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Case Study

A Tale Of a Torn Heart
Dr Meena Mankani.
` Plat.

A young girl of 20, with a dark complexion, greasy face, dry cracked lips came to see me on the 16th of March 1991 with complaints of sleeplessness, irritability and hairfall since one year, following Disappointment in love.

This young lady was very expressive and she narrated the story spontaneously. She came from a very affluent family. She belonged to Jain caste, which according to her was her "bad luck". She said that all the people of her caste were extremely orthodox, but her family never followed any strict customs of their caste and she was brought up in an atmosphere of freedom.

The search:
The problem began when she attained marriageable age. In her words "Initially I thought that I would get married abroad; but then I dropped that idea due to rise of divorces in western countries. At the same time I did not want to marry a boy of my same caste because not only are all Jain families very orthodox but not fitted to our level of high thinking. I wanted all the freedom after marriage which I am so used to. I also wanted to work after marriage and not just be a house wife or a doormat. Therefore the only ray of hope came from a young Jain boy in my neighbourhood whose family was not only broad minded, but were also multimillionaires. Also they were our good family friends. Even my parents desired that I should go in that family and I never saw any reason why they should say no if we proposed to them. I had looks, smartness, intelligence and everything that one could ask for. So in order to get close to the boy I started working in their office under the pretext of wanting to be occupied to pass time. As time passed, I found myself deeply in love with him".

The rejection:
It so happened that after having some good time with the boy, when finally that alliance was proposed, she was straight away rejected. The girl could not believe that she could be rejected so easily. She said-"I felt extremely humiliated". She would weep a lot specially at night when the tension reached its peak and would feel lighter after pouring out a flood of tears. She became sleepless and extremely irritable especially from slightest contradiction and would get thoughts of commiting suicide. She would also feel like taking a knife and killing the unfaithful lover. About her temperament she said that - "Since childhood, I am very aggressive. I hold no grudges and I am very self willed. Neither do I forgive anyone nor am I scared of anyone. I have even slapped a rash driver for hitting my car. I am extremely bad tempered and I blurt out anything at any time, forgetting who is in front of me".

When very angry, she trembles (4+), gets a splitting headache, shouts loudly and always weeps. Also, since 7-8 years, she often wakes up in the morning feeling extremely depressed, without knowing why. Often she wakes up with palpitation, tremors and profuse sweat all over, feeling suffocated; so she would open all the windows and take a deep breath till she felt better. Her education was only upto matriculation and after that she tried her hand in fashion designing, but failed twice.

Associated complaints :
Since puberty menses every 12-2 months.
Skin allergy to all soaps.

Past History: Nothing particular.

Family History: TB, Asthma, Hysteria (mother), Diabetes (father), Hypertension, Rheumatism, and insanity.

Personal History and Physical General:

  1. Appetite-Good
  2. Cravings - Spicy + + +, Salty + + +, Rice.
  3. Aversions - Sweets + + +.
  4. Thirst - "I dont like the taste of water".
  5. Sweat -Profuse + + +, On nose, upper lip, axilla, palms and scalp. Sweat in axilla is very offensive. No sweat in sleep. Occasional burning in the palms.
  6. Urine & Stool-No problems.
  7. Menses-Menarche at 11 years. Flow dark red with dark clots ; stains washable. Irritability and depression + + + one week before menses.
  8. Sleep-Sleep nowadays. Occasional salivation H/o somnambulism.
  9. Dreams-Recurrent dreams of being ditched by her boy friend.
  10. Hot patient + + + -always takes a cold bath. Sun headaches.

My Understanding of the Case: 
In this case I perceived three main aspects of her psyche which blend beautifully, reflecting both her consciousness as well as her subconscious psychology and forming a picture of a most wonderful remedy of the Materia Medica.
Firstly, the most important feature of the case was the way she went into the relationship with the boy whom she professed to love so much. She did not just happen to lose heart, but she planned to lose her heart. Also the effects of disappointment in her was not grief but extreme humiliation. Therefore, it was not a matter of a torn heart but rather of bruised ego. Hence we take.

  1. Egotism, self esteem. (SR I 437)
  2. Ailments from -Wounded pride (Phatak M M 473).

a.   Scorn, being scorned (SR I 22)

b.   Embarrasment (SR I 22).

c.   Anger, vexation (SR I 14).

d.   Disappointment (SR I 17).

I am the Princess!
Secondly, a careful scrutiny of the girls attitude reveals that she considered herself extremely good looking possessing the best of qualities; to the extent that she was 100 percent sure that the boy would never say no to me. She considered herself to be highly intelligent (although she failed twice in fashion designing and was just matric pass). Also according to her 'Just a housewife' was equal to being a 'Doormat', which for her was disgusting. On the other hand she never liked people of her caste as she felt they were not Her type of people. The exact replica of this combination of feelings is found in Herings Guiding Symptoms under the remedy Platinum metallicum. The text mentions "Pride and over estimation of ones self ; looking down with haughtiness on others."
So we take the rubrics -

  1. Presumptuous (SR I 801)
  2. Contemptuous (SR I 181)
  3. Haughty (SR I 572)
  4. Censorious, Critical (SR I 126)
  5. Mocking (SR I 759)
  6. Pompous (SR I 798)
  7. Delusion, family does not belong to her own (SR I 284)(in a broader sense community means a family)
  8. Delusion, great person he is (SR I 294)
  9. Delusion, humility and lowness of others, while he is great (SR I 305).
  10. Delusion, inferior people seem, mentally and physically (SR I 310).
  11. Delusion, noble being (SR I 327)
  12. Delusion, superiority of (SR I 362)
  13. Delusion, proud (SR I 339).

And when her Highness was kicked by someone!, She reached the pinnacle of anguish wherein she desired either to commit suicide or crush and destroy the cause of her suffering and humiliation. Therefore we can very well understand that actually she did not love that boy, but was meticulously trying to secure a luxurious life for her own self. So we take the rubrics-

  1. Selfishness, egoism (SR I 895)
  2. Contradiction, is intolerant of (SR I 184)
  3. Anger, violent (SR I 39)
  4. Anguish, anger from (SR I 42)
  5. Kill, desire to (SR I 682)
  6. Kill, desire to, knife, with a (SR I 684)
  7. Malicious (SR I 720)
  8. Suicidal disposition (SR I 974)

Thirdly, we learnt that she desperately wanted to escape from the rigid norms and customs of her community, which were suffocating. This fear was so very deep rooted that, many a times she would wakeup frightened and get tremors, palpitation and perspiration, suffocated, wanting open air, which in her conscious level is expressed in her intense craving for total freedom from any binding force. It was this same subconscious fear which produced in her an unknown sadness on waking in the morning. The rubrics-

  1. Delusion, narrow everything seems too (SR I 326)
  2. Libertinism (SR I 707)
  3. Sadness, waking on (SR I 868).

The other mentals :

  1. Insolence (SR I 647)
  2. Quarrelsome (SR I 806)
  3. Audacity (SR I 101)
  4. Obstinate (SR I 787)
  5. Somnambulism (SR I 933)
  6. Anger, trembling with (SR I 38)
  7. Weeping, amel (SR I 1072)
  8. Weeping, anger after (SR I 1072)
  9. Mental concomitant before menses (Boger Boen 678)

Physical General & Particulars :

  1. Warm agg (SR II 648)
  2. Menses, late too (SR III 547)
  3. Face, cracked lips (Kent Rep 357)
  4. Face, dryness (Kent Rep 365)

So remedy Platinum Metallicum emerged as the most probable similimum. A single dose in 10 M potency was given to her on 18thMarch 1991. Very soon we saw a tremendous improvement at mental emotional level with amelioration of all her complaints. One dose of the same remedy in 50 M potency was repeated on 2ndSeptember 1991. Shortly therefore, she gained objectivity and was married to a boy of her own caste in January 1992. Soon she became pregnant and no longer proud.

The inference:
This case draws our attention to Aphorism 5 of the Organon ie "useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, his moral and intellectual, character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc. are to be taken into consideration".

Here, the probable exciting cause, disappointment in love produced in her feelings of great Anger and humiliation giving us the impression of a wounded tigress.

Even when her car was hit, she got out of her car and slapped the guilty driver. This again is a peculiar reaction. A young girl, of her age might have just abused the driver or quietly driven away! Hence what happened to her does not assume as much importance as the way she reacted, which typified her as haughty.

From this case we learn that the expression of the basic dynamic disturbance which represents the success of a prescription, depends only on the individual features.