The implication here is that "externals" are not important,
As Joshua likes to say on the podcast - "WHAT!!!????"
I don't see that implication at all. There's no presumption that you have lived in a bed of roses, only that you would prefer to live and experience SOME pleasure, even at the cost of some pain, rather than not live at all.
I think what we see in these discussions is that people are presuming lots of things about their own orientations that are not necessarily entailed at all in the summary statements.
Certainly to say something like "it is better to be alive than dead" cannot be analyzed without reference to presumptions. Someone can have all sorts of different pespectives on various parts of life but "it is better to be alive than dead" is a generalization that has to be understood as a generalization. It IS valid and helpful to make generalizations even while at the same time we recognize that there are exceptions. In fact, that is why it is the "exceptions that prove the rule." We are able to geeneralize and reach a rule exactly because we are able to separate the concept of "always" from "most of the time." "Most of the time" is a perfectly valid concept even though what is being referenced is not "always" the case.
So there is no implication that there are not circumstances in which we would be better off dead, but those situations are the minoority of cases. There is no fatalism OR determinsm that requires that we obtain bad results in life.
We have to be able to walk and chew gum at the same time and say yes "sometimes" terrible pain is in face inescapable and we are better off dead, but that "most of the time" terrible pain is not inescapable and we are NOT better off dead.