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Case Study

Encounters of the Hysterical Kind
Dr Rama Hariharand
'Puls / Arg-nit / Dysentry-co

Case 1:
This is a case where the undercurrent anxiety was present throughout the case but surfaced as a symptom after months of unraveling physical disturbances.

Mrs. AB is my 65-year-old aunt whose husband died 25 years ago. She now lives with her only daughter.

Chief Complaint - Continuous and loud eructation's since 6 months. When I visited her in Feb 98, my cousin was desperate. Detailed investigations and visit to consultants revealed no major disease. Many kinds of therapies given (incl H) but to no avail. This fat, jolly aunt of mine who used to bake the most fabulous cakes and biscuits and who had never allowed her widowed status to interfere with her warm and affectionate lifestyle now lay weak, sad and forlorn. I had to do something. ASAF, Iod, Arg-nit tried by a colleague in various potencies to no avail.

Upper GI Endoscopy had revealed a relaxed condition of Gastro-esophageal sphincter, which herniated into the cardiac orifice each time she swallowed. It was not hiatus hernia as there was no heartburn.
First clue: her loud eructation's were better lying down! Also considerably better by evening - both eructations & vertigo.

Other Symptoms: H/o IHD with low BP, cardiologist ruled out as contributory.
THERMALS - Hot patient.
DESIRE - sweets
Very active around the house looking after her daughters kitchen, the garden, attending music concerts nearby and going for her regular walks. Very well informed, kept abreast with all the magazines and TV serials.
F/H - M severe DM, F senile dementia at 93 years, just before dying,
Both Brothers: glaucoma, MGF-DM,
M uncle- Ca mediastinal gland,
M uncle - CAD, M uncle (m) DM, M 2nd Uncle: glaucoma.
Paresis of the lower oesophagus was a good start and so I consulted the Rep- Synthesis version 5.2 by F. Schroyens. Following rubrics taken initially.

Pg 1545

evening >

Pg 605

paralysis oesophagus

Pg 631

eructation's lying >

I sat for hours sifting through various Materia Medica. Finally a remedy emerged Alumina. She responded to single doses of Alumina 200, fortnightly for two months, later SOS. In 6 months, eructations were history and only the occasional giddiness remained. A reputed ENT and a neurophysician again ruled out any pathological focus.
Now what surfaced was FEAR OF VERTIGO, preventing her from again participating in household chores, gardening and walking. She just sat at home and was melancholic.

She preferred open air, was afraid of closed or narrow rooms and by evening she wanted some one to talk to. But her fear of anticipating the giddiness prevented her from going out, so she was peevish and miserable (cantankerous and stubborn +++, according to her daughter, despite the entire household loving her!). That particular period in their lives was hectic-one child in final BCom along with Inter CA; second child in 10th, my cousin switching to a part-time job so that she could look after her mother and the husband was struggling with a new business in a down sliding economy.

Pt felt alone. Wanted her daughter's opinion for everything, including how much sugar and maida to put into the cake-she, which had taught baking to 2 generations of housewives!
Come monsoons & her sinuses were blocked, and some white phlegm easily expectorated in mornings but foul. Hunger every 2 hours till lunch.
Sadness worse evening, better open air & talking to somebody.

Repertorial Rubrics:

Pg 1717

wet weather <

Pg 1550

open air >

Pg 30

company, desires evening

Pg 14

anxiety anticipating an event (vertigo)

Pg 105

fear in narrow places

Pg 617

appetite increased

Pg 998

expectoration white

Pg 995

expectoration, odours offensive, fetid

Puls and Arg-nit were the forerunners. I chose Puls as it covered a broader spectrum of her problems. Puls 1M -1dose and waited for 6 weeks. My cousin frantically called one night and said her mother's stubbornness and fear of giddiness continues, although her sinuses had vanished! Could I please help her out with some more magical sweet pills as the kids were having exams and her mother was not prepared to do any chores due to the fear of giddiness? I immediately sent Arg-nit 1M and a week later a relative remarked how she had seen my aunt go for her walk and even watering the garden! She is visiting me currently and has already promised to bake her special chocolate cake much to my son's delight!

Editor: here we will have to sort out why the first Arg-nit given by a colleague did not have any impact. I think that phase was of Alumina, which paved the way for Arg-nit. Puls were only an acute remedy for the sinuses.

Case 2:
Here was a case that had the major ingredients of anxiety, fear and hysteria. From the watchman to the compounder, everyone knew Mrs. CD, a 53 year old, smiling, shawl-clad (whatever be the season in Chennai!) sometimes replete with socks, muffler and flask if the temperature went a shade under 250C! She used to be accompanied by her soon-to-be-retired husband, who was uncomfortable by his wife's antics.

She was scared of the dark, being alone, death, news of death, cancer, heart attack, dogs, large expanse of water, closed lifts, small-closed rooms, crowds, noises, to cross the road, to travel by auto rickshaw/ bus as passing vehicles frightened her esp. trucks and buses. If by chance she travelled by bus, she had to sit by the window but could not see outside as she felt the trucks and other passing buses and vehicles were almost going to come on to her. She had no problems traveling by train but reaching the station was nearly impossible. So long distance travel was impossible.

She felt safe only at home. She hated silence, wanted the house full of people and when alone the radio/tape-recorder was always on. Loved music, sang both classical and bhajans. She used to play the veena. She could neither watch the news on TV or any violent programs, nor read the newspapers as, "they only report murders, killings, death.'' When frightened she would become tense, had palpitations, increased perspiration, cried and shouted. She would shout if she had to do anything in a hurry. Preparing the family breakfast, when everyone was in a rush, was an ordeal though lunch and dinner was not so bad. She was unable to sleep as she felt something pushed her from the pillow though she said she wasn't scared of ghosts! She would eventually sleep out of sheer tiredness. She loved her terrace garden and looked after the plants like her own children.

All these fears started 8 years ago when her husband, who worked for the Govt, was posted elsewhere and she had to remain behind for the sake of children's education. Her menstrual history was uneventful and she was menopausal since 4 years. She was diarrheic by nature, needing to evacuate after an extra-full meal or when tense. Of late, she also felt bloated. Milk & sweets were irresistible despite ensuing diarrhoea. She felt very chilly esp. in her palms and soles, which increased when she was anxious. Yet she needed the fan and even more of it when she was anxious. Very thirsty, with normal appetite. Easily excitable; cried and laughed easily.

PH: She had Typhoid when small.
FH Mo - a chronic asthmatic died of renal failure at 43 years; Fa had fits after 80 years and died soon after.
Life Story: Being the youngest of 5 sisters and 2 brothers, she was brought up by elder sisters. As a youngster she was a jovial and carefree person. "It is only after these fears that I have become like this'' was her constant refrain.

Her entire family humored her and rallied around whenever the need arose. This case came in 1991, when I had just returned from attending Dr Rajan Sankaran's seminar and I was thrilled to get a case with such predominant 'mind symptoms'. On analyzing the case, the core fear was of being alone; when she was at home with lots of people there were no problems at all.
Repertory-Synthetic by Barthel was referred. Vol. 1

Pg 64

Anxiety, anticipation, from, an engagement

Pg 477

Fear, apprehension, dread, alone, of being


Pg 274

Food, sweets desire and AGG Pg 29 - Air, open, AMEL

Arg-nit was staring in my face. After consulting my teacher, Arg-.nit 1M for 3 mornings, followed by Kali-phos 12x BD, Avena-sativa Q at bedtime daily. She came after 3 months, so much better that she had ventured by bus and auto rickshaw a few times but needed to hold onto someone. She had to go for finalizing her daughter's marriage and her anxiety was very high. She had to go as it was a question of her daughter's future and the boy's family were very nice people. Arg-nit 1M 1dose was repeated. My apprehension took over and I gave her 1 dose of Dysen-co 200 as an SOS because I did not have a higher potency of Arg-nit and her symptoms matched those of Dysentry-co too. She was also asked to continue Avena-sat. and Kali-phos.

On her return she called to say she needed the SOS medicine. To my surprise she had a wonderful Bombay trip, was able to sleep better, need for stool less frequent, able to go out daily but still scared to look at passing traffic and her energy level was better. She was still afraid of noise, crowds, crossing the street and by the end of the day esp. if she had gone out, palpitations, anxiety, and loss of energy was back. Dysentry-co 200 was repeated.

She came after 6 weeks with some of the old complaints in a lesser intensity but with a new one too. Her 26-year-old cousin died suddenly of a heart attack 3 days ago. She was totally rattled - sweats, anxiety, palpitation and chilliness of extremities. She continually spoke of death of self and how she may not survive to see her daughter's wedding. Aconite 1M set her mind at peace. The wedding went off well and she was even able to see the daughter off to USA without too much of histrionics. In the subsequent 2 years, she needed Dysentry-co about 4 times.

Marriage proposals were beginning to come for her son. Once she came to me totally hysterical, with all old symptoms and an extreme fear of any loud sound and couldn't even listen to her favourite music! She felt very weak and exhausted and just wanted to lie down. She had a "wobbling feeling in the legs'' worse walking. In the evenings when nobody was around, all symptoms got < but she continued her hysterical ways even after. No pain, BP normal, other parameters OK. Theridion, (vol 1 Pg 590 hysteria, lie down must, Pg 904 sensitive, noise, to slightest) Stramonium, Arg-nit, Aconite, Cimicifuga, Dysent-co, Gels, Baryta-carb. All acted for some time for some fears. But her core hysterical fear was still lurking to rear its head at the slightest provocation.

One day in Oct 96 she came for headache, Rt sided < evenings;
> moving around slowly - no other modalities, no obvious cause. Sleeps well, active, able to go though not alone, appetite, thirst, and urine, all OK. Sudden sweats on the body, chilly yet needs the fan. Here was the remedy announcing itself and suddenly I realized that all her hysterical fears too were part of the same remedy! In my anxiety to help, I had overlooked to apply the golden rule of allowing the physical generals to help select the remedy. Pulsatilla 1M was put on her tongue, lots of Sac-lac given and asked to keep in touch.

Fearful, tearful, clinging, manipulative, desire sympathy, desire company, no two stools alike, chilly yet likes the breeze, evening <, emotions like a rainy day. I couldn't have thanked God enough to show the remedy.... all the different anxieties and fears were manifestations stemming from the central delusion of being alone, when her husband was transferred to another city. Then the disease/imbalance of the Vital Force began and every stress was fuel enough to stoke the fire of fear and anxiety.

In the next 3years she needed Puls 1M- 7 times but what a turn around! She allowed her son and daughter-in-law to move downstairs, allowed her youngest daughter to stay in the hostel, restarted her veena playing and even visited her eldest daughter at Bombay a couple of times and even flew back (first time) without any SOS!! In December 98 she had typhoid with minimum anxiety and responded in a week's time to Ars-alb 200 and Eucalyptus Q.

Conclusion :
In both cases I learnt the magic of the minimum dose, when it is the right similimum. I also learnt to be more observant and pay more attention to the physical and mental general symptoms even in a predominantly "mental" case. In the first case the physical disharmony had to be peeled off layer by layer, whilst in the second one, probably the peeling off the layers of anxieties and fears revealed the similimum (or is this just my justification for not sighting Puls early). I also learnt the importance of daily study of Materia Medica. Above all, the memorable encounter with Pulsatilla was of the hysterical kind!

It is a case that taught me a lot about:

  1. How functional changes can wreck havoc in a normal middleclass household.
  2. How the depth of the central delusion of "being alone" dictates disease and disharmony on all the three planes of body, mind and emotions.


It proved to me without a doubt, that there are no diseases but only diseased people.