Musings: Food for Thought


Food is as necessary as water for survival.  Perhaps that is why it is so often used as a metaphor for life. Yet we say, “Man cannot live by bread alone.”  Given its fundamental nature, food is often juxtaposed with lofty ideals. Presumably, we could starve for our ideals given the right circumstances. 


We all have associations and memories (as Proust famously observed upon biting that madeleine) attached to taste and smell.  These associations tie us to a place, a moment in time; they even evoke a face long gone. (My grandmother, early mornings with cocoa, oatmeal with cream and brown sugar.) 

In a time of abundance, we can take food for granted. There is so much of it and in such variety. We’re a culture that worries about obesity and overeating, with diabetes on the rise and other ills. An entire industry exists to undo the effects of overeating. There is a vast literature, both popular and scientific, devoted to these issues. Food can come to be seen as the enemy. Eating disorders are not the subject here. These issues have been addressed many times over. Were the disorders easily amenable to treatment, solutions would have been found long ago.  

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Third-Wave Cognitive Behavior Therapies and Older Adults


The global average lifespan was 73.3 years in 2024, and the older adult population is estimated to rise to 1.4 billion in 2030 (World Health Organization [WHO], 2025). While the population is aging, mental illness remains highly prevalent. In the United States, in 2021, 57.8 million adults reported having a mental illness, 14.1 million adults reported having a serious mental illness, and 19.4 million adults reported having a co-morbid substance use disorder and mental illness (National Alliance on Mental Illness [NAMI], 2023). There is a paucity of research on the intersection of older adulthood and mental health. 

Older adults face unique mental health challenges due to aging, chronic health conditions, cognitive decline, identity disturbance, and changes in interpersonal functioning. Ageism, internalized stigma, and generational perceptions of psychological treatment are additional factors that likely contribute to the ambivalence older adults may feel about seeking help for mental health issues (Elshaikh et al., 2023). This situation poses risks: Elevated levels of anxiety in older adults, for instance, heighten the risk of coronary heart disease (Kubzansky et al., 1998) and suicide (Pearson & Brown, 2000). Despite the risks associated with medications for older adults and the proven effectiveness of behavioral treatments (Thorp et al., 2009), psychopharmacological treatment has been prioritized over behavioral interventions in this population despite the risks of medications in older adults and the strong efficacy of behavioral treatments for older adults (Thorp et al., 2009). 

Cognitive-behavioral therapy (CBT) is the most widely accepted, evidence-based treatment for some psychiatric disorders (American Psychological Association [APA], 2017b). CBT focuses on how thoughts, feelings, and behaviors are connected and how they can influence each other (Beck et al., 1979). CBT works by increasing adaptive behaviors (as through behavioral activation and exposure therapy), challenging distorted thought patterns, and encouraging adaptive coping mechanisms (Beck & Fleming, 2021; Beck, 1963). Psychosocial therapies have shown reduced levels of attrition, greater reduction in symptom severity, and lower risk of recurrence compared to pharmacotherapy (Van Etten & Taylor, 1998; Thorp et al., 2011). 

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Psychotherapy with Older Adults

Working with a senior population has been satisfying and rewarding for me as a psychologist.  One might think that the therapeutic issues revolve around loss, adverse physical issues, death, and dying; however, it has been quite the opposite experience.  The focus is staying vibrant, healthy, and engaged with life and relationships.  My oldest patients are 95 and 100.  The 95-year-old drives, takes long walks with her dog, goes to the gym daily, and has no cognitive impairment.  My 100-year-old patient walks daily, attends symphony concerts, is politically active, and has an astute mind.

I currently have about 15-20 Medicare patients in my practice.  I find them reliable, likable, and often quite wise about life. They are typically on time and appreciate the opportunity to have someone to talk to.    Working with this population has genuinely been fulfilling.

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