Abstract: In taking a case, we are asked to simultaneously take on two seemingly conflicting roles; these being to listen and observe carefully, free from bias, to the spontaneous presentation of the patient, while on the other hand, being carefully attentive to and cognizant of what is unusual or characterizing in this presentation. Here is a presentation of a case of a lady whose gestures and enthusiasm helps in understanding her nature and constitution and who got a favourable response after receiving a simillimum.
Keywords: Histrionic Personality Disorder, Psychology, Cluster-B Personality Disorder, Veratrum Album.
(This case originally appeared in the summer 2013 issue of ‘The Homeopath’)
Case: When we first met, Charu* seemed to radiate enjoyment of life. She brought along on this visit her friend, another one of my patients, who later on helped me to better understand Charu’s nature. Charu often dresses very flamboyantly. She was single, in her late 20’s and teaching in a primary school, and when she didn’t have class she was often out late on a date. When I first spoke with her, she enthusiastically told me how impressed she was with the results of my work and started giving me references of so-and-so people whom I treated. She was clearly overdoing the praise, but who would not appreciate such flattering comments?
From then on, she always accompanied her friend to my clinic and tried to gather my attention by praising me or my clinic. Over a period of weeks, however, our interactions grew strained. She frequently complained of various illnesses and injuries like falling in the parking lot or twisting her neck looking out a window that interfered with her work. She was quite disorganized, often leaving to the very last minute tasks that required considerable planning. Charu made promises to other people that were impossible to keep but seemed to be aimed at winning their approval; when she broke the promise, she usually made up a story designed to elicit sympathy and compassion. For example, she promised the mother of one of her students that she would put on a “massive and unique” birthday party for her daughter, but completely forgot about it until the mother showed up with cake and juice. Upon seeing her, Charu flew into a rage and blamed the principal for keeping her late after school, although there was no truth to this accusation.
Charu often interrupted the discussions to talk about her latest boyfriend. The boyfriends changed almost monthly, but her enthusiasm (“Like no other man I have ever met!”) and optimism about the future (“He is the guy I want to spend the rest of my life with!”) remained high for each of them. Wedding plans were seriously discussed with almost everyone, despite their brief acquaintance. Her disorganized habits often got her into trouble, but by ingratiating herself to the male teachers, she was saved from one dilemma after another.
When it became clear that she would probably lose her teaching job because of her poor performance, Charu managed to manipulate several of the male teachers and the assistant principal into recommending her for a new job in a nearby school district. A year later she was still at the new school, but had been moved twice to different classrooms. According to her friend, Charu still lacked close interpersonal relationships, although she described her current relationship as “deeply involved”.
Diagnosis: Histrionic Personality Disorder
Discussion: Individuals with histrionic personality disorder tend to be overly dramatic and often seem almost to be acting, which is why the term histrionic, which means theatrical in manner, is used. People with histrionic personality disorder are inclined to express their emotions in an exaggerated fashion, for example, hugging someone they have just met or crying uncontrollably during a sad movie. They also tend to be vain and self centered, and uncomfortable when they are not in the limelight. They are often seductive in appearance and behaviour, and they are typically very concerned about their looks. (Charu, for example, spent a great deal of money on unusual jewelry and was sure to point it out to anyone who would listen.) In addition, they seek reassurance and approval constantly and may become upset or angry when others do not attend to them or praise them. People with histrionic personality disorder also tend to be impulsive and have great difficulty delaying gratification. Speech is often vague, lacking in detail, and characterized by hyperbole. For example, when Charu was asked about a date she had had the evening before, she might say it was “way cool” but fail to provide more detailed information.
Homoeopathy proposes a pragmatic solution for people with histrionic personality disorder, but still they are usually difficult to treat for a multitude of reasons. As with most personality disorders, people present for treatment only for some physical complaint, or when stress or some other situational factor within their lives has made their ability to function and cope effectively impossible. Unlike other people who suffer from personality disorders, histrionics seek treatment quickly and exaggerate their symptoms and difficulties in functioning. These emotionally needy persons reluctantly terminate therapy.
Persons suffering from histrionic personality disorder exhibit suicidal tendencies, which should be assessed on a regular basis, and suicidal threats should NOT be ignored or dismissed. Suicide sometimes occurs when all that was intended was a gesture, so all such thoughts and plans should be taken with the same seriousness as with any other disorder. Homoeopaths will often experience reactions to treating this disorder, because of the dramatic nature of the patient. Because of this possibility, the doctor should be more attuned to their own feelings within the therapy setting and ensure that they are treating the patient fairly and with respect.
Homoeopaths provide a more holistic treatment with constitutional case taking. From an integrative theoretical point of view, histrionic personality disorder appears to be rooted in childhood events, the family system, as well as the environmental or cultural system. So we must take into consideration all of these while selecting a simillimum. Distinctive features like genes, childhood nurturing, surroundings and the way an individual establishes their life, elucidates their personality. The correct homoeopathic medicine will catalyze a healing process that will raise the person’s overall level of health.
Homoeopathic remedies help reduce dissatisfaction, anger, hatred, guilt, shame, jealousy, dubiousness, fear and other negative emotions. These medicines will enhance suppressed inner capabilities, shape the inborn behaviors with the existing circumstances, get rid of mental negativities and restore well being. Treatment will help a patient stabilize emotions, attain mental peace and bring eventual happiness. After a constitutional homoeopathic treatment, patients become more realistic, less intimidating, much more accommodating, and easier to live with. Homoeopathic remedies help develop a better sense of right and wrong and help a patient go back to living a more normal life. This is what exactly happened after a few doses of Charu’s constitutional medicine VERATRUM ALBUM. Consider the following rubrics:
Just to mention, herewith, that Charu didn’t come for treating her personality disorder but simply for burning pain in the abdomen after fruits, for which she had a marked craving. It is the magic of homoeopathy and the constitutional treatment that not only Charu’s physical complaint gets better but also her personality changes for good. No longer a histrionic, Charu has become more organized and conscientious about her future. All she needed was a couple of doses of VERATRUM ALBUM 1M over a time-span of 3-4 months.
One thing worth noticing here is that patients with histrionic personality disorder not only require a proper constitutional treatment but psychological counseling as well. Since many people who have histrionic personality disorder will emphasize attractiveness (“style over substance”) in their lives and relationships, discussing alternatives and trying out new behaviors may be helpful. A large part of therapy for these individuals usually focuses on the problematic interpersonal relationships. They often manipulate others through emotional crises, using charm, sex, seductiveness, or complaining. People with histrionic personality disorder often need to be shown how the short-term gains derived from this interactional style result in long-term costs, and they need to be taught more appropriate ways of negotiating their wants and needs. Charu’s case illustrates how the homoeopath brings the patient into the process in a way that  encourages the patient to experience the tension of the persistent disorder, while  interpreting the underlying enactment in a way that helps the patient discover meaning in her life situation and adapt better to reality.
* Name changed