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  • Writer's pictureFinding Allostasis

Deaths of Despair to Lives of Repair

Not just another article about despair: solutions included.


If we are at all paying attention, it can feel like we are swimming in a sea of natural and unnatural disasters across the globe. Even before the COVID-19 pandemic rolled in, what are termed “deaths of despair” in the United States were sharply increasing for over two decades. The US ranks first in the rising of deaths of despair: deaths related to alcohol and drugs, suicides, as well as gun violence, obesity, and diseases like heart disease, diabetes, and cancers, that overlap with alcohol, drug, and food addictions. Whatever addiction or disease develops, the common core is despair.


Why is there so much rising despair?


We need to ask why despair has been increasing and sit honestly with the evolving truth of it. Despair stems from disconnection, fear, and helplessness. In the US, there is a growing disconnect within families, communities, schools, and workplaces. Peter Sterling describes how this transpired for the US and explains what has led to a sharp increase in despair since 1995 (see references below). A long story short: lack of life choices – feeling trapped with no way out – is oppressive and leaves people desperate. The lack of basic social supports such as health care, child care, and living wages keep working class people locked into jobs, poor communities, and uneducated, scrambling from day to day without the freedom to pursue more sustainable sources of joy (via the neurotransmitter dopamine) such as socializing, spiritual practices, creative interests, and hobbies. Without basic safety and needs met, there is limited time to relax and the options for daily satisfaction are more limited. Any number of compounding financial or relationship strains leads to common and accessible coping via food, alcohol, drugs, TV, social media, violence, and other generally short-lived unfulfilling options that have negative long-term consequences. This fuels more despair.


What can we do about this widespread and ongoing crisis of despair?


“Shift to fundamentals,” Sterling says. The four fundamentals need to include:

  1. Investment in holistic family care and support, especially for young families.

  2. Investment in education that develops childhood interests and talents that spur natural joy in play and work.

  3. Investment in an economy that supports use of these talents as adults.

  4. Investment in community members to participate in regular practices that increase personal connection that honor the sacredness of each other.


How do we pay for these investments?


The US spends twice as much on healthcare (20% of GDP) compared to wealthy western European countries (who spend 10%), yet the US ranks 34th in life expectancy. At the highest level, Sterling suggests reinvesting half of healthcare spending, $2.5 trillion (10% of GDP), toward supporting families from the ground up rather than treating illnesses and despair after the fact – as we are doing – or rather, failing to do. All of us can help to dispel myths about cost by talking with others about how improving equity and inclusion with more affordable education, health care, and child care in the US is estimated to save over a trillion dollars.



Meanwhile, what can I do as an individual since I don’t make policies?


We must actually care about one another and see each other as valuable and worthy of tending to on large and individual scales. Individually, we each decide how we engage each day, how we take action to expand our capacity to build relationship bridges instead of walls, redefine what success means in our families, ensure how we live reflects our deepest values, change the narrative we have about poverty (and others in general) in our friend groups, identify and address hierarchies in our homes and workplaces, and work in collaboration within our communities to the reduce shame and stigma associated with those who live differently than we do. We can acknowledge with humility when we are in a place of power and continue to empower those around us. We can connect to our own pain when systems put in place by humans fail to recognize us as such. We can remind each other to fully see one another – stranger, client, friend, or yourself – as a whole person with a complex history in a real life context.


Social repair and inclusion as a remedy for all.


When people are hurting, they may not even be aware of their constant survival mode. That hurt has a high cost, but it can be changed. When addressing despair, Buddhists often use the words suffering or agony. I couldn’t help but notice how Sterling’s four-fold path forward for the US lines up with the four truths of Buddhism:

In addition to just, merciful, and financially sustainable social supports, we need to have repair and inclusiveness at every level. To have this, we need wide and attractive routes to reconciliation on small scales in our own homes and large scales in our social networks. This includes being open and honest with ourselves, taking on a posture of humility, and being okay with being wrong. This allows apologizing without humiliation and making amends whenever possible. We need to see the short-term and long-lasting rewards for social repair over the short-term dopamine hits of winning or crushing one’s opponent. We need more examples and maps of healing conversations and grace as we allow each other to practice. We need support along the way to forgive each other, be emotionally generous, and still have healthy boundaries. Rather than allowing cultural norms of exclusion and unforgiveness to continue, we can break these patterns, hold people accountable for destructive behavior, but keep the paths of reconciliation open.




Image: Mark Tulin/Unsplash


References

Sterling, P (2023). How should biomedicine respond to Rising us mortality rates and “deaths of despair?” Journal of Medical Humanities, (In Press).


National Academies of Science, Engineering, and Medicine (2021). High and Rising Mortality Rates Among Working-Age Adults. The National Academies Press. doi:10.17226/25976


Sterling, P & Platt, ML (2022). Why Deaths of Despair Are Increasing in the US and Not Other Industrial Nations-Insights From Neuroscience and Anthropology. JAMA Psychiatry, 10.1001/jamapsychiatry.2021.4209


Schoeni RF, Dow WH, Miller WD, Pamuk ER (2011). The economic value of improving the health of disadvantaged Americans. Am J Prev Med; 40(1Suppl1):S67–72.


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