A CASE OF SCHIZOPHRENIA AND A CASE OF CHRONIC FATIGUE SYNDROME

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A CASE OF SCHIZOPHRENIA AND A CASE OF CHRONIC FATIGUE SYNDROME

Introduction

This first case is quite long, in part because it is given in the patient's words and in part because nothing has been left out. I was hesitant to condense it in any way. The remedy is not frequently used in chronic cases, and I was concerned that I might inadvertently omit some element that is representative of the remedy. So, I suggest that you read the case in a relaxed and receptive frame of mind, absorbing the language and imagery of the patient.

Case Number 1

Male

Age 24

Initial Visit

(All symptoms are given in the patient's own words.)

The main situation is a problem with sleep. I hate going to bed.

I don't know why I am here. My father sent me.

I don't like talking that much. Well, part really does, and another part likes to do things for father.

I am not sleeping well. I don't think sleep has ever come easily. It's been a problem for a while. I wake up, or part wakes up sometime throughout the night. I can't go to sleep at night. I end up tossing and turning. Can't get things together. Aware, but asleep at the same time. Semiconscious, as though my body is awake. Or parts of my body are awake -- tossing and turning -- but parts are asleep. It's hard to explain how it is.

It's hard to think. It is confusing.

It's as though some parts are awake, and some parts are asleep, and different places in between.

I really don't like going down to my room. It is in the basement, and it's dark, cold, and damp. There is a rotten smell in there. I hate going to bed. Don't like going down there.

They say when I was a baby I didn't sleep.

I have been on lots of pills for it (sleep problems). Now I'm on Halcion. The psychiatrist put me on that when I went to the "pit." That's what everyone calls the psychiatric hospital.

I've been there (the pit) a few times. My father has told you? They have sent me there when there has been very little sleep, and then I go into the pits very quickly and other behavior comes up.

Without sleep, things just get too scattered and all over the place. When I don't sleep for a long time, reality just gets too fragmented -- and then into the "pit."

The first time down in the hospital was when my family fell apart. As I am falling to pieces my family is falling to pieces. My father left. He couldn't st and being so angry all the time -- with me, with my mother.

Our house is like the black hole of Calcutta.

Mother gets angry a lot.

Do you want to know more?

I don't know where to go from here. I am all over the place.

When father left I really didn't understand that he wasn't coming back for a long time after he was gone. That's the way it is. Sometimes I don't really notice. Mother never said anything. More and more trouble then -- at school and at home.

I couldn't play the game. Or the game, the world, gets more and more complex with everything. So many facets. The world seemed like either a battlefield or a stage. But there is a force to try to keep playing the game. Sometimes I just wanted to let go and retreat into my own world, but mother seemed to insist on me trying to cope and I don't want to end up in the hospital again.

There are so many pieces to all this.

Mother gets very upset with me as it becomes more and more obvious that I am not coping.

The school would call complaining of me not participating. I just zoned out. I sat there unable to respond, or only able to give a short response and then lapse back into nothingness. "Was I on some drugs?" they asked her.

Just not there. Everything was falling apart in different places. Running fast enough to keep them all together. Well, I can't get them together. They don't come together. They don't stick together, and they all fall to the ground and splatter.

I couldn't understand what people were saying to me, like parts of me were just shut down.

I would walk out of classes, throw things, and get violent. Then I would lapse into nothing and become unresponsive. I couldn't focus anymore.

I couldn't bring all the pieces together to surface, like a trance.

When there is not much sleep I can grasp the depth, but only of the simplest things. It's like everything is reduced to just colors or rhythms or sensations.

People asked me what drugs I was taking.

Trouble being aware of things. Difficultly responding to the things around me. When I stay aware and alert and watch what is happening it takes so much energy and it always feels like so many battles are going on. Different parts are battling. Different pieces of the puzzle.

It's like climbing out of a hole -- a pit -- to come to a place where things gather together and appear like I am "normal." Sometimes I am desperately trying to appear normal, to stay on that edge where part of me can be in the normal world and function even though most of me is scattered all over the place. Like one leg here and the other over there. But most of that time returning to a state of fragments, and only then do I feel I am being with me, with my nature. So many levels disconnected from each other, most often warring with each other.

Then, home, and mother is angry. She doesn't know how to reach me at all. I don't know how to be reached.

I hate to go down into the basement to my room. It stinks. But that's where mother sends me -- parts screaming and kicking and throwing things.

I have a lot of trouble sleeping during these times. A lot of trouble expressing. A lot of trouble with everything during these times.

I became pretty much "nonresponsive." (That's what they call it when there's no communication or it appears that I don't understand.) Mother can't stand that.

I don't eat much. Sometimes I can't figure out what or even how to eat. It all seems so confusing and impossible to bring it all together to create a will to do any action.

I became angry at any need to go to the toilet or eat or any call to participate with the family.

Father even came and stayed at the house in an effort to help me to "come out of myself."

They took me to the hospital, and I was there for ten months. Most of that time I don't remember, just fragments here and there. That was the longest stay. I have been back two times since then, but not for as long.

When there is a lot of stress, the more delayed my mind is in responding to what people say. That's what happens. I can't really make sense of what is being said. Just sit there looking. Never feel I can respond because I don't get all the pieces of the question. I hear bits of what is said, and part of my mind segments the sentence into words and gives me a strange message. That drives mother crazy, and then she gets upset and hits one side and then the other side.

Everything falling apart, then shattering.

A glass just crashes on the floor. All the pieces everywhere.

I don't have many friends, or people to talk to. I don't really do well answering questions. It's hard to respond to what people want. I have actually wanted a girl to speak to me, but the ones I wanted to talk to were always the quiet ones who never talked to me. So, nothing happened.

Teased a lot by the stronger kids at school. They call me crazy, nuts, wild.

I am told that I can be easily led, easily conned. And there are a lot of situations where I followed the path of somebody who got a kick out of me and how dumbfounded I became when too many things came at me.

I just can't put it all together. Like my legs say, "Yes, let's go." But my hand is jammed in my pocket and it is hurting, somehow saying, "No, don't do that."

I lose any sense of what is going on.

Part of me just ends up wanting to run away. I have to run away to try to pull the different aspects together.

If I sleep it seems better.

I'm working now in the library. I like books a lot. I like to read and like the feel of books. I get anxious if there are a lot of books to file, or if I make a mistake.

When sleep is bad and there is a lot of stress, work is too difficult. It is very hard to know how to function. Often, if someone approaches for help in the library, I completely ignore them. If they continue to ask for help I sort the books compulsively or rearrange the shelves. I can get confused and think they are trying to disrupt the order of things.

Talking with different doctors, I understand what my behavior is like for other people, how other people experience me. The psychiatrists try to help me to overcome my "problems" and behave more normally, but they don't really try to understand all the parts of me or the way I see the world. It seems so easy for them. The rules are simple, and they keep everything together. But without the rules...everything falls apart and dissolves.

I get headaches. They can be very painful. They come on when I am not sleeping well. Sharp pains that fly around my head. They start in the back and shoot down -- inside my head. Very sharp pain.

There is a sewer in my head. A sick feeling, toxic feeling. Like I drank too much. Polluted feeling. Then my mind flies around, a craziness in my head. I sit my head in front of the mirror when it feels this way, looking into one eye and repeating my name to call myself together -- to call myself back.

With the headaches I feel a sense of losing all the parts of me. I feel at odds with myself. There is no core -- just components. The headaches come now and then. I don't know how often. On painkillers for these headaches since 14 years old. Different ones. They really don't seem to stop the pain. I've stopped taking them now.

I find looking in the mirror somehow calms this crazy feeling in my head. Then the pain is just there. The head feels big and very different from the rest of the parts of me. The blood is stuck in my brain, and that sends crazy signals. Sick feeling.

I close my eyes and try to sleep. Then things are difficult. Wandering mind. Wild dreams. I lose the ability to keep a grip on "my world." I feel in limbo. Scattered all over the place. No connection, without any feeling or comfort. No way to pull together. Crazy feelings in my head and a sense of disconnection with all the other parts.

I did have a friend, but was unable to focus and feel enough to let it happen. She is someone who noticed me at the library. She talked to me, and we went to the coffee shop together.

I don't know how to proceed, how to make friends, how to talk. Often my strategy would be to become a person I had seen at the movies or in a book, or a person I had met that I liked. I would become them and push all the other bits down, down deep. I would behave like them, take on their sense of humor, mimic them.

She kissed me once. I wasn't really there. She kissed my face, not really me, because I was somewhere down inside scrambling all over the place. She kissed the character, the outer persona behaving like the TV personality.

I think she stopped our walks together because of my lack of response. If she only knew how much I was responding. Crying when I realized that she had pulled away, but I don't know if any part of me felt sad.

I hate going to bed. It smells like something rotten in my room. It's cold and dark like the sewer. Go out walking at night to avoid going to bed, to move. I walk past the sewer, and I can smell that smell, rotting smell. Walking to avoid the experience of dissolving into the darkness and losing myself. I try to bring things into focus by walking, to bring things together.

I wake in the morning, and there is black dried blood around my mouth. It frightens me. Maybe my tongue is bitten or I grind my teeth in the night. My mouth and tongue are covered. Everything smells foul. I have to shower to get the smell out. I guess I sweat at night.

To fall asleep I try to focus. There are so many things racing around. I try to focus everything together, to pull all the pieces together. Am I here? Am I there? I lose myself in the patterns of the wallpaper.

Mother comes down into my room. I know she is there in the dark.

I feel like I am sinking down into the bed. Through the bed. Down, down into a hole. I feel all over the room. Parts of me everywhere in the room.

Restless. Legs can't keep still.

I walk around and around the room to focus.

At night in the dark muddy hole the anxiety becomes unbearable. The battles inside make me want to scream.

I can use words but I want to communicate. I want to express something. I want to let something out.

I want to focus.

Medical history of recurrent pneumonia with high fevers. Long time for recovery. Antibiotic treatment.

The most recent pneumonia started after walking in the rain and no sleep. Started with a fever and chills, and then I was in and out of it. Not here at all. It happened after a time of not much sleep, so I was more susceptible to go down with it.

I am all over the place when I get sick and have no strength to pull it together. No energy to focus myself.

I was in the hospital one time with it, because I just didn't have the energy to pull it together.

I was adopted by my mother and father. They split up. Life was good as a young kid, but then I went to school, kindergarten, and the teacher began to tell me things to do and how to behave.

I started to notice that things were different in "my world." I didn't know how to respond. I missed a lot of my first year at school because of being sick.

I don't think I ate much as a kid, so I wasn't very strong.

I remember surfacing now and then into awareness.

Mother says they were lung infections. Oxygen tents. Feeling very safe and secure.

Even then, feeling divided. Part of me in awareness and parts of me in different levels of awareness. Up and down.

Father took me, one time, to the circus and we went into the house of mirrors. I looked at myself reflected hundreds of times and felt that it was the closest expression of how I experienced myself. Fragments -- divided and divided and divided and divided. My head in one mirror, and one arm here, another in a different place. All separate.

As far back as I could see there was no one person.

When father left, mother became very angry. She was angry at me. I didn't do or behave the way she wanted her son to. She began to hit when I did things that upset her.

I never gained any weight. I didn't eat much. That was frustrating for her.

I didn't like it when she hit me, so I was determined not to let her know how she hurt me. I got to the point of being able to show a smile on my face or to laugh while she hit me. She just hit more.

I learned to lock parts of me in and to lock her and everyone else out, mostly because it is too confusing to have so many parts coming at you. How do they fit?

I developed a well-mannered, more-or-less presentable, shell. But no one inside.

It drove her crazy, with screaming and kicking.

I don't believe I am like I am because of my home life, although it is not normal, I learned later.

Father visits me often. He tried to teach me to play ball and golf. I only liked swimming. Somehow floating in the water I feel free and one. I love to float and swim.

Sometimes I spend the night in an old house, with closed eyes. Losing all conception of night or day, light or darkness, time or space. That's the restlessness -- the baseless feeling -- that can happen at night.

Really, everything can become unreal. Time, miles, calendars, clocks create structure -- structures that I can't fit into. Or parts of me can fit but, in the end, I feel frustrated and fragmented and nothing makes sense.

(I called his mother and father in hopes of filling in some blanks. His mother related the following information.)

He was adopted.

He was hospitalized three times in the psychiatric ward. He was diagnosed as schizophrenic, multiple personality disorder, and, now, more recently, borderline personality disorder. He has been on a long list of medications. But he seems to take only the Halcion, and it often doesn't seem to work.

She kept saying that he can be normal. He did eventually graduate from high school and even completed a year of college.

He is working in a library.

It is up and down because at any time he goes into one of his "fits."

The library is very understanding.

"It happens any time, any place. You cannot predict it. But something happens at least every week, and sometimes it can last for a week or a month. You never know."

"You just never know with him....There are episodes of cutting himself, with seemingly no response -- no pain."

(The following symptoms are reported in the mother's own words.)

Talks to himself a lot.

Head banging.

Rearranging things compulsively.

Breaking things, especially glass.

Rocking back and forth, from one foot to the other.

You never know when he will behave this way.

He can have arguments with himself.

The sleeplessness has been a problem since he was very little -- the sleeplessness and the tendency to walk all night. I never know where he is.

Several times I found him huddled in the closet with his eyes closed, and when I yell at him to come out he looks up and then lapses back into a spaced out, stupid, nonresponsive state.

(I asked him about some of the symptoms his mother had related to me. The following is a clear explanation in his own words.)

The head banging creates a rhythm in my head and it drowns out the fixations in my head. When everything is scattered all over the place, the rhythm allows me to escape.

I cut myself because a lot of the time no "one" person is there, just fragments. I can cut to reach some semblance of someone there -- some core. But most often when I cut I don't feel anything.

Rearranging things compulsively is a way of making order -- order so that the "world" or normal behavior can seem closer and more attainable.

Breaking things is an escape, reminding myself that escape may be possible. The pieces all falling and shattering is like me somehow. The pieces are all there.

Rocking back and forth and back and forth is another way of keeping me moving when the darkness seems like it will overtake me. It creates a rhythm, a hum, a consistency that comforts.

Analysis of Case Number 1

I'd like to spend a few moments exploring this case with you. Instead of thinking about remedies, let's focus on the patient, on the feeling of the case, on the direction of the case, or on anything that comes up for you about the case.

Krista Heron: I think several ideas or themes are presented in this case. One is the idea of disconnection. Some of the ways he expressed this disconnection were that he was adopted and that he couldn't connect with himself unless he looked in a mirror. Another is the idea of something unclean. He used the words foul sewer, and muddy. He had to shower. And another is the idea of being fragmented and divided. He feels he is in parts. His parents had split up. He rearranged things at the library. He cut himself. There was also a sense of movement, mostly going down -- down to his room, the pit, the black hole of Calcutta. But, also, he didn't know where to go.

Sharon Ryals: I loved being able to see the patient from the inside. When we look at the behavior of people with severe mental states, watching from the outside, it often doesn't make sense. But looking at things from his point of view, I was able to make complete sense out of everything he did. It was so clear that his behavior worked for him. It was his way of surviving. The theme of fragmentation is so powerful all the way through.

I kept thinking about the smelly room. I was thinking, "What's wrong with this family? Why do they put him in this horrible room?" And then I started to wonder if that was his perception, rather than reality. When he talked about the black blood and the smell I began to feel that there was something in his body that was rotten in some way and that he was in a kind of septic state, a very deep septic state. Perhaps the smell in the room was actually coming from him.

Marcia Neiswander: It seems as if he has a bunch of parts on a switchboard but no central telephone operator. No one is directing the parts. His sentences don't make sense. Data are coming through, but there is no decoder to make any sense. He has a major tong-standing sleep disorder. He also has tremendous difficulty with emotions, especially with intense emotions or if anyone comes close to him. He has a great need to be safe. The cutting is primitive. It is almost a desire to be safe through cutting, to connect back to himself.

Mary Byrd: Darkness pervaded the whole case: the pit, the dark, coming out of the hole, the black hole.

Christine Bautista: He is talking not only about descending to the depths, but also about surfacing. That image keeps coming up, along with loving to swim. That was striking to me.

Dack: Yes. There's a kind of hopeful element to it, that he will keep on trying to surface.

What stands out for me with this patient is his incredibly pervasive sense of fragmentation -- his sense of being in "pieces," "divided," "scattered." He expresses this theme over and over again in various ways. When he describes his sleeplessness, he says, "...some parts are awake, and some parts are asleep" or "Aware, but asleep at the same time...can't get things together...I am all over the place."

He expresses such a profound feeling of separateness or disconnection from the world when he says "my world." He says, "Sometimes I am desperately trying to appear normal -- to stay on that edge where part of me can be in the normal world and function even though most of me is scattered all over the place." E yen in kindergarten this distinction was evident. He says, "I started to notice that things were different in 'my world.' I didn't know how to respond."

His sense of separation from the outside world is seen so clearly in his reaction to people, such as his inability to respond to people at the library. If someone asks him for help he ignores them. He can't connect. He doesn't have friends because it is "hard to respond to what people want." He feels so separate inside and outside toward other people that he doesn't know how to act. He feels he can't fit into the "rules that keep the structure in place."

There is a feeling of separation from his family. He is adopted, and he makes a point of telling me this directly. After that, he tells me that his parents split up. "As I am falling to pieces my family is falling to pieces." He never mentions his younger brother. I didn't know that there were any siblings until I talked to his mother.

He felt very disconnected from other children at school. He couldn't make friends and had periods of not responding at all, sometimes even becoming violent. He said, "Everything was falling apart in different places. Running fast enough to keep them all together. Well, I can't get them together. They don't stick together."

The sense of fragmentation is so profound that he feels separate, on a very deep level, from himself. He says, "...most of me is scattered all over the place. Like one leg here and the other over there." He also says that the psychiatrists don't try to "understand all the parts of me...." And the description of the house of mirrors graphically shows the fragments "divided and divided and divided. My head in one mirror, and one arm here, and another in a different place. All separate....So many parts, fragmented."

At night these feelings become very strong when sleeping is a problem. He describes a restlessness, a feeling of being scattered and all over the place. "The battles inside make me want to scream."

He presents with the complaint of sleeplessness. It is always interesting to listen to the way a person describes their concerns. He creates a picture around sleep. He describes the "pit...sewer...cold, damp, dark pit...smells terrible, rotten....I don't like going down there....It stinks....I hate going down there...the black hole of Calcutta...in the hole." To add to the picture, he says he often wakes with "black dried blood around my mouth....Everything smells foul." He says he feels as if he is "sinking down into the bed. Through the bed. Down, down into a hole." It is a very ugly place -- a pit -- and sometimes he has to get out. He has to go walking, to move. The restlessness and sense of fragmentation are so great he can't stay there. His language strongly indicates a downward, underground movement.

Another aspect that stood out is a kind of loss of sensation, or an inability to feel. He cuts himself and feels no pain. He cries, but with no feeling of sadness. He has a mental confusion -- a delay in responding. He says, "I can't really make sense of what is being said...zoned out." When he describes his father leaving the family, he says, "Sometimes I don't really notice." He "sat there unable to respond, or only able to give a short response and then lapse back into nothingness....I can grasp the depth, but only of the simplest things. It's like everything is reduced to just colors or rhythms or sensations."

There is a sense of unresponsiveness. He can answer briefly but lapses back into "another world." The description of his first kiss, "She kissed my face, not really me," again shows a deep sense of separation from himself.

His description of his headaches is also interesting in that it continues the theme. Certainly, the separateness and the feeling of being scattered are demonstrated when he puts his head in front of the mirror and chants his name to try to bring things together. He says his "head feels big and very different from the rest of the parts of me." He also has a toxic feeling, a feeling of congestion in the brain that makes him feel crazy and disconnected from himself. He says there is a sense of a sewer in his head -- a toxic, polluted feeling. "The blood is stuck in my brain, and that sends crazy signals."

These themes all seem important to understanding the patient: the sense of fragmentation (fragmented from the center), the movement to bring the pieces back to the center, the sense of toxicity, and the direction downward.

I chose the following rubrics:

- MIND, Bed, aversion to.

- MIND, Delusions, body scattered about bed, tossed about to get the pieces together.

- MIND, Wildness, headache, during.

- MIND, Answers, stupor returns quickly after.

Another possible rubric is MIND, Confusion, identity, as to his.

The remedy that comes through these rubrics is Baptisia. On consulting the materia medica, I found that Baptisia is described mostly as an acute remedy, used in the treatment of typhoid, diphtheria, gangrenous complaints, and septic states that come on very quickly. It is also used for malaria, for the effects of drinking bad water, and for blood poisoning that is highly septic. But there are some passages that are interesting with regard to the patient in this case. Kent says the following:

You take an individual who has been in a mine, in the swamp, down in the mud, in the sewers, who has inhaled foul gases, who goes into bed with a sort of stupor...

Another passage from Kent reads:

His mind is gone. He does not know what he is talking about. He is in confusion and when aroused he attempts to say something and utters a word or two and it all flits away, and he is back in his state of stupor again...a peculiar kind of mental confusion, in which he is in a constant argument with his parts. He seems to feel that there are two of him. He realizes a dual existence whenever he is roused up. It is said clinically that "his great toe is in controversy with his thumb." Or, "one leg is talking to the other leg..." or, he is scattered around over the bed; fumbles and you ask him what he is trying to do -- "why, I am trying to get those pieces together." He never succeeds; he is in a delirium, of course. These are only examples; you will get a new phase every time you get a Baptisia case.

I think Kent's last comment in the passage is interesting. He is saying you will hear these symptoms in many different ways with different patients, referring to the importance of the patient's own language and way of expressing.

Kent continues with the following:

When the stupor is not so great he is restless and turns and tosses. In that case he cannot sleep, because he cannot get the pieces together. He feels if he could once get matters together he could go to sleep, and these parts that are talking to each other keep him awake.

Kent goes on to cover some of the symptoms of Baptisia: bleeding mouth, blood oozing from the mouth. The bleeding is black and offensive -- never bright red -- always black. There is a putrid, foul, pungent, penetrating smell, like decomposed meat. Kent talks about confusion and blood accumulation in the brain and the toxic feeling.

The patient also experienced a kind of unresponsiveness and loss of feeling. He felt fragmented from the center, with no connection to his source of feelings. Kent describes an aspect of Baptisia that is a painless ulceration: swelling and ulceration of the various parts that are painless. He talks about gangrenous swelling and severe ulcerations of the throat with no pain. I wonder if we could see the thread of this idea and relate it to the patient's inability to feel on a mental or emotional level. The parts are so scattered, so far away from the center, that the "normal" reaction of pain or pleasure doesn't register, as in his cutting hims elf with no pain, his crying with no sadness, and his lack of responsiveness.

Plan: Baptisia 1M, single dose.

Follow-Up on Case Number 1

Seven Weeks After the Remedy

I am feeling different. Have been feeling different.

It's difficult somehow.

I see past events in life. They have been running through different parts of my mind.

It is difficult to put them together, to make out why I am this way.

Sleep. I have trouble sleeping.

There are these dreams that frighten me. Dreams of a cat. And the cat opens its mouth and all these little creatures come out -- frantically running around, bumping into each other, on top of each other, overlapping. They all are fragments, and nothing on their own. They want back into the cat, but she won't let them in.

It is so frightening somehow that parts of me wake up and part of my body is sweating. Part of me is still asleep though. My leg starts rocking, and I see the little creatures, and I begin to interact with them. Caressing some of them, just watching others, laughing at the antics of others.

It was actually a pleasant dream. The creatures began to go into the cat, not all through her mouth but being absorbed through different parts of her.

I tell you this because I don't think I have ever had this experience of enjoying a dream. It felt somehow resolved when I woke up.

You asked me to watch for changes.

Been quieter lately. The library has been busy, but I have been quieter -- focused and coping.

Twice, J. has walked out the door at work at the same time as me. We haven't talked, but I enjoy the feel of her as our shoulders touch going through the door. That can scare me, not knowing which aspect of me is being touched. Touch can be very confronting.

I am not walking the streets at night.

I think the smell is gone in my room.

If sleep is not coming I can sit in my room and rock, or in the closet and shut out the sounds.

The smell is gone, so I am not in the dark hole.

My mother went away.

I enjoyed doing things in the house. Independent and free. Went shopping and prepared dinner.

Made three huge pots of soup and gave some to Mrs. C. (a neighbor who checks in). Put the rest of the soup into separate containers for dinner.

Enjoyed being independent.

No headaches. Haven't missed work with headaches.

Sleeping is easier. My room at home smells better. It's easier to sleep.

The battles continue.

Don't really know what is changing. Feeling different.

Plan: Wait.

Three Months After the Remedy

(He is wearing clean, new clothes.)

I am sleeping longer. I don't feel the anxiety about bed. Able to find a center and sleep.

J. and I went to the coffee shop, and we talked about things.

Don't know how to communicate really. Searching for a persona to take on, and nothing seems to stick or feel right. That is difficult.

She says she wants to know "me." Who is that? What to say? "I'm crazy but getting it together slowly?" Which "me"? Which part of "me" do you want to know?

Mother was angry last week. She yelled and hit. It was familiar. I remembered her getting angry at me as a child.

What is strange about this is that mostly the past is nothing. Events are all a series of isolated episodes that could have happened yesterday, three years ago, twenty years ago, or all at once simultaneously. The meaning is the same.

But this was a different sensation -- that she was angry now and she was angry in the past -- and the reaction was different. I felt free of the reaction of the "past," able to react differently now, more "normal."

Having some walks at night.

Going out with a friend for walks in the evening. She struggles like I do. We can understand each other a little and know when quiet is okay. I like her a lot.

No cutting.

Rocking sometimes when people ask something at work.

No headaches.

Sleep is easier.

When J. and I are sitting at the coffee shop my fingers play with the sugar packet. I watch my fingers flip it around and around and wonder how they can do that so easily and agilely.

My appetite is better. I'm liking to eat; liking to prepare food, different foods; liking spicy foods.

Thinking of moving out and living in an apartment alone.

No medication.

Plan: Wait.

Six Months After the Remedy

(His mother called and said he is at it again. She had found him it. the closet banging his head and cutting himself. He came in for another visit.)

Behavior is going into the pit.

Started dropping things at work and switching the lights on and off.

I'm pulling inward, away from the "world." Somehow retreating.

The battles are all over the place.

I have blood all over the mouth in the morning. Over the teeth and tongue. All over the face.

I'm sinking. Sinking into the shit.

The smell has come back into my room. Rotten, damp, sick smell Like a sewer. Going to the sewer at night, walking there. Have to get out of the room.

Everything all over the place.

Went walking with J. She said she "wanted to reach out to me."

Don't know what to do. Lost all sense of myself. There was a feeling of "me-ness" that had been there. All that was shattered. The battles are raging in this dank hole.

Dove into confusion.

Pieces flying all over the place.

Searching for a personality to be. This person? This reaction? No, that personality over there sitting on the couch. No. No. That one on the bed. That is the one that knows how to behave.

Restless. Can't sit still.

Rocking back and forth. Unaware, until J. told me.

She touched this arm, and it felt like fire. Needles of fire going through me. Like blood rushing into my head. Confusion. Unable to talk to her.

I don't know how to pull it all together. Don't know what to do. One part says behave like this, and the other part says behave like that. And there are many parts saying this and that.

My head hurts, and my stomach is burning. My leg aches, and they all are at odds with the other parts.

Anxiety. Battling inside.

Don't know who I am. I am so many different parts. How to gather the portions together.

Not working. The remedies aren't working.

Don't know why I am like this. So fragmented.

Can't go to work. Just arrange and rearrange the same shelf. Can't stop. It feels incomplete and not together. Can't seem to get it all together.

Feel lost inside.

Can't think.

Not sleeping. Wandering at night. Finding places to sit and look into the darkness.

Cutting this arm. Don't even know whose arm it is.

Banging this head. Blood trickles down. I can feel that sensation.

She became a stranger. She became like a color with no form, or a sensation without any origin. Just a stranger. No one that I recognize.

Assessment: It seemed that the cause of this relapse was the confrontation with the woman at work. I could not find anything else that might have interfered. Perhaps her attempt to get close to him was simply too much for him to handle at that point. It would be a good test for the remedy, to see if a repetition would keep the case moving forward.

Plan: Baptisia 1M, single dose.

One Week After the Last Remedy

(He called.)

After the remedy I slept for two days.

Back at work. Able to work.

Feeling shaky still.

I'm not crazy. I went down the tube. That was it.

I felt too vulnerable, and that is shattering.

The "me" couldn't hold it together when J. was trying to be closer. I know that affection won't hurt me, but it feels painful, frightening. And, instead of feeling that, I shatter into tiny, tiny pieces. I see how tiny and separate they are now.

I felt in a state of shock. So confused and unable to surface. Unable to think. Unable to connect the pieces.

Things are better now: no cutting, no head banging, sleeping well.

Plan: Wait.

Long-Term Follow-Up

I saw this man several more times. He continued to be well. The symptoms of sleeplessness were much better. No medication has been needed. His ability to be with people and interact continued to improve. He was planning to move into his own apartment. About one year and three months after the Baptisia, his mother called saying he was sick.

He aches and is sore all over.

He is exhausted, but restless, and has difficulty lying still.

His arms and legs feel sore. Sore to the touch.

His fever is climbing.

He feels weak and exhausted.

He talks and mutters. Not making sense. Dreaming and talking in his sleep.

His mother is not able to make any sense of his muttering.

His mouth is dry.

He is sweating. He smells. It smells horrible, as if something died in there.

He is congested. Tightness in the chest. He wants the window open.

He is coughing up mucus. Dark green, black.

He has a nasal discharge. Green, streaked with black and red blood.

Very bad smelling.

He has some diarrhea. Yellowish. Dark, dark yellow.

Terrible smell.

He has a pain in the chest and in the right lower quadrant of his abdomen.

Feels generally sore and achy.

He is worse from any touch or any applications.

He doesn't know where he is. All over the place.

Then, he just curls up on his side with legs pulled up and doesn't acknowledge his mother's presence.

Assessment: I was able to talk to his mother only. He couldn't come to the phone. I asked her to ask him some questions, but she said he doesn't answer. He just looks at her as if he is drunk and then falls back to sleep. I couldn't ascertain what may have triggered this situation. He seemed to have been doing well up until this point. It is possible that this was a recurrence of his pneumonia. Because he had been sick for three days, because it had started suddenly, and because he was deteriorating quickly, they had consulted an MD and antibiotics were prescribed.

Plan: Baptisia 1M, single dose.

Current Status

The episode resolved over the following two days and he has continued to do well over the last two years.

He now lives in his own apartment and has less and less to do with his mother.

No episodes of head banging or cutting himself.

The rocking and compulsive organizing still come up from time to time.

He still lives in a "different world."

The sense of fragmentation in his world is gone.

He still feels separate or apart from others. "There are times when I am free of it all, though."

Plan: Wait.

Case Number 2

Female

Age 43

Initial Visit

(In the patient's own words.)

Chronic fatigue syndrome diagnosed in March 1990. Really down since November 1989.

Haven't been able to work at all this year.

Have been working with different doctors with food allergies and different supplements but not getting very far. Doing some supplements and dietary changes for food allergies. Working with a chiropractor for spinal alignment, and with a body worker to deal with some old patterns of "holding" and to free up my energy. Some work with a physiotherapist for my muscle and joint pains. Working with a therapist on some past emotional trauma. I think I am covering all parts of me. I am sure there are parts I am missing. It feels that way anyway.

I was hypersensitive before this disease brought me down, but now I am allergic to the whole world. Everything makes me feel sick.

Hard time concentrating if even the smallest stress.

My body just aches. All the muscles and joints. They are calling it fibromyalgia.

I get completely scattered with any type of upset.

I really don't know who I am anymore.

"Sleep disorder" since this disease. I have been to the sleep disorder clinic. They tell me that I never reach REM sleep and that this is the source of a lot of my health problems, because the body never regenerates unless it goes into deep, deep sleep. I cannot fall asleep without sleeping pills.

I have never had a great immune system, but now things are scattered all over the place. I don't know where I am. I feel I am spinning apart and caught in a vicious circle. Things are splitting off all over the place.

I have always had trouble with allergies all of my life.

Extreme fatigue. I don't know what it is about, but as the evening comes I become anxious. Wound up somehow. Extremely tired and wound up at the same time. Anxious at night. Prevents me from sleeping. I feel restless and agitated at night. Like some part of me is wanting to sleep, and the parts of my body are just restless and can't get in sync somehow.

I feel sometimes like I am looking on at this person in my bed and wondering how anybody could be so tired and not be able to sleep.

I wonder if I will ever be able to pull it together and sleep.

Extreme fatigue. I can't even think half the time.

I watch myself go through the motions during the day and wonder how I can be functioning.

Depression.

Loss of concentration. Inability to think. I lose my train of thought all the time. I am just about to say something, and then it completely disperses.

I used to be an active, driven person. I had a "high-profile" job. I was going to school and teaching for two years.

September 1988 I developed tonsillitis. Not much pain, but it was very swollen and red. The tonsils were covered with smelly pus. I was extremely tired with it. I lost my voice and was on antibiotics. Three courses, and still not much change, except it gradually moved into my chest and I ended up with pneumonia and had to be hospitalized with IV antibiotics. Then on antibiotics for four months after I was released from the hospital.

I have never been well since then.

In the middle of that, before I went to the hospital, I was on a naturopathic regime, and then it went into my chest. I just watched myself falling to pieces.

My intellectual abilities just dissolved. My brain works so much slower now. I feel confused a lot of the time. I go to the grocery store and I know why I am there, and then suddenly I can't remember. The thought just disappears.

Feels like this brain just isn't working. Like it's clogged up with some kind of sludge. I attribute that to the sleeplessness, but there have been other times in my life where this difficulty in concentrating has been a problem. Mostly in times of stress.

After I got out of the hospital the sleeping became a problem, although it has been a problem at different times.

The anxiety in the night started after that.

I was ill as a child. "Failure to thrive" they called it. Spent a lot of time in the hospital in my early life. I had a kind of seizure. Low-grade seizures, mostly consisted of rolling back and forth on the ground or in bed, moaning.

When I was five years old my father had a nervous breakdown and. was hospitalized.

We went to live with a man who took us in, and my mother worked for him. He sexually abused my sister and me. I became terrified of being out of my mother's sight. I spent a lot of time with animals and pets.

My mother denied the sexual abuse that was going on. I just felt confused. I told my mother, but she couldn't deal with it. So, she denied it and I didn't know what to feel. I was shattered. Half of me being sexual with this man and the other parts just all over the place.

The "seizures" became worse between these ages of seven and twelve years. I really was a mess. Shattered. Really didn't know who I was, or what I was. I felt so disconnected and scattered.

The sleeping was a big problem during this time. Restless and fearful at night.

I am still afraid in the dark. Restless. Moaning and rolling from side to side to try to find some continuity, something that would pull all the pieces together.

My father was diagnosed with schizophrenia.

We were never able to establish what was real in our family. A lot of dark, deep, low, cesspool-type secrets. That's what it feels like, an infectious mass o f toxins in our family.

My father finally came out of the hospital, and we all lived together again. He was really not functional. A non-entity really.

My mother institutionalized me because I had a boyfriend who she didn't approve of, and I was sexual, which was against the laws of God. So, she put me in a psychiatric institution when I was 18 years old. I was very controlled by my mother and terrified that she would catch me with this boyfriend, which she did.

I think my mother has been a Valium addict all her life. Father is schizophrenic. Sister is on tranquilizers for sleeping problems.

I was institutionalized for four months. I was desperate and terrified that I would never get out of there. Then, I got really sick. Some kind of pneumonia. They had to transfer me to another hospital for treatment. I had a very high fever and delirium. Didn't know who I was or where I was. Kept feeling like I was dissolving all over the place, that I was going to die. I eventually got out.

When I got out and was a little stronger I left the city completely. Split from my family. Out of my life.

I felt reborn when I left that city and started living on my own. I started drinking heavily, though, because I felt so separate from everything I knew.

Got involved with a man who I really thought I loved. I even slowed down the drinking for him, but then he separated from me for another woman and again I was shattered.

I got very sick and was hospitalized again. A similar kind of pneumonia-like illness. High fever, delirium. Really afraid I was going to die. Completely confused and unresponsive to anyone talking to me. Really down in it for days. I recovered and slowly surfaced.

Then I trusted no one emotionally. I was too vulnerable, too easily shattered.

Now I have been in a relationship for seven years.

A lot, a lot, of anger towards my mother. Hatred towards my mother.

I lost my ability to think and my ability to feel.

Spent a lot of time feeling that my head and my body parts were not connected to each other. I still struggle with this feeling of disconnection from myself.

I started therapy two years ago. I was never going to see a psychiatrist because of being institutionalized. They were to be avoided at all costs. But I found a psychologist who I am cautiously growing to trust. It is hard to allow anyone in.

Aching pains in my joints and muscles.

Fear that my heart will stop. I remember this fear when I was in the hospital with a fever and feeling like my body was all in pieces and that my heart was going to stop. I get really fearful and confused about it. I am confused about it. I have my heart checked often by a cardiologist. This is a fear still, especially at night. It is not logical at all. It is a crazy fear. When my mind starts going, it goes and goes. Wanders all over. It gets wilder and wilder, and I get afraid I am going to die. Confusion about my heart. What's wrong with it. It is totally crazy.

I don't know myself half the time.

I used to be a busy person. Now, I just don't have any vitality.

Fear of not being able to be independent.

Fear of rejection, of love and affection being withdrawn.

Since I have been sick I have spent a lot of time alone, in confinement. Not wanting to be with many people.

Fear of losing control. That's a joke because I feel I have completely lost control and all the pieces are scattered about. I feel I am desperately trying to collect all these pieces and pull myself into a whole again, to integrate it all.

I avoid time to get in touch with emotions. It's too hard.

Fear of completely dissolving.

I hate it as the evening comes on and I know that the time to go to bed is coming on. I try to avoid going down to bed. I become restless and I start to think about my health. I start to descend into worry about not being able to sleep. I start to fall to pieces. Restlessness.

Can't think well. I want to say something to my husband, and all of a sudden it's gone, what I wanted to say. I can't even reach out for help from him. The thoughts just disappear.

Anxious. Start to think about my health. Feel like I will never pull it together. My heart starts pounding. I am terrified and confused. I think I am going to die.

I can't think straight. I want to call my husband to help me, but I can't remember what it is I wanted to say.

It's confusing, I know. I feel all over the place. All dispersed. No center. Desperately trying to gather things together.

Analysis of Case Number 2

The sense of being divided comes out right at the beginning when this woman describes her approach to her health care. She is seeing about nine or ten practitioners for all the different parts of herself. This sense of separateness comes out to the point of asking, "Who am I?" and of saying, "I think I am covering all the parts of me."

Her way of describing her sleeplessness, "the parts of my body are just restless and can't get in sync somehow," is another way of expressing this same idea of separation. There is a mental weakness, in that she loses her "train of thought." She has it, and then it disappears. Another way she relates the idea of being scattered or separated is by saying, "My intellectual abilities just dissolved." She associates this with a feeling like the brain is clogged with sludge, like her brain is not working.

The patient's early life experiences of sexual abuse really "shattered" her, and continue the theme of being divided. Contributing to this is the way her mother denied her ongoing trauma. She is left feeling shattered to the point that the seizures become worse: rolling back and forth in bed, moaning, and rolling around unable to find a central point to rest. The way she describes the sexual abuse creates a picture of rolling back and forth looking for the center: "Half of me being sexual with this man and the other parts just all over the place....I felt so disconnected and scattered."

She describes the "cesspool-type secrets" in her family, "an infectious mass of toxins." The secrets continue the fragmentation. The dilemma between w hat she experienced and what was acknowledged by her mother is the fragmentation again. It starts with her mother's denial of the sexual abuse, and it culminates in the patient's institutionalization by her mother for being sexual with her boyfriend. The inconsistency and denial again reinforce the fragmentation and manifest in her "rolling from side to side to try to find some continuity, something that would pull all the pieces together."

The idea of disconnection, of being scattered, and of dispersement of all the parts and the movement to pull them all together seems to be a theme in this case. Interestingly, her fear of heart disease is very strong. The heart is often considered the center of a person, both physically and emotionally. The fear that the center is diseased or will not exist is terrifying, especially when one is feeling scattered and the movement is pulling all the fragments back to the center.

This situation leads to a despair of recovery -- a despair that the pieces will never come together and that the center will never be found.

I considered the following rubrics:

- MIND, Confusion, identity, as to his.

- MIND, Fear, heart disease.

- MIND, Thoughts, vanishing of.

- MIND, Despair, recovery.

The remedies that run through these rubrics are Medorrhinum, Lachesis, and Baptisia.

Plan: Baptisia 1M, single dose.

Follow-Up on Case Number 2

Six Weeks After the Remedy

I am much more together today.

I'm feeling better.

My sleep is much easier. I have not used any sleeping medications for the last three weeks, and I have been able to sleep.

Somehow, I feel things are coming together. Things are not so overwhelming.

No acute illness, even though I have been around people who have been really sick.

I feel like I might be pulling out of the mud.

I had two episodes of anxiety about my health, but they didn't have the same hold on me that they had in the past.

I have been doing more things.

I feel somehow my faculties are more at my disposal. I can think. I don't forget things.

I feel things are coming together.

I am more centered somehow.

I am still restless at night, but now I go for a strong walk and come home and fall asleep.

Plan: Wait.

Long-Term Follow-Up

No other remedy was needed for 22 months. The patient then developed a vaginal varicosity with excessive bleeding (a return of an old symptom from ten years previous). She was given one dose of Hamamelis 30c, which resolved the problem, and she has remained well for the past year.

Case Number 3

In this last case the patient was also treated successfully with Baptisia. It is more of an acute case than the first two cases, but I have included it because it is interesting to see how the same themes, especially that of fragmentation, run through -- -different words and different expressions from different people, but the same themes.

Female

Age 45

Initial Visit

(She was treated by another homeopath, but I was not able to get a list of remedies given. The symptoms are presented in the patient's own words.)

I have the plague. Flu and tonsillitis. It has been going on for months, off and on. Now it's episodic.

I feel like I am dying.

It started suddenly. Just couldn't get out of bed one morning.

I feel sick all over. Everything is affected. Every muscle and bone aches.

Headaches, like something is pushing inside and my eyes are going to pop out one at a time. My head feels so heavy and dazed. It feels like it doesn't belong to me.

Some diarrhea. Explosive. Awful smelling. One or two times a day.

Feverish, about 103øF.

Don't feel really hot or cold, but my face is definitely flushed looking and a bit swollen.

Just can't get out of bed. Feel wiped out.

Can't think. I feel stupid. Can't read or even watch TV. Can't concentrate, like in a stupor.

Feel restless and unable to settle.

The bed doesn't feel right. Everything is sore. Everything is wrong. Too hard. But can't get out of bed. Not comfortable anywhere.

Can't collect myself. I feel so dispersed.

Want the window open. Need to have air.

The doctor came to check me out because I just didn't know what was happening to me. I thought if I was dying I had better call in the doctor. All he said was there was swelling and redness of the tonsils, and he prescribed antibiotics. I have taken three courses of antibiotics now.

Not really hungry or thirsty with this.

Not much pain in my throat. I was surprised that the doctor was so concerned about the throat. He just looked at the throat, and that's all he saw.

I feel really shattered with this.

I took three courses of antibiotics, and they really didn't do much. Some days I felt better. Then, all of a sudden, I was way down there again.

For a few days after the antibiotics part of me felt better. It seemed to help my throat, according to the doctor. But I didn't have any pain there anyway. The other various parts of me were not affected really.

The muscle aches and pain, and the overall sick feeling, just come and go on their own.

Suddenly, I am down again. Tired and wading through the mud. It has been really upsetting.

I can't get any work done. Just the thought of work overwhelms me. It is impossible. I hate to even think about it. The papers I have to mark.

Fatigue and incredible confusion, like "who am I?" Am I this sick person, or am I someone else? Really confusing.

I can't even look at work.

Don't want to talk to anyone.

I just want to curl up and die. I feel lifeless.

It is good I have come today because I feel pretty good and I feel together enough to talk. But when I am in it, I tell you, I just think I am dying.

I want to sleep, but sleep is no refuge. Restless sleep, and full of dreams. In fact, I almost don't want to sleep. I feel so fatigued, but unable to sleep or settle.

That's what it is. A feeling of being all over the place -- part of you wanting this and the other part not wanting it.

I want to go to sleep, but the bed feels too hard for my muscles so I want to move. Part of me wanting to call the doctor and get help, and the other part thinking "Oh, what's the use?"

With the headaches, my arm goes numb. Dead feeling. Numbness in my arms and hands, like a dead feeling. Lack of sensation.

Feel sleepy and dull. Head feels heavy and stupid.

I don't know what's happening to me. It goes on and on. I'm very upset by this, but then there is another part that is sort of resigned to it.

I tell you, sitting here and telling you these symptoms I feel weird. All over the place. Part here and part there. No continuity.

All this has been really strange too. It's like I don't know myself. I have never been sick like this. I am generally a healthy person. Something like this has never affected me before.

I work out and eat relatively healthfully. I eat chocolate around my period, but that's been forever.

Generally, I'm fairly together. But now I feel like there is another side to me that is falling to pieces.

I moan in bed.

I feel like dying.

Luckily, my husband doesn't take me seriously.

The words are even slurred.

When I have a good day, I am a completely different person.

But, as soon as I feel it coming on, I go right down into the darkest of dark.

Plan: Baptisia 1M, single dose.

Follow-Up

The patient recovered within a few days and has remained well for the last two years.

Dack: It was interesting that the first two cases both had a history of pneumonia.

Stephen King: Yes. But if you look up pneumonia in the repertory (CHEST, Inflammation, lungs), Baptisia is not listed there even though it is a large rubric. It's a good reminder, perhaps, to not put too much focus on a "diagnostic" rubric. Obviously, Baptisia should probably be in that rubric, but it's not.

Durr Elmore: The second case also had the fear of the bed, of going to bed.

Peggy Chipkin: One theme that struck me was the idea of moving "downward."

Dack: Yes. If you read Baptisia in Kent, it's very clear that there's a strong element of downward motion in the remedy.

Sharon Ryals: The downward movement seems different from that of Veratrum album or Aurum metallicum where the fall is from a height, a motion downward from above ground level. The motion described here is actually starting on the ground and going deeper, moving underground. That seems quite different.

Peggy Chipkin: The second patient said that she spent a let of time with animals. And, in both of the first two cases, the world was very threatening and other people weren't safe. These elements made me think of Aethusa. I wonder if these cases might go on to need Aethusa.

Michael Traub: I have been thinking about the meaning of the cat in the first patient's dream (after Baptisia was given). A cat can have many different symbolic meanings. There is the idea that a cat finds its "spot" and sleeps there, contained within itself. There is also the contrast between wildness and domesticity in the cat, and as it becomes more integrated it becomes more domestic. And the cat licks and cleans itself frequently.

Fran Brooks: I was wondering how you drew so much information out of these people. They don't seem like the type of people who would sit down and...

Dack: It's very interesting, because the first patient was really talkative -- not talkative, exactly -- but he just talked. You wouldn't think he would. And he was surprisingly articulate, considering the complexity of what he was expressing, which made it a really graphic case. It's nice for us because it allows us to learn more about the remedy.

Conclusion: Extracting and Applying Themes from Our Literature

In conclusion, I want to mention that I have been thinking about the idea, suggested by Karl Robinson earlier today, that some of the descriptions in our books are only of acute states and do not help us in many of our chronic cases. It is certainly true that the descriptions of Baptisia in our books focus on very acute kinds of illness -- states of gangrene, malaria, serious physical illness. And we probably don't see these states very often in North America right now because of antibiotics, hygiene, and so on.

Certainly, we need to better understand the chronic mental picture of remedies such as Baptisia. However, I'm not so sure that the necessary information is not there in Kent's descriptions. In my experience with Baptisia, the major themes really were there -- the theme of fragmentation (all the pieces trying to come to the center), the theme of underground, the theme of restlessness and movement. I felt that Kent very clearly described them. We may have to extract the main themes from the descriptions by Kent and others of physical manifestations that we do not see as frequently these days-extract the themes and apply them to the mental states presented by our patients.

International Foundation For Homeopathy.

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By Laurie Dack

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