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136 DOWN AND OUT IN MIDDLETOWN AND JACKSON: DRUGS, DEPENDENCY, AND DECLINE IN J. D. VANCE’S CAPITALIST REALISM Travis Linnemann and Corina Medley It is curious how people take it for granted that they have a right to preach at you and pray over you as soon as your income falls below a certain level. —George Orwell, Down and Out in Paris and London In December 2016,not long after J. D. Vance’s Hillbilly Elegy: A Memoir of a Family and Culture in Crisis had climbed atop the New York Times bestseller list,1 garnering rave reviews from pundits and the public alike, Eric Eyre of the Charleston Gazette-Mail published a multipart series detailing how three pharmaceutical companies had helped fuel the highest drug overdose rates in the nation’s history.2 Eyre found that in just six years, McKesson, Cardinal Health, and AmerisourceBergen had dumped nearly nine million pain pills on the tiny hamlet of Kermit, West Virginia, population 392. All told, nearly 780 million hydrocodone and oxycodone pills—some 400 pills for every man, woman, and child in the state—found their way to Kermit and the other small towns that dot the southern West Virginia coalfields.3 Although a system was in place to intervene in cases of “doctor shopping” and “suspicious orders,” state and federal agencies had ultimately done little to halt the flood of pills 137 DOWNANDOuTINMIDDLETOWNANDJACKSON that, over the same period, had taken more than seventeen hundred lives from the sparsely populated corner of West Virginia.4 While Eyre was eventually honored with a 2017 Pulitzer Prize for investigative journalism, his account of greed, neglect, and death has yet to register in the ways that has Hillbilly Elegy. From back-flap endorsements by high-profile conservatives to the New York Times and network news, Vance’s memoir has been lauded for giving voice to the discounted denizens of the southern Appalachians and postindustrial Rust Belt. Reviewing the book in the New York Times, for instance, Jennifer Senior gushed that Vance offered “a compassionate, discerning sociological analysis of the white underclass that has helped drive the politics of rebellion, particularly the ascent of Donald J. Trump.”5 Others, however, found very little sociology in Hillbilly Elegy. Writing in the New Republic, Sarah Jones rebuked the book as little more than “a list of myths about welfare queens repackaged as a primer on the white working class” and derided Vance for his lazy conclusion that “hillbillies themselves are to blame for their troubles.”6 Although they take up the same conceptual terrain and moment in history—postindustrial West Virginia, Ohio, and Kentucky—Vance and Eyre begin and thus end at radically different ontological positions. Whereas Eyre’s work is a muckraking account of the political and economic collusion leading to the “opioid crisis,” Vance’s self-referential account of a “family and culture in crisis” holds that nearly all hardships, including those with drugs and alcohol, whether ending in acquiescence or triumph, are simply matters of individual choice, character, and will. Mapping a Lamarckian culture of poverty onto the conditions of poor white “hillbillies” in the Ohio and Kentucky Appalachians he called home, Vance’s story is one of determination and chance, utterly devoid of honest engagement with questions of history and political economy, outside of a clichéd understanding of his “Scots-Irish” heritage as irrevocably violent and tribal. Nevertheless, as we write in the fall of 2017, Hillbilly Elegy has sat near the top of the New York Times best-seller list for more than sixty weeks, while the corporate malfeasance at the center of the Appalachian opioid crisis uncovered by Eyre remains a mostly disregarded strapline, Pulitzer be damned. In order to grapple with the politics of the unfolding opioid crisis, in this chapter we read Hillbilly Elegy as diagnostic of what Mark Fisher called capitalist realism.7 Here Vance’s is not simply a story of determination and 138 TRAVISLINNEMANNANDCORINAMEDLEY triumph, but rather a moralizing tale that reaffirms the view of the poor as a morally deficient, self-defeating lot best kept cordoned off from conventional society, while simultaneously upholding the overriding belief that there is simply no alternative to the present social order. Morally Indefensible, Spatially Excluded Before moving forward, it is important to distinguish the broader current of respectability politics that underpins Vance’s narrative from analyses of the opioid crisis taken up in other contexts. For...


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