Jerry didn’t necessarily want to follow in his dad’s footsteps and become a coal miner. But there aren’t too many ways to make money in eastern Kentucky, and after his dad was diagnosed with black lung, a disease that can be caused by chronic exposure to coal dust, and could no longer work, Jerry needed a way to support his parents.
“Instead of going to college, I went underground,” said Jerry, whose name has been changed for privacy reasons.
For generations, U.S. coal miners have publicly buried their feelings about working a dark and dangerous job where it’s not unusual to see co-workers die or be seriously injured, and where rates of black lung are reaching their highest levels in two decades.
Now, a new study from the University of Virginia is shining light on a shocking mental health crisis. More than one-third of current and former coal miners seeking treatment for black lung (which potentially afflicts one-tenth of veteran miners) struggle with serious depression and anxiety, the study suggests, and over 11 percent said they’d considered suicide in the past year.
“There’s no population I’ve seen that has the levels of mental illness that we’re seeing in coal miners,” Dr. Drew Harris, a pulmonary medicine expert at UVA who led the study through a black lung clinic he runs in Southwest Virginia, told VICE News.
Over 2,800 coal miners suffering from black lung voluntarily filled out a survey asking about their mental health. Harris said it’s likely the largest survey of its kind ever conducted in the U.S.
“The rate of suicidal ideation (11.4 percent) far exceeded the past-year prevalence among U.S. adult men living in West Virginia (3.7 percent) and Virginia (2.9 percent),” the study explains. “The prevalence of PTSD (26.2 percent) was more than 3 times higher than the lifetime rate of PTSD in adults living in rural US counties (7.0 percent).”
The day-to-day challenges of having black lung, a disease that steadily makes it harder for people to breathe, often killing them, exert a heavy psychological toll.
Jerry himself was recently diagnosed with third stage progressive massive fibrosis, a particularly aggressive form of black lung. Jerry had watched the disease slowly squeeze the life out of his dad. And now, at age 45, his teenage kids are seeing his strength and energy fade.
“I can’t keep up with my children while we’re hunting,” he told VICE News. “I see them kind of fall back. Instead of me helping them, they’re trying to help me.”
Mental illness tends to be worse among coal miners with the most advanced cases of black lung, the study says, some of whom require oxygen tanks in order to breathe. Roughly half of respondents in this group say they have major depression or anxiety. But Harris thinks that the actual nature of working deep in a coal mine is also contributing.
“It’s the dirtiest, dustiest, hardest job I’ve ever heard about,” he said. “Some of my patients have spent their career in 3-foot high spaces or lower in pure darkness in conditions where they can’t even see their hand.” Harris said the amount of trauma coal miners experience on the job is comparable to soldiers serving in the military.
Jerry Coleman, a different miner who is 68, remembers one day when he was working in a West Virginia coal mine and some loose rocks fell onto another miner. “He went to the hospital and three days later he died of internal bleeding,” Coleman told VICE News. “There were several people I’ve seen that got killed.”
After spending 37 years often working 4 or 5 miles beneath the Earth’s surface, Coleman was diagnosed with black lung. “It changes your life, when you see other people your age doing things and you can’t do them,” he said, reflecting on the two decades he’s now spent with a disease that can make him feel like he’s constantly suffocating. “You want to do things with your grandkids and you can’t. It affects your whole mind. And you wonder, ‘How bad is it going to get?’”
Cases of black lung among coal miners reached record lows in the late 1990s, but then began rising drastically, even as coal production plummeted. A 2018 report from the National Institute for Occupational Safety and Health found that over 1 in 10 underground coal miners with at least 25 years of experience suffer from black lung. In Central Appalachia—a major coal-producing region that includes parts of Ohio, West Virginia, Kentucky, Virginia, Tennessee, and North Carolina—the rate is potentially 1 in 5.
One explanation for the spike is that the biggest coal seams in Appalachia have mostly been mined, meaning companies have to cut into thinner seams embedded in sandstone, which releases silica dust that lodges permanently in miners’ lungs. This dust is more toxic than typical coal dust and can cause coal miners to develop black lung much faster and earlier in life than in previous generations. Harris says that he now sees miners in their 30s and 40s coming into his black lung clinic.
The National Mining Association, an industry group that represents coal mining companies, insists that safety is improving. “In recent years, effective ventilation controls, implementation of industry best practices, strict adherence to mine ventilation control plans, increased operator and miner safety awareness…have all contributed to exponentially lower dust levels inside the mine,” a spokesperson wrote to VICE News.
The organization is aware of Harris’ mental health survey. “We have seen the study and it is of concern but is an area we haven’t seen a great deal of research,” the statement said.
Once a miner is diagnosed with black lung the coal company that last employed them is supposed to pay for benefits covering the cost of treatment. But this is a complex bureaucratic process that can take years. “The coal companies don’t want to pay,” Coleman said.
Adding to the timeline for miners is a wave of coal company bankruptcies in the U.S., which reached its highest level last year. When companies go bankrupt they often shed their legal obligation to pay out benefits. In some cases the federal government will then cover treatment costs for miners through the Black Lung Disability Trust Fund.
But coal companies have in the past lobbied Congress to cut the tax on industry that supports the black lung fund, and coal miners themselves are sometimes forced to show up in person at the offices of state and federal lawmakers to lobby for extensions of health benefits.
Coleman recognizes the energy system is shifting. But if the Biden administration is going to prioritize policies that accelerate renewable electricity, he argues, that needs to be accompanied by sturdy long-term health support for the coal miners who got us here.
“At one point every time you turned your light on, a coal miner helped make that happen. When you got heat, a coal miner helped. There’s so many things. We’ve sacrificed our lives,” he said. “If Congress wants to do away with coal, they should take care of us.”
Follow Geoff Dembicki on Twitter.