Talk about crazy: Even after the tobacco industry was cornered into revealing in 2007 that it had targeted mentally ill people for decades with fake science and free cigarettes, the puffing continued apace.
Some things did change. Shrinks rarely hand out cigarettes any more as a reward for good behavior, and psych wards are now solidly smoke-free (except in a few holdouts). But mentally ill adults still smoke one third of all cigarettes in the US—schizophrenics* many more than their share—and there’s no simple reason why.
“The effects [of the targeting] are longstanding,” says Stanford psychologist Judith Prochaska, the researcher who dug up the offending industry documents in 2007, unveiling campaigns first devised in the 1950s and enduring all the way through the 1990s.
Two big lies—that smoking relieves the symptoms of psychosis, depression and anxiety and that mentally ill people have a special immunity to tobacco-related diseases—were propagated so aggressively by cigarette-makers that plenty of people still believe them, says Prochaska: “It continues in the culture and in the mental health field.”
Capitalist greed is not quite enough to explain why these particular people keep lighting up, however. Cigarettes do offer a little something special to the mentally ill—and their families and doctors too.
For starters, there’s still nothing quite like a smoke to incentivize a tobacco-addicted inpatient into showing up for an appointment, for instance, or taking his or her medicine on time. A brief visit to the sidewalk will often do it.
And while the clinicians and researchers interviewed for this article all complained about a shortage of funding and training for mental illness-focused cessation programs, they also blamed family members’ objections that “Smoking is all they have!”