Harry M. Caudill, in his monumental 1963 book Night Comes to the Cumberlands
, describes how relief checks became a kind of bribe for the rural poor in Appalachia. The decimated region was the pilot project for outside government assistance, which had issued the first food stamps in 1961 to a household of fifteen in Paynesville, West Virginia. “Welfarism” began to be practiced, as Caudill wrote, “on a scale unequalled elsewhere in America and scarcely surpassed anywhere in the world.” Government “handouts,” he observed, were “speedily recognized as a lode from which dollars could be mined more easily than from any coal seam.”
Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters.’ If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’... to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family.”
Joe and I are sitting in the Tug River Health Clinic in Gary with a registered nurse who does not want her name used. The clinic handles federal and state black lung applications. It runs a program for those addicted to prescription pills. It also handles what in the local vernacular is known as “the crazy check” -- payments obtained for mental illness from Medicaid or SSI -- a vital source of income for those whose five years of welfare payments have run out. Doctors willing to diagnose a patient as mentally ill are important to economic survival.
“They come in and want to be diagnosed as soon as they can for the crazy check,” the nurse says. “They will insist to us they are crazy. They will tell us, ‘I know I’m not right.’ People here are very resigned. They will avoid working by being diagnosed as crazy.”
The reliance on government checks, and a vast array of painkillers and opiates, has turned towns like Gary into modern opium dens. The painkillers OxyContin, fentanyl -- 80 times stronger than morphine -- Lortab, as well as a wide variety of anti-anxiety medications such as Xanax, are widely abused. Many top off their daily cocktail of painkillers at night with sleeping pills and muscle relaxants. And for fun, addicts, especially the young, hold “pharm parties,” in which they combine their pills in a bowl, scoop out handfuls of medication, swallow them, and wait to feel the result.
A decade ago only about 5% of those seeking treatment in West Virginia needed help with opiate addiction. Today that number has ballooned to 26%. It recorded 91 overdose deaths in 2001. By 2008 that number had risen to 390. Modified from Tomdispatch