Book Review
“I Would Rather Die”: A Review of <em>Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland</em>

“I Would Rather Die”: A Review of Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland

Andrea Milne

On April 27 of last year, sociologist and psychiatrist Jonathan M. Metzl was at a public reading for his new book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland, when a group of megaphone-wielding “identitarians” interrupted him. They offered up a cringe-inducing nativist political platform and chanted “this land is our land” before finally leaving the bookstore.

The neckbeards in question were members of the “American Identity Movement” (AIM), the newest iteration of Identity Evropa — a white supremacist, neo-Nazi organization best known for its role in organizing the Charlottesville Unite the Right rally. Many academics, myself included, first learned about the organization when their fliers mysteriously appeared all over college campuses during the 2016 election, part of a larger effort to recruit disaffected students. Familiar with some of Metzl’s other books, I had already planned on reading Dying of Whiteness. It became a priority when I found out that it was making AIM cranky.

Metzl’s argument is as complicated as it is simple: “[W]hite America’s investment in maintaining an imagined place atop a racial hierarchy — that is, an investment in a sense of whiteness — ironically harms the aggregate well-being of US whites as a demographic group, thereby making whiteness itself a negative health indicator.”1 Put differently: racist policies hurt, and kill, all of us, regardless of our skin color. Metzl uses three case studies, on three different policies, in three different states, to advance this argument.

Dying of Whiteness cover. (©Basic Books)

Dying of Whiteness begins in Missouri, interviewing members of a suicide support group, most of whose loved ones used guns to end their lives. The Show Me state has one of the highest gun death rates in the country, the majority of which are suicides.2 The federal ban on funding gun research meant Metzl and his team of researchers undertook a lot of original biostatistical analysis to determine what impact, if any, Missouri’s deregulation around gun purchases had on this trend. His conclusion: rural white men are disproportionately represented in gun suicide statistics. White Missourians are also disproportionately represented in injuries and deaths caused by intimate partner violence and accidental shootings. A long history of guns symbolizing the privileges of whiteness, citizenship and masculinity — privileges long denied people of color — underpins this outcome.

Next, Metzl and his researchers travelled to Tennessee to investigate healthcare. The debate around Medicaid expansion is also, at its core, a debate about race — indeed, through most of the nineteenth century insurers covered African Americans as property, not people. Likewise, early debates around Medicare and Medicaid in the South hinged, in part, on concerns that these federal programs would force hospitals to integrate.3 Like many former slave states, then, Tennessee’s healthcare system has always been unequal, and discussions about its provision rooted in racism.4 The racial rhetoric around Medicaid continues to affect Tennesseeans to this day: state health outcomes suggest that failing to expand Medicaid has cost ALL of the state’s white Americans 14.1 days of life.5

2019 Patient Protection and Affordable Care Act Medicaid expansion by state. Black = Expanding Medicaid, Gray = Not expanding Medicaid. (Kurykh/Wikimedia Commons)

Metzl’s final case study focuses on education in Kansas. Once again, we see that debates around policies like public school funding are inextricable from discussions of racial equity. White Americans in Kansas — epicenter of debates around segregation in public schools thanks to Brown V. Board of Education of Topeka (1954) — are dropping out of high school at much higher rates in the aftermath of then-governor Sam Brownback’s 2012 reduction in taxes and education spending. Dropping out of high school reduces life expectancy. Metzl’s statistical research suggests the state’s education cuts correlate to 6,195.51 lost white life years. This is the shakiest of the three chapters by its very nature, as Metzl had to argue that the correlation between life expectancy and education, in this case, equals causation.

Taken together, these three case studies demonstrate that conservative policies, framed both implicitly and explicitly in the language of racial grievance, are killing white people. They kill people of color too, to be sure; one could argue that that’s by design. But Metzl’s argument is that “a renewed focus on restoring equitable structures and infrastructures will improve individual and communal health” for people of all races.6

Fundamentally, the issue here is discursive. Sure, there are plenty of racists in the United States at all levels of the social hierarchy — and many of those racists would make the affirmative choice to die rather than see the proverbial playing field levelled on their watch. There are, however, far more people in this country (including, it seems, the majority of the folks Metzl interviewed) who have been trained to think in terms of having and not having, winning and losing, deserving and undeserving: knowingly or unknowingly, they have been trained to talk about race without talking about race. In a politics framed by scarcity and borne of institutional racism, one person’s loss is always another’s gain. Turns out, that’s not really how the world works, at least when it comes to guns, healthcare, and education. Backlash conservatism, then, is a powerful force, but what’s really doing white people in (literally) is backlash governance.7

Jonthan Metzl. (Vanderbilt University)

Dying of Whiteness is at once deeply academic and deeply personal. In addition to providing insight into his personal background (Metzl grew up in Kansas and Missouri, and now lives in Tennessee), he does a great job setting the scene for his readers, helping us understand what it was like conducting this research. To this end, there are extended interview transcriptions scattered throughout the book. It’s hard to maintain objectivity when you read statements like “[N]o way I want my tax dollars paying for Mexicans or welfare queens.”8 The interviews with members of a support group for people who’ve lost loved ones to gun suicide — many of whom are quicker to blame themselves than the gun — are especially affecting.

Still, this book at its core is a sociological text, and most of its readers (myself included) are not sociologists. Balancing the narrative and analytic work this book is doing is a big ask. Metzl understands this. As a result, he restates his thesis innumerable times throughout the book — enough that it felt repetitive. Despite the careful articulation of his claim, though, even assiduous readers may occasionally read Dying of Whiteness as perpetuating the problematic stereotype that rural white voters are just a bunch of uneducated racists voting against their own interests. It’s not. The book argues that race is a social determinant of health for white Americans as much as it is for marginalized groups, for largely the same reasons. Simply put: public policy rooted in white supremacy hurts everybody — and every body.

I did not expect that this book would be a difficult one for me to get through, but maybe I should have — not because of the content, but because the topic hits so close to home. I’m three-fourths white, and (absent a good tan) I look it. As a result, I live with white privilege others in my family can only imagine. I grew up in the South — first Florida, then North Carolina — and I now live and teach in Ohio.

I also lost my (white) father to suicide two years ago. He struggled with alcoholism his entire life, and eventually lost everything and everyone he cared about to his addiction. He didn’t use a gun, but it hardly mattered; while reading the interviews with families struggling to make sense of their loved one’s suicides, I still felt like the book’s object.

The story Metzl tells doesn’t map cleanly onto my father’s at all, and that’s the point. The story he tells is not that of an unimaginable other, or of individual failings. Dying of Whiteness asks, instead, that we see the life and death of people like my dad as part of a larger architecture of loss. They are a feature — not a bug — of a democracy anchored in white supremacy. My dad killed himself, yes, but this books raises the troubling possibility that he was also murdered.

Would my dad still be alive if we lived in a country with universal healthcare? Probably not… he had health insurance, and he got a lot of specialized care. But I’ll never know for sure. That’s probably for the best; I’m not sure which answer would be more painful.

I’m glad I read this book. The emotions it dredged up meant it took a long time to get through, and this review still longer to write. I would advise other suicide survivors to think long and hard before reading this book — preferably with the support of a therapist. If you are in a position to read it, I suggest doing so with a friend or as part of a reading group. It’s important that the central message of the text not be lost in or reduced by the emotional responses it generates, and academics and non-academics alike will get more out of the book if it is accompanied by structured dialogue.

I will be thinking about this book for a long time, and I don’t expect I’ll get any more comfortable with it as time goes on. I’m glad, because there are few things more pernicious — and, as Metzl demonstrates, more dangerous to our health — than allowing a status quo anchored in white supremacy to feel comfortable.

If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.


  1. Jonathan M. Metzl. Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland. (New York, NY: Basic Books, 2019). 8. Return to text.
  2. Metzl, Dying of Whiteness, 12. Return to text.
  3. Metzl 142. Return to text.
  4. Metzl, 141. Return to text.
  5. Metzl 176. Return to text.
  6. Metzl, 267. Return to text.
  7. Metzl, 7. Return to text.
  8. Metzl, 3. Return to text.

Featured image caption: Missouri: the show-me state. (Becky/Flickr)

Andrea Milne is a SAGES Teaching Fellow and Full-Time Lecturer in the Department of History at Case Western Reserve University. Her current research focuses on the nurses who developed the first AIDS ward in the United States. She received her PhD from the University of California, Irvine in 2017.