So in hearing about this surge in “deaths of despair” - suicides, overdoses, etc - what portion of that is that an artifact of medicine pushing back on other causes of death?

I mean, as humans Americans have a 100% mortality rate, they’re going to die of something, in a world where all infirmities were casually treatable, everyone would die in murders, suicides, and accidents.

At the dawn of the 20th century it was a lot more normal for people to die of trauma or infectious disease, death had such an undertow that the late 1800s saw regular speculation that in the absence of active, fecund thriving, native Americans and emancipated blacks would just die out.

But then antibiotics, vaccinations, hygiene, surgery. I suspect a lot of early 20th cen. “social hygiene” stuff - contraception, “eugenically spaced” births, forced sterilization, invalids’ homes and asylums – was an attempt to maintain the social order pre-medical revolution, where middle class families might have three children survive to adulthood, lower class families might have none, and those most in need of burdensome care just… disappeared. (It also fit really well into a primarily agricultural culture that was going through a revolution in deliberate crop and livestock breeding.)

And so then the understanding was unless something actively went wrong, you’d live to at least middle age and die of cancer or heart disease, but even that’s become less of a thing.

Like, I remember before statins got big, and we’re not talking ancient history, we’re talking the mid-90s, Nintendo was already releasing nostalgia-bait releases of its classic games. And it was just understood, that starting in their mid-40s, plus or minus a bit based on how fit they were, people you knew would start to suddenly and unexpectedly die from like heart attacks, or cardiac arrest, or strokes, or cerebral hemorrhage.

And the midcentury Heroic Age of Surgery left us with angioplasties, and coronary bypasses, and heart and valve transplants, and ambulance staffs were training up on critical first-line care, and it was already starting to be like “well maybe you’ll just suddenly and unexpectedly be severely crippled”, but I’m just now realizing that this background thrum of sudden circulatory failure, or the things leveraged out from it – diets that minmaxed on cholesterol, say – just isn’t audible anymore.

But, like, if a hard-living construction foreman goes on blood pressure medication instead of just keeling over in his early 40s, he’s still going to have to die of something, and even if that something is “supposed” to be lymphoma at age 72, that’s still another 30 years of chances to pick up the needle or the shotgun.