The horrors persist, but so do i.
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I'm a big fan of this one, I started using it as a mantra when I got sick of "this too shall pass"
Monty Python also has a good response:

Sometimes I ignore the question and just move on in conversation. Most people don't even notice because they're asking out of habit, not to actually ask you how you're doing.
I do this sometimes. I've had people ask again where i tell them that I'll get there after i fonish my story, but then obviously never go there. lol
In German, we say "shitty would be bragging".
Beschissen wär geprahlt!
The one who can not cope with this answer should not ask!
I'm here is an answer. If you deflect you also get your point across.
Something similar. I Normally go with "I'm breathing" if I really don't want to answer honestly and saying "good thanks" feels like too much of a stretch lol.
I find most people kind of laugh the answer off and continue with conversation from there

Really though, it depends entirely on the person. With my partner I will try to give the most complete answer I can, with friends and coworkers it depends on how close our relationship is. With strangers it may be a completely perfunctory answer to a completely perfunctory question, especially if I'm not up for defending a non-perfunctory answer, but I like to keep my answers real when I have the spoons for it.
I find this question quite fascinating: Culturally, there are countries where this gets asked indeed as a form of greeting, not a genuine question.
In Slavic countries, I feel like if you get asked this question, it's generally considered to be of genuine interest, and you'll get a genuine reply. Nothing offensive or informal about saying "Things are bad." or "I feel bad.", or any variant of such.
This might be my perception however, and feel free to correct me. I myself think that if someone asks how I'm doing, I have no need or responsibility to "remain positive/pleasant".
Around here it's definitely more of a greeting. I wish it was more of a genuine interest because then I wouldn't feel so weird about answering truthfully when things aren't great.
The context can make a big difference here. Friends and family are more likely to actually care. With coworkers and customers it's often better to keep them at arms' length because a negative response can get you labelled as not a team player, or receive customer complaints.
Some days I worry I'll be too candid with my employer and I'll lose my job as a result. That one is probably my own biased perception, but shit, it's happened before.
In Finnish we have a phrase "ei kurjuutta kummempaa" which is said in a happy, jolly way and its usually accepted as "not great but I don't want to expand on it." It translates to "nothing worse than misery."
Not dead yet
“Eh, been better.”
I feel like that response is real without oversharing, and invites someone to respond however they want. If they care, they can ask what’s up, or they can just say, “aw bummer man, hope it gets better for you,” or whatever.
"Great!"
"Alright, you?"
"Living the dream."
"Another day in paradise."
"One day closer to death."
Depending on my mood
"Its going" gets the message across. Kind of shit, but time passes.
"Hangin' in there" is what I generally use when I'm not fine but I know it's just a greeting. It conveys that things are less than fine, but not by how much, and that I'm still functioning.
Some other, more flippant ones: "As well as can be expected", a shrug and a "meh", "Too early to tell" (if it's first thing in the morning / just arriving to work), "Sitting up and taking nourishment", etc.
You can even skip answering at all, and move directly to the response greeting, "Hey, how are you?"
Took me years to realize that the "correct" reply is to ask the same question back, not answering.
But my go-to phrase when having just gotten out of bed, headed for my shift was "too early to tell"
"Eh, tired.", usually.
People tend to get it. They're probably tired too.
-- Frost
"Fine" tone of voice fills in the rest.
just say "not well" if you are not well. if they dont care, then what do you care what they think.
personally i find it degrading to pretend everything is fine if things are not fine.
Treat it non-literally. Say 'How's it going?' which turns it into a greeting rather than a question.
My go-to is the ol Lebowski quote, "Strikes and gutters, ups and downs"
"Getting by" or "carrying on" assuming I don't want to invite deeper discussion of my issues.
“I’m alright” seems like the universal way to say “I’m not alright”
I like to use lines from Country + Western songs.
"I'm another day older and deeper in debt." 16 Tons.
"I killed a man in Reno, just to see him die.' "Folsom Prison Blues.'
You get the idea.
Depending on the person:
"Not great tbh."
"Pretty fucking bad. lol"
"NOT GREAT MY DUDE, NOT GREAT"
This is going to come off with a heavy “if life gives lemons” vibe, but over time it does work. Where I went to college, there was a day every year, I think during Fall or Spring, where everyone greeted everyone. Nobody made a big production about it, just a simple, “hi” or “what’s up.” Weird thing is it had a tendency to keep going beyond the day. Most people only did it on the day, but a surprising number of people kept doing it outside of that. Including me, eventually! I still make an effort to be nice to people, and I trace it back to that. No, it doesn’t magically make my day better, but it’s one nice thing that happened. Plus, over time it helps me see/appreciate even small positives, which helps keep me from getting too weighted down by the bad stuff.
Don’t mean to trivialize the bad stuff in your life, OP. I do hope you’re able to manage it, and not let it beat you down. When I started college, I was a pretty negative person. While I wouldn’t call myself “sunny” all these years later, I do see a big difference in my general outlook compared to younger me.
Adding: not saying anyone shouldn’t be genuine, like plastering on a big psychotic grin and reply with, “I’m great!” Maybe just responding with something like “g‘morning,” “hey”. Even, “Been better, but thanks for asking.”
“Better now that the voices have finally sto… ah dammit.”
I'm usually asked this at work, so my go-to response is, "Well, I'm here." Which most seem to understand.
It depends on who's asking.
Generally I like to tell what's on my mind. Or, if I say stuff is fine, I'll explain what I've been doing lately.
I'm not a person who avoids difficult topics so it's kinda natural for me to answer "more honestly".
“I’ve been better” is my go to
I'm awake, but I'd rather not be.
"Still kicking but not screaming!"
"I've been worse"
"breathing" or "alive"
To which they normally say: "better than the alternative!"
And my final reply to that is: "some days."
Hanging in..
@Bougie_Birdie "I'm awake" is what I go for when I'm not being recorded, "Not too bad" when I am. I have heard that "Living the dream" is White Man for "Push me off of the roof. We can make it look like an accident."
just say "Life,,, ya know"
If they are only being polite they'll answer "for sure" and thats it.
If they really care and want to know theyll ask more and then you can go into more detail.
Brought to you by "protocols autistic people have to memorize" lol that being me
"Better than I deserve"
“Well enough” if you want to be genuine, but brief and convey that things are not aces.
But usually just mirroring “How are you!” in the same tone as the first part of the greeting establishes that it is a ritual, not a question.
"Vertical."
"Existing!" and then usually they pause and we talk about something else.
“Could be worse” assuming it can be worse (and it probably can)
"I am"
"Fair to muddling." or
"Just another day in paradise."