Split-Minded about Smoking

by Mark Stewart on August 24, 2011

It is back-to-school time again.  As the University of Michigan students begin their re-immigration to Ann Arbor, some will be presented with a surprise: the U of M has become a smoke-free campus.  The University of Michigan – as of July 1, 2011 – has initiated its Smoke-Free University Initiative.  Robert Winfield, M.D., the Chief Health Officer of U of M and the Director of the University Health Service, has requested that all students and staff show “patience, respect, and professionalism” in the act of transitioning to a smoke-free environment.  I think what he meant by this was to avoid treating the members of our community who smoke like criminals.  Perhaps, it is good for a community such as ours, a community in which we all know what is best, to be reminded to act with civility even towards those who do things we spend our whole life fighting against.

It is a tough time to be a tobacco smoker, or a tobacco company for that matter.  Big tobacco cannot advertize on racecars anymore, much less on television or in print media.  And, in addition to the Surgeon General warnings, they have to put those “scary” pictures on their packs now.  The effects of the Family Smoking Prevention and Tobacco Control Act are still settling in.  But, for the smokers themselves, I feel that our society may have crossed the final checkpoint on the path towards universal cessation: smoking has become completely and irretrievably stigmatized as a “bad and dirty habit” and perhaps even an “evil habit.”  No longer do people have to sit in a restaurant or workplace or even their apartment and be forced to breathe in the results of burning tobacco (if modern day cigarettes can even be said to be “tobacco” anymore, it is kind of like saying a hot dog is made of meat – if you are curious you should Google “cigarette components”).  Non-smokers have decided that we do not have to put ourselves at risk to avoid hurting someone’s feelings.

It has been a long struggle.  “[We’ve] come a long way, baby!”  From the era of Lucky Strikes being given to our soldiers in World War II (smoking as patriotism), to a period where 60-80% of adult males smoked (smoking as societal norm), to the first big movements toward quitting in the 1960s and 1970s (smoking as dangerous to health), to now (smoking as evil).  Currently, about 20% of our country’s adult citizens are smokers.  The decreasing trends that began in the 1960s flatlined in the 2000s (George W. Bush was a friend of big tobacco), but hopefully they will begin to head southward again.  However, the smokers in our country are now overrepresented by the “uneducated poor,” thus giving us an epoch where one social problem runs smack into another.

Regardless, strides have been made and battles have been won.  The war is not yet over, however.  Despite tobacco smoking being the most extensively researched cause of disease and death in the history of science, tobacco is still legal and readily available.  Cigarettes are still being marketed to children.  Nicotine is still crossing millions of blood-brain barriers.  Prohibition as a concept still scares people, but it is likely that millions of lives would be saved.  My personal recommendation would be for the United States Department of Health and Human Services, through the Food and Drug Administration, to give the pharmaceutical companies the Letters of Marque needed to get into the nicotine delivery business.  That is, the U.S. government should start a war between competing corporations.  (“Win-win,” anyone?)

However, in my time studying, discussing, and thinking about these issues, I came across a new horn of the dilemma.  I discovered that the severely mentally ill members of our country are smokers in massive numbers.  For example, more than 80% of schizophrenics are smokers (some studies show numbers as high as 95%).  The self-reported reasons for smoking by schizophrenics are the same as those for the general population: relaxation and habit.  However, there has been a growing body of evidence, which many have now termed proof, that schizophrenics are using cigarette smoking as a means of self-medication.

I will not go into all of the current knowledge about schizophrenia etiology and symptoms, but I will say that smoking does have effects on dopaminergic pathways and has positive effects on cognition.  Schizophrenics often have auditory hallucinations, paranoia, delusions, and disorganized thinking.  These symptoms are predominantly caused by the inability of the brains of schizophrenics to differentiate, sort, and focus on the multitude of stimuli that go on around us.  Think of being in a busy restaurant.  Imagine that instead of being able to block out all the noises, conversations, and movements around you, every single piece of sensory information is as important as the interesting things said by the attractive person sitting across from you.  The effects of cigarette smoking and nicotine help schizophrenics through increased selective attention.

“They should use other forms of medication,” I hear you say.  Great idea, except for the fact that anti-psychotic drugs are very expensive, do not work very well for most people, and have extreme side effects.  Tardive dyskinesia is the most common side effect.  This makes it very hard for the body to move in normal ways at normal speeds.  Also, there are common metabolic side effects that are quite similar to an individual having diabetes.  (Just what someone with a severe mental illness needs!)  Thus, the cheapness, effectiveness, and availability of cigarettes offer most schizophrenics some succor.  Smoking leads to schizophrenics having a 30-60% increased risk of respiratory disorders and heart disease, but is this a risk that is worth taking?

It is a type of tragedy when ideals come into conflict.  Free expression, free choice, and freedom of action can all lead to injury, disease, and death.  Yet, I would never give them up.  Public health professionals want to help people and society to make better decisions about health and wellbeing.  And, after all, there is nothing worse for an individual’s health than smoking with the possible exception of sedentary life style.  If we could get everyone in the country to give up smoking and to start exercising seven days a week, the morbidity and mortality rates would drop precipitously.  However, I do not want to live in a nanny state that can determine what I can and cannot do.  Once smoking and exercise as social problems are solved, public health would move on to banning motorcycles and theme parks, or something.

We should continue on our path of eliminating tobacco smoke from our society.  However, we should keep in mind that there are minority groups out there who perhaps benefit from the effects of smoking much more than they are harmed by the risks.  Minorities should be protected from the tyranny of the majority.  And, we should all be protected from the “tyranny of health promotion.”  Even at the risk of being hung up on the horns of a dilemma, we should remember our ideals.  It is easy to have ideals when nothing is at stake.

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{ 15 comments… read them below or add one }

Ute August 24, 2011 at 11:59 am

“However, we should keep in mind that there are minority groups out there who perhaps benefit from the effects of smoking much more than they are harmed by the risks.”

More than _they_ are harmed. Well, ummm… That’s a tad beside the point, isn’t it? What about the fact that their smoke also hurts their children (born and unborn) and everyone else around them? Is smoking still justifiable then? Can you actually set up an equation which determines that the smokers’ benefits outweigh the damage done to those _around them_? I guess not…

I reckon it would be a better idea to determine & then administer the substance(s) in question by other means. Schitzophrenic or not – I’m not willing to put up with anyone’s smoke in my house or office.

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EZK August 31, 2011 at 5:12 pm

The concept of second hand smoke being harmful in a clinical sense is vastly overblown and if done outside of confined areas (building or cars) is virtually harmless.

http://www.stats.org/stories/2003/secondhand_smoke_jun3_03.htm

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Ute September 2, 2011 at 5:33 pm

Be that as it may (quite a few studies say otherwise) – I also don’t want to reek of smoke. Even a cigarette smoked by someone next to me at the bus stop makes my hair and clothes stink until I wash them. I find that downright disgusting, and as long as there is still one iota of doubt left w.r.t. to the harm smoke might do, I don’t see why I should tolerate smoke around myself and my kids. Even if it is of some benefit to a minority of people. Let them smoke that stuff elsewhere if they must.

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Bronko August 30, 2011 at 3:50 pm

“We should continue on our path of eliminating tobacco smoke from our society. However, we should keep in mind that there are minority groups out there who perhaps benefit from the effects of smoking much more than they are harmed by the risks.Minorities should be protected from the tyranny of the majority.”

If minorities should be protected from the tyranny of the majority, then, concluding from what you wrote (not speaking as a smoker here), smokers should be protected from being banned from public places such as restaurants etc., as well.

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Phoenicia August 30, 2011 at 11:03 pm

If i had to choose between:

a 90% chance of severe uncontrollable obesity, loss of control of my limbs, Digestive problems & sometimes permanent body tremors

- OR –

a 30-60% increased chance of pulmonary or respiratory disease

I think i’ll go with quality of life over quantity of life… I’m not schizophrenic, but I have severe anxiety and suffer from agoraphobia… Smoking a cigarette will calm me down from a panic attack in a matter of seconds… It helps me calm down when i get over-stimulated when I leave my house… and though the side effects of anxiety medication aren’t as bad as the side effects of anti-psychotics, I will always choose having a cigarette over taking a pill every day to control situational anxiety…

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Niklas August 31, 2011 at 2:34 am

I think its pretty cheap to use Schizophrenia in your arguments for accepting smoking. Your logic is flawed. Yes, smoking may be good against a lot of the symptoms. However, its the nicotine, not the smoking. There are a lot of nicotine products available that does not include the risks that cigarettes do.

If someone doesn’t care about their own health, I wont stand in their way. By all means, destroy your own body if you feel like it. But never expose other individuals to this. I’m happy for the laws banning smoking at public places like restaurants for instance.

I am both bipolar and schizophrenic. I too have been a heavy smoker. But as research progressed on the subject and my self-awareness has grown. I realized that since it was the Nicotine I wanted I could easily switch to one of the other products. And have happily done so.

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Éamon August 31, 2011 at 5:57 am

Add depression to the list, Mark. The last numbers I saw said about seven percent of the adult US population had depression. That number shoots to 50 percent or more amongst smokers. And while all the arguments everyone’s made against smoking are valid, and the health risks with smoking well documented, I doubt anyone will ever hear cautionary statements like, ‘…may increase thoughts of suicide…’ when talking about tobacco.

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fadetomute August 31, 2011 at 7:29 am

I smoke. Have for about twenty years. I’ve never had a medical problem because of it. I have known people who did. I’ve also met a lot of people who quit.

Basically, I see the current legislation as financially and socially motivated. Politics tends toward the useless. Wise leaders can keep it from that, but that’s beside the point. There is money for the people willing to protect others from themselves. Anybody that dislikes smoking is a potential donor.

I’ve also met people from Michigan. Really dug a couple of them. Makes me want to visit. Shame to hear about U of M, though I bet you meant by July 2011.

Anyway, carcinogens cause cancer. If cigarettes were carcinogenic all smokers would get cancer. Smoking just makes it less likely that your lungs will expel carcinogenic material. The main cause of cancer is our industry and other businesses/individuals that utilize known carcinogens. Always use ‘adequate’ ventilation with certain furniture polish removers for example. That smell when you open benzene means contact (which is why it only sees industrial use for the most part). It’s not as profitable to police our manufacturing and refining industry I guess.

It’s obvious I don’t support smoking bans. I’m not against them either. They’re just another stupid way for poly-sci majors to make a dollar.

As to the benefits of smoking, meh. I stink. My clothes stink. If I smoke inside that stinks (and gets dusty).

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Ewan Hoyle August 31, 2011 at 8:09 am

It’s worth looking into e-cigarettes and nicotine patches as a means of treatment rather than ask people to smoke cigarettes.

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Susan L Whigham August 31, 2011 at 11:27 am

Schizophrenics self medicate using caffeine as well, not that smoking should be illegal. But if businesses want to offer smoke-free environments, that should be their prerogative.

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Andi August 31, 2011 at 3:38 pm

Sorry to say, but that is absolute b o l o g n a!

I’ve worked at a psychiatry, and my brother is schizophrenic. N O N E of the people I met there, and certainly not my brother, were able to successfully and treat their illness with nicotine.

(1) Maybe it is true that people suffering from psychosis can practice “selective attention” through smoking. But have you ever seen schizophrenic smoke a cigarette, and JUST smoke a cigarette, savoring it? Most literally inhale, quickly, until the cigarette is gone.

(2) And also: it’s not just the inability to focus that is part of the illness. Paranoia, aggression against others/self, and comparable symptoms are way more dangerous and grave.
Neuroleptica are so much stronger and more effective than cigarettes.

Just imagine the astronomical amount of tobacco you will have to smoke just to get near their degree of efficiency in blocking dopamine? Googol plantations?

(3) I like your idealism, Mark, but you’re running the same problematic arguments that the anti-psychiatry movement has been giving since the 60s (though there are some assessments that I agree with). Mistakes were made, no doubt about that.
But: Schizophrenics often are NOT able to decide for themselves. They can not decide to treat themselves with whatever, nicotine drugs etc.. We can be lucky when they do not decide to go off their medication. You don’t want to live in a “nanny state”. That’s fine, that’S your opinion and you are entitled to it.
These individuals have severe problems, the need to be looked after, and it is their right that they are looked after!

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Miranda McKennitt September 1, 2011 at 1:38 am

Andi, I’m sorry, but you are full of bull. Neuroleptics make your life a living hell. They did mine. Sure, they will stop hallucinations and then make a vegetable out of you for the rest of your life. I can’t even sit here long enough to write something longer, neuroleptics-induced akathysia makes it very hard to just sit down and type. I call bullshit.

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smoke shop Long Beach March 14, 2012 at 1:02 am

It is indeed true that in our society today, smoking is being treated as an evil habit. Yes, there are evidences of its effects to one’s health, however, people must respect that there are people who benefit from this habit. They should be treated equally since as of today, smoking is not a federal offense. Though there are groups that dedicate themselves in campaigning against this vice, respect should still be given to those who opt to live a lifestyle with smoking.

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Jules May May 17, 2012 at 12:48 pm

Yeah, and it’s not just schizophrenics that smoke like crazy, it’s the majority of the mentally ill. Medication is not only expensive but also makes your life a living hell, not that you notice, being a complete vegetable, and nicotine really isn’t that bad for you, it’s the smoke that’s killing people. So if the nicotine is improving these people’s quality of life, I say use other means of delivering the stuff

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