The sandwich generation of women that are burning out hard and fast
This newsletter was originally posted on my Substack- please follow this link to sign up if you’d like my weekly newsletter delivered to your inbox!
My boundaries challenge starts this coming Thursday 1st June!
Every Thursday for 4 weeks I will be sending out an additional newsletter on the theme of boundaries. You will learn how healthy your boundaries are currently, how to work out your sphere of influence, how to learn and develop your empathetic assertion skills, plus how to manage The Guilt and show yourself some self compassion too.
Expect advice, guidance, exercises, a quiz, some journal/reflective writing prompts, my favourite therapeutic technique and a self compassion guided meditation. PLUS I’ve provided the newsletters in audio format so that you can listen on the go if you find that easier too. It’s not one to be missed! If you would like to have these newsletters direct to your inbox, please subscribe, and don’t forget to share with your friends and colleagues if you think they might benefit too!
Last weekend, as the UK finally basked in some beautiful Spring sunshine, I sipped a glass of Prosecco in my back garden with one of my very good and longstanding friends. At the top of her professional game in a senior role in a difficult public sector job with huge and very public responsibility, 2 young children including one with likely as yet undiagnosed neurodiversity, plus 2 elderly and increasingly dependent parents in their 80s who need her to help with, well, everything, in addition to perimenopause looming on the horizon, makes me wonder in awe, “how on earth does she do it all and stay sane?”.
The truth is that for the majority of working women in their 40s, their mental health is being stretched to beyond breaking point thanks to the unholy trinity of having young children, caring for elderly parents and approaching the perimenopause. Worse, this unholy trinity is contextualised by the fact that society that still expects and demands women to carry the majority of caring responsibilities and domestic load alongside their paid work. This is the perfect storm for burnout.
In cis-heterosexual relationships, we know from data that women do more of the household chores compared to men, even when both spouses work full-time jobs, and that this gap gets bigger when a couple has children (from US government data).
But it’s not just the physical domestic workload that falls disproportionately to women, the mental work of keeping a family running also falls to us. The data shows that women are primarily responsible for keeping household routines, organising schedules, maintaining order, and providing emotional support to children. This disproportionate share of the mental workload is associated with a poorer sense of wellbeing for women and lower levels of satisfaction with their relationships (source: Ciciola, 2019).
The disproportionate mental load on women is in fact even more nuanced and complex than this.
Hands up which of you identify with worrying about childcare when you’re at work. Do you constantly dread the phone call of doom from nursery to say your beloved child has got a fever? Do you worry about the commute home and getting to nursery pick up in time to avoid a fine? Do you feel guilty for being away from your children, even though you know that they are safe?
This is seen in the scientific literature too. Women are more likely than men to worry about childcare even when they are not with their children. It causes huge additional stress, because it is always present – even when you should be concentrating on other things.
The mental load process can be divided into four parts: anticipate, identify, decide, and monitor, and women disproportionately engage with different parts of the process compared to men.
To give an example of how to break the process down, let’s imagine that you are thinking about applying for a school place for your child. “Anticipate” means looking for schools the year before; “identify” involves setting up tours and talking to others about your options; “decide” requires choosing the best school for your child; and “monitor” entails making sure the paperwork is turned in, the school uniform is bought (hopefully not grown out of yet!), and your child is ready for the first day.
Women are much more likely to handle the “anticipate” and “monitor” steps in the process. In the majority of families, women are more likely to put an item on the agenda and more likely to follow up to make sure it got done. This is true even for household tasks assigned to the male in the household. Male and female participation in decision-making is roughly equal; essentially, once the item was on the agenda and the research completed, couples tended to make decisions together (source: Daminger, A, 2019).
What this means for us is that women aren’t just disproportionally taking on more of the mental load, we’re also taking on the most draining bits. No wonder we’re knackered.
Steph, the founder of Don’t Buy Her Flowers, describes this never ending overwhelm perfectly in her recent article for The Juggle:
“I think part of the problem is that we can see how lucky we are compared to many, and we do cope. And when I say ‘we’, let’s be straight - women are still carrying the load required to run a family. In fact CNBC reported that as women’s financial contributions increase, they pick up a heavier load when it comes to household chores and caregiving responsibilities. Perhaps because they’re trying to make up for working and not having total focus on the family.
Because we are a guinea pig generation. More women are working in some capacity, but that hasn’t led to a fundamental shift in what happens at home. So we’re just adding, while often trying to simultaneously replicate the more traditional role we saw women in our parent’s generation carry out. Then as we’re having children later, we’re also managing a timely triumvirate of kids that still need us, ageing parents and perimenopause. And we’re wondering why we feel broken?”
You can see that the increased load on women is, in itself, a risk factor for burnout. But then added to this, not only are working women in their 40s being lumbered with additional invisible and internal mental load, in addition to childcare and care of ageing parents, you’re likely to be battling against the perimenopause at the same time. This adds a very much unwanted layer of complexity to how women feel in themselves, and their mental wellbeing.
The physical and mental effects of perimenopause and the menopause on women has, quite rightly, had a lot of publicity over the past couple of years. As a clinician I’ve seen far greater numbers of women coming forward and asking for help with their symptoms as a result of “the Davina Effect”. Whilst this is great, what I’m now seeing is a subgroup of women whose symptoms of mental and physical exhaustion, sleepless nights, anxiety, worry, panic are not fully due to the perimenopause, but burnout.
One such patient came to me having had lots of tinkering done to her HRT by other GPs in an elusive attempt to manage her mental and emotional symptoms. She had the preparation changed and the dose increased. Whilst a lot of her physical symptoms, such as hot flushes and joint pains, had settled, her mental health was still the pits. She wanted me to make more changes to her HRT.
We chatted, and it was obvious to me from what we were discussing that she had burnout as well as menopausal symptoms. She described overwhelming pressure and stress at work, which was overspilling into her personal life. We discussed that, as her physical symptoms had settled on the new formulation of HRT and now on the maximum dose, we would have expected to have seen an improvement in some of her mental health symptoms. As we hadn’t seen this, we agreed to explore the possibility of her having burnout in addition to her menopause. I saw over a number of times over the coming weeks, and we both came to the conclusion that this was the case and she was grateful to me for having suggested burnout as a cause for her symptoms. This recognition really matters, because HRT alone is not going to solve burnout.
The take home from this patient’s story is that we shouldn’t be pigeon holing women in their late 30s onwards into blaming everything on the perimenopause and menopause, simply because of their age. As always in medicine, context matters. You have to understand these women in their work context, their societal context, their economic context, and in their personal context in order to really work out why they feel like crap. For some it will purely be menopause, for some purely a primary mental health problem, and for some a brutal combination of the 2.
And, we’re tired. Not a little bit tired, but bone achingly tired and utterly depleted. The way in which we live our modern lives as working women is the perfect storm for burnout, let alone with the added complexities of perimenopause.
Coming back to my friend. She is, somewhat miraculously, genuinely doing ok. Her level of resilience astounds me, and I’ve learned a lot from seeing how she copes with her stress. Here are some ideas about how to stay strong and resilient if you are from the sandwich generation:
Outsource and delegate everything that you can. I know that the ability to outsource comes with huge privilege, and that this won’t be accessible to all of you. But, if you have the means, please outsource everything you can. Whether this is the cleaning or extra childcare, having a smaller physical load will make a difference. But don’t forget that delegation is accessible to us all regardless of socio-economic status. You can delegate the laundry to your children, if they’re old enough. You can delegate some of your work tasks to other members of your team. You can alternate the cleaning with your partner (or whatever it is that you would like to share with them). Don’t be afraid to offload the physical stuff. When you do this, you will gain a bit of space for some of that annoying mental stuff that we tend to carry as women (such as “anticipating” and “monitoring”, and worrying about childcare when you’re at work).
Talking of your partner, when you ask for what you need, they need to listen and deliver. Even if delivering means compromise (this is what a long term relationship is, continuous compromise!!), they still need to share the load in a meaningful way. If they don’t, you need to question whether you really want to be in a relationship with someone who does not put your emotional needs on a par with their own.
You can’t change who you are, but you can change how you think. CBT and ACT are 2 excellent and evidence based forms of therapy that will help you to carry the mental load, and both are evidenced in burnout too. If you are finding things hard I do recommend that you think about accessing some therapy- trust me, it is a game changer.
Don’t get sucked into thinking that if you get up at 5am to work out, try to time block, or write multiple to-do lists. F!ck productivity hacks, you don’t need an extra hour in your day, what you need is proper physical and emotional support. You need a Village. Peer support is key for burnout prevention and recovery. Find them, either online or in real life, and use them.
If you can’t do it all remember that it is NOT your fault. You’re human and your capacity for stress is not infinite. If you are worried about your mental health then please do speak to your doctor. We are here to help for whatever problem or combination of problems you are currently experiencing. We can’t change how society is structured (smashing the patriarchy isn’t yet on medical school curriculums!), but we can help you through the difficult times.
References:
US Government data: https://www.bls.gov/news.release/atus2.t01.htm
Ciciolla, Lucia; Luthar, Suniya S (2019). Invisible Household Labor and Ramifications for Adjustment: Mothers as Captains of Households. Sex Roles; New York Vol. 81, Iss. 7-8, 467-486. DOI:10.1007/s11199-018-1001-x
Daminger, A. (2019). The Cognitive Dimension of Household Labor. American Sociological Review, 84(4), 609–633. https://doi.org/10.1177/0003122419859007