Feelings and Voting: Lessons from Kentucky for Pennsylvania

Author: Kenneth S. Thompson MD, Pittsburgh

Several years ago I got a call from a friend. She was working in a town outside of Pittsburgh, where she was hoping to spark a renewal of its main street. Knowing I was a psychiatrist she called with a specific question: “I know you treat people with depression, but what do you do when the whole town is depressed?” I have been thinking about this ever since. Just a couple of days ago I got another call about another town outside Pittsburgh in the opposite direction. He asked me the same question and added an observation: “The only thing young people want to do here is leave.”

Election Day 2024 is just ahead and it appears much will depend on the actions of Pennsylvanians – especially those residing in our rural and de-industrialized regions. Arlie Hochschild, an acclaimed sociologist, has just published a book about a similar place located in the mountains of eastern Kentucky. The book, titled “Stolen Pride”, follows up on her previous book “Strangers in Their Own Land”. Together they constitute an ongoing effort to understand the deep links between historical developments and the collective emotions underlying political life.

 What’s left is unspoken shame and articulated anger

“Strangers in Their Own Land” examines how people living among the chemical plants of Louisiana felt about and dealt with the ongoing degradation and pollution of the land around them. “Stolen Pride” examines how people in eastern Kentucky are dealing with the collapse of the coal industry and their sense that they and their community have become invisible. It is explicitly focused on the factors driving people from being Democrats to increasingly right-wing Republicanism.

Given the historical, social, and geographic similarities across Appalachia, it is not too great a stretch to consider what Professor Hochschild learned in the context of Pennsylvania. Below see a comparison of key facts about Kentucky Congressional District 5, the focus of “Stolen Pride”, and Pennsylvania Congressional District 14, which includes Fayette, Indiana, Greene and Washington County.

Figure 1: Kentucky Congressional District 5

Distribution– 76.49% rural[1]
– 23.51% urban
Population (2023)738,681[2]
Median household income$44,175[3]
Ethnicity– 93.7% White
– 2.6% Two or more races
– 1.5% Hispanic
– 1.4% Black
– 0.4% Asian
– 0.3% other

Figure 2: Pennsylvania Congressional District 14

Distribution99.78% rural ???
0.22% urban ???
Population (2023)753,602[1]
Median household income$63,720
Ethnicity– 90.4% White
– 3.7% Two or more races
– 3.3% Black
– 1.6% Hispanic
– 0.6% Asian
– 0.4% other

In addition to the shared population statistics and mountainous terrain is the collective experience of a history of economic decline and subsequent societal dislocation. Communities have deteriorated, taking valued social roles, status, and pride with them in both Kentucky and Pennsylvania, as well as other parts of Appalachia and the “Rust Belt”. What’s left in these left behind places is often unspoken shame and articulated anger that expresses a sense of being mistreated and displaced with a desire for revenge and restoration-taking back what is felt to have been stolen. It is an economy of emotions exchanged between people in reaction to perceptions, not necessarily to facts. It might be called “emotional reality”.

Addressing the reality of painful emotions

It’s on this terrain that I became engaged with Professor Hochschild’s work. I am a psychiatrist who works in de-industrialized, left-behind communities in Pittsburgh and at the policy level in the Commonwealth and the nation. I have been particularly concerned with the epidemic of the „deaths of despair” (drug and alcohol related deaths and suicide) that have devastated the places I have worked and many others like them.

Addressing the reality of painful emotions is difficult. It’s far easier to run from them and to not discuss them – which helps explain the use of substances and alcohol. This is particularly true when shame is involved. It is much easier to display anger than it is to admit fear, loss and shame. No wonder these latter feelings are generally absent from the national conversation, going unacknowledged while they drive the nation’s emotional reality, a powerful current under our raging sea.

Where are the multitude of sacrifices memorialized?

Pennsylvanians have experienced their share of profound losses. Entire industries and the communities they created have become shadows of themselves. People could blame the powerful global forces that have been driving our economy. But our culture of individual responsibility doesn’t see it that way. So these losses are experienced as failures that are both personal and collective. Failure is experienced as deeply shameful. Because of difficulty talking about these feelings, our communities have not worked through mourning our myriad losses – we hardly acknowledge them.

Where are the monuments to those bygone days – other than the now useless rusting ruins? Where are the multitude of sacrifices memorialized? Who remembers that the Mon Valley made the steel that won World War II? Who cares how heroic coal miners were? Who are we? We don’t know and no one else does either. No wonder regional pride is at an ebb. No wonder young people just want to leave.

Somehow, the abuse has to stop

It’s not helpful that those in our society who are doing well are often scornful of the failures and the related emotional reactions. These attitudes both reinforce the shame and, in their lack of empathy, drive further disconnection. They further decrease the likelihood that painful feelings will be discussed and reinforce the idea that we can express anger instead. This locks us in a pattern of arrogant big city elites and ignorant residents of „Pennsyltucky” – unable to grasp each other, looking to our respective leaders to somehow to put the other in their place – „A basket of deplorables” and “Marxist Fascist Communists”. 

This election, built on the fulcrum of these emotions, is revealing what has all the earmarks of a mutually abusive toxic relationship. Each side is hoping to overwhelm the other. What if we don’t? What if we do? What will get us off this high stakes emotional roller coaster? We must find a way. The truth is that we are dependent on each other – we are each other. It’s a fantasy to imagine otherwise. Somehow the abuse has to stop. Somehow we all have to find a way to think again and not allow ourselves to repeat our usual pattern of emotional reactions.

Not giving up on reinvigorating the future, but giving the past its due

I am worried that, in their mutual desire to escape an intolerable sense of shame about the losses they have experienced, large numbers of people will identify with and vote for a candidate who articulates that rage – and nothing else. I understand the desire and the importance of sending a message of anger, but the desire for revenge has left many people extremely vulnerable to the siren call of a manifestly treasonous charlatan and bully who is invested in continuing the abusive relationship for his own gain. It is impossible to imagine that his call, if answered, won’t lead to much regret and even greater shame. Very strong emotions can lead to very poor choices that make things worse, not better.  

At the same time, I hope that Vice President Harris and Governor Walz continue to build on President Biden’s extensive efforts to engage left behind Americans in a new future. I hope they can address the losses, the shame and the anger that have long been neglected and initiate a process of societal mourning – remembering rural and industrial America and the people who made it. This is not to suggest that they give up on reinvigorating the future, but that they give the past its due. It and the people in it deserve to be recognized. They are never going away. We must reconcile with them. That’s what mourning is about-the future is built out of the past.  

As they mourn, the people in these areas need to be reassured that the societal collapse they experienced wasn’t their fault and that it was a terrible mistake to undervalue and ignore them – to shame them. They need to be shown that this time things will be different, that the success of the nation must and will include them as it does everyone else. It must be made clear that, without them, we are not wholly who we are, and we cannot become who we aspire to be. I hope the Democrats continue to throw themselves into this.

The people of America on both sides of this election have many positive attributes that, if

elicited, can overshadow the depression, shame, anger and arrogance described here. I hope this election becomes a path toward healing – one that moves beyond feelings of anger, revenge and arrogance in favor of the better angels of our nature: empathy, reason, compassion, love and hope, in a country where no one feels they have no future in their community.

Time is short. We have a lot of emotional work to do.

Kenneth S. Thompson, MD, practices psychiatry in Pittsburgh, Pennsylvania. After completing his residency in psychiatry at the Albert Einstein College of Medicine in the Bronx, NY, he did a postdoctoral fellowship in mental health services research at Yale University. He served on the faculty at Yale and the University of Pittsburgh School of Medicine and Graduate School of Public Health and was the Director for Medical Affairs at the Center for Mental Health Services in SAMHSA in the US Department of Health and Human Services. He is a founder and is currently medical director of the Pennsylvania Psychiatric Leadership Council. He is focused on social medicine and community psychiatry. He has written extensively and consults and lectures globally on issues pertaining to public service, leadership and advocacy, disaster response, personal and community recovery and resiliency, whole person primary health services and mental health policy, public health and the struggle for health equity, democracy and human rights.