Individual Mental Health

Marijuana's Unknown Risk

The risks of drinking alcohol seem to be public knowledge, which can be life saving in many instances. For example, we are aware that while most people can use alcohol in moderation and be okay, while others are at risk for alcoholism.

Marijuana is similar to alcohol in that most people can use it moderately without suffering any long-term repercussions. However, what fewer people know about is the connection between marijuana use and severe mental illness (meaning that it can have psychotic symptoms), specifically schizophrenia and bipolar disorder. As with alcohol or any other substance, it’s important to understand the risks that using marijuana poses, so you can make informed choices.   

The Link Between Marijuana and Mental Illness

At time of writing, researchers do not fully understand the connection between marijuana use and mental illness. They have, though, developed several theories.

First is that individuals who are already predisposed to schizophrenia and/or bipolar disorder may be using the drug to self-medicate their symptoms. If that’s the case, by the time a diagnosis is made, it’s impossible to ascertain if the symptoms of mental illness were present before drug use began.

A second theory posits that brains predisposed to mental illness find marijuana use more pleasurable than the average brain, leading to higher rates of drug abuse among individuals with clinical diagnoses.One study found that “early use and heavy use of cannabis are more likely in individuals with a vulnerability to psychosis.”

Finally, some researchers theorize that marijuana use directly contributes to an individual actually developing mental illness.

More research is necessary in all three cases.  

What Do We Know about Marijuana and Mental Illness?

  • Research  shows that marijuana use by individuals born with two types of genes  increases the chance of developing schizophrenia.

  • Studies show that pre-illness cannabis use causes earlier onset and more severe symptoms for individuals predisposed to schizophrenia and bipolar disorder (1).

  • Marijuana use before adulthood (age 18) increases an individual’s chance of developing early-onset schizophrenia (1).

  • NPR’s article on new research showed daily use of high potent cannabis quadruples the risk of psychosis.

Marijuana Use as a Lifestyle Choice

Just like alcoholism, individuals cannot know for certain if they are predisposed to a mental illness or if cannabis use will increase the chances of developing one.  That said, there are some risk factors that you can be aware of to make better decisions about marijuana use.

Think of marijuana use like any other lifestyle choice.  If you know, for example, that you have a higher risk of getting a certain type of cancer or other disease, you can decrease that risk by making conscious choices about the foods you consume and the activities you engage in.  Doing so doesn’t automatically guarantee that you won’t get cancer, but your choices can reduce or increase your chances.

Marijuana and Higher-Risk Individuals

People who have medical histories like the following may be more at risk for developing a mental illness as the result of marijuana use.

  1. Those with mental illness in their family history, especially schizophrenia and bipolar disorder.

  2. Those who use marijuana before age 18.

  3. Those who are heavier and more frequent cannabis users than the rest of their peer group.

  4. Those who use marijuana to fight feelings of depression and anxiety when not prescribed by a doctor.

  5. Those who exhibit premorbid signs of schizophrenia, which can look like anxiety, depression, and social withdrawal.

  6. Those who exhibit any of the prodromal phase symptoms.

  7. Those who use high potent cannabis on a daily basis.

Note: Having one or more of these traits does not mean that you will eventually develop a mental illness. If you are concerned about your chances, however, it’s a good idea to see a qualified medical health practitioner, as the sooner one seeks treatment, the better the prognosis.

Note: I am not trying to debate the merits of medicinal marijuana. I am simply offering information about the potential risks of cannabis use for some individuals.

  1. Ringen, P., Nesvåg, R., Helle, S., Lagerberg, T., Lange, E., Løberg, E., . . . Melle, I. (2016). Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder. Psychological Medicine, 46(15), 3127-3136. doi:10.1017/S0033291716001999

How Positivity Can Become Toxic

What could be the downside of a “look at the bright side” mentality? There’s no road map to handling emotions that aren’t positive.

Humans are built to withstand tough emotions. These emotions provide helpful information to survive and thrive in this world. Old fairy tales talked about darkness, injustice, and often lacked a happy ending. These storytelling traditions helped set the expectation that sometimes life will be lonely, scary, and require grit and resilience to find happiness. These stories also provide parents an opportunity to talk about darker emotions and how to navigate them. It normalizes these feelings and can support kids in finding ways to cope with them, and move through them, rather than sweep them aside. Being “positive” even when our circumstances are challenging is not by itself a healthy or resilient coping strategy

Today, many popular children’s books and movies end happily, even if there is pain or suffering that precedes it. This can send a number of troubling messages: that deep happiness comes only through suffering; that if you aren’t happy, there is something wrong with you (because even these fictional characters find happiness in spite of their travails); that happiness is its own reward, no matter how you got it; that the sadness of a situation only depends on how you look at it.

Emotions provide us with useful information and signals (just like our bodies do) and can help us make changes that may lead to more fulfillment and happiness. Ignoring or avoiding darker emotions may eventually lead to mental health issues or turn (somatize) into lethargy or physical pain.  

Our bodies signal to us when we’re getting sick and need to rest. Our reactions give us insights into our emotional needs. So the next time you tell yourself (or someone tells you) you are ‘overreacting,’ be curious about the root cause of your reaction (emotionally) and why.

Is it sometimes helpful to try taking a positive outlook? Yes, of course.  But if you find yourself ignoring feelings and experiences in attempt to be ‘positive,’ it can actually become toxic. . Death is hard, breakups are hard, rejection is hard. Hard things happen and it doesn’t mean that they will not eventually have a deeper meaning or positive impact in your life. However, the change comes from experiencing the emotion first (or accepting that it happened). (On the flip side, getting stuck in the negative is also a sign that you may need support in processing your emotions). Studies show that accepting mixed emotions is better for your overall physical and mental health and reduce age related health declines.

The resistance to negative emotions impacts our relationships: people tend to be defensive and dismissive of his/her partner’s experience if they are afraid of a negative emotion. This tends to show up in ways of gathering evidence to prove why the person shouldn’t feel that way to protect themselves from acknowledging their behavior hurt the person. In doing so, one has ‘protected’ themselves from a negative experience by rationalizing why the other shouldn’t feel bad, but it disconnects the relationship instead strengthening it through connection. It actually makes the relationship stronger to be able to acknowledge each person’s experience.


I highly recommend watching the movie Inside Out. The point of this well done movie is for the emotion Joy to figure out why the emotion Sadness needs to exist. If we can accept our emotional experience and needs, we provide an opportunity for healing, growth, and connection. Therapy can be helpful in learning how to recognize and accept your emotional world. All of us learn how to experience our emotions. Most of us need help unlearning how to deny our emotions.

Are You in a Toxic Work Relationship?

Are you in a toxic work relationship?

Job interviewing is a lot like going on first dates. There are highs and lows. In between interviews you imagine how wonderful this company may be and how it could meet your professional needs. Or you may be worried about some red flags that could lead to an unhealthy work environment. Knowing when to take a new job, or to leave a current job that isn’t a good fit, can be hard (just like a relationship) because normally it isn’t all bad.  

Work is where you spend the majority of your week and a positive or negative environment can really impact your overall health and life. Here are some warning signs that may make you want to rethink your workplace situation:

  • Does your boss/company keep making promises they do not fulfill to keep you ‘happy’?  Examples are: No-to-little raise this year but we really value your work and will be giving raises next year (repeat cycle).

  • Company is under resourced (not enough employees, funds, etc.) and ask you to work more because the work is so important and the need is so great (without adequate compensation for you).  

  • You feel blamed, belittled, or unsupported by your manager.

  • Do you lack influence on what you do or the work environment you are in?

  • Are you not credited for the work you do?

If these things are present, spend some time thinking about your work environment. Are there concrete ways you can imagine improving your work environment? Do you feel able to approach your supervisor or HR manager about your professional needs and ask what they could do to support you?  It can also be helpful to set check-ins with yourself to gauge how you’re feeling and honestly assess how your work environment is impacting you in all areas of your life. Is it so energy-consuming that you’re not tending to other needs - physical health, mental wellness, being a present romantic partner or family member?  

Making the decision to leave can be a hard and complex one. For example, it can be scary to bring up concerns if you fear that you may experience a negative consequence at work. It can be terrifying (and perhaps not feasible) to leave a job if you do not have another one lined up. Or if the work situation has become toxic, you may not have the energy to even look for another job. You may also be concerned about the impact on your friends and colleagues if you left.

Getting support during these times to help you understand what is going and why, can bring clarity on what you want to do.  A few steps to help make a decision are:

  1. Spend time examining your values and goals.  

  2. Reflect if your work environment is aligning with your values and goals.

  3. Examine your boundaries around your values.  Are there boundaries that are too flexible or strict?

    1. Sometimes it’s helpful to think of what you would want for a loved one or your child. Would you think it’s ok for them to put up with (fill in the blank) environment or behavior?  If it’s ok for you, but not for them, that’s a sign that you may need a better boundary for yourself.

  4. Examine any ways you may be able to influence your work environment to be a healthier fit.

  5. Weigh the pros and cons of staying in the job or leaving, and the impacts this would have in all areas of your life - financial, professional, personal.

  6. Intentionally make a decision knowing the potential consequences and accept that whatever happens, you made the best decision with the information you had at the time.  

If you find yourself struggling with a particular boundary, therapy may be helpful.  Many times, intense feelings at work can be a sign of unresolved pain from the past. Seeking therapy can help heal from past events that may be influencing your current work situation, like helping you realize how work situations are actually triggers for painful, unresolved feelings unconnected to your job.  An example of this are children who helped their families by over functioning (the parent was sick or unavailable, or a sibling needed a lot of attention). These children may grow into adults who tend to dismiss their own needs and prioritize the needs of others or the company to the detriment of their own health.  

If you’re someone who compartmentalizes your emotions, it’s difficult to predict how a workplace environment will impact other carefully guarded areas of your life. This doesn’t make it any less urgent. Sometimes realizing that the workplace has become toxic is the first step in figuring out the solution - not only to your professional happiness, but also within your other intimate relationships. And just like a relationship,  the earlier you work on areas of concern the easier it can be to make a positive change.

HOW TO FIND THE RIGHT THERAPIST FOR YOU

Why getting started is often the hardest part

Many friends ask me how to find a good therapist. There are many different types of therapies that work great for some but not for others because each of us is wired differently. I find that certain people connect well with talk therapy while others respond better to activities and tools. Tools can be mental exercises or physical actions to take.

 For example: when you feel anxious, do this deep breathing exercise.

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You can think of achieving mental health in the same way you think of physical exercise. The end goal of exercise  is good physical health and there are many ways to obtain it (bootcamp, gym, swimming, yoga etc.). Maybe you prefer running over swimming, and finding out what works for you will better motivate you to obtain your goal. Similarly, the goal of good mental health is resiliency (strength);there are several ways to achieve this. So  if you had a counseling or therapy experience you didn’t connect with, don’t be shy about trying a therapist who uses a different technique.

But first, how to narrow down the best type of therapy for you to explore? Here’s my quick breakdown:

If you want: Tools, activities, ‘homework’

Look for a therapist that uses:  Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT)

Good for: Anxiety, intrusive or repetitive thoughts, attention deficit hyperactivity disorder (ADHD), phobias, obsessive-compulsive disorder (OCD)

 

If you want: Connection and understanding

Look for: Attachment and Relational Therapists

Good for: Depression, isolation, loneliness, healing from childhood issues

 

If you want: Direction, problem-solving

Look for: Strength-based, Coaching, Motivational Interviewing, Solution Focused

Good for: People experiencing transition (college, job change, new relationship, etc.)

 

If you want: Understanding of relationship patterns and behavior, understanding how you’re feeling

Look for: Psychodynamic therapy

Good for:  Personality disorders, childhood difficulties (especially with parents), fears within a relationship (abandonment, etc.)

 

If you want: Help changing behaviors with addictive substances (caffeine, alcohol, nicotine, drugs)

Look for: Licensed Chemical Dependency Counselor (LCDC), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT)

Good for:  People wanting to make difficult lifestyle changes with a substance that has addictive properties

 

If you want: Peace, managing turmoil and difficult experiences, tools to connect you to yourself

Look for: Mindfulness, Acceptance and Commitment Therapy (ACT)

Good for: Anxiety, depression

 

If you want: Healing from a traumatic event

Look for: Eye Movement Desensitization and Reprocessing (EMDR) therapy, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Narrative Therapy

Good for: Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder, Traumatic Event(s) (car accident, natural disaster, etc.)

 

If you want:  Support with grief and loss

Look for: Specializing in Grief, Narrative Therapy, Attachment Therapy

Good for: People who lost a loved one, complicated bereavement

 

If you want: Help with your relationship

Look for: Someone who specializes in couples therapy, uses Emotionally Focused Therapy (EFT), The Gottman Method (good for left-brain thinkers), and Psychobiological Approach to Couples Therapy (PACT)

Good for: Strengthening your relationship, reconnection, decreasing stress and conflict, extramarital affairs, parenting issues, healing from past hurts

 

Once you’ve identified which type of therapy you think might address your needs, see if you can set up an initial consultation or time to talk on the phone with a therapist. Tell the therapist what you’re looking for and ask if it they think the two of you would work well together. You can share any concerns or fears that you may have about therapy and see how they respond. You can always bring up what you like and don’t like in your therapy sessions and change therapists if it doesn’t feel like a strong fit.
                       

A good place to start looking for a therapist is Psychology Today.  You can search by location, insurance accepted, and specialties.  
 

Stepping into therapy can be overwhelming and intimidating. Sometimes the hardest part is simply getting started. Use this guide to arm yourself with more knowledge upfront, and hopefully that will give you the confidence to take this positive step for your well-being, both now and in the future.