I agree with all of the above, and note that we are also mostly happy, but still need confession for whatever we find amiss. They must as well. That need to face reality, strip everything away, and go forward requires a method. I've admired those who have used 12 step programs to overcome their vices, they have a method to dig themselves out of whatever they face, they have met their 'darkness'.
Culturally, it is most vivid in the streets of singapore in the legal red light districts, where you will seem women from all over asia fly in on a 6 week visa and generate money for the family. It is certainly a different, more pragmatic, less guilt free mentality. Yet we can't forget how many want to get out of the business some day, own a business, not be the workhorse.