Category Archives: poliitics

Are we now voting on mental health?

Here in Florida, we have a process in which citizens can gather enough signatures and put an initiative on the ballot to alter the state constitution.

I vote no, even if in principle the idea seems good, because I don’t think that a majority vote is the way to treat a constitution. I would vote no, even if the amendment proposed to preserve, in perpetuity, the tax-exempt status of dark chocolate due to its obvious necessity to life. The whole idea of a constitution is that it sets forth basic principles: natural law, the essentials. All other laws and rules get held up to it to see if they fit within the boundaries of that constitution.  

In the upcoming election, Floridians will be asked to vote on a proposed amendment that would legalize non-medical marijuana for adults age 21 and over in Florida.  My libertarian side doesn’t much care what people do until it impacts other people. People who mess up their brains with drugs often seem to feel entitled to drive; ultimately, they demand their healthcare be paid for by other people; they clutter up emergency rooms, and do all sorts of other things that do impact others, making drug use a social, not a merely personal, issue.

Professionally, this deserves a resounding “no.” Not just because popular votes are not the way to treat a constitution; but because there is so much information not being openly and clearly presented on this.

To begin with, it is fairly laughable that there is so much so-called medical use of marijuana, when the research is sketchy for even the handful of possibly legitimate uses.  Anxiety? Insomnia? Marijuana is practically a recipe for anxiety, and in fact, can lead to very severe anxiety, especially among younger users.

Secondly, most people have been effectively shielded from information on the impact of marijuana on mental health, physical health, and crime. Why? Whose interest is served by hiding the number of ER visits for psychosis, panic, and/or hideously violent vomiting due to marijuana or other forms of THC use? Whose interest is served when the impact of THC in criminal activities is hidden? There is evidence that use of the modern, stronger forms of marijuana is leading to substantial increases in psychosis, self-destructive behavior and violence against others. Most people seem quite unaware of this. Did you know that the emergency room visits due to marijuana use – psychosis, panic and/or “scromiting” (screaming and vomiting) increased 53 to 400% in the first few years, from city to city? Or that even in Europe, the rate of marijuana psychosis slipping into schizophrenia has increased between 300 and 400% in the past twenty years?  In Colorado, a tragic experiment in progress on pot legalization, emergency room visits related to marijuana use increased 500% in the 5 years post-legalization, with severe psychiatric symptoms including psychosis and panic attacks. Then there is the pain and terrifying projectile vomiting typical of cannabinoid hyperemesis syndrome.

Critically, marijuana is not safe. It is prescribed medically (despite the evidence being rather variable and inconclusive) with a shrug: “well, the possibility of benefits outweighs the risks.” Fair enough; no reasonable person is worried about someone who needs appetite support or help with pain while in treatment for cancer or AIDS having long-term effects from marijuana; the possibility of benefit outweighs the risks.

That doesn’t make it safe. In 2021, about one-third of high school seniors were using marijuana in some form. We ought to be very worried about the effects on teenagers and young adults, whose brains are still in development and whom, evidence shows, will have long-term impacts years after they have stopped using marijuana. That, of course, assumes that they stop. About 17% – 1 in 6 – of people who start using marijuana in their teens will become addicted. The addiction rate is about 9% for adults, and that is old data from 2015, and thus trails the upticks in use and in potency.

The increased risks, especially for young males, for unremitting anxiety, psychosis, and a lingering apathy and lack of initiative ought not be brushed off or laughed off with stories of the late 1960s. Then, the available marijuana caused hallucinations for many people and was far less potent that modern varieties. In the past 40 years or so, the potency has increased about 4-fold.  For adolescents, the rate of suicidal ideation triples in those with cannabis use disorder; the rate of depression nearly triples; truancy, fighting, poor concentration all increase markedly with regular cannabis use.

Interestingly, we are urged to accept psychiatry when it comes to destigmatizing mental disorders and treatment, but this enthusiasm for psychiatric expertise melts away when it comes to legalizing weed in all its forms. The American Psychiatric Association still officially opposes the use of marijuana, noting it is not research-supported for psychiatric diagnoses and bears substantial risks for psychiatric side effects. The experts are discounted on this one thing. What could possibly drive that behavior?

Stepping back and gazing at these points – and I am sure there are others – I ponder why there is so much interest in promoting this particular amendment.  Is it because, as the old Judas Priest song goes, “Out there is a fortune, waiting to be had”? Is it really the case that so many people who are enthusiastic about bossy rules about the size of people’s American flags, house colors or the time people roll out their trash cans are libertarian on this one thing? How will they feel when it is their son or daughter who slips away into depression, relentless anxiety or psychosis?

The argument is made that legal marijuana will be pure – not laced with fentanyl or other deadly substances. Assuming this is the case, and that there arises no underground market to avoid taxes – moonshiners versus revenuers, remember? – the question remains as to whether the risk is worth it in terms of psychiatric and gastric impacts.

Who will pretend, later, to not have known how dangerous what will no doubt be called something like “Big Weed” really was, and rush to sue because of brain damage, the loss of loved ones to suicide or cancer? What about those whose death is due to initiating violence while “high” and being killed by someone in self-defense? What class action suits will emerge to right the wrongs of mass hospitalizations for psychosis and its long-term medical management? Will it in fact be the same ruse of not-knowing used against tobacco, despite its having been referred to as “coffin nails” even in the 1800s? And beyond these major effects, what about the many lives and talents wasted by indifference and ennui as the years-long lingering apathy steals young adulthood and early middle age?

What would make sense:  this proposition as a possible law, not as an amendment, with publicly available hearings and testimonies from all sides: those incarcerated for years for petty possession charges and those whose loved ones spiraled into psychosis and suicide.  Let’s hear sworn testimony and evidence from medical experts on both sides and statisticians who can break down the data on crime and medical impacts.  Then, having heard the information, we can, through the legislative process, pass a law that adheres to the principles of the state constitution and best suits the facts of the situation.

Not So Complicated

I channeled Mary Poppins: resplendent with unwavering decisiveness and spit-spot, lickety-split efficiency, two of us turned the spare-bedroom/storage-room into comfy guest quarters in less than 45 minutes. Easy-peasy…

…because it was not MY spare bedroom. No emotional investment, no weariness at once again facing the task at hand, it was, actually, fun. Change is refreshingly simple when it doesn’t cost you a thing.

When it costs something, change seems complicated and hard, even impossible.

Almost everyone I know has argued, in vain, with newspaper articles, the radio or television newscasts. As if briefly overcome with psychoses, they shout at the television and argue with the radio in their car. (Me, too). Whatever their position – progressive or conservative, libertarian or statist – they are frustrated and amazed, over and over, at officials’ protestations of how hard it is to make change happen.

Everyone has ideas on how to make change happen. Some are terrifying; others are naïve. Many, however, have the ring of common sense, and it makes one wonder, why are these officials, whether elected or snugly sinecured, acting as if everything is so complicated?

There are many different government programs aimed at moving people from one place to another. Why many? Who knows? Could it be simplified? Yes, and probably elegantly. Everyone on Medicare, for whatever reason, use service A; everyone who meets whatever clearly established criteria (such as Medicaid) for need, use service B. Give every participant a chipped card to use, require photo ID (or put it on the card) to be sure the cards don’t turn into underground currency like food stamps sometimes do, and then the details entered into the program (A or B) for that individual will determine: medical taxi, van assistance, reduced or free bus fare? A bright STEM high school senior could write the bulk of the program in a day or so. If you immediately imagined the most complicated possible situations just to pick a fight with me: sure, those exist. If someone needs a wheelchair-accessible van, then that goes into the electronic info on their card; if they merely need a cab for doctor appointments, that’s on the card. As circumstances change, someone in a remote office can input the update. When Mr. X no longer needs a wheelchair van to get to his appointments, his account can (spit-spot, lickety-split) be adjusted to provide for the appropriate transportation benefit. Plus, with GPS it won’t be hard to figure out if the beneficiary had the cab drop them at Dr. K’s or at K-Mart: auditing for abuse becomes simple. Ta-da: not easy, but simple.

If the object was to make sure poor people had good quality healthcare, one might wonder, why not simply work with what we have? One, we have a public health department system and two, we have a VA system to serve as a model for comprehensive (albeit labyrinthine) healthcare. What makes it so complicated to appropriately expand the one, based on what we know from the other? Doctors are leaving, or not going into, private practice and instead signing on as employees in the private sector, so a nice government job with benefits and a pension seems like a tempting offer for many D.O.s, MDs, ARNPs, RNs, dentists, and other healthcare providers angling to be someone’s employee. Yes, we’d need more buildings and more staff, and probably some specialty services would be outsourced (the VA knows all about that, too). Who uses them? How about anyone who meets criteria for transportation assistance, as above? They already have the ID card; add that info. Outsourcing so little of it will lead to much less fraud, the latter a cause of handwringing for the same politicians who resist change.

Oh, I know. I can’t possibly understand. It’s far more complicated than that. Well, no, it’s not. It’s not going to be easy, but that is not the same as complicated. From out here, it is very clear that sometimes what is explained as “complicated” really means “not easy.” These are different things.

A marathon is not complicated. It is a matter of stepping forward and repeating that action for 26.2 miles. I know; I ran 79 of them. They were not easy. They were simple and hard. So are lots of things. It is just easier to see “simple and hard” from the outside than from the inside.

“Complicated” is a euphemism for something along the lines of, “Well, we don’t want to change anything; some people will be unhappy, and maybe we’ll lose some votes, so somehow we must give the appearance of changing things without actually changing anything.” The best we seem to get sometimes is the legislative version of buying storage containers during the January sales. It’s the same pile of junk, but it’s temporarily neat. If the object is to pretend to change, then, yes, everything we shout at the newspaper and radio about is quite complicated. I have no idea how to run AND not run at the same time, so how could a bunch of bureaucrats figure out how to simplify programs while simultaneously avoiding any changes?

Our ambivalent relationship with change makes it simple, and enjoyable, to help other people organize their stuff. The books were not MY books, the stuff was not MY stuff. People who have enough money and stuff hire people to come in and bully them into getting rid of stuff. The theory is that someone else, who is not emotionally invested, will be able to confront me. I can imagine the process:

Professional organizer: “Now, Lori, how many CS Lewis books do you really need?”

Me: “I dunno. How many ARE there? Ought I leave room for more?”

It goes downhill from there.

The analogy ought to fail because the people we elect should not be emotionally attached to ineffective programs. They behave like people suffering the deep heartache that leads to hoarding behavior, but I suspect the attachment is less suffering and more sinister: each entanglement serves a gratifying purpose or two.

Imagine members of Congress clinging, weeping, to the thousands of pages of regulations that describe the several programs to provide fuel (or rather, money for fuel) to poor people in winter. Why would they fret about merging these into one, clear, program? Where is the burning enthusiasm to ensure that the funds to help people stay warm are used prudently and effectively? I don’t want to read about one person collecting fuel benefits from multiple funds and using some of it for frills, while someone else freezes to death. I want everyone to be warm and cozy. If there were one program, would people find a way to abuse it? Surely; but simplicity reduces the camouflage.

I suspect we will all be shouting at the news for a long time. Meanwhile, I have to go pretend to be someone else so that I can impose some order on my stuff: a process that will be simple and hard.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.