There is at least a kernel of truth in every cliché, whether we like that or not. One such cliché is that New Yorkers are all in therapy – in fact, it’s such a common cliché that it’s the hallmark of many Woody Allen movies, and a great many New Yorker cartoons. We laugh, whether we’re laughing at ‘them,’ or laughing at ourselves as New Yorkers. Still, it’s worth asking whether it’s true, and if it is, why?
In fact, a disproportionate number of people living in New York City struggle with emotional problems, compared with other areas of the country. You may have heard about the big Gallup poll that was conducted in 2010, ranking New York City very near the bottom on emotional health – 132nd out of 162 cities. That study included measures of happiness, worry, anger, and stress. The same year, more than 100,000 calls were placed to LifeNet, the city’s crisis hotline; more than a quarter of the callers were considered to have mood problems, and 15% were struggling with substance abuse. According to the New York City Public Health Survey, 14% of those completing the survey were given referrals for the treatment of depression alone.
Additionally, a disproportionate number of people in New York City seek psychotherapy, which is easy to find here. There are 4,478 licensed psychologists practicing in New York City. That’s one psychologist for every 1,868 people. Manhattan has more than twice as many psychologists as the rest of the boroughs combined. In comparison, Los Angeles has 4,143 licensed psychologists, which is one for every 2,380 people.
Many HMOs report statistics on mental health referrals of patients in their networks; when you examine regional and national statistics, it’s clear that the percentage of subscribers in rural America and smaller cities who seek psychotherapy referrals is significantly smaller when compared to Manhattan, which appears to be the point of highest concentration for psychotherapy referrals.
The natural question, then, is why do so many people living in New York City see psychotherapists? A number of possible explanations for this include that life in the city simply is more stressful, the city attracts more people who have emotional problems, and another explanation could relate to stigma and culture. And of course it is easier to find a therapist in New York City simply because there are so many therapists around.
Life in such a large and complex city may make it harder to form basic interpersonal connections. Lower levels of connection are intimately associated with an increase in alienation, despair, depression, anxiety and addiction. Although there are many great things about living here, it can be a difficult place. There are more opportunities for social interactions and relationships to go bad, and it’s harder to simply ignore them. It may be much easier in the suburbs to simply avoid the people or situations that produce conflict.
New York City might attract people who are already struggling with emotional problems, and hence are more likely to seek psychotherapy. People who feel alienated, out of place, and different often gravitate to New York City because of its reputation for tolerance and acceptance of differences, and its wealth of opportunities. These people may come to New York City hoping and expecting to find others who are similar – which can happen, certainly, but even that can take time.
Finally, it may be easier to feel OK about going to therapy in major metropolitan areas. Although some degree of stigma still exists in certain circles, it is also true that in other circles it is valued. Not only do more people seek therapy in New York City, but those who do can find it easier to talk about it here, where it is more common. In smaller cities and rural America, considerable stigma continues to exist in regard to therapy; even those who choose therapy may be more likely to keep that fact private.
Of course, some people choose therapy because they see it as a means to increased personal growth and creativity. They may consider psychotherapy a form of self-enhancement rather than just a place to address problems. For various reasons, it is easy to imagine that more artistic and intellectual people choose to undergo psychotherapy. While this may be another cliché, there is also some truth to it.