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Understanding Fright and Differential Materia Medica: A case series
*Corresponding author: Dr. Bhavik Ramesh Parekh, M.D.(Hom), Associate Professor, Homoeopathic Materia Medica, Dr. M. L. Dhawale Memorial Institute, Palghar, Maharashtra, India. drparekhbhavik@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Parekh BR. Understanding fright and differential Materia Medica: A case series. J Intgr Stand Homoeopathy 2021;4(1):12-9.
Abstract
Objectives:
To successfully prescribe a homoeopathic remedy, it is important to have not only good knowledge of symptomatology but also an ability to closely differentiate a remedy from others indicated for similar conditions. Despite good knowledge of Materia Medica, its clinical application often fails. Therefore, the best way to understand Materia Medica is to study it in an actual clinical setting. Fright which is an extreme fear excited by sudden danger; something strange, ugly or shocking, is one such emotion that the homoeopathic physician encounters in his practice.
Materials and Methods:
Five successfully treated cases with prominent shades of fright from the author’s practice were studied to understand the causation, evolution and expressions of fright. The qualified expressions were studied through repertory and their finer shades were studied through Materia Medica to understand the key differential indications of the remedies prescribed.
Results:
The events or life situations that lead to fright and the patients’ response and its evolution lend a characteristic value to individualisation and prescribing based on differentiating from other remedies. Aconite, Opium, Stramonium and Gelsemium were drugs found in this study. Aconite has sudden and extreme effects of fright or repeated sudden effects leading to febrile expressions. Opium has prolonged effects of fright at the sensorium in the form of insomnia, but lacks the intensity or violence of Aconite. Stramonium has a fear of imminent danger or being attacked. The fears are intense, to the extent of terrors; the patient desires company and clings to persons OR hides and tries to escape from the situation. Gelsemium has fright leading to anticipation as well as fear of falling and/or receiving injury.
Conclusion:
In this study, plant remedies prescribed in higher potencies and infrequent repetition brought about effective resolution of fright in all five cases. The remedies also mitigated the consequences of fright on the mind and body and improved the overall susceptibility in all cases.
Keywords
Fright
Differential Materia Medica
Causation
Evolution
Expression
INTRODUCTION
To successfully prescribe a homoeopathic remedy, it is important to have not only good knowledge of symptomatology but also an ability to closely differentiate a remedy from others indicated for similar conditions. In the homoeopathic Materia Medica, many remedies are indicated for a clinical condition or symptom; it is the physician’s job to determine the exact similimum through accurate differentiation. At the physical level, we see several remedies indicated for conditions such as jaundice, diarrhoea and cough. At the mental level, we can study differentiation based on mental symptoms such as fear, fright, anxiety and sadness.[1] An in-depth study of the causation, evolution, expressions and differentiating modalities enables us to reach the similimum.
Despite good knowledge of Materia Medica, its clinical application often fails due to multiple reasons. These can be in the realm of receiving, understanding the symptoms of the patient and converting them into rubrics or it can be at the level of finer differentiation between different remedies. Therefore, the best way to understand Materia Medica is to study it in an actual clinical setting.[2]
Fright is one such emotion that homoeopathic physicians encounter in practice.
Definition
Fright is extreme fear excited by sudden danger; something strange, ugly or shocking.[3]
Fright is an emotional reaction to a dangerous situation or encounter. It is immediate, physical and concrete and can sometimes be overwhelming. The universal function of fear is to avoid or reduce harm. The immediate threat of harm focuses our attention and mobilises us to cope with the danger. The evolutionary pre-set actions of fear include fight, flight and freezing.[4]
When a person is confronted with danger – be it real or perceived – the autonomic nervous system is activated through the psycho-neuro-endocrine axis, leading to sympathetic overactivity. Expressions of fright include increased heart rate, increased blood pressure, rapid breathing, increased respiratory rate, flushed or pale skin, increased motor activity, increased core body temperature and trembling, which are caused by increased muscle tension.[5]
In some cases, the expressions of fear/fright remain even after the dangerous situation has resolved, as the individual continues to perceive the threat as affecting its functioning. Hence, it is vital to understand and manage both these aspects when encountered in practice. In homoeopathic practice, individualisation is essential to determine the correct prescription for any case.[6] Two chief components individualise fright: The event itself and the individual’s response to the event.
There are numerous remedies listed under fright in various repertories. Kent’s repertory lists 46 remedies under the rubric FRIGHT; complaints from, with nine remedies in the highest grade.[7]
In a study conducted on 2681 patients with panic attacks with 191 evaluated follow-ups, the most frequent symptoms were fear of death and anxiety about health. The majority of cases were aged 25–44 years, with 77% women; the most common remedies prescribed were Aconite (14%), Arsenic album (11%), Phosphorus (14%), Stramonium (6%) and Natrum muriaticum (6%).[8]
Integrative medicine for children, 2009, suggests indication of Aconite for fever in children that develop after frightening or shocking experience.[9]
This paper attempts to study the symptom of fright and its differential Materia Medica through cases seen in the author’s practice and further refining the understanding of the drugs through the study of Materia Medica so that future application of the drugs becomes more practical.
MATERIALS AND METHODS
Five successfully treated cases from the author’s practice that had prominent shades of fright were studied retrospectively to understand the causation, evolution and expressions of fright. The qualified expressions were studied through repertory and Materia Medica to arrive at key differential indications of the various remedies of fright used in the cases.
Ethical Approval: Not required
Study design: Retrospective case series
Study setting: The author’s clinical practice
Consents: Patients consent not required as identity not compromised
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Inclusion criteria
Cases of all age groups and both sexes
Acute as well as chronic cases.
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Exclusion criteria.
Nil.
CASES
Case 1
The parents of an 8-year-old girl called with the complaint of sudden-onset high-grade fever (103–104oF). The child was unable to rest in one place, would move from mother to father to grandmother. When asked about the cause of the fever, the mother reluctantly narrated that she had shouted at the child and locked her inside a dark bathroom. The patient was frightened and developed a fever the same night. The mother stated that the patient had frightened expressions.
Clinical diagnosis
Psychogenic fever.
As seen in [Table 1], Considering the qualified mental state and the mental symptoms, Kent’s approach was selected.
| Qualities of fright | Symptom | Rubric |
|---|---|---|
| Causation | A/F fright | A/F fright |
| Evolution | Sudden | Sudden effect |
| Expression | Restlessness fever | Restlessness from fear |
Discussion
Aconite and arsenic were coming up in repertorisation [Figure 1]; however, aconite covers all the three rubrics with higher gradations. In this case, we see a sensitive child who immediately somatised after fright and developed a high-grade fever with a frightened expression. Thus, in this case, Aconite, Arsenic alb and Belladonna came up for differentiation.
- Case 1 – Repertorisation.
Dr. Kent describes Aconite, that attacks come on suddenly, sudden congestion and sudden fever or convulsions. Aconite fever is generally one short, sharp attack of fever.[10] Phatak states that aconite’s symptoms are acute and violent. The mind is affected by violent emotional factors, as FRIGHT; SHOCK, Vexation. The patient is terror stricken. It is a remedy for acute inflammation and congestion. The patient is anxious, excited, nervous and feverish.[11] Farrington compares Aconite with Arsenic alb. Arsenic also causes intense fever with anxiety, restlessness and fear, but the fever and inflammation of arsenic are such as belong to intense local disease, to inflammation progressing to destruction of the part, to fever of a typhoid type, with putrid discharges; whereas in aconite, we are able to see in early stages of inflammation from which the patient recovers more quickly.[12] Thus, Arsenic album is indicated in later stages of the disease process. Arsenic suits inflammatory fever in a state that is further advanced than one requiring Aconite.[13] Phatak describes Arsenic album as, anguish with despair of recovery, agonising fear of death, from starvation, financial loss. Restlessness, changes place continually, children are capricious and want to be carried.[14] According to Phatak, Belladonna with fever has fullness, congestion with throbbing of arteries, redness and burning heat. At the mental level, the patient is in a wildly delirious and excited state with violence. They also start in fright at approach of others.[15] Thus, Belladonna has more erethism and more violence in fever. Belladonna requires presence of brain symptoms, such as starting from sleep, throbbing headache, hot head and cold body and extremities.[16] Farrington states that Aconite is indicated in inflammatory fever, which has about it no quality of weakness or asthenia.[17]
Finally, the remedy administered was Aconite 1M. A single dose brought the fever and the extreme mental state of fright under control within a few hours. After resolution of the acute state, a single dose of the patient’s deep-acting remedy (Calcarea Iodatum 200) was prescribed.
Case 2
A 47-year-old woman reported with the chief complaint of allergic rhinitis for 10 years. There were no major events in her life space; however, the patient tended to get frightened easily at small incidence. She was unable to attend death or see dead bodies, as they scared her. She would get frightened and develop fever even on hearing of such things. On two occasions, she had no choice but to attend a funeral, she was admitted with fever due to fright. Since childhood, she also had a marked fear of the dark and of being alone.
Clinical diagnosis
Phobic anxiety disorder-specific phobia: Necrophobia (ICD-10 classification 40.2), psychogenic fever and allergic rhinitis.
Thermal state: Chilly patient.
As seen in [Table 2], considering the qualified mental state and the mental symptoms, Kent’s approach was selected.
| Qualities of fright | Symptom | Rubric |
|---|---|---|
| Causation | A/F fright A/F bad news |
A/F fright A/F bad news |
| Evolution Expressions |
Repeated sudden effects Fear of dark Fear of alone Fear trifles Fear of hearing bad news Fever |
- Fear of dark Fear of alone Fear trifles Fear of hearing bad news - |
Discussion
In this case, we see a lady who is quite fearful with extreme sensitivity to events of death; so much so that even hearing about them would lead to fright and somatisation in the form of fever. She avoids attending funerals for the same reason. Although the case was a chronic one, the impact of fright has consistently been immediate and intense, which is the interesting aspect of the case.
Aconite predominantly covers all symptoms, while Arsenic comes close [Figure 2]. Farrington compares Aconite with Arsenic; he states that Arsenic also causes intense fever, with anxiety, restlessness and fear, but the fever and inflammation of arsenic are such as belong to intense local disease, to inflammation progressing to destruction of the part and to fever of a typhoid type, with putrid discharges, whereas in Aconite, we are able to see in early stages of inflammation from which the patient recovers more quickly. Phatak describes Arsenic alb as having anguish with despair of recovery, agonising fear of death, from starvation, financial loss. Restlessness, changes place continually, children are capricious and want to be carried. In Aconite, the fears are intense. Fear is depicted on his countenance, first thing he thinks of is that he must die; this must mean death, which he fears.
- Case 2 – Repertorisation.
Therefore, the patient received Aconite as a deep acting medicine. Initially weekly doses of 200 potency and later few doses of 1M helped to cure the patient of her allergic rhinitis and also helped in reducing patient’s responsiveness to events causing fright.
Case 3
A 50-year-old widow consulted the OPD with the chief complaint of insomnia for 5–6 months. The patient could hardly sleep for 1–2 hours. The patient had witnessed a road traffic accident in which she saw a young boy’s head being crushed under a vehicle. Since then, she developed intense fright. She keeps recalling the accident, due to which she cannot sleep. She has also become extra cautious while crossing the road and about her grandchildren playing on the streets.
Clinical diagnosis
Post-traumatic stress disorder (ICD-10 classification 43.1)
As seen in [Table 3], considering the qualified mental state and the mental symptoms, Kent’s approach was selected.
| Qualities of fright | Symptom | Rubric |
|---|---|---|
| Causation/s | A/F fright – sight of an accident Fear of fright |
A/F fright – sight of an accident A/F fright with fear |
| Evolution | Prolonged fear (5–6 months) | Fear – chronic |
| Expression/s | Fear of a frightful incidence sleeplessness | Fear – fright – previous fright, because of a sleeplessness fright, after |
Discussion
In this case, we see that the accident continues to trouble the patient even after 5 months. The effects can be seen at both mental and physical levels. At the mental level, we see that the fear of the event still persists and she gets visions of the accident, which has made her very cautious. At the physical level, we see sleeplessness due to the fear. Thus, we see a deeper and a more long-lasting impact on the fright on the patient.
The prominent remedies coming up are Aconite and Opium [Figure 3].
- Case 3 – Repertorisation.
Hering’s Guiding symptom describes Opium thus after fright, fear of the fright still remaining.[18]
Kent’s Materia Medica18 describes Opium as, fear and its results. Long lasting fears. Complaints from fear where the fear remains or the idea of fear remains or the cause of it comes before the eyes. The object of fright constantly looms before her eyes.[19] In comparison, in Aconite, as we have seen in earlier cases, the effects are more sudden and intense and short lasting or with recurring episodes.
The patient received a single dose of Opium 1M, which relieved her; she thanked the doctor for giving her peaceful sleep. The patient did not require any further medication as she did not have any other complaints.
Case 4
A 6 ½-year-old child presented with complaints of recurrent respiratory complaints every 15 days, for 4 years. Each episode would consist of cold, cough, breathlessness and wheezing. The patient was brought in with an acute exacerbation; he was admitted and responded to Coccus Cacti 200 (4 times/day) within 2 days.
The child was the youngest of his siblings and was, therefore, the most pampered. The child’s basic nature as described by the parents was very fearful. He fears the dark and being alone; always wants company. However, at home, he is quite irritable, especially with mother. He beats people and throws things if contradicted. Outside the home, he is shy, averse to strangers and hides himself. He has a peculiar fear of fat people; if he sees an obese person, he hides.
Once, when outside, he saw a dog biting a man; he was so afraid that he refused to go anywhere near that road. He had a similar reaction on seeing a seemingly insane person; refused to take that road again. The patient’s father is an alcoholic; the patient completely avoids the father when he is drunk. During the interview, he was hiding behind the mother and clinging to her. He maintained very poor eye contact with the physician.
Clinical diagnosis
Phobic anxiety disorder-specific phobia: Cacomorphobia (ICD-10 classification 40.2) and Hypersensitivity airway disease.
As seen in [Table 4], qualified mental state and mental symptoms indicate Kent’s approach.
| Qualities of fright | Symptom | Rubric |
|---|---|---|
| Causation/s | Afraid on seeing man bitten by dog Seeing mad person on the road | A/F fright |
| Evolution | Consistent pattern of response | - |
| Expression/s | Fear of alone3 Fear of dark3 Aversion to strangers++Never going by road where he witnessed the incidence3 Hiding behind mother++Clinging to mother++ |
Fear of alone Fear of dark Stranger, presence of strangers, agg, children in Fear – terror Frightened easily Hiding Clinging children in |
| Other expressions | Anger beating mother and brother++Anger throwing things++Anger when contradiction++ | Anger violent Anger throwing things around Anger contradiction from |
| Qualities of fright | Symptom | Rubric |
|---|---|---|
| Causation | A/F fright after fall | A/F fright |
| Evolution | ||
| Expression | Anxiety after fright Anticipation of falling Fear of falling Fear of getting injured |
Anxiety fright after Anxiety anticipation Fear of falling Fear of being injured |
Discussion
In this case, we see a very fearful child who appears to be quite irritable in familiar company. The impact of fears from witnessing the dog bite or the seemingly insane person is tremendous, where he runs from there, clings to mother and avoids going to that place again. These situations are terrorising to the child and he completely avoids those situations that he perceives as threats.
The prominent remedies after repertorisation are Stramonium 9/15; Silica 7/10; Spongia 7/7; Lycopodium 6/13; Nux vomica 6/10; Belladonna 6/10 and Hyoscyamus 6/10 [Figure 4].
- Case 4 – Repertorisation.
Dr. TF Allen describes Stramonium as having fear of dark and being alone. Delirium of fear, as though a dog, was attacking him. Much excited under the impression of some immediate danger, clinging to the person who had him in her lap.[20] Dr. CM Boger’s Synoptic Key describes Stramonium as dreads darkness and has a horror of glistening objects. Fearful, desires company or wants to escape.[21] Silica too comes up in repertorisation; however, the intensity of fright in the form of terror as seen in stramonium is not so much in Silica. We thus have the same picture of stramonium in the child as is described in the literature.
Stramonium was selected for the patient and was administered 200 potency weekly. The patient was under treatment from 25 October 2012 to 26 April 2013 for 6 months during which the patient did not have any episodes of acute exacerbation of respiratory complaints. The fears and their impact were also reduced to a significant extent.
Case 5
The patient was an 85-year-old man. The case was reported by his son telephonically. He had a fall in the home without any injury. However, he developed fear of falling and injury, which caused difficulty in walking and avoidance of the same. Walking had become stressful for him due to fear.
Qualified mental state and symptoms indicated Kent’s approach.
Discussion
In this patient, we can see the impact of fright due to a minor fall. However, the incident has led him to have an anticipation of falling and being injured.
The remedies coming up were Gelsemium 5/10; Lyssinum 4/5; Arsenic album 4/5; Silica 4/8; Lycopodium 4/7; Natrum mur 4/7 and Argentum nitricum 3/4 [Figure 5].
- Case 5 – Repertorisation.
Gelsemium and Silicea come close for anticipation of falling after fright.
Phatak describes gelsemium, A/F fright, fear, exciting news, worse by emotions, dread and ordeals. Dread; of falling, of ordeals, death, pain.[22] Farrington[22] in Clinical Materia Medica mentions Silicea for remote consequences of fright.[23] Phatak[23] describes Silicea thus loss of confidence, dreads failure, but unfounded.[24] Gelsemium specifically has fear of ordeals, pain as well as injury.
Gelsemium 1 M single dose helped the patient overcome his anticipation of walking and fear of falling. The patient’s deep-acting remedy Silicea was followed after the acute phase settled.
RESULTS
A total of five cases were studied: Three patients were female and two males. The three female patients (Cases 1, 2 and 3) were aged 8, 47 and 50 years, respectively. The male patients (Cases 4 and 5) were aged 6½ and 85 years, respectively. Two cases (Case 1 and Case 5) were of acute fright and its effects, one case of prolonged effect of fright (Case 3) and the remaining two cases showed a consistent pattern of reaction to frightening situations. Case 1 had impact fright after being locked in a bathroom, Case 2 had tendency to get frightened by trifles, bad news, witnessing death or seeing dead bodies, Case 3 had fright from witnessing an accident, Case 4, a fearful child had fright on seeing a dog bite and a seemingly insane person and Case 5 had fright after a fall. Cases 1 and 2 had immediate impact of fright with somatisation in the form of fever. Case 3 had prolonged effect of the fright in terms of sleeplessness. Case 4 had typical flight response to the terrifying situation and clinging and hiding in unfamiliar situations. Case 5 developed anticipation of falling down and getting injured after fright. Cases 1 and 2 responded to Aconite, Case 3 responded to Opium, Case 4 to Stramonium and Case 5 to Gelsemium. Three cases (Case 1, 3 and 5) responded to 1 M potency single dose, whereas two cases (Cases 2 and 4) which were associated with other physical complaints and with dispositional features of fear and fright responded to infrequent doses of the 200 potency. In case 2, the potency was stepped up to 1 M at a later stage. The cause-effect relationship was clearly available in four cases (Case 1, 2, 3 and 5). All five cases responded quite favourably to the indicated homoeopathic medicines and simple amelioration occurred. Cases 1 and 5 were followed up by deep-acting constitutional remedies Calcarea Iodatum and Silicea, respectively. Cases 2 and 4 showed tendencies to get frightened with other qualified fears; they received aconite and stramonium as deep-acting medicines, respectively. Case 3 did not require any follow-up medication as the patient did not have any other complaints. Amelioration was seen at the physical as well as mental levels. At the physical level, it helped to resolve fever in case 1, allergic rhinitis in case 2, insomnia in case 3 and hypersensitivity airway disease in case 4. At the mental level, there was a significant reduction in the patients’ sensitivity to fright and its impact, thus indicating overall improvement in susceptibility.
DISCUSSION
The cases represented varied age groups, ranging from childhood to old age. The cases represent both acute and chronic aspects of fright. Each patient has experienced and responded to the fright in their own characteristic manner. Both cases of aconite were terror stricken by the frightful situation and showed immediate somatisation in the form of fever. While Case 1 was acute, they had fright after a punishment and the patient was restless with visibly frightened expressions, Case 2 had fright from events of funerals, dead bodies and bad news that symbolises the end. The patient chose to avoid such events, indicating the flight response that had become a pattern for her. If she was unable to avoid the situation, she would immediately somatise in the form of fever for which she required admission. In addition, the patient had fear of trifles, hearing bad news, of dark and being alone. Case 3 peculiarly experienced prolonged fright response leading to disturbed physiological functioning in the form of sleeplessness after witnessing an accident. The lady even after 5–6 months was unable to overcome the experience and suffered the consequences wherein till date the patient gets flashbacks of the accident leading to insomnia; at the behavioural level, she became extra cautious, which responded well to opium. Case 4 classically shows the flight response in the child, where the child runs away and totally avoids facing the terrorising situation and clings to his mother to save himself from threat. However, the same patient is quite aggressive in a familiar environment. This case presented with recurrent physical complaints in the form of hyper-responsive airways, which resolved completely with stramonium. In addition, the patient was very fearful and had numerous fears of dark, alone, strangers and fat people. Case 5 depicts the anticipation of an old man who had fright after a fall, which shook his confidence; he now had anticipation and fear of falling down and getting injured. All this despite the fall being a very minor one, thus again indicating the individual’s peculiar sensitivity, which required gelsemium. Interestingly, all the remedies that came up were of the plant kingdom, which suggests that the heightened sensitivity of plant remedies makes them more prone to the flight or freeze response rather than the fight/struggle that is seen in animal/ metal remedies. Three cases were given higher potency at the outset itself whereas one case required 1 M after initial 200 potency, indicating again the heightened state of susceptibility and sensitivity.
Limitations
This retrospective study of five cases brought out only plant remedies, necessitating a study of causation, evolution and expression of fright in remedies belonging to metal, mineral and animal kingdom to understand how quality of fright differs in different remedy groups. At the same time, the effects of different potencies in conditions of fright can be studied as well.
CONCLUSION
The correct appreciation of the causation, evolution and qualified expressions of fright plays a significant role in the process of individualisation and correct selection of the similimum. Aconite has sudden and extreme effects of fright or repeated sudden effects. Opium has prolonged effects of fright at the sensorium and lacks the intensity or violence like aconite. Stramonium has fear of imminent danger or being attacked. The fears are intense to the extent of terrors and the patient desires for company, clings to persons or hides and tries to escape from the situation. These fears are especially seen in strange unfamiliar situation. Gelsemium has fright leading to anticipation, fear of falling and getting injured. All the patients try to avoid the situations and/or become very cautious of encountering the situations that have brought on the fright.[25,26]
Acknowledgments
Department of Homoeopathic Materia Medica, Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar.
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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