Trigger or reliever?
Posted Nov 02, 2019
Every day, the media brings more stories about the benefits of marijuana. Impressive, convincing, and encouraging. Almost every day, my practice brings a different story—about the serious disorder of depersonalization and derealization that occurs after using marijuana. Life-breaking, painful, and disturbing. Should marijuana, then, be blamed for depersonalization-derealization?
But at the same time, my practice occasionally brings opposite stories—about easing the burden of chronic depersonalization after using marijuana. Should marijuana, then, be recognized as an aid in coping with depersonalization?
The ongoing cannabis revolution has transformed the label of marijuana from an “illegal, forbidden, potentially dangerous drug” into a “fashionable, all-natural wellness enhancer” and has made it widely available around the globe. Patients, their families, and friends wonder: Is marijuana “bad,” and does its legalization, along with aggressive marketing, increase the risk of depersonalization? Or is marijuana “good,” and does its legalization offer the possibility of relief from the burden of depersonalization?
Depersonalization is both less known and more peculiar than depression, anxiety, or obsession, which occasionally occur in connection with marijuana. A person with depression looks sad. With anxiety—worried. With obsession—preoccupied.
But a person with depersonalization looks and behaves normally. Depersonalization troubles a person who experiences it, but remains invisible to bystanders. Moreover, presentations of depersonalization so diverge from common customary occurrences that patients often call them “indescribable.”
The Disorder of Depersonalization-Derealization is one of the most murky, painful, and treatment-resistant psychological ailments. Its core is a feeling of a strange, disturbing change in the self and the surrounding world. The main characteristic of this change is unreality.
Depersonalization refers to a feeling of unreality of one’s own self: “I feel not mine, altered, and detached.” Derealization refers to a feeling of unreality of the surrounding world: “I experience things and people around me like in a strange dream or in a surreal movie: unfamiliar, foreign, removed.”
An “as-if” quality is a key trait of this feeling of unreality: The knowledge that “I” and the world are real coexists with feelings of the unreality of “I” and the world. “I know that I am real, but this knowledge only enhances my feeling of unreality and darkens the peculiarity of my sickness.” This disconcerting mismatch between objective reality and subjective unreality aggravates the pain.
A person behaves and is perceived by others as normal, whereas inside, she feels like a “lost, non-existent shadow.” The language created to convey “real reality” fails to express the “as if unreality.” Attempts to use metaphors often do not provide understanding, but instead, deepen “isolation inside of the bubble of unreality.”
Depersonalization frequently emerges after marijuana intake. However, “after” does not mean “because.” Marijuana is not the cause of depersonalization. Its cause remains unknown. The vast majority of people who use marijuana never experience depersonalization-derealization. Marijuana is viewed as a trigger for or contributing factor to the development of depersonalization-derealization.
In some cases, depersonalization occurs after the very first intake of marijuana. In others, it takes months or years of consuming weed. Sometimes, full-blown depersonalization appears as an exacerbation of previous fleeting “flashes of unreality” experienced after former marijuana usage.
The clinical manifestation of depersonalization-derealization often comes as a “mental crash” that can end up in the emergency room. This shocking experience usually ends the consumption of marijuana. Fear and aversion toward the substance dominate. Many are concerned about the damaging consequences.
As depersonalization-derealization develops, the attitude toward marijuana fluctuates. Depersonalization rarely resolves itself or reduces with treatment. Unfortunately, the disorder often takes a debilitating chronic course harmful for professional activity, personal relationships, and emotional well-being: “The burden of depersonalization keeps my entire life on hold.” Patients long for any aid that relieves their burden and gives them their life back.
Such a quest for relief, more likely than not, includes thoughts about marijuana. Even though these thoughts vary significantly from person to person, and from one moment to another moment in the life of the same person, there are two polar attitudes. One sees marijuana as a harmful depersonalization-provoking substance that should be avoided. A second—polar—attitude sees marijuana as a possibly helpful, depersonalization-soothing substance that should be considered for the management of depersonalization.
The first attitude is illustrated by what I call the “Freshman Syndrome.” John, a handsome and bright Boy Scout, the leader of his high school debate team, with the highest scores on all of his AP tests, is accepted to an Ivy League college. He and his family are beyond happy.
A few weeks after school begins, stressed by the challenges of college, he seeks relaxation in his first joint. Suddenly, “I feel as if reality crashed, and the world is removed. I feel I have lost my own self and am watching myself from the outside.” Panicking that he is “going crazy,” he rushes to the emergency room. In a few hours, he is released with the diagnosis of a panic attack.
His anxiety is diminished, but the unreality remains. He cannot think or go to class. Arriving for the festivities of their first College Family Weekend, his parents are shocked by his “strange illness.” His dreams have crashed. He and his parents are upset and angry. They blame marijuana for “destroying his entire life.”
John also blames himself, questioning if the pain of depersonalization comes as a punishment for his “wrong behavior.” He accuses himself of being a “bad son” who “puts down” his parents. John saw many physicians of different specialties and tried various prescribed medications. Everything that he and his family learn about his disorder makes them see the potentially dangerous role of marijuana as a trigger of depersonalization.
John and his family join an educational group aimed at enhancing awareness of the harmfulness of marijuana: in particular, depersonalization and related anxiety. The group grows, attracting new members with its idea of life “without marijuana.” This is a safe and encouraging place for people with depersonalization to share their stories and to find support in building a better life with depersonalization.
The second, opposite attitude towards marijuana is exemplified in the story of Tom, a coy and timid digital prodigy. He had been using marijuana for some years before his depersonalization began. Marijuana helps him relax and brings an emotional spark to his life: “It melts away my insecurity, turning me into an easy-going dude, eager to joke and flirt.”
But then “just another joint” is followed by full-blown depersonalization. Right after that “shock of losing myself,” Tom ceases to use marijuana. “I no longer trusted weed; instead, I was afraid of it.”
Anxiously searching the internet, he diagnoses his depersonalization but feels too ashamed to talk about it to his family. His primary care provider advises him never to use marijuana. He tries meditation, exercises, and vitamins, but “the suffocating bubble of unreality gets so unbearable that I need some relief right now.”
He thinks about his “old pal”—marijuana—“that used to facilitate my relationship with the world, but it took only one time to break myself and the world around me.” The exhausting obsessive comparison of the risk of aggravating depersonalization and the hope of getting relief results in a call to a cannabis dispensary to order some marijuana products. Emotional relief comes right away.
Tom resumes his marijuana routine. It helps him manage the “pain of being depersonalized.” He occasionally meets with his pals from depersonalization forums, at that dispensary. They search for an optimal cannabis product to reduce the stress of depersonalization and enable “people with depersonalization to succeed in their lives.”
Attempts to find an answer to the questions of self and “mind extensions” under marijuana seem to have noticeably increased since its legalization. The situation is reminiscent of the golden era of marijuana and psychedelics nearly half a century ago, with serious efforts by clinicians, scientists, philosophers, and artists to unlock the enigma of consciousness and self. Depersonalization, as a peculiar distortion of self-consciousness, stands at the forefront of research during that period. Infamously, that era ended with the failure to understand consciousness and self with the help of marijuana. However, the current generation of marijuana enthusiasts, vigorously promoted by the powerful cannabis industry, demonstrates energy and optimism to scientifically prove cannabis’ healing properties.
John and Tom take different paths. Each is supported by some relevant facts and reasoning. Each correlates with traditions of dealing with elements that affect physical and mental processes, like alcohol or tobacco. One pole is a rejection of them as toxic, choosing abstinence, and creating groups like Alcoholics Anonymous or Marijuana Anonymous. The opposite pole is acceptance as a special product, appreciating its consumption and with the creation of groups of connoisseurs.
The stories of John and Tom tell how marijuana can affect people’s lives and how they can deal with the aftermath. Knowledge builds a ground for one’s own independent thinking and decision making about one’s own life. As often happens in life, data exist about the potentially harmful impacts of marijuana that provoke depersonalization as well as about the potentially soothing impacts of marijuana, relieving the burden of depersonalization. The legalization of marijuana makes a person freer and so more responsible for finding her or his own answer to this dilemma.
Should marijuana be blamed for depersonalization-derealization? Or should it be recognized as an aid in coping with the burden of depersonalization?
Teens, Marijuana, and Depersonalization
The search for self in the time of cannabis parlors.
Posted Jul 17, 2018
A teen smokes weed and ends up with a disturbing experience of an alarmingly strange shift of existence. They lose reality and the old familiar self, and find themselves in a changed, removed world of frightening unreality.
No, it is not just another exciting turn of an altered state of consciousness. It is a mental disorder called depersonalization and derealization. Visit a teen social network, open a marijuana users’ chat or go to a depersonalization forum—this story will come up again and again.
Depersonalization can occur after the first joint or months of using marijuana. A mild beginning feels like “weird vertigo that just needs to be slept through.” Acute onset with the “annihilation of self” and a “dark abyss” can lead to the emergency room. Sometimes, depersonalization resolves itself in a few days or weeks. But, unfortunately, it often turns into months or years of torment.
The relationship between depersonalization and marijuana is not clear. The specific cause of depersonalization is unknown. Marijuana does not directly cause depersonalization. The majority of people who use marijuana never experience depersonalization. However, many people with depersonalization develop it for the first time after using marijuana. This happens most frequently during adolescence and young adulthood, between 12 and 28 years of age.
This ambiguous kinship between adolescent age, marijuana use, and the development of depersonalization links to the process of personalization: Awakening of awareness of “I” and searching for identity. Adolescence includes a youth identity crisis with questioning, “Who am ‘I’?” and overwhelming self-analysis. This intense development makes adolescence’s personalization unstable and susceptible to de-personalization. Some scholars distinguish a youth transient depersonalization–fleeting elements of mini-depersonalization that is normal for adolescence.
Marijuana is traditionally seen as a medium to explore personalization by gaining access to hidden parts of the self or world. Many marijuana-induced experiences balance on the edge of depersonalization. Cannabis might provoke the dissociation of “I” into “I”–acting, and “I”–observing these actions “as if from outside.” Marijuana blurs the boundaries between “I” and the world, and unpredictably toys with the senses, including depersonalization-related senses of reality, time, and space. Marijuana also powerfully affects anxiety, sometimes increasing anxiety to a psychotic level.
Depersonalization is the negative form of personalization: Unreality of self in a removed and foggy world intensifies self-analysis that, in turn, increases the frightening experiences of detachment. When teens with fragile personalization use marijuana that targets this personalization, depersonalization might emerge.
The exact motivation that drives teens to cannabis remains a rhetorical question. Interpersonal conflicts, yearning to be accepted by peers, loneliness, anxiety, academic problems, concerns about appearance, depression, failure to find a meaning of life, shame, envy, guilt, or just boredom and craving for some excitement.
And here comes marijuana–an easy and promising refuge from the adolescent trap between the shame to be “nobody as everyone” and the shame to “be different.” Marijuana seems like a ticket to a club where, if dreams don’t come true, then at least pain flies away. However, for some teens, this ticket might turn into a ticket to marijuana-induced depersonalization.
Frightening and stressed by depersonalization, many teens blame themselves for “sin” or the “transgression” of taking marijuana. Suffering from depersonalization is aggravated by humiliating self-accusation, shame, and guilt. Sometimes family and friends contribute their bitter measure of reproaching.
The teens who are in this difficult situation need understanding, trust, and help to re-build self-respect. Self-respect–a healthy opposite to shame–forms a foundation of solid, stable, and authentic personalization. Self-respect creates powerful responsibility, not destructive guilt. Self-respect gives power to accept true responsibility for one’s own actions, based not on fear of punishment but on care for oneself and others. Self-respect gives freedom to understand one’s own actions and their consequences. This helps teens make free choices and take full responsibility for the results.
The motivation to use cannabis is framed by the social-cultural context. Illegal marijuana had the appeal of “forbidden fruit,” so attuned to adolescence’s zeal of opposition. The current legalization of marijuana with the growing business of cannabis parlors attracts young adults by convenience and safety, but also turns them into consumers influenced by advertisements.
Teens’ interest in marijuana is easy to understand. This is a puzzling substance with a puzzling effect on the human psyche. There have been many attempts to solve this puzzle. In the middle of the 19th century, the eminent French psychiatrist Moreau de Tours founded the notorious Paris Club of Hashish-Eaters. De Tours believed that studies of Hashish-induced experiences would help to reveal the mystery of mental pathology. The greatest names of French culture frequented the Club. They described their experiences, including hashish-induced depersonalization, in their works. T. Gautier’s The Hashish-Eaters Club and C. Baudelaire’s The Poem of Hashish depicted “disconnection with reality,” “foreign body,” “fog in the head,” and other depersonalization signs. Both poets felt disappointed, concluding that hashish-induced experiences led to a loss of self rather than to self-actualization.
More than a century later, during the golden hippie era, American psychiatrists researched the potentials of marijuana, strongly supporting its medical benefits. On the West Coast, an iconic name was Oscar Janiger, who was especially interested in depersonalization. On the East Coast–the eminent Lester Grinspoon. His “marijuana sessions” were frequented by the legendary poet Alan Ginsberg and the legendary astronomer Carl Sagan. The investigations of De Tours, Janiger, Grinspoon, and many other researchers did not find answers but raised new questions about the marijuana enigma.
A teen smokes weed and ends up with a strange shift of existence, not just another turn of an altered consciousness; It is the disorder of depersonalization and derealization.