The emotions arising from the Tucson tragedy run strong, empathy for the survivors and sadness for the loss of those who did not survive.  The shooter, who did survive, has not garnered much public understanding or empathy.  Putative explanations for his behavior have been forthcoming.

From descriptions of his persona and words reported by the Wall Street Journal and Mother Jones, using posts to the internet and interviews with long time friends, one sees a fairly typical middle school lad with a gift for “creative writing,” from time to time doing typical things young boys may do such as play video games, go to concerts and use illegal drugs like tobacco and cannabis (under age 16).  His social performance and academic performance was at least satisfactory.  At 18 or 19 years of age his life had taken a sharp turn and by the end of 2010 he was unable to function academically, withdrawn from most friends, living in a world of dreams, delusions and 24/7 anger.  The anger was fueled by his inability to get a job, even at a fast food joint.  And the government.  And grammar and the meanings of words.

The trajectory from imaginative middle school kid to frustrated, angry, dysfunctional young adult living in an alternate reality is consistent with the premorbid function, prodrome and onset of psychosis (Compton et al, in press).  What, if any, psychiatric diagnosis will ever be applied to the shooter is unknown to the public.  But putative explanations published have included “pot head.”  The usual “stoner” image of an amotivational syndrome does not fit as he was frustrated by repeated rejections from work, working out, and off drugs for two years, according to friends.  Indeed stopping nicotine and cannabis was associated with his “theories” going off the wall.

The prohibitionists identify cannabis as the cause of psychotic disorders, schizophrenia.  This has been hard, or impossible to prove.  This is in part because the onset of illegal drug use (underage nicotine, alcohol and cannabis) overlaps the onset of schizophrenia.  So the greater drug use by schizophrenic patients may be contributory, or self treatment – adult patients use drugs at a higher rate than their peers to mitigate the discomfort of their disease (Bottorff et al, 2009).  Or the association in youngsters may be coincidence, along with getting a driver’s license and going off the parent’s dole, explaining the impossibility of proving a connection.  In populations, at least, there is no increase in the incidence of schizophrenia when the use of cannabis among youth increases, and cultures that have low rates of cannabis use are not preserved from typical rates of schizophrenia (Frisher et al 2009). In medical school we are taught “to listen to the patient.”  Schizophrenic patients do not believe cannabis contributes to their disease (Buadze et al 2010).  The prohibitionists are wrong.  . . .

The shooter attributed his frustration to the inability to get a job because he had misdemeanor crimes in his history.  Apparently he was prosecuted as a teenager for drug and drug paraphernalia possession.  Pot and a bong?  Unusual for a white kid to be prosecuted.  The government that did that to him, threatening prison as well, fueled his anger.  What good for the shooter or society came from that arrest and prosecution?  He quit smoking cigarettes, and that is good.  It was a lost opportunity to recognize the disturbed thinking and initiate diagnosis and treatment.

The Congressional representative was targeted because she responded to a question from the shooter in a way he could not understand.  “What is government if words have no meaning?”  It is a difficult question.  In the reality of the shooter the government, the frustration and anger and the Representative are conflated.  To the rational mind the reality games, the internet, fascism and cannabis are incidental, not causative.  But cannabis, particularly an Indica with high cannabidiol content, might be therapeutic (Zuardi et al 2006; Schwarcz et al, 2009).  Using this unfortunate individual to support a particular political party or policy is irrational.


References:

Compton MT, Broussard B, Ramsay CE, Stewart T.  ” Pre-illness cannabis use and the early course of nonaffective psychotic disorders: Associations with premorbid functioning, the prodrome, and mode of onset of psychosis” Schizophr Res. (2011) in press

Bottorff, JL, et al “Relief oriented use of marijuana by teens”  Substance Abuse Treatment, Prevention, and Policy (2009) 4:7

Frisher, M et al  “Assesing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005” Schizophrenia Research (2009) 113:123-8.

Buadze, A. et al “Do patients think cannabis causes Schizophrenia? – A qualitative study on the causal beliefs of cannabis using patients with schizophrenia”  Harm Reduction Journal (2010) 7:22

Zuardi, A.W., et al “Cannabidiol, a Cannabis Sativa constituent, as an antipsychotic drug”  Brazilian Journal of Medical and Biological Research (2006) 39: 421-429

Schwarcz, G, et al “Synthetic delta-9-Tetrahydrocannabinol (Dronabinol) Can Improve the Symptoms of Schizophrenia” J Clin Psychopharmacol (2009) 29: 255-258

Joseph McSherry, MD, PhD, is a professor and neurologist at the University of Vermont, College of Medicine. Dr. McSherry has advocated for and served on various advisory panels to the Vermont Legislature regarding Medical Cannabis since 1980. He also serves as the specialty representative for Neurology/Neurosurgery in the Vermont Medical Society. He has lectured on Cannabis and Pain and Cannabis and Cancer at the College of Medicine and commented on journal articles on marijuana, including a 2005 article on applications for Parkinson’s disease in the journal Neurology. He has also advocated for Medical Cannabis for the New Hampshire Legislature and the Iowa Board of Pharmacy. “Dr. Joe” is on the board of Just Say Now.