Gail Sheehy: Managing Midlife Stress

What midlife women can do to inoculate themselves against depression, obesity, and other chronic illnesses that come with raising children while caring for aging parents

Today’s midlife women should be much healthier and happier than their mothers were in the same life stage, right? Mom was probably less well-educated, didn’t jog or pump iron, and was clueless about how to handle menopause and avoid osteoporosis. Why, then, according to startling findings of a longitudinal study by Gallup-Healthways, do middle-aged American women now have the lowest well-being of any other age group?

One key reason is the physical and emotional stress of family caregiving.

The average profile is a 49-year-old woman who still has at least one child at home and works outside the home while juggling another 20-hour work week caring for an aging family member.

“I already had three jobs before my mother and father-in-law got sick,” says Bonnie Heath. Between dropping off and picking up her two children at different schools, she put in six hours as a substitute teacher, then rushed to her mother-in-law’s home to lift her from wheelchair to an SUV and drive her to physical therapy every day, then back to pick up her father-in-law for an appointment with one of his six doctors.

“I was never home in time to make dinner for my family,” Heath continues. She and her husband David had to give up the long walks they used to take after dinner, their only time to be close. Nine months after they abandoned their walks, Bonnie had gained 50 pounds. Her kids were acting out. Her marriage was shaky. She never saw friends. She staggered through her days in a fog of undiagnosed depression and slept fitfully under a burden of undone guilt.

This commonplace caregiver’s lifestyle is one reason that obesity, smoking, and chronic diseases — including depression — are steadily increasing in midlife women. They are less healthy than their mothers were at the same age. Between 40 and 70 percent of caregivers suffer from clinically significant symptoms of depression, according to the latest data from AARP. Chronic depression contributes to heart disease and degrades the immune system, which protects against all illness.

“If these lifestyles and the decline in well-being continue for women, we will see the first generation of women to begin losing the longevity dividend — five to seven years — they’ve traditionally enjoyed over men,” says Joseph Coughlin, director of the Age Lab at MIT.

What can a midlife woman do in everyday life to inoculate herself against depression, obesity and illness? Reverse the typically negative thought pattern of family caregivers I have interviewed:

  • Why am I so alone? In fact, 61 million Americans are performing this most compassionate of roles. The value of their unpaid contribution to the economy has increased in only two years from 385 billion in  2007 to 450 billion in 2009. So, you are not alone. You are the backbone of our broken long-term care system.
  • My family member refuses to let anyone but me care for her/him. Call a family meeting, but be sure to have a neutral mediator run it – a geriatrician, social worker, psychoanalyst, or care manager. Make sure your loved one is present. Everyone will hear the same medical facts and be asked what they can bring to the table to assist the primary caregiver so she doesn’t get sick. When Bonnie Heath did this, her husband’s siblings each took a day and the Heaths resumed their nightly walks.
  • Why can’t I do anything right? To interrupt the drift into depression, before going to sleep write down three things that went well today and what you did to make sure they went well. This technique has survived placebo-controlled tests and proven to be extremely effective as a guard against depression if it’s done regularly for six months.
  • I’m exhausted all the time but I can’t sleep. You need a happy hour, at least one hour, every day, to break the cycle of hypervigilance that keeps stress hormones circulating through your system. Go off and do something pleasurable for yourself. Take a brisk walk or bike ride or a   Zumba class. Have coffee with another caregiver, your best source of support. Watch episodes of your favorite comedy show and laugh out loud.

Journalist and lecturer Gail Sheehy is the author of 16 books about adult life stages, including Passages in Caregiving: Turning Chaos into Confidence.

12 comments so far.

  1. avatar Joan Larsen says:

    “Why are we so alone?”  Getting down to basics, our world has changed so radically in the last 50 years.  . and there are few friends and family we can count on now.  Generations of family, often living close by, are now scattered to the four winds.  The husband that helped us raise the children has a fairly good chance of being long gone.  Few people know the real meaning now of “close friends who would do anything for you” — as they are off living their own lives.  There are exceptions, but how many of the present generation of midlife women still have childhood friends that still mean more to them than newfound friends?  It used to be common.  I still have 8 that stick with me and vice-versa through thick and thin — listening to me., being there for me — and vice versa.  Can anyone in this day and age get close??? 

    Then there is the caregiving issue.  Family is living longer and with it comes long-term illness that very often assures that someone in that family is caregiving.  Now we come down to the basic problem:  with scattered families, with males who still believe that caregiving is a woman’s job, it is rare when a whole family shares caregiving.  If by chance they live close by, there are usually issues between family caregivers on how well they are doing their job.  Another pressure.  But the main load comes down to one.  .  . and as months go into years, they often are living a living hell.  And then there are the family members who think by sending money once in a while, they can avoid even seeing the sick member — or seeing the now declining and worn out caregiver. 

    Frankly, a large number of us who care give are too tired for exercise class, having responsibilities that go into the night, like it or not.  My own favorite way to relieve the tension and the feeling of put upon – sad to say – is to get to the computer and spill the day’s frustrations out.  Some years back, we could call up our best friend – that one there for us in thick and thin – who would listen to us.  We need to “spill it out” to enable us to go on to the next day.  But our listening post is often too busy to even answer the phone, much less walk with us for half an hour.

    “Why can’t I do anything right?”  Frankly, I think we often think of ourselves as martyrs, working, taking care of children, and perhaps a family member, without enough money.
    We are doing everything “right” — but the point is that we are doing EVERYTHING with no let up and no end in sight.  We internally believe that we should have every gold medal in the world pinned on us – or at least be recognized and thanked.  Hasn’t “thanking” those who are doing good almost gone out of style — along with manners??? 

    Those of us who have passed midlife took care of our children, were sole caregivers of relatives (I took care of 5 in sequence of 20 years and it was a strain to put it mildly).  To me, it goes back to my first point.  . and that is our quality of life is not nearly as good as it once was.  The stability of family is not there.  The reliability of friends — well, try counting those friends you can count usually on with one finger.  Call it problems of society – call it anything you want — put bandaids of advice out there and hope some will work . . . but let’s be honest here, and let’s dig into the roots of all of this.  Unfortunately though, we just don’t seem to have the answers that will return us to what was – to many – a far more stable and better life – life filled with love and caring and “being there”.  I don’t see an answer in sight, do you?  And how sad is that  ????

    • avatar Lila says:

      Joan, so right, and so depressing. And – why is it that so many more women than men are affected by this “sandwich generation” issue? For the same reasons that women are still so unequal in matters of balancing careers and parenthood. Women are still viewed as the caregivers, the nurturers, the ones who can shut themselves away from society and devote themselves to the long-term care of a family member. Never mind about her social, intellectual, and recreational needs.

      This is made so much worse today because – as you observed – families are scattered to the four winds and we really are left pretty much alone. The only way to NOT be left alone is to get yourself out and about. But caregivers usually can’t do that…

      • avatar Joan Larsen says:

        Lila . . . In writing, you are opening up another question that is rarely if ever looked into — and that is the make-up of men.  Over my lifetime, I have spent far more time with men than women, observing them, watching as we talk, and seeing how they respond in private situations and in emergencies and more.

        I don’t think it is a surprise to any of us that women are intrinsically “the nurturers”.  Is this something we learned at our mother’s knee?  As we have all kinds of mothers with all types of personalities, I somehow doubt that is something we can point to.  Not being a scientist, I cannot explain.  But just guessing — I think that it may be something within our female hormones from Day One. 

        Some of us are very good at it — and love this role most of the time.  I am proud to say “I care”.  In watching men in circumstances where they must take on duties long term that women are seen doing, in general they handle it in a far less personal way.  Most actually can “be there” but tend to stand 10 steps back.  In personal issues, in health issues where time must be spent, the emotional element that women have kicks in.  We are quick to establish a closeness, sensing needs before they are voiced, giving love in words and deed far more easily. 

        Again – in general – if situations were reversed, I would far more like to have a woman friend or relative as a caregiver.  They “get it” and often they give us that big dose of love that comes with our package as women – naturally for most. 

        Talking caregiving now, is this inequality fair?  If we split a pie in half, it is not.  But perhaps we should not talk of “fair” so much.  Even though it is a killing job when it goes on to the end, almost killing me more than once, I know I am giving someone I love the nurturing at a level that I have not seen men (in general) can give.  They don’t seem to have the “hands on” that is needed.  I am not sure this is learned at a mother’s knee.

        I want to give what I would like to GET if the shoe were on the other foot.

        Good men have other qualities that have held me in great stead at other times and on other issues.  There are many daily things that I just don’t like or want to do that they do without making an issue of helping.  They can “be there” in other ways.

        Is it then an even exchange?  Life should not and is not going to be an “even exchange” — as we all know sometimes we – the women – give 110% — and, if we are honest, there are times when we are at such low ebb and notice that men have risen to be all they are able to be.  Nurturing men?  Well, I guess – some times – you might call it that :-) But – in my own life – in the areas that I am far from perfect, I have someone who IS, thank God.

        But to caregiving for any age of a person — no gold stars are enough.  But for those who watch their close ones give their all as they sit and watch, they could start off by giving the person thanks — and thanks often.  And small touches of any sort that say any appreciation is better than feeling like you are going alone on this long journey, falling in more pitfalls than you could ever believe. 

      • avatar Lila says:

        Joan, I think men ARE different, more impersonal. Not only does it show in childcare issues in developed countries – it is SO much more pronounced in developing countries. This is why Grameen Bank soon began making its micro-loans almost exclusively to women: men would spend the money on themselves and rarely pay it back; women used the money to build an enterprise that would feed and educate their kids and improve the home, AND they almost always paid the loan back. I recall an article about an African woman who earned a pittance sweeping streets; at home, all the wives and children slept on the dirt floor, while the sole man had possession of the sole bed. Stories like that abound.

        There are theories that this difference between men and women is tied to biology: women take much greater biological risks and invest much more biological energy in procreation, than men do. (Think of a time before modern medical care here). A woman of typical fertility can only have a few children in her lifetime, each pregnancy representing a significant risk to the mother’s life and health. A man of typical fertility can have children by however many women he can manage to impregnate, and there is very little intrinsic risk for him. Look up “man with most children” and you run across quite a few extreme polygamous cases where the man has 78, 94, 170, 210 kids.

        So. It is in the woman’s reproductive interests to land and keep a man who can help support her and her offspring, and to invest a lot of attention and energy in making sure her offspring make it to adulthood. It is in the man’s reproductive interests to just screw as many women as he can. Diametrically opposed. Seems a miracle that any of us find any decent men at all… thank God that human beings can sometimes use their brains to think.

        “Dangerous Liaisons” had it right when the old lady told Michele Pfeiffer: “Do you still think men love the way we do? No. Men enjoy the happiness they feel. We can only enjoy the happiness we give.”

      • avatar Lila says:

        PS, I think this was the secret of the popularity of the series “The Golden Girls.” It struck a chord of truth; that older women, finding themselves alone, might be better off keeping house together than seeking out a new husband.

      • avatar Joan Larsen says:

        Don’t know whether I fully agree with Michele Pfeiffer.  I think she may be right about men, but as me, I can enjoy the happiness I feel but get pleasure also in the happiness I give.

        And I notice I am one of the few — or less — who seems to have found just not one man – my wonderful husband – but more than a few others that could be cloned and I would seriously consider being with if death intervened here.  Is there only one perfect match for a woman?  Most would say there was none.  But I have already found that like attracts like and high qualities attracts high qualities in return.  I would never settle but on these hand-picked men, the top three would beat out any group of women.

        But I know that is unusual — and women roll their eyes.  In the meantime, I am living in clover.

      • avatar Lila says:

        Joan, long may your clover be thick and green!

  2. avatar Chris Glass` says:

    As a long term caregiver for my husband, mother (now deceased), and father-in-law I have learned to set priorities. If I break down everything crashes. When my husband was diagnosed with Myasthenia I made taking and keeping up with his medication his responsibility. I expected him to do what he could to help himself for as long as he was able to do so.

    When my mother had cancer I made sure the entire family was plugged into her care. Of course there were siblings that didn’t do their share but no one person was overwhelmed.

    The dementia issue was the straw that almost broke me physically. My husband only has one sibling living across the country who wanted no part of his care. My father-in-law was not a calm person he was prone to outbursts of temper. There was no place that either my husband or I could find peace in our home. During the years he was with us I had three broken ribs from being pushed down the stairs, a cracked hip from having a car door slammed on it in anger while loading his walker because it wasn’t fast enough to suit him. I stayed exhausted because he rarely slept for more than three hours at a time. I asked his social worker at the VA for help to get a referral for long term care. Not because we didn’t love him but because my husband and I had developed high blood pressure, were sleep deprived and unable to bounce back from minor illnesses. We looked at many places but chose a Veterans home because he could be with other people that understood he never recovered mentally from WW2. The facility is modern and cheerful with activities going on all day. The staff is well trained to handle any emergency. I do not regret the placement.

    Learning to let go and do what you can and set boundaries is the key to surviving as a caregiver without breaking down physically and mentally. It is not weak to seek help when you are overwhelmed.

  3. avatar Jeannot Kensinger says:

    Joan and I have been email buddies for years now…she knew daily what I was feeling and how I was reacting to the latest changes in my life. I took care of my husband for 13 years, the last one he was violent. A sweet, caring man and he did not know any of us and would hit if I tried to bathe him. The caregiving was non stop as we all know. I could hardly sleep wondering if he would run out …my ears no longer working very well made this a priority. Just stay awake, Jeannot, keep your arm on top of his body, You will feel him move. The laundry list NEVER stopped, no matter how often I would change the diaper. Often he took the plumbing out of the diaper soaking the bed. Cooking 2 or 3 different meals so he would at least eat one of them.
    Little by little I became older, in and outside. Wrinkles came out of nowhere, my BP was out of sinc even with my medication, the psoriasis tripled.
    I did not have time to think that I was a martyr .I only felt that I could not let go of him, he had been my big love and vice versa, we had such a lovely past.
    I started out with great help from my faith I ended up being agnostic (please no emails on that) I have been known to be brutal in my honesty.
    One icy day I fell down the steps and broke my ankle in 3 places. My man was inside sleeping not knowing me nor my change in life. We had to put him in a nursing home, my recovery took 6 months. He was gone in 6 months ..I think he had the best of care…not what I did for him for sure and he gave the nurses a run for their money.
    He left me 10 months ago and I can’t bear to hear the word “Alzheimer”. I am surprised I am opening up here this much. I do not want to know if I have it because I know for sure I would commit suicide before it would all happen in order to save my daughter this chagrin and work for years to come.
    I did not know to take care of myself during those years so one year after I broke my ankle I had to have the kidney removed full of cancer and 5 days later I fell and broke my back.
    Took 16 weeks to be able to walk and vacuum again but I am bouncing back, I started a small business again, retail being my life. I miss my husband a lot but I am living for tomorrow. I will be 80 in March and with my background it has got to be a miracle that I am still here. Oops! did I say “Miracle”? Old habits die hard.
    Sorry for the long 2 cents worth.

  4. avatar Joan Larsen says:

    Some of the loveliest, most caring women in the world I have met on this site.  I am sure they have not learned from me, but I have listened to every word, every deep thought and concern of theirs.  I feel in 4 years I have had a lifetime of learning what others have gone through, what others are going through.  And how they cope.  I find them unbelievable in their resilience, their sharing, and their beliefs that life can knock you down.  .but often, it finds ways – with the help of loving friends – to pull you back up.

    Jeannot, who has written above, is beautiful – inside and out.  Her life’s story from its childhood beginnings I will promise cannot be matched by the rest of us in its highs but also in its never-ending sorrows.  And yet, Jeannot is the strongest of the strong — and she has proved it over and over as she cared for her Alzheimer’s husband for too many years to mention.  She has written her feelings of the truth of each day of caring.  I did not know things could be so bad.  Nothing has been written of life with a husband you continue to love as if he were the stars and the moon – and yet have to do the things she has related above, over and over forever.

    She was young when her caregiving began.  Filled with joy.  The years of giving and giving tore her apart, wore her out.  Sometimes I would think she would not make the next day.  Each took its toll but she did, this strong little lady did.  Gold stars should have sprinkled down for the rest of her life, but instead one accident after another and then a bad illness followed in months of her husband’s death. 

    Jeannot touches me as I have never been touched.  The song “I will survive” must have been written for her alone — as, with all the tragedy in her life, she seems to find and cling to the rays of sunshine that may peek in, believing in the better life that will follow. 

    Jeannot still believes in miracles . . . and she has made those of us who met her through wOw, read her wise words as well as the words that told it as it was, believe that she is “the best of the best”. 

    Let’s all hope that the future for her is a time of happiness newly found and gorgeous rainbows that end at her feet.  I believe it is never too late for a new life to blossom.  I hope NOW is the hour!.  No one deserves it more.  Joan

  5. avatar Jeannot Kensinger says:

    Joan makes me blush.
    I owe part of my sanity to Joan. I have never talked to her but we know each other so well. No one in my family could console me or give me advice the way she did for years.
    I would get on the computer and look for her mail the very first thing in the morning, before my brew. I would sit and laugh or cry and I just knew I was not alone even so a 1000 miles are between us. I still do that looking for the latest on this or that that we share.
    If you have a friend, near or far, and the friend is in need of a few kind words, do not hesitate to email and open up your heart. You do not even know the solution to the problem but you can say :talk to me!I am here to listen.”
    Do not wait for birthdays, Mother days, Christmas or Hanukkah to write a few words, life is not about holidays, life is about every day. Some days with tears pouring salt into our mouth and sometimes the tears are from joy , alone we can’t make it.
    Trust me alone we can’t make it!
    Joan has been my rock but make no mistake this gal is busy, she has several people who need her emails and she keeps it up.
    Thank you, Joan Larsen, even my kids ask me :”what is new with Joan?” They heard me talk about her day in and out.
    wowowow was a door opening for a new world for me at a time I did not even know that I needed that world.
    Viva the internet and the friendships within.