Dark Medicines: On Seeing Patients With "Bad Habits"

Faced with a patient who habitually uses certain problematic herbs or substances such as tobacco, coffee, alcohol, cannabis, or harder drugs, most herbalists instinctively frown upon such use, or take a “harm reduction” approach that emphasizes the harm these tools may inflict. More discerning practitioners will pass judgment only if the substance(s) are likely contributors to the presenting symptom picture or apparent underlying imbalance. Still, it can be safely said that, at best, mainstream herbalism tolerates but does not support the use of these dark medicines. I believe that, as healers, we could have a subtler and more holistic approach, but to get there we needed to examine the nature of balance, and our definition of health.

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The concept of balance is a major touchstone for holistic practitioners. Balance can be used as a conceptual tool to evaluate, and guide our interventions in, the health of almost any system, be it physiological, emotional, interpersonal, ecological, and more. Instead of seeing the use of problematic herbs and drugs as simply detrimental behavior that would ideally taper off or cease to be, we can, I think, more usefully and humanely see it in the context of a strategy of balance—in this case, the balance between dark and light.

The poles of dark and light are as natural and obvious as the rhythm of day and night, the day naturally associated with the sun, dark and night with the moon. Under the signs of light and dark, solar and lunar, fall all sorts of traditional correspondences. In the light, the world is visible, discernible, clear. As humans, we do most of our productive work in the day. Thus the light, the solar, signifies that which is productive, clear, orderly, rational, safe. In the dark, on the other hand, the demands of the day are set aside, so we rest. Our visual perception is limited and easily fooled. In bed, we lie close with other bodies. Asleep, we dream. The dark and the moon is thus associated with mystery, imagination, danger, sensuality, intuition, dissipation, and even destruction. A natural balance arises from the oscillation and interpenetration of these two poles.

Other associations commonly made with light and dark are less primal, and more recent historically. These include the association of light with what is positive and good, dark with what is negative and bad. Good and bad, positive and negative are not natural or primal polarities; they are the products of civilized (and therefore political) morality. The gory death of a prey animal at the hands or teeth of its predator might be a “dark” moment, but we can’t, ecologically speaking, call it bad. Yet every invented morality I’m aware of has sided with the light over the dark, setting the stage already in antiquity for a dangerous imbalance. And once political hierarchies brought the productivity of the work day under the control of bosses and overseers, the relative freedom of the night, and everything it stands for, became a liability and a risk for the dominators, who in response vilify the dark and minimize its importance. The movement revealingly named The Enlightenment has since the 17th century exacerbated the imbalance, promising to bring Europe out of the “dark ages” of superstition and magical thinking through the development of a human reason that would finally penetrate the mysteries of nature (shedding “light” into all those dark corners). That very human reason, with help from the technologies that its science would create, has made solar productivity and accumulation its god, and invented a machine for the consumption of the Earth that has done its best to enslave all of humanity to its purpose.(1) The dark, mysterious, imaginal, non-linear, animist, dissipative and non-rational force that might balance this cruel logic of accumulation is neglected, even suppressed.

So it’s time to reclaim the dark and move towards a healthy balance of solar and lunar. Which brings me back to my subject, dark medicines, and another word I’d like to reclaim: poison.

The fundamental inseparability of poison and medicine is a long-acknowledged fact of the art. Paracelsus famously wrote that the only difference between poison and medicine is the dosage. Going further back, the Greek word pharmakon, the root of many familiar medical terms in English, can equally mean poison or medicine, attesting to an ancient consciousness that did not draw firm distinctions between the two. But a more relevant point—relevant to our herbal practice—needs to be made here: poison is an opening to the dark. The poisonous aspect of an herb or substance is exactly that which supplies the lunar medicine, and lunar medicine, broadly speaking, is as necessary as solar.

In a polarized way of thinking, we may admit that problematic substances have a “bright side” that exists in the shadow of a potent dark side. For coffee, the bright side is alertness and energy; the dark side might be adrenal exhaustion. For alcohol the good times and relaxation are the bright side; cirrhosis and drunk driving are the dark. Tobacco would seem to many to consist only of dark side, without substantial benefit. Addiction and dependence are a dark side possible for all.

As herbalists we are commonly, if subliminally, taught to steer our clients away from substances with a potent dark side such as these, but in doing so we fail to see that through the dark side the user connects with the whole darker half of life, and use of dark materials is therefore part of a larger strategy to activate balancing lunar energy in a world gone solar. Users pursue a broader notion of health by seeking dark to balance light. Of course it makes sense not to smoke tobacco, but in the dark not everything makes sense, and we need the dark too.(2)

What I call poisons are those agents that offer us ready access to the dark side. The common definition of poison as an agent of destruction pure and simple captures something essential about poisons—their capacity to do harm—while failing to convey their positive role in navigating light/dark balance. I reclaim and persist in using the word poisons, defiantly against those who would see them as essentially negative, to refer to a volatile, risky but ever-present and useful subset of medicine.

Poisons facilitate the necessary dark side in two ways. First, they induce lunar states of consciousness: drunkenness, hallucination, poetic vision, impulsiveness, extreme mirth, engorgement or derangement of the senses.(3) Second, and actually not fully distinguishable from the first, is their toxic (q.v. “intoxicating”) nature: hangover, vomiting, terror, sickness, withdrawal, dependence, etc. This second order of darkness is what makes poison a variety of ordeal— a challenge, something difficult to live through. Now folks might say that life guarantees enough ordeals without us having to go looking for extra ones. But the truth is that the practice of seeking a deliberate ordeal, often for the purpose of spiritual growth, is older than recorded history. In the shamanic context, these ordeals might involve extreme fasting or lonely treks through wilderness, but just as often they are catalyzed by poison use. Whether the poisonous agent and the attendant ordeal are administered all-at-once, as in the case of a peyote ceremony, or in protracted intermittent doses, as in today’s tobacco smokers who inhale their ordeal one cigarette at a time, depends on the user, the poison, the intent, and the cultural context.

The purpose of the traditional shamanic ordeal is the initiation of a special kind of person: the shaman. But more broadly and democratically, much of our spiritual growth in general—our strength of character, our deepest understanding—is forged in the fires of ordeal. Ordeal cultivates lunar medicine in the forms of subtlety, flexibility, wisdom, sense of humor, and creative vision. Those who do not find some way (poisonous or not) to develop their moon side often suffer from a deficiency of these important human qualities. As an old alchemical dictum has it, “For a tree’s branches to reach to heaven, its roots must reach to hell.”

It can be argued that the weak link in my support of poisons, and what’s missing from most contemporary poison use as seen in our herbal practices, is the faculty of intention: clear intention and mindfulness are the markers of a healthy and sustainable practice, while merely habitual or unconscious use, which is more common, tips the balance, always delicate anyway, towards truly harmful and addictive relationships with these substances. I agree that a relationship that is consciously and thoughtfully engaged is the safest and most beneficial in the long run, in fact balancing the poison’s moon energy with solar responsibility, clarity, and attention. But I would not underestimate the power of the poisonous ally to deliver a real, though perhaps darkly mysterious, boon to the user regardless of their state of intention or appreciation. Likewise, a person’s deepest logic and intention are often not fully conscious to or communicable by that person at the time, and we must leave room for the possibility that what appears self-destructive today may be revealed down the road to be a step on a true and righteous path. Furthermore, in the context of many modern lives, intention is a luxury that not everyone can afford. Yet it is our role as herbalists to empower our clients’ relationships with their own well-being, helping them to a place of active engagement, responsibility, and conscious intention. If we can facilitate the growth of such intention regarding our clients’ use of poisons, then their own innate ability to navigate balance in their lives—light, dark, and otherwise—will benefit.

With these principles in mind, I’d like to offer some clinical tips, distilled from my own experience, for working with clients who use risky substances.

Respect the essential validity of poison use. I hope I have sufficiently laid the groundwork for this most basic guideline. Specifically, do not assume, without other evidence, that a patient is reckless, immature, uneducated, less evolved, weak, careless with their health, that they have poor boundaries, they are beset by demons, they use drugs as a crutch, or they are trying to “fill a hole” in their soul or anywhere else because they use harsh medicines. Remember that something valuable is lost whenever a person ends their relationship with a drug, no matter how necessary and beneficial separation may be.

Evaluate your experience and abilities as a practitioner. If you haven’t felt what is sublime in smoking a cigarette, life-affirming in a bout of drunkenness, or sensuous in being stoned on pot, then you might not be an appropriate practitioner for someone whose desire for health is complicated by these practices.

Remember that an affirmative and non-judgmental attitude toward poisons invites your client to be completely honest and open with you about past and current use. Valuable information may be lost to us as practitioners—and therefore can’t be used for the client’s benefit—if they don’t feel comfortable discussing these aspects of their life with us.

Be informed about the theory and practice known as “Harm Reduction.” Harm Reduction is a philosophy and modality that argues for a humane, non-coercive, and client-centered approach to the treatment of substance use. While generally stopping short of acknowledging the virtues of poison use, Harm Reduction encourages non-judgment and assumes that the client knows what is best for them, including knowing when to quit and when to keep using. Harm Reduction practitioners focus on reducing the harm that drugs can cause (in the body, the family, the community, etc.) and supporting the user’s overall well-being.

Support poison use in your plan of care if the patient intends to keep using. All of our tools (herbs, supplements, diet, exercise) can be of help to buffer and mitigate the ill effects of substance use. If material support is impossible or not desired, emotional and energetic support can still be offered. Sometimes it’s not the practitioner, but the patient, who needs to be reminded that these potent medicines are in fact valuable and we are lucky to have the chance to work with them. Cultural shaming and judgment around drugs can lead even committed users to undervalue their tools and not take them seriously.

Try to assess whether the patient is “self-medicating”, i.e. using a poison in part to palliate a condition that can be addressed through standard herbal practice. For example: using cannabis for chronic pain or anxiety, coffee for depression, fatigue, or constipation. If this is the case, it may be possible to resolve the condition using standard means, leaving the patient to reassess their relationship with their poison. However, assessing whether a patient is self-medicating can be complicated. It’s not always effective simply to ask. Some folks are just not aware of the therapeutic dimension of their drug use when it does exist. Others will rush to claim they are self-medicating because it tends to legitimize a practice that they otherwise feel ashamed of or judged for, thus distorting the truth of the situation. Such distortions can be quite unconscious. It’s up to us as practitioners to be sensitive and alert to clues as to whether self-medication is a relevant factor. And remember, a poison used partly as a medication is still a point of contact with the vital dark side. If it is replaced with benign medicines, this point of contact will be lost. Will something need to fill the void?

Honestly inform the patient if you believe their poison use is negatively impacting their health, especially if the impacts relate to their primary complaints. Do this respectfully. One can often assume that a patient is aware of the long-term risks associated with an herb like tobacco; at other times we may feel compelled to review them. But patients frequently need us to make clear the connections between poisons and their immediate ill health.

Trust and support the patient if they want to quit or reduce their use. Whatever we may think of the value or potential of a substance, if a person feels that a tool is no longer serving them, or that it’s time to change things up, that choice should be respected and supported with our herbalist’s tools and referrals as appropriate. Only a couple of modifications to this guideline come to mind. First, sometimes a person doesn’t want to quit, but feels they have no choice. If you see possible alternatives to quitting that the client does not, you may want to bring them up for consideration. Second, I’m wary of the tendency in some to cycle between “binge” and “purge” episodes. The sustainability of the strategy is questionable: it’s difficult to find balance between extremes, and the psychology of binge/purge is usually tangled up with the puritanical shame and self-loathing that make it hard to have healthy relationships with poisonous intoxicants. The assumption seems to be that a “clean” healthy body is pure of all “contaminants” and does not touch poison. A client in this phase might express a desire for detoxification, for abstinence from all manner of things, and for more exercise, yoga, meditation, etc. On the flip side, since there is no middle road, any incidental (or addictive) indulgence in poison can only be justified, perversely, by giving up on self-care altogether and bingeing heedlessly, as if to prove that failure is inevitable and total, or that nothing really matters anyway. Remorse usually follows, setting the stage for another purge, and so on. If this pattern is evident, it might be helpful to address it. In general, however, assume that the patient knows best when they want to change their relationship with a substance.

When a client wants to quit or reduce their use, there are many ways we can support them. These couple of insights have come from my practice:

Have a conversation about timing. Once I had a client whom I was helping with intense winter depression. In the middle of her bad season she fixated on her tobacco habit as central to her predicament and resolved to quit. Great, except her timing added some new difficulties to the situation. The negativity she directed toward her dependence was challenging her self-esteem during her most vulnerable period. She also overlooked the fact that tobacco was a reliable companion and confidant, a grounding point, during a dark night of the soul. I asked her to consider waiting to quit smoking until she was stronger, rather than complicate, and possibly exacerbate, her depression by testing her willpower, going through withdrawal, and throwing away her crutch at a time when walking unaided did not come easily. She agreed, and in fact seemed relieved that I had “given her permission” to wait. This was a tough call, because the somewhat sinister and draining nature of the tobacco ally resonated with my client’s depression, and it made sense to try and separate the two. She made the decision, knowing that I would support her either way, and was happy with her choice.

Suggest other activities on the “dark side”. Some folks overindulge in poisons as a response to the intrusion of too much rational, orderly, productive solar energy in their lives. I see this often in people whose life demands an abundance of sobriety, planning, productivity, and accountability to others: working full-time or more in a high-demand job, parenting, intense schooling, maintaining a house, caring for sick loved-ones, or combinations of these are all common. At the end of the day, work done, kids are in bed, it’s time to get wasted. Some don’t even wait that long. Sometimes to us their lives don’t even seem that demanding relative to others. Still, they need that lunar fix in a solar world. This might be a good time to suggest some other practices to shift a person toward the dark side of life they are seeking. Art, magic, spiritual practice, exploring one’s sexuality, trance states, lucid dreaming, ecstatic dancing, keeping strange hours, night journeying, and pure play in general all involve a lot of satisfying lunar energy without most of the risks involved in using substances. If a person is already doing plenty of this and still has a problem with their poisons, then they’re probably a constitutional moon warrior living out of balance, leaning too heavily on their native strengths (a.k.a. weaknesses). These patients need solar medicine, though it will likely not come easy for them.

Our healing work as herbalists may begin with our clients’ physical ailments, but we quickly find that vast forces come into play when working holistically. To acknowledge and support the need for a vital dark side might make our jobs as facilitators of radiant bodily health more difficult, but in the long run it allows us to serve our clients needs more deeply, and to be healers of another sort—healers of the rift between light and dark.

“Everything is poison, nothing is poison.” – Theophrastus Bombastus von Hohenheim, a.k.a. Paracelsus.

(1) You might notice that this image of solar excess in systematic extremity is actually a dark and chilling one. It’s not a contradiction: often we see that extremes of light give birth to extremes of dark and the two seem to merge. Thus the apparent wealth and luxury of American capitalism (the outgrowth of a basically solar process) is supported by a practice as dark as torture. A twisted and pathological light will spawn an equally twisted darkness to be its balance/mirror. This is akin to a principle in Daoist philosophy, where you find yin in the depths of yang and vice-versa, symbolized in the familiar graphic by the black & white dots appearing in the midst of the opposing color.

(2) At the most esoteric level, balance itself must be balanced with imbalance, resting our deepest truth appropriately on the crux of a paradox.

(3) Some, of course, do so more than others. Coffee in particular has a strong solar aspect, notoriously compatible with capitalism’s insatiable demand for work, though it is in other ways a dark medicine.