human behavior

Smoking for your mental health

Posted in Habits & Manners, Health & Medicine by humanb on September 26, 2009


I wrote a post after I finished my first year of medicine about my struggles with quitting smoking. I’m in my 5th year of medicine now… and still smoking. I’m not a smoker however. I’m a nicotine addict.

I’ve been on nicotine replacement since before I applied to medical school – mainly nicotine gum, but this year that stopped working – worse – the gum began making me sick. So I have switched to nicotine mints, and boy are they great. The nicotine dissolves faster under the tongue, the breath stays fresh longer, and the mint is a perfectly awful thing to pop after you’ve had a cigarette.

They say withdrawal from nicotine only takes about 24 hours, which would suggest that smoking is primarily a psychological addiction. I’m not so sure about that. I’m equally addicted to nicotine replacement as I am to cigarettes, so it’s not just the act of whirling that delicate white phallus between your fingers that becomes a habit, or the drawing in of one’s cheeks. But there’s no denying that a cigarette or a nicotine mint does settle the mind.

Doctors hate smoking. They shake their hands and make “tut-tut” noises and produce deep sighs when they leave the bedside of a patient with end-stage emphysema on palliative care. They shrug when they leave the room of a smoker whose had his leg amputated or a leg ulcer redressed that hasn’t healed in three years. We smokers are masochists. We’ re idiots. We’re burdening the health system with our preventable peripheral vascular disease, our chronic obstructive pulmonary disease, our lung cancer, our bladder cancer, our mouth cancer, our [insert organ here] cancer, our heart attacks and our strokes. They have banned us from their hospital grounds and the sidewalks encircling them – though you wouldn’t know it from the cigarette butts that crunch under your feet on your way in.

I hide my smoking from doctors like the bad habit it is. I keep my cigarettes at home for morning and after-work relief, or I keep them in my car for a post-lunch digestif. I keep my nicotine mints in my work pants pocket, and on rounds surreptitiously place a white tablet under my tongue.

But then I started my psychiatry rotation, and so entered Bizarro World.

More than 70% of schizophrenics and other mentally ill persons smoke cigarettes, which is why they predominantly die – and die sooner – of cardiovascular disease. No one is quite sure why they smoke. There is a theory around, that smoking may actually aid concentration and other measures of cognitive function in long-term schizophrenics. Who knows.

As interesting, is the shocking percentage of mental health workers that smoke. In every hospital I’ve worked – with its smoking bans and anti-smoking doctor-crusaders, the mental health unit has been staffed by unapologetic smokers. This excludes the actual doctors – the psychiatrists – of course.

But here’s where things get very interesting…

Patients in the longer-stay mental health ward where I’m attached are allowed to smoke. I suppose any patient in any ward is allowed to smoke. They may have cigarettes in their side drawer and go outside to smoke if they’re healthy enough to get there. But it’s privately done and discouraged. The main hospital staff would prefer to dispense nicotine patches and encourage patients to break the habit. But in the long-stay mental health ward of one particular hospital, the patients’ packs are all kept at the nurses station in a drawer that makes me drool. Every ten minutes or so a patient approaches the nurses’ station requesting a cigarette, to which the nurse on duty replies “Sure thing Johnno, here ya go” or “Sorry Fran, you haven’t got any more”. Here’s one conversation that actually occurred:

Patient: Nurse I need some more of that pain medication. (NB: many patients have substance abuse problems and seek more pain-killers than is healthy or warranted.)

Nurse: Sorry hun, but I just gave you a dose less than one hour ago. I wish I could, but you can’t have any more for another three hours. How about a cigarette?

Patient: Yeah, okay.

Bizarro World.

Later that day, after the nurse had seen to various patients, dispensed medications, and recorded progress notes in files, she sat down to see to one particular patient’s needs, by rolling him his own cigarettes:

Nurse: This will get you through the day, hun.

I bet they didn’t teach that in nursing school.

Schizophrenia is a devastating illness, and is a major contributor to a nation’s burden of disease and years of life lost due to disability (YLD). When a patient is mentally incapacitated by the anxiety of persecutory delusions and nightmarish hallucinations, I’m not sure I would have the strength or determination to deny them the solace of a coffin nail.  Not when the shock of my first day on the psych ward drove me to the corner store.

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One Response

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  1. Condor said, on October 1, 2009 at 7:42 am

    I find it amazing that with so much disgust for cigarette smoking, people seem to be smoking in almost every car on the road. While driving home at red lights, I see men and women smoking. Sometimes in the same car, both of them are smoking.

    I have also noticed while at fast food restaurants and strip malls people actually lighting up a cigarette while walking towards the store, only to put it out before entering. In that time, they can only get two drags before throwing it away and entering the store. Again, on the way out, from the store to the car, another two drags. Don’t they know how much cigarettes cost?

    Who invented cigarettes anyway? ( Cigarette smoking has been around since the 1800’s and most smokers do so because they enjoy it.

    It may be true that many suffering from Schizophrenia may smoke, but just as many without it also smoke, unless we are all just a little schizophrenic.

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