In 1935, W.E.B. Du Bois, one of America's greatest thinkers and historians, wrote about the distinctive situation of poor white people in his landmark book "Black Reconstruction in America":

It must be remembered that the white group of laborers, while they received a low wage, were compensated in part by a sort of public and psychological wage. They were given public deference and titles of courtesy because they were white. They were admitted freely with all classes of white people to public functions, public parks, and the best schools. The police were drawn from their ranks, and the courts, dependent on their votes, treated them with such leniency as to encourage lawlessness. Their vote selected public officials, and while this had small effect upon the economic situation, it had great effect upon their personal treatment and the deference shown them. White schoolhouses were the best in the community, and conspicuously placed, and they cost anywhere from twice to ten times as much per capita as the colored schools. The newspapers specialized on news that flattered the poor whites and almost utterly ignored the Negro except in crime and ridicule.

As Du Bois and others would observe from in the antebellum period and through to Jim Crow and now the present day, poor whites had less political and economic power than other white people, but they were still able to translate their skin color into material advantages over nonwhites. In total, the wages of whiteness were both psychological and economic.

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Some 80 years since Du Bois wrote "Black Reconstruction," however, the material rewards of whiteness are diminishing: It now pays fewer economic and other material dividends in an era of globalization and neoliberalism.

Yet, as shown by a resurgent white identity politics backlash and the rise of the "alt right" and Donald Trump, Du Bois' core thesis still holds true in America, Europe and other parts of the world.

Why do poor and working-class white Americans still cling to the psychological wages of whiteness when in may ways it has not benefited them? How are white people in red state America literally dying of whiteness? Why do white working-class and poor people continue to support the Republican Party and Donald Trump when the latter's policies have caused them great financial and even physical harm? What are the limits of empathy across the color line in America? Does racism hurt white people as well as nonwhites?

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In an effort to answer these questions I recently spoke with Dr. Jonathan Metzl. He is the Frederick B. Rentschler II Professor of Sociology and Psychiatry, and the director of the Center for Medicine, Health, and Society, at Vanderbilt University in Nashville.

Metzl is the author of several books, including "Prozac on the Couch" and "The Protest Psychosis." His new book is "Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland".

This conversation has been edited for clarity and length. You can hear our full conversation on my podcast, "The Chauncey DeVega Show."

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﻿ You have spent several years in red state America with Trump's voters. How did this political moment come into existence?

There were various points of despair that nobody saw happening that were bubbling beneath the surface. This is connected to race and socioeconomic class. The economy looked on the surface like it was doing well but there are many unhappy people who are being left behind. Those divisions were very easily manipulated by Trump. There is also the reality of lower-income white populations in the Midwest and the South dying at rates which are almost unheard of in a country such as the United States. Winning an upcoming election to defeat Trumpism is important. But the bigger question is, how do we heal the societal divisions which have been exposed, enhanced and manipulated by Donald Trump and others?

Whose responsibility is it to make the first move in terms of this healing? And what of empathy and sympathy for black and brown people who continue to suffer far more than white people in America?

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There's no right answer. I think that people are traumatized right now. There is a massive empathy void in the United States at present. I think people have stopped listening to each other. In a way, the means that we use to engage with each other are designed to foment conflict. We tweet at each other. We have Fox News and other echo chambers, which are highly partisan and divisive.

It's not just who's going to reach out first. It is really, what would it mean to know enough about somebody else's concerns to actually address the problems that they are feeling?

Part of what motivated me to write "Dying of Whiteness" is this cultural problem in America where we are unable to understand one another across lines of class, region and other identities. I spent seven or eight years talking to people that I do not really agree with. What I found was pretty surprising because these were people I likely would be fighting with in other venues such as social media.

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When I started talking to people in probably the most strongly pro-gun, pro-Trump red state part of America -- which is in part where I'm originally from, by the way -- I found myself listening to and understanding people who I deeply disagree with on the issues. These conversations also helped me to understand why I feel a given way about certain social issues as well. We have all these spaces for conflict but not for conversation and consensus-building. Who is really benefiting from having us fight with each other about these issues while corporations and very wealthy individuals keep getting wealthier and more powerful?

Donald Trump's voters inflicted something horrible on America. My level of empathy for these "white working class" voters who made such a horrible decision, largely motivated by racism, is nonexistent. They did this to America and need to be held responsible. Please convince me otherwise.

I argue in "Dying of Whiteness" that we need to look at this first and foremost as a policy issue, as seen with the rising rates of gun deaths, despair from not having health care or health insurance, and tax cuts in states like Kansas that eviscerated funding for roads and bridges and schools. These policies lead to public divisiveness which in turn creates that empathy gap.

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I could tell you stories for the next eight hours about how having more guns around makes people less empathetic and probably more racist in certain ways. But I will say that all of these divisions, for me, ended up being the result of specific public policies. The United States has made it way too easy for people to get guns. Blocking the expansion of the Affordable Care Act and other types of programs took place without there being any viable backup plan for how people in need would get health care.

If we can create empathic policies -- meaning public policies that people can see themselves in -- the empathy question will largely start to fix itself. However, I am not letting people off the hook in terms of racial animosity and racial resentment.

In my research I focus on the white working class in the Midwest and South. Some people were racist and some people were not. Some people were willing to share their views about race with me and others were not. But these people were all suffering negative health effects, not because of their individual attitudes but because of the policies that had failed them or that had been implemented on their behalf to make it so easy to get guns or not to get health care.

How do rational and fact-based approaches to public policy overcome emotion and irrationality when it comes to political decision-making? These variables are especially powerful in terms of whiteness, identity and politics in America.

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Having talked to people for the last seven or eight years, I developed a sense that they were making decisions, for better or worse, based on the stressors and material realities of their own lives. I do completely agree with you that there are structural problems with the ways that whiteness is defined and implemented in this country.

There is this understanding of group position and race where for many white people there is a hierarchy where "I'm on top of this pyramid and people below me are trying to take things from me." This is incredibly pathological because we know that expanding opportunities helps the great majority of people.

Certainly, I agree with you that there's a pathological construction of whiteness which is not doing anybody any favors and we've been living with this thing for centuries. It is time to really start having more open and honest conversations and thinking about the meaning and power of whiteness in America. White Americans are being hurt by not having a more developed rhetoric for understanding whiteness not just as power or strength but also talking about whiteness as vulnerability.

Here is an example. There is all this rhetoric and messaging by the NRA and other parts of the right wing which connects guns to fear of "black crime" or "crime by minorities."

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If you look at who are actually the victims of most gun deaths in this country -- there are 40,000 a year and two-thirds of those are gun suicides. Upwards of 80 or so percent of those suicides are white men. Ironically, white men are the main people who are dying of gun deaths in this country but there's no serious public discussion about it because of whiteness being powerful and not being interrogated enough.

That is just one example of the ways in which the type of whiteness that white people are being sold by many politicians, the news media and other influencers is literally at odds with white people's lives.

What does "whiteness" mean for the white people you interviewed?

In my book I am not discussing whiteness as a biological category. Whiteness is a social contract and a type of self-identity. One of the unifying threads of whiteness for the people I spoke to for my book was that whiteness is a privileged position that is under attack by the government or immigrants or minorities. Whiteness is something that needs to be defended. I talked to people who were literally on death's doorstep and in low-income housing communities and medical clinics who were not getting health care because Tennessee didn't fully adopt the Affordable Care Act. The one thing they were holding onto was that at least their tax dollars weren't going to what they said were "Mexicans and welfare queens."

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Whiteness as superiority over other groups is a feeling that is so powerful that people were literally almost going to their graves holding on to it.

Whiteness is so powerful that these people are willing to die to protect it. That is pathological.

I would say powerful. But I do actually make an argument about pathology in the book, and it is based on quantitative data. To that end, I consider examples of white people who are dying because of policies that were ostensibly designed to make white America "great again."

When I started analyzing the data I discovered that white supremacy was more dangerous for working-class white people than asbestos or not wearing seat belts or cigarette smoking. For example, when you look at the health effects of what we might describe as "white backlash" in terms of how certain states rejected the expansion of Medicaid because of hostility to Barack Obama, this actually kills a lot more people than what we might think of as everyday manmade pathogens like cars or cigarettes.

What are some hard numbers?

Missouri used to be a state where it was relatively hard to get a gun. What happened in 2007 is that the Missouri legislature made it easier to get guns by changing the permit laws. This made it much easier not just for people to buy guns but to have concealed carry and open carrying of guns. The law also allowed people to have guns in places such as bars and on school campuses. .

There is then a dramatic rise in white male suicides. Beyond the loss of life there were also lost wages and income for Missouri. These were in the tens of thousands in terms of lost work hours and many millions of dollars.

Consider that Tennessee rejected the Affordable Care Act. This cost every white person in the state about 21 days of life. Other people's lives were also negatively impacted, of course. In Kansas where the Republicans started cutting the budgets for schools, that in turn was associated with more people dropping out of high school. This correlates with losing between six and eight years of one's lifespan.

Gun culture is a central part of "Dying of Whiteness." The people you speak with are literally willing to die, and to let their own children die, because of a loyalty to guns and what guns mean to them psychologically and spiritually and those intersections with whiteness. How are these calculations made?

That question is at the core of "Dying of Whiteness." Health is of course only one of the variables that people consider when making decisions. People also want to feel good. We want to feel like we and our group is superior. We want our team to win. What is the mortality trade-off in terms of decision-making? I am trying not to make that decision for the reader or for the people I spent time with. I am trying to be true to the narratives about their lives which people told me. But at multiple points throughout the book, people told me quite literally that they were willing to die in support of a particular ideology.

Those white people at the low-income housing project I spoke with would rather die than get Obamacare -- and many of them actually did die. There was no illusion that Donald Trump's policies were going to all of a sudden make their material lives better. But for them the trade-off was this sensation and feeling of winning and keeping other people held down. This was a trade-off these working-class white people were willing to make, even it cost them years of their lives.

I think such a decision can be read two ways. One is: What's wrong with these people that they are going to trade their lives for someone who is not really looking out for them? Liberals overlook that dynamic by assuming that people are rational. Liberals did not understand the depth to which many working-class white people were actually putting their bodies on the line in a kind of suicide bargain in support of Trump's right-wing ideology.

These working-class and other white people are not going to be talked out of this bargain through appeals to reason. I am worried that even now when liberals and progressives are talking about "Medicare for All," that there is such a deep well of resentment it will not be possible to reach these people.

You have both the macro-level data and the in-person interviews. What are the white working class people you spoke with mad about? And why would they be attracted to a man like Donald Trump, who has nothing at all in common with them beyond skin color?

I think elites have manipulated unease and insecurity among the public, especially lower-class whites, since before the Founding. I want to give the empathic answer which is that it is an uncertain proposition to be a working-class white person in this country. Certainly you are better off in many ways compared to nonwhites, but there is also a sense that you are never going to get up to the next level of the social pyramid.

I don't think I would have given you that answer before I wrote this book. I have now spent such a long time looking at people struggling .

Donald Trump tapped into this unhappiness among a certain class of white people and he manipulated and extended it. I honestly cannot think of one material benefit that Trump is actually offering to his white working-class voters and other supporters. What Trump has skillfully done is manipulate this feeling that you might not have very much but somebody's out to take what you've got. This plays right into his demands about building a wall on the U.S.-Mexico border and his nativist immigration plans.

But the flip side is that the Democratic Party does not really have a substantial and sustained response to this maneuvering and manipulation by Trump. The Democrats have given up on these people too. Policies that help working-class white populations would also likely benefit everyone else. I am frustrated because that is an easy point for Democrats to make and they often do not make it.

The right-wing conservative movement has very successfully tied political issues to questions of white identity. Gun ownership, for example, is highly central to white male identity. People would share their dissatisfaction with the NRA but only do so quietly for fear of being stigmatized by other white people in their social circle.

They had guns on their nightstand but then in the middle of the interview they would say, almost as an aside, "Actually, I've lost a lot of close people to gun suicides. I do think we should have gun safes and mandated trigger locks and safe storage when kids are around." Then they would go back to the NRA talking points. Their sharing was almost like a kind of secret moment. These were among the most powerful moments for me in doing the research for the book.

What were some assumptions you had before writing "Dying of Whiteness"? How were they complicated by doing the research and speaking with people?

When I actually talked to people the party line was not quite as dogmatic as I would have thought if I had just talked with them online. In talking to people one-on-one, there were moments where compromise seemed more likely.

But the depth of suffering that I found as a result of these misguided Republican policies was powerful, devastating in a way. I interviewed parents who had lost children because of preventable gun suicides and other violence.

These people were actually willing to sacrifice their children for guns?

I invite people to read the interview excerpts that are in the book. They are uncensored. I want the readers of "Dying of Whiteness" to judge for themselves. I will say that the interview excerpts I chose for the book suggested that there were more complicated factors going on than just being pro-gun or anti-gun.

There is a long history of racism and racial resentment involved with guns in America. Guns were a white man's prerogative since before the country was founded and that continues through to the present. A white person carrying a gun in a Walmart is a patriot and a black open-carrying person is going to get tackled and arrested, or worse yet shot.

Much has been written about the "deaths of despair" that are supposedly afflicting the white working class. Why are white men of a certain age and income killing themselves in America?

We know from the data that white men have the majority of the guns, and most guns are concentrated in red state America. Guns suicides tend to take place within 59 minutes or less from when a person gets drunk, they find out their wife is having an affair, a person gets fired, and so on. Gun suicides are very often an impulsive form of suicide and the guns themselves are incredibly lethal. Ninety-six percent of gun suicide attempts are successful.

The other explanations link back to what we were talking about in the beginning of this conversation regarding hierarchical constructions of race and whiteness. If you feel like you're perched atop this pyramid, you have farther to fall in a way. There may be a lack of resilience in terms of how white people deal with hardship. I do want to be clear, however: For almost every issue I look at in my book, particularly health care, people of color come out worse.

Given the popularity of books such as "Hillbilly Elegy" and others in this whole Trump era "let's be sympathetic to poor rural white people" genre, are you concerned about how your book is going to be received? Will it be misunderstood or misrepresented by the general public and the news media?

If you are a white guy with a book called "Dying of Whiteness," you are opening yourself up for multiple interpretations. For me, this is a question of policy. You cannot look at questions of individual choice without looking at public policies which end up making working-class white people's lives harder, sicker and shorter. "Hillbilly Elegy" and other books in that genre are not making those points and instead are focusing on empathy and individual stories above policy.