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Case Study

Im not OK - You're not OK
Dr Meena Mankani

Presenting Observations: A 16 yr, young girl from a well-to-do family was brought by her mother on 27.1.94, with Amenorrhoea for 8 months. She was very short, 4'- 11'', sat absolutely straight and stiff, her facial expression reflected rebellion and assertiveness with flapping nostrils and tight lips. Her voice was loud and sharp; the tone-lacked modulations of warmth and emotion .Her face was expressionless, steady and piercing. Her posture, facial expression and speech instantly gave the impression of defiance - come what may. She wore spectacles and was shabbily dressed with her hair untidily tied up - a striking contrast to her neatly dressed mother.

Life Story: Her mother began by saying "She is very lazy and a very poor eater. She doesn't seem to be interested in anything on this earth. She is neither bothered about her looks nor health. Here the girl sharply retorted, "Mummy keeps on lecturing me all the time for everything, which is damn irritating. And the more she nags me, the more I don't feel like doing things." The girl was the youngest of 3, having 2 brothers elder to her.

When she was around 1½ years old, she was parceled off to stay with her maternal grandmother since her mother; due to financial and health problems (lumbar spondylitis) could not manage to look after 2 boys, and a girl, "Oh!" The girl said, "I was kept away till I was 11 years old, so that my mother could give better attention to my brothers." Although she was well taken care of at her grand parents', her resentment for being "sent away" was fresh and expressed itself in sarcastic remarks. Her father had an electronics business in Dubai and she was never fond of him. Similarly, her relationship with her brothers was filled with sharp lashings, leading her brothers to remark, "We two were enough for Mummy and Daddy.

Why on earth had you to jump into our lives?" Her mother continued further "She is very rude and disobedient. She is totally disinterested in every activity that girls of her age enjoy. I force her to go for swimming, cycling, discos, etc. but no amount of coercion or explanation can budge her. She would only do things that give her importance and attention, like being the CR of her class. She is also very money minded. She says that if in future she happens to earn a lot of money, she will not give me even a single penny, even if I need it badly".

About herself, the girl said, "I am certainly very lazy. Even if thirsty, I never get up to drink water and may do without a drop the whole day. Not that I like water, or feel thirsty. I am also extremely short tempered. As a child I would scratch my face when angry and even now I blurt out my worst at everyone. I am extremely rude. I am a 'totally disinterested being'. My cupboard overflows with clothes mother buys - I am just not interested in wearing them. I also hate studying and lag behind in class. I somehow manage to pass by copying.

I am very vengeful, like my star sign 'Scorpio'. All scorpions that I know are damn vengeful, fanatic and sadistic - like me". About her friends she said, "I had no friends in school. I was not very intelligent and so nobody liked me. But in college, I made friends by being extra nice to everyone, to the extent that everyone comments that I know the whole college. I am very famous and that is why I won my CR elections. I always like being one step ahead of others. It's nice ruling other people and I know that I can do that very well, so why not? Also, a CR gets a lot of importance and is very popular. And I love to be known by everyone."

I asked her why she loves to be popular and famous? To this she answered, "If you are popular, you get a lot of attention and you can get above other people."

She was averse to doing all that her mother greatly wished and forced her to do: studying, cooking, dressing well, eating well, going for social visits, cleaning and helping around the house or attending to the guests. She just lazes around or watches TV. High heels make her tall and attractive, but that she detested most of all; wears only flat shoes. About her future plans, she said "Basically I am not dedicated to anything. I'd like to be a singer or an air-hostess or to get into business, anything. I am not ambitious nor do I have any dreams of achieving anything in life. At the moment, it is just studies that are hanging on my head."

She gave all the information in that sharp, non-fluctuating tone, revealing everything unabashedly, without the slightest tinge of ego, guilt or embarrassment. She feared darkness3, water3 and heights2.

Past History: Nothing significant.

Family History:

  1. Mother always had scanty periods, only for 1 day. Lumbar spondylitis
  2. Father Diabetes
  3. On maternal side, schizophrenia and heart trouble.
  4. On paternal side, all ailments including cancer.

Personal History And Physical Generals:
Appetite And Cravings: "I am a poor eater. Many a times even if I am very hungry I do not get up and eat, nor do I ask my servants to get me anything. But I can eat chocolates at any time. In fact, I literally live on them. I love pickles very much and ice-creams to some extent."
Thirst : Zero
Urine : Very scanty. "I am lazy even to pass urine, especially when I am lying down in bed. I don't get up easily and I just remain lying".
Stools : NAD
Sweat: Very scanty-especially on the face. Face remains greasy2.
Menses: Menarche 12. Before she began menstruating for the first time, she had a very high fever up to 105oF for 3 days, which subsided gradually after the flow got established. Periods regular, but many a time got fever before menses. Acne2 before menses. Flow normal, washable stain. No mood changes.
Sleep: Always lies on abdomen with salivation3. Never fresh on waking3. She said, "I don't know exactly what being fresh means."
Dreams : Nothing particular
Thermal - Hot Patient3
Since childhood severe vomiting from travelling in bus, train, car or plane.
Can never tolerate tight clothes, especially around neck3 and chest3

Some Other Observations:

  1. At the end of the consultation, the girl put me a question in her usual sharp tone. She said, "Doctor, I have heard that you can change a person's mentality. Please do not do that for me. I don't want that to be altered. I want to be as I am. You just bring my menses back, that's all".
  2. She had been investigated and reports were normal. The gynecologist had asked her to wait for six more months. In the mean time she had come to me.
  3. Father and mother both are short.

Step By Step Analysis Of The Case

  1. What is most striking in the Patient?
  2. What reflects the Central Pathology in her?
  3. What is the language used by her dynamis to express its derangment?
    The Central pathology of the case is contained in the question that she put to me. She says, "I have heard that you can change a person's mentality, so will you do that for me also? I don't want that to be altered. I want to remain as I am. You just get my menses back. That's all."
    -- Now what do we understand from this?
    -- The questions that patients ask have much significance.
  4. We understand that She Does Not Want To Change. But Why Is She So Adamant About Not Changing?

For that we will have to understand her PERCEPTION OF HER CHILDHOOD AND HER TYPICAL INDIVIDUALISTIC REACTION TO IT. Again, her perception of her childhood is reflected in THE TYPICAL WORDS SHE CHOSE. What were they?
She said, "I was kept away from the house so that my mother could give better attention to my brothers".
What does this indicate?
Why specifically these words?
She could have used any other set of words. "My mother could not cope up with the demands of three children. My mother had no other alternative but to send me to my loving grandparents"
Or anything else. Why particularly "BETTER ATTENTION TO MY BROTHERS".
Herein lies the gist of the case wherefrom arises each and every expression of hers. We always have to go behind the expressions of the patient as to why they say what they say.


Here she believes that she was not as important to her mother as her brothers were. Her father was nowhere in the picture since he was always abroad. The mother was 'the culprit'! Which is the most appropriate rubric? The first rubric that I selected;
1. FORSAKEN feeling, feeling of not being beloved by his parents, wife and friends. (SR I 547).

She has been constantly carrying this feeling right from her childhood, which was clearly reflected in so many of her expressions even now. She concluded very early in life that she was not a cherished creature and easily discarded off.

Now we have to understand that in what way did she react and try to cope up with this FIXED PERCEPTION of life in her mind.

In what peculiar way did she compensate for her feeling of not being loved and wanted? The individual characteristic response to a given stimulus is always the deciding factor in every case - no matter what the stimulus.

Im not OK - You're not OK
Dr Meena Mankani

Our patient tries to compensate in two ways:

Her being the CR of her class reflects one part, and the interaction with her mother during the interview, reflects the other part.
I also like to observe the expressions on the face of the relative when patient talks. This INVOLUNTARY AND SPONTANEOUS expression of agreement, disagreement, resentment, speaks volumes of what may be going on between them.

Also synchronize the facial expressions of the patient with what he tells about himself. NOW HER FIRST WAY is reflected when she says, "I love to be the C R of my class, because I love to be known to everyone, I love to be famous and popular because then you get a lot of attention and you can get above other people".

And, THE SECOND WAY is reflected when she says, "I am very revengeful, which is typical of my star sign "Scorpio". All scorpions I know are damn revengeful, fanatic and sadistic - so am I". But we know Scorpios are also very loyal and honest.

Now we are going to study her REVENGEFUL and SADISTIC part.
The question that comes up is, what crucial part is this revengeful and sadistic trait of hers playing in her life? And why does she call herself as being so? How do they interact? A hint is evident in the interaction of mother and the daughter during the interview.

We see the mother as a scornfully critical and nagging type and our young patient being openly disobedient and defiant; talking with mock sarcasm and care-a-damn attitude. Whatever her mother wants her to do, she strongly detests doing that. If her mother wants her to eat well, our patient very comfortably develops a poor appetite. If her mother wants her to dress well and socialize, our patient on the contrary allows her lovely clothes to rot in the cupboard and chooses to dress shabbily--- which is in striking contrast to the smartly dressed young girls of her age.

She has in fact become an object of constant embarrassment to her mother and she continues to embarrass her even during the interview by her unabashed revelations. But why is she doing what she is doing?

First of all we know, that she had strongly concluded long back THAT SHE WAS NOT SOMEONE WHO COULD BE LOVINGLY NURTURED WITH ALL THE WARMTH AND CARE. Her mocking sarcasm to mother clearly reflects her bitter resentment to being "LEFT AWAY".

And her basic nature being revengeful, SHE TAKES REVENGE ON HER MOTHER for her "unfair behavior" towards her by subjecting her to the same emotional trauma which she had undergone, and derives sadistic pleasure from doing so.

Why? Because that is her only way of LICKING HER PAINFULLY SORE WOUNDS. REVENGEFULNESS is her survival mechanism and if she is deprived even of that, then how else will she survive?

So, the next important rubric that we have to take is "malicious". And this malice is directed towards whom? Her mother. So the exact corresponding rubric for this characteristic state of mind would be:

Malicious, spiteful, vindictive to loved ones (SR I 722)
She is taking her revenge on her mother by neglecting her own self--- her looks, her pleasures, her food and drinks, her everything. In the process of getting this sadistic pleasure, she is actually going against her own self; actually destroying herself completely, a self- destructive behavior.

Which exact rubric corresponds to this typical behavior?
And she has stuck to it with STUBBORN OBSTINACY - not deviating even slightly - that is again perfectly reflected in her stiff posture and harsh tone of speech.
Her feeling of being DESERTED, she tries to compensate by being the center of attraction, BY BEING SOMEONE SPECIAL, by being someone who is INDISPENSABLE in any class, by being someone who is VALUED, CHERISHED and LOOKED UP AT. Thus she satisfies her needs to an extent. As a result she has absolutely no love for any of her family members. If she doesn't mean anything to them, why should they mean anything to her?

SR I 444

Estranged from her family

SR I 1

Abrupt, harsh

SR I 201


SR I 185


SR I 787


SR I 798


SR I 806

Mocking, Sarcasm

SR I 806

Quarrelsome, scolding

SR I 104

Aversion, members of family to

SR I 117

Business, averse to

SR I 624


SR I 611

Indifference, business affairs, to

SR I 616

Indifference, family, to his

SR I 618

Indifference, life, to

SR I 618

Indifference, loved ones, to

SR I 620

Indifference, relations to

SR I 620

Welfare of others, to

SR I 25

Ambition, loss of

SR I 928

Sits, stiff, quite

SR I 39

Anger, violent

Now, having a fairly good idea of her mental make-up, we have now to ascertain the singularly striking characteristic concomitant physicals.
What are they? They are:

KR 1288

Fever before menses

SR II 229

Food + drinks, chocolate, desire

SR II 261

Food + drinks, pickles, desire

SR II 563

Riding, cars AGG, in a wagon or on the

SR 1254

Sleep, unrefreshing

KR 471

Throat - external, clothing AGG

PH 107

Acne, menses before

SR III 523

Menses, absent

KR Expanded


Face, greasy

And this combined characteristic totality leads to no other remedy than the wonderful Sepia.
What, Sepia for a young girl of 16? How is that possible?
Where is the Sepia saddle and the typical bearing down sensation?

In her drug pictures Dr Margaret Tyler describes Sepia as follows:

"Picture her - the sallow, tired mother of a big family. She is perspiring profusely. Her back aches fearfully, she feels she must sit down, or cross her legs, as her whole inside seems to be dragging down, and coming out of her --- the worry of the children is more than she can bear --- she is so nervous and jumpy --- Her eyelids are too heavy to hold up ---- etc., etc."

DRUG PICTURES ALTHOUGH VERY HELPFUL, CAN ALSO BE GROSSLY MISLEADING. They can narrow our thinking and limit our growth as efficient prescribers.

Therefore, the most important lesson that we learn from this case is that of being - what Hahnemann asks from us in aphorisms 83 of the Organon. He says: "This individualizing examination of a case of disease, for which I shall only give this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease."
She was given 1 dose of Sepia 10M on 31st Jan '94 and called back after one month.

Part IV Analysis Of The Follow-Up

  1. She came back for her follow-up on the 1st of March 1994. She had not got her menses yet and also I could not see even the slightest of improvement at any of her levels.

    Her stance and her attitude had remained totally unaltered.
    So what is to be concluded from this? Did we select a wrong remedy? Or was the potency wrong- not sufficient enough? In that case what should be done? Should we give a fresh look at the case and examine if any other remedy is indicated? Or should we increase the potency?
    Or should we give some more time and wait and watch?

    We change very quickly only if we are not confident of our prescription. We can very easily doubt our own selves if we have not based our prescription on sound principles. Fortunately, I was hundred percent sure of my prescription. And one month was sufficient enough to produce a reaction; if not to get her menses back but to at least produce minimal favorable improvement in her mental and emotional level.
    I felt that the 10M potency was insufficient, and I gave her one dose of Sepia 50M.
  2. The very next day, early in the morning, I was urgently called since the patient had developed a high fever of 104oF. The symptom picture that I gathered were as follows:

         i.        Very irritable and was crying while talking.

        ii.        Wished to be left alone.

      iii.        Had a very bitter taste and no thirst at all, although her lips were very dry.

      iv.        Headache +++, AGG coughing and moving eyes.

       v.        She had developed small painful pustules around lips and apthae, overnight.

      vi.        Nausea++

    vii.        Feeling very chilly, with ice coldness of hands and feet.


  1. So what should be done now?
    Should we prescribe a new remedy for this newly developed symptomatology?
    Which remedy? Byronia-alba? Or Nux-vomica?
    IT IS FOR HANDLING SUCH FUTURE COMPLEXITIES THAT A WELL-TAKEN CASE WILL NEVER FAIL US. Earlier when we first took the case, we learnt that her FMP began with fever which lasted for a few days before the flow commenced. And this can be an indication that she will now get her menses?

So the best procedure was to wait and watch. At this stage if we interfere with the curative process that has begun by prescribing a different remedy, we will certainly spoil the whole case.
Besides, the present symptomatology also pointed out to no other remedy than Sepia the rubrics that we can take are as follows:

SR I 1080

Weeping, irritable

SR I 1088

Weeping, telling of her sickness, when

SR I 144

Company, aversion to

KR 530

Stomach, thirstless, heat

KR 1288

Fever, menses, before

PH R 107

Eruptions, acne, menses, before

KR 139

Head, pain, coughing on

KR 144

Head, pain, moving eyes on

KR 422

Mouth, taste, bitter

KR 507

Stomach, nausea, fever, during

KR 959

Extremities, coldness, hand, icy

KR 963

Extremities, coldness, foot, icy

KR 1348

Generalities, cold, in general AGG

She was only given placebo. Fever lasted for 3 days and she got her menses on the 4th day and the fever and accompanied ailments reduced with menstrual flow. The next follow up encountered a smiling and neatly dressed young girl, accompanied by her mother with a satisfied look.

In follow up, improvement can be judged instantly by the expressions on the patient's and mother's faces.
Follow up: I was told that she was taking interest to eat, drink and dress better. She was less irritable and would not pick up fights with everyone as often as she would before. Also, I noticed that the tone of her voice was softer and for a change she kept smiling every now and then.

During her next follow up, she said something really beautiful. "Doctor, I understand that I am being very selfish and mean. Could you please help me overcome it all? I think that I do require to change for the better".

I could not believe my ears! The girl who was stubbornly adamant about not tilting even a little bit now was requesting me to help her to CHANGE FOR THE BETTER.

Here, I give obeisance to the infallible principles of our wonderful science gifted to us by our great Master, to whom we owe all the hard work and effort in order to get such wonderful results each and every time we are to place our hands on any patient; as he was once heard saying, "when we have to do with an art whose end is the saving of human life, any neglect to make ourselves masters of it becomes a crime."
So, for her Sepia 50M and CM was repeated at infrequent intervals and this girl has never looked back since.


Editor: it is a beautiful case and very well analyzed. I have only one comment to make and that is on the picture of the Sepia as a remedy. The Sepia described in our text-books is of an adult Sepia after she has gone through the hardships of life. To get a picture of the remedy before this happened ie in normalcy, we have to go behind the current picture. That is what the study of the evolution of a remedy means. And we can study this by understanding patients as they were in their earlier days. This is the basis for the evolutionary Materia Medica books that we have tried to pen down. In the little book on Sepia and Lachesis: In Sepia the Sepia girl is like this: unattractive, adamant unlovely, certainly very far from that elusive feminine quality which is say Phos, rude and very manly. The only sport she really likes is dancing. All this then can fit into our patient here. The way Meena has come to the remedy is another way of prescribing. After she gets well, we can incorporate this picture into our own drug picture of the Sepia as she obtains in teenage.