— BOOK AND MEDIA REVIEWS —

Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland

Annick D. Westbrook, MD

Fam Med. 2020;52(3):227-228.

DOI: 10.22454/FamMed.2020.661725

Book Title: Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland

Book Author: Jonathan M. Metzl

Publication Information: New York: Basic Books, 2019, 341 pp., $32, hardcover

Dying of Whiteness is a very timely, highly political book by Jonathan M. Metzl, a Missouri-born physician who is now Professor of Sociology and Psychiatry at Vanderbilt University. Dr Metzl uses his familiarity with the heartland to tackle the fraught question of why people vote against their own interests. He “wanted to learn how people balanced antigovernment or pro-gun attitudes while at the same time navigating lives impacted by poor health care, increasing gun-related morbidity, and underfunded public infrastructures and institutions” (p 2). Metzl mines decades of data surrounding gun legislation and gun suicides, health care policy, and life expectancy to make his case that racism and racial resentment are at the heart of this behavior. In addition, he suggests that many do not see the connection between their political decisions and the effects on their personal health and well-being.

Metzl develops this provocative position by dividing the book into three parts: Missouri, Tennessee, and Kansas. Each is a case study of a state where he argues that right wing politics have caused a quantifiable increase in death among their white populations—Missouri by relaxing its gun laws, Tennessee by refusing to expand Medicaid, and Kansas by slashing taxes and thus school funding. The most compelling section is Part I: Missouri, which outlines changes in gun laws in Missouri from the 1990s when they were among the strictest in the nation, to the beginning of the 21st century when they began to be relaxed. This part of the country has a strong culture of gun ownership for hunting and sport. Since the author grew up in Missouri, he is in tune with this culture. After discussing the specific legislative changes, he pivots to argue that racial bias and fear are the true motivators behind them. Despite decreasing rates of gun violence, white people felt the need to own and carry a gun for self-protection. Metzl finally connects this to the increasing rate of death by gun suicide, mostly with white victims. He does suggest the link is evidence of cause rather than a simple association.

Long, dense, data-driven chapters form the heart of these sections, with short interview chapters interspersed. The interviews are with locals directly affected by the changed policies. They sometimes highlight lack of personal insight and sometimes social resignation, but mostly they emphasize real-world interpretation of the statistics presented. In an interview entitled “The Biggest Heart,” where the 54-year-old aunt of a gun suicide victim is asked whether her experience has changed her views about guns, she replies “It absolutely has not changed my view about guns. This does not make me anti-gun…but part of me blames the parents…if you choose to leave loaded weapons lying around your house and one of your own kills themselves with it, then why are you not criminally responsible? I don’t understand that” (p 93). In a different interview entitled “The Whys and What-Ifs,” another relative of a gun suicide victim also remains in favor of gun rights but advocates for stricter background checks. Metzl uses the interviews to expose common ground—a place to start rebuilding policy.

Interestingly, Dr Metzl began his research conducting interviews in 2013, well before anyone could have predicted the Trump presidency, and he seems to have tapped directly into the societal fractures that culminated in Trump’s election. He continued his research well after the 2016 election into 2018, showing how many of Trump’s policies victimize his own voters and still manage to escalate the divide. This book is not objective in tone, but it is respectful of the people spotlighted and of local culture. For those who embrace gun control legislation, Medicaid expansion, and school funding, it is a fascinating read with plenty of supportive statistics. This seems to be the target audience, and the book may provide these readers with something of a road map to reach common ground. For those who oppose these positions, Dying of Whiteness provides food for thought in the form of the historical background behind incremental policy change and its effect. Because of the divisiveness of the topics covered, it seems unlikely to change minds, but may offer depth of perspective to both sides. The book would benefit hugely from a more visual layout with graphs and pictures replacing some of the more tedious data-filled narrative, but otherwise this is an insightful framework for the poorly understood tensions and divisions in American society and politics.

Lead Author

Annick D. Westbrook, MD

Affiliations: Dartmouth Hitchcock Family Medicine Residency Concord, NH

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