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Depression – Case taking and analysis

Female, 33 years, tall, strong physical constitution, pale face, dark hair and eyes. Not married, employed; finished highschool (gymnasium) and 2 years at Faculty of Philology (Russian language); several times had enrolled at various faculties and then dropped out. Lives with parents, sister (32) and brother (27). 

She comes because of her mental difficulties: depression, treated allopathically for several years, unsatisfied with the results, stopped taking antidepressants on her own accord, but later in the conversation says she occasionally takes Rivotril. She had her first panic attack after an abortion.

H: Where do you live and who do you live with?

P: With my parents, brother and sister in a family house.

H: How old are your brother and sister? What do they do?

P: My parents are retired. My sister is born in 1979 and my brother in 1984, they are unemployed, they aren’t in emotional relationships, they have similar problems to mine, they’re both depressed. I think my parents did all that when we were kids.

H: What did they do?

P: They destroyed our lives even back then in childhood.

H: In what way?

P: With indifference, neglect. They always came first.

H: In what way did you feel their indifference?

P: They were always occupied only with their own stories and lives – she with her work and he with alcohol. We were a burden to them, they did what they had to do for us, even less than that, I think. She was never interested in my problems and duties, nor in anything that happened in my life. I never got a recognition from her.

H: Recognition of what?

P: Of anything. For example, when I would do what she told me to do, she would say that it’s no good. I never looked good to her, my friends were bad. I was successful in school but it wasn’t matter to her. Simply, she always criticized me. (She begins to cry and feels uncomfortable…)

H: In which period of your life it was the most prominent? When did it bother you the most?

P: When I was in highschool, and later. It bothers me now too. When I enrolled at university for the first time, she said: “You don’t need that, get a job and start earning money.” And now she wants my brother and sister to do the same: to get a job, to get married, like she can’t wait for us to leave. At that time, I used to go out with my friends a lot and I was extremely destructive.

H: In what way?

P: Alcohol, mostly. I drank a lot and used alcohol to run away from home, in a way.

H: And now? Do you use alcohol?

P: No, I can’t stand it now. I don’t like drinking.

H: Tell me what are the problems that made you come here?

P: I have only one problem and that is my mental state. Just to say in advance, I’ve been to psychotherapy, I’ve been on medications.

H: Describe that state to me.

P: I have panic attacks, I’m anxious all my life. Many times during the day I find myself in need of medications.

H: What medications do you take and when?

P: As soon as my heart starts pounding, I take Inderal. I take Bensedin without fail  before going to sleep. Occasionally, when I feel panic arriving, I take Rivotril.

H: Describe panic.

P: I slid into that state for the first time after abortion. I was in a long-term relationship, it lasted for about 5 years. I was terribly afraid of pregnancy and still am.

H: Why?

P: Because I don’t feel capable of taking care of anyone. I don’t feel capable of having a child and taking care of it.

H: Why?

P: Because I feel like a little child. Like I am still a child about whom somebody should to take care. I’m not capable to take care of my child when I’m like this.

H: What happened when you got pregnant?

P: I can’t explain it, but 2 days after the intercourse I knew I was pregnant.

H: How did you know? What made you come to that conclusion?

P: I know it sounds impossible, but I just knew. 6 days after the intercourse, I went to gynecologist and I told him that. He told me it was impossible and that he could determine pregnancy only after several weeks. When I came back he was in shock and couldn’t make sense of it, but I was pregnant.

H: What happened during the time you were waiting?

P: It was the most horrific time of my life. That is when everything started.

H: What did it seem like? What was it that happened for the first time?

P: I was anxious before, but that was really dreadful.

H: Describe that anxiety.

P: I’m just tense all the time, I have this unpleasant feeling in my stomach, a feeling like something is going to happen.

H: For example?

P: I don’t know, but I’m anticipating something all the time. Something bad.

H: During what part of the day is this feeling the strongest?

P: In the morning, as soon as I wake up. Mornings are the hardest.

H: Alright, what happened that first time you remember?

P: Well, I suddenly felt heat in my head, it still feels like that, but it’s not that strong. I was trembling then, it was like a fever.

H: That heat in your head, describe it to me. Was it just the heat?

P: No, that’s how a headache starts and then, with it, everything begins.

H: What kind of a headache is it?

P: Those are terrible, tense headaches, like I’m going to have an epileptic seizure, like I’m going to turn upside down from here (she points to the back of her head and makes a motion backwards).

H: Where did you get the idea of an epileptic seizure?

P: I don’t know, I’ve never had epilepsy, but I have that feeling, like I’m going to have one.

H: What would happen during that seizure?

P: I would turn upside down from about here.

H: How does that headache feel like? Describe it a little bit.

P: It is very heavy in my brain, I feel heaviness, like I can’t make my brain calm down, my brain flickers, like my head is full of brain, my head is heavy. I have a need to pull out my brain and massage it.

H: That heat, describe it to me.

P: A feeling that the heat is engulfing my face and then immediately goes over to my head, a strong feeling of heat in my head and mouth.

H: What problems do you have in addition?

P: I have a polycystic ovary, I don’t know which one (she touches herself). I think it is right.

H: Do you have any other problems with it?

P: None.

H: Menstrual cycle?

P: Normal.

H: What are your other complaints?

P: I’m always tired. I get tired really quickly, both physically and mentally. I always feel like I have a flue. I’ve had a body temperature of 37,2 degrees for 6 months. I threw away the thermometer and I no longer measure the temperature. I don’t have a will to do anything. I take all kinds of stuff, I always take vitamins. I’m in a relationship with an older man now, he consumes herbs and teas a lot, so then I also drink that with him and I think it makes me feel good.

H: How satisfied are you in that relationship?

P: I am satisfied because he takes care of me. I feel protected with him. Sometimes when I get into that madness of mine, his touch just calms me down and everything stops.

H: You mentioned that you used to go out with friends a lot. How much spending time with people means to you today?

P: I don’t like it, I don’t like to go out and see people. Even at work, when I go to the toilet, I don’t like to encounter anybody.

H: Why?

P: I don’t know, I just don’t like it.

H: What is it that is uncomfortable in encounters with others?

P: It doesn’t feel good.

H: OK, let’s say you’re walking to the toilet and you encounter someone in the hallway. What’s the most uncomfortable in that encounter?

P: That I have a feeling that it can be seen in my face…

H: What?

P: That I’m ill.

H: That you’re ill from what?

P: Mentally. That it’s going to show everything that happens to me mentally.

H: How much water do you drink daily at average?

P: I’m often thirsty and I can drink a lot of water. At one gulp, but not very cold water.

H: What do you like to eat the most?

P: Fish, pasta, roast. But when I eat and drink something, I don’t feel good, I feel weariness.

H: When do you cry?

P: I don’t like to cry in front of others. I don’t cry as much as I feel like. I’m lazy to cry (she laughs).

H: How do you sleep?

P: I always take Bensedin before sleep.

H: And when you wouldn’t?

P: I don’t know, I wouldn’t dare to try. Those headaches and panic attacks happen to me when I don’t take tranquilizers for a few days.

H: How do you wake up?

P: I feel terrible when I wake up. That’s when I’m scared the most. My heart pounds.

H: Are your hands and feet warm or cold?

P: I’m a warm type in the upper part of the body, but my feet are always cold.

H: What kind of weather do you enjoy the most?

P: I don’t like summer because we’re all exposed. Winter feels the best, solely because I’m completely dressed, not one part of my body is exposed.

H: Why don’t you like when parts of your body are exposed?

P: I like to be protected. I cover myself at night in the same way.

H: What are you afraid of?

P: Only of these conditions of mine.

H: Heights?

P: Well, I don’t like climbing.

H: Climbing where?

P: Up the stairs, in buildings for example.

H: Why?

P: When I’m climbing up the stairs in a building, I feel like I shouldn’t. Sometimes when I’m on stairs I get this sad feeling that I’m going somewhere where I can’t come back from.

H: How do you feel that you can’t come back? What is there?

P: What am I doing up here? I can only jump from here. (!) I can’t go up at all, I can’t sleep at heights. I lose my balance at heights.

H: What makes you sad?

P: In the bathroom, when I’m alone, some sadness grabs me while I’m in the shower. I have some girlfriends who feel exactly the same while showering. When I get out, I feel better.

H: What is the sadness related to?

P: I don’t know, it’s not defined.

H: How much do you sweat?

P: My palms are always wet. My armpits are always wet. Even my feet – even though they’re ice-cold.

H: Tell me a bit more about that feeling of safety you mentioned.

P: I like to feel protected. I like when someone takes care of me. I think that I’m in this relationship because of that, because he can really calm me down. It’s enough to make me a tea, hug me and tell me that everything is going to be OK. With him I even like to travel.

H: And otherwise?

P: I don’t dare stepping on the ground outside Serbia. Last summer I went to the seaside with a friend, an as soon as we had crossed the border, this thing of mine started.

H: Well, did you go to the seaside?

P: I did, I had taken one swim and then immediately went back.

H: And with him?

P: We travel often, but it’s important to me that we go back the same day. I don’t have a problem with distances, I could go to Germany, as long as I come back the same day.

H: What do you expect of this treatment?

P: Only to end this condition. I can’t go on like this anymore, I’m tired.

Themes:

- need to be protected

- fear, the strongest in the morning

- worries about her health

- fear of people seeing that she’s mentally ill

- problems related to anticipating

- heat in the head

- heat in the mouth

- feeling that she’s going to turn upside down; instability

- feeling that her head is heavy from the weight of her brain; tired brain

- general fatigue, from the smallest exertion

- lack of will to do anything

- uncomfortable at heights; climbing up the stairs; doesn’t have balance at heights

- upper part always warm, feet always cold

- palms always sweaty

- palpitations from anxiety

Mentally:

- fatigue

- lethargy

- doesn’t feel like doing anything

- tiredness of the mind

- restlessness during the day

Emotionaly:

- fears, the strongest in the morning

- feeling she’s been rejected by her parents

- anxiety

- restlessness over health

- need to be protected

- fear of others seeing her mental illness

- anticipation

- fear of heights and loss of balance

Physically:

- fatigue; after the smallest activity

- heat in the head

- heat in the mouth

- palpitations from anxiety

- head heavy from the brain

- feels the heaviness of the brain

- upper part of the body warm, feet always cold

- gold and sweaty feet

- palms sweating

- cystic ovaries

Miasms:

Psora – rejection, anxiety, anticipation, headache; sweating; fatigue; palpitations; lack of will

Sycosis – irritability; boredom

Syphilis – fear of madness

Cancer – cysts

Tubercular - /

Predominantly psoric miasm.

Rubrics:

Mind; anticipation; ailments from, agg.; mental and emotional consequences of

Mind; anxiety; health, about; careful about health, therefore very

Mind; anxiety; palpitations; with

Mind; clairvoyance

Mind; delusions, imaginations; confusion, that people would observe her

Mind; ennui, boredom

Mind; fear; convulsions, of; epileptic

Mind; fear; happen; something will; bad, evil

Mind; fear; insanity, of losing his reason

Mind; confusion of mind; eating; agg.

Mind; indolence, aversion to work; heaviness, with

Mind; prostration of mind; mental exertion agg.

Mind; restlessness, nervousness; cares, worries, from

Head; internal; heat, with; face, of

Head; heaviness; painful

Head; pain, headache; brain; extending; outward

Vertigo; high places

Vertigo; ascending; agg.; stairs

Mouth; heat

Extremities; perspiration; cold; feet

Extremities; perspiration; clammy; hands

Generalities; heat; flushes of; upper body only

Generalities; weariness; exertion; agg.

Generalities; uncovering; agg.

Calc 200C

Gordana Jujić

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