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Case Study

Case of Self Denigration
Dr Sunil Anand.
` Lac-c

The following is a case of a woman who used to suffer from repeated nervous breakdowns. She was very expressive yet it was difficult to select the essential points about her emotional make up and life situation. But her dreams clearly revealed her sub-conscious and guided me to the remedy.
Initially the patient handed me her personal written case which she termed brief. As her story is very interesting and detailed, the presentation in her own words is given first.

Brief for doctor
 : 3 Dec 1991
I am 36 years old mother of three normal children. At 5 years of age I was sent to hostel for schooling. At 10 years I suffered a severe jolt when my one and only friend refused my friendship. My whole class, except one boy, ganged up against me and used to push and beat me. Since I did not know what else to do I started studying hard and thereafter mostly came first. I have done very well throughout my formal education and passed out in Business Management from the prestigious IIM Ahmedabad.
Thereafter, I worked upto middle management position in well known companies for 8 years (i.e. 5 years ago.)

Case history:
Periodically I suffer from, bouts of extreme depression (and in such a depression) I remember the one at 9 years, when I felt unwanted and disliked by my friends and had some rough treatment from my teachers.
At 5 years I had a panicky fear of losing those friends who were told to look after me.
At 13 years again I experienced months of depression and inability to handle school-work which other students were able to do. After some months I again started topping my class.

I have suffered periodical bouts of depression, feelings of inadequacy that severely eroded my ability to apply myself ; At 24 I was jilted and went into a deep depression lasting for six months. Again, at 27, immediately after marriage (love marriage), my relationship with my husband and in-laws was strained due to my alcoholic father. Though the marital conflicts were very minor I could not sleep at all for three days and had a complete break down within 20 days of marriage in which I became incoherent and out of touch with reality and had paranoid fears of some people (including my husband) and exaggerated notions about others.
Thereafter I have had 2 further breakdowns at ages 31 and 36. In each of these, I underwent psychiatric treatment.

The pattern of breakdown in each case has been similar. It begins with a kind of manic phase in which I tend to generate a lot of stress by over reaction to events (either positive or negative). The sleeplessness for days at a stretch leading to complete disorientation, totally unrealistic fears and apprehensions and wrong perceptions of events and people, and my own abilities. After about 15 days of induced sleep and other medicines I have been able to resume a regular life.
This breakdown is generally followed by an extended phase of deep depression for months. I am still in this deep depression.

My feelings at present:
In this depression I lose confidence and faith in myself completely, and also lose all interests in life. I get fearful obsessive thoughts. I feel afraid to participate in normal activities e.g. in going out to buy household items, conversing with even close friends. I get immobilised in discharging my duties as a wife and mother.

I am in a constant state of fear and panic, have no faith in myself. I feel desperately afraid of taking up employment because I feel I will not be able to discharge it and I would feel a fool for not knowing what others know.

I keep comparing myself unfavourably with everyone, even uneducated servants. My heart pounds, my hands are clammy, and I am very tense and fearful. I feel I have lost my courage and confidence. I feel so hopeless and would not mind dying. I feel so tense I cannot remember and even cannot comprehend what I read. That starts a cycle of disparaging thoughts about myself and my capabilities.

Medical History:
I have a sturdy constitution and rarely take medicines. Occasionally I suffer from Migraines. I have not experienced severe migraines in the last year or two.
I had Chicken pox at 7 years of age.
I had a Haemangioma of the Upper respiratory Tract and under went cauterisation at 21 years. But it reappeared and was successfully treated with corticosteroids etc.
For the three breakdowns (age 27, 31, 36) doctors tried to treat with : Largactil, Trinicalm, Serenace, Stresscaps, Nitravet, Valium.

Other Personality Features :
When I am not in this depressive phase, I tend to be rather aggressive but not appropriately assertive, intolerant of uncertainty and differences with my opinion, impatient, reactive, tenacious and persistent sometimes to a fault. I tend to be oversensitive and handicap myself by taking peoples negative reactions to heart. I used to suffer terribly from feelings of inferiority and still feel insecure especially financially though we are comfortably placed and I am well educated. But since I handicap myself with fears of my abilities to survive I feel very insecure.

On the positive side I am enthusiastic, energetic, with a love of life, zest of laughter, bright and perceptive, straightforward and honest in my dealing with others naive.

Family History:
My father was an alcoholic from 1969. After 1989 he gave up alcohol and underwent Psychiatric treatment. He too suffers from depression.
Please help me and treat me so that;

  1. I am able to retain a better balance and do not experience these terrifying depressions.
  2. I do not have a recurrence of the breakdown in which I become out of touch with the reality of the world.
  3. I re-experience the enthusiasm, motivation, interest and aspiration that will help me lead a life that is useful and productive for myself and people with whom I come into contact.

On taking the case she mentioned 4 repetitive dreams.

  1. Flashes of mathematical symbols. She would wake up in a panic and be overcome by an intense fear of not been able to cope with her childrens studies (additional Maths).
  2. Son has fever and is moaning. She wakes up in a panic and feels she is not equipped to cope with her sons distress.
  3. Learning balance in cycling.
  4. Spinning in air and on water with perfect motion and no force of gravity.

All the four dreams have a common link, though interpreted differently.
The first two dreams convey a feeling of inadequacy. Note that the patient has done her MBA from a prestigious institute. She has also done advanced mathematics but she gets intimidated by Additional mathematics, when her children are only 4 & 6 years of age.
The third dream shows the compulsion to keep learning. As she had been put in a hostel at a very young age she had not learnt cycling and it is this very thing that she gets in her dreams almost as if to remind her of her inadequacy and incompetency which she cannot cope up with.

The fourth dream again conveys the high standard of achievements and perfection that she has set for herself. So inspite of achieving tremendous success, academically and in her career she falls in her own eyes. This stems from a poor perception of herself and her abilities. In the last dream the feeling of no force of gravity. This is the exact symptom of her medicine which has the feeling as walking on air.

She was given Lac-caninum 1M, single dose. She has needed only one more dose, 4 months after the first. She has got a new job since six months and is coping with it very well. Sleeps well and is refreshing. She is not disturbed by her dreams any more. She is coping on the domestic front too very confidently. The main feelings Lac-caninum are -

  1. Contemptous of self.
  2. Confidence, want of self.
  3. Delusion, that she is despised.
  4. Delusion, that he is dirty.
  5. Delusion, diminished.