This book is written with a scholarly audience in mind and may be a challenging read for anyone who is not a professional in the field of mental health or medicine.

The author of The Natural History of Alcoholism, George E. Vaillant, is a Professor of Psychiatry at Harvard Medical School. He is also Director of the Study of Adult Development at Harvard University Health Services and Director of Research in the Division of Psychiatry of Brigham Hospital and Women's Hospital in the Boston, Massachusetts area.

The insights on alcoholism in this book come from a long-term study conducted by the Harvard Medical School's Study of Adult Development (SAD). The following groups have funded SAD: the National Institute of Mental Health, the National Institute of Alcohol Abuse and Alcoholism, the National Institute of Aging, the William T. Grant Foundation, the Spencer Foundation, the Milton Fund and the Commonwealth Fund. SAD has followed 655 men from 1940 to the present, over 60 years. Other than this study, five to eight years is the most any other scientists have followed alcoholics. At the start of SAD, the subjects were young men, and none of them had yet manifested any symptoms of alcoholism. By following their lives over many decades, the researchers learned a great deal about how alcoholism, a chronic condition, manifests and changes over time.

In 1940, the participants of SAD were divided into two groups: (1) College Sample: 268 upper-class, male, Harvard sophomores were selected with 27 eventually excluded due to death, withdrawal from the study or lack of adequate information on them. Of the 241 that were left, at age 70, the lifetime prevalence of alcohol abuse was 22%. That is, during their adult life, 52 of them met the DSM-III criteria for alcohol abuse. (2) Core-City Sample: 456 lower-class boys from Boston's inner city were junior-high-school age at the start of the study. Of these, 414 were able to be adequately studied over time. By age 60, at some point in their adult lives 36%, or 150, of them met the DSM-III criteria for alcohol abuse. Dr. Vaillant states that the lifetime prevalence of alcohol abuse is 24% among white, middle-aged males, according to another study released 10 years ago of 20,000 adults. This figure falls between the 22% for the College sample and the 36% for the Core City sample.

Dr. Vaillant thoroughly discusses the findings of SAD on the following research questions: (1) Is alcoholism a symptom or a disease? (2) Does alcoholism usually get progressively worse? (3) Are alcoholics, before they begin to abuse alcohol, different from nonalcoholics? (4) Is abstinence a necessary goal of treatment, or can insisting on abstinence sometimes be counterproductive? (5) Is returning to safe, social drinking possible for some alcoholics? (6) Does treatment alter the natural history of alcoholism? (7) How helpful is Alcoholics Anonymous in the treatment of alcoholism?

Here are a few fascinating points on these issues that Dr. Vaillant reports:

Alcoholics participating in various recovery programs have, over time, little more success at recovery from alcoholism than if they were not treated at all.

Contrary to popular belief, alcoholism has a slow onset, often as long as 20 years.

In the case of moderate drinkers, "given enough education, willpower, social supports, and an undemanding lifestyle," their abuse of alcohol can be sustained for almost all their life without any major price in health or social success.

It isn't underlying psychopathology (personal and social problems due to either genetics or inadequate nurturing) that causes alcoholism. Rather, it is alcoholic drinking that produces psychopathology, including: psychological dependence on alcohol, problems with friends, family and coworkers, accidents, health problems, financial problems, blackouts, depression, anxiety, oral fixation, self-doubts, self-loathing, pessimism, self-defeating behavior, paranoia, aggression and violence leading to trouble with the police. When alcohol abuse ends, these destructive traits and actions frequently go away, leaving the recovered alcoholic no more dysfunctional than "normal" people.

After over 50 years of looking at the alcoholics from this study, Dr. Vaillant has concluded that while alcoholism progresses, getting heavier from age 18 to 40, after that, it starts to stabilize, and alcoholics are rarely worse off at 65 than they were at 45. By 65 one-third of alcoholics are either dead or in terrible health (progressive), one-third are abstinent or drinking in a safe, social manner (recovered), and one-third are trying to quit and haven't been able to (unrecovered). The progressives tend to have the worst symptoms (see the list above) once they start abusing alcohol and spent more years feeling out of control (progressing from bad to worse). Of the three groups, the ones most likely to recover are those at either end of the spectrum. Those who are the worst off have the most to lose if they don't quit--all they hold dear and their very lives. Those who have a mild drinking problem have relatively little to give up, and are much more likely to have supportive social connections (very important in giving up alcohol) because their behavior isn't as bad as that of the progressives, so they've alienated less people.

I highly recommend this book to all mental health professionals and medical doctors--especially general practitioners. I also recommend it to motivated non-professionals who have a personal stake in learning everything they can about addiction.

This book is one-of-a-kind. There has never been a more carefully done longitudinal study of alcoholism over a longer period of time (we're talking following young men, many of whom became alcoholics, for 50 years, here). This book is a national treasure to those interested in what happens to the unfortunate folks who develop alcoholism. I only wish we had more than 5 stars.

Seldom does a book, written by a psychiatrist for scholarly and professional reasons, make so much sense and resonate so deeply. George Vaillant M.D., a brillant mind and a gifted researcher, culls his vast sea of knowledge about the inner workings of the psyche and has shows us therapists and lay people alike how to better understand ours'. Dr.Vaillant writes with wit , warmth and compassion. He makes complex psychoanalytic theories very accessible and relevant to our daily lives.This text is absolutley indispensible for the psychotherapy student, the curious lay reader or the seasoned cliniciain who seeks to deepen and expand his or her understanding of the soul .Having delighted in reading the book when it was first published, I find myself returning to it again and again for its wise and engaging commentary on being human.

George Vaillant has put a life time of work into a 375 page book. It allows the reader to delve into the wonders of the psychoanalytical world. With a constant review of three cohorts he goes onto explain and give thorough examples of his theories. Despite the inconsistencies of the book and the constant contradictions, Vaillant is able to prove his point. The human psych is unstable and dependant on a level of maturity and development of the Ego.

This book is used as a basic text for an Abnormal Psychology class at Harvard. It is an easy read, very interesting and filled with information that makes sense.

It takes a very humanizing view to Freud's defenses and shows how that be thought of as good things.

This book is a very important tool for understanding human behavior. Not only is it suited for students of psychiatry but also anyone who wants to learn more about himself/herself (why he/she acts and reacts in a particular way). This book gives you a historical perspective of these mechanisms and likewise tells you about the importance of these mechanisms.

I am now thinking about buying this title. I've read the opinion of the reader that backs it, but .... I am almost sure (due to many previous experiences) that the only shortcoming is not just about women, it for sure has been very probably written taking into account (hope I'm wrong) that north-americans are the only people living in this planet. So, if you are looking for readings that help you to succesfully deal with another and/or different type of society, or another type of country, opinions are so deeply oriented to northamerican way of handling life, they are not worthwhile and hardly applicable.

Dr. Vaillant mines a long-term study of exemplar Harvard graduates and plots those men along a dimension of "adjusted-ness" to life. Some the best-adjusted share particular personality traits. Some the least-adjusted also have commonalites of ego defense mechanisms. Truly, time will tell who gets the most out of life and who does not. Thanks to the Grant Study and Dr. Vaillant, much has been revealed about what influences the course of one's life.

I've read ''Adaptation to Life'' several times over the past decade, and I'm not a mental health professional. It's extremely interesting to anyone who wants to learn more about the ego mechanisms of defense, yet is markedly different from the usual self-help tome authored by a psychiatrist or a social worker based on findings from his/her practice. Why? ''Adaptation to Life'' is based on the findings of a study of actual human beings from the time they graduated from college through late adult life (60 years old or so). That long-term view helps to illustrate that what might be construed as good adjustment to life in one's twenties might be less useful when one is over 50. Its main theme, that rather than being absolute and unchanging, mental health develops and matures over a lifetime, is reassuring. I've found the book useful as a ''guide,'' of sorts, to return to again and again as I grow older. The only shortcoming to ''Adaptation to Life'' is that the study did not include women. I'm curious as to whether the development and maturation of ego mechanisms of defense might be different for women than for men. But to dismiss this well-written book entirely for that reason alone would be a mistake; after all, many of the hurdles that must be addressed in the course of human development are the same for males and females. The final plus is that ``Adaptation to Life'' is fairly free of medical jargon and therefore an easy read for non-clinicians.

Skip this one and go for the original AGING WELL by Dr. Jeanne Wei, which came out a couple of years before this..., which even uses a similar jacket design! AGING WELL by Jeanne Wei is much more comprehensive and practical than this new pretender, and I learned a lot more about how to manage my life to stay young.

With around 320 pages of main text, not counting the appendices, Vaillant takes some time to present a popularization of several longitudinal studies of adult development, and to put forth the idea that development doesn't simply stop at 5, 12, 21, or even 45, but that it continues, with specific challenges, into the late and late-late years of life.

As a book intended for popular reading, Vaillant can be expected to make assertions and hopeful noises that his data don't necessarily back up to the same extent as he would for a peer reviewed journal. Generalizability from the studies he has available (which are impressive accomplishments in social science research, even with all of their limitations) is sketchy, especially since he gives most of his time to the Harvard group of white men.

Still, even seeing a limited portrayal of a slice of the population that's gotten young-old (60-69), old-old (70-79), and become the oldest-old (80+) has its benefits. For one thing, it does help lay out a trajectory that those of us who are distant from the older generations can use of to conceive the future of our parents and the present of our grandparents in ways beyond loss.

So if you want a pick=me up and a reminder about many of the strengths and successes of the elderly go ahead and pick this up. Just don't expect it to tell you as much about the disadvantaged elderly.

Mountains of research was reviewed to write this book. For that effort I added an additional star to the three I gave for the book itself. The three studies referenced in this book began before the author was born or when he was a youngster. Dr. Vaillant's participation with these projects began decades later. This data was fragmented and resided on many different mediums. He undertook the task of getting all the data compiled onto a hard drive. His next task was to correlate the data (which was not always consistent between the three studies) to form meaningful patterns about aging.

His book is an "attempt to offer models for how to live from retirement to past 80 with joy". Comparing his pursuit to Dr. Spock's career in the study of child development, the author also perceives his book as "an attempt to anticipate development of old age and understand what can be changed and what has to be accepted."

Using composite histories of the study participants for comparison, six adult life tasks are reviewed: Identity, Intimacy, Career Consolidation, Generativity, Keeper of the Meaning and Integrity. The author strives to determine if we are genetically predisposed in how we experience these phases or in some cases choose to stay indefinitely in a phase that is comfortable rather than move on to experience another.

I read this book out of curiousity about the experiences of advanced aging in the United States and feel I now have a good foundation for developing a philosophy about my own aging process.

This book is not a deep scholarly rendition, however, the majority of the 300+ pages examing statistical data and percentage references became tiresome and difficult to analyze in lengthy reading sessions. I preferred reading a chapter and putting the book down for a while.

A helpful tip: I realized, after the fact, that reading the appendices first would have helped me understand of some terms and jargon used to refer to elements of the studies.

Great resource but extremely difficult to read and not recommended for the layman. Full of research data and references. Great material for a clinician but reads like a doctoral thesis, not a book.