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Culture War Roundup for the week of July 8, 2024

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People don't become psychotic out of nowhere.

Yes and no.

Drugs can make people become psychotic (acutely/temporarily), we think they can also make you stay psychotic permanently less commonly. We think they can set off psychotic disorders in people would not otherwise be likely to get that disorder and also trigger people earlier. People with a psychotic disorder (such as schizophrenia) that appears absent substance often end ups with addiction problems of all different kinds. Because we don't full understand the pathophysiology of these things and these populations are um....not reliable historians that does make it difficult to be sure about some of this stuff.

But yes psychosis does come out of nowhere....and at the same time is almost always associated with substance abuse (even if we are just talking about smoking).

Not all drugs have this impact on psychosis. It's generally pretty obvious (PCP!) but not always (Marijuana).

If you were a homeless schizophrenic with a disease addled brain and zero social support you'd probably abuse drugs also.

All that being said a whole bunch of things probably come together to make the U.S. so uniquely troublesome with this stuff. I think an underrated cause of this is probably the support for freedom in the U.S. (which I support) this means less ability for police to just toss and/or arrest vagrants, but also things like more limited ability to involuntarily commit and force medications on the severely ill. Since many of these diseases have a stepwise decline it's pretty easy to burn through your resources and supports and end up in a spiral leading to extremely poor functioning. Same person forced to take medication by their family maybe dodges the whole thing.

Drugs can make people become psychotic (acutely/temporarily)

No kidding. I have a friend who I've known since undergrad. Very smart guy - graduated from high school early so he could play around with robotics, did an undergrad double major in math and philosophy, breezed through a T-5 law school and was doing really well for himself working BigLaw.

However, in addition to the smarts (or maybe as an adjunct to them) this guy was quite neurotic, and developed a quite serious fear of flying. Needless to say he wasn't happy about this, and so started self-medicating with THC whenever he needed to fly. This led to a discovery that he quite liked being high, and in short order he wound up escalating to quite heavy marijuana use.

I'm not sure how long he had this habit or how heavy his use had been, but one morning I got a call asking if I could come pick him up and maybe let him crash at my place for a couple nights...only to find out once I had got him that he was in the depths of full-blown (if well-mannered) psychotic incident, complete with auditory hallucinations, paranoia, insomnia, erratic behavior, and mania. I spent about 18 hours convincing this alien inhabiting my friend's body that no, the cars parked out front of my apartment weren't there to surveil him, that the faint sounds audible through the apartment walls was just my neighbor watching a movie, and that no he really didn't need to go find a gun store.

He eventually calmed down and I let him loose when he seemed clearly in control of himself again. Three days later he called and let me know that his doctors had told him it was THC-induced psychosis, and that he really needed to lower his dose. Fortunately it hasn't happened again, but man was that a weird moment.

One thing that has happened is that modern weed is stronger than older weed (and therefore people are more likely to have severe shit happen). Synthetic marijuana is popular in some communities and can also cause extremely severe issues.

For a fun one: too much caffeine (and stimulants of any kind) can also cause psychosis.

I love college students who are super crazy because they are drinking too many monsters and not sleeping. One of my favorite presentations. Consistently hilarious to see when you walk into the ED.

For a fun one: too much caffeine (and stimulants of any kind) can also cause psychosis.

A guy I knew a long time ago with no history of drug abuse got prescribed new sleeping pills (might have been Ambien), ”sleep walked” on those to taking an entire package of his ADHD meds (dexamphetamine) at once and promptly ended up in a psych ward due to acute amphetamine psychosis.

Ambien side effects include: sleep talking, sleep walking, sleep driving, sleep eating, death.

All the good drugs have death listed as side effect.

Yup, America's inherent libertarian values is something that trips up both the paternalistic right-wingers here and my fellow paternalistic left-wingers here.

The reason why Europe is OK with being harsher to homeless people is partly, there's a larger social safety net, but also, there's more people OK with basically a harsh rules-based order, as opposed to a bunch of descendants of people who didn't like that rules-based order, and risked their lives getting on a boat and being on the ocean for weeks, if not months.