At the time of this writing, devastating wildfires are raging in the L.A. area. And today there was a well-researched news story about the psychological impacts of natural disasters. With increasing attention to mental health and its intersection with many of our current societal concerns—the economy, climate change, homelessness, war, etc.—it’s important to ensure accurate information. Here are a few important topics that are frequently misrepresented, to the detriment of us all. Of course, our understanding of these issues is always evolving as we gain new information.
Cannabis Use Risks*
Widespread decriminalization has reinforced the general misperception that cannabis is safe. And the “medical use” of marijuana for an extensive list of conditions gives the false impression of wide-ranging therapeutic benefits.
In fact, there are significant risks to cannabis use, especially for young people. And though physicians in some states are prescribing cannabis for conditions such as anxiety and PTSD, there is no consistent evidence of effectiveness for any mental health conditions. In contrast, the evidence shows that cannabis is more likely to worsen symptoms such as anxiety, depression, and insomnia over time.
The risks listed below have increased as cannabis has become more potent: from an average of 9% THC in 2008 to 17% THC in 2017. Some products are as high as 90% THC.
Some potential dangers, based on research evidence:
- Addiction: Up to 30% chance of addiction. Risk is highest for: those starting use before age 18, frequent use, having a mental illness, family history of substance abuse, use of high potency products
- Psychosis: Cannabis can result in onset of psychosis, such as paranoia and schizophrenia-type syndromes, which sometimes can be chronic. Higher risk for: starting at a younger age, heavy/regular users, high potency cannabis, family history of mental illness
- General functioning and achievement: Negative effects on IQ, learning, attention and decision-making. Greater likelihood of: lower educational and career achievement, lower life satisfaction, problems in relationships
- Impaired driving: Cannabis decreases coordination, slows reaction time, distorts perception, and affects judgement. Increases risk of accidents.
- Contaminants: Lack of federal standards for testing of cannabis products. Products have been found to contain dangerous heavy metals (such as arsenic, cadmium and lead), pesticides, carcinogens, microbes, and fentanyl.
- Cannabis Hyperemesis Syndrome (CHS): Recurrent and severe nausea, abdominal pain and vomiting, especially in heavy users.
- Mental Health: May cause worsening of conditions such as anxiety, depression, suicidality and paranoia
Violence and Mental Illness
One longstanding and damaging myth is that people with mental illness are often violent. This misperception has been perpetuated by distorted portrayals in the news media, TV and film. Think Norman Bates in Psycho!
Although people with psychotic illnesses such as schizophrenia (especially in combination with substance use) are somewhat more likely to commit a violent act, the vast majority are not violent. And there is little evidence that people with mental illness in general (e.g. anxiety and depression) are more likely to be violent. In contrast, people with mental illness are much more likely to be the victims of assault and other crimes.
By some estimates, 3 to 5% of violent acts are committed by people with mental illness. Most assaults and shootings, by far, are perpetrated by people without a psychiatric diagnosis.
Unfortunately, the widespread tendency to associate mental illness with violence and criminality has negative consequences for the people struggling with these illnesses, as well as for society at large. When seen as dangerous, people needing mental health care are often demonized, marginalized and isolated from society. The irony is that social support and compassionate treatment can reduce the risk of violence.
And after tragic acts of mass violence, when we reflexively look to mental illness as the sole explanation, we do society a disservice by avoiding the harder work of investigating other possible underlying causes and solutions. Ultimately, this failure makes us all less safe.
Eating Disorders
The typical image of someone with an eating disorder is of a very thin, young, white female. All aspects of this stereotype are incorrect and lead to under-recognition in people who don’t fit this picture. Eating disorders, including Anorexia Nervosa, affect people of every body shape, size, race, gender, and socioeconomic status.
Weight
The current guidelines (in DSM-5-TR) for a diagnosis of Anorexia Nervosa do not specify a BMI cut-off, but instead describe “significant” weight loss or low body weight in relation to physical health (in addition to the other criteria such as body image disturbance, fear of gaining weight, and behaviors interfering with weight gain).
“Atypical Anorexia,” is a relatively new term to describe people with the symptoms of anorexia but with average or elevated BMI’s. In the past, they have been discounted with refrains such as: “You don’t look like you have an eating disorder” and “You’ve lost weight! You look great!” But even at a “normal” or high BMI, rapid weight loss, insufficient nutritional intake, and purging behaviors can cause significant medical risk. Not to mention the psychological suffering.
Men
Up to 1/3 of those diagnosed with an eating disorder are boys and men. People are often surprised to learn that many males struggle with poor body image and develop behaviors such as restricting food, unhealthy weight loss, compulsive exercising, and/or vomiting after eating.
The disorder may take the form of excessive focus on building muscle (e.g. compulsive weight training or taking supplements such as anabolic steroids or creatine). These behaviors may be encouraged and praised as “healthy,” especially in athletes. Images of “cut” bodies and idealized male shapes on social media can also perpetuate the unhealthy behaviors.
Our cultural biases and societal stigma intensify the shame experienced by men with eating disorders, so they are less likely to tell anyone. And due to the stereotype of eating disorders as a “female illness”, the warning signs are often missed by others (including mental health and medical professionals), thus delaying diagnosis and treatment.