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Notes -
(Also tagging @Muninn)
Does weed - and, for that matter, alcohol - induced psychosis manifest all at once? rapidly over several days weeks? Or can it be gradual over months-years?
Seems relevant
So @Throwaway05 has answered this well and the point made about the cause vs. reveals debate is a good one with no clear, correct answer. For the anecdote in question, this gal had been a long-term recreational user and was well into middle age when she started exhibiting acute psychotic symptoms pretty much out of the blue. Fortysomething is pretty late in the game to develop schizophrenia, though it isn't unheard of, like 15-20% IIRC, and her case generally seemed to be more of the sudden onset variety that was slowly clearing after each episode until she used again. On the work front, again, I'd agree that we see folks that french fried when they should have pizzaed and as a result are having a bad time.
May not be relevant to this specific person, but one of the common teaching points for Schizophrenia is that most people develop it in their late teens to early/mid 20s. But there is also a big bump in the 40s - for women specifically, often associated with menopause.
Significant stressors seemingly can cause the illness, which altered consciousness or medical illness associated with advancing age can provide.
Clearly waxing and waning course is something a little unusual because we do usually see gradually worsening symptoms, but slow vs. fast onset is a thing that happens often enough to be labeled a prognostic indicator.
Sidebar: I tried briefly checking your posting history to figure out if I'm mansplaining at you and saw a post where you mentioned 12 Miles Below. Impeccable taste!
Yeah, for the record, when it comes to mental illness in general, while I find the entire field fascinating, and I've been told that I could absolutely do clinical work if I actually wanted to do it badly enough to get the sheepskin, but it's more like I know a thing or two because I've seen a thing or two, since I've never been formally trained. As a Mottizen I would request that you please err on the side of mansplaining/docsplaining/etc in the future since it's hard for me to hit information overload. And I will shamelessly admit that I've become a sucker for any half-decent LitRPG stuff so the world of 12 Miles Below turned out to be quite the pleasant surprise.
Back to the topic at hand! I believe I have inadvertently muddied the waters there since the thrust of my original post was really a more off-the-cuff and less elegant version of your saying that it's not a high percentage of people but a certain population absolutely needs to avoid [drugs and alcohol], ie that for some folks drug and alcohol use can lead to psychotic symptoms while under the influence of the substance in question and perhaps dealing with those symptoms for some time afterwards. Our crisis department deals with the fallout from that often enough. I was not, in that reply, intending to delve into the much muddier question of whether or not drugs, and particularly psychedelics and hallucinogens, can cause psychosis all by themselves. Since you've already covered that ground, I'll just add to that particular question that my personal suspicion is that for some folks, their long-term drug use does contribute to periods of or even lasting psychosis, though I wouldn't go so far as to say that drug use alone was responsible for the psychosis. While this shows my age, my go-to association there is the story of Syd Barrett. He was definitely schizophrenic and I personally believe from the obvious and fairly common progression in his case that he would have been schizophrenic regardless of his drug use, but as Roger Waters put it, his enthusiasm for, and frequent use of LSD certainly didn't help. In the case of my particular anecdote I think it's there's a good chance that schizophrenia was brewing but the symptoms started subtle enough to be dismissed, but of course it's almost impossible to separate cause and effect out given that she was smoking dope regularly at that time as well. It certainly didn't help her any, either, and I think that if she were able to lay off of the Devil's Lettuce, she'd certainly be better off than she otherwise would be.
LitRPG/Prog Fantasy Recommendations (other than 12 Below): Mother of Learning, Cradle, Dungeon Crawler Carl, The Perfect Run (anything else by that author), The Game at Carousel. I find those all to be a higher tier than the rest.
I find those all much better than the rest.
Re: clinical work. Don't feel bad about not jumping in, medicine and adjacent fields are some of the most interesting stuff there is, but the life is often awful, and it can be ultra draining. If you like where you are at, just read for fun and avoid the shit show.
Re: drugs and psychosis.
I suspect when we get more information and knowledge we'll find that most drugs (and I mean that beyond the ones that usually get fingered for this) can cause psychosis, temporarily, and rarely permanently.
And at the same time we'll find that most drugs can provide a second hit to a genetic and behavioral predisposition to psychosis (chiefly schizophrenia).
As it probably does both....who the fuck cares keep these mother fuckers away from drugs.
In my experience people who are predisposed to psychotic illness (outside of atypical situations like an otherwise normal college student go on a caffeine and sleep deprivation bender pre-finals) look like they could end up psychotic. Odd affect. Weird thoughts. Seems a bit off. Keeping these people away from drugs is probably reasonable harm reduction and prevents Jimbob Chad the tech bro from being annoyed at hearing "MJ bad" after we just sorted out that its totes fine.
I think we are mostly on the same page.
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Weed appears to work a little differently from most other substances, most substances mostly cause drug induced psychosis - you take the thing, you act like a crazy person, you sober up, uhhhh whoops OR you get some kind of medical derangement that involves substances. People with bad alcohol withdrawal having hallucinations is the common example of that.
Some things appear to cause actual psychiatric illness. Marijuana and synthetic marijuana are the biggest culprits here. This can manifest as drug-induced psychosis that takes a long, long time to clear (or never does), or as generation of typical psychiatric illness (like Schizophrenia). In the former case the onset is rapid, you get high...and crazy and stay that way. In the latter you seem to have some element of increasing/worsening disease over a variable onset.
This is complicated by the fact that we know the psychiatclly ill like drugs of all kinds (which includes everything from nicotine to Marijuana). Are they treating early prodrome symptoms with weed and the weed is a sign of illness instead of a cause? Were they always going to become schizophrenic and the weed makes it happen earlier? Were they at risk of getting schizophrenia and then get it because of the weed? We don't know yet.
It's also possible that most or all drugs of abuse cause this and we are only having a clear picture with the weed because it's now popular and legal in most places in the U.S.
I'm sure their is some research out there somewhere that feels it has clarified some of this (maybe something like looking at schizophrenia rates in places with recreational weed and without) but I don't think we have an excess of clarity.
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