By Europaeus *

Continued from Part 16

In a nation where a mass shooting occurs on average about once a day, it is easy to be cynical about the prospect of change. But following the El Paso and Dayton attacks, there are glimmers of hope, however slight.

The crowded field of Democratic presidential candidates has jumped on the issue, ensuring that the national spotlight of the 2020 campaign will keep the debate over guns and domestic terrorism from fading away. In Congress, Democrats have rallied behind legislation which would require D.H.S., the F.B.I. and the Justice Department to address ‘white supremacism’ and right-wing extremism, including training and information sharing.

Among law enforcement there has been a new push for domestic terrorism to be codified as a federal crime. “Acts of violence intended to intimidate civilian populations or to influence or affect government policy should be prosecuted as domestic terrorism regardless of the ideology behind them,” Brian O’Hare, president of the F.B.I. Agents Association, wrote in a statement. Such a change would give prosecutors new tools to confront the threat of domestic radicalisation.

There has also been a noticeable shift in how law-enforcement and government officials talk about these attacks. F.B.I. agents, politicians and federal attorneys have become quicker to label extremist violence committed by Americans as “terrorism.” On 6 August 2019 the F.B.I. announced it was opening a domestic-terrorism investigation into the suspect in Gilroy, California noting that the gunman responsible for the massacre on 28 July 2019 at the Gilroy Garlic Festival had a ‘target list’ of religious institutions, political organisations and federal buildings. The day after the El Paso attack, the top federal prosecutor in western Texas declared that the incident would be treated as terrorism. “We’re going to do what we do to terrorists in this country, which is deliver swift and certain justice,” said U.S. Attorney John Bash.

This language matters, experts say. If we cannot call an evil by its name, how can we hope to defeat it? “You can’t really deal with the problem unless you acknowledge it exists,” said Mark Pitcavage, senior research fellow at the Anti-Defamation League Center on Extremism. Mr. Pitcavage has studied far-right extremism since the mid-1990s. “We need a consensus that this is a problem, and we need to get together, irrespective of people’s partisan beliefs or anything else, to confront this problem for the good of everybody.” (V. Bergengruen and W.J. Hennigan, ‘We are being eaten from within.’ Why America is losing the battle against white nationalist terrorism, ‘We are being eaten from within.’ Why America is losing’, TIME, 8 August 2019).

The memoir of a physician may help further to understand the pervasive, threatening nature of ‘white supremacy’. In his book Dying of whiteness: How the politics of racial resentment is killing America’s heartland (Basic Books, New York, N.Y. 2019, professor Jonathan M. Metzl, of Vanderbilt University in Nashville, Tennessee, wrote about one of his patients, ‘Trevor’. In early 2016 Dr. Metzl had met Trevor, a forty-one-year-old uninsured Tennessean who had driven a taxi for twenty years until worsening pain in the upper-right part of his abdomen forced him to see a physician. Trevor had learned that the pain resulted from an inflamed liver, the consequence of years of hard partying and the damaging effects of hepatitis C. When Dr. Metzl met him at a low-income housing facility outside Nashville, Trevor appeared yellow with jaundice and ambled with the help of an aluminium walker to alleviate the pain he felt in his stomach and legs.

Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act, popularly named nicknamed Obamacare because it was signed into law by President Barack Obama, in 2010, and the related expansion of Medicaid coverage. Had Trevor lived some forty minutes away in neighbouring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky had adopted the Affordable Care Act and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms.

One may barely conceive of a white body which refuses treatment rather than supporting a system which might benefit everyone. One should read that act as a metaphor for the decline of the nation as a whole.

Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support ‘Obamacare’ or sign up for it,” Trevor told Dr. Metzl. “I would rather die.” When Dr. Metzl asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.” [Emphasis added]

Trevor died of the toxic effects of liver damage caused by hepatitis C. In fact, Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma impressed on him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma, aligned with beliefs about a racial hierarchy, overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and non-white others. Dogma prescribed to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system which might have placed him on the same plane as immigrants or racial minorities – why, “Mexicans or welfare queens.”

Trevor also died because the dogmata and hierarchies he supported reflected the agendas of politicians who clamoured that health care reform and Medicaid expansion represented everything from government overreach to evil incarnate. Anti-A.C.A. invective found particular champions in Republican lawmakers in Tennessee, a once moderate, at the centre, state which had turned hard right. These politicians repeatedly made sure that Tennessee did not create its own Obamacare exchange, expand Medicaid, or embrace the health care law in any way.

Thus, routine screenings, filled prescriptions, visits to doctors’ rooms, and many other factors linked to better health outcomes rose steadily in Kentucky in the four years after that state expanded Medicaid. Such trends lifted the overall well-being of many Kentuckians and particularly helped people who suffered from what are oddly called preexisting conditions such as hepatitis C. Preventive care and proper treatment remained unattainable for many lower-income Tennessee citizens, in large part because of their state’s political choices.

Dr. Metzl had some sense of the complex medical and psychological explanations for Trevor’s symptoms. He had worked in an intensive care unit during his internship. He had witnessed the devastating effects of organ failure. He later trained in psychiatry, where he came to appreciate how people’s deep defence mechanisms and projected insecurities can lead them to act in ways which seem at odds with their own longevity.

Yet, the more Dr. Metzl spoke with Trevor, the more he realised how his experience of illness, and indeed his particular form of ‘white identity’, resulted not just from his own thoughts and actions but from his politics. Local and national politics claimed to make America great again – and, tacitly, white again – on the backs and organs of working-class people of all races and ethnicities, including ‘white’ supporters. It was politics which made vague mention of strategies for governance but ultimately shredded safety nets and provided massive tax cuts which benefited only the very wealthiest persons and corporations. Such politics, all too often, gained traction by playing to anxieties about white victimhood in relation to imagined threats posed by “Mexicans and welfare queens.”

Between 2013 and 2018 Dr. Metzl had travelled extensively in the South and Midwest – in Sarah Palin’s words, “the real America.” He had wanted to learn how people balanced anti-government and pro-gun attitudes while at the same time navigating lives impacted by poor health care, widening gun-related morbidity, and underfunded public infrastructures and institutions. During his travels he met many people who, like Trevor, were dying in various overt or invisible ways as a result of political beliefs or systems linked to the defence of white ‘ways of life’ or concerns about minorities or poor people hoarding resources. The stories these people told Dr. Metzl became the stimulus for a more sustained investigation of how particular American notions of ‘whiteness’ – notions shaped by politics and policies as well as by institutions, history, media, economics, and personal identities – threaten ‘white’ well-being.

Dr. Metzl found that Donald J. Trump supporters were often willing to put their own lives on the line in support of their political beliefs. As a result, when viewed more broadly, actions which may have seemed from the outside to be crazy, uninformed, or self-defeating served larger political aims. Had southerners, including Trevor, embraced the Affordable Care Act and come to depend on its many benefits, it would have been much harder for politicians such as Trump to block or overturn health care reform. By design, vulnerable immigrant and minority populations suffered the consequences in the most dire and urgent ways. Yet the trade-offs made by people like Trevor frequently and materially benefitted people and corporations far higher up the socioeconomic food chain – the agendas and capital gains of which depended on the invisible sacrifices of low-income ‘whites’. The white body which refuses treatment rather than supporting a system which might benefit everyone then becomes a metaphor for, and parable of, the threatened decline of the larger nation.

Dying of whiteness, which came out of Dr. Metzl’s research project, explores the effects on white population-level health of what became central Republican policy issues: loosening gun laws, repealing the Affordable Care Act, or enacting massive tax cuts which largely benefited the wealthy and corporations. Dr. Metzl also tracked the health effects of what various authors have called anti-government, anti-tax, pro-gun, and oft-Republican forms of ‘white backlash conservatism’ – a dynamic illustrated by Trevor’s rejection of the A.C.A. because of concerns about non-white minorities taking advantage of his resources.

Dr. Metzl’s research enabled him to assemble a narrative about how, in five steps, the embrace of ‘white identity’ politics by American voters produced catastrophic health outcomes for those same voters.

Rather than landing a man on the moon, curing polio, inventing the Internet, or promoting structures of world peace, a dominant strain of the electorate voted for politicians whose platforms of American greatness were built on embodied forms of demise.

Dr. Metzl concluded that:

Firstly, a host of conservative political movements emerged – or re-emerged – in southern and mid-western states over the latter twentieth and early twenty-first centuries which released into mainstream American politics once-fringe agendas, such as starving government of funding, dismantling social programmes, or allowing free flow of most types of firearms. These movements – ranging from the Tea Party to iterations of libertarianism funded by the Koch brothers, to the Freedom Caucus, to the so-called alt-right given voice through outlets such as Breitbart – arose from vastly different agendas and points of origin. However, their interests grew ever-more aligned as they came to power in southern and mid-western states in ways which shaped state agendas, national Republican platforms, and, ultimately, policies of the Trump Administration. As this played out, theories of backlash conservatism gave way to something even more powerful: practices of backlash governance.

Secondly, these increasingly unified forms of conservatism advanced politically through overt or implicit appeals to what has been called ‘white racial resentment.’ In other words, these agendas gained support by trumpeting connections to unspoken or overt claims that particular policies, issues, or decisions served also to defend or restore ‘white privilege’ or quell threats to idealised notions of ‘white authority’ represented by demographic or cultural shifts. This was both a top-down process – in which politicians used racial resentment as a tool for class exploitation – and a bottom-up one – the language of ‘white resentment’ became an increasingly accepted way of talking about ‘whiteness’ more broadly.

To be sure, groups such as the Tea Party rose to prominence for a wide array of cultural, economic, and religious reasons, many of which had relatively little to do with whiteness or race. Lower-income communities left behind by globalising economies, disenchantment with Democrats, and the growing influence of corporate lobbies and mega-rich donors on party politics unquestionably played major roles. A number of persons with whom Dr. Metzl spoke, when he explained his thesis, told him that positions which appeared to reflect racism instead reflected a larger, colour-blind ‘hatred of the poor.’

Yet a major part of these movements’ appeals lay in rallying cries which tapped into emotionally and historically charged notions that ‘white Americans’ should remain atop other racial or ethnic groups in the United States ‘social hierarchy’, or that white ‘status’ was at risk. This is not to say that any one specific person was expressly racist. Rather, frameworks of ‘white racial resentment’ shaped debates about, and attitudes toward, various public policies and pieces of legislation. Sometimes, the racial agendas of these calls to arms were overt and obvious. For instance, posters of then President Barack Obama photo-shopped with a feather headdress and a bone through his nose began to appear at anti-A.C.A. Tea Party rallies. In 2016 former Missouri Republican Party director Ed Martin told a cheering ‘Tea Party for Trump’ rally in Festus, Missouri: “Donald Trump is for Americans first. You’re not racist if you don’t like Mexicans.” That same year, the ‘Tea Party Patriots’ funded Asia-bashing advertisements featuring fictional Chinese executives in suits ostensibly speaking Mandarin and laughing about how they were able to buy thousands of acres of Missouri farmland. At other times, the racial underpinnings of the agendas appeared all but invisible to people on the ground, as with decisions to rally around issues such as guns, health insurance, or public schools – issues the racially charged histories of which had been obscured by the passage of time.

Thirdly, the policies which took shape when these once fringe forms of conservatism entered the mainstream Republican Party and assumed legislative power often negatively affected the health of middle- and lower-income populations. While some of these policies and actions directly affected health care, others not expressly linked to health, such as the proliferation of civilian-owned firearms, nonetheless carried profound medical implications. ‘White backlash politics’ gave certain white populations the sensation of winning, particularly by upending the gains of minorities and liberals; yet the victories came at a steep cost. When ‘white backlash policies’ became laws, as in cutting away health care programmes and infrastructure spending, blocking expansion of health care delivery systems, defunding opiate-addiction centres, spewing toxins into the air, or enabling guns in public spaces, the result was increasing rates of death.

Fourthly, a wide array of middle- and lower-income people experienced negative health consequences from these policy decisions – again, largely because the policies involved elaborate strategies for tearing down community structures for middle – and lower-income Americans but hardly any blue-prints for building them back up. Minority and immigrant communities, often the targets of backlash’s ire, suffered greatly and needlessly. But the health and well-being of ‘white Americans’ suffered from the health effects of these policies as well. Such effects played out in public ways – such as when white concertgoers died in high-profile mass shootings linked to gun policies – or lack thereof – enacted by conservative white politicians. Other effects were far less obvious, such as the long-term implications of blocking health care reform or defunding schools and infrastructure.

Finally, as with Trevor, many lower- and middle-income ‘white Americans’ continued to support these policies and ideologies – with their inherent links to narratives of imagined victimhood and domination – even after their negative effects became apparent and promises made by politicians such as Trump unravelled. Indeed, for a variety of reasons, ‘white Americans’ in parts of the United States saw drops in life expectancy. But instead of scrapping these state-level policies as examples of historically bad governance, they became the foundations for legislation at the national level, in the form of Trump-era tax bills, gun policies, health care strategies, and other ill-fated initiatives. All the while, the issues themselves – such as guns, health care, or taxes – accrued larger symbolic or moral meanings in ways which rendered conversations about the effects of specific policies ever-more difficult.

The combination of these elements has led to a perilous state of affairs: a host of complex anxieties has prompted increasing numbers of ‘white Americans’ such as Trevor to support right-wing politicians and policies, even when these policies actually harm ‘white Americans’ at growing rates. As these policy agendas spread from southern and mid-western legislatures into the halls of Congress and the White House, ever-more ‘white Americans’ are then, literally, ‘dying of whiteness’. This is because white America’s investment in maintaining an imagined place atop a racial hierarchy – that is, an investment in a sense of ‘whiteness’ – ironically harms the aggregate well-being of United States whites as a demographic group, thereby making ‘whiteness’ itself a negative health indicator.

A wrong turn is made by addressing racism mainly as a disorder of people’s brains or attitudes. Instead, racism matters most to health when it shapes politics and policies which then affect public health.

Dr. Metzl’s focus on the health effects of American backlash politics for ‘white Americans’ is in no way intended to minimise the larger effects of racism in the United States. It should be taken as a matter of fact, but all too often is not, that systems in which ‘race’ correlates with ‘privilege’ have devastating consequences for minority and immigrant populations. Cuts to health delivery networks, communal safety nets, schools, and social services, alongside policies which enable the proliferation of guns, often impact minority populations first and most severely. Racism itself can also have profoundly negative health consequences. Rather than landing a man on the moon, curing polio, inventing the Internet, or promoting structures of world peace, a dominant strain of the electorate voted for politicians whose platforms of American greatness were built on embodied forms of demise.

Professor Yvette Cozier, an epidemiologist at Boston University, and her colleagues have uncovered associations between frequent experiences of racism – such as receiving poor service in restaurants and stores or feeling unfairly treated on the job or by the police – and higher risks of illness and obesity among African American women. Professor Michael A. Grandner, the Director of the Sleep and Health Research Programme at the University of Arizona College of Medicine, has found links between perceived racism and sleep disturbances. And Dr. Mario Sims, of the University of Mississippi Medical Center, found that lifetime discrimination was associated with greater rates of hypertension among adult African Americans.

Increasingly, one now hears that people with racist attitudes fare poorly as well. Racist views make people ‘sick’ and ‘unhealthy,’ neuroscientists claim, because the psychological effort of discrimination can raise blood pressure or cortisol levels and heighten risk for heart attacks or strokes. “Harboring prejudice may be bad for your health,” writes professor Elizabeth Page-Gould, of the Department of Psychology, University of Toronto, because racially prejudiced people experience such “bodily reactions even during benign social interactions with people of different races.”

Dr. Metzl’s findings suggest that one makes a wrong turn when one tries to address racism mainly as a disorder of people’s brains or attitudes, or try ‘to fix’ the problem simply by attempting to sensitise people or change their minds. On an aggregate level, people’s individual racial attitudes have relatively little correlation to their health. In extreme cases like that of Trevor, racial animus can lead to medical disaster. Yet this correlation rarely holds true at the level of population health. Racial animosity rarely makes a person sick in and of itself – otherwise there would be many more sick people of all backgrounds in the world.

Instead, racism matters most to health when its underlying resentments and anxieties shape larger politics and policies and then affect public health. Dr. Metzl wold say this in part because many of the middle – and lower-income white Americans he met in his research were not expressly or even implicitly racist. Race did not even come up in many of their conversations. Yet racism remained an issue, not because of their attitudes but because they lived in states the elected officials of which enacted overly permissive gun policies, rejected health care reform, undercut social safety net programmes. In these and other instances, racism and ‘racial resentment’ functioned at structural levels and in ways which had far broader effects than the kinds of racism which functions in people’s minds.

Understanding why conservative white Americans vote in ways which negatively affect their own lives involves far more than pointing out ways in which these voters may have been deceived.

Addressing racism structurally allowed Dr. Metzl to raise what became the most troubling findings of his research. He found that, when tracked over time, racially driven policies functioned as mortal risk factors for all people living in states which had adopted them. This is because illness and death patterns which followed actions such as expanding gun proliferation or massive tax cuts mimicked those once seen in relation to other man-made pathogens, such as water pollution, second-hand smoke, or not wearing seat belts in cars, or during certain disease outbreaks. Society mobilised to reduce risk and improve health when toxins dumped into the water, cigarettes, or faulty automobiles led to declining health. But when the pathogens were policies and ideologies, they instead laid the foundations for politics furthered at the national level by the Republican Party, the National Rifle Association, and the Trump Administration. In these ways, stories such as Trevor’s come to embody larger problems of an electorate which, in its worst moments, votes to sink the whole ship – except for a few privileged passengers who get lifeboats – even when they are on it, rather than investing in communal systems which might lift all boats. ‘Anti-blackness’, in a biological sense, then produces its own ‘anti-whiteness’ – as an illness of the mind, weaponised onto the body of the nation. The particular issues about which Trump supporters appear to have been “duped” also tap into larger histories, myths, and ideologies. These histories, myths, and ideologies go a long way toward explaining the complex tension between promises of restored ‘greatness’ on one hand and practices of self-sabotage on the other. Better awareness of this paradoxical tension might allow the better to promote an alternative investment in collaboration and equality – in many instances, by addressing ideologies of ‘whiteness’ head-on rather than by proxy.

However, the electorate chose a regime the policies of which came cloaked in the promise of restored privilege, enacted through mechanisms of polarisation and divisiveness. As a result, Americans pursued a policy about eliminating financial safety nets and social support programmes, allowing ever-more guns, and defunding roads and bridges while at the same time enacting tariffs and building walls. Such talk, and the policies which flow from it, often signify protection, preservation, or continued supremacy. But in many instances, they ultimately serve to hemorrhage collective abilities to solve problems or help people in times of need. Ultimately, when ‘white’ voters are asked to defend ‘whiteness’, ‘whiteness’ often fails to defend, honour, or restore them. (J. M. Metzl, Dying of whitness: How the politics of racial resentment is killing America’s heartland, Basic Books, New York, N.Y. 2019).

Continued tomorrow … (Part 18)

* Europaeus landed in Australia over fifty years ago. Except for the blue skies and starry nights between 02.12.1972 and 10.11.1975 the place has been constantly overwhelmed by what Hannah Arendt called the ‘sand storm’ – a metaphor for totalitarianism.