A Case of Childhood Depression
The New England Journal of Homeopathy
Spring/Summer 1999, Vol.8 No.1
by Robert Kaladish, MD
Many remedies share similar symptoms. Finding the simillimum to a case can be a challenging (and humbling) undertaking. However by using Dr. Herscu’s method of cycles and segments I believe one can sometimes quickly get an insight into the nature of the patient’s difficulties in a way that helps to find the remedy more easily.
The following case demonstrates this idea. The patient was brought to me for a child psychiatric evaluation by his parents in desperation. They had already been to their local homeopath, who treated the boy for depression with Aurum 1M, Natrum muriaticum 1M and Aurum muriaticum natronatum 200C.
Certainly these remedies can be useful for depression, suicidal concerns, anger/irritability, etc. and although these elements were a big part of the case it was only by understanding the whole case through the cycle that the remedy was found.
Case: The patient was an 8 year 9 month old 3rd grader who lived at home with his working parents and older sister. He was brought by his parents to the child and adolescent psychiatrist for evaluation of depression, low self-esteem and temper problems.
Since birth the patient has had a difficult temperament. He started with earaches at age 10 days and since then he has been fussy and unhappy.
When younger he would have terrible fits that could go on for an hour. He would have 2-3 fits per day.
At time of evaluation the temper outbursts were down to 15-30 minutes about once a day. The patient noted that he would start out feeling okay and mother reports that he is essentially a sweet, likable, gentle, affectionate and sensitive boy. During the outburst he would yell, stomp, throw things, and threaten to hurt or kill others. Generally he would not go after people. His mother noted that during the outburst he would clench his teeth, open his eyes wide and tense up like a “ferocious animal”. During this time he was unreasonable and unreachable. Holding him just aggravated the attack. Finally after the outburst ran its course he was left feeling sad, bad and remorseful. He found that the only thing that helped was going off by himself. Sometimes he would experience suicidal feelings because he felt so badly about what he had done. He always promised to do better next time but he was frustrated and disappointed that he would fall back into the same pattern over and over again.
The patient also had a number of fears and anxieties including fears of the dark, ghosts, monsters under the bed, dying, and flesh-eating bacteria. He was also afraid of heights and snakes.
His sleep was remarkable for scary dreams, having them at least once a month. When he was 3 he had a scary dream about the monkeys in the Wizard of Oz. When he was 6 he dreamt of a skeleton on a pole. He found it hard to fall asleep even with a night light because he found it so scary to be alone in his room.
He was a restless sleeper who liked to sleep close to the wall for safety-he worried something might come up from under the bed and get him.
His appetite was good. He craved sweets, salty, pasta and meat. He was not big on citrus or dairy and was averse to broccoli and cauliflower. He was thirsty for soda, water, milk, and orange juice.
Morning was the worst time of day. He did not want to get up and mother noted, “sometimes nothing was right even before he opened his eyes.” Body temperature was warm and he felt better in open air.
His past medical history was remarkable for ear infections starting at 10 days. Finally went for tubes at one year. He had a great deal of colic as a baby and actually had an umbilical hernia from screaming so much.
Family medical history was remarkable for depression, anxiety, panic and alcoholism on mother’s side. History of alcohol problems on father’s side. Mother’s grandfather and father’s great-grandfather both died by suicide.
The social history was remarkable for the fact that the lad had actually done well in public school. He was generally accepted and liked by the teachers and other kids but everyone gave him slack for his well-known temper.
Analysis: While taking the case it would have been easy to focus on the symptoms of low self-esteem, self-reproach, frustration with himself, etc. but this approach might have missed the essential nature of the boy’s difficulties. However by focusing the interview on how and why the symptoms relate to each other (the segments and the cycle) it quickly became evident that the strong fears (of death) led to the intense over-reaction that was followed by the overly intense shutting down/deadening that led to the sense of vulnerability and the fears. Once this was clear the case appeared to be a textbook case of Stramonium.
Prescription: Stramonium 200C, one dose.
Follow-up at 4 weeks: About 2 weeks after the remedy the patient suddenly developed a fever and headache with exhaustion and extreme despair. It lasted about 6 hours and afterwards he felt better and was feeling better since. His temper was better with outbursts less frequent and less intense. He appeared happier and energy better. No suicidal feelings. His sleep was better with no nightmares but some good dreams.
Plan. Wait.
Follow-up at 11 weeks: Temper is still better. He feels “good” and mother feels that the patient is better natured and more pleasant. He has woken “grumpy” only twice in past 7 weeks. Physically he has had some allergies and congestion. He also had one episode of bronchitis that responded to antibiotics prescribed by the pediatrician. He did have one brief episode of left ear pain that went away after one day.
Plan: Wait.
Follow-up at 18 weeks: He continues to do well but more “snappy” lately. Still afraid of snakes and heights but not afraid of ghosts, monsters, death, etc. Did fine over Halloween. Sleep, appetite and energy fine. He reported a recurrent dream that he has had since age 4 or 5. He couldn’t elaborate but he did say it involved naked girls and women touching each other in a way that made him “uncomfortable”. He found it “weird”-not scary or violent. It was unclear if the dreams were more frequent or if the patient was talking about them more. Physically some post-nasal drip that comes and goes.
Plan: Wait for now since most important symptoms are still better than when we started.
Follow-up at 23 weeks: Some further regression in temper. He is becoming snappy and pushy with sister. Short daily outbursts now. His sleep is fine with no dreams to report. Physically on and off nasal congestion and occasional headache.
Plan: Stramonium 30C, one dose. I suggested 200C but patient was afraid of possible aggravation.
Follow-up 7 weeks later: Things were better for 3-4 weeks and then regressed. He is more serious and somber. His energy is lower. The daily temper outbursts last for 5 minutes. Lots of remorse and contrition afterwards. More headaches and some congestion in left ear.
Plan: Stramonium 200C, one dose and wait, watching for new symptoms of next remedy.
Discussion: This case nicely demonstrates how Dr. Herscu’s method of cycles and segments can help to organize one’s case taking and thinking about a case in a manner that ultimately helps to find the correct remedy. Without using the concept of the cycle and its interrelated parts (the segments) when taking the case it would have been easy to focus only on the depression, the suicidal thoughts, the low self-esteem, the frustration with himself, etc. and thereby have missed the greater whole of the boy’s difficulties. Unfortunately, that kind of approach could have led to missing the remedy.
To Read More About Cycles & Segments, click here
Robert Kaladish MD practices in Wilton, New Hampshire and graduated from the NESH Postgraduate Course in March 1999.
 |