18 Jun Wealth & Mental Health: Assimilating an identity of wealth into a health self concept.
Integrating our identities into a healthy self-concept is central to our mental health and relational well-being.
This can be challenging for patients of wealth due to the dissonance between how they view themselves and how they are viewed by others.
In the following article, published June 16, 2025, I discuss how clinicians who work with patients of wealth can help them accommodate and assimilate their identities into a healthy self-concept in the context of a mental health disorder.
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Introduction
“I’m terrified of becoming a donkey,” lamented one of my patients with whom I was working. The patient, a 53-year-old man who sold his tech firm for two hundred million Euros, was referred to me by his financial advisor to deal with a treatment-resistant depression that became debilitating in the wake of his liquidity event*.
While placing his donkey reference took me a minute, I finally got it and smiled. His metaphor was brilliant and highly relevant to our work.
For those who can’t place it, the donkey reference comes from the 1940 Disney classic Pinocchio. It refers to the dehumanization and corruption that occur when people succumb to an aimless life of pleasure and hedonistic indulgence on a place called Pleasure Island.
As the story goes, boys who visit Pleasure Island are seduced by the promise of endless fun, freedom from rules, and the ability to indulge in destructive behaviours such as smoking, drinking, and lawlessness. In the process, they are transformed into donkeys, serving as a punishment and a warning that irresponsibility and laziness lead to loss of freedom, self-respect, and relational decay.
Such fear is common among patients who struggle under the weight of a mental health issue in the context of an identity of wealth.
Like the patient referenced above, they are terrified their wealth will undermine their drive and result in their becoming negative clichés of the idle rich. In our contemporary culture, these include labels such as mean, narcissistic, entitled, lazy, and selfish.
While such fear is common even amongst the most well-adjusted individuals, when it occurs in the context of an issue related to one’s mental health, it can amplify a host of personal, relational, and systemic pathologies.
Avoiding the phenomenon
In working with patients of wealth (PoW) struggling with the Pleasure Island Syndrome, I apply a six-step clinical formulation that enables them to accommodate and assimilate their identity as a person of wealth into a consistent and healthy self-concept
Such formulation grounds the work in the science surrounding issues relating to my PoW’s mental health and delivers culturally competent care in an empirically based and humanistic psychotherapeutic frame.
Specifically, the clinical formulation follows a six-step protocol that consists of:
- Technique-grounded psychotherapies such as Cognitive Behavioural Therapy.
- Psychopharmacological interventions as medically indicated.
- Behavioural modifications.
- Nutritional interventions.
- Interpersonal, systemic therapies such as those found in marriage and family therapy and social work.
- Exploring identity through existential philosophies to assimilate and accommodate it into a cohesive and healthy personal narrative.
Regardless of the technique used, successful clinical outcomes in each step depend on the trust the clinician has earned with the PoW.
In this regard, the PoW needs to feel the clinician genuinely wants them to heal and sees them as human beings to understand rather than objects to manipulate.
Accommodation and assimilation
The constructs of accommodation and assimilation are grounded in the work of the Swiss psychologist Jean Piaget.
Accommodation involves integrating new information about the self into one’s existing mental framework. Assimilation entails seeing this new identity as consistent with and enhancing one’s self-concept rather than corrupting it.
As this applies to the PoW above, he, like most of us acculturated in a Western, capitalistic culture, had been taught that rich people were yet another class of ‘other’—objects of disdain and envy, void of humanness and unworthy of compassion.
He recognized that while he was considered rich on paper, in his heart and soul, he viewed himself as a member of the middle class who found meaning and joy in the striving for success. His liquidity event and his being labeled as an ultra-high-net-worth individual, however, conflicted with this identity as a member of the middle class and caused his depression to deepen to the point of despair and suicidal ideation.
In working through this conflict, we began by getting him the best-in-class psychiatric care to address his treatment-resistant depression. Once we found the proper medical interventions, we began assimilating his identity as a person of wealth into a personal narrative consistent with his admirable moral values and strong work ethic.
This process involved working interpersonally to expand his notion of a ‘good’ and productive person to include being a person of wealth.
While the client may have gotten there on his own, his mood disorders and the isolation he experienced in his new identity presented obstacles that are best overcome in the context of a structured, safe, empathic, and culturally humble psychotherapeutic frame.
In this regard, the work was slow going. He had moments of clarity, but also retreated into negative stereotypes about what he was taught people of wealth are supposed to be. Over the course of a year, however, we made great strides, first in giving him symptom relief for his debilitating mood disorders and then empowering him to accommodate his new identity as a person of wealth in healthy, constructive, and reparative ways.
Conclusion
Although we were warned of the dangers of succumbing to a life of hedonism on Pleasure Island nearly a century ago, its relevance remains. Unbridled hedonism can lead to dehumanization, despair, and decay.
For patients who’ve yet to assimilate and accommodate their identity as a person of wealth into their psyches in positive ways, the fear of becoming a ‘donkey’ can compromise their individual and relational functioning and inflame issues relating to their mental health through the dissonance between who they feel they are and who they are told they’ve become.
It’s important to note that mental health matters for everyone, everywhere, and can exist in an identity of wealth.
Central to this outcome is providing the PoW with the following core condition:
Regardless of their place on the socioeconomic spectrum, everyone needs to feel loved and valued for who they are rather than disdained for the labels of ‘other’ that have been given to them.
For those who live under an identity of wealth- and I hasten to add, poverty- achieving such a goal takes effort. Both identities carry highly charged, culturally condoned, negative stereotypes that diminish the humanness of those who live under them.
Clinicians who work with PoW can assist them in accommodating and assimilating their wealth as something that does not diminish but rather enhances their mental health and relational well-being. Central to this outcome is creating a safe, contained, and culturally humble frame that enables them to come forwa
rd with the fullness of their identities and mirror back to them their value as human beings striving towards increments of better for themselves, those they love, and the planet they are privileged to live on.
#mentalhealthmatters 4 everyone, everywhere.
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