Welcome to midlife. Almost everything changes:


  • Hello, family: Your parents are aging and need assistance. Your kids are aging and may be pushing you away. You feel sandwiched between two shifting generations. 
  • Hello, partner:  ‘Who are we when we aren’t running ‘project family?’’ 
  • Hello, menopause, and hello, andropause: ‘This isn’t the pause I was asking for.’ 
  • Hello, self: ‘Who am I, what do I want, what comes next?’  

You’ve been busy taking care of business on all fronts and tending to “all the things.” You may have lost touch with yourself, your partner, and your inspiration. Now there is an imminent sense of change. 

Some approach midlife easily and transition to the next phase with both gratitude and ease. Having sat with thousands of patients, I can say that is not the norm. We often hear about the “midlife crisis” involving a sports car, divorce, change of jobs, or some sudden shake up. While a crisis may feel overwhelming,  how do we respond consciously rather than reactively detonating our life?

If we approach midlife in overwhelm, we are more likely to feel stuck or make reactive choices. If we see it as an opportunity for growth, we can embrace the next phase of our journey. Then instead of just growing older, we can grow Elder. 

Please take a moment to reflect on this poem:

“My Brain And Heart Divorced” by John Roedel

My brain and
heart divorced
a decade ago
over who was
to blame about
how big of a mess
I have become
they couldn’t be
in the same room
with each other
now my head and heart
share custody of me
I stay with my brain
during the week
and my heart
gets me on weekends
they never speak to one another
– instead, they give me
the same note to pass
to each other every week
and their notes they
send to one another always
says the same thing:
“This is all your fault”
on Sundays
my heart complains
about how my
head has let me down
in the past
and on Wednesday
my head lists all
of the times my
heart has screwed
things up for me
in the future
they blame each
other for the
state of my life
there’s been a lot
of yelling – and crying
lately, I’ve been
spending a lot of
time with my gut
who serves as my
unofficial therapist
most nights, I sneak out of the
window in my ribcage
and slide down my spine
and collapse on my
gut’s plush leather chair
that’s always open for me
~ and I just sit sit sit sit
until the sun comes up
last evening,
my gut asked me
if I was having a hard
time being caught
between my heart
and my head
I nodded
I said I didn’t know
if I could live with
either of them anymore
“my heart is always sad about
something that happened yesterday
while my head is always worried
about something that may happen tomorrow,”
I lamented
my gut squeezed my hand
“I just can’t live with
my mistakes of the past
or my anxiety about the future,”
I sighed
my gut smiled and said:
“in that case,
you should
go stay with your
lungs for a while,”
I was confused
– the look on my face gave it away
“if you are exhausted about
your heart’s obsession with
the fixed past and your mind’s focus
on the uncertain future
your lungs are the perfect place for you
there is no yesterday in your lungs
there is no tomorrow there either
there is only now
there is only inhale
there is only exhale
there is only this moment
there is only breath
and in that breath
you can rest while your
heart and head work
their relationship out.”
this morning,
while my brain
was busy reading
tea leaves
and while my
heart was staring
at old photographs
I packed a little
bag and walked
to the door of
my lungs
before I could even knock
she opened the door
with a smile and as
a gust of air embraced me
she said
“what took you so long?”

When you have time, consider the following:

  • Change is ever present.
  • Life flows like the rhythm of our breath. 
  • Midlife is a pause in a larger cycle. 
  • It is the pause between the great inhalation, and exhalation of our life. 

For a few moments: 

Check your breathing. Is it relaxed? Are you breathing in your belly, or your chest? Do you feel a sense of comfort, trust, and ease in the fullness of your breath? Of your life?

Midlife is a pause, a passage, and an opportunity. Though to receive what is next we need to release what has been. To release may mean grieving things that we have avoided facing, or circumstances out of our control. We tend to hold these trapped in the tightness of our bodies and our minds. I see this often in patients, and have seen it myself. Do we hold our breath while tending the past or bracing against uncertainty? 

Our Western culture does not grieve well. By midlife, many of us have calcified the tensions of fighting loss and the emotions of grief. This hardening can numb us from experiencing the fullness of life that flows through each moment. It is as though we need to remember how to do something that is so natural… but are afraid.  

A mentor once told me that “knowledge is easy to come by, but wisdom is only earned by hard living.” This is even more relevant now when it is easy to confuse information for experience, and experience for wisdom. The digital world of content and filters cannot replace the depth of a life lived well. Direct experience with self reflection opens a deeper sense of beauty. To hold a fragile rose, in full appreciation of its transitory fragrance, is to let life touch you fully. According to my mentor, only then can we become “wise.” Only then can we become “elders.”

And so in midlife, we can pause to let life touch us fully, and grieve what has been. In releasing we do not lose. What we have touched becomes part of us, and we live on through those we encounter. By exhaling, we have an opportunity to find renewed meaning and connection. We relax the hardening as we allow ourselves to grieve and exhale. Then there is room for the next breath of inspiration.

I know that it isn’t always easy. At times it can feel like the ground is disintegrating beneath us. Our world or sense of self is dissolving. Midlife can be a passage of unlearning and unknowing, so that we can breathe life fully again. It invites us to trust in the spaciousness and possibility of the next breath. 

With all of the demands and the pace of modern life, it is easy to lose a sense of our priorities.  If we do not put a rhythm to life, the busy-ness of life will run away with us. Taking the time to pause is a kind of medicine, especially for midlife. I find the following practice helpful:

Space for Listening and Inquiry

Creating the space and time:

  1. Begin by finding a space where you won’t be interrupted for 10-20 minutes. This will be your place for the morning and evening practice. 
  2. Ideally, we would have a time at the beginning and end of each day, and this would be without screens or other distractions. 
  3. Throughout the day, we will have brief check-ins triggered by a cue of your choosing. For instance, every time you touch a door knob, or every time you pick up your phone you will return to the practice for a moment. 
  4. The morning/evening sessions are the ‘bookends’ of your day. The book-ends and check-ins give a rhythm to your practice and thread the practice throughout your day. 

The Practice
Main practice (the bookends)

  1. For the morning and evening sessions divide your available time in half or whatever makes sense to you.
  2. The first part will be for settling down, and developing an awareness of your body. We will begin by finding a comfortable seated position, and taking a few slow deep breaths. Pay attention to the sensations of your body and your breath. On each exhalation, release any tension. On each inhalation, gently breathe into any tight areas. If your mind wanders, return to the sensations of your breath. It’s ok. 
  3. For the second half, let your mind turn towards a relaxed curiosity and inquiry. Stay grounded in what you are feeling and thinking currently. Use the physical sensations of your breath as an anchor back into this present moment if your mind starts to run away with you. If you get lost in the past or the future, return to the breath. If difficult sensations arise, continue to breathe fully and let them move through like weather. Give yourself permission to feel and the space to be. 
  4. Begin to open awareness to your physical body. Scan your body from the top down, and see if there is anywhere that is tight. With each inhalation, open to the sensation. With each exhalation, let go and relax. Repeat the cycle moving from your head down through your feet. Care for every bit of yourself. 
  5. Let your awareness shift to your emotions. What are you feeling? Feel the emotions, instead of ‘thinking about your feelings.’ Give them space. With each inhalation greet them, and open the space. With each exhalation, let them go. 
  6. Let your awareness shift to your thoughts. This can be challenging because our thoughts are very compelling. We also strongly identify with our thoughts. If you get swept by them, then return to the physical sensations of your breath and body. Slowly you will learn to watch your thoughts, and let them go. This can leave an open spaciousness in our body, breath, emotions, and mind. Tensions can then arise and resolve in this spaciousness. 
  7. As you begin to notice this spaciousness, let your awareness relax. With each inhalation, incline your awareness to the sensations arising (physical sensations, emotions, thoughts.) With each exhalation, relax your awareness into the spaciousness. Sometimes it is helpful to be in a spacious environment. Gazing into the sky, or looking over the horizon can help with this part. Relaxing your eyes with your exhalation can also help. 

It is fine if you only make it part way through the series of steps. Each time that we show up for the practice we cultivate a deeper capacity to touch life fully in the present experience. Rather than reacting from the past or bracing against the future, we have the freedom to choose wisely in each moment. It is a practice that deepens slowly over time. 

The Check-Ins
Anchoring the practice to our breath creates a link that helps us return to the full practice when we become aware of our breath. These moments of ‘returning to our breath’ are our check-ins throughout the day. 

  1. Choose your ‘awareness cue.’ This should be something that you do on a regular basis throughout your day: touching a door knob, walking through a door, picking up your phone, etc. 
  2. Throughout the day as you encounter your ‘awareness cue,’ pause to take a breath. Breathe fully, and relax. 
  3. Briefly check-in:
    • How is your body? 
    • How is your breath?
    • How are your emotions? 
    • Where are your thoughts?
    • Do you sense spaciousness?

It can be a brief check-in, and doesn’t have to be everything listed above. Try to do at least 3-4 check-ins throughout the day. We tend to tighten down in different areas, just as each of us tends to put tension in different places of our bodies. If you only have time to check one thing, tune into your breathing. Inhale fully, and exhale. Let yourself relax and open. Give yourself the time and space. It is an act of compassion towards yourself that will begin to permeate your daily life.

This blog post was written by Dr. Brian Lewis, MD, MPH, Medical Director and Co-Founder of Integrative Family Medicine of Asheville.