Life Transitions During a Psychiatry Career
Request for Advice
“Jack, I read your advice earlier this year to the retired psychiatrist. I found it helpful. I myself would like to get some of your ideas to make use of in my life. I’m in a very different point in my life and career than the 70+ year old psychiatrist.
I’m a 44 year old man and have my own psychiatric practice. It is thriving. I like seeing patients and I like building the practice. I think I’m good at both. Life at home is good today. I’m married to another psychiatrist – she works at our county mental health clinic – and we have two middle school kids. We both work partially from our home offices these days since we do telepsych.
So far so good. I’m writing because in the last year or so I’ve been questioning myself and the choices that I made. Something about me – I’ve always been a go-getter. My parents guided me to always work hard, to be my best, to feel pride in being really good at what I do. As an adult, I’ve lived by these values and they worked. But now I find it harder to focus on my patients, on the other clinicians in the practice, or on building the practice or even making sure it runs well. Somehow the thrill is gone. I feel guilty that I’m feeling this way when in so many ways my life is so great. I mean what’s missing? How do I get out of this rut?
Thanks for writing. Let me respond in three related ways. That’s just how my response evolved in my mind.
I believe we are creatures who evolved to strive and struggle, to overcome and master. These are not the only features of our nature, and they differ in degree among individuals, but they are an important part of core selves, nonetheless. We often feel most alive, engaged, and happy (in a sweaty kind of way) when we strive to achieve a goal. The path of working hard, figuring things out, becoming more skilled and resilient, pushing past what feels comfortable, achieving milestones on the way and the final goal at the end, turns out in hindsight to have been more of the goal than the putatively desired outcome we sought in the first place. Once success or victory is achieved, however, it can only be savored for so long. It’s not the dwelling in achievement that is the driving force. It’s the struggle, the ‘game,’ of getting there.
Note that the words strive, stride, strife, and straddle (a horse) all have the same Germanic root with the various meanings circling around fighting, contending, disputing, making a strong effort, making one’s way, and taking long steps forward.
So, now that you have achieved all that you worked so hard to achieve, you are done resting. It seems it’s your nature to set off on new adventures. Let me pause here to clarify two things.
First, just because you are looking for your next challenge in no way means that you should discount what you have achieved. You have a wonderful foundation of a good life. You should celebrate both the work of achievement and what you have achieved, topmost is having a wonderful family. Because you need to continue your path forward does not mean that what you have is unimportant or lacking in preciousness. I think it important that you pause and in some way celebrate all that you have, whether achieved through your efforts or not. Hold a celebration with your family, and also with your colleagues and employees. It sounds like many people have benefited from your success just as you have benefited from others’ successes. All can celebrate together.
Second, when I wrote that you’re ready for a new adventure, does not mean that this >adventure< will be something frivolous. It certainly can be – there are plenty of stories of middle-aged men buying fancy
sportscars and such – but it need not be. In fact, you now face a time of discernment: what will you devote your considerable intellect and energies to? The goal is to choose wisely, in ways that align with your core values and life goals.
Before I move on to the second part of my response, I want to address the issue of ‘over-striving’ or striving for the sake of striving. Many people who are restless in place and always on to something else, end up exhausting themselves and becoming captive to their incessant striving. Striving, struggling, achieving are a good but in moderation.
Therefore, I advise you explore mindfully inhabiting (at rest and without forward movement) the present moment and finding the riches found therein. Mindfulness and meditation practices provide respite, balance, and a sense of appreciation to strong strivers. It can lead to a greater chance of choosing wisely and controlling what can often be ceaseless and directionless movement.
You’re Entering a New Life Stage
Another relevant lens is the concept of life stages. Consider Erikson’s approach. It sounds like you are entering the life stage of generativity vs. stagnation. In fact, a growing sense of stagnation is where you find yourself. This is not a failure nor a setback. Rather this sense of stagnation is the impetus to engage with and latch onto a generative pathway. Psychologically, you are poised for success for the coming stage because you have successfully completed the life stage that has now come to a close, that of intimacy vs. isolation.
What does generativity entail? It means decentering yourself and developing goals for the good of others. You have done this in spades already, I’m sure. But now, from your base of security and ample resources, a focus on community and care for others comes to the fore. I’m sure you already engage in plenty of selfless acts, but now they will play an even larger role. I’m also sure that are plenty of ideas, plans even, you already have in mind in pursuing such generative goals.
Given what I know and guess about you, I’d advise thinking big. Why not? The worst you can do is fail and then try again. However, you’re more likely to partially succeed and then work to improve your project with each stride forward.
You’re on the Verge of Eying Your Ultimate Concerns
A third lens through which to view your point in life is that of ultimate concerns. It is not by accident that it is just at about this time in your life that you face this particular challenge. Based on male life expectancy in the US, you are just over the midpoint of your life. You likely are aware of this and this realization makes you both uncomfortable and disposed to confront the fact of your mortality. Such a focus is welcome. It is good and a blessing. Death comes whether you consider it or not. When you dwell in this fact of bounded time, it affords an opportunity to discern, to separate the wheat from the chaff, the valuable from the less value, the life-affirming from the life-draining.
I need not say more here. I have engaged with you and not shied away from the promises and challenges of middle age. I will just once again emphasize: pause, dwell in contemplation, discern, decide with intention, and move forward resolutely.
Jack Krasuski, MD
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