Home > Uncategorized > Epidemic of pain, suicide, and drug overdoses (3 graphs)

Epidemic of pain, suicide, and drug overdoses (3 graphs)

from David Ruccio


We already knew that the number of Americans who are on disability has skyrocketed over the past three decades. But the usual response was that they are gaming the system, claiming disabilities that “lend themselves to subjective manipulation” and being encouraged to do so by overly generous government payouts. Therefore, the conclusion was, “taxpayers are paying able-bodied Americans to drop out of the work force, increasing the burden on those who are still working.”

That was the existing common sense—the widely shared view that society had the responsibility (in the name of all “those who are still working”) to identify the truly disabled, weed out the others who were falsely claiming disability, and force them to get back to work.

Now we know, thanks to a recently published study by Anne Case and Angus Deaton, that something else has been going on: American workers are suffering from an “epidemic of pain, suicide, and drug overdoses.”

Specifically, Case and Deaton show that, after 1998, there was a marked increase in the morbidity and mortality of middle-aged white non-Hispanic men and women in the United States, especially for workers with less education.

The changes are dramatic. As we can see in the chart at the top of this post, even while mortality rates in other rich countries were declining (as were the rates for Hispanic and black Americans), U.S. white non-Hispanic mortality rose by half a percent per year. As they observed, “No other rich country saw a similar turnaround.” That turnaround in mortality was driven primarily by increasing death rates for those with a high-school degree or less. And, while their focus is on middle-age, they also make clear that all 5-year groups between 30 and 64 have also suffered increases in mortality.



According to Case and Deaton, the three causes of death that account for the mortality reversal among white non-Hispanics are not long cancer (which is declining) or diabetes (which has remained relatively constant), but drug and alcohol poisoning, suicide, and chronic liver diseases and cirrhosis. All three increased year-on-year after 1998.

And it’s not just that white Americans are being killed by this epidemic; they’re also increasingly victims of poor health, both physical and mental, as well as of pain and alcohol consumption. What we’re talking about here is a dramatic increase in the walking wounded (who often find it difficult to even walk).

The question is, why? Why have the rates of mortality and morbidity for white non-Hispanic Americans risen so dramatically in the past 15 years?

Case and Deaton say the epidemic may have been caused by the increased availability of opioid prescriptions for pain (although it’s not at clear if the increase in opioid use or the increase in pain came first) as well as growing economic insecurity (which started even before the crash of 2007-08), which may in fact continue into the future, given the shift away from defined-benefit to defined-contribution pension plans, if U.S. workers “perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans.”

What they don’t mention are the role of jobs. The fact is, most Americans are forced to have the freedom to sell their ability to work to someone else—and their suffer both when they have a job and when they don’t. When they’re fortunate enough to have a job, they’re working in Walmart stores, Amazon warehouses, and fast-food restaurants and suffering the physical and mental pains and indignities imposed by their employers. And when they don’t have a job—when they’ve been discarded by their employers—they’re suffering from the jobs they once held and from the struggle to find another job. As a consequence of both having jobs and joblessness, an increasing number of middle-age Americans are dying, committing suicide, and are the victims of pain, poor health, and psychological distress. And, unless we do something about it, the middle-age Americans who do survive the current epidemic, will carry their pain and ill health into old age.

As for the political consequences, Paul Starr suggests we may be witnessing a “dire collapse of hope.”

The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. We are not talking merely about “status anxiety” due to rising immigrant populations and changing racial and gender relations. Nor are we talking only about stagnation in wages as if the problem were merely one of take-home pay. The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change. Much of that support is now going to Republican candidates, notably Donald Trump.

And, I would add, support to Kentucky’s new elected governor Matt Bevin and to Tea Party favorites in other states (such as Maine’s Paul LePage, Kansas’s Sam Brownback, and Wisconsin’s Scott Walker). They’ve all enacted—or promised to enact—a wide variety of radical measures, from Right to Work laws to restrictions on welfare and federally funded healthcare programs.

We now live in a society in which, on one hand, those at the top have simply discarded the white non-Hispanic working-class and left it to suffer “an epidemic of pain, suicide, and drug overdoses.” And, on the other hand, many of those same workers have responded, out of fear and hopelessness, by electing public officials who are making their plight even worse.


  1. November 5, 2015 at 2:29 pm

    These statistical surges appear to begin with the bubble of the dot com fleecing of gullible enthusiasts and then continues at a more moderate pace. I posted this a few days back on zerowastenews.org What would an economy that does not destroy Earth and Life be like?

    The foundation of a free market is free people. I see the modern economic riddle as describing prosperity on a healing planet with a gently declining human population, say, .03 to .05% per year. Efficient democracy is the only path from impending extinction these old eyes notice.

    Luckily the Kurds worked with the Zapatistas and created autonomous democracy, which does not require a government and can work with governments, at least until a dictator panics already frightened people into totalitarian war or extreme austerity.

  2. graccibros
    November 5, 2015 at 3:16 pm

    Which is why, before even hearing about this study, and the discussion here at this site about the Nobel Prize, I had called for a National Truth Commission on what happened since the mid-nineteen seventies to the working class. I addressed this to candidate Sanders, and Bill Greider liked the idea, because he has been exploring some of the same terrain in recent essays in the Nation magazine.

    Yes, a rhetorical, gesture I knew, and I could draw up quite a list as to why it won’t and can’t happen even within the Sanders camp. I wanted two parts: workers testifying themselves, and then economists on the economic causes, especially trade and de-industrialization.

    I’ve lived some of this in my own life, so this is not a distant academic observing. I think the hardest think to fathom is the distance the Democratic Party has travelled in its own history since the New Deal in letting this disaster unfold. At many places, and many times, I have written that I experienced the Democratic Party since Reagan as increasingly dominated by upper middle class professionals, totally subservient labor…and as entrepreneurially driven as the Republicans. Labor has lost a lot of standing within the party, I just cringe every Labor Day in how that is expressed. Could the current head of the AFL-CIO deliver a from the heart Labor Day message in 2015, when it was really needed to address the depths of this alienation? Not at all, chasing Joe Biden’s long shot entry instead.

    By the way, among those who saw this coming, credit Richard Sennett very early, in the “Hidden Injuries of Class,” and more recently, in 1998, in “The Corrosion of Character: The Personal Consequences of Work in the New Capitalism.”

    It’s worth pondering from his last two pages, as he thought about the goings on at the Davos gathering he attended:

    “Yet I had an epiphany of sorts in Davos, listening to the rulers of the flexible realm. ‘We’ is also a dangerous pronoun to them. they dwell comfortably in entrepreneurial disorder, but fear organized confrontation. They of course fear the resurgence of unions but become acutely and personally uncomfortable, fidgeting or breaking eye contact or retreating into taking notes, if forced to discuss the people who, in their jargon, are ‘left behind.’ …the flexibility they celebrate, does not give, it cannot give, any guidance for the conduct of an ordinary life. The new masters have rejected careers in the old English sense of the word, as pathways along which people can travel; durable and sustained paths of action are foreign territories.

    “It therefore seemed to me, as I wandered in and out of the conference halls, weaved through the tangle of limousines and police on the mountainous village streets, that this regime might a t least lose its current hold over the imagination and sentiments of those down below. I have learned from my family’s bitter radical past ; if change occurs it happens on the ground, between persons speaking out of inner need, rather than through mass uprisings. What political programs follow from those inner needs, I simply don’t know. But I do know a regime which provides human beings no deep reasons to care about one another cannot long preserve its legitimacy.”

    I’ll leave it at that. It’s still hanging on, as Yanis Varoufakis can tell us.

  3. Larry Motuz
    November 6, 2015 at 4:34 am

    When the working age population faces eking out a living at jobs that don’t even pay minimum wages or offer any form of job security or benefits, and when job growth is less than labor market withdrawal rates, this is a recipe for physiological and psychological insecurity and associated stress-filled behaviors. In this process, the middle class is least resilient with coping with the losses they have undergone, including the great ‘house’ robbery of unsubstantiated foreclosures and the crowding out of loans to them in favor of more loans/gifts in the guise of incentives to the well-off corporate sector.

  4. November 7, 2015 at 8:12 am

    Others have pointed out a flaw in this study. The cohort 45-55 has on average gotten older during this time. Basically the increase in death rates can be accounted for by this.

    There is still an issue – why has the fall in death rates stopped? But death rates have not actually increased it seems.

    • graccibros
      November 7, 2015 at 10:59 pm

      I’m sorry innocentthefifth, I don’t fully understand what your are saying because the study is about the causes of death and implied loss of quality of life in this income group and age group…and I’m trying to think of any age group who hasn’t gotten older…”as time goes by.” And the comparison to the same groupings in other nation’s and races in the US, as well as other income categories would seem to nullify what you are saying.

      Perhaps you don’t believe that comparable bad things happened to those industrial workers and areas which were de-industrialized in the 1970’s-1990’s. Like Charles Murray’s “Coming Apart…” I took Murray head-on in a review at Amazon…invaded enemy territory to tell him we couldn’t have lived through the same time period…especially with the statistics I listed for the loss of industrial jobs in Philadelphia…he blamed on the loss of good character among the workers…contrasting “Fishtown” in Philly with an upper middle class neighborhood in Mass.

      Here’s some of the text:

      Who “Done” It? Who Did in the “White Working Class?” They Did It to Themselves, according to Charles Murray.

      Charles Murray’s new book is actually a book about change, how some parts of American society, like the upper middle class residents of Belmont, Massachusetts, have done very well, and others, the working class residents of Fishtown, a neighborhood in Philadelphia, have not. But it’s also, implicitly at least, about causality: a book about “winners and losers” between the years 1960-2010, and he is covering a span of American cultural and economic life which saw enormous changes in both. But which sphere of human activity drove the changes? Murray says it was character changes in the working poor that did them in, while the Belmontians thrived by their retention of the right values. If only, if only, the poorer Philadelphians could have kept the virtues of our “Founding Fathers,” they would have done much better than portrayed here. This, readers, is one gigantic fairy tale, and if the book does not sell well, I’ll personally recommend Murray as an advisor to Colonial Williamsburg or Disneyland – and Mr. Murray – you of course will be “free to choose” which one you fits you the best….

      We can talk about all the other factors contributing to the decline of the work ethic and self-discipline in the blue collar white world, the cultural factors, as Daniel Bell has done in his classic Cultural Contradictions of Capitalism, but let’s leave them out for now: the view of the physical wreckage is enough to convey a sense of what went on…and it’s bad enough just by itself. But I’ll give you the numbers that Murray avoids any mention of in his book, and that Sperling obscures from his high altitude flyover, taken from Walter Licht’s brief but moving little online essay about Philadelphia’s industrial history, with the nostalgic title “Workshop of the World”: in 1953 Philly had 365,500 industrial jobs; by 1977 it was down to 168,400; and by 2008, it was down to 29,800! Here’s the link at […]

      So here’s my take, fellow readers, and citizens. As we look back over our shoulders from the economic wreckage of 2012, and dare we say too, the cultural wreckage, over the time period when Charles Murray says the working class lost its values, we would do ourselves, and the complexities of history, and change, a big favor by asking: what was the relationship between economic change, when we went from a “River-Rouge model” of vertically integrated industrial capitalism, to our contemporary one, the one of “flexible accumulation,” vastly dispersed thanks to the neoliberal model of globalization, where those sturdy blue-collar workers today, if they are lucky, can work at half-the pay – $15 dollars an hour, and far fewer benefits – than their 1970 brothers and sisters did – and cultural change, where the very messages of business through its advertising – messages to all of us – are to spend and consume like there is no tomorrow; and come to think of it, there may well be no tomorrow, for tomorrow your job may be in China. Now, Mr. Murray, that’s a little different perspective – and set of values – than those of the “Founding Fathers,” don’t you think?

      My advice to you though, readers, if you want to begin to unravel why things have gone so badly for those in the middle, and the bottom of our society, then start with Jefferson Cowie’s “Stayin’ Alive,” and then also work in David Harvey’s” The Condition of Postmodernity,” (1990). They’ll fill you in on that complex interaction between economic and cultural change, and the price we all pay for the “inhuman pace” of it.

      That characterization I have taken from Wendell Berry’s 2012 Jefferson Lecture, given right in the face of the Washington establishment on April 23, 2012. I have to wonder if either Gene Sperling or Charles Murray were in attendance, and if they were, what they thought. I can tell you this, though: at least one of Murray’s founding fathers, Thomas Jefferson, would be pretty horrified at the national landscape of today; the one, where, in Berry’s terms, the “nation and its economy will conquer and destroy the country.”

  5. November 9, 2015 at 12:59 pm

    I don’t remember the exact numbers but the percentage of americans on various prescription drugs is very high—maybe from 10 to even 20 percent. Some is due to aging—so as ‘/innocent the fifth’ says one might want to look at age adjusted figures (as is also done for income distribution). If one simply lumps all psychoactive substances together (antidperessants, adhd drugs, illegal drugs, alcohol, maybe coffee, cigarettes, and even some nutritional supplements of the kind ray kurtsweil favors—for mental alertness, life extension, etc.) one does see a sort of culture reminscent of the world of Soma (brave new world) or marx’s opium of the people. (Bryan Ferry argued that ‘love is a drug’ too). (Among the ‘college’ and ‘high achiever’ set apparently there are all kinds of ‘designer drugs’ good for cramming for exams. On the street there are also all kinds –eg K2 which is ‘synthetic marijuana’ . (Its poison too (and deceiving since at first glance one thinks its marijuana. There is a sort of epidemic of this in my area, and its almost impossible to regulate since chemists just change slightly the content everytime it gets regulated—its sort of a ‘red queen game’ familiar from alice in wonderland and evolutionary theory, as well as other arms races).

    Its seems possible this may explain things like political apathy, the rise of donald trump and ben carson, etc. (I heard on the radio a speech by Trump to a college graduating class—he advised them to ‘do what you want’ (rather than get any job—create yourself a good one) and also avoid alcohol (ie dont drink if you go to a Trump casino or resort, though likely it might be ok to make a multibillion dollar business selling alcohol to others—‘eat or be eaten’.) As conservatives say , people often don’t care about income inequality (and alot of this is relative, a la Fred Hirsch or Thorsten Veblen—amazonian indians may not worry about bill gates) but some of this is because they know where to get something to ease any unease they feel. (My area they certainly do—even homeless people find ways to get a few dollars and can, using modern cheap cell phones (4$ plus a monthly bill) get a delivery any time of day or night, usually somewhere on some street corner.)

    (alot of these poor people are also the sort of ‘reserve army of the umemployed—eg all these social science researchers, addiction specialists in hospitals and research centers–can always call them up to do things like raking leaves, a painting job, shoveling snow, etc. since alot of people are willing to do anything to get a few dollars (there is also alot of ‘women’s work’ around here, from the most poor to wealthy college kids trying to avoid student debt).

    Of course, banks also have made money off of the drug trade (laundering money tyo keep it clean). The addiction industry, hollywood and media sensalizations also employ many.

    It may be this is just the way its going to be,. Like war its an industry and also a form of creative destruction. (Much of the music i listen to is probably created under some influence; much of pop culture seems inspired by war, crime, etc. But so was Shakespeare and Homer, and religious books).

  1. No trackbacks yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s