The Study of Adult Development

Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development
by George E. Vaillant, M.D.

Think diet and exercise are the keys to a long, healthy life? Think again.

What can you do to increase the likelihood of living a happy, healthy, fulfilling life into your sixties, seventies, eighties, and beyond?

For more than five decades Harvard Medical School has studied the basic elements of adult human development, analyzing the health and happiness of hundreds of individuals from a wide variety of backgrounds. In Aging Well, George E. Vaillant, M.D., the director of the study, draws on the data gathered and reveals for the first time why some people turn out to be more resilient than others. His surprising conclusion is that individual lifestyle choices play a greater role than genetics, wealth, race, or other factors in determining how happy people are in later life.

Among the topics Dr. Vaillant explores:

• The importance of marriage and the impact of divorce

• The role of play and creative activity

• The effects of tobacco, alcohol, and other mood elevators

• The benefits of forming new friendships and new social networks

• The importance of intellectual curiosity and lifelong learning

With its step-by-step advice and its revelation of scientific secrets, this inspiring book can help you - whether you are thirty-five or sixty-five - ensure that your golden years are truly golden.

Chapter 1

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:

• It is not the bad things that happen to us that doom us; it is the good people who happen to us at any age that facilitate enjoyable old age.

• Healing relationships are facilitated by a capacity for grati-tude, for forgiveness, and for taking people inside. (By this metaphor I mean becoming eternally enriched by loving a particular person.)

• A good marriage at age 50 predicted positive aging at 80. But surprisingly, low cholesterol levels at age 50 did not.

• Alcohol abuse-unrelated to unhappy childhood-consistently predicted unsuccessful aging, in part because alcoholism damaged future social supports.

• Learning to play and create after retirement and learning to gain younger friends as we lose older ones add more to life's enjoyment than retirement income.

• Objective good physical health was less important to successful aging than subjective good health. By this I mean that it is all right to be ill as long as you do not feel sick.

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.)

Copyright © 2002 by George E. Vaillant, M.D.

About the Author

George E. Vaillant, M.D., is a widely respected researcher, a psychiatrist at Brigham and Women's Hospital, and a professor at the Harvard Medical School. He is also the author of several books, including Adaptation to Life, Wisdom of the Ego, and the classic The Natural History of Alcoholism.