Last weekend I attended our 25 year medical class reunion at the University of Cape Town, and it was great to see so many old friends and medical student colleagues from my University days. What struck me most was that many of us had aged physically, but most folk’s basic personality seemed to have not changed much since the days of our youth, although just about everyone seemed to be more at peace and more comfortable ‘in their skins’ as they approached the fifties than I remember them (and myself) to be in the halcyon days of our youth in our twenties. What was interesting too was hearing about everyone’s lives and the life changes they had gone through – for example one or several marriages, the birth of children and their growth into young adults, moves overseas or to other cities, and / or a succession of jobs. Most folk were in senior medical clinical or management positions in esteemed institutions across the world, which made us all laugh to remember how fancy-free and footloose we were in out twenties, and it in many ways surprised us that we had all done relatively well compared to how we thought we would all turn out back then. This reunion experience got me thinking about the concept that while us alumni at our reunion last week were all different individually, we all seemed to be pretty much in the same stage of life currently, with the same expectations and concerns for the future phase of our career, and often with the same reflective knowledge as wisdom. The same could have been said for the time period of our lives 25 years ago, when we also then had the same expectations and concerns as a group, albeit very different issues and concerns back then compared to what they were now. This got me thinking about life transitions and the effect of these on the development and maintenance of one’s personality and self-identity through the life cycle, and how we all seemed to have managed to negotiate these life transitions, both negative and positive, and have got through to this different life stage in a reasonably similar way and with a reasonably similar life expectations and world views, when one would rather have expected folk with different daily experiences over 25 years to have wildly divergent world views and significant changes in their personalities and self-identity 25 years later.
A transition is defined as a passing or change from one place, state or condition to another. It has long been recognized that the process of life requires or involves the individual transitioning or passing through a number of different stages. For example, in William Shakespeare’s play, As You Like It, seven stages of ‘man’ were described, with all men and women being ‘merely players’ in them, having their ‘entrances and exits’, and that ‘one man in his time plays many parts’. Shakespeare (or whoever wrote the plays attributed to Shakespeare) described seven different stages we go through, from the infant ‘mewling and puking in the nurse’s arms’; to the whining school-boy ‘creeping like a snail unwilling to school’; to the lover ‘sighing like a furnace’; to the soldier ‘jealous in honour, sudden and quick in quarrel, seeking the bubble reputation’; to the justice ‘in fair round belly, with good capon lined, with eyes severe and beard of formal cut, full of wise saws and modern instances’; to the lean and slippered pantaloon ‘with spectacles on nose and pouch on his side’; to finally second childishness and ‘mere oblivion, sans teeth, sans eyes, sans taste, sans everything’. These wonderful descriptions of the stages we go through by Shakespeare are difficult to match, but of course a number of psychologists, such as Erik Erikson, have more formally described a number of stages we go through during life, particularly during childhood and early adolescence, and suggested further that in order to reach a subsequent stage, one has to successfully negotiate the prior stage as a learning platform on which the following stage develops. For example, in early infancy we learn basic hope and basic trust (and mistrust) from our interactions with our primary parent (usually but not exclusively our mothers). If this trust and hope successfully develops, it forms the basis for positive self-identity, and allows the infant to move on to a phase of learning about will and autonomy (and shame), where again parents or caregivers are required to balance protection and safety with the requirements of the young child to explore the world in a reasonably autonomous way. Doing so will allow development into the next phase of purposive activity, followed by a learning of competence phase, then one of learning fidelity and identity (as an adolescent), then love and intimacy (in the early 20’s), then care and generativity as an adult, and finally wisdom and integrity as an old adult. Erikson suggested that failure to develop successfully at any stage will lead to development of such negative self-concepts as mistrust, shame, guilt, feeling of inferiority, role confusion, isolation, stagnation and despair at different points in a person live as they move through it.
What is interesting is that these stages appear to be crucial to our personal development and self-identity, but often do not occur as smoothly as these above descriptions suggest. In a brilliant scientific article published a few years ago, an old colleague of mine from the University of Northumbria, Dr Linda Allin, suggested that life transitions are not always predictable, and while the formal stage transitions described above could be defined as structured transitions, there are also transitions that occur that are self-initiated in response to intolerable living conditions, or are forced on one due to external events that are dramatic enough to require the self-initiation of a major life-changing response. For example, Linda describes the case of an athlete, whose whole self-concept and identity is that of an athlete, who sustains an injury that is severe enough to lead to the athlete’s career being abruptly terminated. The athlete thereafter has to in effect transition to another life stage directly as a result of the injury, and indeed has to successfully negotiate an entire change in self-concept from that of being an athlete to that of being something else, which is obviously tremendously challenging, and can often lead to a period of catastrophic psychological breakdown before a new stage of life is reached and acceptance of a new self-concept and identity is obtained – perhaps as a coach, or teacher, or any other career related to, or not related to, their old athletic career or self-concept. There are a number of such challenging forced transitions to overcome during most folks life, such as getting retrenched from a job, getting divorced (marriage itself is a transition creating challenge), the death of loved one, or a major illness, which all can create forced transitions and changes in self-concept and identity.
What appears to be strongly / tightly linked to relative success or failure of life stage transitions (and perhaps therefore failure or success of life itself) is an individual’s self-concept / self-identity, interchangeable concepts which are defined as the extent to which one’s self-knowledge is defined, consistent and applicable to ones attitudes and dispositions. Self-identity is different to, but linked, to the concept of self-esteem, with self-identity being descriptive of one’s self, while self-esteem is evaluative of the self. For example, one’s self-identity may be that one is a doctor / father / husband, while one’s self-esteem would create a personal (and often self-fulfilling) perspective that one is either a good or bad doctor / father / husband. Self-identity is generated during prior / early life stages, and is related to self-assessments in childhood and interpretations of other’s assessments of oneself during adolescence and early adulthood of one’s personality, skills and abilities, occupations and hobbies, and physical characteristics. Paradoxically, not only do prior life stages generate self-identity (and self-esteem), but successful negotiation of life transitions between the different life stages requires positive self-identity and self-esteem (though to what degree is still controversial), so life stages, life transitions and self-identity and self-esteem all appear to be inextricably linked. A failure of development during a life stage or transition, which is associated as above with self-identity issues in a causative or interactive manner, will lead to both an inability to develop in life and an identity crisis in some folk. The psychologist James Marcia suggested there are four ‘statuses’ of identity ‘crises’ associated with life stage transitions. Firstly there is identity foreclosure, where a transition is made without exploring alternatives or for example when career or life decisions are made on parental beliefs or ideas that are accepted without question. If no external life-changing events occur this can lead to a ‘successful’ transition in life, but can lead to a complete psychological breakdown when challenging external events occur. For example, if someone plans to become a farmer because ones parents own a farm, that may be well and good, but if one’s parents subsequently sell their farm, this will obviously create a self-identity crisis and transition issues in the person that puts ‘all their eggs in this one career basket’. Marcia’s second ‘status’ was that of identity diffusion, where adolescents and young adults are unable to face or make commitments or career or life decisions due to failure to transition adequately, and ‘drift’ through life battling to make commitments or identify with other folk, and become indecisive and / or do not ‘grow’ as most folk do through successfully overcoming the challenges related to each formal or forced stage transition. Thirdly, Marcia suggested there is an identity moratorium status, where folk in the middle of a transition-related crisis also remain uncommitted and indecisive, but are actively exploring alternatives and are trying to change. Folk with identity moratorium often describe anxiety and that they have an ‘identity crisis’, and for them, the ‘world is not a predictable place, and they are engaged in a struggle to make it so’. The fourth ‘status’ is identity achievement, where when stage transitions are successfully worked through, self-identity is enhanced, and folk who achieve this eventually develop an internal, as opposed to an external locus (which most adolescents and young adults have) of self-identity. Folk in any of the three other ‘statuses’, particularly the identity moratorium status, can eventually reach this pro-active identity achievement stage, and thereafter successfully ‘tackle’ the next stage of life and its associated challenges.
How do these concepts help us understand how a ‘successful’ life develops, and how can they be related to the folk I saw at my 25 year medical reunion last week? Transitions and self-identity appear to be inextricably linked – to be successful in transitioning through the stages of life one needs to have a well-developed and positive self-identity, and to be have a well-developed and positive self-identity one needs to be successful in transitioning through the stages of life. It was fascinating to have this 25 year gap, and the two ‘windows’ the passing of time created then and now, which allowed me to ‘observe’ the changes as a result of life transitions in the folk I interacted with during my medical training all those years ago, and again, albeit for a brief period, last week at our reunion. Clearly it appeared that most of the folk I saw again had successfully adjusted to and developed from all the transitions and life changes they had undergone, or were forced to undergo due to external challenges, and were ‘successful’ and had a contentment about them which was not always obvious in them (and me) 25 years ago. It must be noted though that one does not have to successfully transition through the stages of life or have a positive self-identity to be successful in one’s career – one can be a tormented soul and still be a great surgeon or scientist in the ‘doing of it’ – even if one is perhaps not happy or at peace when doing so as one would be with a ‘healthy’ self-identity and life stage transition history. Furthermore, I realized at the reunion when we were all recounting stories from our medical school times, that the folk who interact with one / who one meets at later stages of one’s life may be surprised at, or even not believe, stories from previous life stages they are told about which they were not privy too. For example, from a personal perspective, the folk who have only met me now, when I am in the contented ‘capon lined’ justice phase of life and currently involved with university / clinical management as my career focus after a 20 year period as a clinical and basic researcher, and with a happy family life, would be astonished by the stories folk could tell about my time in the Shakespearean lover / soldier phases of my life of 25 years ago. Then my self-identity was very different and perhaps that of a sportsman who did medicine, and later on a bouncer / doorman who did science, and responded with the ‘passion of youth’ to each challenge faced then, rather than with the calmness and reflection of the justice phase we are currently in and which is how now I mostly respond to any challenging situation (like we all do and did). Everyone will have similar stories and likely more intense ‘lives’ in earlier stages of their life – but if one didn’t have those passionate times of our youth, and been able to successfully transition away from them, would one be the person one is now? Each person’s life is a rich kaleidoscope of history, experiences, challenges met and failures accepted. Each person’s needs and life history may be very different, and often appears full of daily drama, with countless changes and issues to face, and never ‘seems’ to travel a linear / straight line from ‘A to B’. But, ultimately we all seem to go through the same stages of life and end up most often in the same ‘place’ in the end / in later life. The life stages and transitions we go through appear to set boundaries and conditions for our lives, yet impact on us in a way that is often unnoticed until we are long past them and reflect back and realize we have changed, hopefully for the better. And if we haven’t changed, perhaps we are drifting because of issues related to our self-identity and lack of capacity to pass through each life stage successfully, and have thus remained in the river of life rather than floating out into the wide blue sea. Eventual awareness / insight about this ‘drifting’ status may in itself become an external factor allowing eventual growth and change through acknowledgement of one’s own stasis and consequent initiation of action to attenuate the stasis and move on to a ‘new’, different and potentially ‘better’ stage of life more synchronous with that of one’s peers.
At the end of the day, it seems that change and transition is the basis of our life and development, and the capacity to do so is strongly related to our self-identity and self-esteem in a circular way. Sadly for me and my medical colleagues at the reunion last week, the bad news is that the only stages ahead for us are the baggy pantaloon and second childhood phases with our ‘big manly voices turning again toward childish treble, with pipes and whistles in our sounds’, and our ‘youthful hose, well saved, a world too wide for our shrunk shank’. Hopefully at our 40 year reunion, which is planned to be held in 15 years time, the organizers will take note of this wisdom and natural law, and ensure we have enough balloons, whistles and cakes to satisfy us all in our second childhood phase which by then will be well upon us. Sans teeth. Sans eyes. Sans taste. Sans everything – except for a life past full of unforgotten and unforgettable memories, and a life lived to the full!