The immediate cause is an increase in deaths from drug overdoses, alcohol and drug-related accidents, and suicide, concentrated among middle-aged people without college degrees. Almost without thinking we can all produce cardboard liberal and conservative "explanations": liberals would point to increasing economic insecurity and inequality, conservatives to declining church attendance and family breakdown. There is another, even simpler explanation floating around, although I have yet to find a full-throated defense of it: maybe the whole business is an unintended side effect of the liberalization of pain treatment with opiates, which made these dangerous drugs widely available. After all, one of the striking things about the crisis is that it seem to be happening only in America, and it is only in America that prescription opiates have become such a prominent feature of the landscape.
One problem with the liberal theory -- and also with the drugs only theory -- is that death rates for black and Hispanic Americans have continued to fall, even as they have suffered more in economic terms than whites. Which brings me to what I think is a very interesting suggestion made by Andrew Cherlin and Brad Wilcox in a paper back in 2012. Cherlin and Wilcox are leading experts on marriage and family life in America, one liberal and the other conservative. Ross Douthat has a succinct summary of their paper:
Noting that religious practice has fallen faster recently among less-educated whites than among less-educated blacks and Hispanics, their paper argues that white social institutions, blue-collar as well as white-collar, have long reflected a “bourgeois moral logic” that binds employment, churchgoing, the nuclear family and upward mobility.In two words, the difference between the experiences of white and black Americans in the recent recession might be summed up as different expectations. White Americans have been raised to believe that their fates are in their own hands, that if they work hard and follow the rules they will get ahead. Many have also been raised to think that poor people's problems are their own fault. A more cynical analyst might also say that white Americans, especially white male Americans, have always believed that they are the elite, and that however bad things got in the ghetto life would always be good for the Real Americans.
But in an era of stagnating wages, family breakdown, and social dislocation, this logic no longer seems to make as much sense. The result is a mounting feeling of what the American Conservative’s Rod Dreher calls white “dispossession” — a sense of promises broken, a feeling that what you were supposed to have has been denied to you. (The Donald Trump phenomenon, Dreher notes, feeds off precisely this anxiety.)
For obvious historical reasons, though, Hispanic and (especially) black communities have cultivated a different set of expectations, a different model of community and family (more extended and matriarchal), a different view of success and the American story writ large.
These distinctives come with their own set of problems, particularly where family structure and fatherhood are concerned. But they may create a kind of resilience, a capacity for dealing with stagnation and disappointment (and elite indifference or hostility), which many working-class white Americans did not necessarily expect to ever need.
Minority Americans, on the other hand, have always known that the odds were stacked against them, and that many people fail for reasons largely beyond their control. So they are less likely to take their own failures personally, or at least so personally as to lead to suicide, and less ashamed about reaching out to others for help. Cherlin and Wilcox focus on how this works out in institutional terms; one of their findings is that white Americans who get divorced or lose their jobs often stop going to church, which is not true for blacks and Hispanics. Why would white Americans turn away from spiritual help when they need it most? According to Cherlin and Wilcox, they do so because the message they get in church is a religious version of the same basic American message I just recited: personal responsibility, marriage, hard work, and moral rigor lead to success. (Imagine a congregation of Mormons in a nice suburb.) So when people fail -- lose their jobs, get divorced, get addicted to drugs -- their churches make them feel accused, not loved and protected. Whereas a stereotypical black church is more open and forgiving, and a character like former DC mayor Marion Barry can go through multiple divorces, affairs, addictions, convictions, prison sentences, and more while always remaining a fixture of the amen corner. In Cherlin and Wilson's terms, the forgiving habits of minority churches and other organizations give their communities a "resilience" that white communities lack.
I think this is insightful, but I wonder if it is even necessary to invoke churches at all. To me it seems that the personal responsibility ethic might do all of this work psychologically: if you are used to thinking that people rise and fall by their own efforts, failure hurts more than if you are used to blaming the man. (Or fate, witchcraft, evil spirits, or any of the various outside agents regularly blamed by peasants.)
Which sets up a serious problem. Because belief that you rise or fall by your own effort is indisputably one of the factors that leads to economic success in America. People who "do well," as Republicans like to put it, overwhelmingly believe that people are responsible for their own fates. And while it is hard to measure the impact of something so vague, the ethic of personal responsibility is certainly central to the culture of white Americans, even when they are spectacularly failing to live up to it. Is it possible to create a mindset that encourages effort to the degree that ours does but is more understanding of the role of outside forces in both success and failure?
Our cynical left-wing commentator also has something to say here, pointing out that while white Americans believed they were succeeding by their own efforts, they were really propped up by racism, and white men by sexism as well. What they miss, and what drives them to support Trump, is not a loss of fairness but a loss of unjustifiable privilege. Less educated white Americans are unhappy, this argument would have it, because they used to have a guaranteed status just from their skin color, but in the new meritocracy of education and income they have lost their privileges and are sliding down to the same level as less educated blacks and Hispanics.
What can be done? I doubt there is much we can do about the availability of opiates at this point, since people who are finally getting good treatment for chronic pain are not going to give up their oxycontin without a fight. More could be done to find and prosecute the corrupt doctors who provide a big share of the supply, but even if this was effective it would only drive up the black market price and lead even more addicts to switch to heroin.
The economic woes of less educated Americans are also not going to be easy to fix. So will the ongoing convergence of the white and black underclasses continue, and working class whites end up with attitudes toward life and their chances of success that mirror those of historically oppressed groups? In my darker moods, this seems to me to be where we are heading. Unless something happens to reverse what looks to me like unstoppable economic logic, our world will become ever more unequal and ever more class bound, as poor people of all races become ever more divorced from the world of the thriving elite, especially in their expectations about life.