Homeopathy
Excerpt from: Bell, I, Pappas, P. Homeopathy. In Lake, J and Spiegel, D (ed.),
Clinical Manual of Complementary and Alternative Treatments in Mental Health.
Washington, DC: American Psychiatric Press, Inc. 2006.
Introduction
Classical homeopathy is a controversial system of medicine founded over 200 years ago by German physician Samuel Hahnemann, a pioneer in the field of psychosomatic medicine. A contemporary of Dr. Phillippe Pinel, who in 1793 broke the chains of insane patients at the Bicetre hospital, Hahnemann was also one of the first to humanely treat the mentally ill (Winston 1999). In fact, Charles Frederick Menninger MD, psychiatrist and founder of the Menninger Clinic, wrote that “Homeopathy is wholly capable of satisfying the therapeutic demands of this age better than any other system or school of medicine.” (Menninger 1897)
Law of Similars
Although its principles are at least as old as Hippocrates, Hahnemann was first to use the term “homeopathy.” Coming from the Greek “homoios” meaning “same,” and “pathos,” meaning “suffering,” this name reflects one of homeopathy's cornerstones, the Law of Similars. Hahnemann discovered through personal experimentation that taking cinchona (Peruvian bark, source of the medicine quinine) produced the same fevers, chills, palpitations, and rigors appearing in malaria, the disease it was supposed to treat. He further noted that syphilis and its purported treatment, mercury, caused similar bone destruction, gingivitis, and salivation - in fact conventional physicians of his era used salivation to signify the appropriate mercury dose. The Law of Similars states that a substance producing a characteristic set of symptoms in a healthy person can, when given in a small dose, cure an ill person suffering similar symptoms. The defining principle of “similar suffering” brings homeopaths to prescribe medicines that act in concert with the patient's symptoms, encouraging the patient's perturbed defenses to reestablish homeostasis (evoking self-healing). In contrast, the allopath (Hahnemann's term for physicians whose treatments produce suffering “other” than related to the cause of illness) might suppress those symptoms with antidepressants, antibiotics, and antipyretics, etc, or use completely unrelated methods (Carlston 2003). Hahnemann was passionate in his views that “allopathic” treatments were generally off the mark, bearing little relation to the patient's clinical situation. “Antipathic” (“opposite” suffering) medications (antianxiety agents, for instance) might correspond at least partially to this, even if, as Hahnemann felt, they led to deeper overall illness in the patient.
Carefully examining the Law of Similars shows compatibility with many modern biomedical observations (Merrell and Shalts 2002). Merrell and Shalts point out, for example, that the drug aspirin can lower temperature at a therapeutic dose, but a toxic dose produces hyperthermia. Also, some medications can have effects opposite to expected therapeutic activities, such as benzodiazepines producing agitation rather than sedation in some patients. Additionally, hormesis is a well-documented biological and chemical observation in the conventional field of pharmacology-toxicology. Hormesis involves interactions between agent and host to stimulate homeostatic compensations in the host. As a result, nonlinear, often bi-directional, differential effects of the same substance can occur with variations in dosage (Calabrese and Baldwin 2001). Notably, scientists observe hormesis at low levels of various agents, typically a) below the lowest-observed-adverse-effect dose and b) under appropriate sampling intervals relative to the half-life of the host's adaptation to a given exposure regimen (Rozman and Doull 2003). Conventional scientists object to linking homeopathy with hormesis (Calabrese 2005), but the phenomenological overlap remains an empirical question.
Several other principles of homeopathy also bear discussion for their relevance to the field of psychiatry: the Vital Force, the Law of Minimum Dose, Provings, Totality of Symptoms, and the Laws of Cure.
The Vital Force
Like certain other types of medicine such as Ayurveda and Oriental Medicine/Acupuncture, classical homeopathy posits a life energy that animates all organisms (Oschman 2000). Known as “prana” or “qi” in these other medical systems, homeopathy calls this the Vital Force (Vithoulkas 1980). According to Hahnemann, this force combines the soul and emotions of man with more physical energies (Bailey 2002) and dynamically responds to change:
“In the healthy human state, the spirit-like life force (autocracy) that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious, vital operation, as regards both feelings and functions, so that our indwelling, rational spirit can freely avail itself of this living, healthy instrument for the higher purposes of our existence.” (Hahnemann 1843 (1996))
Hahnemann's understanding of the vital force's operation mirrors what modern physiologists know of homeostasis: organisms are constantly and simultaneously adjusting to myriad perturbations on multiple levels, in order to maintain healthy equilibrium. When the organism is healthy, all levels function freely and smoothly, with resilience to internal and external stress. If, however, the organism is weak or encounters an extremely strong stress, symptoms may show up in mental, emotional, or physical areas as the vital force struggles to correct the disharmony. The latter point explains why homeopaths feel suppressing symptoms is dangerous: it fights the body's physiologic attempts to regain healthy balance.
Hahnemann felt that “mistunements” of this vital force underlie all physical, mental, and emotional symptoms that patients experience, and that only applications of medicines that correctly act on the Vital Force can restore health. For him, the mistunement of the vital force as a unified whole is the disease needing treatment, and symptoms provide the unique picture of how this is deranged. Consistent with these conceptualizations, recent research suggests that cell walls have a nanomechanical motion at particular frequencies that generate audible, low-level sounds (Pelling et al 2004). Moreover, individual cells also self-organize into communicating networks of cells, even with more primitive organisms such as yeast cells (Barabasi 2003). Interestingly, cells such as cancer cells exhibit a noisy, disorganized motion (Pelling 2004).
At a clinical level, a recent study found significant correlations between classical homeopaths' ratings of fibromyalgia patients' vital force and scores on standardized conventional rating scales. For example, the data, collected under double-blind conditions, included correlations between greater vital force ratings and less severe illness on observer-rated clinical global impression scores (by both homeopaths and an independent conventional medical examiner), as well as lower patient-rated mental confusion and higher vigor on the Profile of Mood States questionnaire, and greater positive states of mind on the Positive States of Mind scale (Bell et al 2004b). Thus, historical notions of “vital force” may soon translate into systematic empirical studies at both the cellular and clinical levels of scale.
Law of Minimum Dose
Hahnemann felt strongly that “the physician's highest and only calling is to make the sick healthy, to cure, as it is called. The highest ideal of cure is the rapid, gentle, and permanent restoration of health; that is, the lifting and annihilation of the disease in its entire extent in the shortest, most reliable, and least disadvantageous way, according to clearly realizable principles.” (Hahnemann 1843 (1996)). Ever working to make his methods safer and more efficient, he diluted some of his medicines because they were toxic in their crude form (as used by his conventional contemporaries.) Surprisingly, he found that the more dilute medicines worked more curatively for his patients; he also found he could make his medicines still more effective by vigorous shaking (succussion) between dilutions. He proposed that the energy of the diluted medicine might be more subtle, and affect the patient's vital force more efficiently and gently.
This dilution and shaking (“succussion” or “potentization”) process used to make remedies remains one of the features of homeopathy conventional medical professionals find most controversial (Jonas et al 2003). For instance, many commonly used homeopathic medicines are diluted past the point of Avogadro's number of molecules of material substance. On the health food store shelf, this would mean anything beyond 12X (1:10, repeated 12 times) or 6C (1:100, repeated 6 times). Since professional homeopaths frequently use potencies of 200C and above, this raises questions about what is curative in the medicine. Homeopaths find clinically that these higher potencies, given to the correct patient with the correct kind of complaints, often produce more complete and lasting results than the lower ones. This can be most pronounced when treating patients with chronic emotional or mental symptoms, even though “lower” potencies such as 6X certainly have their place especially in first aid and acute illness.
Also in contrast to the physicians of his day, Hahnemann recommended one medicine (“remedy”) at a time for the integrative pattern of the whole person, at a dose corresponding exactly to patient need. This practice is one of the features differentiating classical (single remedy) homeopathy from other sorts of homeopathy available today. Some homeopathic practitioners use remedy combinations (“complex” homeopathy) for specific symptoms or select remedies through electronic instruments, intuition, muscle testing, or other techniques (Jonas et al 2003). Hahnemann did not practice any of these methods although he updated his Organon of the Medical Art six times as his clinical experience grew. There (Hahnemann 1843 (1996)) he decried the practice of mixing multiple therapeutic agents because of uncertain effects and potential danger to patients. Psychiatry has had its own controversies about polypharmacy, especially in consultation-liaison (psychosomatic medicine) practices caring for patients with complex medication interactions and side effects. Still, it is rare today to find a psychiatric (or general medical) patient taking only one medicine. Even in conventional psychopharmacology, optimal dosing is an art that becomes more challenging the more interactions one must juggle.
To learn the properties of individual medicines, homeopaths conduct “provings” (Hahnemann coined the term “Prüfung,” the German word for “test”) according to strict protocols (Sherr 1994). This process is like a Phase I drug trial, but with healthy rather than ill people taking an unknown substance and carefully recording every symptom (“side effect”) experienced. From the patterning of these symptoms, a “drug picture” is developed that can then guide homeopaths in using the now “proven” medicine (“remedy”) for healing sick patients. The collected information is categorized into each system affected and recorded into “repertories,” which are books that systematically list these symptoms along with the medicines known to cause/cure them. Although the well-known Greek physician Galen was first to suggest using healthy people for such testing, Hahnemann was first to rigorously do it (Carlston 2003). With the help of his family, friends, and about 50 of his physician colleagues, he proved approximately 100 substances during his lifetime. Provings of new medicines continue, since human need continues to evolve. Some question whether historic repertory symptoms accurately describe 21st century human experience, so re-proving older remedies is also done as well.
Most of the remedies so proven are made from natural botanical, mineral, or animal substances; certain pharmaceuticals (such as haloperidol) and ubiquitous dietary items (such as Coca-cola) have been homeopathically prepared and proven also. Other ways to learn about remedies include cured cases and toxicology; homeopaths access all these databases when studying their patients and corresponding remedy pictures. Software search engines such as ReferenceWorks, Encyclopedia Homeopathica, and ISIS help with this.
Selecting the appropriate remedy from the more than 3,000 now available can be difficult. To accomplish this, the homeopath gets to know the patient as deeply as possible through a lengthy interview that explores the patient's very being as much as his or her symptomatic complaints. It is crucial to recognize that a human is an integrated, whole entity rather than merely a sum of parts (Vithoulkas 1980). This said, the world impinges on patients as a totality, but patients may show symptoms primarily in one central area - mental, emotional, or physical (“center of gravity”) (Vithoulkas 1980). The person's overall health and constitutional weaknesses determine where symptoms most strongly appear. Skeptics often assert that the in-depth interview process and the patient-provider alliance contribute more than the remedies to the favorable outcomes in homeopathy. This possibility is irrelevant for self-care uses of homeopathy. For practitioner-provided care, the data are mixed in support for (Jacobs et al. 2005) or against (Bell et al. 2004) the latter hypothesis.
Hahnemann did not view mental or emotional illness as sharply separate from physical illness, because “in all of the so-called somatic diseases as well, the mental and emotional frame of mind is always altered” (Hahnemann 1843 (1996)). However, he held emotional state as an extremely important guide to understanding the person's energetic imbalance: “The preeminent importance of the emotional state holds good to such an extent that the patient's emotional state often tips the scales in the selection of the homeopathic remedy” (Hahnemann 1843 (1996)). In addition, the remedies themselves affect mental and emotional states in very particular and unique ways, such that matching remedy to patient is possible.
Appreciating patient individuality becomes extremely important in chronic illness, which conventional medicine finds most challenging to treat. Two patients with identical DSM IV diagnoses, for example, may need different homeopathic remedies based on their unique individual characteristics. A depressed patient who cries easily, is openly emotional, clings to others, and wants consolation might benefit from the remedy Pulsatilla (windflower, a plant), but one who is more stoic and reserved in public, hates consolation, yet holds grudges and sobs uncontrollably when alone might need Natrum muriaticum (table salt, a mineral). Remembering that different patients with the same diagnosis of major depressive disorder may have very different responses to the same conventional antidepressant may help translate this idea into current psychiatric relevance. Some may respond with symptom amelioration, some might experience no result at all, and a third group might respond with intolerable side effects. Additionally, many psychiatric patients experience symptoms that do not fit into the DSM IV, yet persist throughout treatment. Classical homeopathy at least provides some way to utilize these seemingly “eccentric” characteristics - in fact some are strange and peculiar enough to lead right to the curative remedy.
Homeopaths have developed a hierarchy of levels in human functioning, based on importance to the expression of the individual as a human being. Notably, Engel also described a hierarchy of functional levels in his biopsychosocial model for conventional medicine and psychiatry. In homeopathy, one's degree of health or illness can be assessed by examining mental/spiritual, emotional, and physical levels as they impact ability to seek unconditional and continuous freedom from dysfunctional patterns, i.e., happiness (Vithoulkas 1980). This happiness is more than a simple mood state, but evolves from the unselfish and creative expression of one's deepest soul purpose. Symptoms on any level (physical, emotional, or mental) limit sense of well-being and ability to experience this form of happiness.
In this hierarchical model, psychiatrists might appreciate the homeopathic view that mental illness is the deepest humans can experience because it impacts the expression of the person's very essence. Optimal mental functioning would include “clarity, rationality, coherence, logical sequence and creative service for the good of others as well as for the good of oneself.” (Vithoulkas 1980) Mental disturbances may lead to dysfunction in the next outer, emotional level, such as depression, anxiety, irritability, anger, etc. Also according to Vithoulkas, emotional health is “a state of being capable of freely feeling the full range of human emotions without being enslaved by them from moment to moment. . . . the individual experiences an absolute dynamic calmness combined with love for self, others, and the environment.” Feeling part of something larger than oneself is a necessity for health. The still important, but most external, layer of a person is the physical, which can reveal disturbances from the underlying two, as well as be diseased itself. Conventional research has shown that a sense of meaning and purpose in life explains additional amounts of the variance in greater hope and lower levels of depression, even after controlling for baseline mood and personality traits (Mascaro 2005).
Closely related to the “totality of symptoms” idea above is the concept that healing from illness proceeds in an organized, understandable fashion (Vithoulkas 1980). (The development of disease follows a similar process as well, but in the opposite direction.) Understanding this provides a way to assess the effectiveness of treatment, monitor patients' clinical progress, and direct further interventions, no matter what type of therapy is used. Dr. Constantine Hering, father of homeopathy in the United States, is credited with developing these “Laws of Cure.” With considerable patient care experience, he noted that:
Holding these laws in mind enables physicians to see the vital force (i.e., whole complex system that is the person) respond to therapeutic measures. For instance, one can suppress a physical skin rash with steroids, and find that the patient develops asthma in the following months. Or, it is possible to successfully treat the asthma and have the patient return showing more irritability and anxiety. Noting these hierarchies, continua, and direction of healing, one can see that the symptoms' center of gravity has moved deeper, indicating deterioration of overall health even though the chief complaints are ameliorated. Another example might be treating panic disorder and depression with a homeopathic remedy, and having those symptoms ameliorate while the patient develops allergic rhinitis. In this example, healing of the emotional level is occurring but symptoms are appearing on the physical level, specifically in the nose. While temporarily bothersome for the patient, healing is still proceeding in a positive direction - and interfering with the body's homeostatic wisdom would be counter-therapeutic. If treatment is absolutely required during this temporary period, using non-suppressive therapies that support the body's process would be more helpful to the patient's overall health. The Law of Cure is compatible with principles of nonlinear dynamical self-organization in complex living systems described in the complexity science literature (Bellavite 2003).