Knowing the Mind in Homoeopathic Practice - II
NATIONAL JOURNAL OF HOMOEOPATHY 2003 May / Jun VOL V NO 3.
Dr K M Dhawale
INTRODUCTION
In the first part we attempted to define Mental Disposition in its
evolutionary form. We shall now turn our attention towards the understanding of
another key word: Mental State.
Editor: The Part I can be given in a future issue, if demanded by
readers. This second part has been pending with us for a long time. It is given
first as more relevant to clinical practice. Both parts are independent and not
necessarily dependent on each other.
EXAMPLE 1
A Clinical Interview is in progress. The patient is narrating a past unhappy
event. The eyes fill, the voice falters and the gaze lowers. There is a pause in
the narration. The physician reflects on what he has heard and becomes conscious
of the emotional response of sadness which has arisen within him. He then
endeavours to put himself at ease. The patient relaxes and is able to continue
the rest of the narration more calmly.
Mental State: Definition
Let us examine the above chain of events more closely for it allows us to
understand what we mean by the "Mental State". This comprises:
- The intellect
- The emotions / feelings
- The behaviour and
- The context in which the above is manifested, including the important aspect of the time - frame in which the events take place.
(b) The emotional component is the feeling of sadness experienced by the physician. Obviously, any emotion has to be felt subjectively for it to have any certainty. It is the sensitivity of the physician to the emotions experienced by the patient which contributes to the accurate appreciation of the mental state.
(c) The behavioural component is the change in tone and the tearfulness. This allows us to be certain of the emotion of sadness that we felt during that part of the interview.
There are two additional observations that we are now able to make:
(a) All the above components are in alignment with each other, i e we are able to appreciate the integrity of the intellect, emotion and behaviour. We expect the patient, who is narrating an unhappy event, to experience a feeling of sadness (as we did) and to express it perhaps in the form of tears. We would be surprised if the patient were to burst into a peal of laughter in the same circumstances. We would be equally uncomfortable if the narration was to continue in a dead-pan manner, where we would feel the emotions, but the patient shows no signs of experiencing the same. Either of these responses would be distinctly unusual and hence characteristic due to the inconsistency.
(b) The above changes have been transiently present. They remained as long as they were "required" by the situation. The state within the patient and the external environment of the interview situation demanded the expression of these effects. The physician "required" to be disturbed so that he realized the full impact of the event on the patient. When this impact was acknowledged, the patient relaxed. The mood changed. The interview proceeded in a different direction. Imagine a situation where the patient continues to weep helplessly in spite of the physician’s noting the effect. This behaviour would again be usual and would demand an investigation on the part of the Physician.
Mental State, Mental Symptom & Disposition:
From the above, we are able to see the distinction between these three categories.
The mental symptom, as we have noted previously, is a simple event occurring in any of the above-mentioned planes, ie intellect, emotion or behaviour. It changes, as does the mental state. It may be qualified symptom (Tyler) when it has a characteristic expression, or it may remain a common one.
The Disposition is a complex combination of attitudes, which evolves over a period of time in response to the external circumstance. After reaching a certain complexity, it becomes fairly stable and resistant to change. Thus, it gradually acquires certain rigidity.
The mental state, as we have seen, combines certain features of both the mental symptom and the disposition. While it retains the fluidity of the symptom, it shares the complexity of the disposition.
We have just seen the fluidity of the mental state as experienced in the Clinical Interview. Let us now appreciate its complexity in the example cited below.
EXAMPLE 2
A 26-year-old married female consulted for what had been termed as "tinnitus" by an ENT Surgeon. This is what she wrote of her complaints: "I have this noise problem, diagnosed as tinnitus? Even the TV, which is played at a really loud level at our house, irritates me. The clanking of the wheels, the cries of hawkers in local trains, my husband and one of our couple friends’ loud conversations, my nephew wailing - the area affected is my head. I feel a withdrawing and a sort of spasm takes place and I feel the noise is going to engulf me. There is no sensation, just a blocked feeling in the ears. A month ago it was at its height, following my return from US in September. For a while, I was unable to even go out, so loud were / seemed the surrounding noises. Emotionally, I was undergoing a traumatic time as I had come back without doing school - something I’d wanted to do very much. I just thought my marriage wouldn’t last, so I came back. Of late, I’ve noticed that stress (trivial really) situations at home - sister-in-law occupying both gases while my in-laws were away, seems to trigger it off. I feel lethargic, exhausted, cut-up and contemptuous towards her. Relief is found in going away from here. I do sweat a lot at those times."
