The Role of Purpose in Wellbeing Transcript

INTRODUCTION

Dr Ed Rainbow: When you ask children, "What do you want to be when you grow up?" and they say something amazing, like "A spaceman," and you reach a point in midlife thinking, "Right, I’m not a spaceman. I’m not some superhero, I’m just me."

If your sense of purpose is tied to your work, which I still believe is very true for many men, then the future can make that very vulnerable.

The things you do and the people you support are important, but if you don’t understand yourself or what drives you, you’ll probably end up trying to meet other people’s needs. 

I was feeling incredibly low, flat, and had regular suicidal thoughts. I used to cycle to work, and I’d think about just cycling into the other side of the road.

Paul Sutton: Dr Ed Rainbow has been practising medicine for over a decade but believes the medical treatment of the mind is outdated. Instead, he advocates for a process of understanding yourself and making scientifically proven changes to your life to improve your sense of well-being. 

Purpose forms a big part of that and is an area that many midlife men struggle with. One of the biggest factors in my own realisation that something needed to change in my life was a lack of not just knowing who I am, but why I am. 

So, what impact can discovering a new sense of purpose in midlife have on both your mental and physical well-being?

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PS: I'm Paul Sutton, and this is Middle Man, the show for midlife men and the people who love them.

EPISODE

PS: Ed, you’re a GP who now works with men to help them master their mindsets without the use of medication, essentially. For me, it’s an interesting pivot away from general practice and medication to focusing on mindset, because I was diagnosed with depression about 20 years ago, and I’ve been on and off antidepressants ever since—currently off, but on and off. What’s been your journey from being a GP to now working with mindset and stepping away from the medication side of things a bit?

DR: First of all, thanks for sharing that you’ve had these difficulties yourself, because I think one of the big problems for men is the lack of openness about mental health. We know that it gets very little recognition, and a lot of men suffer in silence. So the more of us sharing these things, the better.

What led me down this path was a few different strands coming together. Like yourself, I had some mental health problems about five years ago. If I reflect back to that time, if you’d come up to me at a social event, like a wedding, and asked, "How’s life?" I’d have said, "Great! I’ve got a lovely wife, two beautiful daughters, a nice house, good holidays, and I’m a partner in a GP practice. Life’s going great!"

But the reality was very different. I was feeling incredibly low, flat, with regular suicidal thoughts. I didn’t share any of that with anyone, and I did what many men do—just tried to push through. I worked harder, drank more at the weekends to cope, and kept going. But things started to go wrong. Occasionally, I made mistakes at work, felt constantly tired, and my body hurt.

As I mentioned earlier, I used to cycle to work, and I would think about cycling into the other side of the road. Fortunately, I didn’t, but I did reach a point where one Saturday morning I couldn’t get out of bed. I was physically exhausted. That was when I realised I couldn’t carry on like that anymore.

I sought help from the NHS's confidential service for healthcare professionals, as many doctors are afraid of seeking help due to concerns about their license to practise. I was diagnosed with severe depression, anxiety, and burnout. At first, I didn’t believe it—I didn’t see myself as someone who could get ill. But eventually, it sank in.

I was very clear about not wanting to use antidepressant medication. Having prescribed them myself, I was aware that they often didn’t help much. I think this is because we weren’t addressing the underlying issues. If you’re being bullied at work, not exercising, or eating junk food, giving someone a tablet to increase serotonin isn’t going to fix everything. So I decided against medication and instead started exploring lifestyle changes.

I read a book and listened to some podcasts that highlighted how diet, sleep, and lifestyle choices could improve mental health. I started eating a more plant-based diet, getting eight hours of sleep, and gradually felt better. Eventually, I felt healthier than I had in years. This was when I realised that non-drug interventions were incredibly powerful.

However, when I returned to work, I found that general practice in the NHS was not good for my health, and I started to feel unwell again. I realised that the environment was part of the problem. And then I noticed something else: Where were all the men? Women were coming in to discuss their mental health, but very few men. When men did come in, they were often accompanied by their wife, sister, or mother.

This sparked my interest. I started researching, and it turns out I was a walking stereotype. Men generally don’t seek help, they avoid talking therapies, and they rarely go to the doctor for mental health concerns. Talking about feelings triggers shame, fear, and stress for many men. Without addressing this, change is difficult.

PS: So, when you talk about work being a trigger, it sounds like there’s a lot more to it than just the job itself. Do you now understand what those elements were? Are they common to midlife men in general?

DR: Some of them are probably typical of midlife. Being a GP is hard—12-hour days, listening to the problems of 40-odd people daily. It’s emotionally draining. I’ve learned that I’m very empathetic, and absorbing other people’s emotions takes a toll. In midlife, you’re also dealing with internal and external pressures. Internally, I wasn’t getting enough sleep, was constantly stressed, and had high blood pressure. I used caffeine to keep going.

There’s also the issue of testosterone levels. As we age, testosterone declines, which impacts our mental and physical health. Low testosterone shares symptoms with depression: low mood, poor sleep, and weight gain, among others. So, part of my struggle was probably physiological.

Externally, I had career ambitions. I’d become a GP partner, was pursuing academia, and pushing myself to achieve more. But I kept hitting barriers—people weren’t interested in change, or I had to follow rigid rules. Around the age of 40, I realised that the clear career path I had followed since deciding to become a doctor at 24 had stopped. That’s quite common for men—hitting a plateau in their careers.

You also start earning well, but with that comes financial pressure: a mortgage, a family to support. If I couldn’t continue working, everything would fall apart. It was a huge burden.

There’s also the existential side of it. You start asking, “What am I doing with my life? Who am I?” It’s easy to feel disillusioned when you realise you’re not the spaceman or footballer you imagined as a kid, just an average guy doing his best. That can be quite unsettling.

PS: When you were talking about being a kid and dreaming of being a spaceman or a footballer, it made me think of the many kids who probably dream of becoming a doctor. In your case, as a doctor, I wonder if your purpose was hindered because, like you said, you were hitting a ceiling and didn’t have the space for personal growth because you were so busy in your job. I’ve seen you post quite a lot about purpose. What role do you think purpose specifically plays in the mindset you’ve been talking about, in terms of growth and looking forward to the second stage of your life?

DR: I became interested in this because, when you talk to men, they’ll often start by talking about their job for 10 minutes or so. They’ll describe their work problems, then maybe talk about their family. Eventually, they might start talking about themselves, but not always. 

There’s often this underlying question of, "What am I doing with my life?"

There’s a phrase, something like, "A man without purpose is a man lost." We struggle when we don’t have a clear sense of purpose. Erik Erikson, a Swedish psychologist and psychiatrist, had this idea of "generativity versus stagnation." Generativity means contributing to society, giving guidance to others, and having value in yourself. Stagnation is when you feel stuck, just going through the motions without any real purpose.

The idea of a "midlife crisis" was coined by a Canadian psychoanalyst called Elliott Jaques in 1965. He suggested it’s linked to anxiety about life and death, and the realisation of what you want to do with your life now that you’ve reached a certain point. It’s not necessarily about becoming a spaceman or a doctor, but it’s more about questions like, "Can I help my children grow up well? Can I contribute to my community?" There needs to be meaning and purpose in what you do.

PS: I like the idea of generativity. That’s a really nice concept.

DR: Yes, I think it resonates. Carl Jung, the famous psychoanalyst, also had a relevant idea. He spoke about how, as we age, we start to wonder, "Who am I, really?" You’ve got all these roles—father, doctor, son, cyclist, whatever—but they’re just roles you perform. 

The real question is, who are you underneath all of that? What is it that makes you you?

That’s what we’re trying to understand: to make sense of everything that’s happened and everything that’s going to happen, and where we are in the present moment. I think this process of reflection is very normal in midlife. There’s a sense of "freewheeling" or grinding to a halt, and David Levinson had this idea of different seasons in a man’s life. It’s natural to go through stages where you feel like you’re slowing down before picking up again. It’s part of the process of becoming a more productive, purposeful person.

PS: Biologically speaking though, this whole area of purpose and identity must be irrelevant from a biological perspective, except perhaps psychologically?

DR: From an evolutionary standpoint, you could argue that our purpose is just to eat, reproduce, and survive—like a flea or something. But humans are much more than that. We have the ability to choose how we lead our lives, shape society, and change our environment.

If you think about it, no other animal can alter its environment to the extent we can. Most animals respond to their environment, but we have consciousness. We can think abstractly, reflect on our thoughts, and that’s why these questions of purpose and identity arise. My cat, for example, doesn’t sit around questioning the meaning of life. He just wants food and a bit of attention.

PS: I saw you post something recently about how men’s purpose in life is changing or has already changed. Do you want to expand on that?

DR: Yes, if you look at my dad’s generation, he started working as a bank clerk when he was 19. The model back then was that you had a job for life. You learnt a skill and did that job until you retired.

PS: Yes, my dad was the same. He worked in the same place for over 40 years.

DR: Exactly. That was the expectation. But in my dad’s case, during the last five years of his career, the bank kept telling him his job might be replaced by part-time workers or automation. Each year, they’d say the same thing, until it finally happened. He was made redundant at 54, and six months later, he sadly passed away from a heart attack. He was a healthy guy, but losing his job was an utter disaster for him.

His work was everything—his social life, his purpose. He didn’t have anything else. At his funeral, there were hundreds of people, and most of them were his work colleagues. They were devastated by his death, but it really highlighted how much of his identity was tied to his job.

Unfortunately, he found himself in a different time. The post-war expectation of a job for life, with a pension, was disappearing. Capitalism had changed things. There’s now constant fluctuation in the job market, and many of the jobs men have—physical jobs, solitary jobs like taxi driving, or even some aspects of medicine—are becoming vulnerable to automation.

If your purpose is primarily through work, which I think is still true for many men, the future is very uncertain. You have to constantly adapt and change with the times, and that’s a big shift from the stable post-war era.

PS: That’s so true. It might be generational, but I do think most men tie a huge part of their identity to their job. For me, though, I set up my life about 10 years ago to be more about my family. I work as a consultant, which gives me flexibility, but even then, I would have said my purpose was providing for my family.

However, I’ve started to realise that’s still dangerous. It’s still tied to one thing. What happens when that one thing changes, like when my kids leave home? That’s got to be a question for every man—what else is there beyond work and family?

DR: Absolutely, and there’s nothing wrong with wanting to provide for your family. That’s a very healthy purpose. Ensuring your family isn’t hungry and has a roof over their heads is important for a better quality of life.

But, as you say, many men tie their purpose to external factors like work or family, and that’s when they start asking, "Who am I, really?" Because everything has been externalised, they lose sight of themselves.

PS: Yes, exactly. It’s easy to get lost in external roles and forget about your own needs. That’s when the question of identity becomes really important.

DR: One of the exercises I do with men is to get them to identify what truly drives them. I have a pack of cards with words like ‘helping’, ‘creativity’, ‘learning’, ‘respect’, and so on. There are hundreds of these words. I ask them to separate the cards into two piles: what’s important and what isn’t. Then, from the important pile, we rank them and discuss them.

When I did this exercise for myself, I realised that things like creativity, being outside, music, having fun, and learning were what mattered most to me. But as a GP, there’s not much room for creativity. It’s not like you can be a ‘jazz GP’ and make things up as you go along—you have to follow the guidelines. So, it made sense why I felt unfulfilled. My values didn’t align with my job.

Once you understand what drives you, you can start to make changes. For me, I started playing the piano again and going for walks in nature, which helped me feel more like myself. These small steps can make a big difference.

PS: I like that exercise, and it makes sense. It’s really important to understand what drives you, otherwise, you’re just living to meet other people’s needs and never really focusing on yourself. That’s where you can end up feeling lost.

DR: Exactly. It’s very easy to fall into that trap, especially if you’re a people-pleaser or have been brought up to serve others. I was raised with the idea of doing what you’re told, and I went to a school where the motto was "Serve and Obey". In a way, general practice is a form of service—you’re helping people. But at no point did anyone say, “Make sure you’re healthy too.” Well, one person did. There was a GP I knew who once told me, “You’ve got to find a way to look after yourself if you want to be able to look after others.” But I didn’t really take that advice seriously at the time.

The problem is, when you’re in an environment where many people are perfectionists or highly compassionate, it creates a culture where you adopt other people’s approaches and ignore your own needs. That’s something I think happens in a lot of environments, not just in healthcare.

PS: Yes, that’s definitely true. I think it’s a common issue in many professions. One model I’ve come across and really like is a Japanese concept called ikigai. To simplify it, it suggests that your purpose in life is the intersection of four things: something you love, something the world needs, something you’re good at, and something you can get paid for. If you can find that, you’ve found your purpose. I think it’s a helpful framework to get your brain thinking about what’s important.

DR: Yes, I’ve heard of ikigai, and it’s a good way of thinking about purpose, especially from a job perspective. But I encourage people to look at it more broadly—across their whole life, not just their career. Ideally, you want a job that doesn’t make you miserable, but if it doesn’t fully align with your passions, how can you still meet those needs in other parts of your life?

Maybe you can’t change your job easily, but you could find ways to include more of what you love outside of work. Maybe you can mentor someone at work, get involved in a project, or pursue something that satisfies you in your personal time. There are ways to make small adjustments rather than feeling trapped in a role that doesn’t fulfil you.

PS: Yes, I like that. It’s about finding fulfilment in different parts of your life, not just pinning it all on your job. Do you think there are specific actions men can take to address this sense of purpose and bring more alignment into their lives?

DR: Absolutely. It’s easy to get stuck in the inertia of doing nothing and just coasting along, but small changes can make a big difference. For example, career-wise, you could look for opportunities within your current role: can you learn something new, take on a new project, or get involved in something outside your usual responsibilities? Is it time to consider a career change, or even a shift in organisation?

If you’re feeling socially isolated, you could join a group or volunteer for a cause that interests you. Community connection is so important, and it’s one way to regain a sense of purpose.

For many men, improving physical fitness is often a starting point. But instead of slogging away in a gym you hate, find an activity you enjoy, whether it’s a team sport, walking, or something social like badminton, which is what I enjoy. Physical and social activities can make a huge difference to your mental health and sense of wellbeing.

If you feel you’ve lost touch with friends, reach out to old mates you haven’t seen in a while. Even arranging to meet for a walk or lunch can be hugely beneficial.

Financial stress can also be a big issue for men. If money is tight, have a chat with your partner about what’s coming in and going out, and set some goals for the future. Planning ahead can alleviate a lot of stress.

Another way to reconnect with your sense of purpose is to find a passion project. Maybe it’s something you’ve always wanted to do but never found the time for—like taking up a hobby you enjoyed as a child or pursuing a long-held dream. For instance, if you wanted to be an astronaut as a kid, maybe now’s the time to get a telescope and start stargazing!

Finally, keep learning. Trying something new and being a beginner again is incredibly rewarding. There’s a perception that men should know everything, but it’s actually powerful to embrace being new at something. It’s good for your brain and your mental health.

PS: That’s great advice. It’s all about action, isn’t it? If you’re feeling stuck or lost, the key is just to try something—anything—to break out of that cycle.

DR: Yes, exactly. Inaction keeps you stuck. By doing something—whether it’s learning something new, reaching out to someone, or trying a new activity—you start to shift your mindset. Even if it doesn’t work out, you learn from it, and that leads to more action.

Once you start, you create an upward spiral. Each action leads to more learning, more change, and eventually, you’ll find yourself in a place that feels more aligned with who you are and what you want from life. It’s all about taking that first step and then building on it.

PS: Are there any clinical or medical benefits to developing a sense of purpose? We’ve talked about depression and mental health, but are there more concrete health benefits?

DR: Yes, there are definite health benefits. If you’re unhappy or feeling purposeless, your body is often in a constant state of stress—what we call the "fight or flight" response. This stress system releases cortisol and adrenaline, which are designed to be short-term survival mechanisms, like if you’re facing a threat in the wild.

But if you’re always stressed, that system stays switched on, leading to chronic inflammation. Over time, this can cause high blood pressure, type 2 diabetes, heart disease, and even mental health issues like depression and anxiety. Many mental health conditions are now thought to be related to inflammation rather than just chemical imbalances.

So, yes, developing a sense of purpose can help reduce chronic stress and inflammation, which in turn lowers your risk of all these health problems. If your life is more aligned with your values, you’re much less likely to end up in that state of chronic disease.

PS: That makes so much sense. If you could give one tip to help people find their purpose and live a more fulfilling life, what would it be?

DR: I’d say: try something new. It doesn’t have to be a big change—just start with one small action. Doing nothing keeps you stuck, but trying something, no matter how small, creates movement. You’ll learn from it, and even if it doesn’t work out, you’ll gain insight.

Just doing something different, meeting someone new, having an interesting conversation, or even going for a walk can shift your perspective. You’ll start to see what works for you and what doesn’t. Once you start, it creates momentum, and that’s when real change begins.

PS: That’s great advice. So, for people listening who want to make that change, what are some practical actions they can take?

DR: It’s a great question, because it can be overwhelming if it feels too vague. But start small. If we’re talking about work, look for opportunities within your current role. Could you learn something new, take on a new project, or mentor someone? Or maybe it’s time to consider a career change—big questions like that can sometimes require support, so don’t hesitate to seek coaching or guidance.

If you’re lacking community or connection, find a local group or volunteer for a cause that interests you. Or reach out to old friends you haven’t seen in a while. It’s hard to make new friends as an adult, but reconnecting with old ones can be just as powerful.

In terms of health, start exercising, but choose something you enjoy. It’s not just about slogging away at the gym—it could be a team sport, walking in nature, or something that’s both social and physical.

And financially, if that’s a stress point, have a good look at what’s coming in and going out. Make a plan, set some goals, and start taking small steps to manage it. That alone can reduce a lot of stress.

Finally, a passion project is a great way to reconnect with what you love. Think back to childhood—what hobby did you love? Or maybe there’s something you’ve always wanted to do but never had the time for. Start there, and let that passion lead you.
Ultimately, it’s about learning. When you learn something new, it keeps you fresh, challenges you, and gives you a sense of accomplishment. It doesn’t matter if it’s something small—it’s the act of learning and growing that makes the difference.

OUTRO

PS: I hope you found today’s show interesting. You can connect with Ed at mensmindgp.com.

If you found the show useful, please tell someone who might benefit from listening. You can also sign up for the Middle Man newsletter at middlemanpodcast.com, where we cover topics like today’s show.

Next week, we’re talking about why so many men fall into the trap of saying "yes" too much, and the damage it causes.

Daniel Glyde: People-pleasing is not something to laugh at. If you’re someone who says, "I’m a bit of a people pleaser," it’s not funny.

It’s toxic, it’s bad for your health, and you’re letting people down - not just yourself.

It’s not selfish to make sure your cup is full - it’s self-love.

PS: See you then.