A sick society

I hope you enjoyed the weeks I was away in April, working on my next book, Snowblind. I’ve been spending a lot of time recreating a polar world from a hundred years ago that’s strangely tied to events happening today. I’ll turn the manuscript in to my editor later this month and am excited to share it with you in 2027.

Even though I was mostly staying off the grid during that window, I did participate a couple events on the current national crisis. One was hosted by Duke University’s Sanford Center for Child and Family Policy last week—a panel of the effects on families of ICE detention. You can watch it here. I was one of several panelists, most of whom are medical experts, and they all made great observations.

In honor of that conversation, I want to spend today’s post torturing a medical metaphor for what’s going on in the U.S. and many other countries today. We’re living in a very sick society, one that has been suffering a chronic illness for centuries, but that condition is afflicting it in new and increasingly serious ways at the present moment.

Those who are thinking that our society might be just one election away from a full recovery have only to look at major court decisions in the last week and their ramifications to see that a simple voting cure won’t do. (Don’t get me wrong, though—it is critical to vote!)

Last Wednesday, we saw the Supreme Court of the United States taking a sledgehammer to the Voting Rights Act. And we saw the predictable reaction: an immediate scramble to take advantage of that decision in southern states that no longer see themselves as hemmed in by the court or the law in terms of their ability exclude voters—particularly Black ones—from electoral representation.

We also saw the ruling on mifepristone, making it illegal for now to prescribe via telemedicine and send in the mail. Among other things, mifepristone is used for medical abortions, which is why it was targeted. And we also saw the Supreme Court stay that initial ruling, at least for this week. Serious court-watchers have suggested this is a move by the conservative justices to both look reasonable and try not to rile voters ahead of the upcoming elections. That we are even at this point with a medically sound and well-vetted treatment is a ridiculous imposition of one specific religion on everyone. This, too, is a sign of our current sickness.

And to mention a third development that is important, though at first it might seem trivial: billionaire Ken Griffin bought the U.S. Constitution—literally. He recently purchased a first printing of the U.S. Constitution, and now owns the only two copies of one of our core founding documents that are held privately. Billionaires are literally buying our history and our institutions.

Our society is sick. Things like voting restrictions and ICE concentration camps are symptoms of the rot, and pathways to expand it. Today I’ll use a medical frame to address how we tackle a society-wide affliction. 

First, an aside on metaphors and illness: a lot of writing exists about how metaphor can be dangerous when talking about being sick. Using war metaphors to describe cancer treatment, for instance, can be demeaning, inaccurate, and even harmful. So I’m going to use some other kinds of metaphors today while attempting not to fall into that kind of framing.

One thing to know about the illness debilitating the U.S. right now is that the country will not get better without pretty serious change. The national malady isn’t like a cold that resolves on its own. The U.S. has a grave condition that requires significant treatment, more than just bringing in a new Congress or electing a new president. We’ve seen expanding violence against civilians, erosion of free speech and civil liberties, and mushrooming corruption at every level of government. Trump and DOGE have inflicted devastation overseas that’s already led to hundreds of thousands of deaths, illegal military interventions, and one hapless and extremely dangerous war. Fixing this is going to take work on a number of fronts.

The “he can fix me” problem

On an aggregate level, the country can’t put all its hope in new governors or a new president. Imagining a new leader is going to save everyone is like being in a disastrous relationship multiple times and then skipping therapy to find a better boyfriend. Or going to therapy, but then not doing any of the things you planned on doing, because dating seems more exciting.

Except in this case, people aren’t looking for an “I can fix him” as much as a “they can fix us” for political leaders. But politicians aren’t the actual leaders of change. They follow demands that are made on them—demands by everyday voters, corporations, their peers, their party, and particularly by billionaires. Elected leaders can play a tremendous role by getting out and front and leading on various topics—and I would 100% rather have the ability to elect leaders than to not have that ability. Yet politicians are dependent on the political moment at hand and are rarely the core drivers stopping society’s ills.

Blind spots

Another thing to remember is that part of the current disease afflicting the country is that under the right circumstances, almost all of us are susceptible to some kind of serious affliction. If you grew up in the environment I did, then you know that if people are raised in certain communities, exposed to different information, anyone could be part of the problem in the U.S. rather than part of the solution.

And honestly, we might have a parallel ethical dysfunction or a serious blind spot. It might just be that ours just doesn’t matter for the future of democracy in the current place and time.

Or it could even be that, depending on what we’re doing, you or I might accidentally be part of the problem right now without realizing it. I don’t mean that to paralyze you into not taking action. But once in a while, I do try to stop and ask myself if what I’m doing is achieving any of the things I’ve been hoping it would. If a treatment isn’t working, it’s okay to revisit the care plan or try another intervention.

But if you find yourself getting angry at your fellow Americans on a regular basis (as I do!), it may be worth remembering that the actions of many of the people who are visibly part of the problem we have today in the U.S. are part and parcel of a secondary condition, not the underlying one.

Of course, pneumonia is an example of illness that’s often a secondary condition—and it can still kill. So I won’t minimize the effects of secondary conditions or the need to triage them in significant ways. But in the end, if there’s an underlying illness, you’re probably going to have to deal with that at some point, too.

Diagnosis vs. prescription vs. buy-in

Another way I often think of public health as offering useful analogies to our national crisis is that any treatment for it will have different stages. Diagnosis tells you what’s happening, what’s wrong. Prescription involves recommending the best treatment for a given person for their condition. And buy-in is—on an individual level or a global one—persuading people to adopt that treatment or choose from multiple effective options.

At this point, I read a lot of good diagnosis of the threats to U.S. democracy—why and how it’s collapsing—in reporting by independent media or analysis in newsletters. At the same time, only a small percentage of the population is hearing this information or is even ready to hear it, because, to be honest, most people in the U.S. are not as terminally online as me or my audience.

As for the second stage, there’s even a decent amount of solid prescription out there—I see a lot of individuals, communities, and disciplines talking about the need to take action, and how to organize or create change on the local and national levels. It can sometimes be hard to cut through the din from blowhards who have a schtick or a grift they’re working in terms of recommending what to do. But I see a lot of good suggestions for how to tackle emergencies nationwide in the short term and work for structural change in the long term.

Where I see the biggest gap, if I’m going to run this medical metaphor into the ground, is often the most challenging part of public health. If you have a pretty good idea about what’s wrong and specific ideas about what can be done to improve the situation, how to you get people to do that thing? How do you, on a community level, and an individual level, convince people to take action, to take care of themselves, their neighbors, and their society?

A Covid example

It’s a question that some corners of medicine tend to skip over, too. And government as well. I know a reporter who covered the Covid pandemic. Near the end of 2020 the two mRNA vaccines had been developed and were rolling out to doctors and nurses. It was an incredible scientific feat, but the Trump administration was botching the rollout.

In January 2021, the Biden administration came in and actually significantly improved the rollout in a matter of weeks, which was a major accomplishment. But another problem began rearing its head: vaccine hesitancy.

In April, this reporter asked at a White House press conference about whether the new administration had any shifts in their plan to deal with vaccine hesitancy, and if this hesitancy might or might not affect where and how they approached the rollout.

He meant it as a serious question, not a gotcha, but wonders if it was taken as a bad-faith inquiry. The response at the time was a dismissive statement that they weren’t going to change anything.

The plan at the time was that by mid-summer, enough people would be vaccinated that it might break the back of the pandemic before the virus had an opportunity to mutate and emerge with variants that might turn out to be even more contagious or more lethal. But that threshold was missed. So despite an accurate diagnosis, and the breathtaking medical achievement of developing a treatment that could be prescribed and made available quickly to millions, a significant number of additional deaths occurred when enough people weren’t vaccinated, even in the new administration.

Persuading people to do the thing that will help them is often difficult. That’s why most of us spend more time thinking about diagnosis and prescription, long past the point at which we already have a pretty good understanding what’s going on. Seeing what’s wrong and saying what to do is much easier than persuading people to take action.

Addiction, empathy, and lies

In prior episodes, I’ve likened our current political catastrophe to someone dealing with addiction, or a person staying with a partner despite domestic violence. People are responsible for their own actions, but they’re also vulnerable—vulnerable to bad actors and bad policies, whether it’s for physiological, financial, or psychological reasons. It’s important to be able to keep those two things in your head—vulnerability and agency. Both can be true.

The path to real empathy is not to suggest people have no agency at all. The path to empathy is realizing that when a society is sick, it’s a disease any of us could have caught. And if you’re mad at the rural folks who are suffering for bringing this on us all, if you’re mad at people in Michigan or some other state for not voting for Kamala Harris, I agree that anger can be a pretty normal reaction to any number of situations.

But it’s worth remembering that a lot of the everyday folks you might be mad at are already being punished, and will continue to be punished in increasingly painful ways. So if you want the satisfaction of harm coming to them for their bad decisions, it’s already here for most of them.

False empathy

And to be clear, if you have people you need to shut out of your life, I’m not arguing against that. And I encourage you to stand up against the hate you see. That’s a critical part of how the country will heal. At the same time, if you’re out there working for bigger change, there should be some group of people who aren’t already on board with you or doing what you’re doing that you’re hoping to bring along. And—surprise!—they’re going to show up their own ideas.

I’m also not advocating for false empathy. You can legitimately be mad at people for a variety of reasons—for being suckers, for being naive, for being hateful. You don’t have to pretend Trump voters, for instance, were all motivated by nothing more than economic anxiety. A correct diagnosis and prescription actually treats people with respect and agency.

But to bring about change—the public health part of health care—you have to understand where people are at and invite them somewhere better. You don’t have to drink with your alcoholic sister to understand her, but it might be good to have an idea what’s happening in her head or her body. You don’t have to coddle racist voters by indulging their bigotry in order to figure out what might motivate them to make better choices.

Empathy doesn’t mean you have to spend your time pretending to agree with people who are harming themselves or others. That’s not a good public health intervention either. We can’t make the future of the country dependent on hardcore Trump voters, any more than you should center your life on someone who’s addicted and stop living your own. Build the life or the country that you want to have, and make room for those who are willing to come along. Imagine a life and a community that people would want to be a part of.

A prognosis

Our national ailment is treatable. People are out there every day making measurable gains in their communities. They’re stopping ICE warehouses from opening. They’re getting people in ICE detention out of jail. They’re voting in record upsets to change representation. They’re protecting libraries, saving their school boards, or standing up to Trump’s White House. In each situation, someone has set an actual goal in the world and has called on their neighbors, their colleagues, or even strangers to join them.

Online political debates are both real and not real. So many people have replaced their actual lives with the digital realm that in some cases, it might feel more real to them. But if sick public burns that get broadcast over media were sufficient to end careers, Drake wouldn’t have had a number one album last year. Dunking on politicians is unlikely to be any more effective.

I’m not trying to take anyone’s hobby away. But if curing what ails the United States of America is your goal, it’s going to require action in the real world. Online communities can be a way to build connections, a tool to spread ideas, and even to get buy-in. But that actual change has to happen on the ground. And you want to create the conditions that will make it possible.

Who’s the dealer?

The final metaphor I’ll use here is about the underlying cause of this disease. There’s no doubt that hating minorities and women is a deep part of U.S. history, and a lot of evil has unfolded as a result. But communities exist that have chosen to reject those hatreds. They are not fundamental aspects of humanity.

They are, however, weaknesses to which a lot humans are vulnerable. These flaws in society have to be cultivated and nourished in order to thrive. Just as a cancer cell can pervert a system and reproduce, hate can too.

The dealer in this addiction metaphor is the extremely rich, who are corrupting society. They actively use their power to keep the country ill, and to foment discord. Every vulnerability is exploited. You can hold individual users to account for the harm they do while understanding that bigger forces are in play.

And from mifepristone to gerrymandering and voter turnout—and yes, even owning the Constitution—it’s income inequality that gives billionaires the ability to target our society’s vulnerabilities and use them to their own ends. This is currently playing out in billionaire-owned media cosseting Trump, fossil fuel companies reneging on climate change commitments, and universities pressured by big donors and the administration to walk away from freedom of speech and commitment to actual education.

There are so many bad actors in high positions right now in the U.S., and many should be impeached or prosecuted. But the majority of them are the equivalent of your obnoxious aunt at holiday dinners compared to the control that billionaires are exerting on the U.S. and the harm that results. Without reducing the power of the super-rich and creating more substantial protections for democracy itself, we’ll never be able to cure the underlying disease.

Keep your focus

Next week, I’ll return to my usual roundup of concrete things you can do to take action that usually appears here at the end of the Tuesday post. But for today, I’ll say that to the degree that you’re able, recognize that diagnosing what’s wrong and prescribing an effective remedy on their own are insufficient.

A worthy coach doesn’t remind players of how they screwed up the last time they were in the playoffs and say, “You better not ruin it for everyone again.” A supportive friend doesn’t tell a friend who’s leaving a domestic abuser that they already did that four times and went back to him again, so “why bother?”

The key is to bring people along by showing what’s at stake, working toward it, and inviting others to join in. Trump is doing most of the work for us in the country right now by revealing just how dangerous he is. And people who didn’t get it before—or didn’t want to—are beginning to realize how bad the situation has become. We can take advantage of the moment. But we have to act.

[I wrote today’s post in part by incorporating ideas learned from organizing and teaching violence prevention programming in community to thousands of children and adults for most of a decade in the greater DC area, as well as my time founding a violence prevention newsletter, which included coverage of successful public-health interventions addressing violence and trauma. However—as you probably know!—I’m a journalist, not a public health professional.]

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