The Cost of Competence: Why Inequality Causes Depression, Eating Disorders, and Illness in Women

Since the advent of the women's movement, women have made unprecedented gains in almost every field, from politics to the professions. Paradoxically, doctors and mental health professionals have also seen a staggering increase in the numbers of young women suffering from an epidemic of depression, eating disorders, and other physical and psychological problems. In The Cost of Competence, authors Brett Silverstein and Deborah Perlick argue that rather than simply labeling individual women as, say, anorexic or depressed, it is time to look harder at the widespread prejudices within our society and child-rearing practices that lead thousands of young women to equate thinness with competence and success, and femininity with failure. They argue that continuing to treat depression, anxiety, anorexia and bulimia as separate disorders in young women can, in many cases, be a misguided approach since they are really part of a single syndrome. Furthermore, their fascinating research into the lives of forty prominent women from Elizabeth I to Eleanor Roosevelt show that these symptoms have been disrupting the lives of bright, ambitious women not for decades, but for centuries.
Drawing on all the latest findings, rare historical research, cross-cultural comparisons, and their own study of over 2,000 contemporary women attending high schools and colleges, the authors present powerful new evidence to support the existence of a syndrome they call anxious somatic depression. Their investigation shows that the first symptoms usually surface in adolescence, most often in young women who aspire to excel academically and professionally. Many of the affected women grew up feeling that their parents valued sons over daughters. They identified intellectually with their successful fathers, not with their traditional homemaker mothers. Disordered eating is one way of rejecting the feminine bodies they perceive as barriers to achievement and recognition.
Silverstein and Perlick uncover medical descriptions matching their diagnosis in Hippocratic texts from the fourth century B.C., in anthropological studies of Africa, Asia, and Latin America, and in case studies of many noted psychologists and psychiatrists, including the "hysteric" patients Freud used to develop his theories on psychoanalysis. They have also discovered that statistics on disordered eating, depression, and a host of other symptoms soared in eras in which women's opportunities grew--particularly the 1920s, when record numbers of women entered college and the workforce, the boyish silhouette of the flapper became the feminine ideal, and anorexia became epidemic, and again from the 1970s to the present day.
The authors show that identifying this devastating syndrome is a first step toward its prevention and cure. The Cost of Competence presents an urgent message to parents, educators, policymakers, and the medical community on the crucial importance of providing young women with equal opportunity, and equal respect.

Brett Silverstein is Associate Professor, Department of Psychology, City College of New York, and the author of Fed Up. Deborah Perlick is Associate Professor of Clinical Psychology, Department of Psychiatry, Cornell University Medical College.