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Assessment and homoeopathic management of psychological stresses and somatic illnesses in high school students from rural Palghar: Observational case series
*Corresponding author: Rajesh Ramkunwar Yadav, Department of Psychiatry, Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar, Mumbai, Maharashtra, India. docrajesh87h@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Yadav RR, Patel MK. Assessment and homoeopathic management of psychological stresses and somatic illnesses in high school students from rural Palghar: Observational case series. J Intgr Stand Homoeopathy 2021;4:112-9.
Abstract
Objectives:
Children are often taken to paediatricians for recurrent physical illnesses, which often cannot be diagnosed due to a lack of confirmed investigation findings. It is important to study various psychological stressors they might be undergoing to explain such somatic complaints. Understanding the types of somatic symptoms and nature of stressors in school-going children would also enable us to use Homoeopathy in managing these cases. This is all the more important in a rural set-up, where specialist consultation is difficult to obtain.
Material and Methods:
Six successfully treated children from three rural high schools in Palghar area with recurrent and different somatic illnesses were selected from a part of a larger population studied. These cases have been presented with an aim to study the clinical manifestations and underlying stressors. Management with Homoeopathic medicines along with the use of some stress management skills have been presented.
Results:
Various life situations such as change of school, staying away from parents or interaction patterns of family members were found to have a direct impact on the genesis of either anxiety or anger. As a result, children developed recurrent somatic illnesses, which in turn affected their academic performance. Homoeopathy, along with stress management skills, helped the children to overcome the psychological stresses and reduce the burden of somatic illnesses.
Conclusion:
The external environment is often the same for all students in schools, but a vulnerable few are affected. This results in the development of anxieties, specifically of strangers, of the future, of teachers, or of losing parents; this in turn causes insecurity.
Keywords
Somatic illnesses
Somatoform disorder
Homoeopathy for children
School mental health
INTRODUCTION
We often come across many instances where children with physical symptoms are repeatedly brought to the clinic and are treated symptomatically, as various investigations reveal nothing. The treatment is, however, unable to prevent further visits with the same or similar set of symptoms. The phenomena raise an important question: Are we missing an important element? Cause, for instance, in the form of certain stressful factors at the personal, academic, or social levels, which often gets neglected in our efforts to treat without knowing the entire problem. As a result, the child repeatedly visits with the same complaints.
Somatic complaints in children are a puzzling phenomenon, as their aetiology has been poorly understood. They are by no means solely explained by medical causes such as infections or injuries.[1] Cohen and Herbert[2] stated that emotional processes incorporate the activation of physiological systems and play a major role in the development of somatic complaints. Negative effects are strongly associated with somatic complaints in children. Frequent or long-term negative affects reflect maladaptive emotional processes, but tell us very little about the underlying psychological processes.[3] Children’s emotional functioning is strongly affected by cognitive-emotional processes and indirectly by certain social influences.
The prevalence of somatic complaints in children is high, especially in middle childhood and adolescence. Approximately, 25% children are bothered by recurrent or continuous complaints such as headaches, abdominal pain or fatigue. All these are accompanied by increase in utilization of health care services without any clear-cut evidence of medical causes and benefit.[4]
Various somatic illnesses observed in children[5]
Chronic headaches
Chronic loss of appetite
Long-lasting sleeplessness or sleepiness
Muscle pains
Bed wetting
Sudden appearance of unexpected fever
Stomach pain see usually in children when it’s time for school
Sudden onset of diarrhoea
Falling or premature greying or hairs.
Factors responsible for development of somatic illness in children
Stress: Adolescents experience normative and non- normative stressors on a daily basis. Normative stressors include developmental changes such as puberty, school transitions and increased academic pressure. Non-normative stressful events include minor chronic events such as parent-child conflict, academic requirements, interpersonal relationships and uncertainty about the future[6]
Parental influences: Parental characteristics and parenting behaviours affect children’s health care in numerous ways. As parents are the ones who are responsible for their child’s medical care, they are more attentive, concerned and responsive to their children’s symptoms, perceiving a need for prompt health care. Family dynamics with respect to the disturbed parental relationship may also affect the health of children. Conversely, positive parenting behaviours likely decrease children’s health risk (for example, by reducing stress, avoiding exposure to infection or reducing opportunities for injury) resulting in fewer illnesses and reducing the child’s need for health care[6]
Linking illness to life events: In treating somatic illness, a symptom search for a link in the child’s life may reveal a symptom parallel to an illness of someone close to the patient. Example: A child who just happened to lose his grandparent to stomach cancer might start complaining of stomach-ache[7]
Academic stress: Types of school-related stresses include academic performance, attendance, interaction with teachers, and balancing one’s leisure time with academic demands. A conflict-inducing attitude from teachers may lead to somatic complaints in children.[7]
A somatic complaint list developed in 2004–2006 by Jellesma et al. aimed to identify how often children and adolescents experience and feel pain. The questionnaire consists of 11 items wherein participants rate the frequency with which they experience certain bodily complaints, such as stomach-ache, on a 3-point scale (1 = never, 2 = sometimes, 3 = often).[8]
Homoeopathy has long recognized the psychological origin of somatic symptoms; Homoeopaths examine the patient’s mental make-up in all cases. Remedies are prescribed taking into consideration the totality of symptoms of the mind and body. Homoeopathic remedies are capable of influencing the state of mind and bringing about a harmonious state of health.[9]
Homoeopathic management of the patient after assessing the susceptibility and miasmatic understanding can also prevent the child from developing behavioural or personality problems in the future.[10,11]
Since 2005, the Dr M. L. Dhawale Memorial Homeopathic Institute has been involved in various school health projects across the Palghar and Mumbai regions. These projects have explored, assessed and managed a range of physical and mental illnesses in children. This gave me an opportunity to work in my area of interest from 2012 to 2015 through an exploratory-observational study.[12]
Objectives
Studying the nature of somatic illnesses frequently found in high school children
Studying the various psychological stressors (academic, social and emotional) that may be responsible for these somatic illnesses
Determining the kind of Homoeopathic and other interventions useful in the treatment and study the therapeutic results.
METHODOLOGY
Study design
Observational case series.
Study setting
30 students from 3 rural higher schools participated in Institute’s school mental health project at Palghar region.
Selection of sampling
Simple random sampling.
Student screening was done using the somatic complaint list
After determining children with somatic illnesses, they were advised for investigations, if required, to rule out medical illness
With the help of life space exploration, the psychological stress that could have caused the somatic illness were determined
Supportive data from parents was collected.
Inclusion criteria
Students from high school (8th, 9th, and 10th) in rural areas
Students of all sexes
Students with somatic illnesses/somatoform disorders as per DSM- V, 300.82, ICD-10, and F-45.1 diagnostic guidelines.
Exclusion criteria
Children who clearly had a physical illness and required urgent medical attention.
ILLUSTRATIVE CASES
Case 1
Name: Miss PK, 13 years/female, 8th std student.
Chief complaint
Recurrent throbbing temporal headaches since 2–3 years; all investigations were normal. Headaches are accompanied by blackouts and were triggered by academic stress++, being reprimanded++ for anything and anxiety regarding menarche++. She felt better in company++.
The patient was short, dark complexioned with an anxious expression while talking. She would cry in between and had a habit of nail biting++. She had craving for raw rice++, ice cream+++ and spicy food+ with aversion to sweets+. She had perspiration on the tip of the nose++. Thermally, she was chilly.
Life space
She belongs to a poor socioeconomic class; father is a labourer and an alcoholic. Mother is a house maid. Patient is very afraid of father as he creates a disturbance at home under the influence of alcohol. She has a very cordial relationship with siblings and shares everything with them. She has several friends who share personal issues, including their menstrual problems, which makes her very anxious. She is always afraid of blood or accidents, which make her tremble and perspire a lot. She is afraid to meet any strangers as feels they might take her away. She likes to participate in extra-curricular activities in school such as singing and dancing. Her complaints started after 7th standard in anticipation of the new school and students. She gets angry if someone scolds her or criticises her work but cannot express and gets headaches.
Diagnostic evaluation
She was diagnosed with somatization disorder with prominent psychological stressors including stepping into adolescent age, parental nature and conflicts and anxiety regarding change of school with academic stress.[13,14]
Totality
Ailments from anticipation
Blood cannot look at
Anxiety anticipation from an engagement an
General trembling externally anxiety from
Sleep disturbed anxiety due to
Rice desires dry
Desires spices
Cold drink, water aversion.
Remedies: Phos, Lyco, Nat Mur.
Phos: Highly sensitive to all external impressions with trembling throughout the body from slightest exertion, anxiety glooming foreboding, fears that something will happen with great anticipations.
Lyco: Apprehensive with confused thoughts, more of haughtiness and high motivation will and drive with fear to be alone.
Nat Mur: Depressed with consolation aggravation, very irritable and gets into passion easily which brings about headache of throbbing type.
Final impression: Phos 200.
She was prescribed Phos 200 1 dose weekly for 3 weeks. Her headaches stopped completely along with reduction of anxiety. She could appear for exams without being anxious anymore. She started with her menses after the 3rd week of treatment and did not have any related fears. She was kept on placebo for a month and medicines were discontinued thereafter with no recurrence of complaints.
Discussion
Children can face stress while experiencing transition into another phase of life, especially in adolescence, which was the case here. Assurance and Homoeopathic intervention resulted in reduced stress and the patient traversed menarche with no difficulty.
Case 2
Name: RSH, 15 years/male, 10th std. student.
Chief complaints
He reported recurrent epigastric region pain++ with occasional burning+, without any nausea and vomiting since 5 years. This happens daily, duration 10–15 min. Complaint is aggravated after anxiety+++ or on being reprimanded+. During the complaint, he gets heat sensation in body with weakness++.
He is a lean, thin boy with long hair with a long tikka on his forehead and an anxious look. Thermally chilly with perspiration in axilla that stains clothes white+. He craves potato2 and cold drinks++.
Life space
Patient comes from a nuclear family. Father is a high school teacher and very strict. He will shout or beat patient and older sister if they make any mistakes. Mother is caring by nature and has epilepsy. The patient weeps for mother when she gets attacks. He was very attached to his paternal grandfather; his abdominal pain and anxiety developed after he came to know about the grandfather’s stomach cancer. He had fever for about a week, which subsided after he met his grandfather. Since then, his anxiety has increased, especially regarding grandfather’s health. When he changed schools, the teachers at the new school knew his father. He was worried that if he does poorly, they will inform his father and he will be scolded. This caused deterioration of his academic performance; now, the 10th board exam has aggravated the condition.
His grandfather died 3 years prior, which aggravated the abdominal pain. He is very short tempered and gets angry if anyone contradicts or abuses him. He has beaten up friends for the same, sometimes with rods. When angry, he gets heat sensation all over body with redness of eyes. If he cannot hit the person, he will get pain in his arms; this happens if he quarrels with his sister.
Diagnostic evaluation
Somatization disorder with prominent psychological stressors of academic stress, and family stress causing anxiety and anger. Due to his grandfather’s illness, the child experienced similar pain at a similar location.
Totality
Sensitive reprimands to
Anxiety anticipatory from
Anger violent
Anger contradiction from
Face red anger from
Diarrhoea anxiety from
Trembling of extremities anxiety from
Cold drink, water desires
Potatoes desires
Aversion to sour.
Remedies coming up
Ars alb, Lyco, Fer met, Argentum nitricum.
Fer met has bipolarity in terms of the anger and anxiety, which are mostly on the higher side. His impulsive nature and affection of the arterial system results into flushed face and eyes. On the other hand, Lyco has more of ego issues, which he is unable to overcome, causing irritation.
Final impression: Fer met 200 1 dose weekly
Discussion
The patient’s anxiety was centred in the stomach. Understanding his linking of the illnesses and their effects in further development of somatic illnesses was tackled with proper counselling and Homoeopathic remedy. The child became more relaxed, which positively affected the studies.
Case 3
Name: Miss BSA, 14 years/female, 8th std. student.
Chief complaints
She had recurrent throbbing headache in the left temporal region since 1 ½ year. The frequency was 2–3 times/week and duration 2 h. The occurrences were related to remembrances of her mother or anxiety related to future, studies, or when she suppressed her anger. She was better after sleep and cold application.
Life space
The patient is from D district but lives in P with uncle and aunt for studies. Father was a chronic alcoholic and would cause disturbances at home when drunk. Approximately 1 ½ years prior, the patient was at home on vacation and had gone to meet one of her relatives with her mother and siblings. They came to know that the father, in a drunken state and not finding anyone home, burnt down the house. They came back immediately. This act by her father embarrassed her and shocked her; she felt that many people were viewing them differently. She was very angry with father and wanted to slap him but could not. From that day, she has developed headaches. She always wanted to fulfil her mother’s dream of becoming a teacher. At her uncle’s place, aunt is very irritable and dominating. The aunt asks her uncle about the need of sending her to school; this angers her, but she suppresses it, resulting in headache. Mother has asked her to study at her uncle’s place till 8th and come home from 9th. She hopes that someday the aunt will start caring for her. She likes to study and does well but sometimes gets anxious before exams. She is very fastidious and does not like anything to be misplaced or unclean, which causes irritability.
Diagnostic evaluation
She was diagnosed with somatization disorder with prominent psychological stressors of living away from parents and constant state of vexation due to strained relationship with her aunt (family interaction pattern).
Totality
Ailments from-embarrassment
Ailments from-anger-suppressed
Conscientious about trifles- children, in
Fastidious
Anxiety anticipation from
Gen-food and drinks-ice cream-desires
Gen-food and drinks-spices desire
Gen-food and drinks-eggs-aversion.
Final impression: Carcinocin.
An ailment from anger or suppressed anger is the prominent feature in Nat mur but is also present in Carcinocin. The anger along with conscientiousness impels her not to hurt her aunt. She remains upset with father but harbours the hope that he will change one day; this aspect is absent in Nat mur who continuously broods on the matter and is cannot resolve such feelings easily.
Discussion
Homeopathic medicines work in curing such cases of somatic complaints despite the stressors continuing in their lives. Our remedies help in changing the cognitive functions, which can alter the stress perception and thus the effect on health.
Case 4
Name: OMO, 13 years/male, 8th std. student.
Chief complaints
He reported recurrent dull type of headache++ with sick feeling+, since 6th std. after teacher shouted at him in class. Since then, headache occurs whenever there is incomplete work and he is at school or about to go to school++.
Life space
Patient is from a good family; father owns a chicken shop and mother is a sweeper in a municipal office. Patient is the youngest of all siblings and is cared for by all. He is afraid of teachers and their scolding, especially if his homework is incomplete. Once in 6th std., a teacher had shouted at him and beaten him because of his incomplete work and mischief in class. Since that day he fears teachers and scolding from them. He always gets headaches whenever he comes to school. He is fearful by nature, especially of dark, animals, or being alone. He is obstinate and will get whatever desired by throwing tantrums. At times, he gets into fights with friends because of his obstinate nature, but these are never serious.
Dreams: frightful; startles awake and takes 1–2 h to sleep again.
Diagnostic evaluation
Somatic complaint: Somatization disorders with recurrent headache and body ache due to fear of teachers. Prominent psychological stresses are of fear of teacher and of going to school.
Totality
Ailments from anticipation
Fear dark of
Fear being alone of
Dreams frightful
Motion agg.
Craving for sweets
Perspiration on back
Coryza from getting wet.
Calc phos was selected on the basis of the dispositional quality of fear and anxiety and a sensitive mind affected easily by stress. Physical make up of patient like short height and poor nutritional status despite good food consumption helped identify the physical disposition.
Final impression: Calc Phos 200, 1 dose weekly.
Discussion
Somatic complaints are troublesome to many children with such emotional problems. They need to be addressed by teachers and parents so that they understand the child’s problem. In this case, the constant stress factor was the school but patient responded well to remedy and his headaches stopped.
Case 5
Name: DCY, 13 years/female, 8th std. student.
Chief complaints
The child had recurrent epigastric region pain with fullness and nausea since almost a year. Ailments from vexation++; pain aggravates between 6 and 7 pm++ and on seeing non veg foods++. Pain is ameliorated by fasting+. Alongside there are recurrent pulsating headaches++ since 5–6 years, which are aggravated by anger++ or after being reprimanded++, which is better after sleep.
Life space
Patient is from a middle-class family. Father is an auto rickshaw driver; he is irritable and patient fears him a lot. Mother is calm and caring by nature and very fastidious, which the patient is as well. Patient used to stay at paternal grandfather’s place for 2–3 years, but he was strict and once scolded the whole family because father did not send money on time. Patient was very angry with him and wanted to hit his head with a stone but could not; since then, her anger and frequent headache has started. If father brings something for younger siblings and not for her, she will get angry and demand until she gets what she wants. She does not like eating non-veg, but father wants it almost daily. Her mother cooks it in the evening and tells the patient to quietly eat it. This causes a lot of anger, which causes epigastric pain. She is reserved by nature and will not share her things because she thinks others will laugh at her. Dreams of her sister being separated from her.
Diagnostic evaluation
The somatic complaints of abdominal pain and headache are due to suppressed anger: somatization disorder. Psychological stresses are in the form of separation from sister and the family routine of forcefully giving her non-veg food.
Totality
Ailments from anger
Admonition agg
Confidence wants of
Head pain anger from
Abdominal pain anger after
Stomach vomiting riding in carriage while
Sweets desires
Ice-creams desires
Meat aversion
Hunger agg.
Differential remedies- Nat mur, Sepia, Nux vom.
Vexation as the basic mental state runs in the child. It is expressed in terms of breaking of relations or ambivalence of relations. That indicates the Nat mur quality, which is not found in Sepia, which shows strong rebelliousness and indifference after that.
Final impression- Nat mur 200, 1 dose weekly.
Discussion
Patient, who in the first instance was not willing to talk to me, later started communicating freely and the goal was achieved when all the somatic complaints got resolved. She is now used to this new environment and new school.
Case 6
Name: SMP, 13 years/male, 8th std. student.
Chief complaint
The child reported recurrent dull headaches++ with heaviness++ since 1 ½ year. Headache occurs about 3–4 times per week and lasts for about 1–2 h. Headache always occurs after he develops anxiety related to his studies2, exams3 or anxiety for his family members+. It is relieved by cold application+ and sleep+.
Life space
Patient is from a poor family. His father is a labourer and a chronic smoker. The patient does not like this because he is anxious about the father’s health. Father had an asthma attack once; this caused immense fear in patient that father was about to die and what would happen to him? He weeps if something happens to parents. Patient is the youngest in the family and hence he has been pampered. He always misses his elder sister who stays with their uncle. He is very fearful by nature, cannot sleep alone, needs someone with him while sleeping, and gets startled in sleep after having frightful dreams. He has an intense fear of dark and dogs, becomes nervous after seeing dogs, and changes his path. Since 1–1½ year, due to the increased syllabus and comments from senior students regarding studies in 9th std., he has developed anxiety, which causes regular headaches that are not better with allopathic medications. Exams are about to start; he is most worried about those at the moment.
Dreams: Dreams of dogs that are going to bite him; occasional dreams of ghosts with startling
Thermals: chilly
Diagnostic evaluation
Frequent headaches enabled to the diagnosis of somatization disorder with psychological stresses in the form of academic stress, which was felt strongly due to his fearful and anxious nature.
Totality
Fear examination of
Fear alone being of
Anxiety anticipation from
Trembling of extremities anxiety from
Dreams of pursued dog by
Eggs desires
Head pain cold water amel.
Final impression
Gelsemium 200, 1 dose weekly. Gelsemium was prescribed on the basis of the anxiety he presented with; the anxiety was generated after someone talked about the vast syllabus. The anxiety was accompanied with weakness, which did not allow him to perform. Examination funk was also one of the points suggesting Gelsemium as the remedy.
Discussion
The case was managed with the help of the Homoeopathic medicine along with breathing exercises to overcome anxiety. Subsequently, his headaches reduced and his academic performance improved without much exam-related anxiety.
RESULTS
Transitions in life are difficult to negotiate; some adapt quickly, while some fall prey to anxiety and other negative emotions. Most of our cases presented with a failure to adapt, be it from childhood to adolescence or from one medium/school to another. These had an impact on students and produced recurrent somatic complaints
Academic changes as well as language shifts and social separation from friends can also produce stress and somatic complaints
Family interactions are always very important as they play an important role in the overall shaping of the personality. If the interactions amongst family members are not good or stable, it can affect the psychological health of children and can cause development of somatic symptoms
Sibling rivalry amongst children can also generate stress. It is also observed that children find it difficult to face separation from their siblings or from parents, resulting in frequent somatic symptoms
School or teachers may also cause stress when there is a need to catch up with academic performance and a negative interaction can act as an important precipitant to the complaints
Friends or peer groups may also produce stress. Constant fights or bullying may produce somatic symptoms in children.
CONCLUSION
The external environment may be the same for all the students in school but a vulnerable few are affected. This results in anxiety, specifically of strangers, the future, or teachers. The fears were high with respect to teachers or parents or losing parents, that is, insecurity
Headache was found to be the commonest somatic symptom along with recurrent abdominal pain. These generally result from constant fights at home amongst parents or other family members
Homoeopathic medicines are capable of bringing the desired changes in children, enabling better coping with stressful situations and reduction in recurrent somatic complaints
Stress management skills along with Homoeopathic medicines help children to overcome stressful situations and reduce the recurrence of somatic symptoms.
Acknowledgements
We wish to thank the Director, Rural Homoeopathic Hospital, for permission to publish the cases. The paper originated in a Dissertation entitled “Studying the Psychological stresses in high school students having somatic illnesses and its homoeopathic management” by the first -named author, which was in part-fulfilment of the MD (Hom) degree granted by Maharashtra University of Health Sciences (MUHS), Nashik. The second author was the guide to the study. We are thankful to the MUHS, Nashik for permission to conduct the study. We are thankful to the management and teachers of the schools for allowing us access to the children and permission to treat them.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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