Introduction

When you look in the mirror, do any of the following statements come to mind:

"My dress is too tight. My waist is disappearing."

"I can't wear short sleeves anymore. My arms are too chunky."

"My makeup settles in the lines on my face."

"This haircut makes me look old. I looked better with long hair."

If you're over forty, most likely your answer is yes. Midlife is a time of change for you and your body. Some changes may be for the better, but others can leave you feeling anxious, ineffective, and out of control -- especially when a youthful appearance is equated with sex appeal and is a ticket to approval and attention for women in our society.

We know from research that women's dissatisfaction with their bodies has skyrocketed since the 1960s, when worship of youth first came into vogue and ideals of beauty changed from the mature sensuous body of Elizabeth Taylor to the Twiggy look. It's fascinating that during the sixties and seventies, when women were gaining more economic and other power in the world, that a prepubescent girl became the ideal. Could the world not handle a mature, sensuous, and powerful woman? Creating an ideal that so few women could achieve keeps women in line -- feeling bad about themselves. As women gained more freedom in the world, many felt imprisoned by this impossible ideal.

Literature specifically on female body image at midlife is scarce and inconclusive. Although most of it suggests that women over forty tend to be unhappy with their appearance, a few studies indicate the opposite. Clinical observation and case reports suggest that eating disorders are occurring with greater frequency in women over forty. Concerns about an aging appearance, including aging skin, can be associated with a drive for thinness and excessive dieting, factors that are key components in the development of eating disorders.

Symptoms of eating disorders in midlife include: preoccupation with body image, use of over-the-counter or prescribed drugs to lose weight, exercise addiction, inability to make life transitions or to mourn significant losses, fear of aging, and unrealistic goals.

In the workshops I conduct and in my private practice, I see many middle-aged women who 0don't like (or even hate) how they look -- and the dissatisfaction affects virtually every aspect of their lives. Most do not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa, but have symptoms of a subclinical eating disorder such as restrictive dieting, exercise addiction, and obsession with their weight and shape. They come in to see me for other reasons, but their negative body image is what is holding them back. American culture has told them that they must have the bodies of twenty-year-olds to have value as women. Consequently, they long for and focus on an appearance that is impossible to achieve for all but a few. In pursuit of this elusive goal, they often engage in destructive behavior, such as yo-yo dieting. The investment takes so much time and energy (psychic and otherwise) that they have little left to put into anything else. Instead of using midlife as an opportunity to explore themselves and the world around them, they are imprisoned by an obsession with every piece of food they eat and with their weight.

When women fail to meet these impossible body-type standards, they feel bad about themselves. A forty-five- or fifty-year-old will tell me that she has no self-control, although she's a wonderful mother, or one of the best fund-raisers in the city, or renowned for her work in her field. Deep inside she doesn't experience her self-worth because her body isn't perfect. I've also seen how women project onto their bodies bad feelings about themselves or tension in their relationships, leading them to binge and/or become exercise addicts.

Nobody likes to see the signs of aging, and it's natural to wish that you didn't have crow's-feet, lines on your neck, or weight that just won't come off. We all struggle at times with negative feelings about our bodies, and there's more to be dissatisfied with after forty. But you don't have to dwell on inevitable changes or become depressed about them. You can focus on the possibilities you do have and get on with your life. You can move from thinking, "If I have a certain look I'll be sexy and attractive," to becoming a woman who honors the wisdom she has acquired over the years, knows who she is, and is sexy and attractive because of it.

The chapters ahead are not simply about accepting yourself, however. They are about sculpting yourself into a vibrant, adult woman and using the wisdom and experiences you've gained to shape a new vision of what you want your life to look like. Our society tells us that midlife, generally considered to be the years from forty to sixty-five, is a stage of decline. In reality, it is an opportunity for renewal and strength -- a time to redefine who you are and what you want, and to set new goals.

I'm in midlife myself, and one of the things I love about being a baby boomer is being part of a group that questioned everything. We questioned as we marched in college, and we've continued to question and revise values we were taught about sex, politics, child rearing, women's roles, and virtually everything else. Yet we haven't questioned the issue of body image and a culture that tells us the ideal of beauty is a shape that is reed thin, rather than womanly, and that we're supposed to have that shape at forty, fifty, and beyond. Ours is the generation that attempted to overthrow institutions in the hope of building more meaningful ones. Yet we aspire to look like anorexic actresses and childlike models with vacant stares, many of whom have undergone cosmetic surgery, endure dangerous eating habits, and devote much of their lives to working out. We may have taken off the girdles our mothers wore, but we haven't discarded the girdle mentality.

We see women exercising tremendous power in business and government, running companies, and having babies at forty five. Yet we still let society dictate an ideal of beauty that is often impossible to achieve and sometimes unhealthy. And we beat ourselves up when we fall short of that ideal. In an era that heralds powerful women, a successful prosecutor is just as likely to spend lunch talking about how fat she is as about her latest case.

A Body Image Revolution

Our bodies have been through a lot, and they're incredible. They menstruate every month, have babies, and then go through menopause. Yet rather than honor our bodies, we concentrate on what's wrong with them. All of us, no matter how attractive we are, want to lose weight. Isn't it past time to question this response -- and rebel? Midlife is a chance to shift into another, more satisfying way of being, one that is centered not on a perfect appearance but on becoming more authentic and alive. It is an opportunity to embrace the many strengths you possess, expand your capabilities, and, in the process, live a more adventurous, pleasurable, and meaningful life.

Many women are afraid of change. Fear can freeze you into old patterns that don't work and hold you back. To get unstuck, you're going to need new skills. Part of my mission in this book is to provide them. Along the way, I will help you take a serious look at what you lose in midlife, what you can gain, and how to grow up and blossom. The fact is, you can become more fit, looking and feeling sexier than when you were younger, with new approaches to exercise. Fitness is a crucial goal because it maximizes your physical, emotional, and social abilities, which make you a more effective person. Building a resilient, strong body is as important as building a resilient, effective self in midlife. As your body grows stronger, you'll find that you also develop a stronger voice in the world and the power to handle what life throws your way.

The practical exercises and strategies in this book will help you deal with your fears of aging and turn them into tools for positive growth, emotional maturity, and increased spirituality. I will share creative strategies to help you overcome emotional eating and develop a healthy relationship with food. The stories of women from different ethnic groups will show you a different way to look at your own body. You will also learn how to help your daughter and other young women around you develop a healthy body image.

Part of your transformation will involve a whole new way of thinking about yourself and your appearance. You'll learn to look at the mistakes you've made as part of the fabric of life and use them as sources of information rather than reasons to punish yourself. You will search within to develop your own beauty ideal. This is important because body dissatisfaction derives from the practice of judging yourself as deviating from the cultural standards of attractiveness. Remember, grown-up appeal, sexual and otherwise, is about attitude and energy, strong bodies, and openness to new possibilities. These traits are ageless and timeless, and others are drawn to them.

You won't make the shift to loving your body and yourself overnight. But by consistently and repeatedly practicing the techniques that follow, you will find that you gradually spend more of your time accepting your body and less time criticizing it. When you do feel bad about your appearance, you'll learn ways to restore your newfound body acceptance faster. A little bit of change each day eventually leads to a marked improvement in body image.

Middle age is the prime of your life -- a time to renegotiate your relationship with your body, your self, and those around you. Read on to discover the power in your body and in your ability to move ahead in new directions.

How Do You Feel About Your Body Now?

Body image is the mental picture you have of your body, including thoughts and feelings about your physical self. We all have everyday issues with body image, which are often magnified by the physical changes that take place at midlife. This quiz will help clarify your own feelings and attitudes about your appearance, and identify behaviors that can be damaging.

Circle the answer that applies.

1. I feel generally satisfied with my body.

a. True

b. Somewhat true

c. False

2. I have at least some attractive physical attributes.

a. True

b. Somewhat true

c. False

fs203. I feel self-conscious about my body.

a. Rarely or never

b. Sometimes

c. Usually

4. I usually compare my body to the bodies of other women

a. my own age.

b. somewhat younger.

c. under thirty.

5. When someone compliments me on the way I look, I usually feel

a. flattered.

b. skeptical.

c. self-conscious.

6. I worry about the effect of aging on my looks.

a. Never

b. Occasionally
d. Most of the time

7. I exercise

a. at least three times a week.

b. a few times a month.

c. rarely or never.

8. I have taken diet pills, fasted, or followed an extremely low-calorie diet.

a. Rarely or never

b. At least once in the past year

c. Several times in the last year

9. Compared to five years ago, I feel that I look

a. better.

b. the same.

c. worse.

Check Your Answers

1. Your answer to this question is important because unhappiness about appearance erodes self-esteem and can lead to unhealthy behaviors. Recently I pulled out and examined the responses of 282 midlife women, aged forty to sixty, to a 1997 survey I conducted of Shape magazine readers. I found that 58 percent were dissatisfied with their appearance, a very high level of discontent, and one that can contribute to low self-esteem.

2. Too often we focus on our flaws and pay little or no attention to our appearance strengths, which we all have. In responses to a 1999 Shape magazine survey I conducted, 86.4 percent of midlife women were satisfied with their hair; 86 percent with their facial attractiveness; 61.7 percent with their arms; 72.7 percent with their chest/breasts; 61.8 percent p0with their legs; and 62.8 percent with their muscle tone. Name three of your own appearance strengths. Be sure to include assets such as graceful hands and beautiful eyes.

3. Self-consciousness is evidence of dissatisfaction with the body. In a 1997 Shape magazine survey, 85 percent of midlife respondents acknowledged some level of self-consciousness about their appearance. Self-consciousness often leads to behaviors like "hiding the body" and feelings of shame and withdrawal from others. Make a list of the times you are overly self-conscious about your body. Think of different ways you can talk to yourself during these times and move through space in a more confident manner.

4. If you contrast yourself with cover girls twenty or thirty years younger, you are setting yourself up to feel bad. Research3 suggests that comparing yourself to your peers may help maintain your self-esteem and your satisfaction with life in spite of age-related losses.

5. Inability to respond to, accept, or feel comfortable with compliments is a common sign of a negative body image. This robs you of the pleasure of feeling good about your body. It also robs the giver of warm feelings. A compliment is actually a gift.

6. A study of 125 women aged fifty to sixty-five and 125 women sixty-six and older4 found a direct relationship between fear of aging and body dissatisfaction, increased binge eating, and an inability to listen to body signals, such as hunger. Research indicates that a concern with aging can be associated with a drive for thinness and excessive dieting, which may precipitate the development of eating disorders, osteoporosis, and stress fractures, due to nutritional deficiencies.

7. Midlife Shape magazine readers with a positive body image were more likely to exercise -- and to exercise more often -- than those who were dissatisfied with their bodies. Regular exercise makes a difference in how you look by firming and toning your body, and helping to control weight. Exercise also builds confidence -- and confidence is an essential factor in sex appeal.

8. Shape magazine research found that unhealthy weight control efforts are more likely to be used by women who are dissatisfied with their bodies than by satisfied women. Other research found a direct correlation between dissatisfaction with the body and women who believe weight loss is associated with youthful looks.

9. There is a double standard of aging for men and women in America. Men are perceived as more attractive and appealing to women as they age, but women tend to view themselves as less attractive and less desirable as they age. Have you bought into this? Remember that you are a grown woman, not a young girl. You can challenge this double standard. I know and have treated women in midlife who, at the completion of therapy, actually feel more attractive and desirable after forty because of choices they make each day in the way they treat their bodies. For example, research on 144 men and women aged twenty to eighty found that getting older was associated with greater body satisfaction for women who exercised. Midlife can actually be a season of your life when you feel better -- not worse -- about your body.

Interpreting Your Score

You can learn a whole new way of looking at your body and yourself. But first you need insight into what's going on. If you circled mostly as, you seem to feel generally positive about your body. Keep it up. If you circled mostly c's, you owe it to yourself to make changes. Negative feelings and attitudes can interfere with your life and erode self-esteem. It's important to explore what gets in the way of accepting your body. If you circled a relatively equal mix of a's, b's, and c's, your body image could be improved. Can you see areas and attitudes that need work?

Copyright © 2004 by Anne Kearney-Cooke, Ph.D., with Florence Isaacs

Chapter One: Do You Have a Problem with Your Age?

The Grand Canyon has been and continues to be formed by cataclysmic events, as well as millions of momentary changes. Still the whole is ever present, the changing yet undiminished. I ask myself, "Why are we afraid of dramatic or devastating change in our life, in ourselves? Is it possible to recast what we perceive to be negative, as something beautiful, something sculpting our lives, our psyches, our souls. Aren't we, like the canyon, made new again and again, yet always intimately whole?"

-- Kathleen Jo Ryan,

Writing Down the River

You are a woman of forty, or forty-five, or fifty-one. The next half of your life lies ahead of you. Do you want to spend it fighting your body, or fixing what you can, accepting what you can't, and embracing the power within you? A lot of dissatisfaction with the body in midlife is really about aging and failure to come to terms with it. Sometimes you use your body as a screen upon which you project negative feelings about other aspects of your life.

The fact is, your body is changing and will continue to do so. Instead of fearing change, you can use it to grow stronger, more fulfilled, and happier with yourself and your life. Accomplishing that, however, requires acknowledging and dealing with the real anxieties all of us experience about aging.

How Do You Feel About Getting Older?

Our culture makes it difficult to accept the process of getting older. It encourages an endless adolescence. Although we used to see beauty in voluptuous, strong women like Sophia Loren and Elizabeth Taylor, the ideals today are teen idols. Youth dictates the trends in fashion and TV.

How do you experience your own aging? Does getting older mean moving from being a girl to being an old lady? A patient of mine told me, "I look old. I feel old." She's fifty-one, and she's bought into the myths of our culture -- that the glorified qualities of adolescence equal beauty, that getting older means being unattractive, asexual, and less valued.

In fact, there is a great big middle ground between being a girl and an old lady. It is being a woman -- someone who knows who she is, what she wants, and how to go after it. A woman is wiser, more confident, and sexier in her way. A woman takes responsibility for her needs and takes credit for her strengths. She honors the knowledge that she's gained and a history of perseverance and effort in the obstacles she's overcome. That rich history didn't exist when you were twenty-something. When you give voice to that part of yourself, you move through the world in a way that is very attractive and alluring.

I see the transformation in my own patients. Initially, they come to me blaming their unhappiness on their thighs or faces. But they discover it goes far deeper than that, and that they have the power to effect change in their bodies and themselves. The same power exists in you. You can feel helpless when you confront the first signs of aging, but watching and despairing are not your only choices. There's another way to go. You can learn to change some of your attitudes and develop new skills as you move ahead in your life. But first you need to deal with unfinished business that can get in the way.

Looking at Losses

The reality is, as we get older, we face very real losses in our lives, such as loss of parents or loss of a goal or dream. Because these losses are rarely acknowledged as such, they often linger in the shadows, becoming roadblocks to positive change. But if you look at them openly, you don't have to fight them. You can put the energy of ignoring your losses elsewhere. Let's examine these losses of midlife and see how they may affect you.

Loss of Youthful Appearance

As you get older, you may notice that fewer men turn around when you walk down the street. You are referred to as "ma'am" and treated in a different manner. The signs of aging may be most painful for those of us who have defined ourselves by our looks and sexuality. In a way, age is the great equalizer -- the former prom queen has more to lose than the wallflower.

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How do you experience the signs of losing your youthful appearance? Nobody wants to get older, of course, but do you generally accept it and get on with your life? Or do you tend to obsess about your face, flabby arms, and the rest of your body? If you do obsess over aging, it stops you from living and enjoying your life to the fullest. Negative feelings about your body affect your moods, your eating habits, your sex life, and your relationships. That's why it's important to develop many sources of self-esteem, such as close relationships with others or involvement in meaningful work, whether paid or unpaid -- not just appearance.

Loss of Menstrual Cycle

The upside of losing your menstrual cycle is the opportunity for a freer, more spontaneous sex life. You no longer have to worry about pregnancy. But other issues arise.

Some women mourn the loss of fertility. A door has permanently closed. They've lost the option to have children, or to bear more children, and they may have regrets.

For example, I've seen some lesbian women in midlife who look back and recall that twenty-five years ago it was not acceptable for a lesbian to bear a child. Yet today they see younger lesbian women feeling free to do so. They wish they had had the opportunity to become parents.

Some women miss the rhythms of the menstrual cycle. I see participants in my groups who have irregular periods during perimenopause, the time preceding menopause when levels of the hormones estrogen and progesterone decline. They are not sure from month to month whether or not they will have a period, and the uncertainty leads them to feel out of control. Sharing with the group personal accounts of what they are experiencing helps them accept menopausal changes more easily. A woman will say, "I don't have a period at all for three months and then suddenly I get this incredibly heavy period." Others in the group respond by sharing similar experiences and ideas on how to deal with this, and they all wind up laughing about their unpredictable lives.

In addition, some women in my groups had children in their twenties, while others waited until their thirties or even forties. Those who became mothers later often feel excited but tired. For many women who had children earlier, the question is, What is your role once you can no longer bear children? The answer is they can move from focusing on their role as parent to greater focus on their own autonomy and self-care. This transition can be difficult, because social norms have established a woman's role as caring for others -- and cultural messages requiring women to put others' needs first must be challenged. Often women see the move to taking better care of themselves as becoming selfish.

I urge these women to say to themselves, "I'm not being selfish -- I'm building a self. And that's the best investment I can make in maintaining my quality of life into old age."

There are other concerns, as well. If you don't dread the loss of your menstrual cycle, then you probably, like most women, dread the changes associated with menopause, such as hot flashes and loss of energy. You may also worry that because of menopausal changes you won't feel very sexual, you'll have vaginal dryness, and the changes will affect your sexual performance. Lubricants, hormone replacement therapy (if you are a candidate), and other options can help. Your health and sexuality, in fact, can reach their peak in midlife if you can learn to celebrate your body and yourself.

Empty Nest

When children leave home, the structure that has surrounded them disappears. This affects all moms to some degree but is particularly difficult for full-time homemakers. When your kids move on to college or other choices, there's something exciting about it -- it frees up your time and allows you to address your own needs more immediately. But even positive changes involve loss. If your identity has been based largely on being a mother, you do feel the pain of that changing role.

A few years ago, Theresa, a forty-eight-year-old patient of mine, vacationed in Italy for ten days with her husband. She immediately experienced the loss of separation from her three children. She felt a bit overwhelmed at being in a strange country and found herself clinging to her husband at times.

"The worst thing was the day I got home," she told me. "One of my kids really missed me, but the others did great. My mother, who watched them, said there wasn't even that much work. My husband said I should feel so proud, that it means the kids are independent. They can operate without us. But what I feel is sadness because my whole identity is what I do for them. I feel that I have no worth because it doesn't matter if I'm here or not."

Although this is an extreme example, most mothers can identify with some of these feelings. When you can let yourself feel the pain of loss fully and grieve for it, you can eventually let go of the sadness. You can transform it into energy to pursue something else. For Theresa, the trip was the beginning of her grieving and beginning to accept that there's a point at which your children don't need you in the same way. Your identity and good feelings are going to have to come from something different.

Women who worked full-time while raising their children have additional issues to face as kids leave. Some regret spending too much time building a career rather than being with their children when they were young. I see many women who feel the pain of opportunity lost, yet 0who also see chances to forge a new relationship with their children. They make sure that they are involved in their kids' adult lives. They never miss college weekends. They go to help out for two weeks when a daughter or daughter-in-law has a baby. And they are loving, attentive grandparents.

Some women, however, channel their empty nest sadness into eating. They head straight for the refrigerator, and the pounds go on. Other women move in the opposite direction, thinking, "Okay, now that the kids are gone, my energy is going into looking great." It's a good thing to take better care of yourself, but for some women it becomes an addiction. Their mental energy revolves around diets, face-lifts, and how many hours they can exercise a day. This attitude disempowers women because there's a limit to the amount you can do with your body. Even if you do two hours of aerobics a day or lose five more pounds, you've still lost that piece of your identity or that way to structure your life if you haven't replaced it with something else.

Do you find yourself overeating -- or, just as bad, dwelling on diets, liposuction, or plastic surgery? Then it's time to ask, Will overeating or obsessing about losing weight or erasing the lines on my neck really make me happy? Or is this a distraction, a way of not looking at other issues in my life?

Loss of Parents

The changing relationship with your parents represents another loss at midlife. As you get older, they grow frail. In a role reversal, they may not only be unable to lend a helping hand to you but they may also need you to help care for them.

Vangie, a forty-six-year-old psychologist, experienced this role reversal when her mother was diagnosed with cancer. Since Vangie had children later in life, her two sons were young. She loved that her parents truly enjoyed the boys, babysat them on Saturday mornings, and attended all their athletic events. Within a year of her mother's diagnosis, however, everything changed. Instead of Vangie's parents providing help, enthusiasm, and comfort, they were depressed and needed her support. Her father had to deal with the effects of caring for his desperately ill wife. Her mother never felt well, and was less attentive to, or interested in, Vangie and the children.

This was an unexpected loss for Vangie, but one that led her to learn to reach outside the family to others. She began to attend a cancer support group for the families of patients. Here, she was able to talk about her fears about her mother dying and express a spectrum of other feelings, such as anger and sadness. Sharing honestly with others in similar situations helped her grieve her loss and get through this difficult time.

Loss of Peers

When your own peers are diagnosed with terminal illness, you begin to feel how fast time is moving and how soon life can end. It's a sobering realization that can paralyze you -- or lead you to reassess what you want in life, set priorities, and act on them. For example, Rachel, a patient of mine, was shocked when Alan, her best friend's husband, died at forty-five. A policeman who ran daily and rock climbed, Alan was one of the fittest men on the police force. He had grown up with Rachel and her friend. How could he die so young?

As Rachel and her widowed friend grieved together, they pulled out photograph albums and looked at snapshots of Alan and themselves as teenagers. "I hadn't seen these pictures in many years, and I was surprised to see the good shape I was in. I had always felt overweight then. I thought I was never thin enough," Rachel told me.

"And here I am twenty-five years later, still worrying about how I look, when Alan has died. His life is over. I don't have time for this anymore." Rachel was alive, and she realized that she wanted help in therapy to change her focus on appearance.

Changes in Your Health

At midlife, you may feel a vulnerability about your own health for the first time. One woman who grows her own herbs explained, "I love to garden, but I notice that I can't do it for long stretches anymore. My joints stiffen much sooner." Suddenly she is aware that her health isn't what it used to be.

Serious conditions such as diabetes, arthritis, and heart disease begin to appear in midlife, and one in every fifteen women will develop breast cancer between thirty-five and fifty-five. Such realities can motivate you to adopt a healthier lifestyle, or they can lead you into feelings of hopelessness and depression. Which way do you want to go? Many women in my groups feel that through exercise, taking vitamins, and staying out of the sun, they can do something to counter the effects of aging. They are making active efforts to prevent disease.

Loss of Goals and Dreams

Many of my midlife patients come to me because they just got divorced, or they're in pain about the choices they've made that are irreversible. Some losses involve old goals and dreams that have been forgotten or compromised over the years. A woman may realize that she'll never be the ballerina she had once hoped to be. Some may never have a happy marriage with two kids in the suburbs. Spouses may be blamed bitterly for lost dreams. To get past such losses, women must not only mourn the way they've spent their adult years but also honor the road taken. You can't be who you are without all the choices you've made, both the good and the bad. You need to appreciate how much you've grown as a result of your choices.
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You may think, "I never pursued my career. I raised my children instead, and now that they are away at school, I have nothing." But part of who you are at this moment is all the things you learned as you raised your children. You can transform that learning into something else now.

And don't forget what a powerful effect you've had on your children's lives. You may lament, "Why did I have to work so hard when my kids were little?" You owe it to yourself to honor that choice, and honor yourself as a role model to your kids. They got to see a woman being effective in the world. They saw how you handled challenges, and how you recovered when your work life tipped out of balance.

Moving Ahead

Whatever midlife losses apply to you, bring them out into the light. Allow yourself to feel the pain. Only then can you truly move on.

Different losses contribute to the experience of loss of a former younger self, which often makes women feel sad. It's a period of transition, but the exciting prospect is that you can transform yourself into a wiser new you.

Let me tell you about how a patient of mine is dealing with her losses. At age forty-eight, Jane has experienced both a breast cancer scare and the effects of an empty nest as her daughter, the eldest of three children, has gone off to college this year. Her daughter is struggling with being away at school and comes home every weekend. Jane struggles with it, too. She feels the loss of her daughter profoundly. The two of them used to watch TV together at night. They used to shop together. They did the dishes together and talked.

Jane has two other children still at home, but they are boys. Her daughter is her confidante and close friend. Jane's husband, although a good and loyal man, eats dinner after work and heads for the computer. Jane, who is thirty pounds overweight, fills the void with food and TV. Unconsciously, eating is a way to avoid grieving for the loss of her daughter at home. Jane dislikes her body shape and weight, and describes herself as looking frumpy.

In Jane's case, I helped her talk through the pain of "losing" her daughter, and helped her grieve. I also pointed out that she was reinforcing her daughter's difficult adjustment to college because she felt so lost and lonely herself. Jane's daughter felt guilty about leaving her mother. Because her daughter had spent so much of her time meeting Jane's needs, she had developed few outside relationships. She was afraid to be on her own.

Jane needed to get out of the house and try something different. I asked her, "What one thing would you like to do that is not at all like you?" She answered, "I'd love to go to San Francisco by myself to visit an old friend." For the first time in her life, Jane focused on herself and taking care of her own needs. She decided to take that trip. She bought the airline tickets and flew on a plane alone for the first time. She stayed with her friend, who has young children and was happy to have Jane go off on her own during the day. Jane would leave in the morning and explore the city, returning at 6 p.m. to spend the evening with her friend.

"Here I was in San Francisco and I found my way around. I felt so proud of myself," Jane told me. "I walked everywhere. I talked to people. I went to art museums. Nobody in my family would have been interested, but I loved it.

"This is the first time in my life I didn't have to plan my schedule around everyone else's. I woke up, ate what I wanted, when I wanted. If I wanted to go to a restaurant, I did. If I wanted to just have a pretzel for lunch from a stand, I did that." Interestingly, her trip marked the first time her daughter didn't come home for the weekend -- and it's leading to other changes. Jane has joined a book club and now talks of signing up for a yoga class. Who knows? She may even pry her husband away from his computer, which marital therapy was unable to do. She's certainly becoming a more interesting woman to talk to.

Jane has found an adventurous part of herself, which gives her daughter permission to move on and find an adventurous part of herself. Her daughter has made new friends at school and is building a social life.

Simultaneously, Jane is overeating less. She originally came to see me about her weight, but the real issue wasn't her body -- it was being stuck in an old pattern. She couldn't break out of that pattern until she grieved for her loss, experienced the emptiness, and opened herself up to possibilities.

Jane bought the idea that you always put others first, and she never thought of herself in a role other than caretaker for her children. Yet all of her children will leave home eventually. It was scary for her to confront the question, Who am I then? But conflict and instability are part of change. The answer is to embrace them.

Outside the Cage

If you ask people what they regret, it's usually actions they haven't taken: risks like pursuing educational opportunities, having children (if they did not), or having more children. Taking a risk and trying something different is what I call moving outside the cage. What is this cage I'm talking about? I learned about the cage from a story my father told me when I was in college, struggling with choosing a major and other personal decisions. It changed my life then and continues to guide me today.

There was once a community that was so proud of its zoo that it raised money to acquire a polar bear. In preparation, the zoo staff began to build an elaborate natural habitat to accommodate the bear and make it feel at home. People were very excited about it. But the polar bear arrived earlier than expected, over a month before the habitat was ready. To keep the bear healthy and comfortable in the meantime, a temporary cage was constructed at the edge of the habitat. For thirty-five days, the bear paced around the cage in the same kind of circling pattern.

On the day that the habitat was ready, the community held a gala ribbon-cutting ceremony. The entire town showed up, happy and proud. As the cage was removed, everyone waited expectantly for the bear to walk into the spacious new habitat, exploring the terrain and all the water holes that had been provided. Instead, the polar bear continued to pace around in a circle as if still enclosed by the cage. The old limits, although invisible, remained.

My father was trying to tell me that I was still stuck in an old vision of myself, with old boundaries and expectations of others. It was time for me to get out of the cage. I often tell this story because, like the bear, many of us remain inside the cage at midlife, restricted by old limits that no longer apply. It's scary to venture out of the cage, because you're accustomed to it, even though it prevents growth. But when you find the courage to do so, it's going to lead you to an exciting new life.

Although change is frightening and difficult, not changing is sometimes even harder. We forget how much energy is expended on staying stuck and often, how much suffering accompanies it. It takes effort to avoid a major issue, to procrastinate over a decision, and that effort often involves numbing behaviors like overeating, overworking, or drinking alcohol. Is staying in place easier if you have to drink two glasses of wine every night to medicate yourself? Is it scarier to open up and get closer to others than to bury fears of intimacy by working all the time?

Moving outside the cage can be especially important if you are employed. Working women often face both personal and career-related crises in midlife. The challenge may be how to slow down and deal with too much structure in your life, rather than too little. Take Phyllis, a partner in a Chicago law firm. Married for twenty-five years, she is the mother of three. She's achieved the success she's always wanted, but she's also deeply depressed. She feels tired. In the past, she always liked her appearance, but now she's having trouble living with a body and face that looks older. The reality is, she is a very attractive fifty-year-old.

Phyllis has had Botox injections, which temporarily reduce wrinkles, and has considered plastic surgery. She feels she is getting fat. "I diet, then I slack off, and I'm heavier than ever. I never thought I'd obsess about these things," she explains, "yet I look in the mirror and I'm flabby. I'm not very sexual anymore, and I don't feel good about myself."

Superficially, women think it's the spreading waist or age spots that are at the root of their dissatisfaction, but once they look deeply, they learn that other issues lie beneath. At this time of life, there are not only losses. You're also outgrowing activities and attitudes.

Phyllis feels she's on a treadmill working fourteen-hour days and traveling too much. She told me, "I keep saying to myself, 'Once I get to this spot, I won't be working so many hours.' Or 'Once I get to that, I won't have to do the community work.' But I've realized I'm fifty and my life hasn't changed. I'm not happy."

She also feels envious of her son, who is away at college on the West Coast. She muses, "What would it be like to be nineteen again and out in California, walking on the beach, falling in love, and talking about politics? I'm tired of going to dinner parties with my friends. We're all middle-aged, and it's the same old same old. And maybe you're right. It's not the wrinkles on my face or the weight in the middle of my body that's the problem. It's that I don't feel like I've been living for a long time. I feel like a robot."

For Phyllis, the big problem isn't losing her youthful appearance. She needs to deal with her dissatisfaction with her frantic work schedule and extra time she spends on community work to help attract new business. Obsessing over her appearance is a way of not looking at what's going on in her life.

I am working with Phyllis to redefine her role in her firm. We're talking about her slowing down and using the wisdom she's gained as a lawyer. She doesn't have to be on every board. Instead of being out on business three nights a week, she can reduce her rainmaking role and move further into work she enjoys: management, mentoring, and training younger associates. It may be time to shake up her social life: invite new friends for dinner parties, take a dance class with her husband, etc.

Tune in to Your Feelings

To help midlife women recognize what's going on internally and begin to move outside the cage, I ask them to do this exercise. Try it for yourself:

Write the word "aging" in the middle of a piece of paper. Then close your eyes and jot down any other words that come to mind. No censoring or editing allowed. See what comes out. Write the words all over the page. Then take all these words and use them to write a letter to someone or to write a short story. You can use each word as many times as you want, but you must use all the words.
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Rose's Story

When I asked my client, Rose, a forty-five-year-old human resources director in Miami, to try this exercise, she came up with the following words:

old wrinkled aches and pains

worn gray hair memory fading

wise maturing illness

saggy spirited unafraid

mentor inevitable like a fine wine

getting better getting worse like a good cheese

getting on with it

This is the story Rose wrote:

She had seen it all, done it all, and now she looked back at all the people and events that had shaped her life. Yes, while maturing, she had acquired the typical aches and pains of an old woman, but the deep wrinkles, gray hair, and saggy muscles had not drained her spirited personality. At times she felt that like a fine wine or a good cheese, she had gotten better with age. She had grown wise and been unafraid of the future as uncertain as it might seem. Lately, chronic illness had slowed her and she felt worn out, like she was getting worse. The unspeakable, inevitable lay ahead. She was afraid to be alone. Yet her friends were still close and a great comfort to her. They often reminisced about the neighborhood parties, the dinners at their favorite restaurants, and the band. With memory fading, she still felt she could be a mentor to others, leaving a legacy to her children and grandchildren. She was getting on with it, getting on with her life.

Rose, the mother of two teenagers, wrote this story imagining herself at the end of life. She illustrates her resiliency in handling ups and downs, and she has had her share of heartache. In the last two years, her husband left her, and both her parents succumbed to cancer. She's made it through the divorce and her parents' deaths. She's been able to grieve those losses.

Although disturbed by the physical changes of aging, she's confident they won't stand in her way. She's able to hang on to good memories of friends and family. But her story reveals that she needs to work through her anxieties about being alone for the first time in her life and her fears (unfounded so far) that her family history will cause illness to strike her next.

Carla's Story

This exercise can pinpoint areas of dissatisfaction, often turning up issues about values, and relationships with husband, children, friends, and work. For example, Carla, a forty-six-year-old accountant, maintained a low-profile practice that enabled her to put family duties first. She liked that arrangement, but she was very dissatisfied with the same old routine in her relationship with her husband. She felt stuck and projected that onto her body, dwelling on being overweight.

A part of her story read:

She was married to a handsome prince who loved her, but it was a marriage steeped in tradition. History would dictate that the expectations of her job as princess included remaining loyal to the prince. She saw this as her duty, and she always fulfilled her obligations. She knew that if she left her role as a princess, she would never forgive herself for breaking the prince's heart. Still, the routines and habits they had fallen into left her sad and tired. Once she raised her two sons, she thought she would be free, but instead she felt trapped. Yet others around her seemed content. She wondered if something was wrong with her.

Carla was beginning to question unwritten rules about the roles she and her husband held. They operated in an emotionally disengaged marriage, which avoided conflict but resulted in boredom. When people ignore conflicts between them, the problems don't disappear. Women are often afraid to discuss with their husbands what's really going on. They fear opening a Pandora's box that will split the marriage. Ironically, not opening the box is a far greater threat to the relationship. The effect is deadening.

As shown in her words, Carla felt her only options were to stay in her marriage and suffer, or leave and feel guilty. I helped her focus on a third option: She and her husband could grow and change together. Her complaints of boredom and lack of intimacy with her husband were actually opportunities to set goals instead of getting depressed and eating. When you feel down and dissatisfied, overdosing on chocolates isn't what will remedy these feelings. You need other sources of pleasure. These can involve new, yet simple, changes in routines, such as breaking out of your vacation rut and going someplace different, expanding your social circle, and/or following new interests.

Carla found the courage to discuss her dissatisfaction with her husband, which led him to start talking about his discontents. This conversation opened a whole new dialogue between them.

So far, Carla and her husband have decided to shake up their vacation pattern of two weeks in Maine every August. They're taking a Caribbean cruise instead. They also plan to get active at the art museum and meet some new people. They're entering an exciting new phase of married life. It's full of risks, yes, but also rewards.

After you've written your story, show it to a trusted friend, someone in your age group who can empathize, understand, and discuss it with you. This can help you talk through your dissatisfactions and the pain of losses, whatever they are. It can help you examine questions such as, How do I want to live now that my children are growing up? What will make me happy? How will I relate to men sexually? How can I honor the wisdom I've gained through my years of experience? When you embrace these questions and combine them with new perspectives, midlife becomes an exciting process of transformation.

Part of this process includes celebrating the power of your body as experienced through menarche, pregnancy, menopause, and sexuality through the life span. Do you remember how it felt to be sixteen? No, you're not sixteen anymore, but you can have a strong body and feel your physical power through weight training and attention to fitness. You can find creative ways to look great, such as using a personal shopper (available free in many department stores) who can find the most flattering clothes and colors for you.

You can also define your success by self improvement instead of triumph over others. Good feelings don't have to come from "I exercise more than my neighbor next door." They can come from goals that are important to you and which you are setting and meeting. Channel competitive feelings, which we all have at times, into being the best you can be, whatever the endeavor -- which is different from being better than someone else. Stop comparing yourself, because that leads to body hatred.

I'm going to challenge you to break out of your cage and become the writer of your own story, rather than someone acting out a role in a drama someone else has created. In the pages ahead, you'll find tools to help you take what you know and honor it instead of feeling bitter that you didn't take another route.

You have thirty or forty years ahead of you. Are you going to spend them worrying about the last ten pounds? Or are you going to grow up, learn from your failures instead of being demoralized by them, and use your considerable strengths?

Copyright © 2004 by Anne Kearney-Cooke, Ph.D., with Florence Isaacs