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  • “Some of the bad choices just happen out of anxiety—running away from bad situations,” Kareem said. ”And in the process, it gets worse.”  Tweet This
  • What if there is something about modern life and modern family structures that make our brains more vulnerable to mental illness?  Tweet This

I picked him up at a Columbus hotel late one Friday night. Out of a job and money, Kareem* was set to join the ranks of Ohio's homeless. 

“Would you let Kareem stay with you for a couple of days?” was the question our New York City friend asked us. Kareem, the son of an Egyptian immigrant, was born in New York City, but after his mom divorced his father, he moved back with his mom to her home state of Ohio. 

After only a couple days at our house on the edge of Cincinnati’s suburbs, Kareem found an IT call center job through a temp agency. He didn’t know anything about IT, but the job paid $15 an hour with the potential to become permanent, and the company promised training. 

Kareem did not have a driver’s license, but we hatched a plan together: after receiving his first paycheck, he could book a room at the budget motel within walking distance of his new job. Kareem seemed excited. Something about suburban Ohio was a breath of fresh air to him—it seemed like there were more opportunities here than in Columbus, where he had spent the last year.

Kareem had been living with us for about two weeks and had already started his new job at the IT call center, when my new issue of National Review arrived. David French’s article, “Those Bootstraps Still Work,” caught my eye. French starts by telling the story of a young man in crisis whom he and his wife helped out. The young man had just graduated high school, but his dad was an alcoholic, and his parents had separated, and he was starting to drink a lot himself. As French explains:

Together with friends from church, my wife and I went to work. We set him up in an apartment next to our house, paid his first month’s rent, and dropped by constantly. Friends got him a good job that would teach him a trade. Next, he found a girlfriend. A year later I was at his wedding. Soon after that, he bought his first home. And now? He’s a member of the upper middle class — living the American dream and raising kids that some would call 'children of privilege.'

Encouraged by the young man’s progress, French and his wife took other people in. But things didn’t work out the same way. As French tells it, "Nobody was blocking their path. In fact, there were people doing their best to push them along—to put them in a position to succeed. But they wouldn’t take the steps. They wouldn’t walk the walk." He concluded: “Is there a boot on the neck of the working-class American? Yes, there is. Sadly, it is typically a man’s own boot. His own choices weigh him down. His own decisions destroy his future.” 

I shared the article with Kareem and asked for his reactions.  

“I think what’s missing is mental health,” he told me after reading the article. He said he didn’t appreciate that French seemed to imagine only two possibilities: a person who makes good choices and succeeds, or a person who makes bad choices and fails. In Kareem’s mind, there is also a category of people who are trying to make good choices but are struggling with deep mental health problems. 

Kareem has struggled with debilitating anxiety for years. At one point, things got so bad that he committed himself to a mental health hospital, where he could get medication. But, as he told me, the medication didn’t work. 

“Some people put a lot of faith in this stuff. Medication. Therapy. Stuff like that—I’ve been trying this stuff for a long time,” he admitted. “I’ve had one doctor straight up tell me, ‘you’re an enigma.’”

Over the years, Kareem has been diagnosed with different problems by different doctors (“It changes with the doctors, really”): major depression, social anxiety disorder, schizoaffective, and bipolar disorder. Kareem said several people in his family have been diagnosed with bipolar disorder, but he does not pretend to understand why he is afflicted the way he is, or even what precisely afflicts him. 

On the one hand, Kareem questions how much choice people really have. “People are not making choices as much as you think,” Kareem said about French’s analysis. “I’m starting to think that the behavioral scientists are right about a lot more than I had expected.”

What were they saying, I asked?

“That a lot of what people do is just reaction. It’s just kind of built in,” he said.

On the other hand, Kareem looks at the lives of other homeless people at the shelter, other people he has worked with, and within himself, too, and he laments his own bad choices. 

“Where you are today,” I asked, “is it mostly a result of bad choices or is it mostly a result of bad circumstances and not good genetics?”

“I think it’s all of it,” Kareem responded. “I think some of my bad choices—some of the worst choices I made—was when I was in college; I just wasn’t right.”

Many of us make our earliest choices in a landscape frozen over by isolation, our mental health affected by the reality that there never was a big coal fire to warm us at all. 

He was a gifted kid who basically coasted through high school, never really putting in a lot of work. He thought he could do the same at Bowling Green State University, putting in a minimal amount of effort for good results, but he failed. When a group of friends invited him to tag along with them to southern Ohio to live, he did. He wasn’t happy in college—in fact, he told me he couldn’t remember ever being happy—and he thought he might find happiness with his friends. So he took a job at a pizza shop and spent five years there. But somewhere during those five years, he ended up in the mental health hospital. 

“Some of the bad choices just happen out of anxiety—running away from bad situations,” Kareem said. ”And in the process, it gets worse.” 

Today, Kareem has come to some peace with his own bad choices, putting them into the context of what he inherited. “I had to get to a point to where I had to hold myself accountable for my decisions, but I had to recognize that some of these decisions I made happened before I was done cooking mentally,” he said. “Bad circumstances, when I was a teenager and a child, affected the decisions I made, and I can’t beat myself up for that stuff. So, if I had finished college, I’d be in a very different place right now.”

Kareem also wonders if he carries some trauma within him from his parents’ divorce. Kareem has never had a girlfriend, but there was a girl he really liked, though they were never formally in a relationship. 

She came from a broken home, too. When we were together/not together, people who watched us interact in person made the observation, ‘They’re like this divorced couple.’ And I’m wondering if that’s because we had already sort of broken up—or if that’s just because that’s what we’re carrying around with us, like that’s what we knew? I’m not sure.


We were out of town for my grandpa’s funeral when I got a call from Kareem: after only a week of job training, he was done. It was a terrible work environment that brought out the worst of his anxiety, he said, and there was no way he could be expected to do his job with the level of training provided. So he was back to square one: without a job, without money, and looking for work. 

Was Kareem back at square one because of a bad choice? And could he get to a better place by making better choices? Or was there also something mysterious at work—some combination of genes and biochemicals interacting with free choice that is overwhelming people like Kareem? 

“Mental illness is like any other bodily illness” is a common thing we say—and, in many ways, it’s true.  But what if modern society is also sick, tearing apart organic groups meant to grow and stick together? A mom and dad for a child, an extended family and a community to shelter the nuclear unit, and a web of meaning and support surrounding those core communities. What if there is something about modern life and modern family structures that make our brains more vulnerable to mental illness? 

I ask these questions as a child of the Old Order Amish. Yes, I can point to my Amish cousin—a father and husband surrounded by a supportive community of parents, siblings, extended family, neighbors, and religious meaning—who nevertheless struggles with such severe mental illness that he lives for the time at an in-patient mental health clinic several states away from his family. Without a doubt, Amish people are not exempt from mental illness. But as journalist Johann Hari points out in Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions, a 1970s study on Amish mental health found that they had significantly lower levels of depression than other Americans (Hari says smaller studies have confirmed the finding). 

Why? Perhaps because, as one Indiana Amish man said to Hari, the Amish experience a “sense of being at home.” Hari went on to explain,  "[The Amish man] gave me an image to describe this. Human life, he says, is like a big warm coal fire that is glowing. But if you take out one coal and isolate it, it’ll burn out quickly. We keep each other warm, he says, by staying together."

This keeping each other warm was impossible to miss at my Amish grandfather’s funeral in Lancaster, Pennsylvania, where I was staying when Kareem told me he was quitting his job. My grandfather died on a late Friday afternoon, and over the next three days, hundreds of family, neighbors, and fellow churchgoers made a pilgrimage to the old family farmhouse to view his body, to comfort those who mourned, and to help out a grieving family. With astonishing alacrity and generosity, a team of about 25 families of neighbors and church people promptly pulled together to coordinate every last detail: traveling to far-flung counties to tell others of my grandfather’s death, cleaning the massive farmhouse that would be the site of the viewing and funeral, making meals for everyone, and shoveling the fresh six inches of snow that fell on the day of the funeral. The visits began immediately on Friday night and never stopped until Monday, the day my grandfather was buried. The Amish have had about three centuries to perfect the art of community, and they have become masters of the craft. 

Often due in part to family breakdown, Kareem and so many others like him have no such community from which to draw—and are devoid of this centuries-old support system. 

“I think a big problem is isolation,” he told me. 

When I mentioned Hari’s thesis to Kareem, it made sense to him. “People in these less advanced countries being happier, [they’re] just not being concerned with stuff,” he said. “Like, ‘I was with my family today and it was a great day.’ That’s where they get their satisfaction.” But, he added, many people today do not have these kinds of family connections.

He said it reminded him of the Pixar film Wall-e, whose dystopian plot he considers an apt depiction of isolation in the modern age. In the film, the humans of the future, atrophied and immobile, are unable to move from their motorized chairs and interact with others through the interface of the personalized screens that constantly hover in front of their faces. 

“We are living in something very unnatural,” Kareem said. “We created our own hell.” 

Isn’t that the nub: We created? Many of us make our earliest choices in a landscape frozen over by isolation, our mental health affected by the reality that there never was a big coal fire to warm us at all. So even if we are invited into the glow of those fires later in life, we find ourselves instinctively turning away, our habits formed amid the fissures of fragmentation and isolation. As Kareem told me, “there is help available”—but his “gut level” instincts kick in, and he finds himself walking away from opportunities and conversations. 

“And sometimes it’s not like I even really want to [walk away],” he said. “You kind of feel like you’ve been uninvited—and then you walk away and realize you uninvited yourself.” 

Is there a boot on the neck of working-class Americans? It may often be a man’s own boot. But we are social beings coming of age in a particular society with brains and bodies that have surely been negatively affected by the weaknesses of our society. That, too, is part of the story that we can’t afford to overlook.

*Name has been changed to protect his privacy. 

David Lapp is a co-founder of Better Angels and a research fellow at the Institute for Family Studies. Along with his wife, Amber, David serves as co-investigator of the Love and Marriage in Middle America Project.