and a stick, making the suicide look like a murder, and had ... the feet from a gallows, and thrown onto ... cide and throwing himself into a commu- nal well.
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Debt and Health “He that dies pays all debts.” –William Shakespeare, The Tempest1
n April 1732, Richard Smith, an impoverished London bookbinder, and his wife Bridget shot their two-yearold daughter, went to their rooms, and hanged themselves. In a suicide letter they explained, “It was an inveterate Hatred we conceiv’d against Poverty and Rags; Evils that through a Train of unlucky Accidents were become inevitable; we appeal to all that ever knew us whether we were either idle or extravagant, . . . and we state that we have taken as much trouble to earn our living as any of our neighbors; but our cares have not had the same success. . . .”2 In his scholarly treatise, The History of Suicide: Voluntary Death in Western Culture, Georges Minois observes that during the 18th century “suicide continued to occur where it always had, in huts and shops, and always for the same simple reason: suffering.”2 The cause of suffering was often poverty, as with the Richard Smiths of London. Typical also were the well-recorded suicides among the common people of Brittany. Three examples shall suffice. On February 13, 1720, Marquet, a 35-year-old peddler, “whose business was lagging,” stabbed himself several times with a knife, then threw himself into the Loire River at Nantes. On February 20, 1742, a peasant hanged himself at Kervignec. All his belongings had been seized the day before because of debt, leaving him penniless.
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On November 29, 1769, Françoise Royer, 15, drowned herself at Fourgères. For some time she had been abused, starved, and sent out to beg by her mother. The night Françoise killed herself, her mother had beaten her, called her a whore, and threw her out into the street.2 Patterns of suicide in 18th-century Europe had not changed since the Middle Ages. Women continued to commit suicide five times more frequently than men. The peak day and time for suicides was Tuesdays between 8 and 10 in the morning. The preferred methods were hanging for men and drowning or poison for women. There was only one new element—alcohol—which had become more freely available.2 Although villagers invariably expressed pity for the victims and family, suicide was regarded with horror by both church and state. The stigma was so great that the family and friends of the deceased tried anything to disguise the suicide, such as attributing it to murder or madness, the latter often being ascribed to the influence of the moon. The family would often restage the event or swear false testimony at inquest. When the body of Jean-François Battais, 21, was discovered hanging in their house, his parents—who had previously chased him out of their home—felt remorse. An investigation revealed that they had beaten the body with a crowbar and a stick, making the suicide look like a murder, and had rehanged the body in the woods.2 The courts routinely ignored the poverty or suffering that prompted suicides.
Someone was required to pay for the transgression. Often it was the cadaver. When Christophe Caud, a 55-year-old French peasant, hanged himself in the village of Les Escures on Sunday, May 9, 1773, surgeons promptly examined the body, opened it, and wrote a report. Later the same day, the corpse was taken to the prison at Vitré, where the forehead was marked with a stamp. It was embalmed the next day to preserve it until the hearing began two days later. The cadaver was present at the inquest, but was hardly recognizable because “it had fallen into putrefaction.” The fuss did not end until two years and four months later. The verdict of the court was that Caud was indeed guilty of hanging himself. His memory was to be extinguished and suppressed in perpetuity. The corpse was ordered to be dragged through the streets of Rennes, hanged by the feet from a gallows, and thrown onto the common refuse heap. His goods were confiscated and sold off, and the profits were distributed to his debtors after trial costs and a profit to His Majesty were deducted.2 Caud’s case was not unusual. In some areas of France, half the suicide inquests resulted in execution of the cadaver. The authorities often were not in a hurry to carry out justice. During the late 1800s, one corpse in Quimper was salted down and awaited execution for five years; 20 others awaited trial in Saint-Malo.2 From our vantage point, we marvel at the lack of sympathy for those who were driven by poverty, debt, and suffering to take their own lives. Why was society so
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intent on punishing the deceased, when they had already visited the ultimate punishment on themselves? What drove citizens to wreak vengeance on a rotting corpse and hound the memory of an individual, beyond the grave?
A MODERN SUICIDE SPREE Perhaps the most tragic evidence of a connection between debt and health is in India, where more than 25,000 peasant farmers have taken their lives since 1997.3 Kailash Jhade, 18, an impoverished cotton farmer in the state of Maharashtra, committed suicide by swallowing pesticide and throwing himself into a communal well. Jhade owed $200 to a moneylender. With the high interest rate, which is often 35% or more for Indian farmers, his debt ballooned to $500. This was five times his annual income. Jhade was concerned about how he would pay it back and how he would finance his upcoming wedding. Just prior to his suicide, he had received a bank notice and a threat to confiscate his land.4 Chandra Bhan, a relatively well-off farmer, owed $3,000, which he was unable to repay. While his family was taking an afternoon nap, he poured kerosene over himself and lit a match. Before he died two days later in hospital, he said demands from moneylenders had pushed him over the edge.4 Some Indian farm families have multiple suicides. The husband of 18-year-old Anjamma committed suicide by hanging himself from a tree on his arid farm after he fell ill and could not afford treatment. Two years later, Anjamma’s father-in-law ended his life after he could not repay a moneylender. She was left with a two-yearold son, a half acre of land, and a debt of $3,500, which she has no prospects of repaying.5 India’s small farmers have cultivated their lands for more than 5,000 years. But now, says physicist, environmental activist, and author Vandana Shiva, “The Indian peasantry, the largest body of surviving small farmers in the world, today faces a crisis of extinction.”3 Farm suicides began to escalate in India in 1997. Indebtedness was at the root of them, resulting from historic increases in the costs of growing crops on their tiny plots and falling prices for their commodities. According to Shiva and many other
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analysts, these developments resulted from policies of trade liberalization and corporate globalization. “In 1998,” she says, “the World Bank’s structural adjustment policies forced India to open up its seed sector to global corporations like Cargill, Monsanto, and Syngenta. . . . Farm-saved seeds were replaced by corporate seeds which needed fertilizers and pesticides and could not be saved. As seed saving is prevented by patents as well as by the engineering of seeds with non-renewable traits, seed has to bought for every planting season by poor peasants. A free resource available on farms became a commodity which farmers were forced to buy every year. This increases poverty and leads to indebtedness. As debts increase and become unpayable, farmers are compelled to sell kidneys or even commit suicide. . . . Seed saving gives farmers life. Seed monopolies rob farmers of life.”3,6 The “new-and-improved” seeds failed to perform as predicted by the corporations. When Monsanto introduced its Bt cotton in India in 2002, it predicted a yield of 1,500 kg per acre. Instead, the harvest was as low as 200 kg per acre. In the state of Bihar, when farm-saved corn seed was replaced by Monsanto’s hybrid variety, the entire crop failed, leading to increased poverty among farmers already desperately poor.3 A perfect storm of other factors combined to intensify debt and poverty among India’s peasant farmers. Drought played a role, as it has always done periodically throughout India’s long history. Another factor is the policy of price supports and farm subsidies to farmers in the European Union and the United States. Farm subsidies make it possible for subsidized farmers in Europe and America to sell their products on the international market at cheap prices. Unsubsidized small farmers in poor countries can’t compete. Shiva states, “High subsidies of $400 billion [in the United States] combined with forced removal of import restrictions is a ready-made recipe for farmer suicides [in India].” In the case of cotton, “This has brought . . . prices down artificially, allowing the U.S. to capture world markets that were earlier accessible to poor African countries such as Burkina Faso, Benin, Mali. . . . The rigged prices of globally traded agricultural commodities are stealing incomes from poor peasants. . . . This
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is a burden their poverty does not allow them to bear. Hence the epidemic of farmer suicides.”3 The response of state governments in India has sometimes been bizarre. As cotton has become increasingly unprofitable, the Maharashtra state government has begun encouraging farmers in the Vidarbha region to grow sugarcane instead. Sugarcane is a water-intensive crop, and Vidarbha is a drought-prone region lacking in irrigation.7 Shiva offers a scathing critique of governmental investigations of the suicide epidemic. “[O]fficial agencies in India are in deep denial of any links between free trade and farmers’ survival,” she states. One such report, from the state government of Karnataka, blamed psychological factors and alcoholism as the root cause, and recommended that farmers “be required to boost up their self respect . . . and selfreliance. . . .” Although the majority of suicide victims were identified as small and marginal farmers, 90% of whom had high levels of indebtedness, debt was not identified as a major factor leading to suicide. Amazingly, the report included a recommendation that the government should actually prosecute persons who “mislead” the public and the government by attributing farmers’ suicides to crop failure or indebtedness.3 There is nothing new here. For centuries, the poor and the indebted have been blamed for their plight. If only they were more industrious, had stronger character, higher self-esteem and self-respect, greater dignity, more education, and keener intelligence, they would be less of an embarrassment to society and less inclined to kill themselves. There are hopeful signs. In 2003, a sensible study emerged on farmers’ suicides in the Indian states of Andhra Pradesh and Karnataka. It concluded, “Suicide of farmers on such phenomenal scale cannot be dismissed as personal and psychological problems or mass hysteria. . . . This debt trap is tightening. . . . Government policies . . . under the WTO [World Trade Organization] regime have created havoc and exposed the farmers to the volatility of international markets and prices. This situation has helped in strengthening . . . moneylenders. . . . [M]ono-cropping has damaged the fertility of the soil and created ecological imbalances. All these fac-
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tors along with the usual social pressure have made many small and marginal farmers to throw up their hands. This process is intensifying during the last decade under the regime of liberalization and globalization.”8 The 2003 World Trade Organization meeting in Cancun, Mexico, which was aimed at liberalizing trade between rich and poor nations, collapsed when a coalition of poor countries arose in defiance. They accused rich nations of hypocrisy for urging poor countries to open their markets but not being prepared to open their own or to reduce subsidies to their own farmers. Predictably, both sides blamed each other for the breakdown of the talks.9 India’s peasant farmers are emblematic of the plight of small farmers in thirdworld countries worldwide. They are largely out of sight and have no voice. It is easy to ignore them and to focus on the glittering growth of other sectors of the economy, epitomized by “India Shining,” the slogan adopted by one of India’s political parties in 2003 to reflect the overall feeling of economic optimism due mainly to the high-tech boom in information technology. The boom is real and has brought unprecedented economic opportunity for many. Yet, while this is happening, India’s farm peasantry is being decimated. Shiva, speaking on behalf of India’s small farmers, has raised a voice for poor farmers worldwide. “It is necessary to stop this war against small farmers,” she insists. “It is necessary to re-write the rules of trade in agriculture. It is necessary to change our paradigms of food production. Feeding humanity should not depend on the extinction of farmers and extinction of species. Another agriculture is possible and necessary—an agriculture that protects farmers’ livelihoods, the earth and its biodiversity and public health.”3 Debt can oppress, smother, crush, and kill. It can creep into every niche of a person’s life. Even the pesticide swallowed by 18-year-old peasant farmer Kailash Jhade was bought on credit—a debt now owed by his family. The Shakespearian epigraph is wrong: He that dies does not pay all debts.
DEBT AND DISGRACE The sudden convergence of debt and social shame can be fatal. An iconic example
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is Ken Lay, the late founder, chairman, and CEO of Enron Corporation. Following his conviction in May 2006 of fraud and conspiracy in one of the most sensational debacles in American corporate history, Lay died two months later at age 64. He was scheduled to be sentenced in October to what most believed would be a prison term for the rest of his life. Lay knew poverty. He was the son of a poor Baptist minister in Missouri who ran a general store and sold stoves before becoming a preacher. Lay spent his childhood helping his family make ends meet by delivering newspapers and mowing lawns. He earned a bachelor’s degree in economics at the University of Missouri, served time in the Navy at the Pentagon, joined the oil and gas industry in Texas, and eventually led Enron’s rise to number seven on the Fortune 500 list in 2000. Enron’s wealth seemed limitless; Lay claimed $101 billion in revenues in 2000. He also soared in his personal connections and influence. He was a close friend of President George H. W. Bush and was one of President George W. Bush’s largest patrons. Following Enron’s crash, Lay found himself drowning in a personal debt of $100 million. Even so, he continued to spend lavishly, such as a $200,000 yacht for wife Linda’s 2001 birthday party. It was “difficult to turn off that lifestyle like a spigot,” he told jurors. The courts turned the spigot off for him. In December 2001—when more than $60 billion in Enron’s market value evaporated overnight—thousands of jobs and employee pension plans were lost. One month later, Lay was pushed out of the company. Five years later, his disgrace complete, Lay died of a heart attack while vacationing in Aspen, Colorado. He had shown no signs of ill health, even during his intense four-month trial. The coroner ruled that the cause of death was heart disease. Lay insisted to the end that he was no criminal, and his close friends defended him even after he became a felon. “I guess when you’re facing the rest of your life in jail and in your heart you know you’re an innocent man, I guess it’s too much to bear,” one of his close friends said.10 “Kenny Boy”—President George W. Bush’s nickname for him— got off light. In spite of the fact that his misdeeds blighted the lives of thousands, his cadaver was not
tried, tortured, defaced, and executed like the aforementioned suicidal debtors. His corpse was not dragged through the streets of Houston and thrown on a refuse heap. No attempts were made to eradicate his memory in perpetuity and to shame his descendants. In fact, the opposite happened. On October 17, 2006, a federal judge in Houston erased his fraud and conspiracy conviction and removed 10 criminal charges from the record. The judge’s decision conformed to a long-held doctrine called abatement, which allows a conviction to be annulled if defendants die before they are able to exercise their right to appeal. “It’s as if the indictment never occurred,” exulted the lawyer for the Lay family. This development thwarted the efforts of former employees to recoup the money they lost when their pension plans were devastated.11
OVER THE LIMIT Half of all Americans say they worry often about their debt, and many of them admit that they worry “most of the time.”12 What’s the effect of all this fretting? The most influential study linking debt and health appeared in 2000 in the journal Social Science and Medicine. The study, “Over the Limit: The Association Among Health, Race and Debt,” was conducted by sociologist Patricia Drentea, of the University of Alabama-Birmingham, and behavioral scientist Paul J. Lavrakas, of The Ohio State University. Drentea and Lavrakas used data from a representative sample of more than 900 adults in Ohio. They found that both credit card debt and stress regarding debt are associated statistically with poorer health. Part of this association, they found, can be explained by unhealthy behaviors and risks that indebted people often engage in, such as excessive drinking, smoking, or being overweight.13 Drentea and Lavrakas found that Americans are aspiring to have more, even though they are not earning proportionally more. Although Americans used to match their lifestyle with others in their local reference group, such as their neighbors, they now choose reference groups of people whose incomes are three, four, or five times their own salary. This relentless ratcheting up of standards has caused many to incur massive debt and stress.14 In 2005, the average American household had 10 credit cards, for which the
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average interest rate was 19%. To pay off each card at the monthly minimum payment rate would take decades. To compound the problem, credit card companies have almost saturated the market and are seeking more ways to make money, such as upping interest rates even when cardholders are not in arrears in their payments, or by making cancelled accounts payable in full. Beyond that, one’s credit card record influences other areas of life— how much one pays for a home mortgage and, in some instances, whether one gets a job or insurance.15,16
AGING EFFECTS Manual labor accompanies debt and poverty. Evidence suggests that people who do manual labor age faster than nonmanual laborers of the same age, even when factors such as smoking, drinking, and obesity are taken into account.17 Cell aging in manual and nonmanual workers was estimated by researcher Tim Spector and his colleagues at St. Thomas Hospital in London by measuring the lengths of telomeres, the repeating DNA patterns that cap and protect the ends of chromosomes. Each time a cell divides, the telomeres grow shorter, so the more cell division they undergo, the shorter they become and the more stress they are likely to have endured. Since the telomeres in manual workers were on average 140 DNA base pairs shorter than in nonmanual workers the same age, and since 20 base pairs of telomere DNA are lost on average annually, this made the cells from manual workers about seven years older. In some female twins on opposite ends of the socioeconomic scale, the difference was as high as nine years. Spector believes people on the manualwork end of society may undergo cellular aging faster because of greater psychological stress. He states, “The greater psychological stress of being in a low social class, with more people above you in the food chain and less control over your life, is the unseen hand that might mean more stress at the cellular level.”
DEBT AS A MONEY REMINDER To be mired in debt is to be continually reminded of money—and reminders of money can profoundly alter one’s behavior, according to “The Psychological Con-
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sequences of Money,” a paper published in Science in November 2006 by Kathleen D. Vohs, of the University of Minnesota’s Carlson School of Management, and her colleagues.18 These researchers asked 50 undergraduate students to participate in a variety of tasks, during which half of them were given subtle reminders of money—a stack of Monopoly money within their peripheral view, or a picture of money floating across a screen saver. The students were not aware that the money cues were even a part of the experiments. In one variation, the scientists gave all the students a challenging problem to solve and let them know that the experimenter was available to provide help if needed. The “money subjects” persisted much longer in the task before asking for assistance. During another task, a supposed student walked into the room and asked the subjects for help in coding data sheets. The money group volunteered an average of about 25 minutes of their time, whereas the control subjects were more generous, giving about 43 minutes of their time. In another test involving a staged accident, a person walked into the room, where all the subjects were filling out a questionnaire, and spilled a bunch of pencils. The money participants picked up far fewer pencils than did the controls, who again proved much more generous with their assistance. In another situation, all the subjects were required to conduct a one-on-one interview with a supposed new participant in the studies. The subjects were asked to set up two chairs for the interview while the experimenter left the room to retrieve the new individual. The money group distanced themselves from the new individual by setting up the chairs farther apart than did the control subjects. In experiment after experiment, the money-reminded subjects preferred to work alone and play alone. They were less inclined to assist others and to ask for help. The mere thought of money, even fake cash, appeared to increase selfishness and form a barrier to others. “Cooperation really goes down the drain when money is an issue,” says Vohs. “In a lot of businesses, we train our MBA’s to work in teams. If the team has a sales goal, then to the extent that money is re-
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ally a big topic to that team, you’re likely to see that cooperation is going to be reduced.” Debt and financial stress are major factors in divorce—thus the folk saying, “When poverty comes in at the door, love flies out the window.” (You can view a captivating painting that illustrates this aphorism by the celebrated Victorian artist George Frederic Watts [1817-1904] at http://www.amazon.com/When-PovertyComes-in-at/dp/B000BV8CXK.) The money-reminder experiments may shed light on why this happens. Debt is a continual cue of the money that couples don’t have, and in this way it functions as a powerful money reminder. Debt, therefore, as a surrogate of money, may promote the selfishness, lack of cooperation, and isolation seen in the above studies, all of which are qualities that failed marriages are made of.19
STUDENT DEBT In January 2006, 20-year-old Geraint Banks-Wilkinson hanged himself in his room at Swansea University in Wales, where he was a superior second-year student in computer design. He had won the British Environmental Crest Award, and his A-level work was selected to be shown around the country. According to press reports, he had no history of depression or other mental problems and was happy and upbeat. His sole worry seemed to be money. His mother explained, “We earned a little too much to get financial help to put Geraint through college, but not enough to be able to help him ourselves. . . .” Geraint juggled his studies with a five-night-a-week job at the local McDonald’s. The young man had a £1,000 overdraft at the local bank, which had begun to pressure him for payment through phone calls and letters to both him and his parents. The day prior to his suicide, he had walked away in tears from a meeting with a bank manager.20,21 Debt has become a particular burden for medical students. According to the Association of American Medical Colleges (AAMC), over 80% of medical school graduates carry educational debt. The median debt is $115,000, and one fourth of indebted students carry a principle over $150,000. These figures do not include credit card debt, which is often thousands of dollars. Medical student debt is fueled
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by massive increases in tuition, which have been driven by government cutbacks in education and healthcare appropriations. Dental students fare even worse. According the American Dental Association, over 91% of dental students graduate with debt averaging around $142,000.22 Nursing students are also burdened with debt. National data are difficult to come by, but in one representative nursing program at the University of Texas Health Science Center at Houston, the average debt for nurses at graduation is around $29,000.23 Many people are not sympathetic to the debt acquired by medical and dental students, because they assume that the students can pay off their debts quickly after they enter private practice. This is true in some cases, but not for primary care physicians such as family doctors, internists, and pediatricians, or physicians offering care for underserved, low-income patients. Data show that these physicians may face up to 30 years of repayment and end up paying three times as much as they borrowed. As a result, 2002 was the sixth year in a row that the number of students entering family medicine had fallen. This trend threatens the quality of healthcare provided to large segments of society. The AAMC survey found that the costs of attending medical school were the main reason why qualified students of color chose not to apply. Increasing costs therefore concentrate medical education among the wealthiest; over 60% of medical students come from families with incomes in the top 20% income bracket; only 3% come from families in the lowest 20%. In addition to the debt they accumulate during medical school, medical students from poor backgrounds pay another price. Even though they may achieve high socioeconomic status after entering professional practice, their risk of early coronary heart disease— before the age of 50 —is more than double that of medical students who come from wealthier families. This finding, published in Archives of Internal Medicine in November 2006, comes from the Johns Hopkins Precursors Study, which enrolled graduates of the university’s medical school between 1948 and 1964.24 The increased coronary risk for students from poor backgrounds was not
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mediated by other risk factors such as smoking, high cholesterol, or elevated blood pressure. Low socioeconomic status during childhood seemed a risk factor all its own. Why is it important that poor and minority students enter medicine? The reason is that they make a unique contribution to healthcare. According to Healthy People 2010, published by the Department of Health and Human Services, minority physicians are more likely to serve in physician-shortage areas and to research diseases that afflict mostly minorities when compared with their privileged colleagues. Thus, helping qualified minority, low-income students enter medical school without acquiring a large burden of debt can be seen as an investment in the health of the nation and as a return on investment, not as a giveaway to wealthy doctors, as it is often portrayed.25 It isn’t just minorities in urban areas or America’s rural population who become underserved when our medical schools don’t produce enough primary care physicians; in some areas of the country, the affluent are being underserved as well. There are now so few primary care physicians in Boston’s top-tier teaching hospitals that nearly all of these doctors have closed their practices because they are overwhelmed.26 The family physicians and internists simply cannot keep up; their practices are typically 150% the size they should be. Unless solutions are found for the oppressive debt accumulated by medical students entering primary care, this situation will spread as students continue to choose more lucrative specialty areas. Two excellent guides for managing medical school debt are available on the Internet for free: (1) The American Medical Student Association Guide27 and (2) Debt Management Guide, from the American Academy of Family Physicians’ Division of Medical Education.28 How might we do better? Leaders in the field of medical education have suggested a national service plan to reduce medical school debt and to improve healthcare delivery to underserved regions simultaneously. One proposal is from Robert J. Petersdorf, MD, a respected leader in the field of infectious disease and former president of the AAMC. Dr. Petersdorf says, “I would. .. ask all young physicians to give
two years of service to society, in return for which tuitions would be virtually eliminated and the medical schools would receive major subsidies from government in lieu of tuition payments by students. .. To some, that plan may seem too expensive. But it is hardly that. In 1990-1, tuitions and fees totaled $242 million for state medical schools and $464 million for private schools. In a country that spends nearly a trillion dollars annually on health care, this amount is by no means prohibitive.”29,30 A similar national health service proposal for medical students has been advanced by internationally recognized cancer surgeon Michael M.E. Johns, MD, executive vice president for health affairs of Emory University. He observed in 1993, The financing of this plan is workable. The cost of paying 16,000 physicians per year in an expanded national health service would amount to only about 0.1% of the $1 trillion that economists predict will be the annual cost of healthcare within the next two to three years (assuming an average salary of $40,000 per year).31 These suggestions are a win/win all around. But the goal of the current administration is comprehensive privatization of student loan lending. Even Pell Grants for low-income college students— one of the most valuable forms of aid because they don’t have to be repaid—were cut in 2005 for the first time in six years, along with a reduction in the number of students considered eligible for them. As government aid has spiraled downward, private lending has soared. The predictable result is towering debt.32
WORRYING ABOUT IT In 2006, the University of Minnesota examined the impact of credit card debt on students’ lives. Students carrying high debt were more likely to be diagnosed with depression, tended to have higher rates of risk drinking, and high smoking rates. As their credit card debt went up, their grade point average tended to go down.33 In 2003, the British Association for Counselling and Psychotherapy sounded the alarm about “the twin miseries of debt and poverty” that many British college and university students complain about. At least 10% of students who sought counseling were suicidal or had attempted to kill themselves.34
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Similar findings exist among UK medical students. In 2004, the University of Aberdeen examined the connections between medical student debt, academic performance, and stress. The median medical student debt was £7,300 (roughly $13,070), with higher debt found among students from lower socioeconomic backgrounds and postgraduate students. There was no overall correlation between debt and class ranking. However, the 38% of students who said that worrying about money affected their studies did indeed have higher debt and ranked lower in their classes. The researchers concluded, “Students’ perceptions of their own levels of debt rather than level of debt per se relates to performance. Students who worry about money have higher debts and perform less well than their peers in degree examinations.”35
ECO-DEBT Gordon Gekko, the predatory entrepreneur who is actor Michael Douglas’ screen character in the 1987 movie Wall Street, famously boasts, “[G]reed. . .is good. Greed is right, greed works. Greed clarifies, cuts through, and captures the essence of the evolutionary spirit. Greed, in all of its forms; greed for life, for money, for love, knowledge has marked the upward surge of mankind.”36 Gekko’s bravado makes for colorful moviemaking, but the hellbent consumption it implies would be suicidal if emulated by billions of individuals worldwide. Sustainability is based on the concept that when resources are consumed faster than they are produced, the resource is depleted and eventually used up. When we use more than nature can supply, we move into what has been called ecological overshoot or ecological debt.37 The Global Footprint Network is an ecological think tank, based in Oakland, California, that has been doing “eco-audits” since 1961. According to their assessment, the first year the human family exceeded its “eco-budget”—its available natural resources—was 1987. We overshot our available resources that year on December 17. Since then, we have exceeded them earlier each year. In 2006, we went into the red on October 9. This means that it now takes the earth about 15 months to generate what we use in 12 months. “Debt is good; the more you owe, the more you own,” I once heard a confident
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young banker announce during cocktail conversation. He was correct within limits; debt can help us finance a college education or buy a home. But as we are beginning to realize, sustained ecological debt can be a fatal gift to future generations. We once believed that ecological debt applied only to nonrenewable resources such as petroleum and minerals. But our consumption has now put renewable resources at risk as well— collapsing fisheries, species extinction, deforestation, desertification, and the depletion of aquifers and groundwater in much of the world.37
SHOPPING AND DEBT Is uncontrolled shopping debt a personal failing, or could it reflect bad brain chemistry? According to a paper published in the October 2006 American Journal of Psychiatry, there are an estimated 10 million “shopaholics” in the United States who can’t resist the temptation of credit cards.38 Lorrin Koran, a psychiatrist at Stanford University, and his colleagues found that these individuals often end up in personal bankruptcy. They suffer, they suggest, from a biologically rooted disease similar to alcoholism. The American Psychiatric Association is considering listing compulsive buying as an official disorder in The Diagnostic and Statistical Manual, the bible of psychiatrists. Others say, “Not so fast.” This view, they maintain, is as an attempt by psychiatrists to turn a wayward human behavior into a disease. The problem, they say, isn’t in the brain, but in the culture—the influence of easy credit, 24-hour shopping channels, on-line click-and-buy, and advertising on one’s impulse to buy something, anything. “With this latest diseasemongering scheme, drug companies and psychiatrists will try to convince anyone who has ever made an impulse purchase that they are suffering from a brain chemistry disorder requiring chemical treatment,” says Mike Adams, a consumer health advocate.39 “We have constructed an elaborate Skinner Box around ourselves,” says New Scientist on-line journalist Sean O’Neill, “where instant reward— be it drugs, gambling, the latest Jimmy Choos—is never more than a click or a flash-of-plastic away.”40
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WHO’S TO BLAME? This biology-versus-culture debate over the origin of debt borders on silliness. There are always a host of reasons why people do anything: physical, psychological, cultural, spiritual, and—in the case of shopping— there are sometimes even political and patriotic reasons (President Bush’s admonition following 9-11 that Americans “go shopping”41). These motivations vary from person to person, and they change across a person’s lifetime. Yet, the psychological and cultural influences on debt can be misinterpreted. There is a pernicious tendency these days to ignore that we are complex, composite creatures and to take a one-sided behavioral, social-Darwinian, blame-the-victim approach to debt. According to this view, people bring debt on themselves. They don’t know how to budget and won’t learn. They spend unwisely on things they cannot afford and don’t need. The indebted class willfully engages in poor health habits—smoking, excessive drinking, and obesity. If their health suffers as a consequence—well, they reap what they sow. Our responsibility as a society may be to find ways of treating their heart attacks, strokes, and diabetes, but not to provide them better lifestyles by shifting our money to their pockets through taxes. This stereotypical view of debt and debtors is generally wide of the mark. “Why are Americans so deeply in debt?” asks Washington Post journalist Kirstin Downey in May 2006. “It’s not because they are using credit cards to buy plasma TVs and premium coffee drinks at Starbucks. The real culprit, according to a new analysis [from the Center for American Progress], are the rising costs of housing, health care and education.”42 “Very little [household debt] can be explained by frivolous spending,” says senior economist Christian E. Weller, author of the 2006 report. Elizabeth Warren, a law professor at Harvard University and an expert in the causes of personal bankruptcy, agrees. Warren emphasizes the precarious economic status of most citizens, saying, “The average American family is walking a high wire and hoping there is no wind.”42
ANOTHER WAY For one shining moment in our history, we Americans looked on those in need with genuine compassion and did some-
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thing truly magnificent about it. Edward Humes, the Pulitzer Prize–winning journalist and author of Over Here: How the GI Bill Transformed the American Dream,43 describes how we did it:44 Imagine telling the members of an entire generation they could receive a free college education at any school that accepted them—Cal State, Harvard, the Sorbonne— courtesy of Uncle Sam. Throw in a monthly stipend and textbooks. After graduation, there are government-backed home loans, no money down— buy a house cheaper than renting. Throw in subsidized business loans, farm loans, job training, medical care and up to a year’s worth of unemployment checks. What insane politician would ever propose such a costly boondoggle, such outright social engineering? It would be the most enormous, farreaching, life-changing program in the history of the world. And so it was. We know it today as the original GI Bill. Today’s unthinkable was yesterday’s matter of course. FDR and Congress adopted the humbly named Servicemen’s Readjustment Act of 1944 with bipartisan fervor. The stated goal was simple: to help 16 million veterans and their families resume their lives after the scourge of World War II. But this investment in the nation’s future powered far more than a return to the status quo. It transformed the nation and the very nature of the American dream, opening up colleges, raising suburbs out of bean fields, creating a new middle class and providing the medical, engineering and scientific prowess that conquered long-feared diseases, ushered in the Information Age and helped win the Cold War. There was never anything like the GI Bill. There’s nothing like it on the horizon. And that’s a problem. . . .Three presidents—George H. W. Bush, Gerald Ford and Jimmy Carter— dozens of congressmen, 14 Nobel Prize winners, giants of literature, Broadway and Hollywood and hundreds of thousands of teachers, doctors, nurses and businessmen got their starts with the help of the GI Bill. “Biggest piece of legislation the country ever passed,” says former Sen. Bob Dole, a war hero and GI Bill beneficiary. “Maybe we need something like it again.”
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Which begs the question: What happened to the Washington that created something so magnificent? Why do we no longer expect— or demand— greatness from Americans’ joint enterprise, our government? . . .The original GI Bill was powerful because it touched a whole generation, and the ripple effects washed over the entire nation, not just veterans. . . .Would such a program be expensive? Absolutely—about what we’ve spent so far on the war in Iraq. But spending hundreds of billions at home to generate opportunities for future doctors, scientists, teachers, leaders and productive, healthy citizens would be a far sounder investment, with a proven rate of return. Where would you rather spend your tax dollars? In an era in which college is a skyrocketing financial burden for many families, when home ownership is less affordable than ever, when the nation is losing its competitive edge in advanced degrees and when the American dream so generously nurtured after World War II is under siege, it is time to expect greatness from our government once again. Our children deserve it. Aside from its humanitarian value, the GI Bill was a phenomenally successful financial investment for the United States. For every dollar invested in the higher education of GIs, the government and economy received nearly seven dollars in return.45 It is easy to dismiss Humes’ suggestions as the overheated enthusiasm of an unreconstructed socialist and to retreat behind the ramparts of rugged individualism where it is every man for himself. This go-it-alone attitude has fostered a creeping miserliness in our society toward middleand low-income Americans. This is expressed as opposition—to affordable healthcare, Pell Grants for struggling college kids, programs of national service for medical students, a robust GI Bill for returning veterans, a livable minimum wage. Federal objection to measures such as these on the basis of frugality is hypocritical, because a government that in the last six years has accumulated the largest fiscal debt in our nation’s history has no right to preach the virtues of financial responsibility to hardworking Americans who are trying to stay afloat.
Debt is too important to be left to economists, financial planners, and politicians. It is time for healthcare professionals to join the debt dialogue. Because of the health consequences of debt and poverty, we are in a privileged position to speak sensibly about these issues and to elevate debt above the bloviation and blogorrhea that frequently smother it. We must begin to view debt as a health factor as real as blood pressure, cholesterol, and body weight. We must recognize not just the economic meaning of debt, but its biological and psychological dimensions as well. No other approach is consistent with science. No other view is humane. –Larry Dossey, MD Executive Editor
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