Hahnemann as Psychiatrist
“I always tell GPs: ‘Adults don’t suddenly become depressed. The depression is possibly linked to a malignancy.'” This paraphrase of a conversation with a consultant psychiatrist shows mental symptoms and physical symptoms are not separate but expressions of a single disease. Therefore treating the two separately is not rational. While GPs may not be aware of this, judging from this quote, Hahnemann was aware of this unity more than two hundred years ago. A more ideal method on how to understand, treat and manage such patients with their various intricacies has been explained by Hahnemann in his Organon, predominantly in aphorisms 210-230, which I shall reference below.
Regarding psychiatry and homeopathy, Hahnemann was probably the first to treat humanely the mentally ill. Despite this Hahnemann is not even mentioned in the Wikipedia entry History of Psychiatry. As Peter Morrell shows in his essay Hahnemann – the Real Pioneer of Psychiatry:¹
As Dudgeon tells us, Hahnemann “settled for a time in 1792,” (Dudgeon, xxiii) in Georgenthal, and it was while residing there that he “accepted an offer of the reigning Duke of Saxe-Gotha to take charge of an asylum for the insane,” (ibid.). In a letter of May 1792, Hahnemann states that the Duke would soon be “handing over to me his hunting castle in Georgenthal,” (Haehl, 2, 32), and it was here that Hahnemann was able to “pursue his painfully interesting investigations,” (Dudgeon, xxiii), eventually establishing a dramatic cure of a patient, Herr Klockenbring. The account of this cure was published in 1796 (see Lesser Writings, 243-49) and this proves Hahnemann was “one of the earliest, if not the very first,” (ibid.) to advocate a “treatment of the insane by mildness rather than coercion,” (ibid.). In fact, it was on 2 September in the year 1793, that “Pinel made his first experiment of unchaining maniacs in the Bicêtre,” (ibid.), which was some fifteen months after Hahnemann had commenced treating Klockenbring.
The French philosopher of the Left who made a name detailing a history of psychiatry, Michel Foucault, is likewise guilty; not mentioning Hahnemann.
Psychiatry and Homeopathy
In the first aphorism on treating mental and emotional diseases ( § 210 or here) Hahnemann states mental illness is not different to bodily illness because the mind is always altered – they are like the “one-sided diseases” he dealt with in aphorisms 172-184 (or here) – “all morbid symptoms disappearing before the single great symptom…”
Of psoric origin are almost all those diseases that I have above termed one-sided, which appear to be more difficult to cure in consequence of this one-sidedness, all their other morbid symptoms disappearing, as it were, before the single, great, prominent symptom. Of this character are what are termed mental diseases. They do not, however, constitute a class of disease the condition of the disposition and mind is always altered;121 and in all cases of disease we are called on to cure the state of the patient’s disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able therefrom to treat it homoeopathically with success.
He then tells us how, having improved in health, the patient then returns to their old personality which had been subdued or repressed due to their pathology:
121 How often, for instance, do we not meet with a mild, soft disposition in patients who have for years been afflicted with the most painful diseases, so that the physician feels constrained to esteem and compassionate the sufferer! But if he subdue the disease and restore the patient to health – as is frequently done in homoeopathic practice – he is often astonished and horrified at the frightful alteration in his disposition. He often witnesses the occurrence of ingratitude, cruelty, refined malice and propensities most disgraceful and degrading to humanity, which were precisely the qualities possessed by the patient before he grew ill.
Those who were patient when well often become obstinate, violent, hasty, or even intolerant and capricious, or impatient or desponding when ill; those formerly chaste and modest often frequently become lascivious and shameless. A clear-headed person not infrequently becomes obtuse of intellect, while one ordinarily weak-minded becomes more prudent and thoughtful; and a man slow to make up his mind sometimes acquires great presence of mind and quickness of resolve, etc.
Unlike dualists in philosophy and medicine who split the mind and body, or materialists who reduce the person to the physical, Hahnemann considered the person as one whole constitution (for more on the subject see my posts on mind).
§ 211 Disposition determines the remedy
This holds good to such an extent, that the state of the disposition of the patient often chiefly determines the selection of the homoeopathic remedy, as being a decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician.
§ 212 And all medicines affect mind – thank God!
The Creator of therapeutic agents has also had particular regard to this main feature of all diseases, the altered state of the disposition and mind, for there is no powerful medicinal substance in the world which does not very notably alter the state of the disposition and mind in the healthy individual who tests it, and every medicine does so in a different manner.
§ 213 Treat whole disease at once
Unlike the psychiatrist who still treats the mind separately to the body, Hahnemann says the two must be treated as one. In the footnote he gives examples:
We shall, therefore, never be able to cure conformably to nature – that is to say, homoeopathically – if we do not, in every case of disease, even in such as are acute, observe, along with the other symptoms, those relating to the changes in the state of the mind and disposition, and if we do not select, for the patient’s relief, from among the medicines a disease-force which, in addition to the similarity of its other symptoms to those of the disease, is also capable of producing a similar state of the disposition and mind.122
122 Thus aconite will seldom or never effect a rapid or permanent cure in a patient of a quiet, calm, equable disposition; and just as little will nux vomica be serviceable where the disposition is mild and phlegmatic, pulsatilla where it is happy, gay and obstinate, or ignatia where it is imperturbable and disposed neither to be frightened nor vexed.
Cause of Mental Illness
§ 215 Origins of psychiatric state
He now explains that bodily symptoms can turn into one-sided mental symptoms – they are not different:
Almost all the so-called mental and emotional diseases are nothing more than corporeal diseases in which the symptom of derangement of the mind and disposition peculiar to each of them is increased, while the corporeal symptoms decline (more or less rapidly), till it a length attains the most striking one-sidedness, almost as though it were a local disease in the invisible subtle organ of the mind or disposition.
§ 216 From body to mind
The cases are not rare in which a so-called corporeal disease that threatens to be fatal – a suppuration of the lungs, or the deterioration of some other important viscus, or some other disease of acute character, e.g., in childbed, etc. – becomes transformed into insanity, into a kind of melancholia or into mania by a rapid increase of the psychical symptoms that were previously present, whereupon the corporeal symptoms lose all their danger; these latter improve almost to perfect health, or rather they decrease to such a degree that their obscured presence can only be detected by the observation of a physician gifted with perseverance and penetration. In this manner they become transformed into a one-sided and, as it were, a local disease, in which the symptom of the mental disturbance, which was at first but slight, increases so as to be the chief symptom, and in a great measure occupies the place of the other (corporeal) symptoms, whose intensity it subdues in a palliative manner, so that, in short, the affections of the grosser corporeal organs become, as it were, transferred and conducted to the almost spiritual, mental and emotional organs, which the anatomist has never yet and never will reach with his scalpel.
An illustrative case
In 1987 Dr Roger Morrison presented a seminar in Burgh-Haamstede in the Netherlands.² He began by explaining his journey from medical student to homeopathic training with George Vithoulkas in Greece. He then gave some examples of patients he met in his first week with George. One of those patients was an elderly lady in hospital. He explains the case as follows:
‘At the end of the first week we went to see a case in the hospital. The family had begged George to come to see the case of an old woman about 70 years old. The story was this: she had a pneumonia, she was well. She had some minor complaints, arthritis or something. She developed pneumonia and went into the hospital. She was treated with antibiotics. The fever came down, the pneumonia was resolved and she went mad. She went out of her mind, talking constantly, hallucinating, talking about God, Jesus is with me, Jesus tells me to do this” etc. She was violent, would strike the nurses, she was extremely agitated and restless, walking back and forth.
‘So I walked in and saw this crazy woman. I thought: “My God, what is this?” I thought we were coming to see a case of pneumonia in the hospital and we see a woman who was completely delirious. I thought, “She must have fever and she is delirious from the fever.” So I was thinking “Must be perhaps Belladonna or may be Stramonium.” I listened to the chest and the chest sounded perfectly clear, no pneumonia at all. The fever: completely gone.
‘This state had been going on now for or or five days. George elicited all the information and he said to the family: “I don’t think that I can take this case, I don’t think that I can treat this case.” The family got very upset. They said: “But there is nothing we can do, she is just going to be like this for ever! He said that she had had a psychotic breakdown and they want to put her on Thioridazine. You have to treat her!”
‘And George said: “If I treat her, what will happen is this: she will become normal and the pneumonia will come back, you will put her on antibiotics again, instead of letting me treat her with homeopathy. And she will go crazy again.” The family said: “Oh no, we would never do such a thing, she is your patient, you treat her.”
‘George agreed and he treated her. Roger then asked the audience which remedy George used. “Veratrum album, came a reply.” Roger explained: “Veratrum album has great tendency for pneumonia and if a pneumonia is suppressed and goes into a deep psychotic state of this sort, Veratrum album is the first remedy to give. But if I tell you, however, that she went into this state but when she stuck out her tongue there was a bright red streak down the centre of her tongue, then we have to give what remedy? It is a keynote for Veratrum viride: bright red streak down the centre of the tongue.
‘She took Veratrum and by the next day the mental state became completely normal. She was back to herself and the family was overjoyed. But about noon time the next day, the fever started to rise. By the next day the fever was very high and she started to cough again. They took her again for an x-ray: the pneumonia had recurred. “The doctor said: the homeopathy helped her to get over this state but now she has pneumonia and we have to treat her with strong antibiotics to get it under control, once and for all.” The woman is now living in a mental institution.”‘
Case-taking in Homeopathic Psychiatry
§ 217 What and how to treat
We need to treat the whole disease, in its entirety, and with one remedy only which is homeopathic:
In these diseases we must be very careful to make ourselves acquainted with the whole of the phenomena, both those belonging to the corporeal symptoms, and also, and indeed particularly, those appertaining to the accurate apprehension of the precise character of the chief symptom, of the peculiar and always predominating state of the mind and disposition, in order to discover, for the purpose of extinguishing the entire disease, among the remedies whose pure effects are known, a homoeopathic medicinal pathogenetic force – that is to say, a remedy which in its list of symptoms displays, with the greatest possible similarity, not only the corporeal morbid symptoms present in the case of disease before us, but also especially this mental and emotional state.
§ 218 Here he explains the need to trace the physical symptoms before it turned into a disease of the mind and disposition:
To this collection of symptoms belongs in the first place to accurate description of all the phenomena of the previous so-called corporeal disease, before it degenerated into a one-sided increase of the physical symptom, and became a disease of the mind and disposition. This may be learned from the report of the patient’s friends.
§ 219 Some clues
Some remaining physical symptoms can show these earlier physical symptoms to be present, if only to a lesser degree. Such symptoms can return if mental symptoms ease for a while.
A comparison of these previous symptoms of the corporeal disease with the traces of them that still remain, though they have become less perceptible (but which even now sometimes become prominent, when a lucid interval and a transient alleviation of the psychical disease occurs), will serve to prove them to be still present, though obscured.
§ 220 Physician and friends complete the picture
By adding to this the state of the mind and disposition accurately observed by the patient’s friends and by the physician himself, we have thus constructed the complete picture of the disease, for which in order to effect the homoeopathic cure of the disease, a medicine capable of producing strikingly similar symptoms, and especially an analogous disorder of the mind, must be sought for among the antipsoric remedies, if the physical disease have already lasted some time.
Managing Acute and Chronic Psychiatric Cases
§ 221 Acute insanity
Hahnemann now advises what to do if acute “insanity” appears due to exogenous causes such as fright, vexation, abusing alcohol etc. The physician should withhold deeper “antipsoric” treatment (even though the symptoms are arising from the inner psoric disposition), instead using the “other class of remedies”. This is to subdue psora to its latent state, wherein the patient appears well.
§ 222 Anti-psoric needed
Such treatment is not curative, we are reminded, so needs to be followed up with a deeper anti-psoric medicine (for the chronic disposition). Footnote 123 (to this aphorism) is a significant comment from Hahnemann:
It very rarely happens that a mental or emotional disease of long standing ceases spontaneously (for the internal dyscrasia transfers itself again to the grosser corporeal organs); such are the few cases met with now and then, where a former inmate of a madhouse has been dismissed apparently recovered. Hitherto, moreover, all madhouses have continued to be choke full, so that the multitude of other insane persons who seek for admission into such institutions could scarcely find room in them unless some of the insane in the house died. Not one is ever really and permanently cured in them! A convincing proof, among many others, of the complete nullity of the non-healing art hitherto practised, which has been ridiculously honoured by allopathic ostentation with the title of rational medicine. How often, on the other hand, has not the true healing art, genuine pure homoeopathy, been able to restore such unfortunate beings to the possession of their mental and corporeal health, and so give them back again to their delighted friends and to the world!
§ 223 A warning
If this follow-up treatment is omitted, he warns, a worse return of symptoms will take place – excited by an even slighter cause than which brought on the first attack of insanity. In other words, the patient is now more susceptible to their disease.
But if the antipsoric treatment be omitted, then we may almost assuredly expect, from a much slighter cause than brought on the first attack of the insanity, the speedy occurrence of a new and more lasting severe fit, during which the psora usually develops itself completely, and passes into either a periodic or continued mental derangement, which is then more difficult to be cured by antipsorics.
§ 224 Medicine or psychotherapy?
Now Hahnemann makes an important distinction between “true mental illness” and others due to lifestyle. The subtle nuances are important for case-management:
If the mental disease be not quite developed, and if it be still somewhat doubtful whether it really arose from a corporeal affection, or did not rather result from faults of education, bad practices, corrupt morals, neglect of the mind, superstition or ignorance; the mode of deciding this point will be, that if it proceed from one or other of the latter causes it will diminish and be improved by sensible friendly exhortations, consolatory arguments, serious representations and sensible advice; whereas a real moral or mental malady, depending on bodily disease, would be speedily aggravated by such a course, the melancholic would become still more dejected, querulous, inconsolable and reserved, the spiteful maniac would thereby become still more exasperated, and the chattering fool would become manifestly more foolish.124
124 It would seem as though the mind, in these cases, felt with uneasiness and grief the truth of these rational representations and acted upon the body as it wished to restore the lost harmony, but that the body, by means of its disease, reacted upon the organs of the mind and disposition and put them in still greater disorder by a fresh transference of its sufferings on to them. (See also § 228 below)
§ 225 When the mental state harms the body
It might seem obvious but it needs to be stated…
There are, however, as has just been stated, certainly a few emotional diseases which have not merely been developed into that form out of corporeal diseases, but which, in an inverse manner, the body being but slightly indisposed, originate and are kept up by emotional causes, such as continued anxiety, worry, vexation, wrongs and the frequent occurrence of great fear and fright. This kind of emotional diseases in time destroys the corporeal health, often to a great degree.
§ 227 It’s still psora
Even in these cases psora, the inner disposition to chronic disease, is present as a “fundamental cause.” A stressor like anxiety may be an exciting cause, psora is the basic underlying cause, without which symptoms wouldn’t take hold in a chronic form. (Conventional medicine has not postulated any reason as to why some symptoms become chronic, others acute, meaning self-limiting.):
But the fundamental cause in these cases also is a psoric miasm, which was only not yet quite near its full development, and for security’s sake, the seemingly cured patient should be subjected to a radical, antipsoric treatment, in order that he may not again, as might easily occur, fall into a similar state of mental disease.
Humane and Gentle Psychiatry
§ 228 Mangement and humane treatment
This is again significant as it shows Hahnemann to the fore in introducing in theory and practice humane psychiatry (see the quote above by Peter Morrell). As in § 224 Hahnemann offers more advice on managing patients who do not need medication:
In mental and emotional diseases resulting from corporeal maladies, which can only be cured by homoeopathic antipsoric medicine conjoined with carefully regulated mode of life, an appropriate psychical behavior towards the patient on the part of those about him and of the physician must be scrupulously observed, by way of an auxiliary mental regimen. To furious mania we must oppose calm intrepidity and cool, firm resolution – to doleful, querulous lamentation, a mute display of commiseration in looks and gestures – to senseless chattering, a silence not wholly inattentive – to disgusting and abominable conduct and to conversation of a similar character, total inattention. We must merely endeavor to prevent the destruction and injury of surrounding objects, without reproaching the patient for his acts, and everything must be arranged in such a way that the necessity for any corporeal punishments and tortures125 whatever may be avoided. This is so much the more easily effected, because in the administration of the medicine – the only circumstance in which the employment of coercion could be justified – in the homeopathic system the small doses of the appropriate medicine never offend the taste, and may consequently be given to the patient without his knowledge in his drink, so that all compulsion is unnecessary.
125 It is impossible to marvel at the hard-heartedness and indiscretion of the medical men in many establishments for patients of this kind, who, without attempting to discover the true and only efficacious mode of curing such disease, which is by homoeopathic medicinal (antipsoric) means, content themselves with torturing these most pitiable of all human beings with the most violent blows and other painful torments. By this unconscientious and revolting procedure they debase themselves beneath the level of the turnkeys in a house of correction, for the latter inflict such chastisement as the duty devolving on their office, and on criminals only, whilst the former appear, from a humiliating consciousness of their uselessness as physicians, only to vent their spite at the supposed incurability of mental diseases in harshness towards the pitiable, innocent sufferers, for they are too ignorant to be of any use and too indolent to adopt a judicious mode of treatment.
§ 229 What not to do
On the other hand, contradiction, eager explanations, rude corrections and invectives, as also weak, timorous yielding, are quite out of place with such patients; they are equally pernicious modes of treating mental and emotional maladies. But such patients are most of all exasperated and their complaint aggravated by contumely, fraud, and deceptions that they can detect. The physician and keeper must always pretend to believe them to be possessed of reason.
All kinds of external disturbing influences on their senses and disposition should be if possible removed; there are no amusements for their clouded spirit, no salutary distractions, no means of instruction, no soothing effects from conversation, books or other things for the soul that pines or frets in the chains of the diseased body, no invigoration for it, but the care; it is only when the bodily health is changed for the better that tranquillity and comfort again beam upon their mind.
The treatment of the violent insane manic and melancholic can take place only in an institution specially arranged for their treatment but not within the family circle of the patient.
§ 230 Homeopathy better for mental and emotional diseases
If the antipsoric remedies selected for each particular case of mental or emotional disease (there are incredibly numerous varieties of them) be quite homeopathically suited for the faithfully traced picture of the morbid state, which, if there be a sufficient number of this kind of medicines known in respect of their pure effects, is ascertained by an indefatigable search for the most appropriate homoeopathic remedy all the more easily, as the emotional and mental state, constituting the principal symptom of such a patient, is so unmistakably perceptible, – then the most striking improvement in no very long time, which could not be brought about by physicking the patient to death with the largest oft – repeated doses of all other unsuitable (allopathic) medicines. Indeed, I can confidently assert, from great experience, that the vast superiority of the homoeopathic system over all other conceivable methods of the treatment is nowhere displayed in a more triumphant light than in mental and emotional diseases of long standing, which originally sprang from corporeal maladies or were developed simultaneously with them.
There you have it; homeopathy is the best psychiatry – even by today’s standards according to many reasonable critics e.g. Deadly psychiatry and organised denial by Professor Peter C. Gøtzsche, among the many, or have a read of the first chapter here for free. His article in the BMJ.com “Does long term use of psychiatric drugs cause more harm than good?” is answered in the affirmative (link). See also my other posts on psychiatry.
¹ Peter Morrell tells me an updated version of this essay is available in Homeopathy and Mental Health Care by Christopher K. Johannes & Harry van der Zee; Homeolinks Publishers (2010).
² Originally published by Ilse Bos, The Netherlands, is now available as A Collection of Case Records. The case cited above is Case E; pages 6 and 7. This individual volume is available from Emryss.
The brilliant and informative set of ten volumes of seminars by Roger Morrison, Nancy Herrick, Shore, Bill Gray, Ananda Zaren and Henny Heudens is available at a great price from Minerva though in limited stock (click here).
On psychiatry and homeopathy I highly recommend the essay Hahnemann – the Real Pioneer of Psychiatry
by Peter Morrel. Peter’s book of essays Hahnemann and Homeopathy is available at Minerva etc.
Psychiatry and Homeopathy by Fernando Risquez is worth a read. Currently out of print but some copies available at Narayana-Verlag.
All quotations are from the sixth edition of the Organon, 1833, translated by William Boericke.
Photo of Veratrum viride: Wikipedia