The ‘sandwich generation’ and the dilemma of caregiving

For people in their 40s and 50s, who are taking care of their parents as well as their own children, being the “sandwich generation" comes with a variety of anxieties and stressors. A 49-year-old female client recently told me that after her father’s death eight years ago, her mother’s health began deteriorating to the extent that she requires dialysis twice a week. To help out, they moved her into a flat in their building complex, even as their 21-year-old daughter began looking for a job and needed help with the process. “My father-in-law, who lived by himself, had a fall last week and my husband is trying to bring him to Mumbai so we can care for him," she said, adding that they are also pet parents and don’t have the space in their home for elderly parents. “I feel stretched whether it’s financially, emotionally or physically. My husband and I only discuss logistics, we have forgotten what’s it like to laugh and pause."

Others in this age group who find themselves in this position talk about their responsibilities that range from caregiving and hospital visits to caring for their own children, paying bills and managing finances, while also juggling their own jobs.

Also read: What is the sandwich generation's dilemma?

They show up in therapy feeling unhappy, anxious, irritated and lost when it comes to planning for their own life. They are overwhelmed with responsibilities and feel a loss of autonomy. Then there is also guilt about having unpleasant feelings and a lingering fear that they are not doing enough for their children or their parents.

The term “sandwich generation" was coined in 1981 by social workers Dorothy Miller and Elaine Brody. More women than men bring this up in therapy as they find themselves juggling multiple roles. What I also see in my clinic is what Carol Abaya, an elder care expert, calls the “club sandwich" generation. This refers to adults who are supporting their ageing parents, their adult children and young grandchildren. This also includes a section of young people, who are supporting their parents, their grandparents and their own children.

Multi-generational care is tough at every level. What makes it more challenging is that families choose not to actively talk about the responsibilities, scheduling and emotional challenges that come with it. Often there are unsaid expectations and beliefs around caring and sharing of duties, which becomes a trigger for conflict between couples.

Continuous caregiving can lead to hypervigilance and put individuals in a chronic state of uncertainty. Given this degree of anxiety, many individuals who are caring for others in the family report feeling dissatisfied with their quality of life and how their patience and stress threshold is continually being tested.

Both the individual and family resilience gets compromised. There is no guidebook or manual that tells us how to attend to these concerns that may show up in very subjective ways across families.

My understanding is that the stress around care can only be managed, rather than solved. This at the family level, requires an acknowledgement that it’s tough, and a process of structure, clear communication and larger conversations around financial awareness so that there aren’t any assumptions around who’s supposed to do what.

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There is a risk of burnout and empathy fatigue, so making space for self-care and being aware of one’s own unmet needs is crucial. Companies too need to recognise this issue in their workforce and focus on building spaces, either through workshops or resources, where employees feel that their concerns are seen and heard.

Sonali Gupta is a Mumbai-based clinical psychologist. She is the author of the book Anxiety: Overcome It And Live Without Fear and has a YouTube channel, Mental Health with Sonali.

Also read: The power of friendships across age groups