"Instead of possibilities, I have realities in my past, not only the reality of work done and of love loved, but of sufferings bravely suffered." —Viktor Frankl

As a psychotherapist, cancer survivor, and card-carrying member of AARP, I often find myself meeting with clients with whom I share the common concern of what happens when the aging process is complicated by a life-altering illness. While most people accept the inevitable aches and pains that are associated with a body that is growing older, adjusting to the impact of something like cancer, heart disease, or diabetes can often lead to the sense that aging itself is a disease.

I often joke in training classes on aging that with every new candle on my birthday cake, a new medicine bottle shows up in my cabinet. Like many people my age, the first item packed for any extended vacation is not swimming trunks and suntan lotion but the items from my in-home apothecary. The myriad of tonics, remedies, capsules, etc. are constant reminders of the wisdom that aging is not for the weak of heart—though if you have a weak heart, there is medicine for that as well.

Coping with the onset of physical challenges has a profound psychological impact that can strain the limits of one’s psyche; depression and anxiety are common responses. The literal battle scars from surgeries are no longer seen as badges of honor of a life well-lived, but reminders of alterations of the natural order of things and the replacement of organic parts with modern-age mechanics.

For those of us who have faced the challenge of serious illness, the age-old issue of quality or quantity is not some philosophical luxury but, very often, an actual accounting of pros and cons. Like many of the cancer survivors I have spoken with, I was both surprised and disappointed by how quickly my sense of being happy to still be alive was replaced with the moans and groans of new ailments. It’s been challenging to watch as the survivor’s smile has been replaced with the nervous “what’s next?” twitch.

This is not to say that in my personal and professional life, I espouse cynicism and pessimism. I know enough about physiology and neuropsychology to understand that a negative mind frame only tenses the body, thus limiting blood flow and increasing the experience of chronic pain, and creates a negatively charged thought circuit. These days I find pragmatism—dealing with problems in a practical way, rather than by using theory or abstract principles—as the most useful approach to living in the shadow of a major illness. In therapy sessions, this is presented as a plan to step out of the dark corners of lamentation and into the light of responsibility for one’s attitude toward aging.

One often hears survivors of serious illnesses say that they would not let their illnesses define them. While the sentiment expressed can be emotionally uplifting, the reality is that our illnesses do define us in the same way that we are shaped by all our experiences. The pragmatic approach is to take charge of how we incorporate our illnesses into the definition of “self.”

This becomes particularly important as we age and find those roles that once defined us change with every passing year. It's helpful for those of us who have been impacted by such challenges to live somewhere between the cold reality of illness and the warm glow of a life lived despite limitations. We learn that pushing through chronic pains and degenerative symptoms is a side-effect-free antidote to becoming grumpy old men and women.

Taking our illnesses and aging head-on does not mean we do battle with them since we understand this only puts us at war with ourselves (I have always considered myself a pacifist in the war on cancer). Nor do we surrender to a life half-lived, feeling cheated by a life-altering illness happening during our “golden years.”

Ironically, as we begin to come to terms with the failings of the physical body, many of us become acutely aware of the energizing spirit which has been ever-present and, in many cases, the very force that pulled us through life’s most challenging moments. We experience the felt reality of the Rumi quote, “The wound is the place where the light enters you.”

The transformative power of suffering is an age-old concept woven into the very fabric of philosophical, spiritual, and psychological teachings—currently referred to as post-traumatic growth in the field of positive psychology. In colloquial terms, this is referred to as “what doesn’t kill me makes me stronger.” When, as Viktor Frankl describes them, these “realities” arise later in one’s life, the alchemical opportunities to turn the lead of suffering into the gold of transformation are compressed by time.

In my counseling sessions, I have noted that this can raise the anxiety level but also the window of opportunity to, as one client described it, “make this mean something.” For some, including myself, this window can seem very small at times and occasionally disappear altogether.

The good news is that this window remains despite losing sight of it when the day-to-day machinations of aging take center stage. Whether or not one is transformed or simply gains a new perspective on growing older, what remains is the awareness expressed by the philosopher Seneca, “The things hardest to bear are sweetest to remember.”