An historian by training and gerontologist who transcends disciplinary boundaries, Achenbaum provides much more than a biography of Butler in this beautifully crafted, historically grounded account of Butler's life from childhood, through his long career in geriatrics and gerontology, until his death. The book benefits from Achenbaum's lengthy relationship with Butler, who generously provided him interviews and access to his personal files. Butler's humanity and warmth is visible in this account of his move into geriatrics and his profound effect on that field throughout his career. While working as the first Director of the National Institute on Aging, he engaged in numerous professional and organisation-building activities which resulted in the ideas and (despite his claim that he never aspired to be a theorist) the concepts he gave to us.
The book appropriately begins and ends with one of these concepts, the ‘life review’. Achenbaum describes how, while a major contribution to theory in ageing, the concept was most important to Butler clinically. Butler saw reminiscence in later life not as pathological but as a normal activity that, if successful, would enhance quality of life and promote healthy ageing and he developed a manual to promote the therapeutic use of the principle. This is a valuable approach that runs counter to the misguided focus on ‘reality orientation’ that discouraged long-term care residents from ‘living in the past’. Achenbaum's extensive description of this important contribution is book-ended with an appendix of 19 pages, ‘Prologue or Introduction to Life Review’. This work was completed by Butler a week prior to his death and was primarily intended for his children. Butler grounds the overview with references to clinical data and the writings of clinicians, ancient philosophers and contemporary authors, as well as to Bergman's motion picture, Wild Strawberries. These are literally Butler's ‘last words’ on this theoretically and clinically important concept and Achenbaum does us a service in bringing it into print.
Chapters Two and Three deal with ‘The Formative Years’ and Butler as ‘A Professional Apprentice’, grounding this account in the lifecourse approach, specifically Elder's Children of the Great Depression (Reference Elder1974). Butler was a child during the Depression, raised from infancy by grandparents, but through intelligence and character he was able to move from poverty into higher education at an outstanding university and on to a brilliant career. Achenbaum describes in detail the core curriculum at Columbia College, where Butler did his undergraduate degree, and the influence of several brilliant academics such as Jacques Barzun, John Dewey and Ernest Nagle. Butler honed his writing skills editing the college newspaper (skills which enabled him to win the Pulitzer Prize for his Reference Butler1975 book, Why Survive? Being Old in America). He continued his medical education at Columbia. He became interested in geriatrics only during his internship but then made a bold move to the west coast and a residency with the relatively new and unorthodox Langley Porter Neuropsychiatric Institute. Achenbaum's detailed description of Butler's ‘apprenticeship’ there situates his move into psychopharmacy in an Institute that was itself pioneering new approaches to clinical care and research on ageing. This led Butler to the National Institute of Mental Health, which was conducting not only basic but clinical, behaviour and social science research. As Achenbaum records, Butler counted his eight years there of interdisciplinary research on healthy ageing as the most stimulating phase of his career. The move from seeing ageing as pathology to healthy ageing became a foundation for all of Butler's subsequent involvements.
The remaining chapters carry Butler through his leadership as the first Director of the National Institute on Aging (founded 1974), his decision to give high priority to Alzheimer's disease, and his limited success in promoting clinical geriatrics and enhancing Alzheimer's disease research in American medical schools. Butler had greater, if transient, success at New York's Mount Sinai Hospital following his departure from the National Institute on Aging. He then played a critical role in creating the concept of ‘productive ageing’, considered a step beyond ‘healthy ageing’. As Achenbaum documents, Butler travelled in high, moneyed circles and was remarkably successful in finding financial support for his projects. In 1990 he used corporate support to establish the US Branch of the International Longevity Center at the Mount Sinai Medical Center and subsequently to assist in developing International Longevity Centers in other countries to examine the socio-economic, health and quality-of-life impact of population ageing, through the overarching construct of ‘productive ageing’. Achenbaum the historian meets Achenbaum the biographer in these as in the earlier chapters, providing considerable detail of the changing historical circumstances in which Butler struggled, and in large measure succeeded, as one of a very few ‘big thinkers’ of gerontology.
A major strength of this book is that it is much more than a biography. Achenbaum provides extensive historical information about the social institutions that were part of the environment in which Butler worked. These institutions shaped Butler's biography and, in turn, influenced his own ability to shape history. For example, Achenbaum provides a persuasive account of why Butler's first book, Why Survive? was more successful than his last, The Longevity Revolution (Reference Butler2008). In short, following the best principles of lifecourse and ageing research, Achenbaum links biography and history. He does not hesitate to ‘preach the gospel’ of gerontology, using the ‘book of Butler’, albeit reserving most of his advice to an Epilogue.
Veteran gerontologists will treasure this exceptionally fine book, which reminds us that building and sustaining social institutions to help us understand ageing and better the lives of older people has been an arduous and never-ending task, as evidenced by Butler's struggles to develop and preserve the International Longevity Center. The younger generations of gerontologists will benefit from this historically and conceptually grounded account of Butler, whose life and accomplishments were truly remarkable and influential in shaping the field. Achenbaum portrays Butler as someone who fought the good fight, but a fight that has not ended. He notes that Butler ‘left the rest of us an unfulfilled strategy for advancing the new gerontology to serve the common good’ (p. 186) and Achenbaum argues that ‘we invariably will build on Butler's legacy, but we may have to redirect the course of action to achieve his goals’ (p. 187). Despite his humility about his own theorising, in addition to the power of the life review concept, Butler provided strong critiques of deterministic age category or stage theories that seemed so prominent over much of his career. Finally, the concluding Appendix on the life review construct includes Butler's own advice as to how, as an individual, to live and age in a meaningful way and with a sense of purpose through the later years. Since he did so well himself, this advice may benefit us all.
