Hahnemann and Mental Health

Hahnemann was a pioneer in the field of mental health. From Richard Haehl’s records it emerges that as early as 1793 — at the same time Pinel was breaking the chains at Bicêtre — Hahnemann began to call for a more humane treatment of the mentally ill.

Pinel became famous because of the many patients affected and the importance of the institution he led.

At the Georgenthal asylum near Gotha in Germany, Hahnemann treated Mr Klockenbring, the chancery secretary. The case resembled an acute mania. Initially he observed the case and ordered a treatment that today would be called occupational therapy.

We do not learn which medicines were given, but they were probably homeopathic remedies, since at that time Hahnemann had only just begun to announce his theories. (Haehl, 1922)

In 1796 Hahnemann wrote: "The physician who cares for these unhappy people (the mentally ill) must not only command respect, but also inspire trust. He will never feel offended, because one who is unable to think rightly is incapable of insulting another." This is his view regarding the necessity of a therapeutic alliance and his recommendation for dealing with counter‑transference.

Concerning mental illnesses he writes in § 215 of his Organon: "Almost all so‑called mental and emotional diseases are nothing but bodily diseases, in which each characteristic symptom of mental and emotional derangement becomes intensified while the bodily symptoms diminish (faster or slower), and finally is transferred, to a striking unilateral degree, almost like a local ailment, into the invisibly delicate mental or emotional organs."

Hahnemann was also a pioneer in psychosomatics. He regarded the human being holistically and saw mind and body as a unity, in opposition to the prevailing dualism of his time. In § 210 he says: "...in all cases of disease to be cured the mental state of the patient must be included as one of the most important parts of the totality of the symptoms, if one wishes to record a faithful picture of the disease in order thereby to be able successfully to cure it homoeopathically."

For him "emotional and mental disturbances do not, however, form a class of diseases sharply separated from the others; for in every one of the so‑called bodily diseases the mental and emotional condition is always altered..."
"How often, for instance, in the most painful, long‑standing diseases, does one meet with a mild, gentle disposition, so that the practitioner is moved to respect and compassion for the patient. But when he has conquered the disease and restored the patient — as is often possible by homoeopathic means — the physician is often astonished and frightened at the dreadful change in the disposition. He often sees ingratitude, hardness of heart, studied malice and those most dishonouring and shocking humours which in the healthy days of this patient had belonged to him."

"Those who were patient in health are often found in illness to be obstinate, violent, hasty, even peevish, stubborn and again perhaps impatient or despairing; those formerly modest and shy are now lascivious and shameless. The clear head is often found to be dull, while the usually feeble‑minded appear on the contrary somewhat cleverer, more sensible, and those of slow reflection are sometimes full of presence of mind and quick decision, etc." In this paragraph we can see how important observation of emotional reactions, behaviours and personality traits was to Hahnemann.

In § 220 he mentions cases in which violence and madness alternated with melancholy and depression and the recurrence of certain behavioural features in certain months. According to W.M. Butler (1880), it was Baillarger and Falret who described this illness in 1854 and named it "folie circulaire" (1) and "folie à double forme". The differentiation between "manic‑depressive" syndrome and schizophrenia is attributed to Kraepelin (1896) (APA, 1944) (2). Nevertheless, Hahnemann made important observations in the field of psychopathological phenomenology without ever receiving recognition for them.

Hahnemann distinguished between organic and mental illnesses. He even applied psychotherapeutic techniques. In § 224 he recommends: "If the mental disease is not yet fully developed and there remains some doubt whether it has really arisen from bodily disease or rather from errors of education, bad habits, depraved morals, neglect of the mind, superstition or ignorance; a sign that it is amenable to reasonable, well‑meant persuasion, to consolatory reasons or to serious and rational representations is that the symptoms abate and improve thereby, whereas true mental disease based on bodily disease is quickly worsened by this, melancholy becomes still more dejected, plaintive, inconsolable and withdrawn, and malicious insanity thereby grows more embittered and foolish talk becomes still more senseless."

 § 225: "There are, as said, indeed a few mental illnesses which do not merely degenerate from bodily diseases, but take their beginning and course from the mind in the reverse direction, with slight bodily sickness, through long‑continued grief, vexation, mortification, injuries and great, frequent causes of fear and fright. This kind of mental illness then often in time greatly impairs the bodily state of health." For these forms of illness he recommends psychotherapeutic treatment.
Here we see with what clarity he grasped the relationship between body and mind. Hence he can be regarded as a pioneer in the study of psychosomatic illnesses. Only at the beginning of the 20th century, 100 years after Hahnemann’s writings on this subject, did a coherent concept of psychosomatic medicine emerge.

 "Previously there were occasionally forerunners who drew attention to the problem of psychosomatic diseases and presented them as fundamental to medical treatment; but only in recent decades have these insights begun to permeate and completely transform the medical literature. Hahnemann appears to have been one of those leaders who were more than 100 years ahead of their time." (Dunbar, 1935)
His insights into the role of the mind in disease led him to state: It is possible that "even the highest disease may be brought about by sufficient disturbance of the life‑principle through the imagination and may in the same way be removed." He also mentioned the use of suggestion and counter‑transference in the treatment of patients. He himself advocated the use of "Mesmerism", which today is considered a forerunner of hypnosis. (Organon, §§ 17, 288 ff).

Homeopathy and mental health

Psychiatry remained an undefined speciality until well into the 20th century and teaching in this field was left to physicians of other disciplines. In the early 19th century some institutions were founded and by 1843 there were about 24 clinics for the mentally ill. (APA, 1944) (2)

The first homeopathic clinic for the mentally ill was founded in May 1874 in Middletown, New York. According to the attending physicians "...no opiates, bromides or chloral hydrates were needed to keep the patients under control." (Stiles, 1875).

A report published in 1891 in the "Transactions of the American Institute of Homeopathy’s meeting (3)" records between 1883 and 1890 a difference of 50% in patient discharges from the homeopathic psychiatric clinic in the state of New York, compared with 30% from conventional hospitals. In these hospitals the mortality rate was also 33% higher than in the homeopathic clinic. (Talcott, 1891)

At the end of the 19th century homeopathic treatment was used in asylums for the mentally ill in seven US states, two of those states having more than one clinic (Keith, 1899). At the start of the 20th century the Allentown State Hospital (4) in Pennsylvania was opened and associated with the Hahnemann Hospital in Philadelphia. Unfortunately no records from that time survive.

It was philosophers and theologians who tackled the theory of mental illness, while medicine focused on cellular pathology and showed little interest in psychiatry. Nevertheless, there was already a more humanitarian approach to the care of the mentally ill, particularly through the teachings of Pinel, Esquirol, Tuke and Bucknill. These were taught in most medical schools, regardless of their ideological orientation. (APA, 1944)
At the Hahnemann Hospital in Philadelphia Professor H. N. Guernsey was one of the teachers of psychiatry, though he was actually an obstetrician. In 1866 he described hysteria as a consequence of sexual or emotional conflicts, a hypothesis later proposed by Freud. (Guernsey, 1866)

Another prominent physician who used homeopathy to treat the mentally ill, was Charles Frederick Menninger, founder of the Menninger Clinic in Kansas, which is still operating but no longer practices homeopathy. He was an active member of the American Institute of Homeopathy and commented: "Homeopathy is better adapted to the therapeutic demands of our time than any other or in the medical direction." And: "We must first exhaust the possibilities of the homeopathic art before resorting to another mode of treatment if we wish to obtain the greatest possible success." (Menninger, 1897)
Davidson has noted similarities between modern psychiatry and homeopathy. Current neurobiological research has confirmed some of the old homeopathic ideas. Psychotherapeutic techniques are aimed at uncovering a patient's symptoms in a controlled way in order to heal the patient. This applies to cognitive, behavioural and psychoanalytic therapies alike. In his article Davidson also discusses themes such as self‑healing forces, the microdose effect, the disappearance of symptoms in reverse order of their appearance and diagnosis by recognising symptom patterns. (Davidson, 1994)

Other biological therapies incorporate the concept of similarity into their treatment. This is the case in the treatment of depression with sleep disturbance (Wu et al., 1990), or the use of reserpine in treatment‑resistant depression (Ananth and Ruskin, 1974). Tricyclic antidepressants are used in only small doses in the therapy of panic attacks, because these antidepressants at higher doses can worsen the symptoms. (Kaplan and Sadock, 1995, p. 1201)

According to homeopaths, the symptoms are an expression of the organism’s efforts to restore health. In today’s psychiatry Post and Weiss (1992) and Nesse (2000) express similar views. They argue that the symptoms of major affective disorders can be adaptive and reflect the activity of the body's self‑healing forces. Post and Weiss recommend therapeutic strategies that stimulate the organism’s self‑healing forces. This is likely to be the way homeopathic remedies act. (Kent, 1979)
Most conventional physicians do not take homeopathy seriously because they find it hard to accept that such highly diluted substances can have a therapeutic effect. Homeopathy is often rejected without appropriate scientific justification. Many scientists claim that acknowledging homeopathy would mean abandoning current theories of physics and chemistry. This is not necessarily the case, just as Newton’s theories were not superseded by quantum physics. It is necessary and possible to assess homeopathy by the usual scientific standards.

Linde et al. carried out a meta‑analysis of homeopathy in 1997 with 189 subjects who took homeopathic remedies. 89 of them met predefined criteria. The results show that patients taking homeopathic remedies reported a positive therapeutic effect 2.45 times more often than those receiving placebo (Linde, 1997). Kleijnen et al. reviewed 107 studies. 81 (77%) showed a positive effect of homeopathy. Of the 22 best studies, 15 demonstrated the effectiveness of homeopathy. The researchers concluded that "the evidence presented in this contribution is probably sufficient to allow homeopathy to be used routinely as a treatment for certain indications." They noted that they themselves were "surprised at the extent of positive results even among the best studies" (Kleijnen, 1991).

Only a few studies on the use of homeopathy in psychiatry have been published so far and most lack sound scientific methodology. Among the studies reviewed by Kleijnen et al. were ten studies on the treatment of psychiatric problems such as depression, insomnia, nervousness, restlessness, aphasia, behavioural disturbances in children and others. Of these ten studies, eight showed good success with homeopathic treatment. None of the studies were replicated.

Davidson and colleagues conclude that homeopathy can help in the treatment of anxiety or depression, either as an adjunctive therapy or as sole treatment for patients who explicitly desire it. Of course the physician must weigh the risks and benefits of homeopathic treatment, especially in situations where conventional treatments have proven efficacy or when the patient is acutely psychotic or suicidal. However, as the author notes, this study has various limitations, and only larger controlled double‑blind trials can answer the questions raised by the use of homeopathy in the treatment of disease in general and specifically in psychiatry (Davidson, 1997).
Chapman et al. conducted a randomised, double‑blind, placebo‑controlled study of 60 patients with mild traumatic brain injury with persistent symptoms. The results show that homeopathy alone or together with conventional treatments and rehabilitation can be used successfully in treating patients with persistent mild traumatic brain injury, while conventional treatments are only of limited efficacy (Chapman, 1999).
J. Lamont conducted a placebo‑controlled double‑blind study on the treatment of 43 children diagnosed with ADHD (5). He was able to demonstrate statistically significant differences supporting the thesis that a homeopathic treatment is superior to placebo. Studies of this type should be replicated (Lamont, 1997).

In 19th and 20th century homeopathic journals hundreds of case reports were published about patients with mental disorders who were successfully treated homeopathically. Even if the presentation of some cases is insufficient for proper evaluation, many patients meet the criteria for a psychiatric disorder according to DSM‑IV (6) and would today be candidates for conventional pharmacotherapy.

A study of 120 patients diagnosed with anxiety neurosis, phobia, psychosomatic disorder or neurotic depression was published by Gibson et al. (1953). Priestman (1951) described 20 cases of anxiety neurosis, phobia and hypochondria. Reichenberg‑Ullman and Ullman (1996, 1999) have published books on a number of patients with ADHD, depression and behavioural disorders.

Detinis (1994) presents six cases of depressed, suicidal patients, patients with chronic pain, sleep disorders, premenstrual syndrome and anxiety disorders. Bodman (1990) describes a series of cases with depression, anxiety, sleep disorders, phobias, neuroses, cerebral consequences of stroke, Ménière’s disease, migraine and other problems successfully treated with homeopathy.

Boltz (1968) and Phalnikar (1962) describe some patients with acute psychosis who recovered through homeopathic treatment without relapses — after conventional treatments had failed. The results are supported by long‑term follow‑ups. Saine (1997) presents a series of cases of psychotic patients with manic‑depressive disorders, obsessive‑compulsive disorders and neuroses. Shevin (1989) treated several patients with dissociative disorders, character weakness and post‑traumatic stress disorders.

Gallavardin (1960) reported a series of cases of alcoholism successfully weaned by homeopathic treatment. Many patients were treated homeopathically without their knowledge. M. Grazyna et al. (1993) published 30 cases treated for alcohol withdrawal and delirium tremens. About 30% of the patients continued treatment for 12–18 months. Most of them remained abstinent during the long follow‑up period of up to seven years.

Some authors have treated mentally handicapped children who improved with homeopathic treatment. Haidvogl et al. (1993) describe 40 cases of disabled children. They report that almost 75% of the children responded to treatment, almost 50% showed improvement in all major symptoms. The authors point out that children with organic brain damage, autism and other syndromes responded well, as opposed to socially deprived children. Griggs (1968) treated four such cases, including one with seizure disorder. Wright‑Hubbard (1965) presents four cases of mental disability with convulsions, autism and muscle twitches that responded well to homeopathic remedies when not given conventional medicines.

Cortina (1994) presents 20 cases of children with enuresis and behavioural disorders treated with Ilex, a herbal remedy. They report a 50% improvement in enuresis and behavioural disturbances. Unfortunately the study was uncontrolled and is therefore difficult to verify.

There are many case reports of patients with anorexia nervosa (Gray, 1981), anxiety neuroses (Crothers, 1980) and manic‑depressive disorder (Whitmont, 1980) who were successfully treated with homeopathy. Boericke (1965) presents an interesting case of a dementia patient with psychosis whom he treated with a homeopathic preparation of chlorpromazine after conventional dosages of this drug had caused deterioration.

In all these cases the disorders presented are described clearly enough to withstand strict scrutiny. However, in many cases there are not sufficient data to meet modern diagnostic standards. Most reports in the homeopathic literature are individual case reports mainly aimed at showing homeopathic practitioners how the remedy was chosen. These case presentations were intended as teaching aids rather than for scientific purposes.

Slonim and White (1983) have addressed the particular issues that arise in preparing and evaluating case reports in complementary medicine and especially in homeopathy. They show that there is at least as much evidence for the effectiveness of homeopathic treatment as there is for many conventional treatments that have not yet been properly evaluated.

Homeopathic remedies in the treatment of psychiatric disorders

Homeopaths use various remedies with apparently different biological effects. Some have an acute symptomatology in their remedy picture such as Belladonna, Hyoscyamus, Stramonium and Veratrum album. These symptoms occur shortly after taking the remedy.
Others, so‑called slow remedies like Natrium muriaticum (sodium chloride), Silicea, Phosphorus or Sepia take more time and repeated doses to unfold their characteristic symptomatology and sphere of action. (Hahnemann: Organon, § 221).
The selection of remedies is always based on the totality of the symptoms and attention to characteristic physical features such as: congestion of blood in the face, red skin, glossy eyes, throbbing jugulars, excitement, oversensitivity of all the senses, delirium and restless sleep, dry mouth etc. This clinical picture correlates with the remedy picture of Belladonna (Atropa belladonna). These are the symptoms of an anticholinergic intoxication.

A manic state and a quarrelsome and obscene character, shamelessness, use of indecent gestures and expressions, as well as a tendency to exhibitionism, are characteristic of Hyoscyamus. These symptoms are supported by provings, and these are the symptoms that must match the patient's symptoms. Then the remedy is administered in homeopathic doses.

Guernsey describes thirty‑nine further remedies with their characteristic symptoms for the treatment of mental illnesses (Guernsey, 1866; Boericke, 1927). Alongside the mental symptoms, the physical characteristics and complaints are also matched with the remedy picture obtained from provings on healthy subjects in order to choose the correct remedy.

Hahnemann noted that often an initial aggravation of the symptoms occurred, followed by an improvement. This is comparable to the phenomenon observed in the treatment of anxiety disorders with tricyclics. (Kaplan & Sadock, 1995).

The specific remedy pictures resemble clinical syndromes that are also found in today’s nosology. In the proving report of Aurum metallicum (gold) it reads: "Hopeless, despairing and strong desire to commit suicide; life disgusts him, self‑condemnation and a feeling of utter worthlessness". Very different is the remedy picture of Staphisagria: "Nervous disorders with pronounced irritability, bad effects of anger and humiliation; very sensitive to what is said about them; prefers solitude" (Guernsey, 1866).

The first picture could correspond to melancholic depression and the latter resembles the sensitivity and rejecting behaviour of a patient suffering from Donald Klein’s hysterical dysphoria or atypical depression (Kaplan & Sadock, 1995). These clinical pictures often develop in persons already predisposed to these syndromes. Participants in remedy provings must be free from any apparent disease so that the symptoms can be recorded correctly in the materia medica.

The chosen remedy not only corresponds to the mental picture; the physical conditions are also taken into account when selecting the remedy. For example, Aurum seems to have an affinity for the cardiovascular system, while Staphisagria is more associated with the urogenital system.

Another interesting remedy is Arsenicum album. The patient is characterised by great anxiety and restlessness and constantly changes position or shifts about. He fears death and fears being alone. These symptoms are often found in anxiety disorders, especially panic attacks.

The remedy picture of Natrium muriaticum shows the negative effects of grief, fear, anger etc.; he is depressed and irritable and is upset by trifles; wants to be alone to cry. These symptoms also occur in dysthymia or adjustment disorders.
Nux vomica is driven and has a fiery temperament. He is very irritable and cannot tolerate noises, smells, light and touch. Sullen and critical, he needs stimulants, sometimes tends to excess and suffers from constipation. These symptoms also occur in patients with autonomic dystonia or dysthymia and are mostly of organic nature.

These are only some of the mental symptoms which have entered the homeopathic materia medica as proving symptoms. Remedy provings produce the clinical remedy pictures that are elicited in "healthy" subjects by taking potentised substances. They form the basis for homeopathic treatment. The core question of controversy is: Are these highly diluted solutions, in which no molecules of the original substance remain, biologically active?

Homeopathy — a placebo?

Because of their self‑righteousness and the mystical tendencies that homeopaths sometimes exhibit, the scientific examination of their doctrine was limited. The fact that the homeopathic remedy is selected individually according to the patient's symptoms poses a difficulty in designing well‑constructed studies and complicates the conduct of double‑blind trials.

In a review of the homeopathic literature Scofield (1984) states: "… despite much experimental and clinical work there is little scientific evidence for the efficacy of homeopathy. This is due to poor planning, execution, analysis and presentation of results or to experimental errors and by no means to the inefficacy of the healing method. It should now be tested again properly on a large scale. There is probably sufficient material available for the conduct of well‑designed, carefully controlled investigations. The experimental work done to date justifies the assumption that homeopathy can be used successfully in the treatment and prevention of diseases in plants, animals and humans."

In a clinical double‑blind study Reilly and colleagues (1986) concluded: "The homeopathically treated patients showed a significant improvement both on the patient‑rated and on the physician‑rated symptom scales. There is no evidence to support the notion that the effect of homeopathic remedies can be explained by a placebo effect..."

Conclusions

From the above discussion we can conclude that Hahnemann was one of the early innovators of humane treatment for the mentally ill. He initiated the theory of psychosomatic diseases and studied pharmacology and toxicology. He placed importance on observing the natural reactions of living organisms to medicines and diseases and valued a thorough history. The patient was more important to him than any doctrine of disease.

Homeopaths had a considerable influence on the way medicine is practised today. More recent research has found that some of the homeopathic postulates may indeed be correct, and this could initiate a new perspective in medicine. Modern homeopathic remedy provings are conducted as placebo‑controlled double‑blind studies, and the results are statistically significant (Int. Hom. Med. League, 1987) (7).

Proof that homeopathy works would revolutionise medicine and offer people an inexpensive, less toxic and holistic treatment. This would have immense social, economic and political implications.

(1) Folie circulaire - folie à double forme - bipolar affective disorder - manic‑depressive illness

(2) APA - American Psychiatric Association – American Psychiatric Association

(3) AIH‑Journal

(4) Pennsylvania State Homeopathic Asylum, Allentown

(5) ADHD – Attention‑Deficit Hyperactivity Disorder

(6) DSM‑IV – current version of the Diagnostic and Statistical Manual of Mental Disorders – classification system of the American Psychiatric Association.

(7) International Homoeopathic Medical League