5

FROM EMOTIONS TO MOTIVATION

Snakes, rickety bridges, Mad Men, and stress

Two of my favorite singers, Joni Mitchell and Stevie Wonder, do something that no one else I know does—they embrace a full range of emotions and make you feel them too, oftentimes within a single line of a song. When Stevie sings, “People hand-in-hand, have I lived to see the milk and honey land?,” he is able to command both vulnerability and confidence, sorrow and hope, in the same line. When Joni sings the single word blue (from the song and album of the same name), she sounds as if she’s crying and laughing at the same time—as if the depression is awful but she can step aside from it and see that it is only a passing phase.

Many of us turn to music for emotional support, comfort, or inspiration, or to motivate us to move. Music can trigger emotions and sometimes help us interpret our feelings when we’re not sure how we feel. It can pull people with Alzheimer’s out of their closed-in world and help them to reengage with life and their surroundings.

Emotions arise inside of us and profoundly affect our moods. What are these psychological states exactly? Emotions are related to moods, but they’re not the same thing. Emotions are an acute state of affect and arousal lasting from seconds to minutes, whereas mood refers to a longer-term emotional tone. Emotions occur against a background of mood. You might be in a slightly irritated mood after having had an argument with your boss. Then, when someone steps on your foot in line at a Starbucks, or your seven-year-old keeps interrupting you, well, that’s when you begin to exhibit emotion.

Emotion, motivation, reinforcement, and arousal are closely related topics and often appear together in neuroscientific research. Emotions evolved because they motivate us. They are that surge of something (arousal) you feel welling up in you that makes you want to take some kind of action. They move us away from danger and toward food, dry shelter, and potential mates: key elements that positively reinforce our identities. It is no accident that the word motion is contained in the word emotion. Nor is it a coincidence that when we are feeling particularly deep emotion, we say we are moved. Emotions are the body’s way of encouraging us to do what is best for us, and as biologist Frans de Waal says, they “focus the mind and prepare the body while leaving room for experience and judgment.”

It may seem that emotions just happen in response to the environment, but that’s not how neuroscientists see it. Like perception, emotions appear to be constructed out of bits and pieces of experience and inference, and the job of our brains is to tie disparate threads together and try to make sense of what’s happening around us and inside of us.

In other words, emotions come about in a way that is exactly the opposite of what we usually imagine. You think that you see a snake, feel fear, and then jump back to avoid it, but snakes are fast and your conscious, analytic brain is slow. If you waited for your brain to determine that the rustling in the grass was a snake, it would be too late—you’d get bitten. Instead, a subcortical, subconscious process moves you out of the way rapidly. Only then does your brain figure out why you’ve jumped and signal to you, “You’re afraid.” This all happens so quickly that you think it’s happened in the opposite order. Similarly, if you feel an ache on your arm, you rely on context. If you just got punched, your brain assigns a particular emotion—perhaps anger and a desire to retaliate, perhaps fear and a desire to run to avoid getting punched again. However, if the ache is because you just got a flu shot, you feel a different emotion—perhaps resignation, frustration, or stoicism, mixed with the optimism that it will help you avoid getting sick this winter. The same bodily feeling gives rise to two different streams of emotion.

Neuroscientist Joseph LeDoux makes a distinction between emotions that arise from survival behaviors and other emotions. Survival behaviors include things like defense, maintenance of energy and nutritional supplies, fluid balance, thermoregulation, and reproduction, and they have distinct neural circuits underlying them. Our human survival strategies go back to single-cell organisms, such as bacteria, which, despite not having a nervous system, have the capacity to close their semipermeable outer wall in the presence of harmful substances and to accept substances that have nutritional value. Our own survival circuits include chemical systems that regulate how we react to others. In humans, oxytocin and vasopressin influence our bonding and affiliations. Even a creature as lowly as the worm has an equivalent to these, a neuropeptide called nematocin that, when active, causes them to want to mate. Worms who have nematocin blocked don’t particularly want to mate, and when they do try, they aren’t very good at it.

Survival circuits, from worms to humans, cause specific brain and bodily responses to rise in priority, while inhibiting other circuits and actions. When the brain and body become aroused, attention becomes focused on relevant environmental and internal stimuli, motivational systems become engaged, action is taken, learning takes place, and memories are formed. What we call emotions or feelings occur when we consciously detect that a survival or motivational brain circuit is active or we detect some change in body state, and then—here’s the amazing part—our consciousness appraises and labels this state.

One of my favorite experiments in psychology, the rickety bridge experiment, illustrates this. Male college students walked across one of two bridges. One bridge was chosen to be fear inducing—a rickety bridge that was high up over a deep ravine. The other was chosen to be non–fear inducing—a sturdy bridge only about ten feet above the ground. A female confederate of the experimenters was waiting at the other end of each bridge and asked the male participants if they would fill out a questionnaire about scenic environments for a psychology project she was doing. When they were done, she wrote down her phone number in case they had further thoughts. The experimenters hypothesized that the men who crossed the rickety bridge would be physiologically aroused by the time they reached the end (due to fear) but that they would construe, or misattribute, this arousal as sexual attraction to the female. Accordingly, the experimenters predicted that the rickety-bridge crossers would be more likely than the sturdy-bridge crossers to telephone the female researcher for a date. That’s exactly what they found. (This experiment was the basis for one of the most memorable scenes in the television series Mad Men. Roger Sterling and Joan Holloway were walking at night in New York City and got mugged, causing them both to become severely frightened. Right after the mugger leaves, the two of them duck into the shadows and have passionate sex.) Other experiments showed that a whole range of emotions can easily be misattributed. All of this underscores the counterintuitive point that emotions are cognitive constructions that depend on circumstances and interpretation.

This way of looking at things causes us to reevaluate animal emotion. No one is claiming that animals don’t experience emotions—they clearly do—but they probably experience them differently because they lack the cognitive analytic tools to interpret them in the complex ways that we do. It seems to many dog owners that our beloved pets experience a wide range of humanlike emotions—joy when rolling in the grass, shame after being caught peeing on the couch, jealousy when we play with another pet, sadness when we leave them alone too long. One possibility is that we are anthropomorphizing them. Another is that they experience proto-emotions that are somewhat humanlike, based on findings that they have similar neurochemistry and similar brain activations to humans in response to stimuli that would cause us to feel particular emotions. But then there are emotions that dogs and other animals appear to lack completely. For example, my dog, Madeleine, although we often think of her as human, does not experience disgust. Neither did the succession of best friends who preceded her: Winifred, Shadow, Isabella, Charlotte, Karma, or 99. Dogs will eat or roll in practically anything and show no evidence of the emotion of disgust, which appears to be uniquely human. As infants, we don’t have it until we’re three to seven years old, but once we get it, we hang on to it for life. In fact, the older we get, the wider our experience of disgust becomes, as we contemplate injustice, violence, and fraud in our world—not just excrement or rotten food.

Many emotions appear to be built in. Human infants don’t have to be explicitly taught to avoid certain dangers. Encountering a fast-approaching, large creature with sharp teeth—even if one has never encountered it before—causes an automatic fear and avoidance reaction. Evolution has hardwired a general fear template into our brains, rather than a particularized fear of specific things, and the things we can easily become afraid of are part of that general fear template. It’s easier to develop a fear of snakes, for example, than a fear of flowers.

Are there emotions that all humans have that span different time periods and cultures? A long-standing theory attributed to Paul Ekman is that there are six such basic emotions, cultural universals, meaning that they exist independent of culture: fear, anger, happiness, sadness, disgust, and surprise. According to this theory, the hundreds of other emotions we describe, such as vexation, winsomeness, regret, and hope, may be culturally dependent, or cognitive constructions. The theory is controversial and the evidence for it is mixed—even those six may not be truly universal; we just don’t know yet. There may be more, including emerging evidence that we should add spite to the list. (That’ll show ’em!)

On the other hand, there appear to be hundreds of emotions that are culturally specific. Words exist in disparate languages for things that your own language may not have a word for. The Dutch describe a specific emotion for the revitalizing effects of taking a walk in the wind: uitwaaien. If you’ve never had the irresistible urge to take off your clothes as you dance, you haven’t experienced the Bantu emotion of mbuki-mvuki. If you have a crush on someone and get a jittery, fluttering feeling, you may recognize the feeling but not have a word for it unless you speak Tagalog, which calls it kilig. The Danish have a word for the emotion of feeling cozy, safe, comforted, and cared for, but it’s more than that—it includes the feeling of pleasure that comes from chatting with a friend or bicycling in the sunshine: hygge. And, famously, the Germans have the word schadenfreude, the pleasure we take when we see others’ misfortunes (especially people we don’t like). These words have no equivalent in English, but they represent very precise emotions in other cultures.

One noncontroversial function of emotions is to regulate your body budget, the physiological resources that you have available at any given time, conserving or spending them as situations require. If you’re breathing rapidly and sweating, what should your body’s reaction be? It depends on what caused that state, your causal attribution. Is it because you’ve just encountered an angry tiger or because you have the flu? These situations call for different physiological reactions.

Emotions also promote social currency, the understanding of others’ mental states. To do this, your brain makes emotional inferences. As emotion researcher Lisa Feldman Barrett says, “If you see a man taking quick breaths and sweating, it communicates one thing if he’s wearing a jogging suit and something else entirely if he’s wearing a groom’s tuxedo.” Making such determinations means that your brain has to be making predictions all the time. You hear that rustle in the grass, and your brain puts together a statistical inference about what it’s likely to be, taking into account factors such as whether your friend is behind you, whether a wind is blowing, whether you’re in an area known for snakes.

So when it comes to the emotional interpretation of events, your brain is making not predictions but superfast “postdictions,” after-the-fact inferences about things that have already happened. Your brain is continually rewriting your perceptual history to conform to new incoming facts. This is a form of Bayesian inferencing: form an opinion and update that opinion as new information becomes available.

Our emotional life has to develop and mature just like anything else. Infants begin with no emotional self-consciousness and experience only a limited range of emotions: in the first month, there’s not much happening other than crying (distress) and contentment. Social smiles (happiness or joy) emerge at two months. Other emotions layer onto those only after six months. Near the end of their first year, infants begin to experience fear, and in the second year, anger (the terrible twos!). Then there’s a whole class of social emotions that arise in our relationship to other people, and they don’t emerge until later, when the child has acquired a sense of self-consciousness and begins to worry about how others see him or her; these include guilt, shame, embarrassment, and pride. Emotion differentiation, being able to appraise and describe emotions, isn’t complete until the early twenties—adolescents, for example, tend to report feeling one emotion at a time, while young adults can report mixtures of emotions and can conceptualize emotions as co-occurring.

Are Emotions Scientific?

Are emotions completely reducible to neurochemicals? In other words, would it be fair to say that your neurochemicals are your emotions? In theory, yes. It is an assumption of modern neuroscience that given enough information, we can map all thoughts, feelings, hopes, and desires onto specific brain states. But at the moment, and for many years to come, this is just a theoretical ideal. We are a very long way from being able to say things like “Add two microliters of progesterone to the parahippocampal gyrus and this will happen.”

Why?

For one thing, there are a large number of players in the story—more than fifty hormones and neurochemicals working within a system of chemical receptors, synapses, neuronal firing rates, brain architecture, and blood flow. We don’t yet have the ability to measure the momentary state of all of these factors and so we can’t yet assign roles to them. In addition, they interact in complex ways. It would be like asking if ten people can cause a revolution. Maybe—it depends on the society, on the streets, the weather, and the presence of alternative political options. It’s complicated.

Another practical barrier to understanding is that each of us is unique, differing from one another in uncountable ways. A dollop of dopamine in your frontal lobes may do something very different from what it does in mine, because we may have different numbers of dopamine receptors, and the circuitry they support almost certainly operates differently (that’s part of what makes us different from one another). And your brain is constantly changing: That same dopamine spike may affect you differently today than tomorrow, and at age twenty versus age seventy. Our individual differences arise in part because we have different genes that influence brain development and, accordingly, behavior. Also important are gene-by-environment interactions and gene expression: You might have a genetic predisposition toward narcissistic psychopathy, but without the right environmental triggers, that gene may never become active. (Then again it might.)

Neuroscientists posit that all of our feelings, hopes, desires, beliefs, and experiences are encoded in the brain as patterns of neural firings. Just how this happens is not precisely understood, but we have made strides in understanding how neurons communicate with one another. Progress has also been made in mapping which brain systems control which kinds of operations: One system is responsible for blinking your eyes, another senses the pain when you are stung by a bee; one system helps you to solve crossword puzzles, another enjoys watching Young Sheldon. A new approach to studying brains and individual differences involves making maps of how neurons connect to one another. Following the term genome, these are called connectomes. Your experiences are encoded in the way your neurons connect to one another.

At some future point, when the connectome is worked out and we have better techniques for measuring brain chemistry, we may be able to talk about emotions in specific hormonal and neural terms. This medicalization of experiences may seem odd, but we’re already doing it. One hundred years ago, if someone was getting cranky or sleepy before a meal, we’d just say they were hungry. Now we might say they’re experiencing low blood sugar, another way of saying that the body doesn’t have enough bioavailable glucose. Seventy years ago if a child acted out in school and seemed inattentive, we’d say the child was unruly. Now we might diagnose that same child with a disorder (ADD) and treat it by prescribing a dopamine agonist such as methylphenidate (Ritalin) or Adderall. (An agonist promotes the action of a particular neurochemical system; an antagonist blocks it.)

The Surprising Thing about Stress

Stress is also an emotion, one that we share with other animals and with one another across the life span, although the causes of stress can be quite variable. Chronic stress is especially harmful. Stress is also highly variable—what would stress out one person another takes in stride, and vice versa.

Stress can have a substantial impact on longevity. Consider an experiment with Pacific salmon. After swimming upstream to spawn, and releasing tons of glucocorticoids because of the stress, they die. It’s not because they’re exhausted, or for some other biologically preprogrammed reason—rather, they experience rapid aging because of the production of those stress hormones. When researchers removed the adrenal glands of the salmon, which release all those glucocorticoids, the salmon didn’t die after spawning.

As biologist Robert Sapolsky says,

If you catch salmon right after they spawn . . . you find they have huge adrenal glands, peptic ulcers, and kidney lesions, their immune systems have collapsed . . . [and they] have stupendously high glucocorticoid concentrations in their bloodstreams.

The bizarre thing is that this sequence . . . not only occurs in five species of salmon, but also among a dozen species of Australian marsupial mice. . . . Pacific salmon and marsupial mice are not close relatives. At least twice in evolutionary history, completely independently, two very different sets of species have come up with the identical trick: If you want to degenerate very fast, secrete a ton of glucocorticoids.

Earlier, I mentioned my University of Montreal colleague Sonia Lupien, one of the world experts on the physiology of stress. She writes:

A week seldom passes without hearing or reading about stress and its deleterious effects on health. . . . There is a great paradox in the field of stress research, and it relates to the fact that the popular definition of stress is very different from the scientific definition of stress.

In popular terms, stress is mainly defined as time pressure. We feel stressed when we do not have the time to perform the tasks we want to perform. . . . In scientific terms, stress is not equivalent to time pressure. If this were true, every individual would feel stressed when pressured by time. However, we all know people who are extremely stressed by time pressure and others who actually seek time pressure to perform adequately (so-called procrastinators). This shows that stress is a highly individual experience.

The term stress dates back to Old English in 1303 as a variant of distress and was typically used in contexts of coercion or bribery. In modern times, stress was first used by engineers in the 1850s to describe outside forces that could put a strain on a structure—heat, cold, and pressure. In the 1930s, endocrinologist Hans Selye revived this use of the term to include physiological reactions to outside forces acting on the body, such as heat, cold, and injuries that lead to pain. It wasn’t until the 1960s that we began to use the word the way we use it today, to mean the psychological tension we feel from anticipating adverse events, and the biological correlates of them.

You may be familiar with homeostasis, the idea that the body seeks to maintain consistency, say, in core temperature, or blood levels of oxygen. In the last twenty years, though, we’ve recognized that levels of some of our physiological systems—such as blood sugar levels, heart rate, blood pressure, and respiration rate—require continual adjustment to function optimally. This idea of stability through change is called allostasis—systems fluctuating regularly in response to life’s demands.

When a situation is perceived as being stressful (because it is novel, unpredictable, uncontrollable, or painful), two major classes of stress hormones are secreted, catecholamines and glucocorticoids. They are the first hormonal systems to respond to stress. The short-term secretion of these hormones in the face of a challenge serves an adaptive purpose and leads to the fight-or-flight response (allostasis). However, the same stress hormones that are essential for survival can have damaging effects on both physical and mental health if they are secreted over a longer period of time (called allostatic load). This happens because when these primary stress hormones are increased for long periods of time, it leads to dysregulation of other major biological pathways in the body and the brain, for example, insulin, glucose, lipids, and neurotransmitters. This in turn causes a dysregulation of various other operations, such as the immune system, the digestive system, the reproductive system, cardiac health, and mental health.

Your allostatic load is the cumulative effect of stress over time; it indexes your changes in various biomarkers of stress (blood sugar, insulin, immune markers, stress markers, etc.) in response to the events of your life. Your allostatic load can be calculated by looking at levels of certain “stress biomarkers,” including C-reactive protein, insulin, blood pressure, and so on. Social support is a strong predictor of allostatic load, with those having less social support showing the highest load. This is another case of not knowing the direction of causality—does having few or no friends increase stress? Probably. Does being stressed to begin with drive friends away? Probably. Does not having friends to comfort you cause that stress to linger instead of dissipating? Again, probably.

There are many ways to reduce stress, of course. Cognitive behavioral therapy (CBT), a form of talk therapy that teaches tools to help you cope, is one of them. Exercise, meditation, listening to music, immersing yourself in nature, and sometimes just talking to friends and having social support can help to reduce stress significantly.

If emotions are constructed, like perceptions, you might think that the brain tries to fill in and predict what is going to happen next to us emotionally—and it does. For most of us, our bodies seek to maintain a kind of emotional consistency; we internally regulate our emotions so that we don’t experience extremes, because they can be emotionally and physiologically overwhelming. The central nervous system learns to anticipate stressors and to make allostatic adjustments in advance. The entire process is dynamic—it is an adaptable, plastic system that responds to sensory perceptions and cognitive processing by regulating neurotransmitters and hormones to either produce or recover from stress.

Part of effective regulation is the reduction of uncertainty. Our brains try to anticipate the outcome of future events, to anticipate our needs and plan how to satisfy those needs in advance. Doing this is metabolically expensive if your life is marked by great uncertainty, and the brain can easily use up its resources, resulting in a harmful increase in allostatic load.

Because allostasis is a predictive system, it can be influenced or miscalibrated by early life stressors or extreme traumas. A stable fetal and early childhood environment can lead to a well-functioning allostatic system. But adverse childhood experiences can result in a system that either overreacts or just shuts down in response to what might otherwise be considered normal daily ups and downs, creating hypervigilance, reduced resilience, and sometimes wild mood swings—a lifetime in which normal allostatic regulation is never reached. Someone who has grown up in adverse conditions will have long-term memories that contain threatening and stressful information; their default prediction for even neutral events is that something bad could happen, and this kicks in their stress response, releasing cortisol and adrenaline in advance of a great many situations that are benign. On a systems level, we’d say that they are not regulating their HPA (hypothalamic-pituitary-adrenal) axis—the body’s stress response system.

When we lack this kind of regulation, because either our lives are chaotic or our neurochemical systems are not properly calibrated, we can experience mood swings; we can act irrationally or impulsively, causing ourselves harm; and we can experience a range of illnesses, diseases, and other problems across the life span. Increased allostatic load (and the resulting loss of hormone regulation) can lead to cardiovascular disease, diabetes, compromised immune function, and cognitive decline. It has also been linked to a number of psychiatric conditions, for example, depression and anxiety disorders, and burnout and post-traumatic stress disorders.

Elevated cortisol levels in response to early life stress have been linked to accelerated hippocampal atrophy among both healthy individuals and people in the early stages of Alzheimer’s disease. Thus, successful emotion regulation may protect not only older people’s physical well-being but their mental capacities as well.

There are many factors that influence the stress response and the health of the allostatic system—it’s not just the obvious things like a mother who took drugs during pregnancy or an early toddlerhood surrounded by domestic violence. These factors include:

But not everyone with a stressful childhood ends up with a psychiatric disorder, or even a high allostatic load. Stressful experiences can lead to very different outcomes, depending on the interaction of the factors listed above. Some people develop resilience, grit, tenacity, and focus. Others fall apart. The prized combination that allows some people to live more positive lives, to turn lemons into lemonade, is still unknown and an active topic of research. One thing we do know is that thoughtful parenting and/or education can put people on the more positive path and give them better overall life outcomes, reducing the disadvantages caused by childhood adversity.

Because allostatic load is defined as the cumulative effects of stress and your body’s responses to that stress, the load and associated cellular damage increase with age, no matter how well-functioning the system is. In particular, normal age-related changes in structures that regulate allostasis, the hippocampus and the prefrontal cortex, make healthy allostasis more difficult to maintain. Higher load has also been associated with reductions in the brain’s gray matter. Three recent studies have also linked sleep disturbances to increases in load.

Reducing stress and increasing resilience, the ability to bounce back from adversity, can be coached and taught through specialized psychotherapy, strengthening of social networks, physical exercise, and programs that help people find meaningful and purposeful activities in their lives. But that can take some effort (and openness to new experiences).

Depression

Our emotions can certainly become crippling. Children throw tantrums. Adolescents withdraw and become pouty. As adults, we can succumb to depression, an intractable disease that affects approximately 15 percent of Americans. This number is more or less the same across continents. I say intractable because in spite of the great advances made in neuropharmacology, antidepressant drugs tend to work only 20 percent of the time.

Negative emotions can interfere with our being able to do the things we want; they can be debilitating, and the neurochemicals they release can cloud our thinking.

I went to visit the Dalai Lama at his monastery in Dharamsala, India, in order to ask his advice about successful aging. While waiting to see him, I was seated in a waiting room. He was just outside greeting a long procession of followers, one at a time. I could watch through the window where I saw him in profile, seated in a chair, with a long line stretching out through the courtyard. The people appeared to have come from all over, and from all different backgrounds and life experiences. They ranged in age from children to the very old. Some were dressed in their finest clothes; others were barefoot and in rags. As they moved slowly ahead in the procession, I could see in the lines and creases of their faces, in the set of their mouths, and in their heads leaning forward, all of the hope they attached to meeting His Holiness. It was clear they felt that he would relieve their suffering, their pain, and put their lives back on track. Some had traveled for weeks to get to this mountaintop, sixty-five hundred feet up in the Himalayas.

His Holiness spent about forty seconds with each person in the line as they filed in front of him one at a time. He spoke with them, put his hand on their foreheads, and blessed them, and they moved on. The moment was so profoundly full of emotion for so many people that there were three beefy men standing next to the Dalai Lama whose sole job was to prop up people whose legs gave out from under them when it was their turn to actually stand in front of him. They were busy that day.

At one point, I heard a woman wailing and weeping, making the most awful distressed sounds. I couldn’t make out the words—it could have been Tibetan, Nepalese, or any number of languages. I went to the window and saw the woman—the Dalai Lama’s attendants were holding her up by her armpits; her legs had already given out. As she was wailing, I heard her cries interrupted by the Dalai Lama, who spoke in a gruff, deep, staccato voice, a few scolding words. The woman immediately fell silent. Then he whispered to her. There was silence again for a few moments, and suddenly the two of them started laughing.

After the procession, we met in his office. I asked him about this intriguing encounter.

“She came to me and she was saying things like ‘I am so miserable. I am so unhappy. I have a husband who is missing. I have a child who is malnourished. I have terrible pain in my feet . . .’

“I interrupted her,” the Dalai Lama said, “and I said, ‘What is this I that you speak of? This is not in our teaching!’ And she became quiet. And I asked, ‘Tell me about this I that is so unhappy—where is it?’ She pointed to her chest. I said, ‘What shape is it? A triangle? A square? A circle?’ She said, ‘It’s a circle.’ I said, ‘Okay. Imagine the circle in your chest. Meditate on it. Don’t let it move one centimeter to the left or to the right.’ She closed her eyes and focused on it. After a few moments she whispered, ‘It disappeared!’ And we both laughed.” The disciple awakened to the realization that she did not exist and since she did not exist there was no one to suffer.

Controlling our emotions, or at least channeling them toward positive things, is good for our health. We know this now through neuroscience, but this has been part of Buddhist teaching for centuries. The Dalai Lama is a science buff; he has attended, and spoke at, the Society for Neuroscience annual meeting, and has made his monks available for neuroimaging studies. And he notes that, “Anger, hatred, and fear are very bad for our health. . . . Passing through life, progressing to old age and eventually death, it is not sufficient to just take care of the body. We need to take care of our emotions as well.”

This is not the perspective typically embraced by artists. I had the opportunity to work on an album with Stevie Wonder, who was often late, because he would be overcome by an emotion and unable to extract himself from it. One day when we were working together, news broke in the morning that a horrific fire in the United States had killed a number of people. When Stevie showed up four hours late, he was visibly shaken and said that he just couldn’t stop thinking about the family. Letting your emotions carry you away might be a good thing if your job is communicating emotion to others. For the rest of us, not so much.

Depression can affect people of any age, and it often goes undiagnosed in older adults. We may notice depressive-like behaviors in ourselves or other older adults and think it is normal aging. It is not. By depression, I don’t mean the occasional sadness we all feel, but persistent feelings of hopelessness, sadness, and emptiness that last for more than a couple of weeks. Depression is an illness with biological causes, not merely something you can “buck up” and will yourself out of. Signs of depression in the elderly don’t always manifest themselves the way they do in younger people—they can more often show up as lethargy, lack of motivation, and lack of energy rather than sadness. So older adults may not realize that what they are suffering from is physiological depression. And some people mistakenly believe that depression is just a normal part of aging. But depression is definitely not normal and it should be treated.

The good news is that depression is less frequent among older adults than younger adults. But that’s not to say that there is no risk. Eighty percent of older adults have at least one chronic medical condition, and 50 percent have two or more; the lifestyle and biological changes brought on by illness can contribute to depression, along with various bodily systems slowing down or wearing out. Some prescription medications have been associated with depression. Many older adults have trouble sleeping and so turn to prescription drugs to help them sleep—but habitual use of these drugs, including Ambien, Ativan, and Halcion, can actually cause depression after even a short period of use. The beneficial effects of a good night’s sleep are completely wiped out by the depressed mood that sets in during the day. (Occasional use for periodic bouts of insomnia may be beneficial.) Other drugs associated with depression include estrogen, blood pressure medication, statins, and opioids.

Depression in old age is an independent cause of disability, and it can exacerbate existing physical problems, slowing down recovery from injury and illness by weakening our immune systems. It’s also important not to underestimate the impact of the curtailment of daily activities that can accompany growing older—things that we used to derive pleasure from become physically difficult, painful, or hazardous, and that can contribute to depression.

Risk factors for depression in old age are consistent with the triad of genes, culture, and opportunity we’ve been looking at so far, and their interactions: genetic vulnerabilities, age-related changes in brain volume and processing speed, and stressful events. Insomnia, a hallmark of aging for many, is an often overlooked risk factor for late-life depression, affecting 25 percent of men and 40 percent of women in their eighties. Changes to the integrity of the hypothalamus, which helps regulate sleep-wake cycles, as well as age-related reductions in the production of melatonin and other neurohormones, also contribute to insomnia. If you can’t get a good night’s sleep, all kinds of neural and physiological systems begin to go haywire. Practicing good sleep hygiene, as detailed in Chapter 11, is almost always more effective than medication.

Blood flow to the brain decreases with age—sometimes simply due to reductions in exercise, in other cases due to normal deterioration of the circulatory system or buildup of arterial plaques. This can lead to vascular depression. White-matter hyperintensities form—regions of the brain where white matter atrophies due to lack of oxygenated blood—and these regions can be quite extensive. Depression symptoms are associated with the size of these lesions.

Some of the risk and corresponding protection factors for old-age depression are shown in the illustration on the following page, with the age at which they first emerge as factors.

Given all this, it might seem surprising that more oldsters aren’t depressed. Three categories of factors appear to be most protective. First is the presence of resources that some older adults enjoy—health, cognitive function, and sufficient financial stability to get everyday needs met. Second are psychological resources—over a lifetime, and sometimes through trial and error, many older adults have learned strategies and ways to use social support to manage their health-related stresses. Third is an understanding of the role of meaningful engagement with other people, through social activities, volunteer work, or congregational religion. Along these lines, the presence of intimate others in one’s life significantly reduces the risk for developing depression.

People who are experiencing depression have lower levels of serotonin. So why not just give them serotonin? For two reasons—one is technical; the other is conceptual. Technically, there is no way to administer serotonin directly because a pill or injection would not be able to cross the blood-brain barrier. In the late 1980s, a new class of drugs was developed called SSRIs—selective serotonin reuptake inhibitors. SSRIs cause whatever serotonin is in the brain to linger around the synapses longer—it’s as though you’re giving the brain more serotonin, but you’re just squeezing more mileage out of the serotonin that’s already there. A fad in these drugs resulted. SSRIs such as Prozac were widely prescribed for people with depression.

David Anderson is a neurobiologist at Caltech who has been working on the neurochemistry of emotion for thirty-five years. One of the things that frustrates him about this approach is that serotonin is just one of more than a hundred neurotransmitters and neurohormones, and all of them interact in complex ways. SSRIs affect the entire brain, rather than focusing on the particular circuits that need correcting. That is the conceptual problem.

It’s like spraying STP all over the engine and hoping that a little will trickle into the carburetor. As David says, your brain is not just a bag of chemicals. His TED Talk about it has more than a million views and he’s become something of a hero to many of my colleagues. That list of drugs I mentioned earlier that can contribute to insomnia underscores the delicate balance that needs to be achieved in our brains for us to enjoy good mood. One well-meaning intervention, such as a heart medication, can throw everything out of whack.

I’ve been talking a lot about dopamine up to this point, and although it is an important neurochemical, there are many others that we shouldn’t ignore. But if you read the popular press, dopamine seems to be responsible for everything! This drives neuroscientists like Jeffrey Mogil crazy. “A lot of scientists think this way, but I think that in, oh, say, twenty years from now, we’re all going to look back and realize that dopamine was the drunk looking for his keys under the lamppost because there is more light there. It’s just that for now, dopamine is the one we have tools for studying. But it’s no more important than the one hundred other transmitters, two hundred other ion channels, or one thousand other signal transduction molecules. The actions we are most interested in are embedded in very complicated circuits.” For now, it looks like much of the story of brain, behavior, emotion, and motivation is about dopamine, but that’s just because it’s where we can look. It’s where the light is better.

David’s call, an exposé of sorts, is for better biomedical and pharmaceutical research. In the meantime, however, Prozac and other SSRIs are about the best shot we’ve got. Indeed, the prestigious British Medical Journal recently concluded that SSRIs should be the first-line pharmacological treatment in older adults, including those with chronic physical illness—just like my friend and mentor John R. Pierce, who had Parkinson’s, and who experienced a new lease on life within a few weeks of starting Prozac. The most effective approach to depression involves developing tools to deal with changes, through cognitive behavioral therapy or other therapeutic interventions. Other drugs, not traditionally thought of as antidepressants, can also be effective in older adults. Low doses of methylphenidate or armodafinil, either alone or in combination with antidepressants, can compensate for lost dopaminergic function and a host of signaling and transmission problems in the aging brain.

Psychotherapy can change the structure of the brain. This isn’t at all surprising, given what we’ve seen throughout this book—that every experience changes the brain. In particular, cognitive behavioral therapy engages similar neural mechanisms as antidepressant medications, but without the side effects of withdrawal. Long dismissed by physicians who were more focused on pharmaceutical, electroshock, or other “medical” interventions, talk therapy has proven its effectiveness, and even its superiority. For depression, it is at least as effective as antidepressant drugs in the short term, and over the long term, we see less relapse—two years after intervention, people who received prior cognitive therapy are doing better than people who simply stayed on medication.

Coping

The way that we cope with setbacks and adversity is largely influenced by the combination of genes, culture, and environment. A genetic predisposition toward resilience and optimism can lead to different coping styles and outcomes than one toward fatalism and pessimism. In general, children learn to react to the world by modeling their parents. Parents who have strategies for dealing with unpleasant or traumatic events will display those to their children, and their children are likely to imitate them. (It makes you think that there should be a boot camp for parenting, doesn’t it? Well, there kind of is—your own childhood.)

One of the most important findings about coping styles in depression was made by Susan Nolen-Hoeksema, who distinguished rumination from distraction and found that distraction was far more effective than rumination in coping with bad fortune, and that rumination was associated with significantly longer periods of depressed mood.

People who ruminate have a tendency to repetitively focus on what went wrong, and the causes and consequences of what went wrong, over and over and over again. They lock themselves in their rooms; they stay in bed; they catastrophize the future. All of us have a tendency to do this, to varying degrees. Withdrawal from the world after a negative experience is evolutionarily adaptive—it gives us time to heal and to reflect productively on what went wrong so that we can avoid or correct patterns of our own behavior that can lead to trouble. And to some extent, the sadness that rumination steeps us in feels good: It releases the neurochemical prolactin, which is calming and soothing—the same hormone released in mothers and their infants while nursing.

But excessive rumination increases stress hormones. It drives a downward cycle of unhappiness and can trigger one or multiple episodes of major depression. Rumination interferes with interpersonal problem solving, depletes motivation to engage in constructive behaviors, and impairs social relationships. Rumination also feeds the destructive aspects of mood-dependent memory retrieval because the hippocampus is exquisitely sensitive to emotion. When you’re unhappy, the hippocampus has a far easier time accessing negative memories to the point that it can become very difficult to recall times when you didn’t feel unhappy. This perpetuates the downward cycle of not only feeling bad in the moment, but anticipating a future that holds no promise.

The more effective strategy, according to Nolen-Hoeksema, is positive distraction—that is, immersing yourself in positive, forward-looking activities you enjoy: sports, baking, travel, music making . . . whatever it is that is engaging enough, absorbing enough, to distract you from your unhappiness, and is enjoyable and positive. Even relatively neutral activities furnish almost the same magnitude of benefits—things like looking at art, reading a book, taking a leisurely walk in natural surroundings, or spending time with pets.

Talking to others in the context of healthy supportive relationships isn’t the same as rumination. It can be helpful after a negative experience and has been shown to reduce distress when it leads to greater insight and understanding about the source of one’s problems. But not all social support is healthy. Talking to a friend who helps you to catastrophize, obsess, and co-ruminate increases stress hormones. (Friends like that can be worse than no friends at all.)

There are other ways to break the cycle of depressive rumination besides distraction. Meditation is one of them—it doesn’t work for everyone but it does work for many. Depressed people have a magnified sense of self-consciousness. The Dalai Lama’s instructions to the depressed woman I mentioned earlier cut through all that. Perseverative thought and an intense focus on yourself is bad for the brain. Meditation can cure perseverative thought because it removes the “you” from your thoughts.

One of the surest ways to get over depression is to help others—this allows you to step outside of yourself and your preoccupations. Helping others is powerful medicine.

There are countless ways to reach bodhi, or what Western cognitive psychologists call the flow state. As you might imagine, it involves that daydreaming network I wrote about earlier (see this page), the brain’s default mode. Very few people live in this state of egolessness. Some claim to, egotistically, and they say that they’ll teach you to do it too for a large sum of money. If you’re interested in this state, look for a reluctant guru, someone who doesn’t have an inflated sense of themselves as a great teacher.

I have come to believe that this egolessness is at the heart of what draws us to the music of great improvisers like John Coltrane and Miles Davis. They become absorbed in the moment, listening to the other musicians and responding, either with playing or not playing, doing whatever will enhance the music, with no sense of self or other. Many people say they have similar experiences doing community service, working to help others in a crisis situation, or during team and individual sports . . . there are lots of ways to reach this state.

Motivation and Hormones

Much of our motivation to do things is controlled by our brains and by the hormones and neurochemicals circulating within. (Hormones are a kind of neurochemical that works both inside the central nervous system and outside of it.) We tend to think that our motivation and desire to do things are driven by our own ideas, our will. We decide to go out for a brisk walk and then we do it. But the hormones are the hidden strings that pull our bodies. For example, estrogen production in women follows a monthly cycle and reaches its peak around the midpoint of the menstrual cycle. Women are far more likely to walk more at this point than at any other point in the cycle. It’s been speculated that this is the time of the month when women get cabin fever and want to explore the territory around them to find the most desirable mate—even if at a subconscious level. Higher estrogen is also related to increased competitiveness and possibly to reduced fearfulness.

These hidden strings pull us at all stages of life. The increased progesterone production that accompanies pregnancy causes a reduction in the body’s immune-system response, and in particular a reduction in inflammation. Pregnant women who have had rheumatoid arthritis, multiple sclerosis, and migraine report reductions in their symptoms. Of course, a reduced immune-system response also makes pregnant women (and other high-progesterone women) more likely to succumb to infections, and here is where the hormones interact with thinking, the very thinking you think is under your control. High progesterone leads women to avoid situations in which germs might be transmitted and women with high progesterone levels are far more likely to wash their hands after coming into contact with germs.

Elevated progesterone is also associated with quicker reading of facial cues and body language and quicker categorization of friends versus potential enemies. Psychological scientist Martie Haselton writes, “A high-progesterone woman can potentially read the room, weed out the frenemies, and make a good call about whom to lean on and whom to avoid.” Progesterone is associated with seeking out friends and spending time with them. There is also evidence that progesterone promotes calmness and diminishes suicidal tendencies.

In both women and men, testosterone appears to regulate the seeking and maintenance of social status, including sexual status and the displays that go along with seeking attractive mates. Both men and women who are high in testosterone are more likely to engage in risky activities, such as gambling and having sexual relations with multiple partners. Indeed, most people in monogamous relationships show lower levels of testosterone than those not in committed relationships. You can imagine an evolutionary basis for this, that people in a committed relationship will do a better job at staying together, and parenting, than people who are not, and this will enhance the ability of their offspring to seek a committed relationship, reproduce, and become parents themselves.

Circumstance plays a role in testosterone levels. In “the smelly T-shirt study,” men were exposed to the scent of either ovulating women or nonovulating women, by smelling T-shirts that the women had recently worn. The men did not know the women involved and were not told their ovulatory status. Men’s testosterone levels increased after smelling all the T-shirts, but they increased more after smelling the T-shirts of ovulating women, presumably to increase their libido and partner-seeking behaviors. Men’s testosterone levels also increase after achieving public success, and decrease after public failure (possibly an evolutionary adaptation that results in high-achieving men being motivated to seek the best genetically equipped mate).

The role of testosterone in influencing behavior goes back hundreds of millions of years. In birds, song is a fundamental component of territorial defense and mate attraction, and it is typically the males that sing. When given testosterone, male finches sing more, but only in the presence of a female finch.

A feature of aging is that both sex-linked hormones, testosterone and estrogen, decline with age, and these declines have well-documented effects. First, there is a decline in interest in sexual activity. When Socrates asks sixty-eight-year-old Cephalus about his libido, Cephalus responds, “Most gladly have I escaped the thing of which you speak; I feel as if I had escaped from a mad and furious master.” A sixty-eight-year-old friend of mine, H., whom I’ve known for forty years, was one of the most sexually active people I’ve ever known until a few years ago, when his libido just up and disappeared. “I can’t believe how much time I have now to do other things,” he notes. Indeed, we might look at our life span as occurring in three stages: childhood, before the pubertal sex hormones kick in; puberty to late adulthood, when sexual desire dominates many of our thoughts; and old age, when we are back, like children, to wanting friends to play with, but not thinking so much about sex.

Of course, there are vast individual differences. Some people maintain an active interest in sex, others lose it, and some who begin to lose it have it restored through some romantic happenstance or hormone replacement therapy (HRT). These are effective and, if properly prescribed, have few side effects and many ancillary benefits. This is because reductions in testosterone and estrogen lead to fuzzy thinking and losses in a number of areas: cognitive function, memory, motivation and mood, immune-system function, and bone density. It is wise, after age fifty, to have your hormone levels checked and possibly restored, pharmaceutically, to physiological levels if you do not have a medical condition that precludes this. Hormone replacement therapy, in both women and men, can restore quality of life and energy in a way that nothing else seems to.

Although it is commonly believed that high testosterone increases aggressive behaviors, we still aren’t sure about cause and effect—it could be that aggressive behaviors increase testosterone. But I am friends with a number of men in their eighties who, according to others, were terrible people when they were younger. I know them only as sweet, kindly old men. Some of them have very few friends, having ravaged through relationships with success seeking and competitiveness—but this is a side of them I’ve never seen. I wonder if I, too, should be wary of them. But they are so delightful and interesting now that I am not.

Are emotions reducible to hormone levels? In other words, with more neurochemical knowledge, will we be able to say that a certain hormone balance leads to guilt and another to elation? Perhaps. But the situation is more complicated—the same hormones or neurochemicals act differently in different parts of the brain. Our emotional appraisals, as we’ve seen, are influenced by our cognitive appraisals of the situation. And your brain is more than a bag of chemicals.

Motivation and Learning across the Life Span

Motivation is a condition that pushes us to achieve a goal. The goal can be for survival or amusement, pleasure or a reduction of pain. If you’re reading this book, there’s a good chance you are motivated to learn, that you benefit from an innate or cultivated curiosity about the world. As we’ve seen, curiosity can be protective against aging, and a great motivator to obtain an education, which is also protective.

Tenacity and grit support staying engaged with a goal even when achieving it is difficult—and especially when achieving it turns out to be more difficult than we first thought. For many of us, those goals are intellectual—the desire to learn new skills and concepts and to apply these in pursuit of meaningful work or hobbies. The physician who attends a workshop on the newest techniques for treating Parkinson’s disease is not that different from the weekend athlete taking tennis lessons or the birdwatcher going to a new locale to identify birds she’s never seen before.

The compulsory education that is taught in K–12 schools is relatively well-defined and doesn’t leave much room for individual choice. People have differing levels of motivation for learning school subjects and for learning more things after school is finished. Some may continue with more school, some may enter specialized vocational training, and some may go right to work. There is great variation in the degree to which people desire to learn once they are out of school, and it doesn’t have a whole lot to do with the kind of work you’re in. You might think that people in the professions—professors, doctors, lawyers, business leaders—are constantly pursuing self-improvement, and that people in the trades—bricklayers, pest exterminators, truck drivers—are not. But this is mistaken thinking. I’m sad to say I’ve encountered many doctors, lawyers, and professors who are intellectually lazy, who have grown complacent and simply don’t have the motivation to keep up with changes in their fields. And I’ve known construction workers and truck drivers who are sponges for new technology and new information, constantly looking for ways to increase their skill level, like Pablo Casals was, in his eighties, on the cello.

What differs across these kinds of people is motivation and, to some extent, a worldview about who’s in charge of your life. If you tend to think that the course your life takes is governed by other people, systems, organizations, and circumstances, you’ll tend toward “accepting your fate” and not exerting yourself much to change things. In technical terms, this is called having an external locus of control (the external world is in control of you). If you tend to think otherwise, that you can change the story of your life, you have an internal locus of control and are typically more motivated, more driven, to make changes. Take Paul Simon—at one of the many peaks in his career, after his hugely successful solo album There Goes Rhymin’ Simon, he decided that he wanted to learn more about music theory so that he wouldn’t be constrained by the relatively straightforward chords and structures he already knew. So he took music lessons from Philip Glass and others. And, as great a singer as he is, he also took voice lessons for many years.

Believing you can’t change your life ends up being a self-fulfilling prophecy because you bypass opportunities that could help you change your life.

There is an irony here, in that believing you can change your life isn’t the same as being able to predict or plan how your life will go. As Linda Ronstadt said, “People always think careers are based on calculated decision-making, that your career is the outcome of how you think it’s going to look. . . . The process is so different than that.” Paul Simon again: “I never thought about what the public wanted to hear, or how I might write a hit. I always wrote what I wanted to hear. For a period of time, other people wanted to hear that too. Then they didn’t, and then they did again. I had a career writing these songs because sometimes there was an alignment between what I wanted to hear and what the public did. But I never planned to make a hit record.”

Immersing yourself fully in whatever activities you engage in—work, leisure, family, community—is protective against cognitive decline and physical illness. The rewards from doing things that please you lift your mood, and strengthen the immune system, increasing the production of cytokines, T-cells, and immunoglobulin A.

Motivation to Make Change

There is a tendency as we age to resist change, owing to a variety of factors. Depletion of dopamine and deterioration of dopamine receptors in the brain lead to a lack of novelty seeking—we’re chemically less motivated to look for new experiences or to learn new things. Bodily and cognitive limitations make learning and doing new things more difficult. And memory! Our memories and perceptions are based on millions of observations of things being a certain way; our prediction circuits are basing their calculations on what happened over and over again in the past. The intact memory system becomes a competing force against our brains’ quest to stay current. Add to that the hippocampal volume reductions, which make it harder to store new memories and easier to retrieve old ones, and you have a formula for conservatism.

Two knowledge domains that are of most importance to older adults are personal health and finance, and acquiring new information about them is important. Prior experience is a factor: Older adults who have a base of knowledge about health and finance are better able to retain new information on those topics, because the structure of their knowledge minimizes cognitive load. Physicians have an easier time comprehending new discoveries in medical texts than medical students, because they have memory structures and schemas within which to incorporate the new information.

Problems can arise in aging when new information contradicts prior learning or doesn’t fit into the well-worn pathways of your knowledge base. Then the general slowing down of cognitive processes plus the decline in reasoning ability that accompany old age can cause difficulties that take a major surge in motivation to overcome.

If you’re an older doctor, the gold standard had long been to surgically remove any cancer that was amenable to surgery (certain hard-to-get-to tumors or especially large or embedded ones were the exception). We now live in a time when some low-risk, slowly advancing cancers, such as prostate cancer, are best ignored because the treatment is more likely to cause serious harm than the cancer. Some cancers are treatable with radiation therapy, others with chemotherapy. The cutting edge is immunotherapy for cancer. I heard a talk a couple of months ago by one of the founders of immunotherapy, Nobel laureate Jim Allison, describing his work. It involves what are called checkpoint inhibitors, which cure 60 percent or more of melanomas and other cancers. Former president Jimmy Carter received a checkpoint inhibitor, Keytruda, in 2015, when melanoma had spread to his brain and liver, and as of this writing, he is cancer-free. Now, if you are an older physician who is set in your ways—and there are plenty of those—trying to integrate this new information with your old ways of thinking can be difficult. It’s not a case of just taking in new information, but of tearing apart your old and entrenched ways of thinking about an entire field. How do you get the motivation and wherewithal to do that?

Consider music and films. If you’re of a certain age, you lived most of your life with the idea that if you wanted to listen to music or watch a film at home, you had to buy it in a store and play it back on a suitable player. You had to put a collection together, item by item, and there were storage considerations, and ease of browsing considerations if your collection got too big, not to mention financial consequences. It can require a boost of motivation to overcome your fixed way of looking at things and embrace the new “jukebox in the sky” way of hearing music and watching TV and movies.

Or take modern security features found on web forms and apps. If you were born before 2000, there was no precedent for being asked to prove that you’re not a robot when trying to accomplish basic tasks on the Internet (which itself is an entirely new and unprecedented concept if you were born before 1990). Now, before advancing to the next online page or step in what used to be a routine process carried out in person or with a telephone agent, you might be asked to “identify all the photographs that have a part of an animal in them” or “mark every photo that has a street sign in it.” These work as security screens because computers can’t solve these problems . . . yet. In another ten years or so, when computer vision and AI have advanced, we’ll all be doing something else for authentication (possibly face or iris scans).

There are ways to jump-start your motivation in the face of these kinds of changes. First, people who are curious (the first C in the COACH principle) and who enjoy learning for its own sake do better in a whole big basket of life outcomes. People who focus mainly on getting recognition for their achievements are far less likely to seek challenges and less likely to persist in learning than those who focus on the learning itself. In other words, intrinsic motivation is always more powerful than extrinsic motivation.

Second, motivation takes work. As the title of a paper by psychologist Carol Dweck states, even geniuses work hard. Dweck describes two kinds of mind-sets we can adopt—fixed versus growth—and they relate to locus of control. As with most things, these two mind-sets refer to ends of a continuum; few people are entirely one or the other in all aspects of their life. People with a fixed mind-set believe that their qualities and abilities don’t change; they say things like:

People with a fixed mind-set generally have an external locus of control. They are low in Curiosity and Openness. They aren’t interested in learning new things and don’t think that the payoff of learning new things will be worth the effort.

People with a growth mind-set believe that they can change their skill sets, that they can continue to learn. They have an internal locus of control and believe that effort is sometimes its own reward and that it can yield big dividends. Hard work can be enjoyable. People with a growth mind-set are energized by learning and invigorated when they succeed at something that was previously difficult. To them, life is a journey of gathering new information, meeting new people, seeking helpful feedback from mentors or teachers, and learning new skills. People of all ages with a growth mind-set outperform students with a fixed mind-set. Often, all it takes is someone pointing out to you that you can change your brain and that you can overcome limitations you’ve encountered previously, not just with effort, but with focused, directed learning (this is why education works). Beyond effort, learners need to try new strategies and to seek help from others when they’re stuck. Having a repertoire of approaches and perspectives to draw on enriches your mental life and can spur that much-needed motivation. Without these things, knowledge tends to stagnate.

Dweck counsels the following:

Watch for a fixed-mindset reaction when you face challenges. Do you feel overly anxious, or does a voice in your head warn you away? . . . Do you feel incompetent or defeated? Do you look for an excuse? Watch to see whether criticism brings out your fixed mindset. Do you become defensive, angry, or crushed instead of interested in learning from the feedback? Watch what happens when you see [someone] who’s better than you at something you value. Do you feel envious and threatened, or do you feel eager to learn? Accept those thoughts and feelings and work with and through them. And keep working with and through them.

As we age, our motivations to be recognized for our achievements, and to rack up more and more achievements, tend to decline—that is, older adults tend toward being more intrinsically than extrinsically motivated. Older adults show increases in their motivation to use their accumulated knowledge, to help others, to preserve their resources, and to maintain a sense of autonomy and competence.

There’s a seventy-something-year-old in my neighborhood who runs up and down a steep hill every day. Twice. He’s got good running shoes and knee compression, and he is staying fit. Joni Mitchell at seventy-five still swims every day and has started working with a swimming coach to improve her form and endurance. And don’t forget Julia “Hurricane” Hawkins, who at 102 (in 2018) set a world record for the sixty-meter dash. My McGill colleague Jim Ramsay was a bicycling enthusiast into his seventies. When I was forty-eight and he was sixty-four we did the Tour de L’Île, a fifty-kilometer bike ride that encircles the island of Montreal and attracts thousands of cyclists every summer. I had a hard time keeping up with Jim. A few years later, at sixty-seven, he bicycled from Vancouver to Winnipeg, a twenty-four-hundred-kilometer trip that took him over the Coast Mountain Range, the Cascades, and the Canadian Rockies.

What are age-appropriate goals? They require a frank self-assessment. It was reasonable for Pablo Casals to learn to master a new cello piece. It was reasonable for my mother to stage her first play, and for Jim Ramsay to bicycle twenty-four hundred kilometers—he was in good shape and had regular checkups with his doctor. I’ve been a musician all my life and have played professionally, but it would probably be unrealistic for me to suddenly take up violin—an instrument I’ve never played before—and hope to become a world-class soloist. On the other hand, I could probably get good enough in three or four years, with focused effort and instruction, to play in a community orchestra. That’s an age-appropriate goal.

With no athletic training, it might be unreasonable for an eighty-year-old to plan to become a hockey player, a sport that tends toward violence and can be harmful to brittle bones. Physical limitations are no laughing matter. A friend of mine, at sixty-two years old and a professional musician, was showing some of his twentysomething students “the proper way” to load equipment in a car without hurting your back. He saved his back but ended up rupturing two tendons in his shoulder, just like that. I severed two tendons and a nerve bundle in my right hand last year, not by engaging in an inherently risky activity, but by doing an everyday activity without inspecting the situation and environment carefully—I let my vigilance down for just thirty seconds and the consequences were severe and long-lasting.

On the other hand, it’s important to fight the tendency to give up or to restrict your activities too much. Tim Laddish (age seventy-seven), former senior assistant attorney general for the state of California, writes,

I have to not give in to age when it is not necessary. The other week, as I was walking to our mailbox, I realized that I had assumed the old man stoop—bent forward, with my chin out in front of my body. I tried telling myself, “You’re not 77, you’re 66.” (That seemed about as far back as my imagination could carry me.) With that, I straightened up, my stride increased (was that a slight bounce to my step?) and I truly had a better point of view because of my improved posture.

I’m not saying that you are only as old as you feel, but you can set your mind to feel not as old as you are.

That works until it doesn’t. Since that day I’ve been diagnosed with a torn rotator cuff, arthritis in my hips, and an ailing psoas muscle that right now is causing me to walk with a stick for help. But my massage therapist is helping the psoas, I have an appointment with an orthopedist for the shoulder, and I can take Advil for the hip.

I’m convinced I’ll be back—running, kayaking, playing catch with my grandson and hiking (with care) mountain trails. With luck, effort and some medical fixes, I’ll get back to feeling like, well, maybe, 67.

In any event, my wife and I went to REI on Friday and bought a new camping tent.

Happiness

Happiness is an odd construct. It is highly subjective, variable, and dependent on a number of factors, such as culture and expectations. It’s also fiendishly relative, context dependent, and based on social comparison theory. This is the idea that you gauge your own happiness in comparison with what those around you are doing, or—more materialistically—what they have that you don’t. Few of us today would find a 1919 Model T comfortable, but if you had one in 1919, it was more comfortable than a horse, and more convenient than walking—it’s relative. You might never have thought about whether a lawn would bring you happiness, but if all your neighbors have lush green lawns and yours is full of crabgrass, you might find yourself unhappy.

Happiness may also be subject to an observer distortion effect in that trying to assess it all the time may actually interfere with it. Probing happiness stops the flow of activity and pulls you out of time to inspect it. And the one constant of happy people seems to be that they don’t think about happiness—they’re too busy doing things and being happy to stop and think about it. Happiness therefore is a judgment made in retrospect.

Humans are adaptable, resilient; we bounce back. When people are asked what they think will make them most happy they often point to winning the lottery. But lottery winners tend not to be happy one year after the big win. They are besieged by people looking for money, which transforms relationships that were formerly based on the sharing of experiences and affection to transactional, monetized relationships. And if they hated their neighbor or couldn’t get along with a brother-in-law, that doesn’t go away just because they have money. When people are asked what they think will make them most unhappy, they often point to losing a limb. But paraplegics and quadriplegics adapt, living mostly normal lives (with some accommodation, of course) and they end up rating their lives as far happier than they would have imagined.

On happiness, the Dalai Lama says,

I usually describe happiness in the sense of more satisfaction; happiness is not necessarily some pleasurable experience, but a neutral experience that can bring deep satisfaction.

What makes him truly happy? He says,

Ultimately, you get the most benefit from making other people happy.

Former president Vicente Fox of the United States of Mexico agrees. “What is the key to happiness?” I asked him.

The main thing is I was just so dedicated to this one idea all along; from kindergarten through university. I owe everything to Ignacio de Loyola, who created the largest university system and the largest number of campuses ever in the history of this world. And there is one single teaching there, which is “be for others.” Being for others is the shortcut to happiness. Give as much as you can and you can get back more than you expected.

This may be why President Fox left office with the highest approval rating of any president in Mexican history.

The biggest tip of all to promote healthy emotions as we age is to find a way to help others. It is much more difficult to be depressed or feel dreary if you are working to make someone else’s life better.