“Grow old along with me! The best is yet to be.”

–Robert Browning (1812-1889)

When we are young, the future is spread before us like an open field, awaiting our next step into the expansiveness of life. As life goes on, the number of next moves grows progressively smaller, while accumulated wisdom and experience from past moves grows richer and more abundant. The questions pondered in one’s youth – What will my future hold? How will life unfold? What will I be able to accomplish? What challenges will I overcome? – have already been answered. The new questions in our so-called “third act” become: Did I lead a meaningful life? Am I happy with what I accomplished? Do I have regrets? As we age, it is therefore our past and not our future that becomes the subject of reflection and inquiry. Yet the future still matters.

As we age, questions about the future are just as important, but what the future entails has changed. As we cross the threshold of 60 (or 70 or 80 or even 90, for some), our thoughts about the future focus on the legacy we will leave behind through our contributions, creations, family and teachings. We also begin to ponder questions about a different future, or what awaits us on in the afterlife. Reconciling these questions is an important part of finding meaning and fulfillment in the later stages of one’s life.

As a psychiatrist in Manhattan, it is not uncommon for me to see somebody who, after years of living a productive life, is dissatisfied upon entering late middle age and retirement. Their answers to questions about their legacy and afterlife are, for various reasons, unsatisfactory to them. But far more often, I see the exact opposite: energetic older individuals entering the “third act” of life with an enviable and beautiful joie de vivre. People find love in their 60’s, 70’s, 80’s or 90’s. They get married. They get divorced. They travel the world. They publish their first books. They invent amazing things. They discover new hobbies. They take risks they would never have taken when they were younger. They decide to go to college. They run marathons. They win Nobel Prizes. They are the proud matriarchs and patriarchs of their families. So what differentiates those who are fulfilled in their third act of life from those who are not?

Psychologist and psychoanalyst Eric Erikson described the years after age 60 as time to reflect and reconcile the lives we have lived and the key choices that have defined us. This stage entails recognition of our own mortality, and the understanding that we live on and gain proverbial immorality through our extended family, our community and the various contributions we have made over the course of our lives. Erikson describes this developmental stage as a time when human beings seek to reconcile the conflict between Integrity vs. Despair.

The most important part of this developmental stage of life is coming to terms with the choices and events that have made our life unique, and accepting our life for what it is. When one is able to do this, one develops a sense of Integrity. Older adults that reach Integrity become self-affirming and self-accepting, and they judge that their lives have been, for the most part, worthwhile and good. They feel a sense of fulfillment about life and accept death as an unavoidable reality. In contrast, if a person looks back on their life with predominant feelings of dissatisfaction, shame, guilt and regret, they develop Despair. They may feel bitterness because of what they were not able to do in their lives, longing to turn back the hands of time for second chances. They focus more on their failures and as such, may experience fear of death, as they are still not done with searching for their life’s meaning, still wondering, “What was the point of life?”

When patients ask me, “What’s my prognosis?” I always tell them, “We all have the same prognosis: fatal.” Despite our best efforts to avoid death, deny death, or defy death, one day our lives will inevitably come to an end, which begs the question: What’s next?

Isaac Newton believed there was no afterlife. Socrates, in contrast, believed in the immortality of the soul and expected to befriend a community of like-minded truth seekers after his time on Earth had ended. According to Sigmund Freud, clinging to hope of an afterlife is a form of infantile thinking: human beings need to create fantasies of an afterlife because we are too afraid to face the possibility that this life is all we’ve got. Most Americans do not agree with Sigmund Freud, however. According to the 2014 Religious Landscape Study conducted by the Pew Research Center, 72% of Americans believe in Heaven, 21% do not, and another 7% don’t know.

The most powerful way to deal with death anxiety is to engage in the adage of living each day as if it were your last, without fear or regret. Although death itself will lead to the end of our physical life, as we know it, the recognition that life is finite may be the very thing that opens us up to our aliveness.

Ways of reaching Erickson’s state of Integrity, as opposed to Despair, and reconciling the very human feeling of death anxiety include embracing our authenticity (that which has made our life unique and special), recognizing the legacy you have created through your relationships and the work you’ve done in this world, and embracing your freedom by taking full responsibility for your life. At the same time, it entails seizing the third act of life with openness, joy and presence: trying new things, learning new skills, engaging in creative activities, telling your story to others, living with purpose, fostering meaningful connections, and, most importantly, living mindfully and in the present moment. None of these things will make you immortal, but they will enable you to live the life you have on earth most fully. By living in a constant state of presence, we begin to appreciate the miraculous in the mundane. As Albert Einstein once said, “There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.”