From the passionate response pieces that I had read, I was somewhat prepared for the eugenics-tinged genetic arguments that stain the text and the deeply clichéd tropes that strangle the film version, but I was not prepared for a stunningly major omission: the fact that though much of the 265 pages of the book and hour and 56 minutes of the movie are taken over by suicide attempts and domestic and substance abuse, neither one manages to grapple at all with mental health.
The ways in which each version of "Hillbilly Elegy" avoids this crucial topic are different, but both are tragically ill-advised. The book itself is a Frankenstein hybrid of looping, repetitive memoir chapters told almost entirely in a voice-over style summary (the creative writing teacher in me kept screaming give us something to see, smell, feel — any sensory detail at all, please!) sandwiched between slapdash social science commentary on the “lurking” “ethnic component.” Vance argues that the bad genes passed down through his Scots-Irish ancestors are the cause of the current social ills he is examining. He bases this argument almost entirely on a blog post from Discover magazine by a writer with a history of contributing to racist, far-right publications.
Even more surprising, many critics were duped by these deeply troubling genetic theories. It is one thing to call Vance a “Trump whisperer” and attempt to utilize his book as an answer for the vote, but it is something else entirely to take him on as a “fiercely astute social critic.” For all of his supposedly fierce astuteness, and all of his focus on hereditary genes, Vance somehow managed to never engage with the fact that his mother and grandmother both struggle with mental health issues that look very much like bipolar episodes.
In his film adaptation, Ron Howard mostly avoids the second half of Vance’s hybrid — the overtly political part — but what he substitutes instead is possibly even worse. The film is peopled by gaudy clichés in place of real human characters. Vance’s grandmother, played by Glenn Close, is her own kind of Frankenstein, an amalgamation of every stereotypical mamaw character Hollywood has ever peddled from the Ma Kettle to Granny May Moses. When she’s not spouting curse words, she’s spouting “hill people” philosophies. Her wildly roving eyes are matched in their melodrama only by the sweeping orchestral soundtrack attempting to pull the film up out of its doldrums.
There are many problems with Howard’s adaptation of "Hillbilly Elegy" but one of the most basic ones is that without his eugenics rants, Vance’s story is nothing but a pat on his own back, and rendering this half of the story into a movie doesn’t help it. Sure, in the film, we can see the visual details lacking from the book, but that isn’t enough. The dramatic soundtrack and jump cuts between past and present try to make up for the lackluster storyline but within ten minutes of her first screen appearance, Vance’s mother Bev (Amy Adams) has quoted four canned clichés: “I’ve got a hot date with not being bored off my ass,” “I’ll kill him. I’ll kill him,” “Get the hell out of Dodge” and “Thank God, back to civilization.” This supposedly complex and dynamic woman (a salutatorian who put herself through nursing school as a single mom) is whittled down to nothing more than a hot mess. Vance may have refused to engage with her mental health, but at least a twinge of his love for her shone through in the book. In Howard’s version, she does nothing more than hold her son back.
Appalachia has a long and deeply troubled relationship with media representations and Howard pushes nearly every one of these familiar buttons: the shirtless, longhaired redneck who is stupid but nonetheless threatening, the signature quick-to-anger hillbilly who would kill anyone who threatened his or her family, the hillbilly who mistrusts all outsiders. And in his characterization of Bev, he revives yet another stereotype: the Appalachian parent as a figure who stands between their children and progress.
This trope has been displayed in various ways throughout the years but it was perhaps first potently branded in the American mind in 1937 with the Michael Curtiz film "Mountain Justice." In a New York Times review that could just as easily be describing Howard’s "Hillbilly Elegy", Frank S. Nugent wrote, "[T]he film gallops posthaste in all directions and never really gets anywhere. The point it makes, if any, is that mountain men are an ornery lot" who would “shoot a 'furriner' on sight and whale the daylights out of [their] daughter when she sold her acre to help Doc Barnard establish a health clinic in the hills.” "Mountain Justice" pits a hillbilly father against his daughter who, Nugent wrote, “picked up her new-fangled notions at a nurses' training school.” The daughter is trying to better herself and work to uplift her people, just like plucky little JD Vance, but her father would rather beat her than see her succeed. In Howard’s film, Bev may not be holding a shotgun between her child his progress but her pleading, trembling hand (seen in close up several times) serves just as well.
It is disheartening to see that Ron Howard chose to recycle trite Appalachian stereotypes instead of digging deeper into a story ripe with salient issues, not the least of which is mental health. At a time when, according to the American Psychological Association, “we are facing a national mental health crisis that could yield serious health and social consequences for years to come,” both Vance and Howard have strewn their stories with suicide and domestic violence and then looked at every reason except for the psychiatric ones.
The closest Vance ever comes is to say of his mother that “she listened too much to the wrong voice in her head.” Of his own mental health, he says he tried counseling once but “it was just too weird.” Howard opts for hysterics, zooming in on a scantily clad Adams laying in the street with blood dripping from her razored wrists, only to have her mother sum up the situation by saying, “She just stopped trying.” The film closes with a Vance voice-over explaining that “we choose every day who we become,” a statement that feels like it is pointed directly at the “choices” of hot mess Bev.
But Vance and Howard have made choices too. In a period when psychologists have published studies showing the direct links between untreated mental health problems and poverty — evidence indicating that poverty causes stress and negative affective states which in turn may lead to short-sighted decision-making — and in a region where mental health services are just as rare as waning jobs and clients often travel more than an hour to see a psychiatrist, Vance and Howard have chosen to avoid the subject entirely.
One of the most sadly ironic aspects of Vance’s book, and by default Howard’s film, is the link between the mental health crises that impact his family and the eugenics movement that Vance hints at favoring. When Vance and Howard depict Bev’s mental health crises as poor choices and weak will that are a result of “racialness” and inherited “bad traits” they are echoing a long lineage of eugenicist doctors and scholars. To put it bluntly, if Bev had been born just a little earlier, she likely would have been sterilized if her own mother was not sterilized first. At the top of the list of “characteristics targeted for elimination from the human population” from the late 19th century up through at least the 1950s were “manic-depressive psychosis” and “bipolar disorder.”
Lack of adequate access to mental health care has historically been widespread in Appalachia but up until frighteningly recently, there was another very common method deemed appropriate to deal with psychiatric illness. Proponents of eugenics saw Appalachia as a particularly ideal location for their experiments because they looked around and, just like JD Vance, saw a preponderance of “people coming into the world to get on the welfare.” As one Welfare Director from Montgomery County Virginia recalled, “they were hiding all through these mountains, and the sheriff and his men had to go up after them” to bring them to a clinic and sterilize them. Dr. Joseph DeJarnette, one of the leading advocates of sterilization, practiced just an hour and a half from where I grew up. He penned a poem called “Mendel’s Law: A Plea for a Better Race of Men” and which read in part:
Oh, why are you men so foolish —
You breeders who breed our men
Let the fools, the weaklings and crazy
Keep breeding and breeding again?
The criminal, deformed, and the misfit,
Dependent, diseased, and the rest —
As we breed the human family
The worst is as good as the best.
Just two years before Vance’s grandfather was born, a court case that began in the foothills of Virginia set a precedent for the widespread use of eugenics. The Supreme Court’s decision in Buck v. Bell cleared the way for the sterilization of over 70,0000 “unfit” individuals. And just one year before the birth of Vance’s beloved Mamaw, Adolph Hitler enacted the Law for the Prevention of Offspring with Hereditary Diseases, which American doctors, including Dr. DeJarnette, praised highly. DeJarnette thought American doctors were not doing nearly enough. “Germany in six years has sterilized about 80,000 of her unfit,” he noted, “while the United States with approximately twice the population has only sterilized about 27,869.” I say all of this to point out that Vance’s genetic take on current “social ills” is nothing new, it has a deep, dark history, one which easily could have affected his own grandmother and mother.
A year after Vance’s debut, poet Molly McCully Brown, who grew up not far from my hometown, published a book titled "The Virginia State Colony for Epileptics and Feebleminded." In her poems, Brown, who has cerebral palsy, wrestles with the reality of being raised in the shadow of one of the infamous eugenics hospital founded by DeJarnette in Lynchburg, VA. Regarding a visit to the grounds, she writes “by some accident of luck or grace,/ some window less than half a century wide,/ it is my backyard but not what happened/ to my body—”. It is through that same window that Vance’s own mother escaped — a window that is uncomfortably narrow, and one that Vance seems to want to make even narrower still.
While sterilization is mostly a practice of the recent past (the Forced Sterilization Law in my home state of West Virginia was only repealed in 2013), the lack of mental health care is very much present in Appalachia. I knew that the situation was dire from my own personal experience of trying to access counseling services after moving back to my hometown in 2015 but when I began to research the statistics, I was struck by not only how difficult access is but also how little this has changed over time. The language about the dearth of mental health facilities in Appalachia in a 1988 monograph is nearly word for word identical to quotes from articles published in 2017. According to Kaiser Health News, “Getting mental health services [in Appalachia] is fraught with challenges. But the need is great.” Dr. Joanna Bailey who practices in McDowell and Wyoming counties in southern West Virginia says that 30 percent of her caseload is treatment for mental health issues.
Wyoming County is a perfect example of the role that the waning economic prospects in Appalachia play in mental health crises. The World Health Organization asserts a direct causal link between “economic vulnerability, lack of educational opportunities, reduced access to health and social services” and “worsened mental health” and this link is illustrated painfully well in former coal company communities.
When the Pocahontas Fuel Company came to Wyoming County in 1916, the Guyandotte River valley was home to small family farms. Pocahontas Fuel bought 1,000 acres and built a mine and mine camp that was a quintessential paternal company town. Everything was controlled by the shareholders, including the name of the new settlement, Itmann for the principal shareholder I. T. Mann. At its heyday, Pocahontas Fuel employed 1,800 men and built an enormous sandstone complex that included a grocery store, schoolrooms, a post office, doctor’s office, barbershop, pool room and payroll office. The Itmann Company Store complex functioned as “the center of the community,” according to the building’s National Register nomination form, “The building was not only the location of much-needed services, but also the center of casual social interaction between Itmann residents.”
The problem was, it did not belong to the residents but rather to the shareholders. And so when Pocahontas Fuel Co. closed its mines in the 1980s, the community lost not only the entire local source of employment but also all the services, social and financial, that were linked to Itmann. The sandstone store-school-health complex was abandoned until sometime around 2007 when a homeless rehabilitative service called Stone Haven opened a shelter there. The structural center of a once bustling town became the last physical refuge and only local source of mental health care for a community suffering cataclysmic losses. But by 2010, the shelter had lost funding and the building was once again abandoned—empty stone corridors echoing and classrooms littered with sleeping bags and mouse-chewed sweaters.
To write a book and shoot a film about the struggles of a multigenerational Appalachian family without mentioning mental health is not only a travesty, it is dangerous. To blame Bev’s psychiatric crises on bad genes and ethnicity is to shift blame entirely away from entities like the Pocahontas Fuel Company who profited off of our land until it was no longer profitable and then left black holes of economic and social devastation in their wake. Howard scratched the surface of this dynamic when he juxtaposed shots of the booming industrial Middletown of the 1940s with the shuttered factories of the 1990s but he did not engage beyond the optics of it. Vance does no better.
Near the end of the book, Vance muses that “a lot European countries seemed better than America at the American Dream.” He states this with an apparent total unawareness of the fact that many European countries provide ample social safety nets for their citizens — free healthcare (including mental health), free education, monthly stipends for students, childcare stipends, and ample maternity and paternity leave. It is Vance’s dreaded welfare that is helping Europeans achieve the American Dream and it is the very lack of this safety net that is dragging Americans down. But Vance and Howard, through "Hillbilly Elegy," would rather have us believe our personal failures are what's holding us back — those bad ethnic choices we make every day.
If you are in crisis, please call the 988 Suicide and Crisis Lifeline by dialing 988, or contact the Crisis Text Line by texting TALK to 741741.
Correction: A previous version of this story mentioned the poet Molly McCully Brown as having epilepsy and has been edited to reflect that she has cerebral palsy.
