Most people who suffer from schizophrenia smoke. A lot.
This is one of those stereotypes that not only happens to be true, but there’s a special reason why schizophrenics smoke:

Cigarette smoking may improve attention and short-term memory in persons with schizophrenia by stimulating nicotine receptors in the brain, according to a study by Yale School of Medicine researchers in the June issue of The Archives of General Psychiatry.

This explains not only why they smoke, but why they smoke so much more than people who don’t have schizophrenia. They are engaged in self medication.

Persons with schizophrenia smoke two to three times more than smokers without mental illness, said the researchers. They found that when study subjects with schizophrenia stopped smoking, attention and short-term memory were more impaired, but, when they started smoking again, their cognitive function improved. No effects from stopping or resuming smoking were observed in smokers without mental illness.
Participants with and without schizophrenia were then asked to smoke while taking a drug called mecamylamine, which blocks nicotinic acetylcholine receptors in the brain, preventing the nicotine from acting on those receptors. Mecamylamine blocked the ability of smoking to improve cognitive deficits in schizophrenia, but not in persons without mental illness. The findings suggest that when people with schizophrenia smoke, they may in part be self-medicating with nicotine to remedy cognitive deficits.

Calls like this have been made for more studies, and new, nicotine-like drugs have been proposed, but never offered.
I have a silly moralistic question, based on what many people would call “fairness.” Considering the evidence that as many as 88% of these unfortunate people are resorting to self-medication with a legal drug, and considering the medical evidence that it helps them, is it really fair to punish them with punitive taxes aimed at making cigarettes unaffordable?
There are economics involved. Schizophrenics do not have as much money as other people. Most of them are poor, disabled, and living on social security. (I don’t think I need to spend a half an hour finding links to prove something that I know is true, and only a fool would dispute.)
I think that inflicting punitive taxation against these people constitutes simple, gratuitous cruelty. But as I pointed out in my last post, fairness is childish, and in the context of the Machiavellian reality of the bureaucratic legal system, it becomes little more than another tactical argument. As a moral issue, fairness might mean something, but legally it counts for very little.
Here’s a true story involving a psychiatric nurse I know quite well. She’s an immigrant from a country where fairness has always been the cruel joke it’s becoming here, but she’s a kind person, and she runs a rest home for chronic schizophrenics — people who don’t have families that will care for them, and who are are unable to care for themselves on their own. (Yes, she makes money doing this. Enough to send her hard working daughter from scrubbing the floors to attending a good college.) The residents are the type of people who but for the rest home would be society’s refuse — hallucinating derelicts walking around aimlessly. Many of them were just that before they managed to find a spot in the rest home. (Society, of course refers to street-walking schizophrenics by the euphemism of “homeless,” which is true only in a literal limited sense.)
Anyway, this rather good woman makes sure that the most important needs are met. Her family keeps the place clean, her mother cooks the meals, and she performs the most important function of all — making sure that each patient takes his or her medication. (If you know anything about schizophrenia, you’ll know that this is the most serious problem in working with them.) Naturally, nearly all the residents smoke, but they are no good at managing their money, and buying cigarettes at the local store (where they go for the grotesque price of $6.50 a pack) is directly against their financial interest. That’s because schizophrenics tend to self medicate heavily — often two packs a day.
It might not be as expensive as some of the drugs they have to take, but social security does not cover cigarettes, nor does Medicare, Medicaid, or any health insurance policy of which I’m aware.
Do the math; at current store prices, the cigarettes alone would eat up much of the very limited money. Local liquor stores often allow these people to run up a tab, which means they become indebted — using their monthly check just to pay for what’s a form of medication.
Now, I realize that this very fair country is not about to supply schizophrenics with free cigarettes, and you can be sure that if any tobacco company even thought about such a fair idea, media moralists would be all over them in one of the biggest moral feeding frenzies you’ve ever seen.
But out of the goodness of her heart, but not knowing enough about the legal system to understand the consequences (her English is poor, by the way), this immigrant psychiatric nurse made the mistake of going on line, where she discovered that cigarettes could be purchased for far, far less than the local store, at websites like this one.
Yes, she should have read the fine print. But on the other hand, the bureaucracy might move with a bit of deliberate speed in cases like where a rest home operator purchases cigarettes in quantity for its patients. Eventually, she received a tax bill for over $9,000.
Most Americans would whine. (In fact, that’s probably what I’m doing right now.) Others would scream bloody murder about the cosmic injustice of it all. But this woman knows all about government, and all about bureaucrats. After all, she comes from a country where tyranny is a way of life. She’s smart enough to know that Americans might feel sorry for her patients, and take pity on someone in her position.
I encouraged her to exploit the emotional factor to the hilt, and I hope it works. I’m thinking that some taxing authority might either take pity on her, or else be afraid of how it might look. (How things might look is often more important than how things really are.)
But if she succeeds in thwarting the tax collector, it will not be because of cosmic justice, or fairness, because there is none, and she’s smart enough to know it.
Why is it that so many Americans see fairness first? As if it’s a thing to be expected!
Is this a flaw in the national character? An asset? Or just part of our naive charm?
I can’t figure it out, but I’m smart enough to pretend to have it when I need to pretend.
And I’m dumb enough to actually believe (in my naive bleeding heart) that laying extortionate taxes on schizophrenics’ cigarettes is profoundly, horribly unfair.
So what, you say?
So I’m writing a blog post, that’s what!