Depression in Middle-aged Women

PART I Beauty, Love and Marriage The Myth an the Reality

Autor(en)

  • Much of this chapter appeared, in a somewhat different form, under the title »Portnoy's Mother's Complaint« Transaction
    (November-December 1970). © 1970 by Transaction, Inc.

A young man begs his mother for her
heart, which a betrothed of his has
demanded as a gift; having torn it
out of his mother's proffered breast he
races away with it; and as he stumbles,
the heart falls to the ground, and he
hears it question protectively,
»Did you hurt yourself, my son?«
Jewish Folk Tale.
I'm glad that God gave me... the
privilege of being a mother... and I
loved them. In fact, I wrapped my
love so much around them... I'm
grateful to my husband since if it
wasn't for him, there wouldn't be the
children. They were my whole life.
...My whole life was that because I
had no life with my husband, the
children should make me happy
... but it never worked out. -
Depressed middle-aged Woman

We have all read numerous case histories in which a child's neurosis or psychosis was attributed to the mother's behavior. Only recently has the schizophrenogenic family replaced the demon double-binding schizophrenogenic mother in theories about the causes of schizophrenia. This inquiry deals with the reverse situation how given the traditional female role, the children's actions can result in the mother's neurosis or psychosis. This is a study of depressed middle-aged women in mental hospitals. The story of one such woman follows.

The Supermother and her Plight

Mrs. Gold is a youthful Jewish housewife in her forties. Her daughter is married and lives about twenty miles away; her hyperactive brain-damaged thirteen-year-old son has been placed in a special school even farther away. After his departure she became suicidally depressed and was admitted to a mental hospital.
I asked her how her life was different now and she responded:

It's a very lonely life, and this is when 1 became ill, and I think I'm facing problems now that I did not face before because I was so involved especially having a sick child at home. I didn't think of myself at all I was just someone that was there to take care of the needs of my family, my husband and children, especially my sick child. But now I find that I - I want something for myself too. I'm a human being and I'm thinking about myself.

She was dissatisfied with her marriage; their mutual concern for their son held the couple together, but when their son entered an institution, this bond was loosened, although they visited him every Sunday. »My husband is primarily concerned with only one thing, and that is making a living. But there's more to marriage than just that [pause] you don't live by bread alone.« Mrs. Gold states that she is not like other women for whom divorce is simple, but she is considering divorcing her husband if their relationship does not improve. Yet, another patient I interviewed later told me Mrs. Gold had cried all the previous night after her husband, came to the hospital to tell her he was divorcing her.
Although she believes her Hf e was »fuller, much fuller, yes much fuller« before her children left, she used to have crying spells:

... but in the morning I would get up and I knew that there was so much dependent on me, and I didn't want my daughter to become depressed about it or neurotic in any way which could have easily happened because 1 had been that way. So I'm strong minded and strong willed, so I would pull myself out of it. It's just recently that I couldn't pull myself out of it I think that if there was - if I was needed maybe I would have, but I feel that there's really no one that needs me now.

She is unable to admit anger toward her children and makes perfectionist demands on herself. »It was extremely hard on me, and I think it has come out now. Very hard. I never knew I had the amount of patience. That child never heard a raised voice.«
While she is proud of her daughter and likes her son-in-law, an element of ambivalence is apparent in her remarks. »Naturally as a mother you hate to have your daughter leave home. I mean it was a void there, but, uh, I know she's happy... I'm happy for my daughter because she's happy.« Since she had used her daughter as a confidant when the daughter was a teenager, a pattern also present among other women I interviewed, she lost a friend as well as a child with her daughter's departure. Mrs. Gold said she did not want to burden her daughter with her own problems because her daughter was student teaching. The closeness they had now was »different« since her daughter's life »revolved around her husband and her teaching and that's the way it should be.« They phone each other every day and see each other about once a week.
Like most depressives she feels inadequate: »I don't feel like I'm very much.« Since her son's departure she spent most of her time in bed and neglected her household, in marked contrast to her former behavior. »I was such an energetic woman. I had a big house, and I had my family. My daughter said, 'Mother didn't serve eight courses. She served ten.' My cooking - I took a lot of pride in my cooking and in my home. And very, very clean. I think almost fanatic.« She considers herself more serious than other women and could not lead a »worthless existence playing cards as other women do. She was active to fund-raising for her son's institution, but apparently without the maternal role, the role that gave her her sense of worth, fund-raising was not enough. Formerly, her son »took every minute of our lives« so that she »did none of the things normal women did, nothing.« »I can pardon myself for the fact [that he was placed in a school] that I did take care of him for twelve years and he was hyperactive. It was extremely hard on me ... I never knew I had that amount of patience.«
Like most of the women I interviewed, Mrs. Gold is puritanical and embarrassed about sex.

I think anything that gives you pleasure or enjoyment, oh, is good as long as it's, uh, decent, and uh, not with us [slight embarrassment] some women I imagine do things that they shouldn't do, but I'm not referring to anything like that. It's just that I'm not that kind of woman.

Where she is at psychologically and sociologically is dramatically apparent in her response to the question in which she had to rank the seven roles available to middle-aged women in order of importance. She listed only one role: »Right now I think helping my children, not that they really need my help, but if they did I would really try very hard.« Thus, she can no longer enact the Tole that had given her life meaning, the only role she considered important for her. Her psychiatrist had told her, and she agreed, that a paying job would boost her self-esteem. But what jobs are available for a forty-year-old woman with no special training, who has not worked for over twenty years?
Mrs. Gold combines most of the elements present in the depressed women I interviewed, elements considered by clinicians to make up the pre-illness personality of involutional depressives: a history of martyrdom with no payoff (and martyrs always expect a payoff at some time) to make up for the years of sacrifice; inability to handle aggressive feelings, rigidity; a need to be useful in order to feel worthwhile; obsessive, compulsive supermother and superhousewife behavior; and generally conventional attitudes.

Why Study Mrs. Portnoy and her Complaints

Some of my hip friends ask, »Pauline Bart, what are you doing studying depressed middle-aged women?« The question itself, implying that the subject is too uninteresting and unimportant to be worth studying, indicates the unfortunate situation in which these women find themselves. But a nation's humanity may be measured by how it treats its women and its aged as well as by how it treats its racial and religious minorities. This is not a good society in which to grow old or to be a woman, and the combination of the two makes for a poignant situation. In addition, there are practical and theoretical reasons why such a study is important. Women today live longer and end their childbearing sooner than they did in the last century. In other words women are more likely now to reach the »empty-nest« or post parental stage (a term used by those investigators who do not consider this life-cycle stage especially difficult). Depression is the most common psychiatric symptom of adulthood, but, like middle age, it too has been generally ignored by sociologists.[1]
Such a study is theoretically important for several reasons. First, it can illuminate that important sociological concept, role - the concept that links the individual to society - because at this stage a woman loses certain roles and gains others; some roles contract, others expand. Moreover, there is contradictory evidence as to whether middle age is a problem for women. Knowing the conditions under which these women become depressed helps us explain these contradictory theories. Why is it that one woman whose son has been »launched« says, »I don't feel as if I've lost a son; I feel as if I've gained a den,« while another thinks the worst thing that ever happened to her was

when I had to break up and be by myself, and be alone, and I'm just - I really feel that I'm not only not loved but not even liked sometimes by my own children... they could respect me. If - if they can't say good things why should they, why should they feel better when they hurt my feelings, and make me cry, and then call me a crybaby, or tell me that I - I ought to know better or something like that My worst thing is that I'm alone, I'm not wanted, nobody interests themselves in me ... nobody cares.

The best times of her life were when she was pregnant and when her children were babies.
One clue to the differing views of middle age is that many of the problem-oriented studies are written by clinicians who are generalizing from their patients, while the studies showing that the postparental stage is no more difficult for most people than any other life-cycle stage, that many people like »disengaging,« come from sury's and interviews conducted by behavioral scientists. The patients clinicians see are not a random sample of the population; they are more likely to be middle class and Jewish. This is precisely the group in which I would expect the departure of children to cause stress because the departure of children is more difficult for -women whose primary role is maternal - the situation in the traditional Jewish family. If this hypothesis is correct, the difference between the two approaches to middle age may Result from clinicians' generalizations about a population that is more susceptible to the stresses of middle age - the Jewish mother.

There Is No Bar Mitzvah for Menopause

Emile Durkheim sheds light on the stresses that a mother may feel when her children leave. His concepts of both egoistic and anomic suicide are relevant to the problems of »the empty nest.« According to Durkheim, marriage does not protect women from egoistic suicide, as it does men; rather, the birth of children reduces the suicide rate for women, and immunity to suicide increases with the »density« of the family. »Density« diminishes as the children mature and leave. Few clear norms govern the relationship between a woman and her adult children, consequently, when her children leave the woman's situation is norm-less or anomic. This norm-less state is apparent in the responses to my question, »What do people expect woman to do after her children are grown?« Mrs. West said that while a married woman is supposed to make a home for her husband, she did not know what was expected from a divorced woman like her. »I don't think they expect anything special ... you just mind your own business. Let them mind theirs...« Another woman said, »My mission in life is completed. I have no place to go« All women verbally denied the obligations of adult children toward their parents. When asked what their children owed them, all the women say »nothing,« even though, in fact, they are apparently dissatisfied with their present situation and want more from their children. Much as some of the mothers want to live with their children, they cannot openly state this as a legitimate demand.
As financial crises lead to anomic suicides because individuals must change their expectations, women whose children leave must also change their expectations. But not only have these expectations been given legitimacy through years of interaction, there are no guidelines, no rites de passage for the mother herself to guide her through this transaction. There is no bar mitzvah for menopause.
David Riesman, following the Durkheimian tradition, notes that autonomous persons have no problems when they age, but both the »adjusted,« who find meaning in their lives by carrying out culturally defined tasks, and the anomic, whom the culture has been »carrying« but then drops, have difficulties as they grow older and these external »props« are no longer available. Thus, the woman's position dramatically changes; from being over integrated into society through the props of domestic and maternal roles, she becomes unintegrated or anomic It is true, as Marvine Sussman claims, that urban kin networks do exist, and that the concept of the isolated nuclear family is false, since kin are turned to in time of trouble.[2] But it is precisely because kin, that is, children, can be called upon in time of trouble that secondary gain is possible from depression. When a woman becomes depressed, once again she gets the attention, sympathy, and control over her children she had before they left.
Durkheim constructed a theory of social control and the pathological effects of its breakdown. The basis of social control is norms, the factors that control and constrain. However, Durkheim lacked an explicit social psychology, failing to posit any mechanism that could account for the manner in which these constraints are internalized. Role theory furnishes us with such a mechanism.

Role

The most important roles for women in our society are wife and mother. For example, one woman stated that getting married was the only thing she ever did that made her parents think she was worthwhile, compared to her younger brother, a doctor. The wife role may be lost any time during the adult life cycle through separation divorce, or widowhood, although the last is most common during old age. However, during the years between forty and fifty-nine, the maternal role is the one most frequently lost.
Two postulates from Ralph Turner's monograph, »Role Theory - A Series of Propositions,« are illuminating. »Almost any stabilized role expectation contains some elements of latent feeling that the other ought to continue the same role and role behavior as before. ... There is a tendency for stabilized roles to be assigned the character of legitimate expectations.«[3] While ideally a mother should be flexible and change her expectations of her children as they mature, if a woman's personality is rigid, as these women's personalities are, she may expect adult children, even if married, to act largely as they did when they were children and dependent on her. To the extent that they no longer act this way, she is likely to feel resentful; since, as Yehudi Cohen suggests, a woman is not »allowed« to be hostile toward her children, she may turn the resentment inward and become depressed.[4] Turner's second postulate states: »The degree to which ego can legitimately claim the privileges of his role tends to be a function of his degree of role adequacy« since »the actor who performs his role more adequately than could be legitimately expected raises thereby the legitimate expectations of other actors. The mother, for example, by being more patient or working harder than could reasonably be expected, places a moral debt on husband and children which is not satisfied by normal adequacy.«[5]

Klayne Kinder, Klayne Tsurus; Grayse Kinder, Grayse Tsurus [6]

Since the women that I predict will be most affected by the departure of their children are the supermothers, the martyrs, the self-sacrificing women who have devoted their lives to their children, they can legitimately expect their children to be more devoted to them, more considerate of them, bring them more satisfaction, than would otherwise be the case. The literature on the Jewish mother quite clearly portrays her as this type of supermother; this supermother is especially likely to be severely affected if her children fail to meet her needs either by not making what she considers »good« marriages, or by not achieving the career aspirations she has for them, or even by not phoning her every day. The moral debt Turner refers to results in the child's feeling guilty. Therefore, if his mother does become depressed, he is particularly vulnerable, and he may expiate his guilt by becoming the »good« child again. Greenburg's best-selling satire, How to Be a Jewish Mother, refers to guilt as the mother's main method of social control;[7] it is no accident that his second booK, How to Make Yourself Miserable, begins with the sentence: »You, we can safely assume, are guilty.«
Not only is the traditional Jewish mother overinvolved with or overidentified with her children, obtaining narcissitic gratification from them, but the children are viewed as simultaneously helpless without the mother's directives and powerful - able to kill the mother with »aggravation. As one depressed empty-nest woman says, »My children have taken and drained me.« In a sentence completion test, she filled in the blank after the words »I suffer« with »from my children.«                
Overprotection and overidentification is apparent in the case of another depressed Jewish woman, Mrs. Berg, who moved from Chicago to Los Angeles with her husband four months after her daughter, son-in-law, and granddaughter did »because my daughter and only child moved here, and it was lonesome for her, you know. And I figured we had nobody,« except a brother, and you know how it is. My granddaughter was in Los Angeles, missed them all.« Mrs. Berg and her daughter are inseparable.« »She wouldn't buy a pair of stockings without me. However, the daughter had written to the hospital; in her letter she stated that much as she loved her mother, her need to be kept continually busy was destroying the daughter's own private life, and she had to enter psychotherapy herself.
Mrs. Berg thought that the worst thing that could happen to a woman of her age was for her children to leave home. »Children leaving home to me is a terrible thing, but mine didn't. She waited until she got married, when her daughter did not have a date this supermother would say to her husband, »Oh, I don't feel so good tonight, so that she and her husband Would stay home in case her daughter was lonesome.

I was one of those old-fashioned mothers. I thought that you have to stay home and take care of your child, or when she has a date see what kind a fellow she's going out with... today the mothers are a little bit different. We manage a building now and we could write a story - write a book about our life there. The way twenty, twenty-one and twenty-two year olds leave home. Even younger, and share an apartment in Hollywood. I - I oughta write a book on that, when I get the time and the health back.

She thought the best time for a mother was from infancy till the child was eleven or twelve »because after that they become a little self-centered ... they think about good times and go bowling, go this and that, you know. The best thing for a woman after her children are raised is working. »Keep your hands occupied. Don't think too much. Just be occupied.« Her greatest concern is her granddaughter. »It will be the greatest joy of my life when my granddaughter meets somebody and she'll get married.

Role and Self

Role and self-concept are intimately interconnected. When people are given the »Who Are You« test to get at their self-concept, they usually respond in terms of their various roles - wife, doctor, mother, teacher, daughter, and so forth. As a person moves from one life-cycle stage to another, or from one step in a career to another, he or she must change their self-concept because the relevant or significant others, the people with whom they interact, change. A loss of significant others can result in what Arnold Rose called a »mutilated self.«[8] Some roles are more central for one's self-image than others; self-esteem comes from role adequacy in these more salient roles. For most people, the social structure determines which roles these are. Because the most important roles for women m our society are the roles of wife and mother, the loss or either of these roles might result in a loss of self-esteem - in the feeling of worthlessness and uselessness that characterizes depressives. For example, one woman said:

I don't. I don't, I don't feel liked I don't feel that I'm wanted. I don't feel at all that I'm wanted. I just feel like nothing. I don't feel anybody cares and nobody's interest and they don't care wether I do feel good or I don't feel good. I am pretty useless... I feel like I want somebody to feel for me but nobody does.

Another woman stated: »I don't feel like I'm doing anything. I feel just like I'm standing still, not getting anywhere.«
Since mental health or a feeling of well-being is dependent on a positive self-concept, it is therefore dependent on the roles felt to be available to the individual. Women whose identity, whose sense of self is derived mainly from their role as mothers rather than 'their role as wives and workers, women whose »significant others« are limited to their children, are in a difficult situation when their children leave. These women's self-conceptions must change, some of these women cannot make this change. They overcommitted to the maternal role and in middle age suffer the »unintended consequences« of this commitment.

Integration of Psychiatric and Sociological Theory

Psychiatric as well as sociological theory is relevant to a discussion of depression. Depression is usually considered a response to loss, loss of an ambivalently loved person or object by the psychoanalytically oriented, loss of a goal or 
self-esteem by ego psychologists, and loss of meaning by existentialists such as Ernest Becker.[9] Role loss is consistent with all of these approaches.
One possible way of combining the Freudian position which considers depression anger directed inward, the existential position concerning loss of meaning, and the sociological theory I am presenting may be the following. People who are intrapunitive, who turn anger inward against themselves rather than express it, are conforming to the cultural norms, especially if they are women. Since they have been »good« they expect to be rewarded. Therefore, when their husbands or children leave them their lives may seem meaningless; their world may no longer »make sense.« Thus introjected anger leads to »proper« behavior which in turn leads to expectations of reward; when this reward does not materialize, but in fact tragedy strikes, they suffer from a loss of meaning and become depressed.
Clinicians use the term »defense mechanism« to scribe the way an individual characteristically copes with the problems of living. This construct can be refined by the addition of sociocultural factors. There is a relationship between the utility of a defense and the person's stage in the life cycle. Withdrawal as a defense in a society valuing instrumental activism is likely to cause problems early in life. However, if one defends by doing, one can manage very well in our society, barring physical illness, until retirement for men or the departure of children for women. My interview data and certain comments on the hospital charts, for example, »She needed to keep busy aU the time,« indicated that many of the women had such defense systems. This system had been rewarded by the society at earlier stages in the woman's life cycle; however, later when many women were physically ill, and there was little for them to do, this life style was no longer effective.

Methods: Cross Cultural, Epidemiological, and Interview

I used three kinds of data in this study: anthropological, epidemiological, and interviews with projective tests. First, in order to test the hypothesis that depression in middle-aged women was the result of the hormonal changes of menopause, I conducted a cross-cultural study o thirty societies, using the Human Relations Area Files, and intensively studied six cultures, using the original anthropological monographs (becoming the Margaret Mead of menopause).
After I completed this cross-cultural study of the roles available to women after childbearing ceased, I examined the records of 533 women between the ages of forty and fifty-nine who had no previous hospitalization for mental illness. I used five hospitals, ranging from an upper-class private hospital to the two state hospitals that served people from Los Angeles County. I compared women who had been diagnosed »depressed« (using the following diagnoses: involutional depression, psychotic depression, neurotic depression, manic depressive depressed) with women who had other functional (nonorganic) diagnoses.
Five methods were used to overcome diagnostic biases. First, the sample was drawn from five hospitals. Second, »neurotic depressives« were merged with the »involutional,« »psychotic,« and »manic depressives« since I suspected that patients who would be called »neurotic depressed« at an upper-class hospital would be called »involutional depressed« at a lower-middle-class hospital, a suspicion that was borne out. Third, a symptom check list was used in the analysis of data, and I found that depressed patients differed significantly from those given other diagnoses for almost all symptoms. Fourth, a case history of a woman with both depressive and paranoid features was distributed to the psychiatric residents at the teaching hospital for »blind« diagnosis. The woman was called Jewish in half the cases and Presbyterian in the other half. The resume showed no differences between the »Jews« and »Presbyterians« in number of stigmatic diagnoses since the most and least stigmatic diagnoses (schizophrenia and, neurotic depression) were given to »Presbyterians.« Fifth, thirty-nine M.M.P.I. profiles were obtained at one hospital and given to a psychologist to diagnose »blind.« He rated them on an impairment continuum. The results supported the decision to combine psychotic involutional, and neurotic depressives, because the ratio of mild and moderate to serious and very serious was the same for all these groups. But all the schizophrenics were rated serious or very serious.
Next, I conducted twenty intensive interviews at two hospitals to obtain information unavailable from the patients' records, to give the women questionnaires used in studies with »normal« middle-aged women, and to administer the projective biography test - a test consisting of sixteen pictures showing women at different stages in their life cycle and in different roles. These interviews provided an especially rich source of information. I did not read their charts until after the interviews so as not to have my perception affected by psychiatrists' or social workers' evaluations.
Maternal role loss was recorded when at least one child was not living at home. I considered an overprotective or such overinvolved relationship present when a statement such as »my whole life was my husband and my daughter« was written on the woman's record or if the woman entered the hospital following her child's engagement or marriage. Ratings of role loss and relationship with children and husbands were made from a case history that omitted references to symptomatology, ethnicity, or diagnosis; high intercoder reliability was obtained for these variable (an interesting serendipitous finding was that the Jewish corders were more likely to call a parent-child relationship unsatisfactory than non-Jewish coders. The categories were refined so that this difference no longer occurred). A woman was considered Jewish whether or not she was religious if she had a Jewish mother. The attitudes and values I am discussing need not come from religious behavior. For example, Mrs. Gold did not attend religious services and was unsure of her belief in God, but she taught her daughter that »we just don't date Gentile boys,« and considered herself very Jewish, »all the way through, to the core.«

Results: You do not have to be Jewish to be a Jewish Mother, but it helps

Before embarking on the cross-cultural and epidemiological studies and the interviews and projective tests, I had made a number of hypotheses; some were confirmed and others were refuted.
Depressions in middle-aged women are due to their lack of important rules and subsequent loss of self-esteem, rather than the hormonal changes of the menopause. The cross-cultural studies indicated that women's status frequently rose at this life-cycle stage, that the two societies in which women's status decreased were similar to our own, and that, since middle age was not usually considered an especially stressful period for women, explanations of such stress based on the biological changes of menopause could be rejected.[10]
Role loss is associated with depression; middle-aged depressed women are more likely to have suffered maternal role loss than non depressed women. Because we are symbolic creatures in which the past and future are ever present, even impending role loss can bring on depression.
I had hypothesized that certain factors - intrinsically satisfying occupations; satisfactory marriages; some children still at home; and children's residence near the mother - would make it easier for the mother when her children left. I had also felt that women who suffered other role loss in addition to maternal role loss and women who had unsatisfactory relationships with the departing children would find role loss much harder to bear. However, neither of these hypotheses was confirmed. Role loss is apparently an all or nothing phenomenon since predictions based on the assumption that such loss is a matter of degree and can be compensated for by the expansion of other roles were not supported.[11]
Certain roles appear to be structurally conducive to increasing the effect of the loss of other roles (see Table 6-1). Women who have overprotective or overinvolved relationships with their children are more likely to suffer depression in their postparental period than women who do not have such relationships (see Table 6-2).
Housewives have a higher rate of depression than working women since being a
housewife is really, as Parsons put it, a »pseudo occupation.«[12] Not only do housewives have more opportunity than working women to invest themselves completely in their children, but the housewife role is cut down once there are fewer people for whom to shop, cook, and clean. Middle-class housewives have a higher rate of depression than working-class housewives, and those housewives who have overprotective relationships with their children suffer the highest rate of depression of all when the children leave home.
Depression among middle-aged women with maternal loss is related to the family structure and typical interactive patterns of the ethnic groups to which they belong. When ethnic groups are compared, Jews have the highest rate of depression, Anglos an intermediate rate, and blacks the lowest rate. Since in the traditional Jewish family the most important tie is between the mother and the children and the mother identifies very closely with her children, the higher rate of depression among Jewish women in middle age when their children leave is not surprising. Table 6-3 shows that Jewish women are roughly twice as likely to be diagnosed depressed than non-Jewish women; in addition there was a higher ratio of depression to other mental illness among Jewish women than among non-Jewish women.

      {{477-6-4}}

However, when family interactive patterns are controlled, the difference between Jews and non-Jews sharply diminish (Table 6-4). Although vertical frequencies show that overprotection or over involvement with children is much more common among Jews than among non-Jews, it is clear that you don't have to be Jewish to be a Jewish mother. For example, one divorced black woman, who had a hysterectomy, went into a depression when her daughter, her only child, moved to Oregon; the depression lifted when she visited her and recurred when she returned to Los Angeles.
The very small group of Jewish women whose mothers were born in the United States had a depression rate midway between that of Jewish women with mothers born in Europe and Anglo women. One of my hypotheses, that the departure of a son would be more closely associated with depression than the departure of a daughter, could not be tested because in every case when the Jewish women had sons who were only children, the sons still lived with their mothers. As one such woman told me, »My son is my husband, and my husband is my son.« Such was not the case for Jewish-only daughters or for sons or daughters in non-Jewish families. (The hypothesis had to be tested with only children because of the way the cards had been punched.)
Black women had a lower rate of depression than white women. The patterns of black female-role behavior rarely result in depression in middle-age. Often, the »granny« or »aunty« lives with the family and cares' for the children while the children's mother works; thus, the older woman suffers no maternal role loss. Second, since black women traditionally work, they are less likely to develop the extreme identification, the vicarious living through their children, that is characteristic of Jewish mothers. In addition, there is no puritanical idea in black culture equivalent to that in Anglo and Jewish cultures, that sex is evil and primarily for reproductive purposes or that older women are inappropriate sex objects. The famous black blues singers—women such as Bessie Smith—reached the height of their popularity when they were middle-aged.
Of course, one cannot entirely overlook the possibility that the low black depression rate simply reflects the black community's greater unwillingness to hospitalize depressed black women. Depressives are not likely to come to the attention of the police unless they attempt suicide. Therefore, if the woman or her family do not define her condition as psychiatric, she will remain at home. Only a prevalence study can fully test any hypothesis about the black family.
There were too few Mexican families in the sample to test my hypothesis that Mexican women would have a lower depression rate because Mexican women have larger families and the extended family is very much in operation; in addition, there is a shift in actual, though not in formal, power to the mother from the father as they become middle-aged.

Interviews

The interviews dispelled any of my doubts about the validity of inferences from the hospital charts that these women were overprotective, conventional, martyrs. Even though they were patients and 1 was an interviewer and a stranger, one Jewish woman forced me to eat candy, saying, »Don't say no to me.« Another gave me unsolicited advice on whether I should remarry and to whom, and a third said she would make me a party when she left the hospital. Another example of the extreme nurturant patterns was a fourth patient who insisted on caring for another patient who had just returned from shock while I was interviewing her. She also attempted to find other women for me to interview. The vocabulary of motives invoked by the Jewish women generally attributed their illness to their children. They complained about not seeing their children often enough. The non-Jewish women were more restrained and said they wanted their children to be independent. All the women with children, when asked what they were most proud of, replied »my children«; occasionally, after this, they mentioned their husbands. None mentioned any accomplishment of their own, except being a good mother.
Two of the Jewish women had lived with their children and wanted to live with them again; their illness was precipitated when their children forced them to live alone. However, living with children was not a satisfactory arrangement for the women in the epidemiological sample, since the few women having this arrangement were all depressed. For example, one woman complained: »Why is my daughter so cold to me? Why does she exclude me? She turns to her husband... and leaves me out. I don't tell her what to do, but I like to feel my thoughts are wanted.«
Table 6-5 shows the conventionality and the rigidity of the women interviewed.

In middle age it is necessary to be flexible so that new roles can be assumed. The mother role, »helping my children«, is most frequently ranked first or second, although only one of the seven, women whose children were all home ranked it first, and one ranked it second. Since it is difficult to help children who are no longer home, women who value this behavior more than any other are in trouble; they are frustrated in behaving in the way that is most important to them. Items that were not chosen are as interesting as those that were; only one woman ranked »helping my parents" first. Her hospitalization followed her mother's move to Chicago after she had remodeled her apartment so that her mother could live with her. No woman listed »being a sexual partner to my husband" first, and only one woman listed it second. Three married women did not include it in their ranking, indicating its lack of importance or their embarrassment or rejection of this role. It is apparent that although eight of the women worked, the occupational role was not important to them; three did not even list it. In short, the women view as important precisely the roles of homemaker and mother that become contracted as the women age. Conversely, they do not consider as important the roles that could be expanded at this time: the sexual partner role, the occupational role, and the organizational role (taking part in church, club, and community activities). The women interviewed were given the projective biography test —sixteen pictures showing women in different rolls and at different stages in their life cycles. The clinical psychologist who devised the test analyzed the protocols »blind" without knowing my hypothesis. He said they were »complete mothers,« showing total identification with the maternal role. I content analyzed the responses to the sexy picture, the pregnancy picture, the old age picture, and the angry picture; Table 6-6 shows the Responses to the old age picture.

The old age picture shows an old woman sitting in a rocking chair in front of a fireplace. The nine women who did not include this picture in their stories of a woman s life do not want to grow old and inactive. Only one woman used the picture in the story and responded positively to it. Two used it, but denied the aging aspects of it. An example of such denial is the following response: »Here she is over here sitting in front of the fireplace, and she's got her figure back, and I suppose the baby's gone off to sleep and she's relaxing.« This woman interpreted every picture with reference to a baby.
Six women did not like the picture (two responses were uncodeable). One woman who used the picture in the story said, »And this scene I can't stand. Just sitting alone in old age by just sitting there and by some fireplace all by herself [pause] turning into something like that. And to me this is too lonely. A person has to slow down sometime and just sit, but I would rather be active, and even if I would be elderly, I wouldn't want to live so long that I     wouldn't have anything else in life e but to just sit alone and you know, just in a rocking chair.« Another woman who was divorced and had both her children away from home said, »This could look very much like me. I'm sitting, dreaming, feeling so blue.« »When she chose that as the picture not liked, she said, »Least of all, I don't like this one at all. That's too much like I was doing. Sitting and worrying and thinking...«
In the inquiry period, one more gave a positive response, four gave a negative response, and one response was uncodeable. One empty-nest woman who was divorced and living alone did not use the picture in her story. After listing eight other pictures which were like her life, she said, »I don't like to point to that one.« One person liked this picture best, but did not perceive the woman as old, while six women included this picture among the ones they liked least.

How about Men

Does this theory explain depression in men? I think it does. Men who have involutional psychosis are usually m their sixties, the retirement age; these are probably men whose occupational roles were »props.« Men whose identity comes from their work role will also be depressed on retirement. For example, the director of admissions at the teaching hospital reported that it was not unusual for army officers to have involutional depressions on retirement. Rafael Moses and Debora Kleiger's study of involutional depression in Israel found loss of meaning a factor among old pioneers who believed »that the values so dear to them were rapidly disappearing. Current ideals and expectations were now alien to them and the sense of duty and sacrifice as they knew it seemed to exist no longer. They felt different, isolated and superfluous.«[13]

What is to be done?

It is very easy to make fun of these women, to ridicule their pride in their children and concern for their well-being. But it is no mark of progress to substitute Mollie Goldberg for Stepin Fetch it as a stock comedy figure. These women are as much casualties of our culture as the children in Harlem whose I.Q.'s decline with each additional year they spend in school. They were doing what they were told to do, what was expected of them by their families, their friends, and the mass media; if they deviated from this role they would, have been ridiculed (ask any professional woman). Our task is to make their sacrifices pay off, though in a different way from what they expected. As their stories are told, other women will learn the futility of this life style.
Two psychoanalysts, Therese Benedek and Helene Deutsch, state that menopause is more difficult for »masculine« or »pseudo masculine« women. Benedek describes the »masculine« woman as one whose »psychic economy was dominated — much like that of man's — by strivings of the ego rather than by the primary emotional gratifications of motherliness.«[14] Deutsch states that »feminine loving« women have an easier time during climacterium than do »masculine-aggressive ones.« While she believes in the desirability of »good sublimations« in addition to erotic and maternal qualities, »if their social and professional interests have taken excessive hold of them, these women are threatened in the climacterium by the danger that I call Pseudo masculinity.«[15] However, my data show that it is the women who assume the traditional feminine role— who are housewives, who stay married to their husbands, who are not overly aggressive, in short who »buy" the traditional norms—who respond with depression when their children leave. Even the M.M.P.I. - masculine-feminine scores for women at one hospital were one-half a standard deviation more feminine than the mean. These findings are consistent with Cohen's theory of depression; he considers depression, in contrast to schizophrenia, an »illness« found among people too closely integrated into the culture.[16]
Ernest Becker's theory of existential depression among middle-aged women is borne out because these martyr mothers thought that by being »good" they would ultimately be rewarded. When there was no pot of gold at the end of the rainbow, their life pattern seemed meaningless. As one woman said:

I felt that I trusted and they—they took advantage of me. I'm very sincere, but I wasn't wise I loved, and loved strongly and trusted, but I wasn't wise I—I deserved something, but I thought if I give to others, they'll give to me. How could they be different, but you see, they be different, but you see those things hurted me very deeply and when I had to feel that I don't want to be alone, and I'm going to be alone, and my children will go their way and get married — of which I'm wishing for it and then I'll still be alone, and I got more and more alone, and more and more alone.

The norms of our society are such that a woman is not expected to »fulfill« herself through an occupation, but rather through the traditional feminine roles of wife and mother. More than that, she is not allowed to do so. The great discrimination against »uppity women« — women professionals — the cruel humor, not being taken seriously, the lower pay scale, the invisibility (literally and metaphorically), make it suicidal for a woman to attempt to give meaning to her life through her work. (We are told that women are not hired because they put their personal life first, and leave with the first available man. I think the
sequence is reversed. It is only after she learns what her situation really is, after she has been treated as a nonperson, that she turns to a more traditional role. If she's lucky she still has that option.)
Until recent years, a common theme of inspirational literature for women, whether on soap operas or in women's magazines, was that they could only find »real happiness« by devoting themselves to their husbands and children, that is, by living vicariously through them. If one's satisfaction, one's sense of worth comes from other people rather than from one's own accomplishments, one is left with an empty shell in place of a self when such people depart. On the other hand, if a woman's sense of worm
comes from her own accomplishments, she is not so vulnerable to breakdown when significant others leave. This point is obscured in much of the polemical literature on the allegedly castrating, dominant American female who is considered to have lost her femininity.
It is, after all, feminine women, the ones who play true traditional roles, not the career women, who are likely to dominate their husbands and children. This domination, however, may take more traditional female forms of subtle manipulation and invoking of guilt. If, however, a woman does not assume the traditional female role and does not expect her needs for achievement or her needs for »narcissistic gratification«, as psychiatrists term it, to be met vicariously through the accomplishments of her husband and children, then she has no need to dominate them since her well-being does not depend on their accomplishments. In an achievement-oriented society it is unreasonable to expect one sex not to have these needs.
The women's liberation movement by pointing out alternative life styles, by providing the emotional support necessary for deviating from the ascribed sex roles, and by emphasizing the importance of women actualizing their own selves, fulfilling their own potentials, can help in the development of personhood for both men and women.