What kind of herbs, though?
February 23, 2017 10:47 PM   Subscribe

My potential new therapist says she works with an herbalist. What is an herbalist, and is this a red flag?

I'm shopping around for therapists and I found one I really like, but I'm concerned she might be a little too far on the hippie end of the scale. For one thing, she mentioned that while she works with psychiatrists who prescribe meds, she also works with an herbalist for people who don't want to take medication. What is an herbalist in this context? Is she talking about medicinal marijuana (which is legal in my state for a condition I have...but I don't think that's what she's talking about) or general homeopathy or what? Otherwise she does seem cool, but this one thing gave me pause as a very evidence-based medicine kind of person.
posted by colorblock sock to Health & Fitness (26 answers total) 3 users marked this as a favorite
Not (necessarily) medical marijuana, and probably not homeopathy, either. The herbalist just prescribes herbs for various ailments, some people really like herbalism and some people don't. However, she did say that the herbalist was an alternative for people who don't like conventional medicine, so unless she really pushes an approach you're not comfortable with, and if you like her, why not give her a go?
posted by glitter at 10:59 PM on February 23, 2017 [10 favorites]

Out here in Silicon Valley, it would probably be a Chinese herbalist. Here is the NIH (traditional US government research-based medical perspective) on traditional Chinese medicines, including herbs. Their opinion seems to be that there is no solid research to support it but it is not as fictional as homeopathy.
posted by metahawk at 11:04 PM on February 23, 2017 [3 favorites]

I am very anti-woo, but in my opinion there's some merit in certain naturopathic treatment. If it's not homeopathy or energy healing nonsense, there's not much to worry about. There's a lot of stuff that an herbalist might give that many doctors suggest as well(but in my experience doctors don't really bother,which is why herbalists/nutritionists can be useful). Things like vitamins, magnesium supplements, and plant-based diet plans can actually help with mental health and are a decent option for those who haven't had success with psychiatric medication or object to it all together. A lot of commercial herbalism is essentially diet and health maintenance services, not the weird magic cures that homeopathy peddles.

I'd ask her further about it if you're really worried. But the fact that psychiatrists are working with her as well is a good sign that she's not trying to force people one way or another. Offering a diverse array of help is rarely a bad thing.
posted by InkDrinker at 11:29 PM on February 23, 2017 [4 favorites]

I would tread carefully here. With herbs you can't control dosage and they are not regulated like drugs. You are not guaranteed to be consuming what is on the label. Also you will not have a pharmacist looking over the herbalist's shoulder (like you would with conventional prescribed meds) to look for drug interactions.

As for working with the therapist? If you like her then go for it, just be clear about what you want.
posted by Toddles at 11:38 PM on February 23, 2017 [2 favorites]

"...she also works with an herbalist for people who don't want to take medication."

This is a red flag for me because of the implication that some of her clients apparently believe that whatever chemicals are in herbs are—by definition—somehow safer/better/more natural/whatever than the chemicals in prescription meds. I would expect a therapist to discuss this in detail with any client who requested a herbalist because they "didn't want to take meds". And maybe she does have this talk. For my own peace of mind, I would want to verify this.
posted by she's not there at 11:42 PM on February 23, 2017 [10 favorites]

Maybe ask her and talk about your concerns? Seems like this is a sort of tangential reason not to work with someone you otherwise like, and we can't give you more information to use to make a decision about her.
posted by Rock 'em Sock 'em at 1:01 AM on February 24, 2017

I'm also very anti-woo, but keep in mind that a lot of our medicines are plant based. And there are plants that are proven to help with certain conditions, but there's no money in it for Big Pharma, so it gets dismissed as woo.

For instance, aspirin comes from willows.
posted by MexicanYenta at 1:41 AM on February 24, 2017 [9 favorites]

Naturopathy is nothing like homeopathy (which is a bullshit way of selling water). That said: it's also not science-based medicine.

I'm no expert, but it seem that the proliferation of 'Chinese Herbalists' (there's one just down my street) is a result of political opportunsim during the cold war, that sort of just stuck.

If a naturopathic treatment could pass standard medical trials it would simply be a part of accepted medicine.

More pithily:

Do you know what they call "Alternative Medicine" that's been tested and shown to work?

Sorry, I've rambled.

In summary: RED FLAG.
posted by pompomtom at 2:22 AM on February 24, 2017 [4 favorites]

I'd say you just have to cj=heck it out, given the spectrum of different things it could be...
I was very surprised recently when, visiting a nearby chemist's, I noticed that maybe a third of its surface was devoted to phytotherapy.
posted by nicolin at 2:59 AM on February 24, 2017

"...she also works with an herbalist for people who don't want to take medication."

This is a red flag for me because of the implication that some of her clients apparently believe that whatever chemicals are in herbs are—by definition—somehow safer/better/more natural/whatever than the chemicals in prescription meds.

It isn't a red flag for me. I love meds but as we see all the time right here on Ask, there are people who flat out refuse to take them. If you are not going to take the Prozac but you're willing to take a tumeric comound, and it works, I don't think it matters if it is a placebo effect or herbal efficacy.

I actually think a practitioner who is willing to help people explore options and meet them where they are is a feature not a bug. YMMV.
posted by DarlingBri at 3:25 AM on February 24, 2017 [33 favorites]

Seconding the "this isn't a red flag". Quite the opposite - she is deliberately providing an alternative to patients who are vigilantly anti-Prozac or whatever. Which strikes me as a good thing; she's not pushing them on you, she's just saying "well, if this is how you roll, this is also an option if you want it."

As for "what herbs" - herbs aren't necessarily woo. I was having a shit time with insomnia a few years back, and one of the things my doctor and I discussed trying was valerian supplements. She and I were in agreement that prescription medication would be a last resort, so we were trying a few other things first; the valerian, a couple vitamins, etc. As it turned out, the magnesium supplement worked better, so we went with that.

My point being, though, that use of herbal supplements isn't necessarily weirdo woo out-there hippie stuff, but that depending on the herb and the ailment, it can be a viable alternative. The important thing is to work with your doctor on this (meaning, don't just try an herb without telling her), and for your doctor to work with you as well (meaning, she doesn't have the right to strong-arm you into taking lavendar kambucha or anything).
posted by EmpressCallipygos at 4:48 AM on February 24, 2017 [3 favorites]

Besides Chinese herbalism, there's also a system often referred to as eclectic herbalism, which is basically the Western version. They have some differences in approaches (Chinese tends to use set combinations and proportions for specific things, while eclectic tends to build unique combos for the particular person, though this isn't absolute.) How much research is behind a particular herb for a particular thing varies widely, but in some cases there are good results from trials, and in a lot of cases, there aren't really good trials that have been done yet, and people find it helpful and not harmful.

I take meds for some things, but I've also found herbalism really helpful for some kinds of long-term chronic stuff where meds are not a great choice for some reason (either because the thing isn't an issue all the time and I don't want an all the time med, or because it's a low-grade chronic thing and the meds I might take have side effects I don't want) or for sort of low-grade 'my body isn't quite handling this as well as I'd like and a little help is nice' stuff.

I have cranky lungs, and there's some stuff I do from working with an herbalist in the past to make colds less dire. I was seeing her partly for menstrual cycle issues that I'd checked out with my doctor (and now have a medical solution for) but for a couple of years the herbal approach helped with avoiding symptoms I really didn't like. I know people who've had really good luck with them for things like sleep issues or managing chronic stress.

Taking them depends on the herb and the practitioner: some people just prefer to drink various things in hot liquid rather than take a pill, or there can be capsules or salves, etc. One of the things I actually really like about them (compared to prescription meds) is that I can adjust dosage (within the limits of whatever's safe for that herb modified by other considerations, like if it might interact with meds) rather than be stuck with whatever dose it comes in. (Great for things like colds, migraine prevention, etc. where what I need can vary a lot day to day.)
posted by modernhypatia at 5:31 AM on February 24, 2017 [1 favorite]

Yes, chiming in to say that this is not a red flag for me at all. I'm a big fan of prescription medication - I take it myself, and my dad is a pharmacist so there's my bias - but some people are vehemently against it and will not be persuaded to try it.

I would prefer that these anti-Rx folks have access to non-judgmental therapy. If this therapist lectured all of her anti-Rx patients about the Power of Prozac, she would likely scare some of them off and they would forgo therapy entirely. Even if you're skeptical about herbal remedies, surely you can appreciate the value of receiving non-judgmental therapy (and maybe a nice placebo effect, to boot).
posted by schroedingersgirl at 6:03 AM on February 24, 2017 [4 favorites]

I would prefer that these anti-Rx folks have access to non-judgmental therapy. If this therapist lectured all of her anti-Rx patients about the Power of Prozac, she would likely scare some of them off and they would forgo therapy entirely. Even if you're skeptical about herbal remedies, surely you can appreciate the value of receiving non-judgmental therapy (and maybe a nice placebo effect, to boot).

I'm a therapist who works in some fairly high-woo geographical areas, and this is exactly it. Many clients come to me terrified of taking medication. My lecturing them on it, even just to provide non-judgmental education, often pushes them away, or we end up arguing about meds rather than doing work that would help them more. Or they don't want to come in the first place because they worry I'm just going to talk to them about meds. Therapy needs to be a place where people who don't necessarily do everything "right" (by whomever's standards) can still receive as much help as possible.

And personally, I tend to appreciate therapists like this who are willing to talk about meds or talk about alternative therapies equally, because some therapists seem to believe that meds are an evil tool of Big Pharma and therapy and/or vitamins will cure everything, which can be a dangerous stance, too.

I would also say that one of the psychiatrists I work with prescribes all sorts of vitamin remedies, in addition to conventional psych meds, so there's not always a hugely bright line between the two.
posted by lazuli at 6:13 AM on February 24, 2017 [10 favorites]

An anecdote: I used to work for a public health researcher whose late-career turn was about integrating complementary medicine into public health - meaning both Asian and Western herbal medicine, folk traditions and also a certain amount of stuff I thought was total woo. She'd worked in a couple of societies where traditional medicine was a really big deal and had also worked with local Hmong communities, and her logic was that public health was most successful when it was a big tent - better to know about herb/meds interactions and better to accept that there is a cultural component to care, for instance. She was very strongly in favor of evidence-based medicine (including evidence-based herbal medicine) but also felt that it was important to integrate people's preferred modalities as much as possible. (Ah, the nineties, those were some good years, actually.)

For me, I would not be put off by a therapist who worked with both evidence-based sciencey-wiencey medicine and traditional/herbal/etc medicine as long as I felt like she genuinely believed in the evidence-based stuff and wasn't just saying that. I would, in fact, feel like she was signalling that she wanted to respect clients from many different backgrounds and might even view it as a mark in her favor.
posted by Frowner at 6:13 AM on February 24, 2017 [3 favorites]

Not a red flag for me; the question is whether the therapist can work with you and your individual desires and values. Tell them exactly how you feel and what you want in this area. Ask a bit about what herbalism means to them, if it matters to you. That'll give you a sense for how the therapist approaches things. If that's not a good conversation, that'd be a red flag.

Also disagree with an earlier commenter that people who don't want to take meds and use herbs instead are, to a person, convinced herbs are superior to the ingredients in Western medicine. That's a false binary and a big generalization. They could both be used, at different times or concurrently. Some people recognize the benefits of Western medicine and still choose herbal remedies, perhaps because they can have fewer and less intense side effects--I know someone like this. For some this is an important part of wellness and health in a cultural sense; perhaps the therapist is skilled at working with people within their cultural context and drawing on a variety of approaches to reach therapeutic goals.

If this doesn't jive with your approach to health and science, I think that is fine also. You have your own context and it's important to work with someone you trust. I'd just caution against some of these reductive "all people who do herbs are [insert word here]" ideas and take this as a learning experience.
posted by ramenopres at 6:42 AM on February 24, 2017 [2 favorites]

Not a red flag at all as long as the herbalist is properly credentialed. In fact, by using a herbalist, she shows that she knows when she's out of her depth.

Do you know what they call "Alternative Medicine" that's been tested and shown to work?

This is cute, but not true. A lot of treatments deemed "alternative" actually are supported by peer-reviewed research. The reason your doctor doesn't bring them up has nothing to do with efficacy, but includes factors such as time constraints, prejudice, and money spent by pharmaceutical companies.

I have cancer and see both an oncologist and a naturopath. The naturopath specializes in the kind of cancer I have and worked at two hospitals before going into private practice. He recommended a number of supplements to help with my cancer treatment and reduce side effects. I checked PubMed, and every single thing he recommended was supported by peer-reviewed research, but my oncologist was not familiar with any of it. She has told me more than once how surprised she is by how well I've responded to chemo (I'm in complete remission after four months), but of course, she just sees this as my idiosyncratic response rather than being related to the supplements I take and the massive dietary changes I've made (and I recognize that I have no proof of why I'm doing so well, but I'm going to keep up with what I'm doing).

While it's true that supplements aren't regulated by the US government, many individual manufacturers have their supplements assessed by independent third-party laboratories, so you can know what's in them.

And drug interactions with herbs are a concern, but Memorial Sloan Kettering has a great site where you can look up herbs and supplements and find out what interactions you need to worry about.

Also, Propublica just ran this article about doctors continuing to prescribe pharmaceuticals and other treatments after they are shown to be ineffective and even dangerous. Remember, the FDA approved fen-phen (though the vote was really close), which was eventually shown to cause potentially fatal heart problems. I say this not to trash prescription drugs - they can be lifesaving - but to show that all medicines - conventional and alternative - are potentially dangerous. I took a hormone for years for perimenopausal symptoms that I now understand could probably have been managed by dietary changes. This medicine has been shown to be connected to a type of brain tumor - I developed three of these tumors.

So if you like this therapist, I would not worry about her recommending a herbalist for some patients at all. It doesn't sound like she's going to push it or try to require it, so if it's not your thing, that's fine.
posted by FencingGal at 7:28 AM on February 24, 2017 [15 favorites]

Also not a red flag for me. No one considers chamomile tea to be medicine but millions of people take it to calm down an upset stomach. Herbalists do this in a bigger scale...worse ailments, more concentrated herbs, etc. As represented in this thread, many people, like me and others, go to doctors and vaccinate, take medicine etc, but still seek alternatives to feel well all around.
posted by CrazyLemonade at 7:49 AM on February 24, 2017 [5 favorites]

This would be a red flag for me, especially because it's related to psychotherapy in this case. I would never dispute that plants contain chemicals that can have effects on the body. Obviously that is the case, as others point out that some pill-type drugs are derived from plant-based sources. But there are too many unknowns to deal with -- what the optimum dosage of a given compound is; how much of that compound is in a given herbal preparation; the toxicity or long-term organ damage that that compound can cause. People cite third-party testing and labs for herbal supplements, but I wouldn't put as much faith in those as in the FDA. The only reason "herbalism" is perceived as safer than the Western pharmacopoeia is that the majority of herbal treatments do absolutely nothing. But it's the ones that DO do something that are potentially dangerous.

Above and beyond these concerns is the fact that the herbs in question would be used to treat psychological or emotional symptoms. There are lots of plant-derived chemicals people use to alter their mental and emotional states. Sometimes they are well-known in the West and understood with regard to their risks and benefits (e.g., opium, coca, cannabis). Other times they are recent arrivals from a foreign cultural context (kratom, khat, kava, ayahuasca), and can have major risks that haven't yet entered the domain of common knowledge. The decision to see an herbalist in the course of psychological treatment should, in my mind, be given the same degree of caution as any other decision to take psychotropic drugs—whether by prescription, for recreation, or for spiritual/religious reasons. There's nothing that makes it qualitatively different from any other form of drug-taking, except for the added risk of reduced qualifications for the person administering the drug.
posted by overeducated_alligator at 9:54 AM on February 24, 2017

With herbs you can't control dosage and they are not regulated like drugs

Yes and no. The US Pharmacopeia and European Pharmacopoeia, for instance, both establish very detailed standards for identity and purity, for instance. As for dose, there are an awful lot of straight up drugs in the biologics category (like most older vaccines) in which dose is only estimated within a broad range, not derived as a specific value.

I'm a toxicologist and I work with drugs, including biologics. Herbalists tip towards woo, but as another commenter noted are not as woo as homeopathy, for instance. I've come to see herbalists and their field as a helpful accompaniment to medicine and pharmacy. A well-trained herbalist is very different from a self-styled one, especially if accompanied by western pharmacy or medical training. If this person has credentials, this might be a positive rather than a negative.

The only reason "herbalism" is perceived as safer than the Western pharmacopoeia is that the majority of herbal treatments do absolutely nothing. But it's the ones that DO do something that are potentially dangerous.

And this perception, I would add, grossly exaggerates the safety and efficacy of the bulk of the western pharmacopeia. Again, I say this as a toxicologist embedded deeply in the western pharmacopeia! We have a strong cultural bias that leads us to trust pharmaceutical treatment (and the marketing that is legally allowed to come with it in the U.S.) with a kind of blindness that is concerning, and occasionally appalling.
posted by late afternoon dreaming hotel at 12:01 PM on February 24, 2017 [9 favorites]

I take perscription medicine when I need to, but when I started having problems with insomnia the research I did on the drugs my docor suggested just freaked me out. I tried Valerian and it has been a lifesaver.

For what its worth. I would consider this, as others said, a bonus not a problem.
posted by WalkerWestridge at 1:34 PM on February 24, 2017 [3 favorites]

Since it's a matter of opinion, it's a bright waving red flag of bullshit to me.
posted by spitbull at 7:14 PM on February 24, 2017

So, let's assume herbalism is bullshit and everyone who uses herbs is deluded. Would you like a therapist who is willing to work with deluded people, or one who insists her way is the right way and anyone who believes otherwise should go figure out how to find help elsewhere?
posted by lazuli at 7:19 PM on February 24, 2017 [1 favorite]

The lack of evidence for plant medicine comes at least partly down to money. If I come up with a potential patentable pharmaceutical antidepressant, GlaxoSmithKline or whoever will pay for drug studies in the hopes of creating a new blockbuster Prozac. But if I do a small study that shows an anxiolytic effect from passionflower, it's going to be damned hard for me to find anyone to fund extensive drug trials 'cause nobody stands to make a ton of money on it.

That said, there is some evidence for some plant medicines. For instance, a BMJ meta-analysis finds the flower St. John's Wort to be "as effective as standard antidepressants," but with fewer side effects. A German meta-analysis of Silexan, a type of lavender oil preparation, found it to perform as well as lorazepam in the treatment of general anxiety disorder. And chamomile extract may just have a moderate anxiolytic effect in the treatment of GAD as well.
posted by hungrytiger at 1:27 AM on February 25, 2017 [2 favorites]

(And since you mentioned it, there is a lot of buzz about cannabidiol right now, otherwise known as CBD, or the non-intoxicating substance in cannabis; that it could have antidepressant effects, anti-anxiety effects, anti-psychotic effects, plus various applications in the fields of pain, epilepsy and more -- but CBD has all the non-patentability of chamomile with the added problem of being treated as a Schedule I drug, so we may never know much about it.)
posted by hungrytiger at 1:41 AM on February 25, 2017 [1 favorite]

I met with a therapist once (ONLY ONCE) who said, flat out, that taking up a personal yoga and meditation practice was an essential component of her style of therapy and that in addition to talk therapy, we would be working on stretches and deep breathing exercises during office visits to help build skills and habits for my personal practice.

Is yoga and meditation generally agreed upon by many to do some good things for your head space? Sure. I'll go out on a limb and say that exercises that benefit your mind and your body are probably going to have a positive effect on your mood and could potentially be a helpful supplement traditional talk therapy.

I will even go a step further and say that I am not opposed to the idea that a therapist might suggest this to a patient as something they might like to explore on their own or during office visits if they thought it might be helpful.

But did I want to see someone whose entire therapy practice was dependent on my adopting and adhering to a new fitness and philosophical regimen, regardless of whatever else I was there for? HELL THE HELL NO.

Long story short, it sounds to me like the fact that she has connections with multiple psychiatrists as well as an herbalist means that her therapy style is probably not heavily prescriptive, and that any recommendations she may have for you would be options, not edicts, and would be tailored to your needs and feelings. Sounds like a keeper to me if that was the only thing that gave you pause.
posted by helloimjennsco at 1:29 PM on February 28, 2017

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