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Comment by vanviegen | Hacker News Reader

> In others, like this one[0], I find it doubly tragic, as there are proven alternative solutions

"eight years of help and 21 stints in rehab" sounds like they tried pretty hard to find a better solution. Not everyone can be cured.

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Like I said, I personally know folks that have been clean for decades, and went through worse. I’ll be hanging out with a bunch, tonight.

Addiction is a very strange problem. Lots of folks have opinions on it, but I have experience with it.

And that’s about all I’ll say on the matter.

Are you discounting the person who chose euthanasia’s experience with it by saying that though?

Nope.

I've always found it interesting that addictive behaviour is often seen as a virtue by our society if it's about the 'right sort of thing' (as far as society is concerned).

We end up considering people as 'dedicated' or 'committed' to some cause or other. If they are a workaholic, or pious, or a sports superstar, or a concert pianist, chances are there is an addictive personality that just happens to have gotten attached to a socially acceptable pursuit.

Meanwhile, the same people with a slight twist of fate end up in rehab.

Worth pointing out. I know of a person who was a workaholic and then died pretty young from also having been a secret alcoholic for much of their life.

That's just utilitarianism?

There's a bunch of things where the morality of what you're doing will change depending on a small detail, with the main action being essentially the same.

Eg, if you dedicate yourself to exterminating rats with dedication and professionalism you'll be a hero, do the same thing using the same tools and attitude to cats and dogs and you'll be a monster.

Which is exactly how it should be IMO. We build the world we live in by enacting change in it. Praising actions in a context devoid of its consequences is a good way to end up in a world where everyone basically hacks the reward algorithm without any concerns about the results of that.

Addiction is defined by the negative impact on the addict, not the behavior itself.

It is a semantics game. Drive, Focus, and motivation are just that unless they are maladaptive and detrimental to the individual.

These behaviors only become addiction when they run counter to the goals and desires of the individual.

No such thing as an addictive personality- it was invented by the pharmaceutical companies (the term) to play down the addictive effects of their drugs, doctors were told only people with addictive personalities will get hooked on the opioids

I can't say much about 'personalities' but it has been quite consistently demonstrated that some people are genetically predisposed and more likely to become addicted to certain substances than others regardless of social factors or even (pre-addiction) consumption patterns.

I also think there's something to it: each person is different.

I've smoked and quit a couple of times, and still get urges to go back sometimes. Meanwhile, I know people who casually smoke once in a while and don't get the habit.

There's a constructive/destructive dimension to all behaviours, even addiction. Constructive addictions have probably created a lot of great art, innovations and achievements, where destructive addictions ruin the lives of a person and those around them. Not that addiction in any form is necessarily healthy, but it seems obvious that constructive ones are more healthy than destructive ones, for all involved.

I don't want to be arrogant or looks like moron, but how can you know that people that you know "went through worse"? How can you measure it? I`m really curious, because all my life I live with understanding that there no way to measure other people feeling, emotions, suffering.

I think the point is that the critical differences are on the inside, not on the outside.

People can go through worse experiences on the outside and recover and overcome.

This points to the somewhat obvious reality that how people handle and respond to their environmental conditions is a critical factor in outcomes.

Sometimes you have to fix the internal root of feelings, emotions, and suffering. You can believe the difference IS the person, without being overly judgmental. In fact, realizing that person themselves needs to be changed is often a key part of recovery.

I think you've really hit the nail on the head here. I think substance abuse is often treated as the underlying root problem when its just a symptom of a much deeper trauma or mental health problem. The lifestyle changes (often) required to deal with the underlying problem can't be forced on the person once the stint in rehab ends. They are usually right back to their old situation with their old friends in their old routines, or they stop taking their medicines or any number of things that lead to relapse.

This is pretty well known. The surviving brother in that story even says that his brother was using alcohol to deal with anxiety and depression.

Sure, it's possible for someone who went to war and ended up killing a family of civilians to recover, overcome and lead happy and fulfilled lives henceforth. Does it mean that another soldier struggling with constant guilt and nightmares is defective and in the need of fixing? Our justice system imposes death penalty for murder. What if someone is truly convinced, on rational bases, that they have committed a murder, but in the circumstances where justice doesn't act? Are they acting insane by taking a matter in their own hands?

Now let's take another person who NEEDS to be surrounded by love and belonging and ends up estranged from family and devoid of friends, living alone in an apartment at the age of 50? Are you suggesting that this person needs to be fixed to not intensely crave those things? Or that efforts to build these up at their age are likely to be successful in today's society? Just what physical, emotional and financial resources is anyone else willing to contribute towards this person's well-being, other than pumping them full of numbing drugs?

> Or that efforts to build these up at their age are likely to be successful in today's society?

I've seen that happen -literally- hundreds, if not thousands, of times.

It's usually difficult. Like, really difficult, but sometimes, it's well worth the effort. We can often help each other through the rough bits.

I've known a few folks that have done pretty awful things (not getting into detail), and have recovered. Many, work hard to help others to recover.

Love, charity, empathy, and generosity are very powerful.

There was a book written by Richard Adams (Watership Down), called Shardik[0]. It's about redemption. Sort of like the Ashoka myth[1]. Not a unique trope.

It's never too late to recover. In many cases, we may not climb "as high" as we once were, but are much happier. In other cases, it's the opposite.

I know a chap that wanted to put the park bench he slept on, in the garden of his mansion. He couldn't find it, though, as the city had replaced them, by that time.

[0] https://en.wikipedia.org/wiki/Shardik

[1] https://en.wikipedia.org/wiki/Ashoka

Oh sure, I know people have rebuilt their lives in 50s. But there is luck and anecdotes and there is prevailing reality. When something is difficult, it requires physical and emotional stamina to overcome. At some point, one may be unable to handle hundreds of rejections after trying to make a single casual friend in a space of years. Not lazy, or insufficiently motivated, just not able to, period. And that assumes, for example, enough financial independence and free time from work to try in the first place. I am not ready to declare people who give up defective or put all the responsibility at their feet, rather than society in general or plain bad luck.

Well, I can only speak for myself, and for those in my peer group, but we regularly help each other to rebuild our lives.

It takes a community. It's not usually something we can do, on our own.

Long story, and not one for press, radio, and film.

My point is pretty simple. It is that the critical differences are on the inside, not on the outside.

I wasn't taking a position on what people should do with this information, but I think that understanding the fact is important if you want to change anything, or simply understand how the world works.

In the context of depression, I think it is up to the individual if they want to change. In your example, the relevant question is if the lonely 50 year old wants to change. As long as they aren't hurting me, I am fine with them choosing either option. What, if anything, I am willing to do the help, would depend on if or how much I care for the individual.

What do you think about your questions? It seems like you have on opinion you aren't stating.

My opinion is that in the end I don't think really wanting a change is enough for most people in sad social circumstances. They simply do not have the stamina, the skills or the opportunities to get out of the rut.

For example, I have a much more modest desire to have a shared hobby with is common and not expensive or difficult to pursue and a group of friends (casual to start with) to go and do that in free time. I have been at it for a year, taking classes, asking classmates and coworkers to join me. Not. A. Single. Luck.

Now, I have family, successful career, financial freedom, enough health to be active, no serious character flaws that would tax friendships. Are you telling me a fat and bitter guy who have been living alone long enough to be rusty in social graces is going to suddenly have willing friend material, let alone romantic prospects?

Personally I am not going to judge him or say he should have just tried harder. You?

>My opinion is that in the end I don't think really wanting a change is enough for most people in sad social circumstances. They simply do not have the stamina, the skills or the opportunities to get out of the rut.

I would agree that it often isn't enough by itself. My thinking is more along the the lines that it is a necessary prerequisite, but not always sufficient by itself. Nothing in this life is guaranteed.

Im not interested in judging some random stranger. Maybe they should have tried harder, maybe they should have tried something else. Maybe it would have worked, maybe it wouldn't. However, I know if they dont try, then they have no chance.

My advice to a friend or someone I cared for would be different. You can't let your happiness be contingent of factors outside your control. If you can't make yourself happy, you are extremely unlikely to find someone or something else to do it for you. If you don't like who you are, then you need to start there because you cant run from yourself. The bad news is that it is your problem to fix, and the good news is that it is your problem to fix. Success is not guaranteed, but these are baseline facts you need to accept if you want to have a chance at change.

You cant force someone to be your friend, let alone a romantic partner.

Oh well, my advice to someone I cared about is tell me what I can do to help. And of course at this point, other commitments in my life as well as general ideas of what is healthy come into play. The other person will have to respect my boundaries and put in a substantial effort to be helped effectively. But, that is very different from being left on your own.

Since I obviously can't care about everyone, I would like to see a society that encourages virtuous cycles rather than downward spirals. Let there be regular public holidays with festivities that single individuals can enjoy without being awkward and that provide opportunities to reconnect with neighbors and meet strangers. Let there be a culture where if one is missing a cooking ingredient or needs to borrow a stepladder, the first impulse is to ask a neighbor for help rather than going to Instacart. This will give these neighbors a license to stop by and chat later without losing their dignity.

Collectively, majority that is doing Ok mentally is in a better position to boost someone who is not, without any single person getting overwhelmed, as opposed to someone who is down figuring it out on their own.

AKA the "man up" argument. You know people who survived worse, thereby somehow invalidating the people who didn't make it when they were suffering less. Because you have experience with it and can therefore judge others.

Nobody is saying it's easy or that people are invalid here.

ChrisMarshallNY is sitting in judgment of the fellow in Holland who made use of the euthanasia laws there.

Specifically:

"I find it doubly tragic, as there are proven alternative solutions" (judgment)

"I personally know many people that were once far worse off than that gentleman, and are now doing quite well" (justification that invalidates the man's suffering)

"Lots of folks have opinions on it, but I have experience with it." (Pushing his opinion above others, to hammer the judgment home)

He doesn't know Mark Langedijk's mind and soul, and yet he feels comfortable desecrating the man's legacy.

I don't find that to be overly invalidating or judgmental.

There is a difference between saying you think someone is/was wrong, and denying their humanity.

It’s the definition of judgmental to say someone is wrong like that. You’re judging their actions as wrong.

Note that I said overly judgmental. Judgment itself is part of the human condition. You can judge an action or choice without demeaning or dehumanizing the person. You can even do it from a place of empathy understanding and compassion.

The idea of that people shouldn't or can't judge any choice or action another makes is absurd at face value.

Except you very rarely have enough information to make informed judgements. It’s inherently dehumanizing to assume the limited information you get from say a news article is all that’s relevant because it treats them as cardboard cutouts of actual people.

It’s easy to see a pregnant teen and think poor thoughts about them without considering if perhaps they are older than you assume and married or they got rapped etc. Read about a convict and perhaps they did something horrible or perhaps they’re wrongly convicted, you simply didn’t know.

You have a point, but I would submit that "desecrating the man's legacy" is a bit ... shall we say ... over-the-top ... rhetoric?

I assume that you have known many, many folks like him (and like me), and are comfortable being extremely and overtly judgmental.

Too bad. I looked at your GH profile, and I suspect that we'd find a lot in common.

Hacker News civility makes it more acceptable to use an over the top phrase like that, where normally I suspect he would have jumped to straightforward ones like “being a dick”.

Well, like I have said, before, I always find it fascinating, when folks in a professional venue, initiate relationships with an attack.

Not exactly sure the advantages it brings, but never a dull moment, eh?

The idea that any posts in this thread "invalidate's this man's suffering" is hyperbole.

Anyway, what's wrong with judgement? Despite some people's insistence on it being taboo, there's nothing wrong with judging other people's behavior.

From what I've seen, I have no doubt Chris means well.

People everywhere have all different things worth living for, and of course there are ups & downs that vary across time and relationships.

Regardless whether someone has the capacity to be helpful or harmful, almost always some judgement needs to be made or absolutely neither one will be forthcoming.

And there is always going to be someone else to disagree.

Whether either one is correct I wonder who is supposed to be the judge of that?

I see not a word of desecration.

Looking at the story of this particular dying Dutchman, seems to me the only thing within reach beforehand were quite temporary solutions not capable of overcoming relatively longer term problems.

I’d appreciate it if you didn’t dismiss everybody’s opinions on the matter for lack of direct experience. You’re setting things up to avoid debate.

There's enough wiseacring as is.

"War talk by men who have been in a war is always interesting; whereas moon talk by a poet who has not been in the moon is likely to be dull."

- Mark Twain

The good thing about interesting vs dull is that you can just filter it on the spot. No need to dismiss people before actually hearing what has been said.

I personally know people who have been dirty for decades. A friend of mine "inherited" the stewardship of one such person and he was a miserable bastard until he died of cancer and the only people who knew him regretted that it didn't progress faster. He was a drag on the few people willing to associate with him (neither his mother or daughter among them) both emotionally and financially. I myself helped clean up the disgusting mass of cigarette tar filled beer cans he left in my friend's house after he passed.

So your mileage may vary I suppose. And that's about all I'll say on the matter.

The first step would be to understand that rehab is not the solution to any kind of problem.

Rehab is about making a lot of money, not healing people, they benefit from relapsing, they have zero incentive to help people.

This is a typical overly cynical and overly online take. I think it would be dispelled by talking to or being friends with a single person that works in rehab

there are certain places where a lot of dubious, predatory drug rehab facilities have popped up in the last decade, since health insurance now has to pay for it, yet it's not quite regulated like other healthcare. if you see a lot of these it can make you very cynical.

I'm sure bad things happen, but to embrace all or nothing cynicism is to reject reality.

It is pathological in it's own right to paint the world with such broad and biased brushstrokes.

You could apply this to countless professions.

Plumbing is about making a lot of money, they benefit from you pipes leaking again.

We just have to hope that human beings actually care about their work.

Rehab helps about a quarter of the people it treats - provided you accept that they'll probably need multiple rounds of treatment. It's wicked to encourage the belief that a single round of rehab, followed by lots of willpower, is likely to solve problems.

Single rounds of rehab do sometimes work, and longer sessions have better changes. Willpower is part of it, but often completely changing one’s social circle is critical.

Commenting under you on the entire subthread here....

I think this is a two part problem. If you talk to a particular therapist/counselor it would be very rare to find one that doesn't want to see you get better. In general the people at this level are empathetic and do care.

But above that there is a 'rehab system'. You start moving away from the people that want to see other people get better towards that people that want to see the system make as much as much money as possible no matter the cost.

We talk about systems like this all the time here on HN with the term 'Molochs'. Systems where the individual optimum would be X, where X is things people actually like and think are good. Instead the system optimizes towards Y, where Y is far worse outcome for individuals, and individuals are seemingly powerless to stop the system from optimizing on Y.

https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

Cleaning houses is about making money too. Eventually you're going to be ready to keep the house clean after they leave.

> "eight years of help and 21 stints in rehab" sounds like they tried pretty hard to find a better solution.

First step towards that would be to ditch Anonymous Alcoholics and other religious cult-based "rehabs".

AA and other twelve-steps programs are not inherently "religious-based". They only ask you to believe in some power higher than yourself that you can tap into as a source of inner sternness and restraint. You can call that a spiritual outlook if you like, but it's a very mild one and quite far from any organized or established religion. And it actually works quite well as far as helping people to stop drinking and stay off alcohol for the long term.

There have been many that linked it to being cultist (e.g. [1]).

> And it actually works quite well as far as helping people to stop drinking and stay off alcohol for the long term.

In any case, that is my biggest issue with AA and a lot of other "abstinence" programs (particularly those mandated by courts): they all but mandate that complete and utter sobriety is the only acceptable way instead of helping people to moderate their consumption or to find out and fix why they are consuming substances. Someone who's in hurt because their partner died or cheated upon them or they lost their job or home (these four causes are behind a lot of addiction careers) doesn't need a sobriety program run by questionably or barely qualified random joes, they need professional counseling.

[1] https://www.skeptic.org.uk/2023/03/from-the-archives-exposin...

I spent decades of my life trying to pursue moderation. It doesn't work (for me). The Sinclair Method worked. I tried AA but the white knuckle approach wasn't right for me. I know people who have absolutely gotten sober using AA, others who use both, and others still who use different medications.

In my experience, moderation was the worst possible solution. It was like perpetually kicking the problem down the road to be dealt with on another day. Relapse was frequent and always right around the corner, and with relapse came shame, guilt, and other feelings of failure.

I just wrote a long reply detailing why moderation isnt an option for people like me, but as usual the best explanation of my relationship with alcohol comes from the Westwing:

> I'm an alcoholic. I don't have one drink. [pauses] I don't understand people who have one drink. I don't understand people who leave half a glass of wine on the table. I don't understand people who say they've had enough. How can you have enough of feeling like this? How can you not want to feel like this longer? [pauses, sighs] My brain works differently.

> sobriety is the only acceptable way instead of helping people to moderate their consumption

That only works for some people and not others (likely due to genetic factors amongst other reasons). Which can be quite hard to grasp for people who are actually able (or believe that they are...) to 'moderate their consumption'.

Have you been to an AA meeting?

I'm a staunch atheist and was also very cynical about this too. That is, until I attended several of these meetings in support of a friend.

The intensity of the religious aspect probably varies depending on where you live but what I observed was pretty minor and wasn't at all offensive.

The two people I know who have been helped by AA are happy and healthy now.

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