A 33-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:
Peculiar 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
Intense symptoms:
- 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.
Repertorisation:
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)[1]
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.
Phosphorus is the first remedy one should think of when we see a combination of anxiety about others (family, children, relatives, friends) and fear that something bad is going to happen. On top of that, it is one of the most anxious and hypochondriacal remedies in our Materia medica. It is a remedy full of fears and it can also have fear of robbers. The fastidious element can be confirmed in some sources but it is not a strong feature of this remedy. Phosphorus has very strong oppression in the chest and we can confirm the anxious feeling in chest in several books of Materia medica.[2] It is a chilly remedy.
Causticum also covers the combination of anxiety about others and fear that something bad is going to happen. The latter is a keynote of this remedy. The anxiety about others in Causticum also originates from its strong sympathetic element, like in Phosphorus. Causticum can be very fastidious, especially in the form of fear that she/he has forgotten something and the person is compelled to repeatedly check what he has done. It is a keynote of this remedy. This remedy is chilly and worse from cold (esp. cold dry weather). Causticum can be found as the only remedy in the rubric CHEST – STONE; sensation of a – Inside. However, here it is rather a raw feeling, not heaviness.
Aconitum napellus is a very anxious remedy. Confirmation of Aconitum’s anxiety about others can be found, for example, in George Vithoulkas’ Materia Medica Viva.[3] Anxiety about others in Aconitum also comes from a sympathetic element. However, anxieties of this remedy come very intensively and suddenly, like an explosion, even in a form of panic attacks. There is a wonderful differential diagnosis of the most prominent remedies for anxiety about others in the Materia Medica Viva3 which is definitely worth reading. Fear that something bad is going to happen can also be present in this remedy, especially fear that he or his relatives or friends will get hurt (in some accident, etc.). And it is no surprise that this remedy with its intense panic attacks and tremendous fear of death has a strong anxiety about his own health. Aconitum is especially afraid of brain stroke and heart disease (heart will stop). However, these states come suddenly and intensively in waves in Aconitum and are not present permanently (unlike in our case).The remedy is listed in the rubric MIND – ANXIETY – pregnancy, in and it can be confirmed for example in Hering’s Materia Medica2. The remedy covers oppression in chest during anxiety and it is generally worse from cold dry weather.
Sulphur has a strong anxiety about his family (esp. about his children) and hypochondriacal anxiety about his own health. It is one of the main remedies for fear of contagion and germs. It is its keynote, as well as a tendency to be critical. It covers hangnails. Sulphur can be fastidious but we mostly see the opposite, a tendency to be sloppy and disorganized, which does not correspond with our case. On top of that, most Sulphur cases are warm-blooded (although we can see exceptions).
Arsenicum album has anxiety about his own health, fastidiousness, desire for order and chilliness as keynotes. It is actually one of the two main remedies (together with Carcinosin) for patients who cannot rest until everything around them is clean and in perfect order. Together with Natrum muriaticum, it belongs to the main remedies for fear of robbers. It also has a strong anxiety for others, especially because they are afraid they would be in danger if they remained alone. Apart from the strong need for visual order, the fastidiousness of this remedy can also take a form of checking what they did. This originates from the constant feeling of insecurity which is the essence of this remedy. Arsenicum album patients tend to be very critical and they can have fear of infections. It covers oppression in chest very well (it is one of the most important remedies for asthma). Fear that something will happen can be confirmed in this remedy too. For example, in Hering’s Guiding symptoms2, we can read:
“Gloomy forebodings while lying in bed, in evening, fears something may have happened to his relatives.“
Carcinosinhas an intense anxiety for others, which originates from its strongly affectionate nature. It covers anxiety about health and it is probably the most important remedy for desire for visual order and tendency to fastidiously clean the environment around them (house, room, etc.). However, Carcinosin is usually worse from heat (or both extremes of temperature) and is not critical. On the contrary, due to their lack of confidence, hearing the slightest criticism is a total disaster for these people.
Sabina is a remedy with a strong affinity for the female hormonal system and has a strong anxiety about losing her child during pregnancy. However, it cannot be confirmed otherwise and it is worse from heat.
Cimicifuga racemosa is another important remedy affecting the reproductive system of women and it covers fears which develop during pregnancy. It is a chilly remedy.
Choice of the remedy
There is only one remedy which covers all the important aspects of the case, namely the hypochondriacal anxiety about health, anxiety about his family, fastidiousness, desire for order, checking, fear of robbers, and tendency to be critical. This remedy can also be confirmed by chilliness, and oppression in chest and its essence (insecurity) fits the case very well. The remedy also covers the aversion to any food which has been already opened (fear of infection). The remedy is Arsenicum album. There is another aspect which could be considered. The patient clearly has syphilitic personal anamnesis (lack of secondary teeth and congenital hip dysplasia) and Arsenicum album is considered to have strongly syphilitic symptomatology. I do not mean that we should base our prescription solely on miasms, but sometimes it is a good confirmation of the remedy. On the other hand, there are cases where miasmatic background may play a major role in the selection of the remedy (family or personal history of tuberculosis, gonorrhea, syphilis, cancer, etc.).
Prescription: Arsenicum album 200C single dose
Outcome of the treatment:
After taking the remedy, the patient’s eczema got much worse for a few days and then disappeared. She also felt more thirst for a few days. Ten days after the remedy, she already noticed being generally calmer.
We made a proper follow up two months after the remedy. She said she felt much better. She did not feel any anxiety and she felt much calmer in general. All physical manifestations of anxiety were gone. She said she was not so fastidious anymore and she could let things go more easily. She did not clean her house every day, but she still preferred when things were in order. However, she said that she was not a slave of it anymore. She was checking things much less than before treatment. She could control it better with her will. Anxiety about her family decreased to a normal degree. She was much less anxious about her own health too. She had more energy.
She felt very well for another two months but then she got pregnant. However, the foetus soon stopped developing and it had to be removed under general anaesthesia.
After the abortion, her original anxieties and other psychological symptoms gradually came back in the course of about one month. First, it was once in a few days, but then it gradually escalated to the same degree as before treatment when she had it every day. Her eczema came back too.
Because the symptom picture was the same as before treatment, I repeated Arsenicum album 200C, single dose. The complaints went away again, but this time, without an aggravation and they have not returned. The follow up of the case is now 2.5 years and she has not needed any other remedy.
Discussion:
The reaction to the remedy was favourable. There was an initial aggravation of the eczema, which is a good sign, because it means the organism was strong enough to produce an aggravation only on the physical level. It had spare energy to do that. There was also a proving symptom of Arsenicum album, the increased thirst. Proving symptoms are a good sign when the overall reaction is positive. It means that we hit the bull’s eye and that the organism is sensitive to this remedy. The improvement was obvious and quite rapid.
Another interesting thing is that the eczema got better as well. In a patient who has psychological and physical problems at the same time, we would expect the pathology to shift from the psychological to the physical level first. In this case, both levels got better at the same time. It means that the organism’s defence mechanism was strong. Most probably the previous homeopathic treatment at the age of 20 contributed to that. She did not know which remedy she took at that time, but it is possible that she may have needed Arsenicum album at that time too.
I am not very happy when I hear that other homeopaths do not tell their patients names of the prescribed remedies. It can be needed or at least handy when a patient changes homeopaths. When we treat somebody, who has previously taken some homeopathic remedies it is very important to evaluate which remedies may have had good effect and which may have only changed the patient’s symptomatology. For example, if a person takes a close remedy which is not exact enough, it may change his symptomatology and produce some new symptoms. These cases are often very difficult to disentangle and when we know that the person took, for example, Pulsatilla and since than he has been thirstless but the remedy has not improved his general condition, we know that we must ignore this new symptom. If we do not know that the person took Pulsatilla and even worse, we do not know what was the reaction, we may not be able to decide whether to use this symptom or not.
The reader will most probably ask how it is possible that the pregnancy was unsuccessful when the remedy was correct. First of all, there are many things that can go wrong during the development of the fetus, so it might just have been a coincidence and it is also important to say that the pregnancy was unintentional. She did not plan it. On top of that, we must not forget that there is a syphilitic background in this case. And finally, she got pregnant very soon after the remedy. I believe that there would have been a higher chance for the pregnancy to be successful if she had gotten pregnant later and the remedy had had more time to act.
This case does not belong to the complicated ones and the remedy picture was clear. However, it is important to keep in mind we have to battle our way through the case to get the final remedy picture. In the beginning of each case, we only have limited information, and we have to spot or find something upon which we can base our further investigation and by asking the right questions we have to confirm or exclude possible remedies. We have to find something in the initial information that would show us which way to turn our helm.
Sometimes one keynote which the person spontaneously gives us or which we get by observation serves as a compass or a directional signpost showing the right direction of investigation.
There is also another type of case, which looks very clear in the beginning and the information we get in the initial part of the interview clearly points to some remedy but as we investigate the case further, possibilities of other remedies grow and we may find some symptoms which finally need to be addressed preferentially and the case may take a completely different turn. There are also cases where we miss any reliable symptoms in the beginning and these are obviously the most difficult ones. One has to make every effort to find something reliable upon which we can base our further investigation, something the person says, something we observe, aetiology, or something in the patient’s personal or family history or what his relatives say about him. This is the “artistic” part of homeopathy and it takes some time and experience to develop these skills. It is almost like a “sixth” sense (figuratively speaking) which gradually develops with years of practice.
[1]SCHROYENS, F. TheEssentialSynthesis 9.2E. London: Homeopathic Book Publishers, 2007. ISBN: 978-0-9557151-0-5
[2] HERING, C. Guiding Symptoms of Our Materia Medica. [online]. https://homeopathybooks.in/guiding-symptoms-of-our-materia-medica/
[3]VITHOULKAS, G. Materia Medica Viva. Volume 1. London: Homeopathic Book Publishers, 1995. ISBN 0-9522744-77, p. 53
