Caring for other people is a horrible, painful privilege. Yes it gives meaning to life, yes it perhaps is what we exist on earth to do, etc, but also, it can be messy, upsetting and dull, often all at the same time, and often at night. There is nobody who knows this better, nobody who knows it with their every cell, their every tooth, than a middle-aged woman who is responsible for the care, not just of their young children, but also their old parents. A 2022 poll estimated that 6 million Britons consider themselves to be in this “sandwich generation”, with increased longevity (a recent study confirmed that people born in the 1940s and 1950s are living longer than their parents) leading to a further descriptor. People in their 40s-60s who care for their children, grandchildren and parents are the “club sandwich” generation, the chicken right up in there next to the bacon, cut into quarters, speared with sticks.
If you’re not in the thing yourself, then you have surely seen at least what it looks like. What it looks like is a woman in motion. It’s not always a woman, but mostly it is – a study in February found that the burden of family care falls disproportionately on women. Women on the phone to the hospice while they’re driving a kid to swimming while the slow cooker’s on while fielding emails from their employer about their holiday allowance and can we have a quick chat on Monday? Four different stress headaches battle for attention and must be dampened with paracetamol that swims dusty and undone in the bottom of a tote bag, and jobs fail and marriages fumble, and adult children live in what was meant to be the home office, and they really don’t want someone to die, but sometimes they might say they do alone in the silence of their own throat where it can be swallowed again, and moved on from. Motion, motion.
It was these women I thought of and these extended families under strain when I read a piece in the Atlantic making the case for sibling therapy. This takes the shape of couples therapy, but concentrates on sibling relationships, which often feel the pressure when the responsibility of caregiving elderly parents arises. I have lost count of the number of people I know who became tangled in grief and fury when they felt a sibling didn’t take their share of responsibility as they got older, and the dynamic was played out, too, in the recent film His Three Daughters, where Carrie Coon, Natasha Lyonne and Elizabeth Olsen were almost-estranged sisters negotiating the nearing death of their father. This is when the issues often spike, but the sibling relationship is one that has already shaped and informed the person we become. This relationship (says a professor quoted in the Atlantic piece) “is like a shadow on us.”
People talk a lot about the impact of our mothers and fathers on the way we grow up, on their discipline, or absence or anxiety or thoughts about butter, but far less attention is given to the impact of our siblings. They’re our first little friends and, very soon after, our first major enemies – I read that young children on average have seven and a half disputes with their siblings every hour. Every hour! We learn everything here, among the Lego, what we want, what we hate, how hard to bite, how to apologise for the bloode teach each other how to behave with other people. Sometimes for the better, sometimes not.
Despite the recent increase in people choosing to cut off contact with family members, “a counter-impulse is brewing”, says Erin Runt, a therapist who works with siblings, a realisation that some problems must be faced head on. Hence her work with clients of that “club sandwich” generation, who arrive to try to repair their relationships before it’s too late. The therapists start by unpicking the narratives each sibling has about their childhoods. They ask, for example, “What was your sister’s role? Who was your mum’s favourite? What was it like at the dinner table?” Rather than aiming for loving friendship, everything forgotten, these therapy sessions are attempts to “survive family gatherings or to come together to care for a sick parent; other times, it’s about letting go of pain.”
It all seems quite sensible, doesn’t it, and could be empathically extended – couples therapy for daughters and fathers, couples therapy for sons and mother-in-laws, every iteration of constellation of tricky family dynamic, sitting on a yellow sofa and pounded delicately with words. But sometimes, of course, especially for those whose care responsibilities include a parent at the end of life, no therapist is necessary – there are just two hospital chairs around a bed, and a history poured out upon the little table.
Once it has been sifted through, the fact of a death can occasionally allow all previous problems to evaporate and the family suddenly, briefly, appear without animus, wide-eyed, unburdened and clean. And being in hospital, whether visiting a loved one or lying quite still in a light medically induced coma, is famously the most relaxing experience for many caregivers, with perhaps a tube anchoring them kindly to a bed so they can’t get up, and sometimes, out of nowhere, a sandwich.
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