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Societal expectations, cultural trends and conflicting messages may be putting teen girls at a higher risk for depression, suicide, eating disorders and other problems. In “The Triple Bind,” Dr. Stephen Hinshaw explores why girls today are under so much stress.
Chapter one: Impossible expectations
Sixteen-year-old Lupe leans forward, so eager to share her thoughts that she almost knocks her schoolbooks on the floor. “The expectations are impossible!” she tells me.
Her classmate Eugenia, a high school junior, agrees. “No one says what is expected of you, you’re just expected to know — and you have a pressure to exceed even that. I think you’re expected to be well-rounded, be intelligent, be outgoing, but also do like community service and do extracurricular stuff, just have the whole package.”
“But sometimes that’s really hard!” Lupe insists.
Fifteen-year-old Jessica chimes in. “I think we’re supposed to know what we’re supposed to be doing with the rest of our lives. They expect you to know what you are doing at like 16 or 17, and you’re supposed to have a big life plan, but sometimes you just don’t. I think also you get a lot of pressure from your parents to do well in school, and you get a lot of pressure from your friends because you want to go out and have fun, and you get pressure about guys, too …. You have to do everything!”
Her classmates nod vigorously as Jessica continues, her fervor building with every word. “And you’re supposed to handle it beautifully. Be completely graceful, poised, have a boyfriend you’ve been seeing for the past year, know everything, make sure nothing’s wrong, talk to your teachers, be best friends with them, everything has to be perfect. Love your siblings, love your parents, no fighting, and of course, you should be going out with your friends — but don’t party, ‘cause you don’t want a bad rep. But you still want to have fun and be a kid — and you can’t. It’s so hard.”
Eugenia shakes her head. “And the second you make a mistake, everything comes crashing down. You feel like the world just kind of stops. I’ve known some people who have kind of gone down the tubes, they just can’t handle it any more.”
“Yeah,” say the others.
Lupe sighs explosively and leans back in her chair. “It all goes back to the expectations,” she repeats. “First of all they are impossible and second of all, we don’t know what they are.”
Video: Teenage girls under pressure
Girls in danger
At first glance, this conversation with a group of prep school girls in the Seattle area might seem like run-of-the-mill teenage angst. Sure, they’re worried about homework, parents, and getting into college — so what? Why should we worry about these routine teenage complaints?
The numbers tell us why — and their message is disturbing indeed:
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Up to 20 percent of girls aged 10-19 are experiencing episodes of major depression. Information from the general population about depressive disorders — which include withdrawal, tearfulness, lassitude, repeated negative thoughts, sleep disturbance, and self-destructive acts — shows that over the past 50 years or more, the average onset of female depression has fallen from the mid-30s to the mid-20s, with a significant portion of young women becoming depressed by their early to mid-teens.
In 2005, about one-tenth of all teenage girls tried to end their lives. Whereas teenage girls once tended to make “non-serious” suicide attempts — attempts that were considered primarily a cry for help — an increased number are now genuinely trying to kill themselves. The teen suicide rate went up more than 300 percent between the 1950s and late 1980s. Although teen suicide rates fell somewhat during the 1990s and early years of the current decade, between 2003 and 2004, they spiked: the number of girls aged 10 to 14 who killed themselves rose by 76 percent, while suicides of girls aged 15 to 19 rose 32 percent.
Self-mutilation among teenage girls — cutting, burning, biting, and other forms of serious self-injury — appears to be on the increase. Because girls go out of their way to hide this practice, statistics are hard to come by. But almost every clinician will tell you that rates are increasing — dramatically.
Close to 5 percent of U.S. teenage girls and young adults suffer from some form of eating disorder — anorexia, bulimia, or binge eating — with some estimates placing that figure at more than twice that rate. When girls and women are specifically asked about binge eating, more admit to this practice than we ever suspected. And even “normal” girls are preoccupied with weight, diet, and body issues at alarmingly high rates and at distressingly young ages — according to some studies, as young as first grade.
Girls’ rates of aggression and violence are on the rise, while boys’ rates have shown either less of a rise or an actual decrease during the past 15 years. Boys are more physically violent than girls throughout their lives, so it is particularly distressing to review the latest government statistics that reveal alarming rates of self-reported girls’ violence. Some experts contend that rates of official violence are distorted because of a tendency to include aggression at home (fights with siblings, for example) as “assaults” for girls, whereas the same acts would be given another label if boys committed them. But there is no doubt that girls have become more aggressive than previously, and that relational and social aggression (spreading rumors, getting even by forming coalitions against a target, and the like) continue to be a major issue for our daughters.
These figures add up to a staggering sum: At least one-fourth of all U.S. teenage girls are suffering from self-mutilation, eating disorders, significant depression, or serious consideration of suicide — or are perpetrating acts of physical violence. And the rest of the girls, the ones who escape without a clinical label, are hardly home free. Too many of them are struggling with hatred of their bodies, obsessive dieting, sexual confusion, and the persistent sense that they just aren’t good enough; that no matter how much they work or how hard they try, they’ll never be able to achieve all that is expected of them.
If we only had to worry about serious clinical conditions plaguing 25 percent of our teenage girls, this would be alarming enough. But in my clinical and personal experience, virtually all of today’s teenage girls are struggling with challenges that threaten to overwhelm them. When I’ve spoken with these girls, both those at risk and those who seem to be doing fine, I’ve heard a persistent note of dismay. Listening to Lupe, Jessica, and Eugenia, I was struck not by how much they complained but by how desperate they were to please their families, their teachers, their friends. “Give us expectations that we can meet,” they seemed to be saying, “and look how well we’ll perform!” They didn’t mind working hard; they minded feeling that they were doomed to fail.
The underlying current of despair reminded me of some of the most famous animals in the history of psychology — Seligman’s dogs. Martin Seligman is a psychologist who set out to understand learning and motivation. So he put three groups of dogs into harnesses through which he could administer painful electric shocks. The first group of dogs was shocked while in the harness and later released. The second group of dogs was likewise shocked, but had access to a lever that could make the shocks stop. The third group of dogs was also given access to a lever — but their lever had no effect. No matter how long and hard this third group pressed the lever, they were unable to affect what happened to them.
None of the dogs liked being shocked. But it was the dogs in the third group whose response was most disturbing. All three groups of dogs were later placed in a “shock box” from which they could escape by leaping over a low partition. The first two groups of dogs quickly left their unpleasant situation — but nearly all of the third group simply lay down and whined. Seligman concluded that when the dogs realized their responses did not affect their situation, they fell prey to “learned helplessness, ” which he came to see as analogous to the human condition of depression.
Today we know that depression is a far more complicated condition, with significant biological and genetic components. (We’ll talk more about that in Chapter 2.) But any of us, regardless of our genetic heritage, can experience the helplessness, hopelessness, and joylessness that come from feeling unable to affect our own lives. That feeling isn’t necessarily an indicator of clinical depression, so let’s call it “distress.” In that sense, the hard-working, eager-to-please prep school girls with whom I spoke were distressed. So, by their account, were virtually all of their classmates.
Indeed, a whole generation of teenage girls is struggling with an impossible set of expectations, one that I’ve termed the Triple Bind.
Video: Teenage girls under pressure
What Is the Triple Bind
?
The original notion of a “double bind” came from social scientists in the 1950s who studied children growing up with contradictory, impossible demands. For example, a child might be told “Tell me everything that’s going on with you,” and then told (either with or without words) “Don’t bother me with so much information.”Trying ever more frantically to do the impossible, the “double-bind”child was thought to be at risk of mental illness.
Of course, mental illness has more complex origins than this picture indicates, nearly always including biological and genetic underpinnings. And the types of family messages most associated with serious disorders aren’t necessarily those of the double bind. But even if “double bind”-style messages don’t produce clinical conditions, they certainly produce distress. When we’re asked to do two contradictory things, and especially when we fear being punished for not doing them, we’re in a bind: confused, frustrated, and likely to blame ourselves. Our feelings might turn into anger, despair, resignation, or an ever more desperate attempt to go in two directions at once.
Today’s girl faces not only a double but actually a Triple Bind: a set of impossible, contradictory expectations. Like Seligman’s dogs, our teenage girls are baffled, distressed, and overwhelmed as they try ever harder to meet these ever more punishing demands. They’ve responded with a lower age of onset of depression, increases in aggression and violence, and skyrocketing rates of self-mutilation, binge eating, and suicide. They’ve also responded by sacrificing key portions of their identities, developing feelings of self-hatred, and becoming overwhelmed with a general sense of pressured confusion. The Triple Bind is possibly the greatest current threat to our daughters’ health and well-being, an enormous obstacle to their becoming healthy, happy, and successful adults.