LEARNINGS FROM THE SEMINAR ON ACUTE MENTAL ILLNESS AND ITS HOMOEOPATHIC MANAGEMENT BY DR MANOJ PATEL
Dr. Vansh Luniya, BHMS
PG Student, Dept of Repertory,
Dr M. L. Dhawale Memorial Homoeopathic Institute, Palghar
A few days ago, I found out that Dr Manoj Patel was going to conduct a CME seminar on mental illness. Naturally, I was curious and wanted to attend. I asked Dr Manoj Patel sir about it and he readily agreed.
The session started at 9 am sharp at The Other Song Academy, Mumbai. The audience comprised around 80 members: a mix of students and practitioners (new and experienced). Some attendees had travelled all the way to Mumbai just to attend the seminar. Dr Patel appreciated them all, especially the senior practitioners who showed enthusiasm about learning at their age. The session was also relayed live to the Bangalore, Pune, Ludhiana, Raipur, Surat, and Rajkot ICR centres. Sir started by introducing himself, his work, and the Dr M. L. Dhawale trust’s Rural Homoeopathic Hospital, Palghar. He also spoke about the Anukampa Ward – the special psychiatry ward of the institute – as well as about the work being done at the Bhopoli Tribal Centre.
Sir then started the session with a brief introduction on mental health and its correlations to Homoeopathy, sharing the story of how, in 1792, Dr Hahnemann set up a mental asylum to deal with psychiatric cases and how a local duke donated part of his castle for the asylum. Dr Patel also touched upon Dr Hahnemann’s emphasis on mental health in the Organon of Medicine, starting with aphorism 9, and the diligence with which Dr Hahnemann revised the Organon over 6 editions.
The group shared their experiences with psychiatric cases from their practices as well. Dr Patel ran an interactive session – he asked the audience their opinion regarding mental health and the concepts of a healthy mind and mental hygiene as defined by the WHO. He also explained how to correlate these modern concepts with aphorism 9. Dr Patel has the ability to effortlessly command everyone’s attention and keep everyone on the same page throughout the session. He gave examples from day-to-day life about how everyone deals with anxieties, fears, and depression phases. He also cited several verses from the Shri Bhagwat Gita, chapters 2 and 55-59, where Lord Krishna first explained the importance of mental health to Arjuna.
From mythology to reality – sir highlighted the statistics showing a large number of the Indian population is diagnosed with a psychiatric illness. He also stressed the importance of dealing with such cases. This concluded the first session, which was followed by a tea break at 11.30 am.
The next session started with cases. The first case was of a patient with paranoid schizophrenia where the acute phase was treated with Kali Iodatum followed by the anti-psoric remedy Magnesium Muriaticum. The case was managed with references to aphorism 221 of the Organon of MedicineHe involved everyone in the case discussion and stressed the importance of noting down the march of events. Sir did not hurry this case along, which helped the group to understand how the patient travelled from aggressive behaviour to surgical excision of the thyroid to depressive features to paranoid schizophrenia. The importance of the lucid interval in such cases was demonstrated by citing aphorism number 219.
Sir also introduced the Stress Diathesis Model, which was intended to be the core tool to understand further cases; this was well received by the group. Along with the chief case, he provided examples from his 35 years of practice, including his happy and sad experiences with psychiatric cases. The session was very easy to assimilate and made such a vast and complex subject so easy to understand. He stressed on understanding the Essential Evolutionary Totality and how it helps the physician to understand the devolution of a healthy individual into a mentally ill being.
He further shared a case of acute psychotic breakdown, where even after 10-12 days of admission, the patient showed no signs of improvement despite administering the best indicated medicines. On review, a single physical concomitant was found, which helped to solve the case and made a positive difference to the patient’s life by leading the physician to prescribe Magnesium Muriaticum. After a single dose, the patient, who had not slept well for an entire week, slept comfortably for more than 28 hours. The two cases requiring Magnesium Muriaticum were so different from each other! He then introduced the importance of Mental State Examination (MSE) to evaluate the patient.
Then, Dr Samiksha Murkute, Resident Doctor, Dept of Psychiatry, Dr M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI), Palghar shared a case of brief acute psychosis wherein using the MSE as a tool helped the physician to prescribe Kali Bromatum as an acute prescription. After a few doses, the patient was back to normal within 12 hours. Here, Dr Patel commented on the efficacy of Homoeopathy in such acute breakdowns. He further added “The physician needs to be observant enough to HOW the patient talks or behaves rather than on the WHAT of it”.
Dr Samiksha explained in detail the various headings of MSE with its application in cases. She also shared the importance of referring to the International Classification of Diseases 10th Revision (ICD 10) and The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) to classify and diagnose the condition. Two cases of alcohol withdrawal, one treated with Hyoscyamus and the other one with Sepia, along with their treatment and follow-up videos were shown. Dr Patel then introduced the Homoeopathic Model of Causation as another important tool for understanding such cases. One of the senior practitioners from the audience, Dr Abhay Chedda, also shared his experiences with psychiatry cases from his private practice.
Post-lunch, Dr Patel shared a few more cases and gave glimpses of his learning from the recent ICR Symposium on Application of the Philosophy of Dr C. M. Boger in Clinical Practice. He then introduced his work place – the Anukampa Ward – and the work done at MLDMHI, Palghar. Anukampa means Compassion. The Anukampa ward is a well-equipped psychiatry ward, with round the clock resident doctors, nursing attendants, qualified staff, and continuous security. The centre also has a full-time psychiatry nurse who has experience of attending to violent case. This ward is a unique model, probably the only one of its kind in the entire country.
Dr Patel stressed the importance of observations, knowledge of body language, and various interview techniques when taking cases. The last case of the session was a very intense one. The patient, who had paranoid schizophrenia, refused to open her eyes and had stopped eating, drinking, and talking. Many doctors had tried and failed to communicate with this patient. Sir stressed the importance of respecting the patient’s space and state and of just being at their side so that the all-important rapport develops. The application of various case-taking techniques, including Questioning, Assuring, Confronting, Reassuring, Listening, Exploring, Blocking, and Guiding were demonstrated through this case. The whole group was engrossed as sir further narrated the case. How Natrum Muriaticum helped this patient to return to her normal state was well demonstrated.
Various doubts and questions from the relay centres related to the topic were then answered by the speaker. Though the session was planned till 5 pm, it went on till 6 pm, and everyone participated actively and enthusiastically. Dr Abhay Chedda, Dr Pankil Dhruv, and Dr Tejas Shah presented a token of appreciation to Dr Patel at the conclusion of the session. The auditorium was houseful and the session ended with a lot of happy faces!
Take Home Learning–
- Importance of mental health and mental hygiene.
- Understanding the Hahnemannian perspective of mental diseases and corporeal diseases through understanding aphorisms 210-230.
- Importance of lucid interval in a psychiatry case.
- Referring to the ICD 10 and DSM 5 to classify and diagnose a condition.
- Stress Diathesis Model.
- Homoeopathic Model of Causation.
- Essential Evolutionary Totality to understand the journey of a healthy individual to a sick one.
- Various interview skills and techniques.
- Scope and limitations of psychiatric counselling.
- Importance of the correct diagnosis in psychiatric cases.
- Training of the internal observer.
- Eliciting the past and family history as an entry point in case with no PQRS features.
- Importance of physical concomitants in mental diseases.