Aphorism 224 – mental disease

These days so many situations are classified as mental disorders, from defiance in children to reasonable depression (where it is normal to be unhappy, due to  temporary or changeable situations of loss, firing etc.) in adults.  So many people are on anti-depressants these days, and the age of those taking the drugs is constantly dropping.

But where will these mental states fit into our prescribing?  Are we looking at early stages of a mental disease, which is part of a systemic problem, or at a reasonable mood change resulting from events and lifestyle where what is really needed is encouragement and advice from friends or professionals?  I am of necessity simplifying a complex differential for this article, as when a reasonable mood change becomes prolonged and entrenched, encouragement and advice may no longer be of use.

Hahnemann relates to this question in Aphorism 224  of the Organon and offers a diagnostic.  If the patient is helped by “sensible, friendly exhortations, consolatory arguments, serious representations and sensible advice,” we’re looking at a changeable mental state rather than a disease result.  So far, so good.  However, he continues to say that “a real moral or mental malady, depending on bodily disease, would be speedily aggravated by such a course.”

Hahnemann defines this further, and tells us that “the melancholic would become still more dejected, querulous, inconsolable and reserved; the spiteful maniac would thereby become still more exasperated, and the chattering fool would become manifestly more foolish.”

This refines the point in a way that is very helpful.  How many of us have experienced a form of “disconnect” with people with disordered mental states, where it seems that what we say is not getting through, that we’re trying to reason with someone who does not speak the language of reason?  I know I have.  And when this happens after a number of different individuals and approaches, professional and personal, have failed – this implies that there is a real mental disease arising from a “corporeal affection”.

However, we do have to be careful in our practical understanding of the matter.  I have frequently heard parents say their children need medication because they behave badly, because they begin shouting and crying for no reason, because they don’t like their teachers.  Many parents report that trying to talk to their children doesn’t help – the behaviour only gets worse.  However, many children choose their parents as preferred targets for bad behaviour, and the “encouragement and advice” route doesn’t offer such a clear-cut diagnostic in these cases.

Anyone who has experienced changes of mood (myself included) will know that there are some people, or some pieces of advice, that just make us want to react violently, or close off, or even bring out physical reactions in us.  The expression “he makes me sick” does not only refer to contagious diseases.  Personally speaking, I can take no responsibility if any kind person tries to shower me with platitudes and exhorts me to “calm down” when my ire has been aroused (a.k.a. I’m furious)…

One man’s “encouragement” is another man’s poison.  Some people can’t stand to be encouraged, it only makes them more miserable.  Some people are worse from talking about their sadness.  Some people just want to be alone, others want to be in company when they are miserable.  This can be useful and give us a solid picture of modalities – but we have to make sure what we’re dealing with.  A classic is the person who says he wants to be alone when he’s sick – but really means he doesn’t want his wife or children to bother him.  When asked, he says he doesn’t mind being with friends when he’s sick, it’s feeling he should be doing something for his wife or children which makes him feel worse.

There is one more question here, which Hahnemann goes on to relate to in the footnote to Aphorism 224.  Why would a patient with mental disease aggravate from words of encouragement?  He suggests that a conflict arises between the mind, which recognizes the truth of those words and tries to restore harmony, and the physical disease process which has caused the mental symptoms and reacts to put the “organs of the mind and disposition” in “still greater disorder by a fresh transference of its sufferings on to them.”

In mental and emotional illness which results from an inner disorder, the kind and sensible words can almost act in a way that is like a stronger dissimilar disease, where the patient may be eased for a short time and then only get worse.  Nothing is resolved because these cases do not belong in the realm of logical reasoning and can only respond to the “language” of the appropriate homoeopathic remedy.