What to Say To Someone Who is Sick | Hacker News Reader

What to Say To Someone Who is Sick

nytimes.com

234 pointsstartupstella87 comments

I'd add "Everything happens for a reason" to the "nevers" list. My mother has leukemia, and her cousin said that to her.

I hope your cousin got slapped! My goodness!

http://ycombinator.com/newsguidelines.html

Seriously +10000.

When my brother died, people would say that a lot to me. It's extremely common in my culture (Mormonism) and I even believe it, but that's something that you need to say to yourself, and not have others say to you. When other people say it to you, it's like someone punched you in the face with what you should believe, and it's not comforting, nor does it feel good in any respect.

Sorry for your loss. It's interesting that it is a worldview adopted by many Christian groups, since for example, the book of Job from the bible is basically on this topic: to simplify, Job becomes sick, friends come and say everything happens with a reason, Job says that's bullshit, God rewards him for it. This is of course my somewhat personal reading of it, so it might be a serious misinterpretation.

Not quite. He's rewarded for not cursing God.

Choose your source...some one argue one is more accurate than the other:

http://en.wikipedia.org/wiki/Job_%28biblical_figure%29 http://www.biblegateway.com/passage/?search=Job+1&versio...

There are several treaties on the nature of faith in rabbinic law. The case of Job is often exemplified as a case of "true" faith as opposed to faith not for faith sake.

The true faith, does not seek reward for good behavior, nor bothers trying to understand the divine will, it simply accepts the Yoke of the heavens. in the case of Job.

He does not ponder the reason, it is all the same to him "...the Lord gave, and the Lord hath taken away..."

I read Job as a story about God settling a bet with Satan, by allowing him to torture the most righteous man he could find to see if he would break - killing his wives, his children, causing him agony and taking away everything he loves. When he doesn't break God shows how generous he is by giving him new wealth, wives and children.

If there is a God, this is a compelling example of the value he places on human life.

I never say that as it doesn't seem right to me. What good reason could God have for the loss of a good man or child that is without sin?

If you're a Christian however, you do have a small comfort that death may only be the beginning. And that's really what Christians should hear - that the loved one is in a better place.

And yes I know, that sucks too as how could you really know that she's in a better place? But I experienced this myself and it sticks in the back of your subconscious, eventually giving you comfort.

It's not that I don't realize he's in a better place, as nerdy as it sounds, I guess I'm all about optimizing short term happiness. I realize that eventually, the knowledge of seeing him again someday is amazing, but in the immediate term, it's not really worthwhile.

It'd be a bit like getting a limb amputated. You know that it's going to be for your benefit, but while you're going through it, I doubt the comfort of "oh it's ok, at least your not dead!" doesn't exactly optimize your happiness. I'd wager if you're there for someone, showing your love and support, gossiping, etc., you'd likely do more good.

As an atheist I would be seriously upset if someone said that to me while I was sick or after losing someone.

However, if you really believe it in your heart of hearts, then shouldn't it be comforting? Similar to 'they're in a better place now' -- it seems like if both people believe it's true, then it should be comforting to talk about.

For me, I honestly can't see how that's supposed to comfort you. They're gone from you now. It doesn't fucking matter if you're going to see them again, because the hurt is all about the actual data that you currently have. I can't wait to see my family again, but I still cry about them on a monthly basis, if not more.

Maybe I'm a more "thinking" guy than other religious types, but for me, religion is about understanding who I am now, how to deal with life now, how to treat people better now, etc. It's not about some mysterious heaven / hell thing that scares you into being a good person. Religion for me is separated from mythology, though they do play into each other. (IE the nuts and bolts of how a religion comes into being are important, but the teachings and purpose of said religion are much more important.)

Given that perspective, with a catastrophic event, "now" will always suck, without exception. You have to work through now in various ways. The new reality is what you need help with, not perceiving the person in some sort of blissful future state.

That's why things like "I love you", etc., play so much better for me. I need a shoulder to cry on when I dream about my brother as if he's still fine and was hiding. I need people to help support me through hard times, not people to deflect reality and pretend like it's all going to be ok.

</rant>

I feel ya bro. I think other religious people often don't grasp as well the fact that we're not robots -- emotions ask for comfort, not to be rationalized away. Which is funny because people often think of religious people as emotional.

It's not that people saying dumb things are rational in any way, but more about people feeling the need to say something, anything to make it better and it kind of is an uncontrollable urge.

Think about this, even as a theist you feel the need to ask yourself, why did your mother/brother/child had to die while others are still living, an irrational question by all means, that begets dumb answers; but it's part of a healthy mourning process and does help you get over it (IMHO).

I also don't think it's about religious people versus the others, as people say dumb things regardless of their beliefs.

I think this is a time in which it pays off to be religious. For instance, I do fall into agnosticism and question my religion quite frequently, but I just can't be an atheist simply because I cannot accept that the people I love (including my child for whom I'm capable to give my life if needed) will one day go into non-existence, sometimes painfully. That's an idea I just can't live with.

My mother believes in God but she reacted quite negatively to it. To her it seemed as if her cousin was telling her that God was punishing her.

Perhaps the most irritating aspect of the phrase "everything happens for a reason" is that it is a truism from a scientific point of view. Of course, everything happens for a reason. But the phrase is usually meant to imply that a higher power has a reason for causing events, and that there is a reason in a cosmic sense for events to happen, as if they were part of a larger plan designed specifically for you, the victim.

The other variation would be that "God has a plan", which is ironic since, philosophically speaking if there is a God, it is impossible to know how He thinks or acts. Even answering if this statement is true or false would mean that we are Gods ourselves.

The correct version would be "God works in mysterious ways".

Also, "everything happens for a reason" is a truism in the sense that every action has a reaction, but otherwise if you replace "reason" with "purpose" it fails the falsifiability test.

> Perhaps the most irritating aspect of the phrase "everything happens for a reason" > is that it is a truism from a scientific point of view

I see where you're going (and you're responding directly to the stated pointless platitude), but I'd inject here consideration about using "reason" vs using "cause"; more specifically, "reason" suggests to me something intended, whereas "cause" says that something happened that led to this happened, personal intents aside. </twocents>

It's classic human behavior to look for some cause of whatever is happening. Sometimes it's to transfer the blame (smoking your whole life and lung cancer is somehow not your fault) and other times it's simply looking for any explanation because we as humans want explanations (it's gods plan, everything happens for a reason, etc...).

"Everything happens for a reason" is about teleology, not etiology. When people say so, they're implying a goal, not a cause.

It depends on who is saying this to whom. Some who are sick will say this about themselves.

Also, you can adjust this saying to "Everything happens for a reason, right?" As to show you are equally as hopeful that there may be something greater at play.

But I agree mostly. Just coming up to someone who is very sick and saying this can be the WRONG thing to say.

Objectively speaking, this is true, there is a reason why something happened. Weak immune system, unhealthy life stile, genetic disease, wrong place at the wrong time, exposed to toxic chemicals/environment, aging, the body has to fail eventually and is just a matter of what goes first depending on many variables I mentioned above. However, to imply that it happened because it was destined to happen no matter what, I don't think so.

"It is as it is" is a better way to say that there is no fucking reason...

The Zen/Tolle approach always sounded better to me, but can anyone really say or do anything that will make the sick one feel better for more than a couple of minutes?

In the past eight months my father's had bowel cancer (surgery worked: currently in remission) and my wife had uterine cancer (surgery worked: hopefully a complete cure). And the cat went blind.

Anyone saying "everything happens for a reason" to me would probably wind up with a black eye. (At the very least, they'd go on my personal do-not-call list.)

Which is to say: you shouldn't say things to immediate relatives that you shouldn't say to the patient, either.

Like you, I had three "issues" (deaths in my case) close in time. I get a lot of "Well, you know, things happen in threes." The last time someone said this to me (yesterday, in fact) I replied, "Yes, I know. When I count them, I start over every time I get to three. Things always happen in threes."

Went right over her head.

We all know things really happen in primes. It's numerology you can believe in.

Black eyes happen for a reason, though.

While definitely not cancer, I had severe acne back in high school (way, way more than most people). There was a never-ending series of half-baked miracle cures chucked my way by strangers.

In this age of the internet, anyone who has an illness is probably more of an expert on it than most doctors are (save their specialists).

I was diagnosed with an inflammatory bowel disease and everyone would constantly tell me all these foods and supplements that would cure my illness.

I had to constantly tell them there were numerous studies showing that diet had no effect on the illness. But they ignored that because "it cured they're friend".

Anecdote is the trump card of the unsceptical. It's a good way of learning not to eat that poison berry, but it's much less useful in the modern world.

The Wikipedia article on ulcerative colitis mentions diet as both a possible cause and treatment, which might add to their confusion. Maybe you could clean up and clarify that section with the studies you know about. Maybe distinguish treatments from cures.

http://en.wikipedia.org/wiki/Treatment_of_ulcerative_colitis...

From the wikipedia page:

"Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors."

Lets go through the three points listed:

> Lactose intolerance

This is common in people with colitis (I have this).

Not drinking milk makes the lactose intolerance symptoms go away (nasuea/vomitting) that but does not reduce the actual colitis symptoms, just the lactose intolerance symptoms.

> Patients with abdominal cramping or diarrhea should avoid fresh fruit, etc"

This is recommended during bad spouts to reduce the extremity. Eating these foods does not cause or make a colitis flare ups go away. It makes makes one of the symptoms slightly easier to deal with.

> The Specific Carbohydrate Diet has been promoted as helping with the symptoms of various auto-immune and gastrointestinal problems

"Following the death of Dr Haas in 1964, there have been no controlled studies published of the SCD related to IBD." The last study being in 1928.

I've also spoken to two nutritionists and three doctors who have spent their careers studying IBD and they reiterated that food is not a significant factor in treating colitis.

The thing is, with diseases such as yours or others that are hard to find the cause and/or cure/treat you have to become your own doctor. First, realize when people offer up suggestions they are trying to help you. Second, while 3 doctors may have spent their career studying something it doesn't mean that a specific diet or treatment will not help you.

A friend of mine has hives. He's seen a ton of doctors and none of them have any clue what is causing them. Other than having a few hives almost all the time he's perfectly healthy. So he has had to become his own doctor and at least attempt a process of elimination with foods and other things that he comes into contact with on a regular basis. At a minimum he gets some illusion of control and is working a process that may find something.

I agree that they might have been just been trying to help, but it's important accept that you might have limited knowledge of something when giving people advice, especially medical advice.

My doctor has prescribed medication that has done a good job of treating the illness so I haven't had to seek alternative remedies.

I'm actually starting a new startup centered around patients sharing their experience with various treatments.

I'm actually starting a new startup centered around patients sharing their experience with various treatments.

That's a great idea! After helping my friend research I think the most challenging part of what you're doing is getting people who are cured to talk about their experiences. It's the old problem that those that are happy without any problems are not the ones who post all day long :)

I understand that you know a lot about your condition, but weren't you discussing the layman's perception of it? Maybe I misunderstood.

What I'm saying is the first thing someone is going to do when he wants to learn about ulcerative colitis is visit the Wikipedia article. I'm offering this as a reason for the misconceptions, not as refutation of what you claim to be true.

The issue was the arrogance it took to tell someone they know of a cure from a 3rd party story, then insisting they are right without even having a basic understanding of the illness.

A basic google search would show is no known "cure" for colitis. Doctors don't even know much about what causes it.

It's fine if they misunderstood a wikipedia article, but that level of research wasn't even done.

Back in april, The Awl published a list of don'ts[1] and then last week, some dos[2], many of which conveniently appeared in this nyt piece.

[1]: http://www.theawl.com/2011/04/some-awesome-things-to-say-to-... [2]: http://www.theawl.com/2011/06/actually-awesome-things-to-say...

Comparing the two, I'm inclined to go with coincidence.

If you have the time, offer the person taking care of the sick person to take over the taking care for a few hours or days.

I took care of my mother when she was sick and none of my 3 older brothers offered to take over the duty of caring for her. It was like my home was the hospital for 3 months and not even one of them offered to take care of her for one night. I developed this deep bitter feeling towards them during that time.

I understand if they have things to take care of but not even 1 night?! It still pisses me off thinking back. For all I care, all of her children have an equal responsibility to take care of her. It was like I had to put my life on hold so that they can continue living their lives like nothing's happening.

You did the right thing and that's all that matters. There's no reason to hold this above their heads, because it will hover up there anyway without you ever having to say or do anything. If I were you, I'd just keep it to myself forever and let everyone know within themselves that I did the right thing because you can be pretty certain that they already know they didn't.

That sounds really frustrating. Have you asked them why they didn't offer, in a non-accusatory way that won't put them immediately on the defensive? They may feel guilty and too ashamed to speak of it now. I can imagine the last thing you want to do is go over this experience with them, but the fact remains that you all hold a shared experience with your mother and there's still the chance to connect with them over that, and honor her memory that way.

Sorry, I don't mean to be presumptuous; I just think this kind of thing is so rarely discussed until you're in the middle of it.

I'm sorry but the writer comes off as being bitter. I'm pretty sure he doesn't come off in the same complaining tone when he speaks to people (or he wouldn't have as many people who'd care to bug him).

If people say or do awkward things, appreciate the fact that they made the effort at all. If they're sending you "miracle cure" suggestions, it's probably because they care enough to do so. These times are times in which you see how your life affects others. If there are a lot of people calling, checking in or being a little annoying, take solace in knowing your life has had an effect on all these people, who care enough to be kind/awkward. I'd much rather have that than not have it.

These Do's and Don'ts aren't for everyone, it may be for the writer, but it's presumptuous to think this really applies to all people.

Simply put, "Do" show up. Knowing that you're there when you could be elsewhere says a lot. Be a friend in times of need.

The point of the article was not to admonish people for their counter-productive efforts, but to answer the question "What should and shouldn't you say to someone whose sick?".

To his list of things NOT to say I would add your sentence "If people say or do awkward things, appreciate the fact that they made the effort at all."

Well, no. I'm sick! Why should I "appreciate" your "efforts" if they do nothing but add to my misery and pain.

Much - not all - of this boils down to the simple rule of being real with someone. Don't flood them with niceties, if you want to be nice and have something you want to say... say it. If you have to THINK too hard about what you want to say, then perhaps you shouldn't say anything.

Honestly, I wish this would be applied in everyday conversation more often, it would give people practice. I loathe small talk and would rather say nothing than talk about the weather.

amen. what i like about this article so much is how real it is...the writing is raw, honest, and speaks to you

Agreed. "I wish I knew what to say" is perfectly appropriate when it's true ... it also lets the other person set the tone of the discussion.

Consider that small talk can simply be a token gesture of openness to someone, a chance to engage them and try to take the conversation to a more interesting place. Few people can't jump straight to deep topics all the time and the people who do can be annoying.

I personally feel the same way the author does, but I suspect the people who love handing out platitudes and ditzy suggestions might thrive on receiving them, too. Do they suddenly get "real" and "grounded" just because they have a serious illness, or do they remain the same sappy and naive person they were before they got sick?

Everyone is different. Take the advice just as things to think about.

I know people who have been through hardship and they actually tell people to hang around, to just talk, say anything. They prefer people say something to not saying anything at all.

Some great points here but just because this applied to this guy doesn't mean every point is a catch-all for sick people.

2. I SHOULD BE GOING NOW. You’ll never go wrong by uttering these five words while visiting someone who’s sick.

I spent 11 months in hospital after a spinal cord injury and every time, I hated when my mates were about to leave. Having visitors can be the only form of escapism.

Also, "You look great". Maybe you do? I get this a lot. People say it behind my back too, i.e. "Hey I saw him the other day he's looking great", which feels awesome because in my mind I look like shit.

If your the trusted advisor-type of the family (brother / sister, best friend), make sure the business affairs are taken care of. Sometime the spouse is too far gone (male or female) or just not experienced enough to deal. It will help what comes next if the paperwork doesn't drift.

My favorite thing to say to someone who is sick is anything unrelated to their illness. It's the same when a friend loses their parent or anyone close to them. Once I get past the obligatory "let me know if I can do anything" I want to be the friend they can talk about football, food, TV shows, whatever with. They have plenty of people to talk to about their illness or loss. They don't have many people that will let them leave that behind for an hour or two and think about something different.

In your mind, please change "someone who is sick" to "someone who is sick or struggling"

The API for humans never changes but the spec is never complete. That's why this kind of item is helpful.

I would definitely recommend people check out the author's memoir on his cancer diagnosis : http://www.amazon.com/Council-Dads-Daughters-Illness-ebook/d...

Please never ask, "Do you mind if I pray for you?" I can't tell you how offensive I find that, and how difficult I find to answer it without being offensive in return.

"I'll pray for you" is okay, I guess, but don't expect a thank-you.

Or you could take it in the spirit in which it is intended, instead of making it about your personal ideologies.

In plainer terms: you could choose not to be an asshole and take a kind word for what it is.

I find it presumptuous.

People expressing that they care in a way that, to them, makes sense is "presumptuous"?

Again: you can choose to accept kindness in the spirit in which it was intended, or you can be the Angry Atheist Asshole. The latter seems to be poor form.

Thank you for confirming my views. Best wishes.

I wrestle with such things. I am not religious -- I actually have a fair amount of baggage about religion but I try not to be an asshole about it (and, no, I am not suggesting you are being one -- I just know how contemptuous I can be). I have known way too many religious folks who seemed to be doing their darnedest to give religion a bad name, but I don't think it is fair or nice to then assume that all religious folks are of that ilk. I prefer it when someone is trying to respect my boundaries and not cram their beliefs down my throat, so I think I would be inclined to view the question as an attempt to respect my boundaries, yet would not be entirely comfortable with it either because "agreeing" to have them pray for me makes me partly responsible for their action when I don't really believe in it.

I currently live in The Bible Belt and I find that saying "bless you" or something similar when turning down favors is the best way to get rid of someone. IE I try to speak their language, even though when I use the word "god" in regards to my own beliefs, I am just using it as short-hand for "whatever intelligence there is behind the workings of the universe". That happens to be a mouthful and problematic in most social settings, so I often settle for "god" as a means to facilitate communication. In most cases, they aren't going to talk to me enough to ever have any real idea of what I believe so I don't see any reason to get all hung up about it. Still, I continue to wrestle with how to respect someone's beliefs and their good intentions towards me when there is often a vast gulf between our beliefs.

I don't have a good answer, just similar discomfort.

If you can (and have a close relation to the sick person), offer frequent but short visits.

Hospital and recovery at home are boring, but long visits are often exhausting.

Yes.

I came down with chronic fatigue syndrome / chronic mono after a second mono flareup in late 2009. It's not cancer, but it's nasty and it doesn't go away, and I have good days where I seem and feel normal, and bad days where I don't even have the brainpower to watch stupid TV. It blows.

To this list, I'd add: Be willing to be the one doing all the work necessary to keep the relationship alive when the other person is too weak and tired.

So many of my "friends" here in Vienna just disappeared when I got sick, because they weren't willing to put in the effort when I couldn't. There's nothing quite like being too sick to leave the apartment, and ALSO having nobody who cares enough to visit you.

I'm sure if I told them this, they'd be absolutely aghast at their own behavior and try to make amends -- they are not bad people or even bad friends -- but now, knowing what I know, I wonder if it would be worth it for me to say something.

Yet another big reason I'm moving back to the US.

I'm from Austria and I mention this solely because you felt the need to mention your location. Still please take this as an opinion of one guy alone (!):

Here is what I think: Friendships are always give+take. When you are sick, you expect them to give a lot. Did you really do so much for them while you were healthy? Because in my opinion only a sociopath wouldn't offer to help you if you had helped him greatly in the past. Or do you rather expect them to help you because it's just what they "should" do. And what exactly do you want them to do anyway? Just mindless visits? So you expect pity? Are you in a habit of forcing your friends through awkardness? Because I'd expect my friends to not expect me to visit them for elusive reasons like "emotional support". I would never expect a friend to visit me when I'm sick, because I know that I'll be another person. They are not friends with a guy who has pains, drools and is in agony. I wouldn't think of demanding friendship like you do.

Compassion is virtuous. Visiting the sick is one of the most value-creating activities a person can do. Someone who has never been sick without parents to care for him might not notice, but once one has the experience, one can appreciate it and pay the debt back (or forward).

First of all, it's not up to you to define compassion for others. Neither is virtue. Secondly compassion, virtue...all that has no inherent value other than the value you decide to give it. Thirdly, did you ever question your own behaviour? I don't agree that visiting the sick has any positive purpose at all. What exactly does a visit do? You could argue that a slight improvement in mental wellbeing may or may not happen and it may or may not speed up recovery. So you would call that slight possibility a "most value-creating activity a person can do"? I sure hope not.

A person doesn't get better from a visit, they get better by being left alone with medicine.

Your view on society is adorable, but remember that it has no roots in reality.

> A person doesn't get better from a visit, they get better by being left alone with medicine.

A possible rephrasing of the sentence above would be that, putting someone suffering from a protracted disease into a solitary confinement with medicine is the path to betterment. I don't think it works that way. There is a reason why even otherwise healthy person are not held in solitary confinement unless as an act of (sometimes disguised) punishment.

You mentioned that emotional health is an elusive concept. It is not, it can be measured, and the measure stands up to a quality that is acceptable to the disciplines of empirical sciences. I think your hesitation to acknowledge it, stems from the fact that it can be defined significantly by the person/patient, while that is true, it does not make it elusive. Many people can voluntarily control waves emitted by the brain. The fact, that brain signals can be so controlled, does not make epilepsy a fictitious condition.

>Depending on others to feel good is not the sign of a mentally healthy person.

EDIT: Responding here to prevent deeply nested threads. By your standards most humans would be unhealthy. The need for social interaction is well documented, and not only among humans. I am an introvert so I get by fine with a level of interaction low enough that it might bother someone else, but that does not mean that those who need it are unhealthy. There is a full spectrum and both extremes are considered deviant.

>I thought it was apparent that social interaction shouldn't be necessary to get better.

EDIT2: I think that's the crux of the argument/disagreement. Social interaction has been deemed a necessity to well being. Can someone not recover from a disease without interaction, sure some can if it can be cured in a short enough duration, no otherwise. Does everybody need the social interaction to get better (stay well)? No, a percentage can do without it. In fact some spiritual school of thought see that to be the ultimate and difficult to attain target frame of mind.

Your emotional state is yours to control and change. Depending on others to feel good is not the sign of a mentally healthy person.

Editing aswell: I'm sorry, I should have been clearer but it's quite lengthy to always be precise and include the necessary disclaimers: Of course everything has its limitations. Humans are social beings, so we like social interactions. During the limited time of sickness, I thought it was apparent that social interaction shouldn't be necessary to get better.

Example: I think it's possible to feel good when doing a walk alone in the park. I think it's possible to feel good when being alone sick. Suffering is often a distinct choice: Do I pity myself for standing in the rain or do I love the feel of fresh, wet water?

Edit2:

   Can someone not recover from a disease without   interaction, sure you can if it can be cured in a short duration, no otherwise

I think you are giving humans too little credit. Social interaction is very important, but it's quite possible to live alone. People don't actually go mad when you leave them alone - given that they are adults and they have sufficient other sensory and mental stimulation. People get used to a lot.

Example: Someone living completely alone at home, getting his meals delivered because he is too fat to leave. I'm not saying his life is awesome, but if he gets sick, there is no reason his recovery should in any way be significantly slower than the one of social people.

It's all a matter of getting used to things, self pity is usually the only culprit of an unhappy life.

"limited time of sickness?" We're not talking about a cold here, amigo. We're talking serious illness like cancer. It may very well last years, or even take the person's life eventually.

It's certainly possible to live alone, but honestly, would you want to? How would you feel if Hacker News spamblocked you, so that nobody ever responded to your posts? How would you feel if that extended to every single aspect of your life, such that not a single person ever acknowledged your existence?

(Side note: a friend and I tried this on my sister when we were 8 and she was 7. She was being a nosy tag-along in the way that little sisters often are, and so we just literally pretended that she didn't exist. She was in tears within an hour, and my mom told us to either acknowledge her existence or my friend was going home.)

Just because healthy people can be alone doesn't mean they should. Over long periods of time, it causes marked social atrophy and can become really difficult to rejoin society.

Science proves you wrong, of course. Visits with people and animals speed recovery. Friendly doctors have a better recovery rate. People without tightknit social networks are vastly more likely to die immediately after a spouse, than those with. Men married to American black women, for example, have the best survival rate after being widowed, due to their wives' tightknit social networks.

Why on earth would you claim otherwise? What basis do you have?

A sense of empathy with my friend's suffering would compel me to visit them. It's not part of a quid pro quo transaction.

Look, I'm a "hobby philosopher", so I hope you'll forgive me when I say that you are wrong. Does your sense of empathy extend to random people on the street? 'Yeah, sometimes' you say. Okay, but it has bounds right? You don't help every single guy with all your power. So what are these bounds? They are the result of give+take, which you can call "quid pro quo" transaction or not, however way you feel most comfortable.

It could also be a result of habit through upbringing. Or cultural pressure. Or perhaps a faulty sense of reasoning. As a hobbiest philosopher you should know the dangers of sticking to one line of reasoning slavishly.

Yes, upbringing and cultural pressure move the boundaries but the underlying rules are the same: No person would tolerate always giving for long.

I only answer as another "hobby philosopher", so please take it in that spirit :) I would argue that just by the fact that you know someone, and know them to be a "decent" person, you'd feel empathy (depending on your personality type also). Part of the reason you don't go "all out" for everyone, is because thankfully you don't "know" everyone.

I really think boiling it down to a simple "give-take" relationship is oversimplifying the dynamics. It goes far beyond that.

A person may visit someone who is sick out of religious convictions, or because being generous makes them feel good, same reason you have many people who volunteer or help push someone's stalled car on the road. Others may be do so to simply pay it forward, maybe to help cultivate a relationship, or with unspoken expectations of the favor being returned had the tables been turned. Yet, others might just be doing it because they have something to gain from the sick/dying person or somehow feel bound/compelled to do so... I personally would value visiting a friend who it sick and does not have a lot of family/friends to care for them vs one who has a lot of people to care for them, I'd probably leave the latter alone until they recover, or contact a close family member to avail myself should the need arise.

Oh yes, life is not so easy! Analogy: If my doctor told me that the human body is easy to understand, I'd look for the door :)

For sake of getting anywhere in an argument, I try to abstract things down a lot but at the same time keeping them valid for discussion. I felt that the addition of things like cultural bias would only detract from the message that everything boils down to give+take, (and pertaining to this particular discussing: that friends only go so far until there is nothing to take anymore.)

Why? Because cultural bias, upbringing and personal choice are things that merely move the give+take 'thresholds'. What I mean, is that you'll still get something out of everything you do. In my opinion, people always act in their own interest, even though their interest may largely be in favor of others.

An extreme example to illustrate the point that everything is give+take: Take for example Warren Buffet donating billions of dollars: You could say that this has hardly any "take" for him. But why do it if there was no take at all for him? I mean no take at all. Not even a passing feeling of pride or accomplishment. You will see that, yes of course, he will have some kind of reward for donating these immense amounts of money. There is always a take :)

Lots of people are nice to others because they enjoy being a good person. I know my American friends would have been over, cooking me meals and making sure I didn't go stircrazy, and trying to cheer me up. I know because I've experienced it. They volunteered to be up at crazy hours so I could text them when I was having surgery and feeling bad... in Austria. They sent me funny pictures and videos, even physical goodies, to cheer me up from over the ocean. I've had American friends volunteer to take me to the emergency room at midnight on a work night, and stay with me the whole time, even though it was 5am and clear I was not in any danger and I told them they should leave. And then two other friends pretended to be angry that I didn't call THEM in the middle of the night to let them know what was going on. I said, "You'd really want me to wake you up?" and they said "YES!"

Why? Because they love me and they're good people. I love them, too.

Austrians make terrible friends, in my experience, because they think like you.

They are so terrified of "losing" something by being connected to people -- so absolutely horrified at the idea that they might be "taken advantage of" -- they they shut themselves down and make no serious connections at all, living a life with only fairweather friends and no one they can truly trust to stand by them.

It's really incredibly sad.

You truly learned nothing from this exchange. These are simply two different cultures and you grew up in yours, and therefore you think only yours is valid. How mature is that?

Likewise I could claim Americans are terrible friends, because they get upset about the tiniest things, are constantly in your face, wasting time with trivialities and use laughter inflationary as a social tool instead of its actual meaning.

But I don't, because that would be childish. Instead I view them as quirky, lively people who embrace the whole world as their home (in a positively, naive way) Your implicit claim that Austria is 'worse' than America is merely a kneejerk reaction to a different culture. You are even equating your personal definition of "nice" with being a good person, insinuating Austrians aren't good people.

Grow up, different people are different.

The reason you don't go "all out" for everyone (or at least the reason I don't go "all out" for everyone) is that you have finite resources and time. There're lots of people that I wish I was a better friend to, but there're only so many hours in a week, and I already have a fairly active social life and a demanding job, and so time and mental energy spent keeping up with them is time that's diverted from keeping up with other people.

It's the same reason that fewer people are willing to take on more "demanding" friendships. That time spent caring for a sick friend is time that can't be spent hanging out with other friends. Some people will do it anyway, either out of a sense of duty or because that particular friendship meant a lot to them before their friend got sick. But we don't often see these people, because all the energy they invest in their sick friend is energy not being spent hanging out with us.

If my friend is sick for a week, sure. If they're sick chronically, for months at a time, the game changes.

"I'd expect my friends to not expect me to visit them for elusive reasons like "emotional support". I would never expect a friend to visit me when I'm sick, because I know that I'll be another person."

And that right there is exactly why Americans make such better friends than Austrians.

There is a huge cultural difference and I honestly am not surprised that the depression and suicide statistics are so much higher in Austria -- a rich land where a person's basic needs will always be assured -- than in the US.

Unless you said something like "I'd love to see you, but I don't have the energy to go out or make big plans", they might have thought the reason you weren't making plans with them was that you didn't want to see them.

An adage I really like is "never attribute to malice what can be equally well explained by stupidity". And then, never attribute to stupidity what can be equally well explained by miscommunication. They probably had no idea that what you needed was for people to put in that effort - they may have thought "well, she hasn't made plans with us, maybe she's bored with us?" They may have just not wanted to bother you.

I don't live in Austria, but I live in Germany, which I suppose has a similar property. Notice how in restaurants, the servers don't bother you unless you get their attention, while in America they're constantly hovering and asking "how is everything? everything fine?" I think Germans in general treat people's personal space as more sacrosanct, while Americans are very... attentive, maybe? The negative way would be to say Germans are aloof and Americans are nosey. Or maybe Germans are askers and Americans are guessers?

Either way, I think you're probably being too harsh on your Austrian friends. They'd probably have been more than happy to be the ones to make the effort - if they knew that's what you needed. And, not being telepathic and with a bit of a culture gap, that one small piece of effort to mention it sort of... ends up being something only you can do.

That's possible, but I don't think it's true, based on the boring details of my situation.

And for the record, in my experience, Austrians are much less friendly than Germans -- or at least, Austrians who live in Vienna are much less friendly than Germans who live in Berlin. The friends I have in Berlin are quite different.

My experience: The friends you make when you are young are those who stick around. People you friend later in your life have a shorter half-life.

"And that right there is exactly why Americans make such better friends than Austrians."

I'm very surprised to read such a generalization about "the Austrians" from you, Amy.

Can't agree everything. Every patient is different, some wants to be discussed about their health and some wants a break from his preoccupied mind about health.

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