Dee Knapp visiting the grave site of four of her five children, near her home in Oklahoma .Credit...Lynsey Addario/Getty Images

By Nicholas Kristof and Sheryl WuDunn Mr. Kristof and Ms. WuDunn are the authors of “Tightrope: Americans Reaching for Hope,” from which this essay is adapted. Jan. 9, 2020

YAMHILL, Ore. — Chaos reigned daily on the No. 6 school bus, with working-class boys and girls flirting and gossiping and dreaming, brimming with mischief, bravado and optimism. Nick rode it every day in the 1970s with neighbors here in rural Oregon, neighbors like Farlan, Zealan, Rogena, Nathan and Keylan Knapp.

They were bright, rambunctious, upwardly mobile youngsters whose father had a good job installing pipes. The Knapps were thrilled to have just bought their own home, and everyone oohed and aahed when Farlan received a Ford Mustang for his 16th birthday. Yet today about one-quarter of the children on that No. 6 bus are dead, mostly from drugs, suicide, alcohol or reckless accidents. Of the five Knapp kids who had once been so cheery, Farlan died of liver failure from drink and drugs, Zealan burned to death in a house fire while passed out drunk, Rogena died from hepatitis linked to drug use and Nathan blew himself up cooking meth. Keylan survived partly because he spent 13 years in a state penitentiary.

Among other kids on the bus, Mike died from suicide, Steve from the aftermath of a motorcycle accident, Cindy from depression and a heart attack, Jeff from a daredevil car crash, Billy from diabetes in prison, Kevin from obesity-related ailments, Tim from a construction accident, Sue from undetermined causes. And then there’s Chris, who is presumed dead after years of alcoholism and homelessness. At least one more is in prison, and another is homeless.

We Americans are locked in political combat and focused on President Trump, but there is a cancer gnawing at the nation that predates Trump and is larger than him. Suicides are at their highest rate since World War II; one child in seven is living with a parent suffering from substance abuse; a baby is born every 15 minutes after prenatal exposure to opioids; America is slipping as a great power.

We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation. Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.”

“The meaningfulness of the working-class life seems to have evaporated,” Angus Deaton, the Nobel Prize-winning economist, told us. “The economy just seems to have stopped delivering for these people.” Deaton and the economist Anne Case, who is also his wife, coined the term “deaths of despair” to describe the surge of mortality from alcohol, drugs and suicide.

The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies. The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them, but under him the number of children without health insurance has risen by more than 400,000.

The stock market is near record highs, but working-class Americans (often defined as those without college degrees) continue to struggle. If you’re only a high school graduate, or worse, a dropout, work no longer pays. If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25.

We were foreign correspondents together for many years, periodically covering humanitarian crises in distant countries. Then we would return to the Kristof family farm in Yamhill and see a humanitarian crisis unfolding in a community we loved — and a similar unraveling was happening in towns across the country. This was not one town’s problem, but a crisis in the American system.

Photo; The center of Yamhill today.Credit... Lynsey Addario/Getty Images

“I’m a capitalist, and even I think capitalism is broken,” says Ray Dalio, the founder of Bridgewater, the world’s largest hedge fund.

Even in this presidential campaign, the unraveling of working-class communities receives little attention. There is talk about the middle class, but very little about the working class; we discuss college access but not the one in seven children who don’t graduate from high school. America is like a boat that is half-capsized, but those partying above water seem oblivious.

“We have to stop being obsessed over impeachment and start actually digging in and solving the problems that got Donald Trump elected in the first place,” Andrew Yang argued in the last Democratic presidential debate. Whatever you think of Yang as a candidate, on this he is dead right: We have to treat America’s cancer.

In some ways the situation is worsening, because families have imploded in under the pressure of drug and alcohol abuse, and children are growing up in desperate circumstances. One of our dearest friends in Yamhill, Clayton Green, a brilliant mechanic who was three years behind Nick in school, died last January, leaving five grandchildren — and all have been removed from their parents by the state for their protection. A local school official sighs that some children are “feral.”

Clayton Green in his shop in Yamhill in 2018.Credit... Lynsey Addario/Getty Images

Farlan, the oldest of the Knapp children, was in Nick’s grade. A talented woodworker, he dreamed of opening a business called “Farlan’s Far Out Fantastic Freaky Furniture.” But Farlan ended up dropping out of school after the ninth grade. Although he never took high school chemistry, Farlan became a first-rate chemist: He was one of the first people in the Yamhill area to cook meth. For a time he was a successful entrepreneur known for his high quality merchandise. “This is what I was made for,” he once announced with quiet pride. But he abused his own drugs and by his 40s was gaunt and frail.

In some ways, he was a great dad, for he loved his two daughters, Amber and Andrea, and they idolized him. But theirs was not an optimal upbringing: In one of Amber’s baby pictures, there’s a plate of cocaine in the background.

Farlan died of liver failure in 2009, just after his 51st birthday, and his death devastated both daughters. Andrea, who was smart, talented, gorgeous and entrepreneurial, ran her own real estate business but accelerated her drinking after her dad died. “She drank herself to death,” her uncle Keylan told us. She was buried in 2013 at the age of 29.

In the 1970s and ’80s it was common to hear derogatory suggestions that the forces ripping apart African-American communities were rooted in “black culture.” The idea was that “deadbeat dads,” self-destructive drug abuse and family breakdown were the fundamental causes, and that all people needed to do was show “personal responsibility.”

A Harvard sociologist, William Julius Wilson, countered that the true underlying problem was lost jobs, and he turned out to be right. When good jobs left white towns like Yamhill a couple of decades later because of globalization and automation, the same pathologies unfolded there. Men in particular felt the loss not only of income but also of dignity that accompanied a good job. Lonely and troubled, they self-medicated with alcohol or drugs, and they accumulated criminal records that left them less employable and less marriageable. Family structure collapsed.

It would be easy but too simplistic to blame just automation and lost jobs: The problems are also rooted in disastrous policy choices over 50 years. The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did. As other countries embraced universal health care, we did not; several counties in the United States have life expectancies shorter than those in Cambodia or Bangladesh.

One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness. A low- end worker may not have a high school diploma and is often barely literate or numerate while also struggling with a dependency; more than seven million Americans also have suspended driver’s licenses for failing to pay child support or court-related debt, meaning that they may not reliably show up at work.

Americans also bought into a misconceived “personal responsibility” narrative that blamed people for being poor. It’s true, of course, that personal responsibility matters: People we spoke to often acknowledged engaging in self-destructive behaviors. But when you can predict wretched outcomes based on the ZIP code where a child is born, the problem is not bad choices the infant is making. If we’re going to obsess about personal responsibility, let’s also have a conversation about social responsibility.

Why did deaths of despair claim Farlan, Zealan, Nathan, Rogena and so many others? We see three important factors.

Image : Keylan Knapp, the sole survivor among the Knapp children, comforting his mother in the house they share in Oklahoma.Credit... Lynsey Addario/Getty Images

First, well-paying jobs disappeared, partly because of technology and globalization but also because of political pressure on unions and a general redistribution of power toward the wealthy and corporations.

Second, there was an explosion of drugs — oxycodone, meth, heroin, crack cocaine and fentanyl — aggravated by the reckless marketing of prescription painkillers by pharmaceutical companies.

Third, the war on drugs sent fathers and mothers to jail, shattering families.

There’s plenty of blame to go around. Both political parties embraced mass incarceration and the war on drugs, which was particularly devastating for black Americans, and ignored an education system that often consigned the poor — especially children of color — to failing schools. Since 1988, American schools have become increasingly segregated by race, and kids in poor districts perform on average four grade levels behind those in rich districts.

Farlan’s daughter Amber seemed the member of the Knapp family most poised for success. She was the first Knapp ever to graduate from high school, and then she took a job at a telecommunications company, managing databases and training staff members to use computer systems. We were struck by her intellect and interpersonal skills; it was easy to imagine her as a lawyer or a business executive.

“PowerPoint presentations and Excel and pivot charts and matrix analytics, that’s what I like to do,” she told us. She married and had three children and for a time was thriving.

Then in grief after her father and sister died, she imploded. A doctor had prescribed medications like Xanax, and she became dependent on them. After running out of them, she began smoking meth for the first time when she was 32.

“I was dead set against it my whole life,” she remembered. “I hated it. I’d seen what it did to everybody. My dad was a junkie who cooked meth and lost everything. You would think that was enough.” It wasn’t. She bounced in and out of jail and lost her kids.

Amber knew she had blown it, but she was determined to recover her life and her children. We had hoped that Amber would claw her way back, proof that it is possible to escape the messiness of the Knapp family story and build a successful life. We texted Amber a few times to arrange photos of Farlan, and then she stopped replying to our texts. Finally, her daughter responded: Amber was back in jail. Image Amber Knapp and her daughter in a park in Hillsboro, Ore. As part of her probation,

Amber had to use an alcohol-test device at regular intervals to show she had not been drinking.Credit...Lynsey Addario/Getty Images

Yet it’s not hopeless. America is polarized with ferocious arguments about social issues, but we should be able to agree on what doesn’t work: neglect and underinvestment in children. Here’s what does work. Job training and retraining give people dignity as well as an economic lifeline. Such jobs programs are common in other countries.

For instance, autoworkers were laid off during the 2008-9 economic crisis both in Detroit and across the Canadian border in nearby Windsor, Ontario. As the scholar Victor Tan Chen has showed, the two countries responded differently. The United States focused on money, providing extended unemployment benefits. Canada emphasized job retraining, rapidly steering workers into new jobs in fields like health care, and Canadian workers also did not have to worry about losing health insurance.

Canada’s approach succeeded. The focus on job placement meant that Canadian workers were ushered more quickly back into workaday society and thus today seem less entangled in drugs and family breakdown.

Another successful strategy is investing not just in prisons but also in human capital to keep people out of prisons. The highest-return investments available in America may be in early education for disadvantaged children, but there are also valuable interventions available for adolescents and adults. We attended a thrilling graduation in Tulsa, Okla., for 17 women completing an impressive local drug treatment program called Women in Recovery.

The graduates had an average of 15 years of addiction each, and all were on probation after committing crimes. Yet they had quit drugs and started jobs, and 300 people in the audience — including police officers who had arrested them and judges who had sentenced them — gave the women a standing ovation. The state attorney general served as the commencement speaker and called them “heroes,” drawing tearful smiles from women more accustomed to being called “junkies” or “whores.”

“I thought we’d be planning a funeral instead,” said one audience member whose younger sister had started using meth at age 12 and was now graduating at 35. Women in Recovery has a recidivism rate after three years of only 4 percent, and consequently has saved Oklahoma $70 million in prison spending, according to the George Kaiser Family Foundation.

Bravo for philanthropy, but the United States would never build interstate highways through volunteers and donations, and we can’t build a national preschool program or a national drug recovery program with private money. We need the government to step up and jump-start nationwide programs in early childhood education, job retraining, drug treatment and more. Keylan Knapp at his home in Oklahoma. He has worked in construction since getting out of prison.Credit... Lynsey Addario/Getty Images

For individuals trying to break an addiction, a first step is to face up to the problem — and that’s what America should do as well. Our own reporting in the past focused on foreigners, affording us an emotional distance, while this time we spoke with old friends and had no armor. It has been wrenching to see them struggle. But ultimately we saw pathways forward that leave us hopeful.

One of our dear friends in Yamhill was Rick “Ricochet” Goff, who was part Indian and never had a chance: His mom died when he was 5 and his dad was, as he put it, “a professional drunk” who abandoned the family. Ricochet was a whiz at solving puzzles and so dependable a friend that he would lend pals money even when he couldn’t afford medicine for himself. We deeply felt Ricochet’s loss when he died four years ago, and we also worried about his adult son, Drew, who is smart and charismatic but had been messing with drugs since he was 12.

Drew’s son, Ashtyn, was born with drugs in his system, and we feared that the cycle of distress was now being passed on to the next generation. We exchanged letters with Drew while he was in prison but lost touch.

Then, when we were visiting a drug-treatment program in Oregon called Provoking Hope, a young man bounded over to us. “It’s me, Drew,” he said.

We have been close with Drew since, and he fills us with optimism. With the help of Provoking Hope, Drew will soon celebrate two years free of drugs, and he holds a responsible job at the front desk of a hotel. He has custody of Ashtyn and is now an outstanding dad, constantly speaking to him and playing with him. Drew still has a tempestuous side, and occasionally he has some rash impulse — but then he thinks of Ashtyn and reins himself in.

Drew Goff getting a tattoo, with his son Ashtyn on the floor beside him.Credit... Lynsey Addario/Getty Images

“I’m a work in progress,” he told us. “The old me wants to act out, and I won’t allow that.”

Drew keeps moving forward, and we believe he’s going to thrive along with Ashtyn, breaking the cycle that had enmeshed his family for generations. With support and balance, this can be done — if we as a society are willing to offer help, not just handcuffs.

“It’s a tightrope I’m walking on,” Drew said. “And sometimes it seems to be made of fishing line.”

Nicholas Kristof is an Opinion columnist. Sheryl WuDunn is a business consultant. Nicholas Kristof’s Newsletter Get a behind-the-scenes look at Nick’s gritty journalism as he travels around the United States and the world. Sign up here.

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Nicholas Kristof has been a columnist for The Times since 2001. He has won two Pulitzer Prizes, for his coverage of China and of the genocide in Darfur. You can sign up for his free, twice-weekly email newsletter and follow him on Instagram. His next book will be published in January. @NickKristof • Facebook

The Times needs your voice. We welcome your on-topic commentary, criticism and expertise. Comments are moderated for civility. NYT Picks Reader Picks NYT Replies

carol commented 6 hours ago carol berkeley6h ago Times Pick Thank you for this piece. So long as poverty is seen as an individual or cultural failing (e.g. the culture of poverty which was linked to race, even though the evidence was non-existent) we will not treat this with the seriousness it deserves. Yes, every individual has responsibility for their lives. But pulling oneself up by one's bootstraps, after we take away not only your boots but your capacity to buy or make boots is unfair and is also emblematic of how poverty is understood. We need to understand that collectively this costs us all - both morally and financially. The solution is collective. It is jobs that pay a living wage, it is opportunities for upward mobility for oneself and one's children, it is training for these jobs and it is a real safety net. Will some people still be poor? Will they self destruct? Of course? But the numbers will be far smaller. And we will be far richer as a society.

47 Replies Nicholas Kristof commented 9 hours ago Nicholas Kristof Columnist9h ago

@carol Thanks for reading my column, and Sheryl and I obviously agree that a crucial step forward is changing the narrative. You mention the "pull oneself up by the bootstraps" phrase. One thing we learned in writing Tightrope (the book from which this excerpt is adapted) is that the phrase originally meant the opposite of what it does now. In the 18th and 19th centuries, to pull oneself up by the bootstraps was to do something impossible. Only in the 20th century did it take on its current meaning.

MLinus commented 9 hours ago M MLinus Boston9h ago “If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25.” This say so much.

20 Replies Nicholas Kristof commented 9 hours ago Nicholas Kristof Columnist9h ago @MLinus Yes, and it's not just about the income, although that's obviously important. It's also about the dignity and self-esteem that come with a decent job, the sense of providing for one's family. When people struggle economically, they sometimes also struggle psychologically, and they sometimes self-medicate. That's one of the lessons we try to convey in Tightrope. Thanks for reading the excerpt.

jrd commented 9 hours ago 9h ago "Globalization", as used here, is a euphemism for putting Americans workers in direct competition with their counterparts in the third world. That is what our vaunted "free trade" deals accomplished, and that was their purpose. There's a name for the disease which has beset so much of America: "neo-liberalism". And both parties, and this columnist, bought it wholesale.

Nicholas Kristof commented 9 hours ago N Nicholas Kristof Columnist9h ago @jrd Yes, I think in retrospect that I was too glib about the benefits of international trade and about "creative destruction" in the economy. But I also think that trade does have real benefits to the overall economy and to some degree is inevitable. Likewise, Germany, Canada and Denmark are all affected by globalization, but only in America is life expectancy falling. That's why we argue in Tightrope that it's too simplistic to blame just globalization. The example we give of Canada looking after laid-off auto workers and retraining them, in a way that did not happen in Detroit, goes to this. We expand on it in the book. Dsurber Orinda, CA9h ago

@Nicholas Kristof Might I suggest a future column where you revisit your past support for the so-called centrist policies that contributed to the problems described here. Over the years I have found your columns maddening because you so obviously cared about people lower on the economic ladder yet in your writing on the US you seemed oblivious to the impact of your positions on the majority of the US population. Perhaps you could write about how the policies of the Presidential candidates would address these issues. Keep in mind that majority of wealthy nations manage to afford socialist programs like universal health care. Obviously the US can as well.

P Wilkinson commented 8 hours ago P P Wilkinson Guadalajara, MX8h ago @Ali Ali more than these third world people take a look at H1b visa use in Disney, Google, tech companies. Young people from the US who play by the rules do not have a chance now. Migrants open restaurants and accept low pay jobs. I suggest a focus on the top tier of corporate owners and players and their cynical manipulations.

Patraklos commented 8 hours ago P Patraklos New England8h ago @Ali I hope that those people -- both asylum seekers and illegal aliens -- are offered the opportunity to become legal citizens. The state where I live has both a negative population growth rate (more people dying than being born) and substructural unemployment. Without the immigration of young, capable workers, states like mine will implode. Our businesses are failing not because of too many workers, but because we don't have enough. Preparing immigrants for contributory work, rather than scapegoating them, made America great in the past, and it can do so again. Study after study has found that over time, immigrants pay far more in taxes than they receive in benefits -- in other words, they are net contributors who help pay for the benefits you receive. Theo D commented 8 hours ago

Theo D Tucson, AZ8h ago @jrd As do all WALMART shoppers, apparently, many of them in the towns and cities discussed here. Ali commented 8 hours ago A Ali Michigan8h ago @Patraklos -- The study by the National Academies of Sciences has found that skilled, educated immigrants are a NET benefit to us, while uneducated, unskilled ones are a NET COST. We do not need unskilled, uneducated immigrants to compete with the workers mentioned in this article, nor do we need even skilled, educated ones when they're used to displace skilled, educated American workers--as has happened at companies such as SCE, Disney, and even the University of California, all in the name of reducing costs.

fg commented 8 hours ago Ann Arbor, Michigan8h ago @Ali The statistics also show that where there were 3-plus workers for every social security recipient not long ago there are now only 2-plus so we need to include what I would call" nurturing" legal immigration that trains new workers since we will need them for the health of our country and all citizens and the only way to stop low-wage exploitation is to increase the national minimum wage for all workers to a living wage and not expect this to happen without strong legislation that address the terrible income inequality that causes so much of this misery. Larry Wise commented 8 hours ago Larry Wise Austin8h ago @jrd Other countries seem to have handled the problem far better than than the good ol' USSA. Did you read the part about what happens when one reduces taxes that would possibility go to re-training? E.g. Germany, Canada, Sweden, Norway. In fact, almost every other so-called First World Country. The all also have universal health care. Get off blaming the liberals and get an education. jrd commented 7 hours ago j jrd ny7h ago @Nicholas Kristof Forgive me, but I think you're still too glib, still too apt to seek pathos while unwilling to accept the change that the times demand. In Canada, which isn't the best example, the answer wasn't simply worker retraining. Workers enjoy few other advantages over their American counterparts. But just propose something like their health care system for the U.S., and watch the op-ed liberals react in horror. Isn't it time we Americans accepted international norms? Meaning, you don't have to love Bernie Sanders, but is there something in American political discourse which prevents pundits from acknowledging that the stuff he proposes is accepted as a matter of course by "conservatives" in other rich industrial democracies? Robert Steiner commented 7 hours ago R Robert Steiner Pleasant Hill, CA7h ago @Nicholas Kristof America has been losing jobs to workers who are exploited in places like China and Cambodia. In the latter, working conditions have led to mass faintings in factories supplying American companies like Nike. The problem is not with liberalism. Industrial workers world-wide should be paid fair wages, and they should to be treated humanely. And we should be paying more for our sportswear. Bob Steiner Pleasant Hill, California vtlaser commented 7 hours ago vvtlaser vermont7h ago

@Ali You might note that those low wage workers are paying into Social Security with their "stolen" Social Security numbers. They are unable to collect Social Security on those false numbers, but you and I benefit from the money they put into the system, but don't collect. More workers paying into the fund, especially low wage workers since they never hit the cap, help to keep the system afloat. Five low wage workers earning $30,000 annually will contribute more to Social Security than one individual who has hit the $132,900 cap. For fairness and the future of Social Security, the cap should be eliminated.

Audible Preview of Tightrope (available Jan 14th) "A deft and uniquely credible exploration of rural America, and of other left-behind pockets of our country. One of the most important books I've read on the state of our disunion."—Tara Westover, author of Educated

The Pulitzer Prize-winning authors of the acclaimed, best-selling Half the Sky now issue a plea--deeply personal and told through the lives of real Americans--to address the crisis in working-class America, while focusing on solutions to mend a half century of governmental failure.

With stark poignancy and political dispassion, Tightrope draws us deep into an "other America." The authors tell this story, in part, through the lives of some of the children with whom Kristof grew up, in rural Yamhill, Oregon, an area that prospered for much of the twentieth century but has been devastated in the last few decades as blue-collar jobs disappeared. About one-quarter of the children on Kristof's old school bus died in adulthood from drugs, alcohol, suicide, or reckless accidents. And while these particular stories unfolded in one corner of the country, they are representative of many places the authors write about, ranging from the Dakotas and Oklahoma to New York and Virginia. But here too are stories about resurgence, among them: Annette Dove, who has devoted her life to helping the teenagers of Pine Bluff, Arkansas, as they navigate the chaotic reality of growing up poor; Daniel McDowell, of Baltimore, whose tale of opioid addiction and recovery suggests that there are viable ways to solve our nation's drug epidemic. These accounts, illustrated with searing images by Lynsey Addario, the award-winning photographer, provide a picture of working-class families needlessly but profoundly damaged as a result of decades of policy mistakes. With their superb, nuanced reportage, Kristof and WuDunn have given us a book that is both riveting and impossible to ignore.

Tightrope: Americans Reaching for Hope Kindle Edition by Nicholas D. Kristof (Author), Sheryl WuDunn (Author) #1 Best Seller in Urban Sociology