Pain is a warning that something’s wrong is a line from an underappreciated Madonna song, and not the rallying cry of a socialist revolution, but perhaps it should be. Though the lyric refers to a failing romantic relationship, it could just as easily be applied to an economic system that demands “pain” for “gain.” In capitalism, the two are inextricable, and in this nation that is inextricable with capitalism, enduring pain has always been the implicit price for personal achievement.
A true public-health disaster, the opioid crisis is indisputably urgent and unprecedented in scale with regard to drug overdose deaths. Yet, it’s also true that this urgency—this dilation of the present via language like now, never before, and unprecedented—obscures the historicity of the issue. At root, it was America’s deeply capitalistic abhorrence of the revolutionary potential of pain that at least in part fueled the decades-long ideological battles that enabled OxyContin’s 1996 debut. These battles, which date back to the beginning of America’s postwar era, are themselves part of an older narrative of the body, pain, and capitalism. The opioid crisis emerges at a juncture in this narrative when the role of the “body in pain” is in flux. Formerly the raw material of production itself, the body in pain is now increasingly unimportant to capitalism—and increasingly ascendant as a signifier of a new economic elite.
In Elaine Scarry’s groundbreaking book The Body in Pain (1985), she contends that “civilization” is, in its simplest form, the making of artifacts (language, tools, clothes, homes, etc.) that mediate body and world, mitigating our vulnerability to pain. In this sense, to build a chair is to deposit one’s own body in it, so that one can then draw on that deposit to defray the pain of standing. For Scarry, then, civilization begins when human sentience becomes “disembodied,” or, more concretely, deposited, in artifacts that, like chairs, can be shared with other people. Which is to say, civilization begins when our “sentience is socialized . . . relieved of its privacy.” If civilization is intended to diminish pain for everybody, capitalism diminishes pain for only a few.
Capitalism causes pain-mitigating artifacts to become commodities that are bought and sold without reverence for the human sentience stored in them. Over time, these commodities accrue to a few capitalists, accreting around their bodies in an ever thickening “margin of artifice” such that they become virtually disembodied—or, immune to pain. Given enough time, the capitalist’s disembodiment will attain something like the divine right of kings, as the late Ursula K. Le Guin noted. The worker, meanwhile, must externalize more of her body (that is, work more) to purchase enough of it back to minimize the pain of being living soft tissue in a hard, dead world.
But if the body in pain is the impetus for capitalism, it’s also its potential downfall. Should workers perceive that their native state of “intense embodiment” is in fact engineered, the fiction of capitalism as the state of nature shatters. For this reason, political theorist Claudia Leeb argues that capitalism’s ultimate goal is to anesthetize the bodies from which it extracts value, a move that would disarm the intuitive alert that things are not as they should be. As Leeb contends in Power and Feminist Agency in Capitalism: Toward a New Theory of the Political Subject (2017), the moment of bodily suffering is the crack through which a political subject can break the illusion of capitalism. The body in pain is quite literally “what makes us rebel.”
The battle to contain pain’s revolutionary potential provides the ideological backstory of the opioid crisis. One version of that backstory, historian Keith Wailoo’s Pain: A Political History (2014), shows how the welfare state’s clash with small-government capitalists literally produced the criteria of pain as we understand it today. From the start of the postwar order in 1945, with each boom and bust and each transition from Democratic to Republican control, the definition of pain mutated as the courts, the medical establishment, and public opinion reinterpreted it to fit the changing cultural landscape. At stake in each reinterpretation was not only the proper role of the state in caring for its suffering people but also the criteria by which the facticity of pain could be indisputably established under the law according to medical science. These criteria were vital to protecting the nation from the socialist “Trojan horse” of pain. The body in pain, conservatives would repeatedly (and still) argue, could always be lying.
Without knowing the verifiable truth of pain, these conservatives reasoned that entitlements like disability could be squandered on frauds whose only evidence for their unobservable pain was their own testimony. Any federal disability program, even for limbless patriots, would therefore put the United States on an irreversible path to socialized medicine and a wholesale communist revolution.
Wailoo traces the subsequent decades of litigation and medical research that offered provisional answers to the question of pain. Generally, these answers moved between an idea of pain as something that it was necessary, if not edifying, to endure, and pain as a “fifth vital sign” whose undertreatment was a public-health emergency. This latter line of thinking took hold in the 1980s and 1990s, culminating in the release of OxyContin in 1996 after a compromise that compassionately addressed the “epidemic” of chronic pain by freeing the reins on a “benevolent” drug market. It was only when pain was transformed into an economic problem that could be solved with a particularly lucrative solution (prescription opioids) that it ceased to threaten capitalism.
At the same time as prescription opioids were flooding the market, the information age was arriving. Whereas the political fear of pain as “socialist Trojan horse” created the material conditions for the opioid crisis to take root in the mid-1990s, the digital disembodiment of American labor and life over the following decade would allow the crisis to grow into what it is today.
For Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic, the increasingly disembodied, atomized on-demand economy of the 2000s enflamed a drug-trafficking subculture that would have fizzled out in the community-oriented past. Wealthy white kids with disposable income learned how to order heroin like they order pizza, summoning up a clean-cut, business-card-carrying dealer. Such dealers were integral to the spread of black-tar heroin to the eastern United States, Quinones argues, and their emulation of corporate sales practices (direct, customer-is-always-right relationships with dedicated salespeople; customer loyalty tactics like free replacements for heroin a client deemed inadequate; etc.) both increased their penetration into suburban America and concealed the scale of their operation from police.
At the same time, the robust Main Streets and shared spaces of Ohio Valley small towns were effectively extinct by the early 2000s, when prescription opioid trafficking had already started to “tenderize” communities for later adoption of riskier heroin and fentanyl. Walmarts replaced mom-and-pop merchants, substituting the latter’s intimacy and interconnectedness to local life with corporate, distant anonymity. Across all these examples, the disembodiment of labor and life is the common element. And to Quinones—or at least to his sources—this breakdown of the social body, of a robust communal organism, is what let the poison in.
Dreamland, published in 2015, ends with a nostalgic fantasy of a resurgent nuclear-family-fueled small-town capitalism. In 2018, it’s difficult to conceptualize such a retrograde community as anything other than white and straight, and it doesn’t help that the resurgent Portsmouth, Ohio, of Dreamland’s final chapters shifts into Republican hands. Although the text’s invocation of a renewed industrial heartland is benignly illustrative on Quinones’s part, it overlaps uncomfortably with the rhetoric of MAGA, which pines for a past that never really existed. One wonders if the proliferation of articles, books, and legislation related to the opioid crisis and the election of Donald Trump are parts of the same historical process.
This is not an outrageous thing to wonder. According to Helena Hansen, a professor of psychiatry and anthropology, opioid addiction became a crisis only when its narrative solidified into one of existential threat to white posterity, despite the “chronic losses sustained by Black and Latino communities that experienced an influx of heroin . . . starting in the 1970s.” Her analysis of opioid-crisis news coverage finds that the prevailing image is the addicted white mother. She argues these stories are so frequent because they threaten the whiteness of the future, and not because they stoke “color-blind” sympathy for the suffering of a motherless child.
Were that the case, the Black mothers who figured prominently in coverage of the crack epidemic in the 1980s would not have been routinely reduced to “unfit mothers.” In this sense, the explosion of opioid discourse expresses an old, intrinsically American anxiety over white women’s bodies and the fecundity of the white heterosexual family—a fear of race-wide disembodiment (i.e., extinction) engendered by the same capitalism that essentially was created to ensure a certain kind of white body relief from pain.
Yet, as Hansen’s research shows, the victims of opioids, both prescription and illegal, are not exclusively white, rural/suburban, or working/lower-middle class. Even in the mostly white borough of Staten Island, where she conducted her ethnographic research, the recovering opioid users included people of color. Thanks in part to scholars like Hansen, the media has diversified its coverage of the opioid crisis to assess its impact on people of color and the role of race in seeking treatment. Class diversity in coverage of the crisis has started to emerge, too: the New York Post reported in December on opioid use on Wall Street, illustrating how opioid addiction transcends blue-collar America.
This is all to say that, in 2018, it is clear that the opioid crisis is not the unique plight of white working-class Appalachians. Likewise, it is clear that whiteness is what earned the opioid epidemic a crisis designation from this deeply racist country. What is unclear is whether we would have ever arrived at these realizations if the opioid crisis didn’t erupt into the national discourse under the sign of the working-class body.
I don’t think we would have. At some level, the public interest in the opioid crisis derives from the same public’s nascent fascination with class—a strangely novel-feeling concept in a country where, until recently, almost all (white) people were thought to be vaguely “middle class.” To some people, the concept of an American working class remains suspicious, and the privilege of living in a land of “equal opportunity” and “free enterprise” suggests that one’s failure to prosper can only come from laziness.
Laziness, indolence, sloth are figured as the refusal to endure the pain required to escape poverty, according to this anti–working class narrative. In this sense, the opioid crisis offers proof to these class deniers that poverty, drug addiction, and fatal overdoses are the poor choices of weak people with a “poverty mindset,” and not the unfair symptoms of an inherently inequitable economic system. It affirms the delusion that upward mobility within capitalism, rather than a wholesale reimagining of our economic structure, is the solution to the opioid crisis.
The working class is thus pressured to become resilient to the pain of “tightening their belts” or of “living within their means”—to constrict, painfully, in the present to achieve painlessness in the future. What is important to remember is that this resilience is not now nor has it ever been one of “mind over matter,” a phrase which itself is a capitalist fiction that naturalizes the pain it causes. Rather, it is a resilience of the body. This is evident in several somatic metaphors like “grit,” “fit,” and “pedigree” that have become commonplace in corporate recruitment departments over the past few years.
Such departments control access to the world’s most lucrative, elite firms—what business and sociology scholar Lauren Rivera calls “elite professional service” firms. Though Rivera coined the term for finance, consulting, and law firms, this bracket could also include peers in tech and pharmaceuticals, all of whom compete in the “war for talent”—not the “war for labor.” In fact, this somatic vocabulary emerges at a time when bodily labor is declining. Additionally, it is used to police candidates for jobs for which physical fitness (the root of “culture fit”) and resistance to pain (grit) are not essential. Curious, then, that these metaphors abound.
Grit is perhaps the most curious: It is an intensely embodied word evoking clenched teeth that hold back screams of pain, but in this new somatic vocabulary of merit, it becomes a term for a “mindset.” Dominic Barton, global managing director at McKinsey, writes in the Wall Street Journal that the essential factor in success is this grit mindset, which subordinates the hardships a person encounters to the pursuit of a goal. But if grit is fundamentally a psychological force, why articulate it with such an embodied word so evocative of pain? Perhaps it’s because these somatic metaphors can more opaquely conceal the capriciousness of the economic elite’s social reproduction. Appropriating the incontestable self-evidence of the body, “metrics” like “grit” occult the arbitrary and exclusionary calculus of upward mobility.
In doing so, this new vocabulary of merit shows the extent to which the body in pain has been transposed from the domain of the economically oppressed to the domain of the economically oppressing.
This transposition happened, and this new economic elite emerged, at the same time as the opioid crisis approached its current magnitude. Unlike previous generations of elites, this generation signals itself primarily through the resilience of the body in pain, rather than exemption from it. Consider Sarah Jones’s critique of “raw water” in the New Republic, in which she argues that the wealthy are “gentrifying poverty.” Following Scarry, to gentrify poverty is to inhabit the intensely embodied condition of the powerless. It exchanges exemption from pain for immersion in it, as if to signal that “this body, with all its capacities” has been mastered, hacked, and optimized to withstand pain. The elite body seems to dilate time, becoming unaging, synthetically beautiful, intensely embodied through athletics and dieting.
By signaling their wealth through the resilience of their bodies to the pain inherent in the barely mediated world, the new elite construct a fiction of themselves in which their economic success is simultaneously a predestined fact of nature and a distinction earned by the sweat of their own brows. Accomplishing feats of demonstrable “grit” conceals the outsize role of privilege in capitalistic success. I worked for it, when uttered by a certain kind of body, often means you didn’t.
In contrast, in the narrative of the opioid crisis that emerged in the early days of our broader public interest in the issue, the (imagined) poor, working bodies of the opioid crisis were marked by their desperate disembodiment. Consider that an opioid literally interrupts the body, alienating its pain from the conscious mind, permitting the mind to work or play without being encumbered. The disembodied, atomized world Quinones writes about is the silent instigator of opioid addiction, first in forsaken Ohio Valley working-class towns and later in bourgeois suburbs. And despite the inaccuracy of the idea that opioid use is a means of “escaping the pain” of postindustrial, nosediving whiteness, this metaphor persists: The notion that opioids help despairing people temporarily evacuate a body whose whiteness was its only advantage partakes of the same disembodied symbolism.
The implication in this inaccurate yet shifting narrative of the opioid crisis is that the suffering of the working-class body is the consequence of its weakness and concomitant inability to “upskill” to economic security. By means of this double movement, what should be properly considered a crisis of capitalism is categorized as a crisis of class. Yet, at the same time as capitalism installs itself as the solution to a “class-based” opioid crisis, it is closing its ranks to those who are a not a “good fit,” or who do not have the “grit” to attain the “pedigree” needed for access to better jobs, neighborhoods, and networks. The only exceptions are the beautiful, biohacked, resilient bodies that have translated the scream of revolution into the shibboleth of a new economic elite.