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mental health mondays :: that other problem

with the stigma and the difficulty finding/ holding a job and the people telling you that you're making it up and the reduced life expectancy and the weird side effects of the drugs and the possibility that you could be put in a hospital against your will, life with a mental illness or disorder can get pretty miserable. so it might not come as a surprise that those with serious mental disorders often choose to self-medicate. of course, that ends up meaning that people who already have the odds stacked against them are then saddled with addictions, or with habits that can exacerbate their original problems.

yes, this is a sign that you're crazy
one of the most curious and best-documented correlations is between schizophrenia and smoking. smokers generally account for only about a quarter of the population in most western countries, however studies consistently find that smoking is far more prevalent among schizophrenics- as high as 80-90%. scariest of all, no one can explain why. in fact, while some have theorised that it may help moderate the symptoms of schizophrenia, it appears that nicotine actually interferes with the absorption of anti-psychotic medications, meaning that smokers need to take more of the drugs than non-smokers [that tiny, lucky minority]. of course, it doesn't help that quitting smoking can actually worsen the symptoms of schizophrenia. think your three weeks of irritability and 15lb weight gain was a hassle? picture it when you have a family of invisible squatters in your brain who suddenly start shouting at you.

of course, the trick here is that no one has been able to discover why schizophrenics start smoking in the first place. all we know is that a lot of them do smoke and that it's probably one of the things [along with increased suicide rates and medication-induced obesity] that results in those diagnosed with schizophrenia having a 12-15% shorter life span than "the normals".



substance abuse is also well-established among those diagnosed with bipolar disorder. in fact, the two can be so intertwined that it can be difficult to separate the effects of the addiction from those of the disorder. [it is not uncommon, with both schizophrenia and bipolar, for the disorder to manifest as a result of a drug binge]. frighteningly, up to 60% of those with bipolar disorder are thought to have a co-morbid substance abuse problem. unlike with schizophrenics and their smokes, there is a little more understanding as to why that might be the case.

first of all, bipolar disorder is associated with risky, impulsive, self-destructive behaviour and often times [during manic phases] a sense of invincibility and superhuman strength. second, there is some evidence that both bipolar disorder and addiction are related to abnormalities in the amygdalae. yes, those wonderful little cerebral blobs that put the "nuts" in "nut-shaped" can determine not only whether or not our brain is disordered, but whether or not it's susceptible to addictions. if you're a religious person, i'd like you to think what it would say about your creator if s/he actually made brains function so that one bit could simultaneously work to give two of the most stigmatised conditions possible at the same time. where is your loving god now?

where axis ii mental disorders, or personality disorders are concerned, things become even more confused. again, the prevalence of co-morbidity is incredibly high; alcoholics and drug addicts have personality disorders at ten to twenty times the rate of those found in the sober population.

and, as might be expected, the two of these things combined are much, much worse than either on their own [and they're both pretty awful on their own]. substance abuse can make mood swings both worse and more rapid in those with bipolar disorder. in schizophrenics, it can make hallucinations worse. in the case of any patients on psychiatric medications, the cocktail of drugs, alcohol and pills is absolute hell on the liver and can throw one's brain chemistry into a dangerous sort of overdrive by accidentally crossing the neurotransmitter streams. [hint: drugs that make you feel euphoric do so by manipulating the exact same chemicals in your brain as drugs that are supposed to stop you from being miserable. and yes, there is such a thing as being too happy when chemicals are involved.]

not the way to wash down your pills
one of the main roadblocks to many people finding help, of course, is that addictions, while they may be understood by medical professionals to have a basis in science, they aren't treated that way either culturally- where addictions are understood to be purely a matter of willpower- or legally- where addictions [other than to alcohol or nicotine] are understood to be criminal. i'll admit myself that i have difficulty establishing sympathy for addicts, since i do believe in personal responsibility no matter what our bodies are wired to do. i'm willing to wager that most people reading this piece are in agreement with me on that. there is something incredibly irresponsible about draining health care resources to deal with a problem that one can consciously choose to avoid. [what's worse is that the best-known system for overcoming addiction, the 12-step program, actually reinforces this idea.]

on the other hand, i used to date someone who had been diagnosed with high cholesterol and, while he would take pills paid for in part by our public health care system, he categorically refused to change his 10lbs of meat a day and fast food eating habits, even after complications from his diet necessitated surgery. i am quite certain that his case is not unique and the fact is that people like that are a far heavier [pun kind of intended] burden on the health care system than substance abusers, but i don't see anyone wagging a finger at them [unless they become morbidly obese, which not all will].

very little is going to help with the cultural stigma attached to addiction, other than time. the criminalisation of addiction, however, is easily addressable. countries where addiction is treated strictly as a health problem have actually had greater success in coping with addicts [and, coincidentally, with the various social ills that often accompany addiction] in comparison with those who criminalise it. while that in itself is not going to deal with the compound problem of mental disorders combined with addiction, it is at least going to allow doctors to see the proverbial forest for the trees, separating which personality traits come from the addiction and which from the disorder[s].

but i have no idea what to do about the schizophrenic smokers.

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