Psychiatric patients have always been deemed difficult to treat and as I tried to reason why, I realized that we always think that ‘psychiatric patients are in tune with their delusions and are at the delusion level of experience; and consequently it is easier to take the case, reach the Sensation level, understand their theme and prescribe the appropriate similimum.’ But is this true for ALL psychiatric patients empirically?
Most of the psychiatric disorders are grouped into either Neuroses or Psychoses.
- In Neurosis, the patient is still in touch with reality and their inner self and hence chances are high that they will go to other Areas of their life and speak on a General level. These cases are unlikely to be Local/ one sided cases (where they are only in touch with the disease Area). I observed that these patients do give us qualified PQRS expressions and reach their individualistic expression at the holistic level.
Conversely, the other group of patients with Psychosis loses touch with reality and their inner selves. They can express themselves only through the Area of disease, hence these cases are Local/ one sided cases. During the Case-Witnessing Process nothing but their delusions in the Local disease Area keep surfacing.
From my standpoint they are at a fact level, they are expressing their disease, and hence all their pathological imaginations need to be subtracted to reach their center. However these ‘delusions’ are part of his pathology, that is, they are common symptoms of the disease, hence ‘facts’ of the disease. Even if we do consider them, it will be one area, the chief complaint area, and not the holistic essence of a patient.
A quote I came across provided beautiful insight into the predicament I was facing -
“Your mind is in every cell of your body. And your emotions are the bridge between the mental and the physical, or the physical and the mental. It’s either way.”
- David L. Felten, Ph.D.
- Hence in the psychiatric patients, it is essential to take those symptoms where the mind and the body are connected; those symptoms reflect the holistic state. All those mental symptoms where there is a qualified bodily expression should be taken for prescribing the remedy.
- Also, don’t you think along with the Present Predominant State, we should concentrate on other Areas of life, especially the past and subconscious Areas, where the patient has already expressed his individualistic state?
The aim is to get the holistic picture before the disease-energy became a one-sided mental disease we see today.
PASSIVE CASE WITNESSING PROCESS
The PCWP has been divided in to 4 parts for psychiatric patients -
AREA 1. – The Present Predominant Picture -
The patient is most likely to begin with his chief complaint - the constant irrelevant thoughts and imaginations he suffers from. I observe if –
- Are there any delusions which I cannot explain through his diagnosis? We can thus minus, all known common delusions.
- Are mental symptoms causing an aggravation of the physical symptoms? As we discussed above, mental symptoms can be accompanied by –
- Aggravations of a physical complaint
- Aggravations of the Physical Generals and
- Aggravations of Physical Particulars
Eg: He suddenly has the urge to pass stools and has severe abdominal cramps, and then we know that this delusion is coming from his holistic state.
- Is there anything which is common through all his delusions? A common theme if emerging in all his pathological delusions can be corroborated in other areas to confirm the focus.
- Are any mental symptoms accompanied by physical expressions? As we have discussed, this increases our surety, because naturally, those mental symptoms with physical accompaniments stem from the holistic state.
- Are there any concomitant symptoms on the Physical General and Physical Particular level?
- Is there any physical experience or sensation of the mental delusion he is expressing? While describing a mental delusion, the patient sometimes experiences it physically. For e.g. The patient has a delusion that – ‘somebody is pricking needles in his body’ and he experiences that bodily and feels that needles are being pricked in his body at that very instant.
- Are there any delusions which connect with a dream/ fear/ interests/ physical illness from the past, before the mental disease set in?
Coming back to the PCWP, I view whether the patient is going spontaneously in different areas, but more often than not, he remains stuck to the local area, a one-sided disease pattern, so to take him further, I start the guided PCWP and enquire about –
Guided Passive CWP – the original, unmodified picture.
- I ask about his childhood, his dreams, his fears, together with his ambitions, interests and hobbies etc prior to the mental disease. The aim is to get the unmodified picture where there is no trace of illness.
- Physical expressions accompanying the PQRS, out of place and out of order terms in these sub-conscious areas, like childhood, too.
- And what better area to seek and find the characteristic physical expressions, than the area of the physical ailments itself?
Guided PCWP: The point after which the patient started showing the symptoms becomes the turning point and assists us to know what triggered the disease, So I ask the patients –
- i. Any causative factors – mental/ emotional/ physical which triggered the disease?
- ii. What changes did they perceive on the physical level –in Physical Generals or any characteristic Physical Particulars which appeared at the breakout of the disease?
- iii. What were the presenting symptoms at the onset of the disease? How did the disease progress?
Guided PCWP in the Area the parents’ or relatives’ undiluted observations about the patient with regards to his past h/o of illnesses, any characteristic symptoms they have noticed on mental or physical aspect, their observations about the patient’s behaviour
The focus of the case will be that holistic symptom which has come up in two or more Areas - the Present Predominant Picture and/ or in the past original unmodified picture and/ or in the relatives’ observations and/or in Area of the onset of the disease; that symptom where the mind and body are connected.
Active CWP and Active-Active CWP –
Here too, we look upto the physical sphere to guide us, with the following pointers -
Unmodified PQRS should get connected – the foremost point is that all original, unmodified PQRS have to get united with the focus, to form one smooth flow towards the patient’s centre.
Physical/ bodily connections with the focus and/ or shift in body language – when we start enquiring about the focus, the patient should identify with it physically, either with –
When we arrive at the patient’s centre, it should be the individualistic expression at the holistic level, something not normally associated with the disease. The mind and body should get connected before we call the centre as truly holistic.
For further details refer to upcoming book of scientifically intuitive case witnessing process – Part II in difficult cases and conditions.