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Although previous studies of shorter duration have identified numerous risks and protective factors that powerfully influence outcomes in young adulthood and midlife, this long-term prospective study examines the effect of these prognostic factors on age at retirement and satisfaction with retirement.In this prospective study, a cohort of socially disadvantaged men (N=151) were followed from adolescence until a mean age of 75 years (SD=2). Periodic interviews, biennial administration of questionnaires, and physical examinations every 5 years were conducted to determine biopsychosocial risk variables, age at retirement, and satisfaction with retirement.Early age of retirement was found to be a function of preexisting mental and physical health and later age of retirement a function of occupational status. A surprising finding was that risk factors such as poor objective physical health, low income, and depression, which are commonly associated with poor outcomes in young adulthood and in midlife, were largely unrelated to satisfaction with retirement.A relatively high level of satisfaction with retirement was often attained by men who had reported many risk factors for poor child and midlife development (e.g., low IQ, dropping out of school, poor mental health, and being part of a multiproblem family) but who in later life had some positive resources (e.g., a good marriage, a low level neuroticism, enjoyment of vacations, and a capacity for play). In short, retirement may offer some men a fresh lease on life.

Objective: The present report attempts to replicate on the probands' brothers, a previously reported (1992) negative relationship between maternal grandfather longevity (MGFL) and affective illness in grandsons. Hitherto this finding had not been replicated. To provide further evidence that the association may be recessive and X-linked, we also examined the association between MGFL and affective illness in the probands' mothers. Finally, in order to examine why MGFL might be a predictor of affective illness, the report examines the association of the probands' affective illness and their own mortality.Method: A 60-year prospective study of men selected in 1940 and followed until the present day provided good information on depressive illness in relatives and longevity of ancestors. To overcome the uncertainty of depressive diagnoses, we assessed affective illness in the probands categorically, dimensionally, operationally and with the Lazare Personality Inventory.Results: Presence of affective illness in brothers was negatively associated with MGFL (p=0.003) but maternal affective illness was independent of MGFL. Test items suggesting emotional lability in the probands were significantly and negatively associated with MGFL. Consistent with the association of increased MGFL with low affective distress in the probands, the 70 probands showing the least evidence of affective distress before age 50 had twofold (pConclusion: The strong negative association of proband affective distress – and equally important – the positive association of proband mental health with MGFL and the lack of association of maternal longevity and depression with MGFL points to the possibility of a recessive X-gene or genes playing a role in depressive illness.

Aims To study the course of male alcohol abuse from age 20 to age 70–80 years. Design A prospective multi-disciplinary follow-up of two community cohorts of adolescent males from 1940 until the present. Setting and participants Two hundred and sixty-eight former Harvard undergraduates (college sample) and 456 non-delinquent, socially disadvantaged Boston adolescents (core city sample). Measurements Since adolescence these cohorts have been followed by repeated interview, questionnaires and physical examination. The college cohort has been followed until age 80 and the younger core city cohort until age 70. DSM-III criteria were used to ascertain alcohol abuse and alcohol dependence. At some point during their lives, 54 (20%) of the college men and 140 (31%) of the core city men met criteria for alcohol abuse. Outcome categories were mortality, continued alcohol abuse and stable remission. Findings and conclusions These socially divergent cohorts resembled each other in four respects. First, by age 70 chronic alcohol dependence was rare; this was due both to death and to stable abstinence. By age 70, 54% of the 72 successfully followed alcohol-dependent core city men had died, 32% were abstinent, 1% were controlled drinkers and only 12% were known to be still abusing alcohol. By age 70, 58% of the 19 successfully followed college alcohol-dependent men had died, 21% were abstinent, 10.5% were controlled drinkers and only 10.5% were known to be still abusing alcohol. Secondly, in both samples alcohol abuse could persist for decades without remission, death or progression to dependence. Thirdly, among both samples prior alcohol dependence and AA attendance were the two best predictors of sustained abstinence. Fourthly, few life-time symptoms of alcohol abuse were the best predictor of sustained return to controlled-drinking.

While hemorrhagic complications of portal cavernoma are frequent, compression of the bile ducts by portal cavernoma is uncommon and treatment is still a matter for debate. We report here six new cases in order to describe: (a) the clinical, biological, and morphological features of this condition, and (b) the long-term results of a combined endoscopic and surgical treatment. The median age of patients at the time of diagnosis was 36.5 years. The circumstances of diagnosis were acute cholangitis (n=3), asymptomatic biological cholestasis (n=1), pruritus, jaundice and asthenia (n=1) and jaundice alone (n=1). Portal cavernoma and bile duct dilatation were confirmed by abdominal ultrasonography with pulsed color doppler and endoscopic retrograde cholangiography (ERC). Gallstones were found in four patients. Following stenting of the bile duct, there was a good outcome in two patients. In four patients, after failure of prolonged endoscopic treatment, second-line surgical portal-systemic shunting allowed removal of the biliary stent, and no recurrence of disease. In conclusion, biliary involvement in portal cavernoma is now a well-recognized entity, and our results suggest that combined endoscopic and surgical treatment could be required.

Objectives We explored whether wisdom and well-being in old age are the result of early personality traits related to personality growth or personality adjustment, respectively, or successful human development as outlined by Erikson's stage theory and the life course paradigm. Method Structural equation models were applied to analyze 60-year longitudinal data of 98 white male Harvard graduates born between 1915 and 1924. Different sets of judges rated the men's childhood and adolescence, early adult personality, and midlife generativity. Items measuring wisdom and well-being in old age were self-assessed. Results Although wisdom and subjective well-being at age 80 were positively correlated, early life predictors differed. Openness to experiences in early adulthood predicted wisdom 60 years later, whereas greater emotional stability and extraversion predicted subjective well-being. Additionally, old age wisdom could be traced back to psychosocial growth throughout life, facilitated by a supportive childhood, adolescent competence, emotional stability in early adulthood, and generativity at midlife. Discussion Personality traits indicative of personality adjustment or growth differentially predict late-life well-being and wisdom. Yet a balance between personality adjustment and growth, aided by social support and competence during the formative years, might be required to promote wisdom development throughout life.

Prior studies have shown that perceived health status is a consistent and reliable predictor of morbidity and mortality. Because perceived health status and objective health are not highly correlated, we sought to identify additional factors that shape self-perceptions of health. Research suggests that childhood experience is an important predictor of health in adulthood, but most studies are retrospective. Using data from a 70-year prospective study of psychosocial development, we examined the quality of childhood environment as a predictor of perceived health in late life. This study utilizes questionnaire data from a longitudinal study of adult development to examine predictors of perceived health across seven decades. Participants were members of the Study of Adult Development, a longitudinal study of men followed for seven decades beginning in late adolescence. Childhood environment characteristics were assessed during home visits and interviews with respondents’ parents at entry into the study. At ages 63, 73, and 78, current health status was measured by an internist not affiliated with the Study, and perceived health was assessed via self-report questionnaires. Linear regression analyses were conducted to examine childhood environment as a predictor of perceived health status at these 3 time points while controlling for concurrent objective health and young adult neuroticism. Childhood environment predicted perceived health at all 3 time points. This study supports the hypothesis that the quality of childhood environment makes a unique contribution above and beyond personality traits and objective health status to perceptions of health in late life.

SUMMARY Aims To assess by a survey the management of prisoners with diabetes treated with insulin in French prisons. Methods A questionnaire was sent to the head of healthcare services for prisoners of every French prison. Information was obtained on prevalence of insulin-treated diabetes prisoners and diabetes care in prison. The number of episides of ketoacidosis and hypoglycaemia needing hospital admissions were evaluated during the past year. Results Among the 163 questionnaires sent, 115 were returned, giving an overall response rate of 69%. At the time of the study the prison population was 38 175 people. One hundred and sixty-nine prisoners were treated by insulin (0.4%). Self-monitoring of blood glucose was available only for 94 (55.6%) insulin-treated prisoners. A total of 130 (76.9%) prisoners performed two insulin injections daily or less, 105 (62.1%) prisoners were not allowed to keep their insulin delivery systems with them. Of the prisoners who treated themselves, 14 (12.1%) used syringes and 42 (36.5%) used pen devices. Ninety-two (55.1%) prisoners had had access to a diabetes specialist during the previous year. Diabetic diets were available in only 65 (60.7%) prisons. From June 1998 to June 1999, there were 20 hospital admissions for a diabetic ketoacidosis and 14 for hypoglycaemia. Conclusions This study shows that prison decreases the autonomy of diabetic prisoners who often cannot self-inject or test their blood. Access to visiting consultant diabetologists and specialist nurses to educate both prisoners with diabetes and prison staff could improve diabetic care.

Resume But de l’etude : Le but de cette etude retrospective etait de rapporter les resultats de l’alcoolisation des adenomes parathyroidiens. Patients et methodes : Depuis 1988, 31 patients ayant une hyperparathyroidie primaire et ne pouvant pas etre operes, ont ete traites par alcoolisation de l’adenome sous controle echographique. Les principales contre-indications operatoires etaient 12 fois une insuffisance cardiaque, 11 fois un âge depassant 85 ans. Un dosage de la calcemie et de l’hormone parathyroidienne (PTH) etait realise au bout de 48 heures et repete au cours de la surveillance. Resultats : Les patients ont eu une a trois alcoolisations de leur adenome. Avec un recul median de cinq ans, un succes total avec normalisation de la calcemie et de la PTH a ete observe chez 20 patients (64,5 %) parmi lesquels quatre ont eu une nouvelle alcoolisation au bout d’un a trois ans. Un succes partiel a ete obtenu chez neuf patients (29 %) avec seulement normalisation de la calcemie, ce qui a permis d’obtenir une nette amelioration clinique. Un echec a ete observe chez deux patients ayant un goitre nodulaire, du probablement a un defaut de localisation de l’adenome. Aucun effet secondaire majeur n’a ete constate. Conclusion : Le traitement de l’adenome parathyroidien par alcoolisation est efficace dans la plupart des cas et peut etre envisage chez les patients a haut risque chirurgical. Le reperage echographique prealable de l’adenome est indispensable pour le realiser.

Seventy-three inner-city boys with a mean IQ of 80 were followed prospectively from age 14 until age 65. Their adult adjustment was compared to a socioeconomically matched sample of 38 boys with a mean IQ of 115. Although childhood social disadvantage did not distinguish the groups with low and high IQs, half of the low-IQ men enjoyed incomes as high and had children as well-educated as did the high IQ men. These resilient low-IQ men were more likely to be generative, to use mature defenses, and to enjoy warm object relations than the high IQ group as a whole.

It is well established that until age 40 years, delinquent individuals have roughly twice the mortality of nondelinquent individuals and that the excess deaths are largely due to accidents, violence, and substance abuse. The present study examined if the increased mortality of delinquent subjects continues until age 65 years and, if so, why.The authors followed 475 delinquent and 456 matched nondelinquent comparison boys from age 14 years until age 65 years.Thirteen percent (N=62) of the delinquent and only 6% (N=28) of the nondelinquent subjects died unnatural deaths. By age 65 years, 29% (N=139) of the delinquent and 21% (N=95) of the nondelinquent subjects had died from natural causes. In a univariate analysis, frequency of delinquency, abuse of alcohol, adult crime, dysfunctional home environment, and poor education were significantly related to death, especially to unnatural death. However, when delinquency and alcohol abuse were controlled by logistic regression, education, dysfunctional upbringing, and adult criminality made no further contributions to mortality.Although delinquency is strongly associated with premature mortality, the etiological links remain unclear. Alcohol abuse and poor self-care in adulthood (e.g., infections or accidents) account for most of the modest variance in mortality that could be accounted for.

One hundred sixty-three men who have been followed prospectively for over 45 years were rated on a set of 25 personality traits at the end of their college careers and took the NEO-PI at approximately ages 67–68. The college traits were transformed, via a rating procedure, to scales assessing each of the Big Five dimensions and related to the NEO-PI. Three traits—Neuroticism, Extraversion, and Openness—exhibited significant correlations across the 45-year interval. Furthermore, the trait profiles remained relatively stable over that interval. Both sets of personality traits were related to a wide variety of life course variables representing the domains of global adult adjustment, career functioning/success, creativity, social relations, mental health, substance abuse, childhood characteristics, familial history of pathology, maturity of defenses, and political attitudes. Conscientiousness in college was the best predictor of what happened to the men in the future, whereas Neuroticism in late midlife was the best correlate of life course functioning across a variety of domains.

Objective The literature on the mortality of depression was assessed with respect to five issues: 1) strength of evidence for increased mortality, 2) controlling for mediating factors, 3) the contribution of suicide, 4) variation across sample types, and 5) possible mechanisms. Method All relevant English language databases from 1966 to 1996 were searched for reviews and studies that included 1) a formal assessment of depressive symptoms or disorders, 2) death rates or risks, and 3) an appropriate comparison group. Results There were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk. Conclusion The studies linking depression to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease. Future well-controlled studies of high risk groups may guide efforts to develop treatments that reduce the mortality risk of depression.

L’amelioration du pronostic du cancer epidermoide de l’œsophage passe par un meilleur diagnostic des lesions neoplasiques superficielles chez les patients a risque. Une politique de depistage chez ces patients en collaboration avec les specialites qui sont au contact de la population cible est necessaire.

Background. Many studies have noted a strong association between poor social support and premature mortality. A limitation of such studies has been their failure to control adequately for confounders that damage both social supports and physical health.Methods. A 50-year prospective multivariate study of 223 men was used to examine the possible causal relationships between social supports and health. Alcohol abuse, prior physical health and mental illness prior to age 50 were controlled. Relative social supports were quantified over the period from age 50 to 70.Results. Adequacy of social supports from age 50 to 70 was powerfully correlated with physical health at age 70 (PPPPConclusions. While social supports undoubtedly play a significant role in maintaining physical well-being in late life, much of the association between poor social supports and mortality may be mediated by alcoholism, smoking and pre-morbid psychopathology.

Objective: A 55-year prospective study attempted to determine the antecedents and consequences of positive mental and physical health in adult men. A substudy was conducted to look at the late-life physical health of men selected to be as unlike men with major depressive disorder as possible. Method: Of 237 men selected for health and followed since college, 64 undistressed men had never used mood-altering drugs or consulted a psychiatrist before the age of 50. The health at age 70 of these 64 men was compared with that of 20 men classified as depressed at age 70, 109 men classified as neither healthy nor depressed at age 70, and 44 men classified as having alcohol dependence or abuse at age 70. Results: At age 70, the 64 undistressed men enjoyed significantly better health than the 109 men in the intermediate group. Only three (5%) of the 64 undistressed men were dead or disabled by age 70, compared with 30 (28%) of the 109 men in the intermediate group and nine (45%) of the 20 depressed men. The mean age of the subjects’ maternal grandfathers at death also significantly differentiated the three groups. The differences in longevity among the three groups could not be explained by personality disorder, by cigarette, dietary, or alcohol abuse, or by longevity of the subjects’ other first-degree ancestors. Conclusions: These findings lend support to the hypothesis that risk of affective disorder may lie along a continuum. At one extreme may be men with stable lifestyles, a lifelong resistance to mood disorder, and unusually good physical health in late life. At the other extreme of the continuum may be men with vulnerability to mood disorder and accelerated physical aging. (Am J Psychiatry 1998; 155:184‐191)

Graves' ophthalmopathy (GO) is a specific immune-mediated disorder, whose treatment is sometimes difficult. In order to investigate the efficacy of intravenous methylprednisolone (MP) pulse therapy in GO, we studied eight patients with GO, followed up for at least 6 months by clinical patient self-assessment, ophthalmological examination and orbital computed tomography (OCT). A 12.5 mg/kg dose of MP was administered intravenously over a 10 hour period, once every month. Three to six MP pulse administrations were performed in each patient. All patients were outpatients. A 0.5 mg/kg/day oral prednisone dose was given to each patient as interpulse therapy. Clinical assessment of MP pulse therapy showed a good response in 87.5% and no response in 12.5% of patients. The treatment was rapidly efficient, mostly on patient self-assessment, soft tissue inflammation, ophthalmoplegia, corneal involvement, visual acuity and extraocular muscle enlargement on OCT. Post-treatment ophthalmic index was significantly improved (6.75 +/- 3.06 vs. 2.5 +/- 1.41: p < 0.05). MP pulse therapy had less effect on proptosis (22.94 +/- 2.32 mm vs. 21.56 +/- 2.22 mm: p < 0.05). No adverse effects were noted with MP pulse therapy. Patients showed no relapse of eye involvement during a mean follow up of 31.8 months (2-77 months). In conclusion, our results suggest that intravenous MP pulse therapy is a good immunosuppressive therapy for GO. Moreover, in comparison with the previous studies, the MP dose used in our present study appears to be optimal with high efficacy. MP pulse therapy represents a safe and efficient treatment in GO, which can easily be performed in outpatients.

The patterns of use of defense mechanisms by 306 inner-city men were rated from interviews at age 47 and these ratings were analyzed by cluster analysis. Five clusters resulted. The correlates of cluster membership were examined using data from the 50-year longitudinal study of these men. One cluster exhibited the greatest use of mature defenses; the men in this cluster functioned best on all psychosocial and health variables. Two clusters of men used primarily neurotic defenses; these men functioned at an intermediate level on all outcomes. The men in two clusters primarily used immature defenses. The men in one of these clusters used primarily action defenses, whereas the men in the other cluster were the greatest users of projection and fantasy. In general, the men in both these clusters functioned worse than those in the other three. However, the users of action defenses exhibited greater sociopathy, alcohol problems, and marital instability. The findings provide general support for the DSM-IV hierarchy for nonpsychotic defenses, with mature defenses at the top, neurotic defenses in the middle, and action defenses toward the bottom. In particular, the study supports the DSM-IV distinction of action defenses from other immature defenses.

This prospective study investigated whether major depressive disorder can cause negative life events. One hundred and thirteen normal college men have been followed biennially from age 26 until age 62. Fourteen major negative life events were assessed retrospectively by a self-report checklist. A blind rater read each man's complete records over the 35 years and used the same checklist prospectively. The negative life events were divided into dependent and independent groups according to whether the men's own behavior could have played a role in causing the events. In comparison with the normal control group, depressed individuals had a higher density of dependent negative life events after their first episode of depression. This difference did not exist for the occurrence of independent negative life events. Independent negative life events tended to be related to help seeking behaviors rather than to depression. This study confirmed our hypothesis that affective spectrum disorder can generate self-induced negative life events, which may contribute to the chronicity of the disorder.

This study aimed to examine the possible antecedents of both dementia and sustained intact cognition at age 90 years among men who underwent a prospective, multidisciplinary assessment from ages 19 to 90 years, with little attrition.We conducted a prospective 20-year reassessment of 196 (out of 268) former Harvard college sophomores who survived until age 70 years. Since 1939, the study gathered measurements of childhood environment, dominant personality traits, objective mental and physical health over time, smoking in pack-years, alcohol abuse, and depression. Questionnaires were obtained every 2 years and physical exams every 5 years. Cognitive status was assessed at ages 80, 85, and 90 years.Despite addressing a wide variety of health, behavioral, and social factors over the lifespan, we observed few predictors with strong association with either intact cognition at age 90 years (n = 40) or dementia (n = 44). Univariate analysis revealed seven suggestive predictors of intact cognition at age 90 years or of dementia: warm childhood relationship with mother, exercise at age 60 years, high maternal education, young age of mother at subject's birth, low body mass index, good physical health at 60 years, and late retirement. Only the first three variables, warm childhood relationship with mother, exercise at age 60 years, and high maternal education, remained significant with logistic regression.In this prospective study of long-lived, highly educated men, several well-known putative predictors of Alzheimer's disease did not distinguish those who over the next 20 years developed dementia from those with unimpaired cognition until age 90 years.

A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.

OBJECTIVE This study was an effort to clarify both the psychological contributions to and the long-term consequences of uncomplicated essential hypertension. METHOD The subjects were 193 healthy college students selected as sophomores and prospectively followed for over 50 years. Independent assessments of physical and mental health were made. RESULTS Although objective indices of psychopathology predicted both physical morbidity and mortality, they did not predict hypertension. When pyknic somatotype, college diastolic blood pressure, and well-integrated personality in college were controlled, no other preadult variable predicted hypertension. As expected, heart disease, obesity, and alcohol abuse were each correlated with hypertension. After roughly 20 years, 14 of the 41 men with treated hypertension were in stable remission, and 13 men had developed cardiac complications. No differences between these groups could be discerned. CONCLUSIONS Over time, hypertension appeared to be more a product of biological than of psychosomatic variables. Good psychological health did not diminish the risk of hypertension.

Recent research suggests that affective disorder is associated with increased mortality and physical morbidity, but the reasons for this association remain uncertain. This report describes a 50-year prospective study of 240 men evaluated from the time they were university students in 1940–1942. A family history of mental illness was obtained and the men's habits, psychological adjustment, and marital and occupational satisfaction were followed every 2 years and their objective physical health was tracked every 5 years until age 70. Twenty-five men were identified as having affective spectrum disorder prior to age 53. Of the variables studied, the presence of affective spectrum disorder was the most powerful predictor of poor psychosocial outcome at age 65 and one of the most powerful predictors of poor physical health. Alcohol abuse and cigarette abuse accounted for the observed increased rates of heart disease and cancer. When alcohol abuse, smoking, and suicide were controlled for, affective disorder made a significant contribution to physical morbidity by age 70, but not to mortality from natural causes. Affective spectrum disorder, even in an educated population without antisocial trends, carries a profound negative risk to late-life physical and social adjustment.

Over the past 55 years, two longitudinal studies have been monitoring the drinking behaviors and their consequences of several hundred men from adolescence and early adulthood to old age. The studies identified co-occurring sociopathy, cultural factors (e.g., ethnicity), and genetic factors (i.e., a family history of alcoholism) as risk factors for alcoholism. n most alcoholics, the disease had a progressive course, resulting in increasing alcohol abuse or stable abstinence. However, some alcoholics exhibited a nonprogressive disease course and either maintained a stable level of alcohol abuse or returned to asymptomatic drinking. Long-term return to controlled drinking, however, was a rare and unstable outcome. Formal treatment, with the exception of attending Alcoholics Anonymous, did not appear to affect the men's long-term outcomes, whereas several non-treatment-related factors were important for achieving stable recovery.

Objective The authors took advantage of a 50-year prospective study of World War II veterans to examine the predictors and correlates of combat exposure, symptoms of posttraumatic stress disorder (PTSD), and trait neuroticism. Method The subjects were 107 veterans who had been extensively studied before and immediately after serving overseas in World War II. All served as members of the study until the present time, and 91 completed questionnaires of both PTSD symptoms and neuroticism. Results In this study group, variables associated with positive psychosocial health in adolescence and at age 65 predicted combat exposure. Combat exposure and number of physiological symptoms during combat stress--but not during civilian stress--predicted symptoms of PTSD in 1946 and 1988. Combat exposure also predicted early death and study attrition. Psychosocial vulnerability in adolescence and at age 65 and physiological symptoms during civilian stress--but not during combat stress--predicted trait neuroticism at age 65. Conclusions Combat exposure predicted symptoms of PTSD but not nonspecific measures of psychopathology. Premorbid vulnerability predicted subsequent psychopathology but not symptoms of PTSD.

This paper proposes that eight positive emotions: awe, love/attachment, trust/faith, compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology. Rather, spirituality is all about emotion and social connection that are more dependent on the limbic system than the cortex. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change, if clinicians set about enhancing positive emotions, rather than focusing only on the negative ones.

SEVEN MODELS FOR CONCEPTUALIZING POSITIVE MENTAL HEALTH ARE REVIEWED: mental health as above normal, epitomized by a DSM-IV's Global Assessment of Functioning (GAF) score of over 80; mental health as the presence of multiple human strengths rather than the absence of weaknesses; mental health conceptualized as maturity; mental health as the dominance of positive emotions; mental health as high socio-emotional intelligence; mental health as subjective well-being; mental health as resilience. Safeguards for the study of mental health are suggested, including the need to define mental health in terms that are culturally sensitive and inclusive, and the need to empirically and longitudinally validate criteria for mental health.

Studies supporting Coloninger's original Type 1/Type 2 hypothesis for classifying the generic transmission of alcoholism have sometimes failed to control for important sources of potential bias. First, the environmental effects of parental alcoholism must be distinguished from the genetic effects of parental alcoholism. Secondly, antisocial personality disorder must be distinguished from alcohol dependence. Thirdly, to control for developmental effects a cohort of alcoholics should be followed into late mid-life. The present report, a 50-year prospective study of the development of alcoholism in two community samples of 456 disadvantaged youth and 204 Harvard graduates, addresses these three, potential sources of bias. In this report the age of onset of alcoholism and the degree of antisocial symptomatology was correlated with disturbed family environment but was quite independent of the presence or absence of a heredity positive far alcoholism. The reasons why such findings threaten the validity of the Type 1/Type 2 hypothesis are discussed.