by George E. Vaillant
I enjoy talking with very old people. They have gone be-fore us on a road by which we, too, may have to travel, and I think we do well to learn from them what it is like.
-Socrates, in Plato's The Republic
Having entered the new millennium we are bombarded with contradictory information about what it means to grow old. News reports of people living longer than ever are juxtaposed to horror stories of life in nursing homes and elders wishing for death. Inspiring anecdotes of energetic 85-year-old marathon runners or CEOs or composers who seem as young as ever are followed on the nightly news by stories on the barrenness of life in gated retirement communities filled with decrepit old people who feel superfluous. Will the longevity granted to us by modern medicine be a curse or a blessing? How can we control our last years? These are the questions for which we need answers.
"To know how to grow old is the master-work of wisdom, and one of the most difficult chapters in the great art of living"; so wrote Henri Amiel in 1874. More than a century later, as more and more of us are destined to live into our eighties, his challenge becomes more pressing than ever; and we need to decide from whom to gain that knowledge. As we go through life, we meet octogenarians who offer us rare role models for growing old. We meet vigorous, generative great-grandparents, and we wonder how they became that way. We wonder about their origins -about how their pasts might illuminate our own futures. Foolproof answers, of course, are not possible. But if we are to understand successful aging, we need to ask very old people about the road they travel. The demographers have told us, have they not, that today's young adults can expect to live past 80.If so, we all need models for how to live from retirement to past 80- with joy.
Based on what is arguably the longest study of aging in the world-the Study of Adult Development at Harvard University -this book attempts to offer such models. The Study of Adult Development consists of three separate cohorts of 824 individuals -all selected as teenagers for different facets of mental and physical health more than half a century ago and studied for their entire lives. Therefore, this book will allow the reader to watch the adult life cycle, in its entirety, unfold. It will provide a theoretical framework, as well as data, for understanding how older people end up fulfilled or not.
The Study includes a Harvard Law School graduate who died a derelict's death in a seedy residential hotel but also men who became ambassadors and cabinet members, bestselling novelists, and captains of industry. The Study includes brilliant women, from Lewis Terman's study of gifted children, derailed from career paths by the sexism of their era, but also women whose creativity flowered brilliantly after age 65. The Study includes a number of men who began their lives as Inner City high school dropouts but have gone on to achieve not mere occupational distinction, but great success in living. What is special about the Study of Adult Development is that it consists of grandparents and great-grandparents who have been followed since adolescence. Old age is like a minefield; if you see footprints leading to the other side, step in them.
The Study of Adult Development offers significant, reliable data that tell us what successful aging is and how it can be achieved. Some may argue that the term successful aging is an oxymoron. For is not aging inextricably associated with loss, decline, and approaching death? Is not success inextricably associated with gain, winning, and a zestful life? Perhaps, but the fact is that the majority of older people, without brain disease, maintain a sense of modest well-being until the final months before they die. Not only are the old less depressed than the general population, but also a majority of the elderly suffer little incapacitating illness until the final one that kills them. No, successful aging is not an oxymoron.
Too often, however, the successful great-grandparents whom you or I admire seem a freak of nature-like the doughty Frenchwoman Jeanne Louise Calment, who went on smoking French cigarettes until she was 122 years old. We imagine that there must be something in their lives-something beyond our grasp-that explains their remarkable vigor. We may fear that at 75 or 80 we will ask, "Is this all there is?" But from everything I have learned from the Study of Adult Development, those among the old-old who love life are not exceptions-they are just healthy. As they surmount the inevitable crises of aging, the Study members seem constantly to be reinventing their lives. They surprise us even as they surprise themselves. In moments of sorrow, loss, and defeat many still convince us that they find their lives eminently worthwhile. They do not flinch from acknowledging how hard life is, but they also never lose sight of why one might want to keep on living it.
For example, over the years on the biennial questionnaires sent to the Study members, there were certain questions that produced unusually revealing answers. One such question was: What is the most important thing that makes you want to get out of bed in the morning? An 84-year-old Study member answered, "To live, to work, to learn something that I didn't know yesterday -to enjoy the precious moments with my wife."
To the same question a 78-year-old Study member replied, "All the many plans for the day. I love life and all I do. I love the out of doors....It is a joy to be alive and living with my best friend." He was referring to his wife of fifty years with whom his sex life was still "very satisfying."
Over the past thirty-five years I have enjoyed the privilege of studying and interviewing these generous people who agreed to participate in an experiment lasting for their entire adult lives. Their outcomes often provided surprises that no one would have guessed at the beginning.
Consider 70-year-old Anthony Pirelli. Initially, he experienced most of the early perils that resiliency experts tell us stand in the way of a successful life, including low socioeconomic status, parental marital discord, a depressed mother, an uneducated father, and seven siblings all crowded into a small tenement apartment. These risk factors do, indeed, predict poor life adjustment in young adulthood. Until the Study of Adult Development, no one had investigated whether these same factors also doomed youth to a miserable old age. This sixty-year follow-up revealed that Anthony Pirelli, predicted to fail in young adulthood, has become a stunning success as an old man.
Both of Anthony Pirelli's Italian-born parents could barely read English. As a semiskilled factory worker, his father had worked steadily for Depression wages and then spent both his spare income and his spare time drinking in disreputable neighborhood bars. He was "mean" and would give "terrible beatings" to Anthony's older brothers with "whatever was at hand." They would come out of the cellar "screaming and bloody...bodily injury meant nothing to him." Pirelli explained that during his early childhood, such beatings were a nearly weekly occurrence for his brothers, but that he and his sister had been spared.
When Pirelli was 3 years old, his mother became stricken with manic-depressive illness. She was unable to exert control over her children, and as a result they lost respect for her as a disciplinarian. When together, Pirelli's parents fought continuously and marital separations were frequent. When he was 13, his parents separated permanently. Pirelli went to live with his father, who appeared to the Study staff at the time to be unconcerned by his son's truancy.
In 1941 the first of five Study interviewers to visit Anthony Pirelli's home was struck by the sparse furnishing of his dilapidated fifth-story tenement flat without central heating in "one of the poorest sections" of Boston's West End. The Study investigator noted that it was "quite lacking in comfort and is very unattractive. It shows the lack...of anyone who cares about its appearance." As a boy Anthony Pirelli had seemed very different from the extroverted, tanned tycoon who in 1998 was to show the fifth Study interviewer his stunning high-rise apartment. The Study psychiatrist described the 13-year-old Pirelli as:
Unaggressive, sensitive and fearful of parental disapproval....This is a very mild appearing boy. Wants to make a good impression. Does what he thinks is expected of him, never is quite at ease. Plainly quite insecure in a social way. On the whole, he is so conventional that it is very hard to get any true opinion that is his own. He is quite inhibited in action, never joined in any vigorous athletics but has numerous quiet hobbies of his own such as stamp collecting and ship model building. We do get the impression that he is quite sensitive and has aesthetic tastes.
In addition, the psychiatrist observed that Pirelli was "emotionally stable...considerate of family feelings...presents a perfect example of how children, reared under miserable circumstances, survive through intelligence and character."
At the end of each school year, in order to celebrate advancing to a new grade, the students were supposed to wear a special outfit. Pirelli's parents could not afford these clothes so they were supplied by the school. Sometimes his parents were challenged even to put food on the table. Later, Pirelli wondered why his father hadn't done anything to better himself. "I almost think he didn't want to. Why didn't he?" Nor could Pirelli understand why his mother had not learned English given that she had come to the United States as a young girl. Years later his much older sister, Anna, explained to Pirelli that she had raised him from infancy to 7 or 8. For unlike children in many dysfunctional families, the eight Pirelli children banded together as a unit and looked after one another. That made all the difference. At school Pirelli was on the honor roll. He graduated from a trade high school, and at 17 he enlisted in the air force. Just before he was released from the service, Pirelli met his future wife at a USO dance; when he was 19, they were married. He loved his inlaws. He explained that, unlike his own home, "it was always fun at their house...they never had any real problems."
After discharge from the air force, Pirelli found work as a skilled laborer. His brother Vince became the most important person in Pirelli's early adulthood. Vince would take him out to lunch once a week to talk over Pirelli's plans for the future. It was Vince who insisted that he go back to school.
The second interviewer was struck by the bungalow that Pirelli at age 25 had bought under the GI bill and by "its charming living room." The interviewer also noted that Pirelli "has considerable drive, a very hard worker, mature." At night Pirelli pursued a degree in accounting at Bentley School of Accounting and Finance. He was a grateful student and reported that his teachers had had a profound impact on him. In particular, he admired the school's founder, Harry C. Bentley, who he believed had practically invented modern accounting. He wanted to get good grades for Mr. Bentley, who explained to him, "If you learn accounting, you can do anything." Pirelli never forgot.
Five years later, the third interviewer was struck by his "beautifully landscaped" split-level ranch house. He also noted that Pirelli "has worked hard during this period...very serious about providing for his sons a better environment than what he had." Pirelli was "obviously devoted" to his two children. In the early years of their marriage Pirelli's wife had worked to help out financially. Later, she helped in his restaurant with interior decorating and personnel problems. What Pirelli found most special about his wife was her "ability to cope with difficult situations." When he and his wife had problems, they would sit and "talk them out....She attacks the problem right away." He was grateful for this since it helped circumvent "my stubbornness." In their spare time both Pirelli and his wife loved dancing together.
But then gratitude was one of Pirelli's strong suits. By the age of 30 Pirelli was a certified public accountant and had long since left his job as a skilled laborer. His clients trusted him, and Pirelli's "love for business" and, more important, his friendliness and sense of joy opened one door after another and helped establish him in the business world.
When Pirelli was 47 his large suburban house, swimming pool, tennis court-and the strength of his marriage-impressed the fourth Study interviewer. "They are both sympathetic toward the other." Pirelli seemed to "give thought to each question before he answered it, and he was intelligently curious about the Study." The interviewer wrote that Pirelli "was appreciative when I said that we could send him some articles about the outcome. He felt honored to be part of [the Study] and hoped that the information he had given would prove to be of help to someone else."
Consistent with Reinhold Niebuhr's famous Serenity Prayer, Pirelli had developed throughout his life the courage and perseverance to change the things he could and the serenity to accept the things that he could not. On the one hand, at 47, after discussing the unexpected deaths of both his brother Vince and his closest friend, Pirelli had remarked to the interviewer that life was "like a book filled with many different chapters." He said that when one chapter was finished, you must then go on to the next chapter-not a bad prescription for growing old. On the other hand, continued Study follow-up revealed that this once "unaggressive, sensitive, fearful" boy with a trade school education had triumphed over a large international conglomerate in a patent dispute. Pirelli could fight when he needed to.
At age 63 Pirelli suffered a serious heart attack and retired. He realized that he was "getting old." He turned his accounting business over to his children. By age 65 he had turned almost all his many business interests over to trusted colleagues. He wanted to enjoy his life and do things that he and his wife had always hoped to do while their health was still good. Unlike many high achievers, Pirelli always retained a clear sense of when to let go. He auctioned off his beloved and very valuable stamp collection in order that others could glean the same pleasure that he had enjoyed in adding rare stamps to his collection.
At age 70 Anthony Pirelli met still a fifth Study interviewer at the door of his high-rise Boston condominium. Pirelli was dressed casually but neatly in a brightly colored tennis shirt and fashionable navy tennis warm-up pants. He sported a full head of white hair, and his face was still tan from a trip to his winter beachfront house on the Gulf Coast of Florida. Despite recent coronary by-pass surgery, he glowed with energy and good health. Pirelli loved being retired.
Anthony Pirelli escorted the interviewer to a picture window. The interviewer was impressed by spectacular views of the Boston Public Garden and its swan boats, the gold-domed State House and, in the distance, the Charles River. On the left stately trees divided the grand town houses that march along Commonwealth Avenue. Pirelli, however, drew the interviewer's attention to the right-hand side of the view, to where the blighted tenement of his blighted childhood once stood-the tenement whose barren interior had so depressed the first interviewer.
Pirelli's narrative of his family had now softened. His memory had transformed a painful childhood into a glass half-full. Forgiveness, as well as gratitude, had become a strong suit. Pirelli expressed compassion toward his mother. He explained that she was "the kindest woman in the world....It drove her up the wall not being able to communicate because she couldn't find out about how her kids were doing in school. She felt embarrassed to come to school activities; and she was bothered that she couldn't help with schoolwork. There was nothing that she would not do for her children." He remembered his parents as being committed to taking care of the children and not of themselves. He marveled at how his mother was able to hold the family together for so long and on so little money.
Pirelli seemed unconscious of his increasing capacity for forgiveness over time. He believed that it was his father, not himself, who had mellowed with age. He now recalled his father as a "good family man" who made sure that his sons went to school. His father took care of the garden, and "it was the best garden in the neighborhood." He abused his older sons only because "he was such a failure that he took it out on his kids." He reiterated his father was not abusive to Pirelli or to his younger sister; "We were never touched." He wondered why. Perhaps, he mused, "Times were a little better when my sister and I came along." After all, his older siblings were able to help out, and his father had received a small promotion. He also wondered if "age itself was a healing factor." As we shall see, forgiveness leads to successful aging more often than does nursing old resentments.
Nevertheless, asked what effect he thought his early experiences with his parents had upon his adult personality, Anthony Pirelli replied that they had "a direct impact. I wanted to be the opposite of my father. I didn't want to be an ordinary nothing. My goal in life was to be ambitious." Only during his fifth interview did Pirelli reveal that as a child not only his sister, Anna, but also a financially successful uncle and aunt, invisible to the original investigators, had also been important to him. They were "very warm" and had treated Pirelli and his siblings "wonderfully." At every age we tell our life story in a different way. Clues to the future are present in any life history, but the difficulty arises in distinguishing real clues from red herrings.
In contrast to many self-made men, Pirelli, in retirement, was grateful for how well his successors continued to run his businesses. Pirelli still spent one to two hours a week at his car dealership (another of his many ventures), but he could rely on the good management that he had there. When he went into the office, he explained, he would "just get in the way." In other words, in old age he knew enough not to take himself too seriously.
At age 70 when asked who has been his closest friend over the last forty years, Pirelli shot back, "My wife, without a doubt." Asked how they depended on each other, he replied, "One would be lost without the other." They had just celebrated their fiftieth anniversary. One of his children had earned a Ph.D. in mathematics from Columbia University; the other had attended two years of college.
Pirelli may have been ill, considering his heart attack and open-heart surgery, but he did not feel sick. He was as physically active as ever, and he continued to play tennis. Asked what he missed about his work, Pirelli exulted, "I'm so busy doing other things that I don't have time to miss work....Life is not boring for me." Thus, at age 70 Pirelli enjoyed life as much as anyone in the entire Study. The point of this story is not that yet another poor son of immigrants became a rich man. The real lessons of Pirelli's life are: he was not a prisoner of childhood; he gave to his children what he could not have himself; he loved his wife for fifty years; and he never felt sick, even when he was ill. Ultimately, he could turn what he had built over to others with gratitude, not resentment. The past often predicts but never determines our old age.
In the general population only a third of adults alive at 60 will live past 80; but in the three Study of Adult Development cohorts, 70 percent of college-educated members alive at 60 will be alive at 80-twice as many as expected. In other words, many Study members are now enjoying the exceptional longevity and the prolonged retirement that will become the rule for American children born in year 2000. Throughout this book, biographies of men and women-older than Pirelli-will reveal ingredients essential to successful aging. For as Study members, ten to twenty years older than I, trudge through the minefields of life, I have for three decades now been studying and trying to step in the footsteps they leave behind. In this book I invite readers to join me. Pirelli's story tells us that if we look hard enough, we can find hidden clues that help explain how a person ends up differently from what we might expect.
Among the many significant findings to emerge from the Study of Adult Development thus far are the following:
In a world that seems ruled by genetic predestination, we need hope that we still can change. The lives of the Study members offer us guides. They allow us to anticipate and to shape our own lives according to developmental rules. Benjamin Spock and the researchers from whom he borrowed taught mothers to anticipate child development and to understand what could be changed and what had to be accepted. Similarly, this book tries to do the same for late adulthood. Remember the words of Scrooge in Charles Dickens's A Christmas Carol: "Men's courses will foreshadow certain ends, to which, if persevered in, they must lead. But if the course be departed from, the ends will change." The prospective nature of this book allows us to understand facets of our lives which if departed from will allow our lives to change.
Positive Aging Defined: A First Pass
I shall return to these and other important findings of the Study in the pages ahead. Along the way, I shall develop and expand my definition of positive aging, but it's important to first explain a few key assumptions; for commentators from social scientists to poets can't seem to agree on whether aging is a good thing or not. Do we believe Robert Browning, who invites us to "Grow old along with me! / The best is yet to be"? If so, should not King Lear and Cordelia end their play by riding off into some Walt Disney sunset? Indeed, that is how the play did end before William Shakespeare adapted it to conform to his own pessimistic vision of old age.
In support of Browning's view a distinguished Study novelist wrote to us:
Contrary to all expectations, I seem to grow happier as I grow older. I think that America has been sold on the theory that youth is marvelous but old age is a terror. On the contrary, it's taken me sixty years to learn how to live reasonably well, to do my work and cope with my inadequacies.
For me youth was a woeful time-sick parents, war, relative poverty, the miseries of learning a profession, a mistake of a marriage, self-doubts, booze and blundering around. Old age is knowing what I'm doing, the respect of others, a relatively sane financial base, a loving wife and the realization that what I can't beat I can endure.
All well and good, but in As You Like It another distinguished author, William Shakespeare, asserts that old age "Is second childishness and mere oblivion, / Sans teeth, sans eyes, sans taste, sans everything." Shakespeare makes King Lear's senile narcissism seem unbearable; and even when the bard was feeling kindly about old age, he defined it in a sonnet as:
That time of year thou mayst in me behold When yellow leaves, or none, or few, do hang Upon those boughs which shake against the cold, Bare ruin'd choirs, where late the sweet birds sang.
There can be no definitive answer to this debate. Both sides are right. Old age can be both miserable and joyous. It all depends on the facets we choose to examine. But one thing we do know is that positive aging must reflect vital reaction to change, to disease, and to conflict. Thus, perhaps there is a third way for us to view old age-one that does not try to paint old age as either black or white. A 55-year-old Study poet underscored the dignity even in dying. He rhetorically asked, "What's the difference between a guy who at his final conscious moments before death has a nostalgic grin on his face, as if to say, 'Boy, I sure squeezed that lemon' and another man who fights for every last breath in an effort to turn time back to some nagging unfinished business? Damned if I know, but I sure think it's worth thinking about." He also addressed the difference between successful and unsuccessful aging: "What is the difference? One, I guess you would call 'the celebrant sense' or that wonderful hippie word, 'Wow!' I think it's an important component in the whole adaptive process. Life needs to be enjoyed!" And so whenever in this chapter I write pedantically of successful aging-think joy. The heart speaks with so much more vitality than the head.
Certainly, there will be many paths to successful aging; and there will never be a right way to grow old. But the goal is straightforward: How can we make the journey past three-score-and- twenty one that we will be glad we made? That question will be the focus of this book.
But we shall need to ask the very old to point the way. Thus far, I have been quoting 50-year-olds. Sixty-year-olds. When they wrote with such authority about old age, Browning, Shakespeare, the Study novelist, and the Study poet were middle-aged. What did they know? Even Anthony Pirelli is only seventy.
When he turned 80, the accomplished American literary critic Malcolm Cowley had the same misgivings about the chroniclers of old age. Ralph Waldo Emerson wrote his essay "Old Age" at 57; Alex Comfort wrote A Good Age at 56; Simone de Beauvoir wrote The Coming of Age at 60; and arguably the most quoted of all, Cicero, wrote De Senectute at 62. In his splendid book The View from Eighty, Cowley points out, "Those self-appointed experts on old age knew the literature but not the life." I agree.
Ideally, we would want to consult individuals like the 122-year- old Madame Calment. What does life hold when with the passage of time the elder becomes too frail to attend his land conservation meeting or too hard of hearing to attend the lectures at her genealogy society? Since Madame Calment is neither alive nor studied, we may do well to listen to the 84-year-old Study member whose voice we heard earlier in this chapter. Positive aging means to love, to work, to learn something we did not know yesterday, and to enjoy the remaining precious moments with loved ones.
The Study of Adult Development
At this point let me describe the Study in greater detail. The Study of Adult Development is a rarity in medicine, for quite deliberately it set out to study the lives of the well, not the sick. In so doing it has integrated three cohorts of elderly men and women-all of whom have been studied continuously for six to eight decades. First, there is a sample of 268 socially advantaged Harvard graduates born about 1920-the longest prospective study of physical and mental health in the world. Second, there is a sample of 456 socially disadvantaged Inner City men born about 1930-the longest prospective study of "blue collar" adult development in the world. Third, there is a sample of 90 middle-class, intellectually gifted women born about 1910-the longest prospective study of women's development in the world. (To call a study prospective means that it studies events as they occur, and not in retrospect.)
The Harvard (Grant) Cohort
The "Grant Study" of adult development was begun at Harvard University by Arlie Bock and Clark Heath. These two student health service physicians had received a gift from a philanthropist, William T. Grant, to study healthy development. Never dreaming that in the year 2000 the Study members would still remain active participants, Arlie Bock, in a press release dated September 30, 1938, described the Study's aims:
Doctors traditionally have dealt with their patients after troubles of many sorts have arisen. The Department of Hygiene...proposes to revise this procedure and will attempt to analyze the forces that have produced normal young men....A body of facts is needed to replace current supposition. All of us need more do's and fewer don'ts.
In the original selection process, about 40 percent of each Harvard class were arbitrarily excluded because there was some question as to whether they would meet the academic requirements for graduation. Usually this meant a freshman grade average of C or lower. The health service records of the remaining 60 percent of each freshman class were then screened, and half the remaining men were excluded because of evidence of physical or psychological difficulty. Each year the names of the remaining 300 sophomores were submitted to the Harvard deans, who selected about 100 boys whom they recognized as "sound."
Over a four-year period, 1939-1942, 268 sophomores were selected for study. Twelve of these students withdrew while they were still in college, and 8 more withdrew over the next half-century. For nearly sixty years (or until their deaths), the remaining 248 men have continued to participate with remarkable loyalty. They have received questionnaires about every two years, provided records of physical examinations every five years, and been interviewed about every fifteen years. The men's wives and their children have also been asked to provide details of their own lives, as well as observations about how they viewed their Study husband or father.
In 1940 men who went to Harvard were not always rich or privileged. But they were almost always white and their grand-parents had usually been born in the United States. Oldest children were definitely overrepresented and only 2 percent of the men chosen were left-handed as contrasted to 10 percent of the general population. Put differently, the Harvard cohort had been chosen for their capacity to equal or to exceed their natural ability, and most did so. Four of the 268 ran for the United States Senate. Another net would have had to be cast to include happy-go- lucky dependent, but equally stable, college men.
After being accepted into the Study, each man was seen by a psychiatrist for about eight interviews. These interviews focused on the man's family and on his own career plans and value systems. The Study psychiatrists made an effort to get to know the men as people, not patients.
A family worker, Lewise Gregory Davies, also saw the Harvard men. She took a careful social history from each sophomore subject. She then traveled the length and breadth of the United States to meet their parents. In each boy's home she took a family history that included characterizations of grandparents, aunts, uncles, and made an estimate of social status. She also obtained from the mother a history of each boy's infant-and-child development and any family history of mental illness.
Originally, data were recorded in ink in huge leather ledgers and analyzed by manual counting. Data were not put onto punch cards until 1965, not onto magnetic tape until 1975, and not into the hard drive of an office desktop computer until 1990. Now, as I write in the year 2000, all of the data of sixty years of study resides in a laptop on my desk at home.
Socioeconomically, the Harvard sample men were mainly drawn from a privileged group but not exclusively so. In 1940 a third of their parents had made more than $15,000 a year, but one father in seven made less than $2,500 ($1.25/hr) annually. (In those days a year at Harvard cost $1,500, and a registered nurse made $2,000 a year.) If one-third of the men's fathers had some professional training, one-half of the men's parents never graduated from college. During college almost half of the men were on scholarship and/or had to work during the academic year.
World War II forced the Harvard men into a common experience that permitted them to be compared with their fellow citizens on grounds other than academic excellence. Only 11, instead of a statistically expected 77 out of 268, were rejected for service because of physical defects. Instead of an expected 36 out of 268, only 3 were rejected for psychiatric reasons.
With a few exceptions, like the man whose father made two million dollars a year in the midst of the Depression, the 1940 generation of Harvard men were upwardly mobile and more successful than their fathers. Returning from active military service in World War II, the Harvard men benefited from high employment, a valuable dollar, and the GI bill that virtually guaranteed them an affordable graduate school education. The men themselves were just young enough to be influenced by the health-promoting trends of 1960-1980, like smoking cessation and middle-aged physical fitness.
At age 47 the average earned income of the Harvard sample was about $105,000 in current dollars. Yet the men were Democrats more often than Republicans. In 1954 only 16 percent of the Harvard men had sanctioned the McCarthy hearings; and in 1968, 91 percent had advocated de-escalating our involvement in Vietnam. To generalize, the Harvard sample had the incomes and social status of corporate managers; yet they drove the battered cars and pursued the hobbies, politics, and lifestyle of college professors.
More important to this book, at age 75 the mortality of the Harvard sample is only half that expected of white males in their birth cohort, and their mortality is only three-quarters that of their Harvard College classmates. Sixty percent of the men have survived or will survive past their 80th birthday; only 30 percent of white American males born in 1920 will live that long.
The Inner City Cohort
(The Gluecks' Nondelinquent Controls)
In 1939 Sheldon Glueck, a young law professor at Harvard Law School, obtained funding to conduct a prospective study of 500 youth sent to reform school and of 500 matched schoolboys who at age 14 had not been in any legal trouble. Sheldon Glueck and his wife, Eleanor, a distinguished social worker, restudied both groups of men at ages 17, 25, and 32.10 Like the Harvard men, the Inner City men originally agreed to be studied by a multidisciplinary team of physicians, psychologists, psychiatrists, social investigators, and physical anthropologists. The Gluecks' research study has produced two classic texts in criminology. One, written by the Gluecks themselves and published in 1950, is Unraveling Juvenile Delinquency, and the other, Crime in the Making, was written forty-four years later by Robert Sampson and John Laub, two criminologists who were still in grammar school when the Gluecks died.
The nondelinquent youth-the controls to whom the reform school boys were compared-shared the same social risk factors that helped doom the delinquents. They had attended the same inner city schools and had the same tested intelligence (mean IQ = 95) as the delinquents. One nondelinquent in four had repeated two grades or more of school. The controls were also matched with the delinquents for high-crime neighborhoods and ethnicity. The majority of their parents were foreign born; for two-thirds of the boys this meant Italy, Ireland, Great Britain, or Canada. In childhood, half of these Inner City nondelinquents, like Anthony Pirelli, had lived in clearly blighted slum neighborhoods. Half of their homes had lacked a tub or shower. By way of contrast, in 1940 only 16 percent of all Boston dwellings were without tub or shower. Half of the Inner City men came from families known to five or more social agencies, and more than two-thirds of their families had recently been on welfare.
The Gluecks had last interviewed the Inner City sample in 1960-1962. At that time, for financial reasons, they reduced the sample to 456 by excluding the 44 youngest boys. Until I obtained the funds to reinterview them at age 47 (c. 1975), for fifteen years all contact had been lost. Since their 40s, when I inherited the Study from the Gluecks, the men, like the Harvard men, have returned biennial questionnaires; the most recent one was received in the year 2000 when the men were 68 to 74. They, too, have provided physical examinations every five years. When they were 60 the Study still knew whether all but two of the 456 Inner City men were alive or dead.
The Terman Women Sample
For a female comparison group to the Harvard cohort, the Study selected 90 women from the Stanford (Terman) study of gifted children. The Terman Study began in 1922 when Lewis Terman, a professor of education at Stanford University, attempted to identify all of the grammar school children in urban California with IQs of 140 or higher. Before this, Professor Terman had established his reputation by adapting the French Binet intelligence test for use in America. From the grammar schools of Oakland, San Francisco, and Los Angeles Professor Terman had first selected the 7 percent of children identified by their teachers as the brightest in each class. He then retested this group individually with the Stanford-Binet Intelligence Test. In this fashion he identified the 1 percent of Californian urban schoolchildren with IQs greater than 135 to 140. Most were born between 1908 and 1914.
Originally the aim of Terman's selection process was to identify most of the brightest children in his three-city area. But when he went back and checked entire schools, he found that he had probably captured only 80 percent. The intelligence of unattractive and shy children tended to be overlooked by their teachers. In addition, all children who attended California private schools (Terman did not approve of private education) or Chinese-speaking schools were arbitrarily excluded. Thus, bright upper-class and Chinese-American children were excluded. Bright children for whom English was a second language were also at risk for inadvertent exclusion, for the teachers of that day revealed enormous ethnic prejudices. For example, the father of one Terman woman was a poet, a chess master, and a former mayor of his town; in addition, he had obtained three years of graduate education in his profession as a horticulturist. His daughter's teacher, however, had disdainfully referred to this cultured man as a "Japanese gardener."
Beginning with Lewis Terman, who studied his "gifted children" from 1922 to 1956 17 and then continuing with his successors -first Melitta Oden, 1956-1970, 18 then Robert Sears (himself a member of the Terman Study), 1970-1989,19 and, finally, Albert Hastorf, 1990-2000-the Terman cohort has been studied for almost eighty years. These four generations of investigators have followed the Terman men and women by questionnaire about every five years and by personal interview in 1940 and 1950. After sixty-five years of follow-up, attrition, for reasons other than death or invalidism, is still less than 10 percent. Unfortunately, the Terman women were not asked to provide regular physical exams.
In personality traits, the Terman women showed significantly more humor, common sense, perseverance, leadership, and even popularity than their classmates. They were as likely as their classmates to marry, but their physical health was better. Compared to their classmates, they had better nutrition, better mental stability, fewer headaches, and fewer middle-ear infections. Their siblings suffered only half the childhood mortality experienced by the siblings of their classmates. Finally, by age 80, like the Harvard sample, the Terman women have enjoyed a mortality only half what would be expected for white American women in their birth cohort.
In 1987, through the generosity of Stanford professors Robert Sears and Albert Hastorf, my wife, Caroline Vaillant, and I were permitted to select for reinterview a representative subsample of 90 women from Terman's original sample of 672. We found that 29 of these 90 women had died; and owing to bad health or poor cooperation, 21 surviving women were not seen. We reinterviewed the remaining 40 women. Their average age at interview was 78-the same age as the men of the Harvard cohort who were last followed up in 1999. Except for the vastly inferior physical health reported in their questionnaires, available data suggested that the 50 uninterviewed women did not differ significantly from the 40 women whom we did interview.
Comparison of the Three Cohorts
At the time of their last study, all the Terman women were old-old (seventy to seventy-nine), and a third of the Harvard men were entering the world of the oldest-old (eighty plus). Only half of the Inner City men had passed from being young-old (sixty to sixty-nine) to old-old. In terms of physical decline the mortality of Inner City men at sixty-eight to seventy was the same as that of the Terman and Harvard cohorts at age seventy-eight to eighty. Most of this difference in health could be explained by less education, more obesity, and greater alcohol/ cigarette abuse among the Inner City cohort. When these four variables were controlled, their much lower parental social class, IQ, and current income were not important. Put differently, the health of the 29 Inner City men who graduated from college was identical at age 70 to the health of the Harvard College graduates at age 70.
Although each of the three cohorts in the Study of Adult Development was in itself relatively homogeneous, the samples were very different from each other. A third of the Harvard men's fathers, but none of the Inner City men's fathers, were in social class I (physicians, successful lawyers, and businessmen). A third of the Inner City men's fathers, but none of the Harvard men's fathers, were in Social Class V (unskilled laborers with less than ten grades of education). The parents of the Terman women were largely middle class or skilled laborers (Social classes III and IV); few of their fathers were as privileged as those of the Harvard men or as disadvantaged as those of the Inner City men.
The table illustrates the contrasts between the three cohorts. As noted, the mean (Binet) IQ of the Terman women was 151; the mean (Wechsler-Bellevue) IQ of the Inner City sample was 95; the estimated mean (army alpha) IQ of the Harvard sample was between 130 and 135. The mean education of the Terman women's fathers was twelve years in contrast to eight years for the fathers of the Inner City men and sixteen years for the fathers of the Harvard men. While none of the Inner City mothers had gone to college, a third of the mothers of the Harvard men had graduated from college-twice as many as the mothers of the Terman women. A third of the Inner City men had less than ten grades of education, while a quarter of the Terman women and three-quarters of the Harvard men obtained a graduate school degree.
One final commonality of how these three prospective studies were conducted was that all relied on interviews with the Study members and with parents and teachers. The Study often made use of recorded sources of public information. Ambiguity about whether a life was successful could often be resolved by the use of multiple sources of information. In this book, I may illustrate a point by quoting what a member said during an interview, but my conclusions are almost always supported by more objective evidence. Behavior, not words, predicts the future and reflects the past.
For example, the stepfather of an Inner City man was described by his wife as a man who until recently had been "quite a heavy drinker who would drink anything," but who now "only bought a small bottle of wine every day." She claimed that he was a social drinker and that his use of alcohol never interfered with his work. Field investigation revealed a very different story. Five years earlier a social agency had noted the stepfather had been laid off from work "probably from drunkenness," and that he had a long arrest record for drunkenness. A child welfare agency noted that the "stepfather is apt to be too drunk to be a companion." Two years after the interview, the stepfather had been arrested three more times for drunkenness and twice was committed to a state hospital for alcohol abuse. Five years after his wife alleged that he "only brought home a small bottle of wine," his death certificate noted the primary cause of his death as "cirrhosis and alcoholism." In similar ways, assessments of vague but important judgments like the quality of parental affection or marital support could be substantiated from several points of view and at several different points in time.
On the one hand, none of the three cohorts can be viewed as representative of the general population. On the other hand, the three samples do have the virtue of being demographically vastly different from each other; yet within each sample there was considerable homogeneity. Thus, the similarities between the groups and the differences within the groups may be generalizable to other American Caucasian samples. Like the proverbial half loaf of bread, these studies are not perfect; but for the present they are, arguably, the best lifelong studies of adult development in the world.
At times readers may be irritated that the Harvard examples outnumber stories of women and of the less socially privileged Inner City men. The Study has, for a variety of reasons, more information about the Harvard cohort. But usually the conclusions drawn from each of the three groups were the same.
As we shall see, this book is filled with both data and judgment calls; and in many ways, the latter are the most emphasized. That being the case, the reader is more than entitled to some acquaintance with the person making most of the judgments, namely me. After all, I have my biases and prejudices that I cannot guarantee haven't affected my observations. So the reader needs to take them into account. I was born in New York City in 1934. My father died when I was ten. When I was thirteen I found myself fascinated to read the report of his Harvard College class of 1922 twenty-five years after graduation. Of course, I did not then anticipate that twenty years later I would be interviewing the men of the class of 1942 at their twenty-fifth reunion. I attended Harvard College, and one way or another I have maintained a Harvard connection for almost fifty years. Like many, I fancy myself a political independent, but longitudinal hindsight reveals that over 44 years I have voted only for Democrats for president.
Unlike my archaeologist father I took no courses in college in the social sciences and, certainly, none in anthropology. Instead, I learned the history of science from a young section man named Tom Kuhn, took premed courses, but majored in the humanities. I attended Harvard Medical School with plans to become a community psychiatrist in the public sector. Instead, I became fascinated by interviewing "remitted" schizophrenics and abstinent heroin addicts whose clinical records from ten to fifty years before I had managed to discover. I was intrigued by the changes in their lives, which to me looked a lot like maturation. Adult development happened, and to understand it further seemed worth my professional lifetime.
Thus, in 1967, in the Harvard cohort's thirtieth year, I was excited to join the Grant Study, as it was then called. I became a research professor instead of a community psychiatrist. Although I had always denied interest in his field of archaeology, I now found myself more than twenty years after my father's death rummaging through dusty files in search of artifacts from the past of Harvard men and muttering to myself, "I've turned into a god-damned archaeologist after all." In 1967 the Study members had begun returning to their twenty-fifth Harvard reunions. As a 33-year- old psychiatrist who had just reviewed their extensive records, I was able to interview them in the flesh. I marveled as before my fascinated eyes the men metamorphosed from adolescents in the Study records-even more callow than I-into mature fathers of adolescents. At age 47 many of these "normal" men were at the top of their game. For years I had been trained to study pathology; now it seemed equally exciting to study health.
By 1972 I had reinterviewed a hundred Harvard men at an average age of forty-seven and had experienced enough troubles of my own to have a fuller sense of the ups and downs of any life trajectory. Yet I was more exhilarated than distressed by the complexity of the lives I was studying. In 1977, when the men were fifty-five, I published a book on adult maturation, Adaptation to Life. By that time I assumed that the college men had stopped growing. What did I know? I was only forty-three.
Rich as these lives were, however, the demographic biases implicit in any study of Harvard men meant that the picture I was getting of adult development was necessarily skewed. If I was going to understand "how people keep well and do well" I needed to study a less rarified sample.
In 1970, because of my long-term follow-up of heroin addicts, Sheldon and Eleanor Glueck on their retirement appointed me as one of the three curators of their groundbreaking case files of juvenile delinquents and matched controls. These disadvantaged but resilient controls, of course, made a splendid foil for the "overprivileged" Harvard men. Funded by the National Institute of Alcohol and Alcohol Abuse, my colleagues and I spent the years from 1974 to 1978 reinterviewing the Inner City men. They were the same age as the Harvard men when I had first interviewed them.
Interviews with Study members were consistently exhilarating and exhausting. Indeed, because so much was known about each member, there was an intensity to many of the interviews that was both gratifying and surprising. Talking with Study members was often like resuming an old friendship after a period of separation. Study members who had always found loving easy made me feel warmly toward them, and led me to marvel at their good fortune in belonging to such an enjoyable project. In contrast, Study members who had spent their lives fearful of other people and who had gone unloved in return often made me feel incompetent and clumsy. With them I often felt drained and depressed as if I had done all of the work in the interviews while they took much and gave nothing.
By 1980 the inexorable thrust of adult development had continued. The Harvard men were now 60 and I had just attended my own twenty-fifth Harvard reunion. It had become clear that not only was I committed to following these men for the rest of their lives, but also that I was embarked on a study of aging. Up to that time I had entertained as little interest in gerontology as I had once shown for archaeology. But now, at 46, I was becoming as interested in understanding what life after retirement might be like as I once had been in learning about what it was like to be 45. Besides, since I had already studied the "recovery" process from maladies thought by many to be incurable-schizophrenia, alcoholism, heroin dependence, and personality disorder, to study positive mastery of "old age" seemed a challenging next step. My funding source shifted from the National Institute of Alcohol and Alcohol Abuse to the National Institute of Aging. In 1985 I finally grew up enough to realize that I could not understand human development if I just studied men-a minority group. Thanks to the generous help from the Henry A. Murray Center at Radcliffe (now Harvard) and from Stanford Univer-sity -especially from Professor Albert Hastorf-my wife, Caroline Vaillant, and I reinterviewed Lewis Terman's gifted women. When we interviewed them in 1987 the Terman women were seventy-six to seventy-nine. I was still fifty-two. Not until I had grown up for another ten years and begun interviewing the Harvard men between seventy-five and eighty did I really begin to appreciate the lessons that the three groups were teaching. Adult development affects us all. Now I, too, get a Social Security check.
The Importance of Prospective Study
I have stressed that the significance of the Study of Adult Development is that it is prospective. But why is that important? The extraordinary value of a prospective study lies in the uniqueness of its perspective. A longitudinal follow-back study must depend on memory; a prospective study records events as they happen. Thus, if we wish to understand how our octogenarian role models became that way, it is critical that the elderly survivors should have been followed since adolescence. There are several reasons why this is so.
First, prospective study allows us to view the happy, successful great-grandparents against a background of peers who died young. Is death at an early age merely one more manifestation of God playing dice with the universe, or could many such premature deaths have been prevented? Are those who die young less well loved and less mentally healthy than those who die old? Or is it just genes? Previous studies of "successful aging" have usually not begun until age sixty or seventy; they have not possessed the prospectively gathered data to address such questions. In them premature deaths are invisible. Chapter 7 of this book will answer the above questions.
Second, prospective study means that we do not have to depend on the subject's memory of what happened yesteryear. It is all too common for caterpillars to become butterflies and then to maintain that in their youth they were little butterflies. In October 1941 a young Harvard member had said of America's increasing hostility toward Germany on the eve of our entry into the war: "I am extremely disheartened. I feel the war in Europe [is] none of our business." By the winter of 1966-1967, however, he fully subscribed to Lyndon Johnson's military policies in Vietnam and condemned his sons for actively protesting American involvement. He had completely forgotten his own public demonstrations against American involvement in World War II.
Third, only prospective study permits one to demonstrate objectively the Freudian concept of repression. As a Harvard sophomore, Fritz Lethe had assured the Study that there was no truth in Freud's sexual theories. He boasted to the Study psychiatrist that he would drop a friend who engaged in premarital sexual intercourse. The psychiatrist observed, however, "While disapproving of sexual relations, Fritz is frankly very much interested in it as a topic of thought." At 19, Lethe was also terribly prejudiced against "sneaky liberals" and tore up "propaganda" from the Harvard Liberal Union. He also told the psychiatrist, "I have a drive -a terrible one. I've always had goals and ambitions that were beyond anything practical."
Later, Lethe rewrote his life story. At age 30 he saw his earlier "terrible drive" as derived from his mother. He saw her as his greatest personal problem. "All my life I have had her dominance to battle against...the major change in my philosophy is relevant to my goals in life. My goals are no longer to be a great in science, but to enjoy working with people." By age 49 Mr. Lethe also believed in Freud and premarital sex. The goals of "sneaky liberals" were no longer contemptible. He now believed that "the world's poor [were] the responsibility of the world's rich."
In his interview at age 50, Lethe proclaimed, "God is dead and man is very much alive and has a wonderful future." He now 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 did not jibe with the fact that as a Harvard sophomore, he reported going to Mass four times a week!
But his memory distortions did not stop there. When Fritz Lethe was 55, I sent him the above vignettes so that he might grant me permission to publish them in my book on the Harvard sample, Adaptation to Life. He sent my text back with a terse note: "George, 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. Maturation makes liars of us all.
Fourth, prospective study also reveals that distortions of memory can be adaptive and creative. Let me offer an example from the life of a Terman woman, Matilda Lyre. At age 78, when asked if she had been interested in becoming a doctor, Lyre replied reprovingly, "You have to remember women have come a long way. I never even thought about being a doctor as a possibility." In point of fact, at 14 she had told the Terman staff that she wanted to be a doctor. In college she had majored in premedical studies, and at age 30 her Strong Vocational Interest Inventory had suggested medicine as the vocation best suited to her interests. Indeed, as a child, Matilda Lyre, besides wanting to be a doctor, had wanted to be an astronomer and a poet and a scientist.
But her rewriting of history was healing. When Lyre was 20, one of the Terman staff described her as someone "who seems to adorn anything she attempts." At Berkeley she became editor of the college literary magazine. She was on their all-star swimming team, and as a very young woman, she traveled throughout California giving lectures and writing articles. Then gender bias and limited economic opportunities during the Great Depression combined to squash Matilda Lyre's talents. As a result she began her young adulthood as a part-time physical education teacher in a small town. When her husband found work, she had to give up even that job; for during the 1930s if their husbands obtained jobs, California female teachers had to resign from theirs. School jobs were too scarce for one family to have two.
When she was 78 we also asked Matilda Lyre how she had dealt with the gap between what society had allowed her to achieve and her potential. She responded, "I never knew I had any potential...I had to learn to cook and raise a garden." Her life story, then, became in part a reconstruction to make a life frustrated by prejudice, the Great Depression, and poverty in a small town bearable.
However, the saga of Matilda Lyre reveals that developmentally blighted lives can enjoy happy endings, that the futures of the elderly matter, and that they are interesting. When she was 30 Matilda Lyre's Strong Vocational Interest Inventory revealed that besides being suited to being a doctor, she was well suited to becoming a musician. For most of her adult life, Matilda had not allowed herself to develop this side of her persona; finally, at age 60, she took violin lessons. A little later, after she divorced her husband, she inherited a beautiful violin from her best friend, and her musical career took off. For the last six years this one-time-unemployed physical education teacher has been giving solo violin concerts in Los Angeles and loving it. And at age 78 there was no evidence that her new career would not continue.
A fifth reason why prospective study is valuable is that such study allows its members time enough to overcome shame- and deliberate falsification. For example, one man explained to the Study, "My replies have been frank, but with a period of delay. Whenever anything was badly wrong I tried to suppress it, and on the next Grant Study questionnaire I tried to claim that everything was going fine, but that was an effort. The effort convinced me that I had better do something about the situation. If you want to find out what is really happening to me?read the next questionnaire or the one after that. Having to face my situation, having to formulate an attitude and then having to conceal the situation temporarily have been in the long-run healthy for me." Sixth, perhaps the most important benefit of prospective study is that it permits distinguishing effect from cause-cart from horse, as it were. For example, in interviewing these individuals I often concluded that those who had abused alcohol had done so as a home remedy for their clinical depression. They agreed. However, review of their ongoing case records by two independent psychiatrists, one focusing on alcohol abuse and the other on depression, revealed a quite different conclusion. The symptoms of their alcohol abuse had usually come first; the symptoms of major depression came only later. Like most individuals afflicted with both maladies, the members of the Study could acknowledge their depression but not their alcoholism; and so their retrospective narratives reversed cause and effect. Prospective review of those narratives put them back in order.
Drawbacks to Prospective Studies
If prospective longitudinal studies are so important, why don't we do more of them? The short answer is expense. Prospective studies of human lifetimes are extremely expensive in four currencies: money, luck, investigator perseverance, and subject loyalty. First, granting agencies are reluctant to continue funding the "same old study." Therefore, many promising prospective studies of lives have starved to death financially. To keep the Study of Adult Development going for six to eight decades has cost millions of dollars in consecutive grants from roughly twenty different funding sources.
Second, it took not only talent and dogged perseverance, but it also took unusually good luck for Joe DiMaggio to hit safely in fifty-six consecutive games. Similarly, it has taken enormous luck for the Terman Study, the Glueck Study, and the Harvard Study to survive academic and funding vagaries, not only to the maturity of their subjects, but into their old age. Third, many studies have fallen victim to lack of perseverance or the death of the original investigators. Thus, it has been also due to the patience of its several generations of directors that the Study has survived.
But, to be more honest and more humble, it is the fourth expense, the extraordinary loyalty and patience of its members, that is most essential to create a valuable prospective study. Attrition from a prospective study, like the breakage of unique antiques, cannot be repaired. Thus, low attrition frees study conclusions from a bias that usually plagues prolonged prospective studies- selective loss of members. (The Study of Adult Development has been blessed with the lowest attrition rate of any comparable study in the world-except perhaps the Lundby Study in Sweden.)
Besides expense, a second problem that besets prospective studies is "halo effects." By halo effect I mean that to know of someone's past biases our judgment of their present. An ordinary wine tastes very different if poured from a bottle with a Chateau Lafitte label than from a screw-top jug labeled Thunderbird. To avoid this limitation we took many precautions. Raters of the Study members' childhoods were, of course, blind to the future; and raters of the present were kept blind to the men's and women's childhoods. Raters were also blinded to ratings by other judges. Perhaps thirty different research assistants have worked on this Study. Most were asked to make independent ratings before they, too, became biased. As director of the Study for thirty years, my judgments of the present have been profoundly influenced by my knowledge of the members' past. For that reason, I have rarely provided numerical ratings for the Study database. The thoughtful reader may also ask whether a third disadvantage to prolonged study is that it alters the members' lives. What about the so-called Heisenberg effect? Do we not always change that which we study? As a psychotherapist I must reply, "Alas, if only changing the course of human lives were so easy." If occasionally watching people over the course of a lifetime changed their lives, intensive psychotherapy would be a much more effective force for change than it is. It is true that the Heisenberg effect may apply to electrons studied by physicists, but our own close inspection of a speeding bullet does not usually alter its course. So it is with subjects in a longitudinal study. By studying the members for long periods we may distort what we see, but we don't, necessarily, change them.
A final and very important disadvantage of long-term prospective studies is that they are not representative. They are always limited in size, in historical time, and in composition. Since the Study subjects were all selected for health or nondelinquency or intelligence, they can only illustrate how life unfolds under favorable circumstances. Therefore, the reader may fairly ask how a book about relatively prosperous white Americans chosen for mental health can teach us anything about general humanity. My answer is that in order to understand normal biological development, climate and growing conditions should be optimal.
Had I tried to study successful aging in a random sample of 10,000 of the world's population, my cohort, while being "representative" and "politically correct," would have been so heterogeneous as to boggle both mind and computer. Besides, randomness is neither normal nor healthy. In addition, unlike sociologists and demographers, biologists do not study all of the creatures of Noah's ark simultaneously. Biologists study liver enzymes in purebred rats; they study genetics in the fruit fly; and they study neurophysiology in a single ganglion of the sea snail. Furthermore, control of confounders is essential. For example, the rate of onset of physical disability was dramatically different if Study men had had ten years or sixteen years of education. Thus, in order to study some causes of physical disability other variables must be held constant.
Readers must decide for themselves when the Study members and their behavior reflect people as they know them and when it seems they are reading about unfamiliar tribes. My own belief is that cross-cultural studies will show that mental health from one part of the world to another does not differ as much as we might think. Consider, for example, that the diets of a New York construction worker, of a Japanese aristocrat, and of an Australian aboriginal appear extraordinarily different; but the healthy balance of basic food groups in each diet that makes it nutritious is rather constant. Be that as it may, the three Study cohorts are all unrepresentative. Readers must exercise proper caution about any conclusions that I may draw.
A few years ago a wise participant and Study member, Ted Merton, wrote to me "testily but cordially":
Here you have these wonderful files, and you seem little interested in how we cope with increasing age. You ask us what we can no longer do, what our politics are, whether we're spiritual, how bad is our health, etc., but I detect little curiosity about our adaptability, our zest for life, how our old age is, or isn't, predictable from what went before. You seem mostly to want to chronicle progressive deterioration instead of taking advantage of a database with which to examine aging as thoroughly, as imaginatively, and as vigorously as you did our youth and early adulthood. Young people are always more attractive than the elderly, but they're not necessarily more interesting. We may be has-beens, but does the Study have to be? I write to call your attention to the repeated innuendo that our futures no longer matter...
The rest of this book will be an effort to respond to his wise advice. I will use true-life narratives to offer a guide for positive, interesting old age. The next five chapters will describe the developmental processes that make old age vital. Then, chapters 7 through 10 will try to unpack critical components of the last two decades of life: first, being ill without feeling sick; second, regaining a capacity for creativity and play in retirement; third, the acquisition of wisdom; and fourth, the cultivation of spirituality. The final two chapters, 11 and 12, will summarize the lessons that I have learned from the Study. I shall attempt to leave readers with greater hope for their final decades than is provided by Simone de Beauvoir in her brilliant monograph The Coming of Age or by the equally brilliant but equally dispiriting quip "Old age is not for sissies."
In his fifties, in The Seasons of a Man's Life, Daniel Levinson wrote gloomily that men approaching 60 may "feel that all forms of youth...are about to disappear,...a man fears that the youth within him is dying and that only the old man-an empty dry structure devoid of energy, interest or inner resources- will survive for a brief and foolish old age."29 In contrast, Betty Friedan in her seventies wrote in The Fountain of Age: "We have barely even considered the possibilities in age for new kinds of loving intimacy, purposeful work and activity, learning and knowing, community and care....For to see age as continued human development involves a revolutionary paradigm shift."30 This book will provide clear evidence to support such a paradigm shift.
To convey Study findings, I have selected examples that reflect important issues for more than one member of this Study. I hope they will describe many others outside of it. Any resemblance between individuals in this Study and persons living or dead will be entirely intentional; but I have used pseudonyms and altered identifying detail and specific affiliations. Thus, if the narrative detail fits anyone of the reader's acquaintance too closely, it will almost certainly turn out that he or she has identified the wrong person. Study members who are still living have granted me their permission to print their disguised biographies.
Copyright (c) 2002 by George E. Vaillant, M.D.
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