How to Cope with a Later-Life Crisis

Coping with Loss

How to Cope with a Later-Life Crisis | Johns Hopkins Medicine

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You’ve just left a great retirement party and can sleep in for the firsttime in 40 years.

Or maybe you just sold your house for an empty-nester’sdream condo.

So why are you feeling so down? While we expect to feel asense of loss from such events as divorce and illness, any major changemeans saying good-bye to something that’s been part of your life for a longtime.

“While you may describe certain life events as changes, what you are reallydealing with here is loss,” explains Michelle Carlstrom, LCSW-C, seniordirector at the Office of Work, Life and Engagement at Johns Hopkins. “Aswe get into the final chapters of our lives, experiencing loss becomes afrequent reality.”

While loss and grief can occur at any age, at midlife and beyond you mayfind yourself facing more changes with more finality—from leavingemployment to attending funerals, from having an empty nest to just longingfor your youth. But certain steps can help you cope healthfully, Carlstromsays.

Don’t fake a smile

If you are having trouble coping with a big change in your life, don’tisolate yourself and pretend everything is OK. Pushing those feelings asideis not only ineffective, it will set you up for a lot of heartache.

“Majorlife changes, even if they are for the best, can still leave a hole in yourheart,” warns Carlstrom. “You may feel you could go shopping or drinkaway the pain, but at the end of the day, it doesn’t fill up that hole.

Grieve what you have lost

“Although people in our culture are uncomfortable with conversations aboutgrief, you have to acknowledge and grieve your losses,” says Carlstrom.

Think back to your very first encounter with loss—how did you react? Didyou stifle your tears and push the hurt aside? As adults, we tend to stillrely on coping strategies that developed in our formative years, but we maynow need to relearn how to cope in ways that match who we have become.

Explore your grief

So what can you do to ease the pain of the losses left behind from change?Embrace the pain and explore the grief. If friends ask how you are doing,don’t just say, “Everything is fine.” Admit that you are struggling. Seek asupport group. Speak to a grief counselor.

Meditate on how you feel aboutwhat you have lost. And realize that losing something doesn’t have tosignal an end. “Grief and loss enable you to understand your life in a newway, and that changes the way you see yourself in the world,” saysCarlstrom.

“Ends are also transitions to new experiences.”

Part of the problem is that we tend to associate the words lossand grief with death only. But every person is a griever ofsomething, and there is absolutely nothing wrong with being a griever.“Grief experienced will dissolve, while grief unexpressed will lastindefinitely,” says Carlstrom.

Research Shows

A simple way to cope with change as you age is to adjust your expectations.When British researchers compared life satisfaction among young adults andretirees, they found that adults who underestimated the lihood ofnegative events in their life were unhappier. Anticipating some degree ofchange in life may help scale your expectations and improve your capacityto cope.


Johns Hopkins Scientists Give Psychedelics the Serious Treatment

How to Cope with a Later-Life Crisis | Johns Hopkins Medicine

Psychedelic drugs—once promising research subjects that were decades ago relegated to illicit experimentation in dorm rooms—have been steadily making their way back into the lab for a revamped 21st-century-style look.

Scientists are rediscovering what many see as the substances’ astonishing therapeutic potential for a vast range of issues, from depression to drug addiction and acceptance of mortality. A frenzy of interest has captivated a new generation of researchers, aficionados and investors, triggering some understandable wariness over promises that may sound a little too good to be true.

But late last year the highly respected institution Johns Hopkins University—the U.S.’s oldest research university—launched a dedicated center for psychedelic studies, the first of its kind in the country and perhaps the world’s largest.

With work now underway, the center is aiming to enforce the strictest standards of scientific rigor on a field that many feel has veered uncomfortably close to mysticism and that has relied heavily on subjective reports. Early results have been promising and seem poised to keep the research on a roll.

Psilocybin (a psychoactive compound found in certain mushrooms) and LSD were widely studied in the 1950s and 1960s as treatments for alcoholism and other maladies.

They later gained a reputation in the media and the public eye as dangerous and became strongly associated with the counterculture. Starting in 1966, several states banned their use.

In 1968 LSD was outlawed nationwide, and in 1970 Congress passed the Controlled Substances Act, classifying that drug and psilocybin, along with several others, as having a high potential for abuse and no accepted medical use.

But in recent years a rapidly growing number of studies reporting encouraging results in treating depression, addiction and post-traumatic stress disorder (PTSD) have brought them back the shadows, spurred on by positive media coverage.

In a major boost to the reviving field, Johns Hopkins’s Center for Psychedelic and Consciousness Research is exploring the use of psychedelics—primarily psilocybin—for problems ranging from smoking addiction to anorexia and Alzheimer’s disease.

“One of the remarkably interesting features of working with psychedelics is they’re ly to have transdiagnostic applicability,” says Roland Griffiths, who heads the new facility and has led some of the most promising studies evaluating psilocybin for treating depression and alcoholism.

The myriad applications suggested for these drugs may be a big part of what makes them sound, to many, snake oil—but “the data [are] very compelling,” Griffiths says. And psychedelics may not only hold hope for treating mental disorders.

As Griffiths puts it, they provide an opportunity to “peer into the basic neuroscience of how these drugs affect brain activity and worldview in a way that is ultimately very healthy.”

As author Michael Pollan chronicles in his 2018 best seller How to Change Your Mind, researchers were examining the therapeutic effects of psychedelics in the 1950s—a decade before then Harvard University psychologist Timothy Leary and his colleague Richard Alpert started their notorious study in which they gave psilocybin to students (ultimately leading to Leary’s and Alpert’s dismissal from the university). In the 1950s–1970s, studies conducted with LSD—which acts on the same brain receptors as psilocybin—reported strong results in treating substance use disorders, including alcohol and heroin addiction. But when LSD became illegal in 1968, funding for this work gradually dried up. Most psychedelics research stopped or went underground.

Psychedelics’ New Wave

Griffiths and some of his colleagues helped revive the field around 2000, when they obtained government approval to give high doses of psilocybin to healthy volunteers. The researchers published a foundational study in 2006 showing a single dose was safe and could cause sustained positive effects and even “mystical experiences.

” A decade later they published a randomized double-blind study showing psilocybin significantly decreased depression and anxiety in patients with life-threatening cancer. Each participant underwent two sessions (a high-dose one and a low-dose one) five weeks apart.

Six months afterward, about 80 percent of the patients were still less clinically depressed and anxious than before the treatment. Some even said they had lost their fear of death.

Armed with these promising results, Griffiths and his colleagues turned their attention to other clinical applications.

They decided to investigate tobacco addiction—in part because it is much easier to quantify than emotional or spiritual outcomes.

Johns Hopkins researcher Matthew Johnson led a small pilot study in 2014 to see whether psilocybin could help people quit smoking. It was an open-label study, meaning the participants knew they were getting the drug and not a placebo.

The work followed a classic model for psychedelic therapy in which the participant lies on a couch and wears eyeshades while listening to music.

Researchers do not talk to or guide subjects during the trip, but before each session, they do try to prepare people for what they might experience.

In Johnson and his colleagues’ study, participants also underwent several weeks of cognitive-behavioral therapy (talk therapy aimed at changing patterns of thinking) before and after taking psilocybin.

The drug was given in up to three sessions—one on the target quit date, another two weeks later and a third, optional one eight weeks afterward. The subjects returned to the lab for the next 10 weeks to have their breath and urine tested for evidence of smoking and came back for follow-up meetings six and 12 months after their target quit date.

At the six-month mark, 80 percent of smokers in the pilot study (12 15) had abstained from cigarettes for at least a week, as verified by Breathalyzer and urine analysis—a vast improvement over other smoking cessation therapies, whose efficacy rates are typically less than 35 percent.

In a follow-up paper, Johnson and his colleagues reported that 67 percent of participants were still abstinent 12 months after their quit date, and 60 percent of them had not smoked after 16 months or more.

Additionally, more than 85 percent of the subjects rated their psilocybin trip as one of the five most meaningful and spiritually significant experiences of their lives.

The team is currently more than halfway through a larger, five-year study of 80 people randomized to receive either psilocybin or a nicotine patch at the new Johns Hopkins center. Recruitment for the study is ongoing.

The exact brain mechanism by which the therapy appears to work remains unclear. At the psychological level, Johnson says, there is evidence that the sense of unity and mystical significance many people experience on psilocybin is associated with greater success in quitting, and those who take the drug may be better able to deal with cravings.

At the biological level, he adds, scientists have hypothesized that psilocybin may alter communication in brain networks, possibly providing more top-down control over the organ’s reward system.

A team led by Johns Hopkins cognitive neuroscientist Frederick Barrett is now investigating further by using functional magnetic resonance imaging to measure brain activity before and after patients undergo the therapy.

any drug, psilocybin comes with risks. People with psychotic disorders such as schizophrenia (or a strong predisposition for them) are generally advised against taking the hallucinogen.

People with uncontrolled hypertension are advised to abstain as well, because psilocybin is known to raise blood pressure.

Although it appears to be one of the safest “recreational” drugs and is not considered addictive, there have been reports associating it with deaths—but these may have been the result of multiple drugs, impure substances or underlying medical issues.

In the smoking study, a third of participants experienced some fear or anxiety at a high dose of the psilocybin, Johnson says. But he adds that the risks can be minimized by carefully selecting participants and administering the drug in a controlled environment.

The smoking study results are promising, but Johnson says its relatively small size is a limitation. Also, subjects in such studies cannot comprise a completely random sample of the population, because it would be unethical to recruit people without telling them they may be taking a psychedelic drug.

Thus, participants tend to be people who are open to this category of experience and, potentially, more apt to believe in its efficacy. And it is also hard to tease apart the effects of psilocybin from those of the cognitive-behavioral therapy in the smoking study, Johnson notes.

He and his colleagues at the new center plan to conduct a double-blind, placebo-controlled study—the gold standard for medical investigations—in the future.

Johns Hopkins researchers are also starting or planning studies using psilocybin therapy for a wide range of other conditions, including opioid addiction, PTSD, anorexia, post-treatment Lyme disease syndrome, Alzheimer’s disease and alcoholism in people with depression.

David Nichols, a professor emeritus of pharmacology at Purdue University, who was not involved in the recent Johns Hopkins studies but had synthesized the psilocybin used in Griffiths’s 2006 and 2016 papers, has been conducting research on psychedelics since the late 1960s.

Back then, “you probably could have counted on one hand the number of people in the world that were working in this field. There wasn’t any money; there was no interest. [Psychedelics] were just looked at as drugs of abuse,” he says.

Now “there’s a whole society set up to study these, with probably 150 international scientists working on it.”

Nichols says he has supported Griffiths’s and Johnson’s work since its early days, as they gathered the initial data that excited wealthy donors enough to fund the latest research.

Philanthropic funding “is the way it’s going to be—until the National Institutes of Health decide that this is a field worth funding,” he says.

“There are still too many political considerations that are keeping that from happening, but eventually, we’ll get there. We’ll get institutional support. We’re just not there yet.”


Coping with a Later-Life Crisis

How to Cope with a Later-Life Crisis | Johns Hopkins Medicine

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If current life expectancy is 78.7 years and adulthood begins at age 18, your midlife crisis should hit around age 48.

But the definition of midlife crisis, as first coined in 1965 by psychologist Elliott Jaques, was a bit vague on the specifics. He didn’t specify an age or give any concrete symptoms.

It is merely described as a time when adults contemplate their mortality and the waning years they have left to enjoy life.

And truthfully, that can hit at any age, says Johns Hopkins geriatric medicine physician Alicia Arbaje, M.D., M.P.H.

If you find yourself spending too much time looking into the rearview mirror of life, you may be experiencing a midlife, or later-life, crisis. You’re not alone: In fact, recent research found that one in three people over the age of 60 will go through this experience. Here are some of the signs—and the psychology behind them.

You’re over age 50

For many people, the mid-40s is the time in life when our future isn’t a scary unknown, our past is something we can laugh about, and our present is filled with marriage, kids, careers, and a general satisfaction in knowing who we are and what we want life, says Arbaje. So it’s not surprising that we may feel melancholy beyond our 40s, when the future can once again seem uncertain.

Your family is driving you crazy

Middle-aged people aren’t inherently more stressed-out than younger folks, but the type of stress is different, says Arbaje.

Research shows that only 8 percent of young adults reported no daily stressors, compared with 12 percent of middle-aged adults (ages 40 to 59) and 19 percent of older people (ages 60 to 74).

But the midlifers were more ly to experience conflicts involving children—so getting older can bring more relationship stress with friends and family.

You feel lost and lonely

When researchers from another institution examined the factors that contribute to psychological well-being, they found that some are genetic, but some are having a sense of purpose and a good social network. As we head into retirement and bid adieu to careers, if we’re not careful to stay active in other ways, we risk losing our social networks and sense of self-worth, says Arbaje.

You’ve experienced a recent loss

Research has found that another key trigger of later-life crisis is loss, especially bereavement. Loss of someone close can bring you face-to-face with your own mortality, bringing you down if those feelings aren’t confronted and resolved in a healthy way, says Arbaje.

Moving Beyond the Crisis

So what can you do to deal with these feelings healthfully? “To start, I would recommend you stop thinking of it a crisis,” says Arbaje. “It sets you up for the idea that this is inevitable, instead of thinking about it as an opportunity for growth.” Instead:

Reframe what it means to get older

Instead of lamenting what you never did, or what you’ve lost, Arbaje suggests thinking about this time as a chance to take on new challenges and embrace life in a new way. For example, if you’re approaching or in retirement, you may have more time and freedom to pursue volunteering or travel.

Share your feelings

Find a friend you can confide in—one who will let you answer the question “How are you?” honestly. You might find that your friend is experiencing (or has gone through) similar feelings and can share coping strategies. Research shows that writing (in a journal or a blog) is another healthy way of letting out feelings, and that can help minimize the chances of becoming depressed.

Enjoy movement

Regular physical exercise boosts both your energy and your mood, and it reinforces your power to take charge of your own health and well-being. 

Research Shows

Here are a few qualities that research has shown we can celebrate as we getolder.

  • Decision-making skills. According to a study published in Psychological Science, the insight and life experiences adults acquire over time make them better equipped to make tough decisions.
  • Empathy. Researchers have found that women aged 50 to 59 were more ly to make an effort to relate to different perspectives.
  • Perception. A study published in the journal Psychology and Aging shows that older adults were better than younger adults at discriminating between faked and genuine smiles.


Johns Hopkins Magazine

How to Cope with a Later-Life Crisis | Johns Hopkins Medicine

The trustees held a luncheon in honor of the Women's Medical School Fund members and Gilman wrote a warm and complimentary acknowledgment letter to Mary. “Medical education for women and for men will at once receive an impulse as a consequence of your generosity, which will be felt throughout the land for years and years to come.

” He added that “you have won the acknowledgements not only of all the friends of the University and Hospital, but of a much wider circle of persons who desire to see improved methods of study introduced into medical colleges of the country. I beg you to accept this personal expression of most hearty gratitude.

” Commenting on the unparalleled academic standards, Osler joked to Welch, “It is lucky we got in as professors. We could never enter as students.”27

Mary had required that a “Preliminary Announcement” be distributed by the required date of February 22, giving public notice of the new medical school.

The announcement stated the new medical school “will be opened for the instruction of properly qualified students, October 2, 1893. Men and women will be admitted on the same terms.

28 The announcement reiterated Mary's terms, that candidates for the medical school be “Graduates of approved colleges or scientific schools” and have “a knowledge of French, German, Physics, Chemistry and Biology.”

The simple, four-page announcement, with its unprecedented terms and standards, revolutionized medical education in the United States.

It provided a final vindication of the often-agonized and polarized race between the university and the Women's Medical School Fund.

Unfortunately, the announcement failed to mention one important point: the name of the benefactor who worked tirelessly for four years to make it all possible.

But the press did not overlook this important part of the story. Once again, Mary's name was splashed across the headlines. Un the earlier publicity in the spring of 1891, announcing her $100,000 offer, when the status of the medical school remained unresolved, she might have felt easier with the new wave of public accolades.

“Enlarges Woman's Sphere,” the Chicago Herald pronounced. “Miss Garrett's Princely Gift,” the San Francisco Examiner weighed in. Rev. C. T. Weede, pastor of Baltimore's Exeter Methodist Episcopal Church, in a Sunday sermon in early 1893 felt compelled to thank a higher authority that the protracted impasse was finally solved.

“And who in our fair city has not felt during the past week a thrill of pardonable pride that Baltimore has one woman the noble Miss Garrett who lays almost $400,000 at the altar of science in connection with our beloved Johns Hopkins?” The Baltimore American succinctly summed up the twenty-year effort to open the medical school: “Miss Garrett's Gift Solved the Problem.”29

Much of the publicity focused on the unprecedented, rigorous academic terms that accompanied the gift.

The Baltimore Sun wrote “Miss Garrett, in her letter, sets forth the conditions of her gift clearly and explicitly, not only that women shall be admitted, but that their rights and privileges in the school shall be for all time the same as those enjoyed by men, and further, that the school shall be exclusively a graduate school. She is [unwilling] to contribute at any time to the maintenance of an undergraduate or partly undergraduate school.”30

Mary suddenly found that publicity placed her in the company of the great male philanthropists of the day. “Never in the history of the world were there such general and grand donations to charitable, benevolent and educational purposes,” the Philadelphia Call wrote. “The example set by Mr.

Childs and Mr. Drexel has been followed by P. D. Armour and John D. Rockefeller. Now it is announced that Miss Mary E. Garrett of Baltimore has contributed over $300,000 to the endowment fund of the Johns Hopkins University. The world at large is made better by the existence of such donors.


The New York Review of Reviews wrote an article entitled “What Baltimore's Rich Men Have Done.” In Baltimore, the article noted, “we find about fifty-five large Baltimore fortunes listed as equal to one million or more … and their wealth has been accumulated slowly and by old fashioned business care and sagacity.

Just one-half of the names [belong] to men of a recognized disposition to be generous. . . The most noteworthy of recent benefactions in Baltimore is Miss Mary E. Garrett's check for $350,000 to the trustees of the Johns Hopkins University.” The Philadelphia Ledger found that “for a long time it seemed left to men alone, Matthew Vassar and Henry M.

Sage, to remember that women also had wants of knowledge.”32

Not everyone was impressed. Delaware's Wilmington Journal found little would change in medical education. “Women will now have the opportunity to learn how to give breast pills or listen sympathetically to a dear patient's enumeration of all the diseases the human flesh is heir to.”33

Within six months of striking the deal, the university appointed additional faculty — in pharmacology, anatomy, physiology, obstetrics and gynecology, and surgery — to round out the medical faculty in preparation for the school's imminent opening.

Years later, physician-in-chief William Osler jadedly commented to then- university president Ira Remsen on Mary's blatant bribery of the trustees: “We are all for sale, dear Remsen,” Osler quipped.

“You and I have been in the market for years, and have loved to buy and sell our wares in brains and books — it has been our life. So with institutions.

It is always a pleasure to be bought, when the purchase price does not involve the sacrifice of an essential — as was the case in that happy purchase of us by the Women's Medical Association.”34

It had taken three tries, but Mary finally had “bought” coeducation at the Johns Hopkins University.

Notes to “A Pleasure To Be Bought”

1.Baltimore American, May 4, 1891.

2. MEG to Hon. George Dobbin, President of the Board of Trustees of the Johns Hopkins University, April 27, 1891. Women'sMedical Fund Campaign Papers, File 21, AMC.

3.Sunday Herald, May 3, 1891; Baltimore American, April 29, 1891.


New York Telegraph, May 2, 1891; Sunday Herald, May 3, 1891; Cincinnati Enquirer, May 8, 1891; Baltimore American, May 3, 1891.

5.St. Louis Republic, May 4, 1891.

6. MEG to MCT, July 16, 1891, reel 42, BMC.

7. MEG to Charles Stewart, January 15, 1892, reel 43, BMC; Baltimore Sun, February 8, 1892.

8. Charles Stewart to MEG, February 9, 1892, reel 173, BMC; MEG to MCT, September 24, 1891, reel 42, BMC; MEG to MCT, January 24, 1892, reel 43, BMC.

9. MEG to MCT, February 21, 1892, reel 43, BMC.

10. Ibid.

11. MCT to MEG, November 29, 1892, reel 17, BMC.

12. MEG to MCT, December 9, 1892, reel 43, BMC.


Letter from Miss Garrett to the Trustees of the University, December 22, 1892, Daniel Coit Gilman Papers, ms. 1, Sheridan Libraries, JHU.



16. Ibid.

17. Hawkins, Pioneer, 108; Edmunds, “The Price of Admission,” 65.

18. MCT to MEG, December 23, 1892, reel 17, BMC.


Action of the Trustees, December 24, 1892, Daniel Coit Gilman Papers, ms. 1, Sheridan Libraries, JHU.

20. Edmunds, “The Price of Admission,” 65.

21. “An Account of the Negotiations with Miss Mary E. Garrett Concerning the Terms of Her Gift to the Medical School” [no date]. Daniel Coit Gilman Papers, ms. 1, Sheridan Libraries, JHU.

22. Edmunds, “The Price of Admission,” 65.

23. MEG to Board of Trustees, January 30, 1893, Daniel Coit Gilman Papers, ms. 1, Sheridan Libraries, JHU.

24. MEG to MCT, February 7, 1892, reel 43, BMC; MCT to Hannah Whitall Smith, March 1 1, 1894, reel 29, BMC, noted in Horowitz, Power and Passion, 237.


“Account of the Negotiations with Miss Mary E. Garrett Concerning the Terms of Her Gift to the Medical School.”

26. Baltimore Herald, February 11, 1893.

27. Daniel Coit Gilman to MEG, December 23, 1892. Daniel Gilman Papers, ms. 1, Sheridan Libraries, JHU; Osler quote, Harvey et al., A Model of Its Kind, 28.


“Preliminary Announcement of the Johns Hopkins Medical School,” File 41, AMC.

29. Chicago Herald, December 20, 1892. All newspaper clippings in MCT Subject Files, Reels 172/173, BMC; San Francisco Examiner, February 14, 1893; Baltimore Sun, January 2, 1893; Baltimore American, December 30, 1892.


Baltimore Sun, December 15, 1892.

31. Philadelphia Call, January 5, 1893.

32. Review of Reviews, February 1893; Philadelphia Ledger, January 7, 1893.

33. Wilmington Journal, January 4, 1893.

34. William Osler to Ira Remsen, September 1, 191 1, quoted in Harvey et al., A Model of Its Kind, 140.

Osler was referring to the Women's Medical School Fund.

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