The Unseen Crisis in Midlife: When ‘Giving Up’ Might Be Something More
Victor Meldrew. Basil Fawlty. Reginald Perrin. The grumpy, mentally checked-out, impossible older man is a great comic tradition. Hilarious on screen. Rather less so when you are sharing a bathroom with him.
Recently, a piece in this publication sparked a remarkable response from readers. It described what one writer termed an epidemic: midlife women repulsed by their husbands – men who have stopped washing, stopped engaging, stopped trying.
Beyond Frustration: Recognizing Potential Underlying Illness
The sheer volume of responses was striking, but as a psychiatrist, what resonated most wasn’t just the frustration, but a pattern suggesting something deeper. Some descriptions didn’t point to simple apathy, but to an illness that has largely gone unidentified.
The Male ‘Menopause’: Andropause and Its Subtle Signs
Women experience menopause as a distinct hormonal event. For men, the equivalent – andropause, or ‘male menopause’ – is a gradual decline in testosterone, roughly 0.5% per year. This gradual progression often goes unnoticed. Yet, it’s estimated that up to 840,000 men in the UK may experience symptoms, including irritability, low mood, fatigue, loss of libido, and a general withdrawal from the world.
While testosterone replacement therapy can be beneficial, it requires proper medical guidance.
The Shadow of Undiagnosed Depression in Men
Depression is frequently under-diagnosed in men, particularly older men. It often doesn’t present as sadness or visible suffering, but as irritability, withdrawal, indifference to self-care, and a lack of motivation – a symptom known as ‘avolition.’
The Silent Threat of Transient Ischemic Attacks (TIAs)
Beyond hormonal imbalances and depression, there’s another often-overlooked possibility: transient ischemic attacks (TIAs), or ‘mini-strokes.’ While typically associated with physical symptoms like weakness or slurred speech, TIAs can sometimes manifest as subtle shifts in personality, motivation, and mood, with few obvious physical signs. Research suggests a significant proportion of TIA patients develop apathy in the months following the event, potentially due to changes in the frontal lobe – the brain region responsible for drive and emotional regulation.
One psychiatrist noted that asking patients when they last brushed their hair often revealed early signs of frontal lobe changes detectable on brain scans.
What to Do When You Notice a Change
If you’re living with a partner who seems unrecognizable, it’s crucial to consider factors beyond simple complacency. Ask yourself:
- Has he seen his GP lately?
- Has anyone checked his blood pressure, cholesterol, or testosterone levels?
- Does he seem to get any real pleasure from anything at all?
It’s vital to explore potential underlying medical causes before concluding that a partner has simply ‘given up.’
Navigating Relationship Challenges When Views Diverge
Recent events, such as the reported tension between Zendaya and Sydney Sweeney, highlight a common challenge: navigating relationships when political or deeply held beliefs clash. The key is to separate the person from their views, focusing on shared interests and accepting that changing someone’s mind is often futile.
The Importance of Consistent Sleep for Heart Health
Research from the University of Oulu in Finland, tracking over 3,000 adults, revealed that irregular bedtimes and insufficient sleep (less than eight hours) were linked to a doubled risk of cardiac events. Consistent sleep patterns, however, did not show the same association.
Dr. Max Prescribes: Feel Better, Live More Podcast
One of the UK’s leading health podcasts, hosted by Dr. Rangan Chatterjee, explores the interconnectedness of lifestyle and well-being. It offers practical advice on sleep, stress, and the link between physical and mental health.
FAQ
- What is andropause? It’s the gradual decline in testosterone levels in men as they age, often causing symptoms like fatigue and low mood.
- Can a TIA present without physical symptoms? Yes, TIAs can sometimes cause subtle changes in personality and motivation.
- What should I do if I suspect my partner is unwell? Encourage them to observe a GP for a check-up, including blood tests and a review of their overall health.

