My experience of losing a friend to heroin (2020)

Very well written piece. Makes me wonder if we will soon see a similar piece published but s/heroin/videogames.

> I wish I had a happier note to end this on, but honestly, my biggest takeaway from the whole experience is that maybe some puzzles just can’t be solved. We can try to attribute Jack’s problems to intrinsic biological/psychological issues (social phobia, migraines, etc.) or to environmental causes (super high rate of heroin use and OD in the community), but both sides seem fundamentally lacking in explanatory power. The vast majority of socially anxious people don’t resort to heroin, and despite the problems of these small towns, they are by no means among the worst places to live in America, let alone the world.

Earlier on, the author does speculate about what drove Jack:

> To put it another way, Jack was painfully aware that his future options were, “be a complete loser,” or “be a complete loser who feels really really good for a few hours every day.” He chose the latter.

What's striking about this is how it's possible to live this way without drugs. A brain-numbing job eight hours a day and a life-saving hobby for four. A toxic-family life but wonderful community.

It almost sounds like Tennis could have been this outlet:

> One time when Jack was in middle school, he walked off the tennis court after a well-played match, and his mother asked him how he felt. Jack said something like, “when I’m out there, it’s so nice… it’s like the rest of the world goes away and I don’t have any problems.”

This seems a little insensitive given the original is about a friend dying from drug overdose and video games aren't deadly.

>Then there were the migraines. Even after he died, I never got a straight answer as to the cause or truth of this problem. All I know is that he often complained about getting debilitating migraines that forced him to stay in the quiet dark of his room, sometimes for days straight. Jack’s parents took him to doctors and specialists trying to get to the bottom of it, he tried numerous treatments and medicines, but I don’t think the cause was ever identified.

Migraines are frustrating because there are a thousand different potential causes and no one really understands their physiology. Many people don't respond to medications (outside of opioids, maybe) and even then, a migraine is far more than just pain; it appears to be a general disruption in brain function, possibly related to a phenomenon known as cortical spreading depression, and is often preceded, accompanied, and followed by vague psychological and even gastrointestinal disturbances. What's worse, you may be lucky enough to find a medication to mitigate the pain, but the psychological disturbances generally persist even in the case of a successful abortion. Frequently that means cognitive slowness and emotional disruption that can last for days.

Likely migraines are actually a manifestation of numerous abnormalities which are not always present in all sufferers, and I imagine that makes them particularly difficult to research, especially with first order statistical correlational analysis. Maybe ML will help here with the right data. The only certainty is that a better understanding of and cure for migraines would bring relief to millions of people who suffer unnecessarily.

"What does a scanner see? he asked himself. I mean, really see? Into the head? Down into the heart? Does a passive infrared scanner like they used to use or a cube-type holo-scanner like they use these days, the latest thing, see into me - into us - clearly or darkly? I hope it does, he thought, see clearly, because I can't any longer these days see into myself. I see only murk. Murk outside; murk inside. I hope, for everyone's sake, the scanners do better. Because, he thought, if the scanner sees only darkly, the way I myself do, then we are cursed, cursed again and like we have been continually, and we'll wind up dead this way, knowing very little and getting that little fragment wrong too."