A Case of Depression and Lack of Confidence (Noirin Carr McGarrigle)

On 8, August, 2013 a 21 year old female who I will refer to as “T” came to my clinic for help with chronic anxiety.  She was reserved and childish with great anticipatory fear.  She had little or no confidence / self esteem.  She felt different from others her age. This created feelings of isolation and irritability when around others.

Homeopath: What can I do for you today?

Patient:  I always feel like an outsider. I am not a chatty person. I speak only when spoken to. People don’t understand me. They just don’t get me, get who I am. It makes me feel sad having to put on different faces. I don’t feel strong enough or have the confidence to be me. My mentality is “no I can’t”. It overwhelms me. I put up a wall, a block in my mind.  I cry at night. It takes hold of you. I want to go away, go away from life. The same feeling is always there just the situation changes. I don’t want to do what I don’t want to.

Physical Generals:

Thirst? I drink a lot of water

How does heat /cold affect you?

I don’t like heat but I like to be warm. I really feel worse for being cold and have to wrap up my hands, feet and head when going out in cold weather. When I am unwell I always feel better wrapped up in my warm bed especially when I suffer with migraine or period pains. The cold and wet makes my symptoms feel worse.

Foods you like / dislike?

I like eggs, fresh bread, frozen yogurt, ice cream, vegetables, salads as I am vegetarian.  I dislike meat, chicken I can eat a little fish if I don’t see it being prepared.

Physicals:  I get very bad headaches / migraine The bursting pain starts at the back of my head and moves to my forehead. My period is irregular and very painful. My hearing is impaired as a result of an ear infection when I was 4 years old. I get aching pain at lower end of my spine when standing for a long period of time.

Homeopath: Tell me more about your problem.

Patient: I am no good at anything, better if I am not here, useless, why bother. I am nervous, anxious, flustered. I lose inner control. I feel like I am angry with myself for not being assertive and angry with others for not understanding me. I feel useless, not cut out for this life. But, I just have to go through with it.

Homeopath: What else can you tell me about yourself?

Patient: I get a sharp pain in my lower back and sides. It started in college, probably stress. It is terrible, sharp severe and persistent. The pain is worse at night. My periods were bad too, painful. They stopped for about a year when I was 18. I lost weight. Mom had left home. There was a lot of toing and froing and nobody saying anything. The house was full of tension. I felt I was stuck in the middle of their conflict. I was annoyed, frustrated, did not understand, confused. But, I went along with it and pretended all was normal. I was very angry as I was doing my Leaving Cert examination.

Homeopath: Can you tell me more?

Patient: I get headaches, a dull pain that is worse in the morning. Heat would aggravate it. I like hot weather, you feel healthier. I hate the rain and wind. But it can be nice sometimes. You have a feeling that you do not have to go outdoors. On good days (weather wise) I feel I have to go out, go for walks. But I like having nothing to do, just nothing. That is not a good thing.  When I am stressed I stay up quite late. I do not want the next day to begin. When something has to be done like my driving test, last week, I start munching and leave all my preparation until late, last minute. It’s like self sabotage. I think I am not going to get it so why bother. I have a strange eating style. I don’t like to cook for myself. I don’t   feel worthy. But, I do like cooking meals for others. I give myself as little as possible. I am regimental breakfast, lunch, dinner at regular times. I break my food up into small pieces to make it appear like there is more. I would rather feed than be fed. I feel relieved when people say “well done for cooking that nice meal”. I enjoy eating meals together, shared.

Homeopath: Tell me more

Patient: Nothing works out, so why start it. It’s the same with everything, even work. I have no confidence, nervous, see the worst case scenario. I think why would people want to employ me? Let me pass an examination?  Want to be my friend? It’s because of the things I say. Things get to me. I think too much. I get scared, upset, and revert to “I am not good enough. I t has a hold on me and I can’t get past it. Then my mind freezes. I hate the feeling.

I worked for a few weeks in “Tesco”. I was nervous and afraid to put myself out there. I was in a different zone. Didn’t know what to do, my mind went blank, went on auto pilot – functioning but not thinking. The lights were on but nobody was home. I was all limbs.

Homeopath: Anything else?

Patient:  Well like I said I eat when I am bothered to. I am a vegetarian since secondary school when I had to watch a film about battery hens. I remember for the project being shoved into a group and feeling a real outsider. I did not feel very good. My stomach went a bit. I t was disgusting.

Homeopath: Let’s discuss dreams

Patient: None really. My dreams tend to be an exaggerated version of daily life for me. Scary and glad when they are over. No more to tell about them really.

Homeopath: Do you have a favorite book, film?

Patient: Yes there is a book “Perfume. It was originally written in German and set in 18^th century France. It’s very oppressive. It’s about a young boy growing up in an orphanage. He has a hard life involving child labour. It’s about his experiences and how they molded him. He was looking for a perfect scent. He got the scent from killing virgins. They came to a sticky end! He makes it to the top, very successful. But eventually a mob ravages him. I guess there is no coming back from that.

Homeopath: Anything else?

Patient: I would like to be more ambitious, do better for myself and push myself especially when dealing with people. Get rid of this scary daze. I know I need an attachment. I like to be told what to do and when and where to do it. When I am not told what to do I go blank, become uneasy, anxious. I hate having any responsibility. I don’t know what I am doing. I regress back to a childhood state (hugs herself)

Homeopath: Tell me about your childhood?

Patient: I thought I had freedom, but, my parents did control certain areas of my life.  They restricted me financially. My ideal world would be where things are done for me. I know I have to take a leap do things for myself but, I am so fearful. Maybe I will start by finding a hobby, something I would like to do

Homeopathic Analysis

This young woman withdraws from situations she cannot cope with. Her upbringing was oppressed, restrictive and controlled. I am of the opinion she is unable to mature and move into the “real world” preferring to give her control to her parents and others. When she is faced with responsibility she becomes overwhelmed, panics and her mind goes blank. The adult world appears a very daunting place for this young woman.

I thought she may be suicidal as she says “I don’t want to be here”. Yet it was expressed in a very passive manner. I am of the opinion suicide is more aggressive “I want to kill myself”. Initially the young woman told me quite spontaneously about her feelings including feeling like an outsider, puts on different faces, wants to go away from life, no good at anything, angry with self and so on. While this information forms a good basis for the case and understanding where she is coming from, there will be more to unravel.  As always, with the first interview, I like to let my new patient settle in to the homeopathic process.  At the follow up I intend to ask more probing questions that will indicate how she responds to her life’s circumstances. What she was like as a child? What affected her most strongly etc. I need to deepen my understanding of the case.

Repertorization

MIND, CHILDISH, behavior,

MIND, CONFIDENCE, want of self- confidence

MIND, YIELDING, disposition

MIND, THOUGHTS, vanishing of

MIND, FASTIDIOUS

MIND, FORSAKEN, feeling

MIND, HELPLESS

Differentiation – remedies considered based on the repertorization:

Natrum Muriaticum, Desire for solitude, Builds wall around her. Natrium Muriaticum is more passive than T. While T is introverted it is for a different reason than Natrium Muriaticum who hordes insults and hurts until she festers and then seeks revenge. I do not see this in T as she wants to extricate herself from these feelings, deal with them, move on..

Barc C ,  Inertia, apathy. Conflict between security and exposure. Antagonism with self. Aversion to company but dreads being alone. Full of cares and worries. Much anger with self and others. Dislikes responsibility.  May behave in childish manner. T exhibits an emotional fragility that is not seen in Barc C. Barc C and T can form dependent relationships ( I know I need an attachment. I like to be told what to do and when and where to do it”). In relationships T would be more the caretaker than Barc C. Barc C is more confused about their feelings than T who appears timid but inside she knows exactly how she feels .

Pulsatilla has many fears, is timid, forsaken and finds it difficult to assert her independence. Yet T is more obstinate than the milder Pulsatilla. Pulsatilla is more flexible than the rigid T. Pulsatilla craves consolation whereas T likes to be alone. Pulsatilla is more charming and fun loving than T. I am of the opinion that Pulsatilla while very similar to T is too soft a remedy

Silica covers most of the presenting symptoms.  Refined, shy, timid yet can be stubborn   ( I don’t want to do what I don’t want to do),  Suffers with anticipatory anxiety and agitation (before exams, tests, meeting people), easily embarrassed (when reprimanded) . Lacks stamina if overburdened and tires easily form overexertion. Lacks confidence, tired of life. Sensitive and better for routine. Underestimates her capabilities with fear of new situations. Lack of emotional independence. Headache if overheated pressing out in forehead as if it may split.

I communicated instructions for taking remedies and the homeopathic treatment plan with the patient. I also recorded it in the patient file.

Rx :  1 x Silica 200C potency (pill) was taken. The pill was placed under the tongue and allowed to dissolve. Based on the patient’s sensitivity, low vitality and mental / emotional delicacy I decided to use 200c. We will review matters and possibly adjust potency in another 4 weeks time. Should the patients’ symptoms worsen she is to call me.

The first dose the patient took was on August 9, 2013.

Follow update September 6, 2013

Patient: After I took the remedy I immediately felt better. My mind was less anxious, more relaxed. My headaches have improved. I sat exams a week after taking the remedy and while it was not a good experience I felt more confident than I have ever been sitting exams. I am now aware of my anxiety like when something is about to change or something unexpected happens. I still feel very different from others, shy, quite reserved, but, it doesn’t bother me as much now. That too has improved. I know I dwell on things too much but it’s not as bad now as I am more positive. I push myself to go out and do more things. I have taken up Salsa dancing. My sister is leaving home to go to college. I am worried about that as I will be sad, alone again. It’s another change but I will be able to deal with it better than before. I am not as scared.

I had a confrontation with a manager in the shop I work in at weekends. I became anxious a he would not listen to my point of view. I became quite and went into myself. I wanted to flee, hoped it would go away (observation, she shudders, puts her hands to her face). I got all apologetic, felt awful terror, and took it all to heart. I am a coward I should have challenged him. I don’t like confrontation. Yet even though I had this familiar experience I felt stronger than ever before.

Evaluation: After hearing the patient my evaluation is that Silica supported T greatly. Her anxiety has dropped, her thinking is more positive. The physical symptoms (headaches) have as expected, improved, the patients constitution has strengthened indicating the strong action of the remedy. It was a straight forward follow up that signified repeating Silica 200c with confidence.

Follow up October, 4 2013

Patient:  I had an unmerciful argument with my father last week. That in itself is a good thing. I was never able to confront before always deflected and took the blame. Of course this added to my anxiety. It was always so hard to stand up for myself, put my point of view across. I never liked confrontation. There was no point to it as I did not have the tools to speak up. Yet for the first time I defended myself I was going to be appreciated and I asked my father to assist me financially while at college. He was taken aback, so was I with my outburst but I left the room with a smile on my face. I have come to the realization the “real world” is difficult, demanding and at times I will become upset but I must learn how to cope with it all.

Oh and I have met a really nice guy at college. He has asked me out a few times. He is rather like me shy, reserved, introverted but we get on very well. I feel happier, more optimistic and in control of my life than I have ever been.

Evaluation:  The remedy picture remains the same and the patient continues to improve on all levels. I feel that the remedy should be continued as its action is still in progress.  Follow up was scheduled for 4 weeks time.

Follow up November 1, 2013

Patient:  I am doing fine and am much more comfortable with things, especially work – I just started waitressing in a restaurant at weekends and holidays. I am earning good money; people in the restaurant are really nice. They tell me I am good at my job as I am nice and polite to all. I did get a bad headache but it was not caused by anxiety it was really busy in the restaurant and the noise was unbearable. All the staff had headaches that night. I am eating well and taking regular exercise. My only concern now is about the future and getting a job after college. I speak up for myself now. I don’t get as fearful or suffer from anticipatory anxiety to the same degree. It’s still there but much more manageable. I am more accepting of any given situations I find myself in. I relax into it a bit more. I sleep well as I am physically tired now from working hard. I could not cook for myself before but now I can. I need to as I am away from home. I am earning money and can buy nice things now.  I have become more independent and go places in my new (second hand) car.  I don’t get bogged down with my parents and others peoples troubles anymore. I feel very, very happy.

Evaluation: Based on the patient’s description of events, I feel that the patient is making wonderful progress. She is in a better position to manage her life. I feel we are nearing the end of treatment but not quite there yet. Therefore I will repeat Silica 200c until its effect is exhausted and schedule a follow up for 4 weeks from now. I also instructed the patient to continue her new exercise regime and eat healthier foods.

This case has given me great encouragement as the outcome has been remarkable. It is wonderful to see a young woman once crippled with anxiety turn her life around, i.e. leave home, become financially secure, sit her exams, enter into a lovely relationship etc. It continues to be a positive experience for both patient and homeopath.