I was listening to a NPR interview with a novelist in New York City. About seeing a psychotherapist regularly, he laughed and said something to the effect that this is New York City, everybody sees a therapist.
I’ve lived in a large Midwestern city and a medium size Midwestern city, and I’ve never known anybody who was seeing a psychotherapist. Was is it about NYC that so many people who live there are in psychotherapy? Does it attract neurotics, or just create them?
I dunno, but Mike Doughty from Soul Coughing said it pretty well:
New York, New York,
I won’t go back
Indelible reminder of the steel I lack.
I gave you seven years
What did you give me back?
A jaw-grind, disposistion to a panic attack.
How would you know whether I had limited experience?
Actually, I have had reason to know. My father was a general practitioner on the family practice staff of a hospital. I used to work for him, and later was custodian of his private practice records after his death. Psychotherapy referrals were rare, and this was not a small town but a large Midwestern city. Most of the few psychotherapy referrals he made involved children with severe behavioral disorders.
Later, I worked for three years for an HMO, with the staff who approved, among other things, mental health referrals. Like any other HMO, we constantly kept statistics on usage, and compared those with published regional and national standards of care.
It wasn’t hard to see that as a percentage of subscribers, fewer people in our area asked for psychotherapy referrals compared to such places as New York City, which seemed to be the epicenter of psychotherapy referrals, judging by the statistics (as a percentage of subscribers, may I say again).
Sorry I don’t still have these statistics with me, but as you can see, I’m going by some experience with the numbers, not just impressions.
With the stigma that still exists about getting therapy, how do you know that people just aren’t talking about it for fear of what people might think or say?
Even if the percentage of people in therapy in NYC is higher than in other areas, it doesn’t necessarily mean that NYC either attracts or creates neurotics.It could just mean that New Yorkers are more willing to go into psychotherapy than people in other areas.You said that most of your father’s referrrals were for children with severe behavioral problems. In NY, it wouldn’t be uncommon for a child to be in some form of therapy for much less severe problems- underachieving in school, feelings about an absent parent, etc.
I think it’s like any profession, the more there are, the more people think about them and the more there are.
Like there’s a town near here with a reputation for antiques.
Three little shops on one block got the town a reputation a couple of years ago.
People would make antique-hunting a weekend hobby and show each other what they’d found.
Now there are over 20 shops.
Same thing with shrinks. You get one and mention it to someone and they go and it snowballs.
Starting a reply with “um” is a polite way of saying your question is stupid and the answer I’m about to give should have been obvious.
Or so I’m told.
So a novelist in New York hangs out with other novelists and artistic/intellectual types, some percentage of whom are undegoing therapy. If the novelist assumes his/her circle of friends are typical of New Yorkers, then the assumption that many or most New Yorkers are undegoing therapy is a valid one.
Except that the assumption is bullshit (or, I’ll assume, the author meant to use humerous hyperbole). Most of the people who live and work in NY do not meet that definition. They’re factory workers, teachers, cops, firemen, clerks, accountants, vendors, bankers, brokers, janitors, technicians, librarians, cooks, doctors, nurses, lawyers, mechanics, hairdressers, cabdrivers and waiters. These people are no different than their counterparts in other major cities, including in the midwest. Some of them may want therapy and they can get it in New York simply because of availability, New York having more hospitals and medical schools than a smaller city.
This doesn’t prove New York is a particularly stressful place to live, any more than assuming that midwesterners are rubes simply because that’s how some television and movie writers portray them.
Yikes! I’d better change my ways, then. When I start out a reply with “Um” or “Hmm”, I mean that I’m unsure of the answer I’m about to give. I’ve never used it to imply that the question is stupid. I wonder how many people have been put off by that?
For example:
Q: Why isn’t the system allowing the Chesapeake Crabcakes to ship to Juneau?
A: Um, I suspect that zip exclusion rules out anything faster than postal… I’ll check the table and get right back to you.
Later A: I was wrong; it does allow U1. But the vendor’s delivery method table doesn’t include U1. So the system’s working just fine.
I don’t think most people need referrals to see a psychiatrist, so that isn’t really a valid way to judge. Most people don’t tell everyone that they are seeing one, either. I don’t really understand why exactly, but there seems to be a stigma for some people with it. I’ve never experienced that, myself.
Well, okay, saying “um” in response to a verbal question can show honest hesitation and/or uncertainty, but whenever I see “um” written, I take its inclusion as expressing a certain “I can’t believe you bothered to ask, but I’ll reply anyway, so pay attention.” LolaCola’s response seems to support this, though I can’t guarantee it’s what she meant. Giving an obvious factual answer to a question is along the lines of this (paraphrased) X-Files conversation:
Scully: At least we’re sure this isn’t the work of a vampire.
Mulder: What makes you say that?
Scully (sarcastic tone): um, because they don’t exist?
Getting back on topic, New York (and California) are fairly liberal states with less stigma attached to certain behaviours, including seeking counselling. They are also major creative centers for television and film, and since writers tend to write what they know and observe and producers don’t always like to budget for distant location filming, there are a disproportionate number of stories set in New York City and L.A. enforcing stereotypes about those cities. Woody Allen has been using his neurotic Jewish New Yorker bit for decades, and a popular program like Law & Order, set in NYC, often has episodes hinging on psychiatric evidence. Let this and other portrayals play out for years on end and pretty soon people who have never been to NYC have formed opinions that it’s full of neurotic artsy types and sociopathic drug dealers. New Yorkers like the op’s novelist only reinforce the stereotype by joking about it.
By the same token, it’s possible for people who have never been to Los Angeles to believe the place is full of starlets sleeping their way to the top, new-age mysticism, and race-based drug gangs, based on the movies and TV shows set in that city. Like NYC’s psychology patients, these things do exist, but they are not embraced by the residents as key elements in the city’s culture, nor are they unique to that particular city.
As a New Yorker who (erm, probably temporarily) recently graduated from almost 5 years of therapy, I’d say there’s a lot of truth to the perception–at least among the professional class and the wealthy.
Factors? Acceptance, as mentioned - once you realize that almost all of your friends are in therapy, it’s a lot easier to decide to do it yourself. Availability - therapists abound, so it’s easy to find one and easy to switch if the first one you try doesn’t work out. Stress - partly environmental, and partly self-inflicted. New York’s a tough place to live, with a lot more social interactions that can go sour (it’s much easier in the suburbs simply not to deal with neighbors you don’t like, and in less expensive cities you’re less likely to have roommates). The industries that conglomerate here tend to be high-risk, high-intensity, high-flameout: investment banking, advertising, law, performing arts - each of these can easily result in 80-hour workweeks, depression, and burnout. And the competition is probably worse here than most places - people are acutely aware of where they stand in the pecking order, socially, financially and professionally. Failure is much more public, so the fear of it is much more acute.
Yes, the therapized New Yorker is probably a pretty narrow subset of the population - but a narrow subset that easily amounts to hundreds of thousands of the most influential people around. I was able to leave therapy mainly because I left the practice of law, taking a 60% pay cut in exchange for a life. A lot of people here can’t afford to do that, either financially, psychologically or both.
