The Page 99 Test: Carol Graham's "The Power of Hope"

Carol Graham is the interim Vice President and Director of Economic Studies at Brookings and a College Park Professor at the University of Maryland.

She applied the "Page 99 Test" to her new book, The Power of Hope: How Wellbeing Science Can Save Us from Despair, and reported the following:

I have just published a book on hope and despair, which is both about the dangers of the extensive levels of despair in our society and what can be done to restore hope in populations and places where it has been lost. The first of these issues is daunting and the second is a difficult challenge. Neither of these are issues that would typically be addressed by economists, but they are now central to our society’s health, productivity, and democracy. We must make them a priority.

Uncannily, the opening text on page 99 highlights both:
Despair is a state where one does not care whether one lives or dies.…and where the narrative for one’s life is gone, with nothing to replace it. It is the analogue of hope, which combines the sense that things can get better with the will to make them better. How do people get from one state to the other? Why has this happened on a large scale in one of the wealthiest countries on earth? What can be done?
Our crisis of despair at both individual and collective levels is, indeed, unparalleled in our history. Since 2010, over one million Americans have died of “deaths of despair,” which are those caused by suicide, overdoses, and other poisonings among adults in their prime age years. Indeed, prime age workers who have permanently dropped out of the labor force – due to addiction, ill health, and associated despair - are disproportionately represented in these deaths. In 2021, we had over 100,000 deaths from opioid overdoses alone. Our premature mortality rate from these deaths has caused consistent declines in our life expectancy since 2015, rather than the increases that are typical for wealthy countries, reversing the longevity gains made by progress in curing cancer, cardiac disease, and other key factors driving our mortality rates.

How did preventable, premature deaths become so predominant in one of the world’s wealthiest countries? Perhaps the most important explanation, in my view and in my research, is the loss of hope among the cohorts who are most represented, such as the white working class, which has seen its livelihoods disappear and its communities and social structures such as marriages and civil society organizations unravel at the same time. In the past three years, though, minorities and youth have also begun to be part of this death count, due to the increasingly widespread availability of the relatively inexpensive and particularly lethal synthetic opioid, Fentanyl, and to the increase in depression and anxiety among the young.

Despair and deaths of despair constitute a vicious circle and are strongly associated phenomena and spread from individuals to communities and back again. In addition to the decline of manufacturing and other blue-collar jobs, there are also increasing challenges to the supply of low skill jobs, such as technology driven growth and artificial intelligence. The negative effects of these include increasingly uncertain lives and jobs, increasingly unequal access to health care, and increasingly unequal opportunity sets across the rich and the poor. The over-supply of legal opioids beginning around 2005, which primarily affected working class whites, and is now being replaced by the wide availability of illicit drugs such as fentanyl, added to a perfect storm, which is now encompassing a wider range of age and population cohorts.

What can be done? There are, of course, practical public policies that could help, such as expanding access to health care and particularly the reach of mental health care, support for low-income youth seeking to attain the new kinds of education required in the labor markets of tomorrow, such as socio-emotional and cognitive skills, critical thinking and problem solving skills, and technological skills, some of which can be acquired in college and others which are available in new forms of education, with community college often being a good entry point, and restoring the social and economic infrastructure which is in decline in deprived communities, such as access to broadband internet and to credible sources of local news.

Yet critical to the success of any of these and other practical solutions is restoring hope and aspirations of individuals in despair. Without hope, they are unlikely to take up any new opportunities and/or invest in their own futures. There are no established recipes for doing so, however. While psychiatrists, for example, often point to restoring hope as the starting point for recovering from mental illness, there are no clear guideposts for how to. Nor is there a clear, agreed upon definition of hope across the medical and social sciences. What we do know is that hope is different from optimism because of its agentic properties. One example is the comparison of the tragic optimist, who continues to think things will get better even when they are not, to the hopeful pessimist, who is trying to make things better rather than wishing they will get better. As such hope is key to future outcomes.

There are no magic bullets in this area, and at minimum, success will entail mental health treatment along with restoring community resilience and revival. There are also examples of strategies that work at different stages in the life course. One is the Be Well initiative in schools in declining regions of the UK, which teaches children in middle and high-schools socio-emotional skills such as self-esteem and resilience and coping strategies for loneliness and lack of hope. The initiative, which evaluates the participants at different points in their education trajectory and finds that it improves both the wellbeing and academic performance of the majority.

Other initiatives aimed at older adults in isolation and/or despair encourage participation in community activities, such as volunteering or participation in the arts. My research on inspiring hope and educational aspirations among young adults preparing for entry into the labor markets highlights the critical role of mentors who can both support the youth in their aspirations but also guide their efforts in training for the skills that will be required in tomorrow’s uncertain labor markets.

We indeed face a daunting challenge as a society and need to develop strategies for taking it on in a new and little-known field. If we do not take it up, though, having a next generation in despair will be an existential threat to our society.