The Self-Renewal of Midlife
At every moment of life, a person is both the image of his future and the likeness of his past.
— Oscar Wilde, De Profundis
Every time my wife's workplace organizes a health checkup, once the results come back, several colleagues are found to have cancer or other major illnesses—mostly around forty or fifty, with some younger ones in their thirties already diagnosed. Others have nodules rated moderate-to-high risk on their reports, some of which will later be confirmed as cancer. At the same time, some colleagues are divorced or have marriage on the rocks. Others have parent-child relations so strained that both adult and child are exhausted.
All these can be called midlife crises. In my view their roots are the same: genetic flaws combined with acquired bad habits. The outcomes look sudden, but the seeds were sown long ago. If we trace them back, we can reach early life—one's childhood. Trace further, and we see the shadows of whole families across generations, because a person's habits are first learned in the family and are heritable. One important part of a doctor's history-taking is asking about familial hereditary disease.
Our dietary and behavioral habits are formed in childhood in our families of origin, and are hard to change for a lifetime. Many of them are bad, and they lead in middle age to serious physical illness, emotional problems, and social-relationship crises.
In youth we are healthy, energetic, and handsome, and many problems are hidden. But in middle age, accumulated bad habits begin to surface. These habits may lead to major diseases like cancer, diabetes, and hypertension, or to serious interpersonal conflict—especially with partners, children, and colleagues. All of this affects our quality of life.
When a person reaches this point, it is time to reflect on his whole life. Across the long span of human evolution, average life expectancy was only about forty years. Only in the last two or three centuries, with the advance of modern medicine, has it risen sharply; now it can reach over seventy. Problems that did not generally exist in earlier times are now common. After forty, our lives either end in accident or major conflict, or undergo renewal.
Wilde said that at every moment a person is both his future image and his past likeness. The force of habit is strong; a person's life seems constantly changing, but in fact it only repeats fixed habits, so behavior over a lifetime is remarkably consistent. Others can predict a person's future.
A middle-school teacher of mine once told me: how a person treats others is how he will eventually treat you. You cannot see it now because the time has not come; when the time comes, you will. His words are close to Wilde's: how a newly made friend will eventually treat us can be seen in how he treats old friends around him, because human behavior has inertia.
From a genetic standpoint we might even say that how a person's parents treat others is how that person will treat others, because habits are learned from one's parents.
If a person never recognizes over a lifetime that his habitual thinking and habitual ways of doing things are wrong, and never undergoes self-renewal, he is merely copying his parents' lives and repeating his own past. Copying one's parents' lives is not necessarily bad: if their lives were good, copying them means one's own life will be good. But if their lives were not good, copying them can only be a tragedy.
Midlife people have a chance at self-renewal. The American psychologist James Hollis, in his book The Middle Passage: From Misery to Meaning in Midlife, divides life into two adulthoods. The first runs from about twelve to forty; in it our personality is a set of reactions to the outside world. We do not fully understand the world; we are merely learning the attitudes and behaviors of the adults around us. We are told to become this or that kind of person, and we fulfill those expectations. But after forty we have a little leisure and our self has gained some strength; only then do we begin to ponder "becoming ourselves."
This resembles Confucius's saying that at forty one is free from doubts. In Confucius's view, from forty a person enters a state free from confusion, and after about another decade of growth reaches "knowing the mandate of heaven." In Hollis's terms, before forty we still harbor fairy-tale fantasies about the "magic of life." After forty we begin to realize that the magic was only fantasy; our idealized expectations of life lose their foam. By fifty we "know the mandate of heaven"—a state in which we know that realizing ideals is hard and no longer force outcomes. By sixty we reach "receptive ear"—able to listen to the unpalatable words we could not hear when young.
Not everyone completes this process, and some complete it early. Many people have all sorts of problems, yet live into their eighties or nineties still merely repeating their childhood. Why? Because they missed the second growth of their lives; in their forties and fifties they do not reflect and simply continue old ways. In the end their lives are a tragedy.
Marriage, love, family, career, and health are our five mirrors; they reflect every problem in ourselves. If we keep meeting the same predicaments in intimate relations, parent-child relations, career, and health, we should first look for the problem in ourselves rather than blame others. We must trace our problems to their roots; to solve them we need the courage to discover problems and renew ourselves. Only through self-renewal can we meet a new life.
Lung-cancer patients often keep smoking while undergoing treatment, telling me they cannot quit. For lung cancer, the number-one risk factor is smoking; without quitting, the most effective treatment is meaningless. People who grew up eating all kinds of pickled foods keep strong tastes all their lives; after middle age their probability of hypertension, gastric cancer, and esophageal cancer is far higher than others', yet they still find it hard to give up. Some patients even tell me they cannot eat a meal without pickles. Obesity is the second-biggest carcinogen, but dietary habits formed in childhood are hard to change for a lifetime, and they determine how obese a person becomes.
The behavioral habits of patients with all types of personality disorders are likewise learned in childhood from parents, or in adolescence and early adulthood from their environment. These disorders make their behavior clearly deviant and deeply ingrained, hard to change. Yet patients are entirely unaware; even when professionals or others repeatedly tell them their behavior is abnormal, they still believe they are normal and that others are the abnormal ones. They keep repeating the same mistakes, and after being bruised all over begin to doubt everything; some cannot escape the pain and take their own lives.
This is a problem I meet constantly in treating patients. We urge patients to change their habits, but unfortunately only about half can. The other half scoff at the doctors' suggestions, mocking our competence, convinced they are not at fault and that the doctors are simply inadequate.
If a person cannot face his own problems, cannot discover them, and lacks the courage to renew himself, healing is out of reach. Their disease will not improve; their tragedy repeats itself, even worsens, and ends in premature death. Some psychiatric patients choose suicide to end it all; some cancer patients have their lives taken by the disease.
Most chronic diseases are hard to cure, but if patients can recognize their illness, identify which habits are wrong, and correct them, their situation improves greatly and their quality of life rises. If they persevere in change, over the years, five or ten years on, they become a new self. Looking back at their former self, they feel as if from another world. That is because, in the second adulthood of life, we have truly grown.