What To Do About “Deaths of Despair”?

I found Nikolas Kristof’s New York Times column, reacting to some unkind remarks about those who’ve died “deaths of despair”:

When my wife and I wrote about my old schoolmates who had died from “deaths of despair,” the reaction was sometimes ugly.

“They killed themselves,” scoffed Jonathan from St. Louis, Mo., in the reader comments. “It was self-inflicted.”

Ajax in Georgia was even harsher: “Natural selection weeding out those less fit for survival.”

Our essay, drawn from our new book, “Tightrope,” explored the disintegration of America’s working class through the kids on my old No. 6 school bus in Yamhill, Ore., particularly my neighbors the Knapps. The five Knapp kids were smart and talented, but Farlan died after years of drug and alcohol abuse, Zealan died in a house fire while passed out drunk, Nathan blew himself up cooking meth, Rogena died of hepatitis after drug use, and Keylan survived partly because he had spent 13 years in the Oregon State Penitentiary.

Working-class men and women like them, of every shade, increasingly are dying of “deaths of despair” — from drugs, alcohol and suicide. That’s why life expectancy in the United States, for the first time in a century, has declined for three years in a row.

Plenty of readers responded with compassion. But there was a prickly scorn from some that deserves a response because it reflects an ideology that underlies so many failed policies. It arises from the myth that we live in a land of limitless opportunity and that those who struggle have simply made “bad choices” and failed to muster “personal responsibility.” Dr. Ben Carson, who grew up poor and black in Detroit and is now the nation’s housing secretary, has described poverty as “more of a choice than anything else.”

a mixture of things with which I agreed and things I didn’t. For example, I agree that it is wrong to dismiss those who have despaired. And consider this passage:

What changed was diminishing access to good jobs, reduced commitment to investment in human capital, a hurricane of addictive drugs (some peddled by the pharmaceutical industry), and the rise of a harsh social narrative that vilified those left behind — a narrative that workers often internalized. Workers lost their dignity and hope, and that exacerbated the spiral of self-medication and self-destruction, of loneliness and despair that swept through my No. 6 bus.

I agree that we aren’t producing enough “good jobs” to provide them for all of the people who are here and all the people who are coming here. But I disagree that we have a “reduced commitment to investment in human capital”, viz.

and

Point to the declines in those graphs. Quite to the contrary they illustrate increases at every level. We spend more on education than nearly any country. We spend more on health care than any other country. Our problem is not a lack of commitment.

I’m unprepared to say that personal responsibility has less to do with the despair than the trend to reduce guilt and shame as motivating forces in our society or than the decline of all institutions other than the government—marriage, family, church, and social institutions of all sorts.

The cure for despair is hope. In my view the most important things the government can do to instill hope is to reverse the many things it has done over the last half century that have produced the present situation including the financialization of the economy, mass immigration, and too great a dependency on imports.