Triumphs of Experience: The Men of the Harvard Grant Study
Page 33
The take-home messages here are: first, that combat exposure predicted symptoms of posttraumatic stress, but pre-existing psychopathology did not; and second, premorbid emotional vulnerability predicted subsequent psychopathology, but not symptoms of post-traumatic stress. Without the kind of prospective data and prolonged follow-up that the Grant Study made available, this finding would not have been possible.
III. POLITICS, MENTAL HEALTH, AND . . . SEX
As an optimist, a psychoanalyst, and a Democrat, I brought many prejudices to the Grant Study. I’ve always been delighted to have them confirmed, and this actually has happened occasionally. There is such a thing as a happy marriage, for example. And although colleagues derided for years my conviction that alcoholics could not return safely to controlled drinking, patience (as I detailed in Chapter 9) has seen me vindicated.10
Still, the greatest value of longitudinal study is its way of shattering prejudices and superstitions, and the Grant Study has done a real job on some of mine. I held a deep belief, for example, that Republicans are neither as loving nor as altruistic as Democrats. But after it occurred to me that Gandhi was a very bad father and John D. Rockefeller rather a good one, I thought that I had better test that notion out.
My first step was to identify political preferences from 1950 to 1999. Every biennial questionnaire had asked about politics, and we knew a lot about the men’s political views. We knew, for instance, that in 1954 only 16 percent had sanctioned the McCarthy hearings. We knew that like many liberal members of their generation, the Grant men were “for” equal rights, at least after the fact. They applauded the Supreme Court decisions and civil rights legislation after they happened, but only very few took an active role in trying to bring about racial or gender equality. In 1967, 91 percent were for de-escalating our involvement in Vietnam; this was true of only 80 percent of their classmates. Had the Grant Study subjects had their way, Eugene McCarthy and Nelson Rockefeller would have been nominated in 1968 rather than Humphrey and Nixon; Gore would have easily beaten Bush in 2000, and the U.S. would never have invaded Iraq without further consultation or U.N. permission.
With all this information, it was not hard for independent raters to score the men along a political continuum from 1 (very liberal) to 20 (very conservative). Let me illustrate these abstractions briefly. Bert Hoover received a 20 on our scale (the highest score possible) for political conservatism. In 1964 he was a Goldwater supporter who thought that America should plan an invasion of Cuba. In 1967, he advocated “dropping Lyndon and Hubert on Hanoi” to resolve the problem of Vietnam. He saw student protests (and hippies and drug users as well) as “evidence of a sick society, a culture that is overripe and ready to be clobbered by a more vigorous one.” In 1972 Hoover disapproved of long hair, premarital sex, anti-war demonstrations, and marijuana, and said that he would forbid his children to date a black person. Asked in 1981 what blessings he perceived in a Reagan presidency, he almost shouted, “The country may survive. Especially if we can rid the House of idiot liberals!” The public figure in the last two hundred years that he most admired was Herbert Hoover; and in 1985 when asked to check his current political stance—conservative or liberal—he wrote in, “just left of Genghis Khan.” In 1988, with regard to “student protests over disarmament and university divestment in South Africa,” he circled “Disapprove” and inked in, for emphasis, “The dumb bastards.” In 1995, he was asked to check “What do you think of Newt Gingrich?” with choices ranging from “Delight” to “An abomination.” Hoover circled “Delight” and again ad-libbed for emphasis, “Sorry. The abomination [that is, Bill Clinton] is in the White House!” In 1999, Hoover nominated Ronald Reagan for Time’s Man of the Century.
Oscar Weil, on the other hand, got a score of 3 on the political continuum. He had returned far fewer questionnaires than Hoover had, but of the Study black sheep Weil was one of my favorites. In 1964 he had supported Johnson over Goldwater. In 1967, he suggested that the way to end the crisis in Vietnam was to “Halt all offensive operations; start drawing up a time-table with South Vietnam for return of U.S. forces [to U.S.].”
Weil did not buy the whole Sixties package. In 1972, asked how he felt about his children and long hair, he responded insightfully, “I know it is irrelevant, but somehow I can’t cheer it on.” He added, “I know it’s silly, but I have difficulty with premarital sex.” But he had no problem with his daughters dating black people, and about the anti-war demonstrations he wrote, “On the general level of protest, I am most excited. I think that this is a really revolutionary time in this country and holds great promise for a real leap forward.” He supported Walter Mondale for president in 1984, and Michael Dukakis in 1988. With regard to student protests for disarmament and against university investment in South Africa, he checked “approve” and inked in for emphasis, “I am more sympathetic to purely symbolic acts than I once was.” In 1992 he voted for Clinton “with pleasure.” He voted for Clinton again in 1996.
Most of the men in the Study clustered toward these two poles of the political continuum, and most maintained their positions for fifty years. The distribution of scores along the liberal-conservative axis was not a bell curve; it looked more like the twin humps of a Bactrian camel. And when I ran my test of how politics correlated with love, nobility, and so forth, it proved that my lifelong convictions about the virtues of liberals had no validity at all. Democrats had no superiority over Republicans with regard to the stability of their marriages, their mental health, their altruism, or their aging. Conservatives and liberals enjoyed identical scores on the Decathlon of Flourishing, and there was no difference in their relationships with their children.
That didn’t mean that there were no real (and significant) differences between liberal and conservative. Liberals were more likely to be open to new ideas, and to approve of the younger generation’s behavior. They were more likely to have had highly educated mothers, to have gone to graduate school, to display creativity, and to use sublimation as a defense. Conservatives were less open to novelty, but they made more money, played more sports, and were twice as likely to be religious.
I wondered what influences might inform political alignment, and went back to the men’s college records. The two political poles could easily be identified in college, but—at least in this cohort—choice of one or the other had nothing to do with the quality of the men’s childhoods, and little to do with parental social class. Remember, Identity in the Eriksonian sense means disentangling your values, your allegiances, and your politics from your parents’.
Surprisingly, however, the men’s personalities in college had everything to do with their politics at eighty. As I’ve recounted, in 1942 each man was rated on twenty-six personality traits.11 Two of them, Pragmatic and Practical organizing—both consistent with hardheaded common sense—were not significantly correlated with many facets of mental health. But they were very significantly associated with conservatism half a century later. Conversely, five traits quite uncorrelated with mental health and not well regarded by the early Study staff (but epitomizing many people’s stereotype of Harvard students)—Introspective, Creative and intuitive, Cultural, Ideational, and Sensitive affect—were very significantly predictive fifty to seventy years later of being classified as a liberal.
Before he died at eighty-six, my very Republican, very intolerant, and as best I can tell, very mentally healthy grandfather used to chaff me with his take on the old epigram: If you’re not a socialist before you’re thirty, you have no heart; and if you’re still a socialist afterward, you have no brains. But as a good developmentalist and champion of prospective study, I can now see that he was misled by retrospection. He’d been a McKinley Republican even as a young man. The years of Grant Study questionnaires confirmed that political convictions tend to endure, and that most young liberals and conservatives evolve smoothly into older ones. William James wasn’t all wrong.
At the end of the day, those differences were not impor
tant. Even if “openness” were to be counted as a virtue—as my liberal prejudices would have it—that trait did not correlate with successful aging. For a while I was prepared to say that political conservatism predicts nothing about the future but one’s politics. But, as it turned out, there was one big surprise hidden in the men’s political profiles. As I noted in Chapter 6, the two early traits that predicted conservatism also predicted early sexual inactivity, and the five traits associated with being a liberal predicted sustained sexual activity fifty years later. The seven most liberal men (with scores of 0–5) did not on average cease sexual activity until after the age of eighty. The seven most conservative men ceased sexual activity at an average age of sixty-eight. That was a significant difference. I have consulted urologists about this; they have no idea why it might be so, but it is an interesting finding nevertheless. It was curious too that the variables I thought would protect against early impotence—ancestral longevity, maturity of defenses, physical health at age eighty, and quality of marriage—showed no effect, and the men who at eighty-five were still sexually active were eight times as likely to have been rated Shy, Sensitive, Ideational, and Self-conscious and Introspective as those who became sexually inactive before seventy-five.
IV. HEALTH AND RELIGION
The modern world seems to be of two minds with regard to religion. On one hand, in the last fifty years Sunday school attendance in the U.K. has dropped from 74 percent to 4 percent, and Oxford University evolutionary biologist Richard Dawkins can declare, “I think a case can be made that faith is one of the world’s great evils, comparable to the smallpox virus but harder to eradicate.”12 On the other, Gallup polls point out that 85 percent of Americans believe in God, and an increasing number of researchers report a positive association between religious commitment and health.13 Nevertheless, despite growing evidence that there is a relationship between health, religious beliefs, and participation in religious activities, investigators remain uncertain about what might account for it. Some critics suggest that the relationship between religious commitment and physical health may be illusory, due to inadequate control of confounding factors that undermine both physical health and involvement in religion.14 Such confounders—such as, and especially, poorly matched control groups and inadequate assessment of alcohol and smoking history—have marred prior studies. A fifty-year-old church-going Mormon is almost certainly a lifelong abstainer from alcohol. That fact must be separated out from his religious beliefs and engagements as a factor in his physical health outcome. Here again, prospective study is essential.
The College cohort was ideally suited to explore such concerns. Participants were a well-studied, culturally and socioeconomically homogeneous sample of men who varied widely in religious involvement and in health habits, but who all had excellent access to education and health care. Starting in 1967, in the College men’s twenty-fifth reunion questionnaires, I began investigating the depth of their reported religious faith and the extent of their participation in it. I wanted to test a hypothesis that religious interest would increase with age. Also, I suspected that religious involvement would make a positive contribution to aging, both from a medical and a psychosocial perspective.
I assessed religious involvement over a thirty-year period on a 5-point scale: 1 = no involvement; 3 = some involvement; 5 = deep involvement. By design, different questionnaires explored different aspects, including how frequently a man attended religious services, how important he considered a personal belief in God, how applicable he considered religious considerations to his own life, and so on. Ninety men (two-fifths) fell into category 1 (close to atheism), and forty-eight men (one-fifth) fell into category 5 (devoutly religious).
We also assessed interest in “private spiritual practices” and other markers of interest in individual spiritual development as separate from faith-based beliefs and institutions. In our sample, the two admittedly different concepts of religion and spirituality overlapped so markedly that it was not possible to find any significant outcome difference between their effects. Fewer than 3 percent of the men fell in the top third in the religion category and the bottom third in the spirituality category, or vice versa. In short, our measure of “religious involvement” appears to have good face validity in measuring interest in “spirituality” too.
Counter to my first hypothesis that religious involvement would increase with age, 58 percent of the men reported little religious involvement at sixty-five in contrast to only 28 percent in college. Nine (26 percent) of thirty-five men who had gone to church regularly when young had virtually no involvement after age sixty. However, fifteen (25 percent) of the sixty men with little religious involvement when young became very involved after age sixty. Why? One possible reason might be that those fifteen men manifested nine times as many symptoms of depression, and spent three times as many years disabled or dead before age eighty, as the nine men whose religious involvement declined over time. This doesn’t mean that religion is bad for your mental state. But the ill are more likely to go to the hospital than the healthy, and the depressed and anxious are more likely than the psychologically robust to seek religious comfort.15
Table 10.1 contrasts the associations and consequences of religious involvement with the associations and consequences of mental health. Associations included parental social class, warmth of childhood, psychosocial soundness in college, smoking (in pack years), and alcohol abuse.16 I expected to find a positive relationship between physical health and religious involvement, but Table 10.1 reveals none. There were 224 men for whom we had adequate data about their participation in religion over the course of their lives. By 2012, 63 (70 percent) of the 90 men with no religious involvement had died, and 36 (75 percent) of the 48 men with deep involvement had died. Notably, in these two well-matched groups of agnostic and religiously committed men, not only was there no difference in mortality, there was also no difference in cigarette and alcohol abuse. Mormons, Seventh-Day Adventists, and evangelical Christians live longer than their agnostic neighbors; they abuse cigarettes and alcohol far less. This was not true, however, for the devout Grant Study Irish Catholics and Episcopalians. The likelihood is that abstinence from drinking and smoking play more of a role in increased longevity than religious devotion itself.
Table 10.1 Religious Involvement and Adult Adjustment
Very significant = p<.001; Significant = p<. 01
Depression and an increase in stressful life events correlated significantly with increased religious involvement and also with psychiatric visits, but psychiatric visits and religious involvement were not correlated with each other except that they both appear to reflect independent ways that the men coped with life’s difficulties. And if religion was not important to the longevity of the men in general, it was useful to the forty-nine men with the highest “misery quotient,” including eighteen men who suffered from major depressive disorder, twenty-five who had experienced multiple stressful life events not of their own making, and six men of whom both these conditions were true.17 Among the ten “miserable” agnostics, only one survived until age eighty-five. But among the fifteen “miserable” but deeply religious men nine were still alive—an almost significant difference (p<.02). Looked at from a psychosocial perspective rather than a strictly medical one, religious devotion remains one of humanity’s great sources of comfort, and for many denominations replaces the use (and abuse) of alcohol and cigarettes.
My last hypothesis—that religious involvement would be associated with enhanced social support (as a consequence of more loving behavior toward others)—was not confirmed. The items in Table 10.2 were selected from two personality questionnaires, one administered when the men were about fifty years of age, and one when they were seventy-five.18 The first four items were chosen as common reflections of religious faith, and the second three as reflections of real-life loving relationships. All items used a True = 1, False = 0 format.
Table 10.2 Spirituality and Warm Relationships
Very significant = p<.001; Significant = p<. 01; NS = Not significant.
The items chosen to reflect spirituality did correlate highly with religious involvement, but not with adult adjustment from age fifty to sixty-five. Conversely, the second group of items correlated significantly with adult adjustment, but not with religious involvement.19 To embrace the last three items requires a happy childhood or a loving spouse. The first four items do not; they can be honored in the abstract, whatever one’s life circumstances or relational capacities. More, for people whose circumstances or capacities do not facilitate loving real-life relationships, they promise other sources of contact. Even if a bleak childhood has taught you not to trust, or a major depression has distanced your friends, God continues to love you. Religion is a source of comfort for people whose concrete sources of love are limited. Beethoven saved himself in an angry depression by writing incomparable faith-inspired music, and he set to it Schiller’s words: “Be embraced, all ye millions, with a kiss for all the world. Brothers, beyond the stars surely dwells a loving father.”
There are some disparities between these Grant Study findings and those of other well-designed studies, and they deserve comment. An impressive body of research suggests that attendance at religious services protects against premature mortality.20 But none of them show a direct causal effect, and too many rely on self-reports of alcohol abuse and physical health rather than on objective evidence.21 As I’ve said, some deny the effects of alcohol and cigarettes entirely. One elegantly designed and analyzed study by leading social scientists notes that “church attendees were also less likely to smoke and drink, but those variables did not significantly affect mortality; thus they are not considered further.”22 Yet in virtually all studies conducted by physicians, alcohol abuse and smoking are among the most important causes of premature mortality. In the Grant and Glueck Studies, early mortality was four times higher among the alcohol and cigarette abusers than among nonsmoking social drinkers.23 In our underprivileged Inner City sample, religious involvement at age forty-seven appeared to predict significantly fewer years of disability by age seventy. But the significance of this effect disappeared when smoking, alcohol abuse, and years of education were controlled for.