Summary: This is a Bipolari disorder case. The patient has been diagnosed with Cyclothymia. Cyclothymia is a more mild form of bipolar disorder which involves less severe mood swings. People with this form alternate between hypomania, and mild depression. The “mood swings” between mania and depression can be so quick that it is not unusual to alternate between mania and depression every half hour. The majority of patients with Cyclothymia will process to Bipolar. The action of the simillimum in this Plutoninum case was reflected in the patient being able to stop her mood swings and allow herself to feel connected to herself and to other’s feelings.
Keywords: Destruction. Plutonium nitricum is a constitutional remedy suffering from destruction of persona.
Presenting Issue: Alternating moods. These moods can change every thirty minutes, from extremely manic and speedy, to being very slow in action, and speech. From obsessive and perfectionist in everything she does, to being completely unengaged. Instructive and direct in action and thought, to being uncaring and indifferent. Highly critical, to being messy in thought and action. Cooperative to being uncooperative, at work and at home.
Occupation: A financial consultant. Bipolar patients most typically present with a work history which reflects the nature of the disease. This patient is no exception. She has been very wealthy, owned businesses, and lost everything.
The ‘never-well-since-event’ or causation: The cause of Bipolar has not been established. Although several triggers have been noted, and are listed in the endnotes, no definite cause has been established. In homoeopathy we ask the patient what they perceive to be the “cause” of their disease.
Patient:When I was six years of age I was knocked unconscious and hospitalized with a fractured skull. When I was 18 years of age my parents separated. Shortly after that I was diagnosed with Bipolar, hospitalized, and medicated with Lithium.If I am not connected I feel safer. Her father is an alcoholic. Her mother was mentally and emotionally abusive and violent. She suspects that she was abused by her father but has no memory of anything. She knows that she was emotionally abused by her mother but has no memory of anything. To this day she is terrified of her mother.
She is no longer on any medical prescription medication when she first consults me. All medication she took she described as making her feel waves of terror and fear.
Everything I ever took used to make me feel insecure, very scared, and invariably, I would have panic attacks.
Introduction:This patient had no physical illness as such. She does experience a huge amount of physical tightness, neck cramps, and cramps in her legs.When she was a child she suffered with constipation. She is now fifty-six years of age. She has never attempted suicide.
30% of individuals with bipolar disorder will attempt suicide during their lives, and 20% will succeed . . . . Suicide is more common in bipolar depression than in major depression, panic disorder, or schizophrenia. 70% of people will attempt suicide in the first month after diagnosis. Suicide is a very real issue for those with bipolar disorder. The estimates are as high as 20% that people who suffer from Bipolar Disorder will kill themselves. And as many as 50% of all people with this disorder may attempt suicide at least once in their lives. Given these chilling statistics it is important to note that if a patient with Bipolar consults with a homoeopath then the constitutional simillimum which you chose has to have within its nature a desire to live regardless of how unwell they are, and most importantly an enjoyment of polarity. This might seem like an incredibly bizarre, or insensitive statement. Rather, it is a statement which reflects an understanding of the type of constitutional remedies who will decide they do not wish to live with Bipolar. Therefore, if a homoeopath is to successfully treat Bipolar and find the simillimum, she must understand why this patient is the exception, and not the rule in that they have not succeeded, or attempted suicide. In homoeopathy we do not prescribe on the disease but rather on its unique, or peculiar presentation in the individual. The reason why so many commit suicide in the first month of diagnosis is an overwhelming desire to not live with the disease. If a patient has managed to live with the disease then more often than not they have managed to separate themselves from the disease. This is an important understanding in this case in particular, because the patient has numerous rubrics in the case analysis which all pertain to separation from self and the world. This has been a self-protection mechanism. This ability also indicates the simillimum, Plutonium nitricum.
What is unique or peculiarii to this case which indicates the simillimum is that the patient makes a point of telling me that there is no empathy for herself in any state that she is in. She describes it as not being there at all. I need to maintain being dissociated from feeling anything in any role I am playing. It is important to note that in mania, patients typically describe it as being alive and excited and present to every thought or action. What is a key characteristic is that the patient has a need to maintainiii feeling separated from herself. The need to separate from feeling empathy for herself indicates that she needs to maintain that separation to avoid feeling fear and/or panic in connection to her history of abuse. This is confirmed when the patient says; If I am not connected to the role I am playing then I feel safer. The Delusion rubric: is behind a mask, has one remedy listed; Plutonium nitricum.
Plutonium nitricum have a spirit separated from their body – their soul is separated from their body and they have no compassion. Plutonium nitricum are full of emptiness. Plutonium nitricum have the Mind rubric: detached as if observing from the outside.  1
Delusion rubric: dark: balancing with the light: plut-n.  1.
Delusion rubric: mask; is behind a mask: plut-n. 1.
Delusion rubric: separated: world; from the: he is separated: plut-n.
Delusion rubric: separated: body: spirit had separated from body: Plut-n.
Delusion rubric: separated: body: soul; body is separated from: plut-n.
Delusion rubric: clouds: black cloud enveloped her; a heavy: plut-n.
Delusion rubric: emptiness; of: plut-n.
Delusion rubric: body: out of the body: Plut-n.
Mind rubric: detached as if observing from the outside. plut-n.  1.
Prescription: Plutonium nitricum 30 in a dry pilule daily.
Plutonium nitriticum is a homoeopathic remedy derived from plutonium. Plutonium is a radioactive material that is produced in nuclear reactors. It was found to cause lung, liver, and bone cancer in the people who were directly in the fallout area of the atomic bomb testing sites. Trace levels of plutonium can be still be found in the environment from past nuclear bomb tests. The simillimum will not be Plutonium nitricum unless the patient feels threatened and destroyed from the inside and from outside themselves. Plutonium nitricum are as destructive as the substance plutonium to their own psyche. The abandonment is from within and also from outside themselves. Plutonium nitricum don’t have Delusion rubrics of loss of identity or disassociation rubrics pertaining to psychological Dissociative Disorders. They have rubrics which pertain to loss of identification with themselves. The difference might appear subtle however in a psychological framework the difference is marked. Vermeulen in Synoptic Materia Medica 2 notes: “The prover felt clearly that he changed identity depending on where he was and whom he was with.” If one translates that into the Delusion rubric: changing one’s identity depending on circumstances, it could imply Multiple Personality Disorders or Dissociative Disorders. If that rubric was applicable then the remedy Plutonium nitricum would be comparable to Alumina. Alumina have the Delusion rubric: he transferred himself into another and only then he could see.Alumina will transform and morph themselves into another consciousness. Plutonium nitricum in contrast are separated from knowing who they are. Their body is separated from their soul and spirit, and they are separated from the world and from their body.
Plutonium nitricum are a constitutional remedy suffering from destruction of persona as opposed to a transformation of a persona or identity according to circumstances.
It is extremely important when analyzing specific rubrics attached to a remedy that the exact wording is correct. If it is not exact then there is a tendency to misinterpret the psychological disorder associated with the constitutional remedy. Plutonium nitricum are an abandonment remedy. They are lost and fallen from grace. They are a dirty dog trapped in the underworld; they have lost connection with their soul. Their ‘delusions of grandeur’ are that they will be lifted out of the dark into the light. Plutonium nitricum are abandoned – they have been walking for years – elbowing their way through the crowds of their past generations. Plutonium nitricum carries the destructive nature of Plutonium within their somatic psyche. The psychosomatic destruction must be evident across all levels – emotionally in their inability to emotionally connect to loved ones, mentally in their confusion, and physically in their inability to be able to maintain their own structure in the world. Plutonium nitricum have the Back rubric: weakness of back, standing almost impossible.
Plutonium nitricum are also threatened from the outside and feel threatened and insecure about their continual existence. Plutonium nitricum have the Mind rubric: confusion of mind, lost feeling, and the Delusion rubric: seeing the earth exploding.  1. Furthermore, Plutonium nitricum have the Mind rubrics: anger internalized, sensation of being detached, withdrawal from reality, indifference to the suffering of others, exalted love of family, and unsympathetic to family. Their anger is internalized. They are detached from themselves. They alternate between exalted love for others and family, and indifference, lack of sympathy and withdrawal. Exalted love is love which is unrealistically ‘hyped-up’ and disconnected from real empathic and compassionate connection. Their ability to love is corroded from within. Plutonium, the substance, corrodes and destroys the internal organs. Plutonium nitricum have the Delusion rubrics: he is a child and acts like a child and he was newly born into the world. Olibanum sacrum are also listed in the Delusion rubric: he was newly born into the world. Olibanum sacrum believe that they are pure (God) and as yet untouched by the world. In relation to Olibanum sacrum I allocated the Delusion rubric: he was newly born into the world in the Delusion rubrics which pertain to communication to God. Plutonium nitricum, in contrast, are listed in the Delusion rubric: he was newly born into the world because they are emotionally retentive and immature (baby-like); they are unable to live emotionally connected to the world. In relation to Plutonium nitricum, I have allocated this rubric to the Forsakeniv section because they are disconnected (abandoned) from an adult or mature ability to love.
Denial: Delusion rubric: lifted; she was being: plut-n. Delusion rubric: dark: balancing with the light: plut-n.  1. Delusion rubric: visions, has: shadows of light: plut-n.  1. Delusion rubric: objects; about: shining: plut-n. Delusion rubric: dancing: revolving, twirling and spiraling dancers; of: plut-n.  1.
Forsaken: Delusion rubric: mask; is behind a mask: plut-n. 1. Delusion rubric: separated: world; from the: he is separated: plut-n. Delusion rubric: separated: body: spirit had separated from body: Plut-n. Delusion rubric: separated: body: soul; body is separated from: plut-n. Delusion rubric: hunted, he is: plut-n. Delusion rubric: past: generations; elbowing way through crowd of past: plut-n.  1. Delusion rubric: born into the world; he was newly: plut-n.
Causation: Delusion rubric: paradise: lost; the fall from grace: plut-n.  1. Delusion rubric: dirty: he is: plut-n. Delusion rubric: dogs: he is a dog: plut-n.  1.
Depression: Delusion rubric: clouds: black cloud enveloped her; a heavy: plut-n. Delusion rubric: emptiness; of: plut-n. Delusion rubric: walking: he has been walking: years; for: plut-n.  1. Delusion rubric: trapped; he is: underworld; in the: plut-n.
Resignation: Delusion rubric: die: waiting to die; being old and: plut-n.  1. Delusion rubric: body: out of the bodyv: Plut-n.
Extract from the patient video follow up, one month into taking the remedy daily:
Patient: I feel very different, and I didn’t do anything! I have worked so hard with the psychiatrists and psychologists. Being aware of my thoughts and all the cognitive therapies I have done to manage it. Then instantly within a week I don’t have to manage it.
Question: So it doesn’t feel like you have to fight to have control anymore?
Patient: There is nothing to control.It is gone. In the past that would happen very rarely for a couple of hours that I would be very present. Occasionally there would be no feeling of, of my gosh, I am feeling really fast, or I am feeling really sad, or I am feeling really frustrated. For example, I would be sitting on a beach and all of a sudden I would get up in this speediness and say come on we have to go and do something. There was never a reason. I would all of a sudden be overcome with speediness and frustration and then I would become very task orientated. Or, I would have huge project on and then I would feel I don’t really care about that anymore, knowing in my head I had to feel about that because it was my job and I get paid for it.
Question: So you are not doing that polarity anymore?
Patient: I am not polarising at all. I could switch five or six times a day. Cyclothymia is not usually that rapid. But sometimes it would be once a day and sometimes it would be one or the other for a couple of days in a row. But I am so clean. That is the best way to describe it. Whatever mood I am in, it is because for example someone has upset me, or I am upset over a news item on the television, or I am happy because something is going right, or I am at the beach and I am relaxed. There is none of the extra layer of unknown.
Question: And are your friends noticing how much more even you are?
Patient: Absolutely. They are used to waking in and asking which Maryvi are we getting today. Is it the slow Mary, so we will be a bit slower, or is it the fast Mary so we will be a bit faster, and they might need to bite their tongues. But there was a Mary underneath that who was their friend. Now it is like, wow! You are Mary all the time now. So for them, and my husband it is amazing as he was constantly helping me manage whatever was going on. It is hard to explain.
Question: So when you wake up in the morning you are aware of who you are?
Patient: It is just like I am awake. It is not like who am I today, slow or speedy and check for all the signs and how am I going to manage this today. My whole day used to be checking in what state I was in as I wasn’t present to how I was feeling. I was constantly assessing whether I had the right feeling to a particular situation. There is no symptoms of tension.
Question: Do you think feeling the cramps has gotten worse or better? (The patient reported that after two weeks on the remedy her constipation from childhood returned. The patient reports she now has irregular bowel motions.)
Patient: The first two weeks was worse on the remedy and now it has evened out. It is four weeks since I saw you, and within four days of taking the remedy I was a different person. I was so surprised, it was effortless. I have used acupuncture for years to help minimalise the mood swings but it has not got rid of them. I never expected an instant change, I thought it would be years of work with you. When I got diagnosed I was told it was for life, and that it would get worse.
Progress Report: The patient has been consulting with me monthly since October 2011. After the initial month on the remedy she has taken the Plutonium nitricum 30 in a dry pilule daily, or twice, or three times a week, or weekly, or monthly, according to her perceived need in relation to her mood swings, and physical tightness, and constipation. In the first few months I managed the frequency of the remedy, but now the patient manages her own need for the remedy. Her consultations with me for the last year have focused on counselling, and her marriage. It is a generalisation to say this, but more often than not I have found that people who choose to be in a relationship with someone who is mentally or physically disabled, are either hiding behind someone who is more unwell than themselves, or alternatively they feel like a hero saving someone who relies on them. Her husband has not adjusted to her becoming well and confronting him with his emotional unwellness. Understandably, over the last year there have been many times when the patient is aware of very old feelings from her childhood of fear and terror for her safety. Regardless of how terrifying she has felt she has not returned to feeling disconnected from herself or others. She has now acknowledged that her fogginess and speediness were two states which maintained her distance from humanity and herself.
Analysis: The Delusion rubric: is behind a mask, reveals two aspects about Plutonium nitricum. On the one hand they wish to avoid being exposed, and on the other hand they are separated from others. Like Anacardium, Plutonium nitricum are also listed in the Delusion rubric: separated from the world. Anacardium feel separated and abandoned from the world. Plutonium nitricum, in contrast, are not only separated and abandoned from the world, they are also separated from themselves and from their own spirit and soul.
The simillimum will not be Plutonium nitricum unless the patient displays a marked lack of empathic connection to firstly themselves, as well as to others.
Plutonium nitricum will put on a mask and play a role somewhat like an actor will play a role. It is important to note that in playing the role they have not changed their identity, they have just conveniently adjusted their personality to match the required role. Underneath and behind the mask, Plutonium nitricum have not changed their identity or consciousness into another identity. Plutonium nitricum have no emotional body left to change as it has been destroyed. Their spirit has separated from their body – their soul is separated from their body and they have no compassion. Plutonium nitricum are full of emptiness. Plutonium nitricum have the Mind rubric: detached as if observing from the outside.  1. The difference may appear to be a case of semantics, however when analyzing the psychological delusions and psychological disorders associated with a remedy profile it is crucial to be exacting in the interpretation of rubrics.
The homoeopath in a specific case analysis needs to be able to make a distinction between the destruction of a Plutonium nitricum patient’s emotional identity, and personality disorders in which the patient changes identity.
Vermeulen, Frans. Synoptic Materia Medica 2. The Netherlands, Merlijin Publishers, 1992. p.p. 768-772.
Liz Lalor lectures on the symbiotic relationship between the mental and emotional disturbance, and physical pathology inherent within destructive or life-threatening diseases. Lalor has taught extensively in Australia, United Kingdom, Belgium, Netherlands, Canada, and was guest international speaker at the Washington National Conference in 2012. Lalor’s second book Homeopathic Psychiatry is an extensive Materia medica study on the application and meaning of the Delusion rubrics. Homeopathic Psychiatry is also a rubric-repertorising module for Radar Opus™.
i Bipolar disorder is a condition in which people go back and forth between feeling manic or ecstatic good moods and depression. The “mood swings” between mania and depression can be very quick.
Bipolar disorder equally affects men and women. It most commonly starts between the ages 15 – 25. The exact cause is unknown, but it does occur more often if there is a family history of bipolar disorder.
Types of bipolar disorder:
- People with bipolar disorder type I have had at least one manic episode and periods of major depression.
- People with bipolar disorder type II have never had full mania. Instead they experience periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). These periods alternate with episodes of depression.
- A mild form of bipolar disorder called Cyclothymia involves less severe mood swings. People with this form alternate between hypomania and a more mild form of depression.
- There is a high risk of suicide with bipolar disorder. Patients may abuse alcohol or other substances, which can make the symptoms, and suicide risk worse.
- Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.
- The manic phase may last from days to months. It can include the following symptoms:
- Very elevated mood, excessive activity, racing thoughts, hyperactivity, excessive talking.
- Very high self-esteem (false beliefs about self or abilities. In homoeopathy we would repertorise this stage using the Delusion rubrics which pertain to grandeur.)
The depressed phase of both types of bipolar disorder includes the following symptoms:
- Daily low mood or sadness
- Difficulty concentrating, or making decisions
- Fatigue or lack of energy
- Feeling worthless, or hopeless
- Loss of pleasure in activities once enjoyed
- Thoughts of death and suicide
- Trouble getting to sleep or sleeping too much
- Avoiding friends and family
ii Hahnemann said in aphorism 153 of The Organon, that in the search for a homeopathic specific remedy we should concentrate on “the more striking, singular, uncommon and peculiar signs and symptoms of the case”. The disturbance which reverberates with a striking symptom, will be when the patient reveals how they have constructed their mental and emotional outlook around the first disproportionate analysis of their lives. This is the peculiar, queer, rare and strange (P.Q.R.S.) symptom within the patient’s story.
iii I define the psychotherapeutic role that the Delusion rubrics have in case-taking and outline four necessary prerequisites for the use of the Delusion rubrics in a patient’s case analysis and not just the Mind rubrics.
You can only use a Delusion rubric in the case analysis if the following four prerequisites have been noted in the patient’s case-development.
Evidence that the patient has notable inner conflict and evidence of self-destruction and pathology which is proof of the need for a Delusion rubric to be used in the rubric-repertorisation.
Evidence that the patient has used the psychological delusion in a disproportionate way to misinterpret reality.
Evidence that the delusional stance is maintained by the patient because it is to their advantage to delude themselves of reality.
The ‘never-well-since-event’ confirming the primary psychodynamic trauma.
iv In the Rubric-categories I take the most commonly used Delusion rubrics that I have found in my practice, group them according to the five rubric headings and explain their delusional use.
Denial: ‘hubristic denial’ of disease.
Forsaken: disproportionate feelings of abandonment, or persecutory delusional beliefs.
Causation: disproportionate guilt.
Depression: predictions of failure.
Resignation: overblown resignation to disease and death, or exaggerated hypochondriacal fears of illness.
They encompass respectively, the psychological ‘delusions of grandeur’, ‘delusions of abandonment’, ‘delusions of persecution’, ‘delusions of original sin’, ‘delusions of impending doom’ and the ‘delusions of hypochondria’.
The purpose of understanding these five psychological stages is to match the simillimum to the psychological presentation of your patient’s delusional state, whether it be ‘delusions of persecution’ or ‘delusions of hypochondria’, etc. If you learn how to recognize these five psychological stages in the consultation within your patient, it will help you in the rubric-repertorisation and in finding the simillimum.
v It is very interesting that two weeks into taking the remedy that the patient described a feeling of coming back into her body and that she then became aware of how much physical tightness and tension that her body experienced.
vi Mary is not the patient’s real name.