The liver and depression

Abstract

There are to be found in Hahnemann's work ideas which appear to me to be still full of untapped potentialities. One of his most valuable indications is the concept of one-sided diseases. Whereas, he points out, most disorders have some local or somatic aspect intermixed with mental or emotional disturbances, there are cases in which the symptomatology is so one-sided that it is almost completely either local or else mental. There are cases in which even severe disease, gross pathology, occurs in some organ whilst the personality remains to all around normal. It is not uncommon to find patients with quite advanced malignant tumours of some organ who yet still feel in themselves well and manifest no change in behaviour or emotional balance. Again in the so-called mental diseases, such as the schizophrenias, the symptomatology is one-sidedly in the mental sphere and it is not easy to localize it in some organ, even the brain. In such cases physical health may continue over many decades whilst the personality becomes progressively crippled. These two polar extremes of one-sided disease set, as it were, the limits of a spectrum of psychosomatic and psychoneurotic disorders spread out between them. In 1963 the Bahnsons, working on the psychosomatic aspect of malignant disease, put forward a disease spectrum. On one side they pointed to a progression from conversion hysteria through hypochondriacal conditions and psychosomatic disturbances to the somatic diseases and ultimately to cancer. On the other side of the balance the progression indicated was from anxiety hysteria through anxiety neurosis to the phobias and obsessive and compulsive neuroses, and then to the paranoid and deteriorated psychoses. The similarity of this attempt to Hahnemann's seems to me obvious and in need of no further development on this present occasion. They both however demand that we should attempt to build bridges from one side of the psychosomatic, psycho-neurotic balance to the other. One particular instance of this immensely demanding task is the problem of the psychic connections of particular organs. Today it is the liver which is the centre of our considerations. Now where can we look for clues from which to start? Two come immediately to hand. Firstly there is the common experience of infective hepatitis. Whoever has experienced this disease can usually tell of the intense depression which commonly ushers it in and which is often somewhat alleviated when the frank jaundice manifests. Secondly there are the varied symptoms of illness which