Howard Friedman - The Longevity Project

We computed the statistical analyses for predicting long life, and, sure enough, poorer mental health and less maturity in 1950 were related to higher risk of mortality over the half century that followed. This was especially true for the men. These were the individuals who, by their forties, had strayed off the healthier paths to long life, often pushed along by stressful wartime experiences. Not only were those who were not well-adjusted in 1950 at higher risk of dying from all causes, they were especially more likely to die from violence (including suicide) and cardiovascular disease. 94 94 For more information on our study of mental health and mortality risk, see L. R. Martin, H. S. Friedman, J. S. Tucker, J. E. Schwartz, M. H. Criqui, D. L. Wingard, and C. Tomlinson-Keasey, “An Archival Prospective Study of Mental Health and Longevity,” Health Psychology 14 (1995): 381-87.

Where many clinicians and researchers go wrong is to think of depression as a risk factor like smoking. If you stop smoking, your disease risks start decreasing immediately. But depression is more like adult-onset diabetes or other disorders of metabolism—it is caused by and leads to many different things and cannot be simply, permanently cured. Instead, setting off on a healthier pathway is the way to slowly but surely improve both depression and other aspects of health.

If you or a friend or loved one is facing serious anxiety or depression in young adulthood, then this is not only a sign of possible short-term threats to well-being, such as eating disorders, drinking, drug abuse, driving accidents, and even suicide and other violence; it is also a warning of long-term disease threats to health. But the treatment focus should not only be on the severe anxiety and depression. Rather, a broader view is most valuable, in which the individual is slowly integrated back into a supportive community, a stable career, and a caring family or group of close friends. This is not easy to do, but when such folks get moving on this new path, the results are often remarkably deep, wide-ranging, and long lasting.

As was the case with most American women during the war, few of the Terman women served directly. Only about a dozen were formally committed to the war effort—including four in the Women’s Army Corps (WAC, the women’s branch of the U.S. Army) and five in the navy’s WAVES (Women Accepted for Volunteer Emergency Service). Many Terman study women were engaged in war-related work in the government, in industry, or in other crucial positions such as in the Red Cross or in potentially risky information-related positions (such as that of Shelley Smith Mydans, the Life magazine reporter who was captured by the Japanese in Manila). However, there was not enough information for us to evaluate later health effects of the women’s war contributions and experiences.

Think about the most serious and traumatic events you have faced in your life, such as suffering a serious physical assault; facing military combat; being at or near the sites of the September 11 terrorist attacks or other major terrorist attacks; losing a very close friend or relative to suicide or murder; being raped or sexually or physically abused; or experiencing a major fire, flood, or similar major catastrophe. (If you are lucky enough to never have faced such a challenge, then you probably are not at risk from such stress.) Evaluate how much the following statements apply to you.

Not at all true of me 1 2 3 4 5 Very true of me

1. I always try to avoid thinking about my stressful experience.

1 2 3 4 5

2. I try to avoid all stressful events because they may set off my feelings about the stressful trauma.

1 2 3 4 5

3. Since the event, I cry easily or feel my heart pounding and my body sweating in the face of even minor disruptions.

1 2 3 4 5

4. I have given up planning for the future.

1 2 3 4 5

5. I have vivid, recurring nightmares.

1 2 3 4 5

6. I feel emotionally numb, cut off even from those close to me.

1 2 3 4 5

7. I get very upset when reminded of the trauma and avoid situations that are reminders.

1 2 3 4 5

8. I have (daytime) flashbacks of the event.

1 2 3 4 5

9. I have been diagnosed with depression, probably triggered from trauma or severe stress.

1 2 3 4 5

10. I have been diagnosed with post-traumatic stress disorder (PTSD).

1 2 3 4 5

Because this kind of severe stress can involve complicated psychological reactions and be an immediate significant threat to your health in complex ways, we do not provide a scoring system for this scale. But clearly the higher your score, the greater the possibility that you are suffering from health-harming chronic stress. The items help us understand the psychological aspects of significant chronic stress, as opposed to usual, normal worrying. If you get the sense that many of these items apply to you or someone close to you, then professional intervention from a mental health professional is advisable. There are excellent treatments available.

Here’s a dilemma. Many people are comfortable believing that stress and instability can cause health problems. Yet many of the same people think that health is mostly in the genes. We hear of certain hereditary diseases that are tightly tied to genetic makeup. For example, the pioneering American folk singer Woody Guthrie suffered from Huntington’s disease. This is a genetic neurodegenerative disorder wherein defective inherited genes tell nerve cells to atrophy and die; if you have this genetic mutation you will develop this devastating condition. We also know that many common individual characteristics are heavily genetic: the tallest Terman subject was six feet nine inches tall, and not because he was calm and loved to drink orange juice. Many people thus assume that our health, like our height, depends mostly on our genetic luck. Which is true—stress or genes?

Both stress and genes are important, and this is not a hedge but rather a scientific finding. Most health threats in adulthood are not caused directly and simply by defective inherited genes. On the other hand, it is also not the case that the environment and behaviors are all to blame. Most people with lung cancer are or were smokers. But although smoking is one of the most health-damaging and dangerous behaviors one can do, most smokers do not get lung cancer; their genes protect them.

One of the most informative studies of the role of genes in stress and health comes from a group of approximately a thousand people born in Dunedin, New Zealand. These children were followed for about thirty years. Many developed depression but most did not. 95 95 More on the genetic study of depression is in A. Caspi, K. Sugden, T. E. Moffitt, A. Taylor, I. W. Craig, H. Harrington, J. McClay, J. Mill, J. Martin, A. Braithwaite, and R. Poulton, “Influences of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene,” Science 301, no. 5631 (2003): 386-89.

Some participants had genes that inclined them to have low levels of serotonin—the brain chemical that is boosted by antidepressant drugs like Prozac. Some individuals faced a number of stressful life events.

It turned out that risk of depression was predicted by a combination (or interaction) of a certain gene pattern and stressful challenges in life. If you had the risky genes but were on a healthy pathway, you didn’t develop depression. If you faced stress but did not have the risky genes that increased your vulnerability, you again were unlikely to develop depression.

A similar situation is likely for many health risks involving stress. We have found not only that some people are more likely to encounter stress, but also that some are more likely to suffer detrimental consequences of the stress. What is special about the lifelong Terman study is that it reveals how one risk can lead to another and how patterns produce cumulative results.