"No one knows this yet." A friend I've known for more than fifteen years said it at lunch, just before the waiter arrived. Her career looked very solid. She was thinking about what comes next anyway. Within a few weeks, I heard almost the same question from five people who don't know each other.
None of them are in trouble, and none of them want to retire. They're still building, still have financial goals, and are asking in the middle of their careers: how many more years do I want to keep doing this, and how do I want to spend them?
This episode of Under Load looks at why that question arrives in midlife, and what it means for your health.
In 1968, the psychologist Bernice Neugarten described middle age as the point where life is restructured around the time left rather than the time since birth. Laura Carstensen's research at Stanford explains the mechanism: when time feels limited, we shift from collecting knowledge, contacts and status toward what matters emotionally. Her studies showed the shift depends on perceived time, not age. It appeared in older adults, in young adults in Hong Kong before the 1997 handover, and in young men living with HIV.
I argue that counting backwards is the same shift, applied to work. Age can move your horizon, and so can a health issue or an uncertain future. For me, it started with severe back pain and a summer evening on a terrace in 2024.
We also cover:
- Why nobody says it out loud, and what psychologists call pluralistic ignorance, including a study of board directors who each doubted a failing strategy and stayed quiet.
- What the "midlife crisis" data shows, and why the people aged 49 to 53 in one study described "shortened futures."
- A German study of workers in their fifties: those who wanted to change profession but didn't had worse mental health.
- Purpose in life and health, from a 2026 meta-analysis of nearly 490,000 people.
- The honeymoon-hangover effect, and why a new job title rarely settles the question.
- Why any answer has to cover the household first, and why years and healthy years are two different counts.
The episode closes with five things to try: the backwards count, the five-year test, a small real-world experiment, telling one trusted peer, and putting a number on the money fear.
Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still learn, the skills you build, and the reserves your mind and body carry into later life.
Key sources
- Neugarten, 1968, Middle Age and Aging: "The awareness of middle age" and time-left-to-live.
- World Economic Forum, 2025: The Future of Jobs Report 2025, employer-survey projections to 2030.
- Carstensen, Isaacowitz & Charles, 1999, American Psychologist: socioemotional selectivity theory.
- Fung, Carstensen & Lutz, 1999, Psychology and Aging: time horizons, the imagined 20 extra years and the Hong Kong handover.
- Carstensen & Fredrickson, 1998, Health Psychology: HIV status, age and perceived time.
- Westphal & Bednar, 2005, Administrative Science Quarterly: pluralistic ignorance in corporate boards.
- Wethington, 2000, Motivation and Emotion: what Americans mean by "midlife crisis."
- Garthe & Hasselhorn, 2022, Ageing & Society: changing and wanting to change profession in later working life.
- Bigos et al., 1991, Spine: job enjoyment and reported back injury.
- Sutin et al., 2026, Psychological Medicine: purpose in life and mortality, 488,765 participants.
- Boswell, Boudreau & Tichy, 2005, Journal of Applied Psychology: the honeymoon-hangover effect.
- Garmany & Terzic, 2024, JAMA Network Open: healthspan-lifespan gaps in 183 countries.