Scandium metallicum

I can't make any decisions: a case of Scandium metallicum
by Julie Geraghty
Woman aged twenty-four, working on her PhD, was referred in July 2004 with premenstrual tension and anxiety.
Patient (P): “The anxiety seems to be much worse before my period, for about 10-14 days, I feel down, depressed. I find it difficult to go to work. I get very snappy and I argue with my partner.  I get tearful over little things. I’m worse when I get hungry. I can’t make decisions, I can’t solve problems. It’s affecting my relationship quite a lot so we’ve been going to a counsellor.  I’m doing my PhD and at those times of the month I find it easier not to go in to work but that causes more stress and tension later on because then I haven’t kept up with stuff.”
Julie Geraghty (JG): Tell me more about how you feel.
P: “I feel down, there are negative thoughts going around in my head. I feel anxious and I get really stressed. I feel as if the tension is blocked here (Gesture: puts her hand on her chest). It feels as if there’s something blocked here and it can’t release (G: claws fingers towards her chest). I get upset, everything builds up. It’s like a big pressure here, it weighs me down. It’s difficult to think clearly. I can’t make decisions. My thoughts go round in circles.”
JG: Describe this pressure, blocked feeling.
P: “It’s as if something is clenched, something is trapped, nothing can get through. There is a weight on my chest. When I get cross, that releases it (opens arms out). It feels as if it’s coming out. I gesticulate a lot, I free it up.”
JG: What are you freeing up? 
P: “An emotional stagnation (G: clenches fist). For instance, if I’m cooking dinner and my husband asks me a small question, it all comes out, even if I know it’s irrational. I get very aggressive, even if he just asks me if I want a drink. I can’t think ‘do I want a drink or not, and if I do want a drink, what do I want?’ It’s as if too much is going on and I can’t think, I can’t decide, I can’t get it out. It pushes me over the edge. I feel like I’m already dealing with a lot of tension and upset, which is weighty. It is a lot to get on with.
“When I feel tense before my period, it’s often at lunchtime and I feel I should get some food. I’m on the verge of being hungry and snappy, yet when I go into a shop, I don’t know what to get. It all goes round in my head… I won’t buy anything because of that. I find it very hard to decide.”
JG: You mentioned on your information sheet you had depression at eighteen.
P: “I got very down when I started university, I was very homesick. I felt I didn’t fit in, all my flatmates were more worldly than I was, they all had boyfriends. I missed the security of home but my parents had split up, so there wasn’t the same security at home. I phoned my mother every day because I felt insecure, and I missed my father. I’d enjoyed school, the routine of the work, but I found it difficult managing my time on my own at University, that structure fell away. I wasn’t enjoying the work. Having all that unstructured time felt chaotic. People were eating at different times, everyone had different ideas. I didn’t have set ideas. They all had boyfriends, so some of their time was accounted for, but I didn’t have a boyfriend. I missed home. I missed the security my parents gave me. I didn’t find anything to fill the gap. It has been difficult to get structure in my life with the PhD. I set myself a routine to go in from 9-5. I find it helpful in terms of structuring to go in and work for seven hours. Some nights of the week, I go to yoga, other nights, I go to gym. I find it stressful when my routine is disrupted.”
JG: Describe structuring falling away
P: “It was a lostness. It was that decision thing again, it was hard to decide ‘should I have lunch at University or at halls of residence?’ and I didn’t have anything to base my decision on. I felt directionless. I couldn’t see an end point, there was nothing to work towards. Now, I have a goal to work towards. My supervisor won’t be happy if I don’t put the work in. If I have a structure, if I put something in my diary, there is some accountability and justification and I feel better. When I feel lost, things get out of perspective very easily.  Small things become large, big things become huge, unwieldy. When I have pre-menstrual tension, I can’t see the point of my PhD. I start feeling I won’t get a job because the job market is rubbish and I start asking myself, ‘what is the point of my relationship?’”
JG: Describe your periods? 
P: “I have an irregular cycle, it can be twenty-eight days or forty days. My periods last seven days. I have clots, the blood is thick and dark. I have back cramps on day one.”
Prescription: Scandium metallicum 200C
Analysis
Scandium metallicum
This is a remedy from the fourth series, Iron series,of the periodic table, stage 3. It follows Kalium and Calcium, such major remedies, and yet Scandium is rarely prescribed. The remedy seemed very clear to me as the major issue was indecision, a key theme of stage 3 (Scandium is directly underneath Aluminium). She could not decide on even the most basic things like what she would like to eat or drink. Her problems started when she went to university and she says she missed the security of family and home, and the structure of life. This sense of incapacity leads us to the Mineral kingdom, to series 4, where the main issue is attaining security. 
Differentiation
However, she describes various sensations, where there is a differentiation to be made with the Crucifereae (Brassicaceae) plant family. When she is asked a simple question, she cannot get the answer out, she describes it as pushing her ‘over the edge’. She feels that the tension causes a sensation as if something is blocked / trapped and it needs to be released. This polarity of sensation is typical of plants in the Crucifereae family. However, if this was a Crucifereae case, the sensation of block vs flow / release would be mentioned again later in the case, as it would be the core experience throughout all aspects of her life. Instead, what does come back again and again is the need for routine and structure, as well as the difficulty she has with making even the simplest decisions.
Potency: as her problems were on the mental and emotional level with tension, anxiety and stress, I prescribed a 200C.
Follow-ups
Four months later, November 2004: “I’ve felt a big difference, I’ve been so much better. There have been amazing improvements. My partner has really noticed. I took the remedy with the first two periods, there wasn’t the big build-up, then I ran out of the remedy. With the third period, I did feel a little weepy and stressed at mid-cycle, as if stuff had built up, but it wasn’t nearly as bad as before, it was about half as bad as it used to be. I have had quite bad period pain.”
JG: How have you been about making decisions? 
P: “That factor hasn’t even crossed my mind! It has been a lot better. I’ve been writing up my PhD, so there is quite a lot of structure to my day and I can see the end now. I feel quite ambitious, I’d like to stay in academia. I feel a lot more balanced.  I don’t feel on the edge anymore.”
JG: How much better do you feel overall?
P: “About 80%”.
One year later, August 2005: “I took the remedy every two months, which was good, I ran out three months ago. Only in the last month, did I feel any PMT. I felt a bit shaky but I didn’t feel down. I just needed to eat something and sit down or lie down for a short while. I haven’t felt the symptoms at all. It was pretty consistently better before that. My period would start without me noticing it. I am trying to finish my PhD now, which is a bit stressful. I need to hand it in by Christmas.”
Indecisive
JG: What about the indecisiveness? 
P: “The whole indecisiveness thing has not been a problem. Before, it really upset me to be indecisive. I didn’t know what to get when I was hungry, then I would start to get panicky.  The remedy seems to have stopped the spiral.
“I think I did my PhD because I couldn’t decide what else to do, now I have to decide. It’s crunch time. I am seeing a careers person next week to help me decide. I’m applying for academic jobs but I’m also opening up to different options, like doing research. I’ve decided to get my thesis done first. I feel the end is in sight with my PhD. I’ve improved generally. The writing up has helped because you see something concrete when you hand in a chapter. In academia, you can get a concrete thing done. You can send an article to a journal, but then you get it back with horrible comments. Maybe, I’m not resilient enough. That’s why I’m looking to getting a job outside of academia. I think with the external stability of a job I will be better. The remedy has made a big difference to my life.”  
I did not see her again, but I feel the remedy addressed the fundamental issue of the spiral of anxiety arising from indecision. I was interested in her comment that she had done a PhD because she couldn't decide what else to do! Homeopathic treatment enabled her to open up to different options concerning jobs, a situation that would have caused her significant anxiety before. She is now free to pursue her career and to develop her sense of stability and resilience and security in the world. These issues of security and routine are themes of the fourth series of the periodic table.

Keywords: indecisive, decision, direction, security, routine, structure, stability, insecure
Remedies: Scandium metallicum.