May 2013 – Dr. Blue's Mid-life Musings

Pot of Gold

A theorist named Levinson, who studies developmental transitions in men’s lives said that with middle age comes a shift in perspective from thinking about life in terms of time past since birth to thinking about life in terms of time left until death.

Although he was talking about life stages in men, I have been struck by this shift in perspective in myself.

Other researchers have “found that adults who are concerned about providing for future generations tend to be more satisfied with their lives and to view life optimistically – believing that even bad events will eventually have a happy outcome.”

Up until recently I reflected a lot on times past: where I’ve been, where I’ve come from, and what I’ve learned. Perhaps this is what we do while we are trying to reach our career and life goals. But having reached a level of success in my work and personal life, my focus has certainly shifted.

More than ever I’m aware of a feeling that time’s running out. The myriad of options that lay ahead of me before are narrowing. If I’m going to write that book, launch that great idea, or do that next big thing, it needs to be soon.

Anyone else feel that pressure? What do you do about it?

Mental illness and violence

Christopher Gordon, a psychiatrist from Harvard, wrote an excellent letter to the editor of the New York Times inviting a discussion on the issue of forcing people into treatment. He says,

Recent tragic events have linked mental illness and violence. Some people — I, for one — consider this link dangerously stigmatizing. People with mental illness are far more likely to be victims of violence than perpetrators.

He goes on to say that it’s very difficult to reliably predict whether a person will become violent but tragic events like the ones in Newtown or Virginia Tech increase the pressure placed on psychiatrists (and all mental healthcare workers, I need to add) to do just that.

This means that potentially violent people would need to be identified and, if they are not willing to comply with treatment recommendations, could be mandated to undergo at least medication therapy with antipsychotic drugs.

The problem, Dr. Gordon explains, is that we’ll get better results if the patient agrees to and cooperates with the treatment plan.

Still, if psychiatrists humbly try to understand the person on his or her own terms, do not dismiss the person’s experience as meaningless and truly respect the person’s choices about treatment, sometimes this opens the way to an effective treatment relationship. For some suffering and alienated people — certainly not all — feeling respectfully understood can be a critical step toward recovery.

In my experience, “feeling respectfully understood” is the primary step for healing. It’s woven into my work everyday, every session, with people with serious mental illness. I don’t think I would be a useful therapist without believing in the inherent goodness of and realistic possibilities for each person I see. How can marginalized, traumatized, stigmatized people overcome their obstacles to health in therapy with me if I don’t believe that even bad events can lead to good outcomes?

If I don’t take the time to really understand them, how can they trust me? How can I learn what gets in their way and help them navigate around or through those issues so they can live some semblance of a life “in the community”?

But isn’t it strange that this has to be said? Isn’t it what we all want from our doctors or caretakers…for them to take the time to listen to our concerns and be respectful about it?

Silver lining

Not long ago I taught “Introduction to Psychology” to college undergraduates. I had been looking forward to teaching the developmental psychology section of the course because I had enjoyed it, along with social and abnormal psychology when I had taken the class 30 years before. But on reviewing the subject and what we know today, I started to find it quite depressing. Here’s a quote from the text I used:

“By your early 20s, it’s unlikely that you will grow taller and your weight has typically stabilized for many years to come. For the next several decades, changes in your body should be relatively minor. True, you may come to need bifocals, and your hair may begin to gray or to thin. But the basic bodily systems continue to function well. However, after age 50 or so, noticeable changes in the body begin to occur.”

So true! I was looking at pictures of me the other day and was surprised to see that I looked essentially the same from the time I graduated high school until I was in my early 40s, when got married. But something has happened since then that surprises me every time I notice it. I’m aging! I see changes in my face and in my body. I’ve lost weight. The extra weight I had in my 30s doesn’t look healthy anymore, but losing it shows the lines more.

My hair is a lot thinner than it used to be, but I rationalize that by acknowledging that it was way too thick before and now it’s at least manageable. And those grays? Well, mostly I’m proud of them; but I’m always a little shocked when I notice they’ve spread or when I find them in unexpected places.

Here’s another quote, a little further down.

“Cognitive abilities remain stable through most of adulthood, but signs of decline in some abilities begin to appear by age 50.”

This is a tough one because the idea of my mental capacities declining, really scares me. My mom has Alzheimer’s Disease and every cognitive glitch I stumble through feels like foreshadowing of things to come.

Here’s another:

“After age 50 or so, people have increased difficulty hearing high-frequency sounds … and the sense of smell does decline after the middle 50s.”

Thankfully I haven’t noticed any major changes here.

So what’s the good news?

Wisdom. The knowledge that comes from our years of experience, and our ability to reason, increase with age. We make better use of strategies as we get older, so we’re more efficient. Our emotions tend to be more stable. We enjoy longer periods of positive emotions and enduring spells of negative emotions decrease over time. And we’re better able to regulate or manage those emotions when we feel them, than when we were younger.

The rest of the news is mixed, but leaves room for hope:

“Aging has two aspects: changes that are programed into the genes and changes that arise from environmental events. Many changes that come with aging arise not from inevitable processes, but rather from lack of adequate nutrition (such as fragile bones that result from osteoporosis-related calcium deficiency), lack of exercise (resulting in obesity in some elderly people and frailty in others, or just plain sluggishness and poor health), or lack of meaningful activities (which can lead to feelings of helplessness or apathy).”

We can’t change what’s in our genes (yet) but there are things we can do to improve our chances of aging well.

Musings from Midlife

At this midpoint in life (or so it seems these days), that is, age 50, I’m compelled to make note of some of the fascinating observations about life that I’ve made. I grew up with roots in two cultures, no religious indoctrination, and a curiosity about people and life that has been insatiable. I wanted to expose myself to many more diverse experiences than my parents and, later, my budget allowed. It is probably not surprising that I became a psychologist. I have been blessed to meet and work with some of the most interesting yet marginalized people in our society.

While I’m aware that my vantage point may not be typical, my hope is that, at the least, these thoughts will be mildly amusing; at best, they’ll be interesting and thought-provoking; and optimally, useful or helpful to one who reads them.

One of my patients is a young man in his late late 20s with schizophrenia, who is isolated, living at home with his mom and really needs to move to a setting where he can have opportunities to interact with others and become more autonomous. He’s been dragging his feet on this for years. In part this is because he’s not always articulate, coherent or fully-functional. But I’ve figured it’s also because he and his mom have a complicated relationship; even though I know she really loves him and wants to see him settled so she’ll know he’ll be all right when she’s gone.

In session not long ago, while hunched over looking at his shoes, he considered the idea of moving to his own place, he said with perfect clarity: “I just don’t want to get old.”

Wow, who does!?

But finally, I had a better idea about what was happening. For him, moving out meant growing up and staying home kept him young. I said, “You know that staying at home won’t stop you from getting older. And it’s true that moving out means having a lot more responsibility, which IS part of getting growing up and getting older. — But do you want to hear the good news? – [now I had his attention – eye contact] Getting older doesn’t have to mean you feel old. You know what? Inside, I still feel like I did when I was 19.”

He looked surprised and smiled. “I still feel 19, too.”

Since then the beautiful mysterious truth of my words keep ringing back to me. Besides a myriad of experiences I’ve gone through since then, inside I’m no different than I was 30 years ago. So what has changed?

Well, of course, I really am 30 years older and besides some unpleasant, but not altogether unexpected, physical changes, has also come a shift in perspective. I could get seasick thinking of the highest highs and lowest lows life has to offer, and the tragic tumble it can become at any moment. The fearless thrill-seeking bravado I see in my step-kids and younger patients, I no longer possess. I feel the weight of some of my choices. It’s a sense of “been there, done that,” but also a nostalgia for things past, opportunities missed and youth lost. Like most people I studied, worked, made stupid mistakes, and struggled for years; trying to establish a career, find love, and make a family and home. And now that I’ve been so fortunate to have gotten my groove down for the most part, I find myself wondering, “Ok, now what?”

While the thrill-seeking bravado seems to be gone, I’ve gained a new confidence in myself and things I’ve learned. I need to be creative and give back in a new way. That is, I feel a need to figure out a way to take the sum being of me and somehow give of myself with greater confidence and wiser investment than when I was younger. At the same time I find myself fighting the urge to isolate, be self-absorbed, and do mindless things.

I believe this is what psychoanalyst/ developmental psychologist Erik Erikson meant when he talked about the mid-life crisis as a conflict between generativity and stagnation. (He was the one that coined the term “identity crisis”.) Because, after reaching this point I know a lot and have a lot to offer and I can either care by sharing or isolate, think only of myself, and hoard the fruits of my investment and labor.

I have to admit I feel guilty about the fact that my patient has since agreed to start the moving process. Too bad staying home doesn’t keep us young.

Since then I’ve assumed that feeling 19 (or so) inside is everyone’s experience. Is it yours?