How bad are things?

[Axulus]

I work in a wealthy, mostly-white college town consistently ranked one of the best places to live in the country. If there’s anywhere that you might dare hope wasn’t filled to the brim with people living hopeless lives, it would be here. But that hope is not realized. Every day I get to listen to people describe problems that would seem overwrought if they were in a novel, and made-up if they were in a thinkpiece on The Fragmentation Of American Society.

A perfectly average patient will be a 70 year old woman who used to live somewhere else but who moved her a few years ago after her husband died in order to be closer to family. She has some medical condition or other that prevents her from driving or walking around much, and the family she wanted to be closer to have their own issues, so she has no friends within five hundred miles and never leaves her house except to go to doctors’ appointments. She has one son, who is in jail, and one daughter, who married a drug addict. She also has one grandchild, her only remaining joy in the world – but her drug-addict son-in-law uses access to him as a bargaining chip to make her give him money from her rapidly-dwindling retirement account so he can buy drugs. When she can’t cough up enough quickly enough, he bans her from visiting or talking to the grandchild, plus he tells the grandchild it’s her fault. Her retirement savings are rapidly running out and she has no idea what she will do when they’re gone. Probably end up on the street. Also, her dog just died.

If my patients were to read the above paragraph, there are a handful who would sue me for breach of confidentiality, assuming I had just written down their medical history and gotten a couple of details like the number of children wrong. I didn’t. This is a type.

...

– About 1% of people are in prison at any given time
– About 2% of people are on probation, which can actually be really limiting and unpleasant
– About 1% of people are in nursing homes or hospices
– About 2% of people have dementia
– About 20% of people have chronic pain, though this varies widely with the exact survey question, but we are not talking minor aches here. About two-thirds of people with chronic pain describe it as “constant”, and half of people describe it as “unbearable and excruciating”.
– About 7% of people have depression in any given year
– About 2% of people are cognitively disabled aka mentally retarded
– About 1% of people are schizophrenic
– About 20% of people are on food stamps
– About 1% of people are wheelchair-bound
– About 7% of people are alcoholic
– About 0.5% of people are chronic heroin users
– About 5% of people are unemployed as per the official definition which includes only those looking for jobs
– About 3% of people are former workers now receiving disability payments
– About 1% of people experience domestic violence each year
– About 10% of people were sexually abused as children, many of whom are still working through the trauma.
– Difficult to get statistics, but possibly about 20% of people were physically abused as children, likewise.
– About 9% of people (male and female) have been raped during their lifetime, likewise.

These numbers might be inflated, since I took them from groups working on these problems and those groups have every incentive to make them sound as bad as possible. There’s also a really big problem where a lot of these are conditional upon one another – that is, a person in prison is not also in a nursing home, but a person who is unemployed is far more likely to be on food stamps. This will likely underestimate both the percent of people who have no problems at all, and the percent of people who have multiple problems at once.

Nevertheless, I ran the script twenty times to simulate twenty different people, and here’s what I got (NP stands for “no problems”):

01. Chronic pain
02. Alcoholic
03. Chronic pain
04. NP
05. NP
06. Sexually molested as a child + suffering from domestic violence
07. Unemployed
08. Alcoholic
09. NP
10. NP
11. NP
12. Abused as a child
13. NP
14. Chronic pain
15. NP
16. Abused as a child + unemployed
17. NP
18. Alcoholic + on food stamps
19. NP
20. Clinically depressed

If the two problems mentioned above haven’t totally thrown off the calculations, this makes me think Psychiatrist-Me is getting a much better window into reality than Normal-Person-Me.

And remember, this doesn’t count all of the problems that don’t fall into easily quantified categories, like “everyone hates them because they’re really ugly and annoying”. It doesn’t count things that I couldn’t find good statistics on, like “had a child die recently”. It doesn’t count things that I would have gotten in trouble for including, like “autistic” or “single mother”. It doesn’t count a lot of things. Consider that the first patient I mentioned – the homebound seventy year old with no friends who’s being extorted by her drug addict son-in-law – would appear on this list as “NP”.

The world is almost certainly a much worse place than any of us want to admit. And that’s before you’ve even left America.

This is part of why I get enraged whenever somebody on Tumblr says “People in Group X need to realize they have it really good”, or “You’re a Group X member, so stop pretending like you have real problems.” The town where I practice psychiatry is mostly white and mostly wealthy. That doesn’t save it. And whenever some online thinkpiece writer laughs about how good people in Group X have it and how hilarious it is that they sometimes complain about their lives, it never fails that I have just gotten home from treating a member of Group X who attempted suicide.

http://slatestarcodex.com/2015/12/24/how-bad-are-things/

 

[untermensche]

The question is; How bad are things for depressed people going to a psychiatrist?

I suspect things have always been bad for these people and will always be bad.

But the world is not a much worse place than any of us want to admit because there is suffering.

There is suffering and there is laughter and there are a lot of people enjoying the little time they have.

Life is birth and death. Not just death.

 

[AthenaAwakened]

So money isn't enough to make you happy?

 

[Deepak]

So money isn't enough to make you happy?

Can't buy me love

 

[ZiprHead]

Trophy wives would disagree.

 

[T.G.G. Moogly]

Life is not an easy game.

The OP reminds me of a survey my wife recently took that calculates your age based on health, weight, income, etc. Because she now has an ailing mother and there is a son with some psychiatric problems, not to mention that she is a cancer survivor, her survey age, which used to be about ten years lower, is now equal to her actual age.

These surveys ought to have a question that asks how many of these surveys you've taken. If you've taken more than one every ten years it ought to make you older.

Carpe diem.

 

[TV and credit cards]

So money isn't enough to make you happy?

Time makes me happy.

 

[rousseau]

Yea life is a bit of a pain. Luckily that's subjective and most people seem to have enough shades of oblivion that it doesn't bother them much.

 

[Crazy Eddie]

So money isn't enough to make you happy?

I've got 99 problems and money would solve at least 78 of them.

It wouldn't grant me inner peace or ultimate satisfaction with my choices in life, but that would make me REALLY damn happy.

 

[Axulus]

So money isn't enough to make you happy?

Some amount is necessary but not sufficient for happiness.

 

[Loren Pechtel]

1) As he says, many of those are overstated because they're from sources that try to make the problem look more important.

2) Again, as he says there's the problem that many of those problems travel in groups. Assigning them randomly produces garbage.

 

[ronburgundy]

Stop the presses: People who go to Psychiatrists to fix their shitty lives have shitty lives.

Sadly, this author's patients likely have little chance of improvement, because the author is too stupid to be an effective Psychiatrist.

 

[AthenaAwakened]

Money doesn't make you happy, but it does clear away things that make you unhappy, to a point (and that point is about $75,000 annual income)

And yes, a psychiatrist making judgments about the greater group based on his patients probably won't make a very accurate assessment.

 

[rousseau]

Money doesn't make you happy, but it does clear away things that make you unhappy, to a point (and that point is about $75,000 annual income)

Setting politics aside, if something clears away things that make you unhappy, then by definition it's increasing your happiness.

Again, setting politics aside, imho the world is much, much more material than most are willing to acknowledge. Money means a lot of things, life security, entertainment, children, warmth, and so on. Yes, it's only helpful up to a point, but I can tell you I've met many more financially secure people who are content than financially insecure people who are content.

 

[GenesisNemesis]

Yea life is a bit of a pain. Luckily that's subjective and most people seem to have enough shades of oblivion that it doesn't bother them much.

Also some people just get used to the fact that life is full of bullshit and accept it.

 

[fromderinside]

Sadly, this author's patients likely have little chance of improvement, because the author is too stupid to be an effective Psychiatrist.

I remember one professor very fondly exactly because he said: "Psychiatrists are so trained they can't achieve improvement in their patients. A caring intelligent person with two weeks training will do much better than a genius psychiatrist with a doctorate, MD, with residency. Their trained rational attitudes and their predisposition to be judgmental will lead to fail almost all the time." I took notes then and I refer to them now. Thanks.

BTW he felt Jungians were the worst.

PS: stupidity has little to do with the fact they will likely fail.

 

[ronburgundy]

Money doesn't make you happy, but it does clear away things that make you unhappy, to a point (and that point is about $75,000 annual income)

Setting politics aside, if something clears away things that make you unhappy, then by definition it's increasing your happiness.

Again, setting politics aside, imho the world is much, much more material than most are willing to acknowledge. Money means a lot of things, life security, entertainment, children, warmth, and so on. Yes, it's only helpful up to a point, but I can tell you I've met many more financially secure people who are content than financially insecure people who are content.

^This^^ Money not only reduces many sources of unhappiness, it increases access to many sources of happiness. That makes it causal factor on happiness. Almost nothing is a direct neccessary and sufficient cause of any psychological variable, so its not very meaningful to note it fails to meet that kind of strongest level of causality.

In fact, Athena, that is why research shows the relationship tends to level off beyond personal income levels of $75k. Up to $75k, their is huge impact of each added dollar of income on material well being and thus happiness, but after that, much of the added income is a numerical abstraction with less relation to day-to-day material well being.


Human emotions exists because they serves to regulate our actions towards optimizing material outcomes related to our health, longevity, re-productivity, etc..
Thus, while it is possible to construct expectations and goals that optimize or impede your own happiness, regardless of material state, it makes perfect sense that material state would have a major causal impact on emotional state.

 

[AthenaAwakened]

Money doesn't make you happy, but it does clear away things that make you unhappy, to a point (and that point is about $75,000 annual income)

Setting politics aside, if something clears away things that make you unhappy, then by definition it's increasing your happiness.

Uh. No. My child is dying and I have $2. I am unhappy. My child is dying and I have $2,000,000,000. I am still unhappy. I am more comfortable, but not happy. I can be apathetic, unemotional, indifferent, dispassionate all while having a shit ton of money and getting more every day. Simply not being sad, worried or frustrated does not make you happier.

Again, setting politics aside, imho the world is much, much more material than most are willing to acknowledge. Money means a lot of things, life security, entertainment, children, warmth, and so on. Yes, it's only helpful up to a point, but I can tell you I've met many more financially secure people who are content than financially insecure people who are content.

You seem to be saying being less unhappy is not enough. I think being less unhappy is a good thing, but it is not the same thing as being happy.

 

[rousseau]

]Uh. No. My child is dying and I have $2. I am unhappy. My child is dying and I have $2,000,000,000. I am still unhappy. I am more comfortable, but not happy. I can be apathetic, unemotional, indifferent, dispassionate all while having a shit ton of money and getting more every day. Simply not being sad, worried or frustrated does not make you happier.

I think you can look at something like a family member dying, and financial security as two separate, unrelated variables. Depending on who they happen to these variables are going to lead to some increment of happiness or unhappiness.

Let's say financial security = 10 happiness points and losing a family member = -50 happiness points.

If a person is financially secure and all other things are normal, you have a plus happiness factor. If the person is financially secure but some horrid thing happens like losing a family member, the person will be unhappy despite being financially secure.

So of course financial security doesn't guarantee happiness, but it does almost always have the potential to increase happiness, all other things equal.

You seem to be saying being less unhappy is not enough. I think being less unhappy is a good thing, but it is not the same thing as being happy.

My two cents: 'happiness' itself is a bit of a tenuous concept and needs its own discussion. Phrases like 'being less unhappy' or 'happy' don't specify much. I'd actually define what most people call 'happy' as physical and social equilibrium, healthy mind, healthy body, healthy relationships. IMO, a not insignificant component of that is whether you're well provided for in the present and future.

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Yea life is a bit of a pain. Luckily that's subjective and most people seem to have enough shades of oblivion that it doesn't bother them much.

Also some people just get used to the fact that life is full of bullshit and accept it.

Yea I think a big part of contentment can be just accepting life for what it is.

 

[DBT]

So money isn't enough to make you happy?

Not alone. But it is high on scale of things that can improve one's standard of living, therefore happiness.