Deaths of Despair and the Future of Capitalism
Anne Case, Angus Deaton 2020
What exactly are "deaths of despair", and why has this term been used so much in the 21st century to specifically describe white, middle-aged men with less than college education? Despair has been around forever in one form or another. Why does it seem to be more prevalent in America today than in the past? This worrisome trend has been noticed since the 1990's, and has contributed to the US life expectancy numbers to actually go down for the first time in over a century. What's going on, and why are middle-aged white men the most affected by this malady?
These questions and more are covered in this fascinating book by Anne Case and Angus Deaton, both economic professors at Princeton University. Deaton won the Nobel Prize in Economics in 2017, and both authors have been at the forefront of reporting on this disturbing trend.
Deaths of despair are defined by the authors as premature deaths caused mainly by three unnatural causes- alcoholism, drug abuse, and suicide. The authors go into great detail about the statistics that surround the increasing unhappiness that leads to these self-destructive behaviors, and try to come up with an explanation for what's been happening. Other nations in the world have not noticed the same trend, and the authors point to several uniquely American problems that make it much worse here than anywhere else.
Case and Deaton point the finger specifically at our dysfunctional healthcare system as one reason why deaths of despair are on the rise, which is odd because the Affordable Care Act, passed in 2010, was supposed to help. While the Great Recession of 2008 caused disruption in many lives and an increase in general stress and uncertainty, America's lack of a social safety net, especially in the area of health care, has exacerbated the problem for many lower-income Americans. Small ailments, noticed in middle-age, can mushroom into major sources of pain and suffering when left untreated.
They also point the finger at the drug industry, specifically those who created the opioid epidemic in the past ten years that is ravaging rural America particularly. Drug companies pushed pain-killing medicines on unsuspecting patients, ignoring the risks of addiction. These uniquely addictive drugs like Oxycontin and Fentanyl were grossly over-prescribed for even minor aches and pains and have led to greater and more serious addictions. Even after the drugs were more regulated in the past few years, the genie is out of the bottle, and illegal sources of more and more powerful opioids are cheap and plentiful, leading to an epidemic of overdose deaths across America.
While all races are subject to deaths of despair, whites had seemed immune up until the turn of the century, while economic forces of globalization and automation in many areas has caused especially men to question whether they serve any purpose anymore. States in the South and Appalachia are particularly hard hit, while states like California and New York, with more resilient economies and stronger safety nets, have seen less impact. White Americans are feeling increasingly threatened as their privileged place in the American hierarchy has eroded with progress being seen by women and people of color. The election of Barack Obama in 2008 was a watershed moment for many white voters, and the rise of racism since then is a visceral reaction to the perceived threat that whiteness will no longer guarantee status or privilege in the future. Another factor in racial resentments is that economic growth is slowing, and whites are increasingly seeing the economy as a zero-sum game in which when one group gains, they lose.
Why are people so unhappy, and why is it happening specifically in middle age? Middle age can be a pivotal time in a person's life. The years 40-60 appear to present the most vulnerability, because men and women notice a peaking of many abilities- earning potential, sex, social networking- and it's all downhill from there. Rather than adapt to the inevitable declines of aging, or re-evaluate their careers after doors that were once open begin to shut, many people turn to resentment, bitterness, and fear. This is where drugs and alcohol step in, and when they can't do the job anymore suicide becomes more and more of an option. If we can survive middle age, surveys show that happiness rises significantly among the elderly surprisingly.
There have been many books (Bowling Alone is a great one) written about the decline of social capital in American society, and the neighborly emphasis of the 20th century has given rise to a more go-it-alone ethos in the 21st century. Fewer people attend church, join unions, volunteer, participate in local politics, or show much interest in their neighbors than did in the 1950's, when community pride peaked. More people are tied to screens- television, computers, and cell phones- which provide hours of entertainment but little in the way of meaningful connection. The Covid-19 epidemic has made this isolation even more troubling. Families are less cohesive, and marriage is less common, all of which leads to more individualism and less understanding.
Case and Deaton paint a well documented picture of the many factors leading to the increase in deaths of despair, but their proposed solutions seem unlikely in an age when polarization rules and not much gets done. They propose a fairer tax system, an overhaul of the American healthcare system, better safety nets, breaking up big monopolies, raising the minimum wage, improving graduation rates and a huge clamp down on the drug industry and all opioids. All of these reforms seem reasonable to me, and I've seen them many other places, so perhaps if enough books like this get written things will finally start to happen.
The second part of the title "and the Future of Capitalism", is where a lot of the emphasis of this book lays, and it's clear that capitalism has failed many people to the point where they see no place for themselves. The harsh judgments still felt by people who fail to thrive in the high-tech, individualistic economy lead to withdrawal from the world and the vicious cycle of despair leads to death of despair. Only people who have given up on life turn to drugs, booze, and suicide as ways to avoid the pain of loneliness, hopelessness, and alienation. In a way, whites are catching up to people of color, who have dealt with despair for many more years in a nation that has treated them as second-class citizens. Perhaps now that the problem is more widespread and visible, things will finally start to happen.
I recommend this depressing, infuriating book, and plead with anybody who is feeling hopeless to seek out help (and hope) because it's out there. They may have to look hard, but it is out there. We need more action and fewer lost souls if we want to prosper together as a healthy nation.