PCOS in a Woman of 26

A 26-year-old female consulted me on 31-3-20 for polycystic ovarian disease which was diagnosed 9 years ago. Her menstrual cycle was irregular (45-90 days) and lasted for 3 to 4 days.  She tested her thyroid stimulating hormone level in January 2020 and it was 8.17. (normal range is from 0.25 to 5.25). She was on tab thyroxin 25 micrograms.

Education

She did her schooling in Ranchi and was very comfortable throughout her schooling years. She was the prefect student right from the 6^th to the 12^th standard. Her teachers were polite and knew her by name. She was very social and appreciated by all.

After Ranchi she moved to Nasik to study architecture. Here she had some very bad experiences. Students were always in groups, and her seniors particularly the boys were rude, disrespectful and condescending.

She wouldn’t talk to them so they felt she was arrogant and wanted to teach her a lesson. They picked on her, told her to write their notes, put oil in her hair, told her she had to study here for 4 years and , “You are under us, you better watch out”.

Once a senior girl was wearing the same footwear as her. She said, “Oh you have the same, now I will have to throw mine away.” She said this in front of many students. She couldn’t react as the girl was her senior. It was all very humiliating and she hated it.

She felt alienated. It was important for her to have people whom she could relate to, who were nice and with whom she could relax. She would bunk classes. She missed her parents. She felt trapped and wanted to get out. After one year she left Nasik.

She completed her BA in English from Pune and worked with a charitable organisation. When she joined the organisation, she felt engaged and connected. She was given the responsibility of training volunteers which made her feel empowered. She loved interacting with them. She had a nice connection with her students. She would go to orphanages and teach them. She felt satisfied that she was doing something good with her time.

After Pune she took up a job in Bangalore. Here she had two bosses; one was caring and loving and the other didn’t appreciate her work. This caused a lot of friction and she would get confused and stressed. However, her colleagues were well behaved, soft spoken. There was no hierarchy, no competition, no senior/junior. (hint of animal kingdom).

She then got a scholarship to study abroad for her Masters.  She found it difficult to cope abroad. The education system was very different. She felt inadequate that others knew it all and she knew nothing. She also felt accountable, “what if I can’t meet my deadline, what if I can’t finish my work.”

She was unable to focus on her studies and was constantly tired. She couldn’t get up from bed. Taking a bath especially a hair bath was very tiring. She would cry and scream without reason. She felt alone and tired all the time.  She suffered from depression and was on medication for 4 months. TSH was 8.17. Her vitamin D was also very low. She was put on Vitamin D supplements, thyroxine and anti-depressants. She also had a lot of gastric issues and flatulence.

She is now in the final year of her Master’s degree. In January 2020 she got engaged to her boyfriend and was stuck in India because of covid.  She is very stressed as she is working on her final dissertation.  She has no proper routine and wakes up at noon. She feels fatigued and bloated.

Family

She lives in a joint family. Her father has 5 elder brothers, currently fifteen people live together. Her mother does a lot for the family and is working all day long. She feels a need to share the responsibility. She said it is unfair for one person to do it all. Even after doing everything, they complain instead of acknowledging and appreciating her mother.

She says it was difficult to stay at home for more than a month because of the many disputes between her father and his brothers. She is disgusted at how they are always pulling each other down. It would disturb her so much that she sometimes locked herself in a cupboard.

It would affect her so badly that she avoided meeting friends. There were times when she would be very angry with her boyfriend (they stay in different cities) as he was constantly telling her what to do.

She feels there is lot of negativity in her house. Her parents are always in a bad mood and constantly suffer from ill-health. They are unable to enjoy life because of these disputes. She feels helpless that she is unable to do anything for her parents. They don’t have a son, it’s just her and a younger sister.  She feels responsible for them.  She wants to go back abroad as she wants her peace of mind.

Work

She is into developmental studies, her focus being public education. She wishes to do social work and improve the livelihood of poor people. She wants to help the under-privileged, teach them technical skills that will help them get some meaningful work, which can add value to their life.

Her students earned Rs 4000 per month in remote towns and had no standard of living. She felt there are so many rich people in the world yet there are many who don’t get one square meal a day. “It is so unfair, and not right for it to be so.” She too was living in luxury; her life was easy and if she could help a few of her students she would be very happy.

She always voiced her opinion if something wrong or unfair was happening in front of her. Earlier when she was in school, the principal was partial to one group and it would always win in competitions. So, she went and told the principal that the competition was fixed and rigged and did not care about the consequences of doing so.

She didn’t like that her parents didn’t speak with respect to the servants. She would say “just because you are in powerful position, you can’t demean someone”.

Once her family went to a restaurant. There, her father called the waiter, “Hey you bugger, come here”. She was very offended and told her father—“he has a name, you have no right to call him that, just because you are paying here. Don’t give the waiter a tag, his name is his identity. Just because you are in a better position in life, you can’t be disrespectful to the waiter”.

She stopped buying some branded products because she learnt that they exploited their workers, paid them less, take no safety measures and no health care is given to them.

She uses a toothbrush made from bamboo, not plastic. She uses herbs for her hair instead of shampoo. She enjoys going to forests and staying in eco-friendly home stays. She is fascinated by birds and wild life like lions, tigers etc. She doesn’t like going to a zoo because she feels the animals there are taken away from their natural habitat.

She wished she was born 20 years back. She likes old buildings, old songs. Friends call her “Mummy”. She doesn’t like dancing and is averse to loud music. Caring for others comes to her from her mother. She cries if she sees someone in pain.

Books

One of her favourite books is “A Thousand Splendid Suns”. The book is about how women were exploited by the Taliban in Afghanistan. It is the story of a 15-year-old girl forced to marry a 40-year-old man and what unfolds thereafter.

The other one is “Shantaram”. She feels it’s an extraordinary book about a man’s search for himself and for a meaning in life. What especially appealed to her was that there are many discussions between the characters about interesting philosophical issues. Also, Shantaram accepts people for what they are without trying to change them. He respects them for who they are regardless of their status in life. All human beings are equal to him.

Movies

Her favourite movie is:

“Madaari”– It is the story of a father, Nirmal, who loses his son in a flyover bridge collapse. He then kidnaps the home minister’s son, Rohan to teach the minister a lesson. The news becomes a hot item in the media. Towards the end Nirmal calls a TV news channel and gets them to broadcast his demand that the people who were involved in the bridge collapse, including the Home Minister, have to come to his house and if they didn’t then he threatened to kill Rohan and himself.

He makes the bridge contractor, the Home Minister, and the ruling party’s financier, confess to their corrupt activities on a live TV broadcast.  Rohan indicates he understands why Nirmal did what he did and they hug each other before Rohan leaves with his father.

Analysis

Animal kingdom hints
You are under us; you better watch out.
There was no hierarchy, no competition, no senior/junior
Pulling each other down.

Mammal hints

Connection with one’s immediate family, especially father, mother, siblings.

• Fear of failure, lacking confidence. Fear of falling is a big theme.
• Delusion, looked down upon.
• History of abuse
• They have compulsive need to belong to a group. (except felids and fox). They feel safe and secure in a group. It is seen as intense need and dependency on friends, family, community etc. They have fear of being expelled from the group. Since stability of a group provides them a sense of security, they would comply with the norms of the group at all costs. So, there are issues of Self versus Group. This leads to conflict—to do what one feels like doing Versus–or follow the rules of the group.
• Hierarchy and pecking order are seen in most mammals. There is a fight for supremacy in the group. There are issues of dominance/submission in the group—which are seen as superiority and inferiority in patients.

Repertorization Chart

Follow up

On 1-4-20 I gave her Lac humanum 200. I gave it once a month for the first 3 months. Then SOS.

Her last 2 cycles were on 21-1-20, 28-3-20.

After the remedy she got her menses on 8-5-20, 5-6-20, 11-7-20, 9-8-20, 13-9-20, 20-10-20. She continues to get her menses on time till date.

I told her to stop tab thyroxine.  TSH in June 2020 was 3.66

Tiredness is much better. At times she feels exhausted because of erratic sleeping pattern.

As of Aug, 24, 2021 she continues to get her menses regularly. Immediately after getting married she became pregnant.

Lac humanum

Dr Sankaran gave the example of a Hindi movie, “Lagaan” (Taxation). The movie is set in the year 1893 and India is under British occupation. In a small village, the tyrannical Captain Russell has imposed an unprecedented land tax on its citizens. Outraged, Bhuvan, a rebellious farmer, rallies the villagers to publicly oppose the tax. Russell offers a novel way to settle the dispute: he challenges Bhuvan and his men to a game of cricket, a sport completely foreign to India. If Bhuvan and his men can defeat Russell’s team, the tax will be repealed. Against all odds Bhuvan and his men rise to the challenge and win the game.

The main issues depicted in the movie were:

• Exploitation
• Class distinction
• The helper angel
• The criticism by the group
• The working with oneself
• The rise of the hero as an individual
• The adventure
• The return, the victory
• The fruits shared by all
• Love and sacrifice
• Group togetherness and support
• Good vs evil
• Individual vs group conformity

 Lac humanum features in a patient

• My life is easy, I am living in luxury. My students have no standard of living. So many rich people in world versus the poor who don’t get one square meal a day.
• Helpful nature. Her focus is on public education, helping the underprivileged.
• Exploitation vs benevolence
• Unfairness / Injustice
• Precocious (Friends call her Mummy)

Lac humanum characteristics in proving

• 2 wills—spiritual and god-fearing vs unreligious and sinful. Need to improve at work vs need to relax. Individuality vs group conformity.
• Helping others who are weaker or less fortunate. Feeling that I should think of myself first, and then of others and vice versa.
• Friends—forsaken by friends. Quarrelling with them or enjoying their company.
• Family– turned out by family, anxiety for family, unloved by family.
• Community—being helped by members of rival community.
• Fear of snakes and surrounded by them.
• Revered person making sexual advances.
• Being reprimanded by mother or teacher.
• Achieving something better, teaching students better and desiring the progress of his science.