Clinical Cases

Germanium Met. – The Facade

Germanium Met. – They are powerless to carry out their task, but they pretend everything is fine and running as normal (Sherr). But their life has become stuck and there is nothing they can do about it.

Theme: “I reflect on every problem with guilt, like it is all my fault that I’m not good enough.”

XX, 48 years, has been on treatment with us for over 4 years now. She came initially, with predominantly psychological problems and some minor physical problems. She had developed in the course of time, bilateral lumps ? lipoma ? lymph nodes in the groin, one on each side, that swelled or reduced in relation to her menstrual cycle. In addition she has other minor problems like a flaky scalp, figwarts in her armpits, recurrent tendency to colds or allergies in the open air.

These lumps drove her to distraction, inspite of being reassured that they were harmless. They are a big worry to her due to her constant fear of having some dreaded disease like cancer and that would be all her fault! The emotional circumstances surrounding the appearance of these groin lumps, she explains below. She says:

It started back when I was agonizing about leaving my marriage – so I always thought about it with guilt, like it was all my fault I had this thing because what I was thinking/doing was sneaky and wrong. I never really thought about leaving my marriage with a plan and talking about it straight with husband -(instead I thought) always about running away or making all my plans in a solitary way. Never was able to just talk about problems (never really able to handle someone else’s discomfort or anger).

Physical Generals:

She cannot tolerate heat or direct sunshine, but loves pre-storm weather. She dose not like it too cold though feels better in an AC. A good draft makes her feel “alive”. She certainly appears thermally hot. Thirst is for just a few sips of water at a time, but feels hungry with every uncontrolled emotion. Loves sweets, especially those with a crunchy texture, ice creams, cheese, and likes to chew on plastic things. Does not like sour foods or animal insides.

Most times she has a problem with starting stool – having to re-form it to help it come out. This constipation dates back right into her childhood, when her mother had to help her with enemas. These she remembers as very humiliating experiences.

She developed a lot of body hair as a teenager which caused her to be ashamed of her body and hence ashamed to have sex, and to be seen during that time. She is constantly concerned about her appearance and feels she has to be vigilant about showing excess hair or facial hair. This is obvious Sycotic miasmatic expression which is expressed even more vividly in her statements below:

I have only lately come to realize that sex is a natural function or need, and that it’s not this secretive thing, and it’s alright to have these urges. I have a GREAT ability to survive on fantasies and dreams, rather than real life – not only in this area – but all of my life.
Additional mental characteristics:

This is how she describes herself: “Yielding, guarded, friendly, moody, sometimes rigid, introverted, sometimes preoccupied, sometimes compassionate, a dreamer, shy around people I don’t know, but relaxed and louder around those I know, ability to not deal with uncomfortable situations/people/things by ignoring them even when they’re obvious. Striving to please and be accepted. Not daring to make people mad – always checking the ‘undercurrent’ of emotions in the room. Selfish. A loner. Confused. Afraid if I don’t have another person (husband, at least friend) living with me – that I will be mindless and lost and fall into a black hole.”

She describes her fears in this way: “I’m often afraid people are going to humiliate me by pointing out my physical faults. I get fearful when sick sometimes, and think that I’m going to die, and that it’s all my fault because I wasn’t good enough – wasn’t a good person like I should have been. Didn’t do something right. I get very anxious when alone sometimes, especially on a dark rainy cold morning – I get anxious and fearful and like I don’t know what to do – no focus, no future – all alone and forgotten.”

The most stressful situations in her life include: “When I do something that leaves someone else seeming mad. I obsess full-time over the situation, sometimes wanting to actually kill myself because I have ’caused’ such a problem for the other person.
I have very low confidence in all aspects of my life. In the musical realm, I feel confident that I do a good job and that people enjoy hearing our music. Alone, I feel more afraid that people are judging me harshly. I follow the family habit of pretending that things and people don’t bother me, but really have a deep grudge against them. So I can deal with people day to day, and have great resentment that I’ll never deal with.

History Analysis:

As is obvious, there are various aspects of the case that suggest remedies like Thuja, Calc Sulph and Natrum Mur. In fact over a period of 3 years she had these remedies in LM’s and they all helped move her along, while she also had psychotherapy. But I was constantly aware that we were not dealing with the core problem, though she was satisfied with the small but significant progress she had along with psychotherapy. I believe that each of these remedies helped her focus more clearly in the root of all her psychological and adjustment problems in social situations. They were a necessary part of unearthing the origin of her problems around sexual issues and her relationship with her husband which she was never able to clearly articulate to us about earlier.

3 years into treatment, I retook her history (for the 4th time!), and these issues were clearly highlighted above. What struck me at this point was the amount of self reproach she had about her body, about her illness, about her relationships. It seems very important for her to present a facade of apparently being ok and dealing with life, one act after another. She pretending her way through so much that she completely forgot who she was!

At the age of 48 she is still “trying to figure out what ARE my priorities in life, not just having a knee-jerk reaction to ‘inner feelings (mostly anxiety)’. Trying to figure out how to weigh the important things in life – how to balance my needs versus other people’s.” When Germanium came up in the repertorization, I found Scholten’s description very apt in bringing out this theme.

Repertorial Analysis (Mac Rep):

It was obvious in the picture of rubrics below, that we had latched on to something very deep. Here was a need to create an outward facade to pretend that all was well, while underneath she was an empty shell. She did not know herself and was only trying to live life based on how she presented herself to others and their responses to her – even if it was a lie. The strange thing is that she blamed herself for it, to the point of wanting to kill herself for making someone mad at her. This further expressed as tremendous fears of dreaded diseases that she had brought upon herself.

This seed for this psychological imbalance was planted right in her childhood from over strict and distant parents who believed in discipline without loving contact. Add to that the “family tendency” to pretend all is well (as she experiences it). She did rebel against this as a teenager, ran away and ended up in a failed first marriage. But her lack of a developed self identity and the need to portray a mask of normality for others finally had the upper hand in her life decisions.

MIND; DELUSIONS, imaginations; wrong; he has done (K35, K95, SI-386, G28):alum., ars., aur., aur-ar., cand-a., cina, cob., cocc., cycl., dig., digin., germ., hell., hyos., ign., lach., lil-t., lyc., merc., myric., naja, nat-ar., nux-m., puls., ruta, sarr., sil., sulph., thuj., verat.

MIND; REPROACHES; himself (K71, SI-832, G57): acon., ambr., anac., ars., aur., aur-ar., calc-p., cand-a., cob., con., cupr., cycl., dig., germ., gink., hell., hura, hydrog., hyos., ign., lach., lap-c-b., lyc., m-arct., med., merc., myric., nat-ar., nat-m., op., ph-ac., plb., puls., sarr., sil., stram., sulph., thuj., verat.

MIND; FEAR; opinion of others, of (SI-515): Ambr., bar-c., germ., nux-v., ozone, prot., puls.

MIND; SADNESS, despondency, depression, melancholy; weeping; impossible (K78, SI-567, SI-891, G62) (Grief; silent): am-m., apis, aur-ar., carc., coff., coloc., crot-c., cycl., gels., germ., Ignatia, indg., ip., kali-fcy., lach., lap-c-b., lap-gr-m., lap-mar-c., lyc., NAT-M., nux-v., peti., ph-ac., puls., sal-ac.

MIND; ANGER, irascibility; tendency; himself, with (SI-34) (mistakes, over his): aloe, ars., bell., elaps, germ., ign., lyc., nux-v., sep., staph., sulph.

MIND; FEAR; observed, of her condition being (K46, SI-485, SI-515, G35, G37) (looked at): aq-mar., atro., bamb-a., Calcarea, chel., choc., germ., lap-c-b., lap-mar-c.

MIND; CONFIDENCE; want of self (K13, SI-159, G11): agn., alum., am-br., am-c., am-m., Ambr., aml-n., Anacardium, anan., ang., anh., aq-mar., arg-n., arist-cl., ars., aur., aur-i., aur-s., bamb-a., bar-acet., bar-c., bell., bry., buth-aust., calc., calc-sil., cand-a., canth., carb-an., carb-v., carc., caust., chin., chlor., choc., cob., cocc., dros., dys-co., foll., gall-ac., gels., germ., graph., hydrog., hyos., ign., iod., kali-c., kali-n., kali-s., kali-sil., lac-c., lac-h., lach., lap-c-b., lap-gr-m., lyc., manc., med., merc., mur-ac., naja, nat-c., nat-m., nat-s., nat-sil., nit-ac., nitro-o., nux-v., olnd., op., ozone, pall., petr., ph-ac., phos., pic-ac., plb., prot., puls., ran-b., rhus-t., ruta, sac-alb., sant., Silicea, spong., staph., stram., sul-ac., sul-i., sulph., sumb., syph., tab., thea., ther., verat., verb., viol-t., zinc.

Here is some insight from Scholten’s Elements:

Stage 14: Empty, Weak, Eliminating, Diverting, Pushing aside, Irresponsible, Indifferent, Formal Distant, Covering up, Mask
Ferrum series: Task Work Duty, Craft Use, Ability Perfectionism, Routine Order Rules, Control Exams, Observed Criticism, Failure Guilt Crime, Persecuted Tried, Adult, Village

Essence: a formal profession: civil servant, official.
–A formal profession, civil servant, official–
Germanium is the classic type of civil servant. They carry out their task pro forma, but they don’t take any real responsibility. They are afraid of being held responsible for any of their actions.
–Formal routines: formalities–
They love hiding behind formalities. As long as they work with lots of official forms they can be sure they won’t personally be held responsible for anything. They often hold back information, hiding behind a mask of perfectionism (Sherr). But they feel restricted at the same time, a prisoner of controlled movement and measured speech. They are afraid of having made a mistake after all, afraid of authorities, police, parents, teachers or directors watching them and finding out they have done something wrong.
Escaping control: estranged.
They try all sorts of ways to avoid being held responsible. They push responsibilities on to other people, wriggle out of accusations, deny their mistakes or say it was someone else’s fault etc. (Sherr 95). They feel misunderstood and useless compared to their colleagues. As if they are caught up in a fight between two parties, but it has nothing to do with them. To take the attention away from their own mistakes they’ll blame others.
They become an outsider, estranged from their colleagues and their environment. Eventually they’ll feel estranged from themselves, as if they have left their body.
–Failure through irresponsible behaviour–
Because they deny responsibility certain things are bound to go wrong. The outside appearance may still be there, but it is only an empty shell. They are powerless to carry out their task, but they pretend everything is fine and running as normal (Sherr). But their life has become stuck and there is nothing they can do about it. The decline is undeniable and they feel that all their efforts have been in vain. They are too tired to do anything anymore.

Progress Notes:

As explained initially, she had been on Thuja, Calc Sulph and Natrum Mur, each for 8 months upto a year. With each she showed some response that helped her get out of her shell a bit and deal with life more on her own terms. But nothing like the improvement she has had over the last year as detailed below.

During this time, she developed a recurrent yeast type of Leucorrhea which I thought was significant given the chronic inguinal lumps. This has not resolved as yet. She also had an increase of spondylitis symptoms for which she needed Silica that helped alleviate this considerably. I have found Silica to be complementary as well as antidotal to Germanium in a couple other cases. It is interesting that Silica is next to Germanium in the Periodic table

First Dose: June 26th 2005 (Germ 200C dry pills)
I have changed from not drinking caffeine to having a cup of tea a day. Doesn’t strike me as particularly healthy, but it’s moderate.
I have returned to lots of dry flakey scalp (soon after last illness, where you prescribed bryonia).
I’ve been feeling well, the lump on left side is softer, but still sensitive. Period went well this month.
I’ve been having again tingling in legs, arms, hands, roaming all around. I can’t really attribute it to anything in particular, though woke up tired this morning. I had started getting that tingling some time ago (a year?) along with what feels like blood pooling in my legs (that is, they turn reddish, which dissipates if I rub them) when sitting at work or sitting eating dinner or like that. I’ll wait longer to repeat, as I feel it’s allowing me to integrate some emotional stuff.

Second dose: July 30th 2005:(Germ 200C dry pills)
I think the Germanium is doing good. I feel a more complete sense of self – rather than constructing a fantasy person inside that I talk to and keeps me company, I feel more myself. I am fighting reacting to my husband’s trying to upset me (he usually gets argumentative and irritable when I am going away for a few days), trying to stay calm and reasonable, but I really am seeking comforting and love and feeling very sad. So this kind of works against the ground I have gained… once more I seek comfort from a fantasy in my mind.
December 30th 2005: Germ 200C water dose
Had the water dose on 12/20. Now, after a Christmas of chocolate excess, I find the yeast infection back to itchy, stingy and lots of cheesy material. Can’t resist candy when it’s in reach.
I feel overwhelmed sometimes… i keep going through cycles (months long?) of living in fantasy, being insecure and spending all my time and thoughts intent on getting other people’s attention, then suddenly, I’ll have a ‘breakthrough?’ – a time of remembering… oh yeah, I’m supposed to be a mature independent person with responsibilities and goals, etc. so then i spend a time NOT obsessing on getting attention, but working (obsessively?) on goals, etc… till i cycle through again. i guess when i have the bulk of time in the working on being mature and independent instead of the bulk of time in attention-seeking, I’ll feel ‘grown up’.
other than itchy head, sugar-desiring and yeast infection itch, other things seem okay. i think some of the other symptoms earlier were because of great anxiety.

I shifted her to an LM, so that we could repeat more often and that its effect would hold much longer and deeper.

Germ Lm2 March 15th 2006:
I have been doing well, I think on this Germ LM2. But this morning I awoke with a sharp burning pain in the middle knuckles of my left hand, most specifically the middle finger. It hurt on straightening. It lasted about 15 minutes, and there’s residual stiffness… don’t know if this is related to my exercise program, playing instruments?
But the yeast inf, now that my period is over, is not as strong as before at this time. The groin lumps do seem to have a softer quality. Only once during the past month did the one on the left feel larger and stiffer, and they only lasted a day or two during my period.
I have periods of kind of foggy thinking, and periods of more clarity in thinking. Mostly what I think would be a good change for me would be to have a change to thinking of the future and having habits and routines that help me accomplish what I need. In the past I have mostly just tried to keep people happy, more focused on what I THINK other people want. At least now I am ready and more interested in listening to what other people think. But hope for more progress.

The foggy thinking above seems to be a sign of aggravation of germanium, and this was later confirmed when she had a dose once too often (which was once in 2 weeks or so).

Last Follow-Up: May 11th 2006
I’m feeling optimistic emotionally… I am feeling more solid personally-wise, and can feel myself sinking into fantasy, escape, but overall, a good sense of having motivation and sense of direction. i feel like I’m having more of a grasp on my overwhelming sense of fear, little by little, and where that comes from.
The vaginal cheesy material still exists, the groin lumps smaller and softer. elbow pain is off and on during the day, not bothering when I’m fiddling, but tiring when using the computer. lifting things, picking things up, twisting my forearm, all cause ache.

Since then, she has not had another dose, as the foggy mind recurred again. It gradually reduced along with physical improvement in the spondilitis and leucorrhea, over the last 2 months (at the time of printing this article).


Her emotional improvement has been progressive and sustained. This is one of the prime examples of how a good homeopathic remedy either assists or replaces conventional psychotherapy. Once the soul and spirit is well aligned with the vital force that has been balanced with a similimum remedy, one finds one’s way to normality over time, slowly but surely. The next step after this is to wait for the true constitutional picture to come up, which will indicate her basic remedy. For now though, she’s in no hurry. She is simply enjoying this phase in her life, discovering who she is and feeling more and more normal every day.

About the author

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website :
and contact her at: [email protected]

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