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Book Review:

Reviews by Helen Epstein, 2020

Helen Epstein has published an outstanding review of two new books, Deaths of Despair and The Future of Capitalism by Anne Case and Angus Deacon and We're Still Here: Pain and Politics in the Heart of America by Jennifer Silva, in the March 26, 2020 issue of The New York Review of Books. Epstein notes that the U.S. has about 190,000 alcohol related deaths, drug overdose deaths and suicides each year. These deaths are concentrated in cities that have lost manufacturing and in economically depressed rural communities; and they mostly involve White adults without a college degree. Early deaths among African Americans, Hispanics and college educated Whites have "risen, little, if at all, over time." Epstein comments that the disparity in rates of early mortality is most stark in middle age. She writes, "Since the early 1990's, the death rate for forty five to fifty four year old White Americans with a BA has fallen by 40 percent, but has risen 25% for those without a BA." 


Epstein comments that "while poverty in America is all too real, it's not the only reason for for the epidemic of deaths of despair. Poor states like Arkansas and Mississippi have seen smaller increases in overdose deaths than wealthier Florida, Maryland, Delaware, New Jersey, Connecticut, New Hampshire and Maine; and "non- BA blacks ( despite earning 20-27% less than comparably educated Whites) are nevertheless 40 percent less likely to die from suicide, alcohol or drug overdoses." Epstein believes that low income poorly educated White men are more likely to blame themselves for their economic plight than African Americans who have lived with racism their entire lives. Regarding poorly educated Whites, she asserts that  "their sense of personal worthlessness can be profound when jobs are unstable or disappear." Furthermore, the sense of personal worthlessness is compounded by the loss of status in the community and the loss of respect and regard within marriages and extended families. Deaths of despair appear to result from the appraisal of economically marginal, poorly educated persons that there is little or no chance of decent employment which would pay for necessities and support self respect and the respect of extended family members, neighbors and communities. This is ( to put it mildly) a grim picture which can be greatly improved, but not eliminated, by social and economic policies. Many Whites of all income levels in the U.S. have bought in to a social ethos which inflicts self loathing on those regarded as unproductive "losers", an intrapsychic 'mean streets'. The community featured in We're Still Here "is a depressed wasteland of bars, chain stores, fast food restaurants and drug rehab centers."


Epstein writes that "One of Case and Deacon's most striking findings is what I'll call the "pain paradox."  On national surveys, sixty year old white Americans without a BA are two and a half times more likely to report that their health is fair or poor than same aged whites with a BA ...  Each generation of non- BA whites since the Baby Boom has reported more pain, at younger ages, than the previous one."   And "Non- BA blacks who tend to do the most physically grueling jobs are 20 percent less likely than non- BA whites to report pain at all ages. Even odder, non- BA whites "actually  report more pain at age sixty than age eighty, whereas the reverse is true for blacks, whites with a BA and populations in nineteen comparison countries.." Currently, Epstein asserts, 13 percent of 45-54 non- BA whites are not in the workforce compared to 4 percent of this age group in the 1990's.   Pain, observes Silva, "has become a powerful powerful organizing force" in the lives of just about all of the residents of the economically depressed community she writes about in her book.  "Silva's white informants ...  tended to see themselves as lonely warriors facing strange undefined threats to their community. Weird conspiracy theories were common." And, according to Silva, "Many of the white men carried guns everywhere ..          "Their anger focused on a faceless government that neglected people like them and on supposedly shiftless immigrants and minorities who feasted at the public trough." Epstein comments,  "Other white men adhered to a stoic and lonely individualism; ... most whites aspired to a lonely hero ideal ..."


Epstein comments that "Addiction, violence and despair are common to all human societies that have seen their cultures destroyed ..." And (per Epstein)  "Out of the ashes of the current catastrophe, America's white working class seems to have fashioned a new culture of pain and trauma, rooted in white America's peculiar imperative to seem happy all the time (except when you're sick) ... and to personalize and depoliticize financial hardship."  

-- Dee Wilson

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