Mid-life Crisis:

G rovvth or Stag nation

SUMMARY

ROBERT MARTIN, PhD and HARRY PROSEN, MD

Mid-life has developmental stages and particular tasks that must be successfully completed for growth to continue and psychological stagnation to be avoided. Characteristic of different phases of mid-life are three stages of ego mastery: alloplastic mastery is associated with early adulthood, autoplastic mastery is associated with maturity, and omniplastic mastery is found in old age. A special perspective on one's life and a need to examine one's life are found in mid-life. Difficulties can occur in dealing with this phase and the family physician can be of significant help to his patients who are working through the mid-life crisis.

Dr. Martin is chief psychologist at Winnipeg General Hospital, and associate professor of psychiatry at the University of Manitoba. Dr. Prosen is professor of psychiatry at the University of Manitoba and chairman of the Postgraduate Education Committee in Psychiatry.

TO COMPREHEND the full story of a human life has been the genius of some of the great novelists and dramatists. The behavioral scientist has understandably shied away from trying to conceptualize a whole life with its shifts in course, its surface changes, and its underlying continuities. Recently some clinicians and scholars have begun to focus on 'the life cycle', a phrase introduced by Eric Erickson, perhaps the most original and influential pioneer in this field.' In looking at life as a whole, certain stages, neither sharply separated from each other nor completely exclusive of each other, do emerge. One of these stages - mid-life - has received surprisingly little attention. When an individual reaching the mid-course of his life reflects much on that fact and its implications, we have what has been called the 'mid-life crisis'. The individual's way of dealing with his concerns has a major effect on whether the crisis is resolved in the direction of further growth and usefulness or toward stagnation and bitterness.

is that true psychological development ends with physical maturation, and that the individual coasts through the rest of his life, acting out the traumas and acting on the capacities that are the residues of the early development

years".2
Gutmann has taken steps to meet the need for information on middle and later life and his findings on the stages of 'ego mastery' deserve careful attention. Ego mastery refers to "a particular way of relating to the self and to the world, to a particular way of understanding the world, and to a particular way of creating, defining and solving

Mid-Life As One Of The Life Stages It is customary to think of life as being divided into stages. We speak of infancy, childhood, and adolescence, for example, and these concepts convey generally agreedupon meanings. At times these categories are too broad and we may narrow our attention to finer divisions: as we speak of the eight to 10 month old child's going through the phase of stranger anxiety, the two or three year old child's struggle for autonomy and self-control, and the older adolescent's search for identity that may become of consuming importance. The variety and wealth of conceptualizations of developmental processes of early age contrast with the very few available to help us understand middle and later life. Gutmann appropriately observes that "the prevailing assumption concerning middle and later life
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problems".3 Gutmann distinguishes three stages which emerged from his studies of young adult, middle-aged, and old men. He used psychological tests, intensive interviews and the imaginative productions of his subjects as sources of information, and he discovered that the same stages were found in men from the widely different cultures of middle class North America, and preliterate groups from Mexican Indian, American Indian and Middle Eastern people. That the same pattern of life stages emerged in such different settings strongly suggested that these stages are intrinsic organizers of experience and behavior and are developmental or genetic in nature. He has differentiated three adult stages through which we pass: Alloplastic or active mastery is most characteristic of young adulthood and reflects strivings toward autonomy, competence, and control. To achieve, to 'leave one's mark', to be independent in action and choice, are strongly desired. The person may mistrust his dependent yearnings as tempting him to trade compliance for security. Lively ambitions and strong competition against rivals, or against himself, to reach high internal standards are frequently found and the young man may relish his ability to be a mover and a changer and to provide for himself and others.
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Autoplastic or passive mastery is associated with mid-life or the mature years. Here the emphasis shifts to accommodations to the outer world and to mastery over the self. Thought begins to substitute more for action, experience for exploration, and philosophic perspective begins to temper the drives for achievement and autonomy. 'Knowhow' and the fruits of experience are used with discrimination and replace the younger man's pride in his forcefulness and energy. Omniplastic mastery, the last phase, is associated with older men. It is marked by a shift in interests to more global concerns, altruistic activities and broad social issues. The shift in style of ego mastery from alloplastic to autoplastic and then to omniplastic is clearly related to increasing age. Nevertheless, we must keep in mind that each stage relates to a particular age range only in a general way. The stages are not discrete and mutually exclusive; the same person can display them all in different contexts or at different times within the same context. As long as we remember this, it is useful to know that Gutmann has used the age of 50 in some studies and 55 in others to mark the shift between dominance of the alloplastic and autoplastic phases and he sees the omniplastic phase as characteristic of those in their 60s and 70s. But Klemme describes the mid-life crisis as beginning in the late 20s, peaking in the mid 30s and extending through the 40s.4 The mid-life crisis is associated particularly with the gradual shift in orientation from a dominantly alloplastic to a dominantly autoplastic orientation. It typically precedes the main shift and may occur when the balance is just beginning to lean toward autoplastic mastery. As with other stages of psychological development, the mid-life phase can be prolonged, arrested, or can lead to regressions. If the individual has successfully met and mastered earlier developmental tasks, he will have more mature resources to handle constructively his mid-life development, often using the same coping techniques on the new challenges that he employed in the past. Temporary retreats or regressions at any crisis can be expected and in fact are often part of the person's exploring all the possible alternatives open to him. However, if the retreat becomes fixated, rigidly repeating some immature behavior, difficulty in dealing with the mid-life crisis is almost inevitable. Klemme has suggested that symptoms of inadequate handling of the mid-life crisis include accidents, traumatic neurosis, physical illness, drug addiction, alcoholism, mild and severe depression, and suicides.5 The range of both effective and ineffective coping techniques is great, but two which are found especially frequently during the mid-life crisis are denial and projection. By denying, by persuading himself that the changes and problems of mid-life do not exist, an individual can purchase some peace of mind. However, he must spend increasing energy to avoid seeing the reality of his situation, and the unattended problems multiply making even greater demands for more denial. In projection, the person feels that the responsibility for his difficulties is largely outside of himself, and so, rather than coping with his problems, he is suspiciously looking around him for people and events which conspire to cause his trouble. Neither of these methods can be used for long or extensively without taking a toll in mental health. Implicit in the concept of development stages is the general idea of some proper sequence, a sort of time-table,
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as it were, so that a person may be regarded - and regard himself - as precocious or slow or 'on time' in reaching certain stages. For example, we are all acquainted with the person who tries to make time stop by a masquerade of youthfulness. With surprising frequency one finds either a sudden or more gradual appearance of impulsivity which seems 'out of character'. Promiscuity, for instance, may wreck a longstanding and relatively successful marriage; sexual fulfillment and concerns over sexual adequacy often play a significant role in the impulsive activity. An intense affair, often with a younger partner, occurs sometimes when the person who did not 'sow wild oats' as a younger adult is eager to make up for what was missed. Masters and Johnson, as well as others, have described a frequent pattern where "expressions of anger or personal antipathy toward a partner frequently are used as an escape from the feared loss of ability to perform adequately. Innumerable instances of the middle aged male's turning to a younger female partner for sexual stimulation provide everyday cases in point".6 There may be a sudden and drastic shift in a career, or the lifestyle may alter dramatically, suggesting that the impulsivity is far from restricted to the sexual life. The rashness of these sudden shifts in behavior call for a closer look at certain aspects of the psychological world at mid-life.
Time Of Life And Time Perspective This 'out of character' risk taking becomes more comprehensible when we consider certain features of the time perspective of the person in middle life. Neugarten puts the issue succinctly: "A particularly conspicuous feature of middle age is that life is restructured in terms of time left to live rather than time since birth. Not only is there a reversal of directionality but an awareness that time is finite".7 Recalling the different meanings a birthday has to a child and to someone in the middle years helps one grasp the idea. The youngster likely greets his birthday as marking his new size, new knowledge, and ever-growing powers and capacities that he expects to exercise in a future that conceived as limitless and open. It is reason to celebrate. For the middle-aged person, the birthday is likely to be a firm reminder of time's passage. It is frequently a time of weighing what has and what has not been achieved -and the future is seen as time remaining. The person may be reminded of his own mortality as a concrete reality rather than as an abstract principle. This changed time perspective may well foster a 'now or never' attitude. Postponement is easier when the future is extended; when the future is limited, postponenment of goals and wishes merges into relinquishing them. For the middle-aged person, those wishes that had been set aside for such considerations as family, reputation, or career must now be given up or grasped quickly. Choices and changes made under the 'now or never' feeling may be constructive and lead to genuine satisfactions, or they may be disastrous. What is constant is the sense of great urgency, the feeling that the decision will make a major difference in the person's life. The wishes are not trivial to the individual. A successful and conscientious 45-year-old physician took an evening course in anthropology out of a casual interest and a wish to broaden his horizons. Fascinated by the material, he began to form the wish to be an anthropologist and within a month he became
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determined to give up his practice, which had become routine, his security, which he found dull, and take his wife and two teenaged children to do amateur anthropological field work in Africa. His surprised and appalled colleagues and longtime friends wondered what had got into him. Only after great pressure from his family and friends, and some professional help, did he decide that it was an unrealistic plan. In working through his crisis he was able to put into words his feelings and convey much of the essence of the mid-life crisis. As an adolescent he had been eager to travel and he had especially enjoyed stories of adventures and exotic people and places. In the interest of being a successful and responsible person he rather ruthlessly set aside these interests and pursued academic and professional excellence with a rigid singleness of purpose. He explained that taking the anthropology course brought back longforgotten wishes for the life of adventure, and he said: "It's like I betrayed that part of me. He's been waiting so long that he has to have a chance now, or else it will be too late". He also expressed his feeling that time had become his enemy and he wanted to tell it to wait because the adventurer in him had not 'had his turn' yet. It was not fair for time to move on.

Life Review The particular perspective of viewing life from midcourse can provide a chance to examine changing physical conditions, relationships to family and friends. And especially it can pose the problem of choosing priorities and assessing goals. Mid-life is the stage from which one can realistically ask what he has done with his life up to this point and what he intends to do with the remaining portion. This central task of mid-life is often painful, but avoiding it may lead to difficulty. Robert Peck stresses the importance of this task when he says: "It has been my impression that those people who age most successfully in this stage (middle age) with little psychic discomfort and with no less effectiveness, are those who calmly invert their previous value hierarchy, now putting the use of their "heads" above the use of their "hands", both as a standard for self-evaluation and as a chief resource for solving life's problems."8 Klemme has also talked of the need to pause and assess one's goals and objectives. No longer is the person in the position to squander his resources and
energies. A provocative suggestion has been made by some clinicians who work intensively with the psychological problems of the aged. They have come to regard many of the psychological problems of this group as a result of the person's not having managed these mid-life tasks. He is faced with life-assessing tasks when the possibilities of changing direction are severely limited as is his ability tc make sense of his life.

surrounds the phenomenon of the mid-life crisis itself. When one considers the mid-life stage as a normal and essential part of life and a significant life task, one is struck by how little public attention has been given to it. This relative ignorance about a normal development combined with the cultural emphasis on the importance of youth contributes to some people experiencing the stage as a 'sickness', as something shameful to be hidden, some individual preoccupation or hangup, to be revealed only in the confidence of a physician's office. All these are reasons why a family physician should be particularly sensitive to this issue. That the person going through the mid-life crisis needs support and understanding is clear. It has been our experience that helping the patient recognize that he is living through a normal, expected, and necessary reorientation has been greatly supportive. It is sometimes necessary to point out that it is a sign of health and maturity to look at life and review it in mid-course. It should be made clear that it is not a stage to outgrow, but a task to accomplish. Just this information alone is received with great relief by many. Stressing the mature life task aspects of the crisis is useful in helping a person avoid strongly regressive feelings. The person finds echoes of his past life crises in his attempt to cope with the one at mid-life. If the echoes are too loud, or taken out of the context of the present problem, the person feels unnecessarily childish and ashamed. The likelihood of rash and destructive major decisions can be reduced when the person is helped to examine calmly and deliberately what is important, to see what he has achieved as well as ambitions that he must relinquish. The driven hyperactive pursuit of some drastically new goal in mid-life is too apt to be an avoidance of facing the pain and regret that inevitably accompany the mid-life reorientation. A final note: the physician in his mid-life may be having difficulties coping with this task. No more than his patients can he escape the necessity of working it through. If he is open to the reorientations involved in this mid-life stage, and deals with them in a mature way, he will be able to help his patients more effectively. 4

Helping People Meet The Mid-Life Crisis It has been our impression that a number of peoplc avoid confronting the mid-life crisis by devoting theii attention to bodily functions, and worries about theii health. It is as if they tell themselves that if only this o] that physical symptom were eliminated they would be ar youthful as ever. Frequently they will seek the help of physician. Another factor that indirectly acts to brin: people struggling with the mid-life crisis to a physician' attention is the remarkable conspiracy of silence tha
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1. ERIKSON, E. H. Identity: Youth and Crisis. New York: Norton, 1968. 2. GUTMANN, D. Cross-cultural research on human behavior: A comparative study of the life cycle in the middle and later years in "Environmental Influences on Genetic Expression. " KRETSCHMER, M. and WALCHER, D. (eds.) Fogarty International Center Proceedings No. 2, Washington: U.S. Government Printing Office, page 23 7, 1971. 3. Ibid. page 238. 4. KLEMME, H. L. Mid-Life Crisis. Menninger Perspective, 1:(2) The Menninger Foundation, Topeka, Kansas, pages 2-6, 1970. 5. Ibid. 6. MASTERS, W. and JOHNSON, V. The aging female and the aging male in NEUGAR TEN, B. (ed.) Middle Age and Aging: A Reader in Social Psychology. Abridged from MASTERS, W. H. and JOHNSON, V. E. Human Sexual Response. Boston: Little, Brown and Co., Chapter 15, pp. 238-24 7, Chapter 16, pp. 260-2 70, 1966. 7. NEUGARTEN, B. Dynamics of transition of middle age to old age. Journal of Geriatric Psychiatry, Vol. IV, No. 1, page 78, 1970. 8. PECK, R. Psychological developments in the second half of life in NEUGAR TEN, B. (ed.) Middle Age and Aging: A Reader in Social Psychology. U. of Chicago Press, 1968.
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References