Compared with its wealthy peer nations, the United States is failing the most basic test of a civilization: keeping its denizens alive. As my colleague Derek Thompson wrote last week, U.S. life spans are shorter on average than in much of Europe, Japan, South Korea, and Australia. I called Derek to discuss why the nation’s life-expectancy rate is falling behind, and what can be done about it.

First, here are three new stories from The Atlantic:

The most telling moments from the Trump-Carroll depositions Joe Biden’s not popular. That might not matter in 2024. I ruined two birthday parties and learned the limits of psychology. The Mortality Tax

Kelli María Korducki: In your latest article, you repeat a turn of phrase that you used in a previous story, calling the U.S. a “rich death trap.” The rich part is pretty self-explanatory, but unpack the rest of it.

Derek Thompson: The appropriate context is that, over the past 30 years or so, U.S. life spans have increased a little bit, but way behind the pace of similarly rich countries like Western Europe, Japan, South Korea, and Australia. This is a pretty shocking development because throughout economic history, people living in richer countries have generally lived longer. And yet in the U.S.—which is the richest country in the world—we're not getting the long lives that we would expect. So you could say that there is a mortality tax on being an American as opposed to being French or Japanese, for example.

Kelli: When does this mortality tax emerge in the data?

Derek: You start to see it in the 1980s, but it really picks up in the 1990s. That’s where we really start to see this life-expectancy divergence.

Kelli: What might have happened in the 1980s and ’90s to stagnate life-expectancy increases here in the States but not abroad?

Derek: You could look at guns. Clearly, we have more gun deaths here than in other countries. And you can look at car deaths, which we also have more of than in similarly rich countries. But gun deaths per capita and car deaths per capita haven’t clearly increased a lot in the past 30 years. So that leaves things like drug overdoses, obesity, and health inequalities. But the truth is that health-care access has actually probably gotten more equal in the past 30 years; we passed Obamacare, which has extended Medicaid and all sorts of health care to low-income individuals. My bet, then, is that the growing gap between American longevity and that of other rich countries, at least in the past 30 years, is being driven by our poor health, specifically, more drug addiction, more drug-overdose deaths, and a higher risk of obesity.

Kelli: And despite Obamacare and broadly expanded health-care access, there’s also still a pretty significant health-care gap in the U.S.

Derek: That’s absolutely the case, and health outcomes are much more unequal in the U.S. than in countries with universal health care, where you tend to see that life spans in poor areas and rich areas are pretty similar; in the U.S. they’re much more different. Where you’re born in the U.S., and how much income your parents have, is much more determinative of how long you’ll live.

Kelli: What would it take to make America less of a death trap?

Derek: It’s a really big question. I would say that this conversation needs to be about all of these things that are driving our mortality: thinking more about ways to reduce obesity in America and talking more about the importance of exercise for metabolic health. And we have to reduce  synthetic opioid overdoses (primarily fentanyl), which kill more than 70,000 people in the U.S. every year.

This is sort of an aside, but there are almost two separate opioid crises happening in the country right now. One is the opioid-prescription-addiction crisis with the Sackler family and Purdue Pharma at its center, and then there’s the fentanyl crisis. Nearly 17,000 people a year are dying of opioid-prescription addiction—that is, from the abuse of opioids that were prescribed by a doctor—and about 70,000 people died of fentanyl overdoses in 2021. So the fentanyl crisis is four times deadlier than the opioid crisis that we’re used to talking about, but it doesn’t really occupy that much attention from lawmakers. I think we could use some really hard thinking about how to bend the curve of fentanyl abuse.

Kelli: What about the other American death drivers you mention in your article? Cars, guns?

Derek: So far, it seems that a little bit more working from home is probably good for reducing car use and related deaths. More housing in downtown areas that would reduce the need for driving commutes would probably also be good. And when it comes to guns, I can think of some pretty clear policy ideas for reducing gun deaths but, man, I’m not particularly optimistic about their ability to be passed at the federal level.

Related:

America fails the civilization test. America is a rich death trap. Today’s News President Joe Biden formally announced his bid for reelection today. A fourth cease-fire attempt in Sudan has failed, as residents attempt to flee the country. E. Jean Carroll’s rape lawsuit against Donald Trump has gone to trial. Evening Read Illustration by Arsh Raziuddin

The Pandemic’s Surprising Effect on Suicide Rates

By Clancy Martin

In March 2020, my partner, Amie; our 2-year-old son, Ratna; and I, who usually live in Kansas City, Missouri, were visiting Kerala, India, about to be in the throes of the country’s first COVID outbreak. When it became clear that Kerala was going to be locked down, we drove up the coast as fast as we could and boarded a flight to Delhi. From there we set out for the most remote place we knew—a small village in the Himalayan foothills called Bir.

On our way there we were nearly turned around at a series of police checkpoints. To go where? That was never clear. Hotels and Airbnbs were sending foreigners away. On WhatsApp, rumors were spreading about fellow expats being rounded up into camps.

An initially reluctant Airbnb host took us in only a few days before a nationwide lockdown went into effect. “Really I should never have let you stay,” he told me. “But now you can’t leave.”

Read the full article.

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P.S.

With Derek’s blessing, I’m hijacking this platform to recommend the new Laura Poitras documentary, All the Beauty and the Bloodshed, about the photographer Nan Goldin and her fight to bring down the Sackler family by striking at the heart of their cultural credibility: the art-museum wings that bear the Sackler name. Although the documentary focuses primarily on the higher-profile prescription-drug crisis within the devastating sweep of U.S. opioid addiction that Derek and I discussed, it’s worth watching for how it captures the greed and cynicism that so often lie just beneath the surface of our national tragedies.

— Kelli

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Katherine Hu contributed to this newsletter.

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If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 988 or text 741-741 for the Crisis Text Line.

In March 2020, my partner, Amie; our 2-year-old son, Ratna; and I, who usually live in Kansas City, Missouri, were visiting Kerala, India, about to be in the throes of the country’s first COVID outbreak. When it became clear that Kerala was going to be locked down, we drove up the coast as fast as we could and boarded a flight to Delhi. From there we set out for the most remote place we knew—a small village in the Himalayan foothills called Bir.

On our way there we were nearly turned around at a series of police checkpoints. To go where? That was never clear. Hotels and Airbnbs were sending foreigners away. On WhatsApp, we heard from fellow expats who were being rounded up into camps.

An initially reluctant Airbnb host took us in only a few days before a nationwide lockdown went into effect. “Really I should never have let you stay,” he told me. “But now you can’t leave.”

[Jeffrey Ruoff: Between not wanting to live and not wanting to die]

For the next four months, my family and I lived in a place that saw outsiders like us as the source of the virus. On the rare occasions when I went out for supplies (diapers couldn’t wait), I was cursed at and, once, spat on. Another time, while waiting for produce, I was thrown out of the line and told that rations were for locals only. I worried constantly that I wouldn’t be able to feed my wife and son or that we would be taken by the police to some refugee camp.

I have attempted suicide more than 10 times in my life, and the desire to kill myself is among my earliest memories. My adult life has been an ongoing struggle with addiction, depression, anxiety, chronic suicidal ideation, and suicide attempts. And yet in Bir, despite the fretful uncertainty of our time there, I never thought seriously about suicide. I was scared, but I was not depressed. I was panicking about the outside world, but my inside world—so often a source of misery—was relatively calm. My next serious bout of depression didn’t come until a year after we returned home. Judging by my mental health, the start of the coronavirus pandemic was one of the better times in my life. Apparently, I’m not the only one who feels this way.

During 2020—in the U.S. and in many other countries—suicide rates modestly declined, reversing a decades-long trend. We are learning that this is a pattern: Suicide rates typically go down in times of crisis. The sharpest decrease in U.S. suicide rates ever measured was during World War II; terrorist attacks and other catastrophes have also tended to reduce rates of suicide.

But now they’re rising again. This, too, is part of the pattern. In the months immediately following the Japanese earthquake of 2011, for example, suicide rates dropped compared with the rates in the years preceding the earthquake, and then spiked significantly.

I should note that during the coronavirus pandemic, suicide rates did not go down everywhere. Worldwide, suicide rates were generally lower than expected, and suicide rates went down in many countries, but often more so among men and only slightly among women. Some countries saw female suicide increase. A study from Japan showed that suicide rates among 10-to-19-year-olds rose during the early months of the pandemic. In Maryland, a study found that suicide rates decreased by 45 percent for white people during the first few months of the pandemic but increased by 94 percent among Black residents. Suicide rates appear to have risen among minority groups in the U.S.—especially in Black, Hispanic, and Asian communities—that were already experiencing alarming increases before the pandemic.

Though uneven, the overall dip in suicide rates in 2020, the first year of COVID, offers important lessons about how to deal with suicide, both in individual cases and at the policy level. The key to learning those lessons is figuring out why suicide rates went down in the first place.

Maria A. Oquendo, a former president of the American Foundation for Suicide Prevention, has offered three hypotheses for why suicide rates decline after public catastrophes. The first: Crises foster “community cohesion,” which mitigates suicidality. The second: “Individuals become more externally focused.” The third: “Community suffering makes personal suffering more tolerable.” These aren’t mutually exclusive, and they each have evidence to recommend them. All three resonate with my own experience.

I’ll begin with the idea of community cohesion. At least since Emile Durkheim’s 1897 masterpiece Suicide, we’ve recognized that one of the best ways to reduce suicide is to create a sense of belonging in our communities. Many studies have confirmed this fact, as well as its inverse: Living without a spouse, having few social networks, and engaging in few social activities all correspond with high rates of suicidal ideation, suicide attempts, and deaths by suicide. The reason middle-aged and older men tend to be at greater risk for suicide seems to be loneliness and a lack of social connections.

[Read: The millennial mental-health crisis]

The suicidologist Craig Bryan posited that suicide rates may have gone down during the pandemic because, in staying home, many people wound up spending more time with loved ones. Even for people who didn’t have loved ones nearby, there was a sense of collective suffering that seemed to provide many of us with a kind of belonging. As Albert Camus wrote in his novel about a different pandemic, “Plague was the concern of all of us.” Our isolation was, ironically, shared.

My wife, my son, and I certainly didn’t feel we belonged in Bir, but when we explained our fears in an email to one of the community’s leaders, he immediately wrote back: “Don’t worry, we will all take care of each other.” That’s what happened, once the initial shock wore off. The owner of a hotel we’d stayed at the year before drove cartons of canned milk to us; a friend of a friend brought us food from his garden and honey from his bees; another friend found us a house to stay at higher in the mountains, where we could roam freely outside.

This caring extended well beyond Bir. I felt especially close to my students at Ashoka University and at the University of Missouri, in Kansas City, even though our classes were on Zoom. I was talking and texting with my daughters back in the U.S. much more frequently than I did pre-pandemic, when I was constantly traveling for work. We all knew that we needed one another; we were scared, and didn’t know what was going to happen next. Needing others—and being needed—was a source of profound meaning and consolation.

Now the “externally focused” thesis: For many, the pandemic forced us to turn our gaze outward. I should say here that suicide is not the result of navel-gazing. On the contrary, one of the effective treatments for suicidal thinking—dialectical behavior therapy—presupposes that self-reflection is a remedy, not a cause. That said, the fact that the pandemic forced us to collectively face an external threat seems to me to be one of the best explanations for why suicide rates went down. Many of the most dangerous nations in the world have comparatively low suicide rates: The annual suicide rate in Afghanistan is six suicides per 100,000 people; in Turkey, 2.3; in Honduras, 2.6. In 2021, America’s was 14.5.

By focusing my attention on the outside world during the pandemic, I realized and came to accept that I could not control what was going to happen next. Because we were living in a state of unpredictable crisis, I had to let go of my usual anxious desire to determine (or miserably fail to determine) the course of my future. In some sense, my life wasn’t my life at all anymore; it was whatever life COVID decided to give me. Life was looking me in the face and saying, “I’m running things now. What are you going to do about it?” If I had been faced with that alone, I might have turned to my standard recourse: Well, I’ll just try to exit life. But because we were all facing the question together, I felt more up to the challenge.

This leads to the thesis that the community suffering caused by the pandemic made individual suffering more tolerable. I was freed from the usual dark foreboding I have, the certainty that I am somehow going to mess everything up or that I’ll accidentally inflict some ghastly terror on myself and the people I love. Whatever was going to happen probably wasn’t going to be my fault; it was happening to most or all of us. So I had to—well, to be more accurate, I found I could—simply wait and see what happened next. I was forced to learn a particular kind of patience. It was not that I became a patient person (I could only wish), but that one kind of impatience—my impatience with myself and how I relate to my life—was no longer tenable or even psychologically relevant.

I can’t overestimate how helpful learning this sort of patience can be for someone who is chronically suicidal. The inability to wait, or the suspicion that waiting won’t do any good, is at the center of the suicidal impulse. I’m not the first to notice this. The suicidologist James Hillman called suicide the “the urge for hasty transformation.” The musician Alison Mosshart said of her friend Anthony Bourdain: “His impatience was fucking hilarious … When you’re a big figure like that … any time you do have to wait, your brain explodes.” Édouard Levé adds in his novel Suicide, which he gave to his publisher immediately before killing himself, “Your impatience deprived you of the art of succeeding by being bored.”

The fact that suicide rates are now rising again, especially among young people and in Black communities, should not surprise us. Trauma is known to deteriorate mental health and cause rates of suicide attempts and deaths by suicide to increase. And whatever the pandemic’s short-term benefits, its enduring legacy is something resembling a global post-traumatic stress disorder. Mental Health America, an organization that supplies free, voluntary mental-health screening, reported that the number of people taking its questionnaires tripled from 2019 to 2020. Fifty-one percent of 11-to-17-year-olds who took the screening in 2020 reported frequent suicidal ideation.

Other factors are also relevant: Post-pandemic, we are naturally receding back into the habits that changed when we were all in the crisis together. Community cohesion, external focus, and a sense of community suffering are all dissipating. Additionally, suicides that might otherwise have taken place during the pandemic could be happening now. Whatever the causes, the need for mental-health care is abundant and obvious.

Happily, we can learn some simple lessons from the surprisingly salutary mental-health effects of the pandemic. Now is a good time to work on building community cohesion, especially among vulnerable populations. The Bandana Project, which develops peer-to-peer mental-health counseling among college students, is one excellent example. For those of us, like me, who experience chronic suicidal ideation, we can remember that turning our attention outward, toward the benefit of others—by something as simple as volunteering at a local homeless shelter or a community garden—may have profound mental-health benefits. And simply being willing to be open with the people in your own life about your mental-health struggles, to let them know that they can also speak honestly and safely with you about their own challenges, benefits both your own mental health and that of the people you care for. When we know that we are suffering together and not alone, we fight stigma, reduce shame, and lighten the pressure of often-isolating psychological distress.

Dealing with the mental-health fallout from the pandemic will require the kinds of resources we needed in order to fight the virus itself: above all, money and training for health professionals. Many teenagers who attempt suicide have to wait days or even weeks for help, if they receive it at all. Many teens who end up in emergency rooms sit for 24 or 48 hours without seeing a trained mental-health-care professional.

Addressing this will require massive commitments at governmental and institutional levels. But I think COVID helped remind me that we can also help as individuals. One of the most effective treatments for suicidal ideation is simply talking with people who are struggling. Ask a person you’re worried about how they are feeling. Don’t try to solve the problem. Let them talk it out. Talking about suicide doesn’t plant the seed; it provides relief. And for those of us who frequently have suicidal ideation, we can also help ourselves (though you should also always reach out for help, if you can). For me, that means continually trying to put into practice the lessons the pandemic forced me to learn.

And the most important one wasn’t really a lesson at all. It was a question. The pandemic showed me that life has been asking me, asking all of us, one question above all: Will you stick around? Will you wait and see, with the rest of us? As John Donne wrote, one year before an outbreak of a plague that devastated Britain: “No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less.” The person who did not die by suicide during the coronavirus pandemic was one more person who survived it. They helped the rest of us make it through. And they can be proud of that fact.