How to overcome the difficulties in converting mental symptoms expressed by the patient into the language of repertory and which are the reliable methods to avoid the problems in interpretation
Dr Girijakumari R
PG Scholar in Organon GHMC Calicut
Every real follower of Hahnemann ought to know what he is said in his Organon from the first to sixth edition, about the importance of mental symptoms, and it is given in Aphorism 88 ,208,211,212,213 and 253.
Aph 88 : If in this voluntary narration nothing has been mentioned respecting his mental state, the physician can use general expressions, so that his informants may be obliged to enter into special details concerning them.
Aph 208 : Personal history along with the state of his disposition and mind must be attended to, to learn whether that presents any obstacles to the treatment or requires to be directed encouraged or modified.
Aph 211 : Mental disposition determines selection of the remedy
Aph 212 : Each medicine brings change in state of mind and disposition, and every medicine does so in a different manner
Aph 213 : Selection of medicine in mental disease should be based on changes in the state of mind and disposition.
FN : Aconite never effect a rapid or permanent cure in a patient of a quite, calm, equable disposition, Nux vomica not serviceable where the disposition is mild and phlegmatic, Puls where it is happy, gay and obstinate or Ignatia where it is imperturbable and disposed neither to be frightened nor vexed.
Aph 253 : Signs of improvement.In case of ever so slight an improvement we observe a greater degree of comfort, increased calmness and freedom of mind , higher spirits- a kind of return of natural state.
BODILY SYMPTOMS CONNECTED WITH THE MIND
Ailments from emotions and exertions of the mind like
- Happy surprise
- Complaints after laughing
- Fright and fear
Eg : A little girl was accidently wounde by a pistol. Her mother suffered mental shock,paleness and faintness , especially on attempting to sit up: great concern for the result. Relieved after a dose of Aconite. (J.C.Morgan)
- Shock of injury
- Home sickness ,nostalgia : feels homesick when at home with her family -Eup purp apprehension ,sad ,homesick,weeps : mag mur
- Love pangs
- Jealousy : A very irritable lady, suffering under the most violent and threatening nervous symptoms, even spasm; had hectic fever, sleepless night and her mind was nearly deranged;disturbed by unfounded jealousy. After one dose of Hyos 30c , she soon was well and remined so. E.Stapf
- Grief and sorrow
- Better in company and better when alone
- The talk of others increases the suffering : A child 3 years old, apparently well, waked often from sleep with a scream, and continued to cry: the more they try by persuation to quiet it, the worse it gets: Calc ostr.did not help much; after calc.phos the spells ceased altogether.LIPPE
- After mortification
( Analytical rep of mind Hering ) Case taking :
- Ask questions in the opposite direction. If you want to confirm that the patient is really mild, you ask him: “Do you get angry?” Often, even a mild patient will say: “Yes.” Ask him next: “When did you last get angry?” A mild patient will think a lot and tell you: “Seven months back.” Ask him: “When did you get angry before that?” Then he will really have to exert his mind to remember such an incident. Or, for example, ask a patient who you think is very sad: “When do you remember being very happy?” A sad person will be able to give you only two or three such instances in his whole life. It means that it requires a very, very joyous occasion for him to be happy. Sometimes, even these occasions produce no reaction. If you think a person is a coward, then do not ask him anything about his cowardice. He may straightaway say “No”. Ask him to give some instances when he stood up to someone and fought back. These instances will be very rare in the life of a coward.
- Always confirm symptoms from relatives and friends. Observe the expression on the face of the person accompanying the patient while the patient is narrating his symptoms. You will often find an involuntary affirmative nod of the head or a shake of denial if the person agrees or disagrees with the patient’s evaluation of himself. Sometimes you can turn around and ask the accompanying person if he agrees or disagrees with what the patient has said. This is best done when the patient is out of the room.
- Never accept what the patient says at face value.
- Look at the hidden expression behind the symptoms. See the way a symptom is expressed. You ask the patient: “Have you any fear of darkness?” He says: “Never, never, never. I have never had any fear in my life. I can walk in the darkest and most deserted streets at night and I have absolutely no fear!” This is to be taken not as absence of fear but as boastful behaviour.
- The symptom expressed with spontaneity, clarity and intensity is of highest value. So, watch out for symptoms which go beyond the direct response to specific questions. For example, if you ask a patient: “Do you weep easily?”, and he answers: “Yes, especially when I see others suffering!”, there you can get a hint that the patient is sympathetic or sensitive.
- Before finalising a rubric look for the components of the rubric, which means what makes him to behave in a particular manner.
Eg: If a person is very industrious, working even after office hours and during holidays, then we have to question what is making him like this. It could be due to his conscientiousness or due to his anxiety if a time is set, or it could be that he feels better from occupation or that he is very business-minded and ambitious or that he just wants to avoid the company of people, particularly his family.
- If the patient is markedly irresolute, this symptom will be best elicited when you ask him about cravings and aversions. It will take him a long time to answer because he has to come to a decision, and not simply state a fact.
- Try to confirm the essential parameters of the person. These components will be the same in all situations, only their expression will be different. So, you must use your imagination as to how these essentials could manifest. For example, if you think a person is timid when appearing in public, ask him about all the possible situations where this could become evident, like public speaking, parties, etc.
- Try as much as possible to avoid asking the patient directly about his nature. Try to lead him through other questions to express it without being conscious of doing so. In South India there is a proverb that we must go in as smoothly and inconspicuously as a needle in a banana.
- If you cannot elicit characteristic symptoms in the patient’s present state, you have to go back to the time when the last characteristics existed. You can look for this in three situations: – Characteristics after a stressful situation; – Characteristics of illness before medication; – If both are not present, then elicit the characteristic features of the patient in childhood.
- Use a standard questionnaire form which asks questions about the patient’s past history, present complaints with modalities, etc., personal and psychosocial history. Sometimes the patient can express some problems more freely in writing. It gives you the chance to go directly into homoeopathically relevant questioning rather than losing time in irrelevant details, for example chief complaints, treatments, etc.
- The expression of characteristics can often be easily provoked. For example by making the patient wait beyond his time of appointment: Is he patient or impatient, mild or rigid, or is he restless or calm?
- Beginners in Homoeopathy often feel the need to put question after question; especially if the patient stops talking, they immediately ask the next question. This should be avoided. Most patients bring out the best symptoms if you give a pause after the answer. When you ask a question, the patient will give an answer immediately. After this, if you give a pause, he will think about his answer and then may modify or even completely change it. Sometimes, he may say something very spontaneously and this may be most significant. So, a pause means a doctor is telling the patient: – I am not trying to get answers but I want to understand you. – Tell me everything. – I want to know and I am going to give you enough time.
- Look for the reasons for the patients reactions.For that we may have to enter into patients life history. Feelings and reactions make two components of the same person’s state of mind.
Example : a patient complains that he/she is not getting better. From questioning it had found that from childhood onwards her father giving more attention to her sister than her. In that situation we can select Lamenting,appreciated, she is not, Quarrelsome, Jealousy.
- Dreams are concerned with how we feel about the situation as it is, and some dreams reflect the situation as we would like it to be (fantasy). So, when we get a dream that gives pleasure, the opposite of it is our real feeling. Only a beggar needs to dream that he is a king; the king has no such need. When somebody dreams he is a king, it means he really feels he is a beggar. Only through repeated unexplainable dreams can we infer their significance and understand the feelings behind them.
- The patient should feel that the doctor is someone who cares, whom he can trust and to whom he can reveal everything: only then will he really open up.
- What the patient asks you is more important than what you ask him. Many symptoms like anxiety about health, superstitious fears, fixed ideas, suspiciousness or impatience, can be easily judged from the patient’s questions. For example, if you visit a patient with a high temperature who says: “Doctor, how soon will my temperature come down, so that I can get back to my business immediately?” The patient has a high temperature, lack of appetite, tremendous weakness and the whole family feels anxious about his health, and his only question is when he can join his business again. That becomes a highly characteristic feature of him.
- If you come to a dead end in case taking and just do not know how to make the patient talk, just ask him to describe one typical day in his life, his routine from morning to night, you will find many leads from this narration.
- Ailments from : Various disease conditions are caused due to different reasons which are enlisted below. A patient suffering may be due to anger,anxiety,fear,fright,reproaches,sadness,sexual or mental work.
For example, if the father of the patient dies of cancer and he reacts to it by visiting several doctors, the rubric is not “Ailments from grief” but “Ailments from fright”. So, the “Ailments from” is not to be taken from the actual incident but from the expression.
It begins right from the time the patient makes the appointment, or when you meet him outside the clinic situation. Observation has to be totally unprejudiced, which is why Hahnemann used the expression “unprejudiced observer”, and by so doing, he laid down the most difficult condition. observe what is it in this person that makes him an individual, what is it that makes him different from other people. Observe how he conducts himself, how he has filled in the questionnaire, how punctual he is, how he is dressed, how he enters, how he sits – at the edge of the chair or behind, what his hands are doing, what his feet are doing, his facial expressions, his manner of communication and how he reacts to the person he has come with. Every single thing has to be observed: his movements, his postures, his speech, the way he explains himself and what atmosphere he creates in the room. None of them really indicate the remedy, but the state and frame of the patient’s mind. This will be confirmed by other information later, but during this initial observation, looking and feeling are important.
One good way to begin an interview is to put your observation back to the patient and ask him if he is experiencing this. From here you can get straight into the heart of the case. For example, you might say: “You seem to be tense, what is bothering you?”, or “You seem to be in a hurry.” He is caught unaware and the answer spontaneously jumps out; now, if you attempt to go behind the answers, you will straightaway find something very deep in his personality.
Hahnemann wrote in Aphorism 211 about observation: …” characteristic symptom that can least of all remain hidden from the accurately observing physician.”
Mode of narration of complaint
We need to observe the words that the patient uses to describe his complaint. Sometimes this comes out by itself from the casual remarks of the patient, but most often from the patient’s questions and doubts. Different people will react to the same illness in different ways and this will be in tune with their mental states.
Eg : One has to ask further and further non-leading questions. For example, if there is anxiety about health, we have to find out why there is anxiety about health.
Accompaniments to the suffering
Symptoms should be noted during suffering of the patient and in patients own language . Hahnemann said in Aphorism 84 that the physician Sees, Hears and remarks by his other senses what there is altered or unusual character about him. Lesser accessory symptoms should be noted in chronic diseases. Master Hahnemann detailed about it in Aphorism 95.They are very pregnant with meaning(characteristic) often very useful in determining the choice of the remedy.
Interests and hobbies
Are noted too, because it sometimes gives clue to the patient mental makeup.
There are certain things which the patient does that will characterize him. We get those information from the relatives.
Eg : relatives say that he cannot wait for more that a minute .. and relative says he is so restless, he typically gets into the wrong bus since he cannot even wait to see if he is getting into the right bus.
More particulars about single symptom
We have to go from the general to the specific. That he is an anxious person is more important than what his anxiety is about.
If a person gets angry easily,We ask: “When do you get angry?” “I get angry after sleep”, the patient replies. “Anger after sleep” is the rubric we may select.Here we may make a mistake since the anger might have some reason such as his neighbour making a lot of noise in the morning, and his helplessness about it. In this case, “Suppressed anger” is the more appropriate rubric.
Master Kent has given a pamphlet of symptoms on mind in his book “what the doctor needs to know inorder to make a successful prescription.”
- How is your memory?
- For what is it poor?
- At what time is it poor?
- Do you remember what you read?
- Do you read with interest and pleasure?
- Can you apply your mind easily?
- In what way is your disposition changed during sickness?
- Are you mild, easy, gloom,hopeless, obstinate, irritable, snappish,petulant,sullen,cheerful, or happy or in what way is the disposition affected?
- How does the future look to you? Etc….
The whole of this pamphlet is merely suggestive. He mentioned that give your case in your own language carefully and fully.
METHODS IN NUTSHELL VIEW
How to overcome difficulties in tracing the mentals symtoms :
- Extract mental symptoms by Skillful observation. Eg : the way of patient entering the room, how he kept his files, restless or patience while waiting for his turn.
- Confirm mental symptoms from friends and relatives. Observe expression of the patient’s friend and relatives while patient narrating the symptoms.
- Ask about mothers state during pregnancy.
- Ask about reactions in various life situations.
- Occupation and area of work are to be noted.
- How about relationship with friends,wife, family and social.
- Rapport should be developed between doctor and patient, so that the patient can trust and to him he can reveal everything.
- Ask the question in opposite direction.(don’t ask are you sad instead that ask please narrate about good memories of past).
- Ask about dreams that are repeatedly occuring.
- Take the mentals only when they are relevant and also that must be peculiar to the patient.
- The symptoms that can be explained by pathology, therefore become common symptoms. The symptoms that are common to schizophrenia, even though they may be mental symptoms, are mental disease symptoms, and therefore do not taken for repertorisation. The mental symptoms that do not depend on schizophrenia, and which would have persisted even if he did not have schizophrenia, are the symptoms taken into consideration.
- Converting life situation of the patient into the language of repertory or materia medica. Extract mental symptoms by observation.
Eg: complaint started after history of torture in husband’s house, here we can take the rubric Indignation
- Take the mental symtoms only when they are peculiar to the patient, and expressed with spontaneity,clarity and intensity.
- Priority in selection of mental rubrics are given to those symptoms having a causative modalities.
BAD news ,ailments from : the senses of a person are so acute or sensitive that he acquires some ailment from listening any bad(distressing) news. Eg: a person gets fits after hearing the news of death of one of his relatives
- Physician should able to differentiate the close running rubrics.
- Qualified mental symptoms are more important, which means the mental symptoms associated with physical complaints. Eg. Anguish : anxiety with physical suffering / to distress oneself suffer intense pain or sorrow within himself.
A lady has some menstrual problem and so she becomes anguish before menses.
A person does not pass his stools satisfactorily which causes annoyance to him before stool.
HOW TO DIFFERENTIATE CLOSE RUNNING RUBRICS
There are many rubrics in repertory that having similar dictionary meaning, but are totally different in repertorial language. This rubrics can only be used by those who are knowing the correct interpretation of this rubrics for selecting similimum. Here Iam giving some examples :
Jealousy and Envy
Jealousy is a feeling of covetousness of the possession by others with malignity, if somebody is in possession of something or the prosperity of others is not tolerable.
Eg : the person having a malignant feeling if his neighbour has purchased a motor cycle even if he is having it. In so many other aspects also his feelings are of this type.
Envy is a state of covetousness of the prosperity or possession of others. A desire to have the same prosperity or possession which others are having and the feeling and efforts to achieve.
Eg : a lady is generally sick on one or the other score because she is so watchful to her neighbour that whatever she sees with her, she also wants to acquire the same and is always thinking to possess it even though her sources may be limited.
In jealousy prosperity of others are intolerable and is a negative one, while in envy there is only an increased drive to achieve the prosperity of others and it is a positive one.
Avarice, Miserly and Covetous
Avarice is an insatiable desire for wealth or gain. By all means he is always in search of increasing his wealth and possession..
Eg : the patient is always active and not been tired for increasing his wealth and possession. The height is that he may have enough or sufficient for him and his family’s needs yet he is desirous to acquire more and more (more than what he needs).
Miserly is a great desire to save money even from occsions where it is considered necessary to spend. Here the person who hoard money out of avarice and prudence.
Eg : A person is so miserly that he does not want to spend money even on the death ceremony of his mother.
In Covetous there is a deep desire to own wealth or possession.
Eg : a person who wishes to acquire more and more wealth or possession.
In amorous the person is strongly moved by love especially sexual. Greatly attracted towards sexual matters, even in thoughts or dreams. Here practical indulgence is not important but it is the diversion of mental energy towards that side.
In lasciviousness there is excessive desire for lachery. A tendency to have too much desire for sex or always devoting his energy towards this type of lustful desire.
Lewdness , a mental tendency of being lewd or remaining without clothes or exposition of the body or body parts. This is a involuntary act.
Shameless, implies a lack of modesty, decency, respect for others. Devoid of shame and insensible to disgrace. This is a voluntary act.
Naked , wants to be : here the person is generally in the habit of remaining naked despite many advices.
Insanity, imbecility,Idiocy and foolish behaviour
Insanity : madness or unsoundness of mind, lack of understanding that prevents one from having the mental capacity required by law.
Imbecility: feeble minded person with defect in mental ability. One who does not have any sense of humanity or way of life.
Idiocy: Extreme mental deficiency commonly due to incomplete or abnormal development of brain. It is is worse than imbecility. In foolish behaviour there is no deficiency of brain. Fear and anxiety
Fear is an unpleasant emotional state characterised by something involving the nervous system creating an anxious excitement as to what may happen.
The difference between anxiety and fear has to be understood clearly. In anxiety, there may not be any apprehension of something untoward to happen which is definitely felt under fear.
Eg : a person is suffering from fever, and during the course of fever, he feels that he may not get well and may die. This is the fear of death.
In anxiety he/she experiencing a strong or dominating blend of uncertainty, agitation or dread, and brooding fear about some contigency; uneasiness.
An abnormal and overwhelming sense of apprehension and of fear often marked by such physical symptoms as tension, tremor, sweating, palpitation and increased pulse rate.
Absorbed,Brooding,Dwelling Absorbed , buried in thought :
Looking obviously engaged or occupied in thoughts. The type of the thought is yet to be ascertained whether the thoughts are religious, the person is worshipping or thinking anything else, so that the appropriate rubric can be used.
Eg : when the physician ask something about the patient will simply stares before him. It looks from his face that he is thinking something which is a fact.
A state of mental gloom or depression over something with constant thinking.
Eg : a person who has felt much offended due to some provocation and his emotional level feels much disturbed mentally, does not disclose it to anybody. Since that feeling is not removed the person goes on brooding.
Dwells on past disagreeable occurences :
Here the person is always talking or complaining about his past suffering or complaints about somebody..
Eg : sometimes the patient complains like this ” so and so harmed me at that time, I suffered this loss before 10 years and so and so had always been a cause of trouble for me or god has not favoured me at such and such time due to which I suffered like this.
Forsaken feeling, Forsakes his own children and Deserted
Deserted is a condition where one feels much attached mentally but he/she has left him uncared or unattended, a feeling of being deserted arises.
Forsaken is a constant feeling of being neglected. It may be friend, relative, kith and kin. Here the person is constantly having a feeling that he has been or is being neglected by his children and nobody cares for him.
Forsakes his own children, here the person is so much disturbed and dissatisfied with the behaviour of his own children due to certain reasons that he leaves the house and reside elsewhere, which becomes the cause of his sickness.
Exaltation and Exhilaration
Exaltation is a marked or excessive intensification of a mental state or of activity of a bodily part or function.
Exhilaration here the person feels very happy; an exaggerated feeling of pleasure which can be judged from the action of that person.
Exaltation is in respect of the feeling a person is already having and exhilaration is in general.
Timidity and Bashful
In bashful the person is inclined to shrink from public attention due to shyness. When a person is so shy that he cannot appear before public or escapes the notice of others he is regarded as a timid person.
But in timidity there is lack of courage and venturesomeness and a tendency to the safe, accustomed, unobstructive way. He is always keeping away for fear of facing a person or situation.
Abusive,Cursing and Swearing
Abusive is used for persons in the habit of employing harsh,insulting language.Person while telling the symptoms uses words generally used for abusive. These words are used by him as a routine as he is in the habit of using such words. He may be abusing the physicians who treated him earlier.. Cursing is a solemn pronouncement or invoking doom or great evil on one; an imprication for harm;any utterance marked by malafide intention for someone.
Difference is that cursing is due to some provocation by somebody or some provocative ideas , but the abusiveness is the nature of a person or it can be a changed mental state without the involvement of any other faculty.
Hurry,Impatience and Impetous
Hurry is the excessively hasty ; disturbance of mind with a turmoil to hurry up; a state of eagerness or urgency. Here the person will always reach his appointment earlier than the scheduled time.
Impatience is a state of restlessness or eager desire or longing to achieve his goal at the earliest.
Devotion of all mental faculties to one’s goal in the shortest possible time with utter eagerness.
Impetous is marked by force and violence of movement or action, impulsively vehement in feeling.
Acting with headlong energy.
In hurry a person wants to do things in a haste and there is no excitement. In impatience person is mentally restless. In impetous he is violent in achieving his goal.
Irritability, Anger and Rage
Anger is a strong feeling of displeasure and usually of antagonism.
Irritability that which causes irritation in one’s mind. To feel something disagreeable to one’s mind.
Eg : many childrens become irritated during dentition period.
Rage, here the person act so violently, to move wildly or turbulently and spread with destructive effect.
Contradict disposition to, Contradiction intolerant of, Contrary
In contradiction disposition to there is a tendency to oppose or contradict the speech, action, or version of anybody with argument and by using his intellect.
A person who is contrary will oppose whatever is said before him by somebody without applying his intellect due to his obstinacy and nature to oppose.
In contradiction intolerant of ,the person cannot tolerate any contradiction to what they have said or in whatever action they have taken. This intolerance is not supported by anger
Aversion,Disgust,Hatred and Misanthropy
Aversion is a firmly settled and vehement dislike. It can be in various conditions, like with family members, relatives, friends etc but when he feels aversion to anyone of them , he does not like or care even to talk with such a person.
In disgust the person experience intense dislike for something; to lose an interest or intention through exciting distaste.
Eg : a person meets with failures again and again, feels disgusted and stops further efforts.
Hatred is a settled dislike with prejudiced feeling for a particular person or aspect.
There is a hatred feeling towards all mankind, group or a particular community in Misanthropy. Hatred is applied to some particular individual or affair etc , but misanthropy towards total mankind.
Delusion,imagination,hallucination, and illusion
Delusion is an idea or thought which a patient thinks it is true but cannot be reasoned.
Eg: a person says that his family members do not care for him which is not corroborated by facts.
Whatever the patient supposes in his mind is Imagination.
Eg: a person feels that his chin is too long or he is a girrafe.
Hallucination is the apparent perception of an external object when no such object is present. Eg: a person sees people around him with malafide intentions, but in fact there is no person yet he insists that he has seen people.
Illusion is the false perception. An appearance in the vision or mind which the patient knows is not true.
Eg: a person complains that while sitting in the room some robbers come and threat him but on the other hand he knows that this is wrong yet he feels so.
Heedless and Indifference to suffering
Heedless not taking heed. Unaffected by any sort of advice or warning but without understanding any consequences thereof.
Eg : a person suffering from cough with bloody expectoration , he has been advised by the physician to have an x-ray done but he pay no heed to this as he is so careless and does not understand its consequences. While in indifference to suffering, the person is indifferent despite knowing everything about his disease he does not like to take any action.
Kill desire to and Killed ,desired to be
Kill desire to is a mental disposition to think about killing someone. This feelings are not intentional but involuntary.
Killed desire to be is a mental condition when a person feels fed up with his life he wishes that he should be killed.
Jesting, Mirth and Humorous
A person with full of or characterised by pleasant, funny or jocular state of mind. The person is so jolly even in so tense circumstances also he may cut jokes or may be looking cheerful , here we can take Humorous.
Jesting is a disposition of cutting jokes; talking in a such a manner that the person who may be nearby cannot control their laughing.
Facetiousness is the art of cracking excitement or laughter. Here the person transforms the material for laughter but in jesting the feeling automatically comes from within.
Mirth means an excessive feeling of happiness which may not be found in other normal persons. Eg : a person is suffering from fever but he is found to be so happy that he was like that when he had no fever. This is a deviation from normal happiness.
Rudeness and Insolent
Rudeness implies general and habitual deficiency in manners, grace, or polish or coarse intensibility to another’s feelings.
Insolent : the person is of such a disposition that lacks usual or proper respect for rank or position; presumtuously disrespectful or familiar towards equals or superiors.
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