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.
The following case illustrates the good effect of ignatia in depressions.
R.W., aged sixty-one, white, male; occupation that of practical nurse. A quiet, pleasant personality who suffered several depressions earlier in life which did not necessitate hospitalization. In the beginning in 1932 he suffered a severe depression which persisted for six months, made voluntary application here August 15, 1932, and was accepted. Diagnosed depressed type of manic depressive. His mental symptoms called for ignatia. He stated that the drug helped him a great deal.
It had relieved him of his nervous, jumpy feelings and of his insomnia. He went home recovered June 30, 1933. For a time he was in good shape. On December 14, 1934, he came back to the hospital with same complaints. The depression came on six weeks previously. He requested the same drug which he stated had helped him previously. This was done with an improvement of his symptoms. In this case we cant tell whether the security and relief be obtained from the institution was projected onto the drug or whether the drug resulted in his improvement. The drug could have well been a rationalization of the sense of relief he obtained from institutional protection.
The next case of depression is a rather interesting mixture of psychogenic and organic factors, this case being helped by calcarea carb. and iodine. M.P., white, female, aged fifty-one, married, one child, had attack of manic excitement in 1916 which lasted three months. Last year, in worrying over her husbands financial troubles, she became obsessed with the idea that she had concentrated a disease and was infecting others. Had many ideas of bodily changes. Feared her body was rotting away. She spoke of death.
AT night was seized with nightmares during which impulses to kill he son who she feared was going to be kidnapped, overwhelmed he. Calcarea carb. was prescribed Physically, a goitre and signs of hyperthyroidism were found. In this case there was an unconscious rejection of her body, and on this account arose guilt feelings, in the form of self-accusatory ideas and considerable anxiety. Mixed in this picture was also a sense of reality and misinterpretation of environment which we attributed to the organic state produced by hyperthyroidism. This was combated with small doses of iodine. Patient in two weeks and rid herself of all her abnormal ideas and was normal in all respects. Within a month she was home.
In the psychoneurosis we have at our disposal a large number of remedies depending on the character of the obsessions and fears and where the somatic pathology is fixed. What we do here, as in other of our so-called functional cases, is to divorce or abstract from the totality of individual reaction those mental symptoms and other characteristics of the patient and dry to approximate it to a drug giving similar symptoms. It would appear that the tissue alteration and general defense reaction which characterizes the drug would be nullified because of the apparent nonexistence of tissue pathology.
This fallacy can be explained only under the presumption that we postulate the existence of such pathology, in a form that can be only subjectively received but not objectively recognized. At present we have followed the policy of the mental aspect of the patient. If he has somatic complaints we try to correlate still further by finding a drug giving similar somatic symptoms.
For example, we given nux vomica for hypochondriasis, persons who are irritable, sensitive to external stimuli, noises odors, and lights, and if they complain of gastric symptoms, sour stomach, etc., the remedy becomes more fitting. It is also given for alcohols who have similar mental symptoms and who we know have sour stomach, etc. It is obvious that in the latter cases the drug should be and is more of value. The results we obtain in the psychoneurosis are purely due to the suggestion or psychological effect of the drug.
It has an advantage over the placebo in that we possibly may hit a remedy whose total symptomatology may conform to the totality of the organismal reaction. An other point is that in the placebo prescription the patient frequently becomes aware of it, becomes disturbed over the trickery and loses confidence in the physician, whereas, in our prescription they actually taste the medicine.
Some of the drugs commonly prescribed are aconite in combating numerous phobias; anacardium in neurosis produced by excessive mental stain with symptoms of anxiety, despair, fear of future, forgetfulness , inability to concentrate, nervous indigestion. Calcarea carb. for those who are apprehensive; fear of death, of misfortune, of losing their mind., of contracting a disease; nightmares,the obsessive type. For neurasthenia- ignatia, phosphorous; Kali phos. and strychnine phos. are more often prescribed.
For insomnia, some of the drugs we use are ignatia if sleep is due to sadness and worry; arsenicum if it is due to multiple neuritis; zinc met if, as Talcott said, “When prolonged mental overwork and close confinement have produced a state of forgetfulness; mental weakness, inability to apply the mind, broken and unrefreshing sleep.” Following is a average result:
MANIC-DEPRESSIVE ADMISSIONS DURING YEAR BEGINNING JULY 1, 1931, AND ENDING JUNE 30 30, 1932
Ist Admission Readmission Total.
