Dissimilar diseases - Hahnemann's approach to psychiatric patients

During my resident posting, in 1993, at the government homeopathic hospital in Mumbai, India, I saw a man in his late forties who had been disowned by his family because of his frequent hospitalisations; his family was tired of him and his illness, so most of the time he would get admitted to our hospital, where he stayed for months at a time. He received several remedies over the years by different resident house physicians. Therefore, as soon as I joined the hospital the first thing I did was to study his case and to prepare myself for any crisis which might arise.

He had three main complaints:

1) Bronchiectasis: severe cough with breathlessness.

2) Epileptic fits.

3) Mental illness: violent mania with increased strength, whereby he hit others and talked senselessly.

These three complaints never occurred at the same time. After a severe attack of bronchiectasis had run its course, an epileptic fit would come, followed by violent mania.

Here was a case of three dissimilar diseases, where each one occupied a particular locality suited to it. After existing over a period of time, they joined together to form a “double complex disease”. Since they are dissimilar diseases, they cannot remove or cure each other (Ref: Organon 6th edition, aphorisms 36, 38 and 40).

An episode of violent mania:

Once, after we had finished seeing all our patients of the day, I received a call that this man had turned violent, hitting an old patient on the bed next to him. The old man suffered from heart failure and he and his relatives were obviously very frightened by the attack. My patient was talking continuously, at times very loudly, and I could hardly make out what he was trying to say. His case record noted that at such times he was usually prescribed Stramonium, which seemed a logical option. He would, however, not allow anyone to approach him in order to give him the remedy; even with the help of the nursing staff, we could not overpower his physical strength to give him the remedy and we had to abandon our efforts. Since his constant talking and his violent behaviour was disturbing other patients in the ward, I started arguing with him, even scolding and reproaching him a bit. I tried to tell him that he should understand and allow us to give him the remedy. How foolish of me! I should understand rather than expecting him to understand. During this moment of despair, I suddenly remembered the Auxiliary regimen described by Hahnemann on how to behave with such patients (aphorism 22). Here are some of his insightful advices related to this case:

1) Physician and carer must always behave as if believing the patient to be possessed of reason.

2) No corporal punishments, no reproaching patients for acts of destruction and injury of surrounding objects, but merely trying to prevent it by removing such objects.

3) In response to senseless chattering: silence, but not wholly inattentive.  

4) In response to disgusting, abominable conduct and conversation: total inattention.

After reading this, I decided to follow it with a ray of hope. I took steps for the benefit of this patient, as well as others in the ward:

a) I immediately stopped arguing and reproaching him for disturbing and hitting the patient on the next bed.

b) I shifted all the patients to another ward, thereby preventing any act of destruction or injury to them and hence the need to reproach the patient.

c) I instructed the hospital staff to ignore his senseless talking and behaviour. I kept, nevertheless, watch from a distance.

Under the circumstances, this was the best I could do for this patient. Soon, he settled down into a more sober mood and manner. After a few hours, the other patients were shifted back to the ward.

Unfortunately, we could not find a correct remedy for him to break his cycle of diseases. Nonetheless, this experience is worth sharing to emphasise the need to pay close attention to Hahnemann’s advice.