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It's definitely the latter. They got dealt some shitty things in life and there's not much to be done about some of these things. I don't think I could ever tell them that it bothers me. They really don't overburden me or do it incessantly or anything. I'm just not good at being a friend about it.
I don't mean that my life is worthless. However, objectively, some people's lives are worth more than others. Whose life is worth more? A heart surgeon or a serial killer? A 99 year old man who has already lived his life or a 25 year old father supporting 3 children? If you could only save one or the other in any of these scenarios, I know who everyone would pick.
Sure, most of the time it's not an overly obvious line like that. But objectively, my life is far less important than the people I am talking about in the OP. It's just a fact of life. And I both care about these people and recognize this. If I were talking about others in my life, the line would not necessarily be as clear. I don't think it makes me mentally ill for recognizing this.
However, I will say I looked into therapy somewhat recently and was amazed at how expensive it was. $200 per session after insurance. No idea how people afford it.