Diseases of Despair

By Alec Pruchnicki, MD

I was born in 1947, among the first wave of baby boomers. Growing up in the 50s, I had my whole life in front of me and everything looked rosy. The middle class was growing and there seemed to be no limit to what was possible. During the 60s, coming into adulthood, the future was still bright and incredibly exciting. The chaos of the Vietnam War and the resulting anti-war movement was everywhere, but the future was still bright. The movements that were starting and rapidly expanding all had a common goal ─ to make the future even better than the past. Minorities, women, gays, even some parts of the labor movement like the farm workers’ movement were going to make the future better.

Then, something happened ─ the American defeat in Vietnam. Nixon’s resignation, a few oil embargoes, and a relatively slow economy during the 70s started to cast a shadow on Lyndon Johnson’s Great Society, despite gains such as Medicare, Medicaid, the moon landing, the War on Poverty, and other reforms. Some people complained that we weren’t as omnipotent as we thought. This culminated in the election of Ronald Reagan and his “Morning in America” reaction (dubbed “Mourning in America” by cynics) which would make things right again. The civil rights movement slowed down, subsidies for affordable housing and student loans were cut, and unions were attacked ─ but the military was still strong and lots of people and corporations were getting richer. Well, maybe not lots of people, but some people and their success was touted as proof of America’s continued excellence.

Even an unsuccessful impeachment couldn’t undermine the economic success of the Clinton administration. But there was an undercurrent of malaise starting around 2000 with slow increases in several social problems. Deaths from suicide, drug abuse, and alcoholism were persisting and occasionally increasing. These social problems were tied together in the medical literature by an article in the Proceedings of the National Academy of Sciences authored by Anne Case and Angus Deaton in 2015. This prestigious journal is widely read by people in the medical, scientific, and social science fields. The authors’ analysis caught on immediately ─ these social and medical problems weren’t isolated but were linked under the heading of “Diseases of Despair.” As the name indicates, the rosy future we expected was being replaced by despair for the future in the minds of many Americans. It was harder to be successful in the middle class or to rise into it from lower social/economic status. No longer was the stereotypical family of a single bread winner, a house in the suburbs, a new car every few years, and higher education so easily available. More analysis and 20/20 retrospection made people realize that the upward mobility of previous decades hadn’t been as easy as we thought. Groups were left out of the overall prosperity even though everyone thought the future would be better and now it was starting to get worse.

Who was most shocked by this revelation? White males. These problems aren’t limited to white males, but health care statistics showed that these three conditions were usually accelerating fastest among white males. Perhaps racial minorities, native Americans, and women knew about these problems already, but to many white men these problems seemed to come out of nowhere. But this wasn’t equally distributed throughout the white male population. Suicide among males is about four times that of women but especially among those of lower income, lower education, living in rural areas, and with easy access to guns. Suicide rates in rural areas are about twice that of urban areas. Andy Griffith’s Mayberry had a higher suicide rate than The Naked City (both on YouTube, look them up). Rural areas generally have less access to health care, especially mental health services, more inequality, and greater gun access so this isn’t surprising.

But there is another overall condition that has occurred in parallel with the increase in Diseases of Despair. Economic inequality has always been present in Western societies but in the U.S. it really took off during the 80s and the Reagan administration. This resulted from massive changes in the tax structure for wealthy individuals and corporations and the cutting back of benefits for everyone else.

To think that intentional policy decisions led to this situation might be hard to bear so explanations, especially scapegoats, are needed. Demanding racial minorities, pushy feminists (dubbed “Feminazis” by Rush Limbaugh), immigrants, drug-exporting countries, coastal elites (aka Jews), trans individuals, and numerous others are usually blamed, except for one ─ rich white males.

Looking at the demographics of Fortune 500 CEOs and many other sources, it is clear that rich white men rule the world, at least economically. Economic leaders from Asia and the Middle East are trying to catch up, and there is a small increase in CEO diversity, but these groups have a long way to go to achieve equality. Meanwhile, other groups are often demonized by mass media — a sector dominated by rich white men and becoming even more dominated with each merger and corporate acquisition.

So, is this our future? Will the shining city on the hill that was supposedly the U.S. be replaced by a bleak future with widespread deadly despair? Our history can provide an alternative future. The present support of conservatism is often described as “populism.” But at the end of the 1800s and early 20th century there was a left-wing populism also. The elites opposed by “the people” — the original meaning of populism — were not the scapegoats listed above. The large railroad empires, Wall Street, bankers, large trusts/monopolies, were identified as the enemy of the common people.

What is more, they were frequently defeated! The so-called Gilded Era, when the rich ran the country even more blatantly than they do now, was eventually reined in. The Sherman Antitrust Act was used by Teddy Roosevelt to break apart many large monopolies, previously thought of as invulnerable. The 16th Amendment, which authorized a federal tax on income, was adopted after the Supreme Court struck down an earlier income tax.

Imagine that — an unpopular Supreme Court decision overridden by a constitutional amendment. This period became known as the Progressive Era when many reforms, once thought impossible, were enacted. It wasn’t omnipotent with defeats in areas including labor rights and civil rights, but it brought about change against daunting odds before it moved into right wing policies.

If there is one area where leftists, liberals, and progressives can agree with MAGA Republicans (or some of them), it is to tax the rich. Whether this will happen and whether these reforms spread to other aspects of society, as it did during the Progressive Era, is unclear. But it is possible, and maybe Diseases of Despair will be a phrase tossed on the dustbin of history. We can hope.