Lest I give the impression that those who are highly sensitive have it all bad (or that others around them suffer as a result of their sensitivity), let me share with you some of the benefits of being an HSP. Those who are highly sensitive tend to be very creative, empathic, insightful, conscientious, reflective and detail-oriented. They are often aware of subtleties in their surroundings that go completely unnoticed by those without this trait; subtleties that may be clues to changes in their health and well-being or the well-being of those around them.

HSPs often have a history of frustrating encounters with medical professionals as they can detect subtle changes in sensation and functioning of their bodies, which the Western medical paradigm is ill-adapted to address. Thus when symptoms have no known cause or diagnosis, patients end out going through a number of tests and medical visits to no avail and may be labeled ‘neurotic’ or told that their condition is ‘psychosomatic’.

Here is where naturopathic and homeopathic care can lend a hand. Those who are highly sensitive tend to respond well to more subtle herbal, nutritional and homeopathic treatments that nourish their nervous systems and gently rebalance the functioning of their body and mind. Dr. Aron states that HSPs tend to have a harder time working mixed shifts or night shifts and recover more slowly from jet lag. Thus it can be said that HSPs also likely have more vulnerable circadian rhythms and could benefit from counsel and support in this area (chronotherapy).

I have greatly enjoyed working with a number of individuals who could be classified as highly sensitive in my practice. I find that in-depth, time-intensive and supportive care (including homeopathy, flower essences and other naturopathic modalities) can be very healing for HSPs. Naturopathic medicine, particularly homeopathy, pays careful attention to the subtle signs, symptoms and observations that patients experience and express. There are over 2,000 homeopathic remedies, many of which can be helpful for HSPs. Below I will share the picture of Phosphorus, a remedy that depicts Dr. Aron’s description of an HSP to a ‘T’:

Phosphorus, a mineral remedy can help someone who fits the following remedy picture: one who is highly impressionable, sensitive to external impressions (light, noise), easily startled, drained from too much social contact, possessing quick perceptions and prone to anxiety and fears (often felt in the pit of the stomach). Phosphorus types are sympathetic to the suffering of others to the point where they may actually feel other people’s pain. They tend to be artistic, creative and imaginative and have strong intense relationships. They generally feel better in the morning, better from sleep and worse from missing a meal and from coffee. There are a number of mental-emotional and physical symptoms which this remedy can effectively treat: anxiety and fears, colds which settle in the chest, a tendency to bleed easily, vertigo, diarrhea and vomiting… Early on, one needing Phosphorus may suffer from fatigue and concerns about their health that can seem out of proportion to their health problem. Later, indifference, apathy and dullness can set in and one can become more withdrawn.

It is beyond the scope of this article to discuss how remedies are selected, prescribed and act to effect healing, but a brief caveat: even the most astute homeopath is limited in prescribing a remedy for their own chronic condition. If you are suffering from a chronic condition and are interested in homeopathy, please seek the care of a qualified naturopath or homeopath and do not self-prescribe!

For a more detailed discussion of the HSP trait, research and case studies on HSPs, the merits and drawbacks of medication for HSPs, psychotherapeutic support and a number of helpful resources and tips, I highly recommend reading Dr. Aron’s book, The Highly Sensitive Person. You may also like to do a brief self-test to see if you are potentially an HSP, you will find this test on Dr. Aron’s website: http://www.hsperson.com/pages/test.htm, along with newsletter archives and a number of other resources.

If you are an HSP, I hope that you can find the support that you need to flourish! And if you are not an HSP, perhaps you have learned something of value to help someone you know, or just to understand HSPs and homeopathy a little more…

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References:

Aron, E. (1996 ). The Highly Sensitive Person. How to Thrive When the World Overwhelms You. New York, NY: Broadway Books.

Aron, E. (1996 ). The Highly Sensitive Person. Self-Test. Retrieved from http://www.hsperson.com/pages/test.htm

Elmore, D. (2000). Phosphorus handout (from Vithoulkas, Shore, Kent, Whitmont, Cowperthwaite, Gibson & Nash ). Portland, OR: National College of Natural Medicine.

The study examined 2 groups of mice who were fed either a diet containing Lactobacillus rhamnosus (a beneficial bacteria found in dairy products and many probiotic supplements) or a diet without this bacteria. Emotional and mood states of each group of mice were evaluated and it was found that the mice fed the diet with L. rhamnosus generally responded to tests in such a way that suggested improved mood and decreased anxiety than the group of mice fed a diet without probiotics. In addition, the L. rhamnosus-fed mice exhibited lower levels of corticosterone than the mice fed a diet without probiotic organisms. (Corticosterone is a hormone secreted in response to stress.) Furthermore, all of these differences disappeared when the vagus nerves of the mice in both groups were cut, suggesting that the effects were mediated by gut-brain communication.

While the above study was conducted on animals and the results are not directly translatable to humans, evidence from other studies suggest reason to pursue this research further:

- There is evidence that probiotics (and prebiotics) can improve mood and decrease anxiety in patients with irritable bowel syndrome and chronic fatigue syndrome.^2,3

- Epidemiological evidence has identified an association between neurodevelopmental disorders (such as schizophrenia) and microbial pathogen infections during the perinatal period.⁴

- Colonization of the gut with beneficial microbes can impact brain development and subsequent adult behavior (according to another recently published study in the Proceedings of the National Academy of Sciences⁵).

Thus it seems all the more important to consider not only treating the brain and nervous system in those suffering from mental-emotional distress, but also to focus on gastrointestinal health. No wonder so many herbs and natural remedies that are of benefit to the nervous system are also of benefit to the gastrointestinal system—the health of each system may be more interdependent than modern medicine has heretofore appreciated.

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References:

¹Bravo JA,  Forsythe P, Chew MV,  et al. (2011) Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci USA 108:16050-55.

²Rao AV, Bested AC, Beaulne TM, et al. (2009) A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog 1:6.

³Silk DB, Davis A, Vulevic J, et al. (2009) Clinical trial: The effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 29:508-18.

⁴Mittal VA, Ellman LM, Cannon TD (2008) Gene-environment interaction and covariation in schizophrenia: The role of obstetric complications. Schizophr Bull 34:1083-1094.

⁵Heijitz RD, Wang S, Anuar F, et al. (2011) Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci USA 108:3047-3052.

The Economist, 400(8749), 80-81.

“I can easily imagine giving a patient a good (homeopathic) remedy for eczema and placing them on a deserted island fully expecting them to get better. But I do not imagine this to be true of the patient who is suffering from depression or from a compulsive disorder. These patients need to be in relationship, they need the relational field to heal.” ¹

In my practice, I place great value on the relationship that I have and foster with my patients, for without a connected, trusting and caring relationship, healing does not occur, no matter how powerful the medicine. I have observed homeopathy to heal through relationship. I see remedies as restoring one’s relationship to oneself and to the external world on multiple levels.  In so doing, it changes one’s relationship to one’s ailment. Time and again I have seen someone debilitated by a condition, let’s use a case of eczema as an example. The individual is prescribed a single homeopathic remedy and  when they return for a follow-up soon after taking the remedy and are asked how their skin is, though it does not yet look any different, they report that it no longer bothers them?! And then I know that a more complete shift and resolution of their symptoms will soon follow as their relationship to their symptoms has changed and the healing process has begun.

This brings us to a brief examination of illness. Arguably there are pathogenic organisms that afflict us, but many would contend that it is the terrain versus the germ that determines what and if we are affected by an organism or condition.

Florence Nightingale “There are no specific diseases; there are specific disease conditions.” 

William Osler “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”

I tend to agree with this viewpoint in most cases and link this back to relationship. It is the harmonious relationship between our bodily systems, our mind and our environment that determines health from a naturopathic perspective. When these systems are in right relationship, health is to be had. When these systems are imbalanced, symptoms appear, and ultimately more severe conditions manifest if the imbalances are not addressed.

So what does the modern medical literature have to contribute to this discussion? Evidence comes from studies on the efficacy of psychotherapy and from studies on the placebo effect. Compelling evidence on the efficacy of psychotherapy can be found in a 2010 article by Jonathan Schedler, entitled “The Efficacy of Psychodynamic Psychotherapy”, in which an in-depth review of the literature in the field is presented. Schedler speaks to the importance of the psychotherapeutic relationship:

“The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged….The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.”²

The placebo effect has been widely studied and can be summarized very simply as the effects of treatment that cannot be attributed to the medicine itself. The placebo effect can thus be considered the effect that results from the doctor-patient relationship and the patient’s expectation/hope/belief that the treatment will be helpful.  A recent 60 minutes episode interviewing psychologist Irving Kirsch, the associate director of the Placebo Studies Program at Harvard Medical School, says that his research challenges the effectiveness of antidepressants (especially for mild-moderate depression). You can view his interview at: http://www.cbsnews.com/video/watch/?id=7399362n ³ .

Finally to extend this discussion a little farther, the relationship of medicine needs to heal. Our current state of affairs is a fragmented system which often leaves practitioners and patients unsatisfied and unwell. I feel that greater collaboration and integration could bring some healing into the medical sphere. This spring I hope to present a case which illustrates the healing potential of integrative care. This was a case in which I collaborated with a psychiatric colleague in treating a case of alcoholism, obsessive-compulsive disorder and depression using a combination of homeopathy, nutrition, herbal medicine, psychotherapy and antidepressants with good long-term results. More to follow…

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References:

¹ Heron, K. (2012). Expectations. Simillimum. Journal of the homeopathic academy of naturopathic physicians, 2011/2012(XXIV), 43-45.

² Schedler, J. (2011). The Efficacy of Psychodynamic Psychotherapy. E-Journal of American Psychologist, 65(2), 98-109. Retrieved from http://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf

³ Stahl, Leslie. (2012, Feb 19.) .Treating Depression: Is there a Placebo Effect. [Interview of Irving Kirsch, PhD. on 60 minutes]. Retrieved from http://www.cbsnews.com/video/watch/?id=7399362n

Sleep is something so many take for granted and yet insomnia affects a large proportion of the population, 22.1% by recent estimates ².  Untreated insomnia can lead to psychiatric disorders such as anxiety and depression and insomnia commonly occurs in those with psychiatric disorders. Treating the underlying psychiatric disorder will generally improve sleep.³ In the long nights at this time of year, those suffering from insomnia often suffer even more. So to offer some solace in the dark, winter nights, let me explain a little about some of the causative and contributing factors to sleeplessness and some tips that will hopefully improve your slumber.

Insomnia can be caused by a number of factors- ranging from organic (caused by physical health conditions such as pain, headaches, GERD (gastroesophageal reflux disease), hyperthyroidism and hot flashes) to nonorganic causes (not caused by physical health complaints, but may be caused by other factors such as: substances (drugs, caffeine, alcohol and some herbs used to improve adrenal function such as Maca), an underlying mental health disorder, stress, environmental disruptions (bright light at night, uncomfortable temperature in the room) and stress.

In insomnia it is important to rule out physical causes to ensure good physical health and appropriate treatment for insomnia. Once physical causes have been ruled out, a comprehensive evaluation of nonorganic causes is necessary to accurately address the causative and contributing factors to nonorganic insomnia.

A number of medications can contribute to insomnia. These include (but are not limited to): SSRIs, stimulants (such as Ritalin), anticonvulsants, thyroid hormones, steroids (prednisone and others), heart and blood pressure medications and decongestants.

Lifestyle factors that can affect sleep include shift-work, exercising late at night, eating dinner late (especially when it is a heavy or rich meal), nicotine or alcohol up to 6 hours prior to bed, bright ambient light, cool temperatures in the evening and lest we forget a noisy environment due to noise outside one’s bedroom…or within it with a snoring partner!

Helpful tools that one can use to do a bit of evaluation on your own include⁴:

-The Epworth Sleepiness Scale to assess the impact of insomnia on your life (available at: http://yoursleep.aasmnet.org/SleepScale.asp) or for adolescents, the

-A Sleep Diary –a useful tool to track the impact of a variety of factors on your sleep. I encourage people to add in a symbol for when they eat (as meal times can affect sleep) and an asterisk for days in which a note about the stress-level of the day or some other is notable factor seems warranted. These notes can be made on a separate page). For a sample` of a sleep diary, see:  http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf.. Check back on my site soon- in the ‘Patient Forms’ section for an elaborated version of the Sleep Diary.

- A Sleep Evaluation- to assess your need to get further medical help – available at: http://yoursleep.aasmnet.org/SleepEval.aspx

And finally, some tips you can try on your own:

• Sleep Hygiene- reserve the bedroom for sleep and sex. Do not watch TV, read, study or eat in bed. Consider before bed rituals such as a warm bath, meditation, listening to relaxing music, reading a good book (but not too good or stimulating!)….and if you can’t fall asleep after giving it a good try (20-30 minutes), get out of bed, stay warm, use only dim light and don’t eat or drink much unless hunger has been keeping you from sleeping. Limit caffeine, alcohol and nicotine intake for up to 6 hours before sleeping. And establish regular sleep and wake times that are consistent each night.

• Chronotherapy- (Includes some of the suggestions above) and limiting screen exposure at night, wearing amber glasses once it is dark outside, a regular sleep-wake schedule, sleep in a dark bedroom and get morning light

• Hydrotherapy- warm (not hot) salt baths prior to bed. Warm baths warm the core and this signals the body to relax and to sleep. Adding aromatherapy (lavender oil is usually a good one to try) can be helpful too.

•  Herbal/Supplemental/Nutritional- a note on Valerian: while this herb can help many with sleep problems, in a small portion of the population, it can have a paradoxical stimulating effect. As with all herbs, herbs for sleep (of which there are many) need to be used wisely to avoid drug interactions and to improve efficacy. There is validity to the warm milk home remedy. Warmed milk or milk alternative (often with a little nutmeg added) is a widely used remedy in Ayurveda to aid sleep. Eating more simply at night, eating lightly cooked foods and including some carbohydrates in your evening meal can often aid sleep. There are also a number of vitamins and minerals that can be of help. Melatonin is often more helpful in establishing and maintaining a regular sleep-wake rhythm than in inducing sleep per se.

And a note of caution, while sleep medicines may be necessary acutely when insomnia is severely impacting one’s daily functioning and safety, they do not cure insomnia, are associated with a number of side effects ⁵ and can adversely affect the quality of one’s sleep and suppress or affect normal dreaming⁶ (which is important for consolidation of memory and to promote psychological awareness and healing).

We spend a third to a half of our life sleeping and there is so much more to be said about sleep. I will be covering it in more depth in future postings and classes. I hope that you have found this post to be helpful. If you suffer from insomnia, please be sure to seek help- it is critical to your mental-emotional and physical health to get good quality rest on a consistent basis.

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References:

¹ Thompson, A. & Taylor, N., (Eds.). (2006). Hamlet. (3^rd ed.). London: Arden Shakespeare, 63-64.

² Roth, T.,  Coulouvrat, C., Hajak, G., et al. (2011). Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey.  Biol Psychiatr, 69(6), 592-600.

³ The Cleveland Clinic Foundation (2010) .  Health Information. Diseases and Conditions: Sleep and Psychiatric Disorders.  Retrieved from http://my.clevelandclinic.org/disorders/sleep_disorders/hic_sleep_and_psychiatric_disorders.aspx

⁴ American Academy of Sleep Medicine. (2010). Evaluate Your Sleep. Retrieved from http://yoursleep.aasmnet.org/evaluatesleep.aspx

⁵ US Dept. of Health & Human Services. (2012. Mar. 14)*.  Consumer Updates- Side Effects of Sleep Drugs.  Retrieved from http://www.fda.gov/forconsumers/consumerupdates/ucm107757.htm

⁶ Pagel, J.F. & Parnes, B.L. (2001). Medications for the Treatment of Sleep Disorders: An Overview. Primary Care Companion J Clin Psychiatry, 3, 118-125. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181172/pdf/i1523-5998-003-03-0118.pdf

*Post updated with this information after initial posting date