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updated 2/10/2009 10:37:35 AM ET 2009-02-10T15:37:35

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.

Each portion of the Triple Bind is challenging enough. But it’s the combination of all three aspects that makes it deadly:

  1. Be good at all of the traditional girl stuff.
  2. Be good at most of the traditional guy stuff.
  3. Conform to a narrow, unrealistic set of standards that allows for no alternative.

Let’s take a closer look.

1. Be good at all of the traditional girl stuff. 
Today’s girl knows she’s supposed to fulfill all the traditional “girl” expectations — look pretty, be nice, get a boyfriend — while excelling at “girl skills”: empathy, cooperation, relationship-building. Any girl who wants to feel normal knows the drill: bond with your girlfriends, support your boyfriend, and make your family proud. The essence of these girl skills is maintaining relationships: doing what others expect of you while putting their needs first. It’s the quality that leads a girl to spend all evening talking a friend through a crisis rather than using those hours to write her own “A” paper. It’s also the quality that might lead her to suppress her own abilities or desires in order to boost a boyfriend’s ego or reassure an anxious parent.

2. Be good at most of the traditional guy stuff. 
Female skills might once have been all a girl needed — but no longer. Today, a girl isn’t just looking for marriage and family; she expects to succeed at what were once traditionally considered “boy” goals: get straight As, be a super-athlete. Girls, especially those from the middle or upper income brackets, are often expected to win acceptance to a top college. A poor or working-class girl’s family may also look to her for the kind of financial support or upward mobility, through school, sports, or entertainment, that was once expected only of her brother. 

So in today’s competitive environment, “girl skills” are not enough. A successful girl must also master the ultimate boy skills of assertion, maybe even aggression: the commitment to become a winner at anything you undertake, regardless of your own or others’ feelings. It’s the quality that leads the star football player to charge through the line, suppressing any fear he might feel, ignoring both the pain he experiences and the pain he causes. It’s also the quality that might lead a boy to promise himself, “Someday, I’m going to discover a cure for cancer, no matter how hard I have to work, no matter how many hours I miss with my family, no matter how many people think I can’t do it.” 

As you can see, there are pluses and minuses to both approaches, but what’s really difficult, if not impossible, is to master both of them at the same time. How do “best friends 4ever” fight each other over a diminishing number of college slots? What if the empowered basketball star doesn’t fit into the size-2 miniskirt or can’t stand letting her boyfriend win at ping-pong? What about the girl who wants to get off the merry-go-round, explore an alternate identity that allows a little more breathing room? 

3. Conform to a narrow, unrealistic set of standards that allows for no alternative.
Enter the third component of the Triple Bind: the way that alternatives of all types — different ways of becoming a woman, relating to society, or constructing an authentic self — have been virtually erased by the culture. This is the truly insidious aspect of the Triple Bind, which seems to offer choices with one hand only to take them away with the other. 

At first glance, you might think that a girl was free to become anything she chooses. Look a little closer, though, and you’ll see that whatever else she may decide, she must also always be sexy, thin, pretty; have either a great boyfriend or a husband and kids; and be wildly successful at her career. 

Girls used to be able to escape the narrow demands of femininity through such alternate roles as beatnik, tomboy, intellectual, hippie, punk, or goth. They’d embrace the ideals of feminism to proclaim that women didn’t always have to be pretty, nice, and thin; that they didn’t always have to have boyfriends; and that not all women wanted to become mothers. Or girls might follow a counter-culture that challenged the notion of rising up the corporate ladder or fulfilling men’s notions of the ideal woman. They’d imitate pop stars who presented alternate looks and styles of femininity: Janis Joplin, Patti Smith, Tina Turner, Cyndi Lauper. They’d take up basketball or hockey; they’d turn into bookworms or dream of being President. All of these alternatives to traditional female roles gave independent girls a little breathing room, the space to insist that they didn’t necessarily have to fit into skimpy clothes or learn how to flirt at age 11. Other types of alternatives — bohemianism, the counterculture, activism, art, humanitarian ideals — helped girls challenge the achievement-oriented culture that insisted on straight As, elite colleges, and seven-figure incomes as the only prizes worth having. A free-spirited girl might even find a way of being sexy that wasn’t about how she looked, a sexual style that was uniquely her own.

Now virtually all of these possibilities have been co-opted, consumerized, and forced into an increasingly narrow, unrealistic set of roles. Standards have become narrower and less realistic for both looks (“girl stuff”) and achievement (“boy stuff”), even as the cultural alternatives that might have helped girls resist these standards have been erased.

First, the definitions of “sexy” and “pretty” have narrowed enormously in recent years, with an ever-escalating demand that girls turn themselves into sexual objects. For a girl to fit the acceptable look now requires an almost superhuman commitment to dieting, waxing, applying makeup, and shopping; for some girls, plastic surgery has also come to seem like a minimum requirement. These trends begin at frighteningly young ages. Even many lesbian girls, whose choice once seemed to free them from the “male gaze” of conventional beauty, are now also expected to present themselves in sexually objectified terms, sporting the same lipstick and lingerie as their heterosexual sisters.

Video: Teenage girls under pressure At the same time, girls face increasingly unrealistic standards for achievement. Only the top grades and test scores, combined with the most impressive extracurriculars, will fit a girl for a top college, a destination that is becoming virtually a requirement for more and more middle-class girls. Poor and working-class girls now dream of becoming superstar athletes, top models, or self-made entrepreneurs — and attending the Ivies as well. I’m all for dreaming, but girls are being given the message that anything less than the absolute best counts as failure. 

So both the “girl” and “boy” requirements have become harder to meet, even as the alternatives that might have freed girls from either set of demands — feminism, bohemianism, political activism, community spirit — have all but disappeared from the cultural landscape.  Our girls are truly trapped, and the crisis-level statistics I have shared with you are a key consequence. 

This third aspect of the Triple Bind is particularly insidious because it’s so deceptive. On the surface, all jobs, all activities, indeed all possibilities are open to every teenage girl. Look a little deeper, though, and you can see the constraining need for girls to objectify themselves in order to fit the feminine mold. Yes, you might be able to do something “alternative” and unique — you can become the first female Indy driver, like Danica Patrick, or the first female presidential contender, like Hillary Clinton — but you still have to pose in a sexy outfit for Playboy or obsess publicly about your weight. Instead of Chrissie Hynde, we have Britney Spears; instead of Annie Lennox, we have Lindsay Lohan; instead of Queen Latifah, we have Beyonce. Political pundits toss their hair and sport short skirts; women are told to exhibit empowerment, originality, and pride even as they don swimsuits to become the next top model. Our daughters might admire a whole roster of female athletes, but they, too, are expected to look skinny and “hot.” (A colleague of mine, a sports psychologist, tells me that this is a recurring worry among the top female athletes he treats each week.) The 24-7 barrage of media images contributes to the sense that the walls are closing in. Skinny, sexy, scantily dressed teens and preteens appear everywhere, an airtight world that seems to offer no way out, reinforcing the notion that the only possible way to become a woman is to turn oneself into an object. Even the pioneering Nancy Pelosi, who will go down in history as the first female Speaker of the House, seems polite and ultra-feminine compared to such forebears as the hefty, abrasive Congresswoman Bella Abzug.

Despite the apparent wealth of choices, our girls are ultimately presented with a very narrow, unrealistic set of standards that allow for no alternative. A seemingly boundless and hermetic culture insists on every female looking thin, pretty, and sexually available, whether she’s a political pundit, a professional athlete, or a 10-year-old girl, even as it also demands that every girl aspire to being a wife (lesbian or straight) and mother — and all while climbing to the top of her career ladder, becoming a millionaire, and triumphing over every possible competitor. No wonder our girls are increasingly becoming depressed, expressing their anguish through binge eating, self-mutilation, acts of violence, and even suicide. 

Dr. Hinshaw's tips: How girls can overcome 'The Triple Bind'

  • Find out what you're really interested in. Sometimes this is difficult, with the pressures from parents, teachers, and your own "internalized voices" (i.e., you're not succeeding if you don't do X, Y, and Z).  Self-discovery takes time, and it also means that you have to leave some room for mistakes.
  • Connect with a wider world. Animal shelters? Tutoring? Neighborhood clean-up? Political causes? These are just some examples of activities that can stop the relentless self-focus of the triple bind and that can connect you with like-minded peers and friends.
  • Think critically. As you read, as you watch the media, as you connect on social networking sites, think hard — do all girls really look like the computer-enhanced images on magazine covers? Is a diet the solution to everything? Do I have to follow the latest trends to be popular? Don't accept everything you encounter at face value!

Excerpted from "The Triple Bind" by Stephen Hinshaw. Copyright (c) 2009, reprinted with permission from Random House.

© 2012 MSNBC Interactive

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