A reader sent me a link to an article written by psychiatrist Steve Balt, How To Retire At Age 27, in which he describes a typical patient in his practice, a 27 year old named Keisha:

During the interview, she told me, "I just got my SSDI so I'm retired now." I asked her to elaborate. "I'm retired now," she said [boldface in the original].  "I get my check every month, I just have to keep seeing a doctor." When I asked why she's on disability, she replied, "I don't know, whatever they wrote, bipolar, mood swings, panic attacks, stuff like that." She had been off medications for over two months (with no apparent symptoms); she said she really "didn't notice" any effect of the drugs, except the Valium 20 mg per day, which "helped me settle down and relax."

I misspoke when I said "typical patient." She's slightly unusual for his inner city population, because she actually graduated high school and even took nursing assistant classes.

She dropped out, however, because "I got stressed out." She tried looking for other work but then found out from a family member that she could "apply for disability."

A psychiatrist and a lawyer later and she's awarded a pension of $700 a month. No retirement party, though.  And she'll have to buy her own watch.

The rest of his post is a thoughtful back and forth about what constitutes disability, and whether a) giving them this easy way out isn't actually doing a disservice to the human being in front of you; b) whether these false diagnoses aren't artificially inflating disease prevalence estimates; c) the extent to which it contributes to bureaucracy (and cost.)

II.

So when he emailed me the link to the article, How To Retire At Age 27," the reader asked me a tongue-in-cheek question:  "Now why didn't I think of that twenty years ago?"

Thing is, he probably did think of that, or some brief fantasy of something like it, but figured he could make much more money doing something else.  Therein we have the problem:

Evidently, this woman Keisha doesn't think she could make substantially more than $700/month doing something else, so regardless of whether she is truly disabled or not, her conception of her opportunities is seriously limited.  That's social policy problemo numero uno. 

Note that she even took classes to be a certified nursing assistant, and still doesn't think it's worth it.  So either CNAs don't get paid enough (over SSI) to merit giving up all your free time to work with the belligerent poop machines at the hospital, or else SSI pays too much to make that decision even worth considering.  There are no other possibilities.  Choosing between those without sparking riots is social policy problemo numero dos.

Then there's a subtle semiotic issue.  She calls it "retired."  Not disabled, but retired, which means in the language of social policy she has understood that she has somehow "worked"/contributed to society to merit some retirement benefits, and also tacitly accepts she's not unable to work, rather that she's done working.  So what could she have done to merit retirement? The answer probably is nothing.  Right?  But no one has tried to correct her thinking about this because, well, it just isn't worth arguing with some unemployed black woman at a psychiatrist's office because you'll be branded uncaring and racist, not just by her but by some other busybody with a progressive agenda, free time, and a government/media job.   You will also likely get punched.   Besides, you and anyone who values work as a moral good and an end in itself don't have time to explain it to an unwilling Keisha, you actually have to get back to work.  So she's left with her comforting lies that go unchallenged-- bellay that: they are encouraged.  That's social policy problemo numero tres.

III.

But now we have to take three left turns to get at the truth.

There is a significant misconception of what "disability" means, and I'm not going to say what you think I might.  Dr. Balt, and I'll wager most people, think Keisha is probably able to work.  However, the issue isn't whether she can work, but whether any employer would be willing to take a chance on her ability to work. Would you hire Keisha to run your office?  Do billing?  In the spacious comfort of an internet comment you might hire a woman like Keisha to work at a hypothetically inefficient McDonalds, but in practice, are you willing to tolerate "3-4 absences a month due to illness?"  McDonalds neither, which is why the SSI application form asks that exact question.

You will observe the Keisha does not even have the enthusiasm to know what is written on the most important economic documents of her life.  "I don't know, bipolar, panic attacks, whatever they put on there."  She can't be bothered to handle those papers, someone else is in charge of that.  How attentive will she be to the frier?  McDonalds doesn't want to find out.

That specific issue reveals an important bias and misunderstanding America has when it talks about employment.  Yes, there is an issue about people wanting to work but the other issue is that the global economy is too quick and efficient to tolerate your idiotic car troubles or your imbecilic grandmother's death or your moronic lack of child care (cue Scandinavia) or, and mostly, your stupid health.  The economy was a Ferrari and now it's only a Honda, but either way, not much time for absences and no time at all for Keisha's learning curve.  Keisha isn't just unemployed, she is completely unemployable.   We can argue whether auto plants should pay $20/hr or $50/hr, but for certain there is no market for unskilled labor at all.   Let me correct another grand mistake of the politicians and the talking heads in the media:  this problem is likely to get much, much worse, not better, as the economy improves.   There are no typos in that sentence.   Read it again.

The jobs employers would be willing to take a gamble on are jobs that pay too little for it to be worth her showing up at all.  Hence SSI.  Sure, maybe you could work at Walmart for $7 an hour but they don't offer benefits so ultimately, what's the point?  A rich guy may think he pays his Mexican housekeeper good money, but the fact is if Juanita doesn't show up one Tuesday morning he doesn't miss a step, which is why he was willing to hire her.  You send the suits to tell him he has to hire her legally, pay her wage taxes and offer her health benefits and still take the risk she doesn't show up and he'll release the doberman on you and just hire four high school kids to each work a block of two hours a month.  Is that fine with you?  Then go see what Juanita's next step is.

All of this comes down to a very important point: the country's economy understands these issues on an unconscious level, and it has created a system to absorb 10% of the unemployment, i.e. pay them off so they don't riot, exactly like Saudi Arabia buys off its people.  Yes, America is a Petrostate, but instead of oil money it's T-bills.  However, as is evident throughout history, rich white people riot too, hell, they'll overthrow a King because the rum prices fell too much or shoot a President because he wanted a third term; and they'll for damn sure John Galt the Senate if they think poor people are getting free handouts, so the system pretends to offer benefits based on medical disability, just as it pretends on your behalf to be appalled by Mexican illegal immigration even as every restaurant in Arizona employs illegals, and everyone knows it, including the politicians and the Minutemen who eat at every restaurant in Arizona, not to mention California, not to mention America.  Dummy, the sign says "Authentic Mexican Food"--oh, never mind.

For fun, let me point that that another 10% of the unemployed in America are relabeled as "incarcerated", so total you have a real rate of 15-20% unemployment, and this does not include the unemployable who have been relabeled as "military personnel" thanks to two endless wars, or those who manage ten hours a week at the Buy-n-Large who are relabeled as employed and thus are of no consequence;  all of which is good because if the unemployment rate printed higher than "9%" the credit rating of the US would have to fall to C-.   "But you need at least a 3.0 in your major to graduate."  There's your grade inflation.

Psychiatry is the unsuspecting but intentional handmaiden of this process.  Never once thinking it was being pulled into a long con, it self-righteously accepted its grownup label as "medical specialty" and began ostentatiously fighting for "mental health parity" and the Medicaid funds that it thinks it deserves, "we care about patients, about people!"  And it comforted itself with the knowledge that 25 medications and nine academic journals must signify they are scientists, which means that all my Foucaltian ranting couldn't possibly apply to them.  And yet, here we are.  Dr. Balt is obviously earnest and even optimistic when he tries to articulate cause and solution to these social issues, and he's to be commended for seeing through the Fog Of Prozac; but, lamentably, he is too late for change to come from within psychiatry.  Note that-- and this is neither an exception nor a criticism of him--  even though he sees this truth he cannot stop, he can't refuse to participate, and neither can I, or the other psychiatrists who are eyeballs deep in a system none of us conceived yet all of us are responsible for.  The system has been vaccinated against dissent.

I can sense you pulling away from my abstractions, "that's all very clever and all that, but how does it actually work in real life?"  This is what I'm trying to tell you: it doesn't work in real life.  It only works in theory.

He closes, "Using psychiatric labels to help patients obtain taxpayers' money, unless absolutely necessary and legitimate, is wasteful and dishonest."  Maybe, but if you change the system he will lose 100% of his "patients"; and never mind him, you do not want to know how the system will relabel the patients when that happens, or who will be in charge of that relabeling.   I am sure he will not believe me.  Fortunately for him, he will never have to find out.

IV.

And this brings us to the essence of the problem, of all of the social policy problems that we currently face.  "How did this happen?  How did it get so bad?"  The answer is that it has always been this bad.  We didn't care.

Narcissism has been on a steady rise since the end of WWII and went parabolic in the 1980s; all social policies have to be understood in the context of that psychology, that culture.  Hence SSI isn't altruistic but narcissistic, its every (no sic) purpose was not to serve others but to serve us.

Stop thinking of SSI as money.  SSI isn't taxed, and if you recall the First Law of Harbors, "taxation=representation": not taxing them is the same as not giving them representation.  So for $700/month they don't call you to account for all the rest of the money.  "Yeah, but don't they vote?"  HA!  You kill me.  I meant actual representation: lobbyists.

As long as they-- and the inmates and the etc-- are munching on food stamps, weed, and Xboxes, nearly illiterate but keeping their nonsense within their neighborhoods, the rest of us can go on with our lives.  Which means that every unconscious force exists to keep this state of affairs going until we no longer need it.  And if that requires printing money or releasing oil reserves to keep prices down or insisting there's a shortage of psychiatrists, "how about some NPs?", so be it, because the system must be preserved, including and especially at the expense of the future.  It's a popular political refrain that Social Security will soon be bankrupt, but that's meaninglessly obfuscating: it won't be around for the kids when they grow up  because it wasn't for them, it was for the people who were around when it was conceived.    There was never any way it could last forever, no credible way of funding it-- especially the moment productivity went parabolic compared to wages.
 



Don't say that taxes needed to be higher because it was never about funding it, it was always about temporarily buying their apathy.  Truth be told, it stayed solvent longer than it was supposed to-- one of the benefits of having a reserve currency, aka a private meth lab.  But you knew that, didn't you?   Temporary measures, just like a psychiatry that is for the "management of acute symptoms"-- or are you going to tell me you expect/want it to look like this in 30 years?  Then why is it like this now?  And so this is the terrible, awful truth of it all: we created the system only for us, and will last for as long, but only as long, as we are alive, and that was as far as anyone ever thought it out.  That means that any kids under 10, rich and poor, will be left to make do with rubble-- on purpose.    That's what they will inherit from the Dumbest Generation Of Narcissists In The History of The World, who say with not the least bit of irony, "may as well spend it because you can't take it with you!"  No kidding.  You've created a gigantic Ponzi scheme which is not just morally sketchy but downright mean to your kids, but what do you care: you'll be dead.  

In some Bible story Ford Prefect warns the humans, "two million years you've got and that's it, at the end of that time your race will be dead" and he meant it as a fait accompli but that was a guy who took the long view; and when the response came back with a soothing smile, "well, still time for a few more baths!" that was a guy also taking the long view, the difference being his long view was exclusively to justify his present frivolity.  It should be no surprise that this second guy's brilliant solution to a fiscal crisis was to call leaves legal tender and then burn down all the forests.  They didn't survive the winter.   But the warning I offer the younger generations who have to clean up our messes even without the benefit of forests or a functioning psychiatry is what consequently happened to the first guy: he went mad.   It is inevitable.

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Previously:  The Terrible, Awful, Truth About SSI