The Pharmaceutical Journal
Vol 279 No 7478 p570
17 November 2007

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Ash, hazel and the viper

Standing and staring

Meaningless names

Psychosis after cannabis

Ash, hazel and the viper

The lurking habits of snakes and the methods recommended to deal with their menace to humans are recorded from ancient times. In classical antiquity there was a belief that the humble ash tree offered protection against the poisoning menace of snakes of all kinds.

Some commentators, including Sir Thomas Browne in the 17th century, rejected the idea. In the 19th century in our own West Country it was said that a branch from the ash tree would deter the dreaded viper.

In 1890, Mrs M. A. Courtney wrote, “Snakes avoid and dread ash trees; a branch will keep them away”. William Crossing recommended that a rambler should equip himself with a good ash rod that was used to draw a circle round any adder he came across, the snake being unable to cross the line.

If a rider’s horse was snake bitten, placing a collar of ash twigs round its neck averted the ill effect. A circlet of ash twigs was also recommended, both for preventive and therapeutic use for humans encountering a venomous snake.

A strange story is told of a child sitting down habitually next to a snake and sharing bread and milk. In the Welsh Marches the coat of arms of the Vaughans shows three boys with snakes draped around their necks.

It is not established how long the story of the association of the ash tree with the adder reaches back into history. Hazel also has been similarly associated. In France a light stroke with a hazel twig was reckoned sufficient to kill a viper provided the hazel had never borne fruit.

In legend, St Patrick purged Ireland of poisonous snakes by brandishing a hazel wand. Emigrants from Ireland to the US and Canada once took hazel rods with them as a precaution. A decoction of the leaves was also a remedy, and they were used as a poultice. Whether this explains the frequent presence of old ash tress close to Dartmoor farms is uncertain.

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Standing and staring

“What is this life if, full of care, We have no time to stand and stare?” wrote the poet William Henry Davies in ‘Leisure’, 1911. It is easy to dismiss the idea as petty and pointless. Yet it calls for serious thought.

Bertrand Russell, in “The conquest of happiness” in 1930, discussed everyday factors that render individuals unhappy or discontented. He remarked that one of the most powerful of these is sheer competitiveness, which drives people to make massive efforts to raise their status in society above that of their fellows by fair means or foul.

Curiously, this reaction indicates an awareness of inferiority rather than superiority. If people understood this they would cease to maintain an eternal rush and indulge in a little placid meditation.

Contemplation, which modern life-stylers have come to regard as an alien culture derived from oriental mystics, is nothing of the kind. It has been recognised for centuries that the ability to relax and withdraw into one’s own thoughts and dreams is one of the highroads to sanity in a crisis induced by the rush to “keep up with the Joneses”.

The alternative, of recourse to drugs, alcohol in particular, is on the face of it simpler and quicker, and that is why we are confronted with a major social challenge.

I suggest, to anyone who doubts the value of quiet meditation, the adoption of a comfortable position and the deliberate elimination of mental turmoil. If this is practised regularly for brief periods the result is incredibly exhilarating. So away with the inability to stand and stare!

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Meaningless names

The classification of a psychiatric disorder has now become the subject of intense controversy.

The title of “schizophrenia” was coined in 1911 by the Swiss psychiatrist Eugen Bleuler as an improvement for a previous condition known as “dementia praecox” or early onset dementia. But additional conditions gradually crept into the original diagnosis and by the 1970s it grew unmanageable, from covering certain types of delusions but trying to ignore others.

Patients’ individual stresses, strengths and vulnerabilities came to be overlooked and it came to be appreciated that a mere change of name, as happened in Japan, where it was known as “integration disorder” was an inadequate approach.

Determination of the biological basis of schizophrenia over the past century has not been possible. Features agreed upon are so varied that sufferers gain little benefit from being awarded a diagnosis. If they are told that the essential lesion lies within the brain and is not environmental the news may come to be disheartening.

Moreover, it then happens that other individuals tend to distance themselves from those they regard as incurably insane. Research is revealing a possible role of environmental factors such as stress, childhood trauma and stimulant and hallucinogenic drugs.

Findings indicate the idea of subgroups of the condition and lessening the stigma attached. Whereas 63 per cent of diagnosed patients adopt negative attitudes to the term schizophrenia, some 16 per cent show more acceptance of the various subdiagnoses.

Some resistance has been found from the drug industry, since more diagnoses and subdivisions impair sales of any particular remedy. There is ample fear that however much more research is carried out, the old concept of schizophrenia is likely to persist.

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Psychosis after cannabis

A comment in the 29 July 2007 issue of The Lancet offers some valuable information and some dire warnings regarding the likelihood of unpleasant consequences for those youths who use cannabis. It is known that this is the most commonly abused illegal substance in most countries, including the UK and the US.

Some 20 per cent of young people report the routine use, at least once a week, or heavy use at frequent intervals during adolescence. Unfortunately this is the time when a developing brain is especially susceptible to environmental influence, particularly drugs of all kinds.

According to a report from Copenhagen University Hospital, the risk of psychosis later in life is increased by some 40 per cent in people who have used cannabis in the past and the dose-response effect in the heaviest users may vary from 50 to 200 per cent. If individuals with imminent psychotic disorder try to eliminate their symptoms with the drug the urge to turn to cannabis may outweigh the reverse efforts.

There is sufficient evidence to warn young people that cannabis use will increase the risk of psychosis later in life. In a Danish study it seems that among individuals aged 15 to 34 years about 37 per hundred thousand person-years of incidence is such that translated to the UK we should see about 800 cases of schizophrenia yearly attributable to cannabis consumption. There are practical and ethical reasons against a placebo-controlled trial of cannabis.

Although cannabis is in public debate considered relatively harmless compared with alcohol, central stimulants and opioids, its long-term risk of provoking psychosis requires deeper study.