This was one call for water-leak help that the next-door neighbors in Middletown, Ohio, could not ignore.

"The landlord arrived and found Pattie topless, stoned and unconscious on her living room couch. Upstairs the bathtub was overflowing -- hence, the leaking roof," noted J.D. Vance, in his "Hillbilly Elegy" memoir about the crisis in America's working class that shaped his family.

"Pattie had apparently drawn herself a bath, taken a few prescription painkillers and passed out. … This is the reality of our community. It's about a naked druggie destroying what little of value exists in her life."

Vance was in high school at the time and dramas of this kind kept creating a dark cloud over his life. Many of his questions had moral and religious overtones, especially among people with roots back to the Bible Belt culture of the Kentucky mountains.

"Why didn't our neighbor leave that abusive man?", wrote Vance. "Why did she spend her money on drugs? Why didn't she see that her behavior was destroying her daughter?" And ultimately, "Why were all of these things happening … to my mom?"

Economic woes played a part, he said, but the elegy of hillbilly life involves psychology, morality, culture, shattered communities and families that are broken, or that never formed in the first place. Yes, there are religious issues in that mix.

"It's a classic chicken and egg problem," said Vance, reached by telephone. "Which comes first, poverty and economic problems or people making bad moral decisions that wreck marriages and homes? Clearly people -- children especially -- are caught in a vicious cycle."