There is a well known shortage of psychiatrists nationally, however, more specifically, in the Silicon Valley Bay area, there is a tremendous shortage here locally. It is the nature of our supply and demand economic system - some of this imbalance is certainly due to supply, but I suspect most is due to a far greater local demand.
I have practiced psychiatry in Silicon Valley for nearly 20 years, surfed the rise of the internet, floated with dot com bubbles and busts, witnessed fortunes and follies, all from the arms of my leather chair, in my tiny office, through a courtyard window, with two very ancient goldfish in tow.
Everyday a parade of stressed-out “middle class” multimillionaires marches through my office, on the hour, by the hour. I know far more about AMT (alternative minimum tax), series A funding, angel investing, and bankruptcy than any mental health provider ever should have to endure. I am indeed a “Silicon Valley” psychiatrist.
Median family income in Palo Alto is greater than $160,000/year (the third highest in the nation from 2012 statistics). Median home value is upwards of 1.5 million. Average rent for an apartment in nearby San Francisco is around $3K/month (a mortgage payment!). But there are jobs - great jobs - Google, Apple, Oracle, Facebook, Paypal, HP, SAP, Vmware, Stanford and more - and I take all of their insurance plans.
Over the decades - as both a psychiatrist practicing in Silicon Valley and a civilian living here locally - I have witnessed so much success and yet so little happiness. In our valley of material riches and natural beauty, the two are regrettably too often in opposition.
Of the two concepts, “success” is far easier to define than “happiness”, as it is much more concrete. “Success” is the achievement of a goal and the attainment of a higher social status relative to that goal. In Silicon Valley, this typically involves the creation of a product or founding of a company, with a subsequent accumulation of wealth, and thus an associated rise in social status.
The definition of “happiness” is far more abstract. It is difficult to define and a subject of active academic debate by positive psychologists and others. (This debate is beyond the scope of this blog post. Also note that “Positive psychology” is the school of psychology focused on scientific research into the phenomenon of “happiness”.) As a psychiatrist, I do maintain a working definition for “happiness” however - I consider it to be a sustained emotional state of being in which positive thoughts and body sensations are coupled together.
I believe however that it is best practice not to define happiness directly, but rather to observe happiness as a discoverable phenomenon in nature. In this regard, I am an advocate of evolutionary psychology, and find so much in this vast field which is clinically applicable to my patients. A guiding premise of evolutionary psychology as it relates to happiness would be that the factors which make us happy as members of the human species today, now, are the same factors which made us happy as members of the human species during our earliest evolution two hundred thousand years ago. From the Savannah to Silicon Valley, these factors of the phenomenon of “happiness” have not changed - our society has evolved, but our brains have remained the same, and so what makes us happy now should not have changed from what made us happy then.
Much of this is well popularized by Drs. Bob Murray and Alicia Fortinberry in their book Creating Optimism and website www.creatingoptimism.com. They note many stark mismatches between our modern society and the hunter-gatherer societies in which our species first evolved:
Hunter-Gatherer Modern Society
Nuclear family part of band Unsupported, stressed nuclear family
Interdependent Isolated and alienated
Band of 30-50 members Mass society
Relationships a priority Work a priority
Social and technological stasis Rapid societal and technological change
Individual empowerment and autonomy Disempowerment and loss of self
Consensus decision-making Loss of decision-making power
Work 5-10 hours per week Work 40-60 (or more) hours per week
Roles defined and valued Roles confused and devalued
Little specialization Great specialization
Early responsibility and economic role Late responsibility and dependence
Communal child rearing Insufficient adult supervision
Little or no child abuse Prevalent child abuse
Rituals around most activities Few rituals
Pervasive spirituality Fragmented or lost spirituality
At one with nature Separate from nature
Over the years, much of my clinical work with distressed Silicon Valley denizens has been as simple as sharing the table above. I analyze their lives with them in the above rows and help them to move as many factors as feasible in their lives from the right column towards the left column. The phenomenon of greater “happiness” inevitably follows.
Much of the art of psychotherapy is the art of balance - or rather rebalancing. Many traits appear on a valence, and it is as if the psyche consists of the swinging of many such pendula. If a patient’s life or personality has too much of A, push them towards A’s opposite, and so on… A typical patient might be an engineer with complaints of mixed depressive and anxious symptoms impeding his ability to work successfully. My treatment for his depression and anxiety would seem paradoxical to him - a rebalancing away from success with a reorientation towards happiness. We might analyze his life together and soon discover that he is severely overworked, he has too much money but too little time, he lacks any unstructured free time for hobbies, families and friends, he is isolated and lonely, he lacks autonomy, he feels powerless and victimized by an overly hierarchical corporate culture, his job is overly specialized with few decisions under his control, he has ignored regular exercise and become addicted to junk food, he is inside an office all day, surrounded by technology but hidden from nature. Major life decisions and renegotiations in his private and professional life soon follow. His depression and anxiety lifts. He is happier, though now perhaps due to decisions which make him far less successful.
In their work, Drs. Murray and Fortinberry isolate eight fundamentals of happiness: (1) Connection to others, (2) Autonomy, (3) Self-esteem, (4) Competence, (5) Purpose, (6) Connection to the body, (7) Connection to nature, and (8) Spirituality. I sell these eight fundamentals to all my patients, though rarely do they come to me initially looking to buy them. They usually would prefer to purchase more success. I warn them all that “I am in the happiness business, not the success business”, and that “the two are more and more in opposition in this valley”, and finally that “you will get what you pay for”. I sell the eight fundamentals of happiness to all who knock on my door. They soon leave my office satisfied customers, less depressed, less anxious, on a path towards far less success, but paradoxically far happier than ever imaginable.