Last week, CNN devoted seven hours of programming to climate change, bringing the leading Democratic candidates onstage to grill them on the issue. I have no complaints about the decision, but I wish that some network would set aside a similar amount of time for a more immediate crisis, one that is killing tens of thousands of Americans right now – more than the crack epidemic at its worst, more than the Vietnam War.
The working shorthand for this crisis is “deaths of despair,” a resonant phrase conjured by economists Anne Case and Angus Deaton to describe the sudden rise in deaths from suicide, alcohol and drug abuse since the turn of the millennium.
Now, a new report from the Senate’s Joint Economic Committee charts the scale of this increase – a doubling from 22.7 deaths of despair per 100,000 Americans in 2000 to 45.8 per 100,000 in 2017, easily eclipsing all prior 20th-century highs.
By way of comparison to climate change, this summer’s National Climate Assessment estimated that rising temperatures could cause between 4,000 and 10,000 additional heat-related deaths annually by the end of the 21st century. But had deaths of despair remained at 2000-era levels, approximately 70,000 fewer Americans would have died this year alone.
Despite the absence of a CNN marathon on the issue, it’s possible to discern several working theories of the crisis, and to imagine roughly how a “deaths of despair” debate might go:
The Technocrat (voice of Pete Buttigieg): “This is primarily a drug abuse and mental health crisis, and the only way to solve it is with more and better drug treatment programs, more and better psychiatric care. We’ll save these lives one patient, one addict, one treatment center at a time.”
The Socialist (voice of Bernie Sanders): “This is obviously an economic crisis! People are despairing because their jobs have been outsourced. The rich have hijacked the economy. Tax the plutocrats, raise the minimum wage, give everybody health insurance, and you’ll see this trend reverse.”
The Cultural Healer (voice of Marianne Williamson): “You can’t just medicate this away or solve the problem with wonkery alone. There’s a spiritual void in America, a loss of meaning and metaphysical horizon. The problem is cultural, spiritual, holistic; the solution has to be all three as well.”
I have written this for Democratic candidates, but there is an equivalent for Republicans: Instead of the Technocrat, imagine the Enforcer, talking about drug interdiction and border security; instead of the Socialist, the Populist, talking about China and wage subsidies and industrial policy; instead of the Cultural Healer, the Preacher talking about the need for a religious revival while the Online Nietzschean bellows from backstage about restoring masculinity.
Are any of these prescriptions plausible? The Senate report leans toward the technocratic answer, arguing that the surge in drug deaths is distinct from and more dire than the suicide and alcohol trend and clearly driven by “change in the supply, addictiveness, and lethality of drugs” – which suggests that policymakers should keep their focus on the opioid problem specifically, rather than assuming that every trend driving death rates higher must be solved together.
This conclusion fits with an earlier argument from The Washington Free Beacon’s Charles Fain Lehman that we should subdivide the “despair” problem into distinct categories: A drug crisis driven by the spread of heroin and fentanyl which requires a drug policy solution; a surge in suicides and depression and heavy drinking among middle-aged working-class whites to which economic policy might offer answers; and an increase in depression and suicide generally, and among young people especially, that has more mysterious causes (social media? secularization?) and might only yield to a psychological and spiritual response.
As advice to policymakers this disaggregation makes a lot of sense, not least because the next president is more likely to improve drug policy than to ban iPhones or usher in religious renewal.
But at the same time, the simultaneity of the different self-destroying trends is a brute fact of American life. And that simultaneity does not feel like just a coincidence, just correlation without entanglement – especially when you include other indicators, collapsing birthrates and declining marriage rates and decaying social trust, that all suggest a society suffering a meaning deficit, a loss of purpose and optimism and direction, a gently dehumanizing drift.
If we’re going to answer whatever is killing our countrymen, it’s as important to pay attention to the would-be cultural healers – from the old churches to the New Agers, the online Nietzscheans to the neopagans, Jordan Peterson to Marianne Williamson – as it is to have the policy conversations about what’s possible in the next presidential term.
Despair as a sociological phenomenon is rarely permanent: Some force, or forces, will supply new forms of meaning eventually. And it matters not only that this happens, but which forces those will be.
Ross Douthat is a columnist for The New York Times.