Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland

by Jonathan M. Metzl

Even on death’s doorstep, Trevor wasn’t 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,” he told me. “I would rather die.” When I 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.”

Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.

where on-the-ground white Americans make tradeoffs that negatively affect their lives and livelihoods in support of larger prejudices or ideals. By design, vulnerable immigrant and minority populations suffered the consequences in the most dire and urgent ways. Yet the tradeoffs made by people like Trevor frequently and materially benefited persons and corporations far higher up the socioeconomic food chain—whose agendas and capital gains depended on the invisible sacrifices of lower income whites.

pro-gun legislators, the NRA, and gun advertisements touted the abilities of semiautomatic weapons to restore white men’s “privilege” and the “balance of power” in an ever-more-diverse world, even as firearms emerged as leading causes of white, male suicide.

First, a host of conservative political movements emerged (or reemerged) in Southern and midwestern states over the later twentieth and early twenty-first centuries that brought into mainstream US politics once fringe agendas, such as starving government of funding, dismantling social programs, 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 midwestern states in ways that shaped state agendas, national GOP 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. Second, these increasingly unified forms of conservatism advanced politically through overt or implicit appeals to what has been called white racial resentment.

Yet a major part of these movements’ appeals lay in rallying cries that tapped into emotionally and historically charged notions that white Americans should remain atop other racial or ethnic groups in the US 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 acts of legislation.

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 programs and infrastructure spending, blocking expansion of health care delivery systems, defunding opiate-addiction centers, spewing toxins into the air, or enabling guns in public spaces, the result was—and I say this with the support of statistics detailed in the chapters that follow—increasing rates of death.

Succinctly put: a host of complex anxieties prompt increasing numbers of white Americans like 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 midwestern 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 US whites as a demographic group, thereby making whiteness itself a negative health indicator.

When I began to sift through the statistics for gun injury and death in Missouri, I quickly realized that the primary victims of gun mortality were not criminals or inner-city gang members, as the NRA and some politicians implied. Rather, as gun laws were liberalized, gun deaths spiked… among white people.

Through a back door into data on mortality, I detail how legislation that substantially deregulated gun purchases set Missouri on a path toward becoming a top state for gun suicide, even among other pro-gun states, and that the primary victims of these trends were white Missourians, particularly white men living in rural areas.

Soon, as a thoughtful Kansas state legislator told me, “the fire that we set in the fields burned all the way up to the home.” Popular resistance began to form only when cuts began to affect suburban white schools, but then it was often too late. When the data began to roll in, it turned out that white student populations saw flatlining test scores and rising high school dropout rates—trends that correlate directly with poor health later in life.

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

the seeming benefits afforded by such systems of privilege can blind working-class white populations to these system’s negative effects, opening the door for potential manipulation.

When politics demands that people resist available health care, amass arsenals, cut funding for schools that their own kids attend, or make other decisions that might feel emotionally correct but are biologically perilous, these politics are literally asking people to die for their whiteness. Living in a state or a county or a nation dominated by a politics of racial resentment then becomes a diagnosable, quantifiable, and increasingly mortal preexisting condition.

Ultimately, the three states we visit in this book show ways that, when white voters are asked to defend whiteness, whiteness often fails to defend, honor, or restore them.

At the same time, research suggested that gun injuries and deaths rose after it became easier for people to buy and carry firearms. For instance, a team of investigators led by Daniel Webster, director of the Johns Hopkins Center for Gun Policy and Research, analyzed crime data from Missouri and found that the state’s 2007 repeal of its permit-to-purchase (PTP) handgun law “was associated with a 25 percent increase in firearm homicides rates.” Between 2008 and 2014, the Missouri gun homicide rate rose to 47 percent higher than the national average. Rates of gun death by suicide, partner violence, and accidental shooting soared as well. In 2014, gun deaths topped deaths by motor vehicle accident for the first time in the state. News outlets referred to Missouri as the “Shoot Me State.”

For instance, it would hardly seem shocking from a population-level perspective that more people get shot in places where there are more guns, or that locales with basic restrictions on the purchase and carry of firearms see better health outcomes than locales that have none. These are the types of fundamental claims that gun researchers have been forced to continually validate and defend against the headwinds of a congressional ban and a well-funded corporate lobby that counters research with provocation rather than with counterbalanced research.

Yet part of the initial impetus for the Dickey Amendment resulted from the outcry from the gun lobby about a 1992 study in the New England Journal of Medicine (NEJM) titled “Suicide in the Home in Relation to Gun Ownership,” which tested the hypothesis that “limiting access to firearms could prevent many suicides.” After an extensive analysis of nearly a thousand cases, the authors found evidence supporting the notion that “the ready availability of guns increases the risk of suicide in the home” and advised that “people who own firearms should carefully weigh their reasons for keeping a gun in the home against the possibility that it may someday be used in a suicide.”14

a 2018 JAMA study performed an extensive cross-sectional analysis of death data from 3,108 counties in the 48 contiguous states of the United States and found that states with strong gun laws had lower firearm suicide rates.16

Public discourse about gun death instead focuses on violence toward others and homicides and relies more on racial and media stereotypes and anxieties about black criminals than on-the-ground realities. A widely cited opinion study published in the journal PLOS ONE found that “attitudes towards guns in many US whites appear to be influenced… by illogical racial biases” related to the “fear of black violence and crime.” Meanwhile, as the Pew report put it, the dramatic drop in gun homicide rates was not just invisible—most Americans believed the opposite to be true: Despite national attention to the issue of firearm violence, most Americans are unaware that gun crime is lower today than it was two decades ago. According to a new Pew Research Center survey, today 56% of Americans believe gun crime is higher than 20 years ago and only 12% think it is lower.31

THESE RACIAL DISPARITIES between white suicide and black homicide did not exist in a vacuum. Rather, they are in many ways reflective of ways that Americans talk about race, violence, and mortality more broadly. I say this because, all too often, when questions of aggression or violence involve blackness, many observers are quick to look for clues based in “biology” or “culture.” Straight-faced scientists ask whether “blacks” express so-called warrior genes, leading “them” to attack “us” more frequently. They shamelessly suggest that the overrepresentation of African Americans in the criminal justice system results from underlying biological differences that cause “blacks” to commit more crimes, or demonstrate more psychopathic personalities, or act more impulsively or with less cultural regard for long-term consequences than do everyone else. Most scientists and scholars would rightly call this kind of research what it is—namely, racist. But the implicit frame whereby “black” minds or bodies or cultures function as causal categories of analysis in violence research remains too often in place.32

Both researchers study not how guns kill but why guns are deemed worth living and dying for. Stroud, for instance, extensively interviews white, permit-holding, “good guys with guns” and finds that these men carry firearms “because a white person with a gun is not presumed to be a criminal, he or she can navigate the world with some confidence that other people, most notably the police, will not presume they are bad guys.” White privilege allows these men to “distinguish themselves not only from bad guys but also from versions of masculinity that do not measure up to the [armed, white, good-guy] ideal.”42

In early colonial America, firearms were the armaments of white upper-class power and a benefit that upper-class whites bestowed on lower-class whites to separate them from people of color. In England, gun ownership was a right restricted to the wealthy—the principle being that anyone below the rank of gentleman found with a gun was a poacher. But in the New World, white men “were armed and had to be armed,” as historian Edmund Morgan describes it. Upper-class colonial white people allowed poor white people to carry firearms to quell rebellions by chattel slaves or to repel Native Americans and pirates. Aristocratic whites then found a new reason to carry firearms—to quell potential rebellions by lower-class whites. Laws in seventeenth-century Virginia allowed white people to carry firearms and forbade African slaves and Native Americans from doing so. Meanwhile, the first US authorities in New Orleans after the Louisiana Purchase moved to exclude free blacks from positions in which they were allowed to bear arms.

legal historians such as Carl T. Bogus, Robert Cottrol, and Raymond Diamond place white anxieties about control of black populations at the center of these debates as well. In an extensively researched “hidden history” of the Second Amendment, Bogus finds that “the militia remained the principal means of protecting the social order and preserving white control over an enormous black population.”

After Nat Turner’s Rebellion in 1831, armed militias and mobs conducted mass executions in Virginia, and the state legislature passed a series of laws that forbade free black persons “to keep or carry any firelock of any kind, any military weapon, or any powder or lead.” In 1834, the Tennessee Supreme Court revised the firearms provision in its state constitution on racial grounds: “the freemen of this State have a right to keep and to bear arms for their common defence” became “the free white men of this State have a right to keep and to bear arms for their common defence.”10

As Adam Winkler aptly describes it in his terrific book Gun Fight, “few people realize it, but the Ku Klux Klan began as a gun control organization” that aimed to confiscate any guns that free blacks may have obtained during and after the Civil War and thereby “achieve complete black disarmament.”

Melzer writes, “but the role of firearms in expansion has been greatly exaggerated,” and in reality, many settlers who traveled west found little use for firearms in their daily lives. Most settler communities valued cooperation and law and order and thus banned guns in public spaces unless a person was taking a gun for repair, hunting, or going to or from a military gathering.

This shift coincided with the emergence of the so-called new way of the NRA that promoted guns as primary means of self-defense in an increasingly unsafe world, even as crime rates fell considerably over this same period.

“Well, there was this car with like, four… um, youth guys,” a woman named Ruth added. “They weren’t white, Caucasian, they were… darker skinned, I guess. Dressed in really baggy [clothes]… I wish we had a gun with us.” For Stroud, examples of white people who carried guns to protect against racial others were particularly important because most of the racialized altercations never actually happened. Rather, white gun owners imagined these encounters based on anxieties about persons of color. In such stories, gun ownership became a defense of internalized notions of racial order as well as an external personal safety.35

At the same time, investing such deep authority into externalized objects is complicated. Psychiatrists like me sometimes think that men who outsource their sense of power onto external objects—and particularly onto objects shaped like guns—do so in ways that convey deeper, gendered insecurities about potency and perhaps even racial insecurities or projected guilt. Projecting such profound gender and racial meanings onto objects might then render men subject to the maneuvers of marketers, sellers, lobbyists, politicians, and other manipulators of common sense. Of course, guns are also incredibly dangerous, but the danger they pose to people who own and carry them and to their families becomes harder to acknowledge or recognize when these objects of potential self-destruction carry such weighted connotations.

In summary, people who reflexively shouted “Gun research doesn’t add up!” were often the same people who supported a ban on effective gun research. It was as if they reprimanded plants for not flowering during a drought while at the same time blocking the trucks that delivered water. They did so without ever once suggesting they would support research that might better test not just the comparisons between Missouri and Connecticut but also the pro-gun positions that they themselves promoted.

I believe we should press ahead with firearm research whenever we can because I don’t think that anyone on any side of this gun control debate is well served by censorship or the absence of knowledge—save the organizations and industries that benefit from polarizing Americans and making us think we hate each other or will never reach consensus on difficult issues.

To put these additional white male deaths in perspective, 52 deaths in a year would exceed the reported gun deaths by defensive use, home invasion, or accidental shooting in Missouri in every year since 2012. The 413 deaths over eight years equals the total number of reported gun deaths from mass shootings in the entire United States in 2015. The number of additional deaths in Missouri between 2008 and 2015 dwarfs the number of Americans killed by terrorist attacks over this same period. According to a terrorism tracker produced by the nonpartisan New America Foundation, “in the fifteen years after 9/11, jihadists have killed 94 people inside the United States.” According to US State Department reporting, 145 Americans died by “overseas terrorism” between 2007 and 2015, for an average yearly mortality rate of 18, while 70 Americans died via “domestic terrorism” over this eight-year period, for an average yearly death rate of 8.75. (According to WISQARS, the total number of persons killed by terrorism in Missouri between 2008 and 2015 was zero.)

These kinds of odds place death by self-inflicted gunshot as a category whose relative risk functions within the same orbit as risk factors for more well-known causes of death. For instance, a quick WISQARS relative risk analysis reveals that rates of non-Hispanic white male death by gun suicide roughly equaled mortality rates for car accidents, diabetes, Alzheimer’s, influenza, and pneumonia.

Perhaps most important, the aggregate death rate for white men dying from firearm homicide was 2.56, meaning that white men in Missouri were seven times more likely to turn guns on themselves than to be fatally shot by intruders in their castles or assailants against whom white men needed to stand their ground.

The allure of this notion of armed white male power makes sense in many ways. Who wouldn’t be tempted by a platform that claimed to increase one’s own privilege, power, safety, and authority? However, again, the math and the graphs suggest the dangerous, mortal underside of linking privilege so closely to instruments of warfare and of then supporting politicians and policies that allow these instruments to be ever-more easily allowed into people’s everyday lives and intimate spaces. The data overwhelmingly suggests that more guns mean more deaths, and particularly so for the very people whose privileges and potencies Man Cards and pro-gun policies claim to restore.

How in the world might we go about changing white masculinity? Or can we open a space to talk about why white men feel they need guns in the first place? What threats do they imagine, and what safety or reassurance do guns represent?

As this process plays out, the peril to white men comes not just from the instrument, the impulse, or even the legislation. Rather, privilege itself becomes a liability. White men themselves become the biggest threats to… themselves. Danger emerges from who they are and from what they wish to be. Over time, the data suggests, “being a white man who lives in Missouri” then emerges as its own, high-risk category.

At the same time, even before the ACA’s rise and Trump-fueled fall from grace, many leading metrics suggested that, in terms of cost, men like Tom and states like Tennessee had little to fear from the ACA. Federal subsidies protected lower-income persons from the steepest premium increases. Numerous credible reports detailed ways that the ACA was working well, particularly for the poor. An expansive study by the Robert Wood Johnson Foundation found that “widespread slowdown in health spending” saved the United States trillions of dollars and that the uninsured rate dropped to the lowest level on record. ACA-enabled coverage also extended health care to many immigrant and minority persons who were previously uninsured and ended up in emergency rooms under only the direst circumstances.13

somewhat contradictory relationship to authority also manifests: men decry government or elitist interference or colonization in one breath and express deep brand or corporate loyalty (“I love my McDonald’s”) in the next.

Sommers concluded that “2840 deaths [were] prevented per year in states with Medicaid expansions” compared to similar states that rejected expansion.

Most importantly, when we subtracted the number of lives represented by the two projections inspired by Sommers from the actual figures, we learned that if Tennessee had expanded Medicaid, between 1,863 and 4,599 black lives might have been saved from 2011 to 2015. That staggering number is actually conservative: the figures did not account for the many more African American citizens who grew sicker but did not actually die during the time frame.

Only three years after that announcement, Kentucky voters elected a new Republican governor, Matt Bevin, who ran on a promise to dismantle the ACA and Medicaid expansion. In June 2016, Bevin laid out plans to close the state-run Obamacare insurance marketplace and roll back Medicaid. Yet even in the data from late 2013 to early 2016, the effects of expansion in Kentucky posed a stark contrast to trends seen in Tennessee: 425,000 Kentuckians, representing fully 10 percent of the population, gained coverage in the first year alone—even though the Medicaid expansion did not go into effect until a year later. According to an in-depth study published in Health Affairs, the percentages of the state’s low-income adults without insurance dropped from 40.2 percent to 12.4 percent as a result of expansion—one of the largest reductions in the country. Increasing numbers of Kentuckians visited doctors. The state also saw reductions in the numbers of people who skipped taking their medications because of cost or claimed to have difficulties paying their medical bills.10

not only did people in Kentucky have more access to physicians and medical care compared to Tennesseans, but Tennesseans paid more for what care they did receive.15

Families in Tennessee contributed nearly $400 more per year to employer-sponsored health care plans than did families in Kentucky. Meanwhile, the average Tennessee employee in a 2015 employer-sponsored insurance plan paid $6,477 in premium and deductible costs; average costs were only $5,693 for comparable plans in Kentucky.17

Gutting Medicaid would surely decrease taxes for corporations and wealthy people. But those savings would come at potentially devastating costs to less affluent individuals and families living in expansion states such as Kentucky.19

More importantly, research studies consistently showed Medicaid to be a cost-effective program for lower-income persons because it provided financial protections, increased rates of preventive screenings, and improved health. One 2015 study, plainly titled “Considering Whether Medicaid Is Worth the Cost,” found that the benefit of providing Medicaid was “$62,000 per quality-adjusted life-year (QALY) gained” and that states that invested in Medicaid and its expansions saw an average net return of $68,000 per enrollee.21

Reduced personal earnings represented another potential cost of illness ameliorated by health insurance. The logic is straightforward: less insurance correlates with poorer health; poorer health correlates with fewer productive work years and more time off work due to illness or injuries.23

Moreover, this idea of cost also frequently assumed that health was fair and equitable—I pay what I owe, and I pay for the consequences of my own actions—and conveniently overlooked the deep unfairness of medical expenses. According to the World Health Organization, for instance, determinants of health largely result from community and communal factors in addition to individual ones: To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health… the context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health.24 People often get sick despite their attempts to stay healthy. They get sick not because of their poor choices but because they happen to live near plastic factories or drink water tainted with lead, or because of radiation, global warming, or secondhand smoke. Yet this notion of health as a communal responsibility, a network, or an economy remained elusive in the dialogue of the white men in our groups and in the language of Donald Trump. Here, notions of cost sounded as if phrased through the Castle Doctrine, brought to bear on the castles of white bodies. I smoke, I drink, I ride a motorbike without a helmet, the logic implied, and I alone r...

In so choosing, voters and politicians who claimed to bolster white privilege again turned whiteness into a statistically perilous category. Donald Trump and other leaders may have successfully appealed to long-held beliefs about white nationalism and supremacy. But the data suggests that the policies these politicians supported, and that their supporters voted for, effectively assured that white people, too, would pay more and suffer more and, ultimately, die more in the service of these larger ideals.