Words: Dr Bernardo A MERIZALDE
There are similarities between modern psychiatry and homeopathy. Recent neurobiological research tends to validate old homeopathic concepts that Dr Samuel Hahnemann, MD, the founder of homeopathy, described in detail in his Organon — the bible of this holistic medical system.
Psychiatry continued to be undefined as a specialty into the 20th century, and physicians from other specialties carried on the instruction in this field. Some asylums were founded in early 19th century, and by 1843 there were around 24 hospitals for the care of the mentally ill.
The first homeopathic hospital for the mentally ill was founded in Middletown, New York, US, in May 1874. According to the attending physicians “…did not require the use of the opiates, bromides, or chloral hydrate in order to control the patients”
A report published in the Transactions of the American Institute of Homeopathy’s meeting [1891], reports a difference of 50 per cent of patients discharged from the homeopathic mental hospitals in the State of New York, between 1883 and 1890, compared to 30 per cent from conventional hospitals. There was also a difference of a 33 per cent higher death rate at the conventional mental health hospitals as compared to the homeopathic.
By the end of the 19th century, homeopathic treatment was provided in public mental health hospitals in seven states; two of these states had more than one hospital. Allentown State Hospital, in Pennsylvania, opened in the early 20th century and was associated with Hahnemann Hospital in Philadelphia. Unfortunately, the clinical records from that period of time no longer exist.
From the theoretical point of view, philosophers and theologians were the ones that tackled the concepts of mental illness, while the rest of medicine was centred in cellular pathology and disinterested in psychiatry. Nevertheless, there was already a more humanitarian approach to the treatment of the mentally ill and the doctrines of Philippe Pinel, Jean Esquirol, Daniel Tuke and John Bucknill were primordial. They were taught in most medical schools, regardless of its orientation.
At Hahnemann Hospital, Philadelphia, Professor H N Guernsey, the great homeopath, was one of the teachers of psychiatry, even though he was an obstetrician. In 1866, in a paper on hysteria, he presents a process of hysterical affections as a result of sexual, or emotional conflicts, a hypothesis presented many years later by Dr Sigmund Freud, MD.
The Menninger Paradigm
Another prominent physician who used homeopathy to treat the mentally ill was Dr Charles Frederick Menninger, MD, founder of the Menninger Clinic in Kansas, which is still in operation, but no longer uses homeopathy. He was an active member of the American Institute of Homeopathy and is quoted as saying, “Homeopathy is wholly capable of satisfying the therapeutic demands of this age better than any other system, or school of medicine.” “It is imperative that we exhaust the homeopathic healing art before resorting to any other mode of treatment, if we wish to accomplish the greatest success possible.”
Davidson J has noted that there are similarities between modern psychiatry and homeopathy. Recent neurobiological research tends to validate old homeopathic concepts. Psychotherapeutic techniques tend to elicit the patient’s symptoms, in a controlled manner, in order to heal the patient. Such is the case in cognitive, behavioural as well as psychoanalytic treatments. In his article, Davidson discusses other points such as the self-healing principle, the microdose effect, disappearance of the symptoms in reverse order of their appearance and diagnosis by pattern recognition of the symptoms.
Other biological treatments involve the concept of similarity in their treatment. Such is the case in the treatment of depression with sleep deprivation, or the use of Reserpine in the treatment of refractory depression. Tricyclic antidepressants are used in small dosages in the treatment of panic disorder since these antidepressants tend to cause an exacerbation of those symptoms at larger dosages in these patients.
Symptom Portrait
Homeopaths assert that symptoms are the expression of the organism’s effort to restore health. Some researchers have presented a similar view in contemporary psychiatry. They contend that symptoms of major affective disorders can be adaptive and may reflect the body’s self-treating activity. They also suggest the need to develop therapeutic strategies that stimulate the organism’s self-correcting processes. This is a supposed mechanism of action of the homeopathic remedies.
Most conventional practitioners do not take homeopathy seriously, because it is difficult to accept that ‘very diluted’ substances could have any therapeutic value. Usually, homeopathy is rejected without adequate scientific evaluation. Many scientists postulate that accepting homeopathy would require the abandonment of accepted theories of physics and chemistry. This is not necessarily so, just as Newtonian theories are not superseded by quantum physics. It is necessary, and possible, to evaluate homeopathy according to conventional scientific standards.
Linde K et al performed a meta-analysis of 189 trials using homeopathy, 89 of which fit pre-defined criteria. Their results show that the patients taking homeopathic medicines were 2.45 times more likely to experience a positive therapeutic effect than the ones taking placebo [dummy pill]. Kleijnen J et al reviewed 107 studies, 81 [77 per cent] of which showed a positive effect in favour of homeopathy. Of the best 22 studies, 15 showed homeopathy as efficacious. The researchers concluded that, “the evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications”. They note that, “The amount of positive evidence even amongst the best studies came as a surprise to us.”
There have been very few published studies on the use of homeopathy in the mental health field and even fewer follow good scientific methodology. Included in the studies, reviewed by Kleijnen et al, there were ten studies on the treatment of mental, or psychological, problems including depression, insomnia, nervous tension, agitation, aphasia, behaviour problems in children and other conditions. Of these ten studies, eight showed positive effects in favour of the homeopathic treatment. None of those studies have been replicated.
Davidson and his colleagues conclude that homeopathy may be useful in the treatment of anxiety, or depression, either as an adjunctive treatment, or as a sole treatment of patients who specifically request it. Obviously, the clinician must weigh the risks and benefits of a homeopathic intervention, especially in situations when there are demonstrably effective conventional treatments and when the patient is either acutely psychotic, or suicidal. There are several limitations in that study, as presented by the author, and only larger, double-blind, controlled, trials can provide answers to the questions that arise when using homeopathy in the treatment of disease, in general, and in psychiatry in particular.
Chapman T et al performed a randomised, double-blind, placebo controlled study on 60 patients with persistent mild traumatic brain injury. Their results suggest that homeopathy, alone, or used concurrently with conventional pharmacological and rehabilitation therapies, may be effective in treating patients with persistent mild traumatic brain injury, a condition for which current treatment has limited effectiveness.
Lamont J performed a double-blind placebo controlled study in the treatment of 43 children with diagnosis of attention-deficit hyperactivity disorder [ADHD]. He showed statistically significant differences supporting the notion that homeopathic treatment is superior to placebo. This type of study needs to be repeated.
The Homeopathic Repertoire
Hundreds of case reports have been published, in homeopathic journals from the 19-20th centuries, of patients suffering from mental disorders who have been treated successfully with homeopathy. Even though some of the cases are inadequately presented for proper evaluation, many of these patients would meet criteria for a mental disorder according to the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders] and would have been candidates for conventional pharmacotherapy.
A case series of 120 patients with diagnosis of anxiety neurosis, phobias, psychosomatic disorders, or neurotic depression was published by Gibson D et al. Priestman K G described 20 cases of anxiety, phobias and hypochondriasis. Reichenberg-Ullman J and Ullman R have published books with series of patients with attention-deficit hyperactivity disorders, depression, and behaviour disorders.
Detinis L presents six cases of patients suffering from depression with suicidal ideation, chronic pain, sleep disorder, premenstrual syndrome and anxiety disorder. Bodman F presents a series of cases of depression, anxiety, sleep disorders, phobias, neurosis, cerebral sequelae from a stroke, Meniere’s disease, migraines, and other conditions treated successfully with homeopathy.
Boltz O H and Phalnikar M D presented small series of patients with acute psychosis who recovered after homeopathic treatment without relapses after long-term follow ups — even after failure of conventional treatment. Saine A presents a series of cases of patients with psychosis, manic-depressive disorder, obsessions, and neurosis. Shevin W E presents several cases of patients with dissociative disorders, character pathology, and post-traumatic stress disorder.
Gallavardin J P published a series of patients with alcoholism who recovered with homeopathic treatment. Many of those patients were treated without their knowledge. Grazyna M et al presented a series of 30 men treated for alcohol withdrawal and delirium tremens. They report that about 30 per cent of the patients continued homeopathic treatment for 12-18 months with most of them maintaining abstinence during a long follow-up of up to seven years.
Some authors have presented cases of children with mental retardation that have improved with homeopathic treatment. Haidvogl M et al presented a series of 40 cases of handicapped children. They report that close to 75 per cent of the children responded to treatment, with close to 50 per cent showing improvement of all the target symptoms. The authors pointed out that the children with organic brain injury, autism and definite syndromes responded well, generally, in comparison to the children whose handicap was due to social deprivation. Griggs W B presents a series of four of those cases, including one with a seizure disorder. Elizabeth Wright-Hubbard presents four cases of mental retardation, with seizures, autism, and muscle twitching, who responded well to homeopathic remedies when there was nothing else conventional to offer them.
Cortina J et al presented a series of 20 cases of children with enuresis and behavioural problems, treated with Ilex, a plant-derived remedy. They reported a 50 per cent improvement in the enuresis and behavioural symptoms. Unfortunately, the study was not controlled and difficult to evaluate.
There are a number of single case reports of patients suffering from anorexia nervosa, anxiety neurosis and manic depressive illness treated successfully with homeopathy. Boericke G presented an interesting case of a patient, suffering for dementia with psychosis, who he treated with a homeopathic preparation of Chlorpromazine after the patient had worsened at usual dosages of this drug.
These cases have a clear enough description of their disorders to stand up for a close scrutiny. However, many cases reported do not have adequate data to be evaluated by modern diagnostic standards. Most single case reports in the homeopathic literature give only anecdotal information, primarily to show the homeopathic practitioner how the remedy was chosen. These cases are used as educational tools rather than scientific case presentations.
Slonim D and White K have reviewed the particular issues inherent in the preparation and evaluation of case reports, particularly in the areas outside mainstream medicine and homeopathy in particular. They point out that there exists as much clinical evidence for homeopathic treatment as there is for many conventional interventions that have not been subject to stringent testing.
Homeopathic Remedies In The Treatment Of Mental Disorders
Homeopaths use various remedies with apparently different biological actions. Some have acute symptomatology in its picture like Belladonna, Hyoscyamus niger, Stramonium and Veratrum album. In these, the symptoms appear soon after the remedy is ingested.
Other, so-called slow-acting, remedies, like Natrum muriaticum, Silicea terra, Phosphorus, or Sepia officinalis take longer time and repeated dosages in order to manifest their particular symptomatology and sphere of action.
The selection of the remedies is always based on the totality of symptoms of the patient, and in the consideration of the peculiar, or characteristic, qualities of the organism, such as: congestion of the face, red skin, glaring eyes, throbbing carotids, excited mental state, hyperaesthesia of all senses, delirious and restless sleep, dryness of the mouth etc. That particular portrait is found in the Belladonna picture. These are the symptoms of anticholinergic intoxication.
A manic state, of a quarrelsome and obscene character, inclined to immodest acts, gestures and expressions, disposed to uncovering and exposing, are characteristic of Hyoscyamus. These symptoms were evidenced in the ‘provings,’ and would be the symptoms to be matched with the symptoms of the patient. The therapeutic doses used to treat the problem are to be minuscule.
There are other thirty-nine remedies cited by Guernsey with their characteristic symptoms for the treatment of mental illness. Besides the mental symptoms, the characteristics of local pathology, in different organs are matched with the clinical pictures observed during the provings in healthy subjects in order to select the correct remedy.
Dr Hahnemann noted that one can frequently observe an initial aggravation of the patient’s symptoms after which there follows an improvement of the condition. This is similar to the phenomenon observed in the treatment of anxiety disorders with tricyclics.
The clinical picture elicited in the proving of several remedies seems so specific that they resemble clinical syndromes found in today’s nosology. The narrative of the proving of Aurum metallicum reports: “Hopeless, despondent and great desire to commit suicide, disgust of life, feeling of self-condemnation and utter worthlessness.” This can be contrasted to the picture found when proving Staphisagria: “Nervous affections with marked irritability; ill-effects of anger and insults; very sensitive to what is said of her; prefers solitude.”
The first picture could correspond to a melancholic depression and the latter is akin to the rejection sensitivity of a patient with Donald Klein’s hysteroid dysphoria, or atypical depression. These clinical pictures, elicited by the remedies, are brought upon individuals who are already susceptible to develop these syndromes. To participate in a proving an individual has to free from any evident pathology so the symptoms can get included in the Materia Medica accurately.
The remedy is selected not only on the mental picture but the concomitant symptoms found in the review of systems. For example, Aurum seems to have an affinity towards cardiovascular system, while Staphisagria has it towards the genitourinary system.
Another interesting picture is that of Arsenicum album. It is characterised by great anguish, restlessness, and changes place continually. It has fear of death and of being left alone. These are symptoms commonly found in anxiety disorders, especially with panic attacks.
The picture of Natrum muriaticum presents with ill-effects from grief, fright, anger etc., is depressed and irritable, gets into a passion about trifles; wants to be left alone to cry. These symptoms may be found in dysthymic, or adjustment disorders.
Nux vomica will manifest with a zealous fiery temperament, very irritable, cannot bear noises, odours, light, or touch. Sullen and fault-finding, seeks stimulants, sometimes in excess and suffers from constipation. These symptoms are found in patients suffering from neurovegetative dystonia, as well as other dysthymia, usually of organic nature.
These are some of the mental symptoms that the homeopathic Materia Medica reports as observed in people taking these remedies during a ‘proving.’ Provings are the clinical pictures elicited in ‘healthy’ subjects, while taking remedies [prepared with the technique of dilution and potentising]. They are the basis for homeopathic therapeutics. The question at the centre of the controversy is: are these diluted solutions, in which no molecules of the original solute remain, biologically active? The answer is yes — from the therapeutic standpoint.
