In October 2017, Trump’s Department of Health and Human Services declared a public health crisis over what is widely termed the “opioid epidemic.” The 500 percent rise in opioid-related deaths since 1999 is related to a complex set of social and historical factors, from childhood adversity to chronic poverty in postindustrial rural towns; the retreat of social services that work to buffer at-risk individuals; ongoing wage depression; decayed infrastructure; and the corrupt pharmaceutical oligopolies that have subsidized physicians to prescribe painkillers.

The Trump administration’s announcement of a federally funded opioid strategy to deal with the “epidemic” draws on a longstanding and bipartisan consensus that understands mass addiction in impoverished communities as just one expression of a national — or indeed, global — “crisis of mental health.” Hillary Clinton’s 2016 campaign was widely praised for its mental health platform, crowned by a prevention initiative designed to combat the highest suicide rates on record.

The medicalized lexicon of “mental health” purports to cover a vast terrain of everyday experience. According to a report from the World Health Organization, rates of major depression worldwide increased by 18.4 percent globally between 2005 and 2015, reaching 322 million sufferers. Psychiatric epidemiology demonstrates rising levels of psychological stress, anxiety among high-schoolers, major depression (diagnosed roughly twice as often among women as among men, and on the rise globally); “hopelessness” in undergraduate populations; and PTSD rates among civilians that exceed even those found in veterans from Iraq and Afghanistan. This medicalization has made the language of “mental health” sacrosanct across the political spectrum, even on the left.