The Role of Herbal Medicine in Mental Health Counseling.
Every year throughout the country, therapists, social workers, psychologists and mental health professionals see tens of millions of people suffering from mental illness. A large percentage of these people are taking herbal medicines to help themselves feel less anxious, less depressed and more energized. It is estimated that customers spend several billion dollars a year on a variety of herbs and supplements. Consumer Reports recently states that over half of Americans use dietary supplements.
Though millions are taking herbal medicines, mental health professionals rarely take into account these medicines and tend to avoid in depth conversations about their use and efficacy. There is a wide range of reasons for why counselors and therapists avoid or only lightly touch on these subjects but I would suggest there are two main reasons.
The two reasons come down to this; a lack of knowledge of herbal medicines and a fear of malpractice for discussing or advocating their use. My belief is that our clients would be far better served if mental health professionals were more knowledgable about herbal medicines for mental health and we could help people to make wise choices about the use of herbal medications for improving their mental health.
The Fracturing of Mental Health Care
In ancient times and in traditional societies, those experiencing depression, anxiety, rage, grief and altered states would go to a traditional healer. Healers in traditional societies often incorporate a number of tools for helping people to get better including ritual, healing ceremonies, conversation and herbal medicine. Though Western approaches to healing mental illness relies predominantly on pharmaceutical medication therapy, the World Health Organization has recently revealed that illnesses such as schizophrenia have significantly better outcomes in traditional societies where pharmaceutical medications are not administered.
In traditional societies, experiences such as depression, severe rage or hearing voices are put into a cultural and spiritual context specific to that society. Healing takes place as part of a prescribed set of rituals and herbal medicines. As we have “progressed” we have moved further and further away from that model, shifting to a fractured system wheremental health professionals assist mentally ill people in their own specific way.
In our modern model, a psychiatrist or more frequently a general practitioner Doctor sees a patient for a short visit of perhaps 15 minutes and prescribes psychiatric medications based upon that evaluation. If the patient has good insurance or enough money, the patient then can see an individual therapist to heal from their illness through exploratory conversations and developing coping strategies and better life skills.
If they are religious, clients can also seek help from their local pastor and through their religious community. Finally , they may also seek resources from a social worker to go to a case manager, seek out various self-help groups and develop a network of support.
As we have become increasingly fractured, many tens of millions of people have also turned to finding solutions on their own for their mental health problems. Millions of people who suffer from low level malaise, insomnia, anxiety and depression scour the health food section of stores and purchase enormous quantities of herbal medicines and supplements to help themselves feel better.
When these clients come for our care, they often receive only a cursory acknowledgment of these types of therapies. Therapists tend to be concerned that they are either not knowledgable enough or are worried about malpractice if they offer suggestions on the use of these substances. But my belief is that mental health professionals need to become increasingly aware and knowledgable of these supplements so they can provide the best care to their clients. Through greater awareness and understanding, we can then help clients to improve and become healthier while avoiding herbal and supplemental remedies that could be inefficacious and unhelpful.
The issue of malpractice is one that needs to be addressed. Some people would say that Mental health professionals should not offer advice about herbs because it is out of their purview and is a form of practicing medicine. I would suggest it is all in how you talk about herbal medicines. If you promise cures, or make people buy your herbs with an assurance of healing them, then yes, you are engaging in practicing medicine without a license.
But instead, if you act more like a trainer you would see at a gym, who is advocating that their client improve their health through optimizing diet and taking the best quality supplements possible, then you are in no way endangering your practice. In fact you are augmenting it by having a greater degree of knowledge to offer a client.
Here is an example. A client comes in and is feeling increasingly feeling tired with low level energy. They have experienced a high degree of trauma in their life and feel overwhelmed by stressors. You as a therapist could suggest that they begin to take nettles in a tea form. Nettles is an herb that has a high degree of vitamins, minerals, protein and chlorophyl in it. When taken in tea form it is easy to assimilate and for many people it has acted as a tonic to restore energy levels and greater well being.
Nettles is classified as an herb but in this form it acts more like food, gently building up the body’s inner strength and capacity for handling stress. This could be an invaluable tonic for someone managing the emotions of processing trauma. In essence you are coaching a client to become an advocate for heir own health through the proper use of herbal medicine.
Why Herbal Medicine for mental illness ?
There are a number of reasons herbal medicine can be such an effective adjunct tool for helping people who have mental illness. Here’s a few reasons.
1 On a basic level, herbs are effective because they address the somatic as well as the mental. Someone who feels tight, wired, frustrated and upset may be able to feel relief through having a conversation. But they will find instant benefit if you pour them a strong cup of lemon balm tea. If they drink nourishing infusions over a period of weeks, they will start to feel stronger and healthier. In short, herbal medicines address how you feel, the somatic sensations of anxiety, anger, tension and depression.
2 Herbal medicines are also cheap. If you become minimally knowledgable, anyone can grow some of these herbs in their backyard or in a flowerpot. Herbs are nature’s free pharmacy, growing outside our window.
3 Herbs help people get in touch with the natural world. By going into the garden and growing your own herbs, or collecting them in the wild, or buying loose herbs and smelling the aroma of the herb helps individuals reconnect to the natural world. In a world of 24/7 work and shopping, computer screens and florescent lighting, herbal medicine helps us to slow down to the rhythm of nature. This in itself can be incredibly healing.
4 Herbs put the power of their health back in the individual’s hand. Folks with mental illness begin the healing process when they take a tincture they have purchased, or make and drink a tea they themselves made. The act of agency when making and taking herbal medicine is an act of developing personal coping skills and learning ways of modulating and healing one’s owns moods and health.
The Perils of Quick Fix Herbalism
Unfortunately, we have become a society used to quick fixes, and many millions of people with a modest understanding of herbal medicine turn to their neighborhood grocery to buy whatever they think can cure the problem right now. Got depression? A website said St. John’s Wort capsules are good. Can’t sleep? I’ll take these valerian pills. Simply using a plant based medicine for a pharmaceutical reaction rarely heals the underlying problem.
Instead, it is key to have a deeper understanding of the constitutional and energetic patterns of both our clients and plant medicines in order to find a good fit. Plant medicines also work best when taken in conjunction with diet and lifestyle changes. You can take all the St. John’s Wort and Valerian you want, but if you are still drinking Diet Coke and eating cheetohs all day, they won’t do any good.
This is why it is also key for a mental health practitioner to have a greater understanding of traditional and holistic herbalism and not just a cursory understanding of what is available as industrially manufactured forms of herbal medicines. It is helpful for a therapist to understand what plants work best for particular constitutions and temperaments, for different illness patterns and in what form to take them. This may sound daunting but really a mental health herbalist need only be knowledgable in the area of helping those with mental illness, not for every medical problem that exists.
Mental Health Herbalism
So how does mental health herbalism look like in practice? It involves taking a closer look at what our patients are ingesting on a daily basis for their health and welfare and then steering them towards the best choices to help them feel stronger and healthier. It involves becoming more like a coach and trainer and taking greater care of what is happening somatically as well as mentally. On a practical level it can involve some additional training for a mental health professional.
It is helpful to become versed in the main herbal medicines used for treating mental health conditions. There are a number of categories of herbal medicines for treating mental health issues and those include tonics, nervines, analgesics, antispasmodics and adaptogens.
1 The first and mainline course of herbal medicines are nutritive tonics. These are herbs that are useful for most folks suffering from mental illness. They help strengthen and nourish the body and nervous system, are gentle, easily to assimilate and can be used for extended periods of time. Herbal tonics include herbs such as nettles, oatstraw and red clover. One of the main reasons these herbs have a tonic effect is because they are filled with vitamins and minerals. For example, oatstraw helps strengthen the nerve tissue due to its high percentage of calcium and magnesium.
2 The second category of commonly used herbs are nervines. Nervines are herbs that tend to relax the body, either through a sedative effect or through a stimulating effect that helps reduce tension. Relaxing calmative nervines include hops, California poppy, skullcap, valerian and chamomile. Some sedative nervines are quite mild (chamomile) while others can be quite strong (valerian). Stimulating (but also relaxing- yes they can be both) nervines often include aromatic herbs such as lavender, mint and lemon balm. More excitatory stimulant nervines include ephedra (Ma Huang), green tea and coffee.
3 The next category of mental health herbs are analgesics, or pain relievers. While not specifically a mental health herb, many of the clients we see who suffer from mental illness also suffer from pain related problems. This is a trickier area to manage as pain has numerous etiologies, including structural problems and organic illness that are better addressed by other practitioners. However, it is good to know some of the main herbs used for addressing pain as it is likely some of our clients will be taking these herbs. Some analgesic herbs include white willow bark, meadowsweet (both containing salicin, a precursor to the main constituent in aspirin), devil’s claw and feverfew (often used for migraines). There are also numerous herbs used topically for the relief of neuralgia such as St. John’s Wort, calendula and goldenrod.
4 The next category of herbs for mental health are antispasmodics. These herbs tend to have a relaxing effect on muscle tissue and help people who feel restless, are twitching or are experiencing cramping and spasms. Some classic antispasmodic herbs include catnip, peppermint. black cohosh and kava. For example, if someone is feeling wired with a lot of tension in their neck and shoulders and simply can’t calm down due to this tension, a cup of kava tea can be invaluable.
5 The final category of herbs used for mental health conditions include adaptogens. The term adaptogens implies that they help the body to adapt to stress and provide an overall tonic effect for the nervous and immune systems. There are a variety of adaptogens including American, Siberian and Asian ginseng (each with their own characteristics and properties that are suitable to particular constitutions). Other adaptogens include ashwaghanda, astragalus and maca. This category of herbs is very hip and many people buy these herbs for greater vitality without knowing how they work and how well their constitution will handle these herbs. For example, someone who is already robust, red faced and excitable should not be taking Asian ginseng, even if they are feeling worn out and frazzled. This is exactly the type of knowledge that is helpful for a mental health practitioner to have in order to best help our clients.
A Variety of Ways of Using Herbs for Greater Mental Health
Though people generally concentrate on orally consuming herbs for greater mental health, there are a variety of ways mental health practitioners can promote greater mental and emotional health through the use of herbs. Aromatherapy is one of the prime ways of helping clients in a gentle way that avoids any complications with interactions with pharmaceutical medications.
Aromatherapy is the practice of allowing the smell and aroma of an herb to have a positive influence on the mood and emotional state of a client. Herbs such as lavender, rose and peppermint can be incredibly uplifting for someone in a depressed mood. Aromatherapy can be practiced by using a diffuser to help spray the scent in a room, or through adding drops of an essential oil to a bath, through potpourri or a variety of other ways.
Another way to help clients is to encourage the practice of engaging plants outdoors either in a garden or in their natural environment. Using all five senses to make connection to herbs, flowers and trees is amazingly healing. In the hospital where I work, we have a healing garden where mental health patients can smell, touch, see and even taste the plants all around them. I have seen depressed patients who hear horrible voices start to breathe deeper, smile and laugh in this context. You don’t need to just take a St. John’s Wort capsule to gain better mental health. Plus, this method of herbalism is free.
Flower essences are orally administered but really constitute a category of their own. These “medicines” are really essences, or minute concentrations of flowers diffused in water and preserved with a tiny amount of alcohol. Flower essences have been shows to have profound effects on mental and emotional states even though they contain no gross constituents or medicinal properties. The belief is that flower essences trigger changes in the emotional state of those who are taking them and can have profound healing effects. One of the most commonly used flower essences is the “five flower remedy” (FES) and is often taken by people who are under acute emotional and mental distress.
Many of our clients are taking pharmaceutical medications prescribed by a doctor and we want to be careful not to advise herbal supplements that could be contraindicated. There are a many herbs that are very gentle in action and have little contraindications when used with drug medications. Other herbs have potential interactions even when they are not solidly documented. Mental health professionals should have an understanding of possible herb-drug interactions and caution patients about these interactions. I will mention a few herbs that should be monitored but it would take another article to discuss this issue in depth.
Needless to say, as an herbalist it does interest me that over 100,000 people die due to adverse pharmaceutical drug reactions every year and that iatrogenic deaths due to modern medicine is the third leading cause of US deaths. Yes, we need to be vigilant about herbal interactions with pharmaceutical medications. However, the reported cases of serious complications due to these interactions are miniscule compared to iatrogenic complications.
When looking at herbal/drug interactions, its important to have a good understanding of the medications a patient is taking. For example, St. John’s Wort, an herb often used for its antidepressant effect, does not often interact well with other pharmaceutical antidepressant SSRIs. This interaction can increase the possibility of SSRI side effects such as serotonin syndrome. St. John’s Wort can also negatively interact with sedative medication such as benzodiazapenes and anticonvulsants by potentiating their effect.
Other sedative herbs such as kava and valerian should be avoided if the patient also take benzodiazapenes such as xanax or valium. Certain herbs that have a high degree of salicylates such as meadowsweet and white willow bark should be avoided if a patient is taking warfarin, a blood thinner pharmaceutical medication used for patients who tend to develop clots. Please look at other articles for examining this issue more in depth.
Herbal Medicine is not a replacement for Pharmaceutical Medicine
Some people might come to the conclusion from reading this article that herbal medicine can replace pharmaceutical medicine. They really are two different animals and have to be looked at through different lenses. While herbal medicine can be helpful adjunct for anyone experiencing emotional and mental distress, it should never be viewed as a panacea, or as a tool to manage severe mental illness in the form of psychosis and suicidality. But lets look at some various scenarios of where herbal medicine can be helpful.
A woman who has been diagnosed with bipolar disorder who experiences mainly depression but occasionally spikes and has manic episodes where she stops sleeping for days, becomes hyperverbal with fast, rapid, pressured and scattered speech may need some time to stabilize and return to a set point. For some people that involves taking psychiatric medication. For others, they are able to ride out these extreme states with the support of loving friends and family. During this experience of an extreme state, it is always helpful to be offered strengthening healthy whole foods along with nutritious and relaxing herbs to help in the process of returning to a more gentle rhythm.
For example, during an extreme state and especially in the period of time after the manic period is over, drinking oatstraw tea regularly is a way of strengthening the nervous system, bringing calm and providing an infusion of helpful vitamins and minerals. The herbalist /therapist may also suggest drinking a gentle herbal tea of linden, mint and catnip tea to help them feel relaxed throughout the day. These herbs are not contraindicated with psychiatric medication as they are gentle. Simple changes like these are not only helpful to the mood, they will contribute to the stabilization of the individual and are also helpful for lifting the mood of someone who is primarily depressed.
As mental health professionals, I advocate that we become more knowledgable about herbalism as a way to improve our clients emotional and mental health. Tens of millions of people take herbal medicines for mental health conditions and many of these people come to mental health professionals looking for greater guidance and wisdom. We as therapists and counselors can offer greater wisdom if we gain training in the use of herbal medicine, especially training that pertains to mental health.
By understanding the best ways to use and take herbal medicines and what herbal medicines fit best with different disease patterns and constitutional types, we can steer people towards taking the best quality herbs that are most efficacious for helping them to become stronger and feel better. The fear of overstepping our boundaries to provide medical advice is unwarranted as long as we understand the scope of our practice and don’t suggest that we can cure people of their illness using herbs.
Though herbal medicine will not end emotional distress, it is a profound tool for helping lead clients back towards a healthier state of mind. Small acts such as taking a lavender infused bath, sipping a cup of chamomile tea, drinking infusions of red clover blossoms are daily acts and rituals designed to bring a person back into harmony, of bringing them towards their true and unbroken Self. Like healers from traditional societies, a mental health professional can act as a conduit from the natural world to help mentally ill people rediscover their innate health and well being.