one nation under stressone nation under stress

In the 1960s, Americans had among the highest life expectancy in the world. Today, the U.S. ranks near the bottom of major developed nations.

From acclaimed directors-producers Marc Levin and Daphne Pinkerson (Class Divide, Hard Times: Lost on Long Island and Schmatta: Rags to Riches to Rags), and neurosurgeon and Emmy-winning CNN chief medical correspondent Dr. Sanjay Gupta, One Nation Under Stress examines the reasons for this historic decline.

Despite spending more on healthcare than any other country, America is experiencing decreased life expectancy. In One Nation Under Stress, neurosurgeon and investigative journalist Dr. Sanjay Gupta sets out to discover why. Driven primarily by an epidemic of self-inflicted deaths of despair — from drug overdose, chronic liver disease and suicide – this rise in the U.S. mortality rate can be seen as a symptom of the toxic, pervasive stress in America today.

Gupta travels across the country, interviewing experts in a wide range of fields, who share their insights on why we’re experiencing so much stress, how it affects the brain, body and behavior, and the long-term consequences for the health of the nation. Along the way, he speaks candidly with Americans struggling with their own stress-related ailments and those who have lost loved ones lost to deaths of despair, particularly in communities facing economic and social instability.

Just 4 percent of the world’s population, Americans take 80-90 percent of the world’s opioids. “What we are looking at is an increasingly stressed society,” says forensic pathologist Cyril Wecht, who points to stressors like depersonalization, economic uncertainty and unstable family units, all of which can be deadly when coupled with self-medication or over-medication of prescription drugs. Gupta notes, “Ultimately, these premature deaths 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 it could be dangerous and it could end your life.”

Stanford neuroscientist Robert Sapolsky, who has studied the social behavior of baboons in the wild for years, notes, “I think what we know by now from [the] baboon world is what makes psychological stress really corrosive — lack of control, lack of predictability, lack of social support.”

Today, white Americans report greater depression and social isolation, which Gupta believes may be due to economic factors and the dashed expectations of a generation that was led to believe it would do better than their parents. He visits Petrolia, Pennsylvania, where a recent plant closure has left hundreds feeling helpless and angry. Gupta himself grew up in a white working-class community with parents employed by the auto industry. In his hometown of Livonia, Michigan, he sits down with his mom, who remembers being laid off without any warning, and childhood friend Frankie Sgambati Jr., who works at a nearby prison and cites lack of job security as a huge stressor.

Noted primatologist Frans de Waal explains that loss of status can be one of the most stress-inducing events for social animals like people, and the constant fear of losing status — particularly for those in the “middle,” who have the most to lose — can be toxic. But what about those who’ve been at the bottom rung of the social ladder for years? Gupta visits Dr. Charles Moore, his friend from medical school, who practices at Grady Hospital in Atlanta. They discuss the fact that life expectancy for African-Americans is still dramatically lower than for whites, although it has slowly been increasing.

While stress hormones are present across the animal kingdom, they are normally produced in short bursts and serve an important biological function. Persistent, low-level stress can be more problematic. “It’s the constant, never-ending toxic stress that will kill you,” says neuroscientist Robert Sapolsky. Many have turned to medication to cope. After suffering a miscarriage, she was prescribed multiple drugs and now over-medicates, while admitting to having suicidal thoughts.

Chronic stress can reduce the size of key parts of the brain — particularly areas involved with empathy and impulse control — and cause synapses to atrophy. Though some changes are irreversible, practices like exercise and meditation can help manage stress and repair brain nerves, as can fostering strong social networks and relationships. A decades-long study of Italian-Americans in Roseto, Pennsylvania found that their tight-knit community had the “magic ingredient” that helps mitigate stress: strong social support and social cohesion. As a result, they experienced an uncommonly low rate of heart attacks, which is also seen among Hispanics, who tend to be more social than other groups.

Extreme and glaring inequality disturbs the social order and undermines stability, no matter which end of the spectrum a person is on. As Frans de Waal points out through eye-opening experiments, even capuchin monkeys have an innate sense of fairness and become outraged at unequal treatment.

Other experts offering observations in the documentary include: epidemiology professor Sir Michael Marmot; Rajita Sinha, clinical neuroscientist at Yale Stress Center; economists Anne Case and Angus Deaton; Ichiro Kawachi, Harvard professor of social epidemiology; and many more.

One Nation Under Stress was directed by Marc Levin; produced by Daphne Pinkerson and Marc Levin; co-producers, Jackson Devereux, Ashwin S. Gandbhir, Anthony Pedone and Kara Rozansky; associate producer, Jillian Goldstein; edited by Ashwin S. Gandbhir; director of photography, Daniel B. Levin; original music by Giancarlo Vulcano. For HBO: executive producers, Nancy Abraham, Lisa Heller and Sheila Nevins.