Eddie — not his real name — was 35 and not known to mental health services, a relatively unusual situation as symptoms normally develop earlier, often in late adolescence. University-educated and highly-skilled, he was living a comfortable life working in the IT sector. Then, five years before I saw him, he had landed a prestigious new job in Amsterdam.

It was difficult to piece together what had happened to him, because his thought process had become completely disordered, but we eventually learned that Eddie had begun smoking cannabis while in Amsterdam; at first only occasionally, and then more regularly until eventually he was using it every day.

Over a period of time, as psychotic symptoms first emerged and then developed into something bigger, Eddie began his downward drift, losing his job and eventually becoming homeless. His distraught mother paid for him to come back to Britain to live with her, before he was admitted to hospital.

There was no history of serious mental illness in the family, nor had Eddie exhibited any notable problems in childhood or even as he got older; things only began to fall apart in his life after he moved to Amsterdam, where high-strength cannabis is freely available.

Eventually Eddie received a diagnosis of schizophrenia and was placed on a community treatment order, instituted primarily to ensure that he complied with the anti-psychotic medication, given fortnightly via intra-muscular injection and prescribed in order to control his symptoms. Any hopes that he and his mother might have had for his life were now greatly diminished — job, career, children, family, all of his and her dreams crushed. Eddie was by now living with what is essentially a disability, with the prospect of a reduced life expectancy and quality of life.

I’ve been a registered mental health nurse since 2007. Post-qualification I initially worked in a ward for six years, followed by another six in the community. The gap between public perceptions of psychiatry and what you actually see working on the wards and outside can be pretty big sometimes, but none more so when it comes to the issue of cannabis.

Further reading

Stop hating on vaping

By Tom Chivers

I first became aware of the drug as a teen, well before I had even thought about what I was going to do as a career. Like a lot of people my age — I’m 39 now — I knew people who smoked cannabis, and it wasn’t considered a big deal at the time. Despite being illegal, it was widely seen as a harmless soft drug to experiment with, sort of a rite-of-passage to adulthood. This was in the late 1990s, when most cannabis on the black market was low in THC, the psychoactive compound that delivers the high and makes the drug enjoyable to smoke.

My next encounter with cannabis was very different, involving witnessing people on the psychiatric wards where I worked from 2007-2013. Prior to becoming a mental health nurse I had known many people who had smoked cannabis but who had never experienced psychotic symptoms. In my new job it was rare to meet anyone experiencing psychotic symptoms who was not also a marijuana smoker.

The type of cannabis being smoked was by this time very different from that of the late 1990s. Commonly known as “skunk” (after its very pungent smell), this new form had come to dominate the market.

Skunk is much higher in THC than its predecessors, but almost all forms of the drug have become stronger. In a recently published polemic on the dangers of legalisation, Tell Your Children: The Truth About Marijuana, Mental Illness and Violence, author and New York Times regular Alex Berenson wrote that: “through the mid-1970s, most marijuana consumed in the United States contained less than 2 percent THC. Today’s users wouldn’t even recognise that drug as marijuana. Marijuana sold at legal dispensaries now routinely contains 25 percent THC.”

Further reading

Pity the poor avocado-eating graduates

By Mary Harrington

This closely mirrors the situation in Britain, where the reputation that cannabis has acquired in the public consciousness — a mild, harmless, benign, relaxing intoxicant — is dangerously out-of-date.

A recent study published by the Lancet gave a stark warning, stating boldly that “daily cannabis use was associated with increased odds of psychotic disorder compared with never users … increasing to nearly five-times increased odds for daily use of high-potency types of cannabis”. The evidence for a link between cannabis use and serious mental illness is clear, but the difficulty remains in conveying this information to the public.

Psychosis is the clinical term describing what most lay people would understand — and what we historically would have referred to — as “madness”. There is still, even today, a large degree of stigma attached to these symptoms, and consequently not many people wish to speak about their experiences of them. You are unlikely to even hear about them unless you work in mental health services; and unless you have experienced psychosis yourself, or know someone who has, it is difficult to grasp the devastation that it causes to people’s lives.

With psychotic symptoms experienced by cannabis smokers we are primarily talking about hallucinations (usually auditory) and delusions (usually persecutory i.e paranoid.) They can be extremely frightening to those who experience them and, as a consequence, can often lead to social withdrawal, as well as social drift.

The social drift hypothesis notes that individuals who suffer from serious mental illness (SMI) — in particular those diagnosed with schizophrenia — are more likely than the general population to live in socioeconomically deprived areas and that the clinical features of mental illness contribute towards this downward trajectory in socio-economic class.

During my time working as a staff nurse on an acute inpatient male psychiatric unit I observed social drift first-hand, Eddie being only one such example. But social drift and social withdrawal also make it even less likely that the average person will know someone who has experienced these symptoms, and so their story goes untold.

It is true that not everyone who smokes cannabis will experience these symptoms. It is often asserted that the link between cannabis and psychosis is merely correlational and not in any way causative, an argument intended to muddy the waters, when THC is known as a risk factor in mental illness. It is an argument never made in relation to cigarette smoking and lung cancer, even though most cigarette smokers do not die of lung cancer, either.

But cannabis is not safe: it is associated with a number of serious side effects, including problems related to pregnancy — see here, here , here and here — life-threatening vomiting, changes to neuroanatomy, a significantly increased risk of youth suicide — see here, here and also here — an increased number of hospitalisations — see here and here — increased postoperative pain, impaired cognition/lowered IQ in adolescents and an increased risk of car crash injuries — see here, here, here and also here.

By the same author

How the Left locked itself in the echo chamber

By Peter Hurst

It is, therefore, incumbent upon mental health professionals to speak up so that the general public are made aware of the risks. This has become even more important now that North America has undergone a wave of cannabis legalisation spreading from Colorado to Canada, emboldening advocates in Britain in the process.

It is true, as Berenson argues, that decriminalisation reduces the civil rights concerns expressed by legalisation advocates and campaigners. One could argue that cannabis has already been de facto decriminalised in this country anyway, despite the rather overblown claims that are sometimes made to the contrary, and de jure decriminalisation therefore seems the logical next step.

Yet legalisation tacitly endorses and normalises the idea that the drug is safe, which it isn’t, and risks creating an entrenched business community who will then promote cannabis as a product; it will do this without providing us with any certainty or assurances that the process will reduce the black market for the drug or reduce its potency.

This is what has happened in North America already, and represents the worst of all possible worlds – and once we legalise the drug it will be very difficult to turn the clock back.

If cannabis is legalised then the only winners will be big tobacco, alcohol and pharma. The rest of us will all be losers, and the worst affected will be those already living at the margins of society.

Five days after Trump’s victory, the New Yorker ran a piece by Hua Hsu in which he argued that mainstream media attempts to understand the concerns of Trump voters were a kind of normalisation validating “an identity politics that is often rooted in denying other people’s right to the same”.

In his piece for The Atlantic magazine at the end of May 2016, David Frum spoke of the “broken guardrails of democracy” and how the American republic, “long safeguarded by settled norms, was now shattered by the rise of Donald Trump”. This backlash to nationalist populism focuses on one broken guardrail in particular: the loss of traditional gatekeepers to news and information, due to the decline of old media and the advent of social media. The 2016 documentary Hypernormalisation by Adam Curtis took this logic to its ultimate conclusion, by arguing that new media has enabled post-truth politics and the creation of mass false consciousness.

Further reading

Trumpism: America's new religion

By Peter Franklin

Many advocates of the normalisation narrative also stretch the ideas of Karl Popper to argue that the best way to defeat intolerance is by becoming more intolerant. Only by becoming more (politically) intolerant can (social/cultural) tolerance prevail. Only via authoritarian means can liberal ends prevail.

In recent weeks, we have seen the current shadow education secretary, Angela Rayner, call for social media companies to ban anonymous accounts, the former shadow education secretary Lucy Powell call for closed forums on social media to be eradicated, the deputy leader of the Labour party, Tom Watson, call for a social media regulator, and the President of the EU commission, Jean-Claude Juncker, argue that “press freedom has limits”.

These arguments have found a receptive audience among Left-liberals already inclined towards political intolerance.

The political scientist Rob Ford discovered via his research that 57% of Lab voters would be upset by a Ukip-voting in-law joining the family – putting intolerance of Ukip voters above intolerance of potential in-laws with criminal records (51%.) Noah Carl, a post-doctoral researcher at Oxford University, has listed the various pieces of evidence supporting the contention that people with Left-wing or ‘liberal’ views are more likely to block or unfriend their ideological counterparts on social media than those with Right-wing or conservative views. YouGov have also recently published research demonstrating that Labour and Remain voters are more likely to have politically homogenous friendship groups than Conservative and Leave voters.

Further reading

The rise of post-truth liberalism

By John Gray

Of course, we shouldn’t confuse the response to normalisation with the idea itself – however, that too is deeply flawed. The actual evidence that nationalist populism has metastasised because of the advent of new forms of social media is extremely weak. Multiple studies have shown that the role of digital misinformation is greatly exaggerated. Only 21% of all American adults are on Twitter and only 15% of Republicans follow Donald Trump, for instance. In the UK, only 17% of the population use Twitter. Studies have found that political polarisation is more acute among low-level internet users, and that social media can reduce polarisation rather than exacerbating it.

The normalisation narrative therefore grants an illusory sense of control; ie, the false hope that the liberal Left can defeat populism by doing something about social media. As the Financial Times journalist John Burn-Murdoch Tweeted in January:

7/6 Suspect we obsess over social media filter bubbles and not socio-geographic bubbles of physical world coz it's comforting — but wrong — to think FB & Twitter can fix society, when actually it's about us spending face-time w/ people who have different worldviews (god forbid)

— John Burn-Murdoch (@jburnmurdoch) January 17, 2018

The normalisation narrative reinforces the political intolerance of the Left, closing off the constructive criticism and reality-testing required to adapt to new political terrain. It should worry Left-liberals that evidence points towards the fact that Leave voters characterise Remain voters more accurately than Remain voters characterise Leave voters.

By encouraging suspicion of alternative viewpoints, the normalisation narrative makes it harder for Left-liberals to think their way through the current crisis, which they believe is characterised by a turn against the ongoing march of liberal progress. If you believe in the pre-Darwinian idea that history has a telos and that it is one of liberal progress – “the arc of history is long but it bends towards justice” – the only logical conclusion to draw when people vote the wrong way is that they were receiving the wrong information (and that, therefore, the information providers somehow must be to blame).

Further reading

The left-wing zealots are threatening our freedom

By Paul Embery

The evidence suggests otherwise, but Left-liberals cannot hear it from their own padded echo chambers. Instead, they receive distorted information about the world around them from social media sites such as Twitter, because they disproportionately dominate it. This leaves them at a disadvantage in terms of receiving accurate information as to what the rest of the population actually thinks.

Rather than seeking to regulate cyberspace, they might find it more profitable to speak to people in the real world with whom they have political differences. We live in a country in which 25% of all graduate jobs are to be found in one city and so Left-liberals – predominantly university-educated and metropolitan – might want to think twice before they cut themselves off even further from their compatriots.