This illuminating and disturbing book explores how various forms of white supremacy became expressed in policies, laws, and elected officials, such as Donald Trump. Physician and sociologist Metzl details social changes in Missouri, Tennessee, and Kansas, where white Americans backed changes that, ironically, dramatically harmed them with gun suicides, school dropouts, worse healthcare, and shorter life spans. For Metzl, “Whiteness” refers not to skin color but to a political and economic system of white privilege.

Metzl's thesis that: “Trump supporters were willing to put their lives on the line in support of their political beliefs” was, in fact, a sort of “self-sabotage” (pp. 5-6). While a conservative political movement fostered white racial resentment, largely in lower-income communities, the mainstream GOP did its part by crafting policies against the Affordable Care Act, higher taxes, and restrictions on guns. An atmosphere of polarization and political stasis grew. Metzl writes: “Compromise, in many ways, coded as treason” (p. 11).  

Metzl focuses on the examples of Missouri, Tennessee, and Kansas to “suggest how the racial system of American fails everyone” (pp. 16, 20). He visits each state, leading focus groups, interviewing formally and informally, reading newspapers, and inductively formulating concepts that seem to explain the nonsensical behavior of rejecting helpful programs. For example, because “risk” in Missouri has become a code name for possible attacks by black people, white people buy guns, especially when restrictions are removed. Many white men feel that a gun (or many guns) restores their privilege, but suicide of white males, often low-income, goes up. Metzl’s statistics and charts show contrasts with other states with stricter laws and lower suicide rates. He calls for preventive medicine to lower such deaths.  

For Tennessee, the Affordable Care Act offered many benefits to poor or middle-income people, but Republicans (and especially Trump) attacked it as big government over-reach, socialism, exorbitant cost, a program that would help minority people, for example “welfare queens.” “Cost” became a proxy for the “we don’t like it,” even when the economics would be favorable for good healthcare for all. Blacks were generally in favor of ACA, but white blue-collar men swore by their independence and autonomy. Neighboring Kentucky accepted ACA, and ten graphs included in the book clearly chart the better outcomes for Kentucky in such areas as insurance coverage, death rates, and seeing a doctor.  

Metzl returns to Kansas, where he grew up and recalls the pride Kansans had in their state. Republican Governor Sam Brownback enacted massive tax cuts with large reductions to state services and school funding, an “experiment” in “epic defunding.” The GOP, Tea Party, Koch brothers, and “trickle down” theories all played a part in benefiting the wealthy financially, while minority and lower-income groups paid more. Infrastructure, such as roads, suffered. Untested charter schools collected wealthy white students, while public schools plunged in funding, test scores, and graduation rates (see 17 graphs). Since education is a predictor of health, there are and will be long-term costs to Kansans, especially for minority groups.  

Metzl attacks the “Castle Doctrine” (“a man’s home is…”) as a symbol of narcissism, individualism, and as a risk for all citizens when social structures are abandoned. He closes with some hopeful examples of social change for the better.


For many reasons, this is a rich, nuanced and complex book, a major contribution to public health, sociology, and American studies. It's worth reading and rereading.

The startling title and subtitle grab our attention. However could white people kill themselves in the Heartland of our great country? Can Metzl back up this bizarre claim? Soon we see—and are sad to see—a division between the readers of this book (educated people, often professional) and a lower class with less education, less wealth, and increasing losses in a polarized society. Regrettably, this is an underclass of whiteness that joined with conservative Republicans, the alt-right, the Koch Brothers, Fox News, and others to create Trump’s “base.” Trump’s current policies, however, do not help the poor—only the rich.  

Academics and other educated readers may not know a lot about this underclass, and the book is a revelation of the anger, the depression, the desperation that many white, blue-collar men (especially) experience, and their urge to find status in owning guns, rejecting big government, and affirming that they can take care of their health by themselves with no help from outsiders. Further, supporting “plain-talking,” sexist, and racist Trump affirms what a real man is. Metzl shines a light on the underclass of white men (many southern) who have been left behind for decades and especially with changes in industry, computer-based business, even gains by minorities of color and sex, and pressures of immigration. Such whites often believe outside help may advantage black or tan people over themselves.  
This extraordinary book brings together detail and vision, description and theory, bold statement and nuanced consideration of possibilities. The methods used are several and mutually supportive: on-the-ground research, interviews (both formal focus groups and informal discussions), local journalism, academic commentary, and statistics. The careful graphs—for each state—make Metz’s claims clear… and worrisome. How can we defeat these trends of harm and polarization?  

The book is a pleasure to read for its smooth and intelligent style, its organization, and the carefully reasoned and presented arguments. There are also memorable examples of spokespersons who represent white views and a woman who dies, accidentally by her own hand, thus becoming an emblem of whiteness gun violence.   


The “Acknowledgments” (pp. 285-88) are worth reading at any time (even before the formal text) for Metzl’s views and methods, especially his interdisciplinary teams.   
The extensive notes, some 41 pages, are impressive for range of concepts, scholarship, journalism, and commentary, both recent and historical. 

Primary Source



Basic Books

Place Published

New York



Page Count