Deaths of despair: White working class giving up on life

Last year I volunteered as a chaplain at a Saint Louis hospital. This hospital provides a medical detoxification program for folks addicted to opioids, downers and alcohol, although in practice almost all of these patients are using the first, in particular heroin and fentanyl. Around 60% of the hospital’s overall patients are black, but as I made my rounds I noticed that a comfortable majority of patients in the detox program were white.

I wasn’t surprised. Over the last few years the term “deaths of despair” has entered the national vocabulary to describe how increasing numbers of less-educated middle-aged whites are giving up on life, either by literally committing suicide, trashing their livers with alcohol or, most notoriously, overdosing on opioids. So many of these people are dying that it’s increasing the mortality rate of middle-aged white Americans as a whole, an astonishing trend for a first world country.

Angus Deaton, co-author of a 2017 paper studying the phenomenon, told the Atlantic that the rising mortality rate for this demographic means that “half a million people are dead who should not be dead.” To put that number in perspective, that’s more Americans than died in World War II, and over eight and half times the number of American fatalities in Vietnam.

The standard explanation for the growing crisis points to the declining manufacturing sector in the US. There was a time in which a high school graduate could get a good job at the local factory, but that factory has long since closed down or moved to China.  In 2016 Donald Trump campaigned heavily on this issue, vowing to impose tariffs on cheap foreign imports in a bid to create jobs for less educated Americans.

But the truth is that protectionist policies aren’t going to save the white working class. They will, for one thing, end up doing more harm than good. But more importantly, robots are far more effective than China at killing high-paying manufacturing jobs. It’s telling, for instance, that the US steel industry is turning out more product now than it did during World War II with a dramatically reduced number of workers.

The economic explanation for white working class malaise only goes so far anyways. University of Virginia researcher Christopher Ruhm finds in a recent study that the rapid rise in drug-related deaths isn’t fully or even mostly explained by worsening economic prospects.   Among other things, he points out people suffering prolonged hardship in other first-world countries aren’t overdosing at anything like the same rates.    

A bit of reflection tells us that there is no straight line from poverty to despair. For instance, economic prospects have never been stellar for most black people throughout US history. Even so, a 2018 Brookings Institution survey found that for all the overwhelming challenges they face, poor blacks tend to be the most optimistic and least stressed demographic in America.

What makes the difference? I emphatically deny that there is one simple answer, but I also find that even secular writing on this issue usually draws attention to the fact that poor black people go to church while the white church in America is rapidly becoming a strictly middle-class affair. A 2012 paper studying the decline in white working class church attendance points out that with government cutbacks in welfare spending, “civic institutions—including religious congregations—might be one of the few institutional sectors working class Americans can turn to for … support in the face of today’s tough times.” In ever-increasing numbers, however, low-educated white people are turning away from the supportive community that church could provide.

This trend of declining church attendance is bad enough from a sociological perspective, from a theological point of view it’s downright distressing. During his earthly ministry Jesus pointed to the fact that the “poor have the gospel preached to them” as evidence that he was the Christ (Matthew 11:5). He said that the poor are blessed and that the kingdom of God belongs to them (Luke 6:20). Presumably the poor would populate the church Jesus has established, but we’re just not seeing that happen with poor whites in America. What we do see is these people giving up on life.  

A lot has been said recently on what the white American church should do now that it has lost the culture wars and can expect cultural and political marginalization. I would humbly suggest that our next major project should be figuring out how to incorporate folks who are on the margins already, which includes working class whites.

To be very clear, for middle-class Christians this means welcoming people into church who are living together unmarried, who frequently use profanity, who use drugs, who hold wrongheaded or even appalling views on race - in other words, sinners such as ourselves who might happen to sin in different ways than we do. Thank God none of us had to clean up our act before hearing the gospel and experiencing God’s love through Jesus. I believe wholeheartedly in sanctification, but I also believe that it’s a process and not something we can expect from folks who don’t yet grasp the gospel of salvation by grace through faith.

Economic and cultural poverty undoubtedly contribute to despair, but despair is fundamentally a spiritual issue. And to that, God has entrusted us with a message of hope and life.