Minutus

Dear all, below is Tanya's latest case for consideration - please send all
comments to the group to share and please also support your advice and ideas
with rubrics, repertorisation and materia medica. Best wishes, Joy Lucas
RSHom
Case NW

62 yr old woman

retired therapist

married, 5 children, 3 grandchildren by adoption

cc: split high/low feeling. Energy up and can tackle the world; energy down,
and is shy, timid, anxious and withdrawn.

After menopause: vaginal opening developed a tight ring; normal sex painful.

Varies in tightness

sex once was enjoyable but now a bother. To painful or not possible.

Male gyn says it was due to kids and episiotomies.

Used to have feelings of early childhood sexual abuse but has given up on
these memories­could never uncover the situation. It would have been an
infancy experience.

There are several arenas of complaint:

Heart: She has reported tachycardia, especially after suffering 9 deaths in
less than 2 years, including her parents who died within 5 months of each
other. She was given Ig 30c at that time to avoid surgery that was being
touted by her H and others Mds

The heart skips a beat or is like an extra thunk after a beat.

She talks about being heart broken over a sexual experience between 2 of her
children. Her oldest son sexually abused his younges sister when she was 10
and he was 14? The daughter¹s life has been ruined over this. About 2 years
ago a family therapy process was begun and now the daughter can handle
seeing her brother on organized occasions. The Pt is grateful that there is
still a caring base between them. But she is quite overwrought over the
situation. She says she is not guilty but responsible. She understands that
the son was acting out his sexual insecurity after being abused by a male
student at school and she did not know of the sexual abuse with her daughter
till years later when the daughter finally told the family. The son was
always impulsive and used to getting his own way. She had consulted with
Œprofessionals¹ when he was growing up and she followed their advice, but he
was spoiled and self-centered.

It all weighs heavy on her heart.

Stomach: Last year she was experiencing pain across her midriff after
eating. This lasted for a period of time.
It was a time when she was frustrated that her writing and piano time was
being hijacked by others. It was Passover time and she had the
responsibiltliy of getting the house ready plus all the others
responsibilities she had. Says "she couldnt stomach the situation."
Other stomach problems include pain and cramping in the guts with gas and
diarrhea. There

are repeat runs to the bathroom with diarrhea which will last until late
morning. The stools

are skinny, stringers, like elbow maccaroni. This problem was prevalent
during her first year

as a psychotherapist; very scarey doing this work­despite her supervisors
encouragement.

This was a typical way of expressing anxiety as a child, too. If under
pressure this will

occur.

Says this means "I don¹t eat this shit!"

Headaches: She describes 3 different kinds of HA. Migraines, sinus, tension.
The tension headaches
feel like stabbing pain in the temple, amel by presssure. The are like air
pressing on her; like something setting on your head. They occur with sudden
anger or frustration.
The only migraine HA she had, years ago, felt like a spiritual experience.
There was no Head

pain, but the doctors said it was a migraine aura.

Body pains are usually achy and she has many and they change over time.

She is a fast walker but cant climb stairs and uses a chair lift at home
because of her knees.

She forgot that several years ago (about 5) she was walking slowly with pain
and a cane.

Balance: she loses it. Feels insecure on her feet

Skin: very sensitive to touch and to sun.

Just a lite rubbing will irritate the skin on her hands

Two years ago she had a podiatrist work on her big toe for an ingrown
toenail

He was brutal and just dug in. Today there is a double nail that grows and
the sensitivity is so
great that she cant take the feel or weight of a blanket on her toe. It is
numb on the outside edge and painful at the top edge of nail
the toe was traumatized 3x in 6 weeks

She felt her feet were treated unfairly; was indignant that she had the
problem;

Life is unfair!

Was very angry at the 1st podiatrist; he was brutal; wouldnt numb the
toe­just dug in.

The 2nd Md was kinder and considerte

She blames the 1st guy.

Allergies: Has itchy eyellids

Is cold sensitive

Eye: has a protrusion on her lid from a minor surgery, like an ingrown
eyelash. It wont go away.

She complains of constant fatigue and has to sleep in the afternoon. This is
a many years long problem

An organic concentrated fruit and veg supplement seems to have alleviated
this problem. She has been on thyroid medication for several years now.

Food: chocolate­must have a little each day and will hide it.

Coffee­needs to have her 1 cup in the a.m.

Mentally she is a very bright and creative woman. Loves to write sci fi and
childrens stories. She is very precise and careful about her thoughts. Feels
she is ADD and has had it corroborated by a professional peer based on
verbal diagnosis. Her Sx are intensely focusing on something to the total
exclusion of everything else or completely losing track of what she is
doing. She requires careful organization of her time and plans it carefully
in order to get things done. Makes notes and keeps papers in specific piles.
As a very orthodox person, she carefully organizes her kitchen to keep
everything separated and kosher. She cant stand anyone doing anything in her
kitchen for fear that something wont be done right. It takes a long time for
her trust someone else in the kitchen. This is more than simple concern for
procedure.

She complains about a very poor memory. Her children and son-in-law
corroborate her poor memory and her intense focusing when working on
something. They she is sometimes lost in a cloud and they cant get throught.

Emotionally: She acknowledges having control issues, but mainly to keep
herself under control (as opposed to her H who tries to control everyone
else).

Is highly sensitive towards others. Worries about others. Has done hospice
for many people dying, including her parents and closest friend and a close
first cousin.

Began to play music when very young and had several teachers. One man wanted
her to train for the concert stage but she freaked at perfoming. No one had
said she could become a teacher or writer of music so she stopped taking
lessons.

She used to love performing as a young child till she was embarrassed at her
putting herself out there. She would never perform again.

Pt has an enormous aversion to be touched. Yet she allows herself to be
worked on by medical people all the time.

One of the ways she tries to control things in her life is through
meditation and mind-over-body will power. Pt will talk to her head to rid
headaches. Or talk to herself about the stomach pains to alleviate them. She
uses her spirituality to try and heal most things.

But her anxiety over health leaves her open to medical suggestions all the
time. Her latest anxiety if skin cancer. Her doctor noticed a discoloration
in the skin (it is not visible) and the Pt was fearful to not do something
about it. Because of the delay in doing this case, I am sure she has had
some allopathic intervention by now.

Fears: suffocation is a big one. Its like a pillow over the head feeling

at age 2-3 yrs, she was forced to be quiet at home because the landlord
didnt like kids

because of constant sinus problems as a child, she couldnt breathe through
her nose. At meals

she was mocked because she breathed with her mouth open. She was told to
close her mouth

and couldnt breathe.

She felt she was very supressed.

She has other fears and gets fearful easily. A suggestion of a problem of
safety will create a long term fear. For example, drowning. She was
cautioned about safety in the ocean swimming and developed a fear of
drowning.

As a child she was very good. She recalls playing in the street, at the
curb. There were not many cars at that time. A wealthier neighbor had a car
and pulled out into the street and ran over the Pt¹s legs. The driver never
even stopped to inquire about the little girl. There seemed to be some
indignation in telling of this.

At age 3, Pt¹s M was put into a hospital for about 6 months. There was still
a big fear of TB then and all patients were treated with this concern in
mind. The M was sent to a sanitorium, erroneously. The Pt was put with her
MGM, against her M¹s wishes. After being with her paternal relatives for a
short time they could keep her because of her grief. At the Grandmother¹s,
the Pt was force fed and kept indoors. She was made frightened of the
outside world and not allowed to play with any children. When reunited with
her parents, her relationship with her F became somewhat estranged where it
had been very warm and close before. Today she thinks her F might have felt
guilty, but as a young child she thought she had misbehaved, done something
wrong.

Her mother was more like a friend that a parent. The Pt was not allowed to
do physical chores around the house but was under the gun to perform
intellectually by her F.

As a teenager, her social life was estranged due to religious differences
between her and the community. The Pt had already made a personal
committment to an orthodox way of life which prevented her from
participating in Fri nite and Sat events with non-Jewish peers.

Music was her passion during much of her growing years.

She chews her the skin around her finger nails. She cant stand anything
rough feeling. But is very embarrassed to show her hands because of their
appearance. She says she thinks it is an eating disease, like cannabalism.

Loves Egyptology. Has taught herself the Egyptian alphbet and designs
needlepoint plaques using this alphabet to celebrate family events. She had
a cat that was named Egypt who she mourned heavily over when she died about
3-4 yrs ago.

Sees herself as a spiritual healer of herself and others.

There was a period, in her 20's, when she lost her spiritual connection and
went into a depression for about 3 years, till she was able to reconnect
with it. Religion is a major part of her life. When her oldest son married
about 5-6 years ago to a Filipino woman, Pt refused to go to the wedding.
Despite the fact that she adored the woman, she felt she could not sanction
the marriage due to the woman¹s not being Jewish. Pt feels very strongly
that the religion needs to be protected and not diluted. It was an
ideological protest which divided the family. However, since the wedding,
she totally accepts this woman into the family. So there is an element of
strong idealism presented.

Another strong quality of hers is obstinacy. She can be like steel (my word)
when in this state.

Today, this woman is very active in her family and religious community.

She is highly responsible and takes her commitments seriously

Her H is a doctor and they have had a financially secure life once his
practice developed

Of her 5 children, 1 is still at home at the age of 37. The others are out
of the house now and are involved in their careers. They were all late
starters. Two of them married and adopted children who are adored by Pt and
her H. It¹s a very warm family although they do have their problems.

One aspect of the family dynamic is that noone ever raises their voices.
Everything is handled in very low tones. It is hard to detect anger as an
outsider.

This woman¹s responsibility seems to weigh heavily on her. However, she
gives all financial responsibility over to her H.

Analyzing this case seems to point to issues around abandonment and a sense
of personal wrongdoing early in life. She seems to needs to be perfect for
fear of abandonment. So, despite her Œi can take on the world¹ feeling when
in an up state, it is these underlying fears and how she handles them that
has controlled her life. The fears make her very timid and she looks to keep
tight order in her personal doings to stay in control of herself (3). A very
sensitive (4) person, she cares greatly about the people around her.
Idealism is reflected in her piety and obstinacy is her reaction when her
moral sensibilities are threatened. Otherwise, she is pretty cooperative.
Her boundaries around herself are pretty healthy.

Diarrhea under anxiety is characteristic of her.

Difficulty in expressing anger

Sensitivity to medicines, touch, feelings is very strong

Indignation at unfairness is a strong feeling, but one that is not expressed
strongly.

Aches and pains that go through periodic appearance

Dependency seems to be strong, despite her ability to take on projects and
bring them to successful conclusion. After her parents died and her H wasnt
taking good care of himself, she expressed anger at his not surviving for
her.

Rx: Puls and Ig come up strongly. I was surprised that Caust did not make a
strong showing in the analysis. Nux , Staph, Ph-ac, Phos & Acon also show
high.

There is so many more details around physical problems and her religiosity
that I think I got lost in the case and am not sure I have a handle on it.
So comments will be more than appreciated

tanya
[Non-text portions of this message have been removed]

What a fascinating case! And it's the kind of case in which it's easy to
become lost, because it's so complicated and diffuse.

Lots of remedies come up as possibilities, such as ign. related to the
history of grief, Nux-v or Ars with the fastidiousness and anxieties along
with GI complaints, one of the Kalis with the desire to build family and
community and do social good, China or Hep with the distinctive sensitivity
to everything, Calc with the obstinacy...

I was thinking, as you can see, about a mineral remedy because she's very
structured and concerned with propriety. However, the remedy that fits the
whole case quite well, I think, is Lyc.

I started from that duality -- high and low, courageous and timid, energetic
and weary, fearful and obstinate. From there, I looked at what might be the
kernel or heart of the person's picture of symptoms. On the one side, we
have a huge variety of anxieties, fears, and sensitivities, both emotional
and physical. On the other side, we have a person who appears solid,
dutiful, strong -- a "pillar of society," concerned with her social
position. She's been the consummate caretaker in her family and her church,
and yet her internal awareness is filled with a huge tangle of fears about
being injured -- a major sense of weakness on all levels. It's not so much
that she thinks she's two people, as might happen with Stram or Anac -- just
that she appears different outside and inside. This makes me think strongly
of Lycopodium.

Then, when I look at the physical symptoms, Lycopodium fits with all of
them -- the palpitations from anguish, the cutting stomach pain from
indignation, the diarrhea with anxiety worse in the morning, the thin
stools, the nasal obstruction leading to a fear of suffocation, the
sensitive skin, the sense of being off balance, the stabbing and pressing
head pain, the pain and weakness in the knees, the aggravation from
ascending, the itching eyelids, the weariness worse in the afternoon, the
desire for sweets -- Lycopodium has all these symptoms, and its major
physical spheres of action include nasal, heart, GI, head, extremities.

Based on these considerations, I think it might be worth considering
Lycopodium for this patient, especially if she shows any signs of being
thinner above than below, and has any external manifestations about the head
and face of worry, premature aging, graying, wrinkle lines, anxious
expression, etc...

For what it's worth... )

Thanks for the opportunity to "play" with this and analyze a very
interesting case. I'll look forward to reading your followup experiences
and comments.
Rosemary Hyde

One more thought on this case. It occurred to me that one salilent element,
one that is rather peculiar, is her apparent need to ascribe a psychological
explanation or meaning to each physical symptom -- "theorizing." That
should be a high level symptom in considering the case, I suspect.

The thought just popped into my head overnight -- I feel kind of silly
adding these afterthoughts, but this one seemed fairly central. Rosemary

some rubrics
Synthesis Repertory
Mind, Emotions, Suppressed: carc, caust, sep, staph

Boehenhousen Repertory - General conditions
EMOTIONS ANGER, SILENT GRIEF, SUPPRESSED ETC., WITH AGGRAVATION: (23)
3 ACON, 1 alum, 2 ars, 3 AUR, 1 bell, 3 BRY, 2 cham, 3 COCH, 3 COLOC, 2
gels, 1 hyos, 3 IGN, 3 LYC, 1 nat-c, 2 nat-m, 1 nux-v, 1 phos, 3 PH-AC, 1
plat, 1 puls, 3 STAPH, 1 verat, 2 zinc
(the numbers precedding the remedy indicate: 1 regular, 2 italic, 3 bold)

there is the rubric indifference - meaning apathy - and there are alot of
subrubrics of this = if they fit.

Can you find out why they suppress / when did they begin to suppress /
the causation. is there a symptom that began when he first dulled his
emotions? you may find that symptoms in the particular section of the
repertory with a subrubric of agg by emotional suppression.

the unfeeling rubric in Kent is 2 rubric guides as to pertaining to: devoid
of kindness or sympathy - kent also cross references unfeeling to cruelty
and want of moral feeling - this seems to bring this rubric into the light
of not emotional suppression but a lack of humanitarian feeling.

good luck
holly earley
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