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On Empathy, Social Imagination and Efforts to Combat the Current Drug Crisis



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The Institute is now engaged in a number of projects to address our region’s opioid and drug addiction crisis, under the leadership of Associate Director Mary Beth Dunkenberger. She and a number of colleagues at the Institute are working on the epidemic in concert with faculty and graduate students from our university’s Public Health program, the Fralin Biomedical Research Institute at VTC, the Office of Economic Development, the Department of Communication, Virginia Cooperative Extension and the University of Virginia Medical Center. There are important technical aspects to this work linked to the design of interdiction and program evaluation strategies, and the study teams are giving these the time and attention they deserve, but as I have considered their efforts, I have been reflecting on the social currents that together have shaped, and continue to mold, how our society and region have responded to this still unfolding challenge. And, more particularly, I have found myself pondering the critical significance and relative fragility of empathy in forming the social imagination and the major trends that shape its character and contours.

In an October 2014 interview for the New York Times Magazine, the distinguished novelist Marilynne Robinson, then 70, surprised her interlocutor, Wyatt Mason, with the following observation as they began their conversation:

‘I hate to say it, but I think a default posture of human beings is fear.’ Perched on the edge of a sofa, hands loosely clasped, Robinson leaned forward as if breaking news to a gentle heart. ‘What it comes down to—and I think this has become prominent in our culture recently—is that fear is an excuse: ‘I would like to have done something, but of course I couldn’t.’ Fear is so opportunistic that people can call on it under the slightest provocations: ‘He looked at me funny.’ ‘So, I shot him,’ I said. ‘Exactly.’ ‘Can you blame me?’ ‘Exactly. Fear has, in this moment, a respectability I’ve never seen in my life.’[1]

The emergence of that palpable sense of fear and its social legitimation were perhaps understandable. Our nation was then still confronting the long-lived effects of the 2008 global recession and the markedly uneven geography of recovery from it. Some parts of the country had not then, and have not to this day, recovered from that disastrous economic downturn. In Central Appalachia and its environs, for example, the Great Recession exacerbated the long-term decline in the coal or other single-commodity or product economies of many communities. As the recession worsened, the conditions it created contributed directly to what emerged as a pandemic of opioid and other drug addiction among the area’s residents. It is that ongoing social conflagration in our region and beyond that Mary Beth and her colleagues are working to ameliorate, if not to arrest.

Surely one impetus for many people who turned to drugs in Central Appalachia was the sense of helplessness and the wounds to their dignity and self-worth in finding themselves out of work at middle-age and without prospects as a result of economic forces well beyond their province to control. Those dynamics have also been especially cruel and unsparing in their effects on young people in Appalachian communities, as well, who have too often come to perceive their life prospects as dismal or worse as a result. Despair can lead to hopelessness and to a willingness to seek to escape, via substance addiction, from the bitter, economic and social realities one confronts. This has surely been the case for many residents in Central Appalachia who have become addicted to opioids and other substances in recent years.[2]

But this is not the entire story. Opioids especially, as it happens, were foisted on this vulnerable population by some pharmaceutical industry firms that were so ethically bankrupt as to be willing to push their products in the name of profits, whatever the consequences for those whose lives were affected by that choice. And we now also know that a share of malfeasant physicians and pharmacists profited handsomely from their involvement in the wounding or shattering of thousands of lives.[3]  

This is all part of a deeper and still more variegated narrative. Historians and political analysts have informed us in recent years that responses to the present drug addiction crisis cannot be understood apart from deliberate political efforts to exploit the atmosphere of fear that the Great Recession and long-term economic decline have wrought in many parts of the country. The Republican Party has self-consciously employed fear of the economic changes that have engulfed the Appalachians and other rural regions in recent decades, to delegitimize government and governance. The GOP has contended that these alone were responsible for the calamity confronting many communities, pretending that prior conditions can magically be returned. The party has worked just as assiduously, as a part of that strategy, to encourage residents to “other” their fellow citizens on the basis of any difference that might elevate their existing fears and make them more vulnerable to electoral manipulation. Fear of minorities, immigrants and refugees can be engendered fairly easily on the basis of evident differences. Those groups can readily be labeled as interlopers who have come to “steal” employment or to undermine one’s way of life.  The GOP has adroitly followed just that playbook. While it is more difficult to mobilize citizens against their long-time and ethnically or racially similar neighbors who have become drug addicted, it is surely possible to do so on the basis of an underlying fear tied to arguments that the individuals targeted for animus are “weak,” “less than” or “contemptible” to succumb to the difficulties now afflicting them.  And this, too, the GOP has explicitly sought to do with arguments that such people are “takers,” unlike their fellow citizens, and are undeserving of social support.[4]

Whether one empathically relates to a community member who is drug-addicted and wishes to do all one can to assist them, or one instead elects to revile that person for supposed character flaws and assumed “weakness” and assigns them complete responsibility for their condition, turns in good part on what one understands to be socially appropriate behavior. As noted above, for their part, GOP elites and their major supporters have consistently told residents of Central Appalachia and nearby regions for decades that government is responsible for all woes that may befall them and that the national government particularly has given minorities and immigrants benefits that they do not deserve, even as their white brethren have otherwise worked hard to deal with calamitous economic shifts and/or decline. This has led to the ironic turn in many such communities, especially those in rural regions, that finds public sector employees (that is, current staff members of the otherwise unacceptable government) adopting disparaging attitudes toward their fellow citizens and neighbors who have become drug addicted.

Political thinkers as far back as Aristotle, and certainly many scholars writing in recent decades, including John Dewey, Martha Nussbaum, bell hooks and Cornel West, have embraced empathy as a way to educate the social imagination and to serve as the foundation for democracy and social change.[5] These authors have argued that empathy can enlarge the vision of the individual practicing it and allow them to come to grasp, if not fully to comprehend vicariously how the imagined other is experiencing life. Empathy can leaven the perspective of another’s life and help one view that person with openness and compassion rather than with the cruelty always implicit in apprehension and “othering” when encountering individuals different from oneself.  While scholars argue about whether empathy alone is sufficient to result in social change, there is little doubt that it can prevent heedless scapegoating and hate mongering on the basis of difference and fear, however innately human those reactions may be.[6]

Nonetheless, as Robinson contended so clearly, even when, or if, empathy is encouraged or possible, its beneficial effects can be overwhelmed by human fear, and certainly by a combination of anxiety about unalloyed change by unseen forces for which “others” are then held responsible by influential social elites. And this is precisely what has occurred across Central Appalachia for immigrants, minorities and drug-addicted individuals alike. These residents have been held up for scapegoating opprobrium in their communities as agents of negative social and economic forces. This naturally human, if lamentable reality, as Robinson might say, has arisen from underlying fears associated with the vast changes afflicting the region and from residents’ companion desire to hold someone or something accountable for those shifts. For those suffering with drug addiction, this situation has been exacerbated by a related social norm, dating back to the Elizabethan Poor Laws and beyond, that if one is poor or otherwise afflicted, one must be morally weak or degenerate in some way and therefore should be considered unworthy and untrustworthy. 

One result of these social realities is the curious situation in which many of those residents least able to cope with the shifts that have beset Appalachia and who, collectively, are least responsible for those changes, have nonetheless been unjustly saddled in the popular imagination of many of the region’s residents with a major share of accountability for them. Among those affected by this paradox are individuals who are poor and/or coping with drug addiction. Both groups have been the target of attacks and each has had a difficult time garnering empathy from the broader public. In policy terms this has created an environment in which programs to support drug-addicted, vulnerable or impoverished community members are ironically—given how many families depend upon these initiatives—viewed with popular suspicion and there is little public patience for helping the drug afflicted in the first instance, let alone if/when they suffer a relapse.

In short, the conflation of these trends has made for an inauspicious environment in which to seek ways and means to assist those suffering with drug addictions. This is so in no small part because of decades of partisan attacks on the idea of empathy as a fool’s errand. It has also resulted in a decline in what might be labeled the collective capacity for empathy in the Central Appalachian citizenry, an essential characteristic of self-governance. While the human capability for empathy has certainly not atrophied entirely in the region, it has attenuated across Appalachia and this represents a major concern. It is difficult to conceive of how that region, or our nation more generally, will realize any aspiration to social justice without widespread recognition of the centrality of empathy and without a citizenry prepared to act on that vital human capacity. Fear cannot be permitted to result in its widespread eclipse. The present predicament in seeking public support for remedies for the ongoing drug crisis in Appalachia and beyond provides a case in point.

This situation makes the work now underway at VTIPG and with its partners to address that scenario especially important, even as it complicates its pursuit. Those wrestling with addiction in our region can be assisted to help themselves with their difficult circumstances, but such efforts must proceed with all involved fully aware that such an aspiration is, in and of itself, complex and difficult. It is made more so by the imperative to work with the larger populations of affected communities to encourage them to act empathetically to assist those among them requiring help. This shift must occur and succeed if this region’s residents are to realize the central significance of moving forward together, rather than dividing amongst themselves and demonizing some groups within their midst, amid otherwise faltering economies and inadequately resourced governments. In sum, the work that Mary Beth and her VTIPG colleagues and partners are pursuing is vital and much needed as well as challenging on multiple scales. As the old adage goes, this sport is surely worth the candle.  


[1]Mason, Wyatt, “The Revelations of Marilynne Robinson,” The New York Times Magazine, October 1, 2014,, Accessed March 10, 2020.

[2] Cohen, Hannah, “Why Opioid Misuse Policies Must Comprehensively Address Social Determinants of Health to be Effective,” RTI International,, Accessed March 10, 2020.

[3] Hong, Nicole, “6 Drug Companies’ Role in Opioid Epidemic Scrutinized by Prosecutors,” The New York Times, November 27, 2019,, Accessed March 10, 2020.

[4] Hochschild, Arlie Russell, Strangers in their Own Land, New York: The New Press, 2018; Reynolds, Barbara,” “Mitt Romney’s America: Makers vs.Takers,” The Washington Post, September 21, 2012,, Accessed March 10, 2020.

[5] Aristotle, The Politics (especially Books VII and VIII), (Ernest Barker, Translation), Oxford: Oxford University Press, 1946; Dewey, John, “Democracy and Education” in J. A. Boydston, (Ed.), The Collected Works of John Dewey: The Middle Works (Vol. 9). Carbondale: Southern Illinois University Press, 1916/2008; Nussbaum, Martha, Poetic Justice, Boston: Beacon Press, 1995; hooks, bell, Teaching to Transgress: Education as the Practice of Freedom, New York: Routledge Publishers, 1994; West, Cornel, Democracy Matters, New York: Penguin Books, 2005.

[6] Boler, Megan, “The Risks of Empathy: Interrogating Multiculturalism’s Gaze,” Cultural Studies, 11(2), 1997, pp. 253-273; Boler, Megan, Feeling Power, New York: Routledge Publishers, 1999.

Publication Date

April 1, 2020