Are Mental Symptoms Important?
In September 1815, Hahnemann is approached by a 40 year old woman for pain and discomfort that interferes with her work.1 She manually washes clothes for a living, bending over a washtub and vigorously scrubbing and rubbing the clothes until they are clean. Her difficulty is that pain prevents her from working which is a critical situation in the 1800’s when there is no sick leave or health insurance. She lived a mile and a half away but walked from her home to see Hahnemann in spite of her pain. After taking her case, Hahnemann lists her symptoms like this:
On any movement, especially at every step, and worst on making a false step, she has a (shooting pain) in the pit of the stomach, that comes, as she reports, every time from the left side.
When she lies she feels quite well, then she has no pain anywhere, neither in the side nor in the pit of the stomach.
She cannot sleep after three o’clock in the morning.
She relishes her food, but when she has eaten a little she feels sick.
Then the water (saliva) collects in her mouth and runs out of it, like the water-brash.
She has frequent empty eructations after every meal.
Her temper is passionate, disposed to anger.
When the pain is severe she is covered with perspiration.
In his discussion of this case he goes through the symptoms one by one showing what remedies he is thinking of in regard to the details given. For example, with the first symptom he says:
“Now, as regards Symptom 1, Belladonna, China, and Rhus toxicodendron cause shootings in the pit of the stomach, but none of them only on movement, as is the case here.
“Pulsatilla certainly causes shooting in the pit of the stomach on making a false step, but only as a rare alternating action, and has neither the same digestive derangements as occur here at symptom 4 compared with 5 and 6, nor the same state of the disposition.
“Bryonia alone has among its chief alternating actions, as the whole list of its symptoms demonstrates, pains from movement and especially shooting pains, as also stitches beneath the sternum (in the pit of the stomach) on raising the arm, and on making a false step it occasions shooting in other parts.”
Notice his mention of “nor the same state of the disposition” so that we see he is factoring in the mental state of the patient but only as one of several details that are available for consideration. He focuses first on the stomach pain and its associated modality and then brings in the mental state of his patient.
For our discussion here, I want to emphasize this statement towards the end of Hahnemann’s analysis:
“To symptom 7. – One of the chief symptoms in diseases (see Organon of Medicine. 213) is the ‘state of the disposition,’ and as bryonia causes this symptom also in an exactly similar manner – bryonia is for all these reasons to be preferred in this case to all other medicines as the homeopathic remedy.”2
To summarize, Hahnemann analyses this case by going through the details of the physical symptoms and then, at the end, differentiates among the remedies (makes the final decision) based on the mental/emotional state of the patient. He does indeed give Bryonia, a single dose, one drop of undiluted Bryonia juice, and she was told to return in 48 hours for evaluation, but she did not return.
A friend of Hahnemann’s, curious about the outcome, makes the trek himself to visit the woman who he finds quite well and working. When she is asked why she did not return she responds:
“What was the use of my going back? The very next day I was quite well, and could again go to my washing, and the day following I was as well as I am still. I am extremely obliged to the doctor, but the like of us have no time to leave off our work; and for three weeks previously my illness prevented me earning anything.”
Trying to Grasp The Significance of Mental Symptoms
As shown in this case, Hahnemann tells us in the Organon that the mental and emotional state are important parts of a case and have to be taken into account. In paragraph 217 of the Organon, he tells us the remedy must fit the physical symptoms but also “preeminently, offers the greatest possible similarity of the mental and emotional state.” The word “preeminently” has the meaning of “above all, particular”. At the same time it does not mean that the mental symptoms are so important that they trump the physical ones. In par. 218, Hahnemann says that in the elucidation of the symptoms of the patient “these symptoms should include an exact description of all the befallments of the former so-called somatic disease…”
Still, the mental symptoms are often critical in determining the selection of the remedy. So what do we mean by “mental symptoms”? Let’s look first at par. 15 to give us a foundation for answering this question:
“The suffering of the morbidly mistuned, spirit-like dynamis (life force) enlivening our body in the invisible interior, and the complex of the outwardly perceptible symptoms portraying the present malady, which are organized by the dynamis in the organism, form a whole. They are one and the same. The organism is indeed a material instrument for life, but it is not conceivable without the life imparted to it by the instinctual, feeling and regulating dynamis, just as the life force is not conceivable without the organism. Consequently, the two of them constitute a unity, although in thought, we split this unity into two concepts in order to conceptualize it more easily.”
We see that Hahnemann is not thinking of the mental activity as being distinctly different than the rest of the patient, but for our purposes of discussion and analysis it has a practical use of classifying the symptoms in this way.
My Confrontation With This Issue
Early on in my attempts to understand how to use homeopathy in animals, I had to somehow deal with this. I could see that it was important, after all Hahnemann said so, but in what way is it important? Why should it be of more significance than any other symptom? Are animal mental symptoms any relation to those seen in human beings? Most importantly, how does one accurately use the mental section of the repertory? Lots of questions but you can sense the uncertainty with which I approached it at first.
The answer to many of these questions for me came about in this way: I studied what was in the mental section to see what possible organizational thread all of this could be strung on. Is there a common denominator, and if there is, what is it? On examining the mental section I thought I could divide symptoms like this:
Mental symptoms – the functioning of the mental apparatus, such things as thinking in a linear way, connecting thoughts, solving problems logically.
Emotional symptoms – these being the basic emotions of fear and anger and all the variations and subdivisions of these, along with sadness, hopelessness, despair – in short the range of human emotion. These are not all unpleasant emotions and can be ecstasy or blissfulness for example.
Memory symptoms – the ability to remember, to recall.
Exaggerated interests – repetitive behaviors, fascination with certain things.
Delusions, illusions & insanity – and the associated behaviors with these states.
Normal personality traits exaggerated – like fastidiousness, laughing, talking.
Vices – an older term but refers to greed, gluttony, lasciviousness, etc.
Dreams – not included in Boenninghausen or Kent, but moved to this section in the newer repertories. We will discuss the significance of this later.
I could see that this mental section of the repertory is really a compilation of many different types of symptoms. They are not all of the same type or same value and this is what can lead to confusion in terms of which rubrics to choose and what importance to give to them it seems to me.
The thought occurred that it might be of use to look at these from what has been discovered in the field of psychology. After all, this area, more than any other, is focused exactly on these questions – What is the meaning of these altered behaviors? Where do they come from? So I began to study that field, starting with Freud, and then continuing on with Melanie Klein, Jung, Adler, and the other prominent people of this field.
What was the result of all this study? What struck me most was finding out the importance of the unconscious mind as a source of behaviors. I had heard of this, of course, but figured it was a little pimple on the surface of the more important conscious mind, not anything really of much importance except as a repository of bad memories. But as I read about what has been found out about the mind, and the really excellent work both clinically and as research, I found out it is the other way around. The unconscious mind is what we (and animals) are primarily and the conscious mind is the pimple. So let me explain.
The Unconscious Mind
At the time of Hahnemann (1810, first publication of the Organon) the defined concept of the unconscious mind was not in the language. It was later, about 1895, that Freud presented this idea and example cases. However, it is clear that Hahnemann had some inkling of this even thenâ€”insightful man that he was. For example, in the Chronic Diseases, page 76, there is a discussion of the symptoms of a psora that have developed beyond the latent stage, what Hahnemann calls “a manifest secondary disease”. He lists, as one of the symptoms he has observed in this situation, a “mania of self destruction” and follows with this footnote:
“This kind of disease of the mind or spirit, which is also merely psoric, seems not to have been taken into consideration. Without feeling any anxiety, or anxious thoughts, there also, without anyone’s perceiving such anxiety in them, apparently in the full exercise of their reason, they are impelled, urged – yes, compelled by a certain feeling of necessity, to self-destruction.3 They are only healed by a cure of the Psora, if their utterances are noticed in time. I say, in time, for in the last stages of this kind of insanity it is peculiarly characteristic of this disease, not to utter anything about such determination to anyone.4“
Let us turn to Freud and his work for a more complete explanation of the working of this aspect of consciousness. Before we go further, a note about the work of Freudâ€”a statement of the validity of his work before you tune it out. It is common today to dismiss Freud and his ideas as ones that were expressions of a particular time, and even to dismiss Freud himself as someone both obsessed with sex and as patriarchal or sexist. These ideas are not accurate and it will help you to understand this if we compare attitudes towards Freud as similar to that as towards Hahnemann. We know, those of us that do homeopathy, that the work of Hahnemann is often dismissed as either dated, or naÃ¯ve, or incomplete, or even the work of a madman. Yet if have worked with homeopathy we come to have exactly the opposite conclusion. In the same way, Freud’s work is dismissed by those that have not studied what he did or, basically, just don’t like what he foundâ€”and this for the same reason his work was rejected during his life time.
At the time that Freud was in medical school, one of the more frustrating conditions to deal with was what was called “hysteria”. It was a condition of women and was thought to be due to some disturbance of the uterus, females being an unstable and emotional sort of human being overly influenced by this organ of reproduction. The treatment for it was harshâ€”women were physically punished, beaten, packed in ice, had the clitoris or uterus removed. While Freud was studying this condition under the tutelage of another doctor (Dr. Charcot, Paris), he began to think this was not a physical condition at all but one related more to emotions. He approached this differently, treating women kindly, talking to them, asking them about their state. He was surprised to discover that this talking could bring awareness to underlying factors and that this awareness (in the patient) would then completely resolve what seemed to be an entirely physical problem. He did not expect this and was very puzzled over it but as this experience was repeated he gradually came to understand its importance. Here, for example, is how Freud and his collaborator, Breuer, put it in their early writing:
“But the causal relation between the determining psychical trauma (Greek word for “wound”) and the hysterical phenomenon is not of a kind implying that the trauma merely acts like an agent provocateur5 in releasing the symptom, which thereafter leads an independent existence. We must presume rather that the psychical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work;6 and we find the evidence for this in a highly remarkable phenomenon which at the same time lends an important practical interest to our findings.”7
And here they describe this unexpected outcome of working with patients:
“For we found, to our great surprise at first,8 that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words.
“Recollection without affect almost invariably produces no result.”9
Let us look at an example case. One of Freud’s patients was a woman experiencing severe attacks of facial neuralgia, which had already been treated by conventional means and without success, and this many times. As Freud worked with her, she suddenly recalled a period of great upset with her husband and a conversation they had during which he made a comment she heard as a bitter insult. “Suddenly she put her hand to her cheek, gave a loud cry of pain, and said ‘It was like a slap in the face.’ With this statement her pain and attack were at an end.10
Freud & Hahnemann, the similar lives of two pioneers
In closing this part about Freud’s work, I will mention briefly that the life of Hahnemann and that of Freud were similar on a professional level – they were both pioneers whose work was rejected by their professions at large. We know the difficulties that Hahnemann had in terms of being accepted by his medical colleagues. Basically, he had to build his own following, a group that then did further work, established schools and published journals along side of the rest of the medical community that was not interested in, or accepting, of his work (rather much as it is today).
In the same way, Freud was almost universally rejected by the medical profession. This is unexpected today because his name is so well known and many of his discoveries are still considered important and, indeed, continue to be affirmed by subsequent research. In his life time, however, it was very difficult for him. There were two main things that were responsible for his rejection, these being his finding of the importance of sexuality in both adults and children, the other was that the same phenomenon of “hysteria” was also seen in men. Of the latter, when Freud returned from his work in Paris with Dr. Charcot, he described some cases of hysteria he had observed in men. “The president of the Viennese Society of Medicine declared that this was incredible” and he was challenged to present cases to prove this assertion. When he did try to do this “the senior physicians in whose departments he discovered them refused to allow him either to observe the patients or to work with them. The basis of their refusal was epitomized by one old surgeon who protested: But my dear sir, how can you talk such nonsense? Hysteria means the uterus. So how can a man be hysterical?”11
An even more egregious offense was his assertion that when working with both adults and children (and to his surprise he found that children were quite aware of sexuality) that their problems often involved what can be described as a sexual conflict involving their gender, their relationship with their parents, and other acquaintances. In other words, at the root of the problem, as evidenced by the resolution of the issue of concern, a sexual tension was often found. This was simply not acceptable to the medical community and, even today, his discoveries in this direction are often dismissed as unique to his time or even an expression of his own sexual hangups.
Freud described his relation with the medical community like this: “I innocently addressed a meeting of the Vienna Society of Psychiatry and Neurology….expecting that the material losses I had willingly undergone would be made up for by the interest and recognition of my colleagues. I treated my discoveries as ordinary contributions to science and hoped they would be received in the same spirit. But the silence which my communications met with, the void which formed itself about me, the hints that were conveyed to me, gradually made me realize that assertions on the part played by sexuality in the aetiology of the neuroses cannot account on meeting with the same kind of treatment as other communications. I understood that from now onwards I was one of those who have ‘disturbed the sleep of the world’ as Hebbel says, and that I could not reckon upon objectivity and tolerance.”
“At a congress of German neurologists and psychiatrists in Hamburg in 1910, (a professor) interrupted a discussion in which Freud’s theories had been mentioned, by banging his fist on the table and shouting ‘This is not a topic for discussion at a scientific meeting – it is a matter for the police!'”
“In the same year, Professor Oppenheim, a leading German neurologist, an author of an established textbook on the subject, demanded that Freud’s writings should be subject to a boycott in any respectable psychiatric institution.”12
The Function of the Unconscious
The work of Freud and others that followed them is extremely interesting and helped me very much in understanding the meaning of much behavior that is seen as abnormal in human beings and in animals. I want to just emphasize a few points that will help us in our discussion.
1. The word “unconscious” was chosen to mean specifically that this part of the mind is not available to us in our usual state. It is not a question of our preference or lack of attention, but rather the nature of the unconscious part of the mind is simply that it is not known to us and cannot be accessed. “A better working definition of the unconscious is mental processes that are inaccessible to consciousness but that influence judgments, feelings, or behavior.”13
2. There is no sense of time in the unconscious, everything there has happened now. There is no sense of a past. This relates interestingly to memory.
3. We, in our conscious functioning, have the experience of memory recall. That is, we “ask” for the memory to return (though sometimes it comes unbidden). We can observe a lag between “trying to remember” and the surfacing of the item of interest. For the unconscious there is no lag, memory being always there as pristine as when it was first formed.
Freud, in regard to memories that are traumatic:
“To this we must add the general effacement of impressions, the fading of memories which we name ‘forgetting’ and which wears away those ideas in particular, making that area no longer affectively operative. Our observations have shown, on the other hand, that the memories which have become the determinants of hysterical phenomena persist for a long time with astonishing freshness and with the whole of their affective coloring.14
“We must, however, mention another remarkable fact…that these memories, unlike other memories of their past life (e.g., their earlier memories), are not at the patient’s disposal. On the contrary, these experiences are completely absent from the patient’s memory when they are in a normal psychical state,15 or are only present in a highly summary form.”16
More recent studies have confirmed the persistence of memory:
Much of the information does remain in our memory, though we cannot recall it. “To this day”, Bjork says, “most people think about forgetting as decay, that memories are like footprints in the sand that gradually fade away. But that has been disproved by a lot of research. The memory appears to be gone because you can’t recall it, but we can prove that it’s still there. For instance, you can still recognize a ‘forgotten’ item in a group. Yes, without continued use, things become inaccessible but they are not gone.”17
“I then made some short observations upon the psychological differences between the conscious and the unconscious, and upon the fact that everything conscious was subject to a process of wearing-away, while what was unconscious was relatively unchangeable.”18
The unconscious will repress certain experiences or feelings. We are all familiar with the word “repression” and use it easily. However, the word as it was used by Freud to describe what was happening in his patients has a different meaning than most people realize. If the unconscious mind sees the experience (event, feeling, thought) as dangerous it is repressed immediately. It is not that the conscious mind, that part we identify with, represses it. It happens automatically without our awareness. This is very important to understand.
a) The repressed material then undergoes an unconscious processing in which the “content” is separated from the “affect” or emotions associated with it. It is stored (the content) in one place, if you will, while the feeling or emotion (fear? anger?) is attached to some other memory that is quite unrelated to what just happened. For example, an unpleasant and frightening encounter during a meal can be dissociated into the stored memory of the event (on the unconscious level) and the feeling of aversion or anger or whatever is attached to one of the food items in the meal. Sometime later the person may find themselves having an aversion to a particular food with no explanation as to why.
The unconscious does this process to protect the individual. It is seen as necessary and protective. However, the unconscious part of the mind is not able to see, in many situations, that there really is no danger.
What is repressed can sometimes be accessed but it is very difficult as the unconscious mind actively prevents it. Much of the work in human beings to resolve these problems requires convincing the unconscious mind that looking at it is safe. One of the ways that this material can be seen again is through coming upon it indirectly – thus the emphasis on dreams,19 free association, etc.
The unconscious mind is primary, the conscious is secondary. Thus the information gained through interacting with the conscious mind is often of little value in using mental symptoms in homeopathic cases (we will get more to the differences here later in this paper).
As we go through this list one can begin to think of the unconscious as sort of a primitive obstacle that really does not serve us well but this is very definitely not the right understanding. What we call the unconscious is conscious in a sense, just not the experience reflective consciousness that is responsible for our experience as conscious human beings. The correct way to understand the unconscious mind is that it is, by far, the main part of the mind that is engaged with the world and the conscious part a very, very small part.
Here is a graph from research in neurology, showing information flow through the organism, to give you some idea of the differences between the unconscious processing vs the conscious part.20
Almost ALL information flows through the unconscious part of the mind resulting in the output of language, facial expression and motor movement. A very small, almost inconceivable small amount actually is processed through the conscious mind. It looks like this:
Information Flow in Sensory Systems and Conscious Perception
|Sensory System||Total Bandwidth (bits/sec)||Conscious Bandwidth (bits/s)|
“Bits” is a term referring to information pieces if you will. So the larger the number the more information. For example in this table, the eyes actually take in 10 million bits of information each second, while the conscious part of our mind receives only 40 bits out of all of that – 40 bits out of 10 million!
It is the unconscious that runs the organism. It is from here the life force of Hahnemann operates – growing, maintaining, repairing the body.21 Remember that Hahnemann said that the life force is lacking both intellect and awareness.22
All the normal physiological processes go on without our awareness or control – breathing, beating heart, digestion, repair and regeneration of the body tissues. This is the expression of the life force of Hahnemann. However, we add to the function of the unconscious what has been learned through further study in psychology – that it holds memory, creates images, thoughts, makes decisions for us. It is not just a place that repression is stored – this is just a small part of what is there.23
How does this relate to us as homeopathic practitioners?
The conscious mind does not know the impetus or motives behind many of our psychological processes. Such things that can become symptoms such as preferences, likes and dislikes, food cravings, desire for order (or the opposite), interest in certain things – all of these spring from the unconscious mind but are rationalized and explained by the conscious mind (which is its job – what it does for a living). The problem is, for us as homeopathic practitioners, is that the conscious explanation is misleading.
There is considerable and very interesting research that shows how prevalent this is and I will give just a couple of examples. These are not enough to be convincing but I do want to emphasize how very much research has shown that our own conscious explanations of our behavior is really not very accurate.
As one example, a study was done in a park in British Columbia. An attractive female assistant approached males in the park and asked them to fill out a questionnaire as part of a study (having to do with scenic attractions and creativity). When they were done, she thanked them, told them she would be happy to answer more questions about the study, tore off a corner of the questionnaire and wrote her phone number on it. She invited them to call if they wanted to talk more.
The study had to do with assessing how attracted the men were to her and how many would call and ask for a date. What was interesting was that it was done under two circumstances.
1. Half the men were approached on a scary footbridge that spanned a deep gorge, one requiring holding on tight as it swayed in the wind.
2. The other half of the men had already crossed the footbridge and were resting on a park bench.
The study was interested in which group would be most attracted to the woman or would there be no difference at all? The men on the bridge were in a different emotional state that the ones resting on the bench. They were anxious, heart beating rapidly, a bit short of breath, and perspiring. Would they understand their state of arousal was because of the bridge or would they mistake it for attraction to the woman.
When the results were tallied, in terms of how many called for a date, it was like this: