Depression and Asthma

A 19 year old female patient came to me on 15^th November 2003 for treatment of Depression and Asthma

Q] What is the problem?

A] I get angry.

Q] Tell us about this getting angry.

A] I don’t know, like I feel, they (family members) don’t understand me.

(She is staying with her mother, her sister and two maternal uncles along with their families. Her father is unemployed and he lives for most of the time away in a village with his own parents. He comes to meet them once a year. According to the mother the patient is very hypersensitive. Even a trivial matter can make her angry where she is beside herself. She screams, shouts, and starts to throw things. Nothing can pacify her. She is almost always complaining about her situation and is sad and weepy. These symptoms are much more since last one year.)

Q] Tell me.

A] Actually I don’t want to talk about it. I feel like crying (weeping). Actually, I feel lonely; my mother is a single parent. Though I have a father, he is not staying with us. He is not staying with us and she is busy. She is working. But I need some attention from her. Day before yesterday, we won an inter-college match in football and this is at the university level and it is not every day that we win such a match. I expected my mother to come near me, talk to me and appreciate me, but instead she just stood when I came home and said nothing about the match. My maternal uncle too just saw the certificate and left. He didn’t have even a few words of appreciation. They think that I want something big, something expensive. I don’t want any expensive things. I just want some appreciation. I want some time to be spent with my mother. When I want to talk with her, in the mornings, but she is busy and she goes to work. She comes back at 3 o’clock, I want to talk to her then but she wants to sleep. In the evening I spend time purposely in the house, because I want to talk to her and she is like busy all the time or she is tired and wants to sleep. I don’t find time to talk to her and I don’t like to fight with her about this issue. Outside home, I am normal, I’m a peace loving creature, you can say. I don’t like to fight. In fact I intervene if two people who are fighting. At home I don’t know what happens to me.

I hate when my father comes for a month once a year. I feel someone is coming, invading our lives. My sister tells me that he is our father and that he needs to meet his wife and children, but where was he, when I was young? He was never there when I needed him the most. Others at home say that I should call him for my school functions. Why should I call him for any of my school or college functions? I’m used to no one attending my school or college functions. I used to go alone for the functions. I used to attend and do things on my own. I just need a little appreciation. Our team won the match. It’s a big achievement for me. Every day one doesn’t win a match at the university level. My mother hardly comes to attend such functions. At home when I am sincerely doing my work my two uncles whom I stay with come and interfere. They may not be doing it intentionally but they don’t realize how much they hurt me. We have a small house and if I’m writing something, they say you are disturbing us. What am I doing to them? I don’t understand that. They make me feel so angry and irritated. I can’t tell this to anyone.

No one understands me. My mother feels that I am not adjusting and that I am too sensitive. My cousin who seems to understand me, also sides with my mother. She says, “You should talk to your father. He is your father after all. He is your mother’s husband. They should be together and not separate”. All these years they hardly were together. It was their decision, what’s my fault? They are separate for most of the year and then when he comes, my mother gives him attention and not to me. I feel lonely and alone. When I’m with my friends, I’m happy but as soon as I come home, I don’t know what happens to me. This lonely feeling is more since my grandparents expired. The behavior of my mother and uncles hurts me. I become so angry that I break things in my fit of anger. I don’t know, something tells me that you should make them understand what their problem is. They don’t seem to understand. I agree that my way of dealing with the situation is wrong. When I am watching T.V., one of my uncles asks me to shut it. I don’t want shut it especially when I am watching something of my interest on it. He is an alcoholic in my opinion. He drinks and comes home. I don’t know what his problem is if I watch T.V. I feel like my uncles are torturing me. I don’t talk with my other uncle, because he never respects anyone.

At home, no one appreciates me. I am considered of no use whereas my coaches appreciate me. I just need my mother’s attention. I do everything to please her. I love her and she too loves me but I don’t know what goes wrong. She may be busy but she should take some time off and be with me. She gives me lectures on good behavior but they need to practice what they preach. No one understands me. They are just bothered about my behavior and are not listening to what I have to say. My father’s side of family also hates me. They have come to know that I don’t like my dad. Where was he for 19 yrs? I have seen only my mother since childhood. For 19 yrs he was not with us and now all of a sudden he has started visiting us. I don’t remember spending my childhood with him. All of a sudden he comes and takes my mother away from me and wants to take her to his village for some time. I don’t want my mother to go with him and he gets angry with me about it. They don’t understand me. I know, they are husband and wife. They should stay together but they should have been together when I was young. I should have seen them together. They have always been separate. I feel my mother does not love my father and she does not like him coming here. She has told me this. What will I feel? This is the impression I get, that my mother doesn’t like my father when he comes to meet her. I feel I should protect her and not let him come near her but no one likes when I do this. She probably tells me that she doesn’t love him just to please me. She is not frank with me.

My uncle drinks at night and in the morning he is okay and in sound mind. After he drinks he picks upon me like…..when I am watching TV. He would say, “Why are you watching T.V.?” He makes sounds which disturb me when I am reading. I am not coming in anybody’s way. I read in the kitchen so as to not disturb anyone. He says that the light in the kitchen disturbs him. Without light, how will I study? Yesterday night, I was reading, studying, and doing my home assignment and he asked me to shut the light. What is this? Shouldn’t I do my homework? Shouldn’t I do my studies?

I remember the occasion, when I got my Karate black belt. It was a big ceremony. No one from home came for it. At least they could have told me a few words of appreciation to boost up my confidence. Instead of boosting me they are demoralizing me which makes me angry. I tell them to stop doing such things to me but no one listens to me. They argue with me instead. I don’t want to hurt my mother because her health is not proper but indirectly I keep hurting her by my erratic behavior and emotional outbursts. I know what is wrong and what is right. I don’t want to do anything wrong. I know what is right and I see to it that I do everything the right way. If I am not studying or doing my duties, I can understand if you reprimand me and pull the strings (hand gesture). When I am doing everything right and when I am not distracted from my path, why are you pulling (hand gesture) the strings? Why are you distracting me? I work in my own way. I set a time-table and work according to it. I go according to my mother’s wishes. I keep her informed about all my activities. “At 7 O’clock I am going to do this, at 8 O’clock I am going to do this.” My mother is sure that I will do as I say, then why has she to keep telling me what to do as if I am a small kid? I know what my duties are. When I am not doing anything wrong, why are they pulling the strings? Why they are not giving me space to breathe? I don’t go anywhere out. I have my practice, I go there. I go to my classes and to my college, that’s it. I don’t even go to visit my friends. I go to practice my Karate. I spend my time over there. Sometimes I play football with my colony friends. That’s it. (Pause)

My sister tells me to be optimistic but what can I do? My home is full of negative energy. Everyone at home is a pessimist. Even if I do something wrong which is minor, they make it a big issue out of it. They don’t see what good things I have done, what are my achievements…. nothing. One small mistake and Oh! I have done a big crime. (Pause) Only during the day of my exams my mother comes, sits beside me and lovingly pats my back so as to encourage me and tell me that I can do well. What is the point? I know I can do it. My friend’s parents after a match were asking us, what happened in the match? How you scored? How you did? I expected the same response from my mother and my uncles. They didn’t care to inquire after the match whether we lost or we won? They just saw the certificate and that we had won but they should take interest in me. They should make me feel better. I had scored a goal. They should ask as to how I scored a goal. How you did it? Which team you played with? No, nothing, not even one word of appreciation?

Q] So how do you feel when there is no appreciation?

A] I feel lonely (weeping).

Q] Tell me about this lonely feeling.

A] No one is there. No one cares about me, but this is not true, they care about me, but they are not showing it.

Q] Tell me more about this

A] It’s like, my uncle on seeing my certificate should appreciate me and say, “Oh! You did something good. You scored the goal against this tough team. It is something great.” He saw the certificate and gave it to me. My mother didn’t even glance at it. She just kept it on the table. I want to make them understand how I feel. They think I want some expensive gifts and that is not true.

Q] What do you want?

A] I just want to be cared for. They should sit beside me and appreciate me.

Q] What is caring?

A] They should ask me, pat my back and say, “Okay great! You did it.”

Q] So what do you feel when somebody pats your back?

A] I feel nice. It boosts up my confidence and I feel I can do it.

Q] Tell me about it?

A] I am good at drawing, but no one actually used to appreciate me. I happened to exhibit my drawing in a poster competition and I won the 1^st prize in the college. My teacher said, “Good, It was a good concept, nice ideas and good color combination.” He just patted me on my back and said, “Keep it up, and you can do it. You can do better than that.” At home, no good word even after struggling so much.

Q] What is struggling?

A] I was working day and night to complete that painting. I was putting out more than 100%. I was totally committed and I wanted to win. I want somebody to appreciate me.

Q] Then how do you feel when you are appreciated?

A] I feel okay, they recognized my talent. I can do it next time also, if they support me.

Q] And if they don’t recognize you how do you feel?

A] I feel sad and depressed.

Q] What do you feel in that sadness and depression?

A] Why can’t they understand me? They just think about themselves. My mom just wants to do work all the time. Work is more important to her than her child? Why is she working so much? When I ask for her a reason, she says it’s for me and my future. It would be better if she took care of my present than of my future.

Q] How do you feel when your talent is not being recognized?

A] I feel sad.

Q] What is the feeling in that sadness?

A] I feel irritated when no one recognizes me. I can’t explain that. It is like something very sad. I can’t do anything. I feel like a disabled, nothing I can do. I am useless.

Q] Tell me more about this useless feeling.

A] A whole lot of negative things come into my mind. I know I can do it but when no one appreciates me, something comes over me and then everything goes wrong.

Q] Tell me more about it.

A] My arms and legs don’t work. My brain doesn’t work the way when someone boosts my confidence. I don’t like anyone making fun of me.

Q] Tell me about that.

A] It is fine to make fun when you are with friends but not in a family. It makes you feel as if you are nothing. It affects your confidence. You can’t play carefully. In a game like football you can expect anything to happen. You can even injure yourself.

Q] Are you playing football? You are wearing a foot ball T-shirt.

A] Ya.

Q] What else are you good at?

A] Football, Karate, basically all sports and drawing.

Q] What all sports?

A] Badminton, carom… all sports. I am also good in elocution competitions. I have won prizes. I am good at studies too and I pass with distinction marks. But I feel I can do better if someone is behind me.

Q] What is somebody behind you?

A] Someone always telling me that I can do it. If instead someone only points at my mistakes and says, “This is your problem, this is your fault. You can never do it.” Then I lose all hopes. I get all negative thoughts. I want someone to tell me positive things and say that I can do it. Then my brain also works in that way and I feel I can do it.

Q] What did you mean when you said that your father comes and invades your life?

A] Ya.

Q] What is invading your life?

A] When I look around, there are couples staying together. I have never seen anyone staying single. It’s not that they had a fight and they are separated. My mother says that she has got a job over here, so she has to stay away from her husband. I don’t mind if he was staying with me when I was young. For 19 yrs he was not with me and all of a sudden, he came and like invades our space. I know I am wrong. They are supposed to stay together, but then he should have shifted here to stay when I was young. He is not able to adjust anywhere, except his own house in our village and then he expects my mother to go over there. My mother has got a good reason to stay here.

Q] So how do you feel when he is taking away your mother?

A] I feel lonely, alone.

Q] What is taking mother away from you?

A] I feel my father; all of a sudden he is coming and disrupting our lives. He was not bothered to come and see what had happened to us for 19 years. I don’t remember him calling me up or wishing me on my birthdays. I have asthma, but he has never bothered to call me up to enquire how I am. If he would have done that, it would have made me feel better. That would have made me feel closer to him. I don’t feel that he is my father. He has not shared anything with me, so I expect my mother to share everything with me, but she is too busy for it.

Q] And you say that your uncles torture you. Can you tell me more about it?

A] Torture in the sense, one of my uncle drinks. The torture is not physical, it’s more mental. They keep talking and making irritating noises. When I am minding my own business, and I am just sitting and watching T.V… What I am doing to you? Am I hurting you? They have problems with whatever I do. I feel very angry. I feel like bashing on their face. Most of the time, it has happened that I have lost my control. When it happens…….

Q] What do you think they are doing to you?

A] They are trying to make me lose my control over my head.

Q] What are they doing that will make you lose your control?

A] I don’t know what their intention is. I feel they don’t want me to stay quiet and just do my work. They feel satisfied when I am angry.

Q] Why do they want to make you angry?

A] I don’t know. They might not be doing it intentionally but they don’t know what effect it has on me.

Q] They also pull the string. What is pulling string?

A] I am not doing anything wrong. I am doing all right and I am not distracted from my path, why are they pulling me (gesture)?

Q] Do that- what you did just now?

A] Why are you holding me back? Let me go. Let me go, let me progress.

Q] How are they holding you back?

A] Like this.

(Gesture: Pushing the head, shoulders and arms backwards as if pulled back by string/ reins)

Q] So they are pulling your strings & holding you back?

A] Ya, I want to tell them… let me go, let me progress. When I am doing something wrong, hold me. When I am not doing anything wrong then…..

Q] When you are doing right also, they are pulling you back?

A] Yes.

Q] So how do you feel at that time?

A] I feel they don’t want me to progress. I feel they are jealous of me. When I get a medal or do well in studies, I can see the jealous expression on their face.

Q] You say that you are a peace loving creature. What do you mean by that?

A] I don’t like to fight. When my friends fight or argue, I just listen to both of them and tell them to stop fighting. At home, I myself end up fighting with them.

Q] What dreams you get?

A] Most of the time, I get fighting dreams.

Q] Can you describe them?

A] This is a recurrent dream which I get. When I get up, I am shaking when I get up. I am with this group of people. There is a chaos and everyone is running and I am in a corner.

Q] What is the feeling? How do you feel in that situation?

A] Terrible, shaky.

Q] What is the feeling?

A] I am afraid.

Q] What are you afraid of?

A] I don’t know. I get goose bumps. I can’t explain it. It is like a horrible dream. A nightmare and it keeps repeating.

Q] So tell me. It is a nightmare, lot of people, running, you are in a corner and you are terribly afraid. What are you afraid that could happen?

A] I might be get stuck with those people over there.

Q] What is to get stuck?

A] To these people who are running here and there. I don’t want to be with them.

Q] What could happen if you are stuck with them?

A] Anything, anything. I can come under their feet or hit anyone by mistake. I don’t want to go there. I want to stand there and look what is happening.

Q] You can come under their feet? What else could happen?

A] I can hit someone.

Q] How?

A] By mistake, like I can be crushed by anyone’s feet by mistake and anyone can get crushed by my feet. I don’t want that to happen.

Q] So you can also crush somebody under your feet?

A] While I am running with that mob and that chaos is there, I don’t want that.

Q] Why you don’t want that?

A] I don’t want to hurt anyone.

Q] Why you don’t want to hurt anyone?

A] I feel they will feel bad. I don’t want to hurt them.

Q] Tell me about hurt. What would happen if you hurt anybody?

A] They will feel bad. I don’t want to have those negative feelings about anyone, bad feelings. I mean I don’t want someone to curse me for anything. I don’t want to hurt anybody’s feeling.

Q] What would they think if somebody is crushed under you?

A] I don’t know.

Q] What would they think about you?

A] I might be killing that person. I don’t want to be a bad person.

Q] And you are scared that you will kill somebody or you will be killed?

A] I can kill somebody.

Q] Any other dream?

A] The dream I told you comes very often

Q] How organized are you?

A] Pretty much

Q] Any interest in plants and trees?

A] Nothing specific

Q] What about animals?

A] Like them generally, but no particular fascination.

Q] Are you afraid of any animals?

A] Big dogs as one of them has chased me. I have not gone to zoo.

Q] When you talk about pulling string and holding back, can you think of any animal?

A] Horses and camels.

Q] What do you feel about horses and camels?

A] They are being controlled by their rider, according to their will, they are not set free. They are not allowed to do what they want to do. They are made to see what owner wants to see, not they want to see. The horse have that stuff put near their eyes so they can see only straight, what the owner wants to make them see, nothing else.

Q] What else?

A] The horses are not free. They can’t live by their own will. They are used for entertaining people. (She shifts to talking only about horses and not camels.)

Q] So how do those animals feel?

A] They might be feeling depressed. I am not free. I am not in my own environment (patient started weeping). (She shifts from talking about the horse to talking about herself and she identifies herself with them.)

Q] Why are you crying? What made you cry just now?

A] I also felt the same thing.

Q] How is your energy level generally?

A] Normal. I got asthma attack few months back, due to dust. I had to take 1week break at school.

Q] Are you a sports person?

A] Very much

Q] How is your stamina?

A] Good. I had to work from my position as well as my other player’s position too. The coach made my play as a stopper and during the match he made me play centre half and made me run.

Q] So you are a good athlete? Your running is good?

A] Ya, it was good but it has reduced because of asthma.

Remedy given: Lac Equinum 1M, single dose

Follow up on 23^rd December 2003 (after about 5 weeks)

I am feeling very nice. There are no more fights or quarrels at home. There is a good understanding between me, my mother and my uncles. They have changed. They take more interest in me. I am also very calm now. When I came to you I was losing hope as I felt that no one is supporting me. I am much more confident. I have much more stamina when I am playing. Fortunately my breathing too is better and so my game has improved. Did you also give me something for my asthma? My lungs are much clearer. In fact I have no breathing problem.

My anger has gone down. Before, my anger would control me. Now I have control over my emotions. I am concentrating on my work. Surprisingly my uncle has changed. After drinking he used to bother me. Now we crack jokes with each other and we laugh. They are encouraging me to go ahead with my game.

According to mother:

We at home are just the same as before. We have not changed, but she has changed her outlook towards everything since the past few weeks. I hope she continues this way. She does not get angry like before and she is generally in a very good mood. Even her asthma has gone away almost completely.

Summary of follow up after one year:

She continues to do well. She is selected for the national team in football for under 16 age group. Her academic performance has also improved. She is generally in a good mood. No asthma. Better energy levels. Her father came to their house about 2 months back. She was cordial with him, but not too friendly. She did not stop her mother from meeting him. She felt that mother was an adult and she knew what is best for her. She did not see any sense in imposing her views on her mother. Her relations with her uncles had dramatically improved.

Analysis:

The patient is very depressed and gets very angry. She feels that no one understands her and no one really listens to her needs. She needs a lot of attention, care and appreciation. She struggles a lot to make her mother and family members happy, but no one understands her.

She is pessimistic about her life situation and she loses hope very easily. She needs constant encouragement to boost her confidence. Her confidence level is very low. She needs a pat on her back or someone behind her for encouragement. When her confidence is low she feels useless like a disabled person. She needs recognition from her coaches, teachers and family members.

She loves all sports and she has passion for football. Winning a match is a big achievement for her.

She sees herself as a victim suggesting an animal remedy. She feels that the family members are torturing her and not giving her enough breathing space. She also suffers from asthma. She feels that her father invades her space.

The patient came with emotional problems and she kept speaking about it. In the process she came up repeatedly with the use of a metaphor. On probing into it, she started making hand gestures. In the process of case taking we moved from the emotional level to a delusional level and then to the energy level. She talked about family members pulling the strings. She said, “When I know my duties well, when I am doing everything right and when I am not distracted from my path, why are they pulling my strings? They pull the strings and hold me back.” She made a gesture of bending her head, arms and shoulders backwards. It was similar to a horse whose reins are pulled and the horse is not allowed to move forward. The energy level expressed by the gesture throws an immediate light on the vital disturbance.

It is amazing that she dreams of a chaotic situation where people are running everywhere in panic. She is terrified to move as she is afraid that she can crush someone under her feet.

Horses as understood by the proving of Nancy Herrick seem to be very unhappy and dissatisfied creatures. They are domesticated and exploited for various human needs. There is a central theme of frustration and nothing seems to go right for them. Like the dogs they have a tremendous need to belong and to please their master. They struggle to do their duties, but never get the sense of satisfaction. To please the master they want to do the right things and be on the path expected of them. They are made to do things which are difficult for them and they have to put in a lot of efforts. There is a tremendous fear of failure and subsequent feeling of being useless and incapable. They are very loyal and friendly. They need constant encouragement- a pat on the back so to speak, to boost their self-esteem and confidence. People needing this remedy are usually lovers of sports.

Some of the rubrics of Lac Equinum:

Confidence, want of (2)

Delusion, hindered (3)

Delusion, neglected, duty, his (2)

Delusion, running out of control, she is

Disharmony in the family, aggravates (2)

(Horses are herd oriented in the wild)

Dreams, sports (3)

Dreams, football (3)

Dreams, unsuccessful efforts (3)