Winter 2013

What a decades-long Harvard study tells us about mental health

– Charles Barber

"The best predictors of adult success and well-being are a childhood in which one feels accepted and nurtured; an empathic coping style at ages 20 through 35; and warm adult relationships."

When the psychiatrist George Vaillant was a teenager, he received in the mail his father’s 25th Harvard class reunion book, which detailed in short paragraphs the activities of classmates who were by then in their late forties. Young George found the twisting narratives fascinating, and pored over them obsessively. The very arrival of this book must have been extremely difficult for him, as a few years earlier, George’s father, a privileged and successful man with no overt signs of depression or distress, had fatally shot himself in his backyard after a nap. George, then 10 years old, was the last to see his father alive.

Drawing upon the resilience that characterizes the themes of Triumphs of Experience, Vaillant has presided for the last five decades over the ultimate class reunion book, the Grant Study. Named after its patron, the variety-store magnate W. T. Grant, the study began tracking 268 Harvard students, most members of the classes of 1942, ’43, and ’44, in 1938. Vaillant inherited the project in the 1960s, directed it for over 30 years beginning in 1972, and remains a co-director. Exact criteria for selection to the study remain obscure — the original investigators declined Norman Mailer and Leonard Bernstein, but included John F. Kennedy. Sixty-eight members of the original cohort, now in their nineties, are still living.

Over the last 70 years, Harvard scientists have checked in on the members of the group at regular intervals, and poked and prodded them using virtually every psychological and physiological instrument. The sheer amount of data is astonishing, most of it collected by Vaillant himself. “Some men came to Cambridge … but in most cases I went to them — to Hawaii, Canada, London, New Zealand,” writes Vaillant, who himself is now 78.

Triumphs of Experience elegantly summarizes the findings of this vast longitudinal study, unique in the annals of research. (Sustaining the funding for it has also been a herculean feat.) Vaillant has written two previous books about the Grant Study — Adaptation to Life (1977) and Aging Well (2002) — which provide snapshots of the men’s lives at earlier stages. This latest book analyzes how the men fared over their late adulthood, and indeed their entire lives. In it, Vaillant masterfully chronicles how their life successes, or lack thereof, correlate with the nature of their childhoods, marriages, mental health, physical health, substance abuse, and attitudes.

Extensive quantitative findings are interspersed with the detailed stories of individual study participants, under pseudonym, and with identifying details expunged or changed. Here Vaillant proves that his skills are literary as well as scientific. The case histories are engaging novelistic capsules that artfully bring the quantitative material to life. Vaillant, who of course has aged along with his subjects, includes scenes from his own development, honest stories that involve both struggle and maturation.

The study, a product of the period in which it was conceived, has its limitations. Its only subjects are white, privileged men. Still, many of its findings seem universal. If they could be boiled down to a single revelation, it would be that the secret to a happy life is relationships, relationships, relationships. The best predictors of adult success and well-being are a childhood in which one feels accepted and nurtured; an empathic coping style at ages 20 through 35; and warm adult relationships.

Regarding finances, just one of Vaillant’s 10 measures of adult well-being, men who had good sibling relationships when young made an average of $51,000 per year more than those with poor sibling relationships or no siblings at all, and men who had warm mothers earned $87,000 more annually than those who did not (in 2009 dollars). Overall, reflecting their privilege, the Grant Men made a lot of money. The findings go on and on like that, and the message relentlessly emerges: The secret to life is good and enduring intimate relationships and friendships. Mental health, as Sigmund Freud and Erik Erikson indicated, is embodied by the capacity to love and to work.

The other overarching message of this book is that resilience counts. Men with the most mature defense mechanisms — defined as altruism, humor, sublimation (finding gratifying alternatives to frustration and anger), anticipation (being realistic about future challenges), and suppression (yes, “keeping a stiff upper lip”) — were three times more likely to flourish in later life. Furthermore, men with good defense mechanisms were able to alter their paths by developing the capacity for emotional warmth and connection to others despite difficult upbringings or individual setbacks.

Vaillant provides compelling evidence that many individuals — by no means all — can write (or rewrite) their own scripts, disproving F. Scott Fitzgerald’s maxim that there are no second acts in American lives. Other studies of quite different populations have arrived at similar conclusions. In Making Good, a 2001 study of hardcore criminal offenders, the criminologist Shadd Maruna documents that those who learned to desist from crime scored vastly higher on measures of self-agency (taking control of your life) and generativity (being able to respond positively to negative events) than those who continued their criminal careers.

Resilience plays out at a physiological level too, of course. Vaillant found that maintaining a healthy weight, not smoking, not drinking much, and controlling blood pressure before age 50 made all the difference in the health of the men at 80 and 90. But here, too, relationships seem to lay the groundwork. In 1978, Vaillant reviewed a subset of the men who had been healthy at age 40; they were now about 55 years old. Of those who had had the bleakest childhoods, 35 percent were dead or chronically ill, as compared to only 11 percent of those with the warmest childhoods.

There is a small but vital call in medicine and psychiatry to pay much greater heed to the stories of patients, as a means of building empathy and guiding care. Psychiatry, like so much of medicine, has been overrun by technologies and pharmacologies. In the excitement over this supposed progress, the old-fashioned “healing arts” have often been neglected.

In response, Rita Charon, a professor of clinical medicine, has created a highly influential program in narrative medicine at Columbia University’s medical school, predicated on the value of listening to the stories of patients. This past fall I taught a course on the narratives of illness and recovery at Wesleyan University. The students, up to their ears in neuroscience and psychological science, couldn’t get enough of the real-life first-person narratives of people suffering from mental illness and trauma. The point of all this is not to revel in the illnesses, but to learn what constitutes health.

Vaillant is that rare thing: a psychiatrist more interested in mental flourishing than in mental illness. With Triumphs of Experience, he has turned the Harvard men’s disparate stories into a single narrative and created a field guide, both practical and profound, to how to lead a good life.

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Charles Barber is a lecturer in psychiatry at the Yale School of Medicine and director of the Connection Institute for Innovative Practice, dedicated to the study of the narratives of people recovering from mental illness. He is the author of Comfortably Numb: How Psychiatry Is Medicating a Nation (2008).

Reviewed: Triumphs of Experience: The Men of the Harvard Grant Study by George E. Vaillant. Harvard University Press. 457 pp.

Photo courtesy of Wikimedia Commons