One Nation Under Stress (2019) Movie Script

(buttons click)
Autopsy number 2017-358.
What's the story with her?
- -Man: She shot herself.
- -Cyril Wecht: How old is she?
- Woman:
- Nineteen.
- (mutters):
- Jesus fucking Christ.
What a shame.
Where's the gunshot wound?
- Right here.
- Entrance.
-Nobody here for this?
-Man: No.
- There appears to be
- A muzzle imprint
- On the medial aspect
- Of the wound.
All right, Joe, who's next?
- Body's that of a well-developed, -
Well-nourished, young adult - White male,
- Whose appearance is consistent
- With reported age of 28.
No IV puncture sites?
- -That one there. Yeah.
- -Joe: No. He used pills.

- Wecht:
- I had five autopsies today.
We've had a 19-year-old
apparent suicide
from Green County,
and two apparent
drug overdose deaths.
Last year,
I did 556 autopsies,
more than 300
were drug deaths.
And this is what is
being experienced,
tragically,
throughout the country.
Back of the body shows
of recent medical procedures.
the following evidence
Two ECG past or present,
one in the left sub-region...
It is far greater than what
we experienced with AIDS.
It is a very
of monstrous proportions.
significant epidemic


It's a hundred times stronger...
Newswoman: CNN Chief Medical
joins us now. Sanjay?
Correspondent Dr. Sanjay Gupta
- Gupta: - What we're talking about
- Here with fentanyl,
- 50 times stronger
- Than heroin.
- People who would experiment
- With something like this
Are literally putting their
given how powerful...
lives on the line nowadays,
- Gupta: - In the United States,
- Life expectancy
Is dropping faster
demographic in the world.
than any other developed
(broadcasts chattering)
Epidemic of gun violence.
- (overlapping broadcasts): - -Suicide...
- -Substance abuse...
- -Obesity rates...
- -Post traumatic stress...
-Homicides...
-Gun violence...
- -Oxycontin...
- -Mental illness...
- -Obesity epidemic...
- -Epidemic...
- -Epidemic...
- -Epidemic...
- -This epidemic...
- -Epidemic...
President Trump:
We have a lot of sickness.

The CDC says that
the highest increase
middle-aged whites had
in these deaths of despair.
And the CDC folks also noted
the high rates of drug
overdose in this group.
- When I first started
- Looking at these spikes
In different causes of death
among the white working class,
opioid overdoses, suicides,
cirrhosis of the liver,
it felt a bit
mysterious to me.
- It took some time still
- To sort of piece it together
And say, whoa, wait a second.
going on here.
There's something
- We see that someone has died
- Of liver cirrhosis,
Or an opioid overdose
or a suicide.
-(beeps)
-That will be what goes
into the mortality
and morbidity reports,
but what caused
those deaths of despair?
Knowing the cause
far more important
of the cause is
to really understand
in this country.
what's happening
Hey, it's Dr. Gupta.
Just checking in.
- You guys got
- A patient yet?
Oh, okay. Great.
Thanks. Bye-bye.

- Gupta:
- So, my thought was,
Put him in traction,
try and get him to reduce.
-Technician: Ow.
-Gupta: Let me see.
So, why are people
taking as many opioids?
- Part of it's prescribing,
- Part of it is becoming addicted.
- But why are
- So many people drinking?
- Why are so many people
- Dying by suicide?
We are operating in a time
when we're very, very good
at learning about
and treating diseases.
I think we are less good
and less proficient
at understanding health.
Are we gonna be
physicians at a time
remembered to have been
when life expectancy
I don't know.
actually dropped?
It's a little bit
of an existential pain.
Yeah.
- There's probably nobody
- Better in the country
That has seen the ups
and downs of American culture
from a medical perspective
than Dr. Cyril Wecht.
He's the guy that most of us
about pathology,
turn to when we have questions
but he's also the guy
a mystery.
that can help really solve
-Gupta: Hello, good doctor.
-Wecht: Pleasure to see you.
- Gupta:
- Anything exciting?
- I got the reports back
- From National Medical Services.
On three, I felt they were
and so on.
drug deaths, you know,
All three were
only Fentanyl.
- -It's unbelievable.
- -It's crazy.
-So how have you been?
-Thank you, yeah.
You're looking well.
- Did you hear the story
- When my office called you?
I think it was around
the time Prince had died.
- -And...
- -When Prince died, yeah.
And then somehow, the message
got miscommunicated
that I had died.
I said, you know,
how sad it is,
I cannot tell you
- but to whom do
- I submit my application
- To become
- The medical director of CNN?
- You know, no sense wasting
- Any fucking time, right?
(laughter)
- I appreciate
- The pragmatism there.
- The mourning did
- Not last that long.
No, it's... thank you
for your time.
You know,
You've taught me a lot.
you've always taught me...
- Not only did you
- Teach me forensics,
But I think you taught
about things, you know,
me a way of thinking
- a methodical way
- Of thinking about things.
- Well, that's
- Very gracious of you.
There's a few things
in that regard.
I wanna ask you
Liver cirrhosis,
- drug overdose,
- Mainly opioids,
And suicide.
They are called
"deaths of despair."
And it seems
to be this symptom
- of an underlying
- Problem,
- As opposed
- To the problem itself.
What is your sentiment
in that regard?
I think what we're
stressed society.
looking at is an increasingly
I think a society in which
the pressures become
and in all respects.
greater and greater,
Making a living,
depersonalization of society,
the roboticization
of society,
families breaking up,
splitting off...
These are all things
that I think play a role
in leading to this stressful
society that we have.
And then you have changes
on the medical side...
The idea that people
should not have to suffer.
We're gonna take care of it,
and it's very easy.
- You're gonna write
- The prescription.
It seems to be that we
are self-medicating.
We are 4.7% of
the world's population.
We take 80 to 90%
Oxycontin and Hydrocodone.
of the world's
-It's incredible.
- I'm pretty sure we don't have
- 80 to 90% of the world's pain.
How about when I'm looking
lying on the table,
at a 62-year-old woman
and, you know, she's
perfectly healthy looking.
And I'm thinking, "My God.
somebody's mother.
This could be, you know,
- This could be
- Somebody's grandmother."
And most Americans, I think,
do not yet understand,
it's proportionately white,
between 35 to 55.
- I mean, do you think there
- Should be this idea of stress
Being an actual diagnosis?
- Because it seems like
- This very nebulous term.
- You have "A" is
- The immediate cause of death,
- And then you have another box
- Of contributing causes.
That is certainly where
stress should be listed.
(tail rattling)
Robert Sapolsky:
hormones that we secrete,
You look at the main stress
and it's the same exact
in a fish, in a bird.
chemicals in a lizard,
This is, like,
ancient, ancient biology.
For 99% of beasts out there,
what stress is about is
three minutes of
some screaming crisis
- where somebody's
- Very intent on eating you,
- Or you're very intent
- On eating somebody.
And everything that your
makes perfect sense.
body does at that time
You increase your heart rate,
your breathing rate.
your blood pressure,
You turn off everything
that's not essential.
You shut down growth
and tissue repair.
- Lion's chasing you.
- You're running for your life,
And one of the things
you're doing is all sorts
of metabolic stuff to hand
energy to your thigh muscles.
Oh my God! You think about
only three months
until taxes are due,
and you divert energy
to your thigh muscles?
It makes no sense whatsoever.
And that's where
you pay the price.

(knocking on door)
- -Gupta: Hello.
- -Hey, how are you?
- -How you doing?
- -Good.
- -Gupta: Nice to see you.
- -Come on in.
- -Thank you.
- -Come on up.
- Appreciate it.
- Thank you. Shoes okay?
Yeah.

- Gupta: - Dr. Robert Sapolsky
- Is sort of this
- Indiana Jones-like
- Character.
He goes off and lives with
baboons for 20 years in Africa.
- And then he comes out
- And he writes this book,
Why Zebras Don't Get Ulcers.
Sapolsky:
and a lion's chasing you,
If you're a zebra
you want stress
in order to get away.
But once you get away,
then the stress levels
return to normal.
Stress is not the enemy here.
It's the constant,
never-ending, toxic stress,
that's the stress
that'll kill you.
(horns honking)
- I always
- Wondered...
Just when you're not
talking about stress,
- if you in fact are
- Experiencing stress.
Unbelievable
amounts. Yeah.
I've had a transition
in recent years.
I closed my lab
about four years ago.
So rather than
the usual escape
of becoming a dean or a chair
of something or other,
I've just been hiding
out here, writing.

I think what we know
by now from baboon world
is what makes psychological
stress really corrosive:
lack of control,
lack of predictability,
lack of social support.
If you're chronically stressed,
- you've chronically increased
- Your blood pressure.
- You're gonna get
- More fluid turbulence
With lumens,
your blood vessels.
- They hit the walls.
- They pound the walls.
They cause microscopic,
little bits of scarring,
tearing, and you get
inflammation there,
and you get plaques, and you
got the whole cascade there.
- It's a fairly straight line,
- Biologically,
From chronic stress
to your blood pressure's
chronically elevated.
It's a much more indirect
route to liver cirrhosis.
Some of this may sound
but I'm wondering,
more basic for you,
when you think
in the United States now,
about what's happening
these spikes in
among the white working class,
different causes of death
liver cirrhosis,
opioid overdose,
and suicide,
do you think stress is
the root problem here?
Oh, absolutely.
Our lives are
corroded by stress.
more psychologically
Stress: Am I valued?
Stress: Do I have
in the community?
a meaningful place
Stress: Is there
I can ever rely upon?
even a community
Stress:
Why am I here?

Gupta:
our great-great-grand kids
I've often wondered what
- would say about the lives
- That we've led?
(crowd chatters, cheers)
They'd probably say
that we lived in a world
that was changing
faster than ever before.
- I think in many ways,
- We'd say that
The wealth of the nation
was pretty good.
- When it comes to health,
- It actually becomes
- A much harder
- Thing to describe.
- You'd look at things
- Like obesity rates.
You'd look at cancer rates.
You'd look at heart disease.
- But there'd be this
- Underlying current
- That'd be much
- Harder to define...
-(siren wails)
real state of stress.
- which is this
- McNeill:
- Everybody wants a pill.
- Sometimes, we just don't have
- A pill to make you better.
Gupta:
We demand more drugs.
We take more drugs
in the world.
than any other country
There's no question
those drugs can save lives,
but nearly 50 Americans
die every day
from prescription painkillers.

What does stress look like?
Stress is... ugly. (chuckles)
Stress is something
that can cause issues
in every area of your life.
Close your eyes.
There we go.

Gupta:
I met Angela.
In Victoria, Texas,
She's a mother, she's a wife,
- she's a nurse,
- And she's being prescribed
A huge cocktail of meds
for her stress.
Here, let me grab
these clothes.
Angela:
and I was full-term.
I lost my second child
And that's when
I really started to...
look for ways to cope with...
what I was going through.

I took, um, pain medication,
hydrocodone,
and I took...
the Xanax for the anxiety.
- Justin Glass:
- She'd be acting different.
It got worse
after we lost a child.
And... has just steadily
gotten worse since then.
It's come to where
I take way more
than I'm supposed to.
Um, even the other night,
I was sitting there thinking,
maybe I should just
take all of these...
and just go to sleep.

- Gupta:
- It's hard to hear
And to think about
how many Americans
have been led down this
path of drug dependence.
- I know many people
- Who've been helped
By antidepressants
and other medications,
- but then ultimately,
- At the end of the day,
These premature deaths,
they are all...
a reflection of the stress,
the pain that comes with
that stress, and the desire to,
in some ways,
medicate it away.
Even to the point
and it could end your life.
where it could be dangerous

- Anne Case:
- Whites are...
Reporting poorer
and poorer health,
more and more pain,
more and more social isolation,
more depression,
along with this
increase in mortality
from drugs,
alcohol, suicide.
- There's just
- A lot more morbidity,
- Pain,
- Social isolation.
- Anne came up with the term,
- "Deaths of despair,"
But it's really taken off.

- Gupta:
- Anne Case and Angus Deaton,
- Husband and wife economists
- Out of Princeton,
Did this breakout
study on mortality.
Enough people have died
of deaths of despair
- to make it of the same
- Order of magnitude
As all the people
who've died of AIDS
- in the U.S. since the beginning
- Of the AIDS crisis.
Those mortality changes
were large enough
to cause life
expectancy to fall,
first for whites,
and then for
the entire population,
- and that's a really
- Unusual event.
These were the children
of the people who won
the World War.
- They were supposed
- To inherit the Earth.
That's a shocking
statistic.
- So, they were
- Promised the Earth,
But they did not inherit it.
In every state but two,
cirrhosis and alcoholic
liver disease went up,
and in every state,
drug poisonings went up.
In every state
between 1999 and 2015,
suicide rates went up
for people age 25 to 64.
If you treat people
in a really shabby way
for long enough,
bad things
happen to them.
That happened
to African-Americans forever,
- and it started to happen
- To whites
With a high school
degree or less,
starting probably
in the mid-'70s,
and now bad things
to both those groups.
are happening

- Gupta:
- I started this journey
Just outside of Pittsburgh
with Cyril Wecht.
Right there, right there
is where my mother
and father had
the mom and pop grocery store.
-Right there.
-Were those better times?
It depends on
what you mean by better.
Gupta:
decline can impact your health,
If you wanna see how economic
just go visit the Rust Belt.
- Wecht:
- We were producing more steel
Than the rest of
the world combined.
Twenty-four hours a day,
seven days a week,
that smoke went
up into the air,
along the Monongahela River
in the Mon Valley.
(birds cawing)

This valley is the epicenter
of the greatest
industrial collapse
in the entire developed
world in the '80s.
(rumbling)
1983 is when economic
Armageddon hit.
Crowd (chanting):
We want jobs! We want jobs!
Man:
wants to commit suicide,
Now, you wonder why somebody
- you let him go live
- A certain way for 30 years,
And then you pull the rug
out from underneath them.

Gupta:
it's still happening.
Today, it looks like
- Everyone says
- The economy is improving,
But plants are closing,
jobs are being outsourced,
and there are so many
people still left behind.
- Bobbi Boltz:
- So, I worked midnight shift.
- Got done on Monday morning,
- Sunday into Monday,
And phone calls, texts,
everything started coming.
- One of the guys
- At the plant called and said,
"There's a big
the bigwigs are in."
meeting at ten o'clock,
And he said...
(chuckles) "I'm sorr..."
(voice breaking):
It's closing."
My dad worked there.
My sister-in-law worked there.
- My brother worked there.
- (Sniffles)
- Gupta: - It was the best
- Job of your life,
- And then you're told
- One afternoon,
- -the plant is - Just shutting down.
- -Patty Thompson: Yes.
They completely
in a very wrong manner.
went about this
If you're gonna tell
220 people,
a whole facility,
that this place
is closing down,
- bring them
- All in at once.
- Don't let them find out
- Because they're badging in,
- And their badge
- Is not working.
You know, 26-plus years
in one place...
they talk down to you
like you were nobody.
And not only do
you feel helpless,
you feel rage.

- We had something here.
- We had something great here.
- We had...
- This plant was awesome.
- I have a wife
- And five kids at home.
- I mean,
- My thoughts are
- What am I gonna do
- To provide for them?
(patrons chattering)
Gupta:
on the back of...
This country was built
the middle class,
you know?
Is that American Dream
still alive?
Uh...
I don't know.
I hired on there
another 30 years.
expecting to be there
- I'm a dedicated worker,
- A lot of us are.
In this part of the country,
we go to work.
that's what we do,
Courson:
was anger.
My first reaction
- We were lied to, - Straight to our faces.
- We were told
- We were taking our plant down
- For maintenance shutdowns,
And then,
this place up again.
we're never gonna fire
Cyphert:
a kick in the teeth.
It's kind of
They can say all
in the world,
the "I'm sorrys"
it doesn't help any.
We're just workers.

Gupta:
this issue a lot.
I have thought about
I grew up with this issue.
- My parents are immigrants
- To this country,
And we lived in
a very small town
in Michigan
when I was a kid.
This Indian family grew up
with the white working class.
Parents working for
35 years plus,
the auto industry for
saw an incredible downturn,
and saw lots and lots of
people who they worked with
for decades
suddenly lose their jobs.
Frankie Sgambati Jr.:
so they're gone.
We had the two baseball fields,
- -We used to play - Football right there.
- -Yeah.
- I could tell you
- That tree wasn't there.
- The swimming pool
- That we had.
- I loved that
- Swimming pool.
- I think there may
- Have been summers
- -where we didn't pay at all.
- -Exactly!
-We were just sneaking
-Yep.
in all the time.
- -Everything else has changed.
- -Mm-hmm.
- -Gupta: It's good to be back.
- -Mm-hmm.
Glad to have you back.
Gupta:
homogeneous town.
We lived in this really
There was nobody else
who really looked like me.
- And then on top of that,
- When I was a kid,
The Iran hostage
crisis was happening.
And all of a sudden,
anybody of...
a certain skin color was
a target of xenophobia.
So, it was pretty brutal,
I think, for a while for me.
- So, when Sanjay
- Started kindergarten,
- Went to school just
- Across the street.
So one day, he comes home
and he's really quiet.
So he said, "Mom,
can I change my name?"
- I said, "Sure,
- We'll change your name.
What do you want to be?"
"I want to be Steve."
That time, Six Million
his favorite show.
Dollar Man show was
-Steve Austin show. You know?
-Sgambati: Okay. Yeah.
Then I asked Sanjay, I said,
"So, how many Steves
are in your class?"
And he counted five Steves
already in his class.
And I said, Sanjay,
one of the Steves
is gonna do very good.
But then if there
are five, six of them,
people will have a hard time
finding which Steve did good.
But the day Sanjay will do good,
there'll be only one Sanjay.
- I was supposed to go
- With him to school
- And change his name
- The next day.
- He came before
- I even got up.
He said, "Mom, you're
not coming to school."
- I said, "Why not?" He says,
- "I don't want to be Steve.
I want to be Sanjay."
See, now that's something
known as a child,
that I never would've
or even heard. Wow.
Gupta:
Indian family, I think,
I mean, we're the only
around, right?
- What about you
- Guys now though?
Sgambati:
the Michigan prison system
I've been with
for over 28 years, and...
throughout time,
because of economics,
budget cuts, um,
are under a lot of stress
a lot of people I know
because things aren't
as stable or secure
- as things used to be, and
- Things can change real quick.
You can be doing
everything right, but...
they can...
- Damyanti:
- Ford released a lot of layoffs.
Yeah, I was hired in 1967
as the first female engineer
with the Ford Motor Company,
and after close
to almost 34 years,
no notice,
nothing.
- They said,
- "Today's your last day."
- Saw a lot of people,
- They had tears in their eyes
As they were walking out.
Sgambati:
layoff slip a couple times.
I've been handed that
When you're not
in control, and...
it's stressful.
Man:
Everybody stand right here.
Yeah, so here, right here.
Gupta:
of the most stressed guys
I just assumed that I'm one
with my work as a surgeon
and as a journalist.
- And then I look at
- My best friend from childhood.
Probably has a lot more
stress in his life than I do.
- Because I'll tell you
- What I do have.
I have some control.
- With Frankie, I realized
- 'Cause he doesn't have control,
Because he doesn't
have the certainty,
that's a huge stressor.

How does your job
or your status really
impact your health?

There was this famous study
the Whitehall Study,
out of England called
and it was one
and dig into this.
of the first to really try
At the time that I got going
with the Whitehall Study,
everybody knew
caused heart disease,
that stress was what
and everybody knew
had more stress.
that high-status people
- When we looked
- At civil servants,
What we found was
the lower the status,
the shorter your
life expectancy.
Low control at work
increases risk
of heart disease,
of mental illness,
of musculoskeletal disorders,
and so close is the link
between social circumstances
and health that health
gives us a measure
of how well we're doing
as a society.

- -Charles Moore: - Hey, good morning.
- -How are you?
- -Good, good. How are you? - Good to see you too.
- -Good to see you.
- I appreciate you
- Making some time.
You really do dedicate
and so much of your time,
so much of your life
-which is part of what I wanted
-Okay.
to talk to you about today.
- Gupta: - Charles and I have known
- Each other for years.
- We trained together
- As doctors,
And I think we share a lot of
the same objectives in life.
I don't quite know
how to present
- what I'm seeing,
- What I'm learning here.
I'll be honest with you.
On one hand, we're seeing...
these white working class
statistics start to flatten
- in terms of life expectancy,
- Or even come down.
- On the other hand, - You are
seeing a little bit - Of an uptick
In life expectancy
among African-Americans.
It's still worse
for African-Americans,
but you're starting
to see the lines
come a little bit
closer together.
- I don't even know
- What to make of that.
For African-Americans,
it's been a chronic
state of stress.
Um, for certain
it's a new issue.
white populations,
And possibly that's what's
causing that decline for them.
The white working
class have not seen
that systematic...
type of oppression.

- Gupta: - If you look
- At the whole country,
- African-American
- Life expectancy
Is still three and a half
years less than whites.
Which is why Charles spends
his evenings treating people
who'd otherwise have
no access to health care,
in this clinic that he
set up outside the hospital.
- Just have a seat
- Right in here,
And I'll be right
in with you, okay?
Moore:
to ZIP codes that are up north
You can compare these ZIP codes
of Atlanta and there's
difference.
a 12-year life expectancy
Woman:
20 pills or something like that?
It's like 15 bucks for
- But I just don't know
- If I can afford it right now.
Having to make a choice
between medication and food,
or medication and gas is
a very stressful situation.
Moore:
that I have traveled to,
Looking at other countries
even though they're poorer,
there's still hope.
I think in many
places in the U.S.,
you're poor and many
people have no hope.
(wind blowing)
Courson:
Since we've lost the job,
we've gone through a lot
of our severance money.
We're dipping into savings.
And the lack of control
in this has been hard.

- There's always
- Stress in the house.
There's stress
looking for a job.
I can get out here
and calm down.
(panting)
I've probably stocked my house
with 75% of our meat this year
by hunting,
venison, rabbit,
porcupine, squirrels.
My wife depends on me.
I gotta make sure
I have a way.
(gunshot echoes)
It just seemed like
we didn't matter.
We didn't. We don't.
- If we mattered, it wouldn't
- Have been like this.
Gupta:
going on in the world today,
There's so much that's
- and, you know, when you think
- About manufacturing jobs
As a whole, leaving,
why do you think
that's happening?
-Greed.
-Greed.
I don't think we have
for the little guy.
compassion anymore
I think we've lost it
because we're a number.
My parents both worked
for 35 years,
in the automotive industry
and when
they got laid off,
I remember
really, in the household,
we didn't talk about it,
because there was
not much to really say.
If I talk to the guys at work,
that I catch up with or see,
they don't wanna talk
about it. It hurts.
Gupta:
to talk about,
I know it's painful
but if you don't talk about it,
that hurt
can turn to despair,
or even worse.
Stock market's up.
If you pick up the paper,
you hear the economy is
doing really, really well.
It doesn't seem like it when
there are so many struggling.
I mean, you know, Nick,
myself, my husband.
Companies are doing
great, profit-wise.
We're not seeing it.
- You're so used
- To be able to pay bills
And not have
to worry about...
- And then all of a sudden,
- When it's taken away from you,
It's hard.
Um, I think with my brother,
- when he lost his job,
- Unfortunately,
He just bought
a brand-new house,
a brand-new truck,
and two little ones.
I think he kind
of thought that,
he had that security
that it was gonna stay.
(sniffles)
You don't realize how frail
life is until something
unfortunately drastic
or terrible happens.
My mom had called me and said,
straight out, she said,
"Your brother's missing."
And I said, "What do
you mean he's missing?"
You know, in mind it's,
how can he be missing?
It wasn't even 10 minutes
later that she called.

She said he's gone.
I said, "What do you mean
he's gone? He can't be."
She said that, uh,
that he'd shot himself.
(microfiche clicks)
(wind blowing)
-(Michelle sniffles)
-(sighs)
He was an amazing person.
- Gupta:
- In the United States,
More people die by suicide
with a handgun
than die by homicide
with a handgun.
It's gone up 30%
over the last 17 years.
Sadly,
someone dies by suicide.
there are lots of reasons
But for too many people,
come back
I think it really does
to this idea of expectations:
The belief that
enough in this country,
if you just work hard
you can have a decent
standard of living.
Those dashed expectations
end up being the unique
and really toxic factor here.

(machine beeping)
- The headline is
- That stress kills.
- I think this is very important.
- Stress is everywhere.
We're drinking more.
We were smoking more before
we had social interventions,
like a higher taxation.
We have a massive
obesity epidemic
and economic stress.
So, we have the stage for
uncontrollable chronic stress.
The person is laying
in the scanner,
and there are stressful
images coming at them.

- Your response may be
- Very different than mine,
So it's very individualized,
and that's another piece
that we really study.
We also got data from
these subjects about
cumulative adversity
and trauma exposure.
And we showed
using brain imaging,
the amount of stress they've
had in their lives directly
correlates with the volume
in certain specific
regions of the brain.
Gupta:
I'm kind of amazed
As a neurosurgeon,
to hear that chronic stress
can actually reduce the size
of certain parts of the brain.
- I mean, I thought only
- Neurosurgeons could do that.
Your metric is when you
start to feel out of control.
-Yeah.
to basically say, look,
-That is a good time
the stress is now,
tipping point.
it's reached that
- But, you know,
- Even something like that...
- Amy Arnsten spent
- The last three decades
Doing pioneering work
on stress in the brain.
- Arnsten:
- So, even as a teenager,
I wanted to understand how
stress affects the brain,
because there were
several years where
we lost so many loved ones,
and I watched how
we'd go from being
very thoughtful, rational,
to suddenly being
in a swirl of confusion,
and I wondered what's
happening in our brains
that can do something
that powerful?

So, this is
the prefrontal cortex.
This is the part of the brain
that subserves our highest
order of cognitive abilities,
so we can inhibit
inappropriate thoughts,
inappropriate actions,
inappropriate emotions,
like cravings.
But this part of
the brain is incredibly
vulnerable to stress.
And even a mild stressor
makes these circuits
disconnect,
and we often can feel
confused, our mind blank,
unable to concentrate,
unable to make
thoughtful decisions.
With chronic stress,
the synapses where cells
talk to each other atrophy.
They're called dendrites
because they look trees
with little twigs,
and they speak to each other
through those twigs.
And so, their connections
wither away,
out to other cells
and that part of the
brain loses its function.
At the same time, stress
actually strengthens
these primitive circuits
that actually make
us very emotional,
and very much strengthen
habits like cravings.
Gupta:
the critical point.
I think this is
When you are exposed
to chronic stress,
you get these
changes in your brain
- that make it
- Increasingly difficult
To actually deal
with more stress.
So, how do you fix that?
Rajita:
In and out.
Just observing that in-breath
and the out-breath.

Noticing the sensations.
One crucial thing
that's helped me
- with my own stress,
- And I certainly teach others,
Is taking a hold of your mind.
So, we have early data now
that is starting to show
that with, say,
certain types
- of behavioral
- Skills training,
Whether it's mindfulness,
- short-term meditation,
- For example,
Exercise,
there are branches
that are regrowing.
The brain is plastic,
and with treatment,
some of it can come back.
Gupta:
After seeing this,
I couldn't help but think
of Angela back in Texas.
(inhales)

Angela:
be here right now,
If I knew I was gonna
I wouldn't have ever
started taking medication.
I don't wish this on anybody.
And I don't deserve
to live like this,
my kids don't deserve it,
my husband doesn't.
I, uh, I'm not going anywhere.
I don't know.
We said our vows,
we made our commitments.
I'm here for the long haul.
There's only one way
and that would be up.
to go from here,
- Angela:
- I want to learn how to...
Cope other than
self-medicating.
That's something that
I haven't learned before.
(crickets chirping)
I'm sorry.
Please don't hate me.
-Okay.
-Help for a new start.
(sobs)
- -Woman: Hello.
- -Angela: Hi.
-How you doing?
-Good. I'm Angela Glass.

Gupta:
I'm pretty used to knowing
As a doctor,
what the prognosis
is for my patients.
And as I sit here
and watch Angela,
I don't know how
she's going to do.
- And I don't know
- What the prognosis is
For this epidemic of
self-destructive behavior.
(news broadcasts
(playing indistinctly)
- Newswoman: - Extreme weather patterns
- Across the west...
- -White nationalist rallies...
- -Trump: Nuclear conflict.
Gupta:
unsettling feeling.
It's a very
(broadcasts continuing)
Veterans dying by suicide
more than in combat.
Gupta:
you live in a society
What happens when
that continuously stresses
300 million people?
-(broadcasts continue):
-Protests are spreading.
Ban on Muslim immigrants.
Children may remain in holding
facilities for some time.
(chittering)

- John Capitanio:
- Rhesus monkeys are so social,
- They provide a good model
- For understanding how
Social factors can affect
physiological functioning,
and in particular, stress.
(screeches)
(screeching)
Gupta:
social animals,
We are fundamentally
just like our
primate relatives.
Our social relationships impact
our stress and well-being.
Jessica Vandeleest:
we're interested in is
One of the things
the idea
of certainty of status.
You know, in humans,
we have socioeconomic status.
- Well, in monkeys,
- They have a high or low rank,
And it's kind of similar.
- The idea is you can have
- High or low position,
And that does govern,
you know, access to resources.
But in health outcomes,
the uncertainty might
actually play a stronger role.
Brenda McCowan:
the really low-end scale
So, animals that are on
of status and the really
high-end scale of status
tend to show pretty
high certainty.
But the mid-ranking animals
show the most uncertainty.
If you are somewhere
you have the ability
in the middle,
to be upwardly mobile
or downwardly mobile,
- and that creates
- This unpredictability
- And uncertainty,
- Which are affecting
The stress biomarkers,
health outcomes.
that in turn affect
Gupta:
stressful uncertainty
It's this kind of
that we're seeing in our
own shrinking middle class.
There's this constant
fear of downward mobility.
- When folks hear
- The economy is improving,
And they look at
people and they say,
"That's great... for you."
Frans De Waal:
monkeys side-by-side,
We put two capuchin
and there's a very simple
task that they need to do,
and if you give both of
them cucumber for the task,
they're perfectly willing
to do this 25 times in a row.
If you give them grapes,
that's a far better food,
- then you create
- Inequity between them.
The one on the left is
a monkey who gets cucumber.
The one on the right is
the one who gets grapes.
So, she gives a rock
to us, that's the task.
And we give her a piece of
cucumber and she eats it.
The other one needs
to give a rock to us.
And that's what she does.
And she gets a grape.
- And she eats it.
- The other one sees that.
She gives a rock to us now,
gets again cucumber.
(audience laughing)
She tests her rock now,
against the wall.
She needs to give it to us.
And she gets cucumber again.
- So, we're getting very close
- To the human sense of fairness.
(laughter)
The reaction, especially
this reaction, is so...
primate-like
You've seen people
and so human-like.
very much recognize
that response
that we all have
to inequality.

Sapolsky:
socioeconomic status,
When humans invented
we found a way of
subordinating our have-nots
like no primate has ever
come up with before.
What's the surest way
to make people feel poor?
Put them in a lot
of income inequity.
Have them surrounded by all
the stuff they don't have.
Rub their noses in it
over and over.
It's a sledgehammer
that overwhelms
any of these sort of
individual coping styles.
(shattering)
Salazar:
a city full of jobs out there,
I'm stressed because there is
and I don't have one of them.
- Gupta:
- What does it say about us
That we need these rage rooms
to try and relieve our stress?
It's become
a fast-growing business.
I just think there's
so many demands
on people now.
Gupta:
gets so stressed out,
Could it be that a society
that it actually
starts to break?

- Lisa Berkman: - It's not that wealth
doesn't - Buy you health. It does.
- The wealthy are better off
- Than people at the bottom,
Always, in every country.
But what's remarkable is that
in a wealthy country
like the United States,
that people at the top 10%
or top 25%,
they are not the healthiest
people in the world,
and they're not
the healthiest by a long shot.

Marmot:
inequalities in society
The evidence is,
affect the level of
health for everybody.
The greater the inequality,
the lower the levels of
trust of social cohesion,
the higher the levels
of social isolation.

Capitanio:
loneliness is
In human populations,
- associated with considerable
- Morbidity and mortality.
And we've developed
a monkey model of loneliness.
- And what seems to be
- Happening with these animals
Is that they seem to be
experiencing stress
as a result of this.
So, individuals that are
lonely are more likely to die
from a number of different
kinds of factors.
Vandeleest:
to a lot of animals
Animals who were connected
- and those animals were
- Connected to a lot of animals,
- Were actually
- Kind of protected.
And so, what we think
actually social buffering,
is going on here is
and it gets at
susceptibility.
an individual's
- So, it's the idea
- That if you have
A lot of really good,
solid relationships,
it kind of helps you maintain
a healthy physiology.
- And if you look
- At the evolutionary history,
- We've been
- In social groups so long
That it actually is
part of our biology.
And there's a lot of
when you don't have that,
research that shows that
it can be really,
really damaging.

Looking at female baboons
out in the wild who had
just lost a close relative,
glucocorticoid levels
go through the roof.
They're grieving,
exactly as in a human.
And they increase
their social grooming
- and their close
- Social relationships,
Their close relatives,
and the ones who do that
recover faster.
(playing up-tempo music)
- Gupta: - And we've known
- For a while that people
Who live in tight
social structures
have better health.
There was this famous study
in Pennsylvania
out of a small town
which directly showed
community
how living in a close-knit
helped reduce heart disease.
- Ichiro Kawachi:
- So, the Roseto study
Is a more than
50-year-long follow-up
of Italian-American immigrants
from Roseto, Pennsylvania.

They appeared to have
half the heart attack rates
of the rest of America,
including neighboring towns.
Here's a community
within the United States
that has a...
strikingly low death rate
from heart attack,
which is the major killer
in the United States.
- Kawachi: - So, they went about
- Finding out
Everything they could about
the citizens of Roseto,
measuring their blood pressure
or taking their
and diet and so forth.
cholesterol levels
None of these things could
explain their health advantage.
The people in Roseto
seemed to smoke at about
the same rate as people
in neighboring towns.
They had cholesterol levels
that were exactly the same.
In the end,
they settled on one factor
which is the magical
ingredient
- which is the opposite
- Of stress...
Social support
and social cohesion.
People are not only happier,
but they're more effective
and they're healthier
if they are interested
in each other.

Gupta:
Interestingly, today
we still see something like
a Roseto effect with Hispanics,
who actually live longer
than whites and blacks.
They even have a name for it.
- It's called
- The "Hispanic paradox."

The other half of
the story is that as Roseto
became more Americanized,
their advantage
gradually
in heart disease mortality
got whittled away,
until today,
it looks exactly the same
as neighboring communities.
Gupta:
a lot about life in Roseto
Of course, there is
that we might find
unacceptable today.
The answer's not to go back,
but to take what is
valuable and move forward.
Mainly this idea that in order
to best care for ourselves,
we have to care for each other.
Do you get back
in the field much?
My last season was
eight years ago,
um, and that turned out
to be the last one.
After 32 years,
things sort of collapsed there.
Most of my animals
got shot by rangers.

- Gupta: - When you look to the animal
- World and think about
- What's happening in
- The United States now,
- Are you
- Optimistic?
Well, there's definitely
some grounds for hope,
since one of the big
themes in neuroscience is
very little is set in stone.
There's a study of mine
from some years back
and this was
my main baboon troop
that I had been sort of
living with intermittently
for 20 years at that point.
- The baboon troop
- Next-door had
The tourist lodge
in their territory
- that opened up
- A big garbage dump.
Soon, they were in there,
feasting off
tossed food each day.
(chittering)
Along comes this TB outbreak,
and it killed all of my males
who went over there.
- Half the males are dead,
- But the most important thing is
Who were the males
who survived?
- The guys who
- Weren't aggressive.
- The guys who would rather - Sit and
groom with somebody - In the morning
- Than punch it out with someone
- For some thrown-out cake
From last night's dinner.
This became a troop
levels of aggression,
with extremely low
- and the most extraordinary
- Thing is that
As new males would
come in who grew up
in the big bad
real baboon world,
- it would take them
- About six months
- To take on this
- Behavioral style.
And it took one
generation to completely
upend this picture of what's
inevitable in a social system.
And somewhere in there is
some room for optimism.
(insects chirping)

Gupta:
to check back in with Angela.
So a year later, I wanted
She had gone through rehab.
I just wanted to make sure
she was doing okay.
I couldn't believe
what I saw.
-Are you okay?
I'm doing wonderful.
-Angela: I'm doing great.
- -Are you off all these meds?
- -Everything.
I don't take
anything at all.
I feel like being
on medication
alters your mind.
It alters the way you think.
I mean, people
want to...
medicate away everything,
- which it sounds like is
- What happened to you.
- Yes. It was
- A year before
- My grandmother died
- That my best friend
- Of 14 years
- Committed suicide.
In 2014,
I lost my daughter.
I honestly felt
like I was dying.
I had pulled a...
shotgun from
and put it in mine,
my husband's closet,
- thinking that
- I was gonna
Somehow find a way
to not be here anymore.
When you decided
to go to rehab,
how difficult
a decision was that?
It was...
It was hard. Um...
I consider everything that
I learned there a coping skill.
They taught me
to talk, and...
- I thought it was silly
- When the instructor came in,
And was telling us,
Just relax.
"Just sit back in your chair.
Take 10 deep breaths."
Halfway through,
this is working.
I was like, wait,
And I just felt
so much better.
That day was the best day that
I'd had in years, just knowing
that I can make it
without that medication,
through a day
-it's... it's amazing.
-I mean,
the story typically is,
as you know, I mean,
tens of thousands
of people die
every year from
these overdoses.
- But you came out
- The other side.
- I definitely feel like if
- There was a lot more people
Like my husband and my mom,
how supportive they were,
that a lot of people
would get help earlier.
-You are so good.
-Angela: Thank you.
- -I'm really happy - That you're doing well.
- -Thank you.
-Thank y'all for everything.
Angela needed help.
-Gupta: It's very clear
She couldn't have
done this on her own.
- But too often today,
- It seems like we've lost
- Some of that care
- And compassion
For the larger
American family.
- Do you have
- Your own
Stress-relieving
techniques?
It never quite
did it for me.
- Do you get a lot of time
- To walk through here?
Pretty much part of
with the big dog.
an hour a day in here
Gupta:
animal cultures,
When you look at
- and I don't wanna be,
- Again, sound too simplistic,
- But the idea that
- We would ultimately evolve
Toward something that would
be for the greater good,
and yet we have
structures in place where
people who are
seemingly addicted
to power and money,
who are really,
from the majority
truly disconnected
are the ones that are making
decisions on their behalf.
Our motivations
are varied
and often
subterranean,
- and no one can make
- A reasonable claim
That we're consistently
rational beings.

- From my bias
- As a neurobiologist,
The most interesting realm
of stress discoveries
in recent decades is just how
much it's doing to your brain
and the frontal cortex.
And it turns out,
stress and stress hormones
impair one of the most frontally
demanding tasks we have,
which is to be empathic,
which is to take somebody
else's perspective.
Empathy goes down
when you're stressed.
- That's sure not gonna do
- Good things for the world.
So, humans
becoming...
- more stressed or having these
- Different types of stress,
Is this just how
we continue to evolve?
Well, essentially,
from a Darwinian perspective,
you're basically
winnowing out peoples
seeing us slowly
whose stress responses
are least adaptive
in the face of these human
psychological stressors.
Gupta:
frightening concept.
There's this
- This idea that some of
- What we're seeing here
Is a sort of
social Darwinism.
I mean, really. I mean,
blunt about it.
you know, just being
-Right.
at a faster rate,
-If people are dying
uh... is their
utility used up?
- You know, you could say
- The capitalist system
Has very little use for people
who don't have B.A.s anymore.
You know, I don't know
social Darwinism or not.
whether you'd call that
We also have, I think,
- the idea that the poor
- Aren't deserving
Because if they were deserving,
would they?
they wouldn't be poor,
- Gupta: - We demonize
- Those people.
And people will say,
"What? Wait a second.
"I am paying
for the people who...
- "are eating
- Themselves to death.
"They're taking opioids,
whatever it may be.
they're drinking too much,
"Why is that my obligation?
Why am I saving them,
or why are we saving them?"
- Case: - Oh, so you might as well
- Kill them off
With drugs,
alcohol, suicide?
- -Gupta: Or not save them.
- -Or let them go? Not save them?

Gupta:
of an opioid overdose,
When someone is dying
we know how to save them.
- There's a medication
- Called Narcan.
You give it to someone,
it saves their life.
Who wouldn't want that?
- Dan Picard out
- Of Middletown
- Says his community
- Should no longer respond
To drug overdose calls
because of the cost.
Picard:
what we have to do
We've gotta do
- to maintain our
- Financial security.
If it's somebody who's already
been provided services twice,
- we will advise them that
- We're not gonna provide
Any further services, and
we will not send out an EMT.
- You know, there's this talk
- About the three-strike rule.
You know, if you get hit
let them die.
with Narcan three times,
- And I said,
- Are you kidding me?
Paramedics now will start
carrying tattoo guns and then,
if there's a third mark,
I said that's crazy.
they just let you die?
Celeste Trilli Palamara:
it's the same thing.
Well, you know, smokers
- Because they
- "Did this to themselves."
- Heart patients, if they don't
- Take care of themselves,
- Exercise, eat
- The correct diet, diabetics.
- I mean, are we gonna
- Tell those people,
Okay, you come once more
with your sugar sky-high,
- then we're not gonna give you
- Anything to take care of you.
You just go home,
It's the same thing.
you had your chance.

Gupta:
this idea of social Darwinism.
It's hard for me to accept
This idea that unless
you're adding real value,
unless you're
contributing in some way,
what use are you,
really, to society?
But I gotta believe,
thankfully,
that that is still
the minority opinion.
Most people, I think,
is to be compassionate.
their default position
I think it's how we humans
survived and thrived.
We were communal,
- and that's the only thing that's
- Gonna save us going forward.
(monkeys vocalizing)
I started my studies
aggressive behavior,
as a student to study
- and chimpanzees
- Have plenty of that.
Then I discovered
after fights,
that they also reconcile
- and that they share
- Food quite easily.
And I got actually more
interested in those phenomena
than the fights that
occasionally erupt.
- The alpha female
- In the middle,
Who's clearly dominant over
the rest of the females,
and so she could easily
- keep all that food
- For herself,
But the others are allowed
to take pieces out.
People who have
this ideology that
- competition is good for you
- And greed is good for you,
- They like to project
- That ideology on nature,
And they can find
plenty of examples.
(growls)
- And then they come back
- And they say
That confirms that this is
the way we ought to behave,
but that's a bit of a trick.
Deep down,
we are social animals.
Social animals means
that you compromise...
It means that you are
altruistic and help others,
- and that creates an environment -
That is actually more - Productive for you,
- So it is
- A self-interested strategy
'cause you're better off in
a society that is supportive.
Our default
position is to be
- -empathetic toward others.
- -Yeah.
- 'Cause the world doesn't
- Seem that way sometimes.
- Protesters (chanting):
- Hey! Hey! NRA!
How many kids
have you killed today?
- Every day that goes by,
- We wonder,
- Are we really safe
- In our schools?
The other week, a quarter
of our school didn't attend
- because they were
- Scared of guns.
And there were eight
gun threats for one day.

- Gupta:
- If you wanna see the future
Of what this stress
epidemic looks like,
- you just have to look
- At the children.
-A lot of adults have stress...
-Hailey Turner: Yeah.
Their jobs, their lives.
You... You teenagers,
- how would you
- Compare your stress
To your parents'
or to other adults'?
- Hailey: - Our generation has a completely
- Different perspective.
We're not as shocked when
we hear that 17 students
were murdered, you know?
- I've definitely
- Felt that I've been
So angry at the world,
and I just wanted to...
whoop everybody's ass,
you know, 'cause I was so angry.
- It's a sickening
- Feeling.
It's weird how you
your stress, you know?
can physically feel
It's almost like
you know?
impending-doom sense,
- You can't really focus
- On anything else,
- Except what you're
- Stressed out about.

(crickets chirping)
Hailey:
about that, you know,
It's crazy to think
back when our parents
were young, they were...
practicing for the Cold War.
-Samara: Oh yeah.
and now we're...
-Like, nuclear threats,
hiding from ourselves, yeah.
It's just something
that we're scared of now.
I mean, if you can't
feel safe in a school
-or a church, where are
-Exactly.
you gonna feel safe?
- There's nowhere.
- What is America doing wrong?
Lane:
self-centered nowadays.
People are more
And they just really care
about what they want.
-It's all about
-Yeah.
the views you get...
And how many likes
you get, or retweets.
Hailey:
social media, you know,
And another thing, through
-I can post a post,
-Samara: Yeah.
I'm like, "You're so ugly."
- And I don't have to worry
- About seeing her face-to-face.
- I can make her feel
- As crappy as possible,
- And I don't have to worry
- About the repercussions.
We can't just keep going
the way we're going because
-we're collectively
-Samara: Yeah.
kind of killing ourselves.
I really... I really worry
on young people today.
about the pressures
- I mean,
- As I've always said,
Stress in and of itself
is not a bad thing.
It's when it doesn't stop,
and I think social media
and just that incessant
nature of it...
puts a constant level
of stress on kids.
It's probably topic number one,
- I think, when we parents
- Get together.
- Our parents didn't
- Have to deal with this.
- When I go to my parents
- And ask them about
Some of this stuff, they say,
"We didn't have any of this."
-Can you help me
-Q! Q! Sit! Hey! Hey!
get Q, please, Daddy?
Come here.
Hey, Q! Come here!
(groans)
- -You having a good day?
- -Mm-hmm.
You wanna hear
my Iris, um, monologue?
Yes.
- My sisters,
- Who are mean, horrible,
Terrified of teachers,
half-woman, half-bird.
and like I said before,
Gupta:
that I see everything
There's no question
as a dad now.
- What's my kid gonna
- Be learning in school?
- How are their brains
- Gonna develop?
What kind of world are
for our kids?
we leaving behind
The thing I want
is empathy
my kids to learn
because I believe so many other
good things follow from that.
Dinner's ready.
Gupta:
empathy in a world
But how do you teach
where everything around you
can seem like
a potential threat?
(indistinct chatter)

Newswoman:
Life expectancy dropping
Another shocker of a story.
- in the U.S. for the third
- Straight year...
Newsman:
Americans died...
More than 72,000
Newsman 2:
Jump in suicides...
- Gupta: - I started this film
- When I saw
- That U.S. life
- Expectancy had dropped
For the first time in years.
Now, two years later,
the CDC just announced
life expectancy has
declined in America
for three years in a row.
- That hasn't happened
- In a hundred years.
- Last time this
- Really happened,
- You know, there
- Was a World War,
There was an infectious
disease, the pandemic,
- spreading around
- The world.
So, what's driving it now is
a very different situation.
Wecht:
that this epidemic
It does not appear
is going to end in
the foreseeable future.
Who would disagree
that we've got a very stressful
situation in our country?
- How bad is it now compared
- To what you've seen
In decades past?
It is really a very bad
situation at this time.
Sanjay,
you have people
having guns,
and you have these
physical, political,
social confrontations.
- Put all of
- That together,
- And then the stress,
- Let's say, economically,
And you've got
one hell of a mess.
And then, you have
to deal with it and so on.
the drugs that are available
So, you say, gee, how come
we have more drug deaths,
- and how come we have
- More people drinking,
- And how come
- We have more suicides?
As Pogo said,
- "We have met the enemy,
- And he is us."
(indistinct chattering)
- Welcome,
- Sanjay Gupta.
(applause)
Gupta:
in our health care system.
It is a critical time
Sometimes, as we talk
and the solutions,
about these issues
we've put them in the bucket
of medicine and health,
but for me, that issue became
one of justice as well.
And how do we think about
medicine and health and justice?
We cannot ignore
the impact of stress
- on our society,
- And what it's doing to people
In very, very tragic ways.

If the United States
were my patient,
and I were the doctor right
now looking at this patient...
I mean, the prognosis
isn't great.
Let me just point out the spot
that's the problem spot here.
People are dying,
all because of policies
that haven't reflected
scientific knowledge.
It's like you're
creating a problem,
then to have guys like us
go in there and try and...
solve the end product, you know?
- And even worse,
- In some ways,
- It seems like we're
- Manufacturing the disease.
Bad food, opioids,
gun laws,
- and our energy policy have
- Led to these problems.
And as much as they
make short-term sense
for the people who are making
money off of those problems,
it's bad for people.
- Is he eating
- At all or...
- He's eating
- Little bites,
- But hopefully
- The tube will come out
- -in the next couple days, - The NG tube.
- -Okay.
-Gupta: How you feeling?
-Patient: Uh, good.
-Do you feel me touch
-Patient: Yeah.
you okay up here?
-That feel the same
-Yeah.
as over here?
How about this?
-Wanna try
-Yeah.
and stand up for us?
- Here, I'll give you a hand.
- Why don't you hold my hands?
Here hold...
-That's pretty good.
-Yeah?
The majority of the work that
any of us do in this hospital
is to take care of diseases
entirely preventable.
that are almost
And I think once you've seen
that, you can't unsee it.
But we can stop manufacturing
the disease in the first place,
and that's a big idea for me.
A big idea for all of us.