opioid epidemic | Antilogicalism

David V. Johnson | Blog of the APA

Last April, Princeton University economists and married partners Anne Case and Sir Angus Deaton delivered the Tanner Lectures on Human Values at Stanford University. The title of their talks, “Deaths of Despair and the Future of Capitalism,” is also the provisional name of their forthcoming book, to be published in 2020.

The couple’s research has focused on disturbing mortality data for a specific demographic: white non-Hispanic Americans without college degrees. This century, they have been dying at alarming rates from what Case and Deaton call “deaths of despair,” which cover suicide, alcohol-related disease, and drug overdoses (primarily driven by opioids). These deaths have, along with US obesity, heart disease, and cancer rates, contributed to a shocking recent decline in US life expectancy for three straight years—something which hasn’t happened since World War I and the 1918 Spanish flu pandemic. The rates for “deaths of despair” are not as high for college-educated whites or for other racial minorities, and there are many potential economic and sociological reasons for this.

Case and Deaton’s research raises important questions for the US political economy and the legacy of neoliberalism. But I am more interested in the framing of the mortality statistics as “deaths of despair.” Assume for the sake of argument that a large segment of the US population—non-Hispanic white Americans without college degrees—are suffering despair. What does it mean to say this?

We can gain some insight by contrasting its opposite, hope, which has received a lot of philosophical attention for the puzzles it raises about rationality and agency. Hope is a forward-looking emotion with cognitive and desiderative elements. We hope for things that are possible in the future (we don’t hope for the impossible or the certain), which means we make a judgement about their possibility. And when we hope for them, we desire for them to come about, and this desire can motivate our action if we think our acting can help bring it about. Is it rational to hope for something that has a miniscule chance of happening, and if so, under what circumstances? And when is it rational to act based on hope? Much ink has been spilt on these questions.

Philosophers have also thought about hopefulness—about hope as an emotional tendency or character trait that undergirds agency. People who are hopeful or optimistic are generally better able to pursue their plans and succeed, which gives the adoption of a hopeful outlook a pragmatic justification. One could argue that some minimal level of hopefulness is requisite for anyone to plan, act, and live one’s life, insofar as these involve forward-looking judgments and desires that are characteristic of hope.

We can see why despair, as a condition opposed to hope and hopefulness, can be such a debilitating state of mind. Despair undermines agency. The despairing person may conceive of plans and goals but feel that he is so unlikely to achieve them that they are not worth the investment of time and energy, or that even if he does achieve them, it won’t make a substantive difference to his life. So despair undermines the requisite motivation to pursue our plans and goals. A despairing person tends to passivity, to go along with the flow of life and focus on getting by, making due, and assuaging pain and foreboding however she can at the moment.

But despair—or at least the sort of despair I identify in Case and Deaton’s analysis—has a very different structure from hope. If despair were structurally like hope, then it would also be a forward-looking emotion with the appropriate cognitive and desiderative elements. We would be in a state of despair if we believed there was something that could possibly happen in the future that we do not want to have happen, so much so that its possibility gives us anguish and depresses us, to the point that we have difficulty summoning the motivation to avoid it or to go about our lives generally. To be sure, there are forms of despair that are like this. If my boss gives me a poor performance review and warns that I may be subject to termination, and the livelihood of my family depends upon my employment, this may send me into despair. I see my future firing as possible and something I desperately want to avoid, to the point of anxiety and depression. My despondent feelings may undermine my ability to perform better, making my firing even more likely. I may also have trouble living my life in general due to my negative feelings. I may struggle to talk to my spouse about her day or plan my daughter’s after-school activities.

But there is another form of despair that is not like this. This kind of despair is not forward looking, per se, but rather focused narrowly on the present. It sees the present as dark, dreary, painful, and uninteresting, and anticipates this state of consciousness to extend indefinitely into the future. It’s the feeling of unrelenting misery and ennui. No one wants to feel like this, but the person who despairs in this way does not form the desire to avoid it, or is not motivated by such a desire, because he does not see a means of escape or because the present sense of pain and dreariness is so overwhelming that it disrupts his ability to imagine such means. This form of despair is what Case and Deaton have in mind: people who have not only lost the will to live—i.e. to direct their lives, make plans, pursue them—but are so miserable and distressed that they either die by suicide or self-medicate with drugs and binge drinking to lessen their immediate pain, and do so as a way of slowly dying by suicide. It is the constant feeling associated with present consciousness that life is bad, and that it will continue to be bad indefinitely into the future. A sizable portion of the American public feels this way.

Case and Deaton’s appeal to despair, if we understand it correctly, should shock us. The prevalence of despair represents a horrific communal collapse. It goes well beyond statistics of poor welfare outcomes that alarm economists. It is about the obliteration of human lives—the undermining of the very basis of living a life, the ability to enjoy experience moment to moment, have enough peace of mind and stability to anticipate the future, make plans, and pursue them. It is nothing less than a humanitarian crisis.

David V. Johnson is the public philosophy editor of the APA Blog and deputy editor of Stanford Social Innovation Review. He is a former philosophy professor turned journalist with more than a decade of experience as an editor and writer. Previously, he was senior opinion editor at Al Jazeera America, where he edited the op-ed section of the news channel’s website. Earlier in his career, he served as online editor at Boston Review and research editor at San Francisco magazine the year it won a National Magazine Award for general excellence. He has written for The New York Times, USA Today, The New Republic, Bookforum, Aeon, Dissent, and The Baffler, among other publications.

This article was republished with the permission of the APA Blog and the author. View the original article here.

From Wikipedia, the free encyclopedia

The diseases of despair are three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic outlook is bleak. The three disease types are drug overdose (including alcohol overdose), suicide, and alcoholic liver disease.

Diseases of despair, and the resulting deaths of despair, are high in the Appalachia region of the United States. The prevalence increased markedly during the first decades of the 21st century, especially among middle-aged and older working-class white Americans. It gained media attention because of its connection to the opioid epidemic.

Risk Factors

Although addiction and depression affect people of every age, every race, and every demographic group, the excess mortality and morbidity from diseases of despair affects a smaller group. In the US, the group most affected by these diseases of despair are non-Hispanic white men and women who have not attended university. Compared to previous generations, this group is less likely to be married, less likely to be working, less likely to be able to provide for their families, and more likely to report physical pain, overall poor health, and mental health problems, such as depression.

Causes

The factors that seem to exacerbate diseases of despair are not fully known, but they are generally recognized as including a worsening of economic inequality and feeling of hopelessness about personal financial success. This can take many forms and appear in different situations. For example, people feel inadequate and disadvantaged when products are marketed to them as being important, but these products repeatedly prove to be unaffordable for them. The overall loss of employment in affected geographic regions and the worsening of pay and working conditions along with the decline of labor unions is a widely hypothesized factor.

The changes in the labor market also affect social connections that might otherwise provide protection, as people at risk for this problem are less likely to get married, more likely to get divorced, and more likely to experience social isolation. Economists Anne Case and Angus Deaton argue that the ultimate cause is the sense that life is meaningless, unsatisfying, or unfulfilling, rather than strictly the basic economic security that makes these higher-order feelings more likely.

Diseases of despair differ from diseases of poverty because poverty itself is not the central factor. Groups of impoverished people with a sense that their lives or their children’s lives will improve are not affected as much by diseases of despair. Instead, this affects people who have little reason to believe that the future will be better. As a result, this problem is distributed unevenly. For example, affecting working-class people in the United States more than working-class people in Europe, even when the European economy was weaker. It also affects white people more than racially disadvantaged groups, possibly because working-class white people are more likely to believe that they are not doing better than their parents did, while non-white people in similar economic situations are more likely to believe that they are better off than their parents.

Effects

Starting in 1998, a rise in deaths of despair has resulted in an unexpected increase in the number of middle-aged white Americans dying (the age-specific mortality rate). By 2014, the increasing number of deaths of despair had resulted in a drop in overall life expectancy. Anne Case and Angus Deaton propose that the increase in mid-life mortality is the result of cumulative disadvantages that occurred over decades and that solving it will require patience and perseverance for many years, rather than a quick fix that produces immediate results.

Terminology

The name disease of despair has been criticized for being unfair to the people who are adversely affected by social and economic forces beyond their control, and for underplaying the role of specific drugs, such as OxyContin, in increasing deaths.

References

Cunningham, Paige Winfield (30 October 2017). “Appalachian death from drug overdoses far outpace nation’s”. The Washington Post.

Danny, Dorling (2015-06-03). Injustice (revised edition): Why social inequality still persists. Policy Press. ISBN 9781447320777. “Part of the mechanism behind the worldwide rise in diseases of despair is suggested, with evidence provided below, to be the anxiety caused when particular forms of competition are enhanced… The effects of the advertising industry in making both adults, and especially children, feel inadequate, are also documented here.”

McGreal, Chris. American overdose: The opioid tragedy in three acts (First ed.). New York, NY. pp. 109–112. ISBN 9781610398619. OCLC 1039238075.

Case, Anne; Deaton, Angus (Spring 2017). “Mortality and Morbidity in the 21st Century”. Brookings Papers on Economic Activity.

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The Humanitarian Crisis of Deaths of Despair