Sometime in 1993, after several trips to Russia, I noticed something bizarre and disturbing: people kept dying. I was used to losing friends to AIDS in the United States, but this was different. People in Russia were dying suddenly and violently, and their own friends and colleagues did not find these deaths shocking. Upon arriving in Moscow I called a friend with whom I had become close over the course of a year. “Vadim is no more,” said his father, who picked up the phone. “He drowned.” I showed up for a meeting with a newspaper reporter to have the receptionist say, “But he is dead, don’t you know?” I didn’t. I’d seen the man a week earlier; he was thirty and apparently healthy. The receptionist seemed to think I was being dense. “A helicopter accident,” she finally said, in a tone that seemed to indicate I had no business being surprised.

The deaths kept piling up. People—men and women—were falling, or perhaps jumping, off trains and out of windows; asphyxiating in country houses with faulty wood stoves or in apartments with jammed front-door locks; getting hit by cars that sped through quiet courtyards or plowed down groups of people on a sidewalk; drowning as a result of diving drunk into a lake or ignoring sea-storm warnings or for no apparent reason; poisoning themselves with too much alcohol, counterfeit alcohol, alcohol substitutes, or drugs; and, finally, dropping dead at absurdly early ages from heart attacks and strokes.

Back in the United States after a trip to Russia, I cried on a friend’s shoulder. I was finding all this death not simply painful but impossible to process. “It’s not like there is a war on,” I said.

“But there is,” said my friend, a somewhat older and much wiser reporter than I. “This is what civil war actually looks like. “It’s not when everybody starts running around with guns. It’s when everybody starts dying.”

My friend’s framing stood me in good stead for years. I realized the magazine stories I was writing then were the stories of destruction, casualties, survival, restoration, and the longing for peace. But useful as that way of thinking might be for a journalist, it cannot be employed by social scientists, who are still struggling to answer the question, Why are Russians dying in numbers, and at ages, and of causes never seen in any other country that is not, by any standard definition, at war?

In the seventeen years between 1992 and 2009, the Russian population declined by almost seven million people, or nearly 5 percent—a rate of loss unheard of in Europe since World War II. Moreover, much of this appears to be caused by rising mortality. By the mid-1990s, the average St. Petersburg man lived for seven fewer years than he did at the end of the Communist period; in Moscow, the dip was even greater, with death coming nearly eight years sooner.

In 2006 and 2007, Michelle Parsons, an anthropologist who teaches at Emory University and had lived in Russia during the height of the population decline in the early 1990s, set out to explore what she calls “the cultural context of the Russian mortality crisis.” Her method was a series of long unstructured interviews with average Muscovites—what amounted to immersing herself in a months-long conversation about what made life, for so many, no longer worth living. The explanation that Parsons believes she has found is in the title of her new book, Dying Unneeded.

Parsons chose as her subjects people who were middle-aged in the early 1990s. Since she conducted her interviews in Moscow over a decade later, the study has an obvious structural handicap: her subjects are the survivors, not the victims, of the mortality crisis—they didn’t die—and their memories have been transformed by the intervening years of social and economic upheaval. Still, what emerges is a story that is surely representative of the experience of a fair number of Russians.

People of the generation Parsons describes were born in the desolate, hungry years following WWII. They grew up in communal apartments, with two or three generations of a single family occupying one or two rooms and sharing a hallway, bathroom, and kitchen with three or seven or even a dozen other families. But then, in the early 1960s, Nikita Khrushchev organized a construction boom: cheaply constructed apartment buildings went up all around the periphery of Moscow, and Russians—first and foremost, Muscovites—moved out of communal apartments en masse. By the Brezhnev years, in the late 1960s and 1970s, there were also Soviet-made cars and tiny country houses—such at least was the Soviet consumer dream, and it was within reach for a significant number of Russians.

In addition, three important things made life not only less harsh, relative to earlier years, but even worth living. One was the general perception of social and economic stability. Jobs were unquestionably secure and, starting in the 1960s, followed by a retirement guaranteed by the state. A second was the general sense of progress, both of the sort Soviet propaganda promised (the country was going to build the first communist society, in which money would be abolished and everyone would share in the plenty); and the personal material improvement this generation experienced itself moving toward. A third source of comfort of Soviet life was its apparent equality. A good number of people with connections enjoyed extraordinary perquisites compared to the vast majority of the population, but the wealth-and-privilege gap was concealed by the tall fences around the nomenklatura summer houses, the textbook and newspaper depictions of Soviet egalitarianism, and the glacial pace of mobility into one of the favored groups at the top.

Parsons and her subjects, whom she quotes at length, seem to have an acute understanding of the first two forces shaping Soviet society but are almost completely blind to the last: the hidden nature of Soviet social inequality. One woman says that the difference between current poverty and poverty in the postwar era is that “now there are rich folks.”

But by the early 1980s, the Soviet economy was stagnant and the Soviet political system moribund. Finally, a younger leader, Mikhail Gorbachev, emerged, but the decrepit structure proved incapable of change and, in short order, collapsed, taking with it the predictable life as hundreds of millions of people had known it. Russia rushed into a new capitalist future, which most of the population expected to bring prosperity and variety. Boris Yeltsin and his team of young, inexperienced reformers instituted economic shock therapy. As far as we know today, this series of radical measures jerked Russia back from the edge of famine but also plunged millions of people into poverty. Over the next decade, most Russian families—like their counterparts elsewhere in the former Soviet Union—actually experienced an improvement in their living conditions, but few who had spent many adult years in the old system regained the sense of solid ground under their feet.

“To Lyudmila, economic shock therapy looked a lot like war-ravaged Russia,” Parsons writes of one of her respondents. “In a terrible sense it was as if the poverty of her youth and the poverty of the early 1990s had merged together. Thirty-five years of her life, from age nineteen when she started work in the mechanics factory to age fifty-five when the Soviet Union fell, fell out of view.” Parsons devotes an entire chapter to comparisons between the collapse and chaos of the 1990s and the devastation that followed World War II. “Margarita told me with some disgust, ‘It is just like after the war.’ And then she would add—half angry, half baffled—’But there was no war.’ …The fifty-seven-year-old taxi driver I interviewed said, of those older than himself, ‘They will never understand what happened. No war, nothing. And everything fell apart.’”

Not only had the retirement system collapsed, but neither the job market nor their own families—those grown children who had once been entirely dependent on their parents—had any use for these people. Gone, too, was the radiant future: communist slogans were replaced with capitalist advertising that didn’t speak to the masses, who were in no position to over-consume. For those over forty, the message of the new era was that no one—not even the builders of an imaginary future—needed them anymore. Above all, the veil that had hidden the wealth of the few from the incredulous and envious gaze of the many had been ruthlessly removed: for the 1990s and much of the 2000s, Moscow would become the world capital of conspicuous consumption. No longer contributing to or enjoying the benefits of the system, members of the older generations, Parsons suggests, were particularly susceptible to early death.

Parsons’ argument is provocative but not entirely convincing. She describes Russia as though it were a new country that replaced the USSR, and it was this new country that suffered a mortality crisis, which can and should be explained entirely by social forces specific to itself. This is a standard way to approach the problem, and it is not a bad description of what many Russians actually experienced. But, by attempting to identify a single turning point, she overlooks more gradual changes that may have been underway well before 1991. For example, Parsons largely skips over the 1980s, with the broad social movements and the severe economic crises that marked the Gorbachev period.

In fact, if we zoom out from the early 1990s, where Parsons has located the Russian “mortality crisis,” we will see something astounding: it is not a crisis—unless, of course, a crisis can last decades. “While the end of the USSR marked one [of] the most momentous political changes of the twentieth century, that transition has been attended by a gruesome continuity in adverse health trends for the Russian population,” writes Nicholas Eberstadt in Russia’s Peacetime Demographic Crisis: Dimensions, Causes, Implications, an exhaustive study published by the National Bureau of Asian Research in 2010. Eberstadt is an economist who has been writing about Soviet and Russian demographics for many years. In this book-length study, he has painted a picture as grim as it is mystifying—in part because he is reluctant to offer an explanation for which he lacks hard data.

Eberstadt is interested in the larger phenomenon of depopulation, including falling birth rates as well as rising death rates. He observes that this is not the first such trend in recent Russian history. There was the decline of 1917–1923—the years of the revolution and the Russian Civil War when, Eberstadt writes, “depopulation was attributable to the collapse of birth rates, the upsurge in death rates, and the exodus of émigrés that resulted from these upheavals.” There was 1933–1934, when the Soviet population fell by nearly two million as a result of murderous forced collectivization and a man-made famine that decimated rural Ukraine and, to a lesser extent, Russia. Then, from 1941 to 1946, the Soviet Union lost an estimated 27 million people in the war and suffered a two-thirds drop in birth rate. But the two-and-a-half decades since the collapse of the Soviet Union are the longest period of depopulation, and also the first to occur, on such a scale, in peacetime, anywhere in the world. “There is no obvious external application of state force to relieve, no obvious fateful and unnatural misfortune to weather, in the hopes of reversing this particular population decline,” writes Eberstadt. “Consequently, it is impossible to predict when (or even whether) Russia’s present, ongoing depopulation will finally come to an end.”

Russia has long had a low birth rate. The Soviet government fought to increase it by introducing a three-year maternity leave and other inducements, but for much of the postwar period it hovered below replacement rates. An exception was the Gorbachev era, when fertility reached 2.2. After 1989, however, it fell and still has not recovered: despite financial inducements introduced by the Putin government, the Russian fertility rate stands at 1.61, one of the lowest in the world (the US fertility rate estimate for 2014 is 2.01, which is also below replacement but still much higher than Russia’s).

And then there is the dying. In a rare moment of what may pass for levity Eberstadt allows himself the following chapter subtitle: “Pioneering New and Modern Pathways to Poor Health and Premature Death.” Russians did not start dying early and often after the collapse of the Soviet Union. “To the contrary,” writes Eberstadt, what is happening now is “merely the latest culmination of ominous trends that have been darkly evident on Russian soil for almost half a century.” With the exception of two brief periods—when Soviet Russia was ruled by Khrushchev and again when it was run by Gorbachev—death rates have been inexorably rising. This continued to be true even during the period of unprecedented economic growth between 1999 and 2008. In this study, published in 2010, Eberstadt accurately predicts that in the coming years the depopulation trend may be moderated but argues that it will not be reversed; in 2013 Russia’s birthrate was still lower and its death rate still higher than they had been in 1991. And 1991 had not been a good year.

Contrary to Parsons’s argument, moreover, Eberstadt shows that the current trend is not largely a problem of middle-aged Russians. While the graphs seem to indicate this, he notes, if one takes into account the fact that mortality rates normally rise with age, it is the younger generation that is staring down the most terrifying void. According to 2006 figures, he writes, “overall life expectancy at age fifteen in the Russian Federation appears in fact to be lower than for some of the countries the UN designates to be least developed (as opposed to less developed), among these, Bangladesh, Cambodia, and Yemen.” Male life expectancy at age fifteen in Russia compares unfavorably to that in Ethiopia, Gambia, and Somalia.

Eberstadt sets out to find the culprit, and before conceding he can’t, he systematically goes down the list of the usual suspects. Infectious diseases, including not only HIV and TB but also normally curable STDs and every kind of hepatitis, have the run of the land in Russia, but do not in fact seem overrepresented in its death statistics; from a demographer’s point of view, as many Russians die of infections as would be expected in a country of its income level. Cardiovascular disease is an entirely different matter:

As of 1980, the Russian population may well have been suffering the very highest incidence of mortality from diseases of the circulatory system that had ever been visited on a national population in the entire course of human history—up to that point in time. Over the subsequent decades, unfortunately, the level of CVD mortality in the Russian Federation veered further upward…. By 2006… Russia’s mortality levels from CVD alone were some 30% higher than deaths in Western Europe from all causes combined.

And then there are the deaths from external causes—again going from bad to worse. “Deaths from injuries and poisoning had been much higher in Russia than in Western Europe in 1980—well over two and a half times higher, in fact.” As of 2006, he writes, it was more than five times as high.

So why do Russians have so many heart attacks, strokes, fatal injuries, and poisonings? One needs to have only a passing knowledge of Russian history and culture to tick off a list of culprits, and Eberstadt is thorough in examining each of them. True, Russians eat a fatty diet—but not as fatty as Western Europeans do. Plus, Russians, on average, consume fewer calories than Western Europeans, indicating that overeating is not the issue. Yes, Russia has taken abominable care of its environment, but it sees only a few more deaths from respiratory diseases than does Western Europe—and fewer deaths of diseases of the kidneys, which would be expected to result from pollution. Yes, Russians have lived through severe economic upheaval, but there is no indication that economic shock in a modern society leads quickly, or at all, to increased mortality—the Great Depression, for example, did not. Russia spends roughly as much on health care per capita as do the less-affluent European countries like Portugal. Russians smoke a lot—but not as much as Greeks and Spaniards, who live on average roughly as long as other Western Europeans.

The most obvious explanation for Russia’s high mortality—drinking—is also the most puzzling on closer examination. Russians drink heavily, but not as heavily as Czechs, Slovaks, and Hungarians—all countries that have seen an appreciable improvement in life expectancy since breaking off from the Soviet Bloc. Yes, vodka and its relatives make an appreciable contribution to the high rates of cardiovascular, violent, and accidental deaths—but not nearly enough to explain the demographic catastrophe. There are even studies that appear to show that Russian drinkers live longer than Russian non-drinkers. Parsons discusses these studies in some detail, and with good reason: it begins to suggest the true culprit. She theorizes that drinking is, for what its worth, an instrument of adapting to the harsh reality and sense of worthlessness that would otherwise make one want to curl up and die.

For Eberstadt, who is seeking an explanation for Russia’s half-century-long period of demographic regress rather than simply the mortality crisis of the 1990s, the issue of mental health also furnishes a kind of answer. While he suggests that more research is needed to prove the link, he finds that “a relationship does exist” between the mortality mystery and the psychological well-being of Russians:

Suffice it to say we would never expect to find premature mortality on the Russian scale in a society with Russia’s present income and educational profiles and typically Western readings on trust, happiness, radius of voluntary association, and other factors adduced to represent social capital.

Another major clue to the psychological nature of the Russian disease is the fact that the two brief breaks in the downward spiral coincided not with periods of greater prosperity but with periods, for lack of a more data-driven description, of greater hope. The Khrushchev era, with its post-Stalin political liberalization and intensive housing construction, inspired Russians to go on living. The Gorbachev period of glasnost and revival inspired them to have babies as well. The hope might have persisted after the Soviet Union collapsed—for a brief moment it seemed that this was when the truly glorious future would materialize—but the upheaval of the 1990s dashed it so quickly and so decisively that death and birth statistics appear to reflect nothing but despair during that decade.

If this is true—if Russians are dying for lack of hope, as they seem to be—then the question that is still looking for its researcher is, Why haven’t Russians experienced hope in the last quarter century? Or, more precisely in light of the grim continuity of Russian death, What happened to Russians over the course of the Soviet century that has rendered them incapable of hope? In The Origins of Totalitarianism Hannah Arendt argues that totalitarian rule is truly possible only in countries that are large enough to be able to afford depopulation. The Soviet Union proved itself to be just such a country on at least three occasions in the twentieth century—teaching its citizens in the process that their lives are worthless. Is it possible that this knowledge has been passed from generation to generation enough times that most Russians are now born with it and this is why they are born with a Bangladesh-level life expectancy? Is it also possible that other post-Soviet states, by breaking off from Moscow, have reclaimed some of their ability to hope, and this is why even Russia’s closest cultural and geographic cousins, such as Belarus and Ukraine, aren’t dying off as fast? If so, Russia is dying of a broken heart—also known as cardiovascular disease.