Recently, I read an important article in The Washington Post. The title reveals the content: Americans Use Far More Opioids Than Anyone Else in the World.
The title describes accurately the premise of the article but the specifics tell the deeper story. Not only do Americans use more opioids than anyone else in the world, we are prescribed about six times as many of the pain-relieving drugs per capita as the citizens of Portugal and France. And almost twice as many opioids as the second highest nation on the list.
Equally alarming, Americans consume more than 99 percent of the world’s supply of hydrocodone. More than 33,000 people died of opioid overdoses in the United States last year—more than gun homicides by an almost 3 to 1 margin.
This is, indeed, a significant problem.
But what was even more fascinating to me was the author’s identification of the reasons why the statistics are the way they are.
Keith Humphreys, the author of the piece in The Washington Post, is a professor of psychiatry at Stanford University. As part of the story, he sought to understand why America would lead the world in this troubling category. It’s not, as he begins, because we are aging. Other nations have older populations than the US. There must be other economic, political, and cultural factors at play.
This is where it gets really interesting.
One significant reason he identifies for America’s addiction to pain-relieving medication is “relative to Europeans, Americans have more faith that life is perfectible (e.g., all pain can be avoided).” He explains:
Consider, for example, a 55-year-old who feels acute back and leg pain after doing the workout that was easy when he was 25. A European in this situation might reflect sadly that aging and physical decay must be accepted as part of life, but an achy American might demand that his doctor fix what he sees as an avoidable problem by prescribing him opioids.
In other words, our desire to eliminate all pain from life and experience perfection regardless of circumstance may be contributing to the level of opioid addiction and death in our nation. In this specific case, the need for perfection may be literally killing us. A sober thought.
Whether the doctor’s hypothesis is correct or not, the idea is important.
The constant need for perfection in life is a harmful way to live. (tweet)
Whether we are talking about the negative effects of pain-relieving medication or any number of other scenarios, the need for perfection often results in negative outcomes on our lives. Not only does it distract us from happiness, it routinely sends us down paths away from it.
The search for perfection in our work may send us jumping from one career to another constantly looking for that one job with no bad days. But that job does not exist—the most beautiful rose still has thorns.
The search for perfection in our relationships causes us to give up too quickly on other people. But there are no perfect people and relationships, at their core, require commitment. Without patience, grace, and faithfulness, there is no opportunity for love.
The search for perfection in our homes often results in the accumulation of unnecessary possessions. Marketers routinely promise comfort and better living in their newest offering. An unhealthy pursuit of perfection makes us more susceptible to their falsehoods. These excess possessions quickly begin to monopolize our time and energy and focus.
The search for perfection in our external image gives rise to unhealthy body image pursuits. Rather than seeing them as instruments through which we accomplish our life’s goals, we begin to see them as ornaments to impress others. Sometimes even, while we never experience perfection in our own minds, we seek to present that reality to the world around us.
The search for perfection in our actions often prevents us from trying new things or experimenting with new skills. By its very nature, the desire to commit no mistakes or ever having to admit failure keeps us from attempting new things in life. But every expert started as a beginner.
As noted in The Washington Post article above, the need for perfection may cause harmful addictions to take root in our life, resulting in ruined or destroyed lives.
But even before that most extreme consequence, the desire for perfection or the avoidance of pain can still be harmful. It causes us to lose opportunity to experience happiness in every circumstance.
Life is not perfect. It never has been and it never will be. But this can be good news. It means we can stop pursuing the mythical, perfect life. It means we can stop chasing perfect skin, the perfect job, the perfect house, or the perfect spouse. And it means we can find freedom to live victoriously even within our imperfections.
About Joshua Becker
I don’t trust the Washington Post to give accurate information.
I don’t trust the Washington Post.
Great post! I am a physician that works with people struggling with addiction. I often use the concepts of “minimalism” to help direct my patients to evaluate their values and beliefs. Thank you for all you do.
A well-said thought. I agree, we all are lacking a bit of self-esteem in the run to be a perfectionist.
I’m going to address the second part of the post and play devil’s advocate. While obsessive perfection-seeking may lead to harmful results, the opposite can be just as, if not more harmful, to the individual as well as society at large. If we go down the road of acceptance (assuming this to be and opposite of perfection-seeking) we may reach a point of complacency. And here is the risk of negative or non-activity, doing nothing.
With the desire for perfection there is a continual forward motion, even if harmful to the self or others in closer relationships. But acceptance and potential lack of forward motion can also be harmful to the individual, possibly leading to depression, poverty, illness, disease, etc. Additionally, society (not just those in closer relationships) may be harmed by the individual now needing assistance and draining society rather than contributing in some way.
Acceptance is cool, as long as it is intended.
The flip side of the pain issue and the pursuit of perfection – http://thepainfultruthbook.com/2017/03/survey-says-cdc-guideline-need-honestly-assessed/
“Based on the results of the survey and hundreds of emails I have received; it may be appropriate for the CDC to invite the pain community to help revise the guideline to create a public heath policy that strikes a better balance of avoiding opioid-related problems while allowing opioids to be used in a responsible way. The proper use of opioids, under any public health policy, should be determined by clinicians who treat people in pain and informed by their patients’ individual needs.
Finally, any guideline that is proposed without acknowledging the needs of people in pain runs the risk of worsening the opioid problem and causing people who are in pain to suffer more than they must. It is time for the CDC to assess the impact the guideline has had for people in pain and to act on their findings.”
Thanks for the great article! I think you made a really good point. In so many aspects of our lives, we are convinced that things should be way better, but that leads to unrealistic expectations, and those expectations can be harmful.
This may be one of your very most imporatant articles. I see this on a daily basis when I am at work as a nurse, living as a Grandmother/mother/family member and as a member of the Body of Christ. There is no group of people this does not touch. Keep talking!
A very interesting read, and sobering! Thank You
Thanks for the article. Being a Brit who has lived and worked in US I have observed an aspect of US culture I have described as ‘Americans believe there is no problem that should be able to go unfixed’.
That shouldn’t be taken as a criticism as it has led to good things as well as bad. Pioneer optimism, entrepreneurial attitudes, medical advances and gadgets at Walmart for every conceivable need (bearing in mind where I’m posting you can take that last one with a pinch of salt! ;)
But it manifested itself in things I noticed that I would never see in the UK like adverts for someone to come clean out the fluff in your dryer (that’s a job?) or the fact I had to sit through an advert for cosmetic laser surgery when calling for a doctors appointment then be told by TV adverts in the surgery waiting room that if I didn’t already have arthritis, I was sure to get it soon so ask my doctor for product x now.
No one likes pain, and where there is chronic pain it can damage quality of life more than anyone who hasn’t experienced it can appreciate. But medication is only a part of a solution. If we want people to take a more holistic approach to recovery then we have to support them through what can be lengthy and difficult changes in lifestyles otherwise the quick fix is too tempting for many because they hurt ‘now’
There is something though about developing an inner resilience and confidence that allows a person to accept that not every thing needs fixing, not every passing ache needs medicating, not every minor activity needs a gadget to make it easier and not every minor grievance needs legal resolution that is becoming more difficult for some societies to grasp.
As many will recognise, it is largely a ‘first world problem’
I enjoy reading through an article that can make people think. Also, many thanks for allowing me to comment!
Very well said Joshua!
Thank you for publishing this article. As a 9 year recovering addict from drugs and alcohol. I am a perfectionist that works on myself on a daily bases with my addictive and perfectionist personality. Minimalism has helped me in that I have less stuff and with less stuff I have less stuff to be perfect. I am very grateful to have found your website. I have incorporated minimalism into my recovery and it works well together. Thank you!
Things are heading in the right direction. I think a lot of these problems will be worked out sooner than later.
What an insightful post! I really enjoyed reading it. I myself am a control freak lol. My name is Brandy and im new to the blogging community, so its nice to meet all of you. I hope you have a lovely day http://whimsicalwolfblog.com/
The article quoted, your opinion piece, and the comments (far as I can tell) 100% ignore the other side of opioid “abuse”: improper care of those with chronic pain and disabilities. Those with chronic pain are ignored, dismissed, fed antidepressants, treated like convicted dope dealers, and otherwise put through the wringer. We ignore treatable conditions because we can’t bear the idea of one more stranger questioning our pain as “drug-seeking” or “blowing things out of proportion.” And now the government is pushing an agenda that will leave tens of millions without any care at all, not even mental health or drug abuse treatment. Maybe stop feeling superior about “whiny Americans wanting a perfect life,” and take a hard look at all sides of the equation?
I totally agree, Ann.
Hang in there! Things will get better! :)
Amen! Well stated. Many people don’t understand real, chronic pain.
Hello from Europe!
I am not sure that we accept pain, but we tend to be critical and not swallow everything (at least in northern Europe where I am from). We try to fix things with healthy food and exercises rather than to take a pill. It might be this difference because our healthcare are almost for free, due to high taxes wich I gladly pay because it help others in need.
Of course you need to take your medication if you have some kind of disease and of course we have people in this part of the world that act like you discribe in the article. Where I am from we don’t look up to people with the biggest house or the nicest surface. We tend to value other things.
Josefine:
I appreciate your perspective. I’m tired of hearing sweeping generalizations about Europeans and Americans. The truth is that there are addicts and health buffs, hoarders and minimalists, educated and ignorant, every extreme in both places. I do not feel as an American that I live in a fundamentally ignorant or unenlightened society. Thanks for providing some balance there.
And in general:
As a back pain sufferer for many years, I offer the idea that there is a broad spectrum of pain and pain management; it’s not simply suffer agony gladly or demand perfection. There is a certain amount of back pain that I’ve walked around with from time to time, and then there’s a point where, without medication, I’m reduced to spending all day sitting around suffering. It’s not “demanding perfection” to use medication to allow me to function on those days, especially as I don’t find that medication restores me to a perfect state anyway. (No, I don’t take opioids regularly.) I just don’t see the wisdom of insisting on suffering for its own sake, in the belief that it represents some kind of enlightenment. I say time is too precious to squander it when relief is available.
We all need to learn to do our best and let go of the rest! It is great to have drive, ambition and goals, but life is too short for perfection.
I was in law enforcement for 26 years and noticed how many people have holes inside them. Holes they fill with drugs, sex or gambling/overspending. They want perfection in their lives, but perfection is illusory. As the line in an old Alabama song says:”We’re only here for awhile, so why not smile, hey living ain’t all that bad.”
I agree with everything said here, but one thing not said is in America, our greed fuels are politics, which has fueled this epidemic. Big Pharma is one of the biggest lobbyist groups in America, spending hundred’s of millions a year to get laws passed that make it easier and easier to prescribe opioids. It’s not necessary a case of demand creating supply, but a case of supply creating demand. And it’s all in the name of greed. More profits, more campaign contributions.
Dave, those political and economic issues are addressed in the original Washington Post article. My post was not a critique of the medical industry in the US—that’s why they were not brought up here.
I blame the Opioid abuse on the good old-fashioned “high” it gives people. With Opioids you don’t worry as much, and little things don’t bother you. Perfectionism isn’t an issue when you’re on them because you just don’t care. The peace you get by trusting God is better than taking Opioids and without the side effects or cost.
I wonder too if we need to reframe what we think is “perfect”. Our definition may be part of the problem. Thanks for your thoughts!
One of the first things that struck me when I began to study at the Option Institute was “We are all perfectly imperfect”. How liberating.
If your life was always perfect, you wouldn’t have any good juicy stories to tell during conversation hour or to your grandkids. I’m a perfectionist trying to get over it so I can have some good stories to tell about when life wasn’t perfect, and what we did about it.
While looking through old photos recently with my Mom I noticed something. The kids in the pictures (my mom, aunts, uncles) were dressed in mismatched clothes, barefoot in summer, had messy hair. Many photos included beloved pets. Life was far from perfect and definitely not easy or pain free as the pictures showed; but, they were for the most part all smiling, looked happy and healthy, as they are today.
Joshua, what an eye opener for me! This article can open the eyes and hearts of many. It is really so simple, we are bombarded daily with images of perfect, then we strive to have it all…then the pain and disappoint of never reaching these insane goals has us reaching for ways to get rid of the pain! If only we could look and see what is happening to us…we Americans have so much, yet it is really not much at all. We strive after what is killing us…I find what I need and work at is quiet and introspection and trust in One greater than I. I am learning to look for all the awesome subtlies around me, regain the wonder of childhood. Life in itself is awesome. Ann
Thanks Annie.
Oops, I kinda messed that up.
It seems to me that all of society’s pursuit of perfection in jobs, houses, possessions, and image is rooted in the need to have some kind of need met. There is a longing inside of people that they need to have filled. I have read that addictions are rooted in the need to be loved. I believe that receiving the unconditional love of God that we receive when we know His Son Jesus is the only way to have that need met. What makes it difficult to receive God’s love is the misconception that God expects us to be perfect just like the world does. We don’t have to be perfect, because Jesus is. That is what is setting (present tense because I’m still a work in progress) me free from perfectionism.
true :)
Thank you for this article. I have read the comments as well. You need this to go viral as it says more than I have ever read in a way that is very understandable .
Thank you
What’s the perfection ? It’s in pain that progress is being made.
The opioid addiction in this country is indeed very troubling. While you bring up some interesting food for thought, I question if the primary driver is a need for perfection. The epidemic is largely driven by the pharmaceutical industry and “addiction” is a key component. Addiction is a disease. Pain used to be managed by professionals, often in a hospital setting. Not anymore. Young people, have an incredible tolerance for pain (from getting wisdom teeth out…to outpatient surgery) yet have easy access to highly addictive drugs AND many a physical vulnerability to addiction. Seeing the young people in our communities caught up in this perfect storm is heartbreaking.
Sarah, I did not focus on the other factors raised in the article by Dr. Humphrey—mostly because this post was not a critique of the medical or pharmaceutical industry. For comments on which economic and political factors may also be contributing to the epidemic, I’d refer you to the original article in The Washington Post.
For many (over 35 years) our design firm’s philosophy to our designers and clients, it the only “perfect” is the one that feels right to each of us. In life, and design we need to practice a little more self compassion and live in our own “perfect” world. Great article.-Laurel
I work in a small community hospital with a pain clinic. I would say a driving force is that the patient demands meds as a quick fix rather than the physical therapy, weight loss, lifestyle changes that a medical condition often necessitates. In the clinic, I don’t see the drive for perfection in a quest for meds. I think it’s quick and easy over slow and effortful.
And I won’t even go into using pain as not only a reason to get meds but also as a way to get disability.
Lisa, I did not focus on the other factors raised in the article by Dr. Humphrey—mostly because this post was not a critique of the medical or pharmaceutical industry. For comments on which economic and political factors may also be contributing to the epidemic, I’d refer you to the original article in The Washington Post.
I do agree that a driving force is perfection, but also many people can’t cope and don’t ever want to feel any kind of pain at all…from a stubbed toe to back pain to not getting the job we want or not having the house we want. And on and on. Instead of listening to the pain (heartburn=ate too much garbage) we want a pill to mask and avoid.
This is so true! People (Americans?) Stevie Jwant an easy way out. Your example was spot on! Diet pills are another good example.
It’s funny that you mention heartburn. I was diagnosed with acid reflux and did not want to be on meds long term so I had to give up certain foods and eat smaller meals. I won’t lie and say it’s been easy, I really do miss the taste of coffee, but the pain of reflux and risk of side effects from pills are not worth it. I talk to people all the time who have bad indigestion or reflux and refuse to make changes and say, “oh, I’ll just take the pill” because I refuse to give up coffee, alcohol, whatever. I choose instead to focus on all the good things I can eat like green tea, chicken noodle soup, dark chocolate, and peanut butter and accepted that my latte days are over.
Meditation helped with the healing process and getting through the days of pain before I healed by teaching me to sit with the discomfort and that it will pass eventually.
I think what you’re saying is so true, Annie. Most people I know would rather take a pill with possibly horrible side effects (like cholesterol-lowering drugs, for example) than change their diet/behavior. Americans seem to want to take the easy way, and most have decided that popping a pill is the easy way.
I applaud you, Annie. I have found a combo of eating well and practicing yoga/meditation has worked well for me.
Attentive listening and long term involvement are a part of what makes us feel better (via the placebo effect). Doctors are rewarded, not by the quality of care and long-term results, but by volume (http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care).
Following the general theory that ‘Brits are dour and Americans are chirpy’, I also wonder if the European way is to automatically accept that things are never perfect, and there is often more humour in focussing on what can and usually does go wrong. Perhaps our generally bleak outlook (often down to the dismal weather) means that we view a happy, sunny day as a rarity amidst a life that is usually cloudy ;o)
Hmmm… not quite sure I agree w/ your extrapolation of avoiding pain = pursuit of perfection. After practicing for >20 years, including stints while stationed in Europe and Asia, I would agree w/ Dr. Humphrey that Americans are poorly equipped to deal with pain when compared to other cultures.
You write “as noted in the WP article above, the need for perfection…” but I don’t read that conclusion/ assumption/ implication anywhere in the article. If I read your post correctly, then I think you have misinterpreted the article. It is very important to not confuse avoidance of pain with something else. This is especially relevant to my practice as an anesthesiologist.
Americans have expectations not comparable to other cultures. This can apply to not just how much pain can be tolerated, but many other life aspects. Medicine is practiced very differently in the US than almost any other country in the world. Dr. Humphrey was very circumspect and careful in his writing of his article. There is a lot that is not even implied but can be read between the lines.
“Relative to Europeans, Americans have more faith that life is perfectible (e.g., all pain can be avoided),” was the exact phrasing from Dr. Humphrey in the Washington Post article.
Yes, in the context of his sentence:”perfectible” = elimination of pain, NOT “perfectible” = perfect house/ dream job/ unblemished body
“perfectible” = zero pain
If one wants to preach against vain lifestyle aspirations, OK.
I just don’t think this article had anything to do with it, specifically “perfecting” lifestyle.
What the WP article DOES allude to LOUDLY, are factors that really need discussing, as some commenters have noted.
Mr. Becker I appreciate the points you have made. I will respectfully sign off this discussion as I feel very strongly about treating patients’ pain and what Dr. Humphrey’s article addresses, the important and main points of which have been redirected from discussion here back to the original article. (??)
Wow this discussion can go very far. Thank you Joshua for bringing up this controversial and very though provoking discussion about pain killer. However, if I may add here, when talking about “avoiding pain”, I am very skeptical. I do understand physical pain is and can be intolerable and with less attention from physical therapy or alternatives would be best choice.
These are good points; however I would add that medical care reimbursement is tied to patient satisfaction scores. Pain was added as the fifth vital sign. If healthcare failed to deliver satisfactory pain scores, reimbursement is affected. In the effort to fight the opiod epidemic, the federal government has dropped pain as a 5th vital. So, I would agree with Zoe: our healthcare delivery system is partially to blame (with a healthy dose of the perfectionism you talk about).
And as I recall, pain was added as the 5th vital sign as the result of a campaign by the pharmaceutical company that created Oxycontin, so it basically started with a marketing scheme by the maker of an incredibly addictive narcotic. A patient would come in for, say, lab results to follow up on her diabetes and hypertension, and to follow the rules, the MA would have to ask for her pain level, and then the doc would have to follow up on that and presumably do something to fix it– even if it was, say, chronic, mild low-grade arthritis in the knees that wasn’t bad enough to merit surgery (or Oxycontin), and that wasn’t even something the patient cared enough to mention. So, the push for perfection (sometimes from the patient, but in this case, more from the quality standards imposed on healthcare without thought for the long-term consequences) meets the push for profit, and it has been a deadly combination.
Kirstin, to be fair, I did not focus on the other factors raised in the article by Dr. Humphrey—mostly because this post was not a critique of the medical or pharmaceutical industry. For comments on which economic and political factors may also be contributing to the epidemic, I’d refer you to the original article in The Washington Post.
@Becker: Right, the good old WaPo, where the entire comment section is filled with neoliberal capitalists and reactionaries who blame the working class for their own exploitation. Do you even hear yourself? But then aren’t you the guy who said you’re a neoliberal capitalist and you support private solutions to social problems? How’s that working out?
I know I have perfectionist tendencies. I now try to strive for ‘excellent’ rather than ‘perfect’. I think there is a high percentage of people for whom perfectionism does work – externally – but at what personal and hidden cost? Also, as you identify, it is the cumulative effect of trying to be perfect in all areas of life. I think we can help one another by being honest about our challenges and open about our realities, allowing ourselves to support one another honestly, rather than trying to present our perfect facades to one another. Thanks for the thought-provoking article!
While I do think our need for perfection is killing us so to speak, our strong desire to avoid any pain and discomfort (in our life and even in the lives of those we love) is a driving factor.
I’d argue that Europe would experience the same epidemic if they delivered health care as the US does.
That was my thought medical health care is a money making business in America.
it is
I agree it’s probably as much about supply as it is about demand.
Amerikkka in particular has a pernicious form of capitalism that is literally killing large numbers of people. It’s responsible for a whole hose of maladies, including but not limited to depression, anxiety, obesity, hypertension, gastric distress, hypercholesterolemia, headaches, mood disorders, anger, pseudobulbar atrophy, diabetes, back and other musculoskeletal problems, fear of failure, shame, guilt, homelessness, fear of homelessness, fear of job loss, etc. Drug use in as violent and exploitive and unequal society as amerikkkan society is pretty understandable if you realize what havoc capitalism is wreaking on the working class. More people will begin turning to street heroin and other drugs since the CDC in March 2016 laid out new guidelines on how docs Rx schedule II drugs.
Very true. Another thing that came to mind is how much influence religion has had in pushing the ideal of ‘the perfect man’ that rests on the top of a heirachal chain that was based on a story that was never true to begin with. I honestly think people try (whether the pressures are internal or external) in their minds to climb up that false hierarchy and are left perpetually frustrated and defeated by the fact that perfection will never be attained. In terms of grappling with perfection in my own life, I always take that old Buddhist saying to heart, “Everything is perfect, and nothing is permanent.”
As a therapist who works primarily with trauma and addiction, your words are frighteningly accurate. One of the common situations in the population I serve that leads to relapse is “not being able to do recovery perfectly.” Letting go (of expectations, clutter, toxic relationships, etc.) can be incredibly healing.
Thanks for adding that Traci.
I TOTALLY AGREE WITH YOU TRACI. LETTING GO (OF UNNECESSARY BURDENS LIKE THE ONES YOU MENTIONED) CAN BE INCREDIBLY HEALING.
THANKS FOR THE ARTICLE JOSHUA, I LOVE IT. IT’S SIMPLE AND ACCURATE. GOD BLESS YOU.