Abstract
A selection of films and books is offered this month for your holiday consideration. The film A Beautiful Mind is important enough to warrant two reviews because of its potential to influence attitudes to schizophrenia over a wide audience.
With best wishes for the festive season.
Jo Beatson
George Vaillant
Melbourne: Scribe, 2002
ISBN 0 908 01164 4 pp.373 $30.00
George Vaillant, Professor of Psychiatry at Harvard Medical School, peppers his latest work on ‘good ageing’ with numerous classical, literary and folksy quotations. One of my favourites comes from Virginia Woolf's Mrs Dalloway: ‘The compensation of growing old… [is] simply this: that the passions remain as strong as ever, but one has gained – at last! – the power which adds the supreme flavour to existence – the power of taking hold of experience, of turning it around, slowly, in the light’.
This book sheds Vaillant's own light, a mixture of research evidence and clinical wisdom, on the personal, familial and social factors that underpin a happy, productive, socially connected old age on the one hand, and a lonely, dispirited one on the other.
The research evidence is considerable. When aged 33, Vaillant inherited the copious interview notes of three previous longitudinal studies of human development: the ‘Harvard study’, endowed by the founder of a dime store chain, that tracked the progress from 1938 onwards of elite male Harvard undergraduates; a study begun in 1922 by a Californian educationalist of children with IQs of 140 or higher (the ‘Terman study’); and the ‘Inner City Cohort’ initiated in 1939 by a Harvard law school professor of delinquent and well-behaved schoolboys from impoverished inner-urban homes. All three studies sought information from the children and youths themselves as well as parents and teachers – a treasure trove indeed!
Through being in the right place at the right time – and Harvard University is a pretty good place to be – the young Vaillant earned access to these files and the goodwill of their owners. It was his genius to then wrench sufficient funding from the National Institute of Ageing to follow survivors until their 80s and beyond. This book, and many dozens of scientific papers, are the fruit of his work.
There was method to his interviews. Subjects were questioned systematically about work, marriage, hobbies, physical health, mental health and the like. What makes the book special, though, are the author's personal observations that round out the raw numbers and bring individuals to life. This blending of statistics and anecdote, and the use of quaint but evocative pseudonyms (the healthy Richard Lucky and a sad, disgruntled Sammy Grimm), look odd to the modern statisticcrunching psychiatrist but are familiar to social scientists. In true social science spirit, the author describes himself and his approach, his background and values, and possible sources of bias. His account reads convincingly.
One chapter concerns factors at age 50 that predict successful ageing at age 75, where success entails physical and mental health, good social supports and life satisfaction. Factors that did not predict success were childhood temperament, ancestral longevity, parental characteristics and high cholesterol levels. The influence of genes and parents fades, it seems, with time. Factors that did predict success were a stable marriage, some physical fitness, mature psychological defences and an absence of smoking and abuse of alcohol. There is a message here: love your partner and take care of your brain.
The bulk of the book is concerned with an amplification and enrichment of the writings of Eric Erikson, a Danish arts student who migrated to the US in 1934 and eventually settled at Berkeley University under the stewardship of psychologists with an interest in human development. Erikson, who followed children and their parents over several decades, developed a typology of life stages, ranging from the establishment of basic trust in infancy to integrity in old age. Vaillant adds to these stages, which he prefers to call tasks, ‘generativity’ and becoming a ‘keeper of the meaning.’ Put simply, his thesis states that integrated, mature human beings shift from immediate personal and family concerns to a higher regard for the whole of their community. This maturation is reflected in a wish to care for later generations and to instil knowledge and a sense of values in those who follow.
Generativity and altruism come easily to some but develop later in others. The fundamental point, though, is that maturation continues into the eighth and ninth decades unless personal maladjustment and physical and mental ill-health make it impossible. Vaillant illustrates each task with examples drawn from his data base. We meet people who were cherished as children, developed healthily and became repositories of wisdom and love for others. Others started well but faltered because of depression or alcohol abuse. Yet others were born inauspiciously but grew in character and imagination following retirement from work.
It is acknowledged that the final year or so of life is often miserable. How can it be otherwise? The ‘good death’ has been the subject of much study and is well described. This book concerns the interval, which extends now for many decades, between establishing a family and career and life's end. Retirement, playfulness and voluntary activity might seem dull to young tyros but are invested here with an empathy and higher mindedness that I found most touching and persuasive.
The book is an easy read. It is written with a general audience in mind and wears its scholarship lightly (Vaillant's many books and papers are listed in an appendix). It should be read by all psychiatry trainees to extend their knowledge of child and adult development; by all old age psychiatrists to remind them of the richness of the lives of their patients, or their patients' carers; and by psychiatrists in their 50s and 60s as a signpost to their future.