3 Oct 2023

Why women put themselves last - and why they should not

From Nine To Noon, 10:05 am on 3 October 2023

Fuelled by self-criticism and social conditioning, many women put their own well-being last on their own priority lists, says Australian GP and writer Dr Cate Howell.

The first step towards a state that she calls "flourishing" is to become aware of our own harsh "inner voices".

"[It's about] learning to be a bit gentler, a bit less harsh, a bit kinder in our thoughts… We are all human, after all, and we have strengths, and we have flaws. We have to give ourselves a little bit of space to make mistakes and to learn."

Dr Cate Howell

Dr Cate Howell Photo: Supplied

Book cover of The Flourishing Woman By Dr Cate Howell

Photo: Supplied

Dr Cate Howell is the author of The Flourishing Woman. Her previous books include Intuition: Unlock the Power and The Changing Man: A Mental Health Guide.

Learning to put others before oneself is something many women are taught in childhood, Dr Howell tells Kathryn Ryan.

While this isn't a bad thing in itself, many take it to the extreme throughout their lifetimes - prioritising work or caring for family above their own health.

"Often we take on that nurturing role to a great degree, and sometimes that means putting ourselves lower down on the priority list, or even self-sacrificing."

Resentment is a common and natural response to feeling overwhelmed by over-caring, she says.

"We're often carrying this big load and we start to feel resentful about it. We have to step back and have a look at 'Okay, what's contributing to this? What's my stuff? What's other people's stuff? What's the influence of society?"

"We were sold this idea of the perfect woman looking great, working, successful mothering, partnering, travelling… all at the one time."

Women need to challenge this unattainable ideal, Dr Howell says, both within themselves and in relation to other people.

"Sometimes we have to do a bit of a reset and sit down and say 'Look, I am feeling resentful around this because I'm carrying such a huge load, and I think as a couple, or a family, or a workplace, we need to have a look at whether it's realistic and do a reset.

"Some of this is about being able to recognise [the imbalance] and being able to verbalise [our own experience]. Be a bit assertive about it and bring about change that way."

As with the "old metaphor" of putting one's own oxygen mask first, Dr Howell says it is possible to care for others while ensuring that you care for yourself - with awareness, dedication and practical strategies.

Moving your body is an excellent way to lift the mood and calm the mind.

"Our brains, our nervous systems need exercise ... Moving gets the blood circulating, it's absolutely vital that we move our bodies."

When it comes to exercise, people who've been struggling with anxiety and depression often benefit from starting with "baby steps", she says.

"Even if it's doing a few stretches in the house or walking around the garden or walking to the shop instead of driving to the shop ... [It's just taking small steps to get that exercise happening.

"Then of course, we get the feedback, we start to feel that little bit better from breathing some fresh air, from a little bit of dopamine in our brain, from seeing nature."

Softening the self-critical inner voice that we develop growing up is another essential strategy for well-being, Dr Howell says.

"We're like sponges when we grow up. We take onboard messages from family and school and society … social media, of course.

"Our self-talk is often much more critical to ourselves than we would be if we were talking to a friend. I often say that to clients: 'Would you say that to a friend?' 'Well, no' [they reply]. But we say it to ourselves. We think we can beat ourselves up in our minds.

"So awareness is the first thing, and learning to be a bit gentler, a bit less harsh, a bit kinder in our thoughts. We are all human, after all, and we have strengths, and we have flaws. We have to give ourselves a little bit of space, you know, to make those mistakes and to learn. Self-compassion is bringing in that awareness, that kinder voice and recognising we are human."

Challenging old, limiting stories about ourselves is also very helpful, Dr Howell says.

"I'm a hopeless cook, and, you know, it's a bit of a joke with my friends because I never really learned to cook particularly. So I give myself a hard time. I go 'I'm a hopeless, cook, you know. I can't cook anything'. But the reality is I did pick up things along the way and I do cook some things for myself and I did cook for my family when they were younger ...we often think in these extremes, so we have to learn to reframe our thinking and find the more positive side."

"Identifying what you really care about can also help reveal a pathway towards flourishing, Dr Howell says.

She likes the Japanese concept of finding one's personal ikigai, which can be translated as "something worth living for".

To do this, you might ask yourself what you're passionate about, what are you interested in, what you enjoy and also what you are naturally good at.

"What's important to you in life? Is it that your family is your primary thing of importance in life? Is it your work and something you're trying to achieve for the community? Or is it your spirituality? Is that your garden? What do you value? What's important to you, that's where your priorities lie."

Well-being is not just about feeling good, Dr Howell says, it's also about functioning well in your day-to-day life and relationships.

As a GP, she likes to take a holistic assessment of each patient's individual circumstances, taking into account hormones, medication, stressors and sleep quality.

"It's teasing all of that out and then working out what do we need to address? Is that those lifestyle changes - getting better sleep, getting exercise, getting good nutrition, cutting down alcohol, what is it? Are there physical hormonal issues that need to be addressed? Or is there also an issue around mental health in terms of anxiety or depression?"

For a long time, anxiety has been the most common mental health struggle, she says. While medication is sometimes required, counselling, yoga and "containing" screen time can also help restore calm.