Midlife crisis

DEFINITION: The emotional, psychological, physical, spiritual, and relationship crises that arise during the transition from early to later adulthood.

ANATOMY OR SYSTEM AFFECTED: Psychic-emotional system

Causes and Symptoms

Before the nature of the midlife crisis can be explored, it is first helpful to identify what is meant by “midlife.” As the average life expectancy has changed throughout history, so has the period termed midlife. For example, according to the US Centers for Disease Control and Prevention (CDC), the human life expectancy at birth in the United States had risen to 77.5 years of age in 2022. The World Health Organization reported that this statistic had also increased globally, with healthy life expectancy at birth estimated to be 61.9 years in 2021. These figures are more than twice as long as the average life expectancy during the time of the Massachusetts Bay Colony and more than three and a half times as long as someone in ancient Greece could have expected to live.

Life expectancy changes as it is influenced by any number of factors, including nutrition, health care and prevention, stress and lifestyle issues, historical period, culture, race, individual variability, gender, and social context. Consequently, there is no precise age at which midlife commences. It is also difficult to state unequivocally when the possibility of a midlife crisis ends. Nevertheless, some developmental theorists, such as D. J. Levinson, have suggested the period from forty to forty-five is the time of the midlife transition where “crisis” may occur. Others have indicated that this time period may last until the age of fifty-three. However, this also varies widely depending upon factors such as gender, social context, culture, and race.

Other researchers, Carol Gilligan among them, have engaged in a critique of the assumptions underlying previous comments on midlife crises and theories of how human beings develop, pointing out how this research may be based on outdated and/or incomplete studies of human development and experience. Gilligan’s line of research demonstrates, for example, how it may be that women have an experience of the aging process that is different from the one commonly experienced by men. As a result, the process of normal adult development and the nature of this crisis remained unclear.

Midlife crisis experiences seem to arise in response to a variety of precipitating factors, including both normal developmental changes and severe or numerous stressors. This variability raises another interesting challenge to the notion of a midlife crisis. Is the experience of a midlife crisis a predictable event or an aberration? Some experts claim that the belief in a “midlife crisis” is one of the many myths about the aging process.

Some argue that many adults do not experience an unusually severe crisis at midlife but, instead, that midlife may be a tremendous period of growth. Others suggest that those who do experience a significant midlife crisis tend to have suffered similar crises throughout their adulthood. The stress involved in the transitions in midlife may be similar to, and not necessarily occurring more frequently than, those experienced by the same individual in any stage of life. If so, the adjective “midlife,” as indicative of a qualitatively or quantitatively different kind of crisis, may be misleading.

On the other hand, some clinical studies have revealed that the male population in midlife has a significant increase in mental health problems, including depression, alcoholism, and suicide. In fact, most studies of adulthood have displayed something atypical among middle-aged men, whether dramatic or subtle. In addition, discussions around midlife changes for women have increased.

Caution is necessary when making general statements about a phenomenon, such as midlife crisis, but it is assumed that midlife crises, however varied in form, intensity, or duration, do commonly occur. In addition, they are best understood from a holistic and contextual perspective on the individual’s life.

A developmental framework that describes the cycle that an individual experiences in life further clarifies an understanding of midlife crises. The life changes of an individual may be seen as summative and consecutive. During this life cycle, one stage, with its tasks and crises, is lived and resolved before another is reached. Erik Erikson developed one framework for understanding the individual life cycle and its tasks, crises, and stages. Life crises are attributable in large part to the stress of transitioning from one part of life to another. The stage relevant to a discussion of midlife crises is termed generativity versus stagnation; in other words, midlife is the period of time during which individuals strive to come to terms with whether they are and may continue to be productive or whether they will stagnate.

Development is also a physical experience. Therefore, an individual’s psychological and emotional responses are influenced by changing physiology and health. One common midlife example in women is menopause and its attendant hormonal changes. At few other times in a woman’s life is there such a complex interaction between physical and psychological factors. Along with the physical stresses brought about by hormonal changes, the psychological and emotional reactions of each woman to this normal transition vary depending on her lifestyle, attitudes, self-image, and network of supportive relationships. This type of experience may contribute to crises in midlife.

In addition to the impact of changing physiology, the experience of midlife is emotional, cognitive, and spiritual. Midlife crises may be precipitated by an individual’s reflection on or reevaluation of the meaning of life. Similarly, midlife may be a time during which people begin or intensify the process of spiritual evaluation and reckoning. It is a time during which people take stock of their lives and come to grips with their mortality.

A decline or change in physical functioning may trigger thoughts about mortality and death. A frequent phenomenon is evident in the change of one’s perspective on time, from a focus on “time since birth” to one on “time left to live.” Self-assessment may lead to greater emphasis on long-neglected aspects of the self or relationships with others.

All these issues are known as developmental issues or stressors, which are more or less predictable in life according to the person’s stage of development. Situational stressors also contribute to the development of life crises. Situational stressors include such things as unexpected illness or injury, unemployment, and war—all things which are not necessarily related to the person’s chronological age or development through time. Consequently, it is reasonable to conclude that these factors may be potent in midlife as well.

Typically, individuals live not in isolation from one another but within the context of relationships. The most common network of relationships is the family. A discussion of issues that have biological, emotional, psychological, and social components, therefore, must include an examination of what is happening with other family members and the family as a group. These factors, including what is termed the family life cycle, may influence the development or severity of the subjective experience of midlife crisis. In fact, the crises of midlife often arise from the interaction between individual and family factors.

Those experiencing midlife crisis are usually members of what has become known as the “sandwich generation”—a generation sandwiched between, and with the responsibility for taking care of, those in two others. For example, a middle-aged woman may have responsibilities with aging parents on one hand and with an adolescent child on the other. The coincidence of adolescence with her child's focus on the development of an identity and their constant evaluation of their own and their parents’ values, beliefs, and behaviors may only exacerbate a similar search for meaning. She also may be reevaluating her accomplishments and striving to do more of what she believes has been meaningful so far in life. In contrast, the older generation may be struggling to find some sense of integrity about a life ending. Each individual in the family becomes a point of contact, contrast, or conflict with the other.

The various manifestations of a midlife crisis are much like the symptoms exhibited by people in response to stress. The symptoms include an anxious or depressed mood, loss of interest in normal activities, an intensified reevaluation of life (both past and future), sudden changes in relationships, difficulty with organic processes (such as sleeping, eating, and concentration), and a subjective feeling of the need for a change. Extreme reactions may be a function of the psychology and emotional makeup of a particular individual in the context of their life. In addition, people who have less social support or who are living a lifestyle that they have long been aware was unfulfilling are more likely to experience a more significant crisis.

The COVID-19 pandemic that began in 2020 is believed to have negatively impacted the onset and severity of midlife crises. A study conducted by the Brookings Institution in 2020 surveyed well-being across various age groups and found that life satisfaction and overall well-being dips between the ages of fifty and sixty—something the study calls "the mid-life dip." The study then further examined this midlife dip and concluded that the midlife dip in life satisfaction is associated with higher levels of depression, trouble sleeping, and suicide. The study argued that the pressures of COVID-19 further exacerbated these issues and worsened the difficulties associated with midlife crises. Furthermore, a 2021 study published in the American Journal of Preventative Medicine found that instances of high-risk drinking increased among middle-aged adults in the United Kingdom during the COVID-19 pandemic by 5.2 percent and that instances of drinking more than four times a week among the same population doubled from 12.5 to 24.6 percent. The study concluded that this increase in high-risk drinking was a direct result of the stressors related to the COVID-19 pandemic and called for closer monitoring and observation of how this added stress negatively impacts other areas of life. As midlife crises and the COVID-19 pandemic both touch on mortality issues, it is easy to understand choosing this coping behavior.

Not only do people and family groups vary in their reactions to midlife stress, but different ethnic and cultural groups do as well. The meaning associated with life events is generated within the context of these various social groups. Each social group develops its own culture with its own rules and regulations regarding how to respond or behave. In other words, individuals understand and respond to stressors as they do because of their experience within larger social groups. As a result, within the context of a particular culture, dramatic lifestyle changes are predicted, explained, and possibly even supported. It must be understood, however, that not all the changes that occur are pathological; in fact, some may be signs of new and important growth.

In summary, midlife crises are those crises that may arise during the developmental stage associated with midlife. Like crises or other stress reactions, midlife crises vary in timing, intensity, duration, and character from one person, family, and social group to another. Crises in midlife seem to be no more frequent than crises at other stages of development.

Treatment and Therapy

Medical science has contributed to the understanding of the concept of midlife crisis through research, theory building, and the development and testing of treatment strategies, including the use of medication and psychotherapeutic techniques. Yet, there are no specific treatments for a midlife crisis or any other kind of crisis because the needs of the individual and the family group vary considerably. The range of possible treatments or clinical applications of medical science to this area are largely in the form of supporting the preexisting resources and coping skills of the individual and their family and other social support systems.

As with other life skills, an individual’s ability to cope with and manage crises depends on the nature of one’s character and personality, past experiences in managing crises, and degree of social support. The more well-developed the person’s character and coping mechanisms, the more numerous their experiences in successfully resolving past crises, and the greater amount of perceived support from family and friends, the more likely they will be able to resolve conflicts and crises in the present and future successfully.

Since midlife crises can differ from those in other stages because of the particular tasks to be negotiated at this stage, resolution may involve the need to address certain tasks constructively. An individual may be called on to reevaluate or reassess their life, putting into perspective what is hoped for relative to what has transpired. An individual struggling with crises associated with midlife should be encouraged to explore the contributing situational and developmental issues openly. This process may involve cognitive reevaluation, working through feelings, or spiritual and existential reassessment.

Professionals have often suggested that several tasks must be addressed to facilitate the successful resolution of a midlife crisis. The individual must reckon with their own mortality, go through a process of self-assessment, and gain perspective on their .generativity. Self-assessment involves taking stock and putting life into perspective. Life’s polarities and contradictions must be examined and resolved in some manner.

One central polarity involves gender roles. The traditional, socially constructed differences between people of different genders often break down during the period of midlife. This process is facilitated by the life review accompanying a midlife crisis. For example, a woman may decide that she has devoted much of her life to the care and nurture of others while putting her own needs second. As a result, she may attempt to remedy the situation by developing the more stereotypical male characteristics of being assertive and goal-directed. Similarly, a male may turn away from his career as the primary source of self-esteem and gratification to develop richer interpersonal relationships. It is critical to note, however, that these situations refer to traditional gender roles that have evolved throughout the twenty-first century, and a male who has been a caregiver and a woman who has focused on her career can also experience midlife change by exploring new experiences and roles.

Clinical and research evidence demonstrates a solid link between life crisis and disease onset. Consequently, medical health professionals may be called on to assist individuals struggling with the effects of a midlife crisis. These professionals, as well as other concerned individuals, may intervene in a variety of ways.

In a preventive fashion, helpers may offer what is termed "anticipatory guidance" to the individual approaching midlife transitions. In other words, conversations can include predictive or educative content orienting the person toward what to expect as they approach or anticipate these changes. Individuals in the midst of midlife review and crisis may also need assistance, support, and/or direction in resolving generativity issues. The individual needs to resolve how they will make a significant contribution to others rather than stagnate and become increasingly self-absorbed. The accomplishment of these tasks may involve repercussions in work, family, and social relationships.

Sometimes physicians are called on to treat individuals exhibiting physical and/or psychological symptoms related to midlife crises. Antidepressant and antianxiety medications are very effective with some conditions, including those in which the symptoms are impairing the person’s ability to function over an extended period.

Various forms of assistance also may be offered through informal conversation, in an office visit for brief counseling, or within the process of psychotherapy for a longer-term approach. Regardless of the context, however, being able to anticipate or come to grips with the issues involved helps individuals to feel less out of control and to believe that the problems are being handled constructively.

Family and social support are very helpful in times of crisis. The degree to which these relationship contexts are flexible and supportive can either exacerbate problems or ameliorate struggles. A balance between permission and validation, with encouragement for the individual to continue managing daily functioning and obligations, is important. In the absence of an individual’s ability to negotiate and resolve successfully the conflicts associated with the crisis, and perhaps without the presence of a supportive network of family and friends, individual and/or family therapy or a support group may be of help. These modes of therapy and support provide helpful perspective, normalization of the experience, and training or advice regarding constructive problem-solving and conflict-resolution techniques.

Perspective and Prospects

In many areas of medical science pertaining to human behavior and emotional experience, important ideas from different theories are often integrated to yield a more comprehensive understanding. Congruently, several theoretical frameworks shape approaches to and perspectives on the understanding of midlife crises. Evolutionary theory, human growth and development, sociocultural theories, theories about the life cycle, behavior theory, family systems theory, learning theory, and theories of stress and coping all contribute to this understanding.

The theory of evolution proposed by Charles Darwin provides the understanding of human beings as living interdependently, as well as adapting to their changing environment. The development of effective coping strategies ensures survival and promotes human community. Midlife crises present the individual and their social context with an opportunity for testing the effectiveness of these strategies.

The work of psychologist Abraham Maslow emphasized the tendency of human beings to strive toward the maintenance of life and the promotion of growth. An individual negotiating transitions in life taps into this growth motivation to maximize and enrich personal experience. In the midst of a crisis, basic necessities of life are the first priority. Once the fundamental needs for food, shelter, and physical survival are satisfied, an individual will strive toward fulfilling what Maslow termed higher-level goals, such as emotional security and spiritual enlightenment.

According to Rudolf H. Moos, crisis theory deals with the impact of disruptions on established patterns of personal and social identity. This framework suggests that, in addition to seeking to maximize human growth and potential, each individual first struggles to maintain a state of social and psychological equilibrium. In a crisis, the midlife adult will seek homeostasis or balance prior to exploring opportunities for productive change. Thus, the similarity between crisis theory and theories of human growth and development may be apparent. The crises involved in midlife are more often related to the higher-level goals defined within each of these frameworks.

The stage or developmental theories described previously provide a framework within which to understand some of these transitions and the emotional, psychological, and physical changes that are involved. In addition, the perspective of the individual as developing, growing, evolving, and coping within the context of a family system enriches the view of midlife crisis. Further sociocultural theories help one to see how individuals within specific cultures may or may not view change at midlife as a crisis. Change is relative with regard to cultural mores. For instance, to the extent that individuals within a culture have a history of having one job or one spouse, or one home throughout a lifetime, changes brought on by any number of factors that might change this could be viewed as a crisis. In other cultures, where such change is more the norm, such events may be seen not as crisis-related but more in accord with what is viewed as normal. In this way, the experience of midlife crises may be saying as much about a culture as it does about individuals within that culture.

The resulting context for an understanding of midlife crisis, then, is one of an integration of ideas and theories. This integration supports an understanding of midlife crisis as a product of normative development and transitions in life. An individual’s reaction to the required transitions depends on their personal characteristics, coping skills, family and social relationships, aspects of the transition or crisis itself, and other features of the physical and social environments.

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