"He died from old age" = "The Unrelated Symptoms Disorder"

People of all ages die of many different things, but it often happens that when an elderly person dies, the doctor can not give a specific cause of death. In such situations we sometimes say, "He died of old age," even though this means hardly anything. It is my goal in this essay, not to explain why these people die, but to put the whole problem in a context.

Organizational Principle 1: For every death, the cause is either internal or external.

The line I am drawing between internal and external causes is not meant to be clear and firm. For example, a bacterial infection is internal even if the bacteria come into the body from the outside. I am thinking more informally where we say, if a man is hit by a car and dies, that the cause was external, whereas, if he has an heart attack, it is internal.

Organizational Principle 2: Causes of death are on one or more levels of organization.

People can die from chemical imbalances within their cells.

People can die from problems with tissues made up of cells.

Organs are made of tissues, and people can die from a problem with an individual organ.

Individual organs are parts of systems (such as the cardiovascular or nervous or respiratory systems), and problems can develop in one or more organ systems.

The human body "contains" or "consists of" cells and tissues and organs and organ systems all "working together" in some sort of balance, and the whole organism can become unbalanced, and death can occur.

On a still higher level of organization, the human being is a person. A person has cells, tissues, organs, and organ systems but also thoughts and feelings and sensations and an imagination. If something goes wrong with or in a person, he or she can die.

And there are groups of people. A group of people can become infected by the same disease or be victims of, say, a bomb blast, and they can all die.

The same for all the people in the world. It never has happened (unless you believe the Hebrew Bible account), but it could happen that everyone on earth is killed by some asteroid or other giant external catastrophe, manmade or natural.

It is possible for the whole planet earth, with all its plants and animals and natural features, to blow up or be obliterated. In this case, every individual living creature on earth would die.

And the same goes for our solar system and our galaxy. Perhaps, even, the whole universe could disappear. 

the 2 principles applied to "Death by Old Age"

"Death from old age" — that is, deaths of the elderly where the doctors can't figure out the cause — are

1. internally caused and

2. are deaths of a person, of an human being.

These deaths are not caused by external factors. And they can not be understood as caused by chemical imbalances or cellular disorders or tissue or organ or organ system disorders or even as disorders of the whole body. And they are not due to problems of groups of people of which the person is a part or of the environment in which he or she is embedded. They are deaths of individual people.

the "Unrelated Symptoms Disorder"

What I am discussing is a phenomenon I will call the Unrelated Symptoms Disorder. Elderly people often seem to accumulate a series of unrelated problems that are not normally found grouped together and are hard to explain. These symptoms are like a school of sardines that flits all around and of which it is hard to get a clear and steady picture. An older person suffering from this Unrelated Symptoms Disorder may develop a sudden weakness or loss of function in a limb, fluid accumulation in another limb, a pain in a shoulder, nausea and vomiting, an irregular heart beat or periods of high blood pressure, itches or red spots, loss of memory and judgment, agitation and violence, and so on.

It is because of the variety of seemingly independent symptoms that, when death comes, it is so hard to pinpoint a specific cause, It seems that the cause is internal but nothing specific. It doesn't seem to be one thing. It is as if the whole personality gives out, and the person just dies.

2 Possible Explanations of the Unrelated Symptoms Disorder

1. Wearing out: The body is a thing, and things wear out. The body has parts and the parts wear out. Cells and tissues and organs and organ systems, and they wear out at different times. Different little pieces may wear out here and other pieces in different systems may wear out over there and still others over there. There is no overall unity or pattern to the wearing out. It is like an old wardrobe where no shirt or pair of pants or pair of shoes wears out completely, but there are problems in many of them.

2. Relaxation (of a supra-organizational center or organizational principle): In this view, besides all the individual aspects of a person, there is something that monitors and oversees the whole thing. This would have to be a process that would be almost completely unconscious, as its "job" would be immense. It would be the force or drive or effort or personality behind all we do. It would pull ourselves together and unite ourselves to fulfill our needs and to meet our goals. It would, as it were, weave together the weaker and stronger parts of ourselves, so the whole could function. It could hold out and push on long after each part was ready to collapse. It would take energy from stronger parts and use it to boost up the weaker parts. It may be, looked at from the outside, what people call the personality or will. And, at some point, it would flag and begin to weaken and to let go of its project, and gaps would begin to appear in the overall structure of the body it had been trying to keep together.

An analogy for the "Wearing Out" explanation would be to the dykes in Holland that hold back the sea. They may be strong for decades, but, over time, if left alone, they would begin to weaken. A hole would develop here and another there, and, finally, a whole dyke would collapse. The holes might seem unrelated until you understand the structure and material of the dykes and the nature of water.

We can turn the dyke analogy into an analogy for the "Relaxation" explanation if we focus on the human who build and maintain the dykes. The dykes are fine a long as there are people to watch over and repair them. If the people relax and stop working, problems in the dykes will being to pop up.

In the 1945 film called The Picture of Dorian Gray, Dorian Gray sells his soul to the devil so that he will never have to age. At some point his will to live forever flags and he destroys the thing that is keeping him young. He ages at once. Suddenly he is an old man. This is like what happens if the executive center decides to stop living: Suddenly, a person who has seemed young at heart and young of body turns into an old man or woman, surprising everyone.

Arbitrating between the "Wearing Out" and "Relaxation" Explanations of the Unrelated Symptoms Disorder

The reader will think of other explanations of the Unrelated Symptoms Disorder, but, sticking for now with the two I have given above, is there any possibility of adjudicating between them? Here are a few relevant points.

1. On the surface, 2 seems conceptually more cumbersome. It hypothesizes a center or principle whose existence may be hard to pinpoint and justify.

2. On the other hand, 2 may allow us to predict a little better how we might expect the wearing out of 1 to occur. It might be that just the thing that a person is most proud of and works the hardest to develop will be the thing that deteriorates the most significantly when it goes. It may be the last thing to go, because it is the most important thing to the person and receives the most effort, but, when it goes, it will fall completely apart.

For example, if a man has valued physical activity the most and has taken exceptional pride in maintaining his physical prowess into old age, when he loses interest in his fitness and relaxes his efforts to maintain it, he may become immobilized or even paralyzed. It's like a master mechanic who has, for years, maintained the engine of a rare old German car. The engine has required infinite patience and the most subtle adjustments over the years. When the mechanic relaxes and loses interest, the engine falls apart in an hundred places.

Another example would be a person who has always been most proud of their social presence. At some point in old age they may lose their interest in the project of maintaining their looks, and, when they relax their efforts to be gracious and charming and helpful, they may start yelling and screaming and insulting and even striking out.

And the same goes for those who have focused on their physical appearance or on their reasoning ability.

3. A positive side to the Unrelated Symptoms Disorder, if 2 is correct, is that, what appears to be a problem for the person from our point of view, might be a good thing from their point of view. It is possible that the end of life is a time to relax and let go. It might not be good for us if an old person relaxes. It may cause problems for those who are caring for him or her. But it may be just what the old person needs and deserves after a life time of struggle in adjusting to people and to the world.

Is there really Death due to Old Age?

In the end it is hard to say. It may be that, in most cases with the very old, it is not worth it to anyone to exert the effort necessary to determine an exact cause of death. Perhaps in all cases of death there is a specific cause whether we are able to find it or not. There must be some autopsies that were done on people who die with Old Timer's Syndrome. Perhaps there was a question of whether the person was murdered, and it became necessary to establish a cause of death. To help solve our puzzle it could be useful to see what such autopsies have come up with.