UP IN SMOKE
A lean young man with black curly hair is standing on a small dune, his back to the sea, talking to the wind: "My brothers, come here. Come close, by my side. It's so beautiful here. Look at the sea. At nature. I am only from nature. Only green, bro [laughing]. Okay, green and black. Kfar Izun, eh? I'm king here. Shhh. Quiet, quiet. Don't talk. I decide. What I say, everyone does, yes? I'm the boss. I make the rules. No, no, don't answer me."
In Kfar Izun ( literally "balance village" ), located on the magical shores of Kibbutz Sdot Yam, near Caesarea, the young man is a whirl of motion, darting about with incredible speed, barely inhaling between sentences and occasionally breaking into uncontrollable fits of laughter. "I am all right, bro, everything is wonderful. Life is beautiful. There is shanti-banti and there is hyper [which he pronounces "heeper"] beeper. Get it? Everything is A-okay. Crazy? You're the crazy ones ... Oish, the boy is sick, the kid freaked out, oy, oy, oy. I'm sick, am I? [Pounding on his chest] I am a man, a man. I have been everywhere in the world, alone. You name it, I was there. Now these freaks [his parents] come and say I am a flop? He is a flop. He is a rag. I am the king."
He's 20-something, with dark burning eyes. A beautiful young man with a captivating smile. "He's a 'rescuee' who just got here. Another kid who was in India and lost his mind," explains Omri Frish, the director of the village, which treats victims of drug abuse. "Another broken family. Here, before your eyes is a fresh cannabis victim, in a live performance. Look at this kid. That is what a lot of them look like when they get here. The family took him out of India and only landed yesterday. He is in a psychotic state."
From the preliminary information they have received, the staff know that he has been smoking charas - Indian hashish - for a lengthy period and in large quantities, and not using heavier drugs ( his case resembles that of Hagar Edlund, as reported in "Four Songs and a Funeral," Haaretz Magazine, May 5 ). His parents and his brother are by his side, their feelings mixed, fluctuating between bewilderment and panic, between despair and tears and laughter. Yes, sometimes it is simply funny. They are waiting for the psychiatrist, Dr. Yaakov Nehamkin, for an initial diagnosis.
When Dr. Nehamkin arrives, the young man falls on him with hugs and kisses. "You're the doctor? Pleased to meet you. I have only one thing to tell you: The cure is time!" Nehamkin says something and the young man puts a hand on his shoulder and shushes him: "Shhh, shhh, doctor. You don't do the talking; I do the talking. Did you hear what I said? The cure is time. Doctor, do you see that woman and that man next to her? They are the problem. They've been sick for the longest time. Give them something, for pity's sake, a few pills. Okay, it was nice meeting you. Really. You're a grand guy. Yalla, bye. I'm outta here."
"It is in this situation, when they have no control over what comes out of their mouth, that you get the most truthful picture," Frish says. "This is not a stage of telling lies. You just have to know what to ask."
Nehamkin has in the meantime completed his diagnosis: psychosis due to the intensive use of cannabis, probably an attack of mania ( the manic part of manic depression ). Pharmacological treatment will be essential, at least at first. If the young man remains, he will be put into a treatment and rehabilitation program. It's a journey of a few months, in which an attempt will be made to stabilize him and restore his sanity, in the hope that the damage he has suffered is reversible. It will cost his parents NIS 10,000 a month, a fee that many families cannot afford.
How many smokers of grass and other drugs fall prey to these psychoses? Is it just a tiny fraction, or are the numbers large? How many young men and women who have been hurtled into psychotic states by smoking marijuana are there in our midst? No one is ready to commit himself to a precise number, not even the staff at Kfar Izun. But there are estimates.
Here are the basic facts: Every year, about 50,000 young Israelis go backpacking in Southeast Asia. About 30,000 of them spend time in India. Of these, 2,000 return to Israel with different levels of mental damage due to drug use; 600 are hospitalized in psychiatric wards. The rest are frequent visitors to clinics of private psychologists and psychiatrists, they deny or repress their illness or, in the worst case, kill themselves.
The working assumption of the health authorities and the Anti-Drug Authority ( ADA ) is that about a quarter of the drug victims are casualties of cannabis - that is, about 500 backpackers a year. Since there is no need to go all the way to India to experience a marijuana-induced psychotic attack, that number needs to be augmented by a few hundred young people who have their breakdown in Israel. So the final estimate ranges between 800 and 1,000 Israeli youngsters who suffer mental breakdowns every year in the wake of using cannabis.
During the facility's five years, Frish says, about 1,000 drug victims have been through Kfar Izun. ( Eight of them committed suicide in their homes while they were on leave from the treatment process or afterward, and another 10, who passed through the village but did not stay, says Frish, killed themselves some time after forgoing therapy. ) He has seen "hundreds who were in psychotic states of different degrees, solely as a result of smoking cannabis." The village treats victims of cannabis, Ecstasy, LSD, cocaine and hallucinogenic mushrooms. The therapists say that in recent years the percentage of victims of cannabis ( marijuana, hashish and charas ) has grown steadily.
About 250 million people around the world use cannabis. The full name of the plant is cannabis sativa, and it includes dozens of substances. One of them, Delta-9-tetrahydrocannabinol ( THC ), foments the psychoactive effects that users hope to experience. Cannabis is used in various forms: as marijuana, a drug that is produced from the leaves, flowers and stems, in which the concentration of THC ranges from 1 to 5 percent; as hashish, which is produced from the resin that is extracted from the plant, in which the concentration is 10 percent; and as charas or ganja, which are also extracted from the resin and have a concentration of up to 20 percent. There is also hashish oil, an even more sophisticated compound of the resin, which takes the form of a black liquid with a THC concentration of up to 60 percent.
The switchboard of Kfar Izun was not the only place that was inundated with phone calls after the publication of last week's Haaretz Magazine article about Hagar Edlund, who committed suicide in the wake of massive marijuana use. Callers also contacted the magazine's editorial offices and the ADA. The authority's spokesman, Shamai Golan, says that after the article appeared dozens of calls came in from young people who are "in states of mental distress of varying degrees of seriousness." Parents and relatives seeking urgent assistance also called.
According to the ADA, there are some 226,000 users of hashish and marijuana in Israel, including 32,000 youths. Most of the material consumed locally is smuggled in from Sinai, where it is grown by Bedouin. The concentration of psychoactive material is now twice what it was a few decades ago.
"Today's young [pot] smoker thinks naively that he is doing just what the flower children he reveres did in the 1960s," Golan says. "But in practice he is introducing a completely different substance into his body - far more concentrated and far more dangerous."
The ADA must cope with smoker's claims that there is no factual basis for the contention that marijuana can cause problems or psychotic illnesses. But common sense says that if it is a psychoactive compound, which can induce a different perception of reality and have a "good" effect on the mind and the psyche, why can it not also have a "bad" effect?
Dr. Rachel Bar-Hamburger, the ADA's chief scientist, has published an article listing the most common effects of cannabis on the central nervous system. Initially she examined the short-term effects of drugs with THC concentrations of up to 5 percent. The users in this case, she says, will experience "uninhibited behavior; garrulousness; calm; a sense of drowsiness; a good feeling; joy; euphoria; distorted perception of time and distance; heightened sensitivity to touch, taste and smell; spontaneous laughter." And some less pleasant effects: "short-term memory damage; a decline in concentration level; reduced ability to execute complex motor tasks ( such as driving )."
Users of THC in higher concentrations, such as Indian charas, will experience additional effects, Bar-Hamburger says, such as "synesthesias ( for example, when sound creates a sense of color ); hallucinations; faulty judgment; slower reaction time; inability to execute simple motor tasks." Still higher dosages can induce "an outbreak of acute toxic psychosis," such as was experienced by Hagar Edlund, according to the psychiatric diagnosis of her condition.
The latest medical literature describes common illnesses as a result of the use of cannabis, including schizophrenia and manic depression, but also of a distinctive illness, "cannabis psychosis." It is characterized by paranoid thoughts and a sense of persecution, a kind of megalomania and, in more severe cases, by attacks of violence against oneself and against others. Nehamkin, at Kfar Izun, and his colleague, Dr. Haim Mahal, who was the founder-director of the Malkishua drug rehabilitation center on Mount Gilboa, say that "there is no way of knowing who will be affected." Nevertheless, researchers have isolated a number of at-risk groups, including:
1. People who have experienced psychotic states in the past.
2. Adolescents and young adults who suffer from anxiety and panic attacks.
3. People with a first-degree relative who has mental problems.
4. Adolescents and young adults with learning disabilities of any type, and adults who had learning disabilities in the past.
But even if you are not in any of these groups, you cannot be sure that it won't happen to you. Two other psychiatrists who specialize in this sphere, Prof. Eliezer Witztum and Prof. Ami Schoffman, surveyed the professional literature and reached the conclusion that "cannabis causes psychotic outbursts and mental illness in ordinary healthy people with no prior background."
In the past experts disagreed about whether cannabis generates psychosis or is no more than a catalyst for its outbreak. That debate is over. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association - the "bible" of the profession - has adopted the formulation "psychosis caused by cannabis" and now views this as a distinct "clinical entity." Therapists are now united in the view that cannabis is a hallucinogenic drug that induces distorted body perception, depersonalization, anxiety and paranoia.
This medical terminology translates into horrific personal experiences. Those who undergo them generally describe them as the nightmare of their life. For example, a Tel Aviv man in his forties mentions "distorted body perception," which he experienced years ago after smoking marijuana: "I felt that my skin was peeling and that a million ants were crawling underneath. It was unbearable. I screamed like a madman. I wanted to scratch, but my hand was paralyzed. It lasted, according to what people told me, an hour and a half, two hours. To me it felt like two days. I was sure I was going to die. I didn't believe I would ever come out of it. It was an absolute nightmare."
Here is "depersonalization" as described by a 24-year-old student, after smoking a full marijuana cigarette for the first time: "My body disappeared and with it my whole existence, as the person I am. It was as though I had turned into a ghost. The corners of the house appeared in flashes, without there being a stage in which I walked and moved from one room to another - I simply did not exist. I tried to grab onto something, but nothing was substantial. It was the most frightening thing that ever happened to me in my life."
An example of "paranoid thoughts" is supplied by Dr. Haim Mahal, a psychiatrist who has accompanied Hilik Magnus, who specializes in rescuing drug victims abroad. "We went to extricate a charas victim in India. A few days earlier he had told everyone that he had spoken with Moses and with the prophet Mohammed and wanted to jump off a bridge into the Ganges. Friends restrained him, kept him under supervision and called his family in Israel. When we arrived, he was in an acute psychotic state. To our surprise, the same friends who alerted us ( who of course were also totally stoned ) went into paranoid attacks when they saw us. They were evasive and didn't want to talk to us - 'We don't know who you are. Who sent you? What will you do to him?' - and whispered among themselves suspiciously. They talked about us being from the Mossad [espionage agency] and recommended to their friend not to cooperate with us."
The Smokers' Secrets
The echoes of World Marijuana Day, which was marked a week ago, have faded. Marijuana has excellent PR. Acquaintances of mine who are fond of marijuana and heard about the emerging article said for the most part they were disappointed that the paper was going to focus "irresponsibly and without any real reason" precisely on the victims of cannabis use and not on the drug's wondrous positive qualities. A few even expressed concern that the article would promote a "reactionary," not to say bizarre, stance they called "hallucinatory."
One of the more surprising discoveries during the writing process was the number of negative testimonies offered by users themselves. Repeatedly I heard personal confessions about appalling paranoid reactions, about dangerous moments that bordered on disaster. People described psychotic states they experienced, and traumatic visits to friends who were affected - some of whom were hospitalized in psychiatric wards and some of whom later committed suicide.
Somehow these testimonies remain well-guarded secrets in the circle of users. An attempt to find out why left several unanswered questions: If it's so good, how come it's so bad? And if it's so bad, is it still so good?
Profs. Witztum and Schoffman believe that the prolonged use of cannabis causes "injury to short-term memory and to attentiveness, to verbal ability, to the ability to store information, to learning skills." Another adverse effect suffered by heavy, daily users is "amotivational syndrome," characterized by "disorders of concentration, memory, volition, social performance. Some of the phenomena fade or disappear after use is stopped for a few weeks."
The symptoms of those who develop "cannabis psychosis" are "psychomotor unease; hurtling thoughts; rapid pressure of thoughts; false thoughts about persecution; hallucinations involving colors and sounds." Among adolescents and young adults "a connection has been proved between taking cannabis, and anxiety and depression disorders, as well as a higher risk of suicide." A "high frequency of these manifestations [was found] especially in first-time marijuana smokers or among those who had increased their dosages beyond the amount that is usually consumed."
The professors sum up: "This is a drug with a risk potential connected to mental illness ... It is of great importance for physicians, especially psychiatrists, to be aware of the formation of psychoses in the wake of cannabis use."
'Hidden Victims' In 1990 Mahal, at the request of the ADA, established the Malkishua rehabilitation center. Originally the facility was intended to treat addicts, hard drug users. However, Mahal says in the past decade there has been a change, and today "between a third and half of those who arrive are cannabis victims." The new pattern has intensified in the past three years. "We are seeing more and more people who went to India and use only or mainly charas," he says. "I found myself making far more frequent diagnoses of psychosis due to cannabis." Like his colleagues, he notes that charas contains a high concentration of the psychoactive substance.
Mahal is dissatisfied with the policy of the Israeli health establishment, and especially with the fact that not enough information about the problem has been collected. He believes that the number of victims is greater than that usually cited. "Most of the smokers will not suffer mental injury," he says, "but in my experience at least 10 percent are affected at one level or another."
What Is the Explanation for the Gap in the Numerical Estimates?
Mahal: "Repression. Denial. Ignorance. And incorrect interpretation of the facts. In the past few years I have encountered a phenomenon, and also heard about it from friends and acquaintances, concerning their children, now in their twenties, who have a 'problem' - only they do not link it to the fact that the children smoke [drugs]."
Can You Give an Example?
"The classic monologue goes like this: We had a terribly successful child. Intelligent. A good student. Talented. An artist or a musician or a wonderful athlete. It was clear to everyone that he would be a top student at university. We expected great things of him. But what happened? The kid is 25, maybe pushing 30, and he is simply not functioning. He lives at his parents' expense. He is detached. He doesn't work or at most does odd jobs. He barely got through some unknown college, if he got through anything at all. He is doing nothing with himself. He sleeps away half the day. The parents don't understand what happened."
"Their child has been smoking hashish or marijuana for five or 10 years. The parents didn't make a fuss about it, because they are cool parents. They were hippies in the 1960s or 1970s. They smoked, too. The kid didn't even have to hide it from them, because he has liberal, modern parents. Parents who know where it's at. What they didn't take into account is that the pot they smoked and today's pot are not the same thing. Because the growers enhanced the plant and today it is far more highly concentrated. They did not take into account that their child would turn this into his central and perhaps only occupation. And he has been hurt. Because after years of cannabis consumption - and this has been proved by scientific studies - he experiences a decline in cognitive ability, in focusing, in learning and concentration capability.
"A survey conducted by Tel Aviv University showed that 21 percent of the students who used marijuana said it interferes with their studies. They have problems sleeping. They suffer from amotivational syndrome. These are borderline cases, and I call them the 'hidden victims.'"
How many young people like this are there in the country?
"Thousands, certainly. Maybe tens of thousands. Everyone who is now reading this should stop and think: How many borderline cases like this do I know? They are the hidden victims. They do not get to Kfar Izun or to Malkishua. They cannot be quantified. They are the children of your friends and mine. They are nameless and numberless. They should bother every society and every sane country. They need help. They are liable to develop suicidal tendencies. They are a type of social parasite. They are not productive. They are not creative. They are borderline in terms of their functioning at every level of life. The main thing they do is sit and smoke pot whenever they can."
Risks of Mental Illness
Dr. Yaakov Nehamkin quotes from studies: "A person who smokes cannabis for more than 10 years is 20 times more likely to suffer from a psychotic illness. A person who started to consume cannabis at the age of 14-16 is four to six times more likely to suffer from mental illness. Anyone who uses the drug on a daily basis significantly increases [the chance of suffering from] psychotic disorders, such as anxieties."
Nehamkin is especially disturbed by drug users' ignorance of what they are introducing into their body. "I say to the guys here, 'You insist on eating organic food, you have a spiritual awareness about healthful things, which you learned in India, but you don't have a clue about what you are taking into your body with these leaves."
They Don't Know?
Nehamkin: "Most of them don't have a clue about the charas in India or about what they are smoking here in Israel. In India a great deal of the charas also includes LSD, added to produce a more powerful effect. When they come here and say, 'We only smoked the green stuff,' it's not exactly so. Because it also contained something else. In Israel almost all the material comes from Egypt, from Sinai, from the Bedouin. It's been tested in labs and found to have small additions of rat poison or of methadone and all kinds of other horrors."
"Yes. It creates a potent blow, a strong effect. And it's also addictive. After that he says, 'I just smoked cannabis, I am not addicted.' But he is addicted, and how! And he has no idea why he is addicted. So what I say to these kids is: When you are at a party or on the beach or in Goa and you smoke 'only pot,' you have no idea what's in it. You don't know what you are doing to yourself."
To this the users have a simple and logical reply: If everyone is so worried about the addition of addictive substances and about the fact that it's impossible to know what pot contains, they say, let us grow a reasonable amount legally and everything will be fine