in PEMISCOT COUNTY, Mo. — The food was nearly gone and the bills were going unpaid, but they still had their pills, and that was what they thought of as the sky brightened and they awoke, one by one. First came Kathy Strait, 55, who withdrew six pills from a miniature backpack and swallowed them. Then emerged her daughter, Franny Tidwell, 32, who rummaged through 29 bottles of medication atop the refrigerator and brought down her own: oxcarbazepine for bipolar disorder, fluoxetine for depression, an opiate for pain. She next reached for two green bottles of Tenex, a medication for hyperactivity, filled two glasses with water and said, “Come here, boys.”

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The boys were identical twins William and Dale, 10. They were the fourth generation in this family to receive federal disability checks, and the first to be declared no longer disabled and have them taken away. In days that had grown increasingly tense, as debts mounted and desperation grew to prove that the twins should be on disability, this was always the worst time, before the medication kicked in, when the mobile home was filled with the sounds of children fighting, dogs barking, adults yelling, television volume turned up.

Talk of medications, of diagnoses, of monthly checks that never seem to cover every need — these are the constants in households like this one, composed of multiple generations of people living on disability. Little-studied and largely unreported, such families have become familiar in rural communities reshaped by a decades-long surge that swelled the nation’s disability rolls by millions before declining slightly in 2015 as older beneficiaries aged into retirement benefits, according to interviews with social workers, lawyers, school officials, academics and rural residents.

How to visualize the growth in disability in the United States? One way is to think of a map. Rural communities, where on average 9.1 percent of working-age people are on disability — nearly twice the urban rate and 40 percent higher than the national average — are in a brighter shade than cities. An even brighter hue then spreads from Appalachia into the Deep South and out into Missouri, where rates are higher yet, places economists have called “disability belts.” The brightest color of all can be found in 102 counties, mostly within these belts, where a Washington Post analysis of federal statistics estimates that, at minimum, about 1 in 6 working-age residents draw disability checks.

[referring back to the family in the introductory paragraph]This month, reality was a $600 electricity bill that included late payments. An additional $350 for the mortgage, $45 for water, $300 for cellphones. Then $98 for cable television, $35 for Internet service, $315 for furniture bought on credit, $35 for car insurance and $60 for life insurance.

Kathy sat with a notepad that said “Live Like Your Life Depends On It” and did the math. Their monthly checks totaled $2,005 — $1,128 less than when the twins received benefits — and bills would consume all of it except $167. There wouldn’t be enough to whittle down her payday loans. Or to settle up with the school for her granddaughter’s cheerleading. Or to pay her lawyer for a divorce from her fourth husband.

She took the family to McDonald’s because they liked it, even though she knew they couldn’t afford to eat out. She went through more pain pills than she needed, and every few weeks, when those pills ran low, like today, she returned to the doctor for more.

The twins had been examined by psychiatrists and counselors, social workers and educators, usually to conflicting conclusions. One counselor in 2015 wrote that the boys had “possible autism” and “severe mood swings.” Another assessment: “Interaction skills . . . not obviously impaired at a level one would typically associate with a child with an Autistic Spectrum Disorder.” And another: “Significant difficulties” and “developmental disorders.” And another: “The symptoms and behaviors in which [the children] presented were not at the same level” as Kathy and Franny had reported. And another: “Asperger’s syndrome.” At one point, Dale was removed from special education, and a school official later had this to say: “To my knowledge, they seem like normal boys.”

Kathy, hunched over, brought a hand to her forehead. “We’re finished, okay?” the representative was telling her. “All right, then, thank you,” she said, hanging up, and then it was quiet once more. She looked out the window, appearing shaken by two hours of questions intended to discern whether the twins met the requirements for a child disability benefit: an impairment or combination that resulted in “marked and severe functional limitations.”

She didn’t know, not yet, that later that month an autism specialist would tell her and Franny that the twins’ limitations weren’t that severe. They had ADHD and a disruptive mood disorder — but not autism. She didn’t know she would drive home venting the whole way. “I asked God to give us the right diagnoses,” she would say. “I don’t feel like I got the right diagnoses.” She didn’t know that they’d probably never get the checks back, that the family would now be composed of two generations on disability rather than three, and that she would arrive home feeling more alone than ever.

There was an opioid crisis before Trump got elected.

Propagated mainly by the pharmaceutical companies. (Specifically Perdue.)

Welfare/Disability cheats existed before Trump was elected.

This isn't news to us.

Well, now all of a sudden Trump gets elected and there's an opoid crisis, gee

I've been reading about the welfare state for decades. I'm not sure where you get your news....

Dude. In your second goddamn sentence:


You made it about Trump.

As far as Pharma influence goes, no, not entirely on their own, but the onus is on their aggressive marketing campaigns to get doctors to prescribe their products. Perdue is *especially* culpable with Oxycontin.

This is a new characterization of the welfare state, and the press is presenting it as if they've discovered some anthropological treasure trove and are only now presenting it to us, and doing so with a complete lack of irony regarding their previous, rather different coverage.

I don't think that was hard to grasp from previous posts.

Except I don't think the coverage has been different. Linda Taylor? A billion stories of urban welfare culture. And this new characterization, best I can tell, is one story on MSNBC? Presenting it as also affecting whites seems hardly a new characterization.

I'm pretty much a news junkie and I don't think the coverage of welfare recipients has undergone any appreciable change in the last several years. Just sayin'

Which can be connected to Trump, because the rural poor were the ones voting for him in droves. It's an attempt to understand why they supported him.

For the last several months, social scientists have been debating the striking findings of a study by the economists Anne Case and Angus Deaton.* Between 1998 and 2013, Case and Deaton argue, white Americans across multiple age groups experienced large spikes in suicide and fatalities related to alcohol and drug abuse—spikes that were so large that, for whites aged 45 to 54, they overwhelmed the dependable modern trend of steadily improving life expectancy.

zomg Trump! zomg lefties! zomg corporations! zomg welfare!

The only thing missing is zomg gunz and zomg Jesus.

zomg!

There's some truth to that, but this really started back well before the first primaries, when everyone was eagerly anticipating the disintegration of Trump's campaign (which arguably actually happened several times and he won anyhow.)

This is right around the start of the primaries



This particular study is probably, if a single catalyst can be defined, really what triggered the interest. Nevertheless, these findings would not have been nearly so striking had some attention been paid to what was going on in what amounts, geographically, to about 75% of the country rather than just making internet memes about them and rolling one's eyes every time country music came on.

This article is post-nomination, but it has a telling tagline on the picture at the top:

"Poor white Americans’ current crisis shouldn’t have caught the rest of the country as off guard as it has."

It certainly didn't catch anyone from rural America off guard, nor many of their political representatives. It did, however, catch the press off guard because they were too used to ignoring or laugh at this part of the country in between calling them racists and dismissing their every thought as "resentment".

Once the death toll from opoids started mounting and the life expectancies started dropping, of course, that didn't work any more. When the Atlantic is hinting that "the country" shouldn't have been caught by surprise (where it really means politicians) what it really should be doing is pointing the finger at itself, and at academia. The fact that this was so striking and so unexpected speaks to a complete dearth of attention paid to the entire problem.

The opoid crisis didn't even initially trigger it. Interest in that was aimed at targeting "big pharma", not at actually remedying the problem. The only real interest in the problem was in promoting a narrative about "corporations". The people actually taking the pills were really ignorant white rednecks who probably were racists and misogynists and owned guns and stuff. It's really not unlike the solutions aimed at cities and minorities; the intent is not to solve anything, it's to ensure that the problem remains so that there's always something to scream about at election time.

Black men from the same demographic never got this, when they were kids all the good jobs were reserved for white people and that's what they were taught.

There's also the problem that no one really wants to deal with the racial issues inherent in the fact that poverty drastically increases the suicide rate of whites but has much less of an effect on the suicide rate of blacks.

The real problem is that white males who are currently middle-aged comprise the "buffer" generation, when they were being raised as kids, they were raised in a world where women did not work and where racism was omnipresent. Jobs were much easier to come by in the 50s and 60s when the US was >50% of the world economy and you did not have to compete with women for jobs, and as such these men were raised to believe that failure to meet fairly high expectations by modern standards meant they were lazy, failures at life, and worthless human beings. Black men from the same demographic never got this, when they were kids all the good jobs were reserved for white people and that's what they were taught.