A Case of Empty Nest Syndrome

Empty nest syndrome is not a clinical disorder or diagnosis. It is a transitional period in life that highlights loneliness and loss. Parents want to encourage their children to grow into independent adults. However, the experience isn’t always pleasant.  Grief, depression, a loss of purpose, or sadness are real and may be experienced when children enter their own relationships or when they start their college careers. Women normally suffer more than men do. In addition, other milestones such as menopause and caring for elderly parents impact the feelings of depression.  The individual may feel sadness, loss, depression, loneliness, distress and a loss of purpose and meaning in life

Case

Sz. M., female, 58 years old, married

Personal circumstances: A 58 year old woman presenting a lot of mind-symptoms and also some  peculiar physical-general symptoms

The date of the consultation: 10.07.2018.

Chief complaints

• a very unpleasant taste in the mouth like a mix between onion-coffee-basil
• a continuing burning pain in epigastrium ( heartburn)
• great fear of death

Main complaints:                  

1. A lot of nausea during the day
2. Perspiration with bad odor, like onion, in axillae and also on forehead, aggravated during the night
3. Headache in vertex since many years, aggravated when she works on computer, ameliorated at sleep and by massage
4. Very sensitive on noises
5. Falling asleep difficult, tossing in bed
6. Unrefreshing sleep
7. Feeling tired, since morning
8. Fear of death (++++)
9. Fear alone on the street ( she goes everywhere with her husband, so she came to the consultation together)
10. Fear to leave the house (she is working at home)
11. Fear of dogs
12. Fear of infections, she use to wash her hands frequently

Other physical complaints

• The bad taste in her mouth is aggravated by eating
• Trembling of hands, when she feels stressed
• Heat-flushes, in the night, since she is in menopause
• Nervousness in epigastrium when she feels stressed
• On stress she also feels her throat constricted and gets constipated

Generals:

• Chilly
• Thirsty, mostly during the night
• Sweets aggravates
• Desire for salt, use to eat very salty
• Cannot tolerate egg, onion, garlic, carrot, raw apple, cucumber, pepper
• She cannot tolerate or is aggravated from chocolate, fat, pork and sweets
• She likes cherries

Mental and emotional symptoms, her nature

• She is very irritable from little things
• Very critical of herself and others
• Perfectionist, great desire for order, cannot rest, when things are not in the proper place
• Pessimistic nature, worrying a lot about everything, ameliorated by consolation
• Feeling depressed
• Introverted
• She has a lots of fears: especially fear of death(++++), but also fear of being alone, fear to leave the house ( she goes everywhere only with her husband), fear to be in a crowd, fear of height, fear of closed places ( like being in an elevator), fear of dogs (+++), fear of infections ( she use to wash her hands frequently), fear of cancer
• Very sensitive on quarreling
• She is in hurry, impatient
• Offended easily and she cannot forgive easily, once she lost the trust in a person, is difficult to her to interact with it
• She also does not trust in diagnosis, and that’s why she used to visit many doctors and make her analysis in different laboratories, to check and double-check the results.

Sensation : “I have got the sensation that I feel tired from living.”

Personal medical history

• When she was 9 year old she was diagnosed with epilepsy – abdominal form (?) and she was treated with Fenitoin and Fenobarbital for that diagnosis till the age of 16 years old
• In 2001 she went on an ovarectomy, now being in menopause since the age 52 years
• In 2008 – she had a heart-surgery ( ablation) because of frequent tachycardia, now she take for this Metoprolol 25 mg daily
• In 2009 she was diagnosed with gastro-duodenal ulcer, being hospitalized in many times in different clinics because her burning pain in epigastrium and the other digestive symptoms. She takes daily reatment with Pantoprazol 20 mg/ day and Trimebutin 300 mg/ day, since many years, without relief
• Because of her fears and depressed mood she was admitted also in the psychiatry for a while, being treated with Doxepin ½ tb daily,since 6 years, and also psychotherapy for a 1 year, but her complaints were not changed

Familiar medical history – causality

Her mother had hypertension and died because of a myocardial infarct. Her father was alcoholic, and because of that the arguments and quarrels happened daily in their house when she was a child.  So she remembered that she was very afraid of him, and every time when he was drunk she started to feel a constricting pain in her abdomen, what was later diagnosed as epilepsy – abdominal form?  Her father used to smoke also, so she became very sensitive to the odor of cigarettes, a sensitivity which remain even now.

Another important aspect in her life was, that 9 years ago her daughter married a man from on other country ( Austria) and they moved there, leaving them. This separation caused a very deep grief in her, which she could never overcome ( the empty nest syndrome). She feels that separation from her daughter and her family, even now, after so many years, like a big loss, she wakes up every morning very sad, depressed, but she cannot weep.

In the same year, when her daughter left them, she also lost her mother and her beloved cat, which was very difficult for her. Three years before she lost her nephew (the son of her sister) in a motorbike accident (it happened that she also saw the crash immediately after the accident, which marked her a lot).

Treatment she take daily since many years:

• Pantoprazol 20 mg/ day
• Trimebutin 300 mg/ day
• Doxepin 12,5 mg/ day since 6 years
• Psychoterapy for 1 year ( she could not mention what kind of psychotherapy)

Analysis of the case

• Prognosis

2. Anatomopathological disturbance: the disturbance on the physical level was of the gastrointestinal tract and the cardiovascular system, but there are only functional disturbances
3. Depth of the disturbance from homeopathic point of view: the main pathology of this woman is on mental-emotional level. According to George Vithoulkas’ Health Levels Theory her complaints correspond to Group C, level 9 or 8 at the first consultation, presenting this deep depressed state, with intense fear of death and generalized anxiety.
4. Personal medical history: her problems are caused from the grief of losing her child and her family because of the separation 9 years before and the death of her mother in the same period. The recent loss of her nephew somehow intensified her emotions. But her main sensitivity, the somatization on gastrointestinal system, is more deep rooted, exactly in her childhood, when she suffered a lot because of alcohol dependency of her father and all the disharmony in family life related to this.
5. Familiar medical history and hereditary predisposition: from her mother side she has the predisposition to cardiovascular diseases and from her father the tendency to a dependent behavior pattern (she has a dependent relation to her husband and to her daughter too). Another pattern characteristic to people with different dependencies is, that they are not able to verbalize their emotions and they usually have this tendency to somatize and engage in substance abuse.
6. Conclusion: the patient, a 58 year old married woman, after suffering a long lasting grief caused by the separation from her daughter and her family, developed a lot of symptoms on a mental-emotional level,  sensation level and also on the physical level, being hospitalized in different allopathic clinics, trying to find relief from her suffering.
7. Miasm: cancerinic miasm because she has this desire to control her life ( perfectionist, desire for order, cannot rest when things are not in the proper place), very fastidious, but she lost that control, because, like in her childhood, when she couldn’t control her father, now things has happened, that her family is apart, so again she cannot control the destiny of her family, which makes her very vulnerable.

I  repertorized the case, using  RADAR 10.0 for Windows, Schroyens, F. – Synthesis 9.0 ( English) , which has also VES, which points to the same remedy.

Sum of symptoms and degrees  –  Sum of symptoms and degrees  –  Intensity is considered

1	1234	3	MIND – CENSORIOUS	99
2	1234	3	MIND – CHECKING – twice or more; must check	10
3	1234	2	MIND – CLEANNESS – mania for	5
4	1234	3	MIND – FEAR – alone, of being	73
5	1234	3	MIND – FEAR – cancer; of	31
6	1234	2	MIND – FEAR – crowd, in a	69
7	1234	4	MIND – FEAR – death, of	157
8	1234	2	MIND – FEAR – dogs, of	28
9	1234	2	MIND – IMPATIENCE	149
10	1234	3	MIND – IRRITABILITY	474
11	1234	3	MIND – OFFENDED, easily	103
12	1234	2	MIND – REST – cannot rest when things are not in the proper place	9
13	1234	2	MIND – RESTLESSNESS – bed – tossing about in	172
14	1234	3	MIND – SENSITIVE – noise, to	185
15	1234	2	MIND – SUSPICIOUS	113
16	1234	2	MIND – THOUGHTS – disease, of – incurable, of some	2
17	1234	1	HEAD – PAIN – noise, from	95
18	1234	2	MOUTH – TASTE – bad – eating – after	11
19	1234	3	MOUTH – TASTE – offensive	104
20	1234	2	MOUTH – TASTE – onions, like	9
21	1234	3	STOMACH – ANXIETY	99
22	1234	2	STOMACH – NAUSEA – daytime	18
23	1234	3	STOMACH – PAIN – burning – Epigastrium	44
24	1234	2	STOMACH – THIRST – night	86
25	1234	3	SLEEP – POSITION – changed frequently	38
26	1234	2	CHILL – CHILLINESS	183
27	1234	2	PERSPIRATION – NIGHT	214
28	1234	2	PERSPIRATION – ODOR – offensive	107
29	1234	2	GENERALS – FOOD and DRINKS – chocolate – agg.	21
30	1234	2	GENERALS – FOOD and DRINKS – eggs – aversion	26
31	1234	2	GENERALS – FOOD and DRINKS – fat – agg.	106
32	1234	2	GENERALS – FOOD and DRINKS – onions – agg.	19
33	1234	2	GENERALS – FOOD and DRINKS – pork – agg.	29
34	1234	3	GENERALS – WEAKNESS	727

 

	ars.	lyc.	sulph.	puls.	phos.	sep.	bell.	nat-m.	merc.	nux-v.
	98	75	70	69	68	67	65	65	65	63
1	3	1	3	1	2	2	1	1	2	2
2	1	–	–	–	–	–	–	1	–	–
3	1	–	1	–	–	–	–	–	–	–
4	3	3	–	2	3	2	1	–	1	1
5	3	1	1	–	1	1	–	1	–	–
6	1	2	1	2	1	–	1	2	1	2
7	4	2	1	2	3	1	2	2	2	3
8	–	–	1	2	1	–	4	1	1	–
9	2	2	3	2	–	3	1	2	1	3
10	3	3	3	3	3	3	3	3	2	3
11	3	3	2	2	1	2	2	2	1	3
12	2	–	1	–	–	1	–	–	–	–
13	3	2	2	2	1	2	2	1	2	2
14	2	2	1	2	2	3	3	2	2	3
15	3	4	3	3	2	2	2	–	2	2
16	2	–	–	–	–	–	–	–	1	–
17	2	1	–	–	2	1	3	1	1	2
18	1	2	–	–	–	–	–	–	–	–
19	3	–	1	1	1	2	1	1	3	1
20	–	–	–	–	–	–	–	–	–	–
21	3	2	1	2	1	1	–	1	1	2
22	1	1	1	–	1	1	–	–	1	–
23	3	–	1	–	2	3	1	1	1	3
24	2	2	2	1	2	1	1	1	2	1
25	3	1	1	1	1	–	1	–	1	1
26	2	3	3	3	2	3	3	2	2	3
27	3	2	3	3	1	3	1	2	3	1
28	2	3	3	3	2	3	1	1	3	3
29	–	3	–	2	–	–	–	1	–	–
30	–	–	2	2	1	–	1	1	–	–
31	2	2	2	3	1	2	1	1	1	1
32	–	3	2	2	1	1	–	1	–	1
33	1	–	–	3	–	3	1	2	–	–
34	3	2	3	2	3	3	1	3	3	2

Vithoulkas Expert System

The most probable remedy is Ars. 154.0 ( confidence rating 112 points).

Analyzing the remedy from the Periodic Table point of view, we see that the remedy Arsenicum is situated in period 4. and group 15. It has this theme of security, which in her case is related to family around her, to her house and health, but considering the facts, that separation from daughter and death of her mother and her nephew has happened, her need for security, that structure of her family has been damaged, which cause in her this great anxiety and grief. The situation is out of her control.

 Prescription with potency

I prescribed Arsenicum album CH 200.  I prescribed this in potency, because most of her symptoms were on the mental-emotional level.

Follow-up after 3 weeks ( 3.08.2018.)

The patient feels better and she could asleep much easier. The bad taste from her mouth, which were her main complaint, ameliorated a lot; now she feels it only in the morning and in the evening.  Her fears ameliorated also and she has no more great fear of death; her fear  to leave the house ameliorated also, so she came alone to visit me.

The pain in epigastrium sometimes is still present.

Prescription: Repeat the Ars. Alb CH 200, 1 month after the first dose

Follow-up after 2 months ( 4.09.2018.)

She came alone to the consultation. She said, that her husband observed, that after the remedy, she is more calm, more patient, her fear from dogs decreased, also and her fear of infections decreased. She tried not to stress herself so much about  order. The bad taste in her mouth like onion-coffee-basil is still there in the morning.

She said, that she cannot leave behind her great loss, that her child is not anymore with her. She is brooding a lot,  feels somehow useless, inconsolable, like a great disappointment. She feels, that she could scream because of pain (put her hands on her heart region). She is introverted, does not speak, she does not manifest herself anyhow, but has a deep pain in her heart. When she gets angry, she becomes sad and used to weep, only when she is alone. She is also irritable, being sensitive to noises. When she is stressed she is constipated and her throat is constricted, and also feels that in her abdomen. In that situation she cannot eat . The same symptoms she has from anticipation, before exams or when she has to go somewhere. She likes to be alone, being with animals. She use to put a lot of salt in her food.

I repertorized her symptoms again using RADAR 10.0 for Windows, Schroyens, F. – Synthesis 9.0 ( English) , which has also VES.

Sum of symptoms and degrees  –  Sum of symptoms and degrees  –  Intensity is considered

1	1234	3	MIND – AILMENTS FROM – grief – silent grief	4
2	1234	2	MIND – ANIMALS – love for animals	24
3	1234	3	MIND – ANXIETY – anticipation; from	76
4	1234	3	MIND – BROODING – grief; over	3
5	1234	3	MIND – COMPANY – aversion to	274
6	1234	3	MIND – DWELLS – past disagreeable occurrences, on	77
7	1234	2	MIND – FEAR – death, of	255
8	1234	2	MIND – FEAR – dogs, of	35
9	1234	2	MIND – IMPATIENCE	231
10	1234	3	MIND – INCONSOLABLE	51
11	1234	3	MIND – IRRITABILITY	640
12	1234	3	MIND – SENSITIVE – noise, to	246
13	1234	1	MIND – WEEPING – anger – during	11
14	1234	2	HEAD – PAIN – noise, from	103
15	1234	1	MOUTH – TASTE – offensive	105
16	1234	2	THROAT – LUMP; sensation of a – swallowing – amel. – not amel.; swallowing does	15
17	1234	1	ABDOMEN – COMPLAINTS of abdomen – accompanied by – constipation	17
18	1234	2	CHILL – CHILLINESS	191
19	1234	1	PERSPIRATION – ODOR – offensive	138
20	1234	2	GENERALS – FOOD and DRINKS – chocolate – agg.	38
21	1234	2	GENERALS – FOOD and DRINKS – eggs – aversion	51
22	1234	2	GENERALS – FOOD and DRINKS – onions – agg.	20
23	1234	3	GENERALS – FOOD and DRINKS – salt – desire	151
24	1234	2	GENERALS – TOBACCO – aversion to – smell of tobacco; sensitive to	18

 

	nat-m.	lyc.	puls.	phos.	sulph.	nux-v.	sep.	chin.	bell.	ign.
	161	112	105	99	98	94	94	91	89	89
1	3	–	–	–	–	–	–	–	–	–
2	1	–	1	1	1	–	–	–	–	–
3	3	2	–	–	–	–	–	–	–	–
4	1	–	–	–	–	–	–	–	–	–
5	4	2	2	1	2	3	3	2	2	3
6	4	3	1	1	2	–	2	2	–	3
7	2	2	2	3	1	3	1	1	2	1
8	1	–	2	1	1	–	–	3	4	–
9	2	2	2	–	3	3	3	1	1	3
10	2	2	2	1	1	2	–	2	–	3
11	3	3	3	3	3	3	3	2	3	1
12	2	2	2	2	1	3	3	3	3	2
13	1	–	–	–	1	–	–	–	–	–
14	1	1	–	2	–	2	1	2	3	1
15	1	–	1	1	1	1	2	1	1	1
16	2	–	–	–	–	–	2	–	1	–
17	1	1	–	–	1	2	1	–	1	–
18	2	3	3	2	3	3	3	2	3	2
19	1	3	3	2	3	3	3	–	1	1
20	1	3	2	–	–	–	–	–	–	–
21	1	–	2	1	2	–	–	–	1	–
22	1	3	2	1	2	1	1	–	–	2
23	4	–	–	4	1	–	1	2	–	–
24	–	2	2	1	–	2	–	1	2	2

Presciption: Natrium muriaticum CH 200 – 1 dose

 Follow up after 3 months (2.10.2018.)

That bad taste in her mouth like onion-coffee-basil is still there. The perspiration increased, especially in the night, smell is like onion-garlic. The most unpleasant symptoms now are the cramping pain in abdomen, in the whole abdomen, one side or the other. She feels also that great sadness because of losing her child, as a deep pain in her heart. Her sadness aggravated 3 years ago, when her nephew died in a motorbike accident and she saw him being carried off. She use to sigh a lot. She has also nausea in the morning.

Because she does not improve enough after taking Nat.m., I repertorized again and got this:

Sum of symptoms and degrees  –  Sum of symptoms and degrees  –  Intensity is considered

1	1234	3	MIND – AILMENTS FROM – fright – accident; from sight of an	3
2	1234	3	MIND – COMPANY – aversion to	274
3	1234	2	MIND – DWELLS – past disagreeable occurrences, on	77
4	1234	3	MIND – IMPATIENCE	231
5	1234	3	MIND – INCONSOLABLE	51
6	1234	3	MIND – IRRITABILITY	640
7	1234	2	MIND – SIGHING – involuntary	4
8	1234	2	MIND – SIGHING – loud	1
9	1234	3	NOSE – SMELL – acute – tobacco	12
10	1234	2	MOUTH – TASTE – offensive	105
11	1234	2	STOMACH – NAUSEA – forenoon	52
12	1234	3	ABDOMEN – PAIN – cramping – Sides	43
13	1234	3	CHEST – PAIN – Heart – grief; from	3
14	1234	2	CHILL – CHILLINESS	191
15	1234	2	PERSPIRATION – NIGHT	237
16	1234	2	PERSPIRATION – ODOR – garlic	8
17	1234	1	PERSPIRATION – ODOR – offensive	138
18	1234	2	PERSPIRATION – ODOR – onions	14
19	1234	3	GENERALS – CONSTRICTION – Internal	155
20	1234	2	GENERALS – FOOD and DRINKS – chocolate – agg.	38
21	1234	2	GENERALS – FOOD and DRINKS – eggs – aversion	51
22	1234	2	GENERALS – FOOD and DRINKS – onions – agg.	20
23	1234	3	GENERALS – FOOD and DRINKS – salt – desire	151
24	1234	2	GENERALS – TOBACCO – aversion to – smell of tobacco; sensitive to	18

 

	ign.	nat-m.	phos.	puls.	lyc.	acon.	sulph.	chin.	op.	nux-v.
	60	48	46	45	44	42	42	39	38	37
1	–	–	–	–	–	4	–	–	4	–
2	3	4	1	2	2	1	2	2	1	3
3	3	4	1	1	3	–	2	2	1	–
4	3	2	–	2	2	2	3	1	1	3
5	3	2	1	2	2	2	1	2	–	2
6	1	3	3	3	3	3	3	2	2	3
7	3	–	–	–	–	–	–	–	–	–
8	1	–	–	–	–	–	–	–	–	–
9	2	–	1	2	–	–	–	1	–	2
10	1	1	1	1	–	–	1	1	–	1
11	1	1	1	1	1	–	1	1	1	–
12	2	1	2	1	2	1	1	1	–	2
13	–	–	–	–	–	–	–	–	–	–
14	2	2	2	3	3	1	3	2	1	3
15	1	2	1	3	2	1	3	2	1	1
16	–	–	1	–	–	–	1	–	–	–
17	1	1	2	3	3	1	3	–	–	3
18	–	–	1	–	2	–	–	–	–	–
19	3	3	2	3	1	2	3	3	1	3
20	–	1	–	2	3	–	–	–	–	–
21	–	1	1	2	–	–	2	–	–	–
22	2	1	1	2	3	–	2	–	–	1
23	–	4	4	–	–	–	1	2	–	–
24	2	–	1	2	2	–	–	1	–	2

Prescription: Ignatia CH 200 – 1 dose

Follow up after 10 days  via e-mail) after Ignatia CH 200

 Three days after Ignatia she felt very good; she was not so sad anymore, went alone outside in the city. That bad taste had ameliorated a lot.

Follow up in 6 November 2018

 She feels good, although they have a big problem in the family (they learned that her granddaughter use to cut herself, being bullied by some classmates) –  a new reason to worry a lot, but she is no more sad like before. Her husband’s observation: She got nervous about trifles. She has also a desire to scream, and she feels like her head is going to explode and in her chest she could feel her heartbeats.

Prescription: Ignatia 1M – single dose

 Follow up in 15. January 2019 ( after 6 months after the first consultation)

 Two weeks after that single dose of Ignatia 1M, that bad taste from her mouth disappeared. The perspiration decreased a lot.

She with her husband visited her daughter in Austria, because of the worrying about her granddaughter. After this visit she is again very sad, worrying a lot, she is afraid to lose her granddaughter (she was being molested sexually by some boys and now she used to cut herself). She feels again very sad, helpless, weeping easily. She feels that there are no reason for her to live.

Prescription: repeat Ignatia 1M – 1 dose

Particularity of the case

The patient has a very deep, long lasting pathology. Most of her symptoms being on the mental-emotional level, and presenting also many symptoms on the physical level, as a somatization.

The inconsolable grief, because of the separation from her daughter, along with the grief from losing her mother, caused this empty nest syndrome, followed by many physical symptoms. All her sufferings were aggravated 3 years before, when she witnessed her nephew’s death. That sensation of  “ I feel tired from living” is the same that we can read in George Vithoulkas’s book The Essence of Materia Medica about Ignatia:” Because of her troubles, her attitude toward life is that life is not worth living”.

All these tragic events from her life reactivated her reaction-patterns from her childhood, when she felt the same loss of control living with an alcoholic father. Her physical symptoms were the same, like those from her childhood, when she was diagnosed  with epilepsy – abdominal form, and was treated 7 years with Fenitoin and Fenobarbital, without any relief.

The peculiarity of the case was the bad taste in her mouth, which bothered her so much, being her chief complaint. Another peculiarity was the intolerance of smoking (smelled like her father).

An important characteristic of this case is, that there are many layers of her suffering, so the treatment has to follow these layers. That is the reason why, although the bad taste from her mouth bothered her most, the first remedy she needed was Arsenicum, because of her intense fear of death, so in this way her cure respected the Hering’s law.

After Arsenicum relieved her many fears, especial her fear of death, she needed the remedy for the causality, which was in her situation the long-lasting and inconsolable grief. Although the repertorization indicated Natrium muriaticum, she did not react well enough to this remedy, and needed Ignatia, because, although she suffered the repeated separations from loved ones many years ago, she experienced that trauma like it happened yesterday.

Ignatia is a remedy from the Plant Kingdom, Loganiaceae  Family, and also belongs to the cancer miasm. It  resonates very deep with her suffering since her childhood, when she was shocked and paralyzed repeatedly by her father’s drunkenness, trying to control a situation impossible to control for any child.

Although she felt a huge sadness and pain, her only reaction most of the times was to remain paralyzed from fear, suffering in silent, not weep. We see in her case the great excitability of the Loganiaceae family in sensitivity to noise, sensitivity to quarrels, ailments from anticipation, angry at trifles. The convulsions were presented on the gastrointestinal level, like abdominal cramps, constrictive pain, choking in throat. Most probably these abdominal cramps were diagnosed in her childhood as Epilepsy-abdominal form.

The most important lesson from this case is that, although the patient was treated during 9 years by many allopathic doctors in different clinics, only homeopathic treatment gave real relief to her. This is possible because homeopathy is the method which treats a person holistically, as an individual, taking into consideration the causative factors (the long lasting grief in her case) and the personal and familial history.