Bach flower remedies: more than placebo?

When I started using Bach flower remedies about eight years ago, purely out of curiosity, I did not really expect them to work. I held the widespread, but misguided, belief that if the mode of action of a therapy cannot be explained by current scientific knowledge it cannot be more than a placebo. The ‘placebo effect’ is a good thing, because it stimulates the potential for self-healing, but for a treatment to be accepted as valid it has to do better than placebo.

I was so surprised when I observed how well my friends and relatives responded to the remedies that I went on to qualify as a practitioner. After treating my first 100 clients I carried out a simple audit. Follow-up information was available in 94 cases. Two clients had discontinued treatment due to ‘healing reactions‘. Three said there was no change in their presenting complaints. Three did not take the remedies, but said they had improved after expressing and reframing their problems during the interview. All the other 86 clients reported some improvement in their emotional and/or physical symptoms, and in 33 of them the response was judged (by me) to be very good or excellent. Clients in this group spontaneously said that they felt calmer, more balanced, lighter, more joyful, more peaceful or more in control, usually within the first week of treatment.

While this can no way claim to be a thorough objective evaluation, its results are impressive. Other descriptive reports have also shown positive effects. However, these carry little weight among orthodox healthcare professionals compared with randomised clinical trials, of the kind used to test new drug treatments. A recent review of seven studies which had used this method concluded that ‘the most reliable clinical trials do not show any differences between flower remedies and placebos’.

Do these trials provide a fair test of the remedies? With respect to their authors – for I know from my previous career in academic medicine that carrying out a good research study is not easy – I think the answer is no. Many of them used a standard combination of flowers, usually the Rescue Remedy, instead of an individualised mixture chosen for each subject through discussion with a practitioner. Many of them were carried out on healthy populations, such as students preparing for exams, some of whom probably did not need any remedies and were unmotivated to take them. This is reflected in high drop-out rates, which detract from the validity of the results.

I am convinced from my own experience that wider use of Bach flower remedies could help a great many people, and reduce the over-prescription of pharmaceutical drugs, but they will not be accepted in conventional medical settings until there is more formal evidence that they work. Future research designs need to reflect the way the remedies are used in practice. The participants should have actually requested treatment for the condition under study: anxiety disorder or chronic pain, for example. Personalised remedy mixtures should be given, selected on the basis of the interview discussion which forms an important part of this therapy. Giving placebo alone would not be ethical, but the remedies could be compared with an established treatment such as medication or cognitive behaviour therapy. I would be pleased to hear from any colleagues who are interested to discuss setting up such a study.

I usually include a picture of a remedy in these posts and as today’s post contains some elements of criticism, I have chosen Beech (Fagus sylvatica) which is given to help a critical person to become ‘more tolerant, lenient and understanding’ (photo courtesy of the Bach Centre).

Healing reactions with Bach flower remedies

A new client  recently called me to say she was feeling worse rather than better since taking her Bach flower remedies. This happens in my practice just a few times per year. The situation calls for sensitive consideration, but in most cases it is cause for optimism rather than concern.

Though most people notice a steady improvement within a week of starting treatment with Bach flowers, a minority complain of worsening of their original complaints, or the emergence of new symptoms. There may be psychological ones such as heightened anxiety, irritabilty or nightmares; physical ones such as skin ‘break-outs’ or looser bowels; or the worsening of a pre-existing medical problem, arthritis for example. Such symptoms suggest a so-called ‘healing reaction’, which shows that the remedy is resonating with the person. Most healing reactions only last a few days and are likely to be followed by a good response in the longer term.

Healing reactions are best explained in terms of cleansing out of suppressed feelings, a kind of detoxification process, for the remedies themselves have no side-effects and cannot introduce anything negative which is not already there. They may also represent a change in perception of the symptoms or a change of attitude towards them, as the flower remedies reveal hidden layers of emotion and personality (‘peeling the onion’). A similar effect can be found with other types of natural therapy too; in homeopathy it is called an ‘aggravation’.

It is always important to consider other diagnostic possibilities. If there are physical symptoms such as a gastric upset, maybe the mixture has become infected – this could happen if it was not prepared hygienically, has been kept longer than the recommended three weeks, not kept cool, or if the dropper has been touched onto the tongue. Or, the symptoms may be due to some other cause unconnected with the remedies, and need medical assessment.

Healing reactions can be seen with any of the 38 flowers, but several times in my own practice I have seen them resulting from mixtures which contain Agrimony (Agrimonia eupatoria). Dr Bach recommended this for ‘ .. people who love peace and are distressed by argument or quarrel … though generally they have troubles and are tormented and restless and worried in mind or in body, they hide their cares behind their humour and jesting … ‘ Such people often conceal their anxieties from themselves as well as others, sometimes with the aid of drink or drugs or comfort eating, but may be restless at night. The remedy enables more open acknowledgement of emotions, and this can be uncomfortable at first. (photo courtesy of the Bach Centre)

Some practitioners do not tell their clients about the possibility of a healing reaction to their clients, but I prefer to explain it, because if they develop a reaction without warning they may assume the remedy does not suit them and stop taking it. If a healing reaction does occur I encourage them to persevere with treatment but to reduce the dose for a while, and may suggest using the Rescue Remedy for a few days.

Bach flower remedies in cancer care

At the beginning of my first career as a medical doctor I worked for several years in a radiotherapy department, and later came to specialise in psycho-oncology. Now as a Bach flower practitioner, though I see clients with a whole variety of problems, I still have a special interest in the psychological aspects of cancer. The main role of the Bach flower remedies in cancer care is to ease emotional distress caused by the diagnosis, the symptoms and the treatment. They are not an alternative treatment for the cancer itself.

One client who came to see me recently has a diagnosis of secondary breast cancer, and quite understandably has often felt despondent about her situation. After her first consultation with me she wrote: ‘My own path is one of deteriorating health and ongoing courses of chemo. I accept “where I am” but recently faced starting a new, stronger chemo regime and became rather melancholy. I decided that over and above medical treatment I needed to keep my own energies in balance in order to cope well and enjoy the present.’ I recommended a mixture of flower remedies including Gentian, Gentiana amarella (pictured below), which helps to restore faith for those who are feeling disheartened by setbacks in life (photo courtesy of the Bach Centre).

My client’s report continues ‘Imagine my delight around five days after starting the remedies to realise that the melancholy feelings had completely lifted. By the first day of my new chemo regime I was able to hold my head high and present at the appointment in comfort and with confidence…I am convinced that the flowers have helped beyond measure’.

Many of the other remedies from the total of 38 may be indicated in cancer care settings, sometimes for relatives and staff as well as patients themselves. Examples would include Mimulus for courage in the face of understandable fears; Red Chestnut to calm anxiety on behalf of others; Star of Bethlehem to provide comfort at times of shock or sorrow.

Some clients want to go to deeper levels; a cancer diagnosis can be the impetus to change a longstanding psychological imbalance such as a chronically pessimistic outlook, or a tendency to suppress feelings and desires in order to please other people. The flowers can help in such cases too.

Although the question of whether having a positive mindset improves the medical prognosis for cancer is still debated, it will certainly improve general well-being and make it easier to cope.

Up to six flowers, selected for each individual according to how they feel at the present time, can be combined in the same mixture. The remedies themselves have no side effects, but they are made up with a small amount of brandy as preservative and although the alcohol concentration is miniscule there is a theoretical risk of interaction with some prescription drugs, so please check with your doctor if they are safe for you to use.

Further Reading: Barraclough, J (ed) 2007. Enhancing Cancer Care: Complementary Therapy and Support. Oxford University Press, Oxford.

Three keys to self-healing

Reports of new treatment advances, whether in orthodox or alternative medicine, come out almost every day. Some will soon be forgotten or discredited, and others will prove to have real benefits, but none will work for all conditions or all cases – as I well know from my long experience of trying ‘cures’ for migraine.

The basic principles of healing are simple and timeless. There is an old saying all healing is self-healing and though external treatments often do achieve excellent results, none can completely replace the body’s own powers of recovery. We are not consciously aware of the wonderfully complex programs of maintenance and repair continually taking place inside us, but we can help them run better with natural therapies and mind-body techniques.

In a recent interview I was asked to sum up my own approach under three headings, and  the ones I chose were Balance, Positive Outlook, and Self-Determination.

Balance: balance is important in all sorts of ways, including a balanced lifestyle and diet, achieving a balanced state of mind, finding the best compromise when faced with a conflict. The Bach flower remedy Scleranthus is indicated for a sense of imbalance, indecision or fluctuating mood. Many of the other Bach remedies relate to achieving balance in one way or another, whether balancing your own needs with those of others, or balancing your focus between past, present and future.

Positive outlook: a genuinely positive outlook helps both in coping with illness and in strengthening the body’s resistance to illness. But negative feelings also have their place at times and demand expression – forcing yourself to ‘be positive’ all the time is unhelpful. Many of the flower remedies are designed to transform negative states of mind into their positive equivalents. Examples are Mimulus to replace fear with courage, and Gorse to restore lost hope.

Self-determination: this involves taking responsibility for those aspects of your life and health which lie within your power to control, for example making informed choices about treatment. One of the flowers which can be helpful here is Cerato, which promotes self-belief and faith in your own judgement. Another is Walnut, to protect from the outside influences which may distract from your chosen path.

I have written more about this in my book Focus on Healing: Holistic Self-Help for Medical Illness (published 2009 by Papawai Press, Auckland and also available through my website www.jenni.co.nz).

Dr Edward Bach was a strong advocate of self-healing. He believed that most bodily illnesses originated with some kind of  imbalance of emotion or personality and that his flower remedies, by  ’flooding our bodies with the beautiful qualities of our higher nature’, would improve both mental and physical well-being. When Bach put forward such ideas in the 1920s and 1930s they were largely rejected by his colleagues, but mainstream research in mind-body medicine is validating many of his intuitive insights today.

A final comment – according to several published trials, the Bach flower remedies work no better than placebo. This contrasts with the excellent results obtained by trained practitioners. Over 80% of the clients treated in my own practice respond well. I have some ideas about the reasons for the discrepancy between research findings and the clinical observations, and will perhaps discuss these in a future post.