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Increasingly, neuroscience is offering models for understanding why some people suffer more than others do from emotional and psychological pain. The idea of the unconscious is being reinterpreted in terms of the limbic system and the autonomous nervous system, powerful shapers of our emotional lives that operate outside our conscious control. An overactive amygdala, an underdeveloped orbitofrontal cortex — these are the kinds of models researchers are identifying as likely causes of chronic emotional dysregulation.
It is a humbling shift from an earlier generation’s belief that if a problem was “all in your head,” that meant it could be dealt with by a dose of vigorous commonsense thinking.
Today, we often treat pain in the mind with medications that appear to alter levels of key neurotransmitters, including dopamine and serotonin. These medications often come with side-effects, and individuals’ experience with their effectiveness varies. Clearly, we do not yet know enough about the extremely complex neural activity involved in any mental illness, let alone how best to treat it.
According to Washington state law, marijuana is authorized as a medication for a limited number of medical conditions, including “Intractable pain, limited for the purpose of this chapter to mean pain unrelieved by standard medical treatments and medications.” The law does not specifically exclude emotional pain, so it is understandable that people suffering from mental illness have asked the state to grant them the legal right to use marijuana to self-medicate, if they find that it works better for them than other available treatments.
So far, such petitions to the state Medical Quality Assurance Commission have been denied. Most recently, a 2012 petition to authorize medical marijuana for obsessive-compulsive disorder and attention-deficit hyperactivity disorder was turned down. While the commission reported that they found the testimony in support of the petition “courageous and moving,” they concluded that there was a lack of data to support the use of marijuana for these conditions, adding a call for such studies to be done.
Research may indeed become more feasible in the future, if marijuana becomes legalized under federal as well as state law. Currently, federal law defines marijuana as a Class I controlled substance, which means that it has a high abuse potential and no accepted medical use — a designation which impedes research into its possible medical uses.
In the meantime, it may not matter much to Washingtonians, who now have a choice whether to seek medical marijuana by prescription — which is easy to obtain — or simply to exercise their new right to use it for their own reasons, without needing a doctor’s permission.
But those of us who work in the field of mental health will still be wondering. Should the way we think about marijuana abuse be revisited, now that using it is less legally risky? When is pain relief therapeutic, and when might it bring more suffering — for our clients themselves, or for the people around them — than it relieves? Are there good reasons for viewing marijuana more skeptically than prescribed psychiatric medications?
Mosshart remarked, “A lot of people who get medical marijuana don’t have conditions that rise to the level of needing marijuana to medicate it. I think it’s misused, quite a bit, actually.”
Perhaps the most hopeful view of current trends is that as marijuana becomes legalized, we may be able to gain a clearer, more objective and nuanced picture of its actual impacts and potentials, so that the line between use and misuse becomes a bit clearer for people trying to decide whether to use it.
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