The Mature Mind

ALSO BY GENE D. COHEN, M.D., PH.D.

The Creative Age: Awakening Human Potential
in the Second Half of Life

Acknowledgments

FIRST, I WOULD LIKE TO ACKNOWLEDGE the great support and patience my family provided me while I wrote this book. The fact that for ten months of the process I was recovering from a broken femur and required two operations made their support all the more precious. My wife, Wendy Miller, and my daughter, Eliana, were simply extraordinary during this time, and my son, Alex, his wife, Kate, and my two granddaughters—Ruby and Lucy—were a fabulous cheering section from their home in Camden, Maine.

I also want to acknowledge the invaluable advice, assistance, and encouragement that Teresa Barker provided in the planning, initial drafting, and development of the book. I am also enormously grateful to Stephen Braun, who collaborated very closely with me in bringing the final draft to fruition, contributing vitally to its quality and timeliness.

Much gratitude goes as well to my agent, Gail Ross, for her successful efforts in connecting me with Basic Books and for her ongoing assistance in keeping things on course. And many thanks to Howard Yoon, who worked so diligently with Gail in this process.

Thanks are due, too, to Jo Ann Miller, my editor at Basic Books, who worked closely with me, and was always prompt and helpful in answering questions, solving problems, and moving things along.

Deep appreciation goes to the sponsors of the major studies I describe in this book. The Atlantic Philanthropies (USA) Inc. supported the 21st Century Retirement Study. In conjunction with the Helen Bader Foundation, they also supported the development and evaluation of the reading list of children’s books described in Appendix 2.

The Creativity and Aging Study was supported by six sponsors led by the National Endowment for the Arts (NEA). The other five supporters were the Center for Mental Health Services of the U.S. Department of Health and Human Services, the National Institute of Mental Health at the National Institutes of Health, AARP, the Stella and Charles Guttman Foundation, and the International Foundation for Music Research. Particular thanks for this study go to Paula Terry, the project officer at NEA. After my book The Creative Age came out, Paula, who heads the Accessibility Office Program and coordinates projects on aging at the National Endowment for the Arts, read it and was interested in the summary of research relevant to the impact of creative expression on health in later life. The Arts Endowment has long been committed to making the full spectrum of the arts available to underserved populations, including older adults. Realizing that little data addressed the impact of professional arts programming on older adults, Paula encouraged me to develop guidelines for a study and to submit a proposal to the Endowment.

Thanks go as well to the Small-Alper Family Fondation, Inc., for their contribution to the process of preparing this book.

Finally, I want to express my special appreciation to my colleagues at the three research sites of the Creativity and Aging Study that I directed. Jeanne Kelly, from the Levine School of Music, served as the artistic director for the metropolitan Washington, D.C., part of the study. Jeff Chapline, who heads the Center for Elders and Youth in the Arts (CEYA), directed the San Francisco site. Susan Perlstein, who heads Elders Share the Arts (ESTA), directed the Brooklyn site and shared the important findings of the Creativity and Aging Study with the National Center for Creative Aging (NCCA), which she also directs, to promote dissemination of the research results for practical use by community-based art programs across the country. Working with these terrific colleagues was like being on a dream team.

Introduction

“Over the hill.”

“Out to pasture.”

“Twilight years.”

“Retired.”

These words reflect a stubborn myth—that aging is a negative experience and that “successful aging” amounts to nothing more than slowing the inevitable decline of body and mind. Rubbish. Some of life’s most precious gifts can only be acquired with age: wisdom, for example, and mastery in hundreds of different spheres of human experience that requires decades of learning. Growing old can be filled with positive experiences, and “successful” aging means harnessing and manifesting the enormous positive potential that each one of us has for growth, love, and happiness.

Of course, aging brings challenges and losses. As actress Bette Davis once famously quipped, “Getting old isn’t for sissies.” Sight may blur, hearing may dull, friends may die or become disabled. All of this is true, but it’s not the whole truth. Historically, both science and culture in Western societies have focused exclusively on the negative sides of aging and ignored the positive. It’s time for a better, truer, and more motivating paradigm—not a rosy, everything-is-wonderful perspective, but a clear-eyed view that acknowledges the hard realities of growing old while at the same time celebrating its benefits, pleasures, and rewards. With this book I want to shatter the illusions of “knowledge” about aging that are based on faulty reasoning, insufficient research, and a preoccupation with disease and pathology. My picture of positive aging is based on cutting-edge scientific research as well as my personal experience as a psychiatrist who has treated older adults and their families for more than thirty-five years.

The latest research findings are encouraging and important. Denying or trivializing the positive potential of aging prevents people from realizing the full spectrum of their talents, intelligence, and emotions. But when we come instead to expect positive growth with age, such growth can be nurtured. We are still a long way from fully realizing this shift in perspective, but I hope this book will be a forceful catalyst for change in that direction.

NEW SCIENCE, NEW HORIZONS

Some of the most exciting research supporting the concept of positive aging comes from recent studies of the brain and mind. Much of aging research conducted during the twentieth century emphasized improving the health of the aging body. As a result of this research, life expectancy and overall health did in fact improve dramatically. Aging research at the beginning of the twenty-first century, in contrast, has expanded with a strong focus on improving the health of the aging mind. Dozens of new findings are overturning the notion that “you can’t teach old dogs new tricks.” It turns out that not only can old dogs learn well, they are actually better at many types of intellectual tasks than young dogs.

The big news is that the brain is far more flexible and adaptable than once thought. Not only does the brain retain its capacity to form new memories, which entails making new connections between brain cells, but it can grow entirely new brain cells—a stunning finding filled with potential. We’ve also learned that older brains can process information in a dramatically different way than younger brains. Older people can use both sides of their brains for tasks that younger people use only one side to accomplish. A great deal of scientific work has also confirmed the “use it or lose it” adage: the mind grows stronger from use and from being challenged in the same way that muscles grow stronger from exercise.

But the brain isn’t the only part of ourselves with more potential than we thought. Our personalities, creativity, and psychological “selves” continue to develop throughout life. This might sound obvious, but for many decades scientists who study human behavior did not share this view. In fact, until late in the twentieth century, psychological development in the second half of life attracted little scientific attention, and when attention was paid, often the wrong conclusions were drawn. For example, Sigmund Freud, whose influence on psychological theory was profound, had this to say about older adults: “About the age of fifty, the elasticity of the mental processes on which treatment depends is, as a rule, lacking. Old people are no longer educable.”

Ironically, Freud wrote this statement in 1907, when he was fifty-one, and he wrote some of his greatest works after the age of sixty-five. Furthermore, Sophocles’s Oedipus Rex, the masterpiece on which Freud based his pioneering psychoanalytic theory, was written when the Greek playwright was seventy-one years old.

Freud wasn’t the only pioneer to get things wrong when it came to aging. Jean Piaget, who made an extraordinary contribution to our understanding of cognitive development, ended his description of intellectual development with what he called “formal operations,” the kind of abstract thinking that matures during the teenage years. As far as Piaget was concerned, development stopped in young adulthood and then began a slow erosion.

Even the great developmental psychologist Erik Erikson, one of my teachers at Harvard, gave only limited attention to development in older age. Erikson delineated eight stages of psychosocial development and defined each one in terms of an issue or conflict that must be resolved. Yet only one of his stages refers to development after the onset of adulthood—mature age, which, these days, amounts to a single stage that can last fifty years! His classic work Identity and the Life Cycle included only one page on each of the two last stages of human life. To his credit, Erikson was one of the first influential thinkers to assert that some kind of psychosocial development continues throughout the life cycle. He acknowledged that his work on aging was incomplete, and he invited his students to continue in this area. This book is, in part, my response to the challenge Erikson made decades ago.

FOUR PHASES

In this book I present a new account of psychological development in the second half of life. This new view explains many things about older age and is fundamentally forward-thinking and optimistic about our potential for lifelong growth, creativity, and emotional fulfillment. Based on my studies of more than 3,000 older adults, using in-depth interviews and questionnaires conducted multiple times over the years, I have identified the following four distinct developmental phases of late life: midlife reevaluation, liberation, summing up, and encore.

People enter and pass through these phases under the impelling force of inner drives, desires, and urges that wax and wane throughout life. I call these drives the “Inner Push” and have witnessed it in thousands of older adults who have participated in my research projects and clinical practice. The Inner Push is the fuel motivating development; it works in concert with the changes in the aging brain that I explore in chapter 1. My conception of phases is more fluid and dynamic than Erikson’s stages because I recognize that by later life people vary widely in every conceivable way, and no rigid system will be accurate for everyone. The phases I propose are real—I’ve seen them manifested time after time—but people experience them in different ways and sometimes in a slightly different sequence than the one I present.

The first phase, midlife reevaluation, is a time for exploration and transition. It is not at all the same thing as a “midlife crisis”—which modern research has shown has been overreported and is largely a cultural myth. Only 10 percent of people I interviewed reported having a midlife crisis. What I found, instead, was that in this period, from roughly ages forty through sixty-five, people undergo a profound reevaluation, asking themselves: Where have I been? Where am I now? Where am I going? Most people experience this period not as a crisis but as a quest—a desire to break new ground, answer deep questions, and search for what is true and meaningful in their lives.

The midlife reevaluation phase is followed by what I call the liberation phase: a time when we feel a desire to experiment, innovate, and free ourselves from earlier inhibitions or limitations. This desire often overlaps with midlife reevaluation and then comes on strong throughout the late fifties and sixties and into the seventies. As this shift is happening, our brains undergo significant physiological changes, including the sprouting of new connections between brain cells and a more balanced use of the two brain hemispheres. This is a time when people express the sense of “If not now, when?”

The summing up phase, from the late sixties through the seventies and eighties, can be a time of recapitulation, resolution, and review. One of the common outcomes of this autobiographical summing up process is a desire to give back—to family, friends, and society. Volunteerism and philanthropy, prominent among older people well into their eighties, are two tangible manifestations of this phase.

For the final phase I use “encore” in the French sense of “again,” “still,” and “continuing.” This phase is not a swan song, but a variation on a theme: the desire to go on, even in the face of adversity or loss. This need to remain vital can lead to new manifestations of creativity and social engagement that make this period full of surprises.

When people come to understand these phases of later life and the mechanisms at work behind them, I have seen them become powerfully motivated and energized. Released from overly negative illusions about aging, people are often stirred by new energy, direction, or purpose.

DEVELOPMENTAL INTELLIGENCE

In this book I introduce a novel concept, developmental intelligence, which I see as the greatest benefit of the aging brain/mind. Developmental intelligence is the degree to which a person has manifested his or her unique neurological, emotional, intellectual, and psychological capacities. It is also the process by which these elements become optimally integrated in the mature brain. More specifically, developmental intelligence reflects the maturing synergy of cognition, emotional intelligence, judgment, social skills, life experience, and consciousness. We are all developmentally intelligent to one degree or another, and, as with all intelligence, we can actively promote its growth. As we mature, developmental intelligence is expressed in deepening wisdom, judgment, perspective, and vision. Advanced developmental intelligence is characterized by three types of thinking and reasoning that develop later than Piaget’s “formal operations” and hence are referred to as “postformal operations”: relativistic thinking (recognizing that knowledge may be relative and not absolute); dialectic thinking (the ability to uncover and resolve contradictions in opposing and seemingly incompatible views); and systematic thinking (being able to see the larger picture, to distinguish between the forest and the trees).

These three types of thinking are “advanced” in the sense that they do not come naturally in youth; we prefer our answers black or white, right or wrong. And we usually prefer any answer to none at all. It takes time, experience, and effort to develop more flexible and subtle thinking. Our capacity to accept uncertainty, to admit that answers are often relative, and to suspend judgment for a more careful evaluation of opposing claims is a true measure of our developmental intelligence. In this book I’ll show you how you can cultivate your developmental intelligence and thereby reap its rewards.

TWO NEW STUDIES

I’ve had the privilege of directing two groundbreaking studies of older age since 2000, one looking at the new face of retirement and the other at the positive benefits of creativity in older adults. Both studies have generated surprising—and encouraging—results. My retirement study shows just how outmoded the word “retirement” really is. For most people these days, the years after age sixty-five are anything but “retiring.” It’s not that everyone is a dervish or that people don’t relax and enjoy themselves, but most people I interview see this life stage as a great opportunity to pursue activities and interests for which they previously didn’t have time. Far from being a time of social and cultural withdrawal (as was postulated by early influential research), “retirement” can usher in greater engagement, more satisfying relationships, new intellectual growth, and more fun.

My other study explores the mental, physical, and emotional effects of participating in a community arts program. Again, my colleagues and I have made surprising discoveries. Contrary to societal myths, creativity is hardly the exclusive province of youth. It can blossom at any age—and in fact it can bloom with more depth and richness in older adults because it is informed by their vast stores of knowledge and experience. As I will explain more fully later, taking part in any kind of art program, including the nonvisual arts of music, dance, and theater, can improve your health, your outlook, and your resilience.

Important implications flow from these two studies, both for private citizens and for those responsible for supporting the health and well-being of older adults. Outcomes from our creativity study, for example, should be invaluable for program directors of senior centers. Similarly, the finding from the retirement study that many older people are seeking part-time work should interest human resources directors in corporations and nonprofit institutions. In reporting the findings from my research, I hope to provide a road map for improving the social supports and educational opportunities for all older adults.

MY HOPE

In 1971, when I entered the field of gerontology, it was a relatively new area of study, underfunded and hobbled by stereotypes and misconceptions. As recently as the 1960s and 1970s, many experts still viewed old age as a disease: the mind and body, they believed, naturally fell apart, like a car after many years of use.

By the mid-1970s, these views began to change as evidence accumulated about the realities of aging and as the population of older adults began to surge. The federal government started spending millions of dollars on new research through two major programs: the National Institute on Aging and the Center for Studies of the Mental Health of the Aging, the latter of which I was fortunate enough to be the first director. Researchers began to understand that aging is not a medical condition in and of itself; it is simply a time of life in which many medical conditions become manifest—the so-called age-associated problems. This new focus fueled the field of geriatrics and provided a more balanced view of old age. Healthy adults, researchers found, retain sound mental and emotional faculties and typically decline only gradually in their physical resources.

Over the next thirty years, funding for aging research grew from $50 million a year to more than $1 billion today. Yet despite this infusion of time and money, studies still tend to focus on the problems of older age. Even the recent and important book Successful Aging, by John Rowe and Robert Kahn, presents the goal as minimizing decline rather than recognizing the huge potential for positive growth in later life. Although Rowe and Kahn rightly emphasize the importance of maintaining health, mental functioning, and active engagement in life, they don’t present the possibilities for improving these areas with age.

The Mature Mind presents a new paradigm of aging, one that I hope will eventually displace today’s negative views and assumptions. It recognizes the potential beyond the problems associated with aging. It reframes the aging process as a set of developmental phases that support real growth as opposed to the view of aging as an inevitable decline. This book shows how we can support and cultivate our natural capacity for positive change. I sincerely hope it will help redirect public dialogue on this topic by delivering a promising message about the value and capacities of the maturing mind.

1

The Power of Older Minds

MY IN-LAWS, HOWARD AND GISELE MILLER, both in their seventies, were stuck. They had just emerged from the Washington, D.C., subway system into a driving snowstorm. They were coming to our house for dinner and needed to catch a cab because it was too far to walk—but it was rush hour, and no cabs stopped. Howard tried calling us to get a lift, but my wife and I were both tied up in traffic and weren’t home yet.

As his fingers began to turn numb from the cold, Howard noticed the steamy windows of a pizza shop across the street. He and Gisele marched through the slush, entered the shop, stepped up to the counter, and ordered a large pizza for delivery. When the cashier asked where to deliver it, Howard gave him our address, and added, “Oh, there’s one more thing.”

“What’s that?” the cashier asked.

“We want you to deliver us with it,” Howard said.

And that’s how they arrived—pizza in hand—for dinner that night.

This favorite family story perfectly illustrates the sort of agile creativity that the aging mind can produce. Would a younger person have thought of this solution? Possibly. Creativity knows no age limits. But in my experience, this kind of out-of-the-box thinking is a learned trait that improves with age. Sherry Willis, of the Human Development and Family Studies program at Pennsylvania State University, calls it pragmatic creativity in everyday problem solving, a capacity that her research has found to be very strong in later life. Age allows our brains to accumulate a repertoire of strategies developed from a lifetime of experience—part of what has been referred to by other researchers as crystallized intelligence. Howard hadn’t done the pizza parlor routine before, but the accumulated experience of other successful strategies helped stimulate the thinking that produced his creative solution.

Howard’s solution reflects not only the experience of years and a certain agility of thought but also a mature psychological development that is prevalent among people in their sixties and seventies. With age can come a new feeling of inner freedom, self-confidence, and liberation from social constraints that allows for novel or bold behavior. Howard wasn’t afraid to make an unusual request of perfect strangers, and that was a key part of his success that night.

In Howard’s story we have a picture of a healthy aging mind at work: clear, creative, resourceful, and powerful. But how does such a mind develop? On what does it depend for its existence? The short answer is the brain.

It’s been said that the mind is what the brain does. The mind is often described as “software” running on the “hardware” of the brain. But this analogy is too simple. The brain is far more malleable and flexible than any computer chip. And the mind, although it seems almost ghostlike, can powerfully influence the brain and, by extension, the body. Mind and brain are really two sides of a single coin—mind/brain. This chapter explores the brain side of this equation and looks at recent discoveries in brain science that illuminate the positive potential of the aging mind.

You may have learned the following “facts” about the brain:

All these “facts” are wrong, as we will see. And that’s good news for all of us. The brain is more resilient, adaptable, and capable than we long thought. Research in the past two decades has established four key attributes of the brain that lay the foundation for an optimistic view of human potential in the second half of life:

Now, let’s be clear. I am not suggesting that the brain is immune to age-related changes. The brain is made of cells, like every other part of the body, and cells can and do “wear out” with age. Certain aspects of brain function do decline with age, such as the raw speed with which complicated math problems are solved, reaction times, and the efficiency of short-term memory storage. But these “negatives” are by no means the whole—or even the most important—story about the aging brain. Unfortunately, because much brain research has focused on age-related problems