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Saturday, December 17, 2011

Depression in Depressed Appalachia

When we speak of "depressed" Appalachia, we normally use the term to describe the lack of jobs, money, and adequate housing. True, Appalachia is sluggish compared to the rest of the country in terms of economic and social growth, and residents are used to this cornball portrayal of their home as a backward, poverty-stricken Dogpatch right out of Al Capp's Li'l Abner.

But recently the word depressed as it applies to Appalachia has been found to carry another connotation.
According to the Gallup-Healthways Well-Being Index for 2010, of the 11 metro areas where residents are most likely to say they have been diagnosed with depression, six are in Appalachia. ("Thursday Roundup: Appalachian Depression," Daily Yonder, August 4 2011) So, Appalachia leads the nation in the medical illness of depression, a disorder that involves the mind and body. Not too surprising. Doesn't it make sense that the most depressed area of the States is filled with people suffering from depression?

Gallup says depression is linked to tough economic times and the sense among individuals that they are not being productive. Huntington-Ashland, (West Virginia-Kentucky-Ohio area) led the group, with 32.1% of its residents saying they had been told by a medical professional that they suffer from depression. Charleston, West Virginia was third (26.3%). Knoxville, Tennessee (24.9%), Kingsport, Tennessee (24.5%), Spartanburg, South Carolina (24.5%), and Roanoke, Virginia (23.5%) also were on the list. Dayton, Ohio (23.5%) was on the list too, and anyone who knows the location and conditions in Dayton could easily say it sits in the same region.

To add to their woes, several of the communities on the list of metro areas in the Appalachian region where diagnosis of depression is most common are also among those with the highest average number of unhealthy days among the 188 U.S. cities surveyed last year. Huntington-Ashland was on top once more with an average of 6.8 days during the last 30 days of people having "poor health keeping them from doing their usual activities." Spartanburg, Fayettesville (N.C), Kingsport, Charleston, and Knoxville also made the top 11 list.

How about the energy of Appalachian residents? The poll on residents who are "most likely to lack enough energy to get things done" show Huntington-Ashland leading the way yet again with 29.6% of the population lacking vitality. Spartaburg, Clarksville (Tenn-Ky), Kingsport, Knoxville, and Roanoke were also in the top 11.

Huntington-Ashland is also high on the list of cities with the highest percentages of obese residents, and ranked near the bottom of the poll signifying the least healthy places in America. (Steve Crabtree, "Appalachia: America's Low-Energy Zone,", August 3 2011)

Should We Consider Appalachia Sunk?

According to Gallop's implications, the Appalachian region's economic woes must be addressed with efforts to attract new industries to many communities where manufacturing, mining, and forestry jobs have dried up. Yet, their findings imply that for many communities in the region, poor psychological health may be a significant barrier to growth.

Anyone with common sense realizes that new organizations 
hesitate to establish operations in a region where energetic, 
highly productive employees are hard to find.

Realizing the need for research, the Appalachian Regional Commission ordered a study by the National Opinion Research Center at the University of Chicago. The report showed that poverty, depression, mental illness and drug and alcohol abuse reinforce each other, especially in the coal mining regions of central Appalachia. ("ARC Study: Disproportionately High Rates of Substance Abuse in Appalachia, Appalachian Regional Commission, August 2008)

Anne Pope, federal co-chair of the ARC, released the report that said the higher incidence of prescription drug abuse directly affected the region's ability to improve its economy.

"Communities cannot grow if there is a major substance-abuse problem," Pope said.
(Bill Bishop, "As Poverty Worsens in Appalachia, So Do Drug Abuse and Depression," 
Daily Yonder, August 14 2008)

Additional findings of the ARC study demonstrate that adolescents in distressed and at-risk Appalachian counties "compared to adolescents in other Appalachian counties" have the highest rate of non-medical use of psychotherapeutics. Cigarette and alcohol use are also key concerns for adolescents in Appalachia.

Proportionately more adolescents reported heavy alcohol use
inside Appalachia than outside of Appalachia. 
Similarly, proportionately more adolescents used cigarettes 
in Appalachia than outside of Appalachia; 
usage was higher for lifetime use, past year use, and past-month use.

Studies of educational achievement in Appalachia show significant deficiencies.

Research by Thomas Shaw found that in 2000, 80.49 percent of all adults in the United States
were high school graduates, as opposed to 76.89 in Appalachia. 

Shaw also found that almost 30 percent of Appalachian adults are considered functionally illiterate, and educational differences between men and women are greater in Appalachia than the rest of the nation, tying into a greater trend of gender inequalities. (Thomas Shaw; Allan DeYoun Allan and Eric Redemacher; "Educational Attainment in Appalachia: Growing With the Nation, But Challenges Remain"; Journal of Appalachian Studies Volume 10 Number 3; 2005)

What To Do?

Very simply, I believe supporting projects that expend energy to encourage Appalachians to stop drug and alcohol abuse is the first step. Eliminating abuse in Appalachian communities leads to better health (both physical and mental), increased initiative and attendance in work conditions, better neighborhoods with less crime, and improved school attendance and academic performance.

Positive attention to no other single cause is more related to cutting the death rate, raising health standards, and lowering the crime rate in Appalachia. No other work will help improve so many Appalachian deficiencies than working to cut the roles of those addicted and those employed in the illegal drug trade.

The spirit of the Appalachian people is deeply rooted in the past, a past full of rich cultural significance. It is both a noble and proud past filled with significant people and important accomplishments.

But today, many residents have bought into the idea that the area is doomed to live out a history of self destruction. I truly believe some outlaws even revel in this view, hoping that our landscape someday becomes a lawless territory much like the American West of old where bad guys used brute force and terrorism to dominate others.

And, I am convinced that many people who desire better living conditions in Appalachia lack the spirit to "pull themselves up by their own bootstraps." Part of the problem is that they now believe the rest of the world sees them (and, will always see them) in old, distorted stereotypes of mountain people -- ignorant, lazy, and clannish. They have come to believe this is somehow advantageous.

The debilitating stereotyping is pervasive, and it does affect all of us negatively on many levels. Still, an individual must, himself or herself, allow a stereotypical image to negate self worth. A person who refuses to do so maintains integrity and control that allows needed progress and change.

Consider this quote from Betty Cloer Wallace (Tipper, "Hillbilly Stereotypes...,The Read on WMC, March 6 2009):

"For the past century, companies that have considered our region (Appalachia) for placing new enterprises have looked for local "hands" to do their low-level jobs, while bringing in management and executives (the 'brains') from outside; and now no one even considers Appalachia as a place where management would want to bring their own families to live or where intelligent local people might be available for employment. 

"Further compounding the problem, too many of our local governments are now made up of second-tier pseudo-leaders who are interested primarily in promoting tourism; but who, we should ask ourselves, will own the new hotels and mountaintop second-homes and assorted eateries the appointed tourist boards and self-serving chambers of commerce say we need—and who will be paying increased taxes for infrastructure to support them, and cleaning their rooms and waiting their tables and manicuring their lawns?

"The local 'hands,' of course, are expected to do those low-level jobs. This servant mentality is deeply embedded in our history and culture and language, and all of us have perpetuated it simply by not rising up and fighting it. 'He/she is a good hand to_____,' we say.


The new view of Appalachians adds "immoral" and "drug-addicted" to the litany of stereotypes. If residents of Appalachia continue to allow a drug minority to thrive, ignoring them as just another sad feature of the area. (I have heard some even say dealers and poor criminals have to exist somehow, so let illegal enterprises alone.), then Pharmageddon is nigh.

In Fox News reporter Bill O'Reilly's mind, Diane Sawyer's interest in improving the lives of Appalachian children, via an ABC documentary about their overwhelming challenges, was nothing less than a waste of time. O'Reilly dismissed the whole subject by calling Appalachia a "culture of poverty," characterizing the adults as a bunch of substance abusers and saying that the only thing kids growing up there should do to improve their lives is “get the heck out of there.”

Listen to the rant of Bill O'Reilly during this interview with Diane Sawyer on the Fox News show The O'Reilly Factor (February 13, 2009):

“'I submit to you that the culture in Appalachia harms the children almost beyond repair... There's really nothing we can do about it,' O'Reilly told Sawyer.

"She had a different view, of course. She said, 'The great opportunity is the information economy... These kids are as smart as the kids in India.'

“'Sure,' O'Reilly agreed. 'But their parents are screwed up. That's the thing... Kids get married at 16 and 17. Their parents are drunks. I'm generalizing now. (Gee, ya think?) There's a lot of meth. There's a lot of irresponsibility. There's fear to go. Look, if I'm born in Appalachia, the first chance I get, I go to Miami. Because that's where the jobs are. But they stay there. And the cycle of poverty for 200 years – boom, boom, boom, boom, boom, boom, boom. And I don't want to sound hopeless about it but I think it IS hopeless.'”

"Evidently, one reason the kids should leave is so that it doesn't become too industrialized and thereby intrude on O'Reilly's sensitive sense of aesthetics. 'I don't want to rebuild the infrastructure of Appalachia. I want to leave it pristine. It's beautiful,' O'Reilly said.

"But, he added, 'I gotta tell you, people have to help themselves, you know? They have to wise up and they have to see that there's a culture of poverty there, a culture of ignorance there. And you either leave or you try to improve it any way you can.'" 

("Bill O'Reilly Attacks Appalachia," News Hounds,, February 14 2009)

This man offends me. I abhor O'Reilly's stereotypical view of Appalachia; I can hardly listen to him because his pompous ignorance makes my native Appalachian blood boil, but I do agree with one of his beliefs. You got this right, you stilted, talking head _ _ _hole:

The people of Appalachia must educate themselves, 
rise up, 
and fight to prevent further destruction 
and eventual total subjugation.
Only then will we breathe a new and
better spirit into our hills and homes.

O'Reilly's Rant

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