Addicted to Mary Jane

I don’t smoke weed. (That’s illegal.) But I know people who do. Some smoke it every now and again, some daily. I never thought much about it, even after I started med school. After all, these folk are holding down jobs (well, most of them). And it’s just pot. Sure, you can become psychologically addicted; that can happen with anything. But can you really become physically addicted to weed?

Apparently you can.

I’m doing my psychiatry rotation in med school at the moment, and I’ve been sitting in on D&A (drug and alcohol) support groups for patients currently in hospital for drug dependence. The patients are addicted to different substances: alcohol, benzodiazepines, prescription pain killers, methamphetamine, heroin, and cannabis. Yes, there are patients who get checked into mental health hospitals for weed addiction.

Cannabis is a recognized drug of dependence now – not just psychological dependence, but physical. And it has a defined withdrawal syndrome that repeatedly affects about 25-30% of regular users.

Cannabis withdrawal syndrome becomes evident about 24-48 hours after you stop using, and withdrawal symptoms are at their worst at 3-6 days, after which symptoms become less severe. By 3-5 weeks of abstinence, most people no longer experience withdrawal symptoms, although cravings may continue for some time.

Physical symptoms of cannabis withdrawal include:

• decreased appetite
• tremulousness
• dizziness
• nausea
• diarrhea
• colicky abdominal pain
• central (sometimes burning) abdominal pain
• sweating
• hot and cold flushes
• restlessness
• headache
• fatigue
• yawning

Psychological symptoms of cannabis withdrawal include:

• irritability, especially on awakening in the morning
• mood swings
• aggressive outbursts and behavior
• difficulty concentrating
• insomnia
• strange dreams
• anxiety
• tension
• fear

Cannabis withdrawal is taken so seriously that there’s a hospital protocol for the administration of a benzodiazepine +/- an antipsychotic to control withdrawal symptoms over the course of a month. Cigarette smokers don’t get that.

I struggle with nicotine addiction, and I find pot smokers so self-righteous at times. They’re always turning their noses up at cigarette smokers. We stink up the room. We give ourselves cancer, emphysema, and strokes. We poison the lungs of those around us. We give our kids asthma. We litter the streets. We have no impulse control. We’re pathetic addicts for a lame psychoactive drug.  I don’t refute this, except for the last sentence.

But cannabis stinks as well, is bad for the lungs of smokers and innocent bystanders alike, and can make an addict out of you too. At high levels of use, it can also cause an acute psychosis; precipitate the onset of a long-term psychotic disorder in those genetically susceptible; and increase the risk of developing major depression or an anxiety disorder.

Weed has got its benefits, obviously, or most of Australia wouldn’t be smoking so much. And I support its controlled medicinal use. But let’s no longer suffer the delusion that tobacco is poison, but weed is an innocent plant you can smoke without risk of harm and addiction.

Wake up America!

Bob Herbert’s Changing the World drives home the most salient message in Michael Moore’s latest film. Moore may seem focused on demonizing capitalism, but the film is just as much a criticism of the American people – albeit with some notable exceptions. Note the opening remarks about Americans being distracted from what’s important, by what’s on television. Note the closing remarks about his fatigue at going it alone in the fight against America’s economic and social decline.

In Moore’s view, bankers and business do what bankers and business do, while most regular people do jack sh*t to take back their communities and rescue their country from decline.

Here’s Herbert:

Americans have tended to watch with a remarkable (I think frightening) degree of passivity as crises of all sorts have gripped the country and sent millions of lives into tailspins…. This passivity and sense of helplessness most likely stems from the refusal of so many Americans over the past few decades to acknowledge any sense of personal responsibility for the policies and choices that have led the country into such a dismal state of affairs, and to turn their backs on any real obligation to help others who were struggling…. Those chickens have come home to roost. Being an American has become a spectator sport. Most Americans watch the news the way you’d watch a ballgame, or a long-running television series, believing that they have no more control over important real-life events than a viewer would have over a … script for “Law & Order.”

One of the most fascinating aspects of the last presidential election was the explosion of online activity among regular people. I would spend ridiculous amounts of time reading the comment pages of blog posts and mainstream news articles to gauge the political opinions and feelings of voters across the country. Everyone was passionate, and no matter how much their political views differed – and boy did they differ - every commenter began or ended his diatribe with the same call to action:

Wake up America!

I thought it was funny then. A bunch of histrionic silliness.

I don’t now.

New word: autistic fantasy

I learned a new phrase today at the psych hospital to which I’m attached. I thought general medicine had some cool words, but psychiatry hands-down generates the best vocabulary and phrases.

Take verbigeration, which is a bit of a mouthful ironically, and is just a clever way of saying ‘word salad’. It refers to a manner of speech in which a patient uses a mixture of words and phrases that lack comprehensive meaning or logical coherence.

Verbigeration is a feature of speech among the thought disordered, such as some schizophrenics, philosophy students, art critics and former U.S. presidents.

Or take erotomania, the delusion that some specified person is in love with you. Some psychiatric patients, for example, can become convinced that their doctor, nurse or another patient is infatuated with them. Well I don’t have erotomania. I know Spike wants me.

And then there is autistic fantasy, which is excess daydreaming to substitute for relationships and actions. This was humorously portrayed weekly on Ally McBeal and is considered an immature defense mechanism. It is seen in those, for example, with borderline personality disorder.

But who doesn’t daydream excessively of what she would say to her supervisor if her livelihood didn’t depend on her acquiescence to his sadistic will?

Who doesn’t daydream routinely about karate chopping people who display horrific manners, because you couldn’t be bothered having a verbal confrontation?

I’m sure I spent most of my adolescence and teens in a protracted daydream to substitute for friendships and actions. I daydream still. That’s not borderline. No, sirree. That’s a rich internal life. A robust imagination. And a very effective defense mechanism at times, against madness.

Succulent in name alone

Tonight we celebrated my mother-in-law’s 66th birthday. My mother-in-law is a highly intellectual, widely accomplished and decidedly cultured woman. She claims federal ministers and premiers as friends. She’s met the leaders of a number of nations. She’s fluent in German and French and has visited more countries than I have towns. She’s read more books this year than I have this decade, and is regularly solicited for her opinion. And she’s a consummate chef in her own kitchen.

So I thought I should make her a dirt cake.

The dirt cake is not really a cake. It’s just alternating layers of creme filling and ground Oreo cookie. The cream layers are made of sugar and every manifestation of dairy – cream cheese, milk, whipped cream and butter. The Oreo cookie layers are just an obscene amount of Oreo cookies ground up to look like dirt.

Obviously, your top layer must be Oreo dirt, and the whole concoction must be contained within a flower pot or some other object that would typically hold dirt. Then you add some gummy worms poking their heads out to the surface and stick a flower in the sucker.

And voilà!

I have a wide selection of succulents in my house, so I thought I would go for what I know here. Plus, for such a woman as she, a well-manicured succulent garden better suits I think.

Alas, the dirt cake was not a huge success. My cream layers were runny, my dirt layers soggy, and my gummy worms mushy after hours buried in that mess.

My dirt cake was dirt goo. It flowed easily down the kitchen drain like a mud slide; but not before my mother-in-law had finished her allotted portion with espresso, and expressed her heartfelt thanks.

And that’s what makes her impressive.

Recommended reading: The Book that Eats People

I’ve always been a fan of children’s books. They’re fantastic morality tales and character-building tools told in simple, powerful language with provocative illustrations. The best of them are works of art, really.

I don’t have children, but I’ve become even more fascinated by children’s books since my sister had two little girls. They’re delightful girls but like all children, their moral compasses still frantically swivel, uncertain and frequently pointing in suspect directions.

The elder (age 6) has a frightening talent for manipulation and artifice. She’s a gifted faker. The younger (age 3) is highly attuned to her own wants – the hell with yours – and is not above using a bit of physical violence to make her point. My sister calls her a sociopath. In jest, of course.

The elder also went through a phase where she was obsessed with the morbid. I use to worry that it wasn’t normal for a child to be so fascinated by death and the means to get there. And since TV went to multiple 24 hour children’s channels on cable, both girls have become less interested in reading.

Enter the aunt. I periodically browse the children’s sections of Sydney book stores looking for interesting books for the girls that may not be available in Virginia. When I bring presents to the girls, the elder often flatly declares before a gift is even unwrapped “It’s a book.” I’ve dutifully sent them various books on Australian animals and the like, and some that feature Australia’s cruder, more irreverent humor. One such book with a scatological focus was deemed too crass for their American sensibilities, but it was pretty funny. The Australian sales clerk who sold me the book, a middle-aged woman, had assured me that it was appropriate and very popular with mothers, but she also cautioned that its Aussie humor may not go down well in America. She was right. It has joined a collection of books held by their grandmother in the “restricted section” of her bedroom closet.

My latest find is a real gem though.

It’s called The Book that Eats People and it’s wonderfully morbid and scary. I thought it was the perfect book to give a child with morbid fascinations to get her interested in reading again. I thought this book would illustrate that reading doesn’t have to be boring. Who wants to read about mom’s trip to the grocery store, or Sally’s visit to the bloody dentist? Let’s read about a book that eats little children and spits out their bones. Let’s read about a book that never gets caught. Forget honesty and tolerance. Let’s read about unadulterated gluttony, greed and evil, embodied in a book that eats people.

I’m very interested in the moral and character development of children. And I’m confused and fascinated by how some people manage to raise decent, intellectually curious, and well-adjusted children. How do they do it? Maybe a child doesn’t build character by just being told what is right, or by being told, “There are bad consequences if you don’t do what is right, so do it“. Maybe a child needs to see what is wrong too. Maybe they need to make their own judgments for their sense of right and wrong to really stick.

I’m not too sure about this book. I think it’s bloody brilliant; but I can laugh about the kids being eaten whole because I’m at a developmental stage where I think children being harmed in the real world is the most horrific crime imaginable. But should a 6-year-old laugh about it?

The book is also pretty scary. The point of buying the book was to get the girls excited about reading again, and a little less inclined to turn on Hannah Montana when they’re bored. The last thing I want is to make them afraid of books. But I wouldn’t mind their coming to appreciate their power.

The Book that Eats People by John Perry, illustrations by Mark Fearing

5 out of 5 stars

Elsewhere: The infamous book that eats people has a Facebook page.