LETTERS
miliar
primary
alienation
dent
are increased.
way
toward
The
of
the
An open
bridging
scene
Peopk
of assistance, professional
sources
between
these
mind
and
cognitive
of the therapeutic lower
the and
distance and the community
and
cultural
transaction
socioeconomic
of resi-
dence
of opiates,
will go a long
iolytic
agents.
chasms.
analyzed
flexibility
is indeed
status
resent
a urinalysis
showed
trace
amounts
methadone, A sample
as pure
of barbiturates
of crystal
THC
removal
In addition
of
coat and profeswho wish to work
to analgesia,
cyclidine
can
in
image
body
cause and
blood
object
size,
toxic
states
can
develop
complement
his
to play and a stage
performance.
Stepping
out
of
mg of the
setting
character
causes
cognitive dissonance and creates resistances that hamper therapeutic efforts. My appreciation of the paper by Drs. Tseng and McDermott
stems from my heightened awareness of the vital necessity for understanding the cultures of the people who use the CMHC. Their concepts provide a frame of reference that orients one to synergistic
action
rather
than
competitiveness
or
rejection.
This
can only contribute to more effective delivery of mental services to all of the community, whether urban or rural.
health
M. Los
FLORENCE
DOUGLAS,
Angeles.
icity
the
are
alert
to the
marijuana.
In fact,
phencyclidine
can
be
with
of the is ac-
We
inhaled
4.
or
Rainey
JM
Jr.
hope
the
We have recently seen sis that, to our knowledge,
rect inhalation
an example is the first
of the crystalline
of a phencyclidine case reported
THC,”
report. split
single
A 26-year-old it into
dose each
not maintain occasionally
man
14 approximately
day for 5 days.
purchased equal
a gram doses,
He quit hisjob
his balance, spent his days heard laughter when no
Although
it had been
to pinprick
over
10
in con-
JM
suspect
most
or
community
and widespread ( I).
of
these
misdiagnosed
as
will
become
use of phencyclidine:
RENCES
MK:
Prevalence
of phencyclidine 1974 or phencyclidine
in street
Jr.
Crowder
230:824,
1974
MK:
Ketamine
BD, Rosenbaum drug-Sernyl.
81:363-369,
AMA
(ltr
G, et al: Study of a new Archives of Neurology
to ed). schizoand
1959
Reed D, Cravey RH, cyclidine. International
Sedgwick Association
PR:
A fatal case involving of Forensic Toxicologists
phenBul-
7, 1972, p 7 JOHN
M.
RAINEY,
K.
MILES
M.D., Detroit,
JR.,
PH.D.
Mich. M.D. Tenn.
CROWOER,
Nashville,
di-
Smoking
and Mental
Health
form.
listening one in
of “crystal and
because
inhaled
a
he could
to music, the room
and was
denied visual, gustatory, or olfactory hallucinations. When asked what he was thinking, he replied, “nothing,” with a burst of laughter and a flattened, attenuated smile. I-Ic could not understand proverbs but was oriented to time, place, and person. However, he was unable to put his actions in a satisfactory temporal sequence, giving the impression he was floatinsensitive
result
psycho-
following
“
was
hyper-
of 7 to
(actually
laughing. He became frightened because he felt numb, plastic. and was “dripping all over the walls and melting into the furnitune. He was afraid of other people who were in the room but
ing in time.
dis-
N EngI J Med 290:466467.
Luby ED, Cohen phrenomimetic
SIR:
Case
may
agents
medical
caline, psibocybin, cocaine, MDA, THC, and other more attractive drugs, or may be mixed with these agents (I, 2). In one series (1) PCP was detected in 184 of237 street drug samples, and
in our area are purchasing “crystal THC” for $1.50 to $2.00 a pill or $65 a gram.
or violent injection
We
to other
Crowder
preparations.
letin. June
“snorted,” ingested orally, or injected intravenously. It is sprayed on marijuana, parsley, oregano, or other plant leaves and sold as “angel dust,” and, in powder form, is marketed as PCP or “peace pills” (I). It is also frequently sold as LSD, mes-
drug users pencyclidine)
time
amounts
described.
potential of abuse
drug
Psychiatry
or without
smoked,
have
REFE
3.
Journal, Louis R. Hott, M.D., noted that tually phencyclidine smoked in crystal form,
we
M.D. Calif
1974 issue “angel dust”
phen-
alterations
auditory and olfactory or hyperactivity. Pro-
intravenous
Larger
attributed
toxic
it is a major
JAMA
in the December
one (3).
2. Rainey
to the editor
(3).
nystagmus. ataxia,
by semicoma
following
drug
being
schizophrenia
Dust”
In a letter
SIR:
characterized
pure
like
cases
drug on “Angel
was
vulsions, and impurities produced during an improperly controbbed synthesis can cause abdominal cramps, hematemesis, coma, and death (4). This drug is so easily synthesized by amateurs and so widely distributed and sold that there must be many cases of PCP tox-
I.
More
anx-
locally
depersonalization,
activity
The absence of these props health specialist. In short,
and
pressure,
longed
to
obtained
anesthesia,
increased
sential impairs
has a role he is expected
no cvi-
or various
phencyclidine.
tortion, disordered thought processes, hallucinations, delirium, and catalepsy
the therapist
EDITOR
but
phenothiazines,
with them. The community resident knows that powerful people (healers, physicians, etc.) have certain “props” which are an espart of therapeutic activities. the credibility of the mental
THE
important.
the
symbols of authority (for example, the white sional appearance and attitude) by therapists
sense
TO
12 hours the right
since his last dose, forearm
and
he
displayed
a 3 beat per second vertical and horizontal nystagmus with fast upward and lateral components and a slow return. There were no detectable needle marks on his arms, hands, legs, or feet, and
It has been over
10 years
since
the Surgeon
General
first
alerted the country to the serious dangers of tobacco smoking. Since that time, tobacco smoking has been consistently and convincingly implicated in the development of many crippling diseases. Recent research has also revealed that the damaging effects of tobacco smoke are not confined to the user but are inflicted on those in his vicinity as well.
Most in
of the public
a cooperative
and to encourage personnel, who
effort its
have
and almost to
limit
elimination.
observed
all physicians the
increase However,
that
have
responded
of tobacco
smoking
many
smoking
mental
seems
health
to have
a
calming effect on their patients, have been reluctant to discourage the practice for fear of subjecting patients to added stress. This reluctance has led to the common experience of the typical mental health center being a place where both therapists and patients “smoke like crazy.” Although it is to our credit that we try to reduce stress for our patients, it is also true that the gains in physical and emotional health from giving up smoking far outweigh the hardships in-
volved
in the transition
AmJ
period.
Psychiatry
Furthermore,
/32:8,
August
it does
1975
not
make
879