A majority of Americans today (58 percent) believe that smoking marijuana should be legal (1). At the same time, while most Americans recognize that mental illness is a biological problem, most still say they don’t want somebody who is schizophrenic or depressed as a neighbor or a friend (2).
How are these statistics related? They present a possible explanation for a widely recognized problem in our country – most people with mental illness are not getting help. Instead, many are trying to self-medicate in ways that may not be effective and, in fact, may aggravate their mental illness.
Just last month, the Journal of the American Medical Association (JAMA) published research showing that one in 10 adults in the US have a lifetime drug use disorder (3). Analyzing data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, the research included in-person interviews with 36,309 adults. Drugs in the study included amphetamine, cannabis, club drugs, cocaine, hallucinogens, heroin, non-heroin opioids, sedative/tranquilizers or solvent/inhalants.
A variety of mental illnesses were associated with 12-month drug use disorder diagnoses, including major depressive disorder, bipolar disorder, post-traumatic stress disorder and personality disorders. Lifetime drug use disorders were associated with generalized anxiety disorder, panic disorder and social phobia.
Only a quarter of those with a lifetime drug use disorder had received treatment. The authors concluded, “The public is increasingly less likely to disapprove of specific types of drug use (e.g., marijuana) or to see it as risky, and consistent with these attitudes, laws governing drug use are becoming more permissive. However, the present NESARC-III findings on disability and co-occurring disorders indicated that drug use disorders as defined by the new DSM-5 nosology are serious conditions affecting many millions of Americans.”
“A Disease Like Any Other”
It shouldn’t be a surprise that many people struggling with a mental illness don’t want to talk about their suffering. Many Americans are anything but understanding. A 2010 study published in the American Journal of Psychiatry examined how public reactions to schizophrenia, depression and alcohol dependence had changed from 1996 to 2006. The survey used responses to vignettes in the mental health modules of the General Social Survey, the largest American survey of its kind.
While it showed the American public has come to understand that mental illness is a neurobiological disease, largely because of the “A Disease Like Any Other” campaign, the stigma remains. “A majority of the public continued to express an unwillingness to work close with the person (62 percent for schizophrenia, 74 percent for alcohol dependence), socialize with the person (52 percent for schizophrenia, 54 percent for alcohol dependence) or have the person marry into their family (69 percent for schizophrenia, 79 percent for alcohol dependence). The numbers are slightly lower for people suffering from depression, but still above 50 percent in most categories (2).
In a 2014 paper published in the Association for Psychological Science, the authors write, “These displays of discrimination can become internalized, leading to the development of self-stigma: People with mental illness may begin to believe the negative thoughts expressed by others and, in turn, think of themselves as unable to recover, underserving of care, dangerous, or responsible for their illnesses” (4).
Stigma and Ignorance Lead Many to Self-Medicate
Even though there should be protections provided by the Americans with Disabilities Act, people can still lose their jobs when an employer suspects mental illness. Couple that with longstanding comments like, “Honey, just have a drink, it will calm your nerves,” and an overwhelming acceptance of marijuana use that only is growing, many people suffering from anxiety disorders, depression or bipolar disorder may find self-medicating to be a safer, easier way to go on.
But emerging science has shown that self-medicating, even with marijuana, can be ineffective and even dangerous. An abundance of research already exists showing the dangers of mentally ill people self-medicating with alcohol, but until recently, there hasn’t been a lot of science about how marijuana impacts mental illness.
In a 2003 paper, “Chronic Marijuana Use and the Treatment of Mentally Ill Patients,” the authors warn, “In the United States, marijuana is perceived as innocuous and commonly used, which presents problems for the clinician encouraging abstinence in the addicted patient” (5).
Because the DSM-5 generally does not allow for treatment of chronic marijuana use as a condition in and of itself, clinicians at times are labeled judgmental when advising patients to stop using it.
Yet when a patient uses marijuana, a clinician has no accurate baseline of the type and severity of a patient’s mental illness. Research does exist showing that marijuana users who smoke as a coping mechanism appear depressed, while those who don’t use marijuana as a coping mechanism do not. (6)
More recently, research published in Cell Reports has shown why so many people self-medicate with marijuana to relieve anxiety and depression. The research showed that people who do this may be lacking in endocannabinoid-like materials in their brain (7).
In a story published by VICE, psychiatry professor Sachin Patel of Vanderbilt University in Tennessee explained why self-medicating with marijuana is harmful and how a synthetic drug to treat the chemical deficiency in the brain could be a better option. “The problem is — and this has been shown by research groups recently in humans — when people overuse marijuana, THC binds very strongly to brain, and you can’t get it to turn itself back down, so desensitization occurs. After people use marijuana chronically, they are shooting themselves in the foot because it leads them to use more drugs to get the same high” (8).
Disarming Stigma with Laughter, Being “Out”
The biggest challenge America faces in getting help delivered to people with mental illness is halting the cruel stigma they face in the workplace, in healthcare, in public policy, and even within their own families.
The 2010 mental health stigma survey concluded, “Current stigma research suggests that a focus on the abilities, competencies and community integration of persons with mental illness and substance abuse disorders may offer a promising direction to address public stigma” (2).
Recently, mental health stigma has been compared to stigmas associated with homosexuality and diseases like HIV/AIDS and cancer. Those marginalized groups have seen successes simply by “coming out” and sharing their stories of success and contribution.
One of the people employing that approach is comedian David Granirer. Granirer, who suffers from depression, is teaching comedy to adults with mental illness in a class called “Stand Up for Mental Health.”
In a recent interview with USA Today, he said laughter not only serves as great therapy for people suffering from mental illness, but also helps shatter stereotypes that they are dangerous and unlikeable.
“How often do you hear the words ‘hilarious’ and ‘schizophrenic’ in the same sentence?” asked Granirer in the USA Today interview. “Audiences see people with labels like bipolar and schizophrenic, and see them as funny and likable and courageous.”
One of his students, Jessica Dawson, told USA Today that one of the greatest periods of shame in her life were during times she was hearing voices and even underwent electroconvulsive therapy. “Before I had electroshock, I thought I was Jesus Christ,” she quipped in her act. “Afterward, I thought I was a toaster.”
In the USA Today story, Patrick Corrigan, a professor of psychology at Illinois Institute of Technology, said the latest research shows that meeting people with mental illnesses in person can be two to three times more effective at shattering stereotypes than educational programs alone. “The way we’ve diminished the stigma of being gay is by having brave men and women come out. It wasn’t watching anti-stigma programs in middle school.”