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MIASMATIC STUDY AND PSYCHOSOMATICS

Explore the evolution of a patient's chronic colitis and psychological distress over time, linking mind-body expressions to changing circumstances.

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MIASMATIC STUDY AND PSYCHOSOMATICS

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  1. MIASMATIC STUDY AND PSYCHOSOMATICS DR. K. M. DHAWALE HON. DIRECTOR ICR GROUP OF ORGANIZATIONS

  2. RR/23-10-96/NAVIN PRESENTATION RR, 30 YEARS DIP ENG (CIVIL), MARATHA, JR ENGINEER BSES • ACUTE EXACERBATION OF CHRONIC COLITIS OF SIX DAYS DURATION • EXACERBATIONS EVERY 6 MONTHS - SINCE 6 YEARS • SLEEPLESS WITH DREAMS OF BEING PURSUED-EXHAUSTED, UNABLE TO RUN AND FALLING UNCONSCIOUS, FALLING FROM HEIGHT, DEATH OF RELATIVES - SINCE 8 YEARS • HYPERACIDITY - SINCE 10 YEARS • ENDOSCOPY: SPASTIC COLON WITH STASIS COLONOPATHY • HISTOLOGY: MILD ACUTE ON CHRONIC COLITIS

  3. BACKGROUND • POOR FISHERMAN FAMILY FROM INTERIOR • CONSERVATIVE, RITUALISTIC-IDOL WORSHIPPERS, LIVING FROM DAY-TO-DAY • ILLITERATE PARENTS • ALCOHOLIC, NAGGING, VIOLENT FATHER • 3 YOUNGER BROTHERS-ALL SCHOOL DROP OUTS

  4. CHILDHOOD • ELDEST SON-IRRITABLE AND AGGRESSIVE < CONTRADICTION • AMBITIOUS, STUDIOUS - COMPLETED EDUCATION IN HOSTEL • FASCINATION FOR THE ARMY AND HITLER’S EXPLOITS-READING, PLANNING STRATEGIES FOR WAR, DREAMS OF WAR • DISCOURAGED BY FATHER AND INSULTED AND HUMILIATED BY TEACHER FOR THIS OBSESSION-STILL REMEMBERS IT WITH VEXATION

  5. ENGINEERING COLLEGE a • HESITANT, INFERIOR AND COMMUNICATION BLOCK IN ENGINEERING COLLEGE DUE TO POOR ENGLISH • ANXIETY ABOUT STUDIES AND SUCCESS • SOCIAL DISTANCE DUE TO POOR FINANCES • INNER FRUSTRATION VENTED OUT ON FAMILY • RESULT: SLEEPLESSNESS, EPIGASTRIC PAIN AND HYPERACIDITY

  6. EVOLUTION OF TROUBLE a • DIPLOMA STATUS AND EMPLOYMENT  STARTED BEING TREATED WITH RESPECT AND CONSIDERATION BY THE FAMILY • YET PAST INSULTS AND HURTS TROUBLED THE MIND • POWER AND STATUS DOMINATED THE OUTLOOK • PSYCHOLOGICAL DISTANCING FROM FAMILY NORMS AND MODES OCCURRED

  7. EXPRESSIONS • CRITICAL, QUARRELSOME, CENSORIOUS OF THE WAY OF LIFE • ATTACKED TRADITION, RITUALS AND BLIND WORSHIP • ATTACKS OF RAGE WITH TOTAL UNAWARENESS OF SURROUNDINGS • DESTROYING PHOTOS OF IDOLS, TRAMPLED ON SENTIMENTS, FORCED TO STOP TRADITIONAL PRACTICES • EXTENDED OPPOSITION TO THE COMMUNITY AND RELIGIOUS GATHERING EMBARASSING THE FAMILY • REJECTED BROTHER WHO HAD FAILED - DID NOT HELP IN FINDING A JOB RESULT: FRIGHTFUL DREAMS

  8. PRECIPITATION OF COLITIS a • CHANGED JOB-POSTED OUT OF THE DISTRICT FOR TRAINING - SEPARATION FROM FAMILY • ONSET OF DRINKING • HARD WORK - DAY AND NIGHT-TECHNICAL SKILLS DISPLAYED-NO INTERPERSONAL RELATIONS DEVELOPED • GOOD REPUTATION WITH SENIORS, ‘NO NONSENSE’ ATTITUDE WITH SUBORDINATES-HAPPY AND SECURE IN JOB • QUIETENED DOWN ONSET OF COMPLAINTS – COLITIS-MUCUS AND BLOOD

  9. POST-MARRIAGE • WIFE SIMPLE AND RELIGIOUS-MANAGED TO CONVINCE HIM TO ALLOW HER TO CONTINUE WITH SIMPLE WORSHIP • ‘MAN OF FEW WORDS. WILL PROVIDE ON HIS OWN BUT WILL NOT ASK THE NEED’ • ‘STRAIGHTFORWARD, IRRITABLE, PROUD PERSON’ • LOOKS DOWN ON RELATIVES BUT SUPPORTS IN TIMES OF NEED

  10. PHYSICIAN’S OBSERVATIONS DURING INTERVIEW • SITTING STRAIGHT AND UPRIGHT WITH CHIN HELD HIGH • LOOKED STRAIGHT INTO THE EYES OF THE PHYSICIAN • MOIST, SHARP EYES - FACE STERN AND COLD • VOICE-DEEP WITH MEASURED TONE • SHORT, NEATLY COMBED HAIR, CREASE-FREE SHIRT ‘AN OFFICER WITHOUT UNIFORM’

  11. WHAT DO WE NOW KNOW OF THE PATIENT? • TRACED THE EVOLUTION OF THE PATIENT AND HIS COMPLAINTS • STUDIED THE EXPRESSIONS AT THE LEVEL OF THE MIND AND THE BODY • RELATED BOTH TO THE CHANGING NATURE OF TIME AND CIRCUMSTANCE

  12. WHAT ARE STAGES OF EVOLUTION OF THE PATIENT AND HIS ILLNESS? • DISPOSITION-The childhood • DIATHESIS – The early college years • FUNCTIONAL ILLNESS – The hyperacidity and the psychological distress • STRUCTURAL ILLNESS – The colitis

  13. WHAT ARE THE EXPRESSIONS OF THE MIND? • THE DESIRES-The army • THE FEELINGS-The fascination, the humiliation and the frustration • THE IMAGINATION-The fantasies • THE THOUGHTS-The brooding • THE BEHAVIOUR – The violence • THE DREAMS- The danger

  14. ध्यायतो विषयान्पुंसः सङ्गस्तेषूपजायते ।सङ्गात्संजायते कामः कामात्क्रोधोऽभिजायते ॥२- ६२॥ In the case of a person who dwells on objects, there arises attachment for them. From attachment grows hankering, from hankering springs anger.

  15. क्रोधाद्भवति संमोहः संमोहात्स्मृतिविभ्रमः ।स्मृतिभ्रंशाद्बुद्धिनाशो बुद्धिनाशात्प्रणश्यति ॥२- ६३॥ • ** From anger follows delusion; from delusion, failure of memory; from failure of memory, the loss of understanding; from the loss of understanding, he perishes.

  16. WHAT IS THE EVOLUTION OF THE PSYCHOSOMA?

  17. THE CONSTITUENTS OF THE MIND SELF

  18. Know the Atman as the Lord of the chariot, the body as the chariot; Know the intellect as the charioteer and the mind again as the reins. The sense (and the instincts) they say, are the horses, and their roads are the sense objects. The wise call Him the enjoyer (when He is) united with the body, the senses and the mind. One who is always of unrestrained mind and devoid of right understanding, his sense-organs become uncontrollable like the vicious horses of a charioteer. But of Him who knows, and has a mind always controlled, the senses are always controllable as the good horses of the driver. Kathopanishad III:3-6

  19. BIO-PSYCHO-SOCIAL FIELD OF MAN INDIVIDUALS FAMILY SOCIETY CULTURE ENVIRONMENT (SOCIAL) INTERPERSONAL RELATIONS HIGHER MENTAL FUNCTIONS MIND BRAIN CNS AND ANS PNE RES SYSTEM ORGAN CELL SUBCELL BODY ENVIRONMENT (PHYSICAL)

  20. BREAKDOWN OF DEFENSES Non-specific PNE mobilization Evaluation of danger (increasing alarm) Step 1 Altered CNS “State” Non-specific physiologic mobilization (increasing vigour) Physiol expn. Psych expression Step 2 Altered CNS circuitry coupling of central-->peripheral outflow paths Altered levels of consciousness “Ego State” Altered visceral function + other necessary factors e.g. exposure to allergens, compensatory changes in various systems Step 3 Activation of Disease PRECIPITATION OF DISEASE UNDER PSYCHOSOCIAL STRESS

  21. PSORA • HYPER-REACTIVITY • ACTIVITY • QUICK PERCEPTION • ASYNCHRONYIMBALANCE • QUICK CHANGEABLE EXCESSIVE ERRATIC IRRATIONAL UNCONTROLLED INCONSTANT SPASMODIC CONTRARY SWINGS OSCILLATIONS PERIODIC ALTERATIONS • INADEQUACYINAPPROPRIATENESS INEFFICIENCY

  22. SYCOSIS • DULLNESS-PERCEPTION REGISTRATION MEMORY THINKING INTERPRETATION ACTION • ABERRATION-HALLUCINATION LAPSES BROODING DELUSIONS • BASE EMOTIONS-ENVY JEALOUSY SUSPICION ANXIETIES DREAMS

  23. TUBERCULAR-‘HEIGHTENED PSORA’ • FORCED MOBILIZATION • POOR RESOURCES • EXTREME HYPERSENSITIVITY • QUICK RESPONSIVENESS • POOR SUSTAINANCE-WILL - DRIVE • POOR RESULT-FRUSTRATION DISILLUSION DISAPPOINTMENT • UNFULFILLED DESIRES- FANTASIES DREAMS SEXUAL DESIRES & INCOMPETENCE

  24. SYPHILIS • OVERSTIMULATED & EXHAUSTED • LOSS OF CONTROL • VIOLENT RESPONSE • IRRATIONAL DISPROPORTIONATE PROGRESSIVE DESTRUCTION

  25. THE PLAY OF THE MIASMS BETTER CONTROLS PSORA TUB SYPH SYCOSIS PROGRESSIVE DETERIORATION

  26. MIASMATIC ANALYSIS • SYPHILITIC BEHAVIOUR • TUBERCULAR PHYSICAL CHANGES • SYCOTIC SUBCONSCIOUS • PSORIC DISPOSITION

  27. Understanding the psychodynamic

  28. Young boy gets pain from his father. The father is a typical representative of the community (fisherman) He comes from – he is a prototype of his culture. He handles(forces) his son in a typical way

  29. Son gets hurt pain nag him – this would be a routine (typical upbringing). Knowledge opens the door of the other world for him pain hurts hence to shy away from pain child adopts the world of fantasy – he creates and projects his own world his creation brings out his needs towards symbolises decrease • To fight and destroy the enemy • To plan to destroy • To win by destroying • To command

  30. His fascination  chanelization reflects his thoughts and feelings, at that moment. From where did they come? Knowledge imparts many other things then why does he get attracted to these – fantasies ?

  31. The peculiarity of his feelings and thoughts which come out during stress – can thoughts and feeling of this order represent the unprotected basic instincts?  aggression  destruction?

  32. Who is the enemy ? – one who has inflicted pain father – Prototype of community (patriarchial) Second insult occurs when young boy is stopped from fantasizing. He is reprimanded and insulted when he expresses his desire. The typical and expected handling which even the boy anticipated and was trying to block his feelings.

  33. Resultant he is forced to stop channelization and made to face external reality pain his world his creation is destroyed hurts his self-respect, powerful authorities force him to suppress

  34. He is forced to suppress  resultant  hurt and resentment

  35. Subconscious intent  goal  Revenge = Destroy

  36. We get the glimpses of patterns getting established incidence with teacher re – inforces his feelings.

  37. This event has occurred when boy would be passing through his late childhood. Child has been able to develop moderate identity of his own. His interest in learning, will to stay separate form parents to learn and his would of wards admiration for commanders speak for themselves.

  38. He exhibits a fair control on self in not expressing directly his feeling of resentment and vexation. He instead uses fancies imagination and creates a world of his won

  39. Now the young adolescent. Faces the world in city he comes form illiterate, rough, ---- so called culturally backward community. The gap between his serious limitations which makes him feel inferior. He passes through pain – vexation – hostility to circumstances and people who made him face the situation and inflicted pain. The typical pattern of his engagement and sustenance with this circumstances.

  40. This stress runs over a period of 4 year  generates feeling of aggression  destruction in him. The long duration of stress, the intensity of the pain and his helplessness in the situation – frustrates him and in turn he gets sensitized. He also pays cost in terms of increase acid production in stomach (? Part somatization inner)

  41. He exhibits control over self by use of part displacement channelization suppression to balance between self and outside world. Thus he prevents his disintegration.

  42. When he returns home he carries a load of past and new learning about world out side. Circumstances have not changed although he is received well. Attempts to stop what to stop what hurt him as he knows the reaction steps in the commander in him starts acting out commander in him commands and dominates. Imposes decision on family forces them to change values. (Remember he was imposed upon in childhood, now focus on subconscious intent). He wants to do good but intends something different – Emotion dominate – his behavioral pattern come out

  43. He had submitted in childhood – but now family resist – ego – gets hurts. Past gets accentuated (acting out).  losses control  displaces  disintegration  suppress super ego becomes unaware of surrounding and follows his instincts  to destroy and aggressively impose upon his rule (wars – destruction  commands ). Hurts the family – makes them pass through pain – operation revenge starts a violent revolution. The anarch is arrives on scent.

  44. THE AFTERMATH OF WAR One has to face one’s creation, however beautiful or ugly be its face.

  45. He denies guilt/anxiety for what he has done. He not only symbolically destroyed the father = god but manages to hurt society and the deep rooted faiths. The image of his – does not allow him to accept his disintegration in turn rationalizes his action as man of 21st century suppresses the ;super ego  the conscience (Reality testing is at fault)

  46. After all he is a man from the same community by becoming a revolutionary. He has singled himself out and has challenged the collective unconscious of the community. The conflicts between – ego – super ego continues. As ego defends the instincts and suppresses the conscience. Rationalization is the predominate defense at this time. It is way out of the conflict between id and the supper ego.

  47. In the night when consciousness is put off and subconscious rules, fears come out. The symbolism of being chased by community, mob and desperation to escape can be seen. Threat of injury and fear is evident in the current mental state.

  48. Luckily his circumstances allow him to escape and he now faces a different world of work. He is organized sincere his wife recieves him  loves him she has a different communication. To some extent heals him.

  49. Nights are horrible – he continues to pay cost stress mounts. He falls from height – symbolic of his disintegration: SUPER EGO SUPPRESSION AND CONSCIOUS denial continues  mind gives way to the body  somatization of specific conflicts occurs  mind which was inflamed and irritable long time  inflames mucus membrane of colon  and he intermittently disintegrated  so does the inflamed mucosa.

  50. Repertorial totality • Anger, irrascibility : tendency • Anger irrascibility : tendency easily contradiction, from • Anger, irrasibility : tendency: violent • Rage, fury • Hatred • Contradiction, intolerant • Fear: night • Egotism • Dictatorial, domineering, dogmatic, despotic • Seriousness earnestness • Revolutionary • Dreams: Frightful • Dreams: falling: high places from • Dreams : Pursued of being • Dreams: death of

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