Dead, White, and Blue: The Great Die-Off of America’s Blue-Collar White People
Guernica, 2015
The white working class, which usually inspires liberal concern only for its paradoxical, Republican-leaning voting habits, has recently become newsworthy for something else: According to economist Anne Case and Angus Deaton, the winner of the latest Nobel Prize in economics, its members in the forty-five- to fifty-four-year-old age group are dying at an immoderate rate. While the life span of affluent white people continues to lengthen, the life span of poor white people has been shrinking. As a result, in just the last four years, the gap between poor white men and wealthier ones has widened by up to four years. The New York Times summed up the Deaton and Case study with this headline: “Income Gap, Meet the Longevity Gap.”
This was not supposed to happen. For almost a century, the comforting American narrative was that better nutrition and medical care would guarantee longer lives for all. So the great blue-collar die-off has come out of the blue and is, as the Wall Street Journal says, “startling.”
It was especially not supposed to happen to white people who, in relation to people of color, have long had the advantage of higher earnings, better access to health care, safer neighborhoods, and, of course, freedom from the daily insults and harms inflicted on the darker-skinned. There has also been a major racial gap in longevity—5.3 years between white and black men and 3.8 years between white and black women—though, hardly noticed, it has been narrowing for the last two decades. Only white people are now dying off in unexpectedly large numbers in middle age, their excess deaths accounted for by suicide, alcoholism, and drug (usually opiate) addiction.
There are some practical reasons why white people are likely to be more efficient than black people at killing themselves. For one thing, they are more likely to be gun owners, and white men favor gunshots as a means of suicide. For another, doctors, undoubtedly acting in part on stereotypes of nonwhite people as drug addicts, are more likely to prescribe powerful opiate painkillers to white people than to people of color. (I’ve been offered enough oxycodone prescriptions over the years to stock a small illegal business.)
Manual labor—from waitressing to construction work—tends to wear the body down quickly, from knees to back and rotator cuffs, and when Tylenol fails, the doctor may opt for an opiate just to get you through the day.
The Wages of Despair
But something more profound is going on here, too. As New York Times columnist Paul Krugman puts it, the “diseases” leading to excess white working-class deaths are those of “despair,” and some of the obvious causes are economic. In the last few decades, things have not been going well for working-class people of any color.
I grew up in an America where a man with a strong back—and, better yet, a strong union—could reasonably expect to support a family on his own without a college degree. In 2015, those jobs are long gone, leaving only the kind of work once relegated to women and people of color available in areas like retail, landscaping, and delivery-truck driving. This means that those in the bottom 20 percent of the white income distribution face material circumstances like those long familiar to poor black people, including erratic employment and crowded, hazardous living spaces.
White privilege was never, however, simply a matter of economic advantage. As the great African-American scholar W. E. B. Du Bois wrote in 1935, “It must be remembered that the white group of laborers, while they received a low wage, were compensated in part by a sort of public and psychological wage.”
Some of the elements of this invisible wage sound almost quaint today, like Du Bois’s assertion that white working-class people were “admitted freely with all classes of white people to public functions, public parks, and the best schools.” Today, there are few public spaces that are not open, at least legally speaking, to black people, while the “best” schools are reserved for the affluent—mostly white and Asian American, along with a sprinkling of other people of color to provide the fairy dust of “diversity.” While white Americans have lost ground economically, black people have made gains, at least in the de jure sense. As a result, the “psychological wage” awarded to white people has been shrinking.
For most of American history, government could be counted on to maintain white power and privilege by enforcing slavery and later segregation. When the federal government finally weighed in on the side of desegregation, working-class white people were left to defend their own diminishing privilege by moving rightward toward the likes of Alabama Governor (and later presidential candidate) George Wallace and his many white pseudo-populist successors down to Donald Trump.
At the same time, the day-to-day task of upholding white power devolved from the federal government to the state and then local level, specifically to local police forces, which, as we know, have taken it up with such enthusiasm as to become both a national and international scandal. The Guardian, for instance, now keeps a running tally of the number of Americans (mostly black) killed by cops (as of this moment, 1,209 for 2015), while black protest, in the form of the Black Lives Matter movement and a wave of on-campus demonstrations, has largely recaptured the moral high ground formerly occupied by the civil rights movement.
The culture, too, has been inching bit by bit toward racial equality, if not, in some limited areas, black ascendency. If the stock image of the early twentieth century “Negro” was the minstrel, the role of rural simpleton in popular culture has been taken over in this century by the characters in Duck Dynasty and Here Comes Honey Boo Boo. At least in the entertainment world, working-class white people are now regularly portrayed as moronic, while black people are often hyperarticulate, street-smart, and sometimes as wealthy as Kanye West. It’s not easy to maintain the usual sense of white superiority when parts of the media are squeezing laughs from the contrast between savvy black people and rural white bumpkins, as in the Tina Fey comedy Unbreakable Kimmy Schmidt. White, presumably upper-middle-class people generally conceive of these characters and plot lines, which, to a child of white working-class parents like myself, sting with condescension.
Of course, there was also the election of the first black president. White, native-born Americans began to talk of “taking our country back.” The more affluent ones formed the Tea Party; less affluent ones often contented themselves with affixing Confederate flag decals to their trucks.
On the American Downward Slope
All of this means that the maintenance of white privilege, especially among the least privileged white people, has become more difficult and so, for some, more urgent than ever. Poor white people always had the comfort of knowing that someone was worse off and more despised than they were; racial subjugation was the ground under their feet, the rock they stood upon, even when their own situation was deteriorating.
If the government, especially at the federal level, is no longer as reliable an enforcer of white privilege, then it’s grassroots initiatives by individuals and small groups that are helping to fill the gap—perpetrating the microaggressions that roil college campuses, the racial slurs yelled from pickup trucks, or, at a deadly extreme, the shooting up of a black church renowned for its efforts in the civil rights era. Dylann Roof, the Charleston killer who did just that, was a jobless high school dropout and reportedly a heavy user of alcohol and opiates. Even without a death sentence hanging over him, Roof was surely headed toward an early demise.
Acts of racial aggression may provide their white perpetrators with a fleeting sense of triumph, but they also take a special kind of effort. It takes effort, for instance, to target a black runner and swerve over to insult her from your truck; it takes such effort—and a strong stomach—to paint a racial slur in excrement on a dormitory bathroom wall. College students may do such things in part out of a sense of economic vulnerability, the knowledge that as soon as school is over their college-debt payments will come due. No matter the effort expended, however, it is especially hard to maintain a feeling of racial
superiority while struggling to hold onto one’s own place near the bottom of an undependable economy.
While there is no medical evidence that racism is toxic to those who express it—after all, generations of wealthy slave owners survived quite nicely—the combination of downward mobility and racial resentment may be a potent invitation to the kind of despair that leads to suicide in one form or another, whether by gunshots or drugs. You can’t break a glass ceiling if you’re standing on ice.
It’s easy for the liberal intelligentsia to feel righteous in their disgust for lower-class white racism, but the college-educated elite that produces the intelligentsia is in trouble, too, with diminishing prospects and an ever-slipperier slope for the young. Whole professions have fallen on hard times, from college teaching to journalism and the law. One of the worst mistakes this relative elite could make is to try to pump up its own pride by hating on those—of any color or ethnicity—who are falling even faster.
HEALTH
Welcome to Cancerland
Harper’s Magazine, 2001
I was thinking of it as one of those drive-by mammograms, one stop in a series of mundane missions including post office, supermarket, and gym, but I began to lose my nerve in the changing room, and not only because of the kinky necessity of baring my breasts and affixing tiny x-ray opaque stars to the tip of each nipple. I had been in this place only four months earlier, but that visit was just part of the routine cancer surveillance all good citizens of HMOs or health plans are expected to submit to once they reach the age of fifty, and I hadn’t really been paying attention then. The results of that earlier session had aroused some “concern” on the part of the radiologist and her confederate, the gynecologist, so I am back now in the role of a suspect, eager to clear my name, alert to medical missteps and unfair allegations. But the changing room, really just a closet off the stark windowless space that houses the mammogram machine, contains something far worse. I notice for the first time now an assumption about who I am, where I am going, and what I will need when I get there. Almost all of the eye-level space has been filled with photocopied bits of cuteness and sentimentality: pink ribbons, a cartoon about a woman with iatrogenically flattened breasts, an “Ode to a Mammogram,” a list of the “Top Ten Things Only Women Understand” (“Fat Clothes” and “Eyelash Curlers” among them), and, inescapably, right next to the door, the poem “I Said a Prayer for You Today,” illustrated with pink roses.
It goes on and on, this mother of all mammograms, cutting into gym time, dinnertime, and lifetime generally. Sometimes the machine doesn’t work, and I get squished into position to no purpose at all. More often, the x-ray is successful but apparently alarming to the invisible radiologist, off in some remote office, who calls the shots and never has the courtesy to show her face with an apology or an explanation. I try pleading with the technician: I have no known risk factors, no breast cancer in the family, I had my babies relatively young and nursed them both. I eat right, drink sparingly, work out, and doesn’t that count for something? But she just gets this tight little professional smile on her face, either out of guilt for the torture she’s inflicting or because she already knows something that I am going to be sorry to find out for myself. For an hour and a half the procedure is repeated: the squishing, the snapshot, the technician bustling off to consult the radiologist and returning with a demand for new angles and more definitive images. In the intervals while she’s off with the doctor I read the New York Times right down to the personally irrelevant sections like theater and real estate, eschewing the stack of women’s magazines provided for me, much as I ordinarily enjoy a quick read about sweatproof eyeliners and “fabulous sex tonight,” because I have picked up this warning vibe in the changing room, which, in my increasingly anxious state, translates into: Femininity is death. Finally there is nothing left to read but one of the free local weekly newspapers, where I find, buried deep in the classifieds, something even more unsettling than the growing prospect of major disease—a classified ad for a “breast cancer teddy bear” with a pink ribbon stitched to its chest.
Yes, atheists pray in their foxholes—in this case, with a yearning new to me and sharp as lust, for a clean and honorable death by shark bite, lightning strike, sniper fire, car crash. Let me be hacked to death by a madman, is my silent supplication—anything but suffocation by the pink sticky sentiment embodied in that bear and oozing from the walls of the changing room.
My official induction into breast cancer comes about ten days later with the biopsy, which, for reasons I cannot ferret out of the surgeon, has to be a surgical one, performed on an outpatient basis but under general anesthesia, from which I awake to find him standing perpendicular to me, at the far end of the gurney, down near my feet, stating gravely, “Unfortunately, there is a cancer.” It takes me all the rest of that drug-addled day to decide that the most heinous thing about that sentence is not the presence of cancer but the absence of me—for I, Barbara, do not enter into it, even as a location, a geographical reference point. Where I once was—not a commanding presence perhaps but nonetheless a standard assemblage of flesh and words and gesture—“there is a cancer.” I have been replaced by it, is the surgeon’s implication. This is what I am now, medically speaking.
In my last act of dignified self-assertion, I request to see the pathology slides myself. This is not difficult to arrange in our small-town hospital, where the pathologist turns out to be a friend of a friend, and my rusty PhD in cell biology (Rockefeller University, 1968) probably helps. He’s a jolly fellow, the pathologist, who calls me “hon” and sits me down at one end of the dual-head microscope while he mans the other and moves a pointer through the field. These are the cancer cells, he says, showing up blue because of their overactive DNA. Most of them are arranged in staid semicircular arrays, like suburban houses squeezed into a cul-de-sac, but I also see what I know enough to know I do not want to see: the characteristic “Indian files” of cells on the march. The “enemy,” I am supposed to think—an image to save up for future exercises in “visualization” of their violent deaths at the hands of the body’s killer cells, the lymphocytes and macrophages. But I am impressed, against all rational self-interest, by the energy of these cellular conga lines, their determination to move on out from the backwater of the breast to colonize lymph nodes, bone marrow, lungs, and brain. These are, after all, the fanatics of Barbaraness, the rebel cells that have realized that the genome they carry, the genetic essence of me, has no further chance of normal reproduction in the postmenopausal body we share, so why not just start multiplying like bunnies and hope for a chance to break out?
It has happened, after all; some genomes have achieved immortality through cancer. When I was a graduate student, I once asked about the strain of tissue-culture cells labeled “HeLa” in the heavy-doored room maintained at body temperature. “HeLa,” it turns out, refers to Henrietta Lacks, an African-American woman whose tumor was the progenitor of all HeLa cells, and whose unwitting contribution to science has only recently been recognized. She died; they live, and will go on living until someone gets tired of them or forgets to change their tissue-culture medium and leaves them to starve. Maybe this is what my rebel cells have in mind, and I try beaming them a solemn warning: The chances of your surviving me in tissue culture are nil. Keep up this selfish rampage and you go down, every last one of you, along with the entire Barbara enterprise. But what kind of a role model am I, or are multicellular human organisms generally, for putting the common good above mad anarchistic individual ambition? There is a reason, it occurs to me, why cancer is our metaphor for so many runaway social processes, like corruption and “moral decay”: We are no less out of control ourselves.
After the visit to the pathologist, my biological curiosity drops to a lifetime nadir. I know women who followed up their diagnoses with weeks or months of self-study, mastering their options, interviewing doctor after doctor, assessing the damage to be expected from the available treatments. But I can tel
l from a few hours of investigation that the career of a breast-cancer patient has been pretty well mapped out in advance for me: You may get to negotiate the choice between lumpectomy and mastectomy, but lumpectomy is commonly followed by weeks of radiation, and in either case if the lymph nodes turn out, upon dissection, to be invaded—or “involved,” as it’s less threateningly put—you’re doomed to chemotherapy, meaning baldness, nausea, mouth sores, immunosuppression, and possible anemia. These interventions do not constitute a “cure” or anything close, which is why the death rate from breast cancer has changed very little since the 1930s, when mastectomy was the only treatment available. Chemotherapy, which became a routine part of breast-cancer treatment in the eighties, does not confer anywhere near as decisive an advantage as patients are often led to believe, especially in postmenopausal women like myself—a two or three percentage point difference in ten-year survival rates,1 according to America’s best-known breast-cancer surgeon at the time, Dr. Susan Love. I know these bleak facts, or sort of know them, but in the fog of anesthesia that hangs over those first few weeks, I seem to lose my capacity for self-defense. The pressure is on, from doctors and loved ones, to do something right away—kill it, get it out now. The endless exams, the bone scan to check for metastases, the high-tech heart test to see if I’m strong enough to withstand chemotherapy—all these blur the line between selfhood and thing-hood anyway, organic and inorganic, me and it. As my cancer career unfolds, I will, the helpful pamphlets explain, become a composite of the living and the dead—an implant to replace the breast, a wig to replace the hair. And then what will I mean when I use the word “I”? I fall into a state of unreasoning passive aggressivity: They diagnosed this, so it’s their baby. They found it, let them fix it.
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