The Big Sort (20 page)

That is exactly what happened.

The cast of Harlan County, Kentucky's community play
Higher Ground
consisted of retired coal miners, teachers, bluegrass musicians, and members of church choirs. They had assembled in the late summer of 2005 in a darkened auditorium at the community college to work through some scenes. This night they were to begin work on what would come to be known as the "drug zombie dance." In the scene, a doctor sat in a chair as the chorus stumbled and staggered onstage. They were the drug zombies who had come to the doctor for pain pill prescriptions. As the doctor wrote on little slips of paper, the zombies sang—chanted, really—"I've got a pain; I've got a pain; I've got a pain in my back. And I'm searching for a cure to take my pain away." The zombies passed money to the doctor, who tossed dollar bills in the air as police sirens began to whine.

Most small towns put on community plays to celebrate their founding by brave pioneers or a battle won by stalwart local soldiers. They commemorate "little engine that could" determination that leads to inevitable civic success. In 2005, however, Harlan County was producing a community play about civic failure—about the county's battle with drug addiction, primarily the painkiller OxyContin. It was a struggle the county had so far lost.

Harlan County sits in the extreme southeast corner of Kentucky and is perhaps the most infamous coal community in the country. For most of the last century, Harlan County was an outpost of industrial America. Ford, U.S. Steel, and International Harvester all had mines there. In the 1930s, "Bloody Harlan" became the center of union organizing efforts by both the Communist Party and the United Mine Workers of America. And in the 1970s, it was the scene of another mine strike chronicled in the Academy Award-winning film
Harlan County U.S.A.
Fortune, however, has not accompanied fame. Close to 80,000 people lived there in the 1940s. Now the population is roughly one-third that size and dropping with each census.

Traveling the eastern coalfields is a reminder that the most abundant product of the Big Sort has been inequality. Sixty years ago, the proud city of Welch, in southern West Virginia's McDowell County, was a "little San Francisco," local historian Jean Battlo told me. Guy Lombardo and Glenn Miller played Welch, and on a Saturday afternoon, the city was crowded with pedestrians and Packards. McDowell County was at the core of industrial America's economy. Then it wasn't. Three-quarters of McDowell's people left between 1950 and 2000. It lost nearly 10 percent of its population in the first four years of the twenty-first century. "Rational people leave, if they can," Jerry Beasley, president of nearby Concord College, told me. There's always been an economic and cultural distance between the small towns in the coalfields and urban America. But the gap has been growing, and it's now almost unimaginable that Welch and Austin are part of the same country.

It's not just Harlan County and Welch that have lost ground. The Big Sort has left much of rural America behind. The realities of rural life come to light in the list of Americans killed in Iraq and Afghanistan. Bob Cushing and I began tracking the hometowns of those killed in the war when the conflict began, and our very first tallies revealed that the U.S. military was disproportionately filled with young men and women from rural counties. The bigger the city, the smaller the percentage of its young people were likely to die in the war. By late 2006, rural counties had casualty rates 60 percent higher than cities and suburbs.
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By early 2007, Bismarck, North Dakota, had a casualty rate among its military-age citizens that was almost ten times that of San Francisco. The Pentagon is straightforward in its recruiting strategy. The military finds the highest proportion of its recruits among good kids who have few prospects for decent jobs or further education. Or, as a Department of Defense study put it in reverse, "propensity to enlist is lower for high-quality youth, youth with better-educated parents, and youth planning to attend college."
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There has been a form of economic conscription at work in the wars in Iraq and Afghanistan. The death rate among military-age residents living in the nation's high-tech cities has been half that of military-age people from rural America.

The speeding economic collapse in the southern mountains has produced a kind of civic dysfunction. In McDowell County, the state took over the school system in 2001 after an audit found failing students and a school board preoccupied with politics. (Kentucky had ousted the Harlan County school board a few years before for similar transgressions.) In Harlan County, a former sheriff running for his old office was shot and killed in 2002 after he collected a pouch of money from a drug dealer. Just over the mountain, a Wise County, Virginia, grand jury found 1,000 violations of voting laws in one 2004 election—two crimes for every vote cast. The mayor of the town of Appalachia allegedly bought votes with sacks of fried pork rinds. The zombies in the play
Higher Ground
weren't fictional creations. They were neighbors. In 2005, Federal Express stopped making deliveries of prescription drugs in many Eastern Kentucky counties. Drivers had complained that their trucks had been surrounded by staggering, stumbling people anxious for the deliveries. "If a driver goes up one of these hollows and comes up on six or eight people who know he has drugs on there, they may decide to take them," said one Eastern Kentucky sheriff. "There's a legitimate concern."
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Struggles with addiction are part of everyone's daily life in Harlan County. Just off the wonderful main square in the county seat, a large Christian church has strung a banner over its front door promoting "Recovery Night." Every Thursday, two hundred to three hundred people gather at the church for inspiration and smaller twelve-step meetings. Up the Clover Fork in the coal camp of Evarts, the medical clinic quietly opened a drug treatment program; it quickly filled twenty-two openings and had a dozen people on a waiting list, according to clinic director Dr. J. D. Miller. This in a town of just 1,000 people. "It's been said that every family here is touched," Miller told me early one morning in 2005 at a breakfast joint filled with dust-covered miners just off the hoot owl shift. "Everybody here has a close personal friend or a relative who is on OxyContin. That's true." A few years ago, the local mental health agency needed several vans to transport pregnant women from Harlan County to a methadone clinic in Corbin, a nearly two-hour drive over sixty-three miles of mountain roads. Although Harlan County had a population of only 32,000 at the time, Miller said that forty young mothers were in the methadone program.

The "drug zombie" scene in
Higher Ground,
with the actors holding aching backs, zeroed in on how Harlan County's uniquely pervasive drug problem began. "In the past, coal miners spent hours each day crouched in narrow mine shafts," concluded a report issued in 2002 by the U.S. Department of Justice. "Painkillers were dispensed by coal mine camp doctors in an attempt to keep the miners working. Self-medicating became a way of life for miners."
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In the fall of 2005, a disability attorney's come-on could be seen on a large billboard at the entrance to town. It showed an old, bent, and particularly grizzled miner and asked, "Broke Down?" OxyContin came to Harlan County because people here have pains—in hips, backs, and shoulders—resulting from working underground. The country wanted the coal, and the miners needed the work. Pain pills were an unstated part of the arrangement—and it probably lowered the cost that the unsavory bargain was struck in a place so far out of sight, a piece of America that is literally at the end of the tracks.

The OxyContin sales force targeted Appalachian doctors. Reports in the
Lexington Herald-Leader
found that Purdue Pharma's marketing plan for its new medicine was to seek out physicians who were already prescribing large amounts of painkilling drugs. In 1998, according to the newspaper, Purdue shipped more OxyContin per capita to portions of southern West Virginia and Eastern Kentucky than to any other region or city in the nation.
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(In 2007, Purdue Pharma and three of its executives agreed to pay more than $650 million in fines for the misleading ways it had promoted OxyContin.)
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Richard Clayton, an addiction expert who heads the University of Kentucky's Center for Prevention Research, told the Lexington newspaper, "This may be the first epidemic—if it is an epidemic—that started in rural areas."
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Joan Robinett now lives in a brick house perched on a hill above the town of Harlan. She led a decade-long effort in the Dayhoit coal camp that eventually won more than $20 million from a firm that had polluted the town's ground water. The fight changed Robinett from country girl to Kentucky's Erin Brockovich. You have to climb seventy-five steps to get to her house, which also served as headquarters for the Harlan County "listening project." In 2005, Robinett and her coworkers conducted more than 450 interviews with residents about drug abuse and their hopes for Harlan County. The stories are a mixture of hopelessness and horror. A young divorced woman said:

 

The quality of life is so low. People look ahead and see the mountains blown off and the water ruined. And the drugs come around. When you deal with what people have to deal with here. I don't know how to say it ... Me and my son were on our own and everywhere I went I began to feel like a failure. I never dreamed I would turn to drugs but it seemed to be the easy way out. The Xanax at first I used it to help me cope and later found if you took two you would feel good and later realized if I drank on it I felt really good. Before you know it I began to sell my home interior and then my furniture. Before you know it, I thought I couldn't live without it.

 

A middle-aged woman with four years of college education said:

 

Doctors and drug companies feed us drugs just like giving a baby candy ... It's so bad that I can no longer trust some people in my own family. They steal from you—lie. You never know who is on drugs—people drooling—taking from their parents and children. It's awful.

 

Living has never been particularly easy in Harlan County, but it had always maintained a connection with the rest of the country. The Big Sort has cut many of those ties. Now the county has fallen away and staggers about in a haze. FedEx drivers are afraid to deliver, and the life expectancy for men is no better than in Ecuador, Turkey, or Colombia.
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Eugene Goss is a Republican, a lawyer on the main square in the town of Harlan, and one of the grand men of Kentucky. To get to Harlan County from Virginia, you drive the smooth Gene Goss Highway. He's lived through the Depression, strikes, and coal mine disasters. Now this, the zombie dance. "We're at the end of the line," Goss told me while munching a biscuit his secretary had made for a midmorning snack. He described Harlan County as a "storage tank" for the rest of the country, a place tapped for its energy and then forgotten. Goss stayed in Harlan County because he saw a future there, but now even hope is gone. He said, "There's a whole lot of feeling that we are the way we're going to be and there isn't anything to be done about it. We are what we are, and that's how it's going to continue."

In 2000, Robert Putnam commissioned a survey of 30,000 people in forty American communities. Putnam is the author of
Bowling Alone,
the book documenting the decline in civic organizations that began in the mid-1960s. His 2000 survey was designed to measure the nation's civic well-being, so he asked people if they went to church, voted, volunteered, donated to charities, belonged to clubs, or attended discussion groups. Putnam asked how often people socialized and how much they trusted others. People living in different places gave widely varying responses. Those living in places such as Bismarck, North Dakota; Birmingham, Alabama; and Kalamazoo, Michigan, exhibited strong social ties; they volunteered, went to church, stayed close to their families, and voted. Based on his earlier research in both the United States and Italy, Putnam assumed that the stronger the social connections, the healthier the community.
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As Bob Cushing and I looked at how the Big Sort was creating greater inequality among cities—in patents, incomes, and levels of education—we wondered whether there was a relationship between culture and economic success. Putnam's groundbreaking analysis gave us the data, and we set to work examining our high-tech cities with his measures of civic health. In fact, there was a relationship between the health of the local civic culture and the well-being of the economy. It was negative. The tighter the social ties, the fewer the patents, the lower the wages, and the slower the rates of growth. Bismarck, Baton Rouge, and Cincinnati all had whopping numbers of civic connections (social and volunteer groups, high rates of voter participation), but they had relatively few patents and showed slow (if any) growth. Cities such as San Diego, Houston, Los Angeles, and Atlanta (as well as Silicon Valley) all had bottom-of-the-barrel social connections but high rates of innovation and growth and high incomes.
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The high-tech, fast-growing cities scored high on only two of Putnam's eleven gauges of social well-being: their residents registered a high degree of interracial trust and were more inclined to engage in "protest politics." They voted less than those in more traditional cities but signed more petitions and joined more demonstrations and boycotts—in other words, they acted politically as post-materialists.

Some cities boasted strong social ties, while others appeared to be flying apart—volunteers diminishing, church attendance declining, voting rates dropping. Our American sense of right and wrong would tell us that the cities with vibrant clubs, full pews, abundant volunteers, and eager voters should be more economically successful than the civic wastelands. They would be the places with strong businesses and high wages. People would be flocking to these good communities. But they weren't.