To me the answer is: using mutable state is opt-in. I disagree that "mutable state is rampant".
By opting in to the mutable state constructs you are basically saying "I know what I am doing, let me do my work" which is IMO quite fine because "pure" FP languages like Haskell can be a huge hassle when you actually need to deal with the real world.
To me Elixir is a very nice compromise.