Life Transitions During a Psychiatrist’s Retirement
Request for Advice
Request for Advice: “Jack, I’m writing because I ran across one of your Life Briefs from some time back. In it you wrote that you welcome questions and requests for advice. I found this just as I’ve been struggling finding a place for myself in my life. I’ve faced a series of losses and am trying to figure out what to do with my life, or rather, how to live the rest of my life. Here’s my story. Respond in whichever way you think makes sense.
I’m a 78 y/o man, retired and widowed. I had a fulltime practice until I was 70 and then cut back to parttime work until I closed down my practice completely when I was 73. I would have wanted to keep working, at least a little bit, but my wife’s health was poor, and I was her main caretaker. I found I couldn’t leave her alone for the number of hours I needed to go to my office and see patients. She died three years ago. At first, I was coping well. I mean I missed her greatly but that was just normal grieving. I found ways of keeping busy and started taking online courses. Most recently I started a course on the German philosopher Hegel.
And this is where I realized I had a problem and it hit me hard. I know Hegel is hard for everyone, but I just couldn’t keep up. The readings didn’t make much sense to me and I couldn’t even pay attention. Then after about 3 weeks, I just felt this was hopeless and pointless and I stopped attending. But now I feel lost. I now realize how much my cognition has declined. It’s easy to miss when you’re just puttering around.
I know not keeping up with Hegel is not the end of the world. But for me it represents a frightening new reality. I am developing dementia. I live alone. I have 3 kids spread across the country and 7 grandkids. But no one lives near me. I worry about my future and at the same time have nothing to sustain me day to day. Also, I’m an atheist which is probably relevant for you to know. So, what are some thoughts you could share with me. Thanks for your missives and I look forward to your response.”
Dear anonymous. Thanks for writing and sharing as openly as you did. Since there is so much about you I don’t know, take my thoughts as what they are: thoughts based mostly on what I imagine about your life. If some make sense, great. Ignore the rest. Let’s start.
The Seasons of a Good Life
You find yourself at the end of one way of life and facing a new way. This change of “life chapter” is not something you chose and, if you could, you would probably prefer to maintain your previous way of life. You face loss in what is passing away and trepidation in what is emerging.
You mention Hegel, a truly daunting writer and thinker. From this, I surmise you are philosophically-minded. One central concept especially relevant to you at this stage in life is one that many philosophers have explored. It is the nature of “the good life.” Aristotle described what he called eudaimonia, which we translate as happiness. This translation is a mistranslation. Eudaimonia is not about happiness or pleasure or ease. It is literally living in the realm of the good spirit. Aristotle described eudaimonia as the highest human good, the only one that is not a means to an end but rather an end in itself. Aristotle believed that every human and every thing has a characteristic and essential function. The highest good is achieved when a human or thing performs its essential function well. The qualities the human or thing has that allow it to perform that central function well are its virtues or excellences. The essential function of humans is, according to Aristotle, reason. Thus, the highest human good is rational activity performed virtuously or excellently.
Thus, the good life is available to anyone at any stage in life. Paradoxically, the good life is perhaps most available when a person faces life-altering challenges. It is then that approaching those challenges with thought and wisdom and courage are most determinative to achieving the good life.
You are now reaching, or have already reached, the last stage of your life. You will undoubtedly face declining health, perhaps including declining cognition. And there is no escape. At the end of this stage death awaits. But between now and then you are free, free to comport yourself with thought, wisdom, and courage. You are free to face these challenges, deploying all your qualities and abilities, to live excellently. This means, I think, to do what needs to be done. I don’t know what needs to be done in your life, but I will guess and write about them in the sections below.
Grieve and Come to Terms
We humans are temporally-situated beings. We have the capacity to travel through time in our thoughts and imaginings. We remember what once was and we imagine what may come to be. When life changes, it can help to – with intention – come to terms with what is now receding into the past, what is already lost, and what will still be lost in the future. It often helps to face these losses head on, to grieve, to engage in rituals and writing and speaking with trusted others to make sense of it all. It often helps to feel the weight of the sadness, cry, accept and acknowledge, all in the service of being whole; not distracting, pretending, getting lost in wishing it was otherwise.
This last stage in life for many is the hardest one. But it is also, being the last stage, most indicative of the way one has lived one’s life, what one has ultimately achieved, and how one is remembered.
Do What Must Still Be Done
Even though you may no longer be able to engage with Hegel’s thought, you probably remain more than able to think about ultimate concerns. You didn’t mention if you write regularly. If not, you can start.
On one track you can write about your current life journey. This will help clarify and deepen your experience of undergoing these life changes. You can perhaps distill some life lessons and write a Legacy Letter to your kids and grandkids, something they can refer to and remember you by. You can even record a Legacy Video for them. On another track you can explore the meaning of the Good Life and what it means to you in this stage in your life.
One thing struck me about you wrote: you say you are developing dementia but you didn’t mention receiving a medical evaluation. First, it may not be dementia at all. It may be a variant of normal aging or a manifestation of an underlying medical condition. And if dementia is confirmed, an etiology must be established. Not all causes of dementia are incurable and not all are progressive. If you haven’t been evaluated, then man up and get it done. A tragedy is not when a bad thing happens; it is when an avoidable bad thing happens. It would be a tragedy if your cognition continued to decline from a treatable cause, like a subdural hematoma. And, yes, I have had patients with this very cause of their cognitive decline, one that was successful treated.
Another issue that raised a feeling of worry in me about you is that you seem isolated. You have kids and grandkids. They all live distantly from you. It would not be unusual if you – or anyone facing what you’re facing – to be reticent in sharing your challenges with your family: “Why bother the kids? They have their own lives to live,” is a not uncommon response. If this is indeed the case for you, then I here challenge you: do engage with your family. Do travel to visit each of your kids. Do not fear imposing on them. Share with them what is going on. Let them be with you during this stage of your life. This may be the most important gift you give them. It may be the most important gift you give yourself, the gift of the good life, lived excellently.
Jack Krasuski, MD
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