Why Are Women So Exhausted?

Hillary Clinton did not shatter the ultimate glass ceiling for American women, leaving us to pause to assess the landscape that surrounds us. How do we feel?

Exhausted.

Our hard-won battles earned us the freedom to pursue whatever interests and careers we wanted, more or less.

But that, together with the increased socioeconomic pressures weighing upon the lower and middle classes in America, have led to what we all know by now: Doing it all is too much. Motherhood is often underestimated and undervalued as a full-time job. When coupled with an additional full-time job in the workplace, whether by choice or necessity, working motherhood is overwhelming for anyone. And even without children, women take on many additional caretaking roles without even realizing it—for their family, their spouses, their friends, their co-workers, or their clients.

As Carol Gilligan observed in her 1982 classic work, In a Different Voice, women are socialized from a young age to prioritize other people’s feelings before their own. The burdens of this role climb exponentially with each additional duty dumped in women’s proverbial laps.

When I worked as Unit Chief and treating psychiatrist at an all-female psychiatric unit, these burdens poured into my ear daily. Compared to the times I’d occasionally cover the other predominantly male units, and military units which were also mainly male, I noticed some interesting differences. Women talked much more. And they had a lot to talk about. Relationships were the main issue: Romantic, parental, child/baby, friendship, co-workers—they were all at the forefront of their stressors. These women were juggling everything beyond themselves, and the constant self-extension was burning them out. They also had to deal with histories of sexual and domestic abuse on top of everything else. Their identity almost seemed invested in their self-sacrifice, even self-annihilation.

The workplace also remains notoriously geared toward male culture in America, rarely accommodating working mothers with parental-leave policies or offering childcare or a place to pump milk, and all too frequently passing over women for raises and promotions, especially if they've had to take time out for morning sickness, pregnancy-related issues, or caring for sick children. America’s capitalistic workplace culture overemphasizes long hours without much regard for well-being or the work-life balance valued much more in Europe, with its siesta hours and government-mandated vacations and paid maternal leave, child care, and healthcare.

Sweden recently decided to standardize six-hour workdays and mandates that businesses give their full-time employees five weeks of vacation time. France also mandates five weeks off, and Spain gives a generous 30 calendar days off plus 14 public holidays. For maternity leave (and often even paternal leave), nearly every country mandates at least 12 to 14 weeks off PAID maternity leave—and often paternity leave—including most of Africa, Latin America, and Asia. In Europe, the norm is between 16 to 20 weeks—also paid. The U.K. offers 32 weeks at 90 percent salary and allows 20 more weeks unpaid after that.

One whole year of maternity leave.

What about the United States? Six weeks unpaid. In other words, that’s zero weeks paid. The U.S. is virtually the only country in the world that does that.

Stephanie Han, Ph.D., a working mother, scholar, and author of Swimming in Hong Kong, cites America’s systemic lack of support for working women for our exhaustion. While Hawaii conjures an image of laid-back beachy vacations to most outsiders, she had to commute nearly two hours each way via bus to get to work in Honolulu, which entailed waking up at 4 a.m. each workday. Childcare support was unaffordable with her academic salary but a necessity given her long work hours. Eventually, she ended up moving to Hong Kong in part because the infrastructure allowed her family to have the more balanced lifestyle they wanted, with its efficient public transportation, cheaper and public child care, and healthcare options that allowed her to change to part-time work.

Another working mother and physician from Bethesda, Maryland, Mary L. Fairbanks, M.D., says she had to advocate for herself to be allowed to work a part-time schedule as an obstetrician-gynecologist at MedStar Washington Hospital Center. Such advocacy wasn’t necessarily easy; she had to get her contract readjusted at two different jobs to avoid having to take a disproportionate number of on-call shifts. Requesting a reduction in that shared burden though led to some resentment from her co-workers, even though she subsequently received less salary and vacation time and still has to do extra holiday calls. She also struggled to find a practice when she first came to Washington, D.C., that would even allow part-time work, which gave her more reasonable (although still lengthy) work hours and a chance to balance her medical career with motherhood and time with her spouse. Before going part-time, she was approaching burnout. “Moving to D.C. and leaving my house at 6:30 a.m. with an hour commute and a 10-plus-hour day was horrible and exhausting. I could not imagine how anyone could do maintain this for years and have any energy for kids or life in general. I honestly think working 50 to 60 hours a week with kids would make any mom crazy and exhausted and is not a healthy way to live.” She is also concerned that American workplace policies do not support working mothers unless they “can afford armies of help. Six weeks of maternity leave is abysmal.” She was only given breastfeeding accommodations after she spoke up for herself at work.          

The American mass media and bookstore circuit try to offer patchwork solutions to these deep-seated sociocultural problems for overextended women. Arianna Huffington proffers catchy sloganeering mantras in her latest publicity tour about insomnia and its discontents for her most recent book, The Sleep Revolution, which boils down everyone’s ills to a lack of sleep. While it is certainly true that sleep deprivation is a commonplace symptom of our workaholic society, and that it leads to a whole host of medical and psychiatric ailments, it still seems like she is emphasizing the end result and not the core cause. It is admirable that she is trying to publicize and normalize the implementation of some sleep hygiene in her own workplace and not view short workplace naps as a negative behavior.

But at least one male friend of mine who was employed by her at AOL worked incredibly long hours for average pay and ended up quitting due to burnout. In fact, the Huffington Post is known for expecting many of its freelance contributors to write for free. If you’re given gobs of work assignments but expected to finish them on strict deadlines, just to make ends meet with a meager salary, or to please the employer who will otherwise fire you, sleep often gets sacrificed. People often can’t sleep because they can’t afford to sleep. “Telling us to take a hot bath and a yoga class isn’t going to solve systemic lack of accommodation for the reality of women’s physiology and needs,” says Han.

This is not to minimize or ignore those medical and psychiatric ailments either. The cost of our current socioeconomic structure combined with our underlying biology is that women have higher rates of depression and anxiety disorders (two times as much as men according to National Institute of Mental Health (NIMH) statistics), and fewer financial resources to get help, especially given how limited mental health coverage remains in most health insurance plans despite recent parity legislation. According to the Centers for Disease Control and Prevention (CDC) Data and Statistics Fatal Injury Report, women attempt suicide three times more often than men (although men succeed more at completion and die 3.5 times more than women).

Women also have to cope with gender-specific biological vulnerabilities that increase mood and anxiety disorder risk such as menstrual-cycle-related issues (such as premenstrual dysphoric disorder), peripartum and postpartum mood and psychotic disorders as well as perimenopausal mood disorders all from female-specific hormonal fluctuations. These hormonal changes can trigger underlying genetic susceptibilities to developing depression, anxiety, bipolar disorder, even schizophrenia. The fluctuations can also magnify under situational and environmental stress, where increased cortisol levels cause their own cascade of negative biology such as fight-or-flight systemic responses, and over time worsening risk of diabetes, vascular and cardiac disease, and more. Insomnia also worsens all of these risk factors by interrupting everyone’s natural circadian cycle that keeps their systems working in concert. And post-traumatic stress disorder induced by a history of sexual, physical, or verbal abuse, assault, and trauma also worsens all of these systems.  

And for women who aren’t financially privileged, especially single mothers, the lack of social support is almost untenable. Major choices mean major sacrifices. Even some social support can mean a big difference as people get by with compromises. Arden Hunt, an Air Force veteran, has decided to go back to school for a better career, which means not working for now, but still caring for her 7-year-old son, while her son’s father has to live and work elsewhere for his job. Her typical daily schedule consists of taking her son to the bus stop for school, then going to classes, and picking him up from school in the late afternoon. She also raised her first son as a single mother while she was in the Air Force, but through support from the military system, as well as her and her son's perseverance, was able to send him to graduate school where he is pursuing a Ph.D. in psychology. She notes, “It’s tough because I think society expects women to do more in a way than men. Men certainly have their own important stressors, but we have to do it all.”

American individualism also makes it lonelier for women despite the appearance of a community that workplaces and school systems provide. Extended family networks aren’t as prominent or established for many Americans, especially immigrant families, nor is extended family support a cultural given here, putting additional pressure on the nuclear family to take care of itself. And community distances are often wide and car-based here, compared with the smaller, village-like systems in other parts of the world.

Women who prioritize their careers are also held to a higher standard—and double standards. They suffer from regular slights from both genders in regards to their behavior and comport in meetings and daily interactions, from men who tend to ignore or browbeat their female colleagues, or from women who tend to undermine or get jealous of female authority and compete for male approval. Women leaders must straddle a fine line between aggression and passivity, and even then, they get blamed for not being enough of one versus the other.

As seen with Hillary, perceived “unlikeability” is a swift and public way to undermine tough and successful career women. And if women do try to put feelings first and prioritize interpersonal cooperation or civility, they get called out for being “too nice” or “weak” and often are treated as doormats instead of bosses. If you throw sexual attractiveness into the equation, it becomes even more convoluted. (Even open-toed shoes are considered too louche for the boardroom.) The end result is fewer female leaders and fewer female promotions. The ones that do climb do so under continued intense scrutiny and stress. Just “leaning in” is not enough, as has been duly criticized.

But let's look at women (and men) who do appear to juggle it all and are successful in this intense climate. How do they do it? There are some people who are naturally more energetic than others and may have a higher “setpoint” for stress. This stress tolerance also ties into questions of resiliency, which is a huge hot-button topic in psychiatric research. Are there beneficial strategies and protective coping styles where people can control their outlook and function in life? As per the American Psychological Association’s “Ten Ways to Build Resilience,” is it just a matter of following positivity, such as seeking out unconditional social support networks, practicing appropriate self-care and setting necessary boundaries, maintaining a good sense of humor, accepting situations as is, and more?

There's a dark side to resiliency initiatives: They can lead us to blame or fault the rest of us who can’t keep up. Administrations can argue that struggling people aren’t practicing appropriate self-control, instead of changing fundamental policies that overwork and overburden even otherwise high-functioning people. Also, excessive energy and workaholism may reflect less desirable underlying issues like bipolar disorder, attention-deficit hyperactivity disorder, even obsessive-compulsive disorder and anxiety disorders and destructive perfectionistic traits. So even if a person appears successful at work, the rest of their life might be falling apart. Conversely, some people tend more toward depression and low energy and/or stress sensitivity for many reasons too, through no fault of their own. The variable of sociocultural stressors themselves thrown on top of people's natural make-up and lack of sleep or poor diet or exercise and other lifestyle habits will all worsen psychological and physical health.

So what are the solutions as our society adapts to the new demands of women who wanted or have to do it all, but are falling apart? We need to keep advocating for maternal and family-friendly workplace policies and normalize and uphold prioritizing of flexible time for other needs. We need to promote acceptance of workplace cultural values that don’t penalize people for taking time off and only reward obsessive workaholics putting in excessive hours who have no other major distractions as companies prioritize only the bottom line. We need to consider nationalized health care particularly child care and mental health care for all with protected time to attend to medical needs. We need to revamp our deteriorating public transportation infrastructure so people have more time and more money for their families. We need to continue exposing and discussing anti-female bias in workplace culture and promote and observe role models who aren’t just leaning in, but doing it their own way.

As more women run for top offices, we need to overhaul our country to value its female workforce’s neglected needs. The old saying, “Women hold up the half the sky,” doesn’t even account for women holding it up with one arm, and the other holding up everyone else in their lives. It is time to adapt our American society to support and respect women whatever their choices or necessities may be, before the sky falls down.

(A version of this article was published in DAME Magazine on August 25, 2016.)

Jean Kim M.D.