Practice - Mental Symptoms
I began my homeopathic studies in the '70s. At that
time we were taught that the mental and emotional
symptoms were the most important consideration in
prescribing for a patient. Our case analyses reflected
this with a predominance of mental and general rubrics.
Since then I have found this approach to be limiting,
narrow, and misleading. In this article I will examine
why I have come to this conclusion.
Importance of mental and emotional symptoms:
Kent, and later, George Vithoulkas and Bill Gray
suggested that, at the same intensity, mental and
emotional symptoms are more important to the quality
of life than those that are physical. This is fairly clear
when we observe that there is a greater likelihood of
experiencing some richness of life in severe physical
diseases than in psychotic states.
The problem arises when this concept is altered to:
"The emotions of the patient are the most important
factor in finding the prescription." This misconception
will often mislead a prescriber into prescribing a
polychrest and missing a more exact and effective
remedy.
Common mental and emotional symptoms: We often
use repertory rubrics such as a lack of self-confidence,
fear of heights, desire for company, or timidity to point
us toward likely remedies. But these symptoms are
common to many individuals and so many remedies—
many more than are even shown in the repertory. These
common emotional symptoms are more indicative of
broad adaptations to life than a specific remedy.
Mental/emotional pathology: The mental or
emotional symptoms that we repertorize should be true
pathology that we observe clearly limits the patient—not
just a character trait! For instance, if a patient has
difficulty in leaving his room or speaking to others, their
timidity is pathological and it can be taken as a useful
rubric.
Mental disease: Something interesting happens in
true mental disease. Often the mental pathology is
common to the disease and therefore less useful to
prescribe on. In psychotic states, for example, you'll
often find people thinking they are horribly guilty and
God is angry at them. Prescribing on these rubrics will
find a remedy, like Kali bromatum, that helps for a short
period, but does little to move the case in a deep way.
Rubrics in analysis: When analyzing cases it is best
to avoid common rubrics; otherwise you will only find
common, less precise, remedies. Whatever rubrics you
choose, though, should be the most limiting to the
patient.
Rubrics which we select for a patient serve two
purposes: firstly to give us ideas of remedies that we
haven't considered and secondly to confirm a remedy
that we are examining. It is important to be clear which
purpose your rubrics are serving. Common symptoms
can be good confirmations, but make poor pointers.
Modalities: You will have the best results finding
effective remedies by choosing rubrics that include
modalities (e.g., headache in a draft). Boenninghausen
stressed this point strongly. The reason that these
rubrics are more effective is that they include several
elements of the story of the patient. Symptoms are
always related to a personal response to the world; they
will always resonate with the patient's unique story.
The most useful rubrics include modalities that make
sense in the context of the individual patient. For
example, in a patient who is very intellectual with many
stresses at work, the rubric "headache from mental
exertion" would be a good choice as it includes some of
the patient's story.
Matching rubrics to our books: Even the most well
selected rubrics are only as useful as the tools we use
to analyze them. The purpose of case analysis is to
compare our representation of our patient with the
books and tools in homeopathy. In our materia medicas
and repertories, with the. exception of the polychrests,
our remedies have very few mental or emotional
symptoms. This means that if you use many mental or
emotional rubrics in your analysis you will miss the
most precise remedy unless it is a polychrest.
For example, Aqua marina is similar to Natrum
muriaticum. But if a patient needing Aqua marina
walked in you'd never find it through repertorizing
mental symptoms—it just isn't well-known enough.
You'd have to focus on the physicals, otherwise you'd
miss it.
So, even if your choice of rubrics is flawless, if you have
included mostly mental and emotional rubrics there is a
good chance that you won't find an uncommon, though
correct, remedy. The only reliable way to find these
remedies (the vast majority of our remedies) is through
the physical pathology because most of the old
provings, and the bulk of our material, only recorded
physical symptoms.
Case analysis recommendations: My recommendation is
to approach cases in a four-pronged way:
1) Use physical pathology with modalities that include
the tone or story of the case. Leaving out many of the
mental and emotional rubrics will seldom weaken your
analysis.
2) Understand the mental and emotional strategy of the
patient. Then from the remedies that did well in #1
above, choose the ones that correspond with this
understanding. For example, if the physical pathology
points well to Baryta muriaticum don't be too
concerned if it is missing from an important emotional
rubric of the patient's, such as bashfulness, since you
can imagine that all of the Barytas can have this
general symptom. For relatively unknown remedies you
can discover their general emotional tone by reading
through an extraction from the Mind section of the
repertory.
3) Verify that, generally, the patient has their pathology
in the same location and style as the remedy you are
thinking of. You can be most confident if the focus of
the patient's pathology is in the same area as the
remedy's (e.g., when you have mental and general
symptoms that point to Euphrasia and the pathology is
in the eyes). And you can feel more confident if the tone
of the patient's complaints is similar to the remedy that
you hope to prescribe. A patient who speaks in terms of
unbearable pains will be more likely to respond well to a
remedy that is often listed in tearing, violent, lancinating
type pains.
4) And lastly, look for any coincidences between the
natural history or mythology of the substance and the
case.
I think you will find that these suggestions will help you
to discover more effective and interesting prescriptions
and to clarify which rubrics to choose for a patient.
About the author:
David Kent Warkentin, PA, is the creator of
MacRepertory and ReferenceWorks computer programs.
I began my homeopathic studies in the '70s. At that
time we were taught that the mental and emotional
symptoms were the most important consideration in
prescribing for a patient. Our case analyses reflected
this with a predominance of mental and general rubrics.
Since then I have found this approach to be limiting,
narrow, and misleading. In this article I will examine
why I have come to this conclusion.
Importance of mental and emotional symptoms:
Kent, and later, George Vithoulkas and Bill Gray
suggested that, at the same intensity, mental and
emotional symptoms are more important to the quality
of life than those that are physical. This is fairly clear
when we observe that there is a greater likelihood of
experiencing some richness of life in severe physical
diseases than in psychotic states.
The problem arises when this concept is altered to:
"The emotions of the patient are the most important
factor in finding the prescription." This misconception
will often mislead a prescriber into prescribing a
polychrest and missing a more exact and effective
remedy.
Common mental and emotional symptoms: We often
use repertory rubrics such as a lack of self-confidence,
fear of heights, desire for company, or timidity to point
us toward likely remedies. But these symptoms are
common to many individuals and so many remedies—
many more than are even shown in the repertory. These
common emotional symptoms are more indicative of
broad adaptations to life than a specific remedy.
Mental/emotional pathology: The mental or
emotional symptoms that we repertorize should be true
pathology that we observe clearly limits the patient—not
just a character trait! For instance, if a patient has
difficulty in leaving his room or speaking to others, their
timidity is pathological and it can be taken as a useful
rubric.
Mental disease: Something interesting happens in
true mental disease. Often the mental pathology is
common to the disease and therefore less useful to
prescribe on. In psychotic states, for example, you'll
often find people thinking they are horribly guilty and
God is angry at them. Prescribing on these rubrics will
find a remedy, like Kali bromatum, that helps for a short
period, but does little to move the case in a deep way.
Rubrics in analysis: When analyzing cases it is best
to avoid common rubrics; otherwise you will only find
common, less precise, remedies. Whatever rubrics you
choose, though, should be the most limiting to the
patient.
Rubrics which we select for a patient serve two
purposes: firstly to give us ideas of remedies that we
haven't considered and secondly to confirm a remedy
that we are examining. It is important to be clear which
purpose your rubrics are serving. Common symptoms
can be good confirmations, but make poor pointers.
Modalities: You will have the best results finding
effective remedies by choosing rubrics that include
modalities (e.g., headache in a draft). Boenninghausen
stressed this point strongly. The reason that these
rubrics are more effective is that they include several
elements of the story of the patient. Symptoms are
always related to a personal response to the world; they
will always resonate with the patient's unique story.
The most useful rubrics include modalities that make
sense in the context of the individual patient. For
example, in a patient who is very intellectual with many
stresses at work, the rubric "headache from mental
exertion" would be a good choice as it includes some of
the patient's story.
Matching rubrics to our books: Even the most well
selected rubrics are only as useful as the tools we use
to analyze them. The purpose of case analysis is to
compare our representation of our patient with the
books and tools in homeopathy. In our materia medicas
and repertories, with the. exception of the polychrests,
our remedies have very few mental or emotional
symptoms. This means that if you use many mental or
emotional rubrics in your analysis you will miss the
most precise remedy unless it is a polychrest.
For example, Aqua marina is similar to Natrum
muriaticum. But if a patient needing Aqua marina
walked in you'd never find it through repertorizing
mental symptoms—it just isn't well-known enough.
You'd have to focus on the physicals, otherwise you'd
miss it.
So, even if your choice of rubrics is flawless, if you have
included mostly mental and emotional rubrics there is a
good chance that you won't find an uncommon, though
correct, remedy. The only reliable way to find these
remedies (the vast majority of our remedies) is through
the physical pathology because most of the old
provings, and the bulk of our material, only recorded
physical symptoms.
Case analysis recommendations: My recommendation is
to approach cases in a four-pronged way:
1) Use physical pathology with modalities that include
the tone or story of the case. Leaving out many of the
mental and emotional rubrics will seldom weaken your
analysis.
2) Understand the mental and emotional strategy of the
patient. Then from the remedies that did well in #1
above, choose the ones that correspond with this
understanding. For example, if the physical pathology
points well to Baryta muriaticum don't be too
concerned if it is missing from an important emotional
rubric of the patient's, such as bashfulness, since you
can imagine that all of the Barytas can have this
general symptom. For relatively unknown remedies you
can discover their general emotional tone by reading
through an extraction from the Mind section of the
repertory.
3) Verify that, generally, the patient has their pathology
in the same location and style as the remedy you are
thinking of. You can be most confident if the focus of
the patient's pathology is in the same area as the
remedy's (e.g., when you have mental and general
symptoms that point to Euphrasia and the pathology is
in the eyes). And you can feel more confident if the tone
of the patient's complaints is similar to the remedy that
you hope to prescribe. A patient who speaks in terms of
unbearable pains will be more likely to respond well to a
remedy that is often listed in tearing, violent, lancinating
type pains.
4) And lastly, look for any coincidences between the
natural history or mythology of the substance and the
case.
I think you will find that these suggestions will help you
to discover more effective and interesting prescriptions
and to clarify which rubrics to choose for a patient.
About the author:
David Kent Warkentin, PA, is the creator of
MacRepertory and ReferenceWorks computer programs.
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