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Is Charleston really the most miserable city?

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Todd Goldberg Todd Goldberg

Dr. Todd Goldberg, a nationally prominent geriatrician, is Medical Director of Heartland of Charleston and Edgewood Summit Retirement Community and Associate Professor at WVU School of Medicine, Charleston Division.

A recent survey which received a lot of press on Facebook and other news outlets reported that Charleston was the most "miserable" city in the U.S.!  I have lived in Charleston formore than five years and think it's a pretty nice place, so this report got me annoyed and thinking, could this be true?  And how can a city be "miserable" anyway?  A city is just a bunch of streets and buildings and a government, none of which have feelings.  And what exactly do they mean by "miserable?" So I decided to look at the study in detail and compare it to some other similar surveys — is this conclusion valid or statistical rubbish?  The study was the Gallup-Healthways well-being index.

Webster's Dictionary defines "miserable" as "being in a pitiable state of distress or unhappiness (as from want or shame)."  This implies a component of economic deprivation, as well as emotional distress or depression.  There certainly is a lot of deprivation and neediness in pockets of West Virginia but not everywhere, and based on my experience, not that much different than anywhere else.

How to measure and average this among people and cities is difficult. Perhaps the Charleston area being "miserable" means we have a higher than average rate of depression, a psychiatric disease including feeling sad, hopeless and "miserable."  It is conceivable that a given region could have a higher rate of a common disease for whatever reason.  Statistically, some locale has to have a higher rate than average, while some must have a lower rate than average.  The causes may be genetic, environmental, unknown factors, or random statistical variation.  According to the Centers for Disease Control and Prevention, there is indeed a higher rate of depression in West Virginia (about 14 percent) than the national average (9-10 percent), but this is not broken down by city, and several other Southern states share similar or higher depression. But anyone, anywhere can suffer from psychiatric as well as medical illness or other personal/family misfortunes and stresses which may or may not be related to where they live.

Note: there is known to be a higher incidence of depression in people who have no job or insurance and in those with chronic illnesses.  In a 2000 survey, people in rural areas, who had less access to jobs and health care and had higher rates of depression, but this would not be as applicable to the less rural Charleston metropolitan area.  Also interestingly, North Dakota, which is experiencing an economic/oil boom, has the lowest rate of depression in the USA at 4.8 percent!

But is unhappiness and "misery" the same thing as depression? Several highly recommended recent books by University of Pennsylvania psychologist Martin Seligman describe a new field of "positive psychology" which posits that happiness is a positive state of enjoyment, purpose and fulfillment which is much more than just the absence of a negative emotional state, depression.  Some people for reasons of upbringing, genetics or circumstance tend be have a more optimistic and positive disposition and outlook on life, and some people unfortunately are the opposite.  This can be modified somewhat by practice, therapy and medication.  Seligman's website describes many psychological surveys that purport to measure happiness and life satisfaction. However, none of these scales have been used in national surveys.  One important point he makes is that above a certain level of deprivation, economic prosperity does not necessarily make people happier overall.

Common sense would indicate that people who are socioeconomically disadvantaged and live in ramshackle environments probably tend to be somewhat more stressed and unhappy though not necessarily clinically depressed or "miserable."  We all know the facts; there is indeed a lot of derelict property and poverty in West Virginia (as well as everywhere), but statistically the unemployment rate in Charleston was recently reported to be 7.3 percent, actually not much different and in fact a little lower than the national rate of 7.7 percent.  In Camden N.J., which in my experience is the most rundown and miserable city in America without any nice parts or features whatsoever, the unemployment rate is 18.5 percent, and in my former home of Philadelphia, which has great parts and awful parts, the rate is 10.6 percent.  So in terms of jobs and poverty certainly other cities are objectively far more miserable than Charleston.

According to another recent study characterizing words used by people on Twitter, the happiest states appeared to be Hawaii, Nevada, Maine and Vermont, while the saddest were Louisiana, Mississippi, Maryland, Michigan and Delaware, while Beaumont, Texas, was the unhappiest city in the U.S.  West Virginia was just average in this study.  Another recent survey in Forbes Magazine rated Detroit and Flint, Mich., the most miserable cities in America, with the highest violent crime rate, plummeting property values, political corruption and high taxes.  Chicago and Rockford, Ill., were next, followed by bankrupt Stockton, Calif. In yet another survey, the happiest individuals were old, male and Republican (so I'm good!).  And still other studies show that religious people tend to be happier than non-religious people; and religion tends to be strong in the people of West Virginia!  But these widely varying criteria and findings only go to show you that every survey is different depending on who is doing the study and what questions they are asking. 

The Gallup-Healthways Well-Being index is a telephone survey of thousands of Americans in every state and congressional district and includes six components: life evaluation, emotional health, physical health, healthy behaviors, work environment and basic access to clean water, medicine, a safe place to exercise, affordable fruits and vegetables; enough money for food, shelter, health care; having health insurance, having a doctor, having visited a dentist recently; satisfaction with the community, the community getting better as a place to live and feeling safe walking alone at night.  All reasonable factors, but somewhat subjective.

Certainly based on physical health and healthy behaviors it is well known that West Virginia ranks poorly.  We have all seen many government reports indicating Charleston and Huntington, along with West Virginia in general, have higher than average rates of diabetes, obesity, smoking, alcohol and drug abuse, etc., for whatever reasons.  So that part may be accurate to some extent.  But these are problems across the United States, and at least in Charleston and Huntington, as opposed to some of the less-developed areas of the state, we have good access to several fine community and teaching hospitals, a good number and quality of physicians and several urgent care, family care and community health centers.   As a physician at Charleston Area Medical Center, which receives innumerable problem cases from all over the state, I have observed that MANY other parts of West Virginia have much worse health care access than the Kanawha Valley, but rural areas are not counted in the current survey of  metropolitan areas.

In the current Gallup survey, Hawaii was the happiest state.  Well, big surprise — I wouldn't mind traveling there or living in paradise either!  But it's not just the warm and beautiful tropical island climate — cold Minnesota and North Dakota were the next happiest states!  Among smaller cities, Lincoln, Neb., was rated the highest, and among larger cities, Washington, D.C., residents reported the highest wellbeing scores!  Well I guess the lobbyists, politicians and other government bureaucrats there are living large (at taxpayer expense), but for the average person in Washington there is a lot of poverty, crime, high costs of living and horrible traffic.  So whether the Gallup survey really is a "true" measure of overall "happiness" or "misery" is highly debatable.

As for exercise and recreational opportunities, while not everyone takes advantage, West Virginia's mountains, ski resorts, state and national parks and rivers are nationally known to be "almost heaven" for outdoor types (which does not include me unfortunately).  Even right here in Charleston there are plenty of parks, trails and gyms for fresh air and exercise.  There are also a decent amount of cultural opportunities, shopping, restaurants and schools here — certainly nowhere near as much as larger more famous cities, but enough to keep occupied with much less crime, traffic and scarce and expensive parking which believe me are a big problem in larger cities like New York and Philadelphia where I lived for many years before moving here.  And here we are only a few hours from Charlotte, Charlottesville, Pittsburgh, Cincinnati, Columbus, Lexington, Louisville and lots of other nice places if you need some additional sports, culture, restaurants and shopping.  And who even needs to leave the house these days?  You can buy anything or see anything over cable and internet!

Finally, as a geriatrician I have also become aware that West Virginia has a larger percentage of elderly people and an older average age than almost any other state.  Though not all seniors are disabled, depressed or unhappy, many are, which might also feed into the reported statistics.  West Virginia's life expectancy is not high, so part of the reason for the older average age here must be that many young people leave the state.  There is a perceived lack of economic opportunity and social life for young West Virginians graduating from high school and college, and many do leave for perceived greener pastures elsewhere.  But whether they actually find these greener pastures or are happier/less miserable there, who knows?  

So the Gallup survey begs the question — would the "miserable" people in West Virginia (or Mississippi) be less miserable if they moved somewhere else?  An interesting study would measure the success, health and happiness of native West Virginians who stay here versus those who move to other states!  But of course those who move do so precisely because they are unsatisfied here and optimistic and mobile enough and having enough education and vocational skills to travel and prosper elsewhere.  And those who stay behind might be the most unmotivated, miserable people to begin with, who might be miserable anywhere they were!  So any such study would be biased and hard to interpret.

Finally as one of the few geriatricians in the area I must also observe that there are still not as many social, mental health and medical services for the elderly available here as there should be, and this problem will only get worse with the shaky economy, government cutbacks and the aging population.

But overall, in summary, in my opinion, the Gallup survey is interesting but statistical rubbish.  We all know that almost any point can be supported by statistics, and the idea that Charleston or West Virginia is any more "miserable" than anywhere else simply fits into old stereotypes and sensationalistic journalism.  Not that there aren't many miserable individuals and many opportunities for improvement here as in every city and state, but I don't believe for one minute that Charleston specifically is truly overall more "miserable" than most other places.  What you consider a "better place" depends on your circumstances and what you like and value — but my analysis convinces me that Charleston is a better place in a lot of ways than many other cities and towns in America.  And don't get me started on the fact that most Americans, even during hard times, are still much better off in many ways than 99 percent of the people in the rest of the world.  So try to be positive and not to live up to that "miserable" image, Charlestonians!

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