'Welcome to Chasing Life. Today, we're going to be talking about caregiving, and I think this is such an important topic. The idea that caregiving is often seen as something that is difficult - that it is thankless - it is something that drains our time, our energy, and even our health. We think of it as an obligation more so than an opportunity. But think of this: what if caregiving doesn't just take from us? But what if it gives something back as well? Today's guest is Elissa Strauss. She's a writer, she's a journalist, and she's the author of, "When You Care: The Unexpected Magic of Caring for Others." And I just wanna tell you, I've been reading Elissa's work for a long time. I read her work even as I was raising my own kids. She's offered a lot, and it's not dogmatic, but it is very practical in terms of the tips that she provides. But I also think there's a larger issue that we're gonna hit on today. And that is this idea that it feels good to do good. It feels good to do good for someone else. Alyssa's work has really reframed the way that I think about caregiving, not just as something we endure, but something that shapes us, that can help us psychologically grow. It's certainly done that for me. So today, the magic of caring for others. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.

How did you get into this? How did start writing about and thinking about caregiving?

'Yeah, I really came through the lens of feminism. I think for me, when I became a mom, the kind of first wave of ideas that I needed to sort through was how to protect myself from motherhood. I wasn't ambivalent about having kids. I grew up in a big, warm family - there were four children - but I was very concerned that I would tip too far into the identity of mom and never get out. And I think the big surprise for me was that I ended up finding motherhood... intellectually, philosophically, spiritually, more demanding and more meaningful than anticipated.

The book is called, "When You Care: The Unexpected Magic of Caring for Others." How you identify... You identify as a mom, but not solely as a mom? Is that the point you were making?

'Yeah, I think that for me, I realized... I came into it with the work-life balance kind of construct in my head, and I came to think of it as all silly. Like I bring what I learn from parenting my kids into all my relationships. I think dependency relationships... I wanna clarify, when I talk about care, there's lots of different types of care, right? There's collective care, the kind of community neighborly care. I don't talk about those cares. I'm focused on ongoing dependency relationships. Sometimes I joke and say the Hotel California of care relationships. You can check in, but you can't check out, right? These are the care relationships that are ongoing - someone depends on you to survive, hopefully thrive. All those care relationships have taught me so much about life and who I am, like the truest mirror to the self that frankly I've ever experienced. And I bring that quote unquote, "just a mom" stuff into everything. I bring it into my writing, I bring into my friendships. There's really not a separation between my care self and all my other selves, and they all feed each other.

You have this section in the book where you talk about Darwin and it's interesting because I think a lot of people sort of... This idea "survival of the fittest," which is not a term that he actually used, interestingly enough, but I think the directional sort of nature of what he was saying was there, you know, this rugged individualism. And we come to learn that societies survive and thrive not because of rugged individual ism, but because of this concept of reciprocal altruism. And I've always been struck by this, you know, that it feels good to do good. That seems to be at odds with the idea of rugged individualism or survival of the fittest. And yet that is part of our DNA, right?

Darwin was very invested in the parental instinct and really thought that there was a deep connection between parental instincts and our ability to sympathize. That was a more common phrase back then. Today we might call it empathize, but just basically our concern for others, and he saw cooperation as equally important as competition for survival of the species. But that's not the message that took off in our broader culture.

Yeah, we like "survival of the fittest," it's piffy. Rolls off the tongue.

Yeah, exactly. Yeah. And it makes us deny our vulnerability. It's very convenient.

'Right, right. Yeah, and you're right, people co-opt these terms for their own purposes, you know, and they can interpret it as they want. There's a story about Darwin, right, that you write about in the book?

'Yeah, so he had a great tragedy happen to him. His favorite daughter - this is his phrase, not mine - died at age 10, now to, you know, we believe it was probably from tuberculosis. And his grief for her, right, persisted and persisted, and he couldn't figure out how that fit into his thinking about evolution. Like, what was the evolutionary utility of mourning someone decades after they're gone? And that's really where he came to realize that like this, this parental urge to love and care, it's where we get our ability to get along and survive together, which is absolutely right. Like a through line through human history that we are not just a competitive species, we're a cooperative species. And it came from this deeply personal tragedy.

'You know, I wrote this book about brain health a few years ago, and one of the big topics that came up was dementia. And if you look at basically uncompensated, frankly unrecognized caregiving, so much of it is happening in that dementia space. And it's spouses, it's children, whoever it may be. And that was, you know, it was quite striking. I didn't expect to write that much about that topic when I started the book, but after talking to so many patients, it was always something that came up in every conversation - that aspect of it. And I think the general tendency, Elissa, is to think of that as, again, not just being an obligation, but being taxing on your health. But in your book, in some ways, you argue the opposite. You argue that it can actually be good for your health

'There's plenty of research that shows ways that caregiving could be bad for your health, and I don't wanna dismiss it. Again, I really think with care, we need to be in this "yes and" space. So yeah, there is research that shows in the way it hurts you, but there's also research that shows that it can actually be good for you. One particularly interesting case study here is a woman named Lisa Fredman, who studied high-intensity female caregivers - this is a Baylor 2019 study - and was expecting to find that they would have worse health, and was genuinely surprised when she discovered that cognitively they are in better shape, physically they're in better shape, longer longevity - controlled for everything - this was still the result. David Roth has studied inflammation in caregivers, found lower rates of inflammation, surprised by it. Psychologically, there's a big meta-analysis of paid caregivers. And thinking that because the emotional labor of their jobs would be so taxing that they would be in worse shape, but they actually had greater job satisfaction than people in non-care roles. And again, this is controlling for everything, everything. So we see longevity boosts, we see low inflammation, we see cognitive health, but just a general sense of well-being that can actually come from care. And I think it's important to say all this out loud, not to dismiss the very real burdens that people experience from caregiving, parenting in the United States, again, often unnecessarily because we just don't have the infrastructure to support care in this country. But it also... I think the burden narrative diminishes care. And then we're kind of back to square one. I think so much of why we don't have infrastructure to support care in this country is because we've made care small, we've diminished it. We've diminished in every way from how, you know, not seeing how meaningful it can be, to not seeing actually how it can be part of a good life, even in terms of our mental health, our physical health, etc. So I think, right, it's just, we need to pay attention to how it can be good for you, and that should inform the way we build, not just our policies, but also the way act in community, the way that we act in family, to try to increase the odds that someone's gonna walk away from care, having benefited from it, instead of being kind of hurt by it, whether physically or psychologically.

I mean, when you think about these things, being physically better off, lowering inflammation, better cognition, why is that the case?

'Yeah. So I think being an active caregiver, as someone who may or may not have spent a long time navigating the health care system on behalf of a parent yesterday, takes a lot of executive functioning skills, right? I mean, it's... so if you're retired and you aren't necessarily being intellectually, you know, cognitively stimulated by a job... If you become an active caregiver, you're navigating a lot - ask any caregiver for their top 10, you know, Medicare and Medicaid nightmare stories, and they'll have them for you, right? It's so much to navigate. So either way, there's a physical part of it - it just keeps you engaged in the world

Again, I say this and I mean it, I think it feels good to do good, and people should just let that settle in for a second, because maybe it's at odds with how you think about human evolution generally. But it feels good to do good for someone else, even if it's of no benefit to you. That's interesting. But the idea that something must be happening in our body and brains to make that so... Is that something you've thought about?

We know that 'helpers high' is a thing. We know we get surges of dopamine, endorphins, oxytocin when we help another, but that's often in a kind of volunteer setting. And that's where I like to, again, separate, you know, the Hotel California care from, there's an old lady you've never met before, but you help her across the street. You feel really good about yourself after that, or the kind of Mr. Rogers care, right? That's beautiful. I'm not diminishing that, but there has been some neuroscience research on caregiving for parents, right? And there's a woman, Ruth Feldman, who took brain scans of three different groups. She took brain scans of the heterosexual couples, so she had the moms who were more the primary caregivers and the dads, secondary caregivers. And then the next group she took brain scans was gay men who had kids together. And she basically found all of their brains lit up in response to a video of their babies. The moms' brains lit up in kind of this emotional part, motivational part. The dads' brains, the heterosexual dads' brains, were lit up in the kind of executive functioning tasks part, right? And then the gay father's brains lit up in both. And what Ruth Feldman took from this is like, then this is where we have this fantasy idea in the maternal instinct, and that moms know exactly how to care for their babies. That's not true. But what we do have is this like internal wiring that makes us prime to care. And as I like to put it, like we don't care because we love, we love because we care. It's the act of care that can turn on care in our minds. And again, the neuroscience is so new for all this, but we already have this pretty convincing evidence, in my opinion, that our brains respond to care. We see pruning and gray matter right after birth for both men and women. And for the dads, it's really something that happens that they don't have the cascade of hormones from pregnancy that biological mothers have, but if they're engaged caregivers, their brains are also being shaped by care.

It's fascinating stuff. And like you said, it's early and the brain's complicated, and people are gonna respond differently, I think in part because of that. We provide care in many ways, especially people who are of the sandwich generation, to our kids, to our parents, partners, spouses, pets, even. Is there a common denominator? I mean, because as you're pointing out, I mean... We're attached to our kids. Darwin mourned for a long, long time, maybe forever, after he lost his daughter.

'So I think that to all care relationships, we're in a dance, or maybe we're walking a tightrope, it can feel like that sometimes too, right? Between trying to listen and be attentive and receive the other and understand their needs, and then also try to get the other to do what we think they should do. And it's, you know, some care theorists go lean in on one side, others lean on the other side, but my favorite thinkers in this area are the ones that really acknowledge it's - it's a dance, it's ongoing, it is a process. To be a good caregiver, whether you're caring for an aging parent with dementia, or a pretty well-behaved, well-adjusted, adorable eight-year-old, right? I think the through line really is that you're always in that dance of knowing when to step back, to listen, receive, and knowing when to guide and direct. And it's really hard because you absolutely need to do both, and they're kind of opposite instincts, right?

Philosophically, I'm just curious, the idea of caregiving, just in general, do you think of that as an obligation or an opportunity?

'Both. I mean, there's no question that part of our motivation for care is an obligation. It's really, again, so under-discussed in the history of psychology and philosophy, but it's probably the deepest, most demanding moral obligation most of us will make our whole lives, right? So it's absolutely an obligation, and I think actually the splitting of the two suggests a broader problem in our culture that we often think of things that are obligatory as taking away from us, right? We're such an independent, freedom-seeking culture, optimized, you know, all the stuff... And I think you can discover a lot of truth through obligation, and obligation really can become an opportunity. Also, it can become a burden, but it doesn't have to become a burden.

Coming up, practical ways to protect yourself from burnout, and how to get more meaning out of caregiving. That's after the break.

'I'll just tell you a quick thing. My wife deals with pretty significant chronic illness and autoimmune stuff, and she's doing a lot better, but there was a time when she was quite sick and to the point where, because of the condition, she really had a lot of pain and could not move. And there was, I remember there was a period of time and it was like - you know this was going on for a couple of years - a period of time where I thought, "This is now my core identity." And I wasn't upset about it. It wasn't something that caused me to have some resentment or anything, but I did recognize that it was becoming part of my core identity. It was the first thing I thought of in the morning. It was last thing I thought of at night. Like I felt this tremendous sense of purpose. Like wow, you know? I mean, she's dependent on me. But I recognized as well that that probably wasn't healthy. And leaving aside having a loved one with a chronic illness, just in general, the idea that you start to have so much of your core identity wrapped up into caregiving... That's the guardrail that I'm wondering how you navigate. How do you set that dance out, if you will, because it's starting to overwhelm you?

'Yeah. When I've been an intense caregiver for my spouse when he was sick... I mean, a little bit you're running on adrenaline and just keep going, and maybe I didn't even have time to really think about it, but I think what helped me in those moments is to think of it as a season. I think that at the same time, I really, I'll tell you this. I actually do not like the oxygen masks or gas tank metaphors for caregiving. I think -

'Put on your own oxygen mask before -

'Exactly. You have to put your own mask on before you put on your child's mask or any dependent's mask who may not be able to do it themselves. I think when we think of the oxygen metaphor, you're like, don't die because then your kid will die too, right? It's like so it's like just getting... It's just presenting this idea that parents and caregivers need to be like just baseline functional. And I think actually you cannot care well unless you are your own person. Like. I really don't think the peer sacrificial caregiver is a good caregiver. And I think to go back to something I said earlier, and kind of map care, right? We have this idea of collective care, and we have this of dependency, Hotel California care, you know, I call it, right? You check in, you can't check out... You just, you're stuck with this person. I think there's something very different to the, Mother Teresa, volunteer all-in - again, volunteer -caregiving, where we have this... That became our model for dependency care. And that model of care is totally unsustainable for dependency caregiving. But we're all living with that as this, like the sacrificial caregivers, is this ideal form of care. And the sacrificial caregiver can sacrifice so much because it's not Hotel California, right? You're not stuck in this. Like, I think we're totally messed up from equating good care with the kind of volunteer helper care with dependency care. And I just, I think it's like a totally different skill set. And I truly, truly believe, and I'm not saying this just to like excuse my Pilates classes... But I do enjoy them, you know, that too! But I really don't think that I would be a good caregiver to my kids if they didn't go to after-school. Levi stayed at preschool till six o'clock when I was writing my book, like it's, it's not... It's so much more than the oxygen intake. Like I need to be me, and I need to be because I need to see them, and I can't see them if I don't see me.

'It's interesting because I think the idea that... I really like this idea of thinking of it as a season because, I think, you're sort of starting to timestamp things and, you know, I enjoy different seasons for different things, right? So if I think of it is as a season, maybe I'm going to look at... I'm gonna tilt towards looking at the benefits of this relationship, even if, even as the primary caregiver or as a caregiver. I think that the chapter that I was describing with my wife was in my early 40s. So - and I'm in my mid-50s now - so a decade and a half ago roughly. And I remember thinking to myself, I've gone through medical school and training, and I've had various jobs and things like that, but that chapter with my wife was probably, from a psychological growth standpoint, one of the most significant. And I could actually feel it as it was happening. I felt like I matured as a 40-year-old man. And the two things that were at odds were this idea that it was a burden. I was really busy with my life and professional life, and all that. And then, you know, coming home and then, you know, cooking and taking care of my wife, and taking care of the kids and all of that sort of stuff. But at the same time, I had this sense of purpose, this psychological growth. And I think what you're saying is that both things can be true at the exact same time. Right?

Absolutely.

If you're trying to make it all of one or the other, you're probably going to be disappointed.

'Absolutely. And I think when you dive into the kind of happiness versus meaning thing, you find that right, caregivers, parents, like they may not be day to day happier, but they absolutely have a more profound sense of meaning often than people who have not had this kind of dependency care experience in their life. And when you look into what gives you meaning, it's being other-directed, and back to what you're talking about, a season... Meaning is something we construct with a sense of: past, present, and future. Happiness is something we construct with just the present, right? Happiness tends to involve taking; meaning tends to involve giving. And I just wanna flag that if we think about so many of the epiphany-seeking things that we do holed up in our country, it's often about displacing the self on some level, right? So maybe you take psychedelics, you go into ayahuasca, not my thing, but I know people into it, you know? Maybe you go on a Buddhist silent meditation retreat, right? So it's like kind of dissolving the boundaries between self and other are seen as an enlightening process by so many of our religious traditions, spiritual traditions, and care is, for better or worse, one of the realest ways you dissolve boundaries between self and other. But it's just because I think, and I do attribute this to both sexism, patriarchy, not valuing care because it was women's work, and also our fixation with independence... Like we haven't really seen care in that way, like we don't hold it up as this, like amazing, radical experience that it really can be. That paradigm shift, I think, would actually help caregivers so much find the meaning in their own terms.

Don't answer this question if you think it's not a good question, but I am curious... Should caregiving, the way that we're talking about it, be equally shared across gender?

'No, I think it's a great question, and I think care is very good for men. And I found a lot of research that suggests this, as well, that I write about in the chapter on 'men and care' in my book. I've seen this firsthand in my life, from my brothers to my father, to my husband, to my boys - encouraging them to care for others. Like I think care gives men a chance to shake off a lot of the restrictions that expectations surrounding masculinity put on them. It lets them be silly, vulnerable. It lets them accept weakness, right? Accept dependency. Like these are not things that we socialize men to recognize or let alone embody. Men are caring, with 40% of caregivers to old, ill, and disabled individuals are men. And fathers today do not as much as moms, but three times as much as fathers did in the 60s, okay? So men are caring - men are carrying so much. Care is a way to access part of our humanity, and it's a core human experience that you're... This is the thesis of my book. I think you're missing out big time if you never have a care experience in your life.

The story that we tell ourselves about care, being a burden, and instead the story being that it's meaningful, that it's helpful, that it's an opportunity in some way. For people who are listening who may feel, "I'm overwhelmed, Elissa's great and everything, but I'm in the throes of this, man."

I get it. I get.

I'm on the throes of it. How do we shift the story we tell ourselves from burden to meaningful?

'Yeah. So I think we have to get out of this like nightmare fairy tale paradigm that care has often been thrusted into. So it's either the worst thing that ever happened to you, or it's just, you know, Disney movie, and you're this perfect mother, and everything's so seamless. And I think when we can get out... I think society has given us such simplistic, to their detriment, scripts for care, and we take them in. We need to get rid of them and put in their place this idea that it's meaningful and that we are a culture that knows what it means to value something that's difficult as being also meaningful. And I often say you're at a dinner party and on one side of the table is someone, maybe a dad on paternity leave for the first time, and on the other side of table, is someone who just hiked Mount Everest. And everyone's gonna turn to the Mount Everest guy and be like, "Oh, wow, like that must have been so hard, but that's like so amazing and what a feat!" And you are a person that's worthy of curiosity and interest and celebration by the broader culture, right? And then people, you know, may ask the dad a few questions, and I understand taking care of a newborn is more common than hiking Mount Everest, but it's really challenging. I've never hiked Mount Everest. So, and... are caring for a parent with dementia, like, wow! So I think it's... Like, can we at least grant ourselves that curiosity and sense of mattering and doing something important, and then work as we can to build a culture that sees it through the same light? I think that practically multitasking is just the worst thing you could do as a caregiver because the presence is the currency. To go back to my process dance, like, that's all you can really give. You cannot control outcomes - you can control them a little more with your kids than you can with others - but like at the end of the day, the presence, and if you're multitasking, it's gonna muddy up the whole thing. We also don't consider care as productive in our country, but if you dig into the research, it's worth is more than the retail industry, the last I checked - the entire retail industry. So I think, you know, all these internal shifts can really help us... At least have a sense of feeling like we matter, this is important, and then start fighting for the world and the support to help lessen the burden and increase the capacity for median growth.

That was my conversation with writer and journalist Elissa Strauss. I really enjoyed that one. Hope you did as well. Her book is called "When You Care: The Unexpected Magic of Caring for Others," and it can be found wherever books are sold. Thanks for listening.