The statistics are troubling:
Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day — often three packs. Furthermore, smokers with mental illness are much more likely to smoke their cigarettes right down to the filters.
Obviously, it’s extremely important that we encourage people with mental illness to quit smoking. As this excellent op-ed by Steven Schroeder notes, mental health professionals have often tacitly encouraged people with psychiatric disorders to use cigarettes as a crutch.
The reasoning goes something like: “Poor Joe is suffering so much from his illness and gets such pleasure from his cigarettes that I don’t want to take them away from him.” Another reason lies in the extent to which smoking is integrated into mental health treatment. In psychiatric hospitals the denial of the opportunity to take a smoke break is used as a disciplinary tool, and cigarettes have become part of the culture — often being traded for goods or sexual favors as a form of currency.
But I wonder if something else is also going on, and that smoking acts as a form of self-medication for people with mental illness. The one virtue of nicotine as a drug is that it’s extremely consistent: when you light a cigarette you know exactly what kind of rush you are about to get. For people beset by a woefully unpredictable mind, there might be something reassuring about the pharmacological regularity of smoking. And then there’s the calming effect. (Odd for a stimulant, I know.) One of my friends quit smoking and immediately took up meditation, because he said he missed focusing on nothing but his breathing for twenty minutes a day. We eat on the run, we drink coffee in our cars, but I’m often impressed by how smokers will just puff on a cigarette and stare off into the distance. The smoking break, in other words, is a form of toxic contemplation, a rare moment of calm amid the helter-skelter. Does this moment of (carcinogenic) repose help people with mental illness? Do they crave a chance to be still?