SIGNIFICANCE OF MENTAL SYMPTOMS


This discovery promoted by the development of psycho- pathology, that emotions can be a cause of organic pathology may be of far greater importance than we still are inclined to believe. The research in the field of psychosomatic medicine is in its initial stage and the more we learn the more we become aware of the important role emotions play in the pathogenesis of many diseases.


Read before the Bureau of Clinical Medicine at the ninety-seventh Convention of the American Institute of Homoeopathy at Old Point Comfort, Virginia, June 15-20, 1941.

PARAGRAPH 210 of the Organon, 6th Edition, reads : “They (e.g., the mental diseases) do not, however, constitute a class of disease sharply separated from all others, since in all other so-called corporeal diseases the condition of the disposition and mind is ALWAYS altered; and in all cases of disease we are called on to cure the state of the patients disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able therefrom to treat it homoeopathically with success.” Par. 211 states :

“This holds good to such an extent that the state of the disposition of the patient often chiefly determines the selection of the homoeopathic remedy as being a decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician.”.

With these words Hahnemann a hundred years ago has clearly and simply stated facts which represent today the most recent discovery of medicine, concerning the inter-relationship of mind and body, and involving the problem of the psychic origin of many pathological conditions and even anatomical changes due to emotions.

This discovery promoted by the development of psycho- pathology, that emotions can be a cause of organic pathology may be of far greater importance than we still are inclined to believe. The research in the field of psychosomatic medicine is in its initial stage and the more we learn the more we become aware of the important role emotions play in the pathogenesis of many diseases.

The vegetative nervous system functions as the pathway between psyche and soma. The emotional reaction is mediated through the thalamus, and the vegetative nervous system centers in the diencephalon and reaches the organ by means of the sympathetic and para-sympathetic fibres, expressing itself in the “language of the organ”, i.e., its particular functions and their disturbances.

The disturbances may occur chiefly (a) in the sensory functions, (b) in the motor functions, (c) in the secretory functions which are all under the control of the sympathetic and para-sympathetic autonomous system. It can be said in general that the emotional impulses of pain and discomfort effect predominantly the sympathetic and those associated with pleasure, the para-sympathetic. The emotions of fear, rage, worry, anxiety, anger may give rise to effects of sympathetic stimulation.

Every emotion may either disappear after a short time without penetrating into the physiological level or it may continue in the form of a repeated or steady mental stress which may lead to disturbances in the organs governed by the autonomous nervous system. In the same way a sudden emotional shock can upset the functions of an organ or of several organs initiating pathological changes. The emotional reaction must not reach necessarily the level of conscious awareness, but by establishing an unconscious working complex far-reaching effects in the physiological and even anatomical level may result.

Proceeding from the psychological viewpoint, Lange and James developed a theory of emotions and their relationship to bodily changes. According to this theory the bodily changes follow directly the perception of the existing fact, and our feeling of these changes as they occur IS the emotion. We feel sorry because we cry, we do not cry because we are sorry. The bodily manifestation must first be interposed, otherwise we would have a pale colorless perception without any real emotion. The discovery of the emotional secretion of adrenalin seemed to strengthen the James-Lange theory of the emotions.

Proceeding from this theory we may easier understand the influence of drugs on emotions, and particularly the effect of homoeopathic remedies on emotions and their consequences.

Let us bear in mind the Aconite-picture and at the same time read the description Darwin gives in his “Expression of the emotions in Man and Animals”, of the physiological change which takes place in connection with fear : “The heart beats quickly and violently, so that it palpitates or knocks against the ribs; but it is very doubtful if it then works more efficiently than usual, so as to send a greater supply of blood to all parts of the body; for the skin instantly becomes pale as during incipient faintness.

This paleness of the surface, however, is probably in large part or is exclusively due to the vaso-motor centre being affected in such a manner as to cause the contraction of the small arteries of the skin. That the skin is much affected under the sense of fear, we see in the marvelous manner in which perspiration immediately exudes from it. The exudation is all the more remarkable as the surface is then cold, and hence the term “a cold sweat”, whereas the sudorific glands are properly excited into action when the surface is heated.

The hair on the skin also stands erect, and the superficial muscles shiver. In connection with the disturbed action of the heart the breathing is hurried. The salivary glands act imperfectly; the mouth becomes dry and is repeatedly opened and shut. I have also noticed that under slight fear there is a strong tendency to yawn. One of the marked symptoms is the trembling of all muscles of the body; and this is first seen in the lips.

From this cause, and from the dryness of the mouth, the voice becomes husky or indistinct, or may altogether fail.” Going over the proving symptoms of Aconite, we find a complete resemblance between Darwins classical description of the state of fear as expressed by bodily symptoms and the effect of Aconite, laid down in the provings. According to the law of similars, Aconite was always found helpful in ailments due to fear or sudden fright.

I recall a case of severe chronic sleeplessness which could be traced to an extreme shock due to sudden fright suffered in the World War when the patient was accidentally buried; the man could be cured by Aconite although the actual incident of shock had taken place many years ago.

The chapter Consequences of Emotions plays an important part in Homoeopathy, but it was not before the latest development in modern medicine that experimental proof could be found for our old clinical knowledge. Ever since then ample evidence has been gathered that emotions produce bodily changes, and a short survey of the facts may illustrate how right the homoeopaths have been in upholding their experiences through a century against the contemptible derision of a medical majority.

The heart has been considered by common opinion as the seat of the emotions. True, the heart and the whole circulatory apparatus particularly express readily the emotions as f.i. by blushing and becoming pale. Suggestion of emotions made partly in hypnosis, produced definite changes of the pulse, distribution of the blood volume, blood pressure, changes in the heart rhythm, demonstrated by the electrocardiogram, and changes in the heart configuration of more than I cm, controlled by X-rays.

Under the repeated influence of emotions a definite change in blood pressure and heart configuration may take place. Anxiety can be considered as a so-to-speak heart-specific emotion. Even slight sensations of the heart as they may occur after over-exertion produce the feeling of fear and anxiety. The strongest expression of fear occurs in the attack of angina pectoris and the so-called angina pectoris sine dolore is exclusively characterized by strong emotions of undefined fear and apprehension. The feeling of approaching death and the fear of death is closely connected with the heart and the circulatory system.

Homoeopathic provings and clinical experiences have established this connection long ago, and remedies which produce most clearly the sensation of fear of death, like Aconite and Arsenicum are drugs which affect primarily the circulatory system. The effect of Aconite is directed chiefly towards the arteries; arsenic owes its symptomatology to the poisoning of the heart and the capillary system. There is no remedy which is more closely related with death than Arsenic. There is this immense fear of death no other remedy has in such a degree.

Despair of life, anguish, agony, a face showing genuine fear, finally cachexia and hippocratic features are the signs of the deadly intoxication of the heart and of the capillary system which produces a state of chronic collapse, the underlying pathological condition of this impressive picture. Even in the subconscious sphere of dreams the idea of death is prevailing. A patient of mine suffered from a great many functional disorders. I recall particularly, great loss of hair with an enormous amount of dandruff.

After one dose of arsenic all symptoms disappeared but the patient expressed her particular thankfulness that I freed her from her frightful dreams. She dreamed in regular intervals of corpses and the terrible nightmares made her sick for days afterwards. After administration of Arsenic she no longer had these dreams. This is at the same time an example of the influence which the homoeopathic remedy has on the emotions, penetrating even into the level of subconsciousness and the realm of dreams.

The heart as an organ of expression of emotions also causes many functional or subjective symptoms. A syndrome of symptoms such as sensation as if the heart were squeezed, oppression, anxiety, palpitations and repeated sighing has been called phrenocardia and was found particularly as a consequence of unhappy love affairs. This state corresponds exactly to the picture of Ignatia. Sighing respiration, however, is also often the first sign of cardiac failure, and we find it as a symptom in the proving of Digitalis which is also characterized by extreme anxiety and fear, and fearful dreams.

It was found (Eichenberger) that in cardiac patients a definite increase in anxiety dreams appeared as the first sign of cardiac decompensation. The mental symptoms in cardiac cases may arrive at a state of a real psychosis, characterized by delusions, anxiety, restlessness with definite anatomical findings in the brain, probably caused by an oxygen deficiency; all these mental symptoms are also produced by Digitalis.

Everywhere we notice the influence of the mental state on the bodily condition and of the bodily condition on the mental state. The homoeopathic remedy mirrors both mental and physical conditions and gives a true reflection of the integration of both, which characterized all processes of life and disease.

Very considerable is also the influence of emotions on the gastro-intestinal tract. The first classical observation of the influence of fear and anger on the secretion of the stomach was made by Beaumont. Recent experiments by means of hypnotic suggestion showed that the emotions of fear, fright, worry and joy had an immediate influence on gastric secretions as well as on gastric tonus and motility.

Gastric secretion was increased or checked, sometimes the secretion was completely inhibited, so that even injection of histamine could not produce any reaction. Gastric peristalsis could be stopped by hypnotic suggestions of worry and anxiety and the following changes in the mucosal outline, as demonstrated by X-rays, gave the same picture as a gastritis. Recent research in the field of the genesis of stomach ulcer leads more and more to the belief of the psychogenic origin of ulcer.

It was found that peptic ulcer cases are characterized by overcompensatory aggressivity, hyperactivity and excitability, qualities which give rise to emotions known to cause hyper- motility and hypersecretion of the stomach. It is interesting to note that the homoeopathic remedies frequently indicated in stomach ulcer as Anacardium, Nux vomica, Natrum mur., Nitric acid, Arsenicum represent in their picture exactly the mentioned mental type. Gastric tonus changes according to emotions and by X-ray examination of the stomach of manic-depressive mental cases the position of the viscera was found two inches higher in the manic than in the depressive phase.

Schindler considers ptosis, combined with acidity and atonic constipation, the gastro- intestinal correlate of depression. This brings to my mind the case of a young lady who came to see me for stomach troubles from which she had suffered for a year, loss of appetite, gastric pains–feeling of heaviness; she was in a state of great depression and said: “Doctor, I cry all day long.” Suspecting a psychological background, but without intruding, I gave Ignatia. Two weeks later she entered the office smiling : Doctor, what have you done with me, now I laugh the whole day !”

The stomach complaints had disappeared together with the depression. An after-anamnesis revealed that the beginning of the stomach- troubles coincided with an unhappy love-affair. Ignatia cured the whole condition definitely.

The emotional effect on the bile secretion could be studied under hypnotic suggestion. Anger inhibits the bile secretion entirely, and this experiment justifies an old clinical experience. On the other hand, chronic jaundice produces a state of great mental irritability, and repeated icteric attacks are often accompanied by fits of anger and rage.

The homoeopathic use of anger-remedies such as Chamomilla, Bryonia, Colocynthis, Nux vomica in bilious attacks shows how Homoeopathy has made practical use of clinical observations which are now confirmed also by experiment. Whereas all these recent findings are of a more or less theoretical interest, as school medicine cannot make practical use of it, Homoeopathy offers the therapeutic link, combining the mental and physical influences of drugs in treating the whole person as the only existing clinical reality !.

How much different physical or mental etiology of a case may influence the choice of the right remedy–and therefore the cure –may be shown by the following case:.

A 40-years old patient was rushed into my office with an acute attack of neuralgia of both brachial plexuses. It was the most distressing picture of a pain I have ever seen. The patient was rolling on the couch crying that ten gall-stone colics–he had suffered from gall-stones before-are better than this agonizing pain. The patient had caught a cold while sweating under his arms. One dose of Belladonna 200 finished immediately the attack, after Aconite had failed.

However, on pressure, a certain sensitivity of the nerve branches remained. Weeks later the patient again was brought to my office with a new similar attack and even more horrible pains. Although the symptoms at this time were exactly the same, Belladonna failed utterly. In despair–the pain was so strong that the patient, a World War Veteran, was crying–I gave a morphine injection which began to have an effect after half an hour, and the patient was taken home.

Some hours later, I was called to his house, the horrible pain had recurred as I had anticipated. The hard-pressed doctors brain works faster, and after having elicited that this attack had coincided with a suppressed fit to anger, I gave a dose of Chamomilla. Within 5 minutes the pain was gone and did not recur any more.

Less studied than the influence of the mind on the body, is the interesting influence of the sick body on the mind. I refer in this connection to the morosity and ill humor, often accompanying disease of the hypochondrium, so typical, that hypochondria became a name for this characteristic disposition. We have already mentioned the disposition in cardiac cases and in icteric patients.

Typical for the pneumonia delirium is a psycho- metric restlessness with the patient grasping for feathers and picking at the bed clothes, similar to the delirium found in persons saved from asphyxiation, both pictures due to lack of oxygen; they are covered by remedies like Hyoscyamus and Lycopodium. Typical for Grippe was found an anxious-depressive disposition, ranging from irritability to apathy and stupor, and this is very well in accordance with the “angry-apathetic” Flu- remedies, such as Bryonia, Gelsemium, Eupatorium. Measles are characterized in their initial stage by a crying disposition and the tearful Pulsatilla is in fact one of the most successful remedies in this disease.

It would need a separate lecture to point out the relationship between the mental types in our remedies and the psychological types worked out by modern psychology and psycho-pathology. A few words should be said about the queer mental symptoms in Homoeopathy, which were so often derided that sometimes the advice was given to throw them out of our materia medica.

If we learn about such symptoms as: “listening to music causes distress on one side of the body”, or “he feels a half-sided amorousness with the wish to caress all things with the hand of this side”, symptoms actually found in cases of thalamic lesions, or, if we go over the numerous queerest “as if” symptoms in the provings made by Beringer at the Heidelberg Psychiatric Clinic with Meskalin, then we may realize that these queer mental symptoms of our provings may represent a good deal of useful clinical reality.

The sensation of a split of the personality is a well- known fact in psycho-pathology and it appears in a number of our drug pictures too. MacAdam could show that this sensation appeared in the most various forms in the dreams of grippe- patients and he derived from these dreams the hint for a successful prescription of Baptisia.

Par. 212 and 213 of the Organon draw attention to the fact that drugs are capable of altering the disposition and that no homoeopathic cure–i.e. a cure conforming to nature–can be achieved without choosing a remedy which covers as closely as possible, both the physical and the mental symptoms. In a foot- note thereto concerning the adaptation of remedies such as Aconite, Nux vomica, Pulsatilla, Ignatia to the mental state, Hahnemann draws the first outline of a new psychopharmacology which could become the therapeutic key for a future psycho- somatic medicine.

Cannon states : “In modern life infection have diminished and nervous strains have increased”, and “the medical profession has not recognized in a practical way the recent shift in the etiology of disease”, i.e. the rising etiological importance of emotional causes. If we are to treat patients rationally, considering the etiology, we have to keep in mind this most important fact. Von Bergmann says: Psychic phenomena often give us the earlier, because subtler, finer clinical signs.”

The modern trend in medicine is directed towards an early diagnosis and treatment constituting a preventive medicine. If we are to treat patients early we have to pay more and more attention to the mental symptoms and syndromes. Modern medicine takes the patient as a unity of mind and body, and as an individual, tending towards psycho-somatic medicine and a medicine of the individual.

Whereas the organ symptoms are practically the same in each case, the mental symptoms as an expression of the highest organized system reveal the individuality. If we are to treat a patient thoroughly, and individually, we have also for this reason to observe his mental set-up and his individual behaviour.

Homoeopathy, which has always stressed the clinical significance of the mental symptoms has recognized in a practical way the importance of emotional factors for the etiology of diseases. It also finds itself–as could be shown–in accordance with the modern trend towards a preventive and a psycho-somatic medicine and demonstrates at the same time the practical possibility of the most interesting, the pharmacological approach towards the highest goal of medicine, the therapy of the personality.

William Gutman