A Case of Anxiety and Depression

Initial Consultation

January 6, 2012

44 Year old Female

Chief Complaint: Anxiety, and Depression

Client seems tense and anxious on meeting her.  She seems unsure about what I’m about to do or how this is going to go.

She stated:
I have seasonal allergies. (After a long pause, I ask her to tell me what else she’d like help with)

“I’m going through counseling.  I have a lot of anxiety and mild depression.  I’ve learned more about myself through that this past year.  My husband and mother had a fight, and that kicked off my feelings. I have anxiety with my children.  I get irritable easily with them, I yell.  I feel disconnected from them and have for years.  I feel like I babysit them, versus being their mother.  I feel distant.  It’s the same way with marriage.  The emotional impact isn’t there.  I turn to food to keep distance from my emotions.  I’m ashamed of this with my kids.  I should be more emotionally involved.  I keep them at a distance.  I shouldn’t be exploding at them like I do, yelling.  It’s the same way with my husband.  I don’t want to get too emotionally tied, even to myself.  This helped, given the household I grew up in.  I was just surviving then.  Keeping an emotional distance was helpful.  The argument my husband had with my mother was traumatic – it felt like I was 5 years old again.

My mother was a bad alcoholic – abusive verbally and physically.  I was the second oldest child.  I got less physical abuse, but more verbal abuse.  She was controlling.  My dad was a ghost.  Things are better now though.  I had cancer a few years ago and they helped me.  My husband grew up with craziness in the house too.  When arguments happen, it’s ugly.  He and my mom are two strong willed people.  My husband brought up how it was in my house when I was 5 years old to my mom.  I tried to make them stop arguing.  I felt scared and hopeless.  I didn’t even remove my kids out of the house so they couldn’t hear.  I literally stood in between them.  Then, I realized there was nothing I could do.

So, I started counseling, and we started marriage counseling too.  As painful as that fight was, it was a catalyst to finally figure my shit out – to be honest with myself.  I’ve now seen how I’ve lived my life.  I’m controlling just like my mother – it’s not pretty.  If my mom argued like that with me, I would’ve just taken it.  I wish my husband had just taken it.  I was angry at him for arguing with her.

Now, I’m sticking up for myself.  I’m sad, teary-eyed, and irritable.  The anger is very close to the surface.  Anger is my go-to.  When I’m sad, irritated, and frustrated, I yell loudly.  “It’s my way or the highway!”  My kids then go to my husband more because he’s more affectionate.  He speaks to them with respect.  I’m loud.  I want to win the argument so that they fall in line.  It stinks.  I’m exhausted and overweight.

I have two girls (ages 8 and 6) and I’ve always wanted a relationship with them where they could count on me for the emotional stuff.  I can’t even count on myself for that.  I don’t like living this life: no joy, no satisfaction, I’m sad; I’m missing the good stuff: closeness with my kid’s and husband, being healthy mentally and physically.  There was a time I lived on my own.  I paid my own bills.  Things were good.  I felt I was managing okay; things were covered.  Now, I don’t feel that.  I’m not content.  It was quiet and peaceful.  The only one talking back at me was the TV.  I felt real and present.  I could rely on myself.  The financial situation was mine and I didn’t have to rely on anyone.  It felt good and powerful.  I have good friendships in life.  I was taking care of myself, relying on myself; it felt good.  If there were mistakes, it was just me; I wasn’t hurting anyone else emotionally.  I could just trust and count on myself.  I felt proud, accomplished.  This was in my late 20’s.  There was a time my husband and I separated.  We moved back in together, and then I got pregnant.  Then, I got lost. “

Lost?

“Lost means having to take care of someone else; being responsible for someone else’s health.  We were two bulls on either side with a kid and we both wanted to win.  That breeds doubt and frustration.  We’re two headstrong people.  We’d just argue and never resolve or listen to each other’s side.  When I got cancer, he was a great care taker.  That changed some of the perspective.  Our kids were 3 and 1.  It was rectal cancer.  My parents tried helping, and so they moved in.  They were slobs.  My husband would work all day, come home, and cook for everyone.  He’s a good man.  I was on so many medications and chemotherapy and he took care of me.  The cancer went away, and then returned after 6 months.   That time was bleak, I was depressed, and I felt hopeless. Now, I’m a stay-at-home mom and I exercise every day.  I love the freedom.  I take pride in my house.  But, there’s also a sense of not going out so much and not spending money.  So, I volunteer more.”

(I ask her tell me more about emotional disconnection from kids and family)

“Helplessness and disconnection go together.  If I keep my distance emotionally, I don’t feel as helpless.  Juggling their emotions, sitting down with them and giving them emotional energy, listening to them brings me fear.  I don’t want them to rely on me.  It brings me anxiety to know I’m responsible for their emotional health.  Surviving on my own, over eating has all worked for me, but it’s not for my kids.  I’m not content or satisfied.  I’m lonely for human interaction.”

(I ask her to focus in on the anxiety and tell me more.  I felt the energy stored in her anxiety would lead me to better discover what the remedy needs to cover.)

“The anxiety feels like a ball tightening in my chest: a ball inside me that’s kept under wraps.  I feel it tightening when they want me to pick them up.  The ball is just hanging there; it feels it’s being squeezed. I’m screaming inside “I don’t know what to do!”  So, I come out yelling.  Ball of anxiety feels like a ball of rubber bands; it grows.  I feel paralyzed.  It won’t go away unless I yell or eat.  If I’m in the moment, I get loud.  Tightness makes me feel like I want to get the hell out of there.  If I can’t, I come out fighting.  I don’t know what to do.  I just need to get the fuck out of there.  I gotta get out!  I yell.  I say crap to stop the situation.  I try to control the situation.  I yell, and blame, and turn the situation around so the emphasis is not on me.  I feel trapped and helpless if I’m being emotionally called to provide affection.  I’ve doled out what I could.  I’ve met my quota.  To give more gives me anxiety and I feel trapped.”

(Because her chief complaints are rooted in a dysfunctional home growing up, I wanted to know more about her father (in addition to her mother).  So, I ask her to tell me more about him)

“He was a ghost.  He didn’t protect us, yet he knew what was going on.  He just stood by his wife.  We always thought he’d save us.”

Dreams?

“Fighting dreams.  I’m looking for something and I can’t find it.  It never gets solved. I have arthritis in my knees.  Right knee ACL was reconstructed in 1999.  Left knee meniscus surgery in 2010. “

Review of Systems

Mind: Chronic depression, difficulty concentrating, irritability, anxiety

Sleep: perspiration at night

Eyes: blurred vision

Nose: sinus trouble

Extremities: burning feet, sore legs, swollen joints, stiff joints (arthritis)

Gastro-Intestinal: bloating of abdomen, flatulence, diarrhea, constipation

Urinary: urination at night

Generals: Overweight

History of rectal cancer in 2006.

—End of Case–

 

Analysis

This client recently sought counseling to process her emotions related to a dysfunctional upbringing brought on by an alcoholic mother and “non-existent” father. What precipitated her journey into counseling, and thus homeopathy, was an argument between her husband and mother.  This argument seemed to bring up to the surface her own fear, angst, and latent anger towards her mother, which her husband manifested for her.

Through counseling she discovered how distant and disconnected she is emotionally from her husband and children. Instead, she yells loudly quite readily at them; is irritable.  She seems to panic when they have emotional needs.  Her response is to flee and “get the hell outta there!”

She’s a very angry person, but doesn’t show it unless she’s pressed to provide emotional affection.  She gets fierce, and is ready to fight if provoked, or someone gets too close to her emotional vulnerability.

She was happiest when she lived alone and no one had to rely on her or talk back to her.  She could just trust herself and not be bothered, hurt, or hurt others.  She’s extremely emotionally vulnerable and has a retaliatory anger spewed in response to that particular boundary being crossed.

 

Rubrics Selected (Schroyen’s Synthesis – 2009 Edition)

Mind – Anger – Family; at her own

Mind – Irritability – Easily

Mind – Ailments from – Anger – Suppressed

Mind – Ailments from – Abuse

Mind – Sadness, depression

Mind – Anxiety

Extremities – Pain – Arthritic – Lower legs – Knees

 

The three remedies I considered were Crot.-horridus, Sepia, and Staphysagria.

Staphysagria’s keynote symptoms are ailments from suppressed anger, and ailments from abuse, both of which are characteristic of this client.  Rajan Sankaran, in his book The Soul of Remedies, states there’s too much pride and honor in Staphysagria to let their anger out.  My client feels these emotions towards her mother, but freezes when confronted with her, and left her husband to do her bidding through the argument they had.   Sankaran also puts Staphysagria in the cancer miasm.  Since she had rectal cancer, using this remedy to help alleviate the cancer diathesis would be prudent.

Sepia was a strong consideration because in Lectures on Materia Medica, James Tyler Kent considers the Sepia woman to “[seemingly] abolish the ability to feel natural love, to be affectionate.  The love does not go forth into affection.”  This characterization seems to fit this client very well: she’s absolutely intolerant of her kids’ emotional needs for affection and won’t stand to be bothered by them, yet she feels very sad and despondent from these feelings.

In Franz Vermeulen’s Synoptic Materia Medica, Crotolus-horridus is known to have a great aversion to family: “They feel they must help, but actually do not want to.  The family is seen as a duty they can’t avoid.  Their sense of persecution issues from their perceived obligation to maintain family contact.  They are mentally very snappish and irritable.  They resemble Nux-Vomica in the ugliness of their temperament.  They get furious at the slightest provocation.”  I also was considered Crotolus-horridus from a lecture I received at the Northwestern Academy of Homeopathy in 2006.  There, Eric Sommerman, Dean of the school, described the energy of a rattlesnake.  He said they generally keep to themselves, away from humans or anything in general in their environment.  It’s only when a bumbling human stumbles across their path that they will strike.  This energy is reflected very well in my client.  She desires being on her own and away from the plague of human emotion.  But, now that she’s a mother, she can’t avoid others being dependent on her for their emotional support and need for affection.  This drives her bonkers.  As a result, she strikes back violently with the venom of harsh words with great volume.  She does so with her husband, as well.

Plan: I decided to start her on Crot.-horridus 200c, one dose every 8-10 hours for three doses total.  The goal with this is to help her relieve the intense anger and panic attacks from others needing her affection.

 

Follow-Up #1

February 15, 2012

She stated:

I’m feeling OK.  I just returned from a cruise.

I finished the three doses and one week later I was upset with my daughter in the morning for routine stuff.   Physically the ball of anxiety wasn’t as tight and I could then sit down with them and go over calmly my expectations.  I felt clearer and less agitated.  I’m not as weepy either after it releases.

When situations come up, I’m less anxious, a little more free and relaxed.  It didn’t completely go away but I was less anxious and not so overwhelmed.  Normally, the tightness would linger and make me be in a state of intense agitation.  I do feel guilty afterwards if I’m angry at them; I used to get very weepy with the letdown of that.  Now, there’s no weepiness or letdown.  I’m more confident about handling that.

Normally, I’d be agitated about having to talk with my kids and be late to things.  But, now that’s not happening.  This is huge for me!  I just handled that situation in a way that it needed to.

Feeling guilty?  Yelling.  I feel guilty about how I handled myself.  I’m upset at myself that I was loud.  Normally, feeling guilty wouldn’t prevent me from continuing that way and making my point.  But, now that inner tension isn’t there.  It’s just not that big.  I’m not making it big.

Inner tension? I have perceptions of things being a certain way.  If there are changes, I struggle with riding the waves and being flexible.  The inner anxiety at keeping things back in certain ways used to build.  Inner tension is about the perception or expectation of things running a certain way and not going with the flow.  There was a lot of panic and frustration in the beginning, and then it’d build to anger or a feeding frenzy.  The anger would just keep going up and up, and then it’d come out with me being loud.  It was a feeding ball of continuous agitation, anger, and frustration.  My body feels tense; I’m in a battle mode.  I’m gearing up for some kind of battle.  I’m suiting myself up with armor for battle with frustration, anger, agitation.  When it builds, I get tense; voice gets louder, and just builds.  It becomes my way or the highway or all hell will break loose with me running my mouth.  My kids need to hop to my expectations and needs.  I’m trying to get my husband to also hop to it, but he doesn’t.  If I can listen to him, I feel embarrassed I handled myself that way.

Affection for my kids is better.  I’m approaching them more.  I make it a point to hug them more.  I’m not lingering with it.  I always sit with them to ask them about their day.  I’m impatient with the details, but I’m less interruptive and I also look my daughter in the eyes more.  Before I’d be too busy and get distracted.  I’m making an effort now.  I know for something to become so natural, in order to have a better connection; I need to make an effort.  I’m less uncomfortable with doing so.  I feel like I’m somewhat forcing myself less to do so.

—End of Case—

 

Analysis and Plan

There’s marked improvement in anxiety, agitation, and anger.  She still feels like she can access those moments of gearing up for battle with a war words and being loud.  But, it’s much less.  She’s feeling more comfortable finding connection with her kids and deciding to make an effort to do so.  This all tells me she had a good response to the remedy.  I also think the effects may continue to transpire since she hasn’t been completely removed of her anxiety, agitation, and anger yet.  I resolve to wait on any doses of remedy right now for her. We scheduled her next follow-up appointment to occur in about 6 weeks, but also advise her to contact me before then if those feelings noted above begin to come back before then.  I was still considering Sepia as a backup if Crot-H didn’t have any further effects.

Email Correspondence

February 17, 2012 (about a week after her last appointment)

She wrote (summarized):

The next two mornings after our appointment I noticed my feelings of anxiety felt like it was reverting back to what it was prior to the remedy, i.e., weight in my chest, tightness, blood pressure raising.  The weight in my chest has lessened somewhat, but it remains a “ball of tightness/tension” in her chest.

Analysis and Plan

The sensation of tightness/weight on chest/ball of anxiety seems to be a barometer for her anxiety/agitation/anger that builds to a breaking point of yelling at her kids.  Since this sensation is increasing, I suggest she take one dose of Crot.-Horridus 200c.

 

Follow-Up #2

April 4, 2012

She stated:

Things are okay.  I took the last dose of the remedy and was okay for about two weeks.  I’ve also been exhausted the last two weeks too.  My husband and I are bickering.  I have fussiness, and then it settles down for a week or so.  My husband is stressed about the house, and cooking, and doing extra client work on top of his job.  This has escalated more.  It’s coinciding with me not keeping up with things as much.  It creates tension.  We’re two stubborn people who aren’t good at letting things go.  I’ve realized I don’t like to cook.  The housework all gets done, but I don’t enjoy it.  I’m stressed, anxious, depressed, sad, and exhausted – I’m not getting enough sleep.  If he’s fussing, I feel I need to defend my position.  Tension between us; bickering.  The vigilance of maintaining my position makes me exhausted, which then makes me anxious.  It’s a vicious cycle.  I feel defensive that my job is being questioned.  On the defense; on guard; defend self verbally.  It’s exhausting – this has been this way my whole life.

Defend self?

It’s hard to hear constant criticism.  It doesn’t feel so judgmental if I hear it from friends.  Growing up in my family, it felt like character assassination.  My husband and I don’t talk in the gentlest of ways – we’re rude to each other.  I have a need to defend, but the real issue never gets addressed.  It’s hard on our daughters.  We see a marriage therapist.  The way we communicate – there’s no support or position – it’s rough.  Body feels tight, heart accelerates.  Putting on a suit of armor.  Then afterwards, I’m exhausted from having to hold the battle position together.  It’s instinctual.  I’m preparing myself for whatever.  I have a righteous attitude that I have to prove myself that I’m right: Like two lawyers in a court room.  Defending my position of being right and not wrong.

Anxiety?

The weight on my chest is ramping up again.  After the first remedy, the elephant on my chest didn’t feel as big.  If I’m in a room with only my family, I get anxious; I feel I have nowhere to go.  I also feel really tired now.  After the anxiety leaves, I feel weary, depressed, and helpless.  With children’s drama, I feel helpless.  My daughter is now feeling hormonal shifts.  I hug her, but I don’t know what to do, I feel helpless.  It’s hard for me to be affectionate.  I feel anxious.  We say we love each other, but I feel I’m forcing myself to be affectionate towards husband, I fake it.  I feel ashamed that I hesitate.  I’m their mother!  (She begins crying).  It’s not easy for me to admit I need help in this way; that this isn’t natural.  They deserve better!  It’s not easy for me to hug when their upset. (More tears)

(After a long pause…)

Describe affection.

Becoming vulnerable, softening, being warm and fuzzy, and loving.  Growing up in my family, there was no affection.  It was only chaos and dark times.  I don’t remember my mom ever hugging me.  She was a violent alcoholic.  Affection is a weakness.  I must be stern and strong in other ways.

Strong?

You don’t need anybody, don’t need affection, and don’t need people; it’s just you; that you don’t need anybody; you supply anything you need by yourself.  Strength is winning your side of the argument; there’s no one over you.  Strength is never peaceful or soft; it’s aggressive.  I was doing okay until cancer crept it’s way in, then my husband’s argument with my mother 1.5 years ago – that was the icing on the cake for a life not happy.

Dreams?

Of tension; struggle with people; a fight; tension.

I want to be softer.  I’m rough with my husband and kids, verbally.  I get loud and stubborn.  If there was more affection for him, it’d be easier on our communication.

—End of Case—

Analysis and Plan

There was a lot of new information today.  She’s not striking out at her kids in the same way.  At this consultation, she spoke more about winning arguments with her husband and feeling exhausted from defending herself.  This need, as she aptly put, comes from her upbringing.  She was never loved or shown affection.  In fact, she felt subject to character assassinations and had to defend herself to survive.  This theme continues to show up in the arguments so frequent in her marriage with her husband.

She still desires cultivating affection towards her children and really exposed herself in this consultation.  As she noted, it was very hard for her to admit she needs help in these areas.  Yet, the softness she said she desired was already evident, simply by putting down her guard some and admitting her desires and need for affection.

The different picture that is emerging, and which needs to be addressed after this consultation, is her need to defend herself at all costs.  There is a relapse of some symptoms (anxiety, ball of tension increasing) too.

Since Crot.-horridus has helped in the past, I decide to stay with it a bit longer to see what else may emerge.  I have her re-dose 200c, one dose, and then one dose per week after that.  I advise her to contact me in two weeks for an update.  I suspect I may need to go up in dose, or give a different remedy all-together, but I want to exhaust the benefits from the 200c potency as much as possible.

 

Follow-Up #3

May 2, 2012

She stated:
I seem to be fine, more even, more relaxed.  Other emotions are coming out.  When I’m agitated, it’s not overwhelming or consuming me.  It’s still there, but not so overwhelming; I’m just more relaxed; more settled.  Things are clearer.  If I’m overwhelmed with anxiety, the issues are blown out of proportion and blurry.  But, things seem clearer now.  I can still get frustrated, but I just say it.  The anxiety is not a big deal anymore; I know it’ll pass.

Agitation is less now.  I feel I’m out of the trenches with having a narrow focus on winning arguments.  I’m still in the war, but out of the trenches.  I know that this too shall pass. I feel more in control, less anxious, more relaxed about things; more positive.  I take a step back now instead of being all gung-ho about things. I still get agitated with husband.  I feel like I’m failing at something; I feel ashamed; negative.  I feel depressed, sad, dark, and lonely.  I grew up in a battle.  It was a very hard life; truly in the trenches of surviving.  I’m fighting being a survivor instead of just simply living.  I want to do better.  What worked when I was little was to keep your head down.  The war is growing up and maturing now.

Anger?

There are some flare-ups, but I back down sooner.  I’m working very hard on doing what’s right and having a close relationship with my kids.  It’s still difficult when the kids need affection.  But, I know their confidence is taking a beating.  I’m trying to lift her up more, praise her, and ask more about what’s going on with her.  I can be a tough asshole.  The remedy is helping bring up this awareness that my wording with her needs to change.  There’s a huge difference with how I was brought up and to now.  Yet, more still needs to be done.

–End of Case–

Analysis and Plan

She seems better overall: less anxious, less anger, less of a need to defend herself and go to battle.  She’s still dealing with difficulty about affection and meeting her children’s emotional needs.  We’ve gotten some good headway with Crot-H 200c, but I decide to have her move up in potency to help with the rest of the journey.  I have her take Crot-h 1M every 8-10 hours for three doses total.  Even so, with all this talk about battle, suits of armor, and defending herself, I’m strongly considering Ferrum-Metallicum as a backup remedy.

 

Follow-Up #4

May 31, 2012

She stated:
The weekly dose from before was working well.  I wasn’t overwhelmed.  With this new remedy, I’m tired, overwhelmed, and busy.  I feel more on edge.  With the weekly dose, I was not as edgy; I could let things roll off my back.  The edginess came back last week.  I was snappy, bitchier.  But, I’m also really tired.  I’m not sleeping enough or well.  I’m so grumpy.  I feel hotter too.  I took the remedy last week (not sure why she waited).  I’ve also started a different training regimen last week.  I’m looking forward to the kids being home for the summer.  I don’t feel rushed about their schedule.  Sometimes I’m frustrated by how many details my youngest daughter tells me about things.  She starts and stops a lot.  She picks times to talk to me when I’m not able to focus on her.  I’m able to hug them and comfort her if she needs it though.  I want them to feel confident about themselves and their bodies.  I need to do more night time reading with them. Overall, I feel more relaxed.

Analysis and Plan

Because she waited to take her doses last week, and because she’s been feeling more edgy and tired since the remedy doses, I conclude she’s experiencing a healing response (also known as an aggravation).  In other ways, she’s able to have affectionate interactions with her daughters and remain fairly patient with them.  Her inability to do so was a major concern when she first began treatment.  This a great change!  Because I think she’s still in the middle of an aggravation, I ask her to wait and update me in about 7-10 days on how she’s doing.

Email Correspondence

June 22, 2012 (about 3 weeks after the last appointment)

The newest remedy has kept my anxiety at manageable levels until this week.  I am definitely feeling overwhelmed with anxiety.

Plan

I advise her to take one dose total of Crot.-horridus 1M.

Follow-up #5

February 13, 2013

(It’s been over 6 months since our last correspondence)

She stated:
I used the last of the remedy in December.  I didn’t need it at all the rest of last summer.  When they went back to school, I felt the anxiety with all of their different schedules, getting them ready for school in the mornings, etc.  Then again, I felt stress from the holidays too.

Anxiety?

Feels like a crushing weight.  Things just build up.  Tension builds from me having to move quickly for their schedules.  The tension bubbles up, voice raises.  I need them to move, to hustle, and get moving.  “Get your shit done!”  “Let’s get moving!”  I’ve backed off some because they’re older.  With time stressors, I feel tightness in chest.  Things are bubbling up underneath.  It starts at a low level, and then bubbles up.  If I can manage myself it’ll stay low.  If I leave and remove myself from the situation, I’m okay.  I’m able to stop it from welling up.

Affection for daughters is better.  I’m more relaxed with that.  She feels safe and comfortable telling me she loves me. With husband I’m still very controlling, but I’m becoming more flexible.  It’s a big deal for me to admit I have anxiety and that I need help with it.  Admitting it helps me become a better person.  Last couple of weeks, my digestion has been off.  Cramping, tightness, no regular bowel movements.  This brings up past cancer fears, to how it was before.

 

Analysis and Plan

It’s been several months of her not having any issues after taking the 1M potency.  Because some of the past anxiety is resurfacing, and new fears of cancer are arising, I advise her to take one dose of Crot-horridus 1M again.  It helped last time, and I sense this only a slight relapse in symptoms.

 

–End of Case–

As of publishing this case, it has been about 8 months since I last heard from this client.  Overall, there was marked decrease in her chief complaints of anxiety and depression over the course of 14 months of treatment.  The anger towards, and difficulty finding connection and having affection for, her children has dramatically improved.  There were, at times, opportunities to switch remedies, based on the energy of each consultation, and based on what seemed to be emerging, different from the original picture.  Yet, the conservative practitioner in me decided to wait until it was very evident the chosen remedy and potency no longer helped whatsoever before moving on.  It is this conservative approach that Hahnemann laid out for us that has served me well so far in doing classical homeopathy.