I'll preface this all with I'm at level 21. Maybe 35+ hours spent in game.

Sure, the difficulty leaves me with no ammo except a stack of toasters to launch at people after ~killing~ fleeing from two legendary super mutant butchers or legendary mirelurks.

Sure radroaches and bloatflies can easily swarm me and feast on my innards.

Yes, I will run from deathclaws, yao goi, rad scorpions, those winged scorpions, and mini guns because I already used half my stimpacks taking out entire raider settlements.
Of course when I hear that unmistakable whistle of mini nukes my butthole clinches up.

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But there's one major downfall to survival difficulty that ruins it all for me.

The three major elements of survival are missing. Food, water, and sleep. None are required. My survivor has not slept a minute in this game, he's been awake for over 20 in game days. I haven't drank a single bottle of water, nukacola or blood of a raiders unborn baby.

The only reason I eat is for the minute bonuses or to amplify my heal speed along side stimpacks.

Additionally,

Radiation? Hah that's a joke. I can spoon a glowing one for one hot sensual night and walk away with a negligible hit to my overall HP.

I'm also carrying around 50 missiles and 5 mini nukes ontop of hundreds or nearing thousands of unused munitions because no weight.

Addiction? I've been addicted to buffout since about hour 3. I'm on hour ~30. I laugh at the -1 str -1end from withdraw. Why use precious caps or materials to fix an addiction that has no real effect on gameplay.
Speaking of drugs. On the hardest difficulty, sure, I'm almost always out of ammunition. Wanna know what I'm never out of? Drugs. I have 40 bufftats and 60 psycho jet in my home container. And on average 30ish stimpacks.

Many big enemies? I have 15 fusion cores, let me go get my invinci-armour. Hell any cores I use up will just replaced when I kill the big guys and take the core off the suit hidden ontop of or behind the location then I'll get a bonus core when I walk
inside and take it out of the reactor.

Ah, that super mutant has a missile/nuke launcher? Good thing my metal suit defies all realism. Because I just took two missiles to the knee, and it blew the hell out of my suits right leg, effectively destroying it. But that's okay, for the 5 steel I got
from breaking down a toaster or derringer or whatever I can effectively repair a leg plate that was BLOWN TO HELL BY MISSILES like new.

I selected Bethesda's "hardest" difficulty to be punished for mistakes and unfortunate situations. I picked the hardest difficulty to have to think before I act, not simply pop one of each chem and run in blasting.

I picked SURVIVAL to be forced to survive. What I got was insert annually released multiplayer fps on hard mode.

I picked SURVIVAL for immersion, to achieve the feeling that I'm alone in a post apocalyptic wasteland, fighting to survive, with everything and everyone attempting to murder me(read: Australia)
Instead I got "shroom+cocaine+adderall trip simulator 2015"

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Don't get me wrong.

I love this game. And the creatures of the world are largely done perfectly. I actually fear fighting half the enemies in the game. And the ambience has a decent amount of spooky ominous feel. I look forward to my play time ever hour of my awake day. Its perfect in many aspects.


What I don't fear? The environment, myself, my decisions, my BASIC BIOLOGICAL NEEDS. Basically I don't fear that I need to survive in survival.
Also raiders. Raiders are [censored].

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Tl;Dr survival difficulty is a joke. You don't even have to survive.