Author: Devang Shah
I AM NOT FREE TO DO WHAT I WANT – A CASE OF VASO MOTOR RHINITIS
Author – Dr. Devang Shah, In-House Consultant, the other song.
This is a case of 34-year-old female, a yoga instructor by profession. She was diagnosed with vasomotor rhinitis over the past 3 months. She was into the 4th month of pregnancy when I saw her first on 4th February, 2014. (The case is summarized for brevity and interspersed with the physician’s comments in italics.)
At the beginning of the case-taking interview, she was given a free space to talk about her problems and herself.
The patient said that her nose was frequently blocked and was worse lying down, from dust and in cold environment. She felt better when she exercised, did aerobics and climbed stairs. This cold resulted in tremendous fatigue and low energy as a consequence of which she found it very difficult to remain motivated and energized all the time, a must in her profession.
As a person, she felt a lot of anger towards her mother. She described herself as a person who brooded about small things and would weep easily. She had to take lot of responsibility early on in the age due to which she always felt that she was forced to grow up very early on in life. She did not have her freedom, the freedom to choose or do what she wanted. This led to lot of pent-up anger towards her mother. She loved to be active and her cold drained her of all energy refraining her from being active. She loved exercises like aerobics as well. The patient is afraid to be herself in front of others.
At this point she was asked to describe some dreams.
P: Anger and resentment towards mother. Running in forest to escape from evil.
It was apparent that the issue of anger and resentment which the patient had at a conscious level is emerging in her dreams as well. So I chose this as an entry point so as to understand it and see if this road could lead me to deeper experience.
D: Describe this issue with mother?
P: My mother is very controlling type and has made my life miserable. She would threaten and hit us.
D: What was the experience then?
P: The experience was powerless, vulnerable and helpless. There was no control in my life. I felt relationship with my mother will give me comfort security and warmth.”
D: Describe this comfort security and warmth?
P: Physical affection, connection, it is like snuggling in blanket, cozy, protected, warm and secure. Like a vault no one can penetrate. Vault is like some strong thing that no one can penetrate; difficult to open with a strong thick layer.
D: Describe cozy protected?
P: Curled up, safe zone of comfort no harm.
D: What you mean by harm?
P: Someone doing something to me; forcing me, lifting me.
D: Talk more about this harm.
When asked about the harm her memory goes to the experience of her childhood where she was scared of robbers.
D: What did you experience there?
P: They can violate our space; they can rob, kill or rape me. Robbers made me feel vulnerable.
The experience of vulnerable for her is of being under power, helpless like a baby who is innocent, dependent and delicate.
Now if this is her core experience then it has to be seen in other areas of her life as well so I ask a question which is not related to this aspect – a very lateral question.
D: What in news movies and serials are you sensitive to?
By asking this lateral question, my aim is to see if she comes back to the same experience.
P: I cannot see violence, someone hitting someone, heartless people, a weaker person being hit by stronger one. At this point, she immediately connects with her trauma as a kid where mother used to hit her. Once she saw a man hitting a 9-year-old on the roads and after this site she developed fever for 4 days. The feeling that people can be so violent and heartless is something that she cannot see.
So we see in completely different situation of her life she comes back to the same experience of weak and strong, victim and aggressor which is the theme of animal kingdom.
The patient has desire for fish, aversion to idli (a South Indian fermented dish made of rice). She has profuse thirst for water and was chilly.
On trying to understand the case, we see that the patient has vasomotor rhinitis, which is worse lying down, cold weather, dust and in a closed room. The rhinitis is better by exercises and aerobics. Also, we see that the patient has a lot of anger and resentment towards her mother and she feels that she had no freedom of choice and was forced to grow up quite early. Besides, we also see dreams of running in the forest to escape from evil.
When I selected anger towards mother as the entry point for the case, and tried to elicit the experience of the patient, she said that she felt controlled, powerless, vulnerable, helpless like an innocent baby. She went on to say that she needed security, warmth, protection, coziness. She envisioned this protection being in the form of a vault which was strong and which no one could penetrate and cause any harm to her. She did not want to be harmed by which she meant someone doing something to her like violating her space and she is becoming weak against a stronger person.
We see the experience as vulnerable, powerless, and helpless, like a delicate baby and wanting to be safe, secure, cozy, protected like in a vault and warm. There is someone who is controlling or harming her. This language is of a victim. An aggressor wants to harm and the victim experiences vulnerability powerlessness and wants to be in safe secure protected zone of comfort. This is animal kingdom.1
Once the kingdom is clear, we go on to analyze the subkingdom. Her experience is of feeling vulnerable, powerless, helpless, delicate, harm versus to feel protection, safe, secure, cozy and warmth. These are the sensation words. This represents the features of a particular sub kingdom which is mollusks.
The mollusks are soft bodied animals covered by a shell. The softness or delicateness of their bodies makes them vulnerable to the external world and as result to protect them from the external harm they have a protective covering the shell which provides them with warmth, safety and security. Mollusks are further divided into gastropoda, cephalopoda and bivalves. Some evolved mollusks have lost their shell and hence are very mobile.2
Each sub kingdom of the mollusks have their individual features. In this case the kingdom and sub kingdom were very clear. The question was which mollusk to prescribe. Here the symptoms were well represented too which point directly to sepia. So on one side we have the symptoms which point to sepia and this is supported by the system which point to animal kingdom and mollusk. This way one can surest of the remedy.
(Roger van Zandvoort, Complete Repertory, Mac Repertory, 8.2.01, Professional, Kent Homoeopathic Associates)
We see Sepia coming up most prominently in the Repertorisation and it belongs to the mollusk sub-kingdom of animals. This is where the idea of synergy has been of great help to me where the system along with symptoms can yield more consistent results. I then read up more about Sepia from the materia medica to confirm if the patient needs the remedy. On reading Dr. Rajan Sankaran’s Soul of Remedies, we see:
The main feeling of the Sepia woman is that she is forced to undertake things opposed to her intentions, to do what she doesn't want to do. It is a chronic situation in which she has been dominated and not allowed to have her way.
She feels forced to accept situations against her will, because of her feeling of not being good enough. This makes her miserable and she feels unfortunate.
(Here it was with her mother where she felt controlled and no have her own freedom and was forced to take lot of responsibilities at an early age).
Sepia has also the theme of rape (dreams of rape).
(The main fear with robbers was of being robbed but more important was of being raped, violate my space)
As there were a lot of emotions predominant in the case, the level of experience was Level 3, level of emotion and the patient was given Sepia 200, single dose.
She received Sepia 200 twice a day for 2 days a month for period of 9 months. In the first 3 months there were couple of acute relapses of the cold and those subsided with Sepia 200. After 6 months, the cold almost disappeared where she was more than 80% better. Her energy levels improved; she could sleep well without any nasal congestion. She delivered a baby boy (normal delivery). More importantly, the sensation of being controlled reduced to 50. The relation with mother improved where she was able to cope with her controlling behavior in a more easy way. She still continues to follow up and is enjoying life free of vaso-motor rhinitis.
The above illustrates that Homoeopathy can work better when the symptoms and the system can be used inclusively rather than using only the symptoms or the system exclusively. The use of symptom and system should be synergistic and not restrictive.
It is said that there are 3 ways of acquiring knowledge: the first is realist – which says there is no soul, there is no self. All that exists in the world is objects. So a person becomes concerned with knowing the objects and forgets the subjectivity.
The second way is the idealist which says there is no object, the world is illusion. There is nothing to know outside so just close your eyes and go inside. The realist says only the known is true and the idealist says only the knower is true.
Then there is the third way – the way of mystic. He accepts both and rejects both. On one plane both exist – the knower and the known, the subject and object, the inner and outer. But on another plane both disappear and only one remains - which is neither the known nor the knower. The mystics approach is total. The mystic is nothing but synergy – the total!
1- Rajan Sankaran, The Sensation in Homoeopathy, second Edition, 2005, Vital Sensation and the Kingdoms, Miasms, Homoeopathic Medical Publishers
2- Rajan Sankaran, Survival – Mollusc, Homoeopathic Medical Publishers