Quick summary: Isolated families, especially those who moved for work, often run without the informal kin who once absorbed small crises, so exhaustion is read as personal failure rather than missing redundancy. Kin support is linked with modestly better maternal mental health around birth, and higher parental stress tracks lower well-being, but the effects are not large enough to make one relative the difference between coping and collapse. Clinicians help more by naming that structure and treating the household as the unit under strain than by asking a mother who chose the life to try harder.
A mother sits down in my consulting room and, before anything else, apologises. She is not depressed, she says. Other people have real problems. She cannot understand why this is so hard when she has the work, the move, the children, the life she and her husband chose and would choose again.
Then comes the sentence I have learned to listen for. “I should be able to manage this.”
What she is describing is a household with no layer beneath it.
What is actually missing
Most families under strain sit on top of something. A grandmother who takes the children on a Friday. An aunt who can be telephoned at seven in the morning. A cousin who already knows which child will not eat which food. None of it is dramatic. None of it appears on any list of what a family needs. That is why its absence is so hard to name.
Expatriate families do not have it. They relocated for work and for ambition, and the layer they grew up inside is still in the country they left, four hours away by plane and further by the time everybody reaches it. Nobody took it from them. They moved, for good reasons, and it stayed where it was.
The anthropology needs handling carefully. Reviews of child survival find that mothers matter most, and that a maternal grandmother nearby is often linked with better odds for the child. The wider point is simpler. Human reproduction has never been a two person job, and our short birth intervals are hard to afford without others contributing.
That literature concerns child survival in high mortality populations, not a tired couple in a city apartment, and I will not pretend it maps directly. What it establishes is narrower and still useful. The isolated parental pair is not the arrangement our species is built around. Two people doing it alone are not failing at something that was ever supposed to be easy.
The evidence is real, and smaller than you would expect
I want to be careful here, because the temptation to overstate is real.
Grandparental support is linked with slightly better mental health for mothers around birth. The link is modest, and a little stronger when the help comes from the mother’s own mother. In pregnancy, thin social support is more clearly tied to anxiety than to depression. None of this proves cause, and none of it is large enough to make a grandmother the difference between coping and collapse. It does show that the missing layer is measurable, not merely sentimental.
None of that is causal, and none of it is large enough to make a grandmother the difference between coping and collapse. What it does establish is that the support layer is measurable rather than sentimental. It is doing something, and the something is modest.
Nobody in the house is the exception
The absence is only half of it.
The other half is that everybody under that roof is carrying their own load at once. The children have friendships to manage, schoolwork that does not stop, and phones that make both of those louder. The parents are inside work that keeps changing shape. What that costs the parents is measurable. A 2025 meta-analysis of 86 studies and 22,108 parents found higher parental stress tracking lower parental well-being.
Four people, four loads, one household, and nobody with any slack to lend anybody else. That is the structure. It explains what the family cannot. Why a small thing at seven in the morning becomes a row out of all proportion to the toast.
Why the parents never name it
Two reasons, both worth saying out loud.
The first is that an absence is invisible. You can point to a diagnosis, a redundancy, a child who is struggling. You cannot point to the aunt who is not there. There is no event to describe, so it never becomes the thing discussed.
The second is harder. They chose this. Maternal guilt often sits in the gap between the mother a woman is and the mother she believes she ought to be. When you have moved deliberately, for a life you wanted, that gap closes into self blame with unusual speed. The reasoning runs. I chose this, so if it is hard, the problem must be me.
What I see is something structural being experienced as a character flaw.
What helps, and what it does not
In my experience, naming it helps more than it sounds. A family that understands it is running a system with no redundancy stops reading exhaustion as evidence about who they are.
The second thing is to stop treating one person as the problem. Families usually organise themselves around somebody identified that way, and there is reasonable evidence for widening the frame, though it has limits. In adolescent treatment, a 2024 meta analysis of 20 randomised trials found that adding a parental component produced a small overall advantage. It held for externalising problems but did not reach significance for anxiety and low mood
So the claim is not that family work replaces individual treatment. It is that the household is the unit under strain, and treating it as the unit is often a more accurate description of what is wrong.
Which returns me to the woman in my consulting room. She does not need to try harder, and she is not managing a family badly. She is managing a family without the thing that families have almost always had, and she never noticed it had gone, because nothing was taken from her. She moved, for good reasons, and it stayed where it was.
Sarah El Nabulsi, MSc, MA, MA, is a DHA-licensed clinical psychologist and clinical director at Dr Reuter Medical Center in Dubai.
She works with adults and couples on anxiety, panic, OCD and relationships in Arabic, English and French, led a 2015 UAE well-being study, and directs the National Office of Transcendental Meditation in the UAE.
