Freud was right. “Love and work are the two things you have to do in life.” And great wealth often undermines both.

My first practice here in Williamsburg focused on the uninsured. I typically charged anywhere from $100 to $150 for a house call. It was a lot for some people, but so are my $4995 a month medical school loans. Inevitably, I had many patients who were also very wealthy and simply paid me for the convenience of not having to go see a doctor. I took a lot of criticism from both doctors and the general public because many people looked at my practice as a concierge for rich people, the “worried well.” The argument is that if you’re wealthy, you can just buy health and happiness. And if you’re poor, everything is a struggle, especially health and happiness. So health should be something that both doctors and society enable, free of charge, to the poor.

I will always feel that health and happiness are two of the most complicated and sought after accomplishments in this world, and both, rich and poor, struggle significantly to attain them. Of course, food can be a challenge to the very poor, but mental health and anxiety can be the biggest challenge facing the ultra-rich. Which one is worse?

  • a tormented mind with plenty of food or 
  • just enough food but somehow you’ve figured out how to stop worrying and enjoy your life

My definition of health is the combination of optimizing seven areas: body, mind, relationships, money, work, environment, and serendipity.

This article in The Atlantic, Secret Fears of the Super Rich, was one of the more interesting reads I’ve come across lately. A group at Boston College has been studying the super wealthy for the past forty years, and of course, they’ve found that being rich isn’t easy:

“SOMETIMES I THINK that the only people in this country who worry more about money than the poor are the very wealthy,” Kenny says. “They worry about losing it, they worry about how it’s invested, they worry about the effect it’s going to have. And as the zeroes increase, the dilemmas get bigger.”

Typically, he says, an inheritor’s angst arrives in early adolescence, and it blossoms when she arrives at college and, in a group of peers unaware of her wealth, discovers what it’s like to be treated as a “normal” person. She may keep her wealth hidden for a while, until at some point she’s outed and her friends suddenly look at her differently. In some cases, an inheritor isn’t even fully aware of how wealthy she is. “She might be 21,” Kenny says, “and one day her trust officer sits her down and says, ‘Here’s how it’s going to work. You’re going to get this many millions today, and this many millions when you turn 30.’ Then she’ll have to go back to college, and she’ll have to face her friends and her life as a wealthy person.” Often, Kenny says, she’ll then spend some time—in the worst cases, the rest of her natural life—“drifting,” without a career or purpose…

One issue that Kenny says comes up frequently is the question of at what point in a relationship to reveal one’s wealth—a disclosure he makes sound as fraught as telling your date you have herpes. “When do you tell someone that you have got a huge amount of money?” he asks rhetorically. “If you tell them too soon, you are going to worry that they want you for your money. If you wait too long, can the person really trust you?