There are midlife crises; then there are late-life crises
Even by his own measures, my patient I’ll call Morris considered himself to be going off the rails. Against his better judgment but driven by a compelling and yet mysterious siren, Morris donned a pair of designer jeans and an untucked paisley-patterned shirt, got behind the wheel of his car for the first time in five years, and drove 30 miles through Miami traffic at night to start an affair with a woman he had recently met.
Morris was not acting like his usual 93-year-old self, but he didn’t care. This otherwise bright and logical man abandoned his role as a meticulous caregiver for his cognitively-impaired wife and left her at home with her aide in order to plunge into a romantic rendezvous. When he came to see me several months into the affair, Morris was wide-eyed and drunk with love, feeling as if he were recapturing his lost youth. At the same time, he was confused and guilt-ridden by his behaviors, knowing that he was somewhat out of control.
We typically imagine that people go through such crises of identity, belief or purpose at midlife, when the first gray wisps of mortality begin to rear up and remind us that the time to live out our dreams may be shorter than we think. But truth be told, the phenomenon of the midlife crisis has never been proved to exist, statistically. Its purported driving factors – fears of mortality, losses of role and relationships, and professional burnout – seem more appropriate now to those much older than midlife.
Enter the late-life crisis as a trend I am seeing increasingly in my geriatric psychiatry practice, in which individuals in their 70s through 90s are wrestling with existential questions that eluded their psyches during middle-aged years of active work, love and play. Now, facing a true twilight of illness, disability and loss, all hell can sometimes break loose in these older lives.
There are few studies that have actually examined the concept of a late-life crisis, but the small literature that does exist has described the phenomenon as a period of months or years in which a major life transition or stressor overwhelms a person’s ability to cope, resulting in uncharacteristic emotional and behavioral eruptions. In one interesting study of late-life crises, researchers Oliver Robinson and Xander Stell found several common denominators among their subjects. Most crises were induced by multiple stressful events that involved losses and occurred in close proximity. These stressors led to a period of instability in which the individuals generally felt a loss of identity and self-worth, began to disengage from usual activities, and felt depressed or even despairing.
Morris, for example, felt trapped by his wife’s dementia and didn’t know how to cope with constant feelings of burden and inadequacy. When he met a younger woman of 80 who was enamored of his sense of humor and savoir-faire, Morris became infatuated with both the lady and his awakened sense of purpose. Out of a crisis came behaviors that seemed risky and unhinged for Morris – but it brought some measure of satisfaction. I’ve had other older patients who have had crises after losing a lifelong partner, or long-held religious beliefs, and feel as if everything that made their worlds safe and sensible has been lost. In response, they start doing things impulsively and against their better judgment – like one patient who bought a Harley at age 83 and started riding around until he was almost killed when he wiped out on a rain-slicked road, or another patient who became a 90-year-old pothead. With many of these patients, I’ve morphed from a worried father of three teenage boys to a worried therapist of teenage-behaving octogenarians.
According to Robinson and Stell, the eventual outcomes of late-life crises could be positive or negative, depending on whether the individuals were able to find some acceptance of their circumstances and then either re-engage with new purpose and pursuits or establish a less-engaged lifestyle that is still fulfilling. For his own part, Morris ran out of gas both literally and figuratively, and could no longer transport himself with enough frequency to maintain his love affair. Instead, he found a group of other caregivers with whom he could share some well-needed respite time out of the house – and who could pick him up.
A late-life crisis is often both a cause of instability and a call for help. It stems from losses and other stresses that should be recognized and addressed, especially when they give rise to significant depression, despair or risky behaviors that may bring harm or even potential ruin to the suffering soul. The key is to find support and guidance toward more meaningful ways of coping and re-engaging with life.
Marc Agronin is a geriatric psychiatrist at Miami Jewish Health in Miami, Florida and the author of “How We Age” and “The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer’s Disease and Other Neurocognitive Disorders.”