ASHLEY BIDEN, WE NEED YOU!

Will you step up as the standard-bearer for the mentally ill?

Full disclosure: I have struggled with this blog post for days: post it or throw it away? Revise it one more time so that it reads as Beltway-savvy, or put on my Mister Smith hat and hope it will ignite a 1939 Hollywood moment? Decide to not intrude into the life-choices of an honorable private woman who made it clear recently that she wants to remain private, or say the hell with it and make the intrusion anyway?

Hell with it. Here goes:

On August 23rd of last year, America lost one of the two or three greatest champions of mental healthcare reform since Dorothea Dix. The vast sub-nation of the afflicted, their families, and their ardent yet scattered and over-burdened advocates is seeking a replacement: someone who can help unify this nationwide archipelago of sufferers into a single movement with a coherent voice.

I believe that Ashley Biden, the new President’s daughter, is the person most graced by fate to advance our mission. And I will tell you why: in addition to her experience and expertise in mental health issues, Ms. Biden would embody an influential link to policymakers that the afflicted and their caretakers have yearned for roughly since the founding of the Bedlam Asylum in 1377.

I can already hear the screams of “nepotism!” from the President’s political foes. (At the same time, I’m mindful that some of the most stalwart friends of the mentally ill have been Republicans.)

As Elizabeth Warren used to say, I have a plan for that: make Ms. Biden an unpaid White House staff advisor specializing in the interests of the mentally ill.

(Ashley, is there anything else I can do to enhance your life before I sign off??)

Let me give a thumbnail sketch of the man whose death has created such a vacuum:

Dj Jaffe was 65 when cancer took him from us. Most Americans had never heard of him. Yet within the archipelago, he was a superhero. He’d walked away from a cushy career in advertising to take up the cause when his sister-in-law developed schizophrenia. He understood and worked with Congress, the courts, community health centers, and the county jail, having mastered the complexities of schizophrenia and its related chronic predators upon the human brain. In 2011 he founded the indispensable Mental Illness Policy Org., a colossus of links to data, information, helpful sources, and policymakers. He was a co-founder of the Treatment Advocacy Center along with his own personal hero, the pioneering E. Fuller Torrey. His nonprofit book, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, is the single most comprehensive manual on the subject in our time.

Dj Jaffe’s passing has left an unacceptable void of wisdom, energy, and passion at the center of our efforts to reclaim the grievously broken systems of mental healthcare in America. There are dozens of men and women who would do credit to my late friend’s legacy. And then there is Ashley Biden.

As I say, Ms. Biden has made it clear that she dislikes “the spotlight,” and bravo for that. Yet her role as an advisor to her father, or perhaps as director of a new foundation, need not entail being in the spotlight so much as seizing the spotlight. And turning it around upon a shadow-enshrouded system that to this day abuses insane people with barbaric neglect and cruelty reminiscent of the Middle Ages.

With scattered exceptions, the mental-illness archipelago historically has been starved of government access. And when any level of government intervenes, it usually leaves things worse than they were. (I write this as a believer in active government.)

Think of “deinstitutionalization,” the sixty-year-old policy disaster that set off the national homeless calamity that expands to this day. Think of county jails as our new, dysfunctional mental hospitals. Think of mind-destroying solitary confinement, a useless torture practice that too often serves as a convenient storage-box for possibly prodromal juveniles. Think of un-convicted juveniles, untreated afflicted kids among them, waiting behind bars, often for weeks and months, for their trials. Think of untrained or uncaring police killing psychotic victims on the streets.

The crises and atrocities cited above are known to most people with a passing interest in the squalid fate of “crazy people” in America. The wish-list below will seem arcane to lay readers; yet it is packed with urgent, unaddressed problems that stunt and shorten the lives of the chronically mental ill, spread a widening cone of misery through their families and communities, and diminish the financial—and moral—health of the nation.

I’m indebted for this list to Leslie Carpenter of Iowa City, who with her husband Scott forms a tireless advocacy duo in America. Here it is:

–End the outdated, discriminatory federal rule known as the IMD Exclusion. This will increase the number of acute-care and long-term beds.

–Increase reimbursement rates for mental health professionals, direct care staff and facilities. This will help with recruitment, retention and quality of staff caring for people with serious mental illness (SMI).

–Modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to allow for more reasonable communication with families who are all too often the unpaid caregivers for loved ones with SMI.

–Increase funds for continued research for schizophrenia and related brain disorders.

–Fund and expand Assisted Outpatient Treatment Programs, along with Civil and Criminal Mental Health Courts.

–Expand funding for Certified Community Behavioral Health Centers in every state in the country.

–Stop wasting money on unproductive anti-stigma campaigns and. Use those funds to pay for the treatment of the most seriously ill, and the stigma will go away.

–Stop funding just more housing. Allow HUD subsidized funding for residential care facilities, group homes and facilities all along the continuum of care for people living with SMI and substance use disorders. Funded housing, tied with assisted outpatient treatment (AOT) programs, will allow the housing of people who don’t know they are sick, and keep them in treatment via outpatient civil commitments for treatment.

–Stop shutting down Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) if someone has to be hospitalized for 30 days or more. Shutting down the ability to pay rent is a major cause of homelessness among the chronic mentally ill.

–Create loan forgiveness incentives for mental health professionals practicing in rural locations.

–Fund medical schools to increase enrollment for psychiatrists and other mental health professional programs including nurse practitioners, physician assistants and psychologists.

Every one of these proposals requires intense, coordinated governmental action. As of today, there is no governmental coordinator. Not even Dj Jaffe had such power. This thin and secretly failing hero drew upon his extraordinary passion, his vast self-education in this complex cluster of subjects, and his gift for eloquence in the media, in testimony, and in his book.

The dispossessed mentally ill people among us cry out for a figure to replace Jaffe, and perhaps even surpass his legacy. Given Ashley Biden’s training, intelligence, commitment to the cause of mental health, and principled access to the (recently besmirched) corridors of congressional power, I believe that she could be this figure—a catalyst for reclamation.

We live in a fragile national moment, a moment saturated with promise and with menace. On the hopeful side, I marvel at the brisk accomplishments of President Biden’s first weeks in office, and I hear an old trumpet sounding, and I can almost envision a second New Frontier. On the dark side linger the shock-images and aural bedlam of the Capitol insurrection and the miasma of the impeachment trial, with portents of worse to come. And I wonder whether collective psychosis—madness—is our new pandemic.

It will take every person of good will to steer our future toward the light. Mental illness is just one item in a crushing agenda; yet it looms over us all, a scourge of mostly unfathomed proportions. (How far have some of us drifted into collective psychosis? Is there momentum in this direction?) A voice of informed influence near the apex of our government would be a godsend. The archipelago needs you, Ashley Biden.

“TODAY IS A DARK DAY”

Mark Rippee of Vacaville, California, has entered what may be the final struggle for his catastrophic life. His survival prospects are not good.

Most readers of this blog know about Mark’s grotesque misfortunes that span thirty-three years. And about the shocking indifference to them among the social services and the members of the Solano County Board of Supervisors. To refresh your memory, click on this blog link to read my previous posts.

Mark Rippee -outside the Vacaville hospital where he was released. Credit: Linda Rippee

Mark was released from a Vacaville hospital on October 26. He had spent two hundred fifty-eight days there, the longest respite of his tortured life since June 1987, when a motorcycle crash left him blinded, his body shattered, parts of his brain exposed, and his mind vulnerable to the schizophrenia that soon struck him. He’d been hospitalized after being struck by a car for a second time while wandering sightlessly around the town.

No agency in the city, the county, or the state of California cares about Mark Rippee. The attached links detail how his sisters Linda Privatte and Catherine Hanson, both women in their 60s with major illnesses themselves, have tried in vain to obtain conservatorship over him and to find a secure place for him to live. The care agencies and political bodies enfold themselves in narrow interpretations of law and policy. The sisters believe that in fact some laws meant to protect people such as Mark have been violated, with no one inclined to enforce them.

The family has been helped, materially and spiritually, by a growing army of concerned friends and Vacaville citizens. The sisters have posted a call for blankets, food, medium-sized long-johns and lined sweatpants, beanies, deodorant, lotion, hand sanitizer, baby wipes, a coat, gloves, socks. And water. Always water.

To simply read this sad list is to recoil at the scale of difference between Mark Rippee’s plight and the stony disdain—the contempt—of the agencies and the political structure designed to help him.

The charity now arriving is a godsend, and a tribute to the humanity of Vacaville’s private citizens. Yet it is not enough to assure this broken man’s survival. Mark, now 57, remains vulnerable to winter’s ravages, to further collisions with cars and trucks, and—most threateningly—to his environment’s rising Coronavirus rate. Solano County has entered tier 2, the “red” tier, which signals a “substantial” level of infection.

No one tells Mark’s story with more passion and clarity than Linda and Catherine, who have told it to deaf ears for three decades. Their stories and updated reports are linked below.

I’M PAST ANGER. I’M IN COMPLETE DESPAIR by Linda Rippee

Today is a dark day. Mark was discharged from the Acute Care hospital after 258 days of healing from his injuries after being struck by a car for the second time in the last year. He was taken by the facility’s van back to the streets of Vacaville. He left with only a cane, duffle bag, boots, and 2 sets of clothes. They gave him 1-2 months worth of medications but would not confirm what they were. I don’t know how he will know what he is taking or when it is time. He has been on increased Anti-psychotic meds recently and I do not know if he will be on the streets. His new Social Worker is with Solano APS and is the same one who did the “Snapshot Assessment” of Mark and declared him “Not Conservable.” He was planning to meet Mark on the streets of Vacaville to “Receive” him back to town. When we called the facility this morning to check on when he was to be released and how… he was already gone. The nurse claimed, “Oh he is not going back to the streets, but is going to the Vacaville county building!” I started explaining that he is going back to the streets! That is where he has lived on the streets for years! I have 2 people trying to help with getting him a new ID. The facility could not confirm if he even had a blanket. He was supposed to get a flu shot before leaving – he didn’t. We have already put together many things he will need, but with a bad leg and a shoulder that doesn’t work, it will be even more difficult to carry much. He is supposed to still be using a walker – but chose a cane. He will have difficulty social distancing and not touching everything he comes in contact with. They said they gave him a few masks. His discharge was scheduled for 11 am this morning. I tried calling all morning and couldn’t reach him or the Social Worker. It turns out they released him earlier than 11 am, so he was already gone before I could even talk to him. I did not even go to bed last night thinking that tonight Mark will be sleeping on the streets. CJ has been up for two nights bracing herself for his release. His drastic improvement over the last 8 months was not enough proof for the county to comprehend that housing, treatment, and care was exactly what was needed in his case. I am back to taking it day by day to keep him alive. How long before another traffic accident or injury? We know it won’t be long… and we will go back to jumping every time the phone rings.I just received verification from one of our members that he arrived at the Carroll Building in Vacaville and the APS Social Worker was not there! He is now alone and darkness comes.
Linda Rippee

The Road Ahead… by Linda (Rippee) Privatte Updated June 1.

DEMAND ATTENTION FOR JAMES MARK RIPPEE, FROM GOVERNOR, GAVIN NEWSOM & THE STATE OF CALIFORNIA!

Facebook Private Group “Mark of Vacaville”

Am I Not My Brother’s Keeper? Personal Blog by Catherine J. Rippee-Hanson

The Reporter – Family of mentally ill crash victim considering legal avenues

“We’ve lost our compass.” For California’s most visible mentally ill, is a return to forced treatment a solution — or a false promise? by Jocelyn Weiner, CalMatters.org

No One Cares About Crazy People – Mark Rippee Archives, by Ron Powers, Pulitzer Prize-Winning Author

After accident they warned about, sisters of mentally ill man blame the state — and beg governor to act

Mark Rippee, Oct. 26, 2020.
Mark Rippee
James Mark Rippee – Photo Courtesy Linda Privatte
Mark Rippee two years after his accident. He had calmed down and more lucid although doctors warned that it would not last. Photo Courtesy CJ Hanson.
Mark Rippee

DAY 7 OF LINDEN’S ORDEAL

“No matter the circumstances, what happened on Friday night is a tragedy, and I expect this investigation to be handled swiftly and transparently for the sake of everyone involved.” –Salt Lake City Mayor Erin Mendenhall last Sunday, two days after the autistic 13-Linden Cameron was shot several times by a city police officer. Linden remains in serious condition.

It has been a week. We are waiting, Madame Mayor.

https://www.sltrib.com/news/2020/09/07/salt-lake-city-mayor/

https://civilrights.org/2020/09/09/the-leadership-conference-on-civil-and-human-rights-statement-on-the-shooting-of-linden-cameron/

https://www.wnycstudios.org/podcasts/takeaway/segments/people-mental-illness-more-likely-be-shot-police

https://noonecaresaboutcrazypeople.com/?s=linden+cameron

UPDATE ON LINDEN CAMERON

On Tuesday I posted a blog about Linden Cameron, the 13-year-old Salt Lake City boy who was shot repeatedly by a police officer, whom his mother had called to help him through a psychotic episode.

This blog will be brief: Linden is in serious condition—he somehow survived—in a Salt Lake City hospital. Two private citizens have started fundraisers for the medical bills that would otherwise overwhelm his mother. Their links are here https://www.gofundme.com/f/24rhnm8shc and here https://www.gofundme.com/f/linden039s-medical-bills.

Linden’s story has been picked up by newspaper, broadcast, and online outlets around the world. Below is the New York Times account. I will have more to say on this.

https://www.nytimes.com/2020/09/08/us/salt-lake-city-autism-shooting.html

https://noonecaresaboutcrazypeople.com/?s=linden+cameron

A Movie Star, Her Serious New Book, and a Fawning Public That Could Give a Damn

But we care, Diane Keaton. Join our cause to make America care about “crazy people.”

I can visualize the scene: a book-tour venue; a synagogue in Washington. (I can visualize it thanks to the subtly bravura piece by the Washington Post reporter Ellen McCarthy, linked below.) Every seat is taken, because today this is a celebrity book-tour venue. The celebrity author, an iconic movie star, walks onstage. The audience leaps up in a standing ovation. They are mostly middle-aged women who had paid forty dollars each to come and see the movie star in person. In person!

The folks squirm back into their seats and the iconic movie star–Diane Keaton–begins to speak. Diane Keaton has just published her third memoir. It is a departure from the usual books from Hollywood stars. Its subject is her younger brother. Her mentally ill younger brother, whose name is Randy. Its title is Brother & Sister.

Diane Keaton speaks ruefully about the book’s rueful theme, which is her regret over abandoning Randy during the decades when she was driving herself to Hollywood stardom and the adulation of the millions. As children, the two had been close. But Ms. Keaton’s growing fame had come at the expense of this bond. Randy sank into the morass of “alcoholism, joblessness, divorce, isolation, fantasies about violence against women and a suicide attempt,” in reporter McCarthy’s retelling.

Diane Keaton. Photo Credit: Firooz Zahedi / CC BY-SA (https://creativecommons.org/licenses/by-sa/3.0)

(Brother and sister reconciled some ten years ago, and Keaton now visits Randy in his assisted-living quarters.)

“’There are so many people who live through the pain of having a family member who doesn’t quite fit in,’” she remarked, as McCarthy reports. “She said she wanted to open up a dialogue about mental health and to offer herself up as a cautionary tale that could inspire people to ‘be better’ to their loved ones sooner than she had.”

And then Diane Keaton consented to answering some questions written in advance by audience members.

McCarthy: “The questions . . . had nothing to do with Randy’s [life]. They had to do with [the Keaton movies] Something’s Gotta Give, The First Wives Club and Father of the Bride. With whether Keaton has a favorite co-star.”

And there you more or less have it: No one in the room cared about crazy people. Or if they did care, they kept it to themselves. Diane Keaton’s cautionary tale was smothered–banished, rendered nonexistent–beneath an avalanche of forty-dollar-a-seat celebrity worship.

And my guess is, that’s the way it will go as long as Diane Keaton continues her tour for Brother & Sister. Lots of jam-packed venues with expensive seating. Lots of standing ovations. Lots of iterations by Diane Keaton about the travails of her mentally ill brother Randy, her lamented separation from him, and the late-life restoration of their loving bond.

Followed by lots of “Do you have a favorite co-star?” “How did you like working on The First Wives’ Club“?

Ms. Keaton, I have an invitation for you. It is for when you grow weary of fielding fangirl and fanboy questions during your tour for the book about reclaiming the union between your brother and you. Or even if you don’t grow weary.

Come and make common cause with us. Give your support to the growing nationwide movement to reform mental healthcare. You will have caught us at the floodtide: our activists have presented proposals to all of the Democratic candidates for the 2020 presidential election. And they have listened, and shown that they care.

This would not require much in the way of your personal time and commitment. Your imprimatur . . . your endorsement of our goals . . . perhaps a shout-out to one of our several organizations or causes, or brief remarks at one of our national gatherings . . . any or all of these things could supercharge our efforts. The moral dimensions of your journey with (and without, and with again) Randy; your insights as a denizen of the pressurized and volatile Hollywood community, where psychic balance often lives at the border of madness; your message to a nation still largely clueless about mental illness . . . and, yes, the weight of your hard-fought and well deserved celebrity hood.

A partial list of leaders in the movement follows. There are many others. Please join us and support us.

The National Alliance on Serious Mental Illness

Advocates for People With Mental Illness

The Treatment Advocacy Center

The Mental Illness Policy Organization

NAMI

Mark of Vacaville

The National Shattering Silence Coalition

Mental Health for US

The National Coalition for Mental Health Recovery

The Depression and Bipolar Support Alliance

Bazelon Center for Mental Health Law

The World Federation for Mental Health

Sooner Than Tomorrow (a blog)

Pete Earley’s blog

No One Cares About Crazy People (a blog)

Schizophrenia and Related Disorders Alliance of America

www.washingtonpost.com/lifestyle/style/diane-keaton-neglected-her-mentally-ill-brother-for-most-of-his-life-shes-looking-for-redemption/2020/02/14/b854553e-49ed-11ea-9164-d3154ad8a5cd_story.html

“Mentally Ill Monsters”

In the aftermath of two traumatic mass shootings, the president re-invokes a horrid, distorted falsehood about the mentally ill.

And there it is: history’s defining damnation of sufferers of incurable damage to the brain, distilled into a three-word phrase of transcendent ugliness and stunted understanding.

The phrase was uttered on Monday. It was uttered to identify the provenance of the weekend’s massacres by shooters using legally purchased high-capacity semi-automatic weapons toward their collective harvest of 31 people dead and some 50 wounded.

The phrase was uttered by the President of the United States. It left stains, stains which, in moral and intellectual terms, replicated the stains of blood shed by the shooters’ victims.

*Donald Trump | Image Credit Gage Skidmore via Flickr*

Blaming “mentally ill monsters” (or “nut jobs,” or “wackos,” or “lunatics”) for such carnage is a morally repugnant, if time-tested device for shifting the public’s passion for safety away from gun control and toward the presumed demons in our midst. The president could not have been more transparent in exploiting the device. “Mental illness and hatred pulls [sic] the trigger, not the gun,” he instructed us, going on to label one of the shooters as “another twisted monster.”

In fact, it is a settled truth in psychiatric research that victims of brain afflictions are no more prone to violence than the general population. The prominent advocate Dj Jaffe makes an important stipulation: that the untreated mentally ill—those not stabilized by antipsychotic medications—can be more likely to cause harm to themselves or others. Still, implying that mental illness itself equates to degenerate aggression serves only to further isolate and punish the most helpless members of our society; to herd them back toward the dark corners and confinements of “insane asylum” days.

And herein lies the “intellectual” stain that President Trump’s words help spread: most people—like the president himself—do not understand mental illness: what it means, how it occurs, how it differentiates, why its victims behave as they do, and how even its most abject sufferers can be aided, often stabilized, by medications and therapy. In this vacuum of understanding, people tend to substitute prejudice, false science, myth, and hostility toward “crazy people.”

Briefly:

“Serious” mental illness—the kind in question here—is rare and unique. And incurable. Unlike alcoholism or anger or depression, serious mental illness is rooted in genetic flaws of the brain. Its various names include schizophrenia, schizoaffective disorder, bipolar disorder—similar yet not interchangeable conditions. It results in a loss of reason and rational control; hallucinations and the hearing of voices; alienation from family and friends; and, yes, sometimes—rarely—violence.

My wife and I have educated ourselves about serious mental illness because we’ve had to. It invaded our family several years ago, causing the suicide of a beloved son. Unfortunately, this is the painful route to understanding for most people: a loved one is stricken.

The costs of this cluelessness describe a cone of destruction that widens from the stricken individual through society.

The cone draws in and ravages parents and siblings of the stricken. It can cripple the finances of families without adequate insurance to cover treatment and medications. It drains human capital from the workforce, and thus economic revenue. It reduces the budgets of hospitals that can’t get reimbursement for their mentally ill patients. It overburdens police, whose lack of training and, sometimes, self-restraint, can result in death by gunshot of unarmed people in psychosis. It coarsens our criminal-justice system: think of schizophrenic adolescents hustled into jail by untrained or uncaring judges, where they await trial—often for weeks and months—while their unmedicated psychosis deepens. Think of solitary confinement. Think of a brain-afflicted child, perhaps your own (as countless parents must) ensorcelled in a cell, abused by fellow inmates and guards, with no end in sight, no comprehension. No hope.

Now think about “mentally ill monsters.”

Mentally ill monsters are not the source of our current crisis of public massacres. The monster is the gun: too many guns, with too little restraint and oversight regarding purchase. To his credit, President Trump gave lip service to keeping guns away from those “who pose a grave risk to public safety,” and to strengthening gun laws generally.

But leave the gun issue aside. Part of any president’s duty—a foundation of his “bully pulpit”—is to educate his fellow citizens on matters of complexity and urgent public import. The nature of serious mental illness, and the reclamation of its victims, comprise one such matter. The president could make a great, galvanizing contribution to ending the centuries-old oppression of “crazy people.” He could lead us in that direction. He could educate us. But first he must educate himself.

Top 10 Books of the Year

The Best Books of 2017

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Are you ready for Big Marijuana?

Big Marijuana is ready for you.

The fact is that Big Marijuana has been ready for some time. Now it is on the cusp of near-universal legalization in America. And that spells trouble, especially among the mentally ill, as we shall see.

But not just for the mentally ill. As we shall see.

Here is a quick annotation of what I mean by “trouble”:

To legalize, in our consumer-dominated society, is to legitimize. To legitimize is to strip away any considerations of risk—any considerations whatsoever, except price.

To legitimize, in short, is to commodify.

Consumers are paying for this particular commodity—this exciting new product being rolled out, or rolled up—in various ways. Some pay with their credit cards. Some pay with cash. Some pay with their sanity. Some pay with their lives.

As of September, twenty-nine states—three-fifths the total—and the District of Columbia have moved to legalize cannabis¹ use under varying conditions. With a few exceptions on either side, only the Great Plains states, parts of the Midwest, and the Deep South have resisted legalization. The rules are complex in those states where it is approved. Many states, for instance, restrict it to medical use, as a relief for chronic pain.

Yet few players in what is now being called, without irony, “the industry” doubt that most if not all of these holdouts will eventually fall into line. And that the rules will relax. Some already are being flouted with impunity.

This is what happens when a “substance” becomes a commodity. Money begins to talk; and money, big money, is drowning out the rest of the conversation surrounding Big Marijuana.

The volume went all the way up to eleven when hip and youthful Colorado (2014) and then massive California (2016) became the fifth and sixth states to legalize pot for recreational use. California is expected to be issuing licenses for pot shops by January 1, 2018. Canada—Canada!—is working on legislation. The money people are lining up, clutching their open checkbooks.

They will be writing checks in the aggregate billions.

The “commodity” cachet of cannabis is being reinforced by such impeccably establishment periodicals as Forbes, which in May was pleased to advise its elite readers concerning “The Top 5 Financial Leaders in the Cannabis Industry.”

As the reporter Tristan Green wrote last July in the online magazine Finance: “It’s difficult to determine exactly how much money there is in the cannabis industry. A report from Forbes states that North American sales totaled $6.7 billion in 2016. Investors looking for an emerging industry that’s worth billions, doesn’t have stiff competition from major international companies, and is as close to a ‘sure thing’ as possible need look no further than cannabis. The Motley Fool expects a 300 percent increase in cannabis revenues, in the US alone, over the next five years. That figure could increase exponentially if more US States legalize cannabis for adult recreational use.”

I suppose I should say here that I don’t oppose marijuana use because I think it’s immoral. As a young Chicago journalist in the 1970s, I found it commonplace among the people I knew and liked. In my beloved adopted state, Vermont, I sometimes wonder whether the blue haze over the Green Mountains is mist or smoke. Yet I have never judged anyone on the basis of race, color, or tokes. Hell, I toked up myself. Once. It made me hungry for a pizza. I lost interest after that. In grass, not in pizza. Yet I was never “against” it. It was none of my business.

I’ve lately changed my mind. I have come to believe that marijuana poses a critical societal threat. Not to our morals, but to our public health—particularly the health of the mentally ill among us.

And the bedrock reason that it poses a critical threat? Commodification.

By this, I don’t mean to say simply that legalizing pot makes it easier to obtain. While that is certainly true, the deeper threat is more insidious, and more troubling. The deeper threat is increased potency. The cannabis on the market today is mind-altering on a scale far higher than the weed puffed by the counter-culture in the 1960s and 70s.

Cannabis’s main psychoactive component is tetrahydrocannabinol, commonly known as THC. You will find a variation of “cannabis” inside that name. Cannabinol is a chemical that interacts with receptors in the brain that are associated with pleasure. It is an adversary of dopamine, the neurotransmitter that controls (among other things) reward-motivated behavior. An overflow of dopamine, triggered by stress, trauma, or—oh—too much THC in the system—can produce psychosis.

(Because no two highly complex neurological systems are identical, some people—me, for example—are not as affected by THC as others.)

Over the long history of pot consumption, the THC level in cannabis plants averaged out to something under ten percent. This relatively benign percentage held through the years of love-beads and “Power to the People.”

That was then. In recent years, researchers have found that the THC in legalized-sale states is three times that percentage. This means that today’s puff produces a higher high—but also a threefold increase in the likelihood of psychosis due to interference with dopamine.

And this is not the only change in the plant. Another component of cannabis is cannabidiol, or CBD. This secretion, traditionally only 0.28 of each plant’s makeup, is responsible for marijuana’s cachet as a benefit to patients who suffer extreme pain. Legalization for medical purposes would be meaningless without it. CBD’s presence in the blood system reduces pain and anxiety. It also is found to block the psychotic potential of THC.

Guess what: lately, those same research projects have found that CBD’s average level has fallen from .028 to 0.15 percent.

What has happened to jack up the potency and lower the medical benefits of cannabis? Is it some abrupt shift in the evolution in the plant?

No. As I have heard public-relations people smirk after their company’s product gets a favorable story in a newspaper: “These things don’t happen by accident.”

The changes have happened because of selective breeding. Another name for this is “eugenics.” Marijuana growers are finding that more potent plants fetch more money from wholesalers. Among the leading wholesalers is Tardiv, Inc., of Boulder, Colorado, a startup in 2015 that now calls itself “the cannabis industry’s largest online wholesale marketplace.” (The acceleration of commodified weed can be grasped from the report of one market research firm Arcview that the cannabis “industry” generated $2.4 billion in sales in 2014, up 74% from 2013.) Tardiv, which keeps its profits a secret, advertises its mission as “To Make Wholesale Cannabis Trade Efficient, Easy & Secure.”

Secure from what?

Secure from being evaluated on its own demerits, for one thing. Big Marijuana is in its infancy compared to, say, Big Tobacco, Big Pharma, and Big Guns. Yet it is learning quickly from its elders.

Learning to turn liabilities into assets, for example: higher wholesale prices mean more cost to the consumer. But with this commodity, that’s not a problem. Higher bucks connote a higher high, not to mention the fantasy of elite consumption. And anyway, many smokers develop a tolerance for THC over time, and actually require ever-larger jolts. In this sense, marijuana is its own gateway drug.

Here some other adaptive skills that Big Marijuana has absorbed.

Its business structures serve to further camouflage the irreducible gaminess of its product. These ape the sleek structures of the Corporation Eternal: advertising, marketing, and research divisions; sophisticated advertising accounts; acquisitions (“Aurora Cannabis Acquires Larssen to Offer Turnkey Cannabis Cultivation Services Worldwide”); flow charts; conferences (the “Aspen High”); burnished websites; speakers bureaus.

All of these strategies are important. None, perhaps, is as important as the manipulation of language to (further) neutralize activist opposition on public-health grounds. Big Marijuana has scrubbed its jargon clean of any usage that might summon thoughts of the product’s potential menace to human well-being and sanity, and replaced that usage with the antiseptic jargon of Corpspeak: “We connect investors and entrepreneurs to the deals and information they need to make the most of this emerging market.” “Cannabis, meet capital.” “Quality Products that Pave the Way for Mainstream Acceptance.”

And get this, for appropriation of the gilt-edged idiom of politesse:

“Snoop Dogg is one of the most revered figures in music, entertainment and more recently, a business pioneer in the cannabis sector. Over a respected career that stretches 25 years, his repertoire has turned him into a cultural icon across mediums. Snoop and business partner Ted Chung recently launched online media platform MERRY JANE, the definitive cultural destination for news and original content.” https://www.canopygrowth.com/

A capitalist juggernaut has formed and is rolling. Armed with its vast arsenal of persuasion; outfitted in the fine-woven haberdashery of Success; anointed with further legitimacy-by-association bequeathed by “progressive” billionaires such as George Soros and former Facebook chairman Steve Parker; dripping second-hand stardust from celebrity investors such as Roseanne Barr, Whoopi Goldberg, Melissa Etheridge, the inevitable Willie Nelson, and others, Big Pharma seems poised to overrun the rusting Maginot Line of social checks and balances: federal and state governments, regulators, educators, medical doctors and psychiatrists. It seems guaranteed to take its place among the rest of the ethically impervious Bigs: a massive Goliath striding forward, its path clear of natural enemies.

And yet a resistance remains in place. Across the country, determined local activists have dug in against the onslaught. They are armed with the flimsy-seeming small-bore weapons of medical research, demographic statistics, personal testimonies, and legal savvy. Their most valuable weapon, in the end, may prove to be what William Faulkner called “man’s puny, inexhaustible voice.” They are determined to prevail.

In some ensuing blogs, we will meet some of these Davids, and we will see what they have in their slingshots.

A Digital Remedy–Or a Digital Intrusion?

If neurochemistry can be thought to have a cruel side, it is evidenced in anosognosia. This loathsome side-effect of severe mental illness accompanies about fifty percent of all cases. As the link explains, it renders its victims incapable of understanding that they are afflicted, and prompts them to strongly resist doctors’ efforts to medicate them and, in cases of active psychosis, commit them to hospital treatment.

My family is acquainted with anosognosia and its lethal power.

Our younger son Kevin almost certainly was a victim of this ride-along predator, and it cost him his life. He accepted psychiatric treatment and medications for most of the three years after he was diagnosed with schizophrenia, yet never acknowledged the disease itself, insisting that it was merely a “condition.” Near the end, after he had been re-diagnosed with schizoaffective disorder he renounced medication of any kind. He hid the pills that we continued to insist he take, and committed suicide just days before his twenty-first birthday.

Kevin’s older brother Dean, stricken a few years after his sibling’s death, has been more fortunate. An enlightened psychiatrist observed Dean’s own resistance to intervention, and turned it to my son’s advantage: In brief, “Report to a clinician for a monthly antipsychotic injection, or be legally hospitalized when the inevitable psychosis erupts.” Dean has taken this carrot/stick choice seriously, and has significantly improved from his psychotic depths.

Now comes medical science (via the pharmaceutical industry) with a product designed to defeat anosognosia. The Food and Drug Administration has approved the digital modification of a popular oral medication, Abilify® (Aripiprazole, manufactured by Bristol-Myers Squibb). As explained in this New York Times story, each pill will be equipped with a digitalized sensor that can transmit electronic data to doctors and family members, reporting whether and when the patient took the medication.

The device will surely be welcomed by parents who have exhausted themselves begging in vain for their children to accept professional intervention, and watched helplessly as their children have refused, and deteriorated into deep psychosis, and sometimes, as with Kevin, death.

My own instinct (naturally) is to celebrate this promising solution to a scourge that would be called “evil” if there were sentience behind it. Yet reason tells me that celebration is premature.

An obvious roadblock to the product’s success is that those who most need it may not take it. If anosognosia leads SMI sufferers to resist acknowledging their illness, why would it not lead them to reject a medication that treats a “nonexistent” illness? (It should be noted that the digitalized medication will also be marketed to older sufferers of various discomforts who tend to forget taking their meds.)

Another barrier is popular distrust–legitimate distrust, to an overwhelming extent–of Big Pharma itself. The distrust has been earned.

Bristol-Myers Squibb is a part of a massive industry that has recently been rated as the second-most hated in America. (The top pariah varies from website to website. The far-flung electronic communications industry is often the No. 1 contender, or nolo contenderer.) Pharmaceutical companies raked in a composite global revenue of more than one trillion dollars in 2014. This ongoing bonanza has made them virtually impervious to the restraints of the law. In 2012, for instance, GlaxoSmithKline paid the U.S. Department of Justice three billion dollars in a false-claims settlement, the largest in the long and bloated history of penalties assessed Big Pharma. Bristol-Myers Squibb’s history of producing Abilify® has been tainted with lawsuits: the watchdog organization drugwatch reports that as of September, 365 actions were pending against the company. Most of them charged that Abilify’s® side-effects include compulsive tendencies toward gambling, eating, shopping and sex.

Big Pharma’s excesses are making headline news, and disrupting America’s social fabric, to this very day. The October 30 issue of the New Yorker carries a bold and searing investigative essay by the writer Patrick Radden Keefe. Keefe’s immersive journalism meticulously lays out the chain of greed, recklessness and “ruthless marketing” that led to our present opioid crisis. Keefe trains his sharp lens on the family of multi-generational philanthropists and drug entrepreneurs, the Sackler family, private owners of Purdue Pharma, which has built them a net worth of thirteen billion dollars, and which is responsible for the prescription painkiller OxyContin. OxyContin’s active ingredient, as most people now know (many of them through catastrophic experience) is oxycodone, a chemical similar to heroin.

Keefe reports that “Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.”

Chapter 15, “Antipsychotics,” in my book NO ONE CARES ABOUT CRAZY PEOPLE, covers the era of Big Pharma from the introduction of Thorazine in 1954 through our present time. The saga is one of proliferating medications, global expansion of companies, almost inconceivable profits, false claims, hidden or downplayed side-effects, and a corporate culture whose manifest amorality was damningly characterized by a former insider, quoted in the chapter, as fulfilling “the criteria for crime in U.S. law.”

Given the details that I have amassed, in this essay and in NO ONE CARES, covering the nearly 70 years of depredations that make up the worst of Big Pharma, it may seem surprising that I do not, out of hand, dismiss the introduction of digitalized Abilify. And the entire universe of antipsychotic pharmaceuticals along with it.

The reason I do not is at once simple and complex: many of them work. Or work for some patients, if not others. Or work in spite of their problematic side effects. Or work until they don’t work. Our vexed universe of care for the seriously mentally ill, even at its best, remains enshrouded in mystery, incomplete science, and human failing.

I believe that until the day that an infallible cure arrives, the advocates of intervention (including conditional support for new products such as digital Abilify, and strong support for laws that ease intervention’s barriers) must acknowledge that we take our stands in a world of risks. Some of the risks we advocate might result in more harm than good, or in harm, period.

But I also believe this: that the biggest risk of all is doing nothing. For this way lies madness.