Transcript for Episode 49
Grant:
My guest today is Brendan Case. Brendan is the Associate Director for Research of the Human Flourishing Program at Harvard's Institute for Quantitative Social Science. The program aims to study and promote human flourishing, and to develop systematic approaches to the synthesis of knowledge across disciplines.
Brendan is a theologian who examines several topics, ranging from well-being and religious participation, to homeschooling, and philosophical accounts of happiness. Before coming to Harvard, he completed his doctorate of theology at Duke Divinity School and served as a post-doctoral research associate at Baylor University's Institute for studies of religion.
Brendan, welcome to the Beatrice Institute podcast. I ask guests to give me a little bit of background on where they came from. How did you end up at the Human Flourishing Program?
Brendan:
I found my way into academic theology, like a lot of people do I suppose, because I realized that the only thing I was really interested in doing in a life in the law, which I was also considering as an undergraduate, was studying constitutional law. And I figured, if I'm going to become an academic anyway, I might as well not take on law school style debt. And so I decided to go to divinity school instead. I did a master's degree at Duke, which was an incredible place to study theology, and I ended up sticking around there to do the doctorate theology program.
So we were in Durham quite a long time, and I loved our time there. As my time in the doctor of theology program was coming to a close, like a lot of people in the humanities these days, I was preparing myself for a life of dignified poverty, as a high school Latin teacher or something like that. Partly because of the wide ranging, if not incoherent, set of interests that I had nourished alongside my more focused work in training to be an academic theologian—an interest in psychology and sociology and political science—I ended up getting a postdoc at Baylor on an interdisciplinary research team that was studying accountability as a virtue. That was the theme, and it brought together psychologists, sociologists, and philosophers, and then me and one other theologian. That team led me eventually to be connected with my current boss, Tyler VanderWeele, who's the director of the Human Flourishing Program at Harvard. By a really wonderful and fortuitous series of events, I ended up getting this awesome job as associate director for research at HFH, where my mandate is tp foster, within our very interdisciplinary program research staff, the kinds of interdisciplinary conversations that I found so fascinating over my life as an academic.
So finding ways to bring the social sciences and the humanities into closer and more robust dialogue in particular. It's a treat to work there, it's a real privilege.
Grant:
So what compels Tyler to hire a theologian at the Institute for Quantitative Social Science? I would think of sociologists or economists, but a theologian?
Brendan:
I think one strong subtext of our program, although this wouldn't necessarily show up on the website, is that Tyler himself is a Christian. He's a relatively recent convert to Roman Catholicism, and his own intellectual journey has also been marked by really strong interdisciplinary interests.
He has extensive training in philosophy and theology, alongside his enormous CV in biostatistics and epidemiology, which is a primary area of focus. When he founded the program in 2016, his vision for it was that it would be a truly catholic—small C catholic—home for conversations about flourishing from across all the relevant disciplines, not just the social sciences. Which also do, you're right, have a hard time talking to each other, and it's amazing how much talking past one another there is even between economists and psychologists. He was really committed to bringing in philosophy, but also had a strong interest in bringing the theological tradition into the conversation as well.
Our basic operating principle that animates all of the work we do as a program is that empirical research without genuine humanistic understanding—this is sort of misquoting Kant I guess—empirical research without genuine humanistic understanding is blind, but humanistic inquiry without genuine empirical research is empty. So the challenge is to bring them together in complementary ways to foster a fruitful dialogue. And this is challenging: you put all of those disciplines in a room together, and often the conversation grinds to a halt. So a lot of what we do right now is take time to try to get up to speed on each other's disciplines, so that we can have meaningful conversations across our narrow disciplinary boundaries. But we've found it to be amazingly fruitful.
For the social scientists, my experience of working with them is they find it very fruitful to realize that concepts which psychologists, say, are apt to sort of blow right past—so the idea of love as a trait, for instance, which is something we're working on as a program right now—it's eye opening for them to realize that there are thousands of years worth of philosophical and theological reflection on what this trait is, and what kinds it comes in, how they're subdivided, and how they relate to the good life, and how they go wrong. The idea that you might need to pause over those conversations before you try to develop a working definition to implement in empirical research—that's kind of revelatory, actually. I think it's been very generative for them to realize that there are all these resources that they, in their own disciplinary training, aren't made to reckon with, but can be very fruitful in shaping empirical inquiry in a number of ways.
Grant:
I've read a lot of the work that's come out of the Human Flourishing Program; I agree that it's greatly benefited by the interdisciplinary conversation that you have there.
Changing gears a little bit to talk about your work: curiosity is one of the great modern virtues. Relentless progress requires us to be constantly curious about the world around us. However, at one point in time, curiosity was considered to be a form of vice. So what might Dante have to say to a faculty member like me at a major research institution about the potential dangers of curiosity?
Brendan:
One of my favorite things I've written actually is a little essay on curiosity as a vice, which of course Dante has a great interest in as well. The 26th Canto of his Inferno is devoted, among other things, to the vice of curiosity, as it's embodied in the figure of Odysseus—Ulysses—from ancient philosophy, who for Dante is a figure of a man who is overcome by a perverse desire for knowledge.
That's what curiosity, in Latin curiositas, was for the ancients and the medieval tradition. It was a sort of restless desire for knowledge that was unmoored from any larger concern for one's own flourishing or for the flourishing of those around one.
We talk about curiosity now as an almost unmitigated virtue. The vice label is just barely with us in the proverb about curiosity killing the cat, but only just. It's a bit of a strange proverb to people today for just that reason. But the idea is really important, because what the idea flags up is the fact that knowledge can go wrong: the search for knowledge can go wrong, not just when it fails to terminate in truth.
We all recognize that one of the aims of knowing is to develop true beliefs about the world, or adequate to reality, however you define them. And universities by and large are pretty good at this. They've built up a whole infrastructure over the centuries designed to focus the inquiry for knowledge and to bias it reliably in the direction of true beliefs. But we're much less good in general—and I think elite institutions are in some ways worse than average today—at reflecting on whether our desires for knowledge have gone wrong, in two ways in particular. The desire for knowledge can become disordered when we desire something we ought to know, but we desire it in the wrong way.
Just to take a really banal example: the eminent researcher who's published 500 papers, but has no relationship with his kids and his marriage has fallen apart, is a person in whom the desire for knowledge has probably gone wrong at some point. It's become disconnected from his overall flourishing. Dante would call that curiositas; that's a vicious desire for knowledge.
Another way that desire can go wrong is when we desire to know things we ought not to know. This is another area where I think we're not doing nearly as well as we could. The paradigmatic examples of this in the ancient tradition are always the desire to know what it's like to commit some kind of sin. The desire to have first person knowledge of what it would be like to kill somebody: you shouldn't want to know that.
But I think there are more contemporary examples, though, that are closer to the ground for us, which raise pretty difficult questions. So, the knowledge of what it would be like to genetically alter twins so that they have an inborn resistance to contracting HIV: this is a real thing that happened. There's a guy out there, a researcher in China, who has that knowledge. It's not at all obvious, actually, that that's a kind of knowledge which properly can be desired licitly. The existence of technologies like CRISPR, for instance—gene editing technologies—raise really serious questions about not just the way in which we use them, but whether there are certain objects of knowledge which we're pursuing which can't be well-used, which are properly out of bounds.
It's not even just that we don’t attend to this as often as we should; we really don't have a language, we don't have a vocabulary, for conceptualizing it in order to discuss it in a fulsome and meaningful way.
Grant:
That's really interesting. Pope Francis recently spoke out against cancel culture, calling it “ideological colonization.” But isn't cancel culture really just public practice of the virtue of accountability?
Brendan:
I was surprised and I'll say I was heartened to see that statement from the Pope. He's fascinating in that you never know what he's going to say; that's why he's so interesting. It's so interesting to be watching the Church in this period for just that reason.
I take the point. My sense is that the expression "cancel culture" is an incomplete concept. On its own as it's commonly used, it doesn't convey sufficient information to know whether I should be upset or excited about its application in a given case.
I'm with you. I think there's an ongoing and increasingly nasty debate within the American right between a group that identifies itself with a kind of Lockean strain in the American founding—a kind of right-liberal, libertarian camp—which takes a fairly absolutist view about this phenomenon, on formal procedural grounds. We shouldn't be restricting speech; we should be pro-pluralism in a maximal sense, pro-diverse in a maximal sense.
And there's an increasingly vocal, still very small minority on the right, the common good conservatives or whatever you want to call them. I think they make a number of very reasonable points in response to the right-liberal to the effect that nobody really believes in any meaningful sense in absolute freedom of speech. Of course all parties agree you shouldn't be able to shout “fire” in a crowded theater; speech that poses clear and present danger is out of bounds. But even if you have that level of common ground, there are always going to be interesting boundary cases. To take the obvious reductio ad Hitlerum, no party to that debate would have any qualms about an avowed Neo Nazi being denied tenure at an American university.
So I think the question is always going to be to what extent does the common good include the protection of a certain zone of liberty that's afforded to individuals? And I think it does—my guess is that my views about the scope of that zone would probably differ significantly from a lot of the common good conservatives in terms of what I would take to be ordered to the common good.
But I don't think that it's right to inveigh against cancel culture as a monolith, as though it's always bad to be against prescribing objectionable views from certain kinds of public airing. I don't have principle grounds for thinking that that's an absolute necessity. You have to take it more on a case by case basis, I think, and ask about the substance of the views and to what extent they're reasonable, to what extent they're grounded in evidence, and to what extent they contribute to real and pressing public evils. I think these are hard questions that you can't decide a priori.
Grant:
How might Google, Facebook, Twitter, practice the virtue of accountability well? Because they do have a certain responsibility, although they're not publishers so to speak; it's becoming increasingly obvious that at least part of their role is as a publisher of online content, and they've begun to take on that role. So how do they practice that virtue of accountability well within that context?
Brendan:
That's a hard question. I think there are two considerations here, which cut in opposite directions. So on the one hand, despite their pretension to be neutral carriers, they are in fact the most significant public outlets for news and other information in the world. And it's clear that they've become increasingly aggressive in embracing that role, at least in certain moments. Most famously, notoriously I guess: Twitter kicking Donald Trump off of its site, with all the other major outlets following suit shortly after.
On the one hand, I think it's true: unavoidably, they have a responsibility for the kinds of content that they carry. There's no way around their being at least morally entangled. The question of what legal prescriptions ought to attach to that moral entanglement are just beyond my scope—I'm going to choose to sidestep those questions. What exactly section 230 is and what implications it has for contemporary debates—I won't pretend to have any expertise on that. But morally, they certainly do have a fairly deep responsibility in that regard. It was always self-serving at best to pretend that they didn't.
On the other hand—and this is what I find most troubling—Twitter and Google, and Amazon as well, increasingly act in the public sphere as quasi- governmental monopolies within their relative spaces. Amazon and Google in particular really are unavoidable. If you want to write a book and you can't host it on Amazon, you might as well not have written it, from the standpoint of sales. The same thing is true for Googling. If you have a website which you'd like people to access, and Google is deliberately burying your site in the search results, you might as well not have a website.
There are always going to be troubling questions which arise when notionally private actors assume quasi-governmental authority over the lives of other private actors. Long-term, I'm sympathetic to the view that these entities have become something like public utilities and ought to be regulated as such; and that the oversight that they exercise over public expression of various kinds is properly a governmental oversight, and we should just recognize and treat it as such.
How that's going to play out even near term, I don't know. One of the difficulties of our present moment is that there is such deep division within American society about how to characterize the most pressing problems that we're facing. You talk to very partisan Democrats and Republicans, and you get a picture of two almost different planets that they seem to be living on. I think even very partisan members from both camps would probably be pointing to some very real and legitimate concerns which any sane person would want to try to address in a fuller and synthetic way.
So that's the challenge: how do you regulate public action in that environment where it's difficult to achieve meaningful agreement on what the evils are, much less how to address them. Unfortunately I don't have really obvious solutions to that problem.
Grant:
Over the last two years during the COVID-19 pandemic, we've seen a major uptick in homeschooling for various reasons, ranging from a concern about the virus, to concerns about the potentially negative impact of virtual learning. This raises serious concerns among what we might call the progressive elite. I hate to use that term, but I can't think of a better one. In particular Elizabeth Bartholet, a Harvard law professor, sparked a debate in May of 2020 by calling for a presumptive ban on homeschooling. So what's so threatening about homeschoolers?
Brendan:
Education, going back 150 years or probably longer, has been one of the most important sites of conflict between the authority of the state, the family, and the church. I point to those three because they're the three institutions that Pope Pius XI identified as the three necessary societies. We might even say, in a more pluralist vein, the state or the polity, the family and religious community, are the three most enduring central nodes of an individual's life; the three most important points of social connection that most people experience, in all times and places. Understandably all of these institutions see themselves as having a stake in the rearing and the nurture of children.
For a state, if a state doesn't take an interest in the existence of its next generation, there's not much point in it taking an interest in anything else—it doesn't need to get social security right if there’s not going to be any people around to draw the checks.
And so it's understandable, particularly in the modern period as states have scaled up and suddenly found themselves with money to spend on things, of course they took an interest in trying to promote public education. Education, until the 19th century, almost everywhere, was the responsibility of families and the church or religious communities. That was just the nature of things. So there wasn't an opportunity for that conflict to arise between the family and the state in the way it has in the modern period, as the state has taken a more robust interest in education. But what's come along with that—and we've seen this in society after society—is that the more ambitious states become in their vision for shaping the lives of their citizens, the more threatened they feel by all alternative modes of educating kids. The most dramatic examples are in totalitarian states. [In] Soviet Russia, it's standard is to eliminate not just religious schools, but religion itself as a public institution, for instance.
All that’s by way of broad background to say: the concern that animates Elizabeth Bartholet's objections to homeschooling are standing in line with this long tradition of strong states, and the representatives, feeling threatened by the existence of these independent nodes of authority over children, particularly in the form of the family. It's interesting that in the law review note in which she advanced this argument for the presumptive nationwide ban on homeschooling, she connected the danger of homeschooling with the danger of religious indoctrination as well.
So these concerns are always very tightly bound together: that the families and the churches work in concert is the fear, to turn children from the womb against the more “enlightened” purposes of the state. The state has a certain vision, or it's representative—self-appointed in some cases—has a certain vision. Whether it's the new Soviet man, or woke progressive kid of the future, parents stand in the way of that. Parents have benighted views which need to be taken out of the equation, insofar as that's possible. There's just a conflict between the state's interest in education, if it becomes ambitious enough, and the parents' interest in educating their kids.
Grant:
One thing that really struck me about Bartholet's piece was also connecting not just religious indoctrination, but abuse, to homeschooling. I found that really interesting. All the homeschool families I know—that just really surprised me, that that was the public perception of typical homeschooling families: essentially bonkers religious zealots, who are hiding abuse from public authorities.
To what extent is there any truth there? I read a paper that showed that experiences of PTSD are actually higher within homeschooling families. To what extent is there any truth to this sort of concern about abuse within homeschooling settings?
Brendan:
Our team has recently published a paper on different well-being outcomes by school type. One of the findings that we report in that paper is a higher level of reported PTSD among home homeschooling kids in the sample, which ranged from beginning in about the year 2000 up through 2010 in terms of follow-up.
The finding was less robust statistically than some of the other findings in the research. It didn't survive what's called Bonferroni correction, where you statistically adjust the results to account for background factors about the study population.
Grant:
In multiple testing.
Brendan:
Exactly, right. I will say, apart from that finding, I don't have any deep subject matter expertise into the prevalence of child abuse within homeschooling compared with other school types. We also homeschool our kids. We have four kids, and the two oldest are in second grade and kindergarten and they're homeschooled, partly for the reasons you indicated. We started doing it with COVID, and we've gotten into quite a lot of homeschooling families around here. Anecdotally, I will say, like you have, that Bartholet’s depiction does not at all ring true to my own experience of it.
But I will say in defense of Bartholet’s point here: there is a real concern here. She's chasing a genuine good, which has to be traded off against other genuine goods, and the good is that of having an adult present in the lives of children who has a fiduciary responsibility to report abuse if she sees it. Teachers are legally bound; it's a stronger obligation than just the ordinary moral obligation any adult would feel to take action if they knew that a kid was being abused. Teachers also have regular access to kids. Teachers typically see their students five days a week. Teachers are among the most common non-family members to report child abuse to child protective services.
And so I understand why it raises a concern. If you take teachers out of the equation, who are the other adults in a kid's life who might be in a position to notice and report the abuse? That is a good which, like everything, could be liable to abuse, and has to be traded off against other goods. We can't maximally pursue every good in the world.
We live in the real world; you have to trade goods off against one another; every approach has costs. A society which rightly recognizes the prima facie right of parents to educate their children as they see fit, in recognizing it, has to trade off certain other goods which it might pursue if it didn't recognize it. And there are plenty of societies around the world today which don't recognize that. Most of Europe has the kind of presumptive nationwide ban against homeschooling that Bartholet's calling for, so it's not unprecedented. Lots of Sub-Saharan Africa has it too. This would not be a totally novel undertaking if we instituted such a ban, and this is one of the ways in which we're exceptional globally, is in the prevalence of homeschooling. Particularly under COVID, but even prior to COVID, we were really an outlier in the extent to which that had remained a common educational form for us.
It's a good, an important thing. I think even advocates should recognize it's not an approach which comes without any costs. But in that it's like everything else that we do in the world. Everything has costs; we should just take what we want and pay for it.
Grant:
The same paper that you mentioned, you found that some of the major benefits of homeschooling seemed to be higher levels of pro-social virtues, such as volunteering, forgiveness, church attendance. Is this simply the type of families that tend to homeschool kids? Or is this something implicit to the model of homeschooling that produces these pro-social virtues?
Brendan:
Those findings show up in this cohort, even after controlling for everything you might want to control for. So it's lifting out family socioeconomic status; it's lifting out family religiosity, religious service attendance; it's equalizing by race. There are strong indicators, given the study design, that these findings are causal to some extent. But there's not reverse causation happening here: that it's just the more religious or nicer families preferentially opting into homeschooling and that's why you see this split.
So it does raise a real interesting question about why school type seems to be making such a difference. Homeschoolers really stand out compared to the public schoolers, in particular, on the measures you mentioned. There are at least two ways of thinking about this.
You might ask on the one hand, why does homeschooling seem to be so effective at promoting these virtuous behaviors? But another way of thinking about it might be that public school, for whatever reason, has become particularly ineffective at promoting [them]. Maybe public school has become a positive hindrance, in the lives of kids who participate in it, to stepping into those fairly ordinary pro-social behaviors. It wouldn't have been that long ago that kids volunteered or went to church wouldn't have seemed particularly striking. It's becoming more striking, given the separation on these measures between homeschoolers and the broader population.
I don't think that the data we have at the moment really lets us say decisively which of the school types is exercising more efficacious causality here. My own hunch is that it's probably at least as much the unpropitious environment in public schools constituting a positive hindrance to students maturing morally in those ways.
Grant:
So what would stand in the way of that sort of character education within a public education system?
Brendan:
In principle, nothing really. There's a lot of work being done right now within positive psychology to develop interventions—to promote character strengths is how it’s usually described. I think the evidence is fairly mixed at this point about whether they achieve meaningful results that last longer than a couple of months. A lot of them are really aimed at warding off negative developments—so training kids to be resilient so they don't develop anxiety, say—rather than developing actual positive virtues.
So it’s a lot of unknowns still. If the Department of Education wrote a blank check to every school system in the country and said, “Do character education,” one big challenge would just be trying to understand what actually works. That's what we don't know an awful lot about in terms of developing new modular interventions. The biggest constraint, in principle, is scarce resources.
This is, again, one way in which we are a real global outlier: schools in this country for several decades, probably going back farther than that, have been unbelievably and myopically focused on college attainment. That's basically what they exist for; everything is geared toward college attainment. This despite the fact that most American high school students won't actually receive a college degree, even a BA. There are an awful lot of resources that are being siphoned off to chase this unattainable goal of full college enrollment or universal college attainment.
That comes at the expense of other educational goals—not just character education, but what in European countries is called technical and vocational education. When you mention this in the US setting to people who do education policy, this is a tracking; tracking is very bad because you're narrowing a poor kid's life choices. Which, fair enough: tracking does that to a certain extent. But I think we have to recognize, as Oren Cass puts it, that actually we have tracking in this country. Everybody's on the college track, whether they want to be or should be or not.
I think that the biggest challenge is coming to grips with the fact that education really does serve a diversity of ends beyond just educational attainment. And if we want to be serious about actually serving those ends, we have to invest in them. You can't just invest myopically in SAT prep and college prep and expect everything else that the school might do to sort of magically fall into place.
What's to stop us? Nothing really, except that there's a deep political and social aversion to recognizing that schools might serve other purposes besides college prep.
It’s a laudable feature of the American spirit: our political ethos is so thoroughly small D democratic, so suffused with the idea that anybody can grow up to be anything, and all life paths should be open to everybody. The idea that everybody, from whatever background, should be able to pursue the goal of going to college, is so attractive to Americans that it's easy to get suckered into this myopic fixation on that one goal. You can feel good about your town's high school sending three of its graduates to the Ivy League, even if 40% of the graduates are going on to be underemployed and struggle to find a way in life.
Grant:
And a substantial portion of those will have two years of college, with two years of college debt and no degree.
Brendan:
Yeah, exactly.
Grant:
Which is another big track.
Brendan:
It's a huge percentage. That’s exactly right. Last I saw something like 20% of high school graduates enroll in college, but don't graduate. That's a huge number of kids every year.
And there's another portion who increasingly get shunted into majors which in actuarial terms are very bad bets in the job market. They end up with four years of college debt and a degree, but a degree that can't really be used in any meaningful way. It's a real problem.
Grant:
One thing I also noticed about your paper was that homeschooled kids are less likely to go to college. I'm wondering, is this something that should concern homeschooling parents about the quality of education they're providing? Or is it they have different goals, or maybe they're directing their kids a little bit more effectively? What's driving differences in college attendance?
Brendan:
The first thing you notice about those figures is that the data that the paper’s based on, as I mentioned, is kind of old at this point. The schooling effectively is assessed in the early 2000s, and then the followup is assessed in 2010.
The reason that's the case is it's surprisingly hard to find large longitudinal data sets that had information on school type, so this is the most recent our team could do. Homeschooling has changed a lot in the last 20 years. Anyone who's homeschooling recognizes that there's been a huge increase in what's called structured homeschooling, which is homeschooling that's curricularly aligned more or less with common core standards, or that's aimed in some way at college prep.
I think there’s good reason to expect that that gap will have narrowed substantially over the last two decades. I think it's also reasonable to expect that the quality of homeschooling will be uneven, just the quality of public education is uneven. It's going to vary a lot family to family, and some families are better equipped. Families where both parents are involved in homeschooling and have graduate degrees, which especially in the last couple of years is becoming more common, are going to be better equipped to prep their kids for college than families where neither parent’s gone to college, and it's a sort of cultural thing not to go to public school. Like with all school types, your mileage is going to vary significantly depending on local factors.
But in my view, it's not an unmitigated evil that homeschoolers attend college at lower rates than public schoolers. Increasingly, it's not obvious that enrolling in college or even graduating from college is a straightforward pathway to a flourishing life, or even a financially successful life.
I don't know the extent to which that divergence reflects different preferences within the homeschooling population; but if it did, it wouldn't necessarily be bad news. I think we need to figure out a way to move toward a more pluralist model of education, where people who are interested in pursuing a technical vocation—whatever that looks like—have opportunities to do it; and where there's opportunities, not just for education, but for gainful employment in those fields after. Nobody's well-served by the fixation on “everybody goes to college, everybody graduates from college,” mostly because it's not going to happen; there's no evidence that it's going to happen. So let's stop pretending that it will.
Grant:
I want to change topics a little bit and discuss a piece that you recently put in First Things magazine on the issues of deaths of despair. Can you give the listeners a really quick backstory of what we mean by deaths of despair?
Brendan:
The expression “deaths of despair” was coined by two economists at Princeton, Anne Case and Angus Deaton, in an enormously influential paper they published in 2015 with that title. The findings that they discussed in this paper were that mortality had substantially increased, particularly in the proceeding 20 years. So beginning in the mid 1990s, and then really ramping up in the mid 2000s, and then up to their time of writing, mortality had substantially increased, particularly among less educated white Americans and especially American men. It had increased so much in the couple of years preceding their publication, that overall American life expectancy actually had declined.
This was a huge thing. Life expectancy had not declined for successive years since World War I in the United States; the Spanish Flu was the last time that had happened. The paper was an attempt to explain what was going on. Their proposed explanation was a surge of what they described as deaths of despair, which is a label for deaths from drug overdose, alcohol poisoning, cirrhosis of liver, and suicide, which are deaths which tend to occur in people who have succumbed to overall despair about the shape of their lives.
People who are becoming addicted to heroin, or drinking themselves to death, or committing suicide, are people who have lost hope and typically, prior to that, have disconnected socially in a variety of ways as well. They've lost touch with their families; they dropped out of church; they lost their jobs; and with that lost a great deal of what makes a life meaningful for most people.
In 2020 they published a long book with the title Deaths of Despair and the Future of Capitalism, where they attempt a more thorough analysis of what's actually driving the surge of deaths. It's quite an elegant discussion. They understandably see one of the principle causal drivers in the grotesque overprescription of opioids—legalized heroin as they call it—starting in the 1990s, and then rising to extraordinary levels up through about 2012. Rates of prescription have subsided some since then, although in America they’re still way higher than almost anywhere else in the world—in 2020, five times higher than the average rates in France, for instance.
But those factors were working in concert with other forces that were driving a more general social disembedding. A key player in their story is the erosion of economic prospects for blue collar workers in the Midwest: the departure of manufacturing jobs particularly, but not only, associated with China's succession to the WTO, and the sudden flight of skilled labor jobs, out of the country. This is also driven to some extent by NAFTA, in the departure of automotive factories south of the border.
So there are a number of factors working in concert, but in their view, the economic forces are the most fundamental, underlying factor that drives a larger erosion of the broader social landscape. It's not just that people become poor and then they immediately become drug addicted or commit suicide. In fact, if you look around the world, most poor people don't do any of those things. This is not a straightforward causal story. What happens instead is that declining economic prospects, for men especially, make it harder to get married. Men who don't get married or can't stay married are much less likely to be strongly attached to their families. They're much less likely to attend church. They're much more likely to drop out of other kinds of community—church and other forms of social participation. Over time, what that leads to is a deep sense of loneliness and despair, which ultimately culminates in their turning to these destructive habits, which are the proximate cause of their death. So it's a really elegant and complicated story. The deaths of despair is a kind of catch all for that whole trend, from the 1990s up to today.
Grant:
It seems to me that the Deaton and Case argument is essentially economic factors leading into the sort of Durkheimian anomie within these communities. Do you think that's a fair representation of that argument? Economics preceding a broader sort of decay of the social foundations of community?
Brendan:
Yeah, that's their view. I think they do on occasion invoke Durkheim; they are economists, so it's not surprising that they see the story as fundamentally an economic one, which is mediated socially in various ways. To their credit, they are really clear that what drives deaths of despair is not declining economic prospects, but the loss of a way of life, which is just what Durkheim meant. His landmark study of suicide is the first great sociological study of suicide in the late 19th century, written during Europe's great wave of secularization—which is sequenced differently in some ways than America's, because it wasn't preceded by crash deindustrialization the way it was in the U.S.
But he wrote this book because he had noticed a pronounced spike of suicide across Europe, particularly in Protestant regions. One of the puzzles that the book is written to explain was why Catholic regions seemed to be relatively less affected by this wave of suicide. One of the explanations he proposes is that in the book, is that many of the suicides that Europe was witnessing in that period were caused by what he called normlessness—-anomie in French— a sort of rootlessness, which arises from the loss of a unified vision of life that was supplied by religion, among other things.
Grant:
I don't know if you see this in the circles that you run in, but I was in an academic seminar, pre COVID focused on opioid deaths. We have a number of opioid researchers here at the University of Pittsburgh. I was surprised that when the term deaths of despair was mentioned, it was largely laughed off. The issues were framed within the terms of physical addiction; and then structural failures, particularly the pharmaceutical industry; and then policy failures. Why do contemporary discussions within academia related to deaths of despair shy away from these existential routes? I was taken aback by how quickly they were discarded, in terms of the conversation.
Brendan:
I can only speculate about it, because I don't share that sensibility. One of the difficulties with the extent of current academic subspecialization is that researchers who tend to focus on deaths of despair are principally working in economics, sociology, and public health. They're really quantitatively focused and policy oriented. If you work in a field that’s heavily shaped by the presumption that the problems you're studying are amenable to public policy, it's difficult to reckon with the idea that wracking social crises might just not have solutions, or not have any obvious solutions. This is a terrifying thought for an economist in particular to consider, that there might just not be a quick fix. You can't just turn off the spigot of the opioids and that'll resolve the problem.So that might be part of it.
Another issue I have noticed in conversation with some peers is that there's a general reluctance to treat deaths of despair as a paramount social crisis, because it's perceived as being a problem with white people, to put it really bluntly. Within the elite academy, especially, there's not a lot of cachet for investigating the problems that white people have. There's a lot of energy being invested in exploring other, very real problems and grievances. But at this point, the very real challenges facing poor, relatively uneducated whites in this country are just not at the top of the agenda for people who are staffing elite media institutions, or who are shaping the research agenda at an elite university.
You might say, this is a problem of public health. We can adjust in the following ways and then we should see the problem is resolved. The idea that there might be deeper, dare I say systemic, factors animating the crisis in these communities—I just think that there's less interest in that, in my experience.
Grant: I think playing into it also is a reluctance to recognize the power of class in outcomes in America, particularly educational attainment. For some reason it doesn't quite get as much attention as the real impact of race and gender.
You've been writing a lot about the importance of religion, especially religious service attendance, on health and well-being. Related to deaths of despair, you've shown that those who attend religious services have significantly lower rates of deaths of despair. Is this merely a socialization effect, meaning that revitalization of the Elks club would have the same effect? Or is this unique to church?
Brendan:
This is an area that our program has been exploring in various ways and at great length. Probably our deepest area of research over the last six years has been religious participation. What we've consistently found, in a number of different cohorts and age groups and study designs, is that religious service attendance in particular shows stronger effects on well-being than all other forms of social participation combined. That's even including marriage in most studies; marriage is the next most efficacious, in terms of its effect on well-being. But yeah, religious service attendance goes way beyond the Elks club.
The interesting question is really why? Overwhelmingly the research to date is on American samples, and that means mostly Christian samples, just given the religious composition of America.
I stress that [religious service attendance] is really the marker to focus on. Very often, I see news stories which say something like, “survey shows that Christians have divorce rates identical to those of non-Christians.” If you take a look at the findings, it's always without fail self-identified Christians, so sort of a general religiosity. But if you actually compare people who attend services at least weekly to those who never attend, the differences consistently are huge. This is quite apart from whether the people not attending self-identify as Christians, or as nones, or whatever. So it's participation that seems to be driving the significant well-being effects.
I think the reason that religious communities continue to be so important for well-being in the lives of so many people, both here and elsewhere in the world, is that they bring together a number of elements which are present in other institutions, but which are not coordinated in the same way.
Social community is a really important part of what makes religious communities a pathway to flourishing for a lot of people. But something else that's really important is being together with other people with whom you share a common transcendental sense of meaning and purpose, a common worldview, a sense of what makes life worth living. You don't get that from most Elks clubs. This strong sense of meaning and purpose itself seems to be causally efficacious at promoting well-being.
Another really important factor, for suicide in particular, seems to be the fact that churches [enforce] a pretty simple and stringent moral code, one aspect of which is don't kill—don’t kill other people, don't kill yourself. This is not something that most other civic organizations are in the business of doing. But it turns out these things matter a lot, and they work together in important ways.
I'm glad you asked about this because it desperately needs to be on the agenda in contemporary discussions in public health about the crisis of loneliness. In 2018, the U.K. appointed a Minister of Loneliness. They recognized they had a growing public health crisis of loneliness in their country. They're also experiencing a fairly sharp upticks and deaths of despair, not on the same order of the U.S., but following a similar pattern. In the press release announcing the creation of this ministry, the minister announced that she was going to be launching a series of initiatives to promote social connection among elderly adults in the U.K., including walking clubs and cooking classes.
This is the U.K.’s answer. They've recognized there’s a crisis of social disembedding, and their answer to it is walking clubs and cooking classes. Which, if you have even a passing familiarity with the research on the kinds of social connection that matter most, this is like putting a band-aid on a cancer patient. This is not the solution to the crisis. I know more about the American scene than the U.K., but I would be willing to bet that the people who are suffering most there are experiencing disembedding from the institutions that historically have mattered the most. So religious participation would be one and marriage would be another. The idea that you're going to solve the problem of social dislocation in this country by promoting membership in Elks clubs, for instance, is just nonsense. That's not the thing that makes the most difference in people's lives.
Grant:
What about from a policy perspective? We obviously can't make people go to church and we can't make people have conversion experiences. We already have, in the United States, a pretty significant tax benefit for giving money to religious organizations; we seem to want them to exist. Other than that, from a policy perspective, what realistically can be done in order to promote religious participation, from a public health and public policy perspective?
Brendan:
It probably makes sense for me to start by saying it's not obvious that there are solutions to these problems. We need to take a long, hard look at that possibility. Civilizations decline; this is just a fact about the world, and all the evidence suggests that every great civilization that has existed has at some point been on its way to not existing.
The reason the U.K. Minister of Loneliness is talking about promoting cooking classes and walking clubs is because it's reasonably clear how you do that. No one knows how to get people to go to church and get married. Everybody's trying to figure it out. People all over the world in lots of different places—China, Japan, Eastern Europe—are trying to figure out how to do these things, and no one knows how to do them.
That being said, I'm not totally without optimism. I think we should be realistic about the scope of the problem; it's significant, and it's much easier to break things than to build them. It's really easy, it turns out, to break things. That's Newton's second law: things fall apart. And so to some extent, the best policy really is just delaying that decay, to the extent that you can. Once it's happened, reverse engineering it is not straightforward. But we have kicked around a number of modest proposals—not in a Swiftian sense—but just genuinely small nudges that we might implement.
One is that from a public health standpoint, there's no good reason why doctors shouldn't be talking with their patients about their religious participation. Obviously you'd want to be very thoughtful and deferential as a physician in the way you did that; but about social participation in a broader sense, and religious participation in particular seems to be, particularly in America, very important. So in an ordinary intake survey, to ask questions about patients' religiosity, and to use that as a guide to further questions about participation—I think that would be very reasonable for a physician.
Again, I'm not a doctor, and I don't pretend to dictate to the AMA what kind of guidelines they should publish. But this is something that my boss Tyler was actually published on, raising this as a question. And I think it's a very reasonable suggestion to say, look, doctors should be able to say to their patients: “Hey, you say that you self identify as a Christian or as a believing Jew or Muslim. You also have told me you haven't been to church in a decade. You should consider the possibility that if you took an hour a week to go to a religious service, it might make a real difference in your life in very tangible ways.”
Because the really striking reality is that in America, about 50% of the population self-identifies with some religious tradition but doesn't participate in it on a regular basis. And that's a huge number of people who I would think of as relatively low hanging fruit. Some of those people are alienated from their religious tradition in various ways. And again, this is where you want to be careful, in any setting, about encouraging people to join a religious community. Some people have histories of abuse, or have lived through terrible scandals in their childhood church; we have to assess every person's situation individually. But in general, what the research bears out is that most of those people who are staying home from church or from synagogue would be happier and healthier. They'd be flourishing more robustly if they attended services.
Part of it is just messaging: just getting the word out about this would be helpful. Because a lot of people just can't be bothered to attend. Something about the church that they used to go to was annoying enough that it drove them away—the sermons are bad or the music's bad or whatever. So I think that's one thing we could consider, messaging of various kinds, both coming from doctors and other public health authorities. We have the president and the CDC, the NIH: they have a bully pulpit. They could use that in various ways if they wanted to. This gets tricky, of course, legally; I don't want to wade into constitutional interpretation, whether the high wall of separation that the Supreme court has recognized in the last whatever 70 years is the best interpretation of the First Amendment. But assuming that there weren't insuperable legal obstacles to exercising that bully pulpit, why not do that too?
Grant:
Brendan, I could talk about this stuff all day. This was a really fun conversation, but unfortunately we've run out of time. Thank you so much for joining the podcast, and hopefully we might see each other in person one day.
Brendan:
Thanks Grant. It was a pleasure being with you.