Cloudscape

There has long been controversy about whether or not marihuana causes psychosis. The correlation that has been found between marihuana and psychosis is indisputable, but it is unclear whether marihuana causes psychosis or vice versa.

It is probably a bit of both: marihuana use can be out of a need to flee from reality, meaning that beside marihuana, the person will also seek other ways of fleeing from reality, which is basically synonymous to psychotic diathesis. It can also be because of isolation, or to find distraction from stress. Stress, isolation and a tendency to flee from reality happen to be the three most important factors of psychosis. At the same time, however, marihuana may also cause a person to flee even further from reality, become even more isolated, and because of this, eventually go through even more stress.

As a result of this, the increased risk of psychosis caused by heavy marihuana use is probably not as high as anti-drug activists are inclined to believe, but also not as low as marihuana users are inclined to believe. Studies indicate that the risk of psychosis in marihuana users is 2 to 8%, compared to 1% in the general population — an increase of 100 to 800 percent. If the correlation is bidirectional, the risk of psychosis would increase with heavy marihuana use, but not by 800 percent.

It may seem hard to find out by how much the risk of psychosis is really increased by marihuana, since there is no way one can subject a random sample of the population to heavy marihuana use and see what happens, but there can be another way:

The researchers should ask not for subjects who are already using marihuana, but for subjects who claim to be interested in using marihuana but have never used it. The subjects would then be split in two groups, both of which would be subject to regular drug tests. In one group, the control group, subjects that are found to have used marihuana are eliminated from the study. In the other group, subjects that have found not to have used marihuana will be eliminated from the study, though not before the end of the follow-up. To prevent the study from manipulating the subjects' behavior, all subjects would be paid the same amount of money at the end of the study, even if they were eliminated at an early stage. At the study's conclusion, it is important that the user group (that is, the group where all non-users have been eliminated) is subdivided into separate groups according to how heavily they used marihuana, and the percentage of psychosis be mentioned for each subdivision. This study would last for at least years and at most decades.

Perhaps all the symptoms of schizophrenia, paranoia in particular, are a direct result of ego-splitting, in which the person's sense of self, or ego, becomes split into separate compartments which seem to assume a role of their own. For instance, the person's own thoughts may seem as though they are those of someone (or something) else, leading to the delusion that thoughts have been inserted into the person mind. These thoughts which have separated from the ego may then turn to intrusive thoughts or voices.

At the same time, if the ego has been split into many compartments, it becomes harder to focus one's attention on one specific compartment, because one's thoughts have basically become scattered across each of these many compartments. In this way, one's attention may become distracted as it rapidly shifts from one train of thought to another.

In ego splitting, the central part of one's ego is still in one's physical body, but most of it has become transferred onto other areas of one's consciousness, such as daydreams, to such extent that these may become extremely vivid. These may then have such impact on one's emotions that they seem real, whereas the part of the ego concerned with reality has become so small that real events have a much smaller impact on one's emotions. The result is an increased response to imaginary stimuli, and a decreased response to real stimuli. In other words, the ego has partly dissolved into imagination.

In addition, parts of the ego may become transferred onto objects in the person's environment, so that it seems as though these are alive, or as though they contain cameras, microphones or other means through which they might be spied upon, or it might seem that the person can control these objects with his mind.

This may also happen with people: when parts of the ego are transferred to other persons, the person's emotions about him- or herself may become projected upon them. It follows that if the person has a high self-esteem, this may lead to the feeling that people will likewise have a high esteem of him or her, increasing the feeling of high self-esteem and so forth. This interaction may lead to grandiloquence. On the other hand, if the person has a low self-esteem, this may lead to paranoia, because he or she then projects his or her feelings about him- or herself onto others.

In addition, some people who suffer from self-loathing may use daydreams to punish themselves, especially people who have a lot of imagination. They may do this by hurting themselves in their thoughts, but also by making other people hurt them in their daydreams. In one's daydreams, one has the ability to exert full power over all things, and for people who live largely in daydreams, this ability might distort their image of reality, leading to the delusion that reality differs little from daydreams.

As the ego splits up, the person comes to feel one with things that are in reality separate from his physical self. In this way, the person's sense of separation becomes blurred. This may cause the feeling that people are too close to oneself and so worsen the sociophobia already caused in part due to the paranoia. Furthermore, because of this lack of sense of separation, it becomes as if all things in the world are in fact part of the person's own mind, things that are therefore controlled by the person's own thoughts. As the person dissociates from their own thoughts, however, and they come to appear to take a form distinct from the ego, it seems as if their thoughts are not their own, and that they are instead thoughts that they pick up from other people.

Furthermore, because of this lack of sense of separation, it may also seem that everyone is much too close to them. Close enough, for instance, to harm them, or to read their thoughts. Strictly speaking, this is not in itself ego splitting, since the ego is one's sense of self, and the paranoid still knows the difference between themselves and other people, and does not see them as part of themselves as one would see one's arm as part of oneself, for example; but the feelings they believe others to have towards them still originate from their own. This is so because the paranoid's sense of self has partly dissolved, so that they no longer recognize these feelings as their own.

If the person hates him- or herself, it may seem to them that the entire world hates them. If the person is also self-destructive, it will seem as if the entire world is keen on destroying them. But to paranoids, this feeling becomes so extreme that is no longer a mere emotion, but a reality to them.

One might argue that ego dissolution is not the only thing that may cause paranoia. Traumas can be another cause, for instance, which neither directly nor indirectly have anything to do with ego dissolution. On the other hand, one might question if this is paranoia at all, since people who develop fear of people because of traumas have an actual reason to do so, namely, the chance that the trauma might repeat itself. The traumatized person's estimation of this chance isn't even necessarily irrationally high, but he or she is so terrified of this chance that no matter how small it may be, it is still significant to him or her.

In ego dissolution, emotion has become a continuum from the ego to empathy, with no well-defined line in between, and so emotion can readily flow back and forth from the ego to empathy. At the other extremity, in the case of egotism, the line between the two becomes an impenetrable wall that cuts the ego off from empathy, and the little shared emotions there are are attributed to the ego.

It may be that schizophrenics are highly empathic, though this does not have to mean that they are compassionate, and, if they have low self-esteem, they will likely not be.

Some Buddhists, and other practitioners of meditation, practice a form of meditation called metta meditation, or compassion meditation, in which the meditator tries to generate compassion for living beings: first him- or herself, then loved ones, then acquaintances, then enemies, then strangers, and ultimately all that lives.

This form of meditation would not actually work with paranoids, because the issue with paranoids is not their own hate for others, but the imagined hate others have for them. However, if this form of meditation were reversed, it might actually serve as a potential cure or prevention for paranoia.

Since the paranoid's emotions have become projected onto other people, he must deal both with the emotions ascribed to the ego as those ascribed to others, meaning that he must re-place him- or herself in the place of others and then deal with the emotions he feels for himself in others' place.

To the paranoid, the metta meditation should be focussed entirely on the first stage of generating compassion for him- or herself, but from the viewpoint of others. In other words, he or she should imagine other people to love them and send them love. This is unlikely to work, but in the process, he or she might resolve the hate that he or she imagines others to feel for them, which is actually their own self-hate projected onto others.

As this form of meditation would require insight on the paranoid's part that he or she is paranoid, this would sometimes be more useful as a preventive than a curative method, at least in severe cases. Nonetheless, it can also be used in less severe forms of paranoia, or while the illness is already or still in full force.

Madness is an abandon of reality to escape into fantasy; schizophrenia is also an abandon of the self in order to do so.

In schizophrenia, severe chronic stress resulted in the failure of the individual's coping mechanisms; she or he loses courage to face his difficulties and therefore to care for her- or himself. In other words, the ego dissolves. Practical thought becomes reduced because the individual has lost the will to concern her- or himself with it. Not finding safety in reality, the individual is then forced to flee into unreality, leading to psychosis.
What remains is simple experience, be it of a sensory nature (i.e. sensations) or abstract (i.e. imagination). No longer having the will to filter perceptions of practical value from those without, perceptions that are normally filtered at once become more prominent. This is referred to as decreased latent inhibition. Perceptions that are normally unconscious encroach upon the conscious, while normally conscious (practical) perceptions become unconscious.
Because the individual's awareness is partly transferred from the practical thought which usually accounts for a large part of our mental processes to experience, this may lead to a state of expanded consciousness. While this may be experienced as pleasant at times, as the illness progresses it becomes so inescapable that it becomes horrifying.

To this day, there is no therapy specific for psychosis except for antipsychotics. A therapist can talk to a psychotic in the hopes that they will gain more insight in their own situation just like any other patient, but they can't give them any treatment which focuses particularly on psychosis.
Perhaps to this purpose, psychologists could subject the patient to a kind of training, a reality training. In such training, questions could be asked about a purely hypothetical person in a specific circumstance which relate to the patient's psychosis, such as:

"Person A finds that someone is following him or her. Is it more likely that:
A) the follower is involved in a governmental conspiracy, or
B) the follower wants to ask person A directions.

It may be useful to sketch the characters in the hypotheses as specifically as possible, so that, although they may be similar to the patient, the patient can think of them as other people. They do not have to be of the same age, sex, race, or personality. Important is that it is asked not what IS true, but what is more likely to be true. Implying that their delusions are false may make them defensive about their truth; they have to decide for themselves if they are true or false, but we can make them have a clearer view of their own situation by projecting it onto other people, so that they learn how others deal with them.
If one tries to convince a patient that their delusions are false by arguing about it, it is very possible that they will see one as being part of the conspiracy in their delusions. This probability is increased by the fact that many schizophrenics are often highly sensitive and might see criticism about their beliefs as a personal attack.
Because psychotics have a lot of imagination, they think highly parallel. They think in multiple possibilities, but are unable to see which is most relevant. They see so many possibilities in their mind that they no longer see which are likely to happen in reality and which are not.
Most people will tell psychotics that their delusions are impossible. In fact, nothing is impossible: it is always possible that they are being followed by someone who is involved in some conspiracy, but it's just very unlikely. Because psychotics are so good in hypothesizing, when they are told that something is impossible, they will eventually realize that this isn't true. "What if my father had somehow gained access to top secret information without my knowing and is keeping it somewhere, what if the FBI is pursuing me for this?" What often happens then is that when the psychotic realizes that their delusions are, after all, a possibility, they will wonder why whoever is telling them that they are impossible is "deceiving" them, which might make them believe that they as well are involved in some conspiracy which is meant to keep them from knowing the truth. Instead, it is better to tell them that their delusions, while possible, are very unlikely.
To a schizophrenic, the relevant possibility is no longer the most probable one, but the most drastic one. Because of their high faculties of imagination, they will also be able to imagine all possibilities very vividly; what then matters to them most is those imagined possibilities which elicit most emotion when they imagine them, that is to say, those which they fear or hope for the most. It doesn't seem to matter how likely they are because in their minds, they are already real: they happen in their fantasy as vividly as a dream happens in our own.