In 2017 alone, 158,000 Americans died from what Princeton economists Anne Case and Angus Deaton deem “deaths of despair” -- a disturbing triumvirate of suicide, alcohol and opioid-related deaths that primarily have ravaged the middle-aged poor and working-class whites.
To put these numbers in stark terms, “That is the equivalent of three, full 737 MAXs falling out of the sky every day,” they lament, “with no survivors.”
Case and Deaton have spent the better part of the last decade calling attention to this devastating national crisis, one which the mainstream media has largely ignored, and many politicians have deliberately obscured.
Occurring at the highest rates among middle-aged whites without a college degree, the severity of this epidemic has caused an overall decline in Americans’ life expectancy, an alarming fact not observed in other developed nations. Case and Deaton’s new book, Deaths of Despair and the Future of Capitalism, raises two intertwined and critically important questions: What is causing the rise in these deaths, and how do we reverse this trend?
Case and Deaton explain how every detail of this crisis unfolded, examining recent historical events and rightly placing much of the blame on the United States’ distinctive strain of capitalism, designed to protect and grow the assets of the wealthy few. And while they do cursorily discuss race, I think a more rigorous evaluation of racism would only strengthen their arguments.
In 1935, one of the most prolific scholars on race and class in America, W.E.B. Du Bois, coined the phrase the “psychological wages of whiteness.” Du Bois wrote in his opus Black Reconstruction in America that after emancipation, former slaveholders devised multiple ways to prevent poor whites and blacks from forming any type of class or labor solidarity – or even more revolutionarily, a multi-racial political coalition.
Although elite whites continued to underpay and exploit both black and white workers, they supplemented white laborers with a "psychological wage."
Although elite whites continued to underpay and exploit both black and white workers, they supplemented white laborers with a “psychological wage.” In addition to sowing the seeds of racist hatred, according to Du Bois, the wealthiest whites devised “a carefully planned and slowly evolved method, which drove such a wedge between the white and black workers that there probably are not today in the world two groups of workers with practically identical interests who hate and fear each other so deeply and persistently and who are kept so far apart that neither sees anything of common interest.”
Whether through habits, customs, folkways, and deference, or through access to better schools, public places, parks, and functions, white Americans – no matter how impoverished – came not only to depend on but to expect certain privileges simply because of the color of their skin. White supremacy did, it seems, elevate all whites in a variety of important ways.
For Du Bois, whiteness itself thus provided both material and emotional compensation – but these were always predicated on the deprivation of African Americans. While his theory has not yet entered the popular lexicon, it explains so much about the complexities of racism in the United States. Above all else, it underscores how the wealthiest whites have long used targeted, incendiary forms of racism as a scalpel, masterfully severing the labor- and class-based coalitions of poorer people of different races. These multi-racial coalitions have reoccurred, time and time again, throughout our history; yet to this day, elite whites have always found a way to stamp them out.
But what happens when certain aspects of the psychological wages of whiteness end, as they did in the aftermath of the civil rights movement? What happens when poor and working-class whites feel as if they have fallen to the bottom of society? What happens when their self-esteem and social statuses – which were already low – worsen?
The termination of the psychological wages of whiteness over the past several decades is starkly evident when we consider the people most affected by deaths of despair. These deaths, Case and Deaton write, “reflect a long-term and slowly unfolding loss of a way of life for the white, less educated, working class.” Focusing on America’s grossly inadequate healthcare system, falling wages, rising inequality, and the erosion of white working-class families and communities, they show that for whites without a college degree, “Something important, awful, and unexpected is happening.”
Unlike the rest of the developed world, Case and Deaton argue, America’s system not only resisted the social safety nets that other democratic nations deem human rights, but it also created one of the most unequal societies in the world. Not surprisingly, the states most affected by deaths of despair are mostly in the South and the non-coastal West, controlled by Republicans who have long used racism as an excuse to impose draconian labor laws, while slashing funding for public-good programs like Medicare expansion, food assistance benefits, infrastructure improvement, and even education.
And although men and women are succumbing to deaths of despair in “almost equal numbers,” the real tell regarding the psychological wages of whiteness is the birth-year cohorts of the victims. Case and Deaton found that non-college educated whites born in 1960 had a 50 percent higher chance of dying from suicide and drug abuse than did their peers born in 1950. For poor and working-class whites, the economists wrote, “The later you were born, the higher your risk of dying a death of despair at any given age.”
Noticing a spike in deaths for lower-status whites who were born during or after the civil rights movement leads to many new questions, all of them predicated on racism, classism, and the loss of white power and privilege. No longer socially courted by the elites, no longer included in the best schools (those went private), no longer steadily employed at a living wage that could sustain a family, poor and working-class whites have experienced a devolution not only of expectations, but also of hope.
While Case and Deaton largely gloss over the alarming availability of guns as a primary driver of suicide, and shy away from discussing the epidemic of veteran suicides (veterans comprise about 7 percent of the population but 14 percent of all suicides), they do a fantastic job talking about the loss of a working-class white community, as well as the rise of unexplainable pain. In one the crucial points of their argument, Case and Deaton rightfully connect deaths of despair to an increase in physical pain; in fact, the states with the highest suicide rates also report the most pain.
Of course, psychological pain – particularly, prolonged and suppressed psychological pain – often manifests as physical pain. Case and Deaton discuss this, but there’s likely much more to this correlation. Today, there is almost no upward generational mobility for poor Americans, there are few social safety nets, and many impoverished people of all races have a bleak outlook for the future.
Yet as physician Jonathan Metzl rightfully argued in Dying of Whiteness, the policies supported by a majority of poor and working-class white voters end up harming them. Unlike Case and Deaton, Metzl directly links whites’ racial resentment, their racism, to their own early deaths from guns, opioids, alcohol, and a lack of access to health care – including psychological health.
Once white supremacy began crumbling and white privilege began to wane, poor and working-class whites were left with a question of where, precisely, they fit into American society. All too often, unfortunately, they do the same thing they have done for a century and a half: they retreat into apathy, withdrawing from society altogether, or they lash out in a livid anger that is nearly always directed at other ethnic groups. As historian Carol Anderson says, for people who have “always been privileged, equality begins to look like oppression.”
To be sure, no human being wants to be in last place, no one wants to occupy the bottom rung of society. But just because someone does not medal in the Olympics of Pain and Suffering does not mean they are not in pain and suffering. To move our country forward, upper and middle-class whites are going to have to not only acknowledge, but also atone for, our country’s grave sins against the most vulnerable – sins made possible by racism and white supremacy. And poor and working-class whites are going to have to grapple with how to move forward from their own history of racism, a racism that is helping to literally kill them.
Racism, of course, has always served as the kindling of our shameful exceptionalism. Antiracism, in turn, can serve as the antidote: It can bring us into modernity, fully into the twenty-first century, where at last we might be able to share a world in which basic human rights – from universal health care to a living wage to paid sick leave – are available to all of our citizens, regardless of race or class.