The Health Blog

As we have seen, heart attacks have been linked to a particular behavior pattern by cardiologists Friedman and Rosenman. The Type A striver is excessively time-conscious, highly competitive, and inclined to push himself to the limits. A victim of “hurry sickness,” he must learn how to slow down. Emphatic about the need for a Type A man to change his pattern, Dr. Friedman suggests the following:

Discontinue polyphasic thinking. The habit of thinking about several things at one time produces a terrific mental struggle. Any man who catches himself doing this must cut it out at all cost, even though he thinks it is useful.

Listen without interrupting. Concentrate on listening to another person’s conversation without ever interrupting, no matter how long it goes on. Patients are advised to practice with their wives by trying never to bring them to a point.

Read books that demand concentration. “I want my patients to have new friends—friends they can respect, whom they can’t talk back to, or interrupt,” says Dr. Friedman. “And that means books. I want them to find something as important to them as the numbers game.” He suggests reading philosophy or a complex novel by Proust.

Have a retreat at home. Every man should have a place in his house—besides the bathroom—where he can be alone. He should have a place for privacy, a space of his own, where he can have the leisure to think and “to meet himself.”

Restructure trips and vacations. Avoid jam-packed, hectic business trips and too much traveling in one day. For conventions and business meetings, arrive the night before and rest; then stay another day after it’s over instead of rushing home immediately. Vacations, too, should be relaxed, unhurried, and noncompetitive.

Plan some idleness in every day. Each day should allow room for idle time. Get up half an hour earlier in the morning so that you can be more relaxed about dressing, breakfasting, and being with your family. Avoid scheduling too many things in any one day. Whenever feasible, take a long lunch break—preferably not with business associates. Keep a clean desk, free of debris, those accumulated reminders that usually trigger guilt. Enjoy the time saved by taking a new look at the world: Walk in the park, go into a church and listen to the organ, watch people stroll by, saunter through a museum.

Underlying these directives, says Dr. Friedman, are three main points: (1) Things worth being arc better than things worth having; (2) live by the calendar rather than the stopwatch; and (3) consider any day that does not contain something of memory value—something related to beauty, love, growth, or novelty—a lost day. Though designed for the Type A man, these prescriptions should be helpful for all men in their middle years. They offer a man a program for restructuring his life to allow more room and time to explore his thoughts and feelings—and this is certainly a necessary step in passing through a mid-life crisis.

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Somewhere in their forties many American men yearn to transform totally a life that now seems sterile, stale, or senseless. They feel an urgent need to make dramatic changes, start fresh, embark on a radically different course—to be born again, in short.

Moreover, there is a feeling of desperation which insists that drastic steps be taken immediately—or else it will be too late. “I’ve always had this dream about owning a ranch, and for years I’ve been talking about quitting my job and moving out West,” said one man. “But suddenly there’s the feeling that if I don’t get the hell out of here and do something now I’ll be in the soup for as long as I live.”

“Not another day dying alive!”—that is the battle cry of all men over forty who feel that life has passed them by. And very often those who have suffered the deepest disappointments, or cowered behind the greatest compromises, or stuck to all the sternest rules now lunge most eagerly toward radical change. No mere tinkering with a stagnant marriage nor toying with a stale career will do. They lust instead for a shiny new slate and stunning alteration. A total sweep. A grand slam.

But fear and trepidation often go hand in hand with this urgent desire for change, creating a powerful pull between opposing forces. A man may want desperately to change, but at the same time feel paralyzed by anxiety and uncertainty. What if he makes the wrong choice? What if he fails? How, in his position, can he afford to take monumental risks? Give up old roles? Forfeit responsibilities? How will his wife, his children, and his colleagues react? What will his boss say?

Dare he gamble so recklessly at this stage of life? Dare he try to realize the dream that has been burning inside him for years? Or is it already too late? Is the pursuit of lofty visions solely the prerogative of the young?

Unfortunately, such doubts and fears are, to some extent, legitimate. They spring from repressive sources that are deeply rooted in our society, sources that not only discourage but also fiercely disapprove of people—especially men in their middle years—making major life changes. It is a strange irony of American life that while we applaud novelty and progress in many areas, we prefer stability in human beings. Those who dare to make radical shifts threaten us profoundly, evoking suspicion and scorn.

“Most lives have been wasteful in comparison to what they could be,”1 says Dr. Robert N. Butler, Director of the National Institute of Aging, who feels that we do not encourage people to be sufficiently resilient and flexible, open to new possibilities throughout their entire life. In favor of a radically revised concept of the human potential, Butler deplores our culture’s overemphasis on the importance of a firmly fixed, established identity as a sign of mental health. Forcing us to continually consolidate our past choices, rather than review and renew them periodically, this static, definition of health causes people to become frozen into set roles that limit self-development, he says. In turn, our society then defines as “sick” those who in their middle years switch careers, break up marriages, or adopt new lifestyles.

Despite this prevailing cultural prejudice, which claims that consistency is a basic human virtue, change a sin, some members of the helping professions are slowly beginning to recognize that people have a natural need to grow and expand, to continually, evolve. Accordingly, some psychiatrists, psychologists, and counselors are now responding in a new way to mid-life men who feel stuck or stagnant. Contrary to the orthodox therapeutic approach, which urges adjusting to the status quo and accepting things as they are, this new breed of counselors is beginning to encourage change, sometimes even prodding their clients to risk more adventures with themselves.

Thus when industrial psychologist Lawrence Zeitlin counsels men over forty who are dissatisfied or in distress, he often challenges an overly cautious man by asking, “What the hell are you doing it all for? If you want to quit your job or leave your wife, why don’t you do it?” Or he might take over a man’s guilt by giving him permission to play out a particular fantasy. “Look,” he would say, “yon don’t need psychiatric treatment and you don’t need vocational guidance. You want to run off to Mexico? Go ahead and run off!”

His approach has had dramatic results. Sometimes a man’s doing what he really wanted to do, even indulging in a brief escapade, resulted in his returning to his job or marriage rein-vigorated. More important, this approach helps a man understand that his need for change is normal, not neurotic, and that he has underestimated his own ability to transform his life. “These men suddenly realized the trap they were in was of their own making,” says Zeitlin. “They realized there was nothing in their lives—except their children, obviously— which was irreversible.”

The greatest barrier to change is a man’s refusal to face his problems realistically, says Zeitlin. Many men resist change by acting as if the problem is not quite “real,” or as if it can be reversed by some simple gesture. In turn, they often seek counseling in the hope of getting a “magical” solution.

“What they don’t want to hear,” he claims, “is that what’s happening is inevitable because of the type of person you are or the situation you’re in. And there’s just no way to change things other than drastically changing the situation—or drastically changing themselves.”

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Today many other American men in their middle years are discovering that having devoted all their energies to work has left them less than whole. Michael describes himself as a man whose business was his life, a man who earlier refused to communicate his thoughts to his wife. But, approaching forty, he complains about the lack of intimacy, sharing, and openness in his marriage. Now his needs have a new dimension. His is a common reaction, related to the mid-life phenomenon of a man’s evolving to a new emotional place, a place where he is likely to be confronting his own repressed or atrophied feelings, a place where he suddenly feels lonely and in need of love. This new yearning for intimacy occurs because in the normal course of development men are beginning, as the Yale group suggest, to discover the softer, more sentimental part of themselves—the part that was ignored earlier.

But what is happening to women?

There is a growing body of evidence from social scientists which suggests that a sexual reversal takes place at this stage of life, a reversal that is likely to be explosive. At mid-life men and women seem to be switching gears and heading in opposite directions. Intent on living out the potentials and pleasures they had relinquished in earlier years, men begin to move toward the passivity, sensuality, and tenderness previously repressed in the service of productivity. Women experience the opposite: Now that their nurturing function is no longer needed, they often become more autonomous, aggressive, and cerebral.1

Jung claimed that their reversal entailed a fundamental psychic shift whereby men become more “feminine” at around forty, women more “masculine.” “We might compare masculinity and femininity and their psychic components to a definite store of substances of which, in the first half of life, unequal use is made,” Jung stated. “A man consumes his large supply of masculine substance and has left over only the smaller amount of feminine substance, which must now be put to use. Conversely, the woman allows her hitherto unused supply of masculinity to become active.”

Pessimistic about the consequences of this shift, Jung predicted trouble: “Very often these changes are accompanied by all sorts of catastrophes in marriage, for it is not hard to imagine what will happen when the husband discovers his tender feelings and the wife her sharpness of mind.”

Despite having been formulated some years ago, Jung’s metaphor is oddly apt today. Many couples now in their forties are clashing in precisely this way. What this mid-life switch means in contemporary terms is that men of this generation are trying to break out of the masculine mystique at the same time that women are seeking to break out of the feminine mystique.

Having come of age at a time when the division of labor implicit in conventional sex roles dictated that men and women be “halved,” prohibited from cultivating traits traditionally labeled masculine or feminine, both sexes begin to discover a forfeited self they now want to develop. At midlife men are groping toward increased self-awareness and more meaningful personal relationships. They are trying to get in touch with impacted feelings and develop the emotional side of their personality, an effort that sometimes leads to creative expression, sexual experimentation, or even to love affairs.

At the same time, a counterpoint to that struggle is occurring among women, who are trying to forge a more complete identity by going back to school, getting a job, or acquiring money and influence. Having been imprisoned too long in a role that restricted them to nurturing their husband and children, they are seeking validation in the outside world.

With rigid sex roles breaking down rapidly, younger men and women will probably develop less narrow ways in the future and not awaken later to find half a “self” badly neglected. But couples now in their forties, caught in the middle of confusing social changes, are likely to find their marriage threatened as each partner struggles to grow and change.

Since two people rarely manage to self-actualize in total harmony, one or both partners sometimes feel that to grow whole they must split. Propelled by the illusion that they can become free of internal shackles by breaking away from external commitments, they insist on leaving the incubator that sheltered them in earlier years. Divorce becomes a necessary rite of passage into full adulthood.

Even if a split does not occur at this stage of life, however, both men and women often feel an urge to break the stranglehold of a well-ordered life, at least temporarily, an urge to relieve the dreariness of dutiful behavior and dutiful sex. Such wishes are understandable. Having been brought up in the conformist 1950s when rules abounded, this generation of men and women were never encouraged to be free, spontaneous, or playful. When they begin to realize that they have spent a lifetime doing what others want, they suddenly yearn to express forbidden impulses and follow where they lead. Mid-life is the time when both sexes become more concerned with pleasing themselves than with placating others.

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Impacted feelings are a form of imprisonment as well as a source of pain. The man who fails to become more open to his emotions and his inner self at mid-life will become weighted down by an overwhelming sense of loss, thereby losing the vitality needed to meet new challenges and make new choices. Unable to surmount his depression, he will suffer instead from a feeling of boredom and stagnation. But this need not happen.

There is a natural tendency at this stage of life for a man to be turning inward, to be moving away from the outer world of work toward the inner world of self. This shift is normal in terms of adult development and necessary for future growth.

It relates to a man’s outgrowing the life structure he built earlier, according to the Yale group’s theory mentioned before, and to his new readiness to listen to “other voices in other rooms.” The parts of his personality that have been silent or unexpressed now begin to clamor for attention.

To achieve at work a man has usually had to emphasize “the rational, consciously intelligent, tough-minded aspects” of his personality until he reaches his mid-thirties at least, explains Charlotte Darrow, the Yale group’s sociologist. Therefore: “He simply has had to sacrifice, to neglect or suppress certain parts of his self. This often meant defending against another whole area, having to do with more emotional, softer, less masculine wishes and feeling.”

But in his forties, when the battles with the outer world have been either won or lost, there is a basic shift marked by an upheaval of those parts of the personality that have been ignored. Now the crucial issue becomes the degree to which a man can listen to these “other voices” and respond to this other side of himself—the side that our society has traditionally labeled “feminine.”

Threatening as well as challenging, this developmental shift brings every man in his middle years face-to-face with all taboos rooted in the masculine mystique.

And as we shall see in more detail shortly, men react in very different ways: Some will experience this shift consciously; others will not. Some will be alarmed; others will be delighted. Some will let their feelings erupt dramatically; others will keep them simmering just beneath the surface; and those who are most rigidly controlled will force their feelings even further underground.

What a man actually does depends on many complex factors, according to Dr. Braxton McKee, the Yale group’s psychiatrist. It depends on his particular background, character structure, and personality development, as well as on his response to social roles and society’s expectations—all of which enables some men to be more in touch with themselves than others.

As an example of a man courageous enough to follow these mysterious inner voices wherever they might lead, McKee tells the story of a forty-year-old man, a personnel manager, who changed his whole life as the result of new feelings that had first surfaced during an extramarital love affair. McKee describes what happened after the other woman broke off the relationship:

This man was very upset when the affair ended, but then he said, “The strangest thing happened. I started getting interested in writing poetry and painting.” Not only did he get interested in it, but he got into it. He had some stuff published and a couple of exhibits. Not only that, but he got very much more interested in being with people.

He and his wife and some friends, all in their 40s, opened a commune so they could be with one another more. And he left his job because he wanted to get into something that allowed him to work more intimately with people.

He was involved in a search for intimacy, and he was absolutely explicit about it.

Not only was he aware of what he wanted, but he said, “You know, as a result of my experience with that woman I discovered there is something down there that I didn’t know anything about! I just want to listen for awhile and find out what I hear.”

Observing that this man was an unusual person, one who had already been fairly open to his feelings, McKee points out that a different sort of man might have done just the opposite:

“Another guy who has not been in touch with himself, for whatever reasons, might experience something like that in a way where he would say, ‘Jesus Christ, I’m queer!’ It would make him anxious and frightened, and lead him to cut it off even more. And perhaps drive him into even more frantic, phallic, hypermasculine kinds of things. It’s very tricky and complicated.”

The Yale group regards a man’s getting more in touch with the caring and nurturing part of himself as an importand developmental step during the mid-life period. But their point is understated.

How well a man succeeds in dislodging impacted feelings—and dealing with his evolving emotional self—is undoubtedly the single most important issue facing every American male during the mid-life crisis.

In the next section of this book we will see more specifically how this issue is at the heart of all the major changes and challenges that occur at this stage of life.

Whether related to work or sex or marriage or fatherhood, there are losses to be faced and worked through, new problems to be confronted, and new choices to be made. And though these choices may differ greatly in scope and significance, they all have one thing in common: They force every man trying to decide what he wants—in his job, his marriage, or his lifestyle—to get more in touch with his emotions, because no man can decide what he really wants until he has discovered what he really feels.

And in the following section of this book, which concerns new directions, we will see that the men who succeed best in making meaningful life changes are those who are courageous enough to shed obsolete prescriptions about success and masculinity, listen to their inner voices, and reclaim their forbidden self—their feeling self.

For members of the handicapped generation this is what the mid-life leap from boy/man to man is all about: daring to revolt against the taboos and prohibitions of the masculine mystique.

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“There has been astonishingly little basic research on the dismal survival record of the male,” states Dr. Estelle Ramey, professor of psysiology and biochemistry at the Georgetown University School of Medicine-—and she is quite correct.

But if we look outside the medical establishment toward a dissident minority of scientists who are exploring how social factors influence human survival, we find some important clues. There is a growing body of evidence which shows that social pressures, stress especially, not only cause disease but also lower life expectancy.

By focusing on man’s relationship to his environment, and the link between mind and body, these studies underscore the point that it is meaningless to question why the American male dies prematurely without first questioning how he lives.

In America today we have become more vulnerable to illness, these scientists have discovered, because we have lost many old sources of comfort and support, including religious beliefs, while being exposed to increasingly rapid social mobility and changes of all sorts. Change itself is a source of stress, it has been found, and so is the increasingly hurried pace of our lives.

Now recognized as the world’s authority on the subject, Dr. Hans Selye first identified the stress syndrome that causes a chemical rallying of the body’s defenses, and also demonstrated how stress diminishes a person’s natural immunity to many diseases. Stress is a drastic wearing force, he found, and once each man’s “adaptation energy” is expended it cannot be replaced.

That the adaptive demands of a man’s environment can significantly influence his survival has been confirmed by others. Dr. George Engel and a group of scientists at Rochester University have discovered that the feeling of loss of control over one’s life, or a sense of helplessness, can lead to illness.

When a man realizes that all control has been lost, he usually struggles first to regain it—and then eventually gives up. This fierce struggle has a corrosive effect on health, which sometimes results in sudden death. Grief can be a cause for this “giving-up complex,” but so can unemployment: Studies show that the loss of work can be so destructive to a man’s identity that he gets sick, or even commits suicide.

‘ Similarly, Dr. Thomas H. Holmes and his colleagues at the University of Washington have found that illness inevitably follows when life events require more coping and adjustment than the body can stand; and they have now identified forty-three of the most common stressful life events that lead to disease. Surprisingly, however, not all these events are negative. But even desirable changes—like moving, career change, or promotion—require varying amounts of coping behavior, and are therefore stressful.

“Many of these events are part and parcel of American values—achievement, success, materialism, self-relianc’e, says Holmes.

Studies like these are disturbing because they force us to recognize that disease is not really the simple medical concept we once thought it was. But they are more disturbing still when they imply that some of our culture’s most cherished values contribute to illness and curb our life span. Nonetheless, there is increasing evidence that our American way of life too often leads to death. And now it is not just social stress that scientists are condemning, but the demands of the male sex role as well.

Today the fact that the American male has more difficulties at mid-life than the female—judging by sex differences in serious physical illnesses, alcoholism, suicide rates, admissions to mental hospitals, and premature coronary deaths—has led some researchers to suspect that our excessively high standards of male performance may be responsible.

One area where suspicions have been raised is that of suicide. Here the difference between men and women is startling: Though three times more suicide attempts are made by women, three times more men actually die of suicide; and the suicide rates increase steadily with age among men only. (We refer here only to whites; suicides among nonwhites is much lower for both sexes.)

Although no completely satisfactory explanation for this discrepancy has yet been documented, some authorities suggest that the need to live up to a strong male image may well be the decisive factor. In her study of adolescent suicides, Boston University psychologist Pamela Cantor found that boys generally choose failure-proof methods, such as hanging and shooting, whereas girls choose a method like sleeping pills, which allows rescue. The boys succeed because they really want to die, says Cantor, observing that because our society “expects” more from males, “boys who doubt their sexual prowess or career prospects may see death as the only way out.”7

Similarly, Dr. Ewald W. Busse, head of Duke University’s Center for the Study of Aging and Human Development, has suggested that older men commit more suicides because the impact of retirement, physical decline, and illness may all be more devastating to a man’s self-esteem than to a woman’s.

Speculative though they may be, such observations suggest that American men are dying prematurely in the prime of life not simply because they were born male, but because they are pushing too hard to be masculine. The toughest evidence to date for this thesis is the research linking Type A behavior to heart disease.

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