his determination to become a physician. In Walking the Night Road, Alexandra speculated on other ways this may have influenced her father. In contradistinction to his typically positive public persona, she wrote about his alter egos of Drs. Ominous, Deplore, and Lament (so named by his wife) who always assumed the worst of any situation as well as his frugality, lifelong passion for work, and difficulties in saying good-bye.
Another missing element in Achenbaum’s book is sufficient detail about the time and environment in which he lived. Why did things happen as they did? An example of this lack would be the details of how he became the first director of the NIA. Butler in later interviews claimed not to know. To say the least, he was a surprising choice. He had virtually no administrative and relatively modest research experience (as an investigator in the National Institute of Mental Health [NIMH] human aging project conducted during the 1950s and 1960s). For the fourteen years preceding his 1976 appointment as NIA director, Butler had been in private practice with a clinical academic position. Butler was not the first person offered the position, but Leonard Hayflick turned it down because he felt the salary was too low (shortly afterwards he entered into a bitter and protracted dispute with the National Institutes of Health [NIH] about ownership of a human cell line he had developed). The Washington-based Butler had written well-regarded books and was a consultant on aging to the Department of Health, Education and Welfare (HEW), the National Institute on Mental Health, Center for Law and Social Policy, and the Senate Special Committee on Aging. He had supporters – in particular, Florence Mahoney who played an essential role in the establishment of the NIA. After she read Why Survive?, Butler became her favored candidate. Butler said that he would not have gotten the position without her influence.
A final omission in Visionary of Healthy Aging is a more detailed consideration of the long-term consequences of the decisions he made while directing the various organizations he led. It might well be too early to comment fully on this. Arguably, the most important one he made at the NIA was deciding that the Institute had to engage in what he called the “health politics of anguish” and focus on a disease. He settled on Alzheimer’s disease even though this condition was already within the scope of the National Institute of Neurological Disorders and Stroke and/or NIMH. Butler successfully negotiated a lead role for the NIA and, with others, contributed to the establishment of what eventually became the Alzheimer’s Association. As an external advocacy group, they lobbied Congress for additional funds in a manner that he, on his own, couldn’t. Eventually this led to substantial – some say disproportionate – relative and absolute investments in Alzheimer’s research by the NIA. In 1976, only 4.4 per cent of an NIA budget of $19.3 million was allocated to work on Alzheimer’s disease and related dementias. By 1989, this had grown to 35.9 per cent of a budget of $222.6 million. It was hoped that more money for Alzheimer’s research would lead to better funding for other areas of aging research, but the effectiveness of this example of trickle-down economics remains contested. While making no apologies, Butler later acknowledged the need for a more balanced allocation of funds within the NIA.
I can wholeheartedly recommend this book to those seeking an introduction to Butler and his professional accomplishments. Readers wanting a deeper understanding of his motivation, how he was influenced by his circumstances, and the impact he had on our era, though, will be left wanting.
