Wednesday, June 28, 2006


This is less about self-medicating with marijuana than it is about how complicated and unmanageable emotions can be. One day it's depression, the next day anxiety; one day we're manic, the next day obsessive-compulsive. We get the symptom of the week, too, whatever we read about on the Internet, hear about on Oprah. We’re complicated organisms, humans.

This conversation isn’t fiction, I’ve had it many, many times.

PATIENT: I don’t know, doc. I’m feeling pretty down, pretty sad. And summer’s my happy season. This is going on for too long. I lost my job. Life sucks.

THERAPY DOC: (At the risk of sounding trite, stroking chin). How long would you say you've been feeling like this?

PATIENT: I don't know. Maybe three months, maybe more.


PATIENT: Yeah. I'm depressed. Everyone's noticed, too.

THERAPY DOC: Excuse me. But I thought that on the phone you said you wanted help with an anxiety disorder. You don’t look or sound very anxious at all.

PATIENT: Well, I've had anxiety my whole life. Panic attacks, obsessive thoughts. I'm a high strung person. If I get depressed it's because of something bad happening, something situational. Like I know I'll be fine when I get a job. Getting laid off really hurt my pride. Talking in therapy like this has helped me before, but the truth is that nothing's ever really stopped the anxiety thing, so that was why I said I had an anxiety disorder when I called.

THERAPY DOC (wondering if there are co-existing disorders, two Axis I disorders, maybe a personality disorder, too): So what do you want to work on?

PATIENT: I’d say the depression right now.

THERAPY DOC: And you say you’re not taking any prescription meds?


THERAPY DOC: Are you drinking alcohol or taking any street drugs?

PATIENT: Oh, I smoke pot every day and drink a little, not much.

THERAPY DOC: All right, so at the risk of you never coming back here again I'm going to recommend that you stop the pot completely for a couple of months at least, go for four months. The pot’s depressing your brain. And the alcohol does the same thing, by the way.

PATIENT: No way. If I stop smoking pot then I’ll get my anxiety back.

THERAPY DOC: So we’ll work on it with some behavioral therapy, some self-relaxation exercises. If you want, we can start you on decent legal psychotropic medication for anxiety, too. We have better drugs for this kind of thing. It’s likely that the marijuana and alcohol are working against you, not for you. Take a holiday from it. It's garbage.

PATIENT: Okay, I can try, but I’m going to be a nervous wreck. I've been smoking for a long time.

THERAPY DOC: But it's killing you.

PATIENT: Not really. It calms me down.

THERAPY DOC: Did you ever try an self-relaxation?

PATIENT: Not really, a little yoga once.

THERAPY DOC: Yoga is great. What did you learn?

PATIENT: I don’t remember, stretching, mostly.

THERAPY DOC: Before you reach for a joint, do that, get down on the floor and stretch for fifteen minutes. This is harder than you think, but do it. Then try some other distraction before the toke.

PATIENT: I’ll try. But I have these feelings all the time.

THERAPY DOC: Which is why you need more portable strategies to regulate your anxiety. That’s the problem right now, so that’s what we’ll treat right now, since you told me you don’t want to spend the time going over childhood issues.

PATIENT: Right, what’s the point?

THERAPY DOC: If you have the time, that life review thing can feel very, very good. But okay. Today you’re just needing something to depend upon other than sucking down poison, and smoking pot, so I’ll teach you a quick muscle-relaxation exercise. Would you like that?

PATIENT: I believe I have no choice.

THERAPY DOC: Not if you want to be happy if you reach retirement age. If you want to be an old drug addict, you can make that happen, too.

PATIENT: Uh, I don’t think that’s what I want.

THERAPY DOC: Grab a couple of thick markers and squeeze the hell out of them until your biceps quiver. Can you do that? Let me demonstrate. (I demonstrate, offer markers to the patient). You can do this by just making a fist and squeezing it, behind your back if you like in public. It’s not so easy if your nails are long. You can squeeze any part of your body. Getting yourself into a push-up position, for example, and not doing the push-up, just holding it, makes those muscles shake quite nicely, or leaning on your hands in that position standing against a wall. Oh, and get out and walk, run, exercise. This shakes off some of the anxiety, too, wakes up the serotonin in the brain, shakes it out of the walls of the neurons in your brain. We don’t call it runner’s high for nothing. Play basketball, tennis. DANCE!

People do much better with these kinds of interventions than they do getting stoned, crazy though it may sound. Not a cure-all for everyone, certainly, but eliminating the downer, the pot or the alcohol, substances that serve as depressants to the central nervous system, surely helps the depression.

A good evaluation by a therapist, and a psychiatrist, too, sometimes, saves you a lot of money on the street. And you might lose a lot of weight, too.



Anonymous said...

What about someone who is severely depressed, has been on antidepressants for years with diminishing effects, tried exercise and cognitive therapy without success and then tries smoking pot once a week and has their mood lift dramatically to normal if not slightly happy, their therapy start working, be better able to cope with anxiety producing situations, etc...? (true story)

therapydoc said...

Get a prescription, right?

Kate said...

My husband is the guy in this conversation. He is in his mid 30s and is very addictive. It is wearing very thin on me anymore since I cannot stand any alcohol or drugs. It is getting to the Breaking point for me, the overindulgence especially. How can I help him stop all this crap?

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