Since the time of Dr. Hahnemann the treatment of mental diseases has been a real enigma. Dr. Hahnemann was a pioneer in bringing a rational approach to treating mental illnesses. His approach in such patients differed from the conventional treatments going on at that time; he said “One must be astonished at the hard-heartedness and indiscretion of physicians in several mental institutions. These cruel physicians, without seeking the true medical mode for such diseases…content themselves with tormenting these most pitiable of all human beings by means of the most violent beatings and other excruciating martyrdoms…. They lower themselves far beneath the level of prison guards, for prison guards execute such punishments only because it is the duty of their official position and do so upon criminals…”
In the Organon of medicine he gives us an account of the treatment of such cases and suggests that the physician should adopt an “appropriate psychical behavior towards the patient,” [Aph. 228] And he advises physicians in general that “I can confidently assert, from great experience, that the vast superiority of the homoeopathic system over all other conceivable methods of the treatment is nowhere displayed in a more triumphant light than in mental and emotional diseases of long standing,” [Aph. 230], acknowledging the general point that “the disposition of the patient often chiefly determines the selection of the homoeopathic remedy,” [Aph. 211]
Always emphasizing that “a homoeopathic medicinal Pathogenetic force – that is to say, a remedy which in its list of symptoms displays, with the greatest possible similarity, not only the corporeal morbid symptoms present in the case of disease before us, but also especially this mental and emotional state,” [Aph. 217]
Here Dr. Hahnemann gives us clues how in such cases also the homeopathic treatment proves to be most appropriate. So also both the mental makeup and the physical complaints are important for perceiving the centre of the patient in such cases. In the Organon of medicine he further divided the mental diseases into categories and gave us clues to treatment of such cases. But the questions which bothered me with such cases and made the treatment of such cases challenging were:
- How to get a holistic picture in such cases, as these are mostly one sided mental diseases.
- In most patients, the mind or the conscious being prohibits the free expression of the subconscious being. But in these patients it goes one step further – it creates a false ‘Reality’ with their pathological delusions and feelings, an additional layer upon their subconscious When we give them the free space to traverse their inner journey (PCWP) in such cases it becomes difficult to differentiate between the common pathological symptoms and PQRS symptoms. E.g. Delusions of being persecuted or being followed are common pathological symptoms in mental diseases and yet they can be characteristic too, if the patient is at an Animal energy pattern. So how do we separate the common from the characteristic symptoms?
- In these cases, the confirmation of the focus is difficult, as we see usually in our routine cases when we explore the focus, a beautiful pattern emerges leading us to active and active-active. As we start seeing the connections we know that we are reaching the centre. But in the psychiatric patients, this process can be missing as they travel in and out of their subconscious and pathological delusional state and often the answers to our questions can be misleading.
As I explored more of such cases, I built up a few basic rules for psychiatric cases like:
- Foremost among them is, to rectify the common misunderstanding that these patients are at a delusion level of experience. From my standpoint they are at a fact level, they are expressing their disease, and hence all their pathological imaginations need to be subtracted to reach their centre. However these ‘delusions’ are part of his pathology, they are common symptoms (facts) of the disease. Even if we do consider them, it will be one area, the chief complaint area, and not the holistic essence of a patient.
- These delusions/ imaginations coming up are in one local area, the disease area; therefore they are not truly holistic and cannot be part of his core, unless substantiated in some other sub-conscious areas. If the same feeling/perception/sensation/experience comes up in his dreams, childhood, hobbies etc. as in his pathological delusions areas, then we know for sure that this is the holistic focus and we can take our journey further
- As we kno, in such cases the delusions and mental general symptoms and emotions are usually a part of the local area or common pathological expressions. In such cases the importance of connection of the physical symptoms becomes all the more important. If we get an expression common to the mind and physical level then it would give us a complete holistic picture in such one sided cases. In these patients we have to travel the journey from local to general to holistic level with the patients,
Now, if one plane is diseased, the other will still convey or speak of the holistic state, joined as they are to the same common root, won’t it? Hence, the stress is on physical expressions in psychiatric patients. These physical expressions with mental symptoms are not mere physical ‘symptoms’ but qualified physical connections with mental/ emotional expressions. Or they can be qualified physical generals or physical particulars. For example – a patient had come the other day, diagnosed as acute agitated depression, and the whole feeling which came up was – ‘I feel suffocated because of all this Doctor, as if I am in a hollow dark space, as if my body parts are cocooned and tightened’. Now this is a physical connection, and not ‘palpitations’ or ‘sweating’ which are common physiological symptoms the patient may experience when he gets in touch with his inner being. The patient has brought in qualified physical expressions along with her deepest experience and we know that they are of utmost importance.
So the whole crux is to get the focus (PCWP) and the surety (ACWP and A-ACWP) from the undiluted physical aspect, where the one sidedness of the disease is not there.
During the Passive Case witnessing technique I observe:
- The patient is most likely to begin with his chief complaint – the constant irrelevant thoughts and imaginations he suffers from. And while I am listening to it, I observe:
- I make note of all the common delusions and see if a common theme is emerging in them, and see if I can observe the same pattern in other unconnected areas
- Are any mental symptoms accompanied by physical expressions.These are Boenninghausen’s physical concomitants in mental diseases, and a vital clue to the patients centre
- Are mental symptoms causing an aggravation of the physical symptoms?
Aggravations of a physical complaint, physical general, or physical
- Finding the original, unmodified picture. The story before the altered pattern manifested as disease at the mental level, will give us a definite clue with regards to the patient’s innate state.
- So to look where the patient was in his natural flow and expressed himself purely, not clouded by his conscious being or his pathology, I ask about his childhood, his dreams, his fears, together with his ambitions, interests, and hobbies etc prior to the mental disease. The aim is to get the unmodified picture where there is no trace of illness.
- So also to look for all those physical expressions accompanying the PQRS, out of place and out of order terms of these areas, too.
- 3. The point after which the patient started showing the symptoms becomes the turning point and assists us to know what triggered the disease and what the early signs of the disease were, before it resulted in a full blown pathology. So I ask the patients –
- Any causative factors – mental/ emotional/ physical which triggered the disease? According to Dr. Hahnemann, it is the major cause of psychiatric illnesses.
- What changes did they perceive on the physical level –in Physical Generals or any characteristic Physical Particulars which appeared at the breakout of the disease?
- What were the presenting symptoms at the onset of the disease? How did the disease progress?
- The parents’ or relatives’ undiluted observations about the patient with regards to his past h/o of illnesses, any characteristic symptoms they have noticed on mental or physical aspect, their observations about the patient’s behavior during both – the symptomatic episode and during the lucid interval etc will also give us more clues about the patient’s centre
As we have these vital 4 points to explore during the passive part, once we find a common pattern emerging in the passive we now move towards the active and active-active case witnessing technique. In such cases we need to be double sure about the focus of the case, hence the pointers during the active case witnessing process for confirmation
Active and Active-active case witnessing process:
- Unmodified PQRS expressions should get connected –
- All those peculiar symptoms of his past illnesses,
- His abstract fears,
- The PQRS expressions of his past dreams,
- Symptoms at the onset of the disease,
- Relatives’ history etc –
should fuse with the focus, especially those which have come up with physical expressions; verifying the focus
- Physical/ bodily connections with the focus and/ or shift in body language – when we start enquiring about the focus, the patient should identify with it physically, either with –
- Physical expressions and/ or with
- A shift in his demeanor as non verbal language increases and gets connected.
- Additionally there might be an aggravation of the Physical Generals and/ or
- Physical particulars.
This gives me surety and leads me to the third point –
- When we arrive at the patient’s centre, it should be the individualistic expression at the holistic level, something not normally associated with the disease. The mind and body should get connected before we call the centre as truly holistic. Also, when we arrive at a conclusion, let us once question ourselves whether this is a part of the disease or truly individualistic. We can then ask direct questions to validate the source.
Thus with this understanding let me illustrate a case to you,