Dr. Jose Zachariah
CERCH, Kottayam 1
A young man of 21 years, came with his father around 5 years back. He appeared very moody and talked hardly anything. It was after strong persuasion, he said a few things. His father gave most of the details. His major complaint was lack of interest and inability to perform in his present job. He graduated with 1st Class and is teaching in a tuition centre. He experiences sudden loss of memory while teaching like, what he was about to say. More over there is trembling to extremities and of the tongue also. His father said that it is probably because of the psychiatric medicines he had been taking since a year.
Why? What for? I asked.
“It is for depression.”
Okay, tell me about the history.
He had a breakup in love and she got married, his father said.
Is it so? I asked him. His eyes were burning with anger and hatred? “This is how my parents behave with me. I told them time and again that it was not a love affair. But they don’t seem to care. It was only a deep friendship. She is Muslim girl and I am a Christian. Even before we became friends, her marriage was fixed and I knew it.”
” But his complaint developed after her marriage” -his father interrupted.
“That is true. But it was because she was my only friend. No one understands me except her. Her presence gives me a feeling of calmness and assurance”.
This guy was basically a loner, an introvert and is withdrawn. This girl was his classmate and is very open and friendly type. She thought of motivating him, helping him to come out of his shell. They made a very good company. They used to exchange letters. Once his mother happened to see one of these letters and she made a hell out of it. She accused him badly and asked him to stop all communications with her. That was too much for him and he developed a deep hatred against his mother. From that day onwards there was no verbal communication between them.
He was a pessimist. He always saw the dark side of everything. He was not able to enjoy the happiness of any event. He even wondered why people (his classmates) are making too much noise, whistling, laughter etc. at the trivial jokes cracked by anybody. What is the fun in it? He cannot see that. He was too serious for such silly things. For him, to enjoy a joke, there must be some content in it.
Perfectionist:- He always aims at perfection but ends up sad because he sets high targets and was not satisfied with anything inferior. He was a bit fastidious. He takes care of even minor details and suffers from small setbacks. He doesn’t read or talk about sex because that is immoral.
He was sad because he was not able to live up to his parent’s expectations. He was happy when there was a relationship with the girl. After her marriage he felt a terrible disappointment- total darkness, the light in his life is gone.
” I felt like why should I live anymore. There is no point in living. I wanted to die. I was haunted by thoughts of suicide quite often. I haven’t done it so far only because of the disgrace it may cause to my parents”.
Since one year he was under psychiatric treatment and it helped in taking him out of his acute phase of depression and he started working in a tuition centre. But one month back he left home and wandered in Ernakulam for two days. He said that he had a feeling as if going mad when he went home. That is why he ran away. There was no peace of mind. I am fed up of life.
His father was working in the postal department. He was hypertensive. Mother was a teacher. One younger sister studying for nursing. His younger brother died of blood cancer. His mother’s last delivery was a stillbirth of twins. His paternal grandfather had Schizophrenia.
Anxiety and worries over trifles. ++
Mental discomfort and restlessness++
Sadness – agg. evening +++, sad songs++
Mental tension and unnecessary fear
Startles at noise++
Fear of strong winds++, loud noise+, thunder-storm+
Desires solitude+++, nervous in a crowd++
Fear of taking up responsibility+
Indolence+++ Wants to lie down in bed++
Indifference to his work++
Enjoys writing stories- mystic,
Belief in God + But does not go to church since 6 years.
Sensation of heat of whole body especially palms.
Does not cover during sleep. Increased sleep after taking medicine. Likes to lie on abdomen. Occasional frightful dreams.
Appetite is less. Likes non-vegetarian food. He desires sweets++ and chilly things+.
Bowels are constipated. It moves only once in two days. Very dry and hard stool.
Pain in lower abdomen after passing stool+.
Earlier he had alternate constipation and diarrhoea.
H/o urinary infection one year back. Pain in lower abdomen after micturition.
Analysis of the case
Even if a few medicines can be considered for differentiation, I don’t think it is difficult for our learned members to see the medicine in this case .
Indifference and apathy after a prolonged grief or sudden acute grief. They isolate themselves, without any interest in their job. No amount of persuasion is going to arouse them. But suicidal thoughts are unlikely to see in Acid Phos.
In spite of the fact that it is present in a lot of relevant rubrics, and the essence of the medicine has a close similarity to the patient, it is very difficult to see Natrum muriaticum in this case. There are no corroborating symptoms to confirm the diagnosis.
Grief followed by tremendous depression, and loathing of life with suicidal disposition characterizes this medicine. It is not listed in the rubrics indifference to business affairs and fear of insanity. Vithoulkas describes Aurum people are having a relative elation during evening. Still then it is listed with 3 marks under Sadness in evening. Industriousness and religiousness are not seen in this case. Religious affections are seen as a compensation of suicidal tendencies. This patient is perfectionist. Before the development of pathology, he used to set high targets and worked hard to achieve it. In the over all analysis, the image of Aurum Metallicum is fairly clear and explicit.
Rubrics Supporting Aurum
Ailments from disappointed love, mortification, grief.
Loathing of life, Suicidal thoughts.
Indolence .Indisposed to talk.
Sadness in evening .Hatred to persons offending.
Fear from noise .Startled from noise
Anxiety of conscience
Constipation alternating with diarrhoea
Abdominal pain after stool
Remedy responses and prognosis
9-01-1995 Aurum met 200/2D
Improvement started after one week of taking medicine. He started going for teaching.
2 months after: Weakness and lack of interest in teaching relapsed. Aurum met 200/2D repeated.
3 months after: He developed abdominal pain and bleeding from rectum after taking meat. Diarrhoea from it. Burning in rectum after stool. Pain in abdomen after stool. Acid Nitricum 200/3D was given. Was it a good prescription?
4 months after: Sleeplessness and thoughts of suicide relapsed. Aurum met 200 was repeated again.
6 months after: Improvement continues. Started talking to his mother. It really was a very positive change that brought happiness to the family. Nervousness in crowd decreased.
7 months after: Appeared for an entrance examination for M.Sc. Biotechnology in Cochin University. He did it very well.
16 months after: Now studying for the above said course. Occasional moodiness. Feels gloomy. Agg. when alone. Concentration difficult. Aurum met 1M/2d was given.
3.5 years after: Did very well in his studies.
Got 4th rank. He fell in love with one of his classmates. Her marriage was about to take place very shortly. Incidentally this again is a Muslim girl. He relapsed again with sleeplessness, moodiness,indisposed to talk, etc.
Aurum Met 10M/1d was given.
After 2 months, he came back again, to report that he got a job and is fine.