Notes on the Mental and Emotional Symptoms

Introduction

Many of the cases that homeopaths see today include a strong psychological component. In the last 20 years, Homeopathy has advanced largely through developing and refining our understanding of the mental images of remedies. This development has expanded the number of remedies used and allowed us to interpret cases more precisely.

However, as a result of this development we find many prescribers looking almost exclusively at mental and emotional symptoms, to the exclusion of physicals or generals. One hopes always to get to the "essence," the "core delusion," the "center of the case," even if the patient does not present with any particularly strong mental symptoms.

I have particularly seen this with students, who have the idea they must always dig into the patient's psyche to find some nugget of emotional discord. They feel that unless they get to the core of the person's state, the remedy will not be found, and that the core has to be in the mental domain. They may dismiss the symptoms that most concern the patient as relatively insignificant compensations of the vital force.

However, as we know, all symptoms represent the center of the person. Nothing is separate, all is connected, and physical symptoms can express as much of the "essence" of the person as mental symptoms. The key is in seeing what is unique in each case, assessing the value of every symptom as it relates to the totality of the patient's symptoms.

The difficulty of distinguishing between our observations of the person's basic nature, and mental symptoms reflecting an imbalance or a compensated state, can lead to great confusion. As their connection is obviously an intimate one and we use both aspects to find a remedy, it is a subtle process to evaluate what is useful. The lack of clarity, however, often results in a degree of projection and interpretation of the individual's words or behavior that can easily lead us astray.

It is also easy to prescribe polycrest remedies based on a loose archetypal image of the remedy's psychology, without any confirming keynotes or general characteristics. Remedies such as Pulsatilla, Lycopodium, Sepia, etc. can easily be justified for many people, based on common personal traits, but is this method precise enough? Conversely, we may only find less common remedies by focusing on a simplistic "essence" image, hampered by the lack of confirmatory keynotes for the remedy.

The following article, based on a lecture given to homeopathic students, explores some issues related to our use of mental and emotional symptoms in prescribing. Practical aspects of how to use mental symptoms are discussed, as well as the potential pitfalls of overemphasizing them. We'll begin with a summary of the process of casetaking, and consider at which point one should explore the patient's psychological condition.

The casetaking process

When taking a case, always let the patient state everything they have to say before starting to ask specific questions. Ask if there is anything else at least twice. Often people think they only need to tell you about the specific thing that concerns them now, and not about all the other things that ail them. Once they have exhausted what they have to say without prompting, review the details and seek more information, especially any particular or general modalities, and any concomitant symptoms.

As all the homeopaths have told us, a complete symptom includes location, sensation, modalities, and any concomitant symptoms. Concomitant symptoms accompany the chief complaint, yet bear no apparent relationship to the chief complaint other than this time-association. They represent the individuality of the person, not the diagnosis of the disease.

When a concomitant symptom displays a modality similar to that of the chief complaint, its importance increases. The further removed a concomitant is from the sphere of the disease, the greater its value in finding the similar remedy. The mental concomitants are of value in determining the remedy for physical ailments, while the physical concomitants assume importance in treating mental ailments. Concomitant symptoms can often remain constant through various conditions, and over a prolonged period of time. They are important because they belong to the person's constitution in a very basic and characteristic way.

After gathering all the details related to the person's spontaneous account, the homeopath has a choice of which direction to go in. I suggest that if nothing else has revealed a natural door to the next level, then go over all the generalities of the case. These include food, weather/temperature, menses, sleep, dreams, overall health history, birthing experience in women, etc. It is also useful to ask about the major body systems, even if nothing was offered, e.g. ENT, chest, stomach, abdomen, rectum, bladder, back, extremities, skin, perspiration, etc.

I recommend doing this before asking about the mental state, if nothing has been offered so far. It can seem abrupt to ask about fears, anxieties, and similar deep questions, right after the person has told you about some specific physical problem that is causing them concern. The more personal issues need to be explored carefully and gently. If a person is not volunteering information, it can often be appropriate to ask a general question about background, childhood, and relationships with parents and siblings. Asking questions framed in the context of their life story is better than open-ended existential questions about their nature, and often opens up a door for further conversation.

Many questions can be asked to explore the mental state and personality of a patient, and there are as many ways of finding out this information as there are patients. Some people propose creating a level of discomfort in the patient, pushing them to the edges and waiting for something significant to come out. Although this may be effective in some cases, in others it can be deleterious, and close the patient down, if not humiliate them. Another way is to create a level of comfort for the person, allowing them the space to talk about their life without feeling there is a particular agenda. This way feels more like a conversation, although the homeopath always has to maintain formality and direction in the interview.

Direct questions always have their place, though, especially when asking for basic information such as fears, anxieties, worries, grief, etc. I often ask, "Tell me about the most challenging event in your life." "Challenging" is a fairly neutral word to use. It is not loaded, and doesn't presume hidden traumas and neuroses.

If the patient reveals a significant emotional state near the beginning of the interview, or if such a state is the main reason for their coming, then it is obviously appropriate to explore it fully at the beginning. Even then, you may find it appropriate to leave an emotionally charged area for a while, and come back to it later. The temptation to dig as deep as possible, as soon as possible, can sometimes lead the patient to "burn out" emotionally, or to close down.

We cannot explore everything about a person in one interview; the idea that we always have to get to the core of a person in two hours is not realistic. Fortunately we can use many types of information to choose a remedy, and through the unique perspective of Homeopathy we can combine unusual physical and emotional characteristics into a specific holistic pattern.

The goal should be to find out as much as we can about a person's life, in a way that seems totally natural for the patient. A sincere interest, combined with sensitivity and an intuition for what is appropriate, will usually produce a good case.

Case analysis

When analyzing mental symptoms, distinguish between what is normal for the person, and what is abnormal and causes suffering. Abnormal conditions can include grief, shock, fright, violence, anger, rage, sadness, fear, etc. These states often begin with a specific cause or etiology. Both the etiology and the reaction to the etiology must be understood. Normal characteristics of the person include general likes and dislikes, hobbies, interests, what they studied at college, important things in their life, their family, career, childhood history, what they wear, the music they like, and so forth, in other words, the basic attributes of their personality.

Obviously the underlying personality and the reactions to difficulties are closely related. The former often provides the soil for the latter. However, when a powerful reaction has been caused by circumstances out of the person's control, the original personality or constitution of the person is less significant. For example, this might be true for survivors after being in a war zone, being injured in a car accident, or being raped. These very intense situations may often require "acute" remedies, the emphasis being on the etiology. Often remedies such as Stramonium, Aconite, and Opium are needed, even if the cause occurred many years ago.

Other reactions are more predicated on the basic personality, such as, grief over a loved one dying, mortification, indignation, censoriousness, sensitive to criticism, forsaken feeling, introspection, inability to express anger, grief, tears, intolerance to consolation, reproaching himself, guilt, uncalled-for anger, industriousness, idleness, optimistic, pessimistic anticipatory anxiety, etc.

The importance of these symptoms depends on the following factors:

Any limitations they impose upon the person. Remember, as some of these attributes have positive qualities to them, and are intrinsic to the person to some extent, it is important to know whether they are a real limitation. In other words, are they pathological states? In some cases, this is very clear, in others it is very subtle. The person may not even be aware of the limiting emotions and ideas.
The intensity of the symptoms in an abnormal mental state. If the person is experiencing more intense emotional or mental states due to a particular experience, then you need to know all about that state, including the modalities and concomitants. It can be important in these cases not to mix the more immediate "acute" symptoms with the underlying constitutional characteristics. They may not indicate the same remedy, like when a patient enters an Ignatia state, although their constitutional state may require some other remedy. In other cases, the same remedy will be needed.
The intensity of the physical symptoms and pathology. When there is chronic or acute physical pathology, the characteristic qualities of related symptoms cannot be ignored. In these situations, look for a connection between the physical symptoms and the constitutional symptoms on a general or emotional level. You can expect the best prognosis in a case when it all fits together. Look for modalities and concomitants that fit both the physical and emotional/mental picture. However, the physical modalities and concomitants may dictate the remedy. Characteristic physical symptoms may lead you to a smaller remedy with a similar emotional state.

If the emotional/mental symptoms of the person, both abnormal and normal, are aggravated by any physical or general condition, they thereby take on great importance as a special category of concomitant symptoms. Hahnemann refers to these in discussing the importance of symptoms on the mental level.

Comments on the significance of the emotional/mental state

Within the personality type of the person lie both the potential for health, evolution, integration, and for disease, delusion, and suffering. This is why we pay attention to the patient's personality. It gives us the "soil" information, within which we can gain an understanding of the whole person. At times, when pathology is expressing itself on a mental level, it may be in a way that is the opposite of how patients say they normally think, feel, or act.

We may see only one side of a person, and not see what they were like earlier. An acute crisis can provide a good time to see how the person reacts to difficult situations. This is why it is important to gain information on all experiences that really affected a person.

It is also important to distinguish between symptoms that are primarily emotional and those of a mental and intellectual nature. Dhawale outlines this distinction clearly in his book, Principles and Practice of Homeopathy:

"The intellect determines the capacities of an individual; the emotions determine their free expression. Symptoms that express themselves more purely on an intellectual level may not have a direct emotional link. Some intellectual symptoms may be due to a history of physical trauma, like a head injury, or some genetic limitation, or reflect a level of deep pathology within the physio-psychic functioning of the whole person.

"The following can be said to be functions of the intellect:

a. Perception of the environment - this includes sensory perception and that of discrimination and interpretation.

b. Formulation of ideas, thoughts, concepts, systems.

c. Memory.

d. Discrimination - the freedom of choice indicates the ability to distinguish between right and wrong.

e. Action - volition in the direction of choice."

"The following are symptoms of the intellectual level:

a. Aberrations of perception and disturbances of formulation: hallucinations, illusions, delusions, ideas, thoughts, confusion etc.

b. Disturbances of memory

c. Disturbances of discrimination and volition: confusion, indecision, impulses-destructive, suicidal, homicidal, guilt complexes, etc."

It could be said that at the highest level of evolution, the intellect controls the emotions, allowing full discrimination, self-knowledge and other higher attributes to be realized. Dhawale distinguishes between Eastern thinking that seeks to control the emotions, and Western thinking that generally allows for much freer expression of these qualities. A balance between unhealthy suppression and inappropriate expression is obviously the healthiest state.

It is important to understand the depth of the mental pathology. This can determine the prognosis and the time required for a curative change. It can also greatly help in making the distinctions in the case that lead to accurate remedy differentiation. Many remedies can look alike. Only knowing the depth and intensity of the symptoms allows correct evaluation. For example, a comparison of the medicines found in rubrics such as "suspicious" and "forsaken" reveals many different expressions and levels of intensity.

Understanding what is truly important on the mental level requires us to create an accurate hierarchical model. The following criteria can be used:

How intense is the symptom for the person?

How much does it limit the person in their life? Intense anger is much more serious than simple irritability; suicidal grief is more important than intense anger. A hierarchical understanding needs to work both as a generalized model and also in a form that is specific for each person.

How much do the symptoms maintain a level of delusion in the person of their true state? How aware is the patient? The scale ranges from a gross level of delusion, to very subtle levels, when we treat someone to refine their psychological evolution. Considerable compensation or avoidance of the fundamental state may reflect a greater lack of integration and self-awareness. Such cases can be very difficult to treat.

Are the symptoms predominantly emotional or intellectual in nature? If the symptoms are intense (see a. above) and mostly affect the intellectual level, the condition is that much more serious.

How antagonistic are the symptoms to social well-being? Here, we are talking of more intense and serious conditions: suicidal states, violent destructive impulses, and severe difficulties with socialization and maintaining basic relationships with others.

How are the miasms involved in the case? An integration of miasmatic knowledge can help in determining the hierarchy; e.g., the knowledge that the case has a strong syphilitic component can help in assessing the prognosis, as well as in remedy choice, and puts the individual symptoms into a larger perspective.

When dealing with mental/emotional states, distinguish between direct expressions of the emotional state, and those that are suppressed or compensated. When we experience feelings of disharmony within ourselves, we all deal with the experience differently. We have coping mechanisms to allow us to "get by," and also to avoid facing the reality of our state. Coping mechanisms have their place. The problem comes when they become a fixed reality for a person; the compensated state they allow becomes the new "normal" state.

Noting the coping mechanisms can be helpful for understanding the patient and choosing the remedy, as they still pertain to the person. However, you'll usually need some knowledge of the underlying causes. Sooner or later the inner state, whatever it is, needs expression. This may come out in a variety of ways, e.g. dreams, fantasies, other emotions such as anger, depression, rage, anti-social feelings, biting nails, self-destructiveness, etc.

Often, suppression of an emotional state may bring on a physical condition. This may occur over a long period of time, and could be seen as restlessness, pain in various parts of the body, stomach ulcer, Crohn's disease, arthritis, asthma, multiple sclerosis, cancer, and other syndromes. The intensity and depth of pathology that develops depends on various factors:

Intensity of emotional trauma.
Depth and strength of suppression.
Duration of suppression.
Genetic and miasmatic conditions which determine the areas of weakness.
Many serious physical conditions result from a combination of an intense unresolved emotional experience and a complex miasmatic situation, although it can be said they are one and the same.

Coping mechanisms can create symptoms that make it harder for us to see the real cause, the deeper feelings, and therefore the remedy needed. These can include:

Compulsive behavior such as hair-pulling, checking things, self-destructive tendencies, etc.
Chronic neurotic anxiety.
Deep guilt and sadness, often manifesting as ennui.
Disassociated states, due to some intense trauma. In order to cope, the person had to detach themselves from their feelings, making it hard for them to understand what their true feelings are and what actually happened originally. This is especially the case in people who show signs of clinical insanity.

Rigid mental control over the feelings, imposed as a means of escape. This can occur in people on intense meditation retreats, who are constantly trying to control their feelings and project an external state of mind that is different than how they really feel. This can reach a point at which they no longer really know what they are feeling.
These difficulties have increased, partly as a result of the overemphasis on psychology in our culture. Some kinds of therapy can also make it difficult for people to be emotionally honest, as they learn to rationalize and categorize their feelings, and lose all spontaneity.

In these situations, physical symptoms can sometimes be useful to help individualize the case. However, often there is very little to go on, as the whole imbalance is manifesting on a mental level. It is also helpful if one can get any emotional or miasmatic etiologies. The presenting symptoms are similar to common symptoms on the physical level. Just because they are on the mental level does not necessarily give them any greater significance.

Mental symptoms and the repertory

One of the biggest problems comes with mental symptoms in the repertory. In some ways it is the most imprecise part of working with the repertory, because it deals with subjective experiences that require interpretation from the homeopath and a degree of clarity from the patient. Unconscious experiences and their effects on a person can be very difficult to pinpoint.

Note the distinction between objective and subjective mental symptoms. Objective symptoms often belong to the person's fundamental nature, but they can obviously be expressions of a compensated state. However, these symptoms can often be useful, as they require less interpretation and are safer to use. Objective symptoms can be seen or distinctly felt by the homeopath. Examples are haughtiness, timidity, anxiety, fear, grief, gestures, loquacity, jesting, laughing, sighing, etc. Subjective symptoms require more seeking and more analysis. Strive to get to the subjective state of the person, as it gives greater understanding of the more objective expressions. The value of the subjective symptoms depends partly on the level of limitation on the mental level, and also on whether there is specific emotional trauma that has been dissociated or repressed. However, even when the patient cannot or does not want to reveal difficult, embarrassing or painful events, compensations can often tell us a lot.

Listen carefully to the words chosen by the patient. Words used repeatedly or in an unusual context can sometimes be very useful in choosing rubrics for mental symptoms, for example, words such as "hate," "humiliation," " torment," "resentment," etc. Also, words chosen to describe physical or general symptoms can help us understand the nature of a person.

Conclusion

Homeopathy is a unique art that can provide an extraordinary window into the nature of a person. It is able to bring together subjective and objective sensations and experiences into a coherent whole. It is a great example of holistic thinking applied to a system of healing. However, as with any potentially powerful healing tool, it is a challenge to apply the art well. The homeopath's effort to simultaneously perceive a person objectively, and at the same time to be a fundamental part of the healing process, involves a delicate dance. The practice of Homeopathy allows the homeopath to see deeply into the nature of human experience, beyond the framework of one's individual reality. To make this journey requires openness, a willingness to challenge one's own assumptions about life, and respect for the individuality of each person's experience. Even when a patient's account seems totally alien to our own experience, we can still reach a helpful understanding of it through homeopathic philosophy and practice.

Richard Pitt RSHom(NA), CCH practices Homeopathy in San Francisco. He is Director of the Pacific Academy of Homeopathy and former President of the Council for Homeopathic Certification.