Clinical Cases

Broken Down, Discouraged Lady

George Vithoulkas Case Conference – Transcribed. She lacks a lot of emotional and mental stamina and when she is excited she breaks down easily. She is a broken down person.

Comments: When she answers a question, she is slow. She stops and thinks for a long time before she gives an answer. I basically think that that is the essence of the case. Out of this [we see] she is withdrawing. She wants to quit the university. She has given up on the whole thing. She is isolating herself from people. Even when she is sleeping, she lies on her side and faces the wall, away from the world. She lacks a lot of emotional and mental stamina and when she is excited she breaks down easily. She is a broken down person. She does not experience any emotions, there is nothing. There is a strong desire for fruits.

George: You see here we have a certain set of symptoms, like consolation aggravates, Impatience, Cannot wait. Let’s have the answers. Most of the answers are Sul-ac. and Ph-ac. Then there are several Medorrhinum, Ph-ac. is overwhelming. There is one Bryonia, one Sulph., one Staphysagria, one Natrum mur. I don’t have to teach you anything. Here is all this Ph-ac.

Response: Hooray! We got one!

George: This is a typical Ph-ac. case. Very good. You see there is symptomatology which you have to ignore.

Question: You gave Ph-ac.?

George: Yes, 10m was what I gave. He wrote this in a way that he had been taught, underlining etc. He has underlined desire for salt three times, aversion to fat two or three times. (It is underlined in such a way that you cannot tell if it is two or three times actually). From the general information, you get that it is quite strong. Aggravated by consolation. She has a tendency to withdraw and be with herself, that could give a Natrum mur. case, but you disregard this information as it does not exist once the main symptomatology gives you the remedy. All of the essence of Ph-ac. is there. We cannot disregard that and go and look at “aggravated by consolation” and “desires fat” or “desires salt and wants to be alone.” That could be a case of Natrum mur. But this is little information to make it into a whole. So you disregard that which might have come down with repertorization… So I am glad that you are prescribing on this basis now. The essence of Ph-ac. is heard very clearly. We cannot disregard that.

Question: Isn’t it odd to have such strong symptoms like that in such a late, declined state?

George: Yes, maybe. She had it.

Response: It was recent. She had only been sick for five months.

Although it occurred rapidly, it may not have been to the stage where you lose the usual mental state.

George: Now shall I give you the continuation? There will be another prescription you will have to make.

Question: So this was a case of Ph-ac. where it went straight to the mental instead of starting on the emotional?

George: Yes. Also the mental is almost destroyed. She says the weakness was on an emotional level- psychological, which are emotional needs and not mental. The weakness is most psychological and this is underlined. Periodically she also gets bodily, physical tiredness. Then she has fever. (Picric fever?)

Question: For our edification, would you say why Pic-ac. was not the remedy?

George: This was second place.

Question: There is one sentence in here which says, “Worse in activities on a psychological level” which would point more towards Pic-ac. More mental level.

George: Pic-ac. is on a mental level, not psychological level.

Question: Aren’t psychological and mental the same?

George: Oh no! We have mental/spiritual level, then the emotional or psychological level. Emotions are mostly affected. Here it affected the mental faculties. Then we get the physical level.

Question: So, it is just a matter of words? Okay.

George: So in order that this would be a Pic-ac. case, what more would you like to have?

Response: More mental fatigue. Worse from mental exertion, rather than emotional or physical exertion.

George: And a history which will show you an over-exertion of the mind. They would give a different history altogether. But now, what she says here is that she takes a long time before she can answer. Emotionally she is flat. Of course the mind of Ph-aC. cannot work either. These three remedies we have said : Mental-Pic- Ac, Emotional Ph-Ac, Physical Mur-Ac.

But …all three have an effect on three levels. But they mainly concentrate their actions and prefer mostly the mental or mostly the emotional or mostly the physical levels! This does not mean that in the Mur. we do not have a mental exhaustion. The way in which the Mur is exhausted is something tremendous and something awful. They just want to sleep and they will say, “Let me die. It is impossible for me to recover.”

With that attitude there is a feeling inside as if all of the forces have been concentrating on recovery in the physical body, therefore there is nothing left in the brain, for it to work with vitality. Therefore given Mur-ac. The moment he has a fever, his mind will not work. Also, emotionally he is not able to take any stress -even the least amount of stress. He cannot even take the stress which comes from a loving person who might say, “Do you want or need something?” He has not the courage to communicate emotionally,

to say that he wants this or that. The attitude is, “Leave me alone. I don’t want any. I am so exhausted. I am dying.” This is Mur-ac. So at the emotional level it is effective as well. But what terrifies you in Mur-ac. is the physical exhaustion!

It is a woman who is 25 years old but still she is looking like a very old person who is completely exhausted. With that exhaustion, do not imagine that this psychological condition will be really ready to take jokes or have communication. We communicate with the vital force, not with the sound of words. We communicate with our vital energies.. Why? Because I may be saying things and you are hearing the sounds, but you don’t hear anything [in].

With Mur-ac, your mind is distracted. But unless you concentrate your energies and attention. and you tune in to what I say, the words aren’t meaningful. You may be hearing my words. They go in the tympanum and they vibrate your physical ear. But there is no communication. So in order to communicate I have to put out my energies and you have to let your energies concentrate on what I say. Now how can Mur-ac. do that? He cannot communicate. He has so little vitality. The vitality does not go more than a few inches. In order to communicate you need vitality, and It is not there. That is why the Muriaticum element, which is in Natrum mur. and in Mag-m., is an element which is going towards withdrawal. It makes the person want to withdraw. It is interesting that the sea, which is the water element, which is the emotional element, aggravates the Muriaticum patient. That patient is disturbed in his Muriaticum element, that is why Natrum mur. is aggravated by the sea.

Mag-m. is aggravated by the sea. Natrum mur. and Mag-m. are listed in the repertory as aggravated by the sea. You can add that to the repertory notes. Those people say, “No, I will never go and have a bath in the sea,” because it upsets their entire organism. They will need one of the three remedies.

Response: When I was in Greece, I went into the sea one day and I was sick for about two days with dullness and tremendous exhaustion, which was a relapse from where I had been. There were headaches. This was just from going in and swimming around for a few minutes.

George: Yes, this was interesting. Bill took Mur-m. [Mag mur Ed.] .while he was in Greece. As he started recovering a bit, I forced him to take a bath. He answered, “I don’t want to take a bath.” I said, “Take a bath, I want to see.” So I forced him to take a bath in the sea. “It is nice to take a bath,” I said. He was in a negative mood anyhow. For two days he was complaining. He had the catarrh, sinusitis, a cold, and he felt miserable. He said, “I am going back.” After the third day he picked up again. He had such a strong aversion to go, (by sea) I was curious.

Response: Even going on a boat in the sea, just close to it, without actually being in it, will make me feel worse.

Question: Wasn’t that true before though?

Response: Yes, it was always true.

Question: You are by the sea now.

Response: I am better here. I am not as bad as I would expect to be, being by the sea.

Question: What was your point about the sea? You were saying something about how the person wants to withdraw and then you mentioned the water and the sea. Is there some connection there?

George: Yes. The emotional level in conjunction with the sea. The water element has that symptom of withdrawal.

George: (Back to the case presentation and follow up). She says, “I am better, I can now get up from bed.” If seems that she was lying down most of the time.” I communicate a little better now. My mind has become clearer.” This is at least one month after the original remedy on 12-12-1977. This second time it is the twelfth of January, 1978, It is approximately one month -30 or 31 days. She says that her mind is clearer, except for the past 15 days. “I have been very irritable”. She said that maybe it was due to the environment. It is interesting to observe here that after this depression and the total exhaustion, that she had become irritable. After three days she said, “I am not getting better at all”, and she had had a clash with her family. She would find any cause to fight. It is interesting to see that from the depression and total annihilation of faculties they become ultra sensitive and cannot take any stress, and they become irritable. This is a very good sign because, as we know from the dialogue, it is better to be irritable than depressed. It is interesting for one who understands homoeopathy to understand what is going on. She says, “Here is my medicine and it doesn’t look like it has done anything”. It is not that she says,” I am better,” or “My head is CLEAR.” I am sure that she is doing better because of that remark. She says, “Now I am more irritable.” Perfect! That is great!

Now she says she can do complicated thinking at intervals. “I again have dyspnoea.” This was in the sun. We had dyspnoea.. When she was little [SHE HAD IT] and she now complains of dyspnoea all the time. She has the impression that [air is not enough] . It is interesting here to see what was happening with the lungs because of tuberculosis, and how the disease goes back towards this direction. You remember that tuberculosis is given there and how the weakness is exaggerated in the lungs again. She is not going into tuberculosis most probably. The dyspnoea is worse and is continuous, and she has a feeling that [air is not enough]. Puff, puff -that kind. The memory is better, psychological, emotional state is not now a continuous condition. That means that she comes out and then goes inside again. “If I try to reconcile, I feel exhausted.” She adds, “My worst time is between 1 and 4 p.m. Now I have developed a great aversion to eggs.” You remember she said that she did not like eggs. Now this aversion is stronger. She is feeling the heat more now. The cold does not bother her. In Greece this is usually the coldest month. Her hair has stopped falling out completely. “I have a lot of irritation and flatulence now, which I have never had in my life.” There is a symptom now which is underlined four times. She has great jealousy.

“It is fantastic how much I feel jealous, especially for a certain girl.” She has developed a particular sense of jealousy towards one specific person. She started cursing. “Curses come out of my mouth. I don’t know how.” Suddenly I have become vindictive. “Acne has started coming out of the back in the last 4-5 days.” The lungs are okay -there are no symptoms. What are you going to do here?

George: Very good. That is what we did-we waited. She then came at the end of March, which was about two months after the second interview. If we wanted to give a remedy on the second visit, what was appearing as a second remedy?

Response: Either Lachesis or Sulph.

George: After two months she says, “Generally I am better. My irritation is much less. I stopped cursing and swearing. I am not vindictive any more. I can think more clearly now. The dyspnoea has almost disappeared. I am no longer jealous.” It is interesting how this syndrome was a reaction to the deadness in which she was living. She took out her emotions and then they balanced by themselves without us needing to stimulate this with another remedy.

Question: Do Ph-ac. often get jealous? When they are getting better, is this common in their experience?

George: I cannot say. Now I can tolerate both heat and cold, but there is a tremendous aversion to eggs. “Even if I think of an egg, I have nausea.” There is an aversion to sauces. She desires meat (underlined 3 times), and she takes a little bit of fat. There are no irritations. “Since five days the fungus infection in the hands and feet have exploded, worse on the right side.” She also has an itching of the calves when she goes to sleep. She

is worse regarding this at night when she is in bed. She says that she sleeps well. I have now spoiled your idea of Sulph. (Laughter) She seldom has nightmares now. The feeling of getting tired is much less, but it still exists. The hearing IN the right ear is much worse, diminished. There was an X-ray in the beginning which showed the tubercular location quite prominently. That is what has impressed the doctor. She now brings, after four months, a new X-ray which is absolutely clear. She has now broken out with a lot of condylomata around the perineum. You see how things come to the surface -there is now a fungus infection, the condylomata, and what do you think that bad hearing is from?

Response: Streptomycin.

George: Yes, she took a lot of Streptomycin for the tuberculosis. But why? Now we have to conjecture. The whole head was dull. Now it is the acoustic nerve which is dull. It seems as if the effect of Streptomycin has concentrated in one place in the brain instead of being diffused in its effects. What are you going to give her? Before I give you the last two symptoms. Can you give anything for the fungus infection, the itching, the condylomata ?

Responses: Placebo.

George: Yes. Now, let us see if we can still wait. I will now give you the last two symptoms. She says, “Generally I feel much better after 7 p.m. (underlined twice), and I really feel good if we go to the sea.” There is amelioration by the sea, which is underlined three times. Now what are you going to do?

Response: Add Medorrhinum for aversion for eggs. (Laughter)

George: The last time she ate eggs.

Response: Wait.

George: Yes. Here is a great temptation to prescribe Medorrhinum with all this condylomata, and being better in the evening, and with so much amelioration by the sea. So I submitted to temptation and I prescribed Medorrhinum

Responses: You were really seeing the next layer.

George: I gave a dose of what potency?

Responses: 1m.

George: 30. Why? Because here is a case, which is doing very well indeed, in spite of all this suffering. So if we spoil that case, don’t let us spoil it too much. This is the idea. But of course there are enough reasons to prescribe and to hope that something is going to happen. Perhaps we could have waited, but from the picture I saw, we might as well give it. Later on, even if you waited four or five months, you would have to give Medorrhinum At some point.

Question: The best procedure is to let the picture stabilize for at least a month?

George: Yes. You can wait for one more month, but she has come after two months from the previous treatment. Sure, you can wait another month. The possibility, of course, is that the patient does not understand what is going on very well. They may go to a dermatologist and take a medicine for this fungus that would cauterize the condylomata and then the case would be ruined. So after the Medorrhinum she came again in about 50 days.

She said that the fungus had increased. The itching has become more and it is voluptuous. The hearing is still very bad. “Again I have this kind of dyspnoea, worse in closed places with smoke.” Now I have the urge to do work and I don’t feel tired. The condylomata are gone-Gone! Just like that.

Response: What did they do? Drop off?

George: One day the patient wakes up and she sees that they are not there. This is very usual. Very usual! Don’t act like a gynecologist in Athens who was trying to suppress the condylomata on a woman for about three years, and the woman had come to us for mental disorders. She never said that she had a condylomata. We started to treat her. She also had leucorrhea. She was doing beautifully. She never mentioned to us whether she had condylomata. We did not know because the mental state was bad. When she went to the gynecologist for re-examination, he said, “What happened to the condylomata? I don’t see them.” She said, “I took homoeopathic treatment.” He said, “What is that?”

So he phoned immediately to find out what the medicine was so that he could give it to his other patients with condylomata. He was so shocked. She was also schizophrenic and now she was well, and I was talking to him about the condylomata. (Laughter) Separate ends of the body. This is very usual that the condylomata will go away with the homoeopathic remedies. Warts are the same thing.

Question: I had a woman who had a wart on her foot and the skin sort of closed off around it. The doctor pulled it off. It came off like a little pea -it just fell off.

George: Now this patient does not want sour foods. She did not mention this earlier. Later she noted that she did not want sour foods. But she had a desire for sweet foods. She eats eggs now. She had desire for meat (underlined twice), and she now dislikes fat (underlined twice). She again has the urge to go back to the university. She is not quarrelsome any more. Her mind is quite clear. There is no falling out of her hair. She has a bad odour in the mouth in the morning which is better when she eats something. She has a kind of numbness in the lips.

What is the prescription now?

Response: Wait.

George: Yes, wait. Now this is 1978. This woman has gone to the university and has finished her studies. This doctor was new in the clinic and he is very proud of her.

Question: Do you think the Medorrhinum did anything? Or did it maybe do nothing except keep her from going to a dermatologist?

George: It did. It is interesting to see the aversion to eggs was so strong here. The fungus infection most probably went away. The hearing I cannot tell you about. What we hear is from other people. She has sent others and we had the information about her finishing the university and so forth. Most probably the fungus infection went away, otherwise she would definitely have come back. It is very nice that the whole class saw Ph-ac. And it does not matter if you had not immediately prescribed the Medorrhinum But everybody also saw Medorrhinum

Question: Where is it in the repertory?

George: Under generalities “evenings”, right column, at the top. She is also suffering from hyperthyroidism. The examination of the thyroid was pathological. She has been given Thyromone, but could not take it because it produced a reaction. She stopped taking it. And she does not like having clothes which are tight. The desire for sweets has now increased (this is underlined three times), desires beer (underlined twice). Now the temperature is normal and she only occasionally has flushes of heat. The thyroid examination is normal (laboratory tests).

She was well all this time until May 1980. Two months previously she had again had a thyroid examination which was normal. That would have been in March 1980. She says, “l am easily grieved (upset) and I have great turmoil inside.”

She says she is worse with standing and she feels that her legs will not hold her up. Again she has black-outs on stooping and there seems to have been a relapse. She says that she again has the vertigo on turning the head suddenly. There is no irritability or fear. There are again flushes of heat. The heat has started coming back since 15 days. She goes to sleep and wakes up in 2- 3 hours and cannot sleep anymore. She feels dyspnoea again on the left side. She has a very heavy feeling in the heart region and she has some fear when she thinks about her heart. She wakes up refreshed but psychologically and emotionally she has sadness. She goes back to sleep and does not want to see anybody. What kind of symptomatology is that and why?

Response: Did the husband get a girl-friend or something?

George: She goes to bed because she feels as though she has a big disease and she wants to lie down. She finds relief in bed. She cannot cry. And of course there the doctor thought that something has gone wrong with the case and he insisted that she had done something to antidote the remedy. She did admit that she had been drinking coffee for the past two months. But the doctor also noted that she was sighing very much during the time of the interview. He asked if something was happening. Then she confessed that three months ago she found out that her husband had a mistress. One month later she started drinking coffee. Do you see how the organism goes down by the first shock. Then she drinks coffee and she brings the organism into further deterioration. Again she has the dyspnoea on ascending. Now she says that she dislikes fruit. She lost her appetite again. Thirst was normal. She wants to go out and try to forget.

Question: I thought that she wanted to stay in bed.

George: When she is not in bed, she wants to go out. Here the differential diagnosis will be between repeating Phosphorus and giving Ignatia

Question: What does she do when she goes out by herself?

George: We don’t know. Which one would you prefer and why?

Response: Phosphorus has an aversion to fruit. If she wants to leave the house, I would not think Ignatia because they close off.

Response: And not crying. Phosphorus cries easily.

Response: The essence has changed.

Response: Though she antidoted her remedy with coffee, this started before the coffee.

George: Who said that the essence has changed? Yes, this is the idea. You see, the symptomatology may seem the same, but the essence has changed. You see now a woman who has closed up herself. She goes to bed, wakes up and goes back to sleep. She doesn’t want to see anyone. She tries to cry and cannot. And then when she is in the house, she wants to go out. Always the going out is Ignatia Ignatia is always best when she is traveling. Changes in impressions are good for Ignatia She wants to go out often from the place where all this is happening.

Response: That is why it is under “motion ameliorates them generally”.

George: Yes. This is “travelling ameliorates.” Travelling is a keynote. -You might hear them say, “I have colitis. I have a stomach trouble. I have a duodenal ulcer.” They have the worst ailments of pain. Then she goes traveling to Spain or something and then she does not have these ailments. She comes back home and there the colitis starts again and the duodenal ulcer starts bothering her again. It is like magic. You remember that symptom and you try to remember this thing is Ignatia It is very important. And there you get an Ignatia who wants to go out from the house, especially in the daylight which is cloudy, and then even likes rainy weather. This is best for them. Ignatia likes dark rooms, closed rooms, and they don’t like the sun. They like to stay by themselves in the room. They cannot cry.

Question: They like cloudy weather because it is dark or because it is damp?

George: It is something which sweeps their mood. It is a melancholy mood. When one is suffering from Ignatia, they are continuously melancholic. This weather seems to resonate with their inner state. It is interesting that the symptomatology is always the same. Yet you have grief and a turning towards the Ignatia side of the case. Phosphorus also has an aversion to fruits. I had mentioned that. Yet we must go towards Ignatia Sure enough, she took a low dose of Ignatia and she has been well until now. Of course it has not been very long, but long enough to see whether the remedy is right. We gave her 200.

Now in this case, if you are not absolutely sure that this is the right prescription and if you want the patient not to have to return (she lives a very great distance -600 miles or so) you may give another dose and tell them to take it after a month if they still have symptoms. If the fear of thunderstorms is back, if Ignatia does not work, after 1-2 months repeat it so they do not have to come back again. But of course it is better if you have seen them and can see what is going on.

Question: Why the 200? It seem like a significant shock she received.

George: In spite of that, 200 was enough. In this case you were not justified in giving Phosphorus There had not been a full relapse. Either you have to give a placebo and tell them to wait and come in after another month, and there might be a relapse, or you give Ignatia which is quite justifiable.

Question: But why not give a higher potency of Ignatia?

George: If you have a good case with a sensitive patient, don’t go too high. The first time you can go too high and it is okay, but then if things are not so drastic and dramatic, do not go and give 10m. This is not necessary. A little bit of stimulation will bring this around.

Question: She will still grieve though as long as there has been this problem of the husband and a mistress, right? How do you handle that?

George: She will handle that.



About the author

George Vithoulkas

George Vithoulkas is an Honorary Professor of the Moscow Medical Academy, Professor in the Kiev Medical Academy, Honorary Professor at the University of the Aegean, Greece, Collaborating Professor in Basque Medical University (2001-2004) and Doctor Honoris Causa of "Doctor ViktorBabes" University of Medicine and Pharmacy of Timisoara in Romania. In 1995, he established International Academy of Classical Homeopathy in Alonissos, of which he is the director. In 1996, he was honored with the Right Livelihood Award (also known as Alternative Nobel Prize) "for his outstanding contribution to the revival of homeopathic knowledge and the training of homeopaths to the highest standards".

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