The Price of Privilege

The Price of Privilege is a book published in 2006 authored by Madeline Levine, Ph.D. in clinical psychology. The book’s main thesis is that teenagers from affluent families are plagued by more intense psychological problems than expected.

Levine maintains that these problems have been ignored because people assumed the wealthy have the resources to take care of themselves. The author defines affluence as a yearly household income in the $120,000 to $160,000 range (a common definition within social science studies). Her findings are based on 25 years of experience as a psychologist working with children in Marin County (an affluent county in the San Francisco Bay Area) and her reviewing related clinical studies on the subject. Dr. Levine has extensively referenced the material of the book. Thus, her thesis and arguments are well supported by contemporary psychological research.

The book is subdivided into the following parts as shown on the table below:

The first three sections overlap a great deal as diagnostics of affluent teenagers' problems, criticism of a materialistic society, and advice on parenting are peppered throughout the book regardless of the section.

Part one. The Diagnosis.
The focus of her firsthand analysis relates to teenagers from affluent households within Marin County. She came across many teenage patients from such families who performed well in school, had excellent grades, and participated in a number of extra curricular activities. Their parents were themselves high achievers, and were extremely concerned about their children’s education and academic performance. Yet, these same teenagers suffered debilitating neurosis including, anxiety, depression, drug addiction, anorexia, bulimia. They also often abused their bodies in unheard ways for previous generation (cutting). She conversed with colleagues within large urban areas all over the U.S. She observed that her experience in Marin County was widespread from Coast to Coast. Thus, the psychological dysfunctions of upper middle class teenagers had nothing specific to do with Marin County. It was a nationwide phenomenon.

The author contrasts these kids external house (homes with everything you could materially want) with their deprived inner house (inner psychological resources, autonomy, independence, awareness, character).

The author asked herself three questions.
 * Why teenagers from the most privilege background run into unprecedented levels of psychological problems?


 * Is there something about the affluent environment (income, expectation, pressure) that is toxic to such teenagers?


 * Why such affluent teenagers have trouble becoming fully developed autonomous adults?

To answer these questions, the author relied not only on her 25 years of experience in treating such kids; she also evaluated hundreds of related studies and contacted numerous clinicians and researchers.

She found that the affluent teenagers have become a new at risk cluster. Despite their material resources, such teenagers experience among the highest rates of depression, substance abuse, and anxiety. Depression rate for teenage girls from affluent background runs as high as 22% or three times the national rate for teenage girls. By the time they graduate, nearly a third of such girls exhibit clinical symptoms of anxiety. Boys from similar wealthy background incur high rate of drug and alcohol addiction to self manage their depression. Girls are more prone to suffer internally. While boys tend to act out with drug abuse and conduct problems.

As we might expect, even though resources are available to avoid or treat such conditions, rich kids are often more vulnerable to having their psychological problems glossed over by their parents and the system in general. Parents are often in denial of any problem as long as they are masked by good grades at school.

Dr. Levine noted two key factors leading to dysfunctional teen among the affluent: The first is achievement pressure. The second is emotional isolation from parents. She observed that parents are over involved as far as grades and performance are involved but they are often too busy for down to earth conversation with their teens that would help their inner self growth.

The parents’ focus on performance leads to the kids’ neurotic perfectionism that ultimately leads to very serious problems. Dr. Levine observed that studies uncovered a strong relationship between perfectionism and suicide among teens that are gifted. It is not the parents’ high expectations that are the culprit, but when parental love becomes conditional to the child’s achievement. This undermines the child’s self development, capability for autonomy. It fosters a toxic culture of the child striving to comply with what the parents want, instead the child finding his or her own path. Parents get in the way of the children’s development when they insist on replicating their own professional success and interest.

Dr. Levine states that successful parents forget about Mendelian genetics. In other words, from one generation to the next there is often a regression to the mean. It is just not natural for each successive generation to be as or more successful than the previous one.

Teens from affluent families are more likely to feel emotionally isolated from their parents. Emotional closeness with the mother is the best counter to a child’s potential psychological problems. Yet, that is often one of the scarce resources of children from affluent families. Dr. Levine adds that studies confirm that teenagers want more, not less, time with their parents. Wealthy adults have often pressing professional and civic responsibilities crowding their schedule. As a result, there is an inverse relationship between income and closeness to parents. This lack of parental closeness translates into higher rate of depression, anxiety, and substance abuse.

Dr. Levine indicates that the family ritual that suggests healthy closeness is the family dinner. If a family has dinner regularly together most every night, their children are much less likely to suffer from the mentioned psychological problems. They also will likely have better GPAs and be better integrated in society.

Within the third chapter of this section, Dr. Levine studies the counterintuitive disconnect between money and happiness. Once basic needs are met, apparently surplus money does not make people happier. Dr. Levine has reviewed cross lateral and longitudinal scientific studies that confirm that. For example, the Irish apparently are happier than the Germans and the Japanese. Yet, the Irish GDP per capita is about less than half the Germans or Japanese. Americans are not happier today than they were a generation ago even though their GDP per capita (adjusted for inflation) has nearly doubled. One could argue that Americans are actually more miserable today as confirmed by much higher teen suicide rate and higher divorce rate. Studies on lottery winners indicate that within two months the winners happiness return to the level previous to their windfall. Dr. Levine expands on materialism being an unhealthy value system for teens development. Whenever material things or external benchmarks are valued above personal relationship with friends and family, the spiritual development of the self takes a beating. External accomplishments become the mean towards a sense of self. These include prestige, power, and money for adults; grades, clothes, and electronics for kids. Dr. Levine shares with concern that in the 1960s, kids main reason to go to college was to get an education and developing a philosophy of life. In the 1990s, the main objective has become spiritually empty as it is simply to make more money. The trend towards increasing materialism does not bode well. Studies indicate that materialistic kids have lower grades and higher rates of depression and substance abuse.

Part two. How the affluence culture hinders self development.
Parents’ demands for achievement have crowded out children’s autonomic development. Many very successful people are perfectly miserable on the inside. Yet, similarly successful parents may instill in their children the same psychological weaknesses they have developed by putting undue pressure on them to achieve or exceed what they achieved. Parents’ overinvolvement and intrusion combined with emotional disconnection make for a lethal combination that will most often trigger debilitating psychological problems upon their children.

On the contrary, the development of a healthy child calls for letting him find his own ways, his own activity likings that are most probably very different from his parents. By doing so, a child develops self-efficacy, the belief that he can successfully impact the world around him to follow his own vocational passion or interests. This leads to agency or the ability to act appropriately in one’s best interest and realize his vocational passion. This leads to the development of a child’s autonomy and overall self esteem. A similar asset is self management that includes self control, frustration tolerance, the capacity to delay gratification. Self management, as it entails resilience, is a powerful precursor to both psychological inner strength and academic achievement.

Regarding developing capacity to love, parents should pay attention to the openness of their own relationship with their child as well as their child’s capacity to have close friendships. These factors are predictive of the capacity for a loving romantic relationship.

Kids with healthy selves have strong internal homes. The later are built upon the building blocks of self-liking, self-acceptance, and self-management. This internal home is an extension of the reassuring and loving relationship with the mother. The kids that Dr. Levine meets in her practice lack this internal home. They lack introspection, a sense of self, and much inner strength. Dr. Levine shares several interesting related cases she worked on consisting of teen patients often really bright and high achieving but who subordinated their own interest and personality development to the competitive wishes of their parents with disastrous psychological consequences.

Within this section, in chapter 5 Dr. Levine does not just focuses on teens but instead outlines the different development stages of a child’s life starting with the early years (age 2 to 4). She explains the specific cognitive and social developments associated with these stages and the associated optimal parenting strategies. In just few pages, she covers much ground in child psychology. This reflects her extensive background in this field as she has worked with kids of all ages.

Part three. Good parenting. Parenting for Autonomy.
Dr. Levine starts this section by referring to the seminal research of Dr. Baumrind who established the foundation of psychological studies on parenting. Dr. Baumrind differentiates between three archetype parenting styles:
 * 1) authoritarian,
 * 2) permissive, and
 * 3) authoritative.

The Authoritarian Parent
Authoritarian is a command and control military style. They think of the child strictly as a subordinate. The parents order, the child obeys. And, that’s it. This typically leads to terrible problems during the teen years. Either the teen violently explode out of rebellion or he breaks down. Such teens have often low self esteem, poor social skills, and a high rate of depression. Such child often lacks curiosity and creativity and is unable to explore and develop his inner self.

The Permissive Parent
The permissive style is very loving and caring but short on guidance, and discipline. They think of the child as a friend. The resulting teen is often likable, social, and has high self-esteem. But, they tend to be impulsive, immature, and lack awareness of the responsibility of their own action. They also have lower rates of academic achievement and higher rates of substance abuse.

The Authoritative Parent
Such parents are warm and accepting, but they also set clear expectations and limits. They place a high value on cooperation, responsibility, and self-regulation. They value achievement and self-motivation but do not emphasize competition. Authoritative parents promote autonomy by encouraging children to figure it out on their own whenever they can. Such parents support the child’s growing autonomy by focusing both on independence and connection. As expected, such households foster better overall child development with lower rate of depression and substance abuse than either of the other two parenting styles. Autonomy, not dependency, is always the goal of such parenting style. Warmth and connection reflect positive parenting. Criticism and rejection are negatives that undermine children development and lower their self-esteem. Children who believe that they are unworthy of love are at high risk for depression and suicide.

Warm and loving connection between parents and children is a good predictor of healthy child development when associated with appropriate discipline than when paired with either harsh or lax discipline. Warmth and acceptance from both mother and father is important. Fatherly acceptance is a strong contributor to academic achievement and good behavior. But warmth can slide into over involvement. It is often market by parents' obsession with comparing their kids to others. This results in children rebutting such over involvement.

Parents should recognize effort and improvement. Parents praising only the highest grades on report cards, and overlooking other improvements, are often misguided. Raising one’s grade from a C to a B in Chemistry reflects a greater learning achievement than maintaining an A in English.

Discipline is the hard work of parenting. It is not fun, but it is associated with huge pay off in child development. Parents who discipline their child in fair and consistent ways, and monitor their child’s social evening activities with curfews and awareness of their child’s whereabouts typically have children who are better adjusted, happier, better academic performers, and have lower rates of depression and substance abuse than otherwise.

Part four. Independent Self.
This section deals with the values the adult parents have to hold to bring up healthy children despite the community pressure associated with often toxic material, competitive values leading to the psychological problems mentioned earlier in the book. Discipline can be challenging to enforce when teens state that all their friends are allowed to do whatever and have no curfew. Materialism is hard to avoid when teens point out all their friends got a car as soon as they got a driver’s license.

In terms of parenting, “do as I say not as I do” obviously does not work well. Parents have to walk the talk and be role models for the values they intend to impart through discipline. Dr. Levine reviews one case where a teen's cocaine habit led to the revelation that both of his parents were also heavy users. The mother gave up cocaine, while the father stated it was a recreational usage under control that he had no intention to give up. Such a message might suggest that a parent does not care about his children’s fate. The son and the father quickly became strangers. In this case, it was the son who became the responsible adult, related to the support of his mom and other therapy.

Dr. Levine goes on addressing the negative psychological side effects of perfectionism prevalent among the affluent. Affluent communities tend to laud individual achievements, top grades, trophies, acceptance to Ivy League schools and competition. Values like cooperation, generosity, philanthropy, originality, ego transcendence, and self-expression leading to unique careers, are discouraged. Affluent parents may tend to overvalue a very narrow range of professions that led to their own success (law, medicine, business, therapy). Dr. Levine has seen numerous bright teenagers who are disinterested in school because their parents are just interested in two careers law or medicine. The skewed values of perfectionism affect the parents just as much as their children. Parents attempt to convey an image of flawless performance whether at work or at home or in society. The intent is to maintain an image of effortless perfection. Dr. Levine indicates that such a concept is self-destructive. Achievements are the results of hard work often associated with occasional failures that one had to overcome. To convey otherwise leads most often to a misrepresentation of our true human experience and contributes to the disconnectedness people experience even among close neighbors.

Interestingly, Dr. Levine observed that while divorce rates are very high among the extremely rich ( Donald Trump, Elizabeth Taylor ), collection of former trophy spouses suggest confirmation), it is below average for the affluent households described in this book. This group views that maintaining a union is key to maintaining social status and economic standard.  The husband becomes highly dependent on the household and parenting services provided by his wife.  The wife is dependent on the husband's contribution to maintaining the economic standard of the household.  This can lead to the survival of bad marriages solely because of these "codependencies."  She suggests that children feel that, and often respond by escaping the household as quickly as possible.  She mentioned one teen patient who selected colleges back East driven mainly by the geographical distance from his family in Marin County. Dr. Levine is quick to point out that divorce is not much of a solution either as kids also suffer the consequences of split families.

In the last chapter of the book, Dr. Levine states that a mother's own happiness is the key to raising psychologically healthy kids. She found that there is an unexpected rate of depression, anxiety, substance abuse, loneliness, and overall unhappiness among mothers of affluent households. This is true for both married and unmarried mothers. Affluent mothers stoically put up a good front as they exhaust their own psychological and emotional resources. Their husbands are often uncooperative out of either ignorance (not being aware of their mate’s emotional state) or selfishness (not taking the time necessary to nurture the mother emotionally to restore her happiness). According to Dr. Levine, when a mother's happiness is ignored, by herself or others, it is detrimental to her children. When a mother is depressed, her children have a 61% probability of developing psychological ailments and have a 45% probability of becoming clinically depressed themselves. These percentages are high multiples of the norm. Dr. Levine suggests that the main cure against depression is to establish connections with others. This means developing a network of close friends to share one's vulnerable side with. Often, affluent mothers lack such friends. Years of maintaining a front of near perfection, while hiding any vulnerability can keep potential friends at bay and has resulted in depressed isolation.

Within the same chapter, Dr. Levine addresses the mother’s challenging work-family life equilibrium. Her findings are sometimes counterintuitive. Some teens of working mothers have complained their mothers should develop hobbies so as not to be overly preoccupied with their lives. Teens from stay at home mothers complain that their mom does too much and is not available enough. So, mothers’ working status does not always correlate to availability as reflected by their own children. Dr. Levine suggests that in either cases (working or not) there are ways to work it out well (or not). She does not make a case that one is preferable to the other (working moms vs stay at home ones). Later in the chapter, she somewhat contradicts herself by acknowledging the self evident: a full time high powered job does represent an inevitable time conflict with motherhood. She mentions the case of a mother who was CFO of a company who traveled several days a week for meetings, often on different continents. The father also had an intense career. The teens were a disaster, plagued by many of the above-mentioned dysfunctions. The mother realized that to save her family and children she had to downscale her career and get a much less demanding job with no travel. Dr. Levine acknowledges she faced the same problem. After her third son was born she, too, was going crazy with the work-life balance. She decided to move her office home, reduce her workload to part-time level, and extend or slow down the pace of her authoring engagements. She confesses that these were trade-offs. You gain something (better mothering, better adjusted children) and you lose something (career advancement, money, prestige, etc…). You have to set where your gains exceed your losses, following the values you value for yourself and your family. Nevertheless, Dr. Levine also indicates that some self-actualization for the mother is absolutely necessary to maintain her happiness. These trade-offs can’t be solely about doing ongoing self-sacrifices for the sake of the children. The mother has the right to also pursue her own hobbies, vocations and aspirations, within or outside her career. This chapter is somewhat confusing as it includes much contradiction about what Dr. Levine espouses from one paragraph to the next (work-life balance is really doable, not really, maybe, sometimes, but critical?!). However, it reflects how delicate, complex, and challenging this topic is [self actualized work life balance].

Within the acknowledgment Dr. Levine pays tribute to Dr. Suniya Luthar, Chair of the Psychology Department at Columbia who did pioneering work on exploring the relationship between economic success and emotional development.