ADD / ADHD and cannabis
Some people with ADD / ADHD use cannabis regularly, and I have had patients who moved on to prescribed ADD / ADHD medication, finding it both more helpful and lower in unwanted effects than cannabis.
As the diagnosis of ADD / ADHD grows in the UK, I suspect this will become more of a factor in the debate about whether cannabis should be criminalised to a lesser extent, or even decriminalised altogether.
I don’t have a formal professional view either way on that issue, especially as I’m not a specialist in “Substance Misuse”. But I would say that the arguments of the leading UK advocate for reducing criminal sanctions on cannabis, Professor David Nutt, seem far from clear-cut.
On his Blog (http://profdavidnutt.wordpress.com), Professor Nutt suggests that the risk of increasing schizophrenia in young people, which could result from decriminalisation, is not of great concern. On his own figures, for every extra million young men using cannabis, about 200 might develop schizophrenia who wouldn’t otherwise do so.
His argument seems to be that alcohol use would probably decline (because of switching from alcohol to cannabis), and the benefits from that would outweigh any cannabis-related harms.
He might be right, but I think at least two aspects of the debate have not received as much attention as they should.
First, it does seem very difficult to compare the harm of an often devastating psychotic disorder, with alcohol-related problems. Is it really as simple as saying that improving and extending life for tens of thousands of people, by reducing their alcohol intake, logically outweighs the risk of ”only” a few hundred people developing schizophrenia?
Secondly, I think the wider debate about “harm reduction”, and Professor Nutt’s related view that UK medical doctors should be able to prescribe cannabis (as they can elsewhere in Europe) would benefit from an acknowledgement that medical prescribing of some mind-altering substances has been, and remains, too lax.
When UK general practitioners, from the mid-1990′s, were widely encouraged to prescribe antidepressants after little more than a ten-minute consultation, this state-approved practice was never properly tested. The concerns about misuse and harms of Seroxat and other antidepressants followed.
Of course, as a specialist prescriber of mind-altering substances myself (hopefully, always as a reasonable therapy), I have a direct vested interest. But it does seem to me that promoters of medication, whether natural or synthetic, branded or generic, freely available or eye-wateringly expensive, would generally be more credible if they listened to my (free) advice.
Maybe there IS a market for nuanced writing about mental health
Manufacturing Depression: the Secret History of a Modern Disease had been in my “to read” pile for a few months. I was in no hurry, assuming from the title that it was a re-hash of the “marketing by pharmaceutical vested interests” arguments of David Healy and others.
But after a patient recommended it, I had a look. The author Gary Greenberg is a psychotherapist, who has episodes of severe depression himself, possibly related to his “inexhaustible penchant for dithering”. He tells a very interesting story, especially about taking part in a double-blind, placebo-controlled trial of an antidepressant. I will not reveal the ending, but do think the book should come with a bit of a health warning because the lack of black-and-white conclusions may make some readers irritated or even depressed.
Another thing I liked about Manufacturing Depression was Greenberg’s willingness to say that pharmaceutical companies and medication prescribers are not the only vested interests in the mental health “industry”. For example: “…even though I am a psychotherapist, I don’t think the only alternative is what I sell in my office one hour at a time”. And, as what Greenberg calls a “depression doctor” myself, I agree with his view that “Depression is surely an affliction, one that at least in some cases may well have a specific, although still undiscovered, brain pathology – a disease in the usual sense of that word.”.
Quotations from Manufacturing Depression: the Secret History of a Modern Disease (2010, Bloomsbury hardback): pages 365-6, 297-8, 13
The Human Condition
This was the title of a talk by the philosopher and journalist Robert Rowland Smith, at London’s School of Life two days ago.
I have known Robert for a couple of years, during which he has published two books exploring how philosophy is relevant to the everyday dilemmas of modern life: Breakfast with Socrates and Driving with Plato.
The essence of the talk, I think, was that despite regular reminders throughout history of humanity’s less than fully rational nature, we still tend to overestimate our self-control. The constant development of technology not only distracts us from evidence to the contrary, but creates neurotic
dissatisfaction which we tend to worsen by seeking relief in materialism rather than by improving our interpersonal relationships.
I’m not sure that Robert is right in seeing the Western rational “Enlightenment” as perhaps now needing some sort of counter in the form of an Endarkenment”, because I think that contemporary philosophies and psychotherapies, as well as older Romantic Western culture, offer a whole range of ways to explore what Jung called our “shadow aspects”. And some people who are stuck in over-rational ways of life are suffering from biologically-based problems such as depression (1) or autistic spectrum disorders: they may need medication or other treatments to fully take part in philosophical or psychotherapeutic discourse.
It might seem odd that medical technology is sometimes necessary to enable a less technologically-dependent life. But in my view this is just a particular case of science liberating rather than oppressing (2). Philosophy too contains many paradoxes of this kind, such as Wittgenstein’s recommendation that we should simply stop chattering about “things of which nothing can be said”: his non-silence was required first, so that therapeutic silence could follow.
(1) In general the more severe and long-lasting the depression the greater is the need for medication. But some severe depressions may respond well to psychotherapy and/or philosophy, and some mild depressions may respond only to medication.
(2) Of course, technology and science are often used oppressively, or at least with neglect, whether deliberately or by mistake. Antidepressants prescribed after a ten-minute consultation with a GP (rather than a much longer consultation with a GP, psychiatrist or clinical psychologist), including little or no discussion of psychotherapy, amounts to state-sanctioned neglect in my view.
Published at www.DrNM.org.uk on 15th April 2011; transferred to DrNMblog.wordpress.com on 7th October 2011
