Rising Violence and the Shifting Fate of American Democracy with Author Stephen Marche Part 1

Facing Uncertainty in American Society: Insights from Stephen Marche on the Interesting MD Podcast

By Dr. Rob Beck, Host of Interesting MD

If you’re a regular visitor to the Interesting MD, you know I’m always curious about how physicians (and all of us, really) can maintain balance, prevent burnout, and adapt as the world around us changes—sometimes in alarming ways. Recently, I've found myself fielding a flood of questions from fellow physicians, colleagues, and friends: "What the hell is happening in the United States?"

Honestly? I don’t have a crystal ball. But I do know that when the world feels uncertain, it helps to turn to people who have studied these issues from every angle. That’s exactly what drove me to sit down with Stephen Marche for a special two-part episode on our podcast, and today I’d like to share some key insights—and personal reflections—from that conversation.

Why Bring a Canadian Novelist onto a Podcast for Doctors?

Some might wonder why a show about doctors features an interview with a Canadian novelist and essayist. Let me tell you—I recently read Stephen's books "The Next Civil War" and "The Last Election," and both profoundly shifted my perspective. His work isn’t just about predictions; it’s about deeply understanding the evolving landscape of cultural and political change, and the ramifications for all of us—especially those of us entrusted with the care and wellbeing of others.

Stephen’s breadth of experience is staggering. He’s lived and worked across North America, conversed with hundreds of experts, and stitches together models from fields that range from economics to environmental science. He’s also co-host of the podcast "Gloves Off," where he grapples with the looming question: How can Canada withstand the social and political shocks facing its southern neighbor?

And yes, he’s talked to everyone from Anne Applebaum to Margaret Atwood—whose insights on authoritarianism and democracy are as relevant today as ever.

Rising Political Violence: What Are the Real Risks?

One theme that emerged in our conversation is the troubling trend of increasing political violence. Stephen’s research, grounded in dozens of predictive models, points overwhelmingly in one direction: greater instability and rising violence. He distinguishes between "civil disturbance" (which the US has already reached) and "civil war," carefully defining these terms for clarity.

But let’s be clear: the image of armies marching state-to-state isn’t the most realistic scenario. Instead, think of escalating localized violence—sectarian, fragmented, fueled by fear and disenfranchisement. Stephen compares the situation to “the Troubles” in Ireland and the “Days of Lead” in Italy, where life became punctuated by political danger and uncertainty.

Perhaps most unsettling is his observation that attempts to suppress violence can lead, paradoxically, to more violence—a warning seen in countless historical examples.

Complex Cascading Systems: How America’s Problems Multiply

Stephen’s analysis doesn’t isolate one cause. He looks at America as a "complex cascading system," where environmental disasters, economic strain, social divides, and polarized politics interact and amplify each other. One stark scenario he described is a major hurricane hitting New York—an event major reinsurance companies are betting will occur, with catastrophic consequences for both infrastructure and the social fabric.

Reflecting on my own experience during Hurricane Katrina—when my wife and I were medical students displaced from New Orleans—I’m haunted by the thought of what a disaster on the scale of New York would mean. Tens of millions of people, some of the wealthiest and poorest Americans alike, suddenly cast out as refugees. It’s hard to fathom how our already-stressed systems would cope.

Losing Faith in Institutions: The Path to Violence

Barbara Walter, whom Stephen interviewed for his podcast, argues that violence erupts when people lose hope in institutions—when votes and courts seem meaningless, and justice appears captured by partisan interests. Stephen echoes this idea, noting that the "gray zone" between democracy and authoritarianism is especially unstable.

It’s not just political structures that are at risk, but the legitimacy of law itself. When individuals feel powerless, some will inevitably turn to violence, especially as the center loses its hold and complementary radicalization takes hold—each side fueling the other’s extremes.

What Does This Mean for Doctors—and Everyday Life?

Here’s where it gets personal. Increasingly, I hear from doctors asking, "How do I get out of this?" Many are considering emigration, looking for ways to reclaim a sense of safety and stability. The anxiety isn’t abstract—it’s about sending our children to school and not knowing if they’ll return home safe.

As physicians, we're trained to look for signs and symptoms—the early warnings that something is amiss. Right now, those warnings are everywhere: gridlocked government, shrinking trust, a sense of oppression, and growing violence in our cities. The models, according to Stephen, don’t offer comfort. If anything, they predict more violence and greater instability.

But it’s not all doom and gloom. Authoritarian states, Stephen argues, inevitably fail; life in such systems is miserable, unstable, and—over time—unsustainable. The prospect for change, for reformation, comes when people finally decide enough is enough.

Final Thoughts: Where Do We Go From Here?

I wish I could offer simple answers, but all I can share is what I’ve learned: The way forward starts with honest conversations, critical self-reflection, and an openness to learning from both our neighbors and our histories. Whether you’re a physician, a parent, or just someone searching for perspective, it’s time to acknowledge how interconnected and complex our challenges truly are.

As we look to next week’s episode, I’ll dig deeper into what history tells us about where physicians fit in these times—and how we can respond.

As always, I’m grateful for your support and engagement. Please share your thoughts, questions, and stories—your voice matters, now more than ever.

Take care, and be well.

To stay updated, subscribe to the Interesting MD podcast on YouTube, and follow us across all major social platforms. If you have thoughts or want to connect, email me at rob@interestingmd.com.