‘Deaths of Despair’ Rising, but Only in the US ‘Deaths of Despair’ Rising, but Only in the US

In the United States, mortality rates are high and increasing among working-age adults, and “deaths of despair” from suicide, alcohol poisoning, and drug overdose are key contributors.

However, this is not the case in 16 other industrialized nations, including Canada, Australia, and Japan, where mortality rates are actually decreasing.

One likely reason is that other countries take better care of their citizens from cradle to grave, authors Peter Sterling, PhD, and Michael Platt, PhD, with the University of Pennsylvania Perelman School of Medicine in Philadelphia, write in a special communication in JAMA Psychiatry published online February 2.

In the US, individuals and families often struggle in isolation to navigate the life cycle, whereas other countries offer communal assistance to every life stage, and this support protects individuals and families in the long term, they add.

The US could solve this “health crisis” by adopting the best practices of these other nations, they write.

US Is an Outlier

From an anthropological perspective, Sterling and Platt point out that “hunter-gatherers” prioritized food, comfort, and companionship. When one of these needs is unexpectedly met, the surprise triggers a pulse of the feel-good hormone dopamine.

However, much of modern life offers few opportunities for surprise and dopamine pulses.

“It is the difference between a day’s hard walk to finally encounter and kill a wild pig to feed the family and community vs a quick trip to aisle 7 to select a pork roast in plastic wrap,” Sterling and Platt note.

The hunter-gatherers were also far more physically active, and cardiovascular disease, diabetes, obesity, and hypertension were virtually unknown.

The small-scale societies of hunters and gatherers also depended on strong family bond and cooperation with community members.

Modern life is also more isolating, often with hours spent alone in front of a computer screen.

Yet the lack of natural dopamine producers in modern society and the increased social isolation is not unique to the US but holds across the board for industrialized nations.

So why has the US suffered more deaths of despair?

Sterling and Platt assert that it comes down to public support other countries provide their citizens across the life span, from prenatal care and quality preschool and elementary school to affordable (or free) education beyond high school.

This support did not require “bloody revolutions, just simple agreements to prepay basic human needs from public funds collected as taxes,” Sterling and Platt note in their article.

By adopting some of the best practices pioneered by other wealthy nations, the US could reduce despair and restore to many the will to live, they add.

However, they caution against the “medicalization” of every identified cause of rising death rates.

“Every symptom of despair has been defined as a disorder or dysregulation within the individual. This incorrectly frames the problem, forcing individuals to grapple on their own,” they write.

“It also emphasizes treatment by pharmacology, providing innumerable drugs for anxiety, depression, anger, psychosis, and obesity, plus new drugs to treat addictions to the old drugs. We cannot defeat despair solely with pills ― to the contrary, pills will only deepen it,” they add.

Platt reported receiving grant support from the National Institutes of Health, the National Science Foundation, and the Charles E. Kaufman Foundation and is co-founder of Cogwear LLC and a scientific advisor to Neuroflow Inc, Amplio, Blue Horizon International, and Progenity. Sterling has disclosed no relevant financial relationships.

JAMA Psychiatry. Published online February 2, 2022. Abstract

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