Glimpses of a system

- Glimpses of a system (R. Sankaran)

 In Homoeopathy, symptomatology has traditionally been categorized into sensations and functions. For example, a patient with skin disease may have itching as a sensation, while scratching may be the function. Or in the case of an insomniac, anxiety may be the sensation and sleeplessness the function. In yet another patient, pain may be the sensation and anxiety the function.
 In the description of physical symptoms, sensations and functions become evident without too much difficulty; one usually has no problem repertorizing them either. But much of the mental symptomatology in our Materia Medica represents functions and expressions rather than sensations. For example, Lachesis is described as jealous, suspicious, and loquacious. These symptoms are all objective, none of them indicating any sensation-what it is that Lachesis feels. In fact, traditionally, very little or no emphasis has been given to understanding the inner feeling of the remedies in the study of Materia Medica, or of the patient while taking his case.
 From developments in my own understanding of the mental states of remedies and patients, it came to me that the sensation or the subjective view of the patient is as important as, if not more important than, the expressions or functions. The patient's view or inner feeling is a distorted view of reality; it is his delusion. If one is to be sure that a prescribed remedy is the simillimum, it has to be based on the totality of symptoms-the peculiar symptoms on the general and particular planes, characteristic mental expressions, and symptoms representative of the patient's delusion. Any prescription that is solid has to include both the objective view of the patient as well as his own view of reality. The delusion theory is very appealing and has been accepted widely, but how to use it in practice has remained something of an enigma. My recent endeavors have therefore been focused on developing a 'system' which can serve as a guideline to those wishing to apply my ideas in practice.
 The system is essentially my method of case-taking, case analysis and prescription, and subsequent follow-up. Case-taking entails eliciting the patient's characteristic symptoms, including his innermost feeling. This innermost feeling or delusion, being a distorted view of reality, is never expressed directly by the patient; were he aware of it, it would cease to exist. But it can be seen at many different points in the case, in various aspects of the patient's life. It can be seen right from the outset, in the manner in which he expresses his chief complaint, in his view of important incidents in his life, and in his dreams. For example, if the patient describes his complaint as a 'sudden attack,' this may be one element of his delusion, and one must expect to see it and look for it elsewhere in the case. If it is apparent in more than one area or it is expressed in such a manner as to indicate that it is very intense, then it assumes importance as a characteristic sensation. The connection between the various sensations or elements of the delusion gives the key to the case.
The connection between the various sensations or elements of the delusion gives the key to the case
 As I studied remedies and understood patients in this light, I came to realize that the delusion or the innermost feeling is best revealed in an understanding of the patient's subconscious mind, especially his fears and his dreams. In repertorizing a case, I often substitute rubrics pertaining to delusions, fears, and dreams for each other, since they are all related to the subconscious mind. For example, if the patient has a fear of being murdered, I would also study the remedies under 'dreams of murder' and 'delusion that he will be murdered.' From my experience, I have realized that the dreams represent the deepest of the subconscious feelings and are the closest to the delusion. When present, they represent the innermost feelings of the patient in their purest form. But often, the dreams are not available to us, either because the patient doesn't remember them or has no dreams at all, or because the physician is unable to understand his dreams. In such cases, one must elicit other symptoms of the subconscious mind, or analyze the things that the patient does subconsciously. For example, one can look at his hobbies and interests, choice of profession, etc. and try to understand the patient through these.
 As traditionally understood, dreams are taken as those seen in sleep. These are actual dreams. But in my understanding, the definition of dreams is much broader. It also encompasses other symptoms of the subconscious mind-e.g. , fears, fantasies, aims and hopes, interests and hobbies. Thus, I like to classify dreams as actual or virtual. Actual dreams may be further delineated as follows:
 -pleasant and unpleasant
 -projected dreams
 -associations with dreams
 -incidental (situational) dreams
 -deep, vivid, repetitive, or connected dreams
 Virtual dreams may be classified into the following types:
 -fears
 -fantasies
 -sensations, as if
 -metaphors
 -interests and hobbies, which may be active or passive
 -hobbies avoided-aims, ambitions, hopes
 -religion and philosophy
Actual dreams 
 Actual dreams may be with or without emotions. When there are emotions present, one should look for similar, related, or opposite sensations in other parts of the case. In contrast, dreams without emotions are usually symbolic. For example, dreams of eating or dreams of falling into water. These dreams can be taken directly, simply by themselves, since there is no feeling connected with them. When there are non-specific emotions connected with a dream, the dream itself becomes significant. For example, suppose there is a dream of being pursued by wild animals. Here, if the feeling is simply of fear, the whole dream will become a symbol of fear. In another case, with dreams of unsuccessful efforts to dress for a party that are associated with a non-specific anxiety, the dream itself is significant.
 When there are emotions present in the dream, they may be pleasant or unpleasant. Often, the pleasant and the unpleasant dreams are opposites of each other. When you discover what is common between the two, you understand an important aspect of the patient. This connection is often subtle, not obvious, and an attempt should be made to unearth it. This is illustrated in the following case.
Often, the pleasant and the unpleasant dreams are opposites of each other. when you discover what is common between the two, you understand an important aspect of the patient.
 A middle-aged woman, with severe joint pains and asthma, complained of being very scared in the dark, with a feeling that two hands are coming from behind to grab and kill her. She has thoughts of death. She dreams of killing people who refuse her daughters admission into college. In childhood, she used to have a pleasant dream of being the richest woman, living in a beautiful bungalow doing whatever she pleases. In the dream, she has a lot of money and people come to her with their problems. She feels like an underworld don. There are no miseries and she feels very happy. But in reality, this woman doesn't want to be like that because of creating a lot of enemies when you are big. She has a fear that even if there were a lot of people around her, these enemies would do some harm, either to her or those close to her. She prays a lot and is fearful of God's punishment.
 Now, in the pleasant dream, you find a feeling that is the opposite of her fears. She is an underworld don and can do as she pleases, kill those who don't do as she wishes. In reality, she has a fear of being harmed and of death. Based on her main fear of being killed by someone behind her, I gave her Crotalus Cascavella, which helped her tremendously.
 Projected dreams are those that involve a third person in place of the patient. The feelings are often blunted. For example, there might be a dream of the neighbor's house being on fire. In such cases, one can ask what the patient would feel like in that circumstance.
 In other cases, the patient will have an association with their dreams. While narrating their dream, the patient may begin to talk about an incident or situation related to the dream or in which he experienced similar feelings. For example, one of my patients was narrating a dream of a horse being reined in too tightly, and soon after went on to narrate situations in which she was under constant performance pressure.
 There are also incidental or situational dreams. These are dreams that follow a recent incident or situation, and are of less significance, unless there is something very individual or peculiar in them.
 Finally, we have deep, vivid, repetitive (connected) dreams. These are usually unconnected with external reality and the patient does not understand their significance. They are usually the most important. For example, one of my patients, a girl of about twelve years, had skin and behavior problems every time she changed homes. Her mother had recurrent dreams during pregnancy of being on a particular street in New York that she had never visited. She said she felt it was extremely familiar, like it was her own home. The rubric "Homesickness" became crucial in identifying the remedy of the girl, which was Magnesia Muriatica.
 Note that when dreams are complicated, they can be broken down into their components and the connection between these components can be traced. But they should be viewed in their overall terms as well.
Virtual dreams 
 Virtual dreams include fears, fantasies, and sensations, as if. The latter can be seen in the description of the patient's physical symptoms. For example, consider the sensation: 'pain in the chest as if a sharp knife was driven through it.' Metaphorical expressions in certain situations express the patient's feeling in that situation rather than reality. For example, "I am so 'tied down' with work." Or, "I felt the relationship was 'so brittle'."
 Interests and hobbies may also be seen as virtual dreams. They may be active-e.g. , travel, sport, collecting, handicraft, painting, drawing, and writing-or passive-i.e. , when the patient is a mere spectator rather than an active participant. For example, if the patient enjoys listening to music, what kind of music? What mood does it produce in the patient? If he listens to songs, what are the words of a song he likes best? What books does he read? What movies does he watch? What are his individual reactions to these? Moreover, what hobbies does he avoid? For example, the patient may avoid violent and horror movies, or may avoid socializing.
 Aims and ambitions are also important. In children and young persons, what do they want to be? In older persons, what are their plans for the future, or what would they have rather been? Hopes are often exactly diametrically opposite to the delusion and to the fears. For example, given the statement, "I hope that my father will live long," the fear or delusion is that his father will die soon. If religion and philosophy come up in a case, we must ask what they mean to the patient.
 Dreams are indeed most important at arriving at the patient's innermost feeling. But they are only part of an entire system of case-taking, analysis, and follow-up. The system that I am currently working on will help in the correct application of my ideas in practice.