Dr. Susan Sands on the Pleasures of Living in an Aging Body

Book Talk

Dr. Susan Sands on the Pleasures of Living in an Aging Body


“Not letting ourselves age is a way of not letting ourselves live.”

Susan Sands, PhD, is a clinical psychologist and faculty member at the Psychoanalytic Institute of Northern California. She specializes in female development and body-based disorders, incorporating Buddhism and meditation into her work with patients.

In The Inside Story: The Surprising Pleasures of Living in an Aging Body, Sands doesn’t deny that aging is accompanied by loss in myriad forms. However, her basic message is that we can age with comfort, vibrancy, and joy.

S&H: Could you share some thoughts about how and why you decided to use “The Inside Story” as the title for your book?

    Susan Sands: My old high school friend Dorty suggested the title over dinner one night. I love it because it suggests something hidden and important most people don’t know about that I’m going to let them in on.

    I chose the title mainly because my book encourages readers to tune into their bodies and develop their inner body awareness—their “inside story.” The theme of the book grew out of my concern about how many of us middle-aged or older women remain fixated on how we look. We believe we look good only if we look “young,” which means that we end up in a war with our own bodies as they change with age.

    Our youth-obsessed culture is part of the problem, but another largely unrecognized factor is that we’ve never been encouraged by our society to get to know, sense, and feel our bodies. We’re disconnected from our somatic selves.

    [Read: “6 Stories on Aging Gracefully.”]

    The new, exciting science of embodiment (called interoception) is confirming this. It’s now established that our mind is rooted in our body, that our body is the foundation of our being. Internal sensory signals streaming from all over the body get integrated and encoded in our brain stem and ultimately in our brain’s cortex in a site called the insula. The insula maps the physiological state of our whole body—it tells us how we’re doing—which is terribly important because it allows us to maintain our physiological equilibrium, which ensures our survival.

    This interoceptive process also creates our consciousness, our emotional awareness, our sense of wellbeing, our very sense of self. Interoceptive awareness is like a sixth sense you didn’t even know you had. Your sense of being you is created from your inner body sensations!

    Most of us probably have a general idea of what is meant by ageism as experienced from the outside, from the way other people think about or act towards someone who is older. Can you talk a bit about how another form of ageism—that is, negative views about oneself as an aging person—can be just as restrictive as the more general idea of ageism?

    Inside story cover

    We definitely have our own ageism that we direct against ourselves, and this kind of ageism lives in our bodies as well as in our minds. Our own ageist beliefs can stoop our shoulders, wobble our balance, and scramble our brains. The internalization of negative aging stereotypes begins all the way back in our childhoods, when we adopt the attitudes and stereotypes of our family and cultural environments. It’s striking that we’re ageist toward ourselves, when aging is something we will all, if we’re lucky, go through. It’s the only remaining prejudice that is still generally accepted, or at least not noticed.

    What ageist messages do you send to yourself and others? Do you lie about your age? Do you imagine people on the street feeling sorry for you because of your age? Do you assume that younger people don’t want to talk with you because you’re boring to them? We all need to ferret out and uproot these ageist beliefs because they make our older age a time of struggle and disappointment when it can be a time of unprecedented freedom and joy.

    A series of eye-popping epidemiological studies show that people with more positive views of aging (measured years earlier) are not only physiologically healthier in older age but actually live longer!

    You write passionately about the importance of tuning into our inner body experience as we age. What do you think are the most effective tools or strategies we can use for this?

    The good news, research shows, is that we can develop our interoceptive awareness and that this leads to all kinds of positive changes: better emotion regulation; increased happiness, presence, and agency; stronger empathy and compassion for others (and ourselves); firmer self-other boundaries; and a more positive body image.

    The importance of building body awareness for aging, however, has not been given its due by researchers and practitioners—despite its being precisely what an aging body needs. It’s intuitively obvious that, as our bodies become less robust, stable, and reliable, the best corrective is to feel firmly rooted in and aware of our bodies, so that we know how to take excellent care of ourselves. We need to feel more grounded internally as we become less adept externally.

    [Read: “Resilience While Aging.”]

    How can we tune into our inner body awareness? We can begin right now by checking in with our bodies, to see what’s going on and what we need. We can practice moving our attention down into our bodies and dwelling there, sensing ourselves from within. A strong body sense doesn’t just happen. It has to be cultivated, practiced, and renewed.

    Of course, there are also wonderful contemplative practices developed over the millennia to help us develop our body awareness. Mindfulness meditation is by far the most researched practice, and hundreds of studies have confirmed that it is particularly good for sharpening our attention, improving emotion regulation, and relieving depression and anxiety. Other body-based meditative practices like sustained breathing, yoga, tai chi, and chanting are also incredibly helpful.

    Could you share a few ideas about how the misguided efforts of triumphing over the body, triumphing over death, and triumphing over nature are related?

    What I call the “triumphing over the body” narrative is characteristic of our whole society at this point. We think it’s strong or cool to override our bodies’ needs—work ’til you drop, skip lunch, get by on five hours of sleep, extreme diets, extreme sports, etc. So then when we approach our older years, it follows that we will try to triumph over the aging body. We become obsessed with denying or defying aging—winning the battle against it (a lost cause if there ever was one). Of course, our society’s fear of aging is really about our fear of death, since the aging of the body is the harbinger and messenger of our mortality. So, we then develop the insane imperative to triumph over death, which leads to the even more insane need to triumph over nature.

    [Read: “Living a Full Circle, Aging, and Coming to Terms With Death.”]

    Our anti-aging “triumphing narratives” are stories cooked up by our tricky, often-misguided brains to assuage our fears about getting older. We absolutely must confront these pervasive cultural fantasies of overturning the natural order because they ravage our bodies, our peace of mind, other living beings, and our planet. Fighting aging is a way of rejecting ourselves, telling ourselves we’re not good enough.

    Not letting ourselves age is a way of not letting ourselves live. These destructive narratives make our older years a time of struggle and unhappiness when, in fact, our later years can be a time of unprecedented freedom and joy.

    This is why it’s so important to consult and listen to our bodies. Our bodies are designed to keep us safe, healthy, and in balance, and we need to let them do their job. Only the body can sense what we really need and who we really are. Getting comfortable in our bodies is one of the best ways to calm our fear of aging.

    You draw on different aspects of Buddhism throughout your book, including in the discussion about death. Could you elaborate on how one or more of the Buddhist beliefs might help us feel more comfortable about death?

    I think the central Buddhist teaching of impermanence (anicca in Sanskrit) is most helpful in facing our aging and mortality. Impermanence means that everything—everything—is always changing. Nothing is permanent or solid.

    Impermanence does not refer only to the changing of the seasons, our moods, or politics. At the most profound level, it means that everything we love and treasure—including our partners, children, parents, friends, even ourselves and our earth—will not only keep on changing and transforming but will eventually pass away. To try to triumph over this truth brings disappointment, frustration, and defeat. The only approach to life that can ultimately bring peace is to accept the way things really are—that things are constantly changing.

    It is here that aging is the best teacher of all, because we can really see the changes in the crinkling and falling of our flesh. Of course, we’ve been aging in a steady, programmed, predictable way since we were born, but it gets so much more obvious as we age. The process of change is all laid out for us to see with our own eyes—if we let ourselves look. As my friend Maureen says, “Aging is like a straight shot of reality.”

    Can you comment on any connections between healthy aging and spirituality?

    Spirituality, to me, is feeling connected to something larger than oneself, whether it’s the natural world, some kind of God, or something more personal. We feel our sense of self expanding, we feel inspired, we feel awe and even states of profound bliss. We feel less lonely, less afraid. We feel a part of the web of life, which helps us find more comfort and better health as we age. These experiences are not thoughts but body feelings, and that is why we sense and feel them deeply and profoundly.

    There is some research showing that people with higher levels of spiritual or religious beliefs have better physical health in general. The most well-known and well-done studies come from the meditation field, however, although there is not much on aging.

    There is some very promising research showing long-term meditators have healthier brains than non-meditators of the same age. Scientists found less age-related gray-matter atrophy in their brains—their brains looked more like those of people seven or eight years younger. Other studies have also found that the most devoted Tibetan lamas who meditate full-time have astonishingly youthful brains.

    Meditation has also been shown to increase the length of our telomeres (the little caps on the end of DNA strands that shorten every time a cell divides), thereby protecting against cell division and increasing life span. It is thought that the stress-reducing and anti-inflammatory effects of meditation explain these telomere changes. There is also research showing that slow, sustained breathing and meditation allow the brain to rest, rebalance, and rejuvenate, providing some of the benefits of sleep.

    What is the difference between body image and body sense, and why is it important to understand how these two concepts differ and how they overlap?

    I focus in my book on body sense (or body awareness) rather than the more familiar term “body image.” We have a strong and positive body sense if we are able to pay attention to our sensations, emotions, and movements in the present moment. A strong body sense does not just happen—it must be actively attended to, cultivated, and renewed. Body image, on the other hand, refers to our imagined body and how we picture ourselves in our minds. This too is constructed slowly over time and is very dependent on the responses we are receiving from our particular culture or subculture.

    I believe that body sense and body image are powerfully related. Without a well-developed body sense, our body image will not feel as real and connected with our full being and will be more of an abstract, and often inaccurate, idea of who we are. On the other hand, a stable and positive body image fits like a comfortable suit.

    My book is not another book about trying to look 50 when you’re really 70 or trying to look 30 when you’re 50. It’s about forging a healthier relationship with your actual maturing body—a relationship of respect, appreciation, tenderness, and, yes, even love.

    [Read: “Aging: One Size Does Not Fit All.”]

    So, how does aging affect our body image? Studies show that our level of what’s termed “body dissatisfaction” does not increase with age but tends to stay the same or decline a bit. And what’s most exciting and unexpected is that older women actually have higher levels of what’s called “body appreciation” than younger women. This has to do with accepting and respecting our bodies more and rejecting the “thin ideal” promoted by the media. We gain more appreciation of our bodies’ abilities as we get older—for example, the ability to stay strong and healthy. Neuroimaging studies show that people with higher interoceptive awareness (a big part of what I’m calling body sense) have more accurate and stable body images. Having a strong body sense helps us accept the body we actually have, which is very important for aging.

    I also believe that the waning of our female hormones changes our body sense as we age. Our bodies become quieter inside—there is less dramatic action in the theater of our bodies without the hormonal tumult of our younger years. As a result, I believe we are actually primed to sense our bodies more deeply and pleasurably as we get older. We can become more embodied—in fact, I think some people can only become truly embodied in older age.

    If you were to put the most important message from your book on a bumper sticker, what would it be?

    “Body Awareness Now!” or “Tune Into Your Body!”

    Read our review of Susan Sands’ The Inside Story; learn more at And be sure to explore more from the March/April 2022 issue of Spirituality & Health.

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