Mood Swings

A psychiatrist surveys the mind and the wider world

Male Menopause

Face to face with the end of it all.

 

Maybe it is just that I am 42 years old and male, but I seem to be noticing that a lot of middle-aged men are killing themselves. My former patient, in his late 30s, said that half a life was enough happiness for him. My sister's friend, about 40, impulsively killed himself with a revolver after his long-time girlfriend told him she was leaving. My personal friend, a 38 year old dermatologist, is severely depressed and suicidal after his fiancée left him.

They say that older males are the most likely to kill themselves, and younger women are the most likely to make suicide attempts. What is happening with the middle-aged male cohort?

I presume it has something to do with the concept of a mid-life crisis. When I was not middle aged, I tended to think of the mid-life crisis as something faintly humorous: the balding 45 year old would buy a red convertible, maybe drive a little fast, remarry a trophy wife, and soothe his pain that way. But now that I am middle-aged - I supposed I have to admit it now - and since most of my friends are too, I realize that it is something really dangerous, and that the pain is not like a toothache; it is more like peering down a deep well and feeling your feet giving way.
If you are lucky enough to have parents and grandparents with reasonably normal life spans, then the mid-life crisis begins to announce itself in your 30s, and usually by your 40s, when those who meant the most to you as a child begin to die, one by one.

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First, it was my aunt; she had schizophrenia. I loved her, but I rationalized her death by thinking that her life had been so painful. Then my grandmother; I loved her too, but she had begun to become distant in her later years through illness and depression. Then my uncle developed Alzheimer's dementia: he died before he died. I missed him: we used to talk about quantum physics. Then my aunt died after going into a coma after kidney dialysis: I missed her; I used to visit her in Los Angeles once a year. Now LA feels empty to me. Then my other uncle, and another aunt. My grandfather was left; I was closest to him. He kept getting ill; we kept curing him by diagnosing and treating whatever he had. We thought we had caught his colon cancer, but it came back, and last year, I spent two weeks with him as he lay dying.

After him, only my parents are left. And after them, I know that our generation is next.

That is the mid-life crisis: Being put face to face with the reality of the end of it all. And then there are the children. They seem to be waiting around to replace us. And yet they are so wonderful; the thought of leaving them makes it all even worse. On top of it all - I believe Freud noticed this - it is haunting how five year olds want to discuss the meaning of death.

Karl Jaspers, the existential psychiatrist and philosopher, talked about death as a "limit-situation" which gives meaning to our lives. We cannot avoid it; we can only live authentically if we face it, he said. Heidegger talked about Being-toward-Death; the idea that we could not live an authentic existence until we first came to terms with the reality of its end. I thought I caught the same idea years ago when a former Black Panther (I can't recall who he was; not one of the more famous leaders) came to speak to Harvard undergraduates. I happened to attend, and I recall how he must have felt odd speaking to that crowd. I don't know what led him to make this remark but I never forgot it.

He said: "Most people do not have any reason for living. They just find themselves alive and they go through the motions. They find nothing to be really important, so important that they would put their own lives on the line. They are not willing to die for anything, so they are not willing to live for anything. You want to know the meaning of life? Figure out what you are willing to die for, and then reason your way back from there."

I think that one can go through one's youth avoiding this question, but sometime, usually by mid-life, we are faced with it. We come face to face with deciding what we are willing to die and live for. And if the answer seems to be nothing, that is when the mid-life crisis itself can lead to death.

These days, Americans probably hear about Shiites only in terms of sectarian conflicts in Iraq. They come across as an ethnic group that seems to like to fight with other ethnic groups. Perhaps this is part of the problem in Iraq: we send our soldiers, who have no knowledge of Iraq or Shiism, into a place where they simply get shot. No wonder neither side makes any attempt to appreciate or value the adversary as human beings.

I am a Shiite, as are most Iranians. The leading figure in the Shiite faith, Imam Ali, lived and died in Najaf, Iraq. (His mosque, where he is buried, was the site of major battles early in the Iraq invasion). For Shiites, his ideas are as alive as those of St. Paul are to Catholics. Ali was the first person to join Muhammad in his new religion; he fought alongside Muhammad in decades of battles as the small band of original Muslims gradually took over Arabia. He killed many people, and he placed his life in jeapordy in battle many times. In the end, he was assassinated. After his death, his followers published a collection of his sermons, Nahj-ul Balagha, long considered a classic of Arabic rhetoric.

In his sermons, he frequently repeated the belief that God only fixes two days in a person's existence: the date of his birth and the date of his death. Neither are changeable. But everything in between is up to us.

Once, writing a letter to his son, he summarized his thoughts in a maxim:
"Plan for the future as if you would live forever," he said. "But live each day as if it might be your last."

I had heard this before: my grandfather repeated it to me when I was a teenager and a young adult. But now I think I understand better: Now I know that those are not morbid thoughts; those are words to live by.

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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