Shimi Kang M.D.

The Dolphin Way

How the Wealthy are Disadvantaged

How Upper and Upper Middle Class Kids are at Risk

Posted Dec 01, 2015

Some things only money can buy – better access to education, healthcare, and security, not to mention iPhones, BMWs and exotic vacations.

However there is one vitally important thing that money cannot buy. There is mounting science of how the wealthy are disadvantaged in one area that may mean more to them than anything else – the fundamentals of their children’s health.

A recent Economist cover story claimed that to be successful in America’s new “meritocracy”, one must increasingly come from the elite. Not long after, The New York Times’ posted an article on Exhausted Super kids, and TIME magazine covered the shocking rise of the college mental health crisis and student suicides in the Pressure to be Perfect. One thing all of these stories missed is that a disproportionate number of emotional, behavioral, and mental health problems, including suicide, are occurring in children of the upper class and upper middle class.

That is, wealth is now a risk factor.

William grew up with everything a child could want. He had loving parents, a nice home, and he went to a good school with access to academic tutors and athletic coaches. He had every advantage of an upper middle class upbringing. So why then at age 15, did William start experiencing anxiety and using marijuana? Why did he start “hating” his parents when deep down him knew they were just trying to give him the “best” in life? Wouldn’t William’s privileged childhood make him less likely to experience such personal, emotional, and mental health issues?

The answer – emphatically --is no.

Mental Health Symptoms:

In studies of upper class and upper middle class high school students across America, serious levels of depression, anxiety, suicidal thoughts, loneliness, and somatic symptoms (physical manifestation of mental health issues such as headaches, stomach aches, and body pains) have been shown to occur at more than twice the rate in comparison to national averages.

Narcissistic behaviors:

A recent meta-analysis study from the University of Michigan examined 85 samples of American College students. They concluded that: “narcissistic exhibitionism scores among affluent boys at elite private schools were almost twice the average scores of a more diverse sample.”

Exhibitionist narcissists are characterized by having an overinflated and grandiose perception of themselves and believes he/she should be admired by others at all times. Now let’s not confuse self-esteem (which is a good thing) with overinflated self-esteem (which is a bad thing). Just like exercise can go too far and cause injury, so too can self-esteem. In the long term, narcissim leads to failure – in the home, in the workplace, and most importantly internally. Narcissism is associated with increased rates of hypertension, heart disease, depression, addiction, crime, interpersonal and occupational problems.

Upper class and upper middle class girls are more at risk:

Researchers found that links between peer admiration and external attractiveness (beauty) were almost twice as strong among affluent girls as compared to boys of all SES and girls of lower SES. Wealthy girls also were more likely to show “externalizing behaviors” of emotional upset such as acting out, rule-breaking, delinquency, and alcohol and drug use.

Needing to “do it all” while still looking beautiful and acting proper brings added stress and unrealistic expectations of perfection to girls of upper class and upper middle class families.  

Substance use, abuse, and dependence problems:

A Columbia University study looked at three indicators of family socio-economic status (SES)—income, wealth, and parental education. Their findings corroborated at least 4 previous studies (I guess it was hard to believe) that young adults with the highest family background SES were most prone to alcohol use, frequent episodic binge drinking, and marijuana use. The authors concluded that “in fact, individuals in the highest SES groups (i.e., highest income and wealth quartiles, parents with postgraduate training) showed the strongest and most consistent effects.”

Crime, delinquency, and acting out: 

When compared to low income, urban youth; affluent, suburban students were found to display high maladjustment including behaviors such as lying, cheating, theft (from parents and peers), destruction of property, and violence toward others. The main differentiating factor between low SES and high SES was in their protective factors such as parental, school, and community involvement, and access to therapists and healthy interventions allowing the high SES youth to change their trajectory away from a downward spiral.

And is getting worse….

Ask any private school or liberal arts college teacher, professor, or administrator and they may all tell you that these problems are all getting worse. In fact the same Columbia University study concluded that “The evidence suggests that the privileged young are much more vulnerable today than in previous generations.”

Now all of this begs the question - why? Why are kids of upper class and upper middle class at such a disadvantage when it comes to the absolute fundamentals of human personal, emotional, and mental health?

Like much in life, the factors are complex but here are a few reasons.

A pressured lifestyle.

There is no doubt that one of the drivers for the crisis in mental health among upper and upper middle class youth is pressure.

Many youth are pressured: The CASA’s (2012) survey established that “[t]he number one source of stress for teens is academic pressure, including pressure to do well in school and to get into college,” and among college students, reducing stress was the most common reason offered for drinking, drug use, and smoking (47%, 46%, and 38%, respectively; CASA, 2007).”

But, the wealthy have the resources – time and money to manifest this pressure into an unhealthy lifestyle of schedules, instructions, tutoring, coaching, and hovering over their children’s performance placing added pressure on them. These over-parenting behaviors manifest themselves in an over-pressured lifestyle.

This is the phenomena of “privileged but pressured” and exactly where being from a high income family can become a disadvantage.

Overscheduled kids are too busy, too stressed, too exhausted, and sleep deprived. Over-instructed kids lack independent problem solving, critical thinking, and the ability to adapt. Overprotected kids never learn from mistakes, don’t know how to fail, and lack resilience.

Of course, every child would benefit from enrichment and instruction, but upper class and upper middle class children are pushed and hovered over too much and too far. By the time they are 16, many of my patients (just like William) tell me they feel like an over-pushed, burnt out “crispie” and/or an overprotected fragile “teacup.”

A pressured mind.

A pressured lifestyle is only part of the cause, the other part comes from the very core of the environment these children grow up in. An environment that directly or indirectly sends them the message that what you do on the outside is of utmost importance, perhaps even more important than who you are on the inside. 

In the last 40 years. There has been a fundamental shift in life values. In 1967, almost 90% of college freshmen rated "developing a meaningful philosophy of life" as an essential life goal. In 2004, only 42 percent of freshmen agreed with them. What replaced “developing a meaningful philosophy in life?” Ranking for "being well-off financially" and "attaining prestigious jobs" rose equivalently in importance over that same time frame.

The research shows that among the upper class and upper middle class, the first signs of problems emerge around seventh grade, when these youth are around 12-13. This age is a developmental marker for when children start to ask themselves questions of meaning, identity, and purpose. They begin to wonder “who am I?”, “what is my place in this world?”, “what is the purpose of my life?”

Tragically in the fast paced, performance-oriented, and hypercompetitive environments many of these children are growing up in, the answers to these life questions all seem to point to some kind of external accomplishment. “Did you make the team?” “What college are you going to?”, “what is your ranking?” This fundamental disconnect of obsessive building the external image (resume, beauty, college application) versus building the internal image (character, values, ethics) is at the core of the maladjustment of upper class and upper middle class kids. 

So if you are thinking “what’s wrong with a little substance use, anxiety or narcissism as a teen? Once my kid gets in to their Ivy League and lands a prestigious job, all will be well.”

Think again. Childhood sets the stage for life.

Personal, emotional, behavioral, and mental health issues in childhood and adolescence bring elevated risk for recurrent problems later in life. Childhood lays the foundation for all aspects of adult life. We know that an unhappy childhood is a risk factor for numerous psychological issues—difficulty with relationships, self-insight, and coping with stress—just to name a few. An unhappy childhood also predisposes individuals to physical health issues such as heart disease, inflammatory conditions, and accelerated cell aging.

The irony is great and tragic.

Like all parents, wealthy parents just want “the best” for their kids. However, regardless of what our society says, the best doesn’t always mean more. Instead of having more, children of wealth end up with less.