In their forthcoming book Deaths of Despair and the Future of Capitalism Anne Case and Angus Deaton, a wife-and-husband team of Princeton economists, explore the causes for the alarming rise in middle-aged white Americans’ deaths of despair by suicide, drugs, or alcohol poisoning.
In their 2017 paper Mortality and Morbidity in the 21st century, they had compared America’s despair with other rich countries' hopefulness (graph above). Their other staggering observation was that while US progress on cancer was on par with its peers, it has made mediocre relative progress on heart disease deaths - which are linked to hypertension and hence intimately connected with stress. These health issues touch so many, that despite spending more on health per capita than any other country, America’s life expectancy still stagnates at 78 years - it even declined for three consecutive years between 2014 and 2017 - while other rich countries’ soar above 80.
The increase in deaths of despair is not a recent phenomenon due to the opioid crisis. It has been increasing with every age cohort since the 1950s. A similar birth cohort increase in psychopathology has been observed in another long term study of young Americans. Case and Deaton’s tentative explanation in 2017 was that it is triggered by worsening labor market opportunities. In their upcoming book they explore additional culprits in the health and educational systems.
They emphasize the fact that fatalities are higher in people with lower educational attainment. I see correlation but not causation. It hardly seems surprising that a nervous system that operates in ways that shorten life - with a fast killing or a slow poisoning - would also have difficulty committing to a long-term effortful pursuit with increasingly uncertain rewards.
I am surprised they make no mention of nurturance. With everything modern neuroscience and psychology is teaching us about the critical effect of responsive relationships on the developing child, it would seem that the emotional distress that their data screams should lead us to consider the upbringing conditions in which these children were shaped.
My thesis is that the alarming recent rise in deaths of despair is at least in part due to the dramatic collapse in children’s upbringing conditions since the 1960s.
This collapse has been steepest for children whose school struggles - the most important indicator of mental and emotional development in childhood - failed to mobilize sufficient resources to restore their trajectories, thus putting their pursuit of a higher education degree beyond reach. Note that although those children are often from low SES households, children of immigrant families whose cultures emphasize education (e.g. Asian-Americans) seem to do particularly well, as shown by The Upshot’s income mobility charts.
Over the last few decades, the relational environments of large proportions of American children have become impoverished. This has happened across all social levels: one-on-one caregiver-child relationships, family dynamics, and community connections:
At the one-on-one level, fewer children have a champion, a committed adult present over the long run. The relationships available - few to start with - have become more tenuous, leaving an emotional void:
Fathers who stay at home to care for children were and remain a small minority
Mothers who do the same have become a minority as well, a privilege of the privileged. According to Forbes, “in the 1960s, only 17% of first-time mothers returned to work within a year. By the 1980s, this number was at 52%, and by 2005-2007 it had increased to 63%”
Nannies are typically only available to higher SES children, and even there they are often no more than a passing presence in their lives. Lower SES parents more often resort to an array of shifting informal caregivers
Caregiving grandparents are also more frequent in families with higher educational attainment
Additional adults who become attachment figures - such as mentors or coaches - are also more frequent in the lives of more advantaged children
It isn’t only the availability of a caregiver that dropped, creating the “latchkey kid” phenomenon. The quality of relationships is also affected when caregivers are stressed or distracted. A 2020 study in Nature demonstrated that the stress mother rats experienced caused their infants’ insecure attachment behaviors. In humans, a meta-analysis shows increasing adult attachment insecurity over recent decades, even among the college-educated.
At the family level, fewer children grow up in a family headed by two adults in a committed relationship.
In 1960, 87% of American kids lived with two married (or re-married) parents in the home. Today, that is only true for children of college-educated adults. Only 40-45% of children whose parents have a high school diploma or less live with two married adults: most live in families headed by single parents - eight out of ten of those mothers.
This has several consequences:
These children are five times as likely to be living in poverty as married-couple families
Their mothers - and hence they too - are more likely to experience ”higher levels of negative life events, insecure housing tenure, more chronic stressors, reduced social support [and] depression” (World Health Organization, 2013)
They are more likely to be caught in parental conflicts, become involved in their breakups and witness their loneliness and mental dysregulation. Their lives are more frequently marked by chaos and unpredictability.
They are more likely to need to organize their lives between homes, move schools, rupture their attachments to people and places and repot elsewhere
They are less likely to witness parents repair their relationship after a rupture, and learn how to deal with those same challenges with friends, future colleagues and life partners. Lucky kids who witness parental affection see long term benefits in life
At the community level, the social bonds that tie families and neighbors together have been measured in surveys that show their fast degradation.
“In 1985, Americans had an average of three confidants. In 2004 they had less than two, including members of their families” writes Susan Pinker in The Village Effect.
Interacting with others has been replaced by screens. Study after study show that it is the least educated who watch the most TV and have the highest screen times. In his lectures, child psychiatrist Dr Bruce Perry notes that an 18-year old today will have had as many face-to-face interactions with adults as a 6-year old of decades ago.
It is no surprise that GenX has been called “the least parented, least nurtured generations in US history”. Children attach to their caregivers and will adapt to the reality they are born in, for better or for worse. In contrast with all other groups that ever advocated for their own rights - women, racial and sexual minorities - they never will. Adults need to protect children’s rights with laws such as those the Swedes established almost 50 years ago now, starting with the right to be wanted (liberal abortion law instituted in 1974. Meanwhile, in 2011 in America, nearly half of pregnancies were unintended.)
By offering inadequate reproductive health, parental leave, family support, and child care, America discourages relational connectedness. Can it afford the resulting deterioration in mental health, i.e. human capital?