Life review is a progressive return to consciousness of memories and unresolved past conflicts for reevaluation and resolution. It is a normal, developmental task of the later years, a private process that differs with each individual. This evaluative process is believed to occur universally in all persons in the final years of their lives, although they may not be totally aware of it and may in part defend themselves against realizing its presence.
In late life, people have a particularly vivid imagination and memory for the past. Early life events are remembered with sudden and remarkable clarity, and people often experience a renewed ability to free-associate. A life review can provide new insights that result in the resolution of old issues, reconciliation with estranged loved ones, atonement for past mistakes, and integration of the past with the present. Life review can culminate in serenity and acceptance of the life one has lived. Elemental aspects of life, such as children, friendship, nature, humor, and human contact, often gain great significance as people identify the things they hold dear and minimize less important parts of their lives. The resolution of life conflicts may result in creative works, such as memoirs, art and music, or in a new interest in sharing their family histories.
However, the life review can be very painful for individuals who believe they have committed unforgivable acts, have led meaningless lives, or are unable to forgive others for perceived wrongs that may have been committed many years ago. In extreme cases, if a person is unable to resolve problems or accept them, terror, panic, and suicide can result. In cases where guilt, depression, and despair cannot be resolved, professional treatment is necessary.
A life review occurs spontaneously, or it can be structured. Structured life review is sometimes referred to as guided autobiography, and is conducted by an individual trained in psychotherapy. Life review can take many forms, among them autobiographical memory, which refers to memories of specific events that occurred in an individual's daily experience. Reminiscence, which is defined as the process of recollecting past experiences and events, is often used as a therapeutic tool. However, reminiscence is not considered to be a true life review because it does not require that the person evaluate the experience.
A brief history
In the 1950s, psychology, psychiatry, and gerontology textbooks often devalued reminiscence and memories. Reminiscing was thought to be an early diagnostic sign of senile psychosis—what is known today as Alzheimer's disease—and people who engaged in reminiscence were thought to be living in the past, even considered "boring" and garrulous."
In 1955–1956 the National Institute of Mental Health conducted studies for the first time on healthy older persons. The importance of reminiscence was demonstrated. In 1961, Robert N. Butler postulated the universal occurrence in older persons of an inner experience or mental process he called the life review. He proposed that life review helps account for the increased reminiscence in the aged. Today, life review is acknowledged to be a way of maintaining cognitive vitality.
Life review as psychotherapy. The life review and similar autobiographical concepts have been suggested as psychotherapeutic techniques. These methods include the Martin Method, originated by Lillian Martin, in which the client is asked to relate life history in detail; life review therapy, promulgated by Myrna I. Lewis and Butler; guided autobiography, described by James E. Birren; and reminiscence and structured life review therapy, described by Irene Burnside, Barbara Haight, and others.
In the 1970s, psychiatrists began to move away from psychodynamics and the inner life, and toward the use of psychoactive medications to ease the emotional burden many people feel as they near the end of life.
These therapies are not necessarily mutually exclusive. Medications that ease anxiety and make pain tolerable can be used in conjunction with therapeutic life review to help patients achieve reconciliation and gentle closure.
To a dying patient, life review can offer validation of the life that has been lived and a way of saying goodbye to family members. Perhaps paradoxically, the review of a life at its end can be a life-affirming experience. Fears about time running out may be reduced and replaced by an acceptance of the past and an appreciation of the here and now.
However, for some individuals, reviewing a life at its end can cause what Eduardo Krapf called "panic at the closing of the gate." In the extreme, life review may involve the excessive preoccupation of the older person with the past. It may proceed to a state approximating terror and result in suicide. The more severe consequences tend to occur when the process proceeds in isolation in those who have been deeply affected by the loss of friends and family, and notable psychosocial discontinuities such as forced retirement and death of a spouse.
Memoir as life review
Memoirs are one form of life review. They represent the writer's search for meaning and the desire to leave a record for posterity. Although religious confessional memoirs, such as the Confessions of St. Augustine and The Book of Margery Kempe survive from the medieval period, it was not until the seventeenth century that people began to view personal experience as having intrinsic value. For the first time in history, men and women who were neither members of the clergy nor of royal lineage revealed themselves through their memoirs. The interest in writing personal memoirs has not diminished, and in the latter part of the twentieth century memoirs became the signature genre of the era.
Memoirs range from angry to tell-all, to personal journeys to confessional and painful soul searching. For example, the memoirs of Robert S. McNamara, (In Retrospect: The Tragedy and Lessons of Vietnam, 1995) illustrate courage and humiliation in acknowledging grave mistakes. Larry McMurtry's memoir, Roads: Driving America's Great Highways (2000) is an example of introspective soul searching.
Neither memoirs, nor autobiographies nor oral life reviews necessarily represent the unvarnished truth. They are attempts to understand, integrate, and evaluate in hindsight the life decisions that were made.
Life review as oral history
Recollections of historic events and the era in which they occurred are valuable eyewitness accounts and part of a nation's heritage. For example, in Britain, the group Age Exchange organized the Reminiscence Theatre company, to which Londoners have shared their memories of living through the blitz in World War II. In America, only a few hundred are still alive of the 200,000 orphaned and poor children who were sent west between 1854 and 1929. They meet annually to share remembrances of that era, and their stories are important historical accounts of a little known social experiment.
During the U.S. bicentennial celebration in the summer of 1976, under the auspices of the Smithsonian Institution, Robert Butler, along with anthropologists Margaret Mead and Wilton Dillon obtained the stories of visitors to the Mall in Washington, D.C. In 1993, Sarah L. Delany and A. Elizabeth Delany published Having Our Say: The Delany Sisters' First 100 Years, a firsthand account of what it was like to live as African Americans in the United States in the twentieth century.
Universality of the life review
Life review has been called a Western phenomenon because of its focus on the individual. However, a number of research studies have been conducted around the world. Major programs of reminiscence and life reviews are carried out under the auspices of both national organizations and individuals in Japan and Singapore as well as in the United States and the United Kingdom. An International Society for Reminiscence and Life Review was established in 1995.
The life review concept has contributed to a better understanding of late-life and end-of-life development as well as development across the life span. It has helped demonstrate the therapeutic value of reminiscence for older people and helped eliminate prejudice against those who reminisce.
Robert N. Butler
See also Life Span Development; Narrative; Psychotherapy.
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Birren, J. E., et al., eds. Aging and Biography: Explorations in Adult Development. New York: Springer Publishing, 1996.
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