Clinical Cases

A Case of Burnout and Exhaustion

Written by David A. Johnson

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This 25 year old female was first seen in October of ’08. Her main complaints included sleep difficulties, lack of energy and concentration, sadness and anger.

I’ve had trouble sleeping for seven months—it started in March. It takes me five hours to fall asleep, and then I’ll sleep for just three hours. I’ll suddenly jar out of sleep, then drift into thoughts. It happens after three to four hours—I’ll wake up, use the bathroom, and sometimes can’t get back to sleep.

I had some depression earlier this year. It makes my brain slow and foggy. It feels locked up. I get headaches and can’t think clearly. I get real frustrated and angry. It’s frustrating. There’s no place of refuge, no escape, no rest, no break. I’m too exhausted and limited to work full time. It’s frustrating. The fogginess feels like a heaviness of my head; I’m not able to think clearly or quickly. There’s nothing I can do about it.

As the hours progress and I’m not sleeping, I get more angry. I want to be able to do things and I can’t. Physically I’m trapped, in prison. I’m really severely limited—I want to live. ‘Where’s God in this?!’ ‘Why aren’t you doing something?!’ I feel disappointed, discouraged and angry.

My whole childhood was very difficult. I’m dealing with a lot of grief. There was physical, mental and emotional abuse—how wrong it was! I’m wrapped in pain. We’d work so late into the night that I’d be exhausted. I kept going and going. I made it when everything was against me. There was always so much work. My dad was horrible. I was just trying to survive.

Growing up, I was hyper-vigilant. I took care of everyone. I can’t hold up the world anymore. Now I’m stuck in bed and can’t even sleep. It’s not life as God intended. I grieve over the things I lost.

I can multi-task. I can do whatever I need to in order to make it. I want to minister to others but it feels like somebody won’t let me because he’s mean; there’s no concern for what I want. I’m helpless; I can’t do the one thing I want to do. I’m left to suffer or die. I’m really struggling with my image of God. It’s as if what he wants is at the expense of what I want. All I want right now is physical health. ‘How long am I supposed to go through this?!’

There’s nothing I can do—God is the only one and he won’t help, or he’s taking his time. It feels like a man on a power trip. My dad was like that—selfish, not a father, just an authority figure out of control. It was like ‘this is the way I’m doing it and you have to get over it!’

When I’m the most angry at God, I’ll be emotionally out of control. I’ll be crying, hurting, saying ‘You’re a liar!’ ‘What kind of Plan is this?!’ I don’t care about his Plan—I care about right now. I’m trying to rest. I ask ‘What is it you want?!’ There’s nothing more I can do. ‘If you’re going to tell me to do something, give me the tools—don’t tell me to do something and then not care if I’m not equipped.’ I feel like a little kid at the mercy of a God who doesn’t even care. He’s delighting in others who are just living their lives.

I’ve been so angry I’ve wanted God to be a physical person so I could beat on him. It’s a rage—I want to destroy something to get the destruction out of me. I’ll think ‘just kill me now!’ I’m tired of waiting for freedom. There’s a sadness that God isn’t who I want him to be. I want a say in things. I want to experience the physical freedom I’ve enjoyed spiritually.

Note: Before this next appointment, the patient had been participating in healing sessions with other members of her church.

Practitioner: Can you describe more about freedom?

Freedom is a lightness, a joy, a peace. I’m not bogged down, I’m not constantly thinking about things of the past. I was so wounded. I’m better able to accept others now. The depression and pain have been heavy, as if I’ve been carrying weights tied to my body. Being healed from that makes the load lighter. It’s like dragging in the mud, being bogged down, held down.

It’s as if my insides were all tangled up, surrounded by darkness, evil preying on things that were supposed to keep me alive. Evil is that which seeks to devour our lives. Now everything has space to expand, to not be tangled up and compressed. It’s like breathing—if your lungs don’t have room, they don’t have the space and air to expand.

When all you’re trying to do is survive, things shut down—you go into starvation mode, things wither down; they’re not fully functioning. I’d turn inward and get tensed up, crumpled up. I tried to become invisible, not seen. All that anger needed room; the rest got tangled up and compressed. The compression was like a force, attacking, taking up residence where life was supposed to be inside of me.

That consuming evil, that force had to be driven out of me. It was an invasion, an attack, a destruction. It’s like the kingdom of darkness is battling to overtake, steal, kill. Withering down is losing life; expanding is gaining life, strength and vitality. It’s gaining a personality, becoming something in your own right. It’s becoming rather than withering, decaying, dying.

It’s like dead animals decaying on a farm. I grew up on a farm, so I saw the whole cycle of life. When the animals died, they’d be pulled to a pile where they’d slowly decay. The more there’s life, the more there’s physical light and lightness. There’s life and then there’s death. Life grows and death takes away. Death eats away at things that once gave you life.

I was front-line ministry—driving out demons. Satan doesn’t want to lose the battle. I’m battle weary. I’m tired. I need some time to be refreshed. Where Satan invaded, he’s been driven out. Satan is death. There was so much attack, so much pain.

Some things may need to be made anew—there’s been so much exhaustion. I see myself as a limp body without strength. It’s like I’m lying out in an open field, weary, tired, exhausted, without shelter or care. It’s a complete burn-out.

The healing drove out the invasion, but now there’s complete exhaustion. In the past I’d take in the pain and wouldn’t react. With the prayer sessions, I’d been holding all that pain and I gave myself permission to release it. I’d scream or retch, that kind of release. It was if I was in contraction with childbirth—the mother says ‘I can’t do this’—but then she does and is released from that. It’s a partial transformation, but I’m left with all this exhaustion. I say to God ‘I want to be in relationship with you—I’ll walk through the fire.’ But I didn’t realize how hot it was. I got halfway through and couldn’t finish. I’m exhausted but can’t turn back.

Assessment: Some of the recurring themes in this history are limitation vs. escape, domination vs. freedom, life vs. death, burn-out and exhaustion. She sees herself as lying in an open field, exhausted and without shelter or care. She made the comparison with dead animals decaying on a farm. She also has recurrent thoughts about the past, and grieves over what was lost.

Plan: Carbo-animalis LM 2

Follow-up in January ’09—two and half months after initial appointment–

I definitely have improved energy. But I was so completely exhausted, I still feel tired. I definitely feel better—maybe forty percent better. I’m not jarring out of sleep as often. About two weeks after starting the remedy, something changed. I don’t feel the anger towards my dad. I’m feeling more stable, on the upswing—there’s hope. My anger was the big issue at my last visit—that’s much better.

I’ve had some bizarre dreams—there’s a lot of family involved, a lot of mixing of old and new relationships. I had a dream of the old farm mixed with where I’m living at now.

I saw my father one week ago. I hadn’t seen him for one and a half years. I felt a lot of distinction between him and me. I thought ‘his behavior doesn’t define who I am.’ I didn’t feel the same pull to do the “dance” we always did, or to try to change him.

I feel sorry for him, but there’s nothing I can do. I didn’t feel the stress of trying to change him. I saw very clearly ‘I’m not my father’s daughter.’ I was happy for the test. I didn’t “spin out” after seeing him as I would in the past, and I didn’t get pulled back into old behaviors. Once it was over it was over.

Assessment: There’s clear early improvement in her overall energy, sleep and mood. Her dreams suggest early reconciliation between the past and present.

Plan: Increase to Carbo-animalis LM 3 (and eventually 4)

Follow-up in April ’09—six months after initial appointment–

I’ve been taking the LM 4 for seven to eight weeks. I’m feeling rested when I wake up. All this time a lot of anger, grief and fear have been released. I feel restored, rested, and more hopeful—I feel lighter. I’ve steadily lost weight on this remedy—fifteen pounds since the first meeting. My energy has definitely been improving. I’m feeling much more free. I don’t feel compressed. I’ve come out of a really dark place. I don’t feel so helpless. I’m a whole lot less angry. I definitely feel like the Lord is working in my life. My thinking—clarity—is definitely, definitely, hugely improved.

Plan: Increase to Carbo-animalis LM 5 (and eventually 6).

Phone follow-up in October ’09–one year after initial appointment: The patient stated she continues to do well. Financial problems have interfered with her ability to follow-up, so she stopped using the remedy after LM 6. She feels the remedy helped her greatly and plans to call if previous problems return.

Physically, carbo animalis is known as a cancer remedy with burning pains, but as Morrison pointed out, this is an end-stage condition. We should also consider disease progression before the appearance of cancer, which includes slow inflammatory processes with induration. The patient talked about a ‘compressive force’ (of anger) ‘taking up space where life should be’. Even though the anger had been ‘released’ through prayer sessions, the result was exhaustion. The patient described the whole process as having ‘walked through the fire’, becoming exhausted, and now not able to ‘turn back’. Similarly, Whitmont described the carbo-animalis state as reflective of incomplete oxidation and not fully living.

The patient also talked about her constant thoughts of the past, and grieving over what was lost. This relates to the carbo-animalis rubric of “homesickness”, which is thought to reflect the desire for a different time and place, when things might have been (or might be) better.

It’s interesting to reflect on the source of this remedy—charred ox-hide. There are carbon themes of work, physical and mental exhaustion, and collapse. There are also “animal” themes of survival and wanting to be nurtured, as well as the human “imprint” of domestication and abuse similar to that seen in lac-equinum.

Just as provings are a starting point for use of a remedy, clinical experience expands our understanding of its indications. This history reveals a broader picture of carbo-animalis, and suggests that differences in the carbon source (animal), the human imprint upon that source (domestication) and other influences (death, decay and charring) all contribute to the homeopathic understanding of a remedy.

About the author

David A. Johnson

David Johnson, CCH, RSHom(NA) is a homeopath residing in the southern Wisconsin area of the US. He is the author of “Radiance, Resonance and Healing: The Homeopathic Periodic Table” (Emryss Publishing) which is based on his 20 years of experience of matching the theoretical schema of Series and Stages with the words of clients. His email is [email protected]


  • Dear Dave,

    Thanks for very that interesting case, I would like to know what was a key innermost experience or sensation expressed by the patient which immediately navigated you to CARB. AN?
    “….We’d work so late into the night that I’d be exhausted. I kept going and going…..” or “The more there’s life, the more there’s physical light and lightness” (like dying charcoal still emitting the light and heat??… ) or “….there’s been so much exhaustion. I see myself as a limp body without strength…… It’s a complete burn-out”…..
    It is interesting that the overall idea was EXHAUSTION, so why you did not choose some acid remedies which are famous with depletion of energy (like picric, muriatic, phosphoric acids for example) I’m SURE 100% that CARB AN was a right remedy, but I would like to know what was an EXACT process of grasping of an INNERMOST EXPERIENCE which resonates with CARB AN. in that given case of our female patient?….Thank you!

    • Hello Vigen,

      Thank you for your very good questions. This was a complex history and it wasn’t until the end that the deeper state was revealed, so I wasn’t immediately directed to carbo-animalis. Many carbon remedies as similar to the acids relative to depletion and exhaustion, foggy thinking, etc. (e.g., carbo-vegetabilis). But if one were to pick an acid, it would be difficult to pick one that fits all the other facets of the history. Perhaps the closest would be nitric acid or carbonic acid, and they may helped. But I don’t feel either fit all the elements of the history–survival, working to exhaustion, feeling of being dominated, etc. Carbon is an element of energy, productivity, value and self-worth, and she compares her situation to farm animals having lived out their life cycle and then thrown onto a pile where they’re left to decay (they’re spent, “all used up”, have no more value).

      The statement which helped the most was at the end, when she said ‘I walked halfway through the fire and couldn’t finish. I’m exhausted and can’t turn back’. This fits very well with charcoal preparation from plant or animal sources.

  • In addition to what already had been written (I mean my an above posted comment) I would like to add the follow:
    Shankaran says that the different symptoms could be choosen by different practitioners and there is no guarantee that it should be the same medicine… in a vast majority of cases that inevitably will lead to administration of few different remedies-and this was a reason why he does elaborated a method of finding of INNERMOST EXPERIENCE, MAIN DELUSION etc.that could not be interpreted otherwise as in terms of ONE REMEDY PICTURE obvious for any trained practitioner who will used special technique to reveal it…. But …..In that given case of burnout and exhaustion a lot of symptoms mostly of emotional origin had been expressed by the patient. And I’m sure that let say 5 practitioners if will work it out independently will come out with at least 2-3 different remedies….For example: The patient clearly expressed feeling of possession by evil, darkness, some other infernal influences, whatever, – Stram, Manc and so on?…..She expressed also great attachment to the religion with a hint of active missionery-Verat, Stram?….She expressed the feeling of been catched, trapped-again Stram?…..She said she work hardly since the childhood, she was exhausted – PHOSPH. AC?….she said she had problems with the father – NAT.MUR?
    So what I’m trying to say is could you provide a detailed process of revealing the INNERMOST EXPERIENCE (resulted here and similar here to CARBO ANIMALIS) and evidences that YES this is our point of destination in the process of analize of the patient, this is a basic idea of CARBO AN (and I believe in that!because it was confirmed with alleviation of the patient -and it is wonderful work been done!!) or main source of suffering is standing behind….Otherwise I can rely upon expression of the patient : ” trapped in the prison, no place of refuge, no escape..” and proclaim STRAMONIUM as an innermost experience in that case….We need a more detailed narration about of DIFFERENTIATION process in that given case, Sir.Thank you in advance.

  • While the trapped feeling can be found in the solanaceae (nitrogen in the alkaloids has this feeling), she doesn’t describe fears of the dark (stram), she doesn’t fear a loss of social standing (verat), and she doesn’t talk about a spiritual possession (secondary to mental weakness–mancinella). So while there are many remedies which fit part of the history, their fuller picture doesn’t match all of it.

    One suggestion is to organize related components of the history, make circles around the various themes (emphasizing the strongest and most pronounced–exhaustion, etc.), and then work to find a remedy which fits with all the components. That sometimes helps to show why certain remedies fit part of the case, but not all. One could say carbo-veg doesn’t fit with the religious affections as well as stram, etc., but she framed her experience using the religious “vocabulary” of her peers, and they were more surface words, still a step away from direct experience. Again, I felt her direct experience came out at the end of the history, when she talked about walking through the fire, exhaustion, partial transformation, etc.

    • Well, dear Dave now it is more or less clear for me, thanks! My speculations had been based on fragmentedl intake of the whole story – if we will apply this partial approach we will come up with many remedies of course. I can see now that the basic experience came at the end, sure….CARBO ANIMALIS is in a fit in that context. Your suggestion to make circles on the anamnesis designed to emphisize the different themes at the same time grading them is very good also! And what is most important- I should learn first those sources that you advised me before!

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