Early and Midlife Predictors of Wisdom and Subjective Well-Being in Old Age.

Objectives: We explored whether wisdom and well-being in old age are the result of early personality traits related to personality growth or personality adjustment, respectively, or successful human development as outlined by Erikson's stage theory and the life course paradigm. Method: Structural equation models were applied to analyze 60-year longitudinal data of 98 white male Harvard graduates born between 1915 and 1924. Different sets of judges rated the men's childhood and adolescence, early adult personality, and midlife generativity. Items measuring wisdom and well-being in old age were self-assessed. Results: Although wisdom and subjective well-being at age 80 were positively correlated, early life predictors differed. Openness to experiences in early adulthood predicted wisdom 60 years later, whereas greater emotional stability and extraversion predicted subjective well-being. Additionally, old age wisdom could be traced back to psychosocial growth throughout life, facilitated by a supportive childhood, adolescent competence, emotional stability in early adulthood, and generativity at midlife. Discussion: Personality traits indicative of personality adjustment or growth differentially predict late-life well-being and wisdom. Yet a balance between personality adjustment and growth, aided by social support and competence during the formative years, might be required to promote wisdom development throughout life.

Development of Adaptive Coping From Mid to Late Life: A 70-Year Longitudinal Study of Defense Maturity and Its Psychosocial Correlates.

The present study examines changes in defense maturity from mid to late life using data from an over 70-year longitudinal study. A sample of 72 men was followed beginning in late adolescence. Participants' childhoods were coded for emotional warmth. Defense mechanisms were coded by independent raters using the Q-Sort of Defenses (, Ego mechanisms of defense: A guide for clinicians and researchers 217-233) based on interview data gathered at approximately ages 52 and 75. We examined psychosocial correlates of defenses at midlife, late life, and changes in defense from mid to late life. Overall, defenses grew more adaptive from midlife to late life. However, results differed on the basis of the emotional warmth experienced in the participants' childhoods. In midlife, men who experienced warm childhoods used more adaptive (mature) defenses; yet by late life, this difference in defensive maturity had disappeared. Men who experienced less childhood warmth were more likely to show an increase in adaptive defenses during the period from mid to late life.

Midlife Eriksonian psychosocial development: Setting the stage for late-life cognitive and emotional health.

Erikson's (1950) model of adult psychosocial development outlines the significance of successful involvement within one's relationships, work, and community for healthy aging. He theorized that the consequences of not meeting developmental challenges included stagnation and emotional despair. Drawing on this model, the present study uses prospective longitudinal data to examine how the quality of assessed Eriksonian psychosocial development in midlife relates to late-life cognitive and emotional functioning. In particular we were interested to see whether late-life depression mediated the relationship between Eriksonian development and specific domains of cognitive functioning (i.e., executive functioning and memory). Participants were 159 men from the over-75 year longitudinal Study of Adult Development. The sample was comprised of men from both higher and lower socioeconomic strata. Eriksonian psychosocial development was coded from men's narrative responses to interviews between the ages of 30-47 (Vaillant & Milofsky, 1980). In late life (ages 75-85) men completed a performance-based neuropsychological assessment measuring global cognitive status, executive functioning, and memory. In addition depressive symptomatology was assessed using the Geriatric Depression Scale. Our results indicated that higher midlife Eriksonian psychosocial development was associated with stronger global cognitive functioning and executive functioning, and lower levels of depression 3 to 4 decades later. There was no significant association between Eriksonian development and late-life memory. Late-life depression mediated the relationship between Eriksonian development and both global cognition and executive functioning. All of these results controlled for highest level of education and adolescent intelligence. Findings have important implications for understanding the lasting benefits of psychosocial engagement in mid-adulthood for late-life cognitive and emotional health. In addition, it may be that less successful psychosocial development increases levels of depression making individuals more vulnerable to specific areas of cognitive decline.

Childhood adversity, midlife generativity, and later life well-being.

OBJECTIVES: Prior studies confirm that after experiencing childhood adversity, resilient adults can recover and engage in generative growth. This study explored the long-term effects of childhood adversity (assessed as harsh parenting and/or childhood poverty) on successful aging for individuals who either achieved or failed to achieve Erikson's psychosocial developmental stage of generativity in midlife. METHOD: The study utilized a sample of 636 men from the Harvard Sample and Inner City Cohort of the 73-year longitudinal Study of Adult Development. Nested ordinary least squares regression models were used to test the mediating and moderating effects of midlife generativity on later life health and adjustment to aging. RESULTS: Men who experienced childhood adversity were less likely than men with no childhood adversity to achieve generativity in midlife. Although achievement of generativity was associated with better later life health and adjustment to aging, it neither mediated nor moderated the negative relation between childhood poverty and later life health outcomes. However, for men who experienced an adversarial childhood, achievement of generativity mediated and moderated adjustment to aging. DISCUSSION: Results suggest that psychosocial growth in adulthood can compensate for the long-term negative effects of an adversarial childhood on adjustment to aging, but not for later life health.

Antecedents of intact cognition and dementia at age 90 years: a prospective study.

OBJECTIVES: This study aimed to examine the possible antecedents of both dementia and sustained intact cognition at age 90 years among men who underwent a prospective, multidisciplinary assessment from ages 19 to 90 years, with little attrition. METHODS: We conducted a prospective 20-year reassessment of 196 (out of 268) former Harvard college sophomores who survived until age 70 years. Since 1939, the study gathered measurements of childhood environment, dominant personality traits, objective mental and physical health over time, smoking in pack-years, alcohol abuse, and depression. Questionnaires were obtained every 2 years and physical exams every 5 years. Cognitive status was assessed at ages 80, 85, and 90 years. RESULTS: Despite addressing a wide variety of health, behavioral, and social factors over the lifespan, we observed few predictors with strong association with either intact cognition at age 90 years (n = 40) or dementia (n = 44). Univariate analysis revealed seven suggestive predictors of intact cognition at age 90 years or of dementia: warm childhood relationship with mother, exercise at age 60 years, high maternal education, young age of mother at subject's birth, low body mass index, good physical health at 60 years, and late retirement. Only the first three variables, warm childhood relationship with mother, exercise at age 60 years, and high maternal education, remained significant with logistic regression. CONCLUSIONS: In this prospective study of long-lived, highly educated men, several well-known putative predictors of Alzheimer's disease did not distinguish those who over the next 20 years developed dementia from those with unimpaired cognition until age 90 years.

Childhood Environment as a Predictor of Perceived Health Status in Late Life.

Prior studies have shown that perceived health status is a consistent and reliable predictor of morbidity and mortality. Because perceived health status and objective health are not highly correlated, we sought to identify additional factors that shape self-perceptions of health. Research suggests that childhood experience is an important predictor of health in adulthood, but most studies are retrospective. Using data from a 70-year prospective study of psychosocial development, we examined the quality of childhood environment as a predictor of perceived health in late life. This study utilizes questionnaire data from a longitudinal study of adult development to examine predictors of perceived health across seven decades. Participants were members of the Study of Adult Development, a longitudinal study of men followed for seven decades beginning in late adolescence. Childhood environment characteristics were assessed during home visits and interviews with respondents' parents at entry into the study. At ages 63, 73, and 78, current health status was measured by an internist not affiliated with the Study, and perceived health was assessed via self-report questionnaires. Linear regression analyses were conducted to examine childhood environment as a predictor of perceived health status at these 3 time points while controlling for concurrent objective health and young adult neuroticism. Childhood environment predicted perceived health at all 3 time points. This study supports the hypothesis that the quality of childhood environment makes a unique contribution above and beyond personality traits and objective health status to perceptions of health in late life.

Psychiatry, religion, positive emotions and spirituality.

This paper proposes that eight positive emotions: awe, love/attachment, trust/faith, compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology. Rather, spirituality is all about emotion and social connection that are more dependent on the limbic system than the cortex. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change, if clinicians set about enhancing positive emotions, rather than focusing only on the negative ones.

Adaptive midlife defense mechanisms and late-life health.

A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.

Positive mental health: is there a cross-cultural definition?

SEVEN MODELS FOR CONCEPTUALIZING POSITIVE MENTAL HEALTH ARE REVIEWED: mental health as above normal, epitomized by a DSM-IV's Global Assessment of Functioning (GAF) score of over 80; mental health as the presence of multiple human strengths rather than the absence of weaknesses; mental health conceptualized as maturity; mental health as the dominance of positive emotions; mental health as high socio-emotional intelligence; mental health as subjective well-being; mental health as resilience. Safeguards for the study of mental health are suggested, including the need to define mental health in terms that are culturally sensitive and inclusive, and the need to empirically and longitudinally validate criteria for mental health.

Involuntary coping mechanisms: a psychodynamic perspective.

Coping responses to stress can be divided into three broad categories. The first coping category involves voluntarily mobilizing social supports. The second category involves voluntary coping strategies like rehearsing responses to danger. The third coping category, like fever and leukocytosis, is involuntary. It entails deploying unconscious homeostatic mechanisms that reduce the disorganizing effects of sudden stress, DSM-5 offers a tentative hierarchy of defenses, from psychotic to immature to mature. The 70-year prospective Study of Development at Harvard provides a clinical validation of this hierarchy Maturity of coping predicted psychosocial adjustment to aging 25 years later, and was associated with not developing symptoms of post-traumatic stress disorder after very severe WWII combat.

The neuroendocrine system and stress, emotions, thoughts and feelings.

The philosophy of mind is intimately connected with the philosophy of action. Therefore, concepts like free will, motivation, emotions (especially positive emotions), and also the ethical issues related to these concepts are of abiding interest. However, the concepts of consciousness and free will are usually discussed solely in linguistic, ideational and cognitive (i.e. "left brain") terms. Admittedly, consciousness requires language and the left-brain, but the aphasic right brain is equally conscious; however, what it "hears" are more likely to be music and emotions. Joy can be as conscious as the conscious motivation produced by the left-brain reading a sign that says, "Danger mines!!" However, look in the index of a Western textbook of psychology, psychiatry or philosophy for positive emotions located in the limbic system. Notice how discussion of positive spiritual/emotional issues in consciousness and motivation are scrupulously ignored. For example, the popular notions of "love" being either Eros (raw, amoral instinct) or agape (noble, non-specific valuing of all other people) miss the motivational forest for the trees. Neither Eros (hypothalamic) nor agape (cortical) has a fraction of the power to relieve stress as attachment (limbic love), yet until the 1950s attachment was neither appreciated nor discussed by academic minds. This paper will point out that the prosocial, "spiritual" positive emotions like hope, faith, forgiveness, joy, compassion and gratitude are extremely important in the relief of stress and in regulation of the neuroendocrine system, protecting us against stress. The experimental work reviewed by Antonio Damasio and Barbara Fredrickson, and the clinical example of Alcoholics Anonymous, will be used to illustrate these points.

Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course.

BACKGROUND: Adverse child environments are associated with the onset of mood and anxiety disorders in adulthood. The mechanisms underlying these life-course associations remain poorly understood. We investigate whether emotional reactivity to stress is a mechanism in the association between childhood environment characteristics and adult mood and anxiety disorders. METHODS: Data are from the Study of Adult Development, a longitudinal study of men (N = 268) followed for nearly seven decades beginning in late adolescence. Childhood social environment characteristics were assessed during home visits and interviews with respondents' parents at entry into the study. Stress reactivity was assessed during respondents' sophomore year of college via physician exam. Onset of mood and anxiety disorders in adulthood was ascertained by research psychiatrists who completed chart reviews of interview, questionnaire, and physical exam data collected during repeated assessments from age 20 to 70. RESULTS: Respondents with better overall childhood environments and a greater number of environmental strengths were at lower odds of developing a mood or anxiety disorder in adulthood than respondents with more adverse childhood environments. Higher stress reactivity was observed among respondents from families with lower socio-economic status and with childhood environments characterized by greater conflict and adversity. Elevated stress reactivity, in turn, predicted the onset of adult mood and anxiety disorders. CONCLUSION: Heightened emotional reactivity in early adulthood is associated with both adverse childhood environments and elevated risk for developing mood and anxiety disorders in adulthood. Emotional reactivity may be one mechanism linking childhood adversity to mood and anxiety disorders in adulthood.

Expert consensus on characteristics of wisdom: a Delphi method study.

PURPOSE: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. DESIGN AND METHODS: A survey questionnaire comprised 53 Likert scale statements related to the concepts of wisdom, intelligence, and spirituality was developed to determine if and how wisdom was viewed as being distinct from the latter 2 concepts. Of the 57 international wisdom experts contacted by e-mail, 30 completed the Phase 1 survey and 27 also completed the Phase 2 survey. RESULTS: In Phase 1, there were significant group differences among the concepts of wisdom, intelligence, and spirituality on 49 of the 53 items rated by the experts. Wisdom differed from intelligence on 46 of these 49 items, whereas wisdom differed from spirituality on 31 items. In Phase 2, we sought to define wisdom further by selecting 12 items based on Phase 1 results. Most experts agreed on many of the suggested characteristics of wisdom-that is, it is uniquely human; a form of advanced cognitive and emotional development that is experience driven; and a personal quality, albeit a rare one, which can be learned, increases with age, can be measured, and is not likely to be enhanced by taking medication. IMPLICATIONS: There was considerable agreement among the expert participants on wisdom being a distinct entity and a number of its characteristic qualities. These data should help in designing additional empirical research on wisdom.

Do formal religious participation and spiritual perceptions have independent linkages with diverse dimensions of psychological well-being?

Recognizing religiosity and spirituality as related yet distinct phenomena, and conceptualizing psychological well-being as a multidimensional construct, this study examines whether individuals' frequency of formal religious participation and spiritual perceptions are independently associated with diverse dimensions of psychological well-being (negative affect, positive affect, purpose in life, positive relations with others, personal growth, self-acceptance, environmental mastery, and autonomy). Data came from 1,564 respondents in the 2005 National Survey of Midlife in the United States (MIDUS). Higher levels of spiritual perceptions were independently associated with better psychological well-being across all dimensions, and three of these salutary associations were stronger among women than men. Greater formal religious participation was independently associated only with more purpose in life and (among older adults) personal growth; greater formal religious participation was also associated with less autonomy. Overall, results suggest a different pattern of independent linkages between formal religious participation and spiritual perceptions across diverse dimensions of psychological well-being.

A prospective study of church attendance and health over the lifespan.

OBJECTIVE: The objective of the current study was to help clarify the previously ambiguous results concerning the relationship between church attendance and later physical health. DESIGN: The current study examined the effect of church attendance on 4 different indicators of later health in a sample of inner city men followed throughout their lifecourse. Measures of previous health status, mood, substance abuse, smoking, education, and social class were used as covariates in regression analyses predicting health at age 70 from church attendance at age 47. MAIN OUTCOME MEASURES: Health at age 70 was assessed by 4 indicators: mortality, objective physical health, subjective physical health, and subjective well-being. RESULTS: Though church attendance was related to later physical health, this was only through indirect means, as both physical health and church attendance were associated with substance use and mood. However, findings do suggest a more direct link between church attendance and well-being. CONCLUSION: Indirect effects of church attendance on health were clearly observed, with alcohol use/dependence, smoking, and mood being possible mediators of the church attendance-health relationship. The effects of church attendance on more subjective ratings of health, however, may be more direct.

Positive emotions, spirituality and the practice of psychiatry.

THIS PAPER PROPOSES THAT EIGHT POSITIVE EMOTIONS: awe, love (attachment), trust (faith), compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology; rather, spirituality is all about emotion and social connection.Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change if clinicians set about enhancing positive emotions rather than focusing only on negative emotions.

The natural history of male mental health: health and religious involvement.

In prior studies, the effect of religious involvement upon physical health has shown generally positive results, but these studies have been marred by confounders. The 65-year-old US prospective Study of Adult Development has offered an opportunity to repeat these studies with somewhat better control over confounders. The physical and mental health of 224 Harvard University sophomores was monitored for 65 years. Their religious involvement from church attendance to private spirituality was prospectively monitored every 2-4 years from age 47 to 85. In this analysis we focus on the male respondent. We found that religious involvement, no matter how measured was uncorrelated with their late life physical, mental and social well-being. The exception was that the 44 men with major depression or with multiple negative life events were twice as likely to manifest high religious involvement as men with the least "stress." If these findings can be generalized, they suggest that religious involvement may exert the greatest mental health benefits on people with the fewest alternative social and personal resources.

Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study.

OBJECTIVE: The authors examined the quality of sibling relationships in childhood as a predictor of major depression in adulthood. METHOD: Study subjects were 229 men selected for mental and physical health and followed from ages 20 through 50 and beyond as part of a study of adult psychosocial development. Data were obtained from interviews with participants and their parents at intake and from follow-up interviews and self-report questionnaires completed by participants at regular intervals. These data were used to rate the quality of relationships with siblings, the quality of parenting received in childhood, and family history of depression as well as the occurrence, by age 50, of major depression, alcoholism, and use of mood-altering drugs (tranquilizers, sleeping pills, and stimulants). RESULTS: Poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50, even after adjustment for the quality of childhood relationships with parents. Poor relationships with parents in childhood did not predict the occurrence of depression by age 50 when family history of depression and the quality of relationships with siblings were taken into account. Quality of sibling relationships and family history of depression did not predict later alcohol abuse or dependence. CONCLUSIONS: Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood. Further study of links between childhood sibling relationships and adult depression is warranted.

Natural history of male psychological health, XV: retirement satisfaction.

OBJECTIVE: Although previous studies of shorter duration have identified numerous risks and protective factors that powerfully influence outcomes in young adulthood and midlife, this long-term prospective study examines the effect of these prognostic factors on age at retirement and satisfaction with retirement. METHOD: In this prospective study, a cohort of socially disadvantaged men (N=151) were followed from adolescence until a mean age of 75 years (SD=2). Periodic interviews, biennial administration of questionnaires, and physical examinations every 5 years were conducted to determine biopsychosocial risk variables, age at retirement, and satisfaction with retirement. RESULTS: Early age of retirement was found to be a function of preexisting mental and physical health and later age of retirement a function of occupational status. A surprising finding was that risk factors such as poor objective physical health, low income, and depression, which are commonly associated with poor outcomes in young adulthood and in midlife, were largely unrelated to satisfaction with retirement. CONCLUSIONS: A relatively high level of satisfaction with retirement was often attained by men who had reported many risk factors for poor child and midlife development (e.g., low IQ, dropping out of school, poor mental health, and being part of a multiproblem family) but who in later life had some positive resources (e.g., a good marriage, a low level neuroticism, enjoyment of vacations, and a capacity for play). In short, retirement may offer some men a fresh lease on life.