by Robin Romm
Little girls need every ounce of self-esteem they can get. To paraphrase Frederick Douglass, it’s easier to build strong children than repair broken adults. I’ve spent my entire professional life seeing firsthand how true that is. Girls who hold on to their assertiveness and self-esteem are less likely to grow up to be depressed women. Speaking your mind is part of a healthy lifestyle. Suppressing your feelings is not only going to make you miserable; it may well make you physically ill. Women are more prone to emotionally induced heart attacks than men are, and we die of heart disease in staggering numbers in America. Clinical studies demonstrate a correlation between self-abnegating women and medical illness. We’re acquiescing ourselves to death.
I’ve been involved in clinical research of schizophrenia when I designed a protocol as a psychiatric resident, and for the past several years, I’ve been involved in research of two treatments for Post Traumatic Stress Disorder, one using MDMA (Ecstasy) assisted psychotherapy, and the other testing various strains of cannabis. If I had stopped trying every time a man told me something was impossible, I’d be nowhere. I like what Michele Roberts, the first woman leader of the NBA union, said, that her past was littered with the bones of the men who underestimated her. My past includes men who told me it’d been done before, when it hadn’t. Or that it just wouldn’t work, making me doubt myself when it turned out I was right and should have stood my ground. Or men in power who tried to dissuade me from my ideas and goals as an underling, only to later take credit for formulating and implementing them.
Sometimes men were simply dismissive or belittling. There was the program director, a man twenty years my senior, who, on the heels of a great conversation about all things neurochemical during a fellowship interview, ended it by saying as I rose from my chair, “You’re cute. How old are you?” I rode the elevator to the lobby, mentally scratching off his program from my list of possible placements after residency. I felt small, invalidated, and wholly pissed off. I don’t know what the feminine equivalent of emasculating is, but that comment took away my power. Then again, hell hath no fury and all that. Enter testosterone.
In women, testosterone is made in the adrenal glands and ovaries, spurring our competitive drive, our assertiveness, and our lust. In adolescence, a girl’s level of testosterone rises five times above normal, but it is in the context of her estrogen increasing ten to twenty times above normal. Estrogen may make us more receptive to sex, taking the brakes off and helping us to be uninhibited, but testosterone is the gas pedal.
We know testosterone fuels the alpha male behavior; is it simplistic to think that it can act similarly in women? It is, because we also have estrogen spurring us on. When researchers measured estrogen in women engaged in competitions of physical prowess, they found that levels were higher in women who had a stronger desire for power, and those levels rose further when they won their competitions, creating a positive loop. In women with less drive, their estrogen levels were more stable. We have two hormones swirling and surging when we are driven, not just one.
That combination doesn’t always make success and victory in women palatable for the men around her. Bitchy, bossy, strident, shrew . . . these are words solely applied to women. If you look at women’s employment reviews (see Kieran Snyder’s “The Abrasiveness Trap” in Fortune), certain words show up repeatedly, like bossy, abrasive, strident, and aggressive. This is when women lead; words like emotional and irrational are used when they object. In reviews, men are exhorted to be more aggressive in the workplace, but not so with women. In the workplace, women are expected to get ahead by some mysterious combination of femininity and intelligence while simultaneously getting things done and disguising drive.
Perhaps part of the problem is with effort. It’s poor form, somehow, if they see you sweat. Thus, our slacker culture. Women, while not encouraged to grow scruffy beards and ride skateboards, are held to a different standard: effortless perfection. My astrological sign is Sagittarius, the archer, and I felt at home on the archery range. I loved the feel of a taut bow, the twang of a full release. It was never lost on me that the male symbol I wrote in my science notebooks was a circle with an arrow. Man is in his element when he is reaching, striving, when he has a vector and is following a trajectory. But I wasn’t a man. I was a tomboy. I resented the female symbol, the reflecting hand mirror. (Especially given recent research suggesting that men preen in a mirror even more than women do.) My ambition, my drive, my tenacious embrace of anything I pursued, was one of my defining traits. I’m a striver.
The Zen monks have a word for striving to not strive, called mushotoku, the goal of having no goals. In this state of mind, there is no attachment to outcomes; there is no obtaining anything, nor giving while expecting something in return. To strike a target, a Zen master must become one with the bow, aim without aiming, and let the arrow release itself. There is no doing, only being.
Easier said than done, and perhaps not my style anyway. Amy, my favorite Bikram yoga teacher, often reminds us to “find the ease in the effort.” I prefer that. It’s a blending, a balance, yin and yang. As with most things in nature, it is not either, but both.
In my own life I was mostly yang until my biological clock kicked in. Over time, I became less interested in hooking up and more invested in mating. My reaction to those Upper East Side stroller-pushing moms morphed from dismissive eye rolls to a yearning in my pelvis. It was when I went off the pill, actually, that this shift fully took hold. Normalized estrogen levels that cycled monthly were a big part of it, but also, I was in love.
Oxytocin is the hormone of bonding, whether between lovers (oxytocin levels rise during hugging and skyrocket after orgasm) or between mother and child (ditto for cuddling and nursing). The drug MDMA (better known as Ecstasy or Molly) is being investigated as a catalyst to psychotherapy because it reliably raises oxytocin levels, helping people to feel closer with others, more open and trusting, and, importantly, less fearful. Oxytocin is a key component in maternal aggression; it tamps down our fear response, allowing us to do whatever’s necessary, fighting like a mama lion to protect our young.
When men are stressed, their bodies go into “flight or fight” mode, with adrenaline as the key ingredient. For women, stress can bring about a different response, which is sometimes called “tend and befriend.” Here, oxytocin acts as a stress hormone, surging in response to a stressor and underlying the behavior of women bonding with each other, which is key for our survival. But this is not indiscriminate bonding. Oxytocin helps discern who is with you and who is against you; it’s about excluding those not in your tribe. In some experiments, with extra oxy on board, people are more harsh against those they feel aren’t a part of their group. Because it is more potent in an estrogen-rich environment, oxytocin’s release affects women more powerfully than men (though it can certainly engender a “bromance” or two).
All of these fluctuations are natural, and though they can be difficult to navigate, chemically altering them can have a bad result. Your brain is full of estrogen receptors, ditto for serotonin, which is often yoked to estrogen. When one is up, the other is likely to be as well. This is part of the reason for PMS mood symptoms; diving estrogen levels tank serotonin levels. So here’s what I worry about: Record numbers of women are taking antidepressants, especially SSRIs (selective serotonin reuptake inhibitors), the most common treatment for depression and anxiety. But those steady serotonin levels unlink the natural ebb and flow of mood with fluctuating estrogen. Estrogen fluctuations help to keep us sensitive. SSRIs deaden our sensitivities, making us more rational and less emotional. At higher doses, feelings are neither fully felt nor processed, and the capacity for elation, empathy, or sorrow becomes muted. It not only becomes difficult to get horny or climax, but also to cry.
Adding birth control pills to the mix, a popular medication combination for millions of women, drives estrogen levels upward and flattens them out, modeling the more static sex hormone levels that men experience. You pot
entially get more accommodating behavior all month long, as well as losing that natural monthly enhanced sensitivity. (And FYI, the pill saps your testosterone levels over time, so your libido wanes.)
SSRIs can reduce aggression, poor impulse control, and irritability while increasing cooperation and affiliative behaviors. This emotional blunting encourages women to take on behaviors that are typically approved and modeled by men: appearing to be invulnerable, for instance, a posture that might help women move up in male-dominated businesses. Primate studies show that giving an SSRI can augment social dominance behaviors, elevating an animal’s status in the hierarchy. So antidepressants that increase serotonin may well help women get along, and even get ahead, in the workplace, but at what cost? I understand that many women will require antidepressants at some point in their lifetimes due to severe depression or anxiety, but many more women in America are being offered a medicine that isn’t appropriate for them, that has real behavioral consequences that aren’t being fully explained in their doctor’s office.
I had a patient who called me from her office in tears, saying she needed to increase her antidepressant dosage because she couldn’t be seen crying at work. After dissecting why she was upset—her boss had betrayed and humiliated her in front of her staff—we decided that what was needed was calm confrontation, not more medication. Was it ambition that made her feel she should erase every emotion to conform to the hostile environment in her workplace?
In mushotoku, there is no profit agenda. Unrestricted growth, the type seen in many corporations, has a different name in medicine. It’s called cancer. Checking corporate malignance is perhaps the most important reason to rely on emotional authenticity. If I give in to my patient’s request to ratchet up her happy pill dosage, her boss’s emotionally incorrect behavior remains unchecked, and the unrestricted growth of corporate greed and malfeasance continues unfettered. It’s not easy. I, like my patient, have teared up in a meeting with my boss, or worse, my boss’s boss, and crying is the last thing anyone wants in the office. But that part of ourselves that gets us misty-eyed when something is amiss is a vital feedback system that the corporate world needs. Cut it off, and the center will not hold.
For centuries, men have been taught to silence their feminine side, their yin energy. Boys are told not to “cry like a girl,” or they’re encouraged to “man up.” Now, these same messages are being carried to girls and women, and we’re buying into it. This is not only mentally unhealthy for each of us, but it’s also a disaster for our culture. The world needs more emotional sensitivity, not less.
Your tears underlie an important lesson that people around you need. They teach emotional correctness. Do not modify your emotional expression for the comfort of others. Do not fear being called hysterical to the point where you say nothing. And don’t buy into Big Pharma’s story that every behavior and feeling is a symptom begging for a pill. Obviously there are people who need psychiatric medications, but 80 percent of those prescriptions are written by nonpsychiatrists.
This is such a natural, easy way to temper our drive: with sensitivity to its effects. Women are particularly well positioned to lead by example, balancing our yin and yang energies, as we navigate the waters of our ever-changing hormonal tides. Our sensitivity and capacity for empathy are gifts we need to share with the world. There is a surplus of aggressive energy evident in our culture these days. You can see it in our wars, our gun violence, our rape culture, and our capitalist greed. Women don’t have to feel just one way about ambition. We don’t have to hide from it or enlist it without restraint. Our ability to embrace complexity is not only a sublime quality, it’s deeply engrained in our biology. It’s the rest of the world that is out of balance, and it’s going to be up to us, ambitious women, to turn this ship around.
Original Sin
FRANCINE PROSE
There are few things more necessary than ambition, more essential to the progress of what we have agreed to call civilization. Without ambition, we might still be living in caves, dependent on the nomadic vagaries of the bison and antelope population, without even the consolation of the paintings done by the artists who—without ambition—might have lacked the will and the desire to decorate the walls. Without ambition (and its important but not always reliable sidekicks and enablers: curiosity, skill, talent, and energy) we would have no bridges, no skyscrapers, no airplane travel, no automobiles, no books, no paintings, no music, no theater, no modern health care. Without the sort of ambition that inspired the earliest tribes to migrate in search of better conditions and that drove the explorers and the pioneers to set out for unknown territory, we might all be living somewhere else. And those who imagine a simpler, more relaxed or forgiving world—an Eden before the destructive onset of the cutthroat, dog-eat-dog, Darwinian scramble to the top that we associate with ambition—might pause to consider the miseries, and the average life expectancy and living conditions of our ancestors.
So given the ways in which we depend on ambition, the extent to which our world would be poorer, more dangerous, less pleasurable, and indeed unrecognizable without ambition, it does seem odd that half our population (the female half, to be specific) is not supposed to or encouraged to be ambitious. Or if, by some chance, women are born with the desire to actually do something—to invent or compose or design something, to become powerful, to run a company or a country—they must rather rapidly (certainly by adolescence) learn to hide those desires, to conceal the hopes and dreams and plans that cannot be realized without ambition.
My mother was a doctor. She was the first in her family to go to college, let alone to medical school. She’d grown up on the Lower East Side of Manhattan; her parents ran a small restaurant for dockworkers and stevedores who worked at the harbor in Lower Manhattan. She was fifteen when she graduated from NYU; her age and that she was a Jewish woman made it impossible for her to get into a medical school in the United States. She traveled first to Glasgow, where she attended medical school for two years. Then, when the war broke out and American students were discouraged from returning to the active or endangered zones, she completed her degree in neutral Switzerland at the University of Lausanne.
By then she had met my father, a fellow student and later a fellow doctor, to whom she always deferred. Over the years, I often asked her how a girl from her sheltered background got the courage, the ambition, the idea to do what she did—when she was just a teenager. She always said she didn’t know, and I believed her. And over the years, I noticed habits of reflection and introspection were not highly valued by my mother and her friends, several of whom she’d grown up with, all of whom came from large families, as she did, in Lower Manhattan.
Perhaps, men are expected to have and freely display ambition: The aspect of character that (at best) combines at least two of the cardinal virtues (wisdom, courage) and (at worst) can involve twice as many deadly sins: anger, greed, pride, and envy. Men are raised to want to rule the world, or (worst case) to destroy it.
The factors that have discouraged and discredited female ambition go back to the roots of our history and culture. The names of a few (a very few) heroines and artists have come down to us (Antigone and Sappho) from Greek antiquity, but we can assume that these remarkable women were vastly outnumbered by those women who (most egregiously in Athens) were forbidden to make decisions concerning marriage, to inherit or control property, to pursue activities unrelated to the domestic sphere, or to be considered full citizens. (Their sisters in Sparta and elsewhere fared somewhat better.)
The first ambitious woman about whom most of us know is, of course, Eve—the mother of sin, the source of Primal Sin, forever guilty of an unfortunate, if admirable, confluence of disobedience and the desire for knowledge. Indeed, much of Genesis and the Old Testament provide a kind of object lesson about the perils and consequences of women stepping outside the boundaries drawn by God—or by their husbands or societies: Eve exiled (along with the rest of us) from the Garden of Eden; Jezebel rip
ped apart by dogs; Delilah presumably killed in the destruction of the temple that Samson (hair regrown, restored to strength) pulled down. There is one judge who is a woman (Deborah) and a few heroines (Esther, in a book that had some trouble making it into the canon), but ambitious or heroic women are few and far between. Mostly they exist to bear male children, to tempt men, to cause discord and war—a form of negative ambition, I suppose you could say, but not necessarily aimed to achieve an effect that any of us might reasonably desire.
Nor did things improve much with the advent of Christianity. The Apostolic Constitution, a fourth-century compilation from older writings on the church liturgy and canon law, tells us that if Jesus wanted women to hold ecclesiastical office, he would have chosen a female disciple from among the many women who followed him. And, according to the same document, there would be other barriers to a female achieving any sort of ecclesiastical office: If the man was the head of the household, the existence of a female priest in the house would mean that the body was ruling the head, and how unnatural would that be? Women in church were expected to be so quiet that, in prayer, they could only move their lips without making a sound.
As modern literature grew out of the Renaissance, and as the eighteenth-century novel began to reflect something resembling daily life, we begin to find ambitious women in plays and on the page, and we can’t help but notice that by and large they are monstrous.
A woman in Shakespeare’s audience would of course have had the example of Queen Elizabeth, a career possibility if one inherited the throne and was willing to behead her rivals to secure her power. But it would have been hard to watch Lady Macbeth without being frightened and duly warned by the scene in which she laments the impossibility of washing the blood from her hands. Lady Macbeth gives us one way to channel our ambition: that is, we can encourage our ambitious husbands to betray their friends and to commit multiple murders.