Patient S Malik, 25 years old, from Islamabad contacted me through phone for multiple ongoing and chronic problems. The clinical picture of patient was very diverse and as some problems were very prominent, others were very vague and complicated. Treatment was started for obvious and acute problems first (this included treatment of chronic insomnia, phobias, fears, anxiety, nightmares, numerous physical problems like anorexia, tremors and many others). The chronicity and severity of problems was such that it took her a while to reach to that point where her main issues started becoming stable and some new symptoms were noticed which were not very clear and slightly unusual too.
During the multiple telephonic interviews, email correspondence and WhatsApp chats few complaints were constantly mentioned which were not very prominent (or significant) but kept on bothering the patient along the way. Patient’s follow ups and feedback were constantly reviewed and monitored. On close and vigilant observation she was noted to show a whole new spectrum of symptoms or more precisely the complicated vague symptoms started making sense like all the pieces of puzzle starting falling into place and indicating a new remedy.
Based on her changing spectrum of symptoms, another detailed telephonic interview was conducted. The current state of patient showed prominent complaint of IRRITABILITY, INTOLERANCE TO WITHSTAND PEOPLE, NOISES and everything else. The most prominent complaint was that she was HYPER RESPONSIVE TO MINOR STIMULI (this include faintest of noises like fans, mobile ring tones, door bells etc). It was really bothersome for her. In her exact words:
I have mentioned earlier, I have complete intolerance to any sound that comes up all of a sudden (like ringtones, vibration of cell, door bells, TV sounds, some random passing by cars with loud music, anything on loud speakers like announcements, screeching noises of doors, SOMEBODY SCRATCHING FINGERS AGAINST A PAPER (completely unbearable). Feel free to assume that when sense of hearing was being distributed I got very lucky??. I have the superpower of listening everything at a pitch slightly higher than other people around me. I listen too much. My nerves receive signals of poor frequency too (by that I mean that if I am talking on phone I am gonna listen to the person and I am supposed to concentrate on it but my nerves get really enthusiastic about every random sound in the background and this package includes everything from the the birds chirping to sabzi wala selling sabzi). Bottom line being, while my nerves are supposed not to get irritated over stupid small pointless noises but they have got no chill and they get stimulated by faintest of voices. Sometimes I think that this over stimulation will make my ears deaf (I mean since they respond too much, they will just end up being exhausted). This is one of many reasons that keeps me bothered round the clock. You can take it as the sounds keep on generating little currents in my head even the harmless sounds.
This led to thought that root cause of current complaint of patient is hypersensitivity of auditory nerves which in turn leads to over activity / hyper responsiveness of brain and keeps her jittery mostly.
MENTAL HYPERSENSITIVITY AND GENERALIZED OVER STIMULATION OF NERVOUS SYSTEM
Overall clinical picture showed the striking feature of generalized hyperactivity of entire nervous system. The mind kept on responding to minor insignificant stimuli for a long period of time until it went into burn-out state leading to complaints of exhaustion and dullness of mind by patient. According to patient she has a brilliant academic record but now she feels that her brain is not working properly as if “SOMETHING” has happened to her. For a long period of time she was unable to understand that “something” and consequently the clinical picture remained unclear for a while.
She puts her state of mind as follows:
Due to constant over excitation and over response of my nerves my brain remains OVERACTIVE most of times and once it sets into action it starts working like crazy and I am unable to stop it. It goes on and on and onnnnnnnn (mostly working in abstracts). This uncontrolled break dance of brain feels like it is never gonna stop. Sometimes to the point that it doesn’t let me sleep (OK I am being modest, it doesn’t let me sleep every single day). This at time alternates with the state of COMPLETE EXHAUSTION where the brain goes on a strike and leads to absent mindedness, the feeling of mind being totally BLANK like it has stopped working. It forgets the simplest of things. It stops processing any information, the kind of confusion where you just listen to person without being able to comprehend whatever he/she is saying and at the end you just find yourself blankly saying “yeah yeah” or something like “ji ji aunty bilkul sahi keh rahi hain ap” or like “exactlyyyy” whereas in reality your brain was so numb and exhausted that it was not willing to take and process ANY information. So you go through books or listen to people like duffers but in reality your brain is chilling somewhere around kohkaaf. When you try to forcefully push your brain trying to make it focus and work it makes the scenario even more worse and frustrating.
She was unable to control her racing mind and felt like her mind is falling apart or going crazy.
DESIRE FOR ABSOLUTE STILLNESS
This constant excitation of nervous system makes her want to live isolated, stay in her room avoiding interactions. The cause being that she was unable to take ANY kind of outside disturbance. She tried her level best to have minimum possible interaction with anything that could possibly propagate any kind of excitation / stimulation of nerves. She states that:
This over-responsiveness of mind and body creates a disturbance that is so miserable that I just end up wanting dead stillness around me.
Don’t shout, speak in low voices volume down, no ringtones, this is the kind of phase I go into. Sometime I become so intolerant of noise of fan (which is not even a noise for other people), and voices of papers moving due to air that I have to turn off fan in the merciless heat of June / July. I am so unable to withstand any shouting that I feel like I will collpase.
SENSITIVITY ON PHYSICAL LEVEL
According to her:
My skin is highly responsive and sensitive to so many things for example hospital’s settings, benign things like lemon, chillies, some fabrics (like regzine), certain chemicals.
RESPONSE TO IMPOSITION
She had another prominent trait that she had intense reactions if imposed irrationally. She resisted forced implementation. She was intolerant to ANY VIOLENCE (even the minor violence on emotional level to herself and also to other). Complete inability to withstand anything that comes under definition of violence on any level. In her exact words:
Since there is so much underhand disturbance going on round the clock ANY outside disturbance is absolutely NOT welcome. I DON’T appreciate being bossed around, it generates strong repulsive feeling in me. Nobody can MAKE me do anything and this kind of emotional violence ends up creating conflict. (wesay bhi u see jub hum disturbance ki paidawaar mai khud Kafeel hain toh bairooni disturbance k liyay — Mai nahi maanta ? mai nahi maanta). (Sorry it’s been two paragraph since I didn’t crack any lame joke so plz compromise with this one =p”).
On probing questions from physical and behavioural aspects, she stated multiple complaints which are as follows:
- Morning stiffness of neck, arms, shoulder, hands. Waking up refreshed in morning
- Accumulation of watery saliva in mouth and sometimes dribbling of saliva during sleep
- Accumulation of thick secretion in throat (may be due to sinusitis)
- Severe pain in lower back which increases with movement
- Dry mouth during the day
- Intense thirst propagating the need of repeated intake of water after short intervals
- Food aversions to fatty food, mutton, chicken, fish
- Tremendous weakness sometimes making the moving around really difficult
- Headache on and off (tension headache type) which requires some light pressure. Pressure (from pillows, cushions) relieves pain
- Abdominal cramps during periods and also mid-cycle
- Rapid pulse
- Pain in joints of lower limb (knee, feet)
- Dizziness on and off
- Cold intolerance (she puts it this way “I am amongst those uncool people who start feeling themselves in Murree in the room with AC=p”). Sometime reaching to the point that my nails start turning blue”
About her condition patients states an overview that:
There is a constant feeling of TIME PASSING VERY QUICKLY. I mean in a blink of an eye half of day is gone. There is a constant state of hurryness in everything that I do (eating fast and eating little, talking too fast, doing everything at a faster pace — I can be really useful for fire-brigade squad =p). In short, I am in constant state of hurry even on the days when i am totally free.
There is an over activity and hyper responsiveness on mental level leading to INTENSE deep down disturbance that makes my life a hell. Tragedy of the situation is that it is a confusing state where you think SOMETHING has happened to you on mental / emotional level and you keep on spending your life trying to figure out that “something”.
IN A NUTSHELL, the whole spectrum of symptoms supports a deep internal disturbance mainly rooted in entire nervous system originating from hypersensitivity of auditory nerves leading to state of jitteriness, irritability, over activity and annoyance to minor stimuli creating a low tolerance threshold in patient.