Mr. J. L. K. came to me in December 2009 with the chief complaint of chronic migraine. He complained of severe pain during migraine, not responding to any pain killer. He also complained of acidity. He was going through a lot of financial stress. He had a snoring problem and was diagnosed with sleep apnoea syndrome. When he came to me, I understood him completely through the case witnessing process.
(NOTE: The case has been edited for brevity. Peculiar sentences are highlighted in italics and/or bold. My explanations are in plain brackets ( ) and in green. D, P stands for Doctor and Patient respectively. Follow ups have been summarized at the end of the case.).
PASSIVE CASE WITNESSING PROCESS:
D: Just feel free and tell me everything about you.
P: (Area: Chief complaint – migraine)
To start with…well, I have a migraine pain, say since, last 35 years. I think when I was 15 I had a migraine pain. It is heredity. My mother had it. My brothers have it. My sister has it. It was very often but since five six years it has reduced but still when it starts it takes about 5-6 days. It used to be an acute attack when I used to sleep in the room for 2-3 days and take on the medicines, unlimited number of proxyvans, even 8 pain killers would not affect me in a day. I still have that. Once in fortnight I do get a pain but one thing is there, every morning I do get up with a headache, whether it is 10% like I am talking to you and I have a headache and this is the portion (Points to the right occipital region with the fingers of his right hand) It is one part where I get a headache, this particular one part. I think I am always in a pain whether it is 5%, 10%, 15% and acutes once in fortnight even today.
(In the area of migraine, the patient qualifies the pain as acute and intense, so much intensity that the pain does not even respond to 8 pain killers a day. We make note of this and passively be with the patient.
At this stage we allow the patient to go into many areas and see what happens there and we do not rush towards asking the patient about the acute and intense pain.)
(Area: associated complaint – sleep apnea)
I have a problem of snoring. I am a sleep apnea case. From the childhood I use a machine every night. If I do not use the machine people around 100 meters around me will not be able to sleep as I snore too much.
(Area: Past complaint of gall stone)
Other than that my problems are, I had an acute pain one evening in 2003, very acute pain and on a Monday- it was a Sunday- right- 3rd of May & the next day we went to the doctor I took the regular medicine for pain killer but it did not help. He prescribed me that you have a sonography where they saw that I have gall bladder stones. And at that time it was such a bad state, before that I never had a pain believe it but when they diagnosed it they said you have such a bad gall bladder that the thickness of the wall is 1 mm. and it had gone to 7 mm. It was about to burst when I took the CT scan. We operated on Wednesday in hurry and that time it had already burst it was a serious thing. With laparoscopy the surgeon Dr. S. took out 48 stones. It was a pyramid, black pyramid stones and the gall bladder had already burst and poisoning effect was about to flair, but by any chance they could just save me from that and they operated on it. Even the team of doctors informed my wife that you can call your son from London because we do not expect that this gentleman will survive any more. But then again due to the god’s grace I was Ok, fine.
(In this area we again see acute pain coming up. In the whole description the patient mentions how serious the whole incident was, so much so that he would have not survived. We make note of this.)
(Area: past complaint of throat and throat surgery)
I have had and I had a mild surgery here in the throat, I had an infection in the gland and nobody could detect so finally we had to operate. Dr. D operated in 1986 it was a big, no Dr. H, not Dr. D he was assisting but Dr. H ENT specialist he operated on it. It was a half glass of pus which they took out so that was one surgery I got done.
(In this area, we see that while describing, the patient mentions that he got a surgery done for an infection in the throat and the doctors took out half glass of pus. This shows that physically, the patient has a tendency towards developing acute troubles where the problem becomes very intense…like in this case the infection was very intense…)
(Area: Past incidence)
I must be very frank to you because at times, I got the attack in 1980 I tell you in my sister’s weeding that time the doctor was so panicky (HG: Palms facing each other, little distance in between, fingers spread apart and moves it in the front) which a doctor should not, he gave me 3 tranquillizers campose, 3 together and he forgot that he has almost killed me. I was in deep sleep for 36 hours I could not get up. The family had to shift me to the hospital and get things rectified.
(Again we see panic coming up in projection also, so much so that he felt the doctor almost killed him…the patient invariably in all the physical complaint related areas has described the same thing about how acute, intense and serious were the problems he has been having, or has had in the past…
In the passive process it is important to not only note the physical complaint, but also note the patient’s description of the complaint, the quality that the patient knowingly or unknowingly associated with the description and also the non verbal language where the patient completely gets involved while narrating the incident.)
And migraine, doctor, such severe attacks; it is like jumping from the bed (HG: Palm of the right hand facing upwards shows a movement in upward direction)But in pain I go and I work. I can’t miss out every 15 days I have migraine I can’t miss out so I take a tablet and I walk. Just now as I am talking to you 20% pain is there. This is a particular part, this much only where I have pain (HG: Points to the right occipital region with the fingers of his right hand) and then it starts shooting and it kills me very, very badly. (HG: Middle finger of the hand goes in the upward direction as if showing a piercing action as he says it kills me) Otherwise I do not think I have any problem. If you ask me may be I will remember but this is my story.
(The intensity of the pain is like jumping from the bed…we make note of this. Here we see that the chief complaint of the patient gets aggravated. This gives us a clue that the patient is on the right track and is slowly getting close to his inner altered self.)
D: You are doing it well. In Homeopathy we need to understand you. Just go on. The more you talk about yourself, the better I can understand you as a person along with your illness.
P: (Area: business and self)
I live a good life. I have two children but tensions yes, off course are there. Business tensions are always there. Financial problems are there. I am a single man, self made man. I left my family in 1982 in Kashmir and without any money came to a place like Bombay where you cannot survive without money for a day but then god was great with me. I have lived it till here, established my life very well, very nicely. I brought up my children very well. Day to day tensions yes off course since I have come to Bombay, since last 7 years they are a little more. Much more because your family grows, your needs grow, you cannot cope up, some loses in business, some profits this is all part of life but yes tensions do hit my day to day routine.
(In every area the patient qualifies his expressions and narrates to us…this is a clue that the patient’s level of experience is delusion.)
I am a little too sensitive I must tell you. Too means very, very sensitive. I just cannot take in small things. I take it to heart straight away. Like you say a word to me and I will take it, why did he say that? Like I am very a stupid sort of a person (HG: contracts the whole body a little bit, joins the finger tips of one hand to that of the other hand and shows a space in between)
If you say today that I have this problem whether it is acceptable with me or not, I think by evening I will find you a solution and I think I do it 99%- I will do. God is so great (repeated 3rd time) that I find some way and it is done, for anyone. I have done it for tremendous, many people. Whether it is a financial problem, family problem, and child problem whatever…. doctor problem, if anyone wants to go to the doctor, call up Mr. K (takes his own name), because I have, touch wood, have got links with everybody in Bombay. Heart specialist Dr. B.K. G is like a father to me Dr. D P you just name any Doctors in Bombay I can just walk in. Dr. B.S. S has no appointment but he does not have to say no to me ever. I have friends in everyone; everybody loves me in that way. I am very lucky for that reason.
(At this level when patient had gone to many areas I observed that the patient exaggerates while describing that area. Like earlier the patient said that he snores so badly that people cannot sleep in 100 meters area around him…in this area he says I have friends in everyone, everybody loves me.
However, I would not get biased in this direction as it is my observation about the patient. If it knowingly or unknowingly happens in other areas then I will take it as part of patient’s centre.)
(Area: Family and nature)
I love my family very, very much. My kids, my wife, really, I love her. Like just day before yesterday she was in pain I think she gave you the call I was not in town, I was away. I left all my business and I just flew back, it was not a very big problem but I cannot take it. Just because I cannot take it! Pain for any one, family yes everybody, why me but anybody else if I see in pain and if I can do anything for anyone, I will come out and stand. No second thought to it. I would go out of the way to do anything for anyone. This is nature I carry.
(In the area of family and also nature of the patient, we see that he talks about pain, and how he gets affected by pain of his family members and of people around him.)
But one stupid nature is I am too sensitive. I take things, very, very small things hurt me which I think at this age should not, I am too matured for all this non-sense but again (Claps few times) some silly parts are still with me which I would love to leave if you can help me to take it out (Laughs) I really mean it.
I would love to do good to everybody but again money comes in the way. If I have money good amount of money I would help everybody, anybody who needs it. You need money to live, I agree to it but if you have excess you should help others also which I would love to do in my life once.
D: What else? Just go on. Whatever you are saying is definitely helping me. Go still closer to yourself. Still see what else is coming up.
P: (Area childhood and mother)
I was too attached to my mother in my childhood. I could not see her sick; she was a very sick person. She was always on her bed and I would cry for hours because she was everything for me and she was in lot of pain. I was very, very close to her. She had asthma and she would sit like this whole night and she would not sleep and I would sit with her whole night till the time I could. She was a very acute asthmatic patient. She got it after the migraine because once she took some medicine, not for migraine but I think she took some medicine for, she had some patch here, white patch for that she took some medicine which resulted into asthma.
(Here we see acute, pain is coming up in a different time zone. With the passive process the patient is going in different areas and slowly making the focus clear for us.)
(Area: his temper)
I have got a very short temper; one thing is there I am a short tempered person. I just blast (HG: moves both the hands away quickly) but in minutes I would be fine (HG: brings the hands closer quickly). But I am a short tempered person. At times I really get angry for no rhyme or reason.
But as on today I must tell you, I am living in a full of tension life, full of tension. Not even a bit of, I pretend to be happy because my family looks at me and they become happy so I try to do that but internally if you ask me I am very unhappy person because of my children not settled yet, son, family problem. I am worried for my wife’s health yeah because she has little pain I can’t take it.
I remember doctor, I used to never take tensions…I used to love having clothes. In my marriage when I came to Bombay to stitch me clothes the 4 tailors were shocked. I think I stitched some 100 shirts for myself. 100 shirts believe it and all the best tailors. All the best possible because with god’s grace we had too much of money, money is never a problem in life till I left my house. We had, you will not believe but we used to have trucks of cash money not in bags, we had trucks of cash money in my house. But, till then I never had a problem, money problem I never had till 1983 till I came to Bombay. But when I came to Bombay I never took a single penny from my father where I could have asked for 5-10 crores but except he bought me a house of 4 lac rupees I have not taken a single penny from my father.
(While talking about money, the patient says he had a truck full of money. I observe the exaggeration again.)
(Area: Lifestyle in past)
Whatever I am today I have made myself! Struggled for that, lived to the standards touch wood till today, tomorrow I do not know where I will have to head, but now I do not have any feelings for myself. I wear a torn brand; I wear a torn shoe I would not care. I have really lived life king size. Believe it; I have moved into a circle I have lived, I have eaten the food in 90’s spending 20,000 rupees for 2 people which would be a very big thing in 1990’s spending 20,000 for a couple eating? I have done that in my life. I think even top class families of Bombay even today wouldn’t have done that how much I have done. I am in the A – list of Taj hotels; I am treated as a best costumer of theirs for last 25 years now. Golden dragon restaurant which is, I was there two days before this terrorist thing happened and I was booked for the night when it happened in golden dragon. My anniversary is on 25th so it was Tuesday, we do not eat non-vegetarian on Tuesday so we had booked a table for Wednesday 26th but by chance we could not go there Sunday the 23rd I was at the same table were the first bullet hitbecause I am very often visited that restaurant because I love the food there, in that restaurant they have 25 VVIP’s they have the plates by their names. One of them is me. So I do not have any, no, no, grudge in my life, I have lived life the way I wanted to live. As I told you people really love me for this and I also love them.
(We see another very important out of focus thing coming up that is, “lived life king size”. The patient qualifies it at a general level and hence this signifies that this is also a part of the patient’s centre.)
That’s all doctor about my life…
D: What else?
P: More! (Laughs)….I think I have given you everything.
D: A little bit more, to understand you. The more you are talking, the more things are becoming clearer you know?
P: (Area: friend circle, links and contacts with people)
I do not believe in many friends but yeah I have contacts with everybody. As I told you, you talk of doctor line, you talk of hotel industry, you talk of any, you talk of income tax, and you talk of sales tax, excise anywhere you will find that I have a person sitting at the top who will not say no to me and that is not possible in this world.
I have got links like that, Bombay hospital why we like because we have all the facilities in Bombay hospital. You talk of any doctor there; I do not have to take an appointment with anybody. I just have to pick up a phone and just say this is this that is all. Nobody asks me why Mr. K (takes his own name)? Till today nobody has said no to me. I will not bother you till the time it is extreme but then if I call you I expect you that yes, you are a friend and you have to be, I do not take undue advantage, never. Monetarily I do not take help from everybody believe it. Even if I am going to Taj I will not take a discount, no! Give the best of the service that you can give to me, I am happy. Other guest shouldn’t feel that Mr. K has a hold in the hotel, no! You charge me extra, I should be the best. I should be, everybody on the other tables should say, I have that little thing that they should say that Mr. K is sitting on that table…
(Exaggeration is coming up again, hence I am now sure that it is also a part of the patients altered pattern. Slowly we also see the patient giving importance to his identity, people loving him, his contacts and links with people. It is important, since it comes up again and again at a general level and here at the level of imaginations, that is the vital level. It is not connected with the focus of pain and suffering as yet. If this is part of the patient’s centre then it will surely get joined with the focus.)
My links with people, wherever I went they welcome me with open hands. Banks were there, bank had, and believe it again I am telling you about the people, how much they love me, if you come with me to the oriental bank of commerce I assure you in 5 minutes I will get you a loan of your choice if your papers are strong. They will never say no to me. Touch Wood! That way I am very lucky.
As far as work is concerned, today we have a unit but it doesn’t belong to me. And company like what! Raymond’s, Reliance, Siayram’s, Doniars, They are my buyers. Till today we have ruled tomorrow morning is up to god. And believe this I am not boasting you, we are 6-7 directors in the company but believe it except yeah production wise they look after because I do not look after the production part of it, no please! But otherwise bringing up of the company is absolutely one man show.
(Here the patient denies that he is boasting…this is important because this is the first thing that the patient has denied till now. We also see in the talk of the patient that he is actually boasting about his identity.)
(Area: His life in Kashmir, before he came to Mumbai…)
Previously I was working in Kashmir at my shop we have got a cloth shop in Kashmir from 1955. When I was 1 year old the shop’s name was on my name even it is on my name till today. Kashmir, I have ruled, believe it I have ruled…I have ruled. At the age of 25 also I had the guts to stop a flight for one hour if I was turning on that. I just had to call up at the airport and they would not leave till the time I have reached there. I left Kashmir in 1984, when, what? I was 31 years! From 74 to 84 in Kashmir I have ruled believe it I have ruled. I was not a big man but again the friends and the relations with everybody. Even the governor of JMK was sitting on that plane and they were waiting for my mother I had to bring her to Bombay because she was very, very bad doctor said please take her otherwise she will die. The whole fare was because my mother was in a very bad shape and then he realized. He told I have seen that lady they said she is like a mother to the whole staff in Kashmir Indian airlines. She is a mother to all of us. You can suspend all of us we had to do it we did it. This is what the governor was told…
(Over exaggeration and boasting about his identity is coming up in this area.)
And people really, as I started with it that people like me, everywhere I have lived I have lived a king size life. Anything I could do in Kashmir, anything. I could buy a car without paying them. Pay them after one year, one month, two months just take a car and go, they would not ask me for money.
Faith and trust in friends always supported me in my life. And yes we were the top leading textile merchants of Kashmir. Everybody from Bombay used to come to us in summers. Anybody you can talk of. Mr. C R has lived in my house for one week today he is a big man he would not even recognize but 1982 he was in my house for one week. Mr. L with his family of 14 people stayed at my house 8 days 9 days in 1971-72, everybody. We were like kings in Kashmir that time and the main ruler in that family was the youngest person me in that family because my father was a very different type of a person. He wanted that everybody should be happy so he entrusted the job to me because he said you could do it.
(Until now the patient has gone into many areas and we see two things coming up in every area : intense pain, and living life king size.)
AT THE END OF PASSIVE CASE WITNESSING PROCESS:
WHY TO END PASSIVE HERE:
All the aims of the Passive process like getting a focus, obtaining and confirming the level of experience of the patient have been fulfilled. The patient has given the focus at a general and also vital level, where he talks about his imaginations too. Hence we end the passive process here.
OUT OF PLACE, OUT OF ORDER:
- It used to be an acute attack when I use to sleep in the room for 2-3 days and take on the medicines, unlimited number of proxyvans, even 8 pain killers would not affect me in a day.
- I am always in a pain
- The doctor was so panicky, he has almost killed me
- And migraine doctor, such severe attacks; it is like jumping from the bed
- Pain – kills me very, very badly
- I am a little too sensitive
- I have friends in everyone; everybody loves me in that way.
- Pain for any one, family yes everybody, why me but anybody else if I see in pain and if I can do anything for anyone, I will come out and stand.
- I would cry for hours because she was everything for me and she was in lot of pain.
- I have really lived life king size.
- I am treated as a best costumer of theirs for last 25 years now.
- They have 25 VVIP’s they have the plates by their names. One of them is me.
- I have a person sitting at the top who will not say no to me and that is not possible in this world.
- Till today nobody has said no to me.
- I have that little thing that they should say that Mr. K is sitting on that table…
- Till today we have ruled
- I am not boasting
- When I was one year old the shop’s name was on my name even it is on my name till today.
- I have ruled; believe it I have ruled…I have ruled.
- We were like kings in Kashmir that time and the main ruler in that family was the youngest person me in that family
FOCUS OF THE CASE:
Pain, intense, acute, panic
King size life, ruling, people should know Mr K
I become active with the pain focus. If the second focus gets joined with the first focus then we are sure that we are on the right track in understanding the patient.
LEVEL OF EXPERIENCE: Delusion
How patient is experiencing the level of experience:
The patient is in touch with himself, occasionally he projects and occasionally he denies certain out of place expressions.
At which level patient is experiencing the level of experience: General and vital
TECHNIQUE OF CASE TAKING (in active):
In the active process, the focus is to be confirmed. Once all the out of place and out of order things of the passive get joined with the focus, we know we are on the right track and then the active-active process will begin.
ACTIVE CASE WITNESSING PROCESS:
D: Can you describe that pain…
P: It is very bad….It is, now I have talked so much, believe me, it has started shooting again and probably if nobody helps I will go out, out of this place first thing I will do is I will buy a combiflam and take it.
(Aggravation of chief complaint gives a hint that we are on the right track.)
D: Describe that pain to me.
P: Very shooting, I think I should bang my, I….believe it I have made my wife sit on my head for an hour. Now you see she is quite heavy weight, she would sit on my head for an hour. I would not feel, just keep on sitting on my head. I used to like, no one should disturb once I am in the pain then I would not eat anything…
D: I am trying to understand your understanding of this pain and the hurt.
P: Pain in the head is too bad. Not my pain, anybody’s pain. If my child’s voice gets lower on the phone and if I can feel unhappiness, I feel very hurt. I have become a little scared.
D: Describe this, too hurt and too scared?
P: Well I am not scared; I am too hurt yes I am because… I feel I am doing so much for everyone but still when they say anything, especially the kids say anything, then I feel hurt. Why should I do it? Why I am doing it? I have lived only for them, my family, my wife, my kids… in my whole life believe me today I am only living for her I assure you I really do not want to live. I am very happy, I have lived a king sized life. Even if I go tomorrow morning I will have no grudge at all. I will be happy person to go, but the only thing that if I go and leave people behind happy. My wife should be secured till the time she lives in this world, my children should be self sufficient. Ok I cannot leave them crores, 100 crores I am not a Dhirubhai Ambani but they should be self sufficient then I don’t mind, I am happy, I can go tomorrow. Believe it; otherwise I really do not want to live. I am very; I have lived really a fantastic life.
(Here patient connects both focus, connects out of place from passive, exaggeration also comes up, hence the focus is confirmed. But the patient is in touch with situations and so we dissociate him.)