I'm delighted to interview my friend and colleague, Dr. Alon Reshef. Hello. Hi. Alon is the head of the Psychiatric Department in Ha'emek Medical Center in a Afula, Israel and a lecturer in the Technion Faculty of Medicine. I would like to talk with you Alon about the subtext, the hidden agenda of treatment with herbal medicine in the context of cancer care supportive or palliative cancer care. Why patients with cancer use herbs beyond the pragmatic aspects of effectiveness and safety and so on, what's the subtext? Why people use it? I think it's a very important and very good question because usually, we don't pay attention to subtext, to hidden agendas, to attitudes of patients. Usually, we stay very much on a concrete level of questions, answers, details, this is the question, this is the right answer, and so on. But as a psychiatrist, I at least I try to focus on meanings and I think we deal with the question of meanings, hidden agendas, and so on. Sometimes people know their agendas, their hidden agendas. Sometimes they can resonate with the meanings. Sometimes it's unconscious or preconscious, but I think it's always there. So, I think the most important thing in my point of view is that it's always there in every patient, especially in cancer patients where the life and death issues are very strong. Sometimes as a fact, sometimes as a fantasy, but it's there. So, you can start ask questions about the inside paradigm or model that people have about disease, treatment, life and death, and medical, the medical thinking, the medical model. I think that herbs and supplements hold first of all the meaning of the relation, the relationship or the relatedness to nature. So, I think the first meaning is the natural versus chemical versus artificial area. If we deal with life and death, life is a business of nature. It's not the business of building robots and so on. So, what we doctors, physicians try to do is interfere or manipulate or help natural processes and diseases to make them more harmonious, make them better, so people can either be well or get cured and so on. So, I think people hold this meaning of natural stuff, but natural is not enough because it's kind of blurred fantasy. What is exactly the meanings, the under-meanings of nature? I mean, is it really always good? Is it magic? So on. So, I think we can try to relate to meanings in terms of metaphors, in terms of agendas. Always, we can always start from the non-hidden, from the known, or how do you say it? Things that we can touch or see first, the agendas that are in the front and then go as much as the patient want. Many patients don't want too much to go inside or trying to understand too much. Alon, we tend as physicians, when we see patients with cancer who use herbs or other supplements, to relate to the concrete aspects of the herb formula and to answer in relation to that, does it help to reduce hot flashes? We have seen a lot of fatigue and so on, or maybe it can cure. But you're also talking about metaphors and l'm thinking about metaphors that may be related to herbs, maybe the roots that stabilized somehow in the ground and grounded. Okay. The herb roots and the branches. Well, I'm like that, I had a core stability that's so maybe the flowers, which blossoms into the air, maybe into the skies. Yeah. So, what kind of metaphors can you identify in patients with cancer that use herbs that are relevant to the dialogue between patients and physicians? l'm talking about setting where it's not a psychiatrist that's there, but a physician and colleges, an integrative physician, a palliative care physician, or a nurse. So, what would you do with that? I mean, what kind of metaphors you may identify and how useful it is to relate to patients who use herbs with these metaphors? It's a good question. I'm not sure. I think that it came to my mind right now. I think it's a question of the dialogue. For instance, when you were talking about the roots and the branches and all that, I thought to myself that I didn't have this metaphor of plants, of herbs. When I think of herbs, I think of this powdery stuff. So, I don't see the plant and I think you do. When you think of some kind of herbs, you see the plant. You see the colors of the fruits, you see it in your mind and the metaphor is there when you see it. It's like when I imagine wind, I have this metaphor of wind, of motion, and so on. So, I think when you talked about it, I can't start to relate to it because I didn't have it. Maybe it's a question of a dialogue with metaphors, which can be at least communicated, if not healing dialogue. For instance, if I'm a patient and I have hot flashes. What is the metaphor or what is the narrative that is connected to this hot flashes? I think the hot flashes is a good example because it's not such a big deal. It's not a big drama, it's not like impotence, or severe diarrhea, or hot flashes. But what is the narrative of a hot flashes? I'm just doing associations. Is it, for instance, "Hot flashes is my body going out of control? It kind of rebellious against me?" Or is it, "Am I becoming a woman with hot flashes?" Because women in menopause, they always, some complain about hot flashes. But we, men, we don't care. It's kind of an expression. So, what is my metaphor of hot flashes? You can suggest me some herb. You have a metaphor with a herb. Can we communicate and create some interaction of metaphors that can make us more creative, more alive, and make something together? Then, I'm not alone and then I can be more connected to myself because it helps me. So, I think we just kind of playing with this notion of with this thing of herbal treatment, but what I think what we're doing now is, when we start to play with these ideas, it's not like technical issue anymore. So, are you referring to herbs with their non-specific effects? I mean, beyond the specific effect, chemical effect, let's say, of ginseng relating to fatigue? Which is, I mean, that could be tested in randomized control trials and so on. You can say, "Well, this herb has a fatigue ameliorating effects." Yeah. It can improve fatigue, cancer-related fatigue. But beyond their non-specific effects that you can maybe empower in a sense, in order to induce their poetic effects. Yeah, of course. I'm not talking about placebo effects but non-specific true effects through this dialogue. Yeah. Even though I think that the placebo effect has true non-specific effect, which is tremendously important and neglected in most areas of medicine. But, yeah, I agree completely that I have a relationship with the herb. I have relationship with you as a prescriber of the herb. So, I really think that, when true and real communication and creative communication occurs, life can find a way, or flourish, or something like this, so I think always it's a rule. When a patient comes to me and he's depressed, and I prescribe some kind of chemical medicine, some antidepressant. The non-specific effect is so much important. So, I don't think we can speak about specific effects and stay calm, like we just did our job. It's not. It's never like this. So, among herbal users- Yeah. -what's the real difference between the herb and the drug? I mean, why patient like that? You mean chemical drug? Yeah, chemical drugs. What's difference for the patient? For the patient. I mean, what's really the difference? Why are they are so eager to use herbs and not commercial, chemical drugs that we easily prescribe in our practice? Why is it?Especially regarding the context of cancer cure. Yeah, yeah. I don't have a clever answer, but I can make some assumptions. I think that, first of all, cancer patients are in an extreme state of mind. So, all those things that everyone deals with, for instance, anxiety, fear of death, "If I die, what happens to my life until I die? What am I doing with my life?" All these existential issues and more, I think it gets much more powerful in cancer patients. So, I think these issues find a way in those lines that we were talking before. To herbal medicine or sometimes exclusively herbal medicine kind of, "Well, I don't want chemicals. I don't want chemical treatment. I will take only natural treatment because these chemicals are poison." I come to think now that maybe we should think more about mythology and all these legends, the kids stories, the boy who went to look for the special flower for his sick mother. I think the unconscious of all of us has this kind of big issues that mythologies and these stories deal with. This magic. Maybe the herbs are more like magic. Maybe herbs are more like food, not only supplements, food supplements. The FDA is the Food and Drug Administration. Maybe it's not a drug. It's more like the food that you were given to grow when you were a child. I think it's in this area, but I think it's a very interesting question. Maybe we don't know enough about this. Maybe we don't do enough research about this specific issues. So, if to conclude our talk, do you envision any role to integrative psychiatry in the area of integrative oncology? Should any communication be established between the two domains of integrative oncology and integrated psychiatry? How would you envision that specifically maybe to that aspect of herbs? I would try to avoid the effect of this narcissus effect in my left side and not getting too megalomaniac. But I think that really a mental health professionals are crucial in every team and especially in oncology, integrative oncology. Because I think that we are more tuned into our, some of us at least get more education to be focused on meanings, the meanings that you can talk about and the hidden meanings. I think that the psychiatrist or mental health- Let's not talk now, but the obvious that there is a lot of depression, and anxiety, and psychiatric problems in integrative oncology unit. That's obvious and psychiatrists can help with that, but that's very, very simple. But I think that mental health professional can help the patients and staff to address more about meanings, agendas, and to address that to relationships. I think it's very important because there is a lot of healing process that takes place in the interaction. I'm sure about this. Thank you very much, [inaudible] - Thank you. -for being with us. Thank you. Thank you.