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.


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