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Stress Part 9: Smoking

By John McManamy

Recently, I was invited to give a grand rounds lecture at a mental facility in Princeton, New Jersey. I arrived early and had a chance to walk the grounds. Everywhere, I encountered notices that thanked me for not smoking.

What is wrong with this picture?

Eighty percent of individuals with schizophrenia and some two-thirds of us with bipolar smoke. The habit undoubtedly contributes to our appallingly shorter life-spans than the general population. But clearly, a lot more is going on than a simple craving or an addiction. Otherwise, most of us (I have never smoked) would have quit years ago.

So what is going on?

To start, for the brief time a cloud is in the lungs, a cloud lifts from the brain. Many of us are apparently willing to put up with a drug with the worst side effects profile in the world to experience for just a few precious seconds what the rest of the world takes for granted - possession of our frontal lobes. The brain scientists have mapped out the pathways involved, and nicotine-based meds are in development.

Then, obviously, people smoke to relieve stress.

A good many patients arrive at a psychiatric facility against their will, often in a police vehicle, often in restraints, severely traumatized, in states of extreme duress. Facilities and procedures are designed for the safety of hospital staff. But how safe does the patient feel?

Perversely, the patient is denied the one thing that may restore his wits and calm him or her down.

Several months before that, I visited a facility operated by the Phoenix-based Recovery Innovations. Patients are allowed to smoke. Indeed, in a crisis situation, handing out a cancer stick may be the safest option for everyone concerned. Significantly, Recovery Innovations has a zero restraints and seclusion policy. Of equal significance, they have no reason to reconsider their policy.

Naturally, it is always a good idea to give up smoking, but a stressful period in your life may not be the best time.

Managing stress is all about finding what works for you, not necessarily what others tell you is good for you. Chances are you have a number of bad habits. Chances are some of them serve you well in times of need - a drink, chocolates, mindless TV, a shopping spree ...

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