Why Should I Care?

A Reflection on Caregiving, Avoidance, and Sustainability

By Liz Smith

We often think of caregiving in terms of sacrifice, survival, inevitability and loss, and while many of these words can describe the process of caring for another they often miss so much of what makes it meaningful, worthwhile and sustainable. The mental health field has come a long way in shifting from deficit-based thinking into strengths-based perspectives, and yet much of the caregiving world remains focused on burden, burnout and loss. From the outside it is hard to imagine the harangued, disheveled, overtired and completely unglamourous life of a long-term caregiver as one that someone would actively choose, and so we fall back on the classic human avoidance response of “I’m glad that isn’t me.” From exhausted new parents to veteran end-of-life caregivers we have a litany of superficial “look at them, they are so…” insert placating, well-meaning superlative here. But there is a significant lack of awareness that one day this will be all of us. Every person you know will either be a caregiver or need a caregiver in their lifetime, and oftentimes they will be both, sometimes simultaneously.

If you talk to any behavioral specialist or trauma therapist, they will tell you that avoidance is a classic survival technique. One that has been coopted by our nervous system to handle uncomfortable truths, awkward encounters, and a myriad of twenty-first century problems that no longer resemble physical predator threat (in most cases). That doesn’t make it any less demanding in its employment as a protective factor. Awareness is the first line of defense in combatting avoidance. This is not to say that avoidance needs to be eliminated from our lives, on any given day we experience around 1 billion bits of sensory data per second, and there is no possible way for us to process all of that. In fact, researchers at Caltech* have discovered that we can only process at a rate of 10 bits per second, meaning we are hardwired to avoid.

As a social species, we are also hardwired to care.

I wonder if caregiving is so easy to avoid because it forces us to confront realities that we work so hard to hide: dependency, frailty, disability, aging, grief, and mortality. We celebrate independence and self-sufficiency while quietly treating the need for care as a personal failure. On the other hand, caregiving reminds us that no amount of planning, productivity, or determination prevents us from eventually needing one another. When we acknowledge caregiving we admit our own vulnerability, and that can be profoundly uncomfortable.

So how do we combat our natural inclination to avoid recognizing caregiving as a complex and universal human state that is filled with meaning and hardship, love and loss, gratitude and grieving? How do we begin to have honest conversations about what we need in order to care sustainably? We need to design systems of care that include education and training, mental and physical support, financial and retirement planning, meaning-making, identity formation, grief processing, and the ever-expanding list of processes we experience throughout the life course.

Caregiving sustainability doesn’t start with burnout prevention. It starts with the awareness that we will all one day be giving or receiving care. It starts with recognizing that our current health infrastructure is not designed for caregivers. It starts with you. It starts with me. With all of us actively choosing to utilize a portion of our 10 bits per second to understand why we should care.

Liz Smith, MSW

PhD Student, Brown School at Washington University in St. Louis

Studying caregiver sustainability, resilience, and meaning-making through storytelling.

*Zheng, J., & Meister, M. (2024). The unbearable slowness of being: Why do we live at 10 bits/s? Neuron, 113(2), 192–204. https://doi.org/10.1016/j.neuron.2024.11.008

Content

Coming Soon