Class and Beyond: Case-Deaton’s “Deaths of Despair,” Embodiment, and Neoliberal Epidemics

By Lambert Strether of Corrente.

When you’ve got your health, you’ve got just about everything –Popular saying

Patient readers, this should be the best post ever, because the “embodiment” concept — I stumbled across it on this Twitter thread from Brian Rahmer — deserves it, but instead it’s going to be me staggering along a conceptual tight-rope until I arrive (I hope) at the other end, because new thoughts are hard. For the same reason, this post will have less rigor and many fewer links than I would normally like to see. I’m going to start by refreshing our memories on the Case-Deaton study — because what says “embodiment” more than excess mortality? — and then ask why our political class isn’t all over Case-Deaton as an issue. After reviewing my priors and defining “embodiment,” I will argue that it is superior to identity politics in every way, including politically (by which I mean electorally). I’ll close with the concept of the “neoliberal epidemic,” which certainly ought to resonate in the flyover states, including the Rust Belt.

Case-Deaton

So, lurching into motion: Naked Capitalism (NC) readers are familiar with the Case-Deaton study (original; and see here, here, here, here, and here[1]). Summarizing it:

This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.

In an interview with the Guardian, Anne Case expands on their findings:

Could you briefly describe your original research and what this new follow-up paper adds to it?

Our 2015 paper documented a set of facts: that after a century of almost uninterrupted progress on mortality, US white non-Hispanics (WNH) in midlife were experiencing a sustained period in which mortality rates stopped falling and rose instead. This stands in contrast to the continued declines in midlife mortality in other rich countries, and to progress being made in the US by black non-Hispanics, and Hispanics, who are on average poorer than whites.

….We found the mortality increases are in sync with the distress midlife WNHs face in many dimensions: poorer health and mental health, social isolation, obesity, marriage (or lack of marriage), poorer labor market opportunities, and weaker attachment to the labor market.

You use the term “deaths of despair”. I’m wondering how you would define “despair” in this context?

We think of drug, alcohol and suicide deaths. In a sense, they are all suicide – either carried out quickly (for example, with a gun) or slowly, with drugs and alcohol.

In the greatest country in the world!

Theory of Change

First of all, it’s madness to think that the country can have an increase in mortality with no political effects; organic damage — AIDS, the trenches of World War I, lynching (ultimately), and even, if you want to think of it that way, abortion — always brings about a political reaction from those damaged, or speaking on behalf of the damaged, often massive. So why don’t we have either major political party directly capitalizing on “deaths of despair”? I mean, aren’t political parties supposed to be about making voters’ lives better? At best, we’ve got Trump putting Kelly Anne Conway in charge of something or other; and the Democrats are silent.[2]

To answer that, let me flounder through my priors. This is not laughably oversimplified, but cliche, so don’t @ me, but I picture our society as having a pyramid-like structure with a 1% (more like a 0.01%) at the tippy top, who own capital, with a cadre of professionals below them, the 10%, who make sure the 1%’s capital stays buffed and tidy, with the remaining 90% below them, who don’t own capital, and therefore sell their labor power by working to make a living. (Figures may not add due to rounding.) Part of buffing capital is managing all that labor power for profit; another part is keeping the 90% divided, “punching sideways” and not, heaven forfend, up.)

So where does electoral politics fit into all that? Teetering onwards and continuing to oversimplify, this is my theory of change: I believe that “change” — and I’ve “had it,” as Gaius Publius says, I want “change” — comes only when a supermajority of the electorate has the power to demand it collectively; in other words, a big chunk of the 90% has to think and act the same way (and some class traitors in the 10% and 1%, too). I posit that constantly hammering on a platform of universal concrete material benefits, especially for the working class, is the way to bring about that realignment (“Peace, land, bread!”). Both party establishments disagree, as they would. Since the focus of the donor class is on keeping the 90% divided, the parties actively avoid seeking a supermajority, instead deploying a strategy of 50% + 1, that is, about half the electorate plus a few marginal voters. Trump did this by flipping Obama voters in 2016; the Democrats are trying to do this by flipping wealthy suburbanites, especially women, in 2018 and 2020. And this is what the whole swing state/bellwether county model of campaigning is about, and has been for years.

So, floundering along, tactically, how to win a supermajority in a deliberately divided electorate? And an electorate in our enormous country that is legitimately different, in that the life experiences — and class and cultural markers — of a first generation Hispanic immigrant woman in Miami will be very different from those of a male black descendant of slaves in Detroit will be very different from a sixth-generation WASP gay male in Brooklyn. Yes, they are all most likely to be selling their labor power at work as members of the 90%, but what about all the differences? The answer ought to be intersectionality, so that we could all see society as a sort of ginormous Venn diagram of overlapping identities. People ought to be able to communicate at the overlaps; to communicate with each other as both working people and black (or white (or…)) and female (or male (or…)). Unfortunately, intersectionality has been vulgarized into “identity politics,” whose logic is not both/and but either/or; that’s why you never hear about a “black working class” from liberal Democrats, for example; the category cannot exist for them. Worse, both intersectionality and identity politics focus the gaze of the citizen inward at the task of self-categorization, no matter whether the logic be the inclusive both/and or the exclusive either/or, and so you end up with absurd politics like this: “The most radical thing we can do is to be ourselves, no matter what that means or who tells us we’re wrong.” Most radical? Really?

Now my priors are out of the way, so onward. If intersectionality has failed — except for the 1% — because the parties have irretrievably polluted it with identity politics (yes), what to do to win that supermajority? I’m glad you asked. Here is a handy chart of Maslow’s famous hierarchy of needs:

You see that I have classified identity politics as a form of Self-actualization (“The most radical thing we can do is to be ourselves…”) and of course self-actualization is something that the 10%, who form the base of the Democrat Party (see Thomas Frank, Listen, Liberal!) have the money and the time and the energy to do; 10% women can worry about the glass ceiling because they don’t have to worry about the floor collapsing under them. (The 10% may also entertain themselves by encouraging self-actualization in the rest of us, and possibly charge or bill for it.) You will also see that I have classified embodiment under Safety and Physiology (“concrete material benefits”). So, Identity Politics at the pyramid’s tippy top; Embodiment at the base.

Embodiment

But what do you mean by embodiment? I’m glad you asked that, too. Rahmer links to a wonderful 2005 paper by Nancy Krieger, which I highly recommend you read in full, since it’s only four pages long, plus a smidge: “Embodiment: a conceptual glossary for epidemiology” (J Epidemiol Community Health 2005;59:350–355), available for download at the US National Library of Medicine as a PDF. From the abstract:

Embodiment. This construct and process are central to ecosocial theory and epidemiological inquiry. Recognising that we, as humans, are simultaneously social beings and biological organisms, the notion of “embodiment” advances three critical claims: (1) bodies tell stories about—and cannot be studied divorced from—the conditions of our existence; (2) bodies tell stories that often—but not always—match people’s stated accounts; and (3) bodies tell stories that people cannot or will not tell, either because they are unable, forbidden, or choose not to tell. Just as the proverbial “dead man’s bones” do in fact tell tales, via forensic pathology and historical anthropometry, so too do our living bodies tell stories about our lives, whether or not these are ever consciously expressed.

(My spidey sense tingled at “tell stories,” because — and this simplification is super-crude — there’s a recurring focus on “black bodies” in the Black Lives Matter Twitter accounts I follow; which makes sense, given that in not-quite-historical times, black bodies were bought and sold. Now, all 90% bodies are rented, today, as opposed to being sold, and for some reason stories aren’t told about that.)

And from the introduction:

Consider only: food insecurity and fast food profiteering; inadequate sanitation and lack of potable water; economic and social deprivation and discrimination; physical and sexual abuse; ergonomic strain and toxic exposures; and inadequate health care—all leave their marks on the body. As do their converse: the security of a living wage, pensions for old age, and societal support for childcare; universal sanitation and sustainable development; safe workplaces and healthy cities; universal health care and immunisations; and the protection and promotion of human rights—economic, social, political, civil, and cultural. As has long been argued, although not always widely appreciated, it is no accident that from population patterns of health, disease, and wellbeing it is possible to discern the contours and distribution of power, property, and technology within and across nations, over time. Or, more pointedly, from the conditions of our bodies—and those of the animals and plants whose environs we now shape—you can gain deep insight into the workings of the body politic. Embodiment, in other words, is literal.

And:

In the case of epidemiology, at the most general level, embodiment, as an idea, refers to how we, like any living organism, literally incorporate, biologically, the world in which we live, including our societal and ecological circumstances.

“Literally incorporate,” for example, opiods. And:

Finally, while perhaps obvious, embodiment is contingent upon having a body. Understanding probable pathways of embodiment thus requires clarity about what it is that bodies do, as jointly biological organisms and social beings. Minimally, this includes, as elaborated in table 2: (a) for biological organism: reproduce; develop; grow; interact; exist in time and space; and evolve; (b) for social being: societal context; social position; social production; social consumption; and social reproduction. Consideration of these integral aspects of bodily existence is key for understanding both population health and social inequalities in health.

(The hashtag for discussion of such matters seems to be #SDoH (Social Determinants of Health). Imagine! And entire discipline!)

Now, why would I prefer “pathways of embodiment” to intersectionality/identity politics as a conceptual tool to support my theory of change? For several reasons:

Better benefits. Embodiment is material, and I like concrete material benefits. Health and a better, longer life — not just for you, but for the hostages to fortune that you care for — are, and ought to be, far more important to most people than self-actualization. That’s a real reason to ask for people’s vote when seeking a supermajority.

Better morality. Embodiment means that we are “simultaneously social beings and biological organisms.” The focus on “social beings” brings altruism to the forefront, as the individualism of intersectionality/identity politics, and the tribalism of the latter, cannot do.

Better systems thinking. Embodiment allows us to think of the health results of lead pipes in Flint, MI and the health results of deindustrializing the Rust Belt and the health results of abandoning Puerto Rico as problems of the same order.

Better metrics. Unlike identity politics/intersectionality, epidemiology has a solid methodology. We know how to detect, measure, and end epidemics; if we have measurable health outcomes from political choices, that’s a very good thing (and allows the supermajority to be kept, once gained.)

Better wedge issue. I am optimistic that Medicare for All is going to happen. When it does, embodiment provides us with the tools to think through how a truly universal health care system ought to be designed. This too allows a supermajority to be kept.

Neoliberal Epidemics

Neoliberal epidemics are particular pathways of embodiment. From Ted Schrecker and Clare Bambra in The Conversation:

In our new book, we draw on an extensive body of scientific literature to assess the health effects of three decades of neoliberal policies. Focusing on the social determinants of health – the conditions of life and work that make it relatively easy for some people to lead long and healthy lives, while it is all but impossible for others – we show that there are four interconnected neoliberal epidemics: austerity, obesity, stress, and inequality. They are neoliberal because they are associated with or worsened by neoliberal policies. They are epidemics because they are observable on such an international scale and have been transmitted so quickly across time and space that if they were biological contagions they would be seen as of epidemic proportions.

(The Case-Deaton study provides an obvious fifth: Deaths of despair. There are doubtless others.) Case in point for one of the unluckier members of the 90%:

On the morning of 25 August 2014 a young New Jersey woman, Maria Fernandes, died from inhaling gasoline fumes as she slept in her 13-year-old car. She often slept in the car while shuttling between her three, low-wage jobs in food service; she kept a can of gasoline in the car because she often slept with the engine running, and was worried about running out of gasoline. Apparently, the can accidentally tipped over and the vapours from spilled gasoline cost her life.

Ms Fernandes was one of the more obvious casualties of the zero-hours culture of stress and insecurity that pervades the contemporary labour market under neoliberalism.

And Schrecker and Bambra conclude:

Neoliberalism operates through labour markets to undermine health not only by way of the financial consequences of unemployment, inadequate employment, or low wages, as important as these are, but also through chronic exposure to stress that ‘gets under your skin’ by way of multiple mechanisms. Quite simply, the effects of chronic insecurity wear people out over the life course in biologically measurable ways.

Barbaric.

Conclusion

So, here I am, collapsed at the end of the tightrope. Once again, I apologize for the scattered nature of this post, which I wrote very fast, but the concept of embodiment hit me like a sledgehammer when I encountered it, and I felt it was vital to get it out there immediately, and to start refining it. And maybe some bright person who actually does politics can take this ball and run with it.

Oh, and “beyond class” because for social beings embodiment involves “social production; social consumption; and social reproduction.” In the most reductive definition of class — the one I used in my crude 1% + 10% + 90% formulation — class is determined by wage work (or not), hence is a part of production (of capital), not social consumption (eating, etc.) or social reproduction (children, families, household work…). So, even if class in our political economy is the driver, it’s not everything.

NOTES

[1] Case-Deaton have published additional papers on the same topic since the 2015 original; Noahpinion has a round-up of critiques and responses here.

[2] Oddly, a Google search for “‘Thomas Frank’ + opioids” brings up nothing. Frank should get on this, if the liberals haven’t managed to gag him and stuff him in a box.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

74 comments

  1. barefoot charley

    Whew! Give that tightrope-walker an umbrella! :^]

    Brilliant balancing, Lambert, between two first-class epithets: embodiment (of evidence), and neoliberal epidemics (that mortify said embodiments). To translate from Latinate to Saxonese, we can label it bipartisan ‘die-now economics.’

  2. Summer

    “So where does electoral politics fit into all that? Teetering onwards and continuing to oversimplify, this is my theory of change: I believe that “change” — and I’ve “had it,” as Gaius Publius says, I want “change” — comes only when a supermajority of the electorate has the power to demand it collectively; in other words, a big chunk of the 90% has to think and act the same way (and some class traitors in the 10% and 1%, too). I posit that constantly hammering on a platform of universal concrete material benefits, especially for the working class, is the way to bring about that realignment (“Peace, land, bread!”).”

    So this is were the meme 99% vs 1% shows itself as an effective meme for awareness, but not one for organization.

    I was re-watching the PBS series about Prohibition. To push a constitutional amendment change, the minority of the electorate realized the most important thing to a politician…a job.

    A supermajority of any kind wasn’t needed, just enough voters to swing enough elections and that swing, devoted minority needs to be persistent and active all over the country. In each state, they do not need to be a supermajority, just dead serious about their platform. Not even 30% of voters is needed to create such a block.

    1. Lambert Strether Post author

      I’ve got to run, but I was thinking of the events of Tahrir Square, where it took a supermajority to get Mubarak to resign and end his regime. I understand your point — which is actually encouraging — but I’m not sure the analogy is a fair one. (Also, I really really deprecate vanguard movements where small minorities do what’s best for the sheeple masses because I think there’s a big risk of a “same as the old boss” problem. So there’s a normative element in my “it takes a supermajority” position as well.)

      Now that I think of it, a more interesting attack would be to think about geographically limited supermajorities, i.e. for slavery in the Confederacy.

      I said I was over-simplifying, and I meant it!

      1. Summer

        I was limited in my addressing the of the post – mostly aimed at the electoral politics aspect Gaius spoke of, as it would work in the duopoly at hand.
        A revolution is a whole other matter. That would be what Tahir square was like.

        1. Lambert Strether Post author

          I’m perfectly happy to erase parts of the sketch and scribble in something new.

          However, I’m not sure that there is a binary opposition between revolution and electoral politics. I think it more likely that there is a continuum between them.

          1. animalogic

            I agree: there is a continuum between electoral & revolutionary politics. However, somewhere along that continuum both the R & D parties must be liquidated completely. They are toxic & unreformable. Electoral politics can only reemerge on the basis of parties which embody, not merely represent the people.

          2. John Rose

            However, only the threat of revolution can loosen the grasping hands of the 1% enough to permit change to happen, as FDR pointed to Russia, warning the plutocrats of his time.
            Support revolution so reformers have leverage.

      2. nonclassical

        L.S.…reminiscent of Ernst Becker’s, “The Structure of Evil” – “Escape from Evil”? (..not to indicate good vs. evil dichotomy) A great amount of perspective must be agreed upon to achieve “change” intoned. Divide and conquer are complicit, as noted….otherwise (and as indicated by U.S. economic history) change arrives only when all have lost all…and can therefore agree begin again.

        There is however, Naomi Klein perspective, “Shock Doctrine”, whereby influence contributes to destabilization, plan in hand leading to agenda driven (“neoliberal”=market fundamentalism) outcome, not at all spontaneous in nature:

        “Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that “the market” delivers benefits that could never be achieved by planning.

        Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counterproductive and morally corrosive. The market ensures that everyone gets what they deserve.”

    2. Oregoncharles

      @ Summer: Prohibition didn’t last very long, because it was a huge mistake.

      A pretty good case for supermajorities.

      1. Summer

        It’s not about the idea of prohibition as much as it is about organizational principles.
        If the issue is as popular as believed, why wait for the supermajority? It can join at any point.

        1. Lambert Strether Post author

          There is the empirical and there is the normative, which I muddled. First, on the empirical, I would need to know — may even have time to find out — more about the Prohibition movement. My impression is that it has quite a long history and grew out of 19th century feminism, so the matter is more complex than saying “30% of voters and you get your program.” Moreover, embodiment is, if I am correct in my views, a way to align and re-align the left generally; it is a paradigm, if you will. That again is more complicated than electoral politics, where success would (IMNSHO) be the outcome of the alignment/re-alignment (and I’m happy to see this in decadal or even generational terms; I think there is entirely too much fetishization of “the streets” and “revolution,” when the former is about as exciting and functional these days as a cavalry charge, and the latter is chancy and unpredictable*).

          On the normative, OregonCharles makes a good point: The supermajority makes the outcome much harder to overturn. Both ObamaCare and Net Neutrality were 50%+1 things, and look where we are with them. Contrast Social Security and Medicare.

          * That doesn’t make me a Fabian, it makes me aMR SUBLIMINAL Careful there! wannabe Grant. Continuous pressure on all fronts.

  3. mle detroit

    Let’s switch “universal concrete material benefits” to “Concrete Universal Immediate” benefits, that is to say, Cui bono?* The answer, as Paul Wellstone had it: “We’re all better off when we’re all better off.” My litmus test: Bernie’s Medicare for All, universal HeadStart, and a carbon tax.

    * “That probably all the Latin I need,
    and certainly all that I want.”

  4. REDPILLED

    A Progressive People’s Party should use this article as a starting point to get disgusted former Democrats, Republicans, and Independents to join and work with it to register like-minded disgusted voters and get like-minded candidates to run. Greens, Working Families Party members, Democratic Socialists, Black Life Matters members, and all other such marginalized progressives should be part of this inclusive new party.

    The two corporate parties no longer deserve any respect, and only negative attention, especially as the Republicans get more and more extreme and the Democrats purge anyone truly progressive.

    It seems so basic and logical that the 90% want a better life materially (re: embodiment), except to the greedheads who run both corporate parties.

    As Upton Sinclair told us long ago: “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

  5. nealser

    Yes, I think talking about the embodiment of policies on people’s bodies is a better alternative to identity politics. Reinforce the fact that select policies made this economy and made your lives what they are, not a natural order of things..

    Pls check link for Embodiment paper by Nancy Krieger. Doesn’t work for me.

  6. Amfortas the Hippie

    Well done, as usual.

    On Case-Deason: Sounds like home. I keep the scanner on(local news)…ems and fire only since 2006(sheriff got a homeland security grant). The incidence of suicide, overdose and “intoxication psychosis” are markedly increased in the last 10+ years out here in the wilderness(5K folks in whole county, last I looked). Our local economy went into near depression after the late 90’s farm bill killed the peanut program…then 911 meant no hunting season that year(and it’s been noticeably less busy ever since)…then drought and the real estate crash(we had 30 some realtors at peak..old family land being sold off, mostly). So the local Bourgeoisie have had less money to spend, which “trickles down” onto the rest of us.:less construction, less eating out even at the cheap places, less buying of gas, and on and on means fewer employees are needed, thus fewer jobs. To boot, there is a habit among many employers out here of not paying attention to labor laws(it is Texas…)…the last minwage rise took 2 years to filter out here, and one must scrutinize one’s pay stub to ensure that the boss isn’t getting squirrelly with overtime and witholding.
    Geography plays into all this, too…100 miles to any largish city.
    It is not really all that surprising that anhedonia and ennui and alienation and ressentiment are continuing to rise….and it’s unsurprising that folks in the bottom half or so are freaking out….often quietly…and boozing and drugging and fighting and screwing their neighbor’s wives and stringing themselves in trees or blowing their brains out.
    Out my way, at least, this has been a growing issue for at least 10 years…and in it’s larval phase for maybe ten years before that.
    ….
    as for the utility of a “Peace, Land , Bread” platform….my frequent random 10 minute symposia in the feed store and the produce aisle indicate that, even in this nominal deep red county, and those surrounding it, there is a deep hunger for such a thing….so long as the Terror Words are studiously avoided(“socialism”, anything containing the root “communal”, etc)

    since november ’16, I have been amazed at the loathing expressed for both parties, by all and sundry(“not worth a damn”-”they don’t care about us”-”betrayal”). I note that this is since the Black Dude vacated the WH, which had many of them sort of exercised(Tea Party) for a time…even though much of this fervor was pavlovian and largely unconscious(like a nervous tic,lol.
    I learned during that time that many folks were easily triggered into incoherent rage)
    …and you’re right on about the vulgarisation of Intersectionality.
    Damn shame, too.

    “embodiment” in your usage reminds me of Foucault. He went on and on about it, but it’s been a long time, so I’d hafta do a wander through him out under the tree first.
    It also reminds me…of more on the folks out here: almost 30% of our population is over 65. a great number(anecdotal) of those between 30-65 are on some kind of disability, or trying to be.
    Service industry…from waitressing to warehousing wears one’s poor body out.
    Farming and Ranching are also quite brutal to the body, and it shows in a random sidewalk census when there’s something going on on the square.
    But we don’t even have a full time doctor at the clinic any more…just a PA, and a doctor from somewhere else who drops in twice a week. The clinic, nursing home, and both home health services are owned by the same Spanish Conglomerate(they closed the nursing home right quick), service is spotty and expensive, but the actual workers are paid peanuts and are definitely as Precariat as everybody else.
    I would be cool if there was some large and organised group who was interested in scooping up all these potential votes just laying out here in the hills, by maybe addressing these numerous problems and dysfunctions.

    1. funemployed

      Yeah… Foucault. MF anticipated all this then died. If the history of now is written in the future (unlikely, IMO). He will be well remembered.

      “Discipline and Punish” is a good starting point, if anyone cares.

      1. Amfortas the Hippie

        I read him(some) in college…extracurricular-ly,lol.
        but it’s a blur, now.
        But I do remember the broadest outlines of biopower/biopolitics.
        So it twanged a string somewhere in my head.
        where I’ve been all my life, to talk about such things was like speaking Klingon.
        Still, he was definitely ahead of his time, and feels germane to what we’re dealing with, today.
        I noticed a long time ago that our political language was moribund and disconnected from felt/lived reality, and therefore what that language represents…the Framework upon which we hang our apprehensions of the world…is broken down, too.
        “liberal” “conservative” “progressive” alt-whatever….we’re deep into post-post-modernism, now;Neitzsche’s “200 years of Nihilism”?
        I hope not,lol.
        regardless, reckon we need a new framework and a new language with which to talk about it.
        I’ve been slowly(20+ years) working on folks out here, asking Socratic Questions(and often being regarded as a lunatic), pointing at all the commonalities that are so readily apparent if we deign to look for them among the dust and old bones that the “Elite” continues to enforce.
        Transvaluate all those Values.
        Edo Dives, baby.

      2. Rosario

        I’m not well versed in Foucault or Lacan but I’ve read some of both and in reading between the lines of their writing (the phantom philosophy?) I saw a very different message than that often delivered by post-modern theorists.

        As opposed to being champions of “self-actualization/identity” and “absolute relativism”, I always got the impression that they were both offering stark warnings about diving too deeply into the self, vis-a-vis, identity. As if, they both understood the terrifying world that it could/would create, devoid of common cause, community, and ultimately empathy. A world where “we” are not possible because we have all become “I”. Considering what both their philosophies claimed, if identity is a lie, and the subject is always generated relative to the other, then how the hell can there be any security or well being in self-actualization? It is like trying to hit a target that does not exist.

        All potentially oppressive cultural categorizations are examples of this (black, latino, gay, trans, etc.). If the identity is a moving target, both to the oppressor and the oppressed, then how can it ever be a singular source of political action? You can’t hit what isn’t there. This is not to say that these groups (in whatever determined category) are not oppressed, just that formulating political action based strictly on the identity (often as an essential category) is impossible because it does not actually exist materially. It is an amalgamation of subjects who’s subjectivity is always relative to some other whether ally or oppressor. Only the manifestations of oppression on bodies (as brought up in Lambert’s post) can be utilized as metrics for political action.

        For example, the shooting of Philando Castile (a obnoxious and burning case of oppressive violence on himself, and psychologically both his lover, and his child) was immediately framed in terms of identity, which in turn framed the political discourse purely in terms of the subject (black man) relative to the other (racist cop). As opposed to recognizing the obvious, material problem of having a group of individuals with seemingly extrajudicial power, often defending Capitalist interests, able to eradicate human life with impunity. Put simply, it is an issue if a racist becomes a cop, and it is an issue if a misogynist becomes a cop, and it is an issue if an asshole becomes a cop, etc. etc. Along this line of thinking, the problem is more policing rather than racist policing (lowest common denominator), and I would argue that broadening the critique in more materialist terms makes the problem universal and materialist as opposed to being based on the relative interpretation of the subject (i.e. were they killed because they were black, gay, trans, etc.)? It does not matter whether the cop was racist or not, what was done was wrong and should always be understood as wrong. That should be the political narrative. That should be the charge to the oppressors. This is not because the cop was or was not racist. None of that ultimately matters when planning political strategy and building critical mass solidarity. What matters is that he had the power to end a human life with no consequence.

        Anyway, what do you all think about it? I enjoyed the post, and am largely in agreement. The intellectual tool kit needs to be updated. IMO, what capacity identity politics had to move politics positively has largely played itself out, if it ever did at all.

        1. Amfortas the Hippie

          Yup. “We” vs “I”.
          Or, in my drunken ruminations in the garden, attempting to Reconcile Neitzsche and Jesus.
          The original Intersectionality was meant…by it’s progenirix…to broaden our connections, rather than shoehorn everybody into discreet categories.
          and the danger you associate with Foucault is also bubbling up from my subconscious….and I remember that he was worried about it, as well(sigh….yet another weighty mess of words I’ll hafta revisit,lol)
          this enforced personal isolationism is anathema to getting together….which is why it’s enforced.
          It’s the same mechanism used by the Southern Planters to keep the Po White Trash from colluding…finding common cause…with the recently “Freed” Blacks, post Civil War.
          Divide and Conquer.
          Currently, Feminists becoming Feminazis(willingly) are a gift to the Right(including the Clintonists)…Hell, I abandoned Faceborg after being made into a “hemanwomanhater” because I still love the music of Miles Davis…and he was a Misogynist…so if one listens to him, one gets those cooties, too.
          I asked at the time, “what about Jefferson? He owned People! Shall we toss out his whole legacy as well?”—-the answer, to my astonishment, was “yes”.
          Save the Whales won’t talk to the Legalise Weed folks, won’t talk to Free the Jury, won’t talk to Occupy Everything….and we languish in our little Reality Tunnels, all alone, and powerless.
          I abandoned Alternet’s disqus for the same sort of thing…always defending myself because I’m a white dude….and therefore an enemy of “the People”,lol.
          It’s crazy…and effective, if one’s goal is to keep the divisions hot and large.

      3. Lambert Strether Post author

        I did read Foucault back when I was a mere sprat, and the word “biopower” popped into my head, too.

        That said, I harbor — nay, cherish — a lingering grudge against all French theoreticians for destroying humanities departments across the country. I also prefer scholarship based on something close to science, like epidemiology; a field with practitioners in it. Hence, Case-Deaton, Schrecker-Bambra in “Social Determinants of Health,” and so forth. *

        * NOTE In addition, as C. Northcore Parkinson writes, of parliamentary proceedings in France:

        There was the further handicap of all the proceedings being in French-an example the United States wisely refused to follow.

        1. Amfortas the Hippie

          My French is terrible.
          and I suspect that most of the translations I’ve managed to gather from all those guys(Ponty, Foucault, Deleauze, etc) are not very good ones.
          But the Anglo-American turn to Analytical Philosophy led to it’s own culdesacs and roundabouts. No place for Metaphysics and a loathing of the truly Human (and unquantifiable).
          A few years ago, this book(adequate translation from the French) literally leapt off the shelf and into my box….and it’s prolly the most consequential and useful thing I’ve read in ten + years:
          https://www.versobooks.com/books/2272-the-new-way-of-the-world

          For all our burgeoning shelves in libraries and book stores, we Americans are kept from much Thought that could potentially liberate us.

    2. Eclair

      ” …. so long as the Terror Words are studiously avoided(“socialism”, anything containing the root “communal”, etc)”

      Gosh, yes, Amfortas. I find the same in the corner of western NY / PA, where my husband’s family lives and farms and works for the county road crew. And most would rather cut their throats than vote ‘Democrat.’ (Well, I’m approaching that point, too.)

      Funny thing, because of the poverty there is a network of shared favors; my friend Dave has a trailer that I borrow to haul some logs that I cut down on my brother-in-law’s woodlot (I had excavated a pit for his new septic tank with my back hoe), logs that I will split with a splitter belonging to neighbor Joe, who gets a half-cord of firewood. And, in the spring, I will spend a weekend helping Dave (of the trailer) set out his acre of strawberry plants, whose fruit he will sell to bring in some extra income (as well as stock the freezer). And, we all check in on the 90 year old couple down the road. Must be some kind of ‘ism.’

      But, they’re all hurting: crappy jobs, poor health (diabetes, obesity), hooked on a half-dozen prescription drugs, young people leaving. But, suspicious brown people-who-don’t-speak-English and who-are-all-on-welfare are moving in (because rents are cheap cheap cheap), so there is a focus for their free-floating anxiety (besides the corrupt politicians of all parties.)

      We’re ready for a Movement. Something with no ties to either old, corrupt, political party.

    3. Lambert Strether Post author

      > so long as the Terror Words are studiously avoided(“socialism”, anything containing the root “communal”, etc

      What would be your positive suggestion for words that appeal? (I’m there for “embodiment” as a concept, but it’s not exactly bumper-sticker, lizard backbrain material.)

      1. Fiery Hunt

        I, too, out here in CA have and involuntary twitch when the term “community” is evoked; always has me looking for the blame cannons.

        I’d go with some variation on that old beloved Mr. Rodgers….

        Neighborism?

      2. Amfortas the Hippie

        I’m still working on a Lexicon,lol.
        It’s hard….and often dangerous…I use a lot of Jesus Words, given my interlocutors.
        ” there, but for the grace of God, go I”…”the Least of These”…etc
        There’s also the German Idealists who first settled out here…their legacy is still there, under the surface..as well as the idea of the Grange/Farmer’s Co-Op. The latter is still in living memory of the older folks.
        (just don’t link it to a “Union”,lol)
        The biggest problem is that folks don’t generally Think all that deeply, and fall so easily into the Faux Newts Rut and start parroting, with much spittle and little Thought, all the Memery of the Righty Web.
        As I’ve said before, even the idea of Universal Healthcare has traction with a great many of these people.
        So long as it’s couched in words they can understand.
        It’s sad(and intentional) that there’s this whole Language to describe all these things that is forbidden to us…100 plus years of “all things Marx are Evil”.

        1. Amfortas the Hippie

          and I almost forgot!
          “Jubilee”!
          https://www.biblegateway.com/passage/?search=Leviticus+25%3A10&version=CEV

          when confronted with such obviously Biblical things, the folks I talk to are visibly taken aback….shocked into silence.
          Quotes from the KJV…especially from Jesus, himself…are very effective in causing an abrupt end to the usual impersonations of raging parrots.
          Presumably, they go and pray on the matter…and I’ve noted a long term change in those who take their religion seriously.(part of my local surveillance is getting all the local sermons by email…it’s ridiculous how seldom the churches preach on the 4 Gospels…especially the Beatitudes, etc.
          It’s all about Paul and Daniel and Isaiah.)

  7. Tim

    Liberal – cerebral

    Conservative – Physical

    There is a fair amount of chicken and egg to it. Some is psychological disposition, some is environmental conditions.

    This along with the subject of the article is why the democrats can be winning the demographics yet losing the electorate.

    As the needs get more basic, the democrats overlook them and they leave.

    Republicans however seem to be cursed with overemphasis on personal responsibility, and lack of empathy, which prevents them from being the welcoming party to those who are physically in need and leaving the democrats.

    Therefore we see an explosion in the independents, which will ultimately be semi conservative (emphasis on the physical benefits), yet economically socialistic to achieve the necessary government intervention into the class warfare that is erradicating them.

  8. Marco

    “The 10% may also entertain themselves by encouraging self-actualization in the rest of us, and possibly charge or bill for it.”

    Can we include the Oprah Winfrey’s in the .01% also cashing in on the self-actualization via toxic positive-ism. Or is that a stretch?

    1. jrs

      if we are being truly fair (but controversial) it would also include most mental health professionals. Except those either working to change society or else those doing early childhood *family* interventions – as the family system does matter for children.

  9. Steve H.

    The tangible aspect of both concrete benefits and embodiment fit together in non-dialectical materialism. An extension via Odum and ecology is not just material flows and effects, also energetic ones. A comment in the last couple days pointed to longevity and infant mortality as valid metrics. It’s not an accident that Turchin started as an ecologist.

    Interesectionality is in opposition to concrete material benefits for everyone. If focuses on what I should have as part of an in-group, as opposed to what the other should have even though they are not me, which is a union of a greater n than myself as my parts.

    For example, metoo looks and is presented (mostly) as a gender issue, but looks to me like a power issue. Of the men I’m close to enough to have had a conversation on-topic, 2/3 have been sexually assaulted, and the difference (whether by man or woman) was the power differential. The under-reporting on this, as well as institutional cover-ups, is tremendous.

    Maslow’s pyramid is convenient but misleading. I’ll soon be looking at Dr. Bessel van der Kolk’s book, ‘The Body Keeps the Score.’ Nature: “Psychiatrist Bessel van der Kolk argues, moreover, that severe trauma is ‘encoded in the viscera’ and demands tailored approaches that enable people to experience deep relief from rage and helplessness.” I’m hoping his work has a stronger basis on how experience is embodied than the Wilhelm Reich line, which (like Maslow) was convenient but non-reproducible.

    1. Lambert Strether Post author

      > non-dialectical materialism

      Yes, [family blog] the dialectic, a fun heuristic, fun much in the same way that the I Ching is fun.

      van der Kolk sounds interesting, so if you have the time and inclination, please report back. Maybe embodiment is coming up on the zeitgeist charts; Case-Deaton and Schrecker-Bambra feel like they meet “the test of independent invention” to me.

  10. DJG

    Lambert, you gone lyrical: This is what happens when we all realize that our minds live in a body. This is what happens when we do synthesis: Put the poor wandering mind back into the body so that it can live in the world.

    And something that came to mind as I read, a revolutionary and well-known political program:

    As we go marching, marching, in the beauty of the day,

    A million darkened kitchens, a thousand mill lofts gray,

    Are touched with all the radiance that a sudden sun discloses,

    For the people hear us singing: Bread and Roses! Bread and Roses!

    As we go marching, marching, we battle too for men,

    For they are women’s children, and we mother them again.

    Our lives shall not be sweated from birth until life closes;

    Hearts starve as well as bodies; give us bread, but give us roses.

    As we go marching, marching, unnumbered women dead

    Go crying through our singing their ancient call for bread.

    Small art and love and beauty their drudging spirits knew.

    Yes, it is bread we fight for, but we fight for roses too.

    As we go marching, marching, we bring the greater days,

    The rising of the women means the rising of the race.

    No more the drudge and idler, ten that toil where one reposes,

    But a sharing of life’s glories: Bread and roses, bread and roses.

    Our lives shall not be sweated from birth until life closes;

    Hearts starve as well as bodies; bread and roses, bread and roses.

    Details
    James Oppenheim, “Bread and Roses,” The American Magazine, December, 1911.

    1. Eclair

      DJG, I love this song, inspired by the Lawrence, Massachusetts mill workers’ strike of 1912. Both sets of my grandparents, as well as their siblings, worked as mill ‘operatives’ there. At least the ones that weren’t digging ditches for the railroad (who later got treated very well, thanks to the Brotherhood of Railway Workers.)

      Joan Baez sings it here.

  11. Fastball

    Possibly the clearest expression of embodiment is in the teeth.

    Teeth bear the scars of neglect, especially from childhood; neglect borne out of class performance. And this is one form people can detect easily.

    During the job search process, people look at your teeth and judge you. They judge your class, even if you have elevated out of your old class and are middle class, just with teeth that are very hard to save.

    Trust me, I’ve been there. By the way I love this article. It’s given me a new way to think. Something I’ve been aware of, but not specifically something I’ve articulated.

    I’ve often wondered, though, what our bones will tell future archaeologists. I suspect, a very great deal.

    1. Lambert Strether Post author

      I am so glad you brought up teeth; I had intended to. If my teeth were bad, I could no longer “pass” as a member of the 10%. This would destroy my ability to interact (advantageously) with bureaucrats, banks, lawyers, law enforcement… And then of course, the pain, potential deformation of the jaw, etc.

  12. Jim

    “I posit that constantly hammering on a platform of universal concrete material benefits, especially for the working class, is the way to bring about realignment.”

    Lambert, what exactly do you see as the key assumptions behind your statement above?

    One such assumption I see is that thought itself and simply walking into a voting booth is the key energizing component of political activity–but that assumption may be much too narrow( especially taken our modern structure of power) to pull off any significant realignment.

    Significant large scale democratic social movements offering real change such as the American populism of the late 19th century (involving farmers against Bankers and railroads) or Polish Solidarity in the early 1980s (involving workers against a Leninist State structure) seen to indicate that it takes a more vigorous collective activity(the creation of actual cooperative institutions for farmers or the creation of the organizational concept of an inter-factory strike committee which led the occupational strike by Polish workers that brought Solidarity into nationwide existence).

    Simply voting or marching in demonstrations–may no longer be adequate for a genuine democratic insurgency.

    Furthermore, as the populist right in now learning with Trump– it takes more than an electoral win, to create the necessary leverage to get what they actually want.

    Wouldn’t it be the same way with Bernie–how can you, for example, offset the pressures of the national security state without creating some sort of alternative institutions through which leverage on Bernie can be asserted, to keep him from making compromises with the enemies of what we, as average citizens, need for, as you say, our material needs. Certainly the national security state today has significant control over the revenue flow that could make our lives better.

    Doesn’t control of that revenue flow have to be taken from them somehow?

    American Populism and Polish Solidarity may further indicate that rather than simply thought or pulling a lever, it was the individual psychological impact of a significant organizational achievement on the recruits to both movements that ultimately gave these people the self-confidence to take on cultural patterns of intimidation.

    What if the voting booth, by itself, is today too narrow and compromised an instrument to be any longer associated with the idea of real democracy?

  13. Brian Rahmer

    Excellent post Lambert. Your analysis is exactly the kind that is needed for the times in which we find ourselves. Consilience is perhaps the most powerful kind of validation.
    Thanks for preparing a juicy seared filet to my skeletal twitter thread. I’m humbled you read along.

    @brianrahmer

  14. Disturbed Voter

    It is not enough to empower. One must empower for a noble purpose. The only noble purpose yet proposed is servant leadership. The corruption of this is rulers waiting to be served.

    And empower all, not just the few. A majority empowered to be servant leaders, nay all … would be a world unrecognizable to us.

  15. Lambert Strether Post author

    I thought of a couple of other advantages of the “embodiment” paradigm:

    Better Framing. Wonks like Yglesias love to mock working class concerns as “economic anxiety,” which is at once belittling (it’s all about f-e-e-e-lings*) and disempowering (solutions are individual, like therapy or drugs). Embodiment by contrast insists that neoliberalism (the neoliberal labor market (class warfare)) has real, material, physiological effects that can be measured and tracked, as with any epidemic.

    Better Appeal. Embodiment doesn’t just appeal to old codgers like me (as I begin to feel the effects of age) but can be framed to appeal to any “demographic.” For example, one could peel of young people from the so-called Obama Coalition by appealing directly to the stress induced by the gig economy; blacks by appealing to the hypertension caused by racism; women with reproductive services (though I don’t especially care for rights-based framing). Of course, you don’t appeal to the 1%, and the portion of the 10% with excellent medical insurance from their jobs, but they are probably lost causes anyhow.

    Better Alliances. In the same way that an endorsement by the firefighters union is a great thing, endorsements by nurses (and class-traitor doctors, as with PNHP) would also be excellent.

    Better Positioning. Positioning as healers would be quite powerful. (Yes, the Beltway wants “healing” too, but to them that’s a matter of making discourse civil, as opposed to provisioning concrete material benefits.)

    Better Strategists. Currently strategists like Penn and Axelrod etc. slice the electorate up using what are in essence marketing categories (“Soccer Moms”; I’m sure there will be one for wealthy suburban women who used to vote Republican quite soon. “Millenials,” for that matter). How much better to situate voters using embodiment, which is more granular, more empowering, and more precisely targeted in terms of benefits delivered as opposed to political beliefs imputed.

    There are probably more benefits, but I think you can see why “embodiment” hit me with sledgehammer force. ZOMG, the possibilities!

    NOTE * Maria Fernandes would disagree.

    1. Barry

      I think that embodiment helps refute the radical individualism (“There is no such thing as society”) underlying neoliberalism. Any examination of our bodies and biology shows that we are obviously not designed to operate solo. If we’re designed to work together, then it follows that the individual is not the only unit of analysis in assessing our well-being, our economics, our communities, our collective choices.

  16. RickM

    Reviewing my “priors.” We NC’ers are such Bayesians! Love it!

    Excellent post! Thank you, Lambert. I teach first-year medical students and have been accused by some of them of committing “politics.” No doubt, because when I point out Case-Deaton to them I prick the bubble of self-satisfaction from which they do not want to emerge. Besides, a molecular cell biologist is supposed to stick to the “facts.”

  17. athena

    Wonderful article. I can only add that a lot of the “deaths of despair” cases (don’t ask how I know) are people without money for any healthcare whatsoever. So, self-medication of all the sorts, and overt suicide when you *know* that thing growing on your body, aligning with your overall illness (inability to breathe, lethargy, constant hard-core flu-like symptoms, etc and so on), absolutely must be cancer, no joke, not webMD fearmongering, and you have *no chance* of getting “saved by charity/gofundmes” (if you’re willing to degrade yourself, fighting to stay alive like like that)… that’s DIY “hospice/palliative care.” The “accidental overdose” is the unspoken chapter in “Where There is No Doctor” by Doctors Without Borders for Americans without healthcare when it comes to end-stage diseases. :(

    I suspect self-euthanizing because of unofficially diagnosed terminal illness has been common since the dawn of humanity.

    1. Lambert Strether Post author

      I really don’t like writing about this topic, because I don’t want to encourage it, or tip anybody over the edge. But since it’s been brought up, not just here but on other posts, I’ve had the same thoughts myself, and in a perfect world I’d have my “accident” on the Capitol Mall in Washington, DC, right next to a big sign saying #MedicareForAll; a big sign instead of a note. We are social beings, after all.

      1. athena

        Yeah, it’s quite literally morbid stuff, deserving of caution when communicating. But I know lots of people facing serious health issues they can’t afford to properly treat in America, and collective denial and being too ashamed to even talk about it hasn’t exactly helped, so…

        One more thought:

        This all also goes back to your “theory of everything” about Bobbitt’s market-state as a reality, too. The nation-state increased life expectancy, and the market-state lowers it. This might be some sort of Iron Law of Neoliberal Economics: Lower life expectancy and more right-wing populist crypto-fascists getting voted into office. The new “death and taxes.”

        1. Amfortas the Hippie

          You hit the bell, there….nobody talks about their economic woes…it’s taboo…shameful.
          We have internalised the mantra:” ignore the polluted water, little fish…it’s all your fault”.
          This goes a long way in our inability to get together on these gigantic Commonalities.

      2. nonclassical

        …which parallels what 40 year friend suffering Hep C performed, University of Colorado, when off and on again told he would – wouldn’t – would – wouldn’t – would be getting new 98%k effective Hep C medication…”medication” to have begun week after he passed…(entire process over 4 years)

        Should note, in reference to earlier reference, Ernst Becker, this reflects in new way, his epitomizing condition of “innovator”…

  18. Webstir

    God damn Lambert. Thank you.
    There it was. Just sitting under our noses all along.
    My spidey-sense is telling me you’ve done something extremely important here today.
    I will be sharing far and wide.

  19. dbk

    This was really, really interesting, and offers support of a more overarching kind to some thoughts I had while watching the Netflix documentary, “Heroin(e)”, on Huntington, WVa, the “overdose capital of the U.S.”

    I’m more literally than theoretically inclined, so the doc spoke directly to me: it follows three women–a judge in Drug Court, a realtor who distributes “Brown Bag” meals to addicted prostitutes each Wed. night, and the woman fire chief leading the city’s struggle against opioid addiction.

    This film, in Lambertian terms, is all about the body/bodies – bodies injured by heavy labor and now-low wages (thus, the injured body), bodies initially relieved from labor-induced pain by pharmaceuticals and being brought back to life by pharmaceuticals (btw, why do two dosages of auto-inject Narcan cost $4,500?), and bodies which are hungry and homeless and selling themselves for the next pain-relieving fix.

    The reviews, while very positive (the film will probably be nominated for an Academy Award), don’t delve into the historical causes of what’s happening in Huntington these days. Rather, they focus on the film’s portrayal of the humanity of the three women and at the same time, the humanity of the sufferers, a shared humanity.

    And this makes the film, despite its subject matter, hopeful, even optimistic.

    I can’t envision how to build a political movement out of what’s happening across the country, most notably but not exclusively in the Rust Belt. But this post has helped me start thinking about it from a new perspective.

    Addendum: re: dental health, Remote Area Medical (RAM) was in Houston, TX last week. Once again – as when RAM visits WVa and western VA – the top medical need was for dental care. This deserves a movement of its own IMHO.

    1. nonclassical

      …some who travel internationally, while physically “training”, note feet = mobility…when consulting those abroad regarding positivity of gait, we find children, Europe, are provided foot care – remediation of problems, and of course uneven cobblestone surfaces provide ongoing conditioning.

      It is impossible to travel anywhere, U.S., perhaps especially in youth education circles, without this observation arising. Adults, U.S., are also prone to “pronation”…and other variety of physical ailment so pervasive they go unnoticed…un-treated. Look around us as humans “move”, through life….

      ancient asian koan defines “shoes” – footwear (eyes averted) as indicative of “character” – path…

  20. W. Aaron

    Bravo, Lambert. This is a great post that should lead to some excellent reframing when many of us talk about these issues.
    However, I want to bring your attention to some deficiencies in the Case-Deaton study. These deficiencies do NOT debunk the main idea that the middle-aged white death rate has not decreased as it has in other developed countries, but it does strike at the finding that the death rate has been steadily increasing inside the US. I think this is well worth a read just to see how general statistical analysis issues can have a substantial impact on the conclusions of a study. It should also be important so that we can all use Case-Deaton in a defensible way within this argument.
    In a nutshell, middle-aged death rates in the US have been flat since 1999. They have increased markedly for women, and decreased for men at approximately the same rate. They have not seen the same decreases that other developed countries have.

    If you (and other readers) aren’t familiar with Andrew Gelman, I highly suggest becoming so. He can get quite weedy at times, but much of his work is accessible and, at least for me, helps one see potential problem spots in these kinds of studies.

    His Slate writeup: http://www.slate.com/articles/health_and_science/science/2015/11/death_rates_for_white_middle_aged_americans_are_not_increasing.html

    His analysis on his own blog:
    http://andrewgelman.com/2015/11/18/first-second-and-third-order-bias-corrections-also-my-ugly-r-code-for-the-mortality-rate-graphs/

    1. dcrane

      Interesting – he argues that the average age of the sample of people in the 45-54 category has gone up, which is important since mortality rates almost double during that age span.

      The census data have numbers for the population by age, and I ran the numbers and estimated that the average age of non-Hispanic white Americans increased from 49.3 in 1999 to 49.7 in 2013. An increase of 0.4 years might not sound like much, but mortality rate increases a lot by age—more than doubling between the ages of 45 and 54—so even a small shift in average age can cause a big shift in the observed trends.

    2. Lambert Strether Post author

      The statistics are above my paygrade, though Gelman doesn’t seem tendentious; I’d have to review the literature since this is from 2015 and doubtless there’s been controversy. However, Gelman writes:

      And there’s more. But before going on, let me emphasize that the main finding of the Case and Deaton paper stands up just fine. I take their main finding to be that middle-aged U.S. whites have not been seeing the rapid declines in death rates that have occurred in other groups and in other countries. Statistical bias corrections on the order of 5 percent—that’s what we’ve just seen—are enough to derail the story of a steadily increasing death rate among middle-aged white Americans, but in no way could they explain away the drops of 20 percent in other groups and other countries. (Some other countries had postwar baby booms, but they generally did not quite coincide with America’s.)

      If I understand it correctly, we have an increasing death rate until 2005, when it levels off (at a still very bad level). This paper from Anne Case in 2017 seems to be the response/advancement of the numbers; more.

  21. freedeomny

    Thanks! Really like this concept. It’s pragmatic, concrete, realistic….an idea that you can grab onto and sink your teeth into! Whereas when some people start talking intersectionality, my eyes tend to glaze over when they go into cerebral la la land.

  22. Eclair

    I’m rambling here, but when I read Lambert’s post yesterday, the word that leaped out at me was ‘incorporate.’

    As in, ” …embodiment, as an idea, refers to how we, like any living organism, literally incorporate, biologically, the world in which we live, including our societal and ecological circumstances.” (quote from the Krieger paper)

    “Embodiment” is the noun, the idea; “incorporate” is the verb, the process by which we each take pieces of our environment (food or lack of it, pure or lead-laced water, hugs, beatings, cold, heat) and make them into our body, our ‘corpus.’

    I thought about how distanced the term (incorporate) has become from its original meaning. Today, ‘to incorporate’ means to wave about some legal jargon that creates a fictional entity that simulates a human, with the rights and privileges of a human, with millions of ‘votes’ per corporation, but without the human limitations of mortality.

    And I thought about how so many corporations have become the embodiment of non-wellbeing, of dis-ease: tobacco, fast food, processed food, pharmaceutical, agricultural, petro-chemical, fast fashion.

    Which leaves us, where? But the images of bloated artificial entities ‘incorporating’ resources, leaving less and less for the corporeal beings, stuck with me throughout the night.

  23. Afrikaan

    Holy Moses! Here I was, reading NC these past months, learning lots and enjoying myself tremendously, but from time to time wondering if I was wasting my time reading about US issues: It looks so different from South African ones. How could solutions to US problems apply to South African problems?

    Embodiment seems to offer a common solution.

    When an uncaring provincial health MEC decides to outsource mental health patients, and many of them then die from neglect, it’s an example of embodiment. When the miners impoverished by shark loans strike at Marikana and the police massacre them, it’s embodiment. When there are child-headed households, it’s embodiment. When farmers are attacked in their homes, it’s embodiment. When there’s a tik epidemic and gang murders on the Cape Flats, it’s embodiment. When children and teens die in unscrupulous initiation schools, it’s embodiment. The hunger of poor people who suffer from the corruption in the distribution of pensions is embodiment.

    Apartheid was about identity — it was protested and dismantled because of its embodiment.

    I could go on and on.

  24. knowbuddhau

    Dude. Whoa. Whoa, dude. A) Nice work. B) Embodiment, what a concept. I think I like it. Hits me right where I live. Much obliged.

  25. Dick Burkhart

    It is no accident that the Case-Deaton study concerns the group with the least status in current identity politics / intersectionality ideology: white, middle aged people (especially of middle to lower income). “Idenity politics” treats these people as the oppressive power structure, when in fact, except for the top 10%, they are often as much the victims of neoliberalism as the rest of the 90%.

    Love your concept of “embodiment” as an alternative basis for political action. That’s exactly Bernie’s “political revolution”.

    1. IowanX

      Lambert–Thank you so much for this. I can understand how the idea of embodiment hit you like a ton of bricks. It’s that powerful! I agree with your thesis 100%, and I write as the brother of a Case-Deaton “victim”, which is kind of a tragic story I’m still “processing” years later.

      I want to expand upon something you wrote, (which I think is correct) because commentators like the guy from South Africa may not understand the fine grind of the US electoral process. You correctly wrote this:

      “Since the focus of the donor class is on keeping the 90% divided, the parties actively avoid seeking a supermajority, [which they’d get if they focused on concrete, material benefits]. instead deploying a strategy of 50% + 1, that is, about half the electorate plus a few marginal voters. Trump did this by flipping Obama voters in 2016; the Democrats are trying to do this by flipping wealthy suburbanites, especially women, in 2018 and 2020. And this is what the whole swing state/bellwether county model of campaigning is about, and has been for years.”

      I think it’s wise to explain why both parties do this, and IMO it’s the perennial requirement for political fundraising for campaigns. Close elections–indeed, controversial Commission decisions, such as the FCC on Net Neutrality tomorrow–create fundraising opportunities for all the players, including the congressional members and their opponents, the astro-turf organizations funded by corporate lobbyists, the “honest” nonprofits trying to fight the lobbyists, etc. Keeping conflict alive–by fighting over individual bits of funding–say, CHIP, or the DREAM Act, for a short period of time, enables perennial rounds of compelling fundraising asks. For both parties, “solving problems” (by doing what 70% of the population want them to do) would starve the biennial electoral resource gravy train. And it goes without saying that the electoral money flows entirely to some portion of the 10%.

      So while your premise is entirely correct, the democratic incentive– to go for the 70% solution, the stuff most Americans actually want–is impeded by the political incentive of both D’s and R’s–to continue to divide and conquer, via class, identity politics, racism, etc. etc., to keep a political money-train running for candidates in particular, and a chunk of the 10% more generally, in place.

      It’s a recipe for bad governance, and the solution is in front of our nose. Getting money out of politics, via “corporations ain’t people, and money ain’t speech” is a conundrum that no court has ever been able to address.

  26. Bern

    See also James Kwak:

    27 words that every thinking human (even politicians!) should endorse…and pretty much matches the spirit of Lambert’s very nice work.

  27. knowbuddhau

    Finally getting around to reading the original. My word of the Hour is now “ecosocial,” which I see no one else has highlighted. It puts this social thing we’re all doing in an actual environment.

    Since my latest thing is testing for which universe the author thinks we’re in, Newtonian vs Quantum, I’m very happy to see that Krieger (2005) ends on the right note.

    This is my kind of myth-making. Krieger is talking about what kind of world we live in, how it functions, and our place in it from a scientifically sound perspective.

    [T]his world is comprised of animate
    populations and inanimate entities interacting at multiple
    scales and levels in myriad ecosystems that have evolved over
    time, with the living beings actively shaping and not simply
    passively responding to their environs. Embodiment,
    for epidemiology, thus entails consideration of more than
    simply ‘‘phenotypes,’’ ‘‘genotypes,’’ and a vaguely defined
    (and implicitly external) ‘‘environment’’ eliciting ‘‘gene-
    environment’’ interactions. We live embodied: ‘‘genes’’ do
    not interact with exogenous (that is, outside of the body)
    environments—only organisms do, with consequences for
    gene regulation and expression.

    “We live embodied” is a bit too indirect for me, though. Krieger calls embodiment “a noun-like verb.” Does she mean a gerund?

    As a poet my favored tense is the present imperfect. We are embodying the universe, the universe is embodying us.

    At long last, we’re finally seeing things right: just look at any organism in “the wild” WITHOUT ignoring the background, ffs, and it’s as plain as day(night).

    And I’m reminded of another paper from 2001 also concerning genes and behavior.

    Humbled by the Genome’s Mysteries I’ve quoted it here, I’m sure. Try as I might, I find no way to distill Gould. His elegant prose and wit bear repeating:

    First, the key to complexity is not more genes, but more combinations and interactions generated by fewer units of code — and many of these interactions (as emergent properties, to use the technical jargon) must be explained at the level of their appearance, for they cannot be predicted from the separate underlying parts alone. So organisms must be explained as organisms, and not as a summation of genes.

    Second, the unique contingencies of history, not the laws of physics, set many properties of complex biological systems. Our 30,000 genes make up only 1 percent or so of our total genome. The rest — including bacterial immigrants and other pieces that can replicate and move — originate more as accidents of history than as predictable necessities of physical laws. Moreover, these noncoding regions, disrespectfully called ”junk DNA,” also build a pool of potential for future use that, more than any other factor, may establish any lineage’s capacity for further evolutionary increase in complexity.

    The deflation of hubris is blessedly positive, not cynically disabling. The failure of reductionism doesn’t mark the failure of science, but only the replacement of an ultimately unworkable set of assumptions by more appropriate styles of explanation that study complexity at its own level and respect the influences of unique histories. Yes, the task will be much harder than reductionistic science imagined. But our 30,000 genes — in the glorious ramifications of their irreducible interactions — have made us sufficiently complex and at least potentially adequate for the task ahead.

    Krieger (2005) ends with a flare that rings loud, clear, and true to me: “Ultimately, it is by embodying this context that we manifest
    the observed population patterns of health, disease, and
    wellbeing…(p. 354).”

    The question then arises, what’s “this context?” And in discovering our context, we discover ourselves, and vice versa, ad infinitum. Now that’s a wonder-full life. (And what is “that”? Thou art that. And you know what? That loves that. Thus we see that altruism is, in fact, the proper way of being human, not some sideshow freak event.)

    Thanks, thanks, and thanks again.

    1. knowbuddhau

      Errata:

      Actually, she calls it a “verb-like noun.” I’m all for defining things as verbs, not nouns, since there aren’t any things in nature, only events.

      And in saying “another article from 2001,” when it’s Krieger (2005) we’re talking about, I’m referring to an earlier paper, Krieger (2001), in the references.

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