Deaths of Despair Show a Country in Disrepair
America's Shadowy Nemesis Looms Large
Anne Case and Angus Deaton mainstreamed the phrase “deaths of despair” in their 2020 book Deaths of Despair and the Future of Capitalism. The book synopsis summarizes the crisis:
Life expectancy in the United States has recently fallen for three years in a row—a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, drug overdose, and alcoholism have risen dramatically, and now claim hundreds of thousands of American lives each year—and they’re still rising. Anne Case and Angus Deaton, known for first sounding the alarm about deaths of despair, explain the overwhelming surge in these deaths and shed light on the social and economic forces that are making life harder for the working class. They demonstrate why, for those who used to prosper in America, capitalism is no longer delivering.
Deaths of Despair and the Future of Capitalism paints a troubling portrait of the American dream in decline. For the white working class, today’s America has become a land of broken families and few prospects. As the college educated become healthier and wealthier, adults without a degree are literally dying from pain and despair. In this critically important book, Case and Deaton tie the crisis to the weakening position of labor, the growing power of corporations, and, above all, to a rapacious health-care sector that redistributes working-class wages into the pockets of the wealthy. Capitalism, which over two centuries lifted countless people out of poverty, is now destroying the lives of blue-collar America.
If you’ve heard the idiom “the Rust Belt” used then you’re already familiar with the repercussions of the collapse of America’s industrial heartland. Deaths of despair run rampant across places like western Pennsylvania, West Virginia and Ohio, to name but a few. However, deaths of despair aren’t unique to industrial areas, as they stretch long and far across America in both urban and rural landscapes. Since the book’s release the concept has caught on and buttresses other narrative-shifting work in the mental health field.
“Normal is just a cycle on the washing machine.”
Whoopi Goldberg gets credit for that quote, however I don’t imagine she was talking about the state of mental health in America. Nevertheless, her quote applies well here too. However, the best professional to reference is renowned, Canadian trauma and addiction expert Gabor Maté. In his 2022 book The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture, Maté says:
I will make the case that much of what passes for normal in our society is neither healthy nor natural, and that to meet modern society’s criteria for normality is, in many ways, to conform to requirements that are profoundly abnormal in regard to our Nature-given needs—which is to say, unhealthy and harmful on the physiological, mental, and even spiritual levels.
Maté’s take on dis-ease in the United States makes a perfect dovetail with the research of Case and Deaton. Something has gone wrong and festered into something insidious. In the 1990s the mortality rate of white middle-aged Americans started rising due to a spike in alcohol-related deaths, fatal drug overdoses and suicides. Deaths of despair continue accelerating. “In 2022 more than 200,000 people died from alcohol, drugs or suicide, equivalent to a Boeing 747 falling out of the sky every day with no survivors.”
Here Maté explains the fallout of deindustrialization across the United States. The hollowing out of America led to mass loss of meaning and purpose in people’s lives. Now mired in a hopeless world of darkness and their way of life destroyed, Americans cling to the worst ways possible to numb the pain.
What Happened 25 Years Ago?
Around 25 years ago, give or take a few years, the United States seems to have crossed an inflection point. Something took a precipitous turn for the worse. Was it a singular event? I’ve discussed how that event may have been 9/11, or even Tony Soprano making Xanax mainstream. Maybe our turn toward darkness didn’t have to do with either of those things. Perhaps we reached peak globalization and began experiencing the economic fallout in earnest.
Whatever it was, something dire changed the societal complexion of the United States. Look at these stats:
110,000 Americans die a year from overdose deaths, or about 1 person every 5 minutes.
In 2016 the US suicide rate soared to a 30-year high in a “growing epidemic across America.”
Male deaths represent 79% of suicides, amounting to roughly 100 men who die by suicide every day, over 36,000 annually.
Farmers are 3.5x more likely to die by suicide compared to the general population.
I have seen deaths of despair in my own life. I had a friend die of an overdose, a best friend die by suicide and a cousin die by suicide all after the year 2000. My best friend and cousin suffered from substance abuse disorder as well. Two of these deaths occurred in Chicago and one in Florida, so deaths of despair aren’t restricted to specific, geographical areas. In fact, maybe geography is a hidden clue.
Globalization Drives Exodus to Cities
The Industrial Era drove people en masse to cities for the first time in history. Although a good number of people could still carve out a comfortable living in rural areas. If you came to own a tractor for example, a farmer could live a quality life. But now in the era of globalization, almost no economic opportunities exist in rural areas.
Gone are the mom and pop dimestores, confectioneries, diners, gas stations and bait and tackle shops. Farmers struggle to survive succumbing to the influence of big agriculture. Young rural people flock to cities now looking for better opportunities. Just do a cursory search on YouTube and you’ll find an entire genre of travel videos that document the ever-increasing number of American ghost towns and those close to joining the ranks. Since 2000, Americans are being displaced in a wholesale manner.
Look no further than the coal mines of West Virginia, the steel mills of Pennsylvania, car manufacturing plants in Illinois, or even the sugar mills of Hawaii. They’re all vestiges of a prosperous America of yesteryear. So on one hand, we have hollowed out once thriving centers of middle America, leaving behind wastelands of economic ruin. On the other, we’ve packed cities full of people lacking the sense of community and social ties that thrive in small, rural towns.
This raises questions around the stories, urban legend or not, of Amish and Mennonite youths who abandon their community to try out big city life and return home posthaste. Maybe we stand to learn something from agrarian cultures about community, nature and place. After all, city life doesn’t pay off in the 21st century as advertised.
Are We Living in the Second Gilded Age?
Decades from now, we may look back on this period and realize we were living in a second Gilded Age, which may lead to a second Progressive Era, or at least we can hope. Thanks to institutions like the 40 hour work week and the Occupational Safety and Health Administration (OSHA), we’ve come a long way since the days of Upton Sinclair’s The Jungle and the tragedy of the Triangle Shirtwaist Factory fire. However, our economic precarity might suggest otherwise.
Without a doubt, we’re entering another economic recession or worse. The structural rot of our economic and fiscal policies wasn’t addressed in the wake of the Global Financial Crisis of 2007-2008. We kicked down the road. So chances are that the economic pain we’re experiencing now will be greater. Available statistics bear this out.
A 2023 survey conducted by Payroll.org highlighted that 78% of Americans live paycheck to paycheck, a 6% increase from the previous year.
13 percent of U.S. workers said inflation is causing them to cut back on health-related expenses, such as out-of-pocket health care services, gym memberships and eyeglasses. An additional 4 percent have cut back on prescription medicines.
One in three U.S. employees say their job has had a negative impact on their mental health over the past six months, with 30 percent saying their job has made them feel overwhelmed and 29 percent saying it's made them feel anxious at least once a week 2023.
The U.S. government gave tacit acknowledgement to the economic crisis with the new SECURE 2.0 rules, which allows Americans to withdraw up to $1,000 from their 401ks without any penalties.
According to the American Psychological Association (APA)’s Stress in America 2022 survey results, money is a major source of stress for 66% of adults, with 57% stating current expenses, such as food and rent, as their main source of money-related stress. 56% of employed U.S. adults report job stability as a source of stress.
That last statistic is already 2 years old, so you can imagine what those figures might look like now. Speaking of food, if you haven’t heard already, food banks across the United States are struggling to keep up with demand. From Iowa to Texas Americans are facing more and more adversity putting food on the table and feeding their families. If we can’t feed ourselves in a proper manner, how do we expect to maintain our mental health? Although, affording anything nowadays, much less basic necessities, seems to be a luxury.
For example, this Missouri man says he killed wife because of her costly medical treatment. Oh and maybe we need to readjust the homeless narrative after this discovery. A woman was living inside a rooftop grocery store sign with computer and coffee maker for a year. We can talk about mental health until we’re blue in the face, but it seems the deaths of despair crisis won’t ease until we repair the system. And if you still have any lingering doubt about how much America is suffering right now watch this video that went viral last month.
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I could write an entire post on this video alone. Heart-wrenching doesn’t even begin to explain what this man is feeling and going through. I wish I could give him a hug, or anyone else feeling like him. I guarantee you he’s not alone.
Furthermore, when he says “eat,” I don’t think he means that just literally, which reflects the chaos of these times. But if there’s a silver lining it’s his awareness that other Americans must be struggling with “the same level of mental health as me.” Decades or generations ago, this acknowledgement wouldn’t have even been allowed. However, with increased awareness comes increased severity of the deaths of despair. With economic hardship looming on the horizon in 2024 and the near future, chances are the problem will worsen.
We’re Broke in America
The irony lands hard in a country that’s the “richest” in the world. We’re broke in a variety of ways. We’re broke in a financial sense for sure. But we’re also “broke” in regards to mental health, wealth of community, time spent in nature, deep ties to place, and our overall psychospiritual wellbeing. The rapacious strip mining of everything in our society for every last dollar that can be squeezed out of us, even includes our mind, body and soul. The crisis appears to be systemic in nature, rather than islolated.
UCLA Health acknowledges the collective dark night of the soul facing Americans.
When compared with some similarly wealthy countries, Americans die prematurely more than twice as often. This is no coincidence. It’s baked into the DNA of our country — starting with our violent past that has condemned generations of people to health struggles and economic precarity, and extending today to our profit-driven health care system and threadbare social safety net that help fuel our epidemic of early death.
The very structure of our country promotes despair in many of its people. We need progress on these issues to extend the lives of all Americans, and possibly reverse our unprecedented declines in life expectancy.
As long as we retain the right to repair our minds, bodies and souls, we can course correct instead of being left to our own devices, which are killing us.