AUTHOR:
George E. Vaillant, M.D. (Little, Brown, and Company, 2002)
REVIEWER:
Ronnie S. Stangler, M.D., Founder, Genomics Advisory
BOOK LINK:
REVIEW:
“It is not true that people stop pursuing dreams because they grow old, they grow old because they stop pursuing dreams.” Gabriel García Márquez
I. Introduction
George Vaillant’s Aging Well: Surprising Guideposts to a Happier Life represents the stuff of dreams. How else to understand the vision, passion, and persistence behind the rigorous analysis of three prospective cohort studies of over 800 individuals, followed over the course of seven, and even eight decades to unravel the mysteries of what constitutes successful aging.
The challenge of successful aging is of vital importance to us at 21/64, both from the strategic perspective of how we engage next generations in philanthropy, but also in furtherance of our broader mandate of “philanthropos”, embracing respect and love for all humankind. We are committed to ensuring optimal, meaningful, fulfilled lives for every generation. How does formal philanthropy fit into the schema of Aging Well? Does Vaillant offer us means of better communication amongst generations?
The book represents both science and art as it analyzes the findings of the Harvard Study of Adult Development, the largest, longest, and richest prospective study of aging in history. This study combines three cohorts, one of Harvard men begun in the 1920s, one of inner city Boston men, and another of exceptionally high IQ women from California. Participants were enrolled as adolescents, studied prospectively by teams of physicians, psychiatrists, psychologists, social scientists, and anthropologists, who used all manner of interviews (of both study subjects, as well as their teachers and family members), physical and laboratory exams, written questionnaires, and periodic personal open-ended conversations that continued through life spans that extended into grand and great-grandparenthood.
Dr. Vaillant, now 79 himself, joined the Harvard cohort in its 30th year as a 33 year old clinical psychiatrist at Harvard Medical School. He writes of the parallel processes of spearheading an extraordinary lifelong commitment to this unique scientific investigation, while moving through stages of adult development himself. He writes candidly of surprise at major unanticipated findings, such as how the impact of early childhood lessens as we age.
The book offers technical analyses of hard data of health, morbidity, mortality, and psychological assessments, and examines relationships amongst all variety of demographics, including education, socioeconomic data, professional status, family background, and an array of psychosocial factors. But it is at its most compelling in story-telling, as Vaillant shares elegant narratives and personal anecdotes, vignettes of all manner of study participants, who are extraordinarily frank and generous with personal details and lessons of living.
The beauty of prospective work is that stories unfold factually without distortions of recall and embellishment related to retrospective memory. Effect and cause are often unraveled in surprising ways (e.g. the devastating impact of chronic excessive alcohol use relates less to “unhappy childhoods” but rather to the malignancy of alcohol’s effects on body, emotional well-being, and family integrity; that is, negative outcome seems related to the effects of alcohol, rather than the more stereotypic view that alcohol use stems from negative early life).
II. Developmental framework
Vaillant provides a theoretical structure for organizing the study findings. He quickly steers us away from earliest understandings of old age as simply a time of senescence and deterioration. While acknowledging inevitable losses and physical challenges of aging, he surprises himself as a scholar in having acquired over his own lifetime a construction of old age as a life period with both continuing developmental mandates and potential to flourish and thrive.
Vaillant incorporates stages of adult development as defined by Erik Erickson: a schema of change and maturation that occur throughout the entire life span. Adult development is viewed as progress, not decline. The tasks of each stage are defined, and although follow sequentially, work overlaps through multiple stages. Young adulthood requires identity creation, development of capacity for intimacy, and career consolidation, As we age, adults have the potential to engage in life from a perspective of widening social radius, a path leading outward, with stages of generativity, “keeping of the flame”, and integrity.
In Vaillant’s words, “Generativity reflects the capacity to give the self, finally completed through mastery of the first three tasks of adult development, away.” Ultimately, generativity involves our putting into the world more than was there before. Its essence is focal awareness that we are part of a social network in which we must act for the benefit of the group. Understanding our relationship to that broader world, we seek to better it, not just for ourselves, but for others. It turns out to be very rewarding personally: “In all three Study cohorts, mastery of generativity tripled the chances that the decades of the 70s (and beyond) would be a time of joy and not of despair.”
Vaillant describes the next phase, “keeper of meaning”, as focus on “conservation and preservation of the collective products of mankind – the culture in which one lives and its institutions. One (concentrates) on responsibility for future generations, but also (cares) for the culture, institutions and environment that allow those future generations to prosper.”
Finally, Vaillant describes the stage of integrity. He states “In old age…(the) many losses…may overwhelm us, if we have not continued to grow beyond ourselves. One looks back on life and creates a story – an integrated and meaningful life that could have been no other way. It is a deep and profound acceptance of life’s journey, including the journey into death. ”
Even during this stage of primarily inner reflection, much can be done to make the world a better place, for an individual’s actions are understood less personally, but in the context of inevitable responses to life forces.
III. Findings and Conclusions
Although this book was written over ten years ago, its findings stand for themselves:
• What goes right in childhood predicts the future far better than what goes wrong.
• It is not the bad things that happen to us that doom us; it is the good people we encounter at any age who facilitate enjoyable aging.
• A good marriage/primary relationship at age 50 predicts positive aging at 80; surprisingly, low cholesterol levels at age 50 do not.
• Alcohol abuse unrelated to unhappy childhood consistently predicts unsuccessful aging, in part because alcohol damages future social supports.
• Learning to play and create in new ways as we age and actively engaging with younger friends as we lose older ones add more to our enjoyment than greater late life income.
• Healing relationships are a key component of aging well and are facilitated by a capacity for gratitude and forgiveness.
• Objective good physical health is less important to successful aging than subjective good health. “It is all right to be ill, as long as you do not feel sick.”
How some of these results might translate into our current era of escalating income inequality and its impact on the elderly is a legitimate concern. But it was never Vaillant’s mandate to predict external sociopolitical global trends, but rather to focus on individual people.
Vaillant observes: “When we are old, our lives become the sum of all whom we have loved. It is important not to waste anyone. One task of living out the last half of life is excavating and recovering all of those whom we loved in the first half.”
Though trained as a psychoanalyst, Vaillant frankly concludes: “Freud vastly overestimated the importance of childhood.” Indeed, the personality is not fully formed by age 5, nor even by 50. True, most of the participants with good outcomes at midlife continued to thrive and enjoy a vital old age. The few all-around successes who fell apart almost always did so as a result of disease. Yet many subjects who looked “unimpressive” at 50 had lives that became startlingly better. This seems to be a consequence of continuing maturation – and of “avoiding accidents”.
There are steps one can take to improve one’s odds. One can create favorable conditions for mature coping styles that facilitate richer old age. First, says Vaillant, “Our defenses are always more mature when we are not hungry, angry, lonely, tired, or drunk. Feeling safe, secure, and ‘held’ allows us to use more mature defenses.” Second, although it is not easy to change our defenses by ourselves, chance favors a prepared mind: “We can start by admiring how other skillful people cope. Then ponder, when things go badly for us, how we might have used self-defeating mechanisms.” Lastly, he says: “Don’t try to think less of yourself, but try to think of yourself less.”
Although Vaillant rarely speaks of philanthropy per se, his analysis of later developmental periods offers a context for recognizing the importance of philanthropy in the life cycle for mastery of its final successive stages. This complex and fascinating book offers lessons for readers of every age. The stories make real the longitudinal science in such a manner to engender empathy, the greatest connector and creative force for good, and a powerful intergenerational communications tool.
“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.” Henri Amiel (1874)
George Vaillant offers us an elegant guide.