Psycho-pathological aspects of the cannabis situation in Monaco: Statistical data for 1956

Title

Psycho-pathological aspects of the cannabis situation in Monaco: Statistical data for 1956

Sections

I. The cannabis problem in Morocco
II. Statistical data for 1956
III. Sociological and socio-pathological study
IV. General statistical data
V. Clinical study
VI. Conclusion
VII. Annex

Details

Pages: 1 to 16
Creation Date: 1957/01/01

Psycho-pathological aspects of the cannabis situation in Monaco: Statistical data for 1956

Report transmitted by the observer for Morocco, Dr. Ahmed Benabud, at the twelfth session of the Commission on Narcotic Drugs

I. The cannabis problem in Morocco

A. HISTORICAL BACKGROUND

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It is impossible to state accurately the date when cannabis was first used in Morocco. Known to antiquity, Cannabis sativa L. seems to have originated in central Asia, whence in remote times it spread east to China and west to Euro-Africa and, in particular, to the countries of the Mediterranean basin. Used in the ancient world for its textile fibres and oil seeds (hemp-seeds), its inebriating properties were for a long time restricted to the esoteric practices of different religions. Subsequently, and before it became a widespread general inebriant, it was used for its therapeutic properties.

In the fifth century B.C., the Zend Avesta mentioned the physiological effects of the resin and the flowering tops of the plant. In the seventh century A.D., originating in Persia and propagated by the Arab invasions, the use of cannabis spread to Syria and Egypt, the three Moghreb countries and Spain. Well-known Arab doctors such as Ibn Djezha, Al-Awan and Ibn-El-Beythar used it as a medicament under the names of konnab, hashish and fokkra (a reminder, subsequently forgotten, of the Indian origin of the plant).

The use of hashish as an intoxicant must have spread rapidly, and with dangerous consequences, among the mass of the peoples of North Africa, because from the eleventh to the fifteenth century the reaction of sultans and emirs was to inflict severe physical punishment (extraction of teeth, imprisonnment and even the death penalty) in cases of abuse of cannabis.

In the sixteenth century, Alpunis mentions that in Egypt the common people, and also those of the wealthy classes, sought inebriation by smoking assis and eating bers, magi-oun and pills of opium, cannabis and datura.

The first descriptions of the physical and mental deterioration caused by cannabis addiction, which they stated to be widespread, were brought back by the doctors of Bonaparte's expedition to Egypt, and the wars of the conquest of Algeria provided similar information.

In Morocco, Army doctors and, later, medical health officers, frequently took an interest in the cannabis problem. The first official measures, however, were exclusively com-mercial : the Allegories Act had already granted to a company the monopoly of the manufacture and sale of kif, as of tobacco. The aim of subsequent dahirs regulating the cultivation, transport, sale and consumption of kif was the exclusive protection of the interests of the monopoly against clandestine producers and sellers ( dahir of 4 May 1915 repressing smuggling - i.e., extra-monopoly trade).

In 1926, a zone of toleration to the north of Fez was set up in order to allow the adaptation to the new economic order of tribes which had recently submitted. That zone was gradually reduced until, in theory, it was abolished in 1929, although in fact, production continued at a high level, particularly during the last few years of the protectorate. The main economic problem of substitution of other crops - an essential prerequisite of any really effective suppression of cannabis-addiction - was in practice never solved.

In the early days, the monopoly manufactured in Tangier chopped hashish (n'rama), which in 1932 was replaced by the jyed kif prepared at Port-Lyautey - a mixture of kif and tobacco in fixed proportions, that of pure kif ktami (tedrika) being 33%. Although, at the request of the Director of Public Health, in order to mitigate the toxic properties of the mixture, this figure was reduced to 20%, from the moral and health point of view this manufacture legalized use of kif.

However, the suppression of the sale of extra-monopoly kif was effectively carried out with the aid of heavy fines, without suspension of sentence, and even of imprisonment, which was authorized where necessary.

In 1940, the monopoly lost its privileges in the Spanish Zone and in the International Zone: The Spaniards permitted the cultivation of kif, which became quite an important source of revenue in their zone. The contraband trade, with a powerful organization, grew rapidly from year to year and, owing to the complete ban on tobacco, was particularly rife during the last two years of the protectorate. The figures provided in this respect by the tobacco monopoly are most revealing.

The seizures of contraband kif during the past ten years are as follows:

Year

Weight (Kilogrammes)

Year

Weight (Kilogrammes)

1946 5,700 1952 18,800
1947 4,987 1953 18,625
1948 8,800 1954 15,560
1949 7,650 1955 30,700
1950 8,125 1956 7,100
1951 16,000
January 1957
1,005

It is to be remarked that, although the volume of seizures doubled between 1954 and 1955, since 1954 the monopoly has received only a proportion of such seizures ( dahir on the prohibition of kif hemp). Although the sherifian Government propaganda had some effect on the consumption of kif, the reduction by four-fifths in 1956 does not seem to indicate any sharp decrease in the trade.

The regular and large increase in the use of kif is none the less striking, as seen from a study of the figures of production and sales of jyed kif for 1943 to 1953.

Year

Weight (Kilogrammes)

Year

Weight (Kilogrammes)

1943 20,234 1949 48,080
1944 19,271 1950 57,013
1945 19,041 1951 55,456
1946 21,581 1952 46,521
1947 31,057
1953 (First three months)
10,211
1948 17,711
 
 

Sales ceased on the publication of the 1953 dahir.

Pharmaceutical preparations with a cannabis basis are under international control on the basis of a recommendation made by the Health Committee of the League of Nations. The World Health Organization took a stronger line. In its view the use of cannabis for medical purposes was obsolete, and it recommended discontinuance.

The dahir of 24 April 1954 confirmed the abolition of the manufacture and official sale of kif and prohibited its production, sale and consumption. Shortly afterwards, cannabis was withdrawn from the French Pharmacopoeia.

The struggle against smuggling, which was principally aimed at protecting the monopoly's interests, however, came to an abrupt stop, and there was a marked increase in contraband trade.

To the figures both for seizures and illegal consumption, which showed a large and steady increase in the use of kif, must be added the number of cases admitted at the neuropsychiatric hospital at Berrechid, a large majority of whom were suffering from cannabis psychosis. The number o hospital cases rose from 460 in 1946 to 1,850 in 1957. The number of patients treated (2,797 for the period 1936-1946) rose to 7,323 for the last five years alone, and at present cannot be far off 10,000, bearing in mind the work of the urban psychiatry services which have been started in the last few years. It would certainly be an exaggeration to suggest cannabis addiction as the sole explanation of this increase in hospital cases; it is, however, interesting to compare the annual graph of seizures of kif, month by month, which hardly varies year by year from that of cannabis cases treated at the Berrechid hospital.

With hardly any divergence, there are the three usual yearly peaks of March-April, August-September and the end of the year. That similarity is unlikely to be a chance one.

To sum up, in Morocco, cannabis addiction is of extremely ancient origin, vigorously combated by successive governments, but always spreading again as soon as there is a weakening of prohibition. In former times, when serious endemic disease was common, cannabis addiction was not regarded as a major social scourge, and by comparison with others, such as alcohol and opium, it does not appear to be the most pernicious. Today, however, two factors justify stress being laid on the problem. In the first place, there is the appreciable, and even considerable, increase - borne out by different statistics - in the use of kif, particularly among the urban industrial neoproletariat, where its effects are often aggravated by associated alcoholism; secondly, the disappearance of major endemic diseases, such as typhus and malaria, and the decrease in serious social scourges, such as syphilis and tuberculosis, which allows Morocco to tackle the public health problems met with in the highly developed countries - e.g., those of nutrition, psychiatry and mental health, and in particular those concerning drug addiction.

B. PRESENT STATE OF THE PROBLEM

The action taken by the sherifian Government, and in particular by the Ministry of Health, at the end of 1955 and during the first half of 1956 to warn the Moroccan public, through the press, broadcasting and even the cinema, against the abuse of kif, resulted in what was probably a considerable decrease in cannabis addiction. In any case, for seven or eight months there was a definite falling-off in the number of cannabis psychosis cases treated in the hospital at Berrechid; but the number of such cases again rose rapidly in the summer, and reached a peak in September-October 1956.

The problem of crop substitution, already mentioned, should be the first to be solved; the next step will be the launching of a publicity campaign which, in view of the definite public desire to co-operate, should be successful.

However, ktami kif is still widely cultivated in the Tetuan region and in the Rif, where thousands of people dependfor their living on its production. In the southern Atlas region and the Moroccan Sahara, there is general cultivation, even by the best families, of the zerouali, soussi, gnaoui, haouzi (sadda, teloeut) and makhlif (Ait makhlif) varieties of kif. There seems to be a tendency among the wealthier classes to smoke it, often for snobbish reasons. Cannabis addiction among females has also appreciably increased in recent years. Whereas previously the hospital cases were almost entirely confined to prostitutes, who smoked kif, and even opium in the company of soldiers, this year a few women from the middle classes were admitted for treatment.

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Nevertheless, cannabis addiction is found mainly among the poorest classes; and cannabis takes the place of the pain-relieving aspirin; of a "comforting and strength-giving" litre of wine and even of an aphrodisiac. The use of cannabis has become so widespread in the last few years that the number of occasional or regular smokers has been estimated at nearly one million, a figure which has certainly fallen recently. It may be taken, therefore, that the number of smokers suffering from recurrent mental derangement is relatively very low, not amounting to more than five per thousand, a fact which illustrates the mildness of cannabis as compared, for instance, with opium. These figures, of course, include not only patients treated at the Berrechid neuro-psychiatric hospital and by the urban psychiatry services, but also all those with brief oneiritic-aberrational periods following cannabis inebriation, who are generally cured in from one to three weeks. It will be seen that the average period of hospital treatment, both by the urban services and at Berrechid, is not more than six weeks for the majority of acute cannabis psychotics of the aberrational type.

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Kif smoker filling his pipe

C. INFLUENCE OF CANNABIS ADDICTION ON THE NUMBER OF ADMISSIONS TO HOSPITAL (mental cases)

The Ministry of Health, which is giving all the attention required to the problem of psychiatric treatment, is at present building up a system of psychiatric hospital services in each of the large towns of Morocco, each with sixty to eighty beds, for active psychiatric therapy under the direction of a qualified psychiatrist. These services are particularly suitable for the treatment of the very frequent cases of curable acute cannabis-psychosis of the oneiritic-aberrational type.

In the Berrechid hospital, in 1955, the number of genuine cannabis psychotics was 239 out of 1,017 male Moslem patients admitted; 72% of those admitted had to some extent been kif smokers.

In 1956, the figure fell to 68%, but the number of genuine cannabis psychosis cases was 328 out of 1,252 male Moslems admitted, which conceals a relative reduction - particularly marked at the beginning of the year.

The precise nature of cannabis addiction as a factor of admission to hospital will be examined in detail in the clinical study, but it was desirable to insist at the outset on the importance of this question in connexion with psychiatric treatment.

It is to be noted that, owing to the various types of treatment (sleep and electroplexy combined), withdrawal of the drug together with treatment of deficiency diseases and nutritional troubles (apomorphine cure), the number of socially rehabilitated cases is considerable and the number of chronic cannabis psychotics comparatively low.

II. Statistical data for 1956

A. METHODS OF INQUIRY

The basis taken was the clinical observation of the 1,252 male Moslems admitted in 1956 to the Berrechid neuropsychiatric hospital, the number of cases of female cannabis addiction - fifteen - being insignificant. A systematic breakdown of the observations was made using a roneoed card containing as full particulars as possible in each case, a model of which is annexed (see page 16).

One thousand, two hundred and three files were used as providing adequate data. In 824 cases, or 68% of those admitted, kif had been used, either regularly or occasionally. The re-classification and comparison of the different elements included enabled a number of tables and graphs, providing interesting statistical information, to be prepared.

B. DEGREE OF ACCURACY OF THE DATA

It must be pointed out that there are a certain number of factors giving rise to inaccuracies which must not be overlooked in any appreciation of the results of this study.

  1. Certain of these factors arise from the present state of psychiatric assistance in Morocco. Until a few years ago, Berrechid hospital had mainly served the region and town of Casablanca. Economic and social progress has led to increased demands for psychiatric treatment throughout Morocco, necessitating the setting-up of psychiatric services in the large towns, which from the outset were compelled to deal with a large number of cases.

    Thus the Berrechid hospital cannot treat a homogeneous group of patients as in a French departmental psychiatric hospital, where patients from all over the department attend regularly and in the same numbers.

    In Morocco, certain regions - such as the extreme south - send only dangerous anti-social cases, whereas others - such as the Rif - are only just beginning to use the hospital services. Elsewhere, on the other hand, such as in Casablanca, there are the same criteria for admission to the hospital as in a French town, and a considerable number of patients therefore come from that city.

    Thus in the seriousness and long-standing nature of their illnesses and in their ethnic and social origin, there is among our patients a very great diversity, which does not help the establishment of homogeneous statistics.

  2. Further, there are not the same facilities for treatment in the different urban services. At the present moment, for instance, Casablanca is acting purely as a clearing-house, sending to Berrechid four-fifths of the cases admitted, whereas Marrakesh can deal with four-fifths of its cases locally and sends only one-fifth. (Since most acute cannabis psychotics are treated in Marrakesh itself, the figures for this region are deceptively low.)

  3. Lastly, statistical research among the Moroccan people meets with a certain indifference towards accurate research into anamnesis. Population movements, the instability of residence, occupation and marriage all make the accurate docketing of the patient a difficult task.

    On the other hand, some factors facilitate statistical work. Most of the patients, being penniless and therefore mentally backward owing to lack of education and the crippling worries of a hard life, live in a world without many complexities. Their reactions to the toxic effects of cannabis addiction will consequently be of little variety, and the symptomatology is generally restricted. That fact has made possible the statistical simplification of the table " Clinical classification ", which has been reduced to a few of the commonest syndromes.

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Cannabis field in the Rif

III. Sociological and socio-pathological study

A. DEMOGRAPHIC DATA

A brief summary of the demographic background of cannabis addiction is now called for.

In Morocco, out of a population of approximately 9,300,000 there are 8,700,000 Moslems, 400,000 Europeans and 220,000 Jews. Of the 8,700,000 Moroccans, 80% are country dwellers, of whom four-fifths are farmers, forest-workers or fishermen, most of the remainder being traders.

The Moslem urban population group, living for the most part in seven large towns, consists of 1,900,000 persons, of whom 550,000 (according to some authorities 600,000 to 700,000) live in Casablanca. In view of the wide population movements, particularly the regular drift of country people to the towns - which increases in years of bad harvests - and the difficulties of census-taking in the derbs and the shanty towns, the exact figure cannot be given.

Professor Montagne has estimated at 700,000 the size of the urban neo-proletariat, most of whom have come from rural areas to the large towns within the last fifteen years, Over half of whom (400,000) are said to live in Casablanca. The capital importance of this neo-proletariat in the spread of cannabis addiction will be seen; it is such that the sociological study of cannabis addiction generally has as its subject the Casablanca neo-proletariat, because it is typical and forms a majority.

Although kif-addiction is widespread in country districts, it is mainly found among moderate smokers, who smoke only at work, in order to keep up their spirits, or as a relaxation. Cannabis addiction there shows no signs of being a compulsive need, and is different from that mass addiction found among the urban proletariat. As the country saying goes, "A little kif warms; a lot burns."

Moreover, the countrymen, who are socially better integrated (because of family, tribal and religious influences), seem to have a much stronger psychical resistance to the drug. The index "number of cannabis psychotics compared with the number of smokers" is estimated at about one-tenth of the figure among the Casablanca proletariat.

Out of 1,250 male Moslem cases admitted in 1956 to the neuro-psychiatric hospital at Berrechid, of whom 68% were kif smokers, - for a total population of 8,700,000 - more than half (639, 78% of whom were kif smokers) came from the Casablanca proletariat, numbering approximately 400,000 persons - i.e., these included twenty-one times the number of patients in the other population groups. When allowance is made, however, for the large number of cannabis psychotics treated by the urban services (Marrakesh, Rabat, Fez, Oujda) and violent cases of kif-smoking cured after a short spell in the Marabouts - whereas four-fifths of the Casablanca cannabis psychotics are directly evacuated to Berrechid - this figure must be reduced to about ten times, which is none the less highly significant.

B. CANNABIS ADDICTION AS A MASS INTOXICATION

Mass addiction in its most pronounced form is found in Casablanca.

As will be seen from the statistics, there is an obvious homogeneity in this neo-proletariat of rural origin, for the most part Berbers with scanty means, in small jobs which are uncertain and changing, wretched food and housing and who, moreover, have no future to look forward to. It is among these people that the use of kif has become widespread, often being taken in considerable quantities, which upsets still more the balance of consumption: irregular and hopelessly inadequate budgets are further burdened by the relatively high cost of kif, which is expensive compared with the general cost of living (2,000 francs per kilo wholesale, but a daily expenditure of 152-200 francs being quite normal).

Addiction has taken a firm hold in this class which is narrow-minded, highly suggestible, with a tendency towards compulsive imitation and always on the verge of an ever deeper frustration in an atmosphere of endemic poverty. Encouraged by tradition, by the therapeutic, strength-giving and tonic properties of the drug, by its innocuousness - which have always been acknowledged - the kif-smoking habit has become an essential part of the personality of the smoker like the daily three litres of wine in certain French proletarian circles.

This mass addiction seems to have such clear characteristics and to be set against such a definite background that it seems justifiable to speak of a veritable socio-genesis of cannabis addiction. The same situation in the other large towns of Morocco and in those areas in the process of industrialization can be compared with the type of addiction in the country districts, which, though endemic, has far fewer psycho-pathological consequences. Cannabis addiction is certainly prevalent there, as among the wealthier classes, where mahjoune, chira and kif (even kif mixed with small sandalwood shavings) are used. But the man in easy circumstances, and even the ordinary farmer with a few animals and a small holding, does not indulge in the kind of drug suicide met with among the uprooted and poverty-stricken proletariat of the large towns.

C. CLOSE RELATIONSHIP BETWEEN THE INEBRIANT AND ETHNIC MORPHOLOGY

The view may be held without exaggeration that the people of every country have a pronounced weakness for one type of addiction, based on fundamental social aspirations as old as mankind itself, and that the choice of the drug is not prompted by chance or by cultural or economic opportunity, but on the contrary corresponds to a congruence between the effects of the drug and certain constitutional compulsive characteristics of the individuals who indulge in it.

Thus, there is an obvious relationship between the European, whose characteristic psychological structure is psychical extroversion, a psychothymic dynamism prompting him to immediate action and the challenge of his environment, and alcohol, which releases active and - on occasion - destructive impulses, aggressiveness and the will to power. In the same way, the schizothymic, introverted and contemplative temperament of the Far East is stimulated by the corresponding properties of opium.

In Morocco, drug addiction seems to induce in the smoker a psychomotor exaltation and an exuberance that cut through the family frustrations and taboos which may be particularly oppressive in Moslem society. The Moroccan, who is normally a visually imaginative person, naturally argumentative, with feelings (often tinged with mysticism and intimations of the supernatural) that may be collectively shared and an emotional love of gesture sometimes expressed in a theatrical manner, may, through kif, give rein to these profound tendencies, for the drug stimulates oneiritic imagery, amplifies emotional overtones and facilitates the kind of collective "osmosis" characteristic of smoking parties. These parties are usually accompanied by interminable, blissful and friendly wordspinning, but not infrequently, after a few pipes, a mood of resigned akinesia will give place to impulsive release in action.

D. NATIONAL PERSONALITY CHARACTERISTICS AS TOXICOPHILIC FACTORS

Apart from individual cases, clinical observation among the most backward classes has enabled certain characteristic features predisposing them to addiction to be singled out. In particular, those people newly come to the city show a structural weakness of the ego, which is no longer buttressed by traditional custom; moreover, they have not received an adequate intellectual and moral training.

Hence, the mental attitudes and behaviour usual in the emotionally immature are extremely common - prevalence of the imaginary over the real, of the present over the future, with the impulsive need of the habitually frustrated for the immediate satisfaction of desire.

All those circumstances encourage the general and excessive use of the drug, in addition to a certain indifference on the part of the individual to his own fate, to the space/time details of his existence, and to the long-term consequences of his actions. The idea of responsibility towards oneself and others, which depends on the individual's degree of emotional maturity, is frequently insufficiently developed among the Moroccan proletariat, who generally prefer to fall back on symbolic interpretations and notions of magical possession and sorcery.

The importance of collective impulsive action, which is the outlet for individual weakness of the personality, is again to be noted. Mental transmission and mimesis, together with proselytizing tendencies characteristic of smokers, further encourage drug addiction.

E. FACTORS ARISING OUT OF CONTEMPORARY SOCIO-ECONOMIC DEVELOPMENT

There is no doubt that in certain areas present-day socio-economic developments have created an atmosphere favourable to the spread of drug addiction.

No further reference will be made to the industrialization of the large towns - and in particular the seaports - which in a few decades has confronted Morocco with the serious social problems found in England in the nineteenth century, but which here are complicated by rapid increase in population. The structure of the working population has undergone radical changes because of a steady and vast rural exodus (an annual increase of 5% of the population of the towns as against 2% of the total population), which has produced an unstable mass of people living on the edge of organized society, with no security in their lives, who are constantly and painfully made aware of the relative opulence of the European way of life, not only through the difference between the "European city" and the "Medina ", but also through the cinema, the press and broadcasting.

The breakdown of the archaic tribal and family structures has encouraged family instability (2.7 marriages per female and 1.8 per male among the 50,000 inhabitants of Ben-M'Sick), while religious and moral principles have weakened.

The forced inactivity of the unemployed and of men without a regular occupation or in small jobs (cf. statistical tables) drive them to drug addiction. Malnutrition and the eusuing deficiency diseases also encourage the individual to seek in drugs - not only in kif, but also, as will be seen, frequently in alcohol - a substitute for food and a sedative for the pangs of hunger. It is natural that these undernourished persons should have a weakened resistance to intoxicants, which rapidly becomes a tyrannical and permanent addiction.

For such people, the use of drugs as a refuge against moral despair and hunger has become a necessary element in their lives.

F. MODES OF SPREAD OF ADDICTION

Casual drug-taking as part of an "initiation" or an isolated therapeutic experiment is the exception.

Stress must be laid on paroxystic abuse during feasts, for such occasions are both frequent and important in the life of Moroccans - even the poorest - which tends to make the consumption of food still more irregular. These abuses, however, like the heavy drinking which accompanies European festivities, appear to have pathological effects only among individuals already predisposed to them, as the simultaneous intake of food diminishes the toxicity of the drug. On the other hand, frequent abuse during the fasting period of Ramadan produces a definite annual peak in the admittances to the Berrechid Neuro-psychiatric Hospital for cannabis psychoses. Further, in addition to personal, emotional and occupational stress, there is social and political stress, which undoubtedly affects the consumption of kif, whether for the purpose of alleviating distress or as a means of celebration, and there was a sharp increase in the number of cannabis psychotics during the outburst of popular rejoicing in October and November of 1955.

In the spreading of addiction, the importance of the prejudice in favour of kif on account of its innocuousness, its curing of toothache, lumbago, cephalea, etc., must also be emphasized. Certain sects (Air Saoua, Hamatcha) use its analgesic and stimulating effects in order to practise public self-mutilations, which can be of a striking nature and which further enhance the prestige of the drug. As for the inveterate smoker, friendly and talkative, he is regarded by the public with the same indulgence shown to the "soak" in western countries. Moreover, kif has the reputation (not upheld by the facts) of stimulating sexual powers, and it is used as an ingredient in certain recipes for reviving a flagging desire.

The extent of the kif distribution network and the large number of places where it is used facilitate the spread of addiction. Although the wholesalers with their bundles of kif are relatively few and far between, the number of small clandestine pedlars in the souks or the street stalls is legion. They come under the category of persons in small jobs without regular income (discussed below), and are obviously more exposed than other people to the danger of addiction.

There is no need to dwell on the frequently described smoking parties, where five or six persons in a closed room - at the back of a cafe, a tailor's shop or a barber's - smoke a series of pipes with resultant progressive inebriation. These parties meet a profound need for friendly relaxation in the company of men, the strong homosexual element in the male psychical constitution sometimes finds release at them, and they are a comparatively common means of initiation of young people into drug taking.

Lastly, especially in urban circles, where less heed is paid to the Koranic principles, wine is often taken while smoking, particularly when the drug taking is inveterate, and moral anaesthesia most prononced. As to the other toxic associations (considered below), from the sociological point of view, the comparative frequency of carbon monoxide poisoning must be mentioned, for this is a real occupational hazard of the ferranji, the stokers in bakeries or in the hamman, who work in unhealthy conditions. These people take kif as a relief from persistent headaches and mental depression, a remedy which merely aggravates the intoxication. Mention must also be made of the poly-intoxication of soldiers drinking wine and smoking kif - and sometimes opium - which may lead to anti-social demonstrations, often serious; and, curiously enough, they show frequent psychotic reactions of the querulant type in connexion with their pension rights.

G. INDIVIDUAL PSYCHO-PATHOLOGICAL FACTORS

Socio-genesis is obviously not the whole explanation, and predisponent mental structures are very common among smokers, in particular periodic compulsivity among those who are constitutionally epileptoid, cyclothymic or hypermotive, which drives them to paroxystic toxic abuse and to recidivism. These are the serious cases, indulging their antisocial impulses, which may be compared with the pathological alcoholic inebriation of Europeans. Forms of mixed intoxication of kif and alcohol are also frequent.

As in the case of alcohol, an inadequate basic personality is particularly frequent: mental debility (accompanied by dangerous suggestibility and imitation of amoral acts stimulated by the intoxication), and emotional immaturity (with a feeling of inferiority or masochistic aggressiveness), which leaves the individual defenceless against the temptation of drug addiction.

Moreover, a certain number of known psychopaths suffering from epilepsy, cranial traumatism or syphilitic or paludal infestation have a particularly sensitive reaction to drugs.

Lastly, it is well known that the prodromic period in schizophrenia is often characterized by incidental drug taking, which is both the effect and the cause of the disease.

Thus, the importance and the frequency of constitutional predisposition are clear, a fact which justifies the adaptation of the well-known saying, "You are a kif addict long before you smoke your first pipe."

There are also the family nature of certain constitutional types of addiction (in five years both a father and son have been under treatment for addiction and there have been nine cases of two brothers) and the craving for any drug whether it be kif, alcohol - and even opium - or datura, with the minor elements represented by tea and tobacco.

IV. General statistical data

The analysis of the cards on the annexed model of kif addiction cases admitted to hospital in 1956 gave the following statistical details:

Proportion of smokers: 68% of cases admitted (824 out of 1252).

(a) Age

The age curve shows:

  1. A few very rare cases (4) of paroxystic incidents among children (12-15 years), all from Casablanca;

  2. A high and broad peak between 30 and 35 years of age;

  3. A rapid fall after 40, with a "plateau" at about 55 years of age.

(b) Sex

It has already been pointed out that the cases are almost entirely males. There were only fifteen cases of female cannabis addiction, of whom five were prostitutes but, on the other hand, three were women in comfortable circumstances.

(c) Vital Statistics

  1. A striking feature is the large proportion of unmarried men or men separated from their wives (42%), which seems to correspond with pauperism (see the table on income: 52% without regular income). Many alcoholics are also unmarried, a fact frequently indicating inadequate social integration.

  2. There is also a high percentage - 18% - of divorced persons (mainly from Casablanca):

     

    Percentage

    Married men
    30
    Widowers
    4
    Status undetermined
    6

(d) Means

Without regular income
52
Income of 10,000-15,000 francs (monthly)
23
Income of 15,000-20,000 francs (monthly)
16
Income of over 20,000 francs (monthly)
9

Since the average annual income of a Moroccan family is about 200,000 francs, the majority of patients, falling appreciably below that level, are in the poorest stratum of the population. Moreover, out of 1,410 Moroccan Moslem hospital cases, there are 1,311 needy persons in the care of the Welfare Service, only 28 of whom can afford to pay hospital expenses. The point must be stressed, therefore, that it is precisely the poorest budgets which are further burdened by expensive purchases of kif. This explains the many examples in the case histories of broken families and abandoned children caused by addiction.

(e) Housing

Under this item, inaccurate replies were common, because many patients appear to attach little importance to settled dwelling: 35% live in shanty-towns, in the towns or in noualla in the country districts; 52% live in houses in the medinas of the large cities and small towns; 11% have no fixed residence; 2% are nomadic shepherds (Berbers from central Morocco or Arab-Berbers from the extreme southwest).

Mention must be made of the patients’ reports of the particular incidence of overcrowding in the houses of the medinas, with the result that they seem less healthy and more pathogenic than the shanty-towns. The proportion of shanty-town dwellers compared with those in stone buildings is obviously much higher in Casablanca than in other cities. Finally, there is the frequent impermanency of lodging: during the year preceding their admittance to hospital, about 30% of patients had changed their residence or their town more than twice.

(f) Place of Origin

The statistics have been established by province, large city, small town and bled.

Distribution by province

Percentage

Province of Casablanca
57
Province of Rabat
10.5
Province of Marrakesh
7.5
Province of Meknes
5.8
Province of Fez
2.3
Province of Tangier
4.4
Others
11.6

The results show:

  1. The great importance in this respect of Casablanca, which sends 47.5% (53%, if the 5.5% of those without fixed residence from Casablanca are included). If Casablanca (550,000 inhabitants) is compared with the whole of the six other large cities (with a total of 1,900,000 inhabitants), the proportion is even greater, amounting to 68%.

    However, it has already been pointed out that Rabat, Marrakesh, Fez, and Oujda have psychiatric services treating curable acute psychoses - usually cannabis cases - which are therefore not included in the Berrechid statistics. On the other hand, Casablanca, which is merely a clearing-house, sends almost all such cases to Berrechid.

  2. A majority of town dwellers: 63% of patients come from the seven largest cities; 12% come from small towns of less than 20,000 inhabitants; 11% have no fixed residence, half of whom come from Casablanca.

  3. Country districts provide only 14% of patients (of whom scarcely two-thirds are farmers).

These figures confirm what has already been said of the importance of cannabis addiction among the urban neoproletariat and its comparative infrequency in the country districts (however, the well known indulgence of the tribes towards mental cases must be stressed).

It should be noted, however, that the proportion of unmarried men and men separated or divorced from their wives is much larger in Casablanca.

(g) Occupation

The striking feature here is the large number of patients without regular means of support, representing 60% of the cases admitted, broken down as follows : (1) No regular occupation, 47%; (2) unemployed, 39%; (3) casual labour or persons without qualifications in small jobs (water-sellers, skewered-meat-sellers, cigarette and kif vendors, bootblacks, beggars, etc.), 14%. The proportion of workers is 17%, composed of : Labourers, 35%; comparatively skilled workers in regular employment (bakers, masons, dockers, chauffeurs). 53%; genuinely skilled workers (mechanics, welders), 12%,

The proportion in agricultural occupations is 10% ( rhames [ share-croppers], small farmers, shepherds).

Note that one-third of the patients from the country districts are not farmers, but traders and persons not in regular employment, etc.

The proportion of craftsmen (tailors, cobblers, carpenters, barbers - whose shop is often used for smoking) is 6%.

The proportion of traders is 3%.

The proportion of civil servants is 2% (with a high percentage of moghaznis, policemen, railwaymen and postal employees).

A balance of 2% gave no particulars.

It is interesting to compare these figures with those given by the general statistics of Morocco as regards distribution in the three sectors of economic activity:

 

Total population (Percentage)

Hospital cases (Percentage)

Primary activities (agriculture and mines)
72 10
Secondary activities (industry)
18 17
Tertiary activities (trade and services)
10 5

V. Clinical study

A. METHODS OF INTOXICATION

(a) Drugs

The commonest drug is cheap kif, deficient in active properties and mixed with tobacco in varying proportions. One out of four addicts have also consumed cannabis preparations in the form of a paste or a decoction. The average number of pipes smoked is between twenty and thirty daily, but figures of forty to fifty are not infrequent. The cost varies between 100 and 400 francs a day.

(b) Associated Intoxicants

The main intoxicant is obviously alcohol, the frequency of which is seen in the annexed statistical table. It is usually combined with kif smoking. The consumption of large quantities of cold tea ( deka) or coffee is an additional stimulant, which is sometimes by no means negligible. The combination of cannabis and datura or belladonna may be much more serious, for it induces a state of either acute rage or stupor, but it is rare. Mention has been made of some cases of the kif-opium association among former soldiers.

(c) The Pattern of Intoxication

The duration of the addiction has often to be taken into account; some patients had already begun to smoke at fifteen years of age. However, the important fact is that cannabis addiction is not marked by the progressively increased consumption characteristic of more serious drug addiction. Habituation is hardly appreciable, and only about one-third of the patients are regular smokers. Withdrawal is not usually followed by psychic or somatic effects.

Occasional smokers have psychopathic reactions only when there is a considerable basic psycho-pathological element. In such cases, there is pathological inebriation, and with certain patients the threshold of excitation and oneirism is reached at a very early stage.

The most typical feature of the addiction is its paroxystic character. The uncertainty of supplies and of funds available encourage irregularity of consumption. Smoking takes place particularly among friends and people of the same occupation and on occasions for rejoicing or at feast times. The craving becomes paroxystic and there is massive intoxication. Most acute attacks begin in this manner.

(d) Duration of Treatment at Berrechid

The table in the annex gives the following groups : 50% of patients are in hospital for under three months; 30% are in hospital for under one year; 20% are in hospital for over one year.

The average length of the first period in hospital is forty days. The over-all proportion of relapses is one-third, and the second period lasts on an average fifty-two days. One in ten patients suffers two or more relapses, the repetition of the treatment being due to psychoses of varying origins in which drug addiction is merely an element. Such psychoses constitute almost the entire number of relapses after the third period of treatment.

60% of cannabis psychotics leave hospital before the end of three months and 40% after three months, whereas in cases of psychoses of varying origins in which drug addiction is merely an element, the proportion is reversed, 40% leaving before the end of three months, and 60% after three months.

The duration of these psychoses varies considerably; some, in which the incidence of cannabis predominates, being of very short duration, and others - the serious psychoses, in which intoxication is merely an accessory cause of aggravation - being fairly prolonged.

Cases of toxi-infectious psychosis, which are serious on account of the association of several etiological factors, form the largest number of admittances, remain for the longest periods, and show the highest mortality (6.8%). On the other hand, there are few relapses in this group.

Cases of psychosis with a cannabis element only show the lowest death rate (2.9%). The general mortality rate of the hospital is 8% of admittances, and the general mortality among cannabis cases is only 4% (the majority of patients being young, serious somatic effects are relatively rare).

B. GENERAL CHARACTER OF PSYCHO - PATHOLOGICAL REACTIONS IN MOROCCAN SOCIETY, WITH PARTICULAR REFERENCE TO CANNABIS ADDICTION.

The general reaction of the Moroccan psychical constitution to morbid processes of whatever origin must first be made clear. It will be seen that, whatever the etiology, there is a certain definite similarity in the general features of these Moroccan defence reactions. In particular, cannabis intoxication does not appear to cause any specific reactions.

Generally speaking, therefore, and whatever the nature of the morbid trauma, the mental defence reaction of backward Moroccans is a progressive and lasting stupor, the elements of which are psychological withdrawal, mental inertia, lack of interest in the surroundings, and a kind of intellectual hibernation, which may be regarded as dementia, but can be completely cured, sometimes after several years. These defence reactions are very different from those of the European, whose resistance to mental disease usually takes the form of a multiplication of delirious patterns or of positive reactions, giving place to dementia - which is then chronic - as the unfortunate conclusion of a prolonged struggle. The Moroccan seems to range time on his side, husbands his strength and, armed with patience, solves the problem by the supernatural explanations so frequently heard on the lips of our patients.

There is, moreover, a fairly widespread thymo-emotional instability, in which short, sharp and violent reactions, not produced by formal mental processes, predominate. The victims of this instability are at the mercy of the slightest trauma, particularly of a toxic nature, but, as will be seen, the trouble usually passes quickly.

It is a quite common psychiatric experience to meet with phenomena of dissolution of consciousness accompanied by oneiritic states of imaginative repression which give the impression of a fundamental deterioration of the psychical pattern, whereas there is merely a temporary functional disturbance.

Lastly, there are repetitive tendencies - in particular, spectacular behaviour - and those of mental perseveration, which may be checked by counter-suggestion and carry no implications of stereotyped attitudes.

To a large extent, the root of all these phenomena, which are the most obvious features of our daily observation, is cannabis intoxication. However, one has the impression that in this respect the response of the psychical constitution to a particular trauma - of a toxic nature, for instance - is less specific than in other cases.

This explains the difficulties and the nature, sometimes rather artificial, of the clinical classification of cannabis cases (cf. statistical table annexed).

In short, there are many cases where a temporary or slight intoxication will have no effects and has no connexion with the mental disorder.

On the other hand, there are many genuine cannabis psychoses in which the role of the intoxicant is both obvious and exclusive, or, on occasion, is supplemented by another intoxication or some organic infection.

In other cases, the psychopathic structure will predominate, cannabis intoxication being merely an element which may have brought about a veritable mobilization of latent psychopathic elements, or - as sometimes with alcohol at the beginning of schizophrenia - may precipitate the development of the prodromic stage of a psychosis.

Further, and finally, the use of kif may merely aggravate a psychosis already developing independently (a toxic oneiritic aberrational-syndrome aggravating, for instance, the development of epilepsy).

C. CLINICAL ASPECTS OF CANNABIS PSYCHOSES

The detailed clinical study will be confined to the main cannabis psychoses, where the mental disorder is directly conditioned by the intoxication, mental predisposition playing only a minor role.

Paroxystic manifestations taking the form of acute or subacute psychosis are by far the most frequent, and are often the first indication of derangement, which, however, is sufficiently serious to justify hospital treatment. This first stage may be succeeded by a more prolonged residual syndrome and a second attack often necessitates further treatment after a short period. Patients who have had several such acute attacks of intoxication often show some degree of psychological deficiency and even of physical deterioration.

(a) Acute or Sub-acute Psychoses

It has already been pointed out that certain subjects, owing to particular susceptibility, show signs of acute disturbance after very small doses of intoxicant. These cases should be compared with the pathological inebriation described in connexion with alcoholism. Generally speaking, these acute states, which are rarely produced by an intercurrent morbid condition, and still more rarely by withdrawal, occur as a reaction to a sharp toxic overdose. The acute stage usually lasts some days, being followed by a residual amnesia of the lacunary type and prolonged intellectual lethargy.

The main features of acute psychosis are excitation and an impulsivity liable to produce serious anti-social reactions (violence shown particularly towards the mother, the wife or the family, or against types of individuals who attract hostility for political or religious reasons).

There are also: phenomena of mental aberration showing every degree of complex, oneiritic and predominantly visual poly-hallucinatory states; disturbances of exteroceptory and proprioceptory categories, with a deterioration of the spatial faculty, which may cause a dissolution of the unity of the personality, and is accompanied by autoscopic phenomena not dissimilar to those found in certain psycho-motor paroxysms of temporal epilepsy. These phenomena of dissociation may also take the form of post-oneiritic ideas, when the patient persists in the conviction of the duality of an "actor-ego" and a "spectator-ego ". However, the atmosphere of oddity and fantasy characteristic of cannabis oneirism only rarely produces an anxiety reaction. There is a kind of detachment facilitating the thymic reactions that encourage recourse to frequent erotic or mystical "elements ", among which ideas of satisfaction or power, themes of greatness and kinship or identification with God, the Prophet or the Sultan are most frequent. Occupational themes are rare, except in cases of associated alcoholism or carbon monoxide intoxication. The frequent impulsivity seems to be linked with a constitutional pattern rather than to depend on oneiritic phenomena, and is similar to epileptoid reactions in its lack of motivation, the absurdity and sometimes the savagery of the acts committed, as if a breaking wave were to sweep over the consciousness, leaving behind it very often only an amnesia and indifference. These are mainly cases of aimless fugues, impulsion to destructive or homicidal acts, outbursts of pyromania, or sexual offences.

Depending on the dominant aspect and the intensity of the disturbance, three basic symptoms may be isolated: aberration, oneirism, and excitation, the clinical forms of which, in order of frequency, are: maniac-aberrational; oneiritic-aberrational; simple maniac; aberrational or catatonic stupor; simple intellectual obfuscation.

(b) Residual Cannabis Psychoses

These are prolonged psychical disturbances following a paroxysm, and are often similar to schizophrenia, chronic hallucinatory psychosis and even dementia. However, traces of oneiritic patterns supporting delirious beliefs are met with; these latter are blurred, scarcely expressed, irregular; and without any tendency to become organized and to proliferate as time goes by. On the contrary, they tend to become dim and to disappear after a few months. There are thus:

  1. Pseudo-dissociations

    In a young subject, towards the end of the initial stage, there is a condition of atypical depression with mimetic insufficiency, oddities of behaviour and an inability to face reality resembling schizophrenia; there is no genuine autism, but rather a sort of paralysis of the personality, leaving nevertheless some possibilities of contact with the outside world, a contact reflected in phenomena of passive, plastic suggestibility.

  2. Prolonged Aberrations

    There is persistent mental obfuscation, apathy and complete inactivity, whether accompanied or not by oneiritic phenomena.

    An infectious additional factor (paludism, syphilis) is common in the etiology of these aberrational conditions. They may be interspersed with attacks of tremor, but often disappear after a few months.

  3. Hallucinatory Syndromes

    Hallucinatory pseudo-delirium may occur residually after the acute initial stage, but the themes of delirium are poor, without any imaginative or interpretative richness, and the absence of reactions on the part of the patient is more or less constant.

    Auditive hallucinations take the form of insulting words, of invective of a religious or political character, or dealing with sexual taboos; they are stereotyped, varying little from one patient to another, and have an anonymous character, because of which the naming of the persecutors is rare.

(c) Psychical Cannabis Deterioration

This occurs in regular smokers to whom prolonged toxic impregnation imparts distinctive characteristics. These are the old addicts, exuberant, friendly, kif-happy vagabonds, often oddly dressed and living by begging.

Their decay - usually progressive - affects, first, their occupational capacity and then their family behaviour; a lowering of affectivity is soon accompanied by a weakening of the moral sense; temperamental disturbances are rarely pronounced and anti-social reactions of minor importance.

Physically, inveterate smokers suffer from a precocious senescence, which occurs sometimes in the forties.

The over-all deterioration of the faculties may be sufficiently serious to produce general paralysis, other symptoms of which may also be found, such as tremulation, dysarthria and vague and puerile ideas of supremacy.

(d) Somatic Trauma

Generally speaking, even when the condition is acute, serious somatic trauma is rarely met with, as in the case of serious toxi-infectious syndromes: Neuro-vegetative derangement is usually not pronounced, and the prognosis quoad vitam favourable, except in the rare cases of a profound physical trauma caused by massive and prolonged intoxication or by an intercurrent infection.

Quite often the impregnation of the nervous system produces trembulation, either digital or lingual, which may even be generalized. Tendinous hyperreflexia is common, but the symptoms of the poly-neuritic series are exceptional, save in cases of associated alcoholic intoxication.

Cephalea, vertigo and insomnia are frequent, as are digestive troubles, loss of weight, subicterus, anorexia, constipation and dryness of the mucous membrane.

Visual trouble is also met with: amblyopia, myosis, decreased photo-motor reflex, retinitis.

Sexual impotence is practically the rule among aged smokers.

Special stress must be laid on deficiency troubles, both nutritional and toxic in origin, which are probably the cause of most nervous and mental derangement. And the prognosis or, at least, the rapid cure of cannabis intoxication, will often depend on their prompt treatment.

D. ANTI - SOCIAL REACTIONS

Cannabis intoxication is generally regarded as being at the root of derangement causing anti-social behaviour, withs a high medico-legal co-efficient.

Difficulties of occupational behaviour are common; idlenes seems to be the first consequence of drug-addiction, and is often accompanied by neglect of family duties.

In most addicts, there is a social degeneration which is mainly responsible for minor anti-social acts, such as disorderly behaviour, vagrancy, petty crime and moral depravity. Despite their frequency, acts of violence do not usually have serious consequences, and they are committed particularly against other members of the family.

The role of intoxication must be stressed in the origin of serious crime, such as arson, indecent assault and homicidal acts. For instance, among the in-patients, three-quarters of the criminal acts were committed in a state of semi-consciousness caused by the intoxicant. Such reactions usually take the form of a psychomotor paroxysm, but they appear to be conditioned rather by heightened constitutional impulsive tendencies rather than by oneirism, in which the thymoaffective element is not usually pronounced, except in the specific cases of additional alcoholic intoxication. Inebriation of the despair type is particularly frequent among isolated smokers, for isolation appears in addiction as a definite factor of pathological predisposition. Frequently, these persons are epileptics or schizophrenes, whose aggressive potentialities em to be aggravated.

Serious anti-social reactions show little variation in nature: there is a lack of precaution, with no premeditation, nor affective or concrete motivation, and frequently the victim is picked at random.

In most criminal acts, there is also an outstanding element of violence and persistence.

It is an interesting fact that there is a comparatively large proportion of incendiaries among cases of toxic psychosis. Suicide, a rare phenomenon in Moslem pathology, is found only among recognized psychopaths, whose mental derangment has been aggravated by drug addiction. Similarly, the proportion of homicidal reactions appears to be relatively greater in persons whose psychological pattern is stamped with definitively abnormal characteristics.

E. PSYCHOSES WITH A TOXIC ELEMENT

The part played by constitutional pattern or morbid predisposition in the birth of the kif smoker's mental derangement has been mentioned. The role of the intoxicant is essentially that of an element, either through the precipitation or mobilization of latent pathological states, or through the aggravation of the clinical symptoms or the development of constituted psychoses, features of which were already clearly determined.

(a) Mobilized Psychoses

These occur in patients whose mental derangement had usually remained in the sub-clinical stage. Intoxication introduces an acute stage, of which the main component is oneiritic-aberrational, during which symptoms of initial mental morbidity appear. The patient enters the active stage of his psychosis, which then seems to develop independently. This is the pattern of development, of a certain number of schizophrenic psychoses, the delirious outbursts of degenerates and paranoiac psychotics.

(b) Aggravated Psychoses

Cannabis intoxication may change the behaviour of some recognized psychopaths, and in most cases there is a low threshold of toxic susceptibility.

Schizophrenic conditions show heightened impulsive tendencies, which are often responsible for acts of violence; the most characteristic complication is seen in catatonic attacks, and there are also hallucinatory delirious outbursts, which appear to affect the subsequent development of the disease.

Among intermittent smokers, toxic excess aggravates not only the frequency of the attacks, but also their symptomatology. Manic attacks are by far the most frequent, and there is always a more or less noticeable element of aberration and oneirism with considerable agitation.

Under the effects of intoxication, epileptics pass through acute psychopathic stages of the oneiritic-aberrational type or else hallucinatory delirious outbursts, and there is also a recrudescence of critical symptoms.

Cases of cranial traumatism are particularly sensitive to intoxicants. They may show symptoms of an epileptic type or oneiritic-aberrational attacks.

F. CANNABIS PSYCHOSIS WITH A TOXI-INFECTIOUS ELEMENT

In certain cases, the clinical pattern of cannabis-psychosis may be aggravated by a toxic or infectious association, the two commonest and most outstanding factors being alcoholic intoxication and evolutive syphilis.

The commonest clinical symptoms are represented by a serious oneiritic-aberrational condition, with strong somatic participation and an element of decompensation, which is unusual in straight cannabis paroxysms. In such cases, the mortality rate is definitely higher than in the other forms of intoxication. Alcoholic intoxication sometimes leads to disturbances of the poly-neurotic series.

VI. Conclusion

The consumption of kif in Morocco, which, liable to fairly wide fluctuations, had appreciably fallen at the end of 1955 and the beginning of 1956, has since then risen again - particularly in August, September and October 1956 - without, however, reaching the level which obtained prior to the government campaign.

From the psychiatric point of view - the approach which interests us - it would seem desirable to unify the anticannabis campaign by the following means:

  1. Better knowledge of the psychiatric and social aspects of cannabis addiction through the general use of a record card for drug-addict mental patients in the different psychiatric services. This could be similar to that used for the present psychiatric statistical enquiry;

  2. The establishment of a central card index for classifying data received, and acting upon the conclusions drawn;

  3. Standardization of the psychiatric and somatic treatment of drug addicts with a view to generalizing, by comparison of methods and results, the most effective methods of treatment; in particular, the correction of deficiency factors might be made on the basis of recent research and the immediate results available. Further use might also be made of conditioning treatments which, having been tested at Berrechid for two years, have already given highly satisfactory results;

  4. The extension in the large towns of psychiatric consultations for out-patients by qualified psychiatrists, which would allow a certain number of cases of intoxication to be detected before the appearance of serious mental derangement, the supervision of convalescent addicts, and the intensification of propaganda in circles from which addiction stems.

Since the socio-economic evolution of the country will inevitably entail an increase in mental disease every year, it is obviously more necessary than ever to reduce the incidence of cannabis addiction, thus relieving the pressure it exerts on hospital facilities.

VII. Annex

Anti-social reactions

Anti-social reactions

Specific cannabis psychoses

Psychoses with cannabis element

Cannabis psychoses with toxic- infectious element

Pure cannabis psychoses Paroxystic symptoms

Minor
 
 
 
 
Disorderly behaviour
71 11 4 19
Violence
20 20 8 17
Anti-family reactions
10 4 1 11
Serious
 
 
 
 
Arson
5 2 1 4
Violence
6 3 1 6
Attempted murder
4 5 0 3
Attempted suicide
-
2
-
-

Syphilitic infection associated with cannabis intoxication (Percentages)

 

Patients showing signs of cannabis intoxication

Acute specific cannabis psychoses

Cannabis psychoses with a toxi-infectious element

Psychoses with a cannabis element

Residual specific cannabis psychoses

B W
38.5 34 82 32 26
Syphilis not determined clinically. No effect on the psychosis
27.3 34
-
25 26
Humoral syphilis constituting an aggravation factor
8.5
-
82
-
-
Syphilitic meningo-encephalitis
2.7
-
-
7
-

Alcoholism and cannabis addiction (Percentages)

 

Association of alcoholism and cannabis-addiction

Determining alcohol factor in the origin of the derangement

Alcohol aggravation factor

Total patients showing signs of cannabis intoxication
25 6
-
Patients with paroxystic symptoms
30 21
-
Cannabis psychoses with a toxi-infectious element
50 50
-
Syphilitic cannabis psychoses
20
-
-
Total addicts from Casablanca
66
-
30

Patients from Casablanca

Kif smokers
78
Total admittances from Casablanca
Pure cannabis psychoses
66
Total cannabis psychosis in-patients
Specific cannabis psychoses
57
Total specific cannabis psychosis cases
Aggravated cannabis psychoses
79
Total aggravated cannabis psychosis cases
Psychoses with a cannabis element
50
Total psychoses with a cannabis element
Alcoholism
66
Total kif smoking alcoholics

Hospital treatment particulars (Percentages)

1st period
67 69 75.8 60
2nd period
23 25 13.7 24
3rd period
7.7 5.4 10.5 10
4th and subsequent periods
2.3 0.6 0 6
Under 3 months (lst period)
53 60 66 40
Over 3 months (lst period)
47 40 33 60
Average length of 1st period (days in hospital)
40 42 47 36
Average length of subsequent periods (days in hospital)
52 49 63 54
Deaths
4 4.3 6.8 2.9

Vital statistics

Family status

Casablanca

Rabat

Marakesh

Fez

Meknes

Tangier

Other towns

Country districts

No fixed residence

Small villages

Total

No particulars

Unmarried or separated
96 26 8 3 13 7 6 30 27 23 249  
Married
81 18 3
-
7 6 5 25 2 25 172  
Divorced
49 13 2
-
5
-
3 15 18 7 112  
Widowers
10 3
-
-
1
-
-
3 5 3 25  
Status unknown
8 4 3 1
-
3
-
3 6 2 30  
TOTAL
244 64 16 4 26 16 14 76 58 60 588 10

Occupations

Occupations

Casablanca

Rabat

Marakesh

Fez

Meknes

Tangier

Other towns

Country districts

No fixed residence

Small villages

Total

No particulars

Not in regular employment
162 44 10 2 16 16 10 16 52 36 364  
Craftsmen
12 4
-
-
4 6
-
-
-
4 30  
Traders
4 0
-
-
2 2 2
-
-
4 14  
Civil servants
6 2
-
-
2 2
-
-
-
2 4  
Farmers
-
-
-
-
-
-
-
54 4
-
58  
Workers
40 10 6
-
2
-
26 2 12 80    
Labourers
20 4
-
2
-
-
-
-
-
2 28  
TOTAL
244 64 16 4 26 26 14 76 58 60 588 10

Statistics 1956, Admittances to the Berrechid Neuro-psychiatric Hospital

Clinical classification

Patients showing physical and psychical signs of cannabis intoxication: 49%
Specific cannabis psychoses: 27%
Acute or sub-acute syndromes:20%
Aberrational: 8%
 
 
 
Oneiritic-aberrational: 8.6%
 
 
 
Excitation: 3.2%
 
 
 
Acute catatonia: 0.2%
Associated psychoses. The intoxi- cant having no effects on the clinical aspect or on the development of the case: 19%
Cannabis psychoses aggravatedby a toxi-infectious element as a determining factor in the clinical aspect of the development of the case: 5%
Residual syndromes:4.5%
Prolonged aberration: 0.9%
 
 
 
Dissociation: 0.9%
 
 
 
Hallucinatory syndrome: 5.7%
 
 
Deficiency syndromes : 2.5%:
Psychical debilitation of the pseudo- P.G. type

Statistics 1956, Admittances to the Berrechid Neuro-psychiatric Hospital

Kif-smoking mental in-patients

Cannabis psychoses. Pure intoxi- cation, non-determining men- tal pattern: 32%
Mobilized psychoses. The toxic factor has a precipitating role in the development of the derangement: 6%
Alcohol: 2.1%
 
 
 
Humoral syphilis : 3.7%
 
 
 
Other factors
Paludism: 0.2%
 
 
 
Carbon monoxide
 
 
 
Other intoxicants
Psychoses with a cannabis element. Psychopathic pat- tern predominant: 17%.
Aggravated psychoses. Normal evolutive psychopathic syn- dromes aggravated by intoxi- cation: 11%
Schizophrenic: 3%
 
 
 
Delirious outbursts of the Magnan type: 2%
 
 
 
Paranoiac psychosis: 1%
 
 
 
Schizophrenia : 3.1%
 
 
 
Intermittent psychosis: 3.1%
 
 
 
Epilepsy: 1.6%
 
 
 
Cranial traumatism: 0.7%
 
 
 
General paralysis (paranoid delirium): 1.4%
 
 
 
Chronic hallucinatory psychosis: 1.2%
 
 
 
Neurosis: 0.9%
 

N B : All percentages on the basis of annual admittances (Moroccan males: I,252).

Statistical card for cannabis-addicted mental patients

Full size image: 86 kB, Statistical card for cannabis-addicted mental patients