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,
(NOTE: The case has been edited for brevity. Peculiar sentences are highlighted in italics. My explanations, observations and notes are in plain brackets ( ) or are mentioned in points. D, P, stands for Doctor and Patient respectively. Follow ups have been summarized at the end of the case. Also the patient’s sentences are as he has expressed them – in his own language and flow)
PASSIVE CASE WITNESSING PROCESS
D: So just feel free and describe everything. As you know in homoeopathy we need to understand your illness and yourself completely. So whatever you think will help me to understand your individuality. Just feel free to express.
P: Ok right. Since I have worked in advertising and I have worked in advertising for 15 years. And it is a high stress job. In fact one of the reports has said that it is one of the most stressful jobs in the world.
Approximately 3 years ago I had sort of like a breakdown you know and I was guided to a psychiatrist. And after examining my case and listening to me he said it is a classic case of you know, you are having stress related you know hypertension and stuff like that. He said that I am going to put you on something and you will feel better pretty soon. And that’s the time he put me on to tryptomer and cypralex. But I have continued taking his medication sheerly because of fear of taking it away you know. I am not addicted to it but it is just that sheer fear that if I stop may be it will recur or whatever.
Like I used to have all these certain amount of paranoia about my health that something is wrong with me I am going to fall sick you know. All this was stress related according to the doctor. Where I felt something is really wrong with me, I have got really bad disease.
I went off alcohol for about 4 years almost, 3 years. Even then there is this guilt that oh my god I have been told that I have not to do it plus there is this guilt that I have gone to him.
Now the thing is that it has helped me reach a certain point I again when I am put under (h/g fist closes and come near each other) immense stress and pressure you know I find some of it coming back to me. Like recently again I was almost close to you know breakdown close to. I have quit recently and started my own company so the pressure is just multiplied many fold, I am just trying to take it as easy as I can. My wife told me that at one point of time I have to decide between your health and your job, which is it going to be and that, is one of the reason why I quit working for my company and doing my own thing. But it has had the opposite effect nobody told me that entrepreneurship is so, it is so demanding so yeah the stress when it starts to reach a certain point it starts to I would say break my mental strength down and I react to it.
I was an athlete for many, many years. Sports were my life. So it was a little disturbing that showed that my cholesterol level was borderline, my blood pressure is high a little bit on higher side at times you know. Nothing is so extravagant that my cholesterol or B.P. should shoot up. The third is I have been complaining off late of knee, knee pain. I used to play quite a bit of squash till about 7 months back. I would get joint pain, I would get it say for example if I stood on a mall for an hour or something I would start getting this joint pain. Severe pain which is very odd for someone of my age, maybe I felt that I am over weight and stuff like that. He said it is the early deterioration of your muscle sounded very drastic, deterioration at 36! So that is another problem that I have, apart from that I think that my health is very good I do not fall sick too often.
(We see up till now a lot of conscious talk related to health and work have come up. We tell him to go more close within and see what out of place comes up spontaneously in a flow in various areas).
D: What else? Just go more close to yourself and see what is coming up. Whatever spontaneously is coming just keep talking and I am sure it will help me to understand you.
P: My work is fine. My life is great. The other thing is that the pressure at this point of time is I think because we have a new born baby at the same time it I have just started my business and I think that (h/g) these two are clashing and I think that is the, that is what I mean by intense pressure (h/g) not just on one side.
(We see this intense stress and pressure coming up again and again also with a gesture. We make a note of it and still allow him to go ahead in various different areas till he gives us new out of place words).
As a child I have had a very healthy childhood, very active, very healthy childhood. In fact I was born and brought up in an army house. My father was an army officer so we travelled every three years. Yeah I have been the only child I have had a lot of attention, lot of support.
P: There were a couple of, now when I look back and retrospect, there are many things which could have triggered maybe I should not be dealing into it but still could have triggered. I was very close to my mother, extremely close to my mother, I would stay with my parents but my mother especially. Unfortunately I think there are few things, although I have had my independent mind of my own, I have been close but I am not of those will do exactly as told, but there is a difference between that but very emotionally bonded and connected to my mother.
(Somethingis out of place in mother’s area and we make note of it and go ahead and see if this is a part of his centre)
But I think in the last 10 years that relationship has really you know soured, and I feel bad about that, it soured quite a bit, and mostly it is in interest of trying to keep the relationship between my wife and my mother equal. Both are as important to me, but what’s happening off late is that I am dropping my defenses and I have been sort of, I think one incident sort of has made me do that in particular was when we were early into our marriage, I was married when I was very young. Being very young at that time obviously the first people to tell is your parents and we told them. I was not sure at that point of time whether we should or should not have a baby you know. And I think we just went with what my parents had to say and that time I think I do not know what the reason was I think the reason was primarily to protect me or my interest you know a false sense of security (h/g) they told us to make sure, to abort the baby. So I just blindly went with it, I blame myself a lot…
(Something very out of place. We see he is touching different areas and new things are coming up. So we allow him to go ahead and see what else comes up)
And I guess being an emotional person I was very close to my grandparents, my grandmother. My wife believes that when my grandmother passed away which was about four years ago I emotionally disturbed a lot and it did. I take these things to heart, but I do not express them and I take them to heart. I think that was, according to her that was the trigger for me, sort of moaning the loss internally for whatever the onset of that anxiety and everything that has happened to me and whatever.
Funnily I do not if it is connected or not connected I do not know if it is genetic or not. Recently there is an uncle of mine my mother’s brother again, very close to me, I think the closest person in the family in fact. I look up to him a lot. He in fact called me one day, he knows about the mundra thing, I told him listen I cannot have because he is too close to me to lie to him. And my wife and me suspect that he has also gone through some internal loss, that was his father and that was his mother and he is never publicly mourned their death. And somewhere I think we are similar to each other, we are so similar that most people think that we are brothers.
Well before this I never had any emotional experiences when I was growing up as a child I was more physical than I was emotional. I would say, up to the age of, easily up to the age of 21 there was no, there was no (h/g) you know mental side to me. When I was a child I have had major inhibitions and stuff like that which I had to cope with so, I mean I was not an inhibited child which I had to cope with, I mean I was not a introvert child, I was extrovert but at the same time I did not have to meet friends I was always picked up on all that nonsense happened to me. And of course I have this deep down the crisis, identity crisis all the time like who am I, who is the real me you know, what am I all about what am I good at, what kind of a person am I.
(Something very out of place and thus important. This also came up with a Hand Gesture of interlocking the fingers. We make a note and see if in any other area he mentions this).
I have got a little tired of hearing constantly from the age of 7-8 that he has immense potential but he is not utilizing it. See I have rose to a certain degree in my work place, it is not like that I did not but then if there was the A team and the B team then this was the B team I rose to not to the A team. Suppose you have to play for India and you had to play for Maharashtra I am the guy who will play for Maharashtra, become the captain of Maharashtra team. That is typically what has happened with my life. As I have launched out, if I cannot do it here then obviously I will find my own plane to do it and tend to create a name for myself.
And the odds are against me doing that and the feeling the knowledge that shit my whole life passed without anybody realizing my potential or me realizing my own potential so that saddens me. By nature I am extremely flexible I am extremely adaptive. I love new things I love experimenting. I would try anything new once, anything or more than once. I am creative, I love the arts. I love music; I love movies I do not get as much time to do all that. I love reading but do not read at all these days books especially. I also feel that I should be doing what; I still feel that I am waiting for my calling that’s the funny thing at 36 is advertising really my calling you know.
I love taking risks I love taking bolder decisions but I think I have not, I take many decisions blindly, many decisions from the decisions to get married, never thought that I am marrying a girl who is 6 years older than me.
I had a job offer in Sri Lanka I went there; I quit my college in 3rd year. Dropped economics I could not take it another day, that’s what a person I am, I cannot go through something that I cannot bear any longer. I had just one semester to go I could have got out of it but the idea that I was doing something that was not me (h/g) was bothering me so much and that I know emotionally was traumatizing my parents but I dropped out so I do a lot of things in blind faith and then get back and then say oh no!
P: I do not know, like I sit here, I feel like my heart is full of worries. Like it does not feel, like for example I came this morning from home and I have this feeling that my new born son, Somehow is already is not growing fond of me. I do not understand why I do not why I feel that way is it the guilt that I am not spending enough time.
I suffer from lot of low self confidence contrary to what I come across the man of high confidence I suffer from a lot of self confidence doubts am I good enough?
Good example is my work place where, for example I think that I have not worked with the best people because I have not believed that I was good enough to work with them, somewhere deep down and I am not the bold move or decision to work and now I am trying to make up with it by trying to team up with the best people.
My stomach problems, I mean, I would never have what you call the normal stomach. I have always had indigestion or I have always had loose motions or I have always had sort of gas, by gas I mean flatulence. My stomach is sensitive it reacts, it got a little better off late but it is still a sensitive sort of stomach and I think that is another area that I would say is very important for me and I would like to definitely, definitely and funnily whenever I read even a horoscope and they say that be careful that your stomach can be your undoing so I am always wondering. Again it is surprising because I do not, it is anxiety stress related because somewhere what I am eating is not leading to it for sure. Everything is perfect I eat at right time I am eating the right stuff and yet it is not that my stomach is fantastic back to normal
Apart from that I have fear of flying, fear of heights to a great extent, in between I went through this phase where I challenged (h/g fist of both hands closes and moves to and fro) my fears, I try to (h/g as if trying to force something through) address the issue rather than run away from it. And yeah so that is one thing that I have tried very hard to but I cannot say that I have got rid of them you tell me to do bungee jumping and I am going to do.
D: Anything else coming up?
(We push and see if any other conscious outpour is left or any new out of place is coming up).
P: You know, emotionally. I do not fear the physical part of so much so I fear the emotional part of it. I sometimes wonder if I will you know truly lose it and many times wonder that I will be admitted to the asylum or, am I too intelligent for my own good or am I too dumb for my own good I do not know what it is. So that is something that I have thought about it, contemplated about it. Sometimes I feel that I have, my decisions have been the reason for which I have landed for where I am, which is the deep thing that I strongly feel for. Like marrying early not getting my career preference over my personal life you know and stuff like that. I do not regret it any more but at the same time I would have liked to do, be at the pinnacle of where I need to be. I do not thing that there are any other issues.