Marijuana legalization is in motion: step by step, state by state. Counting Washington, where I live, twelve states have already passed recreational marijuana legislation. At least seven more states, including New York and Minnesota, both traditionally liberal states, are slated for similar legalization in 2019.
While stopping the weed train is unlikely (there are profits to be made in this new frontier), ensuring that its brakes and safety protocols are in working order is imperative. Protections for our most vulnerable populations — adolescents, young adults, and people with mental illness issues — ought to be mandatory.
I work in an outpatient mental health program adjacent to an acute psychiatric hospital. A major portion of our patient population wrangles with substance use issues. Patients tend to use marijuana to relax, to dampen the pain of loss, or to escape from emotional intensity entirely. There are patients who use marijuana to sleep, and patients who use it for adventure or relief from boredom. Some patients have made recent suicide attempts or serious self-harm gestures. Other patients have intrusive negative thoughts that make life seem untenable.
Marijuana can worsen these symptoms. Marijuana with high THC content, for example, can exacerbate suicidal ideation or psychosis in people who have bipolar disorder. I worry about the vulnerability of these patients when it comes to marijuana. I worry about teenagers using it without understanding the impact it has on their brain development and future mental health. I want to steer vulnerable patients toward a cautionary approach to marijuana or towards avoiding it entirely.
While I’m an advocate for caution around marijuana use, I do not believe that legalization will produce the catastrophic results portrayed by Alex Berenson in Tell Your Children: The Truth About Marijuana, Mental Health and Violence. Berenson is a mystery writer who has in this case written his second nonfiction book in fifteen years — and it shows.
In it, he portrays people with mental illness, particularly those diagnosed with schizophrenia, as violent and dangerous — even more so with legal access to marijuana. To do this, he relies on media portrayals that engender fear and amplify stigmatization of mental illness with all the subtlety of an evangelical pamphlet illustrated with images of marijuana-crazed schizophrenic zombies.
The public’s primitive fear of madness — which likely protects us from getting too close to our own vulnerability — is fueled by negative associations fed by negative media stereotypes. Portrayals of people with mental health challenges as being “other,” that is, outside the shelter of society, are destructive. This “othering” induces shame, remorse, and hopelessness in people who are already tasked with the difficulty of establishing a new version of a self.
In Tell Your Children, Berenson focuses only on the behavioral extremes of schizophrenia mixed with marijuana, skewing his statistics in order to make his argument against legalization stronger. He sometimes includes other forms of psychosis (in addition to schizophrenia) in his numbers without explaining crucial differences, randomly adding bipolar patients and patients with other mental health issues to his numbers. Often, such patients are more at risk of doing damage to themselves — exhausting their primary relationships, destabilizing their own financial well-being, engaging in various forms of self-harm — than to others.
As well, Berenson tends to leave out anything that weakens his case, such as the unfair incarceration of black men for marijuana possession crimes.
I’m angry about Berenson’s choice to link violence, marijuana, and mental illness because it discourages productive public discourse about real human struggles. The patients I meet have a tough enough time coming out to family, friends, workplace acquaintances, and supervisors about their mental health struggles for fear of rejection, judgment, and the possibility of losing their jobs.
Among the patients enrolled in our program are people who were recently hospitalized for psychosis. They are people diagnosed with a variety of conditions: bipolar, depression, PTSD, anxiety, or schizophrenia. Often their symptoms have been exacerbated by marijuana use. Some patients have lingering symptoms of psychosis, both what we call positive symptoms (i.e., hearing voices, seeing things others don’t see, paranoia, uncertainty about what is real) and negative symptoms (i.e., mood issues, disorganized thoughts, difficulty putting thoughts and emotions into words).
I work with a psychiatrist and a psychiatric ARNP who prescribe medication to these patients on an individual basis. These providers are always fine-tuning and titrating doses until they find what works best for a patient. They also know that what works now doesn’t always keep working. They adjust accordingly. Marijuana is not a medication they prescribe; on the contrary, they caution against it.
Historically, funding and federal approval for marijuana research has been limited due to restrictions on access to federally approved research-grade pot. Now these restrictions are lifting, and researchers are increasingly able to collect data about marijuana. If all goes as it should, we may gradually begin to get a reasoned understanding of the plant’s dangers and benefits.
Down the road twenty years from now — maybe less — marijuana may be among the medications that providers are prescribing, fine-tuning, and titrating for patients with schizophrenia.
But that moment hasn’t yet arrived.
There are human scale questions to consider in the grand marijuana legalization debate. I worry that we are missing the opportunity to help people understand what we know and what we don’t know about marijuana at this point, so they can make educated choices. We need to offer more adequate warnings and protections, and more straightforward conversations, to help vulnerable populations. We also need to better educate the general public going forward.
That includes acknowledging the complex layers of background issues that inform mental health conditions. By background issues I mean race, socioeconomic status, gender, sexuality, domicile status, individual and family history, and environmental issues including the impact of living in an increasingly toxic, unpredictable, and polarized world in which violence is granted more than ample media airtime.
I‘ve never been a big fan of marijuana. It’s not something I’ve turned to, even when experiencing side effects from chemotherapy. At the same time, I respect that marijuana has been of great benefit to many people in cancer treatments and with various chronic illnesses such as IBS or Parkinson’s Disease. Marijuana may prove to be a substance that has multiple benefits, and, in the right dosages, may be able to help moderate some of the mental health conditions it can exacerbate.
We ask our patients at orientation to avoid using marijuana entirely for the three weeks they’re enrolled in the program, and even longer if they’re vulnerable to marijuana’s negative effects. At this turning point in marijuana legalization, at least in the business I’m in, caution is essential.
In the meantime, better public education — particularly for young people and vulnerable populations — and more balanced representations of marijuana in media would be helpful, as would explicit and broad warning labels. In solving the mysteries of marijuana, our best course is slow and steady, keeping our focus on funding the research and re-thinking that will keep this train on track.
Berenson, A. (2019). Tell your children: The truth about marijuana, mental illness, and violence. New York, NY: Free Press.
DeAngelo, S. (2015). The cannabis manifesto: A new paradigm for wellness. Berkeley, CA: North Atlantic Books.