Health News. Lots of resources and information

Clearly, the kind of person a man happens to be will have some bearing on the way he and his son get along together and on his son’s readiness to identify with him. For example, a father who is cold or weak may not invite close relationships with his son or seem very interesting or important to identify with. In this regard, studies have described the fathers of homosexual males as passive and ineffective family members who leave major decisions to their wives.

The homosexual men tended to describe their fathers as persons who would presumably be poor objects for identification:

It should be noted that the homosexual respondents did not differ from their heterosexual counterparts in how masculine or feminine, independent or dependent, active or passive, or relaxed or up-tight they said their fathers had been.

In addition, the homosexual respondents’ more-frequent description of their fathers as cold persons appears to be consistent with others’ theoretical expectations. It should be noted, however, that when fathers and mothers were compared, the majority of respondents of both sexual orientations reported their fathers made fewer decisions in the family, and that their fathers were not much colder than their mothers.

Our findings suggest that a father perceived as relatively cold by his son is less likely to get along well with him and offers a less-appealing figure for identification. The influence of paternal traits, however, seems limited to familial relationships; their ultimate effect on a son’s adult sexual preference is at best tenuous.

*5/158/5*

To revitalize his life after forty, a man must acknowledge that change is possible and that new options exist. He must be willing not only to entertain new ideas, but also to open himself up to new aspects of experience. He must be daring enough to risk having some adventures with himself. Here are some general guidelines for making mid-life changes:

Be Realistic. Evaluate realistically what you can and cannot change about yourself, what opportunities for change are actually available, and what risks are involved. Remember that an attempt to change can backfire. Ask yourself how you would respond if it did. Beware of making any change that, if it failed, would shatter your self-esteem. And don’t expect that changing your situation, or changing locations, will transform you as a person.

Harry Levinson suggests that a man start by getting “accurate feedback on who he is.” This means carefully checking out how you see yourself compared to how you actually come across, by talking with a trusted friend, your wife, or a professional counselor. “Some guys will perceive themselves as big and mighty and aggressive,” Levinson explains, “but usually they are much more passive and compliant in fact. And if a man deludes himself with that kind of thing there is bound to be disappointment.” Increasing your self-awareness will enable you to make more rational decisions about what changes are possible for you. If you do not come away from such scrutiny feeling respectful of yourself, however, you should consider going into therapy to make internal changes before changing your situation or your job.

Take an Inventory of Your Life. Deciding what changes to make can be troublesome. Despite feeling restless and dissatisfied, many men are confused about which aspect of their life to alter. Just knowing you are miserable, but not knowing why, is bound to be paralyzing. To break this deadlock, industrial psychologist Lawrence Zeitlin advises, first, that you try “to get a reasonable leg” on the combination of factors causing your discontent. You should try to define the actual problems and objectify what you really want. To this end, Zeitlin suggests making a “cold-blooded inventory” of your life’s assets and liabilities by writing every conceivable factor on a scale from 1 to 10. “Go someplace where you have nothing to do but sit and think for several hours,” he says, “and be totally honest with yourself.”

Next, he advises going through a “what if?” scheme to look at the consequences of every possible action that might change and improve matters: What if I quit my job? Go back to school? Move into the city? Stop paying the mortgage? Take a year off? What if I decide to get a divorce? Consult a therapist? Try a marriage counselor? Start having an affair? Or stop having one?

Test Your Ideas on Others. Having carefully evaluated your feelings about every possible move, and arrived at some tentative notions on what to change, you should then test your ideas by discussing them with other people. If the home situation is tolerable, a man might talk first to his wife. “He should really level with her,” Zeitlin suggests. “Tell her about his frustrations and anxieties and fears, tell her he feels trapped in his life. And maybe she’ll level with him, too, and talk about her problems. They might even arrive at some important decisions together.” Talking honestly with a number of people will enable you to externalize and put limits on your problems. You can then begin to work toward some realistic solutions and make some meaningful changes.

Avoid Making Too Many Changes Too Suddenly. Don’t make changes impulsively without thinking and talking about your plans first. Sudden extreme changes rarely pay off. It takes a lot of preparation, both internal and external, to change old habits and restructure your life. Moreover, all change is stressful and involves an element of loss. To cope with this stress you need some “stability zones” in your life, some areas of comfort and safety. You also need to consider carefully the consequences of your actions. Too many changes in too short a time can even lead to illness.

Try Small Changes First. Paradoxical as it sounds, you need not make a dramatic change in order to change your life dramatically. If you want to transform your life, the most effective way to begin may be to take one step in a new direction. Taking this first step, even if it is a small one—like changing a habit, signing up for a course, cultivating a new friend, learning another language, altering a daily routine, or pursuing a new leisure activity—can lead to bigger things. Especially if you have been feeling trapped, making one minor change can be a major breakthrough. There is a snowball effect. One change often precipitates another, then another, culminating eventually in a series of changes that amount to a genuine metamorphosis.

What is happening is that with each step you confirm your own ability to make choices and take responsibility for your own life. From this you gain strength and energy, facilitating additional changes of greater proportion and greater risk. Part of this process is internal change—-a new feeling of self-assurance, a new attitude about what is possible.

It has even been shown that something as simple as adopting a regular exercise routine can produce definite personality change. When Professor A. H. Ismail of Purdue University put a group of men, aged thirty to sixty-five, through a four-month program of strenuous calisthenics and running, the least fit men were found at first to be much less emotionally stable and self-confident than the fittest. By the end of the program, however, this first group had improved sharply on both counts.

“We have established a fact that is more important than the value of exercise,” says Ismail. “If something as tangible, direct, and accessible as a physical exercise program can cause such distinct and rapid changes in personalities of middle-aged men, there probably are other experiences that can change supposedly crystallized personalities. The adult personality may be much more plastic than we thought.”

The mid-life crisis is a stormy transitional period that is marked by internal changes, by conflicts and challenges. Like the turbulent period of adolescence, it leads to a new and calmer stage of life: middle age. But unlike the earlier crisis, that which occurs in the middle years still seems mysterious and is too often misunderstood. It is time we learn to recognize both the perils and the potentials of this crucial turning point.

In essence, the mid-life metamorphosis from boy/man to man means becoming more authentic, independent, and authoritative. It means getting in touch with parts of the self that had been dormant earlier. It means integrating head and heart, masculine and feminine, body and mind. Becoming a man in the fullest sense means becoming whole.

A moment comes when there is a shift from destruction of the old to borning of the new. The crisis is over….

The renewal of the self has always been described by

metaphors. The process is poetic. It is like:

a butterfly emerging from a cocoon;

coming out of a dark cave into the sunlight…

shedding an old skin;

breathing deeply of fresh air;

being born again….

For me the most helpful metaphors are political: liberation;

a psychological Fourth of July;

an end to tyranny—the tyranny of the oughts,

dissatisfaction, perfectionism, moralism, intellect, the overthrow of psychological capitalism in

which the head (capital) controls the body; the transfer of authority (power) from outside to inside….

Sam Keen

Beginnings Without End

*69\93\2*

Like John Koffend, many men in their middle years feel cheated when they discover that the ideals drilled into them—obedience, self-denial, and diligent work—have failed to deliver substantial rewards. Those who are unable to transcend their feeling of having been exploited tend to view themselves as victims, undercutting their own ability to make new choices. Anxious to flee, they grab at anything that promises release from their despair. Some drown their sorrows with traditional pain-killers like alcohol or drugs. Some deny their sorrows by plunging into promiscuous sex or compulsive overwork. Others are seduced by the siren song of youth.

Although our culture’s neurotic obsession with youth is not new, keeping people young has now become big business: Men are being wooed, along with women, to tint or transplant their hair, consume cosmetics, and banish sags with surgical uplifts. But the American male is no longer satisfied simply to look young. Today he yearns to copy the young as well—their values, attitudes, and lifestyle.

This topsy-turvy trend reached its peak in the late 1960s, a time of collusion between youthful trend-setters and a generation of older men who had never played. Thus the counterculture at its height—with the flower children and the Monterey Pop Festival—charmed many middle-aged Americans with its messianic idealism, sensual freedom, and gentle cry of love. Enchanted by the chance to enjoy an adolescence they had been denied, adults across the country fell in line behind these pubescent pipers. Grown-up men grew sideburns, switched to bell-bottoms and mod ties, tuned in to the rock beat—and turned on with marijuana.

By 1970 much of the mystique of the youth movement had been destroyed. Heads had been busted in Chicago and bullets fired at Kent State. Woodstock had disintegrated into Altamont, heroin had taken its toll, and the Manson murders had brought the show to a bloody climax. The rock culture had turned into the dope culture, and the nation knew that the young were not the saviors they once seemed to be.

Despite this collapse, however, the beguiling ways of the young continue to entice aging males who feel overburdened and underappreciated. Some, having watched their own adolescent children sidestep responsibilities, become irresistibly attracted by the promises of carefree sexuality and hedonistic revolt that a youthful lifestyle seems to offer. This attraction is particularly strong among men who feel that their own life has been too work-oriented and constricted. Their disillusionment often leads to the relentless pursuit of pleasure and a desperate attempt to identify with the youth cult.

Some men straddle the fence by becoming weekend dropouts—dressing in jeans, smoking pot, and frolicking with young swingers. Others attempt a modern-day version of Gauguin’s flight, rejecting establishment standards in favor of a radically different way of life. Rather than sail to the South Seas, however, these men can join the younger generation by taking off for less-distant retreats like New Mexico, Oregon, Colorado, and Southern California—a choice that usually ineludes experimenting with communal living, drugs, and new forms of sexual freedom.

Men who drop out do so for many different reasons, some of which have nothing to do with recapturing their youth. In some cases their flight is motivated by fear and despair. In other cases it is inspired by a genuine search for a better, more human way of life.

Recently, for example, numerous magazine and newspaper articles have documented the fact that a growing number of affluent Americans are quitting the corporate world not for the sake of a new job, but for an entirely different lifestyle. Successful business executives and skilled professionals, they have all changed their minds about what they want and how to get it. At mid-life they have decided that their careers were actually of little consequence. “I discovered I had been chasing a phantasmagorical carrot all those years,” said one executive.

In most cases these men have given up city living or suburban commuting for a simpler, more independent existence closer to nature. Typically the discontent accumulated slowly before the final decision was made. And very often their new choice—a farm, a ski lodge, or a boat—was the realization of an old dream. Some felt a strong desire to work with their hands, like the man who grows cranberries in Wisconsin; or the one who works as a toolmaker on a hundred-acre farm in Colorado, where he also raises animals, and hunts and fishes in his spare time.

Occasionally a profoundly moving experience that triggers a total re-examination of values inspires a man to turn his back on society. John Koehne, for example, is a former CIA official whose life was transformed at the age of forty-six by an experience in an encounter group. Until then he had led a conventional life: private schools, Yale, the Army, steady promotions at the CIA, and a fifty-thousand-dollar suburban home with his wife and three children. But when his agency sent him to a four-day encounter group, he returned “so damned different” that his wife wondered if they could continue living together. Suddenly he began opening up to himself and others, a complete reversal of his old ways. “This was just the opposite of the way I had been living for forty years,” he says. “There was no possibility of ever going back.”

The following summer, Koehne persuaded his wife to participate in some encounter groups with him, and she too began to change. His transformation was further accelerated by rebelling teen-agers, who each, in turn, dropped out of boarding school. “I had to stop and look and begin to understand what was happening,” says Koehne. “I wasn’t the sort of parent who said, ‘You’re going to have my values or get out.’ And as soon as I tried to understand the kids, questions began to come up about myself.”18 As a result of these new forces brewing, Koehne finally quit his job at the CIA a year and a half later.

“It wasn’t right for me,” he decided. “I just couldn’t put my needs first there, not in the selfish sense but in the human one. I was putting the institution and the job first. It was a conflict of values—between the new set emerging for me and the existing set that society wants to impose.”

After leaving his job, Koehne and his wife spent ten months traveling in a camper truck, their new way of life as. yet undefined. With no demands on his time, he found at first that he missed a “sense of obligation and compulsion.” Gradually, however, he evolved a plan to establish a “growth center” based on the principles of yoga. After starting such a center in northern California, and living there for five years, John and his wife, Ana, have recently founded the Dharma Center in Virginia.

How well such middle-aged dropouts fare when they reverse gears and try to acclimate themselves to a totally new way of life varies greatly. In some cases the experiment fails, and a man eventually returns to his old patterns, dejected and disappointed. In other cases the man who makes radical alterations achieves genuine satisfaction and happiness.

Why the difference? Why do some men sink when they make multiple life changes, while others triumph? Most social scientists agree that a man’s capacity for coping with dramatic change depends in part on factors related to his past history, ego strength, and flexibility. It also depends on how realistically he has chosen, in terms of expectations as well as self-awareness.

“When a man in his middle years starts asking, ‘Can I really be that other person I always thought I could?’” says Dr. Lawrence J. Hatterer, a Manhattan psychiatrist, “some men just grab life by the balls and say, ‘Of course! Why not?’ They are the ones who have the vigor and confidence and aggressivety to start entirely new lives for themselves. But as a rule, if a man tries to change his love life and his work life and his home life and his money life—if he zonks himself with all those at once—let’s face it, he’s got to go under. Often it’s the less mature or less aware person who thinks he’s capable of altering all these things suddenly.”

Dr. Harry Levinson warns that it is naive for a man to think he can change himself into anything he wants, or literally start over from scratch at mid-life. “We cannot disregard our life history as if it didn’t exist,” he cautions. “Mid-life changes are outgrowths of what a man has always been. They are new directions.” An excessively optimistic view of how much a man can change his life reflects an element of irrationality, which in turn usually veils excessive discontent with himself, says Levinson. A man will then seek to change his circumstances compulsively as part of a frantic effort to like himself better.

Thus when a man in his middle years decides to burst constraining bonds for the sake of a dream, the decisive issue is self-awareness: Whether or not he dares confront himself honestly and discard illusions about who he is. The man who runs away to avoid this self-confrontation will discover that his geographical move is but a mirage.

*55\93\2*

Today there is a new marital scenario that centers on women who feel less than whole, women who are discovering that they too want something “more.” Influenced by the feminist movement, women are becoming increasingly assertive, and their demands are causing additional problems for the American male at a time when he may feel that coping with his own mid-life turmoil is quite enough.

Today women are insisting on having their needs and desires satisfied in totally new ways, and they arc doing so in unprecedented numbers, with unprecedented force. Even in their forties women arc throwing down the gauntlet. They are saying, “Don’t put me down” or “Stop criticizing me” or “Don’t treat me like a child.” They are insisting that their men be more passionate lovers, more affectionate mates, more giving fathers. They are pushing them into marital or psychiatric counseling, marching them to sex clinics, and pursuing extramarital affairs for their own pleasure. They are forcing their husbands to grow emotionally—or else.

Today women arc leaving home to travel, lecture, attend conventions, find a job, resume their education—or enjoy time alone. They arc asking for separations to “do their own thing.” They are initiating divorces because they are unhappy, or want their freedom, or simply no longer wish to be married. And they arc doing so without another man waiting in the wings, and despite their inexperience as wage earners. Some women are giving their husbands custody of the children. Other women are leaving their families to join the swelling tide of “runaway wives.”

Today women are risking themselves and their marriages for what they want, and their grown-up growth spurts are challenging many an astonished husband. The first dislocation that seems to threaten the male often occurs when a woman moves into the world of work, no matter how slight her first step. Though a husband may couch his objections in reasonable terms, his opposition may actually be quite arbitrary.

“A lot of guys resent losing the service,” observes Dr. Ian Alger. “They are so tyrannical and used to being served that they hate making it possible for somebody else to live a little more fully.”

Or a man may be afraid that once his wife enters the larger world, a whole Pandora’s box will burst open and she’ll go wild sexually. Alger tells of a professor who sought therapy because he felt anxious about his wife’s returning to school. Since she was meeting more people and forming new friendships, he was convinced she would soon start having affairs—and he would lose her. But after he worked through his own insecurity, the marriage actually improved. “When he stopped pressing her and just let her be as free as she wanted, she felt much closer to him,” says Alger.

Many comparable situations are not resolved as happily. The issue of a woman’s infidelity is still an inflammatory one for men who have the “good girl/bad girl” syndrome embedded in their psyche. Determined that their wife be forever monogamous, they become outraged if she is not. When a man’s sense of being violated is so intense that he is unable to surmount his anger, a woman’s infidelity can become the trigger event that destroys the marriage. As an example, Beth and Ernie are divorcing after sixteen years of marriage primarily because of his horrid reaction to her brief affair. Beth describes what happened:

Ernie was from a lower-middle-class Jewish family, and became an executive who moved up very fast—and that kind of scared him. He was vice president of one of the largest furniture companies in the country. But he was so intent on earning money and being successful that he would just come home and collapse. There was nothing left.

I’ve never had a career, but I was always doing something. T worked in an office, and a nursery school, and I studied dancing and singing and acting. I was constantly going to classes. Gradually the marriage bit got very boring, and I was very unhappy. Our sexual relationship had been pretty good when we first got married, but then life got to be such a bore that the sex wasn’t very exciting.

I had an old boyfriend who kept reappearing in my life, and I finally decided to have an affair with him. I had fantasized this mad, passionate affair and built up a big thing in my mind. And then T saw him twice—and I was sorry I had bothered with it. What I wanted was some intellectual companionship and a change from a boring marriage, but that wasn’t it—and I didn’t pursue it.

But I told Ernie about it. Kind of as a danger signal. “Look at what’s happening!” It shook him up tremendously, and that is what started the ball rolling.

Within a month—although I didn’t find out about it until later—he started sleeping with a young hat-check girl. That summer I went to Spain to study dancing for a few weeks, and when he came to meet me I barely recognized him. He had gained forty-two pounds, and he was very distressed and upset. He told me about this girl, and said he was going to leave me. That it was all over! And I was just in a state of shock. We spent a month together in Europe, but it was really bad. He was drinking most of the time, and I just couldn’t respond to him. We had no sex at all during that time.

Anyway, when we got home I became very sick. I got a period that didn’t go away and an inflamed ovary, and I was bedridden. He stayed with me for about seven weeks, and it was terrible. We hardly spoke, and he was running back and forth between me and this girl. And I was bleeding all the time, and terrified.

He said to me, “I’ll never love anyone the way I love you. But I can’t go on in a marriage where I’m constantly worrying that you’re going to find someone else and run off.” And I said, “Ernie, I’ll never forgive you if you leave me like this. I love you and I care about you—but that will be a breach that can never be repaired.”

But he said he couldn’t help it. He was so insecure about me that when I had first told him about having the affair, he had said he was going to kill himself. Imagine—because I slept with somebody twice! I don’t believe for a minute that he really meant it, but he just couldn’t deal with the whole issue. He couldn’t cope with it.

I think he had arrived at a point in his life where he had to take care of himself—no matter what was happening to me. He just had to get away for his own survival. He was at a stage where he suddenly didn’t know what was happening anymore. He was re-evaluating.

And of course I couldn’t understand it then, and I still react to it emotionally.

We’ve been separated for six months now, and Ernie comes to see me and our daughter once or twice a week. He cries, and tells me that he’s a fat old man. Old—at thirty-nine! But he won’t really talk to me. He says his life is miserable, that he’s sick, he can’t sleep. He’s not concentrating on his work the way he should, and his business is suffering tremendously. He’s totally disoriented.

All he says is that he wants to live peacefully, and he doesn’t want any pressure. So after we get divorced, he’ll probably get married again and live a quiet kind of life. But I don’t have very much hope for him in the sense that he’s going to open up. Or change.

Ernie’s reaction is not unique. All hell is likely to break loose because of a woman’s infidelity when a man has not yet matured emotionally. Stuck in old insecurities, Ernie was so tightly controlled, his feelings so deeply suppressed, that he couldn’t even express his rage appropriately. Terrified of facing painful emotions, or engaging in open conflict, he simply withdrew from the relationship. In turn, despite his having found a new girlfriend, he became increasingly despondent, developed physical symptoms, and finally sunk into a kind of muted despair.

Now on the verge of divorce at forty, Peter K. tells an even more melodramatic tale of a break-up caused by a husband’s inability to forgive his wife’s adultery. Unlike Ernie, Peter handled repressed feelings by exploding. Equally damaging and equally immature, his style was to rage, shout, and bully like a self-indulgent child. The trouble began shortly after he and his wife moved to Darien, Connecticut, having been married thirteen years. Tt was a big jump for them. Peter had just been promoted to sales manager for a chemical company; and Jill, who had done some art work earlier, was now in search of a career. She began designing desk accessories and trying to sell them, an effort that upset him:

She was calling up people for help—always men. And her work was thrusting her into the creative world of New York City, into a man’s world. I’m just a pragmatic businessman, and I always had a strong insecurity that I wasn’t the artistic, creative type I thought she preferred. I really felt threatened.

Several months later, Peter discovered that Jill was having an affair. His fury and condemnation set them both on an increasingly destructive course, as he explains:

I caught her in some outright lies—and she’s not a very good liar. When I stepped on her and sort of browbeat her, she finally admitted she’d been seeing someone, and that she was in love with him. I got very upset but reacted fairly normally by saying, “Bullshit! You’re not going to see him anymore. You’re going to cut it out!” As I said I was going to be very ugly about it if it continued. I guess I was sufficiently angry to make the point, and so she said she wouldn’t see him anymore. It stopped soon after that.

During our marriage I had been Joe Straight all the way. I was satisfied with our sex life at home, and though I traveled a lot T wouldn’t go down to the bar and see what developed. It was a lot easier not to try than to risk being rejected.

Anyway, after I found out about her affair, things were very tense for about eight months, and there were a lot of recriminations. We sort of coexisted. Jill would never say she was sorry—and that really bothered me. Her explanation was that I drove her into the affair because of my insensitivity to her needs in the way I treated her. In that respect a lot of what she says is probably true, because I was very much a male chauvinist.

We probably should have gone to see someone about working on thd marriage—but we didn’t. I wish, in retrospect, that T could have been that grown-up about it. But I was very immature. I had always trusted her, and I took it very personally. T couldn’t understand how she could do it—and I was very vengeful.

Their unresolved tensions soon led to a brief separation, a tenuous reconciliation, then another separation a year later. Despite having now begun his own affair, Peter started spying on his wife and discovered that she too had a lover. “I confronted her with it and really blew my cork,” he recalls. “I said I was through and wanted a divorce.”

Their situation then became desperate. Jill went into a depression and begged Peter to come back. After another unsatisfactory reconciliation, she attempted suicide and had to be hospitalized. Though she was treated successfully with shock therapy, Peter was unable to surmount his sense of self-righteous indignation. “She went into the hospital saying / was wonderful and she was wrong,” he remarks. “But she came out as if nothing had happened, and she hadn’t done anything wrong. I was flabbergasted and became terribly antagonistic. From then on it was downhill all the way.”

During the next year they tried going to a marriage counselor, but too much damage had been done, and so they finally decided to divorce. In retrospect, Peter still cannot understand Jill’s need to grow on her own terms, unrelated to him, although he recognizes how he himself has changed:

When T look back and try to sec what happened, knowing a little bit more about myself now, T think we both satisfied some neurotic need in each other—and as long as that was in balance we could continue being “the happy couple.” T think moving to Darien and my starting to be successful upset the balance. It made Jill feel insecure and in need of a career. And I think she had the affair because I started developing some confidence in myself.

She thinks I treated her very badly, but most of it goes back to a period when I admit T was being a shit. I wasn’t doing it intentionally, but T didn’t know any better. I didn’t start to grow up until I was thirty-five. And yet I still want to be married to the person I originally married. And T still feel deep down if she could just straighten herself out we could have a great life together.

I’m just happy I found out that I was heading down the wrong path—a path of more of the same. More attempts to be successful, more competition, more anxiety. But no goals and no self-awareness. Somewhere along the line I lost a lot of my ambition. Maybe I suddenly realized that without a family, what the hell does money and position mean? I was success-oriented, but I didn’t have any goals. I still don’t, but I’m hoping to find some.

One of the things that has changed is that for the first time in my life I feel I have friends. Before I just had people I was friendly with. Now I have close relationships—male and female. And it’s a genuine interest and caring, which at this stage of my life is very important to me.

I don’t think people ever really mature until they’ve had some hard times. Now I feel as if I’ve been going through a soap opera for the last five years. And I think all the pain has caused me to grow and to change.

*40\93\2*

Despite Jung’s suggestive ideas on adult growth, he did not attract many disciples, largely because his outlook was metaphysical and spiritual rather than scientific and sexual. Instead, Erik Erikson became the most influential psychoanalytic thinker on this subject as he built on Freud’s foundations, and then forged beyond the early years to show how development proceeds throughout the entire life span. Erikson’s concepts have influenced scores of social scientists now exploring the problems of adulthood.

Perhaps the most important departure is that Erikson sees the mind in its essence as always developing, whereas Freud saw the mind as largely structured and set in childhood. This fundamental difference led Erikson to regard the life cycle as a continuing series of steps, each presenting possibilities for new growth, in contrast to Freud’s view of the adult years as a mere unfolding of events whose direction has already been determined.

Erikson took another step forward with his concept of identity, which links man’s internal psyche with the external world of culture, history, and society. And by now many of us arc familiar with this concept, and also with his formulation of the Eight Stages of Man.

Outlining these stages, he suggested that psychosocial development proceeds by critical steps, or “crises”: decisive turning points where a shift one way or another, for better or for worse, is unavoidable. Erikson underscored this aspect of a developmental crisis by assigning double terms to each life stage, thereby emphasizing the either/or nature of the outcome.

“A new life task presents a crisis whose outcome can be a successful graduation, or alternatively, an impairment of the life cycle which will aggravate future crises,” he explains. “Each crisis prepares the next, as one step leads to another; and each crisis also lays one more cornerstone for the adult personality.”

In Erikson’s scheme the first five stages correspond to Freud’s stages of psychosexual development; and the next three, it has been suggested, seem to have been inspired by Jung’s concept of individuation. During the identity crisis of adolescence, development becomes more complex than it was in childhood, says Erikson: A restructuring of all previous identifications occurs, which often means having to fight some earlier battles over again.

The complexity increases even more as a person proceeds through the adult stages of this hierarchy. Each of the next three stages adds either a “blessing” or a “curse,” says Erikson, and at the same time makes “a new ensemble” out of the preceding steps in development. When a later crisis is severe, earlier issues are likely to be revived. And despite the identity crisis having been resolved in adolescence, later resses can precipitate its renewal. The crisis of young adulthood concerns intimacy vs. isolation, and if resolved favorably results in the capacity to love. Love in its truest sense cannot evolve until this stage of life because it must be preceded by the forging of an identity, says Erikson, and it also requires a capacity for commitment. Whereas the earlier sex life was really a form of “genital combat,” intimacy can now transform that combat into closeness. In turn, this new capacity for loving sexual relations makes the need for sex less obsessive.

The crisis of the middle years, which begins around forty, centers on generativity vs. stagnation, and results in the ability to care if resolved favorably. At this stage a widening concern with the younger generation is necessary in some form if development is to continue. “Generativity” means becoming more responsible for younger adults, besides one’s own children; and it also relates to products, ideas, and works of art.

“Adult man is so constituted as to need to be needed lest the suffer the mental deformation self-absorption, in which he becomes his own infant and pet,” states Erikson. Teaching is a perfect example of generativity, he says. Teaching also illustrates the way in which the life stages interlock within a total life cycle: By lubricating the turning wheel of the generations, it benefits and connects the adult, the child, and the culture.

The eighth stage of life is the culmination of everything that has preceded. This final crisis pits ego integrity against despair, and if resolved successfully leads to wisdom. Fortified by matured judgment, the wise man is able to accept his “one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions.” Despite being well aware of varied lifestyles, he defends the dignity of his own.

“Only such integrity can balance the despair of the knowledge that a limited life is coming to a conscious conclusion, only such wholeness can transcend the petty disgust of feeling finished and passed by,” says Erikson. Because he sees the life cycle as a circular, interlocking bond between the generations, the successful resolution of this final crisis is of vital importance. Infantile trust, the first ego strength, depends on adult integrity—the last ego strength.

As they rotate, then, the generations nourish and enrich each other. Or at least they should. In fact, however, this reciprocal enrichment can exist only when a culture respects the old as much as the young.

*26\93\2*

Heart disease is the single greatest killer of Americans—and men in their middle years are especially vulnerable: One American male in five dies of a heart attack before the age of sixty.

Relatively rare in the United States until the 1920s, heart disease is a distinctly “modern” affliction that has increased dramatically in recent years. During the past two decades the coronary death rate for men has risen alarmingly. But at the same time the coronary death rate for women, much lower to begin with, declined.

Nutrition experts have virtually convinced the nation that a diet high in cholesterol is responsible for this epidemic. But now this theory has been seriously challenged by two California cardiologists, Drs. Meyer Friedman and Ray Rosenman, who have developed a revolutionary new concept which suggests that how a man lives is more important than what he eats in determining whether or not he will die of a coronary.

Until 1957 Friedman and Rosenman were conventional cardiologists studying the standard risk factors. But they have now built an impressive case for the concept that stress, personality, and behavior account for the high incidence of heart attacks among middle-aged American men.

How did this dramatic transformation in their views evolve? Puzzled by the enormous increase in heart disease in recent years, they first began to suspect that a fatty diet was not the answer when they investigated whether the relative immunity of the American woman to coronaries could be explained by dietary differences.

Although their suspicion was confirmed by cross-cultural studies showing that some groups of people who eat the most fats have little heart disease—the Irish, for example—they decided to test for themselves. Enlisting the help of a Junior League club in San Francisco, they studied what these women ate and also what their husbands ate. Their diets were essentially the same.

What then was protecting the women? these researchers wondered. For years their medical colleagues had argued, and many still do, that female sex hormones are the answer. Not so, Friedman and Rosenman found. Black women in America get even more heart attacks than their husbands. And in other countries, like Italy and Mexico, women and men are equally susceptible to heart disease.

So much for sex hormones, and fatty diets too. Since the experts had not yet come up with satisfying solutions, these Cardiologists decided to solicit other opinions. They sent a questionnaire listing ten possible causes of heart attacks to a group of businessmen and a group of physicians with coronary patients. The majority in both groups picked “excessive competition and the stress of meeting deadlines” as the primary culprits.

Coming from business types this reply didn’t seem startling, but coming from doctors it did. Since the medical literature was filled with studies implicating high-fat diets, their response was clearly at odds with most scientific investigators. And that was news.

Popular folklore had long suggested that people died of heart attacks because of too much stress and strain, but like most of the medical profession, Friedman and Rosenman had always ignored such common wisdom. Now, however, they began to take it seriously.

Aware that the pace of our lives has accelerated rapidly during the years that heart disease proliferated, they began to wonder about the impact of this new stress. Perhaps men were suffering its effects more than women because men were more regularly exposed to such pressure at work. The speculation needed to be tested.

The first indisputable evidence for their thesis that stress— more specifically, an acute sense of time urgency—plays a role in heart disease came from a study of tax accountants. Accountants were selected because the intensity of their workload varies between routine periods and times of pressure when tax deadlines must be met. In this study diet, exercise, and other factors were controlled, and cholesterol levels were measured regularly over a period of several months.

The result: As the April 15 deadline approached, there was a significant jump in cholesterol level for all these men— which fell again in subsequent months when their routine became more placid. Not every man reacted to the tension to the same extent, but the overall peaking of cholesterol level in the blood during a time of great emotional stress meant that these two factors were decisively correlated.

This was the first controlled experiment proving that the amount of cholesterol in the blood can be altered by the brain—and not just by the consumption of fat by mouth. Other researchers have since duplicated these results.

The next step was to analyze more precisely the individual differences in how people handle stress. Friedman and Rosenman developed an interview technique for behavorial typing that focuses on work and leisure habits, as well as on attitudes toward time. But it is analyzed more for the intensity and emotional overtones of the responses than for verbal answers.

These interviews led them to define two main behavior patterns, which they called Type A and Type B. (Since most people are mixtures of the two types, the interview techniques were eventually refined to include four subdivisions in each group.) They found that the Type B man, comparatively relaxed and unhurried, at ease with himself and other people, rarely suffers from heart disease before the age of sixty—regardless of whether he smokes, eats fatty foods, or fails to exercise.

By contrast, the Type A man is three times more likely to be stricken by a heart attack; and if he is under fifty, the risk is ten times greater. What is the Type A man like?

The general picture is as follows: Ambitious, competitive, and aggressive, he is involved in a continual struggle against time and/or other people. His sense of time urgency is accute. Almost always punctual, he is greatly annoyed if kept waiting. Delays in restaurants, at airports, or in traffic irritate him; and he is impatient with people who don’t come quickly to the point. He tends to talk rapidly and eat rapidly, but usually feels way behind in doing everything he thinks he should—and worries inordinately about meeting deadlines.

Not inclined to spare time for hobbies, Type A likes to do several things simultaneously (reading while eating or shaving, for example), and often engages in two lines of thought at once (polyphasic thinking). He is likely to be an inattentive listener, especially when he considers the conversation insignificant.

Type A regards his home primarily as a place to dress for work, and often his family plays only a small role in his life.

He dislikes doing chores, or getting involved in household matters, and usually goes to bed early. Getting a good night’s rest for the next day’s work interests him more than family activities, says Dr. Friedman, because, “He values achievement time—and nothing about his home is achievement.”

As part of the same pattern, he rarely takes a vacation. When he does, he is likely to combine it with business or choose a competitive activity like gambling or hunting. Seldom away from work because of sickness, he rarely goes to a doctor and almost never to a psychiatrist. He doesn’t feel he needs either.

Type A often becomes so mechanized in his responses, so obsessed by numbers, that his life becomes a race in which he is competing against time, against other people—and, ultimately, against himself.

No matter what he buys, only numbers count: how many suits, how many cars, how many cases of wine. It is the same at work: He is concerned about how many clients he has; how many insurance policies he sold; how many articles he published. Likewise during his leisure time: What matters if he travels to Europe is how many cities he visited; in tennis, how many sets he played; in hunting, the number of ducks he shot.

A sense of insecurity about himself and his status usually underlies Type A’s tendency to push and strive incessantly. Almost incapable of dealing with people except by setting up a competitive struggle, he often has difficulty in his personal relationships. But because he is always measuring his own value by the number of his achievements, and feels that others are judging him by this yardstick too, he is never content. The numbers must always rise—and when they don’t, he feels like a failure.

Despite their drive to achieve, however, Type A’s are not necessarily most successful. In fact, they often lose out to B’s for the top jobs, because the A’s are too competitive, too driven. Also, being intensely goal-directed, they are apt to be less creative than B’s. With an eye always on the clock, A’s are unwilling to consider matters they regard as time-wasting; as a result, their decisions tend to be hasty—and often mistaken in the long run.

Though Type A behavior doesn’t necessarily lead to success, it bears a startling resemblance to the American ideal, the style that ambitious parents urge upon their sons, the style that most mid-life men have been trained to emulate. Driving and agressive, the Type A man likes to get a lot of things done, all as quickly as possible. He gives the impression of iron self-control. He has machismo. He is a composite of many of our society’s most admired male traits.

The tragedy is that Type A behavior is also lethal: This living embodiment of masculine ideals is the typical coronary candidate.

Although many questions about coronary fatalities remain unanswered, Friedman and Rosenman have clearly documented that Type A behavior by itself generates certain biochemical changes that cause heart disease: Blood cholesterol rises, adrenalinelike substances flood the body, and the normal reserve of life-sustaining hormones is depleted.

Their statistics are coldly convincing because in addition to studying the personalities of coronary victims, they have also studied a large group of healthy men—and successfully predicted which ones would have heart attacks.

Begun in 1960, this study involves 3,500 men, aged 35 to 59, with no known history of heart disease when the program began. They were interviewed and classified according to behavior type, as well as all other standard risk factors. Regardless of whether these men smoked or not, had high blood pressure or not, or exercised or not, those who got heart attacks ten years later were overwhelmingly Type A’s. (By 1970, 257 men had been stricken—70 per cent of them A’s. And among the younger men 39 to 49, the figure is even higher: Seventy-nine per cent have been A’s.)

About half of all American males are confirmed Type A’s, say Friedman and Rosenman, compared to relatively few females. But as women become more aggressive, and move into the marketplace on higher levels, they expect this to change—and the heart attack rate to rise. (Heart disease rose sharply among Japanese women after World War II, when they were liberated from wholly domestic duties.) The Type A pattern is common among hard-driving executives, but it also occurs in many other occupations—everything from factory workers to truck drivers to psychiatrists.

Says Rosenman about this Type A condition: “It is a sickness, although it is not yet recognized as such.”

*11\93\2*