This research involved the holistic, individualized treatment of patients with post traumatic stress disorder (PTSD), employing homoeopathic medicine. Post traumatic stress disorder can lead to
a variety of complications which may diminish or destroy interpersonal relationships, may handicap the patient occupationally or recreationally, or may lead to substance abuse. Research has
indicated that patients with PTSD are more likely to have a personality disorder; a previous history of depression, abuse or substance abuse or a family history of psychopathology. Given this,
it is presumed that PTSD can occur in anyone who has experienced trauma and sufficient stress. In order to reduce post traumatic stress severity, treatment should emphasise and acknowledge
that mental, emotional, behavioural and social factors contribute to trauma.
This study involved ten patients (plus two additional) who participated in five homoeopathic consultations, over a period of four months. The appropriate homoeopathic remedy, or similimum,
was determined using each patient’s distinguishing mental, emotional and physical symptoms.
Each participant completed the Researcher’s Questionnaire at each consultation and recorded their stress episodes on a calendar to be handed in at each follow-up appointment. These results,
together with holistic progress as noted by the researcher at every consultation, were used to determine the efficacy of homoeopathy on post traumatic stress disorder.
The intent of the research was to prove that treatment should be specific and individualistic, irrespective of the diagnosis. This study aimed to provide a holistic therapy for PTSD and the results indicated that the similimum treatment in sufferers of post traumatic stress disorder was effective in reducing post traumatic stress frequency, severity, and intensity. Moreover, improvement in mental and emotional wellbeing, sleep patterns, appetite, and energy levels were noted in all the patients.
The study aimed to establish the efficacy of the homoeopathic similimum in the treatment of post traumatic stress disorder.
IMPORTANCE OF THE PROBLEM
Persons with chronic PTSD have unusually high rates of associated psychiatric conditions throughout life, including substance abuse and dependence (23%); major depression (20%); alcoholic dependence (75%) and personality disorder (20%) (Brady, Pearlstein, Asnis, 2000: 1837-1844). Marais, de Villiers, Moller, Stein (1999: 638) report that patients with PTSD were more likely
to attempt suicide and had more unexplained physical symptoms and more visits to medical practitioners.
Co-morbidity surveys identified increased odds of school and college failure, teenage pregnancy, marital instability and unemployment associated with a diagnosis of PTSD (Mezey and Robbins, 2001: 561). The subject of PTSD was raised on numerous occasions in the Truth and Reconciliation (TRC) hearings in South Africa. At hearings on conscription by the apartheid military, for
example, a white psychologist in the former South African Defence Force described his personal experiences and the symptoms of PTSD. This emphasised the long-term negative impact that exposure to violence may have (Swartz, cited in Stein, 1998: 456).
High crime and violence rates in South Africa are associated with the progressive disintegration of families and communities that occurred under apartheid.
The potential for research into violence prevention and treatment of victims of violence in South Africa is enormous. This is particularly in a context in which past state policies have seriously undermined social relationships and trust, and in which the legacies of apartheid are still apparent in post-apartheid South Africa (Emmett, 2001: 4, 15).
A central feature of the destructive impact of apartheid on the social fabric was the severe toll it exacted on children, and the implications this had for succeeding generations. With the disruption
of families and communities during the Group Areas Act, relationships, networks and rights were destroyed and with this, the sense of security and social control. Children were thus the main victims, as they had to cope with the absence of parents, neglect, domestic violence and abuse (Emmett, 2001: 6, 7).
In light of the above, researchers observe that the most tragic reflection of violence in which South Africa finds itself, is that it faces the years to come with children who have been socialized to
find violence completely acceptable and human life cheap (Chikane, 1986: 344).
Physical trauma is second only to cardiovascular disease as the largest cause of overall deaths in South Africa and the psychological impact that follows is substantial.
Approximately 1/3 of patients seen in South African emergency units present with injuries – interpersonal violence, and the combination of motor vehicles and alcohol, are the main contributors.
In a typical American emergency unit, trauma patients make up about 12% of the patient population, while in the UK the figure is about 8%. South Africa is the trauma capital of the world, and
some overseas doctors spend time in South African hospitals to gain experience in the management of traumatic conditions (Stein, Seedat, Emsley, 2002: 790).
Post Traumatic Stress Disorder (PTSD) is a significant clinical problem in the mental health field (Elhai, 2000: 449). It is generally accepted that PTSD arises as a consequence of an interaction between the stressor and the amount of exposure to it, personality, such as, particular styles; pre-existing belief systems and attributional style and the recovery environment, such as availability
of social support (Parry-Jones, 1997: 230-237).
PTSD may affect some 2-3% of the general population at any one time and thus accounts for considerable morbidity within the population and deserves greater research scrutiny (Green, 2003: 200).
Stress occurs when individuals have more demands made on them than they are able to cope with. It is really neither the emotional nor the physical sphere which is the cause of these symptoms, but a disturbance in the whole body, expressed in particular ways by particular people (Handley, 1995: 19).
Because of the longevity, the depth and the complexities of the trauma process, superficial healing will often not suffice (Chappell, 1994: 31).
Anxiety disorders is a normal accompaniment of growth, of change, of experiencing something new and untried, of finding one’s own identity and meaning of life.
Pathological anxiety by contrast, is an inappropriate response to a given stimulus by virtue of either its intensity or its duration (Kaplan et al, 1994: 573). It is evident that there are various stressors that could give rise to the symptoms of anxiety and these can produce seemingly illogical - often restrictive - patterns of behaviour (Sue, Sue and Sue, 1994: 161,194). Anxiety disorders are characterised either by manifest anxiety or by behaviour patterns aimed at warding off anxiety. Whatever its form, anxiety involves a subjective sense of tension, fear an d apprehension, behavioural responses such as avoidance of a feared situation, and psychological reactions which include sweating, palpitations and increased respiration (Bootzin, Acocella and Alloy, 1993: 180).
Research shows that the anxiety itself may be the major disturbance (as in panic disorder and generalized anxiety disorder). It could arise when the individual confronts a feared object or situation
(as in phobias), may result from an attempt to master the anxiety-based symptoms (as in obsessive-compulsive disorder), or may manifest during intrusive memories of a traumatic event (as in PTSD) (Sue et al., 1994:164).
Anxiety is an alerting signal that warns of external or internal threat to one’s unity or wholeness. An individual not functioning properly, in an adaptive balance, will manifest an anxiety disorder (Kaplan et al., 1994: 574-575).
Anxiety disorders afflict up to 93% of the general population who report exposure to traumatic events (Lee and Young, 2001: 156). Only one in four persons with an anxiety disorder is correctly diagnosed and treated, many never seek help. Often individuals blame their distress on work, financial problems, or medical symptoms. Many hate to admit that they may be suffering from an
anxiety disorder because they see it as a sign of weakness. Early treatment can prevent a great deal of suffering and help people to feel and functions like themselves again.
Most who obtain help, even those with severe and disabling problems, improve dramatically (Hales and Hales, 1995: 118).
PTSD differs from acute stress disorder in that the minimum duration of the symptoms of PTSD is one month (Kaplan et al., 1996: 606). Lifetime prevalence estimates vary from 1 to 14% and the sequence may be lifelong and serious, particularly in those whose trauma is prolonged or inflicted by other human beings, such as survivors of concentration camps, torture or rape. The effects may extend to the children of these survivors (Smith, Sell and Sudbury, 1996: 331, 332).
Definition of Post Traumatic Stress Disorder The Merck Manual (Beers and Berkow, 1997: 1587) defines PTSD as “a neurotic disorder produced by exposure to an overwhelming external stress
and characterised by recurrent episodes of re-experiencing the traumatic event, numbing of emotional responsiveness and dysphoric general hyper-arousal”. The Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), (APA, 1994: 427-429) criteria state that the A-criterion for PTSD (traumatic exposure) involves experiencing, witnessing or being confronted with an event that is life-threatening or involves serious threat or injury to oneself or others. The B-criterion (re-experiencing) involves persistent intrusive memories, and sudden reminders or flashbacks associated with the trauma.
The C-criterion (avoidance) includes symptoms of persistent avoidance of stimuli associated with the trauma.
Avoiding thoughts, feelings or memories of the trauma, an inability to recall important aspects of the trauma, numbing symptoms, as well as outright refusal to acknowledged or discuss the experience are common.
The D-criterion (hyper-arousal) may manifest as sleep disturbance, irritability, anger outbursts and concentration problems. Symptoms must cause significant distress or impairment and endure for more than 1 month (DSM-IV, APA, 1994: 427-429).
Prevalence and Aetiology
Studies estimates that 5-6% of men and 10-12% of women in the general population have experienced PTSD at some point in their life (Resick, Stein, Seedat, Emsley, 2001: 97). Further studies report that a much higher percentage of females suffer from this disorder than do males (Flannery and Quin-Leering, 2000: 839 and Seedat, Nood, Vythilingum, Stein, Kaminer, 2000: 38).
Research upholds that people who have PTSD are at an increased risk of developing other psychiatric disorders and are at significant increased risk of committing suicide. The effect of this disorder on employment and work productivity is similar to that associated with depression and translates into an annual loss of productivity above 3 billion dollars in the U:S. (Kessler, 2000: 5-10).
Thus the socio-economic consequences, as well as the personal distress associated with diagnosis, are substantial.
Studies propose that there is considerable evidence that students’ exposure to violence is associated with both anti-social behaviour and psychological trauma, for example, depression; anxiety;
anger; PTSD. A significant relationship was found between exposure to violence and their feelings of hopefulness, sense of purpose in life, and symptoms of depression (Flannery and Quin-Leering, 2000: 839).
Levels of anger and aggression were positively related to their experiences of physical as well as verbal abuse (Flannery and Quin-Leering, 2000: 839). Research found that both PTSD and major depression were significantly more common in patients with a history of domestic violence (Marais, de Villiers, Moller, Stein, 1999: 638).
The stressor is the prime causative fact or in the development of PTSD, although individual pre-existing biological factors, pre-existing psychosocial factors and events that happen after the trauma must be considered (Kaplan et al., 1994: 607).
The qualifying level for the stressor is difficult to determine, but the stress must be of a nature or degree which almost anyone would find extremely disturbing. Rather illogically, DSM-IV advises that people with symptoms of PTSD in response to a lesser stress be diagnosed as having adjustment disorder. This would seem to ignore the probability that onset of symptoms must be determined by a subjective threshold level of stress.
This would be determined by interaction of the environment with the individual vulnerabilities, and many studies of at-risk groups have shown that the development of symptoms is related to pre-morbid personality and psychopathology (Smith et al., 1996: 331).
The principle features of PTSD are: the repeated, intrusive, painful recollections of the experience; as flashbacks, images, thoughts or nightmares; a pattern of avoidance of objects or situations reminiscent of the experience, or amnesia for aspects of it; emotional numbing of responsiveness; fairly constant hyper-arousal and hypervigilance (Smith, Sell and Sudbury, 1996: 332).
Patients may also describe dissociative states and panic attacks. Illusions and hallucinations may be present and impairments of memory and attention may be revealed. Associated symptoms include aggression, violence, poor impulse control, depression and substance-related disorders (Kaplan et al., 1994: 608-609).
The DSM-IV diagnostic criteria for PTSD allow the clinician to assess patients suspected of suffering from PTSD. This criteria also allows specification as to whether the disorder is acute (symptoms lasted less than 3 months), chronic (symptoms lasted 3 months or more), or with delayed onset (symptom onset was 6 months or more after event) (APA, 1994: 429).
A careful neurological examshould be part of the evaluation of every patient with suspected PTSD in order to rule out the presence of brain lesions underlying the changes in memory and the difficulty in concentration (Beers et al., 1997: 1587).
With regard to this study however, this was not necessary since all participants were pre-diagnosed.
DD.: PTSD can be distinguished from other mental disorders by interviewing the patient regarding previous traumatic experiences and by the nature of the current symptoms.
Borderline personality disorder can be difficult to distinguish from PTSD. The two disorders may coexist or may be casually related. Patients with dissociative disorders do not usually have the degree of avoidance behaviour, the autonomic hyper-arousal, or the conscious memory of the trauma that patients suffering from PTSD usually report (Kaplan et al, 1994: 609).
Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the stressor do not meet criteria for the diagnosis of post-traumatic stress disorder and require consideration of other diagnoses (e.g. a mood disorder or another anxiety disorder). Moreover, if the symptom response pattern to the extreme stressor meets criteria for another mental disorder
(e.g. major depressive disorder), these diagnoses should be given instead of, or in addition to, post traumatic stress disorder (Kaplan et al, 1994: 609).
In obsessive-compulsive disorder, there are recurrent intrusive thoughts, but these are experienced as inappropriate and are not consciously related to an experienced traumatic event. Flashbacks
in PTSD must be distinguished from illusions, hallucinations, and other perpetual disturbances that may occur in schizophrenia and psychotic disorders. Malingering should be ruled out in these situations in which financial remuneration, benefit eligibility, and forensic determinations play a role (APA, 1994: 427).
Acute stress disorder is a reaction to events that involve actual or threatened death or serious injury or that threaten the physical integrity of the individual or others. Overwhelmed by fear or helplessness, people may develop dissociative symptoms, such as numbing or detachment, as a psychological defense (Hales and Hales, 1995: 270). Symptoms last for a minimum of 2 days and
a maximum of 4 weeks and occur within 4 weeks of a trauma.
The disturbance causes significant distress or impairment in social, occupational or other important areas of functioning or prevents the individual from performing necessary tasks (DSM-IV, APA, 1994: 429-431).
Although little is known about this recently recognized disorder, mental health professionals believe that with early intervention, most individuals can recover and will not suffer long term problems (Hales et al., 1995: 274).
Short term prescription of sedatives and hypnotics are justified to normalize sleep and reduce anxiety (Smith et al., 1996: 330).
Risks and Complications
Individuals who have recently been through trauma are at higher risks of accidents because they cannot concentrate, their attention wanders, and they may overreact to sudden sound or movement. They should avoid driving, operating heavy machinery, and any tasks that demand alertness for safety. PTSD can lead to phobias about certain situations or activities that resemble or symbolize
the original trauma.
Frequent mood swings, depression, and guilt may lead to substance abuse, self-defeating behaviour, or suicidal actions. Other complications can include aggression and violence, as well as their consequences (Hales et al., 1995: 280).
The primary aim of specialised PTSD therapy is to allow the individual to quell the distress and arousal associated with the recurrent and involuntary reminders of the trauma and minimizes the accompanying behavioural and effective constriction. This can be accomplished using any variety of modalities that have the goal of helping the patient move away from the persecution and ongoing suffering (McFarlane and Yehuda, 2000: 942).
Behavioural desensitization and relaxation techniques are particularly helpful, and where disso ciative mechanisms underlie symptom formation, psychotherapy, producing catharsis; abreaction and insight may be useful.
Anti-anxiety and anti-depressant medications may be used adjunctively when necessary, but it should be remembered that this group of patients is particularly prone to develop drug dependency, so that prolonged pharmacotherapy is generally contraindicated (Beers and Berkow, 1997: 1588).
Several drugs are listed for the treatment of PTSD (dopaminergic agents/serotonergic agents/tri-cyclic antidepressants/benzodiazepines/anticonvulsants/anti-manics/opioid antagonists) (Donnelly and Amaya-Jackson, 2002: 167).
The selective serotonin re-uptake inhibitors (SSRIs) are considered broad spectrum agents in the treatment of PTSD. Serotonergic agents may be important in psychiatric symptoms commonly associated with PTSD such as aggression, obsessive/intrusive thoughts, panic attacks and suicidal behaviour. Although controlled trials suggests that most adult drug responders will show general improvement within 2 weeks of SSRI treatment and that SSRIs will ameliorate all symptom clusters of PTSD, optimal results may entail high doses at relatively long duration (8-12 weeks), and side effects such as nausea, vomiting, diarrhea and constipation pose clinical problems (Brent, 1995: 209-15).
Although Benzodiazepines (BDZ) are effective in the treatment of adult anxiety disorders and have been widely utilized in the treatment of PTSD in adults, studies indicate that they have little effect on core PTSD symptoms of re-experiencing, avoidance or numbing and pose the risk for rebound effects such as anxiety, sleep disturbance and prominent rage reactions. Clinicians should
be aware of the troublesome and sometimes serious adverse effects of dis-inhibition, sedation, irritability as well as withdrawal syndrome in patients given BDZs even for short periods (Donelly
and Amaya-Jackson, 2002: 167).
High dose opiate antagonist, naltrexone, therapy has been utilized with mixed results in treating PTSD. Naltrexone blunts the tendency to self-mutilate and reduces rates of relapse in alcoholic patients who have achieved sobriety. Unfortunately, high dosages of naltrexone carries risk of hepatotoxicity, thus is not recommended for clinical use (Donelly et al, 2000: 168).
Tri-cyclic anti-depressants (TCA’s) appear to reduce symptoms of re-experiencing and depression related to PTSD, but their diverse affect profile (dry mouth, blurred vision, urinary retention, tachycardia and postural hypotension) is considerable.
Dopaminergic agents are reserved for patients with refractory PTSD who exhibit paranoid behaviour, para-hallucinatory phenomena, self-destructive behaviour, explosive or overwhelming anger or psychotic symptoms.
Their risks of adverse effects such as extra-pyramidal symptoms and tardive dyskinesia reserve them for only the most debilitating cases when other agents have failed or when symptoms of psychosis, severe mutilation or aggressiveness are limiting recovery (Donelly and Amaya-Jackson, 2002: 164).
Psychodynamic reprocessing, behavioural therapy, cognitive psychotherapy, hypnotherapy and rapid eye-movement desensitization are some of the specialized therapeutic approaches to the treatment of PTSD.
Essentially these treatments differ primarily in the techniques that are used by the therapist to provide safe environments that are conducive to re-collecting the trauma and managing reactions to
the remembering and working through of the memories (McFarlane and Yehuda, 2000: 1994).
Psychodynamic reprocessing emphasizes that symptoms are a result of the individual’s inability to integrate the complexity of the cognitions and affects caused by trauma. The aim of treatment is
to modify the defensive and copying strategies (that is, symptoms) used to modulate the maladaptive representations of the trauma and to facilitate the processing of the meaning of the traumatic memories and their accompanying emotional distress by gently confronting the patient’s feelings of happiness, shame and vulnerability (Marmar, 1991; 21: 405-414).
Behavioural therapy stresses that symptoms result from classical and operant-conditioned responses to the trauma. The aim of treatment is to reduce the anxiety and the physical and emotional conditioned responses by altering the fear reactions to reminders of the trauma. This can be accomplished through the use of guided exposure to triggers (that is, exposure to symbols or places, or guiding the patient’s rehearsal of the traumatic story).
These techniques are based on the application of learning theory principals such as habituation and extinction (Keane, Fairbank, Caddell and Zimering 1989; 20: 245-260).
Cognitive psychotherapy stresses that symptoms result not only from the conditional response, but also from maladaptive assumptions of patients, such as that catastrophic outcome could have been predicted or avoided.
Treatments use cognitive restructuring strategies (e.g. exploration and re-examination of individual responsibility, vulnerability and helplessness), in addition to a behavioural component which relies on stimulating the fear invoked during the trauma, to effect a change in the representation of the memory. In some variants of this treatment stress inoculation training is provided to help modulate unbearable affects (Foa, Dancu, Hembree, 1999; 67: 194-200).
Rapid eye-movement is a novel and controversial treatment for PTSD, in which the therapist instructs the patient to focus on the therapist’s finger which is moved laterally backwards and forwards across the patient’s gaze, while the patient maintains an image of the original traumatic experience. The patient then describes the traumatic event and the associated feelings, and then thinks about
a reassuring or safe image. Although the mechanism through which therapeutic outcome is achieved is unknown, it is believed that symptom relief is acquired by allowing the patient to work through the traumatic event in a state of deep relaxation (McCann, 1992; 23: 319-323).
The goal of psychological intervention is to help the patient move away from the persecution and ongoing suffering, but the actual efficacy of treatment may depend on a range of factors which include age of the patient, severity of the stressor, past medical treatment, education of the patient and the quality of the therapeutic relationship. Regardless of which modality is chosen, there is usually some type of dialectic that occurs in trauma work.
While treatments which have a primary focus on confronting the fear memory of the trauma have been demonstrated to be particularly useful, this is an approach which a significant proportion of patients will not consent to engage in (McFarlane et al., 2000; 34: 943).
2.5 HOMOEOPATHY AND POST TRAUMATIC STRESS DISORDER
All our dysfunctions ultimately stem from being traumatized and not being able to process it at the time or later. This kind of cause and effect are the ‘rule’ in understanding health. Traumas usually have an associated set of emotions, including fear, anger and grief/loss. It has stages of occurrence and recovery. Lack of love seems to be the basis of most traumatic feelings, especially isolation, rejection, lack of confidence, and poor self-esteem, although fear is also a contributing factor (Chappell, 1994: 9, 10, 13).
The prolonged exposure to trauma and its mismanagement can have potentially devastating effects because trauma invades the mental, emotional, physical and spiritual spheres of an individual’s
life (Foaet al., 1999: 195). Homoeopathy is a medicine for the individual (Shepherd 2, 1995: 10). It treats holistically and cures rapidly, yet gently and permanently (Hahnemann, 1998: 112). In this light, it is anticipated that homoeopathy could appropriately heal maladjustments in patients with PTSD.
Experience has gradually proved that a person fitting a trauma picture and given the appropriate remedy will get better irrespective of what is wrong physically, although in reality mind and body symptoms go together.
All physical symptoms mirror the mind state and vice versa. When accurately perceived, mind states, thoughts and feelings reflect the deepest current trauma or inner state that it is necessary to treat.
The inner intelligence of our immune system always presents what is wrong at the forefront of our being, so as to ‘request’ curative help. Frequently the presentation is based on very early experiences. Beyond this, homoeopathy has integrated much from the field of modern psychology, both humanistic and traditional (Chappell, 1994: 91).
We get into trouble and illness not only because, but also in order to, be moved to reach new levels of awareness and differentiation. When we are beset with difficulties or illnesses it may be well,
to ask not only “How may I have caused this?”, but also “What is it trying to teach me?” Our need to learn and develop and grow while we are alive on this Earth is not a matter of fault. It may be
a matter of being offered a learning experience through having to find the appropriate similimum out there and the meaning within (Whitmont, 1991: 74).
Used and succesful remedies in 12 cases:
Stram. Gels. Arg-n.