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Updated: 15 hours 23 min ago

Letter to the Mother of a “Schizophrenic:” We Must Do Better Than Forced Treatment and Laura’s Law

Thu, 02/19/2015 - 20:40

A few months ago I met your son. He said he would be waiting for us in the Berkeley park near where he sleeps outside at night, but at the last minute he called and was in San Francisco. He said he was at “the Mrs. Doubtfire house” with a photograph of his best friend, and that the photo showed numbers and codes predicting Robin Williams’ suicide. He found the house where Williams made one of his films, and was trying to talk to the owner. It was all part of a complex plan, marked mathematically in signs and omens he was collecting.

We drove across the Bay, worried. Were we too late? Would he be arrested and end up in the hospital again, this time for trespassing and harassment, a psychotic man caught bothering someone at a private residence?

When the GPS showed we were getting near the address he gave, I started to see people milling around, a commotion, cars stopped. My first thought was that something had happened. Maybe we weren’t in time, maybe he was already in trouble with the police, arrested at the house he seemed obsessed with?

At Steiner and Broadway we found your son, sitting on the sidewalk — but he wasn’t alone. He wasn’t the only one interested in the Mrs. Doubtfire house. The sidewalk was strewn with flowers, and dozens of other people were also there. What first seemed crazy, now seemed normal: many people, like your son, were drawn to the private residence where a Robin Williams film was made, to commemorate the actor’s suicide with a pilgrimage.

I walked up to your son and greeted him, unsure how this young disheveled man would respond to me. I had been told he was considered “severely mentally ill,” the worst of the worse, so beyond reach in his delusions that clinicians were considering using force to bring him to the hospital for treatment. But as soon as we made eye contact I was surprised. There was a clear feeling of affinity and communication. He explained in rapid speech about the numbers and messages on the photo, Robin Williams’ middle name, and the sidewalk code. It was all part, he said, of an alphanumeric psyche that communicates to him through signs and coincidences.

It was exhilarating and exhausting keeping up with the math calculations, anagrams, and nimble associations that flowed when he spoke. But he also at times talked normally, planned a walk up the street to a coffeehouse, explained what had happened about our meeting. I lost the thread at different points in our discussion, but one thing was clear: your son is brilliant. I was not surprised when he told us he got a perfect score on the SAT. “It was easy,” he explained when I asked. “Anyone can get a perfect score if they take the practice tests.”

We were quickly engrossed in conversation, and when he suddenly wove the author Kurt Vonnegut into the pattern, my eyes widened. Just moments before our meeting I was talking with my colleague, telling my own story of meeting Vonnegut. And now here your son was mentioning the author. I was amazed by the coincidence. As your son ’s talk became wilder and more complex, referencing the Earth Consciousness Coordinating Office, SEGA Dreamcast, and numerology, and as he did math equations instantly to prove his obscure points, I sensed an uncanny power and clairvoyance in the air. I was in the presence of someone in a different reality, but a reality with its own validity, its own strange truth. A different spiritual view.

Perhaps I am eager to emphasize your son’s talents because today he finds himself so fallen. I don’t romanticize the suffering that he, or anyone, endures. His unusual thoughts and behavior led to a diagnosis of schizophrenia, and seem to be part of deeper emotional distress he is struggling with. I don’t romanticize because I’ve been through psychosis and altered states myself. I’ve been diagnosed schizophrenic, many years and many life lessons ago, moving on with my life only after I found ways to embrace different realities and still live in this one.

So when we met your son I was completely surprised. The “severely mentally ill man” I was told needed to be forced into treatment was intelligent, creative, sensitive – and also making sense. Like someone distracted by something immensely important, he related to us in bits and pieces as he sat in conversation. Living on the street and pursuing an almost incomprehensible “calorie game” of coincidences on food wrappers isn’t much of a life, perhaps. And maybe it’s not really a choice – at least not a choice that most of us would make, concerned more with getting by than we are with art, spirit and creativity. What surprised me was the connection I had with your son. Because I took the time, and perhaps I also have the background and skill, I was quickly able to begin a friendship.

By taking interest in his wild visions, not dismissing them as delusional, and by telling him about my own mystical states, not acting like an expert to control him, we began to make a bond. I spoke with respect and interest in his world, rather than trying to convince him he “needs help.” What, after all, could be more insulting than telling someone their life’s creative and spiritual obsession is just the sign they need help? That it has no value? By setting aside the professional impulse to control and fix, I quickly discovered, standing on that cold sidewalk and then over hot tea in a cafe, that your son is able to have a conversation, can relate, communicate, even plan his day and discuss his options. Some topics were clearly pained, skipped over for something else, and he was often strangle distracted — but it was after all our first meeting, and I sensed some terrible and unspoken traumas present that were still not ready to be recognized. To me, clearly, he was not “unreachable.”

That we had a connection in just a short time made it very hard for me to understand why you or anyone would want to use force — to use violence — to get him into mental health treatment. A traumatic assault, instant mistrust, betrayal, restraint, then a complex web of threat, coercion, and numbing medications to impose compliance, possibly a revolving door of re-hospitalization, more medications, more threats and force and police… Surely creating a relationship, building trust, and interacting with compassion over time is a much better way to show concern and offer help?

When you think you know what is best for someone, it might seem faster to send a patrol car and force them off the streets and into a locked hospital cell. But would that really be safer? For who? Or would it push someone farther away, undermine the connection needed to find a real way out of crisis?

You’ve become an outspoken legislative advocate of empowering clinicians to intervene drastically in the life of your son and others like him. In pushing for so-called “Laura’s Law” the idea is to pressure, through force, compliance with medication and hospital care. Your son is today held up as a perfect example of why force is needed. I share your desire to help people in need; that’s why I went to meet your son in the first place. And I agree that our broken mental health system needs fixing, including by legislation and new services. I do want your son to get support. I want there to be more resources, more access to services, more connection, more caring, more healing. But I do not see your son, or people like him, as so “unreachable” that they cannot form a relationship with someone genuinely interested. That just wasn’t the man I met that day. I don’t see him as so less than human that his own voice and perspective should be ignored, rather than understood. I don’t see strange beliefs and outsider lifestyle on the street in any way justify the violence of forced treatment. I don’t see him as any different than any other human being, a human who would be terrible damaged by the violence of force, confinement, and assault, regardless of it being perpetrated in the name of “help.”

That day I met a man possessed by a mysterious artistic and spiritual quest that others around him can’t understand. He is homeless and perhaps very afraid deep down, but he is a person with feelings, vulnerabilities, emotions. Alongside the rapid fire associations that I couldn’t keep up with, he was also capable of connecting. His pilgrimage to Robin William’s Mrs. Doubtfire house wasn’t some lone obsessive symptom, the sign of schizophrenia and a broken brain, but understandable when put in context. His ranting was not a meaningless mutter but a creative and encyclopedic stream of enormous intellect. Yes he seemed to be in touch with some other reality, an altered state that demanded most of his attention. Yes I would love to see him living indoors, less afraid, more cared for and more caring for himself. I’d like to see many homeless people in the Bay Area have the same. But no, this is not a man I would want to force into restraints, injections, and confinement. I would not want anyone to be subjected to such violence — and it is violence, as people who have endured it will tell you. I would not want to destroy my emerging friendship with him with such an attack, because I know it is friendship — long, slow, developing connection and understanding — that can truly heal people who are tumbling in the abyss of madness.

Concerned and wanting to help, wouldn’t it be better for us to find the resources to gently befriend your son, to learn more about him, create trust, and meet him in his life and world? Even if this took patience, skill, and effort? Isn’t this how we want others to approach us if we seem, in their opinion, to be in need of help? Don’t we want our voice respected if we disagree with someone about what is best for us? How can friendship and trust possibly come out of violence?

Again and again I am told the ‘severely mentally ill’ are impaired and incapable, not quite human. I am told they are like dementia patients wandering in the snow, with no capacity and no cure, not to be listened to or related to. I am told they must be controlled by our interventions regardless of their own preferences, regardless of the trauma that forced treatment can inflict, regardless of the simple duty we have to regard others with caring, compassion, and respect, regardless of the guarantees of dignity we afford others in our constitution and legal system. I am told the “high utilizers” and “frequent flyers” burden services because they are different than the rest of us. I am told the human need for patience doesn’t apply to these somehow less-than-human people.

And when I finally do meet the people carrying that terrible, stigmatizing label of schizophrenia, what do I find? I find – a human being. A human who responds to the same listening and curiosity that I, or anyone, responds to. I find a human who is above all terrified, absolutely terrified, by some horrible trauma we may not see or understand. A human being who shows all the signs of flight and mistrust that go along with trauma. A person who may seem completely bizarre but who still responds to kindness and interest – and recoils, as we all would, from the rough handling and cold dismissal so often practiced by mental health professionals. Listening and curiosity might take skill and affinity, to be sure, when someone is in an alternate reality. But that just makes it our responsibility to provide that skill and affinity. Do we really want to add more force and more violence to a traumatized person’s life, just because we were not interested in finding a different way?

Your son may be frightened, may be in a different reality, may spend most of his time very far away from human connection. But his life, like everyone’s, makes sense when you take time to understand it. He deserves hope for change, and he deserves careful, skilled efforts to reach him and to connect – not the quick fix falsely promised by the use of force.

Even under the best of circumstances mothers and sons sometimes have a hard time communicating. Many young people refuse help – just because the hand that offers it is the hand of a parent they are in conflict with. Perhaps the need for independence is stronger than the need to find refuge in the arms of a parent. Perhaps children flee their parents in spite of themselves, because of some complex reality they are seeking to overcome. So maybe the help that is needed is not just for the sick individual but for repairing a broken relationship. I say this because after my own recovery from what was called ‘schizophrenia’ I became a counselor with families. I see again and again  — and the colleagues I work with also see again and again — that by rebuilding relationships, not tearing them down with force, healing can occur. A young person whose promising life and career were interrupted by psychosis can regain hope for that possible future.

A simple look at the research literature over the past 50 years shows that recovery from what is diagnosed schizophrenia is well documented and a real possibility – for everyone. Not a guarantee, but a possibility worth striving for. It is only in the past few decades that we forget this basic clinical truth about the prognosis of schizophrenia and psychosis, and instead predict chronic, long term illness for everyone. Such a prediction threatens to become a self-fulfilling prophecy, as we lower our expectations, give up hope, and relegate people to a lifetime of being controlled and warehoused in the identity of “severely mentally ill.”

I do believe help is need, help not just for your  son, but help for everyone in the family affected by the strange and overwhelming experience of psychosis. But when parents, who are alone and desperate to change their children, resort to pleas for force and coercion, they risk sacrificing the very connection and bond that can be the pathway towards getting better.

I hear the claim that Yes, we should respect the right to refuse help, but when people are suffering so greatly and everything else has been tried, we have no choice but to infringe on freedom. This is false. We haven’t already tried everything we can. We have not tried everything we can with your son, or with you. There is a huge wellspring of creative possibilities, skill, and resources possible if we just direct our mental health system to try harder and do better for you and your son  — and the many people like you. It takes money, vision, and political willpower, but people struggling with mental illness deserve the dignity of true help, not false promises.

We can, and must, do better. We must think outside of the false choice between coercive help or no help. We might start by asking people who have recovered from psychosis – and there are many –  what they needed to get better, and give them a leading role in shaping our mental health policies. We might start by respecting people’s decision to avoid treatment, and seek to understand the decision rather than overpower the person  making it. When you have been traumatized by those offering help, avoiding treatment might even be a sign of health, not madness.

Maybe some of us, when we are terrified, discover different realities to hide in. And maybe some of us, when we are terrified about people we love, reach for desperate measures – like forced treatment policies and Laura’s Law – to help. I believe that people who are afraid, perhaps such as your son  and yourself, need caring, kindness, patience and listening. Trying to force you, or him, to change may only drive us all farther apart.

I believe it is often the most brilliant, sensitive, artistic, and yes sometimes even visionary, telepathic, and prophetic people who get overwhelmed by madness. We need to discover who they are, and meet them as we would ourselves want to be met, rather giving up hope for human connection.

At the cafe where we talked, the waiter was polite, but kept his eye on your son, seeing only a dirty and homeless schizophrenic, not the human being I was getting to know, not the son you love dearly. When we said goodbye I tried to imagine what it would be like, living rough on the street, facing suspicion or worse from everyone I passed. I imagine it would be lonely, that I might fall asleep at night missing my childhood home, missing my mother.

Will Hall is a family counselor, consultant, and host of the FM program Madness Radio. He is also an advisor with the Bay Area Mandala Project.

Thanks to Dina Tyler of the Bay Area Mandala Project for her collaboration on this essay.

AB1421 (“Laura’s Law”) is a forced outpatient treatment scheme currently under consideration in Alameda County CA, despite lack of research showing any effectiveness and despite broad opposition from people who have themselves been patients in mental health care. If you would like to share your opposition of Laura’s Law, please call or email the Board of Supervisors in Alameda County:

Telephone Numbers

District 1: Supervisor Scott Haggerty: 

Scott.Haggerty@acgov.org

and josh.thurman@acgov.org

(510) 272-6691

District 2: Supervisor Richard Valle:

Richard.Valle@acgov.org

and ginny.demartini@acgov.org

(510) 272-6692

District 3: Supervisor Wilma Chan: 

Wilma.Chan@acgov.org

and Dave.Brown@acgov.org

(510) 272-6693

District 4: Supervisor Nate Miley: 

Kamika.Dunlap@acgov.org

and district4@acgov.org

(510) 272-6694

District 5: Supervisor Keith Carson: 

Keith.Carson@acgov.org

and amy.shrago@acgov.org

(510) 272-6695

The Pool of Consumer Champions (POCC) is a grassroots community of over 800 people who have personally used mental health services and outspoken in their opposition to AB1421. Through their united efforts and collective strength of these individual voices, they are active in advocating for recovery-oriented services focused on wellness and peer support. To learn more about the POCC, contact Khatera Aslami: kaslami@acbhcs.org or Mary Hogden: mhogden@acbhcs.org

Thai Translation of Coming Off Meds Guide!

Mon, 02/09/2015 - 17:35

A translator from Thailand volunteered many hours of work to translate the Harm Reduction Guide to Coming Off Psychiatric Drugs into Thai! I am deeply appreciative…

You can download the file, and other translations of the Guide, at www.willhall.net/files/comingoffmeds

and at www.theicarusproject.net/comingoffmeds.

This is an extraordinary service to Thailand and to Thai speakers around the world. The translator is remaining anonymous due to the extreme psychiatric violence that is routine in Thailand, but sent this statement:

The Thai translation of the guide was inspired by a Thai person who went through forced treatment of the mainstream psychiatry and was traumatized because no one listened to her real cause that lay in her mind, but instead people around her judged her superficially and wanted a quick fix. She has learned about the alternative psychiatry and was deeply afraid of the ignorant medical practice and drug use. She deeply wants the mainstream psychiatry to be transformed into compassionate non-judgemental listening and holistic treatment.

Is it Depression? Or Melancholy? Or…

Fri, 01/30/2015 - 23:59

” Depressed. ”

It’s a word I put in quotes because, like so many words we use to describe our mental health experiences, it has as much power to confuse as it does to clarify. We live in a culture bombarded by media and sped up by rapid-fire social interactions. It’s definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. “Depression” is such a word – it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar — and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.

So in my work, when I hear the word “depression” I don’t assume I know what it means, or that I have a sense of things just from the use of the word itself. And that is where the difficulty often arises. Like much human pain, depression is something we are eager to avoid, ignore, rush past, push aside. We want to get to the fix and the solution. Naturally, of course we do. We are in pain. So we reach for a quick simple word, assume we know what it means, and then we are headed down the path of associations set up like marketing pens deposited in offices, a trail of breadcrumbs laid out to subtly push us in a certain direction of thought. We don’t do the difficult exploration of what is actually going on.

Today the very human sense of self is a brand. We are trained to use language by our advertising saturated culture, and we are unconsciously manipulated by marketing strategies leading us quickly to ways of thinking, products, services, and prescriptions. The word “depression” is very often repeated in a get-medical-treatment-your-brain-is-malfunctioning-get-on-medications message environment. We think we can use the word and have it mean what we really might want it to mean. Often we can’t. We have to listen more deeply.

So I often ask, What kind of depression do you have? And I then watch myself be surprised. I thought the person might be low energy: instead they describe a state of high stress. I wondered if they might be grieving or sad: instead they begin talking about intense bottled up rage. I associated the word with sadness: instead I hear a story of fear. I imagined they were isolated: instead they tell me about complicated relationship conflicts. By moving from the sound bite term to the person’s actual definition of what they mean, I begin, like a character in a 1950s film that suddenly goes from black and white to Technicolor, to see an actual human story before me, not a brand or a soundbite.

And I am usually surprised. People tell extraordinary  accounts of their lives that one would never anticipate from the word “depression.” If I had taken that word and begun a symptom assessment and DSM comparison and traced along a discussion of neurotransmitters and possible anti-depressant cocktails, I would miss those accounts. I would miss the person and be lost in my assumptions.

One of the great sadnesses I encounter in my work is when people, struggling to find their own language, have adopted the language of others, or doctors, or the media in a way that only obscures and confuses the sense of who they are. Their very description of self has been usurped. I don’t have contact with the person, I have contact with a cloud of terms and jargon repeated from someone else. But just using the word “depression” does not always have to mean someone else language – sometimes people have their own definitions that are clearly personal and intimate revelations of their direct experience. I can’t assume one word is better than another because it has a set definition, instead I have to listen for how the person relates the word to their own lives. I have to listen for the definition the person themselves gives to a word.

I have met many people who use medical language – “I have an illness,” for example – in ways that nonetheless deeply honor their own unique meaning to that language, rather than just parroting meaning they have been given. But usually – not always – the presence of that medical terminology does, like the marketing pen, link back to the marketing strategy, And it takes some time, and some listening, to find the person beneath the branding.

Depression – what it is and what it isn’t and how to talk about it –  has been a longstanding interest for me — in my own pain, the lives of friends and family, in the community, in my work as a therapist, and on Madness Radio. I interviewed the ever thoughtful Gary Greenberg on some of the history of the “depression” diagnosis a few years ago for example. And I just finished a new Madness Radio interview with Joshua Wolf Shenk. Shenk takes an intriguing look at depression from a very different angle: the biography of US president Abraham Lincoln.

I admit to not being much of an historian, and so I am not in a position to really offer much insight into the historical legacy of Lincoln as a politician. He is certainly revered – almost deified – in US political culture, and so it is easy to overlook that he had his many critics in his own time. Significantly, slavery Abolitionists of the era saw Lincoln as too slow and unmotivated to ending the traffic in humans, and considered him too wrapped up as a politician in the slave trade, which was the very foundation of the plantation based capitalist economy of that time (and formed the basis of the US rise to power that exists today). We think of Lincoln as a man who freed the slaves, but he would be better understood as a system politician who led a country through the transition from slavery to its end. He did that through war, political maneuvering, the force of his leadership and all the things we think of as politics today. That the war was won by the good guys and keept the Union together and ended slavery shouldn’t obscure the complex moral and political realities about who Lincoln was.

At the same time by any measure Lincoln was an extraordinary human being. Reading his writing, for instance, is to be in the presence of a master orator with a first rate mind and deep human sensibility. His political leadership was in a time of intense social turmoil and political violence that demanded exceptional personal qualities to navigate. His life story is evidence of exceptional perseverance, ambition, service, humor, courage, interpersonal savvy and spiritual faith. Too bad, we might think, that he also suffered from depression, which we must imagine got in the way of these more positive aspects to his personality.

And this assumption – that depression is an overall negative in a life – turns out to be, once again, borrowed from soundbite and marketing. Certainly nobody wants to suffer. No one wants to be in pain. Of that we are clear. “Depression,” however you define it, is horrible. Read a few accounts if you haven’t been there yourself. Slowly burning to death locked in an oven would be, for many of us who have been through depression, an apt analogy.

Yet Lincoln’s life reveals, in Josh Shenk’s  Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness, something far more complicated and interesting than depression as a broken part of us holding us back. He describes how Lincoln had a life. Intense despair, suicidal pain, sadness, frustration, demoralization, powerlessness, exhaustion – the states of depression Lincoln went through were the life he lived, and learned and grew through. Shenk documents how the very strategies Lincoln was forced to develop to combat his depression were the source of those personality qualities now considered part of Lincoln’s greatness. The pain of depression is a life experience we endure and struggle with, and through that struggle we might also discover and develop who we are.

It would be too simple to say that for Lincoln depression – or melancholy as it was referred to in his time – was what led to his positive qualities. Again a life is too complicated for such an equation. But Shenk’s biography explores not only the capabilities that depression fostered in Lincoln’s personality, but also how Lincoln himself rejected the idea of depression-as-simple-failure and instead saw his melancholy as a personal and spiritual challenge to rise to greatness. He learned endurance, faith, strength, service, compassion, hard-nosed realism and personal responsibility to make some impact on the world — all, at least in part, from the same “depression” that much of today’s sound-bite and marketing culture would brand as something to just get rid of. Happiness, in Lincoln’s life and in the lives of many of us, is not the highest ideal. Happiness is sold relentlessly in the capitalist marketplace, but some of us prefer to pursue not feeling good, but feeling human.

Living with a purpose. Serving others. Rising to personal challenges. Learning what it is to be human. Finding meaning in life. Facing hard truths with integrity. Though I certainly don’t want pain or suffering any more than anyone else does, I’ve found that pain and suffering – and depression – continue to visit me and continue to be part of who I am. Life seems to do that. Life hurts. And so I want not just to feel better, but at the same time to also, in a way, welcome depression and melancholy. I want see the suffering of being human not just as something to get rid of, but as there for a reason: to teach me something.

You can check out the Madness Radio interview here:

www.madnessradio.net/lincolns-depression-joshua-wolf-shenk-madness-radio/

Lincoln’s Depression | Joshua Wolf Shenk | Madness Radio

Wed, 01/28/2015 - 14:29

Celebrated US President Abraham Lincoln also suffered from life-threatening depression. Did he view his “melancholy” as a treatable illness, as a punishment from God — or as a source of his gifts? How did Lincoln’s extraordinary leadership abilities arise from his struggle with extreme pain?

Joshua Wolf Shenk, author of Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness, explores the famous President’s battle with despair, suicide, and intense sorrow, and discusses what people with depression – and the medical establishment empowered to treat them – can learn from Lincoln’s suffering. www.shenk.net www.theatlantic.com/magazine/archive/2005/10/lincolns-great-depression/304247/ www.theatlantic.com/magazine/archive/2009/06/what-makes-us-happy/307439/ www.shapell.org/manuscript.aspx?lincoln-mccullough-civil-war-condolence

The Substance of Substance Use: Talking About Marijuana, Alcohol, and Other Drugs

Tue, 01/13/2015 - 11:57

When I was locked in a psychiatric hospital, I wasn’t able to have much of a conversation with my parents about what was going on. Phone calls were tense and filled with silence, and as I stood at the ward payphone I was so confused and frozen in fear that each call just confirmed to them how lost I was. Every day as a patient centered around the various prescriptions I was on, and like so many people suffering in a psychosis, helping me became a wait to “find the right combination of medications.”

Before spiraling into crisis I had, like many young people in their 20s, been taking any number of recreational drugs. Going to school in California and living in San Francisco, virtually everything that could get you high was readily available and widely consumed. My friends and I were part of a youth culture where substance use was considered just another way to have a good time, like going to the movies or listening to music. So faced with a son who now was on the phone from a mental hospital, at one point my father said, Well, he must have just taken too many drugs. It was an explanation for my crisis.

Substances exert a huge force over our imaginations. In many ways they are like magic – we know who we are, we are familiar with how we think and the world seems a certain way to us, and then we can drink a liquid or smoke some leaves or swallow a pill and everything dramatically and mysteriously changes. New emotions appear, old ones disappear, patterns of thinking warp and transform, our body wobbles into a new shape and the world becomes electrified or soggy, softer or more vibrant. It shouldn’t be surprising then to realize that we believe substances, and the psychiatric medications that share this same ability to alter consciousness, have the power to save us from a crisis — or to put us in that crisis to begin with.  We look for a cause to our problems in substances, and we look to a solution to our problems in substances. I haven’t met anyone who, faced with some kind of stress, didn’t at some point reach for something, even if it is just a cup of coffee or a sweet treat.

But substances are also always situations, and situations often have no simple, single cause. For example, people I work with frequently ask about marijuana and psychosis, looking to answers. Did marijuana use cause the crisis I am facing or that my family member is in? Is that the reason this happened? The research linking marijuana use to psychosis seems to give a clear answer: for some people psychosis can be precipitated by using pot. But at the same time, marijuana, like alcohol, is widely used without leading to psychosis or other problems, and many states now are moving towards legalization of pot, considering, rightly, that overall pot is much less dangerous than tobacco or alcohol, which are already legal. So does marijuana cause psychosis or not?  There is no way of knowing whether one person will respond to marijuana with a psychotic crisis, or will just end up going to sleep or having a ravenous appetite. In general I do caution that it can make things worse or be a big factor in psychosis, but I have seen that also not be true. The research offers no clue as to what marijuana might mean for a specific individual. To understand that, and to make decisions about substance use in general, you have to understand not the general “drug effects,” but the overall situation a person is in.

Sometimes changes in substances, such as stopping recreational drugs, or starting psychiatric drugs, be the apparent key recovery. I’m pro-choice about substances just as I am pro-choice around psychiatric medications. I myself don’t take recreational drugs, and my friends and people I meet quickly realize I won’t be joining them for a beer, glass of wine, or hit of weed. I also don’t take meds. I believe that not taking mind altering chemicals of the recreational or psychiatric variety helps me enormously to avoid the altered states that landed me in the hospital. But I don’t believe it is the chemistry of the drug that explains this, but my choice itself and the life I live today as part of that choice. I didn’t stop smoking pot because I agreed with my father that drugs were to blame. I stopped smoking pot because of a personal discovery process of learning, exploration, and growth. For me, recreational drug use in my early life wasn’t just some harmful mistake, but a very important and valid part of me that I now honor and welcome – the part that wants to escape or explore, that wants freedom from the ordinary. Today I’ve found ways other than substances to meet my need to get high, escape, or numb myself out.

Choosing to not take substances is very different than being told you can’t take substances by a parent or authority figure. And the sanctuary of following someone’s advice can be very different than the wilderness of figuring things out on your own. Taking a substance for its consciousness effects can be very different than a professional healer prescribing it as a treatment for a disease. Not getting high on marijuana or alcohol is very different when you are high on something else. No trip at all is very different than choosing what kind of trip you will take. Avoiding the risks of substances is different when you are terrified of risk itself, instead of willing to take different kinds of risks. Just saying No is not the same when you have something to say Yes to.

I have seen individuals make advances in their recovery and healing when they found ways to stop using substances — but it is often the way they stop, the process and the meaning, that is central. Taking charge, making decisions, getting support while feeling respected, having your own worldview and your own spiritual perspective and identity different from your parents – substances can become a symbol of selfhood and independence itself. The power to expose yourself to harm and take risks, and the power to avoid harm and avoid risks are, is at essence the power we have as humans to live our lives in our own bodies, not someone else’s. I have seen individuals make just as much positive advance in their recovery without ending substances – or they even started substances or changed substances as a way of moving forward (there are growing numbers of people for example who use cannabis to help them come off psychiatric drugs – completely confounding the belief that cannabis causes psychosis and must be avoided). Sometimes even beginning an addiction or continuing a substance can be part of a personal strategy of compromise and negotiation to get someone through the next stage of their life.

I see people and families make progress (in their “recovery” or whatever language you want to use) when the decision about a recreational drug, or the decision about a psychiatric drug, is put in its proper place: a decision that is part of a larger life situation. Drugs always have a web of relationships and a whole social context surrounding them. Pills have meaning, getting high or drunk has meaning. This larger discussion is hard to have when the focus instead is on whether a drug causes this or cures that.

Can there be discussion about the risks and possible benefits of getting high? What about mom and dad, what kinds of substances did they use when they were young? Haven’t people lived perfectly fulfilling lives with a history of substance use in the past, or regular substance use in the present? Don’t some people do well on psychiatric drugs? Don’t other people sometimes get pulled down into terrible, hellish traps by the same substances? What hopes and dreams, fears and pains, are involved when we get high? What are we escaping? What harm do we notice now in ourselves and others, and what long terms harms should we be aware of? If we feel out of control with substances, could they be serving some need we haven’t yet faced squarely? If we like the high but fear the risk, what harm reduction trade offs can we make? Do I want this drug I am taking, recreational or psychiatric, to be part of who I am? Can I accept that this drug is part of the life of someone I love? Is a substance just a way of saying you don’t trust life to give you what you need, or is a substance the very pathway you need to get what you want from life?

On the phone with my parents from Langley Porter Psychiatric Institute, with my past recreational drug use and the regime of psychiatric medications I was trying every day, I wish there had been more questions and fewer answers. I didn’t need to just say no, or just say yes, to anything. I didn’t need to seek salvation through the right medication combination or fear damnation through the wrong recreational drug choices. I needed to be met and listened to for who I am, substances and all.