The Question of Marijuana

Nearly every day I read an item extolling the virtues of marijuana from a wide range of its apologists.  Even CNN's Sanjay Gupta has gotten in on the action, recently reversing his long-held opinion about its dangers.  It doesn't kill anyone, they say.  You cannot be addicted to it, they say.  Susan Sarandon says it's silly to send folks to jail over pot possession, for example, because no one has ever been harmed by weed.  It is now not only legal to have it in California and Colorado, but also to consume it.  And even distribute it.  There is even a date on which people on college campuses gather to smoke, in public, in areas in which it remains illegal to do so.  I for one won't help the cause by publishing that date.

The champions of pot like to claim that it doesn't harm anyone, that it is a natural substance "from the earth".  They report that they don't know anyone who has told them about having problems with it.  But if someone did have problems with it, would it be them that such individuals approach?  Not likely.

I know that smokers can and do see mental health professionals, and for a variety of reasons.  I know this because I am one, and I have worked with many over more than 20 years of practice.  They arrive in my office with motivational problems.  With broken relationships.  With chronic bronchial disorders.  Some have patterns of academic and career stagnation.  Some exhibit a kind of intellectual stunting, especially if they began smoking in their early teens.  About one or two of every ten present with an anxiety or psychotic disorder which was apparently unmasked by marijuana use.  It is felt that such disorders may never have been triggered were it not for the smoking.  The CDC, in its Surgeon General's Warning page on marijuana, lists many of these known issues related to use, and has done so since 1982.  Anything that has its own warning page by the CDC is worth a little scrutiny, in my opinion.

Recent studies reveal that 12% of young people have reported driving while intoxicated on pot.  It stands to reason that a portion of these drivers have been in accidents which harmed or killed themselves or others.  But I await real data about that.  Nevertheless, I think it is irresponsible to give others the impression that marijuana is always safe, no matter the full context or the individual human brain involved.  That is simply not true.  If I could I would introduce you to young people whose lives, and in some cases their bodies, were badly altered by their abuse of this substance.

This particular debate is independent of questions about legalization or incarceration.  I don't think the war on drugs has been useful or effective when it comes to pot.  Others who know me well will tell you I far from being a prude.  I believe, and have told my clients this many times, that it is possible to be safe, smart, and still have plenty of fun.  I stand by that 100%.

We speak of marijuana as though it were a single substance with uniform properties, which it is not.  It comes in many varieties and degrees of potency, and sometimes it is spiked with other substances which may or may not be known to the smoker.  The fact is that marijuana consists of chemicals which will impair some individuals.  The science has not evolved to the point where we can accurately predict exactly who will have problems resulting from consumption, at any amount and over any course of time.  Questions concerning addictive potential remain unanswered.  But I am here to tell you, if anyone can be addicted to shoes, so can some be addicted to pot.

No matter that it comes from nature.  Neither will kill or maim everyone who is exposed, but arsenic and snake venom come from nature too.

Sleep Quality Linked to Alzheimer's Disease

According to a new study published by Johns Hopkins Bloomberg School of Public Health, sleep quality may influence the onset and progression of Alzheimer's disease. Lead author, Adam Spira, PhD, and his team of researchers discovered a link between shorter and/or poor sleep quality and higher levels of Amyloid beta build-up in the brain.

“Amyloid beta is a peptide of 36–43 amino acids that is processed from the amyloid precursor protein (APP). While best known as a component of amyloid plaques in association with Alzheimer's disease, as Aβ is the main component of certain deposits found in the brains of patients with Alzheimer's disease, evidence has been found that Aβ is a highly multifunctional peptide with significant non-pathological activity.” 

Researchers observed self-reported sleep habits and β-Amyloid deposits of adults from the neuro-imaging sub-study of the Baltimore Longitudinal Study of Aging where the average participant age was 76 years. Subjects reported sleep that ranged from more than 7 hours to no more than 5 hours. Using the Pittsburgh compound B tracer and PET scans of the brain to determine the amount of β-Amyloid in the brain, researchers noted that shorter sleep duration and lower sleep quality were both associated with greater amounts of β-Amyloid deposits.

Even though no causal link has been established, if sleep habits do in fact have such an impact, researchers suggest that these findings could potentially slow the progression of Alzheimer’s simply by promoting and maintaining healthy sleep patterns. Furthermore, as this is not the first study to link sleep and Alzheimer’s disease, more research with objective sleep measures could determine whether poor sleep actually contributes to or accelerates Alzheimer's disease.

“Results could have significant public health implications as Alzheimer's disease is the most common cause of dementia, and approximately half of older adults have insomnia symptoms."

Alzheimer's disease is a type of dementia that causes problems with memory, thinking and behaviour. It is most common in people over 65 years of age; however up to 5% of people develop early-onset in their 40s or 50s. The most common early symptom of Alzheimer's is difficulty remembering newly learned information as changes in the part of the brain associated with learning is often the first to be affected. Eventually these individuals will experience symptoms, including disorientation, mood and behaviour changes; more serious confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more severe memory loss and behaviour changes; followed by difficulty speaking, swallowing and walking.

Shorter Sleep Duration, Poorer Sleep Quality Linked to Alzheimer ’s Disease
Beta amyloid
Alz.org

 © www.mentalhealthblog.com

The Vitality of Youth

Much has been written about millennials and Gen Y students, a lot of it negative.  They have been variously characterized as lazy, self-absorbed, safely cocooned in electronics, and worse.  Some of this is based on real data.  But I am here to tell you, they may save us from the havoc we "adults" sometimes wreak.  We absolutely need them.

For one thing, they are apparently more optimistic than older adults.  They believe they will have more opportunity than their parents did, and that life is better today for them than it was "in the good old days."  It spite of the doom and gloom being written about the state of higher education in this country, they see it as a good investment in their future.  Who doesn't need freshness of opinion, and a hopeful view of the future?

I have written elsewhere in my blog about the energy and creativity of youth, so this item is really just another snapshot of the gifts they bring to the table.  As we older adults wrangle over chronic and confounding issues of our day, such as racism and military conflict, it is our youth who sometimes present brilliant and "never mind all your rules" approaches to problems.  Rule-breaking teens are even thought more likely to become successful entrepreneurs later in life.  I am reminded of a recent news item about a pre-teen who solved a centuries-old mathematical conundrum in just a few minutes, startling others in the room.  Their hopefulness and lack of constraint is very valuable indeed.  While adult members of faith argue over the "right" approach to inter-faith gathering and dialog, for example, younger folk go ahead and get together and talk.  This pattern has occurred among Christians, Muslims, Jews in the middle east, and among Protestants and Catholics in Northern Ireland.

If they can forge ahead there, what else can they do?  What will we encourage them to do?

Vignette 3: What Would You Do?

Juanita, a disoriented student

Background: Juanita has had her head on her desk throughout class.  She appears to be napping.  She is disoriented with slurred speech.  It is not clear if she is intoxicated or not.

Scene: Her professor approaches her desk after class.

Dr. Jones: Juanita class is over.  (No response)  Juanita?

Juanita: (Stirring around a little) Mmmmm?

Dr. Jones: Class is over, time to go.

Juanita: (Speech is slurred) Time to go where?

Dr. Jones: The class is over.  You can leave now.

Juanita: Books are at home.  Left them with my papers.  Be here tomorrow though.  (Giggles)

Dr. Jones: Look, it’s time to go.  What are you doing next?

Juanita: (Slurred) The big question.  No one really knows, do they?  Big planet, you know.  Time to go you say, so say you.

Dr. Jones: (More alarmed) Juanita, are you OK?  Where are you supposed to be?

Juanita: No worries, chief.  Doin’ okee dokee.  Gotta get to formica, need the ruzzle from there.

Dr. Jones: (Worriedly) What is your name?

Juanita: The one who shall not be named, in Madrid.

Dr. Jones: What is today?

Juanita: Today what?

Suggestions: Such behavior is generally an indication of a serious condition, which could be anything from intoxication, psychosis, or another medical crisis.  Consider a swift transport to the emergency department of a local hospital, or summoning paramedics.

Notes on the Matter of Suicide

Recent tragedies which have captivated national attention have raised both awareness and anxiety regarding college student suicide.  Though the reason for heightened awareness is of course unfortunate, the awareness is a positive development.  But the anxiety may or may not be, depending on what one does about it.

If the anxiety translates to knee-jerk reactions in policy and procedure, and in campus-wide interventions, we may not only be ineffective, we may actually unwittingly contribute to the problem.  Here's how.

Research shows that suicide prevalence rates in higher education settings is 4.3 per 100,000*.  This is in contrast to the same rates for same-age non-college peers, which fall between 11.0 and 14.0 per 100,000 according to the CDC and its data for states.  While any loss of life is a tragedy and deserving of prevention efforts, we can conclude that simply being in college offers some protection against suicide.

So one thing we could do to prevent suicide is make it easier for young adults to have dreams (thereby projecting into the future, a major protective factor as you will see below) and attend, stay in, and graduate from college.  Reflexively reacting to the fear of suicide may lead us to respond to less-than-honorable vendors who are hawking suicide reduction wares in higher education and other settings.  (Please note here that some of these may have merit, and some may not.)  In a setting in which the base rate is already considerably lower than that of the surrounding community, and depending on its features, such programs may unintentionally create an ecology of threat, making it appear that it is a larger problem than it truly is.  To the despairing, this may have the most unfortunate outcome of making it appear to be a viable option that others nearby are considering and acting upon.

Questions to ask such vendors are: What rate is your program designed to address?, and What rate will be the outcome of your program?

Surprising as it may seem, researchers are only now investigating motives for suicide among students, the "why" of suicide.  Research to date has focused largely on demographic factors, or the "who" of suicide.  A recent study tells us rather affirmatively where we might focus our attention.  The authors state it is time to move beyond "one size fits all approaches", and strongly indicate that hopelessness and overwhelming emotional pain are the two internal motivational risk factors most associated with suicide.

Campuses would do well, then, to focus on community interventions which promote hope and future orientation toward maximizing and manifesting student gifts, talents, and dreams.  It is important that students feel they belong, that their identity matters and is wanted and needed by others.  They would also do well to promote the adequate funding of mental health resources, so that those in unbearable pain have a place to go for help.  To date, most of the vendors described above appear to focus on identifying those in pain, not their ultimate assistance.  Most college counseling centers can already tell you how to identify those in distress, and their perspectives are based in local experience and not the marketing of a product.  Listen to what these professionals have to say, then make it possible for the suffering to be assisted by them.

*Schwartz, A. J. (2011). Rate, relative risk and method of suicide by students at four-year colleges and universities in the United States, 2004-05 through 2008-09. Suicide and Life-Threatening Behavior; 41(4), 353-371. 

The Incubator

Late adolescents and young adults need space and time to develop an authentic self.  While there are of course a great many contexts in which this can occur, perhaps few are better suited to the purpose than the higher education environment.  In my view, when carried out well, this is a major benefit of the college experience.

During such a time, youth are exposed to ideas, knowledge, experiences, social feedback, and a wide range of relationships which either enhance or detract from personal growth and fulfillment of latent promise.  A forming adult can benefit immensely from this environment, which represents an incubator of the emerging self.  In this way students experiment, explore and try on various selves to see for themselves which one fits and works the best.

It is both an exciting and trying time, for students as well as those around them, especially loved ones.  The experimentation brings highs and lows, successes and failures, flashes of brilliance and the pain of mistakes.  But these ups and downs are absolutely necessary, assuming we all want to produce healthy, competent and productive adults.  Older adults, be they professors, administrators, family members or friends, simply must respect the need for this period of incubation.  Sheltering young adults from all pains can harm them significantly, though we should of course protect them from the most serious ones if we are capable of doing so.  There were times in human history when there was no such thing as this kind of incubation, due to the hardship of living many faced.  But we are able to, and should, provide this now.

Respect requires allowing enough space and time for growth to occur.  For parents this means gritting one's teeth, teaching what one knows but allowing students to venture off, even when mistakes are a near certainty.  Doing this, a sense of faith and trust is communicated, which is the fuel on which the emerging self thrives.  It means patience in the face of a tattoo, purple hair, exploring a major which is a "bad choice", financial incompetence, or partnering which causes heartburn.  The incubation can take a very long time, but learning does in fact occur.  Students learn on their own what will and won't sustain them in life, because life itself teaches them.  We parents don't always have to do the teaching, as much as we want to.  Attempting to do that, we actually interfere with natural consequences and learning, slowing down and disrupting the entire process of development.

So give them space and time to incubate the self.  Trust that the self will unfold in the way it should, one way or another.  Students, take the opportunity to learn about and become who you are.  Just as you have the freedom to do so, so do you have the responsibility to accept the feedback you will receive, and to adjust accordingly.

Listening Always Comes First

So there's a great little video called It's Not About the Nail out in the electronic ether, all about the importance of listening.  Upon watching it one thinks about relationship contexts mainly, especially the oft-seen tendency of men to fix things instead of just empathizing and supporting their partners.

Ah but the video is a great object lesson for professional helpers.  There is a strong sense of urgency among many healthcare providers to quickly and efficiently apply the "intervention" to the "symptom", because that is what the diagnosing/insurance/billing industrial complex demands. The forces behind this complex are tremendous and so embedded in some helping systems that many don't stop and think for a moment about how this form of "helping" may be affecting the "helped".

Sometimes, it doesn't matter how "right" the helper is.  The one receiving the help must feel heard and understood first, as this facilitates acceptance and motivation to be helped in the first place.  I recall a story about a homeless woman, hungry and cold, who upbraided a good Samaritan for "throwing me a bone".  Before she received food and clothing, she wanted to be understood.  In particular she wanted her pain to be understood.  That was her primary need at the moment.  Her "helpers" assumed her physical needs were more fundamental than her emotional or spiritual needs.  This is where many of us go awry.

The video takes us back to the early days of our training.  We were first taught basic helping skills, such as empathy, genuineness, positive regard and active listening.  Somehow the systems we work in may distract us from these elemental approaches to human suffering.  Let's go back then, and learn this all over again.  If you are involved in training the next generation of helpers, consider showing them the video.  After the jokes subside, tell them to get serious about this one.