The Fast-Rising Tragedies of Death of Despair-Part One-
Joe: In my family, we do Christmas a little bit differently. We send each other gifts whenever we please, and like children, we just stare at them under the tree until we can't sit still anymore and open them. I remember a Christmas where our whole family gathered a week or two early. I think I was maybe six or seven, and we started passing them out. The adults were all giggling. My father and my aunt were involved, and they just started passing out these gifts. We tore them all open and played with them all week, but it was so early. We were all out there playing with our presents and stuff about a week early, and the very friendly Christian neighbors down the street who were very strict about when Christmas was supposed to happen were just laughing at us. I remember them giggling because we were all impatient children, even the adults.
Todd: I think it says more about the maturity of the adults. My mother would hide all the presents that were from "Santa," and I would try to find them and then pretend I had not found them and act surprised by over-acting on the day of. And then I would get caught and get grounded almost every year.
Joe: This year, I sent my father's present weeks late. He lived in Vancouver, and we kept saying that we would meet up and not send anything. The idea was we'd meet downtown, or we were going to go on a train trip to Seattle, going to take it up to the Space Needle.
Todd: It's a beautiful scenic ride. You guys could open your gifts and talk father-son time. That sounds like a nice Christmas.
Joe: Exactly. The last few texts I had to him was us hammering out the time to go on this trip. And at some point, because I was packing my things and getting ready to move to Texas, I sent his gift via mail so that I didn't lose it. To me, this was going to be easier. I had jotted down a card, and in that card, I had told him all the things I had done this year. I have a strained relationship with my father. I've joked about him on this podcast. When you first met me at Toastmasters, I would present about writing and contests and writing for articles and then I would joke about my father, who claimed he was a writer, but he never actually put pen to paper. As David Rakoff says, he mostly liked to drink about it. When I sent that box, the card said I got published in a VR game this year.
Todd: Let's backtrack there. So, there's substance abuse in the family? How many years had he been drinking?
Joe: Yes, there is. I actually found out recently that it was very far back. It was in his 20s. He started because he liked to smoke weed. And at the time, that was very illegal here in Oregon. And anyone who's seen state laws probably thinks that we've always been hip-deep in weed on the streets, but it was once very legal. He was trying to get a job, and so he started drinking because he needed an outlet. Drinking was going to be his methadone. And once he started, it was heavy and consistent pretty much ever since. So, I sent him this box (this year), and it got to him, but because we so inconsistently speak and because usually when I talk to him, he is inebriated, and it was spotty whether or not I'd be able to get a clear message to him.
Todd: forgetful - the wet brain kind of symptoms.
Joe: Right, and he would talk about age. He would say it sucks getting old, but he wasn't that old. He was exactly 20 years older than me. So, he was in his mid-50s but looked like he was in his late 70s or 80s. So, the box arrived and, on the card, I had written these publications that I'd done this year. I had written that I got my license to be a private investigator, and I had written which town I would move to when I went south. It was a very brief, very simple recap of what I've been up to. And ended it with I hope you have something to look forward to this year.
Todd: That breaks my heart, that last part.
Joe: When I contacted one of his friends after his death, she was the only person of his friends who seemed shocked because he was very much into holistic medicine, spiritualism, UFOs, etc. Anyone who listens to this podcast and asks why I'm so stuck on science and statistics, that’s why. It's a rebellious act. So, most of his friends who called me or expressed their condolences were like; he was so spiritual - where do you think he went in his death? It was odd. Now, one of his friends called me, and she had become a licensed counselor/psychologist over the course of the years. They had a falling out, and when she asked how he died, I explained it was a death of despair. It took a long time for me to figure out exactly how he had died, and I’ll explain that process. Circling back, he did not get that package; it was on his kitchen table when I arrived there to deal with his possessions. It was such a strange way that he passed. He also passed away with a roommate who was so drunk when the coroner arrived that he wouldn't wake up. When they finally got in and found my father in the room, he had passed in his sleep up against the door. The medical examiner moved him and did not move him back; they didn't bother picking them up, and they left that for the coroners. It was weird to me, and the thing I want to talk about today for this episode, if you're willing, is that they did not write his cause of death on the death certificate.
Todd: Well, as the fiction writer that you are, what would be symbolic that the package got there before he got to open it and say his goodbyes or say Merry Christmas to you?
Joe: I mean, obviously there's some symbolism there of disconnect that it arrived literally the morning that it happened and that he just barely missed opening his Christmas package with candy, a picture of myself and my girlfriend, and a pair of headphones.
Todd: So thoughtful gifts, which is probably a symbol of love, but I also think of maybe a symbol that you’ve known the man for 35 years and you, in your subconscious, somehow knew that this was it.
Joe: I think so. Me agreeing to go on a reminiscing trip to Seattle to see the Space Needle reflected that. It was something we had done when I was very young. I think we both knew it was going to happen. He had told me something was wrong, and there was something that the hospitals weren't catching. He felt something was wrong and had asked in multiple ways for more time - not from the doctors, but he was asking me, and I didn't know what he was asking. So, I don't think the Christmas package was exactly what he needed, but I don't think I knew how to ask because he had burnt so many family bridges before, it was tough for him to get any of our time. Telling us that he needed time with us and things were drastically wrong; we had heard that in the past. We knew that when he said something was wrong, it meant he needed money or a place to stay, or it meant he wanted to get us on the phone so he could argue with us for a while.
Todd: You got a lot of good stories about your dad, and I'll dig into some of them later.
Joe: We'll talk about that a little bit. But the thing that I want to discuss today is that it's weird to me that they didn't write his actual cause of death on the medical record. And yet when I investigated this, death of despair is overcoming the country. It is so much more prevalent than I thought it was.
Todd: That sounds like a made-up or fictional. Like someone dying of a broken heart.
Joe: It really does, but this is a real thing. I actually have who coined the term, how common it is, and why we're about to see a lot of Millennials become depths of despair, and we have the statistics for that too.
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Todd: This is a tough one for me. Joe and I have defined our relationship, and we've been working on creative projects for about three years now. We're more like brothers. However, Joe is very guarded, brutally honest, and he is very sensible. So, all those things kind of go out the window when your father passes on.
Joe: This has now been about a month. I have had some time to process, but I want to take this opportunity to just say that there is no such thing as being too overwhelmed. There's no such thing as having too big of a reaction or being dramatic. There's no such thing as a wrong reaction to a death. So, we just want to remind the audience that if anybody feels overwhelmed, depressed, or anxious and it's becoming too much, and it doesn't matter what the reason is – seek professional help. I want to share a little bit about that too. We start so many episodes by saying we're not doctors and that we believe in seeking help. As of a couple of weeks ago, I started with a therapist, and that's just to let everyone know that you can be mentally stable and honest with yourself and still need to seek help. There's never a bad time for it.
Todd: And you don't have to wait until you are close to suicide or severely depressed to get help. Get it before that before you hit the bottom of all bottoms.
Joe: Right. Climbers secure their safety hooks before they use them. That's how mental health should work too; don't start falling first.
Todd: I also don't think all deaths are the same, you know, because I lost my father too. I don't think they're the same because people lose them at different times, and people have different relationships. And all are hard, but strained relationships tend to carry a lot of regrets than loving relationships do.
Joe: Everybody's different, and there's never like an opportune time to lose somebody. Some losses can happen for expected reasons, and natural causes are usually what we write down when somebody goes from old age - even if that old age is from heart attack, cancer, etc.
Todd: We knew it was coming, so we got to prepare. But when you just find out that day, that's the Will Smith slap in the face.
Joe: Strangely, natural causes are what they wrote on his death certificate. When I got the call, and I eventually got his death certificate, they settled with natural causes. I also found out that a lot of times, if somebody passes from a drug overdose, they will just write “heart attack.” So, there are ways on a death certificate to write things where you don't have to write the actual cause, just the expected reason.
Todd: I went to this play when I was a kid, and it was about HIV and that was a really hot subject at the time and people were dying from it all over the country and all over the world. And one of the moms of the boys who had passed from drugs said her son was not a drug addict and that he died of pneumonia because it said it on his death certificate.
Joe: A couple of years ago, when my mother passed, it was complications with opioids. And that was what they wrote, pneumonia. Now, I want to start with the dry things first. At Princeton, a couple of economists came up with the term ‘Death of Despair.' And that was Annie Case and Angus Deaton. And they first started looking into it because they noticed that people with college degrees, specifically white men and women with four-year degrees, were weirdly dying of suicide, drug overdose, and alcohol-related liver disease shockingly early. So, they coined the term death of despair, and when they dug into it, they investigated those three causes, specifically how they are tied to addiction and depression. They found out that of those three reasons, 158,000 people a year were dying in the US, which they said is the equivalent of three fully-loaded Boeing 737s falling out of the sky every day for a year. But my father had a lot of other conditions too. He had hypertension, which 47% of Americans have to some degree. He also had diabetes, as do 37 million Americans. He had anxiety and depression neuropathy from drinking. Basically, everything that was wrong with him, we have talked about or skirted about in this podcast in some way. And I don't want to linger on that too long because this is a podcast about self-improvement and empowerment. I just wanted to say that even medical professionals are too tired to care about these because they are so prevalent in American society. So, they will just label it natural causes because it's easier to do that.
Todd: How many of these do you think go away if the drinking goes away?
Joe: If you eliminate drinking, you reduce how many people have hypertension by a lot. Drinking is an exacerbation of diabetes. Opioids, I'm not sure if you can get addicted to opioids without alcohol being part of it. But anxiety and depression are made worse with drinking, So it may not be the cause of a lot of these, but it will complicate the hell out of them very quickly.
Todd: You know, my brother died from heroin. He died by getting hit by a car, but it was because he was stumbling into the street high out of his mind. So, his death certificate says he got hit by a car and had head trauma, but that's not what happened. My father also has alcohol and drug problems. But my grandfather was the worst of the worst because he just got nastier. He had a family that loved him, but he just became a recluse in his own head and just became a nasty mean person and pretty much sucked every ounce of joy out of the world.
Joe: I went to a Toastmaster meeting once where one of the women very candidly talked about her brother who was first an opium addict and then switched to heroin. Heroin was his way to get away from opium, strangely enough. And a statistic here in does state that heroin use went up after doctors started cracking down on how many opiate prescriptions they gave out. And she talked about how if you have an addict in the family, it's emotional sandpaper. You repeatedly care for them until you get sanded down. And then once you do, you don't have any more emotion for it. We're going to skip the myths for today, but the big myth we want to talk about is that before covid, our medical system was too tired to care. I think that is going to be the one myth today: hospitals are profit centers, and they started limiting patient-doctor interactions to less than 17 minutes a visit, which was five years ago. It also does not get better if somebody is coming in with an illness that they have done to themselves. It's not that they get less time or less care; it's just much harder for people to have sympathy for them.
Todd: I've been in the people business a long time, and I know for a fact that it takes longer than 17 minutes for people to feel comfortable and be able to be honest with you, even if you are a lawyer or a doctor. You don't have any good information at that point. So, you're just making decisions based on whatever to get to the next one.
Joe: Yeah, it is a processing line. So, if you want to have an idea of my father’s drinking, we used to live on the coast, and there were sea lions that would come by every year; they would lay out on this jetty - just a long stretch of sand into the ocean. And there were hundreds of them. People stopped in Newport here on the coast to see a couple of sea lions at the docks. In Waldport, you can see hundreds of them, and they tell you not to go to the beach when they're there. If they get frightened, they will stampede. They'll either run away from you, or the males will sometimes attack. So, one of my friends Bryce and I went to the beach with my father. It wasn't late at night. It wasn't after a house party. But when we went out, he carried a vodka tumbler like Rodney Dangerfield. It was probably just straight vodka. And when we went out to look at these 200 seals, he started going up to one. Bryce and I just stood back, wondering what he was doing. He knew not to do this, but he got down and stretched out his hand towards one with a drink in the other hand. We expected to see the most hilarious deaths anyone's ever caught on the Oregon coast. We thought we would watch him get killed by an adorable seal and then dragged into the water. And honestly, being eaten by a seal would have been the way he wanted to go. Nonetheless, we watched him pet this seal like it was a dog. Then he walked back, and we asked, what was that? What were you doing? And he's like, oh, it's dead – So he was petting a dead seal that had been gone for hours and hours. I think he was a kooky enough hippie that this made him one with nature petting, basically roadkill of the ocean. That story probably tells you everything you need to know about my father's drinking, and you know what it looked like in person. Okay, do you have young friends or anybody you've seen around the Millennial age who developed a drinking problem? Myself included; I'm definitely going to include myself in this.
Todd: Yeah, I mean, it wasn't uncommon for me in my early twenties to drink 20+ beers a day pretty consistently. By consistently, I mean every single day. And I think you would drink at least half a bottle a day or something, right? You tell me.
Joe: Yeah, It was usually more than a six-pack a day of something stronger than 10%. And often, it was half a bottle to bottle a day in total. It was a lot.
Todd: One alcoholic quote that I remember is from Eddie Van Halen. He said that when his drinking was its worst, he would have to drink a six-pack of beer to feel okay every day. I've personally had those withdrawals where you wake up, and you can't really think or are trembling, but then you drink a beer, and you actually feel normal.
Joe: I think that's a good way of putting it. You get to a point where you drink so that your brain settles back to what it should be. And I don't know how to describe that to somebody who has never drank before.
Todd: You don't feel good. You still feel like shit. You still feel hungover. You still feel terrible. You still feel dull. But you can at least function. I mean, I remember points of not even being able to talk.
Joe: Have you ever met guys at work who will drink an incredible amount, way more than you think they should be able to, and then they function well enough to do something professionally?
Todd: I used to hang out with these guys before while at HSBC. We would go to these huge conferences, and these guys would stay out till 5:00 and then be at the meeting at 7:00, looking perfectly fresh. I was never one of those. You shared the story about the seal, but that was kind of an endurance one. Do you have any other dark stuff that you saw that was embarrassing to you or just really disappointed you, or scared you?
Joe: Yeah, there are lots of those. One that I remember is one of the reasons why nobody took him seriously when he told us he was feeling very sick and very ill is because when my brother and I were teenagers, he drank himself very sick and went to bed. Then he got one of his friends to come over and check on him. And then he very melodramatically called us into the room and told us that he was dying that night and wanted to share his wisdom of the ages with us. He literally said, I want to share my wisdom with you, and we both just rolled our eyes and walked away, but it was so sad. Of course, he didn’t die. He was being dramatic, and he had drunk himself into a depressive state. And we were so used to it that we didn't give it credit for anything, but it was a real marker for depression.
Todd: It was a cry for help.
Joe: It was. And people listening to this, they might think this is such an alien idea, that you may not know anybody like that. But I guarantee you know somebody like that. I was a functional alcoholic for years. I mean, nobody is technically not an alcoholic; once you burn those circuits into your brain, it's there. But that's one in eight Americans right now; One out of eight people is a full-blown alcoholic to the clinical definition.
Todd: And even though you don't see the blows and the bottoms, the people who live with them and are related to them do.
Joe: Everyone knew I drank, but very few people knew that it was as bad as it was. I was good at concealing how bad it was. So, I'm going to quote NPR Here. NPR says that the rise of alcoholic liver disease, especially among young women, is an off-the-charts epidemic. I wanted to find numbers and find exactly how bad it is, but I think having everybody who is lumped into the death of despair should be enough. An alcoholic liver is a terrible way to go, and we're seeing young people go from it. And the funny thing is we still in medical practice, dismiss alcoholics who need a new liver. We triage them. If anyone is unaware of this, if you are an alcoholic and your liver gives out, they won't transplant you a liver until you've been sobered for a year, which means that in the time you need it, you probably won't get it.
Todd: It seems like we can't just give you another one if you're going to abuse it. It's like you wreck a car; you can't buy another one until you take it seriously.
Joe: Right, that's the thinking behind it is that we shouldn't give you a liver if you've burned yours and you haven't gotten sober yet. You should have a year under your belt at least to show that you're not going to ruin your new liver. But pretty much every study I could find all said that it's wise thinking, but nothing in science upholds it. Statistically, for people that need a liver transplant, that's enough to get them off drinking. Not everybody, but statistically, if you get to the point where you need major surgery, people reprioritize.
Weirdly, almost all the stuff we're going to talk about today about addiction is effectively how we look at addiction wrong. So, when I started looking into my father’s death certificate, I wondered why they put natural causes down. My first thought was alcoholism. I bet everybody listening is like, yeah, obviously it was the drinking; that would make the most sense.
You just heard part one out of our two-part series on depths of despair. Next week, we'll talk about the medical system and why my father's death certificate said a death of natural causes. We'll also talk about what it looks like when insurance companies start using errand fatigue as a system for billing and profit. Tune in next week as we go a little bit farther down the rabbit hole.