In a long-ago Peanuts comic, Charlie Brown asks Linus “But is it art?” The next panel shows Snoopy’s garishly redecorated doghouse, with its grinning owner dressed like a used-car salesman standing proudly beside it. Both human characters just sigh.
With October 17 and the legalization of pot approaching, we have much to celebrate but also much to ponder.
Canada adopted the American criminalization of marijuana in the “Reefer Madness” days of the 20s and 30s because that is what we did. We, as mice, did as we were told by the elephant south of the border. No research – American or otherwise – validated the vilification of pot. It is arguable that anti-marijuana laws were racist in origin, because in the early part of the 20th century, African-Americans were targeted for all manner of “antisocial” behaviour; consumption of the demon weed was one.
So, we have turned a corner as an enlightened nation. As such, we owe ourselves the duty to ask what our newly minted law may mean. As this column deals principally with mental health issues, I will toss out a couple of ideas (and perhaps some unwelcome research outcomes) for discussion.
Pot is undeniably good for folks who’s mood might be lower than they’d like. The euphoria and all-round sense of ease THC (the psychoactive component) creates can only be a good thing. However, in my view, the sense of well-being we seek is best found in non-chemical ways. Certainly, it seems better to go for a hike in nature than to coat our lungs and pollute our blood with cancer-causing volatile combustion products.
But onto the research, which deals in large part with marijuana consumption and bipolar disorder – or, as it currently called, “bipolar spectrum disorder,” as there are currently four recognized varieties of this illness.
First, research shows that marijuana use is statistically more prevalent in folks who live with bipolar than in the population at large or those living with other mental illnesses. Why this is so has been subjected to close attention, but because the data are subjective few satisfying interpretations have been reached. Interviews with three pot-smoking folks living with bipolar have told this reporter that any long-term hazards associated with marijuana use are mitigated in the short term by the sense of ease and contentment created by THC.
Now, on to those negative things.
Research (I’d be glad to supply the list of scholarly articles I here summarize) shows that in bipolar patients marijuana use can lead to exaggerated and rapidly cycling mood states, psychosis, a decrease in the remission of symptoms, and an overall decrease in what is called “global functioning.” This simply means that behavioural control and the ability to maintain acceptable patterns of thought are diminished.
Further, research shows that with increased use of marijuana, folks with bipolar face poorer therapy/treatment outcomes, greater risk of suicide, higher rates of hospitalization, and a general increase in the degree and frequency of both manic and depressive symptoms. These, naturally, lead to increased levels of overall disability.
Where should an understanding of this research lead us? Ought we reconsider the legalization of pot because it will lead to increased consumption among the vulnerable mental health community?
I say, emphatically, no way.
Alcohol is legal. Tobacco is legal. Access to other psychoactive medications is legal.
It would paternalistic in the extreme to single out pot for legal sanction because it has negative consequences for folks living with a mental illness.
Note: Primary research reference and link to scholarly publications: “Effects of Marijuana on Mental Health: Bipolar Disorder,” Alcohol and Drug Abuse Institute, University of Washington, June 2017. Author: Susan A. Stoner. No kidding.
We all deal with stress. And it is worth thinking about how we feel it and what we can do about it.
Harsh experiences – all of us have had them. In childhood or after.
When a person living with a mental illness reaches the point of hospitalization, those who care sigh a breath of relief.
“Thank goodness,” we say to ourselves, “our loved one is in good hands.”
And that is true. The mental health professionals both inside and outside the hospital setting do their jobs well and ensure that within the structure of our health care system the most vulnerable and unwell receive the attention they need.
But once outside the institutional system, mental health patients fall off a cliff and enter a revolving door of inside-outside. Allow me to give you an example, from personal experience.
Someone I care about deeply lives with bipolar disorder, a devastating illness that requires constant monitoring and assertive treatment.
Hospitalization has been a frequent feature of this person’s life, but beds on the psychiatric unit are scarce. Six beds serve the whole of the Sunshine Coast. So, when acute medical needs were deemed to have been addressed, this loved one was let out – without a formal discharge plan or follow-up.
The inevitable happened.
Still unwell with her mood cycling dramatically, and with new medications not yet having their effect (psychiatric meds typically take weeks to work), my friend entered the twilight zone between care and chaos.
Homeless, because her landlord did not want her around, and without social support because her behaviour estranged her friends, this incredibly bright and caring woman fell into life on the streets, bush, beaches, and dark alleyways of Sechelt.
In through the out door.
Predictably, after causing a rumpus, she was arrested and again taken to hospital. Released again, she is back on the street – unwell, and vulnerable to the predations of (mainly) men with unfriendly intentions. It’s only a matter of time when the revolving door will once again deliver her into care, eventual release, and back into the cycle.
One does not have to read this sad story all that closely to realize that there is a large and perilous gap between structured, acute care and outpatient well being.
Vancouver Coastal Health funds mental health services. As few as eight years ago, there were several mental health social/outreach workers who attended to the needs of recently discharged patients. Now, I think there is one for the entire Sunshine Coast, though I hear this may change for the better.
Until a few years ago, the Homelessness Project (modestly funded) connected with patients while in hospital to help them find stable housing upon discharge. Yes, the organization that now runs the Upper Deck homeless shelter has, in its remit, the task of finding homes for the homeless. It is a daunting task, as there is no affordable housing on the Coast.
As a caring community, we must do what we can to address the bottom, most fundamental level of Maslow’s Hierarchy Of Needs, which is safe and stable shelter and the basic elements of comfort.
Perhaps you have a spare bedroom you can let out to a person in need. I did, and I did.
If there is anything you can do to help bridge the gap between care and nothingness, then drop by the Arrowhead Clubhouse in Sechelt and talk with staff. Shelter. Clothing. Camping equipment for folks living rough. Anything.
Caring for those in need is our moral imperative.
Note: This regular column on mental health and social issues will appear 11 May at www.coastreporter.net
As I write this, sitting on the wharf with my ancient laptop on a sunny day in Gibsons, looking at so many moneyed folks buying everything in sight, I know that not a stone’s throw from where I am are 30 people – with hearts and souls just like you and me – without a home.
Last night, some slept under rowboats pulled up on the beach. Some didn’t sleep, because the little shelter they sought from last night’s rain – a garage, perhaps, or maybe just a big tree – was made unavailable by a property owner who didn’t want them there.
I’ll keep banging this drum. We have a moral obligation to help and support our fellow community members who are homeless and, quite often, live with a mental illness.
It is important to understand this: Not one of these folks has made a choice to live this way. Not one wants to wait each week for the food bank. Not one would prefer to live without love, support, and happiness. Not one would not embrace the chance to express the talent, spirit, and energy she or he has.
It comes down to us. We who have more than we need.
I ask this: Is it possible that you have ten hours a month to volunteer to support your fellow community members? Think about it. Ten mere hours a month away from Netflix.
It it possible for you to talk to the guy who plays John Prine for dimes on an out-of-tune guitar outside your fancy food market? Is is possible for you to buy him a sandwich – maybe even take him to lunch? Is it possible for you to accept him? (Or her, of course.)
Reject the objections to social housing or shelters that so many don’t want in their neighbourhood. Stand up for what it morally right and true. Share your abundance.
To my Sunshine Coast friends, you might listen to a recent podcast (link handily provided below) and express your support to John Gleeson, my fine editor, and the Coast Reporter, for running my column.
There are times when someone we love and care about becomes unwell – falls down and is harmed, and frequently embarrassed, by the behavioral symptoms and consequences of illness.
Someone I know very well was a soldier, and a brave one. He saw and did things nobody should see or do. He left home an idealistic young person determined to do what he thought was right. He came home a damaged, changed, and a very much older man.
There were flashbacks. Bursts of anger. Alcohol abuse. Reclusiveness.
It was clear that his terrible wartime experiences were tearing apart his essentially sensitive self and that he was suffering what we now call Post Traumatic Stress Disorder (PTSD). In addition to his more obvious symptoms, he had become emotionally unavailable, untrusting, and secretive – quite unlike his previously gregarious nature.
Now, the reason that PTSD is written as a proper-noun phrase – with first letters capitalized – is that it is a formally recognized mental health condition and appears in the Diagnostic and Statistical Manual of Mental Disorders, otherwise known in its current edition as DSM-5. It was not always so.
For years, PTSD and its symptoms were recognized as a species of anxiety disorder that were treatable by various means. But, like depression, there were strong currents of disbelief. PTSD, some said (and still do today), was and is a false diagnosis made by therapists with professional reputations and money to be made. A cure in search of a disease, as Kurt Vonnegut once remarked.
There have been two major areas of contention. The first is the reality that not all people who experience terrible things go on to suffer from PTSD-like symptoms. The second is that symptoms vary so widely in extent and severity, that PTSD cannot be considered a singular condition – that the capital letters are undeserved.
These, in my view, are specious objections.
It will be news to nobody with an even passing understanding of disease – physical or mental – that individuals respond differently to potentially causative agents of illness.
I’ll give you an example.
I grew up at a time when the waters of Georgia Straight were full of poisonous effluent from Port Mellon and were more than once fouled by oil spills. We ate the salmon and cod we caught in front of our place at Roberts Creek, and as well dined on the oysters, clams, and mussels we gathered at the rocky point at Stephens Creek.
None of my family got sick, though other folks eating the same food did. Does this disparity invalidate the fact that certain kinds of industrial waste cause disease? Hardly.
But, medical quibbling aside, the real harm done by PTSD skeptics is social.
To cast doubt on the reality of certain mental illnesses – depression being one – is to create stigma. Those of us who contend with mood and emotional ups and downs, however severe, are more deeply injured by the largely silent opinion that these states of mind are the product of weakness.
“Pull up your socks,” it is said by some. “Stop feeling sorry for yourself. Get it together.”
Another old friend, another former soldier who served with an elite Canadian unit, could not live with the reality that his society viewed his PTSD as no more than weakness and self pity. He was a true warrior who loved a good fight. But his trauma was moral. He could not live with the offenses to human decency he witnessed and took part in and the social shame he experienced. He hanged himself.
Billy’s death by his own hand was unnecessary, and it both saddened and angered me.
I lost a friend, brave, loyal, and true. But he died, as his distant family and friends know, mainly because he could not live with the moral trauma he experienced during his time as a soldier, obeying his orders and commanding others to do likewise.
He also died because few would accept the mental health consequences of his understanding – that he had taken part in an injustice, no matter what the political underpinnings.
PTSD is real, and it can be brought on in myriad ways – from witnessing a traffic accident to fighting in war. We must understand this and reject the social stigma that attends all forms of mental illness.
At long last, a replacement for the old cold weather shelter at St. Hilda’s Church has been found. As readers will know, the Old Upper Deck Guesthouse has morphed into a 20-bed homeless shelter. Also, there is talk of creating a shelter in Gibsons. Both of these are excellent developments.
It seems, then, like a good time to talk about the relationship between mental well-being and homelessness.
But first, an observation: On the Sunshine Coast, homelessness and demand for social services like the food bank are on the rise, and the “typical” client base of 10 – even five – years ago has changed. The death spiral of unaffordable rentals and meager employment means we now see folks lining up for services who arrive in minivans with kids in tow.
This means we must look at homelessness both as a consequence of mental illness and also as a cause of emotional and mental harm.
Folks living with a mental illness face huge housing challenges. The first significant barrier to finding safe and dependable accommodation is financial. If a person’s health challenges are cyclical – that is, if there are occasional bursts of crippling or severe symptoms – steady employment is a virtual impossibility.
But the greater barrier is bias – a chain of discrimination that begins in the job market and extends to housing. Given the choice, many employers would rather not hire a worker who lives with a mental illness, and many landlords would prefer tenant with no medical issues. The economic insecurity that results plays out as a housing issue. No money; no home.
(I should note that there are several enlightened employers here on the Coast who fully accept employees with mental, developmental, and physical challenges.)
For the “new” faces of homelessness, the folks that have been driven to social services by an unaffordable housing market and disappearing job opportunities, the effects of losing a home can be devastating and lead to a severe downturn in mental well being.
Imagine this: Last year you worked in an office, had a family who you were more than able to provide for, and a wide circle of friends. This, broadly, was your social network. Now, take away your job and your house; what do you see and feel?
First there is shame, brought on by the sudden and unfamiliar inability to provide for your family. And embarrassment, too, at the perceived loss of status so hard-won by a lifetime of education and work.
Next, there is isolation and loneliness. Schools, the workplace, and activities that a reliable income can buy create a web of social connections. When this shared support structure and the folks who populate it vanishes, so do the social interactions with friends and like-minded people that give life much of its meaning.
Solitude and social separation, according to recent study, are a health hazard and can lead to a surprising number of ailments. These may include dementia, autoimmune and cardiovascular disorders, and even cancer – all very expensive to treat.
The list of the causes and effects of homelessness is a long one, and the human and financial health care consequences unacceptable.
If we take a harm reduction approach to housing, if we realize that a commitment to the creation of affordable housing mitigates these human and financial costs, then we will have taken a meaningful step towards a solution to a problem that looks to get worse in the future.