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

by Brett Silverstein, Deborah Perlick

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.

Genres: Nonfiction

224 pages, Hardcover

First published January 1, 1995

Reviews

[Skye Adams · Rating 3 out of 5]

Though i’m very late to reading this book, and the research is now outdated, it was very ruminative and interesting to see what stage of psychology we were at during the 20th century. Even though the authors were potentially “ahead of their time”, there was still a bit of gender discrimination in their research and they failed to discuss much about the implications of sexuality. I understand it was important for them to include a wide body of research and really get their point across but the book became a bit repetitive and i think the information could have been condensed.

That said, I rated this book 3 stars because i believe that this is truly a vital area of psychology, and these authors understood its significance. As a woman, some of it really resonated with me and induced a lot of thought about the small, daily experiences i’ve had with gender inequality throughout my life; especially through my transition into young adulthood.

A young girls expressed vocational plans of becoming a ballerina are once met with a grin, but later instil disbelief in the utter of an adolescent woman.

Girls who prefer football to dolls are tolerated in primary school. They can be allowed, but not encouraged, to have a “masculine” interest and just be labelled as a “tomboy”. But being socially successfully in young womanhood comes at the cost of giving up “masculine” activities and interests, and worrying about whether you’re sweet, feminine and attractive to boys.

“puberty, which gives the man the knowledge of greater power, gives to women the conviction of her dependence” - Dr Edward J Tilt.

To successfully find your way into womanhood, not only did you have to sacrifice your hobbies and interests, you also had to bear children and basically become an ‘unpaid maid’ while being shunned for ‘not working’. No wonder women suffered so inconsolably with mental health issues. If “the disease of young women” wasn’t ironic enough, doctors literally used to prescribe mentally ill women… with men. These serious mental health issues were just seen as obstacles for men because women weren’t fit for “performing their natural reproductive function”. Any woman who did “fail” to bear children, was also seen to “fail” at womanhood, and even those who did successfully conceived found that, should they never birth a son, true womanhood was still slightly out of reach.

I would be keen to compare this to modern research.

[Susan Bailey · Rating 4 out of 5]

I used this book for research and also because of anorexia in my family. While I did not agree with several points in this book, it definitely stirred the pot and opened my mind to new questions to pose; in that sense the book did its job well.

My complaint is that at times it seemed the authors were trying to jam a square peg into a round hole. And while I am certain it was not their intention, there was a dismissal of those who have suffered from anxious somatic depression (of which anorexia is a part) who did not fit into their tight profile. I realize men did not figure into the equation but men do suffer from the disease. I was also surprised at the lack of mention of substance abuse (especially alcoholism) for those who suffer from the disease. I have family experiences in all these examples.

I learned things about myself and my own family that I had not previously considered. I recognized things in myself and particularly in my mother's side of the family which really made sense.

Definitely a worthwhile book.