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.