Panic Attacks
The patient is a woman of 36 years old. She is not-too-high in stature. She talks lively, even a little hysterical. The main complaint is panic attacks. She was on treatment in psychiatric clinic concerning panic attacks, improvement after treatment is not significant, medications were tolerated badly and when they were cancelled, all symptoms have returned.
Her case as given on May 24, 2007“All has begun approximately one month ago. On a date with a guy there was an attack of fear, a panic. Such strong wave of fear has rolled, the fear was terrible, the feeling that everything inside me stops, and death is close to me. The guy has escorted me to my house. Sometimes I fight with it, and sometimes there is a feeling that everything is meaningless, and I do not want anything.
Fear attacks happen when I meet people. I am afraid of people, has sat 15 minutes in the car with the familiar guy, heart was beating intensively, I could not be nearby, I have left. I have made an appointment with the well-known psychologist, I do not know if I will go, because I am afraid of a meeting with him. I can not even handle when sister comes or the friend is close so it would be desirable that they have left somewhat quicker, I feel with their presence very badly”.
(I asked, whether she goes to work, and if yes how she deals with fear of people on work). “Yes, everyday I go. When I am occupied by something, it is better to me. Bad thoughts do not bother me; there is no time to suffer. My father is the general director of the company, and I am the sales manager. My father knows production very little, I work for him. In general I am very diligent, and like to work.
We have divorced with my husband a few years ago. I lately had an idea to urgently find a man, sat from 6pm on evenings in the Internet, in ICQ, in chats. I want a man very much, for me it is a strong relief. Sometimes I am like crazy, sexual desire is so strong that I am ready to go to the street and have sex with anyone. But I do not do that. Even from talks about men I feel like in heat. But if I sleep with a man without love, I accuse myself later.
In my childhood my father strongly beaten me and when I was 16, there was one incident. I have gone with the boyfriend to cinema, and have come back in the evening at about 9pm. The father beaten, swore, shouted, you are the tramp, the prostitute, in 16 years old you has laid down under the guy. In general he kept in mind that I sleep with boys, while I did not have sexual relations for a long time; I simply was a friend of them, having outings with them. Since then I have all time inside feeling that I am guilty, if I am dating with a man and that I am indeed the tramp and the prostitute. Once I have decided to kill my father, I took a knife and went to kill him, and my friend called in this moment. My anger has gone and I have decided not to kill him.
When I was 18 and I had birthday celebration, my father has told: «I beaten you, humiliated, trampled down, but you have survived».
I do not like darkness. Even when I leave the house, I leave the light on. It is not that I am afraid of the darkness itself, but I see something in the dark. Dead people come to me and tell me something. In the dark earlier I saw figures”.
(I asked how she behaves herself, when feels fear or discomfort).” I behave in such situations very restlessly, with something I pick at my hands, or constantly I go back-and-forth in a room. In general I am the person unrestful physically if I am nervous, start to rush about back-and-forth or something to crumple. Even when I spoke with you by phone about appointment, I remember something I played with in my hands and hanged back-and-forth in the room”.
Initial Assessment:
Mental condition of the patient is very serious. Strongly pronounced panic attacks, an anthropophobia, a sense of guilt and thus very strong sexual desire. The tough childhood, her father beaten and offended her, it has caused such hatred that she had a desire to kill him.
Discrepancy of the case is that with such a strong sexual desire there is an internal interdiction for relations with a man and a sense of guilt, and also fear of people and it prevents her from building relations with a man and establishing a family. She has a strongly pronounced hysteria. It was not possible to receive any obvious physical or general symptom, except restlessness as, according to the patient, it is all constantly varies.
The remedies seriously considered based on this Repertorization were Mercurius Solubilis, Platinum and Kalium Bromatum.
Mercurius covers all the rubrics, except «Mind; Occupation, diversion, amel.» and “Female; Sex; female, suppressed, desire”.
For Merc are very typical hatred and violence, desire to kill the person who has offended him, desire to kill by using knife, same as for this patient. The physical restlessness is a bright symptom of Merc.
Mercurius patients can develop deep phobias (Morrison). Also the fear of people, delusion that each person is his enemy is possible. (In our case such delusion is not present, but there is a strong anthropophobia). Mercurius patients, as well as this woman, usually have strong sexual desire.
Mercurius patients also can have a sense of guilt. However, Mercurius is a syphilitic medication with strongly pronounced destruction in both - mental and physical levels. Therefore patients of Mercurius type can have valid reasons to feel guilty, because of their tendency to violence. With this patient there was a desire to kill her father once, and thus it was really caused by significant physical and emotional pain caused by him. This impulse has quickly gone. She felt guilty when she tries to establish relationships with a man and felt like a fallen woman because her father named her that way in her youth. Nevertheless she continued to work many years in father’s company and under his management and did not feel to him that hatred as in her youth. She continued to carry out all duties on work, she is executive and the conscientious worker, and it is completely not typical for Mercuric, as well as improvement of a mind condition when she is occupied by something. Besides, Mercurius will hardly suppress the sexual desire, and it is absent in this rubric.
Platinum comes to my mind when I saw how the patient describes her sexual desire («so it would be desirable to go out and have sex with anyone»). The hysteria, alienation and fear of people, an impulse to kill, and the fear of death and feeling of presence of death, a sense of guilt – all these characteristic symptoms of Platinum are present at the case.
However during interview the patient made impression of the woman hysterical, but completely not arrogant. A pride, an increased feeling of own importance (Kent marks these symptoms as very typical for Platinum) for this patient are not remarkable.
Platinum also does not cover a rubric: “Mind; Occupation, diversion, amel.”
Nevertheless there are a lot of symptoms of Platinum in the case and this medication remains as a reserve.
Kalium Bromatum
Sholten:
Concepts
Kali Bromatum
Principles, duty Guilt
Closed Restlessness, escape
Optimism Passion, instinct
Work, task Psychotic
Family
This case has two parts. The first is psychotic: panic attacks, the patient sees dead people in the dark, phantoms, she has feeling of presence of death, an anthropophobia, a sense of guilt. She went with a knife to kill her father in a youth. There is a history of violence in the family. Strongly raised sexual desire.
It corresponds to symptoms of bromide part of Kali Bromatum.
The second side of this case – the patient did not interrupt work, only for that time when she was in psychiatric clinic, and right that after she had returned to work. This fact has amazed me, I did not see that people with such serious problems continued to work, especially as a sales manager, who constantly meets people. Thus her private life has been completely destroyed by the illness. She could not date with a man, could not even handle presence of sister or the close friend. Actually, the first attack of fear has happened during the date with a man. Thus in her youth her father offended her and inside there was a feeling of guilt if she dates a man. Her diligence and a call of duty in work, desire to establish a family correspond to a Kali part of Kali Bromatum.
Kaly Bromatum also covers a rubric “Mind; Occupation, diversion, amel.”
Boger specifies as a characteristic symptom of this medicine: «Fear of people»
The physical restlessness and restless hands are key symptoms of this medication, and they are well shown in this case.
Morrison writes about Kali Bromatum that «often past history of violence in the childhood leads to feeling of isolation, a paranoia and fear”.
Also in the Murphy repertory in a rubric “Female; Sex; suppressed, Desire” there is Kali Bromatum in regular type.
Based on my evaluation, Kali Bromatum was selected.
It was given to the patient in 200C potency at the same day, May 24, 2007.
Follow-up June 30, 2007.
“On Friday I went to Moscow (she lives in suburbs), on Saturday had after-effect – I felt myself badly. In Moscow there are such crowds of people, I handle it bad.
Yesterday I went to store, at once like there was a fear, but later felt better.
To be on the street for me is uncomfortable. Yesterday my friend visited me, she has stayed for 10 minutes , and no symptoms have arisen. Tomorrow is time for me to go to the psychologist, and the fear is not present. It is strange. I do not think yet about dating with men, to me now is the time to learn how to handle presence of people.
This week I have taken a bath for the first time since I became ill. In general I like to take a bath, I mean I loved earlier, and when was ill, could not take for some reason. I had unpleasant sensations. Yesterday for the first time for a few months I have taken a bath, before was only a shower.
I do not see strong changes in my condition, maybe I began to handle other peoples’ presence a bit easier, and the fear is less. Well though such feeling that death is here is not present. I work with the psychologist over a sense of guilt.
There is no sexual obsession that was before. I accept men more easy”.
I asked how she feels herself in the darkness. She said that she does not see figures or dead people any more, however still leaves the light on.
My assessment based on this information was that the Kalium Bromatum was acting.
There was no fear before visit to the psychologist, in contrary to the beginning of the treatment, when on the first consultation she said «I do not know how I will go to him, such a strong fear».
She could handle presence of her friend for 10 minutes without fear and without occurrence of panic attack, but earlier such was impossible.
For some reason she could not take a bath for several months because of her mental condition and now it becomes for the first time possible. The feeling that death near to her has gone, and she has noticed that began to handle presence of other people a bit easier. The sexual desire has decreased. No medicine has been given. Follow up was appointed.
Follow-up August 6, 2007
“My mood is good. I went to another department at work, earlier in such situation there was a fear attack, but now I felt myself well.
The girlfriend came to visit me about 10 days ago and there was no such reaction of estrangement. We have spent time together pleasantly. In general fears appear less during last month. It does not happen any more the way as was for the first time when I became ill. There is a tension and discomfort when meeting with people, but that is not always.
Within last week this discomfort became stronger, even the fear happens, though the panic is not present, but in general the fear is worse. I do not know what the reason is, maybe that I drank coffee and it has neutralized drug action? And the sexual desire overwhelms me. Happens, as earlier that I am ready to have sex with anyone.
Again I began to spend a lot of time in Internet, I try to find a man, and what is the sense in it? I do not know at all, whether I can meet with him without fear. One may tell that some crazy woman is trying to date him”.
My assessment at this point was that the case had partially relapsed.
Certain improvement remains, but the sexual desire has raised again, and within last week she notices strengthening of fears. It is a case of a deep serious mental pathology and I was ready to that, most likely, through certain time it will be required to repeat a medication. I do not think that the issue is in coffee she drank; just the medication was taken more than 2 months ago.
Kali Bromatum 200С, 1 dose is appointed. Follow up in 1 month.
Follow-up September 12, 2007
She has taken Kali Bromatum 200С on August 10, 2007.
“Everything is now better than last time. Mood is still good. I can handle now presence of the person, and there are no panic attacks. Girlfriend and sister visit me and everything is all right. And recently my sister spent the night in my home, and though I have been a little bit tense but nothing as before happens this time. It pleases me very much. Thanks God, I start to leave this awful condition.
I do not like crow, and it is still hard for me to go to Moscow. I am very nervous there. In our small town, here I feel myself better. The sexual desire has lost sharpness. I would like to get to know some man, of course, in the future to establish a family, but later when I will be more mentally stable.
Though I do not refuse to go to places where there are men of my age now, but only if it is not too crowded. And such persuasive desire to find someone immediately now is not present. Your pills help me very well against hypersexuality. My sense of guilt is less too, I think, because we do much work with the psychologist.
My assessment based on this information was that the Kalium Bromatum was acting.
There are no panic attacks; she can handle presence of one person, and even the small company. The sexual desire has lost sharpness, was normalized. She works now with the psychologist over the problems, meets with him without fear. The sense of guilt has decreased.
My decision was to wait and observe. Next appointment is scheduled in a month.
Follow-up October 17, 2007
“In general I feel myself not bad. But I only worry: I was invited by one fellow and there will be a man, he kind of likes me and I like him too. I do not know at all how I will handle it. I did not have dates for a long time already and I am afraid that those fears that were earlier can return. But everything is better, strong fears are not present, hypersexuality too. My sense of guilt is significantly less. I do not have feeling that I am the sinner when I think of possible dating with a man. At work everything is all right, as before. The physical restlessness is less now. I think because my general nervousness is less, therefore restlessness is less also”.
My assessment based on this information was that she continues doing well.
All mental symptoms continue to improve. She is going to go on a visit where will be a man who likes her. Though she worries how everything will go, but she is not going to refuse this possibility.
The physical restlessness and the general nervousness have decreased.
Medication is not prescribed. Next appointment in a month.
Follow-up November 20, 2007
“I have started to date this man about who I spoke to you last time. He is younger than me by 7 years and he is very good. I did not have such man earlier. There was such feeling before that men used me and threw out, and this man is absolutely different.
Panic attacks gone now, but last 2 weeks the feeling of tension and discomfort amplifies, especially during the dates with the man. Feels like I want to escape from him. I hardly restrain myself not to turn around and to leave sometimes. I feel again that I break some law, that I am a bad girl when dared to date the man”.
My assessment was that the patient needs one more dose of medication in the same potency.
In relations with men, fear to be the fallen woman and desire to be good even for such father is the essence of the case. She has again faced this situation when she needs to overcome an interdiction of her father and to dare to be happy without a fear and a sense of guilt. She again would like to escape from the man, though he is good and caring. Her fear and sense of guilt amplifies again.
In such situation I consider necessary to repeat Kali Bromatum 200С.
Repeated consultation scheduled in a month.
Follow-up December 19, 2007
“I continue to date this man. Now there is no such tension and a sense of guilt as was at a meeting with him earlier. He comes now to visit me in my home, and I handle it normally. However, I yet do not allow him to spend the night with me. Sexual obsession is not present now. That means I am not against to have intimate relations with him, but I think it is too early now. It is not necessary to hurry things in my situation. Sister still comes to visit me and my friend comes. Everything is fine with them. I visit them sometimes, but I do not like big companies. I like when it is quiet. The psychologist says that I have a good progress. And I see it too”.
My assessment was that patient’s condition continues to improve.
She tries to build her life and relations with the man. Now the fear and a sense of guilt do not disturb her actions. The psychologist marks improvement of her condition, as well as she does.
In such situation it is better to wait and observe.
Conclusion:
Her condition has considerably improved during the treatment. She has come to me short time after a discharge from psychiatric clinic, and all symptoms with which she entered the clinic, remained. There were panic attacks, fear of people, hypersexuality, a feeling of guilt and the suppressed sexual desire. The patient showed strong physical restlessness during the stress moments. Allopatic treatment was reduced simply to suppression of symptoms by means of psychotropic drugs. But the patient is a clever woman and she has chosen treatment by other methods and has found the homeopathic doctor and the psychologist.
This treatment has appeared much more effective: panic attacks are not present any more, the feeling of guilt and hypersexuality has virtually disappeared, and the anthropophobia has significantly reduced. Tension remains in the big companies and in crowds, but she feels well with sister, her friends and in the small companies. I was pleased very much that she has started to date the man. She has overcome the fear and a feeling of guilt that is going from the childhood and a youth and prevented her from normal private life.