Abstract: Obsessive-compulsive disorder is a dreadful mental illness. People with OCD can have either obsessive thoughts or urges or compulsive, repetitive behaviours. Some have both obsessions as well as compulsions. They are linked to fears, such as touching dirty objects, compulsive rituals to control the fears, such as excessive hand washing. Dr. Close suggested that using well-proven, deep-acting nosodes such as Medorrhinum, Psorinum, Pyrogenium, Tuberculinum, Syphilinum, among others, could lead to improved outcomes chronic cases not responding to constitutional prescriptions
Keywords : Obsessive compulsive disorder, Medorrhinum, Psorinum, Carcinosin, Tuberculinum, Syphilinum, Lyssinum.
Introduction:
Obsessive-compulsive disorder is a type of mental illness. OCD isn’t just about habits like checking locks or always thinking about negative thoughts. Common activities like washing your hands, counting the things, again and again, and checking your phone every 15 minutes. Some may have difficulties in throwing things out as well. This disorder can affect one’s job, school, and relationships and keep them away from living a normal life. Their thoughts and actions are beyond their control. Some of them realize that their behaviour doesn’t make sense at all. This condition is associated with tics, anxiety disorder and an increased risk of suicide.
A patient suffering from OCD has obsessive thoughts that are not wanted. It can start early in life, seen as rigid rituals and routines around meals, bathing, and bedtime. These help stabilize their expectations and view of their world. School-aged children often create group rituals as they learn to play games, take part in team sports, and recite rhymes. Older children and teens start to collect objects and have hobbies. These rituals help children to socialize and learn to deal with anxiety. A great need to know or remember things that may be very minor sometimes; it could also be too much attention to detail or too much worrying about something bad occurring. Aggressive thoughts, urges, or thoughts about doing offensive sexual acts or forbidden, taboo behaviours
We find under “Washing hands”, Psorinum, Medorrhinum and Syphillinum, representing three different miasms. Psorinum is like a motor mechanic who keeps getting dirty and must wash often to keep clean. This is his struggle. Medorrhinum is like a boy who has smoked a cigarette and tries to wash his mouth in order to hide the smell as far as possible, though he knows it will not go. Thus, washing in Medorrhinum is a shameful act. In Syphillinum, the situation is like that of a person who has tainted his hands by killing someone – an unpardonable sin – and makes a desperate attempt to wash off the traces of his crime. This is rather like the “hands washing” of Lady Macbeth. In this situation, there is no hope and the person is doomed. Once he realizes he is doomed, he not only stops washing his hands but goes to another extreme – he doesn’t care (antisocial, drunkards, etc.). In Carcinosin the situation is someone who needs to wash because he does not want anyone to point fingers at him stating that he is dirty. The need for perfection makes them go an extra mile for all their actions stretching it beyond all limits. The renowned Dr. Stuart Close discussed the use of nosodes in his writings. He emphasized their utility in cases where patients exhibit low susceptibility, poor reaction, or disturbed immunity, particularly when suffering from chronic diseases. In situations where the indicated constitutional remedy fails to produce satisfactory results, intercurrent remedies may be introduced.
This essay explores the indication of nosodes in patients suffering from OCD from the point of miasmatic evolution.
- PSORINUM
The word “itch” has an undertone of persistence, progression, continuation in frequent intervals. Similarly, Psorinum is indicated for complaints continuing for a long time. The pessimist mind is full of despair, she is afraid of the future because she is afraid, anticipating that everything she undertakes shall be a failure. A Psorinum patient is despondent: fears he will die; that he will fail in business; making his own life and that of those about him intolerable. Full of imagination, especially at night, Of what he would do and say, if this, that or the other thing should happen; Of impossible things to happen; Of past, present and future occurrences, carrying on an imaginary conversation, pro and con, should such thing occur; Of what he would say or do, should the other person say thus and so. The OCD is usually of uncontrolled repetitive thoughts.
There was once a patient, who had been suffering from uncontrolled itching in his palms and soles. He had several cut marks which he had inflicted on himself out of despair. The reason for his suffering according to him was that he had once unknowingly harmed an old dog. The curse as a result has given him miseries. He would regularly seek advice from different “Gurus” to salvage him from the tangles of this curse. He would then get into superstitious rituals with each new resolution handed on to him from his “Masters”. He would keep a track of incidents of his daily routine with focus on “good omen” / “bad omen”. Religiously follow the instructions in search of salvation, only to know that it did no good then he would meet a new fortune reader and learn altogether new sacrament.
- MEDORRHINUM
Medorrhinum is fascinating and spans extremes of temperament, from introverted to extroverted, from kind to cruel, from intellectual and detached to highly emotional and intuitive. Medorrhinum represents the centre-point of the sycotic miasm. The feeling of incapacity and the fear of being exposed is represented in Medorrhinum by his fears and anxieties. He is always anticipating that something bad will happen. He has an anxiety of conscience, as if guilty of a crime. He had a fear that someone was behind him. On the physical plane, this inner anxiety and restlessness is manifested by signs such as restlessness of the feet, constant nail-biting and the need to wash his hands repeatedly. But in order to cover up this feeling of incapacity, Medorrhinum may appear egoistic, rude, critical, and extravagant and can act as if nothing really bothers or affects him. Tendency to forget, having a poor memory and confusion of the mind, they will be one of the remedies that will be doubtful of what they just did. They go and look in front of their car, they go back to check the door if it is locked or the stove if it is off. They go back and forth: did I do it, didn’t I do it? Medorrhinum will have a high tendency to do this, to be doubtful and to be compulsively repeating the same behaviour. Medorrhinum will also be a hand-washer, because of the fear of contamination. They do it compulsively, repetitively and it is meaningless. If you wash your hands because you think they are dirty, that is meaningful, but if you have to do it ten times, it loses its meaning, it is not rational any more. Mania of washing hands, as if something dreadful had happened; heavy weight and great heat in head; could not rest in bed; felt as if she must do something to rid her mind of this torture. Fear of the dark. There is a constant feeling as if he had committed the unpardonable sin and was sure of going to hell.
. CARCINOSINUM
The clinical picture of Carcinosinum is of a person who is a model of perfection – one with whom it is difficult to find fault. We often find a history of high expectations on the part of the parents and usually a high level of performance on the part of the subject to live up to them. PERFECTIONIST, well organised, meticulous, sets high standards and toils to achieve. FASTIDIOUS: her books look as if they have just come out of the printing press.” There is a need to be something that is almost beyond one’s capacity. The patients stretch themselves to the utmost in the hope of success, because to them failure means death and destruction. This miasm therefore has the sycotic fixity as well as the destructive dimension of syphilis.
Carcinosinum people often have a history of taking on too much at a young age, having too many expectations placed on them, and too strict parental control. They try to live up to these expectations and make a tremendous effort to perform exceedingly well. They set for themselves high standards or goals that are near impossible to achieve and drive them to try and accomplish them. In that sense, they reach out for perfection, and almost finish themselves in doing so.
The need for perfection makes Carcinosinum people sensitive to reprimands and fastidious in every sphere of life to the point of being faultless. But unlike mineral remedies, which merely want order in everything that they do, Carcinosinum patients often show an interest towards artistic things like music, dancing and painting. Neatness and cleanliness simply are not good enough for them, they must be perfect; the furniture should blend with the surroundings, everything should match, etc. They are well dressed people with good taste. They can become neurotic about perfection, and sometimes this can be so extreme that they become suicidal.
A 7 years old child was obsessed with cleanliness. He used to keep all his books and toys in order and could not sleep unless things were in place. Prefers to do it himself, even after mother has tidied things. This often gives him little time for indulging in activities appropriate for his age, like playing with his friends. He dislikes eating street food as he believes that the food is badly contaminated. He falls sick every time he visits his native place as he can’t stand the dirt in the long distance trains.
He comes from a rigid south Indian Brahmin family. Strict upbringing has left deep marks on a patient’s mind. He is quite particular about switching off fans, lights etc. If someone forgets he asks: “Why haven’t you done that?”. He wants his plates to be cleaned well. He will clean his hands thoroughly before meals; if soap happens to fall down; he asks another one and also cleans the fallen soap. He washes his slippers on alternate days. He avoids walking on the cement joints of tiles.
He is quite particular about his bed sheets, belongings, toys etc. He does not like to stay at anybody’s place. He would like to be back home by night. He will not use others’ toilets. He mixes well with strangers, guests. He is quite helpful to others. He has sharp memory and has “excellent grasping power”. He gives his best shot in whatever he undertakes. He does not get discouraged by failures, rather says that he will try it again with better preparation. But off late all his hobbies and interests have been shelved due to ever growing obsessions and compulsions for trivialities.
- SYPHILLINUM:
Syphillinum is a strange and hence fascinating constitutional type. It is uncommonly seen, and its mental features are very poorly dealt with in the older Materia Medica. Syphillinum is frequently used for anxiety and fears in the treatment of obsessive-compulsive disorders, anxiety states. . They are often victims of PTSS, sexual abuse or incidences marked by intense shame and self reproach. The syphilitic dimension of mental disease makes the complaints permanent and so often incurable. An important feature of these patients is that they repeatedly wash their hands and they feel compelled to do so in order to relieve their anxiety. There is intense anxiety and a constant feeling that he (the patient) may go insane. They harbour different kinds of fear – not knowing what they are afraid of. They will refuse to shake hands with others. Not all Syphillinum have a compulsion to wash, but the majority have this compulsion to some degree at some point in their lives (Kent: ‘Always washing her hands’). There is usually a sense of contamination and a fear of germs, and this drives the person to wash her hands tens or even hundreds of times a day. After shaking hands with you she may feel contaminated, and cannot relax until she has washed her hands. Wash hands 50 – 200 times daily – till they have shrivelled skin on hands. If you are not able to wash your hands you will develop sweat, headache. They often know this is ridiculous but do not have strength to stop. Will ask, “Do you think I am going crazy”? Until you give them the answer they want, which is no. The guilt and stigma attached with the trauma may need long sessions of counselling to be washed out of the mind.
I once treated a child whose mother had developed OCD after she accidentally came in close contact with a beggar suffering from leprosy. She would not only spend every evening bathing after returning from work, but insisted that her seven years old daughter also had her hair washed daily after school. Fear of contracting disease from any exposure during the day compelled her to believe that every single day that she steps out of her home; she is at threat of contracting innumerable diseases which can only be kept away by washing and bathing intensely. Her daughter would come down with repeated attacks of respiratory infections as she was too subjected to intense bathing routines every day. The mother of the child was given Syphilinum.
. LYSSIN
Trauma precipitating OCD in Lyssin patients may be seen from abnormal sexual desire or even when sexually abused (abnormally). Mental emotion or mortifying news always makes him worse. Thoughts of something terrible going to happen come into his mind against his will ; feels impelled to do reckless things, such as throwing child, which he carries in his arms, through the window, and the like. Could not get rid of the indescribable tormenting feeling that something terrible was going to happen to him is the compulsive thought that haunts a Lyssin patient.
Strange notions and apprehensions are commonly felt during pregnancy. A strong and uncontrollable impulse to do certain acts; to spring at and to bite any moving object that came within reach is irrepressible. She may be continually tempted to bite her pillow at night. Desire to cut others or an impulse to stab his flesh with the knife he holds. The fear and notion is pathological, harrowing sanity of the patient. Desire to urinate or for stool on seeing running water or cannot urinate unless he hears running water.
A 54 year old single lady was once referred with a complaint of washing mania. She would spend 6-8 hours every day in the washroom. Additionally she had extreme phobia/ aversion to cats and dogs. She would have loud outbursts of tantrums if she would find any pet anywhere close to her. She would scream and go berserk if any of her acquaintances would talk about getting a pet. If she even had faint doubt of a pet entering her home, she would demand that the entire house be washed thoroughly to remove any traces of the cat. The reason for this severe exercise was to avoid any untoward impact of cat’s evil in her life. Her immediate family was unable to support her and hence she was sent to a sanatorium for better care. She would make long video calls back home asking if her bedding was clean and free from any animal hair. Extreme reactions to the objects of dislike and a need to wash belongings thoroughly and endlessly off the traces of offenders point to Lyssin, though Lyssin has hydrophobia.
Acknowledgment :
Express my heartfelt gratitude towards my colleagues, staff and patients at Smt. CMPH Medical College and Shree Mumbadevi Homeopathic Hospital, Mumbai for providing me with the opportunity to apply theoretical knowledge in clinical practice.
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ABOUT THE AUTHOR:
Dr Vanita Rajiv Johari. MD (HOM), MSC (COUNSELLING PSYCHOLOGY)
PROFESOR, HOD, DEPARTMENT OF MATERIA MEDICA. SMT CMPH MEDICAL COLLEGE, VILE PARLE MUMBAI – 400056.
