Mrs. ABT, 31 years, was compelled by one of her friends to make an appointment with me to find help for her anxiety.
PRESENTING COMPLAINTS: anxiety, insomnia and stomach issues
INITIAL OBSERVATIONS AND IMPRESSIONS:
ABT is a pencil-thin, very pale and nervous-looking Caucasian woman with sharp, fine features and very delicate, thin skin. She totally avoids looking me in the eye. When I shake her hand, she looks at the floor, and I get a feeling as if I am holding a cold, dead and limp fish. In my office (heated to a comfy 70 degrees) ABT keeps her outdoor winter jacket and boots on. She prefers to stuff her hands into her pockets. She sits on the edge of the chair. Her lips quiver. When she takes her hands out, it is only to grab a tissue to wipe her eyes. She also likes to fold a tissue several times – very neatly – and then unfold it. She does this folding and unfolding over and over again. ABT informs me that her husband drove her to this appointment, as she was too scared to come on her own.
ABT’s family history includes diabetes, arthritis, asthma and cancer. She does not know anything about her biological father and his family. Her mother does not know either and calls ABT’s father a “sperm donor”.
ABT talks in soft, hushed whispers. Her voice is husky. She uses short-clipped phrases. Some of her sentences are made up of just one word. From her sparse narrative, I gather the following themes.
“Just ill at ease. Depressed. Can’t be there at home and enjoy myself. Not content being at home. Think of other things I would rather be doing. Have to go somewhere, don’t know where, why. Want to stay busy – to the point of exhaustion. Spend a lot of time pacing – like a caged animal. Nothing feels comfy, homey. Searching for that corner that would feel comfy. Can’t. Want to get out of my skin. Jumpy. Use up all my energy and fall off from exhaustion. Jittery.
“Confused, don’t know what is happening? Blank mind. Disorganized home confuses me. ‘ Obsessive-compulsive behavior’ Got this diagnosis in my 20s after losing my boyfriend. Became anorexic. Go on and on cleaning house, cleaning closets. Can’t stop, do till point of exhaustion. If have to stop in the middle, get angry. Start all over again. Never get it all done. Clean organized home – less confusion. Put everything in perfect order till I fall off from exhaustion. Doing it half-way weighs on my head. Can’t stop thinking about unfinished work. Don’t feel comfy in messy spots at home – clean it over and over again. Can’t focus on kids, keep thinking about cleaning. My pottery studio – focused, organized, neat and clean, predictable. I am at ease. I control the place. House is overwhelming, unpredictable, messy.
“Dreading what will happen. Nervous always. Nervous talking to you. Nervous when you look at me. Afraid of coming here. People listening to me, looking at me, words get stuck in throat, I can’t speak. Anxious in social situations when people look at me. Everyday life, tasks are overwhelming. Want to do a lot, don’t want to do anything.”
“Uncomfy with my appearance. Want to look neat and tidy. Dislike clutter. Want to shrink into a ball, go into stomach and disappear. Crumble, crush, be gone.”
“Want distance from husband and kids. Irritable. Don’t want husband to touch me. Want all his attention. Afraid he will leave me. He is very supportive of me, but I am cheating him badly. He deserves someone better. I am lonely. Want someone to be with me. House is extremely disorganized, makes me crazy, confused, irritable, angry with kids.”
“Stay up all night. Go to sleep, wake up with a start around 2:00. Can’t fall back asleep. No sleep meds help. Anxious about son’s asthma attacks. Anticipate it at night. Feel alone. Pace around. Exhausted, shivering.”
“Done something wrong. Don’t know what. Feel guilty for upsetting his sleep, being so needy. Feel so guilty when he gives me his support. Feel guilty I am a burden. Recognize it, can’t help being so. Feel guilty I don’t give him what he needs. I am inadequate.”
“Afraid, will get sick from all this mess at home. Must clean. Afraid to be alone. Afraid to be in social situation, when people give attention, look at me, talk to me, listen to me. Ants, spiders, falling, driving in winter, heights. Deep concerns about money. It will be stolen. Don’t have enough. Keep only five ten dollars in pocketbook. Everything is in bank. Save money, don’t spend. Don’t keep at home. Afraid, intruders will steal all money at night.”
- RECURRENT DREAMS:
“Man turned into evil, climbed on my steps, could not see him in the eyes, if I did, something bad will happen, running away from this evil creature. He has come to steal my money.”
- WARMTH: “Cannot get warm enough. Not ever. Longing for warmth. Always freezing.”
- FOOD / DRINKS: “Very thirsty, keep sipping hot water. Love sweets.”
- PHYSICAL ISSUES:
“Catch a lot of colds. Coughs and headaches. Nose burns with discharge. Vaginal Yeast infection since ten years of age, comes before menses, severe itching, burning, as if skin inside is peeling off, feels better with very hot water baths. Hands feet always icy cold – chilly person, can’t get warm enough. When awake at night, shivering, chilly, can’t stay in bed, must move about. Stomach does half-turns. Can’t eat. Feel anxiety in stomach, like fluttering. Start to fall asleep, stomach does half turns – wake up with a jar. Shock going through. Beyond my control. Afraid when it happens at night. Daytime, feel like butterflies in stomach. Can’t eat. This stomach, this fear is controlling me. Stomach turning with diarrhea and heart burn. Burning in anus. Hot water feels good.”
CENTRAL THEME OF THIS CASE:
ABT’s symptoms started in January 2010. Her main discomfort lies in feeling very anxious, cold, sleepless and in her inability to relax in her home which she finds dirty, cluttered, messy, disorganized – she must bring in organization and cleanliness by working at it relentlessly, doing it over and over again till she falls off from exhaustion. She feels her anxiety in her stomach which, according to her, does ‘half turns’. She needs support and comfort from her husband, but feels guilty in accepting it, and can’t give him back what he needs. She is deeply concerned about money and is afraid her money will be stolen. She does not carry more than $ 5 -10 in her pocketbook. She dreams about her money being stolen by an evil man.
RUBRICS: In selecting rubrics for this case, I kept the central theme in mind and used Mac Rep software. From 2008 complete repertory, I picked the rubrics that cover mental-emotional and as well as physical symptoms experienced by ABT.
- Mind; ANXIETY; MIDNIGHT; After (35)
- Mind; COMPULSIVE DISORDERS (47)
- Mind; REST; CANNOT, when things are not in proper place (14)
- Mind; RESTLESSNESS, NERVOUSNESS; DRIVES him from place to place, must move (128)
- Mind; DELUSIONS, IMAGINATIONS; WRONG; He has done (44)
- Mind; FEAR; POVERTY, of (48)
- Mind; FASTIDIOUS (89)
- Stomach; ANXIETY (127)
- Generalities; WARMTH; DESIRES (40)
- Generalities; FOOD AND DRINKS; WARM; Drinks, water; amel. (67)
Based on my analysis, I chose Arsenicum album, Nux vomica and Silica for further consideration.
Murphy mentions “All-prevailing anxiety, exhaustion and restlessness with nightly aggravation.” An individual needing Arsenicum is extremely nervous and anxious, clinging and desperate. His restlessness and anguish drives him from place to place and still he can’t find rest. His anxiety is about his own health, about his family and other people, and about other trifles. Fear of catching disease from germs drives them to extreme cleanliness, repeated hand-washing. They exhibit a wide range of obsessive-compulsive behavior, and are upset with disorder, dirt, and messy surroundings. They get confused when disorganized. They can be clingy to the caregiver – be it their doctor or a family member, need continuous reassurance. No rest anywhere. Restlessness is one of the grand characteristic of Arsenicum (Clarke). Arsenicum is known to have its sphere of action in gastrointestinal area. Their anxiety is felt in the pit of the stomach. Pains and discharges have a burning quality to them, but are better from heat (headaches better from cold application, Kent). They are sleepless from nervous exhaustion, restlessness and anxiety (anxiety mixed with fear, Kent) and their worst time is after midnight. They are better from company, warm drinks and food, warm wraps, hot dry applications, and worse at sea side, wet, cold and damp. Better moving around, sitting erect and hugging the fire (Murphy). Morrison mentions that Vithoulkas uses the term “insecurity” to describe the essence of this remedy. Patient has an overwhelming sense of vulnerability in the world and fears for his own security, and symptoms like anxiety, dependency, avarice, compulsiveness, need for control and despair –all these spring from their central feeling of insecurity.
I hold this image of Arsenicum album against the portrait of ABT that has emerged from the case taking. ABT presents symptoms of restlessness, sleeplessness and anxiety. She is fearful of a dirty, messy and disorganized household – this confuses her and she feels out of control. To feel secure and in control, she spends a lot of time and energy cleaning and organizing her house – to the point when she falls off from exhaustion. ABT has anxiety and fear for her family members – she waits anxiously at night, awake and restless, for her son’s asthma symptoms. She is afraid that her husband will leave her – she needs his support, but she feels bad for him that she does not give him what he needs. She is afraid her money will be stolen by evil intruders. Her way of controlling this is to keep all her money in the bank. ABT has mentioned being chilly, never warm enough and always looking to get warm. Hot water gives relief to her chilly body as well as relieves her symptoms of itchy and burning vaginal discharge. The remedy picture of Arsenicum and portrait of ABT match very closely at the level of mental-emotional and physical symptoms. The essence of Arsenicum – insecurity – also appears to be the essence of ABT.
Murphy mentions about Nux vomica, “irritable nervous system, hypersensitive and over-impressionable, hypochondriacal states, zealous, fiery temperament. Very irritable. Over-sensitive to external impressions. Angry, impatient when spoken to, quarrelsome, spiteful, malicious, violent, abusive”. Nagging, fault-finding (Kent). Suicidal and homicidal impulses. Competitive, fastidious. Morrison mentions “type A personality” – confident, over achieving, workaholic. Craving for stimulants – needs coffee to work and alcohol to sleep (Vermeulen). Physical pathology centers around gastro-intestinal disturbance (Boericke). Nux patient is chilly, worse from cold, better from warmth and rest (Clarke).
The picture of Nux that emerges here is one of an over-stimulated, over worked person who is driven to be on top, number one, and he can get nasty, cutting, sharp, and malicious when someone gets in the way. Herring mentions, “Hypochondriac mood of persons of sedentary habits, and of those who dissipate it at night, with abdominal suffering and constipation, also when worse after eating, with sensitiveness.” Murphy states, “Nux-v is useful for those …doing much mental work, or to those who remain under stress and strain of prolonged office work, business cares, and worries. Generally thin, spare, quick, active, nervous and irritable. Hypersensitive and over-impressionable. Digestive disturbances. Zealous, fiery temperaments. Easily chilled. Workaholics, ambitious, competitive, can’t bear noises, odors, light, touch, music”.
Nux individuals have obsessive compulsive behavior, nagging, fastidious, spiteful nature and they engage in cursing. Using abusive language, they tend to slander. They are angry, impatient and offended easily. They quarrel, reproach, insult, and scold from jealousy. Abdominal area is a major site of disturbance, as far as physical symptomology are concerned, and one of central experiences of Nux individuals is as if they are never completely done – whether it is evacuating the bowels or urination. The main difference between Nux and Arsenicum individual is that though both are very chilly, in order to stay warm, Nux wants to stay completely covered, and is very uncomfortable if the covers move even slightly. He withdraws from his external surroundings and refuses to allow further sensory input in order to get some repose that he actually craves. Arsenicum individual is chilly too, but is so restless that he has to move from place to place, from one position to another because he never gets to be warm and comfortable in a place. There is a deeply felt sense of inner unrest along with chilliness.
ABT’s portrait does not resemble Nux vomica, as she does not show the over-achieving, angry, competitive, obsessive, chilly, repose-seeking individual who has had a sensory overload. With her insecurities, money related fears, and compulsive need for order and cleanliness, fastidiousness, and her restlessness, she resembles the Arsenic picture more closely.
Morrison states, “need for internal grit” as an indication for Silica. Patient is refined, delicate, sensitive and yielding. Emotional level is fairly well balanced, but self-confidence is often very poor. Paralyzed by irresolution and insecurity about his performance / perceptions, he may give up his work, and being conscientious about trifles, he may dwell compulsively on small details. Low stamina is shown as physical weakness. Physical pathology is around skin, bones, teeth, nails.
Murphy mentions, “… easy exhaustion, emaciation, want of vital heat, faint hearted, anxious, nervous, lack of self-confidence. Anticipates failure. Fear of speaking in front of people, timidity about appearing in public and fastidious for details. Fear of needles, pins, sharp objects. They desire only cold things – ice cream, ice water – even though they lack vital heat. They have disgust for warm food and milk. They are better for warmth. They can over exert their minds, and avoid things that take away their energy, tend to monitor their energy functions.” Lippe outlines “Imperfectly nourished not from want of food taken, but from imperfect assimilation. Weakness with associated sleepiness. Restlessness consequent upon physical inactivity.”
This brings out beautifully the difference in how ABT experiences her symptoms and how different she is from a Silica picture. ABT comes across as one with a high degree of insecurity that dictates how she feels in public, and how she speaks even. It is not from anticipating failure. Unlike Silica, she does not get relief from using cold foods and drinks – she craves warmth, warm food / drinks. Unlike Silica, she does not abstain from activities that take energy, she does not monitor her energy level, instead, driven by her compulsive need for cleanliness and order, she keeps doing something over and over till she falls off from exhaustion. Her anxiousness, sleeplessness, nervousness, fears, and lack of confidence do not appear to arise from lack of internal grit, but mainly from her internal restlessness and insecurity.
PRESCRIPTION AND DOSAGE:
Based on the differential examination of the indicated remedies, I select Arsenicum album for ABT and give her a dry dose in 200c potency. She has mentioned physical complaints like stomach doing half-turns, recurrent yeast infection prior to her menses, sleep issues and for these reasons, I decide to start her on a relatively lower potency – 200c. I would monitor her response to this potency in terms of her stomach symptoms, yeast infection with burning, chilliness and sleep issues. On finding favorable response in these areas, I can move up in potency if and when necessary.
FIRST FOLLOW UP, MARCH 16, 2010:
Snow is beginning to melt. It almost feels like spring but ABT has the same winter jacket on. One difference from before is that she has kept the zip open. ABT still looks at the ground while shaking my hand, and avoids eye contact throughout. Her voice is a bit stronger and her lips are still quivering but not as much as before. Her sentences continue to be small and one-worded very often. She has played with the tissue again, folding and unfolding it, but somewhere along the middle of the session, she wiped her eyes with the same tissue, and then discarded it in the bin. She did not pick up another tissue to fold and unfold. ABT says, “Not sure, feels like a bit better – stomach – haven’t had many half turns.”
I ask her how she has felt in herself, and she says, “Not sure. Sleep ok. Not up, not pacing the house at 2:00 many nights. Not bothered by the front door as much. Don’t feel anyone will come in at night. Sleep ok. Not waking up after midnight. Kids ok. Little one gets lots of colds, but doesn’t upset me.”
Apart of this she is quite reluctant to talk, keeps staring at the floor, and is shifting around in her seat a bit. When I ask her, ‘what is bothering you now?’ she says that she does not like to talk about herself, and feels awkward that I am giving her all my attention.
I do not want to push her beyond her comfort zone this time. The brief interview ends quickly but I have at least one pointer, “Not sure, feels like a bit better – stomach – haven’t had many half turns.” Also, I have observed that she has folded and unfolded the tissue much less this time, just for a short time, and then she has placed her hands in her pockets. I respect her need to speak less. ABT is very relieved that the session is over. Quickly she gathers her stuff, is out the door and into the waiting car – her husband is at the driver’s seat.
ASSESSMENT AND PRESCRIPTION:
I understand the remedy to be working. She has not complained of stomach issues. Her lips are quivering much less. Her preoccupation with folding and unfolding the tissue is greatly reduced. She has said that she is not bothered by the door at night and is not worried that someone will come in. She has mentioned sleeping ok, waking up much less, and not pacing the house at night. This is a good development over all. She has experienced relief in her presenting complaints. I decide not to repeat the remedy.
For reassuring her, I give a dose of placebo, saying that this dose will help her maintain her progress.
SECOND FOLLOW UP, MAY 11, 2010:
It is a rainy and cold spring day – and ABT is all bundled up. “Don’t like this weather. Freeze to the bones. Keep the house at 72 degrees. Still freeze. Spending all money on fuel. Wish to live in a hot country. Save all that money. Yeast bothering me. Burning, itching. Don’t allow husband to touch me – feel guilty – but need him.” While saying this in halting sentences, and looking very pale and cold and anxious, ABT has gotten her hands busy with the tissues – folding and unfolding them again and again.
ASSESSMENT AND PRESCRIPTION:
ABT was given her very first dose of Arsenicum album 200c on Feb 18. It is May now and almost 9 weeks have gone by. She had started responding well, but presently, her issues of feeling very cold, worrying about money, yeast infection that burns and itches, and her feeling of guilt around needing her husband but not giving him what he needs – have resurfaced. She has not mentioned about stomach and sleep symptoms that were bothering her earlier. Arsenicum has helped her but it is called for again because there are more symptoms to be addressed.
Since her physical symptoms are quite active, I decide to repeat Arsenicum in 200c potency and send her home with a dose of the same with instructions to take the dose if the yeast symptoms persisted. I ask her to let me know how she is doing in a week.
One week later, she came for the appointment with her husband. She said, “No more itching. Doesn’t burn either. Doing MUCH, MUCH BETTER. OK.” She does not say much, but her voice is sounding stronger to me. I tell her not to repeat the dose. Just keep it with her.
After the session, her husband asks if he could speak with me briefly. ‘Sure’, I say to him and ask him what he has on his mind. He says, “Can just one dose of whatever you are giving calm down a yeast infection? Isn’t there a course she must complete as they do with antibiotics?”
It is my policy that I address the concerns of family members if these are brought to my attention. I respect the questions and concerns of the family members also because, per my dear teacher Misha Norland – no one suffers alone. When one person in the family is sick, it does affect everyone else as well. Briefly, I explain to him, “Classical Homeopathy is not based on the war model. We do not involve ourselves with fighting with germs and killing them till the last one of them falls dead. Rather, we stimulate the energy of the Vital Force by giving a remedy that closely matches with the mental-emotional and physical symptoms shown by the person. When the picture of the remedy and the individual matches closely, the energy of the remedy stimulates the vital force sufficiently so that it can heal the body and help it get rid of the disease state. It is a healing process from inside out. The closer the match, the smaller the dose required.” He said he was getting the hang of it, but needed to do some serious reading to educate himself. Could I recommend a good book, please? In my view, we all need to continue educating ourselves further and I am always happy to recommend a book. I suggest, “The science of Homeopathy by George Vithoulkas” There you go, Vithoulkas, Sir, one more of your books sold. Congratulations and thank you for writing a book that continues to be of help in understanding Homeopathy.
THIRD FOLLOW UP JULY 13, 2010:
ABT has driven herself for this session. It is a hot and dry day. “Like sun. Drove myself. Coming to your office feels ok.” ABT says and while she continues to look down and away from me, I notice that her lips are not quivering and her voice is not as nervous, and soft. There is some strength in it. She continues, “Last month, no yeast before period. Sleeping better. Stomach is ok – eating more. Not pacing around house much. Husband sees that. He wants me to come here. Get well.”
I noticed that during this session, ABT did not pick up a tissue to fold and unfold. She kept her hands still and lying on her lap. She sat leaning back on the chair. I notice a slight weight gain as well, but have chosen not to comment on it. In the past she has been anorexic and body image consciousness is a part of that syndrome. I will keep observing and see if she holds onto her weight.
ASSESSMENT AND PRESCRIPTION:
After a repeat dose of Arsenicum 200c in May, 8 weeks later, ABT is still doing well. Remedy is working to alleviate her physical symptoms of yeast infection, and stomach doing half turns as well as her mental – emotional symptoms of sleeplessness restless pacing. I decide not to repeat the remedy. No new symptom picture has emerged calling for any other course of action.
FOURTH FOLLOW UP SEPTEMBER 14, 2010:
For this session, ABT has thick corduroy trousers and jacket on – and on her own, she has extended her hand to me! I shake it – and feel a bit of warmth in it. She sits back on the chair and rests her hands on her lap – that is where they stay for most of the session. She has not moved around much on the chair, almost like sitting still. Her voice is stronger, the strongest I have ever heard from her so far. Her sentences have some more structure to them, instead of being monosyllabic. She says, “I am eating much better because stomach has stopped doing those half-turns. I am a lot more rested during the day because I am sleeping better. Not wiped out with exhaustion. Not waking up so many times to pace around, go see the door. I am showing kids how to put their shoes away – in pairs, where to pile their toys so they don’t get crushed underfoot all over the house. I keep the door to their room closed – and don’t go tidying their room every day. Husband says, they are just kids, they will do fine without me killing myself cleaning their room.”
ASSESSMENT AND PRESCRIPTION:
After the first dose of Arsenicum album on February 18, and a repeat dose in May, ABT has continued to do well till now. There is improvement in her restlessness, sleep, energy level, she is eating better, does not have stomach issues, and she is not as bothered by the mess in the house as she used to be. She is not driven to compulsively cleaning her house. She is teaching kids to organize their stuff. She is taking her husband’s advice and not killing herself cleaning the kids’ rooms. She does not look as anxious as before. These developments show overall improvement in the mental-emotional and physical symptoms. I decide to let the remedy continue doing its job and not interfere with it.
FIFTH FOLLOW UP NOVEMBER 6, 2010:
ABT says, “I am too cold today. Just don’t know how I got myself over the mountain and into your office. My younger son is down with fever. Winter is coming. It is not my best time. I am worried about our heating bills. I get tired just thinking about it. I am up again in the night – sick baby, worrying about how he suffers. Worrying how we will pay the bills. Worrying, very restless, very anxious about don’t know what…” she whimpers and sobs softly.
ASSESSMENT AND PRESCRIPTION:
ABT has slid back to her money related worries, and she is restless, anxious about what she does not know. She is worried for her kid’s health, is worrying about heating bills. She reports being tired just thinking about it. She wakes up at night worrying. She is restless. However, she has not mentioned any recurrence of physical symptoms. I can understand a Mother being unable to come for her appointment because her child is sick. But ABT has presented anxiety and worrying tendency on behalf of not just her kid’s health but also about money. In the casetaking, money related issues were so important to her that she kept all her money in the bank and carried only 5 – 10 dollars in her pocket. She was afraid they will be stolen. This is a strange fear about money in our state- it has one of the lowest crime rates in the whole country and people are known to leave their doors open and go on a vacation!