Sadness and Somatisation A Homeopathic remedy Case treatment Report

Sadness (Bereavement) and Somatisation A Homeopathic remedy Case treatment Report  Article by
Dr. Ashish Kumar Dixit

MD (Organon of Medicine, NIH, Kolkata)
 
Abstract: -
 A case of 60 years old female present with several physical symptoms developed after the death of her husband and some misfortune in her family is well responded through the use of Ignatia Amara.
Keywords: - 
Bereavement, Life Change Units (LCUs), Somatisation, Ignatia
Introduction: - 

Bereavement may be defined as, “the state of being sad because a family member or friend has recently died” (Merriam Webster Dictionary) and Somatisation is a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatisation was introduced by Wilhelm Stekel in 1924. It has no doubt that mental conditions affect physical well being and vice-versa. Death of intimate one has very long lasting impact on emotional as well as physical well being. Sometimes patient hide their emotional state only narrate the suffering of physical symptoms but these mental and physical symptoms have unbroken relationship. Present case explores the relation of bereavement and somatisation and resolution by homoeopathic aid.

Case Particulars:- 

• O.P.D. Regd. No.: 88527
• Name of the Patient: Mrs. K.                                       Age:  60                              Sex: Female
• Religion: Muslim                    Address: Beldanga  (W.B.)            Police Station: Beldanga (W.B.)
• Date of examination/ Case taking:  04/March/2014  
Present Complaints:-
Patient was complaining of Palpitation, shortness of breath and oppression of chest which is aggravated in 4-5 A.M. and after disturbed sleep. She has Cough which is bloody, offensive sputum and having no time modality, all complaints are aggravated from cold things and she can’t tolerate cold things in any form.
History of Present complaints:-
Complaints started in 2002 year, when her husband died and when his body was taken for funeral she got unconscious and duration was of 30 minutes. After that incident her complaints started gradually and since one year her complaints hamper her daily activities and also worsen than before.
Past History:-
• She suffered from Typhoid disease 6 years back for which she was hospitalised for 11 days in hospital and took allopathic treatment.
• She was also having uterine tumour after death of her husband, which was completely cured by homoeopathic medicine as she mentioned though the name of medicine and prescription was not there.
Family History:-
• Paternal: Father:  Died from Heart attack.
• Maternal: Mother: Was suffering from Insanity.
• Grand Mother: T.B. & Dyspnoea.
• Others: Not Mentioned
Personal History:-
• Addiction: Nothing
• Occupation: House job
• Marital Status:  Married
• Relation with family members and in the field of occupation: Not good
• Habits and Hobbies:  not such
• Dietetic Errors:  irregular
• History of Vaccination:  not taken
• Medications being taken regularly:  nothing
• Living Environment:  Damp house
• Socio economic condition: Medium

Homoeopathic Characteristics (Generalities):-

• General Modalities:  Affected from both heat and cold.
• General Sensation and Complaints: Can’t bear smell of smoke in any form
• Thermal reaction:  Chilly patient
• Digestion:
• Appetite:  Diminished, only at 10 A.M. Can’t tolerate hunger
• Craving / Desire: Meat, Sour, Sweet, Hot warm food
• Aversion:  Spicy
• Thirst:  Thirsty, all time she take water though little at a time.
• Tongue:  Imprint of tongue, large tongue, white coated
• Taste: No taste at all
• Bowel:  Loose stool but not clear
• Urine:  Burning in urine afterward, as if like fire
• Perspiration:  excessive over whole body, slightly offensive.
• Sleep:  Nothing particular
• Dreams: Nothing particular
• Sexual function:  Nothing particular
 Mental Generals:-
Patient was very much depressed and in grief after her husband death. She said that she didn’t want to live but because of her daughter she has to live. She has a daughter who is married but patient’s son in law humiliate her daughter and tortured her to saying that one day he will leave her and will get married to his lover. Son in law also humiliate verbally to patient. She is in constant brooding and in anxiety about her daughter. She said that she didn’t want to share her familial condition to anyone.
Diagnosis:- Chronic Bronchitis
Totality of Characteristic Symptoms:-
 Depression and grief after her husband death.
 Anxiety with fear
 Hiding tendency, doesn’t want to share
 Constantly brooding
 Can’t bear smell of smoke in any form
 Can’t tolerate cold things, all complaints are aggravated.
 Craving / Desire: Meat, Sour, Sweet, Hot warm food
 Palpitation and shortness of breath, oppression of chest < 4-5 A.M., disturbed sleep
 Chilly patient
 
Repertorial Sheet:-
Repertorisation has been done from Kent’s repertory.

Prescription & Follow ups:-
Rx
Ignatia Amara 200/ 1 Dose
Rubrum 30/ 1 drachm, 1 glob x O.D. x 1 month
Follow up 04/April/2014:-
Patient is much better, cough improved, no haemoptysis but shortness of breath is still sometimes troubling her. Her look appears somewhat better than before. On inquiry about her mental and familial condition, she said that she is feeling well though her son in law still humiliating her daughter. She is doing better in her daily activity.  Placebo prescribed for next one month.
Follow up 08/May/2014:-
Patient is much better; cough improved, palpitation and shortness of breath also better than before. Placebo prescribed for next one month.
Follow up 13/June/2014
Patient is much better, no new or old complaints appear, Placebo prescribed for next one month.
Follow up 20/July/2014
Patient having no complaints, sometimes feeling weakness otherwise well, Placebo prescribed for next two month.

Follow up 15/September/2014
No new complaints, She is feeling much better than before, but still want to continue the medicine. 

Justification of the prescription by reviewing the literature for Ignatia:
 As from the anamnesis of the patient she developed all her symptoms after the death of her husband
                                                      (Bad effects of grief- Allen)
 As she unconscious after the death of her husband.
  (Effects of mortification, Affection of mind, Nervous affections; epilepsy; spasms; tetanus; convulsions- Hering's Guiding)
 Brooding
(Kent’s Repertory first grade Medicine pg 10)
 Silent grief
(Kent’s Repertory first grade Medicine pg 51)
 Anxiety with fear
(Kent’s Repertory first grade Medicine pg 7)
 Unconsciousness after emotion
(Kent’s Repertory first grade Medicine pg 90)
 Unconsciousness transient
(Kent’s Repertory first grade Medicine pg 91)
 Great grief after losing persons or objects very dear. Unhappy love with silent grief
(Hering's Guiding)
 Cannot bear tobacco
(Materia Medica Pura)
 Avoids opening the mouth and speaking; laconic. (782, pg 706, Materia Medica Pura)
 A kind of the apathy in the whole body. (784, pg 706, Materia Medica Pura)
These are the points which favouring for the prescription of Ignatia Amara.
Discussion:-
The above mentioned case suggests the association of death of spouse and afterwards the increasing proneness to develop diseases. As we know from the §§210-230 Hahnemann clearly mentions that in every physical disease there is alteration of mental state simultaneously and vice-versa. According to Holmes and his colleagues (1967, 1970) who gave social readjustment rating scale (SRRS), in which they consider life stress in terms of “life change units (LCU)”. For persons who had been exposed in recent months to stressful events that added up to an LCU score of 300 or above, these investigators found the risk of developing a major illness within the next two years to be very high , approximating 80 percent.

S. No. Life Event Value
1. Death of Spouse 100
2. Divorce 73
3. Marital separation 65
4. Jail Term 63
5. Death of Close Family Member 63
6. Personal Injury or Illness 53
7. Marriage 50
8. Fired at Work 47
9. Marital Reconciliation 45
10. Retirement 45
11. Change in Health of Family 44
12. Pregnancy 40
13. Sex Difficulties 39
14. Gain New Family Member 39
15. Business Readjustment 39
16. Change in Financial State 38
17. Death of a Close Friend 37
18. Trouble with In-Laws 29
19. Spouse Begins or Stops work 26
20. Begin or End School 26
21. Change in Living conditions 25
22. Revision of Personal Habits 24
23. Trouble with Boss 23
24. Change in Work Hours 20
25. Change in Residence 20
26. Change in Schools 20
27. Change in Recreation 19
28. Change in Church activities 19
29. Change in Social Activities 18
30. Change in Sleeping Habits 16
31. Change in Eating Habits 15
32. Vacation 13
33. Christmas 12
34. Minor Vacation of the Law 11

Table 1: Stressors and Their Relative Value
In paper “Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley Study” by Carole L Hart et al (2007) studies report an increased risk of mortality in the bereaved spouse, compared with non‐bereaved spouses. However, it is not clear whether the increased risk is due to a direct effect of the shock and grief of the bereavement or due to the bereaved spouse's own risk factors.
“The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses” by Felix Elwert & Nicholas A. Christakis (2008) report says that “The increased likelihood for a recently widowed person to die—often called the “widowhood effect”—is one of the best documented examples of the effect of social relations on health.”
Conclusion:-
Bereavement and its impact to develop somatisation is a hidden relation which is emerging to establish in recent modern researches. But for our homoeopathic science it is not new, Hahnemann in several places in Organon discussed & established it. We as a physician can break this social disaster cycle by the intervention of homoeopathic medicine at proper time.

BIBLIOGRAPHY
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 Carole L Hart et al (2007); Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley.
 Elwert F. & Christakis N. A. (2008); The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses
 Hahnemann S.; Materia Medica Pura;Vol-1; 16th impression ;Translated by R.E. Dudgeon; New Delhi; B. Jain Publishers(P)Ltd.; 2010
 Hahnemann S.; Organon The Art Of Healing; C. Wesselhoeft (Translator);  Reprint Edition ; New Delhi; B. Jain Publishers (P)  Ltd.; 2007
 Hering C.; The Guiding symptoms Of Our Materia Medica Vol. VI; 7th Impression; New Delhi ; B. Jain Publishers (P) Ltd.; 2010
 Kent J.T.; Repertory of Homoeopathic Materia Medica; Reprint edition; New Delhi; B. Jain Publishers (P) Ltd.; 2003
 http://www.merriam-webster.com/dictionary/bereavement retrieved on 21/09/2014
 http://en.wikipedia.org/wiki/Somatization retrieved on 21/09/2014