The Caregiver's Handbook

Caring for a loved one—and yourself

Man the Fixer, Woman the Nurturer—the Caregiving Gender Gap

Are husbands and wives predestined for different roles?

Do men, in general, cope with the emotional stress of caregiving differently than women do? Are there certain emotional challenges that husbands are more likely to encounter? Do they face different challenges?

Linda and Larry married in their late 30s. They've enjoyed 25 years raising children and now spoiling grandchildren. In many ways, their lives are similar. Linda works part time in real estate and Larry part time at his law practice—and they split all the expenses equally. They enjoy playing golf and riding bikes together, and share many interests and friends.

In other ways, their lives are dissimilar. Larry's in charge of hiring people for house, yard, and pool maintenance, and he makes sure the cars are tuned up. He oversees legal matters, and does all the investing for the couple, because he loves that. Linda was a hands-on Mom to the growing kids, and the chauffeur and cheerleader for their athletics. Now she is in charge of all things medical for the family plus the cleaning, shopping, cooking, and entertaining. She is also very involved in the grandchildren and all of their extracurricular activities.

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Given their separate-but-equal roles and skill sets, what happens if one of them becomes terminally ill? How will they manage their new responsibilities? For both, their life and the marriage they knew will have ended. When we become the caregiver for someone we are in love with, our intimacy and special bond are threatened. How can we maintain the intimacy we once had with someone we are now spoon feeding or cleaning after a visit to the bathroom? How can we feel close to someone who has "ruined" our life and placed so many new demands on us? How can we avoid becoming the "caregiver from hell"? (See Jane Brody's great article, "Caregiving as a Roller Coaster Ride from Hell," based on her interview with me.)

Let's look at what typically happens with each gender. Keep in mind that these are generalizations and don't apply to either sex all of the time.

What men face. The biggest challenge for Larry is that men are providers, protectors, and fixers. That's their biological programming. So Larry approaches Linda's illness as something to fix. That's good because Larry may see caregiving as a separate task, rather than a way of life, and can get away from it mentally more easily. That's bad because he can't fix it. This makes him feel like a failure and may lead to depression. Whatever the reason, the divorce rates are much higher when a wife is sick.

Men are not seen as caregivers, so praise is more likely showered upon them when they do it. While Larry may not seek help, nurturing women around him will offer. If he doesn't cook or clean, friends are more likely to offer assistance, along with information regarding nursing and other services to help Larry avoid dealing with delicate duties.

Rather than share his concerns with friends or use support groups, Larry gets his emotional support indirectly, just doing "guy" things and being with his friends, without having to say a word about what's going on.

Although he took on new duties and roles, those likely will stop when Linda dies. They were things he only needed to do or know about temporarily, including cooking, since the casserole brigade will probably line up at his door the moment Linda has passed on.

What women face. Biologically, women are the nurturers. That's good because the caregiving role is more natural to Linda. That's bad because she isn't even considered a caregiver. It's expected of her—she's just doing what a wife is supposed to do. So Linda's efforts go unnoticed and unappreciated. And since she's expected to know how to do this, help isn't offered—yet there will be plenty of people to tell Linda the "correct" way to perform her duties!

As a "good" wife Linda may immerse herself in Larry's care. While she isn't expected to fix his illness, she certainly should be able manage everything about his care and ensure his happiness. She is at physical risk because she is smaller than Larry, and handling him is difficult. While Linda may normally share concerns with friends, she's learned that people may get tired of listening.

Though Linda has been a nurturer, she hasn't been a nurse. So the nursing duties are just as foreign to her as they are to Larry. Whether changing tubes or emptying catheter bags, this is not the kind of nurturing she did as a mother. Along with her previous roles, caregiving was added. But on top of that has come household maintenance, finances, and legalities. These are difficult to learn quickly and can have dire consequences if handled ineptly. When Larry dies, Linda can only shed her caregiving and must continue these household, financial, and legal obligations. Unlike when a husband dies, there may be no casserole brigade on its way to Linda's doorstep.

"What can couples do about this?" This is the important question. Whether you're the man or woman caregiver, rather than having a negative experience resulting in irreparable damage and regret, you and your loved one may acquire tools to get through your challenges with a very different outcome. You can reclaim your love and your intimacy. Your life and your marriage do not have to be over!

In my book, The Caregiving Wife's Handbook, I offer strategies, tools, and resources that have helped many couples navigate through a long-term serious illness. They can help you too. In future blogs, I will share many of these, so stay tuned.

Diana B. Denholm, Ph.D., L.M.H.C., is a medical psychotherapist and the author of The Caregiving Wife's Handbook.

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