Monthly Archives: April 2010

Marijuana

Cannabis

It’s April 20th.

For the marijuana smoking counter culture, today is known as 420, pronounced four-twenty – National Weed Day. Many marijuana (MJ) users celebrate by convening  across the nation to light up a joint, smoke a bowl, or eat some pot brownies. Unlike Halloween, in which you probably wouldn’t find anyone in costume on the other 364 days, MJ use is ubiquitous and ever-present in the mainstream.  Whether you’re watching TV or listening to music on the radio, attending a sporting event or concert, you’re as likely to be exposed to something MJ-related (like Weeds, Bob Marley, or the downwind smell of pot) as you are to something Kate Gosselin-related at a supermarket checkout line.

MJ is the most prevalently used illicit substance in the world. It is often referred to as the “gateway” drug as once naive recreational drug users may later progress to experimenting with harder drugs such as dropping ecstasy, snorting a line of cocaine, or smoking crystal meth. MJ has more aliases than the National Hockey League has fans. In the medical profession, MJ is frequently referred to as Cannabis, the Greek name of the plant, and THC, its main active ingredient.

Many consider MJ use to be harmless, positive, and even beneficial. Recreationally, MJ is associated with facilitating philosophical thinking, enhancing creativity, and heightening subjective experiences. How many moviegoers do you think were high when they munched on popcorn as they trancedly watched Avatar in 3-D? Medically, MJ has been legalized in 14 US states for treatment of chronic conditions such as glaucoma, pain disorders, chemotherapy-induced nausea and vomiting, HIV unintentional weight loss, and some neurological disorders.

Legalized for medicinal use only in a minority of states, MJ is criminal and illegal on the federal level. As such, the federal governing agency of prescription meds, the FDA, strictly regulates MJ among the highest of controlled substances. MJ is classified as a substance with high abuse potential, no current accepted medical use, and a lack of accepted safety for use under medical supervision. You may get a marijuana card, but you’re absolutely not gonna get a prescription for MJ says Uncle Sam.

The medical marijuana debate remains controversial in the medical profession. Although MJ has been shown to improve the aforementioned medical conditions, it nevertheless has adverse effects on the lungs, heart, and immune and reproductive systems. Moreover, it has the potential to cause cancer.  

In psychiatry, the position on MJ use errs on the side of restriction. Aside from addiction, MJ has been associated with increasing the risk of common psychiatric disorders like anxiety, bipolar, and psychosis. Chronic heavy users of “the chronic” may also experience a generalized lack of interest, decreased motivation, and impaired cognitive functioning. You may want to stay off the grass if you’re gunning to be the school valedictorian. Many MJ users may go through their entire lives without any significant functional impairment, experiencing at worst a “bad trip” from time to time. But what if that bad trip was lasting and permanent like schizophrenia? Is that a journey worth embarking on?

The origin of 420  in reference to weed has as many postulations as that of Tupac’s death. Some think 420 refers to the number of chemicals found in MJ, the police code for MJ use, or Adolf Hitler’s birthday. The leading belief seems to credit a group of pot-smoking teenagers who met up daily to get high after school at 4:20pm back in the early 70s. Whatever the reason, as far as I’m concerned, 420 can mean the number of arguments you can make for or against the use of MJ.

Since I’m a psychiatrist, you can probably surmise where I stand on the issue of marijuana use.

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Antisocial Personality

Criminal Minds (2005-2010)

Hands-down the most disturbing of personality disorders is Antisocial Personality Disorder (ASPD). Many mainstream TV dramas base the content of their shows on people with ASPD – Criminal Minds, Bones, Law and Order, The CSI Series, and the list goes on….

In psychiatry, the meaning of antisocial is not the same as the layman’s term used often to describe the shy and sort of awkwardly charming introvert who embarrasses easily. Think Micheal Cera in Superbad or Juno, or any of his other roles. Instead, antisocial refers to people who are sociopaths or psychopaths. They lack a moral compass and have utter disregard for social norms. These people are entitled, deceitful, and remorseless of any type of wrongdoing. They lie, con, and cheat – not the type of person you’d want to meet on Match.com! Their inability, or refusal, to abide by rules and laws may give rise to criminal behavior and consequently overcrowded prisons – more than 80% of inmates are ASPDs. Unlawful acts can vary widely from vandalism, petty theft, and identity fraud to arson, rape, and killing sprees. They can be an acquaintance, co-worker, or even a friend or relative. Not all ASPDs are violent criminals, but Ted Bundy, Jeffrey Dahmer, and Charles Manson  have been described as some of  the most notorious and infamous ones.

Currently in psychiatry, per our bible the DSM-IV, there isn’t a distinction between a sociopath and a psychopath (pending revision). Although they’re both diagnosed as ASPD, and occasionally used interchangeably,  some experts believe they are separate entities.  A key difference between a sociopath versus a psychopath seems to be related to the underlying cause of their behavior, which summons the nature versus nurture argument.  Sociopaths are thought to have been shaped by an invalidating and traumatic upbringing, whereas psychopaths are born emotionally and morally deficient. The latter is hard-wired differently from the get-go. Thus, fearlessness and stimulation-seeking are seen at an early age. Imaging studies have shown brain abnormalities implicated in emotional detachment and physiologic responses characteristic of psychopathic behavior.

ASPDs tend to possess superficial charm and allure, which serves them well in manipulating others for personal gain. Their bodies may be covered with ostentatious tattoos. This is, of course,  not an absolute sign of an ASPD; otherwise, I can’t imagine what it’d be like to be NBA Commish David Stern, given the growing prevalence of tattooed bodies in the league. Also of note, a juvenile history consisting of the triad of bedwetting, fire-setting, and animal cruelty seems to be a harbinger of violent criminal behavior.

Clinically, ASPDs don’t seek treatment for their symptoms per se as they don’t see anything wrong with their antisocial behavior. They typically present for psychiatric treatment in the context of prescription drug-seeking, substance abuse problems, malingering – feigning an illness to get something they want – and violent behavior. Unfortunately, there is no demonstrated effective mental health intervention for treating ASPD itself. Thus, the criminal justice system becomes their de facto treatment system. Somewhat reassuringly, it has been observed that antisocial behavior in ASPDs attenuates over time, particularly beginning in their late 30s.

Many TV watchers become enthralled by crime drama shows like an unsuspecting victim is drawn to an antisocial’s charm and deceit. Entertaining and seemingly preposterous as the shows may be, the reality is that people with antisocial personality disorder do exist and live amongst us. The next time you feel captivated by someone’s charisma, yet feel like you’re being manipulated, follow your gut instinct and change the channel.

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