Triumphs of Experience: The Men of the Harvard Grant Study (46 page)

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.

Another compelling explanation for our aberrant findings is that many American studies linking religious observance to physical health come out of the so-called Bible Belt, where agnostics are, at least statistically, also social outliers. In our sample of highly educated men centered in the northeastern United States, high religious involvement
was not the cultural norm; more important, it was not deeply tied in to other sources of social supports.
24
In other words, in samples where healthy social adjustment usually includes clear religious involvement, such involvement is likely to correlate with warm relationships, social supports, and good physical health. Evidence of that correlation, however, does not reflect a direct causal relationship between religious involvement and health.

V. THE IMPORTANCE OF MATERNAL GRANDFATHERS

The mean age at death of the College men’s grandparents (an 1860 birth cohort) was seventy-one years, and the mean age at death of their parents (an 1890 birth cohort) was seventy-six years. By historical standards, such ancestral longevity is remarkable, and comparable with that predicted for some contemporary European birth cohorts.
25
The likelihood of adventitious ancestral death from poor medical care, hazardous occupation, poor nutrition, or infection was less in the Grant Study sample than for less socioeconomically favored groups. This reduction in environmentally mediated mortality increased our chances to identify some genetically mediated effects on longevity.

While examining the effects of ancestral longevity on sustained good physical and mental health, we noted a marked and unexpected association between age at death of maternal grandfathers and the mental health of their grandsons.
26
The age of death of the other five first-degree ancestors (mother, father, maternal grandmother, and both paternal grandparents) was associated with virtually nothing in the men’s lives except, modestly, with longevity. But the associations with the maternal grandfather’s (MGF’s) age of death were extraordinary. For example, while the average longevity of the other five ancestors was not relevant to the men’s scores in the Decathlon of Flourishing,
the
maternal grandfathers of the men with the highest flourishing scores lived nine years longer than those of the men with the lowest scores—a significant difference. The average age of MGF death for 147 Study men who never saw a psychiatrist was seventy years. The average age of MGF death for the thirty-two men who made one hundred or more visits to a psychiatrist was sixty-one—a very significant difference—but the age of death of the other five relatives made no difference as to psychiatric visits. The maternal grandfathers of upper-class men lived only three years longer than those of men from blue-collar families.

In 1990, two board-eligible psychiatrists blind to other ratings were given the complete records of the sixty-one men in the Study who, by age fifty, manifested objective evidence of sustained psychosocial impairment (that is, psychiatric hospitalization, scoring in the bottom quartile of psychosocial adjustment at age forty-seven, or having used tranquilizers or antidepressants for more than one month). Many of these men were dependent on alcohol. They were rated for eight correlates of depression, the DSM-III criteria for major depressive disorder not yet having been developed. These eight correlates were (1) serious depression for two weeks or more by self-report, (2) diagnosis of clinical depression at some point in the man’s life by a non-Study clinician, (3) use of antidepressant medication, (4) psychiatric hospitalization for reasons other than alcohol abuse, (5) sustained anergia or anhedonia, (6) neurovegetative signs of depression (e.g., early morning awakening or weight loss when depressed), (7) suicidal preoccupations, attempts, or completions, and (8) evidence of mania.

Of the sixty-one, thirty-six men were categorized as alcoholic or personality disordered. The remaining twenty-five included twelve men categorized by only one rater as having major depressive disorder and thirteen who both raters agreed manifested major depressive
disorder.
These twenty-five men met at least three—and an average of five—criteria of major depressive disorder. The other thirty-six men met an average of only one-tenth as many criteria.

As a contrast, we identified fifty undistressed men who through the age of sixty had never reported evidence of alcohol abuse, had made no visits to a psychiatrist, and had not used psychotropic drugs more than one day a year on average over twenty years. (This stipulation covered the contingency, say, of a man’s having had to take Librium briefly during a surgical admission, or Ambien to recover from jet lag before an important overseas conference.) In addition, these men were classified in college as having well-integrated personalities, and the Study had never assigned them a psychiatric diagnosis. They were the antithesis of the depressed men.

Table 10.3
shows our four diagnostic groups: undistressed, alco-holic/personality disordered, major depressive disorder, and “intermediate”—that is, the men who didn’t fall into any of the first three. The mean age at death of MGF for the twenty clearly depressed men was sixty. The mean age at death of the fifty-eight undistressed men was seventy-five—a very significant difference. The age of death of the MGF of the ten men with the highest anxiety scores on the NEO was fifty-seven, and that of the MGF of the ten men with the lowest anxiety scores was eighty-three, an even greater distinction.

This unexpected discovery—that of the six ancestors, it was only the maternal grandfather’s longevity that was associated with affective disorder in the grandsons—is consistent with a linkage mediated via the X-chromosome. X-linked disorders such as hemophilia, color blindness, and baldness come through the mother’s father, when it is he who supplies the grandson’s only X chromosome. Such illnesses tend to skip the mother, who has a second, usually unaffected X chromosome to protect her. For half a century, researchers have speculated that there might be an X chromosome linkage in the etiology of de
pression.
27
But this hypothesis has been confirmed only inconsistently in the search for a specific gene for bipolar disorder.
28
It seems clear that bipolar disorder and major depressive disorder are genetically heterogeneous—that the genes for the two disorders are different.

Table
10.3
Mean Age at Death of Maternal Grandfather and of Other Primary Ancestors in the Four Affective Disorder Categories

Very significant = p<.001; Significant = p<. 01; NS = Not significant.

To establish firm evidence for X-linked transmission of affective disorder would require full genealogical analysis of the affected families with knowledge of presence or absence of affective disorders in both male and female subjects over three or four generations—evidence that we do not have. Our findings do indicate, however, that for unknown—dare I say mysterious—reasons, early death of maternal grandfathers predicts an increased incidence of affective disorder in the grandsons. Still more exciting is that long-lived maternal grandfathers predict unusual psychological stability in their grandsons—evidence that positive mental health may be in part genetic. The association of very long-lived maternal grandfathers with men scoring low on the NEO anxiety score is particularly intriguing.

My own guess is that someday soon an accomplished geneticist with a larger study, better characterized maternal grandfathers, and complete DNA analyses will win the Nobel Prize for explicating this
phenomenon.
At present it must be considered a preliminary finding, of interest only to the curious. Still, it is provocative, and would not have been discovered but for 60 years of follow-up. And it’s a perfect example of how a seductive gleam can wink out unexpectedly from unruly heaps of unsorted longitudinal data, to be revealed eventually by Time’s assay as either brass or true gold.

11

SUMMING UP

All’s well that ends well; still the fine’s the crown;

Whate’er the course, the end is the renown.

—WILLIAM SHAKESPEARE

LEARNING FROM LIFETIME STUDIES
does not stop until the lives have been fully lived—and not even then, because archives of prospective data are an invitation and an opportunity to go back and ask new questions time and time again, even after the people who so generously provided the answers are gone.

Each time the Study of Adult Development was threatened with extinction—in 1946, in 1954, in 1971, and in 1986—the grant-makers asked, “Hasn’t the Study been milked dry?” There was a time when
I
thought that after the College men reached sixty-five and retired, there was nothing more to do but watch them die. Yet the Study always survived—to teach, to surprise, and to give. Granting agencies must be selective, it is true, but they must be selective the way foresters are. Longitudinal studies are the redwood forests of psychosocial studies. Fallen branches and felled trees are useful in the short run. Faithfully maintained and imaginatively harvested, the older the forest gets, the more it is worth. But once cut down it can never be restored.