It’s time to address the marijuana issue. To put it simply, “What are we thinking?” The substance abuse epidemic is so incredibly destructive to the well-being of our society – to our children, our adolescents, as well as adults. It is problematic enough to deal with the hard drugs – heroin, cocaine, etc.; prescription drug abuse – the opiates, amphetamines; never mind the psychiatric pharmaceuticals- the antidepressants, benzodiazepines, sleeping pills, etc.; and of course alcoholism. While we are going to great lengths to curtail cigarettes and nicotine, we are legalizing marijuana which is far more destructive. We in the psychiatric, psychological, and social work professions need to be active and clear in addressing this pressing issue.
I am limiting my focus to marijuana itself - THC and other cannabinoids, not to the social issues. Marijuana is a psychoactive drug. It is a mild to moderate hallucinogen. While not physically addictive it is powerfully habituating. And the marijuana of today is not your father’s marijuana. It is far, far stronger.
As a psychiatrist I have treated all of the addictions. And marijuana usage has gotten a pass. It has slid under the radar and is somehow considered a junior drug, so it doesn’t count. In fact, because of its psychotropic effects it is very distorting and destructive to the personality. Habitual marijuana use affects the brain. It affects the processing of experience by our consciousness. The altered top-down processing affects the play of consciousness itself. In order for psychotherapy to proceed, a patient has to be marijuana free. I will give an example of the marijuana issue in psychotherapy from my book about my patient, Eddie.
“Eddie said that for some time, smoking pot had made him “paranoid.” This was actually a marijuana anxiety state. Even though it no longer worked and despite the amplification of anxiety, Eddie had kept right on smoking, trying to recapture his earlier positive experiences. Since he was such a veteran smoker, he also felt ashamed of the marijuana anxiety itself.
Eddie turned to marijuana to fortify himself, to fill his emptiness and loneliness, and to inflate his ego. Cigarettes worked up to a point. Always a smoker, Eddie increased his smoking to over a pack a day. The process of smoking, filling the lungs, coincides with the physical location in the body for the feeling of emptiness. It is felt in the chest. Eddie filled his emptiness with a drug. Nicotine also has the drug effect of constricting the arterioles all over the body. This physical shutdown at every capillary mimicked a physical holding, which fortified and fed his emotional shutdown. Marijuana worked even better— a psychotropic, also inhaled. His lungs, full of THC smoke, was a full-filling experience. He felt that it stimulated his creativity. He believed it made him a deeper and creative thinker, the very attributes he felt were missing in himself. Marijuana fostered his specialness, which had already become the criteria for his value as a person. And he quickly became dependent on it to inflate his burgeoning and false sense of superiority. Marijuana also amplified his sensations, which gave him a false feeling of participation and engagement in life. He often smoked before social situations to undo being exposed as lacking and worthless, and to diminish his social anxiety. Eddie had no access to an inner voice saying, “Wait a minute— what am I doing?” He went the other way: “This stuff is great.” He was actively seeking a drug to enhance his sense of specialness. Marijuana fortified his decision to harden himself emotionally, by numbing himself from human feeling. I feel good. I feel great. I don’t need anybody. I’m superior.
Marijuana has a characteristic effect on consciousness itself. It promotes a disjunction between thinking and feeling. It distanced Eddie from participation in his feelings, which he was wont to do in the first place. His thinking, ungrounded in feeling, was free to roam, untethered. In its early phases, this promoted a sense of creativity, due to the liberated ability of his mind to roam free and unanchored. It also fostered obsessional and intellectualized “insights.” Marijuana intellectualization was disconnected from feeling. And as we know, feeling is the anchor of the characterological play. This became an organizing feature of the neuronal loops of his experience and warped the workings of his consciousness. Through habitual usage, this “marijuana mind,” was established in him, whether he was smoking or not.
Eddie took for granted that therapy was about intellectualized insights. (This is a common assumption, which is unfortunately all too frequently shared by many therapists.) This decidedly is not the case. Eddie’s pride in his intellectualized insights was problematic for the therapy because it interfered with real engagement. Eddie valued his insights as special and impressive. His compensatory identity as superior was attached to being a user of not only marijuana but the other hallucinogens as well. And finally, marijuana served to heighten his senses. As a result, Eddie felt super-participatory in sensory experience. This was compensatory for Eddie’s sense of removal as the observer/outsider he normally felt himself to be.
As is typical, in order for Eddie’s brain to work right again, it took him a full year to recover from habitual marijuana usage. This was not about detoxing it out of his system—that took place fairly quickly. Likewise, it was not a physiological dependence. The issue was marijuana’s effects on his consciousness and a psychological dependence on this valued cast of mind which I call marijuana brain.”
Now it is certainly true that not every smoker gets marijuana anxiety, but it is very common. And even more important, this psychotropic drug effects the brain of every smoker. With the legalization of marijuana we are sanctioning this destructive alteration of consciousness, which makes users passive, removed, intellectualized, falsely special, and not equipped to take on the challenges of life with our full and unadulterated where-with-all. This is especially so in the developing brain and consciousness of teenagers, never mind the altered brains of adults. As a society we are supposed to foster the full and best development of our children into capable, responsible, caring adults. We need to oppose the use of marijuana, not foster it.
Robert A. Berezin, MD is the author of "Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”