The economists Anne Case and Angus Deaton published their article “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century” in 2015, the same year the journalist Sam Quinones published Dreamland, his book on the opiate crisis. Both raised the alarm that many middle-aged, non-college-educated white people had lost the will to live, either committing suicide directly with guns or by hanging or indirectly through alcohol and opiate addiction.

But it wasn’t until 2016 that one-third of the country saw a much more conspicuous sign that we’ve got a problem. It came in the form of a Super Bowl ad for Movantik, a drug for treating opiate-induced constipation. Anyone watching the Super Bowl could reasonably infer that opiates were now so ubiquitous that a company would spend millions of dollars advertising a drug to mitigate their side effects. And of course, nine months later, the anguished white working class elected President Trump, whose inaugural address heavily emphasized Rust Belt despair.