http://herbsformentalhealth.org Mon, 17 Dec 2018 22:48:48 +0000 en-US hourly 1 https://wordpress.org/?v=5.0.3 http://herbsformentalhealth.org/wp-content/uploads/2017/01/cropped-IMG_3823-32x32.jpg http://herbsformentalhealth.org 32 32 10 Types of Healing Plants for Mental Health and Emotional Wellbeing   http://herbsformentalhealth.org/10-types-of-healing-plants-for-mental-health-and-emotional-wellbeing/ http://herbsformentalhealth.org/10-types-of-healing-plants-for-mental-health-and-emotional-wellbeing/#respond Mon, 17 Dec 2018 22:48:48 +0000 http://herbsformentalhealth.org/?p=2904 In this article I will be exploring many of the traditional ways that people have worked with plants to help heal from metal and emotional complaints.  In reality any herb can be an “herb for mental health” .  If one is struggling from chronic bronchitis, then lung herbs that help a person recover would impact their mood and overall wellbeing as well.  Herbs that heal external wounds or improve kidney function or work on any level to heal physical maladies will spill over into improving mental health as well.  But in this context I am focusing on herbal categories that traditionally are deeply helpful for emotional complaints such as anxiety, insomnia, stress and sadness.

 

1 Nourish

2 Tonic

3 Bitters

4 Aromatics

5 Environmental Herbalism

6 Energetic medicine

7 Nervines

8 Nerve Tonics

9 Strong Plants

10 Psychedelics

 

1 Herbs that nourish 

These are herbs that are nutrient rich, containing a wide variety of minerals and vitamins.  These herbs are especially useful for those who appear undernourished and lacking vitality.  These herbs are closest to being food and are generally very gentle with few adverse side effects associated with them.  These herbs are also often helpful for those who eat a standard American diet that lacks a great deal of nutrient dense foods.  One of the ways that nourishing herbs can also help is to offer prebiotic starches that act as food for healthy bacteria.  Healthy bacterial flora in the gut are now known to not only improve gut health but to improve mood and wellbeing as well.  One of the ways they help is to stimulate the vagus nerve to encourage a parasympathetic “rest and digest” response.  Some classic inulin prebiotic rich herbs include burodck, dandelion and elecampane root.  Fermented foods are also a time honored way to improve the flora in the gut microbiota.

Some examples include:

Nettles, oatstraw, red clover, seaweeds, hawthorn berries, elderberries, douglas fir tips,  moringa, burdock, dandelion, cacao.

Main methods of administrations:  Broth, teas, syrups, elixirs, ferments such as kim chi, sauerkraut and kombucha.

 

2 Tonic Herbs

These are herbs that have long been used for their ability to strengthen, build resiliency and stamina.  Sometimes called adaptogens, this category of herbs includes many plants and mushrooms that have been used for thousands of years to build and fortify the constitution so that one can adapt to stressors better.   In India this category of herbs is known as rasayanas or longevity promoting tonics and includes holy basil, ashwaghanda and gotu kola.  In Chinese medicine these are often herbs that “tonify qi, blood and yin” and some include ginseng, astragalus and rehmannia.  

Examples:

Stimulating:  Rhodiola, Asian ginseng, Holy basil, eleuthero, devil’s club

Nourishing:  American Ginseng, ashwaghanda, rehmannia, codonopsis, astragalus, solomon’s seal, reishi, red belted conk

Main methods of administration:   Broths, teas, tincture, syrups and double extractions

 

3 Bitters 

Though we don’t tend to think of bitter herbs as particularly associated with mental health, they are often some of the most important herbs for working with people who are struggling with mood issues.  This is because bitters work at a number of levels to help a person.  At the very start of the journey, tasting a bitter herb actually directly activates vagal nerve receptors in the mouth and digestive system to bring greater calmness and improve gut motility.  Bitter herbs also improve gastric secretion of digestive enzymes so if the liver and gut is sluggish, bitter herbs improve digestion and elimination of waste metabolites.  If we are not digesting properly then we won’t absorb nutrients from food fully and the gut lining can breakdown and lead to inflammatory compound leaching into the bloodstream.  Improved liver and gut functioning also decreases skin ailments such as eczema and psoriasis.

So in terms of mental health- bitter herbs are often good for those who have sluggish digestion with chronic backup of waste that comes out as skin ailments and also as low level malaise and depression.   In chinese medicine the term for this diagnosis is “liver qi stagnation” which is treated by a combination of bitter, tonic and aromatic herbs.

Some examples include:

dandelion, burdock, Oregon grape, yellow dock, angelica, gentian, fennel

Methods of administration:  decoctions, tincture, in meals

 

4 Aromatics

These are herbs that have a strong aromatic profile and are some of the plants we notice most immediately in our environment.  Think of walking through a garden of roses, or through a forest filled with aromatic pines and spruces.  Aromatic terpenes evaporate as an aerosol in the air and our nose passively draws these compounds into the body and lead to a quick shift in mood.  From burning smudge such as cedar or sage, to working with essential oils and hydrosols, to making incense, aromatic plants are some of the most easy to incorporate for many people from young to old, infirm to healthy.  Though many people are allergic to synthetic scents in perfume and air fresheners, most people enjoy natural scents.  In terms of mental health, aromatic plants do a number of things:  they stimulate, sedate, improve circulation, improve lymph drainage, gladden the heart, help with expectoration in the lungs and diaphoresis.

Some examples of aromatic plants for mental health include:

lavender, rosemary, douglas fir, cedar, sage, oregano, sagebrush and black cottonowood.

Main methods of administration:  Infused massage oils, salves, creams, bath salts, incense, essential oils, teas, tinctures

 

5 Environmental Herbalism

We can also call this category nature based healing.  This includes the wide range of ways that humans can heal from spending time and doing activities in nature.  Some ways include forest bathing to qi gong to gardening to spending time with plants in forests and fields to backpacking in the wilderness.  Increasingly humans spend most of their time indoors and have lost contact with the natural pulses and rhythms of the seasons and the ebba and flow of the plant world.  Prior to ten thousand years, humans were all subsistence hunters and gatherers.  Only a few hundred years ago we shifted away from agrarian societies to industrial factory based societies.  These changes have made us more sedentary and likely to spend most time indoors.  Nature deficit disorder is a term coined for the increasing lack of connection to the natural world and all its benefits.  In terms of mental health, studies have shown that environmental herbalism helps reduce stress, improve mood and wellbeing, reduce anxiety, depression and improves the quality of sleep.

Examples:  Gardening, hiking, forest bathing, qi gong, backpacking

 

6 Energetic Medicine

One of the most powerful ways of working with herbs is to connect to them energetically- meaning tuning into their subtle and invisible properties to

Coastal Mugwort

access healing.  Traditionally most cultures have a sense of particular “power plants” in their environment that they return to again and again for their “teachings” and wisdom.  From cedar to tobacco to grapes to mugwort to palo santo to cacao these plants not only impart direct physical healing, they also teach lessons about how to walk the world in a good way.

In the Western tradition in modern times,  common ways of working energetically with plants includes sitting with a plant or tree to taking preparations such as flower essences and “drop dosages” of plants.   Tuning into plants subtle vibrations has been a time honored and gentle way to help people heal from emotional concerns.  Perhaps the most famous modern way of accessing energetic plant healing is via flower essences.  Promoted by Edward Bach in the 30’s, he saw that each flower and plant carried messages and teachings that could help us to move through deeply challenging emotional knots and wounds.   More recent teachers such  as Matthew Wood promotes using very tiny (1-5 drops) of plants (known as drop or spirit dosing)  to effect healing for both physical and emotional maladies.

In my view, working with the plants that grow locally is the most profound way of working with plants energetically.  The more we are in deep relationship with the local plants, the more that we can pass that depth of relationship and healing onto friends, allies and clients.  Each plant has its own story and teaching.  For example, black cottonwood helps with releasing stored up tension and sorrow while also calming and building resiliency.  Douglas Fir helps bring us greater strength, joy and openness to life.  Some other examples of plants to work with energetically:

Mugwort, elder, cedar, black cottonwood, wild rose and wild ginger

 

7 Nervines

These are plants that have a marked effect on the nervous system.  Though they can also refer to stimulating nervines like coffee and mate, in general they tend to mean plants that have a marked relaxant effect own the body.  I also use the term anxiolytics, antispasmodics and hypnotics for more specific ways of describing the herbs.  Nervines range from very gentle (linden) to very strong (kava).  In general the gentle nervines are appropriate for most people while one must be more cautious about the use of stronger nervines- especially in terms of med contraindication.

Gentle nervines:  Chamomile, lemon balm, motherwort, hawthorn, passionflower, linden, bleeding-heart, lavender

Strong nervines:  Kava, valerian, hops, cramp bark

Method of administration:  Gentle nervines are commonly found in teas while stronger nervines are more commonly offered as tinctures.

 

8 Nerve Tonics

These are herbs and fungi that have a marked strengthening quality to the nervous system, building resilience and a sense of inner peace andcontentedness.  They range from herbs that have a marked antidepressant and anxiolytic quality (Saint Johns Wort, Albizia, hawthorn) to nervous system tonics such as skullcap, milky oats and reishi.  

 

Examples:  St. John’s Wort, Mimosa (Albizia), Hawthorn, skullcap, milky oats, reishi.   

Method of administration:  Teas, tinctures, double extractions and syrups

 

 

9 Strong Plants

This is a large category of plants that have a strong and marked effect upon the nervous sysetm- ranging from strong stimulation (coffee) to strong sedation (Indica and CBD rich varietals of cannabis).    They are useful for immediate effect and are often used as part of a larger role of social cohesion.  For example, think of folks getting together to drink beer made with wheat and hops.  Or think of gatherings to consume cannabis.  in other cultures, khat or betel nut play the role of stimulant within a social context.  Our beloved coffee houses are places where we not only stimulate our nervous system but also make connections and build community, key to healthy communities.  Of course strong plants can cause a variety of side effects and social ills such as addiction as well so these are tricky plants to work with.

Examples:  cannabis, kanna, alcoholic beverages, khat, kratom

Method of administration:  Smoking, as edibles, alcoholic beverages, in tincture

 

10 Psychedelics

 

Cultures throughout the world commonly use plants and fungi that elect extraordinary changes in perception and consciousness.  Traditionally theseplants and fungi have been strongly revered as transformative agents for divination, self-exploration and healing.  We continue to make these substances illegal to popular consumption but there is increasing evidence that they can be truly helpful and healing for many people.  Recent research from NYU and John’s Hopskins since 2000 have shown efficacy for treating people with concerns ushc a anxiety, OCD traits, addiction and end of life grief.

Examples:  peyote, psychedlic mushrooms, ayahuasca, san pedro,

Method of administration:  Tea, tincture, directly consumed

 

Conclusion

 

Though any medicinal plant can be likely considered an “herb for mental health”, as the health of our body impacts the health of our mind; but there are some plants and fungi that are specifically known for helping to improve mood and emotional wellbeing.  This is a brief primer on ten categories of plants that are specifically helpful in this area.

 

 

This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  For more articles like this, please go to    www.Hearthsidehealing.com.  You can also find me at the Facebook group Herbs for Mental Health.

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Apprenticeship 2019 http://herbsformentalhealth.org/apprenticeship-2019/ http://herbsformentalhealth.org/apprenticeship-2019/#comments Wed, 11 Jul 2018 23:31:55 +0000 http://herbsformentalhealth.org/?p=2877 Apprenticeship 2019

 

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Starting in February 2019,  our nine month 100 hour program on folk herbalism and traditional aromatics begins.  The heart of the work is about developing closer alliances and relationships with 2 dozen plants, learning how to ethically harvest them and make herbal and aromatic preparations.

As a folk herbalist I believe in healing that is based in nourishment, resiliency, joy and direct relationship with the plants.   I feel that learning is best done when we get our hands dirty and connect to the plants directly in the field.  The herbs themselves will teach us by simply observing and listening to them, and then turning them into preparations that we can work with in our day to day lives.

In this series of classes, you will be learning how to make decoctions, teas, syrups, infused oils, salves, broths, bath salts, distillations, natural perfumes, essential oils and hydrosols from these plants.

As a therapist I am deeply interested in how plants can improve mood and wellbeing.  For that reason the program has an emphasis on mental health and emotional resiliency.  From bone broth to syrups to essential oils and natural perfumes, herbs have long played a key role in helping people to heal and recover from stress, trauma and emotional suffering.   As part of the course, we will be covering topics such as the nervous system, thyroid health, the vagal nerve, gut/brain axis, microbiota and the adrenals.

 

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This course also emphasizes aromatics, working with the scent and fragrance of plants for their therapeutic powers.  That means we will dive deeply into traditional distilling with a copper still and the making of hand crafted aromatic preparations.  This practice is key to the ancient arts of perfume making, alchemy, making aromatic liquors as well as essential oils and hydrosols.

I believe that knowing plants directly by growing them and meeting them in the field is key to becoming a good herbalist, perfume maker, aromatherapist, medicine maker and distiller.    I am aquatinted with hundreds of plants but I am only deep friends with a couple dozen.  These are plants that I return to again and again to hear their songs- touch, smell and taste them.  This course is designed to open and deepen relationships with these plant friends.

As part of the course I will be taking folks on two retreats- one to the Oregon Coast and one to the Fire Rose Farm- home of my main teacher Joyce Netishen.  These are opportunities to deepen our relationships with each other, the land and the plants.

As a folk herbalist I believe that we can serve our families, allies and community with simple, gentle plants and fungi that will help us to feel stronger and more resilient.  Here are the dates and a course outline for the year.

 

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Saturday February 8th  Dinner from 5-8

Sunday February 9th  10-5 Working with Cottonwood and Western Red Cedar.  Infused oils, distilling essential oils, soap making.

 

Sunday March 17th  10-5 Exploring bitters- Oregon Grape, burdock and dandelion- with Margi Flint.  Decoctions, and syrups.

 

Sunday April 7th  10-5  Spring rising- nettles, Bleeding-heart:  Making flower essences, long infusions and bone broth.

 

Saturday May 4th  10-5  Ally Drazin  Cosmetic Herbalism:  Salves and Creams.
Sunday May 5th  10-5 Learning Hydrosols with Leslie Lekos.
Working with lemon Balm, mints, hawthorn flower

 

Saturday June 1st and Sunday June 2nd – Both days 10-5 The art of Natural Perfuming with Jessica Ring

 

Friday June 21st to Sunday June 23rd    Retreat to the Coast to work with seaweeds, mugwort, Douglas fir, Saint John’s wort, yarrow.

 

Saturday and Sunday July 20th and 21st   Leave 9 on saturday and return 5 on sunday. Retreat to Fire Rose Farm in McCleary, Washington to work with Joyce Netishen.  “Distilling the Land”, Fire Circle and making Wild Aromatic incense.

 

Sunday August 26th  10-5   Chocolates, Meads and Cordials with summer herbs, berries and fruit.  Elderberry, blackberry, mimosa, cannabis.

 

Sunday, September  22   10-5  Reishi, Red Belted Conk and Artists Conk.  Exploring the mushroom world.  Making double extractions.

 

Saturday October 19th Dinner  5-8

Sunday October 20th  10-5  Devil’s Club, Close up class.

 

Plants:  Cottonwood, cedar, Oregon grape, dandelion, burdock, nettles, bleeding-heart, hawthorn, lemon balm, mints,  seaweeds, mugwort, Douglas Fir, Saint John’s wort, yarrow, elderberry, blackberry, cannabis, reishi, red belted conk, artist’s conk, Devil’s club, mimosa.

 

The Teachers

Joyce Netishen lives and works at the Fire Rose Farm, a small farm located outside of the Olympia area in McCleary,Washington. Joyce was my primary teacher from 1995-1998 when I apprenticed with her.  Above all  else, Joyce taught me the importance of cultivating deep relationships with the plants by spending time in the field getting to know them.  To sit with Joyce is akin to siting with plants themselves. Joyce sees people in private consultations and has led apprenticeships and taught for 30 years.  She is kind, deeply wise, funny as hell,  is an extraordinary healer and is deeply devoted to the magic and beauty of the plant path in life. You can find her website here:  Fire Rose Farms.

 

 

Margi Flint  is one of the most revered and loved herbalists practicing in America today.  Her book “The Practicing Herbalist” and he rfocus on assessment through tongue, pulse and face has influenced thousands of herbalists throughout the years.  Margi practices in the seacoast town of Marblehead, Massachusetts and over the past forty years has become their “village herbalist.”   We are incredibly lucky to have Margi come out to help teach this year.  She not only brings decades of expertise, she herself embodies the best aspects of herbalism today: practical wisdom, a huge heart, love for the plants and for the people she helps.  You can find her website here:  Earthsong Herbals

 

 

Jessica Ring has been deeply immersed in the world of artisan distillation, essential oil, hydrosol and natural perfume making for over adecade.  Her knowledge of aromatics and the chemistry of scent is matched by her deep reverence and poetic enchantment with the natural world and its creatures.  You can find Jessica spending long days hiking along river beds, forest groves and deep in her garden in search of the fragrances that she can distill and weave into her perfumes that are truly medicines for the soul.  You can find her website here: Ring Botanicals.

 

 

 

Leslie Lekos is the director of the Wildroot Herb School in Bellingham, WA which offers herbal courses and intensives by top-notch herbalists from around the country.  I met Leslie a few years back when I brought Margi up to Bellingham to teach.  Leslie is one of the kindest and warmest herbalists I have had the pleasure to meet.  Leslie makes a line of sustainable wild harvested and organically grown hydrosols and essential oils and is truly one of the experts at drawing forth the heart and soul of plants through the still.  We are very lucky to have her teach about making excellent hydrosols this year.  You can find her website here:  Wildroot Botanicals

 

About me:  I am a therapist and herbalist who has long been interested in how plants weave into people’s lives as healers of the heart.  I studied botany and botanical medicine in college, studied with Joyce Netishen for several years and went to graduate school in counseling and became a licensed professional counselor in 2005.  I have a deep knowledge of the role of trauma and how it can profoundly affect people both emotionally and physically. When I was a younger man- I went through a profound time of deep distress emotional anguish and confusion that led me to the medicine and beauty of plants.  I have worked in hospital settings and private practice as a counselor to help people who are struggling through profound periods of sorrow emotional pain and spiritual emergence.

If I have a single philosophy – it is that I believe joy, connection and beauty are ways back from the depths of trauma- and by opening our senses to plants and the natural world, we can write new narratives that connect us back to the land, to each other and to our own good hearts.

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Continuing Traumatic Stress Disorder. http://herbsformentalhealth.org/continuing-traumatic-stress-disorder/ http://herbsformentalhealth.org/continuing-traumatic-stress-disorder/#respond Thu, 29 Mar 2018 18:51:54 +0000 http://herbsformentalhealth.org/?p=2724

 

So much has written about post traumatic stress disorder and complex PTSD.  But not enough has been written about CTSD- Continuing Traumatic Stress (Disorder).  For many people throughout the world, trauma is not in the past tense, but is an ongoing unfolding experience.  Many of the symptoms are the same, but it becomes extremely challenging to heal and soothe the nervous system because the threat of continued harm is very real.

 

Refugees and undocumented immigrants, those in poverty, houseless, fighting oppression, racism and social injustice, as well as those experiencing ongoing abuse all fit this bill.

 

The term is not part of the psychiatric diagnostic manual (DSM) but has its origins in 1980’s South Africa under apartheid.  Therapists working there saw how challenging it was to help South African blacks living under a system where they  experienced ongoing fear of violence and victimization.

 

The road through continued traumatic stress is to understand that intertwining ecological, humanitarian and social justice crises are touching all of us at some level.  These crises are breaking down the essential core resiliency in individuals and communities.  Our mental health and addiction treatment services are ill equipped to treat these forms of understandable communal suffering.

 

Illnesses such as depression, anxiety, addiction and even schizophrenia are not always discrete disorders passed out in some form of genetic lottery.  They are often the symptomatic end result of human communities in deep imbalance- with each other and the land itself.  And these downstream communal symptoms of trauma and mental illness are not so easily solved by prozac or a few sessions of cognitive behavioral therapy.   They are signals of distress calling out for systemic root changes.

 

I’d like to say there is a therapeutic prescription for this- but these are systemic problems that are not easily solved by talk therapy, medication, and stress reduction techniques.   In this context, healing is not seen as a distant goal but instead as small acts of daily resistance, a way of surviving and working through oppression and the challenges of the modern experience.

 

But deeper, it is often about the process of storytelling,  weaving a narrative that is different from the dominant story of the importance of profit, career, stock markets and economic growth.  This narrative comes from the ancestors and from the land itself; stories of reconnection, realignment and relationship with the natural world and ancient traditional ways.

 

We as therapists and mental health professionals need to honor these stories and often our own role in perpetuating forms of colonization that harm our “clients”.   That means that our solutions for distress are often not adequate- and sometimes perpetuate harm.  Simply offering psychiatric medications to individuals who are in daily struggle and danger from oppression not only may be counterproductive, but can lead to side effects that perpetuate trauma by the dominant society.   Antidepressants that cause libido loss, or anxiolytics that lead to horrific withdrawal effects, opioids that lead to addiction- are ways that we may perpetuate ongoing trauma.

 

In therapy, those who focus strictly on diagnoses such as major depression or generalized anxiety disorder- and call them chemical imbalances- without acknowledging the underlying perils of living in this world as a black, indigenous or person of color- also do a disservice to those individuals.   Furthermore, offering superficial skills (breathwork, mindfulness) while not understanding and addressing the deeper layers of how colonization has caused the underlying distress- can also perpetuate ongoing trauma.

 

 

Reclaiming the Old Ways:  Voices of Resilience 

 

Cultures throughout the world have unique languages and tools around how to help people who are suffering.  We are in the process of the “Americanization of Mental Illness” in which the language of psychiatric diagnoses, medication and therapeutic interventions is supplanting traditional ways of understanding suffering.  This is in itself a form of colonization as traditional views of health and healing are disregarded- or worse- deemed unscientific superstition.

 

When we view oppressed people’s struggles through the lens of medicine and therapeutic intervention, we ignore the myriad ways that traditional communities have already established to work through continuing trauma.  Those include:

 

 

Community Reliance.   Gaining supports in one’s own community, engaging in activities and events that celebrate community resiliency is key.  I think of the “Canoe Journeys” that happen here in the NorthWest, where numerous tribes gather to paddle traditional canoes through waterways- as a way of reconnecting to lineage as well as gaining intertribal exchange and support.   Therapeutically this can also mean working with elders and members of one’s own community for help in healing.

 

“Every piece of the cedar tree is used, from carving a canoe, to utensils, to basket weaving and clothing…nothing is wasted. Every part has a responsibility. That’s what we want to use for bringing together our community, and particularly the community healing –  to find a way for our people to belong and be part of participating in helping to get ready and the planning.”- Raymond McCloud, Puyallup Tribe on the Canoe Journey.

 

 

Reconnecting to Land of Origin.  For many people displacement from one’s land of origin- oftento an urban environment- can lead to feelings of alienation and disconnection.  Connection to land, culture, spirituality, food systems and language were all deeply damaged by colonization.  Reconnecting to those roots can be key to building resilience.

“So, our biggest lesson is to understand that we need to take the time to work with the land we come from, and not just have dominance over it. That’s the big picture of why I do what I do. It really is about healing historical trauma, empowering people to feel comfortable in their own identity and helping people have the resources to walk in a modern world – with their ancestors beside them, helping them to make good decisions towards their health.  What we see, time and time again, is that when native people are rekindled with their food cultures, they feel better. These people are reminded of who they are and where they come from, and these memories can also restore the land.”   Native nutrition educator Valerie Segrest

 

 

 

Traditional Healing.  From drumming, singing, chanting, sweats, prayer and fasting, there are a number of ways that can help an individual process and release trauma and regain resilience.

 

“The traditional Native view of health and spirituality is intertwined,” he explained. “Spirit, mind, and body are all one – you can’t parcel one out from the other – so spirituality is a huge component of healing and one not often included in western medicine, although there have been a few studies on the positive effects of prayer.”  Native Veteran Greg Urquhart

 

 

Plant Based Healing.   Traditional cultures have all relied in part on plants for nourishment, strengthening and helping with anxiety, shock and grief.  From the food sovereignty movement to the use of local herbs for healing, plant based therapies have long been intertwined with traditional ways of gaining resilience and healing.

Those days together were an embodied prayer to all those ancestors we descend from, an honoring song and a love poem for all the sacred foods and seeds and cultural memory they have passed down through the ages to feed us. It is in gatherings such as these that we feed those sacred hungers of our ancestors, those who perhaps we caught in the tumult of the generational change that was brought on by colonialism, acculturation and displacement. In our time together, we fed those hungers and stoked the appetites of a whole new generation of Native people who wish to nourish themselves from the foods and flavors that fed their ancestors.   Rowen White, Mohawk activist for seed sovereignty

 

 

Resistance to Dominator Culture/Social Justice Activism.  As long as there is oppression, there will be suffering.  Part of the work of working through ongoing trauma involves activism and standing up to that oppression.  From Amazonian tribes protecting their local lands from logging  to Native Americans protecting waterways from being despoiled by oil at Standing Rock, activism is a conduit for building resiliency and addressing there wounds that are leading to ongoing distress.

 

We are not myths of the past, ruins in the jungle, or zoos. We are people and we want to be respected, not to be victims of intolerance and racism.” Rigoberto Manchu, Guatemalan activist

 

 

Conclusion

In indigenous communities, continuing traumatic stress is part of the fabric of many communities.  The long term effects of colonization and oppression have led to high rates of addiction, depression and suicide.   Simple solutions of more addiction services or mental health treatment misses the larger point that colonization, the loss of land rights, forced boarding schools and religious conversion along with suppression of traditional ways of living have led to underlying suffering.

 

Continuing Traumatic Stress Disorder is a term that couches the effects of colonization and oppression in a psychiatric term.  But it allows us to understand that for much of the world, distress and suffering is not primarily due to endogenous mental illness- but is simply due to the myriad ill effects of colonization and modernity.  Healing is not a straight line that simply requires therapeutic and medical interventions.  Healing is often a path of reclaiming, building resilience and standing up to the dominant forces that have been causing the suffering.

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Holistic Support for Antidepressant Discontinuation http://herbsformentalhealth.org/holistic-support-for-antidepressant-discontinuation/ http://herbsformentalhealth.org/holistic-support-for-antidepressant-discontinuation/#comments Mon, 26 Mar 2018 18:49:46 +0000 http://herbsformentalhealth.org/?p=2717

This article is not medical advice and does not replace consultation with a qualified medical professional of your choosing.

 

These days, more and more people are taking antidepressants as part of a regime to help them manage depression.  Right now over 10 percent of folks are taking an antidepressant.   That figure climbs for certain categories when we consider that 17.5 % of folks 45-64 are taking an antidepressant and 18.9 % of folks 65 and older are taking one.  Many people find relief and improvement in symptoms from antidepressants and some feel that they have been a lifesaver for them.

 

But a good percentage of folks are finding unwanted side effects form taking them and are actively weaning from their use or have stopped them because of this.   Just to add, please never make a decision to stop antidepressant usage without working collaboratively with your prescriber.    When reducing or stopping antidepressant use, many people are finding that symptoms of withdrawal can be deeply challenging and overwhelming at times.  Many people experience symptoms such as sleep disturbances, sensory processing problems (imbalance, vertigo, dizziness, electric ”brain zaps”), mood issues such as anxiety and depression and flu like symptoms such as nausea, headaches and sweating.  Some of these symptoms last just for the duration of the taper off of the antidepressant but for some people these experiences can become prolonged and have long lasting effects on people- sometimes lasting years.

 

The name for the symptoms of antidepressant withdrawal symptoms and prolonged discontinuation symptoms are known as antidepressant discontinuation syndrome.

 

There is not a lot of literature about how to manage these distressing feelings.  In conventional medicine, reinstatement of the same antidepressants, changing to another type of antidepressant such as prozac (with a longer half-life), or increasing dosage back up to a greater level are all ways to manage these symptoms.  But for many people reinstatement or switching antidepressants does not feel like an adequate choice or can incur worsening mental health.  For that reason, a number of groups of people have banded together to look at ways to manage these symptoms.

 

Outside of antidepressant discontinuation usage, there have been numerous groups that have developed to work through managing the symptoms of benzodiazapene discontinuation (xanax, valium, klonopin, etc).  Really complex and sometimes severe complications are noted with that class of medications and entire protocols developed to manage the symptoms of discontinuation (Benzobuddies).  In general these include reducing doses very slowly over a prolonged period of time.  This goes against the usual conventional medical wisdom of relatively short tapers of just a couple weeks to a month.  People taking antidepressants noted that slow tapers were often helpful for them as well and most communities talking about antidepressant discontinuation advocate for slow tapers- sometimes as little as a ten percent cut every couple weeks to a month, and often even less.

 

Because of the lack of a great deal of support from the conventional medicine community around alleviating some of these discontinuation symptoms, many of these folks have gone looking for other alternative approaches to managing these symptoms.  There is a growing body of anecdotal knowledge around the use of diet, herbs and stress management techniques for alleviating some of the worst of these symptoms.  I want to explore some of these interventions in this article.

 

Understanding the neurology of antidepressant discontinuation

 

 

First off, one of the first things to understand about discontinuation of antidepressants is that the body perceives it as a fundamental shock.  Serotonergic antidepressants work in part by reducing the reuptake of serotonin into neurons and allowing for a flooding of serotonin between neurons in the synapses.

 

They also lead to a reduction in actual serotonin receptors- otherwise known as “downregulating”  receptors.   Because serotonin has been artificially increased the body reacts by reducing the number of serotonin receptors as it is trying to balance out the drugs effect.  Now imagine the body loses that artificial boost in serotonin.  Now you have neurons with less serotonin receptors and the body has to adjust again to start repopulating receptors— but that takes time.  In the mean time, the body perceives a strong reduction in serotonergic transmission and it causes the myriad side effects of discontinuation.

 

One of the main theories for why people are given antidepressants is because they naturally lack enough serotonin and these medications provide that replacement.  However, the theory of a chemical imbalance where some people lack enough serotonin has been proven to be false.  Certainly antidepressants provide a boost via the serotonin pathway but they don’t replace a serotonin deficiency just as wine doesn’t cure anxiety because someone lacks an alcohol deficiency.   You can read about the myth of chemical imbalance here, here and here.

 

Antidepressants can be very effective for certain people with moderate to severe depression however.  The main reason is they help to flood the brain with a mood altering neurotransmitter that reduces anxiety and improves mood.  The problem comes from the numerous side effects that can develop when that medication is taken away and how the body reacts.

 

Because of the problem of discontinuation, many people avoid the process and simply stay on the meds for fear of mood disregulation.  Conventional medicine practitioners will often suggest that discontinuation symptoms are simply expressions of the original depression- but increasingly people are aware that discontinuation symptoms are a separate entity outside of any endogenous depression.

 

Interventions

 

 

 

So if discontinuation can be hard, what are some of the interventions that can help?  The best intervention is to work with a competent, caring and collaborative prescriber.  One of the main techniques for managing the effects of discontinuation was mentioned above and that is encouraging the prescriber to offer a slow pathway to discontinuation.  Sometimes this takes a linear course of slowly weaning over a period of many months.  But sometimes it means going in fits and starts- decreasing slowly when one feels strong and resilient and “holding” or waiting at other times when one feels stressed and burdened.  Working with a good prescriber who will honor the need to go slow and take breaks is key here.  There is often a sense of “doctor knows best” but this is not always the case with discontinuation.  The best judge of how quickly to taper is usually the patient themself who can sense how discontinuation affects their mood, physiology and behavior.

 

Outside of working with a good prescriber who will listen and work collaboratively, the other key is to honor what is needed for helping an individual through a taper and afterwards.

 

The first thing to understand is that there is no evidence based research or literature about the best alternative interventions for managing the effects of am antidepressant taper.  That means that people have to really examine what works best for them without a body of evidence to support it.  Essentially that means for most people it is a guessing game of trial and error.  For that reason, the best interventions are the ones that are gentle with the least possibility of exacerbating symptoms.

 

As an herbalist I am often looking for interventions that are gentle, simple, and effective. This is really heterogenous and what works great for one individual doesn’t always work great for others.  Some basic ideas do apply though and here they are…

 

1- Having good supports.  I mentioned the key importance of working with a collaborative prescriber.  But its also often key to have a network of supports to help through this time.  This can include a good therapist as well as friends and peers.  Relying on a group of people to help through this time can improve the process of recovery.

 

2- Reduce Stress.  Yup it is fairly obvious but needs to be said.  As you discontinue and afterwards, reduce stress as much as possible. If possible, reduce work at stressful jobs, try and reduce connections to unhealthy and toxic people.  Essentially you are trying to reduce the possible triggers of increased anxiety and stress until your body recalibrates and becomes more resilient.

 

3- Reduce Stimulation.  So many of things in our lives are stimulating- from our phones, social media, games, florescent lights, etc.  Some of these can feel like good stress busting diversions- but some of them act to increase our stress.  If we are staying up too late gaming, or getting obsessed with the status of our friends on social media- this can feel like an increased load on our nervous system and can impair healing from discontinuation.

 

4- Nutrient dense foods and herbs.  This is really key here and often overlooked.  The nervous system will be happy when you bathe it in a steady diet of concentrated vitamins and minerals.  The nervous system needs a variety of minerals and vitamins in order to stay healthy and repair itself.  For example, potassium is key for regulating nerve impulses, calcium aids nervous system development and B-12 helps maintain the myelin sheathing of neurons.  Vitamins and minerals are better absorbed from proper nutrition than any vitamin or mineral supplement.   That means concentrating on eating foods that are nutrient dense.  There is a strong focus these days on Paleo/Ancestral/Ketogenic diets for helping people with various ailments, including neurological disfunction.  Certainly eating a diet devoid of processed food and rich in fats and nutrient rich vegetables is often very healing for people.  The problem is that most people can’t stick to such strict diets.  It also isn’t culturally normative around the world where most people’s traditional diets include grains and legumes.   I’d also say that eating a diet rich in grass-fed meats and organic produce is often far too expensive for the average consumer.

 

That is why I primarily look at the “art of the possible.”  Making some healthy changes in diet is better than trying to adhere to a diet that is often impossible for most people.  I generally steer people to traditional whole foods diets-  I’m not going to say a lot here as there are loads of books and articles on the subject but I’ll add a couple things.  I am a big fan of Sally Fallon’s books on the subjects here and recommend “Nourishing Traditions”  and a number of her other books such as  “Nourishing Broth” for in depth explorations of the subject and some good recipes.

 

5- Avoiding gut irritants.  This is somewhat overlooked when talking about discontinuation  Because we are talking about serotonergic changes, we need to honor that the vast majority of serotonin is located in the gut and is produced there.  That means that serotonergic drugs have a strong effect on gut health.  Many people who take antidepressants for a long period complain of gut health issues from poor digestion to bloating, cramping, constipation, gastritis and more complex forms of digestive upset including GERD, gastritis and Chron’s.  That means that special care and attention should be paid to the health of the gut.

 

Outside of eating a nutrient dense diet its important to reduce gut irritants.  The low hanging fruit are tobacco, alcohol, heavy coffee consumption, processed foods and especially sugar and high fructose corn syrup.  Heavy sugar intake can lead to blood sugar imbalances that further exacerbate discontinuation symptoms.  Beyond that there are numerous foods that can cause reactions in people.  Many people notice that gluten and dairy can upset their digestion, lead to inflammation and these are often really helpful for people to avoid.  Some people have noticed its best to really strip the diet down and eat more ancestrally (Paleo) and avoid legumes and grains as well.  It can be stressful to radically change one’s diet during this time and I emphasize the importance of making any healthy changes, even if they are small.  Working with diet to help reduce the stress and load on the gut is often really helpful here and can help people recover more easily.

 

6- Movement.   In this process of healing and rebuilding, its key to engage in movement that moves the blood and lymph, remove waste product and circulates nutrients to help heal the nervous system.  The key here is to engage in movement that does not tax the body excessively and lead to an exacerbation of symptoms.  For some people heavy exercise that induces a great deal of sweating can feel helpful- while for others hitting aerobics and spin classes only makes the discontinuation process worse.  Generally I have seen gentle outdoor movement as one of the best options- walks, biking, gardening, hiking, etc.

 

7- Sacred Care.  When dealing with ongoing anxiety and distress from discontinuation it can be helpful to build in a physical and energetic practice that reduces stress.  Gentle forms of yoga, tai qi and qi gong can also be deeply helpful for building resiliency and strength.   I have seen forms of sitting meditation be counterproductive as the discontinuation can cause anxiety and dark thoughts to circulate and meditation just makes a person focus on those sensations more- instead of moving through them, shaking them off and releasing that tension.

 

8- Herbal nutritives.  Just as taking in a nutrient dense diet is key, taking in herbs that are filled with vitamins and minerals can be key to the healing process.  Some of the best herbs to integrate include nettles, oatstraw, alfalfa, seaweeds, and gently bitter roots such as dandelion and burdock root.   See below for resources on this.

 

9- Herbal relaxants.  In terms of symptomatic relief, many people complain of anxiety, insomnia and challenges in managing stress.  Though herbal anxiolytics are essentially a form of symptomatic relief, that can be essential when working through discontinuation.  In this first category, I would stress the importance of gentle anxiolytic “nervines”.   Thats an herbalist term for herbs that will help calm anxiety and strengthen the nervous system.  These are often best taken in tea form with a blend of herbs. Finding a good blend of herbs to make into regular tea can be really helpful here.

So for example, a simple and tasty combination of skullcap, oatstraw, rose and lemon verbena can act as a nice aromatic tea to help reduce anxiety but also improve gut motility and thereby improve intestinal function which is key as well.  Needless to say this also helps with hydration as well.  There are a number of formulas that are possible but in general these herbs should be gentle, relatively tasty (so you will drink cup after cup) and easy to duplicate by going to your local herb store or looking on line.   (See resources below.)

 

10- Herbal relaxants- strong.  This next category include herbs that are stronger in effect and will help reduce the anxiety associated with discontinuation.  Many of these herbs have a very   strong taste and therefore don’t go very well in teas so people often take them as tinctures (alcoholic preparations.)  People going through discontinuation will have different experiences with stronger nervines.  For some people they will be helpful and effective but for others they can actually add a layer of fuzziness and sleepiness without really changing the underlying distress from discontinuation.  This is where it only works by trial and error.  One can try a tincture or two and see the effect and its it is helpful.  Each plant has slightly different effects so I will list a few:

Kava- anxiolytic, muscle relaxant, strong.

Valerian- anxiolytic, hypnotic, sometimes energizing to certain people.

California Poppy: Relaxant,  pain relieving.

Motherwort:  Gently relaxant, cardiotonic

Generally its best to take a formula of herbs and in the resource section I mention a couple.

 

11- Aromatherapy.  Herbs don’t have to just be taken internally and many people are sensitive to taking in anything during discontinuation.  That means working with the other senses (smell, touch) can be useful for helping a person to destress and heal.  Baths infused with herbal salts and massaging in infused herbal oils to the skin can help bring relaxation and a reduction win discontinuation symptoms.  See below for resources.

 

12- Cannabis.  In a number of states cannabis has become legal and many people are using it as a plant to help them with tapering off of psychiatric drugs such as antidepressants.  Needless to say that cannabis is illegal in many places so this doesn’t represent an option for many people.    The legalization of cannabis has allowed for consumers to become very knowledgable and picky about the particular strains of cannabis they want to buy.  That means they can focus on relaxant, calmative and analgesic strains.  Perhaps the largest change outside of legalization is the production of strains that are high in CBD (Cannabidiol).  This is a constituent in cannabis that has relaxant and pain relieving qualities.  Strains high in CBD are often helpful for people in distress.  While some people find relief from strains that essentially only contain CBD, others find relief with varietals that contain some THC- the main psychoactive constituent in cannabis.  Others can find relief in cannabis high in THC as long as it comes from Indica varietals.

 

So for example, some people may choose a purely CBD strain such as ACDC while others may find relief from strains that are more balanced such as Harlequin (with a 5:2 CBD/THC ratio.)  Others may do well with a THC dominant strain such as Graddaddy Purps because it is an Indica that tend to be relaxing for many people.

 

While some people can find relief with cannabis, for many others it can feel dissociative or anxiety provoking so this is really particular to the individual.  In general it is not a great answer for many people but for a select few it really helps.   And of course dosage matters quite a bit.  An edible dose of cannabis is far more potentially challenging to the nervous system than smoking a couple hits. All of this is really trial and error for most of folks- and If you are untrained in cannabis use, please do far more research before engaging in this option.    Leafly has a good article on the subject of anxiety reducing cannabis with some examination of the different strains.  Take a look here.

 

12- OTC.  Other options for help with the withdrawal symptoms are the occasional use of over the counter aids.  The two main ones that are available are melatonin and benadryl as sleep aids.  If antidepressant withdrawal is leading to prolonged insomnia it can be helpful to have an intermittent aid that can help.  Long term use of benadryl is not a good option as it leads to long term health risks such as alzheimers and dementia.  Melatonin is a hormone and can help some people with sleep issues and is less risky than regular benadryl use.

 

Herbal Resources

 

 

OK – so for herbal resources I thought I’d look to my local herb store here in Portland store known as The Herb Shoppe for some options in helping people herbally.  There are no interventions that are going to magically speed up the time before the body can readjust and recalibate.  But certain herbs can help people manage the distressing feelings associated with discontinuation.  The main thing to consider in discontinuation is what herbs to avoid while in discontinuation.

 

Saint John’s Wort is probably the most prominent example of an herb to avoid.  While often offered by doctors in places like Germany for mild to moderate depression, SJW interacts with the liver in a way that can affect the metabolism of drugs.  With serotonergic antidepressants this can cause an exacerbation of negative symptoms and theoretically something known as serotonin syndrome- a nasty set of symptoms due to serotonin toxicity.   I have heard of only a handful of cases where this poor interaction has caused serotonin syndrome but why test it?

 

Outside of SJW, the other herbs to be careful around are those that are very strong in effect, affect hepatic metabolism or act as strong diuretics- thus causing a change in the effect of medications.  Herbs that I tend to avoid include strong plants such as kratom and kanna, tryptamine entheogens like Psilocybe mushroom and ephedra.  Even common “herbs” such as coffee and chocolate can exacerbate withdrawal symptoms as they both are stimulants as well as diuretics that could affect medication metabolism.

 

Many herbs have a diuretic property but do not cause diuresis enough to affect SSRI metabolism unless taken in copious amounts.   Frankly one of the strongest herbal diuretics out there (coffee) is consumed by millions of people who are also taking psychiatric drugs but does not seem to cause excessively poor side effects and I have yet to hear of a doctor saying one should not drink coffee who is taking antidepressants.

 

So that being said here are some suggestions for some good options that one can purchase directly or on line from the Herb Shoppe.

 

Elixirs: 

Delphinus Relaxing Elixir  – A tonic and relaxing combination of herbs that include nutrient support as well.

 

Tea Blends:

Nutritive Beginnings  Tea Blend                 Nutrient dense tea blend.

Here and Now Anxiety Tea Blend              Just how it sounds.

Sweet Slumber Tea blend                           For sleep aid.

 

Flower Essences:

Five Flower Formula   This is often given to people who are in a place of shock or triggered into severe anxiety .  Flower essences are often helpful because there is no risk of contraindication because flower essences are essentially homeopathic (containing no gross medicinal constituents) and act very gently on the system.

 

Bath Salts: 

Unplug – Relaxing Bath Soak   When all else fails, add this to a warm bath and find relief through a good herbal soak.

 

Aromatherapy:

Serenity Oil Blend   A good aromatic oil blend can be really helpful.  Apply some to the temples or massage it into the forehead, hands or feet to help find some relief from anxiety and stress.

 

Tinctures:  

Orbits of the Heart    for modest, gentle relief from anxiety.

Soul Shine    to bring greater resiliency and strengthen the nervous system to manage stress more easily.

 

 

Conclusion

 

The process of coming off antidepressants can be a long and slow one.  Even after discontinuation, people can feel a sense of lingering distress that is attributed to the discontinuation instead of the original depression.  Some of the ideas here can be useful for long term self-care when managing distress and discontinuation effects.  And to repeat, all of this should be done under the care of a physician.  If a doctor does not appear to be amenable to collaboration, I would recommend finding one that is more able to listen well to a patient’s needs.  Naturopaths, functional and integrative doctors are often more understanding of the complexities of antidepressant discontinuation and generally more open to holistic supports.

 

 

 

Further Resources

 

survivingantidepressants.org  A forum devoted to assisting people in their process of coming off antidepressants.

MadinAmerica.com  A website critical of the overprescription of medications with resources and numerous articles on the subject.

Dr. Kelly Brogan  A leading integrative physician specializing in women health and mental health.  You can google her name and find numerous articles by her on the subject of antidepressant use and discontinuation.

Icarus Facebook page This is an organization dedicating to helping people work through mental health issues while not being centered primarily in conventional medicine approaches.  They have a website and also a great Facebook group where people discuss issues such as antidepressant use and discontinuation.

 

Pub Med literature

A review of the management of antidepressant discontinuation symptoms

Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy

Switching and stopping antidepressants

Wikipedia:  Selective serotonin reuptake inhibitor

 

 

This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  If you are interested in a consultation with Jon, please contact him at [email protected]

 

You can also find me at the Facebook group Herbs for Mental Health.

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Alternatives to Psychiatric Hospitalization http://herbsformentalhealth.org/alternatives-to-psychiatric-hospitalization/ http://herbsformentalhealth.org/alternatives-to-psychiatric-hospitalization/#comments Tue, 27 Feb 2018 23:07:44 +0000 http://herbsformentalhealth.org/?p=2705

One of the fundamental questions I am often asked is how to help a loved one who is going through severe emotional distress without going to a hospital setting.  As someone who has worked for a number of years in an inpatient setting I am very familiar with the issues people have with hospital stays.  In this article I want to outline some of the tools people can use to assist someone through a crisis without having to go to a hospital.  At the same time, I do believe that for some people in some circumstances a hospital stay is warranted.  If someone who is opposed to psychiatric care finds themselves in a hospital setting during this time, I will explain some of the process of a hospital stay and how best to navigate this experience.

 

Psychiatric Hospitalization

 

There are a number of reasons people do not want to go to a hospital that make a lot of sense.  Let’s start at the beginning.  Someone who is struggling in a crisis is looking for additional supports to help them navigate a deeply challenging experience.  Sadly there are no strong options for someone who is in the throes of a deep crisis and people are generally steered toward a hospital for an evaluation.

For friends and family members who are worried about an individual this can mean that they will call for a welfare and safety check to the authorities in a municipality.   For some people in the depths of a crisis, a visit by a police officer can worsen the feelings of panic and anxiety.  For people of color, a visit by a police officer can feel extremely dangerous and can lead to acting in ways that could escalate and worsen the situation.  Some cities have shifted out of direct confrontation by sending mental health specialists who can assess the situation in a less dangerous way.

While many people are willing to go to a hospital setting voluntarily, some individuals will not- and this can lead to force being applied to bring a person in to an Emergency Department.  Police officers forcibly taking someone who is crisis to a hospital while in restraints can further a feeling of traumatization and is a main reason people avoid the process of coming to a hospital.

The next reason that people avoid hospital settings for psychiatric care is the problem with many emergency departments throughout the country.  They are not adequately set up for mental health care.  Generally all emergency departments are chaotic, overwhelming and easily intimidating.  Throughout the U.S. a lack of acute inpatient hospital beds is leading to increased stays in Emergency Departments with some people staying for up to 2-3 days waiting for a room (boarding) to become available.  If someone is already in crisis, this can increase a sense of frustration, distress and agitation.  Usually one is warehoused in a small room with few amenities besides regular meals, television and a nurse who can provide “as needed” tranquilizers such as ativan or an antipsychotic.

The ED is the entry portal for a hospital stay and it is also the place where an ED physician will make their initial “assessment” and make a decision whether to involuntarily hold a person for a period of time.  Here in Oregon that hold runs for 5 business days, not including weekends and holidays.  That means the State can keep a person locked up in a hospital setting for about a week without letting them go.  After the third business day, they are required to make a decision to either let the person go, let the hold run until its over, or take a person to mental health court to determine if they should be involuntarily committed, usually for a period of up to 180 days.

So if a person chooses to go to an ER due to severe crisis, there is a possibility that a doctor will require that person to stay there involuntarily for up to a week and possibly much longer if they are committed.  The decision to place a “hold” on someone has to do with the likelihood of danger to themselves or others.  If a person says they are actively suicidal with a plan to go home and use a shotgun to finish the job, it is highly likely a hospital will place the person on a hold.  If a person is brought in by the hospital in a high state of agitation, confusion and psychosis, it is again highly likely that the person would be placed on a hold.  On the other hand, if a person voluntarily comes to a hospital and states that they have been feeling increasingly agitated since their medications were changed and have been thinking about suicide without any specific plan, there is a strong possibility the person will be discharged or  admitted voluntarily and will be allowed to leave when they want.

So the ED is a pivotal portal into the mental health system.  The ED doctor, in conjunction with a psychiatrist make a very powerful choice to keep someone in crisis locked up involuntarily, allow them to be admitted voluntarily, or encourage them to discharge with outpatient supports.

 

Admit to Inpatient Unit

 

Once a person has been admitted to the hospital due to severe emotional distress, they are then transferred to an acute psychiatric unit.  Like all cities, the city where I live (Portland, OR) has a number of different types of psychiatric units.  Some of them are available to people who are more depressed and less intrusive, and some are available to people with a history of violent behavior.  People are transferred to a specific unit based on one’s history, if they are previously known to the ER, or due to their behavior in the ER.  For example, a sad and quiet 65 year old woman with a long history of depression  is likely to be transferred to a psychiatric unit that is fairly calm.  On the other hand, someone who presents as floridly psychotic, loud and intense in manner, is likely to be transferred to psychiatric units that tend to  be more chaotic and disorganized.

Increasingly, however, hospitals are reducing psychiatric beds, which leads to less options if someone is in crisis. That means there is more intermingling with people who are depressed and suicidal, with people who are experiencing severe psychosis and those that are intrusive and sometimes predatory.  This makes the inpatient hospital experience even less inviting for some who are considering it an option.

Once arriving on a psychiatric unit, staff will admit the person, provide information about the unit and offer paperwork to sign.  The main things that happen in the psychiatric unit include:

 

1- Meeting a Psychiatrist

 

This doctor will likely spend a short period doing an “intake” that includes asking questions in order to learn the medical, social and mental health history of a patient.  From that intake, the doctor almost invariably prescribes medication based on a preliminary diagnosis.  If a person has already been on medication, the doctor may keep the medication the same or may change the medication.  If they have never been on medication, the doctor will almost always start the person on a psychiatric drug.

Traditionally the medications prescribed are based on the diagnosis.  Anti-depressants such as zoloft and
prozac are prescribed for depression and anxiety.  Mood stabilizers such as depakote and lithium are prescribed for episodes of mania and depression with or without psychotic features.  And anti-psychotics such as zyprexa and risperdal are prescribed for patients with psychotic features.  Sometimes benzodiazapenes are prescribed for those with symptoms of anxiety.  Sleep medications such as trazadone are also commonly prescribed.

Though these medications have generally been prescribed along these diagnostic lines, they have become increasingly jumbled so that antipsychotics are increasingly prescribed for all mental health concerns including anxiety, depression and insomnia.

When on a hospital hold, a patient is not required to take medications so they can make the voluntary choice to take some, all or none of the drugs prescribed to them.  If a person has been involuntarily committed for a period of 180 days, the doctor can now force a person to take psychiatric drugs, via injection if the person will not take them orally.  The doctor can also prescribe whatever types of medications and dosage they think is reasonable without the patient having any say.  There has been an immense push to make these court committed patients stay on these drugs long after they have been released from a hospital setting via mandated Assisted Outpatient Treatment.    This means that many people who have been court committed and are released to a home environment must take long acting antipsychotic psychiatric drugs such as risperdal consta or Haldol decanoate shots that can last many weeks.

Right now 43 states have implemented these AOT (Assisted Outpatient Treatment) laws.  The belief is that many people go off their medications out of a lack of understanding of their mental illness (anosognosia) or due to side effects, and this leads to deepening psychosis and potential violence.  Though I understand how some family members want some way to make sure their loved one is “medicated”, I believe this can come at a cost for a number of reasons.

The main reason is that this class of drugs (antipsychotics) often cause tremendous side effects such as akathisia, restlessness, sedation, hypersomnia, cognitive impairment and loss of libido.  On a long term level, this class of medications often cause obesity, diabetes, compounded metabolic disorders, tardive dyskinesia and often lead to early death.  I believe it is simply unethical, and frankly unconstitutional, to mandate that a person take a health damaging drug in perpetuity without their consent.

The other reason I have serious concern with these Assisted Outpatient Treatment laws is that one single doctor is often responsible for the drug regime the person must take.  They can arbitrarily decide to put people on multiple combinations of drugs at varying dosages, sometimes very high.  The patient has no recourse, no way to appeal to a higher authority if he thinks he is overmedicated or given a poor combination of psychiatric drugs.  I have seen doctors put court committed people on a huge assortment of drugs at high doses (polypharmacy) that leaves an individual with severe side effects and complications.

Finally, on a simply strategic level, many people are mandated to take psychiatric drugs throughout their court commitment process (180 days) but once they leave they have the choice to stop taking the psych drugs.  Many people do, and if they do it quickly, or via cold turkey, this can lead to severe withdrawal symptoms and the possibility of recurring psychosis created by the quick taper off a drug (iatrogenically manufactured psychosis).  So in essence we are comfortable with forcing people to take drugs until they are no longer committed, then watch as they stop taking the drug, destabilize into psychosis and then return to the hospital for a long term merry-go-round that does nothing to “heal” the individual, and largely harms their health and well being.

So to sum up, when a person first sees a psychiatrist in a hospital setting, they are likely to either start, or adjust the medications a person is already on.  What medications they decide on, and in what dosages, is really up to the psychiatrist.   Those decisions can have enormous impact on the health and wellbeing of the patient and there is generally little or no conversation about side effects, long term health complications or problems with withdrawing off these meds.  Often, the patient is in such distress that the idea of finding some relief makes sense.  In a best case scenario, the patient would have access to a broad array of data discussing the efficacy and problematic effects of the drug they are being prescribed.  A patient would then have a period of time to evaluate the medications being offered before making a decision.  Unfortunately true informed consent is not part of the hospitalization experience.   One of the best “quick-check” ways of examining the effects of a drug is to go to a website where first hand accounts are given.  Askapatient.com  is a great site where you can plug in a drug you are interested in and often see up to a 1000 reviews by folks who have first hand experience taking that drug over prolonged periods of time.

 

 

2-  Meeting the County Investigator

 

In Oregon, each county has a number of county investigators who’s job is to interview a patient if they have been placed on an involuntary psychiatric hold.  Generally, an investigator will meet with the patient the day after they have arrived.  They will talk to the patient, family and friends to determine if the hold should remain in place due to “a danger to self or others.”  After three business days, if they decide the person remains a danger to self or others, they can recommend a hearing before a judge to determine if that person should be committed up to 180 days.

The County Investigator holds a lot of power and essentially acts as the gate keeper to drop a hold, allowing a patient to leave, or to require them to stay and face a court commitment hearing.

Because of a strong lack of State Hospital beds, there is increasing pressure to drop holds.  The vast majority of folks who come into a hospital setting discharge within a few days.  A large percentage of patients placed on holds have their holds dropped within a day or two.   A smaller percentage see their holds “run” the full five business days.  Some remain quasi-voluntarily on a 14 day diversion and a very small percentage go before a judge for a court commitment process.

In previous decades, inpatient hospitalization was often a lengthy process that could sometimes last months.  This has really shifted towards the hospital being a turnstile environment where patients are admitted and discharged quite rapidly, generally while they are still unstable emotionally.  Patients are discharged with an appointment set up with a medication provider to assess their med regime every month or two, and perhaps with a case manager or occasionally with a therapist if there is good insurance.

If you are a support person or family member and a loved one has been placed on a hold in a hospital, you are likely to receive a call from an investigator asking about the state of emotional health of your loved one.  Family who stress concerns about emotional instability, psychosis, violent or suicidal thinking can sometimes steer a county investigator to ask for a court commitment.  Other factors that can steer a county investigator towards endorsing an involuntary civil commitment process is if the patient acts out violently or suicidally in the hospital setting, or appears to be grossly psychotic and unable to care for his or herself.  On the other hand, family members can also steer a county investigator away from a court hearing by refusing to testify at a hearing, or by downplaying behavior that is perceived as a danger to self or others.

 

3-  The Social Worker/Discharge Planner

 

This person is responsible for making the appointments with the providers, case managers and therapists once a patient discharges.  Though many people come to a hospital in part due to emotional distress from homelessness, they have little power to help a person find adequate housing and generally can only offer a couple days of shelter vouchers.  Social workers also act as mediators between family members and doctors who often very challenging to reach.  They can give information about length of stay, how the patient is doing on a unit (if a release of information is given) and medication regimes.

Most commonly, people are released after a few days with a discharge plan to return to a home environment with appointments with mental health providers.  If a person is involuntarily committed due to ongoing fears of being a “danger to self or others”, that person is often sent to a State Hospital or a step down residential facility for a period of time to wait for stabilization.

So we have two twin main problems in hospitalization.  One is that many people do not want to take a strong course of psychiatric drugs, and are especially fearful of being forcibly medicated if they are “acting out.”  On the other hand, there are plenty of individuals and families of individuals who want to have more lengthy hospitalizations and respites to help people who are deeply fragile and are easily triggered into extreme states.  But sadly, except for the more rare cases, most people are being shunted back into the world to try and receive outpatient care when they are struggling deeply.  This usually consists of patchy appointments with providers for med checks and occasional meetings with case managers and occasionally therapists.  This is almost always not enough for people who are in crisis.  So in both cases- for people who don’t want to be hospitalized, and for those who do want a longer stay in hospital but don’t get them because insurance companies will only pay for a short stay- there is a need to explore alternatives to hospitalizations for those going through a mental health crisis.

 

 

Why Does Psychosis Occur?

 

First off we need to explore what the term psychosis means.   This can include profound mania, hearing voices, becoming confused by bizarre thoughts, delusional thinking, odd somatic experiences such as feeling disconnected from the body, sensations of feeling “telepathic”, psychic, becoming extremely talkative, not sleeping for many days, paranoid, or many other types of extreme experience.

There are numerous theories as to why these experiences are taking
place.  In the medical model, there is an emphasis on the likelihood of an inherent disease due to genetic factors.  If this psychosis persists and one can rule out medical factors or adverse reactions to recreational drugs, an individual who experiences these states is often labeled with Bipolar, Schizophrenia or Schizoaffective Disorder.  In the medical model, these illnesses are thought to be pervasive for life, though there is the possibility of remission.  The medical model includes the idea that life stressors can trigger the disease process.

Those who have problems with the medical theory of “madness” tend to think that psychiatric labels tend to be very poor descriptions of a person and not based in scientific evidence.  The idea of labeling someone who experiences a psychotic state with a diagnosis such as schizophrenia or bipolar has gained in popularity over the past 60 years since psychiatrists created a book to differentiate different psychiatric disorders known as the DSM (Diagnostic and Statistic Manual.)  The DSM defines disorders as emotional distress that have on some level incapacitating to normal human functioning.  They define each disorder with a constellation of symptoms that psychiatrists have agreed meet a threshold of illness.

For example,  here is a link to the DSM definition of Schizophrenia.  One of the main critiques of the medical model of mental illness is that definitions of mental illness are not based in any objective scientific test.  They are simply sets of symptoms that a group of psychiatrists have decided constitute an illness.  Unlike diabetes or cancer which has biological markers, schizophrenia does not have any biological markers that can be easily measured for a diagnosis.  Doctors simply note symptoms and decide on a diagnosis.  These diagnoses are often very fluid and someone can be diagnoses as bipolar by one doctor and as having schizophrenia by another.

 

Alternative Explanations for Psychosis

 

There are other models for explaining “first-break” psychosis.  One main alternative model is that stress plus underlying childhood and early adulthood emotional trauma is the main contributor to the present psychotic state.  In essence, toxic family of origin issues, poverty, emotional, physical and sexual abuse are main underlying factors for psychosis.   There is an increasing body of evidence that links trauma and psychosis.

There is also a fair bit of evidence that nutrition and lifestyle patterns contribute to the potential for extreme states.  If someone is susceptible to altered states, a diet high in processed and refined foods, sugar, caffeine, alcohol and drugs can contribute to destabilizing an individual and can lead to a psychotic break.  There have been some remarkable studies here and here that show that diets high in vegetables and meat and low in carbohydrates and sugars (a more Paleo or ancestral diet) can be remarkably helpful for those susceptible to extreme states.

Finally, it is important to note that historically and cross culturally, experiences of extreme states are not seen as always due to “illness.”  Possession states, spiritual rites, ecstatic ceremonies involving fasting, praying, lack of sleep and psychoactive plants have long been connected to extreme states and often seen as healthy experiences of spiritual transformation and celebration.  Western notions of mental illness conform to what we as a society deem as normal and aberrant.

There are movements of people who experience extreme states who are trying to rename their experience outside of the medical model.  Perhaps the most important of these groups are the folks at the Icarus Project.  This is a group focused on peers with lived experience of extreme states helping other peers and honoring a wide variety of cultural and personal explanations of “madness” that don’t necessarily interlink with a medical model explanation of mental health.

To also add, there are many people who extreme some form of extreme state without it becoming a long life condition.  These experiences of psychosis can be truly overwhelming and persist for long periods of time.   Sometimes these experiences happen dud to drug reactions, a period of not sleeping or simply due to some unknown factors.  There are many people who call these experiences “spiritual awakenings”, rebirths or kundalini rising experiences and see extreme states through the lens of spirituality.   Folks who see their experience through this lens view these divergent experiences as a spiritual unfolding and outside of a medical sickness/wellness model.
My belief is that extreme states are engendered by a number of different factors including- personal susceptibility to extreme states, stress, trauma history, oppression, spiritual leanings, alcohol and drug usage and if radical medication changes have recently occurred.   People from different cultures and backgrounds can have different language models for their experience and simple diagnostic language of Bipolar, schizophrenia or schizoaffective disorder do not adequately cover the full range of experience one is having.

Many people can recover from these time limited experiences of psychosis.extreme states.  I know in my personal experience, I went through a number of years of intermittent extreme states and I could have easily been labeled as Bipolar or schizoaffective at the time (20 years ago).  Those experiences faded and  I was never medically diagnosed or treated and have gone on to live a good rich life outside of the medical model.  For many people, there it can be easier to have multiple languages and ways of appreciating their extreme state experiences- sometimes using spiritual transcendent language and at others using a medical model lens.

 

Hospitalization

 

Those who experience psychosis and come to a hospital setting are almost always prescribed antipsychotics.  These include the newer “atypical antipsychotics” such as risperdal, zyprexa, abilify, and geodon.  They may also be prescribed older “typical” antipsychotics such as haldol.  Antipsychotics tend to be sedating and tranquilizing.  The atypicals were developed and marketed in the 90’s and thought to be far superior to the older typicals because of a smaller side effect profile and less potential for long term health problems.  The older antipsychotics were specifically seen as dangerous due to the potential for “Tardive dyskinesia“, a form of irreversible muscle twitching that can be quite severe.  In the 90’s I worked with a man labeled with schizophrenia who had been prescribed thorazine (an old school typical antipsychotic) for a decade and he had developed incontrollable rocking, shaking and spastic arm movements.   This was very sad because he was a painter and he had tremendous difficulty using his brush for his artwork.

Though the newer atypicals have been heralded as a godsend for those experiencing ongoing psychosis, they tend to come with a wide variety of problems as well.  On a short term bass they can cause such symptoms as dry eyes and mouth, blurring of vision, strong sedation, hypersomnia, libido loss, as well as extrapyramidal side effects such as akathisia and parkinsonian like tremors and shaking.  It is common for people that experience these EPS symptoms to be prescribed an anticholinergic anti-parkinsonian drug such as cogentin as well as the atypical.

On a long term basis,   they all tend to cause disorders such as obesity, diabetes, high cholesterol and heart disease, though there are some variations in their long term side effect profile.   Those with a serious mental illness label such as Bipolar I and Schizophrenia die up to 25 years earlier than normal.  Though socio-economic factors certainly play a role, there is a likelihood the long term health effects of the drugs are contributing to this early mortality rate.

Antipsychotics can be incredibly challenging to withdraw from as well.  This class of drugs tend to work by blocking dopamine absorption.  Dopamine is a neurotransmitter responsible for sending signals between neurons.  On a crude level, it has been postulated that too much dopamine might cause some of the psychotic symptoms and therefore a drug that reduces available dopamine could reduce mania and psychosis.  The longer a person takes one of these antipsychotics, the more habituated the body becomes to a drug that reduces available dopamine.  If a person stops taking one of these drugs cold turkey, the body suddenly becomes flooded by dopamine and is likely to experience florid psychosis.  Though some medical professionals will point to the underlying disease as the cause for the reoccurrence of psychosis, it is highly likely that the withdrawal effect off these drugs is playing a large role.

The longer one stays on these drugs, the larger the dose and the larger the prescription (polypharmacy) the harder it is to wean off of them.   For many people, it becomes literally impossible as each attempt leads to a psychotic process.  There is mounting evidence that taken over long periods of time, these antipsychotics can actually increase the susceptibility to psychosis, as well as cause tremendous health problems.  This is a very clear article about the ongoing mounting evidence presented by Robert Whitaker.

In this article, Whitaker points to longitudinal studies done by scientists who examined how people fared when taking lonog term courses of antipsychotics verseus those who did not. Essentially, for those who took antipsychotics long term, there is a far greater  chance of disability, hospitalizations and psychosis long term.  This is an article about these longitudinal studies by Harrow and Wunderink.  The evidence is clear that people who have discontinued antipsychotics or have never started them have a far better chance of recovery from initial psychosis.

Because of this, there are a number of people in the field who are now presenting an alternative model for managing crisis known as a “selective use model”. In this model, the best plan for initial psychosis is to avoid using the drugs altogether and see if the psychosis naturally dissipates.  After that the next best plan is to try a low dose and then to try and taper the person off as quickly as possible.   The selective use model is much more “evidence based” when taking into account the long term outcomes of the effect of antipsychotics.

Unfortunately, this is not what mainstream psychiatry believes is the best course and evidence based medicine.  In hospitals and outpatient clinics, most still posit that early break psychosis is a sign of a chemical imbalance and a long term illness such as schizophrenia or bipolar disorder that will require a lifetime use of antipsychotics.

On a basic level, it is important to note that the theory that psychiatric drugs correct a chemical imbalance is simply false.  To understand why this myth continues, please take a look at this great article by Chris Kresser.  Essentially, this idea was presented as a way to establish the medical efficacy of these drugs for mental illness.  However, no true scientific research has ever determined the exact nature of a chemical imbalance for mental illnesses, nor have they scientifically proved the idea that psychiatric drugs correct any imbalance.

Because of this it is essential that those who are experiencing a “first-break”, as well as their family members, take a long look at the pros and cons of starting one of these drugs.  As tranquilizers, they can often be effective at reducing psychotic symptoms such as mania and hallucinations.  For those who are experiencing extremely disturbing voices, sometimes commanding suicide or violence, any relief may seem worth the potential health risks.  I believe we need to start seeing these antipsychotic medications for what they are, very potent tranquilizing drugs.  They indeed work to quell “extreme state” symptoms such as florid psychotic mania, but long term they come at a cost to health.

Because of this long term information about the effect of antipsychotics, making the decision to start these drugs should be very carefully examined.  In a hospital setting, someone in the throes of severe psychosis may not understand the ramifications of starting one of these drugs.  Often a doctor prescribes this class of medication with little conversation due to the altered state of the patient.  There is often little in the way of informed consent because it is somewhat impossible in that state.

 

Holistic Planning for those experiencing a psychotic episode

 

Complexity arises if a person has already started  a course of antipsychotics and/or mood stabilizers and has been on them for an extended period of time and then goes into crisis.  Probably the most common reason people with these diagnoses go into crisis is because they have gone off the psychiatric drugs.  As I noted before, the body becomes habituated to the artificial changes in neurochemistry and the nervous system can easily go into shock when these drugs are removed, especially if they are stopped quickly or cold turkey.  Those prone to extreme states and psychosis can then easily experience a recurrence of these psychotic symptoms that can lead to hospitalization.  In this state, probably the smartest thing to do would be to reinstate the psychiatric drugs.  Sadly, even though the drugs themselves may be causing quite a few side effects and health problems, a quick and sudden taper can create havoc on an already sensitive nervous system.

In general, if someone has been given a serious mental illness label and is on a number of psychiatric drugs, health complications will likely mount as the years roll by.  It also becomes increasingly difficult to wean off the drugs, especially if the dosages are high and they are on multiple drugs (polypharmacy).   Quick tapers and cold turkey easily leads to new symptoms of psychosis.  Hospitalization can be a way of quickly reinstating the medications.  However,  family members and the labeled individual should take great care of how a psychiatrist intervenes at this point.  Some doctors will decide that previous prescriptions were unwarranted and will quickly change meds, add meds or change and often augment dosages.  Generally, these sudden changes can cause further stress on the nervous system and one should be very careful with making lots of changes without doing a great deal of research on the medication changes.

If a person has been labeled and is on a long term course of antispychotics and mood stabilizers, and health problems mount, the best time to wean off the drugs is in a setting with lots of emotional support and good nutrition.  It is deeply important that the person tapers slooooowly as to avoid a relapse in psychotic symptoms.  Most doctors do not advocate a slow taper but anecdotal evidence points to slow tapering being a much more effective and safe way of getting off meds if a person has decided to do that.  The best guide to coming off meds can be found here.  Some other resources include Beyondmeds.com, survivingantidepressants.com and benzobuddies.com.

 

For those who are looking for alternative approaches and if there is no imminent danger present,  it is important to look at various holistic options for working with severe distress.  These are some general guidelines for helping someone in this state.

1- Housing and support.  Make sure the person has adequate housing and lives in a safe well maintained home that is relatively clean. This is a fundamental class issue and there are millions of people in the U.S. who are homeless or who live in substandard housing.  This is a systemic issue that needs to be addressed.  It is generally key to have a circle of support that provides very close care of the person from a week to several months.  Round the clock care such as living with family members and close allies is often optimal but having the best and most loving support team is key here.   It is important to watch out for burn out here and make sure there are multiple people involved in helping the individual to recover.

2- Nutrition.  Healthy food is an extremely important part of working

through these extreme states.  When someone is in a heightened or manic state, the body is asking for calming, rooting and grounding food.  It is key to reduce foods that exacerbate distress such as caffeine, sugar and processed foods.  Foods that are helpful include lots of vegetables and especially leafy greens, tubers such as sweet potatoes, beets and carrots.

Avoid “fast carbs” such as white wheat flour foods and choose whole grains such as quinoa, brown riceand amaranth for grains.  Wild caught fish and game high in Omega 3 anti inflammatory oils are very good to add.  Wild greens are also extremely dense and nutritious.  My basic rule of thumb is to avoid “PAWCS”…  Or Processed food, Alcohol and drugs, Wheat, Caffeine and Sugar.  Some people feel sensitivities to other foods such as dairy, nightshades, corn or excessive fruit.  It’s important to eliminate all allergenic inflammatory food if possible.

3.  Destim.   Creating an environment that is conducive towards feeling calm and relaxed is very important.  That means lowering lights, reducing electronics, not having loud intense music or media playing, etc.  Spending time in quiet natural spaces near flowers and trees can be immensely healing.

4. Structure.  Having an organized plan throughout the day can be really helpful even if it just means eating at regular meal times.  That can mean doing certain activities such as crafts, art projects, gardening, taking walks, knitting, playing games throughout the day.  Talk based communication can often be really hard during an extreme state and non-verbal forms of connecting can be really helpful.

5.  Finding Meaning.  The experience of an extreme state can be very confusing and lonely. Most people do not understand when someone is going through strange and wild perceptions and thought patterns.  It is key to find peers and helpers who is open to what the person is going through and willing to explore those places to help find meaning and understanding.  When I went through my psychotic process as a much younger man I was deeply helped by an herbalist healer and a therapist.  As a therapist I often help people who are going through these states and I can understand how isolating they can be.  Often people turn away or avoid someone in these states and its key to have allies who are willing to stay present and open to the person’s experience.

6. Safety.  For some people in this state there may be a desire to hurt oneself or

to act in ways that are endangering.   This can be very tricky to manage and every situation is different.  Round the clock care can be helping along with soothing talk and listening to what is going on for a person.  Often these tendencies can be reduced with a lot of kindness, care, attention, good food, herbal approaches.  But at times things can get out of hand and truly dangerous and at that point I think hospitalization is warranted.  if at all possible it is best if family and friends brings the person to the hospital because the alternative is to call the police which is deeply traumatic and often dangerous if there is extreme volatility going on. Deciding how to manage this can be one of the hardest decisions for a loved one to make.  But the paramount concern at that point is making sure everyone stays safe and unharmed.

7.  Love.  A key component to the healing process is having family and friends around that will provide warmth and care.  Again, it is key to avoid too much “therapy” and instead focus the energy towards quieter activities such as playing light soothing music, crafts, coloring, time in a garden or nature walks.  Love in this case generally means being with the person without judgement and avoiding heavy criticism, fear, shame and anger if at all possible.  It does not mean unconditional acceptance of all actions and behavior.  Certainly some behavior is off limits such as abusive language or actions or movement towards hurting self or others.

8. Herbs, supplements and drugs etc.

In general people who are looking for alternative ways of working through an extreme state are not taking psychiatric medications and are looking for other options.  Every extreme state is different and every individual is different and so there is no hard and fast rules about how to help people in these situations but I will review a few basic ideas.

Generally gentle herbal approaches can be applied to anyone..but that comes with caveats.  Some people are deeply sensitive and very few herbs are helpful. The basic idea is to think of using nourishing tonics and broths as nutrient dense vitamin and mineral rich supplements that can help repair and bring someone back to a steady grounded state.  Infusions of oat straw,  nettles. red clover and alfalfa are very helpful here.  Take a look at this guide to doing this here

Then making regular bone broth with herbs such as shitaki, maitake seaweeds and astragalus can be really nourishing as well.  Here is an article on doing that here

Traditional indigenous techniques of  smudging with herbs such as sweetgrass, cedar and sage is very helpful as well as using aromatherapy sprays and diffusers with essential oils such as lavender, rosewood and sandalwood.  You can purchase these items here.

“Visual herbal therapy” such as spending time in gardens, parks and nature is often key to helping someone in an extreme state.  Massage with infused oils such as rose, lavender and lemon balm can really help a person to get grounded and return to center.  You can purchase some of these items here.

My website herbs for mental health has a lot more information about these subjects.  Take a look here.

 

Conclusion

 

Supporting a person who is experiencing psychosis in a holistic manner that is non primarily based on psychiatric drugs and the medical model can be challenging.  But no more than ever, we need to create better models for helping people in crisis.  There are enough people who are adverse to medications, are philosophically opposed to them or are worried about their long term effects on health, that its key to explore ways to help people outside of the medical model.   Creating models and paradigms that allow for people to be gently supported through a psychotic episode without medication (or with a selective and “low-dose” model) is key to supporting healthy recovery.   The good news is that with time, patience, good nutritional and emotional support and lots of love, healing is not only possible, it is probable.

 

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Psychedelic Mushrooms For Mental Health: A Primer http://herbsformentalhealth.org/psychedelic-mushrooms-for-mental-health-a-primer/ http://herbsformentalhealth.org/psychedelic-mushrooms-for-mental-health-a-primer/#comments Fri, 09 Feb 2018 00:38:15 +0000 http://herbsformentalhealth.org/?p=2650

When I walk through nearby woods, I think of how fungi form the underlying fabric of the forest floor.  They literally connect trees and plants together through a microrhyzzal network and help send messages, transport food and provide protection for the vast web of aboveground flora.  In the woods near my house,  fungi such as chanterelles, boletes, Oregon reishi and turkey tail emerge above as delicacies to eat but also as medicinal agents that can improve health and wellbeing.

For thousands of years we have known that medicinal mushrooms can have a tonic effect on the body that help improve physical and emotional health.  They can act as prebiotics to help improve gut healthreduce depression and anxiety, fight cancer and improve cognitive acuity and memory.  They also have important anti-inflammatory effects that are key to helping heal both physical and mental health problems.

 

NW Reishi- Ganoderma oregonense

 

Not only have mushrooms been used medicinally, certain psychedelic species of mushrooms have long been used for sacred and therapeutic purposes.   While forest mushrooms help establish deep fungal connections between neighboring plants and trees, psychedelic fungi help make novel connections between different segments of the brain.  New research is showing some of these connections on brain scans and helping us understand why psychedelic fungi are powerful tools for helping people deal with emotional illness symptoms such as depression, social anxiety, grief and addiction.  In this article I will explore some of this research as well  and see how it is changing how we think about mental health and treatment strategies for people who are struggling emotionally.

 

 

Psychedelic Fungi

 

In the last ten years a revolution has been quietly occurring in the field of mental health.  Research into the use of psychedelic compounds, made illegal since the 60’s, has now become legal again.  Numerous studies have shown positive results from the use of psychedelics for the treatment of depression, PTSD, end of life grief and even migraines.  Because of the positive results, there has been increasing movement to allow their use in therapeutic settings. 

 

Worldwide, there are 209 species of mushrooms that elicit psychedelic experiences but the most popular to consume is Psilocybe cubensis.  This mushroom is primarily popular because of the ease of growing it, but also due to its potent effect.  At “trip doses” that start at around 1.5-2 grams, cubensis can bring on a kaleidoscope of perceptual and auditory changes, synesthesia, feelings of symbiotic connection with the world around one, as well as deep gnostic and psychological insights.

 

Psilocybe cubensis

 

For a small portion of people at higher doses, the experience of reality bending can become overwhelming and lead to feelings of fear and panic.  The importance of “set and setting” are paramount.  “Good trips” are more likely to occur when mushrooms are taken in a good mindset with friends in a natural and comfortable environment.

 

And while people report many positive things about large dose trips, they can be unpredictable and can be especially challenging to anyone who is susceptible to psychosis and extreme states.  They also require a significant amount of time away to fully experience the trip.  For these reasons a large movement of people have explored how to integrate their benefits at smaller doses- or what are known as “microdoses.”  More about that later.

 

 

So how do these fungi work?  

 

Psilocybe mushrooms contains the psychoactive constituents psilocybin and psilocin.   When ingested that psilocybin is broken down by an alkaline phosphate enzyme into the tryptamine molecule psilocin.  Psilocin is what is actually responsible for the “high” one experiences.   There are also two other active psychoactive but far less prevalent constituents known as baeocystin and norbaeocystin.

 

These constituents are extraordinarily similar and stable amongst many different strains from throughout the world.  That means consuming cubensis mushrooms from one batch should have about the same percentage of psychoactive constituents as the same dose from a different batch.

 

P. cyanescens- Wiki Commons

 

 

—————————————————–% Psilocybin        % Psilocin      % Baeocystin

Psilocybe semilanceata (Liberty Caps)           .98                       .02                    .36

Psilopcybe cyanescens                                  .85                       .36                    .03

Psilocybe cubensis                                         .63                      .60                     .025

 

Psilocin is a very interesting molecule that resembles the common neurotransmitter serotonin.  Most folks know about serotonin because of antidepressants that manipulate serotonin levels.

 

Serotonin is actually a very ancient molecule, is found in mammals but also insects, plants and fungi and is responsible for a wide variety of functions.  In humans, serotonin plays a key role in modulating mood, but is also instrumental in encouraging gut motility, organ growth and regulating bone mass.  In plants, serotonin is implicated in regulating growth, flowering and ripening amongst many other functions.

 

The psychedelic mushroom compound psilocin docks at certain serotonin receptor gates and the most notable one appears to be 5HT2A.   That connection leads to a variety of effects- including the release of Brain Derived Neurotrophic Factor (BDNF)- a substance that stimulates increased cerebral flow and interconnectivity.

 

What we are finding from MRIs done on participants who took mushrooms is that the substance transforms the connections happening in the brain.  Certain regions of the brain start to connect to other unrelated parts of the brain that normally would not be connected.  Essentially the organizational structure of the brain changes to allow for more cerebral connections.  This may be one of the reasons for increased perceptual creativity, new insights as well as synesthesia- the experience of crossing senses so that one smells colors and tastes sounds.  Unrelated parts of the brain are neurally connecting.

 

 

Other changes in the brain begin to occur as well.  Areas of the brain associated with memory and emotion located in the amygdala and hippocampus start to neurally connect and become more synchronized.  This is similar to what happens to the human brain when one is sleeping and dreaming.  The waking state becomes expanded to form new perceptions because of new neural connections.

 

The other piece that is key is that it looks like psychedelic mushrooms can disrupt a portion of the brain known as the “default mode network”  or DMN.  This is the networking of parts of the brain that is often overactive in those who are obsessive, anxious and depressed and is associated with excessive rumination, analysis and repetitive thinking patterns.  Disrupting the DMN allows for less rigid thinking patterns and creates space for more creativity and divergent “out of the box” thinking.

 

 

Treatment Research 

 

These research findings are especially important when we discuss mushrooms effects on those who have experienced heavy stress and trauma.  We know that prolonged stress and trauma and a heightened sympathetic nervous system leads to the body “freezing” in a number of ways.  We all know the term frozen with fear- and that is literally what happens with sustained stressors and trauma.  The digestive system freezes up, the heart rate becomes rigid, our muscles can start to tighten and cause painful shoulder, facial and throat rigidity.  We now know that the DMN becomes overactive and thinking patterns become ruminative and rigid as well.

 

We literally lock up.  Much of trauma work is about the process of helping people to slowly “unfreeze”, to come out of these armored states in a way that is safe and gentle.  For some people under the right conditions, psychedelic mushrooms can act as catalysts for unfreezing rigid mental states.

 

1- In recent research at the Imperial College of London have focused on the treatment of depression with psilocybin.  Participants report much reduced levels of depression- even weeks after ingesting mushrooms.  Researchers postulate that one of the mechanisms for improvement is due to reduced cerebral blood flow to parts of the brain that deal with handling stress and fear.

 

2- Other studies have been done as well.  In England, “12 patients with treatment-resistant depression were given two doses of psilocybin one week apart. A week after the treatment, eight patients were completely free of depressive symptoms. Five were still in remission three months later. The drug was well tolerated and there were no unexpected adverse events.”

 

One study done with 36 people showed that many participants felt lasting anti-depressive and positive feelings for “as much as a year.” Another study was done with terminal cancer patients who “had a transcendent or transpersonal experience during their psychedelic treatment session also had the most dramatic subsequent reduction in anxiety, improved mood and better overall quality of life.”

 

A very interesting recent study measured the ability of psychedelic mushrooms to help change belief systems.  In classic talk therapy, entrenched beliefs of clients are often the hardest things to change- especially if they are primarily negative- which is often the case for those with depression.  “For a series of nature-related questions, the researchers reported that the volunteers showed a shift toward more “connectedness to their environment.”  For political and social questions, they evidenced a shift toward a more libertarian mindset. That was even true for those who’d originally answered with an authoritarian bent.”

 

Interestingly, mushrooms seem to also have a marked effect on pain levels for those experiencing cluster headaches and migraines.  Researchers are exploring the use of mushrooms and other psychedelics and many sufferers are reporting significant relief from their pain.

 

Psilocybe cyanescens

 

 

Microdosing

 

Though numerous studies have been done on large dose consumption of psilocybin, there are no known studies on the effects of taking small doses of psychedelic mushrooms.  While there is a lack of scientific research around this subject, consumers have shared reports about their experiences on forums and off-line networks.  There have been so many reports of good experiences that it has become increasingly popular among a larger segment of people.

 

The main reports from microdosing are that life becomes more enhanced and the consumer experiences greater cognitive acuity, presence, and greater feelings of relaxation, energy and spaciousness. One of the main effects seems to be that language centers are stimulated- with people often reporting greater articulation, enhanced connections and greater fluidity of speech.   The main effects would begin after a half hour and last for a few hours.

 

There are a number of protocols that have been offered outside of mainstream research.  One main method is to dose every fourth day.  But in general people have tried a variety of methods including dosing daily for a short period of time all the way to very intermittent dosing schedules.

 

The goal of microdosing is to offer the benefits of the fungi without causing excessive perceptual disturbances.  About .1-.2 grams of psilocybe cubensis- or about a twentieth to a tenth of a “trip dose” would be the start of a microdose- or what is known as a “sub-threshold” dose.   Above that level, the dose starts to become aware to the consumer and perceptual changes are more noticeable.  Some can tolerate slightly higher microdoses but in general doses in the range of .5-1.0 grams become quite noticeable as a low level “trip.”  Though reports have been generally positive, there are some reports of increased anxiety, worsening depression and increased extreme state symptoms.

 

 

Medications/Mental Illness/Mushrooms

 

Medication interactions are another factor to address.  There is no sanctioned research on this matter so the only evidence for interaction has been anecdotal so far.  That being said, its good to take into account what people are saying with regards to med/mushroom interaction.

 

The first thing to think about is that mushrooms primarily affect serotonin (5-HT2a) receptors and that many psych medications affect these same receptors.   In general what we are learning is that medications such as atypical antipsychotics (ability, risperdal) as well as modern serotonergic antidepressants (celexa, prozac) reduce the effect of mushrooms.  In my book this doesn’t mean people should “just take more.” It means its probably a very good idea to avoid taking mushrooms while on these class of meds as they are interacting excessively.

 

People who are taking old school tricyclic antidepressants as well as mood stabilizers like lithium report increased negative interactions with mushrooms, including having seizures.  So again, a definite no.  I would continue on to add stimulants (adderall, vyvanse) to this as well as the effect could easily be too stimulating.

 

So general thoughts on this- psych pharma meds and mushrooms don’t mix.  Yes plenty of people do take them on antidepressants- and many with good effect.  But I would stay in the range of cautious here and suggest that its better to hold off.

 

In general its important to acknowledge that for anyone working through any form of severe depression or dealing with extreme states in the form of mania, hearing voices or delusions, its best just to avoid mushrooms in general.  They are far too volatile even at microdoses and can lead to worsening mental health.

 

 

Psychedelic Fungi pros and cons

 

There is no doubt that psychedelic fungi can be deeply transformational for many people but its key to acknowledge some of the areas where there can be challenges.

 

Cons

 

For some people, any dose- even a microdose- can elicit feelings of fear and panic.  Those who are susceptible to extreme states, psychosis or who have experienced heavy trauma- can become overly stimulated and triggered into deeply challenging states.  The higher the dose, the more risk is involved.  Trip doses starting at 1.5 grams of P. cubensis  can be destabilizing, confusing and overwhelming to some consumers.

 

And while mushrooms can lead to strong shifts in perception and help one move through rigid ruminative distress by altering brain chemistry, they don’t address some of the other somatic reasons for anxiety and depression.  In the last 10 years we have been moving away from the idea that neurotransmitters are solely responsible for poor mental health.  The idea of a chemical imbalance theory of mental illness has been debunked.

 

Instead we are understanding that mental health has far more to do with a complex interweaving of issues that involve digestive health, the gut microbiota, inflammation, thyroid health and adrenal overstimulation amongst many other physiological issues.  These are not directly addressed by psychedelic therapy.  That means you can’t just live a deeply stressful life with bad lifestyle habits and diet and expect that psychedelics will make you happy.  It isn’t a shortcut.  

 

Psychedelic therapy will also not address the myriad systemic issues and injustice that plague society.   Psychedelic fungi will not erase the challenges of racism, sexism and other forms of oppression.  It will not erase the challenges of wealth inequality that lead to many people living in generational poverty.

 

Pros

 

Though psychedelic therapy will not solve deeper physiological health issues or systemic oppression, there is no reason they could not be part of a larger multimodal healing therapies.  We need to get away from the idea of a silver bullet “curing” distress and depression (such as a single psychiatric drug) and move to the idea that it generally requires a multi-pronged approach.

 

One of the best aspects of psychedelic therapy is that it often encourages the individual to live their life better and to be more present.  One of the key issues in traditional therapy is the challenge of helping clients to make positive changes in their lives.  From numerous studies it is apparent that psychedelic therapy often leads to improved ways of living life, from creating more deeper and enriching relationships with friends and family, to better lifestyle choices and even a reduction in addictive behavior.

 

On a deeper level, psychedelic fungi can bring a sense of wonder and re-enchantment with the ordinary experience of life.  For many people who consume mushrooms (at large doses), one is able to feel an intimate connection with the numinous sacred underpinnings of our experience as sentient mammals on this planet.  Many people report a deeper sense of meaning, self-knowledge and a sense of being woven into a larger fabric of connectedness and purpose in life.

 

 

 

Notes from a folk herbalist

 

From my own experiences as a much younger man I experienced long term deeply distressing mental health issues after a period of consuming psychedelics in an irresponsible manner.  I don’t want to be cavalier in promoting their use.  I personally understand how damaging they can be when used poorly and I don’t want to see them promoted as a magic bullet approach to depression, trauma and anxiety.  But from research it is apparent that their responsible use in conjunction with other therapeutic tools could indeed be part of a path of greater healing.

 

I would also add that I worry that psychedelics are being seen as simply a different type of drug that can be manufactured and processed for therapeutic usage.  As a folk herbalist, I listen to the myriad tribal and traditional societies who don’t perceive psychedelic plants and fungi as drugs- but as teachers.  And I don’t mean that in a metaphoric sense.  Most traditional societies have a sense that these plants and fungi embody an intelligence field that carries distinct sentience and purpose.  The idea of certain plants as teachers is common to traditional societies.  In modern society we have lost that concept and focus on particular chemical constituents and active principals.  We may make drugs of psilocybin or mescaline without connecting to the importance of the plant and fungi ecologically, culturally and historically.

 

We also are choosing to look at these substances medicinally- as plants that can achieve some good mental health effect.  This is far different from traditional notions of psychedelics as underlying voices from the land and the spirits- as sacrament to be consumed with specific intentions and sacred purpose.  Deep work with these substances could not be separated from the larger goals of staying healthy and in balance with the nearby forests, streams, meadows and spirits of the land and ancestors.

 

In our rush to popularize therapeutic psychedelic use, we are disconnecting from these ancient forms of animistic psychedelic usage and communion.   I am concerned that their deeper intrinsic value could be negated by trying to make them simple therapeutic agents to be ingested only under the professional guidance of a doctor or therapist only in specific medical environments.  Psychedelic plants and fungi should not be only controlled and doled out by an elite guild of medical professionals.

 

 

Conclusion

 

From cave paintings in Tunisia and Italy, to Dionysian rites and Mayan ceremonies, its clear that psychedelic fungi have long played a role in spiritual ceremony, healing rituals and communion with the sacred.  At a fundamental level, they are connectors.  They literally connect different parts of our brain to bring new neural patterns and to help unfreeze old static ways of thinking . There is fascinating research into their use with helping people in pain such as those with migraines.  Research is pointing to their success in helping people recover from anxiety, depression and to working through the dying process.

 

Like the fungal micorhyzza that weave intricate patterns underground in forests, fungi are the great connectors and alchemists.  In forests they help transform dead and rotting wood into mushrooms that provide spores and food for forest creatures.  They help plants and trees to share nutrients and to communicate along an underground fungal highway.  Internally, medicinal mushrooms can help our immune system to function better by tagging and removing cancerous cells- literally removing death to make room for life.

 

Working with psychedelic mushrooms is a very personal choice and one that should be undertaken wisely.  At this point they are illegal and a schedule 1 drug.  Unless one is enrolled in a scientific study, there is no way to access these fungi legally here in the U.S.  That means for now that the work of understanding these fungi is an underground exercise.  For most people, that is enough to avoid their use.  But for a small group of people, the help that they provide has been worth flouting the law.  Anecdotal experiences have been recorded and reported widely in websites such as Shroomery, Erowid and Bluelight.  Organizations like M.A.P.S.- the Multidisciplinary Association for Psychedelic Studies has been one of the forefront organizations to promote the study of these fungi.  And of course, research on their usage is now booming throughout he country.  We are possibly at a turning point where these ancient mushrooms could be legalized in some form.

 

We are in the midst of a revolution in our understanding of mental health.  As we move away from a simplistic neurotransmitter model of mental health, we are looking at traditional tools for helping us to find balance and healing.  Much of that is centered around how diet and herbs can act as therapeutic agents for improving mood and wellbeing.  Increasingly, psychedelic fungi agents such as magic mushrooms are a part of that conversation as research is showing their efficacy for helping people in distress.  The path forward now is to understand how to work with mushrooms responsibly in a way that brings deep healing to people.

 

 

Further Reading

 

Medicinal Mushrooms

A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota  NCBI

Immune Modulation From Five Major Mushrooms: Application to Integrative Oncology

Recent developments in mushrooms as anti-cancer therapeutics: a review

Reduction of depression and anxiety by 4 weeks Hericium erinaceus intake.

Neuronal Health – Can Culinary and Medicinal Mushrooms Help?

Mushrooms: A Potential Natural Source of Anti-Inflammatory Compounds for Medical Applications

 

Psychedelic Mushrooms

Magic Mushrooms Found to Be “Resetting” Brain Circuits in Depressed People

Magic mushroom compound tested for treatment-resistant depression

Benefits of ‘magic mushroom’ therapy long lasting  Nature

Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study   The Lancet

Magic Mushrooms Create a Hyperconnected Brain  Live Science

How Magic Mushrooms Really ‘Expand the Mind’    Live Science

Magic Mushrooms’ Could Treat Depression & Addiction   Live Science

Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin

Effects of psilocybin on hippocampal neurogenesis and extinction of trace fear conditioning.

The “chemical imbalance” myth

Magic mushrooms can ‘reboot’ brain to treat depression – study   The Guardian

After marijuana, are magic mushrooms next to be decriminalised in California?   The Guardian

This couple wants to make it legal to use psychedelic mushrooms in Oregon    The Oregonian

The Life-Changing Magic of Mushrooms –  A single dose of magic mushrooms can make people with severe anxiety and depression better for months, according to a landmark pair of new studies.  The Atlantic

Study: Psilocybin Reduces Pain From Social Rejection   Reset Me

Longtime Sufferers of Cluster Headaches Find Relief in Psychedelics   The Daily Beast

 

 

This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  For more articles like this, please go to    www.Hearthsidehealing.com.

 

You can also find me at the Facebook group Herbs for Mental Health.

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Healing from Childhood Trauma http://herbsformentalhealth.org/healing-from-childhood-trauma/ http://herbsformentalhealth.org/healing-from-childhood-trauma/#comments Tue, 03 Oct 2017 22:23:51 +0000 http://herbsformentalhealth.org/?p=2616 In this article, I want to briefly explore the relationship of early childhood trauma with persistent emotional  issues.   As a therapist I often work with people who are dealing with long term anxiety and depression that are rooted in part to challenging or abusive relationships with one’s family of origin.  Understanding the role of trauma can be key to understanding how to heal and move through persistent emotional distress.

 

The Kaiser Study:  Adverse Childhood Experiences

 

In the late 90’s Kaiser Permanente created a study to examine the effects of childhood trauma on adult life.  Fotolia_49798831_Subscription_Yearly_MWhat they discovered was nothing short of astonishing and its implications are still being studied today.  Childhood trauma is not only associated with adult mental health issues such as depression and anxiety, but also is correlated with increased addiction rates, high risk behaviors, increased suicidality and health problems such as COPD, heart and liver disease.

 

Kaiser developed a questionnaire to find out if people had experienced childhood trauma in a number of areas.  They called these experiences Adverse Childhood Experiences or ACEs and include:

 

1- Emotional, physical and sexual abuse.

2- Parental substance abuse, violence, mental illness and criminality

3- Emotional and physical neglect by parents.

Here is what they discovered.   This is the percentage of people who experienced trauma in some form:

 

Emotional abuse:  10.6 %

Physical Abuse:  28.3%

Sexual abuse: 20.7 %

Mother Treated Violently:  12.7 %

Household Substance Abuse:  26.9 %

Household Mental Illness:  19.4 %

Parental Separation or Divorce:  23.3 %

Incarcerated Household Member:  4.7%

Emotional Neglect:  14.9 %

Physical Neglect:  9.9 %

 

They then tallied up the amount of multiple traumas (ACEs) that people had experienced.  Here is that information:

 

Number of Adverse Childhood Experiences (ACEs):

 

0   36.1%

1   26.0 %

2   15.9 %

3   9.5 %

4  12.5%

 

That means that 63.9 % of people have experienced at least one trauma in their childhood.

 

And a whopping 37.9 % of us have experienced multiple traumas.  

 

Now here is the part that proved to be so powerful.  The higher the number of ACEs, the more likely that one will experience physical and/or mental illness and will be more prone to addiction issues in adulthood.  Essentially trauma in childhood is predictive of a much higher likelihood of adult behavioral and health problems.

 

 

So what does that mean?

 

In terms of mental health it means that trauma in childhood is a main predictive factor for adult depression, anxiety and other forms of emotional distress.  Symptoms in adulthood of  early trauma include:

 

Fear

Dissociation

Anxiety

Guilt and shame

Sadness, hopelessness, apathy

Lack of being able to feel pleasure

Confusion

Panic

Irritability, anger and paranoia

Feelings of numbness and disconnection.

 

These are symptoms that can be interpreted as due to an underlying psychiatric disorder.    Often people receive a diagnosis based on the challenging behavioral and emotional patterns that develop from trauma.  Some of these diagnoses include:

 

Borderline Personality Disorder

Oppositional Defiant Disorder

Somatization Disorder

Dissociative Identity Disorder

Antisocial personality Disorder

Generalized Anxiety Disorder

ADHD

Bipolar Disorder

Major Depressive Disorder

 

That means we are often diagnosing individuals with disorders without addressing the underlying trauma Unknown (1)that is often at the heart of the symptoms they are expressing.  We have essentially been asking the question What is wrong with you?  when the more important question should be What happened to you?

If trauma is extremely common, and if it plays such a key role in adults developing mental health disorders, its key to assess for trauma when working with people in distress and then to address the trauma if that has occurred.  Its also essential that we stop misdiagnosing people with severe disorders and instead examine how trauma is impacting that person’s life.

Van DerKolk writes that 87 % of subjects with Borderline Personality Disorder had histories of severe childhood abuse and/or neglect. 

-ADHD has often been considered an inheritable biological disorder but there is increasing evidence  that trauma is often the underlying reason. From the linked article:  “Children diagnosed with ADHD also experienced markedly higher levels of poverty, divorce, violence, and family substance abuse. Those who endured four or more adverse childhood events were three times more likely to use ADHD medication.”

-There is even evidence that trauma plays a key role in bipolar disorder, long thought to be simply a genetically inherited disease.

 

 

Developmental Trauma Disorder

 

 

Misdiagnosis is one of the main reasons that  a large group of mental health professionals have lobbied hard to offer a new psychiatric diagnosis known as Developmental Trauma Disorder (DTD).  Sometimes this is referred to as Complex PTSD (also not yet listed as a psychiatric disorder), but that diagnosis also includes severe abuse and neglect that can happen as an adult such as in the case of spousal abuse and  hostage taking.

 

Developmental Trauma Disorder refers to people who experience severe distress due to persistent childhood abuse and neglect.  In essence these are folks who have high “ACE” scores.  DTD really differs from the classic trauma diagnosis of PTSD (Post Traumatic Stress Disorder.).

 

From Bessel Van der Kolk:

While PTSD is a good definition for acute trauma in adults, it doesn’t apply well to children, who are often traumatized in the context of relationships,” says Boston University Medical Center psychiatrist Bessel van der Kolk, MD, one of the group’s co-leaders.

“Because children’s brains are still developing, trauma has a much more pervasive and long-range influence on their self-concept, on their sense of the world and on their ability to regulate themselves.”

 

 

So while there are similarities between people diagnosed with PTSD and those with DTD there are significant differences as well.  Both tend to have symptoms such as hypervigilance, anxiety, potential for dissociation, flashbacks, panic attacks, sleep disturbances and nightmares.  But DTD is at its core about relational trauma.  That means that those core emotional wounds are about basic bonds of attachment and connection that were deeply damaged due to neglect and abuse.

 

Those with DTD also can develop profound challenges with maintaining healthy friendships and intimate relationships as well as have a hard time with a good sense of trust and boundaries. There can also be increased feelings of internal fragmentation with greater chance of a disturbed body image, eating disorders, shame, guilt and low self-esteem.  Emotional regulation can be particularly hard and small triggers can lead to expansive states of anxiety, panic, rage, catatonia, confusion, dissociation and even psychosis.   Addictive patterns and self-injury such as cutting are some common ways to manage the underlying internal feelings of disconnection and fragmentation.  Suicidal thinking and behavior can also be common to explore a way of ending the pain.

 

Humans are profoundly social creatures, and when a sense of essential trust is broken with one’s closest family, it can damage all further relationships and can lead to greater periods of isolation, fragmentation and disconnection.  This can spiral into worsening social anxiety and depression.

 

Healing from this form of trauma really is about learning ways to manage the intense emotional states that were hard wired as a child and to engage in healthy relationships with good personal boundaries and greater trust.   The good news is that many people have discovered ways to navigate the depths of their core emotional wounds and heal from familial trauma.

 

There are a number of therapies designed to help people work through these profound childhood trauma symptoms.  Dialectical Behavior Therapy (DBT) has been extremely helpful for many people and increasingly somatic therapies (TRE, Somatic Experiencing) have been developed to help people navigate the challenges of childhood trauma.  EMDR is  a useful tool for some people though a number of people feel that is best used for working through pinpoint discrete event trauma and less for complex forms of childhood trauma.  Finally, numerous non-western models of working through developmental trauma have long been utilized such as acupuncture and yoga.  (Please see the next article for more in depth discussion of various healing modalities for developmental trauma.)

 

 

Trauma and the Body

 

 

From Wikimedia

From Wikimedia

What we are learning is that childhood trauma contributes to a wide variety of detrimental biological changes.   At the developmental stage of life, trauma can induce structural changes in the amygdala, hippocampus, and prefrontal cortex of the brain.  There is some evidence that there is long term decreased activity in the portions of the brain linked to emotional regulation.  There is some evidence that repeated trauma leads to a smaller hippocampus, which can then increase the risk for increased post-traumatic stress symptoms.

 

Trauma is also connected to a heightened chance of musculoskeletal pain, hypertension, obesity, cardiovascular disease, autoimmune diseases and fibromyalgia.

 

Trauma interrupts healthy patterns of responding to stress in our nervous system.   In a normal response to stress, the hypothalamus signals the pituitary gland to send a message to the adrenal glands to release adrenaline and cortisol in a system known as the HPA axis.  Adrenaline spikes your heart rate, blood pressure, sends blood flow to the muscles and dilates your pupils.  Cortisol converts fat into sugar that is released into the blood stream as energy to be used quickly.  This is known as the sympathetic nervous system response and readies us for “fight or flight.”

 

The problem comes when the stress response is triggered too often, or is overwhelmed with extraordinary trauma.  In those cases of excessiveallostatic load , the brain becomes conditioned to be triggered easily and adrenaline and cortisol are released excessively.  If this becomes the norm (known as HPA dysregulation) then a host of health problems can develop such as chronic high blood pressure, diabetes, autoimmune diseases, digestive problems, sleep disorders and weight gain.

 

 

EscherichiaColi_NIAID

Trauma also has a strong relationship with gut health and can cause numerous changes that persist into adulthood.  Trauma damages this bacteria microbiota and that damage can have long lasting effects such as causing higher systemic inflammatory markers and heightened levels of anxiety, depression and susceptibility to extreme states.

 

Traditionally psychiatrists have focused on an imbalance of neurotransmitters such as serotonin and dopamine as the leading reasons for mental illness.   When we see mental illness through the lens of trauma we are now seeing that depression, anxiety and other forms of persistent distress are much more likely due to systemic inflammation and damage to the gut, the endocrine and nervous system.    As Bessel Van Der Kolk writes about trauma, “The body keeps the score.”

 

 

Conclusion

 

Childhood trauma  has far reaching implications and can lead to a variety of tangled mental and physical health issues in adulthood.  Developmental trauma challenges the core ability to sustain healthy trusting relationships as well as impacting physical health and causing problems such as poor digestion, gut microbiota disturbances, inflammation, HPA dysregulation and associated cardiovascular, immune, nervous system and endocrine health issues.  Often the work of healing from developmental trauma means addressing both the physical and emotional disturbances that developed from those childhood wounds.   In the next article we will look at some of the best ways to help people heal from childhood trauma.

 

 

Some key articles to read and explore about this complex subject:

 

 

The long-term costs of traumatic stress: intertwined physical and psychological consequences  McFarlane, World Psychiatry 2010

 

The role of childhood trauma in bipolar disorders,  Aas, Henry, Andreassen et al, Journal of Bipolar Disorder 

 

About the CDC-Kaiser ACE Study

 

Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems   Schmid, Peterman, Fegert et al, BMC Psychiatry

 

 

Developmental Trauma Disorder:  Towards a rational diagnosis for children with complx trauma histories,   Bessel Van DDer Kolk, MD 

 

How Trauma Can Effect Your Body and Mind,  Christy Matta, World of Psychology

 

Childhood Trauma, Affect Regulation and Borderline Personality Disorder,  a lecture by Bessel Van Der Kolk

 

What is Trauma Informed Care?

 

A new diagnosis for childhood trauma?  Tori DeAngelis, American Psychological Association

 

Developmental Trauma:  What You Can’t See…

 

Developmental Trauma Disorder

 

Trauma and the development of borderline personality disorder,  Van der Kolk, Hosteler, Heron et al,  Psychiatric Clinicians North America

 

A new diagnosis for trauma?  Some push for a new DSM category for children who undergo multiple, complex traumas.  Tori DeAngelis, American Psychological Association. 

 

Posttraumatic Stress Disorder: Does the Gut Microbiome Hold the Key?   Canadian Journal of Psychiatry 2016; Leclerc, Forsythe and Bienenstock 

 

 

 


This article written by Jon Keyes, Licensed Professional Counselor.

If you are interested in herbalism, please go to my website www.herbsformentalhealth.org and connect to me here.

 

You can also find me at the Facebook group Herbs for Mental Health.

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Healing the Heart: Exploring Heart Rate Variability and Trauma http://herbsformentalhealth.org/healing-the-heart-exploring-heart-rate-variability-and-trauma/ http://herbsformentalhealth.org/healing-the-heart-exploring-heart-rate-variability-and-trauma/#comments Thu, 31 Aug 2017 17:16:46 +0000 http://herbsformentalhealth.org/?p=2468 At the top of the heart, a small bundle of cells known as the sinoatrial node regularly send out an electrical impulse.  The signal causes the walls of the heart to contract, sending blood into the ventricles and then out to circulate through the body.   For some of us the rhythm of the heart is quite irregular and that arrhythmia can be dangerous.  But small variations in heart rhythm are actually very healthy.

 

Imagine someone who’s heart beats at 60 beats a minute, or once a second.  That rate is actually not exactly one beat per second but may deviate by a few milliseconds quicker or slower each time.  That variability is actually quite healthy and very important to our physical and emotional health.  Those who have more “heart rate variability” are more resilient and adaptable to stress.  In essence they are more fluid and flexible and stressors don’t bother them quite as much.  Those who have less variability and a more regular rhythm have less resiliency and can become more easily aroused and stressed out.

 

In a way its counter-intuitive.

Usually we equate a steady heartbeat with a more steady disposition but in fact it is just the opposite. That steady regular beat associated with heightened stress is actually a sign of increased rigidity and inflexibility. A more chaotic beat is a sign of more fluidity and dynamism.  We know from studying ecology that the natural world can be modeled by spiral patterns of complex fractals. Variable complex ecosystems such as old growth forests will be far more resilient than tree farms with single trees planted in rows.

 

Variability and chaos are key to good health. 

 

 

 

Trauma and Heart Rate Variability 

 

 

Walter Langley – Never Morning Wore to Evening but Some Heart Did Break

Significant stress and trauma causes heart rate variability to decrease.   The heart
becomes more rigid as a way of coping.   Think of this as similar to how one freezes when presented with a threat.  The body moves towards more holding, rigidity, more tightness.

 

The heart has two main nerves associated with it.  The accelerans nerve is associated with the sympathetic nervous system and speeds up the heart and makes it more regular when there is danger.  The vagus nerve is associated with the parasympathetic nerve and helps the heart to calm, slow down and become more irregular and variable.  The vagus nerve emits from the brainstem and links to the face, the eyes, down to the heart, lungs gut, kidneys and reproductive organs.  When the vagus nerve is operating well, then the body easily rests at a more relaxed parasympathetic state.  This is known as good  vagal tone.

 

 

Now imagine a small child crying out to a parent because they are hungry, cold, tired or lonely.  When a parent comes into the room and soothes the child with eye contact, gentle cooing sounds and warm skin to skin contact, the vagus nerve with its sensors in the eyes and face is stimulated.  It then signals for the release of acetylcholine in the heart which helps calm it and bring greater variability.  But  now imagine if you did not receive that same level of comfort.  Perhaps parents were angry, neglectful and abusive.  Or perhaps parents are under stress due to poverty and oppression and have a challenging time offering optimal care because of systemic injustice.  There is no way to calm down the stress response and the nervous system stays in heightened arousal.  The heart receives the signal to stay on alert with a fast heart beat and decreased variability.

 

We know from research that when a child experiences trauma, heart rate variability is decreased and that can have lasting effects into adulthood.   Essentially, heart rate can become rigid and excessively steady leading to much greater susceptibility to stress as an adult.  The heart is conditioned to poorly respond to stress and become more highly reactive to the environment.

 

 

 

Heart Work:   The Wounds of Modernity 

 

 

The modern world is designed to challenge the rhythm and flow of our hearts.  Most of us no longer spend long hours outdoors breathing in the aromatic compounds from the trees and hills that help our hearts to remain strong and calm.  We are distant from the normal rhythm of day and night, sleep and wake cycles attuned to the variations of the seasons and the movements of the sun.  Most of us are attuned to the rhythm of clocks and alarms, work schedules and deadlines.    As we moved away from the agrarian age to the industrial age, we shifted to the rhythms of factories and shift work.  Season and time of day no longer mattered.  In the age of computers, we entrain ourselves to the speed and rhythm of news, social media updates, emails and videos from morning to well past dusk.

 

There is a collective trauma happening as we increasingly distance ourselves from field and forest, as we become increasingly entrained in technological and shift work rhythms.  The pace has quickened.  Stressors are almost constant.  Those who are under constant threat and prejudice such as people of color, those in poverty and the LGBTQ communities can have a much harder time improving heart rate variability due to systemic injustice.  The frenetic pace of modernity along with systemic injustice are truly a wound to the collective heart, calling for healing at a societal level.

 

 

Healing the Heart:  Tools for Greater Vagal Tone 

 

 

Decreased heart rate variability is akin to a wounded heart that needs slow and steady repair to heal.  Traditional healing systems have a multitude of techniques for stimulating the vagus nerve, improving heart rate variability and strengthening emotional resiliency.  For those with limited means, accessibility is a key issue here.  The good news is that many of the tools for improving HRV are cheap or free.

 

 

 

 

Rest:  One of the most important lessons in athletically training is to make sure there is adequate

Bagby Public Hot Springs

time between workouts for proper rest and recovery.  This allows the body to repair tissue and muscle damage and helps increase long term stamina and endurance.  In physical training, workouts actually lower HRV.

Working out is a form of stress and its key to have a period of rest afterwards to allow HRV to rise.  With folks who have had trauma, their heart rate variability is stuck at a low level, so there is need for a lot of counterbalancing rest.  This can really mean months and sometimes years of taking more time to be quiet, turn off the screens, bathe and take long naps and get plenty of sleep at night.

 

 

 

Sacred movement:   Exercise that helps improve flexibility and relaxation can be deeply helpful for improving heart rate variability  Qi gong and yoga are systems of sacred movement that encourage greater resiliency, strength and improve HRV.  It is important to note that some forms of yoga are often too strenuous and intense for people recovering from trauma and gentle forms of vinyasa and yin yoga are more helpful for improving HRV.

 

 

Breath techniques:  Some of the best ways to improve heart rate variability is to engage in deep breathing exercises.   This doesn’t have to be complicated and literally focusing on slowing down one’s inhalations and exhalations can have a profound effect on improving heart rate variability.

 

With my clients I suggest a simple exercise of breathing in for 4 counts and exhaling for 6 counts.  That comes out to 6 breaths a minute and it only takes a couple minutes of doing this to notice a good effect.  Another technique is to breathe in for 4 counts, hold for 4 counts and then exhale for 8 counts.

 

Finally, a powerful technique that traditionally has been used to strengthen the nervous system and reduce anxiety is called alternate nostril breathing.  In this technique, try holding your right thumb to your right nostril and breathe in deeply for 4 counts.  Then hold both your thumb and third finger on your nostrils and hold your breath for 4 counts.  Then release your right thumb and exhale through your right nostril for 8 counts.  At the end of the exhale, inhale through the same right nostril for four counts.  Hold both thumb and third finger to your nostrils.  Then release your third finger and exhale through your left nostril.  Repeat this cycle for 5 minutes.

 

 

 

Forest Bathing:  One of the most powerful ways to help improve heart rate variability is to engage in Forest Bathing.  For about 8 years, Japanese researchers examined the effects of spending time in forests resting and taking in the natural air.  One of the findings is that heart rate variability improved.   One of the main reasons they cited was due to the aromatic compounds emitted from trees that have a calming and healing quality.   So taking walks in nearby forests has a profound effect on healing the heart through improving vagal tone.

 

 

Aromatherapy:   Research is increasingly pointing to aromatherapy as a key tool for helping improve heart rate variability.   For many people who are stuck in severe trauma symptoms patterns such as dissociation, freezing, derealization and panic, aromatherapy can be one of the most profound tools available.  Instead of having to focus on doing something such as taking a walk, doing breathing exercises or yoga, the simple act of taking in the scent of essential oils can induce a parasympathetic response that helps calm the heart and improve vagal tone.  This can happen in a variety of ways-

 

Smudge:  Smudging with sustainably harvested cedar, sage or mugwort are time honored ways of releasing volatile oils that improve mood.

 

Infused herbal oils:  Try massaging your skin with oils that have been infused with herbs such as lavender, rosemary, lemon balm and rose.

 

Small batch distilled oils:  Try working with essential oils that have been lovingly crafted in a sustainable way.  You can add them to bath salts, massage oils, to diffusers and sprays for helping to strengthen vagal tone.

 

Mountain Rose Herbs has a great section on aromatherapy with organic ingredients here. 

 

 

 

Conclusion

 

 

 

 

Trauma work is heart work.  Abuse and neglect can cause long term wounds to the very rhythm, speed and pulse of our heart.  When the heart beats at a rate that is too steady, rigid and unbending, the work is to loosen that process up- to bring more flexibility and dynamism to that flow.  The process of shifting from a sympathetic dominant state to a more parasympathetic state can be aided by traditional techniques such as breath, sacred movement, aromatic herbs and connecting to nature to heal the rhythm of the heart.  Go well on your journey.

 

 

 

 

Some additional reading:

 

 

What is Heart Rate Variability?  And Why does it Matter?

Heart Rate Variability is Associated with Emotion Recognition

32 Ways to Stimulate your Vagus Nerve 

Vagal Tone and the physiological Regulation of Emotion

Measure your resilience with Heart Rate Variability using your smartphone

Track your HRV to boost adaptive reserves

Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting

The effects of patterned breathing and continuous positive airway pressure on cardiovascular regulation in healthy volunteers.     

Forest Breathing 

The Effect of Lavender Aromatherapy on Autonomic Nervous System in Midlife Women with Insomnia

Aromatherapy Benefits Autonomic Nervous System Regulation for Elementary School Faculty in Taiwan

Heart rate variability index in trauma patients.

Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study.

 

 

 

This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  For more articles like this, please go to    www.Hearthsidehealing.com.

 

You can also find me at the Facebook group Herbs for Mental Health.

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Trauma, the Gut and Healing: Building Deep Resiliency with Herbs http://herbsformentalhealth.org/trauma-the-gut-and-healing-building-deep-resiliency-with-herbs/ http://herbsformentalhealth.org/trauma-the-gut-and-healing-building-deep-resiliency-with-herbs/#comments Tue, 20 Jun 2017 15:50:13 +0000 http://herbsformentalhealth.org/?p=2449

 

 

When you are young Imagine yourself as a small child and living in a household where the parents drink excessively, argue and at times lash out angrily and abusively towards you.  Or imagine living in a situation where you are poor and living in a violent neighborhood where you feel threatened regularly.  Through studies, we now know that this type of stress is linked to higher potential  for physical and mental illnesses such as autoimmune disorders, depression and anxiety later in life.  What we are starting to discover is that one of the main reasons for this is due to the damage that stress does to the gut and to the gastrointestinal microbiota.  

 

E coli Ag Res Mag

Throughout the body there are trillions of bacteria and in the digestive system itself reside 3-4 pounds of bacteria that we call the gut microbiota.  These 500-1000 strains of bacteria are partly responsible for many processes including digestion, absorption, manufacturing vitamins, and helping improve immune system function.  Research over the last decade is increasingly showing how the microbiota plays a key role in mental health as well.

 

Stress, trauma, poor diet, antibiotics, medications such as NSAIDS and chemicals all can cause damage to the microbiota.  When under extreme stress as a child, the microbiota can be damaged to the point of reducing the diversity of flora in the gut.  Not only that but this can lead to lifelong damage to the microbiota.   A lack of microbiota diversity is linked to greater levels of anxiety and depression and heightened inflammatory markers.  The good news is that there are a number of things we can do to improve the health of the gut and to improve the microbiota.  Through changes in our diet and adding key herbs the microbiota can be healed to help people feel better physical and emotionally.  In essence, early childhood trauma can be treated in part by addressing digestive health.

 

The Science

 

Research is increasingly connecting the health of the gut to our emotional wellbeing.  There are several areas of research going on.  One is focusing on how the microbiome impacts our mood and researchers are discovering how certain bacteria can be beneficial for our mood.  A recent study examined the microbiome of folks in urban Italy compared to traditional Hadza foragers in Tanzania.  What they discovered is that the Hadza’s microbiome included a far more diverse array of bacteria while the Italians was far less diverse.    Lacking healthy strains of bacteria  is correlated with heightened levels of inflammation, anxiety, depression, autoimmune diseases and other health problems.   Think of it this way:

 

If our microbiome is like a forest, traditional foragers have far more species of trees and plants in their forest while modern urban people have far less.  We know from studying the environment that greater ecological diversity is a signpost of a healthier, stronger and more resilient ecosystem.  And the more the environment leans towards less biodiversity, the more fragile it is.  In essence, the modern person’s microbiome is increasingly fragile and less resilient.  

photo-1426170042593-200f250dfdaf (1)

So why the difference in the microbiota between traditional foragers and modern people?  There  are a lot of potential culprits.   The Western diet is far less diverse with about 20 ingredients, while traditional foragers ate upwards of 150 different ingredients.  That complexity of diet actually leads to a greater need for different types of bacteria that can break down multiple types of food.  Other culprits include the modern use of antibiotics, preservatives, chemicals and the pervasive effects of stress and trauma impacting our gut health and at times wiping out whole colonies of beneficial bacteria.

Add to that the potential for early childhood stress and trauma.  Those stressors can also negatively impact the gut and lead to a lifelong change in the composition of the microbiota.  Those damaging changes can lead to greater susceptibility to physical illnesses, anxiety and depression.

 

 

Tickle Tickle

 

So if beneficial bacteria are an important part of good mental health, what is the mechanism?  How do they 1c8a9f6edcc97ace30a18a6ec16256a1actually induce greater feelings of of calm and wellbeing?  Well there are a number of different pathways.   One of the most interesting is that the bacteria are interacting with the ventral vagus nerve, the longest nerve that travels from the brain through to the heart and lungs all the way to the digestive system.  The Vagus nerve is connected to the parasympathetic nervous system and the ability to help the body to be calm, relax and digest.  As part of the Gut-Brain axis, certain strains of bacteria “tickle” nerve endings that then communicate through the vagus nerve to the the areas of the brain associated with anxiety.

 

Researchers have also discovered that mice that lack gastrointestinal bacteria (GF or Germ free) exhibit far higher levels of stress and anxiety.    When those mice are fed on a broth that includes bacterial strains such as lactobacillus rhamnosus, they  have much lower levels of anxiety.  This type of bacteria produces GABA, the main calmative neurotransmitter in the body.  This has led to research amongst veterans where they are conducting tests to see if beneficial bacteria can help reduce anxiety in veterans who have PTSD.  This is part of a larger framework of research that is looking at probiotics and certain strains of bacteria as forms of “psychobiotics” that could influence the body to feel less anxiety and improve mood and wellbeing.

 

Gut Lining

 

When talking about Gut health, there is another area that is key to examine, and that is the intricate role of the lining of the gut.  Leaky Gut occurs when this thin mucosal lining is compromised and becomes inflamed and porous so that compounds normally contained in the digestive system “leak” into the blood stream and then travel around the body, leading to systemic inflammation and various forms of illness and poorer mental health.   Leaky gut is associated with chronic fatigue, food allergies, arthritis, autoimmune disorders and poor mood.

 

One of the main markers of inflammation is the over-secretion of inflammatory cytokines.   These inflammatory markers are much more elevated in folks who are having episodes of depression, anxiety, mania and psychosis.   In the medical field there is some interest in prescribing anti-inflammatory drugs as a way of not only managing physical health concerns but mental health issues as well.

 

 

 

The Big Picture

 

The field of psychiatry is changing.  Traditionally the focus of treatment has been on augmenting or reducing certain neurortransmitters such as dopamine, serotonin or GABA through drug therapy (think antidepressants and tranquilizers).   But increasingly the field is broadening to integrate new research into the health of the gut, the microbiota, the gut-brain axis,  and inflammation as causative factors in poor mood and wellbeing.  Though most mainstream medical doctors are still focused on prescribing traditional psychiatric medications, integrative practitioners have been focusing on the importance of gut health as part of improving mood and wellbeing.  This is really a revolution in mental health that acknowledges the importance of not just the nervous system but our digestive system, what we eat, how we nourish ourselves and the health of our microbiota.

 

 

Why is our Gut Hurting?

 

 

When considering how to heal the gut its key to look at the variety of factors that could be contributing:

Diet:    One of the first thing to consider is what you are already eating.  So many digestive disturbances can be healed by reducing/eliminating processed foods, “quick carbs”, sugars, common allergic foods such as wheat and dairy.  Moving to simple easy to digest warm meals filled with broths and traditional meals made with grains and vegetables can also be amazingly healing and often essential to really eliminate symptoms.

 

 

Stress:  So obvious it barely needs mentioning but when we become overwhelmed by obligations, family, relationship or job problems, it takes a toll on our gut.  Our ability to digest and eliminate properly gets easily affected and this can come out as increased loose stools, constipation, inflammation and other factors.   Working through stressors is key to help reduce the load on the gut.

 

 

Previous Trauma:  Trauma in the form of emotional abuse, violence, neglect and other stressors can have a lasting impact on our body and our microbiota.

 

Bessel Van Der Kolk, in his book  The Body Keeps the Score, states  “Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.”

 

Working through this held felt tension in the body and the gut can often be helped by somatic therapies such as yoga, qi gong, dance and trauma release exercises.  Traditionally, indigenous people often work through trauma via ceremony, healing rituals and community reintegration  that help to release this held/felt tension.

 

 

Oppression:  We live in a world where large groups of people are oppressed by low wages, substandard housing, lack of access to good healthcare, good food and adequate school systems.  This leads to a chronic toll on the body that is often felt in the gut in the form of inflammation, a damaged microbiota and poor digestion that then translates into worsening mood and wellbeing.  There are no easy answers to this as it requires systemic approaches to dismantle the widespread oppression that affects billions of people.

 

 

Drugs/Alcohol/Medication:  All forms of medications, drugs and alcohol can have an adverse effect on the gut and tend to slow down and damage digestion.   Its key to particularly note that antibiotics and NSAIDS are deeply damaging to gut health and their frequency of administration is often excessive.

 

 

In come the Plants

 

 

When we think about ways to heal the digestive system, the most common way that humans have traditionally done this is to use herbs.   Herbs are amazing healers for the gut and work on a number of levels.  They can act as anti-inflammatories, nourish and strengthen, promote digestive flow, relax the stomach to help it digest better, improve metabolism and heal the gut lining.   When trauma has impacted the gut, plants act as mediators and keys for transformation.  Let’s take a closer look at all the amazing things herbs can do.

 

 

Aromatics

 

IMG_8864

These are herbs that you likely already have in your spice cabinet or growing on your back deck and are known as aromatic carminatives.  A carminative herb is one that helps ease digestion and has an uplifting, dispersing quality.  They help when there is stagnation, heaviness, difficulty in digestion and absorption, tend to relax the digestive system and are antispasmodic when there is cramping.  They have volatile oils that give these herbs their distinct aroma and are often turned into essential oils that can be used for aromatherapy as well.   They often have an added function of being calming and uplifting.  This can be especially important for folks who have a lot of stress or who have experienced trauma and are tight and are holding in their bellies.

 

They include the Mediterranean herbs such as mint, sage, rosemary oregano, fennel and thyme as well as the more warming middle Eastern/South Asian aromatics such as ginger, cardamom, nutmeg, coriander and turmeric.

 

These are some of the best go-to herbs for people with digestive problems as they tend to be gentle, easy to digest and can be easily added to meals.

 

 

 

800px-Bee_on_dandelion

Bitters

We don’t get much bitter food into our modern diet and this is one of the reasons for poor digestion.  Outside of coffee and the occasional piece of kale, bitter is fairly lacking.  The bitter taste helps things to move and the direction is downward (unless you take a huge amount- then it can be emetic.)   These are herbs that help promote digestive function, improve bile flow and help in the process of assimilation and elimination.   Traditionally bitter plants have been associated with improving liver function.  In Chinese medicine, a stagnant liver is correlated with stored and stuck frustration and anger.  The bitter flavor helps us to feel less stuck and angry and feel like our energy is more easy and free flowing.

 

Some classic bitter herbs include the roots of dandelion, chicory, burdock, yellow dock, bupleurum,  angelica as well as the reishi and fomitopsis mushroooms.

 

 

Demulcents

IMG_8863 (1) These are herbs that help calm and soothe inflamed digestive systems and are especially helpful for those with ulcers, gastritis and heart burn or chronic constipation.

 

Some examples include calendula, licorice, meadowsweet, marshmallow, slippery elm,  and plantain.

 

 

 

 

Polysaccharide Rich “Sweet” herbs: 

IMG_8130

In an important article from Nature, studies were done on ginseng and how it can help restore the gut microbiota.  Ginseng has a high composition of polysaccharides that act similar to prebiotics to stimulate the growth of lactobacillus and Bacteroides spp.   There are a number of “sweet” Chinese herbs that are regularly used to enhance digestive health.  They are often included in formulas such as 6 gentlemen and Gui pi tang.  Interestingly these herbs are also associated with strengthening the “qi” or the overall feeling of energy in the body. Essentially, healing the gut leads to greater feelings of vitality and energy.

 

Examples include ginseng, codonopsis, astragalus, dong gui and licorice.

 

 

 

IMG_4509

Astringents

These are herbs that are helpful for  toning up the digestive lining and helping with loose bowels and diarrhea.  Examples include red raspberry leaf, yarrow, strawberry leaf and geranium.

 

 

 

 

 

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Nutritional

These are herbs that provide an enormous amount of vitamins and minerals and include herbs such as  nettles,oat straw, alfalfa, seaweeds, moringa and red clover.

 

 

 

 

 

Liver HealersIMG_2172

There are a number of herbs that are particularly useful for healing the liver when there has been damage suchas in the case of alcoholism and hepatitis C.  These include milk thistle, resihi, fomitopsis and schisandra.

 

 

 

 

Steps Towards Healing The Gut

 

As we see from research there is increasing evidence that anxiety, depression and other mental health conditions are strongly correlated with gut health.  And we are learning that when the microbiota is damaged or with increased inflammation in the gut lining we can develop a wide range of both physical and emotional complaints.

 

Though each person’s digestive issues are unique and require specific care, there are some general herbal protocols that can be helpful for most people.  Here are some of my basic recommendations:

 

 

1- Reduce irritating foods.  These often include coffee, sugar, processed foods, chocolate, tobacco as well as Unknowncommon allergens such as wheat, dairy and nightshades.  These are the low hanging fruits that can be reduced to help improve gut health and in turn improve mood.   Its also key to avoid cold foods that damage the gut.  That means avoid ice, raw salads and frozen foods and beverages.

 

 

 

 

2- Increase food and herbs in the diet that promote digestion and absorption.  One of the best Unknownways to do this is by eating fermented foods in the form of miso, kombucha, kimchi and sauerkraut.  Fermented foods act as prebiotics to promote certain bacterial strains that are beneficial for to the microbiota.   Its also great to add herbs to the diet that  include the aromatic herbs listed above.   That means add herbs such as  fennel, tarragon, ginger and cardamom to your meals.   Your tummy will love you.    Bitter herbs are also really helpful in promoting digestive juices and better digestion and absorption.  Some examples include dandelion, burdock, yellow dock and gentian.   See below for more detailed information.

 

 

2- Eat slow.  The more work we do with our teeth, the less work out digestive system has to do.   In general we eat faster and eat too much when we are watching the TV, are on the computer and phone.  Try to take a break from the screens while eating.

 

 

3- Lower the Stress.  If you are stressed, your gut will freeze up and won’t have the motility needed to digest and absorb food.   Lowering stress levels can be next to impossible for some folks, especially for folks who have to work multiple jobs or have poor housing.  But even small changes can be key to reducing stress and in turn taking a load off our gut.

 

 

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4- Move.  The human species is one that traditionally has lived mostly outdoors and involved in foraging and hunting.  That means that a portion of the day was always spent moving outside.  Movement helps the digestive system to flow and improves motility and peristaltic function.  Try 30-60 minutes of outdoor gentle movement a day such as walking, hiking, biking, qi gong and yoga.  Heavy exercise can also place serious stress on the digestive system so be careful of those daily spin classes.

 

 

 

 

5- Nourish.     There are a lot of articles and books about what diet is best for people who are trying to repair and heal the gut.  From Paleo to Vegan, often what is missed is that it can be really hard for people to digest food and its best to try and take in warm food in small amounts that are easy to digest.  So think well cooked meals and soups that emphasize whole foods.   While reducing processed foods,  simple carbs and sugar is often key to healing the gut, a paleo diet that emphasizes big pieces of red meat and raw salads can be tremendously hard for some people to digest.  Embracing traditional diets from throughout the world is often key to healing the gut as well.  Nourishing Traditions and Nourishing Broth by Sally Fallon are two of my favorite go-to books that will go along way to improving and healing gut related health issues.

 

Choosing which herbs to use and how to use them as part of a protocol for nourishing and healing the gut can be challenging to know.  The thing I like to keep in mind is that the gut generally likes to deal with things as simple warm liquids.  Pills, capsules, powders and alcohol tinctures are harder to consume and absorb.  So with that in mind I like to promote people taking in broths and teas primarily.

 

 

 

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Gut Healing Recipes

 

Here are a few recipes for herbal preparations that can be consumed regularly to improve digestion and gut health.

 

 

 

 

 

 

Digest Ease Tea:  This is especially helpful for reducing stomach cramping, relaxing the belly and helping people to digest their meals.

 

1 tablespoon of mint

1 teaspoon of fennel

Add herbs to one pint of hot water and let steep for 10 minutes and then strain and drink.

 

 

Warm the tummy tea:     For those who feel cold, stagnant, bloated and tight in the belly, sometimes with pain and distension.

 

1 teaspoon ginger

1 teaspoon cardamom

a pinch of licorice

Add herbs to one pint of hot water and let steep for 10 minutes and then strain and drink.

 

 

Nourish the stomach Tea:  This is an herbal combination that can be taken over a longer period of time (4-6 weeks) on a daily basis when the gut has been compromised and there are feelings of bloating, distension, fatigue, low energy, poor sleep, aches and depression.  This is a classic “spleen qi tonic” with Chinese herbs that can be purchased from Mt. Rose.   Its really important to make this as a tea (decoction) because several of these herbs (astragalus, codonopsis, ginseng) contain polysaccharides that breakdown into probiotics that promote healthy gut flora.

 

1 tablespoon of codonopsis

5 sticks of astragalus

1 teaspoon orange peel

1 teaspoon Hawthorn berries

1 teaspoon Dong quai

1/2 teaspoon Licorice

1/2 teaspoon Ginger

 

Add herbs to a quart of water in a pot.  Then bring to a boil and let simmer for 30 minutes.  Strain and drink over the day.

 

 

Bone Broth with herbs:  Bone broth contains collagen that helps heal the gut lining.  The breakdown in the gut lining (leaky gut) allows for inflammatory compounds to pass through into the blood stream and cause systemic inflammation that has been implicated in both physical and mental illness symptoms.  When you add in an assortment of medicinal herbs you are augmenting the nutritional and tonic value of your bone broth to an amazing level.

 

Ingredients:

Big Stock pot that can hold a couple gallons of liquid.

Bones from a whole roast chicken (or 2-3 pounds of bones)

6 quarts of water

3 tablespoons of apple cider vinegar

2 Cut up whole onions

6 cloves of garlic

 

 

1 tablespoon of codonopsis root

8 stalks of astragalus

1/2 cup of nettles

1/2 cup of burdock root

1 tablespoon of chopped rosemary

1 tablespoon of chopped sage

1 tablespoon of assorted seaweeds

12 shitake mushrooms.

 

After roasting the bones for a half hour, add the bones to a big stock pot. Then add 6 quarts of water and pour in a couple tablespoons of apple cider vinegar.  The vinegar helps breakdown the bones.  Add in the onion, garlic and the herbs listed above and bring the whole thing to a light boil and then simmer the broth for at least 4 hours and 12-24 hours is best.  After the broth has simmered for that time, then strain out everything except the liquid and pour it into containers that can be refrigerated or frozen for later use.

 

 

Heal the Gut lining Tea:  These are herbs that are known as “vulneraries.”  That means they help heal inflamed and damaged tissue.  Add equal parts of these herbs: Calendula, meadowseweet, plantain, chamomile and licorice and place them in their own jar for regular use.

 

Then take a tablespoon of the herb and add it to a pint of hot water.  Steep for 15 minutes and then strain and drink.

 

 

Calm Digestion:  This is a useful combo for those who are so anxious and nervous that they are unable to digest food very well.

 

Catnip  1 teaspoon

Chamomile 1 teaspoon

Peppermint  1 teaspoon

Passionflower  1 teaspoon

 

Add herbs to pint of hot water.  Steep for 10 minutes with lid on the tea and then strain and drink.

 

 

Tone the tummy tea:  This is useful for folks who have been having loose stools and diarrhea and need some astringent, vulnerary and calmative herbs.

 

Red raspberry leaf 2 teaspoons

Yarrow 1 teaspoon

Chamomile 1 teaspoon

 

Add herbs to pint of hot water.   Steep for 10 minutes with lid on the tea and then strain and drink.

 

 

Reduce inflamed stomach:  This is for folks who have been getting heartburn and acid reflux.

 

Try a cup of marshmallow root tea.  This is a mucilaginous tea that will help soothe, cool and  heal the stomach.

1 tablespoon marshmallow root

1 teaspoon catnip.

1 teaspoon mint.

 

Place herbs in pint of cold water (yes cold water) and allow to steep for a few hours or overnight.  Strain and drink.

 

 

Nourishing Long Infusions:  Often our digestive system is fairing poorly because it is lacking in needed nutrients for proper metabolism, digestion and absorption.  There are a number of  herbs that are nutrient rich such as nettles, oatstraw, moringa, red clover, cacao and seaweeds.   One of the best ways to nourish the system deeply is to drink infusions of herbs that have been steeped for many hours.  Try one herb a day (nettles, red clover, oatstraw) for a few weeks to see if your energy levels are improved.

 

Take one cup of herb and place in a quart mason jar.  Fill to the top with hot water and let sit for 4 hours or overnight.  Then strain and drink throughout the day.

 

 

Before meal “bitters”

 

Traditionally in Europe, bitter plants in the form of a liqueur or tincture was offered before  meal to help stimulate salivation and digestive juices.  They often include herbs such as dandelion, chicory, burdock and yellow dock.  Urban Moonshine sells some lovely bitters that I like and you can sample from a few varieties.   You can also purchase tinctures of bitter herbs from places like herbpharm that includes herbs such as burdock root, artichoke leaf and gentian rhizome.  Try taking 30 drops of the tincture before a meal to help improve digestion.

 

 

Golden Milk

 

This is an ancient Indian recipe for reducing inflammation and help in improving digestion.  It includes turmeric, ginger, black pepper and cinnamon, all nice warming aromatics that help improve digestive juices and stimulate blood flow.  Turmeric is now being associated with

 

This is a nice and warming beverage that is best suited for people who are already a little cold, tight and stagnant.

1 teaspoon turmeric root

1/2 teaspoon ginger root

pinch of black pepper

cinnamon stick

1 cup milk (fatty milk such as coconut, almond or cow)

1 cup water

 

Add ingredients to milk and water in a pan.  Blend ingredients with a whisk and bring to low heat (not boil) and simmer for 10 minutes.  Strain and drink.

 

 

Conclusion

 

Traditionally a healthy digestive system has been linked to good energy levels, feeling calm, bright and resilient.   When we think of trauma and ongoing neglect and abuse in childhood, its key to understand that digestive health was likely compromised at that time and that its essential to examine digestive system health as part of the road to healing.    Healing the gut can be instrumental in healing the underlying physical wounds of trauma that can be carried to adulthood in the form of  a damaged microbiota, poor digestion, inflammation, fatigue, autoimmune disorders, anxiety and depression.  By building a stronger and healthier digestive system, it is easier to adapt to stress build the deep resiliency needed to heal from trauma.

 

 

Further Reading:

 

Can the Bacteria in Your Gut Explain Your Mood?  NY Times

 

A Shot against Post-Traumatic Stress Disorder   Scientific American

 

Can Probiotics Improve Your Mood?    Time

 

Inflammatory Cytokines in Depression: Neurobiological Mechanisms and Therapeutic Implications   Felger and Lotrich, 2013, Neuroscience

 

The Body Keeps The Score   Bessel Van der Kolk

 

Gut microbiota-involved mechanisms in enhancing systemic exposure of ginsenosides by coexisting polysaccharides in ginseng decoction    Nature:  Shan-shan zhou, Jun xu, He zhu, et al.

 

The Surprising Gut Microbes of African Hunter-Gatherers  Wired Magazine

 

Inclusion of Fermented Foods in Food Guides Around the World   Nutrients 2015:  Chilton, Burton and Reid  

 

Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry    Journal of Physical Anthropology 2014:  Selhub, Logan and Bested

 

NOURISHING TRADITIONS: THE COOKBOOK THAT CHALLENGES POLITICALLY CORRECT NUTRITION AND DIET DICTOCRATS     SALLY FALLON

 

The Gut Microbiome and Diet in Psychiatry:  Focus on Depression

 

Mental Health May Depend on Creatures in your Gut- Scientific American

 

 

IMG_4615This article written by Jon Keyes, Licensed Professional Counselor and  herbalist.  For more articles like this, please go to    www.Hearthsidehealing.com.

 

You can also find me at the Facebook group Herbs for Mental Health.

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In Praise of Strong Plants http://herbsformentalhealth.org/in-praise-of-strong-plants/ http://herbsformentalhealth.org/in-praise-of-strong-plants/#comments Wed, 10 May 2017 17:15:26 +0000 http://herbsformentalhealth.org/?p=2417 Amongst herbalists, there is a strong emphasis on working with herbs that are generally gentle with not a lot of potential side effects and contraindications.   Think lavender, lemon balm, linden, burdock and dandelion.  Even the stronger plants such as cramp bark, valerian and vervain are fairly benign when we compare them to strong drugs and pharmaceuticals.

There is a reason for mainly working with gentle plants.  Often they are filled with nutrients that strengthen and nourish us.  Gentle bitter herbs can improve our digestion and absorption   Tonic herbs can help build our resiliency to stress.   Anxiety reducing “nervines” can help strengthen our nervous system and help us to relax.  Gentle herbs have slow subtle effects that can be profound over time.  Just the act of slowing down to sip some tea, walk in the woods, soak in a tub with lavender bath salts or get a massage with rose infused massage oil can be deeply healing.

But when I look at the wider world of herbalism, I see an entirely different picture.  We as humans love strong plants; plants that are potent in effect and can strongly change how we feel- today.  Right now.  This moment.  Think of coffee and tea- Coffea arabica and Camelia sinensis.  These are the two most popular plants in the world.  In America we drink 400 million cups of coffee a day; 146 billion cups a year.   We drink coffee because it gets the job done- it is strongly stimulating and energizing- perfect for a society that is focused intensely on productivity.  In other parts of the world, herbs such as khat and bettel nut are equally popular stimulants that are strongly energizing.

If we look to the underground market for illegal plants, poppy and coca leaf are extraordinarily popular.  As the precursors to opiate drugs and cocaine, one could argue that they should not be praised and instead labeled very dangerous.  And sadly perhaps that is true, because we have learned how to extract and potentiate their constituents to make them into very addictive and potentially lethal drugs.  But as plants by themselves, they have a long history of being used traditionally in a good way for medicine and healing.

And finally when we look to some of the most popular strong plants that are legally available to many people, cannabis and kratom top the list.  Cannabis itself was a 6.7 billion dollar industry in 2016 and is estimated to capture over 20 billion dollar in sales by 2020.  That’s a lot of weed.  Because of its recent legalization in many states, many people are turning towards pot not only for a recreational high but as a way to manage pain, anxiety, symptoms of trauma and sleep issues.  Marijuana growers are hybridizing plants to increase more of the anxiety and pain relieving compounds such as CBD.

Kratom comes from the leaves of a South-East Asian tree and while many people are not aware of its benefits yet, it has become enormously popular amongst opiate addicts who are looking for a way to come off of strong pharmaceutical opiates and heroin.  Because it has opiate like effects, it can act as a replacement for those drugs without having the potential for causing a lethal overdose.

Opiate drugs are enormous problem in our country right now with many people starting their addiction after being prescribed them by a doctor and then going on to obtain them illegally when a doctor cuts them off.  More than 50,000 deaths were reported last year alone due to opiate drugs.

Kratom

The reasons plants like marijuana and kratom are so popular are many fold.  Though they can lead to dependence and can cause strong negative side effects (try eating a whole pot brownie and then head to work), they offer the ability for the consumer to control the dosage, the method of administration (smoke, vape, eat) and how often to dose.  This puts the decision of how to manage one’s health outside in one’s own hands and out of the hands of a doctor or medical professional.

 

Strong Plants:  Power to the People

 

Using strong plants to gain greater autonomy and control over one’s own health is an enormous change happening right now.   People are not seeing plants like cannabis and kratom as drugs that should be illegal but instead as plants that can have benefit and healing potential.  With increasing knowledge of the dangers of pharmaceutical drugs such as opiates and benzodiazapenes, people are searching for plants that can have similar effect without the potential for severe addiction and potential overdose.

This shift towards increasingly embracing strong plants is also due to the problems with the medical system.  It can be increasingly difficult for people to get good insurance without large copays and deductibles.  These act as firewalls to people accessing healthcare and that is leading people to search for alternatives that they have more control over.

Strong plants are not always benign.  Unlike the gentle plants mentioned earlier, they can lead to dependence or cause extremes in mood that can be deeply challenging for some people.  Think of drinking a whole pot of coffee or smoking really strong weed when you aren’t ready for it.  But even if we look at strong plants through a “Harm Reduction” lens, these plants present a gentler alternative to very strong and potentially lethal synthetic drugs.  Certainly there is a need for these potent drugs but the severe crisis with prescribed medication dependence and overdose is cause for serious alarm.

As an herbalist I am always pointing to gentle nourishing and strengthening plants to help people heal at a deep level.  Nourishing herbs like nettles, milky oats, hawthorn and skullcap can profoundly improve our wellbeing when taken over time.  They are deeply restorative and can heal underlying imbalances and health concerns.

But I also understand that in this day and age, many people don’t have the desire or capacity to take that slow approach to health.  Strong plants provide that immediate benefit of relaxation, stimulation, pain relief and improved mood that many people are searching for.  They also can be obtained easily and act as alternatives to stronger potent drugs that can cause far worse side effects and health complications.  My hope is that as people explore these strong plants, they act as a doorway to exploring working with other plants that are gentler and more restorative.  Perhaps plants like kratom and cannabis can be “gateway herbs”- not to hard drugs- but to the gentler healing plants- and they can be used in conjunction with a wide array of herbs.

 

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