Self-Silencing Is Making Women Sick

“Be more disappointing” is not a piece of advice most people would pay money to hear, but in my therapy office, it’s often the most valuable guidance I can give. My clients are mostly women, and nearly all of them struggle with a fear of disappointing others. Our culture rewards women for being perpetually pleasant, self-sacrificing, and emotionally in control, and it can feel counterintuitive for my clients to say “no”—or firmly assert their wants and needs. But my work is about helping them realize that their health might literally depend on it.

“更加令人失望”并不是大多數(shù)人愿意付錢去聽到的建議，但在我的治療辦公室里，這往往是我可以給予的最有價(jià)值的指導(dǎo)。我的客戶主要是女性，幾乎所有人都在努力不讓別人失望。我們的文化獎(jiǎng)勵(lì)女性永遠(yuǎn)愉快、自我犧牲和情緒控制，并且我的客戶感覺說“不”或堅(jiān)決表達(dá)他們的需求和想法是違背直覺的。但是，我的工作是幫助她們意識(shí)到她們的健康可能完全依賴于此。

Today, women account for almost 80% of autoimmune disease cases. They are at a higher risk of suffering from chronic pain, insomnia, fibromyalgia, long COVID, irritable bowel syndrome, and migraines, and are twice as likely as men to die after a heart attack. Women experience depression, anxiety, and PTSD at twice the rate of men, and face a ninefold higher prevalence of anorexia, the deadliest mental health disorder.

如今，女性占自身免疫病例的近80%。她們患慢性疼痛、失眠、纖維肌痛、長期COVID、腸易激綜合癥和偏頭痛的風(fēng)險(xiǎn)更高，心臟病發(fā)作后死亡的可能性是男性的兩倍。女性經(jīng)歷抑郁、焦慮和創(chuàng)傷后應(yīng)激障礙（PTSD）的速率是男性的兩倍，并且面臨著患厭食癥（這是最致命的心理健康障礙）的風(fēng)險(xiǎn)高出九倍。

Why is it that women are falling ill to these diseases at a rate so much higher than men? Such jarring disparities cannot be accounted for by genetic and hormonal factors alone; psychosocial factors play an important role as well. Specifically, it seems that the very virtues our culture rewards in women—agreeability, extreme selflessness, and suppression of anger—may predispose us to chronic illness and disease.

為什么女性患這些疾病的比率比男性高得多？這樣駭人的差異不能僅由基因和激素因素來解釋；心理社會(huì)因素也起著重要的作用。具體來說，似乎我們文化中獎(jiǎng)勵(lì)女性的很多美德——如愉快、極端無私和抑制憤怒——可能會(huì)讓我們更易患慢性疾病。

In the late 1980s, Harvard-trained psychologist Dana Jack identified a recurring theme among female patients suffering from depression: a tendency to self-silence, defined as “the propensity to engage in compulsive caretaking, pleasing the other, and inhibition of self-expression in relationships in an attempt to achieve intimacy and meet relational needs.” Through longitudinal research, Jack found that this learned behavior, strongly rooted in gender norms, was linked to an increased risk of depression.

在20世紀(jì)80年代末，哈佛訓(xùn)練有素的心理學(xué)家Dana Jack發(fā)現(xiàn)了患有抑郁癥的女性患者中的一個(gè)反復(fù)出現(xiàn)的主題：一種自我沉默的傾向，定義為“傾向于在關(guān)系中進(jìn)行強(qiáng)迫性照顧、取悅他人和抑制自我表達(dá)，以試圖實(shí)現(xiàn)親密和滿足關(guān)系需求”。通過縱向研究，Jack發(fā)現(xiàn)，這種深深植根于性別規(guī)范的學(xué)到的行為，與抑郁癥的風(fēng)險(xiǎn)增加有關(guān)。

Since then, considerable evidence has revealed that female self-silencing isn’t just tied to psychological issues like depression and eating disorders, but also to physical illness. For instance, in March of 2022 a team of researchers at the University of Pittsburgh discovered that women of color who strongly agreed with statements like “I rarely express my anger to those close to me,” were 70% more likely to experience increased carotid atherosclerosis, a cardiovascular plaque associated with higher risk of heart attack. Other studies have connected self-silencing to irritable bowel syndrome, HIV, chronic fatigue syndrome, and cancer among women.

從那時(shí)起，大量證據(jù)表明，女性的自我沉默不僅與抑郁癥和飲食失調(diào)等心理問題有關(guān)，還與身體疾病有關(guān)。例如，在2022年3月，匹茲堡大學(xué)的一個(gè)研究團(tuán)隊(duì)發(fā)現(xiàn)，顏色較深的女性如果非常同意“我很少向親近的人表達(dá)我的憤怒”之類的說法，那么她們患頸動(dòng)脈粥樣硬化癥的可能性就會(huì)增加70%，這是與心臟病發(fā)作風(fēng)險(xiǎn)增加有關(guān)的一種心血管斑塊。其他研究也將自我沉默與女性的腸易激綜合癥、艾滋病、慢性疲勞綜合癥和癌癥聯(lián)系起來。

Most jarringly, women’s self-silencing has also been linked to higher risk of premature death. In one study, researchers followed nearly 4,000 people in Framingham, Massachusetts over 10 years. They found that women who didn’t express themselves when they had fights with their spouses were four times more likely to die than those who did. This was true even when factors such as age, blood pressure, smoking, and levels of cholesterol were taken into account.

最震驚的是，女性的自我沉默還與早逝的風(fēng)險(xiǎn)增加有關(guān)。在一項(xiàng)研究中，研究人員跟蹤了馬薩諸塞州弗拉明漢的近4000人10年。他們發(fā)現(xiàn)，在與配偶吵架時(shí)不表達(dá)自己感受的女性比那些表達(dá)自己感受的女性死亡的可能性要高四倍。即使考慮到年齡、血壓、吸煙和膽固醇水平等因素，這也是正確的。

When women push their feelings down and cast their needs aside, their health suffers. But it can be difficult for women to do otherwise in a culture that celebrates these self-silencing practices. While young women are praised for “being chill,” moms are revered for being painstakingly altruistic to the point of self-abnegation. These unspoken standards establish a vicious cycle. For many women, it feels easier—beneficial, even—to silence their needs at the expense of their own health, rather than swim against the prevailing cultural current.

當(dāng)女性壓抑她們的感覺并把她們的需求放在一邊時(shí)，她們的健康會(huì)受到影響。但在一個(gè)慶祝這些自我沉默做法的文化中，女性很難做到其他。年輕女性因?yàn)椤氨３掷潇o”而受到贊揚(yáng)，而母親們因?yàn)榫牡責(zé)o私到自我消除的地步而受到尊敬。這些不言而喻的標(biāo)準(zhǔn)建立了一個(gè)惡性循環(huán)。對(duì)許多女性來說，沉默她們的需求以犧牲她們自己的健康似乎更容易——而不是逆著主流文化的潮流而行。

In his best-selling book, The Myth of Normal, physician and author Gabor Mate writes that many of our society’s most “normalized ways of being”—the qualities we regard as “admirable strengths rather than potential liabilities”—are, in fact, incredibly toxic. “That ‘not listening to self’ in order to prioritize others’ needs is a significant source of the health-impairing roles women assume,” Mate explains. “It is among the medically overlooked but pernicious ways in which our society’s ‘normal’ imposes a major health cost on women.”

在他的暢銷書《正常的神話》中，醫(yī)生和作家Gabor Mate寫道，我們社會(huì)中許多最“正常的生活方式”——我們認(rèn)為是“令人欽佩的優(yōu)點(diǎn)而不是潛在的弊端”的品質(zhì)——實(shí)際上是非常有毒的。“為了優(yōu)先考慮別人的需求而‘不聽從自己’是女性承擔(dān)損害健康角色的一個(gè)重要原因，”Mate解釋道。“這是我們社會(huì)的‘正?！砸环N被醫(yī)學(xué)忽視但有害的方式對(duì)女性造成重大健康成本的方式之一。”

It seems that the virtues of womanhood are not really virtuous after all; instead, they are wreaking havoc on our bodies and our health. And the way they often do so is through these seemingly “normal,” daily experiences that slowly, over time, chip away at our vitality and erode our well-being. My clients tell me things like, “I don’t deserve to put my needs first. I’m not the breadwinner,” or “I said ‘yes,’ even though I didn’t want to.” In their gradual attempt to be what society considers “good,” they run the risk of compromising their health.

似乎女性的美德并不真正有美德；相反，它們?cè)谖覀兊纳眢w和健康上造成了破壞。它們通常通過這些似乎“正?！钡摹⑷粘５慕?jīng)歷慢慢地削弱我們的活力并損害我們的幸福感。我的客戶告訴我諸如“我不配優(yōu)先考慮我的需求。我不是家庭的經(jīng)濟(jì)支柱”，或者“我說‘是的’，即使我不想這樣做”。在他們漸漸嘗試成為社會(huì)認(rèn)為的“好人”的過程中，他們冒著損害健康的風(fēng)險(xiǎn)。

As a psychologist, it can sometimes feel challenging to help my clients take back their emotional and physical health when they are contending against a complex cultural system that is reinforcing them to do the opposite. However, I have found that there are some tangible changes that really do, in practice, make a difference.

作為心理學(xué)家，當(dāng)我的客戶在與一個(gè)復(fù)雜的文化系統(tǒng)作斗爭時(shí)，幫助她們重新獲得情感和身體健康有時(shí)會(huì)感覺很有挑戰(zhàn)性，這個(gè)系統(tǒng)是在強(qiáng)化她們做相反的事情。然而，我發(fā)現(xiàn)實(shí)際上有一些實(shí)際的變化確實(shí)有所作為。

It can be paradigm shifting to understand that behind every emotion exists a need. Anger, for example, can signify the desire to change our current circumstances. Rather than women treating our emotions as inconvenient, bodily malfunctions best to be muted and ignored, we can teach ourselves to view them as windows of insight. Instead of casting away our anger, a valuable question we can ask ourselves in moments of frustration is: what am I needing right now?

理解每種情緒背后都存在一個(gè)需求可能會(huì)改變我們的思考方式。例如，憤怒可以表示改變我們當(dāng)前情況的愿望。我們不應(yīng)該將我們的情緒視為最好被消除和忽視的不便的身體故障，而應(yīng)該教會(huì)我們自己將它們視為洞察的窗口。我們可以問自己一個(gè)有價(jià)值的問題，而不是拋棄我們的憤怒：我現(xiàn)在需要什么？

Another practice, closely related, is boundary setting. For women, who have been unconsciously taught to view our likability as our greatest asset, boundary setting can often feel counterintuitive. Many of us fear that if we honestly communicate our needs and limitations, this will threaten our relationships. But it’s the contrary that’s true: when we set heathy boundaries (rather than toxic ones that can lead to radical individualism) our relationships actually become stronger and healthier. And having healthy relationships is integral to our physical well-being; one meta-analysis showed that people with more supportive social relationships have a 50% lower risk of premature death.

另一種做法是設(shè)置邊界。對(duì)于我們這些在無意識(shí)中被教導(dǎo)將我們的受歡迎程度視為我們最大的資產(chǎn)的女性來說，設(shè)置邊界往往感覺違背直覺。我們中的許多人擔(dān)心，如果我們誠實(shí)地傳達(dá)我們的需求和限制，這將威脅到我們的關(guān)系。但相反是真的：當(dāng)我們?cè)O(shè)置健康的邊界（而不是可以導(dǎo)致極端個(gè)人主義的有毒邊界）時(shí)，我們的關(guān)系實(shí)際上變得更加強(qiáng)大和健康。擁有健康的社交關(guān)系對(duì)我們的身體健康至關(guān)重要；一項(xiàng)元分析顯示，擁有更多支持性社交關(guān)系的人早逝的風(fēng)險(xiǎn)降低了50%。

To reshape the virtues of womanhood, a new “normal” needs to emerge—one in which we honor our emotions, prioritize our needs, and actively communicate our boundaries. Such a shift requires change on both the individual and societal level, and will by no means by easy. But it’s certainly worth it—after all, women’s lives depend on it.

為了重塑女性的美德，需要出現(xiàn)一個(gè)新的“正常”——在其中我們尊重我們的情感，優(yōu)先考慮我們的需求，并積極傳達(dá)我們的邊界。這樣的改變需要在個(gè)人和社會(huì)層面上進(jìn)行變化，并且絕不會(huì)容易。但這絕對(duì)是值得的——畢竟，女性的生活依賴于它。

相關(guān)知識(shí)

飲食經(jīng)濟(jì)學(xué)
行為經(jīng)濟(jì)學(xué)與公眾健康
健康經(jīng)濟(jì)
一個(gè)經(jīng)濟(jì)學(xué)家的懷孕指南
綠色經(jīng)濟(jì)
哪個(gè)正確？經(jīng)濟(jì)性貶值＝重置成本×經(jīng)濟(jì)性貶值率經(jīng)濟(jì)性貶值＝（重置成? 愛問知識(shí)人
國家發(fā)改委：銀發(fā)經(jīng)濟(jì)包含“老齡經(jīng)濟(jì)、備老經(jīng)濟(jì)”兩個(gè)方面
經(jīng)濟(jì)壓力感知對(duì)高校學(xué)生心理健康的影響
茶文化的經(jīng)濟(jì)發(fā)展作用(茶文化的經(jīng)濟(jì)價(jià)值)
低空經(jīng)濟(jì)行業(yè)報(bào)告

網(wǎng)址: 經(jīng)濟(jì)學(xué)人 http://m.u1s5d6.cn/newsview541957.html