Rajan Sankaran, Rishi Vyas, Sneha Vyas, Ruchita Shah
A 42-year-old-female consulted me in August 2012 with the complaint of nose block and difficulty in breathing due to recurring polyps for which she had already been operated on once. She also had a deviated nasal septum and dust allergy which aggravated her complaints further. The case has been edited for brevity and for a better reading. The index to the short forms is D: Doctor, P: Patient, HG: Hand gesture.
D: Tell me what is happening?
P: I have difficulty in breathing while sleeping at night. I have to breathe from my mouth as I have blocked nose. My nose is running most times and the sense of smell has also faded. This is all due to huge nasal polyps that I have along with deviated nasal septum. I am even allergic to dust and start sneezing immediately even with least dust. My nose is then completely blocked (HG). So I just have to sit quietly for sometime and have to apply some ointment or inhale steam.
D: What is the effect of this on you?
P: I get irritated and angry with this.
D: When you say it causes irritation and anger can you describe it a little bit?
P: My nose is blocked and breathing (HG) is a problem. So then if anybody tells me to do anything then it bothers me. I get irritated I just tell them to leave me alone for some time (HG). I am irritated by any noise then.
D: Tell more about this – anybody tells you to do something?
P: Like the kids asking me for something or my husband asking me for anything. I need some time to myself and not do anything.
D: What do you feel?
P: I feel just to be alone (HG) at that point of time.
D: Be alone?
P: Yes, I just want to be myself (HG). Take care of my problem first and then handle other situations.
D: Tell more about this.. just to be alone.
P: Being alone is not to be disturbed. Just be myself for some time. Feel like just switching off (HG) from everything and just being by myself for some time.
D: Describe switching off and be myself?
P: Switching off in the sense not responding to any phone calls, not responding to any doorbell, not responding to anybody asking me for something. Just want (HG) to be with myself, be within me (HG). Do not feel like talking to anyone. And then when I feel I am ok, then I am up and all around. It is just for that little time, after steam inhalation I am better.
D: Say a little bit more about … be myself?
P: Me, myself is that what I meant like (HG) just to handle the situation and just to sit or lie down calmly for 10- 15 minutes.
D: Just describe this action, what you are showing with your hand?
P: Yes, this means at that time (HG) I do not want to be disturbed.
D: You have any dreams at all?
P: I do dream but nothing in particular; my dreams vary.
D: For example?
P: My dad passed away one and half months back. And since then I think a lot about what happens when one dies, where does the life go. Then I feel that it all remains here. I get many dreams related to this too.
P: My dad passed away due to a cerebrovascular accident. I was the only child I kept him home for two weeks on ventilator and then he collapsed one day. I did not expect him to pass away so soon. He was my responsibility. This has been the first death of an immediate family member.
D: What was your experience?
P: I felt very sad and hurt.
D: What is the experience of this sadness?
P: I didn’t want to talk about it to anyone. I wanted the grief to be with me within myself (HG – hands raised with palms facing each other).
D: Say more about this.
P: I wanted the grief to be there (HG); did not want to share it with anyone.
D: Describe this grief a little bit more ..I wanted it to be within me?
P: Yes, I didn’t want to share it with somebody as they would pity me.
D: Describe “keep it within me”.
P: Keep it within me is not talking about with anyone else.
D: Little bit more?
P: Not describing of what I am going through.
D: Forget the situation just the words – keep it within you?
P: Keep it within me is holding back (HG).
D: Describe this gesture you made.
P: Holding back. I am a very introvert (HG) person. Means I don’t want to open up (HG – pulling apart upraised hands) to anybody. So I hold back a lot of things.
D: So describe these two gestures of holding back and opening.
P: Holding back (HG) is not opening to anyone, even if he is close friend or anyone really close. I don’t want to open up easily. Open up means talking to my heart’s content (HG).
D: What do you mean by open up?
P: Open up is talking to your heart’s content to somebody and feel satisfied.
D: Describe just the word – open up; forget about yourself.
P: Open up is feeling free to talk to somebody.
D: Forget about somebody, just describe the words – open up?
P: Feeling free.
P: Yes talking free, talking free.
D: What is the opposite of opening up?
P: Closing (HG – hands lifted and facing each other).
D: Describe closing?
P: Closing is holding back things I don’t want to share with someone.
D: What is closing? Just the word – closing.
P: Closing is just shutting yourself.
D: Describe shutting yourself?
P: Shutting yourself from the environment (HG).
D: Describe shutting yourself from environment.
P: Is not opening up and not talking the way one should. When you talk to somebody you feel much lighter.
D: Describe the words… shutting the self only this much. What are you showing like this (HG)?
P: Closed (HG).
D: What is this?
P: This is closed completely closed.
D: Describe this only this much (HG)?
P: (HG) This is completely closed.
D: Describe this.
P: I don’t (HG) want to open up to anyone.
D: Why does one close and open?
P: One closes on not getting the right environment to talk to somebody or even if they get but someone’s nature is to keep things within yourself.
D: Why does somebody close? What makes you to close or what makes anything close up?
P: Don’t want to share with anyone. Not even with anyone close.
D: Just think, there’s no rush, we may solve your case today and your nose block will better. But I need to understand something deeper. So take your own time. Tell me about your childhood any dreams any fears anything that scared you or woke you up?
P: That was long back when I was 5 or 6 years old. We went to our grandparent’s place in Calcutta. While returning from there we almost missed our train after loading the luggage in it. But the fear of not boarding the train gripped me, though we managed with all difficulties to catch the same train. After which I remember getting up from sleep with the fear of not catching the train.
D: What was the experience of this fear? How did the fear feel within you?
P: Very traumatic the fear had gripped me.
D: What do you mean by the word gripped?
P: Gripped is to catch you. (HG – hands raised with palms facing each other)
D: Just describe this – what is this?
P: Catch – catching, holding you, gripping.
D: Just describe this little bit more catching, holding.
P: Gripping is the fear gripped me it surrounded me (HG).
D: Surrounded you?
P: I was surrounded by fear at that point of time (HG).
D: Describe this a little bit more… catching gripping, surrounding, forget about yourself. Whatever you can describe.
P: Gripping (HG) or surrounding is the fear, like the fear of losing the train… It just holds me (HG).
D: Describe… holds you.
P: Holds you in the sense you are surrounded with fear and you cannot come out.
D: Tell me your nature as a child?
P: Timid very conservative background. I was brought up in a very conservative background. Had no freedom. I was not allowed to leave home once I was back from school. Was not allowed to meet friends and had to wear only salwar-kurta or saree.
D: How did you feel to be in that situation of conservative no freedom, can’t go out?
P: (Spontaneously) Claustrophobic.
D: Describe the word claustrophobic?
P: Felt like a bird, caged.
This is just an image. It is very important to persist with this image, but in the process go further to her experience in the delusion (image).
D: Describe this bird who is caged?
P: You can see your friends moving in the open sky and somehow you are caged within.
D: How does it feel within?
P: That is the time when you want to break open the cage and fly.
D: Why did you not open it up and fly away?
P: I did not know how to rebel, I would accept everything the way it is, I got all my freedom after marriage.
D: Say more about being timid, not courageous, not being confident, talk about it.
P: Yes, all my problems were solved by my parents. I never got an opportunity to go anywhere or do anything by myself. Hence I lacked that courage. I was becoming more dependent .
D: Describe this lack of courage a little bit more how would it manifest.
P: After marriage I was given work which I would not be able to do and give it back. My husband supported me and my family told me that it is your work whether it is done well or badly you only have to do it. This was how I got my courage back.
D: Did you have any fear as a child?
P: Yes I had a fear of calling for a rickshaw by myself, the fear that what if the rickshaw guy refuses to come, what if he snaps or humiliates what would I answer him.
D: What was your experience in this situation?
P: I would be numb.
D: What is numb?
P: Numb means quiet, I would not answer back.
D: Describe numb and quiet.
P: Quiet and accepting whatever they ask you. Numb what I meant to say is being quiet and not answering back.
D: What are you sensitive to?
P: Sensitive to anything which is not right, anybody hurting me or talking negative.
D: Describe… anybody hurting me.
P: Hurting means talking or saying anything which I don’t like to discuss. Sometimes people just drag and pull you into issues which you do not want to discuss, that hurts.
D: And what are you feeling within? When you say don’t want to talk don’t want to discuss, how does it feel inside you?
P: I feel hurt and I don’t want to discuss it at all (HG). So basically you are not talking about it, not discussing. Just keeping it within me.
D: When you say within me what you mean by these words?
P: Within me is not talking about it with anyone, it’s just keeping it to myself. Being an introvert.
D: What do you mean by introvert?
P: Some people just talk it out and they are free, but I hold back things.
D: What does hold back mean?
P: Hold back means if I am hurt by certain things, or by certain behaviour or environment, I don’t react at that time.
D: As a child did you have any fears?
P: Fear of unknown (Laughs). Fear for no reason, be it of dog, darkness, being alone. I was afraid from childhood, was brought up like that – don’t go there, this might happen, that kind of fear. I did not go there and see whether that thing was actually there, because I lacked the courage. Also had a fear of not doing things properly and being shameful about it later.
D: What is shameful?
P: Of not completing the task given to you. You feel guilty, shameful – you should have done it.
She was asked to draw whatever came in to her mind. She scribbled something and when asked to explain her doodle she said:
P: It is a front side open box. It has 4 sides, normally a box is closed but this is open.
D: Describe covered or closed whatever you can say about it?
P: It is covered from all sides and it’s closed, has no opening (HG – palms together facing each other). It is made of wood.
D: Describe this word covered from all sides just the word – covered. What does it mean? What comes to your mind spontaneously.
P: Claustrophobic, you want to be in the open and you can’t.
D: Why can’t you?
P: It is a box and is covered from all side so cannot open. (HG – drawing hands apart like a clam).
D: Show this hand gesture.
P: Covered from all sides. Not open, you want to be out in the open.
D: Why be out in open?
P: Because inside is claustrophobic.
Case Understanding and Analysis
The patient suffers from blocked nose, so the first question asked was what is the effect of blocked nose on you? To this she answered, “I want to switch off, I want to be alone, I want to be within me, I want to be by myself, I don’t want to be disturbed.” Now this is something strange, individual. Someone with a nose block, can have hundreds of types of effects. Somebody says, I get desperate, I cannot breathe, I run from here to there, I scream at people. In this case, we see that her state of being by herself and not being disturbed is something peculiar for her. So we understand that this is one of the main things in the case. But this is leading us nowhere in the case, because she is at level 2, the level of fact. According to the Sensation Approach, the symptoms that the patient expresses can be understood at various levels, namely:
Level 1: Name – Here, the patient expresses his complaint only as a diagnostic condition, e.g. I suffer from rheumatoid arthritis.
Level 2: Fact – The experience of the patient is in the form of local sensation or phenomena, which makes him experience his ailment as a local symptom only. e.g.: I have immense joint pain due to this condition which is more at night.
Level 3: Emotion – The experience of the patient due to the complaint is more at an emotional level, the emphasis of expression being on an emotional plane. e.g.: I get very irritated and extremely restless due to these pains.
Level 4: Delusion – The patient’s experience of any ailment will be in terms of imagination. So, he talks of what it feels like rather than what he feels about it. e.g.: The pains are just killing me, they are not letting go of me and not allowing me to rest in peace. Fears and dreams also belong to this level of experience.
Level 5: Sensation – This is the deepest level for a person as all fears and actions boil down to this basic theme. So this is the main Sensation / Experience. Sensation is a level deeper than that of delusion and it encompasses the mind and the body. e.g. – a person feels restricted due to his pains, and on exploring that restriction further, he says that he feels limited, hedged in, as if tightly bound, unable to move. This becomes the main Sensation, and since it manifests at the level of both mind and body, it is also called the Vital Sensation.
Level 6: Energy – The experience of the ailment or complaint will be in the form of an energy pattern.
Level 7: Seventh level – The experience at this level is of the space that supports the energy level, or which houses the energy pattern.1
If we are to have a deeper understanding of the case, we have to dig deeper and try to go beyond level 2 to levels 4 and 5. That is the level of experience or sensation which helps us understand the most peculiar experience of the case. It may happen sometimes, as is seen in the above case that the patient may not go deeper, beyond a certain level. Here, one has to persist, trying to explore deeper but the trick then lies in understanding and trying to explore the experience from another place. If you persist and go deep enough, the whole experience opens up.
Significant in this case was the hand gestures that were prevalent through the case and repetitive in the case, right from the start to the end. Two gestures indicating – opening, sharing versus the one which indicated being closed, holding things to yourself, persisted in the whole case. Then it becomes important that the gestures are explored in detail as regards the experience associated with it. For this, the physician has to help the patient dissociate from the situation and images and go deeper to the level of experience. The case was then understood through her dreams and the incident (grief after the death of her father) which affected her and everywhere it was seen that the theme which was common and running through the case was ‘keeping things within herself, not wanting to open up, being alone, holding back, being closed, shut off from the environment.’ The opposite of this she said was being ‘free, open, having freedom, talking freely’.
These are the same words she is using, switch off, alone, don’t be disturbed, same words she is using again with the grief. So what is true for the nose block, is true for the grief. So this must be a very deep level of her experience, her innermost sensation. If someone describes the experience in all situations with the same expression which goes no further, this is the deepest level of experience for that person. When asked about her fears as a child and she narrated the fear of missing the train the effect of the situation being in the form of experience expressed as gripped, caught, held, surrounded, can’t come out, something has caught. From this we hint that the patient needs a remedy belonging to the animal kingdom, the core experience of the animal kingdom according to the sensation approach being, survival, ‘me’ versus ‘you’, victim versus aggressor.2
So, there are two main things in the case: one is to shut and to open, close, to hold back, to be within self versus being open; the other is something external is coming, holding me and gripping me, catching me and that is scary. So this now becomes one versus the other. Further, if we are to understand, there are two aspects to the remedy that she needs. One is the idea to hold and to shut and to be inside and the other is, something can come from outside, and can grip me and hold me and catch me.
Further, from her childhood, we know that she was always lacking courage, had no freedom, like a bird in a cage, who desired to break free but could not, so she always accepted it. Her father was very strict and conservative, and never allowed her freedom. This again indicates a me-versus-you phenomenon, apart from the fact, that she wanted freedom, but could never speak up. This indicates the sycotic miasm in the case which is also indicative through pathology – recurrent polyps. When asked about her sensitivity, the patient said that she gets hurt when people drag her and pull her in something. Since she is at level 2 she does not go deeper than this but these words dragging and pulling are important. All these words with the miasm, made me think of mollusks, as they have the theme of being within, opening and closing.
Breaking, claustrophobia, no freedom, but at the same time cannot rebel. I feel closed in but I can’t go out either. This is a dichotomy. But there is one thing missing in a Mollusc here, without which a mollusk cannot be prescribed and that’s the shell. So to get to the shell I asked her all intellectual questions like dreams , hobbies fear , sensitivity but everywhere she puts thought and her mind doesn’t switch off. So, I ask her to doodle, so that whatever comes up is without the use of intellect. She drew something and described it to be a box and used the words open, close and wood. So what is solid is enclosing, open and close at the same time and her hand gestures she used to describe it were typically indicative of a bivalve.
Thus we need a Bivalve, two of the main ones being – oyster and clam. The difference between oyster and clam is, oyster is mostly closed, clam opens and closes, which seems to be more the energy in her case. Another thing about the clam is, the clam is found in sandy soil whereas the oyster is usually stuck to a rock. People eat clams and they locate them by the holes in the sand which are formed by the hole in the clam shell through which the clam breathes. The clam gun is inserted through the sand and the gun surrounds the clam on all sides, holds it and drags it out. So the action of gripping, pulling and dragging is more applicable to the clam than to oyster. The source words of clam-like gripping, catching, pulling and dragging, and opening and shutting are also seen in the case. The patient was given Venus mercenaria 30 twice a week for two weeks and she responded extremely well.
O A Julian
– Irritability from noise and
– Dreams of death and disease
From Vital Quest:
The giant clams grow among clumps of other sea growths and tend to pose some danger to divers. If by chance, a hand or a foot comes in between the giant shells, it gets caught as if in an iron vise and cannot be freed easily.
When humans or any other predator hunt for clams, they need to dig each clam hole and pull them out or shovel the surface to drag them out from their hiding place. The world beyond one’s shell appears very threatening to Mollusk patients and so retreating into the confines of their shell gives them a sense of security, which they strongly desire, which is their instinctive, survival response. This aspect denotes the chief energy of the mollusks and is often expressed by patients with the help of a gesture of fingers closing and drawing backwards/inwards
The shell does keep them safe from the unpleasant happenings in their surroundings but at the same time, it deprives them of the pleasure and excitement of the outside world too. Despite the great longing to remain within the security of the shell (as it provides them protection), there is an equally intense claustrophobic feeling that these persons experience within the shell. This happens because the shell cuts them off from the life outside. However they don’t have much choice; they are so overpowered by the vulnerable feeling that they finally choose to remain confined and bear with the restrained life. This aspect may be conveyed by patients by use of expressions such as ‘be out of reach’, ‘cut myself off’, ‘feel vulnerable when open and safe and secure when closed’.
The patient was given Venus mercenaria 30 bd daily for 6 months. She did very well; her nose block gradually decreased and so did her allergy to dust. The polyps went on decreasing in size as well. After a year, the patient was 80% better and emotionally she said that she was a different person altogether. She now did not feel caught or held up. She felt quite free and was not irritated or disturbed by small things. She said that she felt very confident about all things and took responsibility herself.
In many cases, when the symptoms presented, they are mainly the common symptoms of the pathology. In such cases, when it becomes difficult to individualize the case with merely the presenting symptoms, it becomes vital that the case is approached and analyzed using a different approach which helps us understand the common theme of the case. Once this common theme is traced, its deepest level is elicited and it can be successfully used to reach a similimum. Though traditional approaches form the base of understanding, new approaches come in handy analyzing the case from a different perspective. Sensation approach is one such approach which is derived and built from the traditional approaches and when wielded with finesse can lead to a definitive analysis, in the absence of obvious symptoms.
The other song has organized Sensation and Beyond: Latest Advances in Homoeopathic Practice, a 3 day intense learning experience on the 8th, 9th and 10th of January, 2016 in Mumbai, where senior and international homeopaths and experts in the ‘Sensation Method’ will put these new ideas into practice. The main purpose of this event is to highlight the advances made beyond the Sensation method, which have helped treat difficult and challenging cases.
1 – Rajan Sankaran, An Introduction to the Levels, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers, Mumbai, Page 225.
2 – Rajan Sankaran, Vital Sensation and the Kingdoms, Sensation in Homoeopathy, Reprint 2009, Homoeopathic Medical Publishers, Mumbai, Page 289
3 – Michael Hourigan and David Kent Warkentin, ReferenceWorks Pro, 220.127.116.11, Kent Homoeopathic Associates