Blog - Shilpa Bhouraskar

Homoeopathic Case Analysis and Remedy Selection

Bridging the gaps in our case analysis

We all know as homeopaths how the analysis of a case and final selection of our remedies is as critical as a well taken case.
However with our ever growing materia medica and contemporary ways of analysing our cases how do we ensure that we are getting the best of the information we have available today distilled through the centuries.

Let us work out an integration of old and new methods of remedy analysis to work out the following case. In the process you will expand your materia medica knowledge of our remedies greatly.

This was a case which I had taken four years back.

Case Introduction

This 38 year old woman presented with terrible anxiety and irritable bowel issues she had been having since around 15 years.
The consultation was as follows. The case is edited for brevity but as far as possible, my thought process is given in brackets.

Tell me about your problem?

The anxiety attacks and irritable bowel have ruled my life for over 15 years.
Every time I travel, I have these chest pains, tightness of chest, palpitations associated with an irritable bowel.
It is more intense when I am in a hurry, if running late or going to an appointment and haven’t met the person. I get very nervous and feel ‘churned up’ in the stomach, like really bad butterflies in the stomach.
I get it from my mom. (Her mother had suffered a stroke and took Warfarin on a daily basis for the past 30 years. She had a cardiac valve replacement six years ago.) Phobias in confined places. I don’t go on buses, trains. Feel I can’t get out.
My best friend died in a horrific car accident 13 years ago. She was crushed by a garbage truck.
During panic attack I have to empty my bowels. I am very particular about cleanliness. OCD. Washing hands.

(She is very expressive and quickly changes subjects so I bring her back to my initial question.)

Can you please describe what happens during the attack?

For example when going by train to the city, I feel I am trapped. I feel ‘just get me out of here, somewhere to a toilet.’ Its been more so after the kids were born and while coping with them when they were so dependant. My ten year old daughter is full on. I am very anxious. I take Bach flower drops to settle me down during the attack. But they still come back.
During the attack I need to have nobody around me. When in a car I feel I can open the door and just jump. I need to get out. Feel tight and very trapped.

(She mentions a sensation here – tight and trapped and holds her abdomen. She is very expressive verbally as well as non verbally. Uses her hands and body a lot. There is palpable energy in the room. So I decide to use a Stage 4 approach to connect with her at that stage. I enter the case from here)

Describe this (I do exactly what she does) a bit more please?

It goes straight to my stomach and I have this urge to go to the toilet. When I get the urge nothing can stop me. I have to go especially when I am in a train/bus or car with no toilets around. The feeling is ‘what if there are no toilets around?’ I feel trapped as in a cage.
I need to drive and only then feel I am in control. If I am not driving I am not in control. It’s not normal. We are confined at home. I need to plan ahead for trips. I drive my husband insane. I hate spontaneous things. If I have to rush somewhere it churns up things inside. My mum is the same.
It’s a sensation over my entire body. Confined inside, can’t get out. Agitation and anger as if I could hit someone. Get me out. I am possessed. Get me out of here now, just drive over or kill someone but get me there.

(This is the deepest experience of her chief complaint. Trapped, confined and can’t get out. The way she reacts to this is with anger and violence to the extent of killing someone and losing control.
Now I need to explore other areas and confirm whether the same experience pattern is recurring with similar coping mechanism and reaction.)

I had a similar panicky feeling when I visited Jenolan caves. I was spaced out and dazed, couldn’t comprehend. I felt if I go deeper and deeper in the narrow cave I will die.I have fear of crocodiles, spiders; I have had dreams covered with tarantula spiders. I can be so angry. I wouldn’t hurt anyone, but I get a bunch of plates and crash them. Then I laugh. It’s my release.
Push me and I snap.
Tight in the chest and not in control.
Don’t come near me two days before menses.
My dad would niggle and torment mum. She would snap, scream and would pass out. Felt confined. No way in the world I am going to put up with that.

(She takes me to her child hood with a similar sensation – being confined so I let her explain that in detail.)

Niggle?

Cleverly doing things to annoy you. We would be sitting there feeling sick. Chew fingers, pick skin, nervous and edgy, too frightened to open mouth. They do it so quietly.
He locked the TV, whipped us with a lash.
I have anger which I cannot control. I was a good girl in life. Did not touch drugs.
I remember all the traumas. First day at school, I was screaming; it was traumatic. Dad was bashing mum, yelling at her.
I have the most vicious tongue in the world. Stay away from me. Its a lead up. My life is just edgy. I am a perfectionist.
I hate being told what to do. I so hated school. My husband says it has to be your way and on your terms. I have always been rebellious when teachers made me do something. Left school at year 10.
At home it was dad. If you did the wrong thing he never bashed us, but you had to do what was told. He was a control freak. There was no room to move. He never let me go anywhere. He ruled us. No sleepovers. He was a strong personality. Dragged us to the beach. It was doing what he wanted to do. Dad hated my boyfriends. I sneaked out. Deceived him and lied; went to night clubs at 16. Didn’t tell dad as he would be cranky and take it out on mum.

(She describes situations of being controlled, ruled, abused and dominated by her father and teachers. There was no room to move. She is emotionally angry, and expresses being a rebel, using deceit and lies.There is a lot of juice here. So we go a bit further to find the core experience at Stage 4 information.)

What was the experience of being in that situation with your father and no room to move?

He was so strong it was frightening. When he bashed mum she had a fit and we even laughed with him as we had to be good kids!
But when I was a bit older I gave it to dad. I said you are not going to rule me anymore. You push me and I snap. It was push- push- push and I snapped. I can only take so much. I am nice, so nice and then go nasty nasty and it’s your fault. It just irritates me. In the past I had a lot of guilt as he was my dad after all. But now I have dropped that. I have this fiery temper but I don’t bash people. Dad is licking his wound back home now.
I was trapped in his house for 15 years. It was dad’s way or no way. Couldn’t get out. Even my sister is the ruler. She is a lot stronger than me. Doesn't like to be told. Even at work I have been picked on and looked down on.

(Again she came to the same sensation of being trapped at home, with Dad, her sister. She feels the same at work. This confims a part of the remedy information at Stage 4. I will go to subconscious part of her and see if I find more information to get to the source.)

Dreams?

Attacked by a shark. I wake up and my heart is going fast. Something horrible happening to the kids.
Dreams of spiders, big ones, tarantula, huntsmen. Once a spider entered our lounge and I was very scared. I was twitching and climbed a stool on the dining table. I twitched all night.
It was extreme panic and fear.
I don’t remember what I felt as my mind was going too fast.
( So here the experience was this primal fear of survival with twitching.Lot of animal images.)

Hobbies?

I am very creative. I am also very quick with answers and figures. Extrovert. I dart around the room and I can go from one conversation to another.
I like walking. River walks with my dog. I am not happy with myself. I need to lose at least five kgs weight but I can’t walk in a gym! Its too closed!
I have a nice family. We love each other and our family is bonded. We talk non-stop. We are soul mates and people are jealous. We have a dog but he is human-like. Very intelligent. It is like another child in the family. I am not very keen on cats. Once a cat attacked me. I hated cats even as a child and was cruel to them. They are selfish. Dogs can be taught tricks and can be good companions. Our dog doesn’t realise he is a dog. He is a bit of a boss; he looks after the girls.

(She again anthropomorphizes with different examples of animal behaviour, of domination and being dominated.)

I had a huge panic attack during my last holiday. We were in a confined area. I wanted to get out. I felt it come up here. (Points to throat.) Zoned out, stomach turned.

(She again takes me to another situation where she had a huge panic attack in a confined area.)
Now I wanted to qualify the sensation and possibly reach the core through a virtual dream.)

What is the worst type of confinement possible?

Buried alive in a coffin and dying. Suffocating and dying. Drowning is also a horrible way to die. Trapped and not being in control.
( This is a deeper component to the experience of being trapped and confined. It is suffocation.)
Or being caged and cannot unlock the door and walk off. Eaten by shark or crocodile. (This is the exactly the situation in her dreams.). Mum has episodes of TIA.( Its interesting she brought this up at this stage. TIA is ischaemia. The brain cells suffocate with lack of oxygen).
I need ventilation. Lots of air. Trapped and not being able to breathe. Dying a death of suffocation. No one can help. Horrific the way my girl friend was trapped, squashed and killed.
A quick reaction would be to drive off but she froze. She was not in control to make a decision and do something. She just froze. Nobody can help. You can do nothing.
Once I read a horrible story of man being trapped in water. Angry how that poor man couldn’t do anything. Its unfair. He didn’t deserve it. Screaming for help and no one hears you. Somebody put him in and he died by being trapped. The pressure of water pinned him against the railing: he was trapped. No time to get up.

I hate hearing such horrible stories. I don’t like violence.
However I love the program ‘Underbelly’. That type of violence doesn’t worry me.
Police couldn’t pin them and they managed to kill 30 people. It’s interesting how the other side lives. How did police not pin them? How were they so clever to get away? They were cunning and clever. It’s real.

Just like my Dad. Niggling and making me bite. I can pick people and see through them.
My daughter has been called a bully. A girl pinned her and called her a bully.
I react and bite.
However if someone is stronger I back down. They rule over me but I can fight it. If somebody is on top I can be furious if they won.
I am very quick to react. I can think things like that. I do dramatise things. I juice it up, my sister says.
When my stomach turns it feels as a tight knot in my abdomen and then it goes up in my chest. I don’t like tight clothes.

(By this time she had been able to dive right to the deepest core - of being trapped, tight, constricted, pinned and suffocated very clearly. Here reaction is also as intense ie desperately to strike back or escape for survival or simply freeze)

Case analysis and Prescription

Now let me explain how you can use this information to form the patient's totality at all four stages as well as match this with the appropriate remedy through this video.

Hope this video inspires you to expand your materia medica knowledge through your own cured cases. This will bridge the gaps between the traditional and contemporary remedy database and provide us an enriched materia medica in the future.

For me it has inspired me to create course where I will exactly speak about a collected of similar incredible cases from my practice where I have reached the Simillimum and been prviledged to witness an incredible transformation in these clients

I will speak more about this in my next email

Until next time,
Warmest Regards
Shilpa

Discussion:

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Hey, thanks so much for that, Shilpa, great to go over this case in such detail.

It has made me think about the 'compensated' and 'uncompensated' aspects of Rxs. Not sure that I am so clear about that and what you meant.

Is it like an Opium case that is the opposite of dull and dopey? Real wired and senses highly irritable? I had one of those.

Is there one of these videos of yours that addresses this?

Again, thanks heaps, it's so useful (and fun, the way you present it!).

With Love and appreciation,

Eva

Hi Eva

Thanks for your comments. Yes it is similar to Opium.It is one of the most well known remedies where both sides are clearly identified in the proving information.
I have spoken about the two sides of a remedy in one of my earlier blogs "The truth about constitutional remedies"

Thanks
Shilpa

How did you add all the animal remedies?

Hi Madeleine,
I added the Animal remedies through the Kingdom filter.
It is a new feature in the soon to be released HomeoQuest Gold 2012.

Shilpa

I Love your blog Shilpa !

this time I was thinking of Lach from the start. Great analysis of the case and so inspiring! Thank You

Roman

Thanks Roman,
Glad to hear from you after a long time.

Shilpa

Thanks Shilpa. that was a really good explanation of the stages. when she came back to get her bottle filled did she let you know how often she used or needed the remedy after that first year? just wondering how lasting the other doses were?

Thanks Sally. She used it as and when she needed it.
She took them around 3 -4 times in a year when the anxiety feeling came up. But its interesting that that she never had the full blown panic attack since the first dose for a whole year ( without the doses). So the doses in the next year or more were more for eliminating the anxiety feeling quicker when there were triggers.

Shilpa

Thanks Shilpa for that case.
Very interesting!

When will the kingdom filter be available and can we dowload it to our existing Homeoquest programmes?

Fiona

Whoops! Made a mistake there! Sorry Shilpa, I thought you may be adding something to your programme but realise it is Sankaran's.

Hi Fiona,
This is the latest feature in HomeoQuest 2012 where you can analyse your case using the group analysis Kingdoms and Subkingdoms.
Here is a video tutorial

Hi Shilpa,
Thanks for the video on the kingdom filters. If we already have Homeoquest gold can it be added to the programme or do we have to buy a whole new one?

Fiona

Hi Fiona,
If you already have the HomeoQuest Gold then you do not have to buy a whole new one. You only have to pay the upgrade price.

Shilpa

Dr.Shilpa this is a very wonderful blog explaining the themes of animal kingdom. I am fortunate enough to be one of the members of homeoquest community.
Thank you.