Director: Elvira Reale
FAMILY WORK
AS MAIN RISK FACTOR IN DEPRESSION
Female role is culturally learned, built up upon the biological difference between women and men and based on the principle, coming from the reduction of women to their mere reproductive functions, that the activity of family care keeper is the main issues of female role. Within this frame men are considered the ones capable to maintain relationship with society, which are denied to women because too busy with their home activities, which stays for reproductive job and family care giving, on one hand, and, on the other, because considered inferior in comparison to men, either physically or intellectually.
According to this point of view, man turn into a tutor who pays back woman’s work at home with his protection and mediation with the external world, with society.
This is where women’s dependency socially originates as much as it does the herself consideration as a person missing value, compared to men (that low self esteem, often at the origin of depressive pathologies), and her own perception of needing men’s presence to survive.
The crisis of family starts building up when this peculiar balance crashes:
- When a woman relates to the outside on her own
- when a woman can’t find home the gratifications that the relationship with a man supposedly provides to her.
Recent history tells us that:
- House keeper women as much working ones keep their family care giver role, which leads to an overloaded job
- The charge of the family care keeps women away from fully participating into their professional and social life and this is considered as a demonstration of women’s lower professional and social value: they, therefore, need men’s presence to emancipate from their own supposed inferiority.
To talk about family work needs to consider two main issues: charge/quality of the work and the person who’s in charge of it. The home care giving is a complex activity that involves, at the same time, both executive and management chores, technological updated knowledge, capabilities of affective and relational support: a good example could be the complexity of the daily care of a child. If we consider this kind of work applied to all the components of a family, we can, then, have a clear idea not only of its incredible amount of charge on woman’s shoulders but, also, of how much it contributes to a family balance and how much the possibility of satisfying all the needs, without creating internal conflicts, depends on it too.
It appears now how much this kind of job could be considered as a model alternative to the typical marketing organization where profit leads actions bypassing or ignoring consumers health and wealth goals. But, unfortunately, up till now, those aspects are bared or lowered down by the prevalent point of view, the male one, which looks at women as inferior persons and low labour.
We’ll talk, here, about damages caused by these life conditions on women’s health and wealth.
Our work group, since 20 years part of the Italian National Public Health Care System, deals with women’s mental health care and, since 20 years, finds depression the most relevant problem for women.
W.H.O. statistics talk about depression as a world wide emergency, which in 20 years will be at second place among causes of disability and, in our days, is twice more relevant in women than in men.
Official medicine and psychiatry explain this event through a merely biological/hormonal reasons and/or axioms of a supposed link between certain characteristics, considered as “typical” of female personality, and depression problems. Even theories, which look at stress and life events as possible causes of depression, don’t go further on than taking in consideration events of affective kind such as death, abandonee, separations etc..., ignoring or denying the relevance of work as risk factor. And if they do consider work, like in some international researches, they only mention consequences of external work, paid by the market, and not of family care charge.
Work stress is taken in consideration as a risk factor for men when it comes to the aetiology of some men prevalent diseases (cardiovascular) but is not considered in relation to its consequences on some women prevalent diseases such as depression: women become, this way, the easy target of pharmaceutical industries as the largest number of drugs users, especially anti-depressive and tranquillisers ones.
The stress theory could, instead, help us thinking differently about the aetiology of female depression, basing on the specific women’s daily life conditions, allowing, also, in a next future, the possibility of planning real preventive actions, besides or in place of current pharmacological therapies. Thinking about life conditions, better yet, environmental pressure, as possible risk factor in stress diseases, means, then, to think about a solution for its cure or prevention in terms of need to lower down this kind of pressure. In this way, stress does not put a stigma or a guilt on women for being biologically or personality wise different, which can not be changed anyway, but to them their role and the chance of taking care of their problems without necessarily run to drug abuses.
We are, at this stage, in front of two different kinds of problems:
1° QUESTION:
Can family work be a strong stress factor in a woman’s life? Could, better yet, be the most strong stress factor which explains the higher mobility in women and the epidemiological differences between men and women?
According to those researches that have taken in consideration the stressing aspects of family work, there is a greatly shared opinion that family work, because of its peculiarity, becomes the main factor of stress for female gender, causing, besides, even a larger vulnerability in women in their extra-familiar work. If it isn’t always true the opposite - better yet, extra-familiar work can, in many cases, become a protective factor against familiar work stress – it is neither proved that working women fall ill more then house keepers: actually statistics prove that working and not working women have the same rate of mobility.
2° QUESTION:
A second question comes along, now, could the stress from familiar work, common to either women doing extra familiar or to the ones who don’t, lead women to depression state? Stress from family work could, then, be the specific women’s life risk factor leading women more than men to depressive disorders?
We need to analyse what are the elements in family work leading to stress:
a. which are the stressors
b. what is the subjective and objective, answers of the person in terms of perception, personal motivations to cope, styles of answers, available resources, perceptions of personal limits
c. Generally family work, care giving activities, is an high moral and material responsibilities, 24 hours a day, always on alert kind of job.
Compared to other kind of works, in this kind of activities:
q Women can’t deny their presence. This builds up the feeling of being indispensable, just like a factory manager;
q Doesn’t take rewards or incomes because is considered a given chore;
q Is based on full attention given to others needs, which means putting own needs aside;
q Is done in isolation because social life takes time away from it.
When giving care to the rest of the family becomes a sacrifice, incapability of recognizing inner needs, compression of her own spaces to give more to the others, depending on others rewarding to have some sign of being accepted as person, then the work family brings along tiredness, passivity and lack of interests to relate to the outside world. All this could turn into a strong factor of vulnerability, which leads women more than men towards depressive states.
3° QUESTION
If family work leads to depression, then why not all the women and not all at the same way run risk of suffering from depression?
Researches in the last 15 years have proved that in women risks of depression are similar than in men up to adult age. Afterwards, it keeps running higher for women where, for men during that stage, it tends to decrease. This seems to correspond very closely to the major charge women have to face, during adult age, due to the complex task of rising their kids. The theory based on stress factors and life-events helps to explain certain female reactions, as passivity and dependence, as consequences related to necessity to cope with new events. It seems to explain better than the traditional medicine and psychiatry, which relate female behaviour exclusively to biological and female personality’s characteristics.
The W.H.O. Director1 highlights the trend in depression diseases in the last years. If we consider that also the percentage of women in the work market is increasing, then we can suppose that external work doesn’t help against depression. Actually, we believe that this increase doesn’t correspond, yet, to a reduction, socially organized, of the heaviness of family work. New policies as “equal opportunities in a family friendly working world” have not yet produced real changes in social and work organizations.
Family charge is a factor of vulnerability but it takes the occurrence of “shaking factors” to lead to psychic break-down. “Shaking factors” could be life events of any kinds, from affective loss to biological events like pregnancy, characterized by new kind of demands and necessity of changing/modifying previous capabilities in family care along, as their consequence, with necessity of sacrificing subjective spaces to the rest of the family requests. Women start to percept a sudden as much as not understandable incapability to cope with the new event, which they take as their own problem rather than relating it to a different life situation and charge. This feeling brings tiredness, de-motivation, lack of interests, and even physical symptoms, like lost of appetite, insomnia, anxiety, and agitation, which women refer to some kind of hidden disease. This situation can last for long time and can erase energies and personal resource before turning in a recognized physical or psychic problem, but it also develops resistance and custom to a state of generic illness. The result is that it becomes more and more difficult to recognize interconnections with original life risk factors and events, and, then, to prevent the stress reactions.
In the following table, we have put together in sequence all the factors related to an increase of family and/or external work, which in certain life situations (of many women but not all) could lead to depression meant as final break-down during efforts to adjust to life stress events.
The answer to stress in a multifactor model representative of relation between female life conditions and depression
event/change
Life events create necessities to adjust to a changed situation: in women’s life this turns into a change (increase) of the family work load.
These changes involve different answers by women in their family work loads and kinds, in order to cope with the adjustments the new events require. Sometimes the request/acceptance for a different kind of family work is granted by the family roles defined by social models based on women subordination, and is supported by “family love”. Other times, requests may be imposed to women with violence.
In both cases, the answer to an event, requested by men and accepted by women, may not correspond to an increased amount of gratifications and rewards for women and ends up with a need for women to postponing their own interests to the other’s ones.
Changes in work load (increase)
Between the two kinds of work, the familiar one has to face a larger amount of possible events than the extra-familiar: it becomes, then, the main risk factor.
Changes in personal resources (depauperation)
a. personal motivations, projects and expectation
Women’s personal motivations, related to their life projects and expectations, may result lowered down by the new changes in their family work because its major charge reduces the concrete possibilities of carrying on with the project itself.
b. personal interests, relationships
Personal resources, meaning personal interests and relationships, may also be reduced to cope with the new requests.
c. self and attributed esteem
Self-esteem is a fundamental element to support the answer to an event and to reinforce capability of coping with it. Self-esteem could decrease very much if there isn’t a reward from the others, especially when, as in familiar work, women’s activities are mainly focused on satisfying the rest of the family needs.
The “self-perception”, the “perception of personal resources” and “perception of the heaviness of the charge of family work” are important factors that could lead to the passage from stress conditions to arising of disease.
break-down
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