Hahnemann’s concept of mental diseases

smileHippocrates was the first to identify and name the phenomenon as a disorder of the mind with its seat in the brain.

Samuel Hahnemann has also paid a lot of attention towards the understanding of mental illness. In fact he was one of the first physicians to see the mentally ill patients as “sick individuals” requiring empathy and proper medical care (Haehl, 1995). According to him, the mind and body are not two absolutely separate entities but they form an indivisible whole inseparable in fact but distinguishable by mind for easy understanding. In natural diseases the physical disturbances are often found associated with their mental counterparts. Illness is the result of biological as well as of physiological events.

Certain stresses set up discharge themselves along the various peripheral nerves leading to development of somatic symptoms or certainly in the mind leading to changes in the personality. In some cases one outlet is chocked as it were and main outbursts takes place through the other outlet. Thus in extreme cases we find either purely physical diseases or purely psychological disturbance without any concomitant physical changes. To understand such mental diseases, one should try to get the full picture of disease comprising physical and mental symptoms through careful past history and case taking.

There was a middle period where the demonic concept of the mental illnesses again dominated but this was soon replaced by the modern concept of disease during the period of Renaissance, which has been gradually modified according to newer concepts and understanding to the present day concept. With the formation of medical societies and the standardization of diagnostic criteria a somewhat logical pattern has determined the classification of Mental Disorders. Although it is standardized, the classification is changing with the changing criteria of diagnosis. The earlier classification was based on the concept of Psychodynamic disturbances i.e. Psychotic and Neurotic; on the basis of causes, i.e. Endogenous and Exogenous; Primary and Secondary; etc. It is now being gradually replaced by the understanding of the “Clinical Syndromes” consisting of group of symptoms that are the hallmark of each specific type of mental illness. This change is very clearly evident in the changes seen through the editions of the DSM classification (DSM II to DSM IV). (Ballis, 1978; DSM IV, 1991)

Systematization of any branch of human knowledge presupposes classification. Classification is a mental grouping of facts and phenomenon according to their resemblances and differences, so as best to serve some purpose.

Classification is extremely important and will help in the understanding of the phenomena and guide in developing specific therapeutic measures to deal with the specific conditions.As a Homoeopath, understanding the nature of these illnesses helps us to plan our therapeutic measures and gauge the need for the use of different forces – medicinal and non-medicinal.

Hahnemann (1996) has classified mental illnesses in a rather different way. Though the Hahnemannian classification seems to be archaic, its application to the cases has remained crucial in determining a successful outcome. Hence a study of the relationship between the Hahnemannian classification and the modern one becomes important to our daily functioning. We need to explore the application of the principles of management of the mental illnesses as stated by Hahnemann in the Organon of Medicine.

In the Organon of Medicine, he has given a detailed classification about the four types of mental illnesses.

§     First one is where the Mental and Emotional disease begins as a corporeal disease. In due course of time the bodily symptoms disappear and the mental symptoms dominate. This is called the true one-sided illness.(sec.215)

E.g. A case of chronic colilitis becomes eventually transformed into hypochondriasis.

§ Where a life threatening illness suddenly transforms into mental illness (insanity or melancholia) and the threat to life no longer looms large is classified under the second type.(sec 216) He gives clear instructions regarding the management of these different types of mental illnesses as regards the use of acute/phasic or deep acting anti-psoric (anti- miasmatic) remedies. This group of the disorders finds a separate place in the classification of disease proposed by him.

§ Some times Insanity or Mania comes in the form of an acute onset syndrome which may be caused by sudden fright, vexation or drug abuse. (sec 221).

§  The mental illnesses that originate in the mind and not as a result of corporeal illness create inroads into the body and significantly affect it so as to cause bodily disease.

They are maintained by psychical factors viz. continued anxiety, worry, vexation, wrong and frequent occurrences of great fear and fright. If these remain for a long time, they destroy the body to a great extent (§ 225). These illnesses are in their early stages i.e. when they have not affected the body to a great extent, are amiable to any kind of friendly advice or changes in diet and regimen. They can revert to normal with these measures but still require an anti-psoric (deep acting) remedy to prevent a relapse as they are invariably of  psoric origin.

Thus we need to bring together the two very different concepts-one rooted in modern syndrome analysis and the other based on a philosophical approach. We should try to derive the practical implications of this understanding.

A)If mental affection proceeds from one or more factors belonging to psychological conditions, that will be improved by “sensible friendly exhortations, consolatory arguments, serious representations and sensible advice”.(sec 224)

B) If the mental affection depends on a bodily disease it will be aggravated by the same measures.

Management of mental diseases
During Hahnemann’s time mental cases were reckoned as cursed cases often suppressed to be possessed by evil spirits ; and so all the oppressive methods were applied to the patients in the lunatic asylum. The credit of adopting humane methods in the management of insane persons certainly goes to Hahnemann. Hahnemann with his phenomenal genius and clear intuition anticipated the broad principles of psychotherapeutic methods necessary in some cases and also differentiated those cases which called for judicious combination of psychotherapeutic and anti-psoric drug therapy.

A) In mental diseases resulting from bodily diseases and later transformed into one sided diseases  — treatment consist of a judicial combination of anti-psoric drug-treatment and psychotherapy with carefully regulated mode of life and an appropriate psychical behavior towards the patient on the part of physician and attendants of the patient.(Sec 228)

Eg. Raving madness should be met by calm fearlessness and firm resolution.
Loquacity should be listened to in silence, its some degree of attention.

B)  In mental diseases originating predominantly from psychogenic causes and if they are of recent origin – psycho-therapy should be taken recourse to. The physician to the patient should not only be his prescriber, but also his friend, philosopher and guide to keep the patient to resolve his complexes and revert to healthy growth and development of his personality.

C) The third type of mental diseases are to be treated exactly in the same line to what is followed in the treatment of acute diseases, attacking the individually, which are generally only a transient explosion of latent psora. These conditions should be treated by superficial (acute) remedies and not by Anti-psoric (deep acting, constitutional) remedies, in order to subdue it so far that psora shall for the time revert to its former latent state. The latter should be instituted when the acute episode has been adequately dealt with by the acute remedy to prevent a relapse (§ 221, 222, 223 )

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