Wednesday, April 13, 2005

Aging Well from the Landmark Harvard Study of Adult Development by George Vaillant MD 2002

This is another book referenced by Younger Next Year. If you're really interested in the subject you can read it, but it doesn't come with my highest recommendation. Most may find some of my notes illuminating. If you enjoy stories more than facts you might be interested in the biographies that the author chooses to emphasize his points.

Publishers Weekly
This groundbreaking sociological analysis is based on three research projects that followed over 800 people from their adolescence through old age. Subjects were drawn from the Harvard Grant study of white males, the Inner City study of non-delinquent males and the Terman Women study of gifted females, begun respectively in 1921, 1930 and 1911. In all three studies, subjects were interviewed at regular intervals over time, a design that prevented observations from being skewed by the distortions of memory and allowed for analyses that distinguished effect from cause. Vaillant (The Natural History of Alcoholism), a psychiatrist and professor at the Harvard Medical School, brings a nuanced point of view and an acceptance of the project's limitations. (Those followed were not randomly selected and were overwhelmingly Caucasian.) Nevertheless the author makes compelling use of his data, which is based on intensive contacts with a variety of subjects. Vaillant posits that successful physical and emotional aging is most dependent on a lack of tobacco and alcohol abuse by subjects, an adaptive coping style, maintaining healthy weight with some exercise, a sustained loving (in most cases, marital) relationship and years of education. This is good news since factors that cannot be altered, such as ancestral longevity, parental characteristics and childhood temperament, were among those ruled out as predictors. The book's academic tone will reassure some readers and put others off, but Vaillant's arresting interviews with selected subjects (recounted here) and his ability to learn from the subjects make this an outstanding contribution to the study of aging.

"Maturation makes liars of us all... In his interview at age 50, one of the study's member maintained that he had doubted the validity of religion and had stopped going to church as soon as he had arrived at Harvard. Such a memory didn't jibe with the fact that as a Harvard sophomore, he reported (to the study) going to Mass four times per week! His memory distortions didn't stop there. When he was 55, he was sent vignettes so that he might grant permission for the publishing. He sent them back with a terse note 'You must have sent these to the wrong person.' He was not trying to be funny. He could not believe that his college persona could have ever been him." p31

"At age 25, 92% of all wishes are directed towards the individual himself, but by age 60 only 29% of wishes were directed toward the self, 32% towards family, and 21% towards mankind in general." p 42 We all graduate from narcissists to altruists it seems.

"There are 6 sequential tasks in fulfilled life. First, the adolescent must evolve an IDENTITY that allows her to become separate from her parents. Then the young adult should develop INTIMACY, which permits him to become reciprocally, and not narcissitically, involved with a partner. Next comes CAREER CONSOLIDATION. Mastery of this task permits the adult to find a career that is both valuable to society and as valuable to herself as she once found play. After that comes the task of GENERATIVITY, a broader social circle through which one manifests care for the next generation. The penultimate task is to become a KEEPER OF THE MEANING... Becoming a Keeper allows one to link the past to the future. Finally, there is INTEGRITY, the task of achieving some sense of peace and unity with respect both to one's own life and to the whole world." p45

"Among those study members who failed to reach Identity, even by age 50, were men and women who never achieved independence from their family of origin or from institutions. In mid-life, such individuals were not able to commit themselves either to gratifying work or to sustained intimate friendships." p46

"In all 3 studies, mastery of Generativity tripled the chances that the decade of the 70's would be for these men and women a time of joy and not of despair." p48

"Who has not known at least one grandparent who was able to be closer, wiser, more empathic toward his/her grandchildren than he/she ever was in the prime of life toward his/her own children. They elicit a special trust from grandchildren and teach them meaningfully about the past." p49

"In cross sectional studies, one of the most powerful correlates of successful aging is income, but among the 3 study samples emotional riches seemed far more important... financial success seemed much more a reflection of mental health than a consequence of social class or parental privilege." p95

"Good mental health, good coping both as children and adults, warm friendships, admired fathers, and loving mothers predicted high income. In contrast, dysfunctional families and fathers on welfare did not predict future income. What goes right in childhood predicts the future far better than what goes wrong." p95
That is children from good homes will tend to do well, and children from bad homes may or may not necessarily do well.

"Childhoods of men whose parents were alcoholic were decidedly unhappy." p96

"Unhappy childhoods, however, become less important with time... by old age the warmth (or dearth) of childhood was statistically unimportant." p96

"When the Harvard men were middle-aged, the evidence suggested that childhood environment still affected physical health. At age 53, more than 1/3 of the 23 men with bleak childhoods already suffered from chronic illnesses; 4 had died. Among the 23 men with the warmest childhood all were living and only 2 were chronically ill." p96

"By age 75, there was little relationship between the quality of childhood and objective physical health... Four findings, however, did confirm the [poor life outcomes for the men of bleak childhoods "Loveless"]. First the Loveless were more likely to be labeled mentally ill. Second, they found it difficult to play. Third, they trusted neither their emotions nor the universe. Fourth, the Loveless often were relatively friendless for all of their lives." p96

"The Loveless were 2 times more likely to die from unnatural deaths than their counterparts from the warmest childhoods." p97

"By age 50, 80 of the Harvard men had met the criteria for mental illness. Half of these mentally ill men were dead by age 75. In contrast, 111 men had been free of psychological distress. Of these, only 12 - just one man in six - had died by 75." p97 What's more amazing to me is that 80 out of 191 Harvard graduates or 42% of the total became 'mentally ill'. Doesn't that concern anyone in the admissions office?

"I only wish to instill reasonable doubt that it is depression, per se, that is the cause of poor health in old age. Rather it is the heavy smoking and drinking and the poor self care that accompanies depression that are the major culprits." Depression may be the symptom of an addictive self destructive habit, rather than the cause of said habit. This is a concept that will come up again in another book I will review called "The General Theory of Love".

"In the Harvard study, 72% of 75 year old men with good social supports and good habits (absence of cigarette and alcohol usage before age 50) were still healthy. Only 68% of men with just good habits were healthy. Men with good social support, but with bad habits were only 58% likely to be heathy by age 75. And finally, just 39% of men with neither good habits nor social supports were healthy. " p216

"Socially isolated men were 7 times as likely to have been alcohol dependent, and 4 times as likely to have smoked heavily, they were also twice as likely to have engaged in little exercise in the past and to have already become chronically ill by age 50."

"For 28 men in the Harvard study a happy marriage became unhappy following the onset of alcoholism; in only 7 casess did alcoholism first become obvious following a failing marriage. Second, divorce does not cause early death; rather alcoholism causes accidents and divorce and early death... In a large community study divorced men and women were far more likely to die than the stably married, but more often only of illnesses (alcoholism usually) made worse by the very factors that may have lead to the divorce. More specifically the divorced died 4 times more often from accidents, 6 times more often from cirrhosis, yet only 1.2 times more often from leukemia (a disease not related to alcoholism) as the stably married. " p217

"Retirees should replace their work mates with another social network just as they should replace their dead parents and deceased companions with new friends. In meeting such needs grandchildren often work spectacularly well." p224

Research studies have found "a clear increase in wisdom [as measured by a test called Mature Reflective Judgement Interview] up until age 35. After that investigators found no good evidence for futher wisdom growth. In another study mid-level managers could solve complex social problems as well from 28 to 35 as they could from 45 to 55; the only difference was that the younger managers had to gather more (and sometimes extraneous) data. From 65 to 75, however, a manager's performance was clearly inferior. " p254
"The current evidence is not that the majority of older adults, in areas of professional expertise and wisdom, demonstrate superior performances when compared to the young." p254This is sobering news. We really don't get wiser as we get older. In fact, we plateau after 35, and decline after 65. Society doesn't seem to accept to this in general, and clings to the notion of old wise men even though the scientific evidence points to the contrary.

We all like to believe that we change over time, including the author but... "To my consternation, one of the very best indicators of how the Harvard men adapted to old age was whether they had been well adjusted in college. Of the 85 best adjusted, 33% were among the well at age 80 and only 9 were among the chronically sick (of those cases most were alcoholic). Among the 40 worst adjusted college men only 3 at 80 were well."
"Again, as I have followed the lives of the Inner City men, one of the best indicators of successful aging was well they adapted in junior high school. Of the 150 men with the best scores for coping in junior high, 56 were among the well, and only 13 were ill. Of the 19 with the worst scores, only 1 was well, and 11 were ill or dead. Successful adolescence predicted successful old age for both Harvard graduates and ghetto dwellers alike." p284

Coming from a bad home doesn't necessarily doom an individual: "At age 47 men from bad families were not more likely to be chronically unemployed or below the poverty line than men from functional families."p286
It seems more that the person's coping skills (which may be hereditary) rather than the environment is a better predictor for life outcome. Chalk one up for nature vs. nurture. (For more on this subject please read the "Blank Slate" by Stephen Pinker.)

"90% of the Inner City men who at midlife were chronically unemployed or below the poverty line were mentally ill or alcoholic... Once more let me underscore that it is disease not economic poverty per se that led most often to unsuccessful aging." p298

"Centarians on average do pretty well (physically and mentally) until they pass their 97th birthdays." p310

I must note that the book acknowledges in painful detail that all 3 studies had many statistical biases. Appendix A describes the details of each study, including the biases. Thus the results are not 'gold standard' material (randomly sampled from the general population). Nevertheless there are very few studies that go back nearly 100 years to study individuals in such detail. The wealth of knowledge here is tremendous, and we owe the folks at Harvard and Stanford a debt of gratitude for having the foresight in 1910 and 1920 to start such studies.

A General Theory of Love by Thomas Lewis et al 2000

Again, this is another book I discovered by perusing the bibliography to 'Younger Next Year'. Some interesting points, but not on my 'must read' list.

Publishers Weekly
The Beatles may have sounded naive when they assured us that "all you need is love," but they may not have been far off the mark. New research in brain function has proven that love is a human necessity; its absence damages not only individuals, but our whole society. In this stimulating work, psychiatrists Lewis, Amini and Lannon explain how and why our brains have evolved to require consistent bonding and nurturing. They contend that close emotional connections actually change neural patterns in those who engage in them, affecting our sense of self and making empathy and socialization possible. Indeed, the authors insist, "in some important ways, people cannot be stable on their own." Yet American society is structured to frustrate emotional health, they contend: self-sufficiency and materialistic goals are seen as great virtues, while emotional dependence is considered a weakness. Because our culture does not sufficiently value interpersonal relationships, we are plagued by anxiety and depression, narcissism and superficiality, which can lead to violence and self-destructive behaviors. It is futile to try to think our way out of such behaviors, the authors believe, because emotions are not within the intellect's domain. What is needed is healthy bonding from infancy; when this does not occur, the therapist must model it. The authors' utopian vision of emotional health may strike some as vague or conservative to a fault, and the clarity of their thesis is marred by indirect and precious writing. Yet their claim that "what we do inside relationships matters more than any other aspect of human life" is a powerful one. “A mammal in protest shows a distinct physiology. Heart rate and body temperature increase, as do the levels of stress horomones…Cortisol levels rise six fold in some mammals after just 30 minutes of isolation.”

“Despair (prolonged separation response) and depression are close cousins. Growth horomone levels plunge in despair… immune regulation undergoes major alteration… the reason why children deprived of love stop growing, lose weight no matter what their caloric intake, and dwindle away.”

There seem to be two types of memory; we’re only conscious of one of them. “Mr. Underwood was taught to braid – a skill he was unacquainted with before his explicit memory expired. After he mastered it, experimenters asked him if he knew how to braid. He replied ‘No’, a truthful statement from his point of view. Yet when 3 strips of cloth were placed in his hands he wove them together without hesitation.”

Babies seem to hear in the womb, and here is some evidence: “Within days, an infant recognizes and prefers not only his mother’s voice but also her native language, even when spoken by a stranger. You might think this knowledge comes from postpartum interactions – quick learning indeed. But a newborn doesn’t recognize his father’s voice, indicating that neonatal preferences reflect learning before birth.”

Is seeing believing? “Close your left eye, push gently on the corner of the right eye – and the world dips or lurches several degrees, as if it were not your fingertip moving a millimeter but the hand of God shaking the planet. The brain doesn’t detect the eye’s position but tracks only the ocular movements it commands. When it orders no eye movements, the brain assumes that none occurred. Displacing the eye manually shifts the light falling on the retina. The brain concludes that with eyes immobile, the world has turned.”

Does it get harder to learn new things as we age? “Because human beings remember with neurons, we are disposed to see more of what we have seen already, hear anew what we have heard most often, think just what we have always thought. Our minds are burdened by an informational inertia… and as a life lengthens, momentum gathers. ‘In scientific work, we find that new theories are understood only by the graduate students… in contrast the senior professors are burdened with such connectional inertia that when they encounter new ideas there is no apparent effect, other than an occasional vague irritation.’”

Question advice and think about the consequences: “A newspaper column with advice for parents recently advocated letting older and younger children settle disputes without parental interference, so that they might learn what people do in the real world. The children in the unfortunate households that apply this pearl will unerringly distill the timeless lesson of the unsupervised boarding school or playground: justice is weak; might and intimidation triumph.”

“The American habit of sleeping separately (from your children) is a global and historical singularity.” Robert Wright, a proponent of evolutionary psychology and a champion of common sense refutes this habit. “According to the commonly held belief, the trouble with letting a child who fears sleeping alone into your bed is that ‘you are not really solving the problem. There must be a reason why he is so fearful.’ Yes, there must. Here’s one candidate Maybe your child’s brain was designed by natural selection over millions of years during which mothers slept with their babies. Maybe back then if babies found themselves completely alone at night it often meant something horrific had happened – the mother had been eaten by a beast, say. Maybe the young brain is designed to respond to this situation by screaming frantically so that any relatives within earshot will discover the child. Maybe, in short, the reason that kids left alone sound terrified is that kids left alone naturally get terried. Just a theory.” Absolutely classic! I have to look up this Robert Wright character and see what he has to say about the world.

Is cocaine really addictive? “Of all humans that try cocaine, less than 1% become regular users – the other 99 walk away… This staggering imbalance points to a problem not in the juices of the coca leaves, but inside the brains of a tiny fraction.”

Do businesses think like reptiles? Manville’s President Lewis Brown during the asbestos litigation ridiculed the other asbestos manufacturers “for the foolishness in notifying workers about the terminal illness they had contracted on company time.” When questioned about this statement under oath, “’Mr. Brown do you mean to tell me you would let them work until they dropped dead?’ Brown said ‘Yes, We save a lot of money that way.’”

Is your doc's next award going to be the Nobel in medicene or an Oscar? “The Lancet, Europe’s most respected medical journal, advocated teaching acting techniques to medical students… ‘We would suggest that if physicians do feel antipathy toward patients, they should at least act as if they cared.’”

Do HMOs think like reptiles? “The NY State Health Commissioner discovered a short while ago that an HMO was using its data on cardiac surgery death rates to improve the selective routing of patients to NY hospitals. Did the insurer send its patients to the most dependable institutions? Of course not. Instead, administrators used the statistics to bargain for basement rate prices from the most lethal centers. Then they diverted patients to the cheapest facilities available, where those customers were likeliest to suffer and die.”

All in all the book is a quick read on a short plane ride and better than watching reruns of "The King of Queens" on the inflight video. 2 stars