The Crisis of Midlife

Dr. W. M. Bortz II

Q: What is midlife crisis? How does it affect men? How does it affect women?

A: The term midlife crisis does not show up in any medical textbook, and it wouldn’t work as an acceptable diagnosis for any medical encounter such as admission to a hospital, but there is no question that it is a huge health issue. It is huge not only by its medical implications, but because its psychological, social and economic aspects reach immense proportions.

      Midlife crisis is not, therefore, a specific diagnosis, but has several components. Certainly, one of the major contributing forces to the disruptions are the life events that both men and women experience in their middle years. Any change can be traumatizing, but those that cluster in the 40- to 60-year age range are particularly challenging.
      The social events for women have to do with personal identification. The empty nest syndrome, when the last child leaves home, is a substantial crisis. For millions of women, childbearing and rearing is life-defining and absorbing. When this is satisfactorily accomplished, the major question arises: "What next?"
      For the male, his major midlife social crisis concerns his job. When the termination of his career threatens, with or without financial considerations, he also faces the issue of personal identification. Most men are identified by their work, and when this credential is suddenly withdrawn, again the questions "What next?" and "Who am I now?" forcibly emerge.
      Without preplanning, these identity crises for men and women can become haunting. Loss of children to adulthood and job expiration are only two of the many life events that the middle years present. For myself, my father's death when I was 42 crushed me. I was totally unprepared and I am sure the depression from my grief — which lasted six months — was, for me, a huge midlife crisis. For a while, it engulfed my effectiveness as a husband, parent and physician. Fortunately, the veil lifted and my life proceeded even more effectively than before his death. There was life after Dad.
      The varieties of life events that occur in midlife are infinite. I recall Erica Jong relating how shocked she was when she recognized that the whistles she heard while walking down the street were no longer intended for her, but were intended instead for her 18-year-old daughter by her side. This was a midlife crisis in itself.
      Both men and women also encounter unique hormonal changes in midlife, which unsettle the equilibrium. We men get a double hit. First, in the early 40s, we encounter "testosterone toxicity," a phase in which hordes of men, including several of my friends, make disruptive decisions that are generally termed "insane." Loss of family, job and home can follow from crazy decisions based on sexual mania. Boredom and craving unrealistic exotic encounters lead hordes of guys to mess up not only their lives, but many others as well. Certainly, this has a hormonal aspect, but it is embedded in other psychological and social dimensions as well.
      This testosterone frenzy runs its course, and the decade or two that follows is called male menopause. This term is not universally accepted by the scientific world because although testosterone levels fall in the 60s and 70s, the fall is generally pretty gradual — unlike the female drop in hormones — and even centenarians still have some testosterone on board. Regardless of this, older men do tend to become less male and more female. We soften, are less aggressive and are generally easier to get along with. The loss of libido and drive may contribute to a depression, another pattern of midlife crisis. Sometimes testosterone shots are administered to offset this pattern.
      By contrast, female menopause is totally accepted. It is regularly displayed in the ladies' magazines and in the medical literature. Although the last word is yet to be spoken about the best single hormonal replacement program for female menopause, there is virtual unanimity that post-menopausal women should have a major effort extended to them to offset the downside effects of losing their hormonal support system.
      This topic has been the source of hundreds of questions in the past, and will be in the future. Midlife happens to be a time of life when a lot is going on, and life is not — so far as I can observe — a simple and even experience. But the bumps, after all, are what give life its zest, if we have the competence to absorb them.

                                                                          
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