HBO Presents Documentary ONE NATION UNDER STRESS

In the 1960s, Americans had among the highest life expectancy in the world. Today, the U.S. ranks near the bottom of major developed nations. From acclaimed directors-producers Marc Levin and Daphne Pinkerson (HBO's "Class Divide," "Hard Times: Lost on Long Island" and "Schmatta: Rags to Riches to Rags") and neurosurgeon and Emmy®-winning CNN chief medical correspondent Dr. Sanjay Gupta, ONE NATION UNDER STRESS examines the reasons for this historic decline when it debuts MONDAY, MARCH 25 (9:00-10:15 p.m. ET/PT), exclusively on HBO.

The documentary will also be available on HBO NOW, HBO GO, HBO On Demand and partners' streaming platforms.

Despite spending more on healthcare than any other country, Americans' life expectancy is decreasing. In ONE NATION UNDER STRESS, neurosurgeon and investigative journalist Dr. Sanjay Gupta sets out to discover what is happening and why. His starting point is trying to understand the spike in so-called "deaths of despair" - opioid overdose, alcohol-related liver cirrhosis and suicide - primarily among middle-age, white working-class people.

Gupta travels across the country, interviewing experts in a wide range of fields, who share their insights on why we're experiencing so much stress, how it affects the brain, body and behavior, and the long-term consequences for the health of the nation. He also speaks candidly with Americans struggling with their own stress-related ailments and those who have lost loved ones to deaths of despair, particularly in communities facing economic and social instability.

"What we are looking at is an increasingly stressed society," says forensic pathologist Dr. Cyril Wecht, who points to stressors like depersonalization, economic uncertainty and unstable family units, all of which can be deadly when coupled with self-medication or over-medication of prescription drugs. Gupta notes, "Ultimately, these premature deaths are all a reflection of the stress, the pain that comes with that stress, and the desire to, in some ways, medicate it away, even to the point it could be dangerous and it could end your life." Gupta meets with a resident of Victoria, TX, who, after the death of her best friend and suffering a miscarriage, was prescribed multiple drugs and now over-medicates, admitting to having suicidal thoughts.

Stanford University neuroscientist Robert Sapolsky tells Gupta, "What makes psychological stress really corrosive [is] lack of control, lack of predictability, lack of social support. It's the constant, never-ending toxic stress that will kill you." As he explains, "From a Darwinian perspective, you're basically seeing a slow winnowing out of people whose stress responses are least adaptive in the face of these human psychological stressors."

This prompts Gupta to ask Princeton economists Anne Case and Sir Angus Deaton, "There is this frightening concept, this idea that some of what we're seeing here is a sort of Social Darwinism. I mean, really, just being blunt about it, if people are dying at a faster rate, is their utility used up?"

Gupta visits western Pennsylvania, where a recent plant closure has left hundreds feeling helpless and angry. Gupta himself grew up in a white working-class community with parents employed by the auto industry. In his hometown of Livonia, MI, he sits down with his mom, who remembers being laid off without any warning, and childhood friend Frankie Sgambati Jr., who works at a nearby prison and cites lack of job security as a huge stressor.

Mortality rates for African-Americans remain significantly higher than for whites, but Gupta is curious about the fact that black longevity is slowly increasing, while it is decreasing for whites. He visits his former medical school classmate, Charles Moore, MD, who started a clinic in a low-income, black section of Atlanta. Moore postulates, "For African-Americans it's been a chronic state of stress. For certain white populations, it's a new issue and possibly that's what's causing that decline for them. The white working class has not seen that systematic type of oppression."

Chronic stress can reduce the size of key parts of the brain - particularly areas involved with empathy and impulse control - and cause synapses to atrophy. Though some changes are irreversible, practices like exercise and meditation can help manage stress and repair brain nerves, as can fostering strong social networks and relationships.

A decades-long study of Italian-Americans in Roseto, PA found that their tight-knit community had the "magic ingredient" that helps mitigate stress: strong social support and social cohesion. As a result, they experienced an uncommonly low rate of heart attacks, despite smoking, drinking and indulging in a diet rich in fatty foods

Extreme and glaring inequality disturbs the social order and undermines stability, no matter which end of the spectrum a person is on. As Frans de Waal points out through eye-opening experiments, even capuchin monkeys have an innate sense of fairness and become outraged at unequal treatment.
By the end of the film, a new study reveals that American life expectancy has declined for a third year in a row. This hasn't happened in the U.S. for 100 years, not since the flu pandemic during World War I. Gupta talks with his medical colleagues at Grady Hospital in ATLANTA and says, "...in some ways it seems like we are manufacturing the disease. Bad food, opioids, gun laws, energy policy have led to these problems. And as much as they make short-term sense FOR THE PEOPLE who are making money off of those problems, it's bad for people."
Other experts offering observations in the documentary include: epidemiologists Sir Michael Marmot and Ichiro Kawachi, neuroscientists Amy Arnsten and Rajita Sinha, social scientists, physicians and people suffering from chronic stress and are on the brink of becoming deaths of despair casualties.

ONE NATION UNDER STRESS was directed by Marc Levin; produced by Daphne Pinkerson and Marc Levin; co-producers, Jackson Devereux, Ashwin S. Gandbhir, Anthony Pedone and Kara Rozansky; associate producer, Jillian Goldstein; edited by Ashwin S. Gandbhir; director of photography, Daniel B. Levin; original music by Giancarlo Vulcano. For HBO: executive producers, Nancy Abraham and Lisa Heller.

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