Category Archives: Health

Insecure People are a template for disaster

As Astra Taylor says in her 2023 CBC Massey Lectures, this is the age of insecurity.

Charles E. Moore a physician and the Chief of Service Otolaryngology at the Grady Health System points out that for African Americans who have always had a lower life expectancy than comparable whites, it is significant that they have always had chronic stress. The life expectancies of African-Americans have been rising slightly while that of white working-class people has been declining.  He suggests that this might be because whites experiencing stress is something new.

Yet African-American life expectancies are still 3 &1/2 years less than whites. But the gap is closing. Dr. Moore also operates a clinic in Atlanta.  He says you can expect a 12-year difference in life expectancy between the African-Americans he largely treats and the whites that live north of Atlanta. All you have to do is look at their zip codes and you know the story. It is that simple.

Many of his patients have to choose between medication and food, or medication and gas. Those are some tough choices they have to make. That generates a lot of stress.

People who have been laid off from their jobs often blame greed. Often, they believe compassion is lost from society. It is all just about money. The pain they feel can easily turn to despair. Many of the people thought they had job security and then they got laid off. Many times they had committed to buying houses they thought they could afford because they had job security. Then they found out the hard way that they had no security. Those people have suffered. It is even worse when they continually hear that the economy is improving. Laid off people don’t see that. Insecure people don’t see that. Many people don’t see that.

Many of such people find the stress intolerable and turn to suicide. As Dr. Gupta said, “In the United States more people die by suicide with a hand gun than die by homicide with a hand gun. It’s gone up 30% in the last 17 years.”

Dr. Gupta believes that the problem is ultimately expectations. Many people in the United States and Canada for that matter believe that if you just work hard enough everything will work out fine. “Those dashed expectations end up being a unique and toxic feature here. The headline is that stress kills.

As Dr. Rajita Sinha, a Clinical Neuroscientist and Director of the Yale Stress Center said, “Stress is everywhere. We are drinking more. We were smoking more before we had social interventions; we have a massive obesity epidemic, and we have economic and economic stress. So we have the stage for uncontrollable chronic stress.” That is a template for disaster.

It is also a template for a declining society. That is really the point I am trying to make.

The Meaning of Life under Stress

“The meaningfulness of the working-class life seems to have evaporated,” Angus Deaton, the Nobel Prize-winning economist, told Dr. Sanjaya Gupta. “The economy just seems to have stopped delivering for these people.” Deaton and Anne Case coined the term “deaths of despair” to describe the surge of mortality from alcohol, drugs and suicide.

In the end of the second decade of the 21st century everyone seems to think the economy is improving, but all these working class people see are plants closing and jobs disappearing. The economy may be booming but they don’t see that for themselves. Everyone else seems to be doing well. The economy may be booming now but so many people are still left behind. These people feel deep resentment. These people feel betrayed. They don’t think America is great. They want it to be great again like it was. And resentment is a powerful and explosive force!

What do you do when the plant you have worked at for decades shuts down? It is tough. It is also tough on those who work in other plants. They can see that this might happen to them too.  That makes people feel uneasy. They are insecure and stressed. And this has happened over and over again in many sectors. Economic insecurity has become rampant.

The key is the lack of control that leads to stress. How much does your job or your status affect your health? There was a famous study out of England called the Whitehall Study that was one of the first that tried to dig into this issue.

Sir Michael Marmot an epidemiologist from University College in England was involved in that study. He said when his study started everybody “knew” that stress caused heart disease. And everybody “knew” that high status people had more stress. It was obvious to everyone. I knew as a lawyer in what I always thought was a high stress profession that I had much more stress than most other people. Then one day I read a report in a newspaper about stress. It might have been a report about the Whitehall Study in fact. It said legal secretaries had more stress than lawyers. How could that be? Yet the study revealed that among civil servants at least the lower your status the shorter your life expectancy. Lack of control at work increases heart disease, mental illness and muscularly skeletal disorders. That is what chronic stress is all about.

As Professor Marmot said, “So close the link between social circumstances and mental health gives us a measure of how well we are doing as a society.”

Insecurity leads to stress which leads to poor health. This is a dangerous path that so many of us are walking and it can transform our lives sometimes in very unpleasant ways.

Anne Case and Angus Deacon: Deaths of Despair

Dr. Sanjay Gupta for his HBO special and Nicholas Kristof and Cheryl WuDunn for the New York Times, all interviewed Anne Case and her husband Angus Deacon. Both of them are economists from Princeton University but we won’t hold that against them. As she said, “Whites are reporting poorer and poorer health, more and more pain, and more and more social isolation. More depression. Along with this increase in mortality from drugs, alcohol, suicide there is just a lot more morbidity, pain, and social isolation.” Anne Case came up with the expression “deaths of despair” and it has become very popular.

Anne Case and Angus Deaton, conducted an important study of mortality and wrote the book, Mortality and Morbidity in the 21st Century. Dr. Gupta interviewed them for the television show. In that book they described “deaths of despair” as “death by drugs, alcohol and suicide.” According to them, so many people have died from deaths of despair to equal all the people who have died of AIDs since the beginning of the AIDs crisis. Those deaths were enough to cause life expectancy to fall first for whites and then for the entire population. That is a very unusual event.

These people were the children of the people that won the world war and were expected to live glorious lives in the land of the free and the brave. The parents expected their children to do even better than they did. Those expectations were often not met. As Deaton put it, “They were promised the earth but they did not inherit it.” Case said, “in every state but 2, cirrhosis of the liver and alcoholic liver disease went up. And in every state drug poisoning went up. In every state between 1999 and 2015 suicide rates went up for people aged 22 to 64. If you treat people in a really shabby way for long enough bad things happen to them. That happened to African Americans forever and it started to happen to whites with a High School degree or less, starting probably in the mid-seventies. And now bad things are happening to both of those groups.

Dr. Gupta that if we wanted to know the effects of economic decline all we had to do was visit the American Rust Belt.  There they produced more steel than the rest of the world put together. 24 hours a day, 7 days a week smog from those plants went into the atmosphere of American cities.

Swissvale Pennsylvania , according to Eric Horgos, is the valley that is  “the epicenter of the greatest industrial collapse in the entire developed world in the 1980s. 1983 is when economic Armageddon hit them.”

Is it surprising that people who lived a certain way that they liked for 30 years and then had the rug pulled out from under them wanted to commit suicide? Is it any wonder they turned to alcohol or drugs? Is it any wonder that they despaired? Is it any wonder that they gave up on politicians that that they had once respected, and then turned instead to a demagogue?

Constant Change

 

Americans, like Canadians, are living in a world that is changing faster than ever before. And that is change is constant. As a friend of mine always says, ‘Change is the only constant”.  And such constant change can be stressful.

There are all kinds of health problems out there. I know some of them too personally for my taste. People are obese.  It is astonishing how obese people are in the richest nation on earth. In Arizona where I spend a lot of time in recent years, we see it all the time. People have heart conditions. They have cancers. Yet, there is something harder to define. What Dr. Sanjay Gupta called the “real state of stress” in his HBO special.

And everyone wants a pill to solve their health problems. People want quick solutions to their problems. So do I of course. Americans take more drugs than the people of any other country on earth. And Canada is not far behind. Those drugs served a really useful purpose. They can save lives. They can ease pain. Yet, as Dr. Gupta pointed out, in the US  “50 people die every day from prescription pain killers!

Shown on Dr. Gupta’s special, Angela Glass was a mother in Victoria Texas. She knew that stress can be ugly. It can cause issues in every area of your life. Wherever you already have problems, stress can make them worse. Stress compounds the problem. Angela was prescribed a huge cocktail of drugs every day for her stress. She took pain medication–hydrocodone. She took other drugs for anxiety.  Things got worse. She lost a child. She took way more drugs than she was supposed to. She had suicidal thoughts. She considered taking all her pills and ending the pain once and for all. She couldn’t sleep. She was haunted. How many Americans and Canadians have been led down this path to drug dependence? How many Americans and Canadians have died as a result? In one year more Americans died from drug over doses than died in the entire Vietnam War! Since that happened in the United States, it has happened again!

 

Dr. Gupta believes that all this chronic stress, the pain which comes with the stress, and the desire to make that pain go away have combined to create a toxic brew that is destroying America and Canada. Many take medications even when they know it could take their lives.

This is dangerous stuff.

Chronic Stress

 

As Dr. Sanjay Gupta pointed out, in his CNN special, One Nation Under Stress,  in the United States, the self-proclaimed leader of the Free World,  “we are 4.7% of the world’s population and take 80 to 90% of the world’s OxyContin and hydrocodone. And I’m pretty sure that we don’t have 80-90% of the world’s pain.” How could this happen in the richest country in the world?

Another thing is that epidemic of drugs is mostly affecting whites aged 35 to 55. Stress should be listed as a contributing cause to many deaths. Why whites? Why so much stress in the richest country in the world?

Stress of course is a natural phenomenon.  As Robert Sapolsky, a neuroscientist from Stanford University said,

 “When you look at the stress hormones we secrete exactly the same chemicals as a lizard and a fish and a bird. This is ancient, ancient biology. For 99% of the beasts out there what stress is about is 3 minutes of some screaming crisis when somebody is very intent on eating you or you are very intent on eating somebody, and everything your body does at that time makes perfect sense. You increase your heart rate, your blood pressure, your breathing rate, you turn off everything that is not essential and you shut down growth, tissue repair. When a lion is chasing you and you are running for your life and one of the things you are doing is all sorts of metabolic stuff to divert energy to your thigh muscles. Oh my god you think you only have 3 months until your taxes are due and you divert energy to your thigh muscles. That makes no sense whatsoever and that’s where you pay the price.”

 

Robert Sapolsky who wrote a book Why Zebras Don’t Get Ulcers points out that when a lion is chasing a zebra it needs stress to get away. Stress is entirely good in that situation. Yet once the zebra gets away the stress level returns to normal. That also happens quite quickly. Life is good again. The zebra relaxes. The stress was entirely good.  It saved the zebra’s lie.

As Dr. Gupta said, “Stress is not the enemy. It’s the constant never-ending toxic stress–that’s the stress that’ll kill you.” Chronic stress in other words is what we should be stressed out about. Sapolsky says he has learned a lot about stress from the baboon world. What he learned is,

“What makes psychological stress really corrosive is lack of control, lack of predictability, lack of social support. You might say insecurity is the problem. If you are chronically stressed you will chronically increase your blood pressure and you are going to get more liquid turbulence into your blood vessels and hit the walls. They pound the walls and they cause microscopic bits of scarring, tearing, and inflammation there. And you get plaques and you get the whole cascade there. It’s a fairly straight biological line from chronic stress to your blood pressure that is chronically elevated. It’s a much more indirect route to liver sclerosis.”

 

 

Sapolsky was convinced that stress is the common cause of liver sclerosis, suicides, and opioid overdose.  They are all related. Stress is the root problem, he is convinced. “Our lives are more psychologically corroded by stress. Stress: am I valued? Stress: do I have a meaningful place in the community? Stress: is there even a community I can rely upon. Stress: why am I here?”

Note all these questions point to social issues. This is what chronic stress is all about.

Chronic Stress

 

As Dr. Sajay Gupta pointed out on his HBO documentary, in the United States, the self-proclaimed leader of the Free World,  “we are 4.7% of the world’s population and take 80 to 90% of the world’s OxyContin and hydrocodone. And I’m pretty sure that we don’t have 80-90% of the world’s pain.” Another thing is that epidemic of drugs is mostly affecting whites aged 35 to 55. Stress should be listed as a contributing cause to many deaths. Why whites?

Stress of course is a natural phenomenon.  As Robert Sapolsky, a neuroscientist from Stanford University said,

” When you look at the stress hormones we secrete exactly the same chemicals as a lizard and a fish and a bird. This is ancient, ancient biology. For 99% of the beasts out there what stress is about is 3 minutes of some screaming crisis when somebody is very intent on eating you or you are very intent on eating somebody, and everything your body does at that time makes perfect sense. You increase your heart rate, your blood pressure, your breathing rate, you turn off everything that is not essential and you shut down growth, tissue repair. When a lion is chasing you and you are running for your life and one of the things you are doing is all sorts of metabolic stuff to divert energy to your thigh muscles. Oh my god you think you only have 3 months until your taxes are due and you divert energy to your thigh muscles. That makes no sense whatsoever and that’s where you pay the price.”

 

Robert Sapolsky who wrote a book Why Zebras Don’t Get Ulcers points out that when a lion is chasing a zebra it needs stress to get away. Stress is entirely good in that situation. Yet once the zebra gets away the stress level returns to normal. That also happens quite quickly. Life is good again. The zebra relaxes. The stress was entirely good.  It saved the zebra’s lie.

As Dr. Gupta said, “Stress is not the enemy. It’s the constant never-ending toxic stress–that’s the stress that’ll kill you.” Chronic stress in other words is what we should be stressed out about. Sapolsky says he has learned a lot about stress from the baboon world. What he learned is “What makes psychological stress really corrosive is lack of control, lack of predictability, lack of social support. If you are chronically stressed you will chronically increase your blood pressure and you are going to get more liquid turbulence into your blood vessels and hit the walls. They pound the walls and they cause microscopic bits of scarring, tearing, and inflammation there. And you get plaques and you get the whole cascade there. It’s a fairly straight biological line from chronic stress to your blood pressure that is chronically elevated. It’s a much more indirect route to liver sclerosis.”

Sapolsky was convinced that stress is the common cause of liver sclerosis, suicides, and opioid overdose.  They are all related. Stress is the root problem, he is convinced. “Our lives are more psychologically corroded by stress. Stress: am I valued? Stress: do I have a meaningful place in the community? Stress: is there even a community I can rely upon. Stress: why am I here?” Note all these questions point to social issues.

 

Epidemic of Despair  

 

When Dr. Sanjay Gupta, who besides being a physician is also a periodic commentator on CNN  first started looking at the deaths in the white middle class that included deaths by opioid overdose, suicide, cirrhosis of the liver, it felt a bit mysterious. He was struck by the numbers but did not really understand the causes. It took some time for him to piece things together.

 

He found an interesting article with an interesting title. This was “The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999-2015” published by Elizabeth Stein, MD. MS, Keith P Gennuso, PhD, […] and Patrick Remington, MD MPH in the medical journal American Journal of Public Health. An epidemic of despair? That is very strong language? Is it justified? Gupta wanted to know. So did I.

Dr. Gupta wanted to know, ‘what causes those deaths of despair?’ That is an important question. He was not satisfied with the medical causes of death. He wanted to know ‘the cause of the cause.’ He, like me, thought that was a much more significant question. But this one is harder to tackle.

Why are people taking so many opioids?  Why are they becoming addicted? Part of it is overprescribing for which physicians are responsible. Why are so many people drinking to excess? Why are so many people dying of suicide. Is there a common cause of the cause?

As Neurosurgery Resident Kumar Vasudevan put it, “We are living in a time in which we are very, very good at treating diseases, we are less good and less proficient at understanding health.”  I would add, that many of us are reluctant to look at social causes, and, believe it or not, political causes. Is that possible?

As Dr. Gupta said, “deaths of despair seem to be a symptom of an underlying problem, rather than the problem itself.” Cyril Wecht believes that the underlying problem is that American society is increasingly stressed. Pressures make lives more and more difficult. Pressures of making a living, depersonalization, families breaking up, and what he calls the “robotization of society.”

But there were also things that happened on the side of medicine. The idea began to flourish that people should not have to suffer. If they suffer that was seen as a failure of medicine. There always seem to be simple solutions–write a prescription. Drugs can take care of any problem. But simple solutions are often the most dangerous. And prescriptions were one of them.

Of course there is more to it than this. Let’s look farther.

Is Social Liberalism the problem?

 

I am still looking at the issue of why there are so many youth suicides. What happened?

Ross Douthat of the New York Times thinks Jonathan Haidt, the social psychologist, did not go far enough. He should have looked more at the society into which this new technology fell. Douthat said this:

“One answer is that social media entered into a world that was experiencing the triumph of a certain kind of social liberalism, which the new tech subjected to a stress test that it has conspicuously failed.”

 

We must realize that by “social liberalism” he did not mean exactly what you might think. He is not talking about the woke culture that Republicans are currently constantly criticizing. He does not think anti-racism or diversity equity inclusion (‘DEI’) is the real problem. He thinks it is the liberalism that preceded it—the individualism of the 1960s that included secularization, which replaced the decline of religion in the 2000s. From Douthat’s point of view, which is clearly Christian and conservative, (though not in the Trumpian sense), is that social and sexual permissiveness, widespread and open pre-marital sex, out-of-wedlock child rearing, and marijuana use all contributed to the problem. I would point out that Douthat has not backed up his claims with the rigorous kind of evidence Haidt did, but his ideas have some attraction. All of those factors which might even have been morally justified and rational, might very well have contributed to the moral instability of youth, particularly young girls.

Douthat saw such liberalism this way:

“All of which has made social liberalism look much more unsustainable and self-undermining than it did in 2008. It’s threatened not just by political radicalism and returning disorder, but by a collapse of familial and romantic and even sexual connection, a terrible atomization and existential dread, a chasing after ever stranger gods.

These modern technologies fell on soil that was fertile to growing insecurity and anxiety and thus wrecked havoc on our youth. Freedom can be difficult for anyone, let alone youth and children.  They needed a moral foundation to support these liberal freedoms, which was often absent as parents did not know how to supply them, often relying solely on religious teachings and dogma that were not always adequate for the purpose. This combination of new exciting technologies, exhilarating freedom, and dubious religious instructions did not give youth the solid grounding they needed. Freedom alone can be hell.

Douthat concluded this way:

“If you were comfortable with the world of the early Obama years, it makes a lot of sense to focus on the technological shock that brought us to this place, to lament and attempt to alter its effects.

But those effects should also yield a deeper scrutiny as well — because what looked stable and successful 15 years ago now looks more like a hollowed-out tree standing only because the winds were mild, and waiting for the iPhone to be swung, gleaming, like an ax raised with less family stability and weak attachments to religion, with a strong emphasis on self-creation and a strong hostility to “normativity” — to enter and forge a new social world. And they went forth and created the online world we know today, with its pinball motion between extremes of toxic narcissism and the solidarity of the mob, its therapy-speak unmoored from real community, its conspiracism and ideological crazes, its mimetic misery and despairing catastrophism.”

 

I think Douthat’s analysis provides some helpful supplements to Haidt’s scientific analysis. In other words, in my view, new technologies, new freedoms without a solid moral foundation is what left youth unanchored, and weak religious teachings combined to create the debacle of the 2010s. And sadly, that all started a chain reaction which has fed a steady stream of youth suicides. And we are not over it yet.

Why are North American Teens Miserable?

 

I have already commented on a big problem with youth in North America. In particular, I referred to significant work done by Jonathan Haidt and his team of researchers. Unfortunately, there is more to say on th e issue.  It is time to meander back.

Based on the recent CDC Youth Risk Report Ross Douthat commented as follows in the New York Times:

“American teenagers, and especially American teenage girls, are increasingly miserable: more likely to entertain suicidal thoughts and act on them, more likely to experience depression, more likely to feel beset by “persistent feelings of sadness or hopelessness.”

 

We must remember that every generation worries about and complains about the generation that follows them. My parents did, I did it, and my kids will do it. The next generation is never considered as good as our generation. The only other thing we like to blame as much as the youth is modern technology. Yet now, perhaps surprisingly, at least there is some evidence to support this worry.

 

Jonathan Haidt a leading social psychological researcher has done extensive scientific study on the issue of what is happening to our youth. He has testified about it to the United States Senate. He bases his statements on scientific evidence, not bias. He has shown that based on many indicators there has been a severe darkening of the mental health of youth occurred in the early 2010s. These, of course, in the US were the Obama years. His research lab has actually pinned it down to that time. He saw a worrying change that has continued to the present.

 

Haidt bases his claims on the fact that this is exactly the same time when social media changed significantly.  I have seen the effects of social media on young girls and it is not pretty. Ross Douthat who concurs with Haidt said, “The timing of the mental health trend fits the smartphone’s increasing substitution for in-person socialization.” Douthat also said this:

“Then data aside, having lived through the online revolution as both a participant and a parent, it seems obvious that social media has worsened the coming-of-age experience relative to the halcyon 1990s — creating a “sense of another consciousness that’s welded to your own consciousness and has its own say all the time,” as my fellow teenager-of-the-’90s Freddie DeBoer wrote recently, which makes the general self-consciousness of adolescence feel much more brutal.”

 

It has always been tough being a teen.  But social media has greatly exacerbated the problem. This problem is not confined to the United States. Similar evidence of severe mental health issues have been seen in Canada and throughout the west.  I think this indicates  a severe decline in the west.

Social Cancer

 

Nicholas Kristof and Sheryl WuDunn writing in the New York Times in 2020 said there was “a cancer growing at the heart of the nation.” They meant the USA of course, but really as Jonathan Haidt showed it goes much wider than that. I clearly includes Canada and other countries such as the UK and Australia.

It is that social “cancer” that I want to look at. To do that, I must find it. That may not be easy.

Kristof and WuDunn have a suggestion of where to look:

We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation. Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.” [They wrote this in 2020]

 

I had heard that expression before. I think it was another physician, Dr. Sanjay Gupta. Dr. Gupta is both a physician and a television medical analyst. He had some very interesting things to say on a fascinating television documentary.

 

The trigger for Dr. Gupta’s documentary  was another startling fact that as far as I was concerned had gone under the radar. As he said, “In the 1960s Americans had among the highest life expectancy in the world. Today [2019] the U.S. ranks at the bottom of major developed nations.”

In that documentary, Dr. Gupta interviewed another physician a forensic pathologist Dr. Cyril Wecht, in Greenburg Pennsylvania, who said “the previous year I did 356 autopsies. Of those more than 300 were drug deaths. And this is what is being experienced throughout the country.” He also said, “this is far greater than what we experienced with AIDs. It is a very significant epidemic of monstrous proportions.” As Dr. Sanjay Gupta said, “what we are dealing with in fentanyl is 50 times stronger than heroin.” Drugs are part of the problem, but I actually think they are more a symptom than the cause. I will post more about this in the future. It is a fascinating issue.

As Dr. Gupta said, “In the United States life expectancy is dropping faster than any other demographic in the world.” According to the Center for Disease Control, “Middle-aged whites are the highest increase in the deaths of despair.” This group also has very high rates of drug overdose. Whites?  Who would have thought that?

What is going on here? That is what we must figure out. What is the cancer at the heart of the United States and Canada?