this case was culled from my initial 3 therapeutic interviews with this woman, and was not taken with a view to prescribing, though i'm now thinking about it, depending....

Jane, a 43 y.o. depressed woman experienced the death of her boyfriend of 10 years, a married man, about 6 months ago. she was unable to grieve at the time, partly because the fact he was married had been secret, but then revealed to all in his obituary, leading to a good deal of criticism of Jane. within the last month, her depression deepened, she has been avoiding all social company and all activities, and i currently have her on a LOA from her work. she was prescribed an ssri about a week before her first appointment with me; at present (about 3 weeks later) her mood appears improving, though it is too soon to be sure. she has gone to the animal shelter once or twice in the last few days, to help out (she is a regular volunteer there) and finds that caring for the little animals makes her feel worthwhile, is rewarding.

she was born 'deformed' (her word) - wore leg casts for awhile, and shows no obvious signs of more signficant deformity. her job involves much lifting, and as a result her elbows are weakening and painful. she has had two surgeries for carpel tunnel on one hand and one surgery on the other. she has constant headaches, including some she describes as 'migraine.' at yesterday's appointment, she complained of a headache she had had for the past 3 days. she sits in a long, slouching posture, sideways, with an ironic grin on her face much of the time. she feels life is not worth living, and has felt this way most of her life, but denies suicidal intent due to religious scruples.

she is outspoken: if you cross her, you'll hear about it. when her employer refused to review the salary of a worker she supervised, she went to bat for him and succeeded in getting him the raise, though management didn't tell her (he told her out of gratitude for her efforts), as they had just refused her request for a raise and didn't want her to be able to use his increment to bolster her own case. she assured the other worker she would not use the information, to avoid any trouble for him.

friends and family - especially one sister - always encourage her to get up and about, but all she wants is to be left alone, and she is angered, frustrated, and harrassed by their insensitivity.

jane was abused mentally and physically by father and step-mother, beaten with a belt until she succumbed with tears: 'does that hurt enough to make you cry?!' at 18 y.o., finally 'emancipated' and able to see her mother ... then, her mother took ill and died. she feels guilt for not having told her she loved her. likewise, she feels guilt for not having been more attentive to her boyfriend.

ignatia? guidance for further casetaking, management, etc? thank you.

bach

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"The need to perform adjustments for covariates...weakens the findings." BMJ Clinical Evidence: Mental Health, (No. 11), p. 95.... It's that simple, guys: bad numbers make bad science.

Sure looks like ignatia--but I think about Natrum Muriaticum here, just based on the small amount of information you've written up here.
I always want to see some form of "hysteria" and overreaction in an ignatia case--plenty of misplaced energy and reactivity. I am amazed by the number of "inappropriate" lovers ignatias tend to collect, however--impossible relationships based on idealistic understandings of the beloved...and a stubborn refusal to understand the untenable state of that situation.

If the depression has been longstanding and suicidal in nature I might think about ignatia over Natrum mur...or even a remedy like Aurum, which complements ignatia so well. Have a look at both of these other remedies, however, before dosing with ignatia.

By the way, how did you repertorize this case? What did you determine to be the most important thing about the case--the thing which needs to be cured, and why?

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Who looks outside, dreams; who looks inside, awakes.<br />C.G.Jung

thanks for the ideas, cha cha. i will look at nat mur and aurum again: actually, i did look at nat mur already, and discounted it, but i don't know the remedy well enough to remember why i decided against it, so i'll have to look again. and aurum i did not actually look up, but i know it to a degree from my days of rampant self-experimentation, and i felt it represents just too deep a depression for this patient. but, as i say, i will look at both of these more closely.

one of the things that bothers me about ignatia is the absence "...of misplaced energy and reactivity," as you said, or as H. had it, the "...rapid alternations of gaiety and disposition to weep." this may be there, though, possibly subdued in its expression by the heaviness of the current depression --i'll have to consider that next time i see her. i am also aware of a kind of sense of her as 'casual,' and also 'languid.' i said she wore an ironic smile, but maybe i meant sardonic...or both: she wears resentment and guilt equally well, "look where i've got myself to now, damn you!"

as to how i repertorized the case ... well ... if you promise not to have me thrown off the bb, i'll try to explain: i have this habit when i write, that i will not uncommonly insert a word that i have never heard of before, but it sounds right and looks good. after writing it down, i look it up in the dictionary, and invariably i find i've 'created' a real word that fits perfectly in the context in which i used it. this is how i work. this is how i learn. this is why i take a long time getting where i want to go, as though i understand the process first, piece by piece until the whole picture fits ... and then i go back and do the detail work.

anyway, the long and short of it is that i am still a rank beginner, i know precious few remedies and fewer in any kind of detail, and i know the repertories least of all. what happened is this: during my first appointment with "jane," i found myself sitting there, listening to her, looking at her, and thinking, "she's ignatia."

go figure. ignatia is one of a good number of remedies that is kinda at the tip of my tongue, familiar because of frequent references, not because of actual fingertip knowledge. i know i've seen people discuss ignatia here, and i own a number of MMs and also bailey and coulter's children, so out of all of this, somehow, my unconscious thesaurus pulled out another good hunch - though i hardly have the right to say this as a "homeopath," i have this strong personal conviction that ignatia has to be the right remedy, because i'm always right about these things (i wish i could pick stocks like this). still, its back to the books, and further questions for you guys, before i decide anything. honestly, i prefer people who come in and tell me they hurt all over, as though they'd fallen down a flight of stairs ... now that's the kind of prescription i feel ready for!

anyway, i checked in coulter and then went to the MMP. honestly, you coulda knocked my socks off with the MMP: underline most of the sentences in my profile of jane, and you'll find them in H.'s ignatia, down to the bold-faced "in the joint of the humerus, when bending the arm back, a pain as from prolonged hard work..."!

but your question, "...the thing which needs to be cured, and why?" i think the grief reaction, but not simply as a reaction to an actual death, it's "richer" than an uncomplicated mourning, and seems to be a kind of meeting place for a number of issues: it parallels the loss of mother, especially in the patient's failure to communicate her love adequately to mother or boyfriend; it's duplicates in some respects the ambivalent relation to father (married) and the father's (and, maybe moreso, the step-mother's) verbal abuse ("he" published that he was married in his obituary, leading to scornful reactions of many around her); the succumbing to pressure of a hostile workplace (a really bitchy supervisor-"father").

ok - that's it - pick me apart. seriously, that's why i'm here. thanks for your help.

bach

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"The need to perform adjustments for covariates...weakens the findings." BMJ Clinical Evidence: Mental Health, (No. 11), p. 95.... It's that simple, guys: bad numbers make bad science.

Hello Bach,

I agree with Cha Cha, but wanted to add a couple other ideas, just so your analysis is complete. Whereas the grief makes one think of ignatia, nat-m or aur--there are other aspects of the case which also require you to rule out thuja.

There is a history of physical and emotional abuse in her childhood.

She describes a history of deformity, even though there's no evidence of that now. (But she's still using that word--)

She works at the animal shelter because this makes her feel 'worthwhile'.

She feels life is not worth living. (pessimism), and her depression has been long term, only exacerbated by the recent circumstances.

The romance was one of concealment, followed by mortifying exposure. She was unable to openly grieve because of the secret she needed to maintain.

She'll went to bat for another at work (cannot support injustice), and again was maintaining a secret.

She feels guilty about a number of issues--anxiety of conscience.

Consolation agg/av company.

You could ask her about her sense of self-esteem and self-worth. You could also ask about how comfortable she feels in new groups of people--specifically, if she doesn't offer it--how well she fits in, and how comfortable she is interacting with the group--

Then of course you can ask about sycotic physical confirmatories--warts, growths, etc.

Good luck!

[ 24. December 2003, 05:38: Message edited by: David A. Johnson ]

Wow, I hadn't realised I was so scary..."pick me apart"...!

I think "Ignatia" when I look at patients while I'm taking their cases, too...but the reality is, you may very well be right--but it just isn't really scientific or good casetaking to always just move in on your gut reaction. It could be a bias (and I'm not saying you're evil, cause you have a bias, but you do have to know you are as prone to them as everyone else is). It could be you are projecting your own interpretation of your patient's experience. There could be a number of things at work to disable you from being the "unbiased observer" you need to be. Finally, keep in mind that although Coulter's books are very effective at allowing you to understand how a totality might appear, you are still looking at her clinical experience--which might vary greatly from anyone else's, or more importantly, from your own.

So these are some of the many pitfalls you want to avoid--as Hahnemann warned. I think David's suggestions for looking at the case differently (what do you think of his perspective and analysis?) could bring up the possibility of seeing "other" remedies in the case. In homeopathy the skill and discipline aren't in "recognizing" the remedy needed right off the bat--its in actually putting aside that incidental idea, and steadily collecting the information you need to keep digging up--then making sure you understand the facts in the case, and understand your patient.

So, absolute beginner that you are...it doesn't mean the "work" is over, it just means your work's really just begun.

[ 24. December 2003, 11:25: Message edited by: ChaChaHeels ]

__________________
Who looks outside, dreams; who looks inside, awakes.<br />C.G.Jung

david and cha cha -

many thanks and deep appreciation to you both for taking the time to review my case.

right or wrong, in this situation i wasn't about to trust my instincts, no matter how good they are in general, without checking it out thoroughly. i feel much better that you guys are confirming my hunch seems like a good one, and adding lines for further research, but i'm also glad that ignatia is hanging in there as a good option, maybe even still the lead. but i assure you i am not "stuck" on ignatia - i certainly intend to do my best to balance out all the details of all the possible remedies before doing anything decisive.

david's analysis, since you asked, cha cha, is very striking, and seems to cover a lot of the case: bam, bam, bam, bam...one thing after another! to be honest, my initial reaction is still, "yes, yes, yes, that's all right on target," and yet, "no, no, no ... that's not the right remedy." but i have no clear idea why i am having this reaction, and i certainly won't reach any actual conclusions until i have a pretty solid, rational reason to do so. the only thing that comes to mind right now, to distinguish things, is the acute nature of my patient's situation, which is more ign than thuja. for the rest, i seem to have plenty to think about, and will get back to you once i've done my homework.

re coulter and company, i do like to work from pre-digested or 'synthesized' descriptions of remedies, even the introductory essays in the MMs, as they help me organize the detailed listing of symptoms that follows. i am more of a 'theoretical' type than a 'nuts-and-bolts,' so that kinda fits, but its also a good crutch for the newbie. and i would certainly hope that with time and experience, i will have my own 'essays' in my head, and that i'll also have more detailed knowledge of remedy symptom pictures than i do now.

i also appreciate your caveats about the 'work just beginning,' cha cha. i know enough to keep looking, past initial instincts, but i can be a bit impulsive, so any reminders to be methodical are right on the mark. since i'm considering stepping up my involvement in prescribing, from the occasional 'bruising pain all over' kind of homeopathy i've limited myself to so far, i really do want to be pretty careful.

so, it begins! i have to tell you guys, i love this. homeopathy is such a wonderful instrument - thank you for helping me find my way through its many corridors. i'm very glad to have the guidance.


bach

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"The need to perform adjustments for covariates...weakens the findings." BMJ Clinical Evidence: Mental Health, (No. 11), p. 95.... It's that simple, guys: bad numbers make bad science.

I think deciding to learn homeopathy as another tool in your kit of helping other people to heal themselves is terrific. That's exactly what homeopathy should be, one of your many tools for this purpose.

It would be great if you learned how to practice homeopathy so that it could help you in what you do. One way of starting out this learning process while you study is to actually sit in on a homeopathic casetaking from a referral you make for your patient--that is, ask your patient if she/he would like to undergo homeopathic treatment, with a homeopath that you would recommend...and ask if you could sit in during the consultation, and work with the homeopath on the case. If the patient is okay with the idea, and the homeopath is okay with the idea and happy to work with you and your observations, then you'd really benefit...and so would your patient.
Does the idea appeal?

__________________
Who looks outside, dreams; who looks inside, awakes.<br />C.G.Jung

yes - a good idea. thanks.

__________________
"The need to perform adjustments for covariates...weakens the findings." BMJ Clinical Evidence: Mental Health, (No. 11), p. 95.... It's that simple, guys: bad numbers make bad science.

Hi Bach,

I'm out for a couple days, and running out now. But I agree again with Cha Cha--it's difficult to derail one's thinking from a preconceived remedy. Having said that, ignatia may well help her, but it would be nice to know if she's experiencing lump in the throat, difficulty swallowing, etc.

Alternately, you can view her current problems as an exacerbation of a previously existing state. You can think about how she talks of the loss. In your history at least, it's not so much, 'I've lost the love of my life--I'll never have a love like that again--' but rather, 'I was unable to grieve because he was married, and then it all came out in the obituary and people were very critical'.

When she states that she helps out with the animals to feel 'worthwhile', one has to ask, 'so how are you feeling when you're not helping the animals?' My sense is--worthless.

It's a natural inclination, especially in the beginning, to get a hunch about a remedy with which one is already familiar, and 'voila'!--the history begins to fit that remedy. Actually, we tend to overlook all the little details in the history which don't fit our idea, and that's one of the most common ways to make mistakes.

Again, ignatia may certainly help in the short term, but my feeling is there's something deeper here--

Good luck!

thanks, david, for a thought provoking discussion. i won't see jane for 4-5 days, so i'll have time to review the record and the possible prescriptions in more detail, then pursue additional information as you've suggested. in any case, i'm not feeling in any hurry to make the call, and will report back here before i do anything.

happy holidays!

bach

__________________
"The need to perform adjustments for covariates...weakens the findings." BMJ Clinical Evidence: Mental Health, (No. 11), p. 95.... It's that simple, guys: bad numbers make bad science.