A33-year old woman consulted me for anxiety. The complaint started during her first pregnancy five years ago. She has one child. During pregnancy, she was fearful that the pregnancy would not end up well. Although this fear was justifiable, since she had a high-risk pregnancy, the fear was very strong and she developed other symptoms which had remained until now.
The actual problems are nondescript feelings of anxiety (3) with a sensation of heaviness or a stone in the chest (3), sensation of bearing down in chest (2) and trembling of hands (2). She also hears her heartbeat in her ears during these states.(2) In the past, she used to have similar feelings from anticipation, but now she has them in different situations without anticipation.
She has anxiety about her family (3) and a fear that something bad will happen to the family (3). She is also afraid that the world will not be safe for her children in the future.(1-2)
She has had frequent hangnails and eruptions in the corners of her mouth during the past year.(2) She has bitten her nails since childhood.(2-3)
She had eczema since childhood, but she was treated with homeopathy at the age of 20 and it went away. Six years ago it came back and it has been getting gradually worse. It is mostly on her hands, fingers and shoulders, generally more on the left side of her body.(2) It is itching (2). The eruption is generally worse in winter (1), from stress (3) and before menses (2).
This was the basic information upon which I based my further investigation. So far, the most important information was the anxiety about her family, because it is the most specific and peculiar. The fact that the complaints started during pregnancy may be important too.
With the initial set of symptoms in mind, I asked about other symptoms:
Thirst: She says she is rather thirstless (2) and she has an aversion to water (2) but she has had both symptoms since childhood.
Thermoregulation: She says she is a chilly person.(2)
I asked whether she is also anxious about herself:
She confirms being very hypochondriacal and having a strong anxiety about her health. (3)
Then I want to know about other fears: She says she is afraid of being alone and of robbers.(3)
At this point, the case starts being very clear, so I continue confirming the remedy I have in mind.
I ask about compulsiveness and her relationship to order, cleaning the house, etc. She says she is very tidy (3), she cleans her house very often (3) and she even arranges things in line according to their size, colour, or other parameters (e.g. remote controls on the table). She also confirms checking several times things she does. (3) For example, she has to come back several times to check whether she locked the door, turned off the iron, etc.
To my question concerning fear of contagion, she replies that she has dreams about disgusting things, like visiting public toilets which are full of faeces. She also says that when she opens any foodstuff, for instance, a yoghurt, and she does not finish it at once, she never comes back to it anymore. She never eats it any more even if it has been in the fridge for only one hour.(3)
She has been very critical lately. (3) For her whole life she has had stage fright. (3)
She had congenital developmental dysplasia of hips in childhood and congenital oligodontia of many permanent teeth. She still had five primary teeth until the age of 30 and she has implants instead of them.
Analysis of the case:
Pregnancy is often very exhaustive for a woman’s organism. It decreases the overall vitality and it may produce some complaints. Sometimes already established complaints get worse or a completely new set of symptoms may occur. Of course, I do not mean usual pregnancy-related complaints like overall sensitivity, nausea, food desires, etc. These symptoms are actually pathognomonic. However, some women may develop complaints which are not so usual in pregnancy. They are often hormone-related (like headaches, leucorrhoea, hypothyroidism, and others) and even psychological symptoms may develop. On the other hand, some women with a personal history of hormonal problems may actually benefit from the hormonal changes in pregnancy and their complaints may temporarily or even permanently disappear or ameliorate during pregnancy. In this patient, the decline in the overall vitality in pregnancy forced the organism to produce emotional symptoms.
Selection of symptoms:
- anxiety about her family, fear that something bad will happen to the family (3)
- anxiety about health, hypochondriacal (3)
- fear of robbers (3)
- desire for order, fastidious, checking (3)
- ailments started in pregnancy
- anxiety with heaviness and sensation of a stone in the chest (3) and trembling of hands (2)
- chilly (2)
- critical (3)
- hangnails (2)
- eruptions in the corners of mouth (2)
Fear that the world will not be safe for her children in the future is not a symptom from my point of view (unless it is really exaggerated which is not the case here) considering what is going on in our society today.
I believe I could use fear of contagion as a symptom but for the sake of correctness I will not include it in the list of main symptoms. We can come back to it in the differential diagnosis if it fits any of the discussed remedies.
When we treat an adult patient, symptoms which have been present since childhood are usually of a secondary importance because it is rare for a person to need only one remedy for her/his whole life. Older symptoms are usually also less intense than they used to be in the past or they are not present at all anymore. Most patients need different remedies in different stages of their lives. However, if the old symptoms are still very strong and peculiar, or even stronger than in the past, we sometimes take them into consideration for the first prescription (the uppermost layer).
To understand this better, try to imagine what we expect from the remedy. We are looking for a remedy which would produce (in a proving) symptoms similar to the most individual and characteristic symptoms that the organism is producing at the moment.We need a remedy to which the organism is sensitive now. And such a remedy will cover the current most peculiar and most intense symptoms.
In this case, I do not take the lack of thirst, aversion to water and biting of nails into consideration at the moment. We may have needed to use them if there had not been enough other symptoms. Because the eczema does not have any peculiar strong modalities, I will not use it either.
I have to emphasise that I did not need to make a full repertorisation in this case and I only looked into some rubrics to check the remedies they contain. So, the following rubrics by no means represent a proper repertorisation of the case, but instead, I tried to list all relevant rubrics which express the most important symptoms of the case. These are rather possibilities of the rubrics which may have been used.
Possible relevant rubrics: (using The Essential Synthesis repertory)
MIND – ANXIETY – family; about his
MIND – ANXIETY – children – about his
MIND – FEAR – happen, something will – family; to his
MIND – FEAR – happen, something will
MIND – ANXIETY – health; about – own health; one’s
MIND – ANXIETY – hypochondriacal
MIND – FEAR – robbers, of
MIND – REST – cannot rest when things are not in the proper place
MIND – FASTIDIOUS
MIND – CHECKING – twice or more; must check
MIND – PREGNANCY – during pregnancy
MIND – ANXIETY – pregnancy, in
FEMALE GENITALIA/SEX – PREGNANCY
CHEST – OPPRESSION
CHEST – OPPRESSION – anxious
CHEST – ANXIETY in
CHEST – STONE; sensation of a – Inside
EXTREMITIES – TREMBLING – Hands – anxiety; with
GENERALS – TREMBLING – Externally – anxiety – from
GENERALS – HEAT – lack of vital heat
MIND – CENSORIOUS
EXTREMITIES – NAILS; complaints of – hangnails
FACE – ERUPTIONS – Mouth – Corners of
Differential diagnosis of the most probable remedies:
Natrum muriaticum has fear of robbers and eruptions in the corners of mouth as keynotes. It has a great sense of responsibility and the person can therefore also act very responsibly towards her family and children. Natrum muriaticum can have a very strong hypochondriacal anxiety about health. It covers fastidiousness, compulsive thoughts and even fear of germs and contagion. It belongs to the main remedies for hangnails. Natrum muriaticum can be found in the rubric MIND – PREGNANCY – during pregnancy and in Hering’s Guiding symptoms2 we can find this interesting sentence: “A pregnant woman saw a man who had a disfiguring nasal cancer; this haunted her, and she was sure her child would be marked; she was melancholy, avoided society, wept continually.“ This is an example of a hypochondriacal anxiety in pregnancy resulting in a fear about the woman’s child. I do not mean to say that anxiety about one’s family is a strong feature of this remedy, but at least, we have to admit that this symptom was observed in the proving. In any case, Natrum muriaticum’s anxiety about family is not very strong and it is a remedy aggravated by heat.