‘Deaths of Despair’ Rising

November 3, 2020

As 2015 wound down, a foreboding but catchy phrase from a scientific paper blew across the cultural landscape with unexpected force.

The expression “deaths of despair” was born after Princeton University economist Anne Case and Angus Deaton — Case’s colleague, husband and a Nobel laureate in economics — dug into U.S. death statistics and found that, during the 1900s, people’s life spans had generally lengthened from roughly 50 years to nearly 80. But then, near the end of the century, one segment of the population took a U-turn.

Since the 1990s, mortality had risen sharply among middle-aged, non-Hispanic white people, especially those without a college degree, Case and Deaton reported in December 2015 in the Proceedings of the National Academy of Sciences.

The reason, to a large extent: White, working-class people ages 45 to 54 were drinking themselves to death with alcohol, accidentally overdosing on opioids and other drugs, and killing themselves, often by shooting or hanging. Vanishing jobs, disintegrating families and other social stressors had unleashed a rising tide of fatal despair, Case and Deaton concluded. This disturbing trend mirrored what had previously occurred among inner-city Black people in the 1970s and 1980s, Case and Deaton now say.

As low-skilled jobs vanished and families broke apart, Black victims of crack cocaine and the AIDS epidemic represented an early wave of deaths of despair. Even today, mortality rates for Black people still exceed those of white people in the United States for a variety of reasons, with Black overdose deaths on the rise over the last few years.

“The most meaningful dividing line [for being at risk of deaths of despair] is whether or not you have a four-year college degree,” Deaton says.

But despair has no clear scientific or medical definition. Psychiatric disorders plausibly related to a sense of despair, such as major depression and anxiety disorders, have been studied for decades. Despair — derived from a Latin term meaning “down from hope” — might be just another way to describe these conditions.

Or it might be its own special form of suffering. Some researchers regard despair as a distinct psychological status — one that can potentially be traced back to early childhood and may pose a risk for suicide, illegal drug use and maybe even physical pain.

For that reason, mental health clinicians need to work to distinguish despair from depression, even if despair isn’t a disorder in psychiatry’s diagnostic manual, says psychiatrist Ronald Pies of the State University of New York’s Upstate Medical University in Syracuse. “An overreliance on what is sometimes called ‘the Bible of psychiatry’ is likely to be misleading or inadequate when assessing the risk of suicide and illicit drug use,” he contends.

What’s more, recognizing and measuring despair, or something like it, as a state of mind separate from depressive disorders might shed light on the uptick in mental distress reported by people of all backgrounds during the coronavirus pandemic, Pies says. Developing a despair scale may also provide insights into those individuals most likely to succumb to despair-related fatalities. Long-term trends in national mortality data suggest that such deaths will continue to climb, even long after the viral calamity ends.

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