At thirty-nine he wrote, “I feel lonely, rootless, and sort of disoriented.” He said of his painful marriage: “No matter how hollow a marriage it may be, it still gives one a home and a place in society. . . . Despite even some hatred, it’s easier to suffer with Janie than to suffer without her.” He confessed that he was “afraid of giving up marriage and standing on my own,” and one reason for his fear was that his wife was much richer than he was. Clearly he wanted something better, but he was afraid to try to find it. Initiative and autonomy are very difficult when the world is such a perilous place, but Lovelace berated himself for his inadequacies.
I interviewed Lovelace again when he was fifty-three, after the death of his alcoholic wife. I wanted permission to publish his story, and I thought it was important to make that request in person. With the burden of his agonizing marriage relieved, his life was one important degree less dangerous, and he was no longer the cadaverous, worried man I had met three years before. He—almost—had a glow in his face. He was now president of the Louisville Home for the Aged, and had sublimated his fears of aging and death (as marked in him as in any man in the Study) in pride at giving the older residents of his city a better quality of life. His social life had improved, if only slightly. He gave me permission to publish his bleak history, which was certainly an altruistic act.
Even having seen the changes in Lovelace over his first three years as a widower, however, I was not prepared for the man I interviewed just before his eightieth birthday. He was much less depressed. He looked younger than he had twenty-five years before, and when I said something about that he told me that I was not alone in thinking so. Except for the antidepressant Zoloft, he had given up the tranquilizers, sleeping pills, and stimulants of his youth. He had had girlfriends after his wife died. Like many of the Loveless men, it was hard for him to let love in, and for many years he had eluded any serious attachment. But at sixty-three he finally succumbed and remarried. Compared to the other men’s, his second marriage scored in the “unhappy” category. Nevertheless, at seventy-nine he told me that his wife was the best thing that ever happened to him. As we’ll see in Chapters 5 and 7, brain maturation leads to an increased capacity for intimacy, especially when that has been retarded by emotional privation. Even this ambiguous marriage was an improvement over anything he had ever had before, and he could appreciate and rejoice in that.
In his chronic withdrawal and lack of energy, Lovelace had had little room for personal interests. But now, warmed perhaps by his new marriage, the man who had been a “failure” at sports throughout his life was (his wife assured me) a fabulous dancer. Lives change, and things can get better. But the people who don’t learn to love early pay a high price in what Conrad calls woe. And, as I’ll show in a brief statistical foray, Lovelace remained to the end one of the most loveless men in the Study.
IMPORTANT LINKS BETWEEN CHILDHOOD AND OLD AGE
The men at fifty. When the College cohort was about fifty, I explored in a series of analyses the relationship between childhood environment and adult outcome. The results confirmed the qualitative message of Holmes’s and Lovelace’s stories—that for good or ill, the effects of childhood last a long time. Half the men from the best childhoods, but only an eighth from the worst, had made what we then considered optimum adult adjustments. Only a seventh of the Cherished, but fully half of the Loveless, had at one time been diagnosed as mentally ill, under which rubric we included serious depression, abuse of drugs or alcohol, and a need for extended psychiatric care (more than 100 visits) or hospitalization. The Loveless were five times as likely as the Cherished to be unusually anxious. They took more prescription drugs of all kinds, and they were twice as likely to seek medical attention for minor physical complaints. They spent five times as much time in psychiatric offices.
Some readers may object to my classifying a hundred visits to a psychotherapist as a statistical manifestation of mental illness. There are lots of reasons that healthy people go to psychiatrists, you might point out. What about young psychotherapists who seek analysis as part of their training or professional development, for instance? Here I’ll avoid a he-said she-said argument, and let the Grant Study’s telescope provide a statistical resolution. Of the twenty-three men with the lowest Decathlon score, nine had seen a psychiatrist one hundred times and only seven never. Of the thirty men with Decathlon scores over 6, only three had ever seen a psychiatrist at all and none more than ninety-nine times—a very significant difference. Of the five psychiatrists in the Study, all had seen a psychiatrist over one hundred times. Even if for the sake of argument we accept that as irrelevant, four had also used harmful amounts of psychoactive drugs and three had experienced a major depression. This is not to say that having once been considered less than mentally robust by the Study a man was doomed to carry that label forever; Godfrey Camille did not. Nor does it mean that people can’t turn their lives around; Godfrey Camille did. But it does indicate that people who seek a great deal of psychiatric care have something in their lives that needs turning around. People whose lives feel just fine tend to eschew psychiatrists.
In individual case records, we frequently observed the following unhappy sequence. A poor childhood led (first) to an impaired capacity for intimacy, and (second) to an above-average use of mood-altering drugs. Warm childhoods clearly gave the more fortunate men a sense of comfort with and acceptance of their emotional lives that lasted into old age, while bleak early years left their survivors with (third) an enduring apprehension about trusting and facing the world by themselves. The fourth and cruelest aspect of bleak childhood was its correlation with friendlessness at the end of life. The Cherished were likely to be rich in friendships and other social supports at seventy—five times more likely than the Loveless who trusted neither the universe nor their emotions, and remained essentially friendless for much of their lives. The Loveless Adam Newman, for example, who insisted that he never knew what the word “friend” meant, had managed to find a wife who fully satisfied his limited emotional desires. But she was his only friend, and he was all too uncomfortably aware that her death would leave him essentially alone.
The Cherished were eight times more likely to report good relationships with their siblings, and more likely to achieve the wider social radius that Erikson called mature or generative. I will admit that I feel some uncertainty about whether childhood environment is solely responsible for this; I suspect that there are genes for loving natures, undiscovered though they yet be. Here again, time will tell.
Let me turn now to the corollary of this chapter’s lesson—that it is the quality of their total experience that determine the way children adapt to life, not any single piece of good or ill fortune. The Grant Study turned up no single childhood factor that predicted well-being (or its opposite) at fifty. It was the number, or perhaps the constellation, of positive and negative childhood factors that predicted mental health risks, not any particular ones or any pattern among them. But the total mattered.
At about age fifty, the men were asked to respond to 182 true-or-false statements in the Lazare Personality Scale.11 Eight of those statements very significantly distinguished the men who thirty years later would receive the lowest Decathlon scores from the men who received the highest. That is, they distinguished the lonely, the unhappy, and the physically disabled from the happy, successful, and physically well. Remarkably, the same eight midlife questions also very significantly distinguished the men who had been classified as Loveless and Cherished thirty years prior to testing.
• My behavior with the opposite sex has led to situations that make me anxious.
• I have often thought that sexually, people are animals.
• I usually feel that my needs come first.
• Others have felt that I have been afraid of sex.
• I easily become wrapped up in my own interests and forget the existence of others.
• I put up a wall or shell around me when the situation requires it.<
br />
• I keep people at a distance more than I really want to.
• I have sometimes thought that the depth of my feelings might become destructive.
What does this have to do with childhood? These eight revealing questions address a fundamental discomfort with the emotional aspects of life, and a resulting self-doubt, pessimism, and fearfulness. Men with warm childhoods subscribed to very few of these statements, but (very significantly) the less fortunate men often subscribed to four or more. And the more at ease the men were with their feelings, the more successful they were at the rest of their lives.
The College men who did not achieve successful or gratifying careers revealed a life-long inability to deal with anger, which I have documented in Adaptation to Life and also in a statistical examination of the work lives of the Inner City men.12 Anger is a delicate balancing act. No one can avoid anger forever and hope to prosper in the real world, but discomfort with aggression is a developmental challenge not only for women and overeducated men; it was for the Inner City men, too.
So how does a child learn to trust what he feels and other people’s responses to his feelings? When you’re just getting the hang of grief, rage, and joy, it makes all the difference in the world to have parents who can tolerate and “hold” your feelings rather than treating them as misbehavior.13 Maybe Mrs. Holmes’s willingness to let her two sons act up in the living room was a coincidence, but I doubt it.
And what if you don’t have parents like that? How do you learn such things if you can’t engage comfortably with other people? How do you tackle the world confidently, or risk finding someone to love, or even find room among your fears to relax and pay attention to things other than yourself? There was no man in the Study who had a bleaker childhood than Sam Lovelace. All the circumstances in his constellation conduced to a heart that didn’t know how to be satisfied. His Childhood Environment score was a rock-bottom 5, and he alone answered “True of me” to all eight of the questions. His Decathlon score was 0, and at age seventy there were only two men in the Study with fewer social supports than he. It’s not enough to be loved; you have to be able to let love in. As Sam’s mother had told us when he was eighteen, “People like Sam more than he likes them.” But liking—trusting is probably more the issue—has to be learned, and Sam didn’t learn it at home.
HEREDITY VERSUS ENVIRONMENT
In 1977 I wrote, “If isolated trauma did not affect adult life, chronically distorted childhoods did affect adult outcome. Although the mental health of relatives was not related to subsequent psychopathology in the men, the mental health of their parents was. The Worst Outcomes were twice as likely as the Best Outcomes to have a mentally ill parent. This effect would seem to be mediated environmentally.”14
In retrospect, though, I can see that environmentalism in the postwar social sciences was just as extreme as the pre-war hereditarianism had been. This is a good example of the way scientists change science and then are changed by science in their turn. Note too that both the turn to environmentalism and the recent reaction away from it in favor of the neurosciences are encompassed in the lifespan of the Grant Study. Longitudinal studies are inescapably subject to such developments; this is one of their infuriating complications and one of their invaluable advantages. So as the years passed, I had to reconsider some of my nature vs. nurture convictions. Once again, I turned to prospective study to provide accurate data, and to reveal and redress the cultural biases of previous investigators (including myself).
For instance, data that I gathered in 2001, when the men were turning eighty, indicated that the mental health of relatives (not only parents) was an important fork in the road leading from a warm childhood to adult mental health. The presence of mental illness in the family was a wild card with the potential to trump even the most auspicious nurturance. That pointed to hereditary, rather than environmental, influence.
Table 4.1 summarizes some of that analysis. It shows mental health plotted against three conditions: bleak childhood environment, familial mental illness, and personality rating at age twenty-one. I’ve described already how we assessed childhood environment; the personality assessment at age twenty-one was part of the original investigation of the men during their college years. The scores for the second condition, familial mental illness, were established this way. In a process that will be familiar by now, we reduced four concrete indicators of genetic vulnerability—alcoholism, depression, poor familial longevity, and, surprisingly, early death of the maternal grandfather—to 3- or 4-point scales. (It can be surprisingly difficult to assess familial longevity accurately, but we were able to do it. The men’s parents knew the dates of death of their parents, and the Study lasted the necessary six decades until the last parent of a Study man died in 2001. Another gift of lifetime studies. Familial longevity was estimated by summing the ages of the oldest parent or grandparent on the maternal and paternal sides.)
Because these four disparate variables correlated significantly with each other, they were summed to yield a heredity score of 0 to 12, which, as Table 4.1 illustrates, did have some predictive power. These scores did not reflect any kind of genetic testing or even precise diagnoses. They were pragmatic and crude estimates of the presence of three broad syndromes in a family—alcoholism, depression, and short life. Longevity of the maternal grandfather was included individually because its absence had a very significant—and also a fascinating and difficult to explain—association with both neuroticism and depression; much more on this in Chapter 10. It’s worth noting that a high heredity score was very significantly correlated with a bleak childhood, and my work on alcoholism later demonstrated that heredity accounts for almost 100 percent of familial transmission of alcoholism (see Chapter 9). Holmes was blessed with a heredity score of 0, while both Camille and Lovelace had significant genetic loading for mental illness.
Table 4.1 Important Associations of Heredity and Childhood Environment with Adjustment to Life
Very Significant = p<.001; Significant = p<. 01; NS = Not Significant.
* This was a sum of five variables leading to vascular and heart disease (high diastolic blood pressure, Type II diabetes, obesity, heavy smoking, and alcohol abuse). The vascular risk variables are discussed in Chapter 7.
The first two columns of the table illustrate the correlations of childhood environment and heredity with various maturational and situational circumstances in later years. A warm childhood predicted later social and love relationships better than hereditary factors did. But heredity was the better predictor of later health-related developments like alcohol abuse, smoking, and, most dangerously, the vascular risk variables that I’ll discuss in Chapter 7. Why heredity was less associated with adjustment in old age is puzzling. One factor may have been selective attrition by early death among the alcoholics and depressives.
The third column of the table reflects another curious chapter in the history of Woods’s equivocal personality trait schema—an arresting tale of a scientific ghost and the inestimable value of long perspective. In the mid-eighties, Paul Costa and Robert McCrae, longtime senior investigators at the National Institutes of Health and the Baltimore Longitudinal Study of Aging, established an inventory of personality traits that became very well known under several names: the NEO, the Big Five, and the Five Factor model.15 That first name is an acronym for the first three of its five traits—Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness; the second and third are self-explanatory. Among the statistically inclined, the Big Five has emerged as a robust model for understanding personality, but clinicians, including me, have found it less useful. One of my reasons is that McCrae and Costa have used it to argue that personality does not change over time.16 This is a point of view clearly not in accord with my Grant Study experience, and one that has been sharply contested in other quarters as well.17
In 1998 Stephen Soldz, a psychologist expert in statistics and in the Big Five, thought to look back to Woods’s earlier
twenty-six-trait classification and the way it was applied to the College men in the 1940s. As I’ve said, Woods’s methodology was not all it might have been, and the usefulness of his schema has been slight, with the one startling exception that I described in the last chapter. Nonetheless, out of the material from that time, Soldz was able to extrapolate five traits that correlated, with high agreement among seven independent raters, with the Big Five. In his hands, these five traits were highly predictive of most of the outcomes in Table 4.1, a result that forced me to reconsider my distrust of the Big Five’s predictive power. There was also a high correlation between Soldz’s traits and the College men’s results on the Big Five proper, which was administered to the College men at the age of sixty-seven.18
It was fascinating to watch a measure from the very earliest days of the Study—one that for a long time looked almost laughably useless and that redeemed itself only by the skin of its teeth with the surprising success of Well Integrated—receive a whole new lease on life in the hands of a truly sophisticated statistician. Woods tried something. It mostly didn’t work, and the material that he amassed wasn’t much use in his own context. But if he hadn’t tried, his material would not have been available once a larger context appeared. His reach exceeded his grasp, but that overreach is an important attribute of long-sighted and imaginative science.
In another “However,” though, recent twin studies at multiple universities, especially those by David Lykken at the University of Minnesota, have shown that there is a major genetic component to Big Five test scores—perhaps up to 50 percent.19 This implies that many personality characteristics that people tend to attribute to family and societal influences (including ones as unlikely as spirituality) are at least in part genetic. It also means that the “Bleak Childhood Environment” in Table 4.1 reflects contributions from hereditary factors as well as environmental ones. This is a major complication for the analysis of our data, and another issue that we will have to wait for time to sort out.
Triumphs of Experience: The Men of the Harvard Grant Study Page 13
