Marijuana and the Mentally Ill

(City Journal) America’s ongoing marijuana-legalization experiment will have many consequences. That goes especially for the seriously mentally ill, a sliver of the adult population but overrepresented among the ranks of compulsive pot users. Treating schizophrenia and bipolar disorder is never easy; even when treatment is available, the seriously mentally ill often fail to comply. A schizophrenic who spends most of his days in a dark room smoking weed is not a clinically promising case.

Modern mental-health systems are community-based and thus shaped by community norms. Decades ago, clouds of pot smoke were not often encountered on city streets. Now that they’re ubiquitous, a seriously mentally ill individual may be inclined to wonder what’s so objectionable about an activity that normal Americans do daily, in public and even during working hours.

The issue is only partly whether pot causes mental illness. A large body of research studies, involving tens of thousands of people, has suggested, with impressive replicability, that heavy cannabis use increases the risk of developing mental illness. Legalization proponents reject this, contending that, while the rate of marijuana consumption has soared over recent decades, the rate of serious mental illness seems to have stayed flat.

But this debate has eclipsed interest in the effect of continued cannabis use on those already mentally ill. What can be done about that? For scores of clinicians and families of the mentally ill across the nation, it’s the more pressing question.

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