THE object of this paper is to reveal and evaluate homoeopathic principles in the treatment of mental reactions. Such an approach is being practiced at the Middletown State homoeopathic Hospital where our observations were made. In this paper we will also bring forth the observations and conclusions arrived at by others as to the effects of certain homoeopathic remedies in the treatment of certain mental states. As Dr. Talcott once wrote, “The means used for the recovery of patients are numerous and varied. We cannot pin our faith to a single measure. We week to adopt all which experience has proved likely to be beneficial.”
It will be out chief aim to show just what homoeopathic remedies are most effective in mental disease, the principles behind their administration, and to stress in what way they are effective. There is no absolute way of gauging the value of our procedure accurately except by statistical corelations which, of course, do not mean much because of the numerous actors and variables. Such variables as the introduction of other treatment methods and other factors and relationships which cannot be controlled. make it too difficult a task to evaluate the drug per se. However, we will include a few statistical accumulations for those who may wish to make comparisons.
The material for this paper comprises the personal observations and studies made of the authors own cases and we present only a few of our cases to illustrate our remarks.
Homoeopathy is a method of drug therapeutics and plays only a small part in treatment of disease. Other methods, especially in mental disease, are of greater importance than drugs, and are so recognized by used. Such means which we refer to as hygienic, which includes regulation of diet and regimen of patient, habit training, rest and seclusion, choice of environment, cleanliness, kindness, proper education diversion; occupational therapy; psychotherapy of all sorts; use of various forces of nature, such as employment of water in various forms, referred to as hydrotherapy; application of electricity, light rays, heat, grouped under physiotherapy, are employed by us. Endocrinotherapy, vaccine therapy, together with allopathic drugs which have been found palliative or specific are given wherever indicated. They are not being undervalued, but rather excluded from our consideration as we are concerned here with the value of homoeopathic drugs in the treatment of mental disorders.
Briefly, homoeopathy can be defined as a therapeutic method formulated in the “similia similibus curentur” principle-let likes be treated by likes. The two elements of comparison implied in the above statement are the effects if drugs on the healthy body and the clinical features of disease, in either case, both the subjective elements of the disease which is appreciated by the patient as well as the objective manifestations as observed by the physician being taken into account.
Medicines administered on this plan are usually single and in small doses, at least below the generally accepted pharmacologic and so-called physiologic dose. It is a method, not a doctrine or a system. It is a therapy complete in itself and independent of the allied sciences of physiology and pathology so far as these consist of changing doctrines and conceptions. It is a practical method, or organon, as its originator Hahnemann used it for effecting in the best manner a certain end, namely, the cure of disease.
Application of an agent which produces in a healthy individual the symptoms similar to those found in a specific disease process was recognized by Hippocrates and others.
Hippocrates stated that disease was cured through a method of treatment which contracts it and a method where the disease of treatment which counteracts it and a method of treatment which counteracts it and a method where the disease is removed through remedies which produce similar symptoms to the disease. We find that before Hahnemann seized this principle as a general basis, tested and worked out this thought and formulated it as a rule for medical practice, physicians were treating vomiting with an emetic, preparations of organs of animals were given for disorders of the same organ in man, application of heat to burns, acid to acidity of stomach, etc.
Nowadays actually these two principles of Hippocrates for representing remedy finding have been successful. Sometimes both of these principles, although through different thought process, lead to the same remedy.
For instance, in one school of thought mercury is given to oppose the action of a bacillary dysentery by destroying the cause, in the other case the drug is given because it produces a similar picture in a healthy person when given in large doses, but its deadening effect is removed when given in small doses for then it stimulates the resistance, defensive and curative powers of the organism against the disease. Parenthetically, we may insert the fact that it has been shown, for instance, in case or adrenalin, by Renty, and others, that adrenalin dilates rather than constricts in 1/1000, but in the more dilute forms it stimulates the vessels by constriction.
There are three recognizable kinds of actions possessed by drugs which can be referred to as mechanical, chemical and dynamic, respectively. It is in this last chemical and dynamic, respectively. It is in this last class of action of drugs that homoeopathy works its rule of similia. If we avail ourselves of the mechanical or chemical properties of substances, we do so on mechanical and chemical principles.
On the other hand, the dynamic principle which is here involved depends on there being a changed physical state which gives a substance energy to reach and affect tissues. Drug energy, no drug material, is dealt with. The drug mass by its division and agitation energizes the super imposed menstrum (alcohol or sugar) which, when taken into the body, stimulates suitable tissues.
The next principles is important so far as psychiatry is concerned and that is the doctrine of the totality of symptoms which includes the entire reactions of the patient, both subjective and subjective The totality of symptoms, including the sufferings, feeling, reactions of the patient the general and local manifestations of the disease, constitutes the disease. General and local manifestations of the disease, constitutes the disease. General and local symptoms constitute only a small part in the total picture. This concept enables us to treat maladies in their formative state, in state of subjective experiences before the pathologic process has progressed to state of physical diagnosis.
We know that early states and recognizable mainly by symptoms of subjective nature. This concept is taken into cognizance in the general medical aphorism, “Treat the patient, not the disease.” This holds especially true in mental disease where we get the reactions of the patient to the disease before the latter is discernible. Our chief goal is, therefore, to cover the totality of symptoms. This doctrine fits in very well with the concept of the total personality. We must restore the normal integrated pattern in all its aspects, and should not treat the diseased element along. That is what we try to do in using was referred to as hygienic measures.
Our therapeutics are biologically based not entirely on cause, but on organismal reactions, that is on the reactions of human beings as a whole to the situations confronted, on the physical make-up, the constitution, the functional alterations, the pathologic state, the causative factors, presence or absence of past causes both predisposing and exciting, the mental symptoms, reactions of the organism to environment, in short and complete picture of the diseased state in a particular individual. By so coordinating the relationship between the diseased state and drugs effect and by individualizing the case, the smaller is the effective dose which is necessary, so that there is no chance of doing any harm. The smallest amount of the agent that will prove effective is administered.
An important keynote in our prescribing is the individualization of the case. A study of the special factors that differentiate two cases of the same disease from one another as well as a study of the disease itself is important. Such a differentiation is necessary in homoeopathic prescribing. It is not sufficient to stop with the classifications of the diseased state as an entity. Not all individuals are alike in form, functional response, mental and physical make-up, psychologic reactions, etc.
This has been shown by Draper and others who have studied the constitutional make up associated with diseases. We cannot expect dissimilar individuals to react in the same way to same causative agent of diseases. One individuals to react in the same way to same causative agent of diseases. One individual is sensitive to a certain drug whereas another tolerates it.
One can readily see how difficult it would be in mental disease with all its variegated number of mental symptoms, to uncover a “similimum” which would cover he “totality of symptoms.” Although each case has its own individuality, there are basic uniform manifestations in a single disease or drug group, which are common to the disease or group of drugs. For instance, in a case of general paralysis there are certain basis subject and objective symptoms. In the same fashion, a group of drugs give base symptoms referable to the predilected tissues.
The determinative symptoms which distinguish one cases of a certain disease from another or differentiate one drug from another in a certain group, are complex in mental states. We depend, there fore, on a certain group of drugs covering certain disease states, following which we abstract from the diseased state in a particular individual as many determinative symptoms as we can and try to fit them with a drug in the particular group whose pathogenesis closely approximates the symptoms we have abstracted.
Another important concept is the correlation of mental disease with physical illness. This was recognized by homoeopathic therapeutists for some time and they emphasized the metal symptoms produced by the drug more than they did the physical symptoms. Nux vomica, for instance, is beneficial in hypochondriasis, melancholia, out of proportion to dyspepsia, weight being placed on the mental angle. We at Middletown feel that by concentrating on the physical angle in a patient no matter what psychosis he has, we will modify the severity of his mental reactions and in some cases evoke a cure. We therefore search diligently for all physical disturbances, both general and local, and treat any by homoeopathic and other methods.
The Phrase “likes are treated with likes” embodies as aspect of the remedial agent and an aspect of the disease. It is therefore important to know the general action of the medicinal agent, the particular tissues or functions upon which it acts. Nux vomica has an especial affinity for the sensory side of the central nervous system. Alcohol the toxin has a similar affinity; therefore in alcohol cases nux vomica is most often indicated.
As already implied, there is no necessity on the part of the homoeopathic prescriber to make a study of medicines in themselves prior to their application to practice. The pathognomonic effects have been ascertained and recorded. We have but to refer to such a record after we have examined our patient to discover the similimum in his case. The closer we approximate the individual to the drug giving similar pathologic effects in a similar type of healthy individual the more chance we have for cure. Hence, the arrangement of pathogenesis as will be noticed in the form of a schema of disconnected symptoms.
We will now give you a few of the drugs, with emphasis upon their mental manifestations, from which we deduce the type of case in which they are valuable. It is not intended to form any a priori notion of the medicine or to see in its effects any true picture of disease. It simply may be applicable in one type individual with, let us say, manic-depressive and not in another type of individual with the same disease. We will also draw in a few of our own cases as illustrations.
Let us commence with our manic excitements. Talcott stated that out choice commonly lay between three mydriatics: belladonna, hyoscyamus and stramonium. He advocated belladonna in those cases where there was marked hyperemia, sudden explosions of rage and fury, restlessness and destructiveness. Hyoscyamus he gave in those cases that had tendency to expose their person.
We have in mind a case where the patient was given a hypo of hyoscine hydrobromide and who had symptoms.
Butler also recommenced belladonna in intense mental excitement with treatment with great violence and destructiveness against everything within reach. We have used this remedy rather extensively in such cases as described above. More particularly when there is a flushed face, dilated pupils, rapid flow of ideas, emotional instability frequent emotional shifts from an irritable, angry state to one of euphoria and elation. This drug we can verify is certainly the most common one used in manics.
Hyoscyamus is frequently used at Middletown State Hospital. Here the symptoms are restlessness of pressure of ideas and activity, continuous state of elations, obscenity, eroticism and tendency to expose the body.
In the most intense form of excitement we have used Stramonium.
Our findings to the efficacy of these drugs cannot be truly evaluated, due to the introduction of other forms of control of the excitement. We will later introduce statistical data, but in view of such data we can say that out better results are due for one thing to the absence of morphine, hyoscine or any other sedative. We believe the injudicious use of morphine and hypnotics in excitements is injurious. Its supply increases the state of cerebral excitement that already exists. We flood the system with large doses which disturb the normal structures, let along the pathologic structures. It has been shown that 1/4 gr. morphine will produce acidosis lasting one to four hours; a small dose will produce alkalosis.
This would add to the acidosis already existing in cases of excitement. We add fuel to the fire. As in the case of chronic brain disease, an acute organic delirium is a summation of effects. In pure acute delirium either psychogenic or organic, what results is a summation of effects. In our acute psychogenic excitement we have found that those cases that have some organic state, such as heart conditions. are more apart to have an acute organic delirium superimposed upon the functional delirium when hypnotics are administered. The following case is a good example.
H.McC., aged fifty-two, diagnosed mixed manic, third attack, third admission, white male; a lawyer by profession. History of many attacks of rheumatism, rejected during the war for cardiac condition. Three weeks before admission here, he spoke incessantly, was hyperactive, violent. Sedatives were given to quiet him and he came here November 9, 1934, with a mixture of psychogenic and organic features. The latter were disorientation, marked incoherence and confusion, varying levels of consciousness, speech defect, content of occupational character, preservation, all in all an engrafted acute organic delirium.
In two days the entire picture subsided and was replaced by retardation, memory defects, weeps spells, sadness and difficulty in organization of his thoughts. He made the following comments the following week. “If I take something to make me sleep, it is very bad. When I come out of the drug, there is a hazy, uncertain confusion, excitement and bad dreams. Ever since I was a kid, Ive noticed that in every illness when I took a drug to produce sleep, either during during the effect of the drug or after the drug wears off, there is a delirious state.
I havent any such states since Ive been here and youll note I havent asked you what drug you were giving me although all my life either I have been told or I would naturally ask.” He went home recovered the first of this year, having been a fine shape for over a mouth previously, Here the drug given was cactus gran. The symptoms of depression which set in following the excitement together with the sensation of weight on his brain plus frightening spells at night plus the cardiac constricting sensation, fitted this remedy.
It is clear that in these functional cases where there is a physical organic factor, the cerebral cortex is more sensitive to hypnotics. It is the same mechanism that we find in organic brain disease or in chronic toxic infectious processes where the brain is in state of chronic irritation and thereby reacts violently to hypnotics. The following is a good illustration of a chronic toxemia set up by endogenous and exogenous toxins culminating in an acute cerebral excitement upon administration of morphine and hyoscine. In this case the fundamental reactive pattern was a psychoneurotic one.
E.G., white, female, aged fifty-one, married, has three children. Had several illness in her adulthood influenza, pneumonia and appendicitis. In July 1933, she contracted rheumatic fever. She was a neurotic personality who became very impatient with the protracted course of her illness. For two months she received all sorts of treatment from any number of physicians including chiropractors. For two weeks before admission she received an ampoule of hyoscine and morphine daily, and three days before admission here july 2, 1933, she was delirious.
She was brought into the hospital with a typical acute organic delirium. Our summary of the case was as follows. “We have here an intense psychoneurotic reaction caused by a disease process, the latter having been maltreated. Mixed up and superimposed on the type of reactive pattern is an acute delirium prepared by the predisposing factor, that is, endogenous toxins emanating from the arthritic focus; and excited by exogenous toxins, morphine, hyoscine and twenty other varieties of anodynes, sedatives, hypnotics and chologogues, etc.
The delirium cleared up in a few days; the hysterical outbursts and drug craving were satisfied by hypos of sterile water; the rheumatic disease plus the mental signs of apprehension and fears and the hysterical outburst of shrieks of pains called for rhus tox. Patients organismal reaction improved far greater than the arthritic focus, which remained as short of a hysterical conversion symptom, but this ultimately cleared up so that she sat up out if bed within two weeks and was home in a month.”
In pure functional manic depressives we make no claims whatsoever; whatever results are obtained are probably due to the psychologic factor, the satisfaction of psychic craving, suggestion and whatever mechanism it many be depending on the case.
A previously stated in our handling of mental cases we pay especial attention to the physical facts. We do not use homoeopathic means exclusively to combat the physical condition but we resort to any treatment which we feel will help. We give our specific drugs for their antagonistic actions if they have been proved successful. we give palliative drug such as amyl nitrite in angina pectoris, and we use other forms of therapy.
In cases with a physical condition, if we can find the homoeopathic drug that will be appropriate, what usually follows is a marked improvement in the mental status. We may have to combine the remedy with other measures as we did in the following two cases In those two cases, we have organ pathology which could not be definitely associated with he attack. They are both manic depressives, manic type, with Graves disease.
M.S., fifty-three years of age, school teacher, white, female, had three attacks of manic-depressive psychosis. On July 18, 1933, a thyroidectomy was performed. Within twelve days she became manic. On admission here a diagnosis of manic depressive psychosis, manic type, was offered. She had mitral disease, hypertension, showed signs of hyperthyroidism, dehydration and exhaustion. In two months she was sent home recovered.
R.D., aged fifty-seven, female, meningitis at age of two. In 1930, attempted suicide but was unsuccessful Two years later a thyroidectomy, and eight months following she was destructive, agitated, had delusions of death and at one time during this period she attempted suicide by drinking iodine. Admitted here September 23, 1931. Diagnosis of manic-depressive, manic type, offered. Her condition was desperate.
She had a poor heart, rapid pulse, exophthalmus, eye signs, tremors, low diastolic, moist skin, increased metabolic rate, hypertrophied heart; in addition she suffered from acidosis and developed carbuncle. Improvement was slow for a time, and then rapid progress; finally discharged April 6, 1932, residence in hospital being five charged April 6, 1932, resistance in hospital being five and one-half months. In both cases we have iodine in homoeopathic doses together, of course, with cardiac supportive treatment, anti-acidotic treatment, clysis, glucose injections, hydrotherapy, etc. with good results . At least the two cases survived.
We cannot go into the many physical symptoms arising from tissue pathology other than in the central nervous system which are found in our psychotics. Suffice it to say that we attempt in many such cases to find a drug that fits.
In depressed states drugs most commonly used at Middletown are ignatia, arsenicum album, phosphoric acid, cactus gran and baptisia.
Ignatia is probably more often prescribed than any other prescriptions. Butler, Talcott, Boyal and others referred to arsenicum album as most often indicated, the features of this drug being pale face, pinched appearance, emaciation, pallor, ceaseless restlessness, marked agitated depression, mental anguish to point of frenzy, moaning and groaning, self- destruction. Ignatia fits the silent, brooding, seclusive, depressed cases. They are usually quiet, timid, fearful, irresolute, and suffer from insomnia and impotence with sex desires.
Phosphoric acid is given in those cases with anxiety, sadness, grief over a love affair, inclined to weep, physical exhaustion resulting from masturbation.
Baptisia is given in typhoidal-like states.