A CASE OF BEREAVEMENT

AND SOMATISATION

ByDr. Ashish Kumar Dixit

13th Batch PGT

Under Guidance of Dr. Subhas Singh, M.D. (Hom)

H.O.D., Dept. Of Organon of Medicine, Homoeopathic Philosophy, Chronic Diseases and

Psychology

ABSTRACT

A case of 60 years old female present with several physical symptoms developed after the death of her husband and some misfortune in her family is well responded through the use of Ignatia Amara.

KEYWORDS Bereavement

Life Change Units (LCUs)

Tumour

Ignatia

INTRODUCTION Definition of Bereavement “the state of being sad because a family member or friend has

recently died” (Merriam Webster Dictionary) Somatisation is a tendency to experience and communicate

psychological distress in the form of somatic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety.

The term somatisation was introduced by Wilhelm Stekel in 1924.

CASE O.P.D. Regd. No.: 88527

Name of the Patient: K.

Age: 60 Sex: Female

Religion: Muslim

Address: Beldanga Police Station: Beldanga

Date of examination/ Case taking: 04/March/2014

PRESENT COMPLAINTS

Palpitation and shortness of breath, oppression of chest < 4-5 A.M., disturbed sleep

Cough; bloody, offensive sputum

Can’t tolerate cold things, all complaints are aggravated.

HISTORY OF PRESENT COMPLAINTS

Complaints started in 2002 year, when her husband died and his body went for funeral she got unconscious for 30 minutes. After that incident her complaints appear.

PAST HISTORY

She suffered from Typhoid disease 6 years back for which she was hospitalised 11 days in hospital and took allopathic treatment.

Uterine tumour after death of her husband, which was completely cured by homoeopathic medicine.

FAMILY HISTORY

Paternal: Father: Died from Heart attack.

Maternal: Mother: Was suffering from Insanity.

Grand Mother: T.B. & Dyspnoea.

Others: Not Mentioned

PERSONAL HISTORY

Addiction: Nothing Occupation: House job Marital Status: Married Relation with family members and in the field of

occupation: Not good Habits and Hobbies: not such Dietetic Errors: irregular History of Vaccination: not taken Medications being taken regularly: nothing Living Environment: Damp house Socio economic condition: Medium

HOMOEOPATHIC CHARACTERISTICS

(GENERALITIES)

PHYSICAL GENERALSo General Modalities: Affected from both heat and cold.o General Sensation and Complaints: Can’t bear smell of smoke in any formo Thermal reaction: Chilly patiento Digestion: o Appetite: Diminished, only at 10 A.M. Can’t tolerate hungero Craving / Desire: Meat, Sour, Sweet, Hot warm foodo Aversion: Spicyo Thirst: Thirsty, all time she take water though little at a time.o Tongue: Imprint of tongue, large tongue, white coatedo Taste: No taste at allo Bowel: Loose stool but not clearo Urine: Burning in urine afterward, as if like fireo Perspiration: excessive over whole body, slightly offensive. o Sleep: Nothing particularo Dreams: Nothing particularo Sexual function: Nothing particular

MENTAL GENERALS

Very much depressed and in grief after her husband death. She has a daughter who is married but patient’s son in law humiliate her daughter and tortured her to saying that he will leave her and will get married to his lover. Son in law also humiliate to patient. She is in constant brooding and in anxiety about her girl.

She do not want to say much about her condition.

Observations: Patient look is anxious, fearful and in grief.

Provisional Diagnosis: Chronic Bronchitis

TOTALITY OF CHARACTERISTIC SYMPTOMS

Depression and grief after her husband death.

Anxiety with fear

Can’t bear smell of smoke in any form

Can’t tolerate cold things, all complaints are aggravated.

Craving / Desire: Meat, Sour, Sweet, Hot warm food

Palpitation and shortness of breath, oppression of chest < 4-5 A.M., disturbed sleep

Chilly patient

PRESCRIPTION & FOLLOW UP

RxIgnatia Amara 200/ 1 DoseRubrum 30/ 1 drachm, 1 glob x O.D. x 1 month

Follow up 04/April/2014 Patient is much better, cough improved but shortness of breath

is still sometimes troubling her. Her look appears somewhat better than before. Placebo prescribed for next one month.

Follow up 08/May/2014 Patient is much better, cough improved and shortness of

breath also better than before. Placebo prescribed for next one month.

Follow up 13/June/2014 Patient is much better, no new or old complaints appear,

Placebo prescribed for next one month.

Remark: Marked Improvement

JUSTIFICATION FOR THE PRESCRIPTION

As from the anamnesis of the patient she developed all her symptoms after the death of her husband

(Bad effects of grief- Allen). As she unconscious after the death of her husband.

(Effects of mortification,  Affection of mind, Nervous affections ; epilepsy ; spasms ; tetanus ; convulsions- Hering's Guiding)

Brooding(Kent’s Repertory first grade Medicine pg 10)

Silent grief(Kent’s Repertory first grade Medicine pg 51)

Anxiety with fear(Kent’s Repertory first grade Medicine pg 7)

Unconsciousness after emotion(Kent’s Repertory first grade Medicine pg 90)

Unconsciousness transient(Kent’s Repertory first grade Medicine pg 91)

Great grief after losing persons or objects very dear. Unhappy love with silent grief

(Hering's Guiding) Cannot bear tobacco 

(Materia Medica Pura)

Avoids opening the mouth and speaking; laconic. (782, pg 706)

A kind of the apathy in the whole body. (784, pg 706)

(Materia Medica Pura)These are the points favouring the indication of Ignatia Amara

DISCUSSION The above mentioned case clearly suggests the association of

death of spouse and afterwards the increasing susceptibility to develop diseases.

As we know from the §§210-230 Hahnemann clearly mentions that in every physical disease there is alteration of mental state simultaneously and vice-versa.

According to Holmes and his colleagues (1967,1970) who gave social readjustment rating scale (SRRS), in which they consider

life stress in terms of “life change units (LCU)”. For persons who had been exposed in recent months to stressful

events that added up to an LCU score of 300 or above, these investigators found the risk of developing a major illness within the next two years to be very high , approximating 80 percent.

In paper “Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley Study” by Carole L Hart et al (2007) studies report an increased risk of mortality in the bereaved spouse, compared with non‐bereaved spouses. However, it is not clear whether the increased risk is due to a direct effect of the shock and grief of the bereavement or due to the bereaved spouse's own risk factors.

“The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses” by Felix Elwert & Nicholas A. Christakis (2008) report says that “The increased likelihood for a recently widowed person to die—often called the “widowhood effect”—is one of the best documented examples of the effect of social relations on health.”

Above studies as well as our case support the deep impact of bereavement on somatisation.

CONCLUSION

Bereavement and its impact to develop somatisation is a hidden relation which is emerging to establish in recent modern researches. But for our homoeopathic science it is not new, Hahnemann in several places in Organon discussed & established it. We as a physician can break this social disaster cycle by the use of homoeopathic medicine at proper time.

BIBLIOGRAPHY Allen H.C. ; Keynotes and Characteristics with Comparison of

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Colemann J.C.; Abnormal Psychology and Modern Life; Fifth Edition; California; Scott Foresman & Company (In India by D.B. Taraporevala Sons & co. Pvt. Ltd., Bombay) 1984.

Carole L Hart et al (2007); Effect of conjugal bereavement on mortality of the bereaved spouse in participants of the Renfrew/Paisley.

Elwert F. & Christakis N. A. (2008); The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

Hahnemann S.; Materia Medica Pura;Vol-1; 16th impression ;Translated by R.E. Dudgeon; New Delhi; B. Jain Publishers(P)Ltd.; 2010

Hahnemann S.; Organon The Art Of Healing; C. Wesselhoeft (Translator); Reprint Edition ; New Delhi; B. Jain Publishers (P) Ltd.; 2007

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http://www.merriam-webster.com/dictionary/bereavement retrieved on 21/09/2014

http://en.wikipedia.org/wiki/Somatization retrieved on 21/09/2014

THANK YOU