As will be revealed below, it is no exaggeration to say that the CBMPs have changed my life and such disabling and terrifying episodes are no longer part of my daily existence. For the first time in memory, I feel in control of my mental health. Although in the process of documenting various other factors as part of the diarising entailed in autoethnography, I have also come to note the influence that workload and working patterns, diet, sleep, exercise and menstrual cycle, for example, can also exert, but the analysis of these factors falls beyond the scope of the current case report. Right from Day 1, however, within less than an hour of taking my first dose, comprising 0.1 mL of CBD (50 mg/mL) and 0.1 mL of THC (20 mg/mL) oils, I felt as though a massive weight had been lifted. While I have always been able to ‘mask’ my internal turmoil and hide it from the majority of people in the outside world, one of the things I have struggled with is finding the strength and space to ‘step back’ from any negative or triggering situation or feeling. My ‘window of tolerance’ has traditionally been narrow, with very little external input needed to push me beyond my ability to cope and into a highly reactive (in the sense of panicked) state. However, what has been the most significant positive impact of the CBMPs is the sense of being cocooned in a protective blanket, of frayed nerves being soothed by the cannabis’ presence in my system, of space being created between me and the triggers and threats of the outside world. It has enabled me to ‘do the work’ that the talking therapy advocated but which had previously been impossible to achieve in practice. I sometimes notice that the effects of the CBMPs are like an out of body experience. I can carefully, almost dispassionately, observe how I am feeling, evaluate the situation in a balanced rather than hyperanxious manner, and think through appropriate courses of action. In the past, I would react first and deal with the consequences later, and, as is common for abuse survivors, would frequently exist in a disassociated state. Since taking CBMPs, I no longer experience extensive periods of disassociation, but instead can be fully present during most interactions and activities. I am able to be mindfully focused on, and completely present, in any situation, without the gnawing anxiety associated with work, other pressures or intrusive thoughts of my abuse, past trauma and the threat of disaster which had previously dominated my internal state and negatively impacted my emotional focus and consistency. I have also managed to break through crushing writer’s block which had been hindering my academic productivity for years. In the following section, I will unpack some of these positive changes and compare them with the lived experiences of other medical cannabis patients.

• (i)Managing symptoms:

Talshir et al. [17] conducted interviews with eight Israeli women with PTSD following sexual assault who used cannabis to help manage their symptoms, which included insomnia, night terrors, anxiety and panic attacks. One of Talshir et al.’s interviewees used the analogy of cancer remission. The cannabis could not cure the trauma she had experienced, but it provided the support needed for the trauma to recede into the background. Another of their interviewees, Aviv, stated “It’s been years that I’ve been diagnosed with post-trauma and anxiety disorder, and the cannabis changed my life. After years [during which] I barely slept, I found this wonderful plant. Since then, I’ve been sleeping, my anxiety attacks are down by at least 50%, and in general my life changed from surviving day-by-day to a calm and peaceful life.”, while another, Na’ama, stated “You can speak, you can contain [your] feelings. Suddenly, everything is ok. It’s calmer, and you can come back down to earth.”

These reported experiences share some similarities as well as some differences with my own. As noted above, the CBMPs have also helped me to contain my feelings, but I would describe the medical cannabis as facilitating an out of body experience. As I was usually so closely and emotionally bound up in a situation, this seems qualitatively different from a coming back to Earth. Rather, with the help of the CBMPs, I am able to step back and away from being emotionally overwhelmed and see the situation clearly, in a manner which sometimes prompts me to think of the view that astronauts have of the planet—a zooming out and creation of distance and perspective—which is simultaneously very grounding. The following account is an excerpt from my diary entry documenting my first dose of CBMPs, which elucidates this apparent paradox.

“The drops taste unpleasant and I do not enjoy holding them under my tongue as is the required mode of delivery for these oils. I have to struggle not to spit them out and am reminded why recreational cannabis has never appealed—I simply can’t abide the smell and taste of this plant. The pungency of the medicine exacerbates my bad mood and the panic starts to rise as I question the wisdom of what I am doing. But within less than half an hour I can feel a profound change. I return to my desk and the stressors—the emails, the to do list, the intrusive thoughts, the bills, the chores I have yet to tackle—loom. I start to go through the motions of reacting, but then realise I just don’t feel the usual panic or anxiety. It takes me aback. Another email alert with a problem at work. I skim it and automatically start to compose a response, but my reaction is slightly delayed, and in that split second I find I can exhale. In doing so, the urgency and the panic is gone. I feel mildly sedated, body uncharacteristically still while my mind seemingly expands to accommodate and envelop what would previously have overwhelmed me. There is a pleasant, dreamlike quality to this experience. I find myself able to dispassionately assess the situation from a place of calm, like I have stepped outside of my body and am an external observer. I realise I haven’t broken my pen, which usually happens when I encounter something stressful while at my desk. This too feels oddly emancipatory. I look down to examine my hands which are now just resting in my lap, gently holding the intact biro. Over the many years of therapy, the key take home point had always been to try and step back. To implement some intervention as soon as I felt something triggering an attack, the moment my breathing changed, my heart rate spiked, my stomach lurched, my nails dug into my palms, my pen snapped, or my field of vision and window of tolerance began to narrow. I had never been able to do that. I knew the grounding exercises, the breathing techniques, the power of music or movement, I read (but never believed) the motivational post-it notes my therapist had suggested I stick strategically about the place but in the moment it was always impossible. Now, for what feels like the first time in my life, I understand what it means to step back and more importantly, I feel I finally have the capacity to implement this new understanding.”(Day 1 of Month 1)

The next month, another diary entry provides a more concise reading of the situation that I now find myself in thanks to the CBMPs.

“It’s very strange the way the cannabis enables me to cordon off emotions or feelings and work productively around them—I know they’re there but they’re now like background noise and I’m able to examine them from a distance to work out how best to tackle whatever triggered them.”(Day 26 of Month 2)

The following month, these abridged entries from two consecutive days also reveal the positive impacts of CBMPs, even in the face of objectively high-stress situations.

“crazy day with [partner] being rushed to hospital. Managed to cope and stay calm and do everything that needed to be done both at work and home, and be completely emotionally present and available despite being exhausted and worried. It’s like I’m watching what’s going on through a filter or window, or like I’ve been imbued with superhuman strength of mind.”(Day 17 of Month 3)

“some high stress meetings and emails but felt distant from it, like it wasn’t happening to me, and in that place I was able to work through it all productively and not dwell on anything negative.”(Day 18 of Month 3)

Another entry a month later reveals how the CBMPs are not a panacea, but nonetheless provide much needed relief and protection against panic and anxiety triggers.

“low level anxiety was a constant all day, but [I’m] also on low dose due to running out and delay before next prescription will arrive. Very worried about [partner]. Given the level of worry and how long it [his ill health] has been going on, that the anxiety was low level is testament to the power of the CBMPs. But for the first time since starting the trial I’m existing again in a state of hypervigilance. Awoke in the night after hearing B [dog] making an odd noise. Got up to check him and couldn’t see that he was breathing. He was completely inert even when I started trying to physically rouse him and for an instant it seemed as though he’d died so I cried out. That woke him. He was fine, just really groggy after a very deep sleep. While in the moment it was objectively terrifying, the usual fear and panic I would expect to have experienced when confronted with the [in this case imagined] death of a loved one was coated in something that kept it in check and it felt muted. I was able to get back to sleep again myself quickly after that which was also unusual after a panic attack.”(Day 13 of Month 4)

The closest analogy I have been able to come up with is the feeling that I experienced (or rather did not experience) when the epidural started to take effect late into the difficult labour preceding the birth of my daughter. I had been through several days of extremely painful contractions, but due to overcrowding on the maternity wards and being slow to dilate, I had been sent home twice. When my waters finally broke and I was taken to a birthing room, my plans for a natural process went out of the window and I begged for an epidural, despite chronic trypanophobia (fear of needles). The relief was indescribable. The physical pain dissipated almost immediately, and I became much more aware of what was going on. I could feel some of the mechanics of giving birth, but the anaesthesia freed me to focus on breathwork and pushing.

• (ii)Task completion:

Another significant and positive impact of the CBMPs which became apparent very early on in the course of treatment was its seeming ability to enable me to overcome some of the obstacles which had been hampering my professional progress. In my academic career, I have consistently prioritised teaching and the supervision of research postgraduate students at the expense of my own research outputs, due in part to crippling self-doubt or what is termed ‘imposter syndrome’, as well as difficulties with time management and boundary issues which Maté [18] has argued are commonly experienced by individuals with ADD and PTSD. Due to workaholism (an escape or coping mechanism which Maté also links to trauma and ADD), I have been able to be productive over the years, but since the previously buried Pandora’s box of my childhood abuse was unearthed and unlocked during intensive therapy following the birth of my daughter, my ability to complete my own writing projects had pretty much dried up. This led to disappointment, frustration and anxiety on my part, as well as stigma, guilt and shame from feeling that I was letting down colleagues, collaborators, co-authors and publishers, which became a source of deep depression. Much of the extant qualitative research focusing on the experiences of medical cannabis patients has emphasised the stigma that they feel is associated with medical cannabis use itself. Nelson, for example, discussed her own anxiety about external perception, asking “Will others think less of me because I am a medical cannabis patient and advocate?” [19], before describing the complex stigma felt by her family, stating, “My parents fear that others will see me as a less competent, less intelligent woman simply because I use [medical] cannabis.”

Nelson herself acknowledges that “Although I do not always find acceptance as a cannabis patient outside of the medical cannabis community, I become stronger and more resolute each time I share my story. [...] I’m confident that as more patients share our private stories publicly, others will come to have a better understanding of what it means to be a medical cannabis patient—and through this understanding the stigmas associated with cannabis use will dissipate and the use of cannabis as medication will become normalized...” [19]. My perspective is again slightly at odds with the existing prevalent emphasis on stigma as something that medical cannabis patients feel as a result of taking CBMPs. For me, the CBMPs have alleviated the pre-existing stigma and depression associated with writer’s block caused by anxiety, aiding me in ‘doing the work’ (as in the practical labour required to succeed in my profession, as well as the psychological, emotional labour needed for healing) quite literally. During the first four months of taking CBMPs, I was able to complete two long-overdue book chapter contributions, both of which had been very difficult to write due to their emotive subject matter. I have also been able to resume work on several other partially completed manuscripts and collaborative writing projects, and am making significant and productive steps to move them forwards.

• (iii)Risk vs. benefits:

It is nonetheless important to acknowledge that it has not all been plain sailing and that CBMPs are not a panacea. Indeed, many extant studies have also identified that there are sometimes negative impacts which need to be weighed against the positive benefits. For Bar-Lev Schleider et al. [7], for example, 5.9% of the young people with ASD in their study reported negative side effects, including increased restlessness. Talshir et al. [17] also found that “the main challenge with cannabis use in the context of PTSD is the feeling of detachment that it engenders.” While this state enabled interviewees to cope with their symptoms, it had the negative outcome of creating a sense of dissociation and an inability to feel “fully present in their relationships and everyday life”, while at the same time increasing “feelings of self-alienation and helplessness.” As the vignettes from my diary above reveal, for me, CBMPs relieved dissociation and enabled me to be fully present in my life in ways that had previously eluded me.

In my experience, there have been some occasions when the dose does not do what I need it to do and where I have had to ‘top up’ (i.e., take an additional dose of CBD) during the day. I have sometimes felt itchy or restless when trying to get to sleep when I increase the dose of THC above 0.2 mL per day, or I have felt drugged and sluggish if I have taken my THC dose too early in the evening, but these are minor inconveniences and overall it has indeed been life-changing. CBMPs have enabled me to regain some semblance of order and to overcome the disabling symptoms of chronic anxiety, PTSD and depression that stem from childhood abuse and other traumas.

Writing about my mental health and the impacts of CBMPs on it raises another area where my own experiences intersect with those of some other medical cannabis patients. Exposing the psychological challenges that I have faced and acknowledging the beneficial outcomes of CBMPs on my wellbeing and interpersonal relationships is not without risk. Nelson, for example, states “When I was raising my family in Oklahoma and Texas, I spent many years fearing that my children might be removed from my home if others discovered I used marijuana. Although I am no longer plagued by this particular fear, I have spoken with many patients—particularly mothers—who are still quite fearful that their use of cannabis as medication will result in a similar fate.” [19]. Nelson is based in the USA where the legality of medical cannabis varies from state to state, and she had not always lived in states where her cannabis use was legal. In the UK, where I am based, the legal use of a prescribed medication to improve mental health does not carry the same risks. Nonetheless, I do feel fear about disclosing so much deeply personal information. This fear is a form of the stigma so widely acknowledged in the extant literature, a fear that people might form harsh judgements about me as an individual, as a professional academic and as a mother because both mental health and medical cannabis are still heavily stigmatised, including within academia. However, as Campbell, who wrote an autoethnography of her own depression and anxiety in the context of an academic workplace, notes, “if we continue to hide uncomfortable stories then we simply perpetuate the taboo or stigma attached” [20]. As a result, she argues for “opening a conversation on difficult matters.” In the context of medical cannabis, Nelson also advocates for the importance of patients making “their private stories public.” [19]. The desire to challenge the existing stigma around these intersecting issues—mental health in academia and medical cannabis—is one of the main motivations for writing about my experiences. Indeed, as Obegu et al. have argued in relation to the evidence base needed to bring medical cannabis into mainstream use, “Centering equity and lived experience strengthens the rationale for investments and ensures user-led evidence generation and utilization—a key public health gain” [21].

There is one further stigma that I hope my story might help to confront. According to the most current statistics at the time of writing, produced by the Office for National Statistics in 2020, 1 in 5 adults in the UK experienced some form of abuse in childhood, while “3.1 million adults aged 18 to 74 years were victims of sexual abuse [specifically] before the age of 16 years” [22]. Yet, despite abused children being victims, childhood abuse is stigmatised. Until now, there have been very few occasions when I have felt comfortable disclosing this aspect of my identity. When I have shared it, it has been difficult for all of those concerned, myself included, to know how to act or react. I feel immense shame about what I endured, and as I have discussed in part here, the effects of the abuse and trauma that I experienced have pervaded every facet of my life. Not every abuse survivor has the opportunity to share their story however, and many will no doubt be suffering in silence, as I did for more than three decades until the desire to protect my unborn child prompted me to finally seek help, if not restitution. Given the number of individuals who have experienced childhood abuse then, the potential for healing provided by CBMPs needs to be explored as a “key public health gain” in addition to an act of social justice.