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.
littleblackdomicile blogger says
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
Lisa says
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.
joshua becker says
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.
Lisa G says
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.
Stevie J says
This is so true! People (Americans?) Stevie Jwant an easy way out. Your example was spot on! Diet pills are another good example.
Annie says
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.
Karen T. says
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.
Cynthia says
I applaud you, Annie. I have found a combo of eating well and practicing yoga/meditation has worked well for me.
Jennifer says
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).
Naomi says
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)
Priscilla says
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.
joshua becker says
“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.
Priscilla says
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. (??)
TJ says
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.
Kirstin says
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).
Anya says
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.
joshua becker says
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.
commie atheist says
@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?
Jil Shi says
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!
Zoë says
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.
Denise says
That was my thought medical health care is a money making business in America.
Judy says
it is
Jill Caldwell says
I agree it’s probably as much about supply as it is about demand.
commie atheist says
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.
Rick says
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.”
Traci says
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.
joshua becker says
Thanks for adding that Traci.
SOUL JA says
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.