“51-year old female presents today with …”
Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to psychiatric consultation. Mental health practice is funny that way. Groups of people, age clusters, diagnostic groups-they all tend to show up in bunches and herds and gaggles. Could be the full moon. Could be environmental toxins. Could be nothing.
At any rate, I have some thoughts about this whole woman in her fifties thing.
Fifties women are caught squarely in the middle of I’m-grown-and-I-don’t-need-you-to-take-care-of-me-any-more children and I’m-old-and-I-need-you-to-take-care-of-me-constantly parents. They are conflicted. They want to be mothers to their children, who they see slipping away into adulthood and not needing them any more. They want to be adult children to their parents, not quite ready to take on the mantle of the oldest generation themselves but knowing that the time to do so is rapidly approaching. They are worried about empty nests and nest eggs and quiet and emptiness and nights with worries about globetrotting children and parents who left unattended will walk out the front door in nightgowns and slippers. They are the glue that holds their world together, acting as a resonating resin that is pulled and stressed and taken to the limits of its ability to bend but not break. They are stressed, but they feel that this is the place they must be. If they let themselves be pulled too far in one direction or the other, someone they love will be short changed. The only option is to plant both feet firmly on the ground, stretch each arm out, and hold on tight until something gives.
The problem is, the thing that often gives is the fifties woman herself. She suffers from it all, sometimes quietly, sometimes noisily, but she suffers just the same. She has the OCD that has never been diagnosed. She has panic attacks every time she sets foot in Walmart. She has the wild mood swings of bipolar disorder, making the best use of her mania while trying not to kill herself when in the doldrums of a deep depression. She is the mother who never gets over the baby blues and feels uncomfortable every time she picks up a kitchen knife when her baby is within arms reach. She is the closet drinker who could never drink anything but the best wine and the most expensive liquor, though more of it than anyone in her family ever knows. She suffers from unprocessed guilt and rage and disappointment and sadness that her busy life affords no time to deal with.
The fifties woman feels guilty for being ill, so she tells nobody. She constantly tells me that she is the rock of her family, the matriarch, the strong one, the one that everybody else comes to when they need help or solace. She washes the clothes and cooks the meals and bakes the cookies and drives the car pool and goes to the appointments with her frail parents. She keeps her schedule in her head. She is a caretaker, a people pleaser, a model woman, at least in the eyes of the world. In her own eyes, in her own heart, she is a miserable failure. This makes her go faster and try harder and take on more. This eats at her and erodes her physical and mental health.
The good news?
The fifties woman has many, many reasons to get better. She has the love of her children and her parents, who may not tell her often enough but feel it intensely just the same. She has grandchildren coming, or maybe already here, and they open up a whole different world of love and reason for being. She has a home that she has worked on and built and crafted for years, a place of comfort and safety for her and her family that anchors the emotional lives of almost everyone she loves. She has the rest of her life ahead of her, a whole new chapter of being a woman who has run the race, stayed the course, and is now ready to learn new skills, experience new things and find out who she really is.
I’m always glad to see these women.
They know where they’ve been, they know what they’ve accomplished, they know what stands in their way and they are ready to take the next step and grow.
Greg Smith is a psychiatrist who blogs at gregsmithmd.
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