Clinical Cases

Anxieties in a Woman of 46

Written by Petr Hoffman

Homeopath Petr Hoffman shares a case of a woman of 46 suffering from fear of insanity and obsessive thoughts and behaviors.

A 46-year-old woman is coming to be treated for psychological problems. Eight years ago, she went through a regression therapy, which was an unpleasant experience for her. During this regression a scene came in her mind in which she was attacked by wolves. The therapist told her that one of the wolves was her husband. Since then, she has had an aversion to her husband and has been afraid of dogs. (2)

She still lives with her husband (for 25 years), but they are not partners anymore. They just share their household. The husband drinks and they agreed to split up 6 years ago.

She found a new partner and fell in love with him. However, he broke up with her two years ago. That hit her really hard. He was a healer and she was his client. She was dependent on him in this regard as well.

After breaking up with him, she went to see another healer. It helped her, but on her last visit, something went wrong and she has been terribly mentally unwell since then. That was half a year ago.

She has been feeling physical pressure in her head and chest as if from a stone.(3)

She has been taking antidepressants and sleeping pills (Tritico) for the past year. She has also been taking Quetiapine for the past 8 years. She feels she will go crazy and she is afraid of it.(3) She stressed this several times during the consultation.

She is afraid to be alone.(3) There is an unspecific negative feeling going on in her brain all the time.(3) Her head is full of thoughts that cannot be stopped.(2) She is unable to perceive things around her, unable to concentrate.(3) She has unspecific fears and cannot describe her feelings. (3)

She suffers from compulsive and ritualistic behaviour. (3) She has to do things in a certain order.(3) At work she has to have things in certain places – a pencil here, a paper there, etc.(3) But the real reason behind this behaviour is a fear that if she does not do things in a certain way, she will get worse or something bad will happen (3). She has had this for several years.

She panics when she hears somebody saying an ordinary sentence – for example, “the weather will be nice tomorrow” or “I should fix my bike”.

She is afraid to touch door handles, because there may be dirt.(2) She already had it before her current complaints.  She prays in order to ease her anxiety.(2) When she is mentally worse, she has blurred vision.(1) She can feel tickling in her chest and stomach area.(1)

She has always been chilly (3), recently a bit less. She is apathetic (she was already like that before conventional drugs).(3) She is unable to do anything.(3) She wakes up in the morning and lies down in front of the TV. She does not know what to do with herself.

From puberty, she used to have migraines that stopped when she started having current mental problems. (3) Migraines used occur at the beginning or end of menses.(3) They could last up to 4 days. They used to be behind eyes.(2) Sometimes they were triggered by alcohol.(2)

She also used to have severe acne since puberty. She was taking a contraceptive pill until 2 years ago, when she dropped it. The acne returned after that, but it disappeared when she started having the current mental problems.

She had chronic tonsillitis 25 years ago. It was not preceded by episodes of acute tonsillitis. It improved after some immunity boosting medication.

Observation: Sighing (2) when I want her to describe her feelings. Loquacious (3) – she is describing everything in great detail (3) and is talking in a way that wants to emphasize how sick she is (3). She seems to be hysterical. (2) After the consultation, she sent me a long e-mail with additional information, which she forgot to tell me during the consultation. She was afraid that she had not told me everything important.

Acute diseases: She has not had a fever for many years. She used to have high fevers as a child. Now she only has mild colds without fevers.

Family history:

Mother: acne, migraines, high blood pressure, anxiety

Father: allergy to pollen and dust, skin tumour at age of 64, anxieties

Analysis of the case:

This is a case where pathology is predominantly affecting the psychological level. It is a case on the verge of serious psychosis. The fact that former physical problems were replaced by mental and emotional symptoms is not favourable for the prognosis. The organism got weaker and let the pathology penetrate deeper levels of the human being.

These cases are always more difficult to treat and prognosis is worse compared to cases which still have some physical complaints. We can find some mental symptoms (compulsive neurosis, ritualistic behaviour, superstition, abundance of ideas) and a lot of emotional symptoms (different fears, anxieties, apathy). Even if there are some physical symptoms, they seem to be just a somatization of the psychological condition.

The fact that the patient does not get fevers with acute disease is not favourable for the prognosis because it shows that the organism has low vitality. There are anxieties in the family medical history which makes the prognosis worse.

It is obvious that we have a hysterical type of patient whose complaints developed as a result of her hysterical nature. The complaints probably arose from genetic predispositions, which means they will be more difficult to treat.

Selection of symptoms:

Peculiar symptoms:

  • thinks she is going crazy, fear of insanity (3)
  • fear of being alone (3)
  • ritualistic behaviour (3)
  • superstitious (3)
  • fear of contagion (2)
  • head full of thoughts which cannot be stopped (2)
  • sighing (2)
  • loquacity (3)
  • praying (2)

Intense symptoms:

  • difficult concentration (3), unable to perceive things (3)
  • hysteria (2)
  • heaviness as if from a stone in head and chest (3)
  • apathy (3)
  • chilly (3)

Migraines and acne are not currently present so we should not take them into consideration. They probably belong to deeper layers which may be addressed in the future. Fear of touching door handles (of dirt or germs) is an older symptom and it may not belong to the current symptom layer. I include it as it is quite a rare symptom.

I did not include fear of dogs because it is explicable by her scary experience during the regression therapy. If there is any remedy in the differential diagnosis, which has fear of dogs as a keynote, I might take it into consideration as a confirmatory symptom.

Possible relevant rubrics to use in this case:

The following list is not the actual repertorisation of the case, but listing of all relevant rubrics I was able to find. In the real situation, I used only some of these rubrics to repertorize the case.

MIND – FEAR – insanity
MIND – FEAR – alone, of being
MIND – RITUALISTIC BEHAVIOR
MIND – THOUGHTS – compelling
MIND – SUPERSTITIOUS
MIND – FEAR – disease, of impending – contagious, epidemic diseases; of
MIND – FEAR – infection, of
MIND – FEAR – contagion
MIND – IDEAS – abundant
MIND – THOUGHTS – persistent
MIND – SUICIDAL disposition
MIND – SIGHING
MIND – LOQUACITY
MIND – RELIGIOUS AFFECTIONS – too occupied with religion
MIND – PRAYING
MIND – CONCENTRATION – difficult
MIND – HYSTERIA
HEAD – HEAVINESS
CHEST – OPPRESSION
MIND – INDIFFERENCE
MIND – INACTIVITY
GENERALS – HEAT – lack of vital heat
GENERALS – COLD – agg.

Differential diagnosis of the most probable remedies:

Cimicifuga (Actea racemosa) has fear of insanity, sighing, hysteria, loquacity and aggravation from cold as keynotes. It is a remedy with strong depressions (the patient is apathetic).

Mancinella is one of the main remedies for fear of insanity (together with Pulsatilla and Calcarea carbonica). It belongs to superstitious remedies (Arg-n, Con, Rhus-t, Zinc, Syph) and it is a hysterical remedy. It covers fear of the dark and persistent obsessive-compulsive thoughts.

It is remedy suitable for psychotic patients who try to find salvation in praying. The irrational acceptance of the regression therapist’s opinion on her husband and rejection of her husband because of that fits the irrational way of thinking of Mancinella.

Calcarea carbonica has a combination of fear of insanity and fear of infections as keynotes. Chilliness is another keynote of this remedy. It covers oppression in chest, but rather from physical reasons. Calcarea carbonica has fear of dogs as a keynote, but as mentioned earlier, this is not an important symptom of the case because it started during the regression therapy where she saw some wolves.

Pulsatilla is one of the main remedies for both fear of insanity and praying (religious affections). Pulsatilla can be hysterical. It covers fear of dark and it can have oppression in chest and apathy. It is a strongly warm blooded remedy, which might not be so much of a problem as it is an older symptoms and the patient has become less chilly recently.

Cannabis indica has fear of insanity and loquacity as keynotes. Abundance of ideas persisting in the mind is typical for this remedy.

Lachesis is the most loquacious remedy in our Materia medica. It covers fear of insanity (although not as a keynote) and it is known to treat psychotic states. Lachesis has religious affections.

Lyssinum covers ritualistic behaviour, fear of insanity and fear of being alone. It cannot be confirmed otherwise.

Arsenicum album has fear of being alone, fear of contagion, ritualistic behaviour and chilliness as keynotes. Oppression in chest can be confirmed too. It can be apathetic, but this can be confirmed with many remedies in their later stages of pathology.

Syphilinum has fear of contagion as a keynote and it covers superstition. We can find some confirmation for fear of insanity in Syphilinum, but mostly in repertories and it is not a keynote in the Materia medica.

Rhust toxicodendron has superstition as a keynote and it also covers ritualistic behaviour. Abundance of thoughts in mind is very typical for this restless remedy. Chilliness is a keynote of this remedy.

Selection of the remedy:

This case was a bit tricky, because there are two remedies which cover the case very closely and it is difficult to decide between them. One is Cimicifuga and the other is Mancinella. Five symptoms of the case are keynotes of Cimicifuga which is a very solid indication for a remedy. On the other hand, this remedy does not cover some important aspects of the case like praying or superstition, whereas Mancinella covers them.

Although fear of insanity is a keynote for both these remedies, Mancinella is considered to be one of the three main remedies for this symptom (Calc, Puls, Manc). Mancinella does not cover ritualistic behaviour, but it has compelling thoughts which is a broader group of complaints including ritualistic behaviour. Mancinella is warm blooded, whereas Cimicifuga is worse from cold, especially cold draft. However, the patient has always been chilly so it can belong to a deeper layer. Besides that, the chilliness has reduced a bit recently, which means it is not as important symptom as before.

When such a general symptom changes towards the opposite direction, we can even sometimes consider giving a warm blooded remedy. I prefer Mancinella over Cimicifuga, because it covers superstition and praying, which I consider important aspects of the case. The remedy also has stronger fear of being alone than Cimicifuga and covers compulsive behaviour and irrational thinking (like the rejection of her husband).

Because of the allopathic medication which the patient takes, the remedy needs be dosed daily in a lower potency. Once there is a reaction, the dosing will be stopped and we will wait.

Prescription: Mancinella 30C once a day until there is a reaction

Outcome of the treatment:

Follow up 1:  8 weeks from the start of the treatment

The patient took the medicine longer than advised (for approximately 20 days). Then she wrote me that she was feeling better, so I told her to stop dosing.

In the first 2 days or so, she felt a little worse in general and the superstition (“if I do this, something bad will happen”) bothered her more often.

Then she started getting better in general. She had more energy, she was able to  do something in the garden and to do something creative, which was impossible before. For example, before treatment, she had to take Neurol before our appointment in order to handle the consultation at all. After treatment, she was able to go somewhere alone.

Fear insanity has improved significantly. Compulsiveness has not improved yet.

A month ago, a psychiatrist added another drug to her medication – Tritico – so she is now taking 3 conventional medicines. The improvement took place already before the new allopathic drug.

She has developed pain of her SI joint, which she used to have in the past.

The skin on her face and head has deteriorated and is more oily.During her last menses, she had a slightly more severe headache, but it was not a full migraine. She took a painkiller.

Another reverse symptom is incontinence which she used to have years ago before the episode with the healer and it has now returned. She felt better in general, but since yesterday she has felt generally worse again. I asked her if she was drinking coffee and she admitted drinking it 4 times in the past 2 weeks.

Evaluation of the follow-up:

There was an initial aggravation (although rather mild) followed by general improvement. The patient took the remedy unnecessarily long, but fortunately, not long enough to spoil the reaction. The remedy is theoretically indicated as long as its keynotes are still present. However, it may produce a lot of proving symptoms if overdosed.

There has been an improvement on both the psychological and physical levels (more energy to do things) and some reverse symptoms have appeared (SI junction pain, incontinence).

All this means that the remedy is most probably correct and we should wait. Before that, I need to ask the patient to stop drinking coffee. Hopefully, there will not be a full relapse occurring and the organism will get into balance on its own.

Recommendation: withdraw coffee and wait

Follow up 2:  4 months since the last follow up (6 months from the start of the treatment)

The patient is feeling well, even much better than in the first weeks of our treatment. She has more energy and desires to do different things.

Compulsivity and superstition have improved, but only by about 20%.

However, other psychological symptoms are incomparably better than before treatment.

She does not have the fear of insanity and is very stable mentally.

She is not tormented by abundance thoughts anymore and her mind is calmer.

Heaviness in the head and chest have disappeared. She is not afraid to be alone anymore.

She still takes Myraklide, Tritico and Quetiapine (but she cut the last one in half). She sleeps well. There is still some fear of contagion, but only at the places where drug addicts or dirty people go.

She got vaccinated against tetanus 1.5 months ago. A month ago, she had a wisdom tooth extracted under local anaesthesia. She did not feel any decline of her condition after that.

Incontinence still persists (but it is not worsening). It occurs, when she has strong urging and does not go to the toilet for a long time (for example, in the morning after she had not woken up for the toilet at night). (2)

She has developed constipation, which she used to have before her mental problems. She has a bowel movement almost every day, but has to force it. The stool is dry and lumpy at first, then normal – like a plug, which has to be released. (2). She has to help herself with a hand.(2) Stool is offensive.(2)

She has bloating and flatulence after pastries and blue cheese.(2) It has always been like that.

Recently she has had more frequent and shorter menses.(2) (sometimes even after 18-19 days, but the last one was after 26 days). It lasts 3 days (gradually shortens over the years). She probably never had that (but she took hormonal pill from puberty). Her premenstrual syndrome has returned a bit. She has a mild headache at the end of the menses.(1)

Evaluation of the follow-up:

The patient has been feeling generally better so there is no reason to intervene. The reappearance of older symptoms and the fact that the organism is shifting the pathology more on the physical level are very favourable. This is what we want to see in mental cases.

We only have to be cautious and observe the case closely as there have been two occurrences which could shorten the duration of the action of our remedy – the tetanus vaccine and extraction of the tooth. We must not forget that the patient has still been taking three psychiatric medicines which could also antidote the action of our remedies. I therefore expect some relapse to come in the future.

Recommendation: wait

Follow up 3:  1 month since the last follow up (7 months from the start of the treatment)

Three weeks ago, the patient had a cold with a sore throat. She did not have any fever. She began to worry that she may have Lyme disease. She was once told by some therapist that she had Lyme disease. The therapist measured it on an EAV device. Blood tests did not confirm that. She linked this information to her cold and immediately became convinced she had borreliosis.

Compulsive thoughts are starting to come back. Superstition has worsened quite a lot.(3) She has a fear of being alone again.(3) She has no desire to do things and is afraid to do anything. Fear of dirt and infections has worsened too.(2)

She does not have fear of insanity, but she does not want to talk about it. She is afraid that she may end up in the same condition as before treatment. She had severe bloating last month. It disappeared after adjusting her diet. Flatulence has been a problem for the past 2 years.

She used to have anxiety in her stomach in the past. In recent years it has rather been pressure in the head, feeling of pressure around the eyes, cheeks and posterior teeth. (2), as if there was a stone or iron there. (2)

Evaluation of the follow-up:

The case has been heading towards a relapse. The relapse is only partial so far, but I would prefer some intervention because it is very probable that the patient‘s condition will deteriorate more over time. The relapse can be explained by the fact that the patient has been taking the allopathic medication, but I believe consumption of coffee (which the patient admitted at the previous follow-up) or the anaesthesia during tooth extraction 2 months ago might have shortened the action of Mancinella.

On the other hand, the remedy has acted well for more than 6 months, which is quite a long time given that the patient is taking allopathic medication. Symptoms still point to the same remedy, so an obvious thing to do it to repeat it.

Prescription: Mancinella 30C once a day until a reaction

Follow up 4:   4 months since the last follow up (11 months from the start of the treatment)

The patient took the remedy for 5 days and started feeling signs of improvement. She felt a bit calmer and not as anxious. I told her to stop dosing.

She has been feeling well. There are no anxieties whatsoever. She has withdrawn Quetiapine and she is trying to reduce the dose of Tritico slightly.

She had PMS again. PMS = headache, irritability, excessive energy with a need to clean the house the day before menses, swelling and tenderness of the breasts, hunger. (2) Her head hurts in the forehead and temples and it is pressing pain. (2) She has menses every 24-25 days and it is short (about 2-3 days).

She is still a little prone to superstition, but it is not accompanied by anxieties anymore. 2 months ago (around Christmas) the superstition was even better than now. She has been having her long-term back pain, on the right side of the lumbar region and it goes all the way up the right side of the back.(2)

Sometimes it radiates along the back of the right leg.(1) She sits at the computer all day at work. Years ago, doctors found on an MRI narrowing of the L3-L4 intervertebral space and a cyst in the spinal canal.

Incontinence has worsened (2) It is most often in the morning after waking up (when she does not go to the toilet at night). Constipation has improved.

Two months ago her acne worsened. It took a month but now it is better again.

She is even less chilly than before treatment.

Evaluation of the follow-up:          

It is obvious that no intervention is needed at this point because the repetition of remedy has brought about an improvement again. The pathology seems to be shifting from psychological to physical level again. It is possible that some other remedy(s) will be needed in the future, but we must not hurry. The patient is obviously better, so the best strategy at this moment is to wait.

Recommendation: wait

Follow up 5:   8 months since the last follow up (19 months from the start of the treatment)

The patient reports deterioration of her vision. The ophthalmologist prescribed  stronger glasses. She has had long-sightedness for the past few years. The vision is more blurred on the right side. She used to have a black dot in the right part of the visual field, but it disappeared.

A month ago during exercising, she felt a crack in her right SI junction and it has been painful since then. (2) The pain radiates to the right side of the buttocks and sometimes to the right leg.(3) It has been a bit better for the past few days. It improves when lying down.(2) At first it was stabbing pain, but now as it is better and is a rather dull pain.

Psychologically she feels well. She is still taking Tritico and Myraclide. However, she has been taking 2/3 of the original dose of Tritico for the past 3 months. Irritability before menses has improved. Headaches have been milder too. She missed the last menses and it has not appeared yet.

Superstition is better than the last time, but it still persists a bit.(1)

Incontinence has improved. She has a lot of energy does many things.

Evaluation of the follow-up:          

It is quite normal for a person of this age to have troubles with seeing at a short distance. We are all victims of the computer-era and we strain our sight     one-sidedly. I do not consider this a real pathology and definitely not anything which needs an intervention.

It might get better with a homeopathic remedy, but I do not see a need of giving any remedy at this point. Not only is she psychologically better, but some physical symptoms have improved too and the patient has a lot of energy. The absence of menses might pose a problem in the future if it does not appear.

At this point it would be worth waiting at least another month or two. We must also consider a possibility of commencing menopause which could take place at her age. I would consider lowering the doses of allopathic remedies (after consulting with her psychiatrist) to see if the improvement continues.

Recommendation: wait, consider discussing the possibility of allopathic medication withdrawal with her psychiatrist

Follow up 6:  8 months since the last follow up (2 years and 3 months from the start of the treatment)

The patient has been feeling well. She does not have any anxieties or fears. She has been able to reduce the allopathic medication. She is taking a half of the original dose on one drug and a quarter of the original dose of the other drug. Her condition has not been getting worse despite that. Her energy is good.

She has only had some physical problems. She still has involuntary loss of urine (2), especially when she drinks too much. It is the strongest in the morning after waking up (3), but most of the time she manages to hold it. If she was not careful, it would probably escape.

She has had headaches around menses (2) – sometimes before, sometimes during, sometimes after. Most often she has it 1-2 days in advance and at the beginning of the menses.(3) They are rather at the front of the head.(2) She uses painkillers.

One day before menses, she has a need to clean up the house (3), but she sometimes may have it during the month as well. Her back pain persists – right side of the hips, SI junction, but it goes all the way up the right side.(2) She has a feeling of something drawing upwards there.(2) Sometimes it radiates along the back of the right leg.(2) The backache is better by lying on something hard.(2)

She has flatulence.(3)  She has become less chilly. Now she has average thermoregulation like most people. She has an aversion to cold drinks.(2)

Menses came back about one month after the last follow-up. It is still short (2-3 days) and weak.(3) The interval is 24-26 days. She has always been an evening person.(3)

Six months ago, she had covid-19 with influenza-like symptoms. It took her 1.5 months to get back to her original condition. She did not take her temperature, but she is sure she did not have a high fever. She had a little cough and burning sensation in her chest. She does not feel bothered much by her physical symptoms and says it was much worse when she had psychological problems.

Evaluation of the follow-up:          

The patient has had a prevalence of physical complaints for quite some time so we might consider giving another remedy. However, we can prescribe it only when the picture is clear. I am still not convinced that we have enough symptoms to make a confident prescription.

There is a possibility of Lycopodium or perhaps Sepia, but I would still like to be absolutely sure before giving another remedy. The case could still be spoiled at this point and her psychological problems might come back. I would like to wait at least until she manages to withdraw the allopathic medication completely and see if the improvement is stable enough without them. As the current complaints are not bothering her much, I prefer waiting and continue lowering the doses of allopathic remedies.

Recommendation: wait

Discussion:

This case is another proof of how effective homeopathy can be in psychological diseases, including some serious phobias and fears and even mental issues like compulsive neurosis. It is always very rewarding when we see people being able to get rid of allopathic drugs which have strong side-effects.

About the author

Petr Hoffman

Petr Hoffmann is a graduate of the International Academy of Classical Homeopathy in Greece where he studied with Prof. George Vithoulkas. He lives and works in the Czech Republic. Email: [email protected], web: www.hpph.cz Petr runs his own practice, but he also gives lectures at the Prague College of Classical Homeopathy in the Czech Republic (www.pcch.cz), and he occasionally translates homeopathic literature.
Petr also runs a Facebook study group which the readers can join. The group link is https://www.facebook.com/groups/1727619584199693/

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