Composing a Life

caretaking, even when two people alternate, is always a complementary relationship, never exactly symmetrical. One hopes that in a marriage the times of greatest need will not coincide, that when the one is most needy the other will find resources. But these rhythms of give and take are not easy to develop. Even at the dinner table, it takes skill to allow both partners enough of what my husband calls emotional air time to recite the troubles of the day and be comforted; it is harder still when the needs of the whole week must be compressed into a weekend. It can only work if each partner learns to find satisfaction in caring for the other, like learning to enjoy the mutual giving of pleasure in the syncopated rhythms of lovemaking.
    We have also become increasingly thoughtful about the question of self-care. Some of this is fashion, some of it can be dismissed as narcissism or a new way of expressing affluence, but some of it is an investment in autonomy and in sustaining the quality of life through a longer maturity. We joke about women who urge their men, like children, to wear their galoshes or to get needed exercise, but it is a vast relief when these same men start to take some responsibility for their own well-being. Just as important, women need to care enough about themselves to care for themselves as more than the property of some man.
    It is not easy to learn to cherish oneself when one’s life has been organized around cherishing others or when all the cherishing has been delegated to someone else. During my Amherst years, on the weekdays of coming home to a single-parent household, I felt a weary envy of my predecessor, who had a full-time homemaker waiting for him. I justified the time I put into developing an exercise program or learning about computers by what these pleasures would enable me to offer the college. Still, I used to buy flowers and silk scarves as tokens of caring for myself and treat myself to long scented baths with the phone turned off. Alice lives alone since Jack’s death and it is all too easy for her to treat her vacations as expendable when they are not justified by the needs of others. We all need someone to cherish and be cherished by.
    Today, those who begrudge themselves care, feeling that their role in life is to care for others, can be persuaded to think about issues of health and stress reduction. As a result, a little cherishing of the self is translated into responsible behavior, even a way of caring for others—like Johnnetta’s exercise walking. But self-care is important for its own sake as well. It is intimately tied to self-esteem, with the implication that the one who is cherished is important and valuable for his or her own sake.
    Ellen has always moved between the issues of caretaking that accompany privilege and those that arise at the point of desperation. She was working as director of the psychiatric emergency service at Beth Israel Hospital when emergency wards, set up to deal with accidents and sudden emergencies, began to be flooded with patients with chronic complaints whose disrupted lives gave them no regular access to care. The appearance of the homeless on the streets of America is a visible reminder that while some Americans receive the most expensive and skilled forms of care, from organ transplants to psychoanalysis, others may be entirely alone and uncared for. The situation demands both new definitions of need and new institutions and highlights the fact that obtaining care is a skill. There is a necessary spectrum in which a commitment to care for the desperate balances the commitment to provide intimate care within the household. Together, the two offer a perspective for creating a society adequately cared for. Every time we turn away from including compassion in the national agenda, we handicap ourselves for real leadership.
    Ellen has always done some individual psychotherapy, but she was also assigned as a resident to work at Boston State Hospital, a large state mental hospital, before deinstitutionalization. At the state hospital, psychiatrists spent more time resisting the constant threat of disorder than they spent on healing. As a result of this work, she came back to the Harvard University teaching hospitals far more knowledgeable about the use of medications in psychiatry than those who were clinically trained in more fortunate environments.
    Ellen’s mixed experience poses mirror questions, not contradictions. What is the finest