On November 2, 2015 an article in the New York Times reported on a study which revealed that the annual death rate among middle aged non college educated White Americans, both among men and women, ages 45-54 is skyrocketing. Only mortality due to the AIDS epidemic in contemporary times has been comparable. Death rates among Hispanics and African Americans have continued to fall, and internationally the death rate for this age cohort has declined by 30%. The cause of this rising death rate is an epidemic of suicides, overdoses of heroin and prescription opioids, alcohol poisoning and alcoholic liver disease.
The increase in annual death rate rose in parallel with higher levels of emotional distress, physical pain and poor health. A third of the study participants reported chronic joint pain, and one in seven reported sciatica. Those with the least education reported the most pain, the worst general health and the most financial distress. Many reported inability to work, social isolation, physical difficulty shopping, and even trouble walking two blocks.
No one yet really knows why this is happening, and many now have weighed in, speculating about the reasons. That is why I called this statistic a Rorschach, because it is like a projective inkblot test. Subjects interpret the stimulus according to their own psychology and preoccupations.
The following are some of the explanations:
- “The Department of Health and Human Services report identified a number of factors, “such as provider clinical practices; insufficient oversight to curb inappropriate prescribing; insurance and pharmacy benefit policies; and a belief by many people that prescription drugs are not dangerous, which is associated with increased use.” Of course, economic insecurity and stress may also have played an important role in driving the underlying demand for these drugs. Indeed, Skinner suggested to the Washington Post that the combination of an increasingly pessimistic worldview among white working-class Americans and the sudden availability of opioids had produced “this kind of perfect storm of adverse outcomes.”” John Cassidy: The New Yorker
- “A study in the journal JAMA Psychiatry last year reported that 90 percent of the people who tried heroin for the first time in the last decade were white. Three-quarters said they were introduced to heroin through the use of prescription drugs”. Bernstein and Achenbach: The Washington Post
- White middle aged Americans have lost the narrative of their lives — meaning something like a loss of hope, a loss of expectations of progress. Though African Americans as a group are still worse off overall, their quality of life has improved over the past several decades. When Hispanics look back, they may look back to where they came from, or what their parents or grandparents had. This particular group of middle-aged white Americans may have had higher expectations than others when it comes to steady employment and a bright future, and the stress of losing that could well be driving their deadly behaviors. The white non-Hispanics may be more susceptible to despair, and perhaps to the alcohol or drug ‘solution,’ especially those with less education. Angus Deaton (co-author of the study): Vox
I work part time as a psychiatric consultant at an insurance company. In this role I review medical records, speak with psychiatrists, primary care doctors and therapists, and write reports offering an opinion about the appropriateness of the treatment, the legitimacy and extent of psychiatric disability, and advise about duration of restrictions and limitations to occupational functioning. This job has given me a grim window into the misguided conventional medical care of patients around the country. I see so much despair, frustration and loneliness reflected in those voluminous, repetitive and impersonal electronic medical records.
Most of the psychiatric claims that I review involve patients who are also suffering from inflammatory illnesses, such as arthritis, irritable bowel, asthma, dermatologic and neurologic conditions. They also typically have chronic health conditions such as heart disease, hypertension, reflux and diabetes, and are treated with multiple prescription medications, not to mention psychiatric medications to address their depression and anxiety and attentional problems. Many are also prescribed opioid pain medication. It is not uncommon that someone will be taking 15 different prescription medications.
There is almost no discussion of diet or exercise, just a new prescription for every symptom, with another prescription to treat side effects. Pain medication is routinely prescribed for back problems or joint problems, which often actually results in heightened sensitivity to pain and eventual addiction. A much more effective and appropriate approach would be physical therapy.
It seems like the less educated the patient, the more likely they are to follow doctors’ orders, to be without the requisite knowledge or confidence to question medical recommendations, or to seek alternative treatments. They are more vulnerable to advertising because they have not been taught to think critically. They know little about the connection between food and health, are more likely to buy cheap processed foods, or to know how to minimize their exposure to toxic household cleaning or personal care products. They are toxic and inflamed, and feel sick, tired, depressed and in pain.
The psychotherapy that is practiced is primarily teaching coping skills. It is not uncommon that a therapist knows next to nothing about their patient’s history or who they are as a person, their hopes and dreams. Patients are taught relaxation techniques. And forget about any discussion of their spiritual lives. These poor souls cannot stand how they feel, and numb their misery with alcohol and narcotics. The lack of possibility of relief from their suffering leaves them feeling cut off from love and hope, desperate and alone, and thus vulnerable to suicide. And their medical care often makes things worse.
It sounds outrageous, but I wonder if lack of access to conventional medical care is actually a protective factor, as the standard treatment is so often toxic.
This is my response to the Rorschach of why so many poorly educated white middle aged Americans are dying. I would be really interested to hear from you, my readers, about your take on the reasons for this public health crisis.
Here is a clip from “All Things Considered” about this much discussed study.