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Despair doesn’t kill, defending whiteness does
On the morning of Sept 15, 1963, a other white people. From expansive those decisions threaten their own
Sunday, Addie Mae Collins, Cynthia gun legislation to broad divestment wellbeing or that of other white people.
Wesley, Carole Robertson, and in government programmes, Metzl This, in Metzl’s estimation, is how
Carol Denise McNair were killed by characterises white liberties that whiteness harms population health.
whiteness. They were young, 14 and endanger white lives or imperil white But foregrounding “resentment” as
11 year old Black girls, assembled in the futures as “dying of whiteness”. the source of self-destructive white
basement of a church in Birmingham, And it is a timely analysis. Recent political behaviours has consequences.
Alabama, USA. It was dynamite evidence indicates white middle-aged First, it erases white agency through
that tore through the church stairs, Americans’ death rate is increasing. emotional euphemism. Second, it
punctured their small bodies, and burst “…it is not that amid the armed minimises how white racism, especially
the windows of cars and businesses when enacted through political choices,
defence of whiteness some
nearly two blocks away. But it was the can simultaneously be self-interested
armed defence of whiteness that killed people have inadvertently or and self-destructive. At times, Metzl Dying of Whiteness: How the
them. This was the third bombing in indirectly died. Rather, death is artfully articulates and historicises the Politics of Racial Resentment Is
Killing America’s Heartland
11 days and one of the 50 bombs that the inevitable consequence of racist origins of white interest in firearm Jonathan M Metzl
shook the city between 1945 and the full realisation of structural fanaticism and “small government” Basic Books, 2019
1963, each targeting a Black home, racism and the exclusive rights politics. At others, he turns to “racial pp 352, US$17·99
ISBN 9781541644984
business, or church. And the violence and resources it offers those anxieties”, racially charged “fears”, or
was relentless. Within hours of the “racial resentment” to describe white
who can become white.”
attack, two other Black children— people’s political investment in white
Johnny Robinson, aged 16 years, and This upward trend has shifted white racial dominance. The effect is white
Further reading
Virgil Ware, aged 13 years—were killed Americans’ mortality in the opposite choices to advance structural racism,
Palmer B. Bombingham:
in the armed defence of whiteness. direction of most adult populations and the violence those choices engender Sept 15 1963. Parade Magazine
Comprehending the deaths of these in wealthy countries. Combined with at a population level, get misinterpreted September, 2015
Black children—killed by white men rising mortality rates among younger as primarily emotionally driven or Johnson C. Johnny’s death:
and boys in the American South in white Americans, it is clear something disconnected from material reward the untold tragedy in
Birmingham. NPR, Sept 15, 2010.
1963—requires confronting the white is happening to white people in the This tendency, to mis-attribute
racial terror that threatened Black USA that clinicians and clinical scholars white self-destruction and violence story/story.php?storyId
communities and unearthing the have not adequately anticipated or fully to psychological states or to obscure =129856740 (accessed
legacy of death that courses alongside illuminated. Dec 16, 2019)
the impacts of defending whiteness
even the youngest Black lives. Yet, Framed against the backdrop of the Padgett T, Sikora F. The legacy of
through emotional euphemisms,
Virgil Ware. Time Magazine,
as the present historical moment 2016 US election, Metzl tries to fill this is a com­mon practice. For example, Sept 22, 2003
observes a rise in white deaths, the void by naming a common aetiology the disaggregated drivers of all-cause Case A, Deaton A. Rising
connections between white racial threatening the health of white white mortality (conditions such as morbidity and mortality in midlife
terror and premature death appear lost Americans. Something he calls, “racial suicide, chronic liver disease, and drug among white non-Hispanic
Americans in the 21st century.
in public and academic discourse. resentment”. As he argues, “resentment and alcohol poisoning) have been Proc Natl Acad Sci USA 2015;
In Dying of Whiteness, Jonathan Metzl against changing demographics” and described as “diseases of despair” rather 112: 15078–83
attempts to trace these connections groups like “immigrants or minorities”, than diseases of disproportionate Kolata G, Cohen S. Drug overdoes
by probing how the armed defence “shapes [white] attitudes towards opportunity (to wield firearms) and propel rise in mortality rates of
young whites. The New York Times,
of whiteness harms and sometimes various acts of legislation”, particularly access (to prescription opiates). Media Jan 16, 2016
kills white people too. Situating his during times of economic insecurity. responses to white perpetrators of Squires D, Blumenthal D.
analysis within the political landscapes In other words, to “maintain an mass shootings have cited abstract Mortality trends among
of Missouri, Tennessee, and Kansas, imagined place atop a racial hierarchy”, “mental illness”, labelled shooters as working-age whites: the untold
story. Issue Brief (Commonw Fund)
Metzl explores how white Americans white Americans who harbour “lone wolves”, and treated their violence 2016; 3: 1–11
arm themselves with guns or votes, “racial resentment” adopt political as idiosyncratic rather than the deadly Anglemyer A, Horvath T,
and attempt to individually secure orientations and voting patterns largely confluence of white racial terrorism, Rutherford G. The accessibility of
the benefits of whiteness, shaping based on if, and how, those choices patriarchy, and liberalised access to guns. firearms and risk for suicide and
homicide victimization among
in the process the population health seem to limit the freedoms or resources Even research examining the relation
household members: a systematic
outcomes of everyone living in the wake available to non-white and/or Black between white­ness and health suggests review and meta-analysis.
of their political decisions—including people. Yet they also do so, even when psychological “distress” contributes Ann Intern Med 2014; 160: 101–10

www.thelancet.com Vol 395 January 11, 2020 105


Woolf SH, Schoomaker H. to how whiteness impairs health. across racial groups in the USA, access to have always been teth­ered to a legacy
Life expectancy and mortality And increasingly, intellectuals rapt with rights and resources is. Yet scholars, the of untold deaths. This is not the result
rates in the United States,
1959–2017. JAMA 2019; the concept of “white fragility” focus media, and the public seem intent on of an emo­tional positioning, but a
322: 1996–2016 on the emotional discomfort white viewing white voter patterns post-2016 structural one. In Dying of Whiteness,
Metzl JM, MacLeish KT. people experience when confronted and rising white deaths post-2010 as Metzl intricately outlines this structural
Mental illness, mass shootings, with their racism, rather than the born of recessions, resentment, and framework but too often anchors it to
and the politics of American
firearms. Am J Public Health 2015;
legacy of death in whiteness’s wake. To racial divides. This myopathy overlooks an emotional foundation his analysis
105: 240–49 assert that resentment, despair, or any the evolving ways white Americans both critiques and depends on. This
Malat J, Mayorga-Gallo S, emotion that arises from being “left continue to mobilise to maintain is perhaps why his conclu­sion is to
Williams DR. The effects of behind” accounts for white Americans’ or extend the exclusive advantages “Promote more healthy and self-
whiteness on the health of whites
in the USA. Soc Sci Med 2018;
self-destructive actions, violent politics, whiteness offers those who can become reflective frameworks…of structural
199: 148–56 or declining population health misses white, even as those advantages place whiteness” when the only solution is to
DiAngelo R. White fragility. two counterpoints. them in increasing proximity to death. eliminate whiteness all together.
Boston, MA: Beacon Press, 2018 First, if any population has been left When confronted with self-inflicted Because the consequences of struc­
Jones NK. American wasn’t a behind in America’s colonial-turned- or white on white violence, scholars, tural whiteness are fatal and as new
democracy until Black Americans
made it one. 1619 Project.
industrial-turned-technocratic political the media, and the public are evading populations seek its exclusive advan­
The New York Times, economy, it is Black (and Indigenous) the logical conclusion—one Metzl tages, the associated harms continue
Aug 14, 2019 people. Yet despite suffering at every both illuminates and eschews—despair to unfold. For example, as some
Tapia Granados JA, Diez Roux AV. turn of every decade of every century isn’t killing white America, the armed Asian American students challenge
Life and death during the Great
in this nation, generations of Black defence of whiteness is. affirmative action, they not only risk
Depression. Proc Natl Acad Sci USA
2009; 106: 17290–95 Americans have sought political reforms To be clear, it is not that amid the eliminating opportunities for higher
Hsu H. The rise and fall of that expand electoral participation, armed defence of whiteness some education they also risk decreasing
affirmative action. The New Yorker, increase government protections, and people have inadvertently or indirectly life expectancy for affected non-white
Oct 15, 2018 extend public resources beyond their died. Rather, death is the inevitable and/or Black students too. And as
Sasson I, Hayward M. individual or group benefit. And while consequence of the full realisation of Hispanic Americans increasingly select
Association between educational
attainment and causes of death Black Americans’ mortality rate exceeds structural racism and the exclusive white on the census, it reveals pressures
among white and black that of their white peers (similarly rights and resources it offers those who to assimilate that may endanger
US adults, 2010–2017. driven in part by fatal drug overdoses can become white. This type of death is their population health as well.
JAMA 2019; 322: 756–76
and suicides), their deaths are a direct perhaps more easily recognised when it On Sept 18, 1963, just 3 days after the
Hunmer RA, Hernandez EM.
The effect of educational
result of a political economy predicated is sudden and violent—like the deaths 16th Street Baptist Church bombing
attainment on adult mortality in on their individual and collective of Addie Mae, Cynthia, Carole, Carol killed four Black girls, Dr Martin
the United States. Popul Bull 2013; subjugation, not their individual or Denise, Johnny, and Virgil. But it can Luther King Jr took to its pulpit and
68: 1
collective sadness. also be “slow and [nearly] invisible”, as said: “[These children] say to each of
Cohn D. Millions of Americans
changed their racial or ethnic
Second, death and despair are not it is among white Americans who will us…we must substitute courage for
identity from one census to the necessarily associated with economic deteriorate from chronic liver disease or caution…we must be concerned not
next. Pew Research, May, 2014. downturns. Some recessions have substance use. merely about who murdered them,
bolstered investments in gov­ernment Ultimately, white racial terror can but about the system, the way of life,
of-americans-changed-their- supports that safeguard population strike by blunt force or decaying the philosophy which produced the
racial-or-ethnic-identity-from- health. For example, during the Great infrastructure, through frank abuse murderers.” The solution to defending
Depression mortality rates generally or frank neglect. It can kill babies or whiteness is not self-reflection. It is
(accessed Dec 16, 2019)
decreased and life expectancy increased, mothers, immigrants or Indigenous not a difficult conversation. And it is
Cohn N. More Hispanics
declaring themselves white. for whites and non-whites across peoples. But within a white racial not centring white emotions, however
The New York Times, gender. This was partly due to New ordering of humans, rights and distressing they may be. The solution
May 21, 2014 Deal politics that forged the greatest resources, non-white and/or Black is those who can become white must
Asad A, Clair M. Racialized legal advances in social benefits the USA deaths become naturalised and summon the courage to unbecome
status as a social determinant of
health. Soc Sci Med 2018; has ever known—from social security expected. And white deaths appear to white and then to eliminate whiteness,
199: 19–28 and home loan assistance to the be the aberration. But they evidence the “the system, the way of life, the
MIT. Invoking Dr King: eulogy for administrative precursors to welfare. rule, not the exception. philosophy [producing] murderers”.
the victims of the 16th Street In sum, it is clear “conservative For humans to use whiteness to
Baptist Church bombing, 1963.
MLK Visiting Professors and
backlash governance” has not been manufacture access and privilege, Rhea W Boyd
Scholars Program. 2015. the only political reaction to perceived they must engineer scarcity and loss. Palo Alto Medical Foundation, Palo Alto,
https://mlkscholars.mit.edu/ or experienced hardship in America. This entanglement between access CA 94301, USA
(accessed Dec 16, 2019)
And despair and resentment are not and scarcity, privilege and loss, means rheaboydmd@gmail.com
the major drivers of increased mortality white people’s unearned advantages @RheaBoydMD

106 www.thelancet.com Vol 395 January 11, 2020