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November 10, 2006

Treatment of Anxiety; an historical perspective

A while back I promised  to discuss how pot’s ability to quickly and efficiently relieve anxiety in a variety of settings makes it so effective in treating several of the common conditions recently made famous on late night TV as things to ‘ask your doctor’ about: insomnia, ADD, PTSD, and various named anxiety ‘disorders,’ (including the bipolar variety). But first, a little more historical background.

I still feel I should register my objection to the DSM system of nomenclature adopted by Psychiatry with so little apparent realization that the increasingly subdivided conditions being described in mind-numbing detail in each new DSM are NOT diseases; they are, at best, syndromes which clearly can’t be diagnosed with the same confidence as diseases because they don’t produce the characteristic microscopic or chemical changes Pathologists rely on to diagnose physical (somatic) disease.

It’s not that the Brain isn’t the organ of the Mind; most certainly it is; but we aren’t yet able to reliably link characteristic anatomical, laboratory, or imaging abnormalities to the patterns of aberrant behavior that trouble most pyschiatric patients.

In any event, Psychiatric nomenclature didn’t begin to change until the early Fifties at about the same time the first psychotropic medications were being approved by the FDA and marketed by the Pharmaceutical Industry. Ironically, that also happened to be when the parents of the baby boomers who would discover pot in the mid-Sixties were themsleves discovering— and being urged to use— a growing list of major and minor tranquilizers, thought not to be ‘habit forming’ (a claim aiso made on behalf of Heroin by Bayer in 1898), but which would later become Jaqueline Susann’s multicolored ‘dolls’ of valley fame and the most abused prescription medications in history.

Thus did it happen that the same young Fifties parents who were self-medicating with booze and tranquilizers would go on to raise  the hippie boomers who would, in turn,  discover pot and provide Nixon with all the excuse he needed to launch a dug war. Meanwhile, my profession would be getting rich on the Medicare/Medicade benefits they’d just been so bitterly resisting, while happily prescribing the new tanquilzers in record numbers because the Pharmaceutical Industry made it so easy and it also made so much sense to prescribe them for large numbers of the ‘worried well’ cluttering up their offices and keeping them from the ‘really’ sick patients most doctors would rather deal with...

As if all that were not confusing enough, it should be noted that a relatively small, but unknown, fraction of cannabis users experience 'paranoid' reactions  under circumstances which have never been studied clinically (so far as I can tell), but are almost universally  considered to be an example of a cannabis induced 'co-morbid'  condition. In fact, if one simultaneously searches 'cannabis' and 'anxiety,' the overwhelming inference in most of the hits returned is that the pot produced the anxiety.

Of course, another possibility is that the two conditions are related only by the erroneous assumptions of those making both diagnoses, which may be another reason to distrust a system for classifying disease that is entirely bereft  of the objective standards taken for granted in Pathology

Although I have a lot of evidence to the contrary, I also recognize that people who suffered a severe paranoid reaction are highly unlikely to ever seek a pot recommendation. Maverick that I am, I see that as an argument for an unbiased study of the entire pot market, rather than a reason for perpetuation of the failing and destructive policy of pot prohibition.

Doctor Tom

Posted by tjeffo at November 10, 2006 04:25 AM