THE STATUS OF MENTAL SYMPTOMS


The predominant mental symptom was hopelessness as to her health, as to condition of her heart etc., though not worried; weakness marked, increased by mental or physical effort; tearful: desire for open air which relieved; exhaustion from talking; excitement upset her; better going without food; diarrhoea more or less, worst at night, worse from acids; at times globus hystericus, and empty sensation in stomach and abdomen.


Mental symptoms take a place according to their relation to the location of the affection; their “rank of value” is the same as that of other symptoms. To be of most use they must be idiosyncratic and recent.

If the part affected be mind or head, mental symptoms may constitute the sensations; but in most instances, no matter where the location, mental symptoms rank as the chief concomitants. Their value bears direct relation to the fact that man is such as are his thought and affection–by virtue of his ability to think what is true and to will what is good–and hence perversions of truth and goodness, in thought and affection, are valuable as symptoms; for example, desires, aversions, (including longings, mental and even physical), antipathies, fears, doubts, irritability, sadness, etc.

Disorders of the intellect and memory may be, in that order, decreasingly useful and the symptoms of the mind, in Boenninghausen, thus somewhat more important than those of the intellect which follow.

The full working out of a case and especially the concomitants, determines the remedy–the foundation, i.e., location and sensations, having been properly laid–therefore when mental symptoms are classed as the chief concomitants they are not relegated to a subsidiary position but, on the contrary, given the most important and influential place, barring the essentials in the foundation, for location especially, and sensations as far as they can, must be covered, i.e., have been acted on, or rather developed by the remedy in its pathogenesis, if that remedy is to be effective in the case.

Again, the value of a symptom is enhanced by any modification; this is particularly true of mental symptoms with which a modality or associated condition seems to be of higher worth, often times, than the mental symptom itself in leading to the remedy, as the modality defines and gives character to the symptom-group. For example “wild, crazy feeling in the head, with pain in right iliac region,” Lil-t.; or “anxiety on closing eyes.” Con.; or the “despondency after eating” of NUX-V.; or the “despondency during sweat” of Con.

As regards the selection of symptoms, with which to find the remedy, from the mass one is often deluged with in a mental case, I can best illustrate by the following, which I indeed reported once (North American Journal of Homoeopathy, June 09.) but not the “working out” nor the method of deduction from it, which was then, and has since been, a help and gave me an insight as to the handling of mental, or complicated, or partially developed cases, which I could not have found out in any other way. For that reason, perhaps, it will bear repeating.

Case 1

was a nervous prostration following acute articular rheumatism, or rather beginning with it. The patient, a married woman 50 years old, had experienced deep chagrin following a family disgrace–“mortification;” this precipitated the rheumatic attack. Several remedies were given, and the arthritis cured, but neurasthenia followed.

She complained in a voluble manner of numerous symptoms, of pains here and there, of cold and weak sensations, of profuse sweat, which she feared would weaken sensations, of profuse sweat, which she feared would weaken her and cause death. Not an organ or part of the body but was affected in some way. She told her sensations most entertainingly, occupying in the description, provided one would listen.

Here is the repertorial study as I made it then; the rubrics are the same that were taken at that time, but the order in which they are now used was evolved a little later; still that does not alter results nor conclusions. Remembering that the part affected was the mind, the symptoms can be resolved into a first group of cause, location, sensations, and related aggravations and ameliorations thus:

Cause—

1. Mortification (“offense received”), p.280.

Location–

2. Affections of mind in general (disposition generally affected, ), p. 17. 3. Anxiety (constant, of dying, robbers, etc.), p.18.

4. Despair, p. 18

5. Indifference (apathy), p.19.

6. Mistrust, p.19.

7. Activity (loquacity, etc.), p.20.

Aggravations–

8. From noise, especially music, p. 293.

9. In open air (sensitive to a draft, etc. ). p. 294

10. From talking, p. 303.

11. On waking (full of sad thoughts), p.306.

Ameliorations–

12. After sleep (rested from a short nap), p.319.

And a second group of the concomitants, with their aggravations and ameliorations, best arranged in the order they occur in Boenninghausen; i.e., in accordance with the Hahnemannian scheme of the parts of the body.

13. OEsophagus, distress in, with weight at cardiac end; not in Boenninghausen.

14. Abdomen in general, p.78.

15. Empty (faint) sensation in, p. 157.

16. Pit of stomach, p. 81.

17. Coldness internally (sensation of), p.261.

18. Flatulence in general, p.83

19. Eructations (loud), p.72.

20. Much rumbling (borborygmi), p. 84

21. Urine pale, p. 95. 22. Urine profuse, p. 96.

23. Urine frequent, p. 99.

24. Hands, p. 131.

25. Feet, p. 138.

26. Numbness, externally, p. 168.

27. Formication externally (whole body), p. 159.

28. Drowsy in day, p. 242.

29. Wakeful at night (from least sound), p.241.

30. Anxious sweat, p.263.

31. With anxiety (and fear), p. 18.*31 may be omitted, as it is a duplicate of No. 3.

32. Agg. night, p.270.

33. Agg. after sweat, p. 303.

As all the remedies, with two exceptions, failed somewhere in the foundation, and as on looking up those two, Bell and Lyc., in their provings, their inapplicability to the case was manifest, it was necessary to work all the medicines throughout; otherwise there would have been to result.

The study gave one remedy very marked–Puls. 104,–and a second–Sul. 93, –but a glance at their pathogenesis showed that neither was the similimum! What was to be done.

On reference again to the table I found a group of eight medicines whose totals ranged from 76 to 84 and these I began to study, taking them in order downward,–NUX-V.84, Ars. 81, Merc. 80, Bry. 78, Ign. 78 (Bell. 77, Lyc. 76), all, so far, without agreement with the case, and finally Phos-ac. 76, whose symptoms, I found, were identically those of the patient, –the patient,–the proof being the result after its exhibition (3x)– the symptoms disappearing in the proper order and soon complete recovery.

The explanation which is frequently given as to why the similimum does not work out highest–“that there were no peculiar symptoms”–was not altogether satisfactory here, and I sought another, but, for a time, could not decide on one until other cases working out in about the same way the reason became clear.

It seemed probable, on account of mistakes in selection of symptoms, and perhaps some inaccuracies in the repertory, that it must not be expected to always find the remedy for a case, worked out in Boenninghausen, totalling the highest–that is an error commonly made–but one can be sure that the similimum will be found among the group of high one (remedies), This I have since often confirmed ; it explains the want of success so commonly experienced with Boenninghausen, or any other repertory of comparing the results of the repertorial study with the provings–i.e., consulting the materia medica.

If a case be worked out in this way, and the remedy which is most marked be given, without the precaution being taken to see if its proving agrees, failure often results, and then no explanation or further rules being at hand, the repertory is likely to be cast aside as useless–certainly it will be after two or three unsatisfactory results. But remembering that our mistakes may cause it to be inaccurate and if we know that there is still something more we can do, we are then reassured and a most valuable instrument of precision will be retained for our assistance.

Case 2,

which further emphasizes the foregoing, is also one of nervous prostration occurring in an unmarried woman of forty coming on two months after the shock of her fathers death, the onset being a laryngitis. Immediately after her father died she needed and received Ign., which relieved. Later when the laryngitis developed Phos. helped, but prostration persisted and increased; the mental symptoms so slowly unfolding themselves that considerable waiting was necessary before a clear picture could be obtained upon which to further prescribe; finally the following symptom-complex was disclosed.

The predominant mental symptom was hopelessness as to her health, as to condition of her heart etc., though not worried; weakness marked, increased by mental or physical effort; tearful: desire for open air which relieved; exhaustion from talking; excitement upset her; better going without food; diarrhoea more or less, worst at night, worse from acids; at times globus hystericus, and empty sensation in stomach and abdomen.

As Phos. had acted an analogue of that remedy, in the mental sphere, was in order ; if the call for Phos. had not arisen, a similar group under Ign., mind, p. 402, would have been taken, and the symptom-parts should be used in the following order:

Remedies following that medicine which had last been effective–

1. Mind, Phos., p. 436.

Location–

2. Affections of mind in general, p. 17.

Sensations–

3. Hopeless (despair), p. 18.

4. Tearful (sadness), p. 19.

Aggravations–

5. From excitement, p. 279.

6. From talking, p. 303.

Ameliorations–

7. Fasting, p. 313.

Concomitants–

8. Stomach, p. 77.

9. Abdomen, p. 78.

10. Emptiness, p. 157.

11. Diarrhoea, p. 85.

12. Agg. night, p. 270.

13. Agg. acids (sour things), p. 284.

14. Air, desire for open air, p. 143.

15. Amel. in open air, p. 317 (i.e., p. 286).

16. Globus hystericus (ball internally), p. 144.

17. Weakness, p. 195.

18. Agg. mental exertion, p. 280.

19. Agg. physical exertion, p. 280.

With the first two rubrics taken together there results the following:

1-2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Totals

Acon. 6 2 4 3 3

Aloe. 3

Aur. 5 4 4 1 3

Bell. 7 2 3 3 3 1 2 3 3 1 2

Bry. 4 2 2 3 3 3 4 3

Calc-c. 5 3 3 4 2 1 3 3

Can-i. 5 3 2

Cham. 4 1 3 3 3 4 4 4

Coff. 3 1 2 2 3

Con. 4 3 2 1 1 4 3 4

Gel. 5

Hell. 2

Hyos. 5

Ign. 5 4 4 2 4 1 2 3

Lach. 4

Laur. 2

Lyc. 5 3 3 2 3 2 2 3

Meli. 4

Merc. 4 2 3 2 2

Mos. 2

Nat-c. 4 3 4 4 1 2 2 2 1 1 1

Nat-m. 6 3 4 4 3 4 3 3 2 2 2 1 2 3 2 4 3 4 55

Nux-v. 7 1 3 2 4 2 2 3

Op. 5

Pho-ac. 5 1 1 4 4 3 4 2 2 1 2

Pic-ac. 5

Plat. 6

Puls. 8 3 3 1 4 1 4 4

Rhus. 4 3 4 4 3 1 4 4

Sep. 5 2 3 3 2 1 3 4 3 1 1 4 4 3 4 4 4 4 54

Sil. 5 2 3 3 2 3 3 4

Sul. 6 3 4 4 2 2 4 4 3 1 2 2 2 4 4 4 1 4 56

Valer. 3

Verat-a. 7 3 3 3 3 1 4 2

Zinc. 4

Here, again, the remedy–Nat-m. (50m., cm.)–is one of the high group, though not the highest. In this case it took hold promptly, was repeated several times, and carried the case through the health.

The principal reason why Sul. not uncommonly totals the highest, or is one of the highest group, in any study with Boenninghausen, is on account of its general applicability to disease (psora), and also because it is related sequentially to many remedies; but in each case reference to its pathogenesis will reveal whether it is suitable.

The tendency with many to prescribe directly from the repertory is fundamentally wrong for the proving is the essential thing upon which the prescription should be based. The repertory is only intended to be a guide to the appropriate remedy, the comparison of the symptoms of the patient with the provings being the test by which the ultimate choice of the remedy should be established.

This holds true regarding mental cases as with others, and the appeal to the materia medicas is inevitably the final solution in a one-sided, partially developed disease, or when the similimum must be picked from a group of remedies, as well as being confirmatory in a case which works our smoothly with the repertory.

The status of mental symptoms is high–necessarily so–but the manner of their employment in repertorial work must conform to the rules given.

Maurice Worcester Turner