Most psychiatrists of a certain age began their careers thinking marijuana use – even daily marijuana use – was no big deal. We bought the conspiracy theory (somewhat accurate, somewhat false) that marijuana was histrionically banned in the 1920s through sneaky back-room deal making by Hearst and DuPont in order to get rid of hemp, which was a threat to their business models (making paper and nylon respectively). The terrifying, effects of weed on the human mind – particularly the nonwhite human mind, but also the white female mind – was the scare tactic these corporations used to accomplish their financial objectives. And thus, tragically, in white America’s panic to avoid miscegenation and race wars, which turned out merely to deprive them of superior paper and nontoxic, organic clothing and rope – both superior by far to wood pulp paper and cotten clothes and nylon rope – we got rid of a perfectly safe drug.
That was the story.
However after you get through – in my case – a decade and a half of psychiatric practice, something funny happens. You stop thinking about marijuana on a case-by-case basis, the way you did in high school and college, when you just went through your list of friends who smoked and, finding they were more or less as functional (or dysfunctional) as everyone else, concluded that marijuana was no big deal. And you start thinking about marijuana at the population level. And at this point the scare tactics don’t seem quite as problematic. Not because you’re worried about miscegenation – because you’re worried about amotivation.
You’ve seen 500 patients. You’ve seen that roughly once or twice a year you meet a patient who became permanently schizophrenic after smoking pot. And you’ve seen a certain genus of psychiatric patient – the pot-smoking layabout, classically male, classically white, classically overweight, classically sitting in his parent’s basement playing XBOX for 13 hours a day – whose problems seem to correlate closely with the amount of the drug he smokes. And you learn: when two well intentioned parents come in to complain that their smart young boy flunked out of school and isn’t enrolling in classes at the community college and isn’t exercising or taking care of himself but instead just stays in bed playing video games or reading fantasy literature and is obviously depressed, you need to ask them a question: does he smoke pot?
Often they say no, so you have the kid himself come in, and ask him. And around 70% of the time (by my rough calculations, based only on my practice) the answer is yes.
So today on reddit I see a link to an article exploring this amotivational syndrome of marijuana use (link to article here.) There’s a lot more to be done on this, but the idea that THC could lead to downregulation or, more generally, dysregulation of dopamine function, is appealing. Dopamine is the “hey that looks promising, let’s investigate and see if it turns out to be good!” monoamine, and you’d expect amotivationality to be associated somewhere. Let’s hope this kind of research continues.
Image credit: http://hempforyou.com/