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FEMALE ANATOMY: FALLOPIAN TUBES AND OVARIES

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FALLOPIAN TUBES

The Fallopian tubes are two thin, muscular tubes located between the upper (wider) part of the uterus and the ovaries. They transport the egg from the ovaries to the uterus, where it can be fertilized. The Fallopian tubes can become infected in pelvic inflammatory disease. Sometimes a fertilized egg can stop here instead of traveling to the uterus to implant. This type of ectopic pregnancy, called a tubal pregnancy, is a medical emergency, since such a pregnancy can lead to rupture of the tube and cause internal bleeding. This condition is more common in women who have had an infection in the tubes as a result of pelvic inflammatory disease, which often leads to scarring in the tubes.

OVARIES

Every woman has two ovaries, one on each side of the pelvic cavity. The ovaries are located at the ends of the Fallopian tubes. In addition to containing ova (eggs), the ovaries are vital in the production of the hormones estrogen and progesterone; they are analogous to the testicles in men. Each ovary is normally 3-4 cm across. Each month before a woman reaches menopause (the cessation of menstrual cycles, usually at about the age of fifty for most women), one of the ovaries releases an egg at the middle of the menstrual cycle. If the egg is not fertilized by sperm, then it does not implant in the uterus and menstruation occurs. The ovaries, too, can be infected in pelvic inflammatory disease.

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NEW DIRECTION OF WORK: EVOLVING NEEDS, EVOLVING VALUES

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Like Rev. Oler, many men in their middle years are discovering that their desire for a new challenge can best be met by shifting the direction of their work, rather than making a total career change. Thus a man might transfer his special skills from the business world to government; or turn from research to teaching; or switch his focus from products to people; or move from administrative tasks to training and counseling; or broaden his influence by writing and lecturing. Though less dramatic than second careers, such shifts may be a more realistic option for the man who wants more stimulation but doesn’t want to discard his expertise. The man who makes a mid-life shift is often motivated by a desire for more independence and autonomy. He wants the freedom to express his own evolving beliefs, the freedom to do things his way—a need that may require his breaking away from a particular person, or from an organization, Once again, however, as the following two case histories show, he may feel forced to leave a confining situation even before he has fully clarified where he is heading, or why.

Sometimes the pain prodding a man to make this break is an abrasive relationship with a colleague, partner, or boss. Leo W. was forty-three when he quit his job as the manager of a music and entertainment agency, and then set up his own shop. He did so primarily because the animosity between him and his boss had become insufferable. Leo W.’s decision evolved slowly, as he explains:

I worked for a medium-sized agency that specialized in club-date entertainment. We booked and assembled the orchestras, set the shows, and engaged the entertainers. Before I resigned I had been there about thirteen years, and I was really running the place. The guy who owned it had given me more and more responsibility, and I knew all the ins and outs of the business.

It’s very difficult to explain what happened with this man. I guess it was a combination of the two of us growing older and changing, and gradually becoming more incompatible. A close business relationship is sort of like a marriage, and we were together constantly. You do the business in the day, and then at night you go out and play.

Also he was having family problems, and part of that rubbed off on me. It was a case of constant harassment and constant intimidation. He would castigate me in front of people for real or imagined affronts. Things sort of built up for a couple of years until there was a really terrible personality clash.

And I began to feel that gradually I was losing some part of myself. I began to feel I was losing part of my manhood and my human dignity—the phrase I lit on at the time which, whether I’ll admit it or not, is very important.

It began to seep over into my home life, and I became periodically morose and upset. Usually when I’m upset it’s inside, and I’m able to cover it, for good or for worse. By nature I’m a very placid person and I rarely become angry. But I suddenly realized I had cracked twice under the pressure of the situation. I blew up at him. I lost my temper. I was irrational. I cried, literally. We had a screaming match—and when I tell you it was the first time since 1945 when I was in the Army that this had happened to me, consider the magnitude of it in my own mind!

As it became harder and harder to come home and change into what I was ordinarily, I finally realized it couldn’t go anywhere but further down. I felt I had to do something. And the final decision was made in total disregard of security and money and status. It was based purely on what was happening to me personally and emotionally.

I fooled around with the possibility of buying a small club, but I didn’t feel I knew enough to get into that And I didn’t want to go back to teaching, which I had once done. So setting up my own shop seemed the logical step. I was pretty well established in the trade. I had some financial backing, and I got some key people to make the move with me. I really wanted to continue in the same business because that’s where all my contacts and friends were, and I had worked at it for many years and gotten all my degrees in music.

Despite making his change primarily to get out of a destructive situation, Leo W. soon found that the joy of working independently was intoxicating. Though going it alone has been tough, he is determined not to give up:

When I quit the itch for independence wasn’t strong, but now I realize how much it means to me. When you are in business for yourself there is nothing like it. Nothing can match it. Even when you do it wrong the whole thing is your baby! It’s a very important thing for a man and I feel it very strongly.

And that’s one of the reasons I haven’t given this up, even though it’s not in good shape financially. Somebody else would take a quick look at the books and say, “Throw that out!” But you have this tremendous satisfaction, and you are loath to give it up. I’m still optimistic it will go ahead, and I really don’t want to work for anyone else. One of the things I’ve thought about often is that I never worked for anyone I either admired or respected—and that’s a tough realization to come to in your forties.

It may sound cornball, but you’re talking about the same independence the farmers have when they till the soil. It’s your mad thing, it’s your baby, and you don’t want to see it die!

Often the conflict that causes men to change direction relates to a fundamental shift in values. In the process of maturing, a man finds that his beliefs have changed so dramatically they no longer mesh with the work commitment he made long ago. He will then experience discord between his evolving “self” and his old “structure”—which can prompt him to move on. The more self-awareness he has, and the more consciously he recognizes new forces stirring within him, the easier his decision will be. But since this recognition often comes slowly, some men may have to act out their discontent in disruptive ways before truly understanding what caused it.

A forty-two-ycar-old lawyer, Bob S. only recently acquired a strong sense of what he stands for. Barely conscious of the internal changes that were influencing his actions, he actually provoked a senior partner into firing him before he recognized the depth of his own opposition to his law firm’s values. With the wisdom of hindsight, he describes his evolution:

I first went to work for a large law firm that hand-fed very wealthy corporations. Some of the causes we fought for were not particularly noble and I didn’t really believe in them. But I was making a good living and working in a reputable field, and I let myself be persuaded I had a chance to be a partner. By 1962, however, the place had become overcrowded with candidates. So I found myself looking for a job.

We had two kids then and were in a financial vise, so I moved to a smaller firm of the same kind—without any serious reconsideration of the milieu in which I would be working.

Several years later my wife decided to go to social work school, and I followed her career with great interest. This was also a period of increased social unrest in the country, and I became more and more attuned to that—and at the same time more unhappy with my partners, with whom I had nothing in common politically. I also went with my wife to a sensitivity training group, which was quite an eye-opening experience. It made the normal commercial world look pretty tough, and seemed to be quite a contrast to the way our firm was being run.

I began to realize I had been working contrary to my basic political beliefs ever since I came to Wall Street. I was brought up by a father who began as a dirt farmer and never had any sympathies for business. And I suppose I came to Wall Street to spite him, but I really don’t know. I just gradually grew more conscious that what I was doing wasn’t what I believed in.

Without really understanding why at the time, I began to find the firm absolutely intolerable—and it showed. I was handling my interpersonal relations with those guys very badly. Several times I got so angry I went up In flames, and even told one partner what I really thought of him right to his face. Finally they threw me out—”invited” me to resign—and I had to stand on my own feet.

That’s when I decided to take a personal sabbatical, which led eventually to my changing directions.

Forced to re-evaluate his situation, Bob S. gradually clarified the values he endorses and wants to represent Now In-no longer labors for the nation’s largest financial and industrial interests, but works instead for the city government in the field of low-income housing. He feels his transformation is just beginning:

My wife had been working with tenant groups, and doing volunteer work for them. I had always been interested in housing anyway because we had renovated two homes—so that’s how I decided to specialize in low-income housing. I did some reading and studying for a while, and then I decided to take this job with the city government—at about half of what I was making. I’m not deluding myself I’ll accomplish very much, but I will learn the trade. And then after a few years I would like to do something that means working for social change, although I don’t know what yet.

My social beliefs are such that I honestly could not in good conscience continue to work for the commercial interests of this country. I just couldn’t. But I also have the feeling I got sick and tired of bringing in forty thousand dollars a year and having everybody standing around waiting for it. I recognized the extent to which the average male in this society is expected to bring home the bacon. My wife and I had been talking about sharing the load, and about both of us enjoying our home and our kids—and so now we’ve put some sanity into things and we’re doing itl

There was no one I really talked to about making any of these decisions except my wife. And I think I made a mistake in not going into therapy. I talked about it, but I didn’t do it. I wish I had, and I may yet. I’ve always had difficulty in exposing myself—either by expressing my emotions, or else by exposing myself to criticism.

Now I’m very conscious of being calmer and stronger, but I feel I have quite a way to go to mature. Maybe I’ve started to mature. I’m being very candid with you about what happened to me. It was very clear to me that I had to grow up, grab the bull by the horns, and do something—push a little bit to set my own direction. I still have a long way to go to develop a gyroscope inside me. But I view what I’ve done as just taking the first step in a new direction.

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GENERATION IN THE MIDDLE: CHANGING DEPENDENCIES

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Like it or not, new responsibilities are often thrust upon a man during the mid-life period because of a milestone event: The death of his father. This searing experience has been described as “a scab that in no man ever heals” by author William Gibson, who wrote A Mass for the Dead to make peace with his own father, himself, and his sons.

Freud regarded a father’s death as both the most important event, and most poignant loss, in a man’s life. He himself was forty when his own father died. Like many men, Freud suffered guilt for the hostility he had long felt for his father, and also began to appreciate him more. From that time forward, however, Freud surged ahead on a new path toward independence. Within the next few years his self-analysis, including dream interpretation, became increasingly systematic. And he is reported to have emerged from this period of his life “with a deep-reaching interior transformation.”

Not all men undergo such a radical metamorphosis. But in many instances a man’s development does not really begin until he is freed from the shadow of a strong father, a release that may occur only through death.

A clothing manufacturer from Boston, Richard S., did not begin to establish any true direction until he was almost forty. Before then, although he had done traditional things like marry and raise children, his aimlessness was clearly related to the influence of his father, a dominating patriarch. After his father’s death, Richard took over the family business and put his own stamp on it, separated from his wife of eighteen years, and made plans to marry the woman he had fallen in love with. He had just begun to have some sense of his own strength, as he explains:

I had my own turf in sports, but it was a real hassle through school. I screwed around in college for three years, and then sort of drifted out of school and went into my father’s business—which he wanted me to do. I was sort of on the rebound from a really hot romance when I met my wife. She cared for me and I wanted to get out of my house, so I really drifted into getting married, too.

My whole frame of mind was drifting. I had nothing planned, no thought of where I wanted to be or what I wanted to do.

During my marriage I traveled a lot and sometimes I’d be away 100 nights a year. Every once in a while I had casual affairs, but nothing of deep involvement. At home we never had any hostility, but the marriage was unclose—an unbelievable lack of communication. I found it difficult to talk about things that were really bothering me, and Marge also ducked it. So we just never talked about a lot of things.

I met Ellen three years ago when I hired her as a designer. My father and I had a lousy relationship in the business.. We really had some conflicts, which were all personality and power things. As I became more sure of myself I guess T became more threatening to him. I was trying to make some changes in the business, give it some organization. To him it was a one-man business— him, and me, and zilch. Then just about that time we found out he was sick. He had cancer.

Within the next month I got very involved with Ellen and spent a few nights every week in New York with her. T had never been involved with anybody T had really been close to before on a working basis. From that point on, all I wanted to do was be in New York and be around Ellen. And my father was dying, and I really had a torn kind of thing.

Then my father died—and it was a relief. The king is dead! Long live the king! I’ve got it all, baby!

During this period I was really riding high. T could have Ellen, and I could have Marge and my family— and they both really had to do what I wanted them to do. I didn’t really think about the future, because I could have the best of both worlds. And I could be the image of my father. I had this uncle working for me, and my grandmother leaned on me, and I took over some of my father’s charity jobs. It was really a wild scene. And I wasn’t really thinking about all of this. It was just happening to me.

When my father was alive I guess I felt I couldn’t compete with him. He held all the power strings. I know I was trying to live in his world, because after he died I tried to be everything he was. And then gradually I stopped trying to do everything he did. You know, being nice to all the people he was always nice to. It was a difficult period for me—strengthening and confusing.

I began to change from a person drifting to knowing where I wanted to be and what I wanted to be. I had a business I wanted to get together, and a personal life I wanted to get together. I’ve been building up the business with plans to sell it, and then move into some foreign investments. The deals are already negotiated and I’ve got a partnership formed. And then in the next year I’ll be moving towards the divorce. It all happened, I think, because Ellen was there when something dramatic—some great change—was happening in my life.

Regardless whether a man’s father is already dead or only now approaching death, the developmental challenge remains the same: If a man is to mature at mid-life he must give up his dependency on his father and assume the psychological burden of replacing him.

The difficulty in assuming full fatherhood is, of course, that it requires abandoning some very comforting fantasies. “In a way, this final taking-on of responsibility is like the last bite of the Biblical apple,” says Dr. Edward Klein, a psychologist with the Yale group. “You’re no longer the ‘son,’ the one who can’t do certain forbidden things without full awareness of the consequences; you’re the guy who’s in charge of the whole show, the one who’s entrusted to take care of others. The trouble is—who wants to let go of the apple.

What is actually occurring at this stage of life, say the Yale group, is that a man is being forced to redefine his own role as a father, which means assuming more authority and learning how to be genuinely paternal. But this task is complicated by the fact that a man is being challenged to relinquish his own dependency at the same time that he is being confronted by new problems from his own children and from other younger people.

It takes special courage to assume this new paternal role when a man is being assaulted by reminders of his diminishing powers. To his maturing children he is no longer the omnipotent parent who can heal every hurt, conquer every care. The small child who used to gaze adoringly at a beloved father trundling him to the zoo or ball park has suddenly been transformed into a towering, terrible adolescent who glowers at him with disdain. Being caught in this generational crossfire, this double bind, is painful indeed when a man feels as if he is being undercut by his own children just when his father’s death, or decline, requires him to be stronger than ever.

During adolescence the most highly charged issue for many parents, fathers especially, is that of sexual experimentation. Because sex is more open today than ever before, and more openly discussed, the repercussions are often disturbing for men who had a less permissive upbringing.

“It’s a tremendous challenge,” said one beleaguered father. “There’s a fierce desire to say to your kid, ‘No, you can’t do that.’ But inside there’s really the agonized feeling, I could never do that!’”

Suddenly many sexual matters which a man may never have questioned, nor even though, about, now become topics for conversation in his household. When, for example, his teen-age daughter wants to discuss the latest magazine article on oral sex, he is likely to begin asking himself some questions about his own experience: Whether his own sexual life has been satisfying; how responsive his wife has been; and whether he himself is really a good lover. If he has in fact been unadventurous, this may be the moment that sparks a lot of internal conflicts about missing out on something.

“I knew my son was sleeping with his girlfriend,” said the father of one seventeen-year-old boy, “but it didn’t, hit home until I discovered they’d been making love in our double bed when we went out. I exploded at the kid, really went berserk. It wasn’t just the bed, of course. My wife was always lukewarm about sex, but I’ve been afraid to play around much. That incident sure changed my thinking. Now I’m wondering, Well, if my own kid is getting his rocks off, why not me?”

There is no doubt that this generation of mid-life men have trouble understanding and coping with the free-wheeling options now open to the young: sexual freedom, extensive travel, drug experimentation, prolonged schooling, exercises in self-exploration, and leisurely attempts to define work goals.

Some of the viable alternatives pursued by today’s youth reflect the fact that they obviously hear the call of a different drummer. When it comes to going to college or choosing a career, many young people are making it clear that they are scornful of success and achievement as primary goals. They sec work as a means rather than as an end. They want to earn money to buy land, or travel, or support some creative effort. Some want a personal sabbatical from college or graduate school to explore the world, an effort that often leads them to do manual labor—to work as truckdrivers, bartenders, carpenters, house painters, or moving men—while they make up their minds about the future.

Others, unperturbed by a pressing need to fix on career decisions, simply want to concentrate on self-awareness and enjoyment for a while. They say they are in pursuit of happiness, or personal growth, or a better understanding of other human beings. Such amorphous ambitions are not easily tolerated by fathers forced, for most of their lives, to tread a straight and narrow path bound by duty, discipline, and obligation. Thus, even though their children may not be rebelling in cither an antagonistic or a self-destructive way, their simply following a nonconventional path goes deeply against the grain of an older generation’s implicit faith in the work ethic.

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THE YALE GROUP: AGE THIRTY TRANSITION

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Age Thirty Transition, Twenty-eight to Thirty-two: During this period a man generally questions whether he should continue in his chosen occupation, or make a change while he still has a chance. Pointing out that there are wide variations in the course chosen during the twenties, the Yale group found that the most frequent pattern around thirty was for a man to remain in the occupation initially chosen and reaffirm his existing marriage—or get married now.

In some cases, however, when a man decided that his first choice was not the right one—perhaps because it was too constraining, or a violation of his dream, or because he lacked the talent to succeed—he then made a major shift, which sometimes included breaking up his marriage. In still another version, the man who lived a transient, unsettled life in his twenties often began feeling a desperate need around thirty to put some order and solidity into his life. Like other transitions, this one may cause considerable turmoil, or simply involve reassessment and intensified effort. But it is usually marked by some significant changes, and is a prelude to a calmer stage in development.

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A SENSE OF DISILLUSIONMENT AND DEFEAT

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This mid-life crunch in the American marketplace can be shattering for men who regard upward mobility not only as a basic goal but also as a measure of their merit. Conditioned to believe that their identity depends on what they do, this generation of men cannot help feeling that business failure means personal failure. Thus the man in his forties who is fired, or who loses his job for any reason, is likely to experience a devastating loss of self-esteem.

But men who lose their jobs arc not the only ones to suffer at this stage of life. Those who have failed to meet their own goals, or who have simply stopped moving up, must also wrestle with a sense of defeat—and despair. Feelings that bewilder them.

While working as a management consultant and career counselor, a clinical psychologist from Michigan, Dr. Benjamin Shumaker, saw so many discontented men in the thirty-five-to-forty-five age range that he coined the phrase “career menopause” to describe the phenomenon.

“At first I thought there was something wrong with these people,” he explains, “because they had all set a good track record. They were doing very, very well. And then suddenly they say, ‘I’m not happy in what I’m doing.’ But they don’t say it that way. They project the blame on the lousy company, the damn boss, or something else related to the job.

“Of course you immediately say, ‘What’s bugging this guy?’ ‘What’s wrong with him?’ That was my initial reaction. Except there were so many of them that it dawned on me that this was normal. A normal part of career development.”

The root of the problem, in his view, is that American men have been told all their lives that it is possible to be Number 1. “We’ve been led to believe Horatio Alger is it,” he says, “and we approach our career a la Horatio Alger. You get into the race and initially you move very well. You get promoted. You get recognized. And then the movement becomes

slower, and it may stop, and you begin gradually to feel that something is wrong.

“Suddenly you start asking, ‘Am I in the wrong field?’ ‘Am I doing the wrong thing?’ And in our culture that’s terrible. You’re supposed to know what you want, get an education, get started, and that’s it. You’re supposed to be set for the rest of your life.

“So why are they having trouble? Well, they’re having trouble because they’ve been led to believe they shouldn’t have these kinds of feelings.”

What happens to men in their forties who realize they are not going to be Number 1—and then feel like a failure? Stuck in the middle, doing work they deplore or have tired of, they retire on the job psychologically. Or, embittered by a sense of worthlessness, they sabotage their bosses and savage their families.

Though no figures are available, it is now common knowledge in the corporate world that many workers, those in middle management especially, feel thwarted and defeated. Blocked in their ambition to reach the top, they often fault themselves for having “peaked out” when they stop moving up.

For these men the American Dream has turned into a nightmare.

Surprisingly, however, a similar sense of disillusionment often attacks the men who do succeed in making it. When the golden ring of recognition is finally within their grasp, they too feel severely disappointed. The fact of success, they discover, cannot match the fantasy. The dream fulfilled loses its luster.

“When I turned forty I had everything I wanted,” said one prosperous businessman. “I had interesting work. I was making more money than I expected to as a kid. I had a nice family. My kids were healthy and intelligent, and I was fond of my wife. But still, I was miserable.

“I suppose in society’s terms turning forty is symbolic. You start questioning what you’ve really achieved. And sometimes I’m proud of what I’ve achieved and other times I feel it’s absolutely nothing. Actually my life changed a lot because of being successful, but not much was changing within me. I keep wondering why I’m not happier, but I haven’t found any answers.”

Though usually unanticipated, this feeling of depression that follows in the wake of success is a common reaction. Something paradoxical occurs when the executive gets his promotion, the banker his raise, the salesman his franchise, and the teacher his tenure. The battle won, each man expects to feel victorious. Instead, there is a sense of loss. Is this all there is? he wonders.

Sometimes the letdown comes from a man’s sudden perception of the sacrifices required by his ambitious ascent. What he has gained doesn’t seem worth what he gave up. Like Babbitt, who at forty-six exclaimed, “I’ve never done a single thing I’ve wanted to in my whole life!” he feels cheated.

Having reached a long-desired goal, many men experience “feelings of having been had, or exploited,” explains Dr. Robert N. Butler, the director of the National Institute of Aging, who also has a psychiatric practice in Washington, D.C. “Some men reorganize and go on without much clinical noise. But then there arc those who wind up in the doctor’s office, like mine.”

A typical example, he says, is the man who “worked his heart out” to become a Representative to Congress. He made all the right compromises, like marrying the right woman in the area where he lives, and he took all the right steps in his legal career and touched bases with all the right organizations. But when he finally gets elected and comes to Washington, he discovers he doesn’t have as much power and influence as he expected.

“He comes into my office with a raving depression,” says Butler. “He feels as though this is not really the woman he loves—and that everything he’s been doing is really a hollow zilch.”

A similar sense of letdown is often felt by men who harbor no regrets for the sacrifices they made to build a career. They too experience distress when they arrive at the place where they have long been heading.

“A lot of men have lived until they were forty with the myth that if they work hard and move up the ladder, they will find at the end of it some satisfaction,” says Dr. Ian Alger, a Manhattan psychiatrist. “But a great deal of disillusionment comes when they reach a kind of stabilized position. They feel as if they have to settle down to die at that stage—or else try to make some big change in their lives and start looking again for their dream.”

An accomplished thirty-nine-year-old physicist describes this feeling of frustration vividly:

I’m at the stage where I’m taking stock of myself, my professional life, my family life—everything. It started, I guess, about a year ago when I had reached a certain plateau where I was established.

And that’s when I started to say, “Well, this bugs me, or that bugs me,” or “This isn’t good enough, or that isn’t.” Maybe it was one of those long rides on the turnpike . . . you know, starting to ask, “What the hell am I doing here? Why am I in this car? Why am I bucking this traffic jam? Why am I going home to Patty?”—all that kind of thing. You know, “Why do I teach? Why do I write papers? Why am I in this field?”

I ask myself, why should this guy who has the world by the tail, who is an associate professor in a department with an established reputation feel so dissatisfied? I wish I knew why, but you are always seeking and searching for something better.

I think it has a lot to do with the realization of the limits of your profession. In other words, you have defined what your goals are, what your position is, and what the importance of your job is in terms of the overall Universe. Eventually, I’ll be a full professor here, and I know what a full professor at this University is all about.

I’ve been to many international conferences, and given papers I’ve written. I know the feeling of people coming up and saying to me, “Joe, that was terrific, that was great.” I know the feeling of getting reprint requests. I know the feeling of getting gallons of papers published. I know what it’s all about. / know where the walls to the room are.

You say to yourself, “Jesus Christ, I don’t want to live in these walls all the time.” When you start to look around and see the limits, the walls of the room, any intellectual, any dynamic, any responsive guy would say, “This is great”—”Now what else is there?”

Like an undergraduate I thought, “Gee it would be so great if I could be a professor somewhere in some college.” Why? Because I was in awe of professors. I thought, “Boy, he’s really made it.” They represented the end of a long, academic, intellectual trek. There they were, with all those students lapping up their every word. I admired them, I worshipped them. They represented something just phenomenal.

And then suddenly when you become it you say to yourself, . . . “So what!” It loses its meaning, because you know yourself it isn’t so great. I mean if I were stupid and had an IQ of about 60 I could think, well, this is a magnificent achievement. But anyone who is reasonably bright, and has a reasonable sense of his field, can do what I’ve done.

There are guys who would give their left ball to be where I am. I really don’t know why I feel this way—it’s part of the machinery of my head, I guess. If I became President of the United States, I’d wonder why I wasn’t President of the World!

It’s like the concept of the house. The guy who gets the house, and all of a sudden he says, “Jesus Christ. What am I doing here? I’m going to be living here for the rest of my life! I’m like dead already.”

As this physicist makes clear, the disappointment experienced by the man who gets what he wants is not too different from the disappointment felt by the man who doesn’t. At mid-life the man on top, like the man who realizes he is stuck in the middle, must also confront the fact that he has stopped moving up.

In our society lack of continuing progress feels like failure—especially to men in their middle years who have become accustomed to constant climbing as a major source of gratification. Trained to get somewhere, they feel defeated when they finally arrive.

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THE MALE MID-LIFE CRISIS: SOMETHING IS HAPPENING

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We are all familiar with these symptoms, with the ways in which mid-life men change their appearance, their mood, their women, their work, and their way of life. Whether large or small, foolish or brave, these changes tell us that something is happening to the man in his forties.

Something unsettling.

Something we don’t fully understand.

The fact is that nearly all men, extraordinary or ordinary, celebrated or unknown, successful or making-do, experience some depression at mid-life. This is the time when a man begins to realize he is growing older and that someday he will die. Earlier he probably thought about death in abstract terms, but now he is being forced to confront it in a more personal, emotional way.

It hurts, this confrontation.

And it usually causes him to re-examine everything: who he is and the work he’s doing; the people in his life and what they mean to him; his past mistakes, present commitments, and future goals. Dismayed by the collapse of youthful dreams, he feels trapped by his own past choices and the rapid passage of time. But he also feels baffled by this newly urgent need to question everything he had previously taken for granted.

“I really feel ridiculous at forty-two asking myself all the same questions I was asking as a sophomore in college,” lamented one man suffering doubts about both his marriage and his work. “Earlier I knew what I wanted. Everything was focused, like a tunnel, and I could see where I was going and what I wanted at the end. Now that’s all gone. Everything I’ve been doing seems like bullshit, and nothing has any meaning for me right now. I don’t know what the hell I want.”

Worst of all, a man is often convinced that he shouldn’t feel confused or depressed, and that nobody else feels the same way he does. Why does the life he chose himself now seem so confining? Something must be happening to him— but he doesn’t understand what it is.

Thrashing around in the turbulent emotional depths of adulthood, most men now in their forties are terrified by feelings they can’t account for or explain. More accustomed to dealing with problems that can first be defined, and then aggressively tackled and solved, they are likely to reach frantically for some simple solution.

Some try to drown their mysterious inner fears with liquor.

Some anesthetize themselves with tranquilizers, athletics, or frenzied work efforts. And some seek relief in compulsive sex or the comforting arms of young lovers. Others try to dismiss what they can’t fix or flee from by latching onto labels which reassure them that whatever is happening isn’t their fault, isn’t their responsibility, and can be safely ignored.

Unfortunately, we have all complied in this dismissal by supplying and sanctioning a variety of labels ourselves. Although we have long known that something is happening to men around forty, we still don’t really understand it; and we therefore feel disturbed and threatened when the adult men who anchor our society start behaving unpredictably. To ease our discomfort we describe their behavior with denigrating names.

With a condescending shrug we say these men are entering the Foolish Forties or the Dangerous Years. We accuse them of going through a Second Adolescence or a Change of Life. And then, having labeled as sick or silly what we don’t comprehend, we file the phenomena away as just a passing phase.

We are all familiar with men like Harry. We have given his problem many names. But we have not yet taken his predicament very seriously.

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GROWING OLD – EXPECTING

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These attitudes are not peculiar to old people, many middle-aged and young people seek power and status, often by devious and cruel means. Why should we expect old people to be different? In old age, people most often behave as they did when they were younger. Societal attitudes which emphasize ownership, greed, selfishness, and deceit can hardly be expected to produce old saints out of middle-aged ruthless, grasping entrepreneurs. If you were a middle-aged delinquent, you may grow into a senile delinquent.

It is also true that some old people become disabled or ill and have to be in hospital, although it is a myth that the majority of old people live in hospitals, nursing homes, or old folks’ homes. As far as hospitals are concerned, studies in Britain have shown that, in 1973, about half of the hospital beds available were occupied by people over the age of 65. However, three-quarters of them were in ‘acute’ medical or surgical beds and most would be discharged from hospital after a short time. A quarter were occupying ‘chronic’ beds, but even in this case many of the people could be cared for at home if there were appropriate community services and, more importantly, help from other elderly people. Most of them would be happier and more independent at home.

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ADJUSTING TO CRYSIS OF MIDDLE AGE 2

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If he is able to recognize these problems and is flexible enough to adjust to them, he will emerge from the crisis of middle age with greater insight. He will be able to create new dreams and visions, he will become curious about life and about living. He will become more of an individual and less of a stereotype.

Escape from the crisis of middle age begins when the man begins to realize that status and possessions are less important than warm, giving relationships. In many cases it may mean that he and his wife (or his permanent partner) will have to recognize each other as individuals, not as stereotypes who fit into conventional sex-roles and never stray from them. It may mean that he will have to renegotiate his relationships. This may not be easy as, over the years, his wife may have had much of her self-esteem taken from her. She may have become depressed and have let herself go physically because her husband has failed to see her as an individual. Alternatively, she may have realized that her man is petulant, boorish, and selfish, perhaps an alcoholic or a workaholic, and she has had to work hard to keep the relationship going.

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GENITAL WARTS

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Small warts, which may be in a single cluster, but more usually are in multiple clusters covering large areas of skin around the genitals, are not uncommon. Women seem to be more affected than men, but as the disease is sexually transmitted, both sexes are affected.

The warts develop when a virus enters the skin through an invisible abrasion, which occurs during the movements of sexual intercourse. Once within the skin (or in the thinner mucous membrane of a woman’s vagina), the virus lies dormant and only starts multiplying after two or three months. When it does, warts form.

They are more common in people between the ages of 18 and 25. In men they are found on the foreskin, or, in circumcised men, on the skin edge just beneath the glans of the penis. But they can grow in other moist areas, and are around the anus in people who enjoy anal intercourse.

Apart from looking unsightly and, occasionally, being itchy, they do not cause much discomfort and they can be cured using a special ointment (containing podophyllin) or by burning them with a small needle cautery.

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LACK OF SEXUAL DESIRE AND ERECTILE FAILURE – IMPOTENCE

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Impotence is an unfortunate term as it implies that the man is a complete sexual failure. This is not necessarily true, as apart from his inability to achieve an erection, the man may be as sexually successful as previously. He may be ableto show affection, to enjoy body contact, and to relate to his partner sexually, except for his particular disability. However, the word impotence has become embedded in the language, and continues to be used. Impotence may affect men of all ages, of all classes, and of all races: it can affect a bishop or a butcher, a doctor or a docker, a lawyer or a lecher. The degree of impotence and the time when it occurs during sexual arousal are quite variable. At some time or other, under some special condition, most men fail to get an erection, despite sexual arousal. The problem does not last long and should cause no concern. It becomes serious when the man fails to get an erection even with the most sexually arousing pleasuring, or when he gets an erection when sexually aroused, only to lose it when he tries to have intercourse. Some men can get an erection with one woman, and fail to do so with another woman. Some men can get an erection by masturbating, or during oral sex, but cannot when they try to have sexual intercourse. This can be enormously frustrating to both partners

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