Living in ‘survival mode’ causes chronic illness, and may even kill you
Why I'm moving to Italy, part two
This essay is free to read. Please consider becoming a subscriber to support the creation of essays on essential topics like this.
Last week's essay, "The Way We Live In America Is Not Normal," resonated well beyond anything I expected.
I was inundated with messages from Americans (and even some Brits) who felt I was giving voice to their fears and frustrations about living in a country where capitalism has become untethered to ethics, morality or any sense of decency.
If you were brought here by that essay, welcome!
I received many questions about the logistics of purchasing property in or moving to Italy, which I will address in later posts. We are in the middle of this process, and I am learning as I go along. It's complicated, and everyone gives you a different answer, so I will only post about this once I've done a real journalistic deep dive and feel sure that what I am sharing is accurate.
Moving Abroad Is Not “Just For Rich People”
I did hear from some readers that they wished they could make a move like this, but such things exist only for rich people. I can't stress this enough: it's the opposite. Many Americans are moving to other countries, including Italy, because the cost of living and the lack of a social safety net in the United States is crushing them.
I'll give you a sense of how much cheaper it is for us: once Robert and I have built a small two-bedroom house and renovated a Trullo on the land into a one-room guest house with an outdoor kitchen, and have put in a pool (!) the entire cost, including the land, will be less than half of what our 1800 square foot town home with no yard in a pretty basic (not fancy) Washington D.C. neighborhood is worth.
I'm not the only one who thinks that something is so off in the U.S. that moving to another country is a good idea. Burnt-out millennials are flocking to Portugal and this teacher moved to Denmark for a more affordable and less stressful life. Black women are banding together to leave America. I mentioned last week that my therapist joined a Facebook group for Black expats in Panama and has happily relocated there.
I am confronted with people at the end of their ropes everywhere I turn. Wanting to leave the U.S. is more than just a matter of preference. For many, it has become an issue of survival.
Chronic Stress Has Become Normalized
This brings us to something I want to dig into a little deeper today: how chronic stress and burnout culture destroy our health. Americans suffer from chronic illness in a way that is unique among industrialized nations. The insane levels of stress we live with is a major factor in this.
A year-long Washington Post examination sounded the alarm in An Epidemic of Chronic Illness Is Killing Us Too Soon:
After decades of progress, life expectancy — long regarded as a singular benchmark of a nation's success — peaked in 2014 at 78.9 years, then drifted downward even before the coronavirus pandemic. Among wealthy nations, the United States in recent decades went from the middle of the pack to being an outlier. And it continues to fall further and further behind.
Heart disease and cancer remained, even at the height of the pandemic, the leading causes of death for people 35 to 64. And many other conditions — private tragedies that unfold in tens of millions of U.S. households — have become more common, including diabetes and liver disease. These chronic ailments are the primary reason American life expectancy has been poor compared with other nations.
The Yale School of Medicine Stress Center notes that "stress is known to play a key role in many chronic illnesses including chronic pain, heart disease, diabetes, and some forms of cancer."
In a recent report, Stress in America 2023, the American Psychological Association found that among those aged 35-44, nearly 60% reported they suffered from a chronic illness, and 45% percent said they had received a mental health diagnosis. Adults ages 18 to 34 reported the highest rate of mental illnesses at 50%.
I was already concerned about the toll life in America was taking on people's physical and mental health when I picked up Canadian doctor Gabor Mate's latest book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture.
I went from concerned to terrified pretty quickly.
Throughout this Bible-sized book, Mate methodically outlined all the chronic and life-threatening diseases that are caused by and/or made worse by chronic stress and trauma. Mate then unequivocally laid it all at the feet of post-1980s American capitalism, which has introduced a level of unrelenting financial pressure and uncertainty that did not previously exist. As with all American inventions, this type of capitalism has been exported to other countries to visit its misery on them as well.
Mate writes:
Thus, on the very terrain in which capitalism stakes its greatest claims to success—economic achievement—we find many people in a state of chronic uncertainty and loss of control, subject to stress-inducing fears that translate into disturbances of the hormonal apparatus, of the immune system, and of the entire organism.
No wonder, then, that insecurity about work or the loss of it can instigate disease. Studies in the United States showed that the risk of stroke and heart attack in people fifty-one to sixty-one years of age more than doubles in the aftermath of prolonged job loss.
More Mate:
A society that fails to value community—a need to belong, to care for one another, and to feel caring energy flowing toward us—is a society facing away from the essence of what it means to be human. Pathology cannot but ensue. "When people start to lose a sense of meaning and get disconnected, that's where breakdown in our health—mental, physical, social health—occurs," the psychiatrist and neuroscientist Bruce Perry told [me].
Mate notes that "our hormones and nervous systems clock [the] presence or absence" of meaning in our lives.
Corporations swoop in like vultures to fill the void of meaning, selling belonging and identity through their products. Spoiler alert: Lululemon or any kind of “retail therapy” can't heal your nervous system or any of the myriad health problems late-stage capitalism has visited upon you.
The Washington Post examination came to a similar conclusion regarding the scourge of chronic illness in the United States:
[E]xperts studying the mortality crisis say...poor life expectancy…is the predictable result of the society we have created and tolerated: one riddled with lethal elements, such as inadequate insurance, minimal preventive care, bad diets and a weak economic safety net.
"There is a great deal of harm in the way that we somehow stigmatize social determinants, like that's code for poor, people of color or something," said Nunez-Smith, associate dean for health equity research at Yale. And while that risk is not shared evenly, she said, "everyone is at a risk of not having these basic needs met." (Bold and italics added for emphasis).
Almost everyone, lives with chronic stress in the United States. But if you are a member of a marginalized community, it’s a million times worse. The health impacts of systemic racism—on top of all the other stressors—for example, are undeniable.
Self-reported racial discrimination is just as harmful as any of the commonly named “lifestyle” culprits: lack of exercise, smoking, a high-fat or high-salt diet. Black women are three to four times more likely to die from pregnancy-related complications than white women, according to the Centers for Disease Control and Prevention—and a big reason for the disparity may be racism, say experts.
Survival Mode Is No Way To Live
Chronic stress keeps you in a trauma response — fight, flight or freeze. Your body never gets a break because you are always on high alert and living in survival mode. The chronic uncertainty and anxiety naturally leads you to overwork so you will have the resources to survive.
This is a very primal state. You know that if you fall, society will not catch you. (Though you will be given the opportunity to amass credit card debt that will follow you for the rest of your life thanks to criminal levels of interest)
As I briefly touched on last week, most people who overwork will eventually burnout. At this point, functioning becomes almost impossible as your body and mind have been maxed out.
You are running on fumes.
The writer
made the point in a viral article that while people mock and criticize Millennials for not being as “adult” as other generations were at their age, what is missed is that much of their behavior is a result of extreme burnout, since most of them have only ever lived under capitalism gone crazy.We don’t have to live this way. It’s not normal.
In an article about life expectancy, the Washington Post interviewed a cardiologist in Milan, Nicola Triglione, who frequently visits the United States to study the latest health-care innovations:
[Mr. Triglione] said he would never move to the United States. He knows too many Italian doctors who moved to the country but found the lifestyle unsustainable. The problem wasn’t their patients’ health — it was their own. “After maybe 10 years, they come back, and they say: ‘I’m done. [The Americans] work too much, it’s a money game, they have, I don’t know, four weeks of vacation a year?’” Triglione said.
Of course, it’s actually two week’s vacation for most Americans, if they get a paid vacation at all.
The U.K. writer
makes the interesting point that burnout is often about overwork—but not always. Sometimes, she says, it can be an existential burnout. This could occur even if you are keeping reasonable work hours and not pushing your body too hard.“Essentially this kind of breakdown is a way of life saying to you: this current way you are living isn’t working,” she writes.
Gannon quotes the writer Kendra Patterson:
"Existential burnout is a whole-life phenomenon when you begin to question the very foundations of your life and beliefs. It is the state of emotional, psychological, and spiritual confusion and exhaustion that results from years or decades of trying to follow conventional paths and not finding satisfaction or happiness through them."
Wow.
I have experienced both, but these days I relate most to the existential burnout. The “conventional path” got me to a lot of places I didn’t want to be. So, now I’m going to try the unconventional path.
When I was younger, the idea that I could burn out or come down with a chronic illness seemed fantastical.
Until, that was, it happened.
In my late 30s, I started to develop fatigue that I could not shake. By my early 40’s it had turned into full-blown Chronic Fatigue Syndrome. I slept 14-18 hours a day and woke up exhausted, with a brain fog that would never clear.
My official diagnosis was “reactivated Epstein-Barr,” and the infectious disease doctor who diagnosed me told me to take a minimum of six months off from work. “If you don’t do this, one day you will lie down and not be able to get up again,” he said.
I was a consultant and, therefore, did not have access to any disability leave. I needed to work to pay my rent. So, I worked. And I got more sick. Eventually, I could barely function and was mired in a deep depression and anxiety.
Life was beyond miserable; sometimes, I thought I would not make it.
This went on for almost a decade.
I eventually regained my health (that’s another story), though I still feel the repercussions of pushing my body too far for too long. I think having this experience has made me extra-attuned to the pressures our culture puts on our bodies. I will never go back to feeling that way, and nothing seems too dramatic — including moving to another country — if it means I can maintain my physical and emotional health.
Last year, I was talking to a top executive coach about how I wished I could go away for a month just to heal the damage I had done to my body and mental health through three decades of overwork, pushing it beyond anything it should have reasonably asked to do. I wanted my poor nervous system—which was perpetually dysregulated until a few years ago—to have an extended break.
She looked at me with something akin to pity.
Oh, you poor dear.
“It will take a minimum of a year of not working to undo the damage,” she told me. I knew instantly that she was lowballing it. “Think of how many years it took to create the problem. It won’t be undone with a month of rest in another locale.”
Of course, a month can’t fix this.
But who can take a year (or more) off from work? I couldn’t and I still can’t.
But I could move and live in a more affordable and humane society from where I could do my work. I could stop adding more chronic stress to my already worn-out body. I could live among people for whom “hustle and grind” has no meaning. I could learn a different way of being.
This was yet another turning point (in addition to those I outlined in my last essay) that led me to want to make a life in Italy.
What’s interesting to me is that I’ve written two essays about why I think leaving the US makes sense and I haven’t even mentioned the political situation, which, for many, would be reason enough alone to go. I haven’t mentioned it partly because I think it’s pretty well understood to be a factor for many people who want to leave.
But I mostly haven’t mentioned it because I want people to see how fundamentally broken American society is, even if we weren’t looking down the barrel of a potential authoritarian government.
The point of writing these essays is not to convince people to leave the United States. While that may be the right decision for some, it isn’t for others. I’m writing them because I think the fact that so many people are reaching the same conclusion about how unlivable the the US has become tells us just how off course we are. Most of us are people who in the past would never have considered leaving the United States.
We all need to be clear about what is wrong—about how unbelievably abnormal our way of life is—so we can have a plan to fix it.
When my husband and I started seriously talking about moving to Italy, I expressed my frustration that I had not gotten an Irish passport back when all you needed were living relatives in Ireland, which I had at the time. Having an Irish passport would have allowed me to live anywhere in Europe.
How could I have not done this? What was I thinking?
I was berating myself. And then it dawned on me.
Oh right, I never thought I might want to flee the United States.
What Caught My Eye This Week
)Inside The World of Guide Dog Dropouts (Mel Magazine)
So, How Do Adults Make New Friends? (Vogue)
Your feedback is important to me, so if you enjoyed this post, please hit the ❤️ and share it.
This is EXACTLY what I’m dealing with. After realizing everything I was working so hard for 1) wouldn’t make me happy and 2) was causing serious health issues, I took a step back. But I’m finding taking a step back isn’t enough. How do I step OUT of this? Take a year off work? Find a job I can do without feeling this existential burnout? It’s almost like I’ve had this taste - and I want MORE. I want more freedom and more rest very primally. I guess like everything good in life it won’t come easy. But is there anyone who has done this within the US? Is the ONLY answer leaving?
Kirsten, thank you for this article. Your thoughts are personally meaningful and your position cogent.
I have spent 41 years in military and federal government employment. I can speak first hand on the culture of unremitting work as part of an American identity or ethos.
I am particulary struck by the accumulated evidence the medical establishment has documented over the years, as your article alludes to. Despite that, we literally continue to kill outselves.
I spent my youth and career being flogged by this bloody Calvinist work ethic. I compensated by being being an able worker and manager but refusing to go the “extra mile” as an expected matter of course.
I learned quickly the reward for excellence was exploitation and then flogging to exhaustion.
And I feel guilty for saving myself.
I lived in Europe for ten years and am well aware of the gulf between the US and European work models. By and large, they are a humanitarian establishment by comparison.
I spent a further 21 years working for INS/USCIS where I came into close proximity with like European organizations. How they treated their own employees in comparison to ours was like a bucket of ice water over the head.
I believe most of us don’t understand how killing ourselves for our employer has become, not widespread, but de rigueur.
Keep up the great analysis of life but don’t let your work or us, for that matter, flog you to insensibility.