The Inside Story: The Power of Interoceptive Awareness

Tami Simon: Welcome to Insights at the Edge produced by Sounds True. My name’s Tami Simon. I’m the founder of Sounds True. And I’d love to take a moment to introduce you to the Sounds True Foundation. The goal of the Sounds True Foundation is to provide access and eliminate financial barriers to transformational education and resources such as teachings and trainings on mindfulness, emotional awareness, and self-compassion. If you’d like to learn more and join with us in our efforts, please visit

In this episode of Insights at the Edge, my guest is Susan Sands. Susan is a clinical psychologist known for her trailblazing work in female development and body-based disorders. She incorporates Buddhist philosophy and meditation into her work with patients, and she’s also a journalist publishing and presenting widely on the topic of eating disorders and body images. And now on the surprising pleasures of living in an aging body. She’s also a core faculty member at the Psychoanalytic Institute of Northern California in San Francisco. With Sounds True, Susan Sands is the author of a new book. It’s called The Inside Story: The Surprising Pleasures of Living in an Aging Body.

At age 75, Susan has become an expert on something that’s not often talked about, but as you’ll hear in this conversation, it’s so important to our well-being. That’s the power of interoceptive awareness or what could be called our body sense, our interior sense of our body. Measuring interoceptive awareness is something that’s just really started appearing in the scientific literature over the past two decades.

And yet practices, traditional practices, such as yoga and meditation, were actually designed to help us cultivate this type of inner knowing and inner intelligence. And according to Susan, this type of awareness is critical to our happiness as we age. Here’s my conversation. It’s a very deep, interesting conversation with Susan Sands. 

Susan, your new book is called The Inside Story, and right toward the beginning of the book you write, “The body sense is what I’m most interested in.” The body that we feel and experience from within. So for people who are hearing this language, the body sense, for the first time, can we start right there? And can you help us have a feeling? What is the body sense?


Susan Sands: Sure. It’s really what we can feel and sense when our attention is more in our body and away from this mind that’s always going on and on and on and on. And I really believe that it’s so important to have this sense of the body. It’s grounding. It’s stabilizing. It gets us away from the monkey mind. I’m using that word body sense, but the scientists are now using the term interoceptive awareness. In other words, awareness of all these signals—the sensory signals that are coming from all parts of the body. And they’re streaming up through the vagus nerve and up through the brain stem and up to this little point called the insular in our cortex that puts it all together, puts all those signals together to give us the sense of the state of our body—how we’re doing, the condition of our body.

And we need that for our survival, but in doing this it’s also—this is so cool, it’s so miraculous—that is providing our consciousness, our emotional awareness, our sense of self. That’s where it comes from. So it comes from these body sensations. And so just for shorthand, I like to call it body sense. And one reason I like to call it the body sense some of the time is because I distinguish it from body image. And there’s so much talk about body image in our society, which is really your visual picture of yourself. It’s how you see yourself in your mind’s eye, whereas the body sense is how you sense and feel yourself from within.


TS: So there’s a lot here. Let’s start with this notion of—there’s body sense, which I think I have a, pun intended, sense of body image. I also have a feeling for what that is. Is there something like also our actual body, like here’s the actual body. It’s not how I’m sensing it and it’s not this idea I have that other people think I look a little fat or wrinkled or whatever. There’s actually my body right here. What do you think about that? 


SS: Well, I certainly think we have a body and I certainly think our actual body also affects how we think about it. Like people that have heavier bodies, research shows, don’t feel as good about themselves. They don’t feel as good about their body image, for example. And our temperament makes a difference too, how quick we are, how slow we are. Our health, how good we feel. Our emotional health, are we depressed? Are we anxious? So all of this is going on all the time. And I should say, there’s what’s called exteroception too, which is being aware of our body sensations, our external body sensations, not just internal.

And we’ve also got proprioception, which is being aware of our bodies as they move in space. So there’s lots of stuff going on, but I’m focusing on this interoception because I think it’s so important for well-being, and people haven’t thought about it very much. And that’s part of why I called the book The Inside Story, because I think it suggests something that’s hidden, that people should know about, and I want to let people in on it.


TS: Now, I want to talk a lot more about interoception. How do we measure it and how do we develop it? But before we get there, I just want to clarify some things for myself and I think for our listeners as well. So if interoception is this tracking of my internal sensations. What’s what you called exteroception? How am I able to know things if I’m not feeling it internally?


SS: Well, we have … First I should say, Tami, I am not a neuroscientist. So I’m no expert on this stuff. I’m a clinical psychologist doing psychotherapy in private practice. And so I have worked with the body and written professional articles on the body for years, but neuroscience is not my expertise. But there are all different kinds of receptors on the skin. We’ve got the pain and the cold and the warm receptors and pressure and all that stuff. So we’re feeling our skin, we’re feeling the outside of our body. And we also have receptors in our muscles and so forth, which help us know where we are in space and we know how to do things. Like if somebody throws a baseball at us, we know how to get our hand there in time to catch it. So of course there’s a real body, whatever real means, I mean, all this is real. But yes, we have a flesh-and-blood body for sure.


TS: And you’re distinguishing interoception, this felt sense within, from other perceptual capacities that we have. How would we measure our level of interoceptive awareness? Or could I say interoceptive intelligence even?


SS: Yes, that’s a good word. It’s not used very much. There’s interoceptive accuracy, that’s one of the measures. It’s a hard thing to measure. And what scientists have come up with is this measure of interoceptive accuracy, which mostly has to do with being able to be aware of our heartbeat. So what they do is they give you a little heartbeat sound, and you have to say how close it is to your own heartbeat. Or they have you count the number of your own heartbeats in 30 seconds or something. But that’s just your heartbeat. And there are now, after hundreds of different studies, there are lots of people that wonder if this really measures what we want it to.

But that’s the main thing in scientific studies, or let’s say neuroscientific studies. There’s also a questionnaire research though. I’m just trying to think of the name of the guy who came up with it. I can’t think of it right now. But there’s a questionnaire study out of UCSF, a questionnaire out of UCSF that’s been used in a lot of studies that asks you questions about how you’re doing. Would you like to hear some of those questions?


TS: Yes, sure.


SS: There’s this questionnaire called the Multidimensional Assessment of Interoceptive Awareness, it’s called the MAIA, and it was developed by Wolf Mehling. And here’s an example of the kind of thing that they ask: When I am tense, I notice where the tension is located in my body. So do you check that as something that you can do? Here’s another one they ask you about: I notice when I’m uncomfortable in my body. I distract myself from sensations of discomfort. I am able to consciously focus on my body as a whole. I notice how my body changes when I get angry. I can use my breath to reduce tension. I listen to my body to inform me about what to do. Those are some examples.


TS: Now, you mentioned that your focus in your book, The Inside Story, is on interoception because that’s an area that you don’t believe we’ve paid as much attention to as we could benefit from paying attention to. And my question is, why is interoceptive awareness so important to you? Why do you think it should be something that we all understand, know about, and cultivate?


SS: Well, I think it’s because it’s so good for our well-being. There are so many studies that show that we feel better emotionally and physically when we have this capacity. And the meditation research and the yoga research, and all the related meditative practice research, they’re all really about developing interoceptive awareness, the sense of our inside body rather than our outside body. And we know after just hundreds of studies now on mindfulness meditation in particular, that it sharpens our attention, we’re better able to focus. It regulates our emotions, it relieves depression and anxiety. It’s as good as medication for relieving depression and anxiety, even though I don’t want anyone to go off their medication without speaking to their doctor first. Also, as you mentioned earlier, Tami, there’s more of a sense of presence, of being present in the moment. Of agency, of being able to take action on our needs and goals. There’s greater empathy and compassion, happiness, better self-other boundaries, and a more stable, accurate body image. So what isn’t helped by not in increasing our interoceptive awareness?


TS: Hearing you say all that it makes me think, I’m surprised we haven’t heard more about interoceptive awareness, listening to you describe all of the benefits.


SS: Right. Well, it’s really only been studied seriously for the last two decades. There were some studies in the ‘90s. There was some talk about it, just the beginnings of talk about it, like in the 1920s. But then there was a study by Critchley, who really was able to show that the body sensations get mapped up in the insular, that something is really going on, where a lot of stuff in our body is being put on up there. It is put into that particular place in our brain, which really helps us regulate ourselves and which helps us have a sense of ourselves, a firm sense of ourselves and a better body image, a more accurate body image. And of course, all this is really good for aging, because our body image can suffer as we age. And that’s one reason I think it’s so important. I’m writing about aging to encourage developing this inside body sense for aging.


TS: Now, I want to pull out something you said. You talked about how, as we grow in interoceptive awareness, that we have more access to presence, which I think people could probably have a sense of this connection to the present moment. But you also said that we grow in our agency, our ability to bring about change. What’s the connection between having a high level of interoceptive awareness and having access to agency?


SS: That’s a very good question. And the neuroscientist can actually show where it’s happening in the brain. But what’s amazing about interoceptive awareness is that when it goes into the brain stem, it’s actually, by a very complicated mathematical process, it’s turned into emotion. Emotion comes in and the great thing about emotion is that it tells us whether the information streaming in is good or bad. It puts a value on it. So if some pain is coming from our left foot or pain sensations are coming from our left foot, it tells us, oh my God, your foot is being crushed. Or it says, oh, your foot is fine. You’re just meditating. Just shift a little bit. So we really need that to know what to do. So do you see the progression there that is going from sensation into emotion, which tells us what we need to do to ensure our survival or our happiness? We wouldn’t know how to act on things if we didn’t have this awareness coming through our bodies.


TS: Now, you also said, Susan, and I just want to make sure to really make this very explicit for people, that this research in interoceptive awareness it’s really only been happening in the last couple of decades. And I think what you said is that yoga and meditation, these contemplative practices, are actually designed to help us grow in interoceptive awareness. Can you explain that? How does yoga, how do meditation practices, mindfulness practice, how is that a cultivation method for interoceptive awareness?


SS: Well, let me first say, Tami, that when these practices were developed thousands of years ago, there was no thought, I would guess, of signal streaming from all over our body. But I’m sure that they knew that it was about—and of course, all the teachings do from the Buddha—it’s about moving down from the monkey mind into the body and finding stillness and then really understanding more about the nature of reality, being with what is. All these wonderful benefits of these various practices, in part, come out of being aware of our body sensations. There’s also many more spiritual kinds of explanations. And I feel those and I don’t deny those, but what’s so much easier to talk about now with this new research is that the body sensations themselves help us.

And in yoga, we’re lying there on our mat. And our teacher is really taking us maybe through a sweep of the body, starting with the toes and going up through every part of the body, up to the head. Well, that’s really getting you in touch with both internal and of course some external sensations too. But I know my yoga teacher also talks about feeling inside the abdomen and feeling inside the heart and everything. So we’re definitely doing that and it’s pretty clear in yoga. And then in things like tai chi or qigong, you’re also feeling the movement of the body. You’re feeling the shift in balance and you’re feeling the rotation and everything. So you’re feeling all these different kinds of ‘ceptions: interoception and proprioception and exteroception. I don’t know if that answers your question, does it?


TS: It does. I’m curious, right now, if you were to give me a readout of your interoception awareness as a demonstration of how it works, what are you aware of?


SS: I’m very aware of my heart cavity. That’s where I like to reside. So I’m very aware of that and I’m aware of how good it feels when I focus on that. I’m also aware of some tension, because I’m doing an interview with you and I don’t know what you’re going to ask about. And I can feel that, some of that in my chest, I can feel it a little bit in my neck. And I think it’s the interior neck and I can also feel it in my legs. So all that is going on and I am very aware of it. It’s interesting that you ask, because I realize I’m not actually feeling so much in my brain. You could say that’s because I’m dissociated, but obviously I’m thinking, but it feels like my attention is down in my body.


TS: Now, I know in your background and work as a clinical psychologist that you focused quite a bit on body issues. You’ve worked a lot with people that come to you because they have eating disorders. How has this work on interoceptive awareness informed how you work with people who are presenting something like an eating disorder?


SS: Well, I have always known that people with eating disorders have less of a sense of their body. They don’t have a good sense of even what they look like. If you think of people with anorexia, their body image is way off. They think of themselves as much heavier than they are. And they’re usually, I mean, it’s so interesting to hear the, almost, delusional quality of how people feel about their bodies. And not just that, they also focus so much on appearance rather than what’s going on inside. There’s just incredible focus on appearance. And I think of one of my patients, who always starts out the session, because we’re on Zoom, talking about her hair and how terrible her hair is. Meanwhile, her hair, there’s every hair in place in this woman’s hairdo.

So I knew all this, and then when I started studying more about interoception, I realized a lot of what was missing in my patients. And I realized that one way to change that would be to encourage them to sink down in their body. Right in the moment with me, to sink down and see if they could feel the inside of their bodies. And many can’t,. Most can’t, I would say. I also encourage meditation and yoga. And this patient I was talking about just a minute ago, who thinks so much about her hair, she first started with meditation.

She couldn’t really tolerate doing meditation because the negative thoughts about herself and her body and her hair and everything just kept going through her head. And at first I said, “Well, yes, that’s what meditation is.” We have our thoughts and then we try to let them go and so on. But I also suggested that she try yoga, and that was much better for her. I think the same benefits of focusing in and being in the here and now were there, but it was also helping her get in touch with her body and grounding her more. So that was the thing for her.

And then many older people do best with the standing meditations, because they don’t have to get up and down off the floor. And they’re wonderful. And there are tai chi classes, for example, that meet in parks in my town of Berkeley. And when I was in China I saw, particularly, older people doing these various martial arts and also tai chi and qigong and so on. I saw them out there every morning in the parks. There were all these older people. It’s the most wonderful thing, they’re there with bare feet and they’re doing these practices and they’re also walking on stones.

And I didn’t know what was going on, years ago when I went to China, and I actually looked it up when I was doing the book, and it is a kind of walking meditation. And it also makes you have to adjust to the unevenness of the stone path. And that also gives you more of a sense of what’s going on inside. It also improves your balance. It may actually be hitting some acupuncture points on the bottom of your feet. And they’ve been doing this forever in China.


TS: You write in The Inside Story, this is one of the headlines: Interoceptive awareness is an ageism disruptor. An ageism disruptor. Can you explain that?


SS: Yes. It’s good for countering the way we feel about our aging bodies, because it’s taking us inside our body where we don’t have to think about wrinkles and sags, and all that stuff. We can think about how our body is still, if it is, healthy and strong, how it’s still operating. And then there’s also lots of research that the interoceptive awareness is actually so good. In fact, a necessary condition, according to some research for accurate and stable body image. So that in that sense, it’s actually changing the picture we have of ourselves in our brain because we have all this information coming up from our body to tell us more about who we are. We’re not just thinking of ourselves as how we look and how other people see we look.


TS: Help me understand this notion, because I’m not quite clear on it. When you say an accurate and stable body image, what do you mean by that? I mean, my image of my body is changing all the time, because my body is changing all the time. So help me understand this notion of a stable body image.


SS: Well, I don’t mean stable over time, because that would be kind of crazy if we had the same body image at age three as we do at 73. So what I mean is, it’s stable in the moment and from day to day. Some people that really have trouble with body image and with interoception, something goes wrong. Their boyfriend or their girlfriend says something to them they don’t like. Well, there’s this terrible change, not only in mood, but in how they feel about their bodies.

Suddenly they feel older, fatter, weaker, stupider looking. I mean all this stuff. So people get plunged into these terrible states when they’re thinking only about appearance. But if you can ground yourself in your body and feel the pleasure of it—and there’s such pleasure in being in your body—then it’s wonderful for mood, for body image, everything. And it also gives you something to do if you’re feeling bad about how you look. You’re on your way to some party or interview, or something rather, and you’re worried about how you’re looking and you catch yourself right then to just sink down in your body or do some meditation. It really changes how we feel about ourselves, it changes how we feel in ourselves and about ourselves. 


TS: Let’s talk about that pleasure of the inner body, to use that phrase for a moment, and how you experience that. You mentioned that you often keep your attention centered, to some degree, in your heart cavity. What’s the pleasurable feeling that you’re able to connect with there?


SS: I’m not even sure I can describe the “why” of it. I mean, I think just being inside is more grounding. And then of course, however we think about our heart, it is just an organ, but we also think of it as the organ of love and compassion, and so on. And so there can be a kind of a welling up of heart feelings. I’m using that metaphorically, the term heart feelings, when we’re in our body, which of course, expands us into the world. We’re not so alone. We’re feeling compassion. We’re feeling empathy. We’re feeling more connected to other people. And that’s the best thing for us, connected to other people, connected to the natural world, connected to everything.


TS: Now, I was asking you, Susan, about your work with people with eating disorders. And you mentioned how often someone with an eating disorder will have a distorted body image, distorted sense. And that the more we can develop our interoceptive awareness, the more we have available to us a more accurate body image. And I think the question that comes up for me when it comes to body image is, I don’t even know how to think about it. I mean, it’s so informed by cultural views and other people’s perceptions. It’s an image. Do you know what I mean?


SS: Yes.


TS: I’m understanding what it means to feel inside myself, but I don’t even know what an accurate body image is. It depends what century I’m living in, based on what people view as sexy at the time. So what’s your view of that?


SS: Well, I mean, you got it. Body image is always, it’s always changing and it’s very different what century you’re in or whether you’re in a Midwestern rural town or you’re in New York. So when I say accurate or stable, it only has to do with accurate or stable depending on who we are and the context we’re in. But this inner body, I haven’t thought of this before, but I don’t think the inner body has changed very much over the centuries. In other words, I would guess that people who are in touch with their internal body sensations felt kind of the same thing back in the Buddha’s time as they do now.

So that’s another thing. And let me just mention another piece of research, which shows that the more internal awareness you have, the less you’re influenced by external stimuli. So that is a wonderful way of resisting this visual brainwashing of our current society. We’re not going to be so influenced by all those media images that are bombarding us morning until night from this aging industrial complex. It’s trying to sell us products. So as I said, it’s kind of good for everything, it seems to me, to be more in our body. What a good question though, Tami.


TS: And as someone who’s done a lot of work with people with eating disorders, did you find in your experience, and is there research on this, that as people develop greater interoceptive awareness, their eating disorders recede? Is there a direct relationship there?


SS: Absolutely. There’s good research on this, Olga Pollatos in Germany, in particular. So it does actually, of course it changes eating disorders, because it gives us a more accurate sense of our body. Not only accurate picture of our body, but also when we’re hungry, for example, I’ve been talking about anorexia, but let’s talk about people that are compulsive overeaters. They don’t really have a sense, many of them, when they’re full, when they should stop. And so having this internal awareness is telling us what’s going on in our bodies and what we need or don’t need. So in that sense, eating disorders, it’s just really one of the addictions. It’s also very good for people with all kinds of addictive disorders, because if you can calm your body, you don’t need the self-soothing of the addiction as much. And also you understand more about how bad that addiction is for you, for your body, for your mind.


TS: Now, you mentioned the bodily pleasure that can come with increasing our interoceptive awareness. And particularly you seem to reference this as we age, that as we age, it’s possible that we could feel more and more pleasure inside our body despite the misery myths we’re told about how terrible being in an aging body is going to be. And I wonder if you can speak to that. But also let’s not pussyfoot around. And what I mean by that is, a lot of people are like, look, I’m getting older and older and I have more aches and pains, and I have concerns about memory loss. And now here I’m listening to some podcast about these increasing pleasures in the body as we age and I have some real questions about that. So let’s address that person as well.


SS: Sure. Well, and I’m one of those people, I’m 75 years old. I can feel change. I can feel brain changes and I can feel changes in my balance and stuff. I’m in pretty good shape because I exercise and I meditate and all that stuff. And I’m just lucky in terms of my genes, but it’s hard to age. It’s hard to feel weaker and to see our appearance changing. It’s very hard. Now I’m forgetting what the rest of your question was. Oh, yes. And so things actually happen to us in our bodies and in our brains that make it easier to age.

And one of the things is that we get more happy, and it’s called the positivity bias by Carstensen, Laura Carstensen, who’s a big guru of aging at Stanford. And what that means is that given a situation, as we get older, we’re more likely to take a positive slant on it. And the researchers will show people pictures, for example, and then later they’ll ask what those pictures were about. And the people that are older tend to give a more positive rendition of those pictures. And people feel that it has to do with a different sense of time. That we know there’s less time ahead of us, time is limited. So we savor the time that we have left and we focus more on the positive. And there can be a startling sense of present time. And this one author, Daniel Quintos, talks about it as “small seconds of eternity,” where you’re suddenly caught in the moment.

And it seems like the moment will last forever. And I also think of that as a moment of bliss. So some of this greater mellowness and happiness comes from this different sense of time. And then there are these other brain changes and body changes like interoception, you may be surprised to learn actually declines with age. But our perception of our inner sensations is more complex and we can do more with those sensations, as one of the experts told me. And it leaves our body less reactive if we have less interoception. 


TS: What does that mean, we can do more with those perceptions?


SS: Well, really what I was saying, that we know that if we perceive that look on our partner’s face, we know more what to do with that, how to interpret it and then what to do with it. We don’t have to freak out inside necessarily. We can just think, oh God, he or she is really upset about something. And I’m not going to shout back, I’m just going to give him a stare, say nothing and move on. In other words, we’ve learned more about how to interpret and handle situations. But there’s these other brain changes too. Our amygdala, which is the part of our limbic system which deals with our emotions particularly, and also creates and deals with, manages our emotions, particularly our negative emotions, and that gets weaker.

The amygdala gets weaker as we age. So we’re not as affected by negative stimuli, which is kind of a cool change. And then also, there’s other studies that show that we can actually take more cognitive higher brain control of things that are going on, and we can kind of take something that feels worrisome and we can sort of throw it into the prefrontal cortex and organize it and think about it. So what I’m saying is, all this makes the body quieter inside, along with being over the tumult of our hormonal shifts every month. All this new makes the body sort of quieter and a little slower inside.

There’s a little more space in there, and I’m putting forth that I think that we’re actually primed by all these changes to sense and feel our bodies more deeply and pleasurably. And we’re primed to be able to live in our body more, in other words, to be more embodied. And I think some people only become embodied at an older age. And I say this from my personal experience, I feel like I’ve been able to shift down into my body much more as I get older and I’m finding that’s continuing to happen. And I think it’s a combination of putting my attention there and knowing the research, but it’s also something that’s just plain old happening inside me.

And I hear it from my friends and I interviewed almost 30 people for the book and they said kind of the same stuff. That they’re less anxious, they feel more like themselves. And even though we have more sags and creaks and falling of the flesh and, God forbid, serious illnesses and disabilities, dementia, and so forth, that people are able to take more of, an it-is-what-it-is mentality. This kind of Buddhist notion of just be with what is. So I think all this can actually increase our experience as we get older, and it can be a great life stage of increased openness and acceptance and happiness. That’s the surprise.


TS: I know as I was reading The Inside Story and I got to this section about the positivity bias and how we can be more positive as we age, I exclaimed this out loud to my partner and she was like, “Thank goodness, you’re going to get more positive with age. You need the positivity bias.” As someone who has a very hyperactive amygdala and a habit of always seeing what’s wrong in any situation, I was so happy to read this. Now, one of the things that, at first I felt confused, and I think I’m still, to be on honest with you, Susan, trying to process it, is this notion that our interoceptive powers actually lessen as we age and yet we have available to us this greater sense of well-being. And it made me think that maybe interoceptive awareness, there’s so much happening that it can be overwhelming, and that maybe we’re better able to metabolize all of this information, coming from The Inside Story, if there’s not so much information. And I wonder what you think about that.


SS: I think it’s a great idea Tami, that we’re not as overwhelmed by our emotions. The emotion research does suggest that, that as we age and we have these various changes in our body and brain, the physiological ones I was just mentioning, that our emotions get more positive and not so strong. So we can feel happier and we can stay in our bodies more, if it’s more comfortable in there.


TS: It’s more manageable. Yes. It’s more reasonable. Yes. Or we can deal with it. Now, one of the other things that you write about, as we age we’re able to experience more mixed emotions, for example, happiness and sadness at the same time. And I’ve also had that experience and I’m wondering what your view is. Why is that more available to us or for some of us as we age?


SS: I would say this is really a part of wisdom. And I don’t really know, I mean, we’re getting our emotions just as we always have. I think, again, it’s what we do with them. And having lived on the planet for a longer amount of time, we can see that even though we’re having a really hard time right now, for example, we’re growing, we’re strengthening ourselves, there’s light at the end of the tunnel. Things always change. There’s all this wisdom that we have that I think makes it easier to hold both the positive and the negative at the same time.

On the other hand, we also, if something really great happens to us, we don’t think, ah, this is the break. I got all these hits on the internet. Now I’m off and running. We can say, who knows, who knows what’s going to happen? It feels good right now but everything changes. So I’m such a Buddhist at heart and I come back to this, “everything changes” idea of Buddhism. The idea of impermanence, that everything comes into being and then falls away. And not just physical things, but our emotions, our sense of how we feel about ourselves. All these things, they’re constantly changing.


TS: Now, in The Inside Story, you point out, and this kind of goes along with what we’re talking about with this positivity bias as we age, that there’s actually research that shows that for many people, our elder years are actually the happiest times of our lives. What is that research? It’s really true? Because I think we have an idea that old people often experience themselves as lonely and irrelevant. The idea that this could be the happiest time of our lives, really?


SS: Yes. Well, all the aging experts talk about it. And there’s, as you probably are aware, there is this very well-known book called The Happiness Curve, and sometimes called the U-bend of happiness, which summarized lots and lots of different research on happiness, research on thousands of people. And the curve, it starts—or let me put it this way. If we see it as an unhappiness curve, we start out happiest in our younger years and this is barring terrible abuse or whatever. And then our unhappiness rises slowly and it peaks in middle age. And I think particularly for women, because of perimenopause, but there’s some studies that show that 47 is our least happy year. And here we’re supposed to be at the prime of our lives, and maybe the kids have left home and we’re at the peak of our career. 

Well, we’re more overwhelmed. Our hormones are more overwhelming and we’re not as happy. And then the curve starts declining again and shows that we’re the happiest in our older years, starting in our late 60s, early 70s, with the age of 82 being our happiest year. Crazy, huh? And then all the Carstensen research, also on the positivity bias, shows the same thing. And she’s done this research where people actually carry beepers and they’re beeped several times a day and they say how happy they’re at that moment. So she’s had people of all different age groups carry beepers and finds that as people get older, they do get happier. And this is even true for, say, the 20-year-olds. She measures them for 10 years. And even the 20-year-olds get slightly happier over that 10-year period. So there is really something about this and it’s a wonderful thing and it helps us, of course, face mortality too, to be able to feel more happy about things in our older years, as things are winding down.


TS: Yes. Help me understand, so I get you’re 75 and your happiest age, research wise, could be yet ahead of you at age 82. So your happiest days are yet ahead of you, but how does that help you feel positive about dying?


SS: I think it’s not, I mean, it’s an acceptance as we get older, we feel more accepting of ourselves if we’re lucky. Not everyone does. I mean, there’re grouchy older people and there’re people—


TS: For sure.


SS: —that have terrible disabilities too. But it’s this greater acceptance of how things are that I think helps us face our mortality. I talk in my book about these different narratives we have that we’re supposed to triumph over these various things. Like supposed to triumph over our body in our society by doing 1000 things and not sleeping enough and so on. And then that becomes the triumphing over the aging body narrative. We ought to just be able to beat aging. We ought to be able to defeat it and there’re books with these titles and it’s all over the media.

And then that as we get older, it’s also, we’ve got to triumph over death. We have to live longer. We’ve got to increase our longevity. There’s so many articles on this. And so I’m encouraging us to try to fight these aging narratives. And there are various ways of doing it. One is to dump this image of aging as an arc, where we rise up to our peak in our middle years and then we drop down on the other side. As we just found out, the happiness curve goes in the other direction. And if we could think of the aging process as an upward spiral with these different trajectories out, if we could see aging as fulfillment or as culmination, what an idea, rather than decline. And we can work to rewrite these ageist narratives.


TS: That is a very powerful reimagining of upward spirals and moving out versus this aging as decline. That’s very powerful. I realize I’ve internalized a view of aging as decline and that that’s something I really need to question. It’s powerful, Susan.


SS: Yes.


TS: Now, one of the things you write about in this notion of interoceptive awareness as an aging disruptor, ageism disruptor, is how at this time, and this is the note I’d like to end our conversation on. You believe we actually need a movement to counter ageism in the same way or a similar way that we’ve said we need to counter sexism in our society. No, it’s not OK. These are ideas that we’ve taken on, that we’ve taken on from patriarchal constructs. No, we’re going to counter sexism or something like racism even, that this has been sort of built into our structural notions of our world—and ageism as well. And I’m curious if you were to say, here’s what I think the keys are to counter ageism. If we were to have a movement, what would it focus on? Because, no, we’re not going to just sit idly by and see an ageist culture be perpetuated and participate in it. 


SS: Right. We haven’t addressed age inequality even though we’ve addressed all the other or tried to address the other inequalities. So I mean, I think the first step is to really understand how ageism, how it works in our society. And we’ve got to see the aging stereotypes, that we’re dumber, we’re slower, we’re less interesting. I mean, the ageism is really something, and we’ve got to try to recognize and ferret out those negative age stereotypes, because that’s what they are. And we have to look at our own ageism. I mean, that’s really the problem.

Do we lie about our age? Do we assume young people find us boring? These stereotypes begin in childhood and they come through our family and culture, particularly if we’re women, how our mother thinks of her aging. So I mean, I think that we first need to become really aware and then we need to start talking about it and writing about it. And as I said earlier, to change this image of aging into an upward spiral. We can join age awareness groups—one of my friends leads them. It’s good to have intergenerational activities where the young and the old get to work together and really get to know each other. And corporations think it’s also very helpful for their productivity. Yes, I think we have to stand up and offer our gifts, our own gifts to the world. We have to say, no, we’re not over the hill. We’ve got more to offer, much more to offer and we have to get the respect that we deserve.


TS: And look at you Susan, you’re doing it. Here at age 75, writing this beautiful new book, The Inside Story: The Surprising Pleasures of Living in an Aging Body. It’s a book that brings together a lot of research, neuroscience, as well as inner practices that help us develop our interoceptive capacities and find more pleasure living from the inside out. It’s a book I really enjoyed reading. And I really have enjoyed talking with you and getting to know you a little bit Susan. Thank you for your courageous work. Thank you.


SS: Thank you Tami. I’ve really enjoyed the interview and I felt pushed by you into new ways of thinking about all this. So thank you.


TS: Well, and I felt pushed by you and I’m going to embrace this upward spiral idea because I think it’s so important to health and creativity, and flourishing, in our elder years. So thank you. I’ve been speaking with Susan Sands, author of the book, The Inside Story

Thanks for listening to Insights at the Edge. You can read a full transcript of today’s interview at That’s If you’re interested, hit the subscribe button in your podcast app, and if you feel inspired, head to iTunes and leave Insights at the Edge a review. I absolutely love getting your feedback and being connected. Sounds True: waking up the world.

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