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.

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.

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.