Reprinted from the American Homeopath, vol 20, 2014, courtesy Ed. American Homeopath.
Age: 40 years
First consultation: April 8, 2011
First follow up: June 1, 2011
Second follow up: June 28, 2011
Third follow up: August 7, and August 14, 2011
Fourth follow up: October 10, 2011
Fifth follow up: December 5, 2011
HRE is a 40 years old woman who has come for her appointment saying, “I am here due to sheer curiosity. I want to see if Homeopathy can help with my depression.” Her family history includes type II diabetes (paternal grandmother) and hypertension (dad).
PRESENTING COMPLAINTS: Depression, feelings of anxiety and de-personalization since September 2010.
INITIAL OBSERVATIONS AND IMPRESSIONS:
Mrs. HRE is a tall, slender, well built, and quite attractive Caucasian woman with dark, shoulder length hair. Her eyes are dark too, flashy and sharp at times. Her handshake has a strong squeeze and grip to it. She looks ready to make a connection. She is wearing a fashionable yet slightly loose-fitting pair of black trousers and a black top with squiggly patterns. She has taken care to dress well.
HRE walks in with long, graceful strides, settles onto the chair opposite my desk, looks over her shoulder to make sure the door is closed behind her, looks around to see if the window curtains are drawn and asks me if her privacy is assured. In the meantime, she also glances over my diplomas, framed and hanging on the wall behind me.
To my question, “How can I help you?” she gives a very eloquent answer. She has an engaging narrative style and fluidity to her speech, though what catches my attention right away is that she tends to go on a bit and touches upon a few different topics in no particular order. I could discern the following themes in her narrative.
- DEPRESSION, SUICIDAL FEELINGS: “I am in a funk. It started in Sept 2010. I went the medical route first. Saw all the doctors, psychiatrists, chiropractors and ENT specialists. Got all the tests done. Everything has come up “normal”. My medicines are awful. I think of suicide. I am in a fog. Don’t want to be groggy all day. I don’t want to exist anymore. Just want to die. My worries are toxic. I think of the worst. Everything is going to kill me. It is all bad for me. I feel I am alone. Want life to end. I want to run, just want to escape. Just want to jump out of window, kill myself, end it all. Don’t want to live this dirty life anymore. I want this whole thing to be over. It sucks. If only I could jump out the window and die. I am not a psychotic, bipolar person. Depression creeps up on me like waves. I want to get off antidepressants. Don’t want to exist like this anymore. Drugs are a poison for me.”
- DE-PERSONALIZED FEELING: “As if, I am on cold-medication. Feels like, there is a glass film in front of me. I do things but I don’t feel. I am fading. I can hear birds singing, but I don’t feel any joy. Everything I say sounds stupid to me. I am living, but not feeling it. I am spacey. I feel detached.”
- ANXIETY / IRRITABILITY: “Like, I am on a hamster wheel. I clutch my gums. I get short tempered, agitated, irritated by small noises. Phone ringing irritates me. If someone asks me a question, it bothers me. I am snotty and quick. I don’t like people, bright lights in the stores, I get so annoyed, just want to get out. People are so rude. I want to shove them, smack them on the face and choke them to death. It is about me, not about them. I get so angry, I kick my dog, kick my lawn mower. This is going on since last ten months. I wake up feeling this way.”
- PHYSICAL COMPLAINT: HEAD: “I feel this vice-like grip. It is a tight feeling in the back of my head. I can’t shake it out. This grip has a pulsating quality to it and it keeps me awake. It is as if someone put a belt around my head and pulled it beyond the last notch. I feel better when I move away from pressure of pillow. It is constricting, choking off blood supply. I want to slam my head through the window, make it go away.”
- PHYSICAL COMPLAINT: EAR: “When I go to sleep, I can hear my heart-beat. I want to pop my ears with my fingers to make this sound go away. I saw an ENT doctor, ‘Nothing wrong with your ears’ he said. Ears are plugged up, can’t enjoy the outside sounds. It is mostly on the left side but sometimes, both ears.”
- SLEEP: “I do get my eight hours of sleep. But I wake up feeling far worse than the night before. Why can’t the nightlong sleep revive me?”
- MENSES: “Periods are coming up – any day now. Feels like a volcano is ready to erupt. I just want it to erupt, blow up, smack someone on the head and ask them to leave me alone. I feel better when my periods start. I feel dirty and don’t want to be around anyone. Flow lasts 5-7 days. I pass heavy, dark and large clots.”
- GENERALITIES: “I am always hot. Want windows open. I am fire. I hate humidity. Too hot gets me irritated, cool is ok.”
- HRE – THE INDIVIDUAL: “I have been a jealous and competitive person as long as I remember. I am a very, very, very jealous person – but I try not to show it. It is a secret. I feel ugly when I am jealous. I can’t trust girl friends – they steal your man, steal your money, make you feel like crap and they are vicious. I hate every girl who looks better than me or have a boyfriend better than mine.
If someone tries to upstage me, I strike back. I am too quick to defend myself. I am always right, never wrong. No one will defend me so I defend myself. If I am slighted I am quick to fire.
I don’t want to be trampled upon. If I back down, say sorry, then people walk over me and they are higher. They have won. This does not work for me. I fight back, come even, am independent, and will not let any one walk on me.
Take for example, my husband. He gets angry. I get angrier. He opens his mouth, I snap back, choke his head off, I never back off. Who is he to tell me anything? I get jealous if anyone even looks at him. I suspect if he is messing around on my back. You never know men.
I feel totally worthless. I have worked for years in strip joints, and bars. I don’t trust men. I don’t trust women. Men just want to get laid. Women just want to steal your man. They will upstage you – it is always like, my boobs are bigger than your boobs so I can claim your man. I am attractive. I will not let anyone steal my man.
It is a dirty, vicious world out there. It is putrid. IT IS POISONOUS. There is a lot of filth out there – unimaginable, rotting, poisonous filth. I don’t want kids. I don’t hate kids, but why bring them into this POISONOUS, TOXIC world?
I like attention. I will do anything to keep all attention on me. I have always competed – with siblings, with co-workers, and wanted to be number one with all the lime light on me. I have to shine, be on top, be noticed, be appreciated, be number one, be liked. But that was always not easy. I had less money than friends. I got picked on because I was too tall, too thin and I had small boobs.
I like loose clothes, nothing tight anywhere. I can’t stand turtlenecks, necklaces, scarves, collars, ties, even a gentle massage on neck and throat.”
- DREAMS: I could breathe under water, fly really close to ground as if I am slithering. My eyes don’t flutter, eyelids don’t move – as if I have no eyelids. I want to scream, I need help, but no sound comes out, no one can hear me, feels tight in the throat, very chokey.
- PHOBIAS: “Being in wide open filed in the bright sunlight.”
- DESIRES: “Want to be cozy, tight, curled up into a little ball on my couch and cover myself with a blanket.”
- CRAVINGS: Cheese, bread, salty and sugary foods.
- AVERSIONS: “Ground beef, and snakes. I don’t like snakes, even the little garden snakes that we see in the summer. They scare the hell out of me. Big snakes eat small snakes. Yukkk.”
HRE has come to me seeking help for her depression. In many words, she reports having suicidal thoughts and has mentioned a few times that she would like to jump off a window and end her life because she is in such a funk. This state is of utmost concern as I try to obtain a complete picture of HRE with regards to her mental-emotional, physical and general complaints, and understand her as a unique individual. Besides experiencing suicidal depression, she also reports having constricting, pulsating feeling in her head, stopped up ears and hearing the sounds of her heartbeat. In describing herself, she paints a picture of a woman who is intensely jealous, competitive and suspicious.
The exercise of repertorization and remedy selection that I would engage in now, must be comprehensive enough to cover the totality of this case and specific enough to cover the very characteristic features that set HRE apart as a unique individual.
For repertorization, I used Mac rep software and complete 2008 repertory.
- Mind; SUICIDAL DISPOSITION; THROWING himself from; Height, a (28)
- Mind; ANXIETY; WAKING, on (129)
- Mind; LOQUACITY; CHANGING quickly from one subject to another (21)
- Mind; FEAR; POISONED; Being (36)
- Mind; FEAR; SNAKES, of (25)
- Mind; AMBITION; AMBITIOUS (66)
- Head; CONSTRICTION; OCCIPUT (77)
- Sleep; UNREFRESHING (353)
- Generalities; MENSES; AMEL.; Beginning of (13)
- Generalities; WEATHER; WARM and wet, sultry; Agg. (62)
MATERIA MEDICA DIFFERENTIAL FOR REMEDIES:
Based on the above repertorization and considering the totality of the symptom picture and HRE’s individuality, I finally focused on Lachesis, Nux vomica and Sulphur for materia medica differential. A review of each of these three remedies is given below.
Kent – well known for his poetic descriptions of remedies, says, “Nothing stands out more boldly than the self-consciousness, the self-conceit, the envy, the hatred, the revenge and the cruelty of man … an improper love of self. Unwarranted jealousy and suspicion …impelled to talk continuously.” One of the most loquacious remedies, suspicious and jealous remedy, Lachesis covers symptoms of anger, aggression, mistrust and haughtiness, hateful malice and longing for revenge, selfishness, possessiveness, and disposition to be morose and quarrel. Chronic manic-depression, increase in depressive feelings during menopause, and suicidal depression together create a picture of weariness from life (Murphy). There is also a delusional idea that he is being poisoned. Intense, egotistical and arrogant, Lachesis does not hesitate to strike to win. Paranoia about other’s motives makes Lachesis a very suspicious remedy. Vithoulkas describes Lachesis as a remedy with “an over-stimulation seeking an outlet” (Morrison).
Neck and throat are sensitive areas for Lachesis, and no pressure, constriction or touch of any type is tolerated in these areas. Lachesis is warm blooded, worse with heat, worse on waking up from sleep and feels better once discharges set in. It is a left sided remedy and symptoms can move from left to right (Clarke, Tyler). There is an “inner erethism that is expressed as pulsation, hemorrhages, flushes and discharges” – Morrison. There is a marked fear of snakes.
HRE has described herself in these words (her statements have been edited for abbreviation, clarity and focus):
“I have been a jealous and competitive person as long as I remember. I am a very, very, very jealous person. I don’t trust men. I don’t trust women. If someone tries to upstage me, I strike back. No one will defend me so I defend myself. If I am slighted I am quick to fire. I fight back, come even, and will not let any one walk on me. My husband – he gets angry, I get angrier. He opens his mouth, I snap back, choke his head off, I never back off. I get jealous if anyone even looks at him. I suspect if he is messing around on my back. It is a dirty, vicious world out there. It is putrid. IT IS POISONOUS. There is a lot of filth out there – unimaginable, rotting, poisonous filth. I don’t want kids. I don’t hate kids, but why bring them into this POISONOUS, TOXIC world? I like attention and I want to be number one with all the lime light on me. I have to shine, be on top, be noticed, be appreciated, be liked. I hate every girl who looks better than me or have a boyfriend better than mine.”
Jealousy, competition, paranoia, mistrust, suspicion, hatred, revengefulness – these mental-emotional states are brought out very clearly in HRE’s description of herself. Throughout her life, and not just now when she is experiencing suicidal depression, these features have defined her and I tend to take these mental-emotional states into full consideration while choosing a remedy for her.
HRE further says, “I like loose clothes, nothing tight anywhere. I can’t stand turtlenecks, necklaces, scarves, collars, ties, even a gentle massage on neck and throat.”
While HRE mentions her aversion to any tightness in neck and throat area, she also describes her head complaints as constriction with a pulsating quality to it. In her ear complaints, she mentions that she can hear the heartbeats while her ears feel stopped up. She mentions feeling worse after sleep (waking into aggravation), feeling worse from heat and humidity, and feeling better when her menses begin (amel from beginning of discharge).
Lachesis not only covers the mental – emotional symptoms for HRE when she is ill (presenting complaint: suicidal depression) but also in her routine life prior to becoming sick. This remedy covers her physical symptoms (left sided ear complaints, constriction in back of head.
As a confirmatory question, when I asked about snakes, HRE immediately says that she hates snakes and is afraid of even a simple garden snake.
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 spoke 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. 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.
HRE mentions being bothered by – noises, music, people asking her questions, lights in the super stores and bright sunlight. She also specifically mentions her competitive nature, and how she loves to be in the lime light, be the number one. She says she feels like smacking people on the head, give back in a quick and snotty manner. She presents with suicidal depression – wants to jump off a window to end her life, but other than wanting to smack people, she has not brought out any homicidal urges.
HRE does not come across as a “type A personality” the term Morrison has used to describe Nux vomica. This remedy does not cover her loquacity, jealousy and suspicion. HRE does not appear to be a workaholic, or a very fastidious person, though she has taken care to dress well and show her attractiveness to an advantage. HRE has not reported any stimulant use / dependence. Nux is better from repose, and HRE is worse from sleep (wakes into aggravation).
“It seems to contain the likeness of all sicknesses of man” (Kent). The essence of Sulphur is about a great, wide but shallow intellectual interest coupled with a philosophical bent of mind and together these traits bestow a sense of superiority, egotistical arrogance and haughtiness in the individual – he becomes cynical, and condescending. Being ambitious, philosophical, an intellectual and detached, he may even harbor disgust for others. Morrison mentions a practical – idealist type sulphur, who focuses on social interaction, service, approval and appreciation seeking and this type is egotistical, generous, enthusiastic and charming, as well as anxious about his health and family, and can go into depression/ moroseness.
“Lean, lank, hungry, dyspeptic with stoop shoulders, leading a sedentary life confined in their room in study, in meditation, in philosohical inquiry, and who takes no exercise” is a description from Kent. Herring calls Sulphur a “ragged philosopher”. Scattered, lazy, disorganized, shabby, dirty-looking, and critical” (Morrison) – this is another end of the Sulphur spectrum.
Sulphur is warm and worse from heat, standing, bathing, and has that unmistakable hunger at 11 am and a diarrhea that drives him out of bed at 5 am. Standing is worst position for Sulphur (Clarke).
Though HRE has presented as an ambitious, competitive person who seeks to be number one and be in the lime light, she does not show the intellectual breadth and philosophical bent of mind. HRE says, “It is about me, not about them.” But this sounds more like a competition than an egotistic declaration of a Sulphur individual. She has not bragged about her achievements or mentioned anything like she knows the best or is the best – like a Sulphur would do, even claiming an old rag that he possesses, to be precious like silk.
When HRE mentions she has to be number one, be in the lime light, what becomes apparent is that she is feeling that she is less compared to others who are better than her, have more money, better looks, better boyfriends, better body. She will not let these people trample on her, and she will defend herself, stand up for herself, because she has the ambition for wanting to be number one. This type of competitiveness is not a feature of Sulphur—who, in his egotistical way, just believes himself to be the best, the number one. He feels he is so much superior to others – both, intellectually and philosophically – that he need not compete.
Sulphur has strong suicidal tendency by drowning or leaping from a window (Murphy), but the loquacity / jealousy/ suspicion/ malice/ hatred as shown by Lachesis (besides disposition to suicide by jumping from window), are not shown by Sulphur.
OTHER REMEDIES CONSIDERED:
While listening to HRE talk about wanting to end her life, committing suicide by jumping from a high window, I made a note to check Aurum. Her tendency for jealousy and suspicion prompted me to note Apis as well. Aurum is characterized by “Melancholy, hopelessness, profound depression, loathing of life, talks of committing suicide, weeping, praying, self-reproach – sense of guilt, pathologically independent, over responsibility, rage followed by remorse. Chilly and worse from sunset to sunrise (Clarke) .”
HRE has come to her appointment out of curiosity- to see if Homeopathy can help her with her depression and suicidal tendency. If there was a sense of utter hopelessness about her, as seen in Aurum, why would she take the trouble to try Homeopathy? Though HRE has mentioned feeling “worthless”, her symptom is not one of self-reproach, in fact, she mentions that she is always right. She talks about competition, jealousy, and how women are out to get her man and how men are not trustworthy. She is not feeling guilty but she has paranoia about others that they are out to upstage her. She also suffers from paranoia about the world out there being filthy, dirty, poisonous, toxic and so on, and to survive in this world, she is not inclined for meditation and spiritual practices (as an Aurum individual may do, per Nancy Herrick) instead she just gives back, is snotty and quick to defend herself. HRE also does not show a deep sense of responsibility, idealism, high goals, and deep religious convictions as shown by Aurum individuals. Although Aurum presents depression in the many proving symptoms, this remedy does not match the chief complaint, and specific characteristics of my client.
Apis, a remedy known for jealousy (Clarke), also came to my mind – but HRE does not show the busy-ness, awkwardness, need to be controlling, and strong family orientation (Morrison) as seen in Apis.
PRESCRIPTION AND DOSAGE:
Based on the analytical and comparative process as outlined above and weighing each of the three remedies against the various mental-emotional and physical complaints presented by HRE, I selected Lachesis.
Since HRE appeared to be in good vitality, and her symptoms were mainly in the mental-emotional level, I decided to give her Lachesis 1M. She did not present any chronic, severe or acute pathology that would prompt me to select a lower potency. HRE was given one dry dose per orally, on April 8, 2011.
FIRST FOLLOW UP, JUNE 1, 2011:
HRE came for her scheduled appointment looking quite well and said, “I am
“Learning to accept anxiety. Trying to let small things go and not bother me. If my husband gets angry (he angers easily) I give a hug back or walk away. Earlier, I used to get angrier, fight back. Sleeping really well, waking up not feeling as bad as before. Vice-like grip in the back of the head- 80% better.
Stopped up sensation in ears, about 80% better.
Chokey feeling in the neck – gone. Earlier, before my periods, I used to feel like I am ready to erupt. This time, this feeling was a lot less and I did feel better once the menses started. My energy is good. Drinking a lot more water. Really hungry. Hiked to Piko mountain- felt like I did something useful. I used to love people, and want to make them well. They tell me their sob stories. I took it all in, never let anything out. It got over limit – all the accumulated sadness I felt for people had to have a release. Now, I have closed my private practice. I work with a few, hand-picked, positive people so I can take care of myself. Feel better overall, better outlook about my work.”
ASSESSMENT AND PRESCRIPTION:
My assessment is that the remedy has acted. The patient reports feeling better overall, has more energy, feels like she is doing something useful, is learning to cope with anxiety and her husband’s anger issues, is eating, drinking and sleeping well.
Her physical complaints in head and ears have been 80% reduced. She is recognizing the stressors in her lifestyle – input of other people’s sadness into her heart, and as these accumulate, without a venue for release, she in turn feels sadness. This is her way of understanding what bothers her and analyzing it so that she can come to term with the condition. In terms of Homeopathy follow up, this is a good trend. Her mental emotional state improved as she did not mention suicide even once or use the word, “depression”. Since the patient is doing better overall, I did not see any need for repeating the dose or even giving a placebo.
SECOND FOLLOW UP, JUNE 28, 2011: Three months after the first prescription
HRE’s face looks dark and drawn. Her eyes are not as sharp and flashy as they were during her initial visit in April. She plops into the chair opposite me and begins to talk.
“I have started to hear my heartbeat again. I have this intense energy in my limbs that just won’t go away, it is like a coiled snake ready to strike. I have these toxic worries that just won’t go away – think of the worst that could happen. Everything is going to kill me – white flour, conventional foods, butter, cakes and cookies, my drugs – it is all poison after all. It is all so poisonous – I want my life to just end – if only I could jump and fall off dead. I can’t escape from these thoughts. The tight grip on my head, it is there sometimes, not all the times. Not over powering like before. I can sleep on the side that is tight. Earlier I could not. I have always been hot, now feel chilly sometimes. I have stopped going for shopping. People are rude, they only care for themselves, not me. I want to choke them…”
ASSESSMENT AND PRESCRIPTION:
HRE has experienced return of her mental – emotional symptoms, though her physical symptoms are a bit better. She mentions wanting her life to end, and gives an image of everything around her as being toxic. Her physical complaint is better, but she does not say that it has gotten better than her first follow up. It is 12 weeks since her first prescription that she took on April 8.
The remedy is not working as strongly as it did before. I decide to repeat one dose of Lachesis 1M.
THIRD FOLLOW UP, AUGUST 7, 2011:
HRE states: “Right after the remedy, I had one outburst of anger so bad that I kicked the lawn mower. Everything was pissing me off. I had tremors in my hand. These lasted a day. Three days after the remedy, I went to sleep, and realized that I was not hearing my heart beat anymore. Woke up feeling normal. Heard the birds singing. Time was not dragging for me. I am breaking out a lot on my face… purplish eruptions, last a while and then go away.”
On August 14 she said, “Much better. Feeling normal. I am not being that hard on my husband. If I keep arguing, he will do things on my back. I believe he will not mess around. I don’t feel angry with him. Eruptions on my face are gone. Don’t understand what they were. Did not have to do anything – they just came and went. Just like that. I am waking up feeling like I can live my life – it is not as dark as I thought it was. I am ok.”
ASSESSMENT AND PRESCRIPTION:
She has experienced one episode of increased anger, but that did not last. She has reported waking up feeling normal. Purplish eruptions on the face – have come and gone, so no need to intervene for this and it is better to allow the remedy to show its full range of power.