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. ...
So I made a short script based on the following information:
– 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
03. Chronic pain
06. Sexually molested as a child + suffering from domestic violence
12. Abused as a child
14. Chronic pain
16. Abused as a child + unemployed
18. Alcoholic + on food stamps
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.
If you made a similar script for students in an urban public school district, including recent refugees, etc., it would be even more intense. Alexander's post cuts to part of the disconnect about urban school districts in particular.
On one hand people say, usually from a distance, "Poor kids can learn! Black kids can learn! This is totally doable." And on the other hand, up close, others see just how many kids in their classroom aren't just low-income, but working under a whole matrix of issues: homeless and learning disabled and sexually abused. ESL and lead poisoning and parents in prison. That's the reality. It is difficult to wrap your head around, even if you see those kids every day you might not know all or most of the issues, and from a distance it just sounds overwrought and made up.
The two sides are talking past each other because the complexity of the problems just comes across as excuses to the distant optimist. The school level realist doesn't actually disagree with the basic point -- "yes, poor kids can succeed!" -- but that gets muddled because it isn't actually the problem they face.