Mental health is a growing area of concern in our society and times. It needs to be understood and treated on an individual level. Every person is unique and has his life story full of joys, disappointments, and vicissitudes of life in some shape or form.
Homoeopathy is defined as a system of drug-therapeutics based on the law of similars. This law states that ‘a drug, acts as a curative agent when it is capable of producing in a healthy person a diseased-state exactly similar to that observed in a diseased person.’ As drug provings show that the actions of a drug manifest themselves on the body and the mind. So that, in every fully proved drug picture, there are corporeal symptoms along with alterations of thoughts, feelings, affections and intellect, memory etc.
The successful application of law of similars depends upon the concept of individualization and susceptible constitutions. The concept of individualization takes into consideration the total response of the organism to the unfavorable environment.
This unfavorable response is seen through signs and symptoms on three planes: Emotional, Intellectual and Physical, where the life force manifests itself.
On this emotional level arise anxiety, anger, anguish, irritability, fears, phobias, depression and many emotions.
Emotionally disturbed states tend to revolve around the issues of personal comfort, personal survival and personal expression.
Emotions as maintaining causes
When a patient has some harmful emotions, these emotions may act as maintaining causes for illness. The homoeopathic medicines boost the energy of a person to adapt with the energy of his own emotions and as a result to cope with varying types of environments.
The physician is the best person for this because the patient can talk freely with the physician. Also the physician can better understand the emotional problems and co-relate them better with the physical problems. The physician also has to evaluate that whether the anxiety is reasonable to circumstances or the patient is over-anxious.
General treatment of mental diseases
During Hahnemann`s time, mental asylums were usually run in connection with prisons. The mentally ill were crowded in close quarters with insufficient food, were chained, flogged and teased for the amusement of visitors. The physicians also abandoned them believing that insanity was contagious.
Hahnemann founded an asylum in Georgenthal where Duke Ernst of Gotha put one of the wings of his castle at Hahnemann`s disposal in 1792. He had only one patient Klockenbring from the beginning to the end. Klockenbring was cured of his illness. Hahnemann evolved a humane approach to mentally sick patients. He advocated unchaining of the mental patients. His principles for treatment of insane were new to the psychiatry of that time, but are today universally acknowledged as the chief factor in the treatment of insane. He introduced treatment to the mentally sick patient with kindness.
While describing his experience on the treatment of insane, he writes – “I never allow any insane person to be punished by blows or other painful corporeal inflictions, since there can be no punishment where there is no sense of responsibility, and since such patients only deserve our pity and cannot be improved, but must be rendered worse by such rough treatment.”
He further instructs the physicians attending the mental patients as – “The physician of such unfortunate creatures ought to behave so as to inspire them with respect and at the same time with confidence; he should never feel offended at what they do, for an irrational person can give no offence. The exhibition of their unreasonable anger should only excite his sympathy and stimulate his philanthropy to relieve their sad condition.”
Ahead of times, as Hahnemann was, he has coded some ethical approach to mental patients, which he describes in § 228 of the Organon.
Herein, in addition to Antipsoric treatment, he stresses upon psychotherapy with regulated mode of life and instructions for a good behaviour towards the patients by physician and attendants as:
▪ Raving madness should be met by calm fearlessness & firm resolution.
▪ Painfully disconsolate melancholy should be assuaged by silent compassion expressed
through gestures and looks.
▪ Loquacity should be listened to in silence.
▪ Indecent behaviour and obscene languages are to be totally ignored.
▪ In destructive mental tendencies, things should be kept out of reach
of the patient to prevent mischief.
▪ Absolute avoidance of torture and other corporeal punishments.
▪ All exciting factors, which may influence the mind of the patient,should be removed.
▪ Contradiction, arguments, rude correction etc. are to be avoided.
▪ The physician and the attendant should pretend to believe the patient in everything.
In the footnote to § 229, Hahnemann also recommends that the treatment of violent insane maniac and melancholic patients can take place only in an institution specially arranged for their treatment, but not within the family circle of the patient. He believed that the patient must be left alone and must not be excited or distracted by other people; as this hindered his recovery.
Hahnemann on mental diseases
Hahnemann describes mental diseases under One-sided diseases.
In §172 he writes, “A similar difficulty in the way of cure occurs from the symptoms of the disease being too few – a circumstance that deserves our careful attention, for by its removal almost all the difficulties that can lie in the way of this most perfect of all possible modes of treatment (except that its apparatus of known homoeopathic medicines is still incomplete) are removed.”
Mental diseases are one-sided diseases affecting the whole psychosomatic entity where the symptoms of derangement of mind and disposition are increased while the physical symptoms decline.
§ 210- 230
The § 210 to 230 of the Organon describe in detail different types of mental diseases and their treatment.
In §210, he attributes Psora as the cause of one-sided diseases and mental diseases are also a part of it. He stresses for psychic condition of the patient to be noted along with the totality of symptoms in order to treat these successfully with homoeopathic medicines.
In § 211, he stresses the importance of the psychic condition of the patient in selection of a remedy, putting them as characteristic symptoms and these cannot remain hidden from a careful physician.
In § 212, he highlights the fact that medicinal substances alter the mind and disposition of the provers during its proving and every medicine does so in a different manner.
In § 213, he advises to pay attention to mental symptoms even in acute cases and that unless the mental and emotional picture does not match with the remedy, positive results are not possible.
He explains this in the footnote of § 213 as “Thus Aconite will seldom or never effect either 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.”
In § 214, he starts to tell us that a patient with a mental-emotional disease must be perceived the same way as other patients i.e. with a remedy, a disease agent capable of producing in body and psyche of healthy people symptoms as similar as possible as those of the case.
In § 215, he specifies that most mental and emotional diseases are extensions of physical disease. So in the mental disease it starts on the physical level, and then slowly it progresses into the mental level until you have almost no more symptoms of the physical level and finally the disease transfers itself (almost like a local malady) to the invisibly subtle mental and emotional organs.
Showing posts with label anxiety. Show all posts
Showing posts with label anxiety. Show all posts
Tuesday, February 2, 2010
Tuesday, January 12, 2010
BEHAVIOURAL AND COGNITIVE THEORIES OF ANXIETY
BEHAVIOURAL AND COGNITIVE THEORIES OF ANXIETY
Behavioural theory
John Watson, the father of behaviourism, proposed that neuroses arouse out of traumatic learning situations and then persist to influence behaviour throughout life.
‘Stimulus – response’ concept of anxiety, which emerged from this, posits that certain stimuli when associated with fear could show up an anxiety response. For e.g. if a dog bites a child, the child will respond with anxiety the next time he sees a dog. This response will occur even if the dog does not actually bite him again. Thus anxiety has a protective function here. This anxiety could become a reaction to a danger signal that was recognised to forebode a harmful situation.
So, anxiety is viewed as an unconditioned inherent response of the organism to painful or dangerous stimuli. In anxiety and phobias, this becomes attached to relatively neutral stimuli by conditioning.
Systematic desensitization: The principle of reciprocal inhibition (i.e. anxiety and relaxation cannot coexist) is the core of this.
Systematic graded exposure to the source of anxiety is coupled with the use of relaxation techniques (the ‘desensitisation’ component).
Flooding/implosive therapy: The high levels of anxiety cannot be maintained for long periods, and a process of ‘exhaustion’ occurs. By exposing the patient to the phobic object and preventing the usual escape or avoidance, there is extinction of the usual anxiety response.
Anxiety and Cognitive performance
The cognitive model of anxiety postulates that anxious individuals invariably exaggerate the level of threat in a given situation. So, there is evidence of selective information processing (with more attention paid to threat related information), negative automatic thoughts and perception of decreased control over internal and external stimuli.
Cognitive behavioural modification or CBM developed from this approach helps in treatment of anxiety resulting from inadequate coping skills. It aims to ‘change the way you feel, by changing the way you think’.
Anxiety and rational thinking
Albert Ellis developed a treatment technique based on rational thinking in 1955. Several research studies have confirmed the relationship between anxiety and negative / irrational thinking.
The RET (Rational emotive therapy) belief holds that individual’s own thoughts and beliefs about difficulties create negative emotions as anxiety. The individual’s reaction towards a situation is based on his set of beliefs and attitudes. So, the patients are taught to identify, challenge, and change their irrational beliefs which maintain and justify their anxiety. After all, anxiety, by definition is not attributable to sources of real danger and is as such irrational.
Behavioural theory
John Watson, the father of behaviourism, proposed that neuroses arouse out of traumatic learning situations and then persist to influence behaviour throughout life.
‘Stimulus – response’ concept of anxiety, which emerged from this, posits that certain stimuli when associated with fear could show up an anxiety response. For e.g. if a dog bites a child, the child will respond with anxiety the next time he sees a dog. This response will occur even if the dog does not actually bite him again. Thus anxiety has a protective function here. This anxiety could become a reaction to a danger signal that was recognised to forebode a harmful situation.
So, anxiety is viewed as an unconditioned inherent response of the organism to painful or dangerous stimuli. In anxiety and phobias, this becomes attached to relatively neutral stimuli by conditioning.
Systematic desensitization: The principle of reciprocal inhibition (i.e. anxiety and relaxation cannot coexist) is the core of this.
Systematic graded exposure to the source of anxiety is coupled with the use of relaxation techniques (the ‘desensitisation’ component).
Flooding/implosive therapy: The high levels of anxiety cannot be maintained for long periods, and a process of ‘exhaustion’ occurs. By exposing the patient to the phobic object and preventing the usual escape or avoidance, there is extinction of the usual anxiety response.
Anxiety and Cognitive performance
The cognitive model of anxiety postulates that anxious individuals invariably exaggerate the level of threat in a given situation. So, there is evidence of selective information processing (with more attention paid to threat related information), negative automatic thoughts and perception of decreased control over internal and external stimuli.
Cognitive behavioural modification or CBM developed from this approach helps in treatment of anxiety resulting from inadequate coping skills. It aims to ‘change the way you feel, by changing the way you think’.
Anxiety and rational thinking
Albert Ellis developed a treatment technique based on rational thinking in 1955. Several research studies have confirmed the relationship between anxiety and negative / irrational thinking.
The RET (Rational emotive therapy) belief holds that individual’s own thoughts and beliefs about difficulties create negative emotions as anxiety. The individual’s reaction towards a situation is based on his set of beliefs and attitudes. So, the patients are taught to identify, challenge, and change their irrational beliefs which maintain and justify their anxiety. After all, anxiety, by definition is not attributable to sources of real danger and is as such irrational.
Monday, January 11, 2010
Psychodynamic theories of anxiety
PSYCHODYNAMIC THEORIES OF ANXIETY
Sigmund Freud is the forerunner of this school of thought. He defined anxiety as: “a specific state of unpleasure accompanied by motor discharge along definite pathways.”
Freud postulated that human anxiety is initiated during birth process, when an infant is expelled from the safe, warm uterine environment into a potentially dangerous one. This anxiety signal is reproduced in a modified form, whenever danger recurs, throughout the life.
Defense mechanisms:
According to this theory, anxiety is an indication that something is disturbing the internal psychological equilibrium. It is a signal to the ego that an unacceptable drive is pressing for conscious representation and discharge. This is called signal anxiety. This signal anxiety arouses the ego to take defensive action to cope up rationally against the pressures from within.
These defenses serve as disguises through which people hide their motives and conflicts from themselves as well as from others. Defenses are used to reduce anxiety arising from ego’s fear of being completely overwhelmed or destroyed by the power of instincts. Thus the role of defenses is to preserve the psychological organization and stability of the individual.
The most important & basic defense is Repression. Ideally, the use of repression alone should result in restoration of the psychological equilibrium. Repression reduces anxiety by keeping anxiety-laden thoughts and impulses out of person’s consciousness. It is often described as motivated forgetting. It is directed at both, external dangers, such as fear arousing events and internal dangers such as wishes, impulses and emotions that arouse guilt.
If the defenses are successful, the anxiety is dispelled or safely contained. When repression fails, other secondary defense mechanisms are called into play. These include denial, displacement, regression and others. Through these defense mechanisms the drives achieve a partial expression. This expression is disguised in the symptoms of hysteria, phobic disorder or obsessive-compulsive disorder depending on the defense that predominates.
If repression fails to function adequately and secondary defense mechanisms are not called into play, anxiety is found only as a symptom. When it rises above the low intensity, characteristic of its function as a signal, it may emerge with the fury of a panic attack.
Developmental stages
Freud believed that people normally progress through the five stages of psychosexual development. Problems at any stage may retard or arrest development and have long term effect on the life of the person.
Oral stage:
This is observed during first year of life. The newborn is completely dependent on others for fulfillment of all his needs. During this stage,
the body pleasure is centered on the mouth. The baby gets satisfaction from sucking, eating and biting in the course of feeding.
Anal stage:
It is found in the second year of life. It is characterised by a shift in body pleasure to the anus. It is reflected by concern with retention and expulsion of faeces.
Freud felt that during this stage of toilet training, a child has the first experience with externally imposed control. The pattern of toilet training may influence the personal qualities and conflicts experienced by the person in his life. Thus, if a person is subjected to very harsh, repressive type of training during this period, it may make the person obsessed with cleanliness during the adult phase.
Phallic stage:
In this stage the child observes the differences between male and female and experiences what Freud called as Oedipus complex. This occurs at about five years of age. Freud proposed that children develop a desire for opposite sex parent and a wish to displace the same sex parent. This type of attraction leads to serious conflict, which he termed as Oedipus and Electra complex in boys and girls respectively. These two complexes were named after two Greek characters. Oedipus unknowingly killed his father and then married his mother and Electra induced her brother to kill their mother.
Latency stage:
This stage follows phallic stage and in this stage there is very little explicit or overt concern with sexuality. The child represses his or her memories of infantile sexuality and forbidden sexual activity.
Genital stage:
During this stage the person attains maturity in psychosexual development. The person becomes capable for genuine love for other people and can achieve adult sexual satisfaction. He or she may relate to others in a heterosexual fashion.
The Structure of Personality
It refers to a person’s unique and relatively stable qualities that characterise behaviour patterns across different situations and over a period of time.
The personality consists of three dynamic structures i.e. Id, Ego and Superego. They are used as strong psychological forces and not physical locations in brain.
Id: Desire:
This part of personality deals with immediate gratification of primitive needs, sexual desires and aggressive impulses. It is totally unconscious and follows the pleasure principle. Thus, Id seeks the discharge of tension arising out of biological drives. Its main concern
is ‘need gratification’ in any manner. An infant’s mind is conceived as all Id.
Ego: Reason:
It develops out of Id. It works on ‘reality principle’. It tries to maximise pleasure and minimise pain. The ego emerges in childhood and is the personality which moderates the desires of Id.
Super Ego: Conscience:
It deals with the ideals. It represents the societal demands and ideals. If a person falls short of societal norms & ideals, then superego creates the feelings of guilt and punishes the person. It provides judgements on what behaviours are ‘acceptable’ and which are ‘bad’.
Categories of anxiety
Freud broke down his concept of anxiety into three types: Reality, Moral and Neurotic anxiety.
All three are involved with the ego’s response to actual, or potential, helplessness when threatened with overwhelming psychic danger. The function of ego is of mediation between instinctual demands to ensure that some gratification is achieved, while still preserving its own integrity. If such an outcome becomes impossible, pathological anxiety results.
The reality anxiety is due to real external threat. In this the ego’s aim is to expedite the gratification of instincts without making the organism vulnerable to anger, e.g. ‘I must have / do this, but I must avoid having physical harm in the process’. If the ego is uncertain how to achieve this aim, fear related anxiety results.
The moral anxiety is due to id-superego conflict. In this the ego’s aim is to preserve its sense of its own goodness while at the same time placating the instincts, e.g. ‘If I am good and worthy, I cannot allow myself to have / do this’. Shame / guilt related anxiety results if ego fails to meet the moral demands of the superego.
The neurotic anxiety is due to id- ego conflict. In this the ego’s aim is to protect its own identity and structure while an uncharacteristic and powerful instinctual drive threatens to overwhelm it, e.g. ‘I long to have / do this, but I cannot allow myself to perceive that I am the one who has/ does this’. Neurotic anxiety results when ego cannot satisfy these conflicting aims.
Freud writes that, “In some cases the characteristics of reality anxiety and neurotic anxiety are mingled. The danger is known and real but the anxiety in regard to it is over-great, greater than seems proper to us.”
While differentiating neurosis from psychosis, he says that for neurosis the decisive factor would be the predominance of the influence of reality, whereas for psychosis, a loss of reality would necessarily be present.
Sigmund Freud is the forerunner of this school of thought. He defined anxiety as: “a specific state of unpleasure accompanied by motor discharge along definite pathways.”
Freud postulated that human anxiety is initiated during birth process, when an infant is expelled from the safe, warm uterine environment into a potentially dangerous one. This anxiety signal is reproduced in a modified form, whenever danger recurs, throughout the life.
Defense mechanisms:
According to this theory, anxiety is an indication that something is disturbing the internal psychological equilibrium. It is a signal to the ego that an unacceptable drive is pressing for conscious representation and discharge. This is called signal anxiety. This signal anxiety arouses the ego to take defensive action to cope up rationally against the pressures from within.
These defenses serve as disguises through which people hide their motives and conflicts from themselves as well as from others. Defenses are used to reduce anxiety arising from ego’s fear of being completely overwhelmed or destroyed by the power of instincts. Thus the role of defenses is to preserve the psychological organization and stability of the individual.
The most important & basic defense is Repression. Ideally, the use of repression alone should result in restoration of the psychological equilibrium. Repression reduces anxiety by keeping anxiety-laden thoughts and impulses out of person’s consciousness. It is often described as motivated forgetting. It is directed at both, external dangers, such as fear arousing events and internal dangers such as wishes, impulses and emotions that arouse guilt.
If the defenses are successful, the anxiety is dispelled or safely contained. When repression fails, other secondary defense mechanisms are called into play. These include denial, displacement, regression and others. Through these defense mechanisms the drives achieve a partial expression. This expression is disguised in the symptoms of hysteria, phobic disorder or obsessive-compulsive disorder depending on the defense that predominates.
If repression fails to function adequately and secondary defense mechanisms are not called into play, anxiety is found only as a symptom. When it rises above the low intensity, characteristic of its function as a signal, it may emerge with the fury of a panic attack.
Developmental stages
Freud believed that people normally progress through the five stages of psychosexual development. Problems at any stage may retard or arrest development and have long term effect on the life of the person.
Oral stage:
This is observed during first year of life. The newborn is completely dependent on others for fulfillment of all his needs. During this stage,
the body pleasure is centered on the mouth. The baby gets satisfaction from sucking, eating and biting in the course of feeding.
Anal stage:
It is found in the second year of life. It is characterised by a shift in body pleasure to the anus. It is reflected by concern with retention and expulsion of faeces.
Freud felt that during this stage of toilet training, a child has the first experience with externally imposed control. The pattern of toilet training may influence the personal qualities and conflicts experienced by the person in his life. Thus, if a person is subjected to very harsh, repressive type of training during this period, it may make the person obsessed with cleanliness during the adult phase.
Phallic stage:
In this stage the child observes the differences between male and female and experiences what Freud called as Oedipus complex. This occurs at about five years of age. Freud proposed that children develop a desire for opposite sex parent and a wish to displace the same sex parent. This type of attraction leads to serious conflict, which he termed as Oedipus and Electra complex in boys and girls respectively. These two complexes were named after two Greek characters. Oedipus unknowingly killed his father and then married his mother and Electra induced her brother to kill their mother.
Latency stage:
This stage follows phallic stage and in this stage there is very little explicit or overt concern with sexuality. The child represses his or her memories of infantile sexuality and forbidden sexual activity.
Genital stage:
During this stage the person attains maturity in psychosexual development. The person becomes capable for genuine love for other people and can achieve adult sexual satisfaction. He or she may relate to others in a heterosexual fashion.
The Structure of Personality
It refers to a person’s unique and relatively stable qualities that characterise behaviour patterns across different situations and over a period of time.
The personality consists of three dynamic structures i.e. Id, Ego and Superego. They are used as strong psychological forces and not physical locations in brain.
Id: Desire:
This part of personality deals with immediate gratification of primitive needs, sexual desires and aggressive impulses. It is totally unconscious and follows the pleasure principle. Thus, Id seeks the discharge of tension arising out of biological drives. Its main concern
is ‘need gratification’ in any manner. An infant’s mind is conceived as all Id.
Ego: Reason:
It develops out of Id. It works on ‘reality principle’. It tries to maximise pleasure and minimise pain. The ego emerges in childhood and is the personality which moderates the desires of Id.
Super Ego: Conscience:
It deals with the ideals. It represents the societal demands and ideals. If a person falls short of societal norms & ideals, then superego creates the feelings of guilt and punishes the person. It provides judgements on what behaviours are ‘acceptable’ and which are ‘bad’.
Categories of anxiety
Freud broke down his concept of anxiety into three types: Reality, Moral and Neurotic anxiety.
All three are involved with the ego’s response to actual, or potential, helplessness when threatened with overwhelming psychic danger. The function of ego is of mediation between instinctual demands to ensure that some gratification is achieved, while still preserving its own integrity. If such an outcome becomes impossible, pathological anxiety results.
The reality anxiety is due to real external threat. In this the ego’s aim is to expedite the gratification of instincts without making the organism vulnerable to anger, e.g. ‘I must have / do this, but I must avoid having physical harm in the process’. If the ego is uncertain how to achieve this aim, fear related anxiety results.
The moral anxiety is due to id-superego conflict. In this the ego’s aim is to preserve its sense of its own goodness while at the same time placating the instincts, e.g. ‘If I am good and worthy, I cannot allow myself to have / do this’. Shame / guilt related anxiety results if ego fails to meet the moral demands of the superego.
The neurotic anxiety is due to id- ego conflict. In this the ego’s aim is to protect its own identity and structure while an uncharacteristic and powerful instinctual drive threatens to overwhelm it, e.g. ‘I long to have / do this, but I cannot allow myself to perceive that I am the one who has/ does this’. Neurotic anxiety results when ego cannot satisfy these conflicting aims.
Freud writes that, “In some cases the characteristics of reality anxiety and neurotic anxiety are mingled. The danger is known and real but the anxiety in regard to it is over-great, greater than seems proper to us.”
While differentiating neurosis from psychosis, he says that for neurosis the decisive factor would be the predominance of the influence of reality, whereas for psychosis, a loss of reality would necessarily be present.
Tuesday, January 5, 2010
Physiology of anxiety
PHYSIOLOGY OF ANXIETY
Historical Development
Descartes saw the mind & body as different units and noticed the direct effect of emotions on the body reactions. He proposed that pineal body was the main mediating centre between the body and the soul.
The Cannon-Baird theory named thalamus as the centre initiating emotional reactions. It was held responsible for receiving sensory information. It also communicated with cortex & body organs to bring about behavioural changes. Cannon also described the characteristic ‘fight / flight’ stress reaction and the role of sympathetic nervous system in it.
The modern basis of emotional expression in the biology of the brain began with the work of the American neuroanatomist James Papez. Papez described an "ensemble of structures" in the lower, subcortical areas of the brain (as the hypothalamus, the hippocampus and the amygdala) or the limbic system as brain sites associated with emotion. He emphasized the role of hypothalamus rather than thalamus as control centre in initiating emotional response.
Recent evidence highlights the role of genetic influences in the causation of anxiety disorders. Studies have shown that the prevalence of anxiety and related disorders is higher among the relatives of affected subjects than among control families.
THE BRAIN AND ANXIETY
Recent studies suggest that three brain sites are responsible for regulating anxiety, i.e. prefrontal area of cortex, amygdala and hypothalamus in sub cortex.
▪ The higher brain or cortex is responsible for:
Identifying and interpreting stressors and Initiating / coordinating the voluntary action.
▪ The lower brain or sub cortex is responsible for:
Beginning and controlling states of physiological excitement and for involuntary homeostatic functions.
When exposed to stress, following processes happen:
▪The cortex first perceives the stressor.
▪The prefrontal cortex is involved in the cognitive evaluation of the stressor.
▪The subcortical structures are then called into play.
▪The amygdala is responsible for generating the fear response.
▪The hypothalamus regulates the stress response and activates the autonomic and the endocrine systems. It mediates between these two systems and is involved with limbic cortex in regulating emotions.
The Amygdala
The amygdala is believed to serve as a communication hub between the parts of the brain that process incoming sensory signal and the parts that interpret them. It signals that a threat is present and triggers a fear response or anxiety.
Hippocampus
Hippocampus is another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories.
Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficit in clear memory, and fragmented memory for details of the traumatic event.
The Hypothalamus
The hypothalamus helps the body in controlling body temperature. It also contains centres involved with hunger and pleasure. Its main function during stress is to activate and regulate the autonomic and endocrine systems.
The hypothalamus, on stimulation produces emotional and behavioural responses, both autonomic and skeletal. Three main reactions have been observed on experimental stimulation of hypothalamus. They are Alarm, Flight and Rage.
The two lobes of hypothalamus are concerned with the regulation of arousal. The anterolateral lobe inhibits sympathetic nervous system activity and the release of activating hormones from the pituitary. The posteromedial lobe has the opposite effect.
It has direct links with the pituitary gland, the limbic structures, the cortex and the thalamus. Neural pathways from hypothalamus also link it to the brainstem and the spinal cord.
The Autonomic nervous system and anxiety
It has an important part in instigation and maintenance of appropriate levels of physiological arousal. It has two main branches –
Sympathetic nervous system (SNS). It is responsible for the ‘stress’ response. During ‘stress’ states, the SNS prepares the individual for ‘fight or flight’ response. The flow of blood from digestive organs is directed to the fighting muscles and the heart rate increases.
Parasympathetic nervous system (PNS). It is responsible for ‘relaxation’ response. During ‘relaxed’ states, the PNS prepares the individual for digestion, recuperation and sleep.
The two branches of ANS work partly in concert. While most organs are under control of both, some sites & symptoms are under the sole control of SNS, i.e. the sweat glands, lung muscles, blood glucose levels and the basal metabolic rate. Others, such as the ciliary muscles of the eye, are under exclusive control of PNS.
Individual responses and ANS
While the SNS is usually predominant during stress, some individuals may respond to stressors with PNS dominance. It causes a fall in blood pressure and blood glucose levels. Other symptoms may be cold sweating, dizziness, reduced respiratory action and fainting.
Lacey proposed that persons do not respond with simple PNS or SNS dominance under stress. It suggested that individuals might react strongly on one physiological measure and very little on another.
The nature of reaction profile might be determined by the total life experience of the individual as well as genetically determined physiological factors. Several studies on physiological arousal patterns in anxiety neurosis have demonstrated consistent sympathetic hyperactivity.
Anxiety disorders have been correlated with a pattern of raised heart rate levels, frontalis muscle tension, forearm blood flow, skin conductance, respiration rates and blood pressure.
Each individual has a base line norm of autonomic arousal, or starting point. It has been shown that a high baseline norm will lead to a smaller reaction under stress while a low baseline norm will lead to a larger reaction.
The Endocrine system and Anxiety
This system has an important role in total stress response.
During stress, the ‘master gland’ pituitary is stimulated by hypothalamus to release several chemical messengers to the slave glands directly into bloodstream. These include vasopressin, adrenocorticotrophic hormone (ACTH) and thyrotrophic hormone (TTH). Vasopressin contracts the arteries and causes the blood pressure to rise. ACTH and TTH pass on to adrenal and thyroid glands. They work together to increase circulation and basal metabolic rates.
The Adrenal glands
Adrenalin & noradrenalin from medulla and corticoids from cortex are directly released into blood stream.
Adrenalin stimulates the production of glucose from glycogen in liver. The glucose is released in blood increasing the carbohydrate metabolism. It also dilates coronary and skeletal muscle arteries, increases heart rate, blood volume and body temperature.
Gaseous exchange is facilitated by bronchial dilatation and shallow breathing results. Smooth (visceral) muscles tend to relax while the sphincters are constricted. Noradrenalin constricts the peripheral arterioles and increases blood pressure. It has been suggested that adrenalin is the major hormone in states of fear while noradrenalin is predominant in anger. Glucocorticoids from cortex tend to raise blood sugar levels and inhibit inflammation.
Thyroid gland
Thyrotrophic hormone acts on thyroid causing release of thyroxine. The rise of thyroxine in stress conditions causes increased sweating, muscle tremor, heart rate and exaggerated breathing. These effects are similar to adrenalin. Adrenalin tends to predominate in short term stress while thyroxine is released in large quantities in prolonged stress.
General Adaptation Syndrome
Selye used the term ‘stress’ instead of ‘strain’ in its relation to human psychophysiology. He coined the term ‘general adaptation syndrome’ or GAS. GAS has three phases:
• Alarm reaction (involving shock and counter shock phases).
• Resistance (adaptive response).
• Exhaustion.
The Alarm phase: In this phase, mobilization takes place following the detection of a stressor. The stressor can either be psychological or physiological in nature. Increase in adrenocortical hormones also takes place in this phase.
The Resistance phase: It involves selection of an appropriate organ or system to deal with the particular stressor. Adrenocortical hormones diminish once a specific system is delegated. All the internal resources are then directed towards the support of this system, leaving others susceptible. This may reduce the resistance of the organism to disease.
The Exhaustion phase: When the system assigned the job becomes overloaded, the exhaustion phase is reached. At this point, the adrenocortical hormone levels increase again and the alarm phase is induced again. A different system may then be delegated to handle the continuing stress.
The GAS is useful in mobilising protective resources in emergency situations. In prolonged situations, it may lower resistance. The energy for adaptive reaction to stress is provided by suppressing immune reactions and inflammatory responses to invading pathogens. It is suggested that the ‘weakest link’ or most vulnerable part of the body breaks down first under stress. Therefore, factors including heredity and prior disease may predispose an organism towards a specific somatic disorder.
Allergies may also be associated with stress. Allergic reactions involve high levels of inflammatory corticoids for destruction of pathogens. Under stressful conditions the allergic response may be aggravated.
Selye based his conclusions on experimental work in which rats were subjected to prolonged stress. It resulted in drastic body changes including irreversible organ damage. The rats showed enlargement of adrenal cortex and atrophy of thymus, spleen and lymph nodes. A severe reduction of white cells and bleeding ulcers in stomach and duodenum were observed.
According to Selye, ACTH plays an important role in GAS. In acute stress, adrenalin and noradrenalin from the adrenal medulla are most important. In chronic stress the corticoids are the primary agents.
The kidney also plays an important role in GAS, as it is responsible for maintaining a chemical and water balance in the blood and tissues.
In chronic stress conditions, when corticoids are raised for a prolonged period, blood pressure may rise and damage the kidney.
Damage to arteries associated with atherosclerosis may also occur. Continued stress can produce increased hydrochloride acid secretion in stomach leading to formation of ulcers.
Selye also added some suggestions on ways of dealing with stress as:
• Removal of unnecessary stressors from lifestyle.
• Do not allow neutral events to become stressors.
• Develop skill in dealing with stressors.
• Seek relaxation.
Neurotransmitters and anxiety
The nerve cells communicate with one another with the help of neurotransmitters. Some of these play a significant role in anxiety and other psychiatric disorders. Examples of these are noradrenalin, adrenalin, serotonin, GABA, dopamine, acetylcholine and histamine.
The dysfunction of neurotransmitter activity is the cause of the most psychiatric disorders. The excessive activity may lead to anxiety and psychosis while under activity may cause depression.
Recent developments support the view that noradrenalin and serotonin have a central role in mechanisms underlying anxiety in the central nervous system.
By Dr. Dushyant kamal Dhari
M.D. (Hom).
Historical Development
Descartes saw the mind & body as different units and noticed the direct effect of emotions on the body reactions. He proposed that pineal body was the main mediating centre between the body and the soul.
The Cannon-Baird theory named thalamus as the centre initiating emotional reactions. It was held responsible for receiving sensory information. It also communicated with cortex & body organs to bring about behavioural changes. Cannon also described the characteristic ‘fight / flight’ stress reaction and the role of sympathetic nervous system in it.
The modern basis of emotional expression in the biology of the brain began with the work of the American neuroanatomist James Papez. Papez described an "ensemble of structures" in the lower, subcortical areas of the brain (as the hypothalamus, the hippocampus and the amygdala) or the limbic system as brain sites associated with emotion. He emphasized the role of hypothalamus rather than thalamus as control centre in initiating emotional response.
Recent evidence highlights the role of genetic influences in the causation of anxiety disorders. Studies have shown that the prevalence of anxiety and related disorders is higher among the relatives of affected subjects than among control families.
THE BRAIN AND ANXIETY
Recent studies suggest that three brain sites are responsible for regulating anxiety, i.e. prefrontal area of cortex, amygdala and hypothalamus in sub cortex.
▪ The higher brain or cortex is responsible for:
Identifying and interpreting stressors and Initiating / coordinating the voluntary action.
▪ The lower brain or sub cortex is responsible for:
Beginning and controlling states of physiological excitement and for involuntary homeostatic functions.
When exposed to stress, following processes happen:
▪The cortex first perceives the stressor.
▪The prefrontal cortex is involved in the cognitive evaluation of the stressor.
▪The subcortical structures are then called into play.
▪The amygdala is responsible for generating the fear response.
▪The hypothalamus regulates the stress response and activates the autonomic and the endocrine systems. It mediates between these two systems and is involved with limbic cortex in regulating emotions.
The Amygdala
The amygdala is believed to serve as a communication hub between the parts of the brain that process incoming sensory signal and the parts that interpret them. It signals that a threat is present and triggers a fear response or anxiety.
Hippocampus
Hippocampus is another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories.
Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficit in clear memory, and fragmented memory for details of the traumatic event.
The Hypothalamus
The hypothalamus helps the body in controlling body temperature. It also contains centres involved with hunger and pleasure. Its main function during stress is to activate and regulate the autonomic and endocrine systems.
The hypothalamus, on stimulation produces emotional and behavioural responses, both autonomic and skeletal. Three main reactions have been observed on experimental stimulation of hypothalamus. They are Alarm, Flight and Rage.
The two lobes of hypothalamus are concerned with the regulation of arousal. The anterolateral lobe inhibits sympathetic nervous system activity and the release of activating hormones from the pituitary. The posteromedial lobe has the opposite effect.
It has direct links with the pituitary gland, the limbic structures, the cortex and the thalamus. Neural pathways from hypothalamus also link it to the brainstem and the spinal cord.
The Autonomic nervous system and anxiety
It has an important part in instigation and maintenance of appropriate levels of physiological arousal. It has two main branches –
Sympathetic nervous system (SNS). It is responsible for the ‘stress’ response. During ‘stress’ states, the SNS prepares the individual for ‘fight or flight’ response. The flow of blood from digestive organs is directed to the fighting muscles and the heart rate increases.
Parasympathetic nervous system (PNS). It is responsible for ‘relaxation’ response. During ‘relaxed’ states, the PNS prepares the individual for digestion, recuperation and sleep.
The two branches of ANS work partly in concert. While most organs are under control of both, some sites & symptoms are under the sole control of SNS, i.e. the sweat glands, lung muscles, blood glucose levels and the basal metabolic rate. Others, such as the ciliary muscles of the eye, are under exclusive control of PNS.
Individual responses and ANS
While the SNS is usually predominant during stress, some individuals may respond to stressors with PNS dominance. It causes a fall in blood pressure and blood glucose levels. Other symptoms may be cold sweating, dizziness, reduced respiratory action and fainting.
Lacey proposed that persons do not respond with simple PNS or SNS dominance under stress. It suggested that individuals might react strongly on one physiological measure and very little on another.
The nature of reaction profile might be determined by the total life experience of the individual as well as genetically determined physiological factors. Several studies on physiological arousal patterns in anxiety neurosis have demonstrated consistent sympathetic hyperactivity.
Anxiety disorders have been correlated with a pattern of raised heart rate levels, frontalis muscle tension, forearm blood flow, skin conductance, respiration rates and blood pressure.
Each individual has a base line norm of autonomic arousal, or starting point. It has been shown that a high baseline norm will lead to a smaller reaction under stress while a low baseline norm will lead to a larger reaction.
The Endocrine system and Anxiety
This system has an important role in total stress response.
During stress, the ‘master gland’ pituitary is stimulated by hypothalamus to release several chemical messengers to the slave glands directly into bloodstream. These include vasopressin, adrenocorticotrophic hormone (ACTH) and thyrotrophic hormone (TTH). Vasopressin contracts the arteries and causes the blood pressure to rise. ACTH and TTH pass on to adrenal and thyroid glands. They work together to increase circulation and basal metabolic rates.
The Adrenal glands
Adrenalin & noradrenalin from medulla and corticoids from cortex are directly released into blood stream.
Adrenalin stimulates the production of glucose from glycogen in liver. The glucose is released in blood increasing the carbohydrate metabolism. It also dilates coronary and skeletal muscle arteries, increases heart rate, blood volume and body temperature.
Gaseous exchange is facilitated by bronchial dilatation and shallow breathing results. Smooth (visceral) muscles tend to relax while the sphincters are constricted. Noradrenalin constricts the peripheral arterioles and increases blood pressure. It has been suggested that adrenalin is the major hormone in states of fear while noradrenalin is predominant in anger. Glucocorticoids from cortex tend to raise blood sugar levels and inhibit inflammation.
Thyroid gland
Thyrotrophic hormone acts on thyroid causing release of thyroxine. The rise of thyroxine in stress conditions causes increased sweating, muscle tremor, heart rate and exaggerated breathing. These effects are similar to adrenalin. Adrenalin tends to predominate in short term stress while thyroxine is released in large quantities in prolonged stress.
General Adaptation Syndrome
Selye used the term ‘stress’ instead of ‘strain’ in its relation to human psychophysiology. He coined the term ‘general adaptation syndrome’ or GAS. GAS has three phases:
• Alarm reaction (involving shock and counter shock phases).
• Resistance (adaptive response).
• Exhaustion.
The Alarm phase: In this phase, mobilization takes place following the detection of a stressor. The stressor can either be psychological or physiological in nature. Increase in adrenocortical hormones also takes place in this phase.
The Resistance phase: It involves selection of an appropriate organ or system to deal with the particular stressor. Adrenocortical hormones diminish once a specific system is delegated. All the internal resources are then directed towards the support of this system, leaving others susceptible. This may reduce the resistance of the organism to disease.
The Exhaustion phase: When the system assigned the job becomes overloaded, the exhaustion phase is reached. At this point, the adrenocortical hormone levels increase again and the alarm phase is induced again. A different system may then be delegated to handle the continuing stress.
The GAS is useful in mobilising protective resources in emergency situations. In prolonged situations, it may lower resistance. The energy for adaptive reaction to stress is provided by suppressing immune reactions and inflammatory responses to invading pathogens. It is suggested that the ‘weakest link’ or most vulnerable part of the body breaks down first under stress. Therefore, factors including heredity and prior disease may predispose an organism towards a specific somatic disorder.
Allergies may also be associated with stress. Allergic reactions involve high levels of inflammatory corticoids for destruction of pathogens. Under stressful conditions the allergic response may be aggravated.
Selye based his conclusions on experimental work in which rats were subjected to prolonged stress. It resulted in drastic body changes including irreversible organ damage. The rats showed enlargement of adrenal cortex and atrophy of thymus, spleen and lymph nodes. A severe reduction of white cells and bleeding ulcers in stomach and duodenum were observed.
According to Selye, ACTH plays an important role in GAS. In acute stress, adrenalin and noradrenalin from the adrenal medulla are most important. In chronic stress the corticoids are the primary agents.
The kidney also plays an important role in GAS, as it is responsible for maintaining a chemical and water balance in the blood and tissues.
In chronic stress conditions, when corticoids are raised for a prolonged period, blood pressure may rise and damage the kidney.
Damage to arteries associated with atherosclerosis may also occur. Continued stress can produce increased hydrochloride acid secretion in stomach leading to formation of ulcers.
Selye also added some suggestions on ways of dealing with stress as:
• Removal of unnecessary stressors from lifestyle.
• Do not allow neutral events to become stressors.
• Develop skill in dealing with stressors.
• Seek relaxation.
Neurotransmitters and anxiety
The nerve cells communicate with one another with the help of neurotransmitters. Some of these play a significant role in anxiety and other psychiatric disorders. Examples of these are noradrenalin, adrenalin, serotonin, GABA, dopamine, acetylcholine and histamine.
The dysfunction of neurotransmitter activity is the cause of the most psychiatric disorders. The excessive activity may lead to anxiety and psychosis while under activity may cause depression.
Recent developments support the view that noradrenalin and serotonin have a central role in mechanisms underlying anxiety in the central nervous system.
By Dr. Dushyant kamal Dhari
M.D. (Hom).
Monday, January 4, 2010
Anxiety
ANXIETY
Anxiety has been derived from french word ‘anxieté’. It means ‘the state of feeling nervous or worried that something bad is going to happen.’
The Oxford handbook of psychiatry defines anxiety as “A normal and adaptive response to stress and danger which is pathological if prolonged, severe or out of keeping with the real threat of the external situation. It has two components: psychic anxiety, which is an affect, characterised by increased arousal, apprehension, sense of vulnerability and unpleasant emotional state; and somatic anxiety, in which there are bodily sensations of palpitations, sweating, dyspnoea, pallor and abdominal discomfort.”
Anxiety is the most common psychiatric symptom in clinical practice and anxiety disorders are the commonest disorders found in 15 to 20 percent of patients. These are more common in industrially advanced countries. Anxiety disorders have harmful effects upon physical and mental health. They also impair functional ability and quality of life. The causes of anxiety in modern life are uncertainty, insecurity, time pressures, relationship problems and fears of inadequacy.
Anxiety is a common emotion and often a normal response to new, stressful, or potentially dangerous situations. In its mild forms, it may be adaptive. It helps one to perform better. A little anxiety, for example helps a student to prepare for his exams. In its extreme forms, it is incapacitating or terrifying. It may cause the same student to lose his concentration, or even his voice.
Anxiety becomes a problem only when it is abnormally severe, abnormally prolonged, or if it is present at a level out of proportion to the real threat of the situation.
Anxiety often arises in anticipation of danger rather than after a situation has occurred. It is a signal of the approach of danger and a warning to prepare our defenses. It can also indicate an inability to cope with danger.
Anxiety is an extremely unpleasant feeling – it can make people feel frightened, uneasy, unhappy and sometimes desperate. Anxiety symptoms vary widely and may even imitate severe physical or mental illness. These symptoms may affect on physical level, thoughts and emotions and the lifestyle of the individual affected.
The Physical Symptoms of Anxiety
Anxiety may present on physical level as:
• Breathing difficulties. • Feeling faint / dizzy. • Dry mouth.
• Shakiness. • Pounding heart. • Muscle aches & pains.
• Headaches. • Excessive sweating. • ‘Lumps’ in throat.
• Bowel and urinary problems. • Persistent tiredness
In addition to these, body postures such as crossed arms, crossed legs, clenched fists, clenched jaw with tight facial muscles, head bent, rapid and shallow breathing, frowning / staring expression, and stooped posture also present a picture of anxiety.
On the mental level:
• Fear of variety of things, people or situations.
• Negative or unreasonable ideas about themselves or the feared situation.
• Increased episodes of crying, being irritable, difficult concentration,
worrying and feeling guilty.
Two main reasons for persistent anxiety are avoidance of feared situations and faulty thinking.
Avoidance: We may avoid situations which we know will cause us anxiety. As the symptoms caused in a particular situation are uncomfortable, we avoid facing it, but each time we avoid a situation, its tendency to cause anxiety in us increases.
Faulty thinking: It includes our negative thoughts and irrational beliefs. The negative thoughts make us expect the worst, while the irrational beliefs, make us expect too much from others or ourselves. So that leaves us prone to constant disappointment.
The Anxiety trap
The lifestyle may be seriously affected by a tendency to avoid situations or escaping them wherever possible. This involves a lots of ‘NOTS’ and ‘CANT’S’ which make a happy and fulfilled existence impossible and leads to a poor quality of life. It also affects relationships and work performances.
HOLISTIC APPROACH
The modern medicine lacks a holistic approach in its treatment for the
anxiety disorders. In spite of various advances, the medicines for anxiety in modern medicine are not curative in nature. A risk of dependency is also associated with them.
The mind and body work harmoniously in health and in disease. Both of them are considered as a unit in the treatment of diseases. Homoeopathy is a holistic science and has a psychosomatic approach in all diseases. This holistic approach of Homoeopathy gives it an edge in the treatment of affections of the mind. In the Organon of medicine, mental diseases are classified and their treatment is described in detail from aphorism 210 to aphorism 230. Hahnemann was the first to advocate unchaining of the mental patients. He also wrote in detail about the psychotherapy for such patients.
The study of anxiety through homoeopathic perspective
No one can deny the role of emotions as causative modalities in the origin and maintenance of innumerable diseases. The provings on healthy human beings has yielded all kinds of emotions that are recorded in materia medica.
Anxiety falls in the emotional sphere of mind. In homoeopathy, the symptoms of emotional sphere are of great importance. While evaluating the symptoms, they are considered to be second in importance after the “will” symptoms for the selection of remedy.
Dr Dushyant Kamal Dhari
M.D.(Hom)
Anxiety has been derived from french word ‘anxieté’. It means ‘the state of feeling nervous or worried that something bad is going to happen.’
The Oxford handbook of psychiatry defines anxiety as “A normal and adaptive response to stress and danger which is pathological if prolonged, severe or out of keeping with the real threat of the external situation. It has two components: psychic anxiety, which is an affect, characterised by increased arousal, apprehension, sense of vulnerability and unpleasant emotional state; and somatic anxiety, in which there are bodily sensations of palpitations, sweating, dyspnoea, pallor and abdominal discomfort.”
Anxiety is the most common psychiatric symptom in clinical practice and anxiety disorders are the commonest disorders found in 15 to 20 percent of patients. These are more common in industrially advanced countries. Anxiety disorders have harmful effects upon physical and mental health. They also impair functional ability and quality of life. The causes of anxiety in modern life are uncertainty, insecurity, time pressures, relationship problems and fears of inadequacy.
Anxiety is a common emotion and often a normal response to new, stressful, or potentially dangerous situations. In its mild forms, it may be adaptive. It helps one to perform better. A little anxiety, for example helps a student to prepare for his exams. In its extreme forms, it is incapacitating or terrifying. It may cause the same student to lose his concentration, or even his voice.
Anxiety becomes a problem only when it is abnormally severe, abnormally prolonged, or if it is present at a level out of proportion to the real threat of the situation.
Anxiety often arises in anticipation of danger rather than after a situation has occurred. It is a signal of the approach of danger and a warning to prepare our defenses. It can also indicate an inability to cope with danger.
Anxiety is an extremely unpleasant feeling – it can make people feel frightened, uneasy, unhappy and sometimes desperate. Anxiety symptoms vary widely and may even imitate severe physical or mental illness. These symptoms may affect on physical level, thoughts and emotions and the lifestyle of the individual affected.
The Physical Symptoms of Anxiety
Anxiety may present on physical level as:
• Breathing difficulties. • Feeling faint / dizzy. • Dry mouth.
• Shakiness. • Pounding heart. • Muscle aches & pains.
• Headaches. • Excessive sweating. • ‘Lumps’ in throat.
• Bowel and urinary problems. • Persistent tiredness
In addition to these, body postures such as crossed arms, crossed legs, clenched fists, clenched jaw with tight facial muscles, head bent, rapid and shallow breathing, frowning / staring expression, and stooped posture also present a picture of anxiety.
On the mental level:
• Fear of variety of things, people or situations.
• Negative or unreasonable ideas about themselves or the feared situation.
• Increased episodes of crying, being irritable, difficult concentration,
worrying and feeling guilty.
Two main reasons for persistent anxiety are avoidance of feared situations and faulty thinking.
Avoidance: We may avoid situations which we know will cause us anxiety. As the symptoms caused in a particular situation are uncomfortable, we avoid facing it, but each time we avoid a situation, its tendency to cause anxiety in us increases.
Faulty thinking: It includes our negative thoughts and irrational beliefs. The negative thoughts make us expect the worst, while the irrational beliefs, make us expect too much from others or ourselves. So that leaves us prone to constant disappointment.
The Anxiety trap
The lifestyle may be seriously affected by a tendency to avoid situations or escaping them wherever possible. This involves a lots of ‘NOTS’ and ‘CANT’S’ which make a happy and fulfilled existence impossible and leads to a poor quality of life. It also affects relationships and work performances.
HOLISTIC APPROACH
The modern medicine lacks a holistic approach in its treatment for the
anxiety disorders. In spite of various advances, the medicines for anxiety in modern medicine are not curative in nature. A risk of dependency is also associated with them.
The mind and body work harmoniously in health and in disease. Both of them are considered as a unit in the treatment of diseases. Homoeopathy is a holistic science and has a psychosomatic approach in all diseases. This holistic approach of Homoeopathy gives it an edge in the treatment of affections of the mind. In the Organon of medicine, mental diseases are classified and their treatment is described in detail from aphorism 210 to aphorism 230. Hahnemann was the first to advocate unchaining of the mental patients. He also wrote in detail about the psychotherapy for such patients.
The study of anxiety through homoeopathic perspective
No one can deny the role of emotions as causative modalities in the origin and maintenance of innumerable diseases. The provings on healthy human beings has yielded all kinds of emotions that are recorded in materia medica.
Anxiety falls in the emotional sphere of mind. In homoeopathy, the symptoms of emotional sphere are of great importance. While evaluating the symptoms, they are considered to be second in importance after the “will” symptoms for the selection of remedy.
Dr Dushyant Kamal Dhari
M.D.(Hom)
Wednesday, December 30, 2009
Irritable bowel syndrome
Homoeopathy for the layman
IRRITABLE BOWEL SYNDROME (IBS)
Introduction
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, distention and change in bowel habits. It’s prevalence in western countries is about 15-20% in adults with female predominance. In India its prevalence is increasing due to increased psychological stress and the westernization of the diet with a male predominance.
Causes
In most of the patients psychological conditions like anxiety, depression and fear are responsible. These conditions play a causative as well as maintaining role in IBS.
Other causes include weak vitality and poor adaptability.
This syndrome can also be triggered by acute gastrointestinal infection, irregular food habits, abuse of laxatives and other medications etc.
Symptoms
Gastrointestinal symptoms of IBS are:
1. Abdominal Pain - It is felt in lower abdomen, dull or colicky in nature and usually relieved by defecation or passing flatus. It is usually worse after meals.
2. Abdominal distension and bloating - Sense of abdominal distention or bloating is usually complained by majority. It is usually worse throughout the day but is not due to excessive intestinal gas.
3. Variable bowel habits – Most of the patients have alternate episodes of diarrhea and constipation but it is useful to classify patients as having predominantly constipation or predominantly diarrhea. The constipated type tends to pass infrequent pellet like stools, usually in association with abdominal pain. Those with diarrhea have frequent defecation but produce low volume stools and are rarely worse at night. Mucous is commonly seen with stools and no rectal bleeding is there.
4. Other symptoms associated are nausea, headaches; Pains in back, thigh or chest; frequent urination and fatigue. Despite severe symptoms, patients do not loose weight
The diagnosis of IBS is made if the symptoms are present for more than 3 months. The various type of IBS are - Diarrhea predominant (IBS-D), Constipation predominant (IBS-C), Alternating stool pattern (IBS-A).
Investigations
As it a functional problem, no structural changes are present and tests reveal nothing. Usually lab investigations are done to rule out other disease. In older patients barium enema and colonoscopy is done to exclude colorectal cancer. While younger patients with persistent diarrhea may require endoscopy to rule out ulcerative colitis.
Management
Most of the patients have a relapsing and remitting course. Aggravation of the complaints often follow stressful life events, occupational dissatisfaction and difficulties with inter personal relationships.
Along with medicines following measures are of utmost importance in the management of IBS.
1. Diet: - Increase of fibrous diet with supplementation with bulking agents as coarse wheat bran or isaphgul husk. Intake of smaller meals at frequent intervals. Avoidance of alcohol, spices, fatty meals & dietary items that aggravate the condition.
2. Other measures include relaxation techniques for stress management, regular exercise, yoga etc.
Role of Homoeopathy
As per Homoeopathic system of medicine, Disease is a total response of a patient to adverse environmental factors, external or internal; it is conditioned by constitutional factors, inherited and acquired; and it manifests itself through symptoms in the three spheres – emotional, intellectual and physical. This response is divisible into
a) Individual response – characteristic symptoms which denote the constitutional type; which vary from person to person and
b) Group response – diagnostic symptoms.
In Homoeopathic system of medicine, the individual response of the patient is much important than the group response. So, in a set of patients having the same diagnostic symptoms (group response), the medicine given to each of them is different as the individual response of each varies. As in most of patients, the condition of the mind is responsible for IBS; homoeopathy has a much greater role to play. So, while the allopathic physician may refer such patient to the psychiatrist for treatment of mind symptoms, in homoeopathy the patient is treated as a single unit and the medicine which is suited to him for his mental as well as physical state is prescribed. Thus the patient is treated in a holistic way with homoeopathy.
With an eye on the constitution, temperament, totality of symptoms, life style and diet of the patients suffering from IBS, successful results can be obtained with homoeopathic medicines.
Homoeopathic medicines for IBS: - Medicines commonly used for IBS are Abies-nigra,
Aloes, Argentum nitricum, Arsenic Album, Asafoetida, Baptisia, Belladonna, Calcarea carb, Carbo-veg, Causticum, Chamomilla, China, Colchicum, Colocynthis, Gratiola, Ignatia, Iris v, Kali Bich, Lilium tig, Lycopodium, Merc sol, Merc cor, Natrum carb, Natrum mur, Natrum phos, Nux vomica, Phosphorus, Pulsatilla, Raphanus sat, Sulphur, Veratrum alb.
The indications for few of the above remedies are as follows:-
Argentum nitricum: - Digestive upsets accompanied with Anxiety and nervousness.
Diarrhea can be sudden, greenish and may come on immediately after drinking water. Patient has great craving for sugar or salt which aggravate the complaints; meat and fat are disliked. The patient who needs this remedy is impulsive, has fear of heights, claustrophobia & anxiety about health. There is distention of abdomen with rumbling and nausea. Pain is worse when lying on right side.
Asafoetida: - This remedy is suited to hysterical persons with tendency to easy fainting. Flatulence with explosive eructation that smell like garlic. It has a hysterical rising in throat, as if a ball or large body ascended from stomach to esophagus. A feeling that food moves in a wrong way i.e. instead of going down is coming upwards. Excessive abdominal distension and sensation as if everything in the abdomen would burst through the mouth. Complaints are mostly left sided.
Colocynthis: - This remedy is suited to extremely irritable & impatient individuals. Problems start or are aggravated after anger and resentment from being slighted or humiliated especially if not expressed. Agonizing, cutting pains in abdomen causing patient to bend over double and press on the abdomen for relief. Violent, cutting, gripping, grasping, clutching or radiating, colicky. Pains, come in waves, better doubling up, hard pressure, worse least food or drink, except coffee and tobacco smoking.
Gratiola: - It is an important remedy where there is a feeling of incomplete evacuation of stool. Stool is green, yellow gushing, as if water running from a hydrant. It is aggravated in summer and by drinking water. The patient feels empty after meals. Diarrhea alternates with constipation. There is a strong craving for bread and the patient wants nothing but bread.
Lycopodium: - This remedy is suited to intellectual persons with anticipatory anxiety with extreme lack of confidence. Excessive accumulation of flatulence; constant sensation of satiety; good appetite, but a few mouthfuls fill up to the throat, and he feels bloated; fermentation in abdomen, with loud grumbling, croaking, especially lower abdomen. Rumbling with sensation as if everything turns into gas. Warm food and drinks ameliorate. Pains: aching-pressure, drawing; chiefly right-sided, worse four to eight p.m.
Natrum carbonicum: This remedy is suited to persons who are gentle and ready to serve selflessly. They have a cheerful expression even when sad. They are oversensitive to external atmospheric impressions & dietetic errors. Diarrhea from milk. Empty, gnawing, hungry sensation in stomach at 5 a.m.; must leave bed and have some biscuits. Emptiness and hungry feeling also at 10-11 a.m. and 10-11 p.m..Greedy, always nibbling.
Natrum muriaticum: This remedy is suited to persons who are vulnerable to emotional injury especially disappointment in love and do not express their emotions easily. Abdomen is hard to the touch, cramps up, and is accompanied by severe pain as if the colon were being grasped and squeezed by a tight fist. Those afflicted are compelled to double up with this acute attack, which is followed by the passage of flatus and eventually stool. The pains are often precipitated by the abdomen becoming full of gas or by constipation. Patient craves for salty things.
Raphanus sativa – This remedy is suited to hysterical persons where sadness alternates with hopefulness and a delusion that she has an unrecognized disease. Sensation of accumulation and incarceration of gas in abdomen. Colic, griping about navel. During colic, there is a pad-like swelling and movement of the intestines. Intolerance of clothing around abdomen. Post-operative gas pains and constipation. Vomiting of faecal matter.
Homoeopathic medicines should be taken under the advice of a qualified homoeopath after a thorough case taking which includes the mental & physical causes, present at the start of the IBS. The dose, potency and the repetition of the medicines should be under the supervision of a homoeopathic physician.
Dr Dushyant Kamal Dhari
M.D. (Hom)
IRRITABLE BOWEL SYNDROME (IBS)
Introduction
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, distention and change in bowel habits. It’s prevalence in western countries is about 15-20% in adults with female predominance. In India its prevalence is increasing due to increased psychological stress and the westernization of the diet with a male predominance.
Causes
In most of the patients psychological conditions like anxiety, depression and fear are responsible. These conditions play a causative as well as maintaining role in IBS.
Other causes include weak vitality and poor adaptability.
This syndrome can also be triggered by acute gastrointestinal infection, irregular food habits, abuse of laxatives and other medications etc.
Symptoms
Gastrointestinal symptoms of IBS are:
1. Abdominal Pain - It is felt in lower abdomen, dull or colicky in nature and usually relieved by defecation or passing flatus. It is usually worse after meals.
2. Abdominal distension and bloating - Sense of abdominal distention or bloating is usually complained by majority. It is usually worse throughout the day but is not due to excessive intestinal gas.
3. Variable bowel habits – Most of the patients have alternate episodes of diarrhea and constipation but it is useful to classify patients as having predominantly constipation or predominantly diarrhea. The constipated type tends to pass infrequent pellet like stools, usually in association with abdominal pain. Those with diarrhea have frequent defecation but produce low volume stools and are rarely worse at night. Mucous is commonly seen with stools and no rectal bleeding is there.
4. Other symptoms associated are nausea, headaches; Pains in back, thigh or chest; frequent urination and fatigue. Despite severe symptoms, patients do not loose weight
The diagnosis of IBS is made if the symptoms are present for more than 3 months. The various type of IBS are - Diarrhea predominant (IBS-D), Constipation predominant (IBS-C), Alternating stool pattern (IBS-A).
Investigations
As it a functional problem, no structural changes are present and tests reveal nothing. Usually lab investigations are done to rule out other disease. In older patients barium enema and colonoscopy is done to exclude colorectal cancer. While younger patients with persistent diarrhea may require endoscopy to rule out ulcerative colitis.
Management
Most of the patients have a relapsing and remitting course. Aggravation of the complaints often follow stressful life events, occupational dissatisfaction and difficulties with inter personal relationships.
Along with medicines following measures are of utmost importance in the management of IBS.
1. Diet: - Increase of fibrous diet with supplementation with bulking agents as coarse wheat bran or isaphgul husk. Intake of smaller meals at frequent intervals. Avoidance of alcohol, spices, fatty meals & dietary items that aggravate the condition.
2. Other measures include relaxation techniques for stress management, regular exercise, yoga etc.
Role of Homoeopathy
As per Homoeopathic system of medicine, Disease is a total response of a patient to adverse environmental factors, external or internal; it is conditioned by constitutional factors, inherited and acquired; and it manifests itself through symptoms in the three spheres – emotional, intellectual and physical. This response is divisible into
a) Individual response – characteristic symptoms which denote the constitutional type; which vary from person to person and
b) Group response – diagnostic symptoms.
In Homoeopathic system of medicine, the individual response of the patient is much important than the group response. So, in a set of patients having the same diagnostic symptoms (group response), the medicine given to each of them is different as the individual response of each varies. As in most of patients, the condition of the mind is responsible for IBS; homoeopathy has a much greater role to play. So, while the allopathic physician may refer such patient to the psychiatrist for treatment of mind symptoms, in homoeopathy the patient is treated as a single unit and the medicine which is suited to him for his mental as well as physical state is prescribed. Thus the patient is treated in a holistic way with homoeopathy.
With an eye on the constitution, temperament, totality of symptoms, life style and diet of the patients suffering from IBS, successful results can be obtained with homoeopathic medicines.
Homoeopathic medicines for IBS: - Medicines commonly used for IBS are Abies-nigra,
Aloes, Argentum nitricum, Arsenic Album, Asafoetida, Baptisia, Belladonna, Calcarea carb, Carbo-veg, Causticum, Chamomilla, China, Colchicum, Colocynthis, Gratiola, Ignatia, Iris v, Kali Bich, Lilium tig, Lycopodium, Merc sol, Merc cor, Natrum carb, Natrum mur, Natrum phos, Nux vomica, Phosphorus, Pulsatilla, Raphanus sat, Sulphur, Veratrum alb.
The indications for few of the above remedies are as follows:-
Argentum nitricum: - Digestive upsets accompanied with Anxiety and nervousness.
Diarrhea can be sudden, greenish and may come on immediately after drinking water. Patient has great craving for sugar or salt which aggravate the complaints; meat and fat are disliked. The patient who needs this remedy is impulsive, has fear of heights, claustrophobia & anxiety about health. There is distention of abdomen with rumbling and nausea. Pain is worse when lying on right side.
Asafoetida: - This remedy is suited to hysterical persons with tendency to easy fainting. Flatulence with explosive eructation that smell like garlic. It has a hysterical rising in throat, as if a ball or large body ascended from stomach to esophagus. A feeling that food moves in a wrong way i.e. instead of going down is coming upwards. Excessive abdominal distension and sensation as if everything in the abdomen would burst through the mouth. Complaints are mostly left sided.
Colocynthis: - This remedy is suited to extremely irritable & impatient individuals. Problems start or are aggravated after anger and resentment from being slighted or humiliated especially if not expressed. Agonizing, cutting pains in abdomen causing patient to bend over double and press on the abdomen for relief. Violent, cutting, gripping, grasping, clutching or radiating, colicky. Pains, come in waves, better doubling up, hard pressure, worse least food or drink, except coffee and tobacco smoking.
Gratiola: - It is an important remedy where there is a feeling of incomplete evacuation of stool. Stool is green, yellow gushing, as if water running from a hydrant. It is aggravated in summer and by drinking water. The patient feels empty after meals. Diarrhea alternates with constipation. There is a strong craving for bread and the patient wants nothing but bread.
Lycopodium: - This remedy is suited to intellectual persons with anticipatory anxiety with extreme lack of confidence. Excessive accumulation of flatulence; constant sensation of satiety; good appetite, but a few mouthfuls fill up to the throat, and he feels bloated; fermentation in abdomen, with loud grumbling, croaking, especially lower abdomen. Rumbling with sensation as if everything turns into gas. Warm food and drinks ameliorate. Pains: aching-pressure, drawing; chiefly right-sided, worse four to eight p.m.
Natrum carbonicum: This remedy is suited to persons who are gentle and ready to serve selflessly. They have a cheerful expression even when sad. They are oversensitive to external atmospheric impressions & dietetic errors. Diarrhea from milk. Empty, gnawing, hungry sensation in stomach at 5 a.m.; must leave bed and have some biscuits. Emptiness and hungry feeling also at 10-11 a.m. and 10-11 p.m..Greedy, always nibbling.
Natrum muriaticum: This remedy is suited to persons who are vulnerable to emotional injury especially disappointment in love and do not express their emotions easily. Abdomen is hard to the touch, cramps up, and is accompanied by severe pain as if the colon were being grasped and squeezed by a tight fist. Those afflicted are compelled to double up with this acute attack, which is followed by the passage of flatus and eventually stool. The pains are often precipitated by the abdomen becoming full of gas or by constipation. Patient craves for salty things.
Raphanus sativa – This remedy is suited to hysterical persons where sadness alternates with hopefulness and a delusion that she has an unrecognized disease. Sensation of accumulation and incarceration of gas in abdomen. Colic, griping about navel. During colic, there is a pad-like swelling and movement of the intestines. Intolerance of clothing around abdomen. Post-operative gas pains and constipation. Vomiting of faecal matter.
Homoeopathic medicines should be taken under the advice of a qualified homoeopath after a thorough case taking which includes the mental & physical causes, present at the start of the IBS. The dose, potency and the repetition of the medicines should be under the supervision of a homoeopathic physician.
Dr Dushyant Kamal Dhari
M.D. (Hom)
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