Clay Marsh, MD

A while back, I moved from my beautiful house and family in Columbus, Ohio, back home to West Virginia. My friends poked gentle fun at me: the Mountain State suffers a bad rap for poor health, and for the last six years in a row West Virginia came in dead last in a national self-reported survey of well-being. The state is also ravaged by an opioid addiction epidemic, far outpacing any other in overdose deaths. In 2015, for example, one West Virginian was dying of drugs every 12 hours, a staggering number for such a small state.

So why did I move? Because West Virginia is a bright opportunity for me and many others to create meaningful change in health, including impacting the opioid epidemic. We can and will start something here that will echo across the country.

My belief is that the same issues leading to the opioid epidemic are what drives the tremendous cost and disease burden of our country at large. The opioid epidemic is merely a symptom of a much larger crisis, one we as Americans must learn to solve: the crisis of isolation, despair and hopelessness.

To begin to understand it, it helps to know a little bit about Dunbar’s Number. Robin Dunbar, an anthropologist, observed that the maximum number of people you can know well is 150. From an evolutionary standpoint, this makes perfect sense. Communities that are big enough to support their members yet small enough to be able to share food and other vital resources traditionally numbered anywhere from 100 to 200 members. And communities are crucial to our wellbeing: irrespective of genus, the most psychologically damaging experience any young creature, human or animal, can have is being separated from the group and abandoned to fend for itself.

And yet, increasingly, more and more of us are, in a way, abandoned and afraid. Large and sheltering communities, the kind Dunbar imagined, have become a rarity, as the structures that once supported them—religious institutions, civic institutions, strong families—were weakened by a host of economic and sociological conditions. Social media and other technologies compound the problem by giving us an inflated sense of social connection, suggesting that we aren’t really isolated with so many friends or followers online.

Moreover, much of the messaging we receive makes us feel vulnerable, envious or afraid, further impacting our sense of wellbeing. But the real ties that keep us safe, the ties of family and community and society, are increasingly looser and looser, which is why more and more Americans turn to drugs and other forms of escape. Isolation and despair, not opioids, is our true epidemic.

There’s much science to support this assertion. Anne Case and Angus Deaton, who won the Nobel prize for economics, found that white middle-aged people that are 50 to 55 years old and have a high school education or less are suffering a death rate that rivals the peak of the AIDS epidemic. In contrast, almost every other socioeconomic group experienced enhanced life-spans over the same time period.

They are dying of overdose, suicide and chronic liver disease, all hallmarks of addiction. Recently, these findings have been augmented to show that the underlying reason for this issue is despair and hopelessness.

Thus, it appears that how we see the world and our perception of our community status is critical for our health and our resilience to drugs and to disease.

Which, truly, is an insight that should bring us much hope. A famous New Yorker article written by Atul Gawande, The Hot Spotters, (Jan. 24, 2011) recounted the story of Dr. Jeffrey Brenner, an emergency room physician in Camden, N.J. He studied his hospital’s emergency room visits and was surprised to find that a very few patients were responsible for a majority of the hospital admissions. One patient had 324 hospital admissions. He was a morbidly obese man with substance abuse problems, and a lot of associated medical issues. It didn’t take a brilliant physician to see what was going on: at well over 500 pounds, the man had trouble moving around, and every time he fell, his first call was for an ambulance. The medical attention also provided him with some welcome social interaction, as he had no friends and was largely abandoned by his family. His primary problems, it turned out, were hopelessness and isolation.

Determined to change all that, Dr. Brenner stepped in and did what physicians, sadly, infrequently have the time or the training to do these days—he listened to the patient. Slowly gaining the man’s trust, Dr. Brenner connected him with medical and social services, but most importantly cared about this man. Through this relationship of trust and connection, this man lost weight, exercised, overcame his addiction, and, most importantly, reconnected with his loved ones. The hospital visits stopped soon thereafter. Dr. Brenner was merely living out the old adage that argued that to care for a patient, you first must care about a patient.

The answer to our opioid epidemic, then, is the same as the answer to our increasing health care spending and reduced health and lifespan of our population. It’s a very human and perceptional one. It is predicated on realizing that the problem is connected to our hard-wiring as humans to each other and to our survival.

We need strong connections to others. We need a strong purpose. We need a mindset of gratitude. We need to realize that abundance and prosperity is in mindset, not in bank account. We need communities of love and safety. Building them will involve not only scientists and law enforcement officials and policy makers but every single one of us.

That’s what I moved to West Virginia to help realize, and that’s what each of us must do in the places we call home.


This piece is part of a special brain health initiative curated by Dr. Ali Rezai, Director of Ohio State University Wexner Medical Center’s Stanley D. and Joan H. Ross Center for Brain Health and Performance. For more, visit The Huffington Post’s Brain Health page.


This article was originally published in the Huffington Post on 06/16/2017.