(Edited by Linda Nurra –PhD)
“Listen to the patient; they are telling you the diagnosis” is a much-quoted aphorism. Keen observation, careful listening and skillful probing play a key role in understanding the patient’s diagnosis. That said, in homeopathy what exactly is a diagnosis? Does it refer to the medical terminology for a pathological condition – for example, “herpes zoster” or “shingles”? No. In homeopathy the patient’s “diagnosis” is the remedy. The homeopathic diagnosis refers to the complaints affecting the patient’s routine, which are his or her main concern. This brings to light the patient’s adaptation to the problem or the manifestation of the deranged vital principle. This knowledge helps us to identify the patient with a remedy in the materia medica and arrive at the simillimum, all thanks to the patient’s words. The history of the ailments helps us get to the core of the disturbed harmony. We can then expect immediate relief from the present predominating and persistent symptoms revealed during case taking.
Additionally, case taking involves understanding the patient in relation to his environment. A natural, free-flowing and spontaneous conversation between the homeopath and the patient in his or her individual pattern, reveals the patient’s unique adaptation to stress perceived in the environment. The continuous, uninterrupted flow of case taking also uncovers the patient’s subconscious state. The patient’s symptoms, feelings and reactions during a state of discomfort or disease emerge in their words, tone and gestures.
In the following three cases, we can see these principles at work to uncover variations on the theme of celibacy in relation to a common remedy.
A 33-year-old lady visited me with her mother-in-law (MIL). She was dressed in jeans and a snug, form-fitting T-shirt with bold print on it that read “I am not being rude. You are just insignificant”. She sat with an erect posture, exuding an air of superiority and authority!
Patient: I have just begun the ninth month of my pregnancy. Of late, my body starts to swell up. This swelling is variable. It increases at times and, at times, there is no swelling at all. My blood pressure has also shot up in the last couple of months. I experience frequent dizzy spells. My gynaecologist suggested that I be on bed rest the entire month to avoid any complications, such as preeclampsia, etc.
Homeopath: Yes, you should be getting good rest now, as suggested by your gynaecologist. What brings you here to me today?
Patient: Doctor, I am scared to take allopathic medicines during pregnancy. I feel that it can be harmful for my kid.
Homeopath: But the gynaecologist will only put you on medications which are perfectly safe to be consumed during pregnancy.
Patient’s MIL: Doctor, she is a very famous gynaecologist here in the city. We know her well but my daughter-in-law is basically scared to take any allopathic drugs.
Homeopath: Why so?
Patient: I know that these allopathic drugs do carry certain side effects. I want to stay away from them. I do not even give any such meds to my son. Moreover, I cannot put my unborn baby at risk.
Homeopath: What causes the dizzy spells? Are they related to food or any sort of stress?
Patient’s MIL: No, doctor, she is very careful with regard to her food habits. Her problem is that she takes a lot of stress.
Homeopath: What kind of stress?
[Upon hearing this question, the mother-in-law started crying.]
Patient: My husband passed away when I was just one-month pregnant with this second child! A vehicle suddenly hit him while he was travelling and it all happened so unexpectedly as a terrible accident. My fate was bad. I lost him. My world shattered with this news. He was everything for me. Now, I often worry how I should manage myself and my kids.
Patient’s MIL: Doctor, we always support her and make her understand that no matter what, we are always with her, but yet she keeps worrying. She is constantly thinking about something or other all the time.
Homeopath: I believe that you should try to come out of this pain by helping yourself to relax.
[The patient did not respond at all to this, as if she did not hear what I just said!]
Homeopath: Why don’t you try watching some movies or hang out with some friends of yours. It is very important for you to be stress-free for now. You have already stepped into your last trimester! You are about to deliver in just a couple of weeks!
Patient: I fear going out. What if I land up with seizures during labour just like my sister did? Moreover, I do not like spending time with my friends anymore.
Patient’s MIL: Doctor, she hardly steps out of the house these days. In fact, she fears going out especially during the evening hours or after dark. Any sad scene or news on TV makes her terribly scared so we do not even allow her to watch any TV now.
Homeopath: In most South Indian families, the woman goes to her mother’s house for delivery. Why don’t you go visit your parents now? That would be a great change for you.
Patient’s MIL: Yes, we all did ask her to do so; in fact we even forced her to go, but then she becomes all the more worried and anxious if we tell her that. Her mother stays close to us, but she just does not want to be with them.
Homeopath: How is your sexual desire?
Patient: Yes, I do miss my husband a lot. He loved and pampered me a lot! My first pregnancy was the best phase of my life; he showered me with surprises and gifts every now and then! He did everything to ensure the safety, well-being and healthy growth of our first child.
Patient’s MIL: Doctor, just help her get rid of the tension that she always carries with herself. Destiny is not in our hands. We cannot change it, but at least we can help each other during this crisis. Her nervousness makes me and my husband all the more sad and worried. She spends the entire day only thinking about the past.
Homeopath: You are blessed with such loving and caring in-laws. You have a great support system. What is it that makes you so nervous?
Patient: I don’t know! I just cannot sleep at night due to these thoughts.
Patient’s MIL: She is a very caring daughter. She does a lot for all of us and it’s really painful for us to see her moving around the house all through the night and not being able to sleep. She gets angry at me if I sit up at night only to accompany her.
Patient: I do not need any company doctor. How can I sleep? My whole life has turned upside down. I feel so devastated. I just cannot imagine a life without my husband around. How can I live without him? I can do nothing without him.
[At this point, the patient broke down and wept bitterly.]
Analysis and Evaluation of the Case
Careful listening and skillful intervention helped this woman to express her disposition and her mental state. According to aphorism 211 in the Organon, the patient’s disposition often determines the selection of the simillimum. This refers chiefly to the mental state. Master Kent also stated that a single mental general can supersedes all physical generals. The man in disease, while narrating the mental state, is best perceived through his adaptation, which in turn is best understood through mental generals. The woman in the case above spoke about her own individual pattern of adaptation to the deviation caused by the stress of her beloved’s death. The PQRS mental generals were evident so further probing into physicals was not required.
Let us go step by step and analyse this patient.
The woman is not bothered about her diagnosis during the case taking. She is only talking about her concerns. That is her problem which needs to be addressed.
She came in and sat as if showing off a feeling of superiority. The manner in which she sat in front of me gave me a feeling of her arrogance. The subconscious mind constantly communicates through the medium of gestures, facial expressions and postures. Observing these helps to elicit the state of the patient’s subconscious mind. The body adapts to the inner subconscious state of haughtiness in the form of eye rolling, smirking and walking with the nose held high. The patient gave the impression of having a satisfied sense of attachment towards herself, a fulfilled feeling of belonging, an independent self-reflection and self-praise. As an inwardly directed emotion, her haughtiness was subtle although evident.
The bold print on the snug T-shirt she wore while she visited me in the clinic indicated the rubric
- HAUGHTY, clothes
Her tone was loud. The chemistry between her mother-in-law and her indicated to me that the decision-making power is all hers and not her mother-in-law’s. I had the impression that she does not allow anyone else to question her decisions. She pretended to be her mother-in-law’s friend only to get her way. The mother-in-law seems to be more submissive and caring.
Her husband’s sudden, unexpected death has left her in a total state of shock. This loss has traumatized her and emotionally and physically drained her. She still has very loving memories of the days spent with her husband, especially during her first pregnancy. All her glorious and happy days are no more. Her life was turned upside down. She is still grieving this loss and has not been able to cope up with it. Her world was suddenly destroyed by an accident.
She lost all her hopes, wishes and expectations suddenly. The persistent, unresolved emotion has lingered long, locked up inside her body, only to bring in an imbalance in the homeostatic system. The healthy natural emotion of grief was not adequately resolved, hence it formed a psychosomatic disease.
- AILMENTS, grief from
- AILMENTS FROM, reversal fortune of
- SADNESS, fortune from reverse of
She sounded as though she was more concerned about the changes in her lifestyle that happened due to her husband’s death. These material lifestyle changes brought about so much grief and sadness in her. This loss was so disruptive that the ground (the security) provided by her husband was no longer present. She was standing erect and enjoying life on the firm ground provided by her dearest husband. He was the hard soil which nourished all her materialistic and sexual needs. The sudden loss of her husband affected her growth and survival. Now she is unable to stand strong and enjoy life, for the ground beneath her feet exists no more. Although her in-laws are strong and supportive, she believes that her life will never be as beautiful as it was in the past.
- DELUSION, GROUND, beneath her feet gave away
This is the root cause of her anxiety, sadness, and sleeplessness. Her husband is no longer there to care for and love her or even provide for her materialistic needs. These thoughts have robbed her of her peace of mind, causing her to be sleepless at night. Coping up with the loss of her beloved spouse was the major cause of her anxiety. Without a partner, her future seems so uncertain.
- ANXIETY, future about
- ANXIETY, pregnancy in
She also mentioned her fear of developing an epileptic fit during labour, just as her sister did! In fact, she refuses to even step out of her house, especially after dark, due to this fear. This is an irrational fear; there is no reason for her to have it.
She does not feel like going to and staying with her own people, her parents or family. She avoids meeting people; she has withdrawn from all social and cultural activities. Gradually, she has moved into a state of indifference, wherein she feels love to be too tiresome. She desires solitude, as she feels worse in company now. She does not feel like making contact with anyone, even her loved ones. She is unable to establish relationships and this causes her to feel all the more lonely. Her in-laws’ place is her comfort zone, from which she does not want to step out. She chooses to be there and prefers to be silent, away from the rest of the world.
- AVERSION – family members of
- AVERSION – friends, to – pregnancy, during
- BED – remain in bed, desire to
Still, she does care for her family members, her in-laws. She pays attention to all their needs, but she does not desire anyone’s company.
- CARES, full of – company; with aversion to
Her husband was her world. She feels lonely, scared and lost without him. Her days are gloomy; her life is so sad. She is just not able to survive without him. She has lost all the charm in life. She feels incomplete, as if she just cannot function without him any more.
- DELUSIONS, paralysed, he is
She cannot stop thinking about her past. The focus of her attention is only on the misfortune that took place.
- DWELLS, past disagreeable occurrence, on
The other challenge that she faces now is the absence of physical intimacy, which she immediately revealed by listing the ways in which he pampered her. She is missing his affection and physical touch now. She enjoyed sexual intimacy with him and can no longer do so.
- AILMENTS, CELIBACY, from
Celibacy usually means refraining from sexual pleasure, which is instinctive and very difficult to control. Religion talks about this kind of celibacy as a means to reach a higher state of consciousness. According to this view, celibacy ensures that carnal pleasures are within one’s control and deepens the ability to seek God. As long as you give in to worldly things, you will not be able to think “higher” and be spiritual. Hence, abstinence from all forms of sensual pleasure helps conserve energy to attain self-realisation or to serve God, as per the New Testament of the church, for example. This is the notion on which religious celibacy is based.
In the case above, the most evident thought that came to mind was that the patient was missing physical intimacy in the form of sex because it was her husband who had died. However, when asked about her sexual desire, she did not limit her thought process to just the sexual act. She went on to describe the things that she missed – things that she was very fond of and involved in, and that gave her great pleasure. The over-pampering, the support and care he used to give her, the gifts that he used to shower upon her and other things: these were her pleasures that are missing in her life today and that she misses. Now she cannot enjoy them, as he is no longer present. The death of her pleasure provider deprived her of both worldly material things and sensual pleasures, which played an equal role and held high priority in her life.
I prescribed three doses of Conium 30 followed by SL pills for a fortnight.
Her follow-up after 15 days was very encouraging! Her anxiety attacks had reduced and she started sleeping better. She delivered a healthy baby without slipping into eclampsia.
Let us study this remedy in a little detail.
Conium Maculatum (Poison Hemlock)
A Conium patient is not really a “sweet” person; he is hard, down-to-earth, materialistic and practical. He is morose and dictatorial, with an intolerance for any sort of contradiction!
- CONTRADICTION – intolerant of contradiction
He is attached to the material world around him – his property, his habits, his family, etc. Once he loses any material possession, there is a definite morbid, pathological reaction. A Conium patient enjoys life in the best possible way through extravagant shopping, spending on clothes and other material possessions. He has a tendency to think that material objects are more important than people. His focus is on objects, ownership and wealth.
- HAUGHTY – clothes
- HAUGHTY – clothes – best clothes, likes to wear his
- SQUANDERING money
Conium people have a strong sexual urge. Sex is something they just need from time to time to experience the satisfaction of a release. They feel that they must enjoy all good things in life. They do not tend to have bad feelings, or feelings of guilt or doubt about what they do. They know exactly what they want: sex and the release of orgasm to keep them functioning properly and well. Conium is a remedy that lives sexuality in a very special way.
- OBSCENE, lewd
- FANCIES – lascivious
The biggest material loss for Conium is the deprivation of regular sexual activity. What do we mean by sexual activity? Sex is something that people enjoy and find meaningful even if they create meaning in different ways. Sex is pretty much anything that feels sexual. Sexual feelings are exciting. The moment a Conium patient loses regular sexual activity with his or her partner, the problems start. Conium patients’ bodies function well as long as there is a regular release of hormones at the sexual level. This is what they need to feel in balance, or else the balance is lost. Therefore Conium is indicated in people who have lost or are separated from their partners and do not have a new love affair.
- SADNESS – sexual desire – suppressed sexual desire, sadness after
- THOUGHTS – sexual
- THOUGHTS – tormenting – sexual
Conium has the strongest delusion of being pursued by enemies and therefore feels the need to be on guard all the time. This fear of people takes a toll on his energy and disturbs him tremendously. Everyone around appears to him as an enemy.
- DELUSIONS – persecuted – he is persecuted
- DELUSIONS – pursued, he was
- DELUSIONS – pursued, he was – enemies, by
- DELUSIONS – assembled things, swarms, crowds, etc.
- DELUSIONS – animals – bed – dancing on the
- DELUSIONS – door, someone was coming in at the – night
- DELUSIONS – people – entering the house at night
- DELUSIONS – person – entering his room; he hears a person
- DELUSIONS – people – front of him, people in
- DELUSIONS – people – seeing people
- DELUSIONS – person – room, another person is in the
- DELUSIONS – room – people, sees – bedside, at his
- DELUSIONS – thieves – house, in
The main cause of disturbance in a Conium patient is due to loss of the beloved person who has provided him or her with the most important necessities of life – i.e., material possessions and sex. The death or loss of a sexual partner can cause a reversal of fortune for a Conium patient, as everything that he enjoyed until now has been snatched away. When this happens, a Conium patient wants to stay quiet; he cannot tolerate any light, noise, etc.
- COMPANY – desire for – alone agg.; when – fear of people; yet
- COMPANY – aversion to – alone amel., when
- COMPANY – aversion to – desire for solitude
- COMPANY – aversion to – heat, during
- COMPANY – aversion to – menses, during
- COMPANY – aversion to – strangers, aversion to the presence of
- COMPANY – desire for – alone agg., when
- QUIET disposition – noise, intolerable to
- CARES, full of – company, with aversion
Thereon, the mind of a Conium patient slowly starts to wear out and he eventually becomes imbecile.
This is the case of a 15-year-old girl suffering from recurrent migraine attacks for the past 8 months. Her board exams were due and these daily migraine attacks bothered her a lot. In fact, when she visited me, she looked very pale, tired and sad.
The drained and exhausted look on her face was so evident that I could not resist asking her the reason for it before getting into any other details of the case.
The girl informed me that she was very focused on her studies and that she had eliminated all social activities and fun. She had completely burnt herself out in that process. Her only aim was to score good grades and become famous! She wanted to be known as the “most brilliant girl” in her school and amongst all her friends and relatives!
- AMBITION – increased – fame, for
Moreover, due to this, she could not carry on with her dance practice any longer. She loved dancing and was a highly trained classical dancer. She felt very sad about not being able to continue with her dance practise any longer. She had to keep her passion aside only to be able to focus more on her studies and perform her best in the board exams.
- SADNESS – continence, from
Continence means self-restraint or abstinence, the ability to exercise voluntarily control.
This girl has been dancing since the age of four. She was passionate about her dancing. She was dedicated and excellent. She enjoyed dancing more than anything, but this burning desire to be famous makes her devote all her time to her studies now. She chose to keep away from her only passion for a year. This was a self-imposed act of continence or abstinence for her. She forced herself to stay away from dancing, but was never happy while doing so and this made her sad!
A dose of Conium 1M completely settled down all her migraine headache episodes!
As we see in this case, beyond the comprehensive skills involved in case taking, the homeopath should master the skills in taking the patient’s history, through which we come to see his or her ideas, concerns and expectations along with the accompanying diagnosis. The patient’s perspective reveals the deviated state of the vital force. This spiritual, dynamic vital force creates illness when we are resisting changes or issues within our lives. We risk manifesting disease when we refuse to see past the blocks we encounter in life and remain stuck.
A 33-year-old man came seeking treatment for his 65-year-old father. His mother accompanied him to the clinic.
Son: My dad and mom stay together in an apartment. My father would always keep his door shut and does not come out of his room at all. However, it is just the two of them at home and he still fears to go out of his room. He comes out only to eat his meals or to meet any visiting guest.
My dad got retired from his job as a manager in a nationalised bank five years ago. However, he realized that he could not stay at home doing nothing and so he got himself a job, which kept him happy and excited for the next three years. After leaving that firm, he became very sad and depressed. He stopped going out and mingling with people. He could not manage to get himself another job to keep himself busy.
[Being so active socially and professionally, his sudden introvert nature and withdrawal into his shell was disturbing his wife and only son. The son was an old patient of mine and hence expected a homeopathic remedy for the strange behaviour of his father. Once a patient experiences homeopathic treatment, he realizes the depth of the action of a homeopathic simillimum and we should be proud of the fact that this realization comes without any hint from the physician. To say it lightly, it may not be wrong to say that this is also a self-realization without the trauma of celibacy.]
Doctor: How was he before his retirement? Also, did he take up a job after retirement because of financial issues?
Son: No! He did not have any financial stress whatsoever. He was very dedicated and devoted towards his work. He loves to keep himself busy. He had loads of friends and was very active socially. Now, he does not even go out to meet any of his friends. He has changed so drastically after he has stopped working!
Wife: All the time he remains inside his room. He says that someone will enter my room so let me keep the doors closed. I have even tried to make him understand that no one else is present in the whole house other than us, but he still will not believe me. Even when I get into his room or get into the house, he believes that someone else has also entered inside the room along with me.
A true account of what is troubling the patient and how it has evolved over time needs to be understood through history taking.
Without any more information or questioning, I was able to conclude that this passionate, hardworking man could not accept retirement gracefully. His zest made him work for three more years but that did not prepare him for the jobless life that was in store for him. The sudden change in his behaviour and attitude was due to being deprived of the pleasure that he derived from his work. That was the “sexual” element in his life. He now prefers to stay quiet and alone due to his sadness as what gave him such immense pleasure has been snatched away and he is now “celibate”.
The rubrics I took for the prescription were:
- COMPANY – aversion to – desire for solitude
- COMPANY – desire for – alone agg., when
- DELUSIONS – person – entering his room, he hears a person
- DELUSIONS – person – room, another person is in the
Delusion is a sensation of a belief perceived by the person through his sense organs, intelligence, etc. To him this is truth; he cannot be made to believe otherwise. In reality, this may or may not be the truth. It is just a belief created by his thoughts. Others may or may not agree with the belief. The disturbed harmony among the physical, spiritual and intellectual states of the human being creates a psyche with poor willpower and understanding. This makes way for misinterpreting one’s environment. This is the state of delusion; an aspect of the unconscious region of the psyche. Many forms of delusion are subtle and subjective in nature.
Delusions belong to the category of strange, rare and peculiar symptoms, as we see in aphorism 153. Even Jung has said that delusions contain some grain of truth. The deeper state of psychopathology is represented by delusion. A dominant emotion ruling the subconscious mind forms the core delusion. All that the man thinks or plans will be driven by that innermost delusion. Long-lasting, unresolved emotions form a pattern of fixed emotions, which grow to become morbid delusions. The pattern stays inside the patient as permanent and unchangeable. Hence delusions should be given value for determining the simillimum. In the repertory, the main rubric “Delusions” presupposes that these are beliefs of the patient. The physician may or may not agree with them. For example: If a patient comes with his whole family and yet he feels that no one loves him and there is no body to stand up for him, then we might consider the rubrics “MIND – DELUSIONS – alone, being” or “MIND – DELUSIONS – forsaken, is” or “MIND – DELUSIONS – friendless, he is”.