[The background photo is of a pile of empty, orange prescription bottles facing every direction.]
Content warning: medical trauma, electroconvulsive therapy, lobotomization, suicidality, depression, in-patient psychiatry, adverse effects of medication
Did you know that as a species, we have depended on plant medicines since before written history? Even today, 80% of the global population relies on herbal medicine as primary healthcare! Plants like gotu kola, wood betony and lemon balm have been used by humans for millennia to help us with our feelings and cognition, or what we now call our “mental health”. Although the west has devoted itself to biomedicine over the last few hundred years, beforehand, it was common for most villages around the world to have their healer(s), and for households to pass down folk wisdom on local herbs. These herbal traditions are as varied as cultures around the world, carried on by lineages that transmitted knowledge orally, most of the time. In contrast, the history of mental health care is more linear and recent, yet perhaps worth unpacking to be able to make informed choices when interacting with this system.
In this lengthy article, I trace the evolution of mental health as an industry and compare its functions to that of herbalism. In doing so, I hope to illustrate how plant medicines have a place in modern-day mental health care. That said, I don't believe plants should be consumed passively (unless popping a capsule is more accessible to you) but actively engaged with, even outside of the mental health industrial complex. If you're here, you may be familiar with herbs already; you may take them, pharmaceutical drugs, or a combination. You may have a mental disorder, want to regulate stress better, or maybe you're simply curious. Here, I won't persuade or shame you about your approach, but share what I've learned as a master's student of public mental health, a humble herbalist, and a survivor of iatrogenic (medical) trauma. Consider the following words to be the cornerstone of my philosophy at hale & hart.
A note: Sometimes I interchange the terms "emotions" and "mental health". This is because I believe the latter is a euphemism for the former: a colonized, watered-down notion of emotion that healthcare professionals may use to minimize stigma. However, viewing emotions through a wellness/illness binary can contribute to stigma instead of reducing it, because it pathologizes everyday human experiences and can open folks up to coercion, or even incarceration, through the mental health industrial complex. The overuse of "mental health" also demonstrates how uncomfortable medical providers can be with the range of human expression, and how eager they are to differentiate between sanity and madness. Sometimes, I use "madness" as a substitute for "mental illness" in accordance with the mad liberation movement, because the identity has been reclaimed by many psychiatric survivors/consumers and, although seemingly derogatory, is actually preferred by many as a less stigmatizing. Have I lost you? I'll refer to the mad liberation movement again later in the article!
A Brief History of the Mental Health Industry
The seeds of psychiatry have been found, scattered, across India, Greece and the Middle East since the third century BCE, when various leading figures tried to "cure" mental disorders and even set up hospitals for this purpose. In the past, most of the world thought that mental disorders, or madness, had a supernatural origin. They would carry out rituals such as exorcisms in an attempt to treat them, usually under the guidance of the church. Later, in medieval Europe, folks exhibiting signs of mental illness/madness were typically isolated from the community, or even made to entertain members of society for their amusement (the beginning of "freakshows"). This is when lunatic asylums entered the picture, places where inmates would be incarcerated and often forcibly restrained, alongside people thought to be criminals, prostitutes, paupers and orphans.
In the 18th century enlightenment period, societal attitudes changed towards madness in Europe. Physicians began to explore the possibility of madness being rooted in one's biology, focusing their efforts on treatment and rehabilitation instead of physical punishment. During this time, the religious Quakers developed a model for asylums based on what they called "moral treatment", centered on reducing restraints, cultivating rationality and improving moral character. After the Lunacy Act in the 19th century Britain, mad folks began to be viewed as patients who needed to be treated.
State asylums were set up around Europe and North America, modelled after the Kirkbride Plan—think of the architecture in the film, One Flew Over the Cuckoo's Nest—which psychiatrists hoped would play a huge role in curing many mental disorders. However, these hopes were bashed in the 20th century, as hundreds of thousands became residents in these institutions and rarely left. Meanwhile, the mental hygiene movement gathered momentum in the early decades of the 20th century, as medical professionals sought to improve care standards for people with "severe mental illness" (SMI) and promote emotional wellbeing throughout the population. Mental hygiene paved the way for the normalization of mental health as a framework.
Since psychiatric drugs were still undergoing development, the main forms of "treatment" in psychiatric institutions included seclusion, restraint, psychosurgery, electroconvulsive therapy, and psychoanalysis. Psychoanalysis in fact became the most popular therapy for mental disorders after WWII for less severe conditions, however many residents in institutions had limited access to quality psychotherapy. Moreover, hundreds of thousands of patients did not have a choice to leave until the deinstitutionalization era began in the 1960s. As a result of policy changes brought on by US President Kennedy's office, almost every psychiatric institution was shuttered during the next couple of decades, and psychiatric survivors started receiving care in the community—or at least, that was the intention. Unfortunately, due to the neoliberal economic policies that defined President Reagan's government in the 1980s, substantial funding went into erecting other institutions such as prisons, rather than towards community-based mental health care.
The year 1980 was pivotal in the history of US mental health care, which in turn shaped global mental health. Psychiatry was losing credibility for lacking diagnostic reliability and systematically abusing patients. At the same time, multiple schools of psychiatric thought vied to become the ultimate authority. During 1980, the American Psychiatric Association (APA) released its third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) which classified mental disorders according to symptomology instead of etiology (causes) as the APA tried taking an objective, atheoretical approach to diagnosis. However, science is never atheoretical: it always reflect the experiences, and biases, of the researchers involved. For example, up until the DSM-II, homosexuality was seen as a mental disorder and was removed only after LGBTQ+ activists lobbied their hearts out. With the support of the pharmaceutical industry, the DSM became the "Bible" of psychiatry and is still used as a diagnostic tool around the world, despite being unable explain the cause of mental disorders.
On these sweeping sociomedical changes, British psychiatrist Dr. Joanna Moncrieff stated,
“A society that is increasingly socially fragmented and divided, where the gulf between success and failure seems so large, where the only option open to many is highly demanding and low paid work, where the only cheap and simple route to carelessness is through drugs, is likely to make people particularly vulnerable to mental disintegration in its many forms. It has long been known that urban life and social deprivation are associated with high levels of mental disorder. Neoliberal economic policies are likely to further increase their pathogenic effects. By medicalizing these effects, psychiatry helps to obscure their political origin…The social catastrophe produced by neoliberal policies has been washed away and forgotten in the language of individual distress.”
Left to the invisible hand of the free market, the mental health industry has has become an industrial complex. It's phenomenally lucrative, and tinged with corruption. As journalist Robert Whitaker exposed in his book, Anatomy of an Epidemic, the APA has been pocketing pharmaceutical money since the 1980s neoliberalist era. Around 1 in 4 Americans started taking psychopharmaceuticals during this period, yet as you well know, this country continues to experience more emotional distress as the decades roll. Biopsychiatrists and pharmaceutical companies alike advertise these drugs for most, if not all, psychiatric conditions; however, they have shown modest success in clinical trials. For example, only 20-30% of people who take antidepressants in randomized controlled trials (RCTs) experience symptom improvement. Despite this, 80% of the public still believes that mental illnesses are caused by a biochemical imbalance in the brain, even though this has been disproven time and again. Last year, a significant systematic review in Molecular Psychiatry showed once more that there is no evidence of serotonin deficiency among people with depression. While surgical lobotomies are rarely practiced today, society has accepted chemical lobotomization, as these medications are known to irreparably damage neurological functioning, with adverse effects like tardive dyskinesia, desensitization and sexual dysfunction presenting over time.
It's no wonder that the anti-psychiatry/mad liberation movement has run counter to mainstream mental health care since the 1960s, led by survivors of psychiatric institutionalization and their families. They have resisted mental health industrial complex through grassroots organizing and media—specifically pushing against psychiatry's use of diagnoses and treatments as a means of social control. Some see their madness as a type of neurodiversity that should not be "fixed" or even pathologized. Many reject diagnostic labels like schizophrenia and bipolar disorder, although some identify with the biomedical model of mental illness and manage their conditions using psychiatric medications. The organization Hearing Voices Network operates from a neurodiversity instead of a mental illness framework. It provides an alternative paradigm to understanding what is commonly known as psychotic disorders and offers effective crisis and peer support. If you want to read more about these approaches, check out the growing academic field called mad studies or the online magazine called Mad In America, run by award-winning journalist Robert Whitaker.
Comparing Plant and Pharmacological Medicines
The concept of mental health really only makes sense within a Cartesian dualistic framework, where the body and mind perceived as separate from each other. This theory is named after 17th century French philosopher René Descartes (you know, the dude who proclaimed "I think, therefore I am"?) and has laid the groundwork for western medical thought, a.k.a. biomedicine. Since Descartes, scientists have developed numerous fields of medicine, where specialists are trained to treat bodily functions, organs and systems in isolation. In opposition to this, herbalists view the body and mind as inseparable, and life forms as innately animate. For example, in Traditional Chinese Medicine (TCM), practitioners do not focus on finding the “cause” of symptoms; instead, they view mental, emotional, physical and spiritual traits as signs of a fundamental imbalance in one’s meridian (energy) system. In TCM, Qi, or the fundamental life force, animates all things.
Many times, psychiatric medications successfully help people to stabilize and manage symptoms of mental health conditions. However, they are rarely able to treat or even identify their cause. Yet holistic health practitioners are no better at "curing disorders/disease", despite what some may tell you! Finding a cure-all is the exception and not the norm in both biomedicine and holistic health. Research shows that psychopharmaceuticals tend to be more effective when combined with lifestyle changes, psychosocial therapies (like counselling or peer support) or holistic therapies (like acupuncture or herbalism).
I must emphasize here that I’m not suggesting herbs be substituted for psychopharmaceutical drugs: far from it! Rather, I believe that both have their place and can actually be taken together, as long as herb-drug interactions are carefully understood. A well-trained herbalist or naturopath should know which herbs are best for your situation and avoid any contraindicated ones. Some herbalists may be able to help you transition off psychopharmaceutical medications and onto plant medicines; however, I only recommend trying this with stable or "less severe" mental health symptoms. If you are interested but unsure about doing this, please check with a healthcare provider you trust before proceeding.
In herbalism, individuals may experience success from their own customized protocol, which won't work for another person with the same condition. Hence, designing an appropriate herbal mental health protocol depends on many factors: constitution, health history, current medications, personal willingness, time, and more. Importantly, it requires close observation, patience and flexibility from both the client and the herbalist. My practical approach is to support what you're already doing to take care of yourself and introduce complementary herbs, dietary and lifestyle changes that you feel are right for you. The table I’ve made below summarizes the strengths and limitations of both approaches – especially when applied to mental health care.
Considerations for Bridging Healing Paradigms
Because of globalization, capitalism and neocolonialism, the mental health industrial complex has been exported around the world and quashed other culture's epistemological frames for navigating psychospiritual experiences. While some traditions like TCM are thriving because they've been supported by China's policies, other Indigenous herbal traditions have been discredited and driven underground. Herbalism has always been "the people's medicine" globally, because plants are accessible, abundant, and/or "free". In comparison, mainstream medical care is often unaffordable, at least in the US, because it is so commercialized. I'm not surprised that these health traditions tend to clash, because their values and histories are so different. However, I think it's time for herbalists to be bold and decide to work with psychiatrists, doctors, nurses and other medical professionals, if they are willing to work with us. We can bring a humanistic dimension back into mental health care that is non-coercive, community-oriented, educational, and grounded.
If you’re familiar with my practice, then you know how much I value bridging biomedical and holistic health. In my mind, each has its place and can be used in different contexts. However, here's the caveat: combining them should be carried out with care and awareness, to safeguard plants from misuse and prevent harming people. For instance, some psychiatrists and physicians are recommending herbal supplements to their patients without changing other dimensions of their practice--a trend known as green allopathy. Many medical providers and researchers strongly believe that herbalism lacks credibility because it is not "evidence-based enough" to support claims about the traditional plant medicines. And yet the supplement industry is shockingly lucrative, as researchers receive funding to see how useful they can be to us humans and companies find ways to popularize the next super plant/food. More recently, they have been studying psychoactive plants and funghi to treat mental disorders including anxiety, depression and PTSD.
Also, think about hallucinogenic plants like Ayahuasca, which are Indigenous sacred medicines. It’s become common for predominantly white westerners to travel to Central or South America and have exalted trips on these plant medicines, usually with a shamanic guide. Some folks go looking for spiritual breakthroughs, others to heal from chronic or mental illness, and I’m sure more are just curious. Retreat experiences have risen to meet climbing demand, and all this subtracts from the sacred rituals around these traditional Indigenous medicines. People don't realize they can be dangerous if used wantonly. It is important that humans have access to effective medicines, but most of these researchers are not consulting the communities which know these plants intimately . As I learned from Dr. Yuria Celidwen at the Bioneers Conference this year, Indigenous communities should be leading any research into their traditional plant medicines to prevent cultural misappropriation. Following guidelines like hers will help to ensure that people, traditions, and the land are more respected than today.
In short, health providers cannot decolonize their profession by "prescribing" plant medicines or adopting "greener" practices if they are entrenched in capitalist, white supremacist and neocolonial biases, even implicit ones. The plants themselves will withhold their magic, because, like people, they don't want to be used. Herbalists even fear "loving a plant to death", i.e. popularizing it to the point that it becomes an at-risk species. Unfortunately, we're in the cultural habit of loving plants until they become endangered, or the wellness industry gravitates to another superplant/food.
Liberating Our Collective Mental Health
Many times, mental ill-health, distress, and trauma are reasonable bodymind responses to the chaotic collective. It’s not surprising that 700 000 people commit suicide each year globally when so many unjust systems interact and oppress many individuals daily. Health professionals should remember to always view mental disorders within an individual's social and environmental context, as these disorders are often not individual pathologies, but signs of a larger social malaise. Just as herbalism helps us orient within our ecology, mental health care should support us to feel safe in the world that we live in--like we belong. And if society is not facilitating our wellbeing, we must work together to slowly change it. Movements (disability, healing and racial justice, for example) that are working towards collective liberation are ways to improve mental health: by abolishing systems, transitioning structures, and making the world a more equitable place to be. As long as we operate in solidarity and prioritize care, our movements can be healing. As queer Black feminist organizer Cara Page has said, “Our movements themselves need to be healing or there is no point to them.”
In certain ways, mental health is a measure of our connectedness to different ecosystems: social, planetary and internal. The biopsychosocial model in public and clinical health touches upon this, where all three components of that term hold equal weight in the wellbeing equation. This quality of mental health may also be why peer support systems (like those established by Project LETS and Fireweed Collective) are remarkably effective alternatives to biomedical care, because they center our connectedness and lived experiences, which are also integral aspects of herbalism. Herbalism is about solidarity with plants, animals, fungi, humans. It's rooted in justice, not profiteering, and we focus on how folks feel in their bodyminds and experience the world. If psychiatrists and psychologists took notes about how herbalists approach healthcare, maybe they could transform the mental health industrial complex entirely (or maybe it would no longer exist).
More than ever, we need justice for our psyche and our bodies and our hearts. If I was to give you a prescription--which I'm not allowed to do as an herbalist--it would be to abandon individualism, work towards collective liberation, and embrace a “both/and” approach to caring for your bodymind. And please exercise caution when accessing healthcare, since dangers sometimes lurk in the murkiness of the mental health industrial complex, which incarcerates many mad, sick and disabled comrades. To any mental health providers reading this, focus on putting patients' interests and narratives first, so as to not cause further harm. Obviously, we can't erase systemic injustices that have been carried out on folks experiencing madness, illness or distress, but we can make space for each other's lived experiences and, together, redirect the course of mental health care.
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