Posts Tagged ‘Aging’

STRONG SOCIAL RELATIONSHIPS EXTEND LIFETIMES BY 50%

Thursday, July 29th, 2010

People in industrialized countries are experiencing a steady decline in the quantity and quality of social relationships. In Bowling Alone Robert D. Putnam said Americans have gone from a society of joiners to one of loners. He convincingly documented this by marshaling statistics which show startling declines in the membership of political parties, labor unions, civic organizations, religious and charitable organizations, neighborhood associations, sports clubs and so forth. Contemporary social trends along these lines are  reduced inter-generational living, greater social mobility, delayed marriage, dual-career families, increased single-residence households, and increased age-related disabilities. Over the last two decades there has been a three-fold increase in the number of Americans who report having no confidant.

Does lack of meaningful human contact and good social relationships predict early death? The answer is yes. In a study published in the online journal PLOS Medicine in July 2010 University of Utah psychologists Julianne Holt-Lunstad and Timothy B. Smith and UNC epidemiologist J. Bradley Layton performed a meta-analysis on 148 scientific research papers dealing with the link between social relationships with morbidity and mortality. The studies looked length of survival in 308,849 participants who were followed for an average of 7.5 years. The meta-analysis demonstrated a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period.

In their conclusion the researchers say that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity).

Study author Timothy Smith said that relationships provide a level of protection for our physical health across all ages. He reminded us not to take relationships for granted as if we fish that never noticed the water.

Lawyers and other busy professionals need to take this study very seriously. Too many of us spend the bulk of our waking hours working, commuting, thinking about work, preparing for work, and soothing ourselves to relieve the stress of work. We make resolutions to spend more time with family members, but do we keep them? Some of us only see family for milestone birthdays, marriages and funerals. When we run into old friend we say “it’s been way too long, we’ve just got to get together soon,” but how often do we actually follow up? More and more people substitute Facebook communication via the Internet for real in-the-flesh socializing.

How does friendship make us happier, healthier people who lead longer lives?
The authors of the PLOS Medicine article say social relationships buffer stressors which would otherwise damage individual health. They provide resources (informational, emotional, or tangible) that promote adaptive behavioral responses to acute or chronic stressors (e.g., illness, life events, life transitions). Just having friends and knowing that social support is available can increase a person’s stress tolerance. Spending time with friends and sharing a laugh lowers cortisol and increases endorphins. Social relationships may directly encourage or indirectly model healthy behaviors. Loners have less incentive than people in active social networks to engage in self-care and good hygiene. Being part of a social network gives individuals meaningful roles that provide self-esteem and a life purpose. Being alone during non-work hours can be taken as proof that one’s life isn’t meaningful or that other people don’t care about you.

We are social creatures. Our survival during pre-historic times depended on staying together in small, cohesive groups marked by a high degree of cooperation. People have a strong inner need to contribute to the lives of others, to give and receive human touch, and to exchange admiration, appreciation and affection with people they care about. When we experience something truly interesting, beautiful or awe inspiring we naturally want to share it with a friend. When we are lonely, scared or sad we long to share our feelings with a confidant and get his or her support.

Ultimately it’s so much better for our health and happiness to let go of the  chance to make that one extra dollar and spend that time with a friend instead. The real bottom line is not what you have in the bank, but how long you’ll live to enjoy your family, friends, and everything else that brings you joy. If the thought of spending more time socializing and less time at the office makes you apprehensive about your financial bottom line, then remember that avoiding social relationships will significantly increase your odds of dying. To have friends you have to be a friend. Believe me it pays off. Your life will be way more enjoyable and your odds of survival will increase by 50%  Isn’t that the best deal in town?

Right after finishing this blog entry I received a touching  email from my sister-in-law Lori Carlson Watsky in Austin, TX, about the value of friendship. I’m reprinting it here because it so beautifully captures why we need friends:

“If you happened to read a recent front page story of the SF Chronicle, You would have read about a female humpback whale that had become entangled in a spider web of crab traps and lines. She was weighted down by hundreds of pounds of traps that caused her to struggle to stay afloat. She also had hundreds of yards of line rope wrapped around her body,  her tail, her torso, a line tugging in her mouth.

A fisherman spotted her just east of the Farallon Islands (outside the Golden Gate ) and radioed an environmental group for help. Within a few hours, the rescue team arrived and determined that she was so bad off, the only way to save her was to dive in and untangle her. They worked for hours with curved knives and eventually freed her.

When she was free, the divers say she swam in what seemed like joyous circles. She then came back to each and every diver, one at a time,  and nudged them, pushed them gently around…she was thanking them. Some said it was the most incredibly beautiful experience of their lives. The guy who cut the rope out of her mouth said her eyes were following him the whole time, and he will never be the same.

May you, and all those you love, be so blessed and fortunate to be surrounded by people who will help you get untangled from the things that are binding you. And, may you always know the joy of giving and receiving gratitude. I pass this on to you, my friends, in the same spirit.”

DETECTING AND TREATING DEPRESSION IN OLDER LAWYERS

Thursday, July 8th, 2010
Life doesn’t always get easier for lawyers who make it through middle age into their sixties and seventies. Geriatric psychiatrists Mark D. Miller, M.D. and Charles F. Reynolds III, M.D., have written extensively about the unique challenges facing people in later life (people over 60) which can precipitate depression while making it hard to get treatment. According to these physicians if you become depressed for the first time after age 60, the odds are that your depression is not the result of genetic influences but came from something else.
What else might cause a first time depression in someone older than sixty? Their list includes the following: a series of mini-strokes which went undetected but caused cognitive impairment; experiencing the death of one’s parent, spouse, siblings or close friends; living with disability due to chronic pain or other causes which forces one to stop playing sports or engaging in hobbies; thyroid malfunction (either too much or too little output of thyroid hormone); Vitamin B12 deficiency; neuro-degenerative diseases such as Alzheimer’s or Parkinson’s; sleep apnea; liver or kidney disease allowing toxic substances to build up in the blood that goes to the brain; and the use of a beta blocker to lower blood pressure, which can cause depression as a side effect. Current research by other physicians indicates that statin drugs used to lower cholesterol can impair serotonin reception and cause depression, and that Vitamin D deficiency can be source of parathyroid hormone disruption and depression in older people.
Whatever the cause of the depression, Drs. Miller and Reynolds say it is a disease which can and should be treated rather than a natural part of aging. In their practice they have found that the vast majority of older patients who are treated for depression experience significant improvement in mood and increase in daily functioning. According to these physicians whatever the cause of the depression, the existence of depression may be missed in older people or not taken seriously for several different reasons.
First, there is a general assumption that when you’re old you slow down and begin to tune out. Second, there is an assumption that anyone who faces the circumstances of aging (illness, disability and loss of loved ones) is justified in feeling down. Third, older people don’t say they’re feeling “sad,” “blue,” or “depressed,” but talk about feeling “lousy” which can mislead others into thinking they have purely physical problems. These doctors assert the myth that depression is an inevitable part of later life is the biggest obstacle to treatment.
A fourth reason family and friends may fail to detect depression in an older member was recently discovered by Linda Mah, M.D. who works with older adults with depression at the Mood Clinic at Baycrest in Toronto, Canada. Her study appeared in the May 2010 online version of the American Journal of Geriatric Psychiatry. Dr. Mah was aware that in older patients the diagnosis of depression is typically made on the basis of cognitive impairment, whereas in middle aged patients the focus is on poor mood. She explored the possibility that studying emotion could help us better understand depression in older people.
Dr. Mah recruited 22 people age 60-87 consisting of a group of 11 un-medicated outpatients with major depression and another 11 healthy controls. She showed them photographs of faces with happy, sad, fearful or neutral expressions. The depressed patients showed a relative lack of sensitivity to the effects of positive or negative emotional expression, and they had 60% greater difficulty with correctly labeling neutral faces compared to the healthy subjects. Dr. Mah concluded that older depressed patients have an impaired ability to read other people’s emotional expressions (something that would likely damage their social connectivity); and that unlike younger depressed patients, who tend to respond negatively to all emotional stimuli compared with healthy controls, older depressed patients respond in a baffled or confused way to the emotional displays of others.
If you’re concerned that an older colleague might be depressed what symptoms should you be looking for? The chief symptoms are insomnia, loss of appetite with weight loss, low energy or fatigue, difficulty concentrating, feeling worthless or excessively guilty (often expressed by describing oneself as a “burden” to others), slowing of movements (often accompanied by a long face and stooped posture) and suicidal thoughts.
If you see these symptoms in an older colleague, do your best to get him seen by a geriatric psychiatrist. Drs. Miller and Reynolds say that the rate of suicide is five times higher in later life than at other times. This may have something to do with the perception of older people that their time is running out coupled with the depressive thought that things will only get worse and cannot get better. These perceptions are distortions. In a previous blog I detailed the insights of Harvard psychiatrist George Vaillant, M.D. in his book Aging Well on how to make later life the crown and the happiest time of a well lived life.
In their book Living Longer Depression Free: A Family Guide to Recognizing, Treating, and Preventing Depression in Later Life, Drs. Miller and Reynolds cover all the different forms of conventional and alternative treatments now available to help older people with depression. I recommend this book to anyone trying to understand how to deal with issues posed by depression in later life. It has an excellent chapter on how to grieve in a full, expressive, and healthy manner, as well as much useful information on the practicalities of how to access proper care for depression.

PROTECT YOURSELF FROM HEARING LOSS AND DEPRESSION

Wednesday, May 26th, 2010

Hearing loss during your working years is associated with diminished professional competence, social isolation and depression. When a lawyer can’t hear what his secretary, his paralegal or his clients are saying he’s in trouble. When he can’t hear what opposing lawyers, witnesses, court reporters, judges and potential jurors are saying he’s in trouble. Hearing loss is way more common you think. It afflicts 36 million people in America, and although hearing loss is more prevalent in the elderly, one third of those aged 40-49 already suffer from it. When I checked the NY Times Guide to Health it recommended a hearing exam once per year beginning at age 65, but made no recommendation for younger individuals. It looks as if the Times is behind the times when it comes to hearing health.

Could you be losing your hearing? It’s possible if your answer is yes to most or all of these questions: Do you have trouble determining where sounds came from? Do you hear sounds as being muffled rather than sharp and clear? Do you strain to hear people during conversation? Do you frequently ask people to repeat themselves? Do you lose parts of conversations when there is a lot of background noise? Do you often feel that people mumble when they speak or fail to speak clearly? Have colleagues, family members or friends told you they think you have a hearing problem? Do you have to increase the volume on the TV or radio to very high levels in order to hear comfortably? Do you tend to hear better through one ear? Do you have ringing or pain in one or both ears on a regular basis? Do you have fluid drainage from one or both ears on a regular basis? If you have answered yes to a majority of these questions you should get a hearing test. Many health insurance plans cover them.

Which middle aged people are most at risk for hearing loss? People with a family history of hearing loss; a personal medical history of ear trauma, frequent ear infections as a child or of tinnitus as an adult; and anyone exposed to very loud noises from miliary service or occupation (e.g. rock musicians, miners and construction workers). The most surprising category of people at high risk of hearing loss during middle age are regular users of the analgesics aspirin, NSAIDs and acetaminophen. These are the three most commonly used drugs in the United States.

In the March 2010 issue of The American Journal of Medicine Dr. Sharon G. Curhan of the Brigham and Women’s Hospital, Boston, and colleagues from Harvard University, the Massachusetts Eye and Ear Infirmary and Vanderbilt University published an article on hearing loss in men under age 60 from causes other than the conventional ones such as age or noise. They tracked 26,917 men every 2 years for 18 years. They found that men in the under 50 and the 50-59 age groups who regularly used aspirin were 33% more likely to have hearing loss than non-users; that men under 50 who regularly used NSAIDs (e.g. Naproxen) were 61% more likely to develop hearing loss than non-users and those aged 50-59 who regularly used NSAIDs were 32% more likely; that regular users of acetaminophen under age 50 were 99% more likely, and those aged 50-59 were 38% more likely.

What is the causal connection between regular use of these analgesics and hearing loss? All three analgesics are ototoxic when consumed regularly over a period of years. That means they damage the hair cells in the cochlea of the inner ear causing sensori-neural hearing loss. Hearing loss caused by regular use of analgesics appears to be reversible in many patients.

If you absolutely must take analgesics on a regular basis for a chronic pain condition, then avoid acetaminophen and drink plenty of water. You could try exploring alternative means of pain-control to eliminate or at least cut back on your use of analgesics. Such methods include meditation, relaxation techniques, biofeedback, accupuncture and massage.

Click here to purchase The Upward Spiral: Getting Lawyers From Daily Misery To Lifetime Wellbeing by Harvey Hyman

Click here to purchase  audio downloads of  MCLE lectures by Harvey Hyman

SCIENTISTS CONFIRM THAT EXCESSIVE WORRY SHRINKS YOUR BRAIN

Sunday, May 9th, 2010

While there is no such thing as “the lawyer personality,” many lawyers are tense, moody, irritable and engage in frequent worry at work. Scientific research has now confirmed that personality type affects the tissue volume of key brain structures as we age. It turns out that conscientiousness (a positive quality which can make you a better lawyer and enhance many aspects of your life) preserves brain volume, while neuroticism measurably decreases it as early as middle age. We all know that worrying can’t help you protect the people you care about or solve any problems, but now we know it can shrink your brain as you age. Lawyers who worry all the time need to heed these findings and initiate changes in their attitude before it’s too late.

Personality theory has been around a long time. All of us remember terms like warm, cold, introvert, extrovert, thinking type, intuitive type, and so forth. Over the years different  psychologists proposed different models for human personality. The current thinking is that there are no fixed personality “types,” but rather clusters of personality traits associated with particular behavior patterns which are stable over time. Psychologists also agree that personality traits exist on a continuum, that individuals are a mix of these traits (displaying more of some than others), that traits dispose people to act in certain ways rather than absolutely determine how they will act, and that changing life circumstances can temporarily push certain traits into the foreground and others into the background.

There is some consensus that NIH psychologist Robert McCrae’s Five Factor Model most accurately captures basic differences in enduring personality features. McCrae refers to them as “the five basic ways in which individuals differ in their enduring emotional, interpersonal, experiential, attitudinal and emotional styles.” The five different factors in McCrae’s model are extraversion, agreeableness, conscientiousness, neuroticism and openness.

Extraversion equates with being energetic, enthusiastic, outgoing, talkative, trusting, playful and gregarious. Agreeable people are generous, kind, warm, sympathetic forgiving and altruistic. Conscientiousness equates with being competent, efficient, organized, self-disciplined, orderly, reliable, responsible, dependable and thorough.

People with neuroticism are tense, worried, anxious, thin-skinned, touchy, self-conscious, overly concerned with adequacy, self-pitying, depressed, hostile and self-defeating. Openness equates with being curious, imaginative, insightful, original, having a wide range of interests, valuing feelings, valuing aesthetics, enjoying fantasy and having or accepting unconventional viewpoints.

Personality is related to stress in many ways. On the most fundamental level your personality can make you more prone to the biological effects of stress or it can effectively insulate you from those effects. During the second half of the 20th century stress medicine research showed that stress can have many deleterious effects on animals and humans. These included dwarfism, immune system suppression, mood disorders (anxiety, depression), insomnia, stomach ulcers, and increased rates of diabetes, hypertension, heart attacks and strokes.

In the 1990s neurophysiologist Robert Sapolsky, Ph.D. (author of Why Zebras Don’t Get Ulcers) discovered that unremitting stress on monkeys caused them to suffer significant shrinkage in the tissue volume of a key brain structure called the hippocampus that lies in the medial temporal lobe. The hippocampus is the most important module in the brain for encoding long term memories and a healthy hippocampus is necessary for learning new information.

One way that Dr. Sapolsky induced the stress was by keeping younger, weaker males in constant, close contact with an older, stronger, dominant male who kept tormenting them because they had no means of escape. The younger males became visibly nervous, anxious and withdrawn. When Dr. Sapolsky tried to teach these highly stressed monkeys new tricks for acquiring food he saw that they were learning impaired (which could equate with being too distracted by anxiety to learn or with having a shrunken hippocampus). When he sacrificed them and measured the tissue volume of their hippocampi he determined they had significant shrinkage relative to male monkeys in the control group who had not been continually stressed.

What’s the mechanism? When a monkey’s survival is threatened he goes into a fight-flight response which prompts his hypothalamus to tell his pituitary to tell his adrenal glands to pump out the stress hormones adrenalin and cortisol. While adrenalin is quickly cleared from the system, cortisol is slow to dissipate. If a monkey is subjected too frequently to attacks, or credible threats of attacks, his blood cortisol level remains high.

In high amounts cortisol is neurotoxic. The hippocampus has more cortisol receptors than any other organ in the human body. Normally the hippocampus can tell the pituitary to put the brakes on cortisol production by the adrenal glands, but if it gets overwhelmed by too much cortisol over too long a period it loses its ability to do this. The cortisol build up from continuous stress kills off cells in the hippocampus which gradually shrinks and this leads to poor memory with learning impairment.

On May 19, 2009, Johnathan Jackson (a psychologist),  David A. Balota (a radiologist) and Denise Head (who works in psychology and radiology) at the University of St. Louis published a paper titled Exploring the relationship between personality and regional brain volume in healthy aging in the journal The Neurobiology of Aging. The purpose of their research was to determine what effect, if any, three targeted personality traits (extraversion, conscientiousness and neuroticism) had on brain volume in healthy people as they aged. Virtually all persons have some degree of brain shrinkage as they age. The researchers postulated that personality might correlate with and even causally impact the rate of brain shrinkage as people aged.

The researchers selected 79 cognitively intact adult males and females aged 44-88 who had no history of neurological disease, stroke, head injury, hypertension, drug or alcohol abuse or depression. They had all study participants complete the NEO Five-Factor Inventory, a validated measure of McCrae’s five personality trends. The researchers also had all study participants undergo brain imaging using an MRI with software that performs quantitative volumetric analysis. This means the MRI can identify neuroanatomic structures within each study participant’s brain and measure their volume in cubic centimeters.

The results were rather dramatic. Individuals with neuroticism had smaller cerebral gray matter generally with the most decrease in the ventrolateral prefrontal cortex (VLPFC), the dorsolateral prefrontal cortex (DLPFC) and the orbito-frontal cortex. The hippocampi of these individuals was normal for their age, which reflected the fact that these individuals – although neurotic – had not been subjected to lengthy periods of extreme stress akin to being sexually abused, fighting in a war, and so forth. The individuals who were high in conscientiousness had normal brain volume for their age in their VLPFC and DLPFC but higher than normal brain volume in their orbito-frontal cortex. The individuals high in extraversion had normal brain volume for their age in all three structures. The researchers concluded that personality may not only relate to, but may also moderate, age-related decline in the volume of certain key brain structures.

In plain English what this research indicates is that neurotic people (those who are generally tense, worried, anxious, moody and irritable) have a chronically elevated stress level, with chronically elevated levels of stress hormones, and they pay for it by experiencing accelerated shrinkage of key brain areas in their frontal lobes.

The VLPFC, the DLPFC and the orbito-frontal cortex are all frontal lobe structures that play key roles in “executive functioning.” This refers to the ability to plan behavior in accord with one’s goals, to keep one’s goal in mind in the face of distractions, to monitor one’s behavior for errors in task execution and correct them, to shift one’s attention if circumstances dictate and to complete tasks in a flexible manner in response to changing circumstances. These structures enable us to coordinate our cognitive resources to carry out complex tasks like multi-tasking.

Of the three structures the one that has the most to do with emotions is the orbito-frontal cortex. It’s the orbito-frontal cortex that carries out emotional self-regulation based on our awareness of other people’s expectations and reactions and our sensitivity to social rewards and punishment. People with damage to their orbito-frontal cortex experience problems with inhibiting impulses toward anger, rage, violence and substance use. The most famous example of this was Phinneas Gage, a foreman for the Rutland and  Burlington Railway in Vermont. In 1848 Gage accidentally exploded a dynamite cap which sent a 3 foot seven inch long iron tamping rocketing upward from the ground. It went through his cheek bone below his left eye and continued out the top of the head, piercing his brain and obliterating his orbito-frontal cortex on it’s way.

Prior to the incident Gage was a reliable, dependable employee who never drank, cursed or fought and who served as a leader in his church. Afterwards Gage was often late for work or missed work. He was cantankerous. He cursed and spat at people and got into lots of fistfights. He was fired from his job and kicked out of his church. He ended up in a freak show where he displayed the iron rod. He died of seizures. Remember that Gage is an extreme example, and someone who changed by virtue of severe brain trauma rather than someone who affected his brain on a cellular level by the daily stress of  his own neuroticism while practicing law. Although the researchers in this study did not perform neuropsychological testing on the study participants to see if they manifested impairment of brain functions such as executive functions or emotional  intelligence, one can infer they would have picked it up to varying degrees. Why? Because measurable shrinkage of cerebral gray matter is associated in the medical literature with decline in brain function.

What to do with this information

In Dr. Seuss’ wonderful story How The Grinch Stole Christmas he talks about how the Grinch’s heart shrank from a life of isolation, vengeful thoughts and scowling without kindness, friendship or giving. Can hearts literally shrink from such a life? I don’t know. But it’s clear that our brains can and do shrink in some very important places from spending too much time fussing, fretting, imagining the worst, worrying and handwringing. Genes are predispositions not destiny – the child of a depressed parent or an alcoholic parent can grow up free of depression or alcoholism. Personalities are the same. Personality represents a customary pattern of relating to oneself and one’s world but personality is not fixed and frozen.

A lawyer who tenses up, starts churning out worst case scenarios in his head and begins to fret and worry, whenever he faces an unanticipated challenge or a spot of bad news, can learn to relax, breathe and ground himself. There are a huge variety of techniques including seated meditation, walking meditation, yoga, slow and deep abdominal breathing, taking a walk in the nearest park, the Relaxation Response and the Body Scan that I have talked about in my book The Upward Spiral and in other blog articles, which can break the circuit between experiencing difficulty and automatically going into fight-flight. If you have a tendency toward neuroticism (from genes, your upraising or both), I strongly encourage you to begin using these techniques to overcome stress and keep your mind from being a stress factory which can literally shrink your brain.

The fewer brain cells you have as you age the greater your risk of dementia and the more prone you are to become disabled by a stroke or concussion from a fall. Stress reduction is important for all of us who want to stay healthy, active and mentally sharp our whole lives. For those of us in whom neuroticism is their dominant personality trend, stress reduction is absolutely crucial to prevent brain shrinkage and impairment of brain function. Although it’s never too late to start life long habits of stress reduction, you’re better off starting them in your forties than in your sixties or seventies when neuroticism may have done some irreversible damage. Many is the lawyer who changes the oil of his car every 3,000 miles but who doesn’t pay much attention to what’s under his own hood. For your health and wellbeing as you age, please remember to take good care of your brain by managing your stress.

Meditation, smiling and laughter have all been clinically proven to reduce blood cortisol. Meditation has been proven, through the use of volumetric brain MRI studies on Buddhist monks, to increase the thickness of the cerebral cortex, in particular frontal lobe structures dedicated to concentration and the insula (which enables us to have empathy for others). Please consider meditating everyday. It’s good for your brain and good for your life.

HOW TO AGE WELL FOR LAWYERS

Wednesday, February 10th, 2010

      In 1974 Henri Amiel said, “To know how to grow old is the master-work of wisdom, and one of the most difficult chapters in the great art of living.”

      The average age of lawyers working in the U.S. today is 45. This can be a stressful and difficult time for many reasons. You’ve been working for 20 years or so, but work may not have matched your hopes with regard to earnings level, financial stability, intellectual interest or enjoyment. Although you’re straining to put away money for the future college education of your children, are you having trouble communicating and getting along with them? Have you lost a parent to illness or are you under the strain of helping care for an aging parent afflicted with stroke, Alzheimer’s or another disabling illness?  

       Are you sagging or showing a bulge about the middle and wondering forlornly where the body you had in high school went? If you’re a man is your hair gone or thinning on top? Has your long term marriage left you feeling taken for granted, unappreciated or even invisible at times? Are you and your spouse irritable toward each other? Do you argue a lot? Is your level of sexual intimacy unsatisfactory? Are you feeling pressured and harried by all the bills that never stop coming at the office and at home? When was the last time you had a truly fun and relaxing vacation?  Does life seem more and more like a tiring treadmill that you’d like to unplug and take some time away from?

      If you’re not springing out of bed each morning filled with vitality and enthusiasm for the day at middle age, you’re not alone. Middle age is often the time of life when lawyers suffer from struggles with work satisfaction, finances, family relationships, personal health, depression and substance abuse. It can be a time of disillusionment with religion and wavering faith or loss of faith. It is often the time in life when lawyers resort to medications for anxiety, depression and/or sleep, and when they start carving time from their weekly schedule to see a psychologist or therapist.   

       While anti-depressants help a substantial number of people with severe depression, which is a biological event, the medical evidence is that anti-depressants don’t do much for people with mild depression arising from dissatisfaction with the lives they’ve built. Therapy isn’t always an effective solution either because most insurance policies severely restrict the number of visits you can make to a psychotherapist. The idea is to help you just enough so you can adjust to an acutely distressing situation, rather than fund an ongoing exploration and reconstruction of your adult self. Even if you have the resources to pay for long term psychotherapy, the process of re-visiting, making sense of and accepting or forgiving painful situations in childhood is not always successful.

       This article explores self-help strategies to enable lawyers in their middle years to age well and increase their health and happiness as they grow older. In our era improved nutritional and healthcare practices can keep us alive into our 80s. The big question is do you want the next three or four decades to be a blessing or a burden? Are you willing to take control, do some planning and invest some energy in your own future welfare or just keep sliding into a deeper pit? Modern studies of adult development indicate that an old dog can learn new tricks, and that we can transform our attitudes and relationships sufficiently in middle age to overcome an unhappy past.

       The model of adult development which was dominant in the last century was the one articulated by such American psychologists as Charlotte Buhler and Else Frenkel-Brunswick. They said human beings ascend developmental steps until middle age, when the period of “regressive growth” begins marked by symptoms of decline and gradual retirement from life. In 1965 Canadian psychoanalyst Elliot Jacques coined the term “mid-life crisis.” Jacques theorized that most adults underwent an episode of falling apart during middle age when they sensed the passing of their best years and recognized the onset of decline. The conventional image of a midlife crisis for a man was to have an affair and buy a Corvette.

       Between 1978 and 1987 developmental psychologist Erik Erikson published three major books on adult development which set forth a very different view. Erikson advocated a more optimistic model in which psychologically healthy adults continued to change, develop and grow throughout their lifespan as they successfully met life’s challenges. During the 1980s empirical research on adult development showed that the number of adults who had the sort of mid-life crisis described by Elliot was just 10%. This research concluded that for many people mid-life was a time for reflection and re-assessment rather than for freaking out.

       During the past couple of years Carlos Strenger, a Professor of Psychology at Tel Aviv University, has written articles saying it’s time to cast off the stereotype of the mid-life crisis as a myth and to see our middle years as a time of transition. Strenger says if you’re willing to make the most of what you learned during the first half of your life, the second half will be happier and more fulfilling. Making the second half of your life a blessing rather than a burden is more important now than ever, since life expectancies have kept rising.

       How are we to do this? Strenger says you should do four things: recognize you have a great deal of time in front of you with the ability to re-make your life for the better and start planning; identify your strongest abilities and the things that please you the most without regard to what your parents, teachers, coaches or mentors said; make choices based on knowledge and experience instead of “youthful blind ambition” and be willing to invest the energy it will take to make changes no matter how daunting the obstacles; and make full use of colleagues, friends and family to support you in the new directions you want to take. 

       The strongest and most scientific case that people can make major changes in their lives from 50-75 and wind up Happy-Well instead of Sad-Sick at the finish line (the period from 75-85) comes from George Vaillant, M.D. Dr. Vaillant says that no matter how difficult or sad our childhoods were, we each have a chance to mature emotionally and socially and reach a happy old age if we commit ourselves to grow in healthy directions. Do you remember the E.F. Hutton commercial in which everyone stopped to listen to what he had to say about stock investment? Dr. Vaillant is like the E.F. Hutton of adult development. What he says counts.

       The suicide of Dr. Vaillant’s father caused him to have a lifelong interest in adult human development. He became a psychiatrist, a professor at Harvard Medical School and an expert on the process of recovery in schizophrenia, heroin addiction, alcoholism and personality disorder. In 1967 he became the Director of the Harvard Study of Adult Development and he has served in that capacity for the past 33 years.

       The Harvard Study began over 80 years ago and is the longest running, the best financed and by far the most respected prospective study of adult development in the world. Most studies of human development are retrospective, which means the experts review records of past human health and behavior, select variables to study, crunch the numbers and try to account for why certain individuals flourished and others floundered. A prospective study is one in which the participants are screened and selected in advance, and then carefully followed (with questionnaires, medical exams and interviews) as they age to determine how they respond to life’s challenges and opportunities as they age.

       These kinds of studies are expensive and difficult to pull off. They require a high degree of organization, coordination and effort from the investigators and a high degree of loyalty and cooperation from the participants over the decades. The Harvard Study cost millions of dollars, but was worth it, because it was run very professionally and the participants remained extremely loyal and cooperative. It has yielded very valuable data to understand the human aging process.

       The primary objective of the Harvard Study was to ascertain the causes of positive aging and figure out why some people lived longer, stayed healthier and felt happier than others over the course of a lifetime. The researchers wanted to know what factors mattered and which didn’t for the aging process to be successful. During the course of the Harvard Study the participants endured all the ups, downs, joys, and sorrows that all of us do – marriage, divorce, the births of children and grandchildren, deaths in the family, periods of good health/ability and periods of illness/disability, gaining and losing employment, building up a business and losing a business and so forth.

       Watching the participants handle these real life events, the investigators discerned patterns that made for successful aging. On the psycho-social side, they found that investing in your marriage (to deepen the love, intimacy and friendship between spouses); learning to make lemonade out of the lemons life throws at you; working to keep widening your social radius (making new friends as old ones die off); making the time to keep learning, playing and creating; and finding ways to be of service to others were keys to a happy old age. On the physical side, they found that not smoking, moderate use of alcohol, regular exercise and maintaining a normal weight were key to healthy aging.

       The people in the study with bad marriages, the ones who complained bitterly about life’s disappointments and held grudges, the self-absorbed ones who put no effort into making new friends or assisting others; and the ones who watched lots of TV instead of reading, engaging in sports or engaging in creative or artistic pursuits were sad. The ones who didn’t take good care of themselves – the ones who smoked, abused alcohol, didn’t get regular exercise or maintain a normal weight – ended up sick.  

       If you really want to end up Happy-Well rather than Sad-Sick, now is the time to implementing changes in your routines. The Harvard Study demonstrated that people could grow progressively happier into old age if they stayed hopeful about the future, kept active and kept learning, making new friends and playing throughout life. The least happy were those who stopped learning, growing and making friends – the ones who became stuck, passive and complaining – the ones who weren’t living life but felt life was happening to them and didn’t like what life was dishing out.

       The passive complainers were pessimists who felt that happiness depended on having the right set of external circumstances and that they had been dealt a bad deck. The happy ones recognized that even if life had not given them circumstantial advantages (like loving parents, money, high social class, a high IQ or a fine education) they still had an inner potential to make their lives good and be of service to others. The happy ones used their energy to make the most of their inner potential.   

       The Harvard Study (which is still going on) contains three separate groups or cohorts:

 (1) The Grant Cohort consisting of 268 sophomores at Harvard University selected between 1939-1942 by physicians Arlie Bock and Clark Heath as academically solid students without evidence of physical or psychological difficulty. All of them were white, but not all of them were from wealthy or privileged backgrounds. Half of the men were on scholarships or worked during college to help pay tuition. They had a mean IQ of 130-135. At age 50 they had a mean income of $105,000.

(2) 500 inner city teenage boys from Boston (99% Caucasian) selected in 1939 by Harvard Law School professor Sheldon Glueck. They had all the risk factors for juvenile delinquency (such as living in poor families in blighted, slum neighborhoods) but did not engage in delinquent behavior. Their mean IQ was 95 and at age 50 their mean income was $35,000.

(3) 672 female students (99% Caucasian) attending Stanford University selected by Stanford professor Education Lewis Terman in between 1920-1922 on the basis of their having an IQ of 140 or higher. Their mean IQ was 151 and by age 50 their mean income was $35,000 (which reflected lack of opportunity and low pay scales for women).

       Study investigators interviewed the parents and teachers of the participants. Of the 268 Harvard University sophomores who started, 248 remained in the study after graduation. Until their deaths they answered detailed questionnaires every two years, had a physical examination every five years and were interviewed every fifteen years. Some of them are still alive and have been interviewed four times. Glueck reduced the number of inner city youth from 500 to 456 for reasons of expense. The 456 who remained in the study also answered biennial questionnaires, had a physical exam every five years and gave periodic interviews. The Terman Cohort answered questionnaires every 4-5 years and was not given physical exams. They have been studied by successive investigators over the past 80 years. Dr. Vaillant interviewed 40 of the survivors of the Terman Cohort in 1987 at a time when their average age was 78.

       By age 80 both the Harvard Cohort men and the Terman Cohort women enjoyed a mortality only half of what would be expected for their white peers. The Inner City men had a comparatively more rapid rate of physical decline and tended to die about 10 years earlier than the other groups, something associated with lack of education and higher levels of smoking, alcohol consumption and obesity. However, at age 70 the health of the 29 Inner City men who graduated college was the same as that of the Harvard Cohort men. 

       Dr. Vaillant has published and discussed the results of the Harvard Study in many different periodicals. For the benefit of the lay public he summarized the results with plenty of illustrations from his interviews of the study participants in a fascinating book titled Aging Well that came out in 2002.

       In Aging Well Dr.Vaillant groups the study participants into one of four categories once they’ve reached age 50. These are the Happy-Well, the Sad-Sick, the Prematurely Dead and the Intermediate. The Happy-Well were subjectively happy, happy according objective assessment and healthy both mentally and physically according to the study psychiatrists and physicians. The Sad-Sick were subjectively and objectively unhappy, unwell mentally and/or physically and sometimes partially disabled. The Prematurely Dead were seriously depressed with one or more severe illnesses and severe disabilities. The Intermediate were people who overlapped and blurred the boundaries of different categories.

       Only one in six of the Happy Well was dead by age 75. Half of the Sad-Sick were dead by 75. All the Prematurely Dead were dead by age 75. Ninety percent of the Happy Well who reached 80 years of age had “all their marbles” which is considerably higher than the national average. These people had successfully replaced their former workmates with good friends, found creative outlets (e.g. mastering a symphony on the piano or translating a literary classic from a foreign language) and learned not to take themselves too seriously. With age they grew less egotistical, less competitive, more fun loving and more affectionate. They made wonderful grandparents. It pays in many ways to be Happy and Well as an older person.   

       If psychologists knew as much about aging as they thought they did, then it should have been possible for the Harvard Study investigators to predict with certainty, or at least a very high degree of accuracy, who would turn out Happy-Well or Sad-Sick based on their initial, comprehensive assessment of study participants which included interviews with the participants, their parents and their teachers and review of all pediatric health records, college health records, college grades and college activities.

       Not surprisingly the investigators were right in predicting a happy future for students who had happy childhoods in which they were loved, accepted and helped to trust their emotions and the Universe. The big surprise came with regard to predicting the future for students who had desolate and relatively loveless childhoods. The good news is that in a substantial number of these cases, the prediction for unhappy, unsuccessful aging turned out wrong.

       The value of the study as far as Dr. Vaillant was concerned was: (1) in debunking myths that certain factors destined a person to have a certain quality of life; (2) in demonstrating that adults can change, mature and improve with age (like a fine wine); and (3) in showing what factors do promote successful aging – even in people who did not appear to be good candidates for a happy old age based on a bleak childhood. 

       Here are some of the key findings from Aging Well:

       By age 50 the following things had no significant effect one’s psychological status: Birth order, childhood physical health, the distance in age between you and the next child or the death of one or both parents.

        Bad events in childhood do not doom us. They do not deprive us of the potential for happiness. Children who were treated poorly by being ignored, neglected, screamed at, or hit, and who were not loved in a healthy, consistent way while growing up, can still mature into happy, well adjusted adults. Given the number of study participants who overcame loveless childhoods to become happy adults, Dr. Vaillant concluded that an unhappy childhood becomes less important over time.

      While we cannot change our temperament (things like tested IQ, personality style of introversion/extroversion or heredity aspects of our social intelligence) these things do not determine our level of happiness as adults. Happiness as an adult is more a function of character which is within our control. We can make an effort to overcome our fear of others, to increase our comfort with others, to increase our self-assurance, to express our opinions more openly, to criticize our children less and so forth.

      Certainly there were women from the Terman Study with very high IQs who were Happy-Well and flourishing, but some of the women with very high IQs from that study became sad, lonely people with an ever-shrinking social circle. On the other hand there people with low IQs from the Inner City group who grew to enjoy their work, make many friends, find pleasure in family and enjoy life.

      Growing up in a wealthy, privileged home does not guarantee one will be happy and well in old age. There were a number of people in the study who came from a high social class with all the material advantages while growing up, but went through adulthood as negative, friendless people, some of whom drank themselves to a premature death. One of these people was a successful, wealthy trial lawyer. This man had a succession of relationships with women but never married. He put in just the amount of time needed at work to win his cases, but reserved his weekends for heavy drinking. He did not serve a mentor to any associates or serve on any law firm or bar association committees. He had no close friends. He died of alcoholism before age 75.

     On the other hand the study showed that growing up in a family where one was truly and well loved by one’s mother significantly raised the odds of being in the Happy-Well group. Children well loved by their mothers who grew up without depression and who did not seek psychiatric help or anti-depressant medication before age 50 appeared not to need spirituality or religion to be happy. On the other hand, children who grew up without a loving mother and who exhibited serious depression before age 50 were able to use spirituality and religion to become happier after 50.

       How one manages anger is a good predictor of aging well or poorly in adulthood. Study participants who habitually exploded in anger or buried it deep inside did poorly. Study participants who could express anger in a healthy way reported having gratifying careers and relationships. Dr. Vaillant says it’s more challenging for an adult to express anger in a healthy way if he had parents who didn’t tolerate his  emotions, who labeled them as misbehavior and who weren’t able to “hold” his sadness, love or anger. Yet, it’s possible as an adult to recognize you have difficulty expressing anger, to work on it in therapy and get better at it.

       Based on his readings of his predecessors in the study of adult development (such as Erik Erikson) and his own observations of the study participants as they aged, Dr. Vaillant came up with three “essential tasks of adulthood.” According to Dr. Vaillant the more satisfactorily an adult accomplishes these tasks the greater the probability he will be in the Happy-Well group as he ages. The three tasks he named were Generativity, Keeper of Meaning and Integrity.

       According to Dr. Vaillant, “Generativity involves the demonstration of a clear capacity to unselfishly guide the next generation…. and to be in relationships where one cares for those younger than oneself” but where one respects the autonomy of younger people and holds the reins of control loosely. A generative person is one who shares his self and gives it away after he has developed an identity and consolidated his career skills. A generative person helps to build community “by serving as a consultant, guide, mentor or coach to young adults in the larger society.” Dr. Vaillant says that in all three Study cohorts mastery of Generativity tripled the chances that members would experience joy not despair  during their 70s.

       Being a Keeper of Meaning refers to preserving one’s culture (“the collective products of mankind”) by transmitting it to the young. While a generative person takes a succession of individual young people under his wing to mentor, the Keeper of Meaning guides groups, organizations and bodies of people toward the conservation of past traditions. Dr. Vaillant says that a wise old judge, the chairman of a town historical society, the ongoing correspondent for a college class long past graduation, a village matriarch, a genealogy maven and an antique refinisher are all examples of people who discharge this function. Keepers of meaning are not partisans who take sides and do not feel loyalty to any one person. Their virtues are those of wisdom and justice, and their loyalty is to the past and the whole of society.

      Integrity is the hard won sense of order in the world including the “acceptance of one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions.” Integrity is the ability to affirm that life was worth living in the face of declining mental and physical function and the imminence of death – something that models hope and courage for the young.

       In general the members of the three Study cohorts who were Happy-Well in their old age had mastered these three tasks in sequential order. However, not all Study participants handled each task equally well or in the order that Dr. Vaillant laid out. Some participants were much better at one task than another. Some worked on the last task first or worked on all three at once.

       Dr. Vaillant says, “One life stage is not better or more virtuous than another.” and “Adult development is neither a footrace nor a moral imperative. It is a roadmap to help us make sense of where we are and where our neighbors might be located. It also contributes to our ‘wholeness’ from which our word ‘health’ is derived. In old age there are many losses and these may overwhelm us if we have not continued to grow beyond ourselves.” 

      Being generative, a keeper or meaning or having integrity all have to do with one’s attitude and orientation. Are you a philanthropist (a lover of humankind) and an altruist (one who helps others because it’s the right thing to do not because you expect a reward) or are you a ruthlessly competitive person who will sacrifice anyone to win a case, make the big bucks and buy the most toys to flatter his own ego? Being a smart person with a high IQ or having a lot of money in the bank from being a big business success can’t substitute for the three virtues of the second half of life or ease your way into the Happy-Well group.

       We only have so many minutes to spend in our lives and only so much energy to utilize during those minutes. Buddhist monk Matthieu Ricard said “Don’t spend your life killing time since time will eventually kill you.” Clearly we want to stay busy, rather than waste our time, but what we do and the spirit in which we do it is crucial to whether we will age successfully. If we spend it mainly on making money and buying stuff will this make us happy? Matthieu Ricard says a life of self-absorption and chronic selfishness is destined to be unhappy, whereas a life spent being of service to others will be a happy one, because our greatest source of joy is being useful and leaving the world better for our having been here.

      You may be resisting this line of thinking, because lawyers are so very status competitive and because law firms and their systems of compensation and promotion are so money-oriented. But don’t be fooled. The Harvard Study concluded that having abundant money was not related to happiness in old age. Some of the most well off participants were lonely, drank heavily and took poor care of themselves. To avoid loneliness, it’s essential to remain socially useful and help out other people. Acts of kindness and altruism enlarge the heart and increase joy. Even when age has put physical limitations upon you, a person can offer emotional support, comfort and advice to others. Some of the happiest people in the study had become mentors or wisdom figures.

      Dr. Vaillant illustrates this from the lives of participants in the Harvard Study as well as the following quote from psychologist Edmund Stanford: “The real secret of a happy old age is once more in service for others carried on to the end of life – a service which, on the one hand, gives perennial interest to life by making the old man [or woman] a participant in the life of all those about him, and on the other, surrounds him with love in return.”  

      The happy people were the ones who did not complain about every ache and pain, but who showed cheerful tolerance of the indignities of old age and a graceful acceptance of their dependency needs. By seeking medical help when you need it and being openly grateful for the services of a kind physician, you’re making lemonade out of lemons.

      Happy people were able to see life as a journey. Instead of becoming dour and pessimistic as some abilities declined, they maintained hope in life. They not only continued to do for themselves whatever they could still do, but tried new things and celebrated their new skills or activities.

        A good marriage at age 50 predicted positive aging at 80, but surprisingly having low cholesterol levels at age 50 did not. A good marriage sometimes provided the love, care and support a participant did not receive as a child, and made up for that lack.

       Learning to play and create after retirement adds more to life’s enjoyment than retirement income. By play Dr. Vaillant is referring to sports like tennis, skiing, golf, hunting or fishing. He’s also referring to having a good sense of humor and exercising your humor muscle often by laughing. By creating Dr. Vaillant is referring to activities that draw upon feeling, emotion and intuition like painting, sculpting, pottery, writing poetry or singing in a choir.   

       Objective good physical health was less important to successful aging than subjective good health. It’s all right to be ill as long as you don’t feel sick.

         Learning to balance the gratification of one’s appetites (for food, drink, sex, etc.) with one’s capacity for self-control and learning to balance one’s instinct for adventure with one’s tendency  to avoid risk for self-preservation is a key to successful aging. The participants who learned to live with neither too much desire and adventure, nor too much caution and self care were happiest. The health nut who gives up Cuban cigars, scotch whiskey, French cuisine and Italian romance to live to 100 can no longer tell if he’s still alive at age 30. On the other hand, the person who obsessively trains for and participates in super-endurance sports events, can end up anorexic, depleted and an outcast in the family he’s always avoiding.

       One of the essential paths to reaching a happy old age is to befriend “the loving and health giving individuals within one’s social matrix wherever they may be.” By this Dr. Vaillant means making close friends with the good people we encounter (a boss, a colleague, a neighbor, a relative) and remaining intimate with those people through life. Further, it’s crucial to replace those wonderful friends with new ones when the old ones die. The loss of close friends and loved ones is inevitable and can be overwhelming, unless we “widen our social radius” as we age.

       Study participants who made no effort to replace the best friends who died became lonely, sad and depressed. Those who befriended new people as they aged were happiest in their old age. To maximize the benefits of old or new friendship we must “take people in.” By taking someone in, Dr. Valliant means something more than inviting people over for dinner.

       He’s referring to the process of opening your mind to the other person’s perspectives on life (so you can learn something from them) and opening your heart so you allow the other person to care for you and love you in the way they want. To be capable of such friendships requires the capacities for forgiveness and gratitude. It also means taking a break from always being the one to help and take care of others. Dr. Valliant found that the Study participants in the Sad-Sick group were the ones who failed to widen their social radius and to take people in.

Conclusion Aging successfully means staying healthy and growing progressively happier past age 50. The people who do it stand a very high chance of living into their 80s “with all their marbles,” plenty of friends and much to look forward to in the way of social activities, new learning, play and creative activities. While no one is guaranteed successful aging, no one is doomed to be unhappy even those who had desolate, loveless childhoods. You can age successfully by mastering and implementing the techniques and virtues described in Dr. George Vaillant’s book.

Good luck. I hope every one of you ends up Happy-Well.