Neuroses of the Rich and Famous
July 9, 2008 11:15 AM   Subscribe

Psychotherapy in the Age of Obscene Wealth
posted by Weebot (67 comments total) 6 users marked this as a favorite

 
The therapists admitted to feeling jealous or contemptuous on occasion, and though Dr. Karasu said of his patients, “They are, almost all of them, smarter than I am, and certainly more competent,” he rarely missed an opportunity in interviews for a joke or aside about the absurdity of talking about wealth as an affliction.

I wonder if anyone here will choose to share some jokes or asides on this topic. Magic 8 Ball, is this likely?
posted by prefpara at 11:23 AM on July 9, 2008 [1 favorite]


Metafilter: known as an expert in treating the wealthy and powerful
posted by blue_beetle at 11:25 AM on July 9, 2008


Is this something I would have to be a neurotic millionare to care about? Because, if so, I'm willing to try being a neurotic millionaire.
posted by Astro Zombie at 11:29 AM on July 9, 2008 [7 favorites]


“That was precisely the wrong treatment,” he said. “The doctor forgot that addiction cannot be satisfied by its object. The therapist’s job is not to comfort and validate the patient’s excesses and consumption. Those are neuroses.”

Unless the patient's excessive consumption has to be spending $600 a pop on therapy. They can keep on with that sort of addiction, presumably?
posted by PeterMcDermott at 11:29 AM on July 9, 2008 [1 favorite]


I wonder if I ought to speculate about who that elected official is.
posted by kldickson at 11:33 AM on July 9, 2008 [1 favorite]


I have to say, as a psychotherapist treating indigent, heroin-addicted patients who pay $0 per hour, I'd be willing to test my ideals against some of these $600/hour folks.
posted by OmieWise at 11:34 AM on July 9, 2008 [1 favorite]


Driven out of their expensive apartments, therapists fail to cater to their every whim....man, it must really suck to be rich.
posted by DU at 11:34 AM on July 9, 2008


Obscenely rich people hire expensive 'professionals' to help justify their behavior. NYT has an Uncanny Grasp Of The Obvious (UGOTO)
posted by wendell at 11:35 AM on July 9, 2008


Mega wealthy folk? Their shrinks blabbing a little too much?

Damn - that was disappointingly dull!
posted by Jody Tresidder at 11:37 AM on July 9, 2008


I have a cousin, he's a nice guy really, but he's always been focused on business from a very young age and has done really well for himself. He's toiled over his several businesses day and night for years, until the midnight oil began to run thin. His health declined and he realized that he was missing out on seeing his kids grow up. So, after years of prodding by us, his family, and his friends, he decided to trim all but one small retail business and some real estate investments. One-by-one he sold off businesses until he had one left to sell. The business was assesed with about a $90 million value, he worked and found two different investors, he worked those two guys back and forth until he got them higher and higher. We could see after months of this wrangling that he wasn't really pushing them into a sale, he was just prolonging the time he had with his business and relishing in the moment of negotiations. Confronted, he conceded that this was his motivation at this point and he made arrangements to sell out at $100 million to a buyer. The deal was signed and the deed was handed over.

We threw a big "retirement" party for him and invited everyone he knew on the day the deal was finalized. After the toasts and all, he disappeared and another cousin and I went looking for him. We found him alone in a darkened room. He was visibly upset. After talking it out with us he confessed that he was really sad about the deal and felt a real sense of loss. He knew deep down that it was irrational, completely, after all, he now had $10 million dollars over the valuation of the company in cold hard cash and all the time he wanted to spend with his family and friends. His sense of loss was because he really felt he could have pushed them for $105M.

The business brain is not one I have. I think I'm just too satisfied with going home at the end of the day with crap for pay so long as I get to see my daughter's face. There is clearly something terribly wrong with me.
posted by Pollomacho at 11:41 AM on July 9, 2008 [25 favorites]


If that's wrong, don't strive to be right.
posted by Dr-Baa at 11:45 AM on July 9, 2008 [7 favorites]


His sense of loss was because he really felt he could have pushed them for $105M.

On some level, I can sympathize, if the point is to make an extra $5 million now so that, given the magic of compound interest, your great-great-grandkids and their great-great-grandkids can have a bigger leg up on the world. Five large can go a long, long way, and long, long after you're gone.

At the same time, an extra $5 million can make a heck of a lot of difference if you're intending to fund your favorite charity.

But the extra $5 million, so you can have the 105-foot yacht instead of the 100-foot yacht? Yeah, not so much.
posted by Cool Papa Bell at 11:48 AM on July 9, 2008 [1 favorite]


But doesn't it seem clear from Pollomacho's story that the point isn't the 5 mil, as actual money, at all?
posted by OmieWise at 11:51 AM on July 9, 2008


Man, I always thought 'large' referred to $1000.

Clearly, I'll never need this particular sort of therapy.
posted by solipsophistocracy at 11:53 AM on July 9, 2008


Peter McDermott, the high price is paid whether one attends or not, with this rationale:

Most of the therapists interviewed said the rich were also far more able than the average patient to not show up for a session or give up on therapy altogether. “It starts with the way it’s so easy for them to not show up for an appointment because it means nothing to them if they’re out the $300 or $400,” said Dr. Stone. . . . Part of the therapeutic model for many practitioners involves charging whether the patient shows up or not: The idea of obligation — and the notion that there be some cost incurred for not meeting it — becomes essential to the treatment.

With patients this rich, too, to charge less might make them think they aren't getting the highest level of care. So while I, too, feel $600 an hour is unbelievably high, there are reasons for it.
posted by fiercecupcake at 12:00 PM on July 9, 2008


$600 for a 45 minute session? 20 of those a week dealing with people who's biggest problem is that they don't think they are unhappy and don't want to be fixed? That's $12,000 a week, or about $52,000 a month. Work 10 months a year, make over half a million, with two months of vacation.

I think these doctors are their own kind of clients.
posted by hincandenza at 12:09 PM on July 9, 2008 [1 favorite]


I would imagine that if the therapy doesn't cost a substantial amount, they are less likely to respect its value and see it as something that less-well-off people do. Because that is how they've grown used to assessing almost everything.

Also, it makes sense that it would take a lot of study to determine what sort of techniques are useful for treating the super-rich, just like with the super-poor. So while I am just as alienated by rich people as the next guy, I don't actually see this as being so ridiculous.
posted by [NOT HERMITOSIS-IST] at 12:17 PM on July 9, 2008


As a psychoanalyst in training I find myself both curiously appalled yet envious of both these analysts and patients. Bearing in mind that I pay 20% of my monthly salary to my own analyst it seems inexpensive for these "masters" of the "universe" *ahem clears throat* to see somebody for an hour.

For some reason I find myself thinking about Freud's meeting with Salvador Dali (not short of cash, ?narcissistic and perhaps not unlike the super-rich in his attitudes) who had been desperate to meet the bearded father of psychoanlysis for some time. Freud's remark at the end of the interview.

"i have never met a more complete Spaniard."
posted by you're only jung once at 12:23 PM on July 9, 2008


This article was great for reminding me why I hate rich people.
posted by tiger yang at 12:33 PM on July 9, 2008


I'm always reminded how there's some point of personal wealth beyond which prices below a certain amount don't matter at all.

For most of us here I'm guessing that's around $1, or maybe $10. (When's the last time you gave a moment's thought to buying something below $1, beyond your pure desire to have it or not?)

For people like this it's probably more like $1,000, or maybe more. (For the ultra-rich it's probably more like $10k, or $100k.)

I always wonder what that's like. I can't help but think it screws up something inside you, being able to have anything you want up to a certain (to "normal" folks, huge) amount, simply because you want it.

Not showing up for a $600 therapy session? Eh. Oops. Didn't feel like it. Just the thought of it makes me ill.
posted by gottabefunky at 12:40 PM on July 9, 2008


Was anyone else totally certain Pollomacho's story was going to end with a muffled gunshot from the drawing room?
posted by rusty at 12:42 PM on July 9, 2008 [6 favorites]


With patients this rich, too, to charge less might make them think they aren't getting the highest level of care.

I see the point, fiercecupcake, but it was precisely that point that I thought made his argument so paradoxical.

An expensive painting (as opposed to a $20 poster) is compulsive self indulgence. Umpteen sessions a week with a $600 an hour therapist (as opposed to half an hour on the pc with Eliza) is money well spent.

But doesn't it seem clear from Pollomacho's story that the point isn't the 5 mil, as actual money, at all?

It wasn't clear to me, which I guess is why some people pay $600 an hour for a psychotherapist.
posted by PeterMcDermott at 12:45 PM on July 9, 2008


[NOT HERMITOSIS-IST]: Despite the flip title, I don't think that the rich are necessarily more undeserving of psychotherapy than the not-rich. I'm more interested in the strange relationship dynamics between therapist and patient, and how class and authority screw with that. These therapists are extremely smart people, yet the article depicts them as something akin to a syncophantic executive assistants.
posted by Weebot at 12:45 PM on July 9, 2008


When you're really wealthy, after awhile you run out of good things to spend money on.
posted by orange swan at 12:45 PM on July 9, 2008


I dunno. If there's one group of people I'd prefer to see in the care of a competent therapist, it's the ultra-rich and ultra-powerful. A lot of the time, these people got to where they are by being less than human, and now that they have some sort of say in =my= life, through politics or finance, I'd rather they be on a progression path back to human.

I know a philosophy prof. who told me that the genius of Ayn Rand and objectivism wasn't that it provided a workable alternative ethical system that gratified the psychopathic and powerful, but that it was so successful in giving the psychopathic and powerful any sort of ethical system at all.

I don't know if that's true, but this article brought that to mind. I don't care if they drop $600/session on their shrinks, just so long as they keep going back once every other week.
posted by Slap*Happy at 12:48 PM on July 9, 2008 [2 favorites]


Is there a word for the type of bonding people do in these threads? It's getting to be cliché, "Insert generic proud-to-be-middle-or-lower-income comment here." I see this type of thing all the time, whether the topic is the economy or the weather. I'm super curious to read more about it, but I don't know what to call it. It's sort of like the grumbling about gas prices, where I feel compelled to nod in agreement, rather than tell the truth, which is, it really doesn't bother me. No one wants to be the outsider, right?

Sorry to interrupt, resume grumbling below.
posted by knave at 12:49 PM on July 9, 2008 [4 favorites]


knave, I think it's called "class consciousness".
posted by overglow at 12:52 PM on July 9, 2008 [4 favorites]


Our Time is Up
posted by homunculus at 12:59 PM on July 9, 2008 [2 favorites]


It's easy to laugh at moneyed douchebags going into therapy because their tennis game isn't so hot but, you know, I've been through therapy and in that course of therapy, I've revealed some things about myself that would make me seem like an ass too.

I would most emphatically not enjoy reading about those personal disclosures in the pages of The New York Times.
posted by jason's_planet at 1:03 PM on July 9, 2008 [8 favorites]


I remember reading about how schools were finding that fines for parents who were late to pick up their kids ended up backfiring, as once the courtesy was monetized, people felt entitled to it. I wonder if a better approach might be to make the therapy inexpensive but unable to be rescheduled for any reason. I realize that some might abandon it anyway, but it might be a bulwark against the assessment mindset.
posted by klangklangston at 1:20 PM on July 9, 2008


The therapist thought the patient was merely trying to impress him. This happened whenever the man felt unsure of himself, which was most of the time.

There is nothing wrong with being unsure of yourself. Most people are. Especially if being hesitant has got you to a point in life where you're spending $8mil on a painting. In fact, I would suggest a rich bastard who was unsure of himself is much more appealing to people than a rich bastard who is sure of himself.

I dunno which is worse: rich people spending hundreds of dollars to talk about their character traits, or doctors taking that money and calling it treatment.
posted by dydecker at 1:24 PM on July 9, 2008 [2 favorites]


This article was great for reminding me why I hate rich people The NY Times.

Fixed that for you.
posted by tippiedog at 1:36 PM on July 9, 2008


these people got to where they are by being less than human

wtf does that mean
posted by Zambrano at 1:53 PM on July 9, 2008


I thought this was a joke a la Tom Lehrer when I first read the article...

"He soon became a specialist, specializing in diseases of the rich. He was therefore able to retire at an early age... to the land we all dream about: sunny Mexico, of course"

But then I read it. I guess I just don't understand the point of writing this article. It seems like just "OMG Rich People Pay Lots of Money and Are Sometime Rude to People Who Work for Them!" to me.
I would be more interested in something that talked about the frequencies of different kinds of problems in superwealthy clients; do i-bankers have worse dreams than venture capitalists, etc.
posted by rmless at 1:55 PM on July 9, 2008


Anyone think that the guy who started as a business man and moved to politics was Mitt ?Romney. I did!
posted by I Foody at 1:59 PM on July 9, 2008


Man, I always thought 'large' referred to $1000.

Yeah, this is large2.

I'm always reminded how there's some point of personal wealth beyond which prices below a certain amount don't matter at all.

In the Warren Buffet makes a million dollar bet thread we had a while back, I tried to figure out what that would be in terms of my salary; for him a million dollars is roughly the same as $0.50 is to me.

That is crazy rich, right there.
posted by quin at 2:06 PM on July 9, 2008 [1 favorite]


These guys can blow $600/hr on therapy as easily as passing a fart (and with about as much care), and I have to battle with Anthem to get them to approve 8 lousy sessions for my son with an $80/hr counsellor.

Makes my head spin sometimes.
posted by Thorzdad at 2:11 PM on July 9, 2008


one man after another trying to conquer his mortality

Which always makes me wonder why they aren't pumping their money into Alcor or something similar. Where are the modern day Pharaohs?
posted by Skwirl at 2:27 PM on July 9, 2008


Where are the modern day Pharaohs?

Seriously. Rich people seem have so little sense of ambition in the sense of accomplishing big projects in the real world. Their ambition all seems to be tied up in simply increasing their bank accounts, which I guess is why they're rich in the first place, but you'd think they could do something with all that money.
posted by adamdschneider at 2:43 PM on July 9, 2008


The interesting part of this to me is how a therapist justifies $600 an hour. i realize living and maintaining an office in Manhattan is expensive but it's not that expensive. If it's just a matter of charging what the market will bear, aren't then just expressing the same neurotic desire for cash as their patients?
posted by doctor_negative at 2:52 PM on July 9, 2008 [1 favorite]


Good article.

Firstly, the drive to acquire wealth so much greater than that of one's fellow human beings is in itself a psychological problem, or a sign of problems. Secondly, acquired wealth so much greater than one's fellows, even if one were sane and happy to start with, will have an alienating effect.

There are many quandries facing a therapist, with what fees to charge the rich. No psychotherapist (I expect) deliberately sets out to become exclusively a counsellor to the super-rich. Even if they seriously wanted to do so, the plan of action to break into that circle would be difficult. From the article, the super-rich often choose their therapists on the basis of academic credentials; acquiring these involves self-sacrifice and often poverty.

So if our therapist explicitly decides to charge patients on the basis of their capacity to pay (which is very often done at the lower end; most therapists are highly compassionate people), that puts him in the position of being able to charge, say $10,000 a session. Many of the super-rich got that way due to good financial management. If one very good therapist charges $10,000 because he knows who you are, you might be tempted to have your secretary quietly make an anonymous appointment for you at $500/hour with another therapist. Charging to true capacity to pay, at the high end, is both self-defeating, and easily defeated.

My view on the matter is, respect for the process and the appointments is not instilled with money, at either end or in the middle of the scale. Therapists only charge money for their services (and the same goes for plumbers or stockbrokers, and even to some extent the people under discussion) because they personally need money to live. They set up their desired lifestyle standard, compare their abilities to those of others, and charge accordingly. A therapist who is happy with a nice little three-bedroom townhouse in a comfortable suburb will probably charge $100-$300/hour depending primarily on patients' ability to pay (as filtered through health insurers and government subsidies), and if doing well, will do a certain amount of pro bono work, or reduce their hours, etc. A therapist who has, by luck or good management, fallen into the circle of treating the wealthy will probably want to live a wealthy lifestyle, charge $300-$1000 per hour, but still--if he or she is sincere in his or her practice--cannot treat patients every working hour and still treat them properly, so will inevitably have to assess his or her time commitments regardless of what patients offer to pay.

There probably already are ethical guidelines from the AMA or APA (or whatever it is called) on the subject of treating patients whose personal wealth exceeds the therapist's by 10 times or more; if not, there should be. If the patient personally offers grossly more money, I would suggest that the therapist's best ethical course is to request the patient pay fees on behalf of lower-income clientele, ie those persons who want and need therapy and would attend appointments, but cannot financially afford to attend; reducing these people's fees down to $5 or $10. Thus super-rich-guy gets to do something unambiguously good for other people, which (at least in the case of anxiety, depression, and narcissism) will be good for him to do.

Another way to instill respect, if the therapist can afford it, is not to charge at all. To tell the super-rich guy: "Money means nothing to you. Any success of your therapy is heavily dependent on you taking it seriously, which means, giving up something to do it. Your time, on the other hand, means a lot. I will therefore treat you for free, and I will treat you from ten to eleven in the morning, or two to three in the afternoon; right in the middle of business hours."

That won't work on the layabout heirs; IMO, the way to deal with them is, give them a meaningful task to do, to "pay" for the therapy. An hour's volunteer work, actual work, somewhere charitable (and any good therapist can arrange a place where this will be useful, and private, which is vital; the damage done by paparazzi to their victim's mental health deserves a whole article of its own), and the heir has earned, possibly for the first time in his or her life, the appointment.
posted by aeschenkarnos at 3:04 PM on July 9, 2008


I hope that, for six hundred an hour, they at least have decent magazines in the waiting room - my shrink's were terrible.
posted by turgid dahlia at 3:07 PM on July 9, 2008 [1 favorite]


Pollomacho writes "He knew deep down that it was irrational, completely, after all, he now had $10 million dollars over the valuation of the company in cold hard cash and all the time he wanted to spend with his family and friends. His sense of loss was because he really felt he could have pushed them for $105M."

I think that people like that can channel their competitive natures into something else. Bill Gates is famously devoting all his time to charitable work now, which is not as easy as it sounds, but it takes all his time, and the rewards for meeting those challenges are greater than monetary gain on his part. But then I remember Givewell, and I'm not sure all these A-type personalities would be suited for charitable work. Still, idle hands and all ... my uncle starts businesses out of boredom these days, successful ones, too, but he doesn't try to start high-stress businesses or those that would require 100 hrs/wk. He's happy, he's making money, and he's mostly hanging out on the beach in Mexico.
posted by krinklyfig at 3:14 PM on July 9, 2008


Why is this in the newspaper? It raises no social issues outside of itself, there is no wrong to be righted, there is no significance to the subject outside of the people involved. Obviously being rich comes with a whole set of issues to deal with (check that HBO movie Born Rich for the subject done justice), but instead of dealing with the subject head on, it reads like the reporter couldn't think of a better tack than visit a couple of extremely expensive therapists and asked "tell me about your patients problems". Well hey Mr. Reporter, how about asking the subjects of your article themselves? Or their families?

It's kinda bizarre that America's paper of record thinks that a secondhand account of the psychological peccadillos of wealthy people is entertaining or insightful. Gossip about movie stars or politicians, yes, at least they stand for something. But I'm surprised wealth per se is of interest.
posted by dydecker at 3:36 PM on July 9, 2008


600 bucks would buy a lot of coke. Who needs therapy?
posted by The Light Fantastic at 3:40 PM on July 9, 2008


Why pay $600/hr? Paid friends are a dime a dozen.
posted by grounded at 3:50 PM on July 9, 2008



The business brain is not one I have. I think I'm just too satisfied with going home at the end of the day with crap for pay so long as I get to see my daughter's face. There is clearly something terribly wrong with me.

You know, I know a zen priest who has shared a dojo with some nationally (and internationally) known movers and shakers and rich folk, all trying to figure out what to do NOW, now that hitting the top level of their careers/the US tax bracket hasn't filled the void.

She says some of them drop out of zen training after getting to the point where they gain perspective and lose some attachment to assigning so much personal identity to material possessions and status....it makes them feel they've "lost their edge."

(This was in response to my incredibly mature--yet sincere--question of whether or not anyone hits a stage of enlightenment, after years of working towards it...and decides enlightenment is a real letdown or even a grave mistake.)
posted by availablelight at 3:56 PM on July 9, 2008 [1 favorite]


I also found this incredibly sad...maybe it's better to have a Willy Loman for a dad, than a master of the universe:

Dr. Seth Aidinoff, a NewYork-Presbyterian Hospital psychiatrist who practices on the Upper East Side and also consults for hedge funds and Wall Street firms, illustrated the consequences with the Saturday-afternoon choice faced by “your typical master of the universe,” who can either play outside with his 7-year-old or stay inside to complete a business deal on the phone.

“The phone call might involve the most important and interesting people in the world, being well compensated for his time, and the chance to handle it with A-plus skill,” Dr. Aidinoff said. “Whereas playing with his 7-year-old might be sort of boring, or unsatisfying; his son might not fully express his appreciation, or the child could even be in a bad mood. So this person might find himself terrified of spending time with his child because it’s not an activity he can control or succeed at the high level of accomplishment to which he is accustomed.”

posted by availablelight at 3:58 PM on July 9, 2008


I like to tell myself that I don't experience much class envy. I read many articles and discussions on metafilter (like this one) that bring out the class envy in others and I always get self-righteously mad at them.

Well it hit me hard with this one. I wasn't even mad so much at the narcissistic patients, I mean, narcissists will do what they do, and if it means retaining a high-priced psychiatrist in order to have one other person to feed the ego then so be it. You can always skip appointments when things hit too close to home, what's a few hundred dollars and the doc will take you back anyway. All the while feeding your narcissism with his own envy.

No, it was the doctors who made me angry. Just angry at the system and angry at them too. And I know this is how the system is but it still gets to me. I just want to say "stop treating these people and help some of us! I want to have any life at all, I'd be happy just to have a job!" But I know I'm whistling into the wind.

I'm bipolar and poor. My disability gets me Medicare and my poverty gets me Medicaid because I couldn't afford the Medicare premiums and copays on my own. So I'm already ahead of the people who need help but have no insurance, or they have access to insurance but the costs put actually using it out of reach. At the same time, where I live it is very, very, very, very difficult to find mental health professionals who will take patients who have the combination of Medicaid and Medicare. I can count on one hand the psychiatrists, I know the names because I've received the same dwindling depressing list time after time. I've been really desperate, gone to emergency rooms for treatment, called the city for help, gone to crisis center after crisis center. To see those docs you have to get on long waiting lists, long enough that by the time they can call me to make an appointment (that won't be for another 4-6 weeks but at least there will be a date), my mental health is always in such a state that it's a real longshot if I'll be able to see them. Not to mention the ones that retire or die on you or get deported (yes!) while you're in the middle of treatment.

And of course, these aren't the kind of psychiatrists that can actually talk to a patient anyway. Just the same old meds and come back in 6 weeks. All those sciency theories and innovative treatments and things, I will never have any kind of access to. Whenever I read about new treatments and interesting insights, the kind a doctor like the head of Psych at Columbia would know about, well I just hope one day it trickles down. I don't even feel like my complaints are completely rational or fair and I do know they're not all narcissists beyond help and greedy doctors but I just see such a gulf sometimes. The system of things is so broken.
posted by Danila at 4:00 PM on July 9, 2008 [8 favorites]


600 bucks would buy a lot of coke. Who needs therapy?

Even better, $20 for two good hits of acid and $580 for gummi worms.

the environments in which a lot of these patients have become successful do not necessarily leave them well equipped to benefit from the talking cure.

There's an understatement.
posted by mrgrimm at 5:22 PM on July 9, 2008 [1 favorite]


This is the way super-rich Roman senators used to maintain philosophers on their staff. In antiquity, a philosopher might be soemthing like a psychoanalyst.

The article is silly; it reminds me of something I read years ago in Allure (at the beach while my brain was on vacation) about psychotherapists for Hollywood celebs' diet issues. One such diet doctor talked her client out of eating an entire carrot cake, and found that what the woman really wanted was to buy an opal.
posted by bad grammar at 5:59 PM on July 9, 2008


$600/hr? That's unreasonable! Hell, that's almost what Elliot Spitzer's hookers cost!
posted by jonmc at 6:13 PM on July 9, 2008


Danila I like to tell myself that I don't experience much class envy.
Your story isn't class envy, it is anecdotal evidence describing a very common experience, that indicates that, as you say later, the system is broken.

It's not a bad thing that the super-rich can get psychiatric treatment soon and easily. That ought to be what everyone gets. Even in countries with a workable national health system, there is still the possibility of circumvention of waiting lists by paying money (an action indistinguishable in its effect and motivation from bribing the surgeon, but desperation makes a person more likely to bribe, and being bribed by the desperate makes a person more likely to accept it). The problem here is that you don't get the treatment you need. That others do is not a problem, except if they are somehow able to deny it to you by doing so. And I don't think they are. If anyone's denying you treatment by taking your place, it's the middle class, and who are we to say their problems are any less pressing on their minds than ours are on ours?

Even if you applied strict triage, how do you triage mental health? The best we've come up with is a model based on physical harm to self or others, which leads to undesirable consequences later on in domestic violence and child abuse. I can see a utilitarian triage argument for prioritizing the mental health treatment of the ultra-rich, at least the capitalist/industrialist type: they are capable of harming a hell of a lot more people than you or I are.
posted by aeschenkarnos at 6:52 PM on July 9, 2008


availablelight (This was in response to my incredibly mature--yet sincere--question of whether or not anyone hits a stage of enlightenment, after years of working towards it...and decides enlightenment is a real letdown or even a grave mistake.)
I don't know if you meant to write "immature", but this seems to me to be a really good question, either way. My guess at that is, "enlightenment" can't be a mistake, it's the correct answer to the question by definition. It may not be desirable to you now (ie, "give up all material possessions") but enlightened you will understand it. Bootstrappy as that seems. :)
posted by aeschenkarnos at 8:00 PM on July 9, 2008


question of whether or not anyone hits a stage of enlightenment

well, I've always been of the opinion that if you consider yourself 'enlightened,' that should automatically disqualify you, but then again a wise man once said 'to be enlightened is to lighten up,' so maybe I'll just spray seltzer at everyone.
posted by jonmc at 8:13 PM on July 9, 2008


I like the fact that one shrink admits that his wealthy patients are "more competent" than he is. That's the intimidating part: These people are rich because they do something very well. And whatever it is, it turns on a money spigot. It's a wonderful world, when you think about it. Many of these people are louts and boors. Others are as sensitive and literate as you or I, and use their money to enjoy their lives and their families and the arts and nature. But they've all done something to earn their money, and there it is. God bless 'em.
posted by Faze at 8:23 PM on July 9, 2008


It's a wonderful world, when you think about it. Many of these people are louts and boors ... But they've all done something to earn their money, and there it is.

I know, it's so true!
posted by Paris Hilton at 9:40 PM on July 9, 2008 [3 favorites]


Oh, I laughed at Paris Hilton's little epon-posting!

But they've all done something to earn their money, and there it is.

I've known a lot of extremely rich people and most of them did nothing particular except be somewhat above average intelligence and be born into wealth, then did the standard prep school -> Ivy League -> Wall St/lawyer/doctor crap.

I've worked for people who were making millions a year and who really were more or less faking it all the way, and had been for years.

Had I gone to a school comparable to the one I went to but in the US, I believe I'd be still struggling. The only reason I got hired for my first major job (Drexel Burnham Lambert) is that: they told me later they wouldn't even talk to candidates with an American degree who hadn't gone to an Ivy League school (though they did sensibly enough hire a bunch of people later from Queens College).

This is not sour grapes, I've done very well. Some of this is no doubt due to talent, but I am under no illusions that if I were an equally talented African-American woman I'd have gone anywhere near the distance.
posted by lupus_yonderboy at 10:34 PM on July 9, 2008


I just read the article. I am disgusted. I wish these people to die, the "superbly rich". I wish the Times to burn down and all their writers to be struck with dyslexia. That none of these psychiatrists have killed any of their patients astonishes me, but then I suspect they're just as bankrupt in human terms.
posted by lupus_yonderboy at 10:39 PM on July 9, 2008


IMO, the way to deal with [layabout heirs] is, give them a meaningful task to do, to "pay" for the therapy. An hour's volunteer work, actual work, somewhere charitable (and any good therapist can arrange a place where this will be useful, and private, which is vital; the damage done by paparazzi to their victim's mental health deserves a whole article of its own), and the heir has earned, possibly for the first time in his or her life, the appointment.

aeschenkarnos,
I've taken the time to skim through quite a few of your profile comments - and I can see you're incredibly thoughtful and sincere etc etc.

But I kept coming back to this quote above - which I don't get.

On the one hand, you accept that the idle rich have valid mental health problems too - generally speaking.

But it seems here you are diagnosing the layabout heir's wealth as the problem.

Which is why you are suggesting a way of first reducing the effect of their wealth. (By "earning" the right to therapy through therapist-appointed humble volunteer work).

I'd say he or she has "earned" the appointment, surely, by asking for it?

I thought that was a cornerstone of all therapy - the therapist saying "congratulations, you're here, this is something you've done - that's a great start!"

I suppose I dislike the image here of the therapist playing social engineer before the therapy has even started by infantilizing his or her idle, wealthy client in this way. (Who has surely already been somewhat infantalized by all this moolah in the first place!)

In the end, these high end shrinks do seem unduly distracted by their clients' extreme wealth.

I sometimes feel shrinks work best only for the motivated bang-in-the-middle middle classes - clients without either the wretched complications compounded by poverty - as explained so movingly above by Danila. Or by the masking, distracting effect of obscene bank balances.
YMMV:)

(Basically, if you want to understand the rich, read novels!)
posted by Jody Tresidder at 6:50 AM on July 10, 2008


"But it seems here you are diagnosing the layabout heir's wealth as the problem.

Which is why you are suggesting a way of first reducing the effect of their wealth. (By "earning" the right to therapy through therapist-appointed humble volunteer work).

I'd say he or she has "earned" the appointment, surely, by asking for it?

I thought that was a cornerstone of all therapy - the therapist saying "congratulations, you're here, this is something you've done - that's a great start!"
"

The therapists said that with normal, everyday clients, it's an accepted practice to make the cost a significant one in order to manifest a commitment to the therapy. With the rich this is less successful, as for them the money is not as big of a motivating factor. Aeschenkarnos, like I did earlier and with less thought, was positing possible alternative regimens that would achieve the same result.
posted by klangklangston at 3:09 PM on July 10, 2008


klangklangston,
Thanks for that.

I'm just not convinced, so far, that these shrinks have revealed any great insights into attitudes to wealth and the super rich that haven't come from the back of an envelope.

Most people here seem to agree these people have wealth far in excess of their needs. The general thinking seems to be, therefore, that the SRs require special manipulation to attach appropriate value to their therapy sessions.

It seems like a crowd-pleasing solution. Many of us like to think the SP can be forced to want something money can't buy!

I just don't see that's necessarily a great basis for mental health treatment. Though it certainly favors the therapists!

(Also, funny that we all know the SR have too much money! I wonder how many people here would agree happily that they personally have exactly the right amount of income for their needs? Surely, the majority would say they'd prefer to have more? Maybe the SR feel exactly the same?)
posted by Jody Tresidder at 5:19 AM on July 11, 2008


I'm just not convinced, so far, that these shrinks have revealed any great insights into attitudes to wealth and the super rich that haven't come from the back of an envelope.

Indeed. While I'm not sure I agree with the rest of your comment, what's most striking about the article is that $600/hr seems to buy you some pretty pedestrian thinking, and that's a charitable reading. (At one point a therapist and his supervisor confuse an addiction for a neurosis, something which makes no sense in any accepted diagnostic nosology.)
posted by OmieWise at 10:10 AM on July 11, 2008


OmiWise,
Actually, I'm not sure I agree with the second bit of my comment either!

The thought struggling to be born was simply we all seem - in a "pedestrian" manner - to assume we can diagnose the problem with the Super Rich. It's too much money. Easy.

On the other hand, we who comment are doubtless all convinced we don't have enough of the stuff - or we would be if someone tried to take some away as a means to a "cure" - which would probably prompt those much further down the income ladder to think we were all nuts too, by comparison.
posted by Jody Tresidder at 11:19 AM on July 11, 2008


I haven't been reading super closely, but I wasn't sure that "we" were diagnosing their problem as too much money, as much as some people were suggesting that too much money was part of the problem with how committed they might be to therapy as we generally understand it. I tend to think the [a?] problem is that they 1) don't necessarily have problems they are trying to solve, and 2) the therapists they're going to aren't really helping them much (aren't effective). Trust me, the best way to get people to show up is to actually help them.

I also disagree with the relativism inherent in your last point. It is not the same to want more money when you make 7k/year, or even 100k/year, as it is when you make 10 million or 100 million per year. The latter folks who want more fall outside the normal distribution.

(It's OMIEwise, by the way.)
posted by OmieWise at 11:42 AM on July 11, 2008


OmieWise,

Trust me, the best way to get people to show up is to actually help them.

On this, at least, we agree. (Sorry about the name mangling.)
posted by Jody Tresidder at 12:38 PM on July 11, 2008


Joey Tresidder - having them do volunteer work (or pay for others' treatment, or some other method of making them value the appointment) isn't something I'd necessarily suggest for all super-rich patients straight out. I suggested it as a possible alternative where the patient is having trouble making appointments (for whatever reason) and the normal social engineering torque applied, charging them anyway, won't work.

On your second point, I agree with OmieWise. Most of us could do with some extra money; this discussion is about people who by definition, don't need extra money. That's what makes them super-rich. If they continue to believe themselves to need extra money despite having upwards of $10 million, I think it's fair to say that their thinking is at odds with reality. Simply changing their attitude from "need" to "want, for the following reasons" (without other alterations) would be significant progress, and should increase their personal happiness and quality of life. Those reasons are examinable, and alterable, whereas a "need" is not. The same is true for many mentally-ill behavior patterns. Getting perspective on one's thoughts and insight into their nature as thoughts, not reality, is often seen as the first step for treatment. It's a major part of cognitive behavioral therapy.
posted by aeschenkarnos at 8:29 AM on July 12, 2008


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