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Book Forum: Psychiatry in Society   |    
Aging Well: Surprising Guideposts to a Happier Life From the Landmark Harvard Study of Adult Development
JOHN F. MITCHELL, M.D.
Am J Psychiatry 2004;161:178-179. doi:10.1176/appi.ajp.161.1.178
View Author and Article Information
Allentown, Pa.

By George Vaillant, M.D. Boston, Little, Brown and Company, 2002, 373 pp., $24.95; $14.95 (paper).

Aging well: it can be done. Dr. Vaillant suggests that successful aging means giving to others joyously whenever one is able; receiving from others, gratefully, whenever one needs it; and being capable of personal development in between. To accomplish this, one must employ the social model of developmental stages and the emotional model of adaptational mechanisms of defense.

This book was written for a wide audience. It is appropriate for anyone who has an interest in human growth and development. Although written in an entertaining format accessible to the lay reader, it also serves the professional reader because it is scientific in its methodology. Vaillant’s style is not as informal as Gail Sheehy’s respected work Passages(1) or as casual as Gray’s Men Are From Mars, Women Are From Venus(2). The ideas are supported by hard data and a thoughtful commentary, which makes the work credible. The book exemplifies science tempered by common sense and honed by the reality of lives studied.

Vaillant offers two models of human development that are the foundation of this book. First is the social model of developmental stages proposed by Erik Erikson (with refinements by Vaillant himself). With this model, adult development is characterized by a progressive sequence of changes in which adults continue to participate in life within an ever-increasing social circle. Second is the emotional model of adaptational mechanisms of defense proposed by Sigmund Freud, Anna Freud, and Vaillant himself, who outlines a continuum of unconscious strategies for dealing with anxiety and conflict. These defense mechanisms (from immature to mature) allow the person varying degrees of ability to tolerate or hold strong emotion in consciousness.

Vaillant has taken on the daunting task of helping us to understand the aging process and giving us hope in our "youth-oriented" and "throwaway" era. He is a respected professor of psychiatry at Harvard Medical School and a gifted writer. The book begins with an all-inclusive definition of aging that suggests decay, change, and continued growth. It ends with an admonition that the final "task of Integrity is acceptance of one’s one and only life cycle as something that is to be and that permits no substitutions" (p. 159).

This work is based on a scientific evaluation of three prospective, longitudinal, adult development study cohorts. The subjects were all born in the early 20th century. The Harvard study included 268 socially advantaged men, the inner city cohort consisted of 456 socially disadvantaged men, and the Terman study consisted of 90 middle-class, gifted women. A unique database was compiled by means of giving out questionnaires every couple of years and conducting physical examinations every 5 years and standardized interviews every 15 years. Corollary data were also compiled from spouses and children. The data were scrutinized by a panel of researchers who were blind to the identities of the members.

Aging Well is a volume rich in information and themes. Its credibility is based on the value and power of these prospective longitudinal studies. In fact, Vaillant states, "If you wish to maintain pet theories intact, refrain from longitudinal study" (p. 263).

Case vignettes are used, allowing the reader to feel that he or she is accompanying Vaillant and his wife throughout the United States to visit with the subjects. I felt as though I knew many of these people. Pseudonyms, as metaphors, were chosen to either reflect their character’s life accomplishments or connect the reader with familiar literary or historical figures. For example, in discussing issues of mature defenses, Vaillant uses figures such as the gracious Susan Wellcome. A discussion of emptiness and failure uses the life of Gwendolyn (Miss) Havisham in Dickens’s Great Expectations. The bearer of the Keeper of Meaning is Mark Stone (Marcus Aurelius—the first-century Roman emperor and Stoic philosopher). Then there is the perfectly content Judge Oliver (Wendell) Holmes, and who will ever forget Ellen (Helen) Keller, vital in spite of multiple losses of function.

Vaillant proposes three concepts of normal aging. 1) In positive aging, healthy individuals demonstrate characteristics of maturity (e.g., forgiveness, gratitude, and joy). 2) Healthy aging suggests issues related to quantity as well as quality. Here Vaillant debunks six commonly held assumptions and details seven predictive features. 3) Graceful aging is demonstrated by a simple acceptance of one’s fate in a genuine, affable, and socially connected way.

The last major theme of this book is that people can change. This is based on Vaillant’s belief that adult character development is not set in concrete. Poor development is associated with either alcoholism or major depression. Studies of the inner city men showed that coping well in adolescence predicted successful old age (p. 284). Vaillant wisely points out that life is a paradox of change and conformity. By age 70, early life factors are no longer relevant. Rather, character-based choices (e.g., spouse, drinking alcohol, lifestyle) influence the ultimate outcome. Vaillant destroys the myth that early childhood conflict haunts us forever and says that ultimately what went right is more important than what went wrong.

Throughout his discussion of the paradox of life, Vaillant gives us enough pearls of wisdom to make a necklace: "Gratitude is almost always more fun than spite or regret" (p. 69); "Happy families, like bank accounts left to compound interest, build on themselves" (p. 130). "After all, aging is not for sissies but done well is next best to getting what you want" (p. 163).

Vaillant concludes that the paradox of life is that the past may predict but never determines old age: life can be disturbingly wonderful.

Sheehy G: Passages: Predictable Crises of Adult Life. New York, Bantam, 1977
 
Gray J: Men Are From Mars, Women Are From Venus: A Practical Guide for Improving Communication and Getting What You Want in Your Relationships. New York, HarperCollins, 1992
 
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References

Sheehy G: Passages: Predictable Crises of Adult Life. New York, Bantam, 1977
 
Gray J: Men Are From Mars, Women Are From Venus: A Practical Guide for Improving Communication and Getting What You Want in Your Relationships. New York, HarperCollins, 1992
 
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