Case of Calcium nitricum
By Dr. Mahesh Gandhi, M.D. (Psychiatry), Senior Consultant and Faculty, the other song
Co-authors :
Dr. Sneha Vyas, Resident Doctor, the other song
Dr. Devang Shah, Resident Doctor, the other song
This is a case of a 45-year-old man, who had come with the complaint of long standing panic disorder that he had been suffering for the last 20 years and was on medication for the same. He said that he first experienced panic when he was preparing for his MBBS final exams, for which he studied 14-16 hours a day at a stretch and started experiencing a lot of palpitations and chest pain, due to which he started dreading that there was something wrong with his heart.
The patient recollected situations when he was extremely distressed and anxious of being infected when he was posted in leprosy ward during his internship. Even while going through a simple procedure like pleural tap on a patient suffering from tuberculosis, he had lot of trembling and was very anxious fearing that he may have punctured the patient’s lung. He was afraid to give even a vitamin injection fearing that the patient may land up with an anaphylactic shock. His fears of the supposed dangers associated with the field, made him take up pathology as his stream for post graduation later because in his perception, it meant less stress and anxiety.
However, after selecting pathology as his mainstream too, he could not overcome his panic. He regularly sent reports to other laboratories for a second opinion so as to allay his anxiety despite having to spend money from his own pocket. He was under the impression that he would slowly muster enough courage to start his own practice after a year’s time, which never happened, as he soon joined his father’s practice which involved treating obese patient using Ayurvedic medicines, which he thought was extremely safe. Once, when treating an obese person, with blood pressure of 140/100 mm Hg, he panicked, thinking that the patient would get a heart attack and he imagined all possible worst scenarios and was very restless, calling up the patient every few minutes, to check out on his health.
Since this was most intensely coming up in the case, I decided to probe this deeper and try and reach the level of sensation.
D: What is the worst that can have happened?
P: There can be a police case and these legal proceedings linger for years. How will I live in this uncertainty for so many years? There are many grades of their (police) treatment and I will be in jail with all criminals. I will be sexually harassed and what if I get AIDS? These thoughts produce palpitations, dryness of mouth, chest pain and light-headedness.
The patient said that he is very mild, friendly, peace-loving, and does not like to work hard and likes all comforts of life. He loves flying kites. He is cowardly by nature but he dreams of beating up all the bad guys and all his friends are happy with him. His wife tells that he makes an issue out of a small thing and he panics over petty things. E.g. once he misplaced his cell phone and he assumed that criminals would use his phone for killing someone and then he would be implicated for murder and would be put in jail. He was always anxious that he may be sexually abused in jail and might contract HIV infection.
(Observation: He jumps up from the chair and takes deep breaths.)
Here, you see that when he is talking about palpitations, he jumps up from his chair. We see a lot of anticipation which causes palpitations, cramps, etc.
P: Also, any journey where the movement is restricted is discomforting for me. This gives rise to a dilemma whether I should go ahead or no. Should I stay or go? This is like an attempt to escape, his jerkiness is in a way wanting to escape should I stay or go, so whenever I have these symptoms, I feel I want to escape. I then ask for reassurance. I get cheesed off in such circumstances.
He gives one more incidence of his anxiety where his daughter was unwell and after investigations the pathologist asked him to come after 3 days, at which he panicked. The feeling that he has to wait for 3 days causes extreme anxiety. The problem for him is not about the report being bad, but having to wait for 3 days which is an excruciating period for him. This anxiety kills him. It produces a tightness in chest, heaviness, palpitations, etc. He further explains it is similar to someone asking him to board a bus or a train right away, then there is no problem, but if someone asks him to do the same after 2 days, then his anxiety starts and he becomes very anxious as he starts obsessing about it.
At this juncture in the case we go back to the incidence of being in jail and see what comes up.
P: A lot of homosexuals and associative infections abound in jail. Legal processes like that take a long time. They are very slow but I want a quick solution. This would be the main stress for me.
(HG: hand kind of jumps or jerks, Observation: patient taking deep breaths)
The stress is of the uncertainty of what is going to happen. All the time, I am afraid that something is going to happen, the whole legal process is beyond me. The court proceedings will entangle me and drive me out of my mind.
The experience of entanglement, he describes in the legal matters which keep dragging on for days, where they keep calling a person day after day indefinitely. The entire slowness of the procedure will cause sleepless nights and render him completely restless.
The main problem for the patient, the essence of his individuality is the uncertainty that is a source of extreme stress for him. The uncertainty whether it is an anaphylactic shock, pathology, herbal medicines or even routine train journey at a short notice is a strain. Uncertainty is such that it is beyond his control, and where things just keep dragging indefinitely. Restriction of movements, taking deep breaths, jumping from the chair and jerking of the hands when experiencing or even thinking about these situations, are all features peculiar to him. This is something that runs through and through his case. It is seen at the level of mind, and even at the level of body. This innermost experience that runs through a patient and which is seen in different areas of life is called as the Sensation or the Vital Sensation according to the Sensation Approach.
We see that main aspect about this patient is the uncertainty and extreme anxiety about future. There is also anxiety about health that he will contract some infection, that he will suffer from AIDS (Acquired Immune Deficiency Syndrome). By nature, he is not hard working and is a coward who fantasizes hitting people and tries to show off his strength. This fear of future and fear of health especially of contracting an infectious disease is very peculiar to Calcarea. (Ref - Despair in consequence of the impaired condition of the health, or hypochondriacal humor, with fear of being ill or unfortunate, of experiencing sad accidents, of losing the reason, of being infected by contagious diseases.)1
There is one more aspect to the case: being contracted, restricted and entangled. This aspect represent the main sensation of Nitrogen.2
Nitrogen belongs to Lithium line (Row 2 of the Mineral Kingdom). The main experience of the Mineral Remedies is that of Structure. Where the core issue is of one’s structure and one’s need to fulfil all the functions required to maintain that structure. This creates either a lack or loss of abilities which are required to fulfil a particular function. The issues are ‘Am I capable or not?’ This is very well represented in the seven rows of the periodic table, where each row represents a stage of development of human life. The prime issues of the seven rows of the periodic table are:
Row 1: Existence
Row 2: Separation
Row 3: Identity
Row 4: Security and task
Row 5: Creativity and performance
Row 6: Responsibility
Row 7: Disintegration3
As seen above, the main theme of Lithium line is that of separation from the mother. Going from left to right, the Lithium line has Lithium, Beryllium, Boron, Carbon, Nitrogen, Oxygen and Fluorine. The remedies in this line represent different phases of an individual after conception through the journey from the mother’s womb to the outside world and separation from the mother. Hydrogen (Row 1 of the Mineral Kingdom) is the stage where the child is about to be conceived, where the sperm and the ovum unite. Thereafter, remedies in Row 2 represent stages in mature people, who still have their innermost experience of being dependent, within the womb, or separating from the mother figure. Every remedy in this line has its individual stage in development. Nitrogen belonging to the right side of Row 2 has an experience of being restricted and constricted in the passage from womb to the outside world. This experience corresponds to the patient’s experience.
Here, the main issue of the case is Uncertainty. When you read Argentum nitricum from ‘Soul of Remedies’ by Rajan Sankaran, he writes, that patient needing this remedy cannot take suspense which is his unique feature. Moreover, this uncertainty is uncontrollable. This ‘not in control’ is peculiar to right side of Lithium series.
So, on the one hand we see peculiar features of Calcarea like fear of infectious diseases, cowardice and on the other hand we have the experience of uncertainty, restricted, entangled, beyond control which correspond to the Nitrogen belonging to the right side of Row 2 of the periodic table. So, Calcarea nitricum was the remedy similar to his case. Hence, he received Calcarea nitricum 200 (to avoid chances of aggravation).
In his follow up after 6 months, he reported that he is much better and peaceful. Anxiety levels have significantly diminished. Earlier the smallest of situations would trigger off absolute panic, now he is markedly relaxed. His family and friends noted a positive shift in him. He still visits the clinic for some problem of a bloated abdomen which it settles with a dose of his constitutional medicine.