Shortly after she threw up, the timeless dilemma of women`s health priorities became painfully clear.
”I had bronchitis, I had a fever of 102 and I was throwing up in the bathroom, and two hours later my husband wants to know what I`m going to make for lunch–not my idea of nurturing,” says an affluent, educated 32-year-old woman.
For Barbara Ettinger it took a stroke. A perfectionist as wife, mother and homemaker, Ettinger took exemplary care of her family. When it came to her own health, she was less dutiful: She continued to smoke two packs of cigarettes a day despite a family history of heart disease, and she put off seeing a doctor when the dizziness first began. Then a cardiologist showed her a picture of her heart: The right carotid artery was 95 percent blocked. She hurried home to cram a month`s worth of domestic chores into a few days so the family wouldn`t suffer while she took time off for open heart surgery.
”I wanted to give the house a cleaning that would last,” says the 52-year-old homemaker. I did the grocery shopping and went over all the finances and paid everything I could a month ahead. I called the school and talked to my daughter`s counselor so if she had a bad day or two they would give her the benefit of the doubt. I canceled her piano lessons. I wanted everything to be orderly for my family.”
On the morning of surgery she smoked a cigarette on the way to the hospital. At the same time, she felt guilty for being so ill, ashamed ”that it had come to this.” During the surgery, she suffered a stroke.
As women pursue new opportunities that history denied their grandmothers, most labor unconsciously under the burden of a role that generations of women have played to the grave: that of indefatigable nurturer. This warm, dense layer of behavior lies so close to the core of the average woman`s identity that she usually takes it for granted. So do the people around her. And when these nurturing women get sick, they suffer not only the physical discomforts of illness but often anger or resentment from their family, a cold shoulder from society and psychological side effects ranging from guilt and
deteriorating self-esteem to serious depression.
Nurturing women typically shortchange their own health. Whether they work in an office or at home, they tend to put others` needs, however minor, before their own needs for rest or relaxation. They frequently ignore the signs of overwork–headaches, fatigue, depression–and when they become undeniably ill, they make reluctant patients at home. Some find it too emotionally uncomfortable to relinquish the responsibilities that define them to family or co-workers. Others just don`t know how.
”The major message from our culture is the mandate that a woman is to be the physical, psychological, spiritual and emotional caretaker, first of her family and then of everyone else she comes into contact with,” says Judy Terpstra, director of Northwestern University`s Women`s Center. Whether the woman is the epitome of old-fashioned standards or newer, nonsexist ones,
”when it comes down to being sick, all that old-fashioned conditioning clicks right back in. It`s frightening.”
When women made the treacherous trek across the Oregon trail in the mid 1800s, one of every five of them traveled pregnant. This complication goes almost without mention even in their own diaries, despite the grueling physical demands, disease and hardship that characterized the journey, according to Lillian Schlissel in ”Women`s Diaries of the Westward Journey” (Schocken Books, $8.95).
”For women who were pregnant, the overland crossing could be a nightmare. One never knew for certain where labor might begin: in Indian territory, or in the mountains, or in drenching rain. One might be alone, with no women to help and only fear at hand. The birth might be simple or it might be complicated and tortuous,” but as Schlissel notes, ”Among rural Americans of the 19th Century, pregnancy and impending birth were not reasons to defer the decision to move, not when free land lay at the journey`s end.”
Nearly 200 years later the free land is gone, but still intact are the social priorities that place just about any household task, family duty or professional responsibility above a woman`s need to tend to her health.
In studies of gender differences and incidence of serious illness, men who don`t have a woman in their life face the highest risk of illness, while women who are married and have children face a greater risk than their unmarried counterparts, notes Dr. Nada Stotland, chairwoman of the American Psychiatric Association`s Committee on Women.
”It would seem that women serve to provide a healthful atmosphere for other people, but in the process–especially these days–they are almost all in a massive role strain from trying so hard to fill so many roles at once,” says Stotland, who coordinates psychiatric services for patients and their families at Michael Reese Hospital.
In their rush to meet others` boundless expectations, women are more likely than men to become physically run down, researchers say. Women also suffer greater incidence of depression than men, often the result of role overload. Despite their obvious need, when nurturing women fall ill, they rarely receive–or expect–the same level of care they so obssessively dish out. Yet no matter how miserly the attitudes of those around them, typically the women feel guilty.
”Women tend to be focused on meeting the needs of other people,” says Margaret Dahl, an assistant professor of social work at Loyola University and a women`s counselor. ”That`s what we do, and we don`t feel good about ourselves when we aren`t doing that.
”When a woman becomes ill and can`t `perform,` what happens on an internal level is that she feels very guilty because she can`t fulfill her responsibilities, and she is very realistically concerned about the gap–she`s likely to think about that before she thinks about her own needs,” Dahl says. ”She`s worried that she is not a `good wife` or a `good woman` if she is not filling that role.”
Society assigns the role of nurturer to women almost exclusively, regardless of their other responsibilities, and generally measures a woman`s worth by her caretaking performance at home, at work and in her relationships. If she becomes ill, a woman typically is expected to make her own arrangements for help–including asking family members to perform household chores. If anyone volunteers to assume greater responsibilities while she recovers, it is most often a female friend or family member, not a male.
”It`s much more common for a woman to feel constrained to interrupt her work schedule or feel in a terrible bind if her husband returns home from the hospital than if the situation were reversed and she were in need of attention,” says Stotland. ”The husband might stop off and pick up some groceries, but it`s far less likely that he`ll take a leave of absence or change his work scheme–or even consider it–to take care of his wife. That responsibility classically falls on the woman and continues to do so.”
As one 31-year-old single professonal woman put it: ”I can be really, really sick and I won`t even hear from most of my men friends, or maybe one will send flowers. It`s always my women friends who call or offer to pick up a prescription or bring over the chicken soup–men just don`t even seem to think in those terms.”
A sexist tradition in medicine has played a large part in structuring the no-win situation women encounter when ill, say feminist advocates. They maintain that women have typically heard their symptoms shrugged off as
”psychological”–meaning the product of their own faulty thinking–by doctors who routinely prescribe mood-altering drugs rather than suggest reasonable changes in family or workplace demands.
Today more doctors recognize the links between mental and physical health, but few actively use family counseling as a component of patient care. Despite predictable complications in family interactions when a woman becomes seriously ill, doctors rarely provide special counseling or make any substantive effort to help modify expectations by the woman or her family to create a home environment conducive to speedy recovery.
”A man goes home sick, and he needs a special diet and dressings changed, and we assume his wife is going to do that for him,” says Dahl of Loyola. ”You send a woman home with the same needs, and chances are she`ll have to do all that for herself.”
The striking differences in gender expectations become clear when you compare men`s and women`s responses to the same health condition.
In her extensive study of patients recovering from coronary by-pass surgery, chronicled in ”Change of Heart” (Harcourt Brace Jovanovich, $17.95), author Nancy Yanes Hoffman found predictable yet poignant evidence of the double standard.
Although roughly 25 percent of by-pass patients are women, society generally perceives heart disease, and especially by-pass surgery, as exclusively men`s domain, Hoffman says. Women patients reported that doctors frequently treated them unsympathetically–as chronic complainers–and that hospital coronary care units operated like ”men`s only” clinics where women patients were treated as unwelcome outsiders.
”The attitude you heard voiced a lot is, `Well, if those broads want to go after men`s jobs they`d better be ready to get men`s diseases,` ” says Hoffman.
”But the fact is, none of the women I interviewed had even a token acquaintance with disposable income. Most were immaculate housekeepers who felt that the care and feeding of their husbands and children and parents were their most important responsibility.
”They were conventional women and they found their stresses right at home in demanding, wandering husbands, physical and psychic distance from their children and grandchildren, and the job of caring for aging parents.”
Homecoming created even greater stresses for the women. Those who were single had to face the challenges of recovery alone. Those with families struggled with different demons.
”Several wished their husbands would take a week and stay home with them, but they were ashamed to ask,” Hoffman says. ”They were ashamed they were so sick–and with something everyone around them considered a `man`s disease.` ” Often the women were desperate to maintain their caretaking role because they doubted their worth to their families otherwise.
”One woman baked six cakes and put them in the freezer before she went to the hospital,” Hoffman says. ”Several others had cooked up and frozen entire meals for their families to see them through the period. Many feared what would happen to them if they stopped trying to please–they feared they`d be abandoned. They feared they wouldn`t be loved anymore.”
In follow-up surveys of 1,100 by-pass patients and their families, Hoffman says, wives of by-pass patients typically expressed a strong desire
”to wait on their husbands and help them get better.” Husbands of by-pass patients ”wrote complaining replies–they felt put upon–basically they weren`t happy with the service at home anymore.”
Society is slow to change, but individual women are making progress in bringing a healthy balance to their desire to nurture others and their need to nurture themselves. Many are turning to individual or family counseling for help in breaking undesirable behavior patterns. Others are finding success through less formal round-table negotiations with family members.
”Sometimes you have a middle-aged woman with teenaged kids, but she`s still doing all the laundry and the grocery shopping and everything. I usually give them a little nudge with the suggestion that family members could reasonably be doing more–that teenaged son can do some grocery shopping–and sometimes that`s all it takes,” says Dr. Don Casey, an Oak Park internist who routinely considers family dynamics as part of the treatment plan.
Elderly women patients frequently are reluctant to ask for continuing help from their grown children, Casey says, but just as often ”the children feel it is something they want to do for their mother.”
When Barbara Ettinger returned home a month after her surgery, her family had strung banners outside welcoming her back. Inside, a tower of bills and unopened mail awaited her. ”They even saved the ones marked `Occupant,`
” she says. As the dinner hour rolled closer and no one stepped forward to do anything about it, Ettinger knew it was time to call for a huddle.
It had taken her a month to regain the use of her legs, initially paralyzed by the stroke. Now she faced a strenuous rehabilitation program to regain full use of her hands.
”I sat them down and explained briefly how it was going to be–that we were going to assign some tasks that might be distasteful but that it wasn`t punishment and it wasn`t forever,” says Ettinger.
”I`m learning to say `no` more readily and I`m saying what I think more than I ever did before,” Ettinger notes.
”But I have to do it. You have to learn to put yourself first sometimes, you have to learn to be a little bit selfish to survive.”
