I recently had a patient, a black guy from the worst part of Detroit, let’s call him Dan, who was telling me of his woes. He came from a really crappy family with a lot of problems, but he was trying really hard to make good. He was working two full-time minimum wage jobs, living off cheap noodles so he could save some money in the bank, trying to scrape a little bit of cash together. Unfortunately, he’d had a breakdown (see: him being in a psychiatric hospital), he was probably going to lose his jobs, and everything was coming tumbling down around him.

And he was getting a little philosophical about it, and he asked – I’m paraphrasing here – why haven’t things worked out for me? I’m hard-working, I’ve never missed a day of work until now, I’ve always given a hundred and ten percent. And meanwhile, I see all these rich white guys (“no offense, doctor,” he added, clearly overestimating the salary of a medical resident) who kind of coast through school, coast into college, end up with 9 – 4 desk jobs working for a friend of their father’s with excellent salaries and benefits, and if they need to miss a couple of days of work, whether it’s for a hospitalization or just to go on a cruise, nobody questions it one way or the other. I’m a harder worker than they are, he said – and I believed him – so how is that fair?

And of course, like most of the people I deal with at my job, there’s no good answer except maybe restructuring society from the ground up, so I gave him some platitudes about how it’s not his fault, told him about all the social services available to him, and gave him a pill to treat a biochemical condition almost completely orthogonal to his real problem.

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