The Chronic Roots of Acute Crises

April 2017


diabetes-1724617_960_720Louisiana had a lot of rain last summer. In fact, it was a once-every-500-years level of rainfall.[1] The flooding in Louisiana was so extreme that 13 people lost their lives and tens of thousands were forced from their homes, which were partially underwater.[2]

And here’s an interesting factoid: It hadn’t been 500 years since the last time this level of rainfall occurred somewhere in the United States. The Louisiana downpour was the eighth “once-every-500-years” rain/flooding event since May 2015. Others occurred in Oklahoma, Texas, South Carolina, West Virginia, and Maryland.[3] Let that sink in (no pun intended).

Each of these horrific downpours with flooding is an acute event – it happens in a relatively brief amount of time and causes severe damage and suffering. It rivets our attention. It’s hard to ignore the scenes of floating bodies (as in Hurricane Katrina) or the images of whole towns partially submerged in water. But behind all these eye-catching acute events is a chronic problem: climate change.

The words “chronic” and “acute” are most often associated with illnesses or medical conditions. Chronic conditions are long-lasting.[4] Examples of chronic medical conditions include high blood pressure, arthritis, emphysema, osteoporosis, diabetes, and depression.

In contrast, an acute illness is generally thought of as “a disease with an abrupt onset and, usually, a short course.”[5] There are many examples of acute illnesses, such as an asthma attack, pneumonia, sinusitis, measles, mumps, and the common cold. And there are similarly acute medical conditions, such as a broken bone or a concussion. It’s hard to not notice an acute illness or condition.

In contrast, many chronic conditions are processes in the body that are not readily visible or obvious without careful measurement. They are often easy to miss – until a doctor sends a blood sample to the lab, say, or prescribes a series of bone scans. But while these chronic conditions are not themselves easily noticed, they can result in highly noticeable – and painful – acute effects.

For example, diabetes is a condition of persistently high blood sugar.[6] A diabetic person doesn’t see or feel the excessive blood sugar levels in his body; but if the condition is not properly treated, the possible acute effects, including stroke, kidney failure, or blindness, among others, are easily discernible.[7]

Another example is osteoporosis, a chronic condition in which the bones become weak and brittle. That means that if someone with osteoporosis falls, she is much more likely to end up with broken bones. A person with osteoporosis doesn’t feel her bones becoming weak and brittle; she knows about it only because successive bone scans have shown the process. But she cannot miss the pain of a broken bone when it happens as a result of the osteoporosis.

This distinction between chronic medical conditions that are serious but easily overlooked and the acute and highly noticeable effects they can give rise to if not properly treated provides a useful metaphor for thinking about non-medical processes – in both the natural and political worlds – that are equally crucial to human well-being.

Climate change is a chronic condition of the biosphere that has been going on since the industrial revolution. Scientists understand the causes of the condition and have been recommending preventative actions for at least a couple of decades. For all that time they have been collecting reams of data documenting the process – the steady increase in levels of greenhouse gases in the atmosphere and the consequent rise in average global temperature. These scientific measurements are like the lab results the doctor orders when she suspects her patient might have diabetes or the bone scans she orders when she suspects osteoporosis is likely.

When the lab results confirm the doctor’s suspicion, she will recommend a course of action to manage the condition and hopefully ward off the serious acute effects that can result if the condition is not properly treated. Similarly, climate scientists have been warning us for many years that we must greatly reduce the causes of climate change – most notably, the burning of fossil fuels – or we will risk changing the climate to the point where human life on earth will be severely compromised.

So far, we haven’t really listened – or, I should say, our politicians haven’t really listened. Had they heeded the scientists’ warnings these last twenty-five years, we probably could have avoided the high frequency of “mega-storms” that people in places like Louisiana (and Oklahoma, Texas, West Virginia, South Carolina, and Maryland) are now experiencing.[8]

Similarly, our body politic has begun to notice the acute effects of having failed to deal with a variety of underlying chronic conditions for many years. And acute events in the political sphere can “suck all the air” out of the public space, making it harder to focus on the chronic problems underlying them.

We are horrified by the latest random mass shooting by a madman with a gun. We are riveted by the horse-race nature of political campaigns – who’s ahead in the polls; who has the biggest “war chest.” Sometimes our politicians even manufacture crises – like the debt-ceiling crisis of 2011 (described as “a self-inflicted wound as egregious as it was avoidable”[9]) and the debt-ceiling showdown of 2013.[10] In the recent presidential election we were spellbound by the spectacle of the Republican presidential candidate, Donald Trump. What jaw-dropping thing would he do or say next? Now that he is President Trump, we’re still riveted by his latest unhinged and untruthful tweet.

The acute political problems we are currently facing have become so severe of late that they have actually gotten people in the political class talking about the underlying chronic problems. Especially with the rise of the sociopathic Trump, there’s been a lot of “How did we get to this point?” hand-wringing going on.

So how did we get to this point? We got here, I would argue, by ignoring a host of serious chronic problems.

You might have heard Congress described in recent years as “dysfunctional.” And in fact recent Congresses have passed far fewer bills than was the norm for past Congresses. A big part of the reason is the extreme political polarization of recent years. But there is also a strong sense that our elected officials simply don’t care about what ordinary Americans want; they respond to the desires of their donors rather than those of their constituents.[11]

Congress’s approval rating has been correspondingly abysmal in recent years. It reached its all-time low of just 9 percent in 2013, when it was less popular than cockroaches, root canals, and traffic jams, according to a survey by Public Policy Polling.[12] In early January 2017, Congress’s approval rating stood at 19 percent.[13]

The public’s distrust of – and disdain for – Congress is a chronic problem. It is caused, in part, by the chronic dysfunction of a Congress that simply doesn’t get stuff done and, in part, by the sense that Congress is no longer working for ordinary people.

But public distrust of Congress is part of a larger chronic problem of deteriorating trust in public institutions in general – including Congress, the Supreme Court, and the federal government as a whole.[14] Again, this is due in part to the extreme political polarization that has taken place in recent years. But it is no secret that the Right in this country has made a concerted effort to demonize the federal government. And it has been quite successful.

That’s partly because it’s easy to demonize big entities – big government or big corporations. But it’s also partly because, since the mid-1990s, the Right has had a powerful media propaganda machine cranking out its preferred narrative of events.

The rise of propaganda outlets masquerading as news media that relentlessly demonize actual news media is itself a chronic problem. A sizable portion of the Republican base refuses to consider mainstream sources of news and fact-checkers that most of the rest of the country regards as reliable. As one conservative radio host ruefully admitted,

“ … it is impossible for me to say … ‘By the way, you know [what Trump said] is false.’ And they’ll say, ‘Why? I saw it on Allen B. West.’ Or they’ll say, ‘I saw it on a Facebook page.’ And I’ll say, ‘The New York Times did a fact check.’ And they’ll say, Oh, that’s The New York Times. That’s bullshit.””[15]

While there is undoubtedly some degree of insularity on the Left as well, the problem seems to be particularly severe on the Right these days. [16]

Along with the discrediting of reliable news sources has been the demonization of experts as “elitists.” As Isaac Asimov so astutely noted years ago,

“There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.’”[17]

The persistent anti-intellectualism and disdain for “elites,” combined with the successful savaging of credible “referees,” has left many ordinary Americans open to believing whoever confirms their preconceived notions – including the purveyors of “fake news” – rather than experts and those who are actually telling the truth. This makes these people “easy pickins” for a demagogue like Trump. And the deep-seated mistrust of the established institutions of government has made many people conclude that a total outsider to government – even one with no knowledge or experience of governing – might be just the ticket.

I think much of our current predicament can be laid at the feet of specific people who have wielded tremendous power irresponsibly.[18] In the last few years, politicians, particularly on the Right, have been willing to trash long-standing institutions of our democracy to increase the power of their political party.[19]

But perhaps more important, there have been impersonal processes, for which no one is to blame, that have greatly contributed to the systemic corruption of our politics and paved the way for the rise of a demagogue. Political polarization is one process that has substantially increased the tension between our two major political parties, and with it the willingness to apply the scorched earth tactics that have been so damaging to our politics.[20] (This is not to excuse the irresponsible behavior of those who have used these tactics, but only to say that it is somewhat less surprising in the environment of extreme political polarization in which we currently find ourselves.)

Globalization and, more importantly, technological change are two other impersonal processes that, while offering great benefits, have also contributed tremendously to a massive loss of jobs in this country and the corresponding feeling among many in the working class that they have been “left behind.”

And then there are the demographic changes that have been occurring for decades, which shouldn’t be a problem unless people perceive it as such – and many people do. That perception and the corresponding racial resentment is another chronic problem.

So we are witnessing the acute effects of the confluence of several chronic problems that together have created the “perfect storm” of a truly abnormal election, followed by the truly abnormal presidency of Donald Trump, a dangerous demagogue and a real threat to our country and the world.[21]

These chronic problems are insidious. Like some chronic medical conditions, they are not readily obvious – we don’t directly see the general mistrust of government or the absence of evidence-based thinking or the inability to discern “made-up stuff” from actual facts.[22] We become aware of these things when political or social scientists carry out studies or surveys that show them, or when we see their more obvious and acute consequences. Like chronic medical conditions that are not dealt with, they slowly and steadily erode things until they result in some acute effect that gets our attention – such as the surprising rise of a demagogue like Donald Trump.

So why are we so bad at addressing the serious chronic problems underlying all the attention-grabbing acute ones? One reason is precisely that the acute problems are so attention-grabbing, and the media is driven by what “attracts eyeballs” or generates clicks. People are riveted by the latest outrageous Trump utterance, whereas it would get boring for the news media to report on the continued high levels of mistrust in government (“Continuing from last week, Americans still don’t trust their government this week.”)

Similarly, while each extreme and sensational weather or weather-related event does get media coverage, there is little or no mention of climate change as the underlying cause. Moreover, even though the number of such extreme events has risen substantially in recent years, broadcast news time devoted to talking about climate change is small – and actually decreased substantially in 2016,[23] despite the fact that 2016 was by far the hottest year in recorded history.

By their nature, chronic problems aren’t “newsworthy” in the same way acute problems are. Acute problems appear as events – things that get reported on – while chronic problems are the long-term substratum from which those events arise.

This natural human tendency to focus on the acute has been exacerbated, I believe, by a cultural change in the media in recent decades. The responsibility to faithfully report the news has been replaced as the news programs’ primary goal by an emphasis on making a profit – and that means that priority is given not necessarily to what is most newsworthy but to what is “splashiest.” Neil Postman’s observation, back in 1985, that we are “amusing ourselves to death”[24] is even truer now.

But even if the public isn’t constantly kept aware of the serious chronic problems underlying the “splashy” acute ones, you would hope that our elected officials would be quite aware of those chronic problems – and would be working hard to solve them. But, of course, they aren’t – witness our Congress’s refusal to address climate change for at least two decades now.

The influence of money in our politics – itself a chronic problem – is almost certainly a primary factor behind Congress’s negligence in tackling the other big chronic problems. Because of changes in our laws, it’s easier and easier for rich corporations (and individuals) to dominate our politics as well as our legislative process.[25] ,[26] This is very likely a key reason why our politicians, particularly on the right, have been so reluctant to acknowledge climate change, let alone do anything about it. [27]

And those who are most likely to be adversely affected by Congress’s cozy relationship with rich donors are the poor, who are unlikely to vote in Congressional elections, and future generations, who cannot vote in (current) Congressional elections. So congressmen who respond to the desires of the rich over the needs of ordinary (current and future) Americans are often not held accountable.

At the risk of straining the metaphor, one could say that having gorged on the “sweets” of entertaining and eye-catching tweets and other acute diversions, our political “blood sugar levels” are going off the charts. We have become a politically diabetic country, with some of the most serious acute effects that can result. We are now experiencing political stroke (witness the paralysis of our Congress), political blindness (witness the inability of people to discern real news from “fake news”), and political kidney disease (witness the buildup of political toxins in our politics). And, with a sociopathic demagogue as president, our democracy is in danger of going into a “diabetic coma” from which it may not recover.

Most people, when diagnosed with a serious chronic medical condition such as diabetes, follow their doctor’s advice in order to avoid the very serious acute effects that could otherwise result. When it comes to our own health, we listen to the (medical) experts. But when it comes to the health of our democracy or the biosphere on which we depend, we are not taking the experts’ advice.

An acute medical crisis is often a wake-up call to finally address a neglected chronic problem lurking beneath. And so it should be with our current political situation. If the rise of a sociopathic demagogue to become president of the United States isn’t a wake-up call, I don’t know what is. We have neglected some very serious chronic problems far too long. It’s time to get serious about solving them.






[2] See, for example,


[4] Three months is often used as a subjective threshold length of time for a condition to be termed “chronic.”

[5] This definition comes from


[7] Using “acute” here in the sense of “sharp or severe in effect.”

[8] And, of course, torrential downpours are just one kind of acute weather event that we will see with increasing frequency because of climate change.



[11] Recent academic studies support this contention. See Larry Bartels. Unequal Democracy: The Political Economy of the New Gilded Age, ; see also




[14] See, for example: ;


[16] See, for example,


[18] Mitch McConnell is a prime example. In a recent opinion piece, Dana Milbank does a good job of explaining why —

[19] Congressional scholars Norman Ornstein and Thomas Mann have written a lot about this. See, for example,

[20] I would note, however, that the application of scorched earth tactics is not a “both sides do it” phenomenon. The Republican Party has done it way more than the Democrats in recent years.

[21] This is not just my opinion. It is the opinion of many, many experts in fields such as national security and economics – including many Republicans who have publicly come out against Trump.

[22] We may see these things in individual people, but to “see” the high percentage of Americans who, say, are unable to discern fact from fiction we need careful studies or surveys.


[24] ;

[25] As noted in a previous footnote, the influence of the rich on the legislative process has been studied and documented. See Larry Bartels. Unequal Democracy: The Political Economy of the New Gilded Age, ; see also .

[26] The extent to which rich donors affect election outcomes is less clear. Certainly, politicians think they need large “war chests” to win elections. But the triumph of Trump over Clinton (Trump spent a lot less money in his campaign than Clinton) is one of several examples where money did not “win the day.”

[27] See


One comment on “The Chronic Roots of Acute Crises

  1. dougmolitor says:

    Diabetes is an apt metaphor for what is ailing our nation. I sometimes think global warming is a fever the planet is running, to try and kill of the virulent infection of carbon-spewing humans that are attacking its biome.

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