My existence has no meaning; a case of cuprum sulphuricum

We are presenting a case of Mr. S.B age 69 years, who came for depression after his wife’s death.

Complete understanding of our patient at each and every level is our sole objective as homoeopathic physicians. In this journey, we often make mistakes and take the patient astray from their own journey. Through this article, we wish to share the mistakes that we made as beginners and how being aware of it has helped us. We also want to highlight the importance of retaking cases, and to point out factors that help while doing retakes. We have followed the method of case witnessing process (CWP)* in both case interviews.

In our experience, the systematic structure of case taking provided by case witnessing process (CWP)* helps to give a guided and clear map in following the journey from symptoms to the source. With the case witnessing process, you are guided at every step of the case-taking, asking WHAT, HOW and WHAT NEXT; not only that, but the benefit from CWP is appreciable when you go off track during the first case interview. It becomes easy to look at what made you lose your way and to see what steps to follow in correcting yourself and getting back on track. 

Clinical case

PASSIVE CASE WITNESSING PROCESS (PCWP)*

Riddhi/Kadambari (RK): Tell us about yourself. We are not looking for anything particular; you can tell us whatever is coming up spontaneously. Basically we want to understand you and your illness.

P: “My wife passed away four months ago; it was a very serious matter. After her death, I had a medical check done, and all reports were normal. I know the doctor will charge me 4-5 lakhs anyway.

Right now, I am staying with my aunt, my brother and my son in my house. I am feeling helpless. If I get sick or if my aunt falls sick, then who will help whom? My brother is also a bachelor. What will he do? He is also facing a dilemma. He is very fond of cleanliness and aunty has a fussy way of working, so there are clashes in the house. His reactions are very strong. All this is creating a cumulative effect (hand gesture: hands closing to form a circle) on me, and so the conflict increases.

(Here, the one ‘out of place’ expression coming in the midst of common talk about depression, wife, health, family, etc., is the ‘cumulative effect’ with hand gesture. In the passive part of the case witnessing process, the physician passively, yet alertly, listens to the patient and collects all the out of place expressions. )

“My wife used to take care of me, help me. I used to have friends of the same age group, now it has reduced and I do not go for any outings.

“A long time ago, when I resigned from my job, I had a guilty feeling. There was a difference of opinion with my boss and I used to get palpitations.

“I am the head of the household right from the beginning. Now, I have tensions that old people usually have. It is insulting to go to an old people home. At this age, my wife should be around, but it’s my bad luck that she isn’t. I feel hopeless and hollow now. My friends used to enjoy my company. I want a place where I can open up with my problems. Now, I don’t feel like enjoying life.

“What is the use of getting a bypass done at this age?  I am very careful that I should not have a heart problem. These days there is corruption everywhere. We don’t cheat doctors; poor people sell their houses to pay their doctors.”

(In the above conversation, his sensitiveness towards corruption and cheating is evident. Besides that, the rest of his talk seems situational and repetitive, all related to acute depression after loss of his wife. So, we actively try to take him deeper to find the entry point, FOCUS, to his vital core.)

ACTIVE CASE WITNESSING PROCESS (ACWP) TO FIND THE FOCUS*:

RK: How does all this feel deep within you?

P: “Why should I suffer? If I am sick who, will look after me? I was having wonderful life. I help people; had so many friends, my relatives used to help me.”

RK: Tell me about that cumulative effect?

P: “I don’t feel like going out, my confidence is reduced and I am not enthusiastic. I have no companionship, nobody to share my problems with. I feel hopeless and unfortunate. I feel lonely, since I have never been alone. My companionship is suddenly gone. I am not normal like earlier. I am not opening up. It is suffocating, as I can’t open up and can’t tolerate the feeling. Right now the pressure is reduced because I can trust and talk to you.”

(Though the companionship, which he has lost, can be common to his situation, he qualifies it further and the whole deeper feeling of hopeless, being unfortunate, nobody there to share problems with, nervous, suffocating, comes up. Hence this becomes important and we ask about it further.)

RK: Tell about this suffocation and pressure?

P: “I have to keep quiet. It creates pressure within. You suppress your feelings, you are just helpless. For an example, if I don’t reach your clinic by 9:30, you will say I am late, so I run and come. I can’t complain about the doctor but he expects me to be on time. I cannot fight because it is not proper. I have to control my feelings; I have to accept and be submissive. Sometimes. I feel messed up, I can’t tolerate it.”

RK: More about suffocation, pressure, helpless, control?

P: “Corruption, traffic… no point in feeling pressured, so it is better not to read the newspaper. So many girls are getting raped. For every action, there is a reaction. I can’t control external factors. My aunty keeps talking about corruption… I feel bad about it but I have to tolerate it.”

(Here, we see there is sensitivity to issues like rape, corruption, which also came up during PCWP. However, we just overlooked these, which was a mistake, and continued inquiring about the feeling of suffocation.)

RK: Can you talk about suffocation and pressure in general?

P: “Somebody should do something to solve the problem. If police catch people who cheat us, the government should do something but they do not do anything. Doctors also force you to buy treatment from shops. I feel unsafe, helpless, feel pressure on me. I lose my temper. You are being looted; people are robbing you in broad daylight. This causes frustration. You are compelled to tolerate all this injustice and it affects your health. Things are beyond control. If the IAS (Indian Administrative Service) has to wait for 25 years for justice, then who am I; I have to tolerate. I have to keep quiet and control myself. I feel I am just surviving as a helpless creature. Not performing my duty as a citizen. I keep quiet because I don’t want to have problems; besides that, no one will come to rescue me. (Pause) When my wife was there she used to keep my breakfast ready for me, now I have only discomfort. After all this I feel like going to an old age home, but I will feel like an orphan there.”

RK: Describe that orphan feeling?

P: “If an accident occurs and if everybody dies, the child is an orphan. It’s a great damage. If a close person leaves the effect is bigger.”

RK: Describe the feeling deep within?

P: “I have to tolerate. If I protest, my name can get spoiled also. So then you tolerate and then it creates an additional pressure on you…”

(He talks about protest, his name being spoiled; however we get stuck to  ’orphan’ and miss paying attention to what he says. Not only that, we interpret and connect his talk about ‘orphan’ as his own feeling after the loss of his wife.  From there on, the journey followed according our interpretation and not as to what was needed in the case. It turned out to be a mistake to listen selectively, leading to us needing to retake the case.

ACTIVE – ACTIVE CASE WITNESSING PROCESS (AACWP)*:

RK: Tell me in an abstract way about ‘suffocation, pressure’?

P: “We have no power to do anything against powerful people, so we have to tolerate. I feel like they should be hanged to death. I am a one man power; I’ll take action if I know who the culprit is. You take him to task.” 

RK: Just about this suffocation pressure?

P: “I have to suppress, reconcile, I cannot openly talk. There is no way out, I can’t do anything. I feel helpless. Sometimes I break out, I can’t tolerate it, so it is better to release the pressure.”

RK: What do you feel when you break out in anger?

P: “I feel palpitations, helpless. After my wife’s departure what is life? I feel lonely, alone.”

RK: So you have this orphan feeling, the feeling of going to an old age home?

P: “Who’ll look after me? The one who is left behind is the sufferer. I keep all these things inside me and don’t let them out.”

With the one-sided track of thought with which we were taking this case, the case completed here because according to our view the patient had qualified his suppression, pressure, suffocative feeling with abstract examples and he completed the circle by coming back to talking about this wife.  We decided to give him Magnesium Muriaticum 200. (The whole center of the case seemed to be about “no companionship, nobody to look after me, nobody to share problems, lonely, helpless and orphan feeling”. This leads to suppression of feelings, inability to talk openly, having to be submissive and to reconcile himself to the situation, creating pressure which he can’t tolerate; it breaks out in the form of anger.)

In the follow ups after Magnesium Mur 200, the patient felt a little better emotionally. He could adjust with his family for 2 – 3 months; he felt he could control his anger in a better way. However the depression was not really improved. The feeling of insecurity, loneliness and helplessness, continued. He did not feel like going out of the house or meeting his friends. There was no improvement in his energy levels and he continued to feel low.

Six months ago, the patient again came up with mild pain in his chest. Besides that, his depression continued. So, we went over his case file to check if we had missed anything in the case and we realized the need of reassessment.

The objective of reassessment **:

To see if the patient keeps all the issues in center (FOCUS*) that he spoke of during first interview.If YES, then, go and inquire further on that until you find central core.If NOT- then, pay attention to what patient keeps as a central issue (FOCUS*) and then inquire further.

RE-ASSESSMENT

PASSIVE CASE WITNESSING PROCESS:

RK: Tell us everything that is bothering you right now…

P: “There is a feeling of hollowness and palpitations in my chest. I am also bothered a lot by constipation and the joints of my fingers hurt a lot. I have to take support on getting up from bed.  Weakness isincreasing. I don’t feel like going out of the house.  Maybe the chest pain is because of anxiety; it is only about my wife and the change in my life. The feeling that I have to stay alone, feels miserable. I feel I am alone and lonely. I was always attached to family and full of responsibility but now it’s not easy. If I go to doctors, they tell me to get angioplasty done, they advise me to get admitted to hospital, but I do not want such a big amount of expenditure… (pause)”

(Since this is a re-assessment, we did not want to direct the patient in any one area or aspect. A longer passive process would have helped, however it being a follow up there was not much time available. Hence we become active, yet remain open ended…)

ACTIVE CASE WITNESSING PROCESS TO FIND THE CENTRAL ISSUE (FOCUS)*:

RK: Deep within, what are you feeling?

P: “Miserable; my health is not ok, and I am depressed. I feel all alone. This problem is haunting me all the time. I feel my existence has no meaning. I just have to survive and pass time, so I try to be aloof. All this is working inside me. Sometimes, I wonder who is worried about me. In the past, my wife used to take care but now there is no one. Even in my office, I was a well-respected person. I am used to getting special treatment. But now, I am retired, and after my wife’s death, I feel a sudden jerk and I can feel the pinch (weeps).
“I was a busy person and I suddenly became jobless; my wife used to take care of me and now no one has time for me. I feel like I am undergoing a torture.”

(The feeling of special treatment and being a respected person comes in connection with the wife’s care and comes up in the area of his office too. This is not something situational or related to his depression and is coming up in 2 different areas. Hence, we become active with this focus and confirm it. The focus is confirmed if the patient generalizes it and confirms it in other areas of his life.)

ACTIVE CASE WITNESSING PROCESS TO CONFIRM THE FOCUS:

RK: What do you mean by ‘special treatment’?

P: “It means respect; I used to be very busy. I was always called for lunch. My colleagues used to call me on the phone and invite me for lunch during the office every day. This makes you feel that you are someone, not just a commoner. My superiors were also very happy with me…I was very special, everybody used to appreciate that. Sometimes people became jealous, too. My boss and my seniors also appreciated me. I was always in everyone’s good books and so even my boss was good to me. You feel happy and pleased that the boss is happy with you.”

RK: What is that feeling?

P: “You are appreciated. You are like the blue-eyed boy. My wife used to wait until I come for dinner. Of course then, I feel appreciated. My wife used to take as much care as a mother takes for a child. My aunty cannot give special treatment to me… that disturbs me.” 

(Here we know we are on right track because we see that the patient is talking about the focus in connection with wife, boss, office colleagues, and aunt and at a general level. Since the focus is confirmed we keep asking about it.)

RK: More about it?

P: “‘Care’ is cooking for me in a particular way. Care is when my son says ‘hello’ or ‘good morning’ to me. This is special care…”

RK: Give some more examples about this special treatment, care and respect…

P: “Your son should accept all the dictates. A wife should accept the dictates otherwise there will be friction. My brother feels I should behave according to his ideas, but that is not possible.”

(‘Taking his dictates’ is special treatment for the patient and he projects that through his brother. This further confirms that we are on right track and our focus is correct. )

RK: Tell me about ‘they should accept the dictates’?

P: “They should accept my command; this is because of my brother’s insecurity…”

RK: What do you mean by ‘dictate’?

P: “Dominating somebody to respect you…”

RK: How does it feel if you dictate and someone does not accept what you say?

P: “There is no sense of value. We respect him (his brother), and appreciate him, but he feels lonely. He feels insulted, not wanted in the house, like a doormat, lying there for no reason. You are treated like a piece of dirt. You are at this level (hand gesture: hand up) and then brought down to this level (HG going down.) You feel that your existence has no meaning…”

(Here, we see that the verbal and non-verbal language is coming up in alignment, this is the right time to ask about it as the patient is in tune with his whole being, his non-verbal language)

RK: Tell more about this feeling that you are brought from this level (up) to this level (down)?

P: “As a VIP you get special treatment, people care about you. You get the power to flare up if suddenly someone disrespects you, but at lower level you can’t flare up. If you are ordinary, a non-entity, a commoner, not making a difference to anyone.”

(All this connection that the patient is making with the focus is making sure that we are on right track. Here we become Active-Active*.)

ACTIVE- ACTIVE CASE WITNESSING PROCESS*:

RK: Tell about this special treatment and power?

P: “An authority can reprimand you officially. A legitimate power… but I can’t say anything to you, I can’t object since you are a doctor. If someone knows my authority he has to accept my dictates and respect me…”

RK: Just tell me in an abstract about this ‘dictate’ feeling?

P: “Do this, do that, instruct people, get them to follow instructions. I was in charge of exchange bureau; I was in charge of complaints at head office. I had fifteen people working under me.”

RK: What was the feeling during your job?

P: “I enjoyed it, I was in full command.  I collected good number of friends and admirers. Once, when I was absent for 2-3 days, I got a telegram report immediately. I got upset, very angry. I felt they were treating me like all others. Instead of coming to see me at my home they were sending me a letter. “I am something special”. I am superior, I am different from others. I was completely devoted to my work and I was proud about it…”

(We end the case witnessing here since he qualified his focus completely to give us the core language and thus indicating the whole central state and remedy.)

UNDERSTANDING OF THE CASE:
During the retake, he speaks something beyond his situational depressive feelings of loneliness, sadness, change in life, to something very abstract like special respect which he not only connected to his wife but to all areas like his son, his brother, the office etc. He qualifies it further to give us a complete understanding of the situation.

OUT OF PLACE IN RETAKE:
Now, I feel my existence has no meaning.
Before, my wife used to take care of me, but now no one does.
Even in my office I was very respected.
I am used to getting special treatment.Now I’m retired and after my wife’s death it is a sudden jerk and I can feel the pinch (weeps).
Special treatment means respect; I used to be very busy. I was always called for lunch.
You feel you are not a commoner. Some people are very special, everybody used to appreciate that.
You are like the blue-eyed boy.
Care is cooking for me in a particular way. My son says hello or good morning.
Your son should accept all the dictates .
Command .
Dominating for respect.
Value is not there.
To feel insulted, not wanted in house, like a doormat.
You get the power to flare up if suddenly someone disrespects you, at lower level you can’t flare up. You are ordinary, a non-entity, a commoner, not making a difference to anyone.
A legitimate power.
Someone knows my authority so he can’t hit back.
I was enjoying my job, I was in full command.
Superior, I am different from others. I was devoted to work and I was proud.

Now, we look back in the first interview to see whether he had given us hints of this out of place and whether we had missed it.

OUT OF PLACE, WHICH HAD COME UP DURING FIRST INTERVIEW:
Corruption, traffic no point in getting pressured, so it is better not to read the newspaper.
So many girls are getting raped.
For every action there is a reaction.
I can’t control external factors.
Aunty keeps on talking about adultery. I feel bad about it but have to tolerate it.
If police catches governmental thieves, they should do something but I will not do anything. You feel safe.
Doctors also force you to buy treatment from shops.
I am helpless, feel pressure on me.
I lose my temper.
You are being looted, people are robbing you in daylight. This will cause frustration. You are compelled to tolerate all injustice. All this affects your health. Things are beyond control.
IAS has to wait for 25 years for justice, then who am I, I have to tolerate
All this causes frustration and thinking goes on. Have to keep quiet and control. Just surviving as a helpless creature.
Not performing my duty as a citizen

After Re-assessment the PATIENT’S CENTRE AND REMEDY SELECTION comes up as follows:
The whole center is about the authority, command, dictates, legitimate power, special respect from the society (family, friends, office) to his commands and also being able to flare up against corruption, adulteration, external wrong factors, for justice otherwise it causes a helpless, frustrated feeling, like a commoner who is just surviving and has no purpose in his existence and is not performing his duty as a citizen.

Such issues of power, authority to defend their security (money, robbery, rapes, adulteration) represents ROW 4 & COLUMN 11 (in order to maintain their security they have to keep up their defenses), which is Cuprum.

Cuprum: It has been observed that many Cuprum patients are trained in martial arts. This is one expression of their desire to maintain their defense and security. Similarly some may be interested in firearms. There is a need to perform constantly in their jobs. Cuprums have delusions of being an officer, a great person, a person of rank, a general.

The other part of "from the beginning, I am the head of the household; my son and wife should listen to all the dictates, otherwise you feel like dirt." The fact that one should receive special care points towards the "I" feeling of the patient, the ego, and thus the salt part is Sulphur.

Prescription: Cuprum sulphuricum 1M  (During PCWP, he gives all qualified emotions)

BOERICKE MATERIA MEDICA OF CUPRUM:
Its excellent remedy for cramps, spasmodic, violent , contractive pains
HEART: Angina pectoris. Palpitations, precordial anxiety and pain.

PRISMA: FRANS VERMULEN

RUBRICS OF MIND:Contradiction, disposition to contradict.
Too much sense of duty
Dictatorial, talking with air of command
Delusions he is about to get arrested, being a commander, being an officer.
Very respectful of rules, angry when others do not respect themLover of leadership and try to control things in a rigid manner, fastidious. They are serious and cautious and don’t like to take risks.Ambitious and independent. Will try to prove he can make it and is not an ordinary labourer.Wants to be appreciated for his abilities and beauty. Good taste shows nice and sweet side.

MODALITIES:
WORSE: Emotions, anger. Suppressions.

FOLLOW UPS:
After one month of reassessment: Patient was emotionally a little better, was feeling little normal. He also introspected and thought “have I really lost anything?” and realized there was no reason for him to be depressed. Negative impact of society in terms of corruption reduced. Physically, though joint pains, weakness, heaviness and palpitations in chest still persist.

Prescription: repeat Cuprum Sulphuricum 1M, 1 Dose

After 3 months: “The atmosphere in the house has become good. There are no major problems as such.  My body aches are slightly persisting. I have pain in my joints but I am feeling good in general. There were a number of tensions but one by one they are reducing. I think things are better, I am not depressed.”

Treatment: no dose given as the patient has improved in general.

After 5 months:
RK: What difference has this treatment has made in your life?

P: “There is a big, big difference. Life had become totally hopeless for me.  Previously, after my wife’s death I wondered why I was surviving, everything was worse. I felt that friends were doing better than me, they were having fun. Now I am going back to a normal life which I used to enjoy. I am again in a good mood, calling up friends. Previously I used to say “I’m not in the mood, don’t force me”. I used to have negative feelings, but now I am back to normal. I am forgetting my past, I feel it happens with everybody, I give credit to your treatment. Now I am free, I don’t worry, I enjoy life, I live for today. At that time I was mad, I used to think “why all this”, I felt helpless. I also was not able to go to the doctor and explain, I was not in a position to pin-point my problem. I had a nervous breakdown with weakness, and I lost weight. I had a real depression, but because of your treatment I could open up, now I’m quite ok.”

RK: You used to feel that existence had no meaning?

P: “All that is gone.”

RK: What about respect and dictating others?

P: “All that is gone. People are also complimenting me, saying “you are improving.” Today, I am in a position to go out, whereas I only used to sit at home and feel hopeless. I am somehow back to what I was; even if I die, I feel contented and everything is fulfilled. Last year, my life was at a standstill and I was brooding. Now, my heart-related anxiety is also not bothering me.”

RK: So, what shift has this treatment made in your life?

P: “It is a big leap, I never expected this to happen this early. I am 100% ok. Now, I live as I want and I enjoy life. I am eating more; my weight has increased by one-two kgs and my sleep is very good. I have started reading, writing - it’s a big achievement. My joint pains are also much better, and generally, my health is also better. Everything is smooth; I’m now even planning a party with friends.”

We see that there is a major shift in his perceptions and now he wants to live for today and enjoy life. He has completely forgotten his past and has come out of depression. His whole enthusiasm and social interest has returned. There are no physical complaints now, leading to a decrease in his heart anxiety. Even his interest, hobbies of reading, writing have started surfacing. This is what we mean by holistic healing and feeling of being ok with oneself and one’s surroundings. Such holistic healing is easily possible for all if we as physicians understand the whole individuality of the patient in each and every area and select a remedy according to the whole individuality.

Now, the patient comes to us every 2 months and continues to be better.

(* Case witnessing process is a model of case-taking developed by Dr Dinesh Chauhan to understand the patient at the holistic level with ease, in a systematic and scientific manner. The whole technique has been explained in detail in his book and website www.casewitnessing.com).

(** gathered from case discussions with Drs. Dinesh and Urvi Chauhan.)

Photos:
Grief; dar lcp; flickr
Van Gogh; old man in sorrow