Mr President, Ladies and Gentlemen, it is 27 years since my last appearance in this building. I can remember being a little confused and more than a little mystified as Dr McNeill tried to guide me into the way of homeopathic prescribing. And now, after all these years, I find myself back again having arranged to talk to you on probably the most confusing and mysterious subject of all the nervous diseases.
The marked increase in the incidence of the neuroses and of the many ailments which can be classified as psychosomatic affections during the past few years makes them a subject of great importance. To us as homeopaths the importance cannot be over-emphasized. I am sure that in this field of medicine lies a great opportunity for us to demonstrate to our more orthodox colleagues that our system of therapeutics is not only effective, but that it is the only method which is even likely to have any curative effect. I do not wish to belittle in any way the achievements of the scientific system of medicine. The scientific or mechanistic system has made amazing strides in recent times. The remarkable advances in physiology and histology and the ever increasing knowledge of the structure of the body and of its physics and chemistry have all led to a much more accurate diagnosis of organic disease. However, it has also led to a system of therapeutics the main aim of which is to put faulty parts in order e.g. removal of offending parts surgically, replacement of parts in orthopedics, bacteriostatic and bacteriocidal drugs, insulin, vitamin B12, folic acid, anticoagulants, etc. The scientific system has little to offer in the treatment of the nervous disorders apart from the more drastic treatments e.g. ECT, insulin shock, leucotomy, etc. Hypnotics, sedatives, tranquillizers and cerebral stimulants may relieve and comfort, but they cannot cure. If the disease only is considered, without taking into account the psyche (soul) of the individual, then this method of treatment can only lead to the perpetuation of the affection in its original form, or in some other form.
Hahnemann and later Jahr have taught us much of what is now called psychosomatic medicine. However, I think it would be of value to consider the modern orthodox views on the subject to see if by combining the old and the new we can formulate some definite plan of attack on these diseases.
The following is an outline of the modern approach to psychosomatic medicine. Illness is a reaction, or mode of behavior, by an individual to his environment as he progresses in time. The individual is unique and differs from his fellows by one or more characteristics. These characteristics may be inherited (before he appeared in historical time) or acquired (his reactions to his environment). Although constantly changing, he remains the same individual.
The environmental factors are fairly obvious, e.g.:
- Climate, heat, cold, trauma, etc.
- Poisons, medicines, bacteria, dietary deficiencies, etc.
- Grief, frustrations, poverty. All the stresses and strains of life.
To attempt to treat a psychosomatic affection without knowing the individual is ridiculous. You must know all about him and all that has happened to him in his environment, throughout the passage of his life.
There are two main personality types—the histrionic or hysterical type and the obsessional type.
Histrionic or hysterical type or trend
This type desires attention, approval or sympathy and may present as heroic, saint-like, life-and-soul of the party or, if frustrated, as the grouser or barrack room lawyer. The somatic manifestations of this type are:
- Sensorimotor paralysis, anesthesias, severe pains, spasms, etc.
- Autonomic, with some voluntary control-related to eating, vomiting, breathing, coughing, control of lower bowel, etc.
Hysterical somatic manifestations are frequently found in mental defectives, psychopathic personalities and others who are socially inadequate.
Obsessional type or trend
Many vegetative neuroses and psychosomatic organic affections are related to the obsessional personality trends. These trends include such ritual practices as: never lose one’s temper, always keep one’s feelings to oneself, never owe anybody anything, always do one’s duty, always be clean and tidy, etc.
There are many variations of the obsessional personality and different variations tend to be associated with different affections, e.g.
- Colitis-preoccupied with cleanliness and tidiness
- Effort syndrome-morality, honour, religion
- Peptic ulcer-security be it economic, occupational or financial
- Seborrhea and acne vulgaris-work and duty, associated with feelings of insecurity and difficulty in making social contact with others
- Coronary disease – unremitting work, must be on top, must attain or maintain
- Rheumatoid arthritis – sense of duty, abnormal requirement to self-sacrifice and to be attracted to self-restricting life situations
This relationship between personality and illness is of course not absolute because some individuals may develop different psychosomatic illnesses in the course of their lives. At this point I think it would be worth while to mention some of the designated diseases of general medicine which can be broadly classified as psychosomatic affections, i.e. diseases in which the psychological factors have important etiological relevance.
- Gastrointestinal system: Duodenal and gastric ulcer; mucous colitis, certain cases of hemorrhoids and of gall bladder disease
- Cardiovascular system: Effort syndrome; some cases of essential hypertension and of coronary thrombosis
- Respiratory system: Many cases of asthma, allergic rhinitis, and some cases of recurring bronchitis
- Locomotor system: Many cases of fibrositis, neuritis, sciatica, lumbago, rheumatoid arthritis and even some cases of non-traumatic osteoarthritis
- Endocrine system: Many cases of exophthalmic goitre and hyperthyroidism. ‘Certain cases of diabetes, obesity and myxoedema
- Genito-urinary system: Many cases of nocturnal enuresis, dysmenorrhrea and other menstrual disorders; some cases of leucorrhoea
- Nervous system: Many cases of migraine; the countless bodily disturbances of anxiety states and hysteria; psychoses-paranoia, schizophrenia, etc. It is possible that even some cases of these should be included
- Skin: Alopecia areata, many cases of psoriasis, prurigo, pruritis, urticaria, seborrhrea, dermatitis, etc.
- Eyes: Miners’ nystagmus, some cases of chronic blepharitis and conjunctivitis
- What are the factors in the behavior and etiology of an illness which incline us to classify it as psychosomatic?
- Emotions as a precipitating factor: In a series of cases a high proportion of the cases commenced or recovered on meeting an emotional disturbance
- Personality type: Particular type of personality tends to be associated with each particular affection
- Sex ratio: Frequently a marked disproportion in sex incidence
- Association with other psychosomatic illnesses: It is common to see alternation or a sequence of different affections
- Family history: High proportion of cases give a history of the same or associated disorders in parents, relations or siblings
- Phasic manifestations: Illness in its course tends to be phasic – crudescence, intermission and recurrence
- Prevalence related to change in communal environment: Socially-rise in peptic ulcer in the difficult inter-war years
A review of the psychosomatic affections would be incomplete without mentioning the ontogenetic theory—the progressive unfolding of life in time. Physical growth is seen as development of the body; psychological growth is mental, emotional and social development. Without going into any detail, the basis of this theory is that during the intra-uterine phase, the phases of infancy and of early childhood, certain factors may interfere with or frustrate the normal mental and emotional growth. Undue frustration leads to reaction and this in turn leads to defences being set up. There are two main types of defences-
- Defence by avoidance of social contacts the child is over-shy, superior, or daydreams, or lives in a world of fantasy
- Defence by restricted communication – child is the type who always is good, submissive, always busy, always smart
Undue frustration in the first three years of life may lead to obsessional trends, and in the years from 3-6 to hysterical or histrionic trends. Ontogenetically these abnormalities are carried on into later life and then, if certain environmental conditions are encountered, the individual reacts—his store of anxiety and tension becomes too great for his defences which then begin to fail. He then becomes ill both psychologically and physically.
This then is the orthodox conception of psychosomatic illness and I do not think that in it, as homeopaths, we can find too much with which to disagree. I would go further and say that we may find in it much to help us in our approach to the treatment of nervous disorders. We all know the difficulties we encounter in the treatment of the neuroses, e.g. the patient with an anxiety state who has a multitude of mental or emotional symptoms-general apprehension, fear of death or disease, fear of insanity, depression, irritability, inability to concentrate, etc.
One feels that by careful use of the repertory one should be able to find the answer, but I must admit that I have often floundered in the profusion of symptoms and failed, or only half succeeded, in finding the remedy.
Hahnemann and later Jahr impressed upon us the importance of physical symptoms, especially the unusual ones, when choosing a remedy for illnesses of the mind. If we remember this and keep in mind also the orthodox picture of psychosomatic illness with its personality types, its alternation and sometimes sequences of illnesses, we may be able to work out some more definite plan to help us in our search for the remedy. I should like now to mention a few cases without going into any great detail. I have avoided success stories and have chosen those particular cases for quite a different reason.
Miss G., age 48 years, school teacher. Recurring attacks of anxiety and depression for many years which apparently responded reasonably well toSepia or Nux vomica in the past. November 1962 injured right knee while dancing. NAD on X-ray.
Did not improve on physiotherapy. After two months still marked swelling and flexion deformity. At this time there was a recurrence of severe depression and she attempted suicide by car exhaust fumes. However, a neighbour spotted her and prevented her from taking her life. I sent her to an orthopedic specialist privately and he examined her knee under anesthesia, but could find no definite abnormality. When she next came to consult me she told me that she felt as if she had a steel band tied tightly above the knee joint. On further questioning she admitted that she had an almost irresistible desire to use foul language. She then was given Anacardium with almost miraculous results— her knee cleared up, her mental outlook changed, she began to take a new pride in her appearance, applied for a new post and was accepted, and now looks a different woman altogether.
Mrs L., 23 years, housewife and typist. First seen in February 1963. Six months previously her father had died suddenly and she immediately developed attacks of breathlessness. This apparently cleared up after a few weeks, but she then became anxious about her health. Had palpitation, tachycardia, etc., and had constant pain in the left chest about the level of 5th interspace. When I saw her first she was depressed, weeping, had fear of death, unable to concentrate, marked tachycardia, and was complaining of the pain in her chest. She had lost one stone in weight and had been unable to work for the past few months. Arsenicum helped her quite a lot and seemed strongly indicated. However, after a few weeks she seemed to be losing ground and I decided to concentrate on the chest pain. She was given Spigelia 30, 3 doses, and Bryonia 3x morning and evening. Chest pains began to improve and gradually her emotional state returned to normal. After a few weeks she was able to return to work. She has recovered her lost weight and now feels her old self.
Mrs D., 54 years, housewife, now working as a secretary. First seen in 1957. Severe migraine of 10 years’ duration with attacks every week or ten days, lasting up to 48 hours. Depressed, tense and nervous. Nat. mur. appeared to be her remedy, but did not help her as much as expected. EventuallyPrunus gave considerable relief and she had this repeated frequently over the next two years. Then, in 1960, she had a severe attack of hemorrhoids and it was only then that she told me that she had had similar attacks in the past. I gave her Aesculus 30, 3 doses, and Nux vomica 3x b.i.d. The hemorrhoids cleared up at once and it was then noticed how much better her migraine had become. The Nux vomica 3x was continued for a few months with steady improvement in her headaches and general health. I saw her 14 days ago and she told me that it was 9 months since her last headache and that she had only had one headache in the past 14 months.
Mrs W., age 53 years, housewife. Seen first January 1963. Anxious and tense. Complaining of palpitation night and day and of tremor felt throughout the whole body. Losing weight. Also vague digestive symptoms-flatulence, distension after eating and a throbbing dull ache in her back and left hypochondrium. She gave a history of sudden severe epigastric pain and vomiting 4 months previously. Seen by a specialist and was admitted as an acute pancreatitis. She was in hospital for one month. All investigations were negative.
Since then her nervous condition had gradually deteriorated. One or two remedies were tried with no marked improvement and suspecting thyrotoxicosis I sent her for a further check-up. This also proved negative. She had now lost 1½ stones in weight. May 1963: she began to complain more of her digestive symptoms-acidity, discomfort at the lower end of the oesophagus, etc. I sent her to another hospital for investigation and X-rays revealed evidence of peptic ulcer. She was now given Acid sulph. 30, 3 doses, and Nux vom. 3x b.i.d. and told to adhere to her ulcer dietary regime. She immediately began to improve, both physically and emotionally. For the past three months she has been completely well again and has now regained her lost weight.
B.S., age 15 years, male. Seen first in 1953 at 5 years of age. An imbecile, subject to convulsions since infancy and later true epilepsy. Regularly having phenobarbitone. Unable to speak or do anything for himself-feeding, etc. His parents feel that he has improved quite a lot over the years. Calc. carb. and Baryta carb. have been the main remedies. He is still unable to speak, but understands what is said to him and can indicate what he wants and what he likes. He occasionally has periods when he is emotionally disturbed, he whines, cries or beats his head against the wall. These symptoms have not always been easy to help. Recently, when talking to his parents about such a difficult spell, I asked as usual if there was anything else they could tell me. They mentioned that the boy’s nose seemed troublesome and that he was constantly rubbing it with his hands and even against their clothing. On the strength of what appeared to be an “itchy nose” I gave him Cina 30. His father phoned me since to say that this had helped him more than anything ever given to him before-now happier, quieter, stopped rubbing his nose, bumping his head, etc. Now perhaps there is hope for further improvement in his condition.
Miss C., age 85 years, housewife. Normally well and active. May of this year began to appear a little muddled and was unsteady in her gait. Suddenly, about 14 days later, became very confused, unable to stand upright and had to be put to bed. Her condition gradually deteriorated, her speech became more confused and muddled, she had visual and auditory hallucinations, she became violent in the night and was difficult to control and unable to take any food. Hyoscyamus, Stramonium, etc., were tried with no effect. Then one morning, when her relatives had given up all hope, I called to see her. I noticed her hairnet was askew and jokingly I straightened it upon her head. She pulled me towards her and said “her head was so itchy”, and while she spoke she yawned continuously. These two symptoms made me try Nat. mur. 30. By evening she was completely clear mentally and had been able to take a little food. Next day she walked to the bathroom and three days later was downstairs. She has been quite normal ever since looks after her home, does quite a bit of baking and takes a lively interest in the stock market.
It is easy to be wise after the event, but it is cases like these which make one feel sure that one must have a plan of attack in mind when attempting to treat the nervous disorders. Certainly, if I had kept in mind the importance of physical symptoms and remembered the significance of alternation or sequence of affections (syndrome shift some call it nowadays) I would probably have achieved a satisfactory result much sooner in these cases than I did.
I trust you will bear with me if I reiterate and list what I believe to be a few golden rules in the treatment of nervous affections.
- Try to get as complete a picture as possible of the individual’s emotional history and the psychological and social environmental factors which have affected him throughout his life. This may assist one in giving him advice and he may be helped by the fact that one understands and can explain some of the background of his illness.
- Remember that certain personality types are frequently associated with certain organic or functional illnesses.
- Remember that these illnesses are frequently characterized by some association with other organic or functional illness, either in alternation or as part of a sequence. So the clues to treatment may lie in a previous, apparently entirely different affection.
- In choosing the homeopathic remedy do not get submerged in a maelstrom of confusing mental and emotional symptoms. Look for the physical symptoms to guide you and if they are not to be found in the present illness look for them in a previous phase of his illness.
In conclusion I should like to say that I fully realize that there is little that is original in what I have been saying. Indeed, Dr Twentyman in his paper at the recent Liverpool conference spoke on much the same lines. However, I feel sure that in this field of medicine we as homeopaths have much to offer, and if we tackle the problem methodically I think that many of our orthodox colleagues who are interested in the treatment of nervous disorders would not find our offering entirely unacceptable.
I wish to acknowledge that much of the information regarding the modern conception of psychosomatic affections was obtained from Halliday’s Psychosocial Medicine.
Dr T. D. Ross: Dr Burns brought out, I think, the essence of the art of homeopathic prescribing and Dr Burns is an artist as you have seen from these cases. The thing is to seek the characteristic of the patient, either in the mental sphere and there might be only one or two out of these multiple symptoms that are really characteristic-or to seek the characteristics in the physical sphere and, as he says, one may lead you to a remedy which is not obvious from the other. It might be one way, it might be the other.
I think that probably most of the ones in which he was led to the remedy by the physical, such as the heartburn in Sulphuric acid and the band sensation in Anacardium, would be found to cover the mentals of these patients. You all know the mentals of Anacardium, the feelings of having had a raw deal, wanting to do something about it but frightened to do it in case they are abandoned by everybody, and the Sulphuric acid anxiety and hurry-there is a lot of anxiety there. Dr Paschero, the Buenos Aires doctor for whom I have the highest regard and whose papers you will have read in the British Homoeopathic Journal, recently discussed psychological cases treated
He works in this way, and he thinks that very often the initial treatment of a case uncovers what he calls the basic psoric anxiety, so that it might present as a sycotic picture or a syphilitic picture. He uncovers the first skin or two of the onion and then out comes the tremendous basic psoric anxiety which he tells you in his opinion is derived from the infantile instinctive hunger needs. This basic anxiety might prove very serious and upsetting and lead to a very serious neurosis and has to be followed by the correct remedy to control it. This uncovering of basic psoric anxiety can occur from some shock or accident and also from just giving the initial.
Source: The British Homoeopathic Journal, Vol. LIII, No. 3, July 1964
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