IMPATIENCE A DIFFERENTIAL DIAGNOSIS


IMPATIENCE A DIFFERENTIAL DIAGNOSIS. An evaluation of the psychological personality should be a part of the routine case taking. Particularly, when there is a dearth of sufficient generalities and modalities on which to base a proper prescription, we can make the most of our evaluation of the psychological type.


The most important medicines among the 82 which Kent lists under IMPATIENCE are: Acon., Ars., Aur., Bry., Calc., Cham., Coloc., Hep., Ign., Iod., Kali c., Lach., Lyc., Med., Nat. m., Nux v., Plat., Psor., Puls., Rhus tox., Sep., Sil., Staph., Sulf.

Arg nitr. does not appear in kent but certainly should be added to the list, making a total of 25 remedies for our differential diagnosis.

How do we justify the practice of allowing ourselves to be guided by mental symptoms in the selection of medicines for physical illness? Our experience has shown that “mentals are often of overruling importance in determining the remedy which represents the total symptom complex similar to the patients condition. Besides justifying our method of remedy selection, this fact also suggests that the mental attitudes, probably, are also of paramount importance in the establishment of the very psychosomatic complex itself, which represents the illness. By studying, in addition to abnormal chemistry, the mental attitudes of sick people, we may gain a deeper insight into the functioning of pathological happenings.

The provings, experimentally, demonstrate the fact that every constitutional derangement brings forth mental symptoms. On the other hand, modern psychosomatic research has conclusively shown that mental and emotional attitudes deeply influence the physiological functioning.

Thus, impatience, the symptom slated for our discussion, has to be looked upon as the expression of disturbed somatic functions as well as factor which itself may call forth somatic pathology. The therapeutic requirement of the first premise leads to the differentiation of remedies by means of their mental symptoms; the second aspect calls for the task of inner self- development and of psychotherapy. Only to the extent that we keep sight of both of these sides will we be good physicians, not only good prescribers.

On the physical level, a cure can be accomplished only when the disease manifestation is not suppressed by contrariis, but is confronted with the similar, namely analogous, exogenous energy complex. In strict analogy, also on the psychological level, suppression by contrariis will not bring about a cure. Specifically, in the example of impatience, the contraria approach of mere rigid self-discipline or autosuggestion will succeed only in the driving the disturbance underground.

The psychological simile approach consists in the conscious confrontation with the conflicting elements of the unconscious, leading to gradual understanding and conscious integration into a widened and deepened personality. The technique of this approach has been evolved, beyond the one-sided narrowness of Freuds approach, by the school of Analytical Psychology of Carl G. Jung.

Our meeting being concerned with the homoeopathic tool, it is the first-mentioned task of differentiating the remedies characterized by impatience which commands our attention.

The symptom is of practical use for prescribing when it is found in a relatively outstanding degree; then it may be assumed to hold a key position in the total disorder. As long as a certain trait is relatively balanced and integrated into the total functioning, it is not pathogenetic. To some extent, everybody is impatient or indolent, irritable or fearful, etc. Consequently for the purpose of remedy selection, the symptom is of value only when it is:

1. One-sidedly outstanding in quantity (intensity), as in an excessively impatient person or in a quiet person who, contrary to his usual disposition, is acutely seized by his impatience.

2. When the symptom is a distinguishing factor by virtue, not of its quantitative, but of its qualitative importance. A person may not be excessively impatient but his impatience may still be quite characteristic and peculiarly distinctive for his very personality.

In case 1. we have to choose from among the comparatively acute remedies with strong impatience (Acon., Ars., Bry., Cham., Coloc., Ign., Lach., Nux v., Rhus tox.), as well as from among those, of a more constitutional range, which have the symptom to an outstanding degree (Ars., Hep., Ign., Iod., Lach., Med., Nux v., Sep., Sulf.).

In the more qualitative evaluation of case 2, we deal with broader constitutional types, impatience being but one qualifying symptom (Arg, nit., Ars., Aur., Calc., Hep., Ign., Iod., Kali c., Lach., Lyc., Med., Nat. mur., Nux vom., Plat., Psor., Puls., Sep., Sil., Staph., Sulf.).

It must be borne in mind, however, that for didactic purposes we are drawing a line of division where in reality there are but fluid transitions. Therefore the division of remedies into acute and chronic should never become a rigid concept.

In our differential diagnosis, this time, we shall, expressly and deliberately, limit ourselves to an investigation of the various types of impatience as they grow out of the overall psychological make-up of the patient. For reasons of time and space, only the main, pertinent points can be given; we shall disregard all other symptoms which, needless to say, must be considered in the actual, clinical remedy selection. This specialized study of a narrow field is offered as an addition and not instead of a thorough study of the broad remedy totality.

An evaluation of the psychological personality should be a part of the routine case taking. Particularly, when there is a dearth of sufficient generalities and modalities on which to base a proper prescription, we can make the most of our evaluation of the psychological type.

ACONITE.

In the patient who requires Acon. the impatience springs from a state of panicky fear or fright. he vehemently and impatiently pleads that something be done to ward off the catastrophe which he feels to be impending. Though usually indicated in very acute states, it should not be forgotten in chronic states that developed after fright or shock.

ARSENICUM.

Also whenever Ars. is indicated the impatience stems from an underlying anxiety, be it conscious or unconscious. The Ars.personality is overexacting, oversensitive, mercilessly and incessantly driving himself and those around him; quite aptly, this personality type has been likened to a racehorse. Whereas the anxiety of Aconite is associated with the violent assault of acutest congestion upon a hypersthenic type, the Arsenicum state may be described, more aptly, as irritable weakness with anguished restlessness, ending in extremes of prostration, more often found in the asthenic type.

RHUS TOXICODENDRON.

Rhus tox. has impatience springing also from irritable restlessness. Whereas Ars. is almost obsessed and driven mad by his restlessness, the Rhus tox. state is one of a more passive, yielding apprehension and impatience. In a picture this is shown by the fact that the Ars. patient is driven to shift from bed to bed or room to room, whereas the Rhus patient rolls and tosses, yet remains in bed.

CHAMOMILLA.

Cham. is in a state of frenzy, oversensitive to discomfort or pain, unable to endure anything or anybody and to control his or her uncivil temper. Nothing moves fast enough, nothing is being done properly, everything is rejected as soon as it has been carried out, according to the rapidly changing, capricious whims of the ;patient.

COLOCYNTHIS.

Mentally, Coloc. is already over the worst and by the time you see him, he has calmed down and is suffering the physical consequences of his anger. Whereas Cham. may show you the door at your mere approach, Colocynthis temper is hidden; he will not reveal it until you question him about it. His impatience springs from anger and vexation.

NUX VOMICA.

The impatience of Nux vom. may be less acute; however, it is rather deepseated, habitual and permanent. The Nux type is our well-known contemporary, the overcivilized city dweller, overintellectual or mentally overwrought, an overworked lawyer or bookkeeper, a tyrannical clerk, precise, fussy, critical, overbearing, oversensitive, jumpy and subject to fits of uncontrollable temper.

BRYONIA.

When anger, irritability and impatience do not find their expression in open outbursts, but keep slowly nagging and boring from within or remain completely unconscious, the rigid, tensive state of Bryonia develops. Like a bear chewing his paws, he wants to be left alone; he growls and snarls when you attempt to disturb him. Whereas Nux vom. is a more refined, even over- refined type, indulging in, and made ill, by mental intricacies as well as culinary delicacies, Bry. tends to be a more prosaic species concerned about business, stockmarket and the daily bread; he is concerned with quantity rather than with quality. Thus, his suffering comes from business vexation and overeating.

Starting with “acute” medicines, we gradually are led to describe the broader constitutional states in the medicines that are to follow.

IGNATIA.

Ignatias impatience springs from an emotional confusion. She is caught in an impasse of contradictory emotions or of emotions that conflict with the demands of reality. usually refined, well-educated and cultured people, of a gentle disposition, the Ignatia patients are overwhelmed by emotional storms, grief over the loss of a dear person, or disappointment in love. Overwrought, aggrieved, lovelorn and lovesick, they are liable to strange actions and passionate outbursts. Their impatience, springing out of this overwrought almost hysterical state, is the expression of the desperate attempts to break free from the net in which they feel themselves entangled.

LACHESIS.

In Lachesis, the general keynote is suppression, physical, mental and emotional. Deepest passion, when denied open expression, is subject to perversion and turns into the venom of hatred, cruelty and jealousy. Suppressed unconscious emotions, like evil spirits continuously boring from within, permit no peace or quietness, resulting in Lachesis restlessness, impatience, suspicion and anxiety.

SEPIA.

Whereas Lachesis is characterized by suppression in general, Sepia tends more specifically, towards the frustration or inhibition of the feminine qualities. The Sepia patients are strongly emotional, yet repressed in their affections and their sexuality. The picture of love perverted into anger, spite, jealousy and hate, with the accompanying restlessness and impatience, is quite similar to lach., therefore. However, in Lach. the perverted instinct tends to assume a ruthless permanent rule; in Sepia, the feminine quality, obscured and frustrated as it is, still, somehow and somewhere, manages to keep a woman gentle and yielding, as much as she may resent and try to hide this fact.

MEDORRHINUM.

The mental state of Medorrh. we might describe as being helplessly ridden by an unconscious panic. It appears as though a protective function of the inner life had broken down, allowing the patient to become a helpless prey of waves of anxiety, restlessness and hurried impatience. The mental powers may gradually fail, while the uncontrollable restless anguish, alternating with excessive languor and exhaustion, may take on an almost obsessive character.

ARGENTUM NITRICUM.

Arg. nitr., quite similarly, is a person ridden by anxiety, hurry and worry. However, whereas the mental state of Medorrh., the nosode, appears to take effect by stunting and paralyzing the vitality, silver, the metal, affects the nervous functions primarily. Both, Medorrh. and Arg. nitr., have the symptom of anticipation. Medorrh, with deeply disorganized vital, organic functions, shows a changed threshold of consciousness, which anticipates, often correctly, unknown future events. Argent. nitr. is represented by the type of the overwrought, over-nerved intellectual worker or the neurotic, oversensitive, worn out and played out actor, who panic stricken within, finds excuses for all of his shortcomings.

He has exhausted his, however, normal mental functions and has lost his self-confidence. His anticipation is towards known and expected, rather than unknown, events. True to the neurotic pattern, this anticipation is transformed into physical symptoms.

IODUM.

Another personality, driven by restlessness and impatience, we meet in Iodine. Here, the restlessness strikes us as of a rather motor type. Constantly he must be active and on the move; he cannot sit still. Even his anxiety tends to take the form of fear of some imminent disaster, which demands some form of action. This motor restlessness, in which the patient literally burns himself up, we easily recognize as a manifest or occult hyperthyroidism.

SULFUR.

Sulfur, the king of the antipsorics, also is constantly on the go and bursting with initiative. The alchemists called Sulfur the “creator of a thousand things,” the “heat and force of everything” and the “ferment which gives life, intelligence and colour to the imperfect bodies.” Thus, the Sulfur personality, acting as a catalyst, always feels he must keep things and people on the move; he must always take the initiative, lest things become stagnant. he is ever full of new, often quite brilliant ideas, yet rather poor as to systematic planning and execution.

Sulfur is impatient with those around him, with slow world that cannot keep up with the speed and flight of his imagination. For every problem he quickly has a suggestion of what ought to be done, though, alas, it is not for him to waste his precious time in doing it; yet, the ungrateful world, never sufficiently seems to appreciate his genius. Could he be anything but impatient?.

PSORINUM.

Comparable to a Sulfur state with a negative denominator, the antipsoric nosode has Sulfurs drive, but is utterly devoid of any vital energy to back it up. There is the same driving, impatient restlessness, but the optimistic sense of attainment is lacking. Instead of enthusiastically pushing on, Psor., restlessly keeps busy. Full of pessimism, gloom and despair, he expects to fail in every undertaking and to end up in the poorhouse.

HEPAR.

In Hepar, the Sulfur fire is modified by the Calcarea stagnancy and defenselessness. A peculiar state of hypersensitive, irritable sluggishness results, which is punctured by volcano-like eruptions of ire and wrath. Hepars impatience bears the character of rashness and violence, of outbreaks of temper, of a person who cannot stand any opposition, unpleasantness or pain.

In the following group of medicines the impatience is likely to be more of a qualifying factor than quantitatively outstanding in intensity.

CALCAREA CARBONICA.

The typical Calc. patient may be likened to an oyster without a shell; he represents a helpless, flabby organism, lacking in inner organization and outer defense. He is easily exhausted, weak, sluggish and indifferent, lacks initiative, is unable to apply himself to any task and in capable of mental concentration. This weakness and the helplessness breeds anxiety and worried, impatient nervousness.

SILICEA.

Comparing it to Calcareas lack of a protective shell and inner organization, we may describe Silicea as rather well- organized, but devoid of fibre, stalk or firmness (Sil. is the main mineral constituent of stalks and fibrous tissues). Thus, Sil. tends to be a very orderly type of person, spic and span, but shy and timid without self-confidence, often anticipating failure. They are irritable and impatient when they are too hard pressed, aroused, or provoked.

PULSATILLA.

When we find the lack of stamina, not in the deepest grains of the personality, but rather in the more superficial form of emotional shiftiness and instability, the windflower, Pulsatilla, often the acute of Sil., may be indicated. They are fickle, irresolute, impressionable, rather superficial types, always in need of emotional support and sympathy. Their mental and physical states are subject to frequent quick changes, forth and back, from complacent sweetness to irritable, fidgety impatience.

KALI CARBONICUM.

Kali carb. represents a changeable instability, often mindful of Pulsatillas mental state. The Kali carb. condition seems part of a general state of low vital energy with disturbed adrenal functioning and vagotonia. The patient is whimsical, contradictory, quarrelsome, fearful and anxious. He is impatient, since his changing whims cannot be instantly heeded.

LYCOPODIUM.

Lycop. presents the trend of an intellectual overbalance, out of proportion to and at the expense of, an atrophying emotional life and of the purely vital energies. These patients are quite introverted, often asocial types; outwardly, perhaps, haughty and domineering, inwardly unsure of themselves, full of fears and feelings of inferiority. Irritability and impatience are the expressions of this precarious imbalance of their inner lives.

NATRUM MURIATICUM.

Also the Nat. mur. patients are exceedingly introverted like the former, Lycop., but their imbalance stems from a hypertrophy of emotion rather than of intellect. Their state is one of emotional isolation, be it self-imposed, or through the force of circumstances, such as bereavement and grief; violently and impatiently they resent any intrusion into the circle of their lonely withdrawal and introversion.

AURUM.

The gold patient, also, is lonesome and depressed. He is weighted down by a load of real or imagined responsibility, self- imposed, or ordained by the necessity of circumstances. Thus, he is given to self accusations, brooding, melancholic depression, hopeless pessimism and restless, impatient anxiety.

PLATINA.

Whereas Aurum tends to disparage and humble his ego, in relation to what he feels he should have attained, Platina aggrandizes himself and belittles his environment. He indulges in an assumed superiority of his self and disregards all that does not fit into the pattern of his self-inflation. For the sake of the power drive, the life of the other emotions and instincts is sacrificed and suppressed. a perverted instinctual and sexual life results, with irritability and impatience often of a definitely hysterical character.

STAPHISAGRIA.

Also Staphisagria tends to overrate his own importance, though often quite unaware of doing so. He is quite self- indulgent and will not deny himself the satisfaction of his emotional and sexual urges. Since he is very sensitive to the way he is judged, in relation to his own artificially inflated standard, he is constantly forced to hide and suppress his real emotional and personal self. Living by the grace of artificially maintained appearance, he easily lays himself open to injury to his pride, which, again, never must be admitted or noticed by others. The price for the maintenance of this artificial structure is paid for in tension, hysteria, spasticity and impatient irritability. NEW YORK, NEW YORK.

Edward C. Whitmont
Edward Whitmont graduated from the Vienna University Medical School in 1936 and had early training in Adlerian psychology. He studied Rudulf Steiner's work with Karl Konig, later founder of the Camphill Movement. He researched naturopathy, nutrition, yoga and astrology. Whitmont studied Homeopathy with Elizabeth Wright Hubbard. His interest in Analytical Psychology led to his meeting with Carl G. Jung and training in Jungian therapy. He was in private practice of Analytical Psychology in New York and taught at the C. G. Jung Training Center, of which he is was a founding member and chairman. E. C. Whitmont died in September, 1998.